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E. coli responsible for urinary tract infections (UTI) became resistant to obtainable therapies. So, nanotechnology appears currently as promising innovation among various strategies under development. In the present study we evaluate the antimicrobial effects of CuO and ZnO nanoparticles against E. coli isolated from UTI. Biofilm production and expression of quorum sensing genes luxS and motA were performed on E. coli treated with the nanoparticles. luxS and motA genes were detected in the tested E. coli. All isolates produced strong, moderate and weak biofilm. All isolates had a weak biofilm formation and decreased gene expression for luxS and motA genes after treatment with CuO, ZnO and their mixture. Besides, CuO and ZnO had non-toxic effects on Human Dermal Fibroblasts and neonatal normal cells. In conclusion, the mixture of CuO and ZnO had a role in decreasing the gene expression of luxS and motA genes more than each alone.

BackgroundType 2 diabetes mellitus is considered a risk factor for developing recurrent urinary tract infections. This review examined current knowledge on the incidence rates, bacterial strains, risk factors, treatments, and outcomes of recurrent urinary tract infections in type 2 diabetes, predominantly in women.MethodsA systematic review was conducted for all English language articles from inception to June 2022 utilizing the Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards in the databases PubMed, OVID Embase, and Cochrane Library. References were cross-examined for further articles. Data collected described the prevalence, characteristics, and management of recurrent urinary tract infections. Risk of bias assessments were performed for all studies.ResultsFrom 3342 identified articles, 597 met initial study criteria. Fifteen studies from 10 countries were included after full-text reviews. Four studies found higher recurrent urinary tract infection rates in diabetics versus non-diabetics meanwhile others reported recurrence rates from 23.4% to 37%. Four of five studies found diabetes to be a risk factor for recurrent urinary tract infection. E. coli was the most frequent causative pathogen. Antibiotic prescription results varied; however, multiple studies determined that longer treatment (≥ 5 days) did not correlate with lower recurrence rates. Risk of bias assessments found the most frequent study weakness to be identification of confounding variables.ConclusionThis review covered multiple subtopics, with few comprehensive or generalizable results, suggesting a need for more research on how recurrent urinary tract infections can be better evaluated and managed in women with type 2 diabetes.

Background and Objective: Urinary reflux is the most common urological abnormality in children. About half of the children with urinary infection have urinary reflux at the same time. Considering the importance of urinary reflux in children and contradictory results reported regarding the relationship between different grades of vesicoureteral reflux and recurrent urinary tract infection, this study was conducted with the aim of comparing recurrent urinary tract infection in children with different grades of vesicoureteral reflux. Methods: This cross-sectional study was conducted on 150 children with pyelonephritis and vesicoureteral reflux who refered to Amirkola Children's Hospital in 2011-2019. Reflux grades were determined by voiding cystourethrogram (VCUG) or direct radionuclide cystography (DRNC). Children were followed up for 2 years and in case of clinical symptoms with positive urine culture, they were considered as recurrent urinary tract infection. Findings: Of the 150 children studied, 126 (84%) were girls and 24 (16%) were boys with a mean age of 27.17±11.53 months. 95 people (63.3%) had once, 37 people (24.7%) twice, 8 people (5.3%) three times, and 10 people (6.7%) four times experience of recurrent urinary tract infection. The odds ratio of recurrent urinary tract infection was more than two times higher in children with grade 3 and 4 reflux involvement than in children with grade 1 and 2 reflux (OR=3.20, 95% CI=1.05-9.75, p=0.041). However, there was no significant difference in recurrent urinary tract infection in children based on age at diagnosis, gender, and whether the reflux was unilateral or bilateral. Conclusion: The results of the study showed that children with moderate and severe involvement of vesicoureteral reflux experience higher recurrent urinary tract infection compared to mild involvement.

Background & aim: There are several reports regarding the increase and growing prevalence of ESBLs producing organisms from different regions in the country. Considering that Klebsiella pneumoniae includes a significant percentage of hospital infections, therefore, knowing the pattern of resistance and sensitivity of this bacterium to beta-lactam antibiotics plays a significant role in the treatment and control of infections caused by this bacterium. As a result, the aim of the present study was to determine and evaluate the frequency of beta-lactamases The broad spectrum of Klebsiella pneumoniae urinary isolates was drug-resistant by genotypic and phenotypic methods. Methods: In the present cross-sectional descriptive study conducted in 2018, 100 strains of Klebsiella pneumoniae were isolated from urine samples of patients with urinary tract infection from Al-Zahra Hospital, Isfahan. Klebsiella pneumoniae strains were identified and confirmed using standard biochemical tests. Antibiotic sensitivity pattern was investigated by disk diffusion method based on CLSI criteria. To perform the phenotypic verification test of broad-spectrum β-lactamase producing strains, the combined disc method was used based on CLSI criteria. PCR test was done with specific primers to identify blaSHV and bla TEM. The collected data were analyzed using one-way and independent one-way analysis of variance statistical tests. Results: Among 100 isolates related to urinary tract infection, 33 isolates indicated resistance to at least 4 antibiotics, the highest resistance to cefotaxime antibiotic (38%) and the least antibiotic resistance to cotrimaxazole (22%). The results of combined disk indicated that 10 isolates (86.8%) were broad-spectrum β-lactamase producers. Among them, 7 isolates (70%) had the SHV gene and the other 3 isolates did not have any of the TEM and SHV genes. Conclusion: The results indicated a higher frequency of ESBLs and correspondingly a higher prevalence of antibiotic resistance in Klebsiella pneumoniae bacteria isolated from urinary tract infections.

Background & aim: There are several reports regarding the increase and growing prevalence of ESBLs producing organisms from different regions in the country. Considering that Klebsiella pneumoniae includes a significant percentage of hospital infections, therefore, knowing the pattern of resistance and sensitivity of this bacterium to beta-lactam antibiotics plays a significant role in the treatment and control of infections caused by this bacterium. As a result, the aim of the present study was to determine and evaluate the frequency of beta-lactamases The broad spectrum of Klebsiella pneumoniae urinary isolates was drug-resistant by genotypic and phenotypic methods. Methods: In the present cross-sectional descriptive study conducted in 2018, 100 strains of Klebsiella pneumoniae were isolated from urine samples of patients with urinary tract infection from Al-Zahra Hospital, Isfahan. Klebsiella pneumoniae strains were identified and confirmed using standard biochemical tests. Antibiotic sensitivity pattern was investigated by disk diffusion method based on CLSI criteria. To perform the phenotypic verification test of broad-spectrum β-lactamase producing strains, the combined disc method was used based on CLSI criteria. PCR test was done with specific primers to identify blaSHV and bla TEM. The collected data were analyzed using one-way and independent one-way analysis of variance statistical tests. Results: Among 100 isolates related to urinary tract infection, 33 isolates indicated resistance to at least 4 antibiotics, the highest resistance to cefotaxime antibiotic (38%) and the least antibiotic resistance to cotrimaxazole (22%). The results of combined disk indicated that 10 isolates (86.8%) were broad-spectrum β-lactamase producers. Among them, 7 isolates (70%) had the SHV gene and the other 3 isolates did not have any of the TEM and SHV genes. Conclusion: The results indicated a higher frequency of ESBLs and correspondingly a higher prevalence of antibiotic resistance in Klebsiella pneumoniae bacteria isolated from urinary tract infections.

Purpose: Urinary tract infections are among the most common infections in childhood. In this study, it was aimed to evaluate the factors of urinary tract infection in our hospital and to determine antimicrobial resistance patterns and empirical treatment options. Materials and Methods: The results of urine cultures that were sent from the Department of Pediatrics between 01.01.2015 and 31.12.2020 to the Microbiology Laboratory were evaluated retrospectively. The identification of the bacterial growth was tested in Vitek MS (Biomeriux, France) and the antimicrobial susceptibility of the isolates was tested in Vitek2 Compakt (Biomeriux, France). Results: A total of 4257 urine culture samples were evaluated. The most frequently isolated bacteria were E. coli 62.93% followed by Klebsiella spp. 19.6%, Pseudomonas spp. 5.37%, Proteus spp. 4.48%. The highest resistance rates were determined against ampicillin in E. coli (78.96%) and for cefuroxime (63.11%) in Klebsiella spp isolates. The lowest resistance rate was determined against imipenem and meropenem in E.coli (0.12%, 0.15%) isolates and, amikacin and nitrofurantoin in Klebsiella spp. isolates (6.10%, 2.46%). Conclusion: In order to provide effective treatment for urinary tract infections and to minimize morbidity and long-term complications, the frequency of the pathogens causing UTIs, local or regional antibiotic resistance should be known and empirical treatment should be arranged accordingly.

