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PubMedDate not supplied

A comparative study of the mannose-resistant and mannose-sensitive haemagglutinins of Escherichia coli isolated from urinary tract infections.

The distribution of mannose-resistant (MRHA) and mannose-sensitive (MSHA) fimbrial haemagglutinins was examined in 482 strains of Escherichia coli isolated from 390 adult women and 45 pregnant mothers with a variety of urinary tract infections (UTI), and from 47 healthy controls. The proportion of MRHA strains was significantly higher in patients with symptomatic UTI (75%) than in women with non-significant bacteriuria (30%, p less than 0.001), pregnant women with asymptomatic UTI (34%, p less than 0.0001) and healthy controls (0%). The proportion of MSHA strains was significantly lower in patients with symptomatic UTI (22%) than in women with non-significant bacteriuria (46%, p less than 0.001) and pregnant women with asymptomatic UTI (52%, p less than 0.01). Only 17% of the strains from healthy controls had MSHA activity. In pregnant women with UTI, whether this was symptomatic or asymptomatic, there was a significant association between infection with MRHA strains of E. coli and a past history of UTI. Thus, in a pregnant woman with an infection and a past history of UTI there is a seven-fold greater chance that this infection is due to an MRHA-bearing organism than in pregnant women without such a history. There was also a significant association between MRHA organisms and symptomatic infection. The risk of symptomatic patients having an infection with an MRHA strain is six times greater than that for a patient with a covert infection.

Adhesiveness↗
PubMed2003

Management of urinary tract infections.

Urinary tract infection (UTI) is common in childhood. It may result in long-term complications due to renal scaring. Younger children are at higher risk of renal scarring. The diagnosis of UTI is based on urine culture. The bacterial count for diagnosis of UTI depends on the method of urine collection. Urinalysis is useful for making a presumptive diagnosis of UTI and allows initiation of empirical treatment in high-risk patients, after urine culture has been obtained. The treatment of UTI is guided by the severity of illness and age of the patient. Following a UTI, investigation should be performed to identify an underlying urinary tract anomaly. Recurrence of UTI occurs in 30-50% children. Important predisposing factors include VUR, urinary tract obstruction, voiding dysfunction and constipation. Vesicoureteric reflux (VUR) is seen in 30-50% children with UTI. The cornerstone of management of VUR is long-term antibiotic prophylaxis, which has been found to be as effective as surgical reimplantation.

Antibiotic Prophylaxis↗
PubMed2004

Dietary factors affecting susceptibility to urinary tract infection.

Urinary tract infection (UTI) is usually an ascending infection caused by bacteria derived from stools. Since the bacterial composition of stools is dependent on the diet, it is likely that the risk of UTI will change with changes in the diet. Most data describing diet as a risk factor for UTI come from epidemiological and interventional trials. It has been shown in a case-control setting that frequent consumption of fresh berry or fruit juices and fermented milk products containing probiotic bacteria decreases the risk for UTI recurrence in women. Several interventional trials have found Vaccinium berry products to provide protection from UTI recurrence. Probiotics have not been able to prevent UTI in interventional trials. However, the lack of an effect may be related to too low a dose or to the use of non-optimal products in these trials. Limited data are available on the effects of nutrition on UTI in children. However, there is no reason to expect that children would be different from adults in this respect. In this review, we discuss the dietary factors affecting the susceptibility to UTI.

Adult↗
PubMed2005

Community-acquired enterococcal urinary tract infections.

Enterococcal urinary tract infection (UTI) is usually hospital-acquired and affects individuals with predisposing conditions. The aim of this study was to evaluate the community-acquired enterococcal UTIs in otherwise well children. We reviewed all the 257 first UTI episodes in children hospitalized in a General Hospital during a 5-year period. Enterococcus faecalis was isolated in 13 episodes, accounting for 5.1% of the total UTIs. All strains were susceptible to ampicillin, vancomycin and nitrofurantoin. Imaging studies revealed major urinary tract abnormalities in 9 and parenchymal defects in 8 children. During a follow-up period from 2 to 6 years, 4 children suffered break-through infections despite antibiotic prophylaxis, 3 developed renal scarring and 4 underwent corrective surgical procedures. Children with enterococcal UTIs presented with significantly higher rates of anatomical abnormalities and worse prognosis in terms of renal scarring, recurrences and corrective surgery compared with the total cohort of children with Gram-negative UTIs. However children with enterococcal UTIs did not present with a worse prognosis when compared with a group of children with Gram-negative UTIs matched for age and degree of reflux. Enterococcal infection is not an independent risk factor for poor outcome, nevertheless positive urine culture including enterococci is highly indicative for underlying urinary tract abnormalities, recurrences, renal scarring, and need for surgical intervention.

