Type Of Urinary Tract Infection Research Articles

Is stratification of antibiotic susceptibility of urinary pathogens useful in the Emergency Department?

RESUMENObjetivoDeterminar la sensibilidad antibiótica de los patógenos causantes de infección del tracto urinario (ITU) estratificándola en función de datos clínicos y demográficos de los pacientes.Material y métodosSe analizó sensibilidad antibiótica de las bacterias aisladas en orina de 144 pacientes con ITU escogidos al azar y se estratificó en función del sexo, la edad, el tipo de ITU, el haber padecido o no ITU previa y del tratamiento antibiótico previo.ResultadosSe analizó la sensibilidad global de todas las cepas y de las cepas de E. coli observándose diferencias significativas en función del sexo (fluoroquinolonas), la edad (cefuroxima, ertapenem, gentamicina), el tipo de ITU (cefuroxima, cefotaxima, ertapenem, fluoroquinolonas), el haber tenido ITU previa y antibioterapia previa (cefotaxima, fluoroquinolonas, fosfomicina).ConclusionesEl empleo de datos clínicos y demográficos adaptados a la población y a la epidemiología local de resistencia de los uropatógenos, podría ayudar a la elección del tratamiento empírico de la ITU.

Association Between Duration of Constipation and Frequency of Urinary Tract Infection in Children

Background: Constipation and Urinary Tract Infection (UTI) are common problems in children. The gastrointestinal tract and the urinary system are related together anatomically and functionally. Constipation is one of the possible causes of UTI and its recurrence. Objectives: The purpose of this study was to evaluate the association between the duration of constipation and the frequency of upper and lower UTI in children in Sanandaj. Methods: A descriptive-analytical study was performed on children with chronic constipation aged less than 12 years, referring to the Pediatric Gastroenterology Clinic of Besat Hospital in Sanandaj in 2018-2019. Urine analysis and culture were performed for all the patients. Data were recorded in separate questionnaires. Results: There were 220 children in this study. Most cases of constipation and UTI belonged to the group of 3-6 years. Constipation was more common in boys and UTI in girls. Lower UTI was more common than upper UTI. Besides, 45% of the patients had constipation for less than a year. There was no significant relationship between the duration of constipation and the prevalence and type of UTI (upper or lower) (P = 0.405, P = 0.911). Conclusions: Urinary tract infection was common in children with chronic constipation. There was no relationship between the duration of constipation and the frequency and type of UTI.

A Multifaceted Antimicrobial Stewardship Program for the Treatment of Uncomplicated Cystitis in Nursing Home Residents

