Gardnerella vaginalis in urinary tract infections, are men spared?

Gardnerella vaginalis in association with anaerobes has been linked to bacterial vaginosis in women, while urinary tract infections (UTIs) in men have rarely been reported. The aim of the review was to reveal the significance of G. vaginalis UTIs in men. Prevalence of G. vaginalis UTIs in men varied from 0.5 to >27% according to patients' groups. Most patients had comorbidity such as urolithiasis or stents, transplants, tumors and diabetes, however, infections can also affect immunocompetent patients. We observed G. vaginalis-associated bacteriuria and leukocyturia in a kidney transplant man. Complications of the UTIs such as bacteremia (in 9/11 cases), hydronephrosis (4/11) and abscesses or septic emboli have been reported. Bacterial vaginosis in female partners has been a risk factor for UTIs in males. In women, biofilm Gardnerella phenotype, stabilized by Atopobium vaginae and Prevotella bivia was linked to ≥6-fold higher antibiotic resistance rates compared with the planktonic phenotype. Non-susceptibility to metronidazole and levofloxacin was found also in males. Therefore, if aerobic urine cultures are negative, urine and blood samples from male patients with predisposing factors and clinical signs of UTIs and bacteremia, can be taken. Plates should be incubated for 2-4 days in capnophilic/microaerophilic conditions, however only anaerobic incubation can help with detecting G. vaginalis strains which grow only anaerobically. Susceptibility testing of the isolates is highly important. Briefly, adherent G. vaginalis phenotype can be sexually transmissible. Despite the infrequency of G. vaginalis UTIs in men, the infections should be considered since they are often linked to severe complications.

An outbreak of Pseudomonas aeruginosa urinary tract infections following outpatient flexible cystoscopy.

The investigation of an outbreak of Pseudomonas aeruginosa urinary tract infections after ambulatory cystoscopies identified a damaged cystoscope contaminated by P aeruginosa and acting as a relay object. This outbreak urges us not to trivialize urinary tract infections occurring after an elective cystoscopy. Patients should be advised to signal the occurrence of urologic symptoms after urologic exploration.

The Remarkable Biomechanical Properties of the Type 1 Chaperone-Usher Pilus: A Structural and Molecular Perspective.

Chaperone-usher (CU) pili are long, supramolecular protein fibers tethered to the surface of numerous bacterial pathogens. These virulence factors function primarily in bacterial adhesion to host tissues, but they also mediate biofilm formation. Type 1 and P pili of uropathogenic Escherichia coli (UPEC) are the two best-studied CU pilus examples, and here we primarily focus on the former. UPEC can be transmitted to the urinary tract by fecal shedding. It can then ascend up the urinary tract and cause disease by invading and colonizing host tissues of the bladder, causing cystitis, and the kidneys, causing pyelonephritis. FimH is the subunit displayed at the tip of type 1 pili and mediates adhesion to mannosylated host cells via a unique catch-bond mechanism. In response to shear forces caused by urine flow, FimH can transition from a low-affinity to high-affinity binding mode. This clever allosteric mechanism allows UPEC cells to remain tightly attached during periods of urine flow, while loosening their grip to allow dissemination through the urinary tract during urine stasis. Moreover, the bulk of a CU pilus is made up of the rod, which can reversibly uncoil in response to urine flow to evenly spread the tensile forces over the entire pilus length. We here explore the novel structural and mechanistic findings relating to the type 1 pilus FimH catch-bond and rod uncoiling and explain how they function together to enable successful attachment, spread, and persistence in the hostile urinary tract.

[Prevention of Catheter-Associated Urinary Tract Infections]. / Infektionsprävention bei der Katheterdrainage der Harnblase.

With a share of 22.4%, nosocomial urinary tract infections (nUTIs) are among the most frequent infections acquired in hospitals, along with surgical site infections (24.7%), pneumonia (21.5%), clostridium difficile infections (6.6%) and primary sepsis (6%) 1. 80% of all nUTIs are associated with indwelling urinary catheters, with 12-16% of all hospitalised patients and up to 81.8% of all intensive care patients receiving an indwelling urinary catheter during their hospital stay 2 3. Therefore, profound knowledge about the basics of catheter-associated nUTIs and the correct management of urinary catheters are of utmost individual and socio-economic importance 4 5. It is estimated that up to 70% of all nUTIs occurring in Germany may be avoided by using appropriate preventative measures 6 7.In 2012, the authors Conway and Larson compared 8 recommendations in English language for the prevention of UTIs and noticed that they have been largely consistent over a period of 30 years 8. Special issues have rarely been addressed in valid studies, and study results are rather heterogeneous. For example, the 2008 SHEA (Society of Hospital Epidemiologists of America) guideline contains only 3 recommendations and 4 prohibitions which are based on more than one randomised controlled clinical study 9 10 11.The confirmed recommendations on the prevention of UTIs are consistent in the following aspects 12 13 14 15 16 17: · Every insertion of a urinary catheter must be based on a well-founded medical indication.. · Well-founded medical indications include acute urinary retention, interventions lasting several hours with a high fluid turnover, surgery involving the urinary tract, the necessity to record fluid turnover especially in critically ill patients, comfort for the dying, facilitating wound healing in the external genitals in the presence of urinary incontinence. Examples of unnecessary use of urinary catheters include prescriptions based on urinary incontinence alone and prolongation of use, e. g. after surgical procedures or after intensive care monitoring/recording has been completed.. · The insertion technique as well as catheter care and the detection of catheter-associated complications must be trained continuously.. · Catheterisation must be performed under sterile precautions.. · Only sterile and closed urinary drainage systems may be used.. · Catheters must be removed as early as possible..

