- Actinotignum schaalii Infection: A Clandestine Cause of Sterile Pyuria? [Journal Article]
- OFOpen Forum Infect Dis 2018; 5(2):ofy015
- Actinotignum schaaliiis an underappreciated cause of urinary tract infections (UTIs) in older adults. The diagnosis may be missed due to difficulty isolating and identifying the o...
Actinotignum schaaliiis an underappreciated cause of urinary tract infections (UTIs) in older adults. The diagnosis may be missed due to difficulty isolating and identifying the organism. Complications can result because the organism is intrinsically resistant to 2 commonly used drugs to treat UTI, as illustrated by this case.
- Laboratory diagnosis of urinary tract infections: Towards a BILULU consensus guideline. [Review]
- JMJ Microbiol Methods 2018 Feb 07
- The BILULU study group consists of seven microbiologists of hospital laboratories located in the region of Flanders (Belgium). A major goal of the group is to standardize diagnostic microbiology proc...
The BILULU study group consists of seven microbiologists of hospital laboratories located in the region of Flanders (Belgium). A major goal of the group is to standardize diagnostic microbiology procedures based on available evidence and, in the absence of evidence, based on general microbiological principles and expert opinion. Scientific evidence of current urine culture guidelines is incomplete and at some points guidelines don't indicate clear choice. The aim of this project was to develop a clear and unambiguous step-by-step guideline regarding the work-up of urine cultures. Urinary tract infections (UTI) are very common throughout life, both in otherwise healthy as in immunocompromised or debilitated persons. UTI occur more frequent in women, with a lifetime occurrence rate close to 50%. The diagnosis of UTI is based upon clinical signs and symptoms and is supported by laboratory evidence of pyuria and bacteriuria. Laboratory diagnosis consists of urinary WBC count, dipstick analysis and urine culture. Urinary cultures represent a significant part of the workload in microbiology laboratories. Clear instructions for the interpretation of urine cultures by the laboratory technicians are indispensable to obtain standardized, reliable, and clinically useful results. Our search strategy was dual. On the one hand, we consulted reference works and searched the Internet for available guidelines on the subject. The following guidelines were withheld: 'Urine cultures' (Clinical Microbiology Procedures Handbook); 'Laboratory diagnosis of urinary tract infections' (Cummitech); Specimen collection, transport, and processing: bacteriology' (Manual of Clinical Microbiology); Urinary tract infections (Mandell, Douglas and Bennett's principles and practice of infectious diseases). In addition, we consulted reference guidelines of the Infectious Diseases Society of America (IDSA) and the European Association of Urology and performed specific searches on Pubmed (until May 2017) to obtain further evidence on particular items. Discrepancies and unresolved issues were finally discussed by an expert panel of 8 microbiologists.
- Asymptomatic bacteriuria in pregnant women attending Boo-Ali Hospital Tehran Iran: Urine analysis vs. urine culture. [Journal Article]
- EPElectron Physician 2017; 9(11):5760-5763
- CONCLUSIONS: Urine culture is the most useful test for diagnosis of asymptomatic bacteriuria. None of our screening tests had a sensitivity and specificity of 100%, whereas we can only refer the pregnant women with positive leucocyte esterase test and significant pyuria to the urine culture.
- Accuracy of the Urinalysis for Urinary Tract Infections in Febrile Infants 60 Days and Younger. [Journal Article]
- PedPediatrics 2018; 141(2)
- CONCLUSIONS: The urinalysis is highly sensitive and specific for diagnosing UTIs, especially with ≥50 000 CFUs/mL, in febrile infants ≤60 days old, and particularly for UTIs with associated bacteremia.
- Rate and association of lower urinary tract infection with recurrence after transurethral resection of bladder tumor. [Journal Article]
- ICInvestig Clin Urol 2018; 59(1):10-17
- CONCLUSIONS: A significant proportion of patients showed pyuria after TURBT during the follow-up period. Additionally, presence of pyuria in the short-term follow-up period after TURBT constitutes a risk factor for recurrence of bladder cancer.
- Preoperative dipstick albuminuria and other urine abnormalities predict acute kidney injury and patient outcomes. [Journal Article]
- SSurgery 2018 Jan 10
- CONCLUSIONS: Baseline dipstick urinalysis may predict postoperative AKI and may be significantly associated with prognosis after surgery. (Surgery 2017;160:XXX-XXX.).
