Episodes Of Urinary Tract Infection Research Articles

Aerococcus urinae Isolated from Women with Lower Urinary Tract Symptoms: In Vitro Aggregation and Genome Analysis.

Aerococcus urinae is increasingly recognized as a potentially significant urinary tract bacterium. A. urinae has been isolated from urine collected from both males and females with a wide range of clinical conditions, including urinary tract infection (UTI), urgency urinary incontinence (UUI), and overactive bladder (OAB). A. urinae is of particular clinical concern because it is highly resistant to many antibiotics and, when undiagnosed, can cause invasive and life-threatening bacteremia, sepsis, or soft tissue infections. Previous genomic characterization studies have examined A. urinae strains isolated from patients experiencing UTI episodes. Here, we analyzed the genomes of A. urinae strains isolated as part of the urinary microbiome from patients with UUI or OAB. Furthermore, we report that certain A. urinae strains exhibit aggregative in vitro phenotypes, including flocking, which can be modified by various growth medium conditions. Finally, we performed in-depth genomic comparisons to identify pathways that distinguish flocking and nonflocking strains.IMPORTANCEAerococcus urinae is a urinary bacterium of emerging clinical interest. Here, we explored the ability of 24 strains of A. urinae isolated from women with lower urinary tract symptoms to display aggregation phenotypes in vitro We sequenced and analyzed the genomes of these A. urinae strains. We performed functional genomic analyses to determine whether the in vitro hyperflocking aggregation phenotype displayed by certain A. urinae strains was related to the presence or absence of certain pathways. Our findings demonstrate that A. urinae strains have different propensities to display aggregative properties in vitro and suggest a potential association between phylogeny and flocking.

PD32-01 NATIONAL PRESCRIBING TRENDS AMONG ADULTS WITH URINARY TRACT INFECTIONS: FINDINGS FROM THE UROLOGIC DISEASES IN AMERICA PROJECT

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life and Shared Decision Making III (PD32)1 Apr 2020PD32-01 NATIONAL PRESCRIBING TRENDS AMONG ADULTS WITH URINARY TRACT INFECTIONS: FINDINGS FROM THE UROLOGIC DISEASES IN AMERICA PROJECT Lydia Feinstein*, Brian R. Matlaga, Kevin C. Abbott, Tamara Bavendam, Ziya Kirkali, Erline Martinez-Miller, and Julia B. Ward Lydia Feinstein*Lydia Feinstein* More articles by this author , Brian R. MatlagaBrian R. Matlaga More articles by this author , Kevin C. AbbottKevin C. Abbott More articles by this author , Tamara BavendamTamara Bavendam More articles by this author , Ziya KirkaliZiya Kirkali More articles by this author , Erline Martinez-MillerErline Martinez-Miller More articles by this author , and Julia B. WardJulia B. Ward More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000896.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Concerns of multidrug resistance may be influencing prescribing practices for urinary tract infections (UTI). We assessed 10-year trends in pharmacotherapy for UTI among a large sample of US adults treated in outpatient settings. METHODS: We assessed trends in the prevalence of UTI-related prescription fills and medication duration from 2007-2016. To assess trends among those aged 18-64 years (N= 2,691,529 UTI episodes), we utilized the Optum© Clinformatics® Data Mart (CDM), a de-identified administrative claims database that includes individuals covered by commercial insurance in all 50 US states. For analyses among those aged ≥65 years (N=874,043 UTI episodes), we utilized the Medicare 5% Sample. UTI was defined as an outpatient claim with a UTI-related diagnosis code followed by a pharmacy claim for an anti-infectious agent within 72 hours. RESULTS: The most commonly used medications were quinolones, urinary anti-infectives, and sulfonamides (Table 1). Quinolone use was more common among men compared to women, while urinary anti-infective use was more common among women. The mean duration of medication use was 8 days, with variation by medication type (range: 5-16 days). Over time, quinolone use decreased while the use of urinary anti-infectives, cephalosporins, and combination therapy including azoles increased (Figure 1). CONCLUSIONS: Pharmacological treatment of UTI evolved over the 10-year study period, shifting from a primarily quinolone-based treatment paradigm to a more diverse pharmaceutical armamentarium that increasingly relied on cephalosporin agents. This evolution was likely driven by resistance patterns that particularly impact the effectiveness of quinolone agents. Nevertheless, regardless of the antibacterial agent used, treatment duration appeared to be longer than what guidelines typically suggest, representing an opportunity for practice improvement. Source of Funding: Funded by the NIH via a contract to Social & Scientific Systems. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e636-e636 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lydia Feinstein* More articles by this author Brian R. Matlaga More articles by this author Kevin C. Abbott More articles by this author Tamara Bavendam More articles by this author Ziya Kirkali More articles by this author Erline Martinez-Miller More articles by this author Julia B. Ward More articles by this author Expand All Advertisement PDF downloadLoading ...

