“…Studies of probiotics have all had small sample sizes (48). Results are variable for studies of cranberry products (49). Ethanol locks may have potential for preventing urinary catheter infections (50).…”
The article reviews indications for and interpretation of urinalysis and urine culture results for diagnosis of UTI, choice of antibiotics for empiric and definitive UTI therapy, the rationale behind and indications for radiographic investigations, and prevention of UTIs including the complex decision as to whether antibiotic prophylaxis will benefit a child. Expert commentary: Over-diagnosis of UTI is a prevalent problem due to the lack of specificity of both urinalysis and urine culture. The most major recent advance in the field has been the recognition that antibiotic prophylaxis for UTI is rarely indicated as in most situations, the number needed to treat to prevent one UTI is too high to justify the risk of adverse events and development of antimicrobial resistance.
“…Studies of probiotics have all had small sample sizes (48). Results are variable for studies of cranberry products (49). Ethanol locks may have potential for preventing urinary catheter infections (50).…”
The article reviews indications for and interpretation of urinalysis and urine culture results for diagnosis of UTI, choice of antibiotics for empiric and definitive UTI therapy, the rationale behind and indications for radiographic investigations, and prevention of UTIs including the complex decision as to whether antibiotic prophylaxis will benefit a child. Expert commentary: Over-diagnosis of UTI is a prevalent problem due to the lack of specificity of both urinalysis and urine culture. The most major recent advance in the field has been the recognition that antibiotic prophylaxis for UTI is rarely indicated as in most situations, the number needed to treat to prevent one UTI is too high to justify the risk of adverse events and development of antimicrobial resistance.
“…Histologically, the bladder lumen is covered by transitional epithelia, which function as barrier epithelia with extremely low permeability for water and small molecules such as ethanol (Fig. 2 ) [ 19 , 20 ]. Fig.…”
We recently reported the first clinical case of bladder fermentation syndrome (BFS) or urinary auto-brewery syndrome, which caused the patient to fail abstinence monitoring. In BFS, ethanol is generated by Crabtree-positive fermenting yeast Candida glabrata in a patient with poorly controlled diabetes. One crucial characteristic of BFS is the absence of alcoholic intoxication, as the bladder lumen contains transitional epithelium with low ethanol permeability. In contrast, patients with gut fermentation syndrome (GFS) or auto-brewery syndrome can spontaneously develop symptoms of ethanol intoxication even without any alcohol ingestion because of alcoholic fermentation in the gut lumen. In abstinence monitoring, a constellation of laboratory findings with positive urinary glucose and ethanol, negative ethanol metabolites, and the presence of yeast in urinalysis should raise suspicion for BFS, whereas endogenous ethanol production needs to be shown by a carbohydrate challenge test for GFS diagnosis. GFS patients will also likely fail abstinence monitoring because of the positive ethanol blood testing. BFS and GFS are treated by yeast eradication of fermenting microorganisms with antifungals (or antibiotics for bacterial GFS cases) and modification of underlying conditions (diabetes for BFS and gut dysbiosis for GFS). The under-recognition of these rare medical conditions has led to not only harm but also adverse legal consequences for patients, such as driving under the influence (DUI). GFS patients may be at risk of various alcohol-related diseases.
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