Inactivation of bacteria inoculated inside urinary stone-phantoms using intracorporeal lithotripters

Intracorporeal lithotripsy is used to treat a high percentage of urinary calculi. Urinary calculi may contain bacteria, which might cause septicemia after lithotripsy; however, little is known about the effects of lithotripters on the viability of microorganisms inside renal calculi. The objectives of this study were to evaluate the bactericidal effect, and the potential effect on intra-bacterial protein release of four different intracorporeal lithotripters on Escherichia coli (E. coli) inoculated inside artificial kidney stones. An electrohydraulic, a pneumatic, an ultrasonic, and a holmium-laser lithotripter were used to pulverize a set of infected kidney stones inside a test tube containing a saline solution. Two different energy levels were tested per lithotripter. The stones were manufactured by mixing gypsum cement and Vel-mix-stone with a suspension containing E. coli. Results were analyzed by analysis of variance. The release of intracellular protein was measured with a spectrophotometer. Bacteria inactivation was observed with all lithotripters. The highest percentage of inactivated bacteria was obtained with the electrohydraulic lithotripter. The smallest effect was observed using the holmium-laser lithotripter. A relatively high amount of intracellular protein was released into the saline solution after stone pulverization. Intracorporeal lithotripters inactivate a high percentage of bacteria during stone comminution; however, intracellular protein is released, increasing the probability of septicemia.     

Diversity and antibiotic resistance of uropathogenic bacteria from Abidjan

BackgroundUrinary tract infections (UTI) are one of the major causes of prescribing and antibiotic consumption. In order to use the best antibiotic treatment for their patients, reliable and recent data about epidemiology and antibiotic resistance profile of uropathogenic bacteria must be available for clinicians. Therefore regular monitoring in each country is required.ObjectivesThe aims of this study were to investigate the bacterial pathogenic diversity and antimicrobial resistance rates of uropathogenic bacteria at the Treichville Teaching Hospital (Abidjan, Ivory Coast) over a 12-year period (2000–2011) and also to contribute to the monitoring and the geographical adaptation of antibiotic therapy.Materials and methodsA retrospective analysis of 12,175 urine samples over a 12-year period 2000–2011 at Treichville Teaching Hospital was carried out according to the routine protocol of urinalysis. The results were processed to obtain the profile prevalence of UTI, the rate of bacterial resistance to antibiotics, the trend of their evolution over time and the rate of multidrug resistance.ResultsThe presence of bacteria was detected in about 25% of samples in which 3071 bacterial germs belonging to 12 species were identified. Escherichia coli was the dominant species (28.7%) but much lower than observed in European countries (70–80%). Other main detected species were Staphylococcus aureus (17.4%), Klebsiella pneumoniae (14.9%) and Enterobacter aerogenes (10%). These genera were responsible of 71% of the UTI.Resistance tests to antibiotics indicated very high rates of resistance to amoxicillin (78.9%), tetracyclin (76.4%), and trimethoprim/sulfamethoxazole (77.9%). Only a few molecules maintain their effectiveness such as cefotaxime and netilmicin which respectively exhibit 13.9% and 3.1% of bacterial resistance. However bacterial resistance is increasing over a time for all antibiotics except chloramphenicol.ConclusionsThe diversity of uropathogenic bacteria obtained appeared to be a characteristic of sub-Saharan African countries. Their resistances to different antibiotics were following a dramatic trend. Waiting to be confronted with therapeutic dead end with the advent of multi-resistant bacteria, identifying the region-specific causes is crucial to adapt antibiotic therapy.     

