Symptoms Of Lower Urinary Tract Infection Research Articles

The Risk of Preterm Birth in Low Risk Pregnant Women with Urinary Tract Infections.

Urinary tract infections are among the most common infections during pregnancy. The association between symptomatic lower urinary tract infections during pregnancy and fetal and maternal complications such as preterm birth and low birthweight remains unclear. The aim of this research is to evaluate the association between urinary tract infections during pregnancy and maternal and neonatal outcomes, especially preterm birth. This study is a secondary analysis of a multicenter prospective cohort study, which included patients between October 2011 and June 2013. The population consists of women with low risk singleton pregnancies. We divided the cohort into women with and without a symptomatic lower urinary tract infection after 20 weeks of gestation. Baseline characteristics and maternal and neonatal outcomes were compared between the two groups. Multivariable logistic regression analysis was used to correct for confounders. The main outcome was spontaneous preterm birth at <37 weeks. We identified 4,918 pregnant women eligible for enrollment, of whom 9.4% had a symptomatic lower urinary tract infection during their pregnancy. Women with symptomatic lower urinary tract infections were at increased risk for both preterm birth in general (12 vs. 5.1%, adjusted OR 2.5; 95% CI 1.7-3.5) as well as a spontaneous preterm birth at <37 weeks (8.2 vs. 3.7%, adjusted OR 2.3; 95% CI 1.5-3.5). This association was also present for early preterm birth at <34 weeks. Women with symptomatic lower urinary tract infections during pregnancy are also at increased risk of endometritis (8.9 vs. 1.8%, adjusted OR 5.3; 95% CI 1.4-20) and mastitis (7.8 vs. 1.8%, adjusted OR 4.0; 95% CI 1.6-10) postpartum. Low risk women with symptomatic lower urinary tract infections during pregnancy are at increased risk of spontaneous preterm birth. In addition, an increased risk for endometritis and mastitis postpartum was found in women with symptomatic lower urinary tract infection during pregnancy. · UTIs increase the risk of preterm birth.. · UTIs increase the risk of endometritis postpartum.. · UTIs increase the risk of mastitis postpartum..

Multiplex PCR Based Urinary Tract Infection (UTI) Analysis Compared to Traditional Urine Culture in Identifying Significant Pathogens in Symptomatic Patients

ObjectiveTo evaluate whether multiplex PCR-based molecular testing is noninferior to urine culture for detection of bacterial infections in symptomatic patients. MethodsRetrospective record review of 582 consecutive elderly patients presenting with symptoms of lower urinary tract infection (UTI) was conducted. All patients had traditional urine cultures and PCR molecular testing run in parallel. ResultsA total of 582 patients (mean age 77; range 60-95) with symptoms of lower UTI had both urine cultures and diagnostic PCR between March and July 2018. PCR detected uropathogens in 326 patients (56%, 326/582), while urine culture detected pathogens in 217 patients (37%, 217/582). PCR and culture agreed in 74% of cases (431/582): both were positive in 34% of cases (196/582) and both were negative in 40% of cases (235/582). However, PCR and culture disagreed in 26% of cases (151/582): PCR was positive while culture was negative in 22% of cases (130/582), and culture was positive while PCR was negative in 4% of cases (21/582). Polymicrobial infections were reported in 175 patients (30%, 175/582), with PCR reporting 166 and culture reporting 39. Further, polymicrobial infections were identified in 67 patients (12%, 67/582) in which culture results were negative. Agreement between PCR and urine culture for positive cultures was 90%, exceeding the noninferiority threshold of 85% (95% conflict of interest 85.7%-93.6%). ConclusionMultiplex PCR is noninferior to urine culture for detection and identification of bacteria. Further investigation may show that the accuracy and speed of PCR to diagnose UTI can significantly improve patient outcomes.

