Symptomatic Urinary Tract Infection Research Articles

Urinary Tract Infection in High-Risk Pregnancy: A Hospital-Based Study

Background: Unexplained recurrent pregnancy loss with symptoms of urinary tract infection (UTI) is alarming. However, with prompt diagnosis and proper treatment, a healthy, full-term pregnancy can be achieved and the complications can be prevented. Objectives: To assess the fetal and maternal outcomes after completion of treatment with antimicrobials in pregnant women with recurrent UTI. Methods: A sum of 140 pregnant women with UTI symptoms were enrolled in this prospective, observational study attending the Internal Medicine OPD in BSMMU, Dhaka, Bangladesh. These patients had history of recurrent abortions with no significant medical conditions, only having symptoms of urinary tract infection. Baseline urinalysis and culture & sensitivity were done; full course of nitrofurantoin and cranberry were prescribed to these patients and finally repeat routine urinary examination was done. The fetal & maternal outcomes were assessed at the end of delivery. Results: The findings revealed 80.0% participants belonged to age range 25-<35 years; 91.4% belonged to middle socio-economic background; 95.7% of them had 3 previous abortions and 83.6% of them had symptoms of UTI but were untreated which resulted in abortions. In addition, 97% attended regular antenatal care (ANC) visits during current pregnancy. Besides, 95.7% indulged in frequent tea consumption and 90.0% cases complained of increased frequency of micturition as their sole clinical manifestation. Furthermore, before treatment, 97.1% had pyuria and in 62.9% urine cultures, E. coli was the commonest organism. After treatment, 100% patients had pus cells in urine 0-5 in number. Lastly, 83.6% deliveries were conducted by Caesarean section and all deliveries were done at term; all were live births and birth weight was ≥2.5 kg. At discharge, 100.0% mothers and babies were healthy and stable. Conclusion: It can be concluded that, treatment with suitable antibiotics and proper ANC visits can prevent all the adversities ...

A Multicenter Prospective Cohort Study of Antibiotics for OnabotulinumtoxinA.

Urinary tract infection (UTI) is the most common complication of intradetrusor onabotulinumtoxinA (BTX-A) injection. Despite this, there are no evidence-based guidelines on antibiotic prophylaxis. Our primary aim was to determine whether antibiotic prophylaxis decreased symptomatic, culture-proven UTI rates within 6 weeks of intradetrusor BTX-A injection. Our secondary aims were to determine if there are differences between antibiotic regimens and to identify risk factors for developing a UTI. This was a prospective, observational multicenter cohort study of female patients receiving BTX-A for idiopathic overactive bladder. We compared patients who received antibiotics (nitrofurantoin or trimethoprim-sulfamethoxazole) to those who did not. To detect a 15% difference in UTI rates between groups (80% power, alpha = 0.05), 270 participants were needed. A total of 282 participants ultimately received BTX-A and were included in the analysis. One hundred eighty-one (62.6%) were in the antibiotic cohort and 101 (35.8%) were in the no-antibiotic cohort. The overall rate of symptomatic, culture-proven UTI was 12.1%, and there was no difference between the antibiotic and no-antibiotic cohort (10.6% vs 14.9%, respectively; P = 0.29). On multivariable logistic regression, UTI was associated with older age (adjusted odds ratio [aOR], 1.07; 95% CI, 1.02-1.11), BTX-A dose of 200 units (aOR, 4.24; 95% CI, 1.45-12.35), and self-catheterization (aOR, 26.0; 95% CI, 3.62-186.5). The odds of symptomatic UTI were lower among postmenopausal participants (aOR, 0.13; 95% CI, 0.02-0.68) and participants in the Northeast United States (aOR, 0.23; 95% CI, 0.08-0.72). Our study did not find a lower rate of symptomatic, culture-proven UTI among participants who took antibiotics compared with those who did not.

Obstetrical Outcomes in Women With a History of Bladder Augmentation.

