Submitted by Ana Maria Fiscina Sampaio (fiscina@bahia.fiocruz.br) on 2012-07-30T21:03:32Z No. of bitstreams: 1 Maria Goreth. Prevalência de Resistência a Antimicrobianos e.pdf: 781360 bytes, checksum: f2b7c7040f7e8670e3df7e6c9397283d (MD5) / Made available in DSpace on 2012-07-30T21:03:32Z (GMT). No. of bitstreams: 1 Maria Goreth. Prevalência de Resistência a Antimicrobianos e.pdf: 781360 bytes, checksum: f2b7c7040f7e8670e3df7e6c9397283d (MD5) Previous issue date: 2010 / Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, Bahia, Brasil / Estimar a prevalência de resistência a antimicrobianos em isolados de Escherichia coli e avaliar o desempenho dos testes laboratoriais rápidos para diagnóstico das infecções não complicadas do trato urinário adquiridas na comunidade. Métodos: Este trabalho foi dividido em dois estudos, no primeiro para avaliar o perfil de susceptibilidade a antimicrobianos, foi avaliada uma amostra consecutiva de 411 isolados de E. coli procedentes de pacientes com Infecção do Trato Urinário (ITU) atendidos numa unidade de emergência de hospital privado no período de julho de 2008 a julho 2009. A identificação e os testes de susceptibilidade a antimicrobianos utilizou o sistema automatizado WalkAway – Microscan® (Siemens - Califórnia). No segundo estudo, para avaliar o desempenho dos testes rápidos para diagnóstico de ITU, além dos casos de ITU do primeiro estudo, foram incluídos 411 pacientes sem ITU atendidos no mesmo local e período. Os testes rápidos estudados, microscopia direta (Gram), teste de piúria e teste do nitrito, foram realizados conforme respectivos protocolos, realizando os controle de qualidade de todas as etapas. Resultados: A amostra de casos de ITU era formada por 342 (83%) adultos e 69 (17%) crianças. A distribuição por sexo entre adultos e crianças, mostrou predominância dos episódios no sexo feminino (85%). Dos 22 antibióticos testados, a maior prevalência de resistência foi encontrada para ampicilinasulbactam (41%), ampicilina (49%), cefalotina (33%) e sulfametoxazol-trimetoprim (36%), além disso, observamos uma inusitada taxa de resistência à ciprofloxacina (9%). Quarenta e dois por cento dos isolados de E. coli apresentaram resistência a três ou mais drogas. Houve um aumento na taxa de resistência à cefalotina, em comparação com estudo realizado na mesma cidade em 2001-2002. Não foram observadas variações significativas nas taxas de resistência para a maioria dos demais antimicrobianos. Dentre os testes rápidos avaliados a detecção de piúria apresentou a maior sensibilidade (95%; IC95%: 92-97%) e a menor especificidade (66%; IC95%: 61-70%). O teste de nitrito apresentou a maior especificidade (99%; IC95%: 98-100%) e a menor sensibilidade (45%; IC95%: 40-50%). No geral, o teste com maior acurácia foi a microscopia direta (84%; IC95%: 79-88%), seguido da detecção de piúria (80%; IC95%: 77-83%). O teste de nitrito teve o maior valor preditivo positivo (VPP) e o teste de piúria o maior valor preditivo negativo (VPN). Os testes rápidos apresentaram concordância modesta e a combinação de resultados positivos com maior VPP foi obtida com os testes de nitrito e microscopia direta (Gram). Enquanto a combinação de microscopia direta (Gram) e piúria negativos tiveram o maior VPN. Conclusão: Os isolados de E. coli apresentaram elevadas taxas de resistência a: ampicilina, ampicilina-sulbactam, sulfametoxazol-trimetoprim e cefalotina, limitando a indicação desses antibióticos para tratamento empírico das ITUs adquiridas na comunidade. Apesar da variação nos valores de sensibilidade e especificidade dos testes rápidos avaliados, o teste de nitrito positivo e o teste de piúria negativo apresentaram a melhor taxa de acerto para confirmar ou afastar o diagnóstico de ITU, respectivamente. Embora, os testes rápidos possam ser considerados úteis no diagnóstico das ITU-AC, a urocultura ainda é o teste laboratorial definitivo para diagnóstico de ITU. / To estimate