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1.
Niger Postgrad Med J ; 27(1): 37-41, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32003360

RESUMEN

Background: Urinary tract infection (UTI), especially pyelonephritis when inadequately treated may culminate in end-stage renal disease. The study aims to evaluate the risk factors for and clinico-pathologic features of chronic pyelonephritis (CPN) among patients in Aminu Kano Teaching Hospital, Kano, in North-Western Nigeria. Materials and Methods: Data on cases diagnosed as CPN between 2010 and 2017 in the study centre were retrieved from archives and analysed for risk factors and clinic-pathologic features. Results: Forty-three cases of CPN were diagnosed in the study period and comprised 24 males and 19 females, with a male: female ratio of 1.3:1. The ages ranged from 3 to 80 years with a mean age of 37.0 ± 19.6 years. Urinary tract obstruction, poorly treated UTI, HIV infection and polycystic kidney disease were the risk factors in 21 (49%), 15 (35%), 6 (14%) and 1 (2%) cases, respectively. Proteinuria was seen in 10 (23.3%) of the patients, hypertension in 7 (16.3%) and haematuria in 3 (7.0%) of cases. Nephrectomy was done in 17 (39.5%) of the 43 CPN cases, indications for surgery were pus-filled, non-functioning kidneys. The diameters of the removed kidneys ranged from 10 to 28 cm and they weighed between 140 g and 2500 g. Scarring, reported in 79.0% of patients, was the most common pathological finding, followed by pus casts in 48.8% and focal segmental glomerulosclerosis in 27.9%. No statistically significant difference was found between age or gender and aetiology or risk factors of the disease (P > 0.05). Conclusion: CPN with pus-filled and non-functioning kidneys is a common indication for nephrectomy. Urinary tract obstruction, poorly treated UTI, and HIV infection were major risk factors seen in this environment. To prevent this complication there is a need for better training of clinicians in the diagnosis and adequate treatment of UTI.


Asunto(s)
Infecciones por VIH , Pielonefritis , Infecciones Urinarias , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Infecciones por VIH/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Nefrectomía , Nigeria , Pielonefritis/diagnóstico , Pielonefritis/tratamiento farmacológico , Pielonefritis/etiología , Estudios Retrospectivos , Factores de Riesgo , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/etiología , Adulto Joven
2.
Urologe A ; 59(3): 255-260, 2020 Mar.
Artículo en Alemán | MEDLINE | ID: mdl-32077973

RESUMEN

In infants and children, the strategy of antibacterial long-term infection prophylaxis is more widely used in the protection against urinary tract infections (UTIs) than for hardly any other indication. Development of resistance, side effects of chemotherapeutic agents and acceptance problems require an intensive search for alternatives in the prophylaxis of UTIs. In this context, substances such as D­mannose, probiotics and herbal preparations are gaining increasing attention, whereby the effectiveness of which, especially in children, still needs proof through therapy studies. This also applies to approaches to vaccine prevention. However, prophylaxis must not be limited to the prescription of medicines. Equally important are the treatment of bladder dysfunction and constipation as well as the elimination of other predisposing factors. There are alternatives to antibiotic prophylaxis for UTIs. However, in cases with a high risk of recurrence and pyelonephritis, it is still currently the better alternative.


Asunto(s)
Antibacterianos/uso terapéutico , Profilaxis Antibiótica , Pielonefritis/tratamiento farmacológico , Pielonefritis/prevención & control , Infecciones Urinarias/tratamiento farmacológico , Niño , Humanos , Lactante , Prevención Primaria/métodos , Reflujo Vesicoureteral/complicaciones
3.
Int J Antimicrob Agents ; 55(3): 105891, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31923569

RESUMEN

Ceftolozane/tazobactam (C/T) is a novel ß-lactam/ß-lactamase inhibitor combination targeting Enterobacteriaceae and Pseudomonas aeruginosa (PA). It is approved in adult patients for complicated urinary tract infections (cUTIs) and complicated intra-abdominal infections (cIAIs) as well as for nosocomial pneumonia. It displays excellent activity against PA, even multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains. The aim of this systematic review (PROSPERO protocol no. CRD42019117350) was to summarise the available evidence from observational studies regarding the efficacy and safety of off-label use of C/T when administered to treat MDR- or XDR-PA infections. The MEDLINE and Embase databases were screened from inception up to 30 June 2019. Studies were deemed eligible if they described real-life use of C/T in the case of MDR- or XDR-PA infections for non-approved indications. Exclusion criteria were cIAIs, cUTIs, pneumonia (unless occurring in a paediatric population) and infections by non-MDR/XDR-PA. Thirty articles fulfilled the inclusion criteria. In total, 130 cases of MDR- or XDR-PA infections treated with C/T in 128 patients were described. The most relevant off-label uses were skin and soft-tissue infection (49/30; 37.7%), bone and joint infection (42/130; 32.3%) and bloodstream infection (23/130; 17.7%). Five cases involved paediatric patients. The overall clinical success rate was 76.2%. The most common adverse event was hypokalaemia (4.2%, in 48 evaluable cases). C/T may be a useful therapeutic option for difficult-to-treat infections by PA even outside the framework of approved indications. Further studies are necessary to better define new indications for the drug.


