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Background. Women suffering from recurrent urinary tract infections (rUTIs) are routinely treated for asymptomatic bacteriuria (AB), but the consequences of this procedure on antibiotic resistance are not fully known. The aim of this study was to evaluate the impact of AB treatment on antibiotic resistance among women with rUTIs. Methods. The study population consisted of 2 groups of women who had previously been enrolled in a randomized clinical trial: group A was not treated, and group B was treated. All women were scheduled for follow-up visits every 6 months, or more frequently if symptoms arose. Microbiological evaluation was performed only in symptomatic women. All women were followed up for a mean of 38.8 months to analyze data from urine cultures and antibiograms. Results. The previous study population consisted of 673 women, but 123 did not attend the entire follow-up period. For the final analysis, 257 of the remaining 550 patients were assigned to group A, and 293 to group B. At the end of follow-up, the difference in recurrence rates was statistically significant (P < .001): 97 (37.7%) in group A versus 204 (69.6%) in group B. Isolated Escherichia coli from group B showed higher resistance to amoxicillin–clavulanic acid (P = .03), trimethoprim-sulfamethoxazole (P = .01), and ciprofloxacin (P = .03) than that from group A. Conclusions. This study shows that AB treatment is associated with a higher occurrence of antibiotic-resistant bacteria, indicating that AB treatment in women with rUTIs is potentially dangerous.

Background In patients with asymptomatic bacteriuria undergoing hip arthroplasty, the risk of prosthetic joint infection (PJI) and appropriateness of specific antibiotics are unclear. Questions/purposes We determined (1) the prevalence of asymptomatic bacteriuria; and (2) the incidence of PJI in patients with asymptomatic bacteriuria managed with or without specific antibiotics. Methods We conducted a prospective, randomized study of all 471 patients without urinary symptoms receiving a total hip arthroplasty (THA; n = 228; average age 68 years; 122 female) or hemiarthroplasty (HA; n = 243; average age 85 years; 170 female) between April 2009 and November 2010. No patients were catheterized in the perioperative period and all received intravenous cefazolin (allergy, vancomycin) for 48 hours postoperatively. Urinalysis was conducted on all patients; if abnormal, a urine culture was performed. Patients with bacteriuria (> 100,000 colonies/mL cultured) were randomly assigned to receive specific antibiotics (Group A) or not (Group B). Minimum followup was 1 month including those six who died or were lost to followup (average, 10.4 months; range, 1–12 months). Results Asymptomatic bacteriuria occurred in eight of 228 patients undergoing THAs (three of eight with specific antibiotics) and 38 of 243 patients undergoing HAs (23 of 38 with specific antibiotics). Arthroplasty infection after 3 months occurred in one of 228 patients undergoing THAs and 12 of 243 patients undergoing HAs (six of 117 in Group A and six of 126 in Group B); bacteria cultured from the wound were dissimilar to those cultured in urine samples in any case. No patient presented signs of PJI by 1 year after the index surgery. Conclusions We identified no case of PJI from urinary origin in patients with asymptomatic bacteriuria whether or not they had been treated with specific antibiotics. Level of Evidence Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

ObjectivesThe aim of this study was to investigate the impact of age on the diagnostic properties of typical symptoms of urinary tract infection (UTI) in women presenting in general practice with symptoms suggestive of UTI with significant bacteriuria as the reference standard.DesignDiagnostic accuracy study.SettingGeneral practice, Copenhagen, Denmark.ParticipantsAdult 15 years or older. Women presenting in general practice with symptoms suggestive of UTI where urine was collected for investigation.Primary and secondary outcome measuresAccuracy of four symptoms of UTI (dysuria, frequency, urge and abdominal pain) in six different age groups.Results90 practices included 1178 adult women. The prevalence of bacteriuria varied between 30% in women aged 30–44 years and 67% in women aged 75–89 years. The likelihood ratios for dysuria varied between age groups with the best performance in women aged 15–29 (positive likelihood ratio (pLR): 1.62 (1.30–1.94), negative likelihood ratio (nLR): 0.36 (0.19–0.54)) and women aged 30–44 (pLR: 1.74 (1.30–2.17), nLR: 0.48 (0.27–0.68)). CIs included or approximated one for the remaining symptoms in most age groups. When symptoms were combined to calculate post-test probabilities, the combined effect of the varying prevalence of bacteriuria and the varying diagnostic values resulted in a large variation of the post-test probabilities between age groups.ConclusionsThe diagnostic value of symptoms of UTI as well as the prevalence of bacteriuria in women presenting to general practice with suspected UTI vary between age groups with considerable clinical implications. Diagnostic studies should take demographics such as age into consideration.Trial registration numberClinicalTrials.gov: NCT02698332.

