Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the...
Transcript of Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the...
![Page 1: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/1.jpg)
Urinvejsinfektioner
Niels Frimodt-Møller Professor, overlæge dr.med.
Klinisk Mikrobiologisk Afdeling, Hvidovre Hospital
![Page 2: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/2.jpg)
Urinvejsinfektioner
• Ætiologi og patogenese • Overførsel fra dyr? • Epidemiologi (børn,voksne,ældre) • Diagnostik • Behandling (resistens)
![Page 3: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/3.jpg)
Urinvejsinfektion (UVI) • Urinvejene sterile indtil meatus urethrae
externa • Def. Af UVI: Mikroorganismer i urin
![Page 4: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/4.jpg)
Urinvejsinfektion
• En af de hyppigste infektioner i almen praksis (3-400.000/år i DK)
• Forekommer 6 x hyppigere hos kvinder • 20% af kvinder med UVI recidiverer • Årsag til stor del af antibiotikaforbruget • UVI årsag til ½ af E.coli bakteriæmier • E.coli udgør 80%; kommer fra pts egen
tarmflora
![Page 5: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/5.jpg)
Urinvejsinfektion: Smitteveje
• Via blod: S. aureus, Salmonella, Candida • Ascenderende: Rectum -> Perinæum -> (vagina) -> meatus urin. ext. ->
urethra -> blære -> ureter -> nyrepelvis -> nyre E. coli, andre Enterobacteriaceae, enterokokker mm
![Page 6: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/6.jpg)
J. Urol 1997 157: 1127-1129
Urine Faeces
PFGE of E. coli isolates
UTI route of infection • Faecal-perineal-urethral route
• Origin of E. coli in the normal flora unknown: is it influenced by food?
![Page 7: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/7.jpg)
• Possess pathogenic traits: virulence genes • Virulence is a result of a cumulative effect • Definition of ExPEC pathotypes
– Molecular definition proposed (JID 2005 191: 1040-49)
– No distinct virulence profile
ExPEC
Host tissue
Adv
Inte
rn M
ed 1
988
33: 2
31-5
2
7
E. coli
Iron uptake systems
Toxins
Adhesins
Virulence gene functions
![Page 8: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/8.jpg)
80-90% af UVI forårsages af E. coli: • Extra-intestinale patogene E. coli (ExPEC) • Fylogruppe B2 (og D)
3
J Lab Clin Med 2002 139: 155
ECOR fylogruppe-fordeling
Urinvejsinfektioner (UVI)
![Page 9: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/9.jpg)
Structure and genetics of type 1 pili Schilling, Mulvey, and Hultgren
JID 2001;183:S36-S40
![Page 10: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/10.jpg)
Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated FimH-FimC (A) or rabbit antibodies to total uroplakins (B), and then with FITC-conjugated streptoavidin or goat anti-rabbit IgG. Nuclei were counterstained with a blue Hoechst dye. Note the similar staining of urothelial umbrella cells by FimH-FimC and antibodies to uroplakins.
Schilling, Mulvey, and Hultgren
JID 2001;183:S36-S40
![Page 11: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/11.jpg)
(Rosen et al. 2007)
Intracellular Bacterial Communities (IBCs) Transient intracellular niche Have biofilm-like properties (Anderson et al. 2003)
Pathogenesis of UTI and RUTI with E. coli
UPEC can be an intracellular pathogen (Anderson et al. 2003, Justice et al 2004, Mulvey et al 2001)
Quiescent Intracellular Reservoirs (QIRs) Bacterial replication limited May persist for weeks to months No antimicrobial effective against QIRs May revert to be active=>RUTI (Blango et al. 2010 Eto et al. 2006, Kern et al. 2004 Mulvey et al. 2001; Mysorekar et al. 2006, Rosen et al. 2007, Schilling et al. 2002) Quiescent Intracellular
Reservoirs (QIRs)
IBC pathogenic pathway
![Page 12: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/12.jpg)
UVI model i mus med E. coli: Histologi på blære udtaget 28 t efter infektion: Blæreepithel x 600
Intracellulære bakterier
Græm N, Frimodt-Møller N
2010, upubl.
![Page 13: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/13.jpg)
Hvidberg, Struve, Krogfelt, Christensen, Rasmussen, Frimodt-Møller
Development of a Long-Term Ascending Urinary Tract Infection Mouse Model for Antibiotic Treatment Studies Antimicrob. Agents Chemother. 2000 44: 156-163.
Anesthetized mice were inoculated transurethrally with the bacterial suspension by use of plastic catheters. The catheters were made from tubing (autoclavable; inner diameter, 0.50 mm). Pieces of tubing were placed on hypodermic needles (25 gauge by 5/8 in.) and autoclaved. The catheter was carefully pushed into the urethra until it reached the top of the bladder, and 0.05 ml of bacterial suspension was injected in the bladder over 5 s in order to avoid vesicoureteral reflux. The catheter was removed immediately after inoculation.
![Page 14: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/14.jpg)
![Page 15: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/15.jpg)
Urinary tract infection model in mice: EM-of bladder epithelium during treatment with mecillinam
Kerrn et al 2003.
