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PubMed2006

Maternal urinary tract infection and related drug treatments during pregnancy and risk of congenital abnormalities in the offspring.

OBJECTIVE: The association between urinary tract infection (UTI) of pregnant women and preterm birth/low birthweight is known, but the possible association between UTI and congenital abnormalities (CAs) was evaluated rarely. Only one study showed an association with atrial septal defect, thus we decided to check this possible association. DESIGN: The population-based large data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities (HCCSCA); most maternal UTIs were based on medically recorded data. SETTING The HCCSCA, 1980-1996, contained 22 843 newborns or fetuses with CAs and 38 151 matched controls, i.e. newborn infants without any HCAs. POPULATION: Hungarian informative offspring: live births, stillbirths and prenatally diagnosed malformed fetuses. METHODS: Case-control pair analysis. MAIN OUTCOME MEASURES: Twenty-five CA groups. RESULTS: A total of 1542 (6.75%) mothers in the case group had UTI during entire pregnancy compared with 2188 (5.74%) mothers in the control group (adjusted prevalence odds ratios [POR] with 95% CI: 1.15, 1.06-1.24). We did not find a higher prevalence of UTI during the second and/or third months of pregnancy in total case group (adjusted POR with 95% CI: 1.1, 0.9-1.2) and in any group of CAs including atrial septal defect type II. CONCLUSIONS: No evidence for the teratogenic effect of maternal UTI and related drug treatments during early pregnancy.

Abnormalities, Drug-Induced↗
PubMed1987

External catheter use and urinary tract infections among incontinent male nursing home patients.

In order to examine the relative frequency of urinary tract infection (UTI) and bacteriuria among male nursing home patients managed with and without external catheters (EC), we prospectively followed four cohorts of patients (EC worn continuously, N = 30; EC worn at night only, N = 19; incontinent without catheter, N = 13; and continent, N = 30) for a total of 497 patient months at risk. The proportion of patients with EC worn continuously who had at least one episode of bacteriuria (87%) and at least one UTI (40%), and the incidence of UTI (0.08 episodes per patient-month at risk) was significantly higher than among continent or incontinent patients without EC. Patients with EC at night only had an intermediate frequency of these findings. Differences in clinical and functional status characteristics among the four cohorts, in addition to the use of EC, could have contributed to the higher frequencies of bacteriuria and UTI. None of the clinical characteristics we examined were associated with the development of UTI among patients with EC. Further studies are necessary to identify factors associated with UTI among patients who are managed by EC so that effective preventive strategies can be developed and targeted to patients at high risk.

Aged↗
PubMed2006

Renal allograft injury is associated with urinary tract infection caused by Escherichia coli bearing adherence factors.

Urinary tract infections are the most common infection in renal transplant patients and Escherichia coli (E. coli) is the most common clinical isolate. Although acute allograft injury (AAI) secondary to urinary tract infection (UTI) has been reported, the incidence of AAI associated with UTI, the virulence factors express by uropathic E. coli and whether virulence factors are associated with renal allograft outcome have not been described. We collected E. coli from our renal transplant patients with UTI, determined O:H serotypes, P and Dr fimbriae expression and the clinical presentation and allograft function during the UTI and post-UTI period. Pyelonephritis occurred in 40% of our patients, 82% of which had AAI (>20% increase in SCr). Sixty-two percent of E. coli isolates that expressed P fimbriae were associated with AAI, whereas only 29% that did not express P fimbriae had AAI (p = 0.03). The pattern of P fimbriae and O serotypes differed from reported isolates, as the P fimbriae PapG class II and the O25 serotype were the most common. Dr adhesin was expressed on 7 isolates, including 2 of 3 with urosepsis. We propose a unique pattern of uropathogenic serotypes and adherence factors contribute to acute allograft injury in renal transplant patients with UTI.

Adult↗
PubMed1996

Type of nappy and nursing habits in acquiring acute urinary tract infection.

