A clear urine specimen on visual inspection cannot totally exclude a diagnosis of urinary tract infection

We report the case of a 2-month-old infant with incomplete Kawasaki disease that presented as an apparent urinary tract infection. The patient’s fever persisted despite antibiotic treatment. Intravenous immunoglobulin and aspirin therapy cured both the incomplete Kawasaki disease and bacterial pyuria. Renal sonography, voiding cystourethrography, and renal parenchyma radionuclide scanning did not detect any abnormalities. Temporary dilation of the coronary artery was noted. In a urine specimen obtained through transurethral catheterization, the growth of 105 colony-forming units/mL of extended-spectrum β-lactamase–producing Escherichia coli was detected. Polymerase chain reaction analysis revealed that the enzyme genotype was CTX-M-8, which is a rare type in Japan. In conclusion, attention should be paid to a misleading initial presentation of fever and pyuria, which might be interpreted as urinary tract infection in patients with Kawasaki disease. Furthermore, pediatricians should consider incomplete Kawasaki disease when patients present with fever and pyuria, which are consistent with urinary tract infection, but do not respond to antibiotic treatment.

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Draft Genome Sequence ofEnterococcus faecalisStrain F165 Isolated from a Urinary Tract Infection

Genome Announcements ◽

10.1128/genomea.01084-16 ◽

2016 ◽

Vol 4 (5) ◽

Author(s):

Thiago G. S. Paim ◽

Luiza Pieta ◽

Janira Prichula ◽

Gustavo E. Sambrano ◽

Renata Soares ◽

...

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Antimicrobial Resistance ◽

Tract Infection ◽

Enterococcus Faecalis ◽

Genome Sequence ◽

Draft Genome ◽

Draft Genome Sequence ◽

Urine Specimen ◽

South Brazil

We report here a draft genome sequence ofEnterococcus faecalisstrain F165 isolated from a urine specimen in South Brazil. The genome size was 3,049,734 bp, with a G+C content of 37.38%, and genes related to antimicrobial resistance and adherence were found in the strain. These findings are consistent with pathogenesis ofE. faecalisspecies.

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Lack of Clinical Utility of Urine Gram Stain for Suspected Urinary Tract Infection in Pediatric Patients

Journal of Clinical Microbiology ◽

10.1128/jcm.00045-15 ◽

2015 ◽

Vol 53 (4) ◽

pp. 1282-1285 ◽

Cited By ~ 7

Author(s):

Joseph B. Cantey ◽

Claudia Gaviria-Agudelo ◽

Erin McElvania TeKippe ◽

Christopher D. Doern

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Gold Standard ◽

Clinical Utility ◽

Pediatric Patients ◽

Urine Culture ◽

Urine Specimen ◽

Gram Stain ◽

Predictive Values

Urinary tract infection (UTI) is one of the most common infections in children. Urine culture remains the gold standard for diagnosis, but the utility of urine Gram stain relative to urinalysis (UA) is unclear. We reviewed 312 pediatric patients with suspected UTI who had urine culture, UA, and urine Gram stain performed from a single urine specimen. UA was considered positive if ≥10 leukocytes per oil immersion field were seen or if either nitrates or leukocyte esterase testing was positive. Urine Gram stain was considered positive if any organisms were seen. Sensitivity, specificity, and positive and negative predictive values were calculated using urine culture as the gold standard. Thirty-seven (12%) patients had a culture-proven UTI. Compared to urine Gram stain, UA had equal sensitivity (97.3% versus 97.5%) and higher specificity (85% versus 74%). Empirical therapy was prescribed before the Gram stain result was known in 40 (49%) patients and after in 42 (51%) patients. The antibiotics chosen did not differ between the two groups (P= 0.81), nor did they differ for patients with Gram-negative rods on urine Gram stain compared to those with Gram-positive cocci (P= 0.67). From these data, we conclude that UA has excellent negative predictive value that is not enhanced by urine Gram stain and that antibiotic selection did not vary based on the urine Gram stain result. In conclusion, the clinical utility of urine Gram stain does not warrant the time or cost it requires.

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Prevalence of asymptomatic bacteriuria in pregnant women

Journal of Armed Forces Medical College Bangladesh ◽

10.3329/jafmc.v9i2.21830 ◽

2015 ◽

Vol 9 (2) ◽

pp. 64-69

Author(s):

Nishat Jubaida ◽

Narjis Maliha Kawsar ◽

Nahid Elora ◽

Md Rahimgir ◽

Nahid Reaz Shapla ◽

...

