# Latest Research on Urinary Tract Infection : September 2021

The epidemiology of urinary tract infection

Urinary tract infections (UTIs) are among the most common bacterial infections acquired in the community and in hospitals. In individuals without anatomical or functional abnormalities, UTIs are generally self limiting, but have a propensity to recur. Uropathogens have specialized characteristics, such as the production of adhesins, siderophores and toxins that enable them to colonize and invade the urinary tract, and are transmitted between individuals both through person-to-person contact and possibly via food or water. Although generally self limiting, treatment of UTIs with antibiotics leads to a more rapid resolution of symptoms and is more likely to clear bacteriuria, but also selects for resistant uropathogens and commensal bacteria and adversely affects the gut and vaginal microbiota. As uropathogens are increasingly becoming resistant to currently available antibiotics, it may be time to explore alternative strategies for managing UTI. [1]

Urinary tract infection

Symptomatic urinary tract infections (UTI) are either uncomplicated or complicated. Uncomplicated infections occur in healthy women in the community and are usually caused by Escherichia coli. Complicated infections are associated with anatomical, functional, or metabolic abnormalities of the urinary tract that disable the natural innate host defences and lead to tissue injury. Patients with symptomatic infections will have >105 bacteria/ml and inflammatory cells in freshly voided urine. A third group is commonly seen whose symptoms may suggest UTI, but in whom there is no objective evidence for infection. Careful history, examination and investigation are important to avoid repeated and unnecessary courses of antibiotics. Infection is determined by bacterial virulence offset by a complex of innate host defences and some acquired immunity. Urine flow and regular and complete bladder emptying are the first priority; any cause of urine stagnation will promote infection. Investigation is, therefore, primarily aimed at ensuring there is no obstruction and that the bladder voids to completion. This is achieved with plain X-ray, ultrasound of kidneys and the bladder after voiding, and urine flow rate. Acute uncomplicated infection does not require more than 3 days antibiotics. Asymptomatic bacteriuria requires treatment only in infants, pregnancy and before urological intervention. For recurrent and complicated infections, it is mandatory to identify the organism and its sensitivity. [2]

Urinary Tract Infection: Self-Reported Incidence and Associated Costs

PURPOSE: To estimate the annual incidence, cumulative probability of presumed urinary tract infection (UTI) by age, and the social costs.
METHODS: Analysis of a random digit dialing survey of 2000 women in the United States.
RESULTS: 10.8 percent (95% CI: 9.4, 12.1%) of women aged 18 and older reported at least one presumed UTI during the past 12 months, with the majority of the cases occurring among women with a history of two or more UTI episodes in their life. We estimate that by age 24, one-third of women will have at least one physician-diagnosed UTI that was treated with prescription medication. Overall, an estimated 11.3 million women in the United States had at least one presumed UTI treated with antibiotics in 1995. We estimate the annual cost of UTI cases with prescriptions to be $1.6 billion in 1995. If the costs occurring after 1995 are discounted at 5% annually, the total cost over 20 years has a present value of$25.5 billion.
CONCLUSION: If a vaccine were developed that would prevent either initial or recurrent UTI the net benefits to society would be substantial, even at a developmental cost of one billion dollars. [3]

Distribution and Antibiotic Susceptibility Pattern of Bacterial Pathogens Causing Urinary Tract Infection in Mubi General Hospital, Yola-Nigeria

