Treatment Of Urinary Tract Infections Research Articles

Evaluation of the Efficacy of Piperacillin/Tazobactam in Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae Urinary Tract Infections: A Systematic Review of the Literature.

To evaluate the efficacy of piperacillin/tazobactam (PTZ) for the treatment of extended-spectrum beta-lactamase-producing enterobacteriaceae (ESBL-PE) urinary tract infections (UTIs). A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards on PubMed, MEDLINE, Embase, Web of Science Core Collection, and Cochrane Central through July 2024. Studies providing efficacy data associated with PTZ in patients ≥18 years old experiencing an ESBL-PE UTI that documented clinical and microbiological cure data were included. A total of 577 articles were obtained for screening. After applying the inclusion and exclusion criteria, 7 studies comparing PTZ with carbapenems comprised of 1156 patient cases were analyzed. Piperacillin/tazobactam was found to be noninferior to carbapenems in the treatment of both uncomplicated and complicated UTI's caused by ESBL-PE. The observed noninferiority encompassed clinical response, clinical cure, and microbiological cure outcome metrics. Although not specifically evaluated in this systematic review, adverse effects associated with PTZ were found to be minimal and lesser in incidence than with the carbapenem comparators in aggregate. While a definitive dosing strategy remains elusive, a PTZ total daily dose of 13.5 g infused over 3 to 4 hours may be appropriate for this indication. Piperacillin/tazobactam may be an effective carbapenem-sparing agent for the treatment of ESBL-PE UTIs that show in-vitro susceptibility to PTZ. However, additional robust randomized clinical trials are still needed to validate the findings of this review and determine the best dosage regimen of PTZ for ESBL-PE UTIs.

Antibiotic Overprescription for "Urinary Tract Infections" Is Associated With Poor Diagnostic Stewardship and Low Adherence to Guidelines.

While urinary tract infections (UTIs) are thought to be common among women, as many as 65% of UTI diagnoses may be inaccurate. To identify strategies to improve antibiotic stewardship, we sought to determine the clinical and laboratory factors associated with overdiagnosis and overtreatment of UTIs. Electronic health records identified patients bearing an isolated diagnostic code for UTI within a single healthcare system during July 2019. Demographic, clinical, and microbial data were collected by manual chart review. Regression analyses were utilized to determine factors associated with guideline non-concordant UTI diagnosis and treatment utilizing R statistical software (version 4.3.1). In patients diagnosed with UTI, 64% were treated with antibiotics despite only 28% having symptoms consistent with UTI diagnostic criteria. Of patients diagnosed with a UTI who were treated in an emergency room (ER) setting, 95% were given antibiotics compared with only 55% of patients in an outpatient setting. Even without any urinary symptoms, 95% of patients in the ER and 27% of patients in outpatient settings were treated with antibiotics. Patients who presented to the ER for non-localizing symptoms, such as mental status changes (MSC), were more likely to be diagnosed with UTI compared with those in an outpatient setting. The results of this study demonstrate that patients were frequently diagnosed with and treated for a UTI despite not meeting diagnostic criteria. This pattern of overdiagnosis leads to overtreatment, particularly in acute care settings, contributing to worsening antibiotic resistance in conjunction with incomplete evaluation of patients' primary complaints.

Knowledge and Practice of Antimicrobial use for Treatment of Urinary Tract Infections among Female Medical Students in Enugu, Nigeria: A Cross-sectional Study

