Download the Free Unbound MEDLINE PubMed App to your smartphone or tablet.
Available for iPhone, iPad, iPod touch, and Android.
Infectious disease AND Urinary tract infection [keywords]
- The Humoral Pattern Recognition Molecule PTX3 Is a Key Component of Innate Immunity against Urinary Tract Infection. [Journal Article]
- Immunity 2014 Apr 17; 40(4):621-32.
Immunity in the urinary tract has distinct and poorly understood pathophysiological characteristics and urinary tract infections (UTIs) are important causes of morbidity and mortality. We investigated the role of the soluble pattern recognition molecule pentraxin 3 (PTX3), a key component of the humoral arm of innate immunity, in UTIs. PTX3-deficient mice showed defective control of UTIs and exacerbated inflammation. Expression of PTX3 was induced in uroepithelial cells by uropathogenic Escherichia coli (UPEC) in a Toll-like receptor 4 (TLR4)- and MyD88-dependent manner. PTX3 enhanced UPEC phagocytosis and phagosome maturation by neutrophils. PTX3 was detected in urine of UTI patients and amounts correlated with disease severity. In cohorts of UTI-prone patients, PTX3 gene polymorphisms correlated with susceptibility to acute pyelonephritis and cystitis. These results suggest that PTX3 is an essential component of innate resistance against UTIs. Thus, the cellular and humoral arms of innate immunity exert complementary functions in mediating resistance against UTIs.
- [Fever of unknown origin: a challenge for the pediatric infectious diseases specialist]. [English Abstract, Journal Article]
- Rev Chilena Infectol 2014 Feb; 31(1):87-91.
Prolonged febrile syndrome (PFS) is defined as fever 7-10 days, with initial study does not allow etiologic diagnosis.To describe the main causes of the PFS and its temporal behavior in Pediatric Infectious Diseases Unit Outpatient Care of Complejo Asistencial Dr. Sótero del Río (CASR).A descriptive, prospective study between january 2007-december 2012, about 153 patients from 6 weeks to 14 years 11 months old, diagnosed with PFS, tab completing clinical and laboratory monitoring.etiology was obtained in 67.9%, the causes were infection (88.4%), neoplasms (4.8%), rheumatological (4.8%) and Kawasaki disease (2.8%). The most important infectious causes were enteric fevers (typhoid and paratyphoid) (18.4%), urinary tract infection (11.9%), Bartonella henselae infections and adenovirus (8.7%) each one and Epstein Barr virus (7.6%). Ninety eight percent of patients had complete resolution, 60.7% did not require hospitalization and mortality was 0%.As in previous pediatric clinical series the infections were the most frequent causes. Enteric fever persists as principal cause, however, the epidemiological evidence is oscillating in time endorsing the local statistics can count over the years to improve the diagnostic and therapeutic approach.
- The impact of pneumonia on hospital stay among patients hospitalized for acute stroke. [Journal Article]
- Neurosciences (Riyadh) 2014 Apr; 19(2):118-23.
To determine the impact of pneumonia on length of hospital stay in cases of acute stroke.This was a retrospective cross-sectional study on 368 stroke patients admitted with a diagnosis of stroke at the Avicenna Hospital, Qazvin, Iran between January 2010 and March 2011. By reviewing the hospital patient records, the demographic characteristics, stroke characteristics, and complications of stroke in these patients were determined during their hospital stay. In surviving patients, the impact of each variable on length of hospital stay was calculated by logistic regression analysis and the Log-Rank test.Patients with pneumonia during the post stroke period had an increased length of hospital stay (11.5+/-6.4 days), compared with other patients (7.2+/-4.1 days), (p=0.0005). Multiple logistic regression analysis showed a significant association between length of hospital stay and urinary tract infection (p=0.001), steroid consumption (p=0.028), index of stroke severity (p=0.039), pneumonia (p=0.042), and swallowing disorder (p=0.048).Considering the impact of pneumonia on the length of hospital stay and its consequences, prophylactic activities, rapid diagnosis, and treatment of pneumonia may improve outcome and reduce costs in stroke patients.
- Role of Capsule and O Antigen in the Virulence of Uropathogenic Escherichia coli. [Journal Article]
- PLoS One 2014; 9(4):e94786.
