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PubMed1987

Kelfiprim versus co-trimoxazole in recurrent and persistent urinary tract infections: multicenter double-blind trial.

Kelfiprim (KP) is a new bactericidal agent containing trimethoprim (T) and sulfametopyrazine (S), a long-acting sulfonamide (ratio 5:4). The posology is one capsule (T 250 mg + S 200 mg) daily, after a loading dose of two capsules on the first day. To evaluate the clinical value of Kelfiprim (KP) vs co-trimoxazole (CO) in urinary tract infection (UTI) a controlled multicenter double-blind trial (MDBT) was carried out in 76 patients suffering from persistent and recurrent UTIs. About 90 per cent response rate (sterile urine at the end of treatment) was obtained for KP and about 85 per cent for CO in recurrent UTI. In persistent UTI the rate of recovery was 66.8 per cent and 53 per cent for KP and CO, respectively. Safety of treatments was excellent in 97 per cent of patients treated with Kelfiprim and 87 per cent treated with co-trimoxazole. Two patients, one in each group, were dropped from the study because of adverse reactions.

Anti-Infective Agents, Urinary↗
PubMed1989

New apparatus to reduce urinary drainage associated with urinary tract infections.

The automatic release of povidone iodine (PVP-I) into the outlet tube of a urinary collecting bag significantly reduced urinary tract infections (UTIs) and provided a more practical bacterial barrier than manual instillation of PVP-I into the bag as used previously. In 52 patients using a new urinary drainage system with a cartridge that released PVP-I into the outlet tube of the collection bag UTIs developed in 3, compared with 57 patients using a standard closed drainage system and in whom 13 UTIs developed (p less than 0.005). The PVP-I group had 92 percent of the accumulative catheter-days free of bladder infection, compared with 77 percent in the standard group. The main route of bacterial contamination leading to urinary drainage UTIs was through the collection bag.

Adult↗
PubMed1991

Advances in the understanding and treatment of urinary tract infections in young women.

Despite relative ease of management, the high rate of urinary tract infections (UTI) among young women presents substantial problems for the health care community. Although the majority of UTIs in young women are simple and uncomplicated, the rate of recurrence is substantial. Each treatment of UTI recurrence brings greater antibiotic resistance, requiring the use of broader spectrum and more expensive antibiotic therapy. Moreover, infection in patients with underlying urinary tract or systemic diseases can lead to serious medical and financial consequences. A better understanding of antibiotic resistance, particularly in regard to beta-lactamase-producing pathogens, has allowed us to develop more appropriate criteria for selecting antibiotics as well as the duration of therapy. The overall cost for treating UTIs in young women is a substantial health care expenditure, and requires an ongoing examination of new information concerning pathogenesis and available antibiotic therapies.

Adult↗
PubMed1995

The effects of vaccination with inactivated uropathogenic bacteria in recurrent urinary tract infections of children.

Secretory IgA (sIgA) is an important parameter in the predisposition to recurrent urinary tract infection (UTI). We investigated whether sIgA and frequency of UTI could be positively influenced by intramuscular vaccination with inactivated uropathogenic bacteria (Solco-Urovac). Ten otherwise healthy girls aged from 5 to 11 years (mean 9 1.7 years) with recurrent UTI were immunized with Solco-Urovac by i.m. injections three times at weekly intervals. A booster injection was given after 6 months. Urinary sIgA secretory component (SC) concentration was determined by radial immunodiffusion assay. Ten other age-matched girls with UTI were not immunized. Immunization therapy caused a significant reduction in the frequency of infection and an increase in urinary sIgA SC, while in the nonvaccinated group the values remained constant.

Adjuvants, Immunologic↗
PubMed1991

Enterococcus faecalis: specific and non-specific interactions with human polymorphonuclear leukocytes.

