The first report of the qnrB19, qnrS1 and aac(6 ')-Ib-cr genes in urinary isolates of ciprofloxacin-resistant Escherichia coli in Brazil

In this study, we investigated the presence of plasmid-mediated quinolone resistance (PMQR) genes among 101 ciprofloxacin-resistant urinary Escherichia coli isolates and searched for mutations in the quinolone-resistance-determining regions (QRDRs) of the DNA gyrase and topoisomerase IV genes in PMQR-carrying isolates. Eight isolates harboured the qnr and aac(6')-Ib-cr genes (3 qnrS1, 1 qnrB19 and 4 aac(6')-Ib-cr). A mutational analysis of the QRDRs in qnr and aac(6')-Ib-cr-positive isolates revealed mutations in gyrA, parC and parE that might be associated with high levels of resistance to quinolones. No mutation was detected in gyrB. Rare gyrA, parC and parE mutations were detected outside of the QRDRs. This is the first report of qnrB19, qnrS1 and aac(6')-Ib-cr-carrying E. coli isolates in Brazil.

The contrast-enhanced Doppler ultrasound with perfluorocarbon exposed sonicated albumin does not improve the diagnosis of renal artery stenosis compared with angiography

There are no studies investigating the effect of the contrast infusion on the sensitivity and specificity of the main Doppler criteria of renal artery stenosis (RAS). Our aim was to evaluate the accuracy of these Doppler criteria prior to and following the intravenous administration of perfluorocarbon exposed sonicated albumin (PESDA) in patients suspected of having RAS. Thirty consecutive hypertensive patients (13 males, mean age of 57 ± 10 years) suspected of having RAS by clinical clues, were submitted to ultrasonography (US) of renal arteries before and after enhancement using continuous infusion of PESDA. All patients underwent angiography, and haemodynamically significant RAS was considered when ≥50%. At angiography, it was detected RAS ≥50% in 18 patients, 5 with bilateral stenosis. After contrast, the examination time was slightly reduced by approximately 20%. In non-enhanced US the sensitivity was better when based on resistance index (82.9%) while the specificity was better when based on renal aortic ratio (89.2%). The predictive positive value was stable for all indexes (74.0%–88.0%) while negative predictive value was low (44%–51%). The specificity and positive predictive value based on renal aortic ratio increased after PESDA injection respectively, from 89 to 97.3% and from 88 to 95%. In hypertensives suspected to have RAS the sensitivity and specificity of Duplex US is dependent of the criterion evaluated. Enhancement with continuous infusion of PESDA improves only the specificity based on renal aortic ratio but do not modify the sensitivity of any index.

Urinary acidifier in diet with high excess base for adult cats

Maintaining the pH of urine in the ideal range (6.2 - 6.4) is of great importance for health promotion in the lower urinary tract of cats. In the economic and standard feed sector this is a major concern, given that the animal urine tends to be alkaline after food consumption of those commercial segments, which predispose to the formation of struvite urolith. Therefore, this study aimed to study the effects of increasing levels of urinary acidifiers (0.0%, 0.3%, 0.6% and 0.9%, on a dry matter base) in feed with high excess base over the acid-basic balance in the organism, apparent digestibility coefficients of nutrients, urinary pH, hydro-electrolyte balance in cats, as well as the adequacy of equations proposed in the literature to estimate the urinary pH. Twenty-four adult cats, males and females were distributed in a completely randomized design, consisting of six animals per treatment. The dry matter content of urine presented a quadratic behavior (p<0,05; y = 9.5863 + 3.2299x + 0.7871x2 R2 = 99,91%), HCO3-, total CO2 and excess blood base during the period in which the animals were fed were high when including 0.9% acidifier compared to 0.6% (p<0.05). In contrast, the use of the additive did not change the urinary pH, blood electrolyte concentration, nutrient digestibility, fecal score, food and water intake (p>0.05). The equations proposed in the literature, which use excess of base in feed to estimate urinary pH, overestimated the pH values found in this study.