Without
treatment
After 3 d treatment with mecillinam
![Page 16: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/16.jpg)
Ejrnæs et al. 2010
Relaps forårsaget af samme E.coli som 1. dyrkning før behandling:
80/100 (80%) stammer
![Page 17: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/17.jpg)
Importance of phylogenetic groups of E. coli in relapse of UTI
Relapse/ Persistence
Reinfection/cure
Relapse/ Persistence
Reinfection/cure
n= 78b n=78 P a n= 51 n=30 P a
Phylogenetic group A 7 (9) 19 (24) 0,01 6 (12) 4 (13) -
B1 2 (3) 3 (4) -c 3 (6) 1 (3) -B2 61 (78) 40 (51) <0.001 32 (63) 19 (63) -D 8 (10) 16 (21) - 10 (20) 6 (20) -
Placebo groupMecillinam group
Prevalence of phylogenetic group [no. (%)] or biofilm score [median (range)]
Ejrnæs et al. 2011
![Page 18: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/18.jpg)
Prospective Cohort Study of Microbial and Inflammatory Events Immediately Preceding Escherichia coli Recurrent Urinary Tract Infection in Women
Czaja et al. J I D, 2009; 200:528–36
Events (E.coli periurethrally or in urine, pyuria or symptoms) preceding <14 days prior to rUTI
![Page 19: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/19.jpg)
Prospective Cohort Study of Microbial and Inflammatory Events Immediately Preceding Escherichia coli Recurrent Urinary Tract Infection in Women
Czaja et al. JID, 2009; 200:528–36
![Page 20: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/20.jpg)
• Kyllinger (n=138)
• Dansk kyllingekød (n=197)
• Importeret kyllingekød (n=86)
• Svin (n=145)
• Dansk svinekød (n=177)
• Importeret svinekød (n=10)
• Raske mennesker (n=109)
• Patienter med urinvejsinfektion (n=102)
Lægepraksis syd for Kbh 2005-06 N=964
E. coli isolater (n=964)
![Page 21: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/21.jpg)
Fordeling af fylogrupper (n=964)
Foodborne Pathog Dis 2010 7:537
![Page 22: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/22.jpg)
Isolater fra dyr, fødevarer og mennesker (n = 964) Undersøgt for: • Fænotypisk resistens [AMP, CHL, CIP, GEN, STR, SUL, TET, TRI] • Virulensgenprofil [8 ExPEC-relaterede gener: kpsm II, papA,
papC, iutA, sfaS, focG, afa, hlyD]
Clusteranalyse:
UVI isolater grupperer ofte med isolater fra dyr og fødevarer
Int J Food Microbiol 2010 142:264
![Page 23: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/23.jpg)
• Microarray-detektion: - 315 virulensgener - 82 resistensgener
Clusteranalyse: UVI isolater grupperer sammen med isolater fra fødevarer og dyr, dvs stor lighed mellem isolaterne
Genprofilering af B2 isolater (n=161)
DNA Hybridisering Scanning
Mærket DNA Vask
J Med Microbiol 2011 60:1502
![Page 24: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/24.jpg)
PFGE typning
Urine
Bladder
Kidneys
Urine
Bladder
Kidneys
100101102103104105106107108109
CFU
per m
l urin
e,bl
adde
r or 2
kid
neys
Murine UTI model
• Genprofil 1 (42 virulensgener) : • 2 isolater fra dansk kyllingekød (pfge 1-2) • 1 isolat fra en UVI patient (pfge 3) • 1 isolat fra et rask menneske (pfge 4)
1 2 3 4 2 4
Eur J Clin Microbiol Infect Dis 2011, Epub 28 Okt
Klonal sammenhæng
![Page 25: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/25.jpg)
Ligner isolater fra dyr og fødevarer isolater fra mennesker? [fylogrupper, virulensgener, resistens]
Findes kendte uropatogene E. coli typer blandt isolater fra dyr, fødevarer og mennesker? [clonal group A isolater]
n = 964
n = 161 B2
n = 158 D
n = 13 B2/9 D
n = 22 B2/ 25 D
Kan isolater fra dyr og fødevarer give infektion i urin, blære og nyre hos mus? [murin urinvejsmodel]
Er der klonal sammenhæng mellem isolater fra kød og dyr med isolater fra mennesker? [pulsed-field gel elektroforese]
Er E. coli UVI en zoonose? Stammekollektion (n=964): (DANMAP 2004, Køge praksis 2005-6)
√
√
√ √
→ Ja
![Page 26: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/26.jpg)
Urinvejsinfektion (UVI)
• Bakterier i urinen
• Leukocytter i urinen
• Kliniske symptomer – Dysuri syndrom: stranguri, pollakisuri, smerter
over symfysen, lette lændesmerter, evt. feber
![Page 27: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/27.jpg)
Klassifikation
• Asymptomatisk / symptomatisk
• Nedre / øvre
• Ukompliceret / kompliceret
• Akut / recidiverende / kronisk
![Page 28: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/28.jpg)
Klassifikation • Akut ukompliceret
– Cystitis: Kvinder mellem 14 og 60 år med symptomer på UVI (dysuri, pollakisuri), men som ikke har feber og som ikke har haft UVI indenfor 4 uger
– Pyelonefrit: Feber, lændesmerter, Kvinder mellem 14 og 60 år, ingen urologiske abnormiteter
• Kompliceret – Alle andre!!
• Drenge, piger, mænd • Patologiske urinveje • Asymptomatisk bakteruri • Recidiverende (x 3/12 mdr)
![Page 29: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/29.jpg)
Symptomatology and presence of significant bacteriuria
Although none of the patients developed acute pyelonephritis, a substantial number of the women had such complaints as feeling feverish (33% in culture-positive group, 38% in culture-negative group), back pains (44% vs. 56%), and feeling weak and tired (71% vs. 65%). Differences between the culture-positive and culture-negative groups were not statistically significant except for the duration of symptoms, which was shorter in the culture-positive group (4 vs. 6 days).