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Pregnant Women ◽

Asymptomatic Bacteriuria ◽

Armed Forces ◽

Antenatal Visit ◽

Urine Specimen ◽

Antimicrobial Susceptibility Pattern ◽

Increased Risk

Introduction: Women with asymptomatic bacteriuria during pregnancy are more likely to deliver premature or low birth weight babies and having a 20 40 percent increased risk of developing pyelonephritis during pregnancy compared with women without bacteriuria. Asymptomatic bacteriuria is a microbiological diagnosis based on urine culture from persons without signs or symptoms of urinary tract infection. Objectives: The aim of this study was to determine the prevalence of asymptomatic bacteriuria in pregnant women and also to determine the relationship between the asymptomatic bacteriuria and pyuria to isolate the causative pathogens and to find out the antimicrobial susceptibility pattern of the isolates. Methods: A total of 540 urine specimen were collected from 540 asymptomatic pregnant women for urinary tract infection, over a period 2 years from January 2011 to December 2012 at Border Guard Bangladesh (BGB) Hospital, Pilkhana, Dhaka. All specimens were processed using standard microbiological procedures. All the subjects were evaluated for bacteriuria. Results: The prevalence of asymptomatic bacteriuria was 10.2% . Pyuria was found in 15.9% of cases. Escherichia coli (80%) was the commonest causative agent of asymptomatic bacteriuria followed by Staphylococcus saprophyticus (14.5%) and Pseudomonas spp.(5.5%). Nitrofurantoin was found to be highly sensitive to most of the isolates. 64 JAFMC Bangladesh. Vol 9, No 2 (December) 2013 Conclusion: Screening for bacteriuria in pregnancy and proper treatment of diagnosed cases must be considered as an essential part of antenatal care in our country. To prevent complications of asymptomatic bacteriuria, all pregnant women should be screened at the first antenatal visit. A negative test for pyuria is not a reliable indicator of the absence of asymptomatic bacteriuria in pregnant women. DOI: http://dx.doi.org/10.3329/jafmc.v9i2.21830 Journal of Armed Forces Medical College Bangladesh Vol.9(2) 2013

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Urinary tract infection in patients with acute non-gonococcal urethritis

International Journal of STD & AIDS ◽

10.1258/095646202321020035 ◽

2002 ◽

Vol 13 (12) ◽

pp. 801-804 ◽

Cited By ~ 7

Author(s):

Andrew Leung ◽

Shaw Taylor ◽

Angela Smith ◽

Robert Spencer ◽

Paddy Horner

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Cross Sectional Study ◽

Urine Specimen ◽

Sexually Active ◽

Sectional Study ◽

Cross Sectional ◽

Gonococcal Urethritis ◽

Male Patients

In young sexually active male patients, clinical differentiation between non-gonococcal urethritis (NGU) and urinary tract infection (UTI) can be difficult. UTI as a cause of NGU has been suggested before, but the prevalence of UTI among acute NGU patients has not been evaluated. We conducted a prospective cross-sectional study of 156 male patients with clinical features of acute urethritis. The prevalence of UTI among acute NGU patients was 6.4% (CI: 1.5–11.3%). There was a possible association between UTI and NGU but this was not statistically significant. The sensitivity and specificity for combining leucocyte esterase and nitrite tests were 83.3% and 89.8% respectively, with a negative predictive value of 98.8%. We conclude that a mid-stream urine specimen should routinely be collected in patients with symptoms of urethritis. This should be analysed by dipsticks incorporating nitrite and leucocyte esterase tests. Those with a positive dipstick should then be confirmed by culture.

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Urine Specimen Collection For Diagnosing a Urinary Tract Infection-Patient Experience and Preference For Urine Specimen Collection: A Qualitative Study

10.21203/rs.3.rs-159773/v1 ◽

2021 ◽

Author(s):

