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1.
JAMA ; 325(13): 1286-1295, 2021 04 06.
Artículo en Inglés | MEDLINE | ID: mdl-33821897

RESUMEN

Importance: Controlling antimicrobial resistance in health care is a public health priority, although data describing antimicrobial use in US nursing homes are limited. Objective: To measure the prevalence of antimicrobial use and describe antimicrobial classes and common indications among nursing home residents. Design, Setting, and Participants: Cross-sectional, 1-day point-prevalence surveys of antimicrobial use performed between April 2017 and October 2017, last survey date October 31, 2017, and including 15 276 residents present on the survey date in 161 randomly selected nursing homes from selected counties of 10 Emerging Infections Program (EIP) states. EIP staff reviewed nursing home records to collect data on characteristics of residents and antimicrobials administered at the time of the survey. Nursing home characteristics were obtained from nursing home staff and the Nursing Home Compare website. Exposures: Residence in one of the participating nursing homes at the time of the survey. Main Outcomes and Measures: Prevalence of antimicrobial use per 100 residents, defined as the number of residents receiving antimicrobial drugs at the time of the survey divided by the total number of surveyed residents. Multivariable logistic regression modeling of antimicrobial use and percentages of drugs within various classifications. Results: Among 15 276 nursing home residents included in the study (mean [SD] age, 77.6 [13.7] years; 9475 [62%] women), complete prevalence data were available for 96.8%. The overall antimicrobial use prevalence was 8.2 per 100 residents (95% CI, 7.8-8.8). Antimicrobial use was more prevalent in residents admitted to the nursing home within 30 days before the survey date (18.8 per 100 residents; 95% CI, 17.4-20.3), with central venous catheters (62.8 per 100 residents; 95% CI, 56.9-68.3) or with indwelling urinary catheters (19.1 per 100 residents; 95% CI, 16.4-22.0). Antimicrobials were most often used to treat active infections (77% [95% CI, 74.8%-79.2%]) and primarily for urinary tract infections (28.1% [95% CI, 15.5%-30.7%]). While 18.2% (95% CI, 16.1%-20.1%) were for medical prophylaxis, most often use was for the urinary tract (40.8% [95% CI, 34.8%-47.1%]). Fluoroquinolones were the most common antimicrobial class (12.9% [95% CI, 11.3%-14.8%]), and 33.1% (95% CI, 30.7%-35.6%) of antimicrobials used were broad-spectrum antibiotics. Conclusions and Relevance: In this cross-sectional survey of a cohort of US nursing homes in 2017, prevalence of antimicrobial use was 8.2 per 100 residents. This study provides information on the patterns of antimicrobial use among these nursing home residents.


Asunto(s)
Antiinfecciosos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos , Utilización de Medicamentos/estadística & datos numéricos , Casas de Salud/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Estudios Transversales , Femenino , Fluoroquinolonas/uso terapéutico , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Uso Excesivo de Medicamentos Recetados/estadística & datos numéricos , Estados Unidos , Infecciones Urinarias/tratamiento farmacológico
2.
Arch Esp Urol ; 74(3): 276-286, 2021 Apr.
Artículo en Español | MEDLINE | ID: mdl-33818423

RESUMEN

OBJECTIVES:  Emerging urinary infections by rare germs are a public health problem. The objectives of this article are to review urinary tract infections caused by an emerging genus of bacteria called Raoultella and to report a case of asymptomatic urinary tract infection by Raoultella ornithinolytica. MATERIALS AND METHODS:  A review of publications on urinary tract infections caused by the genus Raoultella between 2009 and 2018 is carried out and a case of asymptomatic urinary tract infection by Raoultella ornithinolytica is reported. The search of articles in Medline/ Pubmed and Google was performed with the keywords: Raoultella, Raoultella ornithinolytica, urinary tract infection. Twelve variables were studied: year of publication, authors, specialty, type of infection, number of cases, sex, age, immunosuppression, oncological patient, urological instrumentation, urological surgery and neurogenic bladder. Results were analyzed using descriptive statistics. A new case is described. RESULTS:  24 publications were found with 120 cases of urinary infections of the genus Raoultella between 2009 and 2018, corresponding to Raoultella ornithinolytica 40.8%, Raoultella planticola 28.3%, Raoultella terrigena 30.8% and Raoultella electrica 0%. The series included 43 men (35.8%), 53 women (44.1%) and 24 patients with this data not provided (20%). The minimum age was 14 days, the maximum was 97 years and the average age was 56.6. The types of infection detected were: uncomplicated UTI 94.1%, UTI in newborn 1.6%, acute prostatitis 0.8%, chronic prostatitis 0.8%, giant kidney cyst infection 0.8%, calculous pyelonephritis 0.8% and recurrent cystitis 0.8%. CONCLUSIONS:  Urinary tract infections by species of the genus Raoultella occur in immunocompromised, oncological, instrumented or basic urological patients. The species Raoultella ornithinolytica described in 2011 is an emerging germ in urinary infections. This contribution is the second Spanish publication and twelfth worldwide of urinary infection by Raoultella ornithinolytica.


