Urinary Research Articles

221 Opportunities for Antibiotic Stewardship for Pediatric Urinary Tract Infection for Outpatient Emergency Department and Urgent Care Encounters

221 Opportunities for Antibiotic Stewardship for Pediatric Urinary Tract Infection for Outpatient Emergency Department and Urgent Care Encounters

Molecular Characterization of Carbapenemase (Blakpc-2) Gene From Klebsiella Pneumoniae Involved in Urinary Tract Infection in Al-Najaf City

Background: The human gastrointestinal tract, eyes, respiratory system, and genitourinary tract are all home to K. pneumonia. KPCs, or Klebsiella pneumonia carbapenemases, are β-lactamase enzyme types that have the ability to hydrolyze β-lactam drugs. Because of many co-morbid diseases, immunological suppression, and critical sickness, this KPC-producing strain infection can be fatal. In this study K. pneumonia was isolated from urinary tract infected patients, Where seven clinical urine specimen obtained from patients has UTI were gathered from different diagnostic Al-Sajjad Hospital in Najaf province the KPC gene was amplified by PCR. In this present study, a particular primer derived from the antibiotic sensitivity (blaKPC-2) gene is used to screen the urine samples collected for Klebsiella pneumoniae stains utilizing culture techniques then sequence analysis of the blaKPC-2 gene was conducted in order to gain a fresh understanding of the genetic variations. It's interesting to note that, while comparing our strains' blaKPC-2 open reading frame to previously released sequences, we discovered 6 mutations. Therefore, of the seven samples analyzed, three exhibited a positive band. The purpose of the primer was to amplify the bacteria's blaKPC-2 antibiotic sensitivity gene. Conclusion: In this work, we verified a PCR technique for blaKPC-2 gene identification that is quick, sensitive, and specific. Out of the seven samples analyzed, three exhibited a positive band. The purpose of the primer was to amplify the bacteria's blaKPC-2 antibiotic sensitivity gene.

302 Evaluation of a Cellular Host Response Test for Risk-Stratifying Patients Presenting to the Emergency Department With Signs or Suspicion of Urinary Tract Infection

302 Evaluation of a Cellular Host Response Test for Risk-Stratifying Patients Presenting to the Emergency Department With Signs or Suspicion of Urinary Tract Infection

Vancomycin Resistant Enterococci and Trend of Antimicrobial Susceptibility in Urine Cultures

Background: Enterococci are emerging nosocomial pathogen showing resistance to broad spectrum antibiotics. As reported by the center for disease control and prevention, enterococci (13.9%) are the second leading cause of urinary tract infection, after Escherichia coli. After the first report of vancomycin-resistant enterococci in England (1988), India reported its first vancomycin resistant enterococci isolate from New Delhi (1999). The prevalence of vancomycin resistant enterococci ranges from 1-9%, in India. To evaluate the prevalence of vancomycin resistant enterococci among urinary isolates and to check their antimicrobial resistance pattern. Methods: A retrospective observational study conducted at a tertiary care hospital. Data were analysed from November, 2017 to October, 2018. A total of 12,129 urine samples were received and subjected to culture on HiCrome UTI agar (Hi-Media laboratories, Mumbai) and incubated at 37 °C for a period of 18-24 hours. Antimicrobial susceptibility was performed using Kirby–Bauer disc diffusion method. Identification was done on the basis of colony colour and species identification was done by using biochemical test as per standard laboratory protocol. In one case automated siemens microscan walkaway identification system was used for confirmation. Results: Enterococci were isolated in 4.06% from urine cultures out of which 7.52% were vancomycin resistant. Most of the vancomycin resistant enterococci isolate (86.49%) were multi drug resistant. Conclusion: In vancomycin resistant enterococci related urinary tract infection, nitrofurantoin can be used as an appropriate first choice in uncomplicated cases and linezolid should be reserved for serious and complicated urinary tract infections.

Female sexual dysfunctions in multiple sclerosis patients with lower urinary tract symptoms: an Italian case-control study.

