Urinary Tract Infection

1979 ◽  
Vol 1 (5) ◽  
pp. 133-136
Author(s):  
Richard H. Rapkin

The identification of urinary tract infection (UTI) is important in order to reduce its morbidity, to prevent its sequelae, and to identify underlying disease. This article will discuss methods of diagnosis and management of UTI, screening for UTI, and the importance of further evaluation and follow-up of children with UTIs. Much of what we know about UTI is controversial and rapid generation of new knowledge may make current recommendations passé. CASE V.M., a 4-year-old girl, was brought to the physician's office with the chief complaint of frequency of urination. Nine months before she had been seen because of frequency and dysuria and two consecutive midstream urine cultures grew >100,000 colonies/ml of a Gramneative rod. Sulfisoxazole was begun and a urine culture was sterile 48 hours after therapy was begun. The dysuria and frequency disappeared; therapy was continued for ten days and a urine culture four days later was sterile. One week later a voiding cystourethrogram (VCU) and an intravenous pyelogram (IVP) were performed and were interpreted as normal. Repeat urine cultures at one, two, three, and six months after the episode were sterile. Two days before the child was seen, she had become irritable and wet the bed during sleep (she had been successfully trained at 27 months of age), and she began to void frequently during the next 24 hours.

PEDIATRICS ◽  
1974 ◽  
Vol 53 (2) ◽  
pp. 289-289
Author(s):  
Thomas F. Dolan ◽  
Alan Meyers

We agree that follow-up urine culture should be obtained after the diagnosis of a urinary tract infection is made. The frequency with which such cultures are obtained is, however, debatable. Our questionnaire did not include this aspect of management. Since 59% of family practitioners and 45% of pediatricians diagnosed urinary tract infections without benefit of culture on a routine basis, it would seem likely that follow-up urine cultures are not performed with regularity. We would join with Dr. Browning in urging careful follow-up and evaluation for children with documented urinary tract infections.


CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S67-S68
Author(s):  
N. Walji ◽  
A. Greer ◽  
M. Hewitt ◽  
M. BinKharfi

Background: The diagnosis of urinary tract infection (UTI) is made based on symptoms, urinalysis and urine culture. While simple urinary tract infections do not require routine culture, the Infectious Disease Society of America (IDSA) Guidelines state that complicated urinary tract infections should have urine cultures performed to determine which antibiotics are effective, as there is a higher risk of infection with resistant organisms. We hypothesized that the rate of urine cultures sent for complicated UTI is less than is recommended by the literature. Aim Statement: We aimed to implement a follow-up reporting system for Urinary Culture in patients diagnosed with complicated UTIs and raise our Urinary Culture rates in this population to 80% by June 2019. Measures & Design: We performed a single-center chart review using Emergency Department (ED) charts of non-admitted patients. They were audited daily for two weeks to obtain a sample of patients who had a discharge diagnosis of urinary tract infection, pyelonephritis or cystitis. Charts capturing these diagnoses were assessed to see if a culture was clinically indicated and if it was ordered. Charts were screened for the presence of any of the following criteria indicating complicated UTI: known structural or functional abnormality of the urinary tract, genitourinary obstruction, pregnancy, immunosuppression, diabetes, indwelling or intermittent catheter use, fever, male patient, clinical pyelonephritis, antimicrobial failure, or transfer from a nursing home. Data was then compiled to determine culture rates in complicated and uncomplicated UTIs. This prevalence rate established the baseline performance in the ED which was used to inform the quality improvement project. Evaluation/Results: Over a two week period, 26 patients were discharged from the ED with a diagnosis of UTI, with 17 of these patients meeting criteria for complicated UTI. Only 6 of 17 complicated UTIs were sent for urine culture, therefore our pre-implementation culture rate was 35%. After initial data collection, a follow-up system was designed ensuring that urine culture and sensitivities results would be compiled and reviewed daily at Hamilton Health Sciences. This system was created with input from key stakeholders including department chiefs, core lab services, ED physicians and business clerks. A discrepancy form was created for documentation of culture result recognition and any required patient follow up ie. antibiotic change. In October 2019, the system had been implemented for a month, after which another chart review was completed. 27 cases were captured, 18 of which were complicated. The complicated culture rate had increased significantly from 35% to 72%. Discussion/Impact: In the ED, ordering of cultures for patients being discharged, regardless of type, is commonly associated with concern of result follow up, which may take up to 72 hours. This discrepancy system was implemented to ensure that all urine cultures ordered had appropriate follow up, thus supporting physicians in ordering cultures when indicated. The significant improvement in culture rate from 35% to 72% is balanced by one single culture of all 9 simple UTIs (11%). In PDSA cycle 2, we hope to increase rates to 90% by improving current challenges with the system.