Background: Urinary tract infections (UTI) are a significant clinical problem empirically treated with antibiotics that could worsen the spread of antibiotics resistance. Objective: We described the knowledge, attitude, and treatment practices of UTI among female medical students in Enugu, southeast Nigeria. Methods: A cross-sectional, questionnaire-based survey involving female medical students at Enugu State University of Technology, in Enugu, Nigeria was conducted in October 2023. Overall, 180 students were enrolled. The questionnaires were constructed after systematically reviewing the literature. The data were analyzed by calculating frequencies and means. Results: Our study sample includes 174 female medical students (Response rate, 96.7%). Most of the students are aged 20–24 years (63.2%), with mean (standard deviation) of 23.5 (± 4.6) years, single (86.8%), Igbo (97.1%), and Christian (97.7%). Most students (166 students, 95.4%) had adequate knowledge of UTI, but a minority of students (45.5%) sought treatment from a trained healthcare provider for proper laboratory investigation, diagnosis, and treatment of their previous UTI episodes. Among those that did not seek care with trained healthcare providers, most, 27 (75.0%), self-treated. Most students (27 students, 90.0%) positively practiced completion of their prescribed drugs. The most commonly drugs used for self-medication of UTI were Amoxicillin, Canesten cream, Ciprofloxacin, and Gentamycin. Conclusion: Although our study shows female medical students have adequate knowledge about UTIs, their treatment practices reveal that strengthening educational efforts on antibiotic stewardship is essential to ensure that medical students not only understand the theoretical aspects of UTIs but also apply best practices in their treatment. Our study suggests the need for improved education on antibiotics stewardship to address the spread of antimicrobial resistance, and ensuring effective treatment of UTIs in the future.

Synergistic Effects of Pyrrosia lingua Caffeoylquinic Acid Compounds with Levofloxacin Against Uropathogenic Escherichia coli: Insights from Molecular Dynamics Simulations, Antibiofilm, and Antimicrobial Assessments.

Urinary tract infections (UTIs), primarily caused by uropathogenic Escherichia coli (UPEC), have high morbidity and recurrence rates. Resistance to levofloxacin hydrochloride (LEV), a commonly used treatment for UTIs, is increasingly problematic, exacerbated by biofilm formation mediated by interactions between cyclic di-GMP (c-di-GMP or CDG) and YcgR. In this study, we identified three caffeoylquinic acid compounds from Pyrrosia lingua-chlorogenic acid (CGA), sibiricose A5 (Si-A5), and 3-O-caffeoylquinic acid methyl ester (CAM)-that target YcgR through molecular docking. Biological assays revealed that combining these compounds with levofloxacin hydrochloride significantly enhanced antibacterial activity against standard UPEC strains in a concentration-dependent manner and clinically isolated UPEC strains. Notably, chlorogenic acid and sibiricose A5, when used with levofloxacin hydrochloride, enhanced intracellular c-di-GMP levels and swimming motility, significantly reduced YcgR gene expression, and effectively inhibited biofilm formation of UPEC at multiple time points. Additionally, molecular dynamics simulations elucidated the strong binding of these compounds to YcgR, underscoring the critical roles of residues, such as Arg118 and Asp145. This research serves as a foundation for tackling antibiotic resistance and developing innovative therapeutics for UTIs.

URINARY TRACT INFECTIONS IN CHILDREN: A REVIEW OF CURRENT INTERNATIONAL GUIDELINES

Urinary tract infections (UTIs) are the most common bacterial infections in children, which can lead to renal dysfunction, especially in young children in case of complicated and recurrent course. The aim of this review was to analyze all the latest clinical guidelines on UTIs in children in the world, starting from 2018 to 2024. We analyzed current data on the incidence of UTIs in children depending on age and gender. A classification is presented, the main problems of diagnosis, the most modern approaches to treatment and prevention are discussed. Analysis of these guidelines indicates that UTIs should be diagnosed in all young children with fever over 38 ° C without a focus of infection. Empirical antibacterial therapy should be started within the first 24-48 hours, oral antibiotics have an advantage, third-generation cephalosporins are more often used today, but it is necessary to take into account the data on antibacterial resistance in your region. All modern clinical guidelines emphasize the growth of resistant pathogens and their decreasing sensitivity to protected penicillins. All guidelines recommend identifying a "high-risk recurrence group" that includes children with vesicoureteral reflux (VUR), neurogenic bladder dysfunction, constipation, and "uncircumcised" boys under 1 year of age, and timely conducting imaging diagnostics for such children. According to almost all international guidelines for the diagnosis and treatment of UTIs in children, long-term antibacterial prophylaxis should be carried out only according to strict indications, mainly in children with high VUR and low VUR, taking into account the "risk" factors. In recent years, a large number of modern international clinical guidelines on UTIs in children have appeared. This review, which includes all the latest guidelines on UTIs in children in the world over the past seven years, will allow the use of accumulated modern knowledge in the practical work of pediatricians, pediatric nephrologists, and pediatric urologists in the Russian Federation.