The role of the nappy and nursing habits as possible risk factors of urinary tract infection (UTI) were analysed in a prospective case-control study. Cases entered hospital due to their first UTI attack. Children hospitalized for some other reason, mainly upper respiratory infections or elective surgery, served as controls matched for age and sex. Cases and their controls (208 girls and 184 boys) used nappies day and night. The odds ratios for risk of contracting UTI according to different nappy types used prior to the first UTI diagnosis were 0.95 for all-in-one (superabsorbent) nappies (95% CI 0.62-1.46), 1.04 (0.69-1.57) for standard disposable nappies and 1.00 (0.46-2.16) for washable cotton nappies. The type and number of nappies used daily as well as the number of defecations per day were similar in UTI patients and the controls. There were no significant differences in the frequency of buttock washes nor in the daily time spent without nappy. The use of cotton nappies practically finished during the study. The type of nappy used or other nursing habits with the baby appeared to be insignificant risk factors for UTI during nappy age. The use of modern nappies has become so thoroughly commonplace that the true impact of nappy type on any condition during infancy is difficult or even impossible to evaluate in a case-control setting.

Acute Disease↗
PubMed2006

Association between ICAM-1 Gly-Arg polymorphism and renal parenchymal scarring following childhood urinary tract infection.

Renal parenchymal scarring (RPS) following urinary tract infection (UTI) is an important cause of renal morbidity in children. Studies have shown that the intensity of the inflammatory response following infection is related to the risk of RPS. However, genetic variability in this response has not been studied. Adhesion molecules play a crucial role in leucocyte recruitment following infection, and polymorphisms have been reported in the genes for key cell adhesion molecules. We have investigated the possibility that children who develop RPS following UTI may exhibit altered genotype or allele frequencies for polymorphisms of the intercellular adhesion molecule-1 (ICAM-1) (exons 4 and 6), E-selectin (exons 2 and 4), platelet endothelial cell adhesion molecule-1 (PECAM-1) (exon 3) and CD11b (3'UTR) genes, which may predict outcome of UTI. DNA was isolated from 99 children shown to have developed RPS, 43 children with no evidence of scarring (NS) following UTI and 170 healthy controls. Genotyping was performed by restriction fragment length polymorphism (RFLP) analysis. When the RPS group was compared with the NS group, there was a significant reduction in the frequency of the ICAM-1 exon 4 A allele (10.6 vs. 21.3%, respectively, chi2 = 6.01, P = 0.014). There was no significant difference in either allele or genotype frequency for any of the other polymorphisms studied. These data suggest that the A allele of the ICAM-1 exon 4 polymorphism may protect against the risk of RPS following UTI and may participate in the regulation of the inflammatory response following UTI.

Case-Control Studies↗
PubMedDate not supplied

Persistent urinary tract infections and reinfections in 100 dogs (1989-1999).

A retrospective study was performed of 100 dogs with persistent urinary tract infections (UTIs) or reinfections presenting to the North Carolina State University (Raleigh, NC) Veterinary Teaching Hospital between 1989 and 1999. Criteria for selection included > or = 2 positive urine cultures within a 6-month period. Signalment, presence of predisposing disorders, urinalysis and urine culture results, and treatment strategies were extracted from the medical records. Dogs were a median age of 7 years when the UTI was 1st diagnosed. Dogs younger than 3 and older than 10 years were at increased and decreased risks, respectively, for reinfections or persistent UTIs. Spayed females were more common in the UTI population. More than half of the dogs were asymptomatic for a UTI at 1st presentation. Urine sediment examinations identified hematuria, pyuria, and bacteriuria in 47, 72, and 85% of the samples, respectively. The most commonly isolated organisms were Escherichia coli and Streptococcus/Enterococcus spp.; multiple isolates also were common. Of the isolates, 29.5% were resistant to achievable serum concentrations of all antibiotics commonly prescribed for PO administration. Dogs with abnormal micturition were more likely to have infections by organisms resistant to commonly prescribed antibiotics. Potentially predisposing disorders were identified in 71 dogs. A correction of these disorders was accomplished in 35% of these 71 dogs. Dogs given standard antibiotic therapy without addressing predisposing disorders experienced poor control of their UTIs; 74.5% of these dogs had an apparent disease-free interval (ADFI) of < 8 weeks. By comparison, dogs in which predisposing disorders were corrected or those that were treated with low-dose, long-term antibiotic regimens subjectively had better control.