Urinary tract infections are the most common infections in nursing home residents. However, most antibiotic use is for unlikely cystitis (ie, nonspecific symptoms and positive culture results secondary to asymptomatic bacteriuria or a urine sample improperly collected for culture) that is unnecessary and inappropriate. This antibiotic use is associated with an increased risk of antimicrobial resistance, adverse drug events, and Clostridioides difficile (formerly Clostridium difficile) infections. To determine the association of a multifaceted antimicrobial stewardship and quality improvement intervention with the reduction in unnecessary antimicrobial use for unlikely cystitis among noncatheterized nursing home residents. A quality improvement intervention evaluation was conducted to target antimicrobial use among residents with unlikely cystitis in 25 nursing homes across the United States. Baseline data were collected between February 1, 2017, and April 30, 2017. The intervention was conducted from May 1, 2017, to April 30, 2018. Intervention nursing homes (n = 12) were randomized to receive a 1-hour introductory webinar, pocket-sized educational cards, tools for system change, and educational clinical vignettes addressing the diagnosis and treatment of suspected uncomplicated cystitis. Monthly web-based coaching calls were held for staff of intervention nursing homes. All facilities received quarterly feedback reports regarding the management of uncomplicated cystitis. Control group nursing homes (n = 13) received usual care. The primary outcome was the incidence of antibiotic treatment for unlikely cystitis cases, defined using published criteria. Secondary outcomes included overall antibiotic use for any urinary tract infection and the safety outcomes of C difficile infections, as well as all-cause hospitalizations and death. Among the 25 nursing homes participating in this quality improvement study, including 512 408 intervention facility resident-days and 443 912 control facility resident-days, fewer unlikely cystitis cases were treated with antibiotics in intervention facilities compared with control facilities (adjusted incident rate ratio [AIRR], 0.73 [95% CI, 0.59-0.91]); C difficile infection rates were also lower in intervention nursing homes vs control nursing homes (AIRR, 0.35 [95% CI, 0.19-0.64]). Overall antibiotic use for any type of urinary tract infection was 17% lower in the intervention facilities than the control facilities (AIRR, 0.83 [95% CI, 0.70-0.99]; P = .04). There was no increase in all-cause hospitalizations or deaths due to the intervention (all-cause hospitalizations: AIRR, 0.95 [95% CI, 0.75-1.19]; all-cause death: AIRR, 0.92 [95% CI, 0.73-1.16]). This study suggests that a low-intensity, multifaceted intervention was associated with improved antibiotic prescribing for uncomplicated cystitis in a cohort of nursing homes without an adverse association with other safety outcomes. Although promising, further study is needed to determine whether the intervention could be widely implemented to assist facilities in meeting new federal nursing home requirements for antimicrobial stewardship and quality assurance performance improvement programs.

Risk factors affecting the prognosis of urinary tract infection in Chinese pediatric patients: Single-center experience.

Urinary tract infection (UTI) is common in children. The purpose of this retrospective study was to determine the various risk factors that usually affect the prognosis of UTI in children diagnosed with the disease. In the present retrospective study, we enrolled all pediatric patients diagnosed with UTI and hospitalized between 1 January 2013 and 31 July 2016 at Nanjing Children's Hospital. We then collected all the relevant patient clinical demographics and characteristics. The study involved 2,092 pediatric patients diagnosed with UTI. On logistic regression analysis, factors that could affect the prognosis of pediatric UTI were complications, hospitalization, intensive care unit (ICU) admission, type of UTI, urine culture results, blood lymphocytes, urine nitrites (NIT) and antibiotics (unstandardized coefficients, 0.06, <0.001, -0.28, 0.32, <0.001, 0.01, -0.11, 0.01, respectively, all P < 0.001). Complications, hospitalization, type of UTI, urine culture results, blood lymphocytes, and antibiotics had a significant, positive association with UTI prognosis. Meanwhile, ICU admission and urine NIT had a negative association with prognosis.

Risk factors affecting the prognosis of Chinese pediatric patients with urinary tract infections: one-single experience

Urinary Tract Infection (UTI) is very common among children. The purpose of this retrospective study was to determine the various risk factors that usually affect the prognosis of UTI in children diagnosed with the disease. In our retrospective study, we enrolled all pediatric patients who were diagnosed with UTIs and were hospitalized from January 1, 2013 to July 31, 2016 in Nanjing Children’s Hospital. We then collected all the relevant clinical demographics and the various characteristics of the children. The study included 2092 pediatric patients who were diagnosed with UTI. The analysis of Logistic regression showed that factors that can possibly affect the prognosis on children diagnosed with UTI include: complications, hospitalization, Intensive Care Unit (ICU) admission, type of UTI, urine culture results, blood lymphocyte, urine NIT and antibiotics administration (Unstandardized Coefficients were 0.06, <0.001, -0.28, 0.32, <0.001, 0.01, -0.11, 0.01, respectively, all P < 0.001). Complications, hospitalization, type of UTI, urine culture results, blood lymphocyte, and antibiotics administration were found to significantly influence the prognosis of UTI. Meanwhile, ICU admission and urine NIT showed negative association with prognosis.

