Relationship between urinalysis findings and responsible pathogens in children with urinary tract infections

Ünsal, Hilal; Kaman, Ayşe; Tanır, Gönül

doi:10.1016/j.jpurol.2019.09.017

Cited by 15 publications

(14 citation statements)

References 17 publications

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“…In another study conducted in Kosovo, the second most commonly isolated pathological agent was the Proteus species [ 10 ]. In two other studies from Turkey, Klebsiella species growths were reported as the second most common, similar to our finding [ 11 , 12 ]. Kidwai et al reported S. aureus and Klebsiella species as the second most common growths after E. coli in patients in low socioeconomic strata [ 13 ].…”

Section: Discussionsupporting

confidence: 93%

“…Moreover, the microorganisms reproduced in the culture of patients with UTI may also be related to sex. Similar to our results, previous studies reported that the proportion of females was higher among patients with E. coli growths, and the male-to-female ratio was close to 1 among patients with Klebsiella species growths [12].…”

Section: Discussionsupporting

confidence: 92%

“…The susceptibility of E. coli strains to ampicillin has been reported to range from 11.6% to 28% [12,15], and its susceptibility to fosfomycin ranged from 60% to 98% [7,13,16]. On the other hand, the sensitivity to nitrofurantoin was found to be high in many studies (86.45%-94%) but low (59%) in the study of Kidwai et al [1,7,8,13,15,16].…”

Section: Discussionmentioning

confidence: 95%

“…Although studies on the antibiotic resistance pattern of all gram-negative growths are limited in the literature, studies on the growth of E. coli and Klebsiella species have been conducted in different centers. The susceptibility of E. coli strains to ampicillin has been reported to range from 11.6% to 28% [ 12 , 15 ], and its susceptibility to fosfomycin ranged from 60% to 98% [ 7 , 13 , 16 ]. On the other hand, the sensitivity to nitrofurantoin was found to be high in many studies (86.45%-94%) but low (59%) in the study of Kidwai et al [ 1 , 7 , 8 , 13 , 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

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Bacteria Causing Community-Acquired Urinary Tract Infections and Their Antibiotic Susceptibility Patterns in Outpatients Attending at a State Hospital in Turkey

Öztürk

Tazegül

2021

Cureus

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IntroductionClinicians should know the frequency and resistance patterns of bacteria that cause urinary tract infections (UTI) to provide patients with appropriate treatment and antibiotic management. However, the frequency of culture reproducing organisms and resistance patterns change in each community. Therefore, these data must be determined locally to make better treatment decisions. Herein, we aimed to determine the frequency of UTI-causing agents and current antimicrobial resistance profiles in outpatients attending our hospital. MethodsThis retrospective descriptive study included three hundred eight outpatients attending under the diagnosis of UTI between March and October 2020 who had a positive urine culture for bacterial growth. Age, sex, laboratory tests, urinalysis results, microorganisms grown in urine culture, and antibiograms were evaluated from the patients' medical records. Data were analyzed using SPSS version 23.0 (IBM Corp., Armonk, NY) for Windows. ResultsIn urine culture results, Escherichia coli (E. coli) and Klebsiella species are the most commonly detected agents. The growth in 71 (23%) of the 308 cultures was extended-spectrum beta-lactamase (ESBL) positive.In the E. coli growths, the susceptibility rates to fosfomycin, gentamicin, nitrofurantoin, trimethoprimsulfamethoxazole, and ampicillin were 95.2%, 90.3%, 95.3%, 76.8%, and 49.3%, respectively. The susceptibility of Klebsiella species to gentamicin was as high as 93.7%, similar to that of E. coli, whereas its susceptibility rates to fosfomycin, trimethoprim-sulfamethoxazole, and nitrofurantoin were lower than those of E. coli (76.1%, 48.4%, and 68.4%, respectively). Of the 71 ESBL-positive growths, 52 were E. coli (17.3% of all UTIs), and 14 were Klebsiella species (4.6% of all UTIs). Of the ESBL-positive strains, 88.7%, 81%, and 76.1% were susceptible to fosfomycin and nitrofurantoin, respectively, and 64.9% and 45.7% were sensitive to cefoxitin and trimethoprim-sulfamethoxazole. ConclusionUTIs are among the most common causes of hospital admission and infections for which empirical antibiotic administration is initiated. The increasing rates of ESBL positivity and resistance to antibiotics such as ampicillin, cephalosporins, trimethoprim-sulfamethoxazole, and quinolones, especially in E. coli and Klebsiella strains, which are the most common pathological agents of UTI in our region, have limited the use of these treatments. However, the high susceptibility of E. Coli growths to fosfomycin and nitrofurantoin and susceptibility of Klebsiella growths to gentamicin may make these antibiotics stand out as suitable options for the empirical treatment of UTI in our setting.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Bacteria Causing Community-Acquired Urinary Tract Infections and Their Antibiotic Susceptibility Patterns in Outpatients Attending at a State Hospital in Turkey

