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1.
BMJ Case Rep ; 14(2)2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33547106

RESUMO

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.


Assuntos
Anti-Infecciosos Urinários/uso terapêutico , Cefalosporinas/uso terapêutico , Farmacorresistência Bacteriana Múltipla , Infecções por Klebsiella/tratamento farmacológico , Tazobactam/uso terapêutico , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/microbiologia , Idoso , Humanos , Klebsiella pneumoniae , Masculino , Testes de Sensibilidade Microbiana
2.
Euro Surveill ; 25(30)2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32734857

RESUMO

We report a case of Legionella pneumonia in a dishwasher of a restaurant in Rome, Italy, just after the end of the lockdown that was in place to control the SARS-CoV-2 epidemic. The case highlights the importance of strict monitoring of water and air systems immediately before reopening business or public sector buildings, and the need to consider Legionella infections among the differential diagnosis of respiratory infections after lockdown due to the ongoing COVID-19 pandemic.


Assuntos
Antígenos de Bactérias/urina , Legionella pneumophila/isolamento & purificação , Legionella/isolamento & purificação , Doença dos Legionários/diagnóstico , Levofloxacino/uso terapêutico , Pneumonia/diagnóstico , Administração Intravenosa , Adulto , Anti-Infecciosos Urinários/uso terapêutico , Tosse/etiologia , Febre/etiologia , Cefaleia/etiologia , Humanos , Doença dos Legionários/tratamento farmacológico , Doença dos Legionários/urina , Masculino , Pneumonia/tratamento farmacológico , Pneumonia/urina , Resultado do Tratamento
3.
BMC Infect Dis ; 20(1): 354, 2020 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-32429852

RESUMO

BACKGROUND: Mediastinitis caused by hematogenous spread of an infection is rare. We report the first known case of community-acquired mediastinitis from hematogenous origin in an immunocompetent adult. This rare invasive infection was due to Panton-Valentine Leucocidin-producing (PVL+) methicillin-susceptible Staphylococcus aureus (MSSA). CASE PRESENTATION: A 22-year-old obese man without other medical history was hospitalized for febrile precordial chest pain. He reported a cutaneous back abscess 3 weeks before. CT-scan was consistent with mediastinitis and blood cultures grew for a PVL+ MSSA. Intravenous clindamycin (600 mg t.i.d) and cloxacillin (2 g q.i.d.), secondary changed for fosfomycin (4 g q.i.d.) because of a related toxidermia, was administered. Surgical drainage was performed and confirmed the presence of a mediastinal abscess associated with a fistula between the mediastinum and right pleural space. All local bacteriological samples also grew for PVL+ MSSA. In addition to clindamycin, intravenous fosfomycin was switched to trimethoprim-sulfamethoxazole after 4 weeks for a total of 10 weeks of antibiotics. CONCLUSIONS: We present the first community-acquired mediastinitis of hematogenous origin with PVL+ MSSA. Clinical evolution was favorable after surgical drainage and 10 weeks of antibiotics. The specific virulence of MSSA PVL+ strains played presumably a key role in this rare invasive clinical presentation.


Assuntos
Toxinas Bacterianas/análise , Infecções Comunitárias Adquiridas/diagnóstico , Exotoxinas/análise , Imunocompetência , Leucocidinas/análise , Mediastinite/diagnóstico , Mediastinite/microbiologia , Infecções Estafilocócicas/diagnóstico , Staphylococcus aureus/metabolismo , Abscesso/tratamento farmacológico , Abscesso/microbiologia , Abscesso/cirurgia , Antibacterianos/uso terapêutico , Anti-Infecciosos Urinários/uso terapêutico , Clindamicina/uso terapêutico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Drenagem , Humanos , Masculino , Mediastinite/tratamento farmacológico , Mediastinite/imunologia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/imunologia , Infecções Estafilocócicas/microbiologia , Resultado do Tratamento , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Adulto Jovem
4.
Medicina (B Aires) ; 80(3): 229-240, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32442937

RESUMO

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.


