Assuntos
Enterococcus faecalis , Infecções por Escherichia coli/diagnóstico , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Pseudomonas/diagnóstico , Doenças da Bexiga Urinária/diagnóstico , Infecções Urinárias/diagnóstico , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Cálculos da Bexiga Urinária/diagnósticoRESUMO
OBJECTIVE: To determine whether Escherichia coli strains isolated from patients with uncomplicated acute pyelonephritis can be distinguished from those isolated from patients with complicated acute pyelonephritis on the basis of the genetic background. METHODS: In total, 103 E. coli strains isolated from patients with acute pyelonephritis (59 uncomplicated pyelonephritis (UAP) and 44 complicated pyelonephritis (CAP)) were characterized by RFLP of the intergenic spacer region 16S-23S rRNA, the presence of three alternative sequences found in the polymorphic V6 loop of the 16S rRNA gene, the presence of the pap gene, and antibiotic susceptibility. RESULTS: At similarity levels of 70%, four RFLP groups (alpha1, alpha2, beta1 and beta2) were discerned. Strains from UAP were statistically significant for alpha RFLP, with a strong association with the presence of the pap gene, V6-I sequence and antibiotic multisensitivity. Strains from CAP randomly belonged to the alpha or beta RFLP groups, with a very low presence of the pap gene, and random presence of V6 sequences, and were multiresistant to antibiotics. When the CAP strains were distributed according to underlying pathology, non-obstructive cases had RFLP and V6 polymorphisms similar to those of UAP cases, while obstructive cases were clearly distinct. CONCLUSIONS: UAP and non-obstructive CAP E. coli strains are sensitive to antimicrobials, show a high level of the pap gene and belong to the selective, homogeneous and highly protected molecular alpha2 group, where no recombinations, deletions or insertions are present. On the contrary, obstructive and vesicorenal reflux E. coli strains show significant antimicrobial resistance, high intercistronic heterogenicity (wide presence of block nucleotidic substitutions, deletions or insertions) and significantly lower virulence.
Assuntos
Infecções por Escherichia coli/microbiologia , Escherichia coli/genética , Pielonefrite/microbiologia , Óperon de RNAr/genética , Doença Aguda , Sequência de Bases , Primers do DNA , DNA Bacteriano/química , Farmacorresistência Bacteriana/genética , Eletroforese em Gel de Ágar , Escherichia coli/efeitos dos fármacos , Escherichia coli/patogenicidade , Humanos , Testes de Sensibilidade Microbiana , Dados de Sequência Molecular , Reação em Cadeia da Polimerase , Polimorfismo de Fragmento de Restrição , RNA Ribossômico 16S/genética , RNA Ribossômico 23S/genética , Homologia de Sequência do Ácido Nucleico , VirulênciaRESUMO
The efficacy and safety of rufloxacin (400 mg, single dose) were compared to those of norfloxacin (400 mg twice a day for 3 days) for the treatment of women with uncomplicated cystitis. In addition, urine levels, drug level/MIC ratio, and urine antibacterial activity 72 to 84 h after treatment initiation were determined in a subgroup of patients for pharmacodynamic assessment. A total of 203 women were included and treated in this open, randomized clinical trial; 100 patients received norfloxacin, whereas 103 received rufloxacin. Of these, 156 (74 and 82 patients in the norfloxacin and rufloxacin groups, respectively) were considered bacteriologically evaluable. At the first follow-up visits (3 to 12 days after starting the treatment), bacteriological cure rates were 99 and 94% for norfloxacin and rufloxacin, respectively. Seventy-nine percent (119 of 150) of bacteriologically cured patients attended a long-term follow-up visit (4 to 6 weeks after starting the treatment), where a relapse rate of 4% (2 of 54) and 5% (3 of 64) were found in the norfloxacin and rufloxacin groups, respectively. The pharmacodynamic evaluation performed in 35 patients showed similar median urine levels (approximately equal to 25 micrograms/ml) and urine antibacterial activity for both treatment groups against initial isolates, despite a higher norfloxacin level/MIC ratio due to the lower MIC of norfloxacin. Twenty-one patients (20%) in the rufloxacin group and 12 patients (12%) in the norfloxacin group reported 39 and 16 adverse events, respectively, almost all of them being mild and lasting < 24 h. Overall, gastrointestinal reactions were the most frequent adverse events reported. However, 12 patients treated with rufloxacin reported 15 central nervous system adverse events. This study shows that single doses of rufloxacin are as effective as a norfloxacin 3-day standard treatment in uncomplicated cystitis. The results obtained with rufloxacin are consistent with its pharmacodynamic properties.
