Relationship between urinary tract infections and serum vitamin D level in adults and children- a literature review.

Over time, researchers have accumulated significant evidence indicating that vitamin D deficiency not only impacts skeletal health but also contributes to the development and progression of various diseases, including cancer, diabetes, and cardiovascular conditions. The risk of low serum 1, 25(OH)2D3 level ultimately directs the way to morbidity, the beginning of new diseases, and numerous infections. Infections are the first entity that affects those with vitamin D deficiency. The common infection is urinary tract infection (UTI), and its relationship with vitamin D deficiency or insufficiency remains controversial. This infection affects both men and women, but comparatively, women are more prone to this infection because of the short length of the urethra, which makes an easy entry for the bacteria. The low level of serum vitamin D increases the risk of UTIs in children. Recurrent UTIs are one of the major weaknesses in women; if left untreated, they progress to appallingly serious conditions like kidney dysfunction, liver damage, etc. Hence improving the vitamin D status may help to improve the immune system, thus making it more resistant to infections. In this review, we have focused on examining whether vitamin D deficiency and insufficiency are the causes of UTIs and the association between them in women and children. We have also described the connection between vitamin D deficiency and insufficiency with UTIs and additional nanotechnology- based treatment strategies.

The role of early use of Carbapenems perioperatively for urolithiasis with ESBL-producing Escherichia coli.

BACKGROUND: Urolithiasis combined with ESBL-producing E. coli is often difficult to control and leads to higher postoperative infection-related complications. This study was aim to explore the efficacy and necessity for early use of carbapenem antibiotics perioperatively in urolithiasis patients with urinary tract infections caused by ESBL-producing E. coli. METHODS: The study included a total of 626 patients who were separated into two groups: Group I (the ESBL-producing E. coli group) and Group II (the non-ESBL-producing E. coli group). Antibiotic susceptibility testing was performed and the two groups induced postoperative infection-related events were recorded. the efficacy of perioperative antibiotics was evaluated. RESULTS: All strains of E. coli in our research were sensitive to Carbapenems antibiotics. In addition to Carbapenems, the resistance rates of ESBL-producing E. coli to 6 other commonly used antibiotics were higher than those of non-ESBL-producing strains. Based on the preoperative antibiotic susceptibility test for the ESBL-producing E. coli group and the qSOFA score, the Carbapenems were more effective than the ß-lactamase inhibitors (p = 0.08), while for the non-ESBL-producing E. coli group, there was no difference in the treatment effects between Carbapenems, ß-lactamase inhibitors, Ceftazidime and Quinolones (p = 0.975). CONCLUSIONS: Carbapenem antibiotics significantly reduced the incidence of postoperative infection-related events compared with other types of antibiotics for ESBL-producing E. coli infections in patient with urolithiasis.

Genotypic and phenotypic characterisation of asymptomatic bacteriuria (ABU) isolates displaying bacterial interference against multi-drug resistant uropathogenic E. Coli.

Escherichia coli can colonise the urogenital tract of individuals without causing symptoms of infection, in a condition referred to as asymptomatic bacteriuria (ABU). ABU isolates can protect the host against symptomatic urinary tract infections (UTIs) by bacterial interference against uropathogenic E. coli (UPEC). The aim of this study was to investigate the genotypic and phenotypic characteristics of five ABU isolates from midstream urine samples of adults. Comparative genomic and phenotypic analysis was conducted including an antibiotic resistance profile, pangenome analysis, and a putative virulence profile. Based on the genome analysis, the isolates consisted of one from phylogroup A, three from phylogroup B2, and one from phylogroup D. Two of the isolates, PUTS 58 and SK-106-1, were noted for their lack of antibiotic resistance and virulence genes compared to the prototypic ABU strain E. coli 83,972. This study provides insights into the genotypic and phenotypic profiles of uncharacterised ABU isolates, and how relevant fitness and virulence traits can impact their potential suitability for therapeutic bacterial interference.

Efficacy and safety of preventing catheter-associated urinary tract infection by inhibiting catheter bacterial biofilm formation: a multicenter randomized controlled trial.

