Bacterial profile and prevalence of urinary tract infections in pregnant women in Latin America: a systematic review and meta-analysis.

BACKGROUND: Given the physiological changes during pregnancy, pregnant women are likely to develop recurrent urinary tract infections (UTIs) and pyelonephritis, which may result in adverse obstetric outcomes, including prematurity and low birth weight preeclampsia. However, data on UTI prevalence and bacterial profile in Latin American pregnant women remain scarce, necessitating the present systematic review to address this issue. METHODS: To identify eligible observational studies published up to September 2022, keywords were systematically searched in Medline/PubMed, Cochrane Library, Embase, Web of Science, and Bireme/Lilacs electronic databases and Google Scholar. The systematic review with meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the quality of studies was classified according to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. The meta-analysis employed a random-effects method with double-arcsine transformation in the R software. RESULTS: Database and manual searches identified 253,550 citations published until September 2022. Among the identified citations, 67 met the inclusion criteria and were included in the systematic review, corresponding to a sample of 111,249 pregnant women from nine Latin American countries. Among Latin American pregnant women, the prevalence rates of asymptomatic bacteriuria, lower UTI, and pyelonephritis were estimated at 18.45% (95% confidence interval [CI]: 15.45-21.53), 7.54% (95% CI: 4.76-10.87), and 2.34% (95% CI: 0.68-4.85), respectively. Some regional differences were also detected. Among the included studies, Escherichia coli (70%) was identified as the most frequently isolated bacterial species, followed by Klebsiella sp. (6.8%). CONCLUSION: Pregnant women in Latin America exhibit a higher prevalence of bacteriuria, UTI, and pyelonephritis than pregnant women globally. This scenario reinforces the importance of universal screening with urine culture during early prenatal care to ensure improved outcomes. Future investigations should assess the microbial susceptibility profiles of uropathogens isolated from pregnant women in Latin America. TRIAL REGISTRATION: This research was registered at PROSPERO (No. CRD42020212601).

Sepsis neonatal: Diagnóstico y tratamiento

La sepsis neonatal es causa importante de morbilidad y mortalidad. La OMS reporta que anualmente mueren 2,4 millones de bebés durante el primer mes de vida, siendo la sepsis neonatal una de las principales causas. El objetivo es actualizar en el diagnóstico y tratamiento de la sepsis neonatal. En esta investigación se realizó una revisión de la literatura para sintetizar hallazgos relevantes sobre sepsis neonatal, que se define como afección sistémica, caracterizada por cambios hemodinámicos y otras manifestaciones clínicas, como respuesta desregulada a la infección. La sepsis neonatal precoz se relaciona con factores de riesgo maternos y los microorganismos causantes son del tracto genitourinario materno, mientras que la tardía es causada por gérmenes intrahospitalarios, en neonatos con estancia hospitalaria prolongada y sometidos a procedimientos invasivos. Los signos y síntomas de sepsis neonatal son inespecíficos, lo que hace difícil su diagnóstico, se recomienda identificar factores de riesgo y evaluación clínica minuciosa. Los establecimientos de salud deben realizar vigilancia epidemiológica de gérmenes más frecuentes y sensibilidad antibiótica, para garantizar tratamiento antibiótico adecuado.

Neonatal sepsis is a major cause of morbidity and mortality. The WHO reports that 2.4 million babies die annually during the first month of life, with neonatal sepsis being one of the main causes. The objective is to update the diagnosis and treatment of neonatal sepsis. In this research, a review of the literature was carried out to synthesize relevant findings on neonatal sepsis, which is defined as a systemic condition, characterized by hemodynamic changes and other clinical manifestations, as a deregulated response to infection. Early-onset neonatal sepsis is related to maternal risk factors and the causative microorganisms are from the maternal genitourinary tract, while late-onset sepsis is caused by nosocomial germs, in neonates with prolonged hospital stay and subjected to invasive procedures. The signs and symptoms of neonatal sepsis are nonspecific, which makes its diagnosis difficult, it is recommended to identify risk factors and a thorough clinical evaluation. Health establishments must carry out epidemiological surveillance of the most frequent germs and antibiotic sensitivity, to guarantee adequate antibiotic treatment.

Bacteriuria asintomática en el embarazo. Serie de casos en una clínica privada de Uruapan, Michoacán / Asymptomatic bacteriuria in pregnancy. Cases series in a private clinic in Uruapan Michoacán

Resumen OBJETIVO: Determinar la prevalencia de bacteriuria asintomática, su adecuado tratamiento con base en el reporte del antibiograma de pacientes embarazadas que acudieron a control prenatal en una clínica privada. MATERIALES Y MÉTODOS: Estudio retrospectivo de una serie de casos, descriptivo y transversal efectuado en mujeres embarazadas que acudieron a control prenatal en la consulta externa del Hospital Fray Juan de San Miguel de Uruapan, Michoacán, entre el 1 de enero de 2019 y el 31 de diciembre de 2021. Variables de estudio: edad de las madres, semanas de embarazo, embarazos, bacteriuria, agente causal, antibiótico indicado y respuesta al tratamiento. Para interpretar los resultados obtenidos se aplicaron estadística descriptiva, medidas de tendencia central y de frecuencias simples. RESULTADOS: Se estudiaron 227 embarazadas; de ellas, 49 tuvieron un urocultivo positivo. La prevalencia de bacteriuria asintomática fue de 21.59. Escherichia coli fue el agente causal más reportado. De los urocultivos de control 36 de 37 resultaron negativos y solo 1 de 37 fue positivo. CONCLUSIÓN: La prevalencia de bacteriuria asintomática de este estudio fue de 21.59% y el principal agente etiológico asilado E. coli en la mayoría de los casos, con sensibilidad a nitrofurantoína en la mayoría de los casos.

Abstract OBJECTIVE: To determine the prevalence of asymptomatic bacteriuria, its adequate treatment based on the antibiogram report of pregnant patients who attended prenatal control in a private clinic. MATERIALS AND METHODS: Retrospective study of a case series, descriptive and cross-sectional carried out in pregnant women who attended prenatal control in the outpatient clinic of the Hospital Fray Juan de San Miguel de Uruapan, Michoacán, between January 1, 2019 and December 31, 2021. Study variables: mothers' age, weeks of pregnancy, pregnancies, bacteriuria, causative agent, indicated antibiotic and response to treatment. Descriptive statistics, measures of central tendency and simple frequencies were used to interpret the results obtained. RESULTS: A total of 227 pregnant women were studied; 49 of them had a positive urine culture. The prevalence of asymptomatic bacteriuria was 21.59. Escherichia coli was the most reported causative agent. Of the control urine cultures 36 of 37 were negative and only 1 of 37 was positive. CONCLUSION: The prevalence of asymptomatic bacteriuria in this study was 21.59% and the main etiologic agent was E. coli in most cases, with sensitivity to nitrofurantoin in most cases.