Implementation of global antimicrobial resistance surveillance system (GLASS) in patients with bacteriuria

This study aimed to evaluate the practicality and advantage of Global Antimicrobial Resistance Surveillance System (GLASS) for surveillance of urine culture samples collected from patients with bacteriuria. GLASS has been implemented at a tertiary care university hospital in Thailand by using the web application program to collect clinical data and urine culture data from patients with positive urine culture. There were 5085 urine samples from 3545 patients that were sent to our microbiology laboratory during June-December 2017. Bacteriuria was found in 1944 patients. Of those, 952 had urinary tract infection (UTI), and 1161 had colonization. Among UTI patients, hospital-acquired infection (HAI) was observed in 74.2 %, and community-acquired infection (CAI) was found in 28.7 %. E. coli and S. agalactiae were more frequently observed in CAI, but P. aeruginosa, P. mirabilis, E. faecium, and A. baumannii were more prevalent in HAI. UTI isolates demonstrated less resistance to antibiotics than colonized isolates. Non-duplicate isolates of bacteria demonstrated less resistance than duplicate isolates. E. coli, K. pneumoniae, P. aeruginosa, P. mirabilis, E. faecalis, and E. faecium causing HAI were more resistant to antibiotics than those causing CAI. GLASS is feasible to implement and more beneficial than laboratory-based surveillance. This study collects additional information beyond GLASS including causative bacteria and colonizing bacteria; types of UTI; and more specific criteria to distinguish HAI from CAI so that such data can be used for developing more valid local guidelines for selecting antibiotic therapy in UTI patients in addition to AMR surveillance in urine samples.

Changes in Serum Levels of Interleukin-8 in Upper and Lower Urinary Tract Infections in 3 months to 12 years' children in Semnan

Background: Urinary tract infection (UTI) is one of the most common bacterial diseases in children. This infection can lead to serious complications, such as chronic kidney injury, chronic renal failure, and even hypertension. The aim of this study was to investigate changes in serum levels of interleukin-8 in upper and lower urinary tract infections, and to investigate its association with the type of urinary tract involvement. Methods: This was a cross-sectional and prospective study. The study population consisted of all children aged 3 months to 12 years' old who referred to Amiralmomenin Hospital in Semnan city. By convenience sampling, 57 children were enrolled and received either oral or injectable treatment. Interleukin-8 serum levels were measured before and 3 days after treatment, by ELISA method and using available kits. DMSA scan was performed one week after admission to assess the severity of kidney parenchymal involvement in order to determine and distinguish between lower and upper urinary tract infections. Results: Totally 57 subjects with mean age 21.2 ± 20.76 months were enrolled. Children aged more than 20 months were more likely to have upper urinary tract infection than the other group (P=0.005). In males, the prevalence of upper urinary tract infection was significantly lower (P = 0.049). Children with upper urinary tract infection had a higher interleukin-8 concentration (P=0.001) than the lower urinary tract infection. Conclusion: IL-8 had higher serum concentrations in upper urinary tract infections compared to lower urinary tract infections. As a result, this test can be used as a suitable substitute for DMSA scan, to predict the type of urinary tract infection.

An observational study of antibiotic prescription in management of urinary tract infection in the Arabian Gulf