Eating Red meat and Symptomatic Lower Urinary Tract Infection among female students at King Abdul-Aziz University in Rabigh, Saudi Arabia

Background: Chronic diseases, such as diabetes, hypertension associated-heart disease; and several different cancers were reported to be linked to high meat consumption. Assessment of urinary nutria-metabolomics was also considered and reported as a novel tool for dietary styles. Increased consumption of red meat was associated with increased risk of bladder diseases and infection. Method: This is a cross-sectional study conducted among the Rabigh colleges’ female students throughout 10 months, for measuring the prevalence of symptomatic lower urinary tract infection (LUTI) at King Abdul-Aziz University, Rabigh, Saudi Arabia, 2019. The questionnaire was distributed among 200 students through their mobile via WhatsApp. It was calculated by the sample size equation, using a mean prevalence of LUTI among teenage female. Result: Among the 230 students who received the questionnaire, the response rate was 66%, so the total current studied sample was 152 female students from different colleges in Rabigh. 75.66% of them in age (15- 24 years), and 24.34% of them were in age (25-30 years), 23.68% of them were married, and 78.29% were eating red meat. UTI prevalence was 25.66%. There was a high percentage (66.7%) of UTI among the young female (15-24 years), the married women (35.9%), the group who don’t drink enough water (69.2%), and 59.0% with a high rate of eating meat (2 times/ week). All these differences were found to be statistically significant (P ≤ 0.05). Conclusion: LUTI symptoms seemed to be related to increased trend towards red meat eating besides other factors e.g. water drinking and marital status.

Eating Red meat and Symptomatic Lower Urinary Tract Infection among female students at King Abdul-Aziz University in Rabigh, Saudi Arabia

Background: Chronic diseases, such as diabetes, hypertension associated-heart disease; and several different cancers were reported to be linked to high meat consumption. Assessment of urinary nutria-metabolomics was also considered and reported as a novel tool for dietary styles. Increased consumption of red meat was associated with increased risk of bladder diseases and infection. Method: This is a cross-sectional study conducted among the Rabigh colleges’ female students throughout 10 months, for measuring the prevalence of symptomatic lower urinary tract infection (LUTI) at King Abdul-Aziz University, Rabigh, Saudi Arabia, 2019. The questionnaire was distributed among 200 students through their mobile via WhatsApp. It was calculated by the sample size equation, using a mean prevalence of LUTI among teenage female. Result: Among the 230 students who received the questionnaire, the response rate was 66%, so the total current studied sample was 152 female students from different colleges in Rabigh. 75.66% of them in age (15- 24 years), and 24.34% of them were in age (25-30 years), 23.68% of them were married, and 78.29% were eating red meat. UTI prevalence was 25.66%. There was a high percentage (66.7%) of UTI among the young female (15-24 years), the married women (35.9%), the group who don’t drink enough water (69.2%), and 59.0% with a high rate of eating meat (2 times/ week). All these differences were found to be statistically significant (P ≤ 0.05). Conclusion: LUTI symptoms seemed to be related to increased trend towards red meat eating besides other factors e.g. water drinking and marital status.

Effect of 5-Day Nitrofurantoin vs Single-Dose Fosfomycin on Clinical Resolution of Uncomplicated Lower Urinary Tract Infection in Women

The use of nitrofurantoin and fosfomycin has increased since guidelines began recommending them as first-line therapy for lower urinary tract infection (UTI). To compare the clinical and microbiologic efficacy of nitrofurantoin and fosfomycin in women with uncomplicated cystitis. Multinational, open-label, analyst-blinded, randomized clinical trial including 513 nonpregnant women aged 18 years and older with symptoms of lower UTI (dysuria, urgency, frequency, or suprapubic tenderness), a positive urine dipstick result (with detection of nitrites or leukocyte esterase), and no known colonization or previous infection with uropathogens resistant to the study antibiotics. Recruitment took place from October 2013 through April 2017 at hospital units and outpatient clinics in Geneva, Switzerland; Lodz, Poland; and Petah-Tiqva, Israel. Participants were randomized in a 1:1 ratio to oral nitrofurantoin, 100 mg 3 times a day for 5 days (n = 255), or a single 3-g dose of oral fosfomycin (n = 258). They returned 14 and 28 days after therapy completion for clinical evaluation and urine culture collection. The primary outcome was clinical response in the 28 days following therapy completion, defined as clinical resolution (complete resolution of symptoms and signs of UTI without prior failure), failure (need for additional or change in antibiotic treatment due to UTI or discontinuation due to lack of efficacy), or indeterminate (persistence of symptoms without objective evidence of infection). Secondary outcomes included bacteriologic response and incidence of adverse events. Among 513 patients who were randomized (median age, 44 years [interquartile range, 31-64]), 475 (93%) completed the trial and 377 (73%) had a confirmed positive baseline culture. Clinical resolution through day 28 was achieved in 171 of 244 patients (70%) receiving nitrofurantoin vs 139 of 241 patients (58%) receiving fosfomycin (difference, 12% [95% CI, 4%-21%]; P = .004). Microbiologic resolution occurred in 129 of 175 (74%) vs 103 of 163 (63%), respectively (difference, 11% [95% CI, 1%-20%]; P = .04). Adverse events were few and primarily gastrointestinal; the most common were nausea and diarrhea (7/248 [3%] and 3/248 [1%] in the nitrofurantoin group vs 5/247 [2%] and 5/247 [1%] in the fosfomycin group, respectively). Among women with uncomplicated UTI, 5-day nitrofurantoin, compared with single-dose fosfomycin, resulted in a significantly greater likelihood of clinical and microbiologic resolution at 28 days after therapy completion. ClinicalTrials.gov Identifier: NCT01966653.

