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PubMed2001

Prevalence of urinary tract infection and renal scars in patients with diabetes mellitus.

In a case control study, we assessed the prevalence of bacterial urinary tract infections (UTI) and renal scarring in 155 consecutive type 1 (n=102) and type 2 (n=53) diabetic individuals and 128 healthy controls. Subjects who received antibiotics during the past 6 months, pregnant women and those with overt renal failure were excluded. In all subjects, urine culture and 99m Technetium (Tc) dimercapto-succinic acid renal scan was performed. UTI was diagnosed if two consecutive urine cultures grew the same organism with at least 10(5) colony forming unit (cfu)/ml in asymptomatic and at least 10(4) cfu/ml in symptomatic subjects, respectively. Renal scan was considered abnormal if focal or multiple tracer uptake defects and/or break in cortical outline were observed. The prevalence of UTI in diabetes mellitus was higher, when compared to that in controls (9% vs. 0.78%, P=0.005). Escherichia coli was the most commonly grown organism (64.3%), followed by Staphyloccocus aureus (21.4%) and Klebsiella pneumoniae (14.3%). Prevalence of renal scarring was higher in patients with diabetes (28/155, 18.0%), when compared to that of controls (7/128, 5.4%, P=0.002). Fifty percent of patients with diabetes and UTI had renal scarring. The prevalence in diabetics with no UTI was also higher, when compared to controls (14.8 vs. 5.5%, P<0.01). The prevalence of UTI as well as renal scarring was significantly higher in females, when compared to male diabetics. No significant difference in vascular events, hypertension, proteinuria, renal function tests and HbA1 was observed in patients with and without renal scar. Thus, patients with diabetes mellitus have 10- and 3-folds increased risk of UTI and renal scarring, respectively. The results could help prioritize protocols for management of UTI among patients with diabetes mellitus.

Adult↗
PubMed1998

Urinary trypsin inhibitor suppresses vascular smooth muscle contraction by inhibition of Ca2+ influx.

Urinary trypsin inhibitor (UTI) and its precursor form inter-alpha trypsin inhibitor (ITI) are present in plasma. To determine the action of UTI on blood vessels, we performed isometric vascular muscle contraction tests, microcirculation studies and measurement of cytosolic free Ca2+ in vascular smooth muscle cells. An isometric vascular muscle contraction test showed that the contractions stimulated by endothelin-1 or norepinephrine were suppressed in the presence of UTI, and that the contractions were not inhibited in the presence of ITI. The microcirculation study showed that the contraction of mesenteric arterioles of WKY rats induced by norepinephrine were inhibited by treatment of UTI, and that they did not alter by treatment of ITI. Pre-incubation of UTI, but not ITI, with vascular smooth muscle cells inhibited the increase of cytosolic free Ca2+ induced by endothelin-1 or norepinephrine. Cell-binding study by biotinylated UTI showed that vascular smooth muscle cells have specific binding site for UTI, but not for ITI. We propose that circulating UTI converted from ITI has a regulatory effect on local vascular tone by regulation of Ca2+ influx into smooth muscle cells.

Animals↗
PubMed2003

Have studies of urinary tract infection and preterm delivery used the most appropriate methods?

Published investigations of the association between urinary tract infection (UTI) and preterm delivery used logistic regression or chi-squared tests. Because both exposure and outcome are time dependent, these methods were not optimal and did not account for person-time under observation, potentially an important feature given the variability of women's entry to prenatal care as well as of gestational lengths. Previous researchers probably classified as exposed some women whose UTI occurred after their pregnancies exceeded 37 weeks. We applied the previous analytical methods to 1990-93 births from two Durham, NC, USA, hospitals (n = 4053) and demonstrate survival methods as an alternative. Two logistic regression models were fitted with differing exposure definitions: model 1 in which exposed = UTI diagnosed after 20 weeks' gestation; and model 2 in which exposed = UTI diagnosed between 20 weeks' and 37 weeks' gestation. Model 3 used proportional hazards regression with person-time after 20 weeks and before UTI diagnosis as unexposed, and person-time after diagnosis as exposed. Models were fit with and without five time-constant potential confounders. Model 1 yielded an adjusted odds ratio (OR) of 0.8 [95% confidence interval (CI) 0.5, 1.2], and model 2, which did not include UTI diagnoses after 37 weeks, an adjusted OR of 0.9 [95% CI 0.6, 1.4]. The Cox model hazard ratio (HR) for preterm delivery was 1.1 (adjusted) [95% CI 0.7, 1.7]. As these results indicated some bias, but not remarkable differences, we conducted a sensitivity analysis using 100 samples of 80% of the original data set, with replacement to determine how large the differences might be in other, similar data sets. The Cox method consistently produced higher effect estimates than either logistic model. The two samples with the greatest differences between the Cox and logistic model estimates yielded an OR of 1.47 [95% CI 0.95, 2.29] for model 1 vs. HR of 2.06 [95% CI 1.39, 3.06] for model 3, and an OR of 1.41 [95% CI 0.88, 2.25] for model 2 vs. HR of 1.79 [95% CI 1.17, 2.71] for model 3 respectively. Previous published results on UTI and preterm delivery require cautious interpretation. Data on UTI timing should be gathered to allow appropriate analyses; survival methods account for person-time under observation and ensure that studied exposures precede effects.

