scholarly journals Novel Biomarkers for the Diagnosis of Urinary Tract Infection–-A systematic Review

2009 ◽  
Vol 4 ◽  
pp. BMI.S3155 ◽  
Author(s):  
Neha Nanda ◽  
Manisha Juthani-Mehta
Keyword(s):  
Urinary Tract ◽  
Clinical Presentation ◽  
Asymptomatic Bacteriuria ◽  
Elevated Serum ◽  
The Elderly ◽  
Kidney Transplant Recipients ◽  
Pediatric Age Group ◽  
Cord Injury ◽  
Novel Biomarkers ◽  
Tract Infections

Urinary tract infections (UTIs) are associated with significant morbidity. We rely on clinical presentation, urinalysis, and urine culture to diagnose UTI. To differentiate between lower UTI and pyelonephritis, we depend on the clinical presentation. In the extremes of age and in immunocompromised individuals, clinical presentation is often atypical posing a challenge to diagnosis. In the elderly, the high prevalence of asymptomatic bacteriuria is another confounder. We conducted a search of publications to find novel biomarkers to diagnose UTI and to ascertain its severity. We searched PUBMED, MEDLINE and SCOPUS databases for studies pertaining to novel biomarkers and UTI. Two reviewers independently evaluated the methodology of the studies using the STARD (Standards for Reporting of Diagnostic Accuracy) criteria. We have identified procalcitonin as a biomarker to differentiate lower UTI from pyelonephritis in the pediatric age group. Elevated serum procalcitonin levels can result in early and aggressive treatment at the time of presentation. Interleukin 6 has also shown some promise in differentiating between lower UTI and pyelonephritis but needs further validation. Lastly, given the paucity of data in certain subgroups like diabetics, kidney transplant recipients, and individuals with spinal cord injury, further studies should be conducted in these populations to improve diagnostic criteria that will inform clinical management decisions.

Guidance of antibiotic treatment for urinary tract infections in the early postoperative phase after Kidney Transplantation

2020 ◽  
Author(s):  
Jens Karl Hugo Strohäker ◽  
Silvio Nadalin ◽  
Alfred Königsrainer ◽  
Robert Bachmann
Keyword(s):  
Kidney Transplantation ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Asymptomatic Bacteriuria ◽  
Graft Function ◽  
Postoperative Phase ◽  
Kidney Transplant Recipients ◽  
Laboratory Findings ◽  
Gram Negative ◽  
Tract Infections

Abstract Purpose: Urinary tract infections are the most common infections early after kidney transplantation. The goals of this study were to evaluate our perioperative antibiotic protocol and risk factors for the occurrence of urinary tract and its effect on the early graft function. We evaluated laboratory alterations during episodes of UTI regarding their potential to guide treatment.Methods: Retrospective single-center analysis of all kidney transplant recipients of an academic transplant center between 2015 and 2017.Results: 96 patients were included in the study. Overall, in 22 patients a asymptomatic bacteriuria (ASB) was detected and 33 patients developed a urinary tract infection (UTI). Gram-negative UTIs appeared earlier than gram-positive UTIs. The most common lab findings during UTI were leukocytosis and CRP increase, both more common in gram-negative UTI (p .00 & .03). All complicated UTIs were caused by gram-negative bacteria (p .00). No difference in UTIs was seen between perioperative antibiotic regimens. Patients that suffered from UTIs showed less favorable graft function at discharge (GFR 43 vs 52 ml / min, p .03).Conclusion: UTIs are associated with worse graft functions while ASBs are not. Whether UTIs are caused by or lead to decreased graft function is still unclear. Proper gram-negative coverage is needed in cases of complicated UTIs or severe laboratory findings. Perioperative antibiotic regimens appear to have no beneficial influence on the incidence of UTIs.

Urinary tract infection

2019 ◽  
pp. 267-276
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Diagnostic Tests ◽  
Asymptomatic Bacteriuria ◽  
The Elderly ◽  
Drug Induced ◽  
Recurrent Uti ◽  
Clinical Presentations ◽  
Tract Infections

This chapter on urinary tract infections brings up to date advice on the aetiology, diagnosis, and management of urinary tract infections in adults. The microbiology of this common presentation is discussed, together with recent patterns of resistance. Different clinical presentations are highlighted: lower UTI, upper UTI, asymptomatic bacteriuria, pregnancy, catheterized patients, haematuria, the elderly, urethral syndrome, interstitial cystitis and drug-induced cystitis. The role of different diagnostic tests, in particular routine urine culture, is explored. Guidance on the management of different clinical presentations of UTI is given, as well as an outline of the options for reducing the frequency of recurrent UTI in those so predisposed.

