Urine Cultures Of Patients Research Articles

Видовое разнообразие микробиома мочи больных нейрогенным мочевым пузырем ассоциировано с меньшим риском рецидивирования инфекции мочевыводящих путей.

Introduction. A new paradigm in the diagnosis, treatment, and prevention of urinary tract infections (UTIs) is currently emerging in medical science, based on the understanding that urine is not sterile and the urinary tract is inhabited by a diverse microbiome. Recurrent UTIs remain one of the leadingproblems in the management of patients with neurogenic lower urinary tract dysfunction (NLUTD), but the dependence of UTI recurrence rate on the composition of the urinary microbiome has not been studied. The purpose of the study was to assess the changes in the urinary microbiome in patients with neurogenic bladder and the relationship between these changes and the frequency of recurrent urinary tract infections. Materials and methods. The urinary microbiome was studied in 118 patients with neurogenic bladder without UTI recurrence and 15 healthy volunteers as a control group. Urine cultures were performed using the modified enhanced quantitative urine culture (EQUC) method, with determination of antimicrobial susceptibility of the microorganisms, and real-time PCR analysis of urine samples using the Androflor kit (DNA-Technology, Russia). Results. Bacterial growth was obtained in 72% of urine cultures from NLUTD patients and 80% in the control group. A total of 175 isolates were obtained: from 1 to 6 (on average 1.76±1.22) per patient. PCR analysis of urine samples revealed the presence of microbial DNA in all urine samples, including those that did not show growth on culture media. The most common microorganisms in the microbiome of NLUTD patients were: Escherichia coli (20%), Enterococcus faecalis (19%), Staphylococcus spp. (15%), Streptococcus spp. (12%), and Klebsiella pneumoniae (9%). The microbiome of patients with preserved spontaneous urination was closest to the control group, but differed in an increased proportion of Enterobacteriaceae and Enterococcus spp. The presence of a significant number of representatives of the normal microflora, such as Lactobacillus spp., Streptococcus spp., Staphylococcus spp., and a more diverse composition in general, distinguished the urinary microbiome of patients using intermittent catheterization from those with a permanent drainage. Urine cultures of patients with recurrent UTIs yielded fewer isolates than those without frequent infection exacerbations (1±0.58 and 2.25±1.29, respectively, p=0.001). Conclusions. The urinary microbiome of NLUTD patients is dominated by Enterobacteriaceae. The presence of a significant number of representatives of the normal microflora, such as Lactobacillus spp., Streptococcus spp., Staphylococcus spp., and a more diverse composition in general, distinguish the urinary microbiome of patients with intermittent catheterization from those with cystostomy or a permanent urethral catheter. Species diversity of the microbiome is associated with a lower frequency of recurrent urinary tract infections.

Factors Associated with Inappropriate Urine Culture Orders in Hospitalized Patients with Indwelling Urinary Catheters

Background: Catheter-associated urinary tract infection (CAUTI) is among the most prevalent healthcare-associated infections. Clinical diagnosis of CAUTI and National Healthcare Safety Network (NHSN) definitions do not always align. Most patients with indwelling urinary catheters ultimately develop asymptomatic bacteriuria (ASB) due to bacterial colonization and may be misattributed as CAUTI. Urine cultures ordered on patients with ASB may lead to reporting of non-clinically significant CAUTI to NHSN. We sought to examine factors associated with ordering inappropriate urine cultures in patients with urinary catheters. Methods: All CAUTIs that were reported to the NHSN at a large academic medical center in Eastern North Carolina were evaluated from October 2021-July 2023. A logistic regression model was fit for patients treated for urinary tract infection (UTI) with the following covariates: age, sex, time of urine culture order, provider type, and days that the urinary catheter was in place. All data analysis was performed in SAS (SAS Institute Inc., SAS 9.4, Cary, NC: SAS Institute Inc., 2002-2023). Results: Table 1 demonstrates patient characteristics stratified by treatment for UTI. The analysis suggests that abnormalresults from urine cultures ordered overnight were less likely to be treated with antibiotics,and this result was statistically significant in both the adjusted and unadjusted analyses – see table 2 and 3. The model also suggests abnormal results from urine cultures ordered by housestaff and older patients were more likely to be treated for UTI, but these results were not statistically significant – see table 3. Finally, the longer a catheter was in place the less likely an abnormalurine culture was to be treated and this finding was statistically significant – see table 3. Conclusion: Cultures that did not prompt antimicrobial treatment did not impact patient care decisions and could be considered as inappropriate orders. This can result in CAUTIs reported to NHSN that were not clinically significant. Abnormal results from cultures that were ordered by the overnight team were less likely to be treated for clinical UTI and this may represent an important target for diagnostic stewardship interventions.

