Résumé Introduction: Les infections urinaires (IU) sont les infections bactériennes les plus fréquentes chez les patients hospitalisés. Cette étude décrit les tendances temporelles d'admission et de mortalité liées aux hospitalisations pour les IU, ainsi que le fardeau économique associé. Les prédicteurs de mauvaise évolution clinique et de mortalité sont examinés par la suite. Méthodes: Les données ont été extraites à partir de la base de données du NIS entre le 1er janvier 1998 et le 31 décembre 2010. 1,717,181 hospitalisations liées aux IU ont été retenues. L'incidence et la mortalité ont été calculées et stratifiées selon le sexe, l'âge et la présence de sepsis. Les frais médians et totaux pour les hospitalisations sont calculés et ajustés pour l'inflation. Finalement, les prédicteurs d'avoir un sepsis induit par les IU et de mortalité sont examinés avec une analyse par régression logistique multivariée. Résultats: L'incidence globale d'hospitalisation et la mortalité associées aux IU voit une croissance annuel estimé (EAPC) de +4.764 et +4.610 respectivement (p<0.0001). L'augmentation d'incidence est le plus marquée pour les patients âgés de 55 à 64 ans (EAPC = +7.805; p<0.0001). Les frais médians par hospitalisation ont augmenté de $10 313 en 1998 à $21 049 en 2010 (EAPC +9.405; p<0.0001). Les frais globaux pour les hospitalisations des IU ont augmenté de $8.9 milliard en 1998 à $33.7 milliard en 2010 (EAPC +0.251; p<0.0001). Les patients âgés, de sexe masculin, de race afro-américaine, ainsi que les patients assurés par Medicaid ou ceux sans assurance, et les patients soignés à des centres non-académiques sont à risque plus important de mortalité (p<0.0001). Conclusion: L'incidence et la mortalité associées aux IU ont augmenté au cours de la dernière décennie. Les frais médians ajustés pour l'inflation ainsi que les frais globaux ont augmenté progressivement au cours de la période d'étude. Dans la cohorte étudiée, les patients âgés, de sexe masculin, de race afro-américaine, ainsi que les patients assurés par Medicaid ou ceux sans assurance, et les patients soignés à des centres non-académiques sont à risque plus important de mortalité. Ces données représentent des indicateurs de qualité de soins qui pourraient permettre d'adapter certaines politiques de soins de santé aux besoins des sous-populations plus vulnérables. / Abstract Introduction: Urinary tract infections (UTIs) are the most common bacterial infections in hospitalized patients. This study describes the temporal trends of admissions and mortality, as well as the economic burden of UTI-associated hospitalizations. Predictors of having severe disease as well as predictors of mortality were also examined. Methods: Data were retrieved from the Nationwide Inpatient Sample between 1998 and 2010, yielding a weighted sample of 1,717,181 UTI-associated admissions. Incidence and mortality rates were calculated and stratified according to gender, age, and the presence of sepsis. The median and total charges of hospitalization were calculated and adjusted for inflation. Finally, predictors of UTI induced sepsis and mortality were examined using logistic regression models. Results: The overall incidence and mortality of UTI-admissions has been increasing with an EAPC of +4.764 and +4.610 respectively (p<0.0001). The increase of UTI-admissions is most remarkable for patients aged 55-64 years (EAPC = +7.805; p<0.0001). Median cost per hospitalization has increased from $10,313 in 1998 to $21,049 (EAPC +9.405; p<0.0001). Overall total inpatient yearly cost rose from $8.9 billion in 1998 to $33.7 billion in 2010 (EAPC +0.251; p<0.0001). Increasing age, male gender, African-American race, patients with Medicaid or no insurance and those treated at non-academic centers are at increased risk of UTI-associated inpatient mortality (p<0.0001). Conclusion: The incidence and mortality of UTI-associated hospitalization has increased over the last decade. The inflation-adjusted median cost of UTI-hospitalization as well as the total overall annual associated cost have been steadily increasing. In these patients, male gender, African-American race, those with Medicaid or no insurance and those treated in non-academic hospitals represent attributes associated with higher risk of mortality. These findings represent candidate quality indicators to adapt health care policy for particularly vulnerable sub-populations.

