Urine Culture Reports Research Articles

Urinary tract infection in children: clinical aspects and utility of urine dipstick test

Background: Urinary tract infection (UTI) is a common genitourinary disease in children and accounts for significant morbidity. To prevent the potentially dangerous sequel, early detection of UTI in childhood is essential. This depends entirely on strong clinical suspicion and urine culture report. Recently, advances in investigations are taking place to diagnose UTI rapidly. Urine dipstick is one such bedside method to diagnose UTI. This study aims at studying the clinical features of UTI and evaluating sensitivity and specificity of urine dipstick in diagnosing UTI.Methods: This study was conducted at a tertiary care hospital in Vadodara from January 2013 to June 2014, on 60 children admitted with clinical suspicion of urinary tract infection. Along with study of clinical features, results of urine dipstick tests (Nitrite and Leukocyte esterase), urine microscopy and urine culture were compared. Accuracy of urine dipstick tests was assessed statistically by evaluating sensitivity, specificity, positive and negative predictive values considering urine culture as a gold standard.Results: Fever was found to be the most common presenting features (53%) in all the patients studied. The sensitivity of urine microscopy, Nitrite test and Leucocyte esterase test was 63.5%, 50% and 61% and specificity was 25%, 31% and 25% respectively. Combination of Nitrite and Leucocyte Esterase test had an improved sensitivity (68%).Conclusions: Urinary tract infection can present with variety of non-specific signs and symptoms especially in younger age. Dipstick test using Leucocyte Esterase and Nitrite together is better than urine microscopic examination alone. Urine culture as a confirmatory test still remains gold standard.

Extended spectrum beta lactamase producing organisms causing urinary tract infections in Sri Lanka and their antibiotic susceptibility pattern \u2013A hospital based cross sectional study

BackgroundExtended Spectrum Beta- Lactamase producing organisms causing urinary tract infections (ESBL-UTI) are increasing in incidence and pose a major burden to health care. While ESBL producing Klebsiella species seem to account for most nosocomial outbreaks, ESBL-producing E. coli have been isolated from both hospitalized and non-hospitalized patients. Although 95-100% ESBL organisms are still considered sensitive to meropenem, rapid emergence of carbapenem resistance has been documented in many countries. The objective of this study was to evaluate urinary tract infections caused by ESBL producers and the antibiotic susceptibility patterns in Sri Lanka.MethodsPatients with confirmed ESBL-UTI admitted to Professorial Medical Unit, Colombo North Teaching Hospital from January – June 2015 were recruited to the study. Their urine culture and antibiotic susceptibility reports were evaluated after obtaining informed written consent.ResultsOf 61 culture positive ESBL-UTIs, E. coli caused 53 (86.8%), followed by Klebsiella in 8 (13.1%).30 (49.1%) had a history of hospitalization within the past three months and included 6/8(75%) of Klebsiella UTI and 24/53(45.2%) of E.coli UTI. Antibiotic susceptibility of ESBL organisms were; Meropenem 58 (95%), Imipenem 45 (73.7%), Amikacin 37 (60.6%) and Nitrofurantoin 28(45.9%). In 3(4.9%), E.coli were resistant to Meropenem. These three patients had received multiple antibiotics including meropenem in the recent past for recurrent UTI.ConclusionsWe observed a higher percentage of E. coli over Klebsiella as ESBL producing organisms suggesting most ESBL-UTIs to be community acquired, Carbapenems seem to remain as the first line therapy for majority of ESBL-UTIs in the local setting. However 4.9% prevalence of meropenem resistance is alarming compared to other countries.Although prior antibiotic utilization and hospitalization may contribute to emergence of ESBL producing Klebsiella and E.coli in Sri Lanka, high prevalence of community acquired ESBL-E. coli needs further investigations to identify potential causes . Being a third world country with a free health care system, observed alarming rate of carbapenem resistance is likely to add a significant burden to health budget. We feel that treatment of infections in general needs a careful approach adhering to recommended antibiotic guidelines in order to prevent emergence of multi drug resistant organisms.

