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1.
Urolithiasis ; 52(1): 72, 2024 Apr 29.
Article En | MEDLINE | ID: mdl-38683224

Finding reliable and easy-to-obtain predictors of severe infectious complications after shock wave lithotripsy (SWL) is a major clinical need, particular in symptom-free hydronephrosis. Therefore, we aim to prospectively investigate the predictive value of Hounsfield units (HU) in renal pelvis urine for the risk of severe infectious complications in patients with ureteral stones and symptom-free hydronephrosis after SWL. This multi-center prospective study was conducted from June 2020 to December 2023. The HU of renal pelvis urine was measured by non-enhanced computed tomography. The severe infectious complications included systemic inflammatory response syndrome, sepsis, and septic shock. Binary logistic regression models assessed the odds ratios (ORs) and 95% confidence intervals (CIs). Finally, 1,436 patients with ureteral stones were enrolled in this study. 8.9% (128/1,436) of patients experienced severe infectious complications after SWL treatment. After adjusting confounding variables, compared with the patients in the lowest renal pelvis urine density quartile, the OR (95% CI) for the highest quartile was 32.36 (13.32, 78.60). There was a positive linear association between the HU value of renal pelvis urine and the risk of severe infectious complications after SWL (P for trend < 0.001). Furthermore, this association was also observed stratified by age, gender, BMI, stone size, stone location and hydronephrosis grade (all P for interaction > 0.05). Additionally, the nonlinear association employed by restricted cubic splines is not statistically significant (nonlinear P = 0.256). The AUROC and 95%CI of renal pelvis urine density were 0.895 (0.862 to 0.927, P value < 0.001). The cut-off value was 12.0 HU with 78.59% sensitivity and 85.94% specificity. This multi-center prospective study demonstrated a positive linear association between HU in renal pelvis urine and the risk of severe infectious complications in patients with ureteral stones and symptom-free hydronephrosis after SWL, regardless of age, gender, BMI, stone size, stone location, and hydronephrosis grade. These findings might be helpful in the SWL treatment decision-making process.


Hydronephrosis , Kidney Pelvis , Lithotripsy , Ureteral Calculi , Humans , Lithotripsy/adverse effects , Male , Prospective Studies , Female , Hydronephrosis/etiology , Middle Aged , Adult , Ureteral Calculi/complications , Ureteral Calculi/therapy , Postoperative Complications/etiology , Postoperative Complications/epidemiology , Aged , Tomography, X-Ray Computed , Urine/microbiology , Risk Assessment , Sepsis/etiology , Sepsis/complications , Risk Factors , Predictive Value of Tests , Severity of Illness Index
2.
Bioelectrochemistry ; 158: 108706, 2024 Aug.
Article En | MEDLINE | ID: mdl-38608340

Key nutrients, such as nitrogen measured as total ammonium nitrogen (TAN), could be recycled from hydrolysed human urine back to fertiliser use. Bioelectrochemical systems (BESs) are an interesting, low-energy option for realising this. However, the high TAN concentration (> 5 g L-1) and pH (> 9) of hydrolysed urine can inhibit microbial growth and hinder the enrichment of an electroactive biofilm at the anode. This study investigated a new strategy for bioanode inoculation by mixing real hydrolysed urine with thickened waste activated sludge (TWAS) from a municipal wastewater treatment plant at different volumetric ratios. The addition of TWAS diluted the high TAN concentration of hydrolysed urine (5.2 ± 0.3 g L-1) to 2.6-5.1 g L-1, while the pH of the inoculation mixtures remained > 9 and soluble chemical oxygen demand (sCOD) at 5.6-6.7 g L-1. Despite the high pH, current generation started within 24 h for all reactors, and robust bioanodes tolerant of continuous feeding with undiluted hydrolysed urine were enriched within 11 days of start-up. Current output and Coulombic efficiency decreased with increasing initial hydrolysed urine fraction. The anodes inoculated with the highest sCOD-to-TAN ratio (2.1) performed the best, which suggests that high organics levels can protect microbes from inhibition even at elevated TAN concentrations.


