Search Results (878)

Background: Molecular techniques for microbial identification have highlighted the relevance of polymicrobial infections in humans, such as those affecting the urinary tract. Although in vitro investigations have demonstrated connections between co-infections and microbial interaction, their role is unclear in clinics, given the overlap with host conditions. Objective: We aimed to separate the roles of organisms and patient conditions in human polymicrobial urinary samples by performing a relevant epidemiological analysis. Methods: We analyzed retrospective results from urine cultures performed during one year in a 1200 beds Italian hospital. Patients were grouped as uncompromised and compromised and positive urine cultures were grouped as monomicrobial and polymicrobial. We assessed associations between single microorganisms and the groups of positive samples and between single microorganisms and the group of patients through a multivariate logistic regression model, adjusting by the confounding effect of seven variables. Results: We enrolled 24,067 urine samples, among which 7208 were positive, 75% monomicrobial and 25% polymicrobial. We found that the polymicrobial samples had a microbial scenario wider than the monomicrobial ones and the organisms most sampled had the highest number of different pairwise associations. Certain organisms shown having absolute numerical advantages in the polymicrobial urine cultures with respect to the monomicrobial ones, independently of host’s conditions. Conclusions: The numerical advantage shown by certain organisms in polymicrobial urine samples over monomicrobial samples supports the hypothesis of microbial synergies favouring the occurrence of certain co-infections. Full article

Background: Serious bacterial infections (SBIs) in neonates present a significant diagnostic challenge due to nonspecific symptoms and immature immune responses. Early identification is essential to ensure timely treatment and prevent adverse outcomes. This study investigates clinical, laboratory, and epidemiological parameters associated with SBI in febrile neonates. Methods: A retrospective analysis was conducted on neonates hospitalized for suspected SBI at University Hospital Split from 1 January 2023 until 31 December 2024). The data was analyzed using descriptive statistics, Mann–Whitney U test and Chi-square test. Results: The study included 71 neonates hospitalized with suspected SBI, of whom 38 (53.5%) had a confirmed SBI. Neonates with SBI had a significantly longer hospital stay (p < 0.001). C-reactive protein (CRP) levels at admission were significantly higher in the SBI group (p = 0.020), while other laboratory parameters showed no significant differences. The most common diagnosis in the SBI group was urinary tract infection (50%). In urine analysis, abundant bacterial presence, strongly positive leukocyte esterase (3+), and positive nitrite findings were significantly associated with the presence of urinary tract infection (UTI). Conclusions: In neonates with suspected SBI, elevated CRP levels and prolonged hospital stay were significantly associated with confirmed SBI. Among specific diagnoses, UTI were most frequent, with urinalysis parameters (bacteria, leukocyte esterase, and nitrites) proving useful in identifying affected cases. However, individual clinical signs showed limited diagnostic value, highlighting the importance of combining clinical and laboratory data in early recognition of SBI. Full article

Urinary tract infections (UTIs) are among the most common pathologies, with a high incidence in women and hospitalized patients. Their diagnosis is based on the presence of clinical symptoms and signs in addition to the detection of microorganisms in urine trough urine cultures, a time-consuming and resource-intensive test. The goal was to optimize UTI detection through artificial intelligence (machine learning) using non-microbiological laboratory parameters, thereby reducing unnecessary cultures and expediting diagnosis. A total of 4283 urine cultures from patients with suspected UTIs were analyzed in the Microbiology Laboratory of the University Hospital Virgen de las Nieves (Granada, Spain) between 2016 and 2020. Various machine learning algorithms were applied to predict positive urine cultures and the type of isolated microorganism. Random Forest demonstrated the best performance, achieving an accuracy (percentage of correct positive and negative classifications) of 82.2% and an area under the ROC curve of 87.1%. Moreover, the Tree algorithm successfully predicted the presence of Gram-negative bacilli in urine cultures with an accuracy of 79.0%. Among the most relevant predictive variables were the presence of leukocytes and nitrites in the urine dipstick test, along with elevated white cells count, monocyte count, lymphocyte percentage in blood and creatinine levels. The integration of AI algorithms and non-microbiological parameters within the diagnostic and management pathways of UTI holds considerable promise. However, further validation with clinical data is required for integration into hospital practice. Full article