In this study, we explored the incidence of double J (JJ) contamination of patients who underwent an endourological procedure for urinary stones and ureteral stenosis. We developed a prospective study between January 2019 and December 2021. Ninety-seven patients, 54 male and 43 female, were enrolled. Urine culture was taken during four steps: before stent insertion, a sample from selective renal pelvis catheterization, a sample two days after the JJ insertion and finally, after the stent removal procedure. At the time of the stent removal, 1 cm of proximal and distal ends were cut off and placed in the culture for bacterial evaluation. Cohen’s kappa coefficient value (k) and concordance rates of microbiological culture results were evaluated. The study group comprised 56% of male patients. Proximal and distal stent cultures were positive in 81 and 78 patients. The concordance rate of microbiological cultures between proximal and distal double J stent is 88% (k 0.6). The most common pathogens isolated from urine and stent cultures were Enterococcus spp. in 52 cases and Klebsiella spp. in 27 cases.

Organ abscesses caused by Streptococcus anginosus are relatively rare. We report the case of an elderly woman with splenic abscess caused by S. anginosus bacteremia after urinary tract infection. An 82-year-old woman had a history of frequency of urination, urgency, and fever with chills for over 10 days prior to admission. An abdominal computed tomography (CT) scan performed in the emergency room revealed a low-density lesion in the spleen, kidney cysts, some exudation around the kidney, and cystitis should be valued. She was treated with ceftriaxone and imipenem/cilastatin. After admission, the blood culture yielded positive results for S. anginosus. A contrast-enhanced abdominal CT scan showed that the low-density lesion previously found in the spleen was smaller than before. After percutaneous drainage of the splenic abscess and treatment with piperacillin/tazobactam based on the antibiotic sensitivity pattern, repeated abdominal CT scan revealed a significant reduction in the low-density lesion. The patient was discharged without recurrence or complications. A systematic review of organ abscess caused by S. anginosus bacteremia was performed. To our knowledge, there has been no report of splenic abscess caused by S. anginosus bacteremia secondary to urinary system tract infection, although urinary tract infections are also an important source.

Urinary tract infection is one of the most common indications for prescribing antibiotics among otherwise healthy patients. The lifetime risk of having urinary tract infection among the female population reaches up to 50%. Empirical antibiotic therapy is the first line of treatment in uncomplicated cases. Bacterial resistant to antibiotics is constantly increasing and it is resulting in the evolvement of multidrug-resistant pathogens but also causes a limitation in empirical treatment options. Due to growing antimicrobial resistance, local antimicrobial susceptibility patterns should always be considered especially when empirical treatment is introduced. The article shows the ongoing need for updates in local resistance patterns. Recommendations for the empirical treatment should be constantly verified with reference to the local antimicrobial resistance status. Non-antibiotic preparations may be useful only in the prevention of urinary tract infections.

Renal emphysema, as described by Kelly and MacCallum in 1898, refers to the spontaneous generation of gas within the renal parenchyma and surrounding tissues. Since its initial description, it has become apparent that the spectrum of radiologically visible renal and perirenal gas includes three distinct clinical entities: (1) emphysematous pyelonephritis, a necrotizing infection associated with gas formation in the renal parenchyma, (2) emphysematous pyelitis, in which gas is confined to the renal pelvis and calyces, and (3) gas-forming perinephric abscess. In this article, we will review gas-forming infections of the urinary system in terms of radiological features, clinical manifestations, predisposing factors, and appropriate management guidelines.

There are growing concerns regarding the rise of antimicrobial-resistant bacteria in companion animals. This study aimed to bring new insights into the current scenario of Portugal’s antimicrobial resistance bacteria isolated from companion animals with urinary tract infections and is the first to be performed during a long period on a large scale. Of a total of 17472 urine samples analyzed, 12,166 (69.6%) (CI 12,200–12,200) were negative for bacterial growth, and 5306 (30.4%) (95% CI 5310–5310) had bacterial growth. Of the culture-positive samples, 5224 (96.6%) (95% CI 5220–5220) were pure cultures and 82 (3.2%) (95% CI 81.9–82.1) had mixed growth. Escherichia coli was the most frequently isolated bacteria (n = 2360, 44.5%) (95% CI 2360–2360), followed by Proteus mirabilis (n = 585, 11%) (95% CI 583–583), Enterococcus faecium (n = 277, 5.2%) (95% CI 277–277) and Staphylococcus pseudintermedius (n = 226, 4.3%) (95% CI 226–226). The overall susceptibility rates were low for erythromycin (45.3%) and clindamycin (51.3%), and high for aminoglycosides (96.3%), carbapenems (92.4%), trimethoprim-sulfamethoxazole (81.2%), and quinolones (79.9%). E. coli also showed considerable resistance to amoxicillin-clavulanic acid. The rates of multidrug-resistant bacteria are still high compared to the northern countries of Europe. This study’s findings show the emergence of antibiotic resistance in the antibiotic agents commonly used in the treatment of UTIs in dogs and cats in Portugal.

Abstract The purple urine bag syndrome is an underrecognized but quite common condition, resulting in marked discoloration of the urine bag system due to bacterial metabolism. This syndrome is associated with advanced age and bedridden persons.

Aeromonas hydrophila is representative of group within the Aeromonadaceae family that mainly causes infections in humans. Aeromonads can induce meningitis, septicemia, respiratory and hemolytic uremic syndrome as well as gastroenteritis. Regarding diverse mechanisms involved in virulence and metabolic adaptation of Aeromonas hydrophila to various hosts and environments it is often introduced as “Jack of all trades.” Here we report the first isolation of Aeromonas hydrophila from urine samples of three patients from the Urology Department within the Clinical Centre of Vojvodina. Epidemiological survey identified contact with surface water as the only mutual risk parameter. Following that, novel antibacterial agents against Aeromonas hydrophila are discussed

Background: A prospective randomized study was used to effect of urinary bladder catheterization on UTI, time of first-void discomfort, time of ambulation, hospital stay, and urinary retention in women undergoing cesarean section. Objectives: The aim of study was to assess the feasibility and outcome of cesarean section without Foley's Catheter. Patients and Methods: This Study included 100womens who had the Foley's catheter inserted just before cesarean section and 100womens who had not use Foley's catheter during section in Obstetric and Gynacology department in Qena University Hospital. Prospective method were used to assess patient discomfort with the first postoperative void after , time of ambulation , time hospital stay and need for cathetherization. Result: This study included 200 patients 100 patient with urinary catheter and 100 without urinary catheter mean age of the studied group 25.8±5.5, mean gestational age 37.9 ±1.1 weeks, mean for No. of C.S 1.08±.7, mean duration of C.S 48.5 ±5 minutes. 99% of patients have no bladder injury while 1% have bladder injury.99%of patients complaining of urine retention .mean time of retention 4.8 minutes .mean for post voiding volume 18.02 cc. 4%of patient complaining of voiding difficulty.6.5% of patients complaining of dysuria . urine analysis before C.S(pus cell) 4.2 ±1.43 Urine analysis after 1 week 33.3 ±5.8Uncatheterized patients had a shorter hospital stay. Conclusion: Routine use of indwelling urinary catheter in cesarean section patient with a stable hemodynamic condition is not necessary.