In previous studies we have demonstrated that the ability of Enterococcus faecalis to adhere to and to be internalized in human urinary tract epithelial cells, Girardi Heart cells and human polymorphonuclear leukocytes (PMNs), was dependent on whether the strain had been isolated from urinary tract infections (UTI) or endocarditis (EN) respectively. These properties were further modified by growth of the organism in human serum. In the present report, using competition assays we show that adhesins containing a D-glucose moiety play a role in mediating the interactions between human PMNs and E. faecalis strains isolated from UTI and grown in brain-heart infusion broth (BHIB). On the other hand, adhesins containing both D-glucose and D-galactose moieties were involved in the interactions between PMNs and serum grown UTI isolates or EN isolates grown in either BHIB or human serum. Moreover, the impairment in the association between both UTI and EN strains after growth in serum appears to be at least partially related to a decrease in enterococcal surface hydrophobicity.

Adult↗
PubMed2005

Urinary tract infections among adolescents.

UTIs occur quite frequently among adolescent females. In the vast majority of these patients, UTIs are uncomplicated infections and are not suggestive of underlying anatomic abnormality of the urinary tract. A UTI in an adolescent female is suggestive, however, of sexual debut. A small number of adolescent males suffer from UTI annually; in at least half of such cases, there is likewise no underlying urinary anomaly. Because of the symptomatic overlap and high prevalence of STI in adolescents, the clinician must have a high index of suspicion for STI in any adolescent presenting with urinary symptoms.

Adolescent↗
PubMed2006

Impact of StatLock securing device on symptomatic catheter-related urinary tract infection: a prospective, randomized, multicenter clinical trial.

BACKGROUND: The objective of this study was to assess the impact of using the StatLock securing device on symptomatic catheter-related urinary tract infection (UTI). METHODS: In this prospective, randomized, multicenter clinical trial, adult patients with spinal cord injury or dysfunction because of multiple sclerosis were randomized to have their indwelling bladder catheters secured in place by using the StatLock device (experimental group) versus preexisting methods (control group that included tape, Velcro strap, CathSecure, or none). Patients were monitored for the development of symptomatic UTI within the subsequent period of 8 weeks. RESULTS: Of a total of 127 enrolled patients, 118 (60 in the experimental group and 58 in the control group) were evaluable. The 2 groups of evaluable patients were comparable in terms of clinical characteristics and risk factors for infection. Symptomatic UTI was diagnosed in 8 of 60 (13.3%) patients in the experimental group versus 14 of 58 (24.1%) patients in the control group (P = .16; RR = 0.55, 95% confidence interval: 0.25-1.22). CONCLUSION: Although the trial size precluded the demonstration of statistically significant differences, the finding of a 45% reduction in the rate of symptomatic UTI in patients who received the StatLock securing device is clinically relevant and prompts further investigations.

Adolescent↗
PubMedDate not supplied

Oral infections and glycemic control in pregnant type 2 diabetics.

BACKGROUND: The relationship between diabetes mellitus and infection is bidirectional. Diabetes favors infection, while infections make controlling diabetes much more difficult. The most frequent infections encountered in pregnant diabetics are those of the urinary tract (UTI) and cervicovaginal (CVI) area. Periodontal diseases (PD) and active caries (AC) are infectious diseases frequently found in these cases often remaining as hidden entities of low intensity. The aim of this study was to assess whether there is an association between PD and caries with lack of glycemic control often encountered in pregnant type 2 diabetic women. METHODS: A single skilled researcher performed the periodontal evaluation of PD and AC cases. Glycated alpha hemoglobin (HbA(1c)) over 6.5% was used to diagnose metabolic glucose disturbances. The controlled variables were UTI, CVI and adherence to treatment. The statistical tests used were chi-square adjusted for continuity, analysis of variance, odds ratio with 95% confidence intervals and logistic regression with a significance level of p < 0.05. RESULTS: One hundred twenty-seven type 2 diabetic women were seen during the second trimester of their pregnancies. Mean age was 31.3 years; 55% had lack of glycemic control associated with CVI (chi2 21.07, p < 0.000), PD (chi2 5.72, p < 0.005) and UTI (chi2 13.77, p < 0.000) with therapeutic adherence (TA) (chi2 14.80, p < 0.00). No association was found with AC. The logistic regression results showed that UTI, CIV, PD and TA are associated with lack of glycemic control. CONCLUSIONS: Periodontal diseases may act as "hidden" infections in pregnant diabetics and be associated with lack of glycemic control. This situation should be taken into consideration by healthcare teams in charge of prenatal care.

