Urine culture doubtful in determining etiology of diffuse symptoms among elderly individuals [Urinodling har tveksamt värde vid beslut om antibiotikabehandling av patienter på äldreboenden]

Background: As many as half of elderly residents at nursing homes have asymptomatic bacteriuria. Thus it’s hard to know if a new symptom is related to findings of bacteria in urine or not. There are different opinions on the possible connection between different non-specific symptoms and urinary tract infections (UTI). Non-specific symptoms in combination with diagnostic uncertainty often lead to antibiotic treatments of uncertain value. Antibiotic overuse increases the prevalence of antibiotic resistant bacteria. Research question: What is the relationship between bacteria in the urine and new or increased fatigue, confusion, restlessness, aggressiveness, not being herself/himself, dysuria, urgency and fever. Methods: In this cross-sectional study symptoms were registered and voided urine specimens collected for urine cultures from 651 elderly residents in 32 nursing homes located in south-western Sweden. Correlation between bacteriuria and presence of a symptom at group level were determined using logistic regression. To estimate the clinical relevance of correlations at group level positive and negative etiological predictive values (EPV) were calculated. EPV takes into account the presence of asymptomatic bacteriuria. Results: In this study 207/651 (32%) of urine cultures were positive. Fatigue, restlessness and confusion were the most common symptoms. Logistic regression indicated some correlations at group level. Aside from Escherichia coli in the urine and not being herself/himself present for at least one month, but less than three months, EPV indicated no clinically useful correlation between any symptoms in this study and findings of bacteriuria. Conclusion: Urine cultures are insufficiently specific when evaluating elderly patients at nursing homes presenting with new or increased restlessness, fatigue, confusion, aggressiveness, dysuria or urgency

Urine culture doubtful in determining etiology of diffuse symptoms among elderly individuals [Urinodling har tveksamt värde vid beslut om antibiotikabehandling av patienter på äldreboenden]

Background: As many as half of elderly residents at nursing homes have asymptomatic bacteriuria. Thus it’s hard to know if a new symptom is related to findings of bacteria in urine or not. There are different opinions on the possible connection between different non-specific symptoms and urinary tract infections (UTI). Non-specific symptoms in combination with diagnostic uncertainty often lead to antibiotic treatments of uncertain value. Antibiotic overuse increases the prevalence of antibiotic resistant bacteria. Research question: What is the relationship between bacteria in the urine and new or increased fatigue, confusion, restlessness, aggressiveness, not being herself/himself, dysuria, urgency and fever. Methods: In this cross-sectional study symptoms were registered and voided urine specimens collected for urine cultures from 651 elderly residents in 32 nursing homes located in south-western Sweden. Correlation between bacteriuria and presence of a symptom at group level were determined using logistic regression. To estimate the clinical relevance of correlations at group level positive and negative etiological predictive values (EPV) were calculated. EPV takes into account the presence of asymptomatic bacteriuria. Results: In this study 207/651 (32%) of urine cultures were positive. Fatigue, restlessness and confusion were the most common symptoms. Logistic regression indicated some correlations at group level. Aside from Escherichia coli in the urine and not being herself/himself present for at least one month, but less than three months, EPV indicated no clinically useful correlation between any symptoms in this study and findings of bacteriuria. Conclusion: Urine cultures are insufficiently specific when evaluating elderly patients at nursing homes presenting with new or increased restlessness, fatigue, confusion, aggressiveness, dysuria or urgency

Urine culture doubtful in determining etiology of diffuse symptoms

Background: As many as half of elderly residents at nursing homes have asymptomatic bacteriuria. Thus it’s hard to know if a new symptom is related to findings of bacteria in urine or not. There are different opinions on the possible connection between different non-specific symptoms and urinary tract infections (UTI). Non-specific symptoms in combination with diagnostic uncertainty often lead to antibiotic treatments of uncertain value. Antibiotic overuse increases the prevalence of antibiotic resistant bacteria. Research question: What is the relationship between bacteria in the urine and new or increased fatigue, confusion, restlessness, aggressiveness, not being herself/himself, dysuria, urgency and fever. Methods: In this cross-sectional study symptoms were registered and voided urine specimens collected for urine cultures from 651 elderly residents in 32 nursing homes located in south-western Sweden. Correlation between bacteriuria and presence of a symptom at group level were determined using logistic regression. To estimate the clinical relevance of correlations at group level positive and negative etiological predictive values (EPV) were calculated. EPV takes into account the presence of asymptomatic bacteriuria. Results: In this study 207/651 (32%) of urine cultures were positive. Fatigue, restlessness and confusion were the most common symptoms. Logistic regression indicated some correlations at group level. Aside from Escherichia coli in the urine and not being herself/himself present for at least one month, but less than three months, EPV indicated no clinically useful correlation between any symptoms in this study and findings of bacteriuria. Conclusion: Urine cultures are insufficiently specific when evaluating elderly patients at nursing homes presenting with new or increased restlessness, fatigue, confusion, aggressiveness, dysuria or urgency