A prospective cohort study was conducted on a convenience sample of 1370 pregnant women with a gestational age of 20 to 25 weeks in the city of Ribeirão Preto. Data on obstetrical history, maternal age, parity, smoking habit, and a history of preterm delivery was collected with the application of a sociodemographic questionnaire. Cervical length was determined by endovaginal ultrasound, and urine and vaginal content samples were obtained to determine urinary tract infection (UTI) and bacterial vaginosis (BV), respectively. The aim of this study was to verify the association of cervical length and genitourinary infections with preterm birth (PTB). Ultrasound showed no association of UTI or BV with short cervical length. PTB rate was 9.63%. Among the women with PTB, 15 showed UTI (RR: 1.55, 95%CI: 0.93–2.58), 19 had BV (RR: 1.22, 95%CI: 0.77–1.94), and one had both UTI and BV (RR: 0.85, 95%CI: 0.13–5.62). Nineteen (14.4%) PTB occurred in women with a cervical length ≤2.5 cm (RR: 2.89, 95%CI: 1.89–4.43). Among the 75 patients with PTB stratified as spontaneous, 10 showed UTI (RR: 2.02, 95%CI: 1.05–3.86) and 14 had a diagnosis of BV (RR: 1.72, 95%CI: 0.97–3.04). A short cervical length between 20 and 25 weeks of pregnancy was associated with PTB, whereas UTI and BV determined at this age were not associated with short cervical length or with PTB, although UTI, even if asymptomatic, was related to spontaneous PTB.

INTRODUCTION: The emergence of extended-spectrum beta-lactamase-producing Enterobacteriaceae (E-ESBLs) is currently a major public health problem in the world and, in particular, in developing countries. In Cameroon, data on E-ESBLs are rare, especially in Garoua and in the northern region of the country. The objective of this study is to document the epidemiology of E-ESBL infections in small children and to explore their associations with possible risk factors. METHODS: this was a cross-sectional, descriptive study conducted from June 14 to September 30, 2018, including small children with suspected urinary tract infections (UTI) attending the outpatient pediatric departments of two health facilities in the city of Garoua. Urine samples were analyzed at the Bacteriology Laboratory of the Pasteur Center of Cameroon, Annex Garoua. Bacterial culture was carried out on Bio-Rad UriSelect® chromogenic agar and the identification was confirmed by bioMérieux API 20E. The antibiotic susceptibility was determined using the bioMérieux ATB UR gallery and the ESBL phenotype was detected by the double disk synergy method according to the CA-SFM 2013 recommendations. The data was analyzed with the R Statistical Software version 2.15.2. RESULTS: a total of 57 urine samples were collected from children aged from one month to two years, 37 boys and 20 girls. Bacteria were detected by culture in 20 samples: Escherichia coli was the most frequently (75 %) isolated species followed by Klebsiella pneumoniae (25%). More than half of the infected samples (55%) contained E-ESBL. The presence of an ESBL was significantly associated with previous antibiotic intake up to 3 months prior current UTI (p=0.01664). The E-ESBL strains showed co-resistance to different antibiotics. CONCLUSION: this study reveals the important dissemination of E-ESBLs among small children in the community and a high rate of co-resistance to the different antibiotic families commonly used.

Purple urine bag syndrome (PUBS) is a rare condition that occurs predominantly in the elderly, immobilized and bearer of chronic bladder catheter. It is a phenomenon usually associated with urinary tract infection, particularly in the presence of high bacterial load. The presence of alkaline urine, constipation, high-protein diet and dehydration are predisposing factors. In most cases it is an asymptomatic condition. We described the case of an elderly patient admitted to the geriatric Department in which purple urine was found in the urine collection bag. The culture of urine showed the presence of infection with Klebsiella Pneumoniae. Targeted antibiotic treatment and proper hydration determined the resolution of the phenomenon and the resolution of the infection. Although it is an alarming phenomenon due to the particularity of the color of the urine, it is a treatable and solvable condition with an adequate specific antibiotic treatment. Prevention measures are equally effective and consist in eliminating the risk factors for this condition.

Aim. To study prevalence and etiological structure of urinary tract infections (UTIs) in pregnant women with type 1 diabetes mellitus, to assess sensitivity of various methods of UTIs detection.Materials and methods. 192 pregnant women with type 1 diabetes mellitus (DM1) were examined. The presence of a urinary infection was assessed by detection of nitrites, leukocyte esterase in general urinalysis and by bacteriological culture with the use of the classical and "DipStrik" express method.Results. UTI has been detected in 57.3%. The frequency is as follows: asymptomatic bacteriuria (> 105 cfu /ml) (ABU) – 35.9% (n=69), acute pyelonephritis – 19.8% (n=38), acute cystitis – 1.6% (n=3). The proportion of low ABU (102-104 cfu/ ml) is 16.1% (n=31). Escherichia coli prevailed in the structure of pathogens of UTI: in ABU – 66.7%, in pyelonephritis – 78.9%. Then goes Enterococcus faecalis: in ABU – 14.5%, in pyelonephritis – 13.2%; and then Klebsiella: in ABU – 7.2%, in pyelonephritis – 5.3%. Other pathogens (Streptococcus agalactiae, Staphylococcus aureus, Proteus) were less common. Sensitivity of the nitrite test to detect UTI was 30%; sensitivity of leukocyte esterase detection for low ABU was 22.6%, for ABU – 52.2%, for pyelonephritis –71%. Sensitivity of the express method "DipStrik" with reference to classical bacteriological culture was 98%.Conclusion. The structure of UTI in DM1 differs from that of in pregnant women without DM. In DM1 a "significant" ABU dominates over a low ABU. The share of manifest forms of UTI in DM1 is much higher than in pregnant without DM. In the structure of UTI pathogens in pregnant women with DM1 gram-positive microbes (E. faecalis, S. agalactiae and S. aureus) have a greater proportion compared with pregnant women without DM, in which more than 80% of UTI pathogens are gram-negative (E. coli, K pneumoniae and Proteus). Cultural methods still remain the gold standard of UTI detection, and especially its asymptomatic forms. Moreover, the "DipStrik" express method of bacteriological culture has sensitivity comparable to the classical culture (in our study 98 %).

BACKGROUND AND OBJECTIVE: Pseudomonas aeruginosa is considered as one of the important causes of urinary infections in hospitals. The aim of the current study is the genetic typing for the number of bacterial strains isolated from patients using MLVA technique. METHODS: In this study, 70 isolates were collected from different hospitals located in Tehran city. First, DNA extraction was conducted for genotyping analysis by MLVA method. Subsequently, VNTR sequences located in several genes of bacterial genomes such as MS-214, MS-215, MS-217, MS-222, MS-223, MS-142 and MS-173 were amplified by specific primers using PCR technique. After confirming the PCR amplification using electrophoresis and visualization of their bonds on agarose gel, relationship evolutionary graph for the different strains was constructed based on MLVA technique. FINDINGS: After the electrophoresis and determination of VNTR copy-numbers, 70 strains were classified as 36 types. The genetic evolutionary tree was also constructed based on VNTRs Data. According to the results, PCR products of 70 strains visualized by electrophoresis are divided to 39 types based on VNTR analysis. Evolution tree and MSR algorithm was also constructed for all 70 clinical isolates. According to the MST algorithm, 70 clinical strains divided into 11 clonal complexes which these criteria is interpreted as genetic distance based on the difference of VNTR copy numbers for each group CONCLUSION: The present study showed that MLVA could be helpful for typing clinical strains of P. aeruginosa. The results also showed that this method had great potential to differentiate those strains with high phenotypic similarity.

Abstract Introduction The presence of bacteria in urine is called bacteriuria, which may be symptomatic or asymptomatic. The manipulation of the urinary tract during urodynamic study (UDS), which is an invasive procedure, can result in urinary tract infection (UTI). Studies on the use of prophylactic antibiotics for UDSs are contradictory. Some investigators concluded that they were valuable and others did not. The objective of this study is to evaluate the efficacy of antibiotic prophylaxis before UDS. This is a placebo-control randomized double-blind study. Methods Two-hundred and seventeen women affected by urinary incontinence were eligible for this study. All patients had presented negative urine culture previous to the UDS. They were randomized in four groups: group A received placebo, group B received 500 mg of levofloxacin, group C received 80 mg trimethoprim and 400 mg sulfamethoxazole and group D received 100 mg of nitrofurantoin. A urine culture was performed 14 days after the UDS. Results We observed asymptomatic bacteriuria after the UDS in five patients in group A, one in group B, one in group C and one in group D. Only one patient on group A had symptomatic bacteriuria.We didn’t observe statistical difference between the groups. When we recategorized the patients in two groups, the incidence of bacteriuria was significantly higher in the placebo group compared with the antibiotic group. Conclusion The conclusion is that antibiotic prophylaxis before the UDS did not reduce the incidence of UTI in women within the target population.