Assuntos
Anti-Infecciosos Urinários/uso terapêutico , Consenso , Infecções Urinárias/tratamento farmacológico , Argentina , Cistite/diagnóstico , Cistite/tratamento farmacológico , Feminino , Humanos , Masculino , Gravidez , Estudos Prospectivos , Prostatite/diagnóstico , Prostatite/tratamento farmacológico , Pielonefrite/diagnóstico , Pielonefrite/tratamento farmacológico , Infecções Urinárias/diagnóstico
5.
Medicina (B Aires) ; 80(3): 241-247, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32442938

RESUMO

The second part of the Inter-Society Argentine Consensus on Urinary Tract Infection (UTI) includes the analysis of special situations. In patients with urinary catheter, urine culture should be requested only in the presence of UTI symptomatology, before instrumentation of the urinary tract, or as a post-transplant control. The antibiotics recommended for empirical treatment in patients without risk factors are third-generation cephalosporins or aminoglycosides. UTIs associated with stones are always considered complicated. In case of obstruction with urosepsis, an emergency drainage should be performed via a percutaneous nefrostomy or ureteral stenting. In patients with stents or ureteral prostheses, such as double J catheters, empirical treatment should be based on epidemiology, prior antibiotics, and clinical status. Before the extracorporeal lithotripsy procedure, bacteriuria should be investigated and antibiotic prophylaxis should be administered in case of positive result, according to the antibiogram. First generation cephalosporins or aminoglycosides are valid alternatives. The use of antibiotic prophylaxis with first-generation cephalosporins or aminoglycosides before percutaneous nephrolithotomy is recommended. Transrectal prostatic biopsy can be associated with infectious complications, such as UTI or acute prostatitis, mainly due to Escherichia coli or other enterobacteria. In patients without risk factors for multiresistant bacteria and negative urine culture, prophylaxis with intravenous amikacin or ceftriaxone is recommended. In patients with positive urine culture, prophylaxis will be performed according to the antibiogram, from 24 hours before to 24 hours post-procedure. For the targeted treatment of post-transrectal biopsy prostatitis, carbapenems for 3-4 weeks are the treatment of choice.


Assuntos
Anti-Infecciosos Urinários/uso terapêutico , Consenso , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/etiologia , Argentina , Feminino , Humanos , Litotripsia/efeitos adversos , Masculino , Nefrolitíase/complicações , Nefrolitotomia Percutânea/efeitos adversos , Prostatite/tratamento farmacológico , Prostatite/etiologia , Fatores de Risco , Stents/efeitos adversos , Cateteres Urinários/efeitos adversos
6.
Pediatrics ; 145(4)2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32127361

RESUMO

OBJECTIVES: To determine if a multicomponent intervention was associated with increased use of first-line antibiotics (cephalexin or sulfamethoxazole and trimethoprim) among children with uncomplicated urinary tract infections (UTIs) in outpatient settings. METHODS: The study was conducted at Kaiser Permanente Colorado, a large health care organization with ∼127 000 members <18 years of age. After conducting a gap analysis, an intervention was developed to target key drivers of antibiotic prescribing for pediatric UTIs. Intervention activities included development of new local clinical guidelines, a live case-based educational session, pre- and postsession e-mailed knowledge assessments, and a new UTI-specific order set within the electronic health record. Most activities were implemented on April 26, 2017. The study design was an interrupted time series comparing antibiotic prescribing for UTIs before versus after the implementation date. Infants <60 days old and children with complex urologic or neurologic conditions were excluded. RESULTS: During January 2014 to September 2018, 2142 incident outpatient UTIs were identified (1636 preintervention and 506 postintervention). Pyelonephritis was diagnosed for 7.6% of cases. Adjusted for clustering of UTIs within clinicians, the proportion of UTIs treated with first-line antibiotics increased from 43.4% preintervention to 62.4% postintervention (P < .0001). The use of cephalexin (first-line, narrow spectrum) increased from 28.9% preintervention to 53.0% postintervention (P < .0001). The use of cefixime (second-line, broad spectrum) decreased from 17.3% preintervention to 2.6% postintervention (P < .0001). Changes in prescribing practices persisted through the end of the study period. CONCLUSIONS: A multicomponent intervention with educational and process-improvement elements was associated with a sustained change in antibiotic prescribing for uncomplicated pediatric UTIs.


Assuntos
Assistência Ambulatorial , Antibacterianos/uso terapêutico , Anti-Infecciosos Urinários/uso terapêutico , Infecções Urinárias/tratamento farmacológico , Adolescente , Fatores Etários , Cefalexina/uso terapêutico , Criança , Pré-Escolar , Cistite/tratamento farmacológico , Feminino , Humanos , Lactente , Análise de Séries Temporais Interrompida , Masculino , Avaliação de Processos em Cuidados de Saúde , Pielonefrite/tratamento farmacológico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Infecções Urinárias/epidemiologia
8.
Clin Pediatr (Phila) ; 59(3): 259-265, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31888378