PD22-09 RESULTS OF VESICOURETERAL REFLUX TREATMENT WITH ENDOSCOPIC INJECTION OF BULKING AGENTS IN RENAL TRANSPLANT PATIENTS

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery I (PD22)1 Apr 2020PD22-09 RESULTS OF VESICOURETERAL REFLUX TREATMENT WITH ENDOSCOPIC INJECTION OF BULKING AGENTS IN RENAL TRANSPLANT PATIENTS Affonso Piovesan*, Rogério Sayâo, Matheus Siqueira, Felipe Bernardes, and Willian Nahas Affonso Piovesan*Affonso Piovesan* More articles by this author , Rogério SayâoRogério Sayâo More articles by this author , Matheus SiqueiraMatheus Siqueira More articles by this author , Felipe BernardesFelipe Bernardes More articles by this author , and Willian NahasWillian Nahas More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000872.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Vesicoureteral Reflux (VUR) after renal transplants has been reported to be 3% to 50%. Recurrent urinary tract infections (UTI) with VUR into the transplanted kidney are associated with significantly decreased graft survival. The objective is to evaluate the success rate of VUR treatment in renal transplant patients using endoscopic injection of bulking agents. METHODS: From January 1998 to July 2018, 3468 renal transplants with extravesical ureterovesical anastomosis were performed at our institution. After an acute graft pyelonephritis episode, 31 patients (9 men, 22 women) were diagnosed with VUR and submitted to a bulking agent endoscopic injection. Median age was 39,6 years, 17 deceased and 14 living donors. Mean time between renal transplantation and injection was 1641 days and mean UTI episodes before treatment was 2,2. These patients were divided into two groups according to the grade of VUR: Group A: 14 patients with VUR grades I – III and group B: 17 patients with VUR grades IV – V. Clinical success was defined as absence of new UIT episodes. Radiological success was defined as resolution or decrease of RVU grade. The groups were compared using paired T-test and analysis performed with SPSS 19.0 software. Statistical significance was p < 0,05. RESULTS: Clinical success was obtained in 61,3% of the patients. There was a tendency, not statistically confirmed, of better results in group A compared to group B (71,4% vs 52,9%, p=0,293). Radiological success was similar in both groups (68,3% vs 70,6%). CONCLUSIONS: VUR treatment with bulking agents has a high rate of clinical and radiological success. It should be considered the first choice for treatment in these patients. Source of Funding: Non © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e462-e462 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Affonso Piovesan* More articles by this author Rogério Sayâo More articles by this author Matheus Siqueira More articles by this author Felipe Bernardes More articles by this author Willian Nahas More articles by this author Expand All Advertisement PDF downloadLoading ...

Antibiotic switch after treatment with UTI antibiotics in male patients

Background: There is a lack of evidence on treatment of urinary tract infections (UTIs) in male patients in a primary care setting, and whether narrow-spectrum antibiotics are safe and effective.Objectives: To explore antibiotic switch rates after treatment with UTI antibiotics in men over the last 11 years.Material: We analysed data from the Norwegian Prescription Database (NorPD). Men ≥16 years receiving cefalexin, ciprofloxacin, cotrimoxazole, nitrofurantoin, ofloxacin, pivmecillinam or trimethoprim during the period 2008–2018 were included. Antibiotic switch was defined as being prescribed a different antibiotic drug appropriate for UTI within 14 days after initial treatment. We calculated rates of antibiotic switch and corresponding odds ratios for each antibiotic drug.Results: Seven hundred twenty-six thousand and ninety-six (726,096) prescriptions to 429,807 men were defined as possible UTI episodes. Fluoroquinolones, pivmecillinam and cotrimoxazole were most frequently prescribed. Forty-nine thousand five hundred and thirty-one (49,531) (6.8%) of the treatments resulted in antibiotic switch. Compared to cotrimoxazole, the risk of antibiotic switch was higher for pivmecillinam (OR: 2.46; 95% CI, 2.39–2.53) and trimethoprim (OR: 2.12; 95% CI, 2.04–2.20), and lower for fluoroquinolones (OR: 0.40; 95% CI, 0.39–0.42) and cefalexin (OR: 0.28; 95% CI, 0.26–0.30). Treatment duration of ≥7 days and age of ≥50 years were associated with an increased risk of antibiotic switch.Conclusion: Fluoroquinolones and cefalexin were associated with lower antibiotic switch rates than the recommended UTI antibiotics (pivmecillinam, nitrofurantoin and trimethoprim). However, the rates of antibiotic switch following treatment of male patients with first-line empirical UTI antibiotics are relatively low, indicating that the current guidelines are safe.