Heytens S et al., J Womans Health 2011; 20:1117-21 In women who present with 1 or more symptoms of UTI, the probability of
infection is approximately 50%. Specific combinations of symptoms (eg, dysuria and frequency without vaginal discharge or irritation) raise the probability of UTI to more than 90%, effectively ruling in the diagnosis based on history alone. In contrast, history taking, physical examination, and dipstick urinalysis are not able to reliably lower the posttest probability of disease to a level where a UTI can be ruled out when a patient presents with 1 or more symptoms
Bent S et al. JAMA 2002;287:2701-10
![Page 30: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/30.jpg)
Incidens af hjemmeerhvervet UVI i forhold til alder
Laupland et al. Infection, 2007, 35:150-3
![Page 31: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/31.jpg)
0,0
5,0
10,0
15,0
20,0
25,0
30,0
35,0
40,0
45,0
0-4 5-9 10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85-89
90-95
95+
Alderskategorier
Pro
cent
vise
and
el
begge køn kvinder mænd
Patienter i primærsektoren som i 2003 blev behandlet med enten sulfamethizol,
pivmecillinam eller nitrofurantoin fordelt på køn og alder
![Page 32: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/32.jpg)
Urinvejsinfektion Epidemiologi
• 2. hyppigste infektionssygdom hos børn • < 7 års alder : 7,8 % hos piger ; 1,6 % hos drenge
• Kun få børn har underliggende sygdom
• Kan give alvorlige sequelae
Børn
![Page 33: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/33.jpg)
Urinvejsinfektion Generel definition
• To midtstråle-uriner med vækst af samme bakterie, >10-4 cfu/ml
• Vækst af bakterier > 10-3 cfu/ml ved uretralkateter
• Enhver vækst af bakterier udtaget ved suprapubisk blærepunktur
Børn
![Page 34: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/34.jpg)
Nedre Urinvejsinfektion
• Alment upåvirket
• Temperatur < 38,5 • Alder > 1,5 år • Øget vandladningsfrekvens (> 7 / dag) • Dysuri • Urge • Inkontinens • Abdominalsmerter
Børn
![Page 35: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/35.jpg)
Øvre urinvejsinfektion Symptomer
• Børn > 1 år med høj crp + temp.> 38,5 • Børn < 1 år ….. Som:
– Ikke altid feber – Ikke altid høj crp – Gylp / opkastning / diarre – Pirrelighed – Skrigeture – Dårlig trivsel
• Tænk altid på UVI ved feber hos børn yngre end ½ år Disse behandles alle som øvre UVI og bør indlægges til
behandling og undersøgelse
Børn
![Page 36: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/36.jpg)
Common Risk Factors for UTI in the elderly
• Atrophic urethritis • Artrophic vaginitis • Benign prostatic hyperplasia • Cancer of prostate • Catheter use • Genitourinary abnormalities (e.g. vesicorectal fistula) • Genitourinary calculi • Renal and perinephric abscess formation • Urinary diversion procedure (e.g. ileal bladder diversion) • Urethral stricture
![Page 37: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/37.jpg)
Asymptomatisk bakteriuri hos ældre Population Ref.
Alder, år Antal undersøgte
Bakteriuri-hyppighed, % Mænd Kvinder
Hjemmeboende Rodhe 2006
80 642 6 15
Hjemmeboende Ahktar 1972
65 466 6 17
Plejehjem Dontas 1981
70 342 16 38
Indlagte, ortop. Klarskov 1976
70 65 - 60
Indlagte, geriatri Gladstone 1971
50 – 90 100 15 21
Indlagte, KAD kroniske lidelser, Mou 1962
- - 82 94
![Page 38: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/38.jpg)
Asymptomatisk bakteriuri hos ældre (>80) hjemmeboende: Risikofaktorer
OR
• Urin inkontinens > 1 x uge 3.00 • Nedsat mobilitet 2.68 • Østrogen behandling 2.20
Rodhe et al., Family Practice 2006, 23: 303-7
![Page 39: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/39.jpg)
Concensus criteria for surveillance, diagnosis and treatment of UTI without urine culture in the elderly
McGeer criteria For patients without catheter 3 of criteria must be met: 1) Tp > 38o C 2) New/increased burning,
frequency or urgency 3) New flank/suprapubic pain 4) Change in character of urine 5) Worsening of mental or
functional status
Loeb criteria For patients without catheter 1) Acute dysuria or Tp > 38o C plus at least one of: 2) New/worsening urgency 3) New/worsening frequency 4) Suprapubic pain 5) Gross hematuria 6) Costovertebral angle pain 7) New/increased incontinence
Am J Infect Control, 1991, 19:1-7 Inf Contr Hosp Epidemiol 2001, 22:120-4
![Page 40: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/40.jpg)
Sensitivity, specificity of Criteria – with positive culture as standard
Sens Spec PPV NPV McGeer 30% 82% 57% 61% Loeb 19% 89% 57% 59%
Juthani-Mehta et al, JAGS, 2007, 55: 1072-77
![Page 41: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/41.jpg)
Triggers causing suspicion of UTI in 100 nursing home residents
Juthani-Mehta et al, JAGS, 2007, 55: 1072-77
• Change in mental status 40 • Change in behaviour 27 • Change in character of urine 16 • Evaluation of other infection 11 • Fever or shaking chills 11 • Change in gait 8 • Change in voiding pattern 7 • Flank, abdominal, pelvic pain 6 • Dysuria 6 • Change in functional status 3
![Page 42: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/42.jpg)
Serial concentrations of CrP as an indicator of UTI in patients with spinal injury
Galloway et al., J Clin Pathol 1986, 39: 851-55
![Page 43: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/43.jpg)
Prævalens af nosokomielle infektioner i Danmark 1999 og 2003.
