Features of the vaginal microbiota in recurrent urinary tract infections in childhood

BACKGROUND. Currently, there is a stable deterioration in the somatic health of preschool-age girls, which creates a real threat to the realization of reproductive function in the future. The state of vaginal microbiocenosis in preschool girls suffering from recurrent urinary tract infections (UTIs) remains a little-studied problem.THE AIM: to assess the state of the vaginal biotope in preschool girls suffering from recurrent UTIs.PATIENTS AND METHODS. 92 girls aged 3-6 years were examined, of which: group 1 (n=32) - patients with recurrent UTI; group 2 (n=30) - patients with rare UTI; group 3 (n=30) - girls of 1,2 health groups. Vaginal microbiocenosis was assessed by quantitative PCR using the «Femoflor-17 test system». Statistical analysis was performed using the application program "Statistica 6.0 for Windows".RESULTS. Facultative anaerobes predominate in the vaginal microbiocenosis of patients with UTI, the absolute content of which is significantly higher in patients with the recurrent course (p <0.05). The relative number of facultative anaerobes is significantly higher in patients with rare UTIs (p<0.05). In patients with recurrent UTI, the absolute and relative content of obligate anaerobes is lower than in patients with rare UTI and girls from the control group. The index of total bacterial mass in patients with UTI, compared with girls of the control group, is significantly higher (p<0.05). In patients with UTI, an increase in the colonies of the Enterobacteriacea family and a decrease in obligate anaerobes were determined in comparison with similar indicators of girls in the control group.CONCLUSION. The presence of recurrent UTI in preschool girls is a risk factor for the development of the severe vaginal dysbiotic condition. Rare UTIs can also be a risk of developing vaginal dysbiosis. Real-time multi-dimensional PCR provides quantitative and qualitative characteristics of the conditionally pathogenic flora of the vaginal biotope.

The darkest place is under the candlestick - healthy urogenital tract as a source of UTI-related Escherichia coli lineages

Since the discovery of the urinary microbiome, including identification of Escherichia coli in healthy host, its involvement in UTI development is a subject of high interest. We explored population diversity and antimicrobial resistance of E. coli from urogenital microbiome of asymptomatic and recurrent UTI (rUTI) women. We also evaluated the genomic relationship between extraintestinal pathogenic E. coli (ExPEC) strains from healthy and diseased host, particularly of the ST131 lineage. E. coli was highly prevalent in asymptomatic women (48%) with slightly higher prevalence in vaginal samples comparing to urine, and occasionally with multiclonal population in the same individual. B2 was the most frequent phylogenetic group, with most strains classified as ExPEC. We demonstrated that virulence associated genes profile does not allow to distinguish strains isolated from healthy and rUTI host. We identified E. coli widespread lineages e.g., sequence types (ST) 127, ST131 (asymptomatic cohort) and ST73, ST131 (rUTI), frequently resistant to at least one antibiotic. Phylogenomics of ST131 and other ExPEC lineages revealed close relatedness between healthy and diseased host. These findings demonstrate that healthy urogenital microbiome is a source of potentially pathogenic and antibiotic resistant E. coli strains, including globally spread E. coli lineages causing UTI including ST131.

A study to determine risk factors for renal scarring as detected by dimercaptosuccinic acid scan in children with urinary tract infection

Background: The aim of the study was to determine the risk factors for renal scarring detected by DMSA (dimercaptosuccinic acid) scan in children with culture-proven urinary tract infection (UTI).Methods: A hospital based observational case-control study was conducted from 2018 June to 2020 June in children aged between 1 month to 5 years who underwent a DMSA scan following culture-proven UTI (N=72). Of the children fulfilling the criteria, 43 had renal scarring in the DMSA scan as a case group and the remaining 29 children who had no renal scarring were taken as a control group.Results: Of the total 72 cases with culture-positive UTI, 59% of patients had renal scarring and the rest and 40% were scar negative. There was no significant difference in the renal scarring observed with respect to age in the two groups. There was significant (p<0.05) the association noted between renal scarring and VUR (vesicoureteric reflux). A significant difference was observed in the renal scarring between the two groups regarding the presence of recurrent UTI (p=0.000). Although most cases (97.7%) had a fever in the DMSA positive group, this was not a significant risk factor for scarring (p>0.05). In DMSA positive group, circumcision was not a significant risk factor for scarring.Conclusions: VUR and recurrent UTI were significant risk factors for renal scarring in children with culture-proven UTI as detected by DMSA scan. The other risk factors like age, sex, fever, leucocytosis and circumcision were not found to be significant.

