The prevalence of urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae is increasing worldwide. A retrospective analysis of medical records was conducted for patients with UTIs admitted to a general tertiary university hospital in Brazil, over a 1-year period (2022–2023). Among 1193 UTI episodes, 179 (15%) were caused by ESBL. No significant difference in sex was observed among cases of ESBL-causing UTI, and the mean age of the patients was 55 years (range: 1–102 years). Most ESBL-producing bacteria (70%) were isolated from hospitalized patients, with an average length of hospitalization of 27.5 days. Escherichia coli and Klebsiella pneumoniae were the predominant ESBL-producing species. Over 99% of ESBL isolates demonstrated resistance to third- and fourth-generation cephalosporins and aztreonam, whereas sensitivity to amikacin and polymyxin B was observed among the majority of bacterial strains, with carbapenems being the most effective drugs. Understanding antimicrobial resistance patterns in ESBL-producing strains associated with UTIs is crucial for guiding empirical antimicrobial therapy. Prompt implementation of infection control measures and rational use of antibiotics are essential to prevent the development and dissemination of ESBL-producing bacteria.

To bridge the clinical and methodological gap created by Poland's widespread OTC use of furazidin in empirical urinary tract infections (UTIs) management versus EUCAST's reliance on nitrofurantoin for susceptibility testing, by comparing their activity against E. coli isolates and identifying nfsA mutations associated with reduced nitrofuran susceptibility.Thirty-three E. coli isolates were obtained from outpatient urine samples. MICs for furazidin and nitrofurantoin were determined using broth microdilution, and MIC₅₀/MIC₉₀ values were calculated. Isolates with MIC ≥ 8µg/ml underwent nfsA detection and Sanger sequencing of the examined nfsA gene. This analysis was performed as a targeted, exploratory assessment of genotype-phenotype associations, with results interpreted according to current EUCAST methodological standards.Furazidin showed higher in vitro activity than nitrofurantoin (mean MIC: 6.05µg/ml vs. 10.46µg/ml; MIC₅₀: 2µg/ml vs. 4µg/ml; MIC₉₀: 16µg/ml vs. 32µg/ml). The nfsA gene was detected in 75% of isolates with elevated MICs. Gene sequencing revealed nonsense and frameshift mutations leading to truncated nitroreductase, consistent with reduced susceptibility, although none of the isolates met EUCAST clinical resistance breakpoints.Nitrofurantoin MICs do not fully reflect the activity of furazidin, which is widely used in Poland and East European countries. These results underscore the need for region-specific evaluation of nitrofuran susceptibility and caution against extrapolating nitrofurantoin MICs to furazidin efficacy in clinical practice. Moreover, the findings highlight the need for improved standardization of nitrofuran susceptibility testing and further investigation of resistance mechanisms to guide optimal UTI therapy, particularly in outpatient populations where nitrofurans remain first-line empirical agents.

Amid concerns over primary care shortages, many states have expanded nurse practitioner (NP) scope-of-practice (SOP) laws to grant full practice authority (FPA), allowing NPs to practice without physician supervision. While prior research has focused on adult populations and narrow clinical contexts, this study provides the first evidence on pediatric outcomes using hospitalization-based pediatric quality indicators (PDIs). Using inpatient discharge data from 22 states between 2010 and 2019, I estimate two-stage difference-in-differences models to assess the causal impact of FPA on preventable pediatric hospitalizations. FPA reduces hospitalizations for chronic conditions, such as asthma and diabetes complications, by about 10%, but increases hospitalizations for acute conditions, including gastroenteritis and urinary tract infections, by roughly 16%. The results reveal important heterogeneity: expanded NP authority may improve chronic disease management while posing challenges for acute care delivery. These findings inform policy debates on SOP reform and its implications for pediatric health.

