Urinary tract infection with anaerobic bacteria following endoscopic urethral instrumentation

A prospective study of the pathogenic role of anaerobic bacteria was undertaken by suprapubic bladder aspiration in 100 patients prior to routine endoscopic urethral instrumentation. Anaerobic and/or micro-aerophilic bacteria were isolated from the suprapubic specimens of 11 patients (greater than 10(5) organisms/ml from 8), with identical species growing heavily from corresponding cystoscopic specimens and/or urethral swabs. Previous cystoscopies in all 11 patients and the presence of bladder tumour at the time of sampling in six were significantly and independently associated with the isolation of anaerobic bacteria from suprapubic specimens. It was concluded that transurethral instrumentation entails a definite risk of anaerobic urinary infection in addition to the recognised risk of aerobic urinary infection. The findings suggest that the antibiotics used as prophylaxis for or treatment of patients undergoing transurethral procedures should be effective against anaerobic bacteria.     

Urinary tract infection caused by group-B streptococcus in infancy and childhood

Group-B streptococcus (GBS) was isolated from 21 cases (1.4 per cent) of urinary tract infection (UTI) in a pediatric hospital in one year. Seventeen patients were females, and 4 were males. Six patients were less than one month old. This report describes the clinical, urologic, and microbiological aspects.     

Urinary tract and genito-urinary suppurative infections due to anaerobic bacteria

Anaerobes have been involved in many different types of urinary tract infection. This review describes the microbiology, diagnosis and management of urinary tract and genito-urinary suppurative infections caused by anaerobic bacteria. The types of infections of the urinary tract in which anaerobes have been involved include para- or periurethral cellulitis or abscess, acute and chronic urethritis, cystitis, acute and chronic prostatitis, prostatic and scrotal abscesses, periprostatic phlegmon, ureteritis, periureteritis, pyelitis, pyelonephritis, renal abscess, scrotal gangrene, metastatic renal infection pyonephrosis, perinephric abscess, retroperitoneal abscess and other infections. The anaerobes recovered in these studies were Gram-negative bacilli (including Bacteroides fragilis and pigmented Prevotella and Porphyromonas sp.), Clostridium sp., anaerobic Gram-positive cocci and Actinomyces sp. In many cases, they were recovered mixed with coliforms or streptococci. The recovery of anaerobes requires the administration of antimicrobial therapy that is effective against these organisms. These antimicrobials include metronidazole, chloramphenicol, clindamycin, a carbapenem, cefoxitin and the combination of a penicillin and a beta-lactamase inhibitor. Percutaneous drainage, open surgical drainage or nephectomy might be indicated for abscesses.     

Urinary proteins in children with urinary tract infection

The aim of this study was to test our hypothesis that the urinary excretion of C-reactive protein (CRP), alpha 1-microglobulin (A1M), retinol-binding protein (RBP) and Clara cell protein (CC16) is increased in children with urinary tract infection (UTI) and relates to renal damage as measured by acute dimercaptosuccinic acid (DMSA) scintigraphy. Fifty-two children <2 years of age with UTI were enrolled in the study, 44 of whom were febrile. The control group consisted of 23 patients with non-UTI infection and elevated serum CRP (s-CRP) levels. Thirty-six patients had abnormal DMSA uptake, classified as mild, moderate or severe damage (DMSA class 1, 2, 3, respectively). There was a significant association between DMSA class and the excretion of urinary RBP (u-RBP) and u-CC16. There was also a significant difference in u-CRP levels between children with UTI and control children with non-UTI infections, although u-CRP excretion was not significantly correlated to DMSA class. In conclusion, the urinary excretion of the low-molecular-weight proteins RBP and CC16 showed a strong association with uptake defects on renal DMSA scans. The urinary level of CRP seems to distinguish between children with UTI and other febrile conditions. A combination of these biomarkers may be useful in the clinical assessment of children with UTI.     

Urinary tract infection caused by Haemophilus influenzae. A case report

In a patient with frequent symptoms of urinary tract infection during the past 5 years and steadily deteriorating renal function, standard urine cultures were mostly negative. Following microscopy of freshly voided, gram-stained urine, culture on haematin agar plates incubated in 10% CO2 resulted in isolation of Haemophilus influenzae. Augmented culture procedures may identify the cause of symptoms in similar cases.     

