Urinary tract infections (UTIs) are the most common bacterial infections in postmenopausal women, and women with diabetes are possibly at a higher risk. The aim of this study is to evaluate the potential benefit on the prevention of UTI episodes, assessed by urinalysis and urine culture (primary outcome) after two, four and six months, of daily oral dietary supplement (120 mg highly standardized cranberry extract phytosome), compared to placebo, in diabetic postmenopausal women taking SGLT-2 inhibitors. Forty-six subjects (mean age 72.45 ± 1.76) completed the study (23 placebo/23 supplement). Considering UTI episodes, during the six-month supplementation period, an increase of 1.321 (95% CI: -0.322; 2.9650) was observed in the placebo group, while it remained at a steady value of 0.393 (95% CI: -4.230; 5.016) in the supplemented group. Regarding UTI episodes, in both groups, interaction between times for supplementation was statistically significant (p = 0.001). In particular, at follow-up 4, 9% of the placebo group showed infection versus only 3% with cranberry supplementation. Glycaemia and glycated hemoglobin values (secondary outcomes) were not modified at the end of six months with respect to the basal values in both groups, as expected. While in terms of quality of life per the SF-12 health questionnaire, there were no differences between the two groups, an improvement in SF-12 quality of life was observed in both groups (six months vs. basal). In conclusion, highly standardized cranberry extract phytosome supplementation reduced UTI recurrence.

Background/Objectives: Spinal cord injuries are debilitating conditions with significant impacts on physical function and patient quality of life. The high incidence of urinary tract infections in these patients can be attributed to neurogenic bladder-a major complication of spinal cord injuries. The aim of this study is to investigate the incidence of urinary tract infections in patients with spinal cord injuries and their relation to the method of bladder emptying. Methods: A retrospective analysis on 560 patients admitted for rehabilitation at the Clinic for Rehabilitation \"Dr Miroslav Zotovic\" from December 2009 to January 2023 was conducted. Patients over 18 years old who were inpatients for longer than 30 days without any symptoms of urinary tract infection on admission were included. Patient demographics, injury details, and bladder emptying methods were recorded. Results: In our study, 402 (71.8%) participants developed a urinary tract infection during their rehabilitation. Urinary tract infections were significantly more common in patients with traumatic spinal cord injuries, lower ASIA scores, and thoracic-level injuries. The highest incidence of urinary tract infections was observed in intermittent self-catheterization patients (62.7%), with Escherichia coli and Proteus mirabilis being the most frequently isolated pathogens. Conclusions: The method of bladder emptying significantly impacted the incidence of urinary tract infection in patients with spinal cord injuries. Despite guidelines favoring intermittent catheterization, this study found it to be associated with the highest infection rates. These findings suggest a need for personalized bladder management strategies to reduce the risk of urinary tract infections and improve outcomes for spinal cord injury patients.

OBJECTIVE: To determine the added diagnostic value of dipsticks for urinary tract infections (UTI) in acutely hospitalised individuals.
METHODS: Prospective population-based cohort study.
METHODS: North Denmark.
METHODS: All adults (≥18 years) examined with dipsticks at emergency departments in North Denmark Region from September 20 through 23 October 2021.
METHODS: UTI was defined as ≥1 symptom of new-onset frequency, dysuria or suprapubic tenderness combined with a positive urine culture. Positive dipsticks were defined as any reaction for leucocyte esterase and/or nitrite.
RESULTS: Dipsticks were used in 1052/2495 (42%) of acutely hospitalised patients with a median age of 73 years (IQR 57-82) and 540 (51%) were female. Overall, 89/1052 (8%) fulfilled the UTI criteria and urine cultures were done in 607/1052 (58%) patients. Among patients examined with both dipstick and urine culture, sensitivity and specificity for UTI were 87% (95% CI 78% to 93%) and 45% (95% CI 41% to 50%). Positive and negative predictive values were 21% (95% CI 17% to 26%) and 95% (95% CI 92% to 98%), whereas positive and negative likelihood ratios were 1.58 (95% CI 1.41 to 1.77) and 0.30 (95% CI 0.18 to 0.51). Pretest probabilities of UTI ranged from 29% to 60% in participants with specific UTI symptoms with corresponding post-test probabilities of 35-69% if dipsticks were positive and 12-27% if dipsticks were negative. Results remained comparable if final clinical diagnosis was used as outcome among all patients examined with dipsticks. Modified Poisson regression yielded an adjusted relative risk of 4.41 (95% CI 2.40 to 8.11) for empirical antibiotics for UTI in participants without specific UTI symptoms and a positive dipstick.
CONCLUSIONS: Dipsticks yielded limited clinical decision support compared with a symptom-driven approach in this study and were independently associated with excess antibiotics for UTI.

