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International Urology and Nephrology Mar 2024Asymptomatic pyuria and bacteriuria are more prevalent in diabetic patients and may be associated with urinary tract infection (UTI). The aim of this study is to...
PURPOSE
Asymptomatic pyuria and bacteriuria are more prevalent in diabetic patients and may be associated with urinary tract infection (UTI). The aim of this study is to investigate the association between asymptomatic pyuria/bacteriuria at the initiation of SGLT2 inhibitor and UTI risk in female patients with type 2 diabetes.
METHODS
The study was designed as a practical, single-center, prospective, cohort study. The female outpatients with type 2 diabetes initiated SGLT2 inhibitor were included. Patients who were symptomatic or treated in the past 3 months for urinary or genital tract infection, had a high risk for UTI were excluded. Hospitalization/antibiotic use for indications other than UTI were exclusion criteria during follow-up. All patients were followed up for 3 months. Pyuria and bacteriuria were exposure and, UTI was the outcome. Cumulative incidence and relative risk of UTI were analyzed for pyuria and bacteriuria.
RESULTS
143 female patients were included among 1132 female type 2 diabetic patients. 13 patients were excluded during follow-up. 41.5% of the patients (n = 54) had pyuria and 28.5% (n = 37) had bacteriuria. The cumulative incidence of UTI was 20% in the whole cohort, 25,9% (n = 14/54) in the pyuria group and 18.9% (n = 7/37) in the bacteriuria group. The relative risk of UTI was 1.64 (95% CI: 0.82-3.26, p = 0.15) for pyuria, 0.92 (95% CI: 0.42-2.01, p = 0.84) for bacteriuria, and 1.2 (95% CI: 0.47-3.08, p = 0.69) for pyuria plus bacteriuria. Adjusted odd ratios revealed similar results.
CONCLUSIONS
Asymptomatic pyuria/bacteriuria at the initiation of SGLT2 inhibitors are not risk factors for UTI in women with type 2 diabetes.
Topics: Female; Humans; Bacteriuria; Cohort Studies; Diabetes Mellitus, Type 2; Prospective Studies; Pyuria; Sodium-Glucose Transporter 2 Inhibitors; Urinary Tract Infections; Asymptomatic Infections
PubMed: 37715859
DOI: 10.1007/s11255-023-03798-5 -
International Journal of Colorectal... Sep 2023Acute appendicitis is a common cause of acute abdomen in general surgery and early diagnosis is crucial for prognosis. Abnormal urinalysis results have been associated...
AIMS
Acute appendicitis is a common cause of acute abdomen in general surgery and early diagnosis is crucial for prognosis. Abnormal urinalysis results have been associated with appendicitis in some studies, with reports of microscopic hematuria or pyuria in laboratory tests. The aim of this article is to evaluate the relationship between laboratory findings of hematuria, pyuria, and the location of acute appendicitis.
METHODS
This retrospective study included 577 patients who underwent appendectomy for suspected acute appendicitis between January 1, 2018, and December 31, 2022, at the general surgery clinic of Samsun Training and Research Hospital.
RESULTS
Among the 577 patients, 247 were female and 330 were male, with a median age of 34 years. A statistically significant difference was observed between appendicitis location and erythrocyte values (p = 0.009), specifically in paraileal and retrocecal locations. There was a statistically significant difference between appendicitis location and leukocyte values (p < 0.001), with significant differences found in paraileal, promontoric, and retrocecal locations. A statistically significant difference was observed between appendicitis location and leukocyte esterase values (p = 0.002), specifically in paraileal and retrocecal locations.
DISCUSSION/CONCLUSION
Abnormal urinalysis findings are not uncommon in patients with acute appendicitis. Our study demonstrated a significant correlation between tit erythrocyte, tit leukocyte, and tit leukocyte esterase positivity with appendicitis locations. Therefore, we believe that pathological findings in urine tests of patients undergoing surgery with a preliminary diagnosis of appendicitis can provide valuable information to surgeons regarding the location of the appendix, ultimately aiding in optimizing the timing and cost of the operation.
Topics: Humans; Female; Male; Adult; Appendicitis; Pyuria; Hematuria; Retrospective Studies; Urinalysis
PubMed: 37713118
DOI: 10.1007/s00384-023-04527-1 -
Current Urology Jun 2023This study aimed to describe patterns of presentation, etiology, risk factors, management, and treatment outcomes of periurethral abscesses using a systematic review...
OBJECTIVES
This study aimed to describe patterns of presentation, etiology, risk factors, management, and treatment outcomes of periurethral abscesses using a systematic review framework.