Amikacin therapy for urinary tract infections caused by extended-spectrum β-lactamase-producing Escherichia coli.

Background/Aims:The number of urinary tract infections (UTIs) caused by extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) is increasing. In an outpatient setting, there are limited therapeutic options to treat ESBL-producing pathogens. We evaluated the outcomes of amikacin outpatient parenteral antibiotic therapy (OPAT) for UTIs caused by ESBL-EC in patients not pre-treated with carbapenem.Methods:We retrospectively evaluated the outcomes of amikacin OPAT for UTIs caused by ESBL-EC.Results:From November 2011 to October 2012, eight females, who could not be hospitalized for carbapenem treatment, were treated with amikacin OPAT for nine episodes of non-bacteremic ESBL-EC UTIs. Seven of the eight patients had one or more comorbidities. Of the nine UTI cases, three had symptomatic lower UTIs and six had non-bacteremic upper UTIs. In all of the cases, symptomatic and laboratory improvements were observed following amikacin OPAT. One patient showed a delayed relapse with bilateral microabscesses 3 weeks after treatment cessation; however, a clinical and microbiological cure was eventually reached. All of the patients were able to tolerate amikacin OPAT without any significant nephrotoxicity or ototoxicity.Conclusions:Amikacin OPAT represents a feasible therapeutic option for non-bacteremic UTIs caused by ESBL-EC in settings with limited resources.

Fosfomycin tromethamine. Antibiotic of choice in the female patient: A multicenter study.

IntroductionThe aim of this study was to evaluate oral single/multiple doses of Fosfomycin Trometamol with clinical and microbiological efficacy in:Asymptomatic bacteriuria in pregnancy.Endourological procedures.Lower urinary tract infections. Material and methodsThis prospective, uncontrolled, open label study was conducted in two tertiary hospitals over a period of three years. A total of 400 patients were included in the study. Group A (200 patients) with asymptomatic bacteriuria in pregnancy and Group B (200 Patients) with symptomatic lower urinary tract infections and with any day care endourological procedures were enrolled in our study. Efficacy end points like post- antibiotic urinalysis, microbiological efficacy and clinical improvement with adverse effects of the drug were evaluated.ResultsOf the 400 patients studied, 98% returned for follow-up. Out of the 304 urinary isolates in Table 2 (ASB and symptomatic LUTS) grown on urinary culture, majority of the isolates were Gram-negative Enterobacteriacae family. After oral single/multiple doses of fosfomycin, bacterial eradication, bacterial persistence, bacterial reinfection were 96.3%, 3.9%, 3.9% respectively (Figure 2). No isolates were grown in 8 cases (Table 2). However, on administration of the drug 23.5% patients noticed diarrhea (loose stools) followed by itching (19.7%) in genital area (Figure 1).ConclusionsFosfomycin Trometamol is a bactericidal antibiotic with a broad spectrum activity against Gram-positive also Gram-negative bacteriae. It has an advantage of oral single /multiple doses, higher eradication rate of bacteria after 48 hours, excellent tolerability and safety in pregnancy and other female age groups. We recommend Fosfomycin Trometamol as the drug of choice particularly in patients with poor drug compliance and for minor day care endourological procedures.

