Urinary System Infection Research Articles

Analysis of Drug Resistance, Virulence, and Phylogeny of Klebsiella pneumoniae in Patients with Different Infections

Background: Klebsiella pneumoniae is an important pathogen among nosocomial infections, which can cause urinary and respiratory system infections, surgical site infections, and sepsis. Recently, carbapenem-resistant K. pneumoniae showed an upward trend with the wide use of clinical carbapenem antibiotics. However, there are few studies on the relationship between drug resistance, virulence, and phylogeny of K. pneumoniae in patients with different infections. Objectives: We investigated the drug resistance, virulence, and phylogeny of K. pneumoniae in patients with different infections. Methods: Seventy infected patients were selected as subjects. The extended-spectrum β-lactamases (ESBLs) color screening plane and blood plate medium were used for culture. Identification and drug resistance analysis was carried out by VITEK-2 compact automatic bacterial analyzer. Multilocus sequence typing (MLST) and capsule genotyping analysis were also performed. The Xpert CarbaR cartridge detected the carbapenem resistance genes. Comprehensive Antibiotic Research Database (CARD) and Virulence Factor Database (VFDB) predicted the drug-resistant genes and virulence factor genes, respectively. The phylogenetic tree was constructed, and the correlation was analyzed. Results: A total of 43 K. pneumoniae strains were cultured. We found that all K. pneumoniae strains exhibited different multiple drug resistance. MLST analysis indicated that ST11 was the main ST (60.61%). Analysis of the carbapenem-resistance genes showed that all isolates harbored the blaKPC-2 gene and some others blaOXA. The prediction result of capsular blood genotyping and virulence factor genes indicated that K47, K64, and K25 were the main types of capsular blood, and the top three detection rates of virulence genes were fimH (97.67%), mrkD (94.19%), and entB (84.88%). All isolates were clustered into one branch based on the virulence factor genes in the phylogenetic tree, and the strains of the same ST type or capsular blood type showed a closer relationship. Correlation analysis manifested that the drug resistance of K. pneumoniae in infected patients was positively correlated with virulence and phylogeny (r = 0.682, P = 0.000). Conclusions: There were complicated differences in the multidrug resistance to K. pneumoniae, resulting in high independent gene-positive rates of strains and a strong correlation with phylogeny, which can provide a reference for the selection of clinical antimicrobial drugs.

Short-term efficacy of empagliflozin in children with glycogen storage disease type Ⅰb

Objective: To analyze the short-time efficacy of empagliflozin in the treatment of glycogen storage disease type Ⅰb (GSD Ⅰb). Methods: In this prospective open-label single-arm study, the data of 4 patients were collected from the pediatric department in Peking Union Medical College Hospital from December 2020 to December 2022. All of them were diagnosed by gene sequencing and had neutropenia. These patients received empagliflozin treatment. Their clinical symptoms such as height and weight increase, abdominal pain, diarrhea, oral ulcer, infection times, and drug applications were recorded at 2 weeks, 1 month, 2 months, 3 months, 6 months, 9 months, 12 months, and 15 months after treatment to assess the therapeutic effect. The liquid chromatography-tandem mass spectrometry method was used to monitor the changes in 1, 5-anhydroglucitol (1, 5AG) concentration in plasma. At the same time, adverse reactions such as hypoglycemia and urinary tract infection were closely followed up and monitored. Results: The 4 patients with GSD Ⅰb were 15, 14, 4 and 14 years old, respectively at the beginning of empagliflozin treatment, and were followed up for 15, 15, 12 and 6 months, respectively. Maintenance dose range of empagliflozin was 0.24-0.39 mg/(kg·d). The frequency of diarrhea and abdominal pain decreased in cases 2, 3, and 4 at 1, 2 and 3 months of treatment, respectively. Their height and weight increased at different degrees.The absolute count of neutrophils increased from 0.84×109, 0.50×109, 0.48×109, 0.48×109/L to 1.48×109, 3.04×109, 1.10×109, 0.73×109/L, respectively. Granulocyte colony-stimulating factor was gradually reduced in 1 patients and stopped in 3 patient. Plasma 1, 5 AG levels in 2 children were significantly decreased after administration of empagliflozin (from 46.3 mg/L to 9.6 mg/L in case 2, and from 56.1 mg/L to 15.0 mg/L in case 3). All 4 patients had no adverse reactions such as hypoglycemia, abnormal liver or kidney function, or urinary system infection. Conclusion: In short-term observation, empagliflozin can improve the symptoms of GSD Ⅰb oral ulcers, abdominal pain, diarrhea, and recurrent infection, also can alleviate neutropenia and decrease 1, 5AG concentration in plasma, with favorable safety.