Asunto(s)
Antibacterianos/uso terapéutico , Cefalosporinas/uso terapéutico , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Enterobacteriaceae/efectos de los fármacos , Infecciones por Pseudomonas/tratamiento farmacológico , Pseudomonas aeruginosa/efectos de los fármacos , Tazobactam/uso terapéutico , Antibacterianos/farmacología , Cefalosporinas/farmacología , Farmacorresistencia Bacteriana Múltiple/efectos de los fármacos , Humanos , Infecciones Intraabdominales/tratamiento farmacológico , Estudios Observacionales como Asunto , Infecciones de los Tejidos Blandos/tratamiento farmacológico , Tazobactam/farmacología , Infecciones Urinarias/tratamiento farmacológico
4.
Int J Antimicrob Agents ; 55(3): 105887, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31926283

RESUMEN

The STEP surveillance study was designed to increase knowledge about distribution of multidrug-resistant (MDR) Enterobacterales and Pseudomonas aeruginosa in Portugal, focusing on the intensive care unit (ICU). Antimicrobial susceptibility of common agents was also evaluated and compared with that of one of the latest therapeutic introductions, ceftolozane-tazobactam (C/T). Clinical isolates of Enterobacterales (n=426) and P. aeruginosa (n=396) from patients admitted in Portuguese ICUs were included. Activity of C/T and comparators was investigated using standard broth microdilution. Isolates were recovered from urinary tract (UTI, 36.9%), intra-abdominal (IAI, 24.2%) and lower respiratory tract (LRTI, 38.9%) infections. In P. aeruginosa, overall distribution of MDR/extremely-drug resistant (XDR)/pan-drug resistant (PDR) isolates accounted for 21.2%, 23.2% and 0.8%, respectively. C/T was the most potent agent tested against P. aeruginosa and MDR/XDR/PDR phenotypes. In Escherichia coli, extended-spectrum beta-lactamases (ESBL) and carbapenemase (CP) phenotypes accounted for 16.6% and 1.7%, respectively, whereas in Klebsiella spp., ESBL and CP-phenotypes represented 28.5% and 17.9%, respectively. Overall, susceptibility of C/T against Enterobacterales was 86.9%. C/T was the least affected agent in E. coli (99.4% susceptibility), whereas its activity was moderate in Klebsiella spp. (71.5%) and Enterobacter spp. (70.4%), due in part to a high rate of ESBL and CP-phenotypes. In Enterobacterales, blaKPC was the most prevalent CP gene (63.0%), followed by blaOXA-48 (33.3%) and blaVIM (3.7%). These microbiological results reinforce C/T as a therapeutic option in ICU patients with UTI, IAI or LRTI due to P. aeruginosa or Enterobacterales isolates, but not for CP producers.


Asunto(s)
Antibacterianos/farmacología , Cefalosporinas/farmacología , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Enterobacteriaceae/efectos de los fármacos , Infecciones Intraabdominales/tratamiento farmacológico , Infecciones por Pseudomonas/tratamiento farmacológico , Pseudomonas aeruginosa/efectos de los fármacos , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Tazobactam/farmacología , Infecciones Urinarias/tratamiento farmacológico , Antibacterianos/uso terapéutico , Cefalosporinas/uso terapéutico , Farmacorresistencia Bacteriana Múltiple/efectos de los fármacos , Infecciones por Enterobacteriaceae/microbiología , Humanos , Unidades de Cuidados Intensivos , Portugal , Infecciones por Pseudomonas/microbiología , Tazobactam/uso terapéutico
5.
Medicine (Baltimore) ; 99(2): e18769, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914101