826 BOTULINUM-A TOXIN – AN ALTERNATIVE FOR INCONTINENT CHILDREN WITH THERAPY RESISTANT OVERACTIVE BLADDER?

You have accessJournal of UrologyPediatrics: Bladder Dysfunction - Myelodysplasia, Voiding Dysfunction, Enuresis1 Apr 2011826 BOTULINUM-A TOXIN – AN ALTERNATIVE FOR INCONTINENT CHILDREN WITH THERAPY RESISTANT OVERACTIVE BLADDER? Achim Lusch, Patrick Krombach, Felix Wezel, and Maurice Stephan Michel Achim LuschAchim Lusch Mannheim, Germany More articles by this author , Patrick KrombachPatrick Krombach Mannheim, Germany More articles by this author , Felix WezelFelix Wezel Mannheim, Germany More articles by this author , and Maurice Stephan MichelMaurice Stephan Michel Mannheim, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.645AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Botulinum-A toxin is a well established medikation for neurogenic detrusor overactivity. Recent studies showed good short time results in therapy of ideopathic detrusor overactivity in adults. This prospective study included therapy resistant children with overactive bladder. METHODS 17 children (6 boys and 11 girls) with resistant non neurogenic detrusor overactivity, decreased capacity bladder for age and urge were included. All patients showed a urge incontinence as well as a enuresis. Main treatment duration before botox injection was 39 month. A dose of 100 U of botulinum-A toxin was injected in the detrusor muscle. RESULTS 12 patients (8 girls und 4 boys) showed full reponse after 1 injection (dry over the day and complete loss of urge) with a mean increase in bladder capacity from 147 to 233 ml. 3 girls and 1 boy showed a partial response – 60% decrease in incontinence over the day and urge, increase of bladder capacity from 162 ml to 251 ml (p<0,001). One boy remained unchanged. 11 of the 12 full responders were still cured after 12 month, while 1 boy showed relapse after 7 month. The 3 girls with partial response and 1 boy with relapse underwent 2nd injection with full response of the former full responder and in 2 of the former partial responders. 2 girls remained unchanged. Side effects were reported in 3 children mit temporaryly increased residual bladder volume up to 2 weeks after injection, 1 girl experienced 1 episode of symptomatic lower urinary tract infection. CONCLUSIONS Botulinum-A toxin injection in children with non-neurogenic overactive detrusor is an excellent treatment adjunct with marginal side effects and good long time results after 1 injection of 71%, after 2nd injection of 88%. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e333 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Achim Lusch Mannheim, Germany More articles by this author Patrick Krombach Mannheim, Germany More articles by this author Felix Wezel Mannheim, Germany More articles by this author Maurice Stephan Michel Mannheim, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Antibiotic duration for treating uncomplicated, symptomatic lower urinary tract infections in elderly women

Urinary tract infections (UTI) are common in elderly patients. Authors of non systematic literature reviews often recommend longer treatment durations (7 to 14 days) for older women, but the evidence for such recommendations is unclear. To determine the optimal duration of antibiotic treatment for uncomplicated symptomatic lower UTI in elderly women. We contacted known investigators and pharmaceutical companies, screened reference lists of identified articles, reviews and books, and searched MEDLINE, EMBASE, CINAHL, Healthstar, Popline, Gerolit, Bioethics Line, The Cochrane Library, Dissertation Abstracts International and Index to Scientific & Technical Proceedings without language restriction. Date of most recent search: 7 May 2008. All randomised controlled trials (RCTs) comparing different treatment durations of oral antibiotics for uncomplicated symptomatic lower UTIs in elderly women were included. Whenever possible we obtained outcome data for older women included in studies with a broader age range. We excluded patients with fever, flank pain or complicating factors; studies with treatment durations longer than 14 days and prevention studies. The two authors independently assessed study quality and extracted data. Statistical analyses were performed using the random effects model and results expressed as risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes with 95% confidence intervals (CI). Fifteen studies (1644 elderly women) were included. Three studies compared single dose with short-course treatment (3 to 6 days), six compared single dose with long-course treatment (7 to 14 days) and six compared short- with long-course treatment. Methodological quality of all studies was low except for a more recent geriatric study. There was a significant difference for persistent UTI between single dose and short-course treatment (RR 2.01, 95% CI 1.05 to 3.84) and single versus long-course treatment (RR 1.93, 1.01 to 3.70 95% CI), in the short-term (< 2 weeks post-treatment) but not at long-term follow-up or on clinical outcomes. Patients preferred single dose treatment (RR 0.73, 95% CI 0.60 to 0.88) to long-course treatments, but this was based on one study comparing different antibiotics. Short versus longer treatments showed no significant difference in efficacy. Rate of adverse drug reactions increased significantly with longer treatment durations in only one study. Short-course treatment (3 to 6 days) could be sufficient for treating uncomplicated UTIs in elderly women, although more studies on specific commonly prescribed antibiotics are needed.