Type af infektion Prævalens (relativ fordeling i %)
2003 1999 Urinvejsinfektion 2,9 (27,6) 2,1 (26,6) Postop. sårinfekt. 1,8 (17,1) 2,0 (25,0)
Nedre luftvejsinf. 1,7 (15,6) 1,4 (17,4) Hudinfektioner 1,4 (13,6) 0,4 (4,8) Andre 2,8 (26,1) 2,1 (27,1) I alt 10,6 (100) 8,0 (100)
![Page 44: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/44.jpg)
• Længerevarende kateterisation med KAD (>6-7 dage) • Kvinde • Alder • Inkontinens • Pt. med anden form for infektion • Diabetes • Immunkompromitterede/ supprimerede • Fejlernæring • Nyreinsufficiens • Suprapubisk kateterisation • Intermitterende kateterisation • Kateterisation udenfor operationsrum • Andre urindrænagehjælpemidler (uridom og ble)
Ætiologi, patogenese og risikofaktorer Risikofaktorer for No-UVI
![Page 45: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/45.jpg)
Kateter A Demeure
• Bakteriuri: 25% efter 1 uge, 100% efter 4 uger
• Infektionsrisiko: RIK/SIK < Kondom (Ble?)< KAD
0,0
1,0
2,0
3,0
4,0
5,0
6,0
Syge huse Plejehjem Hjemmepleje
% i
ndiv
ider
med
No-
UV
I
Mænd
Kvinder
Nosok. UVI i DK, Præv.us.,1993 Forbrug af katetre, bleer mm
0
10
20
30
40
50
60
KAD Engangskat. Uridom BleUrindrænagehjælpemidler
Proc
ent
SygehusePlejehjemHjemmepleje
![Page 46: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/46.jpg)
Criteria for catheterized elderly patients
To meet the criteria for a suspected UTTI with an indwelling catheter, two of the following must be met:
• Fever (>38 degree C) or chills • New flank or suprapubic pain or
tenderness • Changes in character of urine • Worsening mental function
![Page 47: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/47.jpg)
KAD • KAD og andre katetre er fremmedlegemer
– Inokulum mindre – Biofilm
• Vanskeligere at behandle – Kolonisering
• ”alle” pt med KAD får bakteriuri – Ved brug af lukkede systemer med tømningshane
» Kolonisering udskydes til i gemmensnit 6 døgn » Halvering af risikoen for egentlig infektion i forhold til
halvåbne systemer – Vævsvenlige materialer – Antibiotika imprægnerede
• Undgå KAD hvis muligt!
![Page 48: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/48.jpg)
Routes of entry of uropathogens to catheterized urinary tract
DG Maki & PA Tambyah, Emerg Infect Dis, 2001
12/18 women and 5/17 men with catheter bacteria colonizing urethra same as found in rectum Daifuku JAMA 1984
![Page 49: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/49.jpg)
Routes of entry of uropathogens to catheterized urinary tract
DG Maki & PA Tambyah, Emerg Infect Dis, 2001
40 – 60%
20 – 30%
20 – 30%
Proportion (%) of entry routes
![Page 50: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/50.jpg)
KAD: Komplikationer
• Ascendering – pyelonefritis – pyonefrose
• Spredning lokalt – Prostatitis
• Spredning til blodbanen – Dansk studie af 3500 bakteriæmier
• 2/3 var nosokomielle – 40 % udgik fra UVI – 90 % som følge af instrumentering inkl. KAD!
Arpi, SJID, 1995, 27, 245
![Page 51: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/51.jpg)
Autopsi hos 75 ældre plejehjemsptt. Warren et al. JID 1988; 158: 1341
KAD ved Mors + -
Akut nyreinfektion
21 (38%) 1 (5%)
Akut cystitis 14 0
Bakteriæmi før mors
92 %
![Page 52: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/52.jpg)
KAD og infektion Risikofaktorer - 1 • Køn % inficerede
– Kvinder 13 % – Mænd 5 %
• Indikation for KAD – Timediurese, operation 8 % – Andre 24 %
• S-creatinin – Normal 9 % – Høj 22 %
Platt, Am J Epid, 124, 977, 1986
![Page 53: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/53.jpg)
KAD og infektion Risikofaktorer - 2 • Tid med KAD % inficerede
– 1 døgn 3 % – 3-4 døgn 10 % – 4-5 døgn 12 % – >6 døgn 27 %
• DM – Ja 18 % – Nej 8 %
• Urinpose koloniseret – Ja 43 % – Nej 8 %
Platt, Am J Epid, 124, 977, 1986
![Page 54: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/54.jpg)
UNOMEDICAL/CONVATEC
In vitro test of ascending infection in Urimeters ”in situ”
Inoculation with Ps. aeruginosa at day 0
1 – 7: Sites of sampling for culture at different days up to 7 days.
”Bladder”
”Catheter”
Urimeter
Urine bag
![Page 55: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/55.jpg)
CURITY BARD
Urimeters with emptying by tilting
![Page 56: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/56.jpg)
APOLLO 450 APOLLO 500
Kendall Urimeters with emptying by backwards tilting
![Page 57: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/57.jpg)
![Page 58: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/58.jpg)
Urimetre: In vitro test med inokulation af Ps. aeruginosa i urinpose Dag 0
Tømning via hane i bunden af urimeter
Tømning ved at hælde fra urimeter over i posen
Tømning ved at vippe urimeter bagover
Frimodt-Møller et al. Br J Infect Control, 2005, 6: 14-17.
![Page 59: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/59.jpg)
Urimetre: In vitro test Dag 4
Tømning via hane i bunden af urimeter
Tømning ved at hælde fra urimeter over i posen
Tømning ved at vippe urimeter bagover
Frimodt-Møller et al. Br J Infect Control, 2005, 6: 14-17.
![Page 60: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/60.jpg)
Urimetre: In vitro test Dag 7
Tømning via hane i bunden af urimeter
Tømning ved at hælde fra urimeter over i posen
Tømning ved at vippe urimeter bagover
Frimodt-Møller et al. Br J Infect Control, 2005, 6: 14-17.