Linda Collins ◽

Rajvinder Khasriya ◽

James Malone-Lee

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Sampling Methods ◽

Patient Experiences ◽

Urine Specimen ◽

Collection Method ◽

Urine Specimen Collection ◽

Specimen Collection ◽

Collection Methods

Abstract Background A urinary tract infection (UTI) is very common and patients frequently present to their General Practitioner and emergency department with symptoms. Diagnosis of the infection is made by examining fresh urine with microscopy, to detect white cells and epithelial cells shed from the bladder or by submitting the urine for microbial culture. Patients are often requested to provide a urine specimen, but very little is known about the patient experiences of carrying out the task or their preference of specimen collection method. The aim of this study was to explore patient experiences and preferences between four different urine specimen collection methods for diagnosing the presence of a UTI.Materials Semi-structured interviews were conducted and explored patient experiences of four different urine specimen collection methods (midstream urine specimen (MSU), catheter specimen (CSU), Peezy MSU™ and Natural void). The interviews consisted of four open-ended questions and all data were collated and organised using NVivo to establish themes that emerged from the data.Results The natural void without technique was repeatedly referred to and was regarded as being the most straightforward of all of the sampling methods. Pain symptoms were described only in the catheter method and not in the MSU, Peezy MSU™ or natural void method. The catheter was regarded as the urine collection method that produced the best specimen for diagnostic testing by the patients’. Conclusion A majority of the participants expressed the desire for straightforward urine sampling methods and preferred the natural void as a standard method in clinical practice.

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Study of incidence and risk factors of urinary tract infection in catheterised patients admitted at tertiary care

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20181768 ◽

2018 ◽

Vol 6 (5) ◽

pp. 1730 ◽

Cited By ~ 2

Author(s):

Bhavana Ashish Kakaria ◽

Ashish K. ◽

Raghuwanshi Tushar

Keyword(s):

Risk Factors ◽

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Tertiary Care ◽

Control Measures ◽

Colony Count ◽

Urine Specimen ◽

Indwelling Catheters ◽

Tract Infections

Background: Catheter-associated urinary tract infections (CAUTIs) are the most common nosocomial infection and a leading cause of morbidity and mortality in hospitalized patients. The aim of this study was to determine the incidence and risk factors of urinary tract infection in catheterised patients in a tertiary care hospital.Methods: Total of 200 patients above 16 years in whom an indwelling Foley‘s catheter inserted were taken in the study. A urine specimen was obtained aseptically and culture done on nutrient agar, sheep blood agar and MacConkey agar plates. After incubation of 24 hours, colony count done for organisms showing growth and colony count ≥105 was taken significant.Results: The incidence of CAUTI in the present study was 31%. Higher incidence of CAUTI (56.46%) was found in female sex as compared to males (43.54%). Incidence of CAUTI was found higher in first weeks (54.83%). Incidence among diabetes patients is found more (63.33%). Most common isolate found was E. coli (38.71%) among all uropathogens. Uropathogens isolated from CAUTI are more resistant to antimicrobials.Conclusions: It is must to implement following strategy for reducing the risk of infection due to indwelling catheters: 1. reducing the duration of catheterization 2. Use antibacterial substance coated catheter 3. Strict infection control measures.

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ASYMPTOMATIC BACTERIURIA IN PREGNANCY AND COMPLICATIONS ASSOCIATED WITH ASYMPTOMATIC BACTERIURIA

10.36106/ijsr/0501251 ◽

2021 ◽

pp. 1-2

Author(s):

Spriha Smriti ◽

R.K Srivastava ◽

N.P Sahu

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Asymptomatic Bacteriuria ◽

Common Species ◽

Microbial Colonization ◽

Urine Specimen ◽

Age Group ◽

Significant Bacteriuria ◽

Tract Infections

Introduction- Urinary tract infections refers to both microbial colonization of urine and tissue invasion of any structure of urinary tract. ASYMPTOMATIC BACTERIURIA (ASB) is a condition in which urine culture reveals significant growth of pathogens that is greater than 1,00,000 bacteria/ml of urine but not showing symptoms of urinary tract infection. Asymptomatic bacteriuria may be of significance or to doubtful significance or of no significance depending on number of bacteria present in urine. ASB is more common in women. Material and Method- The present study was conducted on 200 pregnant women without any symptoms of urinary tract infection attending Obs & Gynae department of RIMS, Ranchi, Jharkhand. It was conducted between August 2013 to December 2014. Urine specimen should be cultured for isolation of the common agents of UTI. The urine should be mixed thoroughly before plating. The plates are inoculated using a calibrated loop designed to deliver a known volume either 0.01 or 0.001 ml. Choice of media to inoculate depends on patient served and microbiologist preference, usually MacConkey Agar and 5% Blood Agar were used. In recent years a selective media CLED (Cysteine lactose electrolyte deficient) agar is used. This media is selective for urinary pathogens cultured plates are incubated at 37⁰C for 24 hrs. Colony count is done>100000/ml of CFU was taken as significant bacteriuria. Kirby Baeur disc diffusion is used for sensitivity test. Result – Asymtomatic bacteriuria is seen in 7.5% cases. It is more common in age group 20- 30 yrs age group and in second trimester of pregnancy. Most common species isolated was E.coli followed by Klebsiella species.Discussion- The percentage of ASB in the present study (7.5%) correlates with the studies of Lavanya SV et al 2002 (8.4%) CA Turpin et al 2007 (7.3%) & R. Sujata et al 2012 (7.3%).In this study, culture positivity with significant bacteriuria was highest in age group 20-30 yrs (73.34%). In 2011 study done by Dr. Rajshekhar maximum incidence was seen in 20-30 yrs age (57.57%).

