Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “UTIs”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,153 records · Page 64Linked to original sources
PubMed2001

Urinary tract infection among women aged 40 to 65: behavioral and sexual risk factors.

We conducted a case-control study to explore the role of health behavior and sexual and medical history on urinary tract infection (UTI) risk among otherwise healthy women aged 40-65. Cases and controls were recruited from nine practices and clinics in Michigan and a single clinic in Israel. In both countries, several factors were reported significantly more frequently among UTI cases than controls: a previous UTI within 12 months, incontinence symptoms, a recent episode of 30-plus minutes of cold hands, feet, back or buttocks, and recent antibiotic use. Cases were less likely than controls to report recent estrogen use, but the results were only statistically significant in Michigan. Sexual activity during the previous 2 weeks and having ceased menses were modestly, but not statistically significantly, protective at both study sites. Risk factors for UTI among women 40-65 differ from those for younger women and these differences cannot be attributed solely to changes in menopausal status.

Adult↗
PubMed2001

Treatment of lower urinary tract infection in pregnancy.

Urinary tract infection (UTI) is a common complication of pregnancy. Approximately 20--40% of women with asymptomatic bacteriuria will develop pyelonephritis during pregnancy. All pregnant women, therefore, should have their urine cultured at their first visit to the clinic. In a clinical study comparing single-dose treatment with 3 g fosfomycin trometamol versus a 3-day course of 400 mg ceftibuten orally, the inclusion criteria were acute symptomatic lower UTI (acute cystitis), significant bacteriuria (> or =10(3) CFU/ml), pyuria and confirmed pregnancy. Excluded were patients with asymptomatic bacteriuria or acute pyelonephritis. Predisposing factors comprised a history of recurrent UTI, diabetes mellitus, analgesic nephropathy, hyperuricaemia or Fanconi's syndrome. Escherichia coli was the most frequently isolated pathogen in both groups. Therapeutic success (clinical cure and bacteriological eradication of uropathogens) was achieved in 95.2% of the patients treated with fosfomycin-trometamol versus 90.0% of those treated with ceftibuten (P, non-significant). The treatment of acute cystitis in pregnant women using a single-dose of fosfomycin trometamol was equally effective as the 3-day course of oral ceftibuten. Both regimens were well tolerated with only minor adverse effects. Long-term chemoprophylaxis should be suggested in patients with recurrent UTI or following acute pyelonephritis during pregnancy.

Adult↗
PubMed2001

Which fluoroquinolones are suitable for the treatment of urinary tract infections?

A number of fluoroquinolone agents are now available for clinical use and even more under development. Whether these compounds are equally effective and thus interchangeable in the treatment of urinary tract infection (UTI) has to be answered by comparing their antimicrobial activity against uropathogens, the pharmacokinetic and pharmacodynamic parameters and outcome of statistically meaningful clinical studies. Whereas almost all fluoroquinolones give equivalent results with short term therapy of acute uncomplicated cystitis in women, for patients with complicated UTI, only those compounds at the appropriate dosage regimen should be chosen for empiric therapy, which would exhibit sufficiently high urinary bactericidal activity against Gram-negative as well as Gram-positive uropathogens. When considering antibacterial activity, pharmacokinetic and pharmacodynamic properties as well as the results of the published clinical studies, a dosage of 500 mg ciprofloxacin twice daily, 500 mg levofloxacin once daily, or 400 mg gatifloxacin once daily may be comparable dosage regimens in the treatment of severe complicated UTI. In the case of ciprofloxacin (750 mg twice daily) and levofloxacin (500 mg twice daily), the dose could even be increased in UTI caused by less susceptible uropathogens, such as Pseudomonas aeruginosa.

Anti-Infective Agents↗
PubMed2002

Urinary tract infection in patients with neurogenic bladder dysfunction.