Child, Preschool↗
PubMed1997

Urinary tract infections in girls: the cost-effectiveness of currently recommended investigative routines.

Current recommendations for the universal investigation of urinary tract infection (UTI) in children by ultrasonography, voiding cystourethrography, and dimercaptosuccinic acid renal scan (and sometimes intravenous pyelography as well) are not based on any convincing evidence as to the necessity or effectiveness of such a routine. Over 8% of all girls will have a UTI during childhood. About 87 individuals in a million will develop end-stage renal disease (ESRD) by the age of 60 years, caused in about 9% by pyelonephritis (PN) or reflux nephropathy. From these statistics, the maximal risk of a first diagnosed UTI progressing to ESRD is approximately 1:10,000. The risk of developing hypertension following a first UTI in childhood, without eventual evolution to ESRD, appears to be very small. The cost of the widely recommended routine imaging procedures ranges from U.S. $355 in Britain to U.S. $1,090 in the United States. The minimal cost of preventing a single progression to ESRD by early diagnosis of underlying pathology-if this were possible in all cases-would range between U.S. $5 million in Britain and U.S. $15 million in the United States. Since in many instances progressive renal damage can not be prevented, the true cost is considerably higher. Lower UTI in girls is a very common and, in most cases, benign finding in primary-care practice. It is suggested that girls with afebrile UTI, presenting with lower urinary tract symptoms alone, need not undergo any imaging procedures, but should be followed with urine examinations and cultures at the time of febrile illness. The recommended investigative routines should be reserved for UTI in infants and in girls with fever or other symptoms suggesting PN, and for proven recurrent UTI. Such a regimen will allow a marked saving in terms of costs and in terms of unnecessary radiation, psychological stress to children, and stress, inconvenience, and time loss to parents. There is no evidence that this approach will compromise the course or final outcome of this very common condition.

Child↗
PubMed2003

Molecular Epidemiology of Acute, Uncomplicated Urinary Tract Infections in Young Women.

Molecular biological methods, a relatively new addition to the epidemiologist's tool chest, are now applied to the study of urinary tract infection (UTI). By combining sound epidemiologic methods and the ability to genetically stratify UTI-causing Escherichia coli, recent studies have added to our understanding of UTI. These advancements include the possible identification of outbreaks of community-acquired UTI, the contribution of person-to-person transmission of E. coli to the risk for UTI in young women, and changes in the community prevalence and distribution of UTI caused by drug-resistant organisms. The application of molecular methods to future UTI research studies may yield novel approaches to UTI prevention.

Journal Article↗
PubMed1993

Epidemiology and risk factors for urinary tract infection following spinal cord injury.

A prospective study was performed to quantitate frequency and evaluate risk factors for urinary tract infection (UTI) in 64 catheter-free spinal cord injury (SCI) patients who were visited monthly in their homes for up to 1 year by a public health nurse who performed a physical examination and collected urine for culture and urinalysis. Patients also mailed in urine dip slides weekly. UTI was defined as > or = 100,000 CFU/mL. Of 406 UTIs evaluated, 111 (27%) were asymptomatic, whereas 295 (73%) evidenced some sign or symptom possibly referable to the urinary tract. Fever and chills occurred in 43 (11%) episodes. Incidence of UTI overall was 18.4 episodes per person-year at risk whereas the rate for those associated with fever and chills was 1.82 episodes per person-year at risk. Prevalence of UTI was 57.4%. Pyuria was significantly associated with the occurrence of fever and chills (p < 0.0001), with gram-negative bacterial species being relatively more pyogenic than gram-positive species. Demographic and behavioral factors shown to correlate with risk for UTI by rate ratios and 95% confidence intervals were: black ethnicity, poor personal hygiene, and less-than-daily condom catheter changes. Racial difference was observed independently of the other two variables. Bladder drainage method, age, years since injury, income, education, sex, neurologic level, and administration of prophylactic antibiotics were not correlated with increased risk of UTI. This study provides new data regarding characteristics and frequency of UTI following SCI as well as risk factors that influence its development.

