Suspicion Of Urinary Tract Infection Research Articles

302 Evaluation of a Cellular Host Response Test for Risk-Stratifying Patients Presenting to the Emergency Department With Signs or Suspicion of Urinary Tract Infection

302 Evaluation of a Cellular Host Response Test for Risk-Stratifying Patients Presenting to the Emergency Department With Signs or Suspicion of Urinary Tract Infection

Uropathogens and their Culture Sensitivity Pattern in Children with Urinary Tract Infection.

Objective: To determine the frequency of bacteria causing Urinary Tract infections and their susceptibility to antibiotics in children of Sialkot.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Department of Pediatrics Islam Teaching Hospital, Children Complex Hospital, and Islam Central Hospital, Sialkot Pakistan, from Jan to Dec 2020.
 Methodology: All patients presenting with Urinary Tract infections, aged one month to 15 years were included in the study. Inclusion criteria were clinical suspicion of Urinary Tract infections and positive urine culture of a single bacterium. Antibiotic susceptibility was performed on all culture-positive samples. 
 Results: A total of 300 children were included, but 248 fulfilled the criteria of culture-positive Urinary Tract infections. Fiftytwo children were excluded as they had non-pathogen growths, multi-organisms or were already on antibiotics. Gramnegative bacilli were most frequently isolated, accounting for 236(95.2%), whereas Gram-positive cocci comprised only 12 (4.8%) of cases. E. coli was the most frequent isolate among gram-negative rods, followed by Klebsiella, Proteus and Pseudomonas. All gram-negative rods were sensitive to Imipenem, whereas most were resistant to Ampicillin and TMP-SMX. Gram-positive cocci were sensitive to Vancomycin, Linezolid, Meropenem and Tazobactam.
 Conclusion: Increasing resistance of uropathogens to commonly prescribed antibiotics is highly alarming. Therefore, the strategy of empirical treatment of Urinary Tract infections in children should be reevaluated based on regional studies.

P97 AORTIC PSEUDOANEURYSM AS PRESENTATION OF INFECTIVE ENDOCARDITIS FOLLOWING VALVE IN VALVE TAVR: THE IMPORTANCE OF A MULTIMODAL DIAGNOSTIC APPROACH

Abstract Transcatheter aortic valve implantation complicated by infectious endocarditis (TAVI–IE) is an uncommon clinical event with a death rate of 24–46%. Despite several risk factors (young age, sex male, CKD, concurrent PM implantation, residual aortic insufficiency and valve–in–valve implantation) have been reported, the identification of this clinical scenario remains a diagnostic challange due to less sensivity and specificity of echocardiography ascribed to possible imaging artifacts or to a localization of the infectious process that cannot always be evalueted. Clinical case Sixty day after TAVI valve–in–valve procedure, during a rehabilitation recovery, an 80 years old female patient presented intermitted fever with an elevation of flogosis index. In suspicion of urinary tract infection, antibiotic therapy with ciprofloxacin has been started and at the same time the patient has been transferred to our center. At the admission time a blood colture resulted positive for Staphylococcus epidermidis. A complete echocardiogram(TTE+TEE) has been performed and showed an aortic bioprothesis with normal morphology, position and shape and normal gradient at continuos doppler analysis(17/30 mmHg). The distal part of the ascending aorta has not been evalueted due to a masking phenomenon caused by prostetich cage artifact. Considering the high probability of infective endocarditis, a chest CT was performed and showed a 22x11x18mm pseudoaneurism in the extreme distal point of the cranial part of the prosthesis. Therefore, the patient underwent to an emergency cardiac surgery with replacement of the ascending aorta with a prosthetic graft and the aortic valve with a new bioprothesis. The diagnosis of infected pseudoaneurysm was confirmed by the hystologic examination and after 22 days since the intervention, the patient was transferred to the sending rehabilitation center with an indication to continue Daptomicin therapy, started during the recovery, for 6 weeks. Even with non–suggestive ecocardiographic evidence, the presence of positive blood colture test in patients with endocarditis risk factors, need a multimodal imaging approach to diagnosis (for instance, CT or PET) in order to provide prompt and appropriate therapy.

Antibiotic Resistances of Enterobacteriaceae with Chromosomal Ampc in Urine Cultures: Review and Experience of a Spanish Hospital.