Purpose To evaluate the impact of the type of urinary diversion (suprapubic vs. transurethral catheterization) on patients’ postoperative pain after radical prostatectomy, development of bacteriuria and long-term functional results. Methods A randomized, prospective clinical trial was performed including 160 patients who underwent robot-assisted radical prostatectomy after randomization into two groups: intraoperatively, a transurethral catheter (control group) or an additional suprapubic tube (with removal of the transurethral catheter in the morning of postoperative day 1; intervention group) was placed. Primary study endpoint was postoperative pain objectified by the numeric rating scale questionnaire. Secondary endpoints were bacteriuria after catheter removal and functional outcomes after up to 2 years of follow-up. Results There were no significant differences in demographic and perioperative data. Starting on postoperative day 2, patients in the suprapubic diversion group had significantly less pain on every time point preceding the removal of the catheter compared to the control cohort with a median overall numeric rating score on postoperative day 1–4 of 2.4 points in the transurethral versus 1.3 in the intervention group ( p  = 0.012). No statistical difference was found in postoperative bacteriuria and complications as well as in functional results, quality of life and incontinence rates after a median follow-up of 22 months. Conclusions Suprapubic drainage in robot-assisted radical prostatectomy shows significantly decreased pain levels during the catheterization period compared to the transurethral diversion without compromising long-term functional results. Intraoperative placement of a suprapubic tube should be discussed as a standard procedure for further improvement of patients’ postoperative comfort.

Background. Persistent Escherichia coli asymptomatic bacteriuria (ASB) is common among persons with diabetes mellitus, but the duration of colonization and the rates of recolonization are unknown. We estimated the duration of colonization and the rate of recolonization among successively isolated E. coli from diabetic women with ASB and compared the virulence profiles with uropathogenic and commensal E. coli. Methods. A total of 105 women with diabetes were enrolled in a randomized, controlled clinical trial for treatment of ASB in Manitoba, Canada, and were observed at least every 3 months for up to 3 years. We analyzed 517 isolates from 70 women with repeated E. coli ASB for genetic similarity using enterobacterial repetitive intergenic consensus polymerase chain reaction. Unique strains were screened for uropathogenic virulence characteristics using dot blot hybridization and compared with different collections of E. coli isolates. Results. On average, differences were found among women assigned to treatment for ASB, those treated only for symptomatic infections, and untreated women in (1) follow-up time with bacteriuria (29%, 31%, and 66%, respectively; P<.001), (2) duration of bacteriuria (2.2, 2.5, and 3.7 months, respectively; P=.04), and (3) carriage of unique isolates (2.4, 2.8, and 4 months, respectively; P=.03). Women assigned to antibiotic treatment usually had recurrent infection (76%), 64% of the time with a genetically new E. coli strain. Virulence characteristics of these isolates were comparable to those of fecal isolates from healthy women. Conclusions. Treatment may reduce the overall proportion of time infected in the long term and carriage of a unique strain, but most treatment regimens were followed by subsequent recolonization. Infecting strains did not have virulence factors characteristic of uropathogenic E. coli.

Urinary tract infections (UTIs) are a major complication in patients with acute-to-subacute stroke. Asymptomatic bacteriuria is prevalent in this population, and the role of prophylactic antibiotics remains unclear. This study evaluated whether prophylactic antibiotics reduces the incidence of symptomatic UTI in patients with acute-to-subacute stroke with asymptomatic bacteriuria. This retrospective cohort study analyzed 111 patients with acute-to-subacute stroke and asymptomatic bacteriuria at a Taiwanese medical center. Participants were stratified into intervention ( n  = 38, receiving oral prophylactic antibiotics) and control ( n  = 73, no antibiotics) groups. The study compared the incidence of urinary tract infections between two groups. A subgroup analysis of subacute patients with stroke was performed to confirm the antibiotics’ protective effect. UTI incidence in the intervention and control groups were 2.7% and 32.73%, respectively ( p  = 0.003). Multivariate logistic regression revealed a 93% reduced risk of symptomatic UTI in the intervention versus the control group ( p  = 0.025). Subgroup analysis demonstrated the persistent protective effect of oral prophylactic antibiotics ( p  = 0.036). Prophylactic antibiotic treatment effectively reduced symptomatic UTI incidence among patients with acute-to-subacute stroke with asymptomatic bacteriuria. Future multicenter randomized controlled trials are warranted to standardize treatment protocols and evaluate long-term outcomes in this vulnerable population.

