Asymptomatic Bacteriuria and Urinary Tract Infection in Pregnant Women with and without Diabetes Mellitus and Gestational Diabetes Mellitus—A Case-Control Study

Background: Asymptomatic bacteriuria (ASB) and urinary tract infections (UTI) during pregnancy may contribute to adverse pregnancy outcomes. Diabetes mellitus (DM) and gestational diabetes mellitus (GDM) are considered to be important additional risk factor for ASB and UTI during pregnancy. Aims: To investigate differences in prevalence of ASB and incidence of UTI in pregnant women with and without DM and GDM to inform ASB screening and treatment policies. Methods: Data from 214 pregnant women who gave birth during 2010 at the Women’s and Children’s Hospital, Adelaide, Australia where cases were women with a clinical diagnosis of (G)DM and controls were matched on date of birth. ASB was defined as the growth of at least 10e5 colony forming units/ml of one organism or any presence of group B streptococcus (GBS) at the first urine culture collected during pregnancy without complaints of a UTI. A clinical UTI was diagnosed by the treating physician, in combination with a positive urine culture it was defined as culture-confirmed UTI. Results: No significant differences in prevalence of ASB (5.6% and 3.7%;relative risk (RR) 1.50;95% confidence intervals (CI) 0.44 - 5.17), incidence of clinical UTI (4.7% and 11.2%;RR 0.42;95% CI 0.15 - 1.14) or culture-confirmed UTI (2.8% and 3.7%;RR 0.75;95% CI 0.17 - 3.27) between pregnant women with and without (G)DM were present. No association was found between ASB and UTI. GBS was the most common causative organism of ASB in women with and without DM (66.7% and 50.0%). Conclusion: In contrast with earlier research, no significant differences in prevalence of ASB or incidence of UTI was found between pregnant women with and without (G)DM.

Effect of "Fuzheng Qingre Tonglin" prescription on rats with complicated urinary tract infection caused by ESBLs-producing Escherichia coli

Objective: To observe the effect of traditional Chinese medicine "Fuzheng Qingre Tonglin"prescription on rats with complicated urinary tract infection caused by extended-spectrumβ-lactamases (ESBLs)-producing Escherichia coli and its possible mechanism. Methods:Specific-pathogen-free female SD rats with 7-9 weeks old were randomly divided into model group, levofloxacin group, low-dose Fuzheng Qingre Tonglin group, high-dose Fuzheng Qingre Tonglin group, levofloxacin+Fuzheng Qingre Tonglin group (n=8 in each above group), and also there was a control group with 5 rats. Each group was administered intragastrically 2 days after model establishment for 14 consecutive days. The general condition of the rats was observed. Renal pathological changes were observed by light microscopy under hematoxylin-eosin staining. The number of white blood cells and the percentage of neutral particles (NEUT%) were detected. ELISA was used for the determination of C-reactive protein (CRP), CD4+, CD8+ in the blood, and secretory immunoglobulin A (SIgA), N-acetyl-β-D-glucosidase (NAG) molecules in urine. Results: There were a large number of inflammatory cells in the kidney of the model group and the levofloxacin group. The inflammatory cells in the treatment group were significantly reduced. The NEUT% and CRP in the blood of each treatment group and the NAG in the urine were significantly lower than those in the model group (P<0.05), except levofloxacin group. Compared with the model group, except for the levofloxacin group, serum CD4 concentration and CD4/CD8 ratio in the other treatment groups were significantly decreased, and CD8 molecules were significantly increased (P<0.05). Conclusion: "Fuzheng Qingre Tonglin" can alleviate systemic and local inflammation of complicated urinary tract infections in rats. It may also have the effect of re-sensing the insensitive antibacterial drug to bacteria and may have the function of regulating immune function and protecting kidney function in rats.

