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1.
Einstein (Sao Paulo) ; 18: eRC5063, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31553357

RESUMO

A 65-year-old male with a history of urinary tract trauma requiring cystotomy and chronic bladder catheterization, presenting with chronic and uninvestigated changes in the color of the urine bag system, with no urine color change, and positive urine culture for Proteus mirabilis . These characteristics refer to the purple urine bag syndrome, a not weel-known condition, with a benign course in most cases, and associated with urinary tract infection in patients with chronic bladder catheterization. Although it is characterized by marked changes, it is underdiagnosed by healthcare professionals.


Assuntos
Infecções Relacionadas a Cateter/microbiologia , Coletores de Urina/efeitos adversos , Infecções Urinárias/microbiologia , Idoso , Infecções Relacionadas a Cateter/patologia , Humanos , Masculino , Proteus mirabilis/isolamento & purificação , Fatores de Risco , Síndrome , Infecções Urinárias/patologia , Urina/microbiologia
2.
Biomed Res Int ; 2019: 3937812, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31032344

RESUMO

Urinary tract infection (UTI) and preeclampsia are common among pregnant women and are associated with adverse maternal-fetal and neonatal outcomes. Despite this, limited information exists on the association between UTIs and preeclampsia in Tanzania to guide specific management and thereby averting the adverse outcomes. A 1:2 matched case-control study (by age and gravidity) involving 131 pregnant women with preeclampsia (cases) and 262 without preeclampsia (controls) was conducted. Sociodemographic and clinical information was collected using a questionnaire. Midstream urine samples were collected during admission for culture and antimicrobial susceptibility testing (AST). Out of 393 pregnant women enrolled, 110 (28.0%), 95% CI: 23.8%-32.7%, had significant bacteriuria [cases: 50.4% (66/131) and control: 16.8% (44/262)]. Pregnant women with preeclampsia had 7.7 odds of having significant bacteriuria than those without preeclampsia [OR=7.7, 95% CI (4.11-14.49); p-value <0.001]. Escherichia coli, 50 (45.5%), and Klebsiella spp., 25 (23.6%), predominated, and resistance to gentamicin, ceftriaxone, and piperacillin-tazobactam ranged from 9.0% to 29.0% in these dominant species. Extended spectrum beta lactamases (ESBL) production in Escherichia coli and Klebsiella spp. was 18.0% (9/50) and 15.4% (4/26), respectively. Routine urine culture and AST among pregnant women with preeclampsia should be introduced in the antenatal clinics to ensure prompt management. Delineation of maternal-fetal and neonatal outcomes among pregnant women with preeclampsia and UTIs would be of interest in future studies.


Assuntos
Farmacorresistência Bacteriana Múltipla , Pré-Eclâmpsia/tratamento farmacológico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Infecções Urinárias/tratamento farmacológico , Adulto , Ceftriaxona/uso terapêutico , Escherichia coli/efeitos dos fármacos , Escherichia coli/patogenicidade , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/microbiologia , Infecções por Escherichia coli/patologia , Feminino , Gentamicinas/uso terapêutico , Hospitais , Humanos , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/microbiologia , Infecções por Klebsiella/patologia , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/patogenicidade , Troca Materno-Fetal , Combinação Piperacilina e Tazobactam/uso terapêutico , Pré-Eclâmpsia/microbiologia , Pré-Eclâmpsia/patologia , Gravidez , Complicações Infecciosas na Gravidez/microbiologia , Complicações Infecciosas na Gravidez/patologia , Tanzânia/epidemiologia , Infecções Urinárias/complicações , Infecções Urinárias/microbiologia , Infecções Urinárias/patologia , Adulto Jovem , beta-Lactamases/química , beta-Lactamases/genética
3.
Dis Markers ; 2019: 5853486, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30944667

