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PubMed1999

Contemporary incidence of morbidity related to vesicoureteral reflux.

OBJECTIVES: The association among vesicoureteral reflux (VUR), renal scarring, and reflux nephropathy is well established. Screening programs for children who present with urinary tract infection (UTI) and their siblings, along with medical and surgical management, have been promoted by pediatric medical and urologic specialists in Buffalo and the surrounding community for more than two decades. Has this comprehensive and costly effort resulted in a decrease in VUR-related morbidity and should it be continued? METHODS: The records of all active patients who presented from 1982 through 1997 to this region's single pediatric nephrology referral center were reviewed. One hundred twenty-two children and adolescents (73 boys, 49 girls) were identified with hypertension (HTN), renal insufficiency (RI), and end-stage renal disease (ESRD) requiring dialysis or transplantation. RESULTS: There were 70 patients (57%) with HTN, 19 (16%) with RI, and 33 (27%) with ESRD. Reflux nephropathy was the underlying cause in 6 patients (5%)-3 with HTN and 3 with ESRD. The etiologies of morbidity in the remaining patients were medical renal disease, 61 (50%); idiopathic, 17 (14%); obstructive uropathy, 14 (11%); primary congenital renal hypoplasia, 12 (10%); and vascular, 12 (10%). Of the 6 patients with VUR-related morbidity, 4 were boys (3 with ESRD, 1 with HTN) and 2 were girls (with HTN). Five children presented in the 1980s and 1 in the 1990s. Only 1 patient had a history of UTI, and she presented early in the series in 1982 at 5 years of age. Ages of presentation were infancy (2 boys), early childhood (1 boy, 1 girl), and adolescence (1 boy, 1 girl). Reasons for presentation were failure to thrive (n = 2), voiding dysfunction without UTI (n = 1), muscle cramps (n = 1), UTI (n = 1), and HTN (n = 1). Reflux grade ranged from I to V, but 4 patients had grade III or less. CONCLUSIONS: Awareness of VUR-related morbidity has led to more widespread diagnosis and treatment, which appears to have resulted in a dramatic decrease in the numbers of affected patients in this community. The diagnosis and treatment of VUR has altered the epidemiology of HTN and renal failure in children and young adults.

Adolescent↗
PubMed2002

Urinary tract infections cranberry juice, underwear, and probiotics in the 21st century.

There is a substantial gap between the viewpoint of urologists and the rest of society regarding UTIs. Urologists spend little time and effort thinking about UTIs. In contrast, UTIs are a major issue for many women. There is substantial concern about "natural compounds" and probiotics that allow women to take charge of their health care. It is easy to understand this concern because UTIs are common, costly, and cause considerable morbidity.

Clothing↗
PubMed1999

Evaluation and management of pediatric urinary tract infections.

Urinary tract infections (UTIs) are relatively common in children. We describe the evaluation and management of children with UTIs, as well as the risks and consequences related to the UTI. This article describes a rational approach to the evaluation and management of childhood UTIs with the relation to the natural history and risk factors.

Anti-Infective Agents, Urinary↗
PubMed1981

Survey of antibiotic prescribing in a district general hospital. III. Urinary tract infection.

A 28 day survey of all antibiotic prescriptions in a district general hospital included a brief interview with the prescriber of each prescription. Fifty-nine antibiotic courses were stated by the prescriber to be for the treatment of urinary tract infection (UTI). Urine specimens from all patients treated for UTI were sent to the laboratory for bacteriological examination. 29 patients' treatment was started as the result of isolation of bacteria from the urine. 20 of the patients also had symptoms suggestive of UTI. 4 patients were treated solely because bacteria had been isolated from "routine" catheter stream urine specimens. 7 patients were treated for UTI despite the availability, at the time of prescription, of a laboratory report stating that bacteria had not been isolated from the urine. 19 patients' treatment was started before the results of bacteriological tests were available. By combining information about bacteriological examination of the urine specimens and clinical details recorded during the interview with the prescribed, it was considered that both initiation and continuation of antibiotic treatment was justified for 28/55 patients and that either initiation or continuation of treatment was unjustified for 27/55 patients.

Anti-Bacterial Agents↗
PubMed1997

Surveillance of nosocomial infections in geriatric patients.

