Search Results (1,979)

Background/Objectives: This intervention study compared the impact of the PA-100 AST System (PA-100) with the standard of care on antibiotic-prescribing behaviour for community-acquired urinary tract infections in a Spanish primary care setting. Methods: Women seeking care for symptoms of uncomplicated urinary tract infections were recruited based on the last digit of their regional personal identification number in a control (no PA-100 result available) or intervention (PA-100 result available) arm. Differences in antibiotic-prescribing behaviour were analysed using Fisher’s exact test, with the sample size powered to detect a change in prescription in ≥6% of patients. Results: Availability of the PA-100 revealed resistance to fosfomycin in 21.5% of confirmed infections. This significantly shifted prescription away from fosfomycin towards nitrofurantoin and amoxycillin/clavulanic acid (p < 0.001). In accordance with local guidelines, fosfomycin was the most frequently prescribed antibiotic in the control arm (65.9%), whereas a significantly lower rate (37.7%) was observed in the intervention arm. Conclusions: The PA-100 shows potential to support antimicrobial stewardship by enabling targeted antibiotic treatment at the first visit and improving care in primary care settings. 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

Cystitis is a common condition in dogs and an important driver of antimicrobial prescription in small animal practice. Although international guidelines provide recommendations for diagnosis and management, their implementation in clinical settings remains variable. This survey-based study investigated the diagnostic and therapeutic approaches to canine cystitis among Italian veterinarians and explored differences between work settings. An anonymous online questionnaire was distributed nationwide between February and March 2024, yielding responses from 359 veterinarians. Of these, 63.2% worked in small clinics, 25.6% in large clinics, and 11.1% in veterinary hospitals. Diagnosis was most commonly based on the combination of symptoms, bloodwork, urinalysis, and abdominal ultrasound (45.1%) or on symptoms and urinalysis alone (43.7%). Urine culture and sensitivity testing (UCS) was performed in more than 50% of cases by 34.4% of small clinics, 55.4% of large clinics, and 72.5% of veterinary hospitals (p < 0.00001). Financial constraints, delayed results, and difficulty in urine collection were the main barriers. Overall, 56.2% of respondents included antibiotics as first-line therapy. Overall, antibiotic use did not differ among workplace categories, whereas fluoroquinolone prescription differed significantly (p = 0.021), being lower in veterinary hospitals than in small and large clinics. The most common treatment durations were 7 days (43.7%) and 10–14 days (43.2%). Management of subclinical bacteriuria was heterogeneous: probiotics (46.2%) and D-mannose (41.5%) were most frequently recommended, while 19.5% prescribed antibiotics and 19.8% opted for no therapy. These findings indicate variability in clinical practice, underuse of UCS, particularly in smaller clinics, and prescribing practices exceeding guideline recommendations. Full article

Klebsiella pneumoniae is an opportunistic pathogen associated with both community-acquired and nosocomial infections. Multidrug-resistant (MDR) strains are increasingly implicated in urinary tract infections (UTIs), traveller’s diarrhoea, bacteraemia, and sepsis. β-lactam antibiotics are commonly used for treatment; however, antimicrobial resistance has emerged largely due to the production of extended-spectrum β-lactamases (ESBLs), which confer resistance mainly to penicillins, oxyimino-cephalosporins, and monobactams, while cephamycins and carbapenems usually remain stable to ESBL-mediated hydrolysis and compromise therapeutic efficacy. ESBL-producing strains represent a major cause of severe Gram-negative infections. This study aimed to determine the prevalence of ESBL-producing K. pneumoniae among UTI patients in Jordanian hospitals (Al Mafraq, Ma’an, and Islamic Hospitals), evaluate their antimicrobial susceptibility patterns, and detect antimicrobial resistance genes at the molecular level. A total of 450 urine isolates of K. pneumoniae were collected from UTI patients between November 2023 and May 2024. Isolates were identified in hospital laboratories using standard microbiological methods. Antimicrobial susceptibility testing was performed, and molecular characterisation of ESBL-associated genes was conducted using polymerase chain reaction (PCR). Out of 450 K. pneumoniae isolates collected from UTI patients across three Jordanian regions, 72 (16%) were confirmed as ESBL producers. Among the 72 ESBL-positive K. pneumoniae isolates, 34 (47.2%) were recovered from the Central region, 20 (27.8%) from the North, and 18 (25.0%) from the South. Molecular analysis revealed that 41.7% of ESBL-producing isolates carried the blaCTX-M gene, while 33.3% harboured the blaOXA gene. All ESBL-producing isolates demonstrated antimicrobial resistance to third-generation cephalosporins. A significantly higher proportion of ESBL-producing isolates was identified in female patients (84.7%) compared with males (15.3%). A significant association was observed between blaOXA gene distribution and geographic region (p = 0.016), whereas blaCTX-M gene distribution showed no significant regional association. ESBL-producing K. pneumoniae accounted for a substantial proportion of UTI isolates in Jordan, with blaCTX-M identified as the predominant resistance gene. The higher burden observed in the Central region and among female patients highlights notable distribution patterns in this cohort. These findings emphasise the necessity for sustained molecular surveillance and strengthened antimicrobial stewardship strategies to limit the dissemination of ESBL-producing strains in Jordanian healthcare settings. 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