Multiple sclerosis (MS) is a recurrent, autoimmune, and inflammatory demyelinating chronic disease that typically manifests in young adulthood and exerts adverse effects on sexual functions. The study evaluated the prevalence of sexual dysfunctions (SDs) and the relationship with neurological disability, depression, and lower urinary tract symptoms (LUTS) in a cohort of MS female patients, comparing these results with those of healthy women. From January 2023 to January 2024, consecutive premenopausal female patients with MS, were recruited and the examination included urinalysis, ultrasonography and a urodynamic test according to the International Continence Society standard. Descriptive statistics were reported as mean and standard deviation for continuous variables (analyzed by independent samples Mann-Whitney U test and independent samples Kruskal-Wallis test) while categorical variables were reported as frequency and percentage (analyzed by chi-square test with Fisher's exact test). Female Sexual Function Index (FSFI) total score and all FSFI subscales scores were significantly lower in patients with MS vs healthy control subjects (P < .001); FSFI total scores and all FSFI subscale scores were statistically significantly lower in patients with MS with an International Prostate Symptom Score ≥20 (P < .001) and considering a cutoff for Beck Depression Inventory-II score ≥17, depression was present in 61% (n = 47 of 77) of patients with MS and completely absent in the control group. The knowledge that SDs are a common problem in MS and in other chronic illnesses can alleviate the feeling of stigma and talking openly of sexual problems can be helpful for the patients and so the doctor-patient relationship can be reinforced. The sample was drawn from a single center, and larger multicenter studies that include both genders are needed to obtain strong results. Our findings confirm the idea of a polygenic and multifactorial etiology of female SDs in MS. Therefore, women with MS should be evaluated in terms of SDs during follow-ups.

Plasma procalcitonin and urine interleukin-8, Neutrophil Gelatinase-Associated Lipocalin, and calprotectin in the diagnostic process of a urinary tract infection at the emergency department

ObjectivesTo assess the usefulness of plasma procalcitonin and urine interleukin-8 (IL-8), Neutrophil Gelatinase-Associated Lipocalin (NGAL), and calprotectin for diagnosis of urinary tract infections (UTIs) at the emergency department (ED). MethodsIn adults presenting at the ED with UTI suspicion, biomarker performance was compared to routine diagnostics (urine dipstick, automated urinalysis). Patients with a urine catheter, leukopenia or neither (standard) were analysed separately. ResultsA UTI was clinically diagnosed in 91/196 episodes (46.4%); standard: 29/67 (43.2%), catheter 46/73 (63.0%), leukopenia 17/60 (28.3%) (4 had both). Procalcitonin did not discriminate between UTI and no UTI. Urinary biomarker levels were elevated in UTI episodes (median, µg/mmol creatinine): NGAL 7.8 vs. 46.3, IL-8 6.1 vs. 76.6, calprotectin 23.9 vs. 265.4; the three subgroups also had higher levels. Biomarker cut-off values (90% sensitivity) showed a low specificity (range 20.8%-64.9%) and moderate accuracy (58.6%-75.4%). The biomarkers performed comparable with routine diagnostics, except for leukopenic patients with not-significantly higher AUC values. All urinary biomarkers correlated positively with urine leucocyte count. ConclusionsPlasma procalcitonin could not accurately diagnose a UTI. Urine IL-8, NGAL, and calprotectin showed no additional value to routine diagnostics, except a minor improvement in leukopenic patients. These urine biomarkers seem to predominantly reflect leukocyturia.

60 Introduction of Urinalysis With Reflex Culture Orders and Association With Screening, Diagnosis, and Treatment Practices for Urinary Tract Infections in the Emergency Department

60 Introduction of Urinalysis With Reflex Culture Orders and Association With Screening, Diagnosis, and Treatment Practices for Urinary Tract Infections in the Emergency Department

&lt;i&gt;Enterococcus hirae&lt;/i&gt; Bacteremia Secondary to Urinary Tract Infection: A Case Report

&lt;i&gt;Enterococcus hirae&lt;/i&gt; (&lt;i&gt;E. hirae&lt;/i&gt;) infection is an uncommon pathogen in human infections. Bacteremia due to E. hirae associated with urinary tract infection is uncommon. We present a case of &lt;i&gt;E. hirae&lt;/i&gt; bacteremia in a young woman with no underlying comorbidities. This case report emphasizes the importance of considering &lt;i&gt;E. hirae&lt;/i&gt; as a potential pathogen in urinary tract infections.