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Bacterial agents of Urinary tract infection in renal allograft recipients and their antimicrobial resistance pattern.

Bangladesh Journal of Medical Microbiology ◽

10.3329/bjmm.v9i1.31334 ◽

2017 ◽

Vol 9 (1) ◽

pp. 13-16

Author(s):

Rehana Razzak Khan ◽

Sharmeen Ahmed ◽

A. H. Hamid Ahmed ◽

A. S.M Nowroz ◽

Ismet Nigar ◽

...

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Antimicrobial Resistance ◽

Tract Infection ◽

Renal Allograft ◽

Bacterial Pathogen ◽

Infectious Complications ◽

Resistance Pattern ◽

Urine Specimen ◽

Enterococcus Spp

Urinary tract infection (UTI) is the most common infectious complications after renal transplantation. Recently many researchers reported that the bacterial agents of UTI in renal allograft recipients changed and demonstrated increased antimicrobial resistance to commonly used cephalosporins. This study was undertaken to isolate the bacteria which are responsible for UTI and their susceptibility pattern for appropriate antibiotic therapy in renal allograft recipients. This was an observational study conducted in the Department of Microbiology Bangabandhu Sheikh Mujib Medical University (BSMMU) from December 2010 to 2011. Twenty one renal allograft recipients from Department of Nephrology were evaluated for UTI after surgery up to six weeks. Microscopic examination, culture and sensitivity of urine specimen were performed. Out of 21 renal allograft recipients, 13 (61.90%) patients developed UTI during initial post transplant period. Of 69 urine specimens collected from them 22(31.88%) yielded positive results for culture. Enterococcus spp. (50%) was the major bacterial pathogen isolated and showed 100% resistance to Cefuroxime, Ceftriaxone and Ceftazidime. Enterococcus spp. is an emerging pathogen responsible for development of UTI in renal allograft recipients which showed 100% resistance to 2nd and 3rd genaration cephalosporin group.Bangladesh J Med Microbiol 2015; 9 (1): 13-16

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Microbiological analysis of urinary tract infection in diabetic patients

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20205315 ◽

2020 ◽

Vol 8 (12) ◽

pp. 4410

Author(s):

Sarita Otta ◽

Bichitrananda Swain ◽

Priyadarshini Bhoi

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Antimicrobial Resistance ◽

Tract Infection ◽

Resistance Pattern ◽

Urine Specimen ◽

Diabetic Patients ◽

Microbiological Analysis ◽

E Coli ◽

Sensitivity Pattern

Background: Diabetes mellitus is a predisposing condition to different infections especially the complicated urinary tract infection (UTI). The susceptibility pattern of organisms in diabetics is different from their counterparts. So, there is always a dilemma while administering empirical regimen for UTI in diabetics. The study aims to find the common organisms implicated in the UTI in diabetic patients and their sensitivity pattern.Methods: Properly collected urine specimen from all the diabetic (cases) and non-diabetic (controls) patients included in this study was processed. Sensitivity pattern and extended spectrum beta lactamase (ESBL) production for the isolated uropathogens was noted.Results: E. coli was the most common organism isolated from both 68 cases and 85 controls in this study. Most of UTI patients with diabetes, 46 (67.7 %) had uncontrolled blood sugar level. Diabetics are more prone for catheter associated UTI (CAUTI) and fungal UTI. Most of the E coli and Atypical E coli isolated were ESBL positive for the diabetic patients (60.5%) than that for the non-diabetics (40.4%). Antimicrobial resistance pattern was similar in both the groups with maximum patients’ sensitivity to tigecycline, colistin, fosphomycin and least susceptibility to cefixime. Both E. coli and Klebsiella also showed high resistance to the fluoroquinolones.Conclusions: E. coli is the predominant uropathogen for both the diabetic & non-diabetic cases. But diabetics are more prone to get ESBL positive UTI. CAUTI and the fungal UTI are more common in diabetics. Diabetic condition does not affect the antimicrobial resistance pattern of uropathogens. But their rising resistance to fluoroquinolones, cephalosporins is a matter of concern while prescribing empiric regimen.

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