Antimicrobial prescribing pattern in urinary tract infection in a tertiary care hospital

Background: Urinary tract infection (UTI) is a common illness affecting both males and females in almost all age groups. Varieties of antimicrobials such as cotrimoxazole, nitrofurantoin, fluoroquinolones, and penicillin are effective for treatment of UTI. Aims and Objectives: The present observational study was planned to generate data on antimicrobial use pattern in UTI which could be beneficial in selection of rational drug therapy in UTI. Materials and Methods: The retrospective study was carried out by analyzing indoor and outpatient department case records of UTI patients of a tertiary care hospital. The demographic data and prescription pattern, urine culture report, along with the antimicrobial sensitivity testing were evaluated. The data were analyzed by routine descriptive statistics. Results: Escherichia coli was the most common organism to be isolated in urine culture followed by Staphylococcus aureus. Cephalosporin group was the most prescribed antibiotics in all age groups. Although nitrofurantoin and cotrimoxazole were showing good sensitivity pattern when compared with other antimicrobial groups, these were least prescribed. Conclusion: The choice of antimicrobial drugs should be individualized based on patient compliance, adverse effects, availability and costing factors, along with prevailing sensitivity pattern in the locality. Nitrofurantoin can be better alternative for uncomplicated UTI when compared to third generation cephalosporins.

Antibiotic Screening of Urine Culture for Internal Quality Audit at Amrita Hospital, Kochi

Urine antimicrobial activity is a seldom analysed laboratory test which greatly impacts the quantification of urine specimens. Presence of antimicrobial activity in the urine reduces the bacterial load in these specimens. Hence, the chances of erroneously reporting insignificant bacteriuria can be reduced on analysis of the antimicrobial activity in urine. The aim of the study was to measure the antimicrobial activity of urine samples obtained from patients in a tertiary care hospital. A total of 100 urine specimens were collected from the study group. Tests like wet mount, Gram staining and culture were performed. Antimicrobial susceptibility testing was done on the bacteria isolated from each specimen. The urine specimens were reported as significant bacteriuria (>105 Colony Forming Unit (CFU)/ml) and insignificant bacteriuria (<105 CFU/ml - clean catch midstream urine; <102 CFU/ml - catheterized urine sample) according to the CFU/ml. Staphylococcus aureus ATCC® 25923™ and Escherichia coli ATCC® 25922™ were used to identify the presence of antimicrobial activity in the urine sample by Urine Anti-Bacterial substance Assay (UABA). McNemar test was used for statistical analysis using Statistical Package for the Social Sciences (SPSS) version 21.0. On analysis of the antimicrobial activity of urine sample with the prior antibiotic history of the patients, 17 were true positives and 43 were true negatives. Twenty six of samples with UABA positivity were culture negative and 28 samples with UABA positivity were culture positive. Sensitivity and specificity of the test was 85% and 53.8% respectively. Accuracy of the test was 60%. The p-value of UABA was <0.001. Enterobacteriaceae was the most common bacterial family isolated from the urine specimens. A total of 85% patients responded to treatment. Presence of antimicrobial activity in urine has a great impact on the interpretation of urine culture reports. Identification of urine antimicrobial activity helps in evaluating the quantification of bacterial growth reported in urine culture. It facilitates speedy recovery of patients by early administration of antibiotics.

Culture and Sensitivity Pattern of Urinary Tract Infection in Hospitalized Children in Patan Hospital

Introduction: Urinary tract infection is one of the most common infections in children. Antibiotics are usually given empirically before urine culture reports are available. The primary aim of this study was to see the causative organisms and culture and sensitivity pattern of urinary tract infection in hospitalized children.Material and Methods: All children aged 0-15 years with culture positive urinary tract infections who were admitted to children’s ward from 14th April 2013 to 14th April 2014 were included. The causative organisms for urinary tract infection along with its antibiotic sensitivity pattern were retrospectively reviewed and analyzed.Results: 48 cases of culture positive urinary tract infection were enrolled in this study in a period of 12 months. The most common causative organism was Escherichia coli (67%), followed by Klebsiella pneumoniae (21%), Non-hemolytics streptococcus (4%), Enterobacter (2%), Acinetobacter (2%), Proteus (2%) and Coagulase negative staphylococcus (2%). Most cases of the culture positive urinary tract infection occurred between 2 months to 1 year of age. Out of 48 cases, 90% were sensitive to Amikacin and 85% were resistant to Ofloxacin.Conclusion: Escherichia coli is the most common organism causing urinary tract infection in children. As resistant to first line antibiotic is increasing, antibiotic stewardship programme should be strengthened.J Nepal Paediatr Soc 2016;36(1):28-33