Prevalence and intensity of urinary schistosomiasis among school children in the district of Niakhar, region of Fatick, Senegal.

BACKGROUND: Urinary schistosomiasis is a parasitic disease that exists in all regions of Senegal. It is a major public health issue in this country. This study was carried out to determine the prevalence and intensity of this parasitosis in 12 villages of Niakhar (Fatick, Senegal). METHODS: A total of 210 schoolchildren, aged 7 to 15 years, were enrolled in this study, and urine samples were examined for Schistosoma haematobium eggs using a standard urine filtration technique. RESULTS: Of these children, 121 (57.6%) were found to be infected with a mean geometric count of 185 eggs per 10 ml of urine. The disease was present in all surveyed villages, and the prevalence ranged from 14.3% to 92.8%. The prevalence of infection was significantly correlated with increasing age and was higher in boys. Infection intensity was significantly higher in boys but did not significantly differ with age. Significant relationships between i) water contact or access to running water and ii) the prevalence or intensity of urinary schistosomiasis were also noted. CONCLUSIONS: The district of Niakhar is endemic for urinary schistosomiasis, with a high intensity of infection. A control program to decrease the prevalence and intensity should be implemented in this area to improve community health.

Characterization and zoonotic potential of uropathogenic Escherichia coli isolated from dogs.

The aim of this study was to investigate the characteristics of canine uropathogenic Escherichia coli (UPEC) and the interaction between canine UPEC and human bladder epithelial cells. Ten E. coli isolates collected from dogs with cystitis were analyzed for antimicrobial resistance patterns, the presence of virulence factors, and biofilm formation. The ability of these isolates to induce cytotoxicity, invade human bladder epithelial cells, and stimulate an immune response was also determined. We observed a high rate of antimicrobial resistance among canine UPEC isolates. All virulence genes tested (including adhesins, iron acquisition, and protectin), except toxin genes, were detected among the canine UPEC isolates. We found that all isolates showed varying degrees of biofilm formation (mean, 0.26; range, 0.07 to 0.82), using a microtiter plate assay to evaluate biofilm formation by the isolates. Cytotoxicity to human bladder epithelial cells by the canine UPEC isolates increased in a time-dependent manner, with a 56.9% and 36.1% reduction in cell viability compared with the control at 6 and 9 h of incubation, respectively. We found that most canine UPEC isolates were able to invade human bladder epithelial cells. The interaction between these isolates and human bladder epithelial cells strongly induced the production of proinflammatory cytokines such as IL-6 and IL-8. We demonstrated that canine UPEC isolates can interact with human bladder epithelial cells, although the detailed mechanisms remain unknown. The results suggest that canine UPEC isolates, rather than dogspecific pathogens, have zoonotic potential.

Community transmission in the United States of a CTX-M-15-producing sequence type ST131 Escherichia coli strain resulting in death.

A middle-aged woman developed fatal urosepsis due to a multidrug-resistant Escherichia coli strain representing sequence type ST131, a recently emerged, disseminated, multidrug-resistant extraintestinal pathogen, after presumably having acquired it from her extensively antibiotic-exposed sister with chronic recurrent cystitis. Susceptibility results (reported on day 4) showed resistance to the initially selected regimen.

Urinary tract infection caused by carbapenem-resistant K. pneumoniae and P. aeruginosa.