Ortholinea nupchi n. sp. (Myxosporea: Ortholineidae) from the urinary bladder of the cultured olive flounder Paralichthys olivaceus, South Korea.

A new myxosporean parasite, Ortholinea nupchi n. sp. (Myxozoa; Bivalvulida), was isolated from the urinary bladder of the olive flounder Paralichthys olivaceus cultured on Jeju Island, Korea. Mature spores were subspherical in the valvular and apical views and ellipsoidal in the sutural view. The spores measured 7.6±0.5μm in length, 6.7±0.3μm in thickness, and 7.3±0.5μm in width. Two pyriform polar capsules measured 3.2±0.1μm in length and 2.7±0.1μm in width and were located at the same level at the anterior half of the myxospores. The suture line was straight in the middle of the spores, and the surface ridges ranged between five and seven, forming an intricate pattern. The result of the 18S rDNA comparison showed ≤ 93.0% similarity with other Ortholinea species. The phylogenetic tree demonstrated that O. nupchi n. sp. was closest to O. auratae and clustered with oligochaete-infecting myxosporeans (OIM) having urinary system infection tropism. Based on the comparison of environmental and host factors in the phylogenetic groups of the OIM clade, we propose that the infection of O. nupchi n. sp. originated from marine oligochaetes.

Evde bakım ve Palyatif Bakım Hastalarının İdrar Kültürlerinin Karşılaştırılması; Kesitsel Çalışma

Background/Aims : Urinary tract infections are an important cause of mortality, especially in geriatric patients. The effectiveness of urine culture and appropriate antibiotic use in geriatric patients followed in primary care is unknown. We aimed to compare the urine cultures and antibiotic susceptibility of patients over the age of 65 who were treated at home by the Home Health Services (ESH) and inpatients in the Palliative Care Service (PBS).
 Methods: Our study retrospectively compared the culture-antibiogram results of urine samples of patients aged 65 years and older with urinary infection complaints and followed and treated by PBS and ESH between January 1, 2019 and January 1, 2020.
 Results: Of the 60 patients included in the study, 30 had PBS, 30 ES Services patients had a mean age of 78.0±12.7 years, and PBS patients had a mean age of 80.7±9.8 years. According to the culture-antibiogram results of the urine samples of the patients, E.coli was the most common microorganism in both groups (p=0.003).
 When we look at the antibiotic sensitivity of the patients in the ESH group, Amikacin (96.7%), Cefoxitin (83.3%), Fosfomycin (73.3%), Nitrofurantoin (70%) sensitive and Ampicillin (76.7%) Cefuroxime (36%) ,7) Ceftazidime(40%) was found resistant to Ciprofloxacin(33%).
 PBS group is sensitive to Amikacin(60%), Cefoxitin(23.3), Fosfomycin(23.3%), Nitrofurantoin(16.6%) and Ampicillin(40%), Cefuroxime(26.7%), Ceftazidime( 33.3% were found to be resistant to Ciprofloxacin(53.3%).
 In both groups, the highest resistance rates were found in Ampicillin, 76.7% in ESH patients and 40% in PBS patients, and the highest sensitivity rates were in Amikacin, 96.7% in ESR and 60% in PBS.
 Conclusion: In this study conducted over the age of 65, empirically in ESR in urinary system infections; on the other hand, it would be rational to use oral Fosfomycin or Nitrofurantoin or Amikacin; It is thought that due to high antibiotic resistance in PBS, caution should be exercised.

Evaluating etiological significance of <i>Enterococcus faecalis</i> isolated from children with urinary tract infection

Aim. To conduct comprehensive evaluation of microbiological properties of Enterococcus faecalis, isolated from urine in children with urinary system infections (UTI), to determine their etiological significance.Materials and methods. The study employed clinical isolates E. faecalis (n = 51) from the urine of children aged 3 days to 17 years who were treated for urinary tract infection between 2013 and 2017. The biological properties of enterococci were evaluated by means of classical microbiological and up-to-date molecular genetic methods. Statistical processing of digital data was carried out using non-parametric methods.Results. Phenotypic and genetic heterogeneity of microbiological properties of the studied urinary enterococci isolates was revealed. Using statistical methods of analysis, the authors established significant correlations between pathogenicity genes, antibiotic resistance and phenotypic manifestations of biological properties in urinary isolates E. faecalis. The results of evaluating the phenotypic manifestations of biological properties and the presence of certain genes enabled the enterococci to be classified into groups that correlated with certain sequence types (ST). Based on the revealed relationships of some biological properties of urinary isolates E. faecalis with certain sequence types, the authors developed an algorithm for assessing etiologically significant and highly virulent E. faecalis isolated from the urine of children with UTI.Conclusions. A comprehensive determination of some, potentially relevant biological properties, of the pathogen – enzymatic activity associated with pathogenicity and biochemical activities, antibiotic resistance (not only at the phenotypic, but also at the genetic level) – allows for assessing the diagnostic value of urostams E. faecalis, isolated from the urine of children with UTI, which will contribute to a personalized approach to treatment of these patients.