Pandrug Resistant Pseudomonus Aeruginosa Isolated From Urine Sample of a Patient of Bitid : A Case Report

A 80 years old diabetic, hypertensive with severe sleep apnoea syndrome male patient who is on BiPAP machine having history of repeated hospitalization in ICU for stroke, LVF,sleep apnoea and chronic urinary retension with repeated urinary catheterization with intake of different parenteral antibiotic therapy presented with burning micturation along with passage of cloudy urine for five days. His urine culture report revealed growth of Pseudomonus aeruginosa which was resistant to all antibiotics like Azithromycine, Cefixime, Ceftriaxone, Cefuroxime, Cotrimoxazole, Amoxyclav, Amikacin, Ceftazidime, Ciprofloxacin, Doxycyclin, Meropenem, Nitrofurantoin, Chloramphenicol, Cefipime, Tetracyclin, Cefpirome, Cefotaxime, Levofloxacin, Piperacilin+Tazobactam, Cefoperazone+Sulbatam, Tygicyclin, and Ticarcillin+Clamlanic acid except Colistin which was sensitive. Patient was given Inj. Colstin for seven days and then was stopped due to severe nephrotoxicity and microbiologically patient was cured. But two weeks after again growth of multidrug resistant pseudomonas occurred in his urine sample. Then patient was given a series of parenteral and oral antibiotics(Inj. Cefuroxime, Inj. Colistin, Inj. Ceftriaxone, Moxifloxacin, Levofloxacin, Azythromycin, Ciprofloxacin, cefixime, cotrimoxazole etc) to which the organism was resistant along with relieve of obstruction by urinary catheterization for last 12 months of study. At follow up after end of study patients well being was good though resistant organism remained in his urine sample proved by repeated urine culture where the colony count of the organism was not in pathological range.&#x0D; JCMCTA 2016 ; 27 (1) : 61 - 64

Correlation between biofilm formation and resistance toward different commonly used antibiotics along with extended spectrum beta lactamase production in uropathogenic Escherichia coli isolated from the patients suspected of urinary tract infections visiting Shree Birendra Hospital, Chhauni, Kathmandu, Nepal.

BackgroundEscherichia coli is the most predominant causative agent of urinary tract infection (UTI). Recently, increase in drug resistance among the uropathogenic bacteria has caused great problem in treatment of UTI. The main objective of this research is to determine the correlation between biofilm formation and resistance toward different commonly used antibiotics along with extended spectrum beta lactamase production in uropathogenic Escherichia coli.MethodsThe urine samples collected from the patients suspected of urinary tract infections (visiting Shree Birendra Hospital, Chhauni, Kathmandu, Nepal between July to December 2013) were cultured in cystine lactose electrolyte deficient (CLED) agar by using semi quantitative culture technique. Extended spectrum beta lactamase (ESBL) production was detected by combined disc diffusion technique and biofilm formation was detected by Congo red agar method. Chi-square test was applied and p-value < 0.05 was considered statistically significant.ResultsOut of 1480 urine samples, E. Coli was isolated from 208 (14.1 %) samples. Of total 69 (33.2 %) ESBL producing uropathogenic strains of E. coli, 20 (29 %) were strong biofilm producers, 22 (31.9 %) were moderate biofilm producers, 11 (15.9 %) were weak biofilm producers and 16 (23.2 %) were biofilm non producers. Whereas among 139 ESBL non producing E. coli, 22 (15.8 %) were strong biofilm producers, 20 (14.4 %) were moderate biofilm producers, 13 (9.4 %) were weak biofilm producers and 84 (60.4 %) were biofilm non producers. Among total 108 biofilm producing E. coli, maximum resistance was observed toward cephalexin followed by amoxicillin and highest susceptibility was seen toward amikacin.ConclusionThe ability of biofilm formation was found to be significantly higher in ESBL producing strains of E. coli than that in ESBL non producing strains (p < 0.05). There was higher resistance rate to antimicrobial agents among biofilm producing strains of E. coli than that in biofilm non producing strains. According to our antimicrobial susceptibility pattern for E. coli, to start preliminary treatment for UTI in Nepal, we recommend to use amikacin or nitrofurantoin. Further, for the treatment of the UTI, the antibiotics should be selected on the basis of the urine culture and sensitivity report.

Review of enterococci isolated from canine and feline urine specimens from 2006 to 2011.

