POS1159 THE ROLE OF URINARY TRACT INFECTIONS AS A SOURCE OF OSTEOARTICULAR INFECTIONS IN A RHEUMATOLOGY DEPARTMENT DURING THE 2010-2020 PERIOD: A RETROSPECTIVE STUDY

Background:There are several sources of infection in the pathogenesis of osteoarticular infections (OAI). Urinary tract infections (UTI) have rarely been involved whereas skin infection and Staphylococcus aureus represent the classic pair.Objectives:To describe the role of UTI as the source of infection in OAI including septic arthritis (SA) on native joints and infectious spondylodiscitis (SPDI). To compare characteristics of these cases with those of others source and those without any known source.Methods:Medical records of patients aged 18 years old or above who were diagnosed with a non-tuberculous OAI in the department of rheumatology of our hospital during the 2010-2020 period were selected and retrospectively reviewed. The following cases were excluded: SA on prosthetic joint, OIA on surgical material, osteomyelitis, post-operative OAI, SA after joint injection, brucellosis, Lyme disease. Only proven cases where included on the basis of an isolated pathologic organism at the site of OAI infection and/or in the blood (with typical clinical, biological and imaging features). Usually the OAI was considered of urinary source if the same microorganism grew in urine and the OA/blood sample. Cases with probable urinary source were also included on the basis of the type of microorganism and a history of UTI and/or urologic surgery and/or recent antibiotic therapy.Results:95 consecutive cases of proven OAI were included. There were 17 cases (18%) of urinary origin. In 12 cases the same micro-organism grew in urine and OA/blood culture: 5 methicillin sensitive Staphylococcus aureus, 2 Streptococcus Gallolyticus (associated with E. Coli in one case), 1 Escherichia Coli, 1 Klebsiella pneumoniae, 1 Enterococcus faecalis, 1 aerococcus urinae, 1 candida glabrata. Five patients had a probable urine source. In one patient with SPDI and an history of recurrent UTI, blood culture grew E. Coli whereas urine culture grew Enterococcus faecalis. In 4 cases, urine was sterile but a sample (OA in 3, blood in 1) was positive for E. Coli (n=2) or Pseudomonas aeruginosa (n=2).The type of OAI was: SPDI in 10 cases, peripheral SA in 4 cases, both of them in one case and pubic symphysitis in 2 cases. Blood culture was positive in 10 cases and OA sample in 9 cases. Demographics characteristics were: male 59%; age 68.7±11 years. Risk factors were: diabetes 29%; cancer treated with cytotoxic chemotherapy 2 cases; inflammatory disease 2 cases; urological disease and/or recurrent UTI in 59%; immunodeficiency 1 case. Duration of symptoms was 47.1 +/- 50.7 days. Urinary symptoms where present in 29% of patients and fever in 47%. There was no case of infectious endocarditis. Surgical intervention was realized in only one patient. No patient has been admitted in intensive care unit and no patient died. Length of hospitalization was 28±8.5 days. Duration of antibiotic therapy was 13.6±9 weeks. One patient with pubic symphysitis was not cured.The comparison between the group of OAI with urinary source (n=17) and the groups with another primary source of infection (n=52) or no known source of infection (n=26) shows in the first one: a higher prevalence of SPDI (59% vs 34% and 19% respectively), an older age (68.7 years vs 61.9 and 59.7 respectively), a higher prevalence of diabetes or cancer, a longer duration of symptoms (47.1+/-50.7 days vs 21.9+/-29.6 and 22.5+/-25.4 respectively) and a lower mean value of CRP (156+/-135 mg/l vs 182+/-124 and 180+/-140 respectively). A UTI was detected in 76% of OAI of urinary source but also in 13% of other cases (including E. Coli 5 cases).Conclusion:In the years 2010-2020, UTI was responsible for 18% of non-tuberculous OAI as we defined them in this study. A UTI does not demonstrate the responsibility of the microorganism isolated. Thoracolumbar SPDI is the main type. This relatively high frequency has not been reported before and is probably the consequence of the increasing population of aged patients with risk factors and urologic diseases. Clinicians have to be aware of it and prevention is required.Disclosure of Interests:None declared.

