Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2010.

Resumo: A triagem de crianças para bacteriúria assintomática objetivando prevenir pielonefrite e danos renais é amplamente recomendada. Amostras de urina, colhidas sem contaminação, de 500 pré-escolares com idade entre 2 a 7 anos foram submetidas ao teste com cloridrato de trifeniltetrazólio (TTC) e a urocultura. Culturas quantitativas foram realizadas usando dois diferentes meios de cultura: ágar CLED e ágar MacConkey. As colônias foram contadas, após 18-24 horas de incubação à 35-37ºC. O achado de 105 ou mais UFC/mL do mesmo microrganismo foi considerado como positivo. Para realizar o teste com TTC, 4 mL da urina foram misturados com 1 mL da solução aquosa de TTC estéril à 1% e incubados à 35-37ºC por 4 horas. Uma segunda urocultura foi realizada para as crianças que apresentaram resultado positivo. A sensibilidade aos antimicrobianos foi determinada. Uma comparação entre a urocultura e o teste com TTC foi feita, para avaliação do teste. Um questionário foi aplicado para avaliar fatores predisponentes comportamentais e funcionais. A triagem para bacteriúria assintomática, em pré-escolares em Araraquara-SP-Brasil mostrou uma prevalência de 1,4%. Escherichia coli foi o microrganismo mais isolado e a resistência a tetraciclina foi significante. Os resultados mostram que o teste com TTC possui 91,3% de sensibilidade; 64,3% de especificidade; 15,5% de valor preditivo positivo e 99,0% de valor preditivo negativo. Esses valores mostram que este teste pode ser usado como metodologia de triagem. O fato de já ter desenvolvido ITU anteriormente; usar o papel de trás para frente na higienização anal; beber menos de 1L de água por dia; e usar roupa íntima apertada foram considerados possíveis fatores de risco para o desenvolvimento de bacteriúria assintomática. / Abstract: Urinary tract infection (UTI) is the most commom of bacterial infections. Screening children for asymptomatic bacteriuria to prevent pyelonephritis and renal scarring is widely recommended. Urine samples, revealed without contamination, from 500 pre-school children aged 2 to 7 years were submited to the tryphenyl tetrazolium chloride (TTC) test and urine culture. Quantitative urine cultures was performed using two different agar types: CLED and MacConkey. Colonies were count after 18-24 hours of incubation at 35-37ºC. The finding of 105 or more CFU/mL of the same microorganism constituted a positive culture. To perform the TTC test, 4 mL of the urine were mixed with 1 mL of the TTC 1% aqueous sterile solution and incubated at 35-37ºC for 4 hours. We performed a second urine culture for all children with a positive result. Antimicrobial susceptibility was determined. A comparison between the quantitative culture and the TTC test were made, for the evaluation of the test. A questionnaire were used to assess predisposing behavioral and functional abnormalities. The screening survey for asymptomatic bacteriuria in pre-school children in Araraquara-SP-Brazil showed a prevalence of 1.4%. Escherichia coli was the commonest organism isolated and resistence to tetracycline was significant. The results show that the TTC test has sensitivity 91.3%, specificity 64.3%, positive predictive value 15.5% and negative predictive value 99.0%. This test can be use as a screening test. History of the urinary tract infection, inadequate hygiene, poor fluid intake and use of tigh-fitting underwear appear to be risk factors for asymptomatic bacteriuria. / Orientador: Maria Stella Gonçalves Raddi / Coorientador: Antonio Carlos Pizzolitto / Coorientador: Elisabeth Loshchagin Pizzolitto / Banca: Maria Jacira Silva Simões / Banca: Isabel Cristina Affonso Scaletsky / Mestre

