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PubMed1993

Drug resistance of coagulase-negative staphylococci from patients with urinary tract infection.

The drug resistance of 202 coagulase-negative staphylococci (CNS) strains isolated from patients with urinary tract infection (UTI) at urinary colony counts of 10(5) or more between 1989 and 1991 was studied. Of the 202 strains, 185 were submitted from UTI patients with underlying urinary disorders (complicated UTI patients) and became rapidly resistant to the majority of drugs tested. In addition, the incidence of methicillin-resistant or multiple drug resistant CNS tended to increase. These resistant strains were significantly more frequently isolated in patients with fever, which was strongly suspected to be due to CNS UTI. These results suggest that the prevalence of drug resistance in CNS from the urinary tract rapidly increases and drug-resistant CNS aggravate CNS UTI.

Anti-Infective Agents, Urinary↗
PubMed1996

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from patients with urinary tract infections (1994). III. Secular changes in susceptibility].

Susceptibilities of Enterococcus faecalis, Staphylococcus aureus, Citrobacter spp., Enterobacter spp., Escherichia coli, Klebsiella spp., Proteus mirabilis, Pseudomonas aeruginosa and Serratia spp. isolated from patients with urinary tract infections (UTIs) in 10 hospitals during June 1994 to May 1995 to various antimicrobial agents were compared with those in the same period of previous years according to a classification, uncomplicated UTIs, complicated UTIs without indwelling catheter, and complicated UTIs with indwelling catheter. No remarkable changes were found in susceptibilities of Citrobacter spp., Enterobacter spp. and Serratia spp. The susceptibilities of E. faecalis to amikacin and quinolones were better than those in 1993. As for S. aureus, susceptible strains to all drugs increased in uncomplicated UTIs. Against E. coli in 1993, the antimicrobial activities of piperacillin, cefotiam and aminoglycosides have decreased, however, in 1994, these activities have turned to the better state. As for Klebsiella spp. susceptible strains to ABPC decreased. The susceptibilities of P. mirabilis to all drugs except minocycline were good. Against P. aeruginosa in 1993, the activities of aminoglycosides have decreased, but, in 1994, these activities have turned to the better state. These data should be considered in clinical treatment of various urinary tract infections.

4-Quinolones↗
PubMed1996

[Postoperative urinary ulinastatin secretion and renal function in hepatectomized patients with and without liver cirrhosis].

We compared ulinastatin secretion into urine with renal function during postoperative period in three groups, hepatectomized group with liver cirrhosis (LC(+), n = 7), hepatectomized group without liver cirrhosis (LC(-), n = 4) and subtotal gastrectomized group with normal liver function (GR, n = 7). In LC(+) group, N-acetyl-beta-D-glucosaminidase (NAG) increased above normal upper limit throughout the postoperative period. Ulinastatin (UTI) also increased but the increase was not remarkable. In LC(-) group, NAG increase but not significantly compared with the preoperative value. UTI increased from 5.8 +/- 3.0 IU.mg x Cr-1 to 30.8 +/- 16.6 IU.mg x Cr-1 and 39.9 +/- 9.0 IU. mg x Cr-1 on the 1st and 3rd postoperative day respectively. In GR group, there was no change in NAG value. UTI on the 3rd postoperative day increased significantly (from 10.0 +/- 7.7 to 75.4 +/- 39.0 IU.mg x Cr-1). A small urinary secretion of UTI and increased NAG during postoperative period in LC(+) group suggest that UTI might play an important role in postoperative renal dysfunction in patients with liver cirrhosis.

Acetylglucosaminidase↗
PubMedDate not supplied

[Non-comparative open study of the efficacy and tolerance of cefaclor in the prevention of urinary tract infections in children].