![Page 61: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/61.jpg)
In vitro test of Urimeters: No. Pos./No. Tested
Product (No. Tested)
Urine bag Urimeter ”Catheter/ Bladder”
Day of sampling 2 4 7 2 4 7 2 4 7
BARD (12)
4/4 4/4 4/4 2/4 4/4 4/4 0/4 0/4 4/4
Apollo (16)
4/4 4/4 8/8 0/4 1/4 8/8 0/4 0/4 1/8
Unome-dical (16)
4/4 4/4 8/8 0/4 0/4 2/8 0/4 0/4 0/8
Braun (4)
4/4 0/4 0/4
SARSTEDT (4)
4/4 1/4 0/4
Frimodt-Møller et al. Br J Infect Control, 2005, 6: 14-17.
![Page 62: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/62.jpg)
Urinvejsinfektion (UVI)
• Urinvejene sterile indtil meatus urethrae externa
• Def. Af UVI: Mikroorganismer i urin • Problem: Ved prøvetagning at undgå
forurening fra m.u.e. • Løsning: 1) Punktur (Suprapubisk
blærepunktur, nefrostomi); 2) MSU: kvantitering af urindyrkning
![Page 63: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/63.jpg)
Quantitative bacteriuria in Mid-Stream-Urine-Sample from asymptomatic women
Kass E. Trans Assoc Am Physicians 1956, 69: 56-64
0
10
20
30
40
50
60
0 10 100
1000
1000
0
1000
000
>1000
000
Asymp As/diab As/cystoc Pyelonef.
Bact/ml urine
No. of patients
![Page 64: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/64.jpg)
Hidtidige kriterier for urinvejsinfektion
• Undersøgelser af midtstråleurin fra asymptomatiske kvinder sammenlignet med patienter med pyelonefritis:
>105 bakterier/ml af samme bakterie i to urinprøver diagnostisk for bakteriuri med 95% sikkerhed.
• Edward Kass 1956.
![Page 65: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/65.jpg)
Diagnosis of coliform infection in acutely dysuric women
Stamm et.al. NEJM 1982; 307: 463-8
0
10
20
30
40
50
60
70
No growth 10 100 1000 10000 >=100000
Neg SP/C Pos SP/C
CFU/ml
No. of ptts.
Neg. 29% 15% 10% 4% 1%
Pos. 100% 95% 81% 70% 51%
![Page 66: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/66.jpg)
Studies in urinary tract infections: The diagnosis of bacteriuria in women: Urine cultures in 95 women with symptoms of UTI
Organ./ml in msu
Organisms per ml urine aspirated by suprapubic puncture
Sterile <103 103-104 104-105 105-106 >106
< 103 27 1 1 0 0 0
103-104 17 1 5 0 0 0
104-105 0 0 2 3 1 0
105-106 2 0 0 1 6 1
106 0 0 0 0 1 26
Total 46 2 8 4 8 27
Mabeck, Acta Med Scand 1969, 186: 35-38.
![Page 67: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/67.jpg)
Studies in urinary tract infections: The diagnosis of bacteriuria in women: Urine cultures in 95 women with symptoms of UTI
Organ./ml in msu
Organisms per ml urine aspirated by suprapubic puncture Sterile <103 103-
104 104-105 105-106 >106
< 103 27 1 1 0 0 0
103-104 17 1 5 0 0 0
104-105 0 0 2 3 1 0
105-106 2 0 0 1 6 1
106 0 0 0 0 1 26
Total 46 2 8 4 8 27 Mabeck, Acta Med Scand 1969, 186: 35-38.
Lave tal < 105: 10/47 ~ 21%
![Page 68: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/68.jpg)
Kriterier for urinvejsinfektion
• Med symptomer: > 103 bakterier/ml urin af urinvejspatogene
bakterier (Enterobacteriaceae, S. saprofyticus, enterokokker m.fl.)
• Asymptomatisk: > 105 bakterier/ml urin af samme bakterie i to
prøver taget med 24 timers mellemrum
![Page 69: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/69.jpg)
Urinvejsinfektion (UVI): Prøvetagning
• Problem: Ved prøvetagning at undgå
forurening fra m.u.e.
• Løsning: • 1) Punktur (Suprapubisk blærepunktur, nefrostomi); • 2) MSU: kvantitering af urindyrkning
![Page 70: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/70.jpg)
Urinvejsinfektion: Prøvetagning
Suprapubisk blærepunktur Blærekateter
![Page 71: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/71.jpg)
Bladder Puncture + Midstream Sex Age Midstream Puncture Crp M 2,6 mdr 10.4 Ent. - - M 9,0 mdr 10.4 E.coli - normal M 6,5 mdr 10.3 E.coli - - M 1,8 mdr 10.3 E.coli - - M 0,5 mdr 10.4 E.coli - - F 2,0 mdr 10.3 E.coli + 10.3Ent - normal M 2,0 mdr 10.5 E.coli 10.5 E.coli - M 3,5 mdr 10.3 Kleb + 10.3 Ent 10.3 Staf,k-neg - F 2,3 mdr 10.2 E.coli - - F 3,9 mdr 10.4 E.coli + 10.4 Staf aur - - M 0,5 mdr 10.3 E.coli + 10.3 Staf.k-neg - - F 0,9 mdr 10.5 Ent + 10.5 Klebs. - - F 2,0 mdr 10.1 Ent cloac. - - M 0,5 mdr 10.3 Staf - normal F 1,3 mdr negativ - - M 1,9 mdr 10.3 Ent - - M 2,6 mdr 10.5 Ent + 10.3 E.coli - - F 2,9 mdr negativ - - M 10,6 mdr 10.4 Ent - normal F 2,6 mdr 10.4 E.coli - normal F 10,6 mdr 10.5 E.coli 10.5 E.coli forhøjet F 1,0 mdr 10,3 Ent + 10,3 E.coli - - F 5,6 mdr 10.5 E.coli + 10.5 Strep-n.h - - M 0,9 mdr 10.3 E.coli - - F 2,0 mdr negativ - normal M 2,6 mdr 10.5 E.coli - - M 1,9 mdr 10.5 E.coli + 10.5 GBS - forhøjet
Børn
![Page 72: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/72.jpg)
Urinprøvetagning:Midtstråleurin (MSU)
![Page 73: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/73.jpg)
MSU: Hvordan tages urinprøven bedst ? 110 raske, yngre kvinder tog op til 8 urinprøver på forskellige dage:
+/- MSU
+/- afvask af perinæum
+/- adskille labiae
(Dipslides – 76% af bakterier var CNS eller enterokokker)
Baerheim et al.
