Multidrug Resistant Urinary Tract Infections in Children Presenting to the Pediatric Emergency Department

In this prospective study of 442 infants younger than 8 weeks of age who attended a pediatric emergency department with temperature ≥100.6°F (38.1° C), urinary tract infections (UTIs) were found in 33 patients (7.5%), 2 of whom were bacteremic. Clinical and laboratory data were not helpful for identifying UTIs. Of the 33 patients with UTIs, 32 had urinalyses recorded; 16 were suggestive of a UTI (more than five white blood cells per high-power field or any bacteria present). Of the 16 infants with apparently normal urinalysis results, three had an emergency department diagnosis suggesting an alternative bacterial focus of infection. If the physician had decided on the basis of apparently normal urinalysis results to forgo obtaining a urine culture, more than half of the UTIs would have been missed. Bag-collected specimens were significantly more likely to yield indeterminate urine culture results than either catheter or suprapublic specimens. In addition, uncircumcised males were significantly more likely to have a UTI than circumcised boys. These results suggest that a suprapubic or catheter-obtained urine specimen for culture is a necessary part of the evaluation of all febrile infants younger than 8 weeks of age, regardless of the urinalysis findings or another focus of presumed bacterial infection.

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Process Mapping in a Pediatric Emergency Department to Minimize Missed Urinary Tract Infections

International Journal of Pediatrics ◽

10.1155/2016/2625870 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Morgan Black ◽

Valene Singh ◽

Vladimir Belostotsky ◽

Madan Roy ◽

Deborah Yamamura ◽

...

Keyword(s):

Emergency Department ◽

Urinary Tract ◽

Chart Review ◽

Pediatric Emergency ◽

Pediatric Emergency Department ◽

Process Mapping ◽

Number Of Children ◽

Positive Urine ◽

Tract Infections

Urinary tract infections (UTIs) are common in young children and are seen in emergency departments (EDs) frequently. Left untreated, UTIs can lead to more severe conditions. Our goal was to undertake a quality improvement (QI) initiative to help minimize the number of children with missed UTIs in a newly established tertiary care pediatric emergency department (PED). A retrospective chart review was undertaken to identify missed UTIs in children < 3 years old who presented to a children’s hospital’s ED with positive urine cultures. It was found that there was no treatment or follow-up in 12% of positive urine cultures, indicating a missed or possible missed UTI in a significant number of children. Key stakeholders were then gathered and process mapping (PM) was completed, where gaps and barriers were identified and interventions were subsequently implemented. A follow-up chart review was completed to assess the impact of PM in reducing the number of missed UTIs. Following PM and its implementation within the ED, there was no treatment or follow-up in only 1% of cases. Based on our results, the number of potentially missed UTIs in the ED decreased dramatically, indicating that PM can be a successful QI tool in an acute care pediatric setting.

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Urinary Tract Infections due to Multidrug-Resistant Enterobacteriaceae: Prevalence and Risk Factors in a Chicago Emergency Department

Emergency Medicine International ◽

10.1155/2013/258517 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 39

Author(s):

Thana Khawcharoenporn ◽

Shawn Vasoo ◽

Kamaljit Singh

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Multidrug Resistant ◽

Tract Infections

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Evaluation of the sysmex UF-5000 fluorescence flow cytometer as a screening platform for ruling out urinary tract infections in elderly patients presenting at the Emergency Department

Scandinavian Journal of Clinical and Laboratory Investigation ◽

10.1080/00365513.2021.1929441 ◽

2021 ◽

pp. 1-6

Author(s):

Lasse Krogh Alenkaer ◽

Lise Pedersen ◽

Pal Bela Szecsi ◽

Poul Jannik Bjerrum

Keyword(s):

Emergency Department ◽

Urinary Tract ◽

Elderly Patients ◽

Urinary Tract Infections ◽

Flow Cytometer ◽

Screening Platform ◽

Tract Infections

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The Antibacterial Activity of Human Amniotic Membrane against Multidrug-Resistant Bacteria Associated with Urinary Tract Infections: New Insights from Normal and Cancerous Urothelial Models

Biomedicines ◽

10.3390/biomedicines9020218 ◽

2021 ◽

Vol 9 (2) ◽

pp. 218

Author(s):

Taja Železnik Ramuta ◽

Larisa Tratnjek ◽

Aleksandar Janev ◽

Katja Seme ◽

Marjanca Starčič Erjavec ◽

...

