Dissertations / Theses on the topic 'Urinary tract infections in children'
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1
Hannula, A. (Annukka). "Imaging studies of the urinary tract in children with acute urinary tract infection." Doctoral thesis, Oulun yliopisto, 2012. http://urn.fi/urn:isbn:9789514298271.
Full textAbstract:
Abstract The aims were to evaluate the occurrence of vesicoureteral reflux (VUR) in children, to assess the frequency of significant ultrasonography (US) abnormalities and to study whether abandoning the use of voiding cystourethrographies (VCUG) is safe in children with urinary tract infection (UTI). We analysed reports on US and VCUG in a consecutive series of 406 paediatric patients and in a large population-based group of 2036 children with UTI. Based on the urine culture data, we analysed the frequencies of VUR and US abnormalities in relation to the reliability of the UTI diagnoses. Using a cohort of 1185 children on whom both VCUG and US had been performed, we evaluated whether US imaging alone is sufficient. In a follow-up study, we excluded 24 cases with major renal dysplasia or obstruction of the urinary tract from this cohort of 1185 children leaving a series of 1161 cases, of which 228 were randomly selected for follow-up and 193 (85%) participated, with a mean follow-up time of 11 years (range 6 to 17 years). The occurrence of VUR was similar among the children with proven (37%) or certain (36%) versus false (35%) or improbable (36%) UTI and decreased with increasing age. Significant US abnormalities were found in 10% and the frequency increased as the diagnostic reliability improved (15% in the proven UTI class and 8% in the false class). In the cohort of 1185 children, initial US was normal in 861 (73%), out of whom VCUG identified two cases of urethral valves and 40 cases of grade III to V VUR who could have benefited from surgical treatment, giving a figure of 42/861 (5%) for pathological findings that might have been missed if VCUG had not been performed. In the follow-up study, unilateral renal parenchymal defect was found in 22 (15%) out of the 150 patients who underwent control US, all except one of these being in patients with grade III to V VUR. Serum cystatin C concentration, estimated glomerular filtration rates and blood pressure were within the normal ranges in all the patients despite the defects seen in US. We conclude that VUR is a common age-related phenomenon in children and is not as closely associated with UTI as was previously thought. Children with UTI could be examined using US alone. Once obstructive uropathy and major renal dysplasia have been ruled out, the risk of long-term consequences in a case of childhood UTI is very lowTiivistelmä Tutkimuksen tavoitteena oli selvittää virtsan takaisinvirtauksen (vesikoureteraalinen takaisinvirtaus, VUR) esiintyvyyttä lapsilla sekä arvioida merkittävien virtsateiden rakennepoikkeavuuksien yleisyyttä ja ultraäänitutkimuksen (UÄ) riittävyyttä virtsatieinfektion (VTI) sairastaneilla lapsilla. Analysoimme sairastetun VTI:n vuoksi tehtyjen UÄ- ja miktiokystografiatutkimusten löydökset 406 lapsen potilassarjassa ja 2036 lapsen väestöpohjaisessa aineistossa. Virtsaviljelytulosten pohjalta luokittelimme potilaat VTI-diagnoosin luotettavuuden mukaan. Väestöpohjaisen aineiston 1185 lapselle oli tehty sekä UÄ-tutkimus että miktiokystografia, ja tässä kohortissa arvioimme pelkän UÄ:n riittävyyttä virtsateiden kuvantamisessa. Seurantatutkimusta varten 1185 lapsen kohortista jätimme pois 24 potilasta, joilla oli todettu munuaisdysplasia tai virtsateiden virtauseste. Jälkitarkastukseen kutsuimme tästä 1161 potilaan tutkimusaineistosta ryväsotannalla 228 potilasta, joista 193 (85 %) osallistui. Keskimääräinen seuranta-aika oli 11 vuotta (vaihtelu 6–17 vuotta). Tutkimuksemme mukaan VUR on yleinen myös lapsilla, jotka eivät ole sairastaneet varmennettua VTI:ta. Näillä lapsilla VUR:n esiintyvyys oli 35–36 %, joka oli sama kuin varman VTI:n sairastaneilla (36–37 %), ja esiintyvyys väheni merkittävästi iän myötä. Merkittävä UÄ-poikkeavuus todettiin kaikkiaan 10 %:lla, ja riski oli suurin varman VTI:n sairastaneilla. 1185 lapsen kohortissa UÄ-tutkimus oli normaali 861:lla (73 %). Miktiokystografiassa heistä 42/861:lla (5 %) löydettiin merkittävä virtsatieanomalia (n = 2) tai VUR, joka oli hoidettu kirurgisesti (n = 40). Jälkitarkastuksessa 22:lla (15 %) UÄ:llä tutkitusta 150 potilaasta todettiin toispuoleinen munuaisarpi, ja yhtä tapausta lukuun ottamatta arvet löytyivät niiltä, joilla oli lapsena ollut III−V asteen VUR. Todetuista munuaisarvista huolimatta kaikilla seurantatutkimukseen osallistuneilla potilailla oli normaali munuaisten toiminta ja verenpaine. Aiemmasta käsityksestä poiketen VUR näyttäisi olevan yleinen, kasvun myötä häviävä ilmiö myös terveillä lapsilla. Virtsatieinfektion sairastaneilla lapsilla UÄ-tutkimus riittää virtsateiden kuvantamiseen ja kun synnynnäinen munuaisdysplasia ja virtsateiden virtauseste on poissuljettu, riski merkittäviin myöhäiskomplikaatioihin on hyvin pieni
2
Roy, L. Paul. "Studies related to diseases affecting the kidney and urinary tract in children and their management." Thesis, The University of Sydney, 2005. http://hdl.handle.net/2123/1819.
Full textAbstract:
Publications 1-49 represent studies that I have undertaken myself or conjointly over a 34 year period to investigate a variety of issues relating to diseases of the kidney and urinary tract in children. The studies were carried out at the Royal Alexandra Hospital for Children, Camperdown when I was Clinical Superintendent from 1968 - 1970; The Department of Paediatrics, University of Minnesota, Minneapolis, USA when I was Overseas Research Fellow of the Post Graduate Foundation in Medicine, University of Sydney, 1970 - 1972, then as Staff Physician in Nephrology at the Royal Alexandra Hospital for Children, Camperdown, 1972 - 1977, and then Head of that Department at the Hospital until 1995 and then as an Honorary Staff Specialist at that hospital. Some of the studies were done conjointly with members of the Renal Unit of Royal Prince Alfred Hospital where I hold an Honorary appointment and others conjointly with members of the Renal Unit of Prince Henry Hospital, Little Bay. I was appointed Clinical Associate Professor to the Department of Paediatrics and Child Health, University of Sydney in 1993. In 1966 paediatric nephrology was in the early phase of development as a medical subspecialty. There was no definitive textbook, the first was published in 1975 (Pediatric Nephrology, Ed. Mitchell I. Rubin. Williams and Wilkins.). In the preface to the 2nd edition of Renal Disease (Blackwell) in 1967 the editor D.A.K. Black noted that he had included a chapter on paediatric aspects which had been planned for the 1st edition in 1962 but ”it could not be arranged”. In the chapter on Renal Disease in Children the author, D.Macauly, comments that the mortality rate of acute renal failure in children was 50%. When I joined the resident staff of the Royal Alexandra Hospital for Children in 1966, children with renal disease were managed by general paediatricians. There was no active program for the treatment of children with acute or chronic renal failure. A small number of kidney biopsies had been performed by Dr Trefor Morgan who, together with Dr Denis Wade, had taught me the technique while I was a resident medical officer at the Royal Prince Alfred Hospital in the preceding year. With the guidance and support of Dr S.E.J. Robertson and Dr C. Lee, Honorary Medical Officers, and Dr R.D.K. Reye, Head of the Department of Pathology, I began performing kidney biopsies on children at the request of the paediatrician in charge. In the same year, encouraged again by Doctors Robertson and Lee, and by J.C.M. Friend and J. Brown, I introduced peritoneal dialysis for the treatment of children with acute renal failure, a technique which I had also been taught by Dr Trefor Morgan whilst I was a resident at Royal Prince Alfred Hospital. Dr Robertson encouraged me to present my experience in percutaneous renal biopsy in children at the Annual Meeting of the Australian Paediatric Association in 1968 and this study became the first paper I published in relation to disease of the urinary tract in children (1). In 1970 I was granted an Overseas Research Fellowship by the Post Graduate Foundation in Medicine, University of Sydney, to enable me to undertake a fellowship in the Department of Paediatrics at the University of Minnesota. I had the great fortune in undertaking studies in the new discipline of paediatric nephrology and related research under the guidance of Dr A. F. Michael, Dr R.L.Vernier and Dr A. Fish. I acquired the techniques of immunopathology and electron microscopy. On my return to Australia I established a Department of Nephrology at the Royal Alexandra Hospital for Children. I introduced immunofluorescent and electron microscopic studies for the kidney biopsies that I continued to perform and, with the support of Dr R.D.K. Reye, I provided the official reports of these studies until 1990. As a result these studies became part of the histopathologic service provided by the hospital. I continue to be consulted concerning the interpretation of some electron microscopic findings in renal tissue. With the assistance of Dr J.D. Harley I set up a laboratory in the Children’s Medical Research Foundation to continue and expand the studies I had commenced during my Fellowship. Establishing a dialysis and transplant program for children with end stage renal disease (ESRD) was extremely time consuming. At that time most children with ESRD died. The program was initially established jointly with the Renal Unit at Royal Prince Alfred Hospital in 1972 and eventually dialysis facilities were established at the Children’s Hospital using predominantly peritoneal dialysis. By 1978 the existence of the Unit was well known in the general community and articles appeared in the press. One prompted the late Sir Lorimer Dods, the first Professor of Paediatrics in Australia to write to me congratulating me on what I had achieved. He remarked “I have just read with special interest Shaun’s review in the SMH of some of your recent achievements in the field of renal failure in infancy and childhood and want to offer you my personal congratulations on all that you have achieved and are achieving in this area of paediatrics which, in my little world of yesterday, meant nothing more than progressive and unrelenting fatal illness”. Taking part in the development of a relatively new discipline led me to study a number of areas. I encouraged trainees to write reports concerning clinical observations and eventually I was joined by Fellows whom I encouraged and supported to study a number of different areas to ensure that children were being cared for in an environment of strong and open enquiry. This led to studies on investigations of chronic renal failure which Dr Elisabeth Hodson pursued and studies on urinary tract infection in small children for which Dr Jonathon Craig was awarded a PhD. As I had been a contributor and co-author in a number of these studies they have been included in my list of publications. As a result of this diversity I have listed the publications in 9 sections. The overall theme is to study diseases of the renal tract in children and treatments used to understand the processes and ensure the most effective treatment. Some published abstracts of papers presented at scientific meetings have been included to clarify invitations I received to prepare reviews and chapters on various subjects and my involvement in some conjoint studies. I was author or coauthor of several book chapters, reviews, editorials and certain published studies to which I was invited to contribute as a result of my primary studies and these I have included as “Derivative References”numbered 50-76.