Prospective surveillance of hospital-acquired infections was undertaken in the geriatric ward of the University Hospital, Utrecht, the Netherlands. The medical records of 300 patients were studied for the presence of nosocomial infections using the criteria defined by the Centers for Disease Control (CDC), Atlanta, Georgia, USA. Data were collected from patients with and without infection, which allowed for the analysis of risk factors for nosocomial infection. In 100 out of 300 patients (33.3%), a total of 126 infections was diagnosed. The incidence of nosocomial infections was 16.9 per 1000 days of stay in the hospital. The mean length of stay of patients with infection was 39 days, while that of patients without infection was 17.8 days. Infections developed after an average stay of 13.3 days in the hospital. Patients with infections were 2.6 years older than patients without infections (P = 0.005). Dehydration was shown to be a major risk factor for infection (RR = 2.1, 95% CI: 1.4-3.2). Of the infections, 58.7% were urinary tract infections (UTIs, asymptomatic and symptomatic). The most important risk factor for an asymptomatic UTI was an indwelling urinary catheter (RR = 7.3, 95% CI: 3.1-17.1). The duration of use of the indwelling urinary catheter was of significant influence in the development of a UTI. Seventy percent of the patients with an asymptomatic UTI were treated with antibiotics. Infections of the gastrointestinal tract accounted for 19.8% of all nosocomial infections. The majority of these infections were due to an outbreak of Clostridium difficile. In conclusion, the length of stay may be prolonged by a nosocomial infection. In this study, the main risk factors for developing a nosocomial infection were age, dehydration and the presence of an urinary catheter. Our observations showed that age is a predisposing factor for nosocomial infection and that the risk increases with each year, even for geriatric patients.

Aged↗
PubMed1984

Single-dose antibiotic therapy of urinary tract infection: is it appropriate in the emergency department?

Accurate diagnosis of urinary tract infection (UTI) is possible in the emergency department. Clinical differentiation of upper tract infection (pyelonephritis) from lower tract infection (cystitis) is difficult. The consequences of untreated UTI justify treatment by the emergency physician. Many treatment schemes are available. Single-dose antibiotic therapy is the preferred treatment method for uncomplicated UTI. It reduces compliance problems, effectively cures lower UTI, and provides for early identification of patients with more complex infection. The complications of this therapy are minimal.

Anti-Bacterial Agents↗
PubMed1986

Utility of urine cultures in the emergency department.

Urinary tract infection (UTI) is a common problem treated by emergency physicians. A midstream urine sample remains the most frequent method of culture collection. Although midstream urine culture growing more than 10(5) colony-forming units per milliliter (cfu/mL) has been considered diagnostic of UTI, high false-positive and false-negative rates as well as a lack of precision have been associated with this method of collection. Alternative methods of establishing the diagnosis of UTI have excellent sensitivity and may be utilized at the time of patient presentation. These include the detection of leukocyte esterase activity in urine and the presence of one or more bacteria on microscopic examination of an unspun urine sample. Women of child-bearing age represent the vast majority of patients seen with UTI. Uncomplicated infection of the urinary tract has a generally benign course in these patients, and is rarely associated with long-term complications. In addition, these patients are infected with a predictable spectrum of uropathogens that respond to the commonly used antibiotics. It appears that urine cultures provide little additional information in this patient population. Urine cultures should be obtained in patients at high risk for pyelonephritis or bacteremia/urosepsis, as well as in those expected to have uncommon or resistant organisms.

Adolescent↗
PubMed1983

[Value of the assay of 4 urinary enzyme activities in the diagnosis of the infectious or toxic (aminoglycosides) origin of a renal disease. Preliminary results].

Occurrence of a renal failure in an infected patient may be referred to various causes: infection, renal toxicity of drugs (for instance aminoglycosides), shock . . . Determination of some urinary enzymatic activities might be helpful in unravelling the mechanism involved in such cases. Therefore a prospective study of the specificity of some urinary enzymatic activities was performed. The whole LDH activity, the LDH isoenzyme 5 (LDH 5), and two lysosomal enzymes, N-acetyl-beta-D-glucosaminidase (NAG) and beta-glucuronidase (beta-GLU) were dosed systematically, in several groups of patients: I (n = 34): healthy control, with normal renal function; II (n = 24): renal impairment, without recent upper urinary-tract infection (UTI) or aminoglycoside treatment; III (n = 27): upper UTI without aminoglycoside treatment, IV (n = 22): patients treated with aminoglycosides (without upper UTI); V (n = 16): upper UTI treated with aminoglycosides. Results showed a rather good specificity of whole LDH and LDH 5 for infectious kidney damage, and of NAG for tubular injury due to aminoglycoside treatments. Values of urinary beta-glucuronidase varied over a wide range; they were little increased in group III, without a great discriminative value. No significant difference was noted between group I and group II, for any enzyme whatever.