<div> Recent advancements of health monitoring sensing technologies are enabling plethora of new applications in a variety of biomedical areas. In this work, we present a new sensing technology that enables a fully autonomous monitoring of urinary tract infection (UTI). UTI is the second most common infection in the human body caused by bacterial pathogens, and costs millions of dollars each year to the patients and the health care industry. UTI is easily treatable using antibiotics if identified in early stages. However, when early stage identification is missed, UTI can be a major source of serious complications such as ascending infections, loss of kidney function, bacteremia, and sepsis. Unfortunately, the limitations of existing UTI monitoring technologies such as high cost, time-intensive sample preparation, and relatively high false alarm rate prohibit reliable detection of UTI in early stages. The problem becomes more serious in certain patient groups such as infants and geriatric patients suffering from neurodegenerative diseases, who have difficulties in realizing the symptoms and communicating the symptoms with their caregivers. In addition to the aforementioned difficulties, the fact that UTI is often asymptomatic makes early stage identifications quite challenging, and the reliable monitoring and detection of UTI in early stages remain as a serious problem.</div><div> To address these issues, we propose a diaper-embedded, self-powered, and fully autonomous UTI monitoring sensor module that enables autonomous monitoring and detection of UTI in early stages with minimal effort. The sensor module consists of a paper-based colorimetric nitrite sensor, urine-activated batteries, a boost dc-dc converter, a low-power sensor interface utilizing pulse width modulation, a Bluetooth low energy module for wireless transmission, and a software performing calibration at run-time. </div><div> To further optimize the sensor module, a new fully integrated DC-DC converter with low-profile and low ripple is developed. The proposed DC-DC converter maintains an extremely low level of output voltage ripples in the face of different battery output voltages, which is crucial for realizing low-noise sensor interfaces. Since the DC-DC converter is a part of a module embedded into a diaper, it is highly desirable for the DC-DC converter to have a small physical form factor in both area and height. To address this issue, the proposed DC-DC converter adopts a new charge recycling technique that enables a fully integrated design without utilizing any off-chip components. In addition, the DC-DC converter utilizes sub-module sharing techniques – multiple modules share a voltage buffer and a recycle capacitor to reduce power consumption and save chip area. The DC-DC converter provides a regulated voltage of 1.2V and achieves a maximum efficiency of 80% with a 300ohm load resistance. The output voltage ripple is in the range of 19.6mV to 26.6mV for an input voltage ranging from 0.66 to 0.86V.<br></div>

Made available in DSpace on 2014-12-17T14:46:39Z (GMT). No. of bitstreams: 1 ParticiaCBF_DISSERT.pdf: 926078 bytes, checksum: 9ea88765b5e731681c2629ed4e7288ec (MD5) Previous issue date: 2009-09-29 / A descriptive, quantitative approach and non-participant observation study, which was aimed at analyzing the association between knowledge and practice of inclusion and maintenance of urinary catheter by nursing professionals in the occurrence of urinary tract infection, performed in the ICU of Onofre Lopes University Hospital in Natal / RN. The original sample was composed of 42 nursing staff professional, five (5) nurses and 37 nursing technicians, 27 of them were outsourced (FUNPEC and IEL fellows) and 10 servers UFRN. Data collection was performed using two instruments, the first observation procedures used in the insertion and manipulation of indwelling urinary catheter (IUC) and the second with a questionnaire that addressed the characterization data of respondents, knowledge and conduct the insertion and manipulation of the IUC. The results were tabulated in Microsoft Excel and analyzed using SPSS software, version 15.0. We found the prevalence of institutional staff members on outsourcing - IEL and FUNPEC - (64.3%) were female (69.0%), aged 21 to 35 years (59.5%) and with mid-level education (88.1%). As to knowledge, we found that the nurses had levels of good to excellent and the nursing technicians, to regulate the poor. The nurses made a mistake when choosing IUC (40.0%) and washing hands (30.0%) and technicians on hand washing (74.4%) and the contents of the tray (34.7%). In relation to the conduct of insertion of IUC, the nurses made a mistake when choosing SVD (66.7%) and washing hands (57.1%). Regarding the handling of IUC/drainage system, the technicians were wrong more about washing their hands (56.0%). Analyzing the misconduct to the categorization of knowledge, we saw that the nursing staff who had missed more had inadequate knowledge (&#961; = 0.001). At the end we found the risk of a patient to acquire UTI is higher in two and a half times when there is a large number of