Adult↗
PubMed2001

One thousand video-urodynamic studies in children with non-neurogenic bladder sphincter dysfunction.

OBJECTIVE: To ascertain the aetiology and epidemiology of non-neurogenic bladder sphincter dysfunction (NNBSD) by assessing the results of prospective video-urodynamic studies (VUD) in 1000 children. PATIENTS AND METHODS: During a 4-year study period (January 1995 to December 1998) 1000 children prospectively underwent VUD to further define their NNBSD. After a noninvasive screening assessment consisting of a history, voiding diary, clinical examination, urine analysis, ultrasonography and uroflowmetry, those children who would benefit from further VUD were selected. The selection criteria included a history of urinary tract infection (UTI), a small bladder capacity not responding to training, dysfunctional uroflow, ultrasonographic abnormalities and resistance to therapy. During the study period 3500 children were screened for incontinence problems, including monosymptomatic nocturnal enuresis; 1000 of these were selected for VUD (524 boys and 476 girls). RESULTS: The urodynamic diagnosis was of normal bladder-sphincter function in 62 (6.2%, male : female 44 : 56), urge syndrome in 582 (58%, 58 : 42), dysfunctional voiding in 316 (32%, 49 : 51) and 'lazy bladder' in 40 (4%, 20 : 80). Boys diagnosed with a 'lazy bladder' were younger than those with urge syndrome and dysfunctional voiding. Girls with dysfunctional voiding were younger than those with urge syndrome. The incidence of UTI was significantly higher in girls than in boys; boys with NNBSD had no greater risk for UTI and in girls the general risk was 34%. Only in girls with a lazy bladder was there a significantly higher incidence of UTI (53%). Reflux occurred equally in all groups, with an overall incidence of 15%. The incidence of obstipation was significantly higher in girls with a lazy bladder, and overall was 17%. CONCLUSION: These results from a large series provide a new insight into the epidemiology and pathophysiology of NNBSD. The age distribution provides evidence against a dysfunctional voiding sequence. The risk of developing UTI in NNBSD is greater only in girls. In children with a lazy bladder the risk is also significantly higher, indicating that residual urine is a greater risk factor than detrusor instability. Urge syndrome and dysfunctional voiding in girls carry the same risk for developing UTI, indicating that bladder instability is a higher risk factor for UTI than detrusor sphincter discoordination. All dysfunctions carry an equal risk for developing secondary reflux. Children with NNBSD have different primary diseases but all have a common risk of incontinence, UTIs, reflux and obstipation.

Age Distribution↗
PubMed2003

Hospital-acquired urinary tract infections in Turkey: a nationwide multicenter point prevalence study.

Hospital-acquired urinary tract infection (UTI) is the most common infection acquired in hospitals. The aim of the study was to determine the prevalence of UTIs in Turkey. A nationwide one day point-prevalence survey was conducted. Centers for Diseases Control and Prevention (CDC) standard definitions for nosocomial UTIs were used. Data were collected by detailed uniform questionnaires for each patient with UTI. A total of 13269 patients were investigated, the number of patients observed in each hospital varied from 21 to 1329 patients, an average of 458 patients per prevalence study per hospital. The overall prevalence of UTI was 1.7%. Fifty-eight (26.1%) of the patients had sepsis or septic shock. Twenty-five (11.3%) patients had culture-proven bloodstream infection. Over 60% (65.3%) of urinary tract infections were associated with urinary catheters. Overall, 78.4% of UTIs were culture-proven. Escherichia coli (32.4%) was the most common reported pathogen, followed by Klebsiella spp. (17.0%), Candida spp. (12.8%),Pseudomonas aeruginosa (11.7%) and enterococci 8.5%. The prevalence of ampicillin-resistant E. coli was 23.9% and accounted for 73.8% of all E. coli isolated from UTI 8.2%, and 24.6% of E. coli were resistant to quinolones and ceftriaxone, respectively. There were no resistance to carbapenems in E. coli but 6.25, 40.6, 59.4% of Klebsiella spp. were resistant to carbapenems, quinolones and ceftriaxone, respectively. The results of this first national point-prevalence study offers a reliable measure of the prevalence of nosocomial UTIs at hospitals in Turkey and provides a baseline for future studies which will enable the monitoring of trends over time.