High grade vesicoureteral reflux in hypospadias: Case report of a rare association and review of literature

The Hypospadias represents a common urogenital anomaly amenable to surgical correction. Vesicoureteral reflux (VUR) are though may be found associated with hypospadias but it is unusual to have a severe VUR along with several episodes of high grade fever and culture positive urinary tract infections. We are presenting a rare association of high grade vesicoureteral reflux with febrile urinary tract infections (UTI’s) with subcoronal hypospadias. We also reviewed the available literature on this rare association and present its work-up and management.

Comparison of Primary and Recurrent Urinary Tract Infections in Children.

AimWe aimed to compare the demographic and ultrasound data regarding first-episode urinary tract infections with recurrent infections in children.MethodsA total of 509 children aged 0-16 years who were diagnosed to have a urinary tract infection (UTI) as confirmed with positive urinary culture tests were retrospectively investigated. A comparison of baseline parameters, responsible pathogen incidences, and ultrasound findings was made between children who had a single episode of UTI (n=418, 82.1%) with those having second or more recurrent episodes of urinary tract infection (n=91, 17.9%).ResultsThe mean age of children with a single episode of urinary tract infection was significantly lower than those who had recurrent urinary tract infection (5.33±4.38 vs. 7.01±4.83 years, p=0.003). Incidences of Escherichia coli and Enterococcus faecalis was significantly higher in patients with recurrent urinary tract infection than those who had single episode (n=315, 75.4% vs. n=80, 87.9%, p=0.009 and n=8, 1.9% vs. n=9, 9.9%, p<0.001, respectively). An abnormal ultrasound was significantly more common in patients with recurrent urinary tract infection than those who had a single episode (n=41, 54.6% vs. n=59, 22.7%). Increased renal parenchymal echogenicity (p=0.002), bladder cystitis (p=0.01) and hydronephrosis (p<0.001) were significantly more common in patients with recurrent urinary tract infection than those who had a single episode of urinary tract infection.ConclusionEscherichia coli and Enterococcus faecalis were the most common responsible pathogens in recurrent urinary tract infections. Structural changes, such as hydronephrosis and bladder cystitis, are likely to have an important role in the etiology of children with recurrent urinary tract infection.

Laparoscopic ureterolithotomy for the management of distal ureteric giant calculi in the endourology era – case report &amp; Brief review of literature

Background: The novel concept of endourology was first introduced to the world in 1978 by three legendary doctors Elwin Fraley, Arthur Smith, and Paul Lange. Fast forward 40 years, endourology today mostly rules the overall management of the majority of urinary tract calculi with some rare exceptions. Large, giant, massive distal-impacted ureteric calculi seem to be one such subset of exceptional situation, where laparoscopic ureterolithotomy (LUL) may have an edge over endourological manipulation. Even though LUL is a well-recognized option, the usage of the same is declining ever since the advent of endourology and its advances. This article brings to light the importance of the role and relevance of LUL versus endourology for the management of select large, giant ureteric stones and aims to bring to light certain inherent combined advantages of LUL versus endourology, such as effectiveness, short learning curve, single-staged nature of procedure, and being minimally invasive. Case Presentation: A 30-years-old female presented to our clinic with complaints of right flank pain and recurrent episodes of Urinary tract infection for the past 4 months. Clinical evaluations/investigations revealed a large distal ureteric calculus with a poorly functioning right kidney without any underlying anatomic/metabolic abnormality. The patient underwent LUL with a modified three-port technique and a large stone of 3.5 × 2 cm was retrieved uneventfully with the placement of a Double J stent. Conclusion: LUL is the preferred therapeutic surgical management modality of choice for select uncomplicated giant/large ureteric calculi, as it is coupled with the dual advantage of being minimally invasive and is accompanied by complete clearance with minimal morbidity thereby acting as a bridge to combine the positives of both endourological and open procedures. We encourage researchers to consider LUL in the minimally invasive management of select large impacted distal ureteric calculi in the otherwise anatomically normal renal units.