BACKGROUND: Catheter-associated urinary tract infection (CAUTI) remains the most significant challenge among hospital-acquired infections (HAIs), yet still unresolved. The present study aims to evaluate the preventive effectiveness of JUC Spray Dressing (name of U.S. FDA and CE certifications, while the medical device name in China is Long-acting Antimicrobial Material) alone for CAUTI without combining with antibiotics and to evaluate the impact of bacterial biofilm formation on CAUTI results on the inserted catheters of patients. METHODS: In this multicenter, randomized, double-blind study, we enrolled adults who suffered from acute urinary retention (AUR) and required catheterization in 6 hospitals in China. Participants were randomly allocated 1:1 according to a random number table to receive JUC Spray Dressing (JUC group) or normal saline (placebo group). The catheters were pretreated with JUC Spray Dressing or normal saline respectively before catheterization. Urine samples and catheter samples were collected after catheterization by trial staff for further investigation. RESULTS: From April 2012 to April 2020, we enrolled 264 patients and randomly assigned them to the JUC group (n = 132) and the placebo group (n = 132). Clinical symptoms and urine bacterial cultures showed the incidence of CAUTI of the JUC group was significantly lower than the placebo group (P < 0.01). In addition, another 30 patients were enrolled to evaluate the biofilm formation on catheters after catheter insertion in the patients' urethra (10 groups, 3 each). The results of scanning electron microscopy (SEM) showed that bacterial biofilm formed on the 5th day in the placebo group, while no bacterial biofilm formed on the 5th day in the JUC group. In addition, no adverse reactions were reported using JUC Spray Dressing. CONCLUSION: Continued indwelling urinary catheters for 5 days resulted in bacterial biofilm formation, and pretreatment of urethral catheters with JUC Spray Dressing can prevent bacterial biofilm formation by forming a physical antimicrobial film, and significantly reduce the incidence of CAUTI. This is the first report of a study on inhibiting bacterial biofilm formation on the catheters in CAUTI patients.

Pathogenic Bacteria and Antimicrobial Resistance in Hospital-Acquired Urinary Tract Infections among Patients with Diabetic Nephropathy.

OBJECTIVE: Hospital-acquired urinary tract infections (UTIs) are common complications in patients with diabetic nephropathy (DN), leading to increased mortality and increased medical resource utilisation. This study investigated hospital-acquired UTIs in patients with DN, focusing on prevalent pathogens and drug resistance to inform clinical management. METHODOLOGY: This retrospective study analysed 141 patients with hospital-acquired UTIs admitted to The Affiliated Hospital of Qingdao University from January 1, 2013 to December 31, 2022, using the Yidu Cloud database. Among them, 109 had DN, and 32 had nondiabetic nephropathy (NDN). Patient demographics, pathogen distribution, and antibiotic resistance were statistically evaluated. RESULTS: The incidence of hospital-acquired UTIs was significantly higher in patients with DN compared to those with NDN (p < 0.0001), with a higher prevalence in women (p = 0.004). Gram-negative bacteria, particularly Escherichia coli (E. coli) and Klebsiella pneumoniae, were the primary pathogens in patients with DN and NDN. E. coli infections were more common in the DN group (p = 0.017). These pathogens exhibited high susceptibility to carbapenems, ß-lactamase inhibitors, amikacin, nitrofurantoin, and minocycline; However, they showed significant resistance to quinolones, cephalosporin, and penicillins. CONCLUSIONS: Preventing hospital-acquired UTIs in patients with DN is crucial. Effective treatment requires selecting antibacterial drugs based on pathogen resistance profiles.

Novel Fabrication of Bio-polymeric Nanogel Loaded with Nalidixic Acid Formulations for the Effective Prevention of Bacterial Pathogens Leading Urinary Tract Infection and Its Biosafety Evaluation.

Management of urinary tract infections (UTI) is a highly challenging process due to the biofilm-forming ability of human-pathogenic bacteria. Here, we designed to fabricate an effective nanogel with a combination of chitosan bio-polymer and nalidixic acid to prevent biofilm-forming bacterial pathogens. Chitosan-coated nalidixic acid nanogel (NA@CS) exhibits outstanding inhibition potential against bacterial strains. In vitro, anti-bacterial analysis methods (well diffusion, colony-forming assay, and anti-biofilm assay) were performed to study the bacterial inhibition potential of prepared nanogel, which reveals that NA@CS nanogel have greater inhibition potential against selected pathogens. The combination of nalidixic acid with chitosan biopolymer decreases the virulence and pathogenicity of biofilm-forming pathogens due to their ability to membrane phospholipids penetration. Furthermore, the fabricated NA@CS nanogel showed reliable in vitro bio-compatibility on L929 fibroblast cells and in vivo compatibility with Artemia salina animal model. Overall, the results demonstrate that NA@CS nanogel could be an effective therapeutic for treating urinary tract infections and urine bladder wound healing.

