Academic literature on the topic 'Urinary infection. eng'
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Journal articles on the topic "Urinary infection. eng"
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Raval, Milan, Anna Lam, Carols Cervera, Peter Senior, James Shapiro, and Dima Kabbani. "1093. Infectious Complications after Pancreatic Islet Transplantation." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S576. http://dx.doi.org/10.1093/ofid/ofaa439.1279.
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Abstract Background Despite the significant advancement in islet transplantation over the past three decades, our understanding of infectious complications post islet transplant remains limited. Methods This is a single center retrospective review of Islet transplant recipients at the University of Alberta between February 2006 and December 2015. All infectious episodes events occurring after transplant were categorized as opportunistic and non-opportunistic. Results We analyzed 142 patients receiving a median of 2 islet transplants per patient, with 18 patients receiving 1 transplant (13%), 77 (54%) 2, 33 (23%) 3, 13 (9%) 4 and 1(1%) 5 transplants. Median age at first transplant was 50 years and 85 (47%) were male. Lymphocyte depleting agent with thymoglobulin or alemtuzumab was used for induction in 94% in first and 53% in second transplant. CMV serostatus was CMV D+/R- 61 (43%), CMVD+/R+ 52 (37%), CMVD-/R+ 16 (11%) and CMVD-/R- 13 (9%). CMV infection occurred in 21 patients (15%) [CMVD+/R- 6 (9.8%) and CMVR+ 15 (22.1%), p=0.06]. Other opportunistic infections included VZV 7 (4.9%), Nocardia 3(2.1%), and Pneumocystis jirovecii pneumonia 1. Non-opportunistic infections included skin and soft tissue infection 14 (9.9%), urinary tract infection 11 (7.7%), pneumonia 7 (4.9%) clostridium difficile infection (CDI) 4 (2.8%), and non-CDI gastroenteritis 5 (3.5%) (Table 1). Table 1: Infectious Complication post islet transplant Conclusion Although the rate of infections after islet cell transplant is less frequent than other types of transplants, opportunistic infections, especially CMV, are not uncommon and should be considered in this setting. Disclosures Carols Cervera, MD, PHD, Merk (Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member, Other Financial or Material Support, Lecture fees) James Shapiro, MD, PHD FRCS(Eng) FRCSC MSM FRSC, ViaCyte (Consultant) Dima Kabbani, MD, Merck (Research Grant or Support)
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Pérez, S., JL Recio, A. Peña, JL Cabrera, N. Chueca, and F. García. "Aerococcus urinae: a rare pathogen in urinary tract infections, associated with patients with underlying urinary pathology." ACTUALIDAD MEDICA 100, no. 796 (December 31, 2015): 124–27. http://dx.doi.org/10.15568/am.2015.796.or03.
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Harms, Hendrik, Elke Halle, and Andreas Meisel. "Post-stroke Infections - Diagnosis, Prediction, Prevention and Treatment to Improve Patient Outcomes." European Neurological Review 5, no. 1 (2010): 39. http://dx.doi.org/10.17925/enr.2010.05.01.39.
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Despite modern stroke treatment in dedicated stroke units and rehabilitation facilities, infection remains the most important medical complication after ischaemic stroke. Pneumonia and urinary tract infections are the most frequent post-stroke infections. Post-stroke infections not only prolong hospitalisation but also constitute a leading cause of early and long-term mortality and morbidity. They are commonly attributed to neurological sequelae such as immobilisation due to motor paralysis or dysphagia as a risk of aspiration. Recently, stroke-induced impairment of immunological competence has been described. This immunodepression syndrome promotes the development of post-stroke infection. Knowledge about risk factors for post-stroke infections, early and proper diagnosis and a deliberate decision for anti-infective treatment are of evident importance, but all of these are considered major challenges for stroke neurologists. In this article we will discuss new insights into diagnostic approaches and risk factors for post-stroke infections. Furthermore, we will focus on preventative approaches and the current treatment options.
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Álvarez Artero, Elisa, Amaia Campo Núñez, Moisés Garcia Bravo, Inmaculada García García, Moncef Belhassen Garcia, and Javier Pardo Lledías. "Utility of the blood culture in infection of the urinary tract with fever in the elderly." Revista Española de Quimioterapia 34, no. 3 (April 15, 2021): 249–53. http://dx.doi.org/10.37201/req/156.2020.
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Introduction. Urinary tract infections are one of the most common community infections. The diagnosis of urinary infections in the elderly is complex because of its presentation and clinic. The aim of this article is to evaluate the usefulness of blood cultures in febrile urinary tract infection in elderly patients, risk factors, causes of discordance between urine and blood cultures, usefulness of biomarkers and mortality. Material and methods. Observational study of patients admitted over 65 years old, with urinary infections. Results. A total of 216 episodes with urinary infections and blood cultures performed. 70 (32,4%) cases with bacteremia. The most frequently detected isolates in blood cultures were: Escherichia coli 50 (71,4%) and Proteus spp. 6 (8,5%). Only septic shock was associated with a higher frequency of bacteraemia (OR=2,93, IC 95: 1,0-8,5; p=0,04). In 26 of the blood cultures a different isolation of the urine culture was detected. Overall mortality was 9.1%, with no association with the presence of bacteremia (p>0. 05). Conclusions. One third of elderly people hospitalized by tract urinary infection had bacteremia. Their detection was not associated with overall mortality. Disagree between blood and urine cultures in febrile is frequent, especially in patients with recent antibiotic treatment or recently hospitalized.
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Puri, Randhir. "Recurrent Urinary Tract Infection (UTI) in Women." Journal of South Asian Federation of Obstetrics and Gynaecology 1, no. 1 (2009): 10–13. http://dx.doi.org/10.5005/jp-journals-10006-1036.
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Abstract Recurrent lower urinary tract infections (UTIs) are usually defined as two or more episodes of such infection occurring in the preceding 12 months. In most cases, such infections are the result of sexual habits and hygiene (e.g., women who are sexually active, especially those using diaphragms and/or spermatocides). A clean-catch or catheterized specimen for culture typically reveals greater than 100,000 organisms per milliliter of urine. The typical infecting organism is Escherichia coli. The route of infection is ascending from the perianal area and vagina via the urethra and into the bladder. However, in uncomplicated lower UTIs, there is complete clearing of bacteriuria and hematuria with appropriate antimicrobial therapy. In some cases, single-dose antimicrobial therapy after intercourse or at the onset of irritative voiding symptoms is adequate to control frequent recurrences of cystitis. Uncomplicated recurrent lower UTIs in women must be differentiated from “reinfection,” which may indicate causes such as a vesicovaginal or vesicoenteric fistula or a paravesical abscess with fistula to the bladder. Furthermore, “bacterial persistence” is defined as an infection with the same organism, typically from a site within the urinary tract, after the bacteriuria has resolved for at least several days and antimicrobial therapy has ceased. Causes of bacterial persistence include calculi, foreign bodies, urethral or bladder diverticula, infected urachal cyst, and postoperative changes such as a remaining ureteral stump that retains urine and results in stasis. In such patients with frequent recurrences and reinfections with the same bacteria, imaging is indicated to detect a treatable condition and monitor its progress. Compromised immunity needs attention to avoid longstanding morbidity. Vaccine developed will lead more prevention in future.
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Rangel, Marcel, Yáscara Tressa, and Sueli Schadeck Zago. "INFECÇÃO URINÁRIA: DO DIAGNÓSTICO AO TRATAMENTO." Colloquium Vitae 5, no. 1 (June 30, 2013): 59–67. http://dx.doi.org/10.5747/cv.2013.v005.n1.v075.
