Urinary Research Articles

Candiduria in Pediatric Patients: Two Case Reports and a Review of Management Strategies.

Introduction: Urinary infections, while common in intensive care and surgical units, present a unique challenge when fungal pathogens are involved. These fungal urinary infections, known as fungiuria, require a more intricate and prolonged treatment plan involving antifungal medications. This complexity underscores the need for specialized knowledge and skills in managing such cases. This study aims to present two cases of operated pediatric patients who developed urinary fungal infections following Catheterization and simultaneous treatment with two antibiotics. Results: Two pediatric patients, aged 12 and 16, underwent surgical procedures in our clinic. The first patient was treated for gangrenous appendicitis complicated by generalized peritonitis. The second patient was treated for a perforation of the small intestine caused by gangrene in a segment of the bowel, resulting from twisting around intestinal adhesions, also complicated by generalized peritonitis. Both patients, aged 12 and 16, developed urinary symptoms four days after surgery. Microbiological analysis confirmed the presence of fungal infections caused by Candida albicans. However, with the administration of antifungal medications, we were able to successfully eradicate Candida albicans from their urinary tracts, as confirmed by follow-up microbiological cultures after several weeks of therapy. This successful outcome should instill a sense of accomplishment in the audience. Conclusion: Candidiasis, a significant complication in patients undergoing prolonged Catheterization and simultaneous antibiotic therapy, requires vigilant monitoring. The challenging treatment often necessitates long-term administration of antifungal medications for successful eradication. This underscores the importance of vigilance in monitoring fungal infections in catheterized patients and adopting preventive strategies to minimize their occurrence.

Sex differences in the time trends of sepsis biomarkers following polytrauma

Sepsis is a major cause of death in polytrauma patients, with delayed antibiotics increasing mortality. Although biological sex influences immune function and disease outcomes, gender-specific differences in inflammatory response and sepsis progression remain underexplored. This study examined the time-dependent behavior of C-reactive protein (CRP), procalcitonin (PCT), and white blood cell count (WBC) in male and female polytrauma patients to evaluate their predictive value for sepsis. Additionally, it compared infection sources between genders. This retrospective cohort study at University Hospital Zurich included polytrauma patients aged ≥ 16 years with an Injury Severity Score (ISS) ≥ 16 who developed sepsis within 31 days of admission. Patients were grouped by sepsis status and gender. Time-dependent inflammatory markers (CRP, PCT, WBC) were analyzed using the Mann–Whitney U-test and binary logistic regression. The Closest Top-Left Threshold Method determined time-specific sepsis thresholds. The study included 3059 polytrauma patients (26% females, 74% males), with a median age of 43 and a median ISS of 27. CRP levels were higher in sepsis cases from 24 h in females and 48 h in males, peaking at 122.5 mmol/L (females, 4 days) and 136.5 mmol/L (males, 48 h). PCT differences were significant only in males from 12 h, with a threshold of 1.55 µg/L. WBC levels became significant from day 3 in males and day 4 in females, peaking at 12.82 counts/µL (males) and 13.16 counts/µL (females) on day 10. Pneumonia was the most common infection (70% males, 65% females). Females had more wound infections (27% vs. 18%, p = 0.042) and borderline higher urinary tract infections (22% vs. 14%, p = 0.059). CRP and PCT are standard sepsis markers, but PCT’s predictive value varies by gender, and women may show different CRP kinetics. Gender-specific differences in inflammatory markers suggest tailored approaches to enhance diagnostic accuracy and improve sepsis management. Further research is needed to evaluate hormonal and genetic influences on immune responses in polytrauma patients.

Paediatric Acute Urinary Retention in Central Queensland.

The aetiology of paediatric acute urinary retention (PAUR) is poorly documented across English medical literature and none from Australasia. This study aimed to document incidence, aetiology and associated time to diagnoses and treatment of PAUR in regional Australia. This was a retrospective study of children aged 0-17 years at presentation to two regional hospitals from 01.01.2008-31.12.2018. Data were extracted from patient files following a search for documented cases of acute urinary retention. There were 56 presentations from 53 children with sex ratio (M:F) of 1.4:1. The median age at presentation was 5.9 (IQR 2.8, 13.3) years, with bimodal peaks at 2-4 years and 12-16 years. Using Poisson regression model, the population incidence increased over the period (p < 0.05). The commonest aetiologies were post-operative (13; 23%), medications excluding anaesthesia (7; 13%), urinary tract infection (UTI) (6; 11%) and phimosis/balanitis (6; 11%), faecal impaction (6; 11%), neoplasia (5; 9%) and uncertain (10; 18%). Time to diagnosis had a median of 3 (IQR 0,14.5) h and a mean of 9.2 (±13.7) h. Time to treatment had a median of 0 (IQR 0,2.5) h and a mean of 3.6 (±11.2) h. Most cases (43/47; 92%) had successful urethral catheterisation, with one requiring suprapubic tap. Nine cases (16%) spontaneously resolved. Analgesia was provided in 49 cases (88%). Majority (40; 71%) were discharged and 15(27%) cases referred. The most common aetiologies for PAUR were post-operative causes, medication use, UTI, phimosis/balanitis and faecal impaction, all providing opportunities for intervention. The incidence significantly increased over time. Diagnoses and treatment were early in most cases.

