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Background: Complicated urinary tract infection (cUTI) is the one which is associated with structural and functional abnormalities of the urinary tract, thus increasing the risk of infection and failure of therapy. Aim: This study aims to determine the risk factors, changing trends in etiology, current treatment options, and outcomes in cUTI. Materials and Methods: This prospective observational study was done on patients presenting with cUTI. Hematological, biochemical workup, urine routine, urine culture, blood culture, ultrasonography, and wherever necessary computerized tomography of the genitourinary tract was done. The medical/surgical interventions and outcomes in these patients were recorded. Results: A total of 100 patients were enrolled in the study. Diabetes mellitus was the most common risk factor present in 53%. The most common organism isolated in urine culture was Escherichia coli (48%) followed by Klebsiella pneumoniae (19%) and similar trend but lesser positive yield was there in blood culture (Escherichia coli - 26% followed by Klebsiella pneumoniae - 3%). The organisms were most susceptible to colistin/polymyxin (100%) followed by carbapenems (88%), and later were the most commonly used empirical antibiotics in our study, yielding 95% survival rate. Surgical interventions (percutaneous/endourological) were required in 28%, renal replacement therapy in 14%, intensive care in 40% and mechanical ventilation in 10%, with 4% overall mortality at the end of 1-month follow-up. The mean duration of hospital stay was 9.1 ± 2.7 days. Conclusion: Escherichia coli was the most common organism causing cUTI, with diabetes being the most common risk factor. Most of the patients were treated with carbapenems with excellent survival outcomes.
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Background and Objectives: Severe acute respiratory syndrome coronavirus 2, caused by the novel coronavirus disease 2019 (COVID-19), led to a devastating pandemic that hit majority of the countries globally in a wave-like pattern. The characteristics of the disease varied in different geographical areas and different populations. This study highlights the epidemiological and clinical characteristics of COVID-19 during two major waves in North India. Materials and Methods: Clinical characteristics and outcomes of all COVID-19-reverse transcription-polymerase chain reaction-positive patients, admitted from March 2020 to June 2021, to a tertiary care center in North India, were studied retrospectively. Results: During this period, total of 5652 patients were diagnosed having COVID. Patients who were incidentally diagnosed as COVID-positive (n=667) with other unrelated comorbid conditions and patients admitted under level 1 facility (n=1655; 1219 from first and 436 from second wave) were excluded from final analysis. Males were most commonly affected in both waves, with male to female ratio 4:1 in first and 3:1 in second wave. First wave had significantly more people with co-morbidities like diabetes mellitus and hypertension (P=0.001), whereas younger age group (age <40 years) were significantly more affected in second wave (P= 0.000). Fever was the most common presenting complaint in both waves, followed by cough and breathlessness. Patients during first wave had more severe disease at presentation and high mortality compared to the second wave. Conclusion: Majority of the patients with COVID-19 infection presenting to our hospital were young during the second wave. Fever was noted as presenting manifestation. Mortality was low during the second wave as compared to the first wave, likely to be due to proper protocol-based treatment resulting in better outcomes.
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BACKGROUND: India recently encountered fierce second wave of coronavirus disease (COVID-19), and scarcity of novel medications added to the management challenges. Various studies have highlighted the effectiveness of tocilizumab and high-dose steroids in severe COVIDs, but none has compared their efficacy. MATERIALS AND METHODS: This retrospective multi-centric analysis compares intravenous tocilizumab (8 mg/kg/day, maximum dose-800 mg), and intravenous Methylprednisolone Pulse (MPS-1 g/day for 3 days) in severe COVID-19. Both the groups had additionally received the standard of care COVID treatment as per protocol. Outcomes were assessed at 30 days. RESULTS: A total of 336 patients, with 249 receiving MPS and 87 receiving tocilizumab were compared. Majority of these were males (72.9%) with a mean age of 57.4 ± 13.6 years. Diabetes was the most common comorbidity. Patients in both groups had comparable age distribution, comorbidities, presenting mean-arterial pressures, d-Dimer levels, serum ferritin, serum leukocyte-dehydrogenase, and procalcitonin. However, the tocilizumab group had more number of males, higher incidence of coronary artery disease, more tachypnea and leukocytosis, more number of patients with severe acute respiratory disease syndrome (PaO2/FiO2 ratio <100), and higher C-reactive protein levels at presentation. Both groups had comparable adverse events' profile. Tocilizumab group had lesser requirement of invasive ventilation than MPS group (17% vs. 29%, P = 0.038), however mortality at the end of 30 days follow-up was similar (36% vs. 34% respectively; P = 0.678). CONCLUSIONS: Tocilizumab decreased the need for invasive ventilation in severe COVID-19; however, it did not translate to improved survival. A planned prospective randomized study is recommended in this respect to compare their efficacy.
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INTRODUCTION: Diabetes has been known to cause severe complicated UTI as a result of its various changes in the genitourinary system. This study of UTI in diabetic females enables us to know the pattern of infections, their causative organisms and severity, particularly with reference to European Association of Urology (EUA) guidelines for UTI 2015. MATERIALS AND METHODS: This is a prospective single centre study done over a period of one year at Dayanand Medical College and Hospital on a total of 151 diabetic (Group A) and non-diabetic (Group B) female patients with diagnosis of UTI. A thorough history of the patients was taken which included looking for the anatomical level of infections, host risk factors; extra urogenital risk factors and nephropathy disease were assessed. All patients were adequately investigated. The UTI was classified according to the EAU classification for UTI, and an effort was made to find out the frequent class of UTI in this study group. RESULTS: A total of 151 females which included 70 diabetic (Group A) and 81 non diabetic (Group B) females were studied. The most common symptom was fever in both the groups. UTI was classified as per the EAU grades of UTI. In group A, the number of patients having severity grade from 1 to 6 were 47, 9, 4, 2, 4, and 4 respectively. The most common clinical presentation in both the groups was cystitis followed by pyelonephritis and urosepsis. In group B, the number of patients having severity grade from 1 to 6 were 66, 4, 5, 5, 0 and 1 respectively. Most common organism was E-coli, which was susceptible to most of the antibiotics. CONCLUSION: UTI in diabetic and non-diabetic female patients have different patterns. Uncontrolled diabetes was more commonly associated with severe UTI like pyelonephritis and emphysematous pyelonephritis. E. coli was most common isolate in either group, followed by klebsiella and Pseudomonas. Candida was isolated only from the diabetic population. Therefore, the most common type of UTI as per the EAU classification in both diabetic and non diabetic female was CY-1R: E. coli(a): 'simple cystitis but recurrent with susceptibility to standard antibiotics', in our study.