This post hoc analysis of the CHAMPION-NMOSD trial evaluated the safety and efficacy of ravulizumab in patients with aquaporin-4 antibody-positive (AQP4-Ab+) neuromyelitis optica spectrum disorder (NMOSD) previously exposed or naïve to rituximab (RTX). Patients received weight-based intravenous ravulizumab with a loading dose followed by maintenance dosing every 8 weeks. Patients were stratified by prior RTX exposure: no RTX exposure (RTX-naïve) vs RTX exposure > 3 months before initiating ravulizumab (RTX-exposed). Key outcomes included treatment-emergent adverse events (TEAEs), serious TEAEs (TESAEs), relapse rates, and vaccination timing from the last RTX dose. Of the 58 patients enrolled, 89.7% were female, with a mean age of 47.4 years, and 21/58 (36.2%) were RTX-exposed. Relapses occurred in 12/21 (57.1%) RTX-exposed patients between their first RTX dose and study entry. The safety profile of ravulizumab was generally similar between RTX-exposed and RTX-naïve groups. Common TEAEs included COVID-19, headache, urinary tract infection, and upper respiratory tract infection. UTIs were more frequent in RTX-exposed individuals. One patient in each group experienced a meningococcal infection. No adjudicated on-trial relapses were reported while on ravulizumab. Following initiation of ravulizumab, RTX-exposed and RTX-naïve patients with AQP4-Ab+ NMOSD achieved sustained disease control and demonstrated a manageable safety profile. The CHAMPION-NMOSD Trial; ClinicalTrials.gov identifier: NCT04201262 (registered October 06, 2020).

Urinary tract infections (UTIs) are a prevalent health issue, particularly among women, and are commonly treated with antibiotics. However, increasing antimicrobial resistance has led to growing interest in complementary and alternative medicine (CAM) as a non-antibiotic approach to UTI prevention and management. This study aimed to assess the knowledge, practices, and perceptions of Jordanian adults regarding the use of CAM therapies, including herbal remedies and natural products, for the prevention and treatment of UTIs. A descriptive, cross-sectional study was conducted using an online survey distributed via social media platforms. The questionnaire assessed sociodemographic characteristics, medical history, awareness of UTI risk factors, sources of CAM information, and perceptions toward CAM use. Descriptive and inferential statistical analyses were performed. A total of 429 participants completed the survey. Nearly half had a medical-related background, and 46.9% reported a personal or familial history of UTIs. While 54.3% preferred antibiotics for treatment, 42.7% used herbal remedies such as parsley and green tea. Awareness of key risk factors like low water intake (87.9%) and urine retention (90.2%) was high, but knowledge gaps persisted regarding hormonal and behavioral risk factors. Participants with medical education had significantly higher awareness scores (p < 0.001). Most participants perceived CAM as a culturally accepted practice. CAM therapies are widely used and culturally accepted in Jordan for UTI management. However, public education and professional guidance are essential to ensure their safe use.

Introduction: Community-acquired urinary tract infection (CA-UTI) is the second most common infection in the community. The gold standard for diagnosing urinary tract infections (UTIs) is urine culture. A urine dipstick can also be used to diagnose UTIs. This study was designed to compare the urine dipstick test with urine culture in the diagnosis of community-acquired urinary tract infections in a tertiary care hospital in the Colombo district, Sri Lanka.Methods: Four hundred and eighty-nine urine samples were inoculated into cysteine-lactose-electrolyte-deficient agar. They were tested for the presence of nitrite and leukocytes using urine dipsticks, following the manufacturer's instructions.Results: In the entire group, the sensitivity, specificity, positive predictive value, and negative predictive value of the leukocyte esterase test were 91.92%, 76.15%, 91.41%, and 77.34%, respectively, and those of the nitrite test were 91.36%, 75.38%, 91.11%, and 75.97%, respectively.Conclusion: The dipstick is a low-cost, user-friendly test that can be used in an outpatient setting to identify patients who require antibiotics. This will help in establishing antibiotic stewardship by limiting unnecessary prescriptions.