Adult↗
PubMed2006

Analysis of ligand binding by bioaffinity mass spectrometry.

BACKGROUND: Ligand binding is commonly analyzed using various immunoassays that are generally time-consuming and some may require secondary antibodies or gel electrophoresis which are also time-consuming and sometimes subjective. We introduced various examples for a more rapid approach using pre-activated surface chips which are analyzed by surface enhanced laser desorption/ionization-time of flight mass spectrometry (SELDI-TOF MS). Specific applications presented in this study include immobilization of antigen, antibody or oligo DNA on pre-activated chips with subsequent identification of the binding antibodies, antigens or DNA binding proteins to demonstrate the universal utility of this novel approach. METHODS: BSA-digoxin conjugate (BSA-Dig), anti-digoxin antibody, anti-urinary trypsin inhibitor (uTi) antibody, or a double stranded oligo nucleotide based on the nucleotide sequence between -91 and -10 of the human CYP 450 2E1 promoter were immobilized on the Ciphergen pre-activated surface chips. Anti-digoxin antibody, BSA-digoxin conjugate, uTi, and CYP450 2E1 promoter binding protein were captured on the chip and identified by SELDI-TOF MS. RESULTS: A protein with 141kDa was identified from anti-digoxin serum using BSA-Dig chips. This binding was competitively inhibited by addition of digoxin. Using anti-digoxin antibody, a peak at approximately 66kDa was detected in the preparation of BSA-Dig. This peak was also inhibited by free digoxin, suggesting BSA-Dig is detected. uTi fragments with approximately 3kDa to approximately 30kDa in the standard and urine samples were captured on the chip by anti-uTi antibody. Finally, we identified a 95-kDa CYP 450 2E1 promoter binding protein in HeLa cells nuclear extracts. CONCLUSIONS: Bioaffinity SELDI-TOF MS is a powerful and versatile approach for analysis of ligands. It eliminates tracer-labeled secondary antibodies and allows for determination of molecular weights of binding proteins and their ligands directly. This approach may also be considered for the detection of enzymes, receptors, or any other specific ligands.

Antibodies↗
PubMedDate not supplied

Urinary tract infections in the elderly: a survey of physicians and nurses.

The purpose of this study was to identify, in the presence of significant bacteriuria, the symptoms that determine and conditions that affect whether a physician will begin antibiotic treatment in the elderly; 2 physician groups were studied: geriatric physicians and family practice/internal medicine physicians. We also sought to compare these results to symptoms and conditions that determine nurses' decisions to begin assessment for urinary tract infections (UTIs) in this population. We also sought to determine the importance these 3 groups placed of monitoring asymptomatic bacteriuria for specific elderly patient populations. Quantitative questionnaires were sent to a convenience sample of 1900 physicians and nurses. Sixty-eight of the 300 geriatric physicians (23%), 113 of the 1000 family practice or internal medicine physicians (11%), and 192 of the 600 nurses (32%) returned surveys. Results showed differences between physician groups and nurses concerning whether cloudy and malodorous urine were symptoms of a UTI. This survey also found that physicians consider patient conditions to a greater extent than nurses do in their decisions regarding UTIs. Geriatric physicians appear to be less likely to monitor asymptomatic bacteriuria in any elderly patient population. Finally, we found that with regard to monitoring asymptomatic bacteriuria, both physician groups and the nurse group gave the greatest support for monitoring among elderly who have difficulty presenting symptoms of a UTI.

Aged↗
PubMed2004

Resistance of uropathogens in symptomatic urinary tract infections in León, Nicaragua.

