Background: The quick Sequential Organ Failure Assessment (qSOFA) score was introduced by Sepsis-3 or the Third International Consensus Definitions for Sepsis and Septic Shock to help physicians in identifying patients outside the intensive care unit with suspected infection who are at high risk for in-hospital mortality. However, sepsis is not a homogenous entity and the outcomes vary based on several factors. This study aimed to determine the predictive accuracy of qSOFA in identifying those at high-risk of in-hospital mortality among adult patients with sepsis secondary to urinary tract infection. Methodology: A retrospective cohort study was done involving the use of qSOFA score to predict in-hospital mortality of adult patients with a diagnosis of sepsis secondary to urinary tract infection, admitted in the hospital from January 1, 2013 to December 31, 2020. qSOFA is computed based on the following independent variables: systolic blood pressure (SBP), respiratory rate (RR), and Glasgow Coma Scale (GCS). Results: Of the 128 charts retrieved, 121 patients were included in the study. Fifteen (12.40%) died while 106 (87.60%) survived. Mean age was 60.76 years old, with more females (71.90%) than males (28.10%). Hypertension and Diabetes Mellitus Type 2 were the most frequent comorbidities. Complicated UTI was the most frequent source of infection. Mean length of stay was 8.29 days. Forty (33.06%) patients had qSOFA ≥ 2 wherein 11 (27.5%) died. Diagnostic performance results revealed: sensitivity (73.33%), specificity (72.64%), positive (27.5%) and negative (95.06%) predictive values, and positive (2.68) and negative (0.37) likelihood ratios. qSOFA accuracy was 72.73% with an AUROC of 0.76. Conclusion Among the admitted adult patients with sepsis secondary to a UTI, qSOFA had a good prognostic accuracy for in-hospital mortality.
Sepsis ; Urinary Tract Infections ; Hospital Mortality

The objective of present study was to develop a simple and reliable voiding spot assay (VSA) system to evaluate the lower urinary tract function of mice, and to establish it as a standardized protocol. Ultraviolet (UV) light was used to screen out the filter paper without autofluorescence and with optimal urine diffusion properties. Next, the appropriate wavelength of UV was determined based on the quality of the photographic image of urine spots on the filter paper. To confirm that the urine stain area on the filter paper was correlated with the amount of urine, a volume-area standard curve was constructed. The utility of this VSA system was validated using female wild-type C57BL/6J mice aged 12-13 weeks, and the data generated under identical procedural settings were compared among laboratories. Furthermore, this VSA system was employed to analyze the changes in voiding patterns in mice with urinary tract infections or transportation stress. No. 4 filter paper with a thickness of 0.7 mm was identified as the most suitable material for VSA, exhibiting no autofluorescence and facilitating optimal urine diffusion. The filter paper retained its integrity during the assay, and there was a linear correlation between urine volume and stained area under 365 nm UV light. Utilizing this VSA system, we determined that female wild-type C57BL/6J mice produced approximately 695.8 μL total urine and 5.5 primary voiding spots (PVS) with an average size of 126.4 μL/spot within 4-h period. Over 84% of PVS volumes ranged from 20 to 200 μL. Notably, PVS volumes of mice were similar across different laboratories. Mice with urinary tract infections or transportation stress exhibited significant changes in VSA parameters, including increased voiding frequency, PVS number, and decreased PVS volume. Therefore, this VSA system can be used to evaluate the urinary function of normal mice, as well as those with urinary tract infection or transportation stress.
Mice ; Female ; Animals ; Urodynamics ; Mice, Inbred C57BL ; Urination ; Urinary Bladder ; Urinary Tract Infections

To investigate the effect and the mechanism of ppk1 gene deletion on the drug susceptibility of uropathogenic Escherichia coli producing extended-spectrum beta-lactamases (ESBLs-UPEC). The study was an experimental study. From March to April 2021, a strain of ESBLs-UPEC (genotype was TEM combined with CTX-M-14) named as UE210113, was isolated from urine sample of the patient with urinary tract infection in the Laboratory Department of Guangzhou Eighth People's Hospital, meanwhile its ppk1 gene knock-out strain Δpk1 and complemented strain Δpk1-C were constructed by suicide plasmid homologous recombination technique, which was used to study the effect of ppk1 gene on ESBLs-UPEC drug sensitivity and its mechanism. The drug susceptibility of UE210113, Δpk1, and Δpk1-C were measured by Vitek2 Compact System and broth microdilution method. The quantitative expression of ESBLs, outer membrane protein and multidrug efflux systems encoding genes of UE210113, Δpk1 and Δpk1-C were performed by using qRT-PCR analysis. By using two independent sample Mann-Whitney U test, the drug susceptibility results showed that, compared with UE210113 strain, the sensitivities of Δpk1 to ceftazidime, cefepime, tobramycin, minocycline and cotrimoxazole were enhanced (Z=-2.121,P<0.05;Z=-2.236,P<0.05;Z=-2.236,P<0.05;Z=-2.121,P<0.05), and the drug susceptibility of Δpk1-C restored to the same as which of UE210113 (Z=0,P>0.05). The expression levels of ESBLs-enconding genes bla_TEM and bla_CTX-M-14 in Δpk1 were significantly down-regulated compared with UE210113, but the expression was not restored in Δpk1-C. The expression of outer membrane protein gene omp F in Δpk1 was significantly up-regulated, while the expression of omp A and omp C were down-regulated. The results showed that the expression of multidrug efflux systems encoding genes tol C, mdt A and mdtG were down-regulated in Δpk1 compared with UE210113. The expression of all of the outer membrane protein genes and the multidrug efflux systems genes were restored in Δpk1-C. In conclusion,the lost of ppk1 gene can affect the expression of the outer membrane protein and multidrug efflux systems encoding genes of ESBLs-UPEC, which increase the sensitivity of ESBLs-UPEC to various drugs.
Humans ; beta-Lactamases/metabolism* ; Uropathogenic Escherichia coli/metabolism* ; Urinary Tract Infections ; Plasmids ; Membrane Proteins/genetics* ; Escherichia coli Infections ; Microbial Sensitivity Tests ; Anti-Bacterial Agents/pharmacology*

