Symptomatic Urinary Tract Infection Research Articles

Asymptomatic Bacteriuria and Antibiogram of Isolates Among Diabetic Patients in Calabar, Nigeria

Asymptomatic bacteriuria is the presence of bacteria in the urine of an individual without any symptom of urinary tract infection. This has been widely observed in diabetic patients and could be detrimental to their health if not effectively managed. This study was to identify the pathogens associated with asymptomatic bacteriuria among patients with diabetes and the antibiogram of those isolates in Calabar. Blood samples were collected for the determination of fasting blood sugar levels using glucometer. Bacterial isolations were done through urine culture and antibiogram were tested in all urine samples of the diabetic patients in this study. The prevalence of bacteriuria in this study was 26.0%. Participants aged, 41-50 years were highest both in blood sugar level (12.3+/-4.38mmol/L) and infection rate (37.5%, 18/48). Females had lower blood sugar (10.9+/-3.370mmol/L) than the males (11.3+/-4.46mmol/L) while the males had less infection rate (22.4%, 22/98) than the females (29.4%, 30/102). Escherichia coli, 46.2% (24/52) had the highest distribution while Proteus spp. 11.5% (6/52) had the least distribution. Ciprofloxacin was the most sensitivity (100%) while Amoxicillin was the most resistant (38%). There was a high prevalence of asymptomatic bacteriuria in this study. The most commonly observed organisms were Escherichia coli. Ciprofloxacin was the most sensitive antibiotics and there was a widespread antibiotic resistance in this study. It is therefore recommended that screening among diabetic patients for urinary tract infections, sensitization and strategies to promote effective drug usage be encouraged.

Urinary Tract Infections: The Current Scenario and Future Prospects.

Urinary tract infections (UTIs) are among the most common bacterial infections worldwide, occurring in both community and healthcare settings. Although the clinical symptoms of UTIs are heterogeneous and range from uncomplicated (uUTIs) to complicated (cUTIs), most UTIs are usually treated empirically. Bacteria are the main causative agents of these infections, although more rarely, other microorganisms, such as fungi and some viruses, have been reported to be responsible for UTIs. Uropathogenic Escherichia coli (UPEC) is the most common causative agent for both uUTIs and cUTIs, followed by other pathogenic microorganisms, such as Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis, and Staphylococcus spp. In addition, the incidence of UTIs caused by multidrug resistance (MDR) is increasing, resulting in a significant increase in the spread of antibiotic resistance and the economic burden of these infections. Here, we discuss the various factors associated with UTIs, including the mechanisms of pathogenicity related to the bacteria that cause UTIs and the emergence of increasing resistance in UTI pathogens.

The phenomenon of urinary tract infection experienced by women with a kidney transplant.

Urinary tract infection is the most common infection among people with a kidney transplant and increases the risk of graft rejection. Women have a higher risk. A literature search did not identify any description of the phenomenon of urinary tract infection experienced by women with a kidney transplant. To examine how women with a kidney transplant experienced the phenomenon of a urinary tract infection. A qualitative study with a phenomenological approach. Eight individual semistructured interviews based on van Manen's four lifeworld existentials and analysed using systematic text condensation. Women with a kidney transplant and recently been admitted to the hospital due to a urinary tract infection. We identified four themes: (1) Feeling both typical and atypical symptoms; (2) Becoming aware of the body and trying her best to prevent urinary tract infection; (3) Having a urinary tract infection is a dual experience, both good and bad; (4) Support from relatives. The urinary tract infection symptoms pathway varied between participants but also between individual episodes of incidents among each participant. Participants felt secure when they experienced a common symptom pattern, but a new symptom pattern made them insecure. Together with their relatives, they experienced a urinary tract infection as a disruption of their everyday life and it decreased their experiences of happiness. They experienced to be supported by relatives but also by healthcare professionals, but needed more information on how to prevent, observe and react to a urinary tract infection in the future.

Coliphages of the human urinary microbiota.

Due to its frequent association with urinary tract infections (UTIs), Escherichia coli is the best characterized constituent of the urinary microbiota (urobiome). However, uropathogenic E. coli is just one member of the urobiome. In addition to bacterial constituents, the urobiome of both healthy and symptomatic individuals is home to a diverse population of bacterial viruses (bacteriophages). A prior investigation found that most bacterial species in the urobiome are lysogens, harboring one or more phages integrated into their genome (prophages). Many of these prophages are temperate phages, capable of entering the lytic cycle and thus lysing their bacterial host. This transition from the lysogenic to lytic life cycle can impact the bacterial diversity of the urobiome. While many phages that infect E. coli (coliphages) have been studied for decades in the laboratory setting, the coliphages within the urobiome have yet to be cataloged. Here, we investigated the diversity of urinary coliphages by first identifying prophages in all publicly available urinary E. coli genomes. We detected 3,038 intact prophage sequences, representative of 1,542 unique phages. These phages include both novel species as well as species also found within the gut microbiota. Ten temperate phages were isolated from urinary E. coli strains included in our analysis, and we assessed their ability to infect and lyse urinary E. coli strains. We also included in these host range assays other urinary coliphages and laboratory coliphages. The temperate phages and other urinary coliphages were successful in lysing urinary E. coli strains. We also observed that coliphages from non-urinary sources were most efficient in killing urinary E. coli strains. The two phages, T2 and N4, were capable of lysing 83.5% (n = 86) of strains isolated from females with UTI symptoms. In conclusion, our study finds a diverse community of coliphages in the urobiome, many of which are predicted to be temperate phages, ten of which were confirmed here. Their ability to infect and lyse urinary E. coli strains suggests that urinary coliphages may play a role in modulating the E. coli strain diversity of the urobiome.