RESUMO

Background: Bacterium and leucocyte counts in urine can be measured by urine flow cytometry (UFC). They are used to predict significant bacterial growth in urine culture and to diagnose infections of the urinary tract. However, little information is available on appropriate UFC cut-off values for bacterium and leucocyte counts in specific clinical presentations. Objective: To develop, validate, and evaluate adapted cut-off values that result in a high negative predictive value for significant bacterial growth in urine culture in common clinical presentation subgroups. Methods: This is a single center, retrospective, observational study with data from patients of the emergency department of Bern University Hospital, Switzerland, with suspected infections of the urinary tract. The patients presented with different symptoms, and urine culture and urine flow cytometry were performed. For different clinical presentations, the patients were grouped by (i) age (>65 years), (ii) sex, (iii) clinical symptoms (e.g., fever or dysuria), and (iv) comorbidities such as diabetes and immunosuppression. For each group, cut-off values were developed, validated, and analyzed using different strategies, i.e., linear discriminant analysis (LDA) and Youden's index, and were compared with known cut-offs and cut-offs optimized for sensitivity. Results: 613 patients were included in the study. Significant bacterial growth in urine culture depended on clinical presentation and ranged from 32.3% in male patients to 61.5% in patients with urinary frequency. In all clinical presentations, the predictive accuracy of UFC leucocyte and UFC bacterium counts was good for significant bacterial growth in urine culture (AUC ≥ 0.88). The adapted LDA95 equations did not exhibit consistently high sensitivity. However, the in-house cut-offs (test positive if UFC leucocytes > 17/µL or UFC bacteria > 125/µL) were highly sensitive (>90%). In female, younger, and dysuric patients, even higher cut-offs for UFC leucocytes (169/µL, 169/µL, and 205/µL) exhibited high sensitivity. Specificity was insufficient (<0.9) for all tested cut-offs. Conclusions: For various clinical presentations, significant bacterial growth in urine culture can be excluded if flow cytometry measurements give a bacterial count of ≤125/µL or a leucocyte count of ≤17/µL. In female patients, dysuric patients, and patients younger than ≤65 years, the leucocyte cut-off can be increased to 170/µL.


Assuntos
Citometria de Fluxo/normas , Infecções Urinárias/urina , Urina/microbiologia , Idoso , Carga Bacteriana , Feminino , Citometria de Fluxo/métodos , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Infecções Urinárias/microbiologia , Infecções Urinárias/patologia , Urina/citologia
4.
Ann Clin Lab Sci ; 49(1): 134-142, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30814089

RESUMO

Whether or not Vitamin D deficiency is associated with urinary tract infections (UTI) remains controversial. We retrieved relevant articles from the PubMed, Google Scholar, the Cochrane Library, Med-line and Embase databases up to Mach 1, 2018 for studies investigating the association between Vitamin D and UTI. The meta-analysis of 9 studies included 1921 participants, of which 580 were diagnosed with UTI. They showed that Vitamin D insufficiency was associated with a significantly increased risk of having a UTI (pooled OR=3.01, 95%CI=2.31-3.91), with moderate heterogeneity (I2 =49.5%). Moreover, Vitamin D level was significantly lower in the UTI group (standardized mean difference (SMD)=-1.65, 95%CI=-2.69--0.60, P<0.001). Significant heterogeneity was also detected (I2 =97.9%, P<0.001). Meta-analysis also revealed a significant association between UTI and Vitamin D deficiency in children (OR=4.78, 95%CI=3.08-7.44, P<0.001). This meta-analysis indicated a significant association between Vitamin D insufficiency and increased risk of UTI, especially in children.


Assuntos
Infecções Urinárias/etiologia , Deficiência de Vitamina D/complicações , Humanos , Prognóstico , Fatores de Risco , Infecções Urinárias/patologia
5.
Biomed Res Int ; 2019: 3080827, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30881985