Urgent call for attention to diabetes-associated hospital infections

In this editorial,we discuss the recent article by Zhao et al published in the World Journal of Diabetes,which highlights the importance of recognizing the risk indicators associated with diabetes mellitus(DM).Given the severe implications of healthcare-associated infections(HAIs)in hospitalized individuals-such as heightened mortality rates,prolonged hospitalizations,and increased costs-we focus on elucidating the connection between DM and nosocomial infections.Diabetic patients are susceptible to pathogenic bacterial invasion and subsequent infection,with some already harboring co-infections upon admission.Notably,DM is an important risk factor for nosocomial urinary tract infections and surgical site infections,which may indirectly affect the occurrence of nosocomial bloodstream infections,especially in patients with DM with poor glycemic control.Although evidence regarding the impact of DM on healthcare-associated pneumonias remains inconclusive,attention to this potential association is warranted.Hospitalized patients with DM should prioritize meticulous blood glucose management,adherence to standard operating procedures,hand hygiene practices,environmental disinfection,and rational use of drugs during hospitalization.Further studies are imperative to explore the main risk factors of HAIs in patients with DM,enabling the development of preventative measures and mitigating the occurrence of HAIs in these patients.

Disseminated osteomyelitis after urinary tract infection in immunocompetent adult:A case report

BACKGROUND Urinary tract infection(UTI)is one of the most common bacterial infections.Acute pyelonephritis or upper urinary tract infection is often accompanied by bacteremia;however,bacteremia resolves in most cases without complication.Rarely,complications due to bacteremia occur.One of these is osteomyelitis.It mainly affects the lumbar vertebral bodies,and rarely affects other site.CASE SUMMARY An 80-year-old woman presented to the hospital with a two-month history of pain in both legs.Two months ago,she was admitted to the hospital for fever,flank pain,and urinary frequency and was diagnosed with bacteremic UTI.During hospitalization,she complained of pain in both legs;however,the pain resolved shortly after,and no abnormalities were observed on physical examination.Therefore,she was placed on 2-wk antibiotic therapy for UTI without further evaluation for leg pain.However,pain recurred after discharge and persisted;therefore,an imaging test was performed.Bone scan and magnetic resonance imaging suggested osseous infection in both femurs,tibiae and patellae.Surgical treatment was performed,and tissue-and bone cultures revealed Escherichia coli,a previously observed pathogen,which demonstrated same antibiotic sensitivities,as noted in previous UTI.She was diagnosed with disseminated osteomyelitis,as a complication of UTI,and was placed on an 8-wk antibiotic therapy.CONCLUSION Indication for osteomyelitis should be high regardless of bone pain at sites other than lumbar spine after or during UTI.

Recurrence of urinary tract infections in postmenopausal diabetic women using different antibiotics

Objectives: Postmenopausal women with diabetes mellitus (DM) have an increased incidence of urinary tract infections (UTI) compared to women without DM. The aim of this study is to compare recurrence rates of UTI in postmenopausal women with DM after treatment with nitrofurantoin, the agent of first choice following the Dutch guidelines, with two other common prescribed antibiotics trimethoprim and norfloxacin. Methods: We used a PHARMO database with pharmacy dispensing data. A total of 8534 postmenopausal (>55 years) women with DM who received a first course of nitrofurantoin, trimethoprim or norfloxacin were included. The UTI recurrence rates after treatment with these three different antimicrobial agents were compared. Recurrence was defined as a second prescription for nitrofurantoin, trimethoprim or norfloxacin or a first with fosfomycin, amoxicillin, fluoroquinolones, or trimethoprim/sulfamethoxazole between 6 and 30 days after inclusion. Results: Postmenopausal women with DM had significantly more UTI recurrences when they were treated with nitrofurantoin (22.7%) compared to trimethoprim (17.7%) or norfloxacin (14.2%) irrespective of the treatment duration. There was a trend that longer treatment duration was associated with higher recurrence rates. Conclusions: Postmenopausal women with DM had more UTI recurrences when they are treated with nitrofurantoin, agent of first choice, compared to trimethoprim or norfloxacin.

Clino-Pathological Features of Urinary Tract Infection in Rural India

The study was aimed to understand the clino-pathological characteristics of urinary tract infection along with the techniques used in diagnosis and treatment of the presenting infection. The study takes into consideration the various risk factors such as age, sex, and diabetes mellitus which can precipitate a urinary tract infection. The study was conducted at the Global Baroda Hospital, Vadodara and Narhari Hospital, Vadodara in the duration from January to March 2012, under the supervision of Dr. Hiten Kareliya. A questionnaire was prepared in accordance to evaluate risk factors of urinary tract infection. The patients under study were chosen according to specific inclusion criteria. The uropathogens were isolated with the help of biochemical testing. E. coli (38%) was found to be the most prevalent organism followed by Klebsiella and Candida albicans (both 10%), Pseudomonas aeruginosa (9%), Staphylococcus (7%).