Keyword(s):

Antibacterial Activity ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Amniotic Membrane ◽

Multidrug Resistant ◽

Basic Knowledge ◽

Resistant Bacteria ◽

Human Amniotic Membrane ◽

Multidrug Resistant Bacteria ◽

Tract Infections

Urinary tract infections (UTIs) represent a serious global health issue, especially due to emerging multidrug-resistant UTI-causing bacteria. Recently, we showed that the human amniotic membrane (hAM) could be a candidate for treatments and prevention of UPEC and Staphylococcus aureus infections. However, its role against multidrug-resistant bacteria, namely methicillin-resistant S. aureus (MRSA), extended-spectrum beta-lactamases (ESBL) producing Escherichia coli and Klebsiella pneumoniae, vancomycin-resistant Enterococci (VRE), carbapenem-resistant Acinetobacter baumannii, and Pseudomonas aeruginosa has not yet been thoroughly explored. Here, we demonstrate for the first time that the hAM homogenate had antibacterial activity against 7 out of 11 tested multidrug-resistant strains, the greatest effect was on MRSA. Using novel approaches, its activity against MRSA was further evaluated in a complex microenvironment of normal and cancerous urinary bladder urothelia. Even short-term incubation in hAM homogenate significantly decreased the number of bacteria in MRSA-infected urothelial models, while it did not affect the viability, number, and ultrastructure of urothelial cells. The hAM patches had no antibacterial activity against any of the tested strains, which further exposes the importance of the hAM preparation. Our study substantially contributes to basic knowledge on the antibacterial activity of hAM and reveals its potential to be used as an antibacterial agent against multidrug-resistant bacteria.

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Response to “Comment on: Cefiderocol, a New Siderophore Cephalosporin for the Treatment of Complicated Urinary Tract Infections Caused by Multidrug-Resistant Pathogens: Preclinical and Clinical Pharmacokinetics, Pharmacodynamics, Efficacy and Safety”

Clinical Drug Investigation ◽

10.1007/s40261-021-01050-5 ◽

2021 ◽

Author(s):

Young R. Lee

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Multidrug Resistant ◽

Efficacy And Safety ◽

Clinical Pharmacokinetics ◽

Multidrug Resistant Pathogens ◽

Tract Infections

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Assessment of Fosfomycin for Complicated or Multidrug-Resistant Urinary Tract Infections: Patient Characteristics and Outcomes

Chemotherapy ◽

10.1159/000449422 ◽

2016 ◽

Vol 62 (2) ◽

pp. 100-104 ◽

Cited By ~ 18

Author(s):

Stephanie E. Giancola ◽

Monica V. Mahoney ◽

Michael D. Hogan ◽

Brian R. Raux ◽

Christopher McCoy ◽

...

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Bacterial Resistance ◽

Clinical Success ◽

Patient Characteristics ◽

Multidrug Resistant ◽

Enterococcus Spp ◽

Tract Infections ◽

Microbiological Cure

Background: Bacterial resistance among uropathogens is on the rise and has led to a decreased effectiveness of oral therapies. Fosfomycin tromethamine (fosfomycin) is indicated for uncomplicated urinary tract infections (UTIs) and displays in vitro activity against multidrug-resistant (MDR) isolates; however, clinical data assessing fosfomycin for the treatment of complicated or MDR UTIs are limited. Methods: We conducted a retrospective evaluation of patients who received ≥1 dose of fosfomycin between January 2009 and September 2015 for treatment of a UTI. Patients were included if they had a positive urine culture and documented signs/symptoms of a UTI. Results: Fifty-seven patients were included; 44 (77.2%) had complicated UTIs, 36 (63.2%) had MDR UTIs, and a total of 23 (40.4%) patients had a UTI that was both complicated and MDR. The majority of patients were female (66.7%) and elderly (median age, 79 years). Overall, the most common pathogens isolated were Escherichia coli (n = 28), Enterococcus spp. (n = 22), and Pseudomonas aeruginosa (n = 8). Twenty-eight patients (49.1%) were clinically evaluable; the preponderance achieved clinical success (96.4%). Fifteen out of 20 (75%) patients with repeat urine cultures had a microbiological cure. Conclusions: This retrospective study adds to the limited literature exploring alternative therapies for complicated and MDR UTIs with results providing additional evidence that fosfomycin may be an effective oral option.

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