Extensive thigh pyomyositis secondary to cystic fistulae due to anaerobic-bacterial infection in a kidney transplant recipient.

BACKGROUND: Managing infectious complications after kidney transplantation (KT) remains a major challenge. Infections are the leading non-cardiovascular cause of death among kidney transplant recipients (KTr). The urinary tract is particularly vulnerable to infections in this group, leading to high levels of morbidity and mortality, as well as significant economic costs. CASE PRESENTATION: This case report presents the first documented instance of extensive thigh pyomyositis resulting from cystic fistulae in an 84-year-old KTr. The patient was referred to our hospital with acute onset fever, pain in the inner thighs and pyuria. A CT scan revealed bilateral pyomyositis of the thighs, characterized by multiple abscesses in the adductor muscles and hydroaerobic levels. Additionally, cystic fistulae complicated by pubic symphysis osteitis were identified. CONCLUSION: In KTr, lower limb pyomyositis resulting from a urinary tract infection is an extremely rare and significantly worsens the overall prognosis for these patients.

Diagnosis and successful medical management of a renal corticomedullary abscess in a dog.

A 10-year-old spayed female mixed-breed dog was brought to the Ohio State University Veterinary Medical Center because of a suspected mass located to the right kidney. The mass was diagnosed by abdominal ultrasound following a recurrent lower urinary tract infection. Abdominal computed tomography revealed 2 isoattenuating, peripherally hypoattenuating, and centrally non-contrast-enhancing nodules in the right kidney; the larger one measured 1.9 cm. Initial attempts at fine-needle aspiration were unsuccessful. The dog was returned and the mass was aspirated using ultrasound guidance under heavy sedation. Cytology confirmed the presence of septic inflammation, consistent with a renal corticomedullary abscess. The dog was administered oral enrofloxacin (15 mg/kg, q24h) after diagnosis. Ultrasound guidance was used 2 wk later, under general anesthesia, to achieve percutaneous drainage of ~0.25 mL of fluid and instillation of 5.7 mg (0.25 mL) of enrofloxacin into the abscess capsule. Two weeks after percutaneous drainage, ultrasound examination showed complete resolution of the renal corticomedullary abscess. Urine culture confirmed resolution of the urinary tract infection. To the authors' knowledge, kidney-sparing medical management has never been successfully reported in a dog with a renal corticomedullary abscess. Key clinical message: Renal corticomedullary abscesses occur infrequently in dogs. Medical management is feasible and can result in complete resolution of clinical signs and imaging abnormalities.

Diagnostic et prise en charge médicale réussie d'un abcès corticomédullaire rénal chez un chienUne chienne croisée de 10 ans, stérilisée, a été amenée au centre médical vétérinaire de l'Ohio State University en raison d'une masse suspectée située au niveau du rein droit. La masse a été diagnostiquée par échographie abdominale à la suite d'une infection récurrente du tractus urinaire inférieur. La tomodensitométrie abdominale a révélé 2 nodules isoatténuants, hypoatténuants en périphérie et centralement sans contraste dans le rein droit; le plus grand mesurait 1,9 cm. Les premières tentatives d'aspiration à l'aiguille fine ont échoué. Le chien est revenu et la masse a été aspirée sous guidage échographique sous sédation lourde. La cytologie a confirmé la présence d'une inflammation septique, compatible avec un abcès corticomédullaire rénal. Le chien a reçu de l'enrofloxacine par voie orale (15 mg/kg, toutes les 24 heures) après le diagnostic. Le guidage échographique a été utilisé 2 semaines plus tard, sous anesthésie générale, pour obtenir un drainage percutané d'environ 0,25 mL de liquide et l'instillation de 5,7 mg (0,25 mL) d'enrofloxacine dans la capsule de l'abcès. Deux semaines après le drainage percutané, l'échographie a montré une résolution complète de l'abcès corticomédullaire rénal. La culture urinaire a confirmé la résolution de l'infection des voies urinaires. À la connaissance des auteurs, une prise en charge médicale préservant les reins n'a jamais été rapportée avec succès chez un chien présentant un abcès corticomédullaire rénal.Message clinique clé:Les abcès corticomédullaires rénaux surviennent rarement chez le chien. La prise en charge médicale est réalisable et peut aboutir à une résolution complète des signes cliniques et des anomalies d'imagerie.(Traduit par Dr Serge Messier).