Pycnogenol® Supplementation Prevents Recurrent Urinary Tract Infections/Inflammation and Interstitial Cystitis

This open pilot registry study aimed to evaluate and compare the prophylactic effects of Pycnogenol® or cranberry extract in subjects with previous, recurrent urinary tract infections (UTI) or interstitial cystitis (IC). Methods. Inclusion criteria were recurrent UTI or IC. One subject group was supplemented with 150 mg/day Pycnogenol®, another with 400 mg/day cranberry extract, and a group served as a control in a 2-month open follow-up. Results. 64 subjects with recurrent UTI/IC completed the study. The 3 groups of subjects were comparable at baseline. All subjects had significant symptoms (minor pain, stranguria, repeated need for urination, and lower, anterior abdominal pain) at inclusion. In the course of the study, the subjects reported no tolerability problems or side effects. The incidence of UTI symptoms, in comparison with the period before inclusion in the standard management (SM) group, decreased significantly; there was a more pronounced decrease in the rate of recurrent infections in the Pycnogenol® group ( p < 0.05 ). The improvement in patients supplemented with Pycnogenol® was significantly superior to the effects of cranberry. At the end of the study, all subjects in the Pycnogenol® group were infection-free ( p < 0.05 vs. cranberry). Significantly, more subjects were completely symptom-free after 2 months of management with Pycnogenol® (20/22) than with SM (18/22) and cranberry (16/20). Conclusions. This pilot registry suggests that 60 days of Pycnogenol® supplementation possibly decrease the occurrence of UTIs and IC without side effects and with an efficacy superior to cranberry.

Not the Postmenopausal Syndromes, Urinary Complaints are the Most Common Presentation of the Post-Menopausal Women

Postmenopausal estrogen deprived state causes various types of vasomotor symptoms, urogenital symptoms, and long-term health hazards. Among the postmenopausal women, this study was aimed to determine the prevalence of urogenital complaints, epidemiological studies relating with recurrent UTI, and to observe the changing pattern of bacterial resistance to commonly used antibiotics for UTI. This cross-sectional study was conducted in Faridpur, Bangladesh, from January-December 2019. Total 244 postmenopausal women attending the clinic with various complaints were selected as the study population. In-depth history, clinical examination, and relevant investigations were done. Urinary culture and sensitivity were done to isolate the causative organism and to identify the current antibiotic resistance and sensitivity pattern. Among the study population, 94.7% had urinary complaints as their first concern. However, upon query, 85.2% of them revealed that they had other postmenopausal syndromes. Among the study population, 43.4% had recurrent UTI. Burning micturition was the most common (79.2%) urinary complaint. On urinary culture, 57.5% cases had no growth; among the rest, the most common organism was E. coli (19.8%) followed by Proteus (12.3%) and Klebsiella (10.4%). In Proteus and Klebsiella isolates, a high number of resistances for Nitrofurantoin have been found (75% and 66.7% accordingly). Urinary complaints are the most common presentation of postmenopausal women attending the gynecology clinic. They are seeking treatment not to improve the quality of life with hormone replacement therapy (HRT), but getting rid of the pain of recurrent UTI. Faridpur Med. Coll. J. 2020;15(2): 85-91

Recurrent UTI in Ventriculoperitoneal Shunted Children's

Objective: To determine the rate and the type of recurrent UTI in ventriculoperitoneal shunted children's admitted to Azady Teaching Hospital, Kirkuk.. Methods: From mid 2015 to end of 2020; UTI in ventriculoperitoneal shunted children's . Once infection was suspected , CSF (from shunt reservoir or from ventricular tapping), blood, and urine samples, analysis, and culture taken and empirical antibiotics were recommended. Results: 25.9% of patients with VP shunts had infections which represents 29.3% of the procedures. 40% of infected patients had recurrent episodes. 59.1% of infections occurred throughout the first two months following insertion. Single pathogen was isolated in each episode. E.coli represented 50% of isolated pathogens compared with 18.2% with Staphylococcus epidermidis. Conclusions: There is a high incidence of recurrent UTI in ventriculoperitoneal shunted children's in Azady Teaching Hospital, Kirkuk. when compared withother international centres. Gram negative organisms are the most common cause of the infection. Keywords: Urinary tract infection= UTI ,Renal scar.,BBD = Bladder Bowel Dysfunction; DMSA = dimercaptosuccinic acid; IV

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.

Urethral duplication in a 1 year old: a rare case report

An 8-month-old male child presented with the complaint of two separate urinary streams from the penis. The child had no complaints of incontinence or recurrent UTI (urinary tract infection). Initial diagnosis of urethrocutaneous fistula was made and proceeded to micturating cystourethrography (MCU) and found to be having a urethral duplication. The duplicated urethra was excised and accessory urethra closed. Postoperatively, the child was followed up for 1 year and had no complaints of recurrence or incontinence. Through this case report, we learn about different classification systems and types of urethral duplication and their associated anomalies, and mode of management, which is mainly surgical. Further, management should be individualised to each patient based on their complaints and intraoperative findings.