Infections

To assess whether the US News and World Report (USNWR) Urology specialty ranking methodology accurately captures and classifies complications following elective outpatient urology procedures.

We conducted electronic health record chart review of n = 80 elective, outpatient urology procedures with complications from 2019-2023 across 4 hospitals in our integrated US health system.

Aim: Compared with uncomplicated urinary tract infections (UTIs), complicated UTIs (cUTIs) including acute pyelonephritis (AP) present with significant morbidity, a higher risk of treatment failure and typically require longer courses of treatment, or alternative antibiotics.

Urological infections significantly impact the wellbeing and quality of life of individuals owing to their widespread occurrence and diverse clinical manifestations. The objective of the guidelines panel was to provide evidence-based guidance on the diagnosis, treatment, and prevention of urinary tract infections (UTIs) and male accessory-gland infections, while addressing crucial public health aspects related to infection control and antimicrobial stewardship.

The goal of the study was to determine predictive accuracy of a negative urinalysis for negative urine culture and the absence of urinary tract infection in men both with and without indwelling urinary catheters. Similar to our findings in women (PMID 36898589), when urinalysis was negative (LE, WBC, nitrite) in men, only 5% of urine cultures grew uropathogenic bacteria, and only 1% of negative urinalyses were associated with urinary tract infection.

To determine accuracy of negative urinalysis (UA) for predicting negative urine culture and the absence of urinary tract infection (UTI), and optimal urine culture growth cutoff for UTI diagnosis in men with and without urinary catheters.

Background: Urinary tract infection (UTI) represents one of the most common infectious diseases and a major cause of antibiotic prescription in children. To prevent recurrent infections and long-term complications, low-dose continuous antibiotic prophylaxis (CAP) has been used.

Importance: Urinary tract infection (UTI) is the most common bacterial infection for which empiric antibiotics are prescribed despite limited progression to urosepsis. More than half of antibiotics prescribed to older adults for a suspected UTI are considered unnecessary.

Objective: The aim of the study was to assess knowledge, attitudes, and practices regarding management of older women (>65 years) with symptoms attributed to UTIs among family and internal medicine providers.

Study design: This cross-sectional study surveyed 330 primary care providers in November 2021 regarding management of UTI symptoms. The primary outcome was the proportion of primary care providers who felt safe waiting for urine culture results before prescribing antibiotics in older women.

Results: The response rate was 43.0% (n = 142) with the majority of primary care providers practicing medicine more than 15 years (56.3%). For the primary outcome, 26.1% (n = 37) of primary care providers felt safe waiting for a urine culture result before prescribing antibiotics, while 62.0% (n = 88) felt delaying antibiotics depended on multiple factors, and 9.2% (n = 13) felt it was never safe to delay antibiotics. Primary care providers that either never felt it was safe to delay antibiotics or felt that "it depends" on a variety of factors, attributed their antibiotics administration to concern for progression to sepsis (n = 50, 49.5%) or progression of symptoms (n = 28, 27.7%). A higher proportion of primary care providers practicing more than 15 years felt safe delaying antibiotics compared with primary care providers with less experience (33.8% vs 18.3%, P = 0.04), and 70.3% of those who felt safe delaying antibiotics had more than 15 years of experience.

Conclusion: Primary care providers with more clinical experience have more comfort delaying antibiotics in older women with UTI symptoms.

Ashley Murillo, Selma Su, Halina Zyczynski, Megan Bradley

From the Division of Urogynecology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, PA.

Source: Murillo A, Su S, Zyczynski H, et al. Management of Urinary Tract Infection Symptoms in Older Women: A Survey of Practitioners. Urogynecology (Phila). 2024 Apr 1;30(4):452-456. doi: 10.1097/SPV.0000000000001416.

Children with a neurogenic bladder are at risk of developing recurrent urinary tract infections and long-term kidney failure. Due to an altered lower urinary tract, children may be overtreated for simple bacteriuria or undertreated for a potentially severe urinary tract infection.

Approximately 85% of women experience an obstetric tear at delivery and up to 25% subsequently experience wound dehiscence and/or infection. Previous publications suggest that intravenous antibiotics administrated during delivery reduces this risk.

Antimicrobial stewardship programmes are needed in long-term care facilities (LTCFs) to tackle antimicrobial resistance. We aimed to identify factors associated with antibiotic use in LTCFs. Such information would be useful to guide antimicrobial stewardship programmes.