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A urinary tract infection (UTI) is a common condition in all ages, from newborns to the elderly, being more frequent in females. This study aims to analyze the main causes of urinary tract infections, assessing its complications, its diagnostic tests and therapeutics. The UTI consists of microbial colonization of the urine that can develop into a tissue invasion of any structure of the urinary tract. Urine analysis is a simple cheap and easy to obtain thesample, yet provides relevant information on renal and urinary tract, as well as some extra-renal diseases, being considered a routine examination. Among the tests performed for confirmation and monitoring of urinary infection are reagent strips ("dipstick"), especially used to screen cases of suspected acute UTI. The downside would be the use of some medications that can alter the outcome of laboratory tests using pharmacological mechanisms, physical, chemical and metabolic, as being a very commonplace infection, people end up self-medicating in order to relieve pain and if there is no improvement in symptoms, only to decide later laboratory examination, thus controlling this interference plays an important role in our laboratory. After completion of the urine culture and getting a positive result, the antibiogram will be made to check the most effective drug. However due to this indiscriminate use, exams can end up suffering changes in the results and sometimes even a negative urine culture.
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Williams, James C., Andrew J. Sacks, Kate Englert, Rachel Deal, Takeisha L. Farmer, Molly E. Jackson, James E. Lingeman, and James A. McAteer. "Stability of the Infection Marker Struvite in Urinary Stone Samples." Journal of Endourology 26, no. 6 (June 2012): 726–31. http://dx.doi.org/10.1089/end.2011.0274.
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Raghubanshi, Birendra Raj, Devendra Shrestha, Mahesh Chaudhary, Bal Man Singh Karki, and Ajaya Kumar Dhakal. "Bacteriology of urinary tract infection in pediatric patients at KIST Medical College Teaching Hospital." Journal of Kathmandu Medical College 3, no. 1 (August 12, 2014): 21–25. http://dx.doi.org/10.3126/jkmc.v3i1.10919.
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Background: Urinary tract infection is common in children and is an important cause of morbidity. Urinary tract infection at young age can lead to renal injury and scarring, and ultimately lead to end stage renal disease in adulthood. Objectives: The purpose of study was to identify the different species of microorganisms, along with their antimicrobial susceptibility pattern, causing urinary tract infection in paediatric patients presenting with urinary tract infection at KIST Medical College, Imadol, Lalitpur, Nepal. Methods: This retrospective study examined microbiological and antimicrobial susceptibility pattern for urine samples collected at KIST Medical College, Imadol, Lalitpur from December 2010 to November 2013. A urine sample was included in our dataset if it demonstrated pure growth of a single organism and accompanying antimicrobial susceptibility and subject demographic data were available. Results: Escherichia coli was the most common organism isolated, followed by Klebsiella species, Staphylococcus species and then by Proteus species, Enterococcus species and Citrobacter species being equal in number. Microorganisms were most susceptible to amikacin and nitrofurantoin and most resistant to ampicillin and nalidixic acid. Conclusion: Though various microorganisms are responsible for urinary tract infection in children, Escherichia coli is the most common causative agent. Antimicrobial resistance has already emerged against many antibiotics, making empiric treatment of these infections challenging. DOI: http://dx.doi.org/10.3126/jkmc.v3i1.10919Journal of Kathmandu Medical CollegeVol. 3, No. 1, Issue 7, Jan.-Mar., 2014, Page: 21-25
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Egilmez, Tulga, I. Atilla Aridogan, Daniel Yachia, and David Hassin. "Comparison of Nitinol Urethral Stent Infections with Indwelling Catheter-Associated Urinary-Tract Infections." Journal of Endourology 20, no. 4 (April 2006): 272–77. http://dx.doi.org/10.1089/end.2006.20.272.
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Kehinde, Elijah O., Vincent O. Rotimi, Adel Al-Hunayan, Hamdy Abdul-Halim, Fareeda Boland, and Khaleel A. Al-Awadi. "Bacteriology of Urinary Tract Infection Associated with Indwelling J Ureteral Stents." Journal of Endourology 18, no. 9 (November 2004): 891–96. http://dx.doi.org/10.1089/end.2004.18.891.
Full textDissertations / Theses on the topic "Urinary infection. eng"
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Meister, Ayumi Renata. "Efeitos do cloreto de amônio, ácido cítrico e cloreto de sódio no controle de cistites em porcas /." Jaboticabal : [s.n.], 2006. http://hdl.handle.net/11449/89216.
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Orientador: Luiz Fernando de Oliveira e Silva CarvalhoBanca: Maria Cristina Thomaz
Banca: Geraldo Camilo Alberton
Resumo: As infecções urinárias (IU) em porcas estão entre as principais causas de falhas reprodutivas que influem na produtividade do rebanho, proporcionando grandes prejuízos econômicos. No presente trabalho foram testados dois acidificantes urinários - o ácido cítrico e o cloreto de amônio e cloreto de sódio, de modo a comparar a atividade destes produtos, no controle de cistites em matrizes suínas. Utilizaram-se 53 porcas adultas, gestantes ou não, de linhagens comerciais, portadoras ou não de cistite, sendo identificados os animais sadios ou afetados com base nos resultados de urinálises e cultivos bacterianos. O primeiro ensaio foi constituído de duas fases - fase 1 - realizada com 25 fêmeas em início de gestação (20 com cistite e 5 sadias), alimentadas com ração de gestação e fase 2 - realizada com 20 animais em final de gestação (16 com cistite e 4 sadias), alimentadas com ração de lactação. O pH, a densidade e a contagem bacteriana nas amostras de urina foram as variáveis estudadas. No segundo ensaio foram utilizadas 8 porcas, todas com cistite e não gestantes. A quatro delas administrou-se ração com cloreto de amônio e outras quatro receberam ração não suplementada com o produto. Avaliou-se o consumo de água, a produção de urina, os pH da urina e do sangue. Os resultados demonstraram que o ácido cítrico determinou diminuição do número de unidades formadoras de colônias, porém não interferiu no pH e densidade urinária dos animais. O cloreto de amônio reduziu o pH urinário demonstrando ação acidificante mesmo colhendo a urina 24 horas após o arraçoamento, porém não interferiu nas densidade e contagem bacteriana. Com relação o cloreto de sódio (1,5% ou 52,5 g/Kg de ração) não se observou qualquer efeito sobre os parâmetros estudados (pH urinário, densidade e contagem bacteriana).
Abstract: The urinary infections(IU) in sows are among the main causes of reproductive imperfections that influence in the productivity of the flock, providing great economic damages. In the present work two acidifiers were tested out - acid citric and the chloride of ammonium and sodium chloride, in order to compare the activity of these products, in orther to control the cystitis in swine. 53 adult, pregnants and non pregnant sows were used , of tradeable ancestries, bearing, donþt bearing cystitis being identified the healthy or affected animals on the basis of the bacterial results of urinalysis culture. The first assay was carried out into two phases - phase 1 - carried through with 25 females in theirs early gestation (20 with cystitis and 5 healthy ones), fed gestation diet and phase 2 - carried through with 20 animals in gestation end (16 with cystitis and 4 healthy ones), fed with lactation ration. pH, the density and the number of CFUs in the urinary samples were the studied. As the assay 8 sows had been held envolving, all cystitis and not pregnant. Four out of 8 sows were fed with chrolide ammonium based rations. The remnants 4 were fed with no supplemented feed. The consumption of water, urinary output, urinary pH and the blood were also evaluated. The results showed that the citric acid determined a decrease in the CFU. However, it didnþt interfere at both pH and urinary density in the animals. The ammonium chloride reduced the urinary pH showing acidifying action even while collecting the urine after a period of 24 hours after the feeding time. Both density and CFU were not changed. Regarding the sodium chloride (1.5% or 52.5g/kg) nothing was found out within the complying parameters (pH urinary, dendity and CFU).
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Ramos, Tatiana Zampiero. "Prevalência de bacteriúria assintomática em crianças durante a idade pré-escolar no município de Araraquara-SP /." Araraquara : [s.n.], 2007. http://hdl.handle.net/11449/95040.