Effect of"Fuzheng Qingretonglin"decoction on complex urinary tract infection in rats by regulating NLRP3 inflammasome pathway

Obiective:To investigate whether"Fuzheng Qingretonglin"decoction can reduce urinary tract damage caused by complex urinary tract infection caused by drug resistant Escherichia coli by regulating Nod-like receptor pyrin domain3 inflammasome,and to explore the feasibility of this decoction combined with levofloxacin in the treatment of complex urinary tract infection caused by drug resistant bacteria.Methods:SD rats were divided into five groups:sham group,model group,levofloxacin group(Lev group),levofloxacin+Fuzheng Qingre Tonglin decoction group(FZ+lev group),and Fuzheng Qingre Tonglin decoction group(FZQRTL group).After the experiment,urine was taken for bacterial culture to determine the urinary tract infection of rats in each group;HE staining was used to observe the pathological changes of kidney and bladder tissues in rats;The expression of NLRP3 in kidney and bladder tissues was detected by immunohistochemistry;The expression of IL-1βand IL-18 in serum of rats was detected by ELISA;The expressions of NLRP3,ASC and Caspase-1 were detected by Western blotting.Results:The positive rate of urine bacteria culture in the sham group was 0%,the positive rate of urine bacteria culture in the model group was 100%;and the positive rate of urine bacteria culture in the FZ+lev group was 37.50%,which was statistically different from that in the model group(P<0.05).A large number of inflammatory cells were observed in the kidney and bladder tissues of the model group by HE staining,while the number of inflammatory cells in the kidney and bladder tissues of the Lev group and FZQRTL group was significantly reduced compared with that of the model group.The FZ+lev group in the number and structure of inflammatory cells in kidney and bladder were similar to the sham group.The NLRP3 immunohistochemistry of kidney and bladder tissue in FZ+lev groups and FZQRTL groups was significantly different from that in model group(P<0.001).The levels of IL-1βand IL-18 in serum of Lev group,FZQRTL group and FZ+lev group were significantly decreased by ELISA compared with model group(P<0.001).The levels of IL-1βand IL-18 in the FZ+lev groups were significantly lower than in the Lev group and FZQRTL group,and the differences were statistically significant(P<0.05).The protein expressions of NLRP3,ASC and Caspase-1 in the Lev group,FZQRTL group and FZ+lev group were significantly lower than those in the model group(P<0.001).The protein expressions of NLRP3,ASC and Caspase-1 in the FZ+lev groups were significantly lower than in the Lev group and FZQRTL group,and the differences were statistically significant(P<0.05).Conclusions:"Fuzheng Qingretonglin"decoction may have a protective effect on the kidney and bladder of rats with complex urinary tract infection caused by drug-resistant Escherichia coli by inhibiting the activation of NLRP3 inflammatory bodies,and TCM combined with levofloxacin has a better therapeutic effect than TCM or levofloxacin alone.

Epidemiological, Clinical, Paraclinical and Evolutionary Aspects of Urinary Tract Infection in Diabetics Hospitalized at the Department of Medicine of Abass Ndao Hospital from January 01, 2018, to December 31, 2018

Introduction: Urinary tract infection (UTI) is a major public health problem because of its morbidity and mortality. It occurs with increased frequency during diabetes. The objective of this work was to study the frequency and etiologies of urinary tract infections in diabetics hospitalized at the department of medicine of Abass Ndao Hospital. Patients and Methods: This work was a cross-sectional, descriptive, and analytical study conducted from January 01, 2018, to December 31, 2018. It focused on hospitalized diabetic patients with urinary tract infection. Epidemiological, clinical, and evolutionary data of UTI were evaluated. Results: One hundred and twenty-eight (128) diabetic patients had a cytobacteriological urine exam (CUE). 44 of who had a positive CUE (34.4%). The age group [60 - 69] years was the most represented (31.8%). Women predominated (61.4%) with a sex ratio (m/f) of 0.63. Abdominal pain was the most frequent reason for consultation, followed by polydipsia. Fever was recorded in 21 patients (47.7%). Type 2 diabetes was found in most patients (70.5%). Glycemia above 2g/l was found in 34 patients (89.5%). Anemia accounted for more than half of the patients with 29 cases (65.9%). Leukocytosis was noted in 28 patients (63.6%) and a positive CRP in 33 patients (75%). An increase in urea-creatinine was noted in 23 cases (52.3%). The results of the CUE revealed Escherichia coli as predominant (43.2%, n = 19), followed by Candida with 22.7% (n = 10). Antibiotic therapy was given to all patients. The mostly used antibiotic in the treatment of UTI was Cefotaxime 27.3% (n = 12). Older age and female gender were associated with the presence of E. coli. Four (4) deaths were recorded (9%). They were all male over the age of 65. Conclusion: UTI in diabetes is an important cause of morbidity and mortality. The development and implementation of a prevention and management program are essential.