mismatches, patient spends more time using the IUC and hospitalized in the ICU. As regards the study hypotheses, we accept the alternative hypothesis and reject the null hypothesis proposed at the start of this research, where the number of gaps in knowledge and behavior increases the incidence of urinary tract infection. / Estudo descritivo, de abordagem quantitativa e observacional n?o participante, que teve como objetivo geral analisar a associa??o do conhecimento e conduta de inser??o e manuten??o da sonda vesical de demora pelos profissionais de enfermagem na ocorr?ncia de infec??o do trato urin?rio, realizado na UTI do Hospital Universit?rio Onofre Lopes em Natal/RN. A amostra pesquisada foi composta por 42 profissionais da equipe de enfermagem, sendo cinco (5) enfermeiros e 37 t?cnicos de enfermagem, deles 27 eram terceirizados (FUNPEC e bolsistas do IEL) e 10 servidores da UFRN. A coleta de dados foi realizada atrav?s de dois instrumentos, o primeiro utilizado na observa??o procedimentos de inser??o e de manipula??o da Sonda Vesical de Demora (SVD) e o segundo, com a aplica??o de um question?rio que abordou dados de caracteriza??o dos pesquisados, conhecimentos e conduta na inser??o e manipula??o da SVD. Os resultados foram tabulados no Excel e analisados atrav?s do programa estat?stico SPSS, vers?o 15.0. Encontramos a predomin?ncia de funcion?rios com v?nculo institucional terceirizado IEL e FUNPEC - (64,3%), do sexo feminino (69,0%), na faixa et?ria de 21 a 35 anos (59,5%) e com n?vel m?dio de escolaridade (88,1%). Quanto aos conhecimentos, verificamos que os enfermeiros apresentaram n?vel de bom a ?timo e os t?cnicos de enfermagem, de regular a ruim. Os enfermeiros erraram mais na escolha da SVD (40,0%) e na lavagem das m?os (30,0%) e os t?cnicos, na lavagem das m?os (74,4%) e no conte?do da bandeja (34,7%). Em rela??o ?s condutas de inser??o da SVD, os enfermeiros erraram mais na escolha da SVD (66,7%) e na lavagem das m?os (57,1%). Em rela??o ? manipula??o da SVD/sistema de drenagem, os t?cnicos erraram mais ao lavar as m?os (56,0%). Ao analisarmos as condutas inadequadas com a categoriza??o do conhecimento, vimos que os t?cnicos de enfermagem que erraram mais apresentaram conhecimentos inadequados (&#961; = 0,001). Ao final, vimos que o risco de um paciente adquirir ITU est? maior em duas vezes e meia quando ocorre um n?mero grande de inadequa??es, paciente passa mais tempo usando a SVD e internado na UTI. Quanto ?s hip?teses do estudo, aceitamos a Hip?tese alternativa e rejeitamos a hip?tese nula proposta no in?cio desta pesquisa, onde a quantidade de inadequa??es no conhecimento e conduta aumenta a ocorr?ncia de infec??o do trato urin?rio.

Made available in DSpace on 2016-12-23T13:56:10Z (GMT). No. of bitstreams: 1 Dissertacao de Ana Raquel Farranha Santana Daltro.pdf: 655316 bytes, checksum: 520ba803452b868f1e86dfd359960936 (MD5) Previous issue date: 2011-08-19 / Introduction Urinary tract infection is reported to affect 2 to 10% of all pregnancies. It is associated with maternal and neonatal complication including premature labor, premature rupture of membranes, low birth weight, intrauterine growth restriction, high perinatal mortality, maternal anemia, maternal and neonatal sepsis, arterial hypertension and renal failure. Objectives: To describe the prevalence of urinary tract infection, to identify etiologic agents and to describe the risk factors amongst pregnant women attending to a high risk antenatal clinic in Serra, Espiríto Santo. Methodology: Cross-sectional study of parturient women giving birth at Hospital Dr Dório Silva Maternity in the period between march 2010 and February 2011. The study collected information using face to face interviews including socio-demographics, epidemiologic and clinical data. The data collected included age, years of schooling, marital status, dwelling place, profession, number of pregnancies and abortions, type of delivery, gestational age and any previous history of urinary tract infection. A sample of urine was also collected and submitted to test1, urine culture and test sensibility antibiotic. Descriptive statistics analysis was performed. Any possible association between urinary tract infection and independent variables were tested using chi-square test with Yates correction or Fisher s exact test. Odds ratio and confidence intervals were calculated and a multivariate logistic regression analysis was used. Results: From 324 pregnant women identified, 305 (94.1%) took part in the study. The prevalence of urinary tract infection amongst the participants was 15.1% (CI 95% 11.0%-19.1%). The median age was 25 (DIQ 20; 30), years of schooling was 9 years (DIQ 7; 11). Fifty nine pregnant women (19.0%) were under 20, twenty eight (9.2%) had up to 4 years of formal education, two hundred and fifty five (83.6%) were married and one hundred and fifty five (50.8%) had a family income of less than 2 minimum wage. One hundred and twenty five (41.0%) were primigravidae, one hundred and seventy three (56.9%) were under 35 weeks when hospitalized and seventy five (24.6%) delivered low birth weight babies. Amongst the morbidities in the