Animals↗
PubMed1992

A clinical study on patients with urinary tract infection due to coagulase-negative staphylococci.

To assess the clinical significance of coagulase-negative staphylococci (CNS) in patients with urinary tract infection (UTI), the clinical characteristics of a total of 117 patients (106 complicated UTI patients, 11 uncomplicated UTI patients) from whom CNS were isolated at urinary colony counts of 10(5) or more per ml were studied. Of the complicated UTI patients, 95 patients (89.6%) suffered from no symptoms while 11 (10.4%) had fever of 38 degrees C or greater, which was strongly suspected to be due to genitourinary tract infections. Six of these patients were managed by indwelling urinary catheters. On the other hand, all of the patients with uncomplicated UTI were young women and had typical symptoms of acute cystitis. These results suggest that CNS, which hitherto have been considered mere contaminants or benign colonization rather than true pathogens, can also cause complicated UTI requiring chemotherapy under certain conditions such as indwelling urinary catheterization and acute cystitis in sexually active women.

Adult↗
PubMed2005

Diagnosis and management of pediatric urinary tract infections.

Urinary tract infection (UTI) is among the most commonly diagnosed bacterial infections of childhood. Although frequently encountered and well researched, diagnosis and management of UTI continue to be a controversial issue with many challenges for the clinician. Prevalence studies have shown that UTI may often be missed on history and physical examination, and the decision to screen for UTI must balance the risk for missed infections with the cost and inconvenience of testing. Interpretation of rapid diagnostic tests and culture is complicated by issues of contamination, false test results, and asymptomatic colonization of the urinary tract with nonpathogenic bacteria. The appropriate treatment of UTI has been controversial and has become more complex with the emergence of resistance to commonly used antibiotics. Finally, the anatomic evaluation and long-term management of a child after a UTI have been based on limited evidence, and newer studies question some of the tenets of prior recommendations. The goal of this review is to provide an up-to-date summary of the literature with particular attention to practical questions about diagnosis and management for the clinician.

Anti-Bacterial Agents↗
PubMed1997

Distribution of drb genes coding for Dr binding adhesins among uropathogenic and fecal Escherichia coli isolates and identification of new subtypes.

The Dr family of related adherence structures, some fimbriated and others afimbriated, bind to decay-accelerating factor molecules on human cells. Dr is associated with recurring urinary tract infection (UTI), but the distribution of Dr subtypes among uropathogenic Escherichia coli causing UTI among otherwise healthy women has yet to be described. A total of 787 UTI and fecal E. coli isolates from college women were screened for the presence of Dr sequences (drb). Fifteen percent of UTI strains were drb positive, compared to 5% of fecal strains. The adhesin (E gene) subtype of each drb-positive strain was determined by type-specific PCR followed by restriction enzyme analysis. Among 78 drb-positive strains, we found 14 (18%) afaE1, 1 (1.3%) afaE2, 1 (1.3%) afaE3, 9 (12%) draE, 9 (12%) draE-afaE3 hybrid, 1 (1.3%) daaE, 32 (41%) afaE5, 4 (5.1%) F131 E gene-like, and 7 untypeable strains. All untypeable E genes were cloned and sequenced, revealing four additional new classes of E genes, including two similar to the previously identified nonfimbrial E series. While a great range of diversity exists among the E genes, restriction fragment length polymorphism analysis demonstrated that all of these drb operons share a highly conserved gene structure. The most common subtype, afaE5, occurred three times as often among UTI than fecal strains. Over half of the drb-positive strains and 80% of those positive for afaE5 have the same virulence signature (positive for aer, kpsMT, ompT, and fim), suggesting an association of this profile with UTI pathogenesis.

Adhesins, Escherichia coli↗
PubMed2000

Escherichia coli serotype O15:K52:H1 as a uropathogenic clone.