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Resumo: A triagem de crianças para bacteriúria assintomática objetivando prevenir pielonefrite e danos renais é amplamente recomendada. Amostras de urina, colhidas sem contaminação, de 500 pré-escolares com idade entre 2 a 7 anos foram submetidas ao teste com cloridrato de trifeniltetrazólio (TTC) e a urocultura. Culturas quantitativas foram realizadas usando dois diferentes meios de cultura: ágar CLED e ágar MacConkey. As colônias foram contadas, após 18-24 horas de incubação à 35-37ºC. O achado de 105 ou mais UFC/mL do mesmo microrganismo foi considerado como positivo. Para realizar o teste com TTC, 4 mL da urina foram misturados com 1 mL da solução aquosa de TTC estéril à 1% e incubados à 35-37ºC por 4 horas. Uma segunda urocultura foi realizada para as crianças que apresentaram resultado positivo. A sensibilidade aos antimicrobianos foi determinada. Uma comparação entre a urocultura e o teste com TTC foi feita, para avaliação do teste. Um questionário foi aplicado para avaliar fatores predisponentes comportamentais e funcionais. A triagem para bacteriúria assintomática, em pré-escolares em Araraquara-SP-Brasil mostrou uma prevalência de 1,4%. Escherichia coli foi o microrganismo mais isolado e a resistência a tetraciclina foi significante. Os resultados mostram que o teste com TTC possui 91,3% de sensibilidade; 64,3% de especificidade; 15,5% de valor preditivo positivo e 99,0% de valor preditivo negativo. Esses valores mostram que este teste pode ser usado como metodologia de triagem. O fato de já ter desenvolvido ITU anteriormente; usar o papel de trás para frente na higienização anal; beber menos de 1L de água por dia; e usar roupa íntima apertada foram considerados possíveis fatores de risco para o desenvolvimento de bacteriúria assintomática.Abstract: Urinary tract infection (UTI) is the most commom of bacterial infections. Screening children for asymptomatic bacteriuria to prevent pyelonephritis and renal scarring is widely recommended. Urine samples, revealed without contamination, from 500 pre-school children aged 2 to 7 years were submited to the tryphenyl tetrazolium chloride (TTC) test and urine culture. Quantitative urine cultures was performed using two different agar types: CLED and MacConkey. Colonies were count after 18-24 hours of incubation at 35-37ºC. The finding of 105 or more CFU/mL of the same microorganism constituted a positive culture. To perform the TTC test, 4 mL of the urine were mixed with 1 mL of the TTC 1% aqueous sterile solution and incubated at 35-37ºC for 4 hours. We performed a second urine culture for all children with a positive result. Antimicrobial susceptibility was determined. A comparison between the quantitative culture and the TTC test were made, for the evaluation of the test. A questionnaire were used to assess predisposing behavioral and functional abnormalities. The screening survey for asymptomatic bacteriuria in pre-school children in Araraquara-SP-Brazil showed a prevalence of 1.4%. Escherichia coli was the commonest organism isolated and resistence to tetracycline was significant. The results show that the TTC test has sensitivity 91.3%, specificity 64.3%, positive predictive value 15.5% and negative predictive value 99.0%. This test can be use as a screening test. History of the urinary tract infection, inadequate hygiene, poor fluid intake and use of tigh-fitting underwear appear to be risk factors for asymptomatic bacteriuria.
Orientador: Maria Stella Gonçalves Raddi
Coorientador: Antonio Carlos Pizzolitto
Coorientador: Elisabeth Loshchagin Pizzolitto
Banca: Maria Jacira Silva Simões
Banca: Isabel Cristina Affonso Scaletsky
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Siqueira, Amanda Keller. "Fatores de virulência em linhagens de Escherichia coli isoladas de infecção do trato urinário, piometra e fezes de cães /." Botucatu : [s.n.], 2006. http://hdl.handle.net/11449/106031.
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Orientador: Márcio Garcia RibeiroBanca: Antonio Carlos Paes
Banca: Domingos da Silva Leite
Resumo: Escherichia coli e considerado o principal agente causal de infeccao de trato urinario (ITU) e piometra em caes. A patogenicidade das linhagens esta relacionada a presenca de adesinas e diferentes fatores de virulencia. Foram avaliadas alteracoes hematologicas e diferentes fatores de virulencia em 51 linhagens de E. coli isoladas de ITU, 52 de piometra e 55 de fezes de caes sem sinais entericos. A producao de ¿-hemolisina foi verificada em 26 (51,0%) das estirpes de ITU e em 20 (38,5%) de piometra. Exames hematologicos revelaram principalmente anemia, trombocitopenia e leucocitose por neutrofilia e monocitose nos caes com ITU e piometra. Os maiores indices de sensibilidade nas 158 estirpes foram observados para norfloxacina, ciprofloxacina e enrofloxacina em mais de 60% dos isolados. Os maiores indices de resistencia foram encontrados em 60% ou mais das estirpes com o uso de sulfametoxazole/trimetoprim. Linhagens resistentes a tres ou mais antimicrobianos foram constatadas em 24 (47,1%) de ITU, 7 (13,5%) de piometra e 4 (7,3%) das fezes, das quais respectivamente, 17 (33,3%), 1 (1,9%) e 3 (5,5%), com resistencia multipla a cinco ou mais drogas. fimH foi observado em mais de 90% dos isolados. papC foi detectado em 12 (23,5%) linhagens de ITU, 19 (36,5%) de piometra e 10 (18,2%) das fezes. papGI nao foi detectado, enquanto papGII foi observado em 3 (5,8%) isolados de piometra. papGIII foi expressado em 10 (19,6%) linhagens de ITU, 15 (28,8%) de piometra e 9 (16,4%) das fezes. sfaS foi encontrado em 22 (43,1%) de ITU, 24 (46,1%) de piometra e 19 (34,5%) das fezes. afa foi detectado em 1 (1,9%) linhagem de ITU e de piometra...(Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Escherichia coli is considered the more important microrganism in urinary tract infection (UTI) and pyometra in dogs. The pathogenicity of strains is associated with different adhesins and virulence factors. Haematological exams and different virulence factors was evaluated in 51 E. coli strains isolated from UTI, 52 from pyometra and 55 from feces of dogs without enteric signs. Alpha-haemolysin was verified in 26 (51.0%) strains from UTI and 20 (38.5%) from pyometra. Haematological exams revealed mainly anaemia, thrombocytopenia and leucocytosis by neutrophilia and monocitosis in dogs with UTI and pyometra. Norfloxacin, ciprofloxacin and enrofloxacin were the most-effective drugs (>60%) for 158 E. coli strains. High rates of E. coli resistance to antimicrobials were observed in 60% or more of strains using sulfametoxazole/trimetoprim. Multiple drug resistance for three or more antimicrobials was observed in 2 (47.1%) strains isolated from UTI, 7 (13.5%) from pyometra and 4 (7.3%) from feces. From these, 17 (33.3%), 1 (1.9%) and 3 (5.5%), respectively, showed multiple resistance to five or more drugs. fimH was observed in 90% or more of 158 isolates. papC was detected in 12 (23.5%) strains isolated from UTI, 19 (36.5%) from pyometra and 10 (18.2%) from feces. None strain expressed papGI, while papGII was observed in 3 (5.8%) strains of pyometra. papGIII was detected in 10(19.6%) strains of UTI, 15 (28.8%) from pyometra and 9 (16.4%) from feces. sfaS was observed in 22 (43.1%) strains of UTI, 24 (46.1%) of pyometra and 19 (34.5%) of feces. afa was identified in 1 (1.9%) strains isolated from UTI and pyometra...(Complete abstract, click electronic address below)
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Feitosa, Danielle Cristina Alves. "Infecções do trato urinário e do trato genital inferior em gestantes de baixo risco do município de Botucatu/SP /." Botucatu : [s.n.], 2008. http://hdl.handle.net/11449/104861.
