<p>The urinary tract is one of the most intractable mucosal surfaces for pathogens to colonize. In addition to the natural barriers at this site, potential pathogens have to contend with the vigorous local innate immune response that is initiated by engagement of surveillance molecule TLRs. TLR4 appears to be not only exclusively expressed on superficial BECs but also critical to triggering robust local innate immune responses. TLR4 recognizes Gram-negative bacterial component LPS and initiates a series of intracellular NF-kappaB associated signaling events resulting in a cytokine response. We examined intracellular signaling events in human BECs leading to the production of IL-6, a major urinary cytokine, following activation by E. coli and isolated LPS, and observed that, in addition to the classical NF-kappaB associated pathway, BEC TLR4 triggers a distinct and more rapid signaling response involving, sequentially, Ca2+, AC3 generated cAMP, and the transcriptional factor CREB. This capacity of BECs to mobilize secondary messengers and evoke a more rapid IL-6 response might be critical in their role as first responders to microbial challenge in the urinary tract. </p><p>Here, we also report two additional distinct TLR4-mediated defense mechanisms in BECs. First, BEC TLR4 inhibits bacterial invasion, a necessary step for successful infection. TLR4-mediated suppression of bacterial invasion was linked to increased intracellular cAMP levels which negatively impacted Rac-1 mediated mobilization of the cytoskeleton. Additionally, we found that BECs continue to fight UPEC even after bacterial invasion by triggering bacterial exocytosis through a distinct TLR4-mediated mechanism following activation by LPS. In addition, we reveal that Caveolin-1, Rab27b, PKA, and MyRIP are components of the exocytic compartment and that they form a complex involved in the exocytosis of bacteria. The ability of TLR4 to mediate the rapid cytokine response, the inhibition of bacterial invasion, and the expulsion of intracellular bacteria from infected cells represents three previously unrecognized functions for this innate immune receptor.</p> / Dissertation

Catheter associated urinary tract infection (CAUTI) incidence continue to rise despite all prevention efforts. The state of Georgia incidence of CAUTI between 2012 and 2013 showed an increase by 350 cases. The challenge is translating CAUTI prevention knowledge into practice by all physicians. The purpose of this correlational study was to improve the epidemiological understanding of CAUTI. Looking at physicians' perception and practice of CAUTI preventions was necessary. A total of 336 physicians from the state of Georgia completed a 26-item survey. Additionally, a pilot study was conducted on a small sample of participants. The result of the Cronbach alpha for the pilot study analysis of the 26-item survey instrument indicated excellent reliability. The analysis revealed that participants' frequency of training on proper catheterization and their perception of CAUTI risk factors and effective implementation of CAUTI prevention bundle elements, varied significantly. It also resulted that many of the participants were not knowledgeable of certain important CAUTI prevention elements. Only a few made changes in their practice despite knowledge of the Center for Medicare and Medicaid Services reimbursement policy. Results of the Pearson's chi-square test for independence indicated a significant correlation (p < .05) between physicians' perception and practice of CAUTI prevention elements and CAUTI incidence. The results of this study suggest that current CAUTI prevention practice may be inefficient without the effective implementation of proven bundled element. Improved understanding of CAUTI and its relation to effective implementation of bundled prevention elements may result in improved prevention efforts, decreased morbidity, mortality, and overall healthcare cost.