O PAPEL DO ENFERMEIRO NA PREVENÇÃO DE INFECÇÃO DO TRATO URINÁRIO ASSOCIADA À GESTANTE NA ATENÇÃO PRIMÁRIA: UMA REVISÃO INTEGRATIVA

Introduction: Urinary tract infection (UTI) is one of the most common perinatal complications, affecting approximately 8% of Brazilian pregnant women. In this understanding, primary health care for these pregnant women is the main form of prevention and treatment for UTI. Objective: To understand the role of nursing in preventing urinary tract infection associated with pregnancy. Methodology: This is an integrative review, involving data collection through health research platforms (pubmed, scielo and BVS). The data were obtained through bibliographic references, books and articles that include urinary tract infection in pregnant women in primary care in the time interval between 2014 and 2024. Results: A total of 133 articles were analyzed, making it necessary to create inclusion and exclusion criteria, with 112 samples being excluded and 21 included. Furthermore, a significant association was identified between UTI and factors such as lack of sexual health education, genital hygiene, previous history of UTI, asymptomatic bacteriuria, resistance to antibiotics and laboratory tests and how prenatal care with nurses is satisfactory for pregnant women and important for reducing these risk factors. Conclusion: This study highlights important areas for improving early detection and adequate management of urinary tract infections in pregnant women, aiming to improve obstetric care and reduce potential complications during pregnancy.

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.

Antibiotic efficacy and resistance patterns of urinary tract infection-causing bacteria in dogs and resistome of multidrug-resistant Klebsiella pneumoniae via whole genome sequencing in South Korea.

Bacterial urinary tract infections (UTIs) are prevalent in dogs and necessitate antibiotic intervention. However, the emergence of multidrug-resistant (MDR) bacteria poses significant challenges to antibiotic therapy. Although fosfomycin has been demonstrated to achieve and maintain high concentrations in urine, suggesting its potential for treating UTIs in dogs, its efficacy and the resistance profiles of urinary pathogens from canine UTIs remain elusive. Therefore, this study was conducted to investigate the antibiotic susceptibility of bacterial pathogens isolated from companion dogs with UTIs, with a particular focus on their susceptibility and resistance to fosfomycin. A total of 70 isolates from urine samples were analyzed, of which Escherichia coli (n = 18), Proteus mirabilis (n = 9), Klebsiella pneumoniae (n = 5), and Staphylococcus pseudintermedius (n = 5) were predominant. Resistance to erythromycin was most prevalent (94.59%), followed by clindamycin (91.89%) and ampicillin (78.37%), whereas the lowest resistance rate was observed for amikacin (5.40%). Resistance to fosfomycin was observed in 15 out of the 37 predominant isolates (40.54%), including all K. pneumoniae isolates (100%). All isolates, except 4 E. coli strains, were categorized as MDR (33 out of 37; 89.18%). The resistance rates for amoxicillin/clavulanic acid and trimethoprim-sulfamethoxazole, which are common first-line antibiotics for canine UTIs, were 48.64 and 56.75%, respectively. Whole-genome sequencing of K. pneumoniae isolates, which exhibited high resistance to fosfomycin, revealed multiple antibiotic resistance genes, with chromosomal fosA present in all isolates. Among the 27 dogs with recurrent infection included in this study, 2 were administered fosfomycin, resulting in clinical remission, as evidenced by negative urine culture tests. Overall, this study is the first to demonstrate the importance of assessing fosfomycin resistance profile for optimal treatment of canine UTIs, particularly in cases involving MDR strains.