Background: Urinary tract infections (UTIs) remain among the most common bacterial infections, yet reliable risk stratification remains challenging. Serum vitamin D has been linked to immune regulation, but its predictive role in UTI subtypes is unclear. Methods: We analyzed 332 de-identified clinical records using six machine learning algorithms: Extra Trees, Gradient Boosting, XGBoost, Logistic Regression, Random Forest, and LightGBM. Two preprocessing strategies were applied: (i) removing rows with missing fasting blood sugar (FBs) and HbA1c, and (ii) dropping columns with Null FBs and HbA1c values. Model performance was evaluated using 10-fold cross-validation. Results: Serum vitamin D showed weak correlations with UTI subtypes but modest importance in tree-based models. The highest predictive accuracy was obtained with Extra Trees (0.9510) under the row-removal strategy and Random Forest (0.9525) under the column-dropping strategy. Models excluding vitamin D maintained comparable accuracy, suggesting minimal impact on overall predictive performance. Conclusions: Machine learning models demonstrated high accuracy and robustness in predicting UTI subtypes across preprocessing strategies. While vitamin D contributes as a supportive feature, it is not essential for reliable prediction. These findings highlight the adaptability and clinical utility of both vitamin D-inclusive and vitamin D-exclusive models, supporting deployment in diverse healthcare settings. Full article

Urinary tract infections (UTIs) are common and create significant clinical challenges. Most UTIs are caused by uropathogenic Escherichia coli (UPEC) and affect 50 to 70% of women at some point in their lives. Of this population, 25% will have a recurrent urinary tract infection (rUTI) within 3 to 12 months of the first episode. High rates of rUTIs may occur because UPEC can enter a non-proliferative or quiescent state within the urothelium of the bladder. This state allows UPEC to evade the host’s immune response and antibiotic treatment. We utilized a library of plant extracts derived from the URI Heber W. Youngken Jr. Medicinal Garden to determine if they reversed UPEC quiescence with a novel in vitro quiescence assay using the classic UPEC endemic lineage ST73 strain CFT073. We found an overall active extract hit rate of 69% (79/114 active) and that active extracts contained high levels of polyphenolic compounds. Further testing showed that polyphenols with adjacent hydroxyl groups on a benzene ring (catechol moiety) were the most effective and potent in reversing quiescence. The ability to reverse quiescence was also linked to the compound’s ability to bind iron (e.g., epigallocatechin gallate and rosmarinic acid were the most potent reversing agents—0.1 mM—and they both had the strongest iron-binding activity as determined via CAS assay). These findings reveal a new class of metabolites that can reverse quiescence in UPEC strains. Full article

Urinary tract infections (UTIs) caused by Uropathogenic Escherichia coli (UPEC) strains are among the most common bacterial infections in humans, causing cystitis, pyelonephritis and, in the absence of appropriate treatment, sepsis. Effective therapies and preventive strategies are still lacking, which highlights the need to better understand UPEC virulence mechanisms. Herein, we describe the role of three groups of bacterial autotransporters (ATs): serine protease autotransporter (SPATE), trimeric autotransporter adhesins (TAA), and autotransporter adhesin AIDA-I, and their possible contribution to the induction of UTI and urosepsis. AT, depending on the type, exhibits functions such as adhesion, serum resistance, hemagglutination, protease activity, biofilm formation and toxin activity. By summarizing the molecular functions of AT proteins, our review highlights their potential as targets for novel therapeutic and preventive approaches against UTIs and urosepsis. Full article

