Therapy Of Urinary Tract Infections Research Articles

Defining effective durations of antibiotic therapy for community-acquired pneumonia and urinary tract infections in hospitalized children.

Community-acquired pneumonia (CAP) and urinary tract infections (UTI) are two common childhood infections often leading to hospital admission. National guidelines for CAP and UTI in children recommend durations of antibiotic therapy of 10 days and 7-14 days, respectively. Due to concerns of rising antimicrobial resistance and an increased awareness of harms associated with prolonged courses of antibiotics, there is a renewed emphasis on reevaluating commonly prescribed durations of antibiotic therapy across bacterial infections. We describe recent clinical trials and observational studies evaluating durations of therapy for CAP and UTI in adults and children and translate the findings to our suggested approach for selecting durations of antibiotic therapy in hospitalized children. There is a growing body of evidence, primarily in adults, that shorter durations of therapy than are commonly prescribed are just as effective as longer durations for CAP and UTIs. Combining clinical trial data from adults with available data in children, we believe it is reasonable to consider 5 days of therapy for CAP, 3-5 days of therapy for cystitis, and 7 days of therapy for pyelonephritis for most hospitalized children with uncomplicated infections.

Empiric Guideline Therapy for Simple Urinary Tract Infection at Outpatient Clinics: A Prospective Observational Study

Background: Community-acquired urinary tract infection is a widespread problem encountered in the outpatient clinics of most hospitals. UTI has various clinical presentations; some are simple UTIs that can be managed with outpatient antibiotics. The current treatment of UTI is empirical, based on the limited and predictable spectrum of etiological microorganisms. Objectives: To collect information on the susceptibility tests of microorganisms in simple urinary tract infections (UTIs) and outline the best empiric antimicrobial prescribed for them. Methods: A total of 117 patients from 14 to 70 years of age (mean age = 43.61years, standard deviation = + 24.5) received the care of our surgical and urological outpatient clinics in Alnuman Teaching Hospital, Baghdad, Iraq, between March 1, 2019, and September 1, 2020. The patients who were showing symptoms of simple uncomplicated UTI and were prescribed empiric antibacterial treatment and requested for a sample of midstream urine for culture and sensitivity tests were enrolled in this prospective study. The susceptibility test for (ciprofloxacin, trimethoprim, gentamycin, and ceftriaxone) was performed using the Kirby–Bauer disc diffusion method. The data were input into SPSS 22.0 for statistical analysis. Pearson’s chi-squared test was used to compare parameters. The data have been presented as the number of variables (n) and percentages (%). Statistical significance was set at P < 0.05. Results: The frequencies of isolated uropathogens were as follows: E. coli, n = 65 (77.4%); Klebsiella spp., n = 9 (10.7%), Proteus spp., n = 3 (3.57%), Enterobacter spp., n = 3 (3.57%)., Staphylococcus spp., n = 2 (2.38%)., Pseudomonas spp., n = 1 (1.19%), and Candida spp., n = 1 (1.19%). The resistance rates of the most prevalent microorganisms were E. coli isolates to trimethoprim, ciprofloxacin, gentamycin, and ceftriaxone. The lower resistance rates to ceftriaxone in E. coli isolates (29.7%) was not clinically significant, with p < 0.05. Gentamycin showed significant sensitivity and resistance rates of 58.3% and 33.3% respectively, among the antimicrobials used (p < 0.05). The clinical effectiveness of empirical antimicrobial use in the treatment of simple UTIs showed no statistically significant correlation with P < 0.05. Conclusions: Trimethoprim and ciprofloxacin should not be used in empirical therapy for UTIs because of their increased resistance rates. A review of the local guidelines should be considered.

