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PubMed1997

Vesicoureteric reflux and timing of micturating cystourethrography after urinary tract infection.

OBJECTIVE: To test the medical belief that the micturating cystourethrogram (MCU) be deferred four to six weeks after acute symptomatic urinary tract infection (UTI) because of the risk of falsely detecting vesicoureteric reflux if performed earlier. STUDY DESIGN: A cross sectional analytic study of preschool children with first time symptomatic UTI. RESULTS: Of the 284 eligible children, 272 (95.8%) had MCU at a median time of 29 days after diagnosis (range 5 to 167 days). Vesicoureteric reflux was present in 77 children (28.3%). Beyond one week after diagnosis (270 children) the proportion and severity of vesicoureteric reflux detected was not associated with the timing of the MCU. Before one week, both children tested had vesicoureteric reflux. CONCLUSIONS: The presence and grade of vesicoureteric reflux is not influenced by the timing of the MCU one week after acute symptomatic UTI. There may be an association between the MCU and the presence of vesicoureteric reflux for children tested within one week after UTI. The MCU need not be deferred for four to six weeks after UTI.

Child, Preschool↗
PubMed2003

Bacterial susceptibility to oral antibiotics in community acquired urinary tract infection.

BACKGROUND: The most common oral antibiotics used in the treatment of urinary tract infection (UTI) are sulphonamides and cephalosporins, but emerging resistance is not unusual. AIMS: To assess the change in susceptibility of urinary pathogens to oral antibiotics during the past decade in children with community acquired UTI. METHODS: The study sample included two groups of children with a first community acquired UTI: 142 children enrolled in 1991 and 124 enrolled in 1999. UTI was diagnosed by properly collected urine specimen (suprapubic aspiration, transurethral catheterisation, or midstream specimen in circumcised males) in symptomatic patients. Antimicrobial susceptibility of the isolates was compared between the two groups. RESULTS: The pathogens recovered in the two groups were similar: in 1991--E coli 86%, Klebsiella 6%, others 8%; in 1999--E coli 82%, Klebsiella 13%, and others 5%. A slight but generalised decrease in bacterial susceptibility to common antibiotics in the two groups was shown: ampicillin 35% versus 30%; cephalexin 82% versus 63% (p < 0.001); nitrofurantoin 93% versus 92%. The only exception was co-trimoxazole, 60% versus 69%. Overall resistance to antibiotics in 1999 was as follows: ampicillin 70%, cephalexin 37%, co-trimoxazole 31%, amoxicillin-clavulanate 24%, nitrofurantoin 8%, cefuroxime-axetil 5%, nalidixic acid 3%. CONCLUSIONS: This study shows a slight but generalised decrease in bacterial susceptibility to common oral antibiotics in the past decade in our population. Empirical initial treatment with co-trimoxazole or cephalexin is inadequate in approximately one third of UTI cases. A larger number of pathogens may be empirically treated with amoxicillin-clavulanate (24% resistance); 95% of organisms are susceptible to cefuroxime-axetil.

Administration, Oral↗
PubMed1980

Diagnostic value and biological significance of antibody-coated bacteria in urine.

The incidence of antibody-coated bacteria (ACB) in the urinary sediments as an indication of the site of urinary tract infections (UTI) was investigated in 103 adult subjects with persistent bacteriuria by means of a direct immunofluorescence technique.ACB were found in 49 of 58 (84.5%) subjects with long-standing upper urinary tract obstruction and in 5 of 45 (11.1%) with lower UTI; this difference was statistically significant (X(2) = 51.79; P<0.001). The group with upper UTI was further subdivided according to renal function (patients with renal insufficiency had both bilateral obstruction and bilateral renal damage); 21 positive results were obtained in 27 (77.8%) patients with normal renal function, whereas 28 positive cases were observed among 31 (90.3%) patients with chronic renal insufficiency. Thus the degree of renal involvement also seemed to influence the outcome of the test. Within the group of lower UTI, a higher rate of ;false-positive' results was obtained in 14 patients with symptomatic long-standing infection (21.4%) than in 31 subjects with asymptomatic bacteriuria (6.4%). The three major immunoglobulin classes and the secretory component were studied in 42 cases. Of these, 29 were found to be positive for ACB. The constant presence of IgA and secretory component on the surface of ACB suggests that the secretory immune system plays an important role in UTI.