the prevalence of antimicrobial resistance in Escherichia coli isolates Escherichia coli and evaluate the performance of laboratory tests for fast diagnosis of uncomplicated community acquired urinary tract infections. Methods: This work was divided into two studies; first to evaluate the profile of antimicrobial resistance we evaluated a consecutive sample of 411 isolates of E. coli from patients with urinary tract infection (UTI) attending an emergency unit of a private hospital from July 2008 to July 2009. The identification and antimicrobial susceptibility testing used the automated Walkaway - Microscan ® (Siemens - California). In the second study, to evaluate the performance of quick tests for diagnosis of UTI, apart from cases of UTI in the first study, we included 411 patients without UTI treated at the same place and period. The quick tests studied, direct microscopy (Gram), pyuria and nitrite were performed according to the respective protocols, quality control measures were performed in all stages. Results: The sample consisted of 342 (83%) adults and 69 (17%) children. The gender distribution showed that a greater number of episodes occurred in females (85%). Of 22 antibiotics tested, the highest prevalence of resistance was found for ampicillinsulbactam (41%), ampicillin (49%), cephalothin (33%) and trimethoprimsulfamethoxazole (36%), and we also noticed an unusual rate of resistance to ciprofloxacin (9%.) Forty-two percent of the isolates of E. coli were resistant to three or more drugs. There was an increase in the rate of resistance to cephalosporins, compared with a study conducted in the same city in 2001-2002. There were no significant variations in rates of resistance to most other antibiotics. Among the quick tests evaluated, the detection of pyuria had the highest sensitivity (95%, 95% CI: 92- 97%) and the lowest specificity (66%, 95% CI: 61-70%). The nitrite test had the highest specificity (99%, 95% CI: 98-100%) and the lowest sensitivity (45%, 95% CI: 40-50%). Overall, the most accurate test was the direct microscopy (84%, 95% CI: 79-88%), followed by the detection of pyuria (80%, 95% CI: 77-83%). The nitrite test had the highest positive predictive value (PPV) and the pyuria test the highest negative predictive value (NPV). Rapid tests showed modest agreement, the combination of positive results with the highest PPV was obtained from the tests of nitrite and direct microscopy (Gram), while the combination of direct microscopy (Gram) and negative pyuria had the highest NPV. Conclusion: E. coli isolates showed high rates of resistance to: ampicillin, ampicillinsulbactam, trimethoprim-sulfamethoxazole and cephalosporins, limiting the indication of these antibiotics for empirical treatment of community acquired UTIs. Despite the variation in sensitivity and specificity of the rapid tests evaluated, a positive nitrite test and a negative pyuria test showed the highest likelihood to confirm or exclude the diagnosis of UTI, respectively. Although rapid tests might be considered useful in the diagnosis of community acquired UTI, urine culture is still the definitive laboratory test for diagnosis of UTI.

Made available in DSpace on 2014-07-29T15:29:09Z (GMT). No. of bitstreams: 1 Dissertacao Rosemary A S Sobrinho.pdf: 331810 bytes, checksum: 90b92fefc7eba79f810a988a776beca0 (MD5) Previous issue date: 2011-05-06 / A urinary tract infection (UTI) is a very common disease and can occur at any age. The vast majority of UTIs is caused by enteric bacteria. The study aimed to identify the etiologic agents most frequently, the profile of antibiotic susceptibility and the factors possibly associated to the UTIs recurrents in women older than 15 years, cared for and / or admitted to the Hospital of the University of Goias. From March to November 2009, were invited and accepted to participate in the study 923 women in this age group and they were interviewed using a questionnaire