RESUMEN

BACKGROUND: Complicated urinary tract infections (cUTI) are universal reasons for hospitalization, and highly likely to develop into sepsis or septic shock. Carbapenem antibiotics with potentially higher efficacy or with fewer and milder side effects have increased in popularity, but evidence is limited by a scarcity of randomized controlled trials (RCTs) comparing different carbapenem antibiotics for cUTI. Network meta-analysis is a useful tool to compare multiple treatments when there is limited or no direct evidence available. OBJECTIVE: The aim of this study is to compare the efficacy and safety of different carbapenems with alternative antibiotics for the treatment of cUTI. METHODS: Pubmed, Medline, CENTRAL, and Embase were searched in November 2018. Studies of cUTI patients receiving carbapenem were included. We performed network meta-analysis to estimate the risk ratio (RR) and 95% credible interval (CrI) from both direct and indirect evidence; traditional meta-analysis was also performed. Primary outcomes were clinical and microbiological treatment success. RESULTS: A total of 19 studies and 7380 patients were included in the analysis. Doripenem (DOPM) was associated with lower clinical treatment success rates than other carbapenems. Although the efficacy of other carbapenems by RRs with 95% CrIs did not show statistical differences, the cumulative rank probability indicated that meropenem/vaborbactam (MV), ertapenem (ETPM), and biapenem (BAPM) had higher clinical and microbiological treatment success rates; imipenem/cilastatin (IC) and MV showed higher risk of adverse events (AEs). CONCLUSIONS: MV was associated with higher treatment success rates for cUTI, especially for cUTI caused by carbapenem-resistant uropathogens, but also with higher risk of AEs. Our findings suggest MV as a first-choice treatment of carbapenem-resistant cUTI. ETPM, BAPM, and meropenem (MEPM) is another reasonable choice for cUTI empiric therapy.


Asunto(s)
Antibacterianos/uso terapéutico , Carbapenémicos/uso terapéutico , Infecciones Urinarias/tratamiento farmacológico , Antibacterianos/efectos adversos , Carbapenémicos/efectos adversos , Humanos , Metaanálisis en Red , Infecciones Urinarias/microbiología
6.
BMC Infect Dis ; 20(1): 75, 2020 Jan 23.
Artículo en Inglés | MEDLINE | ID: mdl-31973704

RESUMEN

BACKGROUND: Healthcare-Associated Infections (HAIs) represent one of the leading issues to patient safety as well as a significant economic burden. Similarly, Antimicrobial Use (AMU) and Resistance (AMR) represent a growing threat to global public health and the sustainability of healthcare services. METHODS: A Point Prevalence Survey (PPS) following the 2016 ECDC protocol for HAI prevalence and AMU was conducted at Ferrara University Hospital (FUH). Data were collected by a team of trained independent surveyors in 2016 and 2018. Risk factors independently associated with HAI were assessed by a multivariate logistic regression model. RESULTS: Of the 1102 patients surveyed, 115 (10.4%) had an active HAI and 487 (44.2%) were on at least 1 systemic antimicrobial agent. Factors independently associated with increased HAI risk were a "Rapidly Fatal" McCabe score (expected fatal outcome within 1 year), presence of medical devices (PVC, CVC, indwelling urinary catheter or mechanically assisted ventilation) and a length of hospital stay of at least 1 week. The most frequent types of HAI were pneumonia, bloodstream infections, and urinary tract infections. Antimicrobial resistance to third-generation cephalosporins was observed in about 60% of Enterobacteriaceae. CONCLUSIONS: The survey reports a high prevalence of HAI and AMU in FUH. Repeated PPSs are useful to control HAIs and AMU in large acute-care hospitals, highlighting the main problematic factors and allowing planning for improvement actions.


Asunto(s)
Antiinfecciosos/uso terapéutico , Bacteriemia/epidemiología , Infección Hospitalaria/epidemiología , Enterobacteriaceae/aislamiento & purificación , Neumonía/epidemiología , Infecciones Urinarias/epidemiología , Adolescente , Adulto , Anciano , Bacteriemia/tratamiento farmacológico , Infección Hospitalaria/tratamiento farmacológico , Femenino , Hospitales Universitarios , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Neumonía/tratamiento farmacológico , Prevalencia , Factores de Riesgo , Encuestas y Cuestionarios , Catéteres Urinarios/microbiología , Infecciones Urinarias/tratamiento farmacológico , Adulto Joven
8.
Mikrobiyol Bul ; 53(4): 457-463, 2019 Oct.
Artículo en Turco | MEDLINE | ID: mdl-31709943

