Use of cefuroxime for women with community-onset acute pyelonephritis caused by cefuroxime-susceptible or -resistant Escherichia coli.

BACKGROUND/AIMS: Efforts to decrease the use of extended-spectrum cephalosporins are required to prevent the selection and transmission of multi-drug resistant pathogens, such as extended-spectrum ß-lactamase (ESBL)-producing Enterobacteriaceae. The objectives of this study were to assess the clinical efficacy of intravenous cefuroxime as an empirical antibiotic for the treatment of hospitalized women with acute pyelonephritis (APN) caused by Escherichia coli. METHODS: We analyzed the clinical and microbiologic database of 328 hospitalized women with community-onset APN. RESULTS: Of 328 women with APN, 22 patients had cefuroxime-resistant E. coli APN, and 306 patients had cefuroxime-susceptible E. coli APN. The early clinical success rates were significantly higher (p = 0.001) in the cefuroxime-susceptible group (90.8%, 278/306) than in the cefuroxime-resistant group (68.2%, 15/22) at 72 hours. The clinical cure rates at 4 to 14 days after completing antimicrobial therapy were not significantly different in the cefuroxime-resistant or -susceptible groups, with 88.2% (15/17) and 97.8% (223/228; p = 0.078), respectively. The microbiological cure rates were not significantly different and were 90.9% (10/11) and 93.4% (128/137), respectively (p = 0.550). The median duration of hospitalization in the cefuroxime-resistant and -susceptible groups was 10 days (interquartile range [IQR], 8 to 13) and 10 days (IQR, 8 to 14), respectively (p =0.319). CONCLUSIONS: Cefuroxime, a second-generation cephalosporin, can be used for the initial empirical therapy of community-onset APN if tailored according to uropathogen identification and susceptibility results, especially in areas where the prevalence rate of ESBL-producing uropathogens is low.

[Peculiarities of diagnostics of weakly symptomatic clinical course of chronic pyelonephritis].

The difficulty of early diagnostics of weakly symptomatic clinical course of chronic pyelonephritis (CP) is attributable to the lack of adequate methods. We used a novel Litos system diagnostic technology based on morphological analysis of dehydrated biological fluid The aim of the study was to develop methods for CP diagnostics from morphological characteristics of urine at different stages of the disease. It included 108 patients aged 58+/-1.3 yr with CP and 24 practically healthy subjects. Standard examination of all patients was supplemented by the analysis of urine using the Litos system. It was shown that morphological picture of urine makes it possible to objectively detect not only complete remission or exacerbation of the disease but also partial remission and high risk of CH even in patients with weakly symptomatic clinical course of this pathology. In case of incomplete remission, the treatment requires adequate long-term (three-course) antibacterial therapy despite normal results of urine analysis and microbiological studies. Patients at high risk of CP need to be prescribed preventive phytotherapy.

[Administration of vitaprost plus for prevention of infectious-inflammatory complications of transurethral prostatic resection in patients with prostatic adenoma].

The study of efficacy and safety of the drug vitaprost plus (rectal suppositories) in its use for prevention of infectious-inflammatory complications after transurethral resection (TUR) of the prostate for adenoma included 55 male surgical patients with prostatic adenoma (PA). The patients were randomized into two groups matched by age, symptoms and clinical data. The control group consisted of 20 patients (group 1), the study group--of 35 patients (group 2). TUR of the prostate was made in both groups, but patients of group 2 were given additional prophylactic treatment--vitaprost plus, one suppository before going to bed 2 days before surgery and for 8 days after TUR, the course lasted for 10 days. Postoperative blood and urine samples showed inflammatory changes more often in group 1, free of infection bacterial tests were more often in group 2. Renal microcirculation in group 1 after TUR evidenced for functional depression on perfusion intensity and renal ischemia and congestion. These changes persisted on postoperative day 8, being a potential cause of renal inflammation and ascending pyelonephritis. Group 2 patients exhibited insignificant postoperative microcirculatory disorders in the kidneys and were not registered on postoperative day 8. Infectious-inflammatory complications in group 1 patients were registered much more frequently than in group 2 patients. Thus, vitaprost plus can be recommended for prophylaxis of infectious-inflammatory complications of TUR in PA patients.