Safety of Empagliflozin in Patients with Type 2 Diabetes Mellitus in Saudi Arabia: A Post-Authorisation Safety Study

Background: Empagliflozin, a sodium-glucose co-transporter-2 (SGLT2) inhibitor is used as a monotherapy or in combination for lowering the elevated blood glucose level in patients with type 2 diabetes mellitus (T2DM). It is often associated with certain adverse reactions (urinary tract infection (UTI), diabetes ketoacidosis (DKA), and genital infections). Thus, the Saudi Food and Drug Administration requested a post-authorisation safety study to monitor the safety of empagliflozin during the defined observation period. Methodology: The local, comparator, non-interventional, regulatory post-marketing study using “new user” design was conducted in patients with T2DM, treated with empagliflozin (10 or 25 mg) and dipeptidyl peptidase-4 (DPP-4) inhibitors (NCT03764631). Study was conducted from 2018 to 2020, wherein each patient was followed up for 12 months after the index period. Incidence and occurrence of DKA, severe UTIs, volume depletion and dehydration were observed along with metformin, insulin and treatment complexity status and adverse events in the index and Ramadan period. All data collected were analysed using descriptive statistics. Results: Among the 1502 patients enrolled (empagliflozin [n = 751] and DPP-4 inhibitors [n = 751]), 0.1% patients (n = 1) in each group and Conclusion: Empagliflozin was well tolerated over a period of 12 months, with no safety concerns and a favourable benefit/risk ratio.

糖尿病合并尿路感染患者酮症酸中毒的影响因素分析

目的探讨2型糖尿病合并尿路感染患者糖尿病酮症酸中毒(diabetic ketoacidosis,DKA)的临床特点及影响因素,为DKA预防及早期干预提供参考。方法回顾性收集2022年1月至2023年9月天门市第一人民医院收治的糖尿病合并尿路感染患者的病历资料,根据住院期间是否发生DKA分为DKA组和非DKA组,比较分析DKA发生的影响因素。结果共纳入137例患者,其中DKA组35例、非DKA组102例,DKA发生率为25.55%,两组患者在年龄以及空腹血糖、糖化血红蛋白(HbA1c)、血清降钙素原(PCT)、尿白细胞水平方面差异均具有统计学意义(P<0.05)。多因素Logistic回归分析显示,年龄≥60岁[OR=2.369,95%CI(1.013,5.541)]、血清PCT≥0.5 ng·L-1[OR=3.234,95%CI(1.215,8.609)]、HbA1c≥7%[OR=2.958,95%CI(1.130,7.743)]是糖尿病合并尿路感染者发生DKA的危险因素。结论年龄≥60岁、血清PCT≥0.5 ng·L-1及HbA1c≥7%是糖尿病合并尿路感染者发生DKA的独立危险因素,临床医生应及时识别,尽早预防。

基于隐结构模型的复杂性尿路感染方药规律分析

目的运用隐结构模型分析法,挖掘复杂性尿路感染(cUTI)的用药规律。方法计算机检索CNKI、万方数据知识服务平台、维普网、中国生物医学文献数据库、PubMed、Cochrane Library中有关中医药治疗cUTI的文献,检索时间为建库至2022年9月,利用Office Excel 2019软件建立并规范数据库,运用隐结构模型学习、综合聚类及频数分析等方法分析数据库,总结cUTI的用药规律。结果共纳入文献335篇,涉及中药254味,频率>0.35%的中药65味,功效以清热药、利水渗湿药、补虚药为主。药性多为寒、平,药味多甘、苦、淡,主归肺、肾经。隐结构分析共得到隐变量17个,结合专业知识后综合聚类为4类,推断cUTI的常见证候为膀胱湿热证、肾阳亏虚证、阴虚内热证、热毒蕴结证,代表方剂分别为八正散、真武汤、六味地黄丸、五味消毒饮等。结论cUTI的治疗以清湿热贯穿始终,其病机复杂,多为虚实夹杂之侯,病性偏实者着重祛湿热并适当配伍养阴药,利水通淋而不伤阴,病性偏虚者重补虚并适当配伍清湿热药避免湿热羁留。

