Female Tract Infections Research Articles

Relationship between Diabetes mellitus and Urinary tract infections

Blood and urine samples were collected from 203 patients to study the relationship between Diabetes mellitus and urinary tract infections (UTI). Blood and urine specimens were subjected for estimation of random blood sugar, in addition to detection of the most pathogen bacteria which cause urinary tract infection in diabetic patients. The study included the detection of bacterial sensitivity to some antibiotics used in treating urinary tract infections, and also included the study of genetic basis which cause both types of diabetes mellitus. The results can be summarized as follows: The incidence of type ? diabetes in males was (35.8%), and (45.9%) in females . and type 2 diabetes in males was (49.6%), while in females was (40.16%).The incidence of urinary tract infection in females was higher (69.6%) in comparison to males (37%).Escherichia coli was the most causative agent of urinary tract infections in diabetic males (19.7%), while Candida albicans was the most causative agent in urinary tract infections in females (18.8%).The majority of isolated bacteria were highly resistant to Gentamycin, Tetracycline, Ampicillin, Penicillin G, while they were sensitive to Cephotaxim, Cephalexin, Ciprofloxacin.

Relationship between Diabetes mellitus and Urinary tract infections

Blood and urine samples were collected from 203 patients to study the relationship between Diabetes mellitus and urinary tract infections (UTI). Blood and urine specimens were subjected for estimation of random blood sugar, in addition to detection of the most pathogen bacteria which cause urinary tract infection in diabetic patients. The study included the detection of bacterial sensitivity to some antibiotics used in treating urinary tract infections, and also included the study of genetic basis which cause both types of diabetes mellitus. The results can be summarized as follows: The incidence of type ? diabetes in males was (35.8%), and (45.9%) in females . and type 2 diabetes in males was (49.6%), while in females was (40.16%).The incidence of urinary tract infection in females was higher (69.6%) in comparison to males (37%).Escherichia coli was the most causative agent of urinary tract infections in diabetic males (19.7%), while Candida albicans was the most causative agent in urinary tract infections in females (18.8%).The majority of isolated bacteria were highly resistant to Gentamycin, Tetracycline, Ampicillin, Penicillin G, while they were sensitive to Cephotaxim, Cephalexin, Ciprofloxacin.

The Prevalence of Chronic Chlamydial Infections and of Infections of the Lower Female Genital Tract in Unselected Infertile Patients - A Prospective Study

OBJECTIVE: Data on upper genital tract infections in females in subfertile couples are well known. However, there are only few data available on lower genital tract infections in this patient group. In addition to the frequently discussed question which infections should be screened, we wanted to evaluate what we can expect if we screen unselected infertile patients. MATERIAL AND METHODS: In a prospective study 163 consecutive unselected infertile women (32.2 ± 4.8 years; mean ± standard deviation) were screened for chronic chlamydial (chlamydial serology - IgG, IgA) and other genital infections (human papilloma virus [HPV] in cervical smear, bacteriological investigation of the vaginal smear) during their first visit to our department. RESULTS: The chlamydial serology detected IgG in 21.6 % and IgA in 7.6 %. The prevalence of positive bacteriology in the vaginal smear was 43.7 % (mainly Gardnerella vaginalis and Ureaplasma urealyticum). The prevalence of HPV DNA in the cervical smear was 18.2 %. CONCLUSIONS: The published association between chronic chlamydial infection and tubal factor, between the different infections of the female genital tract and infertility/reproductive outcome and the prevalence in this study justify a screening in infertile patients which includes chlamydial serology and bacteriological investigation of the vaginal smear. Because a recent study showed a decreased pregnancy rate in HPV-positive women, routine testing of HPV DNA in the cervical smear should also be discussed as a part of routine screening. Additional studies must further evaluate the cost-benefit ratio of HPV screening in infertility.

Influence of probiotic vaginal lactobacilli on in vitro adhesion of urogenital pathogens to vaginal epithelial cells