Br J Gen Pract 1992, 42: 241-3
![Page 74: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/74.jpg)
Fig. 1. Box-and-whisker plots of urine particles in first stream and midstream urine. Boxes show medians and quartiles; whiskers are the 10th and 90th percentiles of each type of urine particle (particle count/μl) in first stream (f) and midstream (m) urine samples. *P<0.05, **P<0.01 vs. that in first stream urine samples, respectively, by the Wilcoxon signed-rank test.
Importance of midstream clean-catch technique for urinalysis, reconfirmed by urinary flow cytometry
Morimoto et al.
Clinica Chimica Acta Volume 333, Issue 1,
![Page 75: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/75.jpg)
Diagnostik af UVI: Dyrkning og Res.best. URICULT (Orion)
FLEXICULT (SSI)
Standard D+R med kalibreret øjennål
![Page 76: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/76.jpg)
FLEXICULTTM SSI-Urinkit
• Agar plate – 6 comparrtments with enlarged sides/walls
• Control for quantitative evaluation
• Antibiotic compartments – Trimethoprim (T) – Sulfamethizole (S) – Ampicillin (A) – Nitrofurantoin (N) – Mecillinam (M)
T
S A
N
M
Proteus mirabilis
Klebsiella pneumoniae
![Page 77: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/77.jpg)
Procedure
1. Urine sample poured over agar in kit 2. Urine decanted after 1-2 sec 3. Agar plate placed in lid and incubated with lid downwards at 350C overnight
![Page 78: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/78.jpg)
FlexicultTM - quantitation of bacterial counts
E. coli
103 cfu/ml 104 cfu/ml 105 cfu/ml
106 cfu/ml 107 cfu/ml
Susceptibility test independent of inoculum
![Page 79: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/79.jpg)
P. mirabilis K. pneumoniae
FlexicultTM
![Page 80: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/80.jpg)
FlexicultTM
E.coli Klebsiella sp
E. faecalis Morganella morganii
![Page 81: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/81.jpg)
Mikroskopi – resultater af fasekontrastmik. (x 1.000) vs. kvantitativ dyrkning Frimodt-Møller et al. UfL
Mikroskopi
Dyrkning bakt/ml
Positiv Negativ Total
> 100.000 116 26 142
< 100.000 83 289 372
Total 199 315 514
SP-DF: 0,58; SN-DF: 0,92
![Page 82: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/82.jpg)
Little P, et al. Dipsticks and diagnostic algorithms in urinary tract infection: development and validation, randomised trial, economic analysis, observational cohort and qualitative study. Health Technol Assess 2009;13(19).
![Page 83: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/83.jpg)
Principper for stix undersøgelse af leucocytter og nitrit
Leucocytesterase: Leucocyt: - henfald ex vivo ½-1
time Leucocytesterase - stabilt - kvantitet relateret til
antal leucocytter
Nitritreaktion: Protein Bakterie Nitrat + Nitrat- reduktase Nitrit
![Page 84: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/84.jpg)
Nitrat-Nitrit reaktionen
organisk molekyle med NH grupper
NO NO NH N og/el. N O
3 - 2 - 3
2 2
2
nitratreduktase
nitritreduktase
![Page 85: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/85.jpg)
UVI hos kvinder med KAD op. for recto-cystocele. (Frimodt-Møller N: Upubliceret)
Urin-dyrkning
Stix Positiv
Stix Negativ
Total
> 100.000 bakt./ml
18 9 27
< 100.000 bakt./ml
16 73 89
Total 34 82 116
Falsk neg. 33% PPV: 53% NPV: 89%
![Page 86: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/86.jpg)
Diagnostik af UVI: Stix
Princip: • Leucocytter: Påvisning af
leucocytesterase = enzym fra leucocytter
• Nitrit: Nitratreduktase fra bakterier omdanner nitrat -> nitrit
• Enzymet findes ikke i Stafylokokker, Enterokokker, Pseudomonas m.fl.
Tolkning L + / N + sikker UVI L + / N - mulig UVI 50% ej inf. L - / N + bakteriuri,
mulig UVI
L - / N - 5-40% falsk negative
N. Frimodt-Møller, SSI
![Page 87: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/87.jpg)
Diagnostik af UVI: Resume af forskellige metoder
Detektion af > 1000 bakt/ml
Nem i praksis Bemærkning
Stix for nitrit og leucocytter
nej ja Falsk neg. 10-40 %
Mikroskopi nej ja Svært at se grampositive
Dyrkning - direkte inokulation
ja ja Flexicult: Nem at flæse/Uricult svær
Dyrkning - kalibreret øjenål
ja nej Afkølet urin Svær at aflæse
![Page 88: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/88.jpg)
Little P, et al. Dipsticks and diagnostic algorithms in urinary tract infection: development and validation, randomised trial, economic analysis, observational
cohort and qualitative study. Health Technol Assess 2009;13(19).
• 66% of patients with symptoms of UTI had pos. culture • Antibiotic resistance or not providing antibiotics is
associated with a 50–60% longer duration of more severe symptoms and more severe frequency symptoms in the days immediately after presentation.
• Patients who delay by more than 48 hours while waiting for MSU results are likely to have much poorer symptom control. Immediate antibiotics targeted using dipsticks with a delayed prescription as backup or an empirical delayed prescription achieve similar symptom control to empirical antibiotics and help reduce antibiotic use.