Impact and Safety of Diagnostic Stewardship to Improve Urine Culture Testing Among Patients with Indwelling Urinary Catheters

Background: Indiscriminate urine culturing of patients with indwelling urinary catheters may lead to overdiagnosis of urinary tract infections, resulting in unnecessary antibiotic treatment and inaccurate reporting of catheter-associated urinary tract infections (CAUTIs) as a hospital quality metric. We evaluated the impact of a computerized diagnostic stewardship intervention to improve urine culture testing among patients with indwelling urinary catheters. Methods: We performed a single-center retrospective observational study at Rush University Medical Center from April 2018 – July 2023. In February 2021, we implemented a computerized clinical decision support tool to promote adherence to our internal urine culture guidelines for patients with indwelling urinary catheters. Providers were required to select one guideline criteria: 1) neutropenia, 2) kidney transplant, 3) recent urologic procedure, 4) urinary tract obstruction; or if none of the criteria were met, then an infectious diseases consultation was required for approval. We compared facility-wide CAUTI rate per 10,000 catheter days and standardized infection ratio (SIR) during baseline and intervention periods using ecologic models, controlling for time and for monthly Covid-19 hospitalizations. In the intervention period, we evaluated how providers responded to the intervention. Potential harm was defined as collection of a urine culture within 7 days of the intervention that resulted in a change in clinical management. Results: In unadjusted models, CAUTI rate decreased from 12.5 to 7.6 per 10,000 catheter days (p=0.04) and SIR decreased from 0.77 to 0.49 (p=0.09) during baseline vs intervention periods. In adjusted models, the CAUTI rate decreased from 6.9 to 5.5 per 10,000 catheter days (p=0.60) (Figure 1) and SIR decreased from 0.41 to 0.35 (p=0.65) during baseline vs intervention periods. Urine catheter standard utilization ratio (SUR) did not change (p=0.36). There were 598 patient encounters with ≥1 intervention. Selecting the first intervention for each encounter, 284 (47.5%) urine cultures met our guidelines for testing and 314 (52.5%) were averted (Figure 2). Of these, only 3 ( < 1 %) had a urine culture collected in the subsequent 7 days that resulted in change in clinical management. Conclusion: We observed a trend of decreased CAUTIs over time, but effect of our diagnostic stewardship intervention was difficult to assess due to healthcare disruption caused by Covid-19. Adverse outcomes were rare among patients who had a urine culture averted. A computerized clinical decision support tool may be safe and effective as part of a multimodal program to reduce unnecessary urine cultures in patients with indwelling urinary catheters.

Causative Microorganisms in Community-Acquired Urinary Tract Infections and Risk Factors for the Development of Infection with Extended-Spectrum β-Lactamase-Producing Species.

This study aimed to determine the microorganisms grown in the urine cultures of patients followed up with the diagnosis of community-acquired urinary tract infection (CA-UTI), their antibiotic susceptibility, and the risk factors that cause extended-spectrum β-lactamase (ESBL) production in microorganisms. Patients diagnosed with CA-UTI in the Yıldırım Beyazıt University City Hospital Infectious Diseases and Clinical Microbiology Clinic between February 2019 and February 2020 were prospectively analyzed. The microorganisms grown in the urine cultures and antibiotic susceptibility rates were examined. The clinical and demographic characteristics of the patients were compared in terms of the isolated agent producing ESBL. Escherichia coli (63.8%) and Klebsiella pneumoniae (22.0%) were the most common microorganisms detected in the urine cultures; the rate of those producing ESBL was 46.6%. Antibiotics with high resistance rates were ampicillin (74.2%), cefuroxime (49.6%), and ceftriaxone (49%). Male gender, complicating factors, immunosuppression, kidney transplantation and history of antibiotic use were determined as significant risk factors for ESBL production. Male gender, immunosuppression, and history of antibiotic use were also independent risk factors. ROC analysis of risk factors showed ESBL-producing bacteria were isolated at a high rate in patients having ≥3 risk factors. The resistance rates in our study are quite high. Male gender, history of antibiotic use and immunosuppression status were found to be independent risk factors for ESBL positivity in patients with CA-UTI, and the more risk factors a patient has, the higher the risk of ESBL positivity.

