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Acta Paediatrica (Oslo, Norway : 1992) May 2024To assess missed urinary tract infections (UTI) in febrile infants ≤2 months when adhering to recent guidelines suggesting not to send a urine culture with a...
AIM
To assess missed urinary tract infections (UTI) in febrile infants ≤2 months when adhering to recent guidelines suggesting not to send a urine culture with a negative dipstick.
METHODS
A retrospective cohort study of 308 infants ≤2 months with a positive urine culture admitted in 2013-2023, divided into subgroups without exposure to urine dipstick results: 'urosepsis' (UTI with bacteraemia), 'UTI' (positive urine culture, elevated inflammatory markers, no other cause of fever) and 'bacteriuria' (positive urine culture, not meeting the above-mentioned criteria). After retrieving the dipstick results, the 'missed UTI' group (UTI+ negative dipstick) was described.
RESULTS
A negative dipstick was found in 2/20 (10%), 32/127 (25%) and 126/161 (78%) of infants with 'urosepsis', 'UTI' and 'bacteriuria', respectively. In the 'missed UTI' group (n = 34), there were more non-Escherichia coli UTI (68% vs. 9% with positive dipstick, p < 0.001), and lower inflammatory markers (leukocytes 15.5 vs. 17.2 k/μL, p = 0.007, C-reactive protein 21 vs. 58 mg/L, p < 0.001). Three infants had high-grade vesicoureteral reflux (VUR) and renal scarring.
CONCLUSIONS
There is a non-negligible rate of infants ≤2 months with UTI and without pyuria, including those with urosepsis, VUR and renal scarring. We suggest obtaining a urine culture regardless of dipstick results.
PubMed: 38761023
DOI: 10.1111/apa.17278 -
The Journal of Pediatrics May 2024To identify factors associated with overtreatment of presumed urinary tract infection (UTI) among children with spina bifida using such criteria.
OBJECTIVE
To identify factors associated with overtreatment of presumed urinary tract infection (UTI) among children with spina bifida using such criteria.
STUDY DESIGN
A retrospective review of children with spina bifida (age <21 years) evaluated in the Emergency Department (ED) at a single institution was performed. Patients with a urinalysis (UA) performed who were reliant on assisted bladder emptying were included. The primary outcome was overtreatment, defined as receiving antibiotics for presumed UTI but ultimately not meeting spina bifida UTI criteria (≥2 urologic symptoms plus pyuria and urine culture growing >100k CFU/mL). The primary exposure was whether the components of the criteria available at the time of the ED visit (≥2 urologic symptoms plus pyuria) were met when antibiotics were initiated.
RESULTS
Among 236 ED encounters, overtreatment occurred in 80% of cases in which antibiotics were initiated (47% of the entire cohort). Pyuria with <2 urologic symptoms was the most important factor associated with overtreatment (OR 9.6). Non-Hispanic White race was associated with decreased odds of overtreatment (OR 0.3).
CONCLUSIONS
Overtreatment of presumed UTI among patients with spina bifida was common. Pyuria, which is not specific to UTI in this population, was the main driver of overtreatment. Symptoms are a cornerstone of UTI diagnosis among children with spina bifida, should be collected in a standardized manner, and considered in a decision to treat.
PubMed: 38734134
DOI: 10.1016/j.jpeds.2024.114092 -
World Journal of Urology Apr 2024To prospectively evaluate the rate and associated risk factors of early infectious complications after ureterorenoscopy for urolithiasis.
PURPOSE
To prospectively evaluate the rate and associated risk factors of early infectious complications after ureterorenoscopy for urolithiasis.
METHODS
After ethical committee approval, 400 therapeutic retrograde ureterorenoscopy procedures between August 3, 2020 and November 24, 2021 were included for analysis in a single-center study. Postoperative infection was defined as an afebrile urinary tract infection, fever (≥ 38 °C) with pyuria (≥ 300 WBC/μL) or proven urinary pathogen, and urosepsis. The primary outcome was the rate of infectious complications after ureterorenoscopy. Secondary outcomes were the perioperative factors that increased the risk of infectious complications within 30 days of surgery using univariate and multivariate logistic regression analysis.
RESULTS
Twenty-nine of four hundred (7.3%) patients developed an infectious complication within 30 days after ureterorenoscopy. Ten (2.5%) patients developed an afebrile urinary tract infection, eight (2.0%) developed fever with pyuria, five (1.3%) febrile urinary tract infection, and six (1.5%) urosepsis. On univariate analysis, preoperative stent-type JFil pigtail suture stent was significantly associated with the dependent variable (p < 0.001). On multivariate logistic regression analysis, older age (OR 1.035; 95% CI 1.006-1.070; p = 0.02) was found to be significantly associated with developing a postoperative infectious complication.
CONCLUSIONS
A 7.3% rate of postoperative infectious complications and 1.5% urosepsis rate were observed after therapeutic ureterorenoscopy, without the need of intensive care admission. The only significant risk factors were preoperative stent type (JFil pigtail suture stent) on univariate analysis, and older age on multivariate logistic regression analysis. Further multicentric prospective observational data are needed in this field.
