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PubMed2004

Urinary tract infection: an update on imaging strategies.

Urinary tract infections (UTIs) are a common cause of morbidity in children. The distinction between upper and lower tract UTI is clinically difficult but important, as permanent renal damage can occur when the UTI involves the kidneys. Children with a history of UTI need investigated promptly and thoroughly. The goal of imaging in UTI is to aid in the diagnosis of acute pyelonephritis, to identify those children who are at high risk of developing permanent renal damage, and to confirm and monitor the presence of renal scarring. This article reviews the role of radiology in each of these aims.

Acute Disease↗

PubMed2004

The role of imaging in urinary tract infections.

The aim of imaging in urinary tract infections (UTI) is to detect conditions that must be corrected to avoid imminent deterioration of kidney function, or to prevent recurrent infections and long-term kidney damage. The most threatening conditions are obstruction of an infected upper tract and abscesses of the genitourinary system. An image-guided percutaneous drainage can be lifesaving. The role of imaging in small children with UTI is controversial in terms of the importance of anatomical and functional disorders in relation to the preventive measures to be taken. In newborns identified with hydronephrosis during pregnancy or by neonatal screening, vesicoureteral reflux (VUR) and renal scarring are congenital and not caused by infection. Most of these patients are males and the VUR is of a higher grade than VUR detected in girls after the first UTI. Imaging in children with UTI should only be ordered after a thorough evaluation of the risk of renal damage and the benefits of preventive measures. In adult females, no imaging is necessary in cystitis, while ultrasonography and plain films are recommended in acute pyelonephritis. Since uncomplicated UTI in men is rare, diagnostic imaging should be started early to rule out complicating factors in the urinary tract. In prostatitis, vesiculitis, epididymitis and orchitis the role of imaging is to rule out abscess formation and testicular malignancies.

Diagnostic Imaging↗

PubMed2002

Prophylactic antibiotics in children at risk for urinary tract infection.

The outcome of using prophylactic antibiotics in children considered at risk for a urinary tract infection (UTI) was documented in 66 children during the period of suppressive antibiotics and for a follow-up period of 3.7+/-2.2 years (range 0.92-9.83 years). A breakthrough UTI occurred in 13 girls but none of the boys during the initial course of prophylactic antibiotics. During the follow-up period, 33 girls and 5 boys had no recurrence of infection, while 25 girls and 3 boys had UTIs. Statistical analysis of the data using chi-square and risk estimate relating factors for infection to the occurrence of a UTI showed that during the period of initial prophylactic antibiotic there was significant risk of infection among children with voiding dysfunction and abnormal kidneys and during the follow-up there was increased risk of infection among those with voiding dysfunction and vesicoureteric reflux (VUR) of grade 3 or greater severity. Lesser grades of VUR and constipation did not significantly increase the risk of UTI. These observations should be useful in developing a study to define the risks and benefits of prophylactic antibiotic in "at-risk" children.

Anti-Bacterial Agents↗

PubMed2004

Relationship between acute pyelonephritis, renal scarring, and vesicoureteral reflux. Results of a coordinated research project.

Acute pyelonephritis (APN) may produce permanent renal damage (PRD), which can subsequently lead to diverse complications. We prospectively evaluated 147 females and 122 males (mean age 3.5 years) with APN in order to analyze the relationship between the presence of PRD, at the time of cortical renal scintigraphy, and age, gender, episodes of urinary tract infection (UTI), and presence of vesicoureteral reflux (VUR). There were 152 children studied after the first proven UTI. VUR was present in 150 children. PRD was observed in 170 children. There were no significant differences between boys and girls. PRD was found in 36.4% of children younger than 1 year and in 70.1% of those older than 1 year ( P<0.0001). Of children with VUR, 72% had PRD compared with 52% of children without VUR ( P<0.0001). Of children with a first episode of UTI, 55.9% developed PRD as did 72.6% of those with recurrent UTI ( P=0.004). Our results showed that PRD in children with APN is important, especially in the presence of VUR, recurrent UTI, and older age.