RESUMEN

Purple urine bag syndrome (PUBS) is a rare syndrome characterized by production of indigo (blue) and indirubin (red) pigments due to bacterial colonization in urinary catheter. The pathogenesis of PUBS is related to the combination of these two pigments produced from the metabolism of tryptophan. Tryptophan turns into indole by deamination, indole turns into indoxyl sulphate by hepatic conjugation and indoxyl sulphate is secreted into urine. Sulphatases and phosphatases enzymes produced by bacteria like Providencia stuartii and Providencia rettgeri, Klebsiella pneumoniae, Proteus mirabilis, Escherichia coli, Enterococcus spp., Morganella morganii, Pseudomonas aeruginosa, Citrobacter spp. and group B streptococci convert indoxyl sulphate to indoxyl. In the urinary tract, oxidation of indoxyl results in the production of indigo and indirubin pigments. These pigments react with polyvinyl chloride (PVC) lining of the urinary catheter bag and the reaction results purple discoloration of urine. Urine discoloration is very important clinical sign in the differential diagnosis of several pathological conditions such as hematuria, urinary system tumors and drug side effects and may be disquieting for patients, families and healthcare workers. Purple urine discoloration is rarely reported in the literature and it is generally associated with urinary tract infection. In this report, a 60 years old woman with a past medical history of significant chronic kidney disease undergoing regular hemodialysis, chronic constipation and hepatitis B was admitted to our neurology clinic because of acute intracerebral hemorrhage. She had confusion and right hemiplegia in her neurological examination and required urinary catheterization due to immobilization. Red coloration was observed in urine on the tenth hospital day. Although this coloration was thought to be hematuria, according to urine examination it was not hematuria. Then urine color turned into purple within two days. The next day, because of fever, full blood count and other blood investigations were performed and urine was sent to the laboratory for culture. Empirical piperacillin-tazobactam and teicoplanin antibiotic treatments were commenced. In the urine culture, 105 cfu/ml Enterococcus faecalis was isolated. According to the antibiotic susceptibility results the therapy was changed and meropenem was added to the treatment. For her constipation, supportive managements such as hydration, nutrition and laxative treatment were applied. After all the treatments, the patient's constipation regressed, the urine had become normal colored and the following urine cultures were not revealed any bacterial growth. As in this case, when the urine discoloration occurs, PUBS should be kept in mind which is especially seen in elderly female patients with chronic constipation, urinary catheterization, urinary tract infection and renal failure.


Asunto(s)
Infecciones Urinarias , Antibacterianos/uso terapéutico , Femenino , Humanos , Persona de Mediana Edad , Resultado del Tratamiento , Catéteres Urinarios , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/microbiología , Orina/microbiología
9.
Int J Infect Dis ; 89: 179-184, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31580939

RESUMEN

BACKGROUND: Limited data on healthcare-associated infections (HAIs) are available from the developing world, thus a point prevalence survey was conducted to determine the prevalence of HAIs and antimicrobial use in Guangdong Province, China. METHODS: A standardized methodology for point prevalence surveys on HAIs and antimicrobial use has been developed by the Chinese Nosocomial Infection Control and Quality Improvement Center. The prevalence of HAIs, antimicrobial use, and baseline hospital-level variables were collected in 189 hospitals from June 2017 to May 2018. RESULTS: Of 5 868 147 patients, 72 976 had one or more HAIs (1.24%), with 82 700 distinct HAIs. The prevalence rates of device-associated infections, including ventilator-associated pneumonia, catheter-associated urinary tract infection, and central line-associated bloodstream infection were 7.92, 2.06, and 0.63 per 1000 catheter-days, respectively. A total of 10 591 (0.18%) HAIs caused by multidrug-resistant organisms were identified. Carbapenem non-susceptibility rates were highest in Acinetobacter species (53.86%) and Pseudomonas aeruginosa (21.60%). Forty-six percent (2 712 258/5 868 147) of inpatients were receiving at least one antimicrobial during this survey. CONCLUSIONS: This survey indicated the relatively lower prevalence of HAIs but higher antimicrobial using in Guangdong Province compared with other mid to low-income and high-income countries. Further studies are warranted to elucidate which HAI-related indicators are the best measures of HAI performance and thus allow improvements leading to better patient outcomes.