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Resumo: Alterações anatômicas e fisiológicas da gravidez predispõem gestantes a infecções do trato urinário (ITU). O não tratamento ou o tratamento inadequado dessas infecções pode levar a complicações obstétricas e neonatais, como amniorexe prematura, trabalho de parto e parto prematuros. Considerando a relevância das complicações, a possibilidade de ocorrência de bacteriúria assintomática e a demora para obtenção do resultado da urocultura, padrão-ouro para diagnóstico de ITU, muitos profissionais optam por iniciar o tratamento de ITU em gestantes, caso o exame de urina simples mostre-se alterado, mesmo na ausência de sinais clínicos inequívocos. Identificar a acurácia do exame de urina simples para diagnóstico de infecção do trato urinário em gestantes de baixo risco. Material e Método: Foi realizado estudo analítico e transversal no município de Botucatu/SP. A propedêutica de atendimento incluiu a realização do exame de urina simples e urocultura, os dados foram colhidos de outubro de 2006 a março de 2008 nos serviços de atenção básica. Resultados: Foram incluídas no estudo 230 gestantes, com mediana de idade de 25,2 anos (14 - 43), 79,2% casadas ou em união estável. A prevalência de ITU foi de 10%, sendo o microrganismo de maior freqüência a Escherichia coli (47,8%). A sensibilidade foi 95,6% e a especificidade 63,3% do exame de urina simples em relação ao diagnóstico de ITU. A acurácia foi de 66,5%. A análise dos valores preditivos positivo e negativo (VPP e VPN) mostrou que na vigência de exame de urina simples normal, a chance de haver ITU foi pequena (VPN 99,2%), frente ao resultado alterado deste exame, a probabilidade de haver ITU foi baixa (VPP 22,4%). Conclui-se que a acurácia do exame de urina simples como meio diagnóstico de infecção urinária foi baixa; alterações no exame de urina simples, mesmo na presença... (Resumo completo, clicar acesso eletrônico abaixo)Abstract: Anatomic and physiological alterations during pregnancy predispose pregnant women to urinary tract infections (UTI). Poor treatment or no treatment at all of these infections may lead to neonatal and obstetric complications like premature amniorexis, premature labor and delivery. Considering complications relevance and the possibility of asymptomatic bacteriuria occurrence and the delay from uroculture results, gold standard for UTI diagnosis, many professionals choose to begin UTI treatment in the pregnant woman, if simple urine examination is altered even in the absence of clear clinical signals. Objective: Identify simple urine examination accuracy to diagnose urinary tract infection in low risk pregnant women. Material and Methods: An analytical and transversal study was performed in Botucatu/SP. The service began with simple urine examination and uroculture, data collected from October 2006 to March 2008 in the basic health service. Results: 230 pregnant women were included in the study with an average age of 25,2 years (14 - 43), 79,2% married or under stable relationship. UTI prevalence was 10%, Escherichia coli as a more frequent organism (47, 8%). Sensitiveness was 95,6% and specificity 63,3% of simple urine examination related to UTI diagnosis. Accuracy was 66,5%. The analysis of predictive positive and negative values (PPV e NPV) showed that during a normal and simple urine examination UTI occurrence was lower (NPV 99,2%), against the altered result of this examination the likely of UTI occurrence was low (PPV 22,4%). One conclude that simple urine examination accuracy as a way of urinary infection diagnosis was low; alterations in simple urine examination, even in the presence of clinical signals do not necessarily means UTI and uroculture is extremely necessary for a right diagnosis.
Orientador: Cristina Maria de Lima Parada
Coorientador: Márcia Guimarães da Silva
Banca: Vera Therezinha Medeiros Borges
Banca: Maria José Clapis
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Alomar, Hussain Abdulrahman. "Antibiotics prescribing by general practitioners for urinary tract infections in elderly patients." Thesis, King's College London (University of London), 2017. https://kclpure.kcl.ac.uk/portal/en/theses/antibiotics-prescribing-by-general-practitioners-for-urinary-tract-infections-in-elderly-patients(d58f6db6-821a-4fb2-94a4-b2a76261d35c).html.
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Urinary tract infections (UTIs) are the second most common infection seen by general practitioners (GPs) in the elderly. UTIs in the elderly can lead to serious complications with increased risk of mortality, yet there are no national or international dedicated guidelines for antibiotic treatment in this patient group. The epidemiology of UTIs in the United Kingdom (UK) for the elderly population and GPs’ antibiotics prescribing for this condition have received little or no attention. This thesis describes GPs’ antibiotics prescribing for UTIs in elderly patients in the UK by exploring the prevalence of UTIs in elderly patients, auditing GPs’ antibiotics prescribing, explaining the variations in GPs’ views and perceptions and identifying the factors that may influence or affect GPs’ antibiotics prescribing using a mixed methods approach. To achieve research aim, a comprehensive explanatory sequential mixed methods approach was undertaken. The initial research was quantitative and took the form of a retrospective, cross-sectional, drug utilisation study that included elderly patients’ data retrieved from electronics medical records, namely, Disease Analyzer (IMS-DA), for the period between 1 January 2010 and 31 December 2012. The subsequent research was qualitative and took a phenomenographic approach with two analytical techniques: phenomenographic analysis and thematic analysis, with data collected through semistructured interviews with 17 GPs. The results from the quantitative study identified 77,290 UTI visits by 21,150 elderly patients, of whom 77.42% (N = 16,375) received at least one antibiotic prescription per visit over the study period. The mean age and sex adjusted UTI prevalence was found to be 23.35 (95% CI 21.84-24.85) per 1,000 person-years for year 2010, 21.44 (95% CI 19.99-22.88) per 1,000 person-years for year 2011 and 17.88 (95% CI 16.56-19.19) per 1,000 person-years. The total number of issued antibiotics prescriptions for UTIs during the study period was 37,815. Adherence results showed that 9,125 (24.1%) broadspectrum antibiotics prescriptions were issued for elderly patients, including ciprofloxacin (N = 1,733; 4.6%), co-amoxiclav (N = 2,350; 6.2%) and cephalexin (N = 5,042; 13.3%). Additionally, 32.2% (N = 12,159) of antibiotics prescriptions were prescribed for durations other than those recommended either for treatment or for prophylaxis; this was seen in 10,605 (33%) female patients’ UTI antibiotics prescriptions and 1,554 (27.5%) male patients’ UTI antibiotics prescriptions. The findings from the qualitative study identified five distinct categories of description representing the ways in which GPs perceive antibiotics prescribing in elderly patients with UTIs. These categories are perceptions, knowledge, decision, practice and approach. Moreover, GPs’ knowledge and perceptions about antibiotics were found to be shaped through seven external horizons: undergraduate education, postgraduate training, personal experience, interaction with peers, interaction and influence of patients’ expectations, the healthcare system, and availability of guidelines and evidence. Additionally, the thematic analysis revealed 29 factors that may influence GPs’ antibiotics prescribing for UTIs including: GPs’ personal experience and familiarity with specific antibiotics, GPs’ education, knowledge and training, complacency, GPs’ fear, responsibility of other healthcare professionals, GPs’ awareness about antibiotic resistance threat, GPs’ awareness about microbial resistance results and information GPs’ awareness about local resistance pattern, GPs’ antibiotic prescribing concerns, diagnosis and clinical decision making by GPs’, GPs’ ethos and ethical values, patient’s age and gender, patient’s medical history and clinical characteristics, patient’s social situation and living conditions, patient’s level of understanding and knowledge, patient’s desire for a quick fix, patient’s autonomy, visits and education by prescribing advisors, audit, monitoring and feedback of prescribing, influence by secondary care doctor prescribing practice, implementation of local policies, guidance and formulary, time, guidelines and evidence, antibiotics shortage, incentives, media, cost, healthcare resources and constraints, pharmaceutical companies, over-prescribing and society experience and expectation. In conclusion, the findings from the mixed methods research confirmed that some GPs in the UK are less likely to adhere to available good practice points for the management of UTIs in elderly patients, that there are variations among GPs’ views and perceptions about antibiotics and that GPs’ antibiotics prescribing practice is influenced by various factors such as guidelines, complacency, clinical presentation, resistance, and audit and feedback. The results highlight the need to optimise and rationalise GPs’ antibiotics prescribing in the elderly by developing robust guidelines synthesised specifically for the elderly population based on studies and evidence from literature designed for elderly patients, to increase GPs’ awareness of and familiarity with guidelines, to increase their uptake and involve GPs in the process of evidence synthesis because of their knowledge of the context of general practice. There is also a need to implement a multifaceted intensive approach with the aim of minimising variations in GPs’ views for AMR and approaching elderly patients, modifying GPs’ antibiotics perceptions and determining whether they will change their practice, correcting some GPs’ misperceptions such as patients’ expectations of antibiotics and patients’ satisfaction through encouraging communication and targeting the GPs’ seven external horizons through multifaceted educational programmes.