3
Roy, L. Paul. "Studies related to diseases affecting the kidney and urinary tract in children and their management." University of Sydney, 2005. http://hdl.handle.net/2123/1819.
Full textAbstract:
Doctor of MedicinePublications 1-49 represent studies that I have undertaken myself or conjointly over a 34 year period to investigate a variety of issues relating to diseases of the kidney and urinary tract in children. The studies were carried out at the Royal Alexandra Hospital for Children, Camperdown when I was Clinical Superintendent from 1968 - 1970; The Department of Paediatrics, University of Minnesota, Minneapolis, USA when I was Overseas Research Fellow of the Post Graduate Foundation in Medicine, University of Sydney, 1970 - 1972, then as Staff Physician in Nephrology at the Royal Alexandra Hospital for Children, Camperdown, 1972 - 1977, and then Head of that Department at the Hospital until 1995 and then as an Honorary Staff Specialist at that hospital. Some of the studies were done conjointly with members of the Renal Unit of Royal Prince Alfred Hospital where I hold an Honorary appointment and others conjointly with members of the Renal Unit of Prince Henry Hospital, Little Bay. I was appointed Clinical Associate Professor to the Department of Paediatrics and Child Health, University of Sydney in 1993. In 1966 paediatric nephrology was in the early phase of development as a medical subspecialty. There was no definitive textbook, the first was published in 1975 (Pediatric Nephrology, Ed. Mitchell I. Rubin. Williams and Wilkins.). In the preface to the 2nd edition of Renal Disease (Blackwell) in 1967 the editor D.A.K. Black noted that he had included a chapter on paediatric aspects which had been planned for the 1st edition in 1962 but ”it could not be arranged”. In the chapter on Renal Disease in Children the author, D.Macauly, comments that the mortality rate of acute renal failure in children was 50%. When I joined the resident staff of the Royal Alexandra Hospital for Children in 1966, children with renal disease were managed by general paediatricians. There was no active program for the treatment of children with acute or chronic renal failure. A small number of kidney biopsies had been performed by Dr Trefor Morgan who, together with Dr Denis Wade, had taught me the technique while I was a resident medical officer at the Royal Prince Alfred Hospital in the preceding year. With the guidance and support of Dr S.E.J. Robertson and Dr C. Lee, Honorary Medical Officers, and Dr R.D.K. Reye, Head of the Department of Pathology, I began performing kidney biopsies on children at the request of the paediatrician in charge. In the same year, encouraged again by Doctors Robertson and Lee, and by J.C.M. Friend and J. Brown, I introduced peritoneal dialysis for the treatment of children with acute renal failure, a technique which I had also been taught by Dr Trefor Morgan whilst I was a resident at Royal Prince Alfred Hospital. Dr Robertson encouraged me to present my experience in percutaneous renal biopsy in children at the Annual Meeting of the Australian Paediatric Association in 1968 and this study became the first paper I published in relation to disease of the urinary tract in children (1). In 1970 I was granted an Overseas Research Fellowship by the Post Graduate Foundation in Medicine, University of Sydney, to enable me to undertake a fellowship in the Department of Paediatrics at the University of Minnesota. I had the great fortune in undertaking studies in the new discipline of paediatric nephrology and related research under the guidance of Dr A. F. Michael, Dr R.L.Vernier and Dr A. Fish. I acquired the techniques of immunopathology and electron microscopy. On my return to Australia I established a Department of Nephrology at the Royal Alexandra Hospital for Children. I introduced immunofluorescent and electron microscopic studies for the kidney biopsies that I continued to perform and, with the support of Dr R.D.K. Reye, I provided the official reports of these studies until 1990. As a result these studies became part of the histopathologic service provided by the hospital. I continue to be consulted concerning the interpretation of some electron microscopic findings in renal tissue. With the assistance of Dr J.D. Harley I set up a laboratory in the Children’s Medical Research Foundation to continue and expand the studies I had commenced during my Fellowship. Establishing a dialysis and transplant program for children with end stage renal disease (ESRD) was extremely time consuming. At that time most children with ESRD died. The program was initially established jointly with the Renal Unit at Royal Prince Alfred Hospital in 1972 and eventually dialysis facilities were established at the Children’s Hospital using predominantly peritoneal dialysis. By 1978 the existence of the Unit was well known in the general community and articles appeared in the press. One prompted the late Sir Lorimer Dods, the first Professor of Paediatrics in Australia to write to me congratulating me on what I had achieved. He remarked “I have just read with special interest Shaun’s review in the SMH of some of your recent achievements in the field of renal failure in infancy and childhood and want to offer you my personal congratulations on all that you have achieved and are achieving in this area of paediatrics which, in my little world of yesterday, meant nothing more than progressive and unrelenting fatal illness”. Taking part in the development of a relatively new discipline led me to study a number of areas. I encouraged trainees to write reports concerning clinical observations and eventually I was joined by Fellows whom I encouraged and supported to study a number of different areas to ensure that children were being cared for in an environment of strong and open enquiry. This led to studies on investigations of chronic renal failure which Dr Elisabeth Hodson pursued and studies on urinary tract infection in small children for which Dr Jonathon Craig was awarded a PhD. As I had been a contributor and co-author in a number of these studies they have been included in my list of publications. As a result of this diversity I have listed the publications in 9 sections. The overall theme is to study diseases of the renal tract in children and treatments used to understand the processes and ensure the most effective treatment. Some published abstracts of papers presented at scientific meetings have been included to clarify invitations I received to prepare reviews and chapters on various subjects and my involvement in some conjoint studies. I was author or coauthor of several book chapters, reviews, editorials and certain published studies to which I was invited to contribute as a result of my primary studies and these I have included as “Derivative References”numbered 50-76.
4
Brady, Patrick W. "Duration of intravenous antibiotics and treatment failure in infants hospitalized with urinary tract infections." University of Cincinnati / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1299169787.
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5
Forster, Catherine S. "Predictive Ability of NGAL in Distinguishing Urinary Tract Infection from Colonization in Children who Require Clean Intermittent Catheterization." University of Cincinnati / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1491558718150357.
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6
Nguyen, Amy, Sarah Deitering, Hanna Phan, Megan Brandon, and Kathryn Matthias. "Evaluation of Treatment and Outcomes in Infants and Children with Urinary Tract Infection." The University of Arizona, 2015. http://hdl.handle.net/10150/614007.
Full textAbstract:
Class of 2015 AbstractObjectives: In 2011, the American Academy of Pediatrics released an updated urinary tract infection guideline that addressed diagnosis, antibiotic treatment, and duration of therapy in children ages 2-24 months. The objectives of this study were to evaluate the appropriateness of antibiotic prescribing and compare outcomes between age groups. Methods: This retrospective chart review included patients aged 1 month through 12 years admitted to a regional academic medical center from January through July 2014 and diagnosed with UTI or pyelonephritis. Patients were identified using ICD-9 codes. Demographic information, antibiotic treatment, length of stay, and complications were collected and the chi square statistical test was used to compare results between age groups. Results: There were 104 patients included in this study. The most common bacteria cultured were Escherichia coli (85%). Ceftriaxone (71%) and cephalexin (30%) were the most commonly prescribed empiric and discharge antibiotic, respectively. Based on guideline recommendations and culture results, inappropriate antibiotic selection only occurred with 7% of the orders while inappropriate prescribing occurred 35% of the time. Readmission within 90 days occurred in 15% of patients aged 2-24 months (guideline age group) and in 14% of all other patients (P>0.05). Conclusions: There was no difference between age groups with respect to inappropriate antibiotic prescribing or complications for pediatric UTI treatment and inappropriate antibiotic dosing occurred more frequently than inappropriate selection. More research is necessary to assess the impact of the guidelines on prescribing practices and factors associated with inappropriate prescribing.
7
Venhola, M. (Mika). "Vesicoureteral reflux in children." Doctoral thesis, Oulun yliopisto, 2011. http://urn.fi/urn:isbn:9789514295652.
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Abstract The aims of the work were to evaluate the comparability and repeatability of urodynamic studies and to examine whether such examinations are useful for predicting the recurrence of urinary tract infections or the presence of vesicoureteral reflux, to analyse the efficacy of treatments for vesicoureteral reflux (VUR), to validate a pre-established clinical decision rule for targeting voiding cystourethrograms efficiently in children and to investigate the occurrence of vesicoureteral reflux. Reports on urodynamic examinations performed on children were evaluated by analysing inter-observer and intra-observer agreement in their interpretations, and 116 children were followed up to examine whether such examinations can be used to predict the recurrence of urinary tract infections and the presence of vesicoureteral reflux. A meta-analysis of publications on treatments for vesicoureteral reflux was made to analyse their efficacy in children. A group of 406 children were examined to validate a pre-established clinical decision rule for managing vesicoureteral reflux in children after the first urinary tract infection and to investigate the occurrence of VUR in children. We found poor agreement among the observers in their urodynamic assessments. Neither the occurrence of VUR nor recurrent urinary tract infection could be predicted from the findings in urodynamic studies. The meta-analysis indicated no significant difference between conservative or operative treatment in terms of the recurrence of urinary tract infections, kidney growth or scarring. Our validation of the clinical decision rule showed that it had good specificity but very modest sensitivity in identifying children with dilating vesicoureteral reflux. The overall prevalence of vesicoureteral reflux was 35%, and its occurrence was similar in children without urinary tract infection. We claim that the occurrence of vesicoureteral reflux in children is higher than the figure of 1% suggested earlier. We could not predict the presence or absence of vesicoureteral reflux from the results of the urodynamic examinations, nor could we predict recurrent urinary tract infections from these findings. We suggest that it is not possible to predict VUR reliably, and that conservative treatment is sufficient for the majority of children with VURTiivistelmä Väitöskirjani tutkimussarjassa selvitimme lapsen virtsateissä tapahtuvan virtsan takaisinvirtauksen (vesikoureteraalinen refluksi, VUR) yleisyyttä ja yhteyttä lasten virtsatieinfektioihin, arvioimme aiemmin julkaistun tutkimusohjeen käyttökelpoisuutta lasten virtsateiden kuvantamispäätöstä tehtäessä ja teimme meta-analyysin virtsan takaisinvirtauksen hoitotapojen merkityksestä munuaisten kehitykselle ja toiminnalle. Selvitimme myös virtsarakon toiminnallisten tutkimusten arviointien toistettavuutta ja vertailtavuutta lastenkirurgien kesken sekä onko näillä tutkimuksilla mahdollista havaita onko lapsella VUR tai taipumusta uusiutuviin virtsatieinfektioihin. Tutkimassamme 406 lapsen aineistossa virtsan takaisinvirtausta löytyi 39 % :lla virtsatieinfektion sairastaneista lapsista ja 36 %:lla muita tulehduksia sairastaneista. Ero ei ollut tilastollisesti merkittävä ja esiintyvyys on huomattavasti suurempi kuin aiemmin on oletettu. Samassa aineistossa testasimme tutkimusohjetta jonka avulla voitaisi löytää lapset joilla on todennäköisesti VUR. Tuloksemme mukaan tutkimusohje ei ole käyttökelpoinen. Kirjallisuuteen perustuvassa meta-analyysissä julkaistuista VUR tutkimuksista lapsilla, havaitsimme, ettei leikkauksella korjattujen tai lääkityksellä hoidettujen lasten munuaisten kasvussa, arpeutumisessa tai virtsatieinfektioiden uusiutumisessa ollut eroa. Virtsarakon toiminnallisten tutkimusten arviointien toistettavuutta lääkärien kesken tutkimme 15 lapsen aineistossa ja havaitsimme huomattavaa vaihtelua arvioinneissa lääkärien välillä ja samaa tutkimusta uudelleen arvioitaessa. Suuren vaihtelun vuoksi näiden tutkimusten hyödyllisyyttä tulisi arvioida kriittisesti. Lisäksi 136 lapsen tutkimuksessa havaitsimme ettei poikkeava virtsarakon toiminnallisen tutkimuksen löydös ennustanut uusiutuvia virtsatieinfektioita tai virtsan takaisinvirtausta näillä lapsilla. Lapsilla VUR on mitä ilmeisimmin varsin tavallinen ilmiö myös terveillä lapsilla ja sen esiintyvyys ylittää aiemmin raportoidun 1 %:n esiintyvyyden. Virtsarakon toiminnalliset tutkimukset eivät ennusta VUR:n esiintyvyyttä tai virtsatietulehdusten toistuvuutta ja näiden tulosten hyöty on vähäinen. Virtsan takaisinvirtauksen leikkaushoitoon on harvoin aihetta eikä arvioimamme tutkimusohje auta löytämään VUR:a sairastavia lapsia
8
Borsari, Andrea. "Susceptibility of escherichia coli strains isolated from outpatient children with community-acquired urinary tract infection in southern Switzerland /." [S.l.] : [s.n.], 2008. http://www.ub.unibe.ch/content/bibliotheken_sammlungen/sondersammlungen/dissen_bestellformular/index_ger.html.