Background/Objectives: Midurethral sling (MUS) surgery is a standard treatment for stress urinary incontinence in women. Obturator-route MUS procedures reduce retropubic morbidity, but rare concealed hemorrhagic complications can be severe and rapidly progressive. This report describes a complex case of life-threatening hemorrhage, upper urinary tract extravasation, and delayed infection involving a persistent pelvic collection after obturator-route MUS. Methods: We reviewed the clinical course, imaging findings, interventions, and follow-up of a 77-year-old woman who developed severe complications after outpatient obturator-route MUS. A descriptive narrative summary of published hemorrhagic complications after TOT or TVT-O procedures was also performed. Result: On postoperative day 1, the patient presented with left lower abdominal pain, dizziness, vomiting, tachycardia, and severe anemia. Contrast-enhanced computed tomography showed active bleeding from the left obturator artery, an 11.5 cm pelvic hematoma with bladder displacement, and upper urinary tract contrast extravasation at the left renal pelvis and ureteropelvic junction. Emergency transcatheter arterial embolization and left percutaneous nephrostomy were performed, followed by delayed antegrade double-J ureteral stenting. Four months later, she developed E. coli urosepsis with a persistent 7.9 cm paravesical collection. Persistent symptoms despite initial antibiotic therapy required broad-spectrum antibiotics and percutaneous catheter drainage. The drainage fluid was serous, and S. hominis isolated from the drainage culture was interpreted as a contaminant; therefore, the collection was managed as a clinically suspected infection involving a persistent pelvic collection rather than as a microbiologically confirmed infected hematoma. Conclusions: After obturator-route MUS, severe abdominal or pelvic pain, dizziness, tachycardia, hypotension, or abrupt hemoglobin decline should prompt contrast-enhanced CT to evaluate for concealed pelvic arterial bleeding and associated urinary tract extravasation. Early multidisciplinary coordination and follow-up of persistent pelvic collections may be important in complex cases. Full article