Background: Recurrent urinary tract infections (rUTIs) significantly impair women’s quality of life, making antimicrobial prophylaxis a critical preventative strategy. This retrospective observational study aimed to characterize antibiotic prophylaxis patterns, relapse rates, comparative efficacy of different agents, and tolerability in 908 women (663 postmenopausal, 245 premenopausal) with rUTIs managed at a tertiary university hospital. Methods: Data from medical records (January 2022–December 2024) were analyzed. Patients were stratified by menopausal status. We assessed antibiotic usage, relapse rates (per 100 patient-months), and adverse events. Comparative efficacy of nitrofurantoin-based versus fosfomycin/other prophylaxis was evaluated for rUTIs caused by E. coli, E. faecalis, or E. coli ESBL using weighted and matched analyses to control for covariates. Results: Continuous antimicrobial prophylaxis was the primary strategy, with nitrofurantoin being most frequently used. Premenopausal women showed a greater tendency for intermittent or combined prophylactic approaches. Postmenopausal women exhibited a higher overall crude relapse rate (5.54/100 p-m) compared to premenopausal women (3.14/100 p-m), with E. coli being the most common causative agent in relapses. For rUTIs caused by E. coli, E. faecalis, or E. coli ESBL, nitrofurantoin-based prophylaxis demonstrated significantly lower adjusted relapse rates than fosfomycin/other regimens (rate ratio: 0.47 for postmenopausal, 0.35 for premenopausal women). This observed efficacy for nitrofurantoin was robust against potential unmeasured confounding. Prophylaxis was generally well-tolerated (3.0% gastrointestinal adverse events overall); however, premenopausal women reported a higher adverse event incidence. Conclusions: Our findings strongly suggest that nitrofurantoin is an effective prophylactic choice for rUTIs caused by common uropathogens (E. coli, E. faecalis, E. coli ESBL), particularly in postmenopausal women. The diverse prophylactic strategies highlight the need for individualized care. While generally well-tolerated, adverse event profiles vary between menopausal groups, necessitating careful monitoring. Full article

Background/Objectives: A variant of autism spectrum disorder (ASD) known as Asperger syndrome (AS) shows increasing incidence worldwide, affecting between 0.02% and 0.03% of children. Patients display abnormal conduct, are limited in social interaction and communication, and are more often affected by micturition disorders, incontinence, and voiding symptoms than typically developing children. Methods: The present study aimed to review the literature related to the current management of lower urinary tract conditions in children with Asperger syndrome and to present a case of a 14-year-old girl with ASD, with characteristic impairments, including communication challenges, stereotyped, repetitive behaviors, and chronic constipation with concomitant bladder dysfunction, presenting recurrent urinary tract infections (UTIs) and lower urinary tract symptoms (LUTS), including voiding and filling storage symptoms. For the AS, she was treated with a selective serotonin reuptake inhibitor (Sertraline). An abdominal ultrasound, PLUTTS—pediatric lower urinary symptoms scoring (21); QL-quality of life (3); voiding diary; and uroflowmetry were performed, revealing an incomplete urinary retention (incomplete bladder emptying of 120 mL), a prolonged and interrupted curve, a maximum urinary flow rate (Qmax) 7 mL/s, and a UTI with Enterococcus. Results: Besides psychiatric reevaluation and antibiotic therapy, functional magnetic stimulation (FMS) sessions were performed. After eight sessions (20 min, 35 MHz, every second day), the ultrasound control and the uroflowmetry showed no residual urine, and the Qmax was 17 mL/s. The curve continued to be interrupted: PLUTSS-11, QL-1. FMS was continued at two sessions per week. At the 3-month follow-up, no residual urine was detected, and Qmax reached 24 mL/s. Conclusions: ASD is an incapacitating/debilitating condition that significantly impairs social functioning. In many cases, in addition to psychological symptoms, other conditions such as LUTS and constipation may coexist. Antipsychotics and antidepressants are frequently prescribed for these patients, often leading to various side effects, including micturition disorders. Therefore, screening for LUTS is recommended, and, if indicated, treatment—especially non-pharmacological and non-invasive approaches, such as FMS—should be considered. Full article