Characteristics of Symptomatic and Asymptomatic Bacteriuria in Patients with Neurogenic Bladder under Neurorehabilitation

2020 ◽  
Author(s):  
Fauster O. B. Lopes ◽  
Maria Rosa Q. Bomfim ◽  
Sílvio G. Monteiro ◽  
Marcello T. da Silva ◽  
Virginia Maria L. S. de Pinho ◽  
...  
Keyword(s):  
Comparative Analysis ◽  
Urinary Tract ◽  
Neurogenic Bladder ◽  
Urinary Tract Infections ◽  
Laboratory Data ◽  
Asymptomatic Bacteriuria ◽  
Intermittent Catheterization ◽  
Laboratory Test Results ◽  
Cord Injury ◽  
Tract Infections

Abstract Background: The definitions of urinary tract infections (UTI) and asymptomatic bacteriuria (ABU) are problematic to apply in patients with neurogenic bladder (NB). Here, we carried out a comparative analysis of the main clinical and laboratory data of NB patients with UTI and ABU.Methods: One hundred ninety five patients with neurogenic bladder were evaluated in the Urology Sector at a neurorehabilitation hospital. Patients were divided into either ABU or UTI group based on clinical and laboratory data. The sociodemographic data, clinical history, and laboratory test results were collected and used in the comparative analysis.Results: Of the patients evaluated, 161 (82.6%) had ABU. Patients of different age groups were affected, predominantly young adults (20-39 years). The median time of bladder involvement was 8.9 years (0-35). Neurogenic bowel was observed in 97.5% of cases and renal lithiasis in 11.3%. The main underlying pathologies leading to urologic involvement were spinal cord injury, myelomeningocele, stroke, and neoplasms. Only 16.4% of patients were not on intermittent catheterization, in which the risk of recurrent infection was higher than in patients who were under for intermittent bladder catheterization (p = 0.016, OR 2.65). Infection rates were significantly different between patients with histories of recurrent urinary tract infections (asymptomatic bacteriuria 29.8% vs 52.9% infection, p = 0.016). Leukocyturia was frequent in both groups, however, our data suggested that only values ≤ 30 cells/high power field excluded infection.Conclusions: In summary, intermittent catheterization was observed to be essential in the prevention of recurrent UTI, as well as the need to adjust the reference values for leukocyturia in the definition of the infectious condition.

scholarly journals Virulence Factors of Escherichia coliIsolates From Patients with Symptomatic and Asymptomatic Bacteriuria and Neuropathic Bladders Due to Spinal Cord and Brain Injuries

1998 ◽  
Vol 36 (1) ◽  
pp. 115-117 ◽  
Author(s):  
Richard A. Hull ◽  
Delbert C. Rudy ◽  
Inge E. Wieser ◽  
William H. Donovan
Keyword(s):  
Escherichia Coli ◽  
Spinal Cord ◽  
Urinary Tract ◽  
Brain Injuries ◽  
Asymptomatic Bacteriuria ◽  
Common Occurrence ◽  
E Coli ◽  
Cord Injury ◽  
Tract Infections ◽  
Virulence Properties

Chronic bacteriuria is a common occurrence among spinal-cord injury patients and others with neuropathic bladders. If bacteria are present in the urinary tract, the patient may develop symptoms of infection or remain asymptomatic. We have compared virulence properties of 28Escherichia coli isolates from patients with symptomatic urinary tract infections (UTI) and 29 E. coli isolates from patients with asymptomatic bacteriuria (ABU). Bacteria from patients with symptomatic UTI were more likely to be hemolytic than isolates from patients with ABU (P = 0.05) or fecal isolates obtained from healthy volunteers (P < 0.001). Bacteria from patients with symptomatic UTI were also more likely than strains isolated from patients with ABU (P = 0.08) or fecal strains (P < 0.001) to exhibitd-mannose-resistant hemagglutination of human erythrocytes. The results suggest that E. coli isolates from nonimmunocompromised patients who require intermittent catheterization and who develop symptomatic UTI may be distinguished from bacteria recovered from patients who remain asymptomatic and possibly from normal fecal E. coli.

scholarly journals 5 Improving Diagnosis and Management of Urinary Tract Infections for Elderly Patients

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i1-i8
Author(s):  
L Al-makdase ◽  
P Ioannou ◽  
Z Y Tew ◽  
M Khan ◽  
M Debnath ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Elderly Population ◽  
Urine Culture ◽  
Asymptomatic Bacteriuria ◽  
Signs And Symptoms ◽  
The Elderly ◽  
Clinical Indication ◽  
Royal Infirmary ◽  
Urine Dipstick ◽  
Tract Infections