The Frequency and the character of bacterial infection in patients with COVID-19

The first human cases of new coronavirus (COVID-19), for the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), were in Wuhan, in December 2019. By June 2022 there had been more than 500 million with confirmed cases of new coronavirus and over 5 million lives lost to the disease. During the earlier SARS-CoV-1 and MERSCoV epidemics, patients often developed bacterial coinfections and had a higher mortality rate. The aim of this work is to summarize the results of a study of the frequency and nature of bacterial infection in patients with COVID-19. Various studies was been in USA and countries of Asia and Europe show conflicting results regarding the prevalence of secondary bacterial infections in patients with COVID-19, from 1% to 50%. Bacterial co-infection is relatively infrequent in hospitalized patients with COVID-19. Risk factors of bacterial infections in patients with COVID-19 are more 60 years old, prolonged hospital length of stay, reanimation unit admission (severe disease COVID-19), chronic bacterial infection in anamnesis, immunosuppression therapy. The most common bacterial microorganisms identified in patients with infection of the lower respiratory tract, who hospital length of stay less than 48 hours are Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae. In patients, who hospital length of stay more than 48 hours the main pathogens are P. aeruginosa, Klebsiella spp., S. aureus. The data obtained indicate a low frequency of bacterial infections in patients hospitalized for COVID-19. Early infections are quite rare, more often bacterial infections are secondary and develop after 48 hours of the patient's stay in the hospital. The causative agents of early and late infections are different. Most often, an infection of the respiratory tract is noted, less often — the urinary system and bacterial infections of other localization.

Comparison of general pediatric ward admissions between the COVID-19 pandemic and pre-pandemic period.

The COVID-19 pandemic has affected many aspects of life as well as hospital admissions. We hypothesized that many infectious diseases and hospitalizations in the pediatric age group might have decreased during the pandemic period. Evaluate patients admitted to the general pediatric wards during the pandemic in comparison with the pre-pandemic period. Retrospective cross-sectional SETTING: General pediatrics wards of a tertiary hospital in Istanbul PATIENTS AND METHODS: The study included patients aged 0-18 years who were followed up while hospitalized in the general pediatrics wards between 11 March 2019 and 11 March 2021. The hospitalizations were grouped as pre-pandemic and pandemic based on the date when COVID-19 was declared a pandemic (11 March 2020). Hospital admissions, length of stay, diagnoses, gender, age. 4343 hospitalizations. Of the total 4343 hospitalizations meeting the inclusion criteria, 2786 (64.1%) occurred before the pandemic and 1557 (35.9%) during the pandemic, a 44% decrease. The distribution of all hospitalization diagnoses during the two years was as follows: respiratory tract diseases, 1768 (40.7%); neurological diseases, 946 (21.8%); gastrointestinal diseases, 550 (12.7%); hematological and oncological diseases, 514 (11.8%); genitourinary system and nephrological diseases, 504 (11.6%); and soft tissue infections, 255 (5.9%). During two years, there were 1418 (32.7%) patients with lower respiratory tract infections, 316 (7.3%) with gastroenteritis, and 440 (10.1%) with urinary system infections. The median hospital stay was 6 days before the pandemic and 4 days during the pandemic (P<.0001). During the pandemic, the rate of respiratory diseases decreased from 48.7 to 26.5%, and that of lower respiratory tract infections decreased from 40.5 to 18.6% (P<.0001). Both previous studies and our results indicate that many infectious diseases in the pediatric age group significantly decreased, especially in the first months of the COVID-19 pandemic. Single-center study. None.

General Characteristics of Palliative Care Patients Admitted to the Emergency Department

Background This study aimed to analyze patients who apply to emergency services and need palliative care regarding appropriate patient care and effective use of health institutions.&#x0D; Materials and Methods The study was conducted prospectively on patients who applied to the emergency services of Bursa Uludag University Health Application and Research Center, Health Sciences University Bursa Yüksek Ihtisas Training and Research Hospital and Bursa City Hospital between 15.08.2021 and 15.02.2022 and needed palliative care. &#x0D; Results A total of 261 patients, 143 male (54.8%) and 118 female (45.2%), were included in the study. It was determined that 50 (19.1%) of these patients had previously received palliative care services. It was determined that the patients included in the study applied to the emergency services 7.52±6.77 times in the last year. The three most common diseases diagnosed in patients admitted to the emergency department were pneumonia (24.5%), urinary system infection (7.7%), and cerebrovascular disease (5.4%). Of the patients, 39.84% were referred/hospitalized, 25.28% were referred/hospitalized to intensive care units, 2.68% refused treatment, 2.68% died, and 29.5% have been discharged.&#x0D; Conclusion As a result, it is understood that most of the patients in need of palliative care do not receive this service, and patients who can be treated in palliative care units are treated in clinics and intensive care units.