Acute Disease↗

PubMed2005

Hypercalciuria and recurrent urinary tract infections: incidence and symptoms in children over 5 years of age.

Hypercalciuria is an important and common risk factor in the formation of renal stones. In this study we evaluated the incidence and the clinical presentation of hypercalciuria in 75 children over 5 years of age with the diagnosis of recurrent urinary tract infection (UTI). We measured random urinary calcium/creatinine value (three times), 24-h urinary calcium excretion, serum calcium, phosphorus, electrolytes, blood gas, blood urea nitrogen and creatinine levels. Hypercalciuria was found in 32 patients (43%). The mean urinary calcium/creatinine ratio for hypercalciuric patients was 0.50+/-0.21 mg/mg (min: 0.24, max: 2.60). The mean urinary calcium/creatinine ratio for the rest of the study population--those without hypercalciuria--was 0.10+/-0.04 mg/mg (min: 0.01, max: 0.18). Presenting symptoms of the hypercalciuric patients and normocalciuric patients were similar. History of familial urolithiasis was positive in 19 patients (59%). Predisposing urinary tract abnormalities in recurrent UTI was shown in 12 of the hypercalciuric patients (12/32, 37.5%) and 8 of the normocalciuric patients (8/43, 19%) without a statistically significant difference between. We conclude that hypercalciuria is not a rare finding among recurrent UTI cases in Turkish children. Hypercalciuria does not modify the clinical presentation of UTI, and we suggest the investigation of urinary calcium excretion in children with recurrent UTI.

Age Distribution↗

PubMed2007

Imaging strategies for vesicoureteral reflux diagnosis.

The prevalence of vesicoureteral reflux (VUR), although reported to be low in the general population, is high in children with urinary tract infection (UTI), first degree relatives of patients with known VUR and children with antenatal hydronephrosis. In addition, it has been shown that VUR and UTIs are associated with renal scarring, predisposing to serious long-term complications, i.e., hypertension, chronic renal insufficiency and complications of pregnancy. Therefore, diagnostic imaging for the detection of VUR in the high-risk groups of children has been a standard practice. However, none of these associations has been validated with controlled studies, and recently the value of identifying VUR after a symptomatic UTI has been questioned. In addition, several studies have shown that renal damage may occur in the absence of VUR. On the other hand, some patients, mainly males, may have primary renal damage, associated with high-grade VUR, without UTI. Recently, increasing skepticism has been noted concerning how and for whom it is important to investigate for VUR. It has been suggested that the absence of renal lesions after the first UTI in children may rule out VUR of clinical significance and reinforces the redundancy of invasive diagnostic techniques. Therefore, the priority of imaging strategies should focus on early identification of renal lesions to prevent further deterioration.

Acute Disease↗

PubMed1998

Urinary tract infections per se do not cause end-stage kidney disease.

The objective of this study was to determine the frequency with which urinary tract infection (UTI) in the absence of concomitant underlying abnormalities caused end-stage renal disease (ESRD). The records of 102 patients with ESRD (disease necessitating dialysis and/or transplant) seen at Children's Mercy Hospital during a 10-year period (1986- 1995) were reviewed. Obstructive uropathy, aplastic/hypoplastic/dysplastic kidneys, polycystic kidney disease, congenital nephrotic syndrome, acquired glomerulonephritis, idiopathic interstitial nephritis, hemolytic uremic syndrome, and a variety of systemic conditions were the cause of ESRD in 99 children; 3 children had reflux nephropathy, 1 of whom had no history of a UTI and another who had a single, afebrile UTI. A girl with a history of recurrent UTIs since 4 years of age had an elevated serum creatinine and grade II-III bilateral vesicoureteric reflux when evaluated at 8 years of age. She had ureteral reimplantations and control of the infections, but progressed to ESRD. This child appears to be the only 1 of 102 children who developed ESRD because of acquired renal injury in which UTIs were an important contributing factor.