Intravenous fosfomycin indications and treatment outcomes in pediatric usage: analysis from a single center in Turkey.

Current data on fosfomycin usage in children are limited. We present data on the clinical use of intravenous (IV) fosfomycin in children. Hospitalized patients who received ≥3 days of IV fosfomycin between April 2021 and March 2023 were analyzed retrospectively. Forty-three episodes of infection in 39 patients were evaluated. The mean age of the patients was 5.35 (10 days to 17.5 years) years, and 54% were male. Infections were hospital-acquired in 79% of the episodes. Indications for fosfomycin were urinary tract infection (35%), bacteremia (32.6%), catheter-related bloodstream infection (16.3%), soft tissue infection (4.7%), sepsis (4.7%), surgical site infection (2.3%), burn infection (2.3%), and pneumonia (2.3%). Klebsiella pneumoniae was identified in 46.5% of the episodes, and a pan-drug or extensive drug resistance was detected in 75% of them. Carbapenem was used before fosfomycin at significantly higher rates in K. pneumoniae episodes (P = .006). Most (88.5%) patients received fosfomycin as a combination therapy. Culture negativity was achieved in 80% of episodes within a median treatment period of 3 (2-22) days, which was significantly shorter in K. pneumoniae episodes (P < .001). Treatment-related side effects were seen in 9.3% of the episodes. Side effects were significant after 3 weeks of treatment (P = .013). The unresponsivity rate to fosfomycin was 23.3%. Nine (21%) of the patients who were followed up in the intensive care units mainly died because of sepsis (56%). IV fosfomycin is an effective agent in treating severe pediatric infections caused by resistant microorganisms. Fosfomycin can be used in various indications and is generally safe for children.

Retrospective Analysis of Risk Factors for Urinary Tract Infection after Ureteral Calculi Surgery.

BACKGROUND: Ureteral calculi are a common diagnosis in the field of urology worldwide, and they represent a prevalent subtype of urolithiasis. Ureteroscopic stone surgery is the cornerstone treatment, but postoperative urinary tract infection (UTI) remains a clinical concern. Our study aims to analyse specific risk factors associated with postoperative UTIs following ureteroscopic stone surgery. METHODS: We conducted a case-control study and collected clinical data from 145 patients who underwent ureteroscopic lithotripsy at our hospital from January 2021 to January 2023. Binary logistic regression analysis was used to investigate risk factors for postoperative UTI. Receiver operating characteristic curves were plotted, and area under the curve (AUC) was calculated to evaluate the predictive value of each factor. RESULTS: Forty patients developed UTI after ureteroscopic stone surgery. Compared with the control group, the case group showed significant differences in stone size, history of diabetes mellitus and preoperative urine culture results (p < 0.05). Multivariable binary logistic regression analysis revealed that stone size (Odds Ratio (OR) = 1.952, p = 0.010), history of diabetes mellitus (OR = 2.438, p = 0.038) and preoperative urine culture (OR = 2.914, p = 0.009) were independent risk factors for postoperative UTI. The AUC values of stone size, history of diabetes mellitus and preoperative urine culture were 0.680, 0.627 and 0.630, respectively. The AUC of the combined prediction was 0.756. CONCLUSIONS: This study identified risk factors for postoperative UTI following ureteroscopic stone surgery and emphasised the importance of stone size, history of diabetes mellitus and preoperative urine culture in the diagnosis.

Factors Contributing to the Recurrence of Urinary Tract Infections and Revisit amongst Children in the Emergency Department: A Single-Centre Retrospective Study.