Reduction of Escherichia coli adherence to uroepithelial bladder cells after consumption of cranberry juice: a double-blind randomized placebo-controlled cross-over trial

To determine the efficacy of the consumption of cranberry juice versus placebo with regard to the presence of in vitro bacterial anti-adherence activity in the urine of healthy volunteers. Twenty healthy volunteers, 10 men and 10 women, were included. The study was a double-blind, randomized, placebo-controlled, and cross-over study. In addition to normal diet, each volunteer received at dinner a single dose of 750 ml of a total drink composed of: (1) 250 ml of the placebo and 500 ml of mineral water, or (2) 750 ml of the placebo, or (3) 250 ml of the cranberry juice and 500 ml of mineral water, or (4) 750 ml of the cranberry juice. Each volunteer took the four regimens successively in a randomly order, with a washout period of at least 6 days between every change in regimen. The first urine of the morning following cranberry or placebo consumption was collected and used to support bacterial growth. Six uropathogenic Escherichia coli strains (all expressing type 1 pili; three positive for the gene marker for P-fimbriae papC and three negative for papC), previously isolated from patients with symptomatic urinary tract infections, were grown in urine samples and tested for their ability to adhere to the T24 bladder cell line in vitro. There were no significant differences in the pH or specific gravity between the urine samples collected after cranberry or placebo consumption. We observed a dose dependent significant decrease in bacterial adherence associated with cranberry consumption. Adherence inhibition was observed independently from the presence of genes encoding type P pili and antibiotic resistance phenotypes. Cranberry juice consumption provides significant anti-adherence activity against different E. coli uropathogenic strains in the urine compared with placebo.     

Antimicrobial susceptibility of bacteria isolated from urine cultures in Southern Turkey

BackgroundPathogen spectrum and antibiotic susceptibility patterns vary in different regions and should consider the empirical treatment of urinary tract infections (UTIs). Information on susceptibility is the basis for providing reliable treatment. This study aimed to determine the antibiotic susceptibility of bacteria isolated from urine cultures at Çukurova State Hospital, which is located south of Turkey and east of the Mediterranean region.Materials and methodsUrine culture results were retrospectively evaluated between April 2018 and January 2021. Variables, such as age, sex, and medical department, were also recorded. Inclusion criteria were patients aged at least 18 years with pathogenic bacterial growth in their urine cultures. Antibiotic susceptibility testing and bacterial identification were performed using the VITEK 2 automated system.ResultsOf 12,288 urine samples, 2033 (16.5%) had pathogenic growth. The rates of bacterial and yeast growth were 93.3% and 6.7%, respectively. Gram-negative pathogens constituted 91.6% of the cohort. The most prevalent bacteria were Escherichia coli with a 66% rate, followed by Klebsiella (14.2%). According to our results, ciprofloxacin, trimethoprim-sulfamethoxazole, and ampicillin are not suitable for empirical treatment of UTIs, whereas nitrofurantoin and fosfomycin are rational options.ConclusionsUropathogens exhibit an increased resistance rate against ampicillin, trimethoprim-sulfamethoxazole, and ciprofloxacin. Nitrofurantoin, fosfomycin, and ceftazidime have better efficacy than other investigated antibiotics in urine culture against common uropathogens and are suitable for empirical treatment of UTI.     

Influence of oral intake of Saccharomyces boulardii on Escherichia coli in enteric flora

Enteric flora constitutes 95% of the cells in the human body. It has been shown that the bacterial content of this flora is affected by diet and changes in nutrition. Considering that urinary tract infections (UTI) are mostly due to ascending infections from the gut flora, the importance of the elements of this flora and their characteristics becomes more evident. The aim of this study was to evaluate the influence of oral Saccharomyces boulardii (S. boulardii) intake on the number of Escherichia coli (E. coli) colonies in the colon. This study was carried out with 14 boys and 10 girls (total of 24 children) aged between 36 and 192 months (mean: 104.3±45.1 months). A commercial capsule or powder containing 5 billion colony-forming units (cfu) of S. boulardii was administered once a day for 5 days. The number of E. coli and yeast colonies was measured in the stool samples of the study group before and after the use of this drug. Before treatment, the mean number of E. coli colonies in g/ml stool was 384,625±445,744. This number decreased significantly to 6,283±20,283 after treatment (p=0.00). S. boulardii was not detected in stool before treatment and the number of colonies increased to 11,047±26,754 in g/ml stool. S. boulardii may be effective in reducing the number of E. coli colonies in stool. The influence of this finding on clinical practice such as prevention of UTI needs to be clarified by further studies.     