Infección urinaria de presentación atípica: caso clínico y revisión de literatura

Introducción: el síndrome de orina púrpura es una presentación clínica poco frecuente en el ámbito de urgencias, caracterizado por coloración anormal de la orina secundaria a una reacción química de algunos patógenos que producen infección de vías urinarias, siendo más frecuente en pacientes con múltiples comorbilidades y diferentes factores de riesgo. Objetivo: el objetivo de este manuscrito es presentar el caso de un paciente con síntomas atípicos de infección de vías urinarias. Presentación del caso: varón de 88 años de edad, con antecedente de diabetes mellitus no insulino-requiriente, con hiperplasia prostática benigna que ingresó al servicio de urgencias por síntomas irritativos urinarios asociados a uso de sonda vesical, con orina de coloración violeta en bolsa recolectora. El urocultivo reportó la presencia de Proteus vulgaris multisensible, por lo que se decidió dar manejo con cefepima de 1 gr cada ocho horas, con lo cual se obtuvo una adecuada evolución clínica. Discusión y conclusión: el síndrome de la bolsa de orina púrpura es una presentación clínica atípica, pero muy llamativa de la infección urinaria. Esta se genera como resultado de la conversión del triptófano en la dieta en indoxil sulfato que, una vez se elimina por la orina, se transforma en índigo (color violeta) e indirrubina (color rojo), dando este aspecto clínico.

Background: Purple urine syndrome is a rare clinical presentation in the emergency room, characterized by abnormal colouration of the urine secondary to a chemical reaction of some pathogens that cause urinary tract infection, being more frequent in patients with multiple comorbidities and different risk factor's. Purpose: The objective of the article is present the case of a patient with atypical symptoms of urinary tract infection. Clinical case: An 88-year-old male, with a history of non-insulin diabetes mellitus, benign prostatic hyperplasia, who was admitted to the emergency room due to irritative urinary symptoms associated with the use of a urinary catheter, with purple urine in a collection bag. Urine culture reported the presence of multisensitive Proteus vulgaris, for which it was decided to give treatment with Cefepime 1 g every 8 hours, with which it was obtained with adequate clinical evolution. Conclusions: Purple urine bag syndrome is an atypical but very striking clinical presentation of urinary tract infection. This is generated as a result of the conversion of tryptophan in the diet into indoxyl sulfate, which, once it is eliminated in the urine, transforms into indigo (purple color) and indirubin (red color), giving this clinical appearance.

Treatment of asymptomatic bacteriuria in the first 2 months after kidney transplant: A controlled clinical trial.

BACKGROUND: The incidence of urinary tract infections (UTIs) in the first 2 months postrenal transplantation (pRT) is very high. We evaluate the efficacy of asymptomatic bacteriuria (AB) screening and treatment on the incidence of UTI in the first 2 months pRT METHODS: We conducted a randomized controlled clinical trial. A urine culture was obtained in all patients on the day of the bladder catheter removal, on week three, and before removal of the ureteral catheter. The intervention group received treatment for AB. The control group did not receive treatment. The primary outcomes were the cumulative incidence of UTI and/or graft pyelonephritis and the time to the first episode of UTI and/or graft pyelonephritis RESULTS: Eighty patients were randomized, 40 in each group, and the median follow-up was 63 days (IQR 54-70). The average age was 29.8 years and 33.7% (n = 27) were women. The incidences of UTI (n = 10, 25 % vs. n = 4, 10%, p = .07) and pyelonephritis (n = 6, 15% vs. n = 1, 2.5%, p = .04) were greater in the intervention group, as also shown in the survival analysis: UTI (HR2.8, 95% CI 0.8-9.1, p = .07) and pyelonephritis (HR 6.5, 95% CI 0.8-54.7, p = .08), respectively. The most commonly isolated bacterium was Escherichia coli (n = 28, 59.5%), and over half were E. coli with extended-spectrum beta-lactamases (n = 15). A major limitation was not obtaining the calculated sample size due to a delay in patient recruitment resulting from the COVID-19 pandemic CONCLUSION: Treatment of AB in the first 2 months pRT does not decrease the incidence of UTI or graft pyelonephritis and may actually increase their frequency. Routine treatment of AB during the first months after renal transplantation should not be a standard procedure.

Susceptibility to first choice antimicrobial treatment for urinary tract infections to Escherichia coli isolates from women urine samples in community South Brazil.

E. coli is the main pathogen of UTI. It is important to be aware the local epidemiological data for an appropriate initial treatment. Resistance to antimicrobial agents has increased, especially to first-choice antibiotics in the treatment of cystitis. There are few studies on the sensivity profile of community uropathogen in our region. OBJECTIVE: To characterize antimicrobials the sensitivity profile to E. coli isolated from urocultures of women treated at Basic Health Units and Emergency Care Units of Londrina- Paraná- Brazil during a period of 12 months (June 1, 2016 to June 1, 2017). METHODOLOGY: A cross-sectional study was carried out from June 2016 to June 2017. All urine samples collected in the Basic Health Units and Emergency Departments in the city of Londrina (Paraná State, Brazil) were sent to a Central Laboratory where the identification and antimicrobial susceptibility testing were performed. Clinical Laboratory Standards Institute (CLSI) breakpoints were used for the interpretation of susceptibility testing results. RESULTS: 56,555 urine cultures were performed in the period, of which 8,832 were positive, of which 5,377 were women. Of these samples, 4.7% were enterobacteria producing extended-spectrum beta-lactamases (ESBL) and 15.5% resistant to quinolones. TMP- SMX was resistant in more than 30% of the samples in all age groups. Among quinolone-resistant isolates, resistance to cephalothin, ampicillin and sulfamethoxazole-trimethoprim was greater than 60%. Nitrofurantoin was the only antimicrobial that showed 90% of sensitivity. CONCLUSION: The antimicrobials sensitivity profile was similar to that reported in the literature, with TMP- SMX resistance greater than 30% in the studied samples. Nitrofurantoin maintains high sensitivity rates greater than 90%. Resistance to quinolones increases proportionally with age, as well ESBL.