Background Urinary tract infection (UTI) in pregnancy, including asymptomatic bacteriuria, is associated with maternal morbidity and adverse pregnancy outcomes, including preterm birth and low birthweight. In low-middle income countries (LMICs), the capacity for screening and treatment of UTIs is limited. The objective of this study was to describe the population-based prevalence, risk factors, etiology and antimicrobial resistance patterns of UTIs in pregnancy in Bangladesh. Methods In a community-based cohort in Sylhet district, Bangladesh, urine specimens were collected at the household level in 4242 pregnant women (< 20 weeks gestation) for culture and antibiotic susceptibility testing. Basic descriptive analysis was performed, as well as logistic regression to calculate adjusted odds ratios (aOR) for UTI risk factors. Results The prevalence of UTI was 8.9% (4.4% symptomatic UTI, 4.5% asymptomatic bacteriuria). Risk factors for UTI in this population included maternal undernutrition (mid-upper arm circumference <23 cm: aOR= 1.29, 95% CI: 1.03–1.61), primiparity (aOR= 1.45, 95% CI: 1.15–1.84), and low paternal education (no education: aOR= 1.56, 95% CI: 1.09–2.22). The predominant uro-pathogens were E. coli (38% of isolates) , Klebsiella (12%), and staphyloccocal species (23%). Group B streptococcus accounted for 5.3% of uro-pathogens. Rates of antibiotic resistance were high, with only two-thirds of E. coli susceptible to 3 rd generation cephalosporins. Conclusions In Sylhet, Bangladesh, one in 11 women had a UTI in pregnancy, and approximately half of cases were asymptomatic. There is a need for low-cost and accurate methods for UTI screening in pregnancy and efforts to address increasing rates of antibiotic resistance in LMIC.

Background In pregnant women, asymptomatic bacteriuria is a public health problem. Untreated asymptomatic bacteriuria is the primary cause of cystitis and pyelonephritis, which increase prenatal mortality and morbidity. Limited research has been conducted on asymptomatic bacteriuria in our study setting. Thus, this study aimed to assess antimicrobial susceptibility and risk factors of asymptomatic bacteriuria among pregnant women who attended antenatal care at public health facilities in Debre Markos town, Northwest Ethiopia. Methods Using a consecutive convenience sampling technique, an institutionally based cross-sectional study was carried out in Debre Markos town's health facilities between May 1, 2023, and July 30, 2023. Pretested structured questionnaires were used to collect clinical and sociodemographic data. Additionally, a sterile container was used to collect the midstream urine sample, which was then inoculated onto sheep blood agar, MacConkey agar (MAC), and cysteine-lactose-electrolyte-deficient agar (CLED). Gram stain, biochemical tests, and colony morphology were used to identify and characterize the isolates. On Mueller–Hinton agar (MHA), the disk diffusion method was used to determine the antimicrobial susceptibility pattern. EpiData 3.0 was used to enter the data. Finally, bivariable and multivariable logistic regression was performed via SPSS version 23 to identify related factors, with a P value < 0.05 being deemed statistically significant. Results The overall prevalence of asymptomatic significant bacteriuria (ASB) among study participants was 30/185 (16.2%; 95% CI 10.8–21.6). Escherichia coli ( E. coli) 13/30 (43.3%) is the predominant isolates, and followed by Staphylococcus aureus ( S. aureus) accounting for 10/30 (33.3%), Coagulase-negative Staphylococcus (CoNS) 6/30 (20.0%), and Pseudomonas aeruginosa ( P. aeruginosa) 2/30 (3.3%) decreasingly. Six (100%) CoNS isolates were susceptible to norfloxacin, trimethoprim-sulfamethoxazole, tetracycline, and nitrofurantoin. About 11/13 (84.6%) of E. coli was susceptible to ceftriaxone, imipenem, gentamicin, and norfloxacin. In contrast, E. coli was resistant to cefuroxime 6/13 (54.5%) and amoxicillin-clavulanic acid 9/13 (69.2%). Despite this, only a few number of P. aeruginosa strains were isolated, and were 100% susceptible to amoxicillin-clavulanic acid, ciprofloxacin, meropenem, and norfloxacin. Asymptomatic bacteriuria was significantly associated with a history of UTI (AOR = 7.281; 95% CI: 2.53–20.96; P  = 0.001), catheterization (AOR = 6.985; 95% CI: 1.61–28.91; P  = 0.007), diabetes mellitus (AOR = 5.009; 95% CI: 1.55–16.19; P  = 0.007), and vaginal douching (AOR = 3.125; 95% CI: 1.10–8.92; P  = 0.033) by considering P  < 0.05 as significant association. Conclusion ASB prevalence was 16.2%; E. coli was the predominant isolate; the MDR rate was 40%. Diabetes, vaginal douching, catheterization, and prior UTI were associated with ASB. Routine urine culture should be considered for targeted screening and culture-guided therapy for high-risk groups. Further studies are needed to evaluate prophylaxis and treatment outcomes.