Unveiling the hidden arsenal: new insights into Proteus mirabilis virulence in UTIs.

Proteus mirabilis is a Gram-negative bacterium commonly found in urinary tract infections (UTIs) and catheter-associated urinary tract infections (CAUTIs). The pathogenic mechanisms of Proteus mirabilis are complex and diverse, involving various virulence factors, including fimbriae, flagella, urease, polyphosphate kinase, lipopolysaccharides, cyclic AMP receptor protein, Sigma factor RpoE, and RNA chaperone protein Hfq. These factors play crucial roles in bacterial colonization, invasion, evasion of host immune responses, biofilm formation, and urinary stone formation. This paper is the first to comprehensively describe the hydrogenase system, autotransporter proteins, molybdate-binding protein ModA, and two-component systems as virulence factors in Proteus mirabilis, providing new insights into its pathogenic mechanisms in urinary tract infections. This review explores the mechanisms of biofilm formation by Proteus mirabilis and the various virulence factors involved in UTIs, revealing many newly discovered virulence factors from recent studies. These findings may offer new targets for clinical treatment of UTIs and vaccine development, highlighting the importance of understanding these virulence factors.

Green Cystoscopy: Does Minimizing the Use of Drapes Increase Infection Rates?

The U.S. health care system has an enormous carbon footprint made worse by the escalating use of single-use supplies. Emerging evidence suggests that smaller surgical fields ("green" draping) may represent a safe alternative to traditional draping. The aim of the study was to determine if the proportion of cases treated for culture-proven urinary tract infection (UTI) within 2 weeks of operating room cystoscopy after the green draping protocol implementation is noninferior to preprotocol cases. Secondary objectives included risk factors for UTI and waste and cost savings. A pre-post implementation noninferiority study was performed from 2021 to 2023 in a urogynecology division at an academic medical center. The green draping protocol eliminated the use of top drapes, leg drapes, and gowns; blue towels were permitted per the surgeon's discretion. All minor cystoscopy cases were included. The cohort included 240 patients. Treatment of culture-proven UTI in the green cohort was noninferior to the preprotocol group (9 [7.5%] vs 7 [5.8%], P < 0.05). The odds of a culture-proven UTI were higher with history of recurrent UTI (odds ratio = 7.02), interstitial cystitis/bladder pain syndrome (odds ratio = 4.33), and older age (odds ratio per 5-year increase = 1.21). Approximately $1,403.92 (2023 USD) was saved, and 165 pounds of waste was diverted from the landfill. A green draping protocol is noninferior to standard draping with respect to rates of postoperative culture-positive UTIs. Clinicians may use a smaller operating room field to decrease the carbon footprint without compromising quality of care.

FOSFOMYCIN SUSCEPTIBILITY IN MULTIDRUG-RESISTANT UROPATHOGENS: A RETROSPECTIVE STUDY IN THE ERA OF ANTIMICROBIAL RESISTANCE