Antimicrobial resistance poses a significant global health threat. Experimental evolution studies are crucial in understanding resistance mechanisms and thereby informing strategies to preserve antibiotic efficacy. We developed a novel continuous experimental evolution system enabling uninterrupted medium exchange with a rising antibiotic gradient, using standard laboratory equipment. We applied this system to three Enterobacter cloacae complex strains isolated from urinary tract infections in Germany between 1990 and 1992, which therefore had no prior exposure to cefepime, a fourth-generation cephalosporin approved in Germany in 2004. After four days of exposure to a cefepime gradient, resistant mutants emerged in all three strains. Notably, one mutant exhibited cross-resistance to the novel antibiotics cefiderocol and ceftazidime-avibactam, due to a single missense mutation in the β-lactamase gene blaMIR-11. Our study demonstrates the effectiveness of this novel approach for investigating antimicrobial resistance development and cross-resistance mechanisms, as well as identifying and characterizing a mutation attributed to major cross-resistance.

Aim: Infections and multidrug-resistant (MDR) pathogens are concerns in pediatric palliative care (PPC) units, where children with life-limiting conditions undergo invasive procedures and prolonged hospitalization. This study evaluated clinical characteristics, microbiological profiles, and factors associated with MDR infections among pediatric patients hospitalized in a PPC unit. Methods: This retrospective observational study included 66 children aged 1 month to 18 years who were admitted to the PPC unit of our hospital due to infection between June 2023 and January 2024. Demographic data, comorbidities, device use, infection sites, and microbiological results were reviewed. Bacterial identification and antimicrobial susceptibility testing were performed using the Vitek2 system and interpreted according to EUCAST. Results: The median age was 48 months (IQR 19–106); 63.6% were male. Lower respiratory tract infection was most common (68.2%), followed by sepsis (13.6%) and urinary tract infection (12.1%). Pseudomonas aeruginosa (36.4%) and Klebsiella pneumoniae (27.3%) predominated. MDR organisms represented 15.2% of isolates. MDR infections were significantly associated with percutaneous endoscopic gastrostomy or mechanical ventilation use (p = 0.033). Prolonged hospitalization and multiple comorbidities tended to increase the MDR risk but did not reach statistical significance. Conclusions: Gram-negative MDR infections constitute an important problem in PPC units. Frequent exposure to invasive devices and antibiotics increases susceptibility to resistant pathogens. Reinforcing infection prevention, optimizing antimicrobial stewardship, and monitoring device-related infections are essential to reduce morbidity and improve care quality in pediatric palliative care.

Trimethoprim is a clinically important antibiotic used for the routine treatment of urinary tract infections as a cost-effective first-line choice for treatment. A unique feature of the drug is that it can have bacteriostatic or bactericidal effects depending upon the metabolites available in the environment. Bacteriostatic activity requires the absence of nucleoside from the growth media. Conversely, bactericidal activity requires the presence of a nucleoside and the amino acids glycine and methionine. Mechanistically, bacteriostatic action does not appear to be dependent upon protein or RNA synthesis, whereas protein synthesis does not appear to be essential for bactericidal activity. Instead, this is likely due to the inhibition of DNA synthesis and the triggering of programmed cell death, involving the suicide module mazEF. In summary, trimethoprim has a complex mechanism of action that should be considered when researching the antibiotic and informing growth media design to test susceptibility.