Alabama↗
PubMed1994

Double antimicrobial prophylaxis in girls with breakthrough urinary tract infections.

OBJECTIVE: Some girls receiving antimicrobial prophylaxis for recurrent urinary tract infections (UTIs) experience breakthrough infections. The clinical characteristics of girls experiencing a breakthrough UTI and the efficacy of an antimicrobial combination was studied. METHODS: Girls were managed by frequent timed voiding, anticholinergic medication for bladder instability, and double antimicrobial prophylaxis consisting of nitrofurantoin (NFN) 2 mg/kg every morning and trimethoprim/sulfamethoxazole (TMP/SMZ) 2/10 mg/kg at bedtime. RESULTS: A total of 31 girls had experienced sixty-four UTIs during three hundred sixty-seven months (17.4 UTIs/100 patient-months) while receiving TMP/SMZ and/or NFN as single-drug prophylaxis. Of the girls, 21 (68%) had reflux, 15 (49%) had detrusor instability/voiding dysfunction, 8 (26%) had both reflux and voiding dysfunction, and 3 (10%) had neither voiding dysfunction nor reflux. While receiving double antimicrobial prophylaxis, 8 girls (26%) experienced a UTI and only 3 (10%) showed a UTI resistant to both TMP/SMZ and NFN. There were only sixteen breakthrough UTIs during four hundred thirty-nine months of double prophylaxis (3.6 UTIs/100 patient-months) (P < 0.001). CONCLUSIONS: Girls with breakthrough UTIs usually have voiding dysfunction and/or reflux, and in these girls double antimicrobial prophylaxis and attention to voiding dynamics were effective in preventing further UTIs.

Child, Preschool↗
PubMed2006

Treatment of bacterial urinary tract infections: presence and future.

Bacterial urinary tract infections (UTIs) are frequent infections in the outpatient as well as in the nosocomial setting. The stratification into uncomplicated and complicated UTIs has proven to be clinically useful. Bacterial virulence factors on the one side and the integrity of the host defense mechanisms on the other side determine the course of the infection. In uncomplicated UTIs Escherichia coli is the leading organism, whereas in complicated UTIs the bacterial spectrum is much broader including Gram-negative and Gram-positive and often multiresistant organisms. The therapy of uncomplicated UTIs is almost exclusively antibacterial, whereas in complicated UTIs the complicating factors have to be treated as well. There are two predominant aims in the antimicrobial treatment of both uncomplicated and complicated UTIs: (i) rapid and effective response to therapy and prevention of recurrence of the individual patient treated; (ii) prevention of emergence of resistance to antimicrobial chemotherapy in the microbial environment. The main drawback of current antibiotic therapies is the emergence and rapid increase of antibiotic resistance. To combat this development several strategies can be followed. Decrease the amount of antibiotics administered, optimal dosing, prevention of infection and development of new antibiotic substances. The aim of this review is to highlight the current and to describe future treatment options for UTIs.

Anti-Bacterial Agents↗
PubMed2005

Effect of Ulinastatin, a human urinary trypsin inhibitor, on the oleic acid-induced acute lung injury in rats via the inhibition of activated leukocytes.

