Search Results (294)

Background: The emergence and spread of urinary carbapenem-resistant organisms (CROs) are a major public health concern, particularly in Sri Lanka. Therefore, we aimed to detect and genotypically characterize CROs in urinary tract infections (UTIs) and their clinical outcomes. Methods: Urinary CROs were collected from two hospitals in Sri Lanka from January to December, 2023. Among 7640 urine samples, 100 CROs were identified by disk diffusion method, and 99 were detected by BD Pheonix^TM automated system. The presence of eight carbapenemase genes; bla_KPC, bla_NDM, bla_VIM, bla_IMP, bla_OXA-23, bla_OXA-48, bla_OXA-51, and bla_OXA-58, among 97 CROs was detected by a multiplex PCR kit. Results: Out of 99 urinary CROs, K. pneumoniae (33.3%; n = 33/97) was the most common species. Among the 97 isolates tested by PCR, a single carbapenemase gene was detected in 35.05% (34/97), while two or more genes co-occurred in 39.18% (38/97). The most frequently identified gene was bla_OXA-51 (47.4%), followed by bla_OXA-58 (41.2%). Most patients (95.74%; n = 90/97) showed clinical improvement within seven days of treatment. Among the 93 patients discharged and followed for three months, 74.20% (n = 69/93) experienced at least one mild UTI recurrence. A total of 10 patients died during the study period. Of which, four (40%) during hospitalization and six (60%) during follow-up, though none of the deaths were attributed to UTIs. Conclusions: K. pneumoniae, showed the highest carbapenemase gene diversity. Recurrent UTIs were observed during the follow-up period. Continuous surveillance and implementation of targeted infection control programs are needed to minimize further emergence and spread of carbapenemase genes. Full article

Background: Biofilm-associated urinary tract infections (UTIs) pose a significant therapeutic challenge due to the increased tolerance of biofilm-embedded bacteria to antimicrobial agents and the high risk of infection recurrence. The increasing prevalence of multidrug-resistant uropathogens necessitates the evaluation of alternative therapeutic strategies, including antibiotic combination therapy. This study aimed to assess the antibiofilm activity of selected antibiotics used individually and in combination against biofilms formed by clinically relevant uropathogens. Methods: Biofilms of Escherichia coli, Pseudomonas aeruginosa, Proteus mirabilis, and Enterococcus faecalis isolated from patients with UTIs were developed on polystyrene microtiter plates and exposed to ciprofloxacin, nitrofurantoin, amikacin, and imipenem applied as monotherapy and in combinations. Biofilm biomass reduction was quantified spectrophotometrically using crystal violet staining and expressed as a percentage relative to untreated controls. Results: Antibiotic monotherapy produced moderate reductions in biofilm biomass, with efficacy dependent on bacterial species and antibiotic concentration. In contrast, antibiotic combinations demonstrated enhanced antibiofilm activity. The ciprofloxacin–nitrofurantoin combination showed increased biofilm biomass reduction compared with monotherapy against P. aeruginosa and E. coli. The imipenem–amikacin combination reduced P. mirabilis biofilm biomass by over 80%. Conclusions: These findings suggest that rationally selected antibiotic combinations may represent a more effective strategy than monotherapy for controlling biofilm-associated UTIs. Full article

Background/Objectives: Children with congenital urogenital anomalies (CUA) face increased risk of urinary tract infections (UTIs) and may harbor resistant organisms due to recurrent infections and antibiotic exposure. This study characterized the distribution of uropathogens and antimicrobial resistance patterns at a tertiary center in Saudi Arabia. Methods: This retrospective cohort study included pediatric patients (<18 years) with documented congenital urogenital anomalies and positive urine cultures at King Khalid University Hospital, Riyadh (2015–2025). Susceptibility interpretations (S/I/R) were extracted from the hospital laboratory information system; multidrug resistance (MDR) was defined using organism-specific Magiorakos criteria. Results: A total of 168 patients (72.0% male; mean age 4.1 ± 4.5 years) contributed 411 UTI episodes. Among 403 mono-organism episodes (after excluding eight polymicrobial cultures), Escherichia coli predominated (150/403, 37.2%), followed by Klebsiella pneumoniae (96/403, 23.8%) and Pseudomonas aeruginosa (33/403, 8.2%). High resistance was observed for ampicillin (83.6%), trimethoprim-sulfamethoxazole (54.2%), and cephalosporins (cefazolin 62.8%, cefotaxime 35.6%). Carbapenems (2.9%) and aminoglycosides (9.2%) retained >90% susceptibility. Overall MDR was 35.5%, highest among Klebsiella oxytoca (57.1%) and Escherichia coli (47.6%). Recurrent infections showed numerically higher unadjusted resistance than single episodes. Conclusions: Pediatric patients with congenital urogenital anomalies showed high first-line antibiotic resistance. Carbapenems and aminoglycosides retained predominantly susceptible in vitro profiles in this cohort and may inform empiric considerations alongside ongoing local susceptibility surveillance for this high-risk population. Full article