Urinary tract infection (UTI) is one of the most common bacterial infections in humans, with uropathogenic Escherichia coli (UPEC) the leading causative organism. UPEC has a number of virulence factors that enable it to overcome host defenses within the urinary tract and establish infection. The O antigen and the capsular polysaccharide are two such factors that provide a survival advantage to UPEC. Here we describe the application of the rpsL counter selection system to construct capsule (kpsD) and O antigen (waaL) mutants and complemented derivatives of three reference UPEC strains: CFT073 (O6:K2:H1), RS218 (O18:K1:H7) and 1177 (O1:K1:H7). We observed that while the O1, O6 and O18 antigens were required for survival in human serum, the role of the capsule was less clear and linked to O antigen type. In contrast, both the K1 and K2 capsular antigens provided a survival advantage to UPEC in whole blood. In the mouse urinary tract, mutation of the O6 antigen significantly attenuated CFT073 bladder colonization. Overall, this study contrasts the role of capsule and O antigen in three common UPEC serotypes using defined mutant and complemented strains. The combined mutagenesis-complementation strategy can be applied to study other virulence factors with complex functions both in vitro and in vivo.
- Safety and Efficacy of Long-Term Outpatient Ertapenem Therapy. [JOURNAL ARTICLE]
- Antimicrob Agents Chemother 2014 Apr 7.
Ertapenem is increasingly utilized in outpatient parenteral antimicrobial therapy (OPAT), but data regarding efficacy and safety of long-term ertapenem therapy are limited. We conducted a retrospective cohort study of adult patients who received outpatient ertapenem therapy at our center between 2010 and 2013. Among 306 unique patients who were discharged on ertapenem therapy, the most common indications were intra-abdominal infections (38%), followed by pneumonia (12%), bone and joint infections (11%), bloodstream infections (10%), urinary tract infections (10%), surgical site infections (5%) and skin and soft tissue infections (4%). Of them, 68 received regular outpatient follow-up visits at our infectious disease clinic, where the majority of patients (91%) were successfully treated with ertapenem by the end of therapy. Of the 6 patients who experienced clinical failure, 2 had adverse events leading to discontinuation of therapy and 4 required additional source control for clinical success. In addition, two patients had recurrent infection at 6 months.
- Fever of unknown origin: a retrospective study of 95 children in an Iranian referral hospital. [Journal Article]
- Br J Biomed Sci 2014; 71(1):40-2.
Fever of unknown origin (FUO) is a common manifestation in paediatrics and is a diagnostic problem especially in primary care. The present study aims to revue the causes of FUO in an Iranian referral tertiary care hospital. Information on 95 patients referred to the Children's Medical Center Hospital, Tehran, between 2004 and 2006 with a primary diagnosis of FUO was evaluated retrospectively. Infectious diseases were diagnosed in 26.3% (n = 25) of the cases, while malignant and non-infectious inflammatory diseases constituted 7.4% (n = 7) and 14.7% (n = 14), respectively. Urinary tract infections, acute lymphoid leukaemia and Kawasaki disease were the most commonly diagnosed conditions. Urinary tract infection accounted for approximately half of the infectious cases (n = 14). Conclusive diagnostic factors included history and examination in 21 cases, analysis of different specimens (i.e., urine analysis, urine culture, serology, peripheral blood and cerebrospinal fluid [CSF] examination) in 12 cases, culture in nine cases and serological tests in four cases. Infection and malignancy in patients aged under three years, and inflammatory diseases in patients aged over three years were more common. In patients aged under three years urine culture, bone marrow aspiration and peripheral blood smear proved more helpful in arriving at a final diagnosis of FUO, while in patients aged over three years, history and physical examination also contributed to the final diagnosis.
- Methenamine: a forgotten drug for preventing recurrent urinary tract infection in a multidrug resistance era. [Journal Article]
- Expert Rev Anti Infect Ther 2014 May; 12(5):549-54.
In the era of multidrug resistance, it is critical to utilize antibiotics in an appropriate manner and to identify new treatments or revisit the use of 'forgotten' drugs. Because urinary tract infections (UTIs) are common, particularly in an increasing elderly population, the 'forgotten' drug, methenamine, may become important as a preventive therapy for recurrent UTIs. Methenamine, a urinary antibacterial agent, can be used as methenamine hippurate or methenamine mandelate preparations and is United States Food and Drug Administration-approved. This article discusses the place of preventive therapy for recurrent UTIs, chemistry, mechanism of action, pharmacology, clinical uses, dosage, adverse reactions and safety, and drug interactions of methenamine. Because of its unique antiseptic property, the authors suggest that methenamine should be considered when more commonly used antibiotics fail to suppress recurrent UTIs.
- Nosocomial infections in the Intesive Care Unit, Univerisity Hospital for Infectious and Tropical Diseases, Belgrade, Serbia. [Journal Article]
- Vojnosanit Pregl 2014 Feb; 71(2):131-6.