Cefaclor has been investigated as an additional prophylactic agent in the UTI. It is active against virtually all common urinary pathogens, is well absorbed in the upper gastrointestinal tract, is well tolerated and safe. The Authors have carried out a clinical trial of the prophylactic use of cefaclor in the prevention of recurrent urinary tract infection in children. We studied 52 children (25 females and 27 males, median age 7 +/- 19 months) with UTI, investigated by imaging (sonography, micturating cystourethrography, renal scintigraphy) and by urodynamic studies. We found vesicoureteral reflux in 37 cases, primitive megaureter in 6 cases, in 1 patient duplication of the collecting system in 1 patient and substenosis of ureteropelvic junction in 1 case. In the others 5 cases the UTI were associated with bladder disfunction and finally in 1 case the UTI occurred in absence of urinary malformations. All patients received cefaclor, as prophylaxis, at the dosage of 10-20 mg/kg/die, administrated as a single bedtime dose. The mean time of treatment with cefaclor was 8 +/- 3,48 months. We observed an optimal compliance in all patients, also in the first year of life. In only two out of 52 patients, during the prophylaxis, we found documented bacteriuria. We stopped treatment in two cases because of an adverse effect (in both children has been demonstrated a cutaneous rash). In conclusion our study shows that cefaclor is an effective, well tolerated and safe agent in the UTI prophylaxis, also in the first year of life, when it seems to offer an optime alternative to other agents.

Cefaclor↗
PubMed1998

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from patients with urinary tract infections (1996). I. Susceptibility distribution].

The frequencies of isolation and susceptibilities to antimicrobial agents were investigated on 680 bacterial strains isolated from patients with urinary tract infections (UTIs) in 10 hospitals during the period of June 1996 to May 1997. Of the above bacterial isolates, Gram-positive bacteria accounted for 30.4% and a majority of them were Enterococcus faecalis. Gram-negative bacteria accounted for 69.6% and most of them were Escherichia coli. Susceptabilities of several isolated bacteria to antimicrobial agents were as followed; 1. Enterococcus faecalis Ampicillin (ABPC) showed the highest activity against E. faecalis isolated from patients with UTIs. Its MIC90 was 1 microgram/ml. Imipenem (IPM) and vancomycin (VCM) were also active with the MIC90S of 2 micrograms/ml. The others had low activities with the MIC90S of 16 micrograms/ml or above. 2. Staphylococcus aureus including MRSA Arbekacin (ABK) and VCM showed the highest activities against both S. aureus and MRSA isolated from patients with UTIs. The MIC90S of them were 1 or 2 micrograms/ml. The others except minocycline (MINO) had low activities with the MIC90S of 32 micrograms/ml or above. 3. Staphylococcus epidermidis ABK and VCM showed the strongest activities against S. epidermis isolated from patients with UTIs. The MICs for all strains were equal to or lower than 2 micrograms/ml. Cefazolin (CEZ), cefotiam (CTM) and cefozopran (CZOP) were also active with the MIC90S of 4 micrograms/ml. Compared with antimicrobial activities of cephems is 1995, the MIC90S of them had changed into a better state. They ranged from 4 micrograms/ml 16 micrograms/ml in 1996. 4. Streptococcus agalactiae All drugs except MINO were active against S. agalactiae. ABPC, CZOP, IPM, and clarithromycin (CAM) showed the highest activities. The MICs for all strains were equal to or lower than 0.125 micromilligrams. Tosufloxacin (TFLX) and VCM were also active with the MIC90S of 0.5 micromilligrams. 5. Citrobacter freundii Gentamicin (GM) showed the highest activity against C. freundii isolated from patients with UTIs. Its MIC90 was 0.5 micrograms/ml. IPM and amikacin (AMK) were also active with the MIC90S of 1 microgram/ml and 2 micrograms/ml, respectively. Cefpirome (CPR) and CZOP were also active with the MIC90S of 8 micrograms/ml. The MIC90S of the others were 16 micrograms/ml or above. 6. Enterobacter cloacae IPM showed the highest activity against E. cloacae. The MICs for all strains were equal to or lower than 0.5 microgram/ml. The MIC90S of ciprofloxacin (CPFX) and TFLX were 1 microgram/ml, the MIC90 of AMK was 2 micrograms/ml, the MIC90S of CZOP, GM and ofloxacin (OFLX) were 4 micrograms/ml. The MIC50S of cephems except CEZ, cefmetazole (CMZ) and cefaclor (CCL) had changed into a better state in 1996, compared with those in 1995. 7. Escherichia coli All drugs except penicillins and MINO were active against E. coli. Particularly CPR, CZOP and IPM showed the highest activities against E. coli. The MIC90S of them were 0.125 microgram/ml or below. Among E. coli strains, those with low susceptibilities to cephems except CEZ, cefoperazone (CPZ), latamoxef (LMOX) and CCL have increased in 1996, compared with those in 1995. 8. Klebsiella pneumoniae K. pneumoniae was susceptible to all drugs except penicillins, with the MIC90S of 2 micrograms/ml or below. CPR had the strongest activity, the MICs for all strains were equal to or lower than 0.25 microgram/ml. Flomoxef (FMOX), cefixime (CFIX), CZOP and carumonam (CRMN) were also active with the MIC90S of 0.125 microgram/ml or below. 9. Pseudomonas aeruginosa All drugs except quinolones were not so active against P. aeruginosa with the MIC90S were 32 micrograms/ml or above. Quinolones were more active in 1996 than 1995. The MIC90S of them were between 4 micrograms/ml and 8 micrograms/ml, and the MIC50S of them were between 1 microgram/ml and 2 micrograms/ml. 10. Serratia marcescens GM showed the highest activity against S. marcescens. Its MIC90 was 1 micro

