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PubMed2003

[Nephrology-part 3: Urinary tract infections].

Urinary tract infections are one of the most common bacterial infectious diseases in humans. Depending on the localization and the effectiveness of pathogenetic factors, various clinical pictures (lower urinary tract infection, pyelonephritis, asymptomatic bacteriuria) have to be differentiated. There are virulence factors of microorganisms on the one hand and defense mechanisms on the other, which influence the manifestation and the course of disease. The process of bacterial attachment to the epithelial cells of the boundary layer, the internalization and invasion of bacteria could be important for acute and chronic disease. Disturbances of local defense mechanisms, such as increased urinary glucose concentration in diabetes or variations of Tamm-Horsfall protein and defensin levels, may influence the course of infection. On the basis of microbiological and laboratory findings as well as the results of clinical and ultrasound procedures, the decision on the therapeutic strategy should be made. There are different treatment recommendations for acute uncomplicated and complicated cases as well as for chronic diseases. Future investigations should focus on effective therapeutic options for special immunocompromised patients in relation to the microbiological aspects and defense mechanisms of the host.

Anti-Bacterial Agents↗
PubMed1999

Evaluation and management of pediatric urinary tract infections.

Urinary tract infections (UTIs) are relatively common in children. We describe the evaluation and management of children with UTIs, as well as the risks and consequences related to the UTI. This article describes a rational approach to the evaluation and management of childhood UTIs with the relation to the natural history and risk factors.

Anti-Infective Agents, Urinary↗
PubMed1977

Urinary tract infections.

Urinary tract infections can be found in either sex at any age. While the majority occur in adult females as acute cystitis, recurrent symptomatic bacteriuria, or asymptomatic bacteriuria, adult males with prostatitis or acute pyelonephritis and children with symptomatic urinary tract infections comprise a considerable portion of patients seen. Management in pregnant females or in males with indwelling catheters or before prostatic surgery presents special problems. The choice of drug and dosage schedule should vary according to the infecting agent and the clinical state of the patient.

Anti-Infective Agents↗
PubMed2000

Vesicoureteral reflux and urinary tract infections.

Urinary tract infection is a common problem in children. The combination of vesico-ureteric reflux (VUR) and urinary tract infection may predispose children to pyelonephritis and subsequent complications. This review outlines the modifications suggested in the recent literature in the protocol for investigations and diagnosing VUR. Recent interest has been expressed in studying certain molecular markers to measure non-invasively renal damage in children with VUR. Long term results of comparative trials between medical and surgical management have been published recently.

Child↗
PubMed2002

Acute renal damage in infants after first urinary tract infection.

Urinary tract infection (UTI) is one of the most common causes of unexplained fever in neonates. The aim of this study was to determine the incidence of urinary tract anomalies and acute renal damage in neonates who presented with first urinary tract infection in the first 8 weeks of life. We reviewed the records of 95 infants, who were hospitalised with UTI during a 6-year period (1994-1999). Patients with antenatally diagnosed hydronephrosis and incomplete radiological investigations were excluded from the study. Of the remaining 57 patients, 42 were boys and 15 girls. The mean age at diagnosis was 32 days (range 5-60 days). All patients underwent renal ultrasonography (US), voiding cystourethrogram (VCUG) and (99m)Tc-dimercaptosuccinic acid (DMSA) scan. Urinary tract abnormalities were detected in 20 (35%) patients. Vesicoureteral reflux (VUR) was found in 19 (33%) neonates, 7 girls and 12 boys. Acute cortical defects on DMSA scan were present in 19 kidneys of patients with VUR and in 25 of those without reflux. Only one-third of neonates after first symptomatic UTI had VUR. We recommend that US, VCUG, and DMSA scan should be routinely performed after the first UTI in infants younger than 8 weeks.

Acute Disease↗
PubMed1994

Chemoprophylaxis and suppressive therapy in the management of urinary tract infections.

Urinary tract infections are among the most common infectious diseases encountered in domiciliary and hospital practice. The ease of treatment and prophylaxis depends on host factors and the nature of invading microbe. Prophylaxis is often effective in preventing infection from exogenous or endogenous sources. It is useful in females with frequent, recurrent infections, in males with a persistent prostatic focus, in renal transplant recipients, and following instrumentation of the urinary tract. It is often useful in children with vesico-ureteral reflux and in patients undergoing urological operations. It is ineffective in patients with long-term indwelling catheters. A wide variety of prophylactic tactics is available. These are designed to meet the special needs of individual patients. Patient counselling is a key feature of a good prophylactic regimen. Desirable features of antimicrobial drugs used for prophylaxis include good oral absorption, minimum toxicity, high concentrations in the urine, minimum potential for development of resistance and low cost. Suppressive therapy is often ineffective and cannot substitute for corrective surgical procedures. It is important to recognize microbial failure and to avoid unnecessary therapy.

