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PubMed1997

Antimicrobial prophylaxis prior to shock wave lithotripsy in patients with sterile urine before treatment: a meta-analysis and cost-effectiveness analysis.

OBJECTIVES: To determine the efficacy and cost-effectiveness of routine antimicrobial prophylaxis prior to shock wave lithotripsy (SWL) in patients with a sterile pretreatment urine culture. METHODS: A structured MedLine search revealed eight prospective, randomized, controlled trials (RCTs) of active treatment versus placebo or no treatment (n = 885) and six clinical series (non-RCTs; n = 597) addressing the use of antimicrobial prophylaxis for SWL. A meta-analysis was performed on the eight RCTs, with the primary outcome being the diagnosis of a urinary tract infection (UTI) post-SWL. A cost analysis was performed comparing a prophylactic strategy (prophylaxis for every patient and treatment for post-SWL UTIs) with a treatment-only strategy for post-SWL UTIs using various antimicrobial combinations and the median probability of post-SWL UTIs determined by meta-analysis. RESULTS: The incidence of post-SWL UTIs ranged from 0% to 28% in the control group and from 0% to 7.7% in the patients who underwent prophylaxis. Combining the placebo/no-drug treatment arms in the six RCTs by meta-analysis (Bayesian analysis) resulted in a median probability of a post-SWL UTI of 5.7% (95% confidence interval [CI] 3.8% to 8.4%). For the drug treatment arms, the median probability of a UTI was 2.1% (95% CI 0.9% to 3.6%). Relative risk (RR) analysis resulted in an overall RR of post-SWL UTIs with prophylaxis versus without prophylaxis of 0.45 (95% CI 0.22 to 0.93) (P = 0.0005). Depending on the antimicrobial regimen used for prophylaxis and treatment, a prophylactic strategy added minimally to the overall treatment cost of SWL, and proved cost beneficial when taking into consideration serious UTIs requiring inpatient treatment. CONCLUSIONS: A policy of antibiotic prophylaxis prior to SWL in patients with sterile pretreatment urine cultures is efficacious in reducing the rate of post-SWL UTIs. Discounting inpatient episodes for sepsis and acute pyelonephritis, however, the strategy is not cost-effective. In contrast, using literature-derived incidence estimates for post-SWL urosepsis or pyelonephritis necessitating inpatient treatment, prophylaxis becomes both efficacious and cost-effective, and thus constitutes a dominant strategy.

Antibiotic Prophylaxis↗
PubMedDate not supplied

Using Tc-99m DMSA renal cortex scan to detect renal damage in women with type 2 diabetes.

Women with diabetes mellitus (DM) have urinary tract infection (UTI) more often than women without DM. It is unknown, however, what the prevalence and type of renal damage due to UTI is in these women. Therefore, in this study, we compared type 2 DM women with or without UTI history for the prevalence and type of renal damage by technetium-99m dimercapto-succinic acid (Tc-99m DMSA) renal scan. A total of 128 type 2 DM women with or without UTI history received Tc-99m DMSA renal scan were included in this study. The patients were separated into three groups: (1) 43 patients without UTI history, (2) 42 patients with only lower UTI (cystitis) history and (3) 43 patients with upper UTI (pyelonephritis) history. The renal scan findings were separated into three types: (A) normal, (B) inflammation and (C) scar. The 31.9% (50/128) of type 2 DM patients had renal damages. Group 1 patients had a significantly lower prevalence of renal damages including inflammation and scar as compared to Groups 2 and 3 patients. In addition, the prevalence of renal damage was significantly higher in Group 3 than in Group 2 patients. Renal scars only were visualized in Group 3 patients. However, other clinical data were not statistically different among the three group patients. Type 2 DM women with UTI history, especially if they had upper UTI have a significantly higher prevalence of renal damage than in those without UTI.

Biological Transport↗
PubMed2003

Urinary tract infection and Chlamydia infection in adolescent females.