Asuhan Keperawatan Gangguan Eliminasi Urin pada Ny. K dengan Infeksi Saluran Kemih di Ruang Ar-Rahman RSI Purwokerto

Introduction: Urinary tract infection (UTI) or Urinarius Tractus Infection is a condition where there is a bacterial infection of microorganisms that occurs in the urinary tract. The occurrence of UTI is due to the presence of pathogenic microorganisms in the urinary tract. These microorganisms enter through direct contact from the nearest source of infection, hematogenous or lymphomatous. Symptoms of UTI are the desire to urinate that continues to be felt, pain or sensation of heat when urinating (this set of conditions is called anyang-anyang), turbid and sharp-smelling urine, frequent urination, bloody or purulent urine, in women generally the patient will feel pelvic pain, especially in the pelvic center and the bone area around the genitals Objectives: To describe nursing care in urinary tract infection patients who have impaired urinary elimination. Method: This research uses qualitative descriptive methods in the form of case studies. Nursing care was given to Mrs. K for 3 days. Data collection techniques obtained from the results of interviews, observations, and physical examinations Result: The problem of urinary elimination disorders that occur in patients with urinary tract infections can be overcome by conducting deep breath relaxation therapy to reduce the pain experienced by the patient, training the patient not to hold urination, and advising the patient to increase the frequency of drinking. The results obtained after the nursing action is the patient's pain gradually decreases, the frequency of urination is smooth even though it still feels pain when urinating Conclusion: After nursing treatment for 3x24 hours, the problem of urinary elimination disorders gradually improved characterized by an improved elimination pattern of decreased patient pain complaints.

Energy Alterations in Patients with Chronic Interstitial Cystitis Predisposing Them to Have Bladder Cancer

There are some studies in the literature showing an increased incidence of bladder cancer when the patient has a history of interstitial cystitis. Cancer in traditional Chinese medicine is caused when there is energy deficiency and Heat retention. The Purpose of this Study: Is to demonstrate that patients with interstitial cystitis have energy deficiency inside the five internal massive organs and when they are submitted to situations that can cause decrease even more of these energies, such as the use of highly concentrated medications (antibiotics, anti-inflammatory and anti-depressant medications), the vital energy can decrease and can cause more propensity to have cancer in the future. Methods: One case report of a patient with a history of chronic interstitial cystitis using several antibiotics to prevent and treat symptoms of urinary tract infection. She was very severe; the pain does not subside and the doctor was thinking about the possibility to take out the Bladder surgically. After this, they made a diagnosis of bladder cancer and she was submitted to treatment with BCG to cure her cancer. She returned to my clinic because she was having so many pains in the bladder without improvement using antibiotics and anti-inflammatory medications. I measured the energy of the five internal massive organs using the radiesthesia procedure. Results: All organs were in the lowest level of energy, rated one out of eight. The treatment of this condition was to orientate the patient to the dietary aspects and she was submitted to auricular acupuncture with apex and Bladder apex ear bloodletting. It was also prescribed highly diluted medications according to the theory of Constitutional Homeopathy of the five Elements Based on Traditional Chinese Medicine and crystal-based medications. The patient improved from her pain condition and she is very well nowadays without any symptoms of interstitial cystitis. The Conclusion of this Study: Is to demonstrate that patients with interstitial cystitis have energy deficiency inside the five internal massive organs and the use of highly concentrated medication can reduce this energy, causing more propensities to have cancer

Purple urine bag syndrome: An unusual presentation of urinary tract infection

Introduction: Purple urine bag syndrome is a rare clinical entity characterized by purple discoloration of the urinary catheter and urinary drainage bag in chronically catheterized patients. Though it can be alarming to patients and clinicians, it is considered benign but can indicate an underlying urinary tract infection. Case Series: The first case was a 68-year-old woman with multiple comorbidities who was admitted to the orthopedic ward with a close fracture of the neck of the right femur. She was bedridden and had an indwelling urethral catheter. Her urine bag was noticed to stain purplish 22 days after bladder catheterization. Urine culture showed a heavy mixed growth. A change of urinary catheter and drainage bag led to a resolution of the condition. The second case was a 58-year-old male who was admitted on account of decompensated liver cirrhosis from chronic hepatitis C virus infection. He also had quadriparesis due to a traumatic cervical spine injury, urine retention, and constipation. On day 24 of his admission, his urine bag was stained with a purplish hue. A urine culture grew Klebsiella oxytoca. The urine bag remained clear and contained amber-colored urine after catheter changes and antibiotic treatment for cystitis. Conclusion: Purple urine bag syndrome can be alarming to the patient and caregiver who need to be reassured of its benign nature. Urine culture would identify any associated infection. Good catheter care, control of risk factors including constipation and antibiotic treatment for symptomatic urinary tract infection leads to the resolution of the discoloration.