RESUMO

Background: Urosepsis and septic shock are a critical situation leading to a mortality rate up to 30% in patients with obstructive diseases of the urinary tract. Aim: To analyze the bacterial distribution and drug resistance of pathogenic bacteria in patients with urosepsis and to provide a basis for the rational application of antibacterial drugs in clinical practice. Methods: A retrospective analysis of 94 hospitalized patients with urosepsis for 6 years was performed. The strain composition, resistance characteristics, and the antibiogram of common bacteria from positive blood and midstream urine culture were analyzed. Results: A total of 87 strains were isolated, including 65 strains (74.71%) of Gram-negative bacilli, 14 strains (16.09%) of Gram-positive cocci, and 8 strains (9.20%) of fungi. The Gram-negative bacilli included 42 strains of Escherichia coli (E. coli) (64.62%), among which 34 strains (80.95%) were producing ESBLs, and 14 strains (21.84%) of Klebsiella pneumoniae (K. pneumoniae), among which nine strains (64.29%) were producing ESBLs. The most common pathogenic bacteria, ESBL+ E. coli and K. pneumoniae strains, showed sensitivity towards imipenem, ertapenem, piperacillin/tazobactam, amikacin, and cefotetan, but were highly resistant to quinolones. The cure rate of urosepsis was 88.30%, and the susceptibility rate of septic shock was 45.47%. Significance: Gram-negative bacterial infections are the main cause of urosepsis. The mild patient group showed more E. coli (ESBL-) infections, and the number of ESBL producing E. coli isolated from the mild group showed higher drug resistance rates for aztreonam and levofloxacin compared with isolates from the severe group.


Assuntos
Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Sepse/tratamento farmacológico , Choque Séptico/tratamento farmacológico , Infecções Urinárias/tratamento farmacológico , Ertapenem/farmacologia , Escherichia coli/efeitos dos fármacos , Escherichia coli/patogenicidade , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Negativas/patologia , Humanos , Imipenem/farmacologia , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/patogenicidade , Quinolonas/farmacologia , Sepse/microbiologia , Sepse/patologia , Choque Séptico/microbiologia , Choque Séptico/patologia , Infecções Urinárias/microbiologia , Infecções Urinárias/patologia
6.
Biomed Res Int ; 2019: 8078139, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30800678

RESUMO

The present study aims to investigate the risk factors for urosepsis and the diagnostic and prognostic values of the bone morphogenetic protein endothelial cell precursor-derived regulator (BMPER) in patients with urosepsis following ureteroscopic lithotripsy. A total of 305 patients with unilateral ureteral obstruction caused by calculi were included in the study. Patients were divided into three groups, namely, high, medium, and low perfusion pressure groups. The serum C-reactive protein, procalcitonin, lactate (LAC), and BMPER were measured after operation. A logistic regression model was used to assess the risk factors for postoperative urosepsis. The relationships of BMPER with laboratory parameters were explored with a multiple linear regression model. Receiver operating characteristic (ROC) curves were used to diagnosis urosepsis. The cumulative incidence of the adverse events after operation was calculated and compared by log-rank test. Forty-five patients (14.8%) had an episode of urosepsis after operation. Irrigation pressure was an independent risk factor for urosepsis. LAC and sequential organ failure assessment (SOFA) were associated with BMPER after operation. The area under curve value of BMPER for urosepsis was 0.829 (95% confidence interval [CI], 0.773 to 0.884). Uroseptic patients with higher BMPER concentration exhibited more adverse outcome. BMPER possesses valuable discriminative capacity for urosepsis and is a strong predictor of adverse outcome in patients with urosepsis.


Assuntos
Proteínas de Transporte/metabolismo , Sepse/metabolismo , Sepse/patologia , Proteínas Morfogenéticas Ósseas/metabolismo , Proteína C-Reativa/metabolismo , Estudos de Casos e Controles , Células Progenitoras Endoteliais/metabolismo , Células Progenitoras Endoteliais/patologia , Feminino , Humanos , Litotripsia/métodos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Ureteroscopia/métodos , Infecções Urinárias/metabolismo , Infecções Urinárias/patologia
7.
Microbiol Spectr ; 7(1)2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30681068

RESUMO

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.


Assuntos
Adesinas de Escherichia coli/metabolismo , Aderência Bacteriana/fisiologia , Infecções por Escherichia coli/transmissão , Proteínas de Fímbrias/metabolismo , Fímbrias Bacterianas/metabolismo , Infecções Urinárias/transmissão , Escherichia coli Uropatogênica/patogenicidade , Infecções por Escherichia coli/microbiologia , Infecções por Escherichia coli/patologia , Sistema Urinário/microbiologia , Infecções Urinárias/microbiologia , Infecções Urinárias/patologia , Escherichia coli Uropatogênica/metabolismo
8.
BMC Infect Dis ; 18(1): 651, 2018 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-30541468