SRT3025-loaded cell membrane hybrid liposomes (3025@ML) enhanced anti-tumor activity of Oxaliplatin via inhibiting pyruvate kinase M2 and fatty acid synthase

BackgroundBladder cancer is one of the most common malignancies of the urinary system. Despite significant advances in diagnosis and treatment, the compromised therapeutic effect of chemotherapeutic agents, such as Oxaliplatin (OXA), remains a major clinical challenge. Thus, a combination therapy is required to enhance the OXA’s therapeutic effectiveness and improve patient outcomes.MethodsThe thin film hydration method was used to prepare the liposomes. Drug encapsulation efficiency and loading capacity were determined to investigate the advantages of the SRT3025-loaded cell membrane hybrid liposomes (3025@ML). Bladder cancer cell lines T24 and 5637 were cultured in McCoy’s 5 A and RPMI 1640 medium, respectively. The Cell Counting Kit-8 assay was used to determine the cell viability by treating cells with a medium containing either the vehicle solution (control), the cell membrane hybrid liposomes (ML), 3025@ML, or compound 3 K. The antiproliferative activities were investigated after treating cells with OXA + 3025@ML and compound 3 K + OXA. Cell death and apoptosis were quantified by trypan blue and Annexin V-APC/PI apoptosis assay after treating cells with control, OXA, OXA + 3025@ML, and 3025@ML. Western blot analysis was performed after treating cells with 3025@ML, OXA, 3 K, 3025@ML + OXA, and 3 K + OXA to determine the protein levels of pyruvate kinase M2 (PKM2) and fatty acid synthase (FASN), etc.ResultsThe present study demonstrated that 3025@ML enhances the chemotherapeutic effect of OXA. 3025@ML + OXA treated T24 and 5637 cells showed that combination therapy significantly reduced cell viability and increased cell death rate. Flow cytometry analysis showed that the combination of 3025@ML and OXA significantly increased the percentage of apoptotic cells in T24 cells. 3025@ML and compound 3 K reduced the levels of FASN in T24 and 5637 cells and increased the anti-tumor activity of OXA. Mechanistic studies showed that 3025@ML inhibited the PI3K/AKT/mTOR signaling pathway and reduced the expression of key metabolic regulators PKM2 and FASN. Furthermore, this study demonstrated that targeting lipid metabolism and inhibiting FASN can effectively overcome the compromised therapeutic effect of OXA.ConclusionThe study demonstrated that 3025@ML significantly enhances the anti-tumor activity of OXA. This novel drug delivery system inhibits key metabolic pathways, which increase DNA damage and tumor cell apoptosis. The results indicate that 3025@ML is a promising therapeutic strategy for overcoming OXA’s compromised therapeutic effect and potentially improving cancer treatment outcomes.

The impact of body mass index on mortality according to age in hemodialysis patients: an analysis of the Korean Renal Data System.

The impact of age on the relationship between body mass index (BMI) and all-cause mortality in hemodialysis (HD) patients is not clearly understood. We analyzed the association between BMI and all-cause mortality, stratified by age, in patients undergoing HD using data from the Korean Renal Data System (KORDS). We analyzed 66,129 HD patients from the 2023 KORDS database, with data collected between 2001 and 2022. Patients were grouped by age: <65 years ("young" group, n = 24,589), 65-74 years ("younger-old" group, n = 17,732), and ≥75 years ("older-old" group, n = 23,808). Patients were further stratified into BMI quartiles. Kaplan-Meier curves and event time ratio for the relative change in the survival time were calculated. During the follow-up period, 14,360 (21.7%) of the patients died, with a median follow-up of 3.4 years. Kaplan-Meier curves revealed poorer outcomes in lower BMI quartiles across all age groups. The lowest BMI quartile was significantly associated with a shorter survival time compared to the highest BMI quartile, with a 15% reduction in the young group (p = 0.001) and a 12% reduction in the older-old group (p = 0.002). Predicted survival time increases with rising BMI in the young group, but the rate of increase slows in the younger-old group and plateaus in the older-old group after around a BMI of 25 kg/m2. The decline in survival time with age was more pronounced in the 7-year survival than the 2-year survival. Lower BMI is associated with higher all-cause mortality in HD patients, with a more pronounced impact in younger patients.