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Ozer, Ahmet. "Increased Bacterial Adherence and Decreased Bacterial Clearance in Urinary Tract Infections with Diabetes Mellitus." Case Western Reserve University School of Graduate Studies / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=case1376406476.
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Alrabiah, Haitham Khalid M. "Advanced metabolomics for the discrimination of uropathogenic Escherichia coli and their response to antibiotics." Thesis, University of Manchester, 2014. https://www.research.manchester.ac.uk/portal/en/theses/advanced-metabolomics-for-the-discrimination-of-uropathogenic-escherichia-coli-and-their-response-to-antibiotics(1c78e191-8652-4ff9-9eae-b746ed1c9e0e).html.
Full textAbstract:
In recent years, the role of metabolomics has become increasingly more important in the advancement of many research fields including medical studies. Due to lack of metabolomics research in the area of infectious disease and the rise in antibiotic resistance, there is a need for further studies on the modes of antibiotic action and the mechanisms of resistance of pathogenic microorganisms at the metabolome level. This study aimed to investigate effects of DNA synthesis inhibitors on the metabolome of E. coli and to develop a workflow for discrimination between E. coli isolates down to the sub-species level using a variety of methods, which can inform the choice of analytical techniques in metabolomics research. A metabolomics-based approach was used to elucidate metabolic alterations in E. coli K-12 upon challenge with trimethoprim at two pH levels (5 and 7) which mimic human urine acidity. FT-IR spectroscopy was used as a preliminary experiment to produce bacterial fingerprints and GC-MS was applied to generate global metabolic profiles in each condition. At pH 7, as the drug molecules exhibited higher permeability, stronger direct effects of the antibiotic were observed, i.e. decreased levels of nucleotides. Trehalose, an osmoprotectant, was up-regulated in these stress conditions and this up-regulation was mirrored by a decrease in glucose levels. This also correlated with up-regulation of pyruvate-related products (e.g. alanine, citrate and malate). Other off-target related effects were observed such as alterations in the levels of various amino acids upon trimethoprim challenge. This study offered a wider view of drug action at pH levels similar to healthy human urine. A high throughput FT-IR spectroscopy method was developed to discriminate between pathogenic E. coli isolates based on sequence type. This method employed a Bioscreen as a micro-culture incubator instead of traditional sample preparation (shaking flasks), which can be labour intensive and time consuming. Excluding the washing step in the protocol enabled discrimination between isolates of different sequence types. Moreover, a reproducible workflow of lipid analysis based on LC-MS was developed and applied on four pathogenic isolates with different sequence type and susceptibility to ciprofloxacin. This workflow enabled detection of a wide range of lipid classes and determination of significant alterations in lipid levels related to susceptibility to ciprofloxacin. Stressed and control isolates were also analysed using the developed Bioscreen FT-IR approach to assess phenotypic fingerprint differences, which were in line with the LC-MS-ve class distribution. Further investigation by means of four analytical platforms (FT-IR, GC-MS, LC-MS-ve and LC-MS+ve) was applied on E. coli ST131 isolates characterised using classical microbiological tests (virulence factors and metabolic tests). Procrustes transformation was used to compare between the analytical methods and the microbiological tests in terms of their capacity to discriminate between the different isolates. As indicated above, the results from FT-IR and LC-MS-ve were comparable and in line with virulence tests, while GC-MS and metabolic tests were in agreement. Complementary information generated by different analytical techniques and microbiological tests may indicate the requirement for careful selection of the method of investigation and may suggest the need to continue using a combination of methods which are applied to study different features of bacterial physiology.
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Marija, Milićević. "Somatske komplikacije u akutnoj fazi moždanog udara: učestalost, prediktori i uticaj na ishod bolesti." Phd thesis, Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, 2019. https://www.cris.uns.ac.rs/record.jsf?recordId=110703&source=NDLTD&language=en.
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Moždani udar predstavlja drugi uzrok smrti u celom svetu i neurološku bolest sa najvećim stepenom invaliditeta. Za povoljan ishod moždanog udara veoma je važno sprečavanje i lečenje somatskih kompikacija (SK), pri čemu je njihova učestalost i značaj za oporavak pacijenata potcenjena, a uticaj na ishod moždanog udara zanemaren. Ciljevi istraživanja su bili da se utvrdi učestalost pacijenata sa somatskim komplikacijama u akutnoj fazi moždanog udara; zatim da se utvrdi učestalost svake pojedinačne somatske komplikacije: pneumonije, urinarnih infekcija, duboke venske tromboze, tromboembolije pluća, dijarealnog sindroma i akutnog koronarnog sindroma; zatim da se utvrde faktori rizika za nastanak svake pojedinačne SK, kao i da se utvrdi uticaj SK na ishod bolesti - iskazan kroz njihovu povezanost sa funkcionalnim statusom, dužinom hospitalizacije i mortalitetom pacijenata. Istraživanje je sprovedeno kao prospektivno i obuhvatilo je 403 pacijenta hospitalizovanih zbog akutnog moždanog udara na Klinici za neurologiju Kliničkog centra Vojvodine u periodu od godinu dana. Pacijenti su podeljeni u dve grupe, gde su prvu grupu sačinjavali pacijenti sa registrovanom jednom ili više somatskih komplikacija (n = 162), a drugu su činili pacijenti koji nisu imali somatske komplikacije (n = 241). Evaluacija pacijenata obuhvatila je registrovanje sociodemografskih karakteristika, ličnu i porodičnu anamnezu, karakteristike moždanog udara, neurološki status na prijemu i otpustu, funkcionalni status na prijemu i otpustu, laboratorijske analize krvi i urina na prijemu, vrstu i vreme nastanka pojedinačne somatske komplikacije, sve relevantne dijagnostičke metode za postavljenje dijagnoze i definisanje potencijalnih faktora rizika. Somatske komplikacije se češće javljaju kod starijih osoba, prosečne starosti 72,9 godina, kod osoba ženskog pola i kod pacijenata sa hemoragijskim moždanim udarom. Somatske komplikacije registrovane su kod 40,2% pacijenata, pri tome urinarnu infekciju imalo je 20,3% pacijenata, pneumoniju 16,3%, infarkt miokarda 4,7%, plućnu tromboemboliju 3,4%, duboku vensku trombozu 2,4% i dijarealni sindrom 2,9% pacijenata. Nezavisni prediktori pneumonije su disfagija, narušeno stanje svesti, hronična opstruktivna bolest pluća, mRS veći od 3. Prediktori urinarnih infekcija su: podatak o rekurentnim urinarnim infekcijama, ženski pol, starost preko 70 godina, mRS veći od 3 i NIHSS skor veći od 16. Kao nezavisni prediktori plućnog tromboembolizma dobijeni su duboka venska tromboza, narušeno stanje svesti i gojaznost, dok se jedinim nezavisnim prediktorom dijarealnog sindroma pokazala starost pacijenta preko 70 godina. Prediktori akutnog koronarnog sindroma su: starost veća od 70 godina i hemoragijski moždani udar. Pacijenti sa SK, na kraju hospitalnog lečenja imaju značajno lošiji funkcionalni status u odnosu na pacijente bez somatskih komplikacija. Somatske komplikacije statistički značajno produžavaju hospitalizaciju. Kod četvrtine pacijenata (25,9%) sa somatskim komplikacijama u akutnoj fazi moždanog udara registrovan je letalni ishod. Najveći procenat smrtnih ishoda kod pacijenata sa somatskim komplikacijama registrovan je kod pacijenata sa infarktom miokarda (63,2%), a najmanji kod pacijenata sa urinarnom infekcijom (18,3%).Stroke is the second cause of death worldwide and neurological disease with the highest level of disability. For a favorable outcome of stroke, the prevention and treatment of somatic complications are of great importance, while their frequency and the importance of the recovery of patients are underestimated, and the influence on the outcome of stroke is neglected. The aims of the study were: to determine the frequency of patients with somatic complications in the acute phase of stroke; to determine the frequency of each somatic complication: pneumonia, urinary infections, deep venous thrombosis, lung thromboembolism, diarrheal syndrome, and acute coronary syndrome; to identify risk factors for the emergence of each somatic complication, as well as to determine the effect of those complications on the outcome of the disease - expressed through their association with the functional status, length of hospitalization and mortality of patients. The study was conducted as a prospective and included 403 patients hospitalized due to acute stroke at the Clinic for Neurology of the Clinical Center of Vojvodina for a period of one year. Patients were divided into two groups; the first group included patients with one or more somatic complications registered (n = 162), and the second group consisted of patients without any somatic complication (n = 241). Patient evaluation included registration of socio-demographic characteristics, personal and family history, stroke characteristics, neurological and functional status at the time of admission and discharge, laboratory analysis of blood and urine at admission, type and time of emergence of each somatic complication, all relevant diagnostic methods for setting diagnosis and defining potential risk factors. Somatic complications are more common in older people (the average age of 72.9 years) in females and in patients with hemorrhagic stroke. Somatic complications were reported in 40.2% of patients, 20.3% of patients had urinary infection, 16.3% pneumonia, 4.7% myocardial infarction, 3.4% pulmonary thromboembolism, deep venous thrombosis 2.4% and diarrheal syndrome 2.9% of patients. Independent predictors of pneumonia were dysphagia, impaired state of consciousness, chronic obstructive pulmonary disease, mRS higher than 3. Predictors of urinary infections were: data on recurrent urinary tract infections, female sex, age over 70 years, mRS higher than 3 and NIHSS score higher than 16. As independent predictors of pulmonary thromboembolism, deep venous thrombosis, impaired state of consciousness and obesity were obtained, while the only independent predictor of diarrheal syndrome proved to be the age of the patient over 70 years. Predictors of acute coronary syndrome were: age over 70 years and haemorrhagic stroke. Patients with somatic complications at the end of hospital treatment had significantly worse functional status compared to patients without somatic complications. Somatic complications statistically significantly prolong hospitalization. A quarter of patients (25.9%) with somatic complications in the acute phase of the stroke had a lethal outcome. The highest percentage of deaths in patients with somatic complications was registered in patients with myocardial infarction (63.2%) and the lowest was registered in patients with urinary tract infections (18.3%).