To evaluate possible problems during pregnancy or delivery in women with pediatric bladder augmentation. Eleven of 59 women, who had undergone bladder augmentation in our pediatric hospital during 1990-2019, had given birth in our hospital district afterwards and their obstetrical records were evaluated. Median age at first delivery was 32 years (range 26-42). Six patients had myelomeningocele, two had bladder exstrophy and the remainder had VATER association, epispadias or traumatic paraplegia with vesicovaginal fistula. The patients had altogether 18 children (all singletons). Catheterizations were performed through continent stoma in six cases and through urethra in five cases. None of the patients needed an indwelling catheter before delivery. Antibiotic prophylaxis was initially in use during two pregnancies. Symptomatic urinary tract infections (UTIs) developed for five mothers in 11 pregnancies without prophylaxis and prophylaxis was continued after UTI in these cases. Three of the five mothers with UTI were treated with intravenous antibiotics due to pseudomonas infection (three infections) or pyelonephritis (one).Two patients with myelomeningocele delivered vaginally (one woman three times and one woman once). In the remaining 14 cases a cesarean section (CS) was performed (two urgent and one emergency CS). A urologist was present in seven CSs. Some difficulties accessing the uterus were reported in seven surgeries. There were 10-term, three late-preterm and one very preterm delivery. In four cases the information on gestational age was unavailable. Six newborns had respiratory problems, two had severe asphyxia. One newborn had myelomeningocele like her mother. Risk for UTIs during pregnancy is high in bladder augmentation patients, hence prophylactic antibiotics are justified. A multidisciplinary team should be involved in the planning of delivery. When indicated for obstetrical or urological reasons, an elective cesarean section with a urologist present may be the most rational option for many, although vaginal delivery is possible in selected patients.

CATHETER II: a randomised controlled trial comparing the clinical effectiveness of various washout policies versus no washout policy in preventing catheter-associated complications in adults living with long-term catheters

ObjectivesDo weekly prophylactic saline or acidic catheter washouts in addition to standard long-term catheter (LTC) care improve the outcomes of adults with LTC compared with standard LTC care only.DesignThree-arm superiority...

Bacteriological Profile and Antimicrobial Resistance Patterns in Pediatric Urinary Tract Infections: A Cross-Sectional Study at Dhaka Shishu Hospital

Urinary tract infections (UTIs) are a prevalent concern in pediatric healthcare, causing distress to children, raising parental concerns, and potentially leading to lasting kidney damage. The highest incidence of first-time symptomatic UTIs occurs in infants during the first year of life, with a subsequent marked decrease. Febrile infants under 2 months, presenting with unexplained fever, constitute a critical subset requiring particular attention. Knowledge of the bacteriological profile and antimicrobial resistance patterns in specific regions is crucial for guiding effective treatment strategies. Methods: A cross-sectional study was conducted at 250 Bedded General Hospital, Jamalpur, Bangladesh from Feb 2016 to Aug 2016 to assess the bacteriological profile and antibiotic resistance patterns in pediatric UTIs. A total of 147 culture-positive UTI patients were included. Bacterial isolates were identified, and colony counts for samples with ≥105 CFU/mL bacteria were considered positive. Antimicrobial susceptibility testing was performed using twelve agents, and resistance patterns were analyzed. Results: Among the 147 culture-positive UTI patients, Escherichia coli (E-coli) was the predominant isolate (70%), followed by Klebsiella spp. (13.6%), Pseudomonas (5.44%), Enterobacter spp (3.40%), Staphylococcus Aureus (3.40%), Proteus (2.72%), and Enterococcus (1.36%). Antimicrobial resistance analysis revealed varying patterns, with Cefradine (79.59%), Co-trimoxazole (SXT) (69.39%), Nalidixic acid (NA) (66.67%), and Ceftazidime (CTM) (48.98%) showing higher resistance rates. No drug exhibited 100% resistance against urinary pathogens, indicating a dynamic resistance landscape. Conclusion: This study highlights the importance of understanding local prevalence and resistance patterns in guiding empirical antibiotic selection for pediatric UTIs. The observed decrease in antimicrobial resistance underscores the need for continuous surveillance and tailored antibiotic strategies. Clinicians should base their treatment decisions on the specific epidemiological context rather than relying solely on universal or national guidelines.