about demographics data and risk factors for recurrent infections. Escherichia coli was the most frequent agent accounting for 67.9% of the total, followed by Enterobacter sp (6.2%), Klebsiella sp (6.2%), Proteus mirabilis (4.5%), Morganella morganii (4.0 %), Acinetobacter baumannii (2.8%) and Staphylococcus aureus (2.2%). %). E. coli showed higher rates of resistance to ampicillin in 46.7% patients with recurrent infection and 50.0% in infections nonrecurring; amoxicillin/clavulanate (32.6% and 35.7%), trimethoprim-sulfamethoxazole (30,0 and 25,0%, respectively) and 100,0% susceptibility to imipenem and nitrofurantoin in both groups. Enterobacter sp showed greater resistance to ampicillin, amoxicillin/clavulanic, norfloxacin and gentamicin (>88.0%) and greater susceptibility to amikacin, cefepime, imipinem and cephalosporins. Klebsiella sp showed high resistance to ampicillin and amoxicillin / clavulanate (> 60.0%) and greater susceptibility to quinolones (> 60.0%), amikacin and imipenem (100.0%) in both groups. There were no statistically significant differences between the risk for recurrent infection or not assessed for menopause, hypertension, hysterectomy, SEL (Systemic Erythematosus Lupus) and smoking. The only risk factor associated to recurrent infection in patients older than 50 years with diabetes. In this study, there was a greater number of E. coli in UTIs, followed by other enterobacteria such as Enterobacter sp and Klebsiella sp. Among all drugs tested, all the micro-organisms, were resistant generally to penicillins, being the most effective quinolones and carbapenems. / A infecção do trato urinário (ITU) é uma patologia muito frequente, podendo ocorrer em qualquer idade. A grande maioria das ITUs é causada por bactérias entéricas. O estudo teve como objetivos identificar os agentes etiológicos mais frequentes, o perfil de suscetibilidade aos antimicrobianos e os fatores possivelmente desencadeantes associados às ITUs recorrentes em mulheres com idade superior a 15 anos, atendidas e/ou internadas no Hospital das Clínicas da Universidade Federal de Goiás. No período de março a novembro de 2009, foram convidadas e aceitaram participar da pesquisa 923 mulheres nesta faixa etária e entrevistadas por meio de questionário sobre dados demográficos e fatores de risco para infecções recorrentes. Escherichia coli foi o agente mais frequente representando 67,9% do total, seguido por Enterobacter sp (6,2%), Klebsiella sp (6,2%), Proteus mirabilis (4,5%), Morganella morganii (4,0%), Acinetobacter baumanii (2,8%) e Staphylococcus aureus (2,2%). E. coli apresentou taxas maiores de resistência à ampicilina 46,7% nas pacientes com infecção recorrente e 50,0% nas com infecções não recorrentes; amoxilina/ácido clavulânico (32,6% e 35,7%), sulfametoxazol-trimetoprima (30,0 e 25,0%) respectivamente e 100,0% de suscetibilidade para nitrofurantoína e imipenem em ambos os grupos. Enterobacter sp demonstrou maior resistência à ampicilina, amoxicilina/ácido clavulânico, norfloxacina e gentamicina (>88,0%) e maior suscetibilidade à amicacina, cefepime, imipinem e cefalosporinas. Klebsiella sp demonstrou alta resistência para ampicilina e amoxicilina/ácido clavulânico (>60,0%) e maior suscetibilidade às quinolonas (>60,0%), amicacina e imipenem (100,0%) nos dois grupos estudados. Não foram detectadas diferenças estatisticamente significantes entre o risco para infecção recorrente ou não avaliado para menopausa, hipertensão, histerectomia, LES (Lúpus Eritematoso Sistêmico) e tabagismo. O único fator de risco associado à infecção recorrente foi diabetes em pacientes com mais de 50 anos. Neste estudo, verificou-se um maior número de E. coli nas ITUs e incidência bem menor de outras enterobactérias como Enterobacter sp e Klebsiella sp. Entre os antimicrobianos testados todos os micro-organismos foram resistentes, de um modo geral, às penicilinas sendo mais efetivos as quinolonas e carbapenemas.