Objectives: The aim of this study was to describe antibiotic prescription for management of urinary tract infections (UTIs) in daily clinical practice in the Arabian Gulf and to compare prescription patterns with the recommendations of different recent guidelines. Method: This was a multicentre, cross-sectional, observational study evaluating antibiotic prescription in the management of UTIs in five countries from the Arabian Gulf. Randomly selected physicians who routinely treat patients with UTIs enrolled consecutively adult patients prescribed an antibiotic for treatment or prophylaxis of a UTI. Data were collected on UTI symptoms, antibiotic prescription, co-medications and relevant diagnostic laboratory tests. Results: Fifty physicians enrolled 522 eligible patients. The reason for antibiotic prescription was treatment of a UTI in 502 patients, and prophylaxis in 20 patients. The most frequent types of UTI documented were cystitis (301 cases) and urethritis (143 patients). Overall, the most frequently prescribed antibiotics for treatment of active UTIs were levofloxacin (344 patients; 68.7%), ciprofloxacin (69 patients; 13.8%) and ceftriaxone (34 patients; 6.8%). The pattern of antibiotic prescription was essentially similar irrespective of the indication. Only six patients with uncomplicated acute cystitis received the treatment recommended as first choice in the European Association of Urology or Infectious Diseases Society of America and European Society of Clinical Microbiology and Infectious Disease guidelines (nitrofurantoin or trimethoprim/sulfamethoxazole). Conclusions: We observed pronounced divergence from international practice guidelines for the use of antibiotics for the treatment or prophylaxis of UTIs in the Arabian Gulf, even though most participating physicians, and essentially all urologists, claimed to be familiar with them. In this context, the development and diffusion of regional practice guidelines may be particularly useful. Level of evidence: Not applicable for this multicentre audit.

Radio-Nuclear Investigations in Children Aged 16 Years and Younger with Confirmed Urinary Tract Infection: A Cross Sectional Retrospective Study

A retrospective cross-sectional study conducted at Mediclinic City Hospital; a teaching hospital in collaboration with Mohammad Bin Rashid University for Medicine and health sciences in Dubai, United Arab Emirates (UAE). The aim of this study is to ascertain conduction of renal radio nuclear investigations, explicitly Kidney ureter bladder ultrasound scans (KUB US), Micturating cystourethrogram (MCUG), and Dimercaptosuccinicacid (DMSA) in children following Urinary Tract Infection (UTI), based on; age, type of UTI, and recurrence. Medical records of 421 patients aged 0-16 years with UTI were retrospectively studied. Sociodemographic variables were age, gender, type of UTI, and recurrence. Results showed that the most carried out investigation was KUB US (38.2%) (n=161). In children aged between 7 months and 3 years, 15% (n=8) of them had VUR or renal scarring, while only12% (n=11) of children aged > 3 years showed abnormal MCUG or DMSA regardless of the KUB US results. Interestingly more than half (56%) (n=236) of all patients (n=421) with recurrent UTI showed abnormalities by MCUG and or DMSA, while only 12.3% (n=14) of children with atypical UTI showed abnormalities. It is concluded that VUR and renal scarring predominantly occurred in patients with recurrent UTI and atypical UTI. Thus, children presenting with recurrent UTI are recommended to undergo MCUG and DMSA after the second recurrent episode rather than waiting for the third UTI incident. This study suggests that children aged 7 months to 3 years post UTI should undergo KUB US, MCUG (if it was a recurring UTI) plus DMSA or MAG3 with post-micturition study instead. Children older than 3 years presenting with recurrent UTI are recommended to undergo DMSA (regardless of the US results) and MAG3 with post-micturition study or MCUG especially if DMSA is abnormal. Keeping in mind, evaluating risk factors like family and past medical history are crucial before conducting any investigation, this is to avoid unnecessary scans, and at the same time implement measures to reduce risks resulting from complicated UTIs.

A retrospective study of urinary tract infections in post-operative gynae-oncology patients in a tertiary care hospital of Chhattisgarh

Introduction: Urinary tract infections (UTIs) are second most common hospital acquired infections. There are multiple risk factors for UTIs. Patients with gynecological malignancies undergoing treatment are more predisposed for getting UTIs as they have multiple risk factors including prolong duration of urinary catheterization. Objective: This retrospective study was done to find the incidence and risk factors related to the occurrence of urinary tract infections (UTIs) inpost-surgerygynecological cancer patients. Methods: Data of Ninety two women was collected and reviewed with domains covering known risk factors for the occurrence of urinary tract infections. Bacteriuria was defined as > 105 colony-forming units per milliliter. Results: 38% of women had UTI post-operatively. Among them, 71.4% infections were Escherichia coli. Catheter in situ for 7 days duration was found to be highly significant in the occurrence of UTI (p<0.01; OR 2.62). A positive correlation was found between the duration of the catheter in situ and type of UTI (P < 0.01). Conclusions: Urinary catheterization is known to be related to hospital-acquired infection, and risk can be reduced by a shorter duration of catheterization post surgery. Gynecologists need to be more aware of this risk and identify women who are more likely to be catheterized for longer and use preventive strategies for managing infection, such as silver nitrite-lined catheters.