<p><strong>Introduction</strong> Every tenth patient in Sweden is affected by nosocomial infections. Among these, urinary tract infection (UTI) is the most frequently occurring within the hospital environment. Nosocomial infections lead to increasing costs for care, more suffering among the patients, increasing use of antibiotics, and longer treatment spells. The Academic hospital have engaged all wards in the so called VRISS-project (“nosocomial infections must be stopped”) in order to reduce the number of nosocomial infections.</p><p><strong>Aim</strong> In connection to the VRISS-project new routines for removal of uretrahl catheters are introduced at ward 70E2 at the Academic hospital. The new routines imply that the catheter should be removed during the first post-op day. According to the old routines the catheter was to be removed no later than on the third post-op day. The authors of this study choose to investigate whether the new routines for uretrahl catheter removal have any effect on the occurrence of nosocomial UTI’s.</p><p><strong>Methods </strong>The study is a restrospective record study with quantitative, descriptive design. 411 journals from 2007 (188) and 2009 (223) have been reviewed. All patients that underwent knee or hip operations during January, February, March, and April 2007 and 2009 are included in the sample.</p><p><strong>Results</strong> The study shows that the new routines at ward 70E2 had some, but not full, influence on the share of patients with nosocomial UTI. Among women under 71 years of age and men older than 70 years, the number of days with uretrahl catheter and the share of patients with nosocomial UTI have decreased. However, among the younger men (<71 years) and the older women (>70 years) no effects of the new routines are detected.</p><p><strong>Conclusion</strong> To summarize it can be concluded that the routines for how to use uretrahl catheters at ward 70E2 work fairly well. However, the results also show that the number of days with uretrahl catheter and the share of patients with nosocomial UTI among risk patients, above all among the older women, are the same in spite of the new routines for removal of uretrahl catheters. Thus, strategies for detecting risk patients in an early stage can be improved upon. Such measures can reduce the risk for nosocomial UTI among these patients.</p>

Introduction Every tenth patient in Sweden is affected by nosocomial infections. Among these, urinary tract infection (UTI) is the most frequently occurring within the hospital environment. Nosocomial infections lead to increasing costs for care, more suffering among the patients, increasing use of antibiotics, and longer treatment spells. The Academic hospital have engaged all wards in the so called VRISS-project (“nosocomial infections must be stopped”) in order to reduce the number of nosocomial infections. Aim In connection to the VRISS-project new routines for removal of uretrahl catheters are introduced at ward 70E2 at the Academic hospital. The new routines imply that the catheter should be removed during the first post-op day. According to the old routines the catheter was to be removed no later than on the third post-op day. The authors of this study choose to investigate whether the new routines for uretrahl catheter removal have any effect on the occurrence of nosocomial UTI’s. Methods The study is a restrospective record study with quantitative, descriptive design. 411 journals from 2007 (188) and 2009 (223) have been reviewed. All patients that underwent knee or hip operations during January, February, March, and April 2007 and 2009 are included in the sample. Results The study shows that the new routines at ward 70E2 had some, but not full, influence on the share of patients with nosocomial UTI. Among women under 71 years of age and men older than 70 years, the number of days with uretrahl catheter and the share of patients with nosocomial UTI have decreased. However, among the younger men (&lt;71 years) and the older women (&gt;70 years) no effects of the new routines are detected. Conclusion To summarize it can be concluded that the routines for how to use uretrahl catheters at ward 70E2 work fairly well. However, the results also show that the number of days with uretrahl catheter and the share of patients with nosocomial UTI among risk patients, above all among the older women, are the same in spite of the new routines for removal of uretrahl catheters. Thus, strategies for detecting risk patients in an early stage can be improved upon. Such measures can reduce the risk for nosocomial UTI among these patients.