Lactobacilli, the predominant micro-organisms of the vaginal microbiota, play a major role in the maintenance of a healthy urogenital tract by preventing the colonization of pathogenic bacteria. The aim of the present study was to assess the ability of four vaginal Lactobacillus strains, previously selected for their probiotic features, to block in vitro the adherence of three human urogenital pathogens to vaginal epithelial cells (VEC). Three types of assays were performed in order to determine the inhibitory effect of lactobacilli on adhesion of urogenital pathogens to VEC: blockage by exclusion (lactobacilli and VEC followed by pathogens), competition (lactobacilli, VEC and pathogens together) and displacement (pathogens and VEC followed by the addition of lactobacilli). Bacterial adhesion to VEC was quantified by microscopy (x1000) after Gram's stain. All the strains were able to inhibit by exclusion and competition the adhesion of Staphylococcus aureus to VEC but none was able to decrease the attachment of Escherichia coli by neither of the mechanisms assayed. Only Lactobacillus acidophillus CRL 1259 and Lactobacillus paracasei CRL 1289 inhibited the attachment of Group B streptococci (GBS) to VEC by exclusion and competition respectively. Lactobacillus of vaginal origin were able to inhibit the attachment of genitouropathogenic Staph. aureus and GBS to the vaginal epithelium. The results support the probiotic potential of these Lactobacillus strains as anti-infective agents in the vagina and encourage further studies about their capacity to prevent and manage urogenital tract infections in females.

The Utility of Bladder Catheterization in Total Hip Arthroplasty

Reply: We thank Drs. Michelson and Lotke for their interest in our retrospective study “The Utility of Bladder Catheterization in Total Hip Arthroplasty”1 in which we evaluated 719 patients who had primary unilateral total hip arthroplasties that were randomized by surgeon into two bladder catheterization protocols. Results of a group of patients who had universal preoperative insertion of an indwelling bladder catheter were compared with results of an observation group that had catheterization as needed. Our conclusions were: there was no difference in the incidence of urinary tract infections between the groups; there was no difference in hospital length of stay; and there was a small increased cost associated with the universal preoperative catheterization group. We suggested that routine preoperative bladder catheterization for patients having total hip arthroplasties may not be necessary. Michelson and Lotke questioned the validity of our conclusions because of potential distribution differences in medical comorbidities among the two treatment groups. We agree that the differences in length of stay and hospital cost might not be fully explained by the catheterization protocol. Charnley class, age, and gender were not significantly different between the treatment groups. We pointed out in the Discussion that there may be the potential of a selection bias toward patients with more comorbidities in the universal catheter placement cohort. This could explain the slightly increased length of stay in the universal catheter cohort. However, these 719 patients were taken from a multispecialty group practice with a relatively homogenous patient population. The patients were randomized by surgeon, but all were treated with the same clinical pathway for total hip arthroplasty. We pointed out in the Abstract that postoperative catheterization as necessary may be more cost effective, and we did not make cost savings a declarative conclusion. One of the major findings of our study was that there was no significant difference in the incidence of urinary tract infection between the two groups. Furthermore, there was a significant difference in incidence of urinary tract infection in females and in patients with increasing age in both groups. Michelson and Lotke question whether our patients had unrecognized or unreported urologic complications attributable to over-distension of the bladder, and they also question the cost of additional catheterizations and the burden on the nursing staff. We respectfully point out that Michelson and Lotke published their data in 1988. The study involved only 100 patients.2 Since that time, routine bladder scan analysis of patients having total joint replacement is done on an every 8-hour basis. Patients with bladder volume residuals of 700 cc or greater are candidates for insertion of a bladder catheter. Our data confirm that only 19 patients (2.6%) required introduction of a catheter for a second time after initial catheterization. We reviewed all of the morbidity and mortality records and the hospital records of the 719 patients for readmissions and potential complications and did not find any in these cohorts. Michelson and Lotke think routine preoperative catheterization is needed based on results their 1988 study of 100 patients. Given the new technology available to scan patients for residual bladder volumes, perhaps it is time to reexamine the routine use of urinary catheterization in patients having total joint replacement. Universal catheterization is not always routine. Issues with prosthetic hypertrophy, urethral stricture, and patients who have had prostate surgery make bladder catheterization of patients while in the operating room by nonurologic personnel, a sometimes nonroutine procedure. These insertions can cause undue operating room delays, urologic tract trauma, and the need for longer-term catheterization than would be necessary if the catheterization were done postoperatively. With the advent of bladder scan technology; we think routine use of bladder catheterization of patients while in the operating room is not necessary at this time. We encourage more study and debate on this topic.