Urinary tract infection in an older patient: a case study and review

This article will discuss and reflect on a case study involving the prescribing of nitrofurantoin, by a non-medical prescriber, for a suspected symptomatic uncomplicated urinary tract infection in a patient living in a care home. The focus will be around the consultation and decision-making process of prescribing and the difficulties faced when dealing with frail, uncommunicative patients. This article will explore and critique the evidence-base, local and national guidelines, and primary research around the pharmacokinetics and pharmacodynamics of nitrofurantoin, a commonly prescribed medication. Consideration of the legal, ethical and professional issues when prescribing in a non-medical capacity will also be sought, concluding with a review of the continuing professional development required to influence future prescribing decisions relating to the case study. Urinary tract infections are common in older people. Haley Read and Gerri Mortimore describe the decision making process in the case of an older patient with a UTI

Screening of asymptomatic bacteriuria in children with sickle cell disease

Abstract Background Asymptomatic bacteriuria (ASB) refers to two consecutive urine cultures growing more than 100 000 CFU/ml in a patient with no symptoms of urinary tract infection. In patients with sickle cell disease (SCD), the anatomical and physiological defects make ASB more prone to worsen the sickle nephropathy. Early detection and management of ASB in children with SCD may retard this progression. Aim To investigate the prevalence of ASB, its major determinants, and its effect on kidney functions in patients with SCD for early detection and treatment. Patients and methods The study was conducted at a children’s hospital during the period between June 2019 and February 2020. The study included 30 children previously diagnosed as having SCD. Midstream urine samples were collected twice from all patients and subjected to urinalysis and culture on chromogenic media. Only significant isolates were identified and subjected to antimicrobial susceptibility testing. Patients were divided into either ASB or sterile urine group. All patients with SCD were subjected to complete blood picture, reticulocytic count, markers of hemolysis, and serum creatinine. Results The prevalence of confirmed ASB was 16.7%. All children in ASB group had pyuria (100%). Staphylococcus saprophyticus (60%) was the commonest organism isolated, followed by Escherichia coli (20%) and Klebsiella pneumoniae (20%). Sulfamethoxazole+trimethoprim was the most sensitive antibiotic among all isolated microorganisms. The differences in kidney function results between the two groups were statistically insignificant. Conclusion ASB was of high prevalence in pediatric patients with SCD in Egypt at our hospital. Pyuria was the only major determinant. S. saprophyticus was the predominant organism. Serum creatinine was a nonsensitive marker to monitor kidney functions.

MP52-03 IMPACT OF GENTAMICIN INTRAVESICAL INSTILLATION ON SYMPTOMATIC UTI FREQUENCY AND BACTERIAL RESISTANCE IN ADULT NEUROGENIC BLADDER PATIENTS

You have accessJournal of UrologyCME1 Apr 2023MP52-03 IMPACT OF GENTAMICIN INTRAVESICAL INSTILLATION ON SYMPTOMATIC UTI FREQUENCY AND BACTERIAL RESISTANCE IN ADULT NEUROGENIC BLADDER PATIENTS Elizabeth J. Adams, Alexander V. Stanisic, Theresa Meyer, Angie Jang, Rachel Berkowitz, Ilina Rosoklija, Elizabeth Yerkes, David Chu, Janna L. Williams, Diana K. Bowen, and Stephanie J. Kielb Elizabeth J. AdamsElizabeth J. Adams More articles by this author , Alexander V. StanisicAlexander V. Stanisic More articles by this author , Theresa MeyerTheresa Meyer More articles by this author , Angie JangAngie Jang More articles by this author , Rachel BerkowitzRachel Berkowitz More articles by this author , Ilina RosoklijaIlina Rosoklija More articles by this author , Elizabeth YerkesElizabeth Yerkes More articles by this author , David ChuDavid Chu More articles by this author , Janna L. WilliamsJanna L. Williams More articles by this author , Diana K. BowenDiana K. Bowen More articles by this author , and Stephanie J. KielbStephanie J. Kielb More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003300.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with neurogenic lower urinary tract dysfunction (NLUTD) may experience recurrent urinary tract infections (UTIs) refractory to traditional preventative measures given their bladder management needs. In smaller scale pediatric studies, intravesical gentamicin instillation has been described as a prophylactic measure to prevent UTIs in patients with NLUTD who catheterize. We describe a robust cohort of adult patients with NLUTD utilizing intravesical gentamicin. The objectives of the study were to 1) Evaluate whether there was a reduction in UTI frequency after initiating gentamicin prophylaxis; 2) Determine if UTI-related hospitalizations decreased with gentamicin use; 3) Assess for increased gentamicin resistance with use of bladder instillations. METHODS: A retrospective cohort study of adult NLUTD patients who have used prophylactic gentamicin instillations at an academic institution between 2007 and 2022 was conducted. All patients intermittently self-catheterized or had an indwelling catheter. Exclusion criteria included absence of at least one symptomatic UTI documented in the medical record prior to gentamicin initiation. The number of UTIs and UTI-related hospitalizations for each patient were abstracted. Urine culture data was reviewed for gentamicin resistance. UTIs were defined as presence of urologic symptoms associated with positive culture. Statistical significance was assessed using Wilcoxon signed-rank test. RESULTS: Forty-three patients with NLUTD were reviewed. Median length of time using gentamicin instillations was 22.9 months (IQR 26.2), with 38 patients continuing to use the instillations at the time of analysis. Overall, there was a significant reduction in the average number of UTIs per year from after initiation of gentamicin from 3.7 [SD=2.7] before gentamicin to 1.6 [SD=2.2] while using gentamicin (p<0.001). The average number of UTI-related inpatient admissions did not significantly change with gentamicin instillation prophylaxis (0.9/year prior to gentamicin initiation, 0.5/year on gentamicin; p=0.06). The proportion of cultured bacteria resistant to gentamicin did not significantly increase after initiation of the instillations (p=0.3). CONCLUSIONS: Gentamicin instillations significantly reduced the number of UTIs experienced by adult NLUTD patients who catheterize and did not increase bacterial resistance to gentamicin. Prospective studies in patients with NLUTD are needed to further define the ideal administrative protocol and patient characteristics for optimal therapeutic success. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e703 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elizabeth J. Adams More articles by this author Alexander V. Stanisic More articles by this author Theresa Meyer More articles by this author Angie Jang More articles by this author Rachel Berkowitz More articles by this author Ilina Rosoklija More articles by this author Elizabeth Yerkes More articles by this author David Chu More articles by this author Janna L. Williams More articles by this author Diana K. Bowen More articles by this author Stephanie J. Kielb More articles by this author Expand All Advertisement PDF downloadLoading ...