Orientadores: Célia Regina Garlipp, Carlos Emilio Levy / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T18:20:39Z (GMT). No. of bitstreams: 1 Martinez_MayaraHidalgoMagri_M.pdf: 2010266 bytes, checksum: 23bb4f89ea7b258a0fd5fe0e20f6cc1f (MD5) Previous issue date: 2012 / Resumo: Infecção do trato urinário (ITU) é muito comum na prática clínica, acometendo pessoas de ambos os sexos em todas as faixas etárias. Para seu diagnóstico é importante definir rapidamente a presença de bacteriúria e piúria bem como a etiologia da doença através da urocultura. A urocultura é o teste microbiológico mais comum na prática laboratorial, embora seja um procedimento demorado e de custo relativamente elevado. Nosso objetivo foi avaliar a aplicação de um sistema automatizado de análise da urina (LabUMat/UriSed) como método de triagem para a investigação de ITU através da comparação de seus resultados com os das uroculturas. Analisamos amostras de urina de pacientes adultos e crianças de ambos os sexos provenientes de ambulatórios e enfermarias do Hospital de Clínicas da UNICAMP encaminhados às Seções de Líquidos Biológicos e Microbiologia da Divisão de Patologia Clínica para análise físicoquímica, sedimento e urocultura. Foram estabelecidos valores de cortes baseados na comparação dos resultados das uroculturas com os parâmetros urinários: leucócito-esterase, nitrito, leucócitos, bactérias e leveduras, sendo que a positividade de pelo menos um destes parâmetros classificava a amostra para uma triagem positiva para ITU. O estudo foi conduzido em três etapas: Na primeira etapa, a análise de 2126 amostras de urinas permitiu adotar um primeiro valor de corte para os parâmetros analisados: contagem de bactérias >11/campo; contagem de leucócitos >5/campo, presença de leveduras além de nitrito e leucócito-esterase positivos. Esses valores foram comparados com os resultados da urocultura em meio CLED e testados na rotina laboratorial. Em uma segunda etapa, com a finalidade de aprimorar o valor de corte dos parâmetros e aumentar o valor preditivo positivo sem comprometer o valor preditivo negativo, estabeleceu-se um novo valor de corte. Para tanto, foram analisadas 2075 amostras de urinas e com os seguintes valores de corte estabelecidos: contagem de bactérias 'maior ou igual'12,5/campo; contagem de leucócitos >5/campo, presença de leveduras e nitrito bem como leucócito-esterase positivo 'maior ou igual'2+. Esses valores foram comparados com os resultados das uroculturas em meio CLED e testados na rotina laboratorial. A fim de refinar e validar o teste de triagem para urocultura foram analisados, em uma terceira etapa, 1379 amostras de urina. Nesta etapa os valores de corte dos parâmetros foram: contagem de bactérias >12,5/campo, contagem de leucócitos >5/campo, presença de leveduras e leucócito - esterase positivos 'maior ou igual'2+. Nesta etapa as amostras cujos parâmetros urinários avaliados estavam abaixo do valor de corte, foram consideradas negativas para ITU e semeadas em meio CLED. As amostras em que pelo menos um dos parâmetros estudados estava acima do valor de corte, foram consideradas positivas, sendo semeadas em meio Chromagar a fim de se identificar presuntivamente os patógenos. O teste mostrou sensibilidade de 97%, valor preditivo negativo de 99%, valor preditivo positivo de 27%, especificidade de 59% e acurácia de 64%. Em todas as etapas observou-se uma potencial redução de 50% nas semeaduras de uroculturas. Os dados sugerem que o sistema automatizado LabUMat / UriSed é uma boa ferramenta para a triagem de ITU, especialmente se considerarmos os dados clínicos dos pacientes / Abstract: Urinary tract infection (UTI) is very common in clinical practice, affecting people of both genders in all age groups. For the laboratory diagnosis of UTI is of great importance the definition of significant bacteriuria and pyuria and a bacterial culture of a urine sample to establish the etiology of the disease. The quantitative urine culture is the commonest microbiology test in Clinical Pathology Laboratory practice, although it is a very time-consuming and expensive procedure. Our aim was to evaluate the performance of the LabUMat with UriSed System as a screening method for the investigation of UTI comparing its results with the outcome of urine culture. We studied urine samples from children and adults of both genders from outpatients and hospitalized patients from Clinical Hospital / UNICAMP referred to Body Fluids and Microbiology Laboratories at Division of Clinical Pathology for physicochemical analysis, sediment observation and urine culture. We established cut-off values based on the comparison of the outcome of urine cultures with urinary parameters: leukocyte esterase, nitrite and quantitative determination of bacteriuria, leukocyturia and presence of yeasts. A positivity of at least one parameter classified the sample as a positive screening of UTI. This study was conducted in three stages: In the first stage, the analysis of 2,126 urine samples allowed to adopt the first cut-off value for the parameters analyzed: quantification of bacteriuria (>11 elements/hpf), quantification of leukocyturia (>5 cells/hpf), presence of yeasts besides nitrite and leukocyte esterase positive. These values were compared with the outcome of uroculture in CLED agar medium culture and tested in the laboratory routine. In the second stage, in order to improve cut-off values of urinary parameters and increase the positive predictive value without compromising the negative predictive value, it was established a new cut-off value. We analyzed 2,075 urine samples with the following established cut-off values: quantification of bacteriuria (> or = 12.5 elements/hpf) and leukocyturia (> 5 cells/hpf), presence of yeasts, nitrite and leukocyte esterase positive (> or = 2+). These values were compared with the outcome of uroculture and tested in the laboratory routine. In order to refine and validate the screening test for uroculture were analyzed, in a third stage, 1,379 urine samples. In this stage the cutoff values of the parameters were: quantification of bacteriuria (>12.5 elements/hpf) and leukocyturia (> 5 cells/hpf), presence of yeasts and leukocyte esterase positive (> or = 2+). In this stage the urinary samples whose evaluated parameters were below the cut-off value were considered negative for UTI and were plated in CLED agar medium culture. Samples which at least one of the parameters evaluated was above the cut-off value, were considered positive, and were plated in Chromagar commercial medium, in order to presumptively identify pathogens. The test showed sensitivity of 97%, negative predictive value of 99%, positive predictive value of 27%, specificity of 59% and accuracy of 64%. In all stages we observed a potential 50% reduction in sowing urocultures. The data suggest that the LabUMat with UriSed System is a good tool for screening for UTI, especially if we consider patients' clinical data / Mestrado / Ciencias Biomedicas / Mestra em Ciências Médicas