RESUMO

BACKGROUND: Nucleic acid amplification tests (NAAT) are well-accepted in diagnosis and surveillance of sexually infectious pathogens worldwide. However, performance differences between a RNA-based NAAT and DNA-based NAAT are rarely reported. This study compares the performances of the RNA-based SAT (simultaneous amplification and testing) assay and the DNA-based quantitative real-time polymerase chain reaction (qPCR) assay. METHODS: A total of 123 urogenital swabs were collected from outpatients with suspected genital infections in our hospital. Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Ureaplasma urealyticum (UU) in these swabs were simultaneously tested by SAT and qPCR. Any swabs were positive in the qPCR assay were further verified by following cloning and sequencing. All statistical analysis was performed using the SPSS software. RESULTS: When the concentrations of CT, NG, or UU were more than 1 × 103 copies/ml, 100% agreements between SAT and qPCR were observed regardless of the pathogen. No discrepancy was found. However, the sensitivity of SAT is significantly higher than qPCR in samples with concentration less than 1 × 103 copies/ml. When tested by SAT and qPCR, 57.14 and 28.57% were positive for CT, 46.15% and 0 were positive for NG, 80% and 0 were positive for UU, respectively. CONCLUSIONS: The SAT assay has better agreements and higher sensitivities when compared with the qPCR assay, and thus could be a better choice for screening, diagnosis, and surveillance of sexually transmitted diseases, especially for CT and NG.


Assuntos
Chlamydia trachomatis/isolamento & purificação , DNA Bacteriano/isolamento & purificação , Neisseria gonorrhoeae/isolamento & purificação , Técnicas de Amplificação de Ácido Nucleico/métodos , RNA Bacteriano/isolamento & purificação , Ureaplasma urealyticum/isolamento & purificação , Sistema Urogenital/patologia , Adulto , Técnicas de Tipagem Bacteriana/métodos , Biópsia , Infecções por Chlamydia/diagnóstico , Chlamydia trachomatis/genética , DNA Bacteriano/análise , Testes Diagnósticos de Rotina , Feminino , Gonorreia/diagnóstico , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Neisseria gonorrhoeae/genética , RNA Bacteriano/análise , Reação em Cadeia da Polimerase em Tempo Real/métodos , Sensibilidade e Especificidade , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/microbiologia , Ureaplasma urealyticum/genética , Infecções Urinárias/diagnóstico , Infecções Urinárias/microbiologia , Infecções Urinárias/patologia , Sistema Urogenital/microbiologia , Adulto Jovem
9.
An. sist. sanit. Navar ; 41(1): 17-26, ene.-abr. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-173366

RESUMO

Fundamento. La infección del tracto urinario (ITU) tiene una elevada prevalencia en atención primaria. Con el fin de mejorar el tratamiento empírico se ha estudiado la etiología y el perfil de resistencia antibiótica de las bacterias más frecuentes productoras de ITU comunitaria en Navarra. Material y métodos. Estudio retrospectivo (2014-2016) en el que se incluyeron los microorganismos aislados con recuento significativo en muestras de orina de pacientes con ITU. Se analizó la etiología global y en función de la edad y sexo. El estudio de sensibilidad se realizó con los aislamientos del 2016. Resultados. Escherichia coli fue el microorganismo más aislado tanto en el conjunto de la población (60,8%) como en cada uno de los grupos analizados según edad y sexo. Su sensibilidad fue: nitrofurantoína 97,4%, fosfomicina 96,5%, amoxicilinaácido clavulánico 83,8%, trimetoprim-sulfametoxazol 68,3%, quinolonas 63,4% y amoxicilina 41,9%. Los datos de sensibilidad ponderada muestran que la sensibilidad a fosfomicina fue 83,4% en varones <15 años, 89,4% en mujeres <15 años y 81,9% en mujeres entre 15-65 años, y a nitrofurantorina 86,7% en mujeres <15 años y 82,2% en mujeres entre 15-65 años. Conclusiones. E. coli continua siendo el microorganismo más frecuente en ITU de origen comunitario con sensibilidad a fosfomicina y nitrofurantoína superior al 95%. El tratamiento empírico de ITU en nuestro medio debería excluir amoxicilina, amoxicilina-ácido clavulánico, trimetoprim-ulfametoxazol y quinolonas. Fosfomicina puede emplearse de forma empírica en el tratamiento de cistitis no complicada en varones menores de 15 años y en mujeres menores de 65 años y nitrofurantoína en mujeres menores de 65 años