Asunto(s)
Infecciones por Enterobacteriaceae , Infecciones Urinarias , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Enterobacteriaceae , Infecciones por Enterobacteriaceae/diagnóstico , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Femenino , Humanos , Recién Nacido , Masculino , Persona de Mediana Edad , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/tratamiento farmacológico
3.
Urologiia ; (1): 5-12, 2021 Mar.
Artículo en Ruso | MEDLINE | ID: mdl-33818928

RESUMEN

OBJECTIVE: To analyze the incidence and resistance of microorganisms to antibacterial drugs isolated in urine cultures of patients with urinary tract infections from 2012 to 2019. MATERIALS AND METHODS: In the Pirogov City Clinical Hospital No1 and in the Bauman City Clinical Hospital No 29 analyzed the results of 15083 urine cultures in 12554 patients from 2012 to 2019. RESULTS: Enterococcus faecalis (41%), Escherichia coli (36.4%), Klebsiella pneumonia (23.4%) and Proteus mirabilis (7.6%) predominate in the occurrence of complicated UTIs. the number of strains resistant to certain groups of antibacterial drugs increased: mesitillin-resistant staphylococci (+ 4%), producers of -lactamases (+ 19.8% (for E. coli) and + 34.7% (for Klebsiella pneumoniae)), vancomycin-resistant enterococci (+ 1.89%), carbapenemase producers (+ 32.9%). A high level of resistance among Enterococcus faecalis strains to ciprofloxacin (23.1%) and gentamicin (38.4%) was revealed. Among strains of Escherichia coli, an increase in resistance to ampicillin (85.7%), ceftazidime (66.7%), ciprofloxacin (54.1%) and nitrofurantoin (42.9%) was noted. The appearance of carbapenem-resistant strains is noted. Among the strains of Klebsiella pneumonia, there is a significant increase in resistance to all antibacterial drugs used. Separately, one can note a sharp (27.1%) increase in resistance to carbapenems. A high level of resistance was found in Proteus mirabilis to ciprofloxacin (66.7%), ampicillin (75%). There is an increase in resistance of Pseudomonas aeruginosa to ciprofloxacin (66.7%), meropenem (50%). There is a high level of resistance for Acinetobacter baumannii to amikacin (94.9%), imipenem (92.3%), ceftazadime (100%), ciprofloxacin (100%), tigecycline (53.6%). Relatively high sensitivity remains to polymyxin E (88.9%). CONCLUSIONS: The results of our analysis demonstrate a rapid increase in resistance to most antibacterial drugs among community-acquired and hospital-acquired strains.


Asunto(s)
Escherichia coli , Infecciones Urinarias , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Farmacorresistencia Microbiana , Humanos , Pruebas de Sensibilidad Microbiana , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/epidemiología
4.
Urologiia ; (1): 140-145, 2021 Mar.
Artículo en Ruso | MEDLINE | ID: mdl-33818950

RESUMEN

Lower urinary tract infections in women represent an urgent medical and social problem due to their high prevalence, frequent recurrences, and the need for an interdisciplinary approach to diagnosis and treatment. Timely and adequate diagnosis of the causes of urinary disorders in women with the determination of risk factors, concomitant diseases and isolation of pathogens allows to choose a rational therapy that may alleviate patients symptoms, improve the quality of life, and prevent the transformation of the disease to a chronic form. It is extermely important that treatment should not contribute to the growth of antibiotic resistance of pathogens, not disrupt the normal microbiome, and not aggravate the disturbances of the normal vaginal and intestinal microflora in women.