Hypospadias is a congenital malformation of the male external genitalia resulting from incomplete fusion of the urethral folds during embryonic development. The perineal form represents the most severe phenotype and is frequently associated with abnormalities such as cryptorchidism and penile hypoplasia. Although surgical correction is generally recommended in young dogs, the long-term clinical course of severe hypospadias under conservative management remains poorly documented. In this study, we describe an unusual canine case of severe perineal hypospadias that survived to geriatric age under conservative management and subsequently developed bilateral testicular tumors arising from cryptorchid testes. Despite recurrent urinary tract infections during early life, the patient maintained an acceptable quality of life with long-term supportive care, providing a rare clinical example of extended survival without surgical correction. Because no molecular material was available from the patient, publicly available mouse transcriptomic datasets related to genital tubercle development and Leydig cell differentiation were consulted only as contextual reference. These datasets illustrate established developmental regulators and steroidogenic pathways relevant to genital formation and testicular function but do not represent direct molecular findings from the reported case. This report primarily highlights the clinical course and management of severe hypospadias in a dog, while using existing transcriptomic knowledge solely to provide biological context. The findings should therefore be interpreted as descriptive and hypothesis-generating rather than as evidence of a direct mechanistic link between developmental abnormalities and endocrine tumorigenesis. Full article

The human virome, comprising eukaryotic viruses, bacteriophages, and viral genetic material, is a dynamic component of the microbiome with growing relevance in infectious diseases. This narrative review is structured to: (i) summarize the general composition of the human virome and methodological challenges, including the fraction of unclassified viral “dark matter”; (ii) describe virome alterations in chronic infections; and (iii) explore site-specific virome dynamics across respiratory, intestinal, and genito-urinary tracts in both chronic and acute infections. In chronic viral infections such as HIV, HBV, HCV, and HPV, a recurrent feature is the expansion of Anelloviridae—particularly torque teno virus—reflecting impaired immune surveillance rather than direct pathogenicity, suggesting their potential as surrogate biomarkers of immune competence. Evidence on virome changes in chronic bacterial and parasitic infections remains limited, highlighting a critical knowledge gap. Acute infections are associated with compartment-specific shifts in eukaryotic viruses and bacteriophage communities, often paralleling changes in bacterial populations and inflammatory responses, with implications for disease severity. Despite advances in metagenomic approaches, a substantial proportion of viral sequences remains unclassified, limiting functional interpretation. Nevertheless, virome profiling provides an ecosystem-level perspective, offering insights beyond single-pathogen detection and supporting emerging applications in diagnostics, immune monitoring, prognosis, and infectious disease surveillance. Full article

Antimicrobial resistance (AMR) is an increasing concern in veterinary medicine and may compromise empirical treatment of feline urinary tract infections (UTIs). This retrospective observational study evaluated antimicrobial resistance patterns and their association with multidrug resistance (MDR) in bacterial isolates obtained from urine cultures of cats presented to a feline referral practice in Lisbon, Portugal, between January 2023 and December 2025. A total of 174 cats with positive urine cultures were included, yielding 178 bacterial isolates. Escherichia coli was the most frequent pathogen (57.30%), followed by Enterococcus spp. (16.98%) and Staphylococcus spp. (14.61%). Antimicrobial resistance was detected in 107/178 isolates (60.11%), and 76/178 (42.70%) were classified as multidrug-resistant. Extended-spectrum beta-lactamase-producing Escherichia coli and methicillin-resistant Staphylococcus strains were also identified. Resistance to penicillins and fluoroquinolones was significantly associated with MDR (p < 0.001). These findings highlight the high burden of antimicrobial resistance in feline urinary isolates in this clinical setting and support routine urine culture and susceptibility testing to guide therapeutic decision-making, particularly in recurrent, complicated, or high-risk cases. Full article