Abstract Recurrent UTI’s represent a challenge for physicians and anatomic abnormalities should be investigated thoroughly in this setting. Not all urinary tract dilatations mean obstruction. Several entities can mimic hydronephrosis without actual interruption of urinary flow. Uniform calyceal dilatation without dilatation of pelvis and ureter suggests megacalycosis.

Bioactive compounds and phenolic compounds are viable alternatives to antibiotics in recurrent urinary tract infections. This study aimed to use a natural functional product, based on the bioactive compounds’ composition, to inhibit the uropathogenic strains of Escherichia coli. E.coli ATCC 25922 was used to characterize the IVCM (new in vitro catheterization model). As support for reducing bacterial proliferation, the cytotoxicity against a strain of Candida albicans was also determined (over 75% at 1 mg/mL). The results were correlated with the analysis of the distribution of biologically active compounds (trans-ferulic acid-268.44 ± 0.001 mg/100 g extract and an equal quantity of Trans-p-coumaric acid and rosmarinic acid). A pronounced inhibitory effect against the uropathogenic strain E. coli 317 (4 log copy no./mL after 72 h) was determined. The results showed a targeted response to the product for tested bacterial strains. The importance of research resulted from the easy and fast characterization of the functional product with antimicrobial effect against uropathogenic strains of E. coli. This study demonstrated that the proposed in vitro model was a valuable tool for assessing urinary tract infections with E. coli.

Fosfomycin represents a relatively old antibiotic, but it is experiencing a comeback in recent years. According to some studies, the increasing therapeutic use of this drug led to a rapid increase in the levels of resistance in bacteria causing urinary tract infection. In the presented study, levels of resistance to fosfomycin in more than 3500 bacterial isolates before and after fosfomycin introduction into therapeutic use in the Czech Republic and the clinical efficacy of treatment in 300 patients using this drug were assessed. The results show that the resistance levels to fosfomycin in Escherichia coli isolates before and after the drug registration were not significantly different (3.4% and 4.4%, respectively). In some other Gram-negative rods, such as otherwise susceptible Enterobacter, resistance to fosfomycin increased significantly from 45.6% to 76.6%. Fosfomycin treatment of urinary tract infections showed an excellent seven-day clinical efficacy (79.7%). However, when used to treat recurrent or complicated urinary tract infections, fosfomycin treatment was associated with high levels of infection relapse, leading to relapse in a total of 20.4% of patients during the first two months. This indicates that fosfomycin exhibits good efficacy only for the treatment of uncomplicated urinary tract infections

Purple-appearing urinary catheter and urosac can be alarming to the patient's attenders and doctors. It may be misinterpreted and overinvestigated if the underlying causes and mechanisms of this phenomenon are not understood. Urinary tract infection with sulfatase- and phosphatase-producing bacteria is implicated in the pathogenesis. We hereby report the appearance of purple color of urinary bag and catheter in an elderly female patient with dementia and chronic paraplegia on long-term Foley's catheterization.

Ureteral stents are commonly used following urological procedures to maintain ureteral patency. However, alongside the benefits of the device, indwelling stents frequently cause significant patient discomfort (pain, urgency, frequency) and can become encrusted and infected. The importance of these sequelae is that they are not only bothersome to the patient but can lead to significant morbidity, urinary retention, ureteral damage, recurrent infections, pyelonephritis and sepsis. When these problems occur, stent removal or replacement alongside antibiotic, analgesic and/or other symptom-modifying therapies are essential to successfully treat the patient. In an attempt to prevent such morbidity, numerous approaches have been investigated over the past several decades to modify the stent itself, thereby affecting changes locally within the urinary tract without significant systemic therapy. These strategies include changes to device design, polymeric composition, drug-elution and surface coatings. Of these, drug-elution and surface coatings are the most studied and display the most promise for advancing ureteral stent use and efficacy. This article reviews these two strategies in detail to determine their clinical potential and guide future research in the area.

Case report of a patient who, while being under study due to total urinary incontinence and multiple urinary tract infections, interoccurs with urosepsis due to a forgotten and encrusted double-J stent. An open surgery is performed with two surgical approaches, suprapubic and minimal lumbotomy, in which a nephrectomy of the atrophic kidney, a resection of the urether with a calcified double-J in its interior and a cystolithotomy were conducted with the resulting favorable resolution of the pathology.

A 26-month-old boy, who was misdiagnosed with urinary tract infection, was admitted to our hospital with increasing complaints of uneasiness, vomiting and nausea. On physical examination, a urethral stone was suspected and was confirmed by plain urinary tract x-ray. In children, the clinical features of a urethral stone may be overlooked because children are not able to express their complaints fully. Therefore, a detailed and careful physical examination is of great importance. In this paper, we present the rare case of urethral stone in a child and a review of the literature.

We report on the observation of a 30-month-old female newborn that was treated for a urinary infection. The medical imaging revealed the existence of a right double system ureterocele with vesicorenal reflux on the ureter of the upper pyelon and a bifid left ureter. The treatment consisted in an ureterocelectomy, a reimplantation of the two right ureters and a repair of the vesical floor. The external drainage of the upper pyelon allowed us to make sure of its functionality that was about 15% of the full renal function. The post-op follow-ups have been simple and thirteen months later, the newborn is doing well and does not present any sign of urinary infection.

The inappropriate use of antimicrobials has a negative impact, in favoring the appearance of drug-resistant strains on patients, in the ecosystem and in the economy. The hospital studied, Hospital do Mar (HM), specializes in providing care during patient recovery and rehabilitation, as well as palliative and geriatric care, to patients originating from general or intensive care hospitals. It is known that drug-resistant strains occur more frequently among bacteria that cause nosocomial infections as opposed to community acquired infections. Furthermore, in hospitals the high occurrence of drug-resistant strains is concurrent with a high use of antimicrobials. In this study the authors performed a retrospective analysis to characterize the infectious pathology present in the Hospital do Mar, test the sensitivity of the microorganisms present to several antimicrobials, and document the antimicrobials prescribed at the time, with the goal of adjusting the therapeutic protocols currently implemented and decreasing the emergence of drug-resistant strains. This study allowed the implementation of clinical protocols, and established criteria for the selection of antibiotherapy prescriptions for the most common infectious pathologies.

Se realizó un estudio descriptivo y observacional de 56 pacientes con infecciones urinarias a repetición que acudieron al Laboratorio Clínico del Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, procedentes de las salas y consultas externas del Policlínico de Especialidades de dicha institución, de junio del 2010 a mayo del 2011, para determinar las características del sedimento de la orina previo al diagnóstico y posterior al tratamiento mediante 2 técnicas: cituria y conteo de Addis. En la serie preponderaron el sexo femenino y las edades de 20 a 51 años, y coincidieron en ambas pruebas las variaciones patológicas del sedimento urinario de la mayoría de los afectados. Después de la terapéutica, no obstante, persistió la positividad en la sedimentación en 100 % de las muestras analizadas por el conteo de Addis, aunque con una mejoría ostensible de esta.A descriptive and observational study of 56 patients with repeated urine infections who were attended at the Clinical Laboratory from "Saturnino Lora Torres" Clinical Surgical Teaching Provincial Hospital in Santiago de Cuba, coming from the rooms and outpatients department from the Specialties Polyclinic in this institution was carried out from June, 2010 to May, 2011, to determine the characteristics of urine sediment previous to the diagnosis and after treatment by means of 2 techniques: cyturia and Addis count. Female sex and ages from 20 to 51 years prevailed in the series, and in both tests the pathological variations of the urinary sediment of most affected patients coincided. However, after therapy, the positive result in sedimentation persisted in 100% of the samples analyzed through Addis count, although with an ostensible improvement of it.