Submitted by Erika Demachki (erikademachki@gmail.com) on 2017-03-31T17:24:43Z No. of bitstreams: 2 Dissertação - Andrea Santana de Oliveira - 2016.pdf: 1927842 bytes, checksum: 5b65d88f78b5077ed835f4eb96131b65 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-04-03T12:01:56Z (GMT) No. of bitstreams: 2 Dissertação - Andrea Santana de Oliveira - 2016.pdf: 1927842 bytes, checksum: 5b65d88f78b5077ed835f4eb96131b65 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-04-03T12:01:56Z (GMT). No. of bitstreams: 2 Dissertação - Andrea Santana de Oliveira - 2016.pdf: 1927842 bytes, checksum: 5b65d88f78b5077ed835f4eb96131b65 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-09-30 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Staphylococcus saprophyticus is a Gram-positive bacterium responsible for genitourinary infections, mainly affecting young sexually active women. Along with Escherichia coli is responsible for 90% of infections in fertile women, however, can cause infections in men and women of all ages. The repertoire of proteins secreted by pathogenic microorganisms is used to ensure success in the establishment of infection and persistence in the host. In this sense, this study aimed to comparative characterization of extracellular proteome of 3 clinical strain of S. saprophyticus, in order to detect possible differences in the secretion of proteins related to virulence and adaptation of the microorganism. The strains used in the study are called ATCC 15305, 7108 and 9325. Ultra-Performance Liquid Chromatography coupled to Mass Spectrometry in tandem (UPLC-MSE) have identified a total of 159 proteins. Among them, 44 were found in exoproteome of 3 strain, while 20 only in strains ATCC 15305 and 7108, 11 in ATCC 15305 and 9325, and 12 in 7108 and 9325. Fifteen peptides were expressed exclusively by S. saprophyticus 9325, 21 by ATCC 15305 strain and 36 by 7108. The three strain secreted molecules with biological function related to the glycolytic pathway, such as the triosephosphate isomerase (TPI), enolase, glyceraldehyde-3-phosphate dehydrogenase (GAPDH) and fructose-bisphosphate aldolase, molecules clearly involved in extracellular processes from other pathogenic organisms, proteins known as "moonlighting". Proteins involved in defense against stress, such as catalase, alkyl hydroperoxide reductase subunit C (AhpC), superoxide dismutase (SOD), were also detected in the analysis, among others related to metabolic processes such as lactic fermentation, cell wall synthesis, protein processing, and iron metabolism. Staphylococcal secretory antigen A (SsaA), a immunogenic molecule previously detected in ATCC 15305 strain, was not detected in strain 7108, as confirmed by Western-blotting assay. PCR reactions with specific primers and genomic DNA of the 3 strains and subsequent sequencing ssaA gene, showed that the strain has the gene under conditions identical to those found in S. saprophyticus ATCC 15305 and 9325, but is not able to secrete the antigen into the extracellular milieu, under environmental conditions in study. In exoproteome S. saprophyticus 7108 was found to take a greater amount of unique proteins, including four of the class of peptidases, enzymes often identified as potential virulence factors of bacterial. Thus, the differences found in repertoire of extracellular proteins of three clinical strain of S. saprophyticus, demonstrate a metabolic flexibility used by this uropathogen to promote pathogenesis in human genitourinary tract. / Staphylococcus saprophyticus é uma bactéria Gram-positiva responsável por infecções do trato geniturinário, acometendo principalmente mulheres jovens sexualmente ativas. Junto com Escherichia coli, é responsável por 90% das infecções em mulheres férteis, entretanto, pode causar infecções em homens e mulheres de todas as idades. O repertório de proteínas secretadas por microrganismos patogênicos é utilizado para garantir sucesso no estabelecimento da infecção e na persistência dentro do hospedeiro. Nesse sentido, este trabalho teve como objetivo principal a caracterização comparativa do proteoma extracelular de 3 cepas clínicas de S. saprophyticus, com a finalidade de detectar possíveis diferenças na secreção de proteínas relacionadas à virulência e adaptação do microrganismo. As cepas utilizadas no estudo são denominadas de ATCC 15305, 7108 e 9325. Por meio da Cromatografia Líquida de Ultra Desempenho acoplada à Espectrometria de Massas in tandem (UPLC-MSE), foram identificadas um total de 159 proteínas. Dentre elas, 44 foram encontradas no exoproteoma dos 3 cepas, enquanto que 20 apenas nas cepas ATCC 15305 e 7108, 11 em ATCC 15305 e 9325, e 12 nas cepas 7108 e 9325. Quinze peptídeos foram expressos exclusivamente por S. saprophyticus 9325, 21 pelo ATCC 15305 e 36 pela cepa 7108. Os três cepas secretaram moléculas com função biológica relacionada à via glicolítica, como a triose-fosfato isomerase (TPI), enolase, gliceraldeído-3-fosfato desidrogenase (GAPDH) e frutose-bifosfato aldolase, moléculas claramente envolvidas em processos extracelulares de outros organismos patogênicos, conhecidas como proteínas “moonlighting”. Proteínas envolvidas na defesa contra o estresse, como a catalase, a alquil hidroperóxido redutase subunidade C (AhpC), a superóxido dismutase (SOD), também foram detectadas na análise, dentre outras relacionadas à processos metabólicos como fermentação lática, síntese de parede celular, processamento de proteínas e metabolismo do ferro. O antígeno estafilocócico secretado A (SsaA), uma molécula imunogênica detectada previamente na cepa ATCC 15305, não foi detectada na cepa 7108, dado confirmado por ensaio de Western-blotting. Reações de PCR com primers específicos e DNA genômico das 3 cepas e posterior sequenciamento do gene ssaA, mostrou que a cepa possui o gene em condições idênticas ao encontrado em S. saprophyticus ATCC 15305 e 9325, porém não é capaz de secretar o antígeno para o meio extracelular, nas condições ambientais em estudo. No exoproteoma de S. saprophyticus 7108 foi encontrada uma maior quantidade de proteínas exclusivas, incluindo quatro da classe das peptidases, enzimas apontadas muitas vezes como potenciais fatores de virulência bacteriana. Desta forma, as diferenças encontradas no repertório de proteínas extracelulares de 3 cepas clínicas de S. saprophyticus, demonstram uma flexibilidade metabólica utilizada por este uropatógeno em promover a patogênese no trato geniturinário humano.