Proteus mirabilis, a Gram-negative bacterium renowned for its distinctive swarming motility, is a major causative agent of catheter-associated urinary tract infections (CAUTIs) and nosocomial complications. While advances in sequencing technologies have generated extensive genomic data, critical gaps persist in understanding the global population structure and evolutionary drivers of antimicrobial resistance in this pathogen. To address this knowledge gap, we performed a phylogenomic analysis of 1,142 P. mirabilis genomes spanning 34 countries and 16 ecological niches. Our investigation identified a dominant multidrug-resistant lineage (Cluster-1) carrying significantly elevated antimicrobial resistance gene burdens, including high-prevalence carbapenemase genes blaKPC-2 and blaIMP-27. Bayesian evolutionary dating traced the most recent common ancestor of Cluster-1 to approximately 1910, with subsequent expansion linked to acquisition of the autotransporter gene agn43 within the PmGRI1 genomic island. Notably, Cluster-1 diversified into two clinically significant subclades: a China-associated branch carrying blaKPC-2 and a USA-associated branch harboring blaIMP-27. Functional characterization revealed that agn43 deletion caused significant attenuation in biofilm formation, heat stress tolerance, and swarming motility. Our findings delineate the emergence of a globally disseminated P. mirabilis clone, highlighting the synergistic role of antimicrobial resistance and agn43-mediated adaptive traits in its epidemiological success.

This study aimed to compare the predictive value of preoperative midstream urine culture (PMUC), intraoperative renal pelvic urine culture (RPUC), and stone culture (SC) for postoperative urinary tract infections (UTIs) following percutaneous nephrolithotomy (PCNL). We retrospectively analyzed 234 patients who underwent supine-PCNL between January 2020 and April 2025. UTI was diagnosed based on systemic inflammatory response syndrome criteria and elevated inflammatory markers. Demographic, peri-, intra- and post-operative data were compared between patients with and without UTI. Multivariate logistic regression identified independent predictors. UTI occurred in 14.1%(n = 33) of patients postoperatively, with 72.7% presenting with fever. Culture positivity rates were significantly higher in postoperative UTI-patients (PMUC = 27.3% vs. 7.5%, SC: 39.4% vs. 8.0% and RPUC: 30.3% vs. 6.0%; p < 0.001). In UTI-patients, only 15.2% of postoperative urine cultures obtained before antibiotic treatment showed bacterial growth, which was lower than intraoperative cultures. UTI was higher in female patients (60.6% vs. 39.4%) and in those with an ASA score of 3 (p = 0.001 and p = 0.020). Female gender (OR = 3.71, p = 0.004), ASA-3 score (OR = 5.13, p = 0.029), positive SC (OR = 5.83, p = 0.001), and RPUC (OR = 3.67, p = 0.023) were independent predictors of postoperative UTI. PMUC was not associated (p = 0.65) with postoperative UTI in the multivariate analysis. Intraoperative SC and RPUC showed a stronger association with postoperative UTI compared with PMUC and may be considered for routine use. Female gender and ASA-3 score were identified as independent risk factors. In patients who develop UTI, prior empirical or prophylactic antibiotic use may limit pathogen detection in postoperative urine cultures; therefore, intraoperative cultures play a critical role in early and targeted treatment.

Background: Urinary tract infections (UTIs) are among the most common bacterial infections in women and remain a significant public health problem. Uropathogenic E. coli (UPEC) is the main cause of UTIs and can form biofilms, which lead to recurrent infections and antibiotic resistance. Type 1 fimbriae in UPEC, encoded by the fim operon, facilitate bladder attachment, while the dam an orphan DNA methyltransferase in E. coli, contributes to bacterial colonization and biofilm formation. Data on the association between antibiotic susceptibility, fimA and dam gene prevalence, and biofilm formation in UPEC isolates from UTI patients in Indonesia remain limited. This study aimed to investigate the association of the dam and fimA virulence genes with biofilm formation in UPEC causing UTIs.Materials and Methods: Fifty UPEC isolates were obtained from a clinical microbiology laboratory. Biofilm formation was assessed using the tube method. Antibiotic susceptibility testing was performed using the Kirby–Bauer disk diffusion method with amoxicillin, ciprofloxacin, and gentamicin. The presence of the dam and fimA was determined by PCR.Results: Seventy percent of UPEC isolates were capable of biofilm formation. High resistance rates were observed for amoxicillin (92%), ciprofloxacin (88%), and gentamicin (56%). In UPEC isolates that were positive for the dam, 62% of them had the ability to form biofilms. Meanwhile, in UPEC isolates that were positive for the fimA, 52% of them had the ability to form biofilms.Conclusion: UPEC isolates showed a high prevalence of the dam and fimA genes, which were associated with biofilm formation and increased antibiotic resistance.Keywords: biofilm, antibiotic, dam, fimA, urinary tract infections