Anti-Infective Agents, Urinary↗
PubMed1990

Diagnostic and therapeutic subsets in the management of urinary tract infection.

Urinary tract infections are common and easily treated, but studies from the last decade have identified important diagnostic subsets that have led to cost-effective therapy based upon rational scientific data. Management of urinary tract infections (UTI) in the immunocompromised, the elderly and young women is addressed. Short-course antibiotic therapy and use of intravenous pyelography in young women with UTI are discussed.

Adult↗
PubMed1991

Proteus mirabilis flagella and MR/P fimbriae: isolation, purification, N-terminal analysis, and serum antibody response following experimental urinary tract infection.

Urinary tract infection with Proteus mirabilis may lead to serious complications, including cystitis, acute pyelonephritis, fever, bacteremia, and death. In addition to the production of hemolysin and the enzyme urease, fimbriae and flagellum-mediated motility have been postulated as virulence factors for this species. We purified mannose-resistant/proteuslike (MR/P) fimbriae and flagella from strains CFT322 and HU2450, respectively. Electron microscopy revealed highly concentrated preparations of fimbriae and flagella. Fimbrial and flagellar structural subunits were estimated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis to be 18.5 and 41 kDa, respectively. N-terminal sequencing revealed that 10 of the first 20 amino acids of the major MR/P subunit matched the sequence of the P. mirabilis uroepithelial cell adhesin N terminus and 11 of 20 amino acids matched the predicted amino acid sequence of the Escherichia coli P fimbriae structural subunit, PapA. In addition, 90 and 80% homologies were found between the first 20 amino acids of P. mirabilis flagellin and those of Salmonella typhimurium phase-1 flagellin and the E. coli hag gene product, respectively. An enzyme-linked immunosorbent assay using purified antigens showed a strong reaction between the MR/P fimbriae or flagella and sera of CBA mice challenged transurethrally with P. mirabilis. A possible role for MR/P fimbriae in the pathogenesis of urinary tract infection is supported by (i) a strong immune response to the antigen in experimentally infected animals, (ii) amino acid sequence similarity to other enteric surface structure, and (iii) our previously reported observation that MR/P fimbriae are expressed preferentially as the sole fimbrial type in human pyelonephritis isolates.

Amino Acid Sequence↗
PubMed1986

Pediatric urinary tract infections.

Urinary tract infection is a frequent diagnosis in infants and children who are referred to a urologist. Infections in children are often benign, yet the potential for significant renal damage in this age group makes adequate urinary tract evaluation mandatory. Urinary obstruction, vesicoureteral reflux, periurethral bacterial colonization, and voiding dysfunction are important in the pathogenesis of pediatric infections. Adequate therapy requires detection and control of these conditions in order to prevent pyelonephritic renal scarring and its sequelae.

Adolescent↗
PubMed1998

Complicated urinary tract infection.

Urinary tract infection is the second commonest infection encountered in both the community and the hospital setting. In order to avoid complications and to minimize the unnecessary use of antibiotics, it is essential to have a useful and rapid screening test to identify urinary tract infection. The presence of nitrite and leukocyte esterase on urinalysis is such a test. Symptomatic bacteriuria requires prompt treatment and pyelonephritis should be treated for 10-14 days, whereas asymptomatic catheter and non-catheter bacteriuria should not be treated, except in the setting of pregnancy and in childhood.

Journal Article↗
PubMed2001

Dynamic interactions between host and pathogen during acute urinary tract infections.

Urinary tract infections (UTIs) have traditionally been viewed as acute and often self-limiting infections caused predominantly by noninvasive Escherichia coli. However, this concept has been challenged by recent findings demonstrating that an acute bladder infection results from a complex series of host-pathogen interactions that can lead to bacterial invasion and persistence and that ultimately can determine the course of the infectious disease. The ability of E. coli to gain a foothold in the bladder is greatly facilitated by type 1 pilus-mediated attachment to and invasion of bladder epithelial cells. Invasion allows uropathogenic strains of E. coli to exploit the intracellular environment by replicating within these epithelial cells while evading a multitude of host defenses. An intracellular location also provides them a safe haven from many common antibiotic therapies. However, attachment and invasion also activates a cascade of innate host defenses, leading to the death and exfoliation of bladder cells and the production of inflammatory mediators. The ability of uropathogenic E. coli to flux out of cells and colonize surrounding cells provides them a mechanism to subvert these defense mechanisms and persist in the bladder epithelium for weeks following the acute infection. The persistence of E. coli in bladder tissue may be relevant to more chronic diseases of the urinary tract such as recurrent UTIs and interstitial cystitis.

Animals↗
PubMed1987

Coordinated multicenter study of norfloxacin versus trimethoprim-sulfamethoxazole treatment of symptomatic urinary tract infections. The Urinary Tract Infection Study Group.