STUDY OBJECTIVE: To examine whether clinical or laboratory findings could distinguish Chlamydia trachomatis (CT) from urinary tract infection (UTI) among adolescent females in whom providers tested for both. DESIGN, SETTING, PARTICIPANTS: A laboratory database at an urban teen health center was reviewed to identify females who had both urine culture and ligase chain reaction (LCR) test for CT ordered at the same visit. History and physical findings were abstracted from the medical record. There were 81 visits with retrievable laboratory results and chart documentation. MAIN OUTCOME MEASURES: UTI was defined as >1000 colony-forming units on culture, and CT was defined as positive LCR test. Pearson's Chi-squared test was used to assess strength of the hypothesized associations. RESULTS: UTI was diagnosed in 20 (24%) and CT in 18 (22%) of 82 visits. Concurrent CT was diagnosed in 6 of 20 subjects with UTI. Symptoms and physical signs did not differentiate UTI from CT. Positive urinary nitrites were associated with UTI, but did not exclude CT. Similarly, wet prep evidence of trichomonas or white blood cells was associated with CT, but did not exclude UTI. Clinical diagnosis of CT or UTI was 50% sensitive and 70% specific. CONCLUSIONS: Adolescent females who are screened for both CT and UTI have high rates of concurrent disease. Urinary or vaginal symptoms do not differentiate well between these infections. Clinical diagnosis is imprecise, suggesting that adolescent females with vaginal or urinary symptoms should be tested for both CT and UTI.

Adolescent↗
PubMed1998

Tocolytic effect of magnesium sulfate and/or urinary trypsin inhibitor against lipopolysaccharide-induced preterm delivery in mice.

BACKGROUND: The purpose of this investigation was to evaluate the effect of magnesium sulfate (magnesium) alone or along with urinary trypsin inhibitor (UTI) in a mouse model in the prevention of preterm delivery. METHODS: On day 17 of pregnancy, female C3H/HeN mice impregnated by male B6D2F1 mice were given two intraperitoneal injections of lipopolysaccharide (LPS; 50 microg/kg) at a 3-hour interval, which treatment induced a 100% incidence of preterm delivery within 25 hours of the second dose. Magnesium (4, 5, 6, 7, or 8 mg/hr, s.c.), UTI (25 x 10(4) units/kg, i.p.), magnesium (5 mg/hr, s.c.) plus UTI (25 x 10(4) units/kg, i.p.), saline solution (0.3 ml/hr, s.c.), or saline solution (0.1 ml/hr, s.c. and 2.5 ml/kg, i.p.) was administered to pregnant animals on day 18 of gestation. UTI was intraperitoneally given 5 times at 2-hour intervals from 8:00 am to 4:00 pm, and magnesium was infused subcutaneously and constantly from 8:00 am to 6:00 pm. In addition, the preventive effect of magnesium on LPS-induced contraction of uterine muscle strips and that of magnesium, UTI, or magnesium plus UTI on LPS-induced calcium influx in uterine smooth muscle cells were examined using muscle tissue isolated from pregnant mice on day 17 of gestation. RESULTS: The incidence of preterm delivery decreased significantly in a dose-dependent fashion with magnesium treatment, and there was a significant and synergistic decrease after combined treatment with magnesium plus UTI. The in vitro uterine contraction and calcium influx induced by LPS were significantly suppressed by magnesium. The latter was significantly suppressed by UTI and additively reduced by magnesium plus UTI. CONCLUSIONS: Combination therapy with magnesium plus UTI may possibly be helpful for preventing preterm delivery in humans without the severe side effects induced by hypermagnesemia.

Animals↗
PubMed2003

A chart audit of factors related to urine flow and urinary tract infection.