Uropathogenic Escherichia coli (UPEC) is a leading cause of urinary tract infections (UTIs) in companion animals. This study characterized 42 UPEC isolates recovered from dogs and cats at the University of Florida, College of Veterinary Medicine Diagnostic Laboratories between 2023 and 2024, focusing on antimicrobial resistance (AMR), virulence gene profiles, biofilm-forming ability, and phylogroup distribution of the isolates. Antimicrobial susceptibility testing (AST) showed that 40.48% of the isolates were resistant to at least one of the tested antibiotics, and 9.52% exhibited multidrug resistance (MDR). Phylogroup B2 was predominant (69.05%), and 61.90% of isolates demonstrated strong biofilm formation in artificial human urine. Virulence gene analysis revealed the presence of genes mediating adhesion (fim, pap, sfa), iron acquisition (fyuA, iro), biofilm formation (csg, bcs, pga, ycg/ymg), motility (fli, mot, flh), and stress response (oxyR, soxR/S, kat). Multiple plasmids carrying AMR and virulence determinants were also identified. The co-occurrence of the traits underscores the potential for persistent and recurrent infections, which can complicate therapeutic outcomes and facilitate horizontal gene transfer (HGT). The detection of antimicrobial-resistant, highly virulent UPEC strains possessing human UPEC traits in companion animals suggests the risk of zoonotic and reverse-zoonotic transmission, particularly in households with close pet–owner interactions. These findings emphasize the importance of judicious antimicrobial use, routine molecular surveillance, and integrated One Health strategies to mitigate the veterinary and public health threats associated with UPEC infections in companion animals. Full article

The non-albicans Candida species Candida tropicalis is an opportunistic fungal pathogen that forms a robust gel-like biofilm on polymeric prosthetic materials. These biofilms are embedded in an extracellular polymeric substance that retains large amounts of water, resulting in a hydrogel-like matrix that protects fungal cells, increases antifungal resistance, and contributes to the biofouling of these prosthetic materials. Biofouling is the unwanted colonization and accumulation of microbial communities on material surfaces, which alters their function and compromises clinical performance. Clinically, it is significant because it is linked to recurrent urinary tract infections, bloodstream infections, and persistent device-related infections, which often result in therapeutic failure and device malfunction. Polymers such as silicone elastomer, polypropylene, polystyrene, polyurethane, polyethylene, and polyvinyl chloride are widely used in catheters, surgical meshes, implants, and prostheses because of their durability, flexibility, and biocompatibility, yet their surface properties often encourage microbial adhesion and biofilm formation. This review emphasizes that the gel-like biofilm architecture of C. tropicalis underpins its persistence and resistance, while also highlighting promising antifungal strategies being developed to mitigate these infections. Notably, palmitic acid has been shown to disrupt mature biofilms by lowering ergosterol and inducing oxidative stress, whereas C-10 massoia lactone damages the extracellular matrix and suppresses hyphal growth. Drug repurposing approaches, such as combining minocycline with fluconazole, restore susceptibility in resistant isolates and demonstrate synergistic antibiofilm activity. Additionally, biomaterial-based interventions, such as chitosan coatings on silicone surfaces, significantly reduce fungal adhesion and biofilm formation. Together, these findings reflect a translational shift toward integrating natural products, repurposed drugs, and functionalized biomaterials into antifungal development. Understanding biofouling and these emerging strategies is crucial for developing effective control measures against C. tropicalis biofilms and for guiding the design of infection-resistant prosthetic devices. Full article

Introduction: Urinary tract infections (UTIs) represent a growing health challenge, due to the rise of antimicrobial resistance (AMR) in common pathogens. Bacteria such as Escherichia coli, responsible for 80% of cases, and Pseudomonas aeruginosa, an opportunistic pathogen of concern, have developed effective virulence mechanisms. These mechanisms include the use of adhesins, such as type 1 and P fimbriae, to attach to uroepithelial cells, and the formation of biofilms, which protect bacteria from immune system and antibiotics, favoring recurrent infections. Methodology: This study is an integrative review based on articles published until 2015, identified in PubMed, Scopus, and Google Scholar using specific keywords. The inclusion criteria considered clinical relevance and the main findings. Results: In this context, cranberry (Vaccinium macrocarpon) emerges as a complementary strategy for the prevention and treatment of UTIs. The fruit is rich in bioactive compounds, particularly type A proanthocyanidins (PACs). The main action of PACs is to inhibit the adhesion of uropathogenic bacteria to the walls of the urinary tract, an effect that extends to type 1 and P fimbriae, which are resistant to other inhibitors. Additionally, studies show that PACs can interfere with quorum sensing, a cellular communication system bacteria use to coordinate biofilm formation. Conclusions: By disrupting this process, cranberries make pathogens more vulnerable to the action of the immune system and medications, possibly controlling the inflammatory response associated with the infection. Clinical evidence, although not always statistically significant, suggests a reduced risk of symptomatic UTIs with consumption of cranberry extract. Full article