Description Of Ciprofloxacin Sensitivity On Bacteria Causing UTI In T2DM Patients

Diabetes mellitus is a chronic metabolic disease characterized by a state of hyperglycemia due to a lack of insulin production by the pancreas or the body's inability to use the insulin produced or both. Uncontrolled hyperglycemia can suppress the immune system and making the body vulnerable to infection, especially urinary tract infections (UTIs). The main choice in UTI treatment is antibiotic therapy, one of the most frequently used is ciprofloxacin from the fluoroquinolone group.The research design used was descriptive method with prevalence studies. The research was done using antibiotic sensitivity tests with agar diffusion methods. The number of samples were taken using total sampling method.The results of ciprofloxacin sensitivity test were obtained as many as 22 isolates. Escherichia coli bacteria are sensitive to ciprofloxacin at 66.67%, intermediate and resistant 16.67% respectively. Pseudomonas aeruginosa are 60% sensitive and 40% intermediate. Enterobacter aerogenes are 66,67% sensitive and 33,33% intermediate. Shigella spp. are 100% sensitive, and Klebsiella spp. 100% resistant.The conclusion from the study showed that ciprofloxacin are an effective empirical therapy for UTI.

The Role of Urinary Nitrite in Predicting Bacterial Resistance in Urine Culture Analysis Among Patients With Uncomplicated Urinary Tract Infection.

ObjectiveThis study aims to determine the relationship between the presence of urinary nitrite and bacterial resistance to antimicrobial therapy in patients with uncomplicated urinary tract infections.MethodsDuring a six-month time period (April-October, 2020), we reviewed the urine samples of 59 adult outpatients from the Urology Department of Tbilisi State Medical University the First University Clinic with the diagnosis of urinary tract infection. The infecting microorganisms and the presence of urine nitrite were recorded. Resistance rates to the antibiotics were compared between the positive and negative nitrite groups. Chi-squared test was used to perform the statistical analysis using Prism software version 9.3.1 (GraphPad Software, Inc., San Diego, California).ResultsWe examined the correlation between the nitrite-positive and -negative groups with the resistance pattern to ceftriaxone, trimethoprim/sulfamethoxazole (TMP-SMX), ampicillin-sulbactam, fosfomycin, amikacin, doxycycline, cefuroxime, cefotaxime, ceftazidime, and nitrofurantoin.A total of 59 outpatients with a mean age of 37 years met the inclusion criteria between April and October 2020. In the positive and negative nitrite groups, there were 23 and 36 patients, respectively. Three (17.6%) of the 17 gram-positive organisms and 20 (62.5%) of the 42 gram-negative organisms yielded positive nitrite results.In nitrite-positive group, resistance rates to ceftriaxone, TMP-SMX, ampicillin-sulbactam, fosfomycin, amikacin, doxycycline, cefuroxime, cefotaxime, ceftazidime, and nitrofurantoin were 52.2%, 70.8%, 63.5%, 67.7%, 25.8%, 31.9%, 29.6%, 32.5%, 22.5% and 83.8%, respectively. These values in the nitrite-negative group were 6.5%, 41.3%, 60.7%, 72.9%, 49%, 3%, 2.3%, 3.3%, 4.3% and 81.9%, respectively.Highest relative resistance rate was recorded against cefuroxime (12.9), followed by doxycycline (10.6), cefotaxime (9.8), ceftriaxone (8.03), ceftazidime (5.2), TMP-SMX (1.71), ampicillin-sulbactam (1.05), nitrofurantoin (1.02), fosfomycin (0.93), and amikacin (0.53).The most commonly isolated pathogen was Escherichia coli, which was detected in 35 (71%) isolates. Other bacteria commonly found were Proteus spp in five (12%) isolates, Klebsiella spp in two (5%) isolates, and Enterococcus in five (12%) isolates.ConclusionThe findings revealed that out of 10 antibiotics, nitrite-positive groups demonstrated higher resistance only against ceftriaxone, cefuroxime, cefotaxime, and doxycycline. Other antibiotics showed no statistically significant differences in resistance. Furthermore, the highest relative resistance rate was recorded against cefuroxime, whereas amikacin revealed the lowest. Therefore, we suggest physicians to not adjust antibiotic therapy for urinary tract infections (UTIs) based on the presence of nitrite. Urine bacteriology should be ordered.