The Enterobacteriaceae Citrobacter freundii, Enterobacter cloacae, Klebsiella aerogenes, Morganella morganii, Providencia stuartii, and Serratia marcescens (CESPM group) produce numerous urinary tract infections (UTIs) which are difficult to treat due to their high multiresistance rate. The objectives of this study were to carry out a systematic review of antibiotic resistances by UTIs and to determine changes over time in urine cultures from a reference hospital in southern Spain. The literature was searched for European data on the resistance rates of each microorganism, and a retrospective cross-sectional descriptive study was performed in samples with suspicion of UTI from patients in Virgen de las Nieves University Hospital (Granada, Spain) between 2016 and the first half of 2021. Among 21,838 positive urine cultures, 1.85% were caused by E. cloacae, 0.77% by M. Morganii, 0.65% by K. aerogenes, 0.46% by C. freundii, 0.29% by P stuartii, and 0.25% by S. marcescens. The lowest resistance rates by microorganism were: E. cloacae to amikacin (3.47%) and imipenem (5.28%); M. morganii to piperacillin-tazobactam (1.79%), cefepime (4.76%), and tobramycin (7.74%); K. aerogenes to tobramycin (3.55%), gentamicin (4.25%), trimethoprim-sulfamethoxazole (4.96%), imipenem (5.75%), and cefepime (6.43%); C. freundii to imipenem (no resistance), nitrofurantoin (1.96%), fosfomycin (2.80%), and ertapenem (6.12%); P. stuartii to cefepime (3.28%) and ceftazidime (3.28%); and S. marcescens to gentamicin (1.8%), ciprofloxacin (3.64%), cefepime (3.70%), piperacillin-tazobactam (3.70%), and trimethoprim-sulfamethoxazole (5.45%). In our setting, CESMP Enterobacteriaceae showed the lowest resistance to piperacillin-tazobactam, cefepime, imipenem, gentamicin, and colistin, which can therefore be recommended for the empirical treatment of UTIs. The COVID-19 pandemic may have had a clinical impact in relation to the increased resistance of E. cloacae and M. morgani to some antibiotics.

Predicting Septic Shock After Emergent Ureteral Stenting in Stone-Related Obstruction and Presumed Infections.

Introduction: Systemic inflammatory response syndrome (SIRS) criteria have long been used to predict septic shock. The sequential organ failure assessment and quick sequential organ failure assessment (qSOFA) scores have been suggested to be more accurate predictors. This study aims to compare SIRS and qSOFA for predicting of septic shock in the setting of retrograde ureteral stenting for obstructing stones and concomitant urinary tract infection. Methods: A retrospective review of records at two centers of consecutive patients was performed. Patients with unilateral ureteral obstruction by a stone who underwent ureteral stent placement and suspicion of urinary tract infection were identified. Primary endpoints were SIRS and qSOFA positive scores, intensive care unit admission, and vasopressor requirements. Results: A total of 187 patients were included. SIRS criteria were met in 103 patients (55.1%) and in 30 patients who experienced septic shock. qSOFA criteria were met for 24 patients (12.8%) and in 18 patients who experienced septic shock. Specificity for postoperative septic shock was significantly higher for qSOFA than for SIRS criteria (75 vs 29.1%, McNemar test p < 0.001). Both SIRS and qSOFA had significant areas under the curve (AUC), qSOFA had a fair AUC of 0.750, p = 0.001, whereas SIRS had a poor AUC of 0.659, p = 0.008. Univariate logistic regression of SIRS and qSOFA for septic shock showed: qSOFA (odds ratio [OR] 46 [0.25-228], p = 0.001) and SIRS (OR 2.29 [0.716-7.37], p = 0.162). Conclusion: Although SIRS offers higher sensitivity, qSOFA score may offer advantages over SIRS criteria in evaluation of risk for septic shock for patients who present with obstructing ureteral stone and urinary tract infection.