Background/Objectives: More than 50% of adult women experience at least one urinary tract infection (UTI) during their lifetime, and approximately 25% develop recurrent UTIs (rUTIs), defined as ≥2 episodes within six months. Management of rUTI is challenging and often requires long-term, multimodal preventive strategies. Escherichia coli Nissle 1917 (EcN) is a non-pathogenic probiotic strain with demonstrated antagonistic activity against pathogenic enterobacteria. This study evaluated the efficacy and safety of EcN in preventing symptomatic recurrences in premenopausal women with rUTI. Methods: In this prospective observational study, 40 premenopausal women with rUTI were enrolled. Twenty patients received EcN prophylaxis (twice daily for four weeks, followed by once daily for eight weeks), while 20 patients received no prophylaxis and served as controls. Patients were followed for six months (three months of treatment and three months post-treatment). The primary outcome was the frequency of symptomatic rUTI episodes during follow-up. Results: Forty patients were analyzed (20 EcN; 20 controls). During the six-month observation period, 55% (11/20) of patients in the EcN group remained UTI-free compared with 35% (7/20) in the control group. Two patients (10%) in the EcN group experienced a single recurrence versus three (15%) in the control group. Recurrent episodes (≥2 UTIs) occurred in 35% (7/20) of EcN-treated patients compared with 50% (10/20) of controls. Overall, EcN prophylaxis was associated with a lower proportion of patients experiencing multiple recurrences. Conclusions: Prophylaxis with E. coli Nissle 1917 was associated with a reduced rate of recurrent UTIs compared with no prophylaxis in premenopausal women, supporting its potential role as a non-antibiotic preventive strategy in rUTI management. Full article

Canine urolithiasis is a common and highly recurrent urinary tract disease, with struvite and calcium oxalate being the predominant stone types. Stone formation has traditionally been attributed to urinary physicochemical factors, including urine pH, mineral supersaturation, and urinary tract infection. However, these factors alone cannot fully explain the persistent growth and rapid progression of stones in affected dogs. In this study, we provide evidence that innate immune mechanisms, particularly neutrophil extracellular traps (NETs), are associated with canine urolith formation. We found that neutrophils, key cells of the innate immune system, release neutrophil extracellular traps composed of DNA and antimicrobial proteins, which are consistently present within urinary stones and their surrounding microenvironments. Common canine urinary pathogens were shown to trigger this response, and these immune-derived structures promoted crystal nucleation, aggregation, and stone growth in experimental systems. Importantly, enzymatic degradation of NETs by DNase I attenuated NET-associated stone growth under in vitro conditions. These findings suggest that canine urinary stones develop not only as a consequence of physicochemical factors, but also in association with inflammation-driven biomineralization processes involving NETs. Recognizing the contribution of innate immunity provides new insight into stone recurrence and may inform future preventive and therapeutic strategies. Full article

Background and Objectives: Genitourinary syndrome of menopause (GSM), previously known as vulvovaginal atrophy, is a chronic, progressive hypoestrogenic condition affecting vulvovaginal, urinary and sexual health in women. Common symptoms include vaginal dryness, itching, dyspareunia, urinary urgency and recurrent urinary tract infections (UTIs). Despite the high prevalence, GSM is underdiagnosed and undertreated, thereby negatively impacting women’s quality of life. To illustrate the practical aspects of GSM diagnosis and provide evidence-based management, we present a case-based narrative review synthesizing recently published, high-quality evidence. Materials and Methods: Evidence was drawn from multiple sources through targeted searches of databases, and included the 2025 AUA/SUFU/AUGS guideline (AUA), the 2024 NICE network meta-analyses (NICE), a 2025 systematic review/meta-analysis in breast-cancer survivors, the 2020 Menopause Society GSM Position Statement, the 2018 NAMS/ISSWSH breast cancer consensus, several primary source citations and other high quality peer-reviewed publications. Results: Five illustrative composite case vignettes of GSM are presented to highlight the evaluation strategy and evidence-supported treatment choices. Nonhormonal options are the first line treatments for mild GSM symptoms, either with or without the addition of vaginal estrogen therapy. For moderate to severe GSM, low-dose vaginal estrogen, vaginal DHEA, and ospemifene are all effective FDA-approved options. In breast cancer survivors, individualized decisions with oncology input are warranted. Maximal caution and a shared decision-making approach is required for women using Aromatase Inhibitors (AIs) for breast cancer risk reduction when choosing treatments for GSM. Conclusions: Treating GSM improves vaginal, sexual and urinary outcomes and quality of life of women. Clinicians need to proactively screen for GSM and offer evidence-based treatment options. The treatment decisions in breast cancer survivors are nuanced, requiring a shared-decision approach. Full article