Avaliar a associação entre as infecções genito-urinárias, o comprimento do colo uterino e a prematuridade é importante para determinar quais podem ser os fatores preditivos para o parto pré-termo. Foi realizado estudo tipo coorte de conveniência, prospectivo, avaliando 1370 gestantes na cidade de Ribeirão Preto, com idade gestacional entre 20 e 25 semanas. Aplicou-se questionário sócio demográfico com história reprodutiva para a identificação do histórico obstétrico, idade materna, paridade, tabagismo e antecedente de parto pré-termo. Foi realizada ultrassonografia endovaginal para a avaliação do comprimento do colo uterino segundo as diretrizes da Fetal Medicine Foundation (FMF). Foram coletadas amostras de urina e conteúdo vaginal para avaliar a presença de infecção urinária e vaginose bacteriana respectivamente. A associação entre infecções, comprimento do colo uterino e parto pré-termo (PPT) foi realizada mediante teste não paramétrico e o cálculo do Risco Relativo das diferentes variáveis, por meio do ajuste de modelos log-binomiais. Das 1370 mulheres grávidas avaliadas, 132(9,63%) cursaram com parto pré-termo (<37 semanas), sendo que 19 (14,4%) dos partos pré-termo ocorreram em mulheres com colo <= 2,5 cm. O estudo microbiológico determinou que no grupo das mulheres que cursaram com parto pré-termo, 15 apresentaram ITU, 19 apresentaram vaginose bacteriana (VB) e uma apresentou ITU e VB. Avaliando as 75 pacientes com PPT espontâneos, 10 apresentaram ITU e 14, VB. Após a análise destes dados, foi possível concluir que o colo uterino curto entre 20 e 25 semanas de gestação está associado ao PPT e que ITU e VB rastreadas nesta idade não se associaram ao encurtamento do colo nem ao PPT. No entanto a ITU, mesmo assintomática apresentou relação com o PPT espontâneo. / To evaluate the association between the genito-urinary infections, cervical length and preterm birth is important to determine which can be predictive factors for preterm birth. It was conducted cohort study of convenience, prospective, evaluating 1370 pregnant women in the city of Ribeirão Preto, with gestational age between 20 and 25 weeks. Applied socio-demographic questionnaire with reproductive history to identify the obstetric history, maternal age, parity, smoking and preterm birth (PTB) history. Transvaginal ultrasonography was performed for evaluation of cervical length in the guidelines of the Fetal Medicine Foundation (FMF). Urine and vaginal discharge samples were collected to evaluate the presence of urinary tract infection (UTI) and bacterial vaginosis (BV) respectively. The association between infections, cervical length and preterm delivery was performed using non-parametric test and calculate the relative risk of different variables, by adjusting log-binomial model. Of the 1370 evaluated pregnant women, 132 (9.63%) presenting with preterm delivery (<37 weeks), and 19 (14.4%) of preterm deliveries occurred in women with cervix <=2.5 cm. The microbiological study found that the group of women presenting with preterm birth(PTB), 15 had UTI, 19 had BV and one presented UTI and VB. Evaluating 75 patients with spontaneous PTB, 10 had UTI and 14, BV. After the analysis of these data, it was concluded that the short cervix between 20 and 25 weeks of gestation is associated with the PTB and UTI and VB screened at this age not associated to the shortening of the cervix or the PTB. However, the UTI even asymptomatic were related to the spontaneous PTB.