Real-World Evidence That a Novel Diagnostic Combining Molecular Testing With Pooled Antibiotic Susceptibility Testing is Associated With Reduced Infection Severity and Lower Cost Compared With Standard Urine Culture in Patients With Complicated or Persistently Recurrent Urinary Tract Infections: Erratum

Real-World Evidence That a Novel Diagnostic Combining Molecular Testing With Pooled Antibiotic Susceptibility Testing is Associated With Reduced Infection Severity and Lower Cost Compared With Standard Urine Culture in Patients With Complicated or Persistently Recurrent Urinary Tract Infections: Erratum

Distribution and antimicrobial resistance patterns of urinary pathogens in preoperative midstream urine cultures from Chinese patients with urinary calculi: a meta-analysis.

This study comprehensively evaluates the distribution patterns and antimicrobial resistance profiles of urinary pathogens in Preoperative midstream urine cultures collected from patients with urinary calculi in China over the last two decades. A cross-sectional analysis of 41 studies was conducted. A systematic search across various databases, including Wanfang Data, CNKI, SinoMed, Embase, PubMed, and Web of Science, was carried out, covering the time period from 2002 to 2022. Using R 4.2.1 software, a meta-analysis was performed to assess heterogeneity using Cochran's Q test and the I2 statistic. In the analysis of preoperative midstream urine cultures from Chinese patients with urinary calculi, gram-negative bacteria dominated at 69%, with Escherichia coli (43%), Klebsiella pneumoniae (8%), Proteus mirabilis (6%), Pseudomonas aeruginosa (5%), Acinetobacter baumannii (3%), and Enterobacter cloacae (4%) being prominent. Gram-positive organisms included Enterococcus faecalis (9%), Enterococcus faecium (5%), and Staphylococcus aureus (4%). Over time, proportions of Proteus mirabilis, Enterococcus faecalis, and Staphylococcus aureus decreased, while Klebsiella pneumoniae and Pseudomonas aeruginosa increased. Notably, Escherichia coli proportion reduced from 37 to 33% within the last two decades. Antimicrobial resistance analysis indicated declining resistance in E. coli (e.g., co-trimoxazole from 73 to 55%, gentamicin from 64 to 40%), but rising resistance in piperacillin and cefotaxime (34-60%). Enterococcus faecalis exhibited increasing resistance to ampicillin (5-69%), gentamicin (59-94%), and tetracycline (77-89%) over time, while resistance to levofloxacin and ciprofloxacin notably decreased (72-16% and 49-8%, respectively). Over the past two decades, the proportion of gram-negative bacteria was declined, while the proportion of gram-positive bacteria increased. Escherichia coli remained the most common pathogen in the urine culture of patients with urinary calculi in China and the resistance of Escherichia coli to commonly used antibiotics increased. Clinicians should select appropriate antibiotics according to the results of urine culture and drug sensitivity test to reduce the occurrence of antibiotic resistance.

Effect of different DMARD use on the frequency of urinary infection in patients with rheumatoid arthritis

Aims: It is known that the susceptibility to infection in general is increased in Rheumatoid Arthritis (RA) patients, but there is not enough information about whether urinary tract infections in particular differ according to different disease-modifying antirheumatic drugs (DMARDs) groups. The aim of this study was to compare the frequency of urinary infection attacks and pathogens in urine cultures of patients with RA treated with different groups of DMARDs. Methods: In this retrospective study, 76 patients using biologic DMARDs (bDMARDs) and 74 patients using conventional synthetic DMARDs (csDMARDs) among patients followed with a diagnosis of RA for at least 5 years who came for regular follow-ups at our department’s rheumatic diseases outpatient clinic were included. Patients with known immunodeficiency conditions, use of prednisolone (>7.5 mg), chronic renal failure, and renal pathologies were excluded from the study. The evaluation and follow-up records of the included patients between 01.01.2019 and 31.12.2022 were examined. Patients age, sex, medications, comorbidities, urine biochemistry, and urine culture results were recorded. Patients with pyuria detected by urine biochemistry were considered to have a urinary infection. Results: The mean age of patients in the csDMARD group was 61.39±11.41 (37-87) and the mean age of patients in the bDMARD group was 58.68±11.42 (33-89) (p=0.149). The number of urinary infection attacks during the follow-up period was similar in both the groups (p =0.090). The positive culture rate was 23.21% in the bDMARD group and 7.5% in the csDMARD group (p = 0.072). Escherichia coli was detected in 81.8% and Pseudomonas aeruginosa was detected in 18.2% of the positive cultures in the bDMARD group. The pathogen in all positive cultures of the csDMARD group was Escherichia coli. Conclusion: Although urinary infection and positive culture rates were higher in patients receiving bDMARDs, no statistically significant difference was observed between the groups.