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9
Bezruk, V. V., and T. O. Bezruk. "Administrative territorial and sex features etiological spectrum of urinary tract infection in children (on the exampl of the chernivtsi region)." Thesis, Матерiали 97 пiдсумкової наукової конференцiї професорсько викладацького персоналу вищого державного навчального закладу України «Буковинський державний медичний унiверситет», 2016. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/12083.
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10
O'Brien, Kathryn. "The prevalence of urinary tract infection (UTI) in children under five years old presenting with an acute illness in UK general practice." Thesis, Cardiff University, 2013. http://orca.cf.ac.uk/47309/.
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Urinary tract infections (UTI) in young children have been associated with serious long-term complications such as renal scarring, hypertension and renal failure. The presenting symptoms of UTI in children are non-specific. If UTI is not suspected, a urine sample is not obtained, and without this, UTI cannot be diagnosed. There is evidence that the diagnosis is often missed. Most published studies have not systematically sampled urine, and those that have are largely based in US emergency departments and only include highly selected groups of children. The true prevalence of UTI in acutely ill children presenting in UK general practice is therefore unknown. My thesis consists of a literature review discussing the association of childhood UTI with long-term complications, the challenges of diagnosis and the evidence that UTIs are being missed; a systematic review of papers reporting UTI prevalence in children which highlights the need for a study in UK general practice; a pilot study to determine the feasibility of recruiting children and obtaining urine samples in UK general practice; and a prospective cohort study to determine the point prevalence of UTI in 597 presenting children, determine the predictive value of presenting symptoms, signs and risk factors, and describe the clinical outcomes for children with UTI. I found that the prevalence of UTI was 5.9% (95% confidence interval: 4.3-8.0%). This may be sufficiently high to justify increased urine sampling in general practice. A multi-variable logistic regression model identified younger age range, pain on passing urine (dysuria) and urinary frequency as being associated with UTI. I propose a urine sampling strategy for GPs assessing acutely ill children and compare this to suspicion-led sampling and current guidelines. In my discussion I discuss the limitations, generalisability and implications of these findings.
11
Rudaitis, Šarūnas. "Urodinaminių ir kitų klinikinių požymių prognozinė vertė vaikų šlapimo organų infekcijos kartojimuisi." Doctoral thesis, Lithuanian Academic Libraries Network (LABT), 2008. http://vddb.library.lt/obj/LT-eLABa-0001:E.02~2008~D_20080415_135240-28491.
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Šlapimo organų infekcija (ŠOI) vaikams yra antra pagal dažnį po kvėpavimo organų infekcijų. Tai dažniausia vaikų nefrologinė liga. ŠOI iki 3–6 mėn. amžiaus dažniau serga berniukai, vyresniame amžiuje – mergaitės. Priešmokykliniame amžiuje mergaitės simptomine šlapimo organų infekcija serga 6–20 kartų dažniau nei berniukai. Beveik kas trečia moteris iki 24 metų ŠOI yra sirgusi bent vieną kartą, o per gyvenimą ŠOI yra sirgusi beveik kas antra moteris. ŠOI linkusi pasikartoti. Kartojantis ŠOI, liga gali įgauti lėtinę eigą, sukelti inkstų randėjimą, lėtinį inkstų funkcijos nepakankamumą (IFN), nulemti hipertenzijos atsiradimą, o moterims – nėštumo komplikacijas. 29 % vaikų, kuriems buvo atliktos inkstų transplantacijos, inkstų pažeidimas buvo sąlygotas pielonefrito ar intersticinio nefrito. Lietuvoje vaikų lėtinio IFN priežastis 31,7 proc. obstrukcinė nefropatija ir lėtinis pielonefritas. Kol nebuvo taikomas profilaktinis gydymas, 60 proc. mergaičių ir 20 proc. berniukų ŠOI pasikartodavo jau pirmaisiais metais po pirmos ŠOI. Taikant profilaktinį gydymą, 1 m. laikotarpyje po persirgtos ŠOI. infekcijos pasikartojimas sumažėjo iki 15 proc. Mažo amžiaus vaikams ŠOI pasikartojimą dažniausiai lemia įgimtos šlapimo organų anomalijos. Dauguma jaunesnio mokyklinio amžiaus vaikų, kuriems yra pasikartojanti ŠOI, turi organiškai nepakitusius šlapimo organus. Pastaruoju metu atliekamos studijos, kurių tikslas nustatyti elgesio ir funkcinių sutrikimų vertę ŠOI pasikartojimui, tačiau duomenys... [toliau žr. visą tekstą]Urinary tract infection (UTI) is one of the most common bacterial diseases in childhood. Recurrent UTI occurs in 20 – 86% of children. Recurrent UTI is relatively frequent in girls. At the age of 7, the prevalence of recurrent UTI in boys population is 1%, in girls population – 5%. Nearly one of three women will have at least one episode of UTI requiring antimicrobial therapy by the age of 24 years. Almost half of all women will experience one UTI during their lifetime. It is known, that in the group of young children the most common reason of recurrent UTI is anatomic abnormalities, such as vesicoureteral reflux (VUR), hydronephrosis. However, not all recurrent UTI can be explained by anatomic abnormalities. The vast majority of school age children with recurrent UTI have anatomically normal urinary tract. We found changes in urodynamic investigation for 91.4% of children with recurrent urinary tract infection at the age of 5–18. Having a history of previous recurrent UTI is a strong risk factor for having subsequent UTI. Antibacterial characteristics of urine and other host defence mechanisms may be important signs associated with UTI risk, but have not been clearly shown to be associated with UTI in healthy persons. Recent studies discuss about the role of behavioural and functional abnormalities (inadequate fluid intake, stool retention, infrequent voiding, etc.) that can predispose recurrent urinary tract infections. Influence of some these abnormalities for recurrent... [to full text]
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Jensen, Heidi Dorte. "Cranberry juice and urinary tract infections /." Copenhagen : Department of Bacteriology, Mycology and Parasitology, Statens Serum Institut : Department of Medicinal Chemistry, The Danish University of Pharmaceutical Science, 2004. http://www.dfh.dk/phd/defences/HeidiDorteJensen.htm.
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Utzinger, Jürg. "Novel approaches in the control of schistosomiasis : from rapid identification to chemoprophylaxis /." Basel : Universität Basel, 1999. http://edoc.unibas.ch/diss/DissB_5365.
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Junior, Silvio Marciano da Silva. "Caracterização de Escherichia coli uropatogênicas isoladas de crianças com infecção urinária." Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/87/87131/tde-05072012-104130/.
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Infecção do Trato Urinário (ITU) é o segundo tipo de infecção bacteriana mais comum em crianças. Nesse estudo amostras de urina de 6012 pacientes pediátricos foram analisadas, a prevalência de ITU foi determinada, os uropatógenos foram identificados e o perfil antimicrobiano dos mesmos foi determinado. Os resultados mostraram que a prevalência de ITU varia de acordo com o sexo e a idade do paciente. Bactérias Gram-negativas foram responsáveis por 89 % de todos os casos de ITU e Escherichia coli foi a espécie mais prevalente. Os uropatógenos foram resistentes a ampicilina 63 %, a nitrofurantoina 37 % e ao trimethoprim-sulfamethoxazole 28 %. Todavia, 99 % deles foram sensíveis a cefalexina e 96 % ao cloranfenicol. Resultados obtidos com a caracterização de 90 isolados de E. coli, mostraram que todas as amostras foram positivas para os marcadores fimA e fimH, 53 % para pap, 32 % para sfa, 10 % para o marcador genético da toxina pic e 29 % foram capazes de produzir hemolisina-a. Esses isolados se distribuíram entre os grupos filogenéticos da seguinte maneira: B2 42 %, D 25 %, A 21 % e B1 11 %. Dessas amostras 19 % não foram tipáveis (ONT), 15,56 % pertenceram ao sorogrupo O2 e 12,22 % aos sorogrupos O6 e OR. A maioria dos isolados de E. coli aderiu às células epiteliais, poliestireno e PVC.Urinary Tract Infection (UTI) is the second most common type of bacterial infection in children. In this study, 6012 urine samples from pediatric patients were analyzed, the prevalence of UTI was determined, the uropathogens were identified and their antimicrobial profile was determined. The results have shown that the prevalence of UTI varies according to the sex and age of the patient. Gram negative bacteria were responsible for 89 % of all cases of UTI and E. coli was the most prevalent species. The uropathogens were resistant to: ampicillin 63 %, nitrofurantoin 37 % and trimethoprim-sulfamethoxazole 28 %. However, 99 % of them were sensitive to cephalexin and 96 % to chloramphenicol. Results obtained with the characterization of 90 isolates of E. coli showed that all of them were positive for fimA and fimH, 53 % were positive for pap, 32 % were positive for sfa, 10 % were positive for the genetic marker of pic and 29 % were able to produce hemolysin-a. These isolates were distributed between the phylogenetic groups as follows: B2 42 %, D 25 %, A 21 % and B1 11 %. Nineteen percent of these samples were untypeable (ONT), 15.56 % belonged to O2 serogroup and 12,22 % belonged to the O6 and OR serogroups. Most E. coli isolates were able to adhere to epithelial cells, polystyrene and PVC.