Topics: Humans; Male; Female; Prospective Studies; Risk Factors; Ureteroscopy; Middle Aged; Urinary Tract Infections; Adult; Postoperative Complications; Aged; Time Factors; Sepsis; Urolithiasis
PubMed: 38691160
DOI: 10.1007/s00345-024-04983-6 -
Asian Journal of Urology Apr 2024This study aimed to explore the global, prevalence, and risk factors of fever after percutaneous nephrolithotomy (PCNL) by conducting a systematic review and... (Review)
Review
OBJECTIVE
This study aimed to explore the global, prevalence, and risk factors of fever after percutaneous nephrolithotomy (PCNL) by conducting a systematic review and meta-analysis.
METHODS
The high-sensitivity searching was conducted without time limitation until December 30, 2020 in Web of Sciences, Scopus, and PubMed based on inclusion and exclusion criteria.
RESULTS
The prevalence rates of fever and sepsis among patient undergoing PCNL were estimated 9.5% (95% confidence interval [CI]: 9.3%-9.7%), and 4.5% (95% CI: 4.2%-4.8%), respectively. Nephrostomy tube was used in 9.96% (95% CI: 9.94%-9.97%) of patients. The mean preoperative white blood cells of patients were 6.401×10/L; 18.3% and 4.55% of patients were considered as the positive urinary culture and pyuria, respectively. About 20.4% of patients suffered from residual stones. The odds ratios (ORs) of fever in patients who suffering from diabetes mellitus, hydronephrosis, staghorn stones, and blood transfusion were 4.62 (95% CI: 2.95-7.26), 1.04 (95% CI: 0.81-1.34), 2.57 (95% CI: 0.93-7.11), and 2.65 (95% CI: 1.62-4.35), respectively. Patients who underwent PCNL in prone position were more likely to develop fever (OR: 1.23; 95% CI: 0.75-2.00) than patients in supine position.
CONCLUSION
The current study showed that patients who suffer from diabetes mellitus, hydronephrosis, staghorn stones, nephrostomy tube or double-J stent, blood transfusion, and also patients who underwent PCNL in prone position surgery are more likely to develop a postoperative fever after PCNL.
PubMed: 38680584
DOI: 10.1016/j.ajur.2022.04.008 -
Therapeutic Advances in Medical Oncology 2024The introduction of immunotherapy has revolutionized the treatment and improved outcomes of multiple types of cancer. Although breast cancer is a less immune-responsive...
The introduction of immunotherapy has revolutionized the treatment and improved outcomes of multiple types of cancer. Although breast cancer is a less immune-responsive tumor type, the incorporation of pembrolizumab into chemotherapy regimens in the neoadjuvant and first-line metastatic setting for the triple-negative disease has improved outcomes. However, the use of this type of treatment is associated with a spectrum of adverse events. Although rarely affected, kidneys can be a target for immunotherapy, leading to irreversible injury if not recognized and addressed early. A 52-year-old woman presented with clinical stage II right breast cancer diagnosed at an outside facility. Neoadjuvant docetaxel/carboplatin/pembrolizumab every 3 weeks was started. Given the partial response on MRI after the 4th cycle, treatment was switched to doxorubicin/cyclophosphamide. However, pembrolizumab was held in cycle 2 due to the rash and then resumed in cycle 3 after the resolution of symptoms. Elevated creatinine was noted 3 weeks after the last dose of pembrolizumab without improvement despite adequate fluid resuscitation. Diagnostic workup was unremarkable except for pyuria and minimal albuminuria on urinalysis. In the absence of other risk factors and the temporal relationship between pembrolizumab administration and the onset of acute kidney injury (AKI), immune-related nephrotoxicity was the underlying diagnosis. After initiation of corticosteroids, creatinine decreased back to baseline without the need for kidney biopsy. An addendum to the original pathology report from the outside facility surfaced 5 months after starting treatment, revealing that the second breast lesion had a Fluorescence in situ hybridization (FISH) test performed that was positive. Given this fact, therapy was changed to two cycles of neoadjuvant paclitaxel/carboplatin/trastuzumab/pertuzumab, with approximately 8 weeks between the last pembrolizumab dose and the first dose of trastuzumab. Thereafter, she underwent a right breast mastectomy which showed residual invasive carcinoma with negative margins and lymph nodes. She completed 1 year of trastuzumab. Immune-related AKI is a rare, but potentially serious complication associated with an increase in mortality. Further research is needed in the development and early detection. There is promising research in the development of noninvasive biomarkers which has the added benefit of identifying patients who can be re-challenged with immunotherapy.
PubMed: 38680292
DOI: 10.1177/17588359241248362 -
Clinical Infectious Diseases : An... Apr 2024In a multi-hospital cohort study of 3392 patients, positive urinalysis parameters had poor positive predictive value for diagnosing urinary tract infection (UTI)....