Asunto(s)
Antibacterianos/uso terapéutico , Infección Hospitalaria/tratamiento farmacológico , Bacterias/clasificación , Bacterias/efectos de los fármacos , Bacterias/genética , Bacterias/aislamiento & purificación , China , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Estudios Transversales , Hospitales/estadística & datos numéricos , Humanos , Neumonía Asociada al Ventilador/tratamiento farmacológico , Neumonía Asociada al Ventilador/epidemiología , Neumonía Asociada al Ventilador/microbiología , Prevalencia , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/epidemiología , Infecciones Urinarias/microbiología
11.
BMJ ; 367: l5205, 2019 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-31578187

RESUMEN

OBJECTIVES: To determine how clinicians vary in their response to new guidance on existing or new interventions, by measuring the timing and magnitude of change at healthcare institutions. DESIGN: Automated change detection in longitudinal prescribing data. SETTING: Prescribing data in English primary care. PARTICIPANTS: English general practices. MAIN OUTCOME MEASURES: In each practice the following were measured: the timing of the largest changes, steepness of the change slope (change in proportion per month), and magnitude of the change for two example time series (expiry of the Cerazette patent in 2012, leading to cheaper generic desogestrel alternatives becoming available; and a change in antibiotic prescribing guidelines after 2014, favouring nitrofurantoin over trimethoprim for uncomplicated urinary tract infection (UTI)). RESULTS: Substantial heterogeneity was found between institutions in both timing and steepness of change. The range of time delay before a change was implemented was large (interquartile range 2-14 months (median 8) for Cerazette, and 5-29 months (18) for UTI). Substantial heterogeneity was also seen in slope following a detected change (interquartile range 2-28% absolute reduction per month (median 9%) for Cerazette, and 1-8% (2%) for UTI). When changes were implemented, the magnitude of change showed substantially less heterogeneity (interquartile range 44-85% (median 66%) for Cerazette and 28-47% (38%) for UTI). CONCLUSIONS: Substantial variation was observed in the speed with which individual NHS general practices responded to warranted changes in clinical practice. Changes in prescribing behaviour were detected automatically and robustly. Detection of structural breaks using indicator saturation methods opens up new opportunities to improve patient care through audit and feedback by moving away from cross sectional analyses, and automatically identifying institutions that respond rapidly, or slowly, to warranted changes in clinical practice.


Asunto(s)
Prescripciones de Medicamentos/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , Medicina Estatal/estadística & datos numéricos , Antiinfecciosos/uso terapéutico , Conjuntos de Datos como Asunto , Sustitución de Medicamentos/estadística & datos numéricos , Medicamentos Genéricos/uso terapéutico , Inglaterra , Medicina General/organización & administración , Medicina General/normas , Medicina General/estadística & datos numéricos , Humanos , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina/normas , Medicina Estatal/normas , Factores de Tiempo , Infecciones Urinarias/tratamiento farmacológico
13.
Aten. prim. (Barc., Ed. impr.) ; 51(8): 494-498, oct. 2019. tab
Artículo en Inglés | IBECS | ID: ibc-185752

RESUMEN

Aim: To determine the patterns of antibiotic susceptibility of Escherichia coli strains isolated from adult patients with urinary tract infection (UTI), and to stratify the results by age and type of UTI to verify if there are statistically significant differences that can help physicians to prescribe better empirical antibiotherapy. Design: Cross-sectional prospective study. Location: Community of Getafe (Madrid). Primary care level. Participants: 100 E. coli strains, randomly chosen, isolated from the urine (104-105 cfu/ml) of different patients from primary care centers in the Getafe area. Main measurements The antibiotic susceptibility of the strains was evaluated and the results were stratified by age and type of UTI. The clinical and demographic data of the patients were analyzed, classifying each episode as complicated UTI or uncomplicated UTI. Results. Strains isolated from patients with uncomplicated UTI showed significantly greater susceptibility than those of complicated UTI to amoxicillin (65.9% vs. 30.6%, p = 0.001), amoxicillin/clavulanic acid (95.5% vs. 77.6%, p = 0.013) and ciprofloxacin (81.8% vs. 63.3%, p = 0.047). In complicated UTI, susceptibility to ciprofloxacin was significantly greater in the ≤ 65 years age group compared to the older age group (78.3% vs. 50%, respectively, p = 0.041). In the rest of antibiotics, no statistically significant differences were obtained when comparing by age (≤ 65 years versus > 65 years), both in uncomplicated and complicated UTI. Conclusions: Clinical and demographic data of patients with UTI are of great importance in the results of the antibiotic susceptibility in E. coli. Antibiograms stratified by patient characteristics may better facilitate empirical antibiotic selection for UTI in primary care