Antibody-Coated Bacteria Test, Urinary↗
PubMed2003

A comparison of the performance of commercially available chromogenic agars for the isolation and presumptive identification of organisms from urine.

AIMS: To compare four media-UTI medium, BBL CHROMagar, CPS ID2, and Harlequin CLED-using a collection of fully characterised organisms and subsequent "field trial". METHODS: Seven hundred and eighty seven fully characterised isolates (730 Gram negative bacteria, 47 Gram positive bacteria, and 10 yeasts) were used to test for accuracy of organism identification. To assess isolation rates and ability to detect mixed cultures, 1435 urine samples were cultured in the three best performing chromogenic media (UTI medium, BBL CHROMagar, and CPS ID2) and CLED. RESULTS: The chromogenic agars differed in their accuracy of identification, with BBL CHROMagar performing best and Harlequin CLED performing least well. Similarly, BBL CHROMagar achieved a higher overall isolation rate than UTI medium and CPS ID2. When mixed growth was defined as greater than two organism types, BBL CHROMagar detected more mixed cultures than did UTI medium and CPS ID2, although the differences were not significant. When mixed growth was defined as greater than one organism type the increased number of mixed growths detected by BBL CHROMagar became significant, largely because of differences in enterococcal isolation rates. CONCLUSION: The use of BBL CHROMagar, UTI medium, or CPS ID2 chromogenic agar as a replacement for CLED agar would improve the detection rate of contaminated urine samples. Enhanced identification helps to distinguish different species, facilitating the monitoring of bacterial resistance in support of the national antibiotic strategy. BBL CHROMagar gave the highest overall organism recovery rates, greatest ability to detect mixed cultures, and the most accurate identification of organisms.

Agar↗
PubMed1978

Urinary tract infection in a clinic for sexually transmitted diseases.

A study of the prevalence of urinary tract infection (UTI) in 430 women attending a clinic for sexually transmitted diseases and its relationship to sexual activity is presented. UTI, usually asymptomatic, was found to be slightly more common in women attending the clinic than in the general population, its prevalence being 4.9%. UTI was more commonly found in patients who gave a history of recent sexual intercourse, which suggests that recent coitus was a factor in the development of significant bacteriuria. The likelihood of finding significant bacteriuria was not related to the number of sexual partners in the previous year. Trichomoniasis was more common in the small group of patients with UTI than in other women. The most common causative organism of UTI was Escherichia coli, and the isolates were usually sensitive to ampicillin, sulphonamides, trimethoprim, and nitrofurantoin.

Adolescent↗
PubMed2005

The effects of oxidative stress in urinary tract infection during pregnancy.

The purpose of this study was to determine the effect of urinary tract infection (UTI) on antioxidant systems and lipid peroxidation (LPO) levels during pregnancy. We also investigated if these antioxidant systems and LPO levels differed in each trimester. One hundred forty-three nonpregnant women, as a control group, and 77 pregnant women were included in the study. Urine cultures were performed according to standard techniques. Catalase (CAT), superoxide dismutase (SOD), and LPO levels were measured using a spectrophotometer. UTI was observed in 14 of 77 pregnant women and the isolated microorganisms were Escherichia coli, Klebsiella pneumoniae, and Staphylococcus saprophyticus. CAT, SOD, and LPO levels were increased in pregnant women compared with nonpregnant women (P<.01). CAT, SOD activities, and LPO levels were increased from the first trimester to the third trimester in pregnancy without UTI. However, CAT and SOD activities were decreased, LPO levels were increased from the first trimester to the third trimester in pregnancy with UTI (P<.01). Pregnancy causes oxidative stress and also UTI during pregnancy may aggravate oxidative stress.