PD14-04 OPTIMIZING ANTIBIOTIC USE IN THE TREATMENT OF OVERACTIVE BLADDER: EVALUATING THE NEED FOR PROPHYLACTIC ANTIBIOTICS PRIOR TO ONABOTULINUMTOXINA INJECTION

You have accessJournal of UrologyCME1 Apr 2023PD14-04 OPTIMIZING ANTIBIOTIC USE IN THE TREATMENT OF OVERACTIVE BLADDER: EVALUATING THE NEED FOR PROPHYLACTIC ANTIBIOTICS PRIOR TO ONABOTULINUMTOXINA INJECTION Justina Tam, Heng Ruan, Matthew Mikula, Hannah Koenig, Alvaro Lucioni, Wai Lee, Jason Kim, Una Lee, and Kathleen Kobashi Justina TamJustina Tam More articles by this author , Heng RuanHeng Ruan More articles by this author , Matthew MikulaMatthew Mikula More articles by this author , Hannah KoenigHannah Koenig More articles by this author , Alvaro LucioniAlvaro Lucioni More articles by this author , Wai LeeWai Lee More articles by this author , Jason KimJason Kim More articles by this author , Una LeeUna Lee More articles by this author , and Kathleen KobashiKathleen Kobashi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003261.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Intradetrusor injection of onabotulinumtoxinA (BTX) is safe and efficacious in the treatment of neurogenic and non-neurogenic overactive bladder (OAB). Urinary tract infection (UTI) is a known potential adverse event. Published guidelines for cystoscopic procedures with manipulation recommend the use of prophylactic antibiotics, and prophylactic antibiotics are commonly administered pre-BTX. However, there is a paucity of data demonstrating that pre-procedural antibiotic administration decreases the rate of post-procedural UTI after BTX. In the era of antibiotic stewardship and avoidance of antibiotic overuse, we aimed to study the difference in UTI rates between patients asymptomatic for UTI who receive and do not receive antibiotics at the time of BTX in a prospective, randomized multi-institutional study. Here, we report our preliminary study results. METHODS: Patients with OAB undergoing BTX who were not symptomatic for UTI and had urinalysis demonstrating fewer than 2+ leukocyte esterase at the time of injection were randomized to receive either a single dose of pre-procedural prophylactic antibiotics or no antibiotics. Patients who had taken antibiotics within 48 hours of the procedure were excluded from study participation. Symptomatic UTIs within 2 weeks of injection was identified and recorded. Demographics and past medical history were recorded. RESULTS: Of 86 patients who have been enrolled, 40 were randomized to receive antibiotics, and 46 were randomized to not receive antibiotics. Table 1 summarizes the patient demographics, clinical history, and UTI rate. At 2-week follow up, a total of 4 patients developed UTI. One patient in the antibiotic group developed UTI, and 3 patients who did not receive antibiotics developed UTI. CONCLUSIONS: Our preliminary results suggest that the use of a single dose of prophylactic antibiotic may not affect the rate of post-procedural UTI. Patient enrollment is ongoing to determine if these findings hold true in a larger patient cohort. Source of Funding: 2020 Society of Urodynamics Female Pelvic Medicine & Urogenital Reconstruction Foundation Grant © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e413 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Justina Tam More articles by this author Heng Ruan More articles by this author Matthew Mikula More articles by this author Hannah Koenig More articles by this author Alvaro Lucioni More articles by this author Wai Lee More articles by this author Jason Kim More articles by this author Una Lee More articles by this author Kathleen Kobashi More articles by this author Expand All Advertisement PDF downloadLoading ...