Multiple Drug Resistant Urinary Tract Infection in Kidney Transplant Recipients: A Retrospective Cohort Study.

Urinary tract infection (UTI) is the most common infectious disease in post-kidney transplantation patients. The objective of the study was to investigate the prevalence, impact and risk factors of multiple drug resistant (MDR) UTI in kidney transplant recipients. This retrospective cohort study recruited 72 kidney transplant recipients between March 2017 and February 2018. Urine cultures performed during the 1st year of posttransplantation with reference to clinical data were evaluated. Predesigned questionnaire was used to collect data regarding demographic, transplant related, and microbiological information. Multivariate analysis was performed to ascertain risk factors of MDR UTI. Out of 72 patients, 28 (38.9%) had culture guided clinical UTI. Overall, 59 UTI episodes were noted throughout the duration of this study. Eschericia coli were found to be the most frequent uropathogen of UTI among kidney transplant recipients (n = 32, 54.2%). MDR bacteria were responsible for 27.1% (n = 16) of the post-transplantation UTI episodes among patients, with E. coli (n = 9, 56.3%) being the predominant bacterial pathogen. Most of the MDR strains of E. coli (n = 7, 77.8%) were extended spectrum beta-lactamase positive. Female gender (P <0.001), prolonged Foley's catheterization (P = 0.002), coexisting diabetes mellitus (DM) (P <0.001) and induction of anti-thymocyte globulin (ATG) therapy (P <0.001) were independently associated with high risk of MDR UTI. The allograft rejection was found to be significantly higher in patients of posttransplantation UTI with MDR uropathogen (P = 0.009). In conclusion, E. coli were the most prominent uropathogen of UTI with and without MDR pathogen in the present study. Female gender, prolonged Foley's catheterization, coexisting DM, and induction of ATG therapy were the risk factors independently associated with MDR UTI in kidney transplant recipients. MDR organisms were significantly associated with allograft rejection.

Validation of "urinary tract dilation" classification system: Correlation between fetal hydronephrosis and postnatal urological abnormalities.

Aim to illuminate the correlation between fetal hydronephrosis and postnatal urological abnormalities by a new classification system—“urinary tract dilation (UTD)” grade.Of 659 pregnancies screened by ultrasound, 34 cases were found with isolated fetal hydronephrosis, and enrolled in our study from 2017 to 2019. These 34 infants had been prospectively followed up to 6 months after birth by 3 times of urinary tract ultrasound. Hydronephrosis was graded in accordance with the UTD classification system.Among 34 infants with isolated fetal hydronephrosis. Twenty-four (70.6%) were classified as UTD A1 grade (mild hydronephrosis), and the other 10 (29.4%) were UTD A2–3 grade (moderate to severe hydronephrosis) by antenatal evaluation. After birth, all of the 24 infants (70.6%) with UTD A1 grade had normal ultrasonic findings of urinary tract; while the other 10 cases with UTD A2–3 grade had persistent abnormalities of urinary tract by postnatal assessment, sorted as UTD P1 grade (mild hydronephrosis) in 6 cases (17.6%), UTD P2 grade (moderate hydronephrosis) in 2 cases (5.9%) and UTD P3 grade (severe hydronephrosis) in 2 cases (5.9%). The most common postnatal urological abnormality of isolated fetal hydronephrosis was vesicoureteral reflux. During the follow-up period, 7 infants (20.6%) had urinary tract infection episodes and very few obtained positive cultures of the urine. Only 2 infants (5.9%) with the diagnosis of ureterovesical junction obstruction required surgery intervention, who were both classified as UTD P3 grade. None of the children with UTD P1 and P2 grades needed operation.The UTD classification system described the urinary tract both antenatally and postnatally, which could point out the correlation between fetal hydronephrosis and postnatal urological abnormalities. This new classification system is expected to be a good prognostic marker for fetal hydronephrosis.