ARE C-REACTIVE PROTEIN AND PROCALCITONIN EFFECTIVE BIOMARKERS FOR URINARY TRACT INFECTION IN ELDERLY PATIENTS? WHAT SHOULD BE ADMINISTERED FOR EMPIRICIAL TREATMENT?

Introduction: In the absence of typical overt symptoms, diagnosis of urinary tract infection is more difficult in elderly individuals. This study investigated the benefits of C-reactive protein, procalcitonin, and leukocyte levels in supporting the diagnosis of urinary tract infection in the elderly and causative factors. Materials and Method: A retrospective examination of information from a hospital data system of patients &gt; 65 years of age, who were diagnosed with urinary tract infection in a 4-year period, was performed. Bacterial identification and antibiotic susceptibility tests were performed. Results: In the case group, procalcitonin and C-reactive protein levels were higher than those in the control group, and a moderately positive correlation with urinary tract infection was found (p&lt;0.001, r=0.454). Although procalcitonin was a better predictor than C-reactive protein , the risk criteria for C-reactive protein were also very close to those of procalcitonin. The cut-off values for C-reactive protein and procalcitonin were 6.93 mg/L and 0.075 ng/ml, respectively, and C-reactive protein levels were normal in 20% of cases. The most frequently isolated microorganisms were Escherichia coli (56%) and Klebsiella pneumoniae (16%). The extended-spectrum beta-lactamase rate was 35% for E. coli and 43% for K. pneumoniae isolates. Fosfomycin and ertapenem were the most effective antibiotics. Conclusion: Procalcitonin levels were high; however, the fact that C-reactive protein was found to be normal in one-fifth of cases should serve as a warning that urinary system infection can be missed in elderly patients in cases in which only C-reactive protein level is evaluated. Keywords: Aged; Drug Resistance; Urinary Tract Infections; C-Reactive Protein; Procalcitonin; Leukocytes.

The role of primary nocturnal enuresis in the aetiology of overactive bladder syndrome.

The aim of this study was to investigate the effect of nocturnal enuresis (NE) in childhood on the development and course of overactive bladder (OAB) in adulthood. Between January and September 2021, data from patients who visited the Urology Outpatient Clinic with OAB symptoms were collected. Patients with a history of diabetes mellitus, neurological diseases, bladder outlet obstruction, active urinary system infection, or previous medical treatment for OAB and those who did not agree to join the study were excluded. Patients with a diagnosis of NE in childhood were classified as group 1, and patients without a diagnosis of NE were classified as group 2. Demographic data were recorded. Frequency of incontinence, and the number of daytime voids and nocturia were evaluated according to a three-day voiding diary. In addition, the maximum urinary flow ratio (Qmax), bladder wall thickness, and postvoid residual volume were determined using uroflowmetry and pelvic ultrasound. After applying the inclusion/exclusion criteria, the mean age of the study group of 103 patients, consisting of 34 women and 69 men, was 32.85 ±11.20 years (18-65), and the mean BMI of both groups was 26.62 ±3.34 (19.49-39.18). Sixty-five of 103 patients (63.1%) had a history of childhood NE diagnosis. Patients in the group with a history of NE were younger than those without a history of NE. The earlier onset and more intense course of OAB symptoms in patients diagnosed with NE in childhood suggests that NE may be a triggering factor in the aetiology of OAB.

Prospective Analysis of Application Reasons of Alzheimer's Patients Applying to the Emergency Department

Background: The aim of this study is to analyze the reasons for admission of Alzheimer's patients who applied to the emergency services.&#x0D; Methods: The study was conducted prospectively on patients with Alzheimer's disease who applied to the emergency departments of Bursa Uludag University Health Application and Research Center, Health Sciences University Bursa Yüksek İhtisas Training and Research Hospital and Bursa City Hospital between 01.07.2021 and 01.07.2022. &#x0D; Results: A total of 248 patients, 103 male (41.5%) and 145 female (58.5%), were included in the study. It was determined that the three most common diagnoses received by the patients in the emergency department were pneumonia (17.7%), ischemic cerebrovascular disease (10.3%), and urinary system infection (9.3%). It was determined that 42.7% of the patients were hospitalized in clinical and 18.1% in intensive care units. &#x0D; Conclusion: As a result, it was determined that the most common diagnoses of Alzheimer's patients admitted to the emergency department were pneumonia, ischemic cerebrovascular disease and urinary tract infection, respectively and more than half of all admitted patients had indications for hospitalization.