BACKGROUND: Clients with long-term urinary catheters are at risk for urinary tract infection (UTI) and catheter blockage that disrupt client/family daily activities. The United States Centers for Disease Control guideline strongly recommends keeping urine flowing to help prevent UTI in this population, but little is known about factors associated with urine flow and how they are related to UTI. AIM: The purpose of this descriptive study was to identify urine flow factors contributing to UTI in home care clients who had had an indwelling urinary catheter for at least 3 months. METHODS: Twenty-four records were reviewed from one home care agency. The sample of 12 males and 12 females ranged in age from 31-102 (mean 70 years, sd 17.2) and they had used a catheter from 5 to 105 months (mean 27.9, sd 32). FINDINGS: Catheter blockage and low urine output were the only 'urine flow indicators' that were significantly related to UTI. Other 'urine flow indicators' were not related to UTI, including bloodstained urine, pulling on the catheter, leakage, and sluggish urine. Thirteen people experienced blockage and 11 did not. Of the 13 with blockage, six had UTI and seven did not, during the 6 months of the review. It was particularly notable that, of the 11 people with no blockage, none went on to experience UTI. CONCLUSION: This finding raises questions about why some people with blockage developed UTI and some did not. We suggest that nurses taught their clients what to do to get the urine flowing, such as, increasing fluid intake or checking for proper placement. Identifying more information from clients about how they monitor and adjust urine flow will be the next step toward understanding how to prevent UTI in those with long-term catheters.

Adult↗
PubMed1998

A bifunctional hybrid molecule of the amino-terminal fragment of urokinase and domain II of bikunin efficiently inhibits tumor cell invasion and metastasis.

Urinary trypsin inhibitor (UTI) inhibits efficiently tumor cell invasion and the formation of metastasis. The anti-metastatic effect is dependent on the COOH-terminal domain II of UTI [UTI-(78-136)-peptide]. To develop a molecule that binds with high affinity to the urokinase (uPA) receptor (uPAR) on tumor cell surfaces, a bifunctional hybrid molecule [uPA-(1-134)-UTI-(78-136)] consisting of the uPAR-binding NH2-terminal fragment [UTI-(78-136)-peptide] of uPA at the NH2-terminus of UTI-(78-136)-peptide was produced in Escherichia coli by genetic engineering. The purified hybrid protein inhibited trypsin and plasmin 2-3-fold less effectively than UTI-(78-136)-peptide and was found to bind to human tumor cells via uPAR, which was confirmed by cell binding and competition experiments. Using a modified Boyden chamber and an artificial basement membrane, Matrigel, it was found that the hybrid protein is very effective at inhibiting invasion by uPAR-expressing human tumor cells. Sensitivities of tumor cells towards the anti-invasive effect of uPA-(1-134)-UTI-(78-136) correlated with the density of uPAR on human tumor cells. Furthermore, in the spontaneous metastasis model, the hybrid protein inhibited the formation of lung and/or lymphatic metastasis by human ovarian carcinoma and choriocarcinoma cells. The hybrid protein was much more effective than uPA-(1-134)-peptide, UTI-(78-136)-peptide, or UTI. We conclude that this approach extends the possibility of applying recombinant protein for therapeutic use in inhibition of human tumor cell metastasis.

Amino Acid Sequence↗
PubMed1999

Risk factors for recurrent urinary tract infection in preschool children.

OBJECTIVE: Children with urinary tract infections (UTI) are at risk of renal scarring which may lead to impaired renal function and hypertension. This study examines the risk factors that predispose to recurrent UTI in children and the role of recurrent UTI in renal scarring. METHODOLOGY: A group of 290 children under 5 years of age with a first symptomatic UTI were studied. Micturating cystourethrogram and dimercaptosuccinic acid (DMSA) renal scintigraphy were performed at entry, and DMSA was repeated 1 year later. Two hundred and sixty-one children (90%) were followed up at 1 year. RESULTS: There were 46 confirmed recurrent infections in 34 children, a recurrence rate of 12%. Multiple recurrence occurred in 14/34 (34%) children. Age of less than 6 months on entry independently predicted for recurrent UTI (odds ratio (OR): 2.9)). Compliance with prophylactic antibiotics fell throughout the year of follow up. Vesicoureteric reflux (VUR) was present in 14/34 (34%) of the group with recurrent UTI, 69/256 (27%) without recurrence. Urinary tract infection was significantly associated with bilateral and intrarenal reflux; grade 3-5 reflux independently predicted for recurrent UTI (OR: 3.5). Recurrent UTI was significantly associated with high grade DMSA defects on entry, renal parenchymal defects at 1 year follow up, and new defects at 1 year. CONCLUSION: The independent risk factors for recurrent UTI identified by this study were an age of less than 6 months at the index UTI and grade 3-5 VUR. These findings suggest more selective targeting may minimize problems associated with prophylaxis and improve outcomes for children with urine infection.