儿童糖尿病合并尿路感染的临床特征及危险因素分析

目的探讨儿童糖尿病(DM)合并尿路感染(UTI)的临床特征和危险因素。方法160例儿童DM患者根据并发泌尿系感染分为UTI组和非UTI组,每组80例。收集儿童DM并发泌尿系感染的临床资料,包括DM类型、性别、年龄、体质量指数(BMI)、病程、住院时间、是否留置尿管、是否酮症酸中毒、抗生素及胰岛素使用情况、尿液标本分离细菌类型及入院时各项化验指标等结果,并进行分析。结果UTI组病原菌主要包括大肠埃希菌(37株,46.3%)、肠球菌(21株,26.2%)、肺炎克雷伯菌(9株,11.2%)等。单因素分析显示2组间肥胖、病程、住院时间、是否留置导尿管、是否酮症酸中毒、抗生素使用情况、糖化血红蛋白(HbA1c)、白蛋白(ALB)及血肌酐(Cr)的差异有统计学意义(P<0.05)。多因素分析显示DM合并UTI的危险因素包括住院时间延长(OR=2.087,95%CI:1.562~2.789)、留置导尿管(OR=15.886,95%CI:2.336~108.007)、酮症酸中毒(OR=9.300,95%CI:1.169~73.992)、病程≥36个月(OR=20.548,95%CI:2.425~174.119)、HbA1c升高(OR=16.686,95%CI:3.666~75.955)及血Cr升高(OR=1.010,95%CI:1.002~1.019);而血清ALB升高(OR=0.799,95%CI:0.702~0.910)为其保护因素。结论儿童DM合并UTI以大肠埃希菌感染为主,与住院时间、留置尿管、酮症酸中毒、病程时间、HbA1c、血Cr和ALB水平密切相关。

基于KABP的细节护理在上尿路结石合并糖尿病患者中的应用研究

目的 探索基于知信行模式(KABP)的细节护理在上尿路结石合并糖尿病患者中的临床应用,并对细节护理效果进行评价。方法 该研究为前瞻性研究,纳入2019年1月至2022年1月该科收治的上尿路结石合并糖尿病患者共100例,采用随机数字表法分为常规护理组和特殊细节护理组,每组50例。其中特殊细节护理组采用基于KABP的细节护理。对2组患者基线数据进行评价,分析2组数据的可比性。对患者的围手术期手术不良反应发生率、负性情绪、疼痛程度评分、日常生活能力评分、满意度和住院时间进行统计学分析,评价2组患者的临床效果是否存在差异。结果 特殊细节护理组患者术后感染、术后腰痛及术后高血糖的发生率显著低于常规护理组(4.0%vs. 16.0%、6.0%vs. 28.0%、16.0%vs. 38.0%),差异均有统计学意义(P=0.046、0.003、0.013),特殊细节护理组患者术后焦虑自评量表和抑郁自评量表评分较常规护理组显著降低[(35.52±3.41)分vs.(46.38±2.91)分、(32.28±3.17)分vs.(47.89±4.01)分],差异均有统计学意义(P=0.012、0.003)。特殊细节护理组患者术后的主观疼痛评分较常规护理组显著降低[(6.54±1.01)分vs.(8.01±1.22)分],日常生活能力评分较常规护理组显著提高[(75.21±5.87)分vs.(66.0±15.21)分],差异均有统计学意义(P=0.017、0.009)。特殊细节护理组患者总体满意度高于常规护理组(98.0%vs. 90.0%),其中特殊细节护理组评价为“非常满意”的比例显著高于常规护理组(68.0%vs. 46.0%),差异均有统计学意义(P=0.092、0.026)。常规护理组和特殊细节护理组总住院时间[5.00(3.75,5.25)dvs. 4.00(3.00,6.00)d]、术后住院时间[2.50(2.00,3.00)d vs. 2.00(1.75,2.00)d]比较,差异均无统计学意义(P=0.732、0.678)。结论 通过对基于KABP的细节护理在上尿路结石合并糖尿病患者中的应用进行多维度、多指标评价,证实人性化、规范化的特殊细节护理模式使患者在围手术期多项指标获益,为此类患者围手术期的护理工作提供宝贵经验。