- Diagnosis and treatment of urinary tract infections across age groups. [Review]
- AJAm J Obstet Gynecol 2018 Jan 02
- Urinary tract infections are the most common outpatient infections, but predicting the probability of urinary tract infections through symptoms and test results can be complex. The most diagnostic sy...
Urinary tract infections are the most common outpatient infections, but predicting the probability of urinary tract infections through symptoms and test results can be complex. The most diagnostic symptoms of urinary tract infections include change in frequency, dysuria, urgency, and presence or absence of vaginal discharge, but urinary tract infections may present differently in older women. Dipstick urinalysis is popular for its availability and usefulness, but results must be interpreted in context of the patient's pretest probability based on symptoms and characteristics. In patients with a high probability of urinary tract infection based on symptoms, negative dipstick urinalysis does not rule out urinary tract infection. Nitrites are likely more sensitive and specific than other dipstick components for urinary tract infection, particularly in the elderly. Positive dipstick testing is likely specific for asymptomatic bacteriuria in pregnancy, but urine culture is still the test of choice. Microscopic urinalysis is likely comparable to dipstick urinalysis as a screening test. Bacteriuria is more specific and sensitive than pyuria for detecting urinary tract infection, even in older women and during pregnancy. Pyuria is commonly found in the absence of infection, particularly in older adults with lower urinary tract symptoms such as incontinence. Positive testing may increase the probability of urinary tract infection, but initiation of treatment should take into account risk of urinary tract infection based on symptoms as well. In cases in which the probability of urinary tract infection is moderate or unclear, urine culture should be performed. Urine culture is the gold standard for detection of urinary tract infection. However, asymptomatic bacteriuria is common, particularly in older women, and should not be treated with antibiotics. Conversely, in symptomatic women, even growth as low as 102colony-forming unit/mL could reflect infection. Resistance is increasing to fluoroquinolones, beta-lactams, and trimethoprim-sulfamethoxazole. Most uropathogens still display good sensitivity to nitrofurantoin. First-line treatments for urinary tract infection include nitrofurantoin, fosfomycin, and trimethoprim-sulfamethoxazole (when resistance levels are <20%). These antibiotics have minimal collateral damage and resistance. In pregnancy, beta-lactams, nitrofurantoin, fosfomycin, and trimethoprim-sulfamethoxazole can be appropriate treatments. Interpreting the probability of urinary tract infection based on symptoms and testing allows for greater accuracy in diagnosis of urinary tract infection, decreasing overtreatment and encouraging antimicrobial stewardship.
- Risk Factors of Infectious Complications after Flexible Uretero-renoscopy with Laser Lithotripsy. [Journal Article]
- UJUrol J 2018 Jan 04
- CONCLUSIONS: We found that positive preoperative MDR urine culture is a significant risk factor for infectious complications after FURSLL. Our findings point to the need for further research on assessment of risk factors forMDR infections to reduce the rate of postoperative infectious complications.
- Benign prostatic hyperplasia and male lower urinary symptoms: A guide for family physicians. [Review]
- AJAsian J Urol 2017; 4(3):181-184
- Male patients with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) are increasingly seen by family physicians worldwide due to ageing demographics. A systematic way to stra...
Male patients with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) are increasingly seen by family physicians worldwide due to ageing demographics. A systematic way to stratify patients who can be managed in the community and those who need to be referred to the urologist is thus very useful. Good history taking, physical examination, targeted blood or urine tests, and knowing the red flags for referral are the mainstay of stratifying these patients. Case selection is always key in clinical practice and in the setting of the family physician. The best patient to manage is one above 40 years of age, symptomatic with nocturia, slower stream and sensation of incomplete voiding, has a normal prostate-specific antigen level, no palpable bladder, and no haematuria or pyuria on the labstix. The roles of α blockers, 5-α reductase inhibitors, and antibiotics in a primary care setting to manage this condition are also discussed.
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- Is the Preoperative Level of Procalcitonin a Valid Indicator for Predicting Postoperative Fever After Percutaneous Nephrolithotomy? [Journal Article]
- JEJ Endourol 2018 Jan 12
- CONCLUSIONS: We concluded that patients with preoperative fever, stone burden >353 mm2, PCT >0.05 ng/mL, or positive urine culture were more likely to develop postoperative fever and that routinely detecting PCT levels before PNL would be helpful in predicting postoperative fever.