MATERIALS AND METHODS
After prospective registration on the PROSPERO database (CRD42020193063), a systematic review of Web of Science, Embase, PubMed, and Cochrane scientific databases was performed. Articles published between 1900 and 2021 were considered. Extracted data included symptoms, etiology, medical history, investigations, treatment, and outcomes. Collated data were analyzed using univariate methods.
RESULTS
Sixty articles met the inclusion criteria reporting on 270 patients (211 male, 59 female) with periurethral abscess. The most common clinical features were pain (41.5%), pyuria (41.5%), dysuria (38.5%), urinary frequency (32.3%), fever (25%), and a palpable mass (23%). Predisposing risk factors included the presence of a sexually transmitted infection or urinary tract infection (55.0%), urethral strictures (39.6%), and recent urethral instrumentation (18.7%). Management approaches included open incision and drainage (64.3%), conservative management with antibiotics (29.8%), and minimally invasive techniques (needle aspiration, endoscopic drainage). Time trend analysis of etiology revealed a decreased incidence of infection (sexually transmitted infection/urinary tract infection, human immunodeficiency virus) and higher incidence of diabetes mellitus and periurethral bulking injections in recent years.
CONCLUSIONS
Periurethral abscesses may display a wide range of clinical features. Presentation, risk factors and underlying etiology vary with sex. The optimal management technique is guided by abscess size. Open incision and drainage combined with antibiotics continues to be the mainstay of management. However, minimally invasive techniques are gaining favor. To the authors' knowledge, this is the first systematic appraisal and management algorithm for periurethral abscess.
PubMed: 37691985
DOI: 10.1097/CU9.0000000000000159 -
Hospital Pediatrics Oct 2023Characterizing inflammatory syndromes during the coronavirus disease 2019 pandemic was complicated by recognition of multisystem inflammatory syndrome in children...
OBJECTIVES
Characterizing inflammatory syndromes during the coronavirus disease 2019 pandemic was complicated by recognition of multisystem inflammatory syndrome in children (MIS-C), contemporaneous with episodes of Kawasaki disease. We hypothesized a substantial overlap between the 2 and assessed the performance of an MIS-C likelihood score in differentiating inpatients with nonsevere MIS-C from prepandemic incomplete Kawasaki disease (iKD) without coronary involvement.
METHODS
A retrospective review of inpatient records was conducted; the nonsevere MIS-C cohort (March 2020-February 2021) met the 2023 definition for MIS-C; the iKD cohort (January 2018-January 2019) met the American Heart Association criteria for iKD without coronary involvement. We applied the likelihood score to both cohorts. We estimated the percent of children with iKD who could have met the clinical criteria of the MIS-C, had they presented in 2023.
RESULTS
The 68 children in the nonsevere MIS-C cohort were older (8 vs 4 years, P < .001) than the 28 children in the iKD cohort. Those in the nonsevere MIS-C cohort had higher rates of thrombocytopenia (P < .001) and lymphopenia (P = .021); those in the iKD cohort had higher rates of pyuria (P < .001). Twenty-four (86%) children in the iKD cohort met the 2023 MIS-C definition. The scoring system correctly predicted 71% to 74% children with their respective clinical diagnoses.
CONCLUSIONS
Though there was considerable clinical overlap, thrombocytopenia, lymphopenia, and the absence of pyuria were the most helpful parameters to distinguish children with nonsevere MIS-C from those with iKD.
PubMed: 37681271
DOI: 10.1542/hpeds.2022-007107 -
The Journal of Small Animal Practice Dec 2023To assess relationships between urine sediment and microbial culture findings and the presence of proteinuria in canine urine samples, and to assess the change in the...
OBJECTIVES
To assess relationships between urine sediment and microbial culture findings and the presence of proteinuria in canine urine samples, and to assess the change in the percentage of proteinuric samples and urine protein-to-creatinine ratio when urine abnormalities resolve.
MATERIALS AND METHODS
Canine urine samples collected via cystocentesis and submitted for culture and contemporaneous urinalysis (including urine protein-to-creatinine ratio) were retrospectively identified. Dogs receiving corticosteroids were excluded. Associations between haematuria (red blood cells>5/high-power field), pyuria (white blood cells>5/high-power field), presence of microorganisms on microscopy, active sediment, and positive culture and proteinuria (urine protein-to-creatinine ratio>0.5) were investigated. Patient characteristics were considered possible confounders. In dogs with repeat urinalysis, the associations between active sediment and positive culture resolution on proteinuria and urine protein-to-creatinine ratio were assessed.
RESULTS
One hundred and ninety-two of 491 samples were proteinuric (39.1%). Age was positively associated with proteinuria. In the multivariable analysis corrected for age, active sediment was the only variable significantly associated with proteinuria (adjusted odds ratio: 2.12; 95% confidence interval: 1.44 to 3.11); however, only 49.8% of samples with active sediment were proteinuric. Neither resolution of active sediment nor positive culture were associated with reduced proportions of proteinuric samples (from 57.9% to 42.1% and from 40.0% to 25.0%, respectively) or significant reductions in urine protein-to-creatinine ratio (median change: -0.16 and -0.14, respectively).