Asunto(s)
Calidad de Vida , Infecciones Urinarias , Antibacterianos/uso terapéutico , Farmacorresistencia Microbiana , Femenino , Humanos , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/epidemiología
5.
BMC Infect Dis ; 21(1): 385, 2021 Apr 26.
Artículo en Inglés | MEDLINE | ID: mdl-33902489

RESUMEN

BACKGROUND: Antibiotic resistance is often reported and great concerned as one of public health problems especially people living with poverty in developing countries including Thailand. The hill tribe people is defined as vulnerable population for antibiotic resistance in Thailand due to poor economic and education status particularly the Lahu people who is the second greatest group of the hill tribe people in Thailand. The study aimed to estimate the prevalence, factors associated with, and typing major species of bacteria with antibiotic drugs resistance among the Lahu hill tribe people in northern Thailand. METHODS: A cross-sectional study was conducted to gather the information from the participants. A validated questionnaire was used for data collection. Participants who presented an illness related to infectious diseases were eligible to participate the study and were asked to obtain specific specimen; sputum, urine or stool. Antibiotic susceptibility was tested by Kirbey Bauer's disc diffusion test. Chi-square and logistic regression were used to detect the associations between variables at the significant level of α = 0.05. RESULTS: A total of 240 participants were recruited into the study. The majority had urinary tract infection (67.9%) with two major pathogenic species of the infection; Escherichia coli (12.8%), and Enterobacter cloacae (8.0%). The prevalence of antibiotic resistance was 16.0%. Escherichia coli and Klebsiella pneumoniae species were found to have multidrug resistance that was greater than that of other species, while ampicillin was found to have the greatest drug resistance. It was found that those who had poor knowledge of antibiotic use had a 2.56-fold greater chance (95% CI = 1.09-5.32) of having antibiotic resistance than did those who had good knowledge of antibiotic use, and those who had poor antibiotic use behaviors had a 1.79-fold greater chance (95% CI = 1.06-4.80) of having antibiotic resistance than did those who had good antibiotic use behaviors. CONCLUSION: Effective public health interventions are urgently needed to reduce antibiotic drug resistance among the Lahu people by improving their knowledge and skills regarding the proper use of antibiotics and eventually minimizing antibiotic resistance. Moreover, health care professionals should strictly follow the standard guideline to prescribe antibiotics.


Asunto(s)
Antibacterianos/uso terapéutico , Farmacorresistencia Bacteriana Múltiple/efectos de los fármacos , Enterobacter cloacae/efectos de los fármacos , Infecciones por Escherichia coli/tratamiento farmacológico , Infecciones por Escherichia coli/epidemiología , Escherichia coli/efectos de los fármacos , Grupos Étnicos , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/epidemiología , Adolescente , Adulto , Anciano , Niño , Estudios Transversales , Enterobacter cloacae/aislamiento & purificación , Escherichia coli/aislamiento & purificación , Infecciones por Escherichia coli/microbiología , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Prevalencia , Encuestas y Cuestionarios , Tailandia/epidemiología , Tailandia/etnología , Resultado del Tratamiento , Infecciones Urinarias/microbiología , Adulto Joven
6.
Pan Afr Med J ; 38: 62, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33889228