Short-term antibiotic exposure affected the type and resistance of uropathogens similar to long-term antibiotic prophylaxis in children hospitalised for urinary tract infections.

We investigated the impact of any antibiotic exposure on unusual and resistant pathogens in children with a urinary tract infection (UTI). This was a retrospective cohort study of 695 children (54% female) hospitalised with 711 UTI episodes at Heraklion University Hospital, Greece, from January 2007 to December 2017. Three groups were studied: no previous antibiotic exposure, ongoing prophylaxis and short-term exposure to antibiotics in the last six months. The median age at hospitalisation was 0.8years (range 25days to 15.9years). Previous short-term exposure and prophylaxis were important determinants of non-Escherichia coli (E. coli) (OR 2.05, 95% CI 1.25-3.36, P=.0017 and OR 3.84, 95% CI 2.32-6.34, P<.0001, respectively) and extended-spectrum beta-lactamase-positive uropathogens (OR 2.43, 95% CI 1.36-4.32, P=.0025 and OR 2.63, 95% CI 1.31-5.33, P=.0070, respectively). Short-term antibiotics in the last 30days or intravenous antibiotics were mostly associated with non-E. coli pathogens (OR 6.71 and OR 2.55, respectively). The most important determinants of E. coli resistance were short-term antibiotics for ampicillin (OR 2.58) and prophylaxis for cotrimoxazole (OR 2.64). Recent short-term exposure to antibiotics and ongoing prophylaxis both had a significant impact on the type and resistance of uropathogens.

Anti-reflux surgery in infancy: contra

The current management of vesicoureteral reflux (VUR) in infants remains controversial. Parameters such as high spontaneous resolution rates even in high-grade reflux in up to 45 %, associated renal hypo-/dysplasia in boys in up to 30 % and immature bladder function characterise the condition in early life. In this context, the reflux per se has become less important. This makes it all the more surprising that endoscopic treatment is recommended in recent papers to eliminate or downgrade the reflux in infants as an alternative to conservative treatment regimes. Compared with antibiotic prophylaxis, there is no difference in outcomes regarding new episodes of urinary tract infections or renal scarring. On the other hand, the necessity of anaesthesia, considerable reflux recurrence rates and the risk of obstruction in the short and long-term follow-up must be taken into consideration. Minimally-invasive anti-reflux surgery techniques are feasible also in infants. However, in due consideration of the high spontaneous resolution rates of reflux during the first 12 to 15 months of life and the fact that bladder function is still immature at that age, they should not be used as routine interventions.

About malpraxis, with love

About malpraxis, with love

The predictive utility of prior positive urine culture in children with recurrent urinary tract infections.

Urinary tract infections can cause renal damage if not treated promptly. The aim of this study was to examine if prior urine cultures can predict antibiotic susceptibility profile in a subsequent culture, in children with recurrent urinary tract infections. The medical records of all children with at least two episodes of urinary tract infection between 1999-2015 that occurred 2 weeks to 1 year apart were reviewed. Pathogen identity and antibiogram were compared between the two cultures for every patient. One hundred sixty-one cases of recurrent urinary tract infections were identified. Seventy-seven (48%) pairs of cultures grew the same pathogen. However, of these, 31 had an altered biogram. In 53% of the culture pairs, the pathogen in the second culture had a similar or better antibiotic susceptibility profile. We found no statistically significant correlation between the elapsed time between the two cultures and the probability of similar susceptibility profile between them. There was no correlation between antibiogram change and any of the demographic characteristics, including a history of renal transplantation and taking antibiotic prophylactic treatment.Conclusions: Antibiotic susceptibility profile of the pathogen in a prior urinary tract infection did not predict antibiotic susceptibility profile in a subsequent urinary tract infection in our study.What is Known:• Children with urinary tract infections often have recurrent infections.• Clinicians often use prior urine cultures to choose empirical antibiotic treatment in subsequent infections.What is New:• In only 50% of the cases, a subsequent urinary tract infection grows the same pathogen as the 1st urinary tract infection.• Even in cultures with the same pathogen growth, antibiogram is often different.