Polygonum capitatum (PC) is an ethnomedicine with reported antibacterial and anti-inflammatory activities and has been clinically used in urinary tract infection (UTI)-related disorders. However, its in vivo exposure characteristics and metabolically associated therapeutic mechanisms in acute pyelonephritis (AP) remain insufficiently understood. To address this issue, this study aimed to evaluate the therapeutic effects of PC in an Escherichia coli (E. coli)-induced rat model of AP and to explore constituents and metabolic pathways associated with its activity. Different PC extracts were screened for antibacterial and anti-inflammatory activities, and the 70% ethanol extract was selected for further study. Seven major compounds were quantified by HPLC. In AP rats, the pharmacokinetic profiles of these compounds in plasma and the renal cortex were analyzed by microdialysis-coupled HPLC-MS/MS. Pharmacodynamic evaluation included urinary bacterial load, urinalysis, renal function, inflammatory cytokines, and renal histopathology. Exploratory PK–PD analysis, untargeted renal metabolomics, and targeted metabolomics of the tryptophan–kynurenine (Trp–Kyn) pathway were also performed. The 70% ethanol extract of PC exhibited the strongest antibacterial and anti-inflammatory activities. The total content of seven active compounds was 3.85%, with gallic acid being the predominant compound (3.42%). Pharmacokinetic analysis revealed that gallic acid, protocatechuic acid, methyl gallate, and quercitrin achieved relatively high systemic exposure and renal distribution. In AP rats, the pharmacokinetic profiles of several compounds were altered, with increased plasma exposure of protocatechuic acid, vanillic acid, ethyl gallate, and syringic acid, while protocatechuic acid also showed higher exposure in the renal cortex. PC treatment reduced urinary bacterial load, improved renal function and urinalysis parameters, alleviated histopathological injury, and decreased inflammatory mediator levels, particularly in renal tissue. Exploratory PK–PD correlations were observed between several compounds and selected pharmacodynamic indicators. Metabolomic analysis suggested disturbances in glycerophospholipid metabolism and the Trp–Kyn pathway in AP rats, some of which were partially reversed after PC treatment. PC showed antibacterial and anti-inflammatory effects in AP rats. Gallic acid, protocatechuic acid, methyl gallate, and quercitrin may be candidate constituents associated with the therapeutic effects of PC, while modulation of glycerophospholipid metabolism and the Trp–Kyn pathway may be involved in its action against AP. These findings provide preclinical pharmacological evidence supporting the therapeutic potential of PC in AP. Full article

Background: Urinary tract infections (UTIs) are a leading cause of urine testing and antibiotic prescribing across healthcare settings. Despite established clinical guidelines, inappropriate practice such as unnecessary urine cultures, treatment of asymptomatic bacteriuria, suboptimal antibiotic selection, and excessive treatment duration remain common. These practices contribute to antimicrobial resistance, adverse drug events, and increased healthcare costs. Methods: This narrative review synthesises evidence from PubMed-indexed studies, including systematic reviews, randomised controlled trials, and implementation studies, to evaluate the impact of antibiotic and diagnostic stewardship interventions on UTI management. Studies assessing outcomes related to urine testing practices, antibiotic utilisation, and clinical safety were included. Discussion: The literature demonstrates that integrated stewardship interventions effectively reduce inappropriate urine testing and antibiotic use without negatively affecting patient outcomes. Diagnostic stewardship strategies such as limiting urine cultures to patients with appropriate clinical indications, implementing reflex testing algorithms, and improving result interpretation reduce downstream antibiotic overuse. When combined with antibiotic stewardship approaches including clinical decision support, audit-and-feedback, and bundled interventions, these strategies lead to sustained improvements in prescribing behaviour and care quality. Conclusions: Antibiotic and diagnostic stewardship are synergistic and essential components of optimal UTI management. Interventions targeting both diagnostic decision-making and antibiotic use can safely reduce unnecessary testing and treatment. Future stewardship efforts should prioritise integrated, multidisciplinary approaches supported by clinical decision support tools to enable real-time, sustainable improvements in UTI care across clinical settings. Full article