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Ng, Kwok-wai Roger. "Predictors of outcome of asymptomatic urinary tract infection in Hong Kong Chinese elderly persons /." View the Table of Contents & Abstract, 2007. http://sunzi.lib.hku.hk/hkuto/record/B38480475.
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Chromek, Milan. "Urinary tract infection and renal scarring /." Stockholm, 2006. http://diss.kib.ki.se/2006/7140-844-4/.
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Nyman, Jesper. "Machine learning approaches for detection of urinary tract infections." Thesis, Umeå universitet, Institutionen för fysik, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-172082.
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Urinary tract infections (UTI) are a common bacterial infection. Diagnosing UTI can be done through urine culturing. While precise, culturing is both time and money consuming. Flow cytometry analysis (FCA) is a different technique that can calculate different attributes in a urine sample. This is both faster and cheaper. Though, the problem with FCA is that it cannot reliably diagnose patients. The aim of this thesis is to investigate how different screening methods perform when applied before culturing. The screening methods uses FCA and some general characteristics to predict UTI. Using machine learning algorithms, different screening methods were compared. The methods were altered using a sensitivity correction such that the sensitivity exceeded 95%. The performance was measured using obtained real life data consisting of 1316 samples and cross validation. The best savings achieved was obtained using random forest. It managed to save up to 46% of the load on the culturing process while keeping a sensitivity of 95.15%. The specificity were 72%. Even though the data set obtained was too small to reliable declare the real performance, the savings looks really promising.
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Irom, Sara Julie. "High Dose Antimicrobial Protocols for Canine Urinary Tract Infections." The Ohio State University, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=osu1274464691.
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Philyaw, Charlotte Evette. "Preventing Urinary Tract Infections in the Acute Care Setting." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2574.
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More than 13,000 deaths and $340 million in health care costs are the result of catheter-associated urinary tract infections (CAUTIs) annually in the United States. CAUTIs can also result in acute patient discomfort and potentially preventable exposure to antibiotics. The hospital for which this quality improvement project was developed was above the National Healthcare Safety Network CAUTI bench mark. Framed within the Iowa model of evidence-based practice, a multidisciplinary team of 8 hospital stakeholders guided the project (n=8). The purpose of the project was to develop an indwelling urinary catheter maintenance checklist using evidence-based practice guidelines related to preexisting inappropriate risk factors for catheterization and appropriate indications for catheterization, as well as evidence-based maintenance practices for care of the indwelling catheter. Each piece of evidence to be included in the checklist was evaluated by 4 content experts using a 10 item 5 point Likert scale ranging from 'strongly disagree' to 'strongly agree'. Descriptive analysis showed an average of 4.8/5 for all items with 'agree' being voiced in two of the items rather than 'strongly agree'. The checklist was completed and presented to hospital senior leadership who recommended that the checklist be incorporated into the hospital CAUTI prevention plan. All project team members (n=8) completed an 8 item 5 point Likert scale summative evaluation of the purpose, goal, objectives, and my leadership which averaged as 5 or 'strongly agree' supporting the development of the project. Implications for social change include improved patient outcomes, mindful stewardship of healthcare dollars, and increased patient and family satisfaction.
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Prystowsky, Elya E. "Sexual intercourse, sexually transmitted infections, and urinary tract infections in post-menopausal women /." Thesis, Connect to this title online; UW restricted, 2006. http://hdl.handle.net/1773/10907.
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Smith, Sharon Phillips. "Community-acquired Urinary Tract Infections| Treatment, Outcomes, and Antimicrobial Resistance." Thesis, University of California, Berkeley, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3616604.
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Community-acquired urinary tract infections (CA-UTI) are common in young women. Reports of increasing resistance to the antimicrobial drugs commonly prescribed to treat CA-UTI, evidence of wide-spread dissemination of strains of multi-drug resistant i that can cause community outbreaks and expanding appreciation of the importance of the rational use of antibiotics are challenging the traditional management of this disease.
Two population-based studies were performed to investigate the epidemiological features of CA-UTI with an emphasis on the antimicrobial resistance of causative bacteria. An eight-year retrospective cohort study was conducted in a large health maintenance organization to identify changes in uropathogen etiology and antimicrobial resistance and in empirical antimicrobial treatment practices and outcomes. A cross-sectional study was performed in a university population to investigate the relationship between changes in the prevalence of genotype-based clonal groups of uropathogen E. coli and the prevalence of antimicrobial resistance.
From 1998 through 2005, less than 20% of the Escherichia coli causing uncomplicated CA-UTI (UCA-UTI) were resistant to the first line empirical treatment antimicrobial, trimethoprim/sulfamethoxazole (TMP/SMX). No trends were detected in the proportions of Escherichia coli that were resistant to TMP/SMX or to nitrofurantoin. In contrast, a small but steady increase in the proportion of Escherichia coli that were resistant to ciprofloxacin was observed. Over the same period of time, the use of ciprofloxacin as empirical treatment for UCA-UTI steadily increased while the use of TMP/SMX decreased. No sustained decreases in treatment failure or in microbiologically incompatible treatment were detected. Thus TMP/SMX remains a viable empirical treatment for women with UCA- UTI in these populations. Molecular typing of Escherichia coli causing CA-UTI revealed that the prevalence of antimicrobial resistance was influenced by a small number of Escherichia coli clonal groups. This suggests that the prevalence of antimicrobial resistant UTI in a community is not only the result of community prescribing practices and individual antimicrobial use but can be significantly impacted by the introduction and circulation of strains of uropathogens that are already drug resistant. Thus, strategies developed to maintain the usefulness of empirical treatment options for CA-UTI must include interventions that target sources of antimicrobial resistant uropathogens.
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Stackleather, Bronwyn K. "Improving catheter-associated urinary tract infections through improved nursing education." Thesis, California State University, Long Beach, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=1528050.
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The changes in health care over the past decade have caused hospitals across the nation to focus on improving quality outcomes for the patients they serve. One of the most preventable hospital-acquired infections is catheter-associated urinary tract infections (CAUTIs). Nursing’s role in the prevention of CAUTI spans patients’ entire hospital stay, and quality education to nursing staff is essential for sustained reduction efforts.
The project’s purpose was to evaluate the content and design of the nursing curriculum on CAUTI reduction given to nurses in a pediatric intensive care unit at one healthcare institution. A process evaluation showed that the curriculum had several key strengths and weaknesses and could be improved through application of Knowles’s adult theory of learning. Management and the clinical leadership team could improve patient outcomes by building nursing curriculum with a greater focus on learners’ needs, an understanding of what motivates learners, and more involvement of the nursing staff.
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Collins, Linda. "Specimen collection technique and standards for diagnosing urinary tract infections." Thesis, University of Southampton, 2016. https://eprints.soton.ac.uk/414108/.
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A urinary tract infection (UTI) is one of the leading reasons for treatment in primary healthcare. It is estimated that 50% of the female population in the UK will have least one occurrence of the infection in their lifetime. It is a debilitating condition and causes a variety of lower urinary tract symptoms (LUTS). The recommended practice for detecting a UTI is by analysing a urine specimen and culturing the sample for bacterial growth and antibiotic sensitivities. There are two main specimen collection methods: the midstream urine (MSU) and the catheter specimen of urine (CSU). The CSU is recognised as the gold standard, but requires an invasive procedure. The MSU which is the non-invasive clinical standard is regarded as insufficient because the method is frequently reported as contaminated with skin and vaginal flora, but the definitions of contamination in the literature varies. Drawing on the published body of knowledge, this study aimed to investigate and determine what constitutes contamination using microbiological culturing and the uroplakin-3 cell staining technique that detects the presence of cells that originate from the bladder. A two phase, single blind, cross over design study was conducted, comparing four different urine specimen collection methods. Experiment one tested the hypothesis that a MSU has equal merits to a CSU when capturing urothelial cells that are indicative of a UTI. A total of 60 patients and 30 controls were recruited into the study. The MSU specimens were compared with the CSU specimens to determine urinary cell origin using uroplakin-3 staining. The findings proved that the cells found in the MSU were not contaminants as commonly assumed, but were inflammatory markers of infection invading the lower urinary tract. Experiment two tested the hypothesis that if a MSU has equal merits to a CSU, then a directly voided urine specimen (natural urination) will be the optimal method when capturing the majority of urothelial cells that have been exfoliated from the bladder. A total of 31 patients were recruited and the MSU specimens were compared with the directly voided urine to determine the proportion of cells that originate from the bladder. The findings demonstrated that the directly voided urine was the optimal method and had the ability to capture predominant urothelial cells. A qualitative study of patient views and experiences of urine specimen collection was conducted. Thirty patients were interviewed and the data were analysed for recurrent themes. The study had shown an ideal urine specimen is that which is sensitive to the underlying pathology of a UTI. It is also a urine specimen that is easy to collect. The direct void is the recommended method of choice but should be accompanied with microscopy. Uroplakin staining should be initiated to further detect the positive presence of uroepithelial cells when distinguishing the difference between urinary contamination.
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Jayanth, Aiden Matthew. "Experimental studies on the microbiota associated with urinary tract infections." Thesis, University of Essex, 2017. http://repository.essex.ac.uk/20191/.
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Urinary tract infections (UTIs) are one of the most common healthcare associated infections (HCAIs) accounting for 17.2% of the total HCAI’s in England. Some of the underlying issues associated with UTIs include recurrent infections, catheter associated UTIs and antibiotic resistance. These issues are responsible for prolonged hospital admissions, increased costs and significant morbidity. Another possible issue relates to the ubiquitous protozoa, Acanthamoeba. Although it is known to cause infections in humans, the amoeba has been isolated from apparently healthy people. Furthermore, Acanthamoeba is known to have an endosymbiotic relationship with bacteria. Therefore, it is reasonable to hypothesise that Acanthamoeba may possibly play an important role in UTIs. Clinical isolates of E. coli, K. pneumoniae and P. mirabilis were used in the current study. All uropathogens exhibited the ability to form biofilms in a nutrient dependent manner and complete the biofilm cycle within 24h. They also displayed the ability to form intracellular bacterial communities in urothelial cells and induce significant cytotoxicity. Moreover, they were able to associate, invade and survive within Acanthamoeba castellanii (T4). Furthermore, 200 urine samples from patients suspected of UTIs were collected from Colchester University Hospital NHS Trust and analysed for the presence of Acanthamoeba. Nineteen samples were positive for Acanthamoeba spp. (unclassified) and two samples for A. castellanii supporting our hypothesis that the amoeba possibly plays a role in UTIs. This is the first study in the UK to have confirmed the presence of Acanthamoeba in urine. This study also investigated the antimicrobial efficacy of cetylpyridinium chloride (CPC). CPC coated latex catheters were able to prevent biofilm formation at very low concentrations. This finding provides promising evidence for the potential application of CPC impregnated catheters in preventing CAUTIs. In conclusion, the findings from this study can be used to develop targeted interventions aimed at the underlying issues associated with UTIs.