BACKGROUND: The acute respiratory distress syndrome (ARDS) is often caused by fat tissue embolism. One of the most common animal models of ARDS is produced by direct administration of oleic acid (OA). Activated leukocytes are critically involved in the pathological mechanism in this model. Human urinary trypsin inhibitor (UTI) is known to inhibit production of tumor necrosis factor (TNF)-alpha, which potently stimulates leukocyte activation. The purpose of this study was to clarify whether UTI improves OA-induced lung injury in rats by inhibiting activated leukocytes via TNF-alpha production. MATERIALS AND METHODS: Rats were subjected to a single intravenous administration of OA into the pedicle vein. Acute lung injury was evaluated by arterial blood gases and histological changes in lungs. Pulmonary vascular permeability, accumulation of neutrophils, and the levels of TNF-alpha in lung tissues were also examined. Rats were divided into four experimental groups: a sham operated, OA, OA + UTI, and OA + nitrogen mustard (NM)-induced leukocytopenia group. UTI was intravenously administered 30 min before OA administration. Leukocytopenia was induced by the administration of NM. RESULTS: UTI significantly improved the OA-induced histological changes for 4 h after OA administration. The OA-induced reduction of PaO2, the increase of pulmonary vascular permeability, and the levels of MPO activity and TNF-alpha in lung tissues were significantly improved in rats administrated UTI. The effects in the leukocytopenia group were similar to those in the UTI-administered group. CONCLUSION: Leukocytes play a critical role in the development of OA-induced lung injury. It was suggested that UTI contributed to the reduction in the OA-induced lung injury by inhibiting TNF-alpha and thereby suppressing leukocyte.

Acute Disease↗
PubMed1997

Social and functional variables associated with urinary tract infections in persons with spinal cord injury.

OBJECTIVE: Urinary tract infections (UTIs) and their complications remain a major source of morbidity and mortality after spinal cord injury (SCI). There has been much investigation into the physiological changes in persons with SCI and how these predispose to the development of UTIs, but other potentially influential variables are not so well understood. The purpose of this study is to examine behavioral, social, and functional factors and their relationship with UTIs. Our hypothesis is that lower UTI frequency will be associated with higher functional abilities, increased productivity, and higher life satisfaction scores. DESIGN: Respondents to a mailed questionnaire reported information on demographics, bladder management methods, functioning, productivity, and life satisfaction. PATIENTS: A volunteer sample from a list of all people with SCI previously treated at a university medical center rehabilitation medicine SCI inpatient service and/or outpatient SCI clinic from 1991 through 1994. RESULTS: There were 81 (35%) responses to 229 received mailings. Mean reported UTIs were 1.37 (SD = 2.66) per year and 4.77 (SD = 6.70) over a 3-year period. UTIs per year and total UTIs over 3 years were negatively associated with functioning and productivity (number of hours worked per week), but were not associated with life satisfaction scores. CONCLUSION: As a result of this study there is an improved understanding of social and functional variables and how these may correlate with UTI incidence in this population. Further research into these variables is warranted.

Adult↗
PubMed2006

Does pre-transplantation antireflux surgery eliminate post-renal transplantation pyelonephritis in children?

PURPOSE: Antireflux surgery for VUR before renal transplantation decreases the risk of post-kidney transplant UTI in pediatric patients with primary vesicoureteral reflux. We studied the risk of post-kidney transplant UTI in patients with or without surgical correction of VUR before transplantation compared to patients without VUR. MATERIALS AND METHODS: We compared 12 patients who had VUR corrected before transplantation (group 1) to 17 patients with VUR who did not undergo antireflux surgery before transplantation (group 2) and 36 patients undergoing renal transplantation without VUR (group 3). A total of 10 patients in group 1 (83.3%) and 10 in group 2 (58.8%) had high grade VUR. RESULTS: Eight patients in group 1 (66.7%), 6 in group 2 (35.3%) and 33 in group 3 (91.7%) remained free of febrile UTI during followup (p = 0.00). Among patients with high grade VUR 6 in group 1 and 1 in group 2 remained UTI-free (p = 0.02). A total of 33 patients in the control group (91.7%) remained free of febrile UTI, an incidence that was significantly lower compared to group 1 (p = 0.03) and group 2 (p = 0.00). Of the patients with high grade VUR 3 in group 1 (30%) and 4 in group 2 (40%) experienced recurrent febrile UTIs (p = 0.64). CONCLUSIONS: Even after surgical correction of VUR before transplantation the frequency of febrile UTI remained higher than that in kidney transplant recipients without VUR. In cases of high grade VUR reimplantation before renal transplantation decreased the rate of febrile UTI but it was still higher than the level of risk in the control group.

Adolescent↗
PubMed2001

Pilot trial of bacterial interference for preventing urinary tract infection.