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POS1158 THE SPECTRUM OF NON-TUBERCULOUS OSTEOARTICULAR INFECTIONS IN A RHEUMATOLOGY DEPARTMENT DURING THE YEARS 2010-2020: A RETROSPECTIVE STUDY OF 102 CONSECUTIVE CASES IN A SINGLE CENTER

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3569 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 857.2-858

Author(s):

M. Chammakhi ◽

C. Bendahmane ◽

F. Kemiche ◽

I. Cerf-Payrastre ◽

E. Pertuiset

Keyword(s):

Risk Factors ◽

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Septic Arthritis ◽

The Other ◽

Imaging Features ◽

Duration Of Symptoms ◽

Source Of Infection ◽

Osteoarticular Infections

Background:osteoarticular infections (OAI) are characterized by a large variety of sites, causative microorganisms, source and route of infection, risk factors and also by the fact that several medical specialties are involved in diagnosis and treatment. These characteristics are subject to changes over the time.Objectives:to describe the spectrum of non-tuberculous OAI in the absence of OA material, including native septic arthritis (SA) and non-postoperative SA or infectious spondylodiscitis (SPDI) during the years 2010-2020. This includes demographics, comorbidities, site of infection, causative microorganisms, source of infection, diagnosis, treatment procedures and mortality.Methods:medical records of patients aged 18 years old or above who were diagnosed with a non-tuberculous OAI in the Department of rheumatology of our hospital during the 2010-2020 period were selected and retrospectively reviewed. OAI with the following characteristics were excluded: SA on prosthetic joints, postoperative SA or SPDI, osteomyelitis, brucellosis, Lyme disease. Only proven cases where included on the basis of an isolated pathologic organism at the site of infection and/or in the blood (with typical clinical, biological and imaging features).Results:There were 102 consecutive patients (males 62%), aged 62.5±16.8 years, with an IMC of 25.1±5.2. Peripheral SA where observed in 52 cases, SPDI in 33 cases, non-peripheral SA in 10 cases (sacroiliitis 5, pubic symphysitis 2, sternoclavicular 2, posterior interapophyseal 1); in 7 patients, there was an association of SPDI and peripheral SA. At least two non-contiguous sites were involved in 22 patients (21.5%). The sites of the positive sample where: osteoarticular (synovial fluid, vertebral biopsy) in 47 cases; blood in 28 cases; both of them in 27 cases.In the 102 cases, 105 microorganisms grew in culture including one Candida glabrata. The following bacteria where responsible in the other cases: 42 Staphylococcus aureus (including 3 cases of methicillin resistant); 7 coagulase-negative Staphylococcus spp.; 6 Group A Streptococcus; 12 group B Streptococcus agalactiae; 8 groups C/G Streptococcus; 3 group D Streptococcus gallolyticus; 2 Streptococcus pneumoniae; 1 Neisseria gonorrhea; 8 enterobacteria; 3 Enterococcus faecalis; 3 Pseudomonas aeruginosa; 3 Haemophilus; 6 others species (2 Parvimonas micra, 1 aerococcus urinae, 1 Nesseiria bacilliformis, 1 bacteroides fragilis, 1 campylobacter fetus).The most frequent host risk factors were: diabetes (21%), inflammatory/auto-immune disease (10%; including 3 rheumatoid arthritis), chronic renal insufficiency (CC<30 ml/mn) (6%), active cancer with local or general extension (6%), immunodeficiency state (SCID revealed by OAI in 2 cases). Three patients where on biological therapy.The source of infection was known in 76 cases: skin infection in 27; urinary tract infection in 17; joint injection in 7 cases; dental infection in 6 cases; infected vascular material in 6 cases; abdominal infection in 5 cases; genital infection in 3 cases; ENT infection in 3 cases; pulmonary disease 2 cases.Mean duration of symptoms ranged from 13 days for peripheral SA to 39 days for SPDI. Fever (≥38°C) was present in 52% of cases. Mean CRP was 182±128 mg/l. Blood cultures where positive in 55.5%. There was only one case of infectious endocarditis. All patients were treated with antibiotics with a mean duration of 10.2±5.6 weeks. Orthopedic surgery was proceeded in 67% of peripheral septic arthritis and in 10% of the other OAI. Six patients where admitted in the intensive care unit; 4 patients died (4.3%). Mean length of hospitalization was 28.6±15 days.Conclusion:in the years 2010-2020, non-tuberculous OAI represents a regular cause of hospitalization in rheumatology. Iatrogenic origin accounts for 13% of cases and urinary tract infection for 17%. Staphylococcus species are involved in only 48% of cases and Streptococcal species in 30%.Disclosure of Interests:None declared.