Therapeutic Effect and Mechanism of Norfloxacin-Loaded Poly(lactic-co-glycolic acid) Microspheres on Urinary System Infections

Urinary system infections are one of the most common infectious diseases in clinical practice. Patients prone to secondary infections need to take antibacterial drugs for a long time. Therefore, the development of a drug-carrying material with long-term antimicrobial activity is an urgent problem for urology-allied medical materials science. In this study, PLGA microspheres with excellent biocompatibility were prepared using PLGA as the carrier and norfloxacin as the drug model. The size of norfloxacin/PLGA microspheres was mainly concentrated in 2.19–8.08 μm, exhibiting a small surface area and good slow-release effect in vitro. Biological experiments showed that PLGA microspheres can reduce the inflammatory cytokine content in plasma, have a good bactericidal effect, and are expected to be used as drug carrier materials for urinary system infections.

Relationship between nosocomial infections and coronavirus disease 2019 in the neurosurgery unit: clinical characteristics and outcomes from a Chinese Tertiary-Care Hospital

BackgroundThe COVID-19 pandemic has raised awareness of infection prevention and control. We found that the incidence of nosocomial infection in neurosurgery has changed. This study aimed to evaluate the impact of “coronavirus disease 2019 (COVID-19) prevention and control measures” on nosocomial infections in neurosurgery.MethodsTo explore changes in nosocomial infections in neurosurgery during the COVID-19 pandemic, the clinical data of inpatients undergoing neurosurgery at Taizhou Hospital of Zhejiang Province between January 1 and April 30, 2020 (COVID-19 era) were first analyzed and then compared with those from same period in 2019 (first pre-COVID-19 era). We also analyzed data between May 1 and December 31, 2020 (post-COVID-19 era) at the same time in 2019 (second pre-COVID-19 era).ResultsThe nosocomial infection rate was 7.85% (54/688) in the first pre-COVID-19 era and 4.30% (26/605) in the COVID-19 era (P = 0.01). The respiratory system infection rate between the first pre-COVID-19 and COVID-19 eras was 6.1% vs. 2.0% (P < 0.01), while the urinary system infection rate was 1.7% vs. 2.0% (P = 0.84). Between the first pre-COVID-19 and COVID-19 eras, respiratory system and urinary infections accounted for 77.78% (42/54) vs. 46.15% (12/26) and 22.22% (12/54) vs. 46.15% (12/26) of the total nosocomial infections, respectively (P < 0.01). Between the second pre-COVID-19 and post-COVID-19 eras, respiratory system and urinary accounted for 53.66% (44/82) vs. 40.63% (39/96) and 24.39% (20/82) vs. 40.63% (39/96) of the total nosocomial infections, respectively (P = 0.02).ConclusionsThe incidence of nosocomial infections in neurosurgery reduced during the COVID-19 pandemic. The reduction was primarily observed in respiratory infections, while the proportion of urinary infections increased significantly.

Analysis of risk factors of hyperpyrexia suffered by post neurosurgical patients after removal of drainage tube