Urine culture doubtful in determining etiology of diffuse symptoms

Background: As many as half of elderly residents at nursing homes have asymptomatic bacteriuria. Thus it’s hard to know if a new symptom is related to findings of bacteria in urine or not. There are different opinions on the possible connection between different non-specific symptoms and urinary tract infections (UTI). Non-specific symptoms in combination with diagnostic uncertainty often lead to antibiotic treatments of uncertain value. Antibiotic overuse increases the prevalence of antibiotic resistant bacteria. Research question: What is the relationship between bacteria in the urine and new or increased fatigue, confusion, restlessness, aggressiveness, not being herself/himself, dysuria, urgency and fever. Methods: In this cross-sectional study symptoms were registered and voided urine specimens collected for urine cultures from 651 elderly residents in 32 nursing homes located in south-western Sweden. Correlation between bacteriuria and presence of a symptom at group level were determined using logistic regression. To estimate the clinical relevance of correlations at group level positive and negative etiological predictive values (EPV) were calculated. EPV takes into account the presence of asymptomatic bacteriuria. Results: In this study 207/651 (32%) of urine cultures were positive. Fatigue, restlessness and confusion were the most common symptoms. Logistic regression indicated some correlations at group level. Aside from Escherichia coli in the urine and not being herself/himself present for at least one month, but less than three months, EPV indicated no clinically useful correlation between any symptoms in this study and findings of bacteriuria. Conclusion: Urine cultures are insufficiently specific when evaluating elderly patients at nursing homes presenting with new or increased restlessness, fatigue, confusion, aggressiveness, dysuria or urgency

Treatment Duration of Febrile Urinary Tract Infections

Although febrile urinary tract infections (UTIs) are relatively common in adults, data on optimal treatment duration are limited. Randomized controlled trials specifically addressing the elderly and patients with comorbidities have not been performed. This review highlights current available evidence. Premenopausal, non-pregnant women without comorbidities can be treated with a 5–7 day regimen of fluoroquinolones in countries with low levels of fluoroquinolone resistance, or, if proven susceptible, with 14 days of trimethoprim-sulfamethoxazole. Oral β-lactams are less effective compared with fluoroquinolones and trimethoprim-sulfamethoxazole. In men with mild to moderate febrile UTI, a 2-week regimen of an oral fluoroquinolone is likely sufficient. Although data are limited, this possibly holds even in the elderly patients with comorbidities or bacteremia

Acute bacterial prostatitis: heterogeneity in diagnostic criteria and management. Retrospective multicentric analysis of 371 patients diagnosed with acute prostatitis

<p>Abstract</p> <p>Background</p> <p>There is currently a lack of consensus for the diagnosis, investigations and treatments of acute bacterial prostatitis (AP).</p> <p>Methods</p> <p>The symptoms, investigations and treatments of 371 inpatients diagnosed with AP were analyzed through a retrospective study conducted in four departments – Urology (U), Infectious Diseases (ID), Internal Medicine (IM), Geriatrics (G) – of two French university hospitals.</p> <p>Results</p> <p>The cause of admission, symptoms, investigations and treatments depended markedly on the department of admission but not on the hospital. In U, patients commonly presented with a bladder outlet obstruction, they had a large imaging and functional check-up, and received alpha-blockers and anti-inflammatory drugs. In ID, patients were febrile and received longer and more appropriate antibiotic treatments. In G, patients presented with cognitive disorders and commonly had post-void urine volume measurements. In IM, patients presented with a wide range of symptoms, and had very diverse investigations and antibiotic regimen.</p> <p>Overall, a 3:1 ratio of community-acquired AP (CA-AP) to nosocomial AP (N-AP) was observed. Urine culture isolated mainly <it>E. coli </it>(58% of AP, 68% of CA-AP), with venereal agents constituting less than 1%. The probabilistic antibiotic treatments were similar for N-AP and CA-AP (58% bi-therapy; 63% fluoroquinolone-based regimen). For N-AP, these treatments were more likely to be inadequate (42% <it>vs. </it>8%, p < 0.001) and had a higher rate of bacteriological failure (48% <it>vs. </it>19%, p < 0.001).</p> <p>Clinical failure at follow-up was more common than bacteriological failure (75% versus 24%, p < 0.001). Patients older than 49 had more underlying urinary tract disorders and a higher rate of clinical failure (30% versus 10%, p < 0.0001).</p> <p>Conclusion</p> <p>This study highlights the difficulties encountered on a daily basis by the physicians regarding the diagnosis and management of acute prostatitis.</p