Resistance to antibiotics in clinical isolates of Escherichia coli producing and non-producing Extended Spectrum Betalactamases (ESBL) obtained from urine cultures in patients with urinary tract infection.

Background: Escherichia coli is a bacterium that is part of the normal biota of the human being, but under certain conditions it can produce diseases such as gastrointestinal and urinary tract infections for which is the main responsible. Enterobacteriaceae such as Escherichia are extended spectrum betalactamases (ESBL) producers, which makes their treatment difficult due to a high rate of resistance to antibiotics.Aim of the study: Identify resistance patterns against various antibiotics in Escherichia coli producers and non-producers of extended spectrum beta-lactamases in urinary infections in a population of the Toluca Valley, MexicoMaterial and methods: 155 samples were collected from patients with suspected urinary tract infection without exclusion criteria such as age or gender. Automated equipment was used for the identification of the etiological agent and sensitivity tests. For the determination of ESBL, the double disc technique was used.Results: 35 strains of Escherichia coli were obtained, of which 45.72 % have ESBL, these strains show 100 % resistance to betalactams, as well as high resistance to quinolones and tetracycline ranging from 70 to 100 %. On the other hand, the resistance shown by non-ESBL producing strains is variable both for betalactams and for other antibiotics.Conclusion: Treatment for urinary tract infections has become increasily difficult due to the high rate of resistance to antibiotics, mainly ESBL-producing strains such as the E coli strains in the present study. Where high rates of resistance to different antibiotics used in clinical practice are shown.

Antimicrobial stewardship program in urinary tract infections due to multiresistant strains in the emergency department

Urinary tract infections (UTI) are a frequent reason for attendance at emergency department (ED). The present study evaluates the impact of a multidisciplinary program for the optimization of antibiotic therapy in patients with UTI caused by multi-drug resistant bacteria treated from the hospital ED. Descriptive study of the implementation of a program in which emergency, microbiology and pharmacy departments participated. Antibiotic treatment of the patients who consulted the ED with positive urine cultures caused by multidrug-resistant bacteria was reviewed upon discharge. In those patients with inappropriate treatment, doctors and/or pharmacists of the next level of healthcare or patients in the case of home discharge were contacted. The impact of the program was evaluated based on new visits to the ED at 30 days after discharge, compared with the results obtained from the usual practice three months prior the intervention. During the first year, 2,474 urine cultures of patients with UTI were reviewed, 533 (21.7%) were caused by multidrug-resistant bacteria. Empirical treatment was inappropriate in 287 (53.4%), making treatment modifications in 243 of them. 73 (19.3%) patients returned to the ED 30 days after discharge, being lower than the results obtained in the three months prior intervention (27.9%; p=0.031), without significant differences in new visits associated with UTI. The implementation of a multidisciplinary program focused on multidrug resistant UTI at discharge form ED correct antibiotic therapy in a large number of patients, being a potentially tool to reduce the number of new ED visits.

Real-World Evidence That a Novel Diagnostic Combining Molecular Testing With Pooled Antibiotic Susceptibility Testing is Associated With Reduced Infection Severity and Lower Cost Compared With Standard Urine Culture in Patients With Complicated or Persistently Recurrent Urinary Tract Infections