PCR Detection of Spreading TEM and CTX-M gene in Klebsiella oxytoca isolate from Urinary Tract Infection

PCR Detection of Spreading TEM and CTX-M gene in Klebsiella oxytoca isolate from Urinary Tract Infection

Diagnosis and Treatment of Hematuria

Hematuria is a common manifestation caused by various factors such as infection, inflammation, trauma, urinary stone and malignancy. Hematuria reflects pathological state of urinary system. Isolated microscopic hematuria without any abnormalities besides of hematuria on urine microscopic examination usually presents a good clinical course or outcome. However, significant proteinuria or hypertension, which accelerates renal dysfunction, can often develop during follow-up period in patients with isolated microscopic hematuria. Compared with non-glomerular hematuria, glomerular hematuria shows several characteristic findings such as dysmorphic red blood cell (RBC) or RBC casts or significant proteinuria on urinalysis. If glomerular hematuria is strongly suspected, a kidney biopsy may be required to differentiate the cause of glomerulonephritis. In this review, we tried to review the differential diagnosis and diagnostic approach and treatment of hematuria.

Urinary tract infection pathogens diagnosed in Basra city hospitals

Background. Urinary tract infection (UTI) is the growth of pathological bacteria within the urinary tract, and is one of the most common types of bacterial infections worldwide. Bacterial resistance to antibiotics is a major public health concern. Antibiotic-resistant bacterial infections exacerbate the situation in developed, developing and underdeveloped countries. Objective. The aim of this research is to identify the frequency of different bacterial pathogens and their sensitivity to different types of antibiotics in patients suffering from UTI in Basra city hospitals. Method. This cross-sectional study included 505 samples positive for bacterial growth. It was conducted by data extraction from hospital laboratory records, where information was obtained about bacterial examination of urine samples taken from patients with urinary tract infection. The samples were cultured and antibiotic sensitivity was tested by laboratory workers, in order to determine the appropriate treatment for patients. Results and conclusions. The average age of patients was 43.5 years, of whom (60.4%) were females. The most common bacteria was Escherichia coli (40.6%). In antibiotic susceptibility testing process, gentamicin (5.7%), ciprofloxacin (4.7%), trimethoprim (4.7%), trimethoprim/sulfamethoxazole (4.1%), and cefepime (3.9%) were the most frequently used antibiotics, while cefotetan (0.06%), ampicillin-sulbactam (0.09%), mupirocin (0.2%), cefazolin (0.2%), fosfomycin and amoxicillin (0.2%) were the least used. The highest sensitivity shown by cultured bacteria was to linezolid (95.5%), ertapenem (91.7%), teicoplanin (79.4%), nitrofurantoin (75.2%) and amikacin (72.4%). The highest resistance shown by cultured bacteria was to cefazolin (100%), oxacillin (94.6%), fusidic acid (91.2%), ampicillin (90.4%), and amoxicillin (88.2%).

Prevalence of multi-drug resistant Staphylococcus aureus and Escherichia Coli isolated from urinary tract

Prevalence of multi-drug resistant Staphylococcus aureus and Escherichia Coli isolated from urinary tract