2012 ◽  
Vol 3 (2) ◽  
pp. 472-473
Author(s):  
Dr G Sucilathangam Dr G Sucilathangam ◽  
◽  
Dr G Velvizhi Dr G Velvizhi

2018 ◽  
pp. 100-108
Author(s):  
Dinh Khanh Le ◽  
Dinh Dam Le ◽  
Khoa Hung Nguyen ◽  
Xuan My Nguyen ◽  
Minh Nhat Vo ◽  
...  

Objectives: To investigate clinical characteristics, bacterial characteristics, drug resistance status in patients with urinary tract infections treated at Department of Urology, Hue University Hospital. Materials and Method: The study was conducted in 474 patients with urological disease treated at Department of Urology, Hue Universiry Hospital from July 2017 to April 2018. Urine culture was done in the patients with urine > 25 Leu/ul who have symptoms of urinary tract disease or infection symptoms. Patients with positive urine cultures were analyzed for clinical and bacterial characteristics. Results: 187/474 (39.5%) patients had symptoms associated with urinary tract infections. 85/474 (17.9%) patients were diagnosed with urinary tract infection. The positive urine culture rate was 45.5%. Symptoms of UTI were varied, and no prominent symptoms. E. coli accounts for the highest proportion (46.67%), followed by, Staphycoccus aureus (10.67%), Pseudomonas aeruginsa (8,0%), Streptococcus faecali and Proteus (2.67%). ESBL - producing E. coli was 69.23%, ESBL producing Enterobacter spp was 33.33%. Gram-negative bacteria are susceptible to meropenem, imipenem, amikacin while gram positive are vancomycin-sensitive. Conclusions: Clinical manifestations of urinary tract infections varied and its typical symptoms are unclear. E.coli is a common bacterium (46.67%). Isolated bacteria have a high rate of resistance to some common antibiotics especially the third generation cephalosporins and quinolones. Most bacteria are resistant to multiple antibiotics at the same time. Gram (+) bacteria are susceptible to vancomycin, and gram (-) bacteria are susceptible to cefoxitin, amikacin, and carbapenem. Key words: urinary tract infection


Author(s):  
Lotem Goldberg ◽  
Yael Borovitz ◽  
Nir Sokolover ◽  
Asaf Lebel ◽  
Miriam Davidovits

PEDIATRICS ◽  
1986 ◽  
Vol 78 (5) ◽  
pp. 871-878
Author(s):  
Candice E. Johnson ◽  
Baz P. DeBaz ◽  
Paul A. Shurin ◽  
Rose DeBartolomeo

Ultrasonography of the kidney may replace the intravenous pyelogram as the study of choice in identifying treatable abnormalities in children with urinary tract infection. In a series of 64 consecutive children with urinary tract infection in whom an intravenous pyelogram, renal ultrasound, and voiding cystogram were performed, only one treatable abnormality (calyceal dilation) was identified by intravenous pyelogram, and it was not detected by ultrasound. Eleven children showed vesicoureteral reflux on the cystogram. In an additional 43 children in whom intravenous pyelogram was done only if the ultrasound or cystogram were abnormal, there were five abnormal cystograms. Four treatable abnormalities were identified by ultrasound, and three were confirmed by the intravenous pyelogram. Ultrasound should replace the intravenous pyelogram in children with a normal cystogram because of its accuracy, safety, and high patient acceptance. We have also documented a significant volume increase with acute infection in one or both kidney(s) of those children having upper urinary tract infection. Fifteen of 18 children with upper urinary tract infection had volume increases of 30% on more in at least one kidney; whereas only four of 21 children with lower urinary tract infection had increases of greater than 30% (P < .005). Ultrasound volume measurements provide a new, noninvasive method for identifying the probable site of urinary tract infection.


2014 ◽  
Vol 27 (3) ◽  
pp. 364 ◽  
Author(s):  
Ana Bispo ◽  
Milene Fernandes ◽  
Cristina Toscano ◽  
Teresa Marques ◽  
Domingos Machado ◽  
...  