To clarify the clinical and bacteriological correlates of urinary-tract infection (UTI) due to Escherichia coli O15:K52:H1, during a 1-year surveillance period we prospectively screened all 1, 871 significant E. coli urine isolates at the Hospital de la Santa Creu i Sant Pau, Barcelona, Spain, for this serotype and assessed the epidemiological features of community-acquired UTI due to E. coli O15:K52:H1 versus other E. coli serotypes. We also compared the 25 O15:K52:H1 UTI isolates from the present study with 22 O15:K52:H1 isolates from other, diverse geographic locales and with 23 standard control strains (8 strains from the ECOR reference collection and 15 strains of nonpathogenic O:K:H serotypes) with respect to multiple phenotypic and genotypic traits. Although E. coli O15:K52:H1 caused only 1.4% of community-acquired E. coli UTIs during the surveillance period, these UTIs were more likely to present as pyelonephritis and to occur in younger hosts, with similar risk factors, than were UTIs due to other E. coli serotypes. Irrespective of geographic origin, E. coli O15:K52:H1 strains exhibited a comparatively restricted repertoire of distinctive virulence factor profiles (typically, they were positive for papG allele II, papA allele F16, and aer and negative for sfa, afa, hly, and cnf1), biotypes, ribotypes, and amplotypes, consistent with a common clonal origin. In contrast, their antimicrobial resistance profiles were more extensive and more diverse than those of control strains. These findings indicate that E. coli O15:K52:H1 constitutes a broadly distributed and clinically significant uropathogenic clone with fluid antimicrobial resistance capabilities.

Bacteremia↗
PubMed2001

An audit of RCP guidelines on DMSA scanning after urinary tract infection.

AIM: To assess the outcome of imaging investigations carried out in children with urinary tract infection (UTI), to compare the investigations with national guidelines, and to assess the impact on management. METHODS: Retrospective review of inpatients and outpatients, aged 0-12 years, referred to the University Hospital of Wales Healthcare Trust between February 1997 and January 1998 with UTI. All children without bacterial evidence of UTI and children previously investigated for antenatal urological anomalies, major congenital anomalies, or UTI were excluded. RESULTS: A total of 164 children (51 boys, 113 girls) were included. Thirteen of 56 infants (23%) and 82/108 older children (76%) were diagnosed at home over one year. The prevalence of dilatation on ultrasound was 8%, renal scarring on dimercaptosuccinic acid (DMSA) scan was 11%, and vesicoureteric reflux (VUR) was 34% when investigations were carried out following guidelines published by the Royal College of Physicians. In children aged 1-6 years, the prevalence of scarring was 1/54 (2%) in those treated at home and 6/18 (33%) in inpatients. CONCLUSION: The low yield of positive results and lack of evidence of impact on management indicate that DMSA scanning, with all the implications of isotope exposure, intravenous injection, staff time, psychological trauma, and expense, could be omitted in children over 1 year with first simple UTI not sufficiently ill to be admitted to hospital. The low rate of detection of UTI in primary care in infants may represent under diagnosis.

Chi-Square Distribution↗
PubMed2003

Parental reporting of smelly urine and urinary tract infection.

BACKGROUND: Parents often report that young children have "smelly urine" or a particular urinary odour. There is little evidence that these observations are relevant to the diagnosis of urinary tract infection (UTI). AIMS: To determine whether parental reporting of smelly urine is of any relevance to the diagnosis of UTI in children less than 6 years of age. METHODS: Parents whose children were having urine collected as part of their admission to a large district hospital were given a simple questionnaire to complete regarding the current smell of their child's urine. Parents were asked whether their child's urine smelled different from usual or had a particular smell. Microscopy and culture results of the child's urine were compared to their parent's questionnaire answers to see if there was a association between parental reporting of a different or particular urine smell and a diagnosis of UTI. RESULTS: One hundred and ten questionnaires and urine samples were obtained. Fifty two per cent of parents thought that their child's urine smelled different from usual or had a particular smell. Only 6.4% of children were diagnosed as having a UTI. There was no statistically significant association between parental reporting of abnormal urine smell and diagnosis of UTI. CONCLUSION: In determining whether a young child has a UTI, asking parents about urine smell is unlikely to be of benefit.

Child, Preschool↗
PubMed2004

Urinary trypsin inhibitor reduces LPS-induced hypotension by suppressing tumor necrosis factor-alpha production through inhibition of Egr-1 expression.