In a coordinated, double-blind multicenter trial among general practitioners, 2,255 consecutive patients with symptoms suggesting urinary tract infection were screened; 886 were randomized to receive 200 mg of norfloxacin (333 patients), 400 mg of norfloxacin (335), or 160 mg/800 mg of trimethoprim-sulfamethoxazole (TMP-SMZ; 218) twice daily for seven days. We analyzed bacteriologic efficacy for 252, 240, and 141 of the patients receiving 200 mg of norfloxacin, 400 mg of norfloxacin, or TMP-SMZ, respectively. The short-term efficacy was 97.5%-98.6%, and the accumulated efficacy was 87.9%-88.8%. In patients with complicated infections and in men, the efficacy for the group receiving 200 mg of norfloxacin was lower than that for the other groups. In patients with recurrent infection, bacterial elimination was greater for those receiving TMP-SMZ. Significantly fewer adverse reactions occurred in patients receiving norfloxacin than in those treated with TMP-SMZ. The 200-mg dosage of norfloxacin seemed to cause fewer side effects than the 400-mg dosage.

Adult↗
PubMed2003

Usefulness of Gram stain for diagnosis of lower respiratory tract infection or urinary tract infection and as an aid in guiding treatment.

During a prospective study of 8 months duration conducted in the Department of Internal Medicine and the Department of Pulmonary Diseases of the Academic Medical Centre, Amsterdam, Gram stainings of sputa and urine were performed for all patients whose clinical symptoms indicated an acute urinary tract infection or pulmonary infection. On the test request, the physician reported which antibiotic treatment he would prescribe if a microscopic examination was not available. The results of the Gram stain were discussed by the microbiologist with the physician, and the antibiotic therapy recommended by the microbiologist was recorded. This recommendation was compared with the antibiotic prescription noted in the patient record 1 day later. Two days after the results of final cultures and susceptibility tests became available, the patient record was again investigated for changes in the antibiotic regimen. Of 57 urine samples and 103 sputa, 27 and 85, respectively, were derived from patients with an infection of the urinary tract or respiratory tract. The results of the Gram stain confirmed the physician's suspicion 91% of the time for urinary tract infections and 81% of the time for pulmonary infections. In 67% of the patients with suspected lower respiratory tract infections and in 58% of patients with suspected urinary tract infections, the antibiotic treatment recommended on the basis of the results of the Gram stain differed significantly from the antibiotic treatment that the physician would have prescribed had a microscopic examination not been performed. The microbiologist's advice on antibiotic treatment was followed in 79% of the cases of respiratory tract infection and in 65% of the cases of urinary tract infection. The antibiotic treatment was adjusted to the final results of culture and antimicrobial susceptibility testing in 54% of the urinary tract infections and in 31% of the respiratory tract infections. The results indicate that the examination of sputa and urine in patients suspected to have an infection of the respiratory tract or urinary tract influences the antibiotic choice considerably.

Anti-Bacterial Agents↗
PubMed2004

Diagnosis of urinary tract infections.

Urinary tract infections (UTIs) are a common cause of urinary tract disease and may be associated with systemic disease. Diagnosis cannot be made on urinalysis and other findings alone. A urine culture is the "gold standard" for diagnosis of UTI. Antimicrobial susceptibility testing performed as part of a urine culture aids in selection of appropriate treatment for patients with confirmed bacterial UTI.

Animals↗
PubMed1998

Urinary tract infections.

Urinary tract infection in women has its origin, predominantly, via ascending bacteria from the periurethral microflora. Asymptomatic bacteriuria, except for the pregnant patient, need not be treated. E. coli is the most common bacterium to cause UTIs, and is usually susceptible to oral antibiotics. Patients who are hospitalized with an indwelling Foley catheter or who have undergone instrumentation, tend to be infected with a bacterium other than E. coli. Patients with uncomplicated cystitis can effectively be treated with an oral antibiotic (Table 1) for 3 days. Patients who do not respond to empiric therapy have a recurrence within 2 weeks of treatment, or who have a recurrence within the first week after treatment, should have a pretreatment.

Anti-Infective Agents, Urinary↗
PubMed1991

Urinary Tract Infection.

Urinary tract infections are among the most common bacterial diseases encountered by clinicians in practice. They are estimated to result in more than five million office visits annually, at a cost of more than one billion dollars. The etiology, presentation, diagnosis, and treatment of urinary tract infections in female and male adolescents are reviewed.

Journal Article↗
PubMed1987

Nontyphoid salmonella urinary tract infections.

Urinary tract infection caused by nontyphoid salmonella is rare. A case is described in a patient with acquired immunodeficiency syndrome who had multiple recurrences. A review of cases in which salmonella involved the urinary tract indicates that this infection usually occurs in patients who are structurally or immunologically compromised. Recurrence is expected and treatment plan should include an extended course of antibiotic therapy.

Acquired Immunodeficiency Syndrome↗