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Point-of-care urine Gram stain led to narrower-spectrum antimicrobial selection for febrile urinary tract infection in adolescents and adults.
Taniguchi, Tomohiro; Tsuha, Sanefumi; Shiiki, Soichi; Narita, Masashi.
Afiliação
  • Taniguchi T; Division of Infectious Diseases, Department of Internal Medicine, Okinawa Chubu Hospital, 281 Miyazato, Uruma, Okinawa, 904-2293, Japan. taniyan260566@gmail.com.
  • Tsuha S; Division of General Internal Medicine and Infectious Diseases, Hiroshima Prefectural Hospital, 1-5-54 Ujinakanda, Minamiku, Hiroshima, 734-8530, Japan. taniyan260566@gmail.com.
  • Shiiki S; Division of Infectious Diseases, Department of Internal Medicine, Okinawa Chubu Hospital, 281 Miyazato, Uruma, Okinawa, 904-2293, Japan.
  • Narita M; Division of General Internal Medicine and Infectious Diseases, Sakibana Hospital, 1-3-30 Nozomino, Izumi, Osaka, 594-1105, Japan.
BMC Infect Dis ; 22(1): 198, 2022 Mar 01.
Article em En | MEDLINE | ID: mdl-35227212
BACKGROUND: Febrile urinary tract infections (fUTIs), which include pyelonephritis, prostatitis, and urosepsis, are the most common cause of sepsis. However, the treatment has become more complex because of the worldwide increase in antimicrobial resistance (AMR). The objective of this study was to clarify whether point-of-care Gram stain (PCGS) of urine contributed to fUTI diagnosis and treatment in adults. METHODS: This hospital-based observational study was undertaken between January 2013 and March 2015 in Okinawa, Japan. All enrolled patients were adults who had been admitted to the Division of Infectious Diseases with suspected fUTI. The usefulness of PCGS results were compared for urinalysis (U/A) and urine cultures (U/Cs). The targeted therapy type and its susceptibility based on PCGS were analyzed, and each was investigated in two groups: the uncomplicated pyelonephritis group and the complicated pyelonephritis/prostatitis group. RESULTS: Two hundred and sixty-six patients were enrolled. The results of PCGS were closely correlated with those of U/A for pyuria and bacteriuria, and moderately correlated with the results of U/C for bacterial types. In the uncomplicated group, narrow-spectrum antimicrobials such as cefotiam were initially selected in 97.9% (47/48) of patients, and their susceptibility was 97.9% (47/48). In the complicated group, the susceptibility was 84.2% (186/221) (p = 0.009) despite frequent AMRs (14.7%; 32/218) and low use of broad-spectrum antimicrobials such as carbapenems (7.7%; 17/221). CONCLUSION: Urine PCGS led to a more precise fUTI diagnosis and prompted clinicians to select narrower-spectrum antibiotics with high susceptibility.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Piúria / Infecções Urinárias / Anti-Infecciosos Tipo de estudo: Diagnostic_studies / Observational_studies Limite: Adolescent / Adult / Humans / Male Idioma: En Revista: BMC Infect Dis Assunto da revista: DOENCAS TRANSMISSIVEIS Ano de publicação: 2022 Tipo de documento: Article País de afiliação: Japão

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Piúria / Infecções Urinárias / Anti-Infecciosos Tipo de estudo: Diagnostic_studies / Observational_studies Limite: Adolescent / Adult / Humans / Male Idioma: En Revista: BMC Infect Dis Assunto da revista: DOENCAS TRANSMISSIVEIS Ano de publicação: 2022 Tipo de documento: Article País de afiliação: Japão