Anti-Infective Agents, Urinary↗
PubMed2003

The etiology of urinary tract infection: traditional and emerging pathogens.

The microbial etiology of urinary infections has been regarded as well established and reasonably consistent. Escherichia coli remains the predominant uropathogen (80%) isolated in acute community-acquired uncomplicated infections, followed by Staphylococcus saprophyticus (10% to 15%). Klebsiella, Enterobacter, and Proteus species, and enterococci infrequently cause uncomplicated cystitis and pyelonephritis. The pathogens traditionally associated with UTI are changing many of their features, particularly because of antimicrobial resistance. The etiology of UTI is also affected by underlying host factors that complicate UTI, such as age, diabetes, spinal cord injury, or catheterization. Consequently, complicated UTI has a more diverse etiology than uncomplicated UTI, and organisms that rarely cause disease in healthy patients can cause significant disease in hosts with anatomic, metabolic, or immunologic underlying disease. The majority of community-acquired symptomatic UTIs in elderly women are caused by E coli. However, gram-positive organisms are common, and polymicrobial infections account for up to 1 in 3 infections in the elderly. In comparison, the most common organisms isolated in children with uncomplicated UTI are Enterobacteriaceae. Etiologic pathogens associated with UTI among patients with diabetes include Klebsiella spp., Group B streptococci, and Enterococcus spp., as well as E coli. Patients with spinal cord injuries commonly have E coli infections. Other common uropathogens include Pseudomonas and Proteus mirabilis.Recent advances in molecular biology may facilitate the identification of new etiologic agents for UTI. The need for accurate and updated population surveillance data is apparent, particularly in light of concerns regarding antimicrobial resistance. This information will directly affect selection of empiric therapy for UTI.

Aged↗
PubMed2003

Dietary factors protecting women from urinary tract infection.

BACKGROUND: Because urinary tract infections (UTIs) are caused by bacteria in the stool, dietary factors may affect the risk of contracting a UTI by altering the properties of the fecal bacterial flora. OBJECTIVE: We studied dietary and other risk factors for UTI in fertile women in a case-control setting. DESIGN: One hundred thirty-nine women from a health center for university students or from the staff of a university hospital (mean age: 30.5 y) with a diagnosis of an acute UTI were compared with 185 age-matched women with no episodes of UTIs during the past 5 y. Data on the women's dietary and other lifestyle habits were collected by questionnaire. A risk profile for UTI expressed in the form of adjusted odds ratios (ORs) with 95% CIs was modeled in logistic regression analysis for 107 case-control pairs with all relevant information. RESULTS: Frequent consumption of fresh juices, especially berry juices, and fermented milk products containing probiotic bacteria was associated with a decreased risk of recurrence of UTI: the OR for UTI was 0.66 (95% CI: 0.48, 0.92) per 2 dL juice. A preference for berry juice over other juices gave an OR of 0.28 (95% CI: 0.14, 0.56). Consumption of fermented milk products > or = 3 times/wk gave an OR of 0.21 (95% CI: 0.06, 0.66) relative to consumption < 1 time/wk. Intercourse frequency was associated with an increased risk of UTI (OR for > or = 3 times/wk compared with < 1 time/wk: 2.7; 95% CI: 1.16, 6.2). CONCLUSION: Dietary habits seem to be an important risk factor for UTI recurrence in fertile women, and dietary guidance could be a first step toward prevention.