Recurrent urinary tract infections (UTI) are a significant problem in all patients with neurogenic bladder leading to high morbidity, poor quality of life and a limited life expectancy. For the diagnosis of UTI, a urine specimen taken by bladder puncture or catheterization is required. In patients with neurogenic bladders, clinical symptoms and leukocyturia must be present together with bacteriuria in order to qualify as UTI. The spectrum of pathogens differs significantly from that in patients with normal bladder function. Culture and antimicrobial susceptibility testing must, therefore, be performed prior to the initiation of antibiotic therapy. This is also important in the prevention of the emergence of antimicrobial resistance. The main way to prevent recurrent UTI in the neurogenic bladder is by restoring the normal low-pressure reservoir function of the bladder and is the aim of neuro-urological management.

Bacteriuria↗
PubMed1999

Experience with the new guidelines on evaluation of new anti-infective drugs for the treatment of urinary tract infections.

The new guidelines of Infectious Diseases Society of America (IDSA) and European guidelines of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) on evaluation of new anti-infective drugs for the treatment of urinary tract infection (UTI) were published in 1992 and 1993, respectively. The experience with these guidelines, including the recommendations for improvement published by an international expert group, are being updated and discussed. The IDSA and ESCMID guidelines define five categories of UTI. Some aspects specific for each group are discussed concerning definition, stratification and outcome. For patients with chronic bacterial prostatitis, a category of its own is proposed rather than using the general category of complicated UTI. The greatest advantage of the new guidelines in comparison with the former FDA guidelines is enrolment of patients according to intention to treat, as has always been recommended by the guidelines of the Japanese UTI Committee. Two problems arising in studies of all categories are addressed: (i) false positive bacteriuria and (ii) handling of dropouts and missing data. Compared with the former FDA guidelines, the new IDSA and ESCMID guidelines reflect much better the clinical situation of the physician taking care of individual patients. Therefore, the results of studies performed according to these guidelines are clinically more significant. A worldwide harmonization of guidelines may finally lead to valid and acceptable results in any country.

Acute Disease↗
PubMed1999

Pharmacoeconomics of treating uncomplicated urinary tract infections.

The frequency of urinary tract infections (UTIs) and mounting pressure for cost containment in medical care emphasize the need to consider costs of evaluating and treating UTIs. Many clinicians base antibiotic choice on drug cost, probably because this information is objective and readily available. However, the cost of treating UTI patients involves other factors, such as pathogenic susceptibility and consequences of inadequately treated infection. These factors and their associated costs can be difficult to assess and weigh against issues such as drug cost. The direct cost of treating a UTI patient includes not only initial medical evaluation and treatment, but what occurs subsequently. If initial treatment is provided with a drug for which a pathogen is not sensitive, patients will be likely to continue to experience symptoms and return for re-evaluation, resulting in a more thorough evaluation and a second antibiotic, generally a more expensive fluoroquinolone. The most important predictor of high cost-effectiveness is high efficacy against the most common urinary pathogen, Escherichia coli. The lower the effectiveness of antibiotics against this pathogen, the greater the number of revisits and cases of progression to pyelonephritis. Increased follow-up care results in diminished cost-effectiveness. Antibiotic cost is a poor predictor of cost-effectiveness, illustrated by the finding that the most and least expensive drugs, ofloxacin and trimethoprim-sulfamethasoxazole, are approximately equally cost-effective. Both of these are more cost-effective than other drugs, nitrofurantoin and amoxicillin, considered in this analysis.

Anti-Bacterial Agents↗
PubMed1998

[Nosocomial urinary tract infections: retrospective study in a pediatric hospital].