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 ourhospital, were investigated prospectively. Our purpose was to determinethe frequency of UTI, species of bacteria caused toinfection and their antibiotic susceptibility in infants withmalnutrition. 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(58–85 cm). Seven of them had mild, 11 had moderate, and 13 hadsevere malnutrition. The most common isolated microorganism from urinecultures was Escherichia coli (54.8%). Most strains ofEscherichia coli were resistant to co-trimoxazole(82.3%), ceftriaxone (17.6%), cefotaxime (17.6%),and ciprofloxacine (17.6%), but none of them were resistant togentamicin. In conclusion, we would like to emphasize that UTIpredominantly by gram negative microorganisms are frequent in theinfants with malnutrition, and these microorganisms are mostly resistantto co-trimoxazole which is used commonly in practical medicine andprophylaxis. This revised version was published online in August 2006 with corrections to the Cover Date.     

Urinary tract infection in children: etiology and epidemiology

The urinary tract is a relatively common site of infection in infants and young children.Urinary tract infection (UTI) may result in significant acute morbidity, as well as longterm medical complications. Recent advances elucidating the pathogen-host interaction have broadened the understanding of the pathogenesis and clinical progression of pediatric UTI. This article focuses on the epidemiology and pathogenesis of pediatric UTI, and briefly discusses UTI-related complications.     

Urinary tract infection

A model for the experimental production of an ascending chronic infection of urinary tract in rats is described. The traumatic action caused by a stainless steel cylinder filled with a suspension ofP. mirabilis, the slowing-down of the elimination of germs by the urine and the induction of a water diuresis by 5% glucose in the drinkingwater, were suitable in producing a urinary tract disease with bladder and renal stones. The model is fairly reproducible and suitable for studying the activity of drugs against uninary tract infections.     

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

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

Risk factors in community-acquired urinary tract infections caused by ESBL-producing bacteria in children

In this study, risk factors were investigated in children with community-acquired urinary tract infections (UTI) caused by extended-spectrum beta-lactamases (ESBL)-producing E. coli or Klebsiella spp. One hundred and fifty-five patients were diagnosed with ESBL-positive UTI (case group) in the outpatient clinics of Hacettepe University Children’s Hospital between 1 January 2004 and 31 December 2006. A control group, 155 out of 4,105 children, was matched by age and sex among children with ESBL-negative UTI. A total of 310 patients’ files were evaluated retrospectively. As regards the symptoms of UTI, no statistical differences were seen between the two groups. Although the most frequently isolated microorganism was E. coli in both groups, Klebsiella spp. was found to be more frequent in those diagnosed with ESBL(+) UTI (p?<?0.001). Having an underlying disease and hospitalization, infections, and use of antibiotics within the last 3 months were found to be potential risk factors (p?<?0.001). With conditional logistic regression analysis, having an underlying disease and hospitalization within the last 3 months were identified as independent risk factors for ESBL(+) UTI. In conclusion, the recognition of risk factors for UTI, caused by ESBL(+) bacteria in children, may aid in the identification of high-risk cases and may enable proper management of these patients.     

Urinary tract infection in children associated with idiopathic hypercalciuria.

OBJECTIVE: The aim of this study was to evaluate the association of symptomatic non-calculous idiopathic hypercalciuria (IH) with urinary tract infection (UTI) in children. MATERIAL AND METHODS: This was a retrospective case review of children who had urinary calcium excretion greater than 2 mg/kg/day or random urine calcium-creatinine ratio (UCa/UCr) greater than 0.18 mg/mg. RESULTS: One hundred and twenty-four consecutive children with clinical complaints and elevated urine calcium excretion were reviewed. Fifty children (40%) had UTI of which 39 (78%) had recurrent UTI. There was no difference in age between children with UTI and those without UTI. Twenty-four-hour urine calcium and random UCa/UCr were also not different. Only 4 children (8%) had renal stones whereas hematuria, abdominal pain and urine incontinence were frequent associated findings. Six of the children with recurrent UTI (15%) had an anatomical urinary tract abnormality. Therapy in all children consisted of increased fluid intake and reduction in diet sodium and oxalate; however, 14 of the 39 children with recurrent UTI (36%) required therapy with a thiazide diuretic. Recurrent UTI was abolished in 24 children, one child had a single recurrence and 4 children had no response to treatment. CONCLUSIONS: We propose that non-calculous IH may be an important contributing factor to recurrent UTI in children.     