Diagnostic variation for febrile children in European emergency departments

The study aimed to explore the use of diagnostics for febrile children presenting to European emergency departments (EDs), the determinants of inter-hospital variation, and the association between test use and hospitalization. We performed a secondary analysis of a cross-sectional observational study involving 28 paediatric EDs from 11 countries. A total of 4560 children < 16 years were included, with fever as reason for consultation. We excluded neonates and children with relevant comorbidities. Our primary outcome was the proportion of children receiving testing after primary evaluation, by country and by focus of infection. Variability between hospitals and effects of blood testing on patient disposition were explored by multilevel regression analyses, adjusting for patient characteristics (age group, triage level, appearance, fever duration, focus of infection) and hospital type (academic, teaching, other). The use of routine diagnostics varied widely, mostly in the use of blood tests, ranging from 3 to 75% overall across hospitals. Age < 3 months, high-acuity triage level, ill appearance, and suspicion of urinary tract infection displayed the strongest association with blood testing (odds ratios (OR) of 8.71 (95% CI 5.23–14.53), 19.46 (3.66–103.60), 3.13 (2.29–4.26), 10.84 (6.35–18.50), respectively). Blood testing remained highly variable across hospitals (median OR of the final model 2.36, 1.98–3.54). A positive association was observed between blood testing and hospitalization (OR 13.62, 9.00–20.61).Conclusion: the use of diagnostics for febrile children was highly variable across European EDs, yet patient and hospital characteristics could only partly explain inter-hospital variability. Focus groups of participating sites should help define reasons for unexpected variation.What is Known:• Although previous research has shown variation in the emergency department (ED) management of febrile children, there is limited information on the use of diagnostics in European EDs.• A deeper knowledge of variability and its determinants can steer optimization of care.What is New:• The use of diagnostics for febrile children was highly variable across European EDs, yet patient and hospital characteristics could only partly explain inter-hospital variability.• Data on between-centre comparison offer opportunities to further explore factors influencing unwarranted variation.

Comparison of Urine Dipstick Nitrite Test with Urine Culture in the Diagnosis of Urinary Tract Infection

Introduction: Urine dipstick is a rapid, cost-effective test used as a marker for quick detection of bacterial Urinary Tract Infection (UTI). Nitrite test depends on the conversion of nitrate to nitrite by the action of Gramnegative bacteria present in urine. The purpose of this study was to determine the sensitivity, specificity, positive predictive value and negative predictive value of Nitrite test in relation to urine culture. Methods: Two hundred fresh uncentrifuged urine samples with suspicion of UTI were collected and tested for nitrite by using urine dipstick strip (COMBI-10SL) prior to the culture. Nitrite was consideredas positive if there was a change in color of dipstick from colorless towards pink within 60 seconds.Quantitative urine culture was performed by using the strips calibrated to deliver 0.02 μL of urine onCystine Lactose Electrolyte Deficient (CLED) agar. All plates were incubated at 37°C and read after 24to 48 hours. Culture was considered as the gold standard to evaluate the performance of the dipsticktest. Antimicrobial susceptibility testing (AST) of the isolates was done using the Kirby-Bauer discdiffusion method following Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: Out of 200 samples, 36 (18.00%) samples showed significant growth whereas 164 (82.00%) samples did not show significant growth. Out of 36 samples, 25 (69.44%) samples showed positive nitrite test while 11 (30.55%) showed negative nitrite test. The sensitivity, Specificity, Positive PredictiveValue and Negative Predictive Value of the nitrite test were 69.44%, 89.63%, 59.52% and 93.03%respectively. The most frequently isolated bacteria were Escherichia coli 29 (80.55%) followed byEnterobacter aerogenes 3 (8.33%) and Pseudomonas aeruginosa 2 (5.56%). The antimicrobial profile ofthe isolates revealed that 14 (38.89%) isolates were MDR. Conclusions: Dipstick test for the detection of nitrite in urine is sensitive and specific and can be used for the primary screening of UTI in a resource-limited setup. Confirmatory diagnosis should be followed by the urine culture method.

Are All Stent Bearers Equal? Ureteral Stent Symptoms in Kidney Transplant Patients: A Case-Control Prospective Study.