L’infection des voies urinaires est l'une des infections bactériennes les plus courantes avec des coûts de soins de santé très élevés. On estime que 50% des femmes connaîtront une infection urinaire au cours de leur vie, ceci de manière récurrente chez la moitié d’entre elles. Le développement de thérapies efficaces a été limité par le manque de connaissance concernant la mise en place de la réponse immune adaptative lors de cette infection. Dans cette étude, nous avons démontré qu'une réponse adaptative est générée lors de l'infection urinaire, cependant celle-ci n’a pas d’action protectrice. Afin de comprendre les mécanismes aboutissant à ce phénomène, nous avons cherché à caractériser les cellules immunitaires présentes dans la vessie. Des tests d’absorption bactérienne ont montré que ces macrophages phagocytent la majorité des bactéries au début de l'infection. Pour évaluer l’influence de ces cellules sur la mise en place de la réponse immune adaptative, nous avons déplété les macrophages et évalué la clairance bactérienne lors d’une deuxième infection. En comparaison avec les animaux non traités, les souris déplétées présentaient une réduction de la charge bactérienne conséquente lors de la seconde infection, cette clairance dépendant de la réponse immune adaptative. Pour comprendre ce mécanisme d'inhibition par les macrophages, nous avons évalué le microenvironnement vésical et la phagocytose au début de l'infection chez les souris déplétées, et chez les souris non traitées. Bien que nous n’ayons pas observé de différences dans la production de cytokines, l'absorption bactérienne par les cellules dendritiques s’avère deux fois plus importante chez les animaux déplétés. Ces données suggèrent que l'absorption bactérienne par les macrophages tissulaires est néfaste pour la mise en place de la réponse adaptative, ouvrant de nouvelles options thérapeutiques. Nous avons également évalué le rôle des lymphocytes T dans ce processus en déplétant ces cellules au cours de l'infection primaire ou avant la deuxième infection. Ainsi, nous avons observé que les lymphocytes T sont nécessaires dans la réponse adaptative, mais ne sont cependant pas indispensables à la clairance bactérienne lors d'une réinfection. De plus, l'infection des souris Batf3-/-, déplétées en cellules dendritiques spécialisées dans la présentation croisée, a montré que ces souris contrôlent une seconde infection aussi bien que les souris contrôle. Ces résultats suggérent que la présence lymphocytes T CD8+ n’est pas nécessaire pour lutter contre l’infection urinaire. Notre étude révèle un mécanisme par lequel le système immunitaire est compromis lors de l'infection urinaire, offrant un point de départ intéressant pour une recherche plus approfondie sur le rôle du système immunitaire adaptatif dans ce contexte, élément fondamental dans le développement de nouvelles thérapies. / Urinary tract infection (UTI) is one of the most common bacterial infections with exorbitant health care costs. It is estimated that 50% of women will experience a UTI during their lifetime and approximately half will suffer recurrent infections. Infected women are treated with antibiotics, however, antibiotic resistance is increasing, raising the need for new therapeutic options. Development of efficient therapies has been impeded by the lack of knowledge of events leading to adaptive immunity. In this study, we demonstrated that an adaptive immune response is generated during UTI, however this response does not confer protective immunity. To begin to understand why the response induced during UTI was not effective, we delineated the immune cell compartment of the bladder and identified macrophages as the most populous immune cell. We evaluated bacterial acquisition in the bladder observing that macrophages phagocytize the majority of the bacteria early in infection. To evaluate the impact of macrophages on the generation of adaptive immunity, we depleted bladder resident macrophages and evaluated bacterial clearance during a challenge infection. Interestingly, mice depleted of resident macrophages, prior to primary infection, exhibited a nearly 2-log reduction in bacterial burden following secondary challenge compared to untreated animals. This improvement in clearance was dependent on the adaptive immune system. To shed light on the mechanism of macrophage inhibition, we evaluated the bladder microenvironment and bacterial acquisition early in infection in macrophage-depleted and control-treated mice. While we did not observe differences in the cytokine microenvironment, bacterial uptake by dendritic cells was increased nearly 2-fold in macrophage-depleted animals. These data suggest that bacterial uptake by tissue macrophages negatively impacts the development of adaptive immunity, revealing a novel target for enhancing host responses to bacterial infection of the bladder. We also evaluated the role of T cells during UTI by depleting these cells during the course of the infection or just prior to challenge infection. We observed that T cells were necessary to mount an adaptive immune response to UTI, however, they were dispensable for bacterial killing during challenge infection. Additionally, infection of Batf3-/- mice, lacking cross-presenting dendritic cells, suggested that CD8+ T cells are dispensable for the response against UTI as these mice cleared a challenge infection as well as wildtype mice. Our study has revealed a mechanism by which the immune system is compromised during UTI, providing an interesting start point for further investigation of the role of the adaptive immune system during UTI, which will be fundamental for the development of new therapies to efficiently treat infection.

