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1.
Urologiia ; (5): 64-71, 2019 Dec.
Artigo em Russo | MEDLINE | ID: mdl-31808635

RESUMO

AIM: A comparative evaluation of the efficacy and safety of Canephron N and Cystone as monotherapy in women with acute uncomplicated cystitis and antibiotic allergy or intolerance was performed. MATERIALS AND METHODS: A prospective, randomized, controlled study of drug Canephron N as monotherapy for acute uncomplicated cystitis in 51 women with a history of antibiotic allergy or intolerance was carried out in 3 urological centers in Perm from 2016 to 2019. In the main group, patients received Canephron N for 30 days, while in comparison group, Cystone was prescribed. The Acute Cystitis Symptom Score (ACSS), microscopic study of urine sediment, urine culture and other methods were used. Results were evaluated 3, 6, 30 days and 1 year after the start of treatment. RESULTS: In the main group, monotherapy with Canephron N for 30 days resulted in a decrease in the total ACSS score from the baseline 12.9 to 0.3 points, while in Cyston group, changes of ACSS score were less pronounced, from baseline 12.8 to 1.4 points (p<0.01). Clinical cure rate in the main and comparison group was 88.5% and 68%, respectively. In another 3.8% and 1% of patients in the main and comparison group, an improvement was seen. The number of patients with leukocyturia in the Canephron N group decreased to 11.5% compared to 28% in Cyston group (p>0.05). Bacteriuria rate in the main group was 7.7%, which was less than in the comparison group (20%, p>0.05). Number of sick days in the main group was 4.9+/-0.4, compared to 7.4+/-0.6 days in Cyston group. In the Canephron N group, 1-year recurrence rate was only 7.7%, while in the Cyston group the recurrence was seen in 16% of patients. CONCLUSION: According to the results, Canephron N is an effective and safe drug as monotherapy for acute uncomplicated cystitis, and can be considered as drug of choice for the treatment of women with antibiotic allergy or intolerance.


Assuntos
Bacteriúria/tratamento farmacológico , Cistite/tratamento farmacológico , Extratos Vegetais/uso terapêutico , Doença Aguda , Adulto , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Bacteriúria/microbiologia , Cistite/microbiologia , Feminino , Humanos , Hipersensibilidade , Estudos Prospectivos , Resultado do Tratamento
2.
BMC Infect Dis ; 19(1): 950, 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31703645

RESUMO

BACKGROUND: Bacterial infection of the urinary tract is among the common reasons for seeking medical attention in the community. Rapidly increasing antibiotic resistance of uropathogens is resulting in limited treatment options. Therefore, knowledge of the current uropathogens and their antibiotic susceptibility is important for better treatment of urinary tract infection. METHODS: A cross-sectional study design was conducted from February to September thirty, 2017 among students who came to Mekelle University student's clinics with symptomatic urinary tract infection during the study period.. Mid-stream urine specimens were collected from 341individuals with suspected urinary tract infection for bacteriological identification and antimicrobial susceptibility testing. Data on socio-demographic, clinical and risk factors were also collected using a structured questionnaire. RESULTS: Among the 341 study participants, 72(21.1%) showed significant bacteriuria. Escherichia coli (48.6%), Coagulase-negative staphylococci (23%), Staphylococcus aureus (13.5%), and Klebsiella spp. (8.1%) were common bacterial isolates. Resistance to ampicillin (81-100%), amoxicillin/clavulanic acid (77-93.6%), co- trimoxazole (55 72.3%), nalidixic acid (57.4%) and tetracycline (46-55.5%) was seen by most isolates. Multidrug resistance was observed in 73% of the bacterial isolates, and 25.5% of the Gram-negative isolates were extended-spectrum beta-lactamase producers. Being female, a history of urinary tract infection, a history of catheterization and frequent sexual activity were found to be statistically associated with urinary tract infection. CONCLUSION: Urinary tract infection is a problem among university students with a prevalence of 21.1%. All isolates have developed resistance to most of the commonly used antibiotics. Therefore, health education on the transmission and causes of urinary tract infection are recommended for the students.