Tira reactiva en orina para el diagnóstico de bacteriuria asintomática en gestantes / Orine reactive strip for diagnosing asymptomatic bacteriuria in pregnant women

INTRODUCCIÓN: Este documento técnico se realiza a solicitud de la Dirección de Salud Sexual y Reproductiva (DSARE) a través de la Dirección General de Intervenciones Estratégicas en Salud Pública. a. Cuadro clínico: Las infecciones urinarias son más frecuentes en las mujeres que en los hombres y esta tendencia se acentúa durante el embarazo debido a cambios fisiológicos. El 2 a 15% de las gestantes, se ve afectada por la bacteriuria asintomática, siendo un problema de salud pública, en algunos lugares en los que este índice es mayor. Se ha demostrado que la bacteriuria no tratada durante el embarazo se asocia con muchas complicaciones, siendo la complicación más frecuente el parto prematuro que se presenta en 5 al 10% de todos los embarazos, siendo causa de morbilidad y mortalidad perinatal, estando relacionado al 75% de las muertes perinatales y al 50% de las secuelas neurológicas. Otras complicaciones son bajo peso al nacer y pielonefritis, esta última condición se presenta con un riesgo de 20 a 30 veces más en las mujeres que tienen bacteriuria, que en las que no tienen la infección(1). Las infecciones del tracto urinario se diagnostican generalmente, mediante muestras de orina y pruebas con tiras reactivas o urocultivos (gold estándar). b. Tecnología sanitária: Una tira reactiva es un instrumento de diagnóstico simple utilizado para realizar un rápido examen físico-químico de orina con el objetivo de detectar algunos cambios patológicos. Consiste en una tira de material plástico o papel, con unas almohadillas impregnadas de reactivos químicos que reaccionan con las sustancias presentes en la orina, produciendo cambios cromáticos característicos, en relación a varias determinaciones simultáneas. Valores altos de leucocitos en la orina, son indicativos de infección urinaria, y son detectados por la tira reactiva a través de la detección de la enzima esterasa leucocitaria. Si bien el aumento de leucocitos está relacionado a infecciones urinarias; las nefritis intersticiales, tóxicas, las infecciones causadas por Trichomonas vaginalis, Chlamydia trachomatis y levaduras producen leucocituria, sin bacteriuria. La tira reactiva detecta la formación de nitritos, por la acción de bacterias reductoras de nitrato, que comúnmente causan infecciones urinarias. Las bacterias gram positivas, también causantes de infecciones urinarias, no son detectadas por este método. El urocultivo estándar se realiza mediante la inoculación de orina, con un asa calibrada, en una placa de agar-sangre (medio de crecimiento) y agar MacConkey (medio selectivo que facilita el desarrollo de la mayoría de las enterobacterias) y sembrando en estrías toda la superficie de la placa para obtener recuentos cuantitativos de colonias. Se incuban las placas aeróbicamente a 35 °C durante 18-20 horas. Cada bacteria viva, da lugar a una colonia, transcurrido el periodo de incubación se cuenta cada colonia de diferente morfología, informando el número de unidades formadoras de colonias por ml de orina (UFC/ml), multiplicando el factor de la alícuota tomada por el número de colonias contadas en la placa. De no observarse crecimiento, el cultivo se informa como "sin crecimiento". En muchos laboratorios se utiliza el medio de CLED (Cistina Lactosa Electrolito Deficiente) como único medio de cultivo, en sustitución del agar-sangre y agar MacConkey (2). El urocultivo, además de permitir identificar los organismos causales de la infección, permite determinar la sensibilidad a los antibióticos. OBJETIVO: Describir la evidencia científica disponible sobre la precisión diagnóstica de la tira reactiva de aplicación en orina, para el diagnóstico de bacteriuria asintomática en gestantes. METODOLOGÍA: Se realizó una búsqueda sistemática en Medline vía Pubmed, Cochrane y LILACS, complementada con la búsqueda en buscadores genéricos (Google Scholar) y literatura gris. Se prioriza guías de práctica clínica (GPC), revisiones sistemáticas (RS) con o sin metanálisis (MA) de ECA, ensayos clínicos aleatorizados controlados (ECA), evaluaciones de tecnología sanitaria (ETS) y evaluaciones económicas (EE) de América Latina. La calidad de la evidencia se valoró usando AMSTAR 2 para RS, la herramienta de evaluación de riesgo de sesgo de la colaboración Cochrane para ECA y AGREE II para las GPC. RESULTADOS: Se seleccionó cinco guías de práctica clínica (3­7) y una revisión sistemática con metanálisis(8) . No se identificaron evaluaciones de tecnología sanitaria ni evaluaciones económicas de la región. En el 2016, Rogozinska E et al., realizaron una revisión sistemática con metanálisis (8), cuyo objetivo fue determinar la exactitud de las pruebas rápidas de bajo costo en el punto de atención, para detectar bacteriuria asintomática en gestantes. Fueron nueve las pruebas evaluadas en 27 estudios (Tabla 11): 1) tiras reactivas con marcador para nitrito, 2) tiras reactivas con marcador para nitrito o leucocitos, 3) análisis de orina con contaje de bacterias (urianálisis), 4) dipslide (Uricult), 5) dipslide con tinción Gram en orina no centrifugada, 6) dipslide (Microstix-3), 7) prueba Griess para detectar nitritos, 8) prueba para reacción de clorhexidina y 9) test de catalasa. CONCLUSIONES: La Organización Mundial de la Salud (OMS) considera que el cultivo de muestras de orina es el método recomendado para diagnosticar la bacteriuria asintomática en gestantes; y en entornos donde no es posible realizar urocultivos, se recomienda realizar in situ la tinción de Gram a muestras de orina antes que usar tiras reactivas. La Revisión Sistemática (RS) seleccionada tuvo un nivel de confianza alta. Las GPC incluidas obtuvieron un puntaje en la valoración global de calidad mayor al 90%. Las pruebas rápidas analizadas en la RS mostraron los siguientes resultados de sensibilidad y especificidad: La sensibilidad agrupada de los dipstick para detección de nitritos positivos fue 55% (IC 95%: 42%- 67%) y la especificidad del 99% (IC 95%: 98% - 99%). La sensibilidad agrupada de los dipstick para la detección de leucocitos o nitritos positivos fue 73% (IC 95% :59% ­ 83%) y una especificidad del 89% (IC95%: 79%­ 94%); La reacción de clorhexidina y test de catalasa (Uriscreen test) contribuyeron a una sensibilidad del 100% (IC95%, 65%­100%) y una especificidad de 54% (IC95%: 46%­62%); el Test de Griess (nitritos) al ser comparado con la prueba de catalasa tuvo una sensibilidad del 65% (IC 95% 50%­78%) con una especificidad del 99% (IC 95% 98%­100%); el urinálisis (conteo de más de 20 bacterias/campo de alto poder [High Power Field (de sus siglas en inglés HPF)] tuvo una sensibilidad del 78% (IC 95%: 45%­94%) y una especificidad del 92% (IC 95%: 88%­94%); Dipslide (Uricult) tuvo una sensibilidad del 92% (IC95%: 69%­100%) y especificidad del 85% (IC95%: 24%­100%); y dipslide con tinción Gram en orina no centrifugada tuvo una sensibilidad de 86% (IC 95% 80%­91%) y una especificidad del 97% (IC95% 93%­ 99%); y el Dipslide (Microstix-3) tuvo una sensibilidad del 67% (IC95%: 38%- 88%) y una especificidad del 93% (IC95%: 89%-95%). El cultivo de orina es el "gold standard" para detectar bacteriuria asintomática. Esta prueba tiene una sensibilidad alta del 94%; siendo su especificidad 89% y su VPP 93%. Por ello, sigue siendo la prueba recomendada para detección de bacteriuria en gestantes; según lo reportado por los estudios incluidos en esta revisión, la tira reactiva presenta una sensibilidad baja, para detectar la bacteriuria asintomática. En los EESS donde existe escasez de recursos y personal entrenado debe accederse a otras pruebas como la prueba dipslide que ha demostrado ser útil, debido a que es muy probable que una gestante con una prueba dipslide positiva tenga un diagnóstico definitivo de bacteriuria asintomática, mientras que un resultado negativo descarta efectivamente la presencia de bacteriuria.