Les infections urinaires (IUs) sont un motif très fréquent de consultation et de prescription d’antibiotique en médecine générale. Le choix de l’antibiotique repose sur les caractéristiques du patient, la susceptibilité des germes aux antibiotiques et des analyses de coût. Cette démarche thérapeutique est devenue de plus en plus complexe en raison de l’augmentation des résistantes aux antibiotiques. Dans ce contexte, mon travail de thèse repose sur deux principales études :A partir des données d’IMS-health France, une analyse spectrale des ventes d’antibiotiques urinaires a montré l’existence d’une saisonnalité annuelle entre 2001 et 2012 avec des pics estivaux. A partir des données de recherche de Google en France et dans six autres pays, le même phénomène a été observé. Ceci représente un argument en faveur d’une saisonnalité des cystites aigues simples.Une étude a été mise en place, visant à estimer l’incidence des IUs à germes résistants et à déterminer les facteurs associés à l’acquisition de ces germes. Un taux d'incidence annuel des IUs présumées en médecine générale a été estimé à 3 200 pour 100 000 femmes en France [IC 95%: 2 400-4 000], avec un taux d'incidence annuel des infections urinaires à E. coli résistant au fluoroquinolone en médecine générale à 102 pour 100 000 femmes en France [IC 95%: 30-50]. Les facteurs associés aux IU à entérobactéries résistantes à plus de trois classes d’antibiotique étaient l'utilisation de la pénicilline par la patiente (OR = 3,1 ; [1,2-8,0]), avoir fourni un hébergement à un résident d'un pays à haut risque de résistance aux antibiotiques (OR = 4,0 [1,2-15,1]) et la consommation de viande crue (OR = 0,3 ; [0,1-0,9]). / Urinary tract infections (IUs) are a frequent reason for consultation and prescription of antibiotics in general practice. The choice of the antibiotic is based on the patient’s characteristics, the antibiotic susceptibility of bacteria and cost analyzes. This therapeutic approach has become increasingly complex due to the increase in antibiotic resistance. In this context, my thesis is based on two main studies:From the data of IMS health France, a spectral analysis of urinary antibiotic sales was shown the existence of an annual seasonality between 2001 and 2012 with summer peaks. The same phenomenon was been observed from Google search data in France and in six other countries. This is an argument for seasonality in acute cystitis.Another study was set up, to estimate the incidence of resistant germs in IUs and identify factors associated with the acquisition of these germs. An annual incidence rate of IUs in general practice was estimated at 3,200 per 100,000 women in France [95% CI: 2,400-4,000], with an annual incidence rate of IUs due to E. coli resistant to fluoroquinolone in general practice at 102 per 100,000 women in France [95% CI: 30-50]. Factors associated with IU due to Enterobacteriaceae resistant to more than three classes of antibiotic were having used penicillin by the patient (OR = 3.1; [1.2 to 8.0]), having provided accommodation to a resident of a country at high risk for antibiotic resistance (OR = 4.0 [1.2 to 15.1]) and raw meat consumption (OR = 0.3; [0.1-0.9] ).

No description available.

In the United States, many hospitalized patients with indwelling urinary catheters acquire catheter-associated urinary tract infections (CAUTI) during their hospital stay. CAUTI negatively affects peoples' health and quality of life and causes a financial burden to individuals and the nation. The purpose of this quantitative cross-sectional study was to explore the relationship between gender, age, and hospital types and CAUTI incidence in New York and North Carolina over a 3-year period. The theoretical framework of choice was the Donabedian model. Simple logistic regression and hierarchical multivariable logistic regression analysis were performed on archival data that was requested from Healthcare Cost and Utilization Project (HCUP) agency. According to the findings, males (n = 61,040) were at a higher risk of developing CAUTI compared to female (n = 66,792) (p < .001) in New York and North Carolina between 2012 and 2014. The odds of getting CAUTI were much higher among age > = 45 compared to the < 17 years. These findings fit in with previous literature identifying age and gender as having a significant relationship with CAUTI occurrence. The outcomes in this study may guide the formulation of policies that are age-appropriate, gender-specific, and facility-tailored to reduce the incidence of CAUTI.