The Impact of Covid-19 on Lower Urinary Tract Symptoms (LUTS) in Patients Treated Conservatively for Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) is a non-malignant urological pathology characterized by a progressive increase in the volume of the prostate gland and one of the important diseases which affect lower urinary tract symptoms (LUTS). Covid-19 is a new viral infection with epidemiological characteristics of a pandemic. The disease is presented as a respiratory, cardiovascular, and neurological late complication. There is limited data that low urinary tract can be affected and aggravate symptoms and quality of life (QoL). Our pilot study describes a male population treated with conservative methods for BPH and the effect of Covid-19 infection on their LUTS and QoL. This was a case-control study between April 2021 and November 2021. The study included 33 patients with a history of Covid-19 infection. The assessment of LUTS was carried out by processing the data obtained from the completed by the patients IPSS questionnaires (the last one before, immediately, and five months after Covid-19). The control group consisted of 50 patients, which for the management of the selection bias, matched according to demographic and clinical features of the group. All patients underwent ultrasound diagnostics giving information about the volume of the prostate gland and the amount of residual urine. Two years after the beginning of the Covid-19 pandemic, we can confidently say that not all characteristics of this type of infection are sufficiently clear. More in-depth studies on Covid-19 as a cause of worsening LUTS and overall progression of BPH could help identify new aspects of infection leading to significant improvements in its treatment.

Complications associated with recovered after COVID-19 in Slovenia: Epidemiological study

Introduction: COVID-19 is an infectious viral disease caused by Sars-cov-2, which affects various organ systems and leads the county in the field of body functions, body structure and, consequently, activity and participation. Since the virus binds to ACE 2 receptors, which are also present in myocytes, intestinal epithelium, vascular endothelium, kidneys and elsewhere, COVID-19 affects not only the respiratory system, but also other organ systems Aim: The purpose of the study is to determine which complications arise after recovering from COVID-19. Methods: We use a retrospective review of medical records is a research method that involves analyzing existing medical documentation to gain insights into the course of diseases, treatments, or treatment outcomes. We performed 502 reviews of medical records and identified 141 patients with post-COVID-19 complications. Statistical analysis was performed with IBM SPSS version 25.0 and show in frequency and percentage. The study was approved by the Ministry of Health, Medical Ethics Committee of the Republic of Slovenia with serial number: 0120-468/5022/6. Results: Most complications after recovering from COVID-19 were observed in the cardiovascular system (n= 79; 56.0%) and the respiratory system (n= 59; 41.8%). Most of these are Palpitations (n= 27; 19.0%), cough (n= 23; 16.2%), Pneumonia (n= 21; 17.8%) and Infectious myocarditis (n= 17; 12.0 %). After recovering from COVID-19, arterial embolism and thromboembolism occur first (14 days), followed by pulmonary embolism (16 days), pulmonary edema (23 days), sepsis (28 days) and infectious myocarditis (29 days). In addition, we noticed complications after recovering from COVID-19 on the skin, urinary system, sensory system, endocrine system, gastrointestinal system and nervous system. Conclusion: Our study has shown that COVID-19 is indeed a systemic disease. Post-COVID-19 complications will barely begin to show themselves, so we believe that we have laid a good foundation for further epidemiological research.

Application of Antithrombotic Drugs in Patients with Acute Type B Aortic Dissection Underwent Thoracic Endovascular Aortic Repair.

This study aimed to evaluate the safety and necessity of antithrombotic drugs for acute type B aortic dissection (TBAD) treated with thoracic endovascular aortic repair (TEVAR).The patients of acute TBAD treated with TEVAR were retrospectively enrolled from January 2007 to October 2022 in General Hospital of Northern Theater Command. The primary outcomes such as mortality and aortic adverse events [stroke, paraplegia, limb ischemia, organ failure (renal and intestinal tract), endoleak, redissection, aortic rupture, reintervention, and mortality] were recorded and evaluated at 1 month (early term) and 18 months (late term).The 697 patients of TBAD treated with TEVAR were divided into the antithrombotic (AT) group (n = 208) and nonantithrombotic (NAT) group (n = 489). The incidence of early mortality, early aortic adverse events, and the 18 months of cumulative freedom from all-cause mortality and aortic adverse events were not significantly different between the AT and NAT groups (2.4% versus 1.4%, 2.9% versus 4.5%, 94.7% versus 96.5% and 88.4% versus 89.9%, respectively). Log-rank tests also indicated that there were no significant differences. In multivariate Cox regression models, only pleural effusion, partially thrombosed of false lumen, maximum diameter of false lumen, and branch involvement were independent predictors of mortality, whereas the systolic blood pressure (SBP), pleural effusion, partially thrombosed of false lumen, true lumen compression, maximum diameter of false lumen, branch involvement were independent predictors of adverse aortic events.The antithrombotic drug for acute TBAD treated with TEVAR does not influence the mortality and aortic events in the early and late terms.