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Fasugba, Oyebola. "Antimicrobial resistance in urinary tract infections caused by Escherichia coli." Thesis, Australian Catholic University, 2017. https://acuresearchbank.acu.edu.au/download/67ce6b272ae23ebc1ea1e8727d748f9cc7a61a59c3d5c0c98d2d1d0350c55a51/5885672/Fasugba_2017_Antimicrobial_resistance_in_urinary_tract_infections.pdf.
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Urinary tract infections (UTI) are one of the most common bacterial infections in hospital and community settings requiring antimicrobial treatment. Escherichia coli (E. coli), a bacterium frequently implicated in UTI, is becoming increasingly resistant to antimicrobials. Antimicrobial resistance (AMR) reduces the effectiveness of antimicrobial agents, leading to difficulty in treatment of patients, with the potential to prolong the duration of illness and increase mortality in patients. To date in Australia, there is a paucity of data comparing resistance patterns over time for hospital- and community-acquired E. coli UTI with no published data on incidence and risk of urinary E. coli resistance in Australia. Ciprofloxacin, a high priority critically important antimicrobial, is not recommended for empirical therapy of UTI yet resistance to this antimicrobial agent is increasing. There are no systematic reviews of studies investigating ciprofloxacin resistance in hospital- and community-acquired E. coli UTI. Therefore, the research program sought to address these knowledge gaps in three separate but interrelated studies. The research described in this thesis is the first of its kind in Australia.
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Hamilton, Elva. "Nurse-Driven Protocol to Reduce Catheter Associated Urinary Tract Infections." NSUWorks, 2018. https://nsuworks.nova.edu/hpd_con_stuetd/33.
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Background: Catheter-associated urinary tract infections (CAUTIs) are a major source of avoidable hospital-acquired infections. The scientific evidence supports utilization of nurse-driven protocols to reduce CAUTIs.
Purpose: The purpose of this quality improvement project was to update and implement an evidence-based CAUTI prevention protocol for the nursing staff on a medical-surgical unit in an adult acute care hospital to decrease the utilization of indwelling urinary catheters and CAUTIs.
Theoretical Framework: Donabedian’s structures, processes, and outcomes (SPO) model was utilized as the framework for this project. Donabedian’s SPO model focuses on strong healthcare structures and processes to improve nurse, patient, and organizational outcomes.
Methods: This project utilized a quantitative design. A convenience sample of 28 nurses from the medical-surgical unit of a South Florida hospital participated in the project. An educational intervention was delivered on CAUTI prevention based on guidelines from regulatory agencies, and the hospital existing protocol was updated and revised to reflect the guidelines. The sample was administered a short demographic survey, and 10-item pretests and posttests on CAUTI prevention before and after implementation of the standardized evidence-based protocol. To determine possible differences in nurses’ knowledge and perceptions of indwelling urinary catheters before and after the implementation, paired t tests were conducted. To determine if the proportions of days with urinary catheters were statistically significantly different 30 days before and after implementation of the standardized evidence-based guideline, a 2-proportion z-test was conducted.
Results: On analysis of the pretests and posttests, a statistically significant difference was found in 6 of the 10 questions, indicating that nurses’ knowledge and perceptions of CAUTIs improved after the intervention (p < .001 to p < .043). After the intervention, urinary catheter days relative to patient days also decreased significantly (z = 5.562, p < 0.001).
Conclusion: Implementation of an evidence-based nurse-driven protocol in a hospital in South Florida improved nurses’ knowledge and perceptions of CAUTI prevention. Nursing practice and healthcare delivery can benefit from development of such guidelines and educational interventions to empower nurses to better manage patients’ indwelling urinary catheters, and decrease the incidence of CAUTIs in hospitals.
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Wong, Hei-man. "Evidence-based preventive care of CAUTI for hospitalized adult patients." Click to view the E-thesis via HKUTO, 2009. http://sunzi.lib.hku.hk/hkuto/record/B43251638.
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Salo, J. (Jarmo). "Long-term consequences and prevention of urinary tract infections in childhood." Doctoral thesis, Oulun yliopisto, 2012. http://urn.fi/urn:isbn:9789514298707.
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Abstract Urinary tract infections (UTIs) are among the most common bacterial infections in childhood and have a tendency to recur. The ability of uropathogens to form biofilm may be important in the pathogenesis of UTI. Although childhood UTIs are thought to increase the risk of chronic kidney disease (CKD), evidence showing this association is scarce. Cranberry juice has been shown to prevent UTIs in women, but evidence of its efficacy in children is lacking. The aim of this work was to evaluate the significance of biofilm formation for the clinical presentation of UTI, the long-term consequences of UTI in childhood and the efficacy, safety and acceptability of cranberry juice in the prevention of UTIs in children. The formation of biofilm in clinical samples was assessed in vitro with optical density measurements and verified by scanning electron microscopy and confocal scanning laser microscopy. A systematic literature search on the association between childhood UTIs and CKD was conducted, and data on patients with CKD treated or monitored at Oulu University Hospital were reviewed. The efficacy of cranberry juice in preventing recurrences of UTIs in children and its effects on the normal flora were evaluated with two randomized controlled trials. About one third of the uropathogenic E. coli strains were capable of forming biofilm, and the strains isolated from patients having pyelonephritis formed biofilm better than those from cystitis cases. We did not find any cases among the 1576 reviewed in the literature search or the 366 in our patient series who had structurally normal kidneys in their first kidney imaging and in whom childhood UTIs could have been the cause of subsequent CKD. The aetiological fraction of childhood UTIs as a cause of CKD was at most 0.3%. The administering of cranberry juice did not reduce the number of children who experienced a recurrence of UTI, but it did reduce the number of recurrences per person year at risk by 39% (0.25 vs. 0.41 episodes, 95% CI for difference -0.31 to -0.01) and the number of days on antimicrobials per patient year by 34% (11.6 vs. 17.6 days, 95% CI for difference -7 to -5). Cranberry juice was well accepted and tolerated by the children and did not cause harmful changes in the normal flora. The ability of bacteria to persist and grow in a biofilm seems to be one of the significant factors in the pathogenesis of UTIs. A child with normal kidneys is not at risk of developing CKD because of UTIs in childhood, so that imaging procedures after the first UTI can be focused on finding severe urinary tract abnormalities. Taking into account the relatively innocent nature of childhood UTIs, cranberry juice offers an alternative to antimicrobials for preventing UTIs in children. The mechanism of action of cranberry juice may be associated with biofilm formation by uropathogensTiivistelmä Virtsatieinfektio (VTI) on yksi tavallisimpia lasten bakteeri-infektioita, ja sillä on taipumus uusiutua. Bakteerien biofilminmuodostuskyky voi olla merkittävä tekijä VTI:n synnyssä. Lapsuudessa sairastetun VTI:n ajatellaan lisäävän kroonisen munuaisten vajaatoiminnan riskiä, mikä ei kuitenkaan perustu tieteelliseen näyttöön. Karpalomehu ehkäisee aikuisten naisten VTI:n uusiutumisia, mutta sen tehoa lapsilla ei tiedetä. Tämän väitöskirjatyön tavoitteena oli selvittää bakteerien biofilminmuodostuskyvyn yhteyttä VTI:n kliiniseen kuvaan, lapsuudessa sairastetun VTI:n pitkäaikaisvaikutuksia sekä karpalomehun tehoa, turvallisuutta ja käyttökelpoisuutta lasten VTI:n ehkäisyssä. Kliinisistä virtsanäytteistä viljeltyjen E. coli –kantojen muodostama biofilmi mitattiin optisen tiheyden perusteella, ja elävien biofilmirakenteiden muodostuminen varmistettiin elektronimikroskooppi- ja konfokaalimikroskooppikuvauksilla. Lapsena sairastetun VTI:n yhteyttä munuaisten vajaatoimintaan tutkittiin systemaattisella kirjallisuuskatsauksella ja selvittämällä OYS:ssa munuaisten vajaatoiminnan vuoksi hoidossa olevien potilaiden munuaissairauden etiologia. Karpalomehun tehoa, turvallisuutta ja käyttökelpoisuutta lasten VTI:n ehkäisyssä selvitettiin kahdella lumekontrolloidulla tutkimuksella. Kolmasosa E. coli –kannoista muodosti biofilmiä, ja pyelonefriittipotilailta eristetyt kannat olivat parempia biofilminmuodostajia kuin kystiittipotilailta eristetyt. Kirjallisuuskatsauksen 1576:n ja OYS:n 366:n tapauksen joukossa ei ollut potilaita, joilla olisi ollut ensimmäisessä kuvantamistutkimuksessa rakenteeltaan normaalit munuaiset ja lapsuuden VTI:t olisivat johtaneet munuaisten vajaatoimintaan. Lapsuuden VTI:n etiologinen fraktio munuaisten vajaatoiminnan syynä oli teoriassakin korkeintaan 0.3 %. Karpalomehu ei vähentänyt uusintainfektion saaneiden lasten määrää, mutta se vähensi uusintaepisodeja 39 % riskiaikaa kohti (0,25/vuosi vs. 0,41/vuosi) ja antibioottipäiviä 34 % potilasvuotta kohti (11,6 vs. 17,6 päivää). Lapset joivat karpalomehua mielellään, eikä sillä ollut haitallisia vaikutuksia normaaliflooraan. Aiheuttajabakteerien biofilminmuodostuskyky vaikuttaa olevan merkittävä tekijä VTI:n patogeneesissä. Lapsi, jolla on rakenteellisesti normaalit munuaiset, ei ole lapsuuden VTI:n vuoksi riskissä sairastua munuaisten vajaatoimintaan. Siten ensimmäisen VTI:n jälkeiset kuvantamistutkimukset voidaan suunnata toteamaan vaikeat rakenteelliset poikkeavuudet. Koska lapsuuden VTI on suhteellisen vaaraton sairaus, karpalomehu on hyvä vaihtoehto VTI:n ehkäisyyn myös lapsilla. Biofilminmuodostuksen esto on sen yksi mahdollinen vaikutusmekanismi
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Lo, Joey Chor Yee. "Novel antimicrobial peptide coating to prevent catheter-associated urinary tract infections." Thesis, University of British Columbia, 2015. http://hdl.handle.net/2429/56262.