study 14.1% presented pre-eclampsy and 6.2% diabetes mellitus. Amongst the forty six cases of urinary tract infection, we identified twenty six with abnormal examination of urine sediment, with twenty three cases presenting pyuria. Four tests returned positive nitrite and twenty six tests presented increased bacterial flora. The agent isolated more frequently in the culture was Escherichia coli (52%), followed by Klebsiella sp. (15.2 %). Conclusion: The prevalence of urinary tract infections amongst the pregnant women cared for in the high risk maternity in Serra was high. These results corroborate the importance of screening for urinary tract infection during pregnancy in order to avoid complications during gestation and childbirth / Introdução: A Infecção urinária na gravidez tem prevalência de cerca de 2 a 10%. No ciclo gravídico ela pode causar parto pré-termo, amniorrexe prematura, recém nascidos de baixo peso, restrição do crescimento intra uterino, altas taxas de mortalidade perinatal, anemia materna, sepse materna e neonatal, hipertensão arterial sistêmica e insuficiência renal. Objetivos: Descrever a frequência da infecção do trato urinário, identificar agentes etiológicos e descrever fatores de associação para infecção em parturientes atendidas em maternidade de alto risco em Serra, Espírito Santo. Metodologia: Estudo de corte transversal em amostra quantitativa de parturientes internadas na maternidade do Hospital Dr Dório Silva, no período de março de 2010 a fevereiro de 2011. As informações utilizadas no estudo foram obtidas por meio de uma entrevista face-a-face contendo dados sócio-demográficos, epidemiológicos e clínicos, tais como: idade, escolaridade, estado civil, residência, profissão, número de gestações e abortos, tipo de parto, idade gestacional, e história anterior de infecção urinária. Foi coletada uma amostra de urina para realização de exame de urina tipo 1, urocultura e teste de sensibilidade ao antibiótico. Foi realizada análise estatística descritiva. As possíveis associações entre infecção do trato urinário e variáveis independentes foram testadas por meio de testes de qui-quadrado com correção de Yates ou teste Exato de Fisher. OddsRatio e intervalos de confiança foram calculados e análise multivariada de regressão logística foi utilizada. Resultados Do total de 324 gestantes selecionadas, 305 (94,1%) participaram do estudo. A prevalência de ITU foi 15,1% (IC95% 11,0%-19,1%). A mediana de idade foi 25 anos (DIQ 20; 30) e a de escolaridade foi 9 anos (DIQ 7; 11). Cinquenta e nove parturientes (19,0%) tinham menos de 20 anos, 28 (9,2%) tinham até 4 anos de estudo, 255 (83,6%) eram casadas e em 155 (50,8%) a renda familiar era menor do que dois salários mínimos. Cento e vinte cinco (41,0%) eram primigestas, 173 (56,9%) tinham menos de 35 semanas de gestação no momento da internação e 75 (24,6%) tiveram recém-nascidos de baixo peso. Entre as morbidades descritas, 14,1% tinham Doença Hipertensiva Específica da Gestação (DHEG) e 6,2% diabetes mellitus . Entre os 46 casos de infecção urinária, o EAS estava alterado em 26 casos, apresentando-se com piúria em 23 . Quatro exames apresentavam nitrito positivo e 26 exames apresentavam flora bacteriana aumentada. O agente isolado mais frequentemente na cultura foi a Escherichia coli (52%), seguida pela Klebsiella sp.(15,2%). Conclusão: A frequência de infecção do trato urinário em parturientes atendidas em maternidade de alto risco em Serra foi alta. Esses resultados corroboram a importância do rastreamento da ITU na gestação a fim de evitar complicações no ciclo gravídico -puerperal

Descrever a prevalência das espécies bacterianas isoladas nas infecções urinárias comunitárias. Descrever os perfis de susceptibilidade aos antibióticos de uso oral utilizado frente às bactérias isoladas nas infecções urinárias comunitárias. Avaliar a prevalência de fenótipos de resistência bacterianos através dos resultados dos testes de susceptibilidade e dos rastreamentos específicos utilizados. Amostras colhidas exclusivamente no atendimento ambulatorial com contagens de unidades formadoras de colônias entre 100.000 a &#8805;1.000.000 por mililitro (UCF/ml) Com ou sem piúria no exame de elementos anormais na urina e sedimentoscopia (EAS). Foram analisados retrospectivamente os resultados de urinoculturas e dos testes de susceptibilidade a antimicrobianos, realizados em um Laboratório da rede privada na cidade do Rio de janeiro, de pacientes atendidos em ambulatórios e com quadros de ITU. As amostras de urina coletadas englobavam basicamente os seguintes bairros: Botafogo, Barra da Tijuca, Ipanema, Copacabana, Tijuca e Centro. Foram analisados um total de 8.475 culturas de urina divididas em 7.286 urinas de pacientes femininos e 1.189 de pacientes masculinos entre Janeiro de 2006 a Dezembro de 2012. As amostras foram todas coletadas na Cidade do Rio de Janeiro e englobavam basicamente os seguintes bairros: Botafogo, Barra da Tijuca, Ipanema, Copacabana, Tijuca e Centro. Encontramos um percentual de resistência de 27% para ciprofloxacina frente à Escherichia coli que com 68.23% é a principal etiologia encontrada na ITU na