E. coli virulence factors in children with neurogenic bladder associated with bacteriuria

The value of E. coli virulence factors in patients with neurogenic bladder has not been established. The aim of this study is to correlate E. coli virulence factors with asymptomatic and symptomatic UTI in children with neurogenic bladder. Fifty E. coli strains, which were collected in sequence, underwent analysis in relation to: the association to pyuria, serotype (O:H), the presence of genes and expression of fimbriae P, type 1, S and hemagglutinin Dr, the presence of the gene and production of hemolysins and cytotoxins (CNF1). We also analyzed the cell adherence capability and pattern and presence of usp (uropathogenic-specific protein). Pyuria was present in most of the positive urine cultures, with 86% AB and 97% UTI. Low rates of uropathogenic strains were observed in the two groups, with 18% AB and 21% UTI. Type 1 fimbria predominated in 44% of the E. coli strains. Of the bacteria studied, 30% (15 strains) exhibited papG genotypes (11 class II and 4 class III). Of these, 12/15 patients presented AB. Production of hemolysins was detected in 38% of the strains (16 AB and 3 UTI) and usp in only 18% of the strains, with 8 AB and 1 UTI. Adherence tests demonstrated the adhesive capacity in all samples analyzed. Neither group (AB or symptomatic UTI) presented a statistically significant difference in relation to the virulence factors studied. E. coli clones that caused symptomatic UTI in children with neurogenic bladder expressed few virulence factors, with no statistically significant difference in comparison to the AB group.     

Antibiotic resistance of urinary tract pathogens and rationale for empirical intravenous therapy

Empirical antibiotic treatment in urinary tract infection (UTI) in children must rely on surveillance data on the epidemiology and resistance patterns of common uropathogens. A retrospective analysis of bacteria isolated from children with UTI irrespective of underlying disease or pre-treatment was performed at the University Hospital of Freiburg, Germany, in 1997, and from 1999 to 2001. In the first study period, 261 positive urine samples and in the second period 684 positive samples were analyzed. Escherichia coli (57.2%) was the leading uropathogen followed by Enterococcus spp. (13.7%), Pseudomonas aeruginosa (7.0%), Proteus spp. (5.9%), Klebsiella spp. (4.7%), and Enterobacter/Citrobacter spp. (4.3%). Almost 50% of the E. coli isolates were resistant to ampicillin, but effectively no resistance against cephalosporins, aminogylcosides, ciprofloxacin, nitrofurantoin, and imipenem was observed. In Enterococcus spp. the resistance to ampicillin was about 15% and 40% to netilmicin, while none of the latter showed high-level aminoglycoside resistance. In P. aeruginosa, there was no resistance to aminoglycosides. No difference in resistance patterns between the two study periods was observed. We conclude that an empirical combination treatment of ampicillin and gentamicin, netilmicin, or tobramycin is appropriate in children with UTI independent of pre-treatment or underlying disease. This therapy should be clinically efficacious, well tolerated, and cost effective, and should prevent unnecessary development of antimicrobial resistance.     

Viable but nonculturable uropathogenic bacteria are present in the mouse urinary tract following urinary tract infection and antibiotic therapy

Involvement of the viable but nonculturable (VBNC) condition in recurrent urinary tract infections (UTIs) was investigated. VBNC bacteria are those which are alive but do not give rise to visible growth under nonselective growth conditions. Urine, bladder, and kidney samples collected over a 2-month period from BALB/c mice inoculated with the uropathogenic Escherichia coli strain J96 were examined to determine the level of culturable and viable bacteria. Urine from uninoculated mice was found to contain more viable than culturable bacteria. Inoculated mice had a transient increase in the level of culturable forms of the uropathogen in their urine, followed by a decrease to background levels; they also had multiple log higher levels of viable cells than culturable cells. The culturable pathogenic bacteria in mice that were inoculated and received antibiotic treatment dropped to undetectable levels within 1 week. At 2 out of 12 subsequent time points spanning an additional 65 days, culturable forms of the inoculated pathogenic bacteria were recovered. Polymerase chain reaction (PCR) analysis confirmed that DNA from the inoculated bacteria was present in a sample that yielded no culturable bacteria. These data indicate that the inoculated uropathogenic E. coli was not eliminated by antibiotic therapy, and suggest that these bacteria may escape detection by current standard culturability assays because they are VBNC. Received: 24 March 2000 / Accepted: 11 September 2000     