Adult↗
PubMed2005

Risk factors for ciprofloxacin resistance among Escherichia coli strains isolated from community-acquired urinary tract infections in Turkey.

OBJECTIVES: To determine the risk factors for community-acquired ciprofloxacin-resistant Escherichia coli urinary tract infection (UTI). METHODS: The study was performed with isolates from community-acquired UTIs collected from 15 centres representing six different geographic regions of Turkey. All microbiological procedures were carried out in a central laboratory. Multivariate analysis was performed for detection of risk factors for resistance. Use of quinolones more than once within the last year, living in a rural area, having a urinary catheter, age >50 and complicated infections were included in the model as variables and logistic regression was performed. RESULTS: A total of 611 gram-negative isolates were studied: 321 were isolated from uncomplicated UTI and 290 were isolated from complicated UTI. E. coli was the causative agent in 90% of the uncomplicated UTIs and in 78% of the complicated UTIs (P < 0.001). Seventeen percent of E. coli strains isolated from uncomplicated cases and 38% of E. coli strains isolated from complicated UTI were found to be resistant to ciprofloxacin. In multivariate analysis, age over 50 [odds ratio (OR): 1.6; confidence interval (CI): 1.08-2.47; P = 0.020], ciprofloxacin use more than once in the last year (OR: 2.8; CI: 1.38-5.47; P = 0.004) and the presence of complicated UTI (OR: 2.4; CI: 1.54-3.61; P < 0.001) were found to be associated with ciprofloxacin resistance. Detection of strains of E. coli producing extended-spectrum beta-lactamase (ESBL) enzymes was two times more common in the patients who received ciprofloxacin than those who did not (15% versus 7.4%). CONCLUSIONS: The increasing prevalence of infections caused by antibiotic-resistant bacteria makes the empirical treatment of UTIs more difficult. One of the important factors contributing to these high resistance rates might be high antibiotic use. Urine culture and antimicrobial susceptibility testing are essential in Turkey for patients with UTI who have risk factors for resistance, such as previous ciprofloxacin use. Fluoroquinolone-sparing agents such as nitrofurantoin and fosfomycin should be evaluated as alternative therapies by further clinical efficacy and safety studies.

Adolescent↗
PubMed2000

Detectable concentrations of urinary trypsin inhibitor in cerebrospinal fluid.

Urinary trypsin inhibitor (UTI) is a physiological protease inhibitor produced in the liver and excreted into urine. Urinary trypsin inhibitor-like antigen has been demonstrated on glial cells in the brain. This study measured cerebrospinal UTI levels in various conditions. Seven subjects in each of the following groups were studied: patients undergoing spinal anesthesia for minor surgery, spinal anesthesia for cesarean section, removal of meningioma, or at postoperative day 3 after ruptured intracranial aneurysm clipping. Cerebrospinal fluid was collected from a spinal needle, a needle puncturing the sylvian fissure, or a drainage tube from the optical carotid cistern. Urine was collected from a urinary catheter. Cerebrospinal and urinary UTI concentrations were measured by radioimmunoassay, and the urinary UTI concentration was divided by urinary creatinine concentration to give the systemic UTI concentration. The cerebrospinal UTI concentration in the brain tumor and postoperative state groups was significantly higher than in the spinal anesthesia and cesarean section groups. The systemic UTI concentration in the cesarean section and postoperative state groups was significantly higher than in the spinal anesthesia and brain tumor groups. The present results demonstrate that UTI can be detected in the cerebrospinal fluid, and suggest that cerebrospinal UTI increases in patients with a brain tumor or inflammation and is not affected by systemic UTI.

Adult↗
PubMed2004

Recurrence risk in infants with urinary tract infections and a negative radiographic evaluation.