Active immunoprophyilaxis with uromune\xae decreases the recurrence of urinary tract infections at three and six months after treatment without relevant secondary effects

BackgroundTo prospectively analyze the efficacy of uromune® in the prevention of uncomplicated recurrent urinary tract infections at 3 and 6 months, and according to gender and menopause.MethodsFrom September 2011 to December 2017 uromune® was administered sublingually every 24 h along 3 months to 784 patients with history of three or more uncomplicated urinary tract infections in the 12 months prior to the first visit.The variables analyzed with statistical package system for science version 15.0 were age, gender, number of urinary tract infections with positive urine culture in the first consultation, and 3 and 6 months after the end of treatment.The results with positive urine culture were registered at 3 and 6 months after the end of the treatment according to gender and also in the menopausal group with respect to pre-menopausal women.ResultsMean age was 73.5 years. 82.7% were women and 94.3% menopausal.The number of episodes of urinary tract infections in the 12 months prior to uromune® were 3 in 37.2%, 4 in 28.1%, 5 in 19.5%, 6 in 9.6%, 7 in 4%, 8 in 1.4%, 9 in 0.1% and 10 in 0.1%.Three months after uromune® 44.1% had 0 urinary tract infections and 27.6% had 1. After 6 months the results were 0 urinary tract infections in 32.3% and 1 in 32.4%.Women had 0 urinary tract infections after 3 months in 45.4% and 1 in 28.5%. At 6 months the female had 0 episodes in 32.7% and 1 in 33.2%.Menopausal women had 0 urinary tract infections at 3 months in 46.5% and 1 in 28% and at 6 months scored 0 episodes in 33.6% and 1 in 32.9%.ConclusionsUromune® was highly effective to reduce the number of episodes of urinary tract infections at three and six months of follow-up. Uromune® reduced the number of episodes to zero or one in 71.7 and 64.7% at three and six months with minimal side effects.The best results were observed in women over 50 years old.Sublingual immunoprophylaxis with uromune® could be the treatment of first choice in the prevention of uncomplicated recurrent urinary tract infections according to the sample analyzed.

2659. Retrospective Review of Biopsy Proven Acute Graft Pyelonephritis in Renal Transplant Patients

BackgroundThere are few studies of histologic acute graft pyelonephritis (HAGPN) following kidney transplant (KT). The goals of this study are to determine incidence, identify potential risk factors and describe outcomes of HAGPN in a large cohort of KT recipients.MethodsRenal allograft biopsies of all patients undergoing first KT at our medical center between 2008 and 2017 were reviewed. HAGPN was defined as the presence of neutrophils within the interstitium and tubules (casts). Medical charts of patients with HAGPN were reviewed. Episodes of bacteriuria (≥10:5 cfu/mL growth in culture) were classified as urinary tract infection (UTI) or asymptomatic bacteruria (ASB) based upon documented symptoms. An episode of acute rejection was defined as pulse parenteral immunosuppressive therapy for histologic evidence of rejection.ResultsHAGPN was identified in 43 of 1,391 (3.1%) KT recipients at a median of 298 days post-transplant. There were no significant differences between recipient age or gender, donor age or transplant type (deceased, living related, living unrelated) between recipients with and without HAGPN. Urologic malformation was diagnosed in 14 (33%) by day 30 post-transplant. Twenty-five (58%), 17 (40%), and 13 (30%) sustained one or more episodes of acute rejection, UTI and ASB, respectively, prior to HAGPN. At diagnosis of HAGPN, 28 (65%), 7 (16%), and 16 (37%) had histologic evidence of rejection, UTI and ASB, respectively. Twenty-two (51%) and 37 (86%) were treated with pulse immunosuppression and antibiotics, respectively. Median nadir serum creatinine before HAGPN was 1.1 mg/day while median serum creatinine at 6 and 12 months after HAGPN were 1.5 and 1.6. Three patients (7%) developed graft failure within 1 year after HAGPN.ConclusionHAGPN is an infrequent complication of KT. A majority of patients with HAGPN have histologic evidence of rejection and either UTI or ASB at diagnosis, though over 40% have neither UTI nor ASB. When rejection accompanying HAGPN is routinely treated with pulse immunosuppression and antibiotic therapy is administered, graft function is preserved for most patients but a minority (7%) loses graft function within 1 year. Potential risk factors to be assessed in further study include post-transplant urologic dysfunction, acute rejection and UTI.Disclosures All authors: No reported disclosures.