RESUMO

It is a common practice to monitor blood tests in patients receiving long-term trimethoprim-sulfamethoxazole (TMP-SMZ) prophylaxis for recurrent urinary tract infections. This multicenter, randomized, placebo-controlled trial enrolled 607 children aged 2 to 71 months with vesicoureteral reflux diagnosed after symptomatic urinary tract infection. Study participants received TMP-SMZ (n = 302) or placebo (n = 305) and were followed for 2 years. Serum electrolytes (n ≥ 370), creatinine (n = 310), and complete blood counts (n ≥ 206) were measured at study entry and at the 24-month study conclusion. We found no significant electrolyte, renal, or hematologic abnormalities when comparing the treatment and placebo groups. We observed changes in several laboratory parameters in both treatment and placebo groups as would normally be expected with physiologic maturation. Changes were within the normal range for age. Long-term use of TMP-SMX had no treatment effect on complete blood count, serum electrolytes, or creatinine. Our findings do not support routine monitoring of these laboratory tests in children receiving long-term TMP-SMZ prophylaxis.


Assuntos
Anti-Infecciosos Urinários/efeitos adversos , Biomarcadores/sangue , Monitoramento de Medicamentos/métodos , Prevenção Secundária/métodos , Combinação Trimetoprima e Sulfametoxazol/efeitos adversos , Infecções Urinárias/prevenção & controle , Refluxo Vesicoureteral/complicações , Anti-Infecciosos Urinários/uso terapêutico , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Estudos Prospectivos , Recidiva , Resultado do Tratamento , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Infecções Urinárias/sangue , Infecções Urinárias/diagnóstico , Infecções Urinárias/etiologia
9.
Int J Antimicrob Agents ; 55(2): 105851, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31770624

RESUMO

Pivmecillinam, a pro-drug of mecillinam, has been used extensively in Scandinavia for the treatment of acute lower urinary tract infections (UTIs) caused by Enterobacterales. It is still an attractive first-line drug for the empirical treatment of UTIs owing to the low prevalence of resistance as well as its favourable impact on the intestinal microbiota as a pro-drug and good in vitro efficacy against extended-spectrum ß-lactamase (ESBL)- and plasmid-mediated AmpC ß-lactamase-producing Escherichia coli. However, optimal dosing of pivmecillinam as well as its in vivo efficacy against UTIs caused by multidrug-resistant (MDR) broad-spectrum ß-lactamase-producing E. coli has not been thoroughly studied. In this study, the efficacy of two mimicked human dosing regimens of pivmecillinam (200 mg and 400 mg three times daily) against clinical E. coli strains, including isolates producing ESBLs (CTX-M-14 and CTX-M-15), plasmid-mediated AmpCs (CMY-4 and CMY-6) and carbapenemases (NDM-1 and VIM-29), in a murine UTI model was compared. Both dosing regimens reduced the number of CFU/mL in urine for all strains, including mecillinam-resistant strains. Combining the effect for all six strains showed no significant differences in effect between doses for all three fluids/organs, but for each dose there was a highly significant effect in urine, kidney and bladder compared with vehicle-treated mice. Overall, this highlights the need for further studies to elucidate the role of mecillinam in the treatment of infections caused by MDR E. coli producing broad-spectrum ß-lactamases, including specific carbapenemases.


Assuntos
Andinocilina/farmacologia , Anti-Infecciosos Urinários/farmacologia , Escherichia coli/efeitos dos fármacos , Infecções Urinárias/microbiologia , Andinocilina/uso terapêutico , Animais , Anti-Infecciosos Urinários/uso terapêutico , Modelos Animais de Doenças , Farmacorresistência Bacteriana Múltipla , Escherichia coli/genética , Genes Bacterianos , Camundongos , Testes de Sensibilidade Microbiana , Infecções Urinárias/tratamento farmacológico , Sequenciamento Completo do Genoma
10.
Ann Pharmacother ; 54(4): 359-363, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31694390

RESUMO

Background: Methenamine is a drug used for the prevention of lower urinary tract infections (UTIs). However, efficacy has not been established in older adults or patients with varying degrees of kidney function. Objective: To evaluate the effectiveness of methenamine for the prevention of UTI in adults 60 years and older. Methods: This was a retrospective, pre-post, observational study. The study included primary care patients 60 years and older who were taking methenamine between January 1, 2015, and September 30, 2018. The primary outcome was the time to first UTI after methenamine initiation compared with the average time between UTIs in the 12 months prior to methenamine initiation. Results: Of 434 patients reviewed, 150 met inclusion criteria. The average time to UTI was 3.3 months prior to methenamine initiation compared with 5.5 months after methenamine initiation (P = 0.0004). There were 33 patients (22%) who did not have a UTI after methenamine initiation. Also, 14 patients (9.3%) had a calculated CrCl <30 mL/min at baseline. The average time to UTI in these patients was 3.3 months prior to methenamine initiation compared with 12.7 months after initiation (P < 0.0001). Conclusion and Relevance: Methenamine use was associated with a longer time to UTI in older adults with varying degrees of kidney function. The effectiveness of methenamine appeared to be similar regardless of kidney function, which is new evidence. Because of a lack of acquired resistance, methenamine may be an effective option for UTI prophylaxis in older adults.