MP08-18 ASYMPTOMATIC BACTERIURIA DOES NOT INCREASE THE RISK OF INFECTIVE COMPLICATIONS IN PATIENTS WITH NON-MUSCLE-INVASIVE BLADDER CANCER UNDERGOING INTRAVESICAL BACILLUS CALMETTE-GUERIN IMMUNOTHERAPY

You have accessJournal of UrologyCME1 Apr 2023MP08-18 ASYMPTOMATIC BACTERIURIA DOES NOT INCREASE THE RISK OF INFECTIVE COMPLICATIONS IN PATIENTS WITH NON-MUSCLE-INVASIVE BLADDER CANCER UNDERGOING INTRAVESICAL BACILLUS CALMETTE-GUERIN IMMUNOTHERAPY Antti Nummi, Pertti Nurminen, Olli Kesti, Mikael Högerman, Otto Ettala, Peter Boström, Antti Kaipia, Jukka Sairanen, and Riikka Järvinen Antti NummiAntti Nummi More articles by this author , Pertti NurminenPertti Nurminen More articles by this author , Olli KestiOlli Kesti More articles by this author , Mikael HögermanMikael Högerman More articles by this author , Otto EttalaOtto Ettala More articles by this author , Peter BoströmPeter Boström More articles by this author , Antti KaipiaAntti Kaipia More articles by this author , Jukka SairanenJukka Sairanen More articles by this author , and Riikka JärvinenRiikka Järvinen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003223.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Asymptomatic bacteriuria (ABU) is common in patients with non-muscle-invasive bladder cancer (NMIBC). Even though ABU is not considered as an absolute contraindication for bacillus Calmette-Guérin (BCG) administration, many urologists prefer sterile urine or use prophylactic antibiotics prior BCG instillation, aiming to prevent acute urinary tract infection (UTI), bacterial sepsis and BCG infection. However, the use of antibiotics may potentially lead to multidrug-resistant bacterial strains, while the clinical benefit is not clear. The aim of this study was to determine whether ABU increases the risk of infective complications and whether it is justified to screen asymptomatic patients for bacteriuria before BCG instillations. METHODS: We analyzed retrospectively patients who received ≥1 BCG instillations as treatment of NMIBC in our institutions during 2009-2018. Patients had submitted urine specimen 1-7 days prior every BCG instillation. Urine cultures were recorded as no growth or the presence of bacteriuria. ABU was classified as having any positive urine culture but no dysuria or fever. Antibiotic prophylaxis prior BCG administration was recorded. Our primary endpoints were admission to hospital because of UTI, BCG toxicity and BCG infections within 2 weeks of BCG instillation. RESULTS: We analyzed 802 patients and 12 882 BCG instillations. ABU was recorded with 2 200 (17%) instillations. Antibiotics were used in 519 (21%) instillations in bacteriuria group. Hospital admission was recorded after 8 (0.3%) and 37 (0.4%) instillations in the bacteriuria and in the no growth group, respectively (p=0.9). There was no significant difference in hospital admissions between the groups with or without antibiotic prophylaxis (p=0.4). CONCLUSIONS: BCG instillation with ABU is safe and does not increase the risk of developing a symptomatic UTI or severe BCG complications. By consequence, our results do not support routine screening of asymptomatic patients for bacteriuria prior intravesical BCG treatment. Antibiotic prophylaxis should only be used with consideration. Symptomatic UTI remains contraindication for BCG instillation. Source of Funding: Finnish Association of Urology © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e101 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Antti Nummi More articles by this author Pertti Nurminen More articles by this author Olli Kesti More articles by this author Mikael Högerman More articles by this author Otto Ettala More articles by this author Peter Boström More articles by this author Antti Kaipia More articles by this author Jukka Sairanen More articles by this author Riikka Järvinen More articles by this author Expand All Advertisement PDF downloadLoading ...

V08-03 INDIANA POUCH CONTINENT CUTANEOUS URINARY DIVERSION AFTER ROBOTIC-ASSISTED RADICAL CYSTECTOMY: A 16-YEAR EXPERIENCE

You have accessJournal of UrologyCME1 Apr 2023V08-03 INDIANA POUCH CONTINENT CUTANEOUS URINARY DIVERSION AFTER ROBOTIC-ASSISTED RADICAL CYSTECTOMY: A 16-YEAR EXPERIENCE Albert Kim and Kevin Chan Albert KimAlbert Kim More articles by this author and Kevin ChanKevin Chan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003306.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Continent urinary diversion after radical cystectomy is an underutilized option even at high-volume centers with studies demonstrating socio-economic, geographical, and gender disparities. Efforts to optimize utilization of continent diversion must concentrate on changing perceptions regarding feasibility and accurate reporting of complications.The objective of this study is to report long-term clinical outcomes in bladder cancer patients receiving an Indiana pouch continent cutaneous urinary diversion (CCUD) after robot-assisted radical cystectomy. METHODS: After Institutional Review Board approval, a prospectively maintained bladder cancer database was queried for patients with T1-T4, N0-N1, M0 bladder cancer undergoing radical cystectomy with CCUD at a tertiary referral center from 2004 to 2020. Complications at 30- and 90-days were recorded according to the Clavien-Dindo classification. Continence rates were recorded by manual chart review. RESULTS: A total of 97 patients were included with a median follow-up of 93 months. Clinically, 91.8% had £T2 disease and 29.9 % received neoadjuvant chemotherapy. The median length of surgery was 8.0 hours, length of hospital stay was 8.3 days, and urinary continence rate was 99.0%. The overall complication rate was 73.2% and 76.5% at 30- and 90-days respectively. Most complications were low grade (Clavien I or II). Acute blood loss anemia and symptomatic urinary tract infection were the most common low grade complications. The major complication rate was 17.5% at 30-days and 22.7% at 90-days. The most common major complications were abdominal infection requiring percutaneous drain placement, Clavien Grade III, and uretero-colonic stricture requiring percutaneous nephrostomy tube placement and surgical revision, Clavien Grade III. The readmission rate was 21.4% and median overall survival was 108 months. CONCLUSIONS: CCUD provides exceptional functional outcomes with acceptable complication rates compared to other diversion types. Source of Funding: NONE Disclosures: NONE © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e749 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Albert Kim More articles by this author Kevin Chan More articles by this author Expand All Advertisement PDF downloadLoading ...