An In-silico Study Showing Potentials of Selected Anthocyanin Derivatives against Uropathogenic E. coli Adhesin Protein

Urinary tract infections (UTI) caused primarily by uropathogenic Escherichia coli (UPEC) are indeed an extremely contagious disease that affects people all over the world. FimH is a major virulence component in UTI pathogenesis, and inhibiting FimH function can be an efficient means to disarm UPEC bacteria, as well as a crucial target in the development of non-antibiotic mediated UTI treatment options. The goal of this study was to identify anthocyanins in plant parts and assess
 their pharmacological characteristics. A computational methodology was used to predict the pharmacological characteristics of such substances. Compounds with pharmacophores comparable to those of known fimH inhibitors were chosen. Following that, additional research was carried out to assess their drug similarity, inhibitory potential, and IC50 values. Thus, the present study reports few novel fimH inhibitors derived from the selected plant’s phytochemicals, and is significant owing to their therapeutic implication as a non-antibiotic mediated therapy for UTI.

Computational approach confirming the therapeutic potential of selected mannose derivatives against fimH of Uropathogenic E. coli

Urinary tract infection (UTI), mainly caused by uropathogenic Escherichia coli (UPEC), is a dreaded infectious disease globally. FimH is a key virulence factor in UTI pathogenesis and inhibition of FimH function can be an effective way to disarm the UPEC bacteria and can act as a vital target in the development of the non-antibiotic mediated approach to treat UTIs. The present study was undertaken to identify phytochemicals from the cranberry and bearberry plant parts and to evaluate their pharmacological properties. The pharmacological properties of those compounds were predicted using a computational approach. The compounds with similar pharmacophores with that of known fimH inhibitors were selected. After that, further studies were performed to determine their drug likeness, inhibitory potential, and IC50 values. The results were promising, and few compounds were found to have high drug likeness and a potent inhibitor of fimH with good IC50 value. Thus, the present study reports few novel fimH inhibitors from selected plant sources and is significant owing to their therapeutic implication as a non-antibiotic mediated therapy for UTI.

Recurrent cystitis in women: principles of rational therapy

Introduction. Urinary tract infections (UTIs) are one of the most common disease among women.Aim. To determine the efficacy and tolerability of furazidin in the treatment of patients with exacerbation of chronic recurrent cystitis.Material and methods. a purpose was to determine the efficacy and tolerance of furazidin in the treatment of patients with chronic recurrent cystitis. In the study 56 female patients were enrolled, 28 of whom received ciprofloxacin (CG) and 28 – furazidin (FG). The patients received furazidin 100 mg three times a day for seven days (FG) or 500 mg of ciprofloxacin twice a day for seven days (CG). As well we analyzed the histories of 37 patients with bladder tuberculosis (TMP) stage 4in order to estimate the negative effect of non-optimal antibiotic therapy for UTI on the timely diagnosis of urogenital tuberculosis.Results. At the end of antibacterial therapy, dysuria persisted in one patient in the FG and in two in the CG. Urinalysis was normal in both groups in 96.4% of patients. The growth of uropathogens was in one case in each group. For 6 months, there were 5 recurrence episodes in the FG, and there were 11 relapses in the CG (p < 0.05). There were no side effects in the FG, but in the CG, adverse reactions developed in 9 patients (32.1%). Patients with TMP had annually from 4 to 7 exacerbations of cystitis, fluoroquinolones were prescribed to all; none investigations for M. tuberculosis were performed. Conclusion. Immediate results did not show statistically significant differences between the groups of patients treated with furazidin and ciprofloxacin, however, the tolerance of ciprofloxacin was lower (p >< 0.01). Long-term results have demonstrated a significant advantage of furazidin in the complex treatment of recurrent cystitis. All cases of stage 4 TMP are iatrogenic; an irreversible disabling complication was developed as a result of non-optimal therapy (primarily fluoroquinolones) for UTIs, which hided tuberculosis. >< 0.05). There were no side effects in the FG, but in the CG, adverse reactions developed in 9 patients (32.1%). Patients with TMP had annually from 4 to 7 exacerbations of cystitis, fluoroquinolones were prescribed to all; none investigations for M. tuberculosis were performed.Conclusion. Immediate results did not show statistically significant differences between the groups of patients treated with furazidin and ciprofloxacin, however, the tolerance of ciprofloxacin was lower (p < 0.01). Long-term results have demonstrated a significant advantage of furazidin in the complex treatment of recurrent cystitis. All cases of stage 4 TMP are iatrogenic; an irreversible disabling complication was developed as a result of non-optimal therapy (primarily fluoroquinolones) for UTIs, which hided tuberculosis.>< 0.01). Long-term results have demonstrated a significant advantage of furazidin in the complex treatment of recurrent cystitis. All cases of stage 4 TMP are iatrogenic; an irreversible disabling complication was developed as a result of non-optimal therapy (primarily fluoroquinolones) for UTIs, which hided tuberculosis.