Urine culture doubtful in determining etiology of diffuse symptoms among elderly individuals: a cross-sectional study of 32 nursing homes

Background: The high prevalence of bacteriuria in elderly individuals makes it difficult to know if a new symptom is related to bacteria in the urine. There are different views concerning this relationship and bacteriuria often leads to antibiotic treatments. The aim of this study was to investigate the relationship between bacteria in the urine and new or increased restlessness, fatigue, confusion, aggressiveness, not being herself/himself, dysuria, urgency and fever in individuals at nursing homes for elderly when statistically considering the high prevalence of asymptomatic bacteriuria in this population.\ud \ud Methods: In this cross-sectional study symptoms were registered and voided urine specimens were collected for urinary cultures from 651 elderly individuals. Logistic regressions were performed to evaluate the statistical correlation between bacteriuria and presence of a symptom at group level. To estimate the clinical relevance of statistical correlations at group level positive and negative etiological predictive values (EPV) were calculated.\ud \ud Results: Logistic regression indicated some correlations at group level. Aside from Escherichia coli in the urine and not being herself/himself existing at least one month, but less than three months, EPV indicated no clinically useful correlation between any symptoms in this study and findings of bacteriuria.\ud \ud Conclusions: Urinary cultures provide little or no useful information when evaluating diffuse symptoms among elderly residents of nursing homes. Either common urinary tract pathogens are irrelevant, or urine culture is an inappropriate test

Virulence Characteristics and Genetic Affinities of Multiple Drug Resistant Uropathogenic Escherichia coli from a Semi Urban Locality in India

Extraintestinal pathogenic Escherichia coli (ExPEC) are of significant health concern. The emergence of drug resistant E. coli with high virulence potential is alarming. Lack of sufficient data on transmission dynamics, virulence spectrum and antimicrobial resistance of certain pathogens such as the uropathogenic E. coli (UPEC) from countries with high infection burden, such as India, hinders the infection control and management efforts. In this study, we extensively genotyped and phenotyped a collection of 150 UPEC obtained from patients belonging to a semi-urban, industrialized setting near Pune, India. The isolates representing different clinical categories were analyzed in comparison with 50 commensal E. coli isolates from India as well as 50 ExPEC strains from Germany. Virulent strains were identified based on hemolysis, haemagglutination, cell surface hydrophobicity, serum bactericidal activity as well as with the help of O serotyping. We generated antimicrobial resistance profiles for all the clinical isolates and carried out phylogenetic analysis based on repetitive extragenic palindromic (rep)-PCR. E. coli from urinary tract infection cases expressed higher percentages of type I (45%) and P fimbriae (40%) when compared to fecal isolates (25% and 8% respectively). Hemolytic group comprised of 60% of UPEC and only 2% of E. coli from feces. Additionally, we found that serum resistance and cell surface hydrophobicity were not significantly (p = 0.16/p = 0.51) associated with UPEC from clinical cases. Moreover, clinical isolates exhibited highest resistance against amoxicillin (67.3%) and least against nitrofurantoin (57.3%). We also observed that 31.3% of UPEC were extended-spectrum beta-lactamase (ESBL) producers belonging to serotype O25, of which four were also positive for O25b subgroup that is linked to B2-O25b-ST131-CTX-M-15 virulent/multiresistant type. Furthermore, isolates from India and Germany (as well as global sources) were found to be genetically distinct with no evidence to espouse expansion of E. coli from India to the west or vice-versa