Association of Serum Vitamin D Level with Symptomatic Urinary Tract Infection in Pregnant Women

Background: Urinary tract infections (UTIs) are the most common bacterial infections during pregnancy. Pregnant women in Bangladesh often suffer from UTIs due to a lack of knowledge regarding proper hygiene practices. Adequate vitamin D levels have the potential to enhance the innate immune response, thereby can reduce susceptibility to bacterial infections. Therefore, vitamin D deficiency in pregnant women could increase the risk of urinary tract infections. Aim: To determine the association between maternal serum vitamin D levels and urinary tract infection in pregnancy. Method: This was a case-control study among purposively selected pregnant women attending the inpatient and outpatient department of Obstetrics and Gynaecology, ICMH, Matuail, Dhaka. A total 80 pregnant women between 18-40 years of age were included in this study at their 6-28 weeks of gestation. Among them 40 women who had urinary tract infection, confirmed by presence of ≥105/HPF pus cell in urine routine microscopic examination and a positive urine culture report, were considered as the cases and the rest of the 40 age and gestational age-matched healthy pregnant women without UTI were enrolled as the controls. Aseptically, 5 mL of venous blood was drawn to measure maternal serum vitamin D levels. Statistical analysis was done using the latest version of analytic software SPSS, where required. Results: Among 40 case respondents, Escherichia coli was found to be the most prevalent (60.0%) cause of UTI, with an average maternal serum vitamin D level of 20.5±11.94 ng/ml among those cases. The overall mean (±SD) vitamin D level was much lower among the cases than the controls, 21.1±11.25 ng/mL and 27.9±9.58 ng/ml, respectively. This difference was found statistically significant p=0.004). Considering vitamin D level of 30 ng/mL as the cut-off value, odd’s ratio calculation showed the mother with serum vitamin D level <30 ng/mL had 3.2 times more risk to develop UTI compared to those ...

Clinical and microbiological profile of patients with urinary tract infection visiting general outpatient department, National Referral Hospital

Background: Urinary Tract Infection (UTI) is one of the most common infections encountered in outpatient settings. The random use of antibiotics, particularly in resource-limited settings, has contributed to the emergence of antibiotic resistance. This study aimed to identify common uropathogens and assess their antibiotic sensitivity patterns among patients with symptoms of UTI attending the General Outpatient Department (GOPD) at Jigme Dorji Wangchuck National Referral Hospital in Thimphu. Method: A cross-sectional study was conducted from September 2021 to August 2022, involving patients over the age of 13 years with symptoms of UTI. Midstream urine collected via proper technique was analyzed by the laboratory. Once there was growth on the urine culture media, antibiotic sensitivity testing was performed against the commonly used antibiotics in the GOPD. Result: Amongst 351 participants, 77.8% were female, and the most common symptoms reported were dysuria (93.4%) and increased urinary frequency of micturition (92.3%). Patient’s age, sex and previous episodes of UTI were significantly associated with the occurrence of UTI (p < 0.05). The overall urine culture positivity rate was 50.53%, with Escherichia coli (84.7%) identified as the predominant uropathogen, followed by Klebsiella pneumoniae (7.3%). Among the antibiotics tested, gentamicin and nitrofurantoin exhibited the highest sensitivity, while amoxicillin and ampicillin were the least effective antibiotics against Escherichia coli. Conclusion: UTI predominantly affected females. Escherichia coli was the commonest causative agent and nitrofurantoin could be the potential drug of choice for UTI treatment. The irrational use of antibiotics, as a contributing factor to resistance should be addressed.

Efficacy and safety of a polyherbal formulation in the management of Escherichia coli urinary tract infection.

Urinary tract infection (UTI) is one of the most frequent reasons for prescribing antibiotics. Escherichia coli implicated in 75-90 % cases of UTI is becoming increasingly resistant to antibiotics. Finding alternative therapeutic agent for this infection is critical, for which herbal drugs may be an option. In Unani medicine, urinary tract infection (Ṭa'diya Majra-i-Bawl) is treated with herbal drugs possessing Da'fe Ufoonat (antiseptic), Muhallilat (anti-inflammatory) and Mudirrat (diuretic) properties. Polyherbal formulations of such drugs are expected to be beneficial in treating Escherichia coli infection. The aim of the study was to assess the efficacy and safety of a Unani polyherbal formulation aimed to develop a safe and efficacious drug for the treatment of urinary tract infection (Ṭa'diya Majra-i-Bawl) caused by Escherichia coli. This open-label, single armed clinical study was conducted on patients with clinical signs and symptoms of UTI and positive urine culture for E. coli. Patients were treated with the polyherbal formulation consisting of 50 % hydro-alcoholic extracts of Khar Khasak (Tribulus terrestris), Bhui Amla (Phyllanthus niruri), Kabab Cheeni (Piper cubeba), Beekh -i-Kasni (Cichorium intybus), Beekh-i-Karafs (Apium graveolens), Asl-us-Soos (Glycyrrhiza glabra), and Giloy (Tinospora cordifolia) in a dose of one capsule (500 mg) thrice a day orally with plain water for 42 days. Maximum (83 %) urine cultures turned out negative for E. coli after the completion of therapy. Polyherbal Unani formulation was found to be very effective for the treatment of Urinary tract infection. Clinical and microbiological cure was achieved in maximum number of patients and drug was very well tolerated without any adverse/side effect.