Canine and feline urine culture reports and medical records were reviewed at a veterinary teaching hospital from 2006 to 2011 for enterococcal growth, coinfections, antimicrobial resistance, urine sediment findings, clinical signs, and concurrent conditions. Of all of the urine specimens with significantly defined colony-forming units/mL, Enterococcus (E.) faecalis was the only enterococci isolated from cats and predominated (77.4%) in dogs followed by E. faecium (12.9%), E. durans (3.2%), and other Enterococcus spp. (6.5%). The majority of specimens with significant enterococcal growth resulted in complicated urinary tract infections in 83.9% of dogs and 81.8% of cats. Specimens with only enterococcal growth were more common than those mixed with other bacterial species. Cocci were observed in urine sediments of 8 out of 8 cats and 21 out of 25 dogs with available concurrent urinalyses. Pyuria was noted in 5 out of 8 feline and 15 out of 25 canine urine sediments, and pyuria in dogs was associated with growth of only enterococci on aerobic urine culture. Multidrug resistance was identified in 6 out of 11 cats and 7 out of 31 dogs, and E. faecium isolates from dogs were 4.5× more likely to be multidrug resistant than E. faecalis.

Drug interaction resulting in massive chest wall hematoma in a patient on therapeutic anticoagulation.

Sir, The incidence of spontaneous large hematomas is rare compared to several case reports of major intracranial bleed in patients on therapeutic anticoagulation. The most commonly involved anticoagulant is warfarin, used in the prevention of thrombo-embolism in deep vein thrombosis, prosthetic valves, atrial fibrillation, etc.[1] The incidence of hematomas requiring invasive intervention is rarely encountered. There is a case of pectoral hematoma reported by Cinar, et al., in a case series, which was managed conservatively.[2] We report a case of an elderly woman, on therapeutic anticoagulation for deep-vein thrombosis, who presented with a large left chest wall hematoma requiring embolization of the bleeding vessel. An 82-year-old female patient was admitted to Intensive Care Unit (ICU) with a history of disorientation for 2 days. She was on therapeutic anticoagulation with warfarin 2 mg OD since 1-year after presenting with chronic deep vein thrombosis due to hyperhomocysteinemia and protein S deficiency and required inferior vena cava filter insertion earlier. Her platelet count and serum creatinine levels were within normal range. At present, she was found to have urinary tract infection for which ertapenem was started. International normalized ratio (INR) at time of admission was 1.8 and was monitored daily and antibiotic was de-escalated to levofloxacin 500 mg intravenous (IV) OD as per the urine culture report and she was shifted to wards. She was back in ICU 3 days later, with a painful swelling in left breast. Ultrasonogram [Figure 1a], chest X-ray [Figure 1b], and CT chest [Figure 1c-​-e]e] showed a large left anterior chest wall hematoma, inseparable from pectoralis major, measuring 15 cm × 8.2 cm axially and 16 cm craniocaudally. Figure 1 (a) Gross appearance. (b) Chest X-ray. (c) Computed tomography (CT) image coronal section. (d) CT image transverse section. (e) CT image, sagittal section Her hemoglobin had dropped to 4.5, and INR had shot up to 6.22 over 3 days. She was resuscitated with IV fluids and packed red blood cells. Fresh frozen plasma and injection Vitamin K 10 mg were given to prevent further bleed. But the hematoma continued to increase in size requiring an emergency angio-embolization of a large branch of left internal mammary artery. INR came down to 0.8 next day. Hemoglobin remained stable, and she went home in 3 days. A significant resorption of the hematoma was observed on review, and anti-coagulant therapy was re-started after 10 days. Hematoma in pectoral muscle has been rarely reported in the literature. Kocer et al. described cases of spontaneous intra-pectoral bleeding.[3] It was considered that in our patient, interaction between levofloxacin and warfarin could have possibly potentiated the action of warfarin, and even mild physiotherapy could have triggered a bleed.[4,5] This case is rare as it occurred over a very short duration and involved an arterial bleed requiring interventional management. The drop in hemoglobin was a very significant 8%. The interaction of warfarin with various medications and food substances is well-known. Its life-threatening complication is something that should be kept in mind considering the fact that levofloxacin is a very common antibiotic prescribed by community physicians for common cold, urinary tract, and upper respiratory tract infections. As noted here, the trigger for a torrential bleed could be very trivial as mild physiotherapy.[4,5] To conclude, a careful screening for interactions is required before prescribing medicines for patients on anticoagulation therapy.