A multicenter study of perioperative and functional outcomes of open vs. robot assisted uretero-enteric reimplantation after radical cystectomy.

Open ureteroenteric reimplantation (OUER) of ureteroenteric strictures (UESs) is related to important morbidity. Robot-assisted ureteroenteric reimplantation (RUER) has been proposed to provide similar outcomes with lower morbidity. We aimed to compare perioperative and functional outcomes between RUER and OUER. A retrospective multicenter study of 80 patients, who underwent 82 ureteroenteric reimplantations (17 OUER vs 65 RUER) at 8 institutions between 2009-2021 for benign UESs after radical cystectomy. All the open procedures were performed by the same center in order to compare the robotic approach with a standardized technique. Data were reviewed for demographics, stricture characteristics, and perioperative outcomes. Complication and stricture recurrence rates were compared between both groups. Among 82 reimplantations, 44 were left sided (54%) and 12 bilateral (14%). Median time from cystectomy to diagnosis of stricture was 6 months (range 3-18). Baseline characteristics (gender, age, BMI, side, type of urinary diversion and previous abdominal radiotherapy) were comparable between RUER and OUER groups, except for ASA score and rates of prior robotic cystectomy. The 30-day overall postoperative complication rate was 37% in RUER compared to 70.6% in OUER (p = 0.026). Patients who underwent a RUER had statistically significant lower rate of intraoperative blood transfusion (0% vs 12%, p = 0.041), urinary tract infection (12% vs 53%, p < 0.001), bowel injury (0% vs 12%, p = 0.041) and high-grade complications (Clavien III-IV) (4.6% vs 23.5%, p = 0.031). RUER patients had shorter median length of hospital stay (3 days IQR[1-6] vs 6 IQR[3-9], p = 0.018) and lower readmission rate (4.6% vs 29.4%, p = 0.008). After a median follow-up of 23.5 months (8.7-43), 80% of RUER cases were stricture free compared to 90% of OUER (p = 0.42). RUER achieved a success rate comparable to that of open revisions and may provide some advantages in terms of perioperative outcomes. Prospective and larger studies are warranted to prove its superiority compared to the standard open technique.

Efficacy of treatment options for complicated urinary tract infections including acute pyelonephritis: a systematic literature review and network meta-analysis.

Aim: Compared with uncomplicated urinary tract infections (UTIs), complicated UTIs (cUTIs) including acute pyelonephritis (AP) present with significant morbidity, a higher risk of treatment failure and typically require longer courses of treatment, or alternative antibiotics. The emergence of drug-resistant organisms represents a considerable challenge in the treatment of patients with cUTIs/AP and has limited antibiotic options. Carbapenems are considered the current last line of therapy, however, carbapenem resistance represents a growing problem. Although several established and novel treatment options are available, direct comparative evidence is lacking. Methods: Randomized controlled trials (RCTs) were identified by systematic literature review of Embase®, MEDLINE® and Cochrane databases (database inception to 15th June 2022). Relevant conference proceedings (2020-2022) were also reviewed. Following feasibility assessment to verify network connectivity at an overall level, outcome specific networks were prepared. Bayesian network meta-analysis (NMA) was performed (using R version 4.2.1) to determine the relative efficacy of various treatments for cUTI/AP, including cefepime+enmetazobactam. Convergence was assessed by visual inspection of trace plots. The accuracy of the posterior estimates was assessed using the Monte Carlo error for each parameter. Published study results were included in the synthesis of the relative risk (RR) of efficacy end points, using a logit link with binomial likelihood distribution. Results: Feasibility assessment was conducted for 40 RCTs identified, to assess the viability of constructing a network of interlinked RCTs. Of those, 28 studies were included in the master NMA network. A fixed effects model (FEM) was selected due to low statistical heterogeneity, according to I2 values. For composite outcome at test of cure (TOC), ceftolozane+tazobactam, cefepime+enmetazobactam, cefiderocol, levofloxacin and plazomicin demonstrated significantly higher RRs versus carbapenems. For microbiological eradication at TOC, cefepime+enmetazobactam, plazomicin, cefiderocol, fosfomycin, meropenem+vaborbactam and ceftazidime+avibactam demonstrated significantly higher RRs versus carbapenems. RRs for cefepime+enmetazobactam were also significantly higher versus several established and novel treatment options for composite outcome, microbiological eradication and clinical cure. Conclusion: Against the backdrop of increasing bacterial resistance, these findings suggest that cefepime+enmetazobactam may represent an effective carbapenem-sparing treatment option in patients with cUTI including AP.