A Case Study of Urinary Tract Infection and its Ayurveda Management

A Urinary Tract Infection (UTI) is the most common bacterial infection encountered in daily medical practice. It is more prevalent in females than males due to the shorter urethra in females, which allows bacteria a quicker access to the bladder. One in five women develop UTI at least once in her lifetime. UTIs in men are uncommon, but when they do occur, they can be very serious. In Ayurveda, the symptoms of UTI closely resemble a condition known as Mutrakriccha. Acharya Charaka has explained eight types of Mutrakriccha in Charaka Chikitsa Sthana 26. In this condition, the aggravated Pitta Dosha, along with Apana Vayu, reaches the Vasti (bladder) and affects the Mutravaha Srotas, leading to painful and burning urination. In this case report, a 50-year-old male patient presented with symptoms of urinary urgency, increased frequency, and intermittent burning urination for the past 1-2 months. He was diagnosed with UTI and was effectively managed with Syp. Neeri, Chandraprabha Vati, Gokshuradi Guggulu, Shweta Parpati, and Hajaralyahud Bhasma. The treatment resulted in significant improvement in signs, symptoms, and urine examination results. During follow-up visits, there were no recurrences of UTI. Ayurvedic management offers a promising alternative for treating Mutrakriccha.

Intradetrusor OnabotulinumtoxinA outcomes for overactive bladder in older adults

Introduction:In older adults, pharmacological treatment of overactive bladder (OAB) with anticholinergics and beta-3 agonists could be associated with negative cognitive effects; highlighting the need for alternative treatment modalities. Currently, there is relatively little evidence assessing outcomes of onabotulinomtoxin-A injection as thirdline therapy in this population. This study sought to evaluate the outcomes of intradetrusor BTX-A injection in patients over 70 years of age between August 2014 March 2022. Methods:A retrospective chart review was performed on patients with a clinical diagnosis of OAB and who underwent an initial intradetrusor onabotulinomtoxinA injection at 70 years or older from three US centers. Patient characteristics and self-reported symptoms before and after injection were statistically analyzed. Results:Amongst the 210 patients, 94% reported urinary urgency, 92% reported urgency urinary incontinence, and 89% reported daytime frequency. The most common medications initially prescribed were beta-3 agonist at 66% and anticholinergics at 65%. Following treatment, 80% reported >50% improvement in incontinence, 81% in urgency, 79% in daytime frequency, and 78% in nocturia. Temporary de novo intermittent catheterization was initiated in 8/210 (3.8%) patients, and one (0.5%) required indwelling catheter placement; with 67% returning for repeat injections. Thirty-six (17%) had a symptomatic urinary tract infection at follow-up. Seventy-five percent of patients did not require drug therapy following injection. In a subgroup analysis of octogenarians (n = 50/210), 73% showed improvement in urgency and 68% had less incontinence post-injection. Discussion:OnabotulinomtoxinA was well tolerated in patients older than 70 with improvement in overactive bladder symptoms and reduction in requirement of drug therapy.

Single-dose vs prolonged antibiotic prophylaxis of fosfomycin for transrectal prostate biopsy: a single-center prospective, randomized, controlled trial