Adult↗
PubMedDate not supplied

[Urinary tract infection by Candida species].

OBJECTIVES: To determine the frequency and characteristics of urinary tract infection (UTI) by Candida in diabetic patients (with and without symptoms) and to compare them with non-diabetic patients (with and without symptoms). DESIGN: Longitudinal, descriptive, and observational study. SETTING: Study conducted at the "Dr Ignacio Chavez" Clinic of family medicine, ISSSTE: Mexico. PARTICIPANTS: There were 2 kinds of patients; 1 with diabetes mellitus diagnosis (DM) with and without clinical picture of probable urinary tract infection (UTI), and 1 without DM and with and without clinical picture of probable UTI. MAIN MEASUREMENTS: A urine culture and a confidential questionnaire were administered to find the presence of urinary symptoms and likely risk factors associated with the infection. To associate these risks, the chi2 statistical method was used, with significance at 95% and Fisher's Exact Test for small frequencies, using the EpiInfo V.6.0 program. RESULTS: Two hundred thirty seven patients between 28 and 82 years old were included. The prevalence of urinary infection by Candida was 5.1%, but only 33% of these had C albicans. There was no association between candidiasis and factors like age, sex, or presence of DM, but it was related to previous treatments, previous UTI and the evolution time of DM. CONCLUSIONS: The conscious search by both doctor and laboratory for Candida micro-organisms as factors causing UTI is important. This is especially so in those patients with factors of risk that may condition Candida's presence.

Adult↗
PubMedDate not supplied

[Antimicrobial susceptibility of uropathogens and outcome following antibiotic treatment for urinary tract infections in primary health care].

BACKGROUND AND OBJECTIVE: An increase in the resistance to antimicrobial agents among bacteria causing urinary tract infections (UTI) has been reported. The aim of this study was to relate uropathogen susceptibility to prescribed antibiotics for UTI to the clinical outcome after therapy in primary health care patients. METHODS: A prospective longitudinal study, including 118 women diagnosed with UTI was carried out in primary health care centers. The results of urine culture, antimicrobial susceptibility testing and the prescribed antibiotic treatment were recorded. The patients' clinical outcome and the results of follow-up urine cultures after therapy were also recorded. RESULTS: The uropathogens isolated were susceptible to the prescribed antibiotic in 86% of patients. Clinical improvement at two weeks was observed in 91% of patients with bacteria sensitive to the prescribed antibiotics and 7% of patients with resistant bacteria (P = 0.06). At 4-6 weeks, there were no clinical symptoms in 88% of patients with sensitive bacteria and 71% of patients with resistant bacteria (p = 0.23). In follow-up urine cultures, bacteria had been eradicated in 74% of patients with sensitive bacteria and 50% with resistant bacteria (p = 0.34). CONCLUSIONS: The majority of women diagnosed with UTI in primary health care had uropathogens sensitive to the prescribed antibiotic and treatment was effective at short term in this study. The results of antimicrobial susceptibility testing were not always related to the clinical outcome; bacterial resistance may overestimate the risk of therapeutic failure in UTI.

Adolescent↗
PubMed1999

Urinary tract infection in diabetic patients.