The incidence of infectious diseases after renal transplantation: a single-centre experience

This single-centre study was designed to investigate the incidence of infections and their causative pathogens during the first three months after renal transplantation (RTx) in patients who had undergone the procedure in 2005 ( n = 174). We compared this group of patients with a previous one (1998–2000, n = 437). In 2005, infection was diagnosed in 82 patients (47%). Symptomatic lower urinary tract infection (UTI) was present in 43 patients (25%), pyelonephritis in 15 (8.6%), and urosepsis in 7 (4%). Wound infection developed in 21 patients (12%), cytomegalovirus (CMV) disease in 15 (8.6%), and pneumonia in 5 (3%). The most frequent pathogens in UTI were Klebsiella pneumoniae and Enterococcus faecalis. Pathogens of wound infection included Staphylococcus coagulase negative and K. pneumoniae. Pneumonia was frequently caused by Mycoplasma pneumophila. Compared with the previous group, we noted decreases in the total number of infections (77.7 vs. 47%, P < 0.001), pneumonia (8.5 vs. 3%, P < 0.02) and UTI (33.3 vs. 24.7%, P < 0.05). We observed an increased incidence of multiresistant Klebsiella. Based on these results, we have changed our scheme of antibiotic prophylaxis and the algorithms of antibiotic treatment. We reduced the use of antibiotics with an adverse epidemiological effect (quinolones, third-generation cephalosporins) and increased the use of relatively safe antibiotics (penicillins, aminopenicillins, with and without beta-lactam inhibitors).

The Effect of Botulinum-A Toxin in Incontinent Children With Therapy Resistant Overactive Detrusor

We determined the effect of detrusor injection of botulinum-A toxin in a cohort of children with therapy resistant non-neurogenic detrusor overactivity. This prospective study included therapy resistant children with overactive bladder. During the study period of 19 months 10 boys and 11 girls were included. All patients showed decreased bladder capacity for age, urge and urge incontinence. Main treatment duration before inclusion was 45 months. A dose of 100 U botulinum-A toxin (Botox) was injected in the detrusor. Side effects were evaluated in all 21 included patients. The side effects reported were 10-day temporary urinary retention in 1 girl and signs of vesicoureteral reflux with flank pain during voiding in 1 boy, which disappeared spontaneously after 2 weeks. No further examinations were done since the boy refused. Two girls experienced 1 episode each of symptomatic lower urinary tract infection. Eight girls and 7 boys with a minimum followup of 6 months represent the study group for long-term evaluation. In this study group after 1 injection 9 patients showed full response (no more urge and dry during the day) with a mean increase in bladder capacity from 167 to 271 ml (p <0.001). Three patients showed a partial response (50% decrease in urge and incontinence) and 3 remained unchanged. Eight of the 9 full responders were still cured after 12 months, while 1 of the initially successfully treated patients had relapse after 8 months. The 3 partial responders and the patient with relapse underwent a second injection with a full response in the former full responder and in 1 partial responder. Botulinum-A toxin injection in children with non-neurogenic overactive detrusor is an excellent treatment adjunct, leading to long-term results in 70% after 1 injection.