[Phytotherapy in combined treatment of chronic infection of the upper urinary tract in patients exposed to extracorporeal shock-wave lithotripsy].

Multicomponent biologically active additive Uroprofit made by Russian company Ecomir is used for phytotherapy of urolithiasis and urogenital infectious and inflammatory processes. Of 60 patients with urolithiasis and chronic pyelonephritis exposed to extracorporeal shock-wave lithotripsy (ECSWL), 30 patients received additional anti-inflammatory therapy with Uroprofit. As shown by reduction of leukocyturia and crystalluria, increased 24-h diuresis in patients with urolithiasis after exposure to ECSWL, a positive effect was achieved on urethral inflammation. Thus, Uroprofit phytotherapy has antiinflammatory, diuretic, lithokinetic effects which makes it appropriate for treatment and prophylaxis of infectious-inflammatory process in the urethra.

[Pharmacodynamic study of Relinqing granules on bacterial pyelonephritis model in rats].

OBJECTIVE: To observe the effects of Relinqing granules (powder of Polygonum capitatum extract) on the bacterial pyelonephritis model in rats. METHOD: The rat bacterial pyelonephritis model was induced by injecting the escherichia coli ATCC-25922 into kidney parenchyma. The rats were divided ramdamly into Relinqing groups(52.32, 26.16 g x kg(-1)), norflorin group (0.03 g x kg(-1)), model group and normal control group, and were given experimental drugs by gastrogavage. The contents of leucocytes (WBC), occult bloo (BLD), glucose (GLU), protein (PRO), ketones, bilirubin and urobilinagen in urine were determined. RESULT: As compared with the model group, Relinqing granules 6.0 g x kg(-1) (crude drug 52.32 g x kg(-1)) could decrease significantly the contents of WBC and BLD in urine and, however, had no markedly effects on the other biochemical parameters of urine. CONCLUSION: Relinqqing granule has significant effects of decreasing urine WBC and BLD on the bacterial pyolonephritis in rats.

[Silver-containing hydrocarbonate-calcium-magnesium mineral water in complex treatment of patients with chronic pyelonephritis]. / Ispol'zovanie serebrosoderzhashchei gidrokarbonatnoi magnievo-kal'tsievoi mineral'noi vody v kompleksnom lechenii bol'nykh khronicheskim pielonefritom.

95 patients suffering from chronic pyelonephritis in active inflammation phase received antibacterial therapy with adjuvant drinking of silver-containing mineral water Serebryany klyuch (21 patients) or without such drinking (17 patients). Spa treatment with mineral water Serebryany klyuch in combined therapy of chronic pyelonephritis is shown to relieve clinical symptoms, decontaminate urine completely in 88.6% cases, to eliminate signs of immunodeficiency and endotoxicosis and to produce a 25.6% decrease in the recurrences for the nearest 2 years.

[The combined therapy of patients with chronic nonspecific pyelonephritis using interference currents and and radon procedures]. / Kompleksnaia terapiia bol'nykh khronicheskim nespetsificheskim pielonefritom interferentsionnymi tokami i radonovymi protsedurami.

The exposure of the lumbar region to interference currents in combination with radon baths conducted in 37 patients with chronic pyelonephritis inhibited activity of the inflammation, hypercalciuria and hyperoxaluria, improved function of the kidneys. The same clinical effects were achieved in 32 patients who had received interference therapy in combination with intake of radon water.

[A crystallographic method in the diagnosis of kidney diseases]. / Kristallograficheskii metod v diagnostike zabolevanii pochek.

Structural aspects of copper chloride crystallization of the urine of patients with pyelonephritis and glomerulonephritis were studied by electron microscopy. It was found that admixtures of urea, creatinine, potassium and, possibly, sodium contained in the urine of patients initiate the formation of copper chloride crystals of different sizes, their shape changes, dendritic and spherolithic crystallization occurs. Results may be used as supplementary differential diagnostic signs of glomerulonephritis and pyelonephritis.

[Urine osmotic pressure and deficiency-excess syndrome of renal disease: analysis of 428 cases].