Should asymptomatic bacteriuria be treated in lupus nephritis?

INTRODUCTION: The risk of infection in systemic lupus erythematosus (SLE) is associated with factors related to disease activity and immunosuppressive treatment. Recently, the persistence of asymptomatic bacteriuria (ASB) has been proposed as an environmental trigger for SLE and its flares, raising the question whether it should be treated systematically to reduce the risk of infection. To our knowledge, there is limited evidence on the screening and treatment of ASB in SLE. OBJECTIVE: The objective is to analyze the occurrence of infection and flare in patients with lupus nephritis with and without ASB. METHODS: A cross-sectional study of a cohort of patients with lupus nephritis during induction therapy with high-dose cyclophosphamide regimen was carried out between January 2018 and 2020, with a total of 37 patients investigated. Urine and blood samples from the two groups (with ASB and without ASB) where taken before the administration of cyclophosphamide. RESULTS: From the sampled 37 patients, 19 (51.4%) had ASB and 18 (48.6%) without ASB; both groups were well balanced in their demographics and clinical characteristics. No statistically significant association was found between the presence of ASB and the systemic lupus erythematosus disease activity index score (p = 0.604), and neither with the 24-h urine protein and leukocyte count (p > 0.177). Urinary tract infection occurred in 5.3% (1) of the patients with ASB, while 5.6% (1) of the patients in the group without ASB presented the infection, and the RR was 0.944 (0.06, 16.33) 95% CI; in addition, no statistically significant association was found between the presence of ASB and the occurrence of infection (p = 1,000). CONCLUSION: Our study did not find a statistically significant association of ASB with the occurrence of infection or disease activity. Further studies need it to clarify this, since treatment of ASB has been recognized as an important contributor to inappropriate antimicrobial use, which promotes emergence of antimicrobial resistance.

Factores asociados a infección de vías urinarias luego de una prostatectomía / Factors Associated with Urinary Tract Infection after Prostatectomy

Introducción y Objetivo La cirugía de próstata es un procedimiento frecuente en varones mayores. Existen diferentes técnicas, cuya elección depende de la patología a tratar, de la experiencia del especialista, y de la disponibilidad técnica. Entre sus complicaciones se encuentra la infección del tracto urinario, que ocasiona incremento en morbimortalidad y costos para el sistema de salud. El objetivo principal de este estudio fue evaluar los factores relacionados con la aparición de infección urinaria luego de este tipo de cirugía. Materiales y Métodos Se realizó un estudio de casos y controles en una población de pacientes sometidos a prostatectomía del 2018 hasta principios del 2020 en Medellín, Colombia. Los casos correspondieron a los pacientes que presentaron infección de vías urinarias hasta 30 días tras la prostatectomía. Se estimó la asociación entre casos y controles por medio del cálculo de la razón de disparidad (RD), la cual se ajustó con una regresión logística y con un modelo aditivo generalizado multivariado. Resultados Se identificaron 96 casos incidentes de infección del trato urinario luego de la prostatectomía, con una prevalencia de 8.99%. La frecuencia de solicitud de urocultivo preoperatorio fue de 52,92% (intervalo de confianza del 95% [IC95%]: 48,34­ 57,44%). Las variables independientemente asociadas con la aparición de infección urinaria fueron: solicitud de urocultivo prequirúrgico, número de dosis, y tipo de antibiótico usado para la profilaxis. Particularmente, se encontró como factor protector el uso de aminoglucósidos. En los pacientes con infección urinaria, los principales gérmenes aislados fueron: Eschirichia coli, Pseudomonas aeruginosa, Klepsiella pneumoniae, Enterococos faecalis y Serratia marcescens.

Introduction and Objective Prostate surgery is a common procedure among older men. There are different techniques, and the choice depends on the pathology to be treated, the experience of the specialist, and the technical availability. Among its complications is urinary tract infection, which causes increased morbidity and mortality and costs for the health system. The main objective of the present study was to evaluate the factors related to the onset of urinary tract infection after prostate surgery. Materials and Methods A case-control study was conducted in a population of patients undergoing prostatectomy from 2018 to early 2020 in the city of Medellín, Colombia. The cases corresponded to patients who presented urinary tract infection up to 30 days after prostatectomy. The association between cases and controls was estimated by calculating the odds ratio (OR), which was adjusted with logistic regression and a multivariate generalized additive model. Results We identified 96 incident cases of urinary tract infection after prostatectomy, with a prevalence of 8.99%. The frequency of requests for preoperative urine culture was of 52.92% (95% confidence interval [95%CI]: 48.34 - 57.44). The independently associated variables were: request for preoperative urine culture, number of doses, and type of antibiotic used for prophylaxis. In particular, the use of aminoglycosides in prophylaxis schemes was found to be a protective factor. The main germs isolated were: Eschirichia coli, Pseudomonas aeruginosa, Klepsiella pneumoniae, Enterococos faecalis, and Serratia marcescens. Conclusion The present study shows that factors such as the preoperative request for urine culture and the use of aminoglycosides for surgical prophylaxis influence the probability of developing urinary tract infection after prostatectomy.