N-terminal pro-B-type natriuretic peptide, eGFR and progression of kidney disease in chronic kidney disease patients without heart failure

Abstract Background Cardiorenal syndrome highlights the bidirectional relationship between kidney and heart dysfunction. N-terminal pro-B-type natriuretic peptide (NT-proBNP), which is the gold standard biomarker in heart failure (HF), may be an important biomarker for chronic kidney disease (CKD) progression. However, NT-proBNP is negatively related with estimated glomerular filtration rate (eGFR). In this study, we investigated the association of NT-proBNP, eGFR and progression of kidney disease in CKD patients without HF. Methods This multicentric retrospective cohort study recruited 23 860 CKD patients without HF, who had at least one NT-proBNP record from China Renal Data System database. Linear regression model evaluated the relationship between eGFR and NT-proBNP. Cox regression analysis assessed the association between NT-proBNP and CKD progression. Sensitivity analysis examined the robustness of the main findings. Results This study involved 23 860 CKD patients without heart failure, distributed across different CKD stages: 10 526 in stages G1-2, 4 665 in G3a, 3 702 in G3b, 2 704 in G4, and 2 263 in G5. NT-proBNP was negatively correlated with eGFR, particularly in stages 4–5 CKD. A 15-unit decrease in eGFR was associated with increases in log (NT-proBNP) levels by 1.04-fold, 1.27-fold, 1.29-fold, 1.80-fold, and 3.50-fold for stages 1–2, 3a, 3b, 4, and 5, respectively. After excluding patients who developed CKD progression within one year, the Cox regression analysis revealed that the relationship between NT-proBNP and CKD progression was not significant in stages 4 and 5. However, for stages 1–3, each standard deviation increase in log (NT-proBNP) was associated with a 26%, 36%, and 28% higher risk of CKD progression, with P-interaction ≤ 0.001. The hazard ratios were 1.26 (95% CI, 1.18 to 1.35), 1.36 (95% CI, 1.22 to 1.51), and 1.28 (95% CI, 1.14 to 1.43) for stages 1–2, stage 3a, and stage 3b, respectively. Conclusions Despite its strong inverse association with eGFR, NT-proBNP was positively associated with the risk of progression of kidney disease in CKD patients with stages 1–3 without HF. Future studies should investigate the effectiveness of NT-proBNP as a predictive biomarker for the progression of kidney disease across diverse racial groups and healthcare settings.

A Rare Case and Literature Review of Pyelo-Hepatic Abscess in an Immunocompetent Patient: When Effective Source Control and Targeted Antimicrobial Therapy Might Not Be Enough

Pyelo-hepatic abscess is a rare complication of upper urinary tract infections (UTIs). We describe a case of polymicrobial pyelo-hepatic abscess in an immunocompetent patient. A 71-year-old male patient with a double-J stent for right ureteral lithiasis was admitted in our Infectious Diseases Department for a pyelo-hepatic abscess. Despite a targeted antibiotic therapy against an extended spectrum betalactamase-negative Escherichia coli, the patient did not improve. Further examinations revealed a possible polymicrobial aetiology, including Candida spp. and E. coli resistant to piperacillin/tazobactam but sensitive to third-generation cephalosporins. To date, a paucity of articles regarding pyelo-hepatic abscess exist, consisting mostly of case reports. Urinary stones and a ureteral stent indwelling time exceeding 90 days are known risk factors for upper UTIs and for bacterial dissemination in contiguous organs. Pyelo-hepatic abscesses usually involve Gram-negative bacilli, but they can be polymicrobial, including fungi. As a range of factors could limit the efficacy of antibiotics inside an encapsulated lesion and might contribute to the selection of resistant species during treatment, clinicians should be aware of this complication and try to prevent this event by acting on the main modifiable risk factor.