Background: Resistance to contemporary broad-spectrum b-lactam antibiotics mediated by extended-spectrum b-lactamases (ESBLs) is increasing worldwide. Klebsiella pneumoniae, an important cause of nosocomial and community acquired urinary tract infections has rapidly become the most common ESBL producing organism. We examined ESBL production in urinary isolates of K. pneumoniae in relation to the presence of blaSHV, blaTEM and blaCTX-M genes.Methods: Antibiotic resistance of 51 clinical isolates of K. pneumoniae was determined to amoxicillin, amikacin, ceftazidime, cefotaxime, cefteriaxon, ceftizoxime, gentamicin, ciprofloxacin and nitrofurantoin by disc diffusion. Minimum inhibitory concentrations were also measured for ceftazidime, cefotaxime, cefteriaxon, ceftizoxime and ciprofloxacin. ESBL production was detected by the double disc synergy test and finally, presence of the blaSHV, blaTEM and blaCTX-M genes were shown using specific primers and PCR.Results: Disc diffusion results showed that 96.08 % of the isolates were resistant to amoxicillin followed by 78.43 % resistance to nitrofurantoin, 49.02 % to amikacin and ceftazidime, 41.17 % to ceftriaxone, 37.25% resistance to cefotaxime and ceftizoxime, and 29.42 % to gentamicin and ciprofloxacin. Both resistant and intermediately resistant organisms were resistant in MIC determinations. Twenty two isolates (43.14%) carried blaSHV, 18 (35.29%) had blaTEM and 16 (31.37%) harbored blaCTX-M genes. ESBL production was present in 14 isolates (27.45 %) of which, 3 did not harbor any of the 3 genes. Among the non- ESBL producers, 9 lacked all 3 genes and 2 carried them all.Conclusion: No relation was found between gene presence and ESBL expression.

Se realizó un estudio descriptivo, longitudinal y retrospectivo de 64 pacientes con infección urinaria, ingresados en el Hospital Infantil Sur de Santiago de Cuba desde enero hasta diciembre del 2010, con vistas a determinar algunos aspectos clínicos diagnósticos. En la mayoría de los niños hospitalizados prevalecieron: anemia, leucocitosis, eritrosedimentación acelerada, así como leucocituria ligera; y entre los microorganismos: Escherichia coli, Proteus mirabilis y Enterobacteriaceae. Para verificar la presencia de esas alteraciones, deben indicarse los exámenes complementarios: hemograma completo, eritrosedimentación, cituria y urocultivo, cuyos resultados posibilitan establecer un diagnóstico concluyente.A descriptive, longitudinal and retrospective study of 64 patients with urinary infection, admitted at the Southern Children Hospital in Santiago de Cuba was carried out from January to December, 2010, with the objective of determining some clinical and diagnostic aspects. In most of the hospitalized children, anemia, leucocytosis, accelerated erytrosedimentation, as well as mild leucocyturia prevailed; and among the organisms: Escherichia coli, Proteus mirabilis and Enterobacteriaceae. To verify the presence of these changes, additional tests such as complete blood count, erytrosedimentation, cyturia and urine culture should be indicated as their results facilitate to establish a conclusive diagnosis.

The increase in the prevalence of bacterial resistance to antibiotics has become one of the main health problems worldwide, thus threatening the era of antibiotics most frequently used in the treatment of infections. The need to develop new therapeutic strategies against multidrug resistant microorganisms, such as the combination of selected antimicrobials, can be considered as a suitable alternative. The in vitro activities of two groups of conventional antimicrobial agents alone and in combination with silver nanoparticles (AgNPs) were investigated against a set of ten multidrug resistant clinical isolate and two references strains by MIC assays and checkerboard testing, as well as their cytotoxicity, which was evaluated on human fibroblasts by MTT assay at the same concentration of the antimicrobial agents alone and in combination. Interesting results were achieved when the AgNPs and their combinations were characterized by Dynamic Light Scattering (DLS), Zeta Potential, Transmission Electron Microscopy (TEM), UV–visible spectroscopy and Fourier Transforms Infrared (FTIR) spectroscopy. The in vitro activities of ampicillin, in combination with AgNPs, against the 12 microorganisms showed one Synergy, seven Partial Synergy and four Additive effects, while the results with amikacin and AgNPs showed three Synergy, eight Partial Synergy and one Additive effects. The cytotoxic effect at these concentrations presented a statistically significant decrease of their cytotoxicity (p < 0.05). These results indicate that infections caused by multidrug resistant microorganisms could be treated using a synergistic combination of antimicrobial drugs and AgNPs. Further studies are necessary to evaluate the specific mechanisms of action, which could help predict undesirable off-target interactions, suggest ways of regulating a drug’s activity, and identify novel therapeutic agents in this health problem.

Objectives: Urinary tract infections are today counted aging as one of the infectious and hospital related disease with high especially in aging women. As we know the infection would be identified in urine sample based on KASS scale while in spite of valuable usage of this method the culture results of a significant number of patients appear to be negative while there may be symptoms of infection. On the other hand organisms which are not identified using the above separation method are called "Fastidious". So the objective in this research work is to find an effective way fro identification and treatment using separation of fastidious bacteria technique in those urine samples showing a negative culture result with common (abovementioned) methods while the patient may have some infection symptoms. Methods & Materials: In this research the job was to identify and separate fastidious bacteria in 1075 samples of aging women urine, with changes in culture media incubation conditions and level of gases able to separation of fastidious Bacterium. As well number of leucocytes in the initial sample and existence of pus in urine sample were determined. Meantime study of medical records for determination of symptoms and antibiotics administration was considered and all results were compared with each other and finally evaluated based on the control group. Results: After aerobic and nocturnal culture of 1075 urine samples, 338 cases were positive, 99 cases had basic count, 159 cases were mixed and 434 cases were negative. Out of negative cases in the said method, using fastidious bacteria separation technique, cases had fastidious bacteria more than 50% of which had some symptoms of infection showing a significant difference. Conclusion: For separation and identification of urine infection factors in aging women patients with negative nocturnal aerobic culture, especially when it was coincided with presence of symptoms. Additional sample in selective and extra environment along with changes in incubation conditions would be necessary for bacteria separation.

HTLV-I is considered to be a virus of low morbidity, since the principal diseases associated with this viral infection, HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and adult T-cell leukemia/lymphoma (ATLL), are observed in less than 5% of infected individuals. Urinary symptoms are frequent in patients with myelopathy and consist principally of nocturia, frequency, urgency, and urinary incontinence; however, the importance of these dysfunctions and their correlation with myelopathy is still to be fully clarified. This review gives particular emphasis to the high frequency of urinary and sexual complaints not only in patients with myelopathy but also in individuals considered to be HTLV-I carriers. Detrusor overactivity and bladder-sphincter dyssynergia are the most common urodynamic findings. The fact that urinary complaints and urodynamic parameters reported in individuals considered to be carriers are similar to those detected in patients with myelopathy supports the hypothesis that urinary disorders may represent an oligosymptomatic form of HAM/TSP. Erectile dysfunction is frequently observed in HTLV-I-infected patients with or without myelopathy. Urinary tract infections are also highly prevalent in these patients. Despite the lack of an effective treatment for myelopathy, the use of anticholinergic drugs and phosphodiesterase type 5 (PDE5) inhibitors may improve urinary complaints and erectile dysfunction in these patients.O HTLV-1 é considerado um vírus de baixa morbidade sendo a mielopatia associada ao HTLV-1 (HAM/TSP) e a leucemia / linfoma de células T do adulto (ATL) as principais doenças associadas à infecção viral, observados em menos de 5% dos indivíduos infectados. Manifestações urinárias são freqüentes em pacientes com mielopatia, e representadas principalmente por noctúria, polaciúria, urgência e incontinência urinária, embora a importância destas alterações, e a correlação com a patologia medular não tem sido devidamente estudada. Nesta revisão enfatizamos a elevada freqüência de queixas urinárias e sexuais em pacientes, não apenas os portadores de mielopatias, mas também em indivíduos considerados como portadores assintomáticos do HTLV-I. Hiperatividade detrusora e dissinergia vesico-esfincteriana são as manifestações urodinâmicas mais freqüentes. A documentação de queixas urinárias e os achados urodinâmicos observados em indivíduos considerados portadores assintomáticos são semelhantes aos detectados em pacientes com mielopatia dão suporte à hipótese que alterações urinárias possam representar uma forma oligossintomática da HAM/TSP. Disfunção eréctil é freqüentemente observada em pacientes infectados pelo HTLV-1, com ou sem mielopatia. Infecção do trato urinário também tem elevada prevalência nestes pacientes. A despeito da ausência de um tratamento efetivo da mielopatia, o uso de anticolinérgicos e de inibidores da fosfodiesterase tipo 5 podem melhorar as queixas urinárias e a disfunção eréctil destes pacientes.