RESUMEN

Introduction: ciprofloxacin is a second-generation fluoroquinolone, which has been used as one of the top three antibacterial agents prescribed in Ethiopia. However, its use has deviated from the recommendation of standard treatment guidelines resulting in a gradual increase in antimicrobial resistance. Therefore, this study aimed to evaluate the annual use of ciprofloxacin in 2016 based on the standard Ethiopian treatment and World Health Organization guidelines, in governmental hospitals, in Eastern Ethiopia from 1st May to 30th June 2018. Methods: a hospital-based retrospective cross-sectional study was conducted to evaluate medical records of patients who had taken ciprofloxacin in 2016. The total sample size (n=522) was proportionally allocated to each hospital based on the respective consumption data. A simple random sampling method was employed to collect the required sample. The collected data were entered into SPSS version 21 and analyzed using descriptive analysis. Results: in this study, 522 medical records were reviewed, with a male to female ratio of 1.03: 1. Ciprofloxacin was indicated in 478 (91.6%) participants whose age was greater than eighteen years. The majority were treated in the medical and emergency outpatient departments (n=477, 91.4%). Urinary tract infections (n=224, 42.9%), acute febrile illnesses (n=68, 13.0%), and typhoid fever (n=54, 10.4%) were the top indications to which ciprofloxacin was prescribed. Non-steroidal anti-inflammatory drugs (NSAIDs) (n=241, 34.7%) and antimicrobials (n=135, 19.6%) were among the most frequently co-indicated agents. Based on the standard Ethiopian treatment guidelines, therapy was appropriate in 30% (n= 159) of patients. The major reason for inappropriate utilization (95%) was the wrong duration of antibiotic use (n=228). Evaluation based on World Health Organization criteria showed that indication, dose, and frequency were in line with the recommendation. Conclusion: ciprofloxacin was primarily indicated for urinary tract infections. The drug was appropriately used in less than one-third of patients, with the wrong duration being the main reason for overall inappropriate utilization. This trend may potentially impose a high risk to the emergence of drug-resistant microorganisms. To this end, further studies addressing the susceptibility pattern of bacterial isolates towards ciprofloxacin should be carried out.


Asunto(s)
Antibacterianos/administración & dosificación , Ciprofloxacino/administración & dosificación , Prescripción Inadecuada/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adolescente , Adulto , Niño , Estudios Transversales , Farmacorresistencia Bacteriana , Etiopía , Femenino , Hospitales , Humanos , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Estudios Retrospectivos , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/epidemiología , Adulto Joven
8.
Arch Esp Urol ; 74(2): 197-207, 2021 Mar.
Artículo en Español | MEDLINE | ID: mdl-33650534

RESUMEN

BACKGROUND AND OBJECTIVE: Adequate empirical treatment should be established for treatment urinary tract infections, considering the prevalence of the most frequent microorganisms in each geographic area and their susceptibility to different antibiotics. The objective of the study is to analyze the epidemiology of UTIs in our Health Area as well as to understand the antibiotic susceptibility of the most prevalent isolated microorganisms to guide empirical treatment. The objective was to establish a reasoned system for recommending ITU empirical therapy, based on the microorganisms causing episodes assisted in a Regional Hospital, knowing their antibiotic susceptibility. PATIENTS AND METHODS: A descriptive-retrospective study was carried out based on the results of 12,204 urine cultures of the year 2018. The overall empirical activity of the antibiotics tested was calculated, differentiating between episodes of the community and of in patients, adults and children. RESULTS: Escherichia coli was the most frequently isolated microorganism in all studied groups. The following microorganisms in frequency, in adults, were Enterococcus faecalis, Klebsiella pneumoniae and yeasts (8%). In the group of children these were Enterococcus faecalis and Proteus mirabilis. There was no difference in the activity of antibiotics against Escherichia coli, in adults or in children, of the community or in patients, with sensitivityto fosfomycin and nitrofuranto in greater than 96%; at imipenem and piperacillin-tazobactam greater than 94% and third generation cephalosporins greater than 90%. However, the overall empirical activity, without distinction by microorganism, was for fosfomycin 77.96-80.60% in adults and 92.73-94.50% in children; to prevent 77.70-78.74% in adults and 92.36-91.28% in children; for piperacillin-tazobactam of 77.57-80.03% in adults and 89.09-94.04% in children; and for cefotaxime of 53.28-54.76% in adults and 68.73-74.77% in children. CONCLUSIONS: Fosfomycin, piperacillin-tazobactam or imipenem were the best option for empirical treatment without covering all episodes in adults. Each Center must establish a reasoned profile of empirical treatment of the infection, which should also take into account risk factors for a microorganism and clinical severity.


Asunto(s)
Infecciones Urinarias , Adulto , Antibacterianos/uso terapéutico , Niño , Escherichia coli , Humanos , Klebsiella pneumoniae , Estudios Retrospectivos , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/epidemiología
10.
BMC Infect Dis ; 21(1): 159, 2021 Feb 08.
Artículo en Inglés | MEDLINE | ID: mdl-33557769