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Introduction: Urinary catheters provide ideal surfaces for bacterial biofilm formation, being a major factor for hospital-acquired infections. With increased antibiotic resistance, there is a push for non-antibiotic-based measures to prevent catheter-associated urinary tract infections (CAUTI). I pursue the use of polymer-linked, broad-spectrum, host-defense-based antimicrobial peptides (AMPs) as novel catheter coatings. Here, I present the efficacy of tethered AMPs against common uropathogens both in vitro and in vivo.
Materials and Methods: Peptides E6, Tet20, Tet26, and Kai13 were linked to surfaces using polymer brushes PDMA, PMPC, and PMPDSAH. All peptides were chosen based on their antimicrobial activity and biocompatibility as suggested by previously published papers. Antimicrobial activity of each coating was determined in vitro via colony counts 6 hours post-exposure to uropathogens. The in vivo efficacy of AMP coatings was also tested using a clinically relevant CAUTI mouse model; bladders of mice were catheterized percutaneously under ultrasound guidance, and 50 μL of 5E+5 CFU/mL P. aeruginosa was instilled. Indwelling polyurethane catheters and urine were collected after 7 days for examination of bacterial adherence and growth.
Results: The most effective peptide-brush combination was E6-PDMA, decreasing bacterial adhesion and planktonic growth by up to 94.1% and 63.8%, respectively based on in vitro data. In vivo results look even more promising; the coating decreased bacterial adhesion by up to 99.9958% and planktonic growth by 99.8660% in comparison to untreated mice.
Conclusions: Based on our in vitro and in vivo data, E6-PDMA coatings may effectively prevent CAUTI. Further testing of these novel coatings against more common uropathogens as well as tests to confirm the safety of such coatings will be important.Medicine, Faculty of
Medicine, Department of
Experimental Medicine, Division of
Graduate
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Vincent, Caroline. "Food reservoir for «Escherichia coli» causing community- acquired urinary tract infections." Thesis, McGill University, 2010. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=95200.
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Closely related strains of Escherichia coli have been shown to cause extraintestinal infections in unrelated persons. This study tests whether a food reservoir may exist for these E. coli. Isolates from three sources collected over the same time period and geographic area were compared. The sources comprised E. coli isolates from women with urinary tract infection (UTI) (n = 353); retail meat (n = 417); and restaurant/ready-to-eat foods (n = 74). E. coli were evaluated for antimicrobial susceptibility and O:H serotype and compared by using six different genotyping methods. We identified 17 clonal groups that contained E. coli isolates (n = 72) from more than one source. E. coli from retail chicken (O25:H4-ST131 and O114:H4-ST117) and honeydew melon (O2:H7-ST95) were indistinguishable from or closely related to E. coli from human UTIs. This study provides strong support for the role of food reservoirs in the dissemination of E. coli causing community-acquired UTIs.Il a été démontré que des souches de Escherichia coli étroitement reliées causaient des infections extraintestinales chez des personnes non-reliées. Cette étude teste l'hypothèse selon laquelle il existerait un réservoir alimentaire pour ces souches d'E. coli. Des isolats provenant de trois sources différentes et récoltés durant les mêmes périodes et régions géographiques ont été comparés. Les sources incluaient des isolats d'E. coli provenant de femmes soufrant d'infection urinaire (IU) (n=353); de viande vendue au détail (n = 417); et d'aliments de restauration/prêts-à-manger (n =74). Les E. coli ont été évalués pour leur susceptibilité aux agents antimicrobiens et leur sérotype O:H, et ont été comparés par l'intermédiaire de six différentes méthodes de génotypage. Nous avons identifié 17 groupes clonaux contenant des isolats d'E. coli (n = 72) provenant de plus d'une source. Des E. coli provenant de viande de poulet (O25:H4-ST131 et O114:H4-ST117) et de melon au miel (O2:H7-ST95) étaient indistinguables ou étroitement reliés à des E. coli provenant d'IUs. Cette étude supporte fortement le rôle des réservoirs alimentaires dans la dissémination du E. coli causant des IUs acquises dans la communauté.
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Bezruk, Т. О., and V. V. Bezruk. "Etiological structure and antimicrobial resistance in pathogens causing urinary tract infections." Thesis, Sumy State University, 2016. http://essuir.sumdu.edu.ua/handle/123456789/47823.
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There is an increase of the number of patients with urinary tract infections in Ukraine. The objective is the definition of the range of sensitivity to the antibiotics of major groups of pathogens of the urinary system among the population of the Chernivtsi region. In order to conduct an accurate bacteriological study 2828 urine samples of patients of medical institutions in the Chernivtsi region were analyzed during 2009 – 2013. Our aim was the verification of the diagnosis «urinary tract infections» (UTI).
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García, Bonillo María Cristina. "Nanostructured silver-based bacteriophobic surfaces against catheter-associated urinary tract infections." Doctoral thesis, Universitat Ramon Llull, 2021. http://hdl.handle.net/10803/671912.
Full textAbstract:
En aquesta tesi s’ha desenvolupat un catèter urinari tipus Foley bacteriofòbic. L’efecte bacteriofòbic es basa en un recobriment superhidrofòbic micro- i nanostructurat amb una topografia específica, recobert per una pel·lícula de plata metàl·lica homogènia, que crea un ambient incòmode per a les bactèries, evitant l’adhesió bacteriana a la superfície, però sense provocar cap efecte sobre el creixement bacterià.
Per aconseguir-ho, s’ha generat un conjunt de recobriments nanoestructurats superhidrofòbics basats en diferents polímers. S'han utilitzat com a polímers base el metacrilat de pentafluorofenil polimeritzat per plasma (pp-PFM) i la polidopamina (PDA), recoberts amb una fina pel·lícula de plata metàl·lica. Tots ells van a mostrar una reducció en l’adhesió bacteriana d’entre 4 i 6 ordres de magnitud respecte a PDMS sense recobriment, així com la capacitat de repel·lir l’adhesió de proteïnes en assajos in vitro.
El recobriment basat en PDA-plata va ser seleccionat per implementar-lo en el catèter urinari. Aquest catèter urinari ha demostrat mantenir l’efecte bacteriofòbic durant 30 dies in vitro, provat amb assajos d’ús simulat en condicions de fluix i estàtiques, utilitzant soques bacterianes uropatògeniques i aïllats clínics. A més, el catèter ha estat validat in vivo mitjançant porcs cateteritzats durant 15 dies. Durant aquest període, el catèter ha pogut mantenir l’adhesió bacteriana 2 ordres de magnitud per debat dels catèters estàndard comercials i els antimicrobiansEn esta tesis se ha desarrollado un catéter urinario tipo Foley bacteriofóbico. El efecto bacteriofóbico se basa en un recubrimiento super-hidrofóbico micro- y nanostructurado con una topografía específica, recubierto por una película de plata metálica homogénea, que crea un ambiente incómodo para las bacterias, evitando la adhesión bacteriana a la superficie, pero sin provocar ningún efecto sobre el crecimiento bacteriano. Para conseguirlo, se ha generado un conjunto de recubrimientos nanoestructurados super-hidrofóbicos basados en diferentes polímeros. Se han utilizado como polímeros base el metacrilato de pentafluorofenilo polimerizado por plasma (pp-PFM) y la polidopamina (PDA), recubiertos con una fina película de plata metálica. Todos ellos mostraron una reducción en la adhesión bacteriana de entre 4 y 6 órdenes de magnitud con respecto al PDMS sin recubrir, así como la capacidad de repeler la adhesión de proteínas en ensayos in vitro. El recubrimiento basado en PDA-plata fue seleccionado para ser implementarlo en el catéter urinario. Este catéter urinario ha demostrado mantener el efecto bacteriofóbico durante 30 días in vitro, probado con ensayos de uso simulado en condiciones de flujo y estáticas, utilizando cepas bacterianas uropatógenas y aislados clínicos. Además, el catéter ha sido validado in vivo utilizando cerdos cateterizados como modelo animal durante 15 días. Durante este período, el catéter ha podido mantener la adhesión bacteriana 2 órdenes de magnitud por debajo de los catéteres estándar comerciales y los antimicrobianos.
In this thesis, a bacteriophobic urinary Foley catheter has been developed. The bacteriophobic effect is based on a homogeneous super-hydrophobic coating with a specific micro- and nanostructure covered by a homogeneous metallic silver film, which create an uncomfortable environment for bacteria, avoiding bacterial attachment to the surface but without causing any effect on bacterial growth. To achieve this, a set of super-hydrophobic nanostructured coatings based on different polymers has been developed. Plasma-polymerized pentafluorophenyl methacrylate (pp-PFM) and Polydopamine (PDA) have been used as base polymers, being coated with a thin film of metallic silver. All of them showed a reduction in bacterial adhesion between 4 and 6 orders of magnitude regarding the uncoated PDMS, as well as the ability to repel protein adhesion in in vitro tests. The PDA-silver coating was selected to be implemented on the urinary catheter. This urinary catheter has been shown to maintain the bacteriophobic effect for 30 days in vitro, tested with simulation-use tests in flow and static conditions, using uropathogenic bacterial strains and clinical isolates. Moreover, the catheter has been validated in vivo using catheterized pigs as animal model for 15 days. During this period, the catheter has been able to maintain bacterial adhesion 2 orders of magnitude lower than commercial standard or antimicrobial catheters.
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Wright, Marshanell. "Decreasing Catheter-Associated Urinary Tract Infections in the Acute Care Setting." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6707.
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The most important risk factor for developing a catheter-associated urinary tract infection (CAUTI) is the prolonged use of the urinary catheter. To address the CAUTI rate at the project site, which was higher than the national benchmark, a team of healthcare practice leaders developed an evidence-based algorithm addressing the appropriate indications for inserting or discontinuing a patient's Foley catheter. Using the plan-do-study-act model, the purpose of this quality improvement evaluation project was to evaluate the effectiveness of the evidence-based Foley algorithm for decreasing the use of Foley catheters and reducing the CAUTI rate and to explore whether using the Foley algorithm shift assessment tool would reduce the incidence of Foley catheter utilization. Data were compared on the rate of CAUTI and Foley catheter use over 4 months before and 4 months after implementation of the algorithm. There was a statistically significant decrease in the Foley utilization rate after implementing the Foley algorithm; the overall CAUTI rate did not decrease. The outcome of this quality improvement evaluation project could produce social change by highlighting the need for consistent application of the algorithm. In addition, reducing the rate of Foley catheter usage could decrease the incidence of CAUTIs, reduce hospital costs, and improve overall patient health during hospitalization.
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Chen, Ming. "Renal cell death in urinary tract infections : role of E. coli toxins /." Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-166-0/.