Anti-Bacterial Agents↗
PubMed1998

[Which treatment should children with recurrent urinary infections, without anatomical anomalies, receive?].

OBJECTIVE: To determine the best treatment for children with recurrent infection of the lower urinary tract and without anatomical abnormalities. METHODS: A clinical study was conducted on 150 children (30 boys and 120 girls), aged 4 to 36 months (mean 16), with recurrent urinary tract infections (UTI) and no radiological evidence of anatomical abnormalities. They were divided into three groups: group I was treated with a single nightly prophylactic dose of an antibiotic; group II received a single nightly dose of oxybutinin, or divided in 2-4 doses; group III received a single nightly prophylactic dose of an antibiotic and oxybutinin as in group II. RESULTS: There were more episodes of UTI in group I (44/50), more hospitalizations and problems of malnutrition, and a longer period of treatment was required. In group II, 14/50 children had episodes of UTI, their nutritional status improved and there were less hospitalizations. In group III, 3/50 children had episodes of UTI; they were the best responders and required a shorter duration of treatment. CONCLUSIONS: Prophylactic therapy requires a longer period of treatment. The use of oxybutinin is an alternative modality in the treatment of these children. Combination therapy with a single nightly dose of an antibiotic and anticholinergic (oxybutinin) appears to be the best therapeutic modality for children with recurrent UTI and no anatomical abnormality.

Child, Preschool↗
PubMed1998

Estrogen replacement therapy and urinary tract infections in postmenopausal women aged 45-89.

OBJECTIVE: An elevated risk of urinary tract infections (UTIs) in postmenopausal women has been attributed to an increase in the vaginal pH. Estrogen replacement therapy (ERT) helps restore the vaginal milieu and may have a beneficial effect on risk of infection. Studies examining the association between ERT and UTIs have been inconsistent. We conducted a nested case control study to clarify this relationship in women aged 45-89. DESIGN: For each case, we selected up to five control women, matched by year of birth. We used pharmacy records to classify women as new users, past users, ongoing users (past and new users), and never users of ERT. There were 254 cases and 1,268 controls. RESULTS: The risk ratio for UTI was 1.02 [95% confidence interval (CI) 0.74, 1.40] for any use versus never use, after adjustment for health care utilization. The risk ratio for the association between new use and UTI was 1.13 (95% CI 0.46, 2.77). For ongoing users the risk ratio was 1.08 (95% CI 0.76, 1.54), whereas the risk ratio for past use was 0.77 (95% CI 0.39, 1.48). CONCLUSIONS: Our results do not support a protective effect of ERT on the risk of UTIs.

