Khurram Danial, Asifa Khurram, Kamal Ahmed, Muhammad Saad, Ahmed Ali.
Urinary Tract Infection among Urogenital Fistula patients at Abbasi Shaheed Hospital, Karachi, Pakistan.
Annals Punjab Med Coll Jan ;9(4):184-8.

Introduction: Urinary tract infections are common in women of developing countries which results in substantial morbidity and health care cost. The Urogenital fistula is frequently related to gynecological conditions. Material & Methods: This is a prospective study was carried out in the Department of Nephrology, Abbasi Shaheed Hospital from March 2011 to May 2014. 79 patients with uro-genital fistula, irrespective of cause of the fistula, with ages between 18–60 years were included in this study. Patients were referred to nephrology clinic. A detail medical history was taken from each patient for episodes of urinary tract infection and the treatment given during the last six months. Patients were educated how to collect midstream morning urine sample. Urine sample were taken from all symptomatic and asymptomatic patients for culture examination and send to laboratory within an hour. Results: We have found that out of 72 patients studied for UTI, 89 percent of the studied patients had culture proven UTI.  Recurrent UTI is very common in patients with uro-genital fistulas and 72 percent of patients experienced an average of 03 episodes of symptomatic UTIs during last six monthsRelapses are more frequent than re-infections. Culture proven but asymptomatic infections were seen in 39 percent of patients. Mean infectious episodes rate during last six months was 3. 73 percent of the observed episodes were symptomatic, while asymptomatic bacteriuria was seen in 27 percent of patients.  The most frequent Bacteria is E. coli followed by Pseudomonas aerugenosa and Enterobacter species. These were the most common pathogen isolated which are highly resistant to Amoxicillin, Cotrimoxazole, Fluoroquinolones and Cephalosporins. We found that the isolated pathogens are mostly sensitive to Piperacillin-Tazobactam and Carbepenem groups of Drugs. Conclusion: We concluded that Urogenital fistula in developing countries are most regularly linked to Gynecological surgery whereas in developing countries, complicated childbirth is the most common cause. Recurrent infections are more frequent in patients with urogenital fistula and mostly represent relapse rather than re-infection. Relapsing infection warrants extensive evaluation of urinary tract and extended period of antimicrobial therapy with appropriate antibiotics.

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