Bioelectric Energy Sources , Urine , Humans , Urine/chemistry , Urine/microbiology , Hydrolysis , Bioelectric Energy Sources/microbiology , Electrodes , Biofilms/growth & development , Hydrogen-Ion Concentration , Sewage/microbiology , Sewage/chemistry
3.
Infect Dis Clin North Am ; 38(2): 255-266, 2024 Jun.
Article En | MEDLINE | ID: mdl-38575490

Urinary tract infections are among the most common infectious diagnoses in health care, but most urinary tract infections are diagnosed inappropriately in patients without signs or symptoms of infection. Asymptomatic bacteriuria leads to inappropriate antibiotic prescribing and negative downstream effects, including antimicrobial resistance, health care-associated infections, and adverse drug events. Diagnostic stewardship is the process of modifying the ordering, performing, or reporting of test results to improve clinical care. Diagnostic stewardship impacts the diagnostic pathway to decrease inappropriate detection and treatment of asymptomatic bacteriuria. This article reviews diagnostic stewardship methods and closes with a case study illustrating these principles in practice.


Anti-Bacterial Agents , Antimicrobial Stewardship , Bacteriuria , Urinary Tract Infections , Humans , Urinary Tract Infections/diagnosis , Urinary Tract Infections/drug therapy , Urinary Tract Infections/microbiology , Anti-Bacterial Agents/therapeutic use , Bacteriuria/diagnosis , Bacteriuria/drug therapy , Bacteriuria/microbiology , Urine/microbiology , Urinalysis/methods
4.
Indian J Med Microbiol ; 48: 100561, 2024.
Article En | MEDLINE | ID: mdl-38458336

Reactive arthritis is included in the spectrum of seronegative spondyloarthritides, occurring secondary to triggers of genitourinary and gastrointestinal tract infections. We describe two cases of sexually acquired reactive arthritis secondary to genital infection by Chlamydia trachomatis, diagnosed by in-house polymerase chain reaction performed on the first void urine. Both patients were managed with a combined approach of short course antibiotics, immunosuppressive agents, biologicals and surgical intervention.


Anti-Bacterial Agents , Arthritis, Reactive , Chlamydia Infections , Chlamydia trachomatis , Humans , Arthritis, Reactive/microbiology , Arthritis, Reactive/etiology , Arthritis, Reactive/diagnosis , Arthritis, Reactive/drug therapy , Chlamydia trachomatis/isolation & purification , Chlamydia Infections/microbiology , Chlamydia Infections/diagnosis , Chlamydia Infections/complications , Male , Anti-Bacterial Agents/therapeutic use , Adult , Female , Polymerase Chain Reaction , Urine/microbiology , Immunosuppressive Agents/therapeutic use
5.
J Microbiol Methods ; 220: 106913, 2024 May.
Article En | MEDLINE | ID: mdl-38458394

Several types of fastidious bacteria can cause tract infections. We evaluated the performance of counting fastidious bacteria using a Fully Automated Urine Particle Analyzer UF-5000. The results showed that UF-5000 counts fastidious bacteria in urine without the need for culture using measurement principles based on flow cytometry.


Urinary Tract Infections , Humans , Urinary Tract Infections/microbiology , Bacteria , Flow Cytometry/methods , Urine/microbiology
6.
J Clin Lab Anal ; 38(5): e25004, 2024 Mar.
Article En | MEDLINE | ID: mdl-38454622

BACKGROUND: Urinary tract infections are responsible for a significant worldwide disease burden. Performing urine culture is time consuming and labor intensive. Urine flow cytometry might provide a quick and reliable method to screen for urinary tract infection. METHODS: We analyzed routinely collected urine samples received between 2020 and 2022 from both inpatients and outpatients. The UF-4000 urine flow cytometer was implemented with an optimal threshold for positivity of ≥100 bacteria/µL. We thereafter validated the prognostic value to detect the presence of urinary tract infection (UTI) based on bacterial (BACT), leukocyte (WBC), and yeast-like cell (YLC) counts combined with the bacterial morphology (UF gram-flag). RESULTS: In the first phase, in 2019, the UF-4000 was implemented using 970 urine samples. In the second phase, between 2020 and 2022, the validation was performed in 42,958 midstream urine samples. The UF-4000 screen resulted in a 37% (n = 15,895) decrease in performed urine cultures. Uropathogens were identified in 18,673 (69%) positively flagged urine samples. BACT > 10.000/µL combined with a gram-negative flag had a >90% positive predictive value for the presence of gram-negative uropathogens. The absence of gram-positive flag or YLC had high negative predictive values (99% and >99%, respectively) and are, therefore, best used to rule out the presence of gram-positive bacteria or yeast. WBC counts did not add to the prediction of uropathogens. CONCLUSION: Implementation of the UF-4000 in routine practice decreased the number of cultured urine samples by 37%. Bacterial cell counts were highly predictive for the presence of UTI, especially when combined with the presence of a gram-negative flag.