Adult↗
PubMed1992

Evaluation of urinary tract infection in malnourished black children.

Urinary tract infection (UTI) is a well recognized complication in malnourished children. The need to investigate these patients for underlying renal pathology has not been clearly defined. Seventy-five children with malnutrition were evaluated for UTI by culture of urine obtained suprapubically prior to antibiotic therapy. All patients with UTI were investigated with renal ultrasonography, intravenous pyelography (IVP) and voiding cystourethrography (VCU). Haemoglobin, white cell count, serum urea, creatinine and electrolytes were determined in all the children. The mean age of the children was 15.5 months (range 3-60 months). UTI was diagnosed in 26 (34.7%), of whom 21 (81%) were boys. The overall prevalence of UTI in those with kwashiorkor/marasmic kwashiorkor was 42%. Escherichia coli was the organism most commonly cultured (84.6%). Renal sonography, IVP and VCU were normal in all infected cases and vesicoureteric reflux was not detected in any. This study confirms the high prevalence of UTI in malnourished children. As no anatomical abnormalities were demonstrated in the patients with UTI, imaging of the renal tract other than real sonography does not appear to be indicated in the malnourished child in a first episode of UTI with normal renal function.

Black People↗
PubMed2004

Laboratory diagnosis of urinary tract infections in adult patients.

Urinary tract infections (UTIs) are among the most common bacterial infections and account for a significant part of the workload in clinical microbiology laboratories. Enteric bacteria (in particular, Escherichia coli) remain the most frequent cause of UTIs, although the distribution of pathogens that cause UTIs is changing. More important is the increase in resistance to some antimicrobial agents, particularly the resistance to trimethoprim-sulfamethoxazole seen in E. coli. Physicians distinguish UTIs from other diseases that have similar clinical presentations with use of a small number of tests, none of which, if used individually, have adequate sensitivity and specificity. Among the diagnostic tests, urinalysis is useful mainly for excluding bacteriuria. Urine culture may not be necessary as part of the evaluation of outpatients with uncomplicated UTIs, but it is necessary for outpatients who have recurrent UTIs, experience treatment failures, or have complicated UTIs, as well as for inpatients who develop UTIs.

Adult↗
PubMed1999

Factors contributing to susceptibility of postmenopausal women to recurrent urinary tract infections.

Recurrent urinary tract infections (UTIs) account for substantial morbidity, losses in work time, and medical costs. Recent studies suggest that the major factors predisposing to recurrent UTIs differ by age and functional status. In premenopausal women, sexual intercourse, spermicide exposure, maternal history of UTI, and a history of UTI in childhood have been associated with recurrent infections. In postmenopausal women, lack of estrogen appears to be an important factor predisposing to recurrent UTI, as does nonsecretor status, a history of UTI in the premenopausal period, incontinence, presence of a cystocele, and postvoid residual urine. In older women who are institutionalized, catheterization, incontinence, antimicrobial exposure, and functional status are most strongly related to risk of recurrent UTI. Further research is needed to better identify measures for prevention of recurrent UTI, which likely differ by age group.

Adolescent↗
PubMed2002

Clinical and molecular epidemiology of quinolone-resistant Escherichia coli isolated from urinary tract infection.

Since the use of fluoroquinolone antibiotic in clinical practice was introduced about a decade ago, quinolone-resistant E. coli (QREC) strains are being isolated with increasing frequency. From 1996 to 2000, 297 cases of urinary tract infection (UTI) due to QREC were observed in our hospital; 218 episodes (73.5%) were community acquired. The incidence of QREC UTIs increased steadily from 14.4% to 21.3% during 5 years when we compared the clinical characteristics of 60 QREC UTI with those of 80 quinolone-susceptible E. coli UTIs. Significant differences in susceptibility to various antibiotics were observed between the QREC and QSEC strains of E. coli. The multidrug resistance rate of QREC was much higher (38.3%) than those of quinolone susceptible isolates (18.8%). Prior fluoroquinolone use (p = 0.05), old age (p = 0.001), and a vegetative state (p = 0.03) were the independent risk factors for the acquisition of QREC UTI. The outcome of E. coli UTI is dependent on quinolone resistance. Thirty-day mortality was higher in QREC UTI patients, probably due to aggravation of underlying illness, but not quinolone resistance. On the basis of PFGE analysis, although some clustering was found in the hospital, genomic diversity was found among both the community and nosocomial strains. The increased frequency of QREC UTIs is thus not due to transmission of resistant strains but probably results from the selection of resistant strains from the endogenous flora of patients.