Background/Objectives: Urinary tract infections (UTIs) represent a major healthcare challenge due to antimicrobial resistance and biofilm formation. Our aim was to evaluate whether repurposed drugs and efflux pump inhibitors (EPIs) could provide alternative strategies by investigating their antibacterial, anti-biofilm, and resistance-modifying properties against Gram-negative uropathogens under varying pH conditions. Methods: Clinical isolates of Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis were tested. Minimum inhibitory concentrations (MICs) of thioridazine (TZ), promethazine (PMZ), fluoxetine (Fx), sertraline (Sr), phenylalanine arginine β-naphthylamide (PAβN), carbonyl cyanide m-chlorophenyl hydrazone (CCCP), and the glutamine uptake inhibitor V9302 were determined at pH 5–8. Biofilm inhibition was assessed by crystal violet staining, while MIC reduction assays tested antibiotic combinations. Efflux pump inhibition was examined using an ethidium bromide accumulation assay. Results: TZ reduced biofilm formation in sensitive K. pneumoniae at all pH levels and enhanced ciprofloxacin (CIP) activity, whereas PMZ showed a weaker effect, limited mainly to neutral pH. Fx and Sr exhibited pH-dependent anti-biofilm activity, with Fx particularly effective against P. mirabilis at alkaline pH. PAβN consistently decreased biofilm biomass in both sensitive and resistant K. pneumoniae and, at pH 7–8, potentiated CIP activity with a 16-fold MIC reduction in the sensitive strain. CCCP showed pH-dependent activity, with stronger effects under acidic conditions, notably in E. coli and P. mirabilis. V9302 was a potent biofilm inhibitor in K. pneumoniae and resistant E. coli and interfered with efflux activity, showing strong effects in acidic environments. Conclusions: Repurposed drugs and EPIs may be useful as antibiotic adjuvants or biofilm inhibitors in treating resistant UTIs. Full article

Urinary tract infections (UTIs) are among the most prevalent infections in the human population. Uropathogenic Escherichia coli, the primary causative agent of UTIs, may also contribute to the development of metabolic kidney stones, particularly those composed of calcium oxalate. Kidney stone disease (KSD), known as nephrolithiasis or urolithiasis, is one of the most common disorders of the urinary system. This review explores the significant clinical association between UTIs and kidney stones, focusing on the mechanisms by which UPEC may promote stone formation, including oxidative stress, inflammation, and altered citrate metabolism. It also examines the role of immune responses, particularly macrophage activity, in the progression of KSD. Recent evidence suggests that the composition of the gut microbiota and metabolic imbalances have an additional impact on stone development. In light of these findings, current prevention and treatment strategies, including microbiota-targeted therapies, probiotics, and immune modulation, are also reviewed. Understanding the complex links between UTI, immunity, and metabolism provide new insights into the pathogenesis of KSD and allows for the development of more effective treatments for this disease. Full article

Background: Urinary tract infections (UTIs) are among the most common hospital- and community-acquired infections, creating a substantial healthcare burden due to recurrence, complications, and rising antimicrobial resistance. Accurate diagnosis and timely antimicrobial therapy are essential. This study aimed to identify trends in the etiology, treatment, and resistance patterns of UTIs through a retrospective analysis of urine isolates processed at the Laboratory of Microbiology at University Hospital St. George in Plovdiv, the largest tertiary care and reference microbiology center in Bulgaria, between 2017 and 2022. Materials and Methods: A retrospective single-center study was performed at the hospital’s Microbiology Laboratory. During the study period, 74,417 urine samples from 25,087 hospitalized patients were screened with the HB&L UROQUATTRO system. Positive specimens were cultured on blood agar, Eosin-Methylene Blue, and chromogenic media. Identification was performed using biochemical assays, MALDI-TOF MS, and the Vitek 2 Compact system. Antimicrobial susceptibility testing included disk diffusion, MIC determination, broth microdilution (for colistin), and Vitek 2 Compact, interpreted according to EUCAST standards. Descriptive analysis and temporal resistance trends were evaluated with regression models, and interrupted time-series analysis was applied to assess COVID-19-related effects. Results: Out of 10,177 isolates, Gram-negative bacteria predominated (73%), with Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis as the leading pathogens. Among Gram-positives, Enterococcus faecalis was the most frequent. In the post-COVID-19 period, ESBL production increased in E. coli (34–38%), K. pneumoniae (66–77%), and P. mirabilis (13.5–24%). Carbapenem resistance rose in K. pneumoniae (to 40.6%) and P. aeruginosa (to 24%), while none was detected in E. coli. Colistin resistance increased in K. pneumoniae but remained absent in E. coli and P. aeruginosa. High-level aminoglycoside resistance in E. faecalis was stable (~70%), and vancomycin resistance in E. faecium rose from 4.6% to 8.9%. Conclusions: Both community- and hospital-acquired UTIs in Southeastern Bulgaria are increasingly linked to multidrug-resistant pathogens, particularly ESBL-producing and carbapenem-resistant Enterobacterales. Findings from the region’s largest referral center highlight the urgent need for continuous surveillance, rational antibiotic use, and novel therapeutic approaches. Full article

