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Trends in Molecular Medicine Nov 2016The clinical syndromes comprising urinary tract infection (UTI) continue to exert significant impact on millions of patients worldwide, most of whom are otherwise... (Review)
Review
The clinical syndromes comprising urinary tract infection (UTI) continue to exert significant impact on millions of patients worldwide, most of whom are otherwise healthy women. Antibiotic therapy for acute cystitis does not prevent recurrences, which plague up to one fourth of women after an initial UTI. Rising antimicrobial resistance among uropathogenic bacteria further complicates therapeutic decisions, necessitating new approaches based on fundamental biological investigation. In this review, we highlight contemporary advances in the field of UTI pathogenesis and how these might inform both our clinical perspective and future scientific priorities.
Topics: Acute Disease; Animals; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Cystitis; Female; Humans; Male; Recurrence; Secondary Prevention; Urinary Tract; Urinary Tract Infections
PubMed: 27692880
DOI: 10.1016/j.molmed.2016.09.003 -
Journal of Feline Medicine and Surgery Nov 2019Urinary tract infection (UTI) is an important cause of feline lower urinary tract disease (FLUTD), particularly in female cats older than 10 years of age. In addition to... (Review)
Review
PRACTICAL RELEVANCE
Urinary tract infection (UTI) is an important cause of feline lower urinary tract disease (FLUTD), particularly in female cats older than 10 years of age. In addition to cats with typical clinical signs of FLUTD or upper UTI, many cats have subclinical bacteriuria, but the clinical relevance of this is currently uncertain. UTIs are one of the most important indications for antimicrobial use in veterinary medicine and contribute to the development of antimicrobial resistance. Adherence to treatment guidelines and confinement to a few first-line antimicrobial agents is imperative to avoid further deterioration of the antimicrobial resistance situation. The decision to treat with antimicrobials should be based on the presence of clinical signs, and/or concurrent diseases, and the results of urine culture and susceptibility testing.
CLINICAL CHALLENGES
Distinguishing between cats with bacterial cystitis, and those with idiopathic cystitis and concurrent clinical or subclinical bacteriuria, is challenging, as clinical signs and urinalysis results may be identical. Optimal treatment of subclinical bacteriuria requires clarification as there is currently no evidence that demonstrates a beneficial effect of routine treatment. Management of recurrent UTIs remains a challenge as evidence for most alternatives used for prevention in cats is mainly anecdotal, and no preventive treatment modality is currently recommended.
EVIDENCE BASE
This review draws on an extensive literature base in veterinary and human medicine, including the recently updated guidelines of the International Society for Companion Animal Infectious Diseases for the diagnosis and management of bacterial urinary tract infections in dogs and cats. Where published evidence is lacking, the authors describe their own approach; notably, for the bacteriuric cat with chronic kidney disease.
Topics: Animals; Asymptomatic Infections; Bacteriuria; Cat Diseases; Cats; Female; Humans; Male; Urinary Tract Infections
PubMed: 31601143
DOI: 10.1177/1098612X19880435 -
Jornal de Pediatria 2020This review aimed to provide a critical overview on the pathogenesis, clinical findings, diagnosis, imaging investigation, treatment, chemoprophylaxis, and complications... (Review)
Review
OBJECTIVE
This review aimed to provide a critical overview on the pathogenesis, clinical findings, diagnosis, imaging investigation, treatment, chemoprophylaxis, and complications of urinary tract infection in pediatric patients.
SOURCE OF DATA
Data were obtained independently by two authors, who carried out a comprehensive and non-systematic search in public databases.
SUMMARY OF FINDINGS
Urinary tract infection is the most common bacterial infection in children. Urinary tract infection in pediatric patients can be the early clinical manifestation of congenital anomalies of the kidney and urinary tract (CAKUT) or be related to bladder dysfunctions. E. coli is responsible for 80-90% of community-acquired acute pyelonephritis episodes, especially in children. Bacterial virulence factors and the innate host immune systems may contribute to the occurrence and severity of urinary tract infection. The clinical presentation of urinary tract infections in children is highly heterogeneous, with symptoms that can be quite obscure. Urine culture is still the gold standard for diagnosing urinary tract infection and methods of urine collection in individual centers should be determined based on the accuracy of voided specimens. The debate on the ideal imaging protocol is still ongoing and there is tendency of less use of prophylaxis. Alternative measures and management of risk factors for recurrent urinary tract infection should be emphasized. However, in selected patients, prophylaxis can protect from recurrent urinary tract infection and long-term consequences. According to population-based studies, hypertension and chronic kidney disease are rarely associated with urinary tract infection.
CONCLUSION
Many aspects regarding urinary tract infection in children are still matters of debate, especially imaging investigation and indication of antibiotic prophylaxis. Further longitudinal studies are needed to establish tailored approach of urinary tract infection in childhood.