Fast antibiotic susceptibility testing of urine microflora using a microbiological analyzer based on coherent fluctuation nephelometry.

BACKGROUND: Traditional culture-based microbiological methods remain the most used for defining the etiology of urinary tract infections and antibiotic susceptibility testing (AST) of isolated uropathogens. They are time-consuming and lead to delays of several days when obtaining the final results of microbiological tests. OBJECTIVES: In this study, we validate the possibility of using a microbiological CFN analyzer combined with MALDI-TOF mass spectrometry (MS) for fast conclusive urine testing (1 day) without obtaining pure cultures. MATERIALS AND METHODS: The study included three stages: detection of urine microflora growth using the CFN analyzer to separate positive and negative samples within 2-4 h; fast MS identification of positive samples without isolating uropathogens; fast AST using CFN analyzer within 3-6 h. In parallel, all urine samples were tested by traditional culture-based microbiological methods. RESULT: In total, 194 urine samples were tested, and 22 urine cultures were identified by MS, among them, 20 monocultures with bacterial counts ≥ 105 and 2 mixed cultures. The AST of these 22 urine cultures and additional 88 pure clinical cultures was performed using eight antibiotics. Overall, 276 tests were performed. The results of AST obtained using the CFN analyzer and traditional methods were in good agreement (98.2%). Although two mixed cultures were falsely identified as monocultures, their susceptibility determined by the CFN analyzer was correct. CONCLUSIONS: The CFN analyzer is promising and effective for fast AST. Combined with MS identification, it allows to perform full urine analysis in 1 day without the lengthy isolation of pure cultures.

Single-dose antibiotic therapy for urinary infections during pregnancy: A systematic review and meta-analysis of randomized clinical trials.

BACKGROUND: During pregnancy, urinary infections are an important cause of maternofetal morbidity and mortality and may lead to several complications. OBJECTIVE: To verify whether the use of antibiotic therapy in a single dose when compared with multiple doses in lower tract urinary infections during pregnancy is effective to obtain microbiologic cure. SEARCH STRATEGY: Online databases were searched. Keywords used were "single-drug dose", "antibiotic", "fosfomycin", "amoxicillin", "trimethoprim", "pregnancy", and "urinary tract infection". SELECTION CRITERIA: Studies were included if they were randomized controlled trials, the population was pregnant woman, microbiologic cure was attained, and one of the treatment groups received single-dose antibiotic therapy. DATA COLLECTION AND ANALYSIS: Preselected studies have been independently read by pairs, and data were extracted according to a predetermined sheet. The Cochrane tool was used for the risk of bias. MAIN RESULTS: A total of 1063 women from nine studies were included. The primary outcome was the microbiologic cure attested by urine culture. When compared with the multiple-day use of antibiotics, the single-dose treatment has shown statistically similar results in reaching culture cure (odds ratio 1.02, 95% confidence interval 0.73-1.44). CONCLUSION: The current study has shown that the use of single-dose treatment for lower tract urinary infections during pregnancy can be recommended, especially using fosfomycin. SYSTEMATIC REVIEW REGISTRATION: This review has not been registered.

Bacteriuria in Pregnant Adolescents and Behavioral Risk Factors: A Cross-Sectional Study at a Brazilian Teaching Hospital.

INTRODUCTION: Bacteriuria during pregnancy is a frequent and important cause of morbidity and complications. Data on its occurrence in pregnant adolescents are still scarce. METHODS: A cross-sectional study was conducted at a tertiary teaching hospital in São Paulo, Brazil. All adolescents (≤18 years) who came for prenatal care between January 2010 and January 2016 were included. Sociodemographic characteristics, medical history, obstetric history, and the results of laboratory tests were selected. A urine sample was aseptically collected from each patient to undergo microscopic and culture analysis. RESULTS: A total of 388 pregnant adolescents averaging 15.30 ± 1.24 years of age were included. The frequency of bacteriuria in this group was 17.01% (66/388). The lack of sports practice (OR = 8.65; 95% CI, 1.09-68.39), the fact that pregnancy was desired (OR = 2.17; 95% CI, 1.08-4.34), and the use of hormonal methods of contraception (OR = 2.46; 95% CI, 1.04-5.84) turned out to be independent risk factors for bacteriuria. Protective factors were identified as late coitarche (OR = 0.75; 95% CI, 0.57-0.98) and a urine culture analysis at a later gestational age (OR = 0.94; 95% CI, 0.90-0.98). The most often isolated pathogens were Escherichia coli (49%) and Streptococcus agalactiae (18%). CONCLUSION: Bacteriuria among pregnant adolescents is a relatively common condition. The infection risk of the urinary tract was increased by physical inactivity and seemingly by the influence of behavioral and sexual factors. Such results can help to identify patients at risk, favoring the early diagnosis of urinary tract infections and optimizing prenatal care.

Susceptibility to first choice antimicrobial treatment for urinary tract infections to Escherichia coli isolates from women urine samples in community South Brazil

ABSTRACT E. coli is the main pathogen of UTI. It is important to be aware the local epidemiological data for an appropriate initial treatment. Resistance to antimicrobial agents has increased, especially to first-choice antibiotics in the treatment of cystitis. There are few studies on the sensivity profile of community uropathogen in our region. Objective: To characterize antimicrobials the sensitivity profile to E. coli isolated from urocultures of women treated at Basic Health Units and Emergency Care Units of Londrina-Paraná- Brazil during a period of 12 months (June 1, 2016 to June 1, 2017). Methodology: A cross-sectional study was carried out from June 2016 to June 2017. All urine samples collected in the Basic Health Units and Emergency Departments in the city of Londrina (Paraná State, Brazil) were sent to a Central Laboratory where the identification and antimicrobial susceptibility testing were performed. Clinical Laboratory Standards Institute (CLSI) breakpoints were used for the interpretation of susceptibility testing results. Results: 56,555 urine cultures were performed in the period, of which 8,832 were positive, of which 5,377 were women. Of these samples, 4.7% were enterobacteria producing extended-spectrum beta-lactamases (ESBL) and 15.5% resistant to quinolones. TMP- SMX was resistant in more than 30% of the samples in all age groups. Among quinolone-resistant isolates, resistance to cephalothin, ampicillin and sulfamethoxazole-trimethoprim was greater than 60%. Nitrofurantoin was the only antimicrobial that showed 90% of sensitivity. Conclusion: The antimicrobials sensitivity profile was similar to that reported in the literature, with TMP- SMX resistance greater than 30% in the studied samples. Nitrofurantoin maintains high sensitivity rates greater than 90%. Resistance to quinolones increases proportionally with age, as well ESBL.