Saccharomyces cerevisiae , Urinary Tract Infections , Humans , Flow Cytometry/methods , Urinary Tract Infections/microbiology , Urinalysis/methods , Bacteria , Leukocyte Count , Urine/microbiology , Sensitivity and Specificity
7.
F S Sci ; 5(2): 163-173, 2024 May.
Article En | MEDLINE | ID: mdl-38336233

OBJECTIVE: To explore the taxonomic and predicted functional relationship between the urine microbiome and alterations of semen analysis (SA) parameters. DESIGN: Cross-sectional study. SETTING: Academic medical center. PATIENT(S): Men presenting for fertility evaluation or men presenting for vasectomy consultation with proven biological paternity were recruited and stratified on the basis of alterations, or lack thereof, in SA parameters. MAIN OUTCOME MEASURE: Changes in the functional and taxonomic urine microbiome profiles of participants with or without alterations in SA parameters. RESULTS: Seventy-three participants were included in our study. Men with abnormal sperm motility (N = 27) showed a nearly 50-fold higher abundance of Dialister micraerophilus compared with those with normal sperm motility (N = 46). This relationship persisted on canonical correlational analysis (r = 0.439). Men with abnormal sperm concentration (N = 20) showed a lower abundance of Enterococcus faecalis and Staphylococcus aureus, compared with those with normal sperm concentration (N = 53). The urine of participants with impaired sperm motility demonstrated dramatic differences in predictive functional profiles in pathways involved in oxidation-reduction balance and cell longevity. CONCLUSIONS: Our findings underscore differences in the urinary microbiome and abnormalities in semen parameters, especially sperm motility. By incorporating predictive functional profiling, we also highlight possible mechanisms that may drive the observed differences in sperm parameters.


Infertility, Male , Semen Analysis , Sperm Motility , Humans , Male , Infertility, Male/microbiology , Infertility, Male/urine , Infertility, Male/genetics , Adult , Cross-Sectional Studies , Semen Analysis/methods , Spermatozoa/microbiology , Microbiota/genetics , Urine/microbiology
8.
Diagn Microbiol Infect Dis ; 108(4): 116192, 2024 Apr.
Article En | MEDLINE | ID: mdl-38330685

We hypothesized that the loop material and size could affect the results of the culture when compared to the calibrated pipette. A total of 484 urine samples were included in the study, and each sample was plated by using different loop types and the calibrated pipette. The bacterial counts per milliliter were calculated and compared, with a focus on the important cutoff values of 10³ and 104 CFU/ml for further identification. When considering the 10³ CFU/ml as cutoff value, 1 µl and 10 µl plastic loops gave the highest sensitivity (86.8 %), whereas the 10 µl metal loop had the lowest sensitivity (64.2 %). For the 104 CFU/ml cutoff value, 1 µl plastic loop inoculation demonstrated the highest sensitivity (75.9 %), while the 10 µl metal loop provided the lowest sensitivity (26.5 %). These results suggest that the single use plastic loops are functional, sensitive, useful especially for critical sample.


Urinary Tract Infections , Humans , Urinary Tract Infections/microbiology , Urinalysis , Bacterial Load , Urine Specimen Collection , Urine/microbiology , Sensitivity and Specificity
10.
Rev Esp Quimioter ; 37(1): 52-57, 2024 Feb.
Article Es | MEDLINE | ID: mdl-38073260