AIM: The aim of the study was to compare the epidemiological, microbiological and clinical features of diabetic patients with urinary tract infection (UTI) to those of nondiabetic ones. METHODS: A prospective study was performed on 490 consecutive patients with proven UTI. The patients were studied on the basis of a specific questionnaire and hospital records. RESULTS: Of 490 enrolled patients, 89 (18.1%) had diabetes mellitus. The mean age of diabetics and nondiabetics was respectively 64.9 +/- 13.2 (SD) and 54.4 +/- 23.3 years. Most diabetics had asymptomatic bacteriuria and had undergone bladder catheterization more frequently than the nondiabetics. The most frequent causative agents of UTI in diabetics and nondiabetics were: E. coli (respectively, 56.1 vs. 56.8%), Proteus sp. (7.9% vs. 7.2%), Pseudomonas sp. (6.7 vs. 8.2%), Enterococcus sp. (6.7 vs. 7.2%). More than 50% of the isolated Pseudomonas sp. strains in both groups were resistant to gentamicin, piperacillin and norfloxacin. Both diabetics (52.8%) and nondiabetics (42.2%) had recurrent UTI during the follow-up period; the difference in the incidences did not reach statistical significance. CONCLUSION: No significant differences in epidemiological, clinical and microbiological evaluated features of diabetics and nondiabetics were pointed out, except for the higher frequency of bladder catheterization of diabetics than nondiabetics. However, the eradication of UTI seemed to be more difficult in diabetics than in nondiabetics.

Bacteriuria↗
PubMed2003

Relationship between febrile urinary tract infection and urodynamics in myelodysplastic children with vesicoureteral reflux.

OBJECTIVE: We conducted a retrospective study in order to identify factors that may predict the incidence of febrile urinary tract infection (UTI) in myelodysplastic children with vesicoureteral reflux (VUR). METHODS: A total of 23 myelodysplastic children with persistent VUR who were managed by clean intermittent catheterization (CIC) were eligible for this study. Any factors, including urodynamic parameters and urinary tract abnormalities, that may have been associated with the incidence of febrile UTI were evaluated using both univariate analysis and multiple logistic regression analysis. RESULTS: Of 23 patients, 10 (43%) had had one or more episodes of febrile UTI. Both univariate and multivariate analyses showed a statistically significant relationship between low bladder compliance (<10 ml/cm H(2)O) and episodes of febrile UTI. CONCLUSION: These results demonstrated that the urodynamics linked to bladder function disorder in the filling phase appear to be correlated with the incidence of febrile UTI in myelodysplastic children with VUR who are managed by CIC.

Child, Preschool↗
PubMed1994

Two-day therapy with cefuroxime axetil is effective for urinary tract infections in children.

Short-course therapy for pediatric urinary tract infection (UTI) remains controversial. The present study was undertaken to compare the effectiveness of cefuroxime axetil (Ceftin) as short-course (2-day) versus conventional (10-day) therapy for uncomplicated pediatric UTIs. In a randomized, controlled, prospective study, we enrolled 50 children, 2-11 years of age, to receive oral cefuroxime axetil, 125 mg twice a day, for either 2 or 10 days. UTI was defined as at least 10(5) colonies/ml of a single pathogen isolated on clean catch, or at least 10(4) colonies/ml on a catheterized specimen. A 10-fold or greater reduction in colony count of the initially isolated organism (3-5) days after stopping therapy was considered a bacteriologic success, as long as the absolute colony count was below the threshold for UTI described above. Patients were followed for 15 months with multiple repeat urine cultures and radiologic studies. Twenty-five of the 50 patients enrolled were withdrawn, including 12 for initially inadequate colony counts. Eight of 12 patients in the short-course group (67%), versus 12 of 14 in the conventional-therapy group (86%), were initial bacteriological successes, a nonsignificant difference. All 37 initially isolated uropathogens were sensitive to cefuroxime axetil in vitro. Cefuroxime axetil is an effective antimicrobial for uncomplicated pediatric UTIs. Two-day therapy with cefuroxime axetil appears to be as effective as 10-day therapy, although sample size was limited in this study.

Administration, Oral↗
PubMed1984

Localization of catheter-induced urinary tract infections: interpretation of bladder washout and antibody-coated bacteria tests.