Urinary tract infections (UTI) are the most frequent nosocomial infection in the adult, yet very few data are available concerning these infections in children. In a retrospective 1-year study in a paediatric hospital, we analysed the incidence of nosocomial UTI and the characteristics of the affected children. The incidence was of 1.97/1,000 admissions which represented 6.8% of all UTI diagnosed by the microbiology laboratory. Most cases were in surgery and neurology wards. The frequency was inversely proportional to the age, with 50% of children being less than 2 years old. Pathogens most frequently isolated were E coli (39%), Pseudomonas sp (12.1%) and Enterococcus sp (12.1%). When compared with the organisms found in all the urine cultures during the same period, two organisms were more frequently found in nosocomial urinary tract infections: Pseudomonas sp and Candida sp. Most patients presented one or more risk factors, mainly:bladder catheterisation (41.4%), prior antibiotic therapy (62%), cerebral palsy (6.9%). No bacteriema was observed. The diagnosis of nosocomial UTI must be interpreted with caution and needs close collaboration between microbiologists and paediatricians. These infections increase the cost of hospitalisation, but only exceptionally do they present with complications. Some risk factors are inherent in hospital conditions, but others can be reduced by improving hand washing or by changing catheterisation practices.

Adolescent↗
PubMed2006

Relationship between Escherichia coli strains causing urinary tract infection in women and the dominant faecal flora of the same hosts.

To clarify whether prevalence or special pathogenicity is more important in determining urinary tract infection (UTI) causation, we compared the biotype, phylogenetic group, and virulence genes of Escherichia coli urine strains from 11 women with acute lower UTI with those of the host's dominant intestinal E. coli strain(s). Twenty-one unique E. coli clones were identified. For three women, the single faecal clone identified was also the host's urine clone, whereas for eight women faecal samples yielded 1 or 2 distinct non-urine clones (total, n = 10), either with (n = 3) or without (n = 5) the concurrent urine clone. The eight urine clones from the latter eight women exhibited significantly greater inferred virulence, according to virulence gene content and phylogenetic background, than did the hosts' 10 corresponding 'faecal only' clones. In contrast, the three urine clones that were detected as the host's sole faecal clone exhibited significantly lower inferred virulence than the other eight urine clones, and were statistically indistinguishable from the 10 'faecal only' clones. In conclusion, special pathogenicity is an important determinant of UTI pathogenesis in women, although prevalence may occasionally allow less virulent strains to cause UTI.

Adult↗
PubMed2000

Urinary tract infection and antibiotic susceptibility in malnourished children.

In this study, 31 (30%) cases of urinary tract infection (UTI) of 103 patients with malnutrition, who were admitted to our hospital, were investigated prospectively. Our purpose was to determine the frequency of UTI, species of bacteria caused to infection and their antibiotic susceptibility in infants with malnutrition. The mean age of the patients with UTI was 11.5+/-7.6 months (ranging 50 days-30 months). The main symptoms were fever, vomiting, diarrhea, cough, and seizures. The mean body weight was 5.8+/-1.9 kg (2-10 kg), and height was 67.5+/-7.8 cm (53-85 cm). Seven of them had mild, 11 had moderate, and 13 had severe malnutrition. The most common isolated microorganism from urine cultures was Escherichia coli (54.8%). Most strains of Escherichia coli were resistant to co-trimoxazole (82.3%), ceftriaxone (17.6%), cefotaxime (17.6%), and ciprofloxacine (17.6%), but none of them were resistant to gentamicin. In conclusion, we would like to emphasize that UTI predominantly by gram negative microorganisms are frequent in the infants with malnutrition, and these microorganisms are mostly resistant to co-trimoxazole which is used commonly in practical medicine and prophylaxis.

Child, Preschool↗
PubMed1997

Management of urinary tract infections: a comprehensive review.

Urinary tract infections (UTI) include a wide range of clinical entities. Starting from this situation, have been differentiated each of the UTI depending on location, age and sex, among other factors. Therefore, UTI have been classified and studied as follows: UTI in women, in men, in elderly people, in catheterized patients and in children. The different pharmacotherapeutic alternatives have been assessed and the classic agents compared with the most recent molecules.