Assessment of correlation between urinary secretary IgA (sIgA) levels and different types of urinary tract infection (UTI) in various age groups

Urinary tract infections (UTIs) currently rank among the most prevalent infectious diseases worldwide, with chronic and recurrent infections being especially problematic. Urinary secretory IgA (sIgA) in mucosal surface is an important immunological defense in preventing bacterial adherence to periurethral epithelia and uroepithelial. This is a thematic review describing and focusing on a central element which is taken into consideration from different point of views .So, the present study surveyed a brief consideration of assessment correlation between urinary sIgA levels and urinary tract infection (UTI) in various age groups. In children with anatomic abnormalities, higher rates of sIgA was seen compared to children without anatomic abnormalities. The interesting point was that children with recurrent UTI with normal urinary tract had lower levels of sIgA compared to the control group. Also, no remarkable difference of the sIgA concentration rate was seen in healthy and rUTI children who had no bacteriuria; yet, it was considerably higher in children with bacteriuria. It was proven that locally synthesized sIgA was low in patients’ urine with recurrent UTI, independent of the presence or absence of bacteriuria. UTI did not interfere with sIgA secretion as shown by high sIgA in patients with upper UTI. Low urinary sIgA may illustrate one factor predisposing to recurrent UTI. The outcomes displayed that the existence of sIgA is associated with the UTI in children as well as in adults; however, sIgA showed to be manipulative to the infective agent and can also be applied to recognize infection type. Therefore, evaluation of urine antibody levels can provide another marker of host responses to infection, which can be used either as a simple screening test or could be beneficial to facilitate along with other experiments in establishing an assessment.

Inactivation of Transcriptional Regulators during Within-Household Evolution of Escherichia coli.

We analyzed the within-household evolution of two household-associated Escherichia coli strains from pandemic clonal group ST131-H30, using isolates recovered from five individuals within two families, each of which had a distinct strain. Family 1's strain was represented by a urine isolate from the index patient (older sister) with recurrent cystitis and a blood isolate from her younger sister with fatal urosepsis. Family 2's strain was represented by a urine isolate from the index patient (father) with pyelonephritis and renal abscesses, blood and kidney drainage isolates from the daughter with emphysematous pyelonephritis, and urine and fecal isolates from the mother with cystitis. Collectively, the several variants of each family's strain had accumulated a total of 8 (family 1) and 39 (family 2) point mutations; no two isolates were identical. Of the 47 total mutations, 36 resulted in amino acid changes or truncation of coded proteins. Fourteen such mutations (39%) targeted genes encoding transcriptional regulators, and 9 (25%) involved DNA-binding transcription factors (TFs), which significantly exceeded the relative contribution of TF genes to the isolates' genomes (∼6%). At least one-half of the transcriptional regulator mutations were inactivating, based on phenotypic and/or transcriptional analysis. In particular, inactivating mutations in the global regulator LrhA (repressor of type 1 fimbriae and flagella) occurred in the blood isolates from both households and increased the virulence of E. coli strains in a murine sepsis model. The results indicate that E. coli undergoes adaptive evolution between and/or within hosts, generating subpopulations with distinctive phenotypes and virulence potential.IMPORTANCE The clonal evolution of bacterial strains associated with interhost transmission is poorly understood. We characterized the genome sequences of clonal descendants of two Escherichia coli strains, recovered at different time points from multiple individuals within two households who had different types of urinary tract infection. We found evidence that the E. coli strains underwent extensive mutational diversification between and within these individuals, driven disproportionately by inactivation of transcriptional regulators. In urosepsis isolates, the mutations observed in the global regulator LrhA increased bacterial virulence in a murine sepsis model. Our findings help in understanding the adaptive dynamics and strategies of E. coli during short-term natural evolution.