Bladder Symptoms Provoked by Short, Rapid-Acting Loop Diuretics: A Frequent but Often Overlooked Problem.

Bladder dysfunction entails overactive bladder (OAB) defined as symptoms of urinary urgency, frequency, and/or nocturia with or without incontinence if there is no obvious pathology or infection or lower urinary tract symptoms that includes recognized causes of bladder dysfunction. Literature search. Symptoms of OAB are reported in about 15% of the adult US population. This is increased 2- to 3-fold in patients with congestive heart failure (CHF), hypertension, cardiovascular disease (CVD), chronic kidney disease (CKD), or the elderly where it often accompanies prescription for short, rapid-acting loop diuretics. However, less than 2% of patients seeking care for OAB receive treatment. The fear of urinary incontinence from short, rapid-acting loop diuretics may contribute to medication nonadherence and less well-controlled, apparently resistant hypertension. The bladder contracts to rapid stretch. Thus, less rapid-acting diuretics such as thiazides or extended-release formulations of loop diuretics may be preferable for those with bladder dysfunction. Alternatively, the use of a mineralocorticosteroid receptor antagonist, angiotensin receptor antagonist/neprilysin inhibitor, or sodium glucose-linked transport type 2 inhibitor may allow a reduction in the dose of a short, rapid-acting loop diuretic for those with bladder dysfunction. A worsening of symptoms from bladder dysfunction by short, rapid-acting loop diuretics occurs frequently in patients with CVD, CHF, hypertension, and CKD where it can contribute to impaired quality of life and poor adherence and thereby to worsening outcomes.

The “prostate-pelvic syndrome” theory used in patients with type-III prostatitis and its correlation with prostate volume

BackgroundType-III prostatitis is the most common prostate disease in adult males below 40 years old. The actual operation of its diagnosis process is cumbersome. Recently, a group of top Chinese urologists have proposed the theory of “prostate-pelvic syndrome (PPS)” and suggested using it to replace the traditional term for type-III prostatitis. However, the practical application effectiveness of PPS theory in clinical practice is still unclear.ObjectiveThe aims of this study were to verify the clinical outcome of PPS theory in diagnosing the adult patients with type-III prostatitis below 40 years old and analyze the related factors for the main symptoms of PPS in adult males below 40 years old, providing references for the prevention and treatment of PPS in young adult males.MethodsThe clinical medical records of 548 adult outpatients with type-III prostatitis under 40 years old between August 2018 and May 2023 were retrospectively analyzed. The patients were diagnosed retrospectively again by using PPS diagnostic criteria in this retrospective cohort study. Subsequently, the age, disease duration, prostate volume (PV), PV ≥ 20 mL detection rate and other related indicators among different symptom groups were analyzed by univariate analysis. The correlation between different symptoms of PPS patients and PV as well as disease duration was analyzed by correlation analysis. Additionally, the related factors for different main symptoms of PPS patients were analyzed by multivariate analysis.ResultsOf the 548 patients, 229 patients had lower urinary tract symptoms, 159 patients had pelvic pain symptoms, and 160 patients had lower urinary tract and pelvic pain symptoms, respectively corresponding to those with voiding symptoms (VS), pain symptoms (PS), and voiding + pain symptoms (VS + PS) defined according to the concept of PPS. There were significant differences in PV and disease duration among the three main symptoms groups of PPS. PV in the VS group was larger than that in the PS group. Spearman correlation analysis showed that VS was positively correlated with PV and disease duration, while four secondary symptoms (including sexual dysfunction, psychosocial symptoms, reproductive dysfunction and other symptoms) were not related to PV. The proportion of VS patients in the PV ≥ 20 mL group was higher than that in the PV < 20 mL group. Multivariate logistic analysis showed that PV and disease duration were independent related factors for VS in adult PPS patients below 40 years old.ConclusionsType-III prostatitis in Chinese adult males below 40 years old can be diagnosed and treated with PPS. PV and disease duration were independent related factors for VS in Chinese adult PPS patients below 40 years old. The risk of VS in PPS patients with PV ≥ 20 mL was 5.348 times as long as that in PPS patients with PV < 20 mL.