Acetylglucosaminidase↗
PubMed1991

Vesicoureteric reflux and renal injury.

Renal injury associated with the intrarenal reflux (IRR) of urine that is either infected, under high pressure, or both, is a major cause of severe hypertension during childhood and adolescence and of chronic renal insufficiency in patients less than 30 years of age. Many, but not all, adolescent and adult patients with reflux nephropathy (RN) give a history of urinary tract infection (UTI) or unexplained fevers in infancy or early childhood, when the kidney is thought to be at greatest risk of injury. Although vesicoureteric reflux (VUR) is observed more commonly in infants than children with UTI, it is rare in uninfected patients at any age and should never be considered a normal finding during human development. Renal scarring may not be obvious in radiographic or radionuclear studies to medical management alone, no definite benefit of one over the other was observed, regardless of the grade of VUR. Moreover, progressive renal injury in scarred kidneys has been noted even after VUR had been corrected, when infection had been prevented, and while hypertension had been controlled satisfactorily. Focal glomerular sclerosis, a lesion found in patients with proteinuria and RN, has been identified not only in scarred kidneys, but also may be seen in contralateral, unscarred kidneys without VUR, which might suggest a humoral factor or, perhaps, a hyperfiltration phenomenon. RN is one of the most frequent causes of end-stage renal disease (ESRD) in children, adolescents, and young adults, which is potentially preventable. However, prevention will depend on early identification of patients at risk--infants and young children after the first UTI and siblings of patients with VUR--aggressive and effective treatment of UTI, minimizing intravesical pressure, and education of patients, parents, and physicians.

Cicatrix↗
PubMed1990

Detection of endotoxiuria in polycystic kidney disease patients by the use of the Limulus amebocyte lysate assay.

Urinary tract infections (UTI) due to gram-negative bacteria are a serious complication in patients with polycystic kidney disease (PKD). Endotoxin, a component of the cell wall of gram-negative bacteria, has been reported to be pro-cystogenic in experimental animals. Because endotoxin levels in urines (endotoxiuria) from PKD patients have not been reported, the Limulus amebocyte lysate (LAL) assay, which detects picogram quantities of endotoxin, was used to probe for this cyst-promoting chemical. Fifteen PKD patients (seven females, eight males), asymptomatic for UTI, were tested and compared with 10 female and 10 male controls. All urines were assessed for (1) evidence of aerobic bacteria by routine quantitative cultures, (2) bacteria and pyuria by microscopic examination of gram-stained urine, and (3) bacterial endotoxin by the LAL assay. LAL tests were positive in 73% (11/15) of PKD patients, but only 25% (5/20) of controls (P = 0.0058). There was no significant difference in test positivity between PKD females (71%) and males (75%). There was no correlation of age, degree of renal dysfunction, or urine osmolality with endotoxiuria. Routine quantitative cultures were negative for gram-negative bacteria in PKD patients and all controls (except one female), as were microscopic findings for intact bacteria and pyuria. Thus endotoxiuria, in the absence of classical signs, symptoms, and microbiological findings of UTI, raises the possibility that endotoxin is available intrarenally to promote cystogenesis even before a potential susceptibility of PKD patients to classical UTI is manifested. Sources of urinary endotoxin observed in PKD patients, such as cryptic intrarenal sites or leakage from the gastrointestinal (GI) tract, remain to be defined.

Adult↗
PubMed2002

Immature ureteric jet doppler patterns and urinary tract infection and vesicoureteric reflux in children.

The Doppler waveform of the ureteric jet is the result of modification of ureteric peristalsis by an active sphincteric mechanism of the vesicoureteric junction (VUJ). The monophasic pattern is associated with immaturity. This study set out to see the correlation between this immature pattern with urinary tract infection (UTI) and vesicoureteric reflux (VUR) in children. Ureteric jets of 241 healthy children and 98 children with UTI were studied. The monophasic pattern was found in 29% of healthy children overall, but varied greatly according to age. The monophasic pattern was virtually universal in the first 6 months of life, dropping to below 15% in late childhood. This immature pattern was more commonly seen in the UTI (73.5%) and VUR (90.5%) groups than in the healthy controls. The difference was statistically significant (p = 0.0005 for both). The persistence of this immature pattern was highly associated with UTI and VUR.