Effect of Antibiotic Prophylaxis on Infectious Complications in Patients with Asymptomatic Bacteriuria Undergoing Urologic Surgery / Efecto de la profilaxis antibiótica sobre las complicaciones infecciosas en pacientes con bacteriuria asintomática programados a cirugía urológica

Objectives To identify the effect of duration of surgical antibiotic prophylaxis (SAP) and other variables on infectious postsurgical complications in patients with asymptomatic bacteriuria (ASB) undergoing urological surgery. Methods We conducted an observational study of a cohort of patients with ASB scheduled for urologic surgery at three health service providers in Colombia. The study population comprised all patients with planned urologic surgery who had ASB prior to surgery from April 2018 to January 2019. The intervention evaluated was the duration of preoperative SAP, and the outcome variable was the development of any postoperative infectious complications for up to 30 days after the procedure. Results The present study included 184 patients with ASB scheduled for urologic surgery. The median duration of preoperative SAP (p = 0.49) or of 1 dose SAP (risk ratio [RR] = 1.24; 95% confidence interval [CI]: 0.45­3.39) were not statistically different in patients with postsurgical infectious complications. Infectious complications were more frequent among patients with benign prostatic hyperplasia (RR = 6.57; 95%CI: 1.98­21.76) and hospitalization in the preceding 3 months (RR = 8.32; 95%CI: 2.69­25.71). Conclusion One dose of antimicrobial therapy is sufficient to avoid infectious complications in patients with ASB. There were other factors associated with postsurgical infectious complications, such as benign prostatic hyperplasia and hospitalization in the preceding 3 months.

Objetivos Identificar el efecto de la duración de la profilaxis antibiótica quirúrgica (PAQ) y otras variables sobre las complicaciones infecciosas posquirúrgicas en pacientes con bacteriuria asintomática (BA) sometidos a cirugía urológica. Métodos Se realizó un estudio observacional de una cohorte de pacientes con BA programados para cirugía urológica en tres instituciones de salud en Colombia. La población de estudio comprendió a todos los pacientes programados para cirugía urológica y con BA en el periodo de Abril del 2018 a Enero 2019. La intervención evaluada fue la duración de la PAQ preoperatoria, y la variable de resultado fue el desarrollo de cualquier complicación infecciosa posoperatoria hasta 30 días después del procedimiento. Resultados El estudio incluyó a 184 pacientes con BA programados para cirugía urológica. La mediana de duración de la PAQ preoperatoria (p = 0,49) o 1 dosis de PAQ (razón de riesgo [RR]: 1,24; intervalo de confianza [IC] del 95%: 0,45 a 3,39) no fueron estadísticamente diferentes en pacientes con complicaciones infecciosas posquirúrgicas. Las complicaciones infecciosas fueron más frecuentes entre los pacientes con hiperplasia prostática benigna (RR: 6,57; IC del 95%: 1,98 a 21,76) y hospitalización en los 3 meses anteriores (RR: 8,32; IC del 95%: 2,69 a 25,71). Conclusión Una dosis de terapia antimicrobiana es suficiente para evitar complicaciones infecciosas en pacientes con BA. Hubo otros factores asociados con complicaciones infecciosas posquirúrgicas, como hiperplasia prostática benigna y hospitalización en los tres meses anteriores.

Urinary Bacterial Profile and Antibiotic Susceptibility in Pregnant Adolescents and Pregnant Low Obstetric Risk Adult Women.

INTRODUCTION: Significant bacteriuria is associated with clinical and obstetric complications. The existing studies on the profile of urinary pathogens in pregnant women have widely divergent results and they hardly include data on pregnant adolescents. METHODS: This observational retrospective study was conducted in a tertiary hospital in the city of São Paulo with 388 pregnant adolescents and 2547 pregnant low-risk obstetric care adults who began prenatal care between January 2010 and January 2016. They were compared in terms of urine sediment, urine culture, and antibiogram results. RESULTS: The prevalence of bacteriuria was 17.01% (66/388) among adolescents and 10.13% (258/2547) among adults. Adolescence was a risk factor for bacteriuria in pregnancy (OR=1.82, CI95%=1.35-2.44, p=0.08). The most frequently isolated pathogen in urine culture was Escherichia coli, both in adolescents (49%) and in adults (42.18%). In positive urine cultures, urinary leukocytes were present in greater numbers in adolescents than in adults (p<0.001). Resistance to quinolones in general was more frequent among adults (OR=5.86, CI95%=0.78-44.20, p<0.001), but the tendency was not statistically significant. CONCLUSION: Escherichia coli and the less frequent Streptococcus agalactiae were the etiologic agents most often found in the urine cultures both of adolescents and adults. Higher rates of bacteriuria and of abnormal urine sediments prevailed among adolescents.

Síndrome de la bolsa de orina púrpura / Purple urine bag syndrome

Resumen El síndrome de la bolsa de orina púrpura es una condición clínica de prevalencia desconocida en Colombia debido al escaso reporte de casos a nivel nacional. Esta entidad se presenta exclusivamente en pacientes portadores de sonda vesical con factores de riesgo asociados como enfermedad renal crónica, patologías neurológicas, residentes de hogares geriátricos, sexo femenino, entre otros. La coloración púrpura de la orina se da en un ambiente urinario alcalino propiciado por bacterias específicas, en donde se genera una reacción de oxidación del indoxil sulfato en índigo e indirrubina por acción de las enzimas fosfatasas/sulfatasas de estos microorganismos, dichos pigmentos se mezclan generando la coloración púrpura en la bolsa urinaria. Se reporta el caso de un paciente masculino de 75 años con un cuadro clásico de síndrome de la bolsa urinaria púrpura, con el propósito de ampliar el conocimiento en la literatura nacional vigente. Adicionalmente, con esta publicación se busca que los profesionales de la salud comprendan los mecanismos fisiopatológicos por los cuales se produce esta entidad para saber abordarla apropiadamente.