V07-12 FULGURATION FOR PANCYSTITIS CYSTICA (STAGE 4) IN WOMEN WITH RECURRENT URINARY TRACT INFECTIONS

You have accessJournal of UrologyCME1 Apr 2023V07-12 FULGURATION FOR PANCYSTITIS CYSTICA (STAGE 4) IN WOMEN WITH RECURRENT URINARY TRACT INFECTIONS Philippe E. Zimmern, Colby P. Souders, Jessie Chen, and Ramy Goueli Philippe E. ZimmernPhilippe E. Zimmern More articles by this author , Colby P. SoudersColby P. Souders More articles by this author , Jessie ChenJessie Chen More articles by this author , and Ramy GoueliRamy Goueli More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003288.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: This movie describes our experience with recurrent urinary tract infections in postmenopausal women who have very extensive lesions of cystitis cystica in their bladder. METHODS: As shown in this diagram of the bladder, a simple staging system was devised to account for the visual extent of cystitis lesions noted on cystoscopy. Stage 1 is just for lesions covering the trigone or trigonitis. Stage 2 includes stage 1 and extension of these lesions to the bladder base. Stage 3 involves stage 2 as well as lesions lateral to the ureteric orifices on one or both sides, and finally Stage 4 is for a complete bladder involvement with stage 3 lesions also extending to the posterior wall, dome, anterior area. This condition is sometimes referred as pancystitis. RESULTS: Here are typical lesions of cystitis cystica noted over the trigone and bladder base, and extending laterally and anteriorly in a patient with antibiotic-recalcitrant recurrent urinary tract infections. We used a small tip bugbee electrode on a low setting under anesthesia on an outpatient basis. We started the procedure by marking around the ureteric orifices to easily recognize their location and protect them. Then we focus on lesions at the dome and anteriorly. One can see here the white pods representing the bacterial infection niches beneath the fulgurated surface mucosa. Fulguration can literally explode or “pop” these niches and drain out these pod collections. Here is a survey of a bladder with pancystitis following extensive fulguration. The ureteric orifices are identified and are still effluxing urine well. On this second patient, a similar pattern of extensive pancystitis can be observed. Due to recurrent infections, that same patient underwent a second fulguration one year later. At that time, healed areas from the first fulguration were noted with a shallow, white or light pink, appearance, and few areas of cystitis cystica were seen interspersed in between and targeted during this repeat fulguration procedure. CONCLUSIONS: Women with antibiotic-recalcitrant symptomatic and uncomplicated recurrent urinary tract infections with stage 4 or pancystitis, who have very few options left for therapy short of undergoing a cystectomy, can benefit at times from fulguration even though the procedure is longer than in an earlier stage, can take longer to recover from, and may not be as successful than in an early stage with lesions just confined to the trigone and/or bladder base. Therefore, our experience invites considering early cystoscopy in the evaluation of women suffering from recurrent urinary tract infections to detect these lesions at a low volume of surface disease. Ma R, Chavez JA, Christie AL, Zimmern PE. Electro-fulguration for extensive inflammatory bladder lesions in post-menopausal women with antibiotic-recalcitrant recurrent urinary tract infections. Int Urogynecol J. 2022 Sep 27. doi: 10.1007/s00192-022-05360-w. Epub ahead of print. PMID: 36166061. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e599 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Philippe E. Zimmern More articles by this author Colby P. Souders More articles by this author Jessie Chen More articles by this author Ramy Goueli More articles by this author Expand All Advertisement PDF downloadLoading ...

MP65-13 DOES EARLY INTRODUCTION OF SELF INTERMITTENT CATHETERIZATION IMPROVE FUNCTIONAL OUTCOMES AND URINARY INFECTION IN ORTHOTOPIC ILEAL NEOBLADDER? RESULTS FROM A PROSPECTIVE MULTICENTRE STUDY