Amostras uropatogênicas de Escherichia coli isoladas de indivíduos moradores de localidades distintas na Cidade do Rio de Janeiro, foram caracterizadas quanto o sorotipo, propriedades hemolíticas e hemaglutinantes, susceptibilidade a antimicrobianos e perfil isoenzimático. O método molecular empregado associado com a investigação de marcadores de urovirulência, permitiu detectar uma grande diversidade entre os isolados. Entretanto, foi observada uma relação mais estreita entre amostras de Escherichia coli epidemiologicamente relacionadas.Uropathogenic Escherichia coli strains isolated from individuals living in different areas of the city of Rio de Janeiro were characterized according to serotype, hemolytic properties, hemagglutination properties, antimicrobial susceptibility and isoenzymatic profile. The molecular approach used, together with investigation of urovirulence markers, enabled detection of great diversity among the isolates. However, closer relationships were observed between epidemiologically related Escherichia coli samples.

The aim of the study was to determine the occurrence of virulence genes expressing fimbriae, production of hemolysin, colicin and aerobactin among a hundred Escherichia coli isolates obtained from in-and outpatients of a tertiary-care teaching hospital, between July and August 2000, showing clinical and laboratory signs of urinary tract infection (UTI). The presence of genes (pap, afa, sfa) for fimbriae expression was assayed using specific primers in a polymerase chain reaction. Among the isolates studied, the prevalence of the virulence factors was 96.0%, 76.0%, 24.0%, for hemolysin, aerobactin and colicin, respectively; the prevalence of genes coding for fimbrial adhesive systems was 32.0%, 19.0% and 11.0% for pap, sfa and afa respectively. The strains isolated from the outpatients displayed a greater number of virulence factors compared to those from hospitalized subjects, emphasizing the difference between these two kinds of patients.O objetivo do trabalho foi determinar a ocorrência de fatores de virulência, tais como, a expressão de fímbrias, produção de hemolisina, colicina e aerobactina em 100 cepas de Escherichia coli isoladas de pacientes ambulatoriais e hospitalizados de um hospital universitário de nível de atendimento terciário, entre os meses de julho e agosto de 2000, que apresentavam sinais clínicos e laboratoriais de infecção do trato urinário (ITU). Foram pesquisados os genes pap, afa e sfa responsáveis pela expressão de fímbrias através da técnica de PCR. A freqüência dos fatores de virulência entre as cepas estudadas foi de 96,0%, 76,0% e 24,0% para hemolisina, aerobactina e colicina respectivamente, e a prevalência dos genes para os sistemas de adesinas fimbriais foi de 32,0%, 19,0% e 11,0% para os genes pap, sfa e afa respectivamente. As cepas isoladas dos pacientes ambulatoriais exibiram um número maior de fatores de virulência quando comparadas com aquelas provenientes de indivíduos hospitalizados.

Existen algunos datos epidemiológicos que demuestran que, en poblaciones rurales, la frecuencia de lesiones inflamatorias de origen infeccioso en el riñón es mayor en individuos expuestos a pesticidas. Estudios previos han demostrado que el herbicida 2,4- D altera las propiedades de adherencia bacteriana a riñón, mediada por fimbrias de Escherichia coli uropatógena, si bien aún no se ha estudiado el mecanismo que podría estar involucrado. El 2,4-D demostró capacidad de generar uniones covalentes a proteínas de bacilos gram negativos. Debido a este hallazgo, se hipotetizó que la unión del herbicida a proteínas involucradas en la síntesis, exportación o ensamble de las subunidades fimbriales podía alterar la expresión de las fimbrias. En este trabajo se demuestra una unión covalente del herbicida a proteínas de membrana externa de Escherichia coli uropatógena y paralelamente una disminución de la fimbriación, determinada por tres técnicas diferentes: hemoaglutinación, cuantificación de proteínas de superficie y microscopía electrónica. Una conclusión importante está referida a que la exposición accidental de trabajadores rurales al 2,4-D en muy bajas dosis y durante un corto período de tiempo tendría un efecto protector de la pielonefritis por disminución de la fimbriación; mientras que los altos niveles de exposición predispondrían a la recurrencia del proceso infeccioso en el modelo de la pielonefritis ascendente no obstructiva en ratón (Balagué et al 2002). Probablemente los estudios epidemiológicos que asocian exposición a los herbicidas e infección renal estén relacionados con este último tipo de exposiciones.Epidemiological data demonstrate, on rural populations, that the frequency of inflammatory lesions in renal tissue is higher for individuals exposed to pesticides. Previous studies demonstrated that the herbicide 2,4-D altered the bacterial adherence properties to renal tissue, mediated by fimbriae in uropathogenic Escherichia coli, but the mechanism involved is still unknown. The acid 2,4- D has the ability to perform covalent bonds to proteins in gram-negative bacteria. Because of this fact, we hypothesized that the 2,4-D acid binds proteins involved in the synthesis, export or ensemble of fimbrial subunits, modifying fimbrial expression. In this work we demonstrated a covalent bond of the herbicide to outer membrane proteins in uropathogenic E. coli and a parallel decrease of fimbriation, assayed by three different methods: hemmaglutination, surface protein quantification and electron microscopy. An important conclusion is that the accidental exposure of rural workers to 2,4-D may have a protective effect by a decrease in fimbriation, when it is used in low doses and during a short period of exposure. But, it must be considered that high doses and several days of exposure had adverse effects, like recurrence of infection, in the mouse model of ascending pyelonephritis (Balagué et al, 2002). Probably, the epidemiological studies that associate the herbicide exposure with renal infection were due to the last kind of exposure described.

El presente artículo trata del cateterismo uretral inspirado en acciones de prevención y de cuidado integral a la persona. Se propone una guía técnica para el procedimiento con aportes de otras guías basadas en evidencia, además invita a la reflexión a partir del análisis de los riesgos que implica, especialmente los que tienen que ver con la infección urinaria, importante causa de la infección intrahospitalaria. De esta manera se quiere problematizar el papel y la responsabilidad del profesional de enfermería frente a este procedimiento, subrayando la necesidad de practicarlo de manera consciente, con un conocimiento profundo de las indicaciones, riesgos, manejo y medidas alternas que facilitan la eliminación urinaria. Se hace énfasis en los principios éticos de beneficencia no maleficencia como garantes de la calidad del cuidado de enfermería, expresada en el bienestar integral del paciente y su familia.This article deals with urethral catheterism and it is inspired by the actions for the preventive and integral care of the persons. A technical guide for the procedure is proposed with contributions of others evidence based guides. The analysis of the implicated risks is taken into account, particularly those related to urinary infection which is an important cause of interhospitalary infection. Accordingly the problems related with the role and the nurses professional responsibility in this procedure are considered stressing how has to be practiced in the utmost conscious manner, with the deepest knowledge of the instructions, risks, handling and alternative procedures helping urinary elimination.The beneficial ethical principles are stressed to warrant the quality of the nursing care to ensure the patient and his family integral well-being.