Risk Factors for Trimethoprim and Sulfamethoxazole-Resistant Escherichia Coli in ED Patients with Urinary Tract Infections

BackgroundWhile trimethoprim-sulfamethoxazole (TMP-SMX) is recommended as one of the first-line empiric therapies for treatment of acute uncomplicated cystitis, institutions that observe resistance rates exceeding 20% for Escherichia coli (E. coli) should utilize alternative empiric antibiotic therapy per the Infectious Diseases Society of America (IDSA). Identifying risk factors associated with TMP-SMX resistance in E. coli may help guide empiric antibiotic prescribing for urinary tract infections (UTIs). MethodsThis multicenter, retrospective study included adult patients who were discharged from 12 emergency departments (EDs) with a urine culture positive for E. coli between January 1, 2019 and December 31, 2019. Logistic regression was used to assess the relationship between potential risk factors and TMP-SMX resistance. The overall institutional antimicrobial resistance rates for E. coli were compared to the rates seen in the study population of ED urinary isolates. ResultsAmong 427 patients included from a randomized sample of 500 with a urine culture positive for E. coli, 107 (25.1%) were resistant to TMP-SMX. Three predictors of TMP-SMX resistance were identified: recurrent UTI (OR 2.27 [95% CI 1.27–3.99]), genitourinary abnormalities (OR 2.31 [95% CI 1.17–4.49]), and TMP-SMX use within 90 days (OR 8.77 [95% CI 3.19–28.12]). When the antibiotic susceptibilities for this ED cohort were compared to the institutional antibiogram, the TMP-SMX resistance rate was found to be higher in the ED population (25.1% vs 20%). ConclusionsTMP-SMX should likely be avoided as first-line therapy for UTI in patients who have recurrent UTIs, genitourinary abnormalities, or have previously received TMP-SMX within the past 90 days. The use of an ED-specific antibiogram should be considered for assessing local resistance rates in this population.

Intravenous to oral antibiotics versus intravenous antibiotics: a step-up or a step-down for extended spectrum β-lactamase (ESBL)-producing urinary tract infections without concomitant bacteraemia?

The Infectious Diseases Society of America (IDSA) recommends numerous antibiotics for the treatment of urinary tract infections (UTIs) caused by extended-spectrum β-lactamase (ESBL)-producing bacteria. The purpose of this study was to evaluate clinical outcomes of oral step-down antibiotics compared with continued intravenous therapy in UTIs without bacteraemia. This multicentre, retrospective, cohort study was conducted in hospitalised patients with ESBL-producing UTIs between July 2016 and March 2020. The primary outcome was a composite all-cause clinical failure, defined as 30-day re-admission, 30-day hospital mortality or a change in oral antibiotics during hospitalisation. Secondary outcomes included individual primary outcome components, re-admission due to a recurrent UTI, change in antibiotic during hospitalisation, hospital length of stay (LOS), antibiotic costs and adverse events. The study included 153 patients. The primary outcome occurred in 28% of both groups (27/95 vs. 16/58; P=0.91). The primary outcome components were similar: re-admission (26% vs. 26%; P=0.95); hospital mortality (2% vs. 2%; P=1.0); and change in antibiotics (0% vs. 2%; P=0.38). Mean hospital LOS and direct antibiotic costs were 8 ± 6 days vs. 5 ± 2 days (P < 0.01) and US$278 ± 244 vs. US$180 ± 104 (P < 0.01), respectively. Adverse events were similar, except diarrhoea (15% vs. 2%; P=0.01). There was no difference in clinical failure, re-admission rate, re-admission due to a recurrent UTI, mortality rate or antibiotic change between groups. The switch group was associated with reduced hospital LOS and inpatient antibiotic costs.