Immature granulocytes (IGs) are used as markers of infection and systemic inflammation. We aimed to investigate the diagnostic value of IGs in children with urinary tract infections (UTIs). Children with their first UTIs were included in this observational study. Blood samples were obtained before antibiotic therapy. The blood analysis was repeated 2 weeks after the treatment ended. In total, 194 children (95 with febrile UTI, 58 with cystitis, and 41 controls) were included. The percentage of IGs (IG%) and IG count (IGC) measured at the time of admission were higher in the patients with febrile UTI than in the patients with cystitis and the controls (P = 0.000). The IGC and IG% after treatment were higher in patients with renal scarring than in those without scarring (P = 0.012 and P = 0.021, respectively). Cox\'s regression analysis showed the significant associations of renal scarring with both IGC and IG% (hazard ratio: 8.181, P = 0.002; hazard ratio: 5.106, P = 0.033, respectively). Both IGC and IG% were positively associated with severe vesicoureteral reflux (VUR) [odds ratio (OR): 22.235, P = 0.025; OR: 15.597, P = 0.038, respectively]. In conclusion, the IG% and IGC, which can be easily measured in a routine complete blood count without the need for additional effort, could be used as biomarkers for predicting febrile UTI, renal scarring, and severe VUR in children.

BACKGROUND: Invasive device-associated nosocomial infections commonly occur in intensive care units (ICUs). These infections include intravascular catheter-related bloodstream infection (CRBSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infection (CAUTI). This study aimed to evaluate the factors associated with invasive device-associated nosocomial infections based on the underlying diseases of the patients and antibiotic resistance profiles of the pathogens causing the infections detected in the ICU in our hospital over a five-year period.
METHODS: Invasive device-associated infections (CRBSI, VAP, and CAUTI) were detected retrospectively by the laboratory- and clinic-based active surveillance system according to the criteria of the US Centers for Disease Control and Prevention (CDC) in patients hospitalized in the ICU of the tertiary hospital between 1 January 2018 and 30 June 2023.
RESULTS: A total of 425 invasive device-associated nosocomial infections and 441 culture results were detected (179 CRBSI, 176 VAP, 70 CAUTI). Out of them, 57 (13.4%) patients had hematological malignancy, 145 (34.1%) had solid organ malignancy, and 223 (52.5%) had no histopathologic diagnosis of any malignancy. An increase in extended-spectrum beta lactamase (ESBL) and carbapenem resistance in pathogens was detected during the study period.
CONCLUSIONS: Antibiotic resistance of the Gram-negative bacteria associated with invasive device-associated infections increased during the study period. Antimicrobial stewardship will reduce rates of nosocomial infections, reduce mortality, and shorten hospital stay. Long-term catheterization and unnecessary antibiotic use should be avoided.

BACKGROUND: About 3.5 million trauma patients are hospitalized every year, but 35%-40% require further care after discharge. Nurses\' ability to affect discharge disposition by minimizing the occurrence of nurse-sensitive indicators (catheter-associated urinary tract infection [CAUTI], central line-associated bloodstream infection [CLABSI], and hospital-acquired pressure injury [HAPI]) is unknown. These indicators may serve as surrogate measures of quality nursing care.
OBJECTIVE: The purpose of this study was to determine whether nursing care, as represented by three nurse-sensitive indicators (CAUTI, CLABSI, and HAPI), predicts discharge disposition in trauma patients.
METHODS: This study was a secondary analysis of the 2021 National Trauma Data Bank. We performed logistic regression analyses to determine the predictive effects of CAUTI, CLABSI, and HAPI on discharge disposition, controlling for participant characteristics.
RESULTS: A total of n = 29,642 patients were included, of which n = 21,469 (72%) were male, n = 16,404 (64%) were White, with a mean (SD) age of 44 (14.5) and mean (SD) Injury Severity Score of 23.2 (12.5). We created four models to test nurse-sensitive indicators, both individually and compositely, as predictors. While CAUTI and HAPI increased the odds of discharge to further care by 1.4-1.5 and 2.1 times, respectively, CLABSI was not a statistically significant predictor.
CONCLUSIONS: Both CAUTI and HAPI are statistically significant predictors of discharge to further care for patients after traumatic injury. High-quality nursing care to prevent iatrogenic complications can improve trauma patients\' long-term outcomes.