Assuntos
Anti-Infecciosos Urinários/uso terapêutico , Metenamina/uso terapêutico , Infecções Urinárias/prevenção & controle , Idoso , Feminino , Humanos , Testes de Função Renal , Masculino , Estudos Retrospectivos , Resultado do Tratamento
11.
J Am Geriatr Soc ; 68(1): 55-61, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31463933

RESUMO

OBJECTIVES: To derive weighted-incidence syndromic combination antibiograms (WISCAs) in the skilled nursing facility (SNF). To compare burden of resistance between SNFs in a region and those with and without protocols designed to reduce inappropriate antibiotic use. DESIGN: Retrospective analysis of microbial data from a regional laboratory. SETTING: We analyzed 2484 isolates collected at a regional laboratory from a large mixed urban and suburban area from January 1, 2015, to December 31, 2015. PARTICIPANTS: A total of 28 regional SNFs (rSNFs) and 7 in-network SNFs (iSNFs). MEASUREMENTS: WISCAs were derived combining Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae, and reports restricted to fluoroquinolones, cefazolin, amoxicillin clavulanate, and trimethoprim/sulfamethoxazole. RESULTS: Pooling the target isolates into WISCAs resulted in an average of 28 of 37 achieving a number greater than 30 with an average of 50 isolates (range = 11-113; >97% urinary). Significant differences were found in antibiotic susceptibility between grouped rSNF data and iSNF data of 75% vs 65% (2.76-11.77; P = .002). The susceptibilities were higher in iSNFs with active antibiotic reduction protocols compared with iSNFs without protocols and rSNFs (effect size = .79 vs .67 and .65, respectively) (I2 = 93.33; P < .01). Susceptibilities to cefazolin (95% vs 76%; P < .001) and fluoroquinolones (72% vs 64%; P = .048) were significantly higher in iSNFs with active urinary tract infection protocols as compared with iSNFs without antibiotic reduction protocols. CONCLUSION: These results suggest that WISCAs can be developed in most SNFs, and their results can serve as indicators of successful antibiotic stewardship programs. J Am Geriatr Soc 68:55-61, 2019.


Assuntos
Antibacterianos/uso terapêutico , Anti-Infecciosos Urinários/uso terapêutico , Gestão de Antimicrobianos , Instituições de Cuidados Especializados de Enfermagem/estatística & dados numéricos , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Infecções Urinárias/tratamento farmacológico , Idoso de 80 Anos ou mais , Gestão de Antimicrobianos/organização & administração , Gestão de Antimicrobianos/normas , Escherichia coli/isolamento & purificação , Feminino , Humanos , Klebsiella pneumoniae/isolamento & purificação , Masculino , Testes de Sensibilidade Microbiana , Estudos Retrospectivos
13.
Turkiye Parazitol Derg ; 43(3): 152-154, 2019 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-31502807

RESUMO

Urogenital myiasis is a parasitic infestation caused by larvae of Psychoda spp. and it is very rare in humans. A 10- year old female was presented with urogenital myiasis and 4th stage Larvae of Psychoda albipennis (Diptera: Psychodidae) were found in urine. The patient was complained of painful sensation, discomfort and burning while urination. Urinary tract antiseptics were prescribed for the patient and advised to drink plenty of water for hydration. Local health authorities should take proper measures to maintain hygienic conditions for the people under risk.


Assuntos
Doenças Urogenitais Femininas/parasitologia , Miíase/parasitologia , Psychodidae/classificação , Animais , Anti-Infecciosos Urinários/uso terapêutico , Criança , Ingestão de Líquidos , Feminino , Doenças Urogenitais Femininas/terapia , Humanos , Larva , Líbia , Miíase/terapia , Psychodidae/crescimento & desenvolvimento , Urina/parasitologia
14.
Obstet Gynecol ; 134(4): 727-735, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31503155