Ciprofloxacin resistances rates in Escherichia coli across Canada (CREAC): a longitudinal analysis 2015–2019

Clinical guidelines recommend empirical fluoroquinolone therapy for urinary tract infections (UTIs) only where local Escherichia coli resistance does not exceed 10%; however, access to local susceptibility data is not uniform across Canada and it is not known which regions meet this threshold. Our objective was to collect susceptibility data from across Canada to evaluate regional trends of E. coli resistance to fluoroquinolones. Antibiogram data were collected retrospectively for the years 2015-2019 from the most local level within each province, typically regional health authorities (RHAs) or local health zones. Antibiogram data were collected from publicly available sources or by directly contacting RHAs or health zones. Susceptibility data were aggregated into regional or population-level data. Antibiograms were collected from 72 regions across 10 provinces. These included 1 949 515 E. coli isolates. Only seven regions throughout Canada met the IDSA target of <10% resistance to consider empirical fluoroquinolone therapy at any point during the study period. The data consistently show that outpatient populations tend to have the highest susceptibility to fluoroquinolones, followed by inpatient populations, and finally long-term care patients. Rural populations also generally had higher susceptibility than urban. Nationally, the Atlantic provinces tended to show the highest susceptibility, especially towards the end of the study period. Fluoroquinolone resistance in E. coli appears to be plateauing within Canada after a rapid increase in the past 20 years. However, fluoroquinolones are rarely appropriate first-line treatment options for UTIs within Canada in the absence of factors eliminating other therapeutic options.

Phage therapy for urinary tract infections: does it really work?

Although phage therapy is still in the research and development stage, there are already a small number of cases where phages have been successfully used as an alternative treatment for multidrug-resistant infections. Given this, this Commentary discusses the potential contribution of phage therapy to combat urinary tract infections.

Etiology and Antibiotic Susceptibility Patterns of Urinary Tract Infections in Children in a General Hospital in Kuwait: A 5-Year Retrospective Study

Objective: The aim of this study was to determine the bacterial profile and prevalence of antibiotic resistance patterns of uropathogens, as well as to evaluate the problem with extended-spectrum β-lactamases (ESBLs)-producing isolates, causing urinary tract infections (UTIs) in children in Al-Amiri Hospital, Kuwait, over a 5-year period. Materials and Methods: Significant isolates from symptomatic pediatric patients with UTIs from January 2017 to December 2021 were identified by conventional methods and by the VITEK 2 identification card system. Antimicrobial susceptibility testing was performed by the disk diffusion method for Gram-positive organisms and an automated VITEK 2 system for Gram-negative organisms. ESBL-producing Enterobacterales were detected by the double-disk diffusion method and VITEK 2 system. Results: Significant bacteriuria was detected in 13.7% of the 9,742 urine samples. Escherichia coli accounted for 67.3% of these, followed by Klebsiella pneumoniae (8.9%), Proteus spp. (5.7%), and Enterococcus spp. (7.4%), respectively. High resistance rates were observed among the Enterobacterales against ampicillin, cephalothin, nitrofurantoin, amoxicillin/clavulanic acid, and trimethoprim-sulfamethoxazole. The prevalence of ESBL-producing E. coli and K. pneumoniae was 26% and 55%, respectively. The most sensitive among the antibiotics tested for Gram-negative organisms were meropenem, amikacin, gentamicin, and piperacillin/tazobactam, while the antibiotics tested for Gram-positive organisms were vancomycin, ampicillin, linezolid, and nitrofurantoin. Conclusion: E. coli remains the most common uropathogen. A high percentage of uropathogens causing UTI in children were highly resistant to the first- and second-line antibiotics for the therapy of UTI. ESBL-producing bacteria were highly prevalent in children in our hospital. Local antibiograms should be used to assist with empirical UTI treatment.