Multidrug resistance is a rising concern for global public health. Antibiotic and antifungal resistance infections demand new antimicrobial approaches. This is the first time Silver Nanoparticles (Ag NPs) were biosynthesized using Eichhornia crassipes leaf extract as a natural reducing and stabilizing agent in Bangladesh. The Ultraviolet-Visible (UV-vis) spectra observed at 468nm and 454nm, with a maximum absorbance of 1.516 for the 1:2 ratio (60min) and 0.546 for the 1:2 ratio (30min), respectively. Fourier Transform Infrared (FTIR) spectra indicated that functional groups, including 3333.11cm-1 (51.06% T) for carboxyl, 2191.23cm-1 (97.27% T) for alkyne, 1632.58cm-1 74.89% T) for carbonyl, and 627.08cm-1 (91.6% T) for chlorinated groups in the leaf extract, probably contribute to the reduction of metallic ions and the formation of nanoparticles. The antibacterial effectiveness of the synthesized Ag NPs was evaluated against antibiotic-resistant bacterial strains obtained from patients with Urinary Tract Infections (UTIs) at Kushtia Sadar Hospital, as well as against fungal infections. The disk diffusion technique is used to evaluate the antibacterial and antifungal activity, as well as the Minimum Inhibitory Concentration (MIC) and the Minimum Bactericidal/Fungicidal Concentration (MBC/MFC) tests. Notably, the synthesized Ag NPs exhibited significant antimicrobial activity against MEBTN 4(EF) and MEBTN 6(EF), with inhibition zone diameters ranging from 6 ± 0.1 to 13 ± 0.1mm. The MIC and MBC values against MEBTN 6(EF) were 15µg/mL and 60µg/mL, respectively, indicating strong bactericidal activity. Antifungal assays revealed a MIC value of 18µg/mL. The findings revealed substantial antimicrobial efficacy of Ag NPs against Multidrug-Resistant (MDR) UTI pathogens and pathogenic fungi, underscoring their broad-spectrum effectiveness in a new era of treatment. Future research should prioritize comprehensive in vivo toxicity assessments, elucidation of the underlying mechanisms, investigation of anti-cancer properties, including ROS-mediated effects, and optimization of large-scale production processes.

In the 2025 novel drug mini-review, one can take a full measure of the ingenuity that underlies current drug design and development, despite the year's smaller harvest (46 novel drugs) compared to 2024 (53) and 2023 (70). 54% of the novel drugs are first-in-class (FIC). The emphasis on proteins/antibodies is maintained (~25% novel drugs in 2025), an industry trend that does not seem to abate. Fewer than half of the novel medicines address major or common disorders. Among the FIC drugs, it is worth mentioning the Nav1.8 channel inhibitor suzetrigine, the first non-opioid approved to palliate acute pain; the first positive allosteric modulator of transient receptor potential melastatin 8 (TRPM8), acoltremon, that increases basal tear production in dry eye disease, a globally common disorder; lerodalcibep, a 'third generation' adnectin inhibitor of the protease Proprotein Convertase Subtilisin/Kexin type 9 (PCSK9) to treat elevated LDL-c; and zoliflodacin and gepotidacin, both innovatively targeting bacterial topoisomerases to treat uncomplicated urinary tract infections. Most of the approved medicines target unmet medical need areas and/or orphan indications (the latter alone accounting for 41% of the 2025 novel drugs) by applying imaginative approaches. These approaches include: the combination of two FIC drugs, the RAF/MEK clamp avutometinib paired with the FAK/Pyk2 inhibitor defactinib, to block more efficiently the RAS-RAF-MEK-ERK/FAK oncogenic pathway in low-grade serous ovarian cancer; fitusiran, the first RNAi therapy for haemophilia, targeting for the first time the production of the natural anticoagulant anti-thrombin in the liver; and brensocatib, which attenuates the activation of downstream neutrophil proteases by inhibiting the protease DPP1, thereby preventing lung tissue destruction in bronchiectasis. The landscape of novel drugs approved in 2025 reveals that pharmaceutical innovation continues to advance through FIC mechanisms, sophisticated therapeutic approaches, and a strong focus on unmet medical need.