CLINICAL SIGNIFICANCE
Attributing proteinuria to urinalysis abnormalities or a positive urine culture in canine cystocentesis samples is not supported by our findings, and could result in alternative causes of proteinuria (e.g. renal proteinuria) being overlooked.
Topics: Humans; Dogs; Animals; Creatinine; Retrospective Studies; Dog Diseases; Urinalysis; Proteinuria
PubMed: 37632274
DOI: 10.1111/jsap.13669 -
Journal of Infection and Chemotherapy :... Dec 2023Retrograde pyelography (RP) is performed for examination of upper urinary tract cancers and hydronephrosis. Although urinary tract infections (UTI) are known to be...
INTRODUCTION
Retrograde pyelography (RP) is performed for examination of upper urinary tract cancers and hydronephrosis. Although urinary tract infections (UTI) are known to be complicated by the examination, there are few reports on the frequency of occurrence and prophylactic antibiotics.
METHODS
The incidence of UTI and febrile UTI (f-UTI) and patient background information were compared in 388 patients who underwent RP at our hospital from January 2018 to December 2022. We also examined the administration of pre-RP antibiotics.
RESULTS
Of the 388 patients who underwent RP, 27 (6.9%) had UTI and 17 (4.4%) had f-UTI. Of the 27 UTI cases, 25 (92.6%) were pyelonephritis; 20 (74.0%) were hospitalized and 2 (7.4%) presented with septic shock and were managed in the intensive care unit. When comparing the background of patients with UTI, no significant differences were found in the present study, but when limited to the 17 cases of f-UTI, the presence of hydronephrosis before RP and not prescribing antibiotics before RP were associated with significantly higher incidence of f-UTI (p = 0.019, p = 0.036, respectively). Especially for patients without pyuria and bacteriuria before RP, prescribing antibiotics before RP resulted in 0 cases of f-UTI (p = 0.020).
CONCLUSION
This retrospective study showed that the presence of hydronephrosis before RP and not prescribing prophylactic antibiotics before RP are risk factors for f-UTI.
PubMed: 37611743
DOI: 10.1016/j.jiac.2023.08.011 -
Ghana Medical Journal Jan 2023This study compared the infection rates, degree of encrustation, symptoms, and complications in patients regarding the duration of urethral catheterisation (three weeks,...
OBJECTIVES
This study compared the infection rates, degree of encrustation, symptoms, and complications in patients regarding the duration of urethral catheterisation (three weeks, six weeks, and eight weeks).
DESIGN
A cross-sectional study with stratified simple random sampling.
SETTING
Urology Unit, Korle Bu Teaching Hospital.
PARTICIPANTS
One hundred and thirty-seven male patients with long-term urinary catheters.
INTERVENTIONS
Participants were grouped into 3 weeks, 6 weeks, and 8 weeks duration of catheter replacements.
PRIMARY OUTCOMES MEASURES
Symptoms due to the urinary catheters, urinalysis, urine and catheter tip cultures, sensitivity, and catheter encrustations were assessed.
RESULTS
Eighty-six patients had a primary diagnosis of benign prostatic hyperplasia (BPH), 35 had urethral strictures,13 had prostate cancer, two had BPH and urethral strictures, and one participant had bladder cancer. There was no difference in the symptoms the participants in the different groups experienced due to the urinary catheters (p > 0.05). The frequency of occurrence of complications (pyuria, p = 0.784; blocked catheter, p=0.097; urethral bleeding, p=0.148; epididymo-orchitis, p=0.769 and bladder spasms, p=1.000) showed no differences in the three groups. There was no statistical difference in the urinalysis for the three groups (p>0.05) and the degree of encrustations (3 weeks: 0.03 ± 0.06, 6 weeks: 0.11±0.27 and eight weeks: 0.12 ±0.27) with p=0.065.
CONCLUSIONS
In this study, the duration of urinary catheterisation using silicone Foley's catheters did not influence the complication and symptom rates; hence silicon catheters can be placed in situ for up to 8 weeks before replacement instead of the traditional three-weekly change.
FUNDING
Enterprise Computing Limited.
Topics: Humans; Male; Catheters, Indwelling; Urinary Tract Infections; Silicon; Urethral Stricture; Cross-Sectional Studies; Prostatic Hyperplasia
PubMed: 37576373
DOI: 10.4314/gmj.v57i1.10 -
Archives of Disease in Childhood Dec 2023To evaluate the need for routine urine studies in children with febrile neutropenia with cancer. (Observational Study)
Observational Study
OBJECTIVE
To evaluate the need for routine urine studies in children with febrile neutropenia with cancer.