To investigate the effect and the mechanism of ppk1 gene deletion on the drug susceptibility of uropathogenic Escherichia coli producing extended-spectrum beta-lactamases (ESBLs-UPEC). The study was an experimental study. From March to April 2021, a strain of ESBLs-UPEC (genotype was TEM combined with CTX-M-14) named as UE210113, was isolated from urine sample of the patient with urinary tract infection in the Laboratory Department of Guangzhou Eighth People's Hospital, meanwhile its ppk1 gene knock-out strain Δpk1 and complemented strain Δpk1-C were constructed by suicide plasmid homologous recombination technique, which was used to study the effect of ppk1 gene on ESBLs-UPEC drug sensitivity and its mechanism. The drug susceptibility of UE210113, Δpk1, and Δpk1-C were measured by Vitek2 Compact System and broth microdilution method. The quantitative expression of ESBLs, outer membrane protein and multidrug efflux systems encoding genes of UE210113, Δpk1 and Δpk1-C were performed by using qRT-PCR analysis. By using two independent sample Mann-Whitney U test, the drug susceptibility results showed that, compared with UE210113 strain, the sensitivities of Δpk1 to ceftazidime, cefepime, tobramycin, minocycline and cotrimoxazole were enhanced (Z=-2.121,P<0.05;Z=-2.236,P<0.05;Z=-2.236,P<0.05;Z=-2.121,P<0.05), and the drug susceptibility of Δpk1-C restored to the same as which of UE210113 (Z=0,P>0.05). The expression levels of ESBLs-enconding genes bla_TEM and bla_CTX-M-14 in Δpk1 were significantly down-regulated compared with UE210113, but the expression was not restored in Δpk1-C. The expression of outer membrane protein gene omp F in Δpk1 was significantly up-regulated, while the expression of omp A and omp C were down-regulated. The results showed that the expression of multidrug efflux systems encoding genes tol C, mdt A and mdtG were down-regulated in Δpk1 compared with UE210113. The expression of all of the outer membrane protein genes and the multidrug efflux systems genes were restored in Δpk1-C. In conclusion,the lost of ppk1 gene can affect the expression of the outer membrane protein and multidrug efflux systems encoding genes of ESBLs-UPEC, which increase the sensitivity of ESBLs-UPEC to various drugs.
Humans ; beta-Lactamases/metabolism* ; Uropathogenic Escherichia coli/metabolism* ; Urinary Tract Infections ; Plasmids ; Membrane Proteins/genetics* ; Escherichia coli Infections ; Microbial Sensitivity Tests ; Anti-Bacterial Agents/pharmacology*

Adult ; Clinical Decision Rules ; Female ; Fever ; Humans ; Male ; Urinary Tract Infections/diagnostic imaging*

Anti-Bacterial Agents/therapeutic use* ; Child ; Humans ; Microbial Sensitivity Tests ; Urinary Tract Infections/drug therapy*

To analyze the risk factors for urinary tract infection (UTI) among inpatients. The case data of 1 875 inpatients receiving urinary bacterial culture in Beijing Haidian Hospital from October 2019 to May 2021 were analyzed retrospectively. According to the etiological diagnostic criteria of UTI, they were divided into infection group and non-infection group. The species and distribution of pathogens in the infection group were analyzed, and the case data and laboratory indexes were subjected to univariate analysis. The variables with statistical significance were selected for binary logistic regression to analyze the risk factors of urinary tract infection and establish a prediction model. The receiver operating characteristic (ROC) curve was drawn for each parameter included in the model, and the area under the curve (AUC) was calculated. The diagnostic and predictive efficacy of each parameter alone and their combination for UTI were evaluated. So, a total of 1 162 patients with non-infection group and 713 patients with UTI were detected. Among the cultured pathogens, the constituent ratio of Gram-negative bacteria, Gram-positive bacteria and fungi was 57.2%(408/713), 35.9%(256/713) and 6.9%(49/713) respectively. Multivariate analysis showed that, Age, duration of urinary catheterization>7 d, stroke and orthopedic surgery were the risk factors of UTI among inpatients. The use of antibiotics is a protective factor for urinary tract infections. The prediction model of UTI was established by the risk factors, age, duration of urinary catheterization>7 d, stroke, orthopedic surgery, urinary leukocyte esterase, urinary nitrite and Coefficient of variability of red blood cell volume distribution width (RDW-CV). The AUC of the combination of the eight parameters in diagnosing and predicting UTI was 0.835 (95%CI: 0.816-0.855), with the sensitivity of 70.7% and the specificity of 82.8%. In conclusion,the combination of the eight parameters can better assist in the diagnosis and prediction of UTI, and provide an experimental basis for clinicians to judge UTI.
Humans ; Retrospective Studies ; Inpatients ; Urinary Tract Infections/microbiology* ; Urinalysis ; Stroke