You have accessJournal of UrologyCME1 Apr 2023MP65-13 DOES EARLY INTRODUCTION OF SELF INTERMITTENT CATHETERIZATION IMPROVE FUNCTIONAL OUTCOMES AND URINARY INFECTION IN ORTHOTOPIC ILEAL NEOBLADDER? RESULTS FROM A PROSPECTIVE MULTICENTRE STUDY Antonio Luigi Pastore, Yazan AL Salhi, Andrea Fuschi, Alessia Martoccia, Fabio Maria Valenzi, Alessandro Sciarra, Stefano Salciccia, De Nunzio Cosimo, Andrea Tubaro, Costantino Leonardo, Giorgio Franco, Manfredi Bruno Sequi, and Antonio Carbone Antonio Luigi PastoreAntonio Luigi Pastore More articles by this author , Yazan AL SalhiYazan AL Salhi More articles by this author , Andrea FuschiAndrea Fuschi More articles by this author , Alessia MartocciaAlessia Martoccia More articles by this author , Fabio Maria ValenziFabio Maria Valenzi More articles by this author , Alessandro SciarraAlessandro Sciarra More articles by this author , Stefano SalcicciaStefano Salciccia More articles by this author , De Nunzio CosimoDe Nunzio Cosimo More articles by this author , Andrea TubaroAndrea Tubaro More articles by this author , Costantino LeonardoCostantino Leonardo More articles by this author , Giorgio FrancoGiorgio Franco More articles by this author , Manfredi Bruno SequiManfredi Bruno Sequi More articles by this author , and Antonio CarboneAntonio Carbone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003323.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Orthotopic neobladder (ONB) is the preferred urinary diversion after radical cystectomy (RC), although its relate quality-of-life improvements are still under discussion. The principal factors associated with decrease in quality of life are continence status (both incontinence as well as urinary retention) and urinary tract infections (UTIs). The aim of this study is to investigate whether early clean intermittent catheterization (CIC) might improve functional outcomes, continence status, and reduce the incidence of UTIs. METHODS: In this study, patients were prospectively randomized in two groups. Patients that were on a standard postoperative care(Group A)or subjects that started CIC within the first post-operative month(Group B).All patients were evaluated postoperatively at 1, 3, 6, and 9 months after ONB. The CIC was executed 4 times/daily after each voluntary micturition. The postoperative evaluation included: postvoid residual volume(PVR), urine analysis and culture, number of pads/day and the selfadministrated questionnaire International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form(ICIQ-UI SF). RESULTS: From September 2017 to March 2021, 39 male and 8 female patients underwent laparoscopic or robot assisted RC with totally intracorporeal ONB (37 U shaped and 10 Padua reconstructions). All patients completed the nine months follow-up(mean 9.2 months; range 6-13 months). At the first follow up all patients were able to do self CIC. At this time mean PVR was 116.5 mL, ICIQ-UI SF mean score was 16, mean no. of pads/day was 3, 14 patients reported 3 episodes of symptomatic UTIs (Escherichia coli was the most common pathogen). At 3, 6 and 9 months follow up after surgery the PVR and the ICIQ-UI SF scores were significantly improved. The number of pads decreased to 2 pads/day at 3 months, and only one safety pad at 6 and 9 months. The episodes of UTIs significantly decreased over the time with only 8 patients at 3 months (reporting 4 symptomatic episodes), and 4 and two patients at 6 and 9 months, respectively. CONCLUSIONS: Our data strongly support the early introduction of self CIC in patients with ONB after RC. The CIC was significantly associated a reduced risk of incontinence, urinary retention, and UTI with significant improvement in QoL. These encouraging data need to be confirmed by further investigations with a larger number of patients. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e896 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Antonio Luigi Pastore More articles by this author Yazan AL Salhi More articles by this author Andrea Fuschi More articles by this author Alessia Martoccia More articles by this author Fabio Maria Valenzi More articles by this author Alessandro Sciarra More articles by this author Stefano Salciccia More articles by this author De Nunzio Cosimo More articles by this author Andrea Tubaro More articles by this author Costantino Leonardo More articles by this author Giorgio Franco More articles by this author Manfredi Bruno Sequi More articles by this author Antonio Carbone More articles by this author Expand All Advertisement PDF downloadLoading ...

Aminopenicillins vs non-aminopenicillins for treatment of enterococcal lower urinary tract infections

Aminopenicillins (APs) achieve urinary concentrations that exceed typical minimum inhibitory concentrations for enterococcal lower urinary tract infection (UTI). The local clinical microbiology laboratory discontinued routine susceptibilities on enterococcal urine isolates, and reports that 'APs are predictably reliable for uncomplicated enterococcal UTI'. The objective of this study was to compare outcomes of APs with non-APs (NAPs) for enterococcal lower UTIs. This was an institutional-review-board-approved, retrospective cohort of adults hospitalized with symptomatic enterococcal lower UTIs from 2013 to 2021. The primary endpoint was composite clinical success at 14 days, defined as resolution of symptoms without new symptoms and no repeat culture growth of the index organism. A non-inferiority analysis was utilized with a 15% margin, and logistic regression evaluated characteristics associated with 14-day failure. In total, 178 subjects were included: 89 AP patients and 89 NAP patients. Vancomycin-resistant enterococci (VRE) were identified in 73 (82%) AP patients and 76 (85%) NAP patients (P=0.54); in total, 34 (38.2%) AP patients and 66 (74.2%) NAP patients had confirmed Enterococcus faecium (P<0.001). Amoxicillin (n=36, 40.5%) and ampicillin (n=36, 40.5%) were the most commonly used APs, and linezolid (n=41, 46%) and fosfomycin (n=30, 34%) were the most commonly used NAPs. Fourteen-day clinical success rates for APs and NAPs were 83.1% and 82.0%, respectively [1.1% difference, 97.5% confidence interval (CI) -0.117 to 0.139]. Among the E. faecium subgroup, 14-day clinical success was observed in 27/34 (79.4%) AP patients and 53/66 (80.3%) NAP patients (P=0.916). On logistic regression, APs were not associated with 14-day clinical failure (adjusted odds ratio 0.84, 95% CI 0.38-1.86). APs were non-inferior to NAPs for treating enterococcal lower UTIs, and may be considered irrespective of susceptibility results.