To analyze the risk factors of hyperthermia after removal of drainage tubes in patients after neurosurgery. The clinical data of 146 patients after neurosurgery with indwelling drainage tubes admitted to the department of critical care medicine of Pecking University Third Hospital from January 2019 to July 2021 were analyzed retrospectively. The patients were divided into hyperthermia group (body temperature ≥ 39 centigrade) and non-hyperthermia group (body temperature < 39 centigrade) according to whether their body temperatures within 24 hours after removal of drainage tubes. General clinical data and outcomes of the two groups were collected, and different tendentious scores were matched with the hyperthermia group and non-hyperthermia group based on Glasgow coma score (GCS), respectively. After such matching, the clinical baseline characteristics [age, gender, admission diagnosis, major complications, acute physiology and chronic health evaluation II (APACHE II) at admission, GCS], number of days of drainage tubes retention, location of drainage tubes, microbial culture results before removal of drainage tubes, white blood cell (WBC) and neutrophil ratio (NEU%) before and after removal of drainage tubes as well as clinical outcomes of the cohort patients were analyzed. The primarily outcome was in-hospital mortality, and then the length of intensive care unit (ICU) stay. A total of 146 patients after neurosurgery were included, 28 of which developed hyperthermia after removal of drainage tubes. The GCS scores at admission in the hyperthermia group were significantly lower than that in the non-hyperthermia group, while the proportion of hypertension and diabetes in the hyperthermia group was significantly higher than that in the non-hyperthermia group. Based on GCS scores, the two groups, each of which included 28 patients, were matched with tendentious scores, and there was no significant difference in gender, age, GCS scores and the proportion of hypertension and diabetes between the two groups. The main disease for patients upon admission was cerebral hemorrhage (53.6%, 30/56). The proportion of indwelling ventricular drainage tube retention in the hyperthermia group was significantly higher than that in the non-hyperthermia group [32.1% (9/28) vs. 7.1% (2/28), P < 0.05], but there was no significant difference in the location of other drainage tubes between the two groups. The proportion of lumbar puncture in the hyperthermia group was also significantly higher than that in the non-hyperthermia group [25.0% (7/28) vs. 0 (0/28), P < 0.05]. Compared with the non-hyperthermia group, WBC [×109/L: 13.0 (9.5, 15.2) vs. 11.5 (8.8, 13.3)] of 1 day before removal of drainage tubes, NEU% [0.892 (0.826, 0.922) vs. 0.843 (0.809, 0.909)] after removal of drainage tubes and positive rate of drainage-fluid culture or drainage-tube-tip culture [7.1% (2/28) vs. 0% (0/28)] in the hyperthermia group increased, but there were not significant differences. There was no significant difference in the proportion of pulmonary, urinary system and blood flow infection before removal of drainage tubes in the two groups. In terms of primary outcomes, compared with the non-hyperthermia group, the length of ICU stay [days: 17.0 (8.0, 32.3) vs. 8.5 (1.0, 16.8), P < 0.05] in the hyperthermia group was significantly prolonged, and the in-hospital mortality [35.7% (10/28) vs. 10.7% (3/28), P < 0.05] in the hyperthermia group was obviously increased. The positive rate of carbapenem-resistant bacteria culture [32.1% (9/28) vs. 3.6% (1/28), P < 0.05] in the hyperthermia group during hospitalization was significantly higher than that in the non-hyperthermia group. Hyperthermia after removal of drainage tubes for patients after neurosurgery can significantly prolong the length of ICU stay and increase the in-hospital mortality, which may be related to the secondary infection caused by indwelling intracranial drainage tubes and the intracranial spread of bacteria caused by removal of drainage tubes, as well as the intracranial multidrug-resistant bacterial infection caused by the drainage tubes.

Dynamic changes of platelet count in first week and their predictive value for prognosis in septic shock patients

To observe the dynamic changes of platelet counts in septic shock patients within first week, and to explore their predictive value for prognosis. Retrospective analysis of clinical data of patients with septic shock admitted to the department of intensive care unit (ICU) of the First Affiliated Hospital of University of Science and Technology of China from January 2020 to December 2021 was conducted. The baseline data on gender, age and primary diseases, clinical indicators on infection site, pathogenic microbial type, acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA), laboratory indicators and the trend of platelet count (PLT) on day 1, 3, 5 and 7 admitting ICU and patients prognosis of in-hospital were collected. Binary Logistic regression was used to assess the independent risk factors of in-hospital death in septic shock patients. Receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive power of each index for in-hospital mortality. A total of 193 patients with sepsis were enrolled. Among them, 73 patients died and 120 patients survived. Univariate analysis showed that the age, proportion of hypertension and respiratory system infection, APACHE II score, SOFA score and blood lactic acid (Lac) in the death group were significantly higher than those in the survival group, while the proportion of urinary system infection, white blood cell (WBC) and neutrophil (NEU) were significantly lower in the death group. Within 7 days after admitting ICU, the platelet (PLT) firstly decreased and then rebounded in the survival group, whereas it's showed a continuous downward trend in the death group. And the PLT count in both day 5 and 7 were significantly higher in the survival group compared with the dead group [×109/L: 94.5 (54.0, 182.0) vs. 50.0 (30.5, 87.5), 135.0 (86.8, 205.8) vs. 46.0 (23.5, 71.5), all P < 0.05]. Multivariate binary Logistic regression analysis showed that age [odds ratio (OR) = 1.059, 95% confidence interval (95%CI) was 1.002-1.118], hypertension (OR = 6.108, 95%CI was 1.340-27.851), respiratory system infection (OR = 5.300, 95%CI was 1.116-25.118), APACHE II score (OR = 1.158, 95%CI was 1.054-1.273), SOFA score (OR = 1.494, 95%CI was 1.060-2.107) and PLT on day 7 after admitting ICU (OR = 0.926, 95%CI was 0.894-0.958) were independent risk factors for in-hospital prognosis in septic shock patients (all P < 0.05). ROC analysis showed that APACHE II score, SOFA score and PLT on day 7 after admitting ICU all had good predictive value for in-hospital prognosis in septic shock patients, and the area under the ROC curve (AUC) of PLT on day 7 (AUC = 0.899, 95%CI was 0.857-0.941) was significantly higher than that of APACHE II score (AUC = 0.748, 95%CI was 0.680-0.816), SOFA score (AUC = 0.767, 95%CI was 0.702-0.833). Clinicians should pay close attention to the dynamic changes of platelet counts in septic shock patients, especially the platelet counts on day 7 after admitting ICU. And active intervention should be provided to improve the prognosis.