Purpose: Develop real-world evidence that rapid identification of uropathogens and susceptibilities improves urologic outcomes for patients with complicated or history of recurrent urinary tract infections (r/cUTIs). Standard urine culture (SUC) is slow, often missing polymicrobial infections and altered antibiotic resistance from their metabolic interactions. Materials and Methods: We compared 1-year UTI-related health care utilization and costs for UTIs diagnosed by outpatient multiplex polymerase chain reaction/pooled antibiotic susceptibility testing (mPCR/P-AST) vs SUC among Medicare beneficiaries with r/cUTIs, using claims from a deidentified random 5% sample of beneficiaries with an index UTI in 2018 followed by 12 months during which all outpatient UTI tests were either mPCR/P-AST or SUC. Outcomes were compared between 69 individuals diagnosed using mPCR/P-AST and 678 propensity-matched individuals using SUC. Regression models modeled cost differences with 95% confidence intervals (CIs). Results: Of 1,654,548 enrollees in 2018, 11.6%, 0.06%, and 9.6% had claims for UTI, mPCR/P-AST, and SUC, respectively. The matched mPCR/P-AST and SUC cohorts were statistically equivalent at baseline. The mPCR/P-AST cohort was nonsignificantly less likely than the SUC cohort to have a postindex UTI (65.2% vs 72.0%, P = .24). Cost per subsequent UTI was significantly lower for mPCR/P-AST ($767 vs $1,303, P = .0013). Average total 1-year UTI-related cost was $501.85 (95% CI: $79.87, $562.08 P = .004) lower per mPCR/P-AST member vs SUC ($629.55 vs $1131.39). Nonoutpatient treatment accounted for 22.5% of mPCR/P-AST vs 53.4% of SUC UTI-related costs. Conclusions: In patients with r/cUTI, rapid identification of pathogens and antibiotic susceptibilities using mPCR/P-AST is associated with lower UTI-related clinical care and utilization costs compared with SUC.

Epidemiology and outcomes associated with carbapenem-resistant Acinetobacter baumannii and carbapenem-resistant Pseudomonas aeruginosa: a retrospective cohort study

BackgroundCarbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Pseudomonas aeruginosa (CRPA) are a growing threat. The objective of this study was to describe CRAB and CRPA epidemiology and identify factors associated with mortality and length of stay (LOS) post-culture.MethodsThis was a national retrospective cohort study of Veterans with CRAB or CRPA positive cultures from 2013 to 2018, conducted at Hines Veterans Affairs Hospital. Carbapenem resistance was defined as non-susceptibility to imipenem, meropenem and/or doripenem. Multivariable cluster adjusted regression models were fit to assess the association of post-culture LOS among inpatient and long-term care (LTC) and to identify factors associated with 90-day and 365-day mortality after positive CRAB and CRPA cultures.ResultsCRAB and CRPA were identified in 1,048 and 8,204 unique patients respectively, with 90-day mortality rates of 30.3% and 24.5% and inpatient post-LOS of 26 and 27 days. Positive blood cultures were associated with an increased odds of 90-day mortality compared to urine cultures in patients with CRAB (OR 6.98, 95% CI 3.55–13.73) and CRPA (OR 2.82, 95% CI 2.04–3.90). In patients with CRAB and CRPA blood cultures, higher Charlson score was associated with increased odds of 90-day mortality. In CRAB and CRPA, among patients from inpatient care settings, blood cultures were associated with a decreased LOS compared to urine cultures.ConclusionsPositive blood cultures and more comorbidities were associated with higher odds for mortality in patients with CRAB and CRPA. Recognizing these factors would encourage clinicians to treat these patients in a timely manner to improve outcomes of patients infected with these organisms.

Accuracy of Dongjui analyzer for reducing the number of unnecessary urine cultures in an outpatient setting

Objectives: The purpose of this study was to evaluate the diagnostic performance of the Dongjui DJ-8602 urinary analyzer for reducing the number of unnecessary urine cultures in patients with suspected urinary tract infection (UTI). Methods: This study was designed as a retrospective study performed in patients with suspected UTI from August 1, 2018 to December 1, 2018. Clinical data, C reactive protein, blood hematologic counts were evaluated. Using positive culture results as the gold standard, the cut-off values by the receiver operating characteristic curve technique, sensitivity, and specificity were calculated. Results: The median values of urine leukocyte levels were 31 cells/high power field (HPF) in the culture-positive group and 5 leukocytes/HPF in the culture-negative group, respectively. The area under the curve for leukocyte and bacteria count were 0.753 (95% Cl, 0.642 to 0.862) and 0.581 (95% Cl, 0.438 to 0.725), respectively. A leukocyte count ≥ 2 cells/HPF, resulting the best sensitivity of 96.3% (95% Cl: 81.03% to 99.48%) and a negative predictive value (NPV) of 96.4% (95% Cl: 79.35% to 99.48%). Conclusions: The use of the Dongjui DJ-8602 urinary sediment and chemistry analyzer did not accurately predict the outcome of urine cultures with an unsatisfactory sensitivity and NPVs of bacteria counts.