Characterization of host and escherichia coli strains causing recurrent urinary tract infections based on molecular typing

BackgroundEscherichia coli is the leading pathogen responsible for urinary tract infection (UTI) and recurrent UTI (RUTI). Few studies have dealt with the characterization of host and bacteria in RUTI caused by E. coli with genetically identical or different strains. This study aimed to investigate the host and bacterial characteristics of E. coli RUTI based on molecular typing.ResultsPatients aged 20 years or above who presented with symptoms of UTI in emergency department or outpatient clinics between August 2009 and December 2010 were enrolled. RUTI was defined as patients had 2 or more infections in 6 months or 3 or more in 12 months during the study period. Host factors (including age, gender, anatomical/functional defect, and immune dysfunction) and bacterial factors (including phylogenicity, virulence genes, and antimicrobial resistance) were included for analysis. There were 41 patients (41%) with 91 episodes of E. coli RUTI with highly related PFGE (HRPFGE) pattern (pattern similarity > 85%) and 58 (59%) patients with 137 episodes of E. coli RUTI with different molecular typing (DMT) pattern, respectively. There was a higher prevalence of phylogenetic group B2 and neuA and usp genes in HRPFGE group if the first episode of RUTI caused by HRPFGE E. coli strains and all episodes of RUTI caused by DMT E. coli strains were included for comparison. The uropathogenic E. coli (UPEC) strains in RUTI were more virulent in female gender, age < 20 years, neither anatomical/ functional defect nor immune dysfunction, and phylogenetic group B2. There were correlations among prior antibiotic therapy within 3 months and subsequent antimicrobial resistance in HRPFGE E. coli RUTI. The use of fluoroquinolones was more likely associated with subsequent antimicrobial resistance in most types of antibiotics.ConclusionsThis study demonstrated that the uropathogens in RUTI were more virulent in genetically highly-related E. coli strains. Higher bacterial virulence in young age group (< 20 years) and patients with neither anatomical/functional defect nor immune dysfunction suggests that virulent UPEC strains are needed for the development of RUTI in healthy populations. Prior antibiotic therapy, especially the fluoroquinolones, within 3 months could induce subsequent antimicrobial resistance in genetically highly-related E. coli RUTI.

Antimicrobial Susceptibility of uropathogens-isolated from Nlalecatheterized patients

A total of 34 catheterized paraplegic patients with age range between 22-53 years old at Dijlah Rehacilitation Hospital (DRH) in Tikrit with signs and symptoms of urinary tract infection ( UTI ) were studied . All 34 ( lA0% ) patients were positive for significant UTI. The highest prevalent pathogen was Escherichia coli (47%). Only in 30 patients , the bacteriuria was associated with pus cells . Most of isolated organisms were highly sensitive to augmentin , ciirroiloxacin and cefatoxime

Перспективы диагностики оптического неврита при оптиконейромиелите Девика

The review presents data on the prospects for the diagnosis of optic neuritis in neuromyelitis optica (NMO). The differential diagnosis of NMO with multiple sclerosis and other autoimmune diseases is complicated by the similarity of the clinical manifestations of optic neuritis. The diagnostic approach, tactics of using and interpreting the results of modern laboratory, instrumental and hardware research methods are described. Additional diagnostic criteria are described for AQPR4-IgGseronegative patients with clinical symptoms of acute urinary tract infections. NMO is characterized by severe unilateral damage to the optic nerve with poor recovery of visual functions after conservative therapy, frequent recurrences of optic neuritis in one or both eyes, bilateral simultaneous damage to the optic nerves or chiasm. Timely diagnosis makes it possible to prescribe pathogenetic therapy for NMO and reduce the number of relapses of optic neuritis and prevent patients’ blindness. Key words: neuromyelitis optica, optic neuritis, OCT, multiple sclerosis, neuromyelitis optica spectrum disorders, AQPR4

Do we need to treat asymptomatic bacteriuria in immunocompromised patients? : Arapid review

Antimicrobial resistance (AMR), especially multidrug resistant Escherichiacoli strains, is aproblem even in Europe. That is why inadequate usage of antibiotic therapy should be avoided, especially in the treatment of asymptomatic bacteriuria (ASB). Should ASB be treated with antibiotics in immunocompromized patients, namely solid organ transplant, especially kidney transplant or stem cell transplant recipients? Arapid review based on asystematic literature search in MEDLINE between 1980 and 2022 was performed. For evidence synthesis, only randomized controlled trials (RCTs) or quasi-RCTs were considered. No studies were identified for the search term solid organ and stem cell transplantation. Three RCTs (antibiotic therapy versus no therapy) were included for adult kidney transplantation. None of the studies showed abenefit for antibiotic therapy of ASB in reduction of symptomatic urinary tract infections, especially in the late transplantation phase two months after kidney transplantation; furthermore, this therapy may promote AMR development. In addition, there are numerous gaps of evidence, e.g., in pediatric transplantation or regarding the influence of special immunosuppressants. There is no evidence for antibiotic therapy of ASB in adult kidney transplantation two months after the surgery. Further studies addressing the identified evidence gaps are essential for the prevention of further AMR development.