Assuntos
Bacteriúria/microbiologia , Infecções por Escherichia coli/microbiologia , Escherichia coli/isolamento & purificação , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação , Estudantes , Adolescente , Adulto , Combinação Amoxicilina e Clavulanato de Potássio/efeitos adversos , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Ampicilina/efeitos adversos , Ampicilina/uso terapêutico , Antibacterianos/efeitos adversos , Antibacterianos/uso terapêutico , Bacteriúria/tratamento farmacológico , Estudos Transversais , Farmacorresistência Bacteriana Múltipla , Infecções por Escherichia coli/tratamento farmacológico , Etiópia , Feminino , Humanos , Testes de Sensibilidade Microbiana , Prevalência , Fatores de Risco , Infecções Estafilocócicas/tratamento farmacológico , Combinação Trimetoprima e Sulfametoxazol/efeitos adversos , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Universidades , Adulto Jovem
4.
JAMA ; 322(12): 1195-1205, 2019 09 24.
Artigo em Inglês | MEDLINE | ID: mdl-31550037

RESUMO

Importance: Screening for asymptomatic bacteriuria can identify patients for whom treatment might be beneficial for preventing symptomatic infection and other health outcomes. Objective: To systematically review benefits and harms of asymptomatic bacteriuria screening and treatment in adults, including during pregnancy, to inform the US Preventive Services Task Force. Data Sources: MEDLINE, PubMed (publisher-supplied records), and Cochrane Collaboration Central Registry of Controlled Trials; surveillance through May 24, 2019. Study Selection: Randomized clinical trials (RCTs) and observational studies on benefits and harms of screening for asymptomatic bacteriuria; RCTs on benefits and harms of asymptomatic bacteriuria treatment. Eligible populations included unselected, asymptomatic individuals without known urinary tract conditions. Data Extraction and Synthesis: Independent critical appraisal and data abstraction by 2 reviewers. Random-effects meta-analysis was conducted to estimate benefits of the interventions. Main Outcomes and Measures: Symptomatic infection; function, morbidity, mortality; pregnancy complications and birth outcomes. Results: Nineteen studies (N = 8443) meeting inclusion criteria were identified. Two cohort studies (n = 5289) found fewer cases of pyelonephritis in the cohorts of screened pregnant women (0.5%) than within retrospective comparisons of unscreened cohorts (2.2% and 1.8%); the larger study estimated a statistically significant relative risk of 0.30 (95% CI, 0.15-0.60). No studies examined screening in nonpregnant populations. Among 12 trials of asymptomatic bacteriuria screening and treatment during pregnancy (n = 2377; 1 conducted within past 30 years), there were reduced rates of pyelonephritis (range, 0%-16.5% for the intervention group and 2.2%-36.4% for the control group; pooled risk ratio [RR], 0.24 [95% CI, 0.14-0.40]; 12 trials) and low birth weight (range, 2.5%-14.8% for the intervention group and 6.7%-21.4% for the control group; pooled RR, 0.64 [95% CI, 0.46-0.90]; 7 trials). There was no significant difference in infant mortality (pooled RR, 0.98 [95% CI, 0.29-3.26]; 6 trials). Five RCTs of asymptomatic bacteriuria treatment in nonpregnant adults (n = 777) did not report any significant differences in risk of infection, mobility, or mortality. Limited evidence on harms of screening or treatment was available, and no statistically significant differences were identified. Conclusions and Relevance: Screening and treatment for asymptomatic bacteriuria during pregnancy was associated with reduced rates of pyelonephritis and low birth weights, but the available evidence was not current, with only 1 study conducted in the past 30 years. Benefits of asymptomatic bacteriuria treatment in nonpregnant adult populations were not found. Trial evidence on harms of asymptomatic bacteriuria antibiotic treatment was limited.