Purpose: The aim of this study is to conduct a prospective, controlled single-center study to determine the prevalence and types of ureteral stent symptoms in kidney transplant (KTx) recipients and compare them with nontransplant subjects. Materials and Methods: From December 2012 to June 2019, a total of 102 patients having undergone a KTx and Double-J stent (DJS) placement and 88 patients having undergone endourological lithotripsy and DJS placement were enrolled. The Ureteral Stent Symptom Questionnaire (USSQ) was administered to patients with a median of 25 (KTx) and 31 (urolithiasis) days after stent placement. USSQ scores were used to compare symptoms between the two groups. Results: Of the 190 patients enrolled, 88 belonged to the lithotripsy group (control group) and 102 to the KTx recipients' group. Mean score for urinary symptoms was 21.42 for KTx patients vs 27.53 for control patients with statistical significance (p < 0.001, CI -7.792 to -4.433). The visual analog scale, overall bother, pain at voiding, flank pain at voiding, and frequency of painkiller use scores were significantly higher for control patients than for KTx patients (p = 0.024, <0.001, <0.001, <0.001, and 0.014, respectively). Frequency of rest, changes in work duration, work domain score, suspicion of urinary tract infection (UTI), and need for professional assistance scores were significantly lower for KTx patients than the control. There were no significant differences in general health and sexual domains between groups. Conclusions: KTx recipients have significantly fewer urinary symptoms, pain, work-related disturbances, suspected UTIs, and hospitalizations associated with stent placement than urolithiasis patients.

Integron detection for prediction of trimethoprim/sulfamethoxazole susceptibility in children with Enterobacterales urinary tract infections.

In some countries, third-generation cephalosporins (3GCs) serve as first-line therapy in children with urinary tract infections (UTIs). However, their use may contribute to the emergence of antibiotic resistance, notably among Gram-negative bacteria (GNB). Integrons are bacterial genetic elements involved in antibiotic resistance in GNB. Their absence is associated with >97% susceptibility to trimethoprim/sulfamethoxazole in adults infected with GNB. The objective of this study was to examine the value of integron detection directly from urine samples as a predictive marker of resistance to trimethoprim/sulfamethoxazole in children with GNB-related UTIs. Children admitted to the Limoges University Hospital's paediatric emergency department between February 2018 and March 2019 with a suspicion of UTI were eligible for the study. Only confirmed cases presenting a positive urine culture with unique GNB were retained for further study analyses. Integrons were detected directly from urines using real-time PCR. The data of 72 patients were analysed and integrons were detected in 15 urine samples. The negative predictive value of integron detection for resistance to trimethoprim/sulfamethoxazole was 100% as all of the GNB (all were Enterobacterales) isolated from patients with no integrons detected in their urine samples were susceptible to trimethoprim/sulfamethoxazole. The detection of integrons in cases of paediatric patients with suspected UTI could help limit 3GC empirical use and empower an empirical first-line strategy better tailored to the needs of each patient.

HYPERAMMONEMIC COMA IN A PATIENT WITH ORNITHINE TRANSCARBAMYLASE DEFICIENCY

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Ornithine transcarbamylase (OTC) deficiency is a rare, X-linked inherited disorder of the urea cycle affecting 1 in 80,000 live births. It is characterized by the inability to break down nitrogen to urea. The resulting hyperammonemia leads to lethargy, hypotonia, seizures and developmental delay if the illness manifests in infancy, and migraines, ataxia, hyperammonemic coma in adults. Early recognition and treatment of hyperammonemia is the key to prevent neurological disability in infancy and hyperammonemic coma leading to death in adults. CASE PRESENTATION: 46-year-old female with past medical history of partial OTC deficiency and complex partial seizures presented to the hospital with chief complaint of altered mental status. In the emergency department, vitals were remarkable for tachycardia. Exam was significant for altered mental status and a Glasgow Coma Scale of 8. Initial labs were significant for hyperammonemia (234 mcmol/L), hypernatremia (160 mmol/L) and abnormal urinary analysis with signs of infection. Patient was admitted to the intensive care unit followed by initiation of lactulose and rifaximin for treatment of hyperammonemia. She was also started on broad spectrum antibiotics for suspicion of urinary tract infection. Electrolyte abnormalities were gradually corrected. However, her condition kept on deteriorating to the point that she was not responding to verbal, tactile or painful stimuli. She was subsequently intubated on the second day of hospitalization due to failure to protect airway. Serial ammonia levels were monitored that kept on increasing. Electroencephalogram showed severe metabolic encephalopathy without seizures. Computerized tomography scan of the brain did not show acute intracranial process. At this point, nephrology was consulted, and patient underwent continuous renal replacement therapy with dramatic improvement of serum ammonia level and her neurological status. This was followed by successful extubation and a gradual return to baseline mental status. She was continued on lactulose, rifaximin and advised to remain on low protein diet. DISCUSSION: This case highlights the rare complication of hyperammonemic coma in an adult patient with history of OTC deficiency. It is an X-linked defect with variable onset and presentation depending on the sex and activity of the enzyme. Patients classically present with lethargy, seizures and hyperammonemia leading to metabolic encephalopathy, coma and death. Diagnosis involves serum amino acid quantitative analysis and urinary orotic acid concentration in urine. Low serum citrulline and elevated urinary orotic acid levels confirm the OTC deficiency. DNA sequencing-based mutation analysis can also be used as first line for diagnosis. Treatment involves rapidly decreasing serum ammonia with lactulose, rifaximin or dialysis. Prognosis depends on the age of presentation and duration of hyperammonemia. CONCLUSIONS: XXX. REFERENCE #1: Summar, Marshall. "Current strategies for the management of neonatal urea cycle disorders." The Journal of pediatrics 138, no. 1 (2001): S30-S39. DISCLOSURES: No relevant relationships by Fatima Ayub, source=Web Response No relevant relationships by Muhammad Hasib Khalil, source=Web Response