comunidade os resultados das três fluoroquinolonas avaliadas no estudo, ciprofloxacina (2 geração), levofloxacina (3 geração) e norfloxacina (2 geração), acharemos respectivamente 27%, 25% e 20% de resistência em Escherichia coli. O uso de fluoroquinolonas em infecções urinárias comunitárias e consequentemente os achados de padrões de resistência neste estudo, reforçam o que já foi descrito em outros trabalhos. A cefalosporina de 2 geração (cefuroxima), demonstrou percentuais de resistência bastante satisfatórios frente as principais etiologias. Em Escherichia coli o percentual foi de 2%, em Klebsiella pneumoniae 3% e em Proteus mirabilis não houve nenhum achado de resistência. Uma das vantagens da cefuroxima é ser ativa quanto à produção de beta lactamase, conferindo um espectro maior frente a possíveis produtoras desta enzima. Seu esquema posológico é de 250mg duas vezes ao dia por 7 dias para infecções urinárias não complicadas. O meio mais eficaz de melhorar a administração antimicrobiana provavelmente envolverá um programa abrangente que incorpora múltiplas estratégias e colaboração entre as diversas especialidades dentro de uma determinada instituição de saúde. Neste contexto, a observação periódica da incidência bacteriana com seus respectivos índices de resistência aos antimicrobianos por sitio de infecção e correlação com os antibióticos mais comumente utilizados, é mandatória para o sucesso terapêutico. / Describe the prevalence of bacterial species isolated from community acquired urinary tract infections and to describe the bacterial susceptibility profiles to oral antimicrobials. The prevalence of resistant phenotypes was also evaluated. Samples were taken from outpatients whose urine cultures showed >= 100,000 Colony Forming Units per milliliter (CFU/ml) with or without pyuria on direct examination of urine sediment samples. Urine culture results were retrospectively reviewed and antimicrobial susceptibility testing performed in a private clinical laboratory located in Rio de Janeiro. A total of 8475 urine cultures performed between January 2006 and December 2012 were analyzed. Female urine samples represented 7286 samples while male samples represented 1189 samples. Escherichia coli was found as the main etiology among urinary tract infections, (68,23%) showing 27% of ciprofloxaxin resistance, 25% Levofloxacin resistance and 20% Norfloxacin resistance. The use of fluoroquinolones in community acquired urinary tract infections and the resistance patterns found in this present study reinforces what has been described by other authors. A second generation cephalosporin (cefuroxime) showed resistance in main etiologies - E. coli 2% and K. pneumoniae 3%, while Proteus mirabilis showed no resistance at all. Among the main advantages of cefuroxime is the activity against the production of beta lactamases. The regimen dosage is 250mg twice a day for 7 days to treat uncomplicated urinary tract infections. The most effective way to improve antimicrobials administration is to develop a comprehensive program that incorporates multiple strategies and collaborative work between different medical specialties inside a healthcare institution. In such a context, the bacterial incidence rates and antimicrobial resistance rates should be closely observed and correlated to infection sites for better achievement of success in antimicrobial therapy.

Made available in DSpace on 2014-06-11T19:35:13Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-02-09Bitstream added on 2014-06-13T21:07:33Z : No. of bitstreams: 1 siqueira_ak_me_botfmvz.pdf: 464792 bytes, checksum: aae10b408540ec568f7000a9c01f5a54 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Escherichia coli e considerado o principal agente causal de infeccao de trato urinario (ITU) e piometra em caes. A patogenicidade das linhagens esta relacionada a presenca de adesinas e diferentes fatores de virulencia. Foram avaliadas alteracoes hematologicas e diferentes fatores de virulencia em 51 linhagens de E. coli isoladas de ITU, 52 de piometra e 55 de fezes de caes sem sinais entericos. A producao de ¿-hemolisina foi verificada em 26 (51,0%) das estirpes de ITU e em 20 (38,5%) de piometra. Exames hematologicos revelaram principalmente anemia, trombocitopenia e leucocitose por neutrofilia e monocitose nos caes com ITU e piometra. Os maiores indices de sensibilidade nas 158 estirpes foram observados para norfloxacina, ciprofloxacina e enrofloxacina em mais de 60% dos isolados. Os maiores indices de resistencia foram encontrados em 60% ou mais das estirpes com o uso de sulfametoxazole/trimetoprim. Linhagens resistentes a tres ou mais antimicrobianos foram constatadas em 24 (47,1%) de ITU, 7 (13,5%) de piometra e 4 (7,3%) das fezes, das quais respectivamente, 17 (33,3%), 1 (1,9%) e 3 (5,5%), com resistencia multipla a cinco ou mais drogas. fimH foi observado em mais de 90% dos isolados. papC foi detectado em 12 (23,5%) linhagens de ITU, 19 (36,5%) de piometra e 10 (18,2%) das fezes. papGI nao foi detectado, enquanto papGII foi observado em 3 (5,8%) isolados de piometra. papGIII foi expressado em 10 (19,6%) linhagens de ITU, 15 (28,8%) de