Increased mortality risk in people with schizophrenia in Lithuania 2001–2020

The aim of this study was to assess mortality risk in people with schizophrenia in Lithuania from 2001 and 2020. Cause-specific and all-cause mortality risk among patients with schizophrenia was assessed using a retrospective cohort study design. The cohort identified all patients with schizophrenia diagnosis (ICD-10 code F20) who were admitted to the Vilnius Republican Psychiatric Hospital from 1 January, 2001 to December 31, 2020. Dates of death and emigration were obtained from the Central Population Register. The standardized mortality ratios (SMRs) were calculated by dividing the observed number of deaths among patients with schizophrenia by the expected number of deaths, calculated using the national rates. The final cohort included 7883 patients, with 2458 observed deaths. An increased all-cause mortality risk was found for both sexes (SMR = 1.96; 95% CI 1.88–2.04) compared to the general population. The most common cause-specific mortality risk was found for diseases of the circulatory system (SMR = 2.17; 95% CI 2.05–2.30). Other significant increases in cause-specific mortality risk were observed for infectious diseases, mental and behavioural disorders, diseases of the nervous system and respiratory system, diseases of the genitourinary system, as well as external causes. Patients with schizophrenia do not benefit from the health strategies that have led to reduced mortality in the general population. To close the mortality gap, smoking and alcohol cessation interventions, cardiovascular and cancer screening and monitoring, early diagnosis, and interventions for identified physical diseases should be regarded as imperative.

Impact of Bone-Modifying Agents on Post-Bone Metastasis Survival Across Cancer Types

Background: Bone metastasis is associated with a poor prognosis. Bone-modifying agents (BMA) are commonly used for the prevention or treatment of skeletal-related events (SRE) in patients with bone metastasis; however, whether or not treatment with BMA improves survival remains unclear. In this study, we investigated whether BMA was involved in post-bone metastasis survival. Methods: A total of 539 cancer patients were retrospectively analyzed to identify significant independent factors in post-bone metastasis survival. Results: Among the overall population, patients with the following cancers had a median survival longer than 24 months: thyroid, 97.2 months; breast, 51.5 months; prostate, 47.2 months; and kidney, 38.8 months. In contrast, median post-bone metastasis survival was significantly shorter in gastrointestinal (GI) (6.5 months), head and neck (6.3 months), and urinary tract (3.4 months) cancers. In non-small cell lung cancer (NSCLC), the log-rank test demonstrated that the epidermal growth factor receptor (EGFR) mutation was a significant factor for post-bone metastasis survival: EGFR mutation (−) n = 67, median post-bone metastasis survival 11.5 months (95% CI: 6.0–15.2); EGFR mutation (+) n = 39, median post-bone metastasis survival 28.8 months (95% CI: 18.1–35.7) (p &lt; 0.05). Intriguingly, treatment with BMA was a significant positive prognostic factor: BMA (−) n = 203, median post-bone metastasis survival 7.8 months (95% CI: 5.8–12.5); BMA (+) n = 336, median post-bone metastasis survival 21.9 months (95% CI: 16.1–26.4) (p &lt; 0.001). Moreover, the Cox proportional hazards model showed that this was particularly evident in cancer types with poor prognosis such as GI cancer (hazard ratio [HR]: 0.62, 95% CI: 0.40–0.95; p &lt; 0.05) and NSCLC without the epidermal growth factor receptor (EGFR) mutation (HR: 0.56, 95% CI: 0.34–0.91; p &lt; 0.05). Conclusions: Treatment with BMA is recommended not only for the prevention and/or treatment of SRE, but also may have a positive impact on post-bone metastasis survival, particularly in cancers with typically poor post-bone metastasis survival such as GI cancer and NSCLC without the EGFR mutation.