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Bacterial Etiology, Antibiotic Sensitivity Pattern and Risk Factors for Asymptomatic Bacteriuria during Pregnancy: Experience in a Tertiary Care Hospital

BIRDEM Medical Journal ◽

10.3329/birdem.v6i2.31289 ◽

2017 ◽

Vol 6 (2) ◽

pp. 79-83

Author(s):

Shakila Khanum ◽

Jamal Uddin Ahmed ◽

Khaleda Khanam

Keyword(s):

Risk Factors ◽

Pregnant Women ◽

Past History ◽

Asymptomatic Bacteriuria ◽

Antibiotic Sensitivity ◽

Urine Samples ◽

Successful Outcome ◽

E Coli ◽

History Of ◽

Tract Infections

Background: Urinary tract infections (UTIs) are common during pregnancy. Untreated asymptomatic bacteriuria (ASB) during pregnancy may cause serious complications including pyelonephritis and delivery of premature or low-birth-weight infants. This study aimed to assess the risk factors for asymptomatic bacteriuria, bacterial agents and their antibiotic susceptibility pattern in pregnant women attending in Combined Military Hospital (CMH), Dhaka.Methods: This cross-sectional study was conducted in a total of 1540 pregnant women with no signs and symptoms of UTI from October 2013 to March 2015. Clean catch mid-stream urine samples were collected from all study participants using sterile containers. Urine samples were cultured using standard bacteriological methods. Identification of suspected colonies and antibiotic sensitivity testing were done. Patients having ASB were further evaluated to find out associated risk factors.Results: Out of 1540 pregnant women, 254 (16.5%) had asymptomatic bacteriuria (Colony forming unit >105/mL).The most frequently isolated bacteria were Escherichia coli (E. coli) (50.4%), followed by Klebsiella (24.0%). The antibiotic sensitivity rate of bacterial isolates were highest for imipenem and amikacin. Among different associated conditions, anemia (16.5%), gestational diabetes mellitus (GDM) (10%) and past history of UTI (5.1%) were found to be the most frequent factors associated with increased prevalence of ASB.Conclusion: In this study, the prevalence of ASB was high among pregnant women with anemia, GDM and past history of UTI. E. coli was the most common organism causing ASB, which is less susceptible to conventional oral antibiotics but more susceptible to imipenem and amikacin. So, careful drug selection is required for successful outcome in ASB.Birdem Med J 2016; 6(2): 79-83

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Protective Factors and Suicidality in Members of Arab Kindred

Crisis ◽

10.1027/0227-5910/a000116 ◽

2012 ◽

Vol 33 (2) ◽

pp. 80-86 ◽

Cited By ~ 6

Author(s):

Sami Hamdan ◽

Nadine Melhem ◽

Israel Orbach ◽

Ilana Farbstein ◽

Mohammad El-Haib ◽

...