BackgroundTransrectal prostate biopsy is a commonly performed urological procedure in which antibiotic prophylaxis is recommended. Fluoroquinolone-type antibiotics are no longer acceptable in the EU. Fosfomycin-trometamol may be used, but there is no evidence regarding its ideal dose and administration time. MethodsPatients who underwent prostate biopsy between 2021 and 2023 were evaluated prospectively. 204 patients were randomized into two arms: 102 patients (Arm A) received a single-dose of fosfomycin-trometamol one hour before surgery, and 102 patients (Arm B) received one additional dose of fosfomycin-trometamol 48 hours after the first dose. Urine tests and questionnaires were administered during the postoperative period and the subsequent four weeks to identify any symptoms, infectious, or other complications. ResultsThere was no statistical difference in the rate of asymptomatic bacteriuria (4.90% (5) vs. 8.82% (9), P = 0.27) symptomatic urinary tract infection (0% (0) vs. 1.96% (2), P = 0.50), or febrile urinary tract infection (0% (0) vs. 0.98% (1), P = 1) between the groups. Only hematuria was significantly more common in Arm B (6.86% (7) vs. 16.67% (17), P = 0.03), whereas other complications did not differ significantly. There was no statistical difference in hospitalization (0.98% (1) vs. 2.94 (3), P = 0.62) or mortality rate (0 % (0) vs. 0.98% (1), P = 1). Sub-group analysis of previous antibiotic users showed no difference in terms of complications. ConclusionThere is no significant difference in infectious complications between single-dose and prolonged prophylaxis of fosfomycin-trometamol for transrectal prostate biopsy. A single-dose of fosfomycin one hour before biopsy is an ideal choice with a better ecological impact compared with prolonged antibiotic prophylaxis for transrectal prostate biopsy.

Midterm Follow-up of Electrofulguration for Vesicular Cystitis in Women With Recurrent Urinary Tract Infections

ObjectivesTo report the midterm outcomes of women with symptomatic recurrent urinary tract infections (RUTI) with findings of vesicular cystitis (VC) on cystoscopy treated with bladder electrofulguration (EF), and to identify factors affecting successful treatment outcome. MethodsFollowing IRB approval, a prospectively collected long-term database of women with RUTI and VC treated with EF was retrospectively reviewed. Patients were divided into two groups based on the associated presence of urinary obstruction (“obstructed group”) or not. Follow-up included an office cystoscopy six months after EF. The primary outcome evaluated was rate of UTI recurrences over time. ResultsFrom 2010 to 2023, 50 women met all study criteria, with 94% being postmenopausal. Overall, the three-year UTI-free survival from repeat fulguration was 71.4% (95% CI, 54.4 to 83.0). Kaplan-Meier analysis showed that patients with obstruction had a higher 3-year survival of no UTI recurrence (40.3%; 95% CI: 18.2, 61.7) than patients without obstruction (20.8%; 95% CI: 6.2, 41.4], p = 0.0085). ConclusionsOver two-thirds of women with VC and symptomatic UTI did not need a second EF or daily antibiotic prophylaxis after initial EF. Those with VC related to bladder outlet obstruction experienced less RUTIs and a longer time to a repeated EF.

Impact of urinary catheters including reusable catheters on quality of life and work productivity in persons with spinal cord lesion

While preventing renal damage and symptomatic urinary tract infection are of paramount importance to persons with a spinal cord lesion (SCL), patient-reported outcomes (PROs) are receiving much more attention than ever before. We performed a cross-sectional internet survey of 282 adult members of SCL patient advocacy groups and investigated, for the first time, the impact of different types of urinary catheter, including a Japanese reusable silicone catheter and a reusable intermittent balloon catheter, on PROs of persons with SCL. Intermittent self-catheterization (ISC) did not surpass continuous indwelling catheterization in terms of a disease-specific urinary quality of life. Urinary incontinence, regular ISC, and performing ISC away from home confronted these individuals. Work productivity and regular activities correlated fairly well with the disease-specific urinary quality of life. Bowel management problems affected all PROs evaluated. The absence of differences in PROs among the types of catheter used for ISC implies that Japanese reusable catheters have the potential to benefit selected persons with SCL. Further research is warranted to develop measures for maximizing work productivity by overcoming urinary as well as bowel problems.

Management of urogenital hygiene health education to improve knowledge and prevent urinary tract infection in patient with chronic kidney disease

Urinary Tract Infections (UTIs) are a prevalent form of Healthcare-Associated Infections (HAIs) in patients with chronic kidney disease (CKD), especially those undergoing urinary catheterization. It is estimated that UTIs affect up to 25% of catheterized patients, significantly impacting morbidity and healthcare costs (World Health Organization, 2021). This study aims to determine how health education regarding urogenital hygiene can increase knowledge and prevent infection for patients undergoing urinary catheterization. This research is quantitative descriptive using a case study approach. A one-group pre-test post-test design was employed to collect data through the administration of pre-test and post-test knowledge assessments before and after health education. The results demonstrated a significant increase in knowledge scores from 67 to 93, indicating the effectiveness of health education in enhancing knowledge about urogenital hygiene. Furthermore, observation of signs and symptoms of UTIs showed a decrease in symptoms during the patient's treatment, highlighting the positive impact of health education. Providing urogenital hygiene education effectively increases knowledge and mitigates the risk of UTIs during patient care.