<strong>Introduction:</strong> Urinary tract infection is the most common infectious complication following renal transplantation and its frequency is insufficiently studied in Portugal. The aim of this study was to characterize the incidence of urinary tract infections and recurrent urinary tract infections in renal transplant recipients.<br /><strong>Material and Methods:</strong> This was a retrospective cohort observational study, obtained from clinical files of all patients who received a renal transplant at the Hospital of Santa Cruz, from January 2004 to December 2005, with a mean follow-up period of five years or until date of graft loss, death or loss of follow-up. After a descriptive analysis of the population, we used bivariate tests to identify risk factors for urinary tract infections.<br /><strong>Results:</strong> A total of 127 patients were included, with a 593 patients.year follow-up. We detected 53 patients (41.7%) presenting with at least one episode of urinary tract infection; 21 patients (16.5%) had recurrent urinary tract infection. Female gender was the only risk factor associated with the occurrence of urinary tract infections (p &lt; 0.001, OR = 7.08, RR = 2.95) and recurrent urinary tract infections (p &lt; 0.001, OR = 4.66, RR = 2.83). Escherichia coli (51.6%), Klebsiella pneumoniae (15.5%) and Enterobacter spp (9.9%) were the<br />most frequently identified pathogens. Patients did not reveal an increased mortality or allograft loss. However, urinary tract infections were the most important cause of hospital admissions.<br /><strong>Discussion:</strong> Female gender was the only risk factor for urinary tract infections in this population. Escherichia coli was the most frequent agent isolated.<br /><strong>Conclusion:</strong> Despite preventive measures, urinary tract infections remain an important cause of morbidity and hospital admissions.<br /><strong>Keywords:</strong> Urinary Tract Infections; Postoperative Complications; Risk Factors; Kidney Transplantation; Portugal.


2019 ◽  
Vol 47 ◽  
Author(s):  
Raylson Pereira De Oliveira ◽  
Débora Mirelly Sobral da Silva ◽  
Maria De Nazaré Santos Ferreira ◽  
Camila Maria Coutinho Moura ◽  
Rômulo Francelino Freitas Dias ◽  
...  

Background: Urinary tract infection in dogs is usually associated with the presence of bacteria, with a higher prevalence of Gram-negative bacteria, represented mainly by enteric bacteria such as Escherichia coli and Proteus spp., followed by Gram-positive bacteria such as Staphylococcus spp., and Streptococcus spp. There are scant reports of Salmonella spp. as the causative agent of urinary tract infection in dogs.  Indeed, the literature describes only a few cases, most of which involve the isolation of these bacteria in feces. This paper reports a case of canine cystitis caused by Salmonella enterica subsp. enterica in the northeast region of Brazil.Case: A female dog of the Fila Brasileiro breed, about 9 year-old, wormed but unvaccinated, was evaluated at the Veterinary Hospital of the Federal University of Pernambuco – UFRPE.  The dog showed clinical signs of apathy, cachexia, polyphagia, polyuria and opacity of the crystalline lens. The dog’s owner stated that the animal was fed with commercial dog food. In the clinical exam, the patient presented pale mucosa, cachexia, absence of ectoparasites, and her rectal temperature was 39.5°C. Moreover, cardiorespiratory auscultation of the patient revealed tachycardia (190 bpm) and tachypnea (36 bpm). The owner’s main complaint was the clinical condition of frequent urination (polyuria). A urinalysis and urine culture with antibiogram were requested as complementary exams, after collecting the urine by cystocentesis. The volume obtained in the physical examination of urinalysis was 7 mL of yellow urine with a putrid smell, cloudy appearance and density of 1.024. The chemical examination revealed pH 6.5, protein (+++), bilirubin (+), normal urobilinogen and negative reactions for glycoses, ketone, nitrite and urine occult blood. Bacteriuria and pyuria were detected in a urine sediment test. Urine was cultured on blood agar and Levine agar in a bacteriological incubator at 37°C under aerobiosis, for 24 h. This culture produced an exuberant and pure growth of glossy grey bacterial colonies on blood agar and glossy colonies on Levine agar. The Gram test revealed gram-negative bacilli. The sample was subjected to biochemical tests to identify Gram-negative enterobacteria, whose results provided a presumptive identification of Salmonella species. The microbial species was identified using a VITEK 2 Compact®, and was followed by a serology test for the identification of the serogroup using a polyvalent serum, which enabled the identification of Salmonella enterica subsp. enterica. The antibiogram showed sensitivity to ciprofloxacin, gentamicin and penicillin, and resistance to amoxicillin and ampicillin.Discussion: Clinical signs of cachexia and polyuria may be related to canine urinary tract infection caused by Salmonella enterica subsp. enterica, since these symptoms had already been recorded previously in a case of a bacterial infection by the same serogroup. Isolation of Salmonella spp. in a non-selective medium was determinant in identifying these bacteria. Since these are not commensal bacteria of the canine urinary tract, their isolation in this tract indicates that they are responsible for the infection or disease, although such cases are rare. Another aspect that should be highlighted is the risk of human infection, because of the zoonotic potential of Salmonella spp., which may be transmitted by contact with dog urine. This is the first report of the isolation of Salmonella enterica subsp. enterica in a case of canine cystitis on the northeast region of Brazil, and underscores the importance of complementary diagnostic exams such as urine culture.


2020 ◽  
Vol 9 (8) ◽  
pp. 4292
Author(s):  
Manisha Bisht ◽  
PreetinderSingh Manshahia ◽  
Ankur Mittal ◽  
Mohit Bhatia ◽  
ShailendraS Handu

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