Adolescent↗
PubMed1996

Biochemical phenotypes of Escherichia coli in dogs: comparison of isolates isolated from bitches suffering from pyometra and urinary tract infection with isolates from faeces of healthy dogs.

Escherichia coli from dogs suffering from pyometra and/or urinary tract infection (UTI) were compared with faecal E. coli. We studied 79 isolates from pyometra, 96 from UTI, 91 from faeces of healthy dogs and 60 from faeces of bitches with pyometra. The isolates included 16 bitches with pyometra where E. coli were isolated from both the uterus and the urinary tracts. All isolates were typed with the aid of an automated typing system for biochemical fingerprinting (the PhP-EC system). The PhP types of uterine E. coli isolates from bitches with pyometra showed higher homogeneity, calculated as the mean of similarity between isolates (rmean = 0.79) than epidemiologically unrelated isolates, such as those isolated from faeces (rmean = 0.69) or UTI (rmean = 0.70). This finding suggests that many of the pyometra isolates derives from related clones. Mucoid and nonmucoid uterine isolates from the same sample were generally of the same PhP type. In all 10 cases uterine E. coli isolates were identical or very similar to isolates from faeces of the same bitch. Furthermore, E. coli isolates from both UTI and the infected uterus in the same bitch were identical or very similar in 88% of the cases. It was concluded that E. coli associated with canine pyometra derive from the faecal flora and that the urinary tract is infected by the same E. coli clone as the uterus of a bitch with pyometra.

Animals↗
PubMed2003

Susceptibility patterns of orally administered antimicrobials among urinary tract infection pathogens from hospitalized patients in North America: comparison report to Europe and Latin America. Results from the SENTRY Antimicrobial Surveillance Program (2000).

Urinary tract infections (UTIs) remain a worldwide nosocomial infection problem. Geographic variations in pathogen occurrence and susceptibility profiles require monitoring to provide information to guide new (garenoxacin [BMS284756]) therapeutic options. Two thousand seven hundred-eighty UTI isolates from Europe (n = 783), Latin America (531), and North America (1,466) were tested and compared against 44 agents by reference methods in the SENTRY Antimicrobial Surveillance Program. The top seven pathogens accounted for 90% of all isolates and the rank order for all regions was: Escherichia coli (1,316; 47%), Enterococcus spp. (351; 13%), Klebsiella spp. (306; 11%), Pseudomonas aeruginosa (210; 8%), Proteus mirabilis (145; 5%), Enterobacter spp. (97; 4%), and Citrobacter spp. (78; 3%). The pathogen rank order was similar among regions except for the rarer occurrence of Enterococcus spp. (Rank #6, 4%) in Latin America. E. coli ampicillin resistance was highest in Europe and Latin America (51-55%). Ampicillin (37%), ciprofloxacin or garenoxacin (4%), and trimethoprim/sulfamethoxazole (23%) resistance remained lowest in North America. Nitrofurantoin susceptibility in E. coli was still at acceptable levels and ranged from 91 to 96% across regions. The regional ciprofloxacin-resistant rank order for P. aeruginosa by region was: Latin America (55%) > Europe (41%) > North America (29%). Vancomycin-resistant enterococci (VRE) were only detected in North America (7%). Garenoxacin possessed a 34 to 44% wider spectrum compared to ciprofloxacin against enterococci UTI isolates. Extended spectrum beta-lactamase rates for E. coli and Klebsiella spp. were 4 and 19%, respectively. These results emphasized the need to assess the often striking differences in pathogen occurrence and resistance rates among the commonly encountered UTI pathogens.

Administration, Oral↗
PubMedDate not supplied

Can urinary nitrite results be used to guide antimicrobial choice for urinary tract infection?

Enterococcus is unable to reduce nitrates and is also considered clinically resistant to trimethoprim/sulfamethoxazole (TMP/SMX), the drug of choice for uncomplicated urinary tract infection (UTI). The purpose of this study was to determine whether urinalysis nitrite results can be used to guide antimicrobial therapy when treating UTI in the emergency department (ED). A retrospective chart review examined 159 university hospital ED outpatients who had signs or symptoms of UTI and had a urinalysis with positive culture. Patients were categorized into two groups based on nitrite results. The proportion of isolates sensitive to TMP/SMX in each group was compared by using a two-sample z-test. Eighty-six urinalyses were nitrite positive: 67 (78%) contained TMP/SMX-sensitive isolates. Seventy-three urinalyses were nitrite negative; 60 (82%) contained sensitive isolates. There was no statistically significant difference in the proportion of isolates sensitive to TMP/SMX. Thus, we conclude that emergency physicians should not adjust antibiotic therapy for UTI based on nitrite results.