Objetivo: Determinar los patrones de sensibilidad antibiótica de cepas de Escherichia coli aisladas de pacientes adultos con infección del tracto urinario (ITU), y estratificar los resultados por edad y tipo de ITU para verificar si existen diferencias estadísticamente significativas que puedan ayudar a los médicos a la prescripción de una mejor antibioterapia empírica. Diseño: Estudio transversal prospectivo. Emplazamiento Comunidad de Getafe (Madrid). Nivel de atención primaria. Participantes:100 cepas de E. coli, escogidas al azar, aisladas de orina (104 ->105 ufc/ml) de diferentes pacientes de centros de atención primaria del área de Getafe. Mediciones principales: Se evaluó la sensibilidad antibiótica de las cepas y los resultados se estratificaron por edad y tipo de ITU. Se analizaron los datos clínicos y demográficos de los pacientes de los que provenían, clasificándose cada episodio como ITU complicada o ITU no complicada. Resultados: Las cepas aisladas de pacientes con ITU no complicada mostraron una sensibilidad antibiótica significativamente mayor que las de ITU complicada a amoxicilina (65,9% vs. 30,6%, p = 0.001), amoxicilina/clavulánico (95,5% vs. 77,6%, p = 0.013) y ciprofloxacino (81,8% vs. 63,3%, p = 0.047). En la ITU complicada, la sensibilidad al ciprofloxacino fue significativamente mayor en el grupo de edad ≤ 65 años en comparación con el grupo de mayor edad (78,3% vs. 50%, p = 0.041). Para el resto de antibióticos no se observaron diferencias significativas cuando se compararon por edad (≤ 65 versus > 65), tanto en ITU no complicada como complicada. Conclusiones: Los datos clínicos y demográficos de los pacientes con ITU son de gran importancia en los resultados de la sensibilidad antibiótica en E. coli. Los antibiogramas estratificados por características de los pacientes podrían facilitar una mejor selección de antibioterapia empírica para las ITU en atención primaria


Asunto(s)
Humanos , Infecciones Urinarias/diagnóstico por imagen , Infecciones Urinarias/tratamiento farmacológico , Sensibilidad y Especificidad , Resistencia a Medicamentos , Infecciones Comunitarias Adquiridas/epidemiología , Estudios Transversales , Estudios Prospectivos , Infecciones por Escherichia coli/diagnóstico , Infecciones por Escherichia coli/microbiología
14.
Clin Lab ; 65(9)2019 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-31532099

RESUMEN

BACKGROUND: Antimicrobial resistance is a growing problem. The current process for determining antibiotic sensitivities is time consuming and often leaves patients waiting for results while using the wrong antibiotic. Reducing inappropriate antibiotic use diminishes the development of resistance and reduces expenses. The objective of the study was to determine if a simplified laboratory process using direct plating techniques in association with class disks to identify antibiotic resistance is a viable option to reduce the time it takes to minimize the use of ineffective antibiotics. METHODS: A tutored office technician collected specimens. Cultures were performed on traditional laboratory media. They were concurrently submitted as routine cultures to our usual certified outpatient laboratory, Quest Diagnostics Inc. RESULTS: We found that in this case series an average of 33 hours was saved over conventional microbial culture techniques with 16/16 (100%) concurrence for UTIs and 57.6 hours saved with 9/10 (90%) comparable results for wound cultures. CONCLUSIONS: Using this abbreviated culture technique and reporting resistance rather than sensitivity, not only can save time, but inappropriate antibiotic use may be avoided.


Asunto(s)
Antibacterianos/uso terapéutico , Farmacorresistencia Microbiana/efectos de los fármacos , Infecciones Urinarias/tratamiento farmacológico , Infección de Heridas/tratamiento farmacológico , Técnicas de Laboratorio Clínico/métodos , Humanos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Factores de Tiempo , Resultado del Tratamiento , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/microbiología , Infección de Heridas/diagnóstico , Infección de Heridas/microbiología
15.
J Assoc Physicians India ; 67(9): 42-45, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31561688