Adolescent↗

PubMed1999

Hypercalciuria and recurrent urinary tract infection in Venezuelan children.

Recurrent urinary tract infection (UTI) has not been widely recognized as a clinical manifestation of hypercalciuria in children. We studied 59 children with two or more episodes of UTI, a normal urinary tract, and with hypercalciuria. Clinical manifestations were fever, dysuria, straining with micturition, hematuria, polyuria, abdominal pain, and failure to thrive. Urinary calcium/creatinine ratio was 0.36+/-0.15 mg/mg. Renal function studies included serum bicarbonate (21+/-3 mmol/l), urinary/blood PCO2 difference (11+/-11 mmHg), urinary net acid excretion (63+/-3 micromol/min per 1.73 m2), uric acid fractional excretion (13%+/-12%), and maximal urinary osmolality (920+/-236 mosmol/kg). Treatment included promotion of fluid intake, avoiding excessive salt and protein, and keeping dietary calcium between 900 and 1,200 mg/day. Potassium citrate or hydrochlorothiazide were indicated if hypercalciuria persisted. With this treatment, in 95% of the children, no further episodes of UTI occurred once normocalciuria was achieved. It is possible that hypercalciuria may play a predisposing role for recurrent UTI in children by promoting the formation of microcrystals which damage the uroepithelium. We advocate the investigation of urinary calcium excretion in children with recurrent UTI and a normal urinary tract.

Acidosis, Renal Tubular↗

PubMed2000

Probiotic Therapy and Functional Foods for Prevention of Urinary Tract Infections: State of the Art and Science.

In the past year, interest has heightened in the potential for probiotics to prevent urinary tract infection (UTI). Mainly, this has been due to concerns about antibiotic resistance and recognition of the scientific efficacy of probiotics. The critical factors in any successful application of probiotics to patient care are the scientific basis for selecting probiotic strains and clinical verification that they are effective against the recurrence of UTI. Three strains--Lactobacillus rhamnosus GR-1 and Lactobacillus fermentum B-54 and RC-14--have been shown to colonize the vagina and act as a barrier to the ascension of uropathogens into the bladder. Their ability to produce growth and adhesion antagonists against urogenital pathogens is clinically important, because these appear to be important mechanisms of action. Probiotic therapy has been shown to be safe, but too few reliable products are on the market, and none are yet available for use against UTI. Given the right strains and delivery system, probiotic therapy could provide the first new UTI-prevention system in 40 years, and may help in the management of recurrent UTI.

Journal Article↗

PubMed2026

The agroenvironmental-clinical link of Proteus mirabilis: Genomic epidemiology, clonal relationships, and shared resistance and virulence profiles.

Proteus mirabilis is an opportunistic pathogen frequently associated with urinary tract infections (UTIs), with its pathogenicity driven by coordinated virulence traits such as adhesion, biofilm formation, and toxin production. The systemic emergence of antimicrobial resistance (AMR) within this species raises critical concerns regarding its persistence across clinical and environmental niches. This study investigated the virulence profiles, AMR determinants, and molecular epidemiology of P. mirabilis isolates recovered from retail vegetables and human community-acquired UTIs (CA-UTIs) in southern Brazil. A total of 310 isolates were analyzed (110 from vegetables and 200 from UTIs). Multidrug resistance was observed in 36.6-42.0% of vegetable isolates and 16.0% of UTI isolates, while extended-spectrum β-lactamase (ESBL) production reached 32.0% in the vegetable group. Notably, the carbapenemase gene blaKPC-2 was identified in vegetable isolates, representing a critical food safety concern. High-consequence resistance genes, including blaCTX-M variants, fosA3, and qnrD, were widely distributed. Furthermore, all isolates harbored multi-element virulence profiles-particularly genes encoding fimbriae, proteases, and iron acquisition systems-and exhibited strong or very strong biofilm-forming phenotypes. Clonal analysis revealed tight genetic relatedness between vegetable and clinical isolates, including indistinguishable profiles. Whole-genome sequencing identified shared sequence types (STs), most notably the high-risk clone ST773, alongside internationally reported lineages such as ST135 and ST336. Moreover, conserved mobile genetic environments flanking blaKPC-2 were structurally characterized. These findings demonstrate that food-associated P. mirabilis serves as an active agroenvironmental reservoir for virulent and multidrug-resistant lineages, posing an unmonitored risk for zoonotic dissemination and human infection within the One Health framework.