Homoeopathic Management of Chronic Urinary Tract Infection (UTI) in Males—Two Evidence-Based Case Reports

AbstractUrinary tract infections (UTI) are uncommon in men, with an incidence of 5 to 8 per 10,000 per year among those aged between 21 and 50 years, in contrast to women, where the incidence is 30 times higher. UTI in men can lead to severe and painful symptoms, often requiring surgical interventions. Considering the limitations and complications of conventional medical or surgical procedures, homeopathy may offer a viable solution for such conditions. Two cases of chronic UTIs in men are presented here, in which constitutional homeopathic medicines were prescribed with positive results. In the first case, the patient experienced frequent urination, urgency, straining before urination, and a drop-wise urine flow. A retrograde urethrogram X-ray diagnosed the condition as a stricture urethra. In the second case, the patient had been suffering from repeated UTIs with painful urination for two years and was diagnosed with cystitis and epididymo-orchitis. After detailed case assessments, both patients were prescribed constitutional homeopathic remedies. Sulphur was prescribed in the first case, and Arsenic in the second case, both in 50 millesimal potencies, providing relief within a short period. However, in both cases, Thuja was prescribed as complementary medicine, which cleared all UTI symptoms, leading to a negative urine culture result. Homeopathy proved effective in providing relief in two cases of chronic UTI. It's important to note that the conclusions drawn from these two cases may not be sufficient to reach a definitive conclusion. Therefore, clinical trials are suggested to establish the efficacy of constitutional medicine in the treatment of chronic UTIs in men.

Bladder irrigation with tap water to reduce antibiotic use for urinary tract infections in catheter users.

To evaluate the safety and effectiveness of bladder irrigation (BI) with tap water to reduce antibiotic use for the treatment of urinary tract infections (UTIs) in patients with recurrent UTI symptoms and to assess the treatment satisfaction of BI. This prospective, observational study included patients with an indwelling catheter or performing clean intermittent catheterisation (CIC) who had recurrent UTI symptoms between July 2022 and March 2024. BI with tap water was used for the treatment of UTIs without systemic symptoms (e.g., fever, flank pain or delirium). Patients started daily irrigation at the onset of UTI symptoms and used a tapering schedule. The number of antibiotic treatments for UTIs, UTI incidence rate ratio (IRR), UTI-related hospitalisations, treatment satisfaction and quality of life (QoL) were compared between a 3-month period before and after BI with tap water. A total of 60 patients were included with a median (interquartile range) age of 64.5 (50.4-72.6) years, 66.7% were male, and 83.3% were performing CIC. Antibiotic use was decreased on average by 38.1% (IRR = 0.62; P = 0.016) and catheter-associated UTIs by 37.9% (IRR = 0.62; P = 0.005). No increase was observed in the incidence of UTIs with systemic symptoms or UTI-related hospitalisations. In addition, no differences were observed in the health-related QoL. The majority of patients were positive about the subjective effectiveness (81%), ease of use (86%) and overall satisfaction (85%) of BI with tap water. These findings emphasise the potential of BI with tap water as a promising and patient-friendly alternative for the treatment of UTIs in patients with urinary catheters. BI with tap water significantly reduces antibiotic use and UTI incidence in patients with recurrent UTIs and is a safe and patient-friendly alternative that can be easily implemented in the management of UTIs.

Emergence of lineage ST150 and linezolid resistance in Enterococcus faecalis: a molecular epidemiology study of UTIs in Tehran, Iran.