LBA02-10 ASSESSING THE RISKS OF A POSITIVE URINE CULTURE IN UNCOMPLICATED RENAL COLIC PATIENTS

You have accessJournal of UrologyCME1 May 2022LBA02-10 ASSESSING THE RISKS OF A POSITIVE URINE CULTURE IN UNCOMPLICATED RENAL COLIC PATIENTS Nikhile Mookerji, Matthew Mancuso, Vardhil Gandhi, Efrem Violato, Stacey Broomfield, Tim Wollin, Trevor Schuler, and Shubha De Nikhile MookerjiNikhile Mookerji More articles by this author , Matthew MancusoMatthew Mancuso More articles by this author , Vardhil GandhiVardhil Gandhi More articles by this author , Efrem ViolatoEfrem Violato More articles by this author , Stacey BroomfieldStacey Broomfield More articles by this author , Tim WollinTim Wollin More articles by this author , Trevor SchulerTrevor Schuler More articles by this author , and Shubha DeShubha De More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002670.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Though septic stones are well recognized as a medical emergency, patients with uncomplicated renal colic (without systemic inflammatory responses or renal impairment) and positive urine cultures pose a dilemma in management considerations. Therefore, the objective of this study is to: 1) Assess the rate of ‘incidental’ positive urine cultures in patients with ureteral stones referred to our Stone Clinic. 2) Determine the risk of infectious adverse events (IAE) in patients with ureteral stones and positive urine cultures. METHODS: A retrospective chart review was performed for all Acute Stone Clinic referrals between November 10, 2019 and October 1, 2020. Urgent referrals necessitating immediate intervention were excluded. Demographics, investigations, procedures, unscheduled visits, and IAE were all documented. Descriptive statistics were used to group patients based on their urine cultures (UC). RESULTS: Over the study period 1029 patients were identified, and 35.4% (n=374) of them had urine cultures (UC) drawn at presentation. Of the 655 patients without UC, 0.6% (n=6) eventually developed sepsis and required urgent renal decompression. 87% (n=333) of UC completed at presentation were negative (no growth or mixed flora), and none of these patients went on to have an IAE. Of the 13% of urine cultures that were positive (n=39) only 2 IAEs (5.13%) were identified, 2-30 days after initial presentation. Both patients had normal acute phase reactants (WBC, CRP) and a history of recurrent UTIs. CONCLUSIONS: Approximately one third of patients referred to our Acute Stone clinic had UC at presentation, with an overall delayed IAE rate of 0.7%. Of those with positive urine cultures, only 5% experienced an IAE, suggesting conservative management may be a reasonable consideration in this patient population. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e1045 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nikhile Mookerji More articles by this author Matthew Mancuso More articles by this author Vardhil Gandhi More articles by this author Efrem Violato More articles by this author Stacey Broomfield More articles by this author Tim Wollin More articles by this author Trevor Schuler More articles by this author Shubha De More articles by this author Expand All Advertisement PDF DownloadLoading ...

Risk factors for concomitant positive midstream urine culture in patients presenting with symptomatic ureterolithiasis

In patients with symptomatic ureterolithiasis, immediate treatment of concomitant urinary tract infection (UTI) may prevent sepsis. However, urine cultures require at least 24 h to confirm or exclude UTI, and therefore, clinical variables may help to identify patients who require immediate empirical broad-spectrum antibiotics and surgical intervention. Therefore, we divided a consecutive cohort of 705 patients diagnosed with symptomatic ureterolithiasis at a single institution between 2011 and 2017 into a training (80%) and a testing cohort (20%). A machine-learning-based variable selection approach was used for the fitting of a multivariable prognostic logistic regression model. The discriminatory ability of the model was quantified by the area under the curve (AUC) of receiver-operating curves (ROC). After validation and calibration of the model, a nomogram was created, and decision curve analysis (DCA) was used to evaluate the clinical net-benefit. UTI was observed in 40 patients (6%). LASSO regression selected the variables elevated serum CRP, positive nitrite, and positive leukocyte esterase for fitting of the model with the highest discriminatory ability. In the testing cohort, model performance evaluation for prediction of UTI showed an AUC of 82 (95% CI 71.5–95.7%). Model calibration plots showed excellent calibration. DCA showed a clinically meaningful net-benefit between a threshold probability of 0 and 80% for the novel model, which was superior to the net-benefit provided by either one of its singular components. In conclusion, we developed and internally validated a logistic regression model and a corresponding highly accurate nomogram for prediction of concomitant positive midstream urine culture in patients presenting with symptomatic ureterolithiasis.