Class of 2012 Abstract / Specific Aims: 1• Determine the results of urine culture and susceptibility testing for patients with uncomplicated UTI at an emergency department 2• Determine empiric antibacterial agents prescribed for treatment of uncomplicated UTI in the emergency department 3• Compare pathogen susceptibility pattern specific for patients with uncomplicated UTI compared to the overall institution antibiogram Examine the use of cephalexin for uncomplicated UTI in emergency department patients Methods: A retrospective electronic medical records of adult female patients admitted to University Medical Center in Tucson, Arizona, emergency department with a diagnosis of uncomplicated urinary tract infection (UTI) between June 1, 2010 and May 31, 2011 were collected. Different aspects of uncomplicated urinary tract infection (UTI) were characterized, and prescriptions for empiric antibiotic treatment were recorded. Culture results and susceptibility reports as well as antibacterial treatment decisions were studied to evaluate types of pathogens and resistance patterns along with therapy prescribed. The data was managed and analyzed by using SAS. All data was tabulated and described using summary statistics. Main Results: The dominant isolate of the study population was E.coli (88%). Cephalexin was prescribed 76% of the time, nitrofurantoin 8.4%, ciprofloxacin 7.6%, and TMP/SMX 5% of the time. The susceptibility rate of ampicillin was 50%, cefazolin 91%, ciprofloxacin 98%, nitrofurantoin 92%, and TMP/SMX 76%. Conclusions: Our study revealed that the resistant rate of TMP/SMX exceeded 20%; however, ciprofloxacin and nitrofurntoin susceptibility remains high. Cephalexin was the most commonly prescribed treatment, but not included in the antimicrobial susceptibility test (AST) panel.

Class of 2015 Abstract / Objectives: In 2011, the American Academy of Pediatrics released an updated urinary tract infection guideline that addressed diagnosis, antibiotic treatment, and duration of therapy in children ages 2-24 months. The objectives of this study were to evaluate the appropriateness of antibiotic prescribing and compare outcomes between age groups. Methods: This retrospective chart review included patients aged 1 month through 12 years admitted to a regional academic medical center from January through July 2014 and diagnosed with UTI or pyelonephritis. Patients were identified using ICD-9 codes. Demographic information, antibiotic treatment, length of stay, and complications were collected and the chi square statistical test was used to compare results between age groups. Results: There were 104 patients included in this study. The most common bacteria cultured were Escherichia coli (85%). Ceftriaxone (71%) and cephalexin (30%) were the most commonly prescribed empiric and discharge antibiotic, respectively. Based on guideline recommendations and culture results, inappropriate antibiotic selection only occurred with 7% of the orders while inappropriate prescribing occurred 35% of the time. Readmission within 90 days occurred in 15% of patients aged 2-24 months (guideline age group) and in 14% of all other patients (P>0.05). Conclusions: There was no difference between age groups with respect to inappropriate antibiotic prescribing or complications for pediatric UTI treatment and inappropriate antibiotic dosing occurred more frequently than inappropriate selection. More research is necessary to assess the impact of the guidelines on prescribing practices and factors associated with inappropriate prescribing.