Age Factors↗
PubMedDate not supplied

Predictors of symptomatic urinary tract infection after 20 weeks' gestation.

OBJECTIVE: To identify predictors of symptomatic urinary tract infection (UTI) after 20 weeks' gestation. STUDY DESIGN: A retrospective cohort analysis was conducted of all deliveries at three North Carolina hospitals between 1990 and 1993. A total of 7403 deliveries remained after exclusions (pre-pregnancy diabetes, HIV-positive, structural urologic abnormalities, no prenatal care) and restrictions (black or white race, county of residence). Cystitis and pyelonephritis were identified by clinician diagnosis. Multiple logistic regression was conducted. RESULTS: Prior UTIs (both before and earlier in pregnancy), nonprivate clinics, and a history of chlamydia (white women only) doubled the risk of symptomatic UTIs after 20 weeks' gestation. The strongest predictor of pyelonephritis was prior antenatal UTIs (adjusted incidence odds ratio = 5.3, 95% confidence interval of 2.6-11.0), followed by less education (< 12 years), a history of chlamydia, nonprivate clinics, illicit drug use, sickle cell hemoglobinopathy, and being unmarried. CONCLUSION: Medical history and demographic factors predict cystitis and pyelonephritis after 20 weeks' gestation. Prospective studies of pyelonephritis predictors and screening strategies are warranted.

Adult↗
PubMed2002

Pathogenesis of urinary tract infections: a review.

Pathogenesis of urinary tract infections (UTIs) is not well-understood. In this paper, we review the current understanding of UTIs, particularly in relationship to individuals using intermittent catheterization. Relationships exist between the human host, infectious agent and the environment. In the human host, the urethra connects the bladder to potential infectious agents on the perineum. A high-pressure zone exists within the urethra at a point where the urethra passes through the urogenital diaphragm. This zone creates a natural barrier to ascent of organisms colonized in the distal urethra and the bladder itself has natural defences against invading organisms. The interaction of host defences with bacteria (infectious agent) determines whether or not the bacteria persist. A small number of bacteria and some types of bacteria are controlled more effectively by natural bladder defence mechanisms and frequent bladder emptying than a large number of bacteria. Escherichia coli, coliforms and enterococci are considered common bacterial causes of UTIs and are found in high numbers on the perineum. Intermittent catheterization is an effective way of bladder emptying but as an invasive procedure it remains a risk factor in the development of UTI.

Bacterial Infections↗
PubMed2002

Type 1 fimbriae and extracellular polysaccharides are preeminent uropathogenic Escherichia coli virulence determinants in the murine urinary tract.

Escherichia coli is the leading cause of urinary tract infections (UTIs). Despite the association of numerous bacterial factors with uropathogenic E. coli (UPEC), few such factors have been proved to be required for UTI in animal models. Previous investigations of urovirulence factors have relied on prior identification of phenotypic characteristics. We used signature-tagged mutagenesis (STM) in an unbiased effort to identify genes that are essential for UPEC survival within the murine urinary tract. A library of 2049 transposon mutants of the prototypic UPEC strain CFT073 was constructed using mini-Tn5km2 carrying 92 unique tags and screened in a murine model of ascending UTI. After initial screening followed by confirmation in co-infection experiments, 19 survival-defective mutants were identified. These mutants were recovered in numbers 101- to 106-fold less than the wild type in the bladder, kidneys or urine or at more than one site. The transposon junctions from each attenuated mutant were sequenced and analysed. Mutations were found in: (i) the type 1 fimbrial operon; (ii) genes involved in the biosyn-thesis of extracellular polysaccharides including group I capsule, group II capsule and enterobacterial common antigen; (iii) genes involved in metabolic pathways; and (iv) genes with unknown function. Five of the genes identified are absent from the genome of the E. coli K-12 strain. Mutations in type 1 fimbrial genes resulted in severely attenuated colonization, even in the case of a mutant with an insertion upstream of the fim operon that affected the rate of fimbrial switching from the 'off' to the 'on' phase. Three mutants had insertions in a new type II capsule biosynthesis locus on a pathogenicity island and were impaired in the production of capsule in vivo. An additional mutant with an insertion in wecE was unable to synthesize enterobacterial common antigen. These results confirm the pre-eminence of type 1 fimbriae, establish the importance of extracellular polysaccharides in the pathogenesis of UTI and identify new urovirulence determinants.