![Page 89: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/89.jpg)
Little P, et al. Dipsticks and diagnostic algorithms in urinary tract infection: development and validation, randomised trial, economic analysis, observational cohort and qualitative study. Health Technol Assess 2009;13(19).
![Page 90: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/90.jpg)
Behandling af Urinvejsinfektioner
• Asymptomatisk UVI ? • Symptomatisk UVI ? • Kateter ? • Resistens ? • Valg af antibiotika • Varighed af behandling
![Page 91: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/91.jpg)
Asymptomatisk bakteriuri
• Definition: >100.000 bakterier/ml af samme bakterie i 2 urindyrkninger taget med 24 timers mellemrum – Gravide – Præoperativt – KAD – øvrige
![Page 92: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/92.jpg)
Ferry, Sven A et al. (2007)'Clinical and bacteriological outcome of different doses and duration of pivmecillinam compared with placebo therapy of uncomplicated lower urinary tractinfection in women: The LUTIW project', Scand J Primary Health Care,25:1,49 — 57
![Page 93: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/93.jpg)
Bakteriuri ved KAD
• Kun behandlingsindikation ved kliniske symptomer! – KAD er fremmedlegemer
• Man kan ikke sterilisere urinen med antibiotika • Man udvikler resistens hos bakterierne • Man laver floraskift til mere resistente bakterier
![Page 94: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/94.jpg)
Screening for UVI ?
• Kun ved symptomer på UVI • Præoperativt ?
![Page 95: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/95.jpg)
Behandling af UVI
• Behandling overvejes: Symptomatisk, ukompl. UVI hos kvinder • Behandling påkrævet: Kompliceret UVI (mænd,børn,ældre, øvre UVI hos kvinder) Asymptomatisk bakteriuri hos gravide Præoperativ asymptomatisk bakteuri • Skal ikke behandles: Asymptomatisk bakteriuri hos alle andre Inkl. kateterbærere
![Page 96: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/96.jpg)
Sulfamethizole urine concentrations after 1g to human volunteers as related to sulfa MICs vs. E.coli from UTI
Sulfamethizole
0 3 6 9 121248
163264
128256512
102420484096
20 22 24
2
2
17
24
45
10
2
45
0 10 20 30 40 50
8
16
32
64
128
256
512
1024
2048
> 2048
Number of E. coli strains
MIC90 > 2048 mg/L
MIC50 = 128 mg/L
Time (h)
Con
cent
rati
on (m
g/L
)
Kerrn et.al. CMI 10, 54-61, 2004
![Page 97: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/97.jpg)
Behandling af UVI: Effekt af antibiotika i relation til resistens før behandling
Sulphamethizole R S
Trimethoprim R S
Total no. of patients
77 228
53 265
Sterile urine
45 162 (58%) (71%)
40 209 (75%) (79%)
P
0.04
0.58
Mabeck & Vejlsgaard UfL 142: 1664-8, 1980
![Page 98: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/98.jpg)
Mecillinam urine concentrations after 400mg to human volunteers as related to mecillinam MICs vs. E.coli from UTI
Mecillinam
0 3 6 9 120.1250.250.5
1248
163264
128256512
1024
20 22 241
39
59
32
7
4
2
1
1
1
0 10 20 30 40 50 60
0,125
0,25
0,5
1
2
4
8
16
32
64
MIC90 = 2 mg/L
MIC50 = 0.5 mg/L
Number of E. coli strains
Time (h)
Con
cent
rati
on (m
g/L
)
Kerrn et.al. CMI 10, 54-61, 2004
![Page 99: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/99.jpg)
Activity against E. coli (N=6) of Sulfamethizole (1g dose; MIC, mg/l: 128; 512; >2048) and Mecillinam (0,4g dose; MIC, mg/l: 0.5; 16; 128) in urine samples 5 h
after dosing
Ex vivo study (5 hrs)
-4 -3 -2 -1 0 1 2 3 4-10-9-8-7-6-5-4-3-2-101
Sulfamethizole
Mecillinam
r2 = 0.27P < 0.0001
r2 = 0.66P < 0.0001
log10 urine concentration/MIC
∆ lo
g 10 C
FU/m
l
Kerrn et.al. CMI 10, 54-61, 2004
![Page 100: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/100.jpg)
Antibiotic resistance in E.coli from urine in primary care and in hospitals
www.danmap.org
![Page 101: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/101.jpg)
Resistens hos E. coli fra UVI i praksis, ukompliceret vs. kompliceret
20
0
22 10 0
Kerrn et al. JAC 1991
![Page 102: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/102.jpg)
Urinvejsinfektion: Valg af behandling og varighed
• Antibiotika (% res. hos E.coli/DK): • Sulfametizol (20-40) • Trimethoprim (10-25) • Nitrofurantoin (5) • Mecillinam (3-5) • Ampicillin (20-40) • Cefuroxim (0-8)
• Varighed af beh.: • Ukompliceret UVI: • kvinder ml. 14-60: (3-) 5 dage • børn, mænd, kvinder > 60: 7 dage • Kompliceret UVI: 14 dage
![Page 103: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/103.jpg)
Clinical Infectious Diseases 2011;52(5):e103–e120
![Page 104: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/104.jpg)
Ferry, Sven A et al. (2007)'Clinical and bacteriological outcome of different doses and duration of pivmecillinam compared with placebo therapy of uncomplicated lower urinary tract infection in women: The LUTIW project', Scand J Primary Health Care,25:1,49 — 57
![Page 105: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/105.jpg)
Nedre urinvejsinfektion Behandling
Peroral behandling 3 – 7 dage: • Sulfametimazol 50mg/kg/døgn på 2-3 doser. (Max 1 g x 2)
• Mecillinam 20mg/kg/døgn på 2-3 doser. (max 400mg x 3)
• Amoxicillin 50mg/kg/døgn på 2-3 doser (max 500mg x 3)
• Nitrofurantoin 3 mg/kg/døgn på 3-4 doser (max 50mg x 4)
• Trimopan 6mg/kg/døgn på 2 doser (max 200mg x 2)
Kontrolurin 2 dage efter endt kur.