DESIGN
A prospective, observational study was conducted in two hospitals between November 2019 and October 2021.
PATIENTS
We recruited 205 patients in total.
MAIN OUTCOME MEASURES
The primary outcome was presence of positive urine culture (UC). Urinary tract infection (UTI) was defined as urinary signs/symptoms and positive UC with or without pyuria. A descriptive analysis of data is provided.We conducted a prospective study of paediatric patients with cancer with urinary continence. Data were analysed using descriptive statistics. The diagnostic performance of urinalysis was calculated using positive UC as the gold standard.
RESULTS
Positive UC was found in 7 of the 205 patients (3.4%; 95% CI 1.4% to 6.9%), 2 presenting urinary symptoms. UTI prevalence was 1.0% (95% CI 0.1% to 3.5%). A 23.8% prevalence of positive UC was found in patients with urinary symptoms and/or history of urinary tract disease (95% CI 8.2% to 47.2%) as compared with 1.1% of those without symptoms or history (95% CI 0.1% to 3.9%) (p<0.001). The sensitivity, specificity, negative predictive value, and area under the curve for urinalysis were 16.7% (95% CI 3.0% to 56.4%), 98.4% (95% CI 95.3% to 99.4%), 97.3% (95% CI 93.9% to 98.9%), and 0.65 (95% CI 0.51 to 0.79), respectively.
CONCLUSIONS
UTI is an infrequent cause of infection in these patients. Urinalysis is indicated only in children with febrile neutropenia with urinary signs/symptoms and in asymptomatic patients with a history of urinary tract disease or unknown history. When urine is collected, UC should be requested regardless of the result of the urinalysis.
Topics: Humans; Child; Prospective Studies; Sensitivity and Specificity; Urinalysis; Urinary Tract Infections; Fever; Neoplasms; Febrile Neutropenia
PubMed: 37553208
DOI: 10.1136/archdischild-2023-325992 -
Antimicrobial Stewardship & Healthcare... 2023The optimal management of bacteriuria/pyuria of clinically undetermined significance (BPCUS) is unknown. Among 220 emergency department patients prescribed antibiotics...
The optimal management of bacteriuria/pyuria of clinically undetermined significance (BPCUS) is unknown. Among 220 emergency department patients prescribed antibiotics for BPCUS, we found frequent readmissions, which were mitigated by outpatient follow-up visits. Observation and follow-up for an unknown diagnosis should be emphasized over antibiotics due to high likelihood of readmissions.
PubMed: 37502236
DOI: 10.1017/ash.2023.204 -
The American Journal of Emergency... Oct 2023Renal infarction (RI) is rare but clinically important because the appropriate treatment depends on the time of diagnosis. RI is often misdiagnosed as acute...
INTRODUCTION
Renal infarction (RI) is rare but clinically important because the appropriate treatment depends on the time of diagnosis. RI is often misdiagnosed as acute pyelonephritis (APN) because both diseases have nonspecific symptoms such as flank pain and abdominal pain. We identified predictors for distinguishing RI from APN.
METHODS
The data of patients visited the emergency department and diagnosed with RI or APN from March 2016 to May 2020 were prospectively collected and retrospectively analyzed. Patients aged under 18 years, with a history of trauma, or incomplete medical records were excluded. Using a matching ratio of 1:5, RI patients were randomly matched to APN patients. Multivariable logistic regression analysis was performed to identify factors that could distinguish RI from APN. In addition, we constructed a decision tree to identify patterns of risk factors and develop prediction algorithms.
RESULTS
The RI and APN groups included 55 and 275 patients, respectively. Multivariable logistic regression analysis showed that male sex (OR, 6.161; p = 0.009), atrial fibrillation (AF) (OR, 14.303; p = 0.021), costovertebral angle tenderness (CVAT) (OR, 0.106; p < 0.001), aspartate transaminase (AST) level > 21.50 U/L (OR, 19.820; p < 0.001), C-reactive protein (CRP) level < 19.75 mg/L (OR, 10.167; p < 0.001), and pyuria (OR, 0.037; p < 0.001) were significantly associated with RI distinguishing from APN.
CONCLUSION
Male sex, AF, no CVAT, AST level > 21.50 U/L, CRP level < 19.75 mg/L, and no pyuria were significant factors that could distinguish RI from APN.
Topics: Humans; Adolescent; Aged; Retrospective Studies; Case-Control Studies; Pyelonephritis; Kidney Diseases; Ureteral Diseases; Flank Pain; Abdominal Injuries; Acute Disease
PubMed: 37499555
DOI: 10.1016/j.ajem.2023.07.036