Anti-Infective Agents↗
PubMed2006

Comparison of nitinol urethral stent infections with indwelling catheter-associated urinary-tract infections.

BACKGROUND AND PURPOSE: To determine the efficacy of intraurethral metal stents in preventing or eradicating urinary-tract infections (UTI) during the management of bladder outlet obstruction (BOO) by comparing the frequency and nature of the infections with indwelling-catheter-associated UTI. PATIENTS AND METHODS: The SAS relative-risk test was used to compare the risks of UTI in 76 patients with temporary urethral stents, 60 patients with BOO who had never been catheterized nor stented, and 34 patients with a permanent indwelling urethral catheter (PIUC). Infection was assessed 1 month after placement of the devices. Scanning electron microscopy (SEM) of the proximal and distal pieces of the stents removed from five patients with and five patients without UTI was carried out in a search for predisposing changes on the surfaces. RESULTS: After insertion of the catheter, UTI developed in 79.4% of the patients who originally had sterile urine. However, after insertion of the stent, UTI developed in only 40.9% of the patients with sterile urine. In 21 (44.6%) of the catheterized patients who had infected urine, UTI was eradicated after stent insertion. The SEM analysis of the stents showed that a thick organic layer had formed only on the infected devices but with no sign of erosion. CONCLUSION: Urinary infection is a significant problem in patients with PIUC but is significantly less frequent and less severe in patients with urethral stents. This advantage of stents over the conventional urethral catheter, in addition to their obvious convenience for the patient, make them good alternatives to reduce the risk of UTI.

Adolescent↗
PubMed2003

Clinical management of urinary tract infection in women: a prospective cohort study.

BACKGROUND: It is unclear how symptoms of urinary tract infection (UTI) influence clinical management in terms of diagnostic testing and treatment with antibiotics. OBJECTIVES: Our aim was to assess how 11 symptoms associated with UTI related to the probability of being tested (near patient test or urine culture) or treated with antibiotics by their GP, and to see if the same 11 symptoms were associated with (i) confirmed infection from urine culture and (ii) re-consultation complaining of the same symptoms within 1 month. METHODS: A prospective cohort study of 160 patients consulting their GP with symptoms of UTI in eight general practices in Avon, UK was carried out. Association between symptoms and the probability of being (i) tested by the near patient test, (ii) tested by urine culture or (iii) treated empirically with antibiotics were examined. The association between symptoms and the probability of being treated empirically or tested (near patient test or mid-stream urine) was examined. Likelihood ratios for symptoms and near patient test results compared with two 'gold standards' for diagnosis of UTI were calculated and their impact on post-test probability of UTI determined. RESULTS: GPs were far more likely to treat empirically patients with symptoms of dysuria and frequency [odds ratio (OR) 6.50, 95% confidence interval (CI) 2.02-20.89] or dysuria alone (OR 5.24, 95% CI 1.62-16.95). They were far less likely to perform diagnostic tests in patients with dysuria and frequency (OR for near patient testing 0.34, 95% CI 0.14-0.83; OR for urine culture 0.15, 95% CI 0.04-0.56). The prior probabilities of UTI were 25% (positive urine culture) and 29% (re-consultation within 1 month), respectively, for each of the 'gold standards' used. Individual symptoms and near patient tests did not raise the posterior probability of UTI irrespective of which 'gold standard' was used. The most useful symptom was a history of vomiting (likelihood ratio 2.96, 95% CI 0.3-31.2), but this occurred in only three patients. CONCLUSIONS: Current clinical practice results in a large proportion of patients receiving unnecessary antibiotic treatment. Individual symptoms of UTI are an inadequate guide on which to base diagnostic testing and antibiotic treatment decisions in primary care. Either this diagnostic inaccuracy should be acknowledged as an inevitable part of clinical practice or more accurate clinical prediction rules that incorporate symptoms, signs and near patient test results that are applicable in everyday clinical practice are required.