Urinary tract infections (UTIs) represent one of the most prevalent bacterial infections, with Enterococcus species now recognized as the second leading cause of these infections. This study focused on symptomatic UTI cases to investigate the risk factors associated with Enterococcus faecalis clinical isolates in patients from Tehran, Iran. Urine samples were collected from patients presenting with symptomatic UTIs. The identification of E. faecalis isolates was performed using standard microbiological techniques, with confirmation via polymerase chain reaction (PCR). Antibiotic susceptibility testing was conducted using the Kirby-Bauer disc diffusion method. The presence of virulence genes was determined through PCR, and biofilm formation was assessed using the microtiter plate method. Additionally, multi-locus sequence typing (MLST) was utilized to genotype linezolid-resistant isolates. Out of 300 UTI cases, E. faecalis was identified as the causative agent in 160 instances. Notably, a high proportion of these isolates exhibited resistance to tetracycline (83.8%) and minocycline (82.5%). Linezolid resistance was observed in 1.3% (n = 2) of the isolates. Conversely, the highest susceptibility rates were observed for vancomycin, penicillin G, ampicillin, and nitrofurantoin, each demonstrating a 98.8% susceptibility rate. Biofilm formation was detected in 25% of the E. faecalis isolates. A significant majority (93.8%) of the isolates harbored the efbA and ace genes, with varying frequencies of esp (72.5%), asa1 (61.2%), cylA (52.5%), and gelE (88.8%) genes. MLST analysis demonstrated that both linezolid-resistant isolates, characterized by strong biofilm formation and the presence of virulence genes, were assigned to the ST150 lineage, which has not been previously documented in clinical settings. The emergence of the ST150 clonal lineage, underscores its clinical significance, particularly in relation to linezolid resistance in E. faecalis. This study adds to the growing body of evidence linking specific clonal lineages with antibiotic resistance, highlighting the critical need for ongoing surveillance and molecular characterization of resistant pathogens.

Implementation of an algorithm for testing, diagnosis, and antibiotic stewardship of asymptomatic bacteriuria in pregnancy

BackgroundAsymptomatic bacteriuria (ASB) affects 2-15% of pregnant women, with 20-40% developing symptoms later. Symptomatic urinary tract infections (UTIs) are more common in pregnancy, with a prevalence of 33%, posing risks like preterm delivery, low birth weight, and maternal pyelonephritis. The gold standard for UTI detection is a urine culture, but point-of-care urinalysis dipsticks are frequently performed as screens during regular obstetric visits. Leukocyte esterase has been used to justify treatment in the asymptomatic, even with low sensitivity and specificity. Confirmatory tests are crucial to avoid false positives and ensure optimal outcomes. Current guidelines for urinalysis dipstick interpretation and the decision to treat ASB in pregnancy are limited. It remains unclear if an evidence-based algorithm can improve test utilization, diagnosis, and treatment decisions for ASB in pregnancy. ObjectivesThe primary objective of our study is to develop, implement, and evaluate an evidence-based algorithm to guide urinalysis interpretation, culturing, diagnosis, and antibiotic stewardship of asymptomatic bacteriuria in pregnant patients during routine obstetric visits. Study DesignThe project involves both retrospective and quasi-experimental prospective chart reviews of pregnant patients aged 18 and older, beyond 20 weeks gestation, from routine obstetric visits with urinalysis dipstick tests. A doctorate in clinical laboratory sciences student developed an educational algorithm to guide urinalysis dipstick interpretation, culturing necessity, and treatment decisions based on evidence-based practice. Our study considered patient records from February 1 – 28, 2022 as retrospective (pre-algorithm implementation) data and January 24 - February 22, 2023, as prospective (post-algorithm implementation) data. Data collected from the electronic medical record included de-identified patient information, urinalysis results, culture dates and outcomes, antibiotic prescriptions, UTI or ASB diagnoses, provider details, adverse pregnancy outcomes, and demographics. Data analysis using SPSS version 29 involved chi-square tests, likelihood ratios, and effect size calculations, with P-values <0.05 considered statistically significant. ResultsIn our study, we examined a total of 1,176 patient records. Pre-implementation data included 440 records, with 224 abnormal and 216 normal urinalyses. Post-implementation data encompassed 736 records, of which 255 were abnormal and 481 were normal. The patient demographics predominantly featured White (87%), with a median maternal age of 27 years and a gestational age of 32 weeks. Our pre-implementation analyses revealed significant associations between algorithm deviations with both culture utilization (P <.001) and antibiotic stewardship (P <.001). However, no significant associations were observed between algorithm deviations and adverse patient outcomes. Culture underutilization decreased significantly from 43.0% (189/440) pre-implementation to 29.5% (217/736) post-implementation (P < .001). The overall reduction in ASB prevalence from 16.3% (8/49) to 6.7% (10/67) suggests a decrease of nearly 60%. Additionally, antibiotic overprescription decreased significantly from 1.6% (4/258) pre-implementation to 0.8% (4/522) post-implementation (P = .003), with a reduction from 7.1% (3/42) to 2.4% (1/41) among abnormal urinalyses. ConclusionOur findings show a strong alignment between the use of the algorithm and subsequent clinical decisions, underscoring its potential to enhance patient care and management in obstetric settings. Notably, adherence to the algorithm was higher among providers displaying prudent antibiotic use.