Development and initial content and face validation of a questionnaire to evaluate pharmacists' attitudes and practices in counselling urinary tract infection patients: A mixed methods study.

To examine pregnancy and delivery outcomes in women who underwent sigmoid colon cystoplasty with retroperitoneal mesentery placement, a novel surgical technique designed to reduce cesarean section (CS) complications. A retrospective review at three institutions identified women who conceived after augmentation cystoplasty (AC). Data included pregnancy-related complications (hydronephrosis, urinary tract infections, and urinary incontinence), delivery-related outcomes, and intraoperative findings at CS. Six pregnancies occurred in five patients after AC; three underwent sigmoid colon cystoplasty with retroperitoneal mesentery placement, while two underwent conventional ileocystoplasty. Median age at AC was 11 years (range, 7-14 years). Hydronephrosis (4 pregnancies, 66.7%) and pyelonephritis (3, 50%) were most frequent, but no patient required nephrostomy or ureteral stenting. Urinary incontinence worsened in two pregnancies but resolved postpartum. Magnetic resonance imaging (MRI) before delivery provided anatomical information on four pregnancies. All deliveries were by CS, including five emergency procedures. In both ileocystoplasty patients, the uterus was covered by the mesentery of the augmented ileal segment, requiring a high uterine incision and careful vascular pedicle preservation. In contrast, the uterus was free of mesenteric coverage in sigmoid colon cystoplasty patients, and no intraoperative vascular pedicle or bladder injuries occurred. Pregnancy and delivery after AC require multidisciplinary management. Pre-delivery MRI may facilitate delivery planning. In this limited cohort, sigmoid colon cystoplasty with retroperitoneal mesentery placement appeared to allow safe cesarean delivery without vascular pedicle or augmented bladder injury. Larger studies are warranted to confirm these preliminary findings.

MicroRNAs (miRNAs) have been shown to regulate many cellular processes and to play a role in host-pathogen interactions. However, the role of miRNA in urinary tract infection (UTI) remains unclear. The aim of this study was to analyze and compare miRNAs from supernatants of human bladder epithelial cells infected with ESBL-producing (ESBL019) and non-ESBL-producing (CFT073) uropathogenic E. coli (UPEC) strains and to identify miRNA target genes in human cells and uropathogenic bacteria. In total, 402 unique miRNAs were found. The statistical analysis showed differential expression of 30 miRNAs from bladder cells stimulated with ESBL019, while stimulation with CFT073 did not show any significantly expressed miRNAs when compared to unstimulated controls. The 30 differentially expressed miRNAs in ESBL019 stimulated cells showed 747 predicted individual human gene targets. KEGG and REACTOME pathways showed enrichments in pathways mainly connected to immune regulation and stress responses. Of the 30 differentially expressed host miRNAs, nine miRNAs were found to interact with predictive targets of the whole genome from the multi-resistant, ESBL-producing UPEC strain EC958. This study shows that ESBL019-infected bladder epithelial cells release miRNAs with predictive targets in both human and bacterial genes, although their role in UTI cross-species interactions remains to be clarified.

Connotation of serum levels of vitamin D3 and LL-37 with urinary tract infection in type 2 diabetic patients

Sodium-Glucose Cotransporter-2 Inhibitors and Acute Kidney Injury Risk: A Systematic Review and Meta-Analysis of Randomized Trials.

False-positive results of the turbidimetric β-D-glucan assay in patients with bacteremia.