PURPOSE: Infants with urinary tract infections (UTI) and no abnormality on radiological evaluation are usually discharged from urological followup but the natural history of these children is unknown. We evaluate the rate of and potential risk factors for UTI recurrence in this specific population. MATERIALS AND METHODS: We reviewed retrospectively charts of children evaluated for first UTI before age 6 months between January 1996 and February 2001. Only patients with a normal ultrasound and voiding cystourethrogram were included in this study. A telephone questionnaire was administered to the parents, which inquired about the UTI, duration of breast-feeding, type of formula, family history of UTI, neurological problems, history of constipation or recurrent fevers, as well as social status. Chi-square test was performed for statistical analysis. RESULTS: We identified 264 children with UTIs, of whom 119 (45%) had a negative ultrasound and voiding cystourethrogram. Followup was available on 68 girls (81%) and 16 boys (19%) of the 119 children (71%). Of the 84 children 16 (19%) had recurrent UTI. Mean followup was 4.4 years (range 1.9 to 7.0). No factors had a statistically significant correlation for UTI recurrence. The p value for gender and history of undiagnosed fevers was 0.077 and 0.082, respectively. CONCLUSIONS: About 20% of children will have recurrent UTIs despite negative radiological evaluation. Although not statistically significant, there was a trend for an increased risk in girls and those with recurrent febrile illnesses. History of daytime dryness and/or constipation was not predictive of recurrent UTIs in our series.

Child↗
PubMed2005

Management of urinary tract infections: historical perspective and current strategies: Part 2--Modern management.

PURPOSE: An understanding of the microbial origin of infectious diseases and the introduction of antimicrobial therapy stimulated more advances in the management of urinary tract infections (UTIs) in the 20th century than had occurred in the previous 5 centuries. MATERIALS AND METHODS: Numerous resources were used to collect the information described in this review. Medical texts from the 19th and 20th century contain information regarding the traditional contemporary treatment of UTI during those eras. Early volumes of the Journal of Urology from the beginning of the 20th century describe the first attempts at chemotherapy for UTI. MEDLINE searches were used to collect appropriate information after 1969. Modern medical journals and modern medical texts were used to collect information on antimicrobial therapy since the late 1960s through today. RESULTS: Numerous advances in the diagnosis and management of UTI were made during the 20th century. Advances in microbiological and chemical assays have facilitated the development of historical uroscopy into modern day urinalysis and culture techniques, which are the cornerstone of UTI diagnosis. Imaging technologies, including x-ray, ultrasound, nuclear imaging, magnetic resonance and computerized tomography, have been particularly helpful in the diagnosis of complicated or recurrent UTIs. Major innovations in nonpharmacological therapy include noninvasive shock wave lithotripsy and percutaneous drainage of kidney abscesses. The most profound advance in UTI management during the 20th century was the discovery of antimicrobial agents. Nitrofurantoin was the first truly effective and safe antimicrobial therapy for UTI but its spectrum of activity is limited. Broad use of amoxicillin (and other beta-lactams) after its introduction in the 1970s led to the development of resistance to this antimicrobial, prompting a gradual change to trimethoprim/sulfamethoxazole (TMP/SMX) as first line therapy for UTI. However, wide use of TMP/SMX also resulted in the progressive emergence of resistance, limiting the clinical usefulness of this therapy in the modern management of UTI. Fluoroquinolones offer an attractive alternative to TMP/SMX, and American and European guidelines recommend their empirical use in areas where TMP/SMX resistance is 10% or higher. CONCLUSIONS: The development of antimicrobial therapy was the defining moment of 20th century medicine and one of the key innovations in medical history. While the initial promise of antimicrobials has been validated in clinical practice, overuse of certain agents has led to the emergence of resistance, illustrating the importance of using evidence based strategies to select therapy.

Anti-Infective Agents, Urinary↗
PubMed2006

Prevalence and characterization of urinary tract infections in dogs with surgically treated type 1 thoracolumbar intervertebral disc extrusion.