Amoxicillin promotes vaginal colonization with adheringEscherichia coli present in faeces

This study is aimed at a better understanding of the pathogenesis of urinary tract infection (UTI) by examining factors influencing the bacterial ecology of the genital tract. It comprises two sets of experiments in a monkey model. In the first the persistence and transmission between individuals of a P-fimbriatedEscherichia coli (strain DS17) in faeces was examined and in the second we studied the influence of amoxicillin on the occurrence of this strain in the vagina. Orally administeredE. coli DS17 was shown to spread to cage mates and to persist in the gut for at least 17–18 months. One of four monkeys so colonized developed three separate UTIs with the DS17 strain. The second set of expriments comprised four other monkeys, who either harboured theE. coli DS17 strain in the faeces and/or in small amounts in the vagina, probably through contamination during defaecation. Amoxicillin induced a persistent vaginalE. coli DS17 colonization in nine of ten experiments. The study thus shows that uropathogenicE. coli may persist for long time in the faeces and that, in this situation, amoxicillin may promote an abnormal, vaginalE. coli colonization similar to that characteristic of females prone to recurrent UTI and often preceding manifest urinary infections.     

Dietary factors affecting susceptibility to urinary tract infection

Urinary tract infection (UTI) is usually an ascending infection caused by bacteria derived from stools. Since the bacterial composition of stools is dependent on the diet, it is likely that the risk of UTI will change with changes in the diet. Most data describing diet as a risk factor for UTI come from epidemiological and interventional trials. It has been shown in a case-control setting that frequent consumption of fresh berry or fruit juices and fermented milk products containing probiotic bacteria decreases the risk for UTI recurrence in women. Several interventional trials have found Vaccinium berry products to provide protection from UTI recurrence. Probiotics have not been able to prevent UTI in interventional trials. However, the lack of an effect may be related to too low a dose or to the use of non-optimal products in these trials. Limited data are available on the effects of nutrition on UTI in children. However, there is no reason to expect that children would be different from adults in this respect. In this review, we discuss the dietary factors affecting the susceptibility to UTI.     

Mannose inhibition of Escherichia coli adherence to urinary bladder epithelium: Comparison with yeast agglutination

The adherence of piliated strains of Escherichia coli (E. coli) to mammalian epithelial cells has been reported by several investigators to be specifically inhibited by D(+)-mannose or its derivatives. Much of this work utilized mannose type compounds to inhibit agglutination of mannan containing yeast cells by E. coli to demonstrate mannose sensitivity. This report investigates the ability of the neotype strain of E. coli (which is sensitive to mannose inhibition of yeast cell agglutination) to bind and metabolize radiolabeled D(+)-mannose. In addition the relative efficacy of D(+)-mannose and heparin to inhibit the adherence of E. coli to rabbit bladder mucosa was compared. Results showed that although D(+)-mannose did block E. coli-yeast cell agglutination in a reversible manner, radiolabeled D(+)-mannose binding by E. coli could not be displaced by 1,000 fold excess unlabeled D(+)-mannose. This suggests uptake of the sugar as opposed to a surface binding phenomenon which was confirmed by the demonstration of significant metabolism of mannose by E. coli. The same concentration of D(+)-mannose which prevented E. coli-yeast cell agglutination was not particularly effective in preventing E. coli adherence to the acid denuded rabbit bladder. Heparin treatment of the acid denuded bladder was very effective in preventing E. coli adherence but was ineffective in preventing E. coli-yeast cell agglutination. This indicates that E. coli-yeast cell agglutination should not be correlated with E. coli adherence to mammalian epithelial tissue.This work was supported in part by grants from the Veterans administration, by NIH Grant #RO-AM-650804, and by the McCabe Fund     

The evaluation and treatment of acute epididymitis in a large university based population: are CDC guidelines being followed?