Assuntos
Bacteriúria/diagnóstico , Programas de Rastreamento , Complicações Infecciosas na Gravidez/diagnóstico , Adulto , Antibacterianos/efeitos adversos , Antibacterianos/uso terapêutico , Bacteriúria/tratamento farmacológico , Feminino , Humanos , Recém-Nascido de Baixo Peso , Masculino , Programas de Rastreamento/efeitos adversos , Microbiota/efeitos dos fármacos , Guias de Prática Clínica como Assunto , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Pielonefrite/prevenção & controle , Fatores de Risco , Infecções Urinárias/diagnóstico
5.
JAMA ; 322(12): 1188-1194, 2019 09 24.
Artigo em Inglês | MEDLINE | ID: mdl-31550038

RESUMO

Importance: Among the general adult population, women (across all ages) have the highest prevalence of asymptomatic bacteriuria, although rates increase with age among both men and women. Asymptomatic bacteriuria is present in an estimated 1% to 6% of premenopausal women and an estimated 2% to 10% of pregnant women and is associated with pyelonephritis, one of the most common nonobstetric reasons for hospitalization in pregnant women. Among pregnant persons, pyelonephritis is associated with perinatal complications including septicemia, respiratory distress, low birth weight, and spontaneous preterm birth. Objective: To update its 2008 recommendation, the USPSTF commissioned a review of the evidence on potential benefits and harms of screening for and treatment of asymptomatic bacteriuria in adults, including pregnant persons. Population: This recommendation applies to community-dwelling adults 18 years and older and pregnant persons of any age without signs and symptoms of a urinary tract infection. Evidence Assessment: Based on a review of the evidence, the USPSTF concludes with moderate certainty that screening for and treatment of asymptomatic bacteriuria in pregnant persons has moderate net benefit in reducing perinatal complications. There is adequate evidence that pyelonephritis in pregnancy is associated with negative maternal outcomes and that treatment of screen-detected asymptomatic bacteriuria can reduce the incidence of pyelonephritis in pregnant persons. The USPSTF found adequate evidence of harms associated with treatment of asymptomatic bacteriuria (including adverse effects of antibiotic treatment and changes in the microbiome) to be at least small in magnitude. The USPSTF concludes with moderate certainty that screening for and treatment of asymptomatic bacteriuria in nonpregnant adults has no net benefit. The known harms associated with treatment include adverse effects of antibiotic use and changes to the microbiome. Based on these known harms, the USPSTF determined the overall harms to be at least small in this group. Recommendations: The USPSTF recommends screening pregnant persons for asymptomatic bacteriuria using urine culture. (B recommendation) The USPSTF recommends against screening for asymptomatic bacteriuria in nonpregnant adults. (D recommendation).


Assuntos
Bacteriúria/diagnóstico , Programas de Rastreamento/normas , Complicações Infecciosas na Gravidez/diagnóstico , Adulto , Antibacterianos/efeitos adversos , Antibacterianos/uso terapêutico , Bacteriúria/tratamento farmacológico , Feminino , Humanos , Masculino , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Pielonefrite/prevenção & controle , Fatores de Risco , Infecções Urinárias/diagnóstico
6.
Pediatrics ; 144(3)2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31431480