RESUMEN

Introduction: The incidence of the urinary tract infections caused by Candida species, are becoming more common. Recently, an increase in the incidence of infection caused by fungi especially non albicans candida species (NAC) has been reported. Several virulence factors like biofilm formation, toxin production and presence of adhesins contribute to its pathogenesis. Objectives: This study was undertaken to determine species distribution, biofilm formation and in-vitro antifungal susceptibility of candida isolated in our tertiary care hospital. Method: Eighty seven clinical isolates obtained from urine specimens were subjected to wet mount, Gram's stain and cultured on Sabouraud's Dextrose agar (SDA) medium. Conventional method for yeast identification was done. Biofilm forming ability of each isolate was detected using microtitre plate method. Antifungal susceptibility against posaconazole, amphotericin-B, fluconazole, itraconazole, ketoconazole, 5-flucytosine, voriconazole, and caspofungin was tested using Sensititre® Yeastone® (Trek diagnostic systems). Results and Discussion: Out of 87 candida isolates, 31.03% (n=27) were C. albicans and 68.97% (n=60) were non albicans candida species (NAC). Among 60 NAC, C. kruseii 29.89% (n=26), C. glabrata 24.14% (n=21), C. tropicalis 14.94% (n=13). Among all isolates, 36.78% (n=32) were biofilm producers and biofilm positivity more among C. albicans 55.56% (n=15) as compared to NAC 28.33% (n=17) (Pvalue<0.002). The maximum positivity was observed with isolates from plastic devices (61.8%). The minimum inhibitory concentrations of all antifungal drugs against all isolates were within susceptible range except for fluconazole which was resistant to C. kruseii. Conclusion: C. albicans remains the major isolate from urine samples and also biofilm formation as a virulence factor might have a higher significance for C. albicans than for NAC and its ability to form biofilm is intricately linked with ability of organisms to adhere, colonize and subsequently cause infection.


Asunto(s)
Antifúngicos/uso terapéutico , Biopelículas/crecimiento & desarrollo , Candida/efectos de los fármacos , Infecciones Urinarias/tratamiento farmacológico , Antifúngicos/farmacología , Candida/aislamiento & purificación , Humanos , Pruebas de Sensibilidad Microbiana , Centros de Atención Terciaria , Infecciones Urinarias/microbiología
17.
Nat Commun ; 10(1): 4379, 2019 09 26.
Artículo en Inglés | MEDLINE | ID: mdl-31558767

RESUMEN

Recurrent urinary tract infection (rUTI) is a major medical problem, especially in the elderly and infirm, but the nature of the reservoir of organisms responsible for survival and recolonisation after antibiotic treatment in humans is unclear. Here, we demonstrate the presence of cell-wall deficient (L-form) bacteria in fresh urine from 29 out of 30 older patients with rUTI. In urine, E. coli strains from patient samples readily transition from the walled state to L-form during challenge with a cell wall targeting antibiotic. Following antibiotic withdrawal, they then efficiently transition back to the walled state. E. coli switches between walled and L-form states in a zebrafish larva infection model. The results suggest that L-form switching is a physiologically relevant phenomenon that may contribute to the recurrence of infection in older patients with rUTI, and potentially other infections.


Asunto(s)
Pared Celular/metabolismo , Infecciones por Escherichia coli/diagnóstico , Escherichia coli/metabolismo , Infecciones Urinarias/diagnóstico , Anciano , Animales , Antibacterianos/uso terapéutico , Escherichia coli/efectos de los fármacos , Escherichia coli/fisiología , Infecciones por Escherichia coli/tratamiento farmacológico , Infecciones por Escherichia coli/microbiología , Humanos , Larva/microbiología , Recurrencia , Factores de Riesgo , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/microbiología , Pez Cebra/microbiología
18.
Eur J Pharm Sci ; 139: 105067, 2019 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-31499170

RESUMEN

The purpose of this study is to evaluate the efficacy of intra-vesical instillations with hyaluronic acid (HA) in relieving lower urinary tract irritation symptoms in patients with urinary tract infections (UTIs) and bladder pain syndrome/interstitial cystitis (BPS/IC). This research, conducted in Romania, includes 30 patients with UTIs (Group I) and 24 with BPS/IC (Group II) as defined by European Association of Urology (EAU) Diagnostic Criteria. Data were collected prospectively, using pre- and post-treatment questionnaires for pelvic pain with a symptom scale for urination and frequency as well as visual analog scale (VAS) pain quizzes. At follow-up visits, at an average of 20 months, a significant improvement in urinary bladder pain, day-time urinary frequency and quality of life was observed in Group I patients. Group II patients experienced significant improvement in urinary bladder pain, urgency, nocturia and quality of life at the 15-month follow-up visit. Eighteen patients (75%) showed a complete response to intravesical HA instillations and required no further treatment. Our study demonstrates that intravesical HA instillations may be considered as an important treatment component, with long term positive effects in therapeutic strategy for optimal results in uncomplicated recurrent UTIs and BPS/IC, with good compliance and minimal side effects.