Background: It is not clear if the administration of iodine-131 in patients with differentiated thyroid cancers induces relevant cystitis and lower urinary tract infections (UTIs). The aim of this study was to evaluate the impact of oral administration of hyaluronic acid and chondroitin sulphate (HA&CS) on the frequency of UTIs induced by iodine-131. Methods: In this study, 166 female patients with a surgical diagnosis of differentiated thyroid cancer who were hospitalized in Sant ’Andrea Hospital of Rome to undergo the first cycle of therapy with iodine-131 for thyroid remnant ablation were evaluated. Sixty-one patients were treated with HA&CS for 8 days, and thirty-nine patients were treated with HA&CS for 17 days. Sixty-six patients were not treated with HA&CS and were used as control subjects. Patients underwent urinalysis at different time points: immediately before ¹³¹I therapy, two days later, and one week later. Patients were divided in six groups based on whether they received the treatment with HA&CS, its duration, and whether they developed a UTI: group A, n = 51 patients who did not receive HA&CS and did not develop UTI; group B1, n = 37 patients treated with HA&CS for 8 days and did not develop UTI; group B2, n = 29 patients treated with HA&CS for 17 days and did not develop UTI; group C, n = 15 patients who did not receive HA&CS and developed UTI; group D1, n = 24 patients treated with HA&CS for 8 days and developed UTI; group D2, n = 10 patients treated with HA&CS for 17 days and developed UTI. Results: The bacteria count, red blood cells and white blood cells did not change when group A was compared to both group B1 and group B2, while pH and epithelial cells showed a decrease over time when comparing group A and group B2 (p = 0.01 and p < 0.0001, respectively). Comparing group C with group D1 and group D2, patients who did not receive HA&CS (group C) showed a higher bacteria and epithelial cell count compared to those who were pre-treated with HA&CS. Conclusions: HA&CS could be an effective supportive therapy to prevent and mitigate UTIs in patients treated with ¹³¹I. Full article

Uropathogenic Escherichia coli (UPEC) is a primary cause of urinary tract infections (UTIs), with recurrent cases often linked to its ability to form biofilms. This study investigated the effects of various antibiotics on UPEC biofilm formation and the subsequent interaction of these biofilms/their supernatants with human neutrophils. We determined the minimum inhibitory concentrations (MIC), minimum bactericidal concentrations (MBC), and biofilm eradication concentrations (MBEC) for ampicillin, gentamicin, chloramphenicol, ciprofloxacin, and levofloxacin. Our results showed an increase in MBEC compared to MBC for all tested antibiotics, confirming the enhanced antibiotic resistance of bacteria in biofilm. We found that sub-MICs of ciprofloxacin, which moderately inhibited planktonic growth, actually stimulated an increase in biofilm biomass. This antibiotic-induced biofilm growth was accompanied by changes in bacterial morphology, including the formation of elongated, filamentous cells, an adaptive stress response. Biofilm-embedded bacteria, but not their supernatants, significantly reduced neutrophil viability, primarily by inducing neutrophil necrosis. The presence of ciprofloxacin during biofilm formation did not fundamentally alter interactions with neutrophils. These findings highlight the importance of studying effects of antibiotic pressure on biofilm formation, underscoring the challenges in antibiotic treatment of UTIs. Full article