Most urinary tract infections in humans and dogs are caused by uropathogenic strains of , and increasing antimicrobial resistance among these pathogens has created a need for a novel approach to therapy. Bacterial iron uptake and metabolism are potential targets for novel antimicrobial therapy, as iron is a limiting factor in . growth during infection. As a trivalent metal of similar atomic size to iron (III), gallium can interact with a wide variety of biomolecules that normally contain or interact with iron. Gallium compounds disrupt bacterial iron metabolism, are known to accumulate at sites of infection and inflammation in mammals, exert antimicrobial activity against multiple bacterial pathogens in vitro, and may be good candidates as novel antimicrobial drugs. We assessed the suitability of orally administered gallium maltolate as a potential new antimicrobial therapy for urinary tract infections by evaluating its distribution into the bladder, its activity against uropathogenic . in vitro, and its pharmacokinetics and efficacy in a mouse cystitis model. Using a novel application of synchrotron-based analytical methods, we confirmed the distribution of gallium to the bladder mucosa and characterized the relationship between iron and gallium distribution in the bladder. In vitro experiments with human and canine uropathogenic . isolates demonstrated that gallium maltolate exerts antimicrobial effects in a time-dependent, bacteriostatic manner. Minimum inhibitory concentrations ranged from 0.144 µmol/mL to >9.20 µmol/mL with a median of 1.15 µmol/mL. Isolates resistant to ampicillin, ciprofloxacin, or with decreased susceptibility to cephalothin were susceptible to the antimicrobial activity of gallium maltolate, suggesting that resistance to conventional antimicrobials does not predict resistance to gallium maltolate. Pharmacokinetic studies in healthy mice and in a mouse model of urinary tract infection confirmed that gallium is absorbed into systemic circulation after oral administration of gallium maltolate. Gallium is slowly eliminated from the body, with a trend toward longer terminal half-lives in blood and bladder for infected mice relative to healthy mice. This study did not reveal any statistically significant effect of infection status on maximum blood gallium concentrations (4.46 nmol/mL, 95% confidence interval 2.75 nmol/mL – 6.18 nmol/mL and 4.80 nmol/mL, 95% confidence interval 2.53 nmol/mL – 7.06 nmol/mL in healthy and infected mice, respectively) or total gallium exposure in blood and kidney as represented by area under the concentration vs. time curves. Gallium exposure in the bladder was significantly greater for mice with urinary tract infections than for healthy mice. The investigation of gallium distribution within tissues represented a novel application of synchrotron-based analytical techniques to antimicrobial pharmacokinetics. Prior to analysing tissue samples, a library of x-ray absorption spectra was assembled for gallium compounds in both the hard and soft x-ray ranges. The suitability of hard x-ray fluorescence imaging and scanning and transmission x-ray microscopy for localizing and speciating trace elements in tissues was subsequently assessed. Of these methods, only hard x-ray microprobe analysis was well-suited to the analysis and was successfully used for this application. This approach confirmed that gallium arrives at the bladder mucosa after oral administration of gallium maltolate. Furthermore, comparison of iron and gallium distribution within the bladder mucosa indicated that these elements are similarly but not identically distributed and that they do not significantly inhibit one another’s distribution. This finding suggests that gallium may be distributed in part via pathways that do not involve iron. Despite the favorable distribution characteristics of gallium and the persistence of gallium in target tissues following the oral administration of gallium maltolate, its efficacy in a mouse model of urinary tract infection was disappointing. In this study, no statistically significant difference was detected between gallium maltolate, ciprofloxacin and sham treatments in their ability to eliminate bacteria in the urinary tracts. The failure of ciprofloxacin treatment to render bladder tissue culture-negative for an organism that is classified as ciprofloxacin-susceptible in vitro is consistent with observations from other research groups. The similar lack of efficacy observed for gallium maltolate may be related to the large gap between minimum inhibitory concentrations observed in vitro and gallium concentrations observed in tissues from treated mice, but may also be related to the small study size if the effect size of gallium maltolate treatment is small. Given the magnitude of the difference between tissue concentrations and minimum inhibitory concentrations, it may not be possible to increase the dose sufficiently to achieve therapeutic concentrations without causing toxicity. While the results of these experiments suggest that orally administered gallium maltolate may not be a reasonable antimicrobial drug candidate for treating urinary tract infections caused by uropathogenic . , it may be useful for other applications. Other bacterial pathogens may be more susceptible to the antimicrobial effects of gallium maltolate, and local or topical administration could produce much higher concentrations than we observed following oral administration. Continued development of the synchrotron-based analytical techniques used in these experiments could provide new and important opportunities to investigate antimicrobial distribution and metabolism within cells and tissues, particularly for metal-based drugs.