RESUMO

OBJECTIVE: To estimate whether nitrofurantoin prophylaxis decreases the incidence of culture-documented urinary tract infection for women with catheter-managed urinary retention after pelvic reconstructive surgery. METHODS: This double-blind, placebo-controlled, randomized trial was conducted at five academic institutions. Women with urinary retention after surgery for prolapse or incontinence were randomized to oral nitrofurantoin 100 mg daily during indwelling or clean intermittent self-catheterization. The primary outcome was the incidence of symptomatic urinary tract infection within 6 weeks of surgery, confirmed by culture demonstrating more than 1,000 colony forming units per milliliter of uropathogenic bacteria. Secondary outcomes were adverse symptoms possibly attributable to nitrofurantoin and bacterial resistance to nitrofurantoin. A sample size of 154 would detect a decrease in urinary tract infection incidence from 33% to 13%, with 80% power, two-sided alpha of 0.05, and allow 10% dropout. RESULTS: Of 154 participants randomized from September 2016 to May 2018, 151 were eligible for analysis: 75 received nitrofurantoin, and 76 received placebo. Demographics were similar between groups. The indication for surgery was prolapse (46%), incontinence (20%), or a combination (34%). Participants were discharged with an indwelling catheter (58%) or performing self-catheterization (42%). Median duration of catheter use was 4 days (interquartile range 3-7). Thirteen women in the nitrofurantoin group and 13 women in the placebo group experienced urinary tract infection (17.3% vs 17.1%, P=.97, relative risk [RR] [95% CI] 1.01 [0.50-2.04]). Adverse symptoms possibly attributable to nitrofurantoin were common in both groups (68% vs 61%, P=.34, RR [95% CI] 1.12 [0.88-1.43]). Resistance to nitrofurantoin was identified in seven urine cultures, four among nitrofurantoin and three among placebo recipients. In total, 52 urine cultures were obtained to evaluate symptoms of urinary tract infection, and only 27 of 52 grew at least 1,000 cfu/mL of uropathogenic bacteria. CONCLUSION: Daily nitrofurantoin did not reduce the incidence of culture-proven urinary tract infection among women with catheter-managed urinary retention after pelvic reconstructive surgery. Culture confirmed urinary tract infection in only half of symptomatic episodes. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02727322.


Assuntos
Anti-Infecciosos Urinários/uso terapêutico , Antibioticoprofilaxia/métodos , Nitrofurantoína/uso terapêutico , Complicações Pós-Operatórias/terapia , Retenção Urinária/terapia , Idoso , Método Duplo-Cego , Feminino , Humanos , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/cirurgia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Resultado do Tratamento , Cateterismo Urinário/métodos , Incontinência Urinária/cirurgia , Retenção Urinária/etiologia , Infecções Urinárias/microbiologia , Infecções Urinárias/prevenção & controle
15.
Ther Umsch ; 73(9): 547-552, 2019.
Artigo em Alemão | MEDLINE | ID: mdl-31113321

RESUMO

Acute and recurrent urinary tract infections in women presenting in primary practice Abstract. Acute and recurrent urinary tract infections in women of all age groups are becoming an increasing problem in primary care and medical practice. Symptoms can be relieved by a guideline-oriented acute therapy and a multimodal infection prophylaxis. The restoration of the body's natural defence mechanisms plays a central role. This article informs about the causes, the basic diagnostic examinations and the practical use of therapeutic and prophylactic measures.


Assuntos
Anti-Infecciosos Urinários/uso terapêutico , Infecções Urinárias , Feminino , Humanos , Recidiva , Prevenção Secundária , Infecções Urinárias/diagnóstico , Infecções Urinárias/prevenção & controle
16.
J Korean Med Sci ; 34(21): e156, 2019 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-31144480

RESUMO

BACKGROUND: Few studies have reported on breakthrough urinary tract infection (UTI) associated with the susceptibility of index UTI to prophylactic antibiotics in children with primary vesicoureteral reflux (VUR) receiving continuous antibiotic prophylaxis (CAP). We assessed the impact of the susceptibility of index UTI to prophylactic antibiotics in breakthrough UTIs in children with primary VUR receiving CAP. METHODS: We retrospectively reviewed the medical records of 81 children with primary VUR who were diagnosed after febrile or symptomatic UTI and subsequently received trimethoprim-sulfamethoxazole (TMP-SMX) as CAP between January 2010 and December 2013. We allocated children to a susceptible group or a resistant group based on the susceptibility of index UTI to TMP-SMX. We evaluated patient demographics and clinical outcomes after CAP according to the susceptibility of index UTI to TMP-SMX. Multivariate analysis was used to identify the predictive factors for breakthrough UTI. RESULTS: Of the 81 children, 42 were classified into the susceptible group and 39 into the resistant group. The proportion of breakthrough UTI was 31.0% (13/42) in the susceptible group and 53.8% (21/39) in the resistant group (P = 0.037). Progression of renal scarring was observed in 0% of children in the susceptible group and 15% in the resistant group (P = 0.053). Multivariate analysis showed that TMP-SMX resistance and initial renal scarring were significant predictors of breakthrough UTI. CONCLUSION: Susceptibility of index UTI to prophylactic antibiotics is a risk factor of breakthrough UTI and is associated with poor clinical outcomes in children with primary VUR receiving CAP.