Culture Requests and Multi-Drug Resistance among Suspected Urinary Tract Infections in Two Tertiary Hospitals in Freetown, Sierra Leone (2017-21): A Cross-Sectional Study.

In sub-Saharan Africa, there is limited information about the use of microbiology laboratory services in patients with suspected urinary tract infections (UTIs). This cross-sectional study assessed the requests for urine culture in patients with suspected UTI in two tertiary (maternal and paediatric) hospitals—Freetown and Sierra Leone, during May 2017–May 2021—and determined antimicrobial resistance (AMR) patterns among bacterial isolates. One laboratory served the two hospitals, with its electronic database used to extract information. Overall, there were 980 patients, of whom 168 (17%) had cultures requested and performed. Of these, 75 (45%) were culture positive. During 2017–2019, there were 930 patients, of whom 156 (17%) had cultures performed. During 2020–2021, when services were disrupted by the COVID-19 pandemic, there were 50 patients, of whom 12 (24%) had cultures performed. The four commonest isolates were Escherichia coli (36), Klebsiella pneumoniae (10), Staphylococcus aureus (9), and Pseudomonas spp. (6). There were high levels of AMR, especially for trimethoprim-sulfamethoxazole (47%), nalidixic acid (44%), nitrofurantoin (32%) and cefotaxime (36%). Overall, 41 (55%) bacterial isolates showed multidrug resistance, especially E. coli (58%), Pseudomonas spp. (50%), and S. aureus (44%). These findings support the need for better utilization of clinical microbiology services to guide antibiotic stewardship and monitoring of trends in resistance patterns.

Evaluation of Treatment Practices for Urinalyses and Urine Cultures at an Outpatient Multiple Sclerosis Clinic.

Patients with multiple sclerosis (MS) experience disease flares that can be precipitated by the presence of infection. Discerning asymptomatic bacteriuria from urinary tract infection (UTI) in patients with MS is complicated by lower urinary tract dysfunction, leading to potentially inappropriate antimicrobial use. In this study the antimicrobial treatment practices for positive urine cultures in patients with MS were evaluated. In this single-center, retrospective study, positive cultures in patients with MS were included. The primary outcome was the proportion of patients appropriately treated with or without antimicrobial therapy. Secondary end points included antimicrobial selection and urinalysis positivity. Two hundred thirty-six cultures from 139 patients were evaluated. Treatment was inappropriate in 81 of 201 treated cultures (40%). Frequency, nocturia, dysuria, and foul-smelling urine were reported by patients in 54 (23%), 10 (4%), 25 (11%), and 14 (6%) cultures, respectively. The antimicrobial selected was too broad in spectrum for 35 of 201 (17%). Of those, fluoroquinolones were the agents used in 33 of 35 cases (94%). A urinalysis was sent in 203 cases (86%), with 197 (84%) positive for at least one predefined positivity criteria. Urinalyses and urine cultures are performed frequently in patients with MS, often independent of symptoms. Patients with MS could be treated for asymptomatic bacteriuria at higher rates than the general population, and traditional urinary symptoms may not be appropriate indicators of infection. Empirical therapy for UTI is frequently used in this population, often resulting in inappropriate and/or too broad of antimicrobial therapy.

Treatment of Asymptomatic Bacteriuria after Implementation of an Inpatient Urine Culture Algorithm in the Electronic Medical Record.

Ordering urine cultures in patients without pyuria is associated with the inappropriate treatment of asymptomatic bacteriuria (ASB). In 2015, our institution implemented recommendations based on practice guidelines for the management of ASB and revised the urine culture ordering process to limit cultures in immunocompetent patients without pyuria. The purpose of this study was to determine how the treatment of ASB has changed over time since altering the urine culture ordering process to reduce unnecessary cultures at an academic medical center. A quasi-experimental study was conducted for inpatients with urine cultures from January to March of 2014, 2015, 2016 and 2020. The primary outcome was the antibiotic treatment of asymptomatic bacteriuria for over 24 h. The secondary outcomes were the total days of antibiotic therapy, type of antibiotic prescribed and overall urine culture rates at the hospital. A total of 200 inpatients with ASB were included, 50 at random from each year. In both 2014 and 2015, 70% of the patients with ASB received antibiotic treatment. Antibiotics were prescribed to 68% and 54% of patients with ASB in 2016 and 2020, respectively. The average duration of therapy decreased from 5.12 days in 2014 to 3.46 days in 2020. Although the urine cultures were reduced, there was no immediate impact in the prescribing rates for patients with ASB after implementing this institutional guidance and an altered urine culture ordering process. Over time, there was an observed improvement in prescribing and the total days of antibiotic therapy. This could be attributed to increased familiarity with the guidelines, culture ordering practices or improved documentation. Based on these findings, additional provider education is needed to reinforce the guideline recommendations on the management of ASB.