Bakgrund: Urinvägsinfektion är den vanligast förekommande vårdrelaterade infektionen och innebär förekomst av bakterier i urinen med eller utan symtom. Det finns ett flertal faktorer som gör att äldre är en riskgrupp för att drabbas av urinvägsinfektion bland annat samsjuklighet och funktionsnedsättningar. Urinvägsinfektioner leder till lidande hos den äldre individen och stora kostnader för samhället. Sjuksköterskan har ett ansvar att förebygga sjukdom och minska lidande. Syfte: Syftet var att beskriva sjuksköterskans omvårdnadsåtgärder, upplevda effekter samt effekter av dessa, för att förebygga uppkomst av urinvägsinfektion hos äldre samt att beskriva de inkluderade artiklarnas urvalsmetod och undersökningsgrupp. Metod: En litteraturstudie med deskriptiv design. Studien baseras på 14 vetenskapliga artiklar. Av dessa var 12 stycken skrivna med kvantitativ ansats och två med kvalitativ ansats. Resultatet analyserades deduktivt utifrån Orems fem hjälpmetoder och subkategorierna framkom efter en induktiv analys. Huvudresultat: Resultatet sammanställdes i följande kategorier: Att göra något eller handla för en annan person med subkategorierna; God hygien, Specifika åtgärder relaterade till kateter, Ökat vätskeintag samt Profylaktiska läkemedel och tillskott. Att handleda en annan person, Att ge fysiskt och psykologiskt stöd, Att skapa en miljö som främjar utveckling samt Att undervisa. Slutsats: Sjuksköterskorna i studien använde sig av ett flertal olika omvårdnadsåtgärder för att förebygga urinvägsinfektion. Att förkorta tid med kateter samt att undvika att sätta kateter var de mest effektiva åtgärderna för att förebygga urinvägsinfektion. Sjuksköterskorna i studien upplevde att utbildning av patienter, omvårdnadspersonal och anhöriga samt ett ökat vätskeintag reducerade incidens av urinvägsinfektion. / Background: Urinary tract infection is the most common nosocomial infection and involves the presence of bacteria in the urine with or without symptoms. There are several factors that make that the elderly are at increased risk of suffering from urinary tract infection among other comorbidity and functional impairments. Urinary tract infections lead to suffering among elderly individuals and high costs for the society. The nurse has a responsibility to prevent disease and reduce suffering. Aim:The aim was to describe nursing care measures, perceived effects and the effects of these, in order to prevent the occurrence of urinary tract infection in the elderly and to describe the included articles in the sampling methodology and survey group. Method: A literature study with descriptive design. The study is based on 14 scientific articles. Of these, 12 studies with a quantitative approach and two studies with a qualitative approach. The results were analyzed deductively based on Orem´s five methods of helping. Subcategories emerged after an inductive analysis Main results: The results were compiled in the following categories: To do something or act for another person with subcategories; Good hygiene, Specific actions related to the indwelling urinary catheter, Increased fluid intake and Prophylactic agents / supplements. To mentor another person, To give physically and psychological support, To create an environment conducive to development and To educate. Conclusion: The nurses in the study used a variety of nursing interventions for preventing UTI. To shorten the time with the indwelling urinary catheter and to avoid inserting indwelling urinary catheter were the most effective methods to prevent urinary tract infections. The nurses in the study considered that education of patients, nursing staff and relatives and an increased fluid intake decreased incidence of urinary tract infections.

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

Objective: Primary transitional cell carcinoma (TCC) of the upper urinary tract represents 6–8% of all TCC cases. Nephroureterectomy with removal of a bladder cuff is the treatment of choice. The rates of TCC recurrence in the bladder after primary upper urinary tract surgery described in the literature range between 12.5 and 37.5%. In a retrospective analysis we examined the occurrence of TCC after nephroureterectomy for upper tract TCC in patients without a previous history of bladder TCC at the time of surgery. Methods: Between 1990 and 2002, 29 patients underwent primary nephroureterectomy for upper tract TCC. The mean age of the patients was 69.5 years. In 5 cases upper urinary tract tumors were multilocular, in the remaining cases unilocular in the renal pelvis (n = 12) or the ureter (n = 12). The follow-up was available for 29 patients with a mean follow-up of 3.37 (0.1–11.2) years. Results: 11/29 (37.9%) patients had TCC recurrence with 9/11 patients having bladder TCC diagnosed within 2.5 years (0.9–6.0) after nephroureterectomy. 13/29 patients are alive without TCC recurrence, 3/29 patients died due to systemic TCC progression and 5/29 died of unrelated causes without evidence of TCC recurrence. Conclusion: Our data indicate a high incidence of bladder TCC after nephroureterectomy for primary upper tract TCC of up to 6 years after primary surgery. Because of the high incidence of bladder TCC within the first 3 years of surgery, careful follow-up is needed over at least this period. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