Topics: Child; Escherichia coli; Humans; Kidney; Pediatrics; Urinary Tract; Urinary Tract Infections; Urine Specimen Collection
PubMed: 31783012
DOI: 10.1016/j.jped.2019.10.006 -
Infectious Disease Clinics of North... Mar 2014Urinary tract infection (UTI) is a commonly diagnosed infection in older adults. Despite consensus guidelines developed to assist providers in diagnosing UTI,... (Review)
Review
Urinary tract infection (UTI) is a commonly diagnosed infection in older adults. Despite consensus guidelines developed to assist providers in diagnosing UTI, distinguishing symptomatic UTI from asymptomatic bacteriuria (ASB) in older adults is problematic, as many older adults do not present with localized genitourinary symptoms. This article summarizes the recent literature and guidelines on the diagnosis and management of UTI and ASB in older adults.
Topics: Aged; Algorithms; Anti-Bacterial Agents; Asymptomatic Infections; Bacteriuria; Humans; Middle Aged; Phytotherapy; Practice Guidelines as Topic; Proanthocyanidins; Risk Factors; Urinary Tract Infections; Vaccinium macrocarpon
PubMed: 24484576
DOI: 10.1016/j.idc.2013.10.004 -
MBio Apr 2020Recent advances in the analysis of microbial communities colonizing the human body have identified a resident microbial community in the human urinary tract (UT).... (Review)
Review
Recent advances in the analysis of microbial communities colonizing the human body have identified a resident microbial community in the human urinary tract (UT). Compared to many other microbial niches, the human UT harbors a relatively low biomass. Studies have identified many genera and species that may constitute a core urinary microbiome. However, the contribution of the UT microbiome to urinary tract infection (UTI) and recurrent UTI (rUTI) pathobiology is not yet clearly understood. Evidence suggests that commensal species within the UT and urogenital tract (UGT) microbiomes, such as , may act to protect against colonization with uropathogens. However, the mechanisms and fundamental biology of the urinary microbiome-host relationship are not understood. The ability to measure and characterize the urinary microbiome has been enabled through the development of next-generation sequencing and bioinformatic platforms that allow for the unbiased detection of resident microbial DNA. Translating technological advances into clinical insight will require further study of the microbial and genomic ecology of the urinary microbiome in both health and disease. Future diagnostic, prognostic, and therapeutic options for the management of UTI may soon incorporate efforts to measure, restore, and/or preserve the native, healthy ecology of the urinary microbiomes.
Topics: Female; High-Throughput Nucleotide Sequencing; Humans; Male; Metagenomics; Microbiota; Probiotics; Urinary Tract; Urinary Tract Infections; Urine
PubMed: 32345639
DOI: 10.1128/mBio.00218-20 -
Microbiology Spectrum Oct 2016Urinary tract infection (UTI) is one of the most common bacterial infections, and the incidence in women is much higher than in men. The diagnosis of a UTI can be made... (Review)
Review
Urinary tract infection (UTI) is one of the most common bacterial infections, and the incidence in women is much higher than in men. The diagnosis of a UTI can be made based on a combination of symptoms and a positive urine analysis or culture. Most UTIs are uncomplicated UTIs, defined as cystitis in a woman who is not pregnant, is not immunocompromised, has no anatomical and functional abnormalities of the urogenital tract, and does not exhibit signs of tissue invasion and systemic infection. All UTIs that are not uncomplicated are considered to be complicated UTIs. Differentiation between uncomplicated and complicated UTIs has implications for therapy because the risks of complications or treatment failure are increased for patients with a complicated UTI. Asymptomatic bacteriuria (ASB) is defined as the presence of a positive urine culture collected from a patient without symptoms of a UTI. Concerning the complicated UTI, it is possible to make a differentiation between UTI with systemic symptoms (febrile UTI) and UTI in a host, which carries an increased risk to develop complications of this UTI. Febrile UTIs are urosepsis, pyelonephritis, and prostatitis. A complicated host is defined as one that has an increased risk for complications, to which the following groups belong: men, pregnant women, immunocompromised patients, or those who have an anatomical or functional abnormality of the urogenital tract (e.g., spinal cord-injury patients, renal stones, urinary catheter).
Topics: Female; Humans; Incidence; Male; Pregnancy; Risk Factors; Urinary Tract Infections
PubMed: 27780014
DOI: 10.1128/microbiolspec.UTI-0002-2012 -
MMW Fortschritte Der Medizin Mar 2022
Review
Topics: Anti-Bacterial Agents; Humans; Urinary Tract Infections
PubMed: 35211909
DOI: 10.1007/s15006-022-0707-4 -
Medicine Sep 2018The association between urinary tract infection (UTI) during pregnancy and preeclampsia (PE) continues to be the subject of debate. This meta-analysis aimed to examine... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The association between urinary tract infection (UTI) during pregnancy and preeclampsia (PE) continues to be the subject of debate. This meta-analysis aimed to examine the relationship between UTI during pregnancy and PE.