RESUMO

OBJECTIVES: To determine the association between parenteral antibiotic duration and outcomes in infants ≤60 days old with bacteremic urinary tract infection (UTI). METHODS: This multicenter retrospective cohort study included infants ≤60 days old who had concomitant growth of a pathogen in blood and urine cultures at 11 children's hospitals between 2011 and 2016. Short-course parenteral antibiotic duration was defined as ≤7 days, and long-course parenteral antibiotic duration was defined as >7 days. Propensity scores, calculated using patient characteristics, were used to determine the likelihood of receiving long-course parenteral antibiotics. We conducted inverse probability weighting to achieve covariate balance and applied marginal structural models to the weighted population to examine the association between parenteral antibiotic duration and outcomes (30-day UTI recurrence, 30-day all-cause reutilization, and length of stay). RESULTS: Among 115 infants with bacteremic UTI, 58 (50%) infants received short-course parenteral antibiotics. Infants who received long-course parenteral antibiotics were more likely to be ill appearing and have growth of a non-Escherichia coli organism. There was no difference in adjusted 30-day UTI recurrence between the long- and short-course groups (adjusted risk difference: 3%; 95% confidence interval: -5.8 to 12.7) or 30-day all-cause reutilization (risk difference: 3%; 95% confidence interval: -14.5 to 20.6). CONCLUSIONS: Young infants with bacteremic UTI who received ≤7 days of parenteral antibiotics did not have more frequent recurrent UTIs or hospital reutilization compared with infants who received long-course therapy. Short-course parenteral therapy with early conversion to oral antibiotics may be considered in this population.


Assuntos
Antibacterianos/administração & dosagem , Bacteriemia/tratamento farmacológico , Bacteriúria/tratamento farmacológico , Esquema de Medicação , Feminino , Humanos , Lactente , Recém-Nascido , Injeções Intramusculares , Injeções Intravenosas , Tempo de Internação , Masculino , Pontuação de Propensão , Recidiva , Estudos Retrospectivos , Resultado do Tratamento
8.
Urologe A ; 58(7): 809-820, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-31263939

RESUMO

Both the demographic shift and progress in medicine are resulting in an increasingly longer life expectancy. It is presumed that a mean age of 90 years will be achieved within the next decade in many countries. Thus, geriatric medicine, which is committed to the specific needs of older, often frail and frequently comorbid patients, is becoming increasingly more important. The prevalence of infections of the genitourinary tract increases with age, simultaneously, a critical and conscious use of antibiotics is required in terms of antimicrobial treatment. The intention of the present review is to make the reader aware of the specific characteristics of urinary tract infections and asymptomatic bacteriuria in the older patient population in terms of epidemiology, spectrum of pathogens and resistance as well as the indications for and performance of antimicrobial treatment.


Assuntos
Antibacterianos/uso terapêutico , Infecções Urinárias/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Antibioticoprofilaxia/métodos , Bacteriúria/tratamento farmacológico , Humanos , Resultado do Tratamento
10.
Am J Health Syst Pharm ; 76(Supplement_2): S41-S48, 2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-30854546

RESUMO

PURPOSE: The results and methods of a pharmacist-driven multifaceted educational intervention on the appropriate management of asymptomatic bacteriuria (ABU) within an emergency department (ED) are reported. METHODS: A retrospective, single-center cohort study was conducted to evaluate the effects of an educational intervention aimed at reducing the rates of mismanaged ABU within an ED at a Level 1 trauma center. The education involved a multifaceted approach directed by pharmacists and involved a handout and algorithm communicated through in-person discussions, emails, and general distribution. In order to evaluate the effectiveness of this education the preintervention and postintervention rates of inappropriate treatments were determined through a retrospective chart review. The primary outcome was the difference in the frequency of inappropriately treated ABU between the preintervention and postintervention periods. RESULTS: A total of 268 patients were included in the study for review (134 in each group). There was a 16.5% reduction in the frequency of patients that had ABU inappropriately treated as a urinary tract infection in the postintervention period compared with the preintervention period (31 [23.1%] versus 53 [39.6%], p = 0.004). CONCLUSION: Pharmacist-driven education was effecitive in reducing the rates of inappropriately used antibiotics for ABU within an ED.