Aged↗
PubMed1996

The association of urinary tract infection with a recent pelvic examination in women.

We tried to determine whether women with a urinary tract infection (UTI) were more likely to have had a recent pelvic examination than were women seen for other reasons. We compared 56 women who were diagnosed as having a UTI with 49 controls who had an unrelated complaint (sinusitis). Significantly more women with UTIs had received a pelvic examination within the preceding 2 months (43% vs 16%, P = .01). We conclude that having a pelvic examination is associated with an increased risk of a UTI developing within the following 2 months. This may be due to physical factors related to the examination or to risk factors related to the patients' reasons for obtaining a pelvic examination. Further study is needed to determine if the pelvic examination is an independent risk factor. If so, established preventive measures could reduce this risk.

Adolescent↗
PubMed2006

Current antibiotic therapy for isolated urinary tract infections in women.

BACKGROUND: Sulfa antibiotics, such as a combination product of trimethoprim and sulfamethoxazole, have traditionally been the drugs of choice for urinary tract infections (UTIs) and remained the most common treatment as recently as a decade ago. However, increasing sulfa resistance among Escherichia coli may have led to changes in prescribing practices. METHODS: We used the 2000-2002 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey to obtain nationally representative data on antibiotics prescribed for women with isolated outpatient UTIs following visits to physicians' offices, hospital clinics, and emergency departments (n = 2638). Logistic regression was used to determine predictors of quinolone use. RESULTS: Quinolones were more commonly prescribed than sulfa antibiotics in each year evaluated. In the most recent year of data, quinolones were prescribed in 48% and sulfas in 33% of UTI visits (P<.04). Quinolones were significantly more likely to be prescribed to older patients and in visits occurring in the Northeast; however, no difference in quinolone prescribing was seen when evaluating insurance status, setting, race, ethnicity, health care provider type, and year. Approximately one third of the quinolones used were broader-spectrum agents. CONCLUSIONS: Quinolones have surpassed sulfas as the most common class of antibiotic prescribed for isolated outpatient UTI in women. Few significant predictors of quinolone use exist, suggesting that the increase is not confined to a certain subset of patients. This pervasive growth in quinolone use raises concerns about increases in resistance to this important class of antibiotics.

Adolescent↗
PubMed1987

The role of bacterial virulence factors and Tamm-Horsfall protein in the pathogenesis of Escherichia coli urinary tract infection in infants.

Forty-three patients and 70 controls were enrolled in an open study to evaluate the role of bacterial virulence factors and Tamm-Horsfall protein (THP) in the pathogenesis of urinary tract infection (UTI) due to Escherichia coli. The ages of the patients and controls ranged from 5 days to 6 months. Nine patients had upper UTIs and 33 patients had lower UTIs, based on bacteremia and radiographic evidence. There were no differences between patients and controls in the percentages of strains showing hemolytic activity of E coli strains isolated from periurethral and rectal cultures. Urinary E coli strains recovered from patients showed a significantly higher percentage of mannose-resistant hemagglutination, greater P and X fimbriation, more type 1 pili, and the presence of mannose-sensitive and mannose-resistant hemagglutination when compared with E coli strains recovered from the controls. The O but not the K pyelonephritogenic serotypes were more commonly recovered from patients than from controls. The mean THP concentrations in urine (micrograms of THP per milligrams of creatinine) were 29.9 and 91.4 micrograms/mg for patients and controls, respectively. With the exception of hemagglutination properties and certain pyelonephritogenic O serotypes, other virulence factors of E coli could not be defined in our infant population. The role of THP, if any, in the pathogenesis of UTI remains unresolved.

Escherichia coli↗
PubMed1997

Risks for bacteremia and urinary tract infections in young febrile children with bronchiolitis.