OBJECTIVE: Urine culture as a gold standard for the diagnosis of urinary tract infection (UTI) involves a considerable workload in Clinical Microbiology Departments, due to the high number of samples received that will ultimately be negative. Therefore, it is necessary to use screening systems that also reduce the turnaround time for UTI diagnosis. The new flow cytometer UF-5000 (Sysmex Corporation) is able to differentiate between Gram-negative and Gram-positive bacteria using the BACT-info parameter according to manufacturer. The aim of our study was to evaluate the gram discrimination ability of the UF-5000 cytometer. METHODS: A prospective study with 449 urine samples collected consecutively was conducted, in the period 7/3/2022-27/5/2022, in which the BACT-info flag was compared with urine culture as the reference method. RESULTS: The sensitivity obtained for both Gram-negative and Gram-positive bacteria was above 95%. However, for Gram-positive bacteria, the moderate Kappa index (0.49) and the low positive predictive value (37.1%) indicated that the correlation between BACT-info flag and urine culture was not acceptable and should not be reported to the requesting clinician. CONCLUSIONS: Implementation of the third generation UF-5000 cytometer represents a significant advance in the aetiological orientation of UTIs caused by Gram-negative bacteria. Reporting the Gram morphology in the urine samples reduces the response time in the microbiological diagnosis of UTI, which would have an impact on the reduction and optimisation of empirical treatment, and thus on the generation of antimicrobial resistance.


Urinary Tract Infections , Humans , Prospective Studies , Urinary Tract Infections/microbiology , Urinalysis/methods , Gram-Positive Bacteria , Gram-Negative Bacteria , Sensitivity and Specificity , Urine/microbiology
11.
Diagn Microbiol Infect Dis ; 108(2): 116121, 2024 Feb.
Article En | MEDLINE | ID: mdl-37984111

Microbiological services consolidation has increased the usage of preservative-containing urine tubes, potentially inhibiting pathogens in low-volume pediatric urine samples, yielding false-negative results. Our study demonstrates comparable growth with 1 ml versus the recommended 3 ml urine, following different shipping intervals. We advocate for regulators to consider similar large-scale validations, ensuring results' consistency.


Automation, Laboratory , Specimen Handling , Humans , Child , Specimen Handling/methods , Boric Acids/pharmacology , Urine/microbiology
12.
World J Urol ; 41(12): 3611-3618, 2023 Dec.
Article En | MEDLINE | ID: mdl-37898576

PURPOSE: Culture-negative urine specimens can be rapidly screened by urine flow cytometry (UFC), while low positive predictive value (PPV) limits the clinical application. We explored the factors associated with a low PPV. METHODS: A total of 5095 urine specimens were analyzed with UFC and culture. Diagnostic performance of leukocytes, bacteria, and BACT-info flags was evaluated by sensitivity, specificity, PPV, and negative predictive value (NPV). The association of contaminated culture and squamous epithelial cell count and BACT-info flag was performed by logistic regression analysis. RESULTS: The NPVs of parallel combination of bacteria and leucocytes were 98.9% in males and 97.9% in females, and PPVs of serial combination were 86.6% and 77.8% in men and women, respectively. The PPV of Gram-negative flag was higher than that of Gram-positive flag. The proportions of contamination in the urine culture results of false positive specimens were 86.9% in males and 98.5% in females at the cutoff points of the serial combination, and these parameters were 53.2% in males and 85.6% in females for the Gram-positive flag. There was a statistically significant association between contaminated cultures and squamous epithelial cells count in females, but not in males. Associations between contaminated cultures and Gram-positive flags or Gram-pos/-neg flags were statistically significant, but there was no association between contaminated cultures and Gram-negative flags. CONCLUSIONS: A serial combination of leukocytes and bacteria may maximize PPV in the diagnosis of bacterial urinary tract infection by urine flow cytometry, and contamination is the main reason for a low PPV.


Bacterial Infections , Urinary Tract Infections , Male , Humans , Female , Predictive Value of Tests , Flow Cytometry/methods , Urinary Tract Infections/microbiology , Urinalysis/methods , Bacteria , Sensitivity and Specificity , Urine/microbiology
13.
Braz J Microbiol ; 54(3): 1803-1808, 2023 Sep.
Article En | MEDLINE | ID: mdl-37407881

We have evaluated the Sysmex UF-5000 cytometer use in microbiology for the screening of negative urines, looking for cut-off points to detect bacteria and leukocytes. The number of processed urines was 3569, the highest to date in these studies. The best general cut-off point has been 100 bact/µl, giving an area under the ROC curve of 0.868, a sensitivity of 96%, a specificity of 50%, 1.17% of false negatives, and saving 40% of cultures. The PPV and NPV have been 35.5 and 95.4 respectively. The leukocyte count has not been useful. Finally, we have evaluated urine screening usefulness, concluding that in laboratories such as ours (284 urines/working day) or smaller, it is not cost-effective.