Sexually transmitted infections and prior antibiotic use as important causes for negative urine cultures among adults presenting with urinary tract infection symptoms to primary care clinics in Zimbabwe: a cross-sectional study

ObjectiveUrinary tract infections (UTIs) are common in primary care. The yield of urine cultures in patients with UTI symptoms can be considerably different between high-income and low-income settings. This study...

Проблема антибиотикорезистентности микроорганизмов у пациентов с инфекциями мочевыводящих путей

Objective To analyze the incidence and resistance of microorganisms to antibacterial drugs isolated in urine cultures of patients with urinary tract infections from 2012 to 2019. Materials and methods In the Pirogov City Clinical Hospital No1 and in the Bauman City Clinical Hospital No 29 analyzed the results of 15083 urine cultures in 12554 patients from 2012 to 2019. Results Enterococcus faecalis (41%), Escherichia coli (36.4%), Klebsiella pneumonia (23.4%) and Proteus mirabilis (7.6%) predominate in the occurrence of complicated UTIs. the number of strains resistant to certain groups of antibacterial drugs increased: mesitillin-resistant staphylococci (+ 4%), producers of -lactamases (+ 19.8% (for E. coli) and + 34.7% (for Klebsiella pneumoniae)), vancomycin-resistant enterococci (+ 1.89%), carbapenemase producers (+ 32.9%). A high level of resistance among Enterococcus faecalis strains to ciprofloxacin (23.1%) and gentamicin (38.4%) was revealed. Among strains of Escherichia coli, an increase in resistance to ampicillin (85.7%), ceftazidime (66.7%), ciprofloxacin (54.1%) and nitrofurantoin (42.9%) was noted. The appearance of carbapenem-resistant strains is noted. Among the strains of Klebsiella pneumonia, there is a significant increase in resistance to all antibacterial drugs used. Separately, one can note a sharp (27.1%) increase in resistance to carbapenems. A high level of resistance was found in Proteus mirabilis to ciprofloxacin (66.7%), ampicillin (75%). There is an increase in resistance of Pseudomonas aeruginosa to ciprofloxacin (66.7%), meropenem (50%). There is a high level of resistance for Acinetobacter baumannii to amikacin (94.9%), imipenem (92.3%), ceftazadime (100%), ciprofloxacin (100%), tigecycline (53.6%). Relatively high sensitivity remains to polymyxin E (88.9%). Conclusions The results of our analysis demonstrate a rapid increase in resistance to most antibacterial drugs among community-acquired and hospital-acquired strains.

Urinary Microbiome Characteristics in Female Patients with Acute Uncomplicated Cystitis and Recurrent Cystitis.

Traditionally, the diagnostic mainstay of recurrent urinary tract infection has been urinary culture. However, the causative uropathogen of recurrent cystitis has not been well established. Urine DNA next-generation sequencing (NGS) can provide additional information on these infections. Herein, we compared urine NGS results and urine cultures in patients with acute uncomplicated cystitis (AUC) and recurrent cystitis (RC), and evaluated the difference in microbiome patterns in the NGS results. Patients who underwent urine culture and NGS due to AUC or RC were retrospectively reviewed. All urine samples were collected via a transurethral catheter and studied utilizing a type of NGS called 16S ribosomal RNA gene amplification and sequencing. The sensitivity of urine NGS was significantly higher than that of conventional urine culture (69.0% vs. 16.7%, p < 0.05). The detection rate of urine NGS was slightly lower in the RC group than in the AUC group (67.7% vs. 72.7%). Microbiome diversity was significantly higher in the RC group compared to the AUC group (p = 0.007), and the microbiome composition was significantly different between the AUC and RC groups. In the urine NGS results, Pseudomonas, Acinetobacter, and Enterobacteriaceae were found in the AUC group, and Sphingomonas, Staphylococcus, Streptococcus, and Rothia spp. were detected in the RC group. Urine NGS can significantly increase the diagnostic sensitivity compared to traditional urine culture methods, especially in RC patients. AUC and RC patients had significant differences in bacterial diversity and patterns. Therefore, recurrent cystitis might be approached from a different perspective.