Keyword(s):

Risk Factors ◽

Protective Factors ◽

Suicidal Behavior ◽

Composite International Diagnostic Interview ◽

Diagnostic Interview ◽

Suicidal Risk ◽

Arab Population ◽

Psychiatric Interview ◽

History Of

Background: Relatively little is known about the role of protective factors in an Arab population in the presence of suicidal risk factors. Aims: To examine the role of protective factors in a subsample of in large Arab Kindred participants in the presence of suicidal risk factors. Methods: We assessed protective and risk factors in a sample of 64 participants (16 suicidal and 48 nonsuicidal) between 15 and 55 years of age, using a comprehensive structured psychiatric interview, the Composite International Diagnostic Interview (CIDI), self-reported depression, anxiety, hopelessness, impulsivity, hostility, and suicidal behavior in first-degree and second-relatives. We also used the Religiosity Questionnaire and suicide attitude (SUIATT) and multidimensional perceived support scale. Results: Suicidal as opposed to nonsuicidal participants were more likely to have a lifetime history of major depressive disorder (MDD) (68.8% vs. 22.9% χ2 = 11.17, p = .001), an anxiety disorder (87.5% vs. 22.9, χ2 = 21.02, p < .001), or posttraumatic stress disorder (PTSD) (25% vs. 0.0%, Fisher’s, p = .003). Individuals who are otherwise at high risk for suicidality have a much lower risk when they experience higher perceived social support (3.31 ± 1.36 vs. 4.96 ± 1.40, t = 4.10, df = 62, p < .001), and they have the view that suicide is somehow unacceptable (1.83 ± .10 vs. 1.89 ± .07, t = 2.76, df = 60, p = .008). Conclusions: Taken together with other studies, these data suggest that the augmentation of protective factors could play a very important role in the prevention of incidental and recurrent suicidal behavior in Arab populations, where suicidal behavior in increasing rapidly.

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Stress, Cortisol and Suicide Risk

10.31234/osf.io/92b7z ◽

2019 ◽

Author(s):

Daryl Brian O'Connor

Keyword(s):

Risk Factors ◽

Suicidal Behavior ◽

Suicide Risk ◽

Stressful Events ◽

Additional Risk ◽

Global Health Issue ◽

History Of ◽

Hpa Axis Activity ◽

The Impact

Suicide is a global health issue accounting for at least 800,000 deaths per annum. Numerous models have been proposed that differ in their emphasis on the role of psychological, social, psychiatric and neurobiological factors in explaining suicide risk. Central to many models is a stress-diathesis component which states that suicidal behavior is the result of an interaction between acutely stressful events and a susceptibility to suicidal behavior (a diathesis). This article presents an overview of studies that demonstrate that stress and dysregulated hypothalamic-pituitary-adrenal (HPA) axis activity, as measured by cortisol levels, are important additional risk factors for suicide. Evidence for other putative stress-related suicide risk factors including childhood trauma, impaired executive function, impulsivity and disrupted sleep are considered together with the impact of family history of suicide, perinatal and epigenetic influences on suicide risk.

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Etiology and clinical features of epididymo-orchitis: A single-center study in Tehran, Iran

Infectious Disorders - Drug Targets ◽

10.2174/1871526520666200218115400 ◽

2020 ◽

Vol 20 ◽

Cited By ~ 1

Author(s):

Sara Abolghasemi ◽

Mohammad Alizadeh ◽

Ali Hashemi ◽

Shabnam Tehrani

Keyword(s):