Background. Urinary tract infection (UTI) is a high prevalence infection at the community level. In order to improve the adequacy of the empirical therapy, we evaluated the etiology and the resistance pattern of the main uropathogens responsible for community acquired UTI in Navarre. Methods. Retrospective study (2014-2016) in which we included microorganisms recovered with significant counts from samples of patients with community-acquired UTI. The global etiology and etiology according to age and sex was analyzed. Antimicrobial resistance was studied with urotopathogens isolated in 2016. Results. Escherichia coli was the most frequently isolated microorganism both in the population (60.8%) and in each of the groups analyzed according to age and sex. The sensitivity of E. coli was: nitrofurantoin 97.4%, fosfomycin 96.5% amoxicillin-clavulanic acid 83.8%, trimethoprim-sulfamethoxazole 68.3%, quinolones 63.4% and amoxicillin 41.9%. Pooled sensitivity shows that the sensitivity to fosfomycin was 83.4% in men <15 years, 89.4% in women <15 years and 81.9% in women between 15-65 years; and to nitrofurantoin was 86.7% in women <15 years and 82.2% in women between 15-65 years. Conclusions. E. coli continues to be the most frequent microorganism in community-acquired UTI with a rate of sensitivity to fosfomycin and nitrofurantoin above 95%. The empirical treatment of UTI in our environment should not include amoxicillin, amoxicillin-clavulanic acid, trimethoprim-sulfamethoxazole or quinolones. Fosfomycin may be empirically used in the treatment of uncomplicated cystitis in men younger than 15 years and in women under 65 years, and nitrofurantoin may be used empirically in women under 65 years


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Infecções Urinárias/diagnóstico , Infecções Urinárias/microbiologia , Testes de Sensibilidade Microbiana/métodos , Infecções Urinárias/etiologia , Infecções Urinárias/patologia , Estudos Retrospectivos , Escherichia coli/isolamento & purificação , Fosfomicina , Nitrofurantoína
10.
Am J Med Sci ; 355(2): 191-194, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29406048

RESUMO

Pheochromocytoma is a neoplasm, which develops from cells of the chromaffin tissues that are derived from the ectodermic neural system and mostly situated within the adrenal medulla. Approximately 15% of pheochromocytoma cases arise from extra-adrenal chromaffin tissue. Pheochromocytoma of the bladder is rare and accounts for less than 0.06% of all bladder neoplasms and less than 1% of all pheochromocytomas. We report a case of a young woman who presented with uncontrolled hypertension, recurrent urinary tract infections and micturition attacks and was found to have a metastatic bladder paraganglioma. In addition, we provide a summary table of the clinical manifestations of paragangliomas based on anatomic locations.


Assuntos
Neoplasias das Glândulas Suprarrenais , Hipertensão , Neoplasias da Bexiga Urinária , Infecções Urinárias , Neoplasias das Glândulas Suprarrenais/microbiologia , Neoplasias das Glândulas Suprarrenais/patologia , Neoplasias das Glândulas Suprarrenais/fisiopatologia , Adulto , Feminino , Humanos , Hipertensão/microbiologia , Hipertensão/patologia , Hipertensão/fisiopatologia , Metástase Neoplásica , Feocromocitoma/microbiologia , Feocromocitoma/patologia , Feocromocitoma/fisiopatologia , Feocromocitoma/secundário , Neoplasias da Bexiga Urinária/microbiologia , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/fisiopatologia , Infecções Urinárias/microbiologia , Infecções Urinárias/patologia , Infecções Urinárias/fisiopatologia
11.
Microb Pathog ; 117: 170-174, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29471135

RESUMO

To evaluate the pathophysiology of catheter-associated candiduria, the bladders of female mice were infected with Candida tropicalis. One group was implanted with a catheter fragment with preformed biofilm by cystotomy technique, while another group received, in separate, a sterile catheter fragment and a correspondent yeast suspension. The bladder tissues were examined by histopathology and the quantity of colony forming units was evaluated. All the animals presented inflammation and the presence of C. tropicalis was observed in the tissue within 72 h of the introduction of biofilm, while 75% of the mice remained infected after 144 h. However, only 50% of animals from the group infected with C. tropicalis in suspension (planktonic yeasts), exhibited such signs of infection over time. The cystotomy technique is therefore viable in mice, and is an effective model for evaluating the pathogenesis of candiduria from catheter biofilms. The model revealed the potential of C. tropicalis infectivity and demonstrated more effective evasion of the host response in biofilm form than the planktonic yeast.


