BackgroundTuberculosis (TB) is the leading infectious cause of death worldwide. A major barrier to control of the pandemic is a lack of clinical biomarkers with the ability to distinguish active TB from healthy and sick controls and potential for development into point-of-care diagnostics.MethodsWe conducted a prospective case control study to identify candidate urine-based diagnostic biomarkers of active pulmonary TB (discovery cohort) and obtained a separate blinded “validation” cohort of confirmed cases of active pulmonary TB and controls with non-tuberculous pulmonary disease for validation. Clean-catch urine samples were collected and analyzed using high performance liquid chromatography-coupled time-of-flight mass spectrometry.ResultsWe discovered ten molecules from the discovery cohort with receiver-operator characteristic (ROC) area-under-the-curve (AUC) values >85%. These 10 molecules also significantly decreased after 60 days of treatment in a subset of 20 participants followed over time. Of these, a specific combination of diacetylspermine, neopterin, sialic acid, and N-acetylhexosamine exhibited ROC AUCs >80% in a blinded validation cohort of participants with active TB and non-tuberculous pulmonary disease.ConclusionUrinary levels of diacetylspermine, neopterin, sialic acid, and N-acetylhexosamine distinguished patients with tuberculosis from healthy controls and patients with non-tuberculous pulmonary diseases, providing a potential noninvasive biosignature of active TB.FundingThis study was funded by Weill Cornell Medicine, the National Institute of Allergy and Infectious Diseases, the Clinical and Translational Science Center at Weill Cornell, the NIH Fogarty International Center grants, and the NIH Tuberculosis Research Unit (Tri-I TBRU).
Objectives Our objective was to examine the performance characteristics of a bladder stimulation technique for urine collection among infants presenting to the emergency department (ED). Methods This prospective cohort study enrolled a convenience sample of infants aged ≤ 90 days requiring urine testing in the ED. Infants were excluded if critically ill, moderately to severely dehydrated, or having significant feeding issues. Bladder stimulation consisted of finger tapping on the lower abdomen with or without lower back massage while holding the child upright. The primary outcome was successful midstream urine collection within 5 minutes of stimulation. Secondary outcomes included sample contamination, bladder stimulation time for successful urine collection, and perceived patient distress on a 100-mm visual analog scale (VAS). Results We enrolled 151 infants and included 147 in the analysis. Median age was 53 days (interquartile range [IQR] 27–68 days). Midstream urine sample collection using bladder stimulation was successful in 78 infants (53.1%; 95% confidence interval [CI] 45–60.9). Thirty-nine samples (50%) were contaminated. Most contaminated samples (n = 31; 79.5%) were reported as “no significant growth” or “growth of 3 or more organisms”. Median bladder stimulation time required for midstream urine collection was 45 seconds (IQR 20–120 seconds). Mean VAS for infant distress was 22 mm (standard deviation 23 mm). Conclusions The success rate of this bladder stimulation technique was lower than previously reported. The contamination rate was high, however most contaminated specimens were easily identified and had no clinical impact.
Sixty-two women with signs and symptoms compatible with lower urinary tract infections were randomized to receive single-dose tetracycline (2 g), multi-dose tetracycline (500 mg four times per day for 10 days), or single-dose amoxicillin (3 g). Urine cultures were obtained upon entry into the study and on days 4, 14, and 28 after therapy. Single-dose tetracycline cured 12 of 16 (75%) of women with documented urinary tract infections, compared with 15 of 16 (94%) in the multi-dose tetracycline group and 7 of 13 (54%) receiving single-dose amoxicillin. Mild nausea in 3 of 20 patients (15%) was the only complication in the single-dose tetracycline group. Two grams of single-dose tetracycline is as effective as other reported regimens regardless of the susceptibility of the initial pathogen and has minimal toxicity.Symptomatic lower urinary tract infections (UTI) in women are a common problem in the United States. It affects approximately 20% of women during child-bearing years and generates approximately 6 million office visits annually. In recent years, numerous studies have attempted to define an effective, easily administered, nontoxic, inexpensive therapeutic regimen, deliverable in a single oral dose (2, 5-7, 9, 14-16, 18, 19, 23). Although these studies tested a variety of single-dose agents, tetracycline (TCN) has certain properties that make