bla KPC−2↗

PubMed1989

Urinary nitrite in Japanese patients with urinary tract infections.

Urinary nitrite, a precursor of carcinogenic nitrosamines, and nitrate were measured in 73 Japanese patients with urinary tract infections (UTI) and in two control groups. Nitrite was detected in 12% of patients with uncomplicated UTI (226 +/- 161 mumol/l) and in 42% of those with complicated UTI (375 +/- 297 mumol/l). None of the subjects in the control groups excreted detectable amounts of nitrite. The excretion of nitrite in four out of five nitrite excretors continued for at least 14-55 days. The concentrations of urinary nitrite were significantly correlated with those of nitrate- plus nitrite-nitrogen, which reflect dietary nitrate ingestion. The results suggest the importance of close monitoring of nitrite excretor group in UTI patients, to clarify the mechanism of the association between UTI and bladder cancer.

Diet↗

PubMedDate not supplied

Comparison of enoxacin versus trimethoprim-sulfamethoxazole in the treatment of patients with complicated urinary tract infection.

Given the prevalence of complicated urinary tract infection (UTI) and the resistance patterns of common uropathogens, antimicrobial therapy for complicated UTI must be carefully selected. For patients with complicated UTI who can be treated with oral medication, the quinolones or trimethoprim-sulfamethoxazole (TMP-SMX) are reasonable treatment choices. Enoxacin and TMP-SMX were compared for efficacy, safety, and bacteriologic response in this study. A total of 260 patients with complicated UTI were enrolled in a multicenter, open-label, randomized study and received enoxacin or TMP-SMX. Short-term assessments 5 to 9 days posttherapy and long-term assessments 4 to 6 weeks posttherapy included physical and clinical evaluations, laboratory testing, urine cultures, and susceptibility testing. Although enoxacin and TMP-SMX demonstrated comparable short-term efficacy rates, enoxacin exerted a potent, long-term bacteriologic response, particularly against Escherichia coli. Enoxacin therapy achieved a 94.7% long-term eradication rate against E coli compared with a 76.0% eradication rate against this pathogen with TMP-SMX. Most adverse events were mild, and a comparable incidence (approximately 17%) occurred in both treatment groups. These data indicate that enoxacin is an excellent addition to the armamentarium of agents commonly used in the treatment of patients with complicated UTI.

Adult↗

PubMed1992

Urinary-tract infections in African neonates.

During a 4-year period between January 1987 and December 1990, 41 high-risk neonates with proven urinary tract infections (UTIs) were studied prospectively and compared with 55 control neonates. An incidence of 2.6 UTIs per 1000 live births was noted, amongst whom no obvious radiological abnormalities of the urinary tract were found. Significantly, more males than females developed UTIs, the ratio being 4.5:I. Low-birth-weight babies were significantly more often affected than those of normal weight (P less than 0.05). Staphylococcus aureus and Klebsiella spp. were the predominant pathogens isolated. Aetiologically, bacteraemia from sepsis was important. Most of the infants presented with a significantly higher incidence of pyrexia, abdominal distension, lethargy and jaundice (P less than 0.01). The overall mortality rate of 17.1% was closely related to these associated problems. The relatively high incidence of UTI and the rarity of radiological abnormalities of the urinary tract in the African neonate contrast with previous reports in the literature and the reason is worthy of consideration. Despite the rarity of urinary-tract anomalies, a continuous surveillance of the trend of neonatal UTI and its outcome is recommended.