Assuntos
Biofilmes/crescimento & desenvolvimento , Candida tropicalis/patogenicidade , Candidíase/microbiologia , Modelos Animais de Doenças , Infecções Urinárias/microbiologia , Animais , Candidíase/imunologia , Candidíase/patologia , Contagem de Colônia Microbiana , Cistotomia/métodos , Feminino , Interações Hospedeiro-Patógeno/imunologia , Evasão da Resposta Imune , Inflamação/microbiologia , Inflamação/patologia , Camundongos , Camundongos Endogâmicos BALB C , Fatores de Tempo , Bexiga Urinária/microbiologia , Bexiga Urinária/patologia , Cateteres Urinários/microbiologia , Infecções Urinárias/imunologia , Infecções Urinárias/patologia
12.
Sci Rep ; 8(1): 1238, 2018 01 19.
Artigo em Inglês | MEDLINE | ID: mdl-29352171

RESUMO

Murine models describe a defined host/pathogen interaction for urinary tract infection, but human cell studies are scant. Although recent human urothelial organoid models are promising, none demonstrate long-term tolerance to urine, the natural substrate of the tissue and of the uropathogens that live there. We developed a novel human organoid from progenitor cells which demonstrates key structural hallmarks and biomarkers of the urothelium. After three weeks of transwell culture with 100% urine at the apical interface, the organoid stratified into multiple layers. The apical surface differentiated into enlarged and flattened umbrella-like cells bearing characteristic tight junctions, structures resembling asymmetric unit membrane plaques, and a glycosaminoglycan layer. The apical cells also expressed cytokeratin-20, a spatial feature of the mammalian urothelium. Urine itself was necessary for full development, and undifferentiated cells were urine-tolerant despite the lack of membrane plaques and a glycosaminoglycan layer. Infection with Enterococcus faecalis revealed the expected invasive outcome, including urothelial sloughing and the formation of intracellular colonies similar to those previously observed in patient cells. This new biomimetic model could help illuminate invasive behaviours of uropathogens, and serve as a reproducible test bed for disease formation, treatment and resolution in patients.


Assuntos
Técnicas de Cultura de Células/métodos , Organoides/crescimento & desenvolvimento , Infecções Urinárias/patologia , Urotélio/citologia , Células Cultivadas , Humanos , Urina/química , Urotélio/patologia
13.
Mycopathologia ; 183(3): 591-596, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29196922

RESUMO

Candiduria is associated with high morbidity, mortality, and long hospitalization, involving high costs for the healthcare system. The use of increasingly aggressive treatments has prolonged the lives of patients susceptible to candiduria, namely the immunosuppressed, the premature, and the elderly. Our objective was to evaluate the incidence of nosocomial candiduria and the implicated species in hospitalized patients aged over 80 years old from three Spanish centers during 2012 and 2013. Urine samples received from these patients were cultured and analyzed by flow cytometry in search of leukocyturia, hematuria, proteinuria, and microbial nitrate reductase activity. The isolated yeast species were identified microscopically, by germ tube formation in serum, colony morphology after subculture onto CHROMagar Candida (Becton-Dickinson, UK), assimilation of carbon compounds ID32C (bioMérieux, France), matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDITOF) (Bruker Daltonics, Germany) and, in case of inconsistency, by sequencing of the ITS regions of ribosomal DNA (ITS1-5, 8S-ITS2). Susceptibility tests were also performed. The incidence of candiduria in the elderly population was 10.3%. A total of 155 strains of yeasts were isolated. The predominant species was Candida albicans, followed by Candida glabrata and then Candida tropicalis. Several infrequent species were found; among them, the first isolate of candiduria-producing Candida pulcherrima described in the literature. Our finding should raise concerns about the elderly population, which is probably the most important risk group for candiduria in the present moment, and the emergence of unusual yeast species producing candiduria, which are resistant against the commonly used antifungal agents.