Background/Objectives: Urinary tract infections (UTIs) represent a considerable challenge within the field of clinical medicine, as they are responsible for significant morbidity and intensify the operational pressures encountered by healthcare systems. Conventional diagnostic approaches, which include symptom evaluation, dipstick urinalysis, and standard urine culture, often demonstrate inadequacies in identifying atypical clinical manifestations, infections with low bacterial counts, or pathogens that show growth difficulties under typical laboratory conditions. These limitations undermine diagnostic accuracy and hinder timely therapeutic measures. Methods: The present manuscript is a systematic review conducted in accordance with PRISMA guidelines. A structured search was performed in PubMed, Scopus, and Google Scholar, yielding 573 records, of which 107 studies were included for qualitative synthesis. The primary aim of this systematic review is to evaluate both conventional and emerging diagnostic methods for UTIs, with specific objectives of assessing their clinical applicability, limitations, and potential to improve patient outcomes. Results: Recent progress in diagnostic technologies offers promising alternatives. Molecular-based assays, such as multiplex polymerase chain reaction, matrix-assisted laser desorption ionization mass spectrometry, and next-generation sequencing, have substantially improved both the precision and efficiency of pathogen identification. Furthermore, contemporary techniques for evaluating antimicrobial susceptibility, including microfluidic systems and real-time phenotypic resistance assays, enable clinicians to execute targeted therapeutic strategies with enhanced efficacy. Results of this synthesis indicate that while conventional diagnostics remain the cornerstone for uncomplicated cases, innovative molecular and phenotypic approaches demonstrate superior performance in detecting low-count bacteriuria, atypical pathogens, and resistance determinants, particularly in complicated and recurrent infections. These innovations support antimicrobial stewardship by reducing dependence on empirical antibiotic treatment and lessening the risk of resistance emergence. Conclusions: Nonetheless, the incorporation of these technologies into clinical practice requires careful consideration of implementation costs, standardization protocols, and the necessary training of healthcare professionals. In conclusion, this systematic review highlights that emerging molecular diagnostics and resistance-profiling tools offer substantial promise in complementing or enhancing traditional methods, but their widespread adoption will depend on robust validation, cost-effectiveness, and integration into clinical workflows. Full article

Background: Refractory overactive bladder (OAB) poses a significant clinical burden, often severely impacting quality of life (QoL). While intradetrusor onabotulinumtoxinA (BoNT-A) and sacral neuromodulation (SNM) are established therapeutic options, a direct comparison of their efficacy and safety profiles is essential to guide clinical decision-making. This study compares BoNT-A against placebo and SNM for the management of refractory OAB in women. Methods: Following PRISMA guidelines, PubMed, Scopus, CENTRAL, and Google Scholar were searched until February 2025 for randomized controlled trials (RCTs) and cohort studies on treatment alternatives for refractory OAB. Treatment outcomes at 3- (BoNT-A vs. placebo) and 6-month (BoNT-A vs. SNM) follow-up were analyzed. Odds ratios (ORs) and mean differences (MDs) were calculated for dichotomous and continuous variables, respectively, with heterogeneity assessed via I² test. Study quality was evaluated using CASP tools. Results: Pooled data from 12 studies (2645 patients) indicated that BoNT-A significantly reduced urgency urinary incontinence (UUI) episodes compared to placebo (p = 0.02) and SNM (p = 0.0008). Additionally, a ≥75% reduction in UUI episodes was more likely with BoNT-A compared to both placebo (p < 0.00001) and SNM (p < 0.00001). Complete resolution of UUI was more likely with BoNT-A compared to placebo (p < 0.00001); however, when compared to SNM, the latter demonstrated a higher rate of complete UUI resolution (p < 0.00001). Patient-reported QoL did not show significant differences between BoNT-A and SNM (p = 0.2). Urinary tract infection (UTI) risk was higher with BoNT-A than both comparators. Conclusions: While BoNT-A offers robust symptom control, its safety profile necessitates careful patient selection. SNM remains a viable alternative for those prioritizing fewer adverse events. The study highlights the need for standardized outcome reporting, long-term cost-effectiveness analyses, and personalized treatment approaches. Full article