Assuntos
Anti-Infecciosos Urinários/uso terapêutico , Antibioticoprofilaxia/métodos , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/prevenção & controle , Refluxo Vesicoureteral/tratamento farmacológico , Antibacterianos/uso terapêutico , Bactérias/classificação , Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Combinação de Medicamentos , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Infecções Urinárias/microbiologia
17.
J Antimicrob Chemother ; 74(9): 2767-2773, 2019 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-31098630

RESUMO

OBJECTIVES: To evaluate the importance of treatment duration for therapeutic efficacy of pivmecillinam for community-acquired urinary tract infections (UTIs) caused by Escherichia coli. METHODS: A retrospective cohort study was conducted between 1 January 2010 and 30 September 2016 in adults with community-acquired E. coli bacteriuria, treated empirically with pivmecillinam. Regimens of 3, 5 and 7 days were compared using clinical treatment failure (i.e. redemption of a new antibiotic or hospitalization due to UTI) within 14 and 30 days as outcome. HR and risk difference with 95% CI were estimated for treatment failure. Results were stratified by age (18-50, 51-70, >70 years) and sex. RESULTS: Of the 21864 cases of E. coli UTI that were analysed, 2524 (11.5%) were in men. In 954 cases (4.4%) E. coli produced ESBL and 125 (13.1%) of the cases were in men. The 3 day regimen increased the risk of treatment failure for all groups. The risk differences between the 3 and 5 day regimens were <10% for women, but >10% for men. Comparing the 7 day and 5 day regimens, only women aged >50 years demonstrated an increased risk of treatment failure within 14 days with the 5 day regimen, but not within 30 days. CONCLUSIONS: With the current data, where data on clinical classification of the E. coli UTI were missing, a 5 day treatment with pivmecillinam at 400 mg three times daily seems to be the rational recommendation for lower UTI in men, pregnant women and women >50 years old. A 3 day regimen seems sufficient for non-pregnant women <50 years old.


Assuntos
Andinocilina Pivoxil/uso terapêutico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/epidemiologia , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/epidemiologia , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Andinocilina Pivoxil/administração & dosagem , Andinocilina Pivoxil/efeitos adversos , Anti-Infecciosos Urinários/administração & dosagem , Anti-Infecciosos Urinários/efeitos adversos , Anti-Infecciosos Urinários/uso terapêutico , Infecções Comunitárias Adquiridas/microbiologia , Dinamarca/epidemiologia , Duração da Terapia , Escherichia coli , Infecções por Escherichia coli/microbiologia , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica , Gravidez , Vigilância em Saúde Pública , Sistema de Registros , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
18.
Rev. clín. esp. (Ed. impr.) ; 219(4): 189-193, mayo 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-186530

RESUMO

Introducción: Las infecciones del tracto urinario (ITU) constituyen una de las infecciones más frecuentes. En el anciano presentan diversas comorbilidades. El objetivo de este trabajo es conocer la epidemiologia clínica y microbiológica en el anciano ingresado por ITU y evaluar la idoneidad de los tratamientos empíricos y su implicación con la mortalidad. Material y métodos: Estudio observacional del 2013 al 2015 en 4 hospitales en pacientes mayores de 65 años ingresados en Medicina Interna con diagnóstico clínico y confirmación microbiológica. Se excluyeron los casos de bacteriuria asintomática. Se evaluó la mortalidad intrahospitalaria. Se realizó un análisis univariante y multivariante. Resultados: Se seleccionaron 349 episodios de pacientes con edad media 82 ±11 años, 51% mujeres. La mortalidad fue del 10,3%, asociada a la edad, demencia y presentación como sepsis grave/shock séptico (p < 0,05). Los aislamientos más frecuentes fueron Escherichia coli (E. coli) (53,6%), Klebsiella spp. (8,7%) y Enterococcus spp. (6,6%). Un 13% del total de los aislamientos correspondían a E. coli y Klebsiella spp. con betalactamasas de espectro extendido; el uso previo de antibióticos, cuidados socio-sanitarios y catéter urinario permanente fueron predictores independientes (p < 0,05). El tratamiento empírico resultó adecuado solo en el 73,6% de los casos. La falta de adecuación se asoció a una mayor mortalidad (p < 0,05). Conclusiones: La ITU del anciano que ingresa presenta una alta mortalidad. El tratamiento empírico es frecuentemente inadecuado y puede asociarse a una mayor mortalidad