Aims: This study was conducted to determine the distribution and antimicrobial susceptibility of uropathogens among patients attending Mubi general hospital as well as to determine the effect of gender on the etiology of bacterial uropathogens.
Study Design: Distributions of urinary isolates and their antibiogram
Place and Duration of Study: Mubi General Hospital, Adamawa State, between April, 2013 and January, 2014
Methodology: Urine samples of 101 patients comprised of 46 males and 55 females were analyzed for bacterial growth, antibiogram and multiple antibiotic resistance index.
Results: Females showed higher prevalence of UTI than males. Gram negative bacteria (61.7%) were found in high prevalence than Gram positive (29.3%). Staphylococcus aureus (58.3%) has the highest prevalence rate among Gram positive organisms, while Citrobacter freundii (25.3%) was the most prevalent Gram negative isolates. Citrobacter freundii (17.9%) was the most prevalent uropathogens closely followed by S. aureus (17.1%). Antimicrobial susceptibility was performed on all isolated bacteria by the disc diffusion method employing multiple antibiotic discs differently for both Gram positive and Gram negative isolates. The results showed that S. aureus and Coagulase Negative Staphylococci (CoNS) were more susceptible to Chloramphenicol (83%), followed by Streptomycin and Amoxicillin (78%). While their resistance profile showed that S. aureus and CoNS are more resistant to Ampiclox, Gentamycin and Rifampicin (31%). Susceptibility to all the antibiotics by Gram positive organisms was significantly higher than their resistance to the same antibiotics (p< 0.05). Gram negative organisms are more susceptible to Streptomycin (62%), followed by Ciprofloxacin (47%) and Ofloxacin (44%), while their resistance profile showed that they are more resistance to Nalixidic acid (79%) followed by Augmentin (76%), Ampicillin (75%) and Reflacine (74%). Resistance to all the antibiotics by Gram negative organisms is significantly higher than their susceptibility to the same antibiotics (p<0.05). Using spearman correlation, the results further showed significant correlation in resistance between P. vulgaris, Escherichia coli and P. agglomerans (p<0.01). Also, there was significant correlation in resistance between E. coli, Klebsiella sp., Citrobacter diversus and P. vulgaris (p<0.05). The multiple antibiotic resistances (MAR) index of each antibiotic was calculated. The MAR index for Gram positive antibiotics was significantly lower than that of Gram negative antibiotics (p<0.05).
Conclusion: In this study, we found multidrug resistance strains which are resistant to most of the antimicrobials agent tested more especially the Gram negative uropathogens. This reflected the fact that Nalixidic acid, Augmentin, Ampicillin, Reflacine, Ceporex and Septrin were the most commonly prescribed antibiotics in the hospital even before the results of urine analyses and also the most easily available in the market without prescription and because they were also very cheap in terms of cost. Consequently, the widespread use or misuse of antimicrobial drugs has led to a general rise in the emergence of resistant bacteria. [4]

Bacterial and Drug Susceptibility Profiles of Urinary Tract Infection in Diabetes Mellitus Patients at Mbarara Regional Referral Hospital, Uganda

Aim: The risk of developing infection in diabetic mellitus patients is known to be higher than in normal individuals. The urinary tract is the most common entry point of infections. Surveillance of urinary tract pathogens and their antibiogram is key to patient management. The main objective of this study is to determine the prevalence of bacterial causative agents of urinary tract infections and their antibiogram in diabetes mellitus patients.

Methods and Materials: A hospital – laboratory based cross-sectional study was conducted from February to April 2014. A total of 105 asymptomatic and symptomatic diabetes patients (55 females and 50 males) that consented were recruited in the study. Mid stream urine samples were obtained for standard culture on CLED agar. Bacterial colonies were subjected to Gram stain and relevant biochemical tests were used for isolate identification and antibiogram determined using Kirby bauer disc diffusion method.
Results: Significant bacteriuria (≥105 Colonies/mL) was detected in 13.3% (14/105) of the participants. The common causative agents were Escherichia coli (50%), Klebsiella pneumoniae (28.6%), Staphylococcus aureus (14.3%) and unidentified coliform (7.1%). Majority of the isolates showed 92.9% and 85.7% sensitivity to Gentamicin and Ceftriaxone respectively but a relatively low susceptibility of 64.3% to ciprofloxacin and resistance of 78.6%, and 64.3% against co-trimoxazole and Ampicillin respectively.
Conclusion: Significant bacteriuria was obtained as 13.3% and Escherichia coli (50%) as was the highest uropathogen. Isolates showed high resistance to Co-trimoxazole (78.6%) and ampicillin (64.3%). The isolation of bacterial pathogens that resist the commonly prescribed drugs calls for an early screening of all diabetes mellitus patients with urinary tract infections. [5]

Reference

[1] Be Foxman, B., 2010. The epidemiology of urinary tract infection. Nature Reviews Urology, 7(12), pp.653-660. nt, S. and Ko, R., 2004. Commonly used herbal medicines in the United States: a review. The American journal of medicine, 116(7), pp.478-485.
[2] Lee, J.B. and Neild, G.H., 2007. Urinary tract infection. Medicine, 35(8), pp.423-428.

[3] Foxman, B., Barlow, R., D’Arcy, H., Gillespie, B. and Sobel, J.D., 2000. Urinary tract infection: self-reported incidence and associated costs. Annals of epidemiology, 10(8), pp.509-515.

[4] Tula, M.Y. and Iyoha, O., 2014. Distribution and antibiotic susceptibility pattern of bacterial pathogens causing urinary tract infection in Mubi general hospital, Yola-Nigeria. Journal of Advances in Medicine and Medical Research, pp.3591-3602.
[5] Ampaire, L., Butoto, A., Orikiriza, P. and Muhwezi, O., 2015. Bacterial and drug susceptibility profiles of urinary tract infection in diabetes mellitus patients at Mbarara Regional Referral Hospital, Uganda. Microbiology Research Journal International, pp.1-5.