Adult↗
PubMed1990

Prevention of catheter-associated urinary tract infection with a silver oxide-coated urinary catheter: clinical and microbiologic correlates.

In a prospective clinical trial involving 482 acutely hospitalized patients, the overall incidence of catheter-associated urinary tract infection (UTI; 10%) was similar in recipients of a silver oxide-coated urinary catheter (silver catheter) or a control silicone catheter. However, female sex and absence of antimicrobial use were independently associated with an increased risk of UTI. After stratification for these variables, the silver catheter reduced the incidence of UTI among women not receiving antimicrobial agents (19% for control catheter vs. 0 for silver catheter, P = .04; confidence interval for the difference in incidence, 0.4%-38%) but not in the other subgroups. Gram-positive UTI was associated with absence of antimicrobial use, the control catheter, and catheter care violations. Gram-negative and candidal UTIs were more common after 7 days of catheterization, and candidal UTI was associated with being female and antimicrobial use. These findings demonstrate that several clinical variables influenced the incidence and microbiology of catheter-associated UTI and that the silver catheter appeared to prevent UTI among women not receiving antimicrobials.

Adult↗
PubMed1995

Virulence characteristics of Escherichia coli causing first urinary tract infection predict risk of second infection.

Escherichia coli causes most urinary tract infections (UTIs) in ambulatory populations. Several bacterial virulence factors occur more frequently among urinary E. coli isolates than among fecal isolates, but none have been reported to predict risk of second UTIs. DNA hybridization was used to characterize the bacterial virulence profiles of urinary E. coli isolates from 174 women with first UTI and compared for risk of second UTI. Of the women, 28 (16%) had a culture-confirmed second UTI within 6 months of a negative test-of-cure. Three virulence factors were associated with a significantly lower risk of second UTI: cytotoxic necrotizing factor (relative risk [RR] = 0.0; 95% confidence interval [CI], 0.0, 0.42); hemolysin (RR, 0.10; 95% CI, 0.01, 0.69), and S fimbrial adhesin (RR, 0.25; 95% CI, 0.06, 1.00). Dr binding was associated with a 2-fold increased risk of second UTI (RR, 2.30; 95% CI, 1.23, 4.29). Half of all paired first and second UTI isolates from the same subject were apparently the same.

Adult↗
PubMed1996

Association between use of spermicide-coated condoms and Escherichia coli urinary tract infection in young women.

Diaphragm/spermicide use increases the risk of urinary tract infection (UTI). To determine whether spermicide-coated condoms are also associated with an increased risk of UTI, the authors conducted a case-control study at a large health maintenance organization in Seattle, Washington. Cases were sexually active young women with acute UTI caused by Escherichia coli, identified from computerized laboratory files during 1990-1993. Age-matched controls were randomly selected from the enrollment files of the plan. Of 1,904 eligible women, 604 cases and 629 controls (65%) were interviewed. During the previous year, 40% of the cases and 31% of the controls had been exposed to any type of condom. The unadjusted odds ratio for UTI increased with frequency of condom exposure from 0.91 (95% confidence interval (CI) 0.65-1.28) for weekly or less during the previous month to 2.11 (95% CI 1.37-3.26) for more than once weekly. Exposure to spermicide-coated condoms conferred a higher risk of UTI, with odds ratios ranging from 1.09 (95% CI 0.58-2.05) for use weekly or less to 3.05 (95% CI 1.47-6.35) for use more than once weekly. In multivariate analyses, intercourse frequency (odds ratio (OR) = 1.14 per weekly episode), history of UTI (OR = 2.64), and frequency of spermicide-coated condom exposure (OR = 3.34 for more than once weekly and 5.65 for use more than twice weekly) were independent predictors of UTI. Spermicide-coated condoms were responsible for 42% of the UTIs among women who were exposed to these products.

Adolescent↗
PubMed2004

A multivariate analysis of dysfunctional elimination syndrome, and its relationships with gender, urinary tract infection and vesicoureteral reflux in children.