Urinary Tract Infections , Humans , Urinary Tract Infections/diagnosis , Urinary Tract Infections/microbiology , Flow Cytometry , Urinalysis , Bacteria , ROC Curve , Sensitivity and Specificity , Urine/microbiology
14.
Int Urol Nephrol ; 55(8): 1899-1902, 2023 Aug.
Article En | MEDLINE | ID: mdl-37277595

PURPOSE: The aim of our study was to evaluate a procedure in which urine culture was only being performed based on fixed cut-off values of urine sediment analysis with intention to prevent unnecessary negative urine cultures. METHODS: From January 2018 to August 2018, all urine samples from patients visiting the urology outpatient department were analyzed. Urine culture was only performed if urine sediment contained more than 130 bacteria per microliter and/or more than 50 leukocytes per microliter. RESULTS: In total, 2821 urine cultures with accompanying urine sediments were analyzed. 2098 cultures (74.4%) were defined negative and 723 (25.6%) positive. By adjusting cut-off values of sediment analysis > 20 per microliter or bacteria more than 330 per microliter, 1051 cultures would have been saved with an estimated cost reduction of € 31.470. Eleven clinically relevant urine cultures would have been missed (1%). CONCLUSION: Using cut-offs values leads to a notable decrease of the total number of urine cultures. According to our analysis, adjusting cut-off values could result in 37% less urine cultures and almost 50% less negative cultures. Hereby, unnecessary cost can be prevented [in our department estimated €31.470 in eight months (€ 47.205/year)].


Microscopy , Urinary Tract Infections , Humans , Urinary Tract Infections/microbiology , Urinalysis/methods , Leukocytes , Bacteria , Urine/microbiology , Flow Cytometry/methods , Sensitivity and Specificity
15.
J Clin Microbiol ; 61(6): e0029123, 2023 06 20.
Article En | MEDLINE | ID: mdl-37227272

PittUDT, a recursive partitioning decision tree algorithm for predicting urine culture (UC) positivity based on macroscopic and microscopic urinalysis (UA) parameters, was developed in support of a broader system-wide diagnostic stewardship initiative to increase appropriateness of UC testing. Reflex algorithm training utilized results from 19,511 paired UA and UC cases (26.8% UC positive); the average patient age was 57.4 years, and 70% of samples were from female patients. Receiver operating characteristic (ROC) analysis identified urine white blood cells (WBCs), leukocyte esterase, and bacteria as the best predictors of UC positivity, with areas under the ROC curve of 0.79, 0.78, and 0.77, respectively. Using the held-out test data set (9,773 cases; 26.3% UC positive), the PittUDT algorithm met the prespecified target of a negative predictive value above 90% and resulted in a 30 to 60% total negative proportion (true-negative plus false-negative predictions). These data show that a supervised rule-based machine learning algorithm trained on paired UA and UC data has adequate predictive ability for triaging urine specimens by identifying low-risk urine specimens, which are unlikely to grow pathogenic organisms, with a false-negative proportion under 5%. The decision tree approach also generates human-readable rules that can be easily implemented across multiple hospital sites and settings. Our work demonstrates how a data-driven approach can be used to optimize UA parameters for predicting UC positivity in a reflex protocol, with the intent of improving antimicrobial stewardship and UC utilization, a potential avenue for cost savings.


Urinary Tract Infections , Humans , Middle Aged , Urinary Tract Infections/diagnosis , Urinary Tract Infections/microbiology , Urinalysis/methods , ROC Curve , Machine Learning , Decision Trees , Retrospective Studies , Urine/microbiology
16.
Ann Biol Clin (Paris) ; 81(2): 156-161, 2023 05 16.
Article En, Fr | MEDLINE | ID: mdl-37144792