Clinical and bacteriological profile of UTI patients attending a North Indian tertiary care center

Introduction: Urinary tract infection (UTI) is a common cause of morbidity in patients attending our hospital. Recently UTI has become more complicated and difficult to treat because of appearance of pathogens with increasing resistance to the commonly used antimicrobial agents. Objectives: The main aim of the study was to determine the bacteriological profile and antibiotic susceptibility pattern of UTI patients attending our hospital. Materials and Methods: 1843 patients complaining of fever with or without urinary symptoms attending medicine and nephrology clinics of Jawaharlal Nehru Medical College Hospital, Aligarh from June 2012 to July 2014 were analysed. Clean catch mid-stream urine specimens collected from each subject were subjected to urine culture and sensitivity tests. Patients with age 15 to 85 years were included. Results: Significant bacteriuria was detected in 33.4% patients. Diabetes, obstructive uropathy, and previous instrumentation were the major risk factors identified. The most common pathogens isolated were Escherichia coli (52.4%), Klebsiella pneumoniae (12.3%) and Citrobacter spp. (9.1%). Most susceptible antibiotic was Amikacin, Cefoperazone-sulbactum, Piperacillin-tazobactum and Nitrofurantoin for most of the isolates. E. coli which was the main isolate was found to be most susceptible to Amikacin (78.3%), Cefoperazone-sulbactum (72.8%), Piperacillin-tazobactum (70.5%), Gentamicin (69.3%), Nitrofurantoin (67.3%), Cefoperazone (64.1%) and Ceftriaxone (61.6%). Conclusion: This study highlights the common pathogens causing UTI in our area and their antibiotic sensitivity patterns which could help clinicians in starting rational empirical antibiotic therapy for such patients while awaiting urine culture reports. This would significantly decrease the incidence of drug resistance and be more cost effective to the patients.

Clinical and bacteriological profile of Uti patients attending a north Indian tertiary care center

Objective: Urinary tract infection (UTI) is a common cause of morbidity in patients attending our hospital. Recently UTI has become more complicated and difficult to treat because of appearance of pathogens resistant to the commonly used antimicrobial agents. The main aim of the study was to determine the causative agents and antibiotic susceptibility pattern of UTI patients attending our hospital. Materials and methods: A prospective cross sectional study was conducted in asymptomatic and symptomatic UTI patients attending medicine and nephrology clinics of Jawaharlal Nehru Medical College Hospital, Aligarh from June 2012 to July 2014. A total of 1843 patients were investigated for urinary tract infection. Clean catch mid-stream urine specimens collected were subjected to urine culture and sensitivity tests. Results: Significant bacteriuria was detected in 19.3% and 55.4% of asymptomatic and symptomatic patients, respectively. The overall prevalence of significant bacteriuria in both groups was 33.4% with female sex, diabetes, obstructive uropathy, previous instrumentation and chronic kidney disease being the major risk factors. The most common pathogens isolated were Escherichia coli (52.4%) followed by Klebsiella pneumoniae (12.3%), Citrobacter spp (9.1%), Enterococcus (6.9%), Proteus spp (5.3%), Coagulase negative staphylococcus (5.3%) and Staph Aureus(4.0%). Most susceptible antibiotic was Amikacin, Cefoperazone-sulbactum, Piperacillin-tazobactum and Nitrofurantoin for most of the isolates. E. coli which was the main isolate was found to be most susceptible to Amikacin (78.3%), Cefoperazone-sulbactum 72.8%, Piperacillin-tazobactum (70.5%), Gentamicin (69.3%) and Nitrofurantoin (67.3%). Conclusion: This study highlights the common pathogens causing UTI in our area and their antibiotic sensitivity patterns which could help clinicians in starting rational empirical antibiotic therapy for such patients while awaiting urine culture reports.