Management of urinary tract infections (UTI) in Central America and especially Nicaragua, is complicated by the lack of knowledge about the antibiotic resistance of uropathogens. We conducted a prevalence study to gain more insight into the aetiology, bacterial resistance and risk factors for symptomatic UTI in the region of León, Nicaragua. In 2002, all consecutive patients with UTI symptoms and pyuria >/=10 WBC/hpf were admitted to the study. Positive cultures from midstream urine specimens were defined as >/=10(5) cfu/ml of a single uropathogen. Susceptibility tests were performed with disc diffusion tests using the Kirby-Bauer method and broth microdilution using National Committee for Clinical Laboratory Standards criteria both in León and a reference laboratory in Utrecht. A positive culture was present in 62 of 208 study subjects (30%). Escherichia coli (56%), Klebsiella spp. (18%) and Enterobacter spp. (11%) were the most frequent pathogens isolated. Presence of cystocele, incontinence and increasing age were risk factors for bacterial UTI. E. coli was least resistant to ceftriaxone, amikacin and nitrofurantoin (>90% susceptible). We observed high resistance rates in E. coli to amoxicillin (82%, MIC(90) 128 mg/l), trimethoprim-sulphamethoxazole (TMP-SMX) (64%, MIC(90) 32 mg/l), cephalothin (58%, MIC(90), 32 mg/l), ciprofloxacin (30%; MIC(90), 32 mg/l), amoxicillin/clavulanate (21%, MIC(90) 8 mg/l) and gentamicin (12%, MIC(90) 2 mg/l). Our results suggests that community acquired uropathogens in Nicaragua are highly resistant to many antimicrobial agents. The use of amoxicillin, trimethoprim-sulphamethoxazole and cephalothin against uropathogens needs to be reconsidered. High quinolone resistance rates among E. coli in Nicaragua gives cause for great concern.

Adult↗
PubMed2006

Bacterial interference--is deliberate colonization with Escherichia coli 83972 an alternative treatment for patients with recurrent urinary tract infection?

The increasing microbial antibiotic resistance motivates research for non-antibiotic treatment alternatives. In recurrent urinary tract infections (UTIs), 'bacterial interference' has attracted interest as a possible alternative treatment option. The observation that asymptomatic bacteriuria (ABU) protects against recurrent UTI has prompted clinical trials with deliberate colonization of the human urinary tract as an alternative approach in patients with recurrent UTI. The strain used for colonization, the ABU isolate Escherichia coli 83972, has been shown to cause symptom-free colonizations for long periods of time. Patients on long-term colonization report a subjective benefit, and UTI treatments are rare in colonized patients. This report presents an update on open long-term E. coli 83972 colonization trials and describes the design of an ongoing randomized trial.

Adult↗
PubMed2006

Incidence of nosocomial urinary tract infections on a surgical intensive care unit and implications for management.

The incidence of nosocomial infections (NIs) in our surgical intensive care unit was evaluated with special consideration of nosocomial urinary tract infections (NUTIs). The trial was a prospective, single-centre, 6-month cohort study. Infections according to CDC criteria, pathogens, devices, APACHE II scores, infection parameters and urinalysis were noted. In total, 420 patients (1543 patient days) were evaluated. Of these, 25% had 160 infections of which 110 were NIs. Mean APACHE II score in all infected patients was 16 versus 12 in non-infected patients (P<0.0001). Of the NIs, 25% were not ICU acquired and 75% were ICU acquired. UTIs accounted for 28% of the NIs, lower respiratory tract infections for 21%, pneumonia for 12% and bloodstream infections for 11%. The rates of urinary-catheter-associated UTIs varied between 4.2 (symptomatic UTI) and 14.0 (asymptomatic UTI). Although asymptomatic NUTI usually deserves no therapy, it needs to be considered carefully in terms of its environmental impact on the emergence of bacterial resistance.

Adolescent↗
PubMed2006

Which clinical indicators and resident characteristics are associated with health care practitioner nursing home visits or hospital transfer for urinary tract infections?