BACTERIURIA MANAGEMENT AND UROLOGICAL EVALUATION OF PATIENTS WITH SPINA BIFIDA AND NEUROGENIC BLADDER: A MULTICENTER SURVEY

We assessed how groups at spina bifida clinics evaluate and manage the urinary tract in patients with spina bifida, neurogenic bladder and bacteriuria. A survey was mailed to all 169 clinics listed by the Spina Bifida Association of America. Survey items addressed baseline and surveillance evaluation, criteria used to assess urinary tract health and approaches to treatment in patients with spina bifida and neurogenic bladder. Of the 169 clinics personnel at 59 (35%) responded to the survey. Almost half of the respondents had an established protocol or standard of care. At most clinics the use of ultrasound (93%), voiding cystourethrograms (85%) and urodynamic testing (76%) was supported but not renal isotopic studies (14%) or excretory urograms (2%) for baseline evaluation. At all clinics ultrasound was supported for routine surveillance but there was no consensus for other imaging modalities. Assessment of clinic approaches to the evaluation and management of bacteriuria demonstrated variable results, although at most clinics fever, flank pain, dysuria, and changes in urinary pattern were identified as being consistent with true infection. Groups at clinics following their protocol or standard of care showed no significant differences in their approach compared to those at clinics lacking a protocol or standard of care. No consensus exists for the evaluation and management of bacteriuria in patients with spina bifida and neurogenic bladder at clinics specializing in the care of such patients, even at those with established standards of care. A clear need exists for an established, national set of evidence based guidelines to assist medical decision making in this high risk population and, thus, improve care.

BLADDER INFECTION IN THE MENOPAUSAL MONKEY

Purpose The highest incidence of urinary tract infection in females occurs in elderly women. This study was done to determine whether this is due to the declining immune response that occurs during advancing age, or the menopausal state in the aged. Materials and Methods Adult female monkeys (average age 19 years) were studied, half being subjected to bilateral oophorectomy to produce the menopause. In addition, old females (average age 29 years) already at menopause were studied before and after hormonal replacement with estradiol and progesterone. Bacterial adherence to vaginal cells was studied prior to and after urethral infection with E. coli. Plasma estradiol and progesterone levels were done, as well as white blood counts, plasma cytokine assays and serum antibody titers. Results Bacteriuria was not prolonged, nor was there a significant difference in bacterial adherence to vaginal cells due to menopause. Interleukin-1 levels were depressed after surgical menopause but not as much as found in the old menopausal females and this low level was not corrected by hormonal replacement. The initial interleukin-2 levels were higher after spontaneous menopause, but the increasing plasma levels seen in cycling animals after infection did not occur in the aged menopausal females following infection even after hormone replacement. The antibody titers to the E. coli infection showed a trend to a lessened response to infection after menopause but were not significantly decreased. Conclusions The deficient Il-1, Il-2 and antibody response following infection was not corrected by hormone replacement and thus appears to be due to aging rather than lack of female hormones. These facts may be explained by the T cell senescence known to occur in aged individuals.

Reactive oxygen species-mediated tissue injury in experimental ascending pyelonephritis

Pyelonephritis is the most common urinary tract infection in females, but the pathogenetic mechanisms are not well understood. Reactive oxygen species (ROS) have been implicated as cause of injury in several renal diseases. In this study, we have demonstrated the role of ROS in pathogenesis of pyelonephritis in Balb/c mice. A clear correlation between extent of ROS generation and subsequent lipid peroxidation and DNA damage in kidneys was observed during the course of infection, from 2 to 14 days. Activities of brush border membrane marker enzymes were also significantly altered. Administration of antioxidants, superoxide dismutase, catalase and dimethylsulfoxide significantly reversed the histopathological changes, reduced the extent of lipid peroxidation in renal brush border membrane, and also reversed the altered enzyme activities to near normal situation. These results clearly suggest that interaction of ROS with various cellular organelles in kidneys has a significant deleterious effect, and this could be the underlying mechanism for renal dysfunction in pyelonephritis.

Differences in urinary tract infections in male and female spinal cord injury patients on intermittent catheterization.

Intermittent catheterization has gained wide acceptance for use in hospitalized patients following spinal cord injury. Most studies evaluating this procedure, however, look only at the infection rate in the male SCI population. In this study the rate and type of infection encountered in the male and female SCI population were evaluated in an inpatient hospital environment. Fifty four patients who were undergoing intermittent catheterization with the MMG/O'Neil catheter system were evaluated. All patients were similar with regard to level of injury and bladder management. There were 45 males and nine females in our study group (n = 45). A total of 10,945 catheterizations were performed with 75 infections indentified. The overall infection rate was 0.68% or one infection for every 146 catheterizations. Of the 45 males there were 58 infections of which 11 (18%) were E. coli. This contrasts with the female population (9) in which there were 17 infections with nine (53%) being E. coli. While a variety of infecting organisms were present in males, females were colonized with either E. coli, enterococcus or Klebsiella. While hospital based intermittent catheterization would appear to be associated with an acceptable low incidence of urinary tract infections (0.68%), infected females have a higher incidence of E. coli (53%) compared to the male population (18%). This study also demonstrated that female patients had a significantly higher infection rate than males (nine females with 17 infections compared to 45 males with 58 infections over the same time period). The higher incidence of urinary tract infections in females with E. coli perhaps is related to the proximity of bowel/stool contamination.