Abstract Purple urine bag syndrome is a rare clinical condition, of unknown prevalence, with few reports published in our country that presents exclusively in catheterized patients with multiple risk factors, such as chronic kidney disease, neurological pathologies, residents of nursing homes and affects more females than males. The purple discoloration of urine is generated by indoxyl-sulfate degradation to indigo and indirubin lead by phosphatases/sulphatases enzymes produced by specific bacteria, associated to an alkaline urine environment, those two pigments combine which turns to purple discoloration appreciated in the urinary bag and catheter. The present case report is about a 75-year-old male, which appears with a classic clinical presentation. This case report has the objective, for health care workers, to remember the importance of basic care of urinary catheters, understand the underlying physiopathology and in consequence improve patient care.

Perfil de farmacorresistencia microbiana en adultos con infección del tracto urinario en una población de Pichincha-Ecuador / Microbial drug resistance profile in adults with urinary tract infection in a population of Pichincha-Ecuador

INTRODUCCIÓN. Las infecciones del tracto urinario son causa de mayor morbilidad en la población adulta y afectan con frecuencia a la mujer. Al ser un problema prevalente, fue fundamental realizar estudios sobre perfiles de susceptibilidad locales para establecer medidas de vigilancia y control de uso de antibióticos. OBJETIVO. Determinar el perfil de farmacorresistencia microbiana en adultos con infección del tracto urinario. MATERIALES Y MÉTODOS. Estudio descriptivo, transversal. La población fue de 437 urocultivos y una muestra de 176 positivos con su antibiograma, realizados en el laboratorio del Hospital Básico de Sangolquí entre enero de 2017 hasta abril de 2018. Los criterios de inclusión fueron: pacientes mayores de 15 años de edad de ambos sexos, ambulatorios y hospitalizados, que presentaron urocultivos positivos definidos por una cuenta mayor a 100 000 Unidades Formadoras de Colonia. RESULTADOS. Del 40,27% (176; 437) de urocultivos positivos, la bacteria aislada con frecuencia fue Escherichia coli. 69,31% (122; 176), con resistencia a ampicilina 77,97% (92; 118), trimetropim-sulfametoxazole 62,26% (66; 106), norfloxacino 37,50% (42; 112), ciprofloxacino 35,65 % (41; 115), ampicilina/sulbactam 32,20% (38; 118) y con susceptibilidad a: fosfomicina, ceftriaxona, amikacina y nitrofurantoina. CONCLUSIÓN. Se determinó el perfil de farmacorresistencia microbiana en adultos con infección del tracto urinario; donde Escherichia coli. fue aislada con frecuencia, con susceptibilidad favorable para nitrofurantoína y fosfomicina.

INTRODUCTION. Urinary tract infections are the cause of greater morbidity in the adult population and it often affects women. As it is a prevalent problem, it was essential to carry out studies on local susceptibility profiles to establish surveillance measures and control of antibiotic use. OBJECTIVE. To determine the microbial drug resistance profile in adults with urinary tract infection. MATERIALS AND METHODS. Descriptive, cross-sectional study. The population was 437 urine cultures and a sample of 176 positive with their antibiogram, carried out in the laboratory of the Hospital Básico de Sangolquí between january 2017 and april 2018. Inclusion criteria were: patients older than 15 years of age of both sexes, ambulatory and hospitalized, who presented positive urine cultures defined by a count greater than 100 000 Colony Forming Units. RESULTS. Of the 40,27% (176; 437) of positive urine cultures, the bacterium frequently isolated was Escherichia coli. 69,31% (122; 176), with resistance to ampicillin 77,97% (92; 118), trimethoprim-sulfamethoxazole 62,26% (66; 106), norfloxacin 37,50% (42; 112), ciprofloxacin 35,65% (41; 115), ampicillin / sulbactam 32,20% (38; 118) and with susceptibility to: fosfomycin, ceftriaxone, amikacin and nitrofurantoin. CONCLUSION. The microbial drug resistance profile was determined in adults with urinary tract infection; where Escherichia coli. was frequently isolated, with favorable susceptibility to nitrofurantoin and fosfomycin.

Parámetros diagnósticos en los lactantes con sospecha de infección del tracto urinario / Diagnostic parameters in infants with suspected urinary tract infection

Introducción: La sintomatología de la infección del tracto urinario es variable en la edad pediátrica, por ende, se presentan cuadros clínicos típicos y atípicos diversos debido a múltiples factores estudiados y definidos, que ofrecen dificultad para la confirmación diagnóstica. Objetivo: Identificar la utilidad de los parámetros diagnósticos de la infección urinaria. Métodos: Estudio observacional, analítico, de caso y controles, en lactantes ingresados con sospecha de infección urinaria en el Hospital Pediátrico Universitario Octavio de la Concepción y de la Pedraja admitidos en el servicio de clínicas pediátricas. El universo fueron los lactantes con sospecha de infección del tracto urinario y la muestra fue de 191 pacientes que cumplieron con los criterios de inclusión. Las variables utilizadas fueron la edad, el sexo, signos y síntomas, factores clínicos, formas clínicas, parámetros microbiológicos, parámetros clínicos según presencia de criterios de Rochester y escalas de evaluación para infección bacteriana y los parámetros de laboratorio. Resultados: Las variables clínicas más importantes asociadas a una infección urinaria fueron la edad menor de tres meses, la fiebre y el no disfrute de la lactancia materna, mientras que las de laboratorio fueron anemia, leucocitosis, neutrofilia y eritrosedimentación elevada. Conclusiones: Se identifica un conjunto de parámetros clínicos y estudios de laboratorio útiles en la atención médica del niño con infección urinaria. La forma de presentación febril es la característica especial de la enfermedad y las investigaciones hematológicas y del sedimento urinario son fuentes de apoyo diagnóstico(AU)