老年糖尿病患者合并尿路感染风险预测模型构建

目的 探究老年糖尿病患者合并尿路感染(UTI)的相关因素,并构建风险预测模型,为糖尿病患者UTI预防方案的制定提供参考。方法 选取2021年1月至2023年1月于成都医学院第一附属医院住院的331例老年糖尿病患者为研究对象,根据有无UTI感染分为合并UTI组(n=63)、未合并UTI组(n=268),分析相关影响因素并建立风险预测模型,并经列线图可视化处理,评估模型的预测价值。结果 合并UTI组尿比重、尿白细胞计数、 24 h微量白蛋白和FPG>7 mmol/L占比、HbA1c>6.5%占比及2 h空腹血糖(FPG)水平明显高于未合并UTI组(P<0.05)。年龄≥65岁、糖尿病病程≥10年、有并发症、留置导尿管、FPG>7 mmol/L是患者合并UTI发生的危险因素,预防性使用抗生素是保护因素(P<0.05)。预测模型的AUC为0.957,敏感性、特异性分别为85.71%、95.15%,Bootstrap内部验证及校准曲线分析显示,模型区分度、校准度、准确度良好。结论 高龄、糖尿病病程≥10年、有并发症、FPG>7 mmol/L和留置导尿管是老年糖尿病患者合并UTI发生风险增高的主要原因,风险预测模型可有效预测患者UTI的发生。

糖化血红蛋白对2型糖尿病患者尿路感染病原菌的影响

目的 探讨糖化血红蛋白(HbA1c)对2型糖尿病(T2DM)患者尿路感染病原菌的分布和耐药情况是否存在影响。方法 选取2021年9月—2022年9月天津医科大学朱宪彝纪念医院160例尿培养阳性的T2DM住院患者。根据HbA1c检测结果分为A组(5.5%9.0%,76例)。比较2个组尿路感染病原菌的分布和耐药性差异。结果 160例T2DM合并尿路感染患者中共分离出182株病原菌。2个组革兰阴性杆菌检出率均最高(分别为69.38%和64.29%),菌株类型主要为大肠埃希菌(>50.00%)。A组革兰阳性菌和真菌检出率分别为16.33%和14.29%;B组革兰阳性菌和真菌检出率分别为10.71%和25.00%。B组大肠埃希菌对妥布霉素和氨苄西林-舒巴坦的耐药率高于A组(P<0.05);B组多重耐药大肠埃希菌检出率高于A组(P=0.046)。结论 高HbA1c水平T2DM合并尿路感染患者真菌检出率较高;T2DM合并尿路感染患者大肠埃希菌对部分抗菌药物的耐药性随HbA1c水平升高而增加。

赵文景教授运用栝楼瞿麦丸类方治疗糖尿病合并再发性下尿路感染经验

糖尿病合并再发性下尿路感染迁延难愈,常对多种抗生素耐药,治疗困难,极大影响了患者的身体健康及生活质量。赵文景教授认为糖尿病合并再发性下尿路感染的病机主要为肾阳亏虚,肾-命门-三焦气化失司,从阳虚为本、阳不化气出发,基于“肾—命门—三焦气化”理论,探讨运用栝楼瞿麦丸类方培补命门、调理肾、膀胱与三焦的功能以复气化,随证选用泻心栝楼瞿麦丸、补中栝楼瞿麦丸、化瘀栝楼瞿麦丸、解郁栝楼瞿麦丸、温下栝楼瞿麦丸等进行治疗,以期为中医药诊治糖尿病合并再发性下尿路感染提供新思路。