Physicochemical analysis of blood and urine in the course of acute kidney injury in critically ill patients: a prospective, observational study

Abstract Background Sequential physicochemical alterations in blood and urine in the course of acute kidney injury (AKI) development have not been previously described. We aimed to describe these alterations in parallel to traditional renal and acid–base parameters. Methods One hundred and sixty eight consecutive critically ill patients with no previous kidney disease, who had an indwelling urinary catheter at ICU admission and who remained with the catheter for at least two days without dialysis were included. A sample of blood and spot urine were collected simultaneously, once daily, until catheter removal or dialysis requirement. Traditional acid–base and renal parameters were sequentially evaluated in parallel to blood and urinary physicochemical parameters. Patients were classified during this period as having or not AKI and, for patients with AKI, duration (transient or persistent) and severity (creatinine-based AKIN stage) were evaluated. Results One hundred and thirteen patients (67.3%) had AKI: 92 at ICU admission and 21 during the observation period. AKI development was characterized in blood by increased values of phosphate and unmeasured anions (SIG), decreased albumin, and in urine by decreased values of sodium (NaU), chloride (ClU) as well as high urinary strong ion difference (SIDu). These alterations began to occur before AKI diagnosis, and they reverted in transient AKI but remained in persistent AKI. NaU, ClU and albumin decreased, and phosphate, SIG and SIDu increased with AKI severity progression. NaU and ClU values increased again when AKIN stage 3 was reached. Conclusions Simultaneous physicochemical analysis of blood and urine revealed standardized alterations that characterize AKI development in critically ill patients. These alterations paralleled AKI duration and severity. Future studies should consider including sequential evaluation of urine biochemistry as part of the armamentarium for AKI diagnosis and management.

Renal function evaluation in patients with American Cutaneous Leishmaniasis after specific treatment with pentavalent antimonial

Background Renal evaluation studies are rare in American Cutaneous Leishmaniasis (ACL). The aim of this study is to investigate whether specific treatment reverts ACL-associated renal dysfunction. Methods A prospective study was conducted with 37 patients with ACL. Urinary concentrating and acidification ability was assessed before and after treatment with pentavalent antimonial. Results The patients mean age was 35.6 ± 12 years and 19 were male. Before treatment, urinary concentrating defect (U/Posm <2.8) was identified in 27 patients (77%) and urinary acidification defect in 17 patients (46%). No significant glomerular dysfunction was observed before and after specific ACL treatment. There was no reversion of urinary concentrating defects, being observed in 77% of the patients before and in 88% after treatment (p = 0.344). Urinary acidification defect was corrected in 9 patients after treatment, reducing its prevalence from 40% before to only 16% after treament, (p = 0.012). Microalbuminuria higher than 30 mg/g was found in 35% of patients before treatment and in only 8% after treatment. Regarding fractional excretion of sodium, potassium, calcium, phosphorus and magnesium, there was no significant difference between pre and post-treatment period. Conclusion As previously described, urinary concentrating and acidification defects were found in an important number of patients with ACL. Present results demonstrate that only some patients recover urinary acidification capacity, while no one returned to normal urinary concentration capacity.

Validation of models for predicting milk urea nitrogen concentrations, estimating dry matter intake by the NRC (2001)

The objective of this study was to validate three different models for predicting milk urea nitrogen using field conditions, attempting to evaluate the nutritional adequacy diets for dairy cows and prediction of nitrogen excreted to the environment. Observations (4,749) from 855 cows were used. Milk yield, body weight (BW), days in milk and parity were recorded on the milk sampling days. Milk was sampled monthly, for analysis of milk urea nitrogen (MUN), fat, protein, lactose and total solids concentration and somatic cells count. Individual dry matter intake was estimated using the NRC (2001). The three models studied were derived from a first one to predict urinary nitrogen (UN). Model 1 was MUN = UN/12.54, model 2 was MUN = UN/17.6 and model 3 was MUN = UN/(0.0259 × BW), adjusted by body weight effect. To evaluate models, they were tested for accuracy, precision and robustness. Despite being more accurate (mean bias = 0.94 mg/dL), model 2 was less precise (residual error = 4.50 mg/dL) than model 3 (mean bias = 1.41 and residual error = 4.11 mg/dL), while model 1 was the least accurate (mean bias = 6.94 mg/dL) and the least precise (residual error = 5.40 mg/dL). They were not robust, because they were influenced by almost all the variables studied. The three models for predicting milk urea nitrogen were different with respect to accuracy, precision and robustness.