Evaluation of modified nitrite test for diagnosing urinary tract infection in pediatrics

Background: Urinary tract infection (UTI) is a common bacterial infection causing illness in children. It may be difficult to recognize UTI in children because the presenting symptoms and signs are non-specific, particularly in younger children. In addition, urine collection and interpretation of urine tests in children are not easy, and therefore, it may not always be possible to confirm the diagnosis unequivocally. The study was conducted to evaluate the value of the modified nitrite test in diagnosing urinary tract infection (UTI) in children.Methods: The study included 150 children of both sexes, aged below 5 years, who were examined due to suspicion of UTI. The efficacy of the modified nitrite test to predict culture positivity was studied.Results: Modified nitrite test was positive in 14 out of the 26 culture-positive urine samples (sensitivity 53.85%). The specificity, positive predictive value, and negative predictive value were 96.77%, 77.78%, and 90.91%. The overall diagnostic accuracy was 89.33%.Conclusions: Modified nitrite test is an effective rapid screening test for diagnosing pediatric UTI.

Deconstructing the urinalysis: A novel approach to diagnostic and antimicrobial stewardship.

The extensive use of the urinalysis for screening and monitoring in diverse clinical settings usually identifies abnormal urinalysis parameters in patients with no suspicion of urinary tract infection, which in turn triggers urine cultures, inappropriate antimicrobial use, and associated harms like Clostridioides difficile infection. We highlight how urinalysis is misused, and suggest deconstructing it to better align with evolving patterns of clinical use and the differential diagnosis being targeted. Reclassifying the urinalysis components into infectious and non-infectious panels and interpreting urinalysis results in the context of individual patient’s pretest probability of disease is a novel approach to promote proper urine testing and antimicrobial stewardship, and achieve better outcomes.

Performance Evaluation of Four Commercial Point-of-Care Testing Urine Analyzers for Diagnosing Urinary Tract Infection.

Urinalysis is used as a screening tool in case of a clinical suspicion of urinary tract infection (UTI). The purpose of this study is to evaluate the analytical performance, agreement, and screening value of four commercial point-of-care testing (POCT) urine analyzers for UTI. The following four POCT analyzers were evaluated: Clinitek Status+, BW-200, Hipee S2, and URS-14K. The agreement of the four analyzers with the laboratory standard was assessed. The diagnostic indicators of the screening tests performed using POCT analyzers for UTI were calculated against the bacterial culture as the gold standard. Overall agreement of the four analyzers was good. For nitrite and leukocytes, all the analyzers showed substantial or excellent agreement with the laboratory reference standard, whereas agreement for erythrocytes varied from moderate to excellent. With each POCT analyzer, combined detection of nitrite, leukocytes, and erythrocytes provided better diagnostic performance than individual detection. Combined detection had higher sensitivity and negative predictive value, while the specificity and positive predictive value were higher for single detection of nitrite. Present findings demonstrate that the overall performance of the four POCT urine analyzers was sufficient for routine use for screening UTI. A result positive for nitrite is helpful for early diagnosis of UTI, and a result negative for the combination of nitrite, leukocytes, and erythrocytes is helpful for early elimination of UTI.