RESUMEN

BACKGROUND: Complicated urinary tract infection (cUTI) is common among hospitalized patients. Though carbapenems are an effective treatment in the face of rising resistance, overuse drives carbapenem resistance (CR). We hypothesized that resistance to routinely used antimicrobials is common, and, despite frequent use of carbapenems, associated with an increased risk of inappropriate empiric treatment (IET), which in turn worsens clinical outcomes. METHODS: We conducted a retrospective cohort study of patients hospitalized with a culture-positive non-CR cUTI. Triple resistance (TR) was defined as resistance to > 3 of the following: 3rd generation cephalosporins, fluoroquinolones, trimethoprim-sulfamethoxazole, fosfomycin, and nitrofurantoin. Multivariable models quantified the impact of TR and inappropriate empiric therapy (IET) on mortality, hospital LOS, and costs. RESULTS: Among 23,331 patients with cUTI, 3040 (13.0%) had a TR pathogen. Compared to patients with non-TR, those with TR were more likely male (57.6% vs. 47.7%, p < 0.001), black (17.9% vs. 13.6%, p < 0.001), and in the South (46.3% vs. 41.5%, p < 0.001). Patients with TR had higher chronic (median [IQR] Charlson score 3 [2, 4] vs. 2 [1, 4], p < 0.001) and acute (mechanical ventilation 7.0% vs. 5.0%, p < 0.001; ICU admission 22.3% vs. 18.6%, p < 0.001) disease burden. Despite greater prevalence of empiric carbapenem exposure (43.3% vs. 16.2%, p < 0.001), patient with TR were also more likely to receive IET (19.6% vs. 5.4%, p < 0.001) than those with non-TR. Although mortality was similar between groups, TR added 0.38 (95% CI 0.18, 0.49) days to LOS, and $754 (95% CI $406, $1103) to hospital costs. Both TR and IET impacted the outcomes among cUTI patients whose UTI was not catheter-associated (CAUTI), but had no effect on outcomes in CAUTI. CONCLUSIONS: TR occurs in 1 in 8 patients hospitalized with cUTI. It is associated with an increase in the risk of IET exposure, as well as a modest attributable prolongation of LOS and increase in total costs, particularly in the setting of non-CAUTI.


Asunto(s)
Antibacterianos/uso terapéutico , Farmacorresistencia Bacteriana Múltiple , Infecciones Urinarias/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Carbapenémicos/uso terapéutico , Enfermedad Crónica , Combinación de Medicamentos , Fluoroquinolonas/uso terapéutico , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Sulfadoxina/uso terapéutico , Trimetoprim/uso terapéutico , Estados Unidos/epidemiología , Infecciones Urinarias/epidemiología , Infecciones Urinarias/patología
11.
Am J Nurs ; 121(3): 48-52, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33625011

RESUMEN

ABSTRACT: This article describes the case of a chronically ill patient whose care was grossly mismanaged as a result of the policies and practices of a dysfunctional health system. This case illustrates the importance of truly listening to patients and communicating effectively with colleagues within the health care system. It also discusses appropriate steps for the practice of patient-centered care, including a reevaluation of late arrival policies at hospitals and clinics.


Asunto(s)
Neoplasias de la Mama Masculina/diagnóstico , Enfermedad Crónica , Prestación de Atención de Salud/normas , Hernia Abdominal/cirugía , Atención Dirigida al Paciente , Infecciones Urinarias/tratamiento farmacológico , Anciano , Hospitales/normas , Humanos , Masculino , Enfermeras Practicantes
12.
BMJ Case Rep ; 14(2)2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33547106

RESUMEN

The management of infections caused by carbapenem-resistant organisms has been a challenge. We report a rare emergence of resistance to the novel beta-lactam/ beta-lactamase combination ceftolozane/tazobactam by Klebsiella pneumoniae, causing urinary tract infection. The K. pneumoniae, in this case, was reported to be sensitive to the other novel beta-lactam/ beta-lactamase combination of ceftazidime/avibactam. The timely administration of ceftazidime/avibactam resulted in prompt clinical resolution of the urinary tract infection caused by an extensively drug-resistant K. pneumoniae.