Öztürk

Tazegül

2021

Cureus

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“…A number of predictive models have been constructed to aid the diagnosis and management of UTIs in children, with varying success. Individual biomarkers have been proposed for guiding diagnosis (6,7), treatment and prognostication, while others propose combining routinely collected information to provide quantitative risk-based assessments (8,9). The lack of explanability and user engagement may be the reason many predictive models, regardless of their accuracy, fail to be successfully implemented or utilised (10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Urinary tract infections in children: building a causal model-based decision support tool for diagnosis with domain knowledge and prospective data

Ramsay

Mascaro

Campbell

et al. 2022

Preprint

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BackgroundDiagnosing urinary tract infections (UTIs) in children in the emergency department (ED) is challenging due to the variable clinical presentations and difficulties in obtaining a urine sample free from contamination. Clinicians need to weigh a range of observations to make timely diagnostic and management decisions, a difficult task to achieve without support due to the complex interactions among relevant factors. Directed acyclic graphs (DAG) and causal Bayesian networks (BN) offer a way to explicitly outline the underlying disease, contamination and diagnostic processes, and to further make quantitative inference on the event of interest thus serving as a tool for decision support.MethodsWe prospectively collected data on children present to ED with suspected UTIs. Through knowledge elicitation workshops and one-on-one meetings, a DAG was co-developed with domain experts (the Expert DAG) to describe the causal relationships among variables relevant to paediatric UTIs. The Expert DAG was combined with prospective data and further domain knowledge to inform the development of an application-oriented BN (the Applied BN), designed to support the diagnosis of UTI. We assessed the performance of the Applied BN using quantitative and qualitative methods.ResultsWe summarised patient background, clinical and laboratory characteristics of 431 episodes of suspected UTIs enrolled from May 2019 to November 2020. The Expert DAG was presented with a narrative description, elucidating how infection, specimen contamination and management pathways causally interact to form the complex picture of paediatric UTIs. Parameterised using prospective data and expert-elicited parameters, the Applied BN achieved an excellent and stable performance in predicting E.coli culture results, with a mean AUROC of 0.86 and a mean log loss of 0.48 based on 10-fold cross-validation. The BN predictions were reviewed via a validation workshop, and we illustrate how they can be presented for decision support using three hypothetical clinical scenarios.ConclusionCausal BNs created from both expert knowledge and data can integrate case-specific information to provide individual decision support during the diagnosis of paediatric UTIs in ED. The model aids the interpretation of culture results and the diagnosis of UTIs, promising the prospect of improved patient care and judicious use of antibiotics.

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Biomarkers for urinary tract infection: present and future perspectives

Mattoo,

Spencer

2024

Pediatr Nephrol

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Relationship between urinalysis findings and responsible pathogens in children with urinary tract infections

Cited by 15 publications

References 17 publications

Bacteria Causing Community-Acquired Urinary Tract Infections and Their Antibiotic Susceptibility Patterns in Outpatients Attending at a State Hospital in Turkey

Bacteria Causing Community-Acquired Urinary Tract Infections and Their Antibiotic Susceptibility Patterns in Outpatients Attending at a State Hospital in Turkey

Urinary tract infections in children: building a causal model-based decision support tool for diagnosis with domain knowledge and prospective data

Biomarkers for urinary tract infection: present and future perspectives

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