Recurrent Urinary Tract Infection- Etiology, Risk Factors and Outcome in a Tertiary Care Hospital of Bangladesh

Background: Urinary tract infections (UTIs) are one of the major causes of morbidity and comorbidities in patients with underlying conditions, and it accounts for the majority of the reasons for hospital visit globally. The high prevalence of recurrent UTIs represents a modifiable determinant for both societal and personal burdens, hence the importance of disease prophylaxis. Consultations for UTIs represent between 1% and 6% of all medical visits (~7 million visits and ~US$1.6 billion annually). They are associated with a significant burden of morbidity and mortality in the elderly, among whom UTIs are most prevalent. Methods: This cross-sectional descriptive type of observational study was conducted in the Department of Nephrology in Anwer Khan Modern Medical College Hospital, Dhaka, Bangladesh from January 2023, to December 2023. A total no of 93 patients were included in the study. Inpatients, age range 21-85 years, presenting or highly suspicious of having UTIs and the occurrence of ≥2 symptomatic episodes within 6 months or ≥3symptomatic episodes within 12 months were recruited in the study. Any patient who was terminally ill, who fails to give urine samples, with a history of antibiotic administration in the last two weeks and any female who was in their menstruation period were excluded from the study. Results: Among them 79 were female and 14 were male. Female to male ratio was 5.64:1. Mean age of the patients was 58.61±17.51 (Mean±SD). Most of the patients were of 61-70 years age group 23/93 (24.73%) and after that41-50 years 19/93 (20.43%). 92.47% (86/93) were married and 7.53% (7/93) were unmarried. Most of the patients were of Diabetes mellitus (DM) 57/93 (61.29%). After that Hypertension, Chronic Kidney Disease (CKD) and CKD + DM about 51/93 (54.84%), 39/93 (41.94%) and 36/93 (38.71%) respectively. 54/79 (68.35%) were of menopause and 24/79 (30.38%) women had regular menstrual cycle. 1/79 (1.27%) was pregnant.Escherichia coli(E coli) was the most prevalent uropathogens with 47/93 (50.54%) followed by Klebsiella pneumoniae 12/93 (12.90%), Pseudomonas aeruginosa 10/93 (10.75%), Streptococcus pyogenes 8/93 (8.60%), Staphylococcus aureus 6/43 (6.45%), Enterococcus faecalis 5/93 (5.38%) and others 5/93 (5.38%). 77.42% were of relapse and 22.52% were of reinfection. The Mean±SD of HbA1c was 7.83±2.15% and that of Serum creatinine and Hemoglobin were 2.17±1.18 mg/dl and 9.82±2.60gm%. On routine examination of urine, 39/93 (41.94%) patient had trace albumin present in urine and 57/93 (61.29%) had reducing sugar. 71/93 (76.34%) had1-2 pus cell in urine and 22/93 (23.66%) presented with plenty of pus cell with 19/93 (20.43%) had 0-4 RBC’s (Red blood cell). Factors associated with recurrent UTI were Age &gt;50 years (56.99%), Female gender (84.95%), Married (92.47%), Menopause (58.06%), Diabetes mellitus (61.29%), Indwelling catheter &gt;6 days (25.81%) and Genitourinary abnormalities (15.05%). Conclusion: This study has demonstrated that hospitalization, married individuals, duration of catheter, diabetes mellitus, genitourinary tract abnormalities, female gender and menopause are the most important factors associated with UTIs. Appropriate measures may help to reduce UTIs due to these associated factors. We recommend routine UTIs screening of patients of the following category: hospitalized, genitourinary tract abnormalities, indwelling catheter, diabetic, female gender, menopause and married individuals. If these routine checks are put in place, prevention of UTI can be realized at lower cost. Bangladesh J Medicine 2024; 35: 173-179

A Unique Presentation of Excitatory Catatonia Alongside AntiNmda Receptor Encephalitis: A Case Report