Asunto(s)
Cistitis Intersticial/tratamiento farmacológico , Ácido Hialurónico/administración & dosificación , Infecciones Urinarias/tratamiento farmacológico , Administración Intravesical , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Calidad de Vida , Resultado del Tratamiento
19.
Acta Med Port ; 32(9): 568-575, 2019 Sep 02.
Artículo en Portugués | MEDLINE | ID: mdl-31493359

RESUMEN

INTRODUCTION: Urinary tract infections in the community setting are quite common. It is necessary to be aware of antibiotic susceptibility patterns in order to provide rational empirical therapy. The aim of this study is to determine the frequency and antimicrobial susceptibility of the strains responsible for urinary tract infections in primary health care, in the district of Coimbra, Portugal. MATERIAL AND METHODS: In this observational and cross-sectional study, we analyzed 7134 positive urine cultures of outpatient laboratories in the district of Coimbra, over one year. In most cases, a positive culture was defined by a threshold of 105 colony-forming units per milliliter and was conducted by the automated system VITEK® 2, by bioMérieux. We used descriptive and inferential statistics to determine the prevalence and antimicrobial susceptibility of bacteria and to ascertain whether there were differences associated with sex and age. RESULTS: From the total of positive cultures, 83.4% pertained to females and 41.0% to individuals over 75 years old. Escherichia coli was the most frequent strain (63.9%), although its prevalence was lower (p < 0.001) in males and individuals over 75 years old. Its susceptibility to fosfomycin and nitrofurantoin was higher than 95% and with ciprofloxacin and trimethoprim/sulfamethoxazole it was lower than 80%. Resistances were more frequent (p < 0.001) in males and in the elderly. DISCUSSION: Escherichia coli was the most frequent strain, revealing less resistance to fosfomycin and nitrofurantoin. Antimicrobial susceptibility was lower in the elderly and in males, populations in whom empirical therapy may be less successful. CONCLUSION: In order to improve clinical results, we recommend periodic surveillance of antimicrobial susceptibility, which could enable the provision of efficient information to clinicians, namely those who prescribe empirically for such infections, as well as standardization of identification methods of bacterial strains diagnosis and of the antibiotic kits to be tested.


Asunto(s)
Antibacterianos/farmacología , Pruebas de Sensibilidad Microbiana , Infecciones Urinarias/tratamiento farmacológico , Factores de Edad , Antiinfecciosos Urinarios/farmacología , Técnicas Bacteriológicas/métodos , Recuento de Colonia Microbiana/métodos , Estudios Transversales , Farmacorresistencia Bacteriana , Escherichia coli/efectos de los fármacos , Femenino , Humanos , Masculino , Portugal , Factores Sexuales , Infecciones Urinarias/microbiología
20.
Acta Med Port ; 32(9): 576-579, 2019 Sep 02.
Artículo en Inglés | MEDLINE | ID: mdl-31493360

RESUMEN

INTRODUCTION: Outpatient antimicrobial therapy programs have been in place for more than four decades. They provide safe and effective treatment for a selected group of patients while reducing costs. In Europe in general, and in Portugal in particular, these programs are still a relatively new phenomenon. The aim of this study is to describe our center's two years' experience with such a program (Antibiotic Clinic). MATERIAL AND METHODS: The cohort of treatments administered by the Antibiotic Clinic in its first two years of existence (September 12th 2016 to September 11th 2018) was analyzed and data pertaining to patients, infections, infectious agents, antimicrobials and outcomes (infection resolution, adverse events and death) were characterized. RESULTS: The Antibiotic Clinic treated 231 patients in 250 episodes, providing a total of 2357 days of antibiotic treatment. The urinary tract was the most common site (39.2%) and Enterobacteriaceae the most common agents (63.7% of isolates). Infections were resolved in 90.8% of treatments (95.6% of patients), adverse events were few (1.2%) and direct mortality was not found. The dropout rate was 1.6%. DISCUSSION: Infection resolution and adverse event rates were comparable to other centers. High treatment and low dropout rates point to high physician and patient acceptance. CONCLUSION: Our experience with this program suggests it is a safe and effective alternative to inpatient admission. This is in line with current literature which suggests efforts should be made to expand this treatment modality.


Asunto(s)
Instituciones de Atención Ambulatoria/estadística & datos numéricos , Atención Ambulatoria/estadística & datos numéricos , Antibacterianos/uso terapéutico , Infecciones Bacterianas/tratamiento farmacológico , Adulto , Anciano , Antibacterianos/efectos adversos , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/microbiología , Farmacorresistencia Bacteriana , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Portugal/epidemiología , Evaluación de Programas y Proyectos de Salud , Factores de Tiempo , Resultado del Tratamiento , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/epidemiología , Infecciones Urinarias/microbiología
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