Animals↗
PubMed1997

Evaluation of the utility of video-urodynamics in children with urinary tract infection and voiding dysfunction.

OBJECTIVE: To assess the use of video-urodynamic studies (VUDS) in children with urinary tract infection (UTI) and symptoms of voiding dysfunction (frequency, urgency, incontinence), to ascertain whether VUDS significantly assists in diagnosis and deciding treatment. PATIENTS AND METHODS: Over a 16-month period, all children seen at our centre with a UTI in conjunction with previous symptoms suggestive of voiding dysfunction underwent free and pressure-flow VUDS. Forty-two children underwent VUDS and 38 (mean age 9 years, range 4-16, 15 male, 23 female) had sufficient information to be included in the study. RESULTS: All children had a prior history of voiding dysfunction (mean 55 months). Only five patients were found to have reflux and three of these had associated detrusor instability. In addition, 24 of 33 patients who did not have reflux had abnormalities on urodynamic study, the most common problem being detrusor instability in 17 of 24 patients. Other abnormalities included sphincter dyssynergia (five patients), poor bladder compliance (two) and hypersensitivity on bladder filling (three). CONCLUSION: VUDS can provide information about the aetiology of UTI and voiding dysfunction in children that cannot be obtained from any other source. The results of VUDS can be used to select specific treatments, to avoid inappropriate therapy and to identify children who may benefit from follow-up studies despite normal findings on voiding cystourethrography. From these results, we believe that VUDS should be considered for children with UTI and voiding dysfunction.

Adolescent↗
PubMed2000

A prospective, controlled, randomized study of the effect of a slow-release silver device on the frequency of urinary tract infection in newly catheterized patients.

OBJECTIVE: To test the effect on urinary tract infections (UTIs) in patients needing continuous indwelling catheterization, of a newly designed urine-collecting system containing an antibacterial device which slowly releases silver ions onto the inner surface of the system. PATIENTS AND METHODS: The study comprised a prospective controlled randomized trial; 213 patients fulfilled the inclusion criteria. They were randomized to a urine drainage system (comprising a Unometer 400 metering system or PP 2000N closed urine-bag system, both from Maersk Medical, Denmark) either with or without the antibacterial device. The efficacy was assessed as the number of UTIs and the time to infection in the 170 patients eligible for analysis. RESULTS: There were fewer UTIs in those using the system containing the antibacterial device (19% vs 24%), but the difference was not statistically significant (P < 0.05). CONCLUSION: The potential importance of different infection routes were highlighted, suggesting that modifications to Foley catheters and urine-collecting systems attempting to prevent UTIs should focus not only on the intraluminal pathway, but on the internal and external pathways of infection.

Adult↗
PubMed2001

Selective urological evaluation in men with febrile urinary tract infection.

OBJECTIVE: To investigate the prevalence and clinical importance of urological abnormalities in men with community-acquired febrile urinary tract infection (UTI). PATIENTS AND METHODS: In this prospective study, 85 men (median age 63 years, range 18--86) were followed for 1 year after an episode of febrile UTI. They were investigated by excretory urography, cysto-urethroscopy, uroflowmetry, digital rectal examination and measurement of postvoid residual urine volume by abdominal ultrasonography. RESULTS: The radiological examination of the upper urinary tract in 83 patients revealed 22 abnormal findings in 19 men. Relevant clinical abnormalities leading to surgical intervention were found in only one patient who had renal calyceal stones. The lower urinary tract investigation disclosed 46 findings in 35 men. In all, surgically correctable disorders were found in 20 patients, of whom 15 had previously unrecognized abnormalities. All patients who required surgery were identified either by a history of voiding difficulties, acute urinary retention at the time of infection, the presence of microscopic haematuria at follow-up after one month, or early recurrent symptomatic UTI. CONCLUSION: Routine imaging studies of the upper urinary tract seem dispensable in men with febrile UTI. To reveal abnormalities of clinical importance, any urological evaluation should primarily be focused on the lower urinary tract.