piometra e 9 (16,4%) das fezes. sfaS foi encontrado em 22 (43,1%) de ITU, 24 (46,1%) de piometra e 19 (34,5%) das fezes. afa foi detectado em 1 (1,9%) linhagem de ITU e de piometra... / Escherichia coli is considered the more important microrganism in urinary tract infection (UTI) and pyometra in dogs. The pathogenicity of strains is associated with different adhesins and virulence factors. Haematological exams and different virulence factors was evaluated in 51 E. coli strains isolated from UTI, 52 from pyometra and 55 from feces of dogs without enteric signs. Alpha-haemolysin was verified in 26 (51.0%) strains from UTI and 20 (38.5%) from pyometra. Haematological exams revealed mainly anaemia, thrombocytopenia and leucocytosis by neutrophilia and monocitosis in dogs with UTI and pyometra. Norfloxacin, ciprofloxacin and enrofloxacin were the most-effective drugs (>60%) for 158 E. coli strains. High rates of E. coli resistance to antimicrobials were observed in 60% or more of strains using sulfametoxazole/trimetoprim. Multiple drug resistance for three or more antimicrobials was observed in 2 (47.1%) strains isolated from UTI, 7 (13.5%) from pyometra and 4 (7.3%) from feces. From these, 17 (33.3%), 1 (1.9%) and 3 (5.5%), respectively, showed multiple resistance to five or more drugs. fimH was observed in 90% or more of 158 isolates. papC was detected in 12 (23.5%) strains isolated from UTI, 19 (36.5%) from pyometra and 10 (18.2%) from feces. None strain expressed papGI, while papGII was observed in 3 (5.8%) strains of pyometra. papGIII was detected in 10(19.6%) strains of UTI, 15 (28.8%) from pyometra and 9 (16.4%) from feces. sfaS was observed in 22 (43.1%) strains of UTI, 24 (46.1%) of pyometra and 19 (34.5%) of feces. afa was identified in 1 (1.9%) strains isolated from UTI and pyometra...(Complete abstract, click electronic address below)

Orientador: Márcio Garcia Ribeiro / Banca: Antonio Carlos Paes / Banca: Domingos da Silva Leite / Resumo: Escherichia coli e considerado o principal agente causal de infeccao de trato urinario (ITU) e piometra em caes. A patogenicidade das linhagens esta relacionada a presenca de adesinas e diferentes fatores de virulencia. Foram avaliadas alteracoes hematologicas e diferentes fatores de virulencia em 51 linhagens de E. coli isoladas de ITU, 52 de piometra e 55 de fezes de caes sem sinais entericos. A producao de ƒ¿-hemolisina foi verificada em 26 (51,0%) das estirpes de ITU e em 20 (38,5%) de piometra. Exames hematologicos revelaram principalmente anemia, trombocitopenia e leucocitose por neutrofilia e monocitose nos caes com ITU e piometra. Os maiores indices de sensibilidade nas 158 estirpes foram observados para norfloxacina, ciprofloxacina e enrofloxacina em mais de 60% dos isolados. Os maiores indices de resistencia foram encontrados em 60% ou mais das estirpes com o uso de sulfametoxazole/trimetoprim. Linhagens resistentes a tres ou mais antimicrobianos foram constatadas em 24 (47,1%) de ITU, 7 (13,5%) de piometra e 4 (7,3%) das fezes, das quais respectivamente, 17 (33,3%), 1 (1,9%) e 3 (5,5%), com resistencia multipla a cinco ou mais drogas. fimH foi observado em mais de 90% dos isolados. papC foi detectado em 12 (23,5%) linhagens de ITU, 19 (36,5%) de piometra e 10 (18,2%) das fezes. papGI nao foi detectado, enquanto papGII foi observado em 3 (5,8%) isolados de piometra. papGIII foi expressado em 10 (19,6%) linhagens de ITU, 15 (28,8%) de piometra e 9 (16,4%) das fezes. sfaS foi encontrado em 22 (43,1%) de ITU, 24 (46,1%) de piometra e 19 (34,5%) das fezes. afa foi detectado em 1 (1,9%) linhagem de ITU e de piometra...(Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Escherichia coli is considered the more important microrganism in urinary tract infection (UTI) and pyometra in dogs. The pathogenicity of strains is associated with different adhesins and virulence factors. Haematological exams and different virulence factors was evaluated in 51 E. coli strains isolated from UTI, 52 from pyometra and 55 from feces of dogs without enteric signs. Alpha-haemolysin was verified in 26 (51.0%) strains from UTI and 20 (38.5%) from pyometra. Haematological exams revealed mainly anaemia, thrombocytopenia and leucocytosis by neutrophilia and monocitosis in dogs with UTI and pyometra. Norfloxacin, ciprofloxacin and enrofloxacin were the most-effective drugs (>60%) for 158 E. coli strains. High rates of E. coli resistance to antimicrobials were observed in 60% or more of strains using sulfametoxazole/trimetoprim. Multiple drug resistance for three or more antimicrobials was observed in 2 (47.1%) strains isolated from UTI, 7 (13.5%) from pyometra and 4 (7.3%) from feces. From these, 17 (33.3%), 1 (1.9%) and 3 (5.5%), respectively, showed multiple resistance to five or more drugs. fimH was observed in 90% or more of 158 isolates. papC was detected in 12 (23.5%) strains isolated from UTI, 19 (36.5%) from pyometra and 10 (18.2%) from feces. None strain expressed papGI, while papGII was observed in 3 (5.8%) strains of pyometra. papGIII was detected in 10(19.6%) strains of UTI, 15 (28.8%) from pyometra and 9 (16.4%) from feces. sfaS was observed in 22 (43.1%) strains of UTI, 24 (46.1%) of pyometra and 19 (34.5%) of feces. afa was identified in 1 (1.9%) strains isolated from UTI and pyometra...(Complete abstract, click electronic address below) / Mestre