Objective: Urinary tract infection (UTI) is one of the most prevalent clinical entities affecting people worldwide. The accelerating rate of Antimicrobial resistance due to the unimpeded and rampant use of antimicrobials with over-the-counter availability of drugs has limited the therapeutic options for the treatment of UTIs. Fosfomycin, an old broad-spectrum antimicrobial with good pharmacokinetics has regained importance for the treatment of multidrug-resistant (MDR) isolates. The purpose of this study was to determine the in vitro Fosfomycin susceptibility of common uropathogens and to study the resistance pattern of these organisms against commonly prescribed antimicrobial agents. Methods: A retrospective cross-sectional study was conducted in the Bacteriology section of the Microbiology laboratory at Adesh Institute of Medical Sciences and Research, Bathinda, Punjab for duration of 6 months from December 2022 to May 2023 from urine samples received from all clinically suspected cases of UTI. Samples were processed immediately as per standard microbiological techniques, followed by culture by a semi-quantitative method. Kass criteria was followed for interpretation of significant bacteriuria according to which significant growth was considered if the colony count was more than 105 colony forming units (CFU)/mL. Culture positives were analyzed by Gram staining and on the basis of colony characteristics, Gram staining, final identification, and Antimicrobial Susceptibility were done through Vitek 2 compact system. Results: A total of 2292 urine samples received in the Microbiology laboratory were processed and cultured during the study period, which yielded 509 significant bacterial isolates i.e.509/2292 (22.2%) culture positivity. Among 509 culture-positive samples, Escherichia coli 235/509 (46.1%) was the most common uropathogens isolated followed by Klebsiella pneumoniae 107/509 (21.1%), Enterococcus species 40/509 (7.8%). Fosfomycin depicted good in vitro susceptibility of a minimum of 94% in both Gram-negative and Gram-positive uropathogens as compared to Nitrofurantoin, which showed sensitivity of 74% and 85%, respectively. Maximum resistance was observed toward Cephalosporins i.e., Ceftriaxone in E. coli (60%) and K. pneumoniae (64%), respectively, followed by 50% in Acinetobacter baumannii. Maximum resistance to Ciprofloxacin (62%) was seen in case of A. baumannii. 172/405(42.4%) isolates of Enterobacteriaceae family were extended-spectrum β-lactamase (ESBL) producers with an average Fosfomycin susceptibility of 95.9%. Among the total isolated uropathogens, 135/509 (26.5%) were MDR, out of which 116/135 (85.9%) depicted Fosfomycin susceptibility. Metallo-beta-lactamase (MBL) production was seen in 14.3% of the isolated Gram-negative uropathogens. 63/73(86.3%) of the MBL producers were found susceptible to Fosfomycin. Conclusion: Fosfomycin has emerged as an effective alternative for the treatment of common uropathogens including the MDRs, ESBL producers, and the MBLs in the era of increasing antimicrobial resistance. It has the potential to act as a promising oral agent for the treatment of UTI in both community and healthcare setups.

Flemish consensus statement on the prevention, diagnosis and treatment of urinary tract infections in older nursing home residents.

Urinary tract infections (UTIs) are one of the most commonly reported infections in Belgian nursing home residents. In older adults, UTI diagnosis and management is complex, often leading to over-diagnosis and irrational antimicrobial use, stressing the need for a guideline approach. A consensus statement on the prevention, diagnosis and treatment of UTIs in older adults residing in nursing homes was developed in a collaborative effort between the Flemish Hospital Outbreak Support Teams, the Flemish Agency for Care and Health, the Association of the Flemish Coordinating and Advising General Practitioners, the Belgian Association of Urology, the Belgian Society for Gerontology and Geriatrics and PhD researchers based on a combination of clinical expertise, (inter)national guidelines and peer-reviewed studies. Optimizing fluid intake, appropriate toilet behaviour and posture, mobilization and local estrogen therapy in women are of proven value in UTI prevention, whereas the use of cranberry and probiotics is not to be advocated. The importance of avoiding bladder catheterization is stressed. In older nursing home residents, the diagnosis of UTIs remains challenging, mostly due to atypical systemic symptoms. A consensus diagnostic algorithm for UTI among residents with and without a urinary catheter was developed, including the presence of suggestive clinical symptoms and a positive urine culture. Urine dipsticks have a high negative but a low positive predictive value. C-reactive protein point-of-care testing is not recommended. Asymptomatic bacteriuria should not be screened for, in order to avoid unnecessary triggers for treatment. In cystitis, nitrofurantoin is the primary choice for treatment, with fosfomycin as an alternative; in prostatitis and uncomplicated pyelonephritis a fluoroquinolone is the advocated empirical antimicrobial.

Prescription of antibiotics for urinary tract infections in outpatient care in Bavaria: An analysis of routine data.