BACKGROUND: Urinary tract infections (UTIs) are prevalent amongst paediatric patients, and they can lead to emergency department (ED) visits. A subset of patients requires a second ED visit, creating a burden on healthcare resources. This study aimed to shed light on the clinical, laboratory, treatment-related and environmental determinants associated with the recurrence of ED visits in this specific paediatric population. METHODS: This single-centre retrospective study involved paediatric patients diagnosed with UTIs and admitted to the paediatric ED of our hospital from September 2021, to August 2023. In accordance with whether a second visit was required, the ED patients were grouped into non-second-visit group or second-visit group. The demographic, clinical, laboratory, diagnostic, and environmental factors were analysed in detail. Statistical analyses, including chi-square tests, t-tests and correlation analyses, were employed to assess the associations between various factors and subsequent ED visits. RESULTS: A total of 357 patients, including 324 patients without a second visit and 33 patients with a second visit, were included in this study. Factors significantly associated with second ED visits included fever (≥38.5 °C) at initial presentation (p = 0.034), longer symptom duration (p = 0.022), increased C-reactive protein (CRP) levels (p = 0.018), hydronephrosis (p = 0.033) and lack of oral antibiotic use before the first visit (45.45% vs. 67.9%, p = 0.017). More bubble bath exposure (p = 0.037) and lower consultation rates with paediatric urology services (p = 0.020) were associated with repeated visits. Multifactor logistic regression analysis showed that the factors significantly associated with second ED visits were longer symptoms duration, fever (≥38.5 °C) at initial presentation, presence of flank pain, increased CRP levels, hydronephrosis, renal stones, vesicoureteral reflux, underlying anatomical abnormalities, lack of oral antibiotic use before the first visit, bubble bath exposure and lower consultation rates with paediatric urology services. CONCLUSIONS: A series of clinical indicators, laboratory findings, diagnostic measures and environmental factors may be associated with the need for a second ED visit amongst paediatric patients with UTI. Early antibiotic intervention, identification of underlying anatomical anomalies and management of environmental exposures may mitigate recurrent ED visits.

The first case of urosepsis caused by Corynebacterium aurimucosum in an immunocompetent patient.

Non-diphtheroid Corynebacterium sepsis is rare and has affected only immunocompromised or particularly predisposed patients so far. We present the first case of urosepsis caused by Corynebacterium aurimucosum in a 67-year-old woman, without any known immunodeficiencies and in absence of any immunosuppressive therapy, admitted to the hospital for fever and acute dyspnea. This work suggests a new approach in evaluating the isolation of Corynebacteria, especially if isolated from blood. In particular, it highlights the potential infectious role of C. aurimucosum (often considered a contaminant and only rarely identified as an etiological agent of infections) and its clinical consequences, detailing also interesting aspects about its microbiological diagnosis and relative therapy and clarifying contrasting data of literature.

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Multiplex antibiotic susceptibility testing of urinary tract infections using an electrochemical lab-on-a-chip.

Urinary tract infections (UTIs) represent the most prevalent type of outpatient infection, with significant adverse health and economic burdens. Current culture-based antibiotic susceptibility testing can take up to 72 h resulting in ineffective prescription of broad-spectrum antibiotics, poor clinical outcomes and development of further antibiotic resistance. We report an electrochemical lab-on-a-chip (LOC) for testing samples against seven clinically-relevant antibiotics. The LOC contained eight chambers, each housing an antibiotic-loaded hydrogel (cephalexin, ceftriaxone, colistin, gentamicin, piperacillin, trimethoprim, vancomycin) or antibiotic-free control, alongside a resazurin bulk-modified screen-printed electrode for electrochemical detection of metabolically active bacteria using differential pulse voltammetry. Antibiotic susceptibility in simulated UTI samples or donated human urine with either Escherichia coli or Klebsiella pneumoniae could be established within 85 min. Incorporating electrochemical detection onto a LOC provides an inexpensive, simple method for the sensitive determination of antibiotic susceptibility that is significantly faster than using a culture-based approach.

Urinary tract infections in chronic kidney disease in Nephrology unit, University Hospital Center of Befelatanana, Antananarivo.