Unexpected Etiology of Pure Macroscopic Hematuria: Emphysematous Cystitis

Introduction: Emphysematous cystitis (EC) is a rare type of urinary tract infection characterized by the presence of gas in the bladder lumen. It is usually encountered in older women with uncontrolled diabetes mellitus (DM). Patients usually present with dysuria, hematuria, suprapubic pain, and less frequently, with pneumaturia. For definitive diagnosis, pathological examination is required but in most cases, computed tomography (CT) is adequate. With appropriate antibiotherapy and drainage; EC can be managed.Case Report: A 78-year-old woman who presented presented with hematuria was diagnosed with EC via CT scan. The patient was treated with antibiotherapy and placement of urethral Foley catheter.Conclusion: In the diagnosis and treatment of urinary tract infection in elderly women with uncontrolled DM, EC should be kept in mind because of its complications, and for suspicious cases, CT should be performed

Biofilm Formation and Immunomodulatory Activity of Proteus mirabilis Clinically Isolated Strains.

Urinary tract infections (UTIs) and catheter-associated UTIs (CAUTIs) are the principal hospital-acquired infections. Proteus mirabilis is characterized by several virulence factors able to promote adhesion and biofilm formation and ameliorate the colonization of urinary tract and the formation of crystalline biofilms on the abiotic surface of the urinary catheters. Since, to date, the role of P. mirabilis in the etiopathogenesis of different types of urinary tract infections is not well established, in this study we sought to characterize two different clinically isolated strains of P. mirabilis (PM1 and PM2) with distinctive phenotypes and analyzed various virulence factors possibly implicated in the ability to induce UTIs and CAUTIs. In particular, we analyzed motility, biofilm formation both on abiotic and biotic surfaces of PM1 and PM2 and paralleled these parameters with the ability to induce an inflammatory response in an epithelial cell model. Results showed that PM1 displayed major motility and a capacity to form biofilm and was associated with an anti-inflammatory response of host cells. Conversely, PM2 exhibited lack motility and a had slower organization in biofilm but promoted an increase of proinflammatory cytokine expression in infected epithelial cells. Our study provides data useful to start uncovering the pathologic basis of P. mirabilis-associated urinary infections. The evidence of different virulence factors expressed by PM1 and PM2 highlights the possibility to use precise and personalized therapies targeting specific virulence pathways.

Identification of novel compounds against lower urinary tract symptoms and cystitis through docking and virtual screening

Motivation: People suffering from infection in their urinary tract are more likely to get disease like cancer. Lower urinary tract symptom (LUTS) in male and Cystitis in female are common types of urinary tract infections. Drugs viz. alpha-blocker, 5-alpha-reductase inhibitors and antibiotics are used to treat these diseases. However, these drugs are also associated with adverse effects viz nausea etc. Therefore to overcome the adverse effects and to develop low-cost drugs, natural compounds need to be employed for target proteins. Result: The study was done with few novel proteins for LUTS and cystitis as targets and predicted their 3D structure using various tools. Predicted structures were validated and selected for the docking and virtual screening. Conclusion: Few natural promising compounds were identified in the study for further drug development.