INTRODUCTION: Urinary tract infection (UTI) diagnosis by urine culture is time- and labor- consuming. In the Ibn Rochd microbiology laboratory, up to 70% of urine culture samples yield no growth or insignificant growth. OBJECTIVE: To evaluate the new generation of Sysmex UF-4000i fluorescence flow cytometry analyzer with a blue semiconducting laser as a method to rule out negative urine samples for UTI, in comparison of urine culture. MATERIAL AND METHODS: Flow cytometry and microbiological analysis were performed on 502 urine samples included in the study. We used ROC analysis to determine cutoff points at which optimal sensitivity and specificity are achieved for clinical use. RESULTS: Our results showed that bacteria count at a cut-off of 100/µL, and/or the leucocytes count ≥ 45/µL are the optimal indicator for positive culture results. At these cut off, bacteria sensitivity (SE), specificity (SP), Positive predictive value (PPV) and negative predictive value (NPV) were 97,3%, 95%, 87,8% and 98,8% respectively. For leucocytes, SE, SP, PPV and NPV were 99,1%, 95,8%, 88,6% and 99,7% respectively. DISCUSSION AND CONCLUSION: The bacterial and leucocytes counts generated by UF-4000i analysis may be useful in our context as a rapid screening to exclude UTI by reducing about 70% of urines cultures and then workload. Nevertheless, further validation is needed for different patient groups especially with urological disease or immunocompromised patients.


Urinalysis , Urinary Tract Infections , Humans , Urinalysis/methods , Urinary Tract Infections/microbiology , Sensitivity and Specificity , Bacteria , Leukocytes , Leukocyte Count , Flow Cytometry/methods , Urine/microbiology
17.
Arch. esp. urol. (Ed. impr.) ; 76(3): 203-214, 28 may 2023. tab, graf
Article En | IBECS | ID: ibc-221856

Objective: Determine the evolution of antibiotic resistance of symptomatic bacteriuria caused by Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) in Granada. Material and Method: A descriptive retrospective study was carried out, including antibiograms of urine cultures in which microorganisms identified as E. coli and K. pneumoniae, were isolated in the Microbiology laboratory of the Hospital Universitario Virgen de las Nieves (Granada, Spain) between January 2016 and June 2021. Results: E. coli was the most frequent isolate (10,048) and its resistance to ampicillin (59.45%) and ticarcillin (59.59%), and the increase to cefepime (15.07%) and amoxicillin-clavulanic acid (17.67%) is noteworthy. K. pneumoniae (2222) is notable for resistance to Fosfomycin (27.91%) and an increase to ciprofloxacin (37.79%) and amoxicillin-clavulanic acid (36.63%). Resistance is generally higher in hospitalized patients, males, and adults. Conclusions: Antibiotic resistance to the studied Enterobacteriaceae is on the rise, requiring empirical treatment targeted to the population area (AU)


Humans , Drug Resistance, Bacterial , Escherichia coli/drug effects , Klebsiella pneumoniae/drug effects , Anti-Bacterial Agents/pharmacology , Urine/microbiology , Retrospective Studies , Urinalysis
18.
J Infect Chemother ; 29(8): 764-768, 2023 Aug.
Article En | MEDLINE | ID: mdl-37100241

INTRODUCTION: Gram staining is a convenient method for bacterial estimation. Urine culture is typically used to diagnose urinary tract infections. Therefore, urine culture is also performed on Gram stain-negative urine specimens. However, the frequency of uropathogen identification in these samples remains unclear. METHODS: From 2016 to 2019, we retrospectively compared the results of Gram staining and urine culture tests on midstream urine specimens submitted for the diagnosis of urinary tract infections to confirm the significance of urine culture on Gram stain-negative specimens. Analysis was performed according to the patients' sex and age, and the frequency of uropathogen identification in the culture was examined. RESULTS: A total of 1763 urine specimens (women, 931; men, 832) were collected. Of these, 448 (25.4%) were not positive on Gram staining but were positive on culture. In specimens without bacteria on Gram staining, the frequencies of specimens with uropathogens detected on culture were 20.8% (22/106) in women aged <50 years, 21.4% (71/332) in women aged ≥50 years, 2.0% (2/99) in men aged <50 years, and 7.8% (39/499) in men aged ≥50 years. CONCLUSIONS: In men aged <50 years, the frequency of uropathogenic bacteria identification by urine culture was low in Gram stain-negative specimens. Therefore, urine cultures may be excluded from this group. In contrast, in women, a small number of Gram stain-negative specimens showed significant culture results for the diagnosis of urinary tract infection. Therefore, urine culture should not be omitted in women without careful consideration.