The aim of this thesis was to explore the features of asymptomatic bacteriuria (ASB) in elderly people living in the community, and to seek diagnostic tools to discriminate between ASB and symptomatic urinary tract infection (UTI). All men and women aged 80 and over living in an urban district of Falun, Sweden, were invited to participate. Urine samples were obtained together with information on symptoms and on health indicators. The same cohort was surveyed again after 6 and 18 months. Urinary cytokines were analysed in 16 patients with UTI, in 24 subjects with ASB and in 20 negative controls. ASB occurred at baseline in 19.0% of women and 9.4% of men, and was found at least once in 36.9% of women and in 20.2% of men. ASB in women was associated with reduced mobility and urge urinary incontinence. Of those with ASB at baseline, 60% still had bacteriuria at 6 and 18 months, but among those with repeated findings of ASB with E. coli, only 40% had the same bacterial strain after 18 months. In women, the risk of developing a UTI within 24 months was higher among those with ASB at baseline than in those without. Urinary levels of cytokines (CXCL1, CXCL8 and IL-6) and leukocyte esterase were higher in patients with UTI than in patients with ASB. There is convincing evidence that ASB is harmless and should not be treated with antibiotics. However, such treatment is still often given, thereby unnecessarily contributing to the increased number of bacteria resistant to common antibiotics. This study confirms the high prevalence of ASB in elderly people living in the community. In order not to be misled by a urinary test showing bacteria, it is important to restrict urinary testing for bacteria to patients where there is a suspicion of UTI. In elderly patients with diffuse symptoms or in patients who are unable to communicate their symptoms, further diagnostic help could possibly be obtained by evaluating the urinary levels of leukocyte esterase and/or IL-6.

Submitted by Ana Maria Fiscina Sampaio (fiscina@bahia.fiocruz.br) on 2014-02-17T18:26:18Z No. of bitstreams: 1 Maria Goreth Matos de Andrade Barberino... Distribuição clonal 2013.pdf: 2055064 bytes, checksum: da2e73dad9d911837f5434c00617e1b0 (MD5) / Made available in DSpace on 2014-02-17T18:26:18Z (GMT). No. of bitstreams: 1 Maria Goreth Matos de Andrade Barberino... Distribuição clonal 2013.pdf: 2055064 bytes, checksum: da2e73dad9d911837f5434c00617e1b0 (MD5) Previous issue date: 2013 / Fundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Salvador, BA, Brasil / A infecção do trato urinário (ITU) é considerada a segunda infecção mais comum em humanos, estima-se que ocorram cerca de 150 milhões de casos de ITUs por ano no mundo. O aumento das taxas de resistência aos antimicrobianos entre os uropatógenos tem tornado mais difícil o tratamento das ITUs. Objetivo: Determinar a distribuição clonal das cepas de E. coli isoladas em pacientes com ITU adquirida na comunidade de acordo com o perfil de susceptibilidade aos antimicrobianos e avaliar o papel dos grupos clonais na disseminação e persistência da resistência nestas infecções. Métodos: Foram isoladas 874 cepas de E. coli em pacientes com ITU, procedentes de unidades ambulatoriais em três hospitais na cidade de Salvador–Ba, no período de 2001 a 2009. O perfil de susceptibilidade foi determinado por microdiluição em placa (Microscan-Siemens®). Nas amostras selecionadas para genotipagem (n=275), a identificação dos grupos clonais foi realizada pela comparação dos padrões de PFGE, utilizando os critérios de Tenover (1995). Em todas as etapas do estudo foi utilizada como controle de qualidade a cepa ATCC E. coli 25922. Resultado: Entre os antibióticos testados, a maior prevalência de resistência foi encontrada para ampicilina (AMP) (49%), cefalotina (12-33%) e sulfametoxazol-trimetropin (SXT) (36-42%). A taxa de resistência à ciprofloxacina (CIP) variou de 9 a 14%. Na análise da distribuição clonal, segundo os fenótipos de resistência aos antimicrobianos, encontramos maior predomínio de um grupo clonal CgA (63%) entre as cepas consideradas multidroga resistentes. Diferentemente das amostras com algum grau de resistência ou multi-sensíveis, nas quais observamos diversidade clonal. Conclusão: A alta prevalência de resistência a SXT, AMP e cefalotina contraindica o uso destes antimicrobianos no tratamento empírico das ITU adquiridas na comunidade. A taxa de resistência à CIP relativamente alta, alerta para o aumento e disseminação de resistência a este antimicrobiano na comunidade. Isto irá dificultar e onerar o tratamento destas infecções. Observamos a surgimento de um grupo clonal (CgA) no período final do estudo (2008 a 2009) associado às cepas multidroga resistentes. Este achado sugere que a expansão de determinados clones pode ter um papel importante na disseminação de resistência bacteriana em ITUs adquiridas na comunidade. / Urinary tract infection (UTI) is considered the second most common infection in humans. It is estimated that there are about 150 million cases of UTIs per year worldwide. Increasing rates of antimicrobial resistance among uropathogens challenges UTI treatments. Objective: To determine the distribution of clonal strains of E. coli isolated from patients with community-acquired UTI according to the profile of antimicrobial susceptibility; and to evaluate the role of clonal groups in the spread and persistence of resistance in these infections. Methods: Eight hundred seventy four strains of E. coli were isolated from patients with UTI, coming from outpatient clinics in three hospitals in the city of Salvador - Bahia, from 2001 to 2009. The susceptibility profile was determined by broth microdilution method (Siemens - Microscan ®). The samples selected for genotyping (n = 275) were identified for clonal groups by comparing the patterns of PFGE, using the criteria of Tenover (1995). All study stages were quality control by strain E. coli ATCC 25922. Results: Among the antibiotics tested, the highest prevalence of resistance was for ampicillin (AMP) (49%) followed by trimethoprim - sulfamethoxazole (SXT) (36-42%) and for cephalothin (12-33%). The rate of resistance to ciprofloxacin (CIP) ranged between 9-14 %. In the Clonal Analysis distribution, performed according to antimicrobial resistance phenotypes, we found a higher prevalence of a clonal group CgA (63%) among multidrug resistant strains. This result differs from samples with some degree of resistance or multi-sensitive in which we observed clonal diversity. Conclusion: The high prevalence of resistance to SXT, AMP, and cephalothin contraindicate the use of these antibiotics in the empirical treatment of community-acquired UTI. The relatively high rate of resistance to CIP, raises attention to the increase and spread of antimicrobial resistance in this community and potentially complicate and encumber the treatment of these infections. We observe the emergence of a clonal group (CgA) in the final period of the study (2008-2009) associated with multidrug resistant strains. This finding suggests that the expansion of particular clones may have an important role in the spread of bacterial resistance in community-acquired UTI.