PURPOSE: We explored and quantified the relationships between dysfunctional elimination syndrome (DES), and gender, urinary tract infection (UTI) and vesicoureteral reflux (VUR) in children. MATERIALS AND METHODS: Data on 2,759 pediatric patients treated at a referral practice who underwent renal sonography and voiding cystourethrography were summarized. The patients were children with VUR or normal genitourinary anatomy who presented with UTI or dysfunctional voiding and children screened for genitourinary problems such as hematuria, sibling reflux or bedwetting. A multivariate logistic regression approach was used to model and quantify the associations between DES and other pediatric urology factors. RESULTS: Of the girls 36.0% with unilateral VUR had DES, while 36.1% with bilateral VUR had DES. The corresponding rates for boys were 20.5% and 21.2%. The higher rate of DES in girls was independent of UTI and VUR status. While UTI was not associated with DES in boys or girls without VUR, in patients with VUR and UTI the risk of DES almost doubled (OR 1.97). Reflux alone without UTI was negatively associated with DES in boys (OR 0.50, 95% CI 0.34, 0.73) and girls (OR 0.26, 95% CI 0.19, 0.36). CONCLUSIONS: Girls had a significantly higher rate of DES than boys in all UTI and VUR subgroups in the current data. UTI significantly impacts the DES occurrence in patients with VUR. No statistically significant difference was detected in the DES rate between the unilateral and bilateral VUR groups, and the reflux group as a whole did not seem to have a higher rate of DES in boys or girls.

Child↗
PubMed1986

P-fimbriated Escherichia coli in adults with renal scarring and pyelonephritis.

The commonest organism in urinary tract infections (UTI) is Escherichia coli. Pyelonephritogenic E.coli strains possess P-fimbriae which firmly attach to uroepithelial cells by recognition of a carbohydrate structure, alpha-D-Galp-(1-4)-beta-D-Galp, which is confined within all glycosphingolipids related to the human P-blood group antigens. Several investigators have studied virulence properties of E.coli and host resistance in relation to UTI. Uroepithelial cells from children and women with recurrent UTI have an increased capacity to bind E.coli. In contrast to previous studies the present one deals with patients with renal scarring, who constitute the major risk group among patients with UTI. P-fimbriae mediated binding to uroepithelial cells was studied and the risk of recurrent UTI in patients with renal scarring was determined. Ninety per cent of the E.coli isolates from female patients with acute non-obstructive pyelonephritis in this study possess P-fimbriae (I). The fecal E.coli colonies obtained from these patients were P-fimbriated in 55% compared to 11% of the fecal E.coli colonies from healthy controls. The P-blood group distribution in 56 female patients with renal scarring and a history of febrile UTI was the same as in a control group of 39 healthy subjects (II). A history of recurrent and/or early infections did not increase the percentage of the P1 blood group phenotype. Forty-nine female patients with renal scarring were prospectively investigated for the incidence of symptomatic UTI in relation to fecal colonization with P-fimbriated E.coli (III). Fifty-three per cent of the patients had altogether 65 episodes of symptomatic UTI during the three-year follow-up (0.036 infections per month). Eight patients (16%) had nine attacks of acute pyelonephritis and 4/5 of the tested E.coli strains from these patients were P-fimbriated. No relationship was demonstrated between the presence of P-fimbriated E.coli in the fecal flora and the development of subsequent acute pyelonephritis. The binding of P-fimbriated E.coli to uroepithelial cells from 19 female patients with renal scarring was studied with the fluorescence-activated cell sorting (FACS) analysis (IV). The uroepithelial cells from the patients with renal scarring exhibited a significantly higher binding capacity (p less than 0.01) than uroepithelial cells from healthy controls. Furthermore, uroepithelial cells from the patients with renal scarring and kidney insufficiency had a higher availability of P-fimbriae receptors on their uroepithelial cells than cells obtained from patients with renal scarring and normal renal function (r = -0.75, p less than 0.001) (V).(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1978

Antibody-coated bacteria in the urine of infants and children with their first two urinary tract infections.

The presence of antibody-coated bacteria in urine has been shown to be an indicator for renal bacteriuria in adults with chronic UTI. To evaluate this method (ABCU test) in pediatric patients, 128 infants and children with their first UTI were investigated. Twenty-nine patients of the 78 who had a first clinically defined upper UTI had antibody-coated bacteria in urine. The test was seldom (2/20) positive in the infants under six months. In the older patients (27/58 ABCU-positive) the frequency of positive tests increased with the duration of symptoms. When the symptoms had lasted for over one weeks, 11 out of the 13 children with their first upper UTI showed antibody-coated bacteria in urine. Four of the 36 first lower UTIs and 5 out of the 14 asymptomatic cases were ABCU-positive. The patients were followed-up for an average of 9 months. Those who were classified as having first upper UTI had in most cases a positive ABCU test in recurrences, independently of the clinical picture. The recurrences after the first lower UTIs showed antibody-coated bacteria in urine only when the recurrence was classified as upper UTI on the grounds of the clinical criteria used.

Adolescent↗