Asunto(s)
Antiinfecciosos Urinarios/uso terapéutico , Cefalosporinas/uso terapéutico , Farmacorresistencia Bacteriana Múltiple , Infecciones por Klebsiella/tratamiento farmacológico , Tazobactam/uso terapéutico , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/microbiología , Anciano , Humanos , Klebsiella pneumoniae , Masculino , Pruebas de Sensibilidad Microbiana
13.
Urologe A ; 60(3): 383-392, 2021 Mar.
Artículo en Alemán | MEDLINE | ID: mdl-33560463

RESUMEN

Perioperative antibiotic prophylaxis in endourology is used to reduce or avoid postoperative surgical site infections and complicated urinary tract infections. Special attention is paid to antibiotic stewardship strategies to avoid the continuing selection of antibiotics and multidrug-resistant uropathogens as well as collateral damage to the microbiome. The individual risk profile, the local resistance situation, the expected pathogen spectrum, the pharmacokinetics and the approval of each substance are important aspects to be considered in the indications and selection of perioperative antibiotic prophylaxis. Furthermore, applicable hygiene regulations and the surgical care of an intervention must be observed.


Asunto(s)
Programas de Optimización del Uso de los Antimicrobianos , Infecciones Urinarias , Antibacterianos/uso terapéutico , Profilaxis Antibiótica , Humanos , Infección de la Herida Quirúrgica/prevención & control , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/etiología , Infecciones Urinarias/prevención & control
14.
J Small Anim Pract ; 62(4): 279-285, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33460135

RESUMEN

OBJECTIVES: The aims of the present study were to describe the prevalence of positive urinary bacterial culture in dogs, to identify the most commonly isolated microorganisms and to analyse changes in antimicrobial susceptibility patterns over time. MATERIAL AND METHODS: A retrospective case series was performed using culture and susceptibility results from canine urine samples collected between January 2010 and December 2017. The presence or absence of infection, identity of the bacterium with heaviest growth, and susceptibility profile were recorded for each sample. Trends in the frequency of positive culture and antimicrobial resistance were assessed by Poisson regression modelling. Prevalence rate ratio and 95% confidence interval were reported for resistance to each antimicrobial. RESULTS: A positive urine culture was documented in 771 (22.5%) of 3420 samples. Escherichia coli was the most commonly isolated microorganism. There was no significant increase in the frequency of positive bacterial culture over the study period (prevalence rate ratio 0.98; 95% confidence interval: 0.92 to 1.0). Overall, there was an increase in antimicrobial resistance within Enterobacteriaceae from 5.2 to 35.6%. The prevalence of multidrug-resistant bacteria varied from year to year throughout the study period. However, the Poisson regression model identified a significant increase in the frequency of multidrug-resistant Enterobacteriaceae over this period, averaging approximately 22% per year (prevalence rate ratio 1.22, 95% confidence interval: 1.06 to 1.42). CLINICAL SIGNIFICANCE: The significant increase in antimicrobial resistance observed in this study is concerning and may have implications for veterinary and public health. Appropriate measures, such as antibiotic stewardship programmes, should be implemented to address increasing antimicrobial resistance.


Asunto(s)
Enfermedades de los Perros , Infecciones Urinarias , Animales , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Enfermedades de los Perros/tratamiento farmacológico , Enfermedades de los Perros/epidemiología , Perros , Farmacorresistencia Bacteriana , Enterobacteriaceae , Pruebas de Sensibilidad Microbiana/veterinaria , Estudios Retrospectivos , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/epidemiología , Infecciones Urinarias/veterinaria
15.
Epilepsy Behav ; 115: 107502, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33323337

RESUMEN

AIM: The aim of this study was to analyze the association between antiseizure medication (ASM) and the risk of urinary tract infections (UTI) in patients with epilepsy treated in general practices in Germany. METHODS: This study includes a total of 2201 patients (mean age: 61.4) whose first documented UTI diagnosis occurred between January 2015 and December 2019 (index date) and who were prescribed at least one ASM in 1198 general practices in Germany within one year prior to the index date. Based on a case-control design, the association between predefined criteria and UTI was investigated by matching (1:1) controls without UTI to cases with UTI by sex, age, and codiagnoses. Logistic regression models were used to analyze the association between ASM use and UTI risk. RESULTS: In the first regression model, phenytoin (PHT), primidone, carbamazepine (CBZ), and valproate (VPA) were associated with an increased risk of UTI. In the second model, these associations were confirmed with effects per prescription for PHT, primidone, CBZ, and VPA use. Additionally, the effect per prescription was significant for oxcarbazepine (OXC), topiramate, and gabapentin. CONCLUSION: The study found that PHT, primidone, CBZ, and VPA in particular are associated with an increased risk of infections of the urinary tract. Oxcarbazepine, topiramate, and gabapentin are also associated with increased risk of UTI, albeit to a less significant extent. In general, the immunological and hematological side effects of these molecules may play an important role in the development of UTI under anticonvulsant therapy.