Assuntos
Anti-Infecciosos/uso terapêutico , Cistite/tratamento farmacológico , Infecções por Escherichia coli/tratamento farmacológico , Fluoroquinolonas , Norfloxacino/uso terapêutico , Quinolonas/uso terapêutico , Adulto , Cistite/urina , Infecções por Escherichia coli/urina , Feminino , Humanos , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Norfloxacino/administração & dosagem , Norfloxacino/urina , Quinolonas/administração & dosagem , Quinolonas/urina , RecidivaRESUMO
Three types of antibiotic prophylactic regimens were evaluated versus a control without prophylaxis (group A: 3,912 cases) in urologic surgery. The antibiotic regimens were: group B = cefazolin 1 g/12 h/3 days (3,660 cases); group C = cefonicid 1 g/24 h/3 days (2,076 cases), and group D = cefonicid 1 g single dose (3,169 cases). The parameters used were the comparison of the corresponding rates of postsurgical sepsis and operative wound infections. Numeric investigations for the validity of a retrospective study (unpaired data) were performed: homogenicity test, relative risk point estimate and confidence limits (95%), and etiological fraction point estimate and confidence limits (95%). Chi-square for other purposes were performed. Endoscopic handling was considered homogeneous (same infective risk), while open surgery was heterogeneous (p < 0.001). In order to avoid probable bias, a correction factor was used. Although in different degrees, prophylaxis significantly reduced the morbidity of surgical wound infections (p < 0.001; etiological fraction > 90%). The differences (p < 0.01) between groups B and C/D were attributed to pharmacokinetic causes (short T 1/2 of cefazolin). To obtain the maximum protective effect, the use of antibiotics with a T 1/2 of > 4 h is suggested. There was no resistant mutans in previously sensitive strains. However, a significant selection of intrinsically resistant strains was observed. Monodose offers at lest the same advantages as multiple-dose therapy. In addition, the monodose selected in a lesser proportion both the resistant strains (p < 0.001) and the number of microbial associations (p < 0.01).
Assuntos
Cefazolina/administração & dosagem , Cefonicida/administração & dosagem , Pré-Medicação , Sistema Urinário/cirurgia , Intervalos de Confiança , Cistectomia , Humanos , Rim/cirurgia , Transplante de Rim , Estudos Retrospectivos , Choque Séptico/microbiologia , Choque Séptico/prevenção & controle , Infecção do Sítio Cirúrgico/microbiologia , Infecção do Sítio Cirúrgico/prevenção & controle , Ureter/cirurgiaRESUMO
In order to determine the pathogenic responsibility of Escherichia coli adhesins (ADHs) in urinary infections (UI), 2,000 different patients suffering different clinical urinary and male sexual gland infections were monitored. The ADHs were determined by agglutination techniques with human and guinea-pig red blood cells, Candida albicans and Saccharomyces cerevisiae cells and latex sensitized with GAL-GAL. In uncomplicated UIs, the possession of ADH is the main invasion mechanism for E. coli. The rate of E. coli ADH strains is very high (89%) in acute cases (727 of 818 cases: 310 of 362 cystitis; 104 of 113 recidivant cystitis; 120 of 126 pyelonephritis; 158 of 173 prostatitis, and 34 of 43 orchiepididymitis) and rare (10%) in asymptomatic or chronic cases (24 of 235 cases: 14 of 148 bacteriurias; 8 of 74 prostatitis, and 2 of 13 orchiepididymitis). A close relation is established between the presence of ADH and clinical symptoms. 90% (218 of 242) of acute cases with systemic symptoms are due to MR-type ADH strains, especially the P subtype. 71% (409 of 576) of acute cases with local symptoms are due to MS-type ADH strains. In complicated UIs the expression of ADH is not an essential condition for the invasion of the urinary apparatus. It has been strongly suggested that males are significantly more resistant to UI, both in the tract and parenchyma, than women. It can be deduced that the underlying disease is more liable to UI the lower the adherence level shown by isolated strains. Thus catheters, reflux and neurogenic bladder are, by far, more aggressive alterations than the prostatic adenoma, vesical tumor or lithiasis.