Bacterial Infections↗

PubMed2005

Urinary tract infection in patients with acute coronary syndrome: a potential systemic inflammatory connection.

BACKGROUND: Inflammation has been linked with atherosclerotic disease development and instability. Contributors to systemic inflammation, such as subclinical infection, may trigger acute coronary syndromes (ACSs). METHODS: Using a case-control study design, we evaluated the prevalence of urinary tract infection (UTI) among 100 consecutive ACS patients, compared with a contemporary control group undergoing elective coronary artery bypass graft (CABG) surgery. Cases were excluded if ACS was not confirmed by chart review or if a urinalysis was not obtained <or=6 hours of arrival. Patients excluded from the control group were those with myocardial infarction (MI) within 21 days before CABG or without a pre-CABG urinalysis. RESULTS: The case and control groups were well matched, with the only significant differences being less congestive heart failure (OR 7.3, 95% CI 3.3-15.9) and more prior MI (OR 0.5, 95% CI 0.3-0.9) in the CABG control group. UTI was present in 27 of the ACS cases and 11 of the controls. Among ACS case patients, those with UTI tended to be older and more often women, with more diabetes, hyperlipidemia, hypertension, and renal insufficiency, and more commonly had non-ST elevation MI. In unadjusted analysis, UTI was 3 times more common in the cases versus controls (OR 3.0, 95% CI 1.4-6.4); results were similar after multivariable adjustment (OR 3.0, 95% CI 1.3-6.8). CONCLUSIONS: Subclinical UTI is common among patients with ACS. Underlying infection may precipitate ACS via activation of systemic inflammation. This hypothesis should be explored in other data sets, and similar relationships with other bacterial and viral infections should be examined.

Acute Disease↗

PubMed2004

Accurate topographical diagnosis of urinary tract infection in male patients with (111)indium-labelled leukocyte scintigraphy.

Background: Although the clinical diagnosis of urinary tract infection (UTI) is straightforward, the precise localization of the urogenital organ affected by the infection is often difficult to establish. Methods: To evaluate this, we prospectively studied 20 males with a clinical diagnosis of acute pyelonephritis (APN), acute prostatitis (AP) and febrile UTI (FUTI), as well as seven control females with APN. (111)Indium-labelled leukocyte scintigraphy (ILS) was performed during the febrile episode and repeated when patients were free of symptoms. Results: ILS showed an abnormal uptake in a urinary organ in every case. All patients with AP showed uptake in the pelvic area. Four male patients presented AP, one of them had uptake in the lumbar area, one in the lumbar and pelvic area, and two in the area of the prostate only. Six out of seven patients with FUTI presented uptake in the pelvic area. All female patients showed kidney uptake. After the clinical resolution of the UTI, no residual uptake was found in any case except for one. Conclusions: These results suggest that ILS is very useful in localizing the affected organ in febrile UTI. Most male patients with a febrile UTI presented a prostatic involvement, suggesting that many cases of APN or FUTI in males may actually be cases of AP not recognized by standard clinical evaluation.

Journal Article↗

PubMed2005

Intermittent catheterisation with hydrophilic-coated catheters (SpeediCath) reduces the risk of clinical urinary tract infection in spinal cord injured patients: a prospective randomised parallel comparative trial.