Assuntos
Antibacterianos/uso terapêutico , Gestão de Antimicrobianos/organização & administração , Infecções Assintomáticas/terapia , Bacteriúria/tratamento farmacológico , Farmacêuticos/organização & administração , Adulto , Idoso , Infecções Assintomáticas/epidemiologia , Bacteriúria/diagnóstico , Bacteriúria/epidemiologia , Educação Continuada/organização & administração , Feminino , Hospitais de Ensino/organização & administração , Humanos , Prescrição Inadequada/prevenção & controle , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros , Médicos , Prevalência , Papel Profissional , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Centros de Traumatologia/organização & administração
11.
BMC Geriatr ; 19(1): 32, 2019 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-30717706

RESUMO

BACKGROUND: Non-specific symptoms, such as confusion, are often suspected to be caused by urinary tract infection (UTI) and continues to be the most common reason for suspecting a UTI despite many other potential causes. This leads to significant overdiagnosis of UTI, inappropriate antibiotic use and potential harmful outcomes. This problem is particularly prevalent in nursing home settings. METHODS: A systematic review of the literature was conducted assessing the association between confusion and UTI in the elderly. PubMed, Scopus and PsychInfo were searched with the following terms: confusion, delirium, altered mental status, acute confusional state, urinary tract infection, urine infection, urinary infection and bacteriuria. Inclusion criteria and methods were specified in advance and documented in the protocol, which was published with PROSPERO (registration ID: CRD42015025804). Quality assessment was conducted independently by two authors. Data were extracted using a standardised extraction tool and a qualitative synthesis of evidence was made. RESULTS: One thousand seven hunderd two original records were identified, of which 22 were included in the final analysis. The quality of these included studies varied, with frequent poor case definitions for UTI or confusion contributing to large variation in results and limiting their validity. Eight studies defined confusion using valid criteria; however, no studies defined UTI in accordance with established criteria. As no study used an acceptable definition of confusion and UTI, an association could not be reliably established. Only one study had acceptable definitions of confusion and bacteriuria, reporting an association with the relative risk being 1.4 (95% CI 1.0-1.7, p = 0.034). CONCLUSIONS: Current evidence appears insufficient to accurately determine if UTI and confusion are associated, with estimates varying widely. This was often attributable to poor case definitions for UTI or confusion, or inadequate control of confounding factors. Future well-designed studies, using validated criteria for UTI and confusion are required to examine the relationship between UTI and acute confusion in the elderly. The optimal solution to clarify this clinical issue would be a randomized controlled trial comparing the effect of antibiotics versus placebo in patients with new onset or worsening confusion and presence of bacteriuria while lacking specific urinary tract symptoms.


Assuntos
Delírio/diagnóstico , Delírio/epidemiologia , Medicina Baseada em Evidências/métodos , Infecções Urinárias/diagnóstico , Infecções Urinárias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Bacteriúria/diagnóstico , Bacteriúria/tratamento farmacológico , Bacteriúria/epidemiologia , Delírio/tratamento farmacológico , Medicina Baseada em Evidências/tendências , Feminino , Humanos , Masculino , Casas de Saúde/tendências , Risco , Infecções Urinárias/tratamento farmacológico
12.
Microbiology ; 165(4): 439-454, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30741628

RESUMO

Rapid changes in the number and flow cytometric behaviour of cells of E. coli taken from a stationary phase and inoculated into rich medium.Cells of E. coli were grown in LB medium, taken from a stationary phase of 2-4 h, and re-inoculated into fresh media at a concentration (105 ml-1 or lower) characteristic of bacteriuria. Flow cytometry was used to assess how quickly we could detect changes in cell size, number, membrane energization (using a carbocyanine dye) and DNA distribution. It transpired that while the lag phase observable macroscopically via bulk OD measurements could be as long as 4 h, the true lag phase could be less than 15-20 min, and was accompanied by many observable biochemical changes. Antibiotics to which the cells were sensitive affected these changes within 20 min of re-inoculation, providing the possibility of a very rapid antibiotic susceptibility test on a timescale compatible with a visit to a GP clinic. The strategy was applied successfully to genuine potential urinary tract infection (UTI) samples taken from a doctor's surgery. The methods developed could prove of considerable value in ensuring the correct prescription and thereby lowering the spread of antimicrobial resistance.