Antibiotic duration for treating uncomplicated, symptomatic lower urinary tract infections in elderly women.

Urinary tract infections are common in elderly patients. Authors of non systematic literature reviews often recommend longer treatment durations (7-14 days) for older patients than for younger women, but the scientific evidence for such recommendations is not clear. To determine the optimal duration of antibiotic treatment for uncomplicated symptomatic lower urinary tract infections in elderly women. We contacted known investigators and pharmaceutical companies marketing antibiotics used to treat urinary tract infections, screened the reference list of identified articles, reviews and books, and searched the following data bases: MEDLINE, EMBASE, CINAHL, Healthstar, Popline, Gerolit, Bioethics Line, The Cochrane Library, Dissertation Abstracts International, Index to Scientific & Technical Proceedings. All randomized controlled trials in which different treatment durations of oral antibiotics for uncomplicated symptomatic lower urinary tract infections in elderly women were compared. We excluded patients with fever or flank pain and those with complicating factors. Trials with treatment durations longer than 14 days or designed for prevention of urinary tract infection were also excluded. No language restriction was applied. The quality of all selected trials was assessed and data extracted by the reviewers. Main outcome measures were persistence of urinary symptoms (short-term and long-term efficacy), effect on mental and functional status and adverse drug reactions. To compare the different treatment durations, we defined the following categories of duration: single dose, short course (3-6 days) and long course (7-14 days). Relative risk (RR) and 95% confidence intervals (CI) were calculated for each trial and outcome and were then combined using a random effects model. Thirteen trials were included in this review. Six trials compared single dose with short-term treatment (3-6 days), three studies single dose with long-term treatment (7-14 days) and four trials short-term with long term treatment. Eight trials also included younger patients, but provided a subgroup analysis for elderly women. The methodological quality of all trials was low. All trials reported results of bacteriological cure rate; less often clinical outcomes (e.g. improvement or cure of symptoms) were analyzed. Only five trials compared the same antibiotic given for a different length of time. We performed a separate analysis for these trials. The rate of persistent bacteriuria rate at short-term (two weeks post-treatment) was better in the longer treatment group (3-14 days) than in the single dose group (RR 1.84, 95% CI 1.18 to 2.86). However, the rate of persistent bacteria at long term and the clinical cure rate showed no statistically significant difference between the two groups. Patients showed a preference for single dose treatment (RR 0.73, 95% CI 0.66 to 0.88), however this was based on only one trial comparing the same antibiotic. The comparison of short (3-6 days) and longer treatments (7-14 days) did not show any significant difference, but the number of included studies and sample size were low. This review suggests that single dose antibiotic treatment is less effective but may be better accepted by the patients than longer treatment durations (3-14 days). In addition there was no significant difference between short course (3-6 days) versus longer course (7-14 days) antibiotics. The methodological quality of the identified trials was poor and the optimal treatment duration could not be determined. We therefore need more appropriately designed randomized controlled trials testing the effect, - on clinical relevant outcomes -, of different treatment durations of a given antibiotic in a strictly defined population of elderly women.

Intraurethral sphincter prosthesis to treat hyporeflexic bladders in women: does it work?

To assess the efficacy and safety of a new intraurethral sphincter prosthesis to treat hyporeflexic bladders in women. Between July 1997 and December 1998, 18 women (mean age 45.8 years, range 26-84) with neurogenic voiding disorders and a hyporeflexic bladder were examined prospectively. All but one patient (who used the Crédé manoeuvre) emptied their bladder using clean intermittent catheterization. The women were fitted with a prosthesis consisting of a valve and a pump inside a short self-retaining silicone device, which was activated by a magnetic remote control unit. The evaluation before implantation comprised a medical history, a neurological evaluation, urodynamic recordings and urine cultures. The follow-up after implantation included a monthly clinical assessment, a symptom questionnaire, urine culture, ultrasonographic examinations and replacement of the device if necessary. Urine samples were also cultured if there was any discomfort or fever. At 16 months of follow-up, only six of 18 patients continued to use the implant (mean follow-up 9.6 months) and were satisfied. In 10 patients major incontinence around the catheter, or irritation, led to removal of the device. Two patients were unable to learn how to transfer to the toilet to empty their bladder; therefore, their implant was removed and they were treated with a suprapubic catheter. Two patients died from unrelated causes. Twelve patients had positive bacteriuria while fitted with the device; six of them became symptomatic. Usually, only symptomatic lower urinary tract infections were treated. Technical problems occurred often; 14 catheters showed technical dysfunction and had to be replaced early and three external remote control units broke for no reason. Despite normal short-term cystoscopic findings (three patients), long-term urethral damage cannot be excluded. Indeed, the six patients who remain fitted with the device already show some widening of their urethra. This experience with the new device was disappointing; in eight of the 18 patients incontinence appeared or worsened and led to removal of the device. Technical problems were common. The other concern is that significant long-term urethral damage could be expected, as observed with indwelling catheters over time. Thus, although this device may function for a short period, it is unsuitable for long-term use.