Although urinary trypsin inhibitor (UTI) has been shown to inhibit tumor necrosis factor (TNF)-alpha- production, the detailed mechanism(s) remains unclear. This study was undertaken to elucidate the molecular mechanism(s) underlying this inhibitory effect in monocytes in vitro and in rats given lipopolysaccharide (LPS). TNF-alpha production by monocytes stimulated with LPS (100 ng/ml) was inhibited by UTI at concentrations higher than 100 U/ml. Expression of early growth response factor-1 (Egr-1) and phosphorylation of extracellular signal-regulated protein kinases 1/2 in monocytes stimulated with LPS were inhibited by UTI. UTI (50,000 U/kg i.v.) inhibited LPS (5 mg/kg i.v.)-induced increases in lung tissue levels of Egr-1, TNF-alpha mRNA, and TNF-alpha in rats. UTI inhibited LPS-induced hypotension by inhibiting pulmonary induction of inducible nitric oxide synthase (iNOS). We previously demonstrated that anti-TNF-alpha antibody and aminoguanidine, a selective inhibitor of iNOS, reduced LPS-induced hypotension in this animal model. Furthermore, we also reported that reduction of LPS-induced coagulation abnormalities in rats did not affect inflammatory responses and hypotension in this animal model. Taken together, these observations strongly suggested that UTI inhibited LPS-induced production of TNF-alpha by inhibiting activation of the extracellular signal-regulated protein kinases 1/2-Egr-1 pathway in monocytes, which might at least partly contribute to reduction of hypotension through inhibition of iNOS induction in rats given LPS.

Animals↗
PubMed2005

[Epidemiology and etiology of urinary tract infections in the community. Antimicrobial susceptibility of the main pathogens and clinical significance of resistance].

Urinary tract infections (UTI) are a frequent problem in primary care. They occur mainly in women without underlying diseases and with no functional or structural anomalies of the urinary tract; consequently most cases are considered uncomplicated UTI. Etiology is influenced by factors such as age, diabetes, spinal cord injury, urinary catheterization, and other factors. Escherichia coli causes 80-85% of acute episodes of uncomplicated cystitis. Staphylococcus saprophyticus, Proteus mirabilis, Streptococcus agalactiae and Klebsiella spp. are responsible for most of the remaining episodes. The spectrum of bacteria that causes complicated UTI is much broader. Rates of resistance have undergone considerable variations, and consequently the empirical treatment of UTI requires constant updating of the antibiotic sensitivity of the main uropathogens of the area, country or institution. To correctly interpret the global data on sensitivity, the type of UTI (uncomplicated versus complicated), sex, age and previous antibiotic therapy in each patient must be taken into account. Resistance in uncomplicated UTI has clinical significance (although less than in systemic infections such as bacteremia), which depends on whether the infection is cystitis or pyelonephritis.

Adolescent↗
PubMed2002

Plasma and urine elastase alpha-1-proteinase inhibitor levels in neonatal urinary tract infection.

OBJECTIVE: To examine whether plasma or urine elastase alpha(1)-proteinase inhibitor (E-alpha(1)-PI) levels could be used as a diagnostic marker of urinary tract infection (UTI) in neonates. SUBJECTS AND METHODS: Plasma and urine E-alpha(1)-PI levels were measured by immunoassay in 23 neonates with UTI at the time of admission and 72 h after the onset of treatment and in 10 'normal' neonates (i.e. with trivial problems). Additionally E-alpha(1)-PI plasma levels were measured in 15 neonates with septicemia. RESULTS: E-alpha(1)-PI plasma levels did not differ between normal neonates and those with UTI. Urine E-alpha(1)-PI levels were significantly higher in neonates with UTI on admission compared to normal neonates. A significant decrease in urine E-alpha(1)-PI levels was noticed 72 h after the onset of treatment in all but 2 neonates in whom infection persisted. In this study, we have found that the urine E-alpha(1)-PI concentration at a cutoff level of 48 microg/l had a sensitivity of 83%, a specificity of 90%, a positive predictive value of 95% and a negative predictive value of 69% for the diagnosis of neonatal UTI. CONCLUSION: Elevated levels of E-alpha(1)-PI in urine seem to be a useful tool for the diagnosis of UTI in neonates (even in those that have already been started on antibiotics) and possibly a valuable marker for early recognition of treatment failure.