Assuntos
Antibacterianos/farmacologia , Bactérias/efeitos dos fármacos , Bactérias/crescimento & desenvolvimento , Citometria de Fluxo , Testes de Sensibilidade Microbiana/métodos , Infecções Urinárias/microbiologia , Antibacterianos/uso terapêutico , Bactérias/isolamento & purificação , Bacteriúria/tratamento farmacológico , Bacteriúria/microbiologia , Meios de Cultura , Humanos , Infecções Urinárias/tratamento farmacológico
13.
Infect Control Hosp Epidemiol ; 40(1): 72-78, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30501661

RESUMO

OBJECTIVE: The aim of this study was to assess the impact of a urinary tract infection (UTI) management bundle to reduce the treatment of asymptomatic bacteriuria (AB) and to improve the management of symptomatic UTIs. DESIGN: Before-and-after intervention study.SettingsTertiary-care hospital.PatientsConsecutive sample of inpatients with positive single or mixed-predominant urine cultures collected and reported while admitted to the hospital. METHODS: The UTI management bundle consisted of nursing and prescriber education, modification of the reporting of positive urine cultures, and pharmacists' prospective audit and feedback. A retrospective chart review of consecutive inpatients with positive urinary cultures was performed before and after implementation of the management bundle. RESULTS: Prior to the implementation of the management bundle, 276 patients were eligible criteria for chart review. Of these 276 patients, 165 (59·8%) were found to have AB; of these 165 patients with AB, 111 (67·3%) were treated with antimicrobials. Moreover, 268 patients met eligibility criteria for postintervention review. Of these 268, 133 patients (49·6%) were found to have AB; of these 133 with AB, 22 (16·5%) were treated with antimicrobials. Thus, a 75·5% reduction of AB treatment was achieved. Educational components of the bundle resulted in a substantial decrease in nonphysician-directed urine sample submission. Adherence to a UTI management algorithm improved substantially in the intervention period, with a notable decrease in fluoroquinolone prescription for empiric UTI treatment. CONCLUSIONS: A UTI management bundle resulted in a dramatic improvement in the management of urinary tract infection, particularly a reduction in the treatment of AB and improved management of symptomatic UTI.


Assuntos
Anti-Infecciosos/uso terapêutico , Bacteriúria/tratamento farmacológico , Pacotes de Assistência ao Paciente/métodos , Infecções Urinárias/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas , Bacteriúria/diagnóstico , Gerenciamento Clínico , Feminino , Hospitais de Ensino , Humanos , Masculino , Pessoa de Meia-Idade , Novo Brunswick , Estudos Retrospectivos , Centros de Atenção Terciária , Urinálise , Infecções Urinárias/diagnóstico
14.
J Am Anim Hosp Assoc ; 55(1): 42-47, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30427719

RESUMO

In dogs with leptospirosis, doxycycline therapy is recommended as the preferred therapy for its ability to eliminate the organism from all tissues, including the renal tubules. Elimination of organisms from the renal tubules terminates leptospiruria and prevents transmission of the organism. This report describes the discovery of persistent leptospiruria in the face of therapy with doxycycline in four dogs and enrofloxacin in one dog. Leptospiruria was confirmed by polymerase chain reaction testing for pathogenic leptospires in all five dogs. In two dogs, leptospiruria resolved after a change in therapy to enrofloxacin. In three dogs, doxycycline and/or enrofloxacin were ineffective at eliminating leptospiruria, which then resolved after therapy with clarithromycin. Pet owners could be at risk as persistent leptospiruria poses a potential zoonotic risk. The potential reasons for persistent leptospiruria as demonstrated by polymerase chain reaction testing are discussed.