Patients with urinary tract infection (UTI) in German outpatient care are usually treated by general practitioners (GPs), as well as by other specialties. To prevent antibiotic resistances and side effects, German guidelines recommend fosfomycin, nitrofurantoin, pivmecillinam and nitroxoline as first-line treatments, and advice against broad-spectrum antibiotics such as fluoroquinolones and cephalosporins. However, data from the European Centre for Disease Prevention and Control indicates a significant proportion of second-line antibiotics in German outpatient care. Our aim was to analyze whether antibiotic prescription has changed over time in accordance with guidelines. In addition, we aimed to investigate whether specialties prescribe different antibiotics for UTIs and whether prescription varies according to patient age and sex. For patients receiving more than one antibiotic, we wanted to determine whether subsequent prescriptions show a change in substances and specialties involved. This retrospective study involved routine data (2013 to 2019) provided by the Bavarian Association of Statutory Health Insurance Physicians. Data on diagnoses and prescriptions were transmitted from outpatient care physicians on a quarterly basis. UTI patients ≥12 years were included. We analyzed 1.7 million UTI prescription cases. In females, shares of fluoroquinolones decreased sharply over time, while shares of first-line substances fosfomycin and pivmecillinam increased. Gynecologists showed the highest shares of first-line substances compared to GPs and urologists. Fluoroquinolone shares decreased in all three specialty groups. In females, older patients showed lower shares of first-line substances than younger patients. If a second or third antibiotic was prescribed, fosfomycin shares decreased, while shares of nitrofurantoin, nitroxoline and cephalosporins increased. Our findings show a trend towards a more guideline-adherent prescribing in the treatment of UTI, with a significant increase of shares of fosfomycin and pivmecillinam, especially in women, and a sharp decrease of shares of fluoroquinolones.

Imidazolium, pyridinium and pyrazinium based ionic liquids with octyl side chains as potential antibacterial agents against multidrug resistant uropathogenic E. coli

Urinary tract infections (UTIs) are the second most prevalent infectious disease with E. coli being the most common etiological agent behind these infections, affecting more than 150 million people globally each year. In recent decades, the emergence of multi-drug resistant (MDR) pathogens has rapidly escalated. To combat antimicrobial resistance (AMR), it is important to synthesize new biologically effective alternatives like ionic liquids (ILs) to control the bacterial infection and their spread. Ionic liquids are poorly coordinated organic salts characterized by melting points typically below 100 °C. The ability of ILs to form anionic and cationic interactions contributes to their versatile chemical, physical and biological attributes. In the present study, a total of 9 previously chemically synthesized and characterized ILs were used. For exploration of their antibacterial potential against the urinary tract infections (UTIs) caused by MDR Uropathogenic E. coli (UPEC) strains, in vitro and in vivo evaluation of ILs were performed. ILs showed pronounced zone of inhibition (ZOI), minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) values of 29.5 mm, 3.81 μM and 5.08 μM by agar disk diffusion and broth micro-dilution methods, respectively. Scanning electron microscopy results depicted substantial morphological changes in UPEC biofilm formation ascertaining antibiofilm potential of tested ILs. Moreover, ILs showed exceptional antioxidant potential depicted by DPPH assay along with low cytotoxic effect toward mammalian cell lines (NB4), red blood cells and whole blood. Furthermore, the gene expression analysis results justified the antibacterial potential of ILs showing down-regulation of fimH, uvrY and up-regulation of csrA gene in UPEC after ILs treatment. In vivo dermal sensitivity assessment also established their non-cytotoxic behavior. In silico analysis validated these results, with the majority of the compounds exhibiting moderate to good absorption.Due to remarkable antibacterial and antioxidant potential and negligible cytoxicity, it could be inferred that ILs could serve as novel antimicrobial alternative agents in the treatment of UTIs.

The Role of the Gut Microbiome in Urinary Tract Infections: A Narrative Review.