Introduction: The symptomatology of urinary tract infection is variable in pediatric ages, therefore, there are typical and atypical clinical pictures due to multiple factors studied and defined but that offer difficulty for diagnostic confirmation. Objective: Identify the usefulness of the diagnostic parameters of urinary tract infection. Methods: Observational, analytical, case-control study in infants admitted with suspected urinary tract infection at Octavio de la Concepción y de la Pedraja University Pediatric Hospital and admitted to the pediatric clinic service. The total sample were infants with suspected urinary tract infection and the sample was 191 patients who met the inclusion criteria. The variables used were age, sex, signs and symptoms, clinical factors, clinical forms, microbiological parameters, clinical parameters according to the presence of Rochester criteria and evaluation scales for bacterial infection and laboratory parameters. Results: The most important clinical variables associated with a urinary tract infection were: age less than three months, fever and non-enjoyment of breastfeeding; while laboratory variables were: anemia, leukocytosis, neutrophilia and elevated erythrosedimentation. Conclusions: A set of clinical parameters and laboratory studies useful in the medical care of children with urinary tract infection are identified. The form of febrile presentation is the specific characteristic of the disease and hematological and urinary sediment investigations are sources of diagnostic support(AU)

Impact of sodium-glucose cotransporter-2 inhibitors-induced glucosuria in the incidence of urogenital infection on postmenopausal women with diabetes.

BACKGROUND: Type 2 diabetes mellitus (T2DM) in postmenopausal women is associated with a high incidence of urogenital infections, which negatively impact the quality of life and increase morbidity, mortality, and health-care costs. Glucosuria is a known risk factor for these infections; therefore, it is of interest to determine if increased glucosuria secondary to sodium-glucose cotransporter-2 inhibitors (SGLT2in) impacts the incidence and severity of urogenital infections in postmenopausal women with T2DM. METHODS: The study was conducted at Gaffrée Guinle University Hospital on two groups of postmenopausal women with T2DM: with and without SGLT2in therapy (n = 80 in each group). Medical records and laboratory parameters (urinary dipstick test and culture; blood glucose, glycosylated hemoglobin, and creatinine; cervical cytologic study) of all subjects were carefully assessed at baseline and thrice during the 12-month study period. RESULTS: We observed a significant incidence of vulvovaginitis (relative risk [RR], 2.37; 95% confidence interval [CI], 1.10-5.10; P = 0.03) and asymptomatic bacteriuria (RR, 2.47; 95% CI, 1.09-5.60; P = 0.03), but not of urinary tract infections (RR, 2.08; 95% CI, 0.74-5.81; P = 0.16), secondary to SGLT2in therapy. Genital infection was severe enough to warrant treatment discontinuation in 57.89% of patients in group 1. All urinary tract infections were of mild intensity with a good response to antibiotic therapy. CONCLUSION: Glucosuria induced by SGLT2in therapy may lead to a high incidence of urogenital infections in postmenopausal women with T2DM and can be considered a risk factor for these infections.

Consenso Argentino intersociedades de Infección Urinaria 2018-2019 - Parte I / Consenso Argentino Intersociedades de Infección Urinaria 2018-2019 - Parte I

La Sociedad Argentina de Infectología y otras sociedades científicas han actualizado estas recomendaciones utilizando, además de información internacional, la de un estudio multicéntrico prospectivo sobre infecciones del tracto urinario del adulto realizado en Argentina durante 2016-2017. La bacteriuria asintomática debe ser tratada solo en embarazadas, a quienes también se las debe investigar sistemáticamente; los antibióticos de elección son nitrofurantoína, amoxicilina, amoxicilina-clavulánico, cefalexina y trimetoprima-sulfametoxazol. Ante procedimientos que impliquen lesión con sangrado del tracto urinario se recomienda solicitar urocultivo para pesquisar bacteriuria asintomática, y, si resultara positivo, administrar antimicrobianos según sensibilidad desde inmediatamente antes hasta 24 horas luego de la intervención. En mujeres, la cistitis puede ser tratada con nitrofurantoina, cefalexina, o fosfomicina y no se recomienda usar trimetoprima-sulfametoxazol o fluoroquinolonas; en pielonefritis puede emplearse ciprofloxacina, cefixima o cefalexina si el tratamiento es ambulatorio o ceftriaxona, cefazolina o amikacina si es hospitalario. En los hombres, las infecciones del tracto urinario se consideran siempre complicadas. Se recomienda tratamiento con nitrofurantoina o cefalexina por 7 días, o bien monodosis con fosfomicina. Para la pielonefritis en hombres se sugiere ciprofloxacina, ceftriaxona o cefixima si el tratamiento es ambulatorio y ceftriaxona o amikacina si es hospitalario. Se sugiere tratar las prostatitis bacterianas agudas con ceftriaxona o gentamicina. En cuanto a las prostatitis bacterianas crónicas, si bien su tratamiento de elección hasta hace poco fueron las fluoroquinolonas, la creciente resistencia y ciertas dudas sobre la seguridad de estas drogas obligan a considerar el uso de alternativas como fosfomicina.

The Argentine Society of Infectious Diseases and other scientific societies have updated these recommendations based on data on urinary tract infections in adults obtained from a prospective multicenter study conducted in Argentina during 2016-2017. Asymptomatic bacteriuria should be treated only in pregnant women, who should also be systematically investigated; the antibiotics of choice are nitrofurantoin, amoxicillin, clavulanic/amoxicillin, cephalexin and trimethoprim-sulfamethoxazole. In procedures involving injury to the urinary tract with bleeding, it is recommended to request urine culture and, in the presence of bacteriuria, antimicrobial treatment according to sensitivity should be prescribed from immediately before up to 24 hours after the intervention. In women, cystitis can be treated with nitrofurantoin, cephalexin or fosfomycin, while trimethoprim-sulfamethoxazole and fluoroquinolones are not recommended; pyelonephritis can be treated with ciprofloxacin, cefixime or cephalexin in ambulatory women or ceftriaxone, cefazolin or amikacin in those who are hospitalized. In men, urinary tract infections are always considered complicated; nitrofurantoin or cephalexin are recommended for 7 days, alternatively fosfomycin should be given in a single dose. In men, ciprofloxacin, ceftriaxone or cefixime are suggested for pyelonephritis on ambulatory treatment whereas ceftriaxone or amikacin are recommended for hospitalized patients. Acute bacterial prostatitis can be treated with ceftriaxone or gentamicin. Fluoroquinolones were the choice treatment for chronic bacterial prostatitis until recently; they are no longer recommended due to the increasing resistance and recent concerns regarding the safety of these drugs; alternative antibiotics such as fosfomycin are to be considered.