Host and Bacterial Markers that Differ in Children with Cystitis and Pyelonephritis.

OBJECTIVE: To determine whether treatment for urinary tract infections in children could be individualized using biomarkers for acute pyelonephritis. STUDY DESIGN: We enrolled 61 children with febrile urinary tract infections, collected blood and urine samples, and performed a renal scan within 2 weeks of diagnosis to identify those with pyelonephritis. Renal scans were interpreted centrally by 2 experts. We measured inflammatory proteins in blood and urine using LUMINEX or an enzyme-linked immunosorbent assay. We evaluated serum RNA expression using RNA sequencing in a subset of children. Finally, for children with Escherichia coli isolated from urine cultures, we performed a polymerase chain reaction for 4 previously identified virulence genes. RESULTS: Urinary markers that best differentiated pyelonephritis from cystitis included chemokine (C-X-C motif) ligand (CXCL)1, CXCL9, CXCL12, C-C motif chemokine ligand 2, INF γ, and IL-15. Serum procalcitonin was the best serum marker for pyelonephritis. Genes in the interferon-γ pathway were upregulated in serum of children with pyelonephritis. The presence of E coli virulence genes did not correlate with pyelonephritis. CONCLUSIONS: Immune response to pyelonephritis and cystitis differs quantitatively and qualitatively; this may be useful in differentiating these 2 conditions.

Surveillance study in Europe and Brazil on clinical aspects and Antimicrobial Resistance Epidemiology in Females with Cystitis (ARESC): implications for empiric therapy.

BACKGROUND: Uncomplicated cystitis in females is among the most frequent infections in community. OBJECTIVE: To determine clinical aspects, epidemiology, and antimicrobial susceptibility of uropathogens. INTERVENTION: Patients were investigated clinically and with urinalysis and urine culture. MEASUREMENTS: This survey started in 2003 and ended in 2006 including 68 centres in nine European countries and in Brazil. Female patients between 18 and 65 yr with symptoms of uncomplicated cystitis were consecutively enrolled and clinically evaluated. Uropathogens were identified and their susceptibility tested for nine antimicrobials. RESULTS AND LIMITATIONS: Clinical data of 4264 eligible patients were analysed. A positive urine culture was found in 74.6%. Within the 3018 pathogens, Escherichia coli (E. coli) was most frequent (76.7%), followed by Enterococcus faecalis (4.0%), Staphylococcus saprophyticus (3.6%), Klebsiella pneumoniae (3.5%), and Proteus mirabilis (3.5%). E. coli showed the highest rate of susceptibility to fosfomycin (98.1%) followed by mecillinam (95.8%), nitrofurantoin (95.2%), and ciprofloxacin (91.8%). The lowest rate was found for ampicillin (45.1%). For the total spectrum the order was fosfomycin (96.4%), mecillinam (95.9%), ciprofloxacin (90.3%), and nitrofurantoin (87.0%). In all countries a susceptibility rate to E. coli above 90% was found only for fosfomycin, mecillinam, and nitrofurantoin. The susceptibility rates varied significantly from country to country (p<0.0001), except for fosfomycin, mecillinam, and nitrofurantoin. CONCLUSIONS: Despite wide cross-country variability of bacterial susceptibility/resistance rates to the other antimicrobials tested, fosfomycin, mecillinam, and nitrofurantoin have preserved their in vitro activity in all countries investigated. They may represent good options for the empiric therapy of female patients with uncomplicated cystitis.

Aspectos de las infecciones urinarias / Aspects of the infections urinary

El conocimiento a cabalidad de las infecciones urinarias por el médico general y el especialista, llevará a disminuir la morbilidad y letalidad de las infecciones urinarias en nuestro medio. Es importante recalcar que será la única forma, con un tratamiento adecuado, evitar el paso hacia los procesos crónicos de las vías urinarias. Evitando así con ello, la insuficiencia renal crónica. El tratamiento está orientado predominantemente al tratamiento de E.coli, agente causal primordial en las infecciones urinarias.

Infecçåo urinária por Escherichia coli: correlaçåo de características clínicas, patogênicas e sorogrupos / Urinary tract infections by Escherichia coli: correlation of virulence, serogroups and clinical characteristics

Estudou-se a uropatogenicidade (pesquisa de adesinas - MSHA, MRHA e hemolisinas) e a sorotipagem (por titulaçåo em tubos) de 248 amostras de E. coli isoladas de pacientes do Hospital das Clínicas da Faculdade de Medicina de Botucatu com quadro clínico de cistite, pielonefrite, bacteriúria assintomática ou indeterminado. Observou-se que: as amostras relacionadas pielonefrite apresentaram hemaglutinaçåo manose resistente (MRHA) em maior proporçåo (54,3 por cento), hemaglutinaçåo manose sensível (MSHA) foi observada em mais de 91 por cento das bactérias de todos os quadros clínicos, enquanto que amostras hemolíticas (53,2 por cento em média) se distribuiram uniformemente pelos mesmos. Os sorogrupos prevalentes foram: O7 (20,8 por cento), O2 (18,5 por cento) e O4 (18,5 por cento) em pielonefrite; O18ac (41,9 por cento) e O7 (41,7 por cento em cistite e O75 (26,9 por cento) em assintomáticos. Todas as amostras O18ac e O4 provenientes de pielonefrite apresentaram MRHA e 82 por cento delas, hemolisinas. Estes dados sugerem que em determinados sorogrupos de E. coli, alguns fatores de virulência coexistem, favorecendo, assim, sua sobrevivência nas céluls uroepiteliais