INTRODUCTION: Urinary tract infection is the leading cause of nosocomial infection worldwide. It is a factor in the progression of chronic kidney disease. AIM: To determine the epidemiological, clinical, microbiological, therapeutic and evolving profile of patients with chronic kidney disease and urinary tract infection. METHODS: This was a retrospective, descriptive study lasting 5 years, from January 2014 to december 2018 in chronic kidney disease with urinary tract infection. RESULTS: Fifty-one patients (7.15%) were retained with a mean age of 53.03 years and a sex ratio of 0.55. Chronic kidney disease was in end-stage in 45.1% (n=23). Cystitis was found in 49.02% (n=25) and gram-negative bacilli were found in 74.50% (n=38), predominantly Escherichia coli (54.90%). Third generation of cephalosporins and fluoroquinolones were frequently prescribed as probabilistic antibiotics. Resistance to beta-lactam antibiotics was 50% for Escherichia coli. Factors influencing severe infection were: advanced age, male gender, urinary lithiasis, multiple antibiotic resistance and non-enterobacterial germs. CONCLUSION: Urinary tract infection in chronic kidney disease were frequent and particularly severe.

Sonographic temporary nephromegaly in children during their first febrile urinary tract infection is a significant prognostic factor for recurrent infection.

There are currently no available data on the relationship between sonographic temporary nephromegaly in children during their first febrile urinary tract infection (fUTI) and recurrent fUTI. For this analysis, a multicenter retrospective cohort study of 343 children who underwent renal ultrasound during their first fUTI was conducted between 2013 and 2020. Sonographic temporary nephromegaly was defined as increased renal length during the initial fUTI, followed by normal renal length after antibiotic treatment. Compared with children without sonographic temporary nephromegaly (n = 307), the duration of fever and intravenous antibiotics was significantly longer, and C-reactive protein, creatinine, and the proportion of children who had recurrent fUTI were significantly higher, in those with sonographic temporary nephromegaly (n = 36). In an additional analysis of 100 patients who received voiding cystourethrography, a logistic regression model confirmed that the odds of vesicoureteral reflux (VUR) were significantly higher in children with temporary nephromegaly or those who experienced fUTI recurrence. In nine out of 16 children with VUR who had temporary nephromegaly, the reason for receiving voiding cystourethrography was recurrent fUTI. Our results suggest that sonographic temporary nephromegaly during an initial fUTI is predictive for recurrence and VUR, and that in children with temporary nephromegaly, VUR may be detectable before fUTI recurrence.

The bacterial displacement test: an in vitro microbiological test for the evaluation of intermittent catheters and urinary tract infection.

AIMS: Intermittent catheters (ICs) are commonly used in bladder management, but catheter-associated urinary tract infections (CAUTIs) remain challenging. Insertion tips may reduce the risk of CAUTIs by minimizing bacterial transfer along the urinary tract. However, there are few laboratory tests to evaluate such technologies. We describe the use of an adapted in vitro urethra agar model to assess bacterial displacement by ICs. METHODS AND RESULTS: Simulated urethra agar channels (UACs) were prepared with catheter-specific sized channels in selective media specific to the challenge organisms. UACs were inoculated with Escherichia coli and Enterococcus faecalis before insertion of ICs, and enumeration of UAC sections was performed following insertion. Four ICs were evaluated: Cure Catheter® Closed System (CCS), VaPro Plus Pocket™, Bard® Touchless® Plus, and SpeediCath® Flex Set. CCS demonstrated significantly reduced bacterial displacement along the UACs compared to the other ICs and was also the only IC with undetectable levels of bacteria toward the end of the UAC (representing the proximal urethra). CONCLUSION: The bacterial displacement test demonstrated significant differences in bacterial transfer between the test ICs with insertion tips, which may reflect their different designs. This method is useful for evaluating CAUTI prevention technology and may help guide future technology innovations.

Update of the Spanish clinical practice guideline for urinary tract infection in infants and children. Summary of recommendations for diagnosis, treatment and follow-up.

The management of urinary tract infection (UTI) in infants and children has changed significantly over the past few decades based on scientific evidence that questioned the efficacy of strategies used to prevent kidney injury and subsequent progression to chronic kidney disease, which is very unlikely in most paediatric cases. However, there is still substantial heterogeneity in its management and uncertainty regarding the diagnosis, indication of imaging tests, treatment or follow-up in these patients. The Spanish clinical practice guideline has been updated through the review of the literature published since 2009 and a rigorous evaluation of current clinical practice aspects, taking into account the evidence on the benefits of each intervention in addition to its risks and drawbacks to attempt to provide more precise recommendations.