Nosocomial infections (NIs) are an important cause of morbidity, mortality and prolonged hospitalizations. Fifty percent of NIs have been reported in Intensive Care Units. The aim of this study was to determine the frequency and type of NIs among critically ill patients treated in the University Hospital for Infectious and Tropical Diseases, Clinical Centre of Serbia, as well as risk factors for acquiring them.This prospective cohort study included 52 patients treated in the Intensive Care Unit from January to June 2004. The diagnosis of NI was established according to the Centers for Disease Control and Prevention (CDC) definition, based on clinical presentation, radiological and microbiological findings, etc. Statistical data processing was done by using the electronic data base organized in SPSS for Windows version 10.0. The level of statistical significance was defined as p < 0.05.NIs were found in 33 (63.4%) of 52 inpatients. Urinary tract infections (UTIs), pneumonia, and soft tissue infections, the most common nosocomial infections in our setting, were recorded in 41.0%, 25.6%, and 23.1%, of patients, respectively. Several factors contributed to a high incidence of these infections: chronic comorbidities (p < 0.01), the presence of indwelling devices such as urinary tract catheters (p < 0.01), endotracheal tubes (p < 0.05) along with mechanical ventilation (p < 0.05).The majority of patients with NIs had chronic underlying comorbidities. All the patients with UTIs had urinary catheters. The most important risk factors for the development of nosocomial pneumonias were endotracheal intubation and mechanical ventilation. The patients with pneumonia had the highest mortality.
- How well do discharge diagnoses identify hospitalised patients with community-acquired infections? - a validation study. [Journal Article]
- PLoS One 2014; 9(3):e92891.
Credible measures of disease incidence, trends and mortality can be obtained through surveillance using manual chart review, but this is both time-consuming and expensive. ICD-10 discharge diagnoses are used as surrogate markers of infection, but knowledge on the validity of infections in general is sparse. The aim of the study was to determine how well ICD-10 discharge diagnoses identify patients with community-acquired infections in a medical emergency department (ED), overall and related to sites of infection and patient characteristics.We manually reviewed 5977 patients admitted to a medical ED in a one-year period (September 2010-August 2011), to establish if they were hospitalised with community-acquired infection. Using the manual review as gold standard, we calculated the sensitivity, specificity, predictive values, and likelihood ratios of discharge diagnoses indicating infection.Two thousand five hundred eleven patients were identified with community-acquired infection according to chart review (42.0%, 95% confidence interval [95%CI]: 40.8-43.3%) compared to 2550 patients identified by ICD-10 diagnoses (42.8%, 95%CI: 41.6-44.1%). Sensitivity of the ICD-10 diagnoses was 79.9% (95%CI: 78.1-81.3%), specificity 83.9% (95%CI: 82.6-85.1%), positive likelihood ratio 4.95 (95%CI: 4.58-5.36) and negative likelihood ratio 0.24 (95%CI: 0.22-0.26). The two most common sites of infection, the lower respiratory tract and urinary tract, had positive likelihood ratios of 8.3 (95%CI: 7.5-9.2) and 11.3 (95%CI: 10.2-12.9) respectively. We identified significant variation in diagnostic validity related to age, comorbidity and disease severity.ICD-10 discharge diagnoses identify specific sites of infection with a high degree of validity, but only a moderate degree when identifying infections in general.
- Factors associated with ciprofloxacin- and cefotaxime-resistant Escherichia coli in women with acute pyelonephritis in the emergency department. [JOURNAL ARTICLE]
- Int J Infect Dis 2014 Mar 19.
High rates of antimicrobial resistance in Escherichia coli isolated from patients with urinary tract infections have been reported worldwide. The aim of this study was to identify risk factors for resistance to ciprofloxacin (CIP) and cefotaxime (CTX) in E. coli isolated from patients with acute pyelonephritis (APN).We prospectively identified women over 18 y of age who visited the emergency department of one of 10 hospitals with APN and whose urine culture grew E. coli. The study was conducted from April 16 to June 10, 2012.Of the 229 patients identified, 173 (75.5%) had community-associated (CA) infections and 56 (24.5%) had healthcare-associated (HCA) infections. Sixty-seven isolates (29.3%) were resistant to CIP, 45 (19.7%) to CTX, and 29 (12.7%) to both CIP and CTX. Multivariate analyses revealed that hematologic disease, chronic kidney disease, a bed-ridden state, indwelling urinary catheter, antibiotic treatment in the preceding 3 months, and isolation of CIP-resistant E. coli in the urine within the preceding 3 months, were significantly associated with resistance to both CIP and CTX.Chronic conditions and healthcare-associated factors were related to resistance to both fluoroquinolones and third-generation cephalosporins in women with APN. Continued and vigilant surveillance is necessary to monitor the dissemination of antimicrobial resistance in uropathogens.