Adult↗
PubMed2005

[Local guidelines and quality of antibiotic treatment in urinary tract infections: a clinical audit in two departments of a university hospital].

AIM: To assess the effect of local guidelines implemented at the Nantes University Hospital regarding antibiotic therapy for urinary tract infections. DESIGN: Before/after study of one medical ward and one urologic surgery ward. Quality was measured by two principal criteria: compliance with guidelines and medical justification in the specific clinical situation. Both criteria considered simultaneously the choice of drug, dose and duration of treatment. Deviations from the guidelines were described. RESULTS: 1086 UTI cases were identified over two 12-month periods, before and after the dissemination of guidelines (for prostatitis, pyelonephritis, indwelling catheter-associated UTIs, and other undefined UTIs). The guidelines were applicable in 313 (30%) cases. Overall, after implementation of the guidelines, the percentage of justified prescriptions did not change significantly (41.8% compared with 38.7%, p=0.299), but the percentage of correct (conforming) prescriptions fell (from 30.4% to 15.7%, p=0.0022). The percentages of correct and justified prescriptions differed in the medical (respectively 45.0% and 46.6%,) and surgical units (13.1% and 36.5%). CONCLUSIONS: Issuing guidelines does not necessarily improve the quality of antibiotic therapy for UTIs in hospitals.

Anti-Bacterial Agents↗
PubMed2003

Microbial virulence determinants and the pathogenesis of urinary tract infection.

The most frequent and best-studied agent of urinary tract infection (UTI) is Escherichia coli, which serves as a useful model pathogen for understanding microbial virulence in relation to UTI pathogenesis. The E. coli strains that cause most UTIs and other extraintestinal E. coli infections represent a highly specialized subset of the total E. coli population. The enhanced virulence potential of such strains, which collectively are known as uropathogenic E. coli or extraintestinal pathogenic E. coli (ExPEC), is thought to be caused mainly by their multiple virulence factors. These virulence factors include diverse adhesins, siderophores, toxins, polysaccharide coatings, and other properties that assist the bacteria in avoiding or subverting host defenses, injuring or invading host cells and tissues, and stimulating a noxious inflammatory response. Although the true evolutionary basis for ExPEC is unknown, the virulence factors of ExPEC serve as useful epidemiologic markers and in the future may provide effective targets for anti-UTI interventions.

Adhesins, Escherichia coli↗
PubMed1997

Pathogenesis of urinary tract infection. Role of host defenses.

In the last decade, there have been modest strides made in our understanding of the pathogenesis of urinary tract infections (UTIs). Matching the advances achieved in unraveling the complexities of bacterial virulence factors using molecular-genetic techniques has been a parallel increase in knowledge of host defense mechanisms. Host susceptibility to UTI in the past has been predominantly studied in patients with structural (obstruction) or functional abnormalities (diabetes mellitus); however, most patients with UTIs have no such demonstrable abnormalities, hence attention has now focused on host behavioral factors in addition to genetically determined cellular mechanisms that predispose to sporadic and recurrent UTI.

Adult↗
PubMed2000

Improving drug treatment in general practice.

In the international Drug Education Project, an educational program involving auditing and feedback in peer groups to improve the treatment of asthma and urinary tract infections (UTI) was developed and tested in primary care. Individualized feedback was provided and discussed in 24 Dutch peer groups showing doctors their prescribing practices and underlying reasons for treatment. A parallel, randomized controlled design was used to test the effect on competence and actual prescribing; in one study arm doctors received feedback on asthma treatment and in the other on UTI treatment. Especially the messages to treat asthma exacerbations with oral corticosteroids (17% increase) and to prescribe short courses for UTI (decrease duration of 1.8 days) brought about large improvements. Both messages concerned acute situations, and were clear and relatively easy for GPs to implement. GPs will experience more barriers when changing maintenance treatment of an asthma patient, which could explain the more limited success of this part of the educational program: the proportion of patients treated with inhaled corticosteroids increased 5%. A ceiling effect was experienced regarding drug choice for UTI.

Adult↗