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.

Escherichia coli et Enterococcus faecalis sont deux principaux agents pathogènes impliqués dans les infections du tractus urinaire (ITU) en médecine de ville et à l’hôpital. Ces espèces bactériennes sont responsables d’ITU aigües avec des phénomènes de récurrence et dans des ITU chroniques. La consommation d'antibiotiques est directement corrélée à la résistance des bactéries uropathogènes ce qui montre l'importance de contrôler l'utilisation des antibiotiques et de développer des traitements préventifs et curatifs alternatifs pour les infections urinaires.La consommation alimentaire de cranberry et de leurs extraits est traditionnellement associée avec le maintien en bonne santé des voies urinaires. Par ailleurs, certaines études cliniques semblent montrer un effet préventif des ITU associé à la consommation alimentaire de cranberry. In vitro et ex vivo, la consommation de ces extraits par l’homme réduit l’adhérence de certaines souches d’E. coli aux cellules épithéliales urinaires et la formation de biofilm de différentes espèces. L’hypothèse de travail est que la consommation alimentaire d’extraits de cranberry conduise à la formation de métabolites urinaires qui diminuent l'adhérence des bactéries uropathogènes à l’épithélium urinaire. Ce mécanisme serait à la base de la prévention des ITU par consommation d’extraits de cranberry. Cependant, les métabolites bioactifs restent largement méconnus. / Escherichia coli and Enterococcus faecalis are two main pathogens involved in urinary tract infections (ITU) in town medicine and in the hospital. These bacterial species are responsible for acute UTIs with recurrence phenomena and in chronic ITUs. The consumption of antibiotics is directly correlated with the resistance of uropathogenic bacteria, which shows the importance of controlling the use of antibiotics and of developing alternative preventive and curative treatments for urinary infections.Cranberry consumption of their extracts is traditionally associated with the maintenance of healthy urinary tract. In addition, some clinical studies seem to show a preventive effect of ITUs associated with cranberry consumption. In vitro and ex vivo, the consumption of these extracts by humans reduces the adhesion of certain E. coli strains to urinary epithelial cells and biofilm formation of different species. The working hypothesis is that the consumption of cranberry extracts leads to the formation of urinary metabolites that decrease the adhesion of uropathogenic bacteria to the urinary epithelium. This mechanism would be the basis for the prevention of ITU by consumption of cranberry extracts. However, bioactive metabolites remain largely unknown.