MARCH 2011 | VOLUME 4 No. 2 | Quarterly Publication Medical Diagnostic Laboratories, L.L.C. Presorted 2439 Kuser Road First-Class Mail Test Announcement U.S. Postage Research & Development Journal Watch Hamilton, NJ 08690 Urinary Tract Infections (UTIs) Tests now available in the clinical Summaries of recent topical PAID Continued ...................... pg 2 laboratory publications in the medical literature Trenton, NJ Full Article ...................... pg 8 Full Article ...................... pg 9 Permit 348 SM The Laboratorian WHAT’S INSIDE Urinary Tract Infections in Women and Men P2 Urinary Tract Infections (UTIs) Author: Jack H. Mydlo, MD, FACS. Table 1: Other Risk Factors for UTIs. Continued By definition, urine is normally free of bacteria. 1. Frequency of intercourse P3 Urinary Tract Infections (UTIs) Bacteriuria indicates the presence of bacteria in the 2. Use of a diaphragm Continued urine, and this may be asymptomatic or symptomatic. 3. Estrogen deficiency P4 Urinary Tract Infections in Women Urinary tract infections (UTIs) can be classified as 4. Antibiotic usage and Men Continue to their site of origin. They are considered to be the 5. Infants P5 Urinary Tract Infections in Women most common bacterial infection. They are usually and Men Continue Research & Development 6. Pregnant women associated with minimal morbidity. Urinary Tract Infections (UTIs) 7. Elderly P6 Urinary Tract Infections in Women Continued ...................... pg 2 and Men Continue UTIs are considered the most common bacterial 8. Spinal cord injury 9. Indwelling catheters P7 Urinary Tract Infections (UTIs) infection, and accounts for nearly 7 million office Continued Test Announcement visits, 1 million emergency room visits, and 100,000 10. Diabetes Tests now available in the clinical 11. Multiple sclerosis P8 New tests and e-quiz laboratory hospital admissions annually. It increases from 1% Full Article ...................... pg 8 in school aged girls to 4% in young adulthood. It then 12. HIV-AIDS P8 Recent Publications SM increases by 2% for every decade of life. 13. Urologic pathology P9 Journal Watch Journal Watch P10 ClassifiedAd Summaries of recent topical publications About 10% of women will have a UTI in any given The bacteria that causes most urinary tract in the medical literature year. More than half of all women have had at least infections is from E. coli, which is mostly present Full Article ...................... pg 9 The one UTI in their lifetime. One in three women will in the bowel. Other organisms include Proteus, Laboratorian have a UTI by the time they reach 24, compared to Klebsiella, Enteroccocus and Staphylococcus. men, in which UTIs are more common after the age of The female urethra is short, and bacteria usually UPCOMING EVENTS 50, due to bladder outlet obstruction from an enlarged enter it via the ascending route. WorldWide Medical Products, Inc. prostate. It is generally believed that some failure of the 04/1-3 ACOG-OR: Oregon Section Sun River, OR Approximately 5 million physician visits a year are host defense mechanism allows for colonization of Item Number - 71011010 the introitus and vaginal mucosa in women, which due to urinary tract infections, which can cost around 04/13-16 SCOG: 52nd Annual Meeting Powder-Free Latex Gloves is subject to recurrent bacterial infection from Item Number - 71011000 1000/case - $48.95 $1.6 billion annually. of the South Central Obstetrical Item Number - 14001003 Powder-Free Nitrile Gloves outside the urinary tract. While colonized, these & Gynecological Society Small Vaginal Speculum, Indiv. Wrapped 1000/case - $54.95 Symptomatic UTIs are increased among sexually women can experience recurrent UTIs every 6-12 Charlottesville, VA 10/pack - $37.95 active women, delayed post-coital voiding, anatomic months. Although these can be easily treated with urinary tract anomalies, reflux, cystocele, stones and antibiotics, they generally recur within weeks to 04/14-16 NASPAG: The North American Society for Pediatric and bladder diverticula. Other risk factors for UTIs are months. Item Number - 14001004 Continued.............pg 4 Adolescent Gynecology Medium Vaginal Speculum, Indiv. Wrapped summarized in Table 1. (NASPAG) Annual Meeting 10/pack - $39.95 Chicago, IL Item Number - 14001005 Large Vaginal Speculum, Indiv. Wrapped Item Number - 14011002 04/27 NEOG: New England OBGYN 10/pack - $41.95 Exam Table Rolls, Crepe, 21” x 125’, Society, Sturbridge, MA White 12/case - $24.92 Urinary Tract Infections (UTIs) 04/28-29 MWS: Matt Weis Author: David W. Hilbert, Ph.D. Symposium 2011 UTIs are a major source of morbidity and associated the presence of a significant level of bacteria in the St. Louis, MO healthcare costs in the United States (US). Community- urine (i.e. bacteriuria). Guidelines