OBJECTIVE: To compare the risks for bacteremia and urinary tract injections (UTI) in young febrile children with and without bronchiolitis. DESIGN: A prospective cohort study. SETTING: The emergency departments of 3 pediatric referral hospitals. PATIENTS: A convenience sample of 432 previously healthy febrile patients aged 24 months or younger. Patients were divided into groups, based on the presence (n = 163, bronchiolitis group) or absence (n = 269, control group) of wheezing and/or retractions on examination. Blood cultures were obtained from all patients, and urine cultures were obtained from female patients, and male patients aged 6 months or younger. Chest radiographs were obtained on patients with lower respiratory tract signs, and those with lobar pneumonias were excluded (7 wheezing and 8 nonwheezing patients), leaving 156 patients with bronchiolitis and 261 control patients. OUTCOME MEASURES: Growth of any bacterial pathogens from the blood or 10(4) colony-forming units per milliliter or more from the urine. RESULTS: None of the 156 patients with bronchiolitis had bacteremia (95% confidence interval, 0%-1.9%) vs 2.7% of the 261 controls (95% confidence interval, 1.1%-5.4%; P = .049); 1.9% of the patients with bronchiolitis had UTI vs 13.6% of the controls (odds ratio, 0.12; 95% confidence interval, 0.02-0.55; P = .001). None of the subset of patients with bronchiolitis aged 2 months or younger (n = 36) had bacteremia or UTI; however, there were not enough of these younger patients to make statistically conclusive comparisons. CONCLUSIONS: Previously healthy febrile children aged 24 months or younger with bronchiolitis are unlikely to have bacteremia or UTI. Therefore, routine cultures of the blood and urine in these patients are unnecessary. More data are needed regarding the subset of febrile infants aged 2 months or younger with bronchiolitis.

Bacteremia↗
PubMed1999

Evaluation of morbidity of multi-channel pressure-flow studies.

This prospective study was carried out to evaluate the morbidity and complication rate of invasive urodynamics of the lower urinary tract after receiving oral antibiotic prophylactic treatment. A total of 105 patients, 55 men and 50 women, were included in the study and underwent pressure flow study (PFS) as part of the diagnostic assessment. Clinical diagnosis was prostatic obstruction from benign prostatic hyperplasia (BPH) in men and stress urinary incontinence or voiding dysfunction in women. Urine was screened for infection both before and after testing, and the incidence of urinary tract infections (UTI), dysuria, and other complications were assessed at 1-week follow-up to evaluate post-investigation morbidity. Dysuria of mild degree was experienced by 33% of patients, with no significant difference between male and female patients. Post-investigational UTI and fever were reported in 3.6% of men and 4% of women. Six patients had macroscopic hematuria of mild degree. No patient had urinary retention or severe complaints after the investigation and no patient required hospitalization. Post-void residual volume was higher in men with BPH obstruction compared to women; a significant difference between post-investigational UTI and residual volume could not be demonstrated (P = 0.8). We conclude that the objective morbidity rate of invasive urodynamic investigation is low. Mild dysuria is common, while severe complications, fever, and hematuria are seldom reported, and the risk of developing UTIs is low with antibiotic prophylaxis, with no significant difference between men and women. Neurourol. Urodynam. 18:647-652, 1999.

Adult↗
PubMed2000

Cranberries for preventing urinary tract infections.