Molecular Analysis of Ndm-1 Positive Klebsiella pneumoniae Strains Isolated From Patients With Bacteremia Due to Urinary System Infection

Introduction: Health concerns about Klebsiella pneumoniae, which causes urinary tract infections (UTIs) and sepsis, are increasing worldwide. In addition, New Delhi metallo-ß-lactamase (NDM) carrier K. pneumoniae and other Gram-negative bacteria appear to cause serious clinical problems. This study aimed to reveal NDM-1 positive K. pneumoniae carrier status, molecular properties, and antibiotic resistance differences of patients who have bacteremia due to urinary system infections. Methods: Blood culture, biochemical tests, Vitek2, polymerase chain reaction, sequencing, phylogenetic analysis, and multilocus sequence typing (MLST) methods were used for the microbiological analysis of K. pneumoniae strains. Results: Overall, 146 K. pneumoniae strains were obtained from the cultures, 16 of which were found to be NDM-1 positive. Although these strains were discovered to have resistance to the authorized antibiotics, they were sensitive to gentamicin (CN), colistin (CT), and trimethoprim/sulfamethoxazole (SXT). Furthermore, it was found that the resistance rates of carbapenem (ertapenem (Etp), imipenem (Ipm), and meropenem (Mem)) were high. All K. pneumoniae strains represented extended-spectrum beta-lactam resistance. It was found that the phylogenetic affinities of K. pneumoniae strains were higher with Asian strains. Five and eleven K. pneumoniae isolates were determined to be ST17 and ST147 type variations, respectively, as a conclusion of the MLST study. Conclusions: It was observed that the presence of NDM-1-positive K. pneumoniae may pose a serious problem in patients with bacteremia caused by UTI. It has been demonstrated that it is important to develop preventive and control measures in the hospital by considering NDM-1-positive K. pneumoniae strains with multi-drug resistance.

The Role of Sulfa Drugs in our Life

Gerhardt Dumac discovered in 1932 that Prontosyl kills bacteria while testing dyes, and in 1934, he began using Prontosyl as a treatment. This was in Germany, and experiments in France showed that the effect of Prontosyl is due to the presence of sulfanilamide in it. In 1908, Gelmo was the first to attend a sulfa drug conference in Germany. Sulfanilamide's medicinal usefulness was endorsed in 1936 by researchers at JohnsHopkinsUniversity in the United States, including Long and Plus, Marshall, and others. Sulfa drugs are used to treat a range of diseases caused by bacteria, with which it has been possible to save countless lives. It is believed that the effect of sulfa is to stop the growth of bacteria, meaning that these drugs prevent the growth and reproduction of bacteria, which creates an opportunity for the body's defensive forces to eliminate them. Humans are currently treated with sulfonamides for specific disorders, such as urinary system infections. However, sulfonamides are more typically seen in veterinary medicine. Therefore we attempted to explain the role and importance of sulfa drugs in our lives because of their widespread use in medical therapy.

Evaluation of agents grown from urine culture and antibiotic susceptibility in patients followed up with the diagnosis of urinary system infection