Descrever a prevalência das espécies bacterianas isoladas nas infecções urinárias comunitárias. Descrever os perfis de susceptibilidade aos antibióticos de uso oral utilizado frente às bactérias isoladas nas infecções urinárias comunitárias. Avaliar a prevalência de fenótipos de resistência bacterianos através dos resultados dos testes de susceptibilidade e dos rastreamentos específicos utilizados. Amostras colhidas exclusivamente no atendimento ambulatorial com contagens de unidades formadoras de colônias entre 100.000 a &#8805;1.000.000 por mililitro (UCF/ml) Com ou sem piúria no exame de elementos anormais na urina e sedimentoscopia (EAS). Foram analisados retrospectivamente os resultados de urinoculturas e dos testes de susceptibilidade a antimicrobianos, realizados em um Laboratório da rede privada na cidade do Rio de janeiro, de pacientes atendidos em ambulatórios e com quadros de ITU. As amostras de urina coletadas englobavam basicamente os seguintes bairros: Botafogo, Barra da Tijuca, Ipanema, Copacabana, Tijuca e Centro. Foram analisados um total de 8.475 culturas de urina divididas em 7.286 urinas de pacientes femininos e 1.189 de pacientes masculinos entre Janeiro de 2006 a Dezembro de 2012. As amostras foram todas coletadas na Cidade do Rio de Janeiro e englobavam basicamente os seguintes bairros: Botafogo, Barra da Tijuca, Ipanema, Copacabana, Tijuca e Centro. Encontramos um percentual de resistência de 27% para ciprofloxacina frente à Escherichia coli que com 68.23% é a principal etiologia encontrada na ITU na comunidade os resultados das três fluoroquinolonas avaliadas no estudo, ciprofloxacina (2 geração), levofloxacina (3 geração) e norfloxacina (2 geração), acharemos respectivamente 27%, 25% e 20% de resistência em Escherichia coli. O uso de fluoroquinolonas em infecções urinárias comunitárias e consequentemente os achados de padrões de resistência neste estudo, reforçam o que já foi descrito em outros trabalhos. A cefalosporina de 2 geração (cefuroxima), demonstrou percentuais de resistência bastante satisfatórios frente as principais etiologias. Em Escherichia coli o percentual foi de 2%, em Klebsiella pneumoniae 3% e em Proteus mirabilis não houve nenhum achado de resistência. Uma das vantagens da cefuroxima é ser ativa quanto à produção de beta lactamase, conferindo um espectro maior frente a possíveis produtoras desta enzima. Seu esquema posológico é de 250mg duas vezes ao dia por 7 dias para infecções urinárias não complicadas. O meio mais eficaz de melhorar a administração antimicrobiana provavelmente envolverá um programa abrangente que incorpora múltiplas estratégias e colaboração entre as diversas especialidades dentro de uma determinada instituição de saúde. Neste contexto, a observação periódica da incidência bacteriana com seus respectivos índices de resistência aos antimicrobianos por sitio de infecção e correlação com os antibióticos mais comumente utilizados, é mandatória para o sucesso terapêutico. / Describe the prevalence of bacterial species isolated from community acquired urinary tract infections and to describe the bacterial susceptibility profiles to oral antimicrobials. The prevalence of resistant phenotypes was also evaluated. Samples were taken from outpatients whose urine cultures showed >= 100,000 Colony Forming Units per milliliter (CFU/ml) with or without pyuria on direct examination of urine sediment samples. Urine culture results were retrospectively reviewed and antimicrobial susceptibility testing performed in a private clinical laboratory located in Rio de Janeiro. A total of 8475 urine cultures performed between January 2006 and December 2012 were analyzed. Female urine samples represented 7286 samples while male samples represented 1189 samples. Escherichia coli was found as the main etiology among urinary tract infections, (68,23%) showing 27% of ciprofloxaxin resistance, 25% Levofloxacin resistance and 20% Norfloxacin resistance. The use of fluoroquinolones in community acquired urinary tract infections and the resistance patterns found in this present study reinforces what has been described by other authors. A second generation cephalosporin (cefuroxime) showed resistance in main etiologies - E. coli 2% and K. pneumoniae 3%, while Proteus mirabilis showed no resistance at all. Among the main advantages of cefuroxime is the activity against the production of beta lactamases. The regimen dosage is 250mg twice a day for 7 days to treat uncomplicated urinary tract infections. The most effective way to improve antimicrobials administration is to develop a comprehensive program that incorporates multiple strategies and collaborative work between different medical specialties inside a healthcare institution. In such a context, the bacterial incidence rates and antimicrobial resistance rates should be closely observed and correlated to infection sites for better achievement of success in antimicrobial therapy.