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André, Malin. "Rules of thumb and management of common infections in general practice /." Linköping : Univ, 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-5183.
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Chu, Pui-shan, and 朱佩珊. "Antimicrobial resistant escherichia coli and sequence type 131 in urinary tract infections." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/206499.
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Background
A pandemic clone, Escherichia coli sequence type 131 (ST131), has been disseminated worldwide and represents an important cause of antimicrobial resistant infections. The spread of this resistant clone has become a great public health concern.
Objectives
The aims of this study were to investigate the prevalence of ST131 in Escherichia coli isolates from human urinary cultures in Hong Kong and study the antimicrobial phenotypes of ST131.
Methodology
This study included 340 E. coli clinical urinary isolates obtained from patients in four district hospitals between May 2013 and July 2013 in Hong Kong. Antimicrobial susceptibilities were assessed by disk diffusion method with reference to CLSI. The isolates were investigated by phylogroup-specific and ST131-specific PCR assays. ST131 strains were further assessed for subclone distribution, antimicrobial resistance and extended-spectrum β-lactamase (ESBL) type.
Results
A total of 18.5% (63/340) of the E. coli population was identified as ST131. ST131 isolates were significantly more likely than non-ST131 isolates to be ciprofloxacin resistant (69.8%, 44/63 versus 31.0%, 86/277; P <0.001), gentamicin resistant (38.1%, 24/63 versus 24.9%, 69/277; P=0.03) and ESBL producers (41.3%, 26/63 versus 18.8%, 52/277; P <0.001). Among the ST131 E. coli isolates, 68.3% (43/63) belonged to the H30 subclone. Most H30 isolates were ST131-O25b (97.7%, 42/43). Also, the ST131-H30 E. coli subclone was statistically associated with ciprofloxacin resistance compared with the non-H30 ST131 isolates (P <0.001). Additionally, strains which were co-resistant to ciprofloxacin, co-trimoxazole and gentamicin were overwhelmingly associated with the H30 subclone than non-H30 (23.3%, 10/43 versus 0%, 0/20; P=0.02).
Conclusion
This study showed that ST131 isolates were widespread among human E. coli urinary isolates in Hong Kong. The increase in antimicrobial resistance phenotypes are highlighted with ST131, especially the H30 subclone isolates. The dissemination of the ST131 resistant clonal group has aroused clinical attention and limited the choice of empirical treatment.published_or_final_version
Medical Sciences
Master
Master of Medical Sciences
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Raja, Farah. "Development and characterisation of novel antimicrobial phosphate glasses for urinary tract infections." Thesis, Aston University, 2018. http://publications.aston.ac.uk/37661/.
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Urinary tract infections (UTIs) affect significant proportions of the population, particularly prevalent in elderly patients. Up to 40 % of healthcare associated infections are UTIs and 80% of those are associated with catheter use. CA-UTIs significantly effect patient’s health and are frequently associated with substantial morbidity and mortality. Furthermore, the financial implications are enormous as the high complication rate arising from catheterisation requires significant time and cost. In the UK, more than a million cases are reported each year accounting for annual economic burden of approximately £125 million. The aim of this study was to develop novel antimicrobial bioactive glasses that can be used to prevent and treat catheter associated urinary tract infections. This was achieved by assessing the antimicrobial efficacy of increasing cobalt or zinc content (1, 3, 5 and 10 mol %) in phosphate based glass system (P2O5-Na2O-CaO). Glass compositions with two metal oxides (cobalt, copper or zinc) were also studied to determine synergistic combinations against a panel of clinically relevant microorganisms. A decrease in the dissolution rates of cobalt glasses was seen with increasing cobalt content, however an increase in dissolution rate was observed with higher zinc content (5% and 10%). A strong antimicrobial activity was exhibited by 5 and 10 mol % cobalt or zinc doped glasses which was not only time dependent but also strain specific. Moreover, combinations such as Co/Cu, Co/Zn and Cu/Zn showed synergism against E. coli and S. aureus. Whilst a strong antimicrobial activity was seen, the cytotoxic studies demonstrated decrease in cell viability of mammalian cells when exposed to glasses directly and their dissolution products. Nevertheless, cobalt and/or zinc doped phosphate based glasses could potentially be used as a cartridge in drainage bags or to coat catheters with a decreasing amount to prevent cytotoxic effects.
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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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Horvath, Dennis John Jr. "The Impact of Phagocyte-UPEC Interactions Upon Pathogenesis of Urinary Tract Infections." The Ohio State University, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=osu1316282102.
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Bagnola, Emily Bagnola. "URINARY TRACT INFECTIONS IN A LONG-TERM CARE FACILITY: A PREVALENCE STUDY." Kent State University Honors College / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=ksuhonors1533662283119186.
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Manikam, Logan Nishant. "Respiratory tract infections in children with Down's Syndrome." Thesis, University College London (University of London), 2018. http://discovery.ucl.ac.uk/1561679/.
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BACKGROUND: Children with Down’s Syndrome (DS) are prone to respiratory tract infections (RTIs), yet there is little evidence to guide clinical practice. AIMS: For children with and without DS, this thesis aims to use routinely collected data to identify RTI-related healthcare utilisation, those most at risk of RTI-related healthcare utilisation, and the effects of antibiotics in preventing RTI-related hospitalisation. METHODS: A systematic review of existing interventions and a retrospective cohort study based on routinely collected primary and secondary care data (CALIBER). KEY FINDINGS: The CALIBER cohort comprised 992 children with DS and 4874 controls. Children with DS consulted their GP for RTIs twice as often as controls, were prescribed antibiotics twice as often, and were hospitalized six times as often. In children with DS, younger age, congenital heart disease and asthma were risk factors for RTI-related healthcare utilisation. Using multivariate analysis, this study found that for infants with DS, the prescription of antibiotics significantly reduced subsequent RTI-related hospitalisation - the number needed to treat is 11.9. Separate analysis, inverse probability of treatment weighting, found that the protective effect for infants with DS was not significant. When prescriptions were analysed by type of RTI, the prescription of antibiotics for upper RTIs did not reduce the risk of hospitalization for children with DS or controls. This was also the case for lower RTIs, although with a small sample. CONCLUSION: For children with DS over the age of one presenting with RTIs to primary care, antibiotic treatment does not prevent subsequent RTI-related hospitalisation. There is conflicting evidence from two separate analysis methods as to whether treating infants with DS with antibiotics prevents RTI-related hospitalisation, so further research is recommended. Further prescribing strategies (i.e. rescue antibiotics) should be explored to broaden the evidence base for this at-risk group.
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Mann, Mary Ann. "The efficacy of short term amoxicillin therapy and the effect of furosemide on conventional antibiotic therapy in experimentally induced bacterial lower urinary tract infection in cats." Thesis, Virginia Tech, 1991. http://hdl.handle.net/10919/41701.
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The efficacy of short term (3 day) oral amoxicillin therapy was compared to conventional (14 day) oral therapy in an experimental model of bacterial lower urinary tract infection (UTI) in the cat. Chemical cystitis was induced using an infusion solution of salicylic acid, 70% ethanol, and normal saline via transabdominal cystocentesis. Cats were challenged with a Staphylococcus intermedius inoculum twenty-four hours later introduced via urethral catheterization. Serial quantitative aerobic bacterial urine cultures obtained via cystocentesis were used to evaluate groups of cats.
Eighteen adult cats (9 males and 9 females) were divided into 3 groups of 6 cats (3 males and 3 females): Group I = conventional amoxicillin therapy (14 day), Group II = control group (no treatment), and Group III = short term therapy (3 day). Results indicated the conventional therapy successfully eradicated infection, however, the short term therapy did not eradicate infection when compared to controls. During the study period the diuretic furosemide was used in some cats to facilitate cystocentesis procedures. Those cats were observed to exhibit less stranguria, which is a common sign of lower UTI.
The second study evolved from observations made in the first study and evaluated the effect of furosemide on conventional antibiotic therapy in an experimental model of bacterial lower UTI in the cat. A similar experimental design was utilized with Group I = control group (no treatment), Group II = oral furosemide (14 day), and Group III = oral furosemide and oral amoxicillin (14 day). Statistical analysis failed to demonstrate the efficacy of the furosemide and amoxicillin combination, but showed furosemide alone was not an appropriate therapy when compared to controls. It was again observed that those cats receiving furosemide showed fewer secondary signs of lower UTI such as stranguria which suggests a possible role for furosemide as adjunct therapy in the treatment of lower UTI in the cat.Master of Science
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黃曦汶 and Hei-man Wong. "Evidence-based preventive care of CAUTI for hospitalized adult patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B43251638.
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Acharya, Dhruba. "Bacterial Flagella as Triggers of the Innate Immune System and IL-10 Production During Acute Urinary Tract Infection." Thesis, Griffith University, 2020. http://hdl.handle.net/10072/391068.