Background and Objectives: Urosepsis is a common cause of sepsis in adults and is associated with substantial morbidity and mortality, particularly when urinary obstruction delays timely source control. The roles of diagnostic uncertainty at presentation, microbiological phenotypes (including multidrug resistance), and biomarkers in shaping management pathways and outcomes warrant further evaluation. Materials and Methods: This retrospective, single-center, observational study included 154 consecutive adult patients hospitalized for urosepsis. Sepsis was defined according to the Sepsis-3 criteria. Baseline clinical modifiers at admission were encoded as binary variables (e.g., malignancy, urinary tract obstruction/altered anatomy, immunocompromised status, acute kidney injury [AKI], and diagnostic uncertainty). Microbiology was standardized into pathogen groups (Gram-negative, Gram-positive, or no isolate), infection complexity (mono- vs. polymicrobial), and multidrug-resistant organism (MDRO) status. Procedures were categorized as no procedure, urinary tract decompression, or other source controls. Biomarkers (C-reactive protein [CRP], procalcitonin [PCT], and creatinine) were analyzed at admission and, when available, during hospitalization. The primary outcomes were in-hospital mortality, ICU admission, and absence/delay of source control. Results: The median age was 68 years, and 60.4% of patients were male. The in-hospital mortality and ICU admission rates were 7.1% and 3.9%, respectively. Diagnostic uncertainty was present in 9.8% and was associated with a higher likelihood of no invasive intervention (86.7% vs. 43.9%, p = 0.002) and a lower rate of urinary tract decompression (13.3% vs. 45.3%, p = 0.01). Gram-negative pathogens predominated (50.0%), and MDROs were identified in 18.2% and were associated with prior urological interventions (53.6% vs. 24.6%, p = 0.003) and higher admission PCT levels (8.6 vs. 3.2 ng/mL, p = 0.04). Bacteremia was associated with mortality (14.5% vs. 2.2%, odds ratio [OR] 7.64, p = 0.007). Mortality was higher in Gram-positive infections (21.7% vs. 4.6%, OR 5.79, p = 0.012) and in patients with AKI at admission (25.0% vs. 5.7%; OR, 5.54; p = 0.043). Conclusions: Urosepsis exhibits distinct clinical and microbiological phenotypes that influence its management and outcomes. Diagnostic uncertainty at presentation was associated with reduced early source control measures, whereas MDRO infections were clustered with prior urological interventions and higher systemic inflammatory burdens. Bacteremia, Gram-positive pathogens, and AKI at admission were associated with an increased in-hospital mortality risk. These findings support a multidimensional early assessment strategy integrating clinical presentation, microbiological risk, biomarkers, and rapid evaluation of obstruction to facilitate timely source control. Full article

Background and Objectives: Candiduria is a common health problem especially among hospitalized patients. In the era of rising azole resistance, evidence from Saudi Arabia remains limited concerning Candida species. This study aimed to assess the prevalence and risk factors of Candida isolated from urine culture and to explore species distribution in relation to clinical characteristics. Materials and Methods: We retrospectively reviewed 188353 urine samples from 2013 to 2023. Using medical records, data on age, gender, hospitalization status, and urine sample type were collected. Identification of Candida species was performed by VITEK Mass Spectrometry (bioMerieux Inc.). Binary logistic regression analysis was used to identify predictors of candiduria. A p value below 0.05 at a 95% CI was considered statistically significant. Results: A total of 1667 urine samples with significant Candida growth were reported. It accounted for 0.88% of all organisms grown from urine culture and 30% of Candida grown from various body sites. Candida albicans was the most frequently identified species (n = 920, 55.2%), followed by C. tropicalis (n = 374, 22.4%), C. krusei (n = 80, 4.8%), C. glabrata (n = 78, 4.7%), and C. parapsilosis (n = 41, 2.5%). However, the rate was not stable throughout the years, and non-albicans Candida (NAC) was often the most prevalent. Female gender was the strongest predictor of candiduria (OR and AOR 1.81, 95% CI 1.46–2.25), whereas significantly lower odds were seen in elderly patients and in random urine specimens. The species distribution of NAC did not seem to change with age, gender, type of specimen, or hospitalization status. Conclusions: Among all Candida spp. isolated in the lab, 30 out of every 100 originated from urine culture, with a significant risk associated with females. The increasing prevalence of emerging Candida species in tertiary care settings can provide clinicians with valuable insights for the diagnosis and management of Candida UTI. Full article

Healthcare-associated infections (HAIs) are clinically relevant complications in critically ill stroke patients, particularly in neurological intensive care settings, where severe neurological injury, dysphagia, immobilization, invasive device exposure, and prolonged hospitalization increase infection susceptibility. Romanian data focused on deceased stroke patients admitted to neurological intensive care units remain limited. This retrospective descriptive single-center hospital-based study, supported by focused literature contextualization, was conducted in the Neurological Intensive Care Unit of the Brașov County Emergency Clinical Hospital, Romania. Adult stroke patients who died during hospitalization over a six-year observation period were included. Clinical data were extracted from a working hospital database and analyzed descriptively after data cleaning and harmonization. The final cohort comprised 190 deceased stroke patients; ischemic stroke was documented in 69.5% and hemorrhagic stroke in 28.9%. Hypertension (73.7%) and ischemic heart disease and/or previous myocardial infarction (60.0%) were the most frequently recorded comorbidities. Pneumonia was the dominant documented infectious complication, recorded in 52.6% of patients, followed by urinary tract infection (11.6%), pressure sore-related infection (4.7%), and sepsis-related coding (6.8%). The median in-hospital survival interval was 6 days (IQR 3.0–10.75). Because year-by-year stratification was not sufficiently robust, the temporal component was interpreted only in aggregate form. These findings provide a descriptive hospital-based profile of documented infectious complications in a fatal stroke ICU cohort and support the need for more standardized infection documentation and better linkage between clinical and microbiological data in neurocritical care settings. Full article