2273. Outcomes of Trimethoprim/Sulfamethoxazole as Definitive Therapy for Urinary Tract Infections with Multi-Drug-Resistant Enterobacteriaceae

BackgroundTrimethoprim/Sulfamethoxazole (TMP/SMX) is not routinely employed for urinary tract infections (UTI) with multi-drug-resistant organisms (MDRO) due to paucity of effectiveness data, concerns regarding inadequate urinary penetration, and risk of adverse effects. We describe our experience with TMP/SMX as definitive therapy for MDRO Enterobacteriaceae (MDRO-E).MethodsWe carried out a retrospective review of patients hospitalized at a tertiary care center and treated with TMP/SMX as definitive therapy for UTI with MDRO-E (as defined by resistance to third-generation cephalosporins in culture). We evaluated rates of overall cure rate (CR), adverse events (AE), recurrence (RC) and reinfection (RI). Repeat growth of same or different pathogen in urine culture (UC) within 30 days of completion of treatment was defined as RC or RI, respectively.Results92 patients had 101 episodes of MDRO-E UTIs treated with TMP/SMX as initial (n = 26, 25.7%) or as step-down therapy (n = 23, 77%) after broad-spectrum empiric antimicrobials (ceftriaxone n = 22, cefepime n = 21, piperacillin/tazobactam n = 12, carbapenems n = 6, ciprofloxacin n = 3). 63 (68.5%) patients were 65 years or older. MDRO-E in 10 (9.9%) episodes were also resistant to carbapenems. Empiric therapy was appropriate in 56 (55.5%) episodes. Median duration of treatment was 8.5 (range 3–24) days for all antimicrobials and 7 (range 2–15) days for TMP-/SMX. Overall CR was 100%. RC/RI was seen in 23/101 (22.8%) episodes (RC n = 9; RI n = 14); UC data were available for 20 of which 8/20 (40%) had a TMP/SMX-resistant organism. 4 (3.9%) patients required readmission for a RC/RI UTI. In terms of AEs: 10 (9.9%) episodes of hyperkalemia (median maximum potassium level 4.5 mmol/L, range 2.7–6.4), 3 (2.9%) episodes of acute kidney injury, 5 episodes of Clostridium difficile infection, and 4 (3.9%) readmissions for a RC/RI UTI within 90 days.ConclusionOur findings suggest that TMP/SMX can be safe and effective as definitive therapy for ESBL-E UTI. The major AE are hyperkalemia and AKI, the incidence of which is high when TMP/SMX is used in combination with ACEI/ARBs. No clinical factors were found to be predictive of recurrence of reinfection. Disclosures All authors: No reported disclosures.

Perfil de susceptibilidad bacteriana en infección del tracto urinario en población infantil de Cali – Colombia

Objetivo: Caracterizar la susceptibilidad bacteriana en la infección urinaria adquirida en la comunidad de la población pediátrica atendida en una institución de Cali-Colombia. Materiales y métodos: Estudio observacional descriptivo, retrospectivo, en niños de 1 mes a 18 años de edad, que consultaron a la Fundación Clínica Infantil Club Noel con una impresión diagnóstica de primer episodio de Infección del Tracto Urinario (ITU) confirmado por urocultivo y que cumple los criterios de inclusión establecidos. Durante el período comprendido entre el 1 de enero a 31 de diciembre de 2015. Resultados: Se evaluaron un total de 196 urocultivos positivos. La ITU de la comunidad en varones, es más frecuente en los menores de 1 año de edad, en comparación con las niñas donde se presenta principalmente entre 1 a 5 años. El microorganismo más comúnmente identificado fue E. coli, seguido de Proteus spp. y finalmente Klebsiella pneumoniae. Los patrones de resistencia fueron: penicilinasa de bajo techo en el 9.1%, Betalactamasa de Espectro Ampliado (BLEA) en el 60.2%, Betalactamasa AmpC en 10,2% y Betalactamasa de Espectro Extendido (BLEE) en 7,1% de los aislamientos. Conclusiones: Se concluye que la primera ITU en niños se presenta con mayor frecuencia en el primer año de vida, mientras que en niñas ese primer episodio ocurre dentro de los primeros 5 años. Respecto a los patrones de resistencia, el patrón AmpC y BLEE se encuentra en el 17.3%, en la población de estudio. La resistencia persiste alta a antibióticos de uso habitual como ampicilina, cefalotina y Trimetoprim- Sulfametoxazol (TMP-SMX).

