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 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.

Urinalysis is a common laboratory test used for diagnosis of a variety of systemic and genitourinary diseases. Although, collection of sample for urinalysis is extremely easy, when performed during an office visit, in pediatric and geriatric populations, who use diaper, such collection is not trivial and can result in missing important diagnostic information. For example, urinary tract infections (UTIs), are a major source of morbidity in incontinent elderly with dementia who cannot communicate their symptom to their caregivers. Although most UTIs are easily treatable with antibiotics, if not identified and treated timely, they can cause ascending infection, loss of kidney function, sepsis, and possible death. Deployment of smart, autonomous, diaper-embedded systems that can detect early signs of urinary dysfunction can have a significant impact on healthcare of our rapidly aging population. In this dissertation, I propose a diaper-embedded, low-cost, and disposable sensing platform comprising of a urine-activated battery and sensors for detection of nitrite (a surrogate for UTI), red blood cells (hematuria), and protein (proteinuria). I will first discuss my efforts to develop an optical/colorimetric nitrite sensor and a urine-activated power source, all fabricated on a hydrophobic paper/polymeric substrate through laser-assisted machining and lamination-assembly. The system stays in a dormant state until wetted by urine, after which the on-board power source is activated, awakening the rest of the measurement system (i.e., a light emitting diode, a photodetector, interface electronics, and a low-power Bluetooth module) and transmitting the presence or absence of nitrite in the urine to vicinal caregivers in a point-of-care and autonomous fashion. Thorough characterization of the performance and reliability analysis of the platform are also presented to envision its use as an end product. Afterwards, I will discuss the characterization of sensors, based on similar principle, for detecting red blood cells (hematuria) and protein (proteinuria), and the extendibility of the proposed platform for a multi-parameter system measuring nitrite, blood, and protein in the urine. Finally, I will conclude with other possible applications besides urinalysis for the proposed system.

The epidemiology of urinary tract infection (UTI) in the population of Vännäs (8 000 inhabitants) was studied during one year. The annual incidence increased from 0.5% in the first decade of life to more than 10% in the age group 90-100 years. Male UTI comprised only 13% of the episodes, increased after middle age and contributed 4 0% by &gt; 80 years of age. At 17 PHC centres (PHCCs) a prevalence study (McPHC) of mainly uncomplicated UTI was performed. Most episodes were acutely symptomatic (lower 75%, upper 5%). Microscopy of wet-stained urinary sediment with a minimum of moderate amount of bacteria and/or 5 leukocytes per high power field (4 00 x) as breakpoint resulted in a desired high sensitivity (97%) and 86% efficacy in acutely symptomatic patients. Diagnosis of bacteriuria using Uricult dipslides yielded acceptable results with an overall efficacy of 88%. Nitrite test and Uriglox showed an unacceptable low mean sensitivity ofR56 and 69%, respectively. A positive nitrite, sediment or Uricult , when used in combination, was optimal in diagnosing UTI with a sensitivity of 98% in acutely symptomatic patients during their office visits. The average risk of drug resistance was 17% in the Vännäs study. Sensicult satisfactorily predicted drug sensitivity (93%) but not bacterial drug resistance (50%). Using Uricult with classification of bacteriuria by Gram-grouping, lactose and catalase reactions for targeting UTI therapy, according to local guidelines, resulted in a similar low risk (6 %) of prescribing drugs to which the organisms were resistagt as when using Sensicult (7%). This development of the Uricult method is simple and can be recommended for office practice in PHC. The spectrum of bacteria causing UTI and their drug resistance was more associated with the selection of patients, sex and age than with symptoms. The pattern of drug resistance was little influenced by UTI history and the mean pretherapy resistance for the seven drugs tested in McPHC was low (7%). Drug resistance was increased in failure (mean 24%) but not in early or repeated recurrence. In McPHC therapy resulted in 8% bacteriological failure and 12% early recurrence, irrespective of whether the bacteria were classified as sensitive or resistant in vitro to the drug given. Thus, in order to be of prognostic value for therapy of uncomplicated UTI, high-level breakpoints focusing more on peak urinary drug concentrations need to be studied. UTI symptoms in McPHC were eradicated in only 2/3 of the bacterio- logically cured episodes and in 1/3 of the failures at control 1-3 days posttherapy showing that symptoms are an unreliable indicator of UTI. From current literature, it seems unlikely that asymptomatic bacteriuria (ABU) plays a major role in the development of uremia due to chronic pyelonephritis. With the exception of ABU in pregnancy, therapy seems to yield no benefit. Omitting posttherapy bacteriuria controls in patients with symptoms eradicated, at least in women with uncomplicated UTI, would lead to considerable savings both for patients and the health care system. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1988, härtill 6 uppsatser.</p> / digitalisering@umu