OBJECTIVES: To examine the safety and efficacy of bacterial interference in preventing symptomatic urinary tract infection (UTI). METHODS: A prospective, nonrandomized, pilot clinical trial was conducted in patients with spinal cord injury who had neurogenic bladder and had frequent episodes of symptomatic UTI. The bladder of patients was inoculated with a nonpathogenic prototype of Escherichia coli 83972. The rate of symptomatic UTI in successfully colonized patients while colonized with E. coli 83972 was compared with (a) their own baseline prestudy rate and (b) the rate of symptomatic UTI in patients who were not successfully colonized. RESULTS: Of 44 inoculated patients, 30 (68%) became colonized with E. coli 83972 for 1 month or longer. Only two episodes of symptomatic UTI occurred in the group of 30 patients while colonized with E. coli 83972 (a total of 34 patient-years), and none was attributed to E. coli 83972. The group of 30 patients experienced a 63-fold reduction in the rate of symptomatic UTI while colonized with E. coli 83972 versus their baseline prestudy period (mean 0.06 versus 3.77 episodes of symptomatic UTI/patient-year, P <0.001). The rate of symptomatic UTI was also 33-fold lower in this group of 30 patients while colonized with E. coli 83972 than in the well-matched group of 14 patients who were not successfully colonized (mean 0.06 versus 1.80 episodes of symptomatic UTI/patient-year, P <0.001). CONCLUSIONS: The results of this pilot study indicate that bacterial interference using E. coli 83972 may be safe and effective in preventing UTI.

Adult↗
PubMed1999

Economic assessment of three antimicrobial therapies for uncomplicated urinary tract infection in women.

This retrospective cohort study used North Carolina Medicaid paid-claims data to assess clinical and economic outcomes of treatments for urinary tract infection (UTI). The study population comprised female Medicaid recipients, between 15 and 64 years of age, with a paid claim filed for a primary diagnosis of UTI or acute UTI from January 1 to June 30, 1994, who were treated with ciprofloxacin, nitrofurantoin, or trimethoprim/sulfamethoxazole (TMP/SMZ). Patients had follow-up for 6 months after the primary diagnosis. Patients who did not receive further treatment for UTI with 1 of the 3 drugs within 30 days after initial treatment were assumed to be cured. Costs were measured as the sum of reimbursements for UTI-related medical services and drug treatments. Outcomes for 409 patients were assessed. Cure rates of initial treatment with ciprofloxacin, nitrofurantoin, and TMP/SMZ were 81%, 88%, and 93%, respectively. Cost-effectiveness ratios of initial treatment with the 3 drugs were $150.80, $81.20, and $69.00, respectively. When efficacy rates generated from published randomized clinical studies were applied, cost-effectiveness ratios for the 3 drugs were $130.96, $86.17, and $72.00, respectively. A decision model of treatment pattern and associated costs is presented. Several patient variables indicate that the ciprofloxacin group included more severe cases of UTI than did the other groups. Study limitations, confounders, and future research suggestions are discussed. Our results show that treatment for >7 days results in a better cure rate regardless of the drug used than does treatment for < or =7 days and that TMP/SMZ is the most cost-effective of the 3 drugs for UTI or acute UTI.

Adolescent↗
PubMed2000

Suppression of urokinase-type plasminogen activator expression from human ovarian cancer cells by urinary trypsin inhibitor.

Urinary trypsin inhibitor (UTI), a Kunitz-type protease inhibitor, efficiently inhibits tumor cell invasion and metastasis. We examined the effect of UTI on urokinase-type plasminogen activator (uPA) expression in ovarian cancer cell lines, HOC-I and HRA. By Northern blot, Western blot, ELISA, and zymographic analyses, we demonstrated that UTI inhibited the expression of uPA mRNA and protein in these cells in a time- and dose-dependent manner, independent of whether induction was triggered by phorbol ester. Monoclonal antibody 4G12, which inhibits UTI binding to the cells, produced a dose-dependent abrogation in UTI-mediated down-regulation of uPA expression. These data suggest that UTI significantly down-regulates tumor cell uPA mRNA expression and protein secretion, and that UTI binding to the cells is necessary to exert the UTI's action.

Down-Regulation↗
PubMed2001

Calcium-induced changes in chondroitin sulfate chains of urinary trypsin inhibitor.