By means of TCM differentiation of symptom-complexes, the authors tested and analysed the urine osmotic pressure (UOP) and the urine and plasma osmotic ratio (UPOR) for 428 cases of renal disease, with the conclusion that the UOP and the UPOR were within the normal value range for not only the 36 cases lack of clinical symptoms so as to be unable to have TCM classification identified, but also for 24 cases of Wind edema excess syndrome mainly caused by pathogenic Wind's invasion to the Lung. But for 74 cases of damp-heat Kidney impairment and 294 cases with the main symptom being Kidney deficiency [including weakness of Qi of Kidney, Yang deficiency of Spleen and Kidney, Yin deficiency of Liver and Kidney], the value of their UOP and the UPOR had the tendency of reduction (P less than 0.01), among which the value of the patients of Kidney Yang deficiency reduced most obviously. The further observation showed that, for the nocturia patients caused by renal disease, the value of UOP and the UPOR reduced more obviously than usual. Therefore the authors assert that the test on UOP and UPOR will offer an objective index to patients' nocturia and Kidney-Qi weakness. 60 cases with renal disease of Kidney deficiency syndrome and 27 cases of damp-heat Kidney impairment syndrome under the diagnosis and treatment based on an overall analysis of symptoms and signs leads to the following conclusion: With the elimination of pathogenic factors and recovery of kidney, the damp-heat Kidney impairment patients' UOP will be increased. The low UOP of patients caused simply by Kidney deficiency, however, will recover slower.

[Shmakovka narzan mineral water in the treatment of chronic pyelonephritis in children]. / Shmakovskii narzan v lechenii khronicheskogo pielonefrita u detei.

The impact of "Pasechnyi" spa of the Shmakovka health resort on the circadian urinary output, renal excretion of magnesium, calcium, nonorganic phosphorus, oxalates, uric acid, phospholipids, acido- and ammoniogenases, daily fluctuations of urinary pH was studied for the first time in 65 children with chronic pyelonephritis. In the presence of spa treatment the authors revealed a 75-100 per cent increase in the circadian urinary output, urinary excretion of magnesium, uric acid, ammonia, titrated acids, a decrease in the levels of calcium, oxalates, nonorganic phosphorus and acidification of the urine at 9 o'clock in the morning mainly in children with primary pyelonephritis and at 9 and 6 o'clock in the morning in patients with concurrent uricosuria. Other parameters were not significantly different from those in the controls. Acidification of the urine in the presence of high uricosuria resulted in crystalluria of urates and oxalates in 26.31 per cent of patients with the concurrent urate diathesis. The water of Shmakovka mineral springs is recommended for patients with primary pyelonephritis, phosphaturia and calcium oxalate crystalluria with alkaline reaction of the urine and unjustified for those who suffered from urate diathesis.

Rapid screening for urease inhibitors.

Two methods are described that are suitable for the rapid screening of compounds as urease inhibitors. The first utilizes an electrode sensitive to NH4+ ions; the second is dependent on pH rise. A feature of both is a direct readout of reaction rate.

Influence of water diuresis on antimicrobial treatment of enterococcal pyelonephritis.

In the present studies, the effect of ampicillin (40 mg intramuscularly twice a day) in combination with water diuresis, produced by the ingestion of 5% dextrose in water, was determined on renal titers of enterococci after intravenous inoculation of 4 x 10(8)-2 x 10(9) enterococci into rats. Ampicillin injections with or without diuresis were started 4 or 21 days after initiation of infection and continued for 7 or 14 days. In comparison to controls (saline injections in rats drinking tap water), diuresis plus saline injections did not lower renal titers of enterococci. Injection of ampicillin in nondiuresing rats had little effect on renal titers of enterococci after 7 days of treatment started 4 or 21 days after initiation of infection. However, 2 wk of ampicillin therapy resulted in a significant decrease in renal titers. The addition of water diuresis to ampicillin treatment markedly potentiated the effect of ampicillin alone in decreasing renal titers of enterococci after 1 or 2 wk of therapy.These studies demonstrate that diuresis resulting from administration of dextrose in water plus ampicillin starting 4 or 21 days after intravenous injection of enterococci reduces renal titers more than ampicillin or diuresis alone.