Evaluation of the etest for antimicrobial spectrum and potency determinations of anaerobes associated with bacterial vaginosis and peritonitis

One hundred ninety-seven anaerobic organisms (24 Gardnerella vaginalis, 16 Mobiluncus spp., 19 Peptostreptococcus spp., 20 Lactobacillus spp., 20 Prevotella bivia/disiens, 81 Bacteroides fragilis group, 12 Clostridium spp., and five Fusobacterium spp.) were processed by the Etest (AB Biodisk, Solna, Sweden) and a reference ( Brucella blood agar) method against 10 antimicrobial agents. For the bacterial vaginosis-associated pathogens, the Etest was more reproducible and correlated acceptably with the reference agar test: within ±1 log 2 dilution for 74.4% of Mobiluncus spp. to 96.0% for Peptostreptococcus spp. (all organisms, 83.4%). The quantitative correlation ±2 log 2 dilution steps between test results was 94.3%. Results with B. fragilis group strains demonstrated 97.3% correlation (±2 log 2 dilution) with a trend toward slightly lower Etest minimum inhibitory concentrations for ampicillin-sulbactam, cefotaxime, imipenem, and clindamycin. The absolute qualitative interpretive agreement between Etest and the reference agar dilution method results was 94.4%, with only a 0.4% false-susceptible error rate. The Etest appears to be a very practical, quantitatively accurate, alternative procedure for clinical microbiology laboratories routinely testing the susceptibilities of anaerobes and, by these presented data, organisms associated with female tract infections.

Urinary tract infections in females.

Urinary tract infections (UTIs) encompass a wide variety of clinical entities. These include urethritis, cystitis, and acute and chronic pyelonephritis. Often the condition is clinically silent and detected only by the finding of large numbers of microorganisms in the urine. Asymptomatic bacteriuria or asymptomatic funguria may be limited to colonization of the urine without an apparent inflammatory response. This condition should be considered to be an asymptomatic infection when accompanied by pyuria. Asymptomatic individuals are at risk of developing symptomatic infection.

Infrequency of slime production by urinary isolates of Staphylococcus saprophyticus

The production of slime by 130 urinary isolates of Staphylococcus saprophyticus, cultured from symptomatic females in the general community, was tested by growing them on Congo red agar. Fourteen of 130 strains (11%) were found to produce slime, 112 strains (86%) did not produce any detectable slime, while four strains (3%) gave an indeterminate result. Slime production does not appear to be an important virulence factor of S. saprophyticus causing urinary tract infection in females of child-bearing age.

Development of lactobacilli therapy to prevent recurrent urinary tract infections in females

Urinary tract infections remain a common urogynecological problem. Although antibiotic therapy invariably eradicates bacteria from the bladder, it can also disrupt the genital flora and lead to emergence of drug-resistant uropathogens. A new therapeutic agent has been developed to prevent recurrence of uncomplicated, lower urinary tract infections in adult females. This unique product contains Lactobacillus casei var rhamnosus GR-1 and L. fermentum B-54, selected for their ability to adhere to uroepithelial cells in vitro and produce inhibitory substances against uropathogens, particularly Escherichia coli and Enterococcus species. In addition, unlike the majority of lactobacillus isolates, the strains GR-1 and B-54 resist the action of spermicide. The bacteria are freeze-dried in gelatin suppositories and instilled intravaginally. Weekly therapy in 8 patients has led to a 78.7% reduction in infection rate, without any major side effects. The results illustrate the potential effectiveness of this therapy in patients with recurrent urinary tract infections.