BACKGROUND: Cranberries (particularly in the form of cranberry juice) have been used widely for several decades for the prevention and treatment of urinary tract infections. The aim of this review is to assess the effectiveness of cranberries in preventing such infections. OBJECTIVES: To assess the effectiveness of cranberry juice and other cranberry products in preventing urinary tract infections in susceptible populations. SEARCH STRATEGY: Electronic databases and the Internet were searched using English and non English language terms; companies involved with the promotion and distribution of cranberry preparations were contacted; reference lists of review articles and relevant trials were searched. SELECTION CRITERIA: All randomised or quasi randomised controlled trials of cranberry juice/products for the prevention of urinary tract infections in susceptible populations. Trials of men, women or children were included. DATA COLLECTION AND ANALYSIS: Reviewers RJ and LM independently assessed and extracted information using specially designed data extraction forms. For each included trial, information was collected on methods of the trial, participants, interventions and outcomes. We were unable to perform statistical analysis due to the nature of the data available for review. MAIN RESULTS: Four trials met the inclusion criteria (three cross-over, one parallel group). Three compared the effectiveness of cranberry juice versus placebo juice or water and one compared the effectiveness of cranberry capsules versus placebo. Two further trials were excluded. The outcomes of interest were number of urinary tract infections in each group (symptomatic and asymptomatic), side effects and adherence to therapy. Data from three out of the four trials indicated that cranberries were effective for at least one of the outcomes of interest. The quality of the four included trials was poor, however, and thus the reliability of the results must be questionable. REVIEWER'S CONCLUSIONS: The small number of poor quality trials gives no reliable evidence of the effectiveness of cranberry juice and other cranberry products. The large number of dropouts/withdrawals from the trials indicates that cranberry juice may not be acceptable over long periods of time. Other cranberry products such as cranberry capsules may be more acceptable. On the basis of the available evidence, cranberry juice cannot be recommended for the prevention of urinary tract infections in susceptible populations. Further properly designed trials with relevant outcomes are needed.

Beverages↗
PubMed2005

Duration of antibacterial treatment for uncomplicated urinary tract infection in women.

BACKGROUND: Uncomplicated urinary tract infection (UTI) is a common disease, occurring frequently in young sexually active women. In the past, seven day antibiotic therapy was recommended while the current practice is to treat uncomplicated UTI for three days. OBJECTIVES: TO compare the efficacy and safety of three-day antibiotic therapy to multi-day therapy (five days or longer) on relief of symptoms and bacteriuria at short-term and long-term follow-up. SEARCH STRATEGY: The Cochrane Library (Issue 1, 2004), the Cochrane Renal Group's Register of trials (July 2003), EMBASE (January 1980 to August 2003), and MEDLINE (January 1966 to August 2003) were searched. We scanned references of all included studies and contacted the first or corresponding author of included trials and the pharmaceutical companies. SELECTION CRITERIA: Randomised controlled trials comparing three-days oral antibiotic therapy with multi-day therapy (five days and longer) for uncomplicated cystitis in 18 to 65 years old non-pregnant women without signs of upper UTI. DATA COLLECTION AND ANALYSIS: Data concerning bacteriological and symptomatic failure rates, occurrence of pyelonephritis and adverse effects were extracted independently by two reviewers. Relative risk (RR) and their 95% confidence intervals (CI) were estimated. Outcomes were also extracted by intention-to-treat analysis whenever possible. MAIN RESULTS: Thirty-two trials (9605 patients) were included. For symptomatic failure rates, no difference between three-day and 5-10 day antibiotic regimen was seen short-term (RR 1.06, 95% CI 0.88 to 1.28) and long-term follow-up (RR 1.09, 95% CI 0.94 to 1.27). Comparison of the bacteriological failure rates showed that three-day therapy was less effective than 5-10 day therapy for the short-term follow-up, however this difference was observed only in the subgroup of trials that used the same antibiotic in the two treatment arms (RR 1.37, 95% CI 1.07 to 1.74, P = 0.01). This difference was more significant at long-term follow-up (RR 1.43, 95% CI 1.19 to 1.73, P = 0.0002). Adverse effects were significantly more common in the 5-10 day treatment group (RR 0.83, 95% CI 0.74 to 0.93, P = 0.0010). Results were consistent for subgroup and sensitivity analyses. AUTHORS' CONCLUSIONS: Three days of antibiotic therapy is similar to 5-10 days in achieving symptomatic cure during uncomplicated UTI treatment, while the longer treatment is more effective in obtaining bacteriological cure. In spite of the higher rate of adverse effects, treatment for 5-10 days could be considered for treatment of women in whom eradication of bacteriuria is important.

Anti-Infective Agents, Urinary↗
PubMed2005

Mild pyelectasis diagnosed by prenatal ultrasound is not a predictor of urinary tract morbidity in childhood.