O presente estudo objetivou descrever as alterações físico-químicas da urina, identificando os agentes etiológicos presentes na urina de matrizes descartadas sem causa definida. De 35 amostras examinadas, 16 (45,7%) foram positivas para presença de sangue e/ou nitrito (positivo para infecção urinária, IU); 8 (50%) tiveram coloração amarela escura e 6 (37,5%) coloração amarela clara; 2 (12,5%) amostras não apresentavam alteração. Dez amostras tinham odor amoniacal, das quais 7 foram positivas para IU. Também houve prevalência de urinas turvas e turvas com grumos, bem como de pH normal (5,5 - 6,5) e densidades maiores que 1,012. Presença de microrganismos foi verificada em 91,5% das 35 amostras examinadas, sendo a Escherichia coli (45,7%), a bactéria com maior prevalência. Em 11 amostras (31,4%), verificou-se a presença de Actinobaculum suis; destas, 4 foram simultaneamente positivas para IU e Actinobaculum suis; 7 foram negativas para IU, observando-se porém, a presença de Actinobaculum suis pelo exame de imunofluorescência indireta.The present study describes the physical-chemical alterations of the urine and identifies etiological agents of the urine of 35 sows. Out of 35 samples, 16 (45.7%) were positive for nitrite and/or blood, positive for urinary infection (UI); eight (50%) were dark yellow and six (37.5%) had clear yellow coloration; in two (12.5%) samples did not show any alteration. Ten samples had ammonia smell, seven among them were positive for UI. Other findings were turbid urine and turbid with grumes, normal pH values (5.5 - 6.5) and densities higher than 1012. Microorganisms were isolated in 91.5% out of 35 urine samples, with prevalence of Escherichia coli (45.7%). In 11 samples (31.4%) Actinobaculum suis was isolated, four were simultaneously positive for UI and Actinobaculum suis; seven were negative for UI, but it was observed the presence of Actinobaculum suis in the indirect immunofluorescence.

Objetivos: avaliar os aspectos diagnósticos, terapêuticos e as complicações dos casos de infecção do trato urinário (ITU) sintomática durante a gestação, que necessitaram de internação hospitalar. Métodos: foram incluídas 136 grávidas com diagnóstico clínico de pielonefrite. Foram avaliados: a idade e paridade da paciente, idade gestacional em que foi feito o diagnóstico, antecedentes de importância epidemiológica, propedêutica laboratorial para avaliação da infecção urinária, tratamento e evolução clínica, antimicrobianoprofilaxia e complicações. Resultados: pielonefrite foi diagnosticada, nas mesmas proporções, em todas as idades gestacionais. Houve maior incidência de ITU entre as primigestas. Apenas 29,3% das gestantes apresentaram história prévia de ITU. Observou-se que 57,0% das pacientes apresentaram anemia e 93,0% mostraram análise urinária alterada. A Escherichia coli foi o uropatógeno mais prevalente (75,8% dos casos), com baixos percentuais de sensibilidade à ampicilina (60,6%) e à cefalotina (63,6%) e altos percentuais de sensibilidade à cefuroxima (95,5%). A maior taxa de melhora clínica foi obtida entre as gestantes tratadas com cefuroxima (95,7%). A antimicrobianoprofilaxia foi necessária em 11,0% das pacientes. O trabalho de parto pré-termo ocorreu em 33,3% das gestantes que deram à luz em nosso serviço, e o parto pré-termo em 18,9%. Conclusões: esses resultados reforçam a necessidade do diagnóstico precoce e tratamento efetivo da ITU em gestantes, a fim de evitar a ocorrência freqüente de complicações perinatais, como o trabalho de parto e o parto pré-termo. Destaca-se a necessidade de avaliação periódica do padrão de sensibilidade dos agentes etiológicos prevalentes aos antimicrobianos de uso permitido durante a gestação, adotando-se a cefuroxima como o antimicrobiano de escolha para o tratamento das ITU na gestação.Purpose: to assess the diagnostic and therapeutic aspects and the complications of symptomatic urinary tract infections (UTI) during pregnancy of patients who were hospitalized. Methods: a total of 136 pregnant women with a clinical diagnosis of pyelonephritis were studied. The studied parameters were: age and parity of patients, gestational age of diagnosis, epidemiologic aspects, laboratory evaluation for UTI, treatment and clinic evolution, prophylaxis and complications. Results: pyelonephritis was diagnosed at the same proportions at all gestational ages. The incidence of UTI was higher among primigravidae. Only 29.3% of the pregnant women had a previous history of UTI; 57.0% were anemic and 93.0% had altered urinalysis. Escherichia coli was the most prevalent uropathogen (75.8% of cases), with low percentages of sensitivity to ampicillin (60.6%) and high percentages of sensitivity to cefuroxime (95,5%). The highest rate of clinical improvement was obtained for the pregnant women treated with cefuroxime (95.7%). Prophylaxis was needed in 11.0% of the patients. Preterm labor occurred in 33.3% of the pregnant women who delivered in our service and preterm delivery occurred in 18.9%. Conclusions: the present results support the need for an early diagnosis and effective treatment of UTI in pregnant women in order to prevent the frequent occurrence of perinatal complications such as premature labor and delivery. We emphasize the need of a periodical evaluation of the pattern of sensitivity of the etiologic agents to the antimicrobials allowed for use during pregnancy, with cefuroxime being adopted as the antibiotic of choice for the treatment of UTI during pregnancy.

La infección urinaria es la patología infecciosa más frecuente en el embarazo. Puede producir graves consecuencias para la madre y el feto. El presente trabajo muestra la frecuencia de los distintos cuadros clínicos, agentes involucrados, antimicrobianos utilizados en el tratamiento, y sensibilidad de los agentes a dichas drogas, durante el período entre marzo y diciembre de 2001. Se comparan dichos resultados con lo publicado por nuestro centro en 1988. Destaca la disminución en la incidencia de pielonefritis aguda y la aparición en los microorganismos de resistencia significativa a la cefazolina en el último período.Urinary tract infection is the most common infectious disease during pregnancy with serious consequences for mother and fetus. The present report shows clinical presentation, bacterial agents involved, treatment used and antibacterial sensitivity, from march to december 2001, and compares this with our own report of 1988. Remarkable is a decrasing incidence of pyelonephritis in the last period and increasing bacterial resistance to cefazolina in the last period.

A 50-year-old woman presented with a 2-years history of chronic flanc and hematuria. Plain abdominal radiography was performed showing bilateral complete staghorn calculi. Urinalysis and urine culture revealed a urinary infection by Proteus Morganii. Biologic investigations did not show any matabolic disorder. The urinary infection was treated by antibiotics and the stone by a combination of percutaneous nephrolitotomy and open surgery. The infrared spectrometry analysis found a calcium oxalate calculi. A Staghorn calculus is a large renal stone with irregular branches that can involve the renal pelvis and extend into calyces. Physiopatholgy of staghorn calculi is based on urinary infection. They are usually seen in the setting of infection with urease producing bacteria. They are composed of struvite (magnesium ammonium phosphate) but also, they can be composed of calcium oxalate. The majority of staghorn calculi are symptomatic: urinary infection, flanc pain, hematuria, urinary symptoms. The diagnosis can be performed by Plain abdominal radiography. Intravenous urography or CT scans are more helpful by showing the stone and delineating the pelvic calyceal anatomy. The treatment recommended of this type of renal stone is based on complete removal of all stone material after Sterilization of the urine with antimicrobial treatment. The elimination of all residual fragments can be obtained by the combinaison of different techniques: percutaneous nephrolitotomy, extracorporeal shockwave lithotripsy, retrograde ureteroscopic lithotripsy, open surgery. No treated, staghorn stone can cause septicemia, chronic renal insufficiency, destruction of kidney by infection and chronic calicial dilatation.

The aim of the present study was to determine biological characteristics such as expression of fimbriae, Congo red binding, production of hemolysin and aerobactin, adhesion to HeLa and uroepithelial cells and invasion of HeLa cells by Escherichia coli isolates obtained from patients showing clinical signs of urinary tract infection (UTI). Also, the presence of genes (apa, afa, spa) for fimbria expression and cytotoxic necrotizing factors (CNF1, CNF2) was assayed using specific primers in PCR. The data obtained were compared with the clonal relationships obtained by analysis of multilocus enzyme electrophoresis (MLEE), restriction fragment length polymorphism (RFLP) of the rDNA (ribotyping) and enterobacterial repetitive intergenic consensus-PCR (ERIC-PCR). All isolates but one presented a combination of at least two of the characteristics studied, a fact suggesting the presence of pathogenicity islands (PAIs). Diffuse adherence type to HeLa cells was observed to occur in most of the strains, but adhesion to uroepithelial cells seems to be a more reliable test to verify pathogenicity. Although four strains seemed to be able to invade HeLa cells when assayed by light microscopy, electron microscopy studies demonstrated that these strains were not invasive. MLEE, RFLP and ERIC-PCR were able to group the isolates differently into main clusters that were not correlated with the presence of pathogenic traits.