OBJECTIVES: (1) To determine factors associated with practitioner visitation and/or hospital transfer for skilled nursing facility (SNF) patients who develop a urinary tract infection (UTI) and (2) to determine if SNF patients with a Do Not Resuscitate (DNR) directive are less likely to be personally assessed and/or transferred to the hospital in the event of a UTI when compared to patients without a DNR directive. DESIGN: Retrospective cohort study using nursing home medical record review. PARTICIPANTS: Participants were 564 residents from 35 nursing homes in 3 states who became acutely ill with UTI during the first 90 days of their nursing home admission. They were identified from 2832 random nursing home Medicare admissions and divided into 2 groups, those with DNR directives (n = 334) and those without (n = 230). MEASUREMENTS: Logistic regression was used to determine factors associated with practitioner in-person assessment and/or hospitalization, and to determine differences in the likelihood of practitioner in-person assessment and/or hospitalization among those with DNR directives versus those without DNR directives. RESULTS: Only one third (29%) of patients with unstable vital signs were seen by a practitioner or transferred to a hospital. Factors associated with practitioner assessment or hospital transfer were elevated temperature (OR 1.7, CI 1.04-2.64), pulse more than 100 beats per minute (OR 1.7, CI 1.01-2.99), and delirium (OR 2.1, CI 1.267-3.44). White residents were less likely to be assessed by a practitioner or transferred to a hospital (OR 0.45, CI 0.22-0.95). DNR directives were not significantly associated with fewer in-person assessments (P = .067). CONCLUSION: Only one third of SNF patients who developed a UTI with unstable vital signs were personally assessed by a practitioner and/or hospitalized. Patients with delirium were twice as likely to be assessed or transferred to a hospital, suggesting that practitioners use delirium as an indicator of illness severity. However, practitioner visit or transfer was also associated with ethnic background. In the absence of good evidence regarding which nursing home residents are likely to benefit from hospitalization or an urgent practitioner visit, these care decisions will continue to be associated with factors that are unknown.

Aged↗
PubMed2004

Predictors of outcome in geriatric patients with urinary tract infections.

A study was conducted to determine the prognosis of geriatric patients with urinary tract infections (UTIs) and identify clinical factors associated with adverse outcomes. This retrospective, cohort study identified elderly patients (age > or =65 years) presenting to an academic, urban Emergency Department (ED) during a 16-week period with UTI, suggested by urinalysis and pertinent symptoms. There were 37 demographic and clinical variables analyzed as potential predictors of outcome. Morbidity was defined as in-hospital death, Intensive Care Unit (ICU) admission, hospital length of stay (LOS) >2 days, or hospital intravenous (i.v.) antibiotics >2 days. Factors identified by univariate analysis were combined using multiple logistic regression to identify independent predictors of morbidity. There were 284 patients who met selection criteria. Thirteen patients (4.6%) died during hospitalization and 27 (9.5%) had ICU admission, 139 (48.9%) had LOS >2 days, and 75 (26.4%) had i.v. antibiotics >2 days. Multivariate analysis identified the following variables as independent predictors of adverse outcomes: mental status change, frequent UTIs, other nonurinary infections, abnormal temperature, tachycardia, hypotension, elevated BUN, hyperglycemia, elevated WBC, and relative neutrophilia. Regression models for adverse outcomes had sensitivities from 74.8% to 96.2% and specificities from 31.1% to 69.0%. In conclusion, this study defines high rates of morbidity for geriatric patients with UTIs and describes predictive variables that may help identify low-risk patients. These data may lay the foundation for determining specific guidelines for disposition of this high-risk patient population.

Age Factors↗
PubMed2006

Nosocomial infections in renal transplant patients: risk factors and treatment implications associated with urinary tract and surgical site infections.