Clinico-demographic profile and comparative assessment of ultrasonography and computed tomography examination in the diagnosis of urinary tract infections

Background and Objective: Urinary tract infections (UTIs) are one of the most commonly reported infections worldwide. The diagnosis of these infections is primarily based on clinical symptoms and biochemical data. Diagnostic imaging plays an important role in the management of UTIs. The main objective of this prospective study was to evaluate and compare of sensitivity and specificity of ultrasonography and computed tomography examination in the diagnosis of UTIs.Patients and Methods: In this study, we examined 100 cases (48 males and 52 females of varying age groups) referred with clinical suspicion of urinary tract infection to the department of radiodiagnosis, KIMS Hospital, Bangalore. After history taking and clinical examination all patients underwent urine analysis, ultrasound, and computed tomography (CT) examination. Results: Uncomplicated cystitis followed by acute pyelonephritis (APN) was the most common type of UTI as per the results. The sensitivity and specificity of ultrasound in diagnosing uncomplicated cystitis were 88.57% and 100%, respectively, whereas, that of CT was 74.29% and 100%. The sensitivity and specificity of ultrasound in diagnosing APN were 64.51% and 100%, respectively, whereas, that of CT were 90.32% and 100%. Sensitivity and specificity of CT in diagnosing chronic pyelonephritis, renal abscess, and emphysematous pyelonephritis remained 100% throughout.Conclusion: Ultrasound was found to be a more sensitive investigation in cases of uncomplicated cystitis than CT. CT on the other hand was found to be more sensitive and specific in the diagnosis of UTI and its complications other than uncomplicated cystitis.

Patterns and Predictors of UTI Treatment Practices in Nursing Homes

Background: Suspicion of urinary tract infection (UTI) is the most common justification for prescribing antibiotics in nursing homes. More than half of antibiotic prescriptions for treatment of UTI in nursing homes are either unnecessary or inappropriate. Achieving a better understanding of the factors that underlie UTI treatment decisions is necessary to improve the quality of antibiotic prescribing in nursing homes. An ongoing hybrid type 2 effectiveness-implementation cluster randomized trial of a recently developed nursing home UTI recognition and management tool kit provided us with an opportunity to explore the influence of organizational, clinical, and staff attributes on UTI antibiotic prescribing practices in nursing homes. Methods: Data on antibiotic starts for suspected UTIs were collected in 29 nursing homes over a 9-month period. Antibiotic practices evaluated included total antibiotic starts per 1,000 resident days, % antibiotic starts with treatment duration &gt;7 days, % antibiotic starts in which the initial antibiotic choice was a fluoroquinolone, and % antibiotic starts meeting UTI tool-kit criteria of appropriateness. Prior research and bivariate analyses were used to select clinical and organizational attributes as well as individual nursing staff-level retention rates for inclusion in a stepwise linear regression model for each antibiotic practice outcome. Results: In total, 602 UTI antibiotic events were evaluated. Four associations were identified for antibiotic starts including nursing home urine culture rate, ICP status, nonprofit and part-time LPN retention. Nursing homes with higher full-time LPN retention had a lower rate of antibiotic treatment duration &gt;7 days. Full-time CNAs and part-time LPNs retention and for-profit status was associated with the proportion of fluoroquinolone antibiotic starts. No attributes influenced the proportion of antibiotic starts meeting appropriateness criteria (Fig. 1). Urine culture rates are driving overall nursing home antibiotic prescribing. Conclusions: Urine culture practices was strongly associated with UTI treatment rates in nursing homes. A variety of organizational characteristics were also associated with UTI treatment rates as well as other UTI antibiotic prescribing practices. Some of these associations appear paradoxical but may reflect increasing resident acuity and increased capacity to standardize practices through organizational centralization.Funding: Support for the project provided by the Wisconsin Partnership Program.Disclosures: None

Impact of the beta-lacta test on the management of urinary tract infections at the emergency department