Background: We aimed to update the 2010 evidence- and consensus-based national clinical guideline on the diagnosis and management of uncomplicated urinary tract infections (UTIs) in adult patients. Results are published in 2 parts. Part 1 covers methods, the definition of patient groups, and diagnostics. This second publication focuses on treatment of acute episodes of cystitis and pyelonephritis as well as on prophylaxis of recurrent UTIs. Materials and Methods: An interdisciplinary group consisting of 17 representatives of 12 medical societies and a patient representative was formed. Systematic literature searches were conducted in MEDLINE, EMBASE, and the Cochrane Library to identify literature published in 2010–2015. Results: For the treatment of acute uncomplicated cystitis (AUC), fosfomycin-trometamol, nitrofurantoin, nitroxoline, pivmecillinam, and trimethoprim (depending on the local rate of resistance) are all equally recommended. Cotrimoxazole, fluoroquinolones, and cephalosporins are not recommended as antibiotics of first choice, for concern of an unfavorable impact on the microbiome. Mild to moderate uncomplicated pyelonephritis should be treated with oral cefpodoxime, ceftibuten, ciprofloxacin, or levofloxacin. For AUC with mild to moderate symptoms, instead of antibiotics symptomatic treatment alone may be considered depending on patient preference after discussing adverse events and outcomes. Primarily non-antibiotic options are recommended for prophylaxis of recurrent urinary tract infection. Conclusion: In accordance with the global antibiotic stewardship initiative and considering new insights in scientific research, we updated our German clinical UTI guideline to promote a responsible antibiotic use and to give clear hands-on recommendations for the diagnosis and management of UTIs in adults in Germany for healthcare providers and patients.

Orientador: Rodrigo Tavanelli Hernandes / Resumo: Escherichia coli uropatogênica (UPEC) causa a maioria das infecções do trato urinário (ITU), incluindo cistite e pielonefrite, no hospedeiro humano. A UPEC utiliza numerosos fatores de virulência para entrar, aderir, colonizar, adquirir nutrientes essenciais, multiplicar e causar danos ao ambiente do trato urinário. Estudos recentes demonstraram que alguns isolados de UPEC carregam fatores de virulência associados à patótipos diarreiogênicos de E. coli (DEC), como EAEC (E. coli enteroagregativa) e EPEC (E. coli enteropatogênica). Uma grande preocupação nas infecções por UPEC é o aumento da resistência antimicrobiana, levando à falha do tratamento em algumas ITUs causadas por esse patógeno. Nesse estudo, um total de 118 isolados de UPEC de amostras ambulatoriais de urina de pacientes atendidos no Hospital das Clinicas da Faculdade de medicina de Botucatu entre março e maio de 2018. Reação em cadeia da polimerase (PCR) foi usada para detectar 29 genes que codificam fatores de virulência, bem como marcadores de DEC (escN, stx1/2, aatA e aggR); além de genes que codificam adesinas e toxinas associadas ao patótipo EAEC. Os isolados de UPEC foram designados nos diferentes filogrupos de E. coli, utilizando um PCR quadruplex; e a determinação do perfil de susceptibilidade antimicrobiana foi realizada pelo método de disco difusão. Entre os isolados estudados, 39,8% foram atribuídos ao filogrupo B2, enquanto UPEC dos filogrupos B1 (14,4%), A (14,4%), D (12,7%), F (8,5%), G (3,4%), E ( ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Uropathogenic Escherichia coli (UPEC) cause the majority of urinary tract infections (UTIs), including cystitis and pyelonephritis, in the human host. UPEC utilizes numerous virulence factors to entry, adhere, colonize, acquire essential nutrients, multiply and cause damage in the urinary tract environment. Recent studies have shown that some UPEC isolates carry virulence factors associated with the diarrheagenic E. coli (DEC) pathotypes, such as EAEC (enteroaggregative E. coli) and EPEC (enteropathogenic E. coli). A major concern in UPEC infections is the constant increasing of antimicrobial resistance, thus leading to treatment failure in some UTIs caused by this pathogen. In this study a total of 118 UPEC isolates were obtained from outpatient urine samples, attended at University Hospital of Botucatu Medical School between March and May of 2018. Polymerase chain reaction (PCR) was used to detect 29 virulence factor-encoding genes, diarhoeagenic E. coli markers, (escN, stx1/2, aatA and aggR), as well as genes encoding adhesins and toxins associated with the EAEC pathotype. The UPEC isolates were assigned in the distinct E. coli phylogroups, using a quadruplex PCR; and the determination of the antimicrobial resistance profile was performed using the diskdiffusion method. Among the isolates studied, 39.8% were assigned to phylogroup B2, while UPEC isolates from other phylogroups were detected as follows: B1 (14,4%), A (14,4%), D (12,7%), F (8,5%), G (3,4%), E ( 2,5%), E. cla... (Complete abstract click electronic access below) / Mestre