A prospective cohort study was conducted from January 2000 to December 2001 to determine the rate of bacterial nosocomial infections in renal transplant recipients. The patients were divided into two groups according to the origin of the allograft, namely deceased or living related donors. One hundred and sixty-three renal transplant recipients were reviewed during hospitalization; 110 (67.5%) kidneys were from deceased donors and 53 (32.5%) kidneys were from living related donors. The median length of hospitalization was 12 days for transplants from living related donors and 26 days for transplants from deceased donors (P<0.0001). Twenty-one (39.6%) recipients of kidneys from living related donors and 68 (61.8%) recipients of kidneys from deceased donors had bacterial nosocomial infectious episodes (P=0.019). The post-transplant nosocomial infections diagnosed during hospitalization included urinary tract infections (UTIs) (44.8%), surgical site infections (SSIs) (11%), pneumonia (6.1%), catheter-related bloodstream infections (4.2%) and others (1.8%). Risk factors for UTI included: recipient of kidney from a deceased donor, substitution of the initial immunosuppressive regimen, duration of urinary bladder catheterization, and length of hospitalization before the infection. Six Enterobacter cloacae strains with multiple resistances to antibiotics were identified in UTIs, and hospital dissemination was documented using molecular typing. UTI was the single most important hospital infection and was significantly higher in recipients of kidneys from deceased donors (P=0.001).

Adolescent↗
PubMed2006

Effect of perineal cleansing on contamination rate of mid-stream urine culture.

STUDY OBJECTIVE: Urinary tract infection (UTI) and chlamydial or gonococcal urethritis are the most common causes of female dysuria. While chlamydia and gonorrhea can be detected with a nucleic acid amplification test performed on an uncleansed first part voided urine sample, urine cultures to test for UTI require a mid-stream clean caught sample. In order to determine whether collecting two sequential non-clean caught urine samples during the same void to test for chlamydia, gonorrhea, and UTI is a reasonable approach, we assessed the degree to which perineal cleansing reduces bacterial contamination of mid-stream urine cultures. DESIGN: Experimental study comparing mid-stream urine samples collected with (n = 25) and without (n = 25) perineal cleansing. SETTING: A university-based adolescent clinic PARTICIPANTS: We recruited fifty 14-23-year-old (mean 18.5 yrs, SD 2.3) asymptomatic females. MAIN OUTCOME MEASURE: Perineal flora contamination rate of mid-stream urine cultures collected with and without perineal cleansing. RESULTS: No culture grew >10(4) colonies of a pathogenic bacterium. Eleven (44%) of the experimental group samples and 9 (36%) of the control samples grew >10(4) colonies of perineal bacterial flora (chi(2) = .33, P = 0.56). Participants' previous experience collecting mid-stream urine was not associated with less bacterial contamination. CONCLUSIONS: Among this small sample of asymptomatic young women, perineal cleansing did not significantly reduce perineal flora contamination of mid-stream urine cultures. If larger studies of symptomatic young women replicate these findings, young women could collect two sequential urine samples from the same void to test for chlamydia, gonorrhea, and UTI.

Adolescent↗
PubMed2004

Mucosal vaccination of mice with recombinant Proteus mirabilis structural fimbrial proteins.

Proteus mirabilis, a common cause of urinary tract infection (UTI), expresses several types of fimbria including mannose-resistant/Proteus-like fimbriae (MRP), uroepithelial cell adhesin (UCA), renamed non-agglutinating fimbriae (NAF) by some authors, and P. mirabilis fimbriae (PMF), which are potentially involved in adhesion to the uroepithelium. In this study, we immunised different groups of mice with recombinant structural subunits of these fimbriae (MrpA, UcaA and PmfA) using two mucosal routes (nasal and transurethral) and we transurethrally challenged the animals with a P. mirabilis uropathogenic isolate. Induction of specific serum and urine IgG and IgA was measured to assess the potential role of the humoral immune response in protection against experimental ascending P. mirabilis UTI. Intranasally MrpA- and UcaA-immunised mice were protected against P. mirabilis ascending UTI, since recovery of bacteria from kidneys and bladders was significantly lower than in PBS-treated mice, and both fimbrial subunits significantly induced specific serum and urine antibodies. Only MrpA and PmfA transurethrally immunised animals were protected only at the kidney level, and in this case only MrpA-immunised mice exhibited significant serum IgG induction. Correlation analysis did not show a significant relationship between serum and urine specific antibody response and protection observed against infection. Our results suggest that an immunisation strategy based on structural fimbrial proteins may be useful to prevent P. mirabilis UTI. Further studies are being carried out to characterise the immune and inflammatory response induced by P. mirabilis recombinant fimbrial subunits.

Administration, Intranasal↗