Chlamydia Trachomatis ◽

Clinical Symptoms ◽

Urine Culture ◽

Clinical Manifestations ◽

Urinary Frequency ◽

Serological Tests ◽

Duration Of Symptoms ◽

Two Samples ◽

History Of ◽

Tract Infections

Introduction: Epididymo-orchitis is a common urological disease among men. Little is known about the clinical and epidemiological aspects of the disease in Iran. Thus, the present study was aimed to investigate the etiology, clinical sequelae and risk factors of patients with epididymo-orchitis in Tehran, Iran. Materials and Methods: Patients presenting with epididymo-orchitis were prospectively analyzed in order to study the etiology and pattern of the disease. Bacteriological, molecular and serological tests were undertaken to look for Chlamydia trachomatis, Neisseria gonorrhoeae, Brucella spp., Mycoplasma spp, and other bacteria. Results: Fifty patients with epididymo-orchitis were evaluated according to their clinical symptoms, duration of symptoms, physical examination, and laboratory studies. The mean age of the patients was 53 years. Fever, dysuria, pain in the flanks, urinary frequency and discharges occurred in 58.0%, 50.0%, 50.0%, 28.0% and 6.0%, respectively. Bacterial pathogen was identified in 26% (13/50) of patients by urine culture. Escherichia coli was the etiological agent in 11/13 patients (84.6%). Two out of 50 patients (4.0%) were also positive for Chlamydia trachomatis. Two samples were serologically positive for Brucella spp. High Mean age, fever, urinary frequency, history of the underlying disease and history of urinary tract infections were found to have a significant association with the positive bacteriologic urine culture (P<0.05). Conclusions: The most common clinical manifestations were fever, dysuria, and abdominal pain. E. coli and C. trachomatis were the major causative agents. Use of a set of diagnostic approaches including clinical symptoms, urine culture and more precise techniques such as PCR should be taken into consideration for the definitive diagnosis.

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Risk Factors for Community Acquired Extended-Spectrum Β-lactamase (ESBL) Producing Enterobacteriaceae Urinary Tract Infections (UTIs)

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.827 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S345-S345

Author(s):

Dheeraj Goyal ◽

Kristin Dascomb ◽

Peter S Jones ◽

Bert K Lopansri

Keyword(s):

Risk Factors ◽

Urinary Tract ◽

Urinary Catheter ◽

Univariate Analysis ◽

Prior History ◽

Factors Associated ◽

Extended Spectrum ◽

History Of ◽

Enterobacteriaceae Infections ◽

Tract Infections

Abstract Background Community-acquired extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae infections pose unique treatment challenges. Identifying risk factors associated with ESBL Enterobacteriaceae infections outside of prior colonization is important for empiric management in an era of antimicrobial stewardship. Methods We randomly selected 251 adult inpatients admitted to an Intermountain healthcare facility in Utah with an ESBL Enterobacteriaceae urinary tract infection (UTI) between January 1, 2001 and January 1, 2016. 1:1 matched controls had UTI at admission with Enterobacteriaceae but did not produce ESBL. UTI at admission was defined as urine culture positive for > 100,000 colony forming units per milliliter (cfu/mL) of Enterobacteriaceae and positive symptoms within 7 days prior or 2 days after admission. Repeated UTI was defined as more than 3 episodes of UTI within 12 months preceding index hospitalization. Cases with prior history of ESBL Enterobacteriaceae UTIs or another hospitalization three months preceding the index admission were excluded. Univariate and multiple logistic regression techniques were used to identify the risk factors associated with first episode of ESBL Enterobacteriaceae UTI at the time of hospitalization. Results In univariate analysis, history of repeated UTIs, neurogenic bladder, presence of a urinary catheter at time of admission, and prior exposure to outpatient antibiotics within past one month were found to be significantly associated with ESBL Enterobacteriaceae UTIs. When controlling for age differences, severity of illness and co-morbid conditions, history of repeated UTIs (adjusted odds ratio (AOR) 6.76, 95% confidence interval (CI) 3.60–13.41), presence of a urinary catheter at admission (AOR 2.75, 95% CI 1.25 – 6.24) and prior antibiotic exposure (AOR: 8.50, 95% CI: 3.09 – 30.13) remained significantly associated with development of new ESBL Enterobacteriaceae UTIs. Conclusion Patients in the community with urinary catheters, history of recurrent UTIs, or recent antimicrobial use can develop de novo ESBL Enterobacteriaceae UTIs. Disclosures All authors: No reported disclosures.