Urinary tract infection in childhood

The importance of establishing significant bacteriuria in the diagnosis of urinary tract infection and the need for a keen awareness of its presence, particularly in young children, is stressed. The approach to the diagnosis, investigation, management and follow-up of children with urinary tract infection is described.     

Urinary tract infection in childhood

Over the past year, research about urinary tract infections in childhood has yielded new data about methods to detect, treat, and evaluate children who develop urinary tract infection. New imaging modalities have been studied. Long term studies following children with urinary tract infection have also been published over the last year. However, major questions remain to be answered, including the underlying basis of host-pathogen interactions in the urinary tract, as well as the most effective methods for clinical diagnosis and management.     

Urinary tract infection in boys

Considerable literature exists regarding the evaluation and treatment of children with urinary tract infection yet little has been reported solely about boys. We reviewed retrospectively 83 boys who were seen after an initial urinary tract infection. Fever was the most common presenting sign (50 per cent) and the most common organisms encountered were of the gram-positive group of bacteria. Escherichia coli accounted for only 21 per cent of the infections. Of the boys 75 per cent (62 patients) had an anatomic abnormality, most commonly vesicoureteral reflux, although more than 25 per cent of our patients had obstructive lesions. Renal scarring was present in half and 58 per cent required early surgical intervention. Urinary tract infection seems to have a higher morbidity in boys and the finding of an atypical organism is to be expected. Based on our findings, we strongly recommend an excretory urogram and a voiding cystourethrogram as the minimal evaluation of boys following an initial urinary tract infection.     

Urinary macrophage migration inhibitory factor in children with urinary tract infection

Macrophage migration inhibitory factor (MIF) plays an essential pathophysiological role in inflammatory reactions. The aim of this study was to investigate the clinical utility of urine MIF (uMIF) level in predicting urinary tract infections (UTI). This multicenter, prospective study was conducted over a 1-year period between March 2008 and March 2009. Sixty patients with symptomatic culture-proven UTI and 29 healthy children were recruited. Urine MIF was measured by enzyme-linked immunosorbent assay. The mean MIF level was found to be significantly higher in the UTI group than in the control group (1082.82 vs. 211.45 pg/ml, p?=?0.0001). Receiver operating characteristic (ROC) analysis revealed that the optimal cut-off uMIF level was 295 pg/ml for uMIF to predict UTI. The sensitivity and specificity of this cut-off level were 91.7% and 69%, respectively. Mean uMIF/creatinine (Cr) was also significantly higher in the UTI group than in the control group (2400.69 vs. 267.56 pg/mgCr, p?=?0.0001). At a cut-off of 815 pg/mgCr for uMIF/Cr, the sensitivity and specificity were 95 and 79%, respectively. The area under curve (AUC) was 0.848 (standard error 0.040, 95% confidence interval 0.756–0.915) for uMIF and 0.889 (0.034, 0.805–0.946) for uMIF/Cr. Urine MIF/Cr was significantly higher in the patients with a positive leukocyte esterase reaction in the urine (p?=?0.047), leukocytosis (p?=?0.0001) and positive C-reactive protein level in serum (p?=?0.003). The uMIF level was not related to leukocytosis, positive CRP level in serum and leukocyte esterase reaction in the urine. Neither uMIF nor uMIF/Cr were correlated to the positive urine nitrite test, pyuria, urine pH and specific gravity (p?>?0.05). These results suggest that urine MIF and uMIF/Cr can be used for the early prediction of UTI in children.     

Urinary tract reconstruction in children

The successful introduction of clean intermittent catheterization and increased awareness of urinary tract physiology and urodynamics have been the basis for recent major advances in urinary tract reconstructive surgery. Surgical techniques are now available to manage anatomical and functional deficiencies of any isolated or combined components of the urinary tract. The high incidence of unsatisfactory long-term results with ileal conduit diversion has led to increased popularity in urinary tract undiversion and greater utilization of reconstructive principles. As with any new surgical field of endeavour, new operative techniques are appearing at a rapid rate. In particular, there has been a recent proliferation of surgical procedures that provide a continent, low pressure, catheterizable reservoir for urine storage. Most children with major urinary tract deficiencies can now be offered socially and cosmetically unobtrusive surgical solutions without jeopardizing renal function.