Børn
![Page 106: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/106.jpg)
Kontrol af behandling ?
• 10 – 30 % får recidiv fra 7 – 30 dage efter behandling afhængig af antibiotikum og varighed af behandling
• 50% af recidiver får ingen symptomer på recidiv • Konsekvens af recidiv ??
– Kureres efter nogen tid +/- antibiotika – Udvikler kronisk UVI
• Optimalt: Kontroldyrkning
![Page 107: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/107.jpg)
Behandling af UVI
• Behandling overvejes: Symptomatisk, ukompl. UVI hos kvinder • Behandling påkrævet: Kompliceret UVI (mænd,børn,ældre, øvre UVI hos kvinder) Asymptomatisk bakteriuri hos gravide • Skal ikke behandles: Asymptomatisk bakteriuri hos alle andre Inkl. kateterbærere
![Page 108: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/108.jpg)
Hjælper det at behandle asymptomatisk bakteriuri hos
patienter med kronisk inkontinens ?
![Page 109: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/109.jpg)
Does eradicating bacteriuria affect the severity of chronic incontinence in nursing home residents ? Ouslander et al. Ann Intern Med 1995, 122: 749-54
Bacteriuria + 7 d treatment
N = 71
Non-bacteriuric - treatment
N = 120 % ptts found wet & other signs for incont.: - before treatment
34 %
29 %
- after treatment
35 % 30 %
![Page 110: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/110.jpg)
Does eradicating bacteriuria affect the severity of chronic incontinence in nursing home residents ? Ouslander et al. Ann Intern Med 1995, 122: 749-54
Bacteriuria + 7 d treatment N = 71
Non-bacteriuric - treatment N = 120
% ptts found wet & other signs for incont.: - before treatment
34 %
29 %
- after treatment
35 %
30 %
”Eradicating UTI has no short-term effects on severity of chronic urinary incontinence – support the practice of not treating asyptomatic UTI in this population”
![Page 111: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/111.jpg)
Skal asymptomatisk bakteriuri hos patienter med diabetes
mellitus behandles ?
![Page 112: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/112.jpg)
Antimicrobial Treatment in Diabetic Women with Asymptomatic Bacteriuria Harding et al. NEJM 2002, 347: 1576-83
O > 16 y, DM, + asympt. bacteriuria
Antibiotic treatment
N = 55
Placebo N = 50
P
No. of UTI during 27 months follow-up
23 (42 %) 20 (40 %) NS
UTI * 0.93 1.10 NS
Pyelonephritis * 0.13 0.28 NS
Hospitalization for UTI *
0.1 0.06 NS
* Rate per 1000 days of follow-up
![Page 113: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/113.jpg)
Skal asymptomatisk bakteriuri hos ældre behandles ?
![Page 114: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/114.jpg)
Does Asymptomatic Bacteriuria predict Mortality and does Antibiotic Treatment Reduce Mortality in Elderly Ambulatory Women ? Abrutyn et al. Ann Intern Med 1994, 120: 827-33.
• 318 ptts with a.b. randomized to antibiotic treatment
(N=166) or placebo (N=192) • Mortality per 100.000 resident-days: 13,8 in antibiotic group vs. 15,1 in placebo group; relative risk = 1,1 (P > 0,2). • Conclusion: 1. UTI not an independent risk factor for mortality 2. Treatment did not lower mortality 3. Screening and treatment of a.b. in elderly not
warranted
![Page 115: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/115.jpg)
Nye udviklinger i UVI: Konklusion • UVI opstår ved ascenderende infektion fra kolonisation omkring
urethras åbning. • De patogene bakterier kommer oftest fra patientens egen tarmflora • E.coli i tarmen stammer fra fødeindtagelse og kan derfor stamme fra
produktionsdyr via fødevarer. • E. coli invaderer blære epithelet og opholder sig intracellulært i en
biofilm-lignende tilstand, som ikke kan behandles med antibiotika. Dette fokus er årsag til recidiverende infektion. Dette er vist på mus, men en række undersøgelser tyder på, at det samme forekommer hos mennesker.
• Antibiotikabehandling kræver tilstedeværelse af antibiotika i urinen indtil bakterierne er forsvundet fra blæreepithelet
![Page 116: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/116.jpg)
Nedre urinvejsinfektion Opfølgning I
Ultralyd nyrer / urinveje : • Bør foretages hos alle børn med 1. UVI (elektivt) • Kan udelades ved 1.gangs nedre UVI hos piger >3 år • Kun børn med sikker klinisk diagnose skal have foretaget
UL • Hvis der foreligger en tidligere normal UL skal den IKKE
gentages Uro-flow + residualurin måling : • Recidiverende nedre UVI • Ledsagende daginkontinens (> 5 års alderen) • Kronisk obstipation
Børn
![Page 117: Dias nummer 1 - Abena · Selective binding of FimH (A) and antibodies to uroplakins (B) to the umbrella cells of mouse urothelium. Sections of mouse bladder were incubated with biotinylated](https://reader033.fdocument.pub/reader033/viewer/2022041707/5e456081d9d92042165895ea/html5/thumbnails/117.jpg)
Nedre urinvejsinfektion Opfølgning II
Vandladningsanamnese • Inkontinens: urge, pollakisuri, dysuri • Vandladningsskema • Milepæle Afføringsanamnese • Inkontinens/obstipation Objektiv undersøgelse • Genitalia externa (phimosis, misdannelse) • Neurologi (anocutan + bulbocavernøs refleks, abnorm
lumbalcolumna)
Børn