it particularly attractive as a singledose regimen. TCN is active against most common bacterial urinary pathogens (17) and is also one of the most effective antimicrobial agents available for treatment of Chlamydia trachomatis, the etiological agent in perhaps 20% of women with the acute urethral syndrome (22). TCN is inexpensive ($0.16 for 2 g at our pharmacy), has a low incidence of toxicity in nonpregnant adults, and is largely excreted through urine (12). TCN has been used successfully without significant toxicity in single-dose regimens for shigellosis (4, 13) and gonorrhea (3,11). We previously evaluated the efficacy of a 2.5-g single-dose TCN (SDT) in uncomplicated UTI and reported that although it was efficacious, frequent gastrointestinal toxicity limited its use (unpublished data). In this study, we compared the efficacy and adverse side effects of a 2-g SDT in the therapy of UTI to single-dose amoxicillin (SDA) (3 g) and to 10 days of TCN (500 mg mented UTI in the preceeding 2 years, or allergy to penicillin or TCN. Informed consent was obtained from all patients.At the initial visit, the following specimens were obtained: a urethral swab, two cervical swabs, and a clean-catch midstream urine (MSU) sample. The MSU was examined chemically by dipstick (N-Multistix-C; Ames Co., Elkhart, Ind.) and cultured by standard microbiological techniques. Antimicrobial susceptibility testing was determined by the Kirby-Bauer disk method. Positive MSU cultures had colony counts greater than or equal to 1,000 organisms per ml of a single isolate (20). The MSU sediment was prepared in duplicate by centrifuging 10-ml portions for 10 min at 1,500 x g. One sediment was suspende...
Conclusion:In infants 1 to 3 months of age undergoing urethral catheterization in the ED, administration of an oral sweet solution did not statistically decrease pain scores as measured by the FLACC and NIPS scales. Participants' heart rate variations and crying time were not significantly decreased when sucrose was provided. Keywords: pain, pediatric LO038 Evaluation of a midstream urine collection technique for infants in the emergency department T. Crombie, MD, R. Slinger, MD, N. Barrowman, PhD, C. McGahern, BA, L. Smith, J. Chu, K. McCoy, S. Akiki, MSc, A. Plint, MD; Children's Hospital of Eastern Ontario, Ottawa, ON Introduction: A novel bladder stimulation technique has been described for midstream urine (MSU) collection in well-feeding, inpatient newborns. We sought to determine the performance of this technique amongst infants presenting to the Emergency Department (ED). Methods: Our prospective ED-based study enrolled a convenience cohort of infants aged ≤ 90 days who required urine testing. Infants with significant feeding issues, moderate to severe dehydration, or critical illness were excluded. Bladder stimulation consisted of finger tapping on the lower abdomen with or without lower back massage while holding the child upright. Healthcare providers received standardized training in the technique. Primary outcome was the proportion of infants with successful MSU collection via the technique. Success was defined as adequate sample collection (≥ 1 mL urine) within 5 minutes of initiating stimulation. Secondary outcomes included the proportion of contaminated MSU samples, time required for MSU collection and full protocol completion, and patient discomfort as perceived by parent/guardian using a 100 mm visual analog scale [VAS]. Assuming success a priori in 50% of infants, a sample size of 115 allowed a 95% confidence interval of + /-9.1% around the point estimate. Results: We enrolled 115 infants. Mean age was 53.0 days old (interquartile range [IQR] 26.7-68.0); 58.3% were male (69.2% uncircumcised). Midstream urine was successfully collected in 61 infants (53.0%; 95% CI 0.44,0.62). Thirty-one MSU samples (50.8%) were contaminated; uncircumcised males held the highest proportion (55.0%). Most contaminated samples (83.9%) were reported as "non-significant growth" or "growth of ≥ 3 organisms" and were easily identifiable as contaminants with minimal impact on clinical care. Only 4 (8.5%) of the 47 patients discharged home after successful MSU collection had a repeat ED visit for urine testing. Median stimulation time for MSU collection was 45 seconds (IQR 20-99 secs). Median time for full protocol completion was 30.83 minutes . Mean VAS for infant discomfort was 20.2 mm (SD + /-20.4 mm). Conclusion: Our pragmatic, ED-based study found the success rate of this bladder stimulation technique to be significantly lower (53%) than its published rate (86%). The contamination rate was high but most contaminated specimens were easily identifiable as such and had minimal clinical impact. Keywords: urine sample, in...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.