Urinalysis , Urinary Tract Infections , Male , Humans , Female , Retrospective Studies , Urinalysis/methods , Urinary Tract Infections/drug therapy , Bacteria , Staining and Labeling , Urine/microbiology
19.
PLoS One ; 18(2): e0281118, 2023.
Article En | MEDLINE | ID: mdl-36724192

The screening performance of urine flow cytometry parameters (e.g., white blood cell and bacteria) for urinary tract infection (UTI) has been widely recognized. The majority of previous studies, however, investigated the screening performance of Sysmex UF-1000i urine flow cytometer. This study aimed to investigate the screening performance of Sysmex UF-5000 analyzer, a third-generation urinary flow cytometer, for UTI and its novel parameter named Gram flag for discriminating gram-positive and negative pathogens. Urine specimens sent to the clinical microbiology laboratory of our hospital for bacterial culture between September 13, 2021, and November 15, 2021, were prospectively and consecutively collected. The Sysmex UF-5000 analyzer was used to determine urine white blood cell (WBC) and bacteria simultaneously. A chemical strip was used to assess urine nitrate. UTI was defined as positive urine bacterial culture > 104 CFU /ml. The receiver operating characteristics (ROC) curve, nomogram, decision tree, and decision curve were used to determine the screening performance of urine WBC, nitrate, and bacterial. A total of 246 UTIs and 425 non-UTIs were enrolled. The areas under the ROC curve (AUCs) for WBC and bacterial were 0.74 and 0.86, respectively. The decision curve showed that urine bacteria had a higher benefit than WBC. The nomogram indicated that urine bacterial had the largest effect on the probability of UTI. The sensitivity and specificity of the decision tree were 0.69 and 0.95, respectively. The flag of Gram-negative had a positive predictive value (PPV) of 0.93 in patients with urine bacteria > 1367 /µl. Therefore, we conclude that urine bacteria determined by the Sysmex UF-5000 had higher screening performance and greater benefit than WBC. The decision tree can be used to improve the screening performance of routine urinary parameters. The flag of Gram-negative is a reliable indicator to confirm gram-negative bacteria infection in UTI patients.


Nitrates , Urinary Tract Infections , Humans , Urinary Tract Infections/diagnosis , Urinary Tract Infections/microbiology , Urinalysis , Bacteria , Leukocytes , Sensitivity and Specificity , Flow Cytometry , Urine/microbiology
20.
J Infect Chemother ; 29(5): 443-452, 2023 May.
Article En | MEDLINE | ID: mdl-36702207

INTRODUCTION: Recent studies have reported associations between fastidious bacteria that are difficult to grow and isolate in conventional urine culture conditions and urinary tract infections (UTIs). Because the Fully Automated Urine Particle Analyzer UF-1000i (hereinafter referred to as "UF-1000i") detects fastidious bacteria without being affected by culture conditions, owing to its flow cytometry-based principle, we evaluated the robustness of UF-1000i detection using clinical urine samples from patients with UTIs following ineffective antimicrobial therapy. METHODS: A total of 150 patients diagnosed with UTIs were enrolled, and their laboratory findings were analyzed, focusing on the discrepancy in bacterial numbers between UF-1000i and conventional culture at each antimicrobial therapy effectiveness classification. In addition, gene identification was conducted by molecular analysis using 16S ribosomal RNA gene sequencing and next-generation sequencing (NGS) to elucidate the reason for the presence of fastidious bacteria in these samples. RESULTS: The ineffective therapy cases showed more than 100-fold discrepancy in bacterial counts, with a higher proportion (30.8%) than effective therapy cases without secondary administration (5.7%) between the bacterial counts in UF-1000i and conventional culture methods. The presence rates of fastidious bacteria were 100% and 66.7% in discrepant cases of ineffective and effective without secondary administrations, respectively. CONCLUSION: This study suggests that discrepancies in bacterial numbers between the conventional culture method and UF-1000i measurement at the primary visit can predict the presence of fastidious bacteria, especially in cases of ineffective antimicrobial therapy.


Anti-Infective Agents , Urinary Tract Infections , Humans , Urinary Tract Infections/diagnosis , Urinary Tract Infections/drug therapy , Urinary Tract Infections/microbiology , Bacteria/genetics , Urinalysis/methods , Leukocyte Count , Flow Cytometry/methods , Urine/microbiology
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