Urinary tract infections (UTIs) represent a substantial health concern worldwide. Although it is known that the gut can act as a reservoir for UTI-causing pathogens, the exact role of the gut microbiome in developing UTIs remains unclear. This review aims to investigate the link between the gut microbiome and UTIs and whether gut dysbiosis increases the risk of getting a UTI. To find relevant studies, a search was conducted across three databases, PubMed, EMBASE and Cochrane Library. Only records that directly described the association between the gut microbiome and UTIs were included in this review. Of the numerous studies retrieved, eight studies met the pre-set criteria and were selected for the review. The findings suggest several potential ways in which gut dysbiosis might enhance UTI susceptibility. A low gut microbiome diversity, a reduced level of bacteria involved in short-chain fatty acid (SCFA) production and a high abundance of Escherichia coli (E. coli) among UTI patients all offer a reasonable explanation for the existence of a link between an altered gut microbiome and UTIs. However, contradictory study results make it difficult to verify this. Research on the link between the gut microbiome and UTIs is limited, and further studies need to be carried out to substantiate this relationship, as this can bring attention to finding improved and more relevant treatment for UTIs.

69 Urinary tract infections in preterm infants: Review in two Canadian tertiary centers

Abstract Background Urinary tract infections (UTI) in premature infants are commonly seen in the neonatal intensive care unit (NICU). The reported prevalence of UTI in this population ranges from 1.9-12.2% due to the lack of standardized criteria for UTI among infants less than two months of age. Enterococcus and Enterobacteriaceae are well known to cause UTI and their resistance pattern has been reported to be rising in the neonatal nosocomial infections worldwide. Objectives To describe the epidemiology, microbiology, and antimicrobial treatment for UTI in premature infants based on different diagnostic criteria. Design/Methods This retrospective study (2019-2022) included infants born at &amp;lt;33 weeks of gestational age (GA) with positive urine cultures and ≥5 days of antimicrobials treatment. We collected data from two tertiary level NICUs in Canada, including demographics, microbial susceptibility patterns, urinalysis and imaging results, and antibiotic treatment. Results We identified 43 infants managed as UTI based on physicians’ discretions. The median GA at birth was 26-27 weeks, while the median onset of first UTI ranged 39-80 days, with male predominance [Table 2]. Mixed growth of organisms constituted 21-42% of cases of UTI [Table 1]. Among UTI cases with only single growth organism, we found 53.5% and 18.6% cases fulfilled UTI diagnostic criteria based on the concentration of colony forming units (CFU) of &amp;gt;104/mL or &amp;gt;107/L and &amp;gt;105/mL or &amp;gt;108/L, respectively [Table 1]. Of these cases, 67.4% of infants had urinalysis sent with the culture, and the higher the concentration of CFU, the more likely the samples showed positive nitrites on urinalysis, with 100% correlation among those with CFU &amp;gt;105/mL or &amp;gt;108/L. [Table 1] The most common pathogens were Enterococcus species, E.Coli, Klebsiella species, Citrobacter species and Enterobacter cloacae complex [Table 2]. Among gram negative bacilli (E. Coli and Klebsiella species), greater than 42-80% were resistant to 3rd generation cephalosporins (3GC). We did not identify any vancomycin-resistant Enterococcus strains. Median duration of antimicrobial treatment ranged from 8-13 days, depending on the diagnostic criteria applied. At least 10% of infants with UTI showed abnormalities on kidney ultrasound [Table 2]. Conclusion There exists a large variation in UTI prevalence according to different diagnostic criteria. Abnormal urinalysis with presence of nitrites were frequently associated with UTI of high CFU count. High resistance to 3GC among gram negative bacilli was concerning and carried an impact on the appropriate empirical treatment choice.

Association Between Spontaneous Preterm Labor and Genitourinary Tract Infections Among Pregnant Women in a Tertiary Care Hospital in South India: A Cross-Sectional Study.