Introduction Rapid detection of extended-spectrum β-lactamases is essential. In this study, we evaluated the potential impact of β-lacta test on both the times to appropriate antibiotic therapy and to the implementation of patient isolation measures. Patients and methods We included prospectively all the patients admitted to the emergency department for clinical suspicion of urinary tract infection. Compared with physician’s decision, we analysed the potential impact of β-lacta test on the initial antibiotic therapy and on the implementation of hygiene measures. This study has been registered under number NCT02897609. Results We included 203 patients, 43% with acute pyelonephritis and 21% with acute prostatitis. The β-lacta test had a 95.2% sensitivity and a 99.5% specificity to detect extended-spectrum β-lactamases. Taking the β-lacta test results into account would have decreased significantly both the times to appropriate therapy and to isolation measures from 54 to 2.7 h and from 55.2 to 2.6 h, respectively. Conclusion The β-lacta test could reduce significantly the times to appropriate therapy and implementation of isolations measures.

Prevalence of Urinary Tract Infections in Children and Changes in Sensitivity to Antibiotics of E. coli Strains

Urinary tract infections (UTIs) are the most common bacterial pathologies in children, but they are difficult to spot. The diagnosis relies on urine culture in order to measure the prevalence of the infection, to identify the etiology and the sensitivity of the germs to different antibiotics. Escherichia coli (E. coli) strains are the most common uro-pathogen germs. The change in sensitivity to antibiotic of these uro-pathogen bacteria should be closely monitored because the physicians should be informed about the evolution of the antibiotic resistance of E coli, for a more effective treatment in their fight against diseases. The study aimed to determine the prevalence of UTIs and the evolution of antimicrobial sensitivity for E. coli. This retrospective study was performed over a period of 4 years, 2013-2016, and included all the patients admitted in the Children�s Hospital, aged 0-18 years, with the suspicion of UTIs; also, the standard culture techniques for urine samples, the modified Kirby-Bauer disk diffusion method for the antibiotic sensitivity testing, and the disk diffusion method to confirm the ESBL production by the clinical isolates of E. coli in urine were used. The statistical analysis was performed using the proportions of sensitive, resistant and intermediates. Descriptive statistics like the total, mean and percentage were performed using the Statistical Package for the Social Sciences (SPSS), version 15.0 and Microsoft Excel. From 15389 urine cultures processed in 4 years, 1530 were positive (9.9 %). Among these positive urine cultures, 1056 (69 %) were positive for E. coli. Testing the E. coli to a range of antibiotics, according to CLSI standard, a high resistance to Ampicillin (69-96%), Amoxicillin/Clavulanic acid (32-70%), Trimethoprim/Sulfamethoxazole (36-42%) was observed and low levels of resistance to Ceftazidime, Cefuroxime, Cefpodoxime, Gentamycin, Nalidixic acid. Among E. Coli strains, 9-9.6 % were ESBL positive. Despite the low number of positive urine cultures in a paediatric population, it is very important to perform the urine culture in order to correctly identify the etiology of UTIs, recommend the right antibiotic, and avoid the wrong use of the antibiotics in children.

Prevalence of Urinary Tract Infections in Children and Changes in Sensitivity to Antibiotics of E. coli Strains

Urinary tract infections (UTIs) are the most common bacterial pathologies in children, but they are difficult to spot. The diagnosis relies on urine culture in order to measure the prevalence of the infection, to identify the etiology and the sensitivity of the germs to different antibiotics. Escherichia coli (E. coli) strains are the most common uro-pathogen germs. The change in sensitivity to antibiotic of these uro-pathogen bacteria should be closely monitored because the physicians should be informed about the evolution of the antibiotic resistance of E coli, for a more effective treatment in their fight against diseases. The study aimed to determine the prevalence of UTIs and the evolution of antimicrobial sensitivity for E. coli. This retrospective study was performed over a period of 4 years, 2013-2016, and included all the patients admitted in the Children�s Hospital, aged 0-18 years, with the suspicion of UTIs; also, the standard culture techniques for urine samples, the modified Kirby-Bauer disk diffusion method for the antibiotic sensitivity testing, and the disk diffusion method to confirm the ESBL production by the clinical isolates of E. coli in urine were used. The statistical analysis was performed using the proportions of sensitive, resistant and intermediates. Descriptive statistics like the total, mean and percentage were performed using the Statistical Package for the Social Sciences (SPSS), version 15.0 and Microsoft Excel. From 15389 urine cultures processed in 4 years, 1530 were positive (9.9 %). Among these positive urine cultures, 1056 (69 %) were positive for E. coli. Testing the E. coli to a range of antibiotics, according to CLSI standard, a high resistance to Ampicillin (69-96%), Amoxicillin/Clavulanic acid (32-70%), Trimethoprim/Sulfamethoxazole (36-42%) was observed and low levels of resistance to Ceftazidime, Cefuroxime, Cefpodoxime, Gentamycin, Nalidixic acid. Among E. Coli strains, 9-9.6 % were ESBL positive. Despite the low number of positive urine cultures in a paediatric population, it is very important to perform the urine culture in order to correctly identify the etiology of UTIs, recommend the right antibiotic, and avoid the wrong use of the antibiotics in children.