A study on the pharmacovigilance of various SGLT-2 inhibitors

BackgroundSodium-glucose co-transporter two inhibitors (SGLT2is) are widely used in clinical practice due to their proven cardiovascular and renal benefits. However, various adverse drug reactions (ADRs) have been reported. This study aims to systematically update the ADRs associated with SGLT2is and identify the differences among various SGLT2is acovigilance of various SGLT-2 inhibitors.MethodsData from the FAERS database covering Q1 2013 to Q2 2024 were selected for disproportionality analysis. ADRs were defined using the System Organ Classes (SOC) and Preferred Terms (PT) from the MedDRA 27.0 dictionary. Four signal detection metrics—reporting odds ratio (ROR), proportional reporting ratios (PRRs), Bayesian Confidence Propagation Neural Network (BCPNN), and empirical Bayesian geometric mean (EBGM)—were utilized to infer ADRs and assess differences among specific SGLT2i drugs through intersection analysis.ResultsExcept for canagliflozin, both dapagliflozin and empagliflozin showed a general increase in ADRs. Specifically, canagliflozin had 93 ADRs, dapagliflozin had 173, and empagliflozin had 214. Most of these were related to Infections and Infestations, Investigations, and Reproductive System and Breast Disorders, notably manifesting as inflammatory conditions of the urinary and reproductive systems, such as orchitis and testicular abscess, consistent with FDA labeling. Additionally, overlooked ADRs were identified, including bladder cancer, cholangiocarcinoma, and thrombotic strokes, none of which were reported for canagliflozin.DiscussionWhile shared ADRs for SGLT2is are noted in FDA labeling, monitoring for high-risk populations, such as those with cancers or strokes, remains crucial to prevent deterioration. Medication regimens may need adjustment, including selecting canagliflozin or non-SGLT2i alternatives when necessary.

Risk of Vertebral Fracture in Individuals with End-Stage Renal Disease Secondary to Vasculitis.

Glucocorticoids are central to vasculitis treatment but increase vertebral fracture risk. This study assessed whether vasculitis as the cause of ESRD is associated with incident vertebral fracture, controlling for corticosteroid use. A retrospective cohort study was conducted from 2006-2019 on adults in the U.S. Renal Data System initiating dialysis between 2006 and 2017, surviving ≥1 year, with continuous Medicare Part D coverage during the first year of dialysis. Primary exposure was vasculitis as the cause of ESRD determined from form Centers for Medicare & Medicaid Services (CMS)-2728, completed by a physician at dialysis initiation. A granulomatosis with polyangiitis (GPA) subgroup had ≥1 International Classification of Diseases (ICD)-9/10 code for GPA in the first dialysis year. One inpatient or two outpatient ICD-9/10 codes within 90 days defined incident vertebral fracture. Clinical covariates were ascertained from form CMS-2728 and ICD-9/10 codes and pharmacy claims over the first dialysis year. Multivariable logistic regression examined the association of ESRD secondary to vasculitis with incident vertebral fracture, and in GPA in a secondary analysis. Among 633,543 individuals with ESRD, vertebral fracture occurred in 6.18% with and 3.23% without ESRD from vasculitis. After multivariable adjustment including corticosteroid daily dose in the first dialysis year, ESRD secondary to vasculitis was associated with vertebral fracture (relative risk (RR):1.33, 95% confidence interval (CI):1.17-1.52), and similarly in those with GPA (RR:1.47, 95% CI:1.23-1.75). ESRD from vasculitis, and from GPA specifically, increases vertebral fracture risk among individuals with ESRD after accounting for first dialysis year corticosteroid dose.

Evaluation of a new model of care for bladder management in a statewide spinal cord service.

Registry-based cohort study. To evaluate the impact of the introduction of a new bladder management model of care at the Victorian Spinal Cord Service (VSCS) on the incidence of subsequent emergency department presentations and readmissions to hospital for urinary tract infection (UTI) in the first 2 years after injury. VSCS, Austin Health, Melbourne, Australia. A new model of care that prioritized intermittent self-catheterization was implemented at the VSCS on 1 August 2017. Data from the Victorian State Trauma Registry and Austin Health medical record were used to compare the rate of readmissions, emergency department (ED) presentations and hospitalisations for UTI in the first two years post-injury before and after practice was changed. A total of 333 cases were included; 149 cases pre-model of care change and 184 cases after. 143 males and 41 females with a mean (SD) age of 48.9 (19.7) were admitted to the VSCS following the change in model of care. The rate of any subsequent hospitalisation for UTI (ED presentation or admission) was lower following the introduction of the new bladder management model of care (Incidence rate ratio 0.30, 95% CI 0.12-0.73). Our data demonstrates the real-world impact of a change in bladder management after new SCI. These data strengthen the consensus recommendation in current practice guidelines.