In a multi-hospital cohort study of 3392 patients, positive urinalysis parameters had poor positive predictive value for diagnosing urinary tract infection (UTI). Combined urinalysis parameters (pyuria or nitrite) performed better than pyuria alone for ruling out UTI. However, performance of all urinalysis parameters was poor in older women.
PubMed: 38666412
DOI: 10.1093/cid/ciae230 -
Indian Journal of Nephrology 2024
PubMed: 38645903
DOI: 10.4103/ijn.ijn_398_22 -
Journal of Endourology Jun 2024To prospectively assess early post-transurethral prostate surgery (TUPS) urinalysis changes and bacteriuria with its clinical relevance. Patients with benign prostate... (Clinical Trial)
Clinical Trial
To prospectively assess early post-transurethral prostate surgery (TUPS) urinalysis changes and bacteriuria with its clinical relevance. Patients with benign prostate obstruction enrolled for TUPS were prospectively assessed. Patients were assessed at 2, 4, 8, 12, and 24 weeks postoperatively by the dysuria-visual-analogue-scale (DVAS), international prostate symptom scores (IPSS)-quality of life, uroflow, and postvoid residual. Routine urinalysis was performed before discharge and at all visits. Midstream urine culture (MSUC) was performed before discharge, and 4 and 12 weeks postoperatively. At final analysis, 152 patients were evaluable. Significant pyuria was reported in 52%, 96.1%, 94.1%, 71.7%, 78.9%, and 52.5% in, before discharge, 2-, 4-, 8-, 12-, and 24-week urinalysis postoperative, respectively. The mean time to nonsignificant pyuria (95% confidence interval [CI]) was 19.1 (17.5-20.7), 20.1 (17.3-22.9), 15.8 (12.8-18.8), and 14 (10.3-17.8) weeks after prostate resection, vaporization, enucleation, and incision, respectively ( = 0.03). Regardless the TUPS technique, half of patients had significant pyuria at 24 weeks postoperative. MSUC was positive in 37/152 (24.3%), 3/152 (2%), 23/152 (15.1%), and 5/152 (3.3%) preoperatively, before discharge, and 4 and 12 weeks postoperative, respectively. Only positive preoperative urine leukocyte esterase independently predicted positive 4-week MSUC (odds ratio 3.8, 95% CI 1.3-11.1, = 0.013). No significant correlation was found between IPSS or DVAS and positive MSUC, nor between IPSS and postoperative pyuria at different follow-up points ( > 0.05). However, the degree of postoperative dysuria was significantly correlated with postoperative pyuria count by urinalysis at 2 weeks ( = 0.69, = 0.03), 8 weeks ( = 0.26, = 0.001), and 12 weeks ( = 0.23, = 0.004). There is a persistent but gradually declining pyuria and microhematuria following TUPS up to 6 months postoperative. An earlier resolution was noted following prostate incision and enucleation. While routine urine analysis screening in these months would be of no clear clinical value, a routine urine culture would be of a reasonable significance at 1 month postoperatively.
Topics: Humans; Male; Pyuria; Aged; Transurethral Resection of Prostate; Middle Aged; Postoperative Complications; Urinalysis
PubMed: 38613814
DOI: 10.1089/end.2023.0667 -
Cureus Mar 2024() infection, primarily observed in elderly patients, is a rare yet emerging occurrence in the pediatric population. Advances in laboratory techniques have facilitated...
() infection, primarily observed in elderly patients, is a rare yet emerging occurrence in the pediatric population. Advances in laboratory techniques have facilitated the increased identification of these bacteria in human infections. There have been only a few recent cases reported among children. The scarcity of literature on the clinical presentation and management of such infections in children presents a challenge for pediatricians. Here, we present the case of a 15-month-old male child with Down syndrome who presented with malodorous urine but lacked other typical symptoms of urinary tract infection. Upon investigation, urine analysis revealed pyuria, and urine culture confirmed infection. The patient also exhibited underlying bilateral mild to moderate hydronephrosis. Successful treatment was achieved with a three-day course of amoxicillin, leading to symptom resolution. This case underscores the significance of promptly identifying infection in pediatric patients presenting with malodorous urine, as a timely intervention with a short course of treatment may avert more severe and invasive infections.
PubMed: 38586679
DOI: 10.7759/cureus.55635 -
Cureus Mar 2024A 53-year-old man with diabetes mellitus presented to the emergency department with a fever and impaired mobility. A preliminary diagnosis of urinary tract infection was...
A 53-year-old man with diabetes mellitus presented to the emergency department with a fever and impaired mobility. A preliminary diagnosis of urinary tract infection was made based on dysuria and pyuria. History-taking revealed a history of gait disturbance and difficult urination. A thorough physical examination suggested a spinal abnormality. MRI scan revealed a narrow spinal canal due to ossification of the posterior longitudinal ligament and diffuse idiopathic skeletal hyperostosis. Throughout the diagnostic process, we employed both vertical tracing to investigate the causes of urinary tract infection and horizontal tracing to explore comorbidities such as diabetes. Additionally, we introduced appropriate social security and support systems under the name of diagnostic excellence.
PubMed: 38571861
DOI: 10.7759/cureus.55475