Background: Urinary tract infection (UTI) is a common bacterial infection that is usually diagnosed by symptoms such as dysuria and frequency, and the golden standard is to take a urine culture to identify bacteria that may cause UTI. This method was founded with the idea that normal urine is sterile, but this is now being questioned because of growing evidence of a urinary microbiota thus giving a new approach to methods for UTI diagnosis. Aim: To identify and re-evaluate findings of bacteria from urine cultures in the ongoing paradigm shift of a potential urinary microbiome, and dysbiosis as a cause for UTI. Materials and Methods: This study used MALDI-TOF MS to identify approximately 250 bacteria isolates that had been cultured by Expanded Quantitative Urine Culture (EQUC) from 162 women with symptoms of cystitis. EQUC had allowed the bacteria to grow in both CO2 and anaerobic conditions, which differs from standard techniques.   Results and Conclusion: Escherichia coli and Enterococcus faecalis dominated the results of most frequently identified bacteria. However, other bacteria were commonly present within the same culture which is traditionally considered as contamination but may now indicate a urinary flora. Anaerobic bacteria – such as Porphyromonas sp. – were also identified, but their connection to UTI is unclear. Lactobacillus sp. – which are associated with a healthy flora in women – were found in urine cultures and often in smaller quantities which could suggest dysbiosis. More research on Lactobacillus sp. and their correlation with UTI is suggested for a more accurate indication of urinary dysbiosis in women.

Bakgrund: En kateterrelaterad urinvägsinfektion är en vanlig vårdrelaterad infektion som drabbar patienter i olika åldrar och medför lidande, förlängda vårdtider samt ökade vårdkostnader. Risken ökar med långvarig kateteranvändning, ålder och andra försämrade hälsotillstånd. Sjuksköterskor har en viktig roll i att förebygga och hantera kateterrelaterade urinvägsinfektioner genom evidensbaserad omvårdnad.  Syfte: Syftet med studien var att undersöka hur sjuksköterskan kan förebygga kateterrelaterad urinvägsinfektion. Metod: En allmän litteraturstudie av tidigare forskning gjordes genom granskning av fem kvalitativa, tolv kvantitativa och en mixad metod-studie. Resultat: Fem kategorier identifierades: arbetsplatsen och samarbetets påverkan, kunskapen hos sjuksköterskor, material och tillvägagångsätt vid kateterisering, sjuksköterskors arbetsrutiner med katetrar och förebyggande åtgärder vid kateteranvändning. Resultatet visade att kunskap bland vårdpersonal och patienter behöver öka samt att valet av kateter kan minska risken att få en kateterrelaterad urinvägsinfektion. Flera olika förebyggande åtgärder identifierades, som specifika riktlinjer för hur katetern ska skötas samt användning av checklistor och bedömningsverktyg för att minska felaktigt användande av kateter. Konklusion: För att förebygga kateterrelaterad urinvägsinfektion krävs förbättrad säkerhetskultur, samarbete, trivsel på arbetsplatsen, utbildning, material och evidensbaserade riktlinjer. / Background: A catheter-associated urinary tract infection is a common healthcare-associated infection that affects patients of different ages, causing suffering, prolonged hospital stays, and increased healthcare costs. The risk increases with prolonged catheter use, age, and other health conditions. Nurses play a crucial role in preventing and managing catheter-associated urinary tract infections through evidence-based care. Aim: The aim of the study was to investigate how the nurse can prevent catheter-associated urinary tract infection. Method: A general literature review of previous research, including five qualitative, twelve quantitative, and one mixed-method study, was conducted to compile current knowledge on preventive measures. Results: Five categories were identified: workplace and collaboration impact, nurses' knowledge, materials and approaches in catheterization, nurses' catheter care routines, and nurses' and patients' impact during catheter use. The results showed that knowledge among healthcare staff and patients’ needs to increase, and the choice of catheter can reduce the risk of catheter-associated urinary tract infections. Preventive measures such as specific guidelines for catheter care and the use of checklists and assessment tools to reduce improper catheter use. Conclusion:Preventing catheter-associated urinary tract infections requires improved safety culture, collaboration, workplace satisfaction, education, materials, and evidence-based guidelines.