English

BACKGROUND: Urinary Tract Infection (UTI) is among the most common serious bacterial infections in infants and children, and is frequently missed, probably because of its non- specific presentation. The knowledge of etiology and antibiotic sensitivity and resistance pattern of the organisms causing urinary tract infection is essential. OBJECTIVES: To record the common clinical presentation and risk factors for UTI in children. The distribution of bacterial strains isolated from these patients and their sensitivity and resistance pattern were also studied. MATERIALS AND METHODS: An observational study was conducted in Department of Pediatrics, Raja Rajeswari Medical College, Bangalore, a tertiary care centre, from August to December, 2013. Patients who had UTI confirmed by positive urine culture reports were included in the study. Statistical analysis was done using the SPSS version 17. RESULTS: 82 children had UTI with positive urine culture reports. Maximum number of cases was seen in the age group 1-5 years (51.2%), where males were 31% and females were 69%. Fever was the commonest presenting single symptom and the commonest organisms isolated in urine were Escherichia coli (73.2%), Enterococcus (8.5%) and Klebsiella (4.8%). History of incomplete course of antibiotic (12.1%) and posterior urethral valve (3.7%) were the major risk factors for UTI. Imipenem (58.5%), Amikacin (57.3%) and Gentamicin (52.4%) were the drugs with highest sensitivity to the organisms cultured. Furazolidine, Tobramycin, Metronidazole, Pefloxacin and Cefuroxime were found the most resistant drugs as 97.5% patients were found resistant against each one of them. The other most resistant drug was Erythromycin (96.3%) followed by Amoxicillin (90.2%). CONCLUSION: Overall, females have a higher risk of UTI. Clinical presentation plays a minor role in establishing diagnosis in UTI in children. E. coli is the most widely prevalent organism causing UTI in children. Imipenam, Amikacin and Gentamicin were the drugs with highest sensitivity and Furazolidine, Tobramycin, Metronidazole, Pefloxacin, Cefuroxime, Erythromycin and Amoxicillin were found to be the most resistant drugs. A strong decision has to be established regarding the antibiotic policies for UTI and stringent measures have to be taken to ensure the effectiveness of the same.

G369(P) Phase Contrast Microscopy of Urine: Meeting the Gold/Beating the Gold

AimsTo compare the results of urine microscopy and urine culture using real time videos of the specimens as a refereeing traceable standard for concordance-discordance testing.MethodsUrine samples sent to be cultured...

Clinico-microbiological profile of urinary tract infection in South India

The knowledge of etiology and antibiotic resistance pattern of the organisms causing urinary tract infection is essential. This study was taken up to determine the presentation and risk factors associated with community-acquired urinary tract infection (CA-UTI). The distribution of bacterial strains isolated from these patients and their resistance pattern were also studied. This multidisciplinary prospective observational study was conducted in M. S. Ramaiah Hospital, Bangalore, between January and December, 2008. Patients who had CA-UTI confirmed by positive urine culture reports were included in the study. Statistical analysis was done using the SPSS version 16. Symptomatology and others risk factors for CA-UTI were studied in these patients and the causative organisms and their resistance patterns were recorded. Of the total 510 patients included, 57% belonged to the elderly age group (50–79 years). Fever and dysuria were the most common clinical presentation, but were not specific in predicting CA-UTI. Escherichia coli (66.9%) was the most common organism causing CA-UTIs with extended spectrum beta lactamase (ESBL) resistance seen in nearly two-thirds of these cases (42.2%). The organisms recorded least resistance against carbapenems (3.9%). A high resistance rate was seen for fluoroquinolones (74.1%). In conclusion, a high rate of ESBL-positive organisms and their resistance to commonly used antibiotics brings a concern for future options in treating these conditions.

Advances in management of urinary tract infections

Urinary Tract Infections (UTI) are a common bacterial infection in children. The diagnosis of UTI is very often missed in young children due to minimal and non-specific symptoms. The developing renal cortex in young children is vulnerable to renal scarring resulting in hypertension and chronic renal failure. A clinically suspected case of UTI should be defined and documented with urine culture report. After the diagnosis of UTI, its category should be defined. It will guide for proper radioimaging evaluation, choice of antimicrobial agent, duration of treatment, need of chemoprophylaxis etc. Even a single confirmed UTI should be taken seriously. Rational use of modern radioimaging for proper evaluation is essential. UTI in neonates, nosocomial UTI and UTI due to ESBL producing organisms are special situations, to be identified and managed with advanced therapy promptly and appropriately.