A review of complications after ureteral reconstruction

Objective:This study aimed to provide a comprehensive overview of the complications unique to ureteral reconstruction in adults,emphasizing their presentation,diagnosis,and management in the treatment of ureteral structure disease.Methods:This review involves an in-depth analysis of existing literature and case studies pertaining to ureteral reconstruction,with a focus on examining the range of complications that can arise post-surgery.Special attention is given to the presentation of each complication,the diagnostic process involved,and the subsequent management strategies.Results:Ureteral reconstruction can treat ureteral stricture disease with low morbidity;however,complications,although uncommon,can have severe consequences.The most notable complications include urinary extravasation,stricture recurrence,urinary tract infections,compartment syndrome,symptomatic vesicoureteral reflux,and Boari flap necrosis.Each complication presents unique diagnostic challenges and requires specific management approaches.Conclusion:Ureteral reconstruction is a highly effective treatment for ureteral stricture disease.Having a strong understanding of the potential complications that patients may experience following ureteral reconstruction is not only critical to adequately counsel patients but also facilitate prompt diagnosis and management of complications when they arise.

Prevalence of Drug Resistant Uropathogenic Escherichia coli from Immunocompromised Diabetic Patients Attending Selected Health Facilities in Benue State

Escherichia coli is the commonest bacterial uropathogen of UTIs, the commonest infections in immunocompromised diabetic patients. Better understanding of their main resistance mechanisms to commonly used antibacterial agents will help to reduce the burden of this infection. The prevalence of drug resistant uropathogenic Escherichia coli isolates from immunocompromised diabetic patients attending selected health facilities in Benue State was investigated. Two hundred and ninety-six midstream urine samples were collected for both study and control diabetic patients. Bacterial isolation was done using semi-quantitative method. Drug resistant Escherichia coli were identified as multidrug resistant (MDR), extensive drug resistant (XDR) and pan-drug resistant organisms (PDR). Statistical significance was considered at p E. coli isolates from the study and control subjects with overall prevalence of 20.9% and 8.4% respectively. The isolates were highly resistant to penicillin (ampicillin), monobactam (aztreonam), older quinolone (nalidixic acid) whereas the majority of them showed high susceptibility to aminoglycoside (streptomycin), cephalosporin (cefotaxime) and carbapenem (imipenem). None showed complete susceptibility to all the tested antibiotics. Twenty-five E. coli were identified in this MDR, eight, XDR while 5 were PDR. High numbers of drug resistant E. coli isolates were identified in the study group of which 25 were MDR, 8 XDR while 5 were PDR isolates. High prevalence of UTI and drug resistant isolates occur in diabetic patients with hyperglycemic condition.

Emphysematous Cystitis: Report of Two Cases and Review of the Literature

Emphysematous cystitis is a rare complication of lower urinary tract infection whose prognosis is conditioned by the delay in treatment. The predisposition of diabetic patients to urinary infections caused by gas-producing bacteria is considered one of the most common factors in the occurrence of emphysematous cystitis. The currently recommended diagnostic test is CT scanning, which has definite value in assessing gas accumulation in the bladder wall and lumen. The authors report the observations of two patients aged 68 and 80 who were treated for emphysematous cystitis complicating diabetes mellitus. The evolution was favorable under treatment with antibiotic therapy, insulin therapy and bladder drainage.

哌拉西林/他唑巴坦治疗成人复杂性尿路感染的真实世界研究

目的 探讨哌拉西林/他唑巴坦治疗成人复杂性尿路感染(cUTI)的有效性和安全性。方法 回顾性分析2021年1月1日至2023年12月31日我院成人c UTI患者资料352例,所有患者均使用哌拉西林/他唑巴坦。观察患者的病原菌检出情况,治疗后的临床有效率、微生物清除率、不良反应发生情况及治疗费用。结果 352例患者中,有54例患者有病原菌培养结果,以产超广谱β-内酰胺酶大肠埃希菌为主(48.1%)。所有患者的临床有效率为94.3%,微生物清除率为81.5%,不良反应发生率为1.4%。临床有效患者中的男性比例、泌尿外科治疗患者比例均显著高于临床无效患者,而移植科治疗患者比例、合并移植肾患者比例均显著低于临床无效患者(P<0.05)。根据病原菌对哌拉西林/他唑巴坦的敏感性分为目标治疗组和经验性治疗组的分析结果显示,两组患者的临床有效率比较,差异无统计学意义(P=0.902 5)。结论 哌拉西林/他唑巴坦治疗成人cUTI的疗效显著,安全性较好。