Books on the topic "Urinary infection. eng"
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Barsoum, Rashad S. Schistosomiasis. Edited by Vivekanand Jha. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199592548.003.0194_update_001.
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The urinary system is the primary target of Schistosoma haematobium infection, which leads to granuloma formation in the lower urinary tract that heals with fibrosis and calcification. While the early lesions may be associated with distressing acute or subacute symptoms, it is the late lesions that constitute the main clinical impact of schistosomiasis. The latter include chronic cystitis, ureteric fibrosis, ureterovesical obstruction or reflux which may lead to chronic pyelonephritis. Secondary bacterial infection and bladder cancer are the main secondary sequelae of urinary schistosomiasis.The kidneys are also a secondary target of S. mansoni infection, attributed to the systemic immune response to the parasite. Specific immune complexes are responsible for early, often asymptomatic, possibly reversible, mesangioproliferative lesions which are categorized as ‘class I’. Subsequent classes (II–VI) display different histopathology, more serious clinical disease, and confounding pathogenic factors. Class II lesions are encountered in patients with concomitant salmonellosis; they are typically exudative and associated with acute-onset nephrotic syndrome. Classes III (mesangiocapillary glomerulonephritis) and IV (focal segmental sclerosis) are progressive forms of glomerular disease associated with significant hepatic pathology. They are usually associated with immunoglobulin A deposits which seem to have a significant pathogenic role. Class V (amyloidosis) occurs with long-standing active infection with either S. haematobium or S. mansoni. Class VI is seen in patients with concomitant HCV infection, where the pathology is a mix of schistosomal and cryoglobulinaemic lesions, as well as amyloidosis which seems to be accelerated by the confounded pathogenesis.Early schistosomal lesions, particularly those of the lower urinary tract, respond to antiparasitic treatment. Late urological lesions may need surgery or endoscopic interventions. As a rule, glomerular lesions do not respond to treatment with the exception of class II where dual antiparasitic and antibiotic therapy is usually curative. Patients with end-stage kidney disease may constitute specific, yet not insurmountable technical and logistic problems in dialysis or transplantation. Recurrence after transplantation is rare.
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Lee, Olivia T., Jennifer N. Wu, Frederick J. Meyers, and Christopher P. Evans. Genitourinary aspects of palliative care. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199656097.003.0084.
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Genitourinary tract diseases in the palliative care setting most commonly involve urinary tract obstruction, intractable bleeding, fistulae, and bladder-associated pain. Sources of obstruction in the lower urinary tract include benign prostatic hyperplasia, invasive prostate or bladder cancer, urethral stricture, or bladder neck contracture. Upper tract obstruction includes intraluminal or extraluminal blockage of the renal collecting system and ureters, such as transitional cell carcinoma, fibroepithelial polyps, stricture, stones, pelvic or retroperitoneal malignancy, fibrosis, or prior radiation. Untreated, obstructive uropathy leads to elevated bladder, ureter, and kidney pressures, bladder dysfunction, urolithiasis, renal failure, pyelonephritis, or urosepsis. Intractable haematuria can cause problematic anaemia, frequent transfusions, clot retention, haemorrhagic shock, and death. In addition, urinary tract fistulae such as vesicovaginal and vesicoenteric fistulae are common in patients who have had prior pelvic surgery or radiation especially in the setting of immunocompromise, poor nutrition, and infection. Untreated, these symptoms lead to rash, skin breakdown, ulcers, chronic infection, and sepsis. Lastly, pelvic and bladder pain, depending on aetiology can be treated with oral medications, intravesical therapies, or surgical therapies such as palliative resection or urinary diversion. Selection of tests and treatment modalities in the palliative care setting should be based on using the least invasive means to achieve the most relief in suffering. Some genitourinary conditions are potentially fatal, and in the acute or subacute setting, require re-evaluation of the end-of-life goals and wishes of the patient and family.
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Fervenza, Fernando C. Evaluation of Kidney Function, Glomerular Disease, and Tubulointerstitial Disease. Oxford University Press, 2012. http://dx.doi.org/10.1093/med/9780199755691.003.0472.
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Several measures are used to evaluate kidney function: serum creatinine, urinalysis, renal clearance, and renal imaging. Creatinine is an end product of muscle catabolism and is commonly used as a filtration marker. Dysmorphic erythrocytes in the urinary sediment indicate bleeding in the upper urinary tract. A urine pH less than 5.5 excludes type 1 renal tubular acidosis. A pH greater than 7 suggests infection. Acidic urine is indicative of a high-protein diet, acidosis, and potassium depletion. Alkaline urine is associated with a vegetarian diet, alkalosis and urease-producing bacteria. Clearance of p-aminohippurate is a measure of renal blood flow. Kidney function is evaluated to determine disease states such as glomeruluar disease or tubulointerstitial disease. Clinical manifestations of glomerular injury can vary from the finding of isolated hematuria or proteinuria, or both. In addition, some patients who present with advanced renal insufficiency, hypertension, and shrunken, smooth kidneys are presumed to have chronic glomerulonephritis. Acute and chronic interstitial disease preferentially involves renal tubules.
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Medforth, Janet, Linda Ball, Angela Walker, Sue Battersby, and Sarah Stables. Introduction. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198754787.003.0001.
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This chapter comprises a midwifery definition and explains the midwife’s role, focusing on the challenges of a changing population demographic with increasing levels of complexity, ill health, and maternal morbidity. Highlights from the latest MBRRACE (2014) report are reflected as is new evidence of the value of midwifery-led care in all settings. Statutory supervision of midwifery in its current model is unique to UK midwifery and there are proposed changes to the regulatory framework pending in 2017. Meanwhile, current supervision arrangements remain in place until regulations are redrafted. Drug administration information is updated and the latest Human Medicines Regulations (2012) are cited along with the list of midwives exemptions. Independent prescribing is included here to indicate how by undertaking further approved training a midwife could be permitted to prescribe medicines promptly and without delay whilst giving care, e.g. prescription of antibiotics for mastitis, infected perineum, or urinary tract infection.