OBJECTIVE: To determine the prevalence of urinary tract infections (UTI), factors that correlate positively with UTI, and whether identified UTI are most likely community- or hospital acquired in dogs with surgically treated type 1 thoracolumbar intervertebral disc (IVD) extrusions. STUDY DESIGN: Prospective cross-sectional clinical study. SAMPLE POPULATION: Dogs (n=92) that were surgically treated for a thoracolumbar extradural compressive spinal cord lesion that was consistent with type 1 IVD extrusion. METHODS: Dogs were evaluated for bacterial lower UTI when possible by cystocentesis and urine culture before surgery, and 48-72, 96-120 hours, and 7 days after surgery while hospitalized. Paraparesis, confirmation of thoracolumbar extruded nucleus pulposus, and informed owner consent were required for study inclusion. Urine specimens (n=297) were cultured and both objective and subjective clinical data were obtained. RESULTS: Prevalence of UTI in dogs with surgically treated type 1 thoracolumbar IVD extrusion was 27% (25 dogs). Temporal prevalence of UTI was 15% (13/89) before surgery, 12% (11/91) at 2-3 days, 16% (12/76) at 4-5 days, and 20% (8/41) at 7 days after surgery. Statistically significant factors affecting UTI prevalence included neurologic and urinary status, sex, administration of perioperative antibiotics, and amount of time body temperature was <35 degrees C during anesthesia. CONCLUSION: UTI are common in dogs with surgically treated type 1 thoracolumbar IVD extrusion. Females, dogs that cannot ambulate or voluntarily urinate, dogs not administered perioperative cefazolin, and dogs whose body temperature falls <35 degrees C during anesthesia have a higher incidence of UTI. CLINICAL RELEVANCE: All dogs with surgically treated type 1 thoracolumbar IVD extrusion should be monitored for the presence of UTI; however, close attention should be paid to females and dogs that cannot ambulate or voluntarily urinate.

Animals↗
PubMed2007

Is omitting post urinary-tract-infection renal ultrasound safe after normal antenatal ultrasound? An observational study.

BACKGROUND: Guidelines recommend obtaining a renal ultrasonogram (RUS) for young children after a first urinary tract infection (UTI). OBJECTIVE: The aim of the current study was to assess the concordance of prenatal and post-UTI RUS findings in children with a first simple UTI. METHODS: This was a prospective study and included all children aged 5 years or younger who were hospitalised with a first simple UTI (determined as clinical response and normalisation of temperature within 48 h on initiation of antibacterial therapy with no complications). Data were collected from each child regarding the results of prenatal and post-UTI RUS. RESULTS: Overall, 250 children were included in the study and the results of late-pregnancy and post-UTI RUS were available for 84% (n = 209). Complete concordance between the two RUS was demonstrated in 96% (n = 201). The predictive value of normal antenatal to normal post-UTI RUS was 96% (95% CI: 93% to 99%). These results include four children with mild transient pelvic dilatation. In eight children in whom renal anomalies were demonstrated only in post-UTI RUS, the influence of these anomalies on the children's management was negligible. CONCLUSIONS: Prenatal-RUS have been performed in most children <5 years old hospitalised with a first simple UTI. Concordance with post-infection tests is very high. Findings which appear only in post-infectious RUS usually have negligible effects on children's management. Thus, in such children with normal antenatal RUS omitting post-UTI RUS could be considered.

Child, Preschool↗
PubMedDate not supplied

Effects of urinary trypsin inhibitor in patients at risk for premature labor with a bulging fetal membrane.