Urinary tract infections (UTIs) impose a substantial burden on women’s health, and probiotics have emerged as an alternative strategy to support urogenital wellbeing. This study evaluated the antimicrobial properties of Limosilactobacillus reuteri 3613-1 and its ability to improve UTI outcomes in women with a history of recurrent uncomplicated UTIs. In vitro assays demonstrated that L. reuteri 3613-1 inhibited the growth of Escherichia coli isolates and proved superior inhibition of Gardnerella vaginalis and Candida albicans compared with a comparator L. reuteri strain, supported by confirmed reuterin production and genomic profiling. A randomized, double-blind, placebo-controlled clinical trial (n = 130) assessed daily supplementation with L. reuteri 3613-1 for 24 weeks. While the proportion, frequency, and intensity of confirmed UTIs did not differ significantly between groups, L. reuteri 3613-1 delayed the onset of the first UTI, reaching significance in participants with suspected while unconfirmed UTIs. Vaginal pH and vaginal microbiome composition remained stable and comparable between groups across the intervention. The product was safe and well tolerated. Overall, L. reuteri 3613-1 shows promise as a probiotic candidate with antimicrobial activity and potential to delay symptom onset in women susceptible to recurrent UTIs, warranting further investigation in larger studies. Full article

Objectives: The variable clustering of comorbidities in gout, including diabetes mellitus (DM), remains poorly understood. We analyzed the frequency and impact of DM in a nationwide Spanish hospitalized population with gout. Methods: Observational, multicenter, longitudinal study assessing 192,062 hospitalizations with gout in Spain from 2005 to 2015 (Minimal Basic Data Set, ICD-9 coding). We estimated the prevalence of DM with 95% confidence intervals (CIs), stratified by DM type and related complications. A logistic regression analysis identified characteristics of patients with both gout and DM. We also matched recurrent admissions in the first tercile (2005–2008) to assess cardiovascular, renal, infectious, and thromboembolic comorbidities in the subsequent terciles (2009–2012 and 2012–2015). Results: DM was identified in 27.72% of the hospital-based gout population, predominantly type 2 DM, with 19.76% having complications. DM was associated with older age, female gender, and conditions such as dyslipidemia, obesity, cardiovascular and kidney diseases, liver disease, obstructive pulmonary disease, urinary tract infections, and dementia. In contrast, non-DM patients showed higher rates of venous thromboembolism and other rheumatic diseases. Readmissions were significantly more common in DM patients, who experienced +10% more cardiovascular and renal issues, similar infections, and fewer venous thromboembolism cases. Conclusions: DM is prevalent in gout and associated with older patients, women, and a particular comorbidity profile. The presence of DM increases the risks of readmission and the development of cardiovascular and renal diseases. Fewer venous thromboses were noted. Thus, diagnosing and managing DM in patients with gout is likely a more pressing issue. Full article

Background and Clinical Significance: Posterior urethral valves are rare congenital anomalies characterized by persistent urethral mucosal folds and causing varying degrees of obstruction. The increasing use of prenatal ultrasound has contributed to the early diagnosis of posterior urethral valves (PUV), a condition associated with a severe prognosis, as approximately one-fifth of affected patients develop chronic kidney disease. Early diagnosis and intervention—namely, valve ablation—provide obstruction alleviation and renal function preservation. Therefore, it is uncommon for patients to be diagnosed in adolescence or adulthood, when patients usually present with frequency, voiding dysfunction, daytime incontinence, enuresis, recurrent urinary tract infections, and renal insufficiency. Case Presentation: We present a 14-year-old adolescent with recurrent urinary tract infections. A thorough medical history, clinical examination, and standard imaging revealed bilateral vesicoureteral reflux and posterior urethral valves. The patient underwent urethrocystoscopy for diagnostic and therapeutic purposes and posterior urethral valve ablation. Despite these interventions, the persistence of his symptoms necessitated endoscopic correction of the vesicoureteral reflux and circumcision. During the 2-year follow-up, the patient remained asymptomatic. Conclusions: Symptomatic adolescent boys should undergo a standard urinary evaluation to identify undiagnosed congenital urinary tract diseases and maintain renal and bladder function. Full article