STUDY DESIGN
Observational studies up to October 2017, extracted from Medline, PubMed, Cochrane Library, and Embase databases, were included in the analysis. Data were extracted to 4-fold table, and the pooled odds ratio (OR) and 95% confidence intervals (CIs) of respective studies were calculated. Then meta-analysis was performed.
RESULTS
Nineteen studies qualified the inclusion criteria. Urinary tract infection during pregnancy was found to be a risk factor for the development of PE (OR: 1.31, 95% CI: 1.22-1.40).
CONCLUSION
Occurrence of UTI during pregnancy increases the risk of PE in pregnant women. Screening for, and treatment of UTI should be part of routine antenatal care, especially in developing countries.
Topics: Female; Humans; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Infectious; Urinary Tract Infections
PubMed: 30200124
DOI: 10.1097/MD.0000000000012192 -
Anales de Pediatria Jun 2019Urinary tract infection (UTI) is defined as the growth of microorganisms in a sterile urine culture in a patient with compatible clinical symptoms. The presence of...
Urinary tract infection (UTI) is defined as the growth of microorganisms in a sterile urine culture in a patient with compatible clinical symptoms. The presence of bacteria without any symptoms is known as asymptomatic bacteriuria, and does not require any treatment. In neonates and infants, fever is the guiding sign to suspecting a UTI. Classic urinary tract symptoms become more important in older children. Urine cultures collected before starting antibiotics is always required for diagnosis. Clean-catch (midstream) specimens should be collected for urine culture. In the case of non-toilet-trained children, specimens must be obtained by urinary catheterisation, or suprapubic puncture in neonates and infants. Specimens collected by urine bag should not be used for urine culture. There are no significant differences in the clinical evolution and prognosis between oral versus short intravenous followed by oral antibiotic. Empirical antibiotic therapy should be guided by local susceptibility patterns. Second-generation cephalosporin (children under 6 years) and fosfomycin trometamol (over 6 years), are the empiric therapy recommended in this consensus. In the case of pyelonephritis, recommended antibiotic treatment are third-generation cephalosporins (outpatient care) or, if admission is required, aminoglycosides. Ampicillin should be added in infants less than 3 months old. Antibiotic de-escalation should be always practiced once the result of the urine culture is known.
Topics: Anti-Bacterial Agents; Child; Child, Preschool; Humans; Infant; Urinary Tract Infections
PubMed: 30979681
DOI: 10.1016/j.anpedi.2019.02.009 -
BMJ Open Quality Dec 2021Catheter-associated urinary tract infections (CAUTIs) represent approximately 9% of all hospital acquired infections, and approximately 65%-70% of CAUTIs are believed to...
Catheter-associated urinary tract infections (CAUTIs) represent approximately 9% of all hospital acquired infections, and approximately 65%-70% of CAUTIs are believed to be preventable. In the spring of 2013, Boston Medical Center (BMC) began an initiative to decrease CAUTI rates within its intensive care units (ICUs). A CAUTI taskforce convened and reviewed process maps and gap analyses. Based on Centers for Disease Control and Prevention (CDC) and Institute for Healthcare Improvement (IHI) guidelines, and delineated by the Healthcare Infection Control Practices Advisory Committee 2009 guidelines, all BMC ICUs sequentially implemented plan-do-study-act cycles based on which measures were most easily adaptable and believed to have the highest impact on CAUTI rates. Implementation of five care bundles spanned 5 years and included (1) processes for insertion and maintenance of foley catheters; (2) indications for indwelling foley catheters; (3) appropriate testing for CAUTIs; (4) alternatives to indwelling devices; and (5) sterilisation techniques. Daily rounds by unit nursing supervisors and inclusion of foley catheter necessity on daily ICU checklists held staff accountable on a daily basis. With these interventions, the total number of CAUTIs at BMC decreased from 53 in 2013 to 9 in 2017 (83% reduction) with a 33.8% reduction in indwelling foley catheter utilisation during the same time period. Adapted protocols showed success in decreasing the CAUTI rate and indwelling foley catheter usage in all of the BMC ICU's. While all interventions had favourable and additive trends towards decreasing the CAUTI rate, the CAUTI awareness education, insertion and removal protocols and implementation of PureWick female incontinence devices had clear and significant effects on decreasing CAUTI rates. Our project provides a framework for improving HAIs using rapid cycle testing and U-chart data monitoring. Targeted education efforts and standardised checklists and protocols adapted sequentially are low-cost and high yield efforts that may decrease CAUTIs in ICU settings.
Topics: Catheter-Related Infections; Catheters; Critical Care; Female; Humans; Intensive Care Units; Urinary Tract Infections
PubMed: 34949580
DOI: 10.1136/bmjoq-2021-001534