Assuntos
Candida/classificação , Candida/isolamento & purificação , Candidíase/epidemiologia , Infecções Urinárias/epidemiologia , Idoso de 80 Anos ou mais , Candida/genética , Candida/fisiologia , Candidíase/microbiologia , Candidíase/patologia , Análise por Conglomerados , DNA Fúngico/química , DNA Fúngico/genética , DNA Espaçador Ribossômico/química , DNA Espaçador Ribossômico/genética , Feminino , Humanos , Incidência , Masculino , Técnicas Microbiológicas , Filogenia , Análise de Sequência de DNA , Espanha/epidemiologia , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Infecções Urinárias/microbiologia , Infecções Urinárias/patologia
15.
Transpl Infect Dis ; 20(2): e12828, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29272071

RESUMO

Urinary tract infections (UTI) are an important cause of morbidity and mortality in renal transplant patients. These infections are quite common, and the goal of care is to identify and reduce risk factors while providing effective prophylaxis and treatment. Better understanding of long-term outcomes from these infections has led to the distinctions among UTI, recurrent UTI, and asymptomatic bacteriuria (ASB), and that each requires a different therapeutic approach. Specifically, new research has supported the perspective that asymptomatic bacteriuria should not be treated. Symptomatic UTI, on the other hand, requires intervention and remains an ongoing challenge for infectious disease clinicians. Many bacteria species are responsible for UTI in renal transplant patients, and in recent years there has been a global rise in infection caused by bacteria with newly acquired antibacterial resistance genes. Many renal transplant patients who experience UTI will also have multiple recurring episodes, which likely has a distinct pathophysiological mechanism leading to chronic colonization of the urinary tract. In these cases, long-term management includes bacterial suppression, which aims to reduce rather than eliminate bacteria to levels below the threshold for symptomatic infection. This review will address the current understanding of UTI epidemiology, pathogenesis, and risk factors in the renal transplant community, and also focus on current prevention and treatment strategies for patients who face an environment of increasingly antibiotic-resistant bacteria.


Assuntos
Transplante de Rim , Infecções Urinárias/patologia , Antibacterianos/farmacologia , Bactérias/efeitos dos fármacos , Farmacorresistência Bacteriana , Humanos , Transplantados , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/microbiologia
16.
J Vis Exp ; (130)2017 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-29286380

RESUMO

Urinary tract infections (UTI) are extremely common worldwide, incurring significant morbidity and healthcare-associated expenses. Small animal models, which accurately reflect disease establishment and progression, permit dissection of host-pathogen interactions and generation of immunity to infection. In mice, intravesical instillation of uropathogenic E. coli, the causative agent in more than 85% of community acquired UTI, recapitulates many of the stages of infection observed in humans. Until recently, however, UTI could only be modeled in female animals. This limitation has hindered the study of sex-related differences in UTI, as well as other bladder pathologies, such as cancer. Here, we describe a method to instill male mice that allows direct comparison between female and male animals and provide a detailed protocol to assess bladder tissue by flow cytometry as a means to better understand host responses to infection. Together, these approaches will aid in the identification of host factors that contribute to sex biases observed in UTI and other bladder-associated diseases.


Assuntos
Cateterismo Urinário/métodos , Infecções Urinárias/terapia , Animais , Modelos Animais de Doenças , Infecções por Escherichia coli/microbiologia , Infecções por Escherichia coli/patologia , Infecções por Escherichia coli/terapia , Feminino , Citometria de Fluxo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Fatores Sexuais , Infecções Urinárias/microbiologia , Infecções Urinárias/patologia , Escherichia coli Uropatogênica/isolamento & purificação
17.
Urologiia ; (5): 150-154, 2017 Oct.
Artigo em Russo | MEDLINE | ID: mdl-29135160

RESUMO

This is a literature review on the role of microbial flora in the development of recurrent urolithiasis. The authors outline pathogenetic aspects of recurrent stone formation associated bacterial flora. A number of studies reported that standard urine culture has limited sensitivity in detecting urinary tract infection.