Introduction and objectives Preterm labor, defined by the WHO as the onset of labor between 20 and 37 weeks of gestation, is a major contributor to neonatal morbidity and mortality, with spontaneous preterm birth accounting for two-thirds of these cases. Genitourinary tract infections, particularly urinary tract infections (UTIs), are a significant risk factor for preterm labor, with studies suggesting that 40% of spontaneous preterm births are associated with genital tract infections. This study aims to determine the association between spontaneous preterm labor and genitourinary tract infections in a sample of antenatal women and evaluate its impact on maternal and neonatal outcomes. Methods This cross-sectional study included 144 antenatal women with spontaneous preterm labor, threatened preterm labor, or preterm premature rupture of membranes (PPROM), presenting between 28 and 37 weeks of gestation at Sri Ramachandra Medical College. Midstream urine samples and vaginal swabs were collected for culture and sensitivity testing. Additional parameters, such as maternal age, body mass index (BMI), parity, socioeconomic status (SES), and history of preterm births, were recorded. Blood tests were performed to measure total counts and C-reactive protein (CRP) levels. Maternal and neonatal outcomes, including birth weight and neonatal sepsis, were analyzed. Results Of the 144 women, 34 (24%) had a positive UTI culture, withEscherichia colibeing the most common organism isolated (35%). The majority of UTI-positive cases were observed in women aged 25-29 years (13, 38%) and those from lower socioeconomic classes (22, 65%). A significant association was found between positive UTI cases and elevated total white blood cell counts and CRP levels. Neonatal outcomes in UTI-positive cases included low birth weight (13, 38%) and neonatal sepsis (3, 9%), while maternal complications were mostly limited to asymptomatic bacteriuria and acute cystitis. Conclusion The study demonstrates a significant association between spontaneous preterm labor and UTIs. Regular screening for genitourinary infections in pregnancy, particularly in high-risk groups such as women from lower socioeconomic backgrounds, could help reduce the incidence of preterm labor and improve neonatal outcomes. Early diagnosis and treatment of UTIs are crucial for preventing complications in both mothers and neonates.

Suppression of virulence factors of uropathogenic Escherichia coli by Trans-resveratrol and design of nanoemulgel

BackgroundDevelopment of multidrug resistance in Uropathogenic Escherichia coli (UPEC) makes treatment of Urinary Tract Infections (UTIs) a major challenge. This study was conducted to investigate the effect of trans-resveratrol (t-RSV) at a subinhibitory concentration (sub-MIC-t-RSV) on phenotypic and genotypic expression of virulence factors of clinical isolates of UPEC and develop a nanoformulation of t-RSV. Fifty-five clinical UPEC strains were investigated for the presence of virulence factors by phenotypic methods and PCR detection of virulence genes. The effect of sub-MIC-t-RSV was studied on the phenotypic and genotypic expression of virulence factors. t-RSV-loaded nanoemulgel formulation was prepared and characterized.ResultsOut of the 55 tested isolates, 50.9% were biofilm producers, 23.6% showed both mannose-sensitive and mannose-resistant hemagglutination, 21.8% were serum-resistant, 18.2% were hemolysin producers, while 36.4% showed cytotoxic effect on HEp-2 cells. A total of 25.5% of the isolates harbor one or more of hly-A, cnf-1 and papC genes, while 54.5% were positive for one or more of fimH, iss and BssS genes. A concentration of 100 µg/mL of t-RSV effectively downregulates the phenotypic and genotypic expression of the virulence factors in positive isolates. A stable t-RSV-nanaoemulgel with droplet size of 180.3 nm and Zetapotential of -46.9 mV was obtained.ConclusionThe study proves the effective role of t-RSV as an antivirulence agent against clinical UPEC isolates in vitro and develops a stable t-RSV-nanoemulgel formulation to be assessed in vivo. The promising antibacterial and antivirulence properties of t-RSV place this natural compound to be a better alternative in the treatment of persistent UTIs.

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.

Pragmatic randomised trial assessing the impact of peer comparison and therapeutic recommendations, including repetition, on antibiotic prescribing patterns of family physicians across British Columbia for uncomplicated lower urinary tract infections

ObjectiveTo evaluate the impact of a personalised audit and feedback prescribing report (AF) and brief educational summary (ES) on empiric treatment of uncomplicated lower urinary tract infections (UTIs) by family...