vary, but typically Item Number - 31031000 04/30-05/4 ACOG: National Meeting 4 6 3” Cotton Tipped Applicator acquired UTIs largely affect women of reproductive a pure culture of between 10 -10 colony forming Washington, DC 1000/box - $3.15 age, with 11% of women experiencing one each year, units (CFUs)/milliliter (mL) of urine is indicative of Item Number - 31031001 Item Number - 14011006 one-third of women having one by the age of 26, and a UTI. Patient symptoms are painful, urgent and 05/22-24 CLMA: Clinical Laboratory 6” Cotton Tipped Applicator Exam Table Rolls, Smooth, 21” x 125’, Management Association 1000/box - $4.49 White10/pack - $35.76 60% experiencing at least one during their lifetime [1]. frequent urination, along with malodorous and/ In 1997 these infections resulted in 7 million physician or cloudy urine. Signs of infection include the Think Lab, Baltimore, MD Item Number - 31031005 51/2” Tongue Depressors Sterile 41021159 10x75- Borosilicate Disposable Culture Tubes- 1000/cs 34.50 office visits and 1 million emergency room visits [2]. presence in urine of blood (hematuria) or white 1000/case - $32.95 41021160 12x75- Borosilicate Disposable Culture Tubes- 1000/cs 38.75 Treatment of these infections cost $1.6 billion in 1995 blood cells (pyuria). 41021161 13x100- Borosilicate Disposable Culture Tubes- 1000/cs 49.25 [1], which is the equivalent of $2.2 billion in inflation- 41021164 16x125- Borosilicate Disposable Culture Tubes- 1000/cs 79.50 Item Number - 31031006 Continued.............pg 2 41021165 16x150- Borosilicate Disposable Culture Tubes- 1000/cs 85.50 adjusted 2009 dollars. UTIs are defined clinically by 6” Tongue Depressors Sterile 1000/case - $32.95 866.889.WWMP(9967) • FAX: 609.570.1110 • WWW.WWMPONLINE.COM For information on placing a classified advertisement, please email [email protected]. Laboratorian_April_2011.indd 1 5/10/11 11:23 AM Urinary Tract Infections (UTIs) normally discovered during childhood, and most adults suffering from recurrent infections have anatomically normal urinary tracts. Ultrasound imaging can be performed if the clinician suspects an anatomical OURNAL ATCH etiology in a patient suffering from recurrent UTIs. J W Yasufuku T, Shigemura K, Shirakawa T, Matsumoto M, Nakano Pallett A, Hand K. 2010. Complicated urinary tract infections: Treatment Y, Tanaka K, Arakawa S, Kinoshita S, Kawabata M, Fujisawa practical solutions for the treatment of multiresistant Gram- Community-acquired symptomatic UTIs are treated with empirical M. 2011. Correlation of overexpression of efflux pump genes with negative bacteria. J Antimicrob Chemother. 2010 65:25-33. antimicrobial therapy upon diagnosis. The recommended first-line antibiotic resistance in Escherichia coli Strains clinically isolated (Review) antibiotic therapy for cystitis is either 100 milligrams (mg) of nitrofurantoin from urinary tract infection patients. J Clin Microbiol. 49:189-94. per day for 5 days or 160 mg-800 mg of trimethoprim-sulfamethoxazole Resistance in Gram-negative bacteria has been increasing, (SXT) per day for 3 days. Nitrofurantoin should be avoided if Escherichia coli is one of the most common pathogens in particularly over the last 6 years. This is mainly due to the pyelonephritis is suspected, as this drug only reaches an effective urinary tract infections (UTIs), and antibiotic resistance in E. coli spread of strains producing extended-spectrum β-lactamases Figure 1. Epidemiology of UTIs. UPEC from an environmental concentration in the bladder. SXT should be avoided if resistance in the is becoming a serious problem in treating UTI. Efflux system (ESBLs) such as CTX-M enzymes or AmpC β-lactamases. Many reservoir (1) colonizes the patient GI tract via the oral route (2). area is >20% or if the patient has been treated with this antibiotic in the overexpression is reported to contribute to E. coli resistance of the isolates producing these enzymes are also resistant to UPEC in the GI tract colonizes the rectum and is shed in feces (3), last three months. Fosfomycin (3 gram single dose) can also be used, to several antibiotics. This study investigated the correlation of trimethoprim, quinolones and aminoglycosides, often due to from where it colonizes the vagina and periurethral area (4). UPEC ascends the urethra to the bladder, causing either asymptomatic but some studies suggest it is less effective than nitrofurantoin or SXT. antibiotic susceptibilities with the over expression of the efflux plasmid co-expression of other resistance mechanisms. CTX-M- bacteriuria (ABU) or symptomatic infection (cystitis) (5). In some Although amoxicillin and ampicillin should be avoided due to endemic pump genes such as marA, yhiU, yhiV, and mdfA and with producing Escherichia coli often occurs