Purpose  To review the evaluation and treatment of epididymitis in a contemporary population and evaluate adherence to Centers for Disease Control (CDC) guidelines. Materials and methods  From 1999 to 2005, 870 patients from a single institution were diagnosed with epididymitis. Information regarding patient demographics, diagnostic evaluation, and treatment was reviewed. Adherence to CDC guidelines for the treatment of acute epididymitis was evaluated. Results  A total of 455 men between 3 and 88 years met inclusion requirements for acute epididymitis. Seven percent of pediatric patients (<18 years) and 29.5% of adult patients (≥18 years) undergoing urine culture demonstrated bacterial growth. Twelve percent of adult patients with urethral swab PCR performed for Chlamydia trachomatis had positive results. A bacterial etiology for epididymitis was documented in 6.6% of pediatric patients and 28% of adult patients who were tested by urine culture and/or urethral swab for C. trachomatis. Less than 35% of adult men underwent the appropriate CDC work-up. Fifty percent of patients, 18–35 years and 85% of patients, >35 years were prescribed an effective treatment according to CDC guidelines. Patients were less likely to be admitted to the hospital (100 vs. 2.3%) and more likely to be treated with antibiotics than in previously published series (97 vs. 75%). Conclusions  CDC guidelines for the evaluation and treatment of acute epididymitis were followed in less than 35% of patients seen in a university based health care system. Despite a paucity of documented urinary infection, 97% of adult men are treated empirically with antibiotics often not in accordance with CDC guidelines.     

多重耐药菌引发的导管相关尿路感染的临床随机对照研究

多重耐药菌是指对3种及3种以上抗菌药物耐药的细菌,常见为非发酵革兰阴性菌、肠杆菌科细菌等,其多为条件致病菌,部分菌致病力弱,但一部分细菌在医用器械表面可长期存活,对常用消毒剂不敏感,而且耐药基因相互之间可传递或转移,造成耐药基因在不同菌种间传播。     

尿路感染中段尿病原菌的分布及耐药性

Objective To analyze the distribution and antimicrobial resistance of pathogenic bacteria in urinary tract infection (UTI) so as to provide evidence for appropriate selection of antimicrobial agents in clinical practice. Methods From January 2001 to December 2008 in Shanghai Ruijin Hospital, 4683 strains of pathogenic bacteria isolated from urine samples were detected by ATB system; drug susceptibility test was performed with disk diffusion method and pathogenic bacteria distribution and drug resistance was analyzed with WHO NET 5.3 software. Results Among 4683 strains of pathogenic bacteria, most was gram-negative bacilli, accounting for about 77.8%, of which predominant strain was Escherichia coli (68.7%, 3217/4683). The predominant strain of gram-positive bacteria was Enterococcus faecalis, accounting for 10.0% (468/4683). Escherichia coli showed high resistance rates to ampicillin, piperacillin and compound sulfamethoxazole (SMZ-TMP), which were 76.6%, 61.7% and 57.4% respectively, while a low resistance to imipenem, cefoperazone-sulbactam, piperacillin-tazobactam. Enterococcus faecalis showed high resistance rates to erythromycin, gentamicin and levofloxacin, which were 65.8%, 43.2% and 31.1% respectively, and were most susceptive to vancomycin and teicoplanin, both with resistance rates of 0. The susceptibility rate of Enterobacteriaceae to imipenem was 100%. From 2006 to 2008, the detection rate of extend-spectrum ?茁-lactamases ESBLs -producing Escherichia coli in outpatient increased year by year, from 28.7% to 43.3% (P<0.05), whereas no significant change was found in inpatients. The detection rate of (ESBLs)-producing Escherichia coli in inpatients was significantly higher than that in outpatients (P<0.05). The detection rate of ESBLs-producing Escherichia coli was 23.6%. The antimicrobial resistance rate in elderly patients was significantly higher than that in overall antimicrobial resistance rate (P<0.05). Conclusions The predominant bacteria of UTI are still gram-negative bacteria, main of which is Escherichia coli. Bacteria are resistant to a variety of antibiotics. Approximate selection of antibiotics in clinical practice should be made on the basis of susceptibility test results.     