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Is there a link between glucose levels and heart failure? An update

Arquivos Brasileiros de Endocrinologia & Metabologia ◽

10.1590/s0004-27302010000500010 ◽

2010 ◽

Vol 54 (5) ◽

pp. 488-497 ◽

Cited By ~ 6

Author(s):

Arnaldo Schainberg ◽

Antônio Ribeiro-Oliveira Jr. ◽

José Marcio Ribeiro

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Epidemiological Studies ◽

Left Ventricular ◽

Glucose Levels ◽

Factors Analysis ◽

History Of ◽

Cv Disease ◽

The Relationship

It has been well documented that there is an increased prevalence of standard cardiovascular (CV) risk factors in association with diabetes and with diabetes-related abnormalities. Hyperglycemia, in particular, also plays an important role. Heart failure (HF) has become a frequent manifestation of cardiovascular disease (CVD) among individuals with diabetes mellitus. Epidemiological studies suggest that the effect of hyperglycemia on HF risk is independent of other known risk factors. Analysis of datasets from populations including individuals with dysglycemia suggests the pathogenic role of hyperglycemia on left ventricular function and on the natural history of HF. Despite substantial epidemiological evidence of the relationship between diabetes and HF, data from available interventional trials assessing the effect of a glucose-lowering strategy on CV outcomes are limited. To provide some insight into these issues, we describe in this review the recent important data to understand the natural course of CV disease in diabetic individuals and the role of hyperglycemia at different times in the progression of HF.

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Risk factors of multidrug-resistant bacteria in community-acquired urinary tract infections

African Health Sciences ◽

10.4314/ahs.v21i1.28 ◽

2021 ◽

Vol 21 (1) ◽

pp. 214-9

Author(s):

Ertugrul Guclu ◽

Fikret Halis ◽

Elif Kose ◽

Aziz Ogutlu ◽

Oğuz Karabay

Keyword(s):

Risk Factors ◽

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Urinary Tract Infections ◽

Multidrug Resistant ◽

Antibiotic Usage ◽

Advanced Age ◽

History Of ◽

Tract Infections

Background: Urinary tract infections (UTIs) are one of the most seen infection among community. Objectives: In this cross-sectional study we aimed to investigate the risk factors of multidrug-resistant (MDR) bacteria that caused community-acquired UTI (CA-UTI). Methods: Consecutive patients admitted to the Urology and Infectious Diseases policlinics with the diagnosis of CA-UTI were included in the study. A standard form including possible predisposing factors for MDR bacteria was applied. Results: In total, 240 patients (51.3% females) were enrolled in the study. The mean age of participants were 59.8 ± 18.3 years old. Escherichia coli (n =166; 69.2%)was the most frequently isolated bacteria and its incidence was higher in females than in males (p=0.01). In total, 129 (53.8%) of the identified pathogens were MDR bacteria. According to multivariate analysis, the use of antibiotics three or more times increased the risk of infection with MDR bacteria by 4.6 times, the history of urinary tract infection in the last 6 months by 2 times, being male and over 65 years old by 3 times. Conclusion: Doctors should consider prescribing broad-spectrum antibiotics in patients with severe UTIs with a history of UTI, advanced age, male gender, and multiple antibiotic usage, even if they have a CA-UTI. Keywords: Urinary tract infection; community acquired; multidrug-resistant; male; multiple antibiotic usage; advanced age.

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Incidence, Clinical Profile, and Risk Factors for Serious Bacterial Infections in Children Hospitalized With Fever in Ujjain, India

10.21203/rs.2.18748/v2 ◽

2020 ◽

Author(s):

Ashish Pathak ◽

Radika Upadhayay ◽

Aditya Mathur ◽

Sunil Rathi ◽

Cecilia Stålsby Lundborg

Keyword(s):