A Case Report of Acute Lobar Nephronia Caused by Enterobacter cloacae

Acute lobar nephronia is an uncommon type of urinary tract infection affecting the kidneys and more commonly reported in the pediatrics population. It can be a precursor to renal abscess formation if undertreated. Escherichia coli is the commonest pathogen observed in adults with this condition but other organisms have also been reported. This case report describes a 65-year-old woman whose work-up for fever, nausea and vomiting led to the diagnosis of acute lobar nephronia caused by Enterobacter cloacae. The acute lobar nephronia was identified on ultrasound of the kidneys. She was successfully treated with intravenous gentamicin followed by oral ciprofloxacin. Repeat ultrasound showed resolution of the nephronia. This case highlights the need for clinicians to be aware of this condition and ensure appropriate antibiotic treatment to prevent progression into a renal abscess.

Routine blood cultures in the management of pyelonephritis in pregnancy for improving outcomes.

Pyelonephritis is a type of urinary tract infection (UTI) that affects the upper urinary tract and kidneys, and is one of the most common conditions for hospitalisation among pregnant women, aside from delivery. Samples of urine and blood are obtained and used for cultures as part of the diagnosis and management of the condition. Acute pyelonephritis requires hospitalisation with intravenous administration of antimicrobial agents. Several studies have questioned the necessity of obtaining blood cultures in addition to urine cultures, citing cost and questioning whether blood testing is superfluous. Pregnant women with bacteraemia require a change in the initial empirical treatment based on the blood culture. However, these cases are not common, and represent approximately 15% to 20% of cases. It is unclear whether blood cultures are essential for the effective management of the condition. To assess the effectiveness of routine blood cultures to improve health outcomes in the management of pyelonephritis in pregnant women. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register without language or date restrictions (31 December 2014). Randomised controlled trials and quasi-randomised trials comparing outcomes among pregnant women with pyelonephritis who received initial management with or without blood cultures. Cluster-randomised trials were eligible for inclusion in this review but none were identified. Clinical trials using a cross-over design were not eligible for inclusion. Two review authors independently assessed one trial report for inclusion. We identified one trial report but this was excluded. No clinical trials met the inclusion criteria for this review. There are no large-scale randomised controlled trials to assess outcomes in the management of pyelonephritis in pregnancy with or without blood cultures. Randomised controlled trials are needed to evaluate the effectiveness of managing pyelonephritis in pregnant women with or without blood cultures, and to assess any adverse outcomes as well as the cost-effectiveness of excluding blood cultures from treatment.

Uropathogenic Escherichia coli virulence genes: invaluable approaches for designing DNA microarray probes.

IntroductionThe pathotypes of uropathogenic Escherichia coli (UPEC) cause different types of urinary tract infections (UTIs). The presence of a wide range of virulence genes in UPEC enables us to design appropriate DNA microarray probes. These probes, which are used in DNA microarray technology, provide us with an accurate and rapid diagnosis and definitive treatment in association with UTIs caused by UPEC pathotypes. The main goal of this article is to introduce the UPEC virulence genes as invaluable approaches for designing DNA microarray probes.Material and methodsMain search engines such as Google Scholar and databases like NCBI were searched to find and study several original pieces of literature, review articles, and DNA gene sequences. In parallel with in silico studies, the experiences of the authors were helpful for selecting appropriate sources and writing this review article.ResultsThere is a significant variety of virulence genes among UPEC strains. The DNA sequences of virulence genes are fabulous patterns for designing microarray probes. The location of virulence genes and their sequence lengths influence the quality of probes.ConclusionsThe use of selected virulence genes for designing microarray probes gives us a wide range of choices from which the best probe candidates can be chosen. DNA microarray technology provides us with an accurate, rapid, cost-effective, sensitive, and specific molecular diagnostic method which is facilitated by designing microarray probes. Via these tools, we are able to have an accurate diagnosis and a definitive treatment regarding UTIs caused by UPEC pathotypes.

Association between body mass index and urinary tract infection in adult patients.