Class of 2011 Abstract / OBJECTIVES: To evaluate the appropriateness of discharge antimicrobial medications for UTI in an adult population based on therapy prescribed. METHODS: In this retrospective chart review study the appropriateness of discharge antimicrobial therapy for patients admitted to an academic medical center during 3 weeks in 2010 was assessed based on culture results, estimated renal function, reported drug allergies, route of administration, and change in UTI from in-house to discharge prescribed therapy. RESULTS: A total of 35 patients with discharge UTI antimicrobials within the study period met inclusion criteria and were evaluated. According to available urinary culture and susceptibility data, 22 of 35 (62.8%) of received an appropriate antimicrobial therapy. Based on reported gastrointestinal function, all 35 patients could take oral medications but two patients with an appropriate oral therapy option received intravenous therapy. All patients were discharged with antimicrobials that were appropriate according to patients’ reported drug allergies and only one patient received an antimicrobial agent that was inappropriately adjusted based on the patient’s estimated renal function. UTI antimicrobial therapies were the same at 24 hours prior to discharge and as the discharge antimicrobial in 100% of patient cases evaluated CONCLUSION: The antimicrobial UTI discharge therapy was evaluated for appropriateness based on urine culture results, patients’ allergies, and patients’ estimated renal function. Overall, antimicrobial therapy was only appropriate in 22 of 35 (62.8%) of patients based on the available culture results.

Master of Science / Department of Clinical Sciences / Greg Grauer / A urinary tract infection (UTI) is defined as a temporary or permanent breach in host defense mechanisms that allows microbes to adhere, multiply, and persist within the urinary tract. Development of a UTI is multi-factorial with bacterial number and virulence and the health status of the patient (normal urogenital tract anatomy and physiology and systemic immunocompetence) playing important roles in determining the outcome. A UTI can involve a single site, such as the renal pelvis, ureter, bladder, urethra, prostate or vagina, or can include multiple sites. Infection of any portion of the urinary tract may increase the likelihood of infection in other locations. Diagnosis of a UTI incorporates findings from the history, physical examination, complete urinalysis, and urine culture. Proper classification and localization of the UTI are important when formulating a treatment regime as well as evaluating treatment success and failure. Most UTI can be successfully managed with appropriate antibiotic treatment; however, bacterial resistance and compromised host defense mechanisms can result in persistent or recurrent infections. In patients with recurrent UTI, identification of underlying predisposing conditions will often improve treatment success. In patients where underlying causes cannot be identified or treated, therapies designed to prevent recurrent UTI may be employed. Proanthrocyanidins found in cranberry juice inhibit E. coli attachment to human uroepithelial cells, impairing bacterial adherence and colonization. These characteristics have encouraged widespread usage of cranberry extract as a prevention strategy for woman predisposed to urinary tract infections. E. coli is a common cause of canine urinary tract infection. Current treatment emphasizes eradication of established infection rather than infection prevention, but increased antibiotic resistance necessitates strategies to prevent infection. We hypothesized that purified cranberry extract (CE) inhibits bacterial adhesion to canine uroepithelial cells. The results of our study show that CE supplementation can reduce adhesion of uropathogenic E. coli to canine uroepithelium and suggests one mechanism by which CE might improve urinary tract health.

Magister Pharmaceuticae - MPharm / Antibiotic resistance (ABR) is a global healthcare burden complicating the treatment of various infections. The infectious diseases burden is heavy in primary care. Urinary tract infections (UTIs) are common outpatient infections. Miscommunication in healthcare may lead to non-adherence, adverse events and fuel ABR. Labelling antibiotics should be explicit and understood by patients. Treatment of UTIs in primary care in the Western Cape is not well defined. This study’s aim is to describe the treatment of UTIs in primary care in the Cape Metropole of the Western Cape province.