Accurate differentiation of upper from lower urinary tract infection (UTI) has been reported based on the presence or absence of antibody-coated bacteria (ACB) in the urinary sediment. The specificity of ACB localization in adults has been reported to be high based on a strong correlation with localization results obtained with the bladder washout technique. The present study examines the efficacy of ACB testing with respect to accurate anatomic localization of UTI in 20 studies in 14 patients exhibiting bacteriuria as a result of chronic urethral catheterization. 17 studies (85%) demonstrated significant ACB. Localization of UTI was assessed in each study by the bladder washout technique. Following instillation of a washout solution, a normal decrease in colony counts was observed in only 3 studies (15%), a frequency significantly lower than the value of 90% previously reported in noncatheterized bacteriuric patients (p less than 0.001). Each of these 3 patients was ACB-positive, yet anatomic localization indicated lower tract UTI. The observed characteristics of the 14 patients included the absence of upper tract signs and symptoms, and spontaneous clearing of ACB and bacteriuria following catheter removal. These findings suggest that in chronically catheterized patients, both (1) the observed abnormal resistance of bacteria to bladder washout and (2) the high frequency of positive ACB tests are indices of severe chronic tissue invasion and intense antibody production in the lower urinary tract in this condition and thus not of value in localizing infection to the upper tract. Neither ACB nor washout testing with current techniques can reliably localize UTI in chronically catheterized patients.

Adult↗
PubMed1982

Urinary trypsin inhibitor and urokinase activities in renal diseases.

Using an improved method of determination, urinary trypsin inhibitor (UTI) activities were assayed in relation to urokinase (UK) activities in a large group of patients with various renal diseases. In normal subjects (n = 50), the mean 24-hour values of the UTI and UK activities were 4.29 +/- 1.44 U/ml and 9.80 +/- 3.81 IU/ml, respectively. Data for renal diseases such as renal stone, hydronephrosis, renal cancer, and chronic glomerulonephritis (UTI, 5.51 +/- 2.29 U/ml (p less than 0.005) and UK, 6.88 +/- 2.64 IU/ml (p less than 0.001); n = 40), and particularly uremia (UTI, 9.90 +/- 5.68 U/ml (p less than 0.001) and UK, 3.85 +/- 2.36 IU/ml (p less than 0.001); n = 30), showed that the UTI level was increased whereas the UK level was decreased. The UTI/UK ratio more clearly demonstrated the difference between these diseases.

Antibodies↗
PubMed1990

Fosfomycin trometamol versus norfloxacin in the treatment of uncomplicated lower urinary tract infections of the elderly.

Ten years of controlled clinical trials supported single-dose therapy efficacy and safety in uncomplicated lower urinary tract infections (UTI). Both local and systematic factors contribute to the high UTI prevalence seen in elderly people. A controlled open randomized study was undertaken to evaluate the clinical efficacy and safety of a new fosfomycin derivative (fosfomycin trometamol) given in a single dose in the treatment of uncomplicated lower UTIs in 60 elderly subjects (mean age 68.4 years). A single 3-gram fosfomycin trometamol dose was compared to a 7-day treatment with norfloxacin 400 mg b.i.d. Midstream urocultures and susceptibility tests were performed to diagnose a UTI and at 3-5 and 25-35 days after discontinuation of therapies. Our results, showing comparable clinical and bacteriological resolution rates in both groups (76.6 and 73.3% in the fosfomycin-trometamol- and norfloxacin-treated subjects, respectively), support the single-dose fosfomycin trometamol efficacy in uncomplicated lower UTIs in an elderly population, suggesting it as a convincing alternative to longer therapeutic regimens.

Aged↗
PubMed1992

Urinary tract infection caused by nontyphoidal Salmonella: report of 30 cases.