Asunto(s)
Anticonvulsivantes , Infecciones Urinarias , Anticonvulsivantes/efectos adversos , Carbamazepina/efectos adversos , Estudios de Casos y Controles , Alemania/epidemiología , Humanos , Persona de Mediana Edad , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/epidemiología , Ácido Valproico
16.
Rev Fac Cien Med Univ Nac Cordoba ; 77(4): 265-271, 2020 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-33351394

RESUMEN

INTRODUCTION: Urinary Tract Infections (UTI) are an important cause of morbidity in the community, constituting one of the main reasons for hospitalization, and the fourth cause of healthcare-associated infection. The objectives of this study were to determine the frequency of community-acquired UTI (CA-UTI) with need of hospitalization and healthcare-associated UTI (HA-UTI), their risk factors, etiologic agents and their antimicrobial susceptibility spectrum. METHODS: A prospective and analytic study was conducted, in which all admissions regarding CA-UTI with need of hospitalization and HA-UTI were evaluated during the period between 2016 and 2017 in two university hospitals. RESULTS: A total of 279 episodes of UTI in hospitalized patients were identified and, among those, 178 episodes corresponded to CA-UTI and 101 to HA-UTI. On average, patients were 60 years old in both groups. HA-UTI were more frequently associated with kidney transplant, recurrent UTI and chronic kidney disease compared with CA-UTI. The instrumentation of urinary tract within the previous month was more frequent in HA-UTI (75.2% vs 32.6%, p<0.001). Escherichia coli was the most frequent isolated microorganism (62.9% in CA-UTI and 56.4% in HA-UTI), followed by Klebsiella pneumoniae and Pseudomonas aeruginosa. A total of 101 multidrug resistant microorganisms were isolated, of which 53.5% were CA-UTI, and were associated with male patients, use of antimicrobials within the previous three months, chronic kidney disease and recurrent UTI. CONCLUSION: It is of great importance for the institutions to identify the local antimicrobial susceptibility spectrum of UTI in order to stablish adequate empiric treatments.


Asunto(s)
Infecciones Urinarias , Antibacterianos/uso terapéutico , Infecciones Comunitarias Adquiridas/epidemiología , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/epidemiología
18.
Urologiia ; (6): 52-57, 2020 Dec.
Artículo en Ruso | MEDLINE | ID: mdl-33377679

RESUMEN

INTRODUCTION: Every year, more than 7 million women go to the doctor for chronic cystitis. An important factor is the psychoemotional component of this disease. OBJECTIVE: comparative analysis of various options for complex treatment of women with chronic recurrent bacterial cystitis using phototherapy, chronotherapy and correction of psychoemotional disorders with the anxiolytic drug Adaptol. MATERIALS AND METHODS: 90 women with chronic recurrent bacterial cystitis in the acute stage were examined and divided into 3 groups of 30 people. In group 1, patients received basic therapy with Furamag (furazidin kalium). In group 2, patients received standard therapy in combination with phototherapy in the acrophase of the chronorhythm. In group 3, basic therapy was performed in combination with phototherapy in the acrophase of the chronorhythm and Adaptol. The severity of dysuria and pain, leukocyturia, bacteriuria, chronobiological and psychoemotional status were evaluated. RESULTS: Initially, all patients showed signs of desynchronosis and psychoemotional disorders. All groups showed signs of exacerbation of chronic cystitis. The results obtained on the 5th day of therapy in groups 2 and 3 were statistically significantly different (p<0.05) from those in group 1. In group 3, the number of nocturnal urination (0.9+/-0.7), the number of imperative urges per day (0.7+/-0.5), and the intensity of pain (0.7+/-0.6) were the closest to normal. By day 10, clinical and laboratory parameters in all three groups reached normal values, which indicates the effectiveness of the therapy in each of the groups. CONCLUSION: Thus, the use of Furamag and Adaptol in combination with phototherapy at the maximum peaks of psychoemotional and physiological activity of the body effectively stops the clinical and laboratory manifestations of the disease, corrects the mental status and improves the quality of life of women in a shorter period of treatment.