OBJECTIVES: To determine whether children with prenatally diagnosed mild pyelectasis have more urinary tract morbidity during childhood than children without this finding. METHODS: Case-control study in children with pyelectasis (anteroposterior diameter of the fetal renal pelvis of 5-10 mm). A validated questionnaire was sent to the parents of 208 cases and 416 matched controls. RESULTS: The questionnaire was returned by 146 cases and 250 controls. There was a male predominance in the case group (p = < 0.0001). There was no difference in voiding habits or in prevalence of urinary tract infections (UTI). The prevalence of UTI was high: 11.6% in cases and 10.0% in controls. The only difference was a higher prevalence of constipation in the case group (p = 0.003). Postnatally, 41 children had an ultrasound examination and 16 were referred to a paediatrician or urologist: 3 had persisting pyelectasis, 3 had a recurrent UTI and 1 required surgery (a pyeloplasty). Four of the controls were referred to a paediatrician or urologist: 3 had recurrent UTI and 1 had urinary incontinence. CONCLUSION: Children with a mild fetal pyelectasis do not have more urinary tract morbidity during childhood than children without this finding. Therefore, there seems to be no need for additional investigation after birth.

Adult↗
PubMed1994

Flagellate and non-flagellate Proteus mirabilis in the development of experimental urinary tract infection.

Three isolates of Proteus mirabilis from symptomatic human urinary tract infections (UTI) were tested for their ability to cause renal infection in mice. All three strains were fimbriated as tested by hemagglutination. One of the strains, Pr 988, did not possess flagella, whereas the other two did and were capable of swarming on solid rich media. We compared the capacity of these strains to infect mice in both the ascending and hematogenous mouse UTI models. Infection was assessed by counting viable bacteria in kidney and bladder homogenates in ascending UTI or by the presence of abscesses in the hematogenously inoculated mice. All three strains were able to infect mice in both UTI models. These results suggest that flagella are not absolutely necessary for virulence in these experimental models.

Administration, Intravesical↗
PubMed1988

Urinary tract infections and diurnal incontinence in girls.

To evaluate a possible relationship between urinary tract infections (UTI) and diurnal incontinence (DIC), we studied 251 girls aged 4 years or more who were referred with a history of recurrent UTI and/or DIC. During follow up (mean 35 months), 110 girls (44%) had both UTI and DIC, 50 (20%) only infections, and 41 (16%) only DIC whereas 50 (20%) had neither infection nor DIC. In 110 girls with infections occurring with intervals of at least 6 and 12 months, DIC was definitively initiated by infection on 32 (19%) occasions. Most girls were continent before the infection occurred. When the girls remained free of infection for 6 or 12 months respectively, the frequency of DIC remained unchanged. In conclusion, no support for the concept of DIC leading to UTI was obtained, whereas the reverse was found in some cases and suggested in others.

Child↗
PubMed1993

Pathogenesis of urinary tract infection--experimental studies of vaginal resistance to colonization.

The review summarizes studies of vaginal colonization resistance against Escherichia coli in a primate model. The genital flora surrounding the urethral orifice exerts a strong colonization resistance. Amoxicillin profoundly disturbs the normal vaginal microflora, reduces its adherence to vaginal epithelial cells in vivo and promotes a persistent vaginal E. coli colonization. Certain cephalosporins may have a similar effect. The induced ecological changes mimic those seen in patients with recurrent urinary tract infections (UTI). Amoxicillin also promotes the spread of E. coli from rectum to vagina, which may be of clinical significance. Trimethoprim and nitrofurantoin do not have these effects. The natural colonization resistance could not clearly be correlated with the presence of lactobacilli, which were only transiently reduced by amoxicillin. The colonization resistance against E. coli could only partly be restored by vaginal instillation of lactobacilli, but was fully restored by flushing of the whole vaginal flora from a healthy monkey. Clinical observations suggest that accumulation of E. coli around the urethral orifice increases the risk of UTI. We conclude that antibiotics and other compounds that interfere with the normal genital flora may increase the risk of UTI. This should influence the choice of antibiotics in the treatment of UTI.

Animals↗