Urinary trypsin inhibitor (UTI) has several roles other than protease inhibition. It is suggested that UTI inhibits calcium influx in cultured cells and that the chondroitin sulfate chain of UTI may play an important role. In order to clarify the mechanistic features of this phenomenon, the chondroitin sulfate chain of UTI was analyzed by (1)H-NMR. The samples were highly purified UTI dissolved in D(2)O in the presence or absence of Ca(2+), Mg(2+) and Na(+). 1D-spectra were obtained and T(1) values of detected signals were estimated from the inversion-recovery method. The addition of Ca(2+) to UTI caused a chemical shift to downfield, line broadening and a reduction of T(1) values at several signals from chondroitin sulfate moiety (especially at axial H-2 of GalNAc), whereas Mg(2+) and Na(+) had no significant effect. Some of the signals in the linkage region of chondroitin sulfate chain showed marked line broadening by Ca(2+). The reduction of T(1) values implies formation of a complex. It is suggested that Ca(2+) generates the sulfate salt and interacts with other polar groups in the chondroitin sulfate chain, thereby causing bridging between UTI molecules. Several properties of UTI may be related to this interaction of Ca(2+) with chondroitin sulfate chains.

Calcium↗
PubMed1998

Identification and characterization of the cell-associated binding protein for urinary trypsin inhibitor.

Urinary trypsin inhibitor (UTI) inhibits not only tumor cell invasion but also production of experimental and spontaneous metastasis. Cell-binding experiments indicated that human choriocarcinoma SMT-cc1 cells have specific binding sites for UTI on their cell surface. [Kobayashi et al., J. Biol. Chem. 269, 1994, 20,642-20,647]. UTI binding protein (UTIBP) was purified to homogeneity by a combination of UTI-coupled affinity beads, preparative polyacrylamide gel electrophoresis and reverse phase HPLC. This protein is very similar to a truncated form of human cartilage link protein (LP). LP was identified structurally by its apparent molecular mass with and without deglycosylation treatment: Immunologically by the reactivity with anti-UTIBP antibody, and functionally by its ability to bind the NH2-terminal domain of UTI. UTI and UTIBP are distributed uniformly in the cytoplasm and/or over the cell surface of tumor cells and fibroblasts. The level of staining for hyaluronic acid, UTIBP and UTI is much lower in sections digested with hyaluronidase. These results suggest that the cell membrane-derived UTI-associated binding protein is the LP of proteoglycan-hyaluronic acid aggregates, which interacts with hyaluronic acid. Cell-associated LP may play a role in modulating protease activity to the environment close to tumor and fibroblast cell surface.

Chromatography, High Pressure Liquid↗
PubMed2002

Is routine screening for urinary tract infection in rehabilitation day-hospital elderly patients necessary?

It is not known whether all rehabilitation day-hospital patients need to be assessed for urinary tract infection (UTI). The aims of this study were to identify patients at high risk to develop UTI and to determine whether there was an association between the amount of post-void residual urine (PVR) and UTI. We surveyed 211 consecutive patients admitted to the day-hospital unit of a geriatric rehabilitation center between June 1998 and February 1999. The main diagnoses were stroke, orthopedic surgeries and deconditioning. Urine samples for general analysis and bacteriology were collected from each patient upon admission. PVR was measured using portable ultrasound. Telephone interviews were conducted with 141 patients, 3-11 months after the initial screening. The prevalence of UTI at admission was higher in women (P=0.007), and patients with decreased functional level (P=0.001). The incidence rate correlated with the functional level but not with gender or main diagnosis. The relative risk of dependent patients to develop UTI was 7.5 times higher than in independent patients. Significant amounts of PVR were equal in males and females. The relative risk of individuals with significant amounts of PVR to develop UTI was 1.63 times greater then those with negligible and moderate amounts of PVR. Gender, degree of functional level and main diagnosis had no effect on the relationship between PVR and UTI. We conclude that low functional level and significant amounts of PVR are risk factors for prevalence and incidence of UTI in elderly patients in a rehabilitation day-hospital. There is no need for routine urine analysis in every elderly patient admitted to rehabilitation day-hospitals, however, PVR measurements by portable ultrasound are valuable.

Journal Article↗