Urinary tract infections (UTIs) are one of the most common infections reported in older adults, across all settings. Although a diagnosis of a UTI requires specific clinical and microbiological criteria, many older adults are diagnosed with a UTI without meeting the diagnostic criteria, resulting in unnecessary antibiotic treatment and their potential side effects, and a failure to find the true cause of their presentation to hospital. The aim of this study was to evaluate the accuracy of UTI diagnoses amongst hospitalized older adults based on clinical and microbiological findings, and their corresponding antibiotic treatment (including complications), in addition to identifying possible factors associated with a confirmed UTI diagnosis. A single-center retrospective cross-sectional study of older adult patients (n = 238) hospitalized at the University of Alberta Hospital with an admission diagnosis of UTI over a one-year period was performed. 44.6% (n = 106) of patients had a diagnosis of UTI which was supported by documents clinical and microbiological findings while 43.3% (n = 103) of patients had bacteriuria without documented symptoms. 54.2% (n = 129) of all patients were treated with antibiotics, despite not having evidence to support a diagnosis of a UTI, with 15.9% (n = 37) of those patients experiencing complications including diarrhea, Clostridioides difficile infection, and thrush. History of major neurocognitive disorder was significantly associated with diagnosis of UTI (p = 0.003). UTIs are commonly misdiagnosed in hospitalized older adults by healthcare providers, resulting in the majority of such patients receiving unnecessary antibiotics, increasing the risk of complications. These findings will allow for initiatives to educate clinicians on the importance of UTI diagnosis in an older adult population and appropriately prescribing antibiotics to prevent unwanted complications.

Soil‐transmitted helminths (STHs) and urinary tract infections (UTIs) pose major public health challenges, especially in regions with poor healthcare access, inadequate sanitation, and limited clean water supply. When these two conditions recur, they can cause stunted growth in children between 24 and 59 months of age, a vital phase for physical development. This study sought to assess the prevalence of STHs and asymptomatic bacteriuria among preschool children aged 1–5 years in the Bosomtwe District. A total of 344 children from 5 educational circuits were randomly selected for this study. Fecal specimens were obtained from each child and examined for STHs via the formol‐ether concentration method, while urine samples were inoculated onto CLED agar to isolate and identify asymptomatic bacteriuria isolates. Antibiotic susceptibility was assessed using the Kirby–Bauer disk diffusion test. Participant demographics were obtained using a predesigned and structured survey questionnaire. The study found a prevalence of 19.8% (68/344) for STHs and 44.8% (154/344) for bacteriuria, with 6.1% (21/344) having both infections. Ascaris lumbricoides was the most common STH, accounting for 12.2% (42/344), followed by Trichuris trichiura 4.4% (15/344) and hookworm 3.2% (11/344). More males, 24.2% (40/165), than females, 15.6% (28/179), were affected by STHs. The Kuntenase circuit recorded the highest STH positivity with 26.1% (18/69). For bacteriuria, more females, 47.5% (85/179), than males, 41.8% (69/165) were affected, with age 5 being the most at‐risk group, 46.6% (41/88). Escherichia coli was the most isolated Bacteriuria pathogen, 37.5% (129/344), followed by Klebsiella spp. 6.1% (21/344) and Proteus spp. 1.2% (4/344). Gentamicin was the most effective antibiotic against Bacteriuria isolates. Given the high prevalence of both STHs and bacteriuria, stakeholders should ensure better sanitation and health services, distribute anthelminthic drugs regularly, and raise awareness of bacteriuria in the district.