There has been an increase in recent years of antimicrobial resistance of Gram negative bacilli (GNB). Carbapenems, the mainstay for the treatment of multidrug resistant GNB infections, are no longer always effective leaving treatment options limited. We present the case of patient with recurrent, complicated urinary tract infections. The current episode was caused by carbapenem-resistant K. pneumoniae and P. aeruginosa and carbapenem-susceptible, but MDR E. cloacae. Resistance to carbapenems of K. pneumoniae was conferred by the production of the class B metallo-beta-lactamase, VIM1. Infection control measures were implemented and following a 2-week course of treatment with colistin, the infection resolved and the patient was discharged. We discuss the changes in the epidemiology, the mechanisms involved and the means of detecting carbapenem resistance in GNB. We would also like to stress the role of infection control measures in limiting patient-to-patient spread of MDR organisms which, are of paramount importance in cases when few treatment options are left available.

Application of the promotion time cure model with time-changing exposure to the study of HIV/AIDS and other infectious diseases.

Infectious diseases are caused by single or successive contacts with pathogens. Nevertheless, contacts with pathogens do not implicate infection. In 1993, Yakovlev et al. proposed a model to study a population of cancer patients with a cured fraction, a well adapted model to describe an infectious disease with a unique infection occasion. Extensions of this model have been proposed in the recent years. We present a mechanistic formulation in the context of infectious diseases with multiple infection occasions. It is a mixture model that enables to study risk factors associated with infection intensity at each infection occasion and factors shortening the delay from exposure to clinical event. Simulations are performed to evaluate the model fitting and two examples are presented for illustration: an analysis of an HIV-1 mother-to-child transmission data set and an analysis of nosocomial urinary tract infections data set.

Sharing of virulent Escherichia coli clones among household members of a woman with acute cystitis.

BACKGROUND: Within-household transmission of extraintestinal pathogenic Escherichia coli (ExPEC) may contribute to the pathogenesis of urinary tract infection (UTI), but this is poorly understood. METHODS: A woman with acute UTI, 4 human household members who cohabited with her, and the family's pet dog underwent prospective longitudinal surveillance for colonizing E. coli for 7-9 weeks after the woman's UTI episode. Unique clones were resolved by random amplified polymorphic DNA and pulsed-field gel electrophoresis analysis. Virulence genes, phylogenetic group, and O types were defined by PCR. Comparisons with reference strains were made using random amplified polymorphic DNA profiling. RESULTS: Serial fecal and urine samples from the 6 household members yielded 7 unique E. coli clones (4 of which were ExPEC and 3 of which were non-ExPEC). For 3 clones, extensive among-host sharing was evident in patterns suggesting host-to-host transmission. The mother's UTI clone, which represented E. coli O1:K1:H7, was the clone that was most extensively shared (in 5 hosts, including the dog) and most frequently recovered (in 45% of samples and at all 3 time points). The other 3 ExPEC clones corresponded with E. coli O6:K2:H1, O1:K1:H7, and O2:F10,F48. CONCLUSIONS: E. coli clones, including ExPEC, can be extensively shared among human and animal household members in the absence of sexual contact and in patterns suggesting host-to-host transmission.

[Anti-inflammatory, antimicrobial and antidesquamative effect of "Uro-Biofon" in treating sexually transmitted urogenital infections]. / Protivovospalitel'nyi antimikrobnyi i antideskvamativnyi éffekt "uro-biofon" v lecheniia urogenital'nykh infektsii, peredaiushchikhsia polovym putem.

The antiinflammatory reaction in patients with sexually transmitted urogenital infections (STUI) was assessed by the leucocyte count, causative agents, amount of lecitin particles and pH in prostatic secretion. Great amount of desquamated epithelial cells indicated natural death of epitheliocytes and tissue necrosis. These processes were traced in the course of different treatments. Standard therapy in combination with the antimicrobial drug (AMD) and URO-Biophon radiation (UBR) produced the highest effect in patients with chronic urethroprostatitis. This promoted reduction in the number of leukocytes, removal of epithelial cells, elimination of the microflora and an increase in the number of lecitin particles. Among patients with chronic urethritis effective levelling of the leukocytic reaction was observed in patients on the standard therapy or with UBR alone, or AMD alone. By the intensity of epithelial desquamation the result was highest in the control group. The highest microbiological disinfection effect was achieved in using combination of the above methods.

[Community acquired urinary tract infection among hospitalized children in northern Israel: pathogens, susceptibility patterns and urinary tract anomalies].