Background: Allergic rhinitis (AR) is commonly treated with intranasal and oral pharmacotherapy or allergen immunotherapy (AIT), each associated with distinct safety considerations. This study aimed to systematically evaluate and compare the safety profiles of these therapeutic approaches by analysing adverse events (AEs) reported in completed randomised controlled trials (RCTs). Methods: A meta-epidemiological analysis was conducted using completed RCTs registered in ClinicalTrials.gov up to 20 October 2023. Trials investigating intranasal drugs, oral medications, or AIT for AR were identified using predefined search terms. Adverse events were manually extracted and categorised according to treatment class and dosage. Other adverse events (OAEs) were classified using Common Terminology Criteria for Adverse Events version 5.0 (CTCAE v5.0) and Medical Dictionary for Regulatory Activities (MedDRA) terminology. Meta-analyses compared OAE incidence across treatment groups, including standard-dose, higher-dose, and placebo arms. Results: A total of 216 RCTs were included. Intranasal therapies accounted for 55.56% of trials, predominantly intranasal corticosteroids (INCS) and intranasal antihistamines (INAH). OAE incidence was 16.37% for INCS, 29.43% for INAH, and 8.71% for combination therapy. INAH was associated with higher rates of dysgeusia and nasal discomfort, while higher INCS doses were linked to an increased risk of urinary tract infections. AIT trials comprised 22.69% of studies and demonstrated higher OAE rates, particularly for sublingual immunotherapy (64.96%), followed by subcutaneous (53.98%) and intralymphatic immunotherapy (62.50%). Oropharyngeal AEs were most frequent with sublingual immunotherapy. Oral medications (18.06%) showed the lowest OAE incidence, with upper respiratory tract infections occurring more frequently with oral antihistamines. Conclusions: Among intranasal therapies, INCS demonstrated the most favourable safety profile. Sublingual immunotherapy was associated with a higher frequency of OAEs compared with other AIT modalities. Combination oral antihistamine and leukotriene receptor antagonist therapy appeared to be the safest oral treatment option. Further well-designed studies are needed to refine comparative safety assessments across AR treatments. Full article

Introduction: Urinary tract infections (UTIs) in male patients are a topic that has received less attention in the medical literature. Current management strategies recommended by most guidelines are largely based on research involving female populations, which limits their applicability to men, in whom UTIs are often considered complicated. While the COVID-19 pandemic has brought about many changes in antibiotic treatment, this study aims to compare antimicrobial resistance patterns of uropathogens in male patients between the COVID-19 pandemic and post-pandemic periods. Materials and Methods: A retrospective descriptive study including urine-culture positive cases in male patients was conducted at a tertiary-level university urology center in Bucharest, Romania. To assess temporal trends, the analysis used four selected six-month intervals during the COVID-19 pandemic (2020–2022) and the post-pandemic period (2023–2025). Inclusion was limited to adult male patients aged at least 18 years who had a single identified pathogen and significant bacteriuria (at least 10⁵ CFU/mL). Duplicate and polymicrobial samples were excluded. In accordance with CLSI guidelines, bacteria were identified and antimicrobial susceptibility was assessed using standard microbiological methods. Statistical analysis was made using Python 3.11.3. Results: A total of 3158 urine positive urine cultures from male patients were included. Gram-negative isolates were the most frequent, with E. coli being the most common urinary pathogen, followed by Klebsiella. The most common Gram-positive isolate was Enterococcus. Antimicrobial resistance in Gram-negative pathogens were higher in the post-pandemic period compared to the pandemic period, particularly to amoxicillin-clavulanic acid, and levofloxacin, with carbapenem resistance exceeding 20%. E. coli showed increased resistance rates to levofloxacin, and amoxicillin-clavulanic acid, and ceftazidime. Resistance of Klebsiella spp. exceeded 30% for imipenem and meropenem. Resistance to amoxicillin-clavulanic, ceftazidime, and imipenem acid increased in Proteus spp. Even though Pseudomonas spp. demonstrated higher resistance rates to several antibiotics, no statistical differences were observed. Enterococcus spp. showed a stable profile, demonstrating resistance to levofloxacin, penicillin, and ampicillin. Conclusion: Among male patients, uropathogens’ antimicrobial resistance was higher in the post-pandemic period compared to the COVID-19 period, particularly among Gram-negative bacteria. Regarding empirical therapy, there are significant concerns regarding the rise in resistance to antibiotics such as fluoroquinolones and β-lactams, as well as the emergence of resistance to carbapenems. Full article