Aim: In this study, it was aimed to determine the reproducing agents and the antibiotic susceptibility of the agents in a total of 89 urine samples cultured in Ankara Training and Research Hospital, Infectious Diseases and Clinical Microbiology laboratory during the 6-month period between 2021-2022. Material and Method: While growth was detected in urine culture in 68 (76%) of 89 urine samples taken in the study, no growth was found in 21 (24%) of them. Antibiotic susceptibility was studied on Mueller-Hinton agar by the disc diffusion method in isolates with growth in urine culture. Results: Reproducing factors are in order of frequency; 25 E. coli, 17 extended-spectrum beta-lactamase (ESBL) positive E. coli, 10 Klebsiella pneumoniae, 3 Pseudomonas aeruginosa, 3 Proteus mirabilis, 3 Enterococcus faecalis, 1 Enterobacter cloacae, 1 Candida krusei, 1 Staphylococcus aureus, 1 patient E. coli and Proteus species were determined. Resistance rates in E. coli strains isolated from urine culture; 20% (4/20) for ciprofloxacin, 5% (1/19) for nitrofurantoin, 9.5% (2/21) for trimethoprim/ sulfamethoxazole (TMP/SMZ). No resistance was found to fosfomycin 0% (0/19) and to carbapenems (imipenem, meropenem, and ertapenem) (0/21). The resistance rates in ESBL positive E. coli strains are; 100% (13/13) for ciprofloxacin, 7% (1/14) for nitrofurantoin, 12.5% (1/8) for fosfomycin, 26.6% (4/15) for TMP-SMZ. No resistance was found to carbapenems (imipenem, meropenem and ertapenem). Conclusion: In our study, it was determined that the most common infectious agent causing urinary tract infection was E. coli. In our study, it was determined that the resistance rates for ciprofloxacin and TMP-SMZ, which are used in empirical treatment, are high, and the resistance rates for fosfomycin and nitrofurantoin are low in E. coli strains that cause urinary system infection. Due to the low rates of resistance in the empirical treatment of urinary system infections, it would be a suitable approach to prefer oral treatment options such as fosfomycin and nitrofurantoin in outpatients.

Evaluation of agents grown from urine culture and antibiotic susceptibility in patients followed up with the diagnosis of urinary system infection

Aim: In this study, it was aimed to determine the reproducing agents and the antibiotic susceptibility of the agents in a total of 89 urine samples cultured in Ankara Training and Research Hospital, Infectious Diseases and Clinical Microbiology laboratory during the 6-month period between 2021-2022. Material and Method: While growth was detected in urine culture in 68 (76%) of 89 urine samples taken in the study, no growth was found in 21 (24%) of them. Antibiotic susceptibility was studied on Mueller-Hinton agar by the disc diffusion method in isolates with growth in urine culture. Results: Reproducing factors are in order of frequency; 25 E. coli, 17 extended-spectrum beta-lactamase (ESBL) positive E. coli, 10 Klebsiella pneumoniae, 3 Pseudomonas aeruginosa, 3 Proteus mirabilis, 3 Enterococcus faecalis, 1 Enterobacter cloacae, 1 Candida krusei, 1 Staphylococcus aureus, 1 patient E. coli and Proteus species were determined. Resistance rates in E. coli strains isolated from urine culture; 20% (4/20) for ciprofloxacin, 5% (1/19) for nitrofurantoin, 9.5% (2/21) for trimethoprim/ sulfamethoxazole (TMP/SMZ). No resistance was found to fosfomycin 0% (0/19) and to carbapenems (imipenem, meropenem, and ertapenem) (0/21). The resistance rates in ESBL positive E. coli strains are; 100% (13/13) for ciprofloxacin, 7% (1/14) for nitrofurantoin, 12.5% (1/8) for fosfomycin, 26.6% (4/15) for TMP-SMZ. No resistance was found to carbapenems (imipenem, meropenem and ertapenem). Conclusion: In our study, it was determined that the most common infectious agent causing urinary tract infection was E. coli. In our study, it was determined that the resistance rates for ciprofloxacin and TMP-SMZ, which are used in empirical treatment, are high, and the resistance rates for fosfomycin and nitrofurantoin are low in E. coli strains that cause urinary system infection. Due to the low rates of resistance in the empirical treatment of urinary system infections, it would be a suitable approach to prefer oral treatment options such as fosfomycin and nitrofurantoin in outpatients.

Effect of metaclopramide on urinary bladder smooth muscle contraction-relaxation mechanism

Objectives: Metoclopramide, a dopamine receptor antagonist, a benzamide, is a commonly used antiemetic drug in many diseases with nausea and vomiting. The aim of this study is to examine the effects of metoclopramide, which is also used in urinary system infections, on the urinary bladder contraction-relaxation mechanism. Methods: In the study, bladder tissue strips obtained from adult female Wistar rats in diestrus were placed in an isolated organ bath containing Krebs solution. The effect of metoclopramide at concentrations of 10 µM and 20 µM on sections where spontaneous contractions were observed under 1.5 g of tension was investigated. Results: Metaclopramide caused a statistically significant increase in the area under the contraction curve (AUC) and peak to peak (p-p) parameters of spontaneous bladder contractions at concentrations of 10 and 20 μM (p &amp;lt; 0.01). Conclusions: Metaclopramide has an activator effect on spontaneous bladder contractions. This effect should be taken into consideration in clinical use, especially when used in urinary system infections.