Assuntos
Antibacterianos/uso terapêutico , Bacteriúria/veterinária , Doenças do Cão/tratamento farmacológico , Doxiciclina/uso terapêutico , Enrofloxacina/uso terapêutico , Leptospirose/veterinária , Animais , Bacteriúria/tratamento farmacológico , Bacteriúria/microbiologia , Bacteriúria/urina , Doenças do Cão/microbiologia , Doenças do Cão/urina , Cães , Túbulos Renais/microbiologia , Leptospirose/tratamento farmacológico , Leptospirose/microbiologia , Leptospirose/urina , Estudos Retrospectivos
15.
Infect Control Hosp Epidemiol ; 40(2): 228-231, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30522544

RESUMO

This survey investigated interventions used by acute-care hospitals to reduce the detection of asymptomatic bacteriuria. Half of the respondents reported using reflex urine cultures but with varied urinalysis criteria and perceived outcomes. Other diagnostic stewardship interventions for urine culture ordering and specimen quality were less common.


Assuntos
Bacteriúria/diagnóstico , Hospitais , Padrões de Prática Médica/estatística & dados numéricos , Procedimentos Desnecessários , Urinálise/normas , Antibacterianos/uso terapêutico , Infecções Assintomáticas , Bacteriúria/tratamento farmacológico , Humanos , Prescrição Inadequada/prevenção & controle , Estados Unidos , Urinálise/métodos
16.
JAMA Surg ; 154(3): 241-248, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30540346

RESUMO

Importance: Limited data suggest that screening for asymptomatic bacteriuria (ASB) prior to nonurologic procedures is not useful. However, high-quality evidence to support consensus recommendations and influence clinical practice is lacking. Objective: To characterize the association between detection and treatment of preoperative ASB and postoperative outcomes. Design, Setting, and Participants: This retrospective cohort study involved patients, predominantly male veterans, who underwent surgical procedures in 109 US facilities within the US Department of Veterans Affairs health care system from October 1, 2008, to September 30, 2013. Participants included patients (n = 68 265) who had cardiac, orthopedic, or vascular surgical procedures. Each received a planned clinician review of complete medical records for antimicrobial prophylaxis as well as 30-day surgical-site infection (SSI) and urinary tract infection (UTI) outcomes, and each had a preoperative urine culture result available within the 30 days prior to the procedure. Data analysis was performed from December 2016 to August 2018. Main Outcome and Measures: The primary outcome was the association between preoperative ASB and postoperative SSI. The secondary outcomes included postoperative UTI and the association between antimicrobial therapy for ASB and postoperative infectious outcomes. Results: In total, 68 265 patients (65 664 [96.2%] were men and 2601 [3.8%] were women, with a mean [SD] age of 64.6 [9.2] years) were identified, and 17 611 (25.8%) were eligible for inclusion in the primary analysis. Preoperative urine cultures were performed in 17 749 (26.0%) patients, and the results were positive in 755 (4.3%), of which 617 (81.7%) were classified as ASB. With adjustments for age, American Society of Anesthesiologists class, smoking status, race/ethnicity, sex, and diabetes status, patients with or without ASB had similar odds of SSI (2.4% vs 1.6%; adjusted odds ratio [aOR], 1.58; 95% CI, 0.93-2.70; P = .08). Receipt of antimicrobial therapy with activity against the ASB organism was not associated with a reduced SSI risk (aOR, 1.01; 95% CI, 0.28-3.65; P = .99). Urinary tract infection occurred in 14 (3.3%) of 423 patients with ASB and 196 (1.5%) of 12 913 patients without ASB (aOR, 1.42; 95% CI, 0.80-2.49; P = .22). Treatment or prophylaxis for the ASB organism similarly was not associated with reduced odds of postoperative UTI (aOR 0.68; 95% CI, 0.20-2.30; P = .54). The ASB organisms matched a postoperative wound culture in 