Bacteremia↗
PubMed1990

Urinary IgA, secretory IgA and secretory component in women with recurrent urinary tract infections.

Urinary secretory IgA (sIgA), consisting of free secretory component (FSC) and dimeric IgA, is involved in the defense against urinary tract infections (UTI). Recurrent UTIs (rUTI) have been suggested to be associated with a defective excretion of sIgA. Therefore urinary sIgA, FSC and serum-type IgA concentrations were measured by ELISA in 68 normal women, 10 asymptomatic women with rUTIs and no urological abnormality (group A), 8 asymptomatic women with rUTIs and a urological abnormality (B), 4 women with acute UTI (C) and 5 women with a selective serum IgA deficiency (D). Annual UTI rates were increased in groups A, B and C, but normal in group D. In no patient group urinary FSC concentration was different from the normals, while sIgA concentrations were increased in group C, markedly reduced in group D, but normal in groups A and B. Urinary serum-type IgA concentrations were significantly increased in group A and C, markedly reduced in group D and normal in group B. These results demonstrate that the urinary sIgA system participates in the immune response to bacterial infections, but that even a complete failure of the sIgA system does not lead to an increased UTI rate. Furthermore, no association of recurrent UTIs with disturbances of the urinary sIgA excretion could be demonstrated.

Adolescent↗
PubMed1997

Inhibition of neutrophil elastase-induced interleukin-8 gene expression by urinary trypsin inhibitor in human bronchial epithelial cells.

BACKGROUND: Urinary trypsin inhibitor (UTI), a potential inhibitor for proteinases including neutrophil elastase (NE), trypsin, plasmin, cathepsin B and H has been used for the treatment of lung diseases with the absence of side effects in Japan. METHODS: In this study, we investigated the inhibitory effects of UTI on both purified NE and NE activities present in bronchoalveolar fluids from patients with chronic bronchitis. We also investigated the inhibitory capacity of UTI with regard to NE-induced interleukin-8 gene expression in human bronchial epithelial cells by Northern analyses. RESULTS: UTI inhibited NE activities in bronchoalveolar lavage fluid from patients with chronic bronchitis and of the purified enzyme. In addition, UTI inhibited NE-induced interleukin-8 gene expression and protein secretion in a human bronchial epithelial cell line. CONCLUSIONS: Our results suggest that UTI is applicable to patients with a variety inflammatory lung diseases in which NE plays a pivotal role.

Bronchi↗
PubMed1990

Fosfomycin trometamol versus netilmicin in children's lower urinary tract infections.

Fosfomycin trometamol (FT), an antibiotic active against the common urinary pathogens, may be demonstrated in adequate urine concentrations up to 36-48 h after a single oral dose of 1-2 g. This pharmacokinetic peculiarity seems to indicate that this antibiotic may be used in single doses in the therapy of lower urinary tract infections (UTIs) in infants and children. The efficacy and safety of FT in single oral doses was compared with those of netilmicin (NM), an aminoglycoside antibiotic with a demonstrated efficacy in bolus doses against UTIs, shown in a multicentric study. One hundred and thirty-five children with lower UTI, diagnosed on the basis of fever (less than 38 degrees C), erythrocyte sedimentation rate (less than 25 mm/l h) and C-reactive protein (less than 20 micrograms/ml), were included in the study: 71 received 2 g of FT, 64 5 mg/kg of NM. Cure, defined as persistence of sterile urine up to 30 days after therapy, was reached in 80.2% of children in the FT group and in 81.2% of children in the NM group. Persistence of infection was demonstrated in 7 and in 3 children, respectively. Recurrence of infection was noticed in 7 patients in the FT group and in 9 in the NM group. No differences between FT- and NM-treated children are demonstrable even if the patient population is analyzed according to the higher risk of UTI because of the presence of an anatomical and/or functional abnormality of the urinary tract or due to a previous tendency to recurrent UTIs. FT is as effective as NM in the treatment of lower UTIs in infants and children.

Adolescent↗