OBJECTIVE: Indwelling urinary catheter is closely associated with the occurrence of urinary tract infection (UTI). Herein, we further explored the correlation of urinary catheter indwelling time and UTI.
METHODS: Retrospectively, the medical data of nosocomial patients (n = 681) were collected during two quarters of April 2023 to June 2023 (the second quarter, 23.4-23.6, n = 330) and July 2023 to September 2023 (the third quarter, 23.7-23.9, n = 351). The baseline data and incidence of catheter-related UTI were analysed. The total hospitalisation days and indwelling urinary catheter days of patients in five departments were assessed, namely, coronary care unit (CCU), respiratory intensive care unit (RICU), surgical intensive care unit (SICU), neurology intensive care unit (NICU) and cardiac surgical intensive care unit (CSICU) departments. The correlation between hospitalisation days/indwelling urinary catheter days and the occurrence of UTI was evaluated by Spearman correlation analysis.
RESULTS: In the CCU, RICU, SICU, NICU and CSICU departments, the number of patients was 463, 83, 29, 91 and 15, respectively. During 23.4-23.6, the incidence of catheter-associated UTI (CAUTI) was 0, 2.85, 6.12, 0 and 12.99 per 1000 urinary catheter days in CCU, RICU, SICU, NICU and CSICU, respectively. During 23.7-23.9, the incidence of CAUTI was 2.98, 6.13, 8.66, 0 and 0 per 1000 urinary catheter days in CCU, RICU, SICU, NICU and CSICU, respectively. Notably, hospitalisation days/indwelling urinary catheter days were positively correlated with the occurrence of CAUTI in each quarter (p < 0.05).
CONCLUSIONS: There was a positive correlation between urinary catheter indwelling time and the occurrence of UTI.

OBJECTIVE: Urinary tract infections (UTIs) are the most common bacterial infection during pregnancy. This study aimed to investigate the risk factors of UTI during pregnancy.
METHODS: In this study, pregnant women who underwent prenatal examination in our hospital from October 2019 to October 2023 were divided into UTI group and non-UTI group in accordance with whether or not they had a UTI. The general data, clinical data and laboratory indicators of the participants were collected. Multivariate logistic regression was used to analyse the influencing factors of UTI in pregnant women, and the results were shown with odds ratio (OR) and 95% confidence interval (95% CI).
RESULTS: A total of 600 pregnant women were included in the study. The results found that 56 women (9.33%) had a combined UTI. The results of midstream urinary bacterial culture in the UTI group showed that Gram-negative bacteria accounted for 60.71% of all detected pathogenic bacteria, and Escherichia coli and Staphylococcus aureus were common strains, accounting for 46.43% and 23.21%, respectively. The proportions of patients in the UTI group who were ≥35 years old, had a high school education or below, had a history of abortion, had gestational diabetes, had ≥three vaginal and anal examinations, had a history of UTI and had urinary tract stones were significantly higher than the non-UTI group (p < 0.05). Multivariate logistic regression analysis showed that age ≥35 years (OR = 9.127; 95% CI: 4.668-17.810; p < 0.001), educational level of high school or lower (OR = 4.184; 95% CI: 2.448-7.160; p < 0.001), gestational diabetes (OR = 3.494; 95% CI: 1.789-6.803; p < 0.001), UTI history (OR = 2.074; 95% CI: 1.114-3.834; p < 0.001) and haemoglobin (Hb) <100 g/L (OR = 8.022; 95% CI: 4.532-14.325; p < 0.001) are risk factors for UTI in pregnant women.
CONCLUSIONS: The common pathogenic bacteria of pregnant women with UTI are mainly Gram-negative bacteria. Older pregnant women, low educational level, gestational diabetes mellitus, history of UTI and anaemia may be risk factors for UTI in pregnant women.