Asunto(s)
Bacteriuria , Cistitis , Infecciones Urinarias , Antibacterianos/uso terapéutico , Bacteriuria/tratamiento farmacológico , Cistitis/tratamiento farmacológico , Femenino , Humanos , Calidad de Vida , Infecciones Urinarias/tratamiento farmacológico
19.
PLoS One ; 15(12): e0243741, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33315921

RESUMEN

Rising incidence of extended- spectrum beta-lactamase (ESBL) induced urinary tract infections (UTIs) is an increasing concern worldwide. Thus, it is of paramount importance to investigate novel approaches that can facilitate the identification and guide empiric antibiotic therapy in such episodes. The study aimed to evaluate the usability of antecedent ESBL-positive urine culture to predict the pathogenic identity of future ones. Moreover, the study evaluated the accuracy of selected empiric therapy in index episodes. This was a retrospective study that included 693 cases with paired UTI episodes, linked to two separate hospital admissions within 12 month-period, and a conditional previous ESBL positive episode. Pertinent information was obtained by reviewing patients' medical records and computerized laboratory results. Multivariate analysis showed that shorter interval between index and previous episodes was significantly associated with increased chance of ESBL-positive results in current culture (OR = 0.912, 95CI% = 0.863-0.963, p = 0.001). Additionally, cases with ESBL-positive results in current culture were more likely to have underlying urological/surgical condition (OR = 1.416, 95CI% = 1.018-1.969, p = 0.039). Investigations of the accuracy of current empirical therapy revealed that male patients were less accurately treated compared to female patients (OR = 0.528, 95CI% = 0.289-0.963, p = 0.037). Furthermore, surgical patients were treated less accurately compared to those treated in internal ward (OR = 0.451, 95CI% = 0.234-0.870, p = 0.018). Selecting an agent concordant with previous microbiologic data significantly increased the accuracy of ESBL-UTIs therapy (p<0.001). A quick survey of the previous ESBL urine culture results can guide practitioners in the selection of empiric therapy for the pending current culture and thus improve treatment accuracy.


Asunto(s)
Bacterias/metabolismo , Infecciones Urinarias/microbiología , Infecciones Urinarias/orina , beta-Lactamasas/metabolismo , Adulto , Anciano , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Bacterias/efectos de los fármacos , Bacterias/aislamiento & purificación , Farmacorresistencia Bacteriana , Femenino , Hospitalización , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Estudios Retrospectivos , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/etiología
20.
BMJ Case Rep ; 13(12)2020 Dec 17.
Artículo en Inglés | MEDLINE | ID: mdl-33334762

RESUMEN

A 44-year-old male person with tetraplegia (C-5 AIS-A (American Spinal Cord Injury Association Standard Neurological Classification of Spinal Cord Injury Impairment Scale)) developed urinary tract infection and received appropriate antibiotic. Subsequently, he started sweating and shivering when he was sitting up; these symptoms resolved while lying on his back. Autonomic dysreflexia triggered by truncal movements continued to occur for 3 months. CT of the spine showed L5-S1 discitis. MRI of the spine showed diffuse marrow oedema in L5 and S1 vertebrae and a large abscess at L5/S1 level. Blood culture yielded Serratia marcescens sensitive to meropenem. Meropenem followed by ertapenem was given for 12 weeks. After 11 months, MRI showed resolution of discitis and epidural collection. The patient was able to sit up for 9 hours without developing autonomic dysreflexia. If a person with cervical spinal cord injury develops posture-related autonomic dysreflexia (eg, in sitting position, lying on sides or while hoisted), disco-vertebral pathology should be suspected.


Asunto(s)
Antibacterianos/uso terapéutico , Disreflexia Autónoma/diagnóstico , Discitis/diagnóstico , Cuadriplejía/complicaciones , Infecciones Urinarias/complicaciones , Adulto , Disreflexia Autónoma/sangre , Disreflexia Autónoma/tratamiento farmacológico , Disreflexia Autónoma/microbiología , Discitis/sangre , Discitis/tratamiento farmacológico , Discitis/microbiología , Humanos , Imagen por Resonancia Magnética , Masculino , Postura , Serratia marcescens/aislamiento & purificación , Resultado del Tratamiento , Infecciones Urinarias/sangre , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/microbiología
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