Efficacy of a pharmacist care protocol to manage uncomplicated female cystitis in community pharmacies: an open-label, multicenter, randomized, controlled, cluster study: the PharmaCyst’ protocol

BackgroundUrinary tract infections are common affections, especially for women. Difficult access to a general practitioner to obtain a prescription has led France to offer dispensing under protocol by community pharmacists. The primary objective of this study is to evaluate the effectiveness of a pharmacist care protocol provided to manage women with urinary tract infection symptoms. This objective will be assessed using the Acute Cystitis Symptom Score.MethodsPharmaCyst’ is an open-label, multicenter, controlled, cluster-randomized study conducted in the Loire region, France. Women aged between 18 and 65 years presenting to a pharmacy complaining of at least one symptom of an uncomplicated urinary tract infection present over the last 3 days (including burning pain during micturition, dysuria, pollakiuria, urgent urination) will be considered for inclusion. All patients will be contacted on day 3, 10, and month 3. A total of 480 patients need to be recruited for the 24 clusters participating in the research. The quantitative data will be described using means and standard deviations and compared using Student’s t-test. The qualitative data will be described using numbers and percentages and compared using chi2 test (or Fisher’s exact test if necessary). The primary and secondary outcomes analyses will consider the intention-to-treat population.DiscussionPharmaCyst’ is the first clinical trial conducted in France only by community pharmacists. Its results could lead to an extension of the protocol.Trial registrationThe protocol has been approved by the French ethics committee on 2022/12/02 and is registered under the number 49RC22_0240 on ClinicalTrials.gov.

Skip The Dip For Urinary Tract Infection in over 65s. A National Initiative To Reduce Antibiotic Prescribing In Older Persons

Abstract Background Urinary tract infection (UTI) is the most common reason for antibiotic use in older persons in residential care. Dipstick urinalysis for UTI is an ingrained practice. Inappropriate use of dipstick urinalysis can lead to inappropriate antibiotic prescribing, contributing to adverse effects and antimicrobial resistance. The ‘Skip the Dip for UTI in over 65s’ quality improvement initiative (QI) aims to raise awareness of best practice for diagnosis and management of suspected UTI to reduce unnecessary antibiotic use. It supports implementation of national guidance stating dipstick urinalysis is not recommended for assessment of evidence of UTI in people 65 years and over. Methods Focus groups with nursing staff in older persons residential care facilities (OPRCFs) identified barriers and facilitators for implementing national guidance on dipstick urinalysis for UTI. Supporting resources developed included a resident leaflet on UTI, staff handbook and webinar recording, hosted on www.antibioticprescribing.ie. Antimicrobial pharmacists delivered workshops on improving assessment of suspected UTI in the HSE OPRCFs from September 2023 to March 2024. Monthly monitoring of antibiotic use for UTI was established in all 119 HSE OPRCFs. Surveys to establish dipstick urinalysis practice in the OPRCFs were administered in March 2023 and March 2024. Results A baseline survey in 2020/21 indicated 98% HSE OPRCFs (133/135) performed dipstick urinalysis for residents with symptoms of UTI, reducing to 53% (57/107) in March 2023, and 24% (25/103) in March 2024 following this QI. Prevalence of antibiotics for treatment of UTI in the HSE OPRCFs decreased by 38%, from a baseline of 2.6% (114/4,446 residents) in 2020/21, to 1.6% (66/4,222 residents) in March 2024. Conclusion The ‘Skip the Dip for UTI in over 65s’ QI has resulted in a change in practice, with the majority of HSE OPRCFs now reporting dipstick urinalysis is not performed for UTI assessment, with a considerable reduction in antibiotics prescribed for UTIs.