English

BACKGROUND Urinary tract infection (UTI) is a very important reason for increased hospital stay, increased morbidity and mortality in the hospital setting. Annually, about 150 million people are diagnosed with UTI worldwide.1The fluoroquinolones have assumed an important role in the therapy of UTI. But the prevalence of urinary tract infections caused by fluoroquinolone-resistant bacteria has been increasing over the years. The purpose of this study was to evaluate fluoroquinolone resistance pattern among the bacterial pathogens causing urinary tract infections. METHODS This is a cross-sectional descriptive study. A total of 200 urine samples were collected from clinically suspected UTI patients, attending out-patient department (OPDs) and were admitted to various wards of our hospital. The samples were inoculated using the standard loop, incubated aerobically, isolates were identified by standard biochemical reactions and antibiotic susceptibility testing was performed. RESULTS Out of 200 samples, the most common organism isolated was Escherichia coli (57 %), followed by Klebsiella pneumoniae subsp pneumonia (27 %). 93.9 % of Escherichia coli and 100 % of Klebsiella pneumoniae subsp pneumoniae isolates were resistant to ampicillin. The present study also documented high level of fluoroquinolone resistance among almost all common uropathogens. Among Escherichia coli and Klebsiella pneumoniae subsp pneumoniae; ciprofloxacin resistance was 77.2 % and 85.2 % respectively. Quinolone resistance was found to be more common in hospitalised patients and catheterized patients. According to our study, although levofloxacin is far effective than ciprofloxacin for uropathogens, the resistance to both are increasing. CONCLUSIONS The results presented in this study indicate that it is time to reconsider the frequent use of fluoroquinolones. Use of fluoroquinolones to treat patients before getting the sensitivity pattern of the isolate should be stopped. It is mandatory to formulate antimicrobial policy according to the local resistance pattern. Resistance pattern must be assessed in hospital and laboratory-based surveillance studies. KEY WORDS Urinary Tract Infections, Escherichia coli, Antibiotic Sensitivity, Fluoroquinolones

Infecção do trato urinário causada por Escherichia coli uropatogênica resistente a antibióticos: um importante problema de saúde pública

Urinary tract infection (UTI) caused by uropathogenic Escherichia coli (UPEC) is one of the most prevalent bacterial infections and is a major cause of health-related morbidity and hospital costs worldwide. The rising bacterial resistance to routinely given antibiotics for infected individuals is becoming a significant source of concern. Current research shows that UPEC is becoming more resistant to multiple antibiotic classes, including fluoroquinolones, beta-lactams, and aminoglycosides, as a result of genetic determinants of resistance and multidrug-resistant clones. Knowledge of the local etiology and the sensitivity profile of the most common uropathogens to antibiotics should guide decisions in the empirical therapy of uncomplicated UTI. Given the high prevalence of UTI and multidrug-resistant bacteria, preventative measures such as the development of an efficient vaccination are essential. The current work is an integrated literature review that synthesizes information on UTIs caused by antibiotic-resistant uropathogenic E. coli and considers the practical implications of key research results.

146. Predictors of Long Duration Antibiotic Therapy for Urinary Tract Infections and Community-Acquired Pneumonia in Pediatric Ambulatory Care Settings