Assessment of typing methods, virulence genes profile and antimicrobial susceptibility for clinical isolates of Proteus mirabilis

Proteus mirabilis (P. mirabilis) is one of the most important causative pathogens associated with complicated urinary tract infections with a 20% incidence. For epidemiological determinations, several phenotypic and molecular typing methods have been implicated. Sixty P. mirabilis isolated undergo antibiotic susceptibility test by standard Kirby Bauer method. They showed high resistance to nitrofurantoin and trimethoprim/sulfamethoxazole that appear mainly in 3rd age group. The 2nd age group comprised most of the resistant isolates to the tested antibiotics. A total of 73.33% of isolates were classified as multi drug resistance (MDR) and 78.3% of isolates were distributed in several antibiotypes with MAR index over 0.2. Twenty-one isolates were strong biofilm-producers and they were significantly related to MDR. Different virulence factors as protease, urease and hemolysin production are detected. Detection of several virulence genes by PCR; zapA and ureC were harbored by all isolates, followed by rsbA (95%), ureA and flaA (93%), hpmA (91.7%) and mrpA (73.3%). Determination of genetic diversity between isolates was performed by different methods (RAPD, ISSR, ERIC, BOX-AIR and REP-PCR) by using several parameters as typeability and discriminatory power indicating that ERIC-PCR was the best method followed by REP-PCR 1R. Rand’s & Wallace coefficients were used for calculating the congruence among typing methods. Conclusions: The results obtained from both conventional and molecular typing methods indicated that molecular methods are superior to conventional methods in the discrimination of isolates. ERIC-PCR and Rep-PCR provide high discrimination ability among P. mirabilis clinical isolates contributing to epidemiological studies.

Integrated Biosensor with Microfluidic Chip and Microwave Sensor Chip for Cell Separation and Detection

AbstractIn this work, an integrated biosensor consisting of spiral microfluidic array and microwave sensors is proposed for simultaneous separation and detection of cells. The biosensor integrated by plasma processing technology is fabricated by soft lithography and glass‐based IC process, which has the advantages of simple preparation, low cost, and reliable structure. In the field of clinical medicine, Escherichia coli (E. coli) is the causative agent of urinary tract infections, which leads to an increase in the number of white blood cells (WBCs) present in the urine. Different concentrations of E. coli and WBCs mixed solution are configured to perform biological cell experiments and the capability of the biosensor in separating and detecting WBCs is verified. Interdigital capacitors (IDCs) and split ring resonators (SRRs) are employed to detect the WBCs obtained by microfluidic array separation. The microfluidic array exhibits a WBC collection rate of 92.7%. The capacitance of the IDC and the resonant amplitude of the SRR exhibit a decrease of 51.36 pF and 0.34 dB, which demonstrates a satisfactory linearity of 0.96 and 0.98, respectively. Consequently, the integrated biosensor used to simultaneously separate and detect WBCs has the potential for the early diagnosis of urinary tract infections in clinical medicine.

Features of diagnosis and treatment of urinary tract infection in the background of diabetes mellitus type 2 (clinical case)

A clinical case of asymptomatic chronic pyelonephritis against the background of decompensation of type 2 diabetes mellitus is presented. The patient sought medical attention with clinical manifestations of diabetes mellitus, but did not indicate symptoms of pyelonephritis. Signs of the inflammatory process in the kidneys were detected only in the hospital based on the results of laboratory tests. In the described multimorbid condition, the presence of hyperglycemia served as a substrate for the accelerated growth of Escherichia coli bacteria, which caused an exacerbation of chronic urinary tract infection in the patient. In addition, diabetes mellitus contributed to the development of virulence and polyresistance of microflora to antibiotics. The complexity of stopping pyelonephritis in this clinical case necessitated constant monitoring and correction of the antibacterial therapy effectivenes. The initially prescribed antibiotic Ceftriaxone was replaced with Cefoperazone + Sulbactam. Since our patient with severe multimorbid pathology had a highly variable glycemic profile, we adjusted antibacterial therapy in parallel with hypoglycemic therapy. As a result, we noted that compensation of diabetes mellitus with normalization of glycemia contributed to the restoration of immune system function and weakening of the inflammatory process in the kidney with subsequent relief of the active phase of chronic pyelonephritis.

The appropriateness of self-care policy for urinary tract infections among women from racialised minorities and low-income households in the United Kingdom: A qualitative study.