Optimal antibiotic duration for treating uncomplicated, symptomatic lower urinary tract infections in elderly women: a systematic review

Optimal antibiotic duration for treating uncomplicated, symptomatic lower urinary tract infections in elderly women: a systematic review

Maternal infectious morbidity following multiple courses of betamethasone.

the beneficial effects of antepartum corticosteroids on the reduction of morbidity and mortality in the premature neonate have been amply demonstrated. The NIH consensus statement has, therefore, endorsed their use in women at risk from pre-term delivery between 24 and 34 weeks gestation. Patients at persistent risk of pre-term delivery nay receive multiple weekly courses. However, increased susceptibility to infection is a well-recognized complication of prolonged high-dose steroid therapy. We examined infectious morbidity among women exposed to three or more courses of betamethasone. METHODS AND OUTCOMES MEASURES: thirty-seven patients at risk of pre-term delivery who received three or more courses of betamethasone (median = 6: range 3-10) and 74 normal controls, matched for maternal age, route of delivery, and year of delivery were included in the study. Data on medical care provided to study and control patients between 24 weeks gestation and 6 weeks postpartum were retrieved from centralized medical records. Incidences and types of infections were compared by Chi-square and Fisher's exact test, as appropriate. Only infections diagnosed at least 1 week after betamethasone therapy was initiated were included. Patients with pre-existing conditions predisposing to infectious morbidity were excluded. twenty-four of 37 patients (64.8%) exposed to betamethasone vs. 13 of 74 (17.5%) controls developed infectious diseases (P < 0.001). Symptomatic lower urinary tract infections occurred in 13 of 37 (35.1%) and two of 74 (2.7%) in the study and control groups, respectively (P < 0.001). Serious bacterial infections were found in nine of 37 (24.3%) vs. none of 74 (0%) patients, respectively (P < 0.001). These included sepsis (n=2), pneumonia (n=4), pyelonephritis (n=2), and cholangitis (n=1). Eight of nine serious infections occurred in patients exposed to five or more weekly courses of betamethasone. Postpartum endometritis related to Caesarean delivery was found in five of 37 patients (13.5%) vs. seven of 74 (9.4%), respectively (P=NS). Three or more courses of antepartum betamethasone in women at risk of pre-term delivery are associated with substantial infectious maternal morbidity. The excess morbidity consisted mainly of bacterial infections, some of which were associated with systemic and potentially life-threatening infections.

A randomized trial of short-course ciprofloxacin, ofloxacin, or trimethoprim/sulfamethoxazole for the treatment of acute urinary tract infection in women