BackgroundSignificant variation exists in the duration of antibiotic therapy for children in ambulatory care settings. Understanding drivers of variation for common conditions such as community-acquired pneumonia (CAP) and urinary tract infection (UTI) is important to informing antimicrobial stewardship interventions. MethodsA retrospective observational study was conducted of patients with CAP and UTI seen in outpatient clinics or discharged from the emergency room (ER) of a tertiary care children’s hospital network from 2016 – 2019. Diagnoses CAP and UTI were identified via ICD-10 coding. Only oral medications ordered for ≥ 3 and < 28 days were included. Multivariable logistic regression was performed to identify predictors of long antibiotic duration (defined as ≥ 10 days). Potential non-clinical drivers of longer duration included race, ethnicity, sex, primary language, and insurance status. ResultsA total of 2,104 prescriptions for CAP from 442 prescribers and 1,070 prescriptions for UTI from 314 prescribers were included. Antibiotic durations were ≥ 10 days in 59.9% and 47.6% of prescriptions for CAP and UTI, respectively. Long duration of therapy was more common in children discharged from the ER when compared to clinics for both CAP (OR 1.795, 95% CI: 1.107 - 2.929), and UTI (OR 5.149, 95% CI: 1.933 - 16.373). The proportion of patients with long duration of therapy increased with younger age for both diagnoses and decreased overall in the final year of the study. Race, gender, ethnicity, and primary language were not associated with prolonged duration of therapy. However, patients with Medicaid insurance were more likely to receive long duration of therapy for CAP (OR 1.337, 95% CI: 1.062 - 1.682) and UTI (1.654, 95%, CI: 1.181 - 2.325). ConclusionIn pediatric patients in ambulatory care settings, younger age, care in the ER, and being insured through Medicaid were independently associated with prolonged duration of therapy for both UTI and CAP.Disclosures All Authors: No reported disclosures

1113. Oral Tebipenem as Step-Down Therapy Following Intravenous Ertapenem in a 7-day Hollow-Fiber In Vitro Infection Model

1113. Oral Tebipenem as Step-Down Therapy Following Intravenous Ertapenem in a 7-day Hollow-Fiber <i>In Vitro</i> Infection Model

Short versus prolonged antibiotic treatment for complicated urinary tract infection after kidney transplantation.

There is no consensus regarding the optimal duration of antibiotic therapy for urinary tract infection (UTI) following kidney transplantation (KT). We performed a retrospective study comparing short (6-10days) versus prolonged (11-21days) antibiotic therapy for complicated UTI among KT recipients. Univariate and inverse probability treatment weighted (IPTW) adjusted multivariate analysis for composite primary outcome of all-cause mortality or readmissions within 30days and relapsed UTI 180days were performed. Overall, 214 KT recipients with complicated UTI were included; 115 short-course treatment (median 8, interquartile range [IQR] 6-9days), 99 prolonged course (median 14, IQR 12-21days). The composite outcome occurred in 33 (28.6%) in the short-course group and 30 (30%) in the prolonged-course group; relapsed UTI occurred in 19 (16.5%) vs. 21 (21%), respectively. Duration of antibiotic treatment was not associated with any of these outcomes. The only risk factor for mortality/readmissions in multivariate analysis was deceased donor. No differences between groups were demonstrated for length of hospital stay, rates of bacteraemia, resistance development, and serum creatinine at 30 and 90days. In conclusion, we found no difference in clinical outcomes between KT recipients treated for complicated UTI with short-course antibiotic (6-10days) versus longer course (11-21days).

A Novel Phage Cocktail Therapy of the Urinary Tract Infection in a Mouse Model.

Escherichia coli (E. coli) is a major bacterial pathogen associated with many cases of serious infections, such as urinary tract infections (UTI) and meningitis intestinal. The rapid emergence of antimicrobial multidrug-resistant bacteria occurring worldwide has been attributed to the overuse of antibiotics. Alternative strategies must be developed to overcome antibiotic resistance. A promising alternative for the treatment of infections is the use of phages as antibacterial agents. A total of 90 female albino mice were randomly divided into three groups (n=30) and used for the induction of UTI. The animals were acclimatized in their cages for 24 h before inoculation and allowed to access chow and water freely. For UTI induction, the peri-urethral area was sterilized with 70% ethanol, and bacterial inoculation was then injected into the bladder through the urethra using a 24-gauge sterile Teflon catheter with an outer diameter of 0.7 mm and length of 19 mm. A single phage and a phage cocktail preparation have been evaluated for their therapeutic activity in the mouse model of chronic UTI induced by transurethral injection of two isolates of the uropathogenic E. coli 8 and E. coli 302. The results of the transurethral and intra-peritoneal injection of phage(s) that prepared on day 10 after the establishment of the mouse chronic model showed no effect of a single phage PEC80 in the treatment of UTI, whereas both administration routes of the phage cocktail preparation resulted in the clearance of bacteria from mice urine and homogenates of the urinary bladders and kidneys of the sacrificed mice after 24 h following the administration of phage cocktail dose. The high activity of the phage cocktail in the treatment of mouse chronic model of UTI is attributed to the broader host range of the phage cocktail, compared to the very narrow host range of the phage PEC80. It is concluded that the phage therapy by using phage preparations as the 25 phages cocktail evaluated in this study is a highly promising and potential alternative therapy for human UTIs.