Urinary tract infections (UTIs) can negatively impact quality of life, especially when recurring. Patients often seek medical advice to relieve painful symptoms. UTIs are also the second most common reason antibiotics are prescribed in English primary care. However, overuse and long-term use of antibiotics for suspected UTIs in women can lead to antibiotic-resistant bacteria, making future treatments less effective. The UK's 2019-24 Antimicrobial Resistance National Action Plan aims to raise public awareness about the risks of overusing antibiotics and encourages self-care for minor infections, like uncomplicated UTIs. We explored how feasible and appropriate this approach is. The transcripts from four online focus groups and 19 one-to-one online interviews involving 25 racialised minority and/or low-income women were analysed thematically. Meetings with lay members of the public with similar socio-demographics and experiences to those we planned on recruiting for the research helped to orientate the study, refine its materials and enhance its recruitment strategies. All participants spoke about UTI-related anxieties, which they experienced differently depending on the frequency and the course of UTI episodes, and how knowledgeable they were about the symptoms. Participants often practised self-care for UTIs before seeking professional advice. They saw consultations with health care professionals as valuable for managing the symptoms of UTIs and navigating self-care options. Those with recurrent UTIs felt they could recognise when they required antibiotics and, therefore, they felt they could take responsibility for minimising overprescribing. Barriers to self-care included high pressure working days and not being able to take time off work to recover. Participants in our study were often able to self-diagnose and assess the severity of their symptoms, which makes them partners in efforts to improve antibiotic stewardship. They still valued consulting professionals for advice and support about their UTIs, irrespective of whether they received a prescription.

Improving UTI Diagnostics in Oncology: Reliability of Reflex Urine Culture in Immunosuppressed Neutropenic and Non-neutropenic Cancer Patients.

Urinary tract infections are prone to overdiagnosis, and reflex urine culture protocols offer a valuable opportunity for diagnostic stewardship in this arena. However, there is no recommended standard testing approach. Cancer patients are often excluded from reflex urine culture protocols, especially if severely immunosuppressed or neutropenic. The aim of this study was to evaluate the performance characteristics of urine screening studies, including dipstick urinalysis for nitrite and leukocyte esterase and urine microscopy for white blood cell count, to detect significant pathogen growth. A retrospective study of 58,098 urine cultures with a paired dipstick urinalysis with or without urine microscopy was performed at Memorial Sloan Kettering Cancer Center in New York City, evaluating data from January 1, 2018, to December 31, 2020. A dipstick urinalysis was considered negative only if leukocyte esterase and nitrite were undetected. A negative dipstick urinalysis had a negative predictive value (NPV) of 98% for clinically significant bacteriuria in voided urine, and 95% for catheterized urine. Notably, a negative urine dipstick test screen maintained a high NPV among patients with neutropenia and in those with antibiotic exposure before testing. Finally, the presence of pyuria ≥10 white blood cells per high power field on urine microscopy offered negligible incremental diagnostic benefit in samples with a negative dipstick urinalysis. Reflex urine culture protocols contingent upon a screening dipstick urinalysis are a safe and effective platform for diagnostic stewardship in patients with cancer including those with neutropenia.

The predictive value of prostate spherical volume ratio in lower urinary tract symptoms and clinical progression of benign prostatic hyperplasia: a retrospective cohort study.

To evaluate the predictive value of Prostate Spherical Volume Ratio for Lower urinary tract symptoms and clinical progression of Benign prostatic hyperplasia. And compared with other prostatic anatomical parameters. A total of 154 patients with Benign prostatic hyperplasia who underwent MRI and urodynamics were included in the study, while prostate anatomical parameters such as prostate spherical volume ratio, prostate volume, intravesical prostatic protrusion, prostatic urethral length and presumed circle area ratio were determined based on MRI measurements. Average length of follow-up was 12months. The primary outcome was follow-up for the clinical progression of Benign prostatic hyperplasia, defined as an increase in the International Prostate Symptom Score of at least 4 points, Benign prostatic hyperplasia-related prostatic surgery. Univariate and multivariate linear regression analyses were conducted to identify risk factors for lower urinary tract symptoms. Logistic regression analyses were conducted to identify risk factors for clinical progression of Benign prostatic hyperplasia. Multivariate linear regression highlighted the significant association of prostate spherical volume ratio with lower urinary tract symptoms. In multivariable logistic regression analysis prostate spherical volume ratio is an independent risk factor for the clinical progression of Benign prostatic hyperplasia to an increase in the International Prostate Symptom Score of at least 4 points (OR = 1.53 p = 0.016) and Benign prostatic hyperplasia -related prostatic surgery (OR = 5.15 p = 0.020). Prostate spherical volume ratio has been significantly correlated with Lower urinary tract symptoms, and it was an independent risk factor for the clinical progression of Benign prostatic hyperplasia. THIS TRIAL IS REGISTERED ON CLINICALTRIALS.GOV: NCT06448533.