Introduction: Urinary tract infections (UTIs) are one of the most frequent infections. In the elderly, they have multiple comorbidities. The objective of this work is to describe the clinical and microbiological epidemiology of elderly persons admitted for UTIs and to evaluate the suitability of empirical treatments and their implications regarding mortality. Material and methods: An observational study was conducted during 2013-2015 in 4public hospitals, with patients older than 65 years who were admitted to the Internal Medicine service with a microbiological diagnosis of UTI. Cases of asymptomatic bacteriuria were excluded. In-hospital mortality was analyzed. Univariate analysis and multivariate analysis was carried out. Results: A total of 349 episodes were selected, with a mean age of 82 ± 11 years, 51% female. Mortality was 10.3% and was associated with age, dementia and sepsis and septic shock (P<.05). The most frequent organisms were Escherichia coli(E. coli) (53.6%), Klebsiella spp. (8.7%) and Enterococcus spp. (6.6%). E. coli and Klebsiella spp. with extended-spectrum beta-lactamases (13% of the total isolated) were associated with the previous use of antibiotics, community care treatment and a permanent urinary catheter (P<.05). The empirical treatment was adequate only in 73.6% of cases. As these treatments were associated with higher mortality, they were not considered adequate. Conclusions: In the elderly, UTIs show a high mortality. Empirical treatment is often inadequate and may be associated with increased mortality


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Infecções Urinárias/epidemiologia , Resistência Microbiana a Medicamentos , Cateterismo Urinário/efeitos adversos , Anti-Infecciosos Urinários/uso terapêutico , Evolução Fatal , Fatores de Risco , Testes de Sensibilidade Microbiana/estatística & dados numéricos , Infecções Relacionadas a Cateter/complicações
19.
Cochrane Database Syst Rev ; 4: CD001534, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30932167

RESUMO

BACKGROUND: Urinary tract infection (UTI) is common in children. Symptoms include fever, lethargy, anorexia, and vomiting. UTI is caused by Escherichia coli in over 80% of cases and treatment is a course of antibiotics. Due to acute illness caused by UTI and the risk of pyelonephritis-induced permanent kidney damage, many children are given long-term (several months to 2 years) antibiotics aimed at preventing recurrence. This is the third update of a review first published in 2001 and updated in 2006, and 2011. OBJECTIVES: To assess whether long-term antibiotic prophylaxis was more effective than placebo/no treatment in preventing recurrence of UTI in children, and if so which antibiotic in clinical use was the most effective. We also assessed the harms of long-term antibiotic treatment. SEARCH METHODS: We searched the Cochrane Kidney and Transplant Register of Studies up to 30 July 2018 through contact with the Cochrane Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal, and ClinicalTrials.gov. SELECTION CRITERIA: Randomised comparisons of antibiotics with other antibiotics, placebo or no treatment to prevent recurrent UTI in children. DATA COLLECTION AND ANALYSIS: Two authors independently assessed and extracted information for the initial and previous updates. A random-effects model was used to estimate risk ratio (RR) and risk difference (RD) for recurrent UTI with 95% confidence intervals (CI). MAIN RESULTS: In this update sixteen studies (2036 children randomised, 1977 analysed) were included. Seven studies (612 children) compared two or more types of antibiotics, six (1088 children) compared antibiotics with placebo or no treatment, one four-armed study compared circumcision with and without antibiotic treatment, one study compared dose of antibiotic, and one three-armed study compared two different antibiotics as well as no treatment. Of the sixteen included studies only one study was judged to be at low risk of bias for all domains, with the majority judged to be at unclear risk of bias due to very poorly reported methodology. The number of studies judged to be a low risk of bias was: selection bias (7); performance bias (4); detection bias (1); attrition bias (6); reporting bias (7); and other bias (2). The number of studies judged to be at high risk of bias was: selection bias (0); performance bias (5); detection bias (1); attrition bias (4); reporting bias (6); and other bias (1).Compared to placebo/no treatment, antibiotics lead to a modest decrease in the number of repeat symptomatic UTI in children; however the estimate from combining all studies was not certain and the confidence interval indicates low precision indicating that antibiotics may make little or no difference to risk of repeat infection (RR 0.75, 95% CI 0.28 to 1.98). When we combined only the data from studies with concealed treatment allocation, there was a similar reduction in risk of repeat symptomatic UTI in children taking antibiotics (RR 0.68) and we have greater certainty in this estimate because of the more robust study designs, the confidence interval is smaller and it does not include the point of no effect (95% CI 0.48 to 0.95). The estimated reduction in risk of repeat symptomatic UTI for children taking antibiotics was similar in children with vesicoureteric reflux (VUR) (RR 0.65, 95% CI 0.39 to 1.07) compared to those without VUR (RR 0.56, 95% CI 0.15 to 2.12) however there was considerable uncertainty due to imprecision from fewer events in the smaller group of children with VUR. There was no consistency in occurrence of adverse events, with one study having more events in the placebo group and a second study having more events in the antibiotics group. Three studies reported data for antibiotic resistance with the analysis estimating the risk of a UTI caused by a bacteria resistant to the prophylactic antibiotic being almost 2.5 times greater in children on antibiotics than for children on placebo or no treatment (RR 2.40, 95% CI 0.62 to 9.26). However the confidence interval is wide, showing imprecision and there may be little or no difference between the two groups.Eight studies involving 659 children compared one antibiotic with another but few studies compared the same combination for the same outcome so little data could be pooled. Two studies reported microbial resistance data and analysis showed that treatment with nitrofurantoin may lead to a lower risk of a UTI caused by a bacteria resistant to the treatment drug compared to children given trimethoprim-sulphamethoxazole as their prophylactic treatment (RR 0.54, 95% CI 0.31 to 0.92). AUTHORS' CONCLUSIONS: Long-term antibiotics may reduce the risk of repeat symptomatic UTI in children who have had one or more previous UTIs but the benefit may be small and must be considered together with the increased risk of microbial resistance.