Background: Diabetes mellitus is frequently associated with complications and comorbidities that often require hospitalization and the use of multiple medications for effective management. However, the simultaneous use of these treatments significantly increases the risk of potential drug–drug interactions (pDDIs). Objectives: This study assessed the prevalence, levels, and associated predictors of pDDIs among hospitalized participants with type 2 diabetes mellitus (T2DM) and evaluated their clinical relevance and implications for monitoring and management. Methods: This retrospective cross-sectional study included 430 inpatients with T2DM at Universitas Indonesia Hospital, Indonesia. Lexicomp^® Lexi-Interact™ software Wolters Kluwer was used to analyze and classify pDDIs based on severity, risk rating, and documentation levels. Additionally, logistic regression analysis was conducted to identify the predictors of pDDIs, and the study assessed the clinical relevance of major pDDIs. Results: Of the total participants, 84.7% (n = 364) experienced pDDIs, with 1642 interactions identified. Moderate interactions accounted for 77.5% (n = 1273), whereas major interactions constituted 12.2% (n = 201). The most common risk rating was category C (77.5%, n = 1187), and the predominant evidence support level was ‘fair’ (64.8%, n = 1064). Multivariate logistic regression analysis showed a significant association between pDDIs and of 7–12 medications used (OR = 30.1; p < 0.001), and hospital stays ≥4 days (OR = 9.7; p = 0.001). Major pDDIs were significantly linked to ≥13 medications (OR = 5.5; p = 0.002), ≥4 days hospitalization (OR = 11.3; p < 0.001), and urinary tract infections (OR = 3.5; p = 0.02). Participants with major pDDIs exhibited hypoglycemia, hyperglycemia, electrolyte imbalances, and reduced therapeutic responses. Conclusions: The findings indicate a high prevalence of pDDIs among participants with T2DM, highlighting the impact of polypharmacy, prolonged hospitalization, and comorbidities. Implementing software-based screening, close monitoring, and targeted interventions are essential to reduce adverse clinical outcomes and enhance patient safety. Full article

Urinary Tract Infections (UTIs) represent one of the most prevalent bacterial infections globally, posing significant health burdens, especially in low- and middle-income countries (LMICs), due to delayed diagnoses, limited access to laboratory services, and rising antimicrobial resistance. This study presents a machine learning (ML)-based diagnostic support framework for early UTI detection, leveraging structured clinical data and explainable artificial intelligence (XAI) techniques to enhance interpretability and trust among healthcare providers. A patient dataset containing 4865 records was used in the study to train and test Extreme Gradient Boosting (XGBoost), Decision Tree (DT) and Random Forest (RF) classifiers, while class imbalance was addressed using Synthetic Minority Over-sampling Technique (SMOTE). The performance of the models was evaluated through accuracy, precision, recall, F1-score, Log Loss, and AUC-ROC, and random forest showed the best results (accuracy: 86.43%, F1-score: 86.71%, AUC-ROC: 0.8695). To ensure that such models can be adopted by stakeholders in the health sector, Local Interpret-able Model-agnostic Explanations (LIME) were integrated, which identified painful urination, urinary frequency, and suprapubic pain as primary predictors in the model. This study shows that interpretable ML models can be helpful in resource-limited regions in predicting UTIs, thereby rendering a solution to improve the management of infections in these regions. Full article