Phenotypical characterization and adhesin identification in Escherichia coli strains isolated from dogs with urinary tract infections

Pathogenic strains of Escherichia coli are the most common bacteria associated with urinary tract infections in both humans and companion animals. Standard biochemical tests may be useful in demonstrating detailed phenotypical characteristics of these strains. Thirteen strains of E. coli isolated from dogs with UTIs were submitted to biochemical tests, serotyping for O and H antigens and antimicrobial resistance testing. Furthermore, the presence of papC, sfa, and afa genes was evaluated by PCR, and genetic relationships were established using enterobacterial repetitive intergenic consensus PCR (ERIC-PCR). The antimicrobial that showed the highest resistance rate among the isolates was nalidixic acid (76.9%), followed by cephalotin (69.2%), sulfamethoxazole + trimethoprim (61.5%), tetracycline (61.5%), streptomycin (53.8%), ciprofloxacin (53.8%), ampicillin (46.2%), gentamicin (30.8%) and chloramphenicol (23.1%). No isolate was resistant either to meropenem or nitrofurantoin. Among the five clusters that were identified using ERIC-PCR, one cluster (A) had only one strain, which belonged to a serotype with zoonotic potential (O6:H31) and showed the genes papC+, sfa+, afa-. Strains with the genes papC-, sfa+, afa- were found in two other clusters (C and D), whereas all strains in clusters B and E possessed papC-, sfa-, afa- genes. Sucrose and raffinose phenotypic tests showed some ability in discriminating clusters A, B and C from clusters D and E.

Cranberries and lower urinary tract infection prevention

Lower urinary tract infections are very common diseases. Recurrent urinary tract infections remain challenging to treat because the main treatment option is long-term antibiotic prophylaxis; however, this poses a risk for the emergence of bacterial resistance. Some options to avoid this risk are available, including the use of cranberry products. This article reviews the key methods in using cranberries as a preventive measure for lower urinary tract infections, including in vitro studies and clinical trials.

Community-acquired urinary tract infection: age and gender-dependent etiology

LO, Denise Swei et al. Community-acquired urinary tract infection: age and gender-dependent etiology. J. Bras. Nefrol. [online]. 2013, vol.35, n.2, pp. 93-98. ISSN 0101-2800. http://dx.doi.org/10.5935/0101-2800.20130016. INTRODUCTION: Choosing the antimicrobial agent for initial therapy of urinary tract infection (UTI) is usually empirical and should consider the prevalence of uropathogens in different age groups and gender. OBJECTIVE: To establish prevalence rates of uropathogens in community-acquired UTI in relation to age and gender. METHODS: Crosssectional study conducted in the emergency department (ED) of a general hospital, from January to December, 2010, in patients younger than 15 years old who had clinical suspicion of UTI and collected quantitative urine culture. UTI was defined as urine culture with growth of a single agent > 100.000 colony forming units (cfu)/mL in a midstream collection or > 50.000 cfu/mL in urethral catheterization. RESULTS: There were 63.464 visits to ED. 2577 urine cultures were obtained, of whom 291 were positive for UTI (prevalence = 11.3% of clinical suspicion and 0.46% of visits), 212 cases (72.8%) in females, median age = 2.6 years. The predominant uropathogen was E. coli (76.6%), followed by Proteus mirabilis (10.3%) and Staphylococcus saprophyticus (4.1%). Among infants < 3 months, prevalence rates of E. coli were significantly lower (50% vs 78.4%; OR = 0.276; p = 0.006). Higher prevalences of Staphylococcus saprophyticus occurred among patients > 10 years (24.4% vs 0.4%; OR = 79.265; p < 0.0001). Proteus mirabilis was significantly more prevalent in boys than girls (24.0% vs 5.2%; OR = 5.786; p < 0.001). CONCLUSIONS: E. coli was the most prevalent community-acquired uropathogen. Nevertheless, initial empiric antimicrobial treatment of UTI should consider the significant prevalence of other agents different from E. coli in infants < 3 months, the high prevalence of Staphylococcus saprophyticus in patients > 10 years and Proteus mirabilis in males.