OBJECTIVE: The association of water loading with several infections remains unclear. Observational studies are hard to investigate definitively due to potential confounders. In this study, we employed Mendelian randomization (MR) analysis to assess the association between genetically predicted whole body water mass (BWM) and several infections.
METHODS: BWM levels were predicted among 331,315 Europeans in UK Biobank using 418 SNPs associated with BWM. For outcomes, we used genome-wide association data from the UK Biobank and FinnGen consortium, including sepsis, pneumonia, intestinal infections, urinary tract infections (UTIs) and skin and soft tissue infections (SSTIs). Inverse-variance weighted MR analyses as well as a series of sensitivity analyses were conducted.
RESULTS: Genetic prediction of BWM is associated with an increased risk of sepsis (OR 1.34; 95% CI 1.19 to 1.51; P = 1.57 × 10- 6), pneumonia (OR: 1.17; 95% CI 1.08 to 1.29; P = 3.53 × 10- 4), UTIs (OR: 1.26; 95% CI 1.16 to 1.37; P = 6.29 × 10- 8), and SSTIs (OR: 1.57; 95% CI 1.25 to 1.96; P = 7.35 × 10- 5). In the sepsis and pneumonia subgroup analyses, the relationship between BWM and infection was observed in bacterial but not in viral infections. Suggestive evidence suggests that BWM has an effect on viral intestinal infections (OR: 0.86; 95% CI 0.75 to 0.99; P = 0.03). There is limited evidence of an association between BWM levels and bacteria intestinal infections, and genitourinary tract infection (GUI) in pregnancy. In addition, MR analyses supported the risk of BWM for several edematous diseases. However, multivariable MR analysis shows that the associations of BWM with sepsis, pneumonia, UTIs and SSTIs remains unaffected when accounting for these traits.
CONCLUSIONS: In this study, the causal relationship between BWM and infectious diseases was systematically investigated. Further prospective studies are necessary to validate these findings.

Electrofulguration (EF) of areas of chronic cystitis in women with antibiotic-recalcitrant recurrent urinary tract infections (RUTIs) can result in improvement of their urinary tract infections (UTIs). We compared urine culture (UC) findings in patients before and after EF, as well as how they vary with cystitis stage at the time of EF, to evaluate for persistent species. After obtaining institutional review board approval, we retrospectively reviewed a prospectively maintained database of EF patients for those with positive UC findings in the 3-6 months preceding EF. Patient pre-EF UC was then compared with first positive UC after EF prompted by a new symptomatic UTI episode, with the hypothesis that the same species will be identified before and after EF. Exclusion criteria included UC from outside institution, neurogenic bladder, and need for catheterization. Ninety-nine women with pre- or post-EF UC-recorded organisms met the study criteria. The median age was 65 years (interquartile range 64-74), with a median time to first positive culture following fulguration of 9.7 months. For 26 patients with positive cultures both pre- and post-EF, the same organism was present in both cultures in 73% of the patients, with predominantly Escherichia coli. EF was effective at reducing the rate of UTIs in this population. For women undergoing EF for antibiotic-recalcitrant RUTIs and associated chronic cystitis lesions, 73% of those with a UC obtained at the time of a first symptomatic recurrent UTI episode post-EF expressed the same organism as before EF. Further study is needed to better understand the evolution of the microbiome post-EF.IMPORTANCEAmong women who experience a recurrent urinary tract infection after a fulguration procedure on areas of chronic cystitis in their bladder, there are no data available on whether the bacterial species found in urine cultures are the same or different from those present before fulguration. By removing the inflamed surface layer of cystitis during fulguration, it is possible that the procedure unmasks deep-seated bacteria. The bacterial kingdom in the bladder wall of these chronically infected women may be different from what is expressed sporadically in urine cultures. Confirming prior studies, we found that fulguration in women with antibiotic-recalcitrant recurrent urinary tract infections and cystitis lesions was effective at reducing the rate of urinary tract infections. At the time of a first symptomatic recurrent UTI episode post-fulguration, 73% expressed the same organism in urine culture as before fulguration. Further study is needed to better understand the evolution of the microbiome post-EF. This article evaluates persistent infections after electrofulguration of areas with chronic cystitis in post-menopausal women with antibiotic-recalcitrant recurrent urinary tract infections. Pre-fulguration urine cultures were compared with the first positive urine culture prompted by a new symptomatic UTI episode after electrofulguration, with the hypothesis that the same species will be identified before and after the fulguration procedure. Electrofulguration was effective at reducing the rate of UTIs in this population. However, 73% of those with a urine culture obtained at the time of a first symptomatic recurrent UTI episode post-electrofulguration expressed the same organism (predominantly Escherichia coli) as before the fulguration procedure. Further study is needed to better understand the evolution of the microbiome after electrofulguration.