住院患者尿路感染病原菌分布及耐药性监测

目的通过调查和分析住院患者尿路感染病原菌的分布及耐药状况,为抗菌药物的合理应用提供参考。方法对浙江萧山医院2009年1月～2011年12月住院患者尿培养阳性样本中分离的1033株菌株进行回顾性分析,尿液采用经典型浸片Urieult培养,药敏试验用K—B法进行,采用WHONET5．6软件对药敏试验结果进行分析。结果1033株阳性菌株中,革兰阴性菌681株（65．9％）,革兰阳性菌197株（19．1％）,真菌155株（15．0％）。分离株位居前三位的是大肠埃希菌402株（38．9％）,肺炎克雷伯菌74株（7．2％）和白假丝酵母菌64株（6．2％）。大肠埃希菌和肺炎克雷伯菌中产超广谱β-内酰胺酶（ESBLs）检出率分别为60．7％（244／402）和45．9％（34／74）。亚胺培南、美罗培南、头孢哌酮／舒巴坦、哌拉西林／他唑巴坦和阿米卡星对大肠埃希菌和肺炎克雷伯菌显示较高的抗菌活性;肠球菌属、葡萄球菌对万古霉素、利奈唑胺和呋哺妥因耐药率低;假丝酵母菌对氟胞嘧啶、伏立康唑和两性霉素B有较高的敏感率。结论本组住院患者尿路感染病原菌以革兰阴性菌为主,尤以大肠埃希菌居多,监测和分析病原菌种类及其耐药性对指导临床合理用药具有重要意义。     

The battle of the bladder: The pathogenesis and treatment of uncomplicated cystitis

An ecological approach to the pathogenesis of uncomplicated urinary tract infections allows awareness of the continual battle being waged in the vagina, urethra, and bladder between the bacterial invaders and the host defense mechanisms. Despite overwhelming odds, the bacteria must be able to persist, colonize, and finally adhere to these various battlefields on their ascent to the bladder itself. The large number of patients presenting to physician offices with acute simple cystitis attests to the fact that the bacteria occasionally win the battle of the bladder. An understanding of the pathophysiology of this constantly raging battle may help us modify our clinical approach to women with simple uncomplicated urinary tract infections.     

Curvularia urinary tract infection: a case report

A healthy 5-year-old child had recurrent symptomatic urinary tract infections, the last of which was accompanied by black specks in her urine. These specks were identified asCurvularia species, a dermatiaceous mold. Symptoms resolved and fungi disappeared with long-term hydration, without specific antifungal treatment.     

Calcaneal osteomyelitis after puncture wound to foot: case report and review of the literature

Abstract Puncture wounds of the foot are relatively common injuries that occur in persons of all ages. A small percentage of puncture wounds becomes infected and can lead to complications such as osteomyelitis, osteochondritis and soft tissue abscess. These wounds must be followed up routinely one week after injury. We report a case of calcaneus osteomyelitis caused by a mixed infection with Escherichia coli and Staphylococcus aureus subsequent to puncture wound of the foot. The characteristics of the patient, the pathogenic organisms, treatment and outcome are presented.     

Antimicrobial susceptibility profile of community-acquired urinary tract infection in adults: A seven months prospective cross-sectional study in Dakar Town,Senegal

Introduction

With the increasing trend of antibiotic resistance, the management of urinary tract infection (UTI) is likely to become complicated, and there is a need for continuous surveillance of antibiotic susceptibility of uropathogens.

Stability analysis of recombinant human TFF2 and its therapeutic effect on burn-induced gastric injury in mice

The trefoil factor family 2 (TFF2), a member of the trefoil factor family, plays a critical role in maintaining homeostasis throughout the gastrointestinal tract. In the present study, we expressed recombinant human TFF2 by Escherichia coli expression system with the purity above 95%. In an in vitro simulated gastrointestinal environment, rhTFF2 was shown to exhibit resistance to proteases, heat, acid and alkali. In addition, in mouse burn-induced gastric injury models, rhTFF2 was demonstrated to accelerate the healing of gastric mucosal lesions. This study provides a new way to treat burn-induced gastric injury.