Risk Factors ◽

Weight Loss ◽

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Blood Culture ◽

Positive Blood Culture ◽

Clinical Signs ◽

Increased Risk ◽

History Of

Abstract Background Fever is a cause for concern for both parents and the treating pediatrician and a common reason for antibiotic overuse. However, the proportion of children hospitalized for fever with serious bacterial infection (SBI) is uncertain. We aimed to evaluate the epidemiological, clinical, hematological, and biochemical risks for SBI among the children admitted with fever. Method This prospective study was conducted in a rural teaching hospital in India on consecutive children, aged 3 months–12 years, presenting with fever 100°F (37.7°C) or higher. The presence of SBI was confirmed with one of the following criteria: (a) a positive blood culture; (b) roentgenographically confirmed pneumonia with high titres of C-reactive protein; (c) a culture-confirmed urinary tract infection; (d) enteric fever diagnosed clinically in addition to either a positive blood culture or high Widal titers; and (e) meningitis diagnosed clinically in addition to either a positive blood culture or cerebrospinal fluid culture. A predefined questionnaire was filled. Results A total of 302 children were included in the study, out of which 47% (95% CI 41.4%-52.7%) presented with SBI. The factors associated with confirmed SBI in bivariate analysis were history of previous hospitalization, history of chronic illness, history of medication in the previous one week, a partially immunized child, history of common cold, moderate-grade fever, toxic look, significant lymphadenopathy, absence of BCG scar, delayed development, irritability, breathlessness, respiratory distress, poor feeding, significant weight loss, suspected urinary tract infection, hyponatremia, hypokalemia, and abnormal leucocyte count. The final generalized logistic regression model revealed partially immunized child (RR 4.26), breathlessness (RR 1.80), weight loss (RR 2.28), and suspected urinary tract infection (RR 1.95) as risk factors for the increased risk of SBI. Conclusion The study identified multiple risk factors for SBI. Pediatricians can be made aware of these risk factors. Further studies are warranted to identify age-specific risk factors for SBI because most clinicians depend on clinical signs and symptoms to identify SBI.

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The Globoseries Glycosphingolipid Sialosyl Galactosyl Globoside Is Found in Urinary Tract Tissues and Is a Preferred Binding Receptor In Vitro for Uropathogenic Escherichia coli Expressing pap-Encoded Adhesins

Infection and Immunity ◽

10.1128/iai.66.8.3856-3861.1998 ◽

1998 ◽

Vol 66 (8) ◽

pp. 3856-3861 ◽

Cited By ~ 65

Author(s):

A. E. Stapleton ◽

M. R. Stroud ◽

S. I. Hakomori ◽

W. E. Stamm

Keyword(s):

Escherichia Coli ◽

Urinary Tract ◽

Kidney Tissue ◽

Human Kidney ◽

Blood Group Antigens ◽

E Coli ◽

Vaginal Epithelial Cells ◽

History Of ◽

Tract Infections

ABSTRACT Women with a history of recurrent Escherichia coliurinary tract infections (UTIs) are significantly more likely to be nonsecretors of blood group antigens than are women without such a history, and vaginal epithelial cells (VEC) from women who are nonsecretors show enhanced adherence of uropathogenic E. coli isolates compared with cells from secretors. We previously extracted glycosphingolipids (GSLs) from native VEC and determined that nonsecretors (but not secretors) selectively express two extended globoseries GSLs, sialosyl galactosyl globoside (SGG) and disialosyl galactosyl globoside (DSGG), which specifically bound uropathogenicE. coli R45 expressing a P adhesin. In this study, we demonstrated, by purifying the compounds from this source, that SGG and DSGG are expressed in human kidney tissue. We also demonstrated that SGG and DSGG isolated from human kidneys bind uropathogenic E. coli isolates expressing each of the three classes ofpap-encoded adhesins, including cloned isolates expressing PapG from J96, PrsG from J96, and PapG from IA2, and the wild-type isolates IA2 and R45. We metabolically 35S labeled these five E. coli isolates and measured their relative binding affinities to serial dilutions of SGG and DSGG as well as to globotriaosylceramide (Gb3) and globotetraosylceramide (Gb4), two other globoseries GSLs present in urogenital tissues. Each of the five E. coli isolates bound to SGG with the highest apparent avidity compared with their binding to DSGG, Gb3, and Gb4, and each isolate had a unique pattern of GSL binding affinity. These studies further suggest that SGG likely plays an important role in the pathogenesis of UTI and that its presence may account for the increased binding of E. colito uroepithelial cells from nonsecretors and for the increased susceptibility of nonsecretors to recurrent UTI.

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