Assuntos
Biofilmes , Nefrolitíase , Infecções Urinárias , Humanos , Nefrolitíase/etiologia , Nefrolitíase/metabolismo , Nefrolitíase/microbiologia , Nefrolitíase/patologia , Infecções Urinárias/complicações , Infecções Urinárias/metabolismo , Infecções Urinárias/microbiologia , Infecções Urinárias/patologia
19.
Microb Pathog ; 113: 102-106, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29066378

RESUMO

We evaluate the role of antioxidant enzyme status and inflammatory cascade in disease progression of cystitis in a rat model. The animals were injected with clinically isolated Uropathogenic Escherichia coli (UPEC) and study the effect of various antioxidant enzymes and inflammatory markers in disease pathology on the 0th day, 12 h and 7th day of infection. The antioxidant status of bladder tissue was decreased during the 7th day of infection. Lipid peroxidation marker MDA was increased on the 7th day of infection in rats. The histopathology of bladder tissue shows severe inflammation and edema. This study reveals the role of decreased antioxidant status during infection play a vital role in upregulation of inflammation and tissue destruction.


Assuntos
Cistite/patologia , Infecções por Escherichia coli/patologia , Glutationa Peroxidase/metabolismo , Glutationa Redutase/metabolismo , Superóxido Dismutase/metabolismo , Infecções Urinárias/patologia , Escherichia coli Uropatogênica/patogenicidade , Animais , Antioxidantes/metabolismo , Catalase/metabolismo , Cistite/microbiologia , Infecções por Escherichia coli/microbiologia , Feminino , Glutationa/metabolismo , Inflamação/microbiologia , Inflamação/patologia , Peroxidação de Lipídeos/fisiologia , Estresse Oxidativo/fisiologia , Ratos , Ratos Wistar , Infecções Urinárias/microbiologia
20.
Proc Natl Acad Sci U S A ; 114(41): E8721-E8730, 2017 10 10.
Artigo em Inglês | MEDLINE | ID: mdl-28973850

RESUMO

Methicillin-resistant Staphylococcus aureus (MRSA) is an emerging cause of catheter-associated urinary tract infection (CAUTI), which frequently progresses to more serious invasive infections. We adapted a mouse model of CAUTI to investigate how catheterization increases an individual's susceptibility to MRSA UTI. This analysis revealed that catheterization was required for MRSA to achieve high-level, persistent infection in the bladder. As shown previously, catheter placement induced an inflammatory response resulting in the release of the host protein fibrinogen (Fg), which coated the bladder and implant. Following infection, we showed that MRSA attached to the urothelium and implant in patterns that colocalized with deposited Fg. Furthermore, MRSA exacerbated the host inflammatory response to stimulate the additional release and accumulation of Fg in the urinary tract, which facilitated MRSA colonization. Consistent with this model, analysis of catheters from patients with S. aureus-positive cultures revealed colocalization of Fg, which was deposited on the catheter, with S. aureus Clumping Factors A and B (ClfA and ClfB) have been shown to contribute to MRSA-Fg interactions in other models of disease. We found that mutants in clfA had significantly greater Fg-binding defects than mutants in clfB in several in vitro assays. Paradoxically, only the ClfB- strain was significantly attenuated in the CAUTI model. Together, these data suggest that catheterization alters the urinary tract environment to promote MRSA CAUTI pathogenesis by inducing the release of Fg, which the pathogen enhances to persist in the urinary tract despite the host's robust immune response.


Assuntos
Cateterismo/efeitos adversos , Staphylococcus aureus Resistente à Meticilina/patogenicidade , Infecções Estafilocócicas/microbiologia , Bexiga Urinária/microbiologia , Infecções Urinárias/microbiologia , Sistema Urinário/microbiologia , Adesinas Bacterianas/metabolismo , Animais , Feminino , Fibrinogênio/metabolismo , Humanos , Camundongos , Camundongos Endogâmicos C57BL , Ligação Proteica , Infecções Estafilocócicas/metabolismo , Infecções Estafilocócicas/patologia , Bexiga Urinária/metabolismo , Bexiga Urinária/patologia , Sistema Urinário/metabolismo , Sistema Urinário/patologia , Infecções Urinárias/metabolismo , Infecções Urinárias/patologia
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