BACKGROUND: Urinary tract infection (UTI) is one of the most common diseases in children. Vesicoureteral reflux (VUR) has been demonstrated in a substantial number of young children with UTI. Empiric antibacterial therapy is recommended before results of the urine culture are available in order to shorten the duration of the disease and prevent renal complications. OBJECTIVES: The aims of this study were to assess the prevalence and susceptibility patterns of UTI pathogens, and urinary anomalies in children admitted with UTI. METHODS: The study population included 151 children younger than 14 years admitted with first UTI. Renal ultrasound was performed in all the patients and voiding cystourethrography (VCUG) in children younger than 5 years. Dimercaptosuccinic acid (DMSA) scan was performed in children with vesicoureteral reflux. The data included age, sex, symptoms and signs, urinalysis, the pathogen and its sensitivity and the results of the imaging studies. RESULTS: A total of 119 patients (79%) were females. Gram negative rods caused 98% of the infections, of which Escherichia coli (87%) was the most prevalent pathogen, followed by Klebsiella pneumoniae (4%), and Proteus mirabilis (4%). The sensitivities to antibacterial agents were: Amikacin 100%, ceftazidime 97%, gentamicin 96%, ceftriaxone 96%, cefuroxime 95%, amoxicillin-clavulanate 84%, trimethoprim-sulfamethoxazole 63%, cephalexin 58%, and ampicillin 28%. Renal US showed minor abnormalities in 24/149 (16%) and VCUG demonstrated vesicoureteral reflux in 38/127 (30%) patients. DMSA revealed renal scars in 7/28 (25%) children with vesicoureteral reflux. CONCLUSIONS: Overall Gram negative rods cause 98% of the UTI in hospitalized children in our area. E. coli is the leading pathogen and aminoglycosides and second or third generation cephalosporins are the most suitable agents for empiric therapy in UTI. A high incidence of renal scars in young children with vesicoureteral reflux was found.

Pasteurella multocida urinary tract infection with molecular evidence of zoonotic transmission.

We describe a patient with a urinary tract infection (UTI) caused by Pasteurella multocida. Pulsed-field gel electrophoresis revealed that the clinical isolate recovered from the patient was identical (100% band match) to P. multocida isolates recovered from the patient's cat, but the isolate differed from an isolate recovered from a visiting cat and from a laboratory control strain. The patient also had abnormal urologic anatomy secondary to surgery; this has also been associated with P. multocida UTI.

[Bladder catheter or suprapubic fistula? Indications and contraindications]. / Blasenkatheter oder suprapubische Fistel? Indikation und Kontraindikation.

Even in closed sterile transurethral catheter drainage, infections of the lower urinary tract are documented in 50% of cases after 1 week of indwelling catheter. Not all of these cases develop symptomatic catheter-associated urinary tract infection. Suprapubic catheter drainage of the bladder results in markedly later urinary tract infection, presenting 50% of patients infected on day 40. The markedly later onset of catheter-associated urinary tract infection makes the suprapubic approach to bladder drainage suitable for all those patients, who may need catheters for more than 3 days postoperatively. Transfusion-dependent bleeding after puncture in 2-4% of cases and perforation of adjacent organs in 0.3% are the main complications. Suprapubic insertion of a catheter is contraindicted in patients with bleeding disorders and in those with bladder cancer in their history.

Factores de riesgo y complicaciones de la infección de vías urinarias durante el embarazo

Las infeccione de vías urinarias (UTI) representa un grupo de enfermedades que constituye las complicaciones médicas más frecuentes del embarazo. Abarcan desde la bacteriuria asintomática hasta la pielonefritis y puede producir morbilidad y mortalidad notoria. La gravedad potencial de la pielonefritis y sus complicaciones requieren hospitalización y tratamiento parenteral. No obstante, tienen importancia semejante los sistemas de prevención de infecciones iniciales y recidivantes. La pielonefritis es una infección grave del embarazo y es consecuencia de bacteriuria no detectada. Cuando se confirma pielonefritis es indispensable tratamiento de inmediato, con la esperanza de prevenir las secuelas maternas fetales potencialmente graves. Después de un tratamiento eficaz, se requiere vigilancia y supresión cuidadosa durante el resto del embarazo. Sin embargo, debido a la gran incidencia de recidivas, está garantizado hacer urocultivos y estudios radiográficos postparto y embarazo subsiguientes en un intento por descubrir anomalías renales subyacentes. El choque séptico subsecuente a una pielonefritis durante el embarazo debe identificarse tempranamente y tratarse en forma intensiva. El tratamiento exitoso debe dirigirse a la estabilización del estado del paciente, eliminación de la causa de la septicemia, cobertura con antibióticos de amplio espectro y tratamiento de las complicaciones concomitantes

Sexual acquisition of urinary tract infection in a man.

A man was admitted with acute pyelonephritis due to Escherichia coli. Three days prior to the onset of his symptoms his wife presented with a 7-day history of cystitis due to E. coli. Before the wife developed her symptoms the couple were having vaginal intercourse every night, and this continued for the first 3 days of her symptoms. The organisms isolated from the urine of both patients were found to have the same biotype, an identical antibiogram, and the same serotype. The temporal sequence of events and the bacteriological findings strongly suggest the sexual transmission of this organism from the wife to her husband.