GDH activity and ammonium excretion in the marine mysid, "Leptomysis lingvura": effects of age and starvation

[EN] Ammonium (NH4+) release by bacterial remineralization and heterotrophic grazers determines the regenerated fraction of phytoplankton productivity, so the measurement of NH4+ excretion in marine organisms is necessary to characterize both the magnitude and the efficiency of the nitrogen cycle. Glutamate dehydrogenase (GDH) is largely responsible for NH4+ formation in crustaceans and consequently should be useful in estimating NH4+ excretion by marine zooplankton.
Here, we address body size and starvation as sources of variability on the GDH to NH4+ excretion ratio (GDH/RNH4+). We found a strong correlation between the RNH4+ and the GDH activity (r2 = 0.87, n = 41) during growth. Since GDH activity maintained a linear relation (b = 0.93) and RNH4+ scaled exponentially (b =0.55) in well fed mysids, the GDH/RNH4+ ratio increased with size. However, the magnitude of its variation increased even more when adult mysids were starved. In this case, the GDH/RNH4+ ratio ranged from 11.23 to 102.41.

GDH activity and ammonium excretion in the marine mysid "Leptomysis lingvura": effects of age and starvation

Máster Universitario en Oceanografía

GDH activity and ammonium excretion during growth in the marine mysid, "Leptomysis lingvura"

[EN] Ammonium (NH4+) and nitrate (NO3-) are the main constituents of the inorganic nitrogen pool that supports primary production in marine systems. NH4+ release via glutamate deamination in heterotrophic organisms represents the largest recycled nitrogen source in the euphotic zone, supporting around the 80 % of the primary producers requirements (Harrison, 1992). Glutamate dehydrogenase (GDH) is the enzyme that catalyzes this process. This fact has lead to the use of GDH activity as an index, a proxy, for physiological NH4+ formation. The result is a measure of potential excretion that avoids incubation artefacts due to manipulation of the organisms. The relationship between GDH activity and NH4+ excretion in cultures of the marine mysid Leptomysis lingvura is analyzed here. With interspecific and environmental interferences minimized, the study shows that the relationship between GDH activity and NH4+ excretion in L. lingvura is similar to equivalent results measured on mixed assemblages of zooplankton.

The impact of body size and starvation on the biochemistry and the physiology of ammonium excretion in the marine mysid, "Leptomysis lingvura"

[EN] Ammonium (NH4+) release by bacterial remineralization and heterotrophic grazers determines the regenerated fraction of phytoplankton productivity, so the measurement of NH4+ excretion in marine organisms is necessary to characterize both the magnitude and the efficiency of the nitrogen cycle. Glutamate dehydrogenase (GDH) is largely responsible for NH4+ formation in crustaceans and consequently should be useful in estimating NH4+ excretion by marine zooplankton.
Here, we address body size and starvation as sources of variability on the GDH to NH4+ excretion ratio (GDH/RNH4+). We found a strong correlation between the RNH4+ and the GDH activity (r2 = 0.87, n = 41) during growth. Since GDH activity maintained a linear relation (b = 0.93) and RNH4+ scaled exponentially (b =0.55) in well fed mysids, the GDH/RNH4+ ratio increased with size. However, the magnitude of its variation increased even more when adult mysids were starved. In this case, the GDH/RNH4+ ratio ranged from 11.23 to 102.41.

Krill excretion boosts microbial activity in the Southern Ocean

[EN]Antarctic krill are known to release large amounts of inorganic and organic nutrients to the water column. Here we test the role of krill excretion of dissolved products in stimulating heterotrophic bacteria on the basis of three experiments where ammonium and organic excretory products released by krill were added to bacterial assemblages, free of grazers. Our results demonstrate that the addition of krill excretion products (but not of ammonium alone), at levels expected in krill swarms, greatly stimulates bacteria resulting in an order-of-magnitude increase in growth and production. Furthermore, they suggest that bacterial growth rate in the Southern Ocean is suppressed well below their potential by resource limitation. Enhanced bacterial activity in the presence of krill, which are major sources of DOC in the Southern Ocean, would further increase recycling processes associated with krill activity, resulting in highly efficient krill-bacterial recycling that should be conducive to stimulating periods of high primary productivity in the Southern Ocean.