Fosfomycin trometamol versus ofloxacin/Co-trimoxazole as single dose therapy of acute uncomplicated urinary tract infection in females: A multicentre study

20 urologists took part in a single blind, randomized study. Female patients with acute uncomplicated UTI were recruited. The patients received either a single dose of 3 g fosfomycin trometamol versus 200 mg ofloxacin or 1.92 g co-trimoxazole. Follow-up examinations were carried out after one and four weeks. Of 562 patients 446 could be evaluated for efficacy and 496 for tolerance. Patients were analysed according to the amount of bacteriuria: "significant" (greater than or equal to 10(5)/ml), "low count" (10(2) - 10(4) ml) and "no bacteriuria" (less than or equal to 10(1)/ml), as well as according to the sensitivity of the infecting organisms: sensitive (resistant): fosfomycin trometamol less than or equal to 16 mg/l (greater than or equal to 128 mg/l), ofloxacin less than or equal to 1 mg/l (greater than or equal to 8 mg/l), co-trimoxazole less than or equal to 2/38 mg/l (greater than or equal to 16/304 mg/l). Up to one week the following results could be achieved: clinical improvement was attained in patients with "significant" bacteriuria (fosfomycin trometamol-150, ofloxacin-89, co-trimoxazole-69) in 94.7% for fosfomycin trometamol, in 95.4% for ofloxacin, and in 94% for co-trimoxazole; in patients with "low count" bacteriuria (fosfomycin trometamol-44, ofloxacin-18, co-trimoxazole-30) in 95.2% for fosfomycin trometamol, in 93.7% for ofloxacin, and in 96.4% for co-trimoxazole; and in patients with no bacteriuria (fosfomycin trometamol-11, ofloxacin-6, co-trimoxazole-4) in 81.8% for fosfomycin trometamol, in 100% for ofloxacin and in 100% for co-trimoxazole.(ABSTRACT TRUNCATED AT 250 WORDS)

Single-dose therapy of uncomplicated urinary tract infections in females--treatment of choice?

Single-dose therapy of uncomplicated urinary tract infections in females--treatment of choice?

Urinary tract infections

Recent advances have led to a renewed interest in urinary tract infections in females. First, current research has reassessed the previously used definition of infection as a positive culture with ≥ 100,000 colonies per ml. Norden and Kass1 originally defined a positive culture as ≥ 105 colonies per ml because they found a 96% predictability of a third positive culture if the 2 previous cultures were positive. However, their studies primarily involved pregnant women who were asymptomatic at the time of culture and were not known to be at high risk for recurrent disease. Other authors2,3 reported that symptomatic disease is often associated with colony counts of less than 105 colonies per ml. These studies have thus led to reconsideration of the best way to define infection microbiologically. The roles of new pathogens such as Chlamydia trachomatis, herpes simplex virus (HSV), and Staphylococcus saprophytics have also been demonstrated in recent studies.

CHLAMYDIAL PNEUMONIA OF INFANCY IN SIBLINGS

Because Chlamydia trachomatis (Ct) genital tract infection in females may persist without symptoms for months to years, and because reinfection may occur, siblings born to chronically infected or reinfected women theoretically are at risk for perinatal Ct infection. We describe two brothers born 16 months apart with Ct pneumonia. A 3 week old infant with cough and eye discharge was hospitalized because of an apneic episode requiring resuscitation. He was afebrile, had eosinophilia, and bilateral interstitial infiltrates on chest x-ray. Ct was identified in nasopharyngeal (NP) washings by direct immunofluorescent microscopy and by culture. The mother's first child also had been hospitalized at 5 weeks of age with afebrile pneumonia. Ct pneumonia was suspected, but a culture of NP secretions, collected after the child had begun oral erythromycin, was negative. An earlier specimen, collected for viral studies before erythromycin was begun, was retrieved from the freezer; it was strongly positive for Ct by both immunofluorescent microscopy and culture. This experience highlights the risk of symptomatic Ct infection in siblings born to chronically infected or reinfected women and provides another important reason to treat the parents of infants with Ct infection for presumed Ct genital infection.

Failure of a Single Dose of 100 mg Ofloxacin in Lower Urinary Tract Infections in Females

A single dose of 100 mg ofloxacin was compared with a multiple dose of cotrimoxazole in lower urinary tract infections in 137 women. The elimination rate was significantly lower in the single dose treated group of patients in spite of all strains being in vitro susceptible in this group.

Single dose treatment of urinary tract infection in females

Single dose treatment of urinary tract infection in females

16 - Urinary Tract Infections

Recent investigations into the pathogenesis of urinary tract infections has led to significant understanding in the interaction between uropathogens and the urogenital tract. From this understanding there is already the potential for new types of therapy. Reviewed here are these mechanisms since they offer future potential pragmatic approaches to infection. In addition, a practical approach to management of lower urinary tract infections in females is discussed, to provide a physician with methods to treat infection. Non-bacterial cystitis, or the urgency-frequency syndrome, also has new developments that offer new therapy of these diseases. Some of these findings are discussed as well as the current methodologies used to treat it.