Adolescent↗
PubMed2002

Female urodynamics and lower urinary tract infection.

OBJECTIVES: To determine the incidence of unsuspected urinary tract infection (UTI) before cystometry, to evaluate reports of a greater tendency to abnormal cystometry in the presence of asymptomatic bacteriuria, and to determine the incidence of iatrogenic significant bacteriuria after cystometry. PATIENTS AND METHODS: A prospective study was carried out in the gynaecology department of a district general hospital in collaboration with the medical microbiology department of a university teaching hospital. The period of investigation was 1 year and the study population was a sample of women undergoing urodynamic investigations during this period. Data were collected on age, menopausal status, parity, cystometric diagnosis and voiding dysfunction. RESULTS: In all, 117 patients provided a urine sample before cystometry; 12 of these patients had a positive culture, giving an incidence of 10.3% for unsuspected asymptomatic bacteriuria before cystometry. There was a significant association between age and the presence of UTI before cystometry (P = 0.003) and between this UTI and sensory urgency (P = 0.01). There was no similar significant association with detrusor instability or genuine stress incontinence. Nineteen of the 97 patients who had negative bacteriology before cystometry had a positive urine culture afterward. Compared with patients who had a negative sample, there was no significant association with age, parity, menopausal status, abnormal cystometry or voiding dysfunction. CONCLUSION: These results do not support a policy of universal screening for bacteriuria before urodynamic investigation. Asymptomatic bacteriuria did not influence the urodynamic outcome except in patients with sensory urgency. However, we recommend that screening and treatment be considered individually in older women who are being investigated for irritative bladder symptoms. About 20% of the present patients developed UTI after the urodynamic investigation. This information should be included in the counselling before urodynamic investigation and should be incorporated into the patient information leaflet as part of good clinical practice.

Aged↗
PubMed2003

Analysis of the long-term outcome of surgically corrected vesico-ureteric reflux.

OBJECTIVE: To review patients who had vesico-ureteric reflux corrected surgically by ureteric reimplantation during childhood, and thus assess their long-term outcome. PATIENTS AND METHODS: Between 1970 and 1979, 322 children underwent ureteric reimplantation; 100 (79 women and 21 men) were re-assessed and the long-term results evaluated using a questionnaire, a review of the patients' current medical records and an appointment in the outpatient clinic. The evaluation focused on the frequency of late urinary tract infections (UTIs), current renal function tests, related complications during pregnancy and the incidence of hypertension at least 20 years after surgery. RESULTS: Of the study group, 51% (66% of men and 47% of women) had no long-term urological complications. The incidence of UTIs was 43% in women and 24% in men, and of pyelonephritis 27% and 9.5%, respectively. Hypertension was detected in 6% of the patients during assessment. There were new renal scars, despite surgery, in 20% of the patients. Forty-seven women had been pregnant, 28% reporting UTIs during pregnancy. In 7% of 94 pregnancies the women also had pre-eclampsia and two women had transient gestational ureteric obstruction which required drainage. Renal functional tests were worse in one man and one woman who developed end-stage renal disease and had a renal transplant. CONCLUSIONS: This series shows that even patients who were treated successfully by ureteric reimplantation during childhood are prone to recurrent UTIs, progressive renal scarring, hypertension and complications during pregnancy. There is a need to establish a protocol for the long-term follow-up of such patients.

Adolescent↗