CONTEXT: There is still controversy as to the use and dosage of antimicrobial prophylaxis of the urinary infection associated with urethral catheterization in the post renal transplant period. OBJECTIVE: To determine whether patients develop urinary infection during short-term urethral catheterization after renal transplant without routine antimicrobial prophylaxis. DESIGN: Prospective study. SETTING: Kidney Transplantation Unit. SAMPLE: 20 patients submitted to non-complicated kidney transplant, with a normal urinary tract and no risk factors present regarding urinary infection. Aged 15 to 65 years. MAIN MEASUREMENTS: Before the transplant, material from the urethral meatus and urine were collected for culture. After the transplant, in the period during which the patient was with short-term urethral catheterization (4 to 5 days), material from the urethral meatus and urine from the bladder and the collecting bag were taken daily from all recipients for culture. RESULTS: There was a predominance of coagulase-negative Staphylococcus and S. viridans in the normal urethral meatus flora and in the first two days of urethral catheterization. After the second day, there was a predominance of E. coli and E. faecalis. Urinary infection did not occur during the period of urethral catheterization. In the follow up only one female patient (7%) had asymptomatic bacteriuria caused by E.coli after the withdrawal of the urethral catheter. CONCLUSIONS: Infection urinary does not occur during the period of urethral catheterization in kidney post-transplant patients. Thus, antimicrobial prophylaxis is not recommended for these patients to prevent urinary infection.

The inappropriate use of antimicrobials has a negative impact, in favoring the appearance of drug-resistant strains on patients, in the ecosystem and in the economy. The hospital studied, Hospital do Mar (HM), specializes in providing care during patient recovery and rehabilitation, as well as palliative and geriatric care, to patients originating from general or intensive care hospitals. It is known that drug-resistant strains occur more frequently among bacteria that cause nosocomial infections as opposed to community acquired infections. Furthermore, in hospitals the high occurrence of drug-resistant strains is concurrent with a high use of antimicrobials. In this study the authors performed a retrospective analysis to characterize the infectious pathology present in the Hospital do Mar, test the sensitivity of the microorganisms present to several antimicrobials, and document the antimicrobials prescribed at the time, with the goal of adjusting the therapeutic protocols currently implemented and decreasing the emergence of drug-resistant strains. This study allowed the implementation of clinical protocols, and established criteria for the selection of antibiotherapy prescriptions for the most common infectious pathologies.

Background: Resistance to contemporary broad-spectrum b-lactam antibiotics mediated by extended-spectrum b-lactamases (ESBLs) is increasing worldwide. Klebsiella pneumoniae, an important cause of nosocomial and community acquired urinary tract infections has rapidly become the most common ESBL producing organism. We examined ESBL production in urinary isolates of K. pneumoniae in relation to the presence of blaSHV, blaTEM and blaCTX-M genes. Methods: Antibiotic resistance of 51 clinical isolates of K. pneumoniae was determined to amoxicillin, amikacin, ceftazidime, cefotaxime, cefteriaxon, ceftizoxime, gentamicin, ciprofloxacin and nitrofurantoin by disc diffusion. Minimum inhibitory concentrations were also measured for ceftazidime, cefotaxime, cefteriaxon, ceftizoxime and ciprofloxacin. ESBL production was detected by the double disc synergy test and finally, presence of the blaSHV, blaTEM and blaCTX-M genes were shown using specific primers and PCR. Results: Disc diffusion results showed that 96.08 % of the isolates were resistant to amoxicillin followed by 78.43 % resistance to nitrofurantoin, 49.02 % to amikacin and ceftazidime, 41.17 % to ceftriaxone, 37.25% resistance to cefotaxime and ceftizoxime, and 29.42 % to gentamicin and ciprofloxacin. Both resistant and intermediately resistant organisms were resistant in MIC determinations. Twenty two isolates (43.14%) carried blaSHV, 18 (35.29%) had blaTEM and 16 (31.37%) harbored blaCTX-M genes. ESBL production was present in 14 isolates (27.45 %) of which, 3 did not harbor any of the 3 genes. Among the non- ESBL producers, 9 lacked all 3 genes and 2 carried them all. Conclusion: No relation was found between gene presence and ESBL expression.

O presente estudo foi realizado em sete propriedades no Planalto Catarinense, os quais apresentavam algum histórico de transtorno reprodutivo. Foram coletadas 101 amostras de urinas de matrizes em produção. Foi colhida uma amostra da primeira urina espontânea da manhã e foi feito imunofluorescência indireta a partir de esfregaços do sedimento urinário. As lâminas foram avaliadas e classificadas como negativas (ausência de bastonete ou raros bastonetes com fluorescência leve) e positiva (presença de bastonetes com fluorescência celular ou nas bordas evidente e brilhante). Dos 101 esfregaços examinados, 17 (16,8%) foram positivos para a presença do Actinomyces suis (A. suis), observando-se uma variaçãno de 14 a 80%, sendo os mesmos procedentes de quatro propriedades. Estes resultados encontrados mostram que em granjas com problemas reprodutivos o A. suis pode ser um dos agentes etiológicos envolvidos no desencadeamento do problema.This study took place in seven farms in the Santa Catarina highlands, in which there were reproductive disorders. One hundred and one urine samples were collected from sows in production. One sample from the first urine in the morning was collected and indirect fluorescense was performed in the urinary sediment. The samples were examined and classified as negative (bacilli absent or rare with light fluorescense) and positive (bacilli with bright fluorescense). 16.8% samples were positive for A. suis, with a variation range from 14 to 80%, which cames from 4 farms. This results showed that in farms with reproductive disorders, A. suis can be involved in the etiology of the problem.

Fungal elements of urinary tract were investigated in two groups of the individuals, either with major underlying illnesses, or without any diseases. Diabetes mellitus was recognized as the most important underlying diseases in this study and Candida glabrata was the commonest species occurring in high numbers in urine Specimens of debilitated patients.

Se realizó la evaluación del desempeño con muestras clínicas de orina para determinar la eficacia del CromoCen(R) CC como medio de cultivo en el diagnóstico de la infección urinaria, e identificar, con su utilización, los grupos bacterianos más frecuentes y el tiempo necesario para realizar el diagnóstico. En una muestra de 500 casos atendidos en la consulta externa de urología y realizados en el servicio de microbiología de San Antonio de los Baños, en la provincia de La Habana, en el período comprendido desde enero a junio de 2003. Se confirmó la hipótesis de trabajo: el medio de cultivo estudiado fue eficaz en el diagnóstico rápido de la infección urinaria. Desde el punto de vista ético se mantuvo la confidencialidad, se elevó la autoestima del binomio médico-paciente, y su calidad de vida desde el punto de vista bioético, por lo que se recomienda emplear este medio de cultivo en el diagnóstico rápido de la infección urinaria.The evaluation of the performance with clinical samples of urine was carried out to determine the efficacy of CromoCen(R) CC as a culture medium in the diagnosis of urinary infection, and to identify with its use the most frequent bacterial groups and the time necessary to make the diagnosis. In a sample of 500 cases seen at the aoutpatient department of urology and analyzed at the microbiology service of San Antonio de los Baños, in the province of Havana, from January to June, 2003, it was confirmed the working hypothesis: the studied culture medium was efficient for the rapid diagnosis of urinary infection. From the ethical point of view, the reliability was maintained, and the self-steem of the physician-patient binomial, as well as the quality of life of the patient from the bioethical view increased. That's why, it is recommended to use this culture medium in the rapid diagnosis of the urinary infection.