Introduction: Anti-NMDA receptor encephalitis, first described in 2007, is a prominent cause of autoimmune encephalitis, predominantly affecting females. Its clinical presentation includes a prodromal phase with flu-like symptoms, followed by psychosis, unresponsiveness, hyperkinesis, and recovery [1]. Catatonia can coexist sounds better than cooccur in patients with anti-NMDA receptor encephalitis, complicating diagnosis and effective treatment. Case Summary: This case report discusses a 41-year-old African American female with a history of seizure disorder, schizoaffective disorder with catatonia, developmental delay, Catatonia in itself is not the diagnosis as per dsm 5. We could use it as a specifier with other diagnosis, be it schizoaffective disorder or seizure disorder here. So we could mention as schizoaffective disorder with catatonia. and recent bereavement. Her symptoms included variable motor hyperactivity, alternating between restlessness and sedation, with an initial Busch Francis Rating Scale score of 18. Initially diagnosed with excitatory catatonia secondary to schizoaffective disorder and treated with benzodiazepines, her condition failed to improve, prompting further investigation. Despite additional treatment for a urinary tract infection and medication adjustment, which included adding valproic acid and amantadine, her condition remained uncontrolled. Subsequent lumbar puncture revealed inflammatory markers, and her anti-NMDA receptor IgG antibody assay was positive at 1:1280, confirming the diagnosis of anti-NMDA receptor encephalitis. Treatment was escalated to include methylprednisolone and intravenous immunoglobulin, alongside six sessions of ECT for management of her catatonia. The patient showed significant improvement, achieving functional recovery and independence in daily activities before discharge. Conclusion: This case emphasizes the importance of considering anti-NMDA receptor encephalitis in patients with unexplained, refractory neuropsychiatric symptoms, such as catatonia, and highlights the value of a multidisciplinary approach in managing and rehabilitating affected individuals. Prompt diagnosis and treatment are crucial to improving outcomes and reducing the risk of persistent cognitive deficits.

A Study of the Characteristics and Properties of P. aeruginosa Isolated from Different Sources and their Resistance to Antibiotics

Pseudomonas aeruginosa, a common opportunistic bacterium, is a major source of human surface infections. Infections with these bacteria are difficult to cure and cause significant economic implications. Objectives The current study looked at the antibiotic resistance patterns of P. aeruginosa isolated from burns, wound swabs, and urinary tract infections that were referred to Iraq Hospitals' emergency health care units. From October 2022 to May 2023, 180 swabs were collected from burn and wound patients (110 burns, 67 wounds, and 3 urinary tract infections) of both sexes, (80) males and (100) females, aged 1-72 years, at Baghdad government hospitals: Ghazi Al-Hariri Hospital, Central Laboratories, Specialized Burns Hospital, and Yarmouk Hospital. Results:(180) diagnostic swabs from patients with burns and wound infections of both sexes, (80) males and (100) females, aged 1–72 years. The current study found 25(31.25) more P. aeruginosa positive cases in males than females, with 29(29) out of 54 positive cases. The study discovered that the age group 21-30 years had the highest rate of bacterial infection, followed by the age groups 11-20 and 1-10, with 11 (20.37%), 10 (18.51%), and 10 (18.51%), respectively. According to the current study's findings, the antibiotics Amikacin, Gentamicin, Ceftazidime, Cefepime, Netilmicin, and Tobramycin showed the highest resistance rates (81.4%, 81.4%, 79.6%, 72.2%, 74%, and 79.6%, respectively).The test findings showed that 52 isolates (96%) produced pyrocyanin and hemolysins. Bacterial colonies were white to gray with a sticky feel. All isolates exhibited β-hemolysis.Alkaline protease production All isolates exhibited a translucent halo surrounding the bacterial colonies.Lipase production All isolates exhibited a hazy halo surrounding the development zone of P.aeruginosa colonies. The current study discovered that the antibiotics Amikacin, Gentamicin, Ceftazidime, Cefepime, Netilmicin, and Tobramycin were the most resistant in cases of burn and wound patients, as well as urinary tract infections in Iraq.