Background:Overweight and obesity have become a global public health over the last decades. Obesity has been suggested to be a risk factor for some infections, but studies often showed controversial findings. Few studies examined the relationship between body mass index (BMI) and urinary tract infection (UTI), showing inconsistent results.Objectives:The purpose of this study was to determine the relationship between BMI and UTI in adult patients.Patients and Methods:Adult patients (≥ 18 years old) who were referred to clinics or admitted in hospital with diagnosis of UTI were considered for participation in the study. Control group were selected from healthy adult normal population whom underwent medical check-ups at the same hospital and without history of UTI. Data about age, gender, history of diabetes mellitus and BMI were registered for individuals who met inclusion criteria.Results:A total of 116 patients with UTI and 156 people as the control group were included in the study. Two groups were matched for age, gender and history of diabetes mellitus. Mean BMI ± SD of patients was 25.2 ± 4.0 kg/m2 and the controls was 25.1 ± 3.6 kg/m2. There was no significant correlation between BMI and UTI (P = 0.757). Mean BMI ± SD of patients with upper UTI was 25.6 ± 4.1 kg/m2 and for lower UTI was 24.9 ± 4.0 kg/m2. There was no significant difference between BMI of controls and patients with any type of UTI (P = 0.573).Conclusions:Our findings did not found an association between BMI and UTI and does not support obesity as a risk factor for UTI in adult patients.

MP44-01 A COMPARISON OF PRACTICE PATTERNS IN THE MANAGEMENT OF VESICOURETERAL REFLUX BETWEEN PEDIATRIC UROLOGISTS AND PEDIATRIC NEPHROLOGISTS

INTRODUCTION AND OBJECTIVES: Vesicoureteral reflux (VUR) is often diagnosed and managed by both Pediatric Urologists (PU) and Pediatric Nephrologists (PN), yet little data exists comparing practice patterns between these two subspecialties. We sought to describe practice variation between PU and PN as it pertains to VUR. METHODS: An e-mail invitation was sent to 675 SPU and 753 ASPN members. Survey Monkey was used to obtain demographic and practice pattern data for commonly encountered clinical scenarios relating to VUR and urinary tract infection (UTI). Data from non-PU/PN responders and from those answering fewer than 37 of the 39 questions (95%) was excluded from analysis. Statistical analysis was performed using SPSS 17.0. Categorical variables were compared using Chisquare test or Fisher’s Exact Test. Pair-wise comparisons were made using the Bonferroni adjustment. RESULTS: 255 (18%) physicians responded; of these, 4 (2%) were non-PU/PN and 48 (19%) answered 95% of survey questions, resulting in a final cohort of 203 respondents (133 PU, 70 PN). Age and practice setting were similar; more non-US PU than PN responded to the survey (20% vs. 7%, P<0.05). 98% of PU and 83% of PN responded that they would evaluate a child with a single febrile UTI with imaging (p<0.001). 91% of PU and 99% of PN would evaluate a child with a multiple afebrile UTIs with imaging (p<0.001). Independent of the type of UTI, PU favor using KUB and DMSA more frequently than PN, whereas PN prefer renal sonogram or VCUG. 78% and 74% of PU were somewhat/very likely to consider deflux or reimplant for breakthrough infection, versus 60% and 28% of PN (p<0.05). 91% of PU vs. 76% of PN believe that treating bowel and bladder dysfunction (BBD) alone may lead to resolution of VUR (p<0.01). BBD screening by PU (58%) involved history and other modalities; PN rely most often on history alone (60%). 58% of urologists are somewhat/very likely to screen siblings with sonogram versus 40% of nephrologists (p<0.01). PU and PN were equally concerned with the emergence of resistant bacterial organisms when making decisions regarding prophylactic antibiotics (PN 72% vs. PU 69%). CONCLUSIONS: Minimal consensus exists between PU and PN in the diagnosis and management of VUR. PU use more diverse imaging in diagnosis and are more likely to pursue surgical intervention for breakthrough UTIs than PN. More aggressive evaluation for BBD by PU than PN may be related to belief in the impact BBD on VUR resolution. Further investigation is necessary to determine if practice variation is related to training, society guidelines, or other factors.