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Urinary Tract Infections (UTIs) are a huge public health problem affecting 150 million people each year worldwide. Expenditures aimed at the management of UTI account for approximately $3.5 billion USD in medical costs annually. More than 80% of all UTIs are caused by uropathogenic Escherichia coli (UPEC). Studies have shown key roles for virulence factors of UPEC, such as flagella, autotransporters, capsule, fimbriae, toxins, lipopolysaccharide (LPS), and siderophores, in UTI disease pathogenesis. UPEC flagella contribute to the pathogenesis of UTI in several ways, such as through flagella-mediated motility, colonization, adhesion, and biofilm formation. The flagella filament is synthesized as a polymerized product of >20,000 protein monomers termed flagellin or FliC (encoded by the gene fliC). The contribution of flagella to innate immune stimulation is only partially defined, for example gaps exist in our understanding of how flagella engage host responses in the bladder during acute UTI. Extracellular FliC is recognized by Toll-Like Receptor 5 (TLR5), whereas intracellular FliC is recognized by Naip5 and Ipaf. Through MyD88-dependent and independent pathways, FliC causes upregulation of various proinflammatory, regulatory cytokines, and growth factors. A detailed understanding of how FliC from UPEC engages innate immunity in the bladder during UTI is lacking. A major focus of this thesis was the regulatory cytokine, IL-10. IL-10 plays pleiotropic roles in defence against infection; depending on the illness and the causal pathogen. Frequently, IL-10 facilitates immune suppression to moderate inflammatory mechanisms that can damage the host. IL-10 is rapidly produced in the bladder in response to UPEC early during UTI. However, the mechanism of engagement of innate immunity by UPEC that leads to elicitation of IL-10 in the bladder is unknown. One facet in understanding the role of IL-10 in infectious disease is the elucidation of microbial products that elicit production of this key regulator of host innate immune responses. The overarching aim of this thesis was to define the role of flagella (particularly FliC) in immune modulation during acute UTI. A plethora of methods have been previously described for the extraction and purification of FliC. However, there is limited literature utilizing highly purified, non-denatured FliC, offering any insight into host-pathogen interactions. In this study, UPEC CFT073, and a derivative strain containing four mutations in genes encoding fimbriae and pili (CFT073Δ4) were used to generate a deletion in the flagellar filament, fliC. This enabled the concurrent preparation of a suitable carrier control to be applied in downstream assays. The flhDC gene, which regulates flagella biosynthesis, was used in an IPTG inducible plasmid (pMG600) to overexpress flagella. Extraction and purification of FliC to homogeneity was performed using a sequential extraction method based on mechanical shearing, ultracentrifugation, size exclusion chromatography, protein concentration and endotoxin removal. Protein purity and integrity was assessed using SDS-PAGE, western blots with anti-flagellin antisera, and native-PAGE. This study established a new, carefully optimized method to extract and purify FliC from the reference UPEC strain CFT073 to be suitable for immune assays. The biological activity of FliC was assessed by measuring cytokine responses in both mouse macrophages (J774A.1) and human monocytes(U937). Macrophage and monocyte responses to purified FliC included significant levels of several cytokines, including TNF-α, IL-6, IL12, INF-γ, consistent with prior literature reports. This thesis sought to identify the role of the major UPEC flagella filament protein, FliC, in triggering IL-10 synthesis in the bladder. Analysis of IL-10 induction in response to various UPEC CFT073 derivatives and purified FliC showed a role for FliC in the induction of IL-10 in both human and mouse cell cultures. The effect of FliC on other cytokines, chemokines, and growth factors indicated several pro-inflammatory, and cell recruitment/ migratory factors are also shown to be induced by host cells in response to this protein. This study also explored the FliC induced immune responses, including IL-10 induction in the bladder in vivo. ELISA and multiplex assays revealed that FliC, when injected via transurethral catheterization, induced a rapid IL-10 response in the mouse bladder. Characterization of the genome-wide innate immunological context of FliC-induced cytokines in the bladder using RNA-sequencing also identified 1400-gene network of transcriptional and antibacterial defences, that were differently expressed compared to carrier control. Of the FliC-responsive bladder transcriptome, the changes in expression of il10 and other genes were dependent on TLR5, according to the comparative analysis of TLR5-deficient mice (Tlr5-/-). Exploration of the potential of FliC, and its associated innate immune signature in the bladder, revealed a significant benefit for the control of infection in the mice that received purified FliC, prophylactically or therapeutically after transurethral UPEC infection. Collectively, this thesis shows that detection of FliC through TLR5 triggers rapid IL-10 synthesis in the bladder, and FliC therefore represents a potential immune modulator for the treatment or prevention of UTI.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Medical Science
Griffith Health
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Aspevall, Olle. "Diagnosis of urinary tract infections : aspects of quality assurance and communication of concepts /." Stockholm, 2001. http://diss.kib.ki.se/2001/91-628-4899-2/.
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Bella, Sinclair, Wallnäs Felicia, Belin Stella, Olby Erik, and Söderberg Hampus. "A Prediction of Antibiotic Resistance with Regard to Urinary and Respiratory Tract Infections." Thesis, Uppsala universitet, Institutionen för biologisk grundutbildning, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-352287.
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In this project we set out to find when the resistance level against first line antibiotics would reach 20%. This was executed by first defining relevant bacteria and antibiotics for urinary and respiratory tract infections (UTI's, RTI's). The data was collected from the European Center for Disease Control (ECDC) and the Center for Disease Dynamics, Economics & Policy (CDDEP). The data included the level of resistance for specific years for countries in Europe, as well as for the USA. A prediction model was made using the programming language R. A linear model was used to make a five and ten year prediction. The accuracy was tested. The results were then visualized using R and MATLAB. The results show a big variation between different bacteria and antibiotic combinations. For the two E. coli combinations the resistance is already near 20% for many countries and the resistance is increasing. For the three K. pneumoniae combinations the resistance is high in Southern Europe, meaning many countries have reached or are near 20%. For the two P. aeruginosa combinations there is also a higher resistance in Southern Europe but the resistance is decreasing in most countries. The resistance for E. faecalis is also decreasing and is generally very low in all of Europe. For the only RTI relevant combination, S. pneumoniae and penicillins, the resistance is low and many countries except for Sweden show a decrease in resistance. The USA did not have data for the same time span as Europe and was therefore analyzed separately. For many combinations the USA are near the 20% limit. Only for two combinations the USA showed a decrease in resistance level, and for one of those combinations the prediction is too uncertain to make any assumptions about. For the USA there were two more combinations for RTI than for Europe. For the S. pneumoniae and penicillins combination they have, just as most of Europe, a decreasing resistance. The two combinations with Acinetobacter spp. have a high resistance that is increasing. The main challenge during this project was finding relevant data with a long timespan and with high certainty. The data found is based on invasive isolates which means that the disease which the samples are taken from is not known. The timespan and the certainty of the data affected the accuracy of the prediction model and how long period that could be predicted. The prediction model generated 202 predictions that were visualized. An ethical analysis was made concerning both research ethics and general ethics on the topic of antibiotic resistance. This analysis is meant to acknowledge these questions since we believe they are important when discussing antibiotic resistance. The objective of this project turned out to be more difficult to attain than first believed. This was because of the lack of quality data. Even though we cannot give a clear answer when each country will reach a resistance of 20% this report gives a good understanding of how the situation looks for UTI and RTI relevant bacteria.
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Takahashi, Akira. "Molecular epidemiological studies of Escherichia coli isolates obtained from lower urinary tract infections." Kyoto University, 2010. http://hdl.handle.net/2433/120579.
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Alhashash, F. A. "Populations of Escherichia coli in clinical samples of urinary tract infections and bacteraemia." Thesis, Nottingham Trent University, 2015. http://irep.ntu.ac.uk/id/eprint/27939/.
Full textAbstract:
Extraintestinal pathogenic E. coli (ExPEC) strains are the main etiologic agent of urinary tract infections (UTIs). ExPEC strains are also reported to be the most common cause of bacteraemia in the world, which often originate from UTI. The population structure of UTI E. coli strains is well described in the literature with increased prevalence of multidrug resistance driven by extended spectrum β lactamases (ESBLs). ESBL carriage and multidrug resistance of bacteraemia E. coli is on the increase yet little information is available about their population structure. With the aim to define the bacteraemia population structure, E. coli isolated from urine samples and blood cultures were collected from the Nottingham University Hospital NHS trust over a five month period. Isolates were tested for antimicrobial resistance, ESBL and virulence associated gene (VAG) carriage, and were typed by MLST. Significantly higher ESBL driven multidrug resistant strains were observed in the bacteraemia E. coli compared to the UTI isolates with no significant difference in the carriage of VAGs. Our data shows a reduction in population diversity within the bacteraemia isolates compared to the concomitant urine sample population resulting in a small number of dominant sequence types (STs) (ST131, ST73, ST95) which is associated with ESBL conferred multi drug resistance and not specific virulence genes. This suggests that the increased prevalence of ESBL carriage in ExPEC isolates is leading to a selective advantage in a small number of dominant lineages causing bacteraemia in patients. Comparative genome analysis of selected isolates belonging to the dominant ST (ST73) from bacteraemia and UTI was performed to investigate the presence of bacteraemia specific loci that may explain the loss of diversity in bacteraemia. No genomic regions were identified specific for the bacteraemia ST73 isolates other than ESBL carriage. Plasmid profiling of the ESBL positive isolates of this ST73 group from bacteraemia and UTI identified diverse types of plasmids spread between the strains. No specific genomic loci were identified specific for ESBL positive ST73 isolates from bacteraemia and UTI. This concludes that random acquisition of ESBL plasmids by any ST73 E. coli may select for its progression to bacteraemia which is serious and debilitating. Our study provided a comprehensive snapshot of the E.coli population structure from contemporaneous clinical cases of UTI and bacteraemia. The large increase in multi-drug resistance in bacteraemia ExPEC populations compared to co-circulating UTI populations is of clinical concern and represents a challenge in control and treatment of serious extra-intestinal E. coli infections. This provides an important clinical insight into how common E. coli STs could adapt to become dominant bacteraemia agents.
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Carlson, Diana Elizabeth. "Preventing Catheter-Associated Urinary Tract Infections with Education on Using the Catheter Bundle." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7278.
Full textAbstract:
The Centers for Disease Control and Prevention, the Joint Commission, and the Agency for Healthcare Research and Quality recognized the importance of reducing health-care-associated infections (HAIs) and catheter-associated urinary tract infections (CAUTIs) for the safety of all patients. The U.S Department of Health and Human Services has focused on approving a plan to address HAIs in the health care setting with an emphasis on CAUTIs. The purpose of this project was to decrease CAUTI rates on a long-term care and rehab unit by educating staff about using the CAUTI bundle and CAUTI maintenance tool kit. The theoretical framework that guided this project was Knowles's assumption of adult learning. The practice-focused questions addressed the effects of staff education on CAUTI prevention using a CAUTI bundle approach. Pretest and posttest data were collected from all current primary care nursing staff providers at the study site. CAUTI rates were also obtained from the infection prevention and control nurse at the study facility. Implementation of education related to the CAUTI bundle approach led to 2 consecutive months of no CAUTIs in 2019. Findings from the CAUTI project may bring about positive social change by improving patients' quality of life by ensuring they do not develop HAIs. Use of the CAUTI bundle approach may be implemented in long-term care facilities throughout the United States to ensure patients do not acquire HAIs.
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Olatunji, Olatunde. "Education Program for Critical Care Nurses on Preventing Catheter-Associated Urinary Tract Infections." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7888.
Full textAbstract:
Catheter-associated urinary tract infections (CAUTIs) are the most frequently reported hospital-acquired condition, affecting more than 560,000 patients each year. CAUTIs prolong hospital stays and increase health care costs, and they can result in patient morbidity and mortality. Nurses can be empowered by receiving education and knowledge to manage and identify urinary catheters that are not clinically indicated. The purpose of this project was to develop an education program on CAUTI prevention for critical care nurses using the teach-back method. The conceptual framework that guided this project was Knowles's adult learning theory. The theoretical model was based on 4 fundamental assumptions of self-concept development. A total of 32 critical care unit nurses participated in the evaluation of the teach-back method. Demographic data were collected from these 32 participants, and the results of a frequency analysis were obtained. Deidentified CAUTI data were provided by the organization prior to the educational intervention. The postintervention CAUTI rate and increase in nurses' knowledge level were evaluated 1 month after the educational intervention using a 1-sample t test. The finding was statistically significant (p < .001). The incidence of CAUTI was followed, and the outcomes indicated that the overall incidence of CAUTI in these patients was decreased. The education program was effective in improving critical care unit nurses' knowledge of evidence-based practices to prevent CAUTIs. Improving nurses' knowledge to decrease CAUTI rates is a strategy that may be effective in many healthcare settings. This educational intervention may create social change by improving the health of patients and serving as an educational resource for nurses.