To study the mechanism of polysaccharides from seeds of Vaccaria segetalis( PSV) in the treatment of bacterial cystitis through the NLRP3 inflammasome pathway. The rat model of urinary tract infection was used and treated with PSV,and the urine and bladders were collected. The level of interleukin-10( IL-10) in rat urine was detected by enzyme linked immunosorbent assay( ELISA). Western blot and immunofluorescence staining were used to detect the expressions of sonic hedgehog( SHH) and NLRP3 inflammasome [NOD-like receptor thermoprotein domain 3( NLRP3),apoptosis associated speck like protein( ASC) and pro-caspase-1]. The expression of Toll-like receptor pathway was detected by RT-PCR. The death of 5637 cells induced by uropathogenic Escherichia coli( UPEC) and lactate dehydrogenase( LDH) release were evaluated using live/dead staining. The results showed that in the rat bladder,the expressions of SHH,NLRP3 inflammasomes and Toll-like receptors were significantly up-regulated,and NLRP3 inflammasomes were significantly activated by UPEC infection. The administration with PSV could significantly increase the concentration of IL-10 in urine,inhibit the expressions of SHH,NLRP3 inflammasomes and Toll-like receptors in bladder,and inhibit the activation of NLRP3 inflammasomes. A large number of 5637 cells were dead after UPEC infection and caused LDH production. PSV could significantly inhibit the death of 5637 cells and the release of LDH. In conclusion,PSV could inhibit the expression and activation of NLRP3 inflammasomes by inhibiting the Toll-like receptor pathway,thereby mitigating the bladder injury.
Animals ; Hedgehog Proteins ; Inflammasomes/genetics* ; Interleukin-1beta ; NLR Family, Pyrin Domain-Containing 3 Protein/genetics* ; Polysaccharides/pharmacology* ; Rats ; Seeds ; Urinary Bladder ; Urinary Tract Infections/drug therapy* ; Vaccaria

Objective To verify the relationship between catheter-related urinary tract infection(CAUTI)and stress hyperglycemia during catheter retention in stroke patients. Methods We used nosocomial infection monitoring system to track the status of CAUTI in stroke patients in a hospital.The study cohort was all the patients who received retention catheterization from January 2016 to March 2020.According to the nested case-control design,multivariate logistic regression analysis was performed to explore the relationship between stress hyperglycemia and CAUTI in stroke patients with indwelling catheter. Results A total of 322 cases of CAUTI and 644 cases of non-CAUTI were enrolled in this study.The length of stay in the case group was(20.68 ± 3.73)d,significantly longer than that[(13.00 ± 4.01)d]in the control group(t=29.473,P <0.001).Compared with non-stress hyperglycemia,stress hyperglycemia posed a higher risk of CAUTI in the stroke patients with indwelling catheter(OR=2.020,95% CI=1.447-2.821,P=0.000)and led to the higher incidence of CAUTI in one thousand days(P<0.001). Conclusion Stress hyperglycemia in the stroke patients with indwelling catheter can significantly increase the risk of CAUTI.
Catheter-Related Infections/epidemiology* ; Cross Infection/epidemiology* ; Humans ; Hyperglycemia/complications* ; Stroke/complications* ; Urinary Catheterization ; Urinary Tract Infections/epidemiology*

OBJECTIVE: To study the clinical features of vesicoureteral reflux (VUR) in children with neurogenic bladder (NB), and to provide a reference for its early diagnosis and treatment. METHODS: Clinical data were collected from 26 children with NB and urinary tract infection who were admitted to the Department of Pediatric Nephrology from January 2014 to December 2019. According to the presence or absence of VUR, the children were divided into a VUR group with 11 children and a non-VUR group with 15 children. Clinical features were compared between the two groups. RESULTS: Compared with the non-VUR group, the VUR group had a significantly higher proportion of children with non- CONCLUSIONS When NB children have the clinical manifestations of non-
Child ; Creatinine ; Humans ; Infant ; Radionuclide Imaging ; Urinary Bladder, Neurogenic/etiology* ; Urinary Tract Infections/etiology* ; Vesico-Ureteral Reflux/diagnostic imaging*