OBJECTIVE: To investigate the effect of urinary trypsin inhibitor (UTI) in patients at risk for premature labor with bulging membrane. METHODS: Patients who had developed a bulging membrane from 22 to 27 weeks and 6 days of gestation were studied. These cases were divided into two types based on the severity: those with a moderately developed bulging membrane like a 'dome' (dome type), and those with a membrane prolapsed into the vagina, resulting in an 'hourglass' shape (hourglass type). We compared the outcomes of treatment with or without UTI (UTI group versus non-UTI group) in each type. Gestational age at delivery, birth weight, prolongation time from admission to delivery, and neonatal mortality rate were examined in each group. RESULTS: A total of 43 patients with a bulging membrane were analyzed. In 21 patients with the dome type, gestational age at delivery (the UTI group versus the non-UTI group; 30.4 +/- 5.0 versus 26.4 +/- 1.9 weeks, p < 0.05), birth weight (1,436.8 +/- 708.3 versus 882.8 +/- 261.6 g, p < 0.05) and neonatal mortality rate (0/13 versus 3/8, p < 0.05) were all significantly improved by the use of UTI. On the other hand, in 22 patients with the hourglass type, there was no significant difference between the UTI group and the non-UTI group. The overall prevalence of histological chorioamnionitis was 60%. CONCLUSION: These results suggest that UTI therapy is very effective in patients at risk for premature labor with a moderately developed bulging membrane during the second trimester.

Adult↗
PubMed1987

Monuril in lower uncomplicated urinary tract infections in adults.

Fosfomycin trometamol is a new fosfomycin salt with much improved intestinal absorbtion, thus providing high levels of the drug both in serum and urine. The range of activity and the pharmacokinetic characteristics of this new salt emphasize its usefulness in therapy of urinary tract infections (UTIs), either as a single dose or in short courses. In a multicentric, open, non-controlled trial, fosfomycin trometamol was employed in the treatment of 365 UTIs (84 males and 281 females, of whom 13 were pregnant). 144 UTIs were community acquired, while 221 were hospital acquired; 48 were diagnosed as asymptomatic bacteriurias, 201 as lower uncomplicated symptomatic UTIs, 49 as lower complicated UTIs, 59 as recurrent lower symptomatic UTIs, and 8 as cystopyelitis. The drug was administered as a single dose, i.e. 3 g at once, in 198 cases and in short courses, i.e. 3 g daily for 2-3 days (in a few patients, though, for 11 days) in 167 cases. High success rates were attained using the single dose in asymptomatic bacteriurias (78.1%), in lower uncomplicated symptomatic UTIs (89.5%), as well as in UTIs of the female (85.3%) and community-acquired UTIs (97.4%). In all these cases, the single-dose regimen seems to be the most rational form of clinical use, since the multiple-dose regimen did not add any further advantage. In infections of the male, or in hospital-acquired or complicated UTIs, short therapy courses gave better results. The drug was well tolerated, even by pregnant women, and clinically irrelevant side effects were recorded in a small number of patients.

Clinical Trials as Topic↗
PubMed2004

Prevalence of vesicoureteral reflux in neonatal urinary tract infection.

Vesicoureteral reflux (VUR) after a first episode of urinary tract infection (UTI) is apparently diagnosed much more frequently (25%-40%) in children than in neonates. The aims of the study were to determine the actual rate of VUR in neonates with UTI and to define the clinical clues to its diagnosis. The study sample included term infants with a diagnosis of UTI during their first month of life who were seen in this hospital between January 1997 and May 1999. All infants underwent complete diagnostic work-up (renal ultrasound and voiding cystourethrography [VCUG]). The medical files were reviewed for patient sex, age at UTI diagnosis, laboratory findings (including causative pathogen), and ultrasonographic findings. These parameters were correlated with the finding of VUR on VCUG. Sixty-four neonates (55 males, 9 females) with UTI were included in this study. UTI was 6 times more common in males than females, although the incidence of VUR was equal between the sexes (about 20%). The presence of VUR was associated with a significantly younger age at presentation of UTI (11.4+/-4 vs 16.9+/-6.6 days, p<0.01). VUR was diagnosed at a fourfold higher rate in neonates with Klebsiella-induced UTI compared to those with E. Coli-UTI. In 80% of those with significantly abnormal ultrasonographic findings VUR was found on VCUG. Jaundice was noted at UTI diagnosis 3 times more often in infants with VUR, and elevated creatinine level, 2.5 times more often.

Female↗