PURPOSE: Bladder infections are very common in otherwise healthy women, and short-course antimicrobial treatment appears effective for many episodes of cystitis. This study reports the results of short-course ciprofloxacin, ofloxacin, and trimethoprim/sulfamethoxazole therapy. PATIENTS AND METHODS: We performed a randomized, double-blind study of the efficacy and safety of a 3-day course of oral ciprofloxacin 100 mg twice daily, ofloxacin 200 mg twice daily, or trimethoprim/sulfamethoxazole 160/800 mg twice daily in women with acute, uncomplicated, symptomatic lower urinary tract infection. RESULTS: A total of 866 patients were enrolled, of whom 688 (79%) were evaluated for the efficacy of treatment (229 treated with ciprofloxacin, 228 treated with trimethoprim/sulfamethoxazole, and 231 treated with ofloxacin). The most frequent reason for exclusion was the failure to identify a pretreatment pathogen. The most commonly isolated pathogen was Escherichia coli (81%). Eradication of the pretreatment pathogen at the end of therapy occurred in 94% of ciprofloxacin, 93% of trimethoprim/sulfamethoxazole, and 97% of ofloxacin-treated patients. At follow-up evaluation at 4 to 6 weeks, recurrence rates (relapse or reinfection) were 11% in the ciprofloxacin, 16% in the trimethoprim/sulfamethoxazole, and 13% in the ofloxacin treatment group. Clinical success at the end of therapy was 93% in the ciprofloxacin, 95% in the trimethoprim/sulfamethoxazole, and 96% in the ofloxacin treatment groups. The frequency of all adverse events was 31% for ciprofloxacin, 41% for trimethoprim/sulfamethoxazole, and 39% for ofloxacin-treated patients ( P = 0.03). Premature discontinuation of study drug due to an adverse event was more common in trimethoprim/sulfamethoxazole-treated patients (n = 9) compared with those given ciprofloxacin (n = 2) or ofloxacin (n = 1; P = 0.02). CONCLUSION: Ciprofloxacin, ofloxacin, and trimethoprim/sulfamethoxazole had similar efficacy when given for 3 days to treat acute, symptomatic, uncomplicated lower urinary tract infection in women.

Serotypes, hemagglutinins, siderophore synthesis, and serum resistance of Klebsiella isolates causing human urinary tract infections.

A total of 146 Klebsiella isolates from human asymptomatic bacteriuria (n = 73), cystitis (n = 54), and acute pyelonephritis (n = 19) were examined for the presence of particular virulence factors. Capsular type K2 was the most common serotype observed (13%). This capsule type was prevalent in isolates from asymptomatic bacteriuria and cystitis but not from pyelonephritis. Type 1 fimbriae were found significantly more often in pyelonephritis isolates than among those from asymptomatic and symptomatic lower urinary tract infection (UTI; P < .05), while no marked differences were detected with respect to the distribution of type 3 fimbriae. Serum resistance was more frequent among isolates from symptomatic (26%) than from asymptomatic UTI (18%). Enterochelin was produced by all but 1 of the isolates as determined by a bioassay. In contrast, aerobactin synthesis was rare (3%), with isolates from pyelonephritis showing the highest frequency of aerobactin production (3/19).

Symptomatic lower urinary tract infection induced by cooling of the feet

Symptomatic lower urinary tract infection induced by cooling of the feet

Symptomatic lower urinary tract infection induced by cooling of the feet. A controlled experimental trial.

We conducted an open, non-randomized experimental study as a first step to find out whether cooling of the feet may cause symptomatic lower urinary tract infection (UTI) in cystitis-prone women. Twenty-nine healthy women, aged 19-68 (mean 42.5) years, who had had three or more symptomatic episodes of UTI during the previous 12 months were included. They registered symptoms and carried out a strip urinalysis at each urination during a control period of 72 hours. Their lower legs and feet were then immersed in increasingly cold water for 30 minutes. Another 72-hour period of registration followed. Six subjects developed acute distal urinary symptoms at a mean of 55 (95% confidence interval 50 to 61) hours after the cooling, compared with none in the control period. Five of the six had bacteriologically verified lower UTI (P = 0.03 v. the control period). Cooling of the feet seems to provoke symptomatic lower UTI in cystitis-prone women.

Residual Urine in Children with Acute Cystitis and in Healthy Children: Assessment by Sonography

Residual urine was assessed by ultrasound in children with single attacks of symptomatic lower urinary tract infection and in healthy controls. Residual urine was found significantly more often in the 39 patients during acute illness as well as during a followup of 6 months, compared to 55 control children. Infections caused by P-fimbriated Escherichia coli were not more often associated with residual urine than infections with nonP-fimbriated Escherichia coli or other bacterial species. It is suggested that residual urine is a facilitating host factor among others in the pathogenesis of symptomatic urinary tract infection in childhood.