OBJECTIVES: To compare the performance of SpeediCath hydrophilic-coated catheters versus uncoated polyvinyl chloride (PVC) catheters, in traumatic spinal cord injured patients presenting with functional neurogenic bladder-sphincter disorders. METHODS: A 1-year, prospective, open, parallel, comparative, randomised, multi centre study included 123 male patients, > or =16 y and injured within the last 6 months. Primary endpoints were occurrence of symptomatic urinary tract infection (UTI) and hematuria. Secondary endpoints were development of urethral strictures and convenience of use. The main hypothesis was that coated catheters cause fewer complications in terms of symptomatic UTIs and hematuria. RESULTS: 57 out of 123 patients completed the 12-month study. Fewer patients using the SpeediCath hydrophilic-coated catheter (64%) experienced 1 or more UTIs compared to the uncoated PVC catheter group (82%) (p = 0.02). Thus, twice as many patients in the SpeediCath group were free of UTI. There was no significant difference in the number of patients experiencing bleeding episodes (38/55 SpeediCath; 32/59 PVC) and no overall difference in the occurrence of hematuria, leukocyturia and bacteriuria. CONCLUSIONS: The results indicate that there is a beneficial effect regarding UTI when using hydrophilic-coated catheters.

Adolescent↗

PubMed2026

Heightened frequency of innate immunity risk alleles in south Indian diabetics with urinary tract infections.

Urinary Tract Infections are an emerging public health concern among individuals with diabetes mellitus, particularly in South Asia where high disease burden, genetic diversity and increasing drug resistance contribute to the progressive increase in burden. While metabolic and clinical risk factors are well studied, the role of host innate immune genetic variations in shaping UTI susceptibility among diabetics remains poorly understood. This case-control study evaluated functional polymorphisms in key innate immunity genes, TLR4 (rs4986790, rs4986791), MBL2 (rs1800450) and LTA (rs909253), in 70 T2D patients with UTI and 70 T2D patients without UTI. Genotyping was performed using 5'-hydrolysis probe assay. Across all the four SNPs, the risk allele consistently showed a higher frequency among T2D patients with UTI, indicating a directional trend suggestive of cumulative susceptibility. Also, a strong and significant protective association was observed for the LTA rs909253 'G' allele, which was less frequent in cases than controls. This low-inflammatory 'AA' genotype was also markedly enriched among rUTI cases compared to controls. Clinically, 34.3% of cases experienced rUTIs. This observed directional increase of risk alleles across all four innate immunity SNPs, along with the protective role of LTA rs909253 'G' allele, highlights cumulative host genetic modulation of UTI risk in T2D and supports translational use of genetic profiling in infection risk prediction.

Humans↗

PubMed2004

Bacterial resistance to antimicrobials in urinary isolates.

Escherichia coli accounted for about 80% of organisms in uncomplicated urinary tract infections (UTIs), followed by Staphylococcus spp. especially Staphylococcus saprophyticus, and Proteus mirabilis. Against E. coli isolates from patients with uncomplicated UTI, faropenem was the most effective. Up to 1999, fluoroquinolone-resistant isolates were not observed in patients with uncomplicated UTI, but in 2001 fluoroquinolone-resistant E. coli isolates emerged and accounted for about 8%. Various types of organisms were isolated in patients with complicated UTI. Enterococcus faecalis, E. coli, and Pseudomonas aeruginosa were the three most frequent organisms isolated. These three organisms accounted for 44.6%. Amongst oral agents, faropenem showed the lowest rate of resistance against E. coli followed by cephems. The rates of highly fluoroquinolone-resistant and cefpodoxime-resistant E. coli isolates increased rapidly from 1998 to 2001. Fluoroquinolone-resistant P. aeruginosa isolates accounted for about 40% in 2001. Against this species, amikacin was the most effective antimicrobials among all agents tested. About 17% of Pseudomonas were resistant to carbapenem. Eight milligram per litre of ampicillin inhibited all E. faecalis isolates; about 60% of Enterococcus faecium were resistant to ampicillin. The rates of levofloxacin-resistant isolates of E. faecalis and E. faecium were 38 and 97% respectively. UTIs caused by vancomycin resistant enterococci (VRE) are rare in Japan.

Anti-Bacterial Agents↗