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Schiller, Adalbert, Adrian Covic, and Liviu Segall. Chronic tubulointerstitial nephritis. Edited by Adrian Covic. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199592548.003.0086_update_001.
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Chronic tubulointerstitial nephropathies (CTINs) are a group of renal diseases, characterized by variable interstitial inflammation and fibrosis and tubular atrophy, and a slow course towards end-stage renal disease (ESRD). The causes of CTIN are numerous, including nephrotoxic drugs and chemicals, infections, autoimmune diseases, obstructive uropathies, and metabolic disorders. Taken together, CTIN are responsible for less than 10% of all ESRD cases requiring renal replacement therapy. The clinical manifestations of CTIN typically comprise low-grade proteinuria, leucocyturia, and variably reduced glomerular filtration rate (GFR), whereas the blood pressure is usually normal or moderately increased. Tubular abnormalities are common, including type 2 (proximal) renal tubular acidosis, Fanconi syndrome, nephrogenic diabetes insipidus, and type 1 (distal) renal tubular acidosis, with hypokalaemia and nephrolithiasis. Radiology exams reveal shrunken kidneys, sometimes with irregular outlines. A renal biopsy is often required for the diagnosis of CTIN and its aetiology. The treatment of CTIN mainly involves discontinuation of exposure to nephrotoxins and specific therapy of renal infections, urinary tract obstruction, or underlying systemic diseases. Agents like ACE inhibitors and pirfenidone, which might reduce interstitial inflammation and fibrosis, are still under clinical evaluation.
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Neary, John, and Neil Turner. The patient with haematuria. Edited by Neil Turner. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0046.
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Haematuria is a common presenting feature of diseases of the kidney or the renal tract. It is also common in screening tests, single dipstick tests being positive in perhaps 5% of individuals. Age and whether the blood is visible (macroscopic) or non-visible (microscopic) impact largely on whether the explanation is likely to be broadly urological or nephrological. Origins are most commonly simple or urological. Macroscopic bleeding is rare in renal disease, and urine colour is then usually more rather smoky than red except when there is very acute inflammation. The chief urological causes are neoplasia, infection, stones, and trauma. Some traditionally medical conditions may cause simple bleeding; examples include cystic kidney diseases, papillary necrosis and macro- or microvascular ischaemic lesions. The major concern to nephrologists is that even non-visible haematuria may be a pointer to inflammatory or destructive glomerular processes. The presence of casts or dysmorphic red cells is a pointer to glomerular disease; more important in clinical practice are the three other key markers of renal disease: proteinuria, renal impairment in the absence of urinary tract obstruction, and hypertension. In the general population, microscopic haematuria does associate with a long-term increased risk of end-stage renal failure, so after negative investigations, occasional long-term checks are indicated. The case for population screening for haematuria appears weak.
Book chapters on the topic "Urinary infection. eng"
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Anees, Iram. "Myth: Urinary tract infection can lead to end-stage renal disease (ESRD)." In Myths and Shibboleths in Nephrology, 1–3. Dordrecht: Springer Netherlands, 2002. http://dx.doi.org/10.1007/978-94-010-0407-7_1.
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Melzer, Mark. "Pyrexia of Unknown Origin (PUO)." In Tutorial Topics in Infection for the Combined Infection Training Programme. Oxford University Press, 2019. http://dx.doi.org/10.1093/oso/9780198801740.003.0033.
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Petersdorf and Beeson defined pyrexia of unknown origin (PUO) in 1961. It is defined as an illness more than three weeks’ duration, with a fever > 38.3°C on several occasions and failure to reach a diagnosis after one week of in-patient investigation. Additional categories have now been added. These include: ● Nosocomial PUO in hospital patients: This is defined as fever of 38.3°C on several occasions caused by a process not present or incubating on admission, where initial cultures are negative and diagnosis remains unknown after three days of investigations. Fever is often related to hospital factors such as surgery, use of biomedical devices (e.g. intravascular devices/urinary catheters), C. difficile infection, and decubitus ulcers related to immobilization. ● HIV- associated PUO: This is defined as fever (as in Nosocomial PUO) for four weeks as an outpatient or three days as an in- patient. The commonest causes of fever are typical and atypical mycobacterial infections, cryptococcosis, and Cytomegalovirus (CMV). Lymphoma may cause fever in up to 25% of cases. ● Neutropenic PUO: This includes patients with a fever (as in Nosocomial PUO) with neutrophils < 1.0 x 109/L, with initial negative cultures and an uncertain diagnosis after three days. Bacterial infection is the commonest cause and should be treated empirically. The causes of a PUO can be categorized as infection (30–40%), neoplasia (20–30%), collagen-vascular and autoimmune diseases (10–20%), and miscellaneous (10–20%). The commonest causes of localized bacterial infections causing PUO are infective endocarditis, intra- abdominal or pelvic infections, oral cavity infections, osteomyelitis, and infected peripheral vessels. These conditions include: ● Infective endocarditis (IE): ■ Organisms associated with indolent onset (e.g. Streptococcus viridans, Enterococcus species, coagulase- negative staphylococci). ■ HACEK organisms (e.g. Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, Kingella). ■ Culture-negative endocarditis (e.g. Chlamydia, Coxiella, or Bartonella). ■ Non- infective endocarditis: ● Marantic endocarditis, associated with malignancy. ● Libman Sacks endocarditis, associated with systemic lupus erythematosus (SLE). ● Intra-abdominal infections. ■ Abscesses: ● Hepatic (GI tract or biliary in origin). ● Splenic (associated with IE). ● Sub-phrenic (associated with previous surgery). ● Pancreatic (post-pancreatitis).
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Farne, Hugo, Edward Norris-Cervetto, and James Warbrick-Smith. "Polyuria." In Oxford Cases in Medicine and Surgery. Oxford University Press, 2015. http://dx.doi.org/10.1093/oso/9780198716228.003.0029.
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In both polyuria and high urinary frequency the patient will be passing urine more often than before. But in polyuria, patients will pass abnormally large volumes of clear urine each time. In urinary frequency, the volume voided each time will be normal or reduced. The only way of knowing objectively whether this is the case is by collecting a 24-hour urine sample (>3 L = polyuria). As this is usually impractical outside of hospital, one must rely on the patient’s recall, with the caveat that many patients find it difficult to estimate urine output. In the history, then, ask them whether they feel they are passing a larger volume every time they go to the toilet. Remember that it is important to be as sure as you can that you are dealing with polyuria and not urinary frequency or nocturia, as the differential diagnoses are quite distinct. Chronic renal failure and hypercalcaemia (e.g. due to bone metastases) cause polyuria by inducing nephrogenic diabetes insipidus. Similarly, steroids and Cushing’s syndrome can cause polyuria by causing diabetes mellitus. • Temporal pattern of urine output (number of times in the day and at night), especially nocturia. At night, the kidneys concentrate urine in order to retain fluid (as intake is zero), removing the need to urinate during sleep. Thus nocturia (in the absence of other causes of nocturia, e.g. benign prostatic hyperplasia (BPH)) is often one of the earliest signs of a loss of concentrating ability. This symptom makes primary polydipsia less likely. • Fatigue, weight loss, recurrent infections. All can be features of diabetes mellitus. • Lower urinary tract symptoms (LUTS), e.g. frequency, urgency, hesitancy, terminal dribbling, incomplete voiding. These symptoms indicate pathology in the bladder or the outflow tract, e.g. prostatism in men, detrusor instability and prolapse in women. Not strictly speaking polyuria. • Pain, frequency, change in urine colour and smell. These are all symptoms suggestive of a urinary tract infection (UTI), which would cause increased frequency but not polyuria. • Past medical history. Look for any history of renal problems or conditions that may precipitate chronic renal failure (e.g. vasculitides, hypertension, chronic urinary retention).
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Tomson, Charles, and Alison Armitage. "Urinary tract infection." In Oxford Textbook of Medicine, 4103–22. Oxford University Press, 2010. http://dx.doi.org/10.1093/med/9780199204854.003.2113_update_001.