ANTIBIOTIC SUSCEPTIBILITY PATTERN OF MICROBIAL ISOLATES OBTAINED FROM OBSTETRICS PATIENTS IN TERTIARY CARE HOSPITAL IN NORTHERN INDIA

BACKGROUND: Urinary tract infections (UTI) are one of the most frequent clinical bacterial infections in women. They are at higher risk to acquire UTI during pregnancy. The emergence and spread of antimicrobial resistance is a cause of increasing concern. Thus, knowledge of local antimicrobial susceptibility patterns of common uropathogens is essential for empiric therapy of UTIs. Retrospective study was conducted in the Department of Microbiology of DRPGM MATERIALS AND METHODS: C Kangra at Tanda. Study was conducted for the period of one years ie. from July 2020 to June 202. Urine samples were collected and sent to the laboratory for identication and antimicrobial susceptibility of bacterial isolates. RESULTS: During the 12-month study period, out of the 1266 samples screened, 977(77.2%) were sterile, 224(17.698%) samples showed signicant growth of &gt;10฀CFU/ml and 65(5.1%) were contaminanst or insignicant growth, which were excluded from the study. E. coli alone accounted for 66.9% of the urinary isolates followed by Klebsiella spp 12.9%. Among the Gram-positive cocci, Enterococcus isolated from a single sample and Methicillin resistant staphylococcus aureus were seen in two urine samples. Signicantly high susceptibility was seen with fosfomycin(90%) and nitrofurantoin(84%). Resistance was quite high against the noroxacin(30.3%) and cefazolin(17.8%). The susceptibility patterns seen in our study see CONCLUSION: m to suggest that it is necessary to obtain sensitivity reports before initiation of antibiotic therapy in cases of suspected UTI

Consumption of cranberry as adjuvant therapy for urinary tract infections in susceptible populations: A systematic review and meta-analysis with trial sequential analysis.

The efficacy of cranberry (Vaccinium spp.) as adjuvant therapy in preventing urinary tract infections (UTIs) remains controversial. This study aims to update and determine cranberry effects as adjuvant therapy on the recurrence rate of UTIs in susceptible groups. According to PRISMA guidelines, we conducted a literature search in Web of Science, PubMed, Embase, Scopus, and the Cochrane Library from their inception dates to June 2021. We included articles with data on the incidence of UTIs in susceptible populations using cranberry-containing products. We then conducted a trial sequential analysis to control the risk of type I and type II errors. This meta-analysis included 23 trials with 3979 participants. We found that cranberry-based products intake can significantly reduce the incidence of UTIs in susceptible populations (risk ratio (RR) = 0.70; 95% confidence interval(CI): 0.59 ~ 0.83; P<0.01). We identified a relative risk reduction of 32%, 45% and 51% in women with recurrent UTIs (RR = 0.68; 95% CI: 0.56 ~ 0.81), children (RR = 0.55; 95% CI: 0.31 ~ 0.97) and patients using indwelling catheters (RR = 0.49; 95% CI: 0.33 ~ 0.73). Meanwhile, a relative risk reduction of 35% in people who use cranberry juice compared with those who use cranberry capsule or tablet was observed in the subgroup analysis (RR = 0.65; 95% CI: 0.54 ~ 0.77). The TSA result for the effects of cranberry intake and the decreased risk of UTIs in susceptible groups indicated that the effects were conclusive. In conclusion, our meta-analysis demonstrates that cranberry supplementation significantly reduced the risk of developing UTIs in susceptible populations. Cranberry can be considered as adjuvant therapy for preventing UTIs in susceptible populations. However, given the limitations of the included studies in this meta-analysis, the conclusion should be interpreted with caution.