Abstract Introduction Diagnosis of urinary tract infection (UTI) in the elderly population is challenging as they commonly present with atypical signs and symptoms. Prevalence of asymptomatic bacteriuria in the elderly population is high. Hence, urine dipstick and urine culture are no longer diagnostic tests. UTI is over-diagnosed and overtreated in the elderly, resulting in poor antimicrobial stewardship. This project was carried out to assess and improve the current practices in the diagnosis and treatment of UTI in the Department of Medicine of the Elderly. Methods We reviewed current Scottish Intercollegiate Guidelines Network (SIGN) and National Institute for health and Care Excellence (NICE) guidelines on management of UTI and defined indications for performing urine dipstick and sending urine culture. We then collected and assessed data on all urine dipsticks performed, urine cultures sent, and use of antibiotics in treating UTI and asymptomatic bacteriuria in three Medicine of the Elderly wards in Aberdeen Royal Infirmary. We carried out intervention by means of presenting and discussing findings of Plan-Do-Study-Act (PDSA) cycles in departmental multi-disciplinary Quality Improvement (QI) meetings followed by educational sessions. Results Our baseline data showed 77% of urine dipsticks were performed without clinical indication and 18% of patients had urine cultures sent without clinical indication. After presenting our initial findings and carrying out an educational intervention session, 25% of patients had urine dipstick done without clinical indication, and 0% of patients had urine cultures sent without clinical indication. However, over the course of four subsequent PDSA cycles, practices in investigation of UTI fluctuated but were overall consistently better than the initial practice with further interventions. In all PDSA cycles, no patients were treated for asymptomatic bacteriuria. Conclusions Multidisciplinary team involvement in discussion of this QI project findings and educational sessions proved to be an effective form of intervention for improving current practice.

scholarly journals Burning for Treatment: Impact of Staff Education on Asymptomatic Bacteriuria Management in the Elderly

2020 ◽  
Vol 23 (3) ◽  
pp. 216-222
Author(s):  
Casara Hong ◽  
Gregory Egan ◽  
Byron Sherk
Keyword(s):  
Urinary Tract ◽  
Interprofessional Education ◽  
Asymptomatic Bacteriuria ◽  
The Elderly ◽  
Staff Education ◽  
Geriatric Population ◽  
Positive Urine ◽  
Chart Audits ◽  
Tract Infections ◽  
Acute Care Unit

Background Studies indicate that elderly patients are often inappropriately treated with antimicrobials for asymptomatic bacteriuria (ASB). Interprofessional education may help improve the assessment and management of ASB. Methods Retrospective chart audits were conducted on two cohorts of positive urine cultures (n = 201) obtained from a geriatric acute care unit to determine the incidence of treated ASB. The first cohort (n = 101) was analyzed from January to July 2017. Education was provided to unit staff (e.g., nurses, physicians, pharmacists) in Fall 2017. The second cohort (n = 100) was analyzed from January to July 2018. Descrip­tive statistics were used to summarize and compare the results from the cohorts. Results 152 patients (n = 201 positive urine cultures) were reviewed: 74% (159) of positive urine cultures were ASB and 21% (42) were urinary tract infections. The incidence of treated ASB was 15% (30) and untreated ASB was 65% (129). The incidence of UTI, treated ASB, and untreated ASB were not significantly different between the two cohorts examined. Conclusion The implementation of education did not result in lasting changes in ASB management. Our study suggests that future systemic solutions are necessary to reduce the incidence of treated ASB in the geriatric population.

Mechanisms of urinary tract infections and asymptomatic bacteriuria

2018 ◽  
pp. 106-110
Author(s):  
I.N. Zaharova ◽  
◽  
E.B. Mumladze ◽  
E.B. Machneva ◽  
A.N. Kasyanova ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Asymptomatic Bacteriuria ◽  
Tract Infections

Urinary tract infections (UTIs); a leaflet for older adults, and carers: the development of a UTI leaflet for older adults and their carers

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X696833 ◽  
Author(s):  
Leah Ffion Jones ◽  
Emily Cooper ◽  
Cliodna McNulty
Keyword(s):  
Older Adults ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Care Home ◽  
Asymptomatic Bacteriuria ◽  
Theoretical Domains Framework ◽  
Antibiotic Use ◽  
Primary Care Providers ◽  
Care Providers ◽  
Tract Infections

BackgroundEscherichia coli bacteraemia rates are rising with highest rates in older adults. Mandatory surveillance identifies previous Urinary Tract Infections (UTI) and catheterisation as risk factors.AimTo help control bacteraemias in older frail patients by developing a patient leaflet around the prevention and self-care of UTIs informed by the Theoretical Domains Framework.MethodFocus groups or interviews were held with care home staff, residents and relatives, GP staff and an out of hours service, public panels and stakeholders. Questions explored diagnosis, management, prevention of UTIs and antibiotic use in older adults. The leaflet was modified iteratively. Discussions were transcribed and analysed using Nvivo.ResultsCarers of older adults reported their important role in identifying when older adults might have a UTI, as they usually flag symptoms to nurses or primary care providers. Information on UTIs needs to be presented so residents can follow; larger text and coloured sections were suggested. Carers were optimistic that the leaflet could impact on the way UTIs are managed. Older adults and relatives liked that it provided new information to them. Staff welcomed that diagnostic guidance for UTIs was being developed in parallel; promoting consistent messages. Participants welcomed and helped to word sections on describing asymptomatic bacteriuria simply, preventing UTIs, causes of confusion and when to contact a doctor or nurseConclusionA final UTI leaflet for older adults has been developed informed by the TDF. See the TARGET website www.RCGP.org.uk/targetantibiotics/

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