Assuntos
Anti-Infecciosos Urinários/uso terapêutico , Infecções Urinárias/prevenção & controle , Antibioticoprofilaxia , Criança , Quimioterapia Combinada , Feminino , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Prevenção Secundária , Infecções Urinárias/tratamento farmacológico , Refluxo Vesicoureteral/prevenção & controle
20.
Trials ; 20(1): 223, 2019 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-30992071

RESUMO

BACKGROUND: Patients with lower neurogenic bladder dysfunction are at an increased risk of suffering from recurrent urinary tract infections. Recurrent symptomatic urinary tract infection is occasionally treated with antibiotics as a prophylactic prevention strategy. This risks increasing the frequency of antibiotic resistance. National healthcare policymakers have requested further research into alternative preventive measures for pathologies that require antibiotic treatment. METHODS: This study protocol describes a two-centre, randomised, double-blinded, placebo-controlled study to evaluate the prevention of recurrent urinary tract infections with the commercial immunotherapy agent Uro-Vaxom®, based on Escherichia coli pathogen-associated molecular patterns. Eligible participants are recruited by the direct healthcare team and randomised to receive Uro-Vaxom® in the form of an oral capsule, or a matching placebo. Participants will receive the study treatment daily for 3 months and followed up for an additional 3 months so that the number of symptomatic urinary tract infection episodes and individual signs and symptoms per episode can be recorded using participant study diaries. Primary outcome measures are: number of symptomatic urinary tract infections experienced over 3 months, number of symptomatic urinary tract infections experienced over 6 months, time from the start of treatment to the first urinary tract infection, and the presence of asymptomatic bacteriuria at 3 and 6 months. Secondary outcome measures are: individually recorded symptoms normally associated with recurrent urinary tract infection and consistency of reported symptoms during the symptomatic urinary tract infection experienced during the study, compliance with study protocol and study medication, and adverse events. DISCUSSION: Healthcare policymakers recommend that alternative preventative strategies are identified for symptomatic urinary tract infections that require antibiotic treatment. If Uro-Vaxom® is shown to be effective, this feasibility study would warrant a larger, statistically powered, multicentre study to investigate whether this immunotherapy strategy is an effective preventative measure for recurrent symptomatic urinary tract infection for people with spinal cord injuries and neurological pathologies. TRIAL REGISTRATION: ISRTCN. Registered on 30 October 2015. ClinicalTrials.gov, ID: NCT0251901 . Registered on 30 October 2015. URL of trial registry record: Ethics Ref: 15-LO-2069. IRAS Number: 185760. Sponsor Number: RXQ/648. NIHR Funding Reference: PB-PG-1013-32017.


Assuntos
Adjuvantes Imunológicos/uso terapêutico , Anti-Infecciosos Urinários/uso terapêutico , Bexiga Urinaria Neurogênica/complicações , Infecções Urinárias/prevenção & controle , Adjuvantes Imunológicos/efeitos adversos , Doença Crônica , Interpretação Estatística de Dados , Método Duplo-Cego , Ética em Pesquisa , Estudos de Viabilidade , Humanos , Avaliação de Resultados em Cuidados de Saúde , Estudos Prospectivos , Recidiva
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