Involvement of NLRP3 and NLRC4 Inflammasome in Uropathogenic E. coli Mediated Urinary Tract Infections.

BackgroundInflammatory response during urinary tract infection (UTI) is mediated by innate immune defense. Nod like receptors (NLRs) have been proposed to work simultaneously beside TLR pathways to mediate pro-inflammatory response and maintain tissue homeostasis. Some in vitro reports have showed the involvement of NLRP3 inflammasome during uropathogenic Escherichia coli (UPEC) mediated UTI. So we have sought to determine the status of various inflammasomes and their components in UPEC mediated UTI.MethodsA total of 186 females experiencing the first episode of UTI were recruited for the study and forty were found to be positive for UPEC (≥105 CFU/ml) in their urine (N = 40). Further, we analyzed the expression of NLRP3, NLRC4, NAIP, AIM2, ASC, CASPASE-4, and CASPASE-1 gene at mRNA and protein level in the blood of UPEC confirmed study subjects through real time qPCR and immunoblotting. Healthy females (N = 40) visiting the OPD for health checkups, family planning advice and subjects undergoing routine medical examinations, were recruited as healthy control subjects. Pro-inflammatory cytokines (IL-6, IL-8, IFN-γ, TNF-α and MCP-1) were measured in the plasma of patients and controls through ELISA. For investigation of the involvement of NLRC4 and NLRP3 inflammasome, in vitro studies were performed using co-immunoprecipitation and confocal microscopy.ResultsMost of the inflammatory regulators studied (i.e., NLRP3, NAIP, NLRC4, ASC, and CASPASE-1) were found to be up-regulated at both mRNA and protein levels in the UPEC infected UTI patients. Also, pro-inflammatory cytokines (IL-6, IL-8, IFN-γ, TNF-α, and MCP-1) were found to be up-regulated in the patients group. However, no significant difference was observed in the expression of AIM2 and CASPASE-4 genes at both mRNA and protein levels. Further, in vitro studies have shown the involvement of NLRC4 inflammasome in UPEC infected THP1 derived macrophages.ConclusionInvolvement of NLRP3 and NLRC4 inflammasomes in UPEC infected UTI is evident from our findings. This is the first report showing levels of inflammasome and its components in UTI patients suggesting a possible role during UPEC mediated UTI. We have also reported the involvement of NLRC4 inflammasome for the first time during UTI infection.

Risk Factors for Urinary Tract Infection After Kidney Transplant: A Retrospective Analysis

Urinary tract infections are the most common type of infections in kidney transplant recipients. They are also important factors for increased morbidity and mortality. The aims of this study were to evaluate the number of urinary tract infections, to identify possible donor/receiver-based risk factors, and to evaluate the impact of these infections on graft function. Medical records of patients who had undergone kidney transplant between 2010 and 2017 were retrospectively analyzed. Our study included 145 patients (49 women [33.8%] and 96 men [66.2%]), with mean age of 35.2 ± 12.4 years. There were 105 episodes of urinary tract infections in 55 of 145 patients (37.9%) during the first year after transplant. Female sex (P = .001), glomerulonephritis as primary kidney disease (P = .04), pretransplant diabetes (P = .05), and presence of ureteral stent (P = .03) were significant risk factors for the development of urinary tract infections. The most frequent pathogens identified were Escherichiacoli and Klebsiella pneumoniae. Mean glomerular filtration rate t 12 months was significantly lower in patients with urinary tract infection than in patients without infection (80 ± 25 vs 68 ± 28 mL/min; P = .006). In kidney transplant recipients, urinary tract infections are common complications and have negative outcomes on graft function. These infections remain an important disease that requires frequent investigations and new ways of approach for prevention.

INFECCIONES URINARIAS ASOCIADAS AL USO DE ISGLT-2

La reacción adversa más frecuentemente asociada al tratamiento con inhibidores del cotransportador sodio-glucosa es la infección micótica genital y en menor proporción la infección urinaria, esto no es dosis dependiente. Es más común en mujeres y en hombres antes de los 50 años de edad. Es infrecuente la necesidad de suspender el tratamiento por estas infecciones. Se recomienda evitar el uso en pacientes con historia de infecciones urinarias recurrentes o con episodio reciente de infección urinaria alta y especial cuidado al indicarla en aquellos con historia de hipertrofia prostática porque se han descripto casos de pielonefritis.