Thirty cases of nontyphoidal Salmonella bacteriuria were identified by review of cultures performed at the Mayo Clinic (Minn.) from 1985 to 1989 and at the Federal Public Health Laboratory Innsbruck (Austria) from 1979 to 1989. All patients had symptoms of an acute urinary tract infection (UTI). In 24 cases nontyphoidal Salmonella was the sole pathogen isolated. Only 1 patient presented with concomitant gastroenteritis and 2 had experienced episodes of diarrhea during the weeks before the UTI, but 15 patients had positive stool cultures in the absence of a gastrointestinal illness. Among all positive urine cultures at the Mayo Microbiology Laboratory, 0.015% were positive for nontyphoidal Salmonella; at the Federal Public Health Laboratory Innsbruck, 0.024% of organisms cultured from urine were nontyphoidal salmonellae. In the majority of our patients, Salmonella UTI did not differ clinically from UTI caused by other members of the Enterobacteriaceae; only in renal transplant recipients was the course of genitourinary salmonellosis more serious. While some urinary isolates of nontyphoidal Salmonella may be fecal contaminants, all 30 isolates recovered from urine during this study were considered to be the cause of symptomatic UTI.

Adolescent↗
PubMed1996

Persistent bacteriuria caused by uropathogenic Escherichia coli.

The predominant strain of Escherichia coli, the most frequently associated causative agent of urinary tract infections (UTI), in the rectal flora of patients with UTI has been reported to match the strain associated with the etiologic agent of UTI. Since acquisition of UTI may depend on the immediate surrounding flora of the patient, the chromosomal DNAs of strains of E. coli isolated from 3 patients suffering from recurrent cystitis and asymptomatic bacteriuria were examined by multiple polymerase chain reaction using 6 sets of primers for all the known urovirulence factors and by pulsed-filed gel electrophoresis. Genetically identical or similar strains were continuously isolated from these patients and each strain carried the identical urovirulence factors. The findings strongly supported the previous notion that the acquisition of UTI is dependent upon the occurrence of the strain carrying the urovirulence factors in patients or in the environment.

Adult↗
PubMed1989

Clearance and distribution of acid-stable trypsin inhibitor (ASTI).

The clearance, organ distribution and metabolic pathway of the acid-stable trypsin inhibitor (ASTI) were studied in mice using 125I-labeled urinary trypsin inhibitor (UTI), the most typical ASTI in the urine. Following intravenous injection of 125I-UTI, the radioactivity disappeared rapidly from the circulation with a half-life of 4 min for the initial part of the curve. Gel filtration of plasma samples revealed that the rapid disappearance of the radioactivity was due to elimination of free inhibitor from the plasma. 125I-UTI was cleared primarily in the kidney. Gel filtration of urine samples showed that part of the radioactivity in the urine appeared at the same elution volume as 125I-UTI in the plasma, indicating that the origin of UTI was ASTI in the plasma.

Animals↗
PubMed1983

Multiple molecular forms of acid-stable plasmin inhibitor derived from human urinary trypsin inhibitor.

It was found that cyanogen bromide (BrCN) treatment of the highly purified human urinary trypsin inhibitors (H-UTI; specific activity 1,897 U/mg protein, and L-UTI; specific activity 1,850 U/mg protein) readily produced new plasmin inhibitors with almost no loss of UTI activity. Five multiple forms of chemically cleaved inhibitors (UTIB-I, UTIB-II, UTIB-III, UTIB-IV and UTIB-V) could be isolated from BrCN-treated L-UTI by isoelectric focusing and gel filtration. These inhibitors were very acid-stable and their isoelectric points (pI) were 4.5, 4.6, 4.9, 5.1 and 6.4, respectively. The molecular weights by SDS-polyacrylamide gel electrophoresis were almost the same at about 23,000 +/- 3,000. Although these inhibitors showed both anti-plasmin and anti-trypsin activities, much higher anti-plasmin/anti-trypsin activities were observed in the cleaved inhibitors than in the parent UTI. They competitively inhibited human plasmin with Ki values of 3.0-4.1 X 10(-8) mol/l (H-D-Val-Leu-Lys-pNA substrate).

Antifibrinolytic Agents↗