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Urinary tract infection (UTI) is a common condition, accounting for 1 to 3% of all primary care consultations in the United Kingdom. It affects patients of both sexes and all ages. The commonest organism causing uncomplicated community-acquired bacterial UTI is Escherichia coli. The occurrence and course of a UTI is influenced by the integrity of the host defence and by bacterial virulence factors. Disruption of the highly specialized transitional cell epithelium which lines the urinary tract, incomplete bladder emptying, anatomical abnormalities, and the presence of a foreign body, such as a urinary catheter, can all contribute to disruption of the host defence and increase the likelihood of infection. Sexual intercourse, use of condoms, and use of spermicides all increase the risk, and genetic factors influence the susceptibility of some people, e.g. girls with the P1 blood group are at increased risk of acute pyelonephritis. Bacterial characteristics that determine their ability to cause infection include specific mechanisms to adhere to the uroepithelium (‘pili’ or ‘fimbrias’ in the case of certain ...
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Christensen, Bryan E., and Ryan P. Fagan. "Healthcare Settings." In The CDC Field Epidemiology Manual, 341–62. Oxford University Press, 2019. http://dx.doi.org/10.1093/oso/9780190933692.003.0018.
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Healthcare-associated infections (e.g., bloodstream, respiratory tract, urinary tract, or surgical site) can be common in patients. Patients receiving acute and chronic healthcare across various settings, such as hospitals, dialysis clinics, and nursing homes, tend to have comorbidities that make them more susceptible to infection than their counterparts in the general community. Also, some pathogens may be more likely to cause infection in healthcare settings because of the unique exposures that patients can experience, such as invasive procedures or indwelling medical devices. Similar to community outbreak investigations, the primary purpose of an investigation in a healthcare setting is to determine the source of the outbreak, define mode of transmission, disrupt disease transmission, and prevent further transmission.
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Alexandre, J., A. Balian, L. Bensoussan, A. Chaïb, G. Gridel, K. Kinugawa, F. Lamazou, et al. "Infection urinaire." In Le tout en un révisions IFSI, 1750–52. Elsevier, 2009. http://dx.doi.org/10.1016/b978-2-294-70633-2.50613-2.
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Hsu, Desmond, and Zahir Osman Eltahir Babiker. "Fever in Returned Travellers." In Tutorial Topics in Infection for the Combined Infection Training Programme. Oxford University Press, 2019. http://dx.doi.org/10.1093/oso/9780198801740.003.0073.
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Travel-related problems have been reported in up to two-thirds of travellers to developing countries and approximately 10% of them seek medical advice during or after return from abroad. Furthermore, global migration from the developing to the developed world has increased over the past decades and these individuals may present with tropical infections soon after arrival in non-endemic settings. Fever, with or without localizing symptoms or signs, is a common presenting symptom in returning travellers. Most unwell travellers seek medical attention within one month of return from abroad. Travellers who visit friends and relatives (VFRs) in their countries of origin are disproportionately affected by the burden of imported infections, e.g. 70% of patients with imported malaria in the United Kingdom (UK) are VFRs. While most febrile travellers have common infections such as respiratory or urinary tract infection, it is of paramount importance not to miss potentially life-threatening tropical infections. Evaluation of fever in returning travellers requires an understanding of the geographical distribution of infectious diseases, risk factors for acquisition, incubation periods, and major clinical syndromes of travel-associated infections. The following points should be considered when assessing febrile international travellers: A. Travel dates: the relationship between the timing of the onset of symptoms and travel dates should be assessed. B. Geography: ● travel destination: a detailed itinerary is required. ● local setting: urban vs rural locations; type of accommodation, e.g. air-conditioned hotel room, outdoor camping, etc. C. Risk factors for acquiring infectious diseases: ● purpose of travel: visiting friends and family; social gatherings (e.g. funerals and weddings); mass gatherings (e.g. Hajj pilgrimage, Kumbh Mela religious festival, Olympic games, etc.); tourism; business; voluntary work. ● contact with unwell individuals. ● activities while abroad (examples): ■ food consumption: street food, seafood, raw food, unpasteurized dairy products, exotic foods, bush meat, etc. ■ contact with animals: visits to game parks, farms, caves, bites or scratches by bats or terrestrial animals, visits to ‘wet markets’, birding events, etc. ■ bites: ticks, insects, snakes, spiders, etc. ■ use of local healthcare system: dental or surgical procedures, blood transfusion, dialysis, tattoos, acupuncture.
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Bowler, Ian C. J. W., and Matthew Scarborough. "Nosocomial infections." In Oxford Textbook of Medicine, edited by Christopher P. Conlon, 669–73. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780198746690.003.0071.
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Hospital-acquired or nosocomial infections—defined for epidemiological purposes as infections manifesting more than 48 hours after hospital admission—are common. They affect 1.4 million people worldwide, involve between 5 and 25% of hospitalized patients at any one time and are associated with considerable morbidity, mortality, and cost. The most common sites of nosocomial infection are the urinary tract, surgical wounds, and the lower respiratory tract. Most are bacterial in origin, the most common species being Escherichia coli, Staphylococcus aureus (including methicillin-resistant Staphylococcus aureus), enterococci, Pseudomonas aeruginosa, and coagulase-negative staphylococci. The principal risk factors are extremes of age, the severity of underlying acute disease (e.g. neutropenia, organ system failure), and chronic medical conditions (especially diabetes, renal failure, and alcohol abuse).
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Rees, Lesley, Nicholas J. A. Webb, Detlef Bockenhauer, and Marilynn G. Punaro. "Congenital abnormalities of the kidneys and urinary tract." In Paediatric Nephrology, 57–86. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780198784272.003.0003.
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Congenital abnormalities of the kidneys and urinary tract (CAKUT) are the commonest cause of renal problems in children, ranging from asymptomatic or incidental findings to a cause of urinary tract infection and obstruction, renal damage, and end-stage kidney disease. The investigation and management of CAKUT depend on the potential for causing renal injury.
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Wani, Robert Serafino, and Satya Das. "Cardiovascular Infections." In Tutorial Topics in Infection for the Combined Infection Training Programme. Oxford University Press, 2019. http://dx.doi.org/10.1093/oso/9780198801740.003.0037.
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Infective endocarditis (IE) is inflammation of the endothelial lining of the heart valves due to infective causes. IE is a rare condition with an incidence rate of three to nine cases per 100,000 population with a male to female ratio of 2:1. The rate is higher in people with unrepaired cyanotic congenital heart disease, prosthetic heart valves and previous endocarditis. Other risk factors for IE include: rheumatic fever (now accounts for < 10% of IE cases in developed countries), degenerative conditions of heart valves, intravenous drug abuse, diabetes, and HIV infection. One third of the cases are now healthcare associated infection (HCAI), particularly with haemodialysis, cardiac surgery, implantable cardiac devices, intravascular lines, and urinary catheters. In the past decade Staphylococcus aureus has replaced viridans streptococci as the leading cause of IE, the rate of enterococcal (mostly E. faecalis) and Bartonella IE has increased, while that of culture negative endocarditis has decreased. Untreated IE is a uniformly fatal condition, but the mortality rate can be reduced to 5–40% with appropriate treatment. There are two important prerequisite steps to the development of IE: 1. A damaged endothelium due to high pressure gradient and turbulent blood flow around a heart valve or septal defect. Fibrin and platelet deposition occur on the roughened endothelium forming a non-infective thrombus or vegetation. 2. Bacteraemia due to endocarditis-prone organisms resulting from trauma to mucous membranes (e.g. oral cavity, urinary, and gastrointestinal tract) or other colonized tissue or foreign body, which is not cleared by host defence mechanisms. Micro-organisms then attach to the damaged endothelium through a specific ligand-receptor interaction (hence the predilection for certain organisms to cause endocarditis, e.g. viridans streptococci from the mouth), colonize the thrombus, and grow and multiply within it to give rise to a mature/infective vegetation, which is the pathological hallmark of IE. Virulent organisms, classically S. aureus, can apparently infect a healthy endocardium. Damage to the endothelium results in valvular incompetence/regurgitation and symptoms and signs of heart failure and when severe, it is a potentially fatal condition that requires urgent valve surgery, even if the infection has fully responded to antimicrobial therapy.