Urinary tract infection in diabetic patients

Sir, We read the article “Prevalence of lower urinary tract infection in South Indian type 2 diabetic subjects” by Janifer et al. with great interest. Diabetic patients with urinary tract infection is a common scenario in the nephrourology outpatient department. Treating them is a real challenge.[1] Here, we would like to highlight few important points. Firstly, fungal urinary tract infection in diabetic patients might be asymptomatic and should be sought in every diabetic patient with urinary tract infection.[2] Secondly, we feel that ultrasound-guided suprapubic aspiration of urine is useful in those patients with repeated contamination in urine culture report.[3] Thirdly, we believe that a minimum of 2 weeks of antibiotic therapy is necessary as eradication of the organism in diabetic patients is difficult. Improper duration of antibiotic will encourage resistance.[4] Fourthly, circumcision might be beneficial, especially in those patients who cannot maintain personal hygiene. We would like to know the author’s views regarding these points.

Antibiotic sensitivity patterns in childhood urinary tract infections

Objectives To assess the current antibiotic sensitivity pattern of urinary pathogens and compare it with the pattern 5 years previously. Method A retrospective analysis was performed on 2650 urine samples in 1997 and 2062 samples in 2002 received by the medical laboratory at the Teaching Hospital, Peradeniya from the paediatric ward and paediatric clinics. Results In 1997 there were 155 urine culture reports with significant colony counts of >10 5 for which ABSTs were performed. 111 were from males and 44 from females. In 2002 there were 278 positive cultures of which 179 were from males and 99 from females. Predominant organism was the coliform, accounting for 90% of isolates in both 1997 and 2002. In 1997 nalidixic acid and nitrofurantoin had high sensitivities of 73.8% and 73.1% respectively, while ciprofloxacin and mecillinam had low sensitivities of 51.9% and 35.5%. In 2002 coamoxiclav had the highest antibiotic sensitivity of 86.7%, while nitrofurantoin, nalidixic acid and norfloxacin had high sensitivities of 80%, 76.6% and 75.7% respectively. Ciprofloxacin and mecillinam had low sensitivity levels both in 1997 and 2002. A change was seen in cotrimoxazole and cephalexin, which had low sensitivities of 40.2% and 54.8% in 1997 and relatively higher sensitivities of 63.8% and 69.2% in 2002 respectively.

Advances in management of urinary tract infections

Urinary Tract Infections (UTI) are a common bacterial infection in children. The diagnosis of UTI is very often missed in young children due to minimal and non-specific symptoms. The developing renal cortex in young children is vulnerable to renal scarring resulting in hypertension and chronic renal failure. A clinically suspected case of UTI should be defined and documented with urine culture report. After the diagnosis of UTI, its category should be defined. It will guide for proper radioimaging evaluation, choice of antimicrobial agent, duration of treatment, need of chemoprophylaxis etc. Even a single confirmed UTI should be taken seriously. Rational use of modern radioimaging for proper evaluation is essential. UTI in neonates, nosocomial UTI and UTI due to ESBL producing organisms are special situations, to be identified and managed with advanced therapy promptly and appropriately.

Urinary tract infection in pregnancy

Urinary tract infection during pregnancy is common and is associated with significant maternal and perinatal morbidity and mortality. It can be asymptomatic. Screening of all women by urine culture should be performed in early pregnancy, despite the cost. Treatment should be guided by urine culture and sensitivity reports. Antibiotic treatment should continue for 7 days, as shorter courses are not as effective during pregnancy. Learning objectives: To identify the clinical presentations. To understand the evidence base for effective investigation and treatment. Ethical issues: The empirical use of antimicrobial treatments increases drug resistance and must be balanced against delay in treatment and the associated morbidities. Please cite this article as: McCormick T, Ashe RG, Kearney PM. Urinary tract infection in pregnancy. The Obstetrician &amp; Gynaecologist 2008;10:156–162.

Clinical symptoms predictive of recurrent urinary tract infections

The purpose of this study was to evaluate clinical predictors that will help diagnose women with recurrent urinary tract infections among women with irritative voiding symptoms. A case control study was performed. Cases were women with the diagnosis of recurrent urinary tract infection and controls were women with irritative voiding symptoms. Symptoms predictive for recurrent urinary tract infection were evaluated. Report of symptoms following intercourse (OR 12.4, 95% CI 3, 59), prior history of pyelonephritis (OR 7.4, 95% CI 2.1; 29), prompt resolution of symptoms with antibiotics (OR 3.9, 95 % CI 1.4, 11), and absence of nocturia (OR 0.22, 95% CI 0.05, 0.87) are significant predictors for women with recurrent urinary tract infection. Among women with irritative voiding symptoms, clinical symptoms can help to identify women with recurrent urinary tract infections at the initial presentation even if urine culture reports are not available.