Effect of a Standard vs Enhanced Implementation Strategy to Improve Antibiotic Prescribing in Nursing Homes

Suspicion of urinary tract infection (UTI) is the major driver of overuse and misuse of antibiotics in nursing homes (NHs). Effects of interventions to improve the recognition and management of UTI in NHs have been mixed, potentially owing to differences in how interventions were implemented in different studies. An improved understanding of how implementation approach influences intervention adoption is needed to achieve wider dissemination of antibiotic stewardship interventions in NHs. To compare the effects of 2 implementation strategies on the adoption and effects of a quality improvement toolkit to enhance recognition and management of UTIs in NHs. This cluster-randomized hybrid type 2 effectiveness-implementation clinical trial will be performed over a 6-month baseline (January to June 2019) and 12-month postimplementation period (July 2019 to June 2020). A minimum of 20 Wisconsin NHs with 50 or more beds will be recruited and randomized in block sizes of 2 stratified by rurality (rural vs urban). All residents who are tested and/or treated for UTI in study NHs will be included in the analysis. All study NHs will implement a quality improvement toolkit focused on enhancing the recognition and management of UTIs. Facilities will be randomized to either a usual or enhanced implementation approach based on external facilitation (coaching), collaborative peer learning, and peer comparison feedback. Enhanced implementation is hypothesized to be associated with improvements in adoption of the quality improvement toolkit and clinical outcomes. Primary outcomes of the study will include number of (1) urine cultures per 1000 resident days and (2) antibiotic prescriptions for treatment of suspected UTI per 1000 resident-days. Secondary outcomes of the study will include appropriateness of UTI treatments, treatment length, use of fluoroquinolones, and resident transfers and mortality. A mixed-methods evaluation approach will be used to assess extent and determinants of adoption of the UTI quality improvement toolkit in study NHs. Knowledge gained during this study could help inform future efforts to implement antibiotic stewardship and quality improvement interventions in NHs. ClinicalTrials.gov identifier: NCT03520010.

Urinary tract infection by Acinetobacter baumannii and Pseudomonas aeruginosa: evolution of antimicrobial resistance and therapeutic alternatives.

Purpose. Acinetobacter baumannii and Pseudomonas aeruginosa are responsible for numerous nosocomial infections. The objective of this study was to determine the development of their susceptibility to ten antibiotics and the antibiotic consumption of patients with suspicion of urinary tract infection (UTI).Methodology. A retrospective study was conducted on the susceptibility profiles of A. baumannii and P. aeruginosa isolates from 749 urine samples gathered between January 2013 and December 2016, and on the consumption of imipenem, meropenem and piperacillin-tazobactam between 2014 and 2016.Results. Hospital patients were the source of 82 (91.1 %) of the 90 A. baumannii isolates detected and 555 (84.2 %) of the 659 P. aeruginosa isolates. Globally, the lowest percentage susceptibility values were found for fosfomycin, aztreonam and ciprofloxacin, while colistin continued to be the most active antibiotic in vitro. In 2016, the susceptibility of A. baumannii to carbapenem and piperacillin-tazobactam decreased to very low values, while the susceptibility of P. aeruginosa to carbapenem remained stable but its susceptibility to piperacillin-tazobactam decreased. There was a marked increase in the consumption of piperacillin-tazobactam.Conclusion. In our setting, it is no longer possible to use carbapenems and piperacillin-tazobactam for empirical treatment of UTI due to A. baumannii or to use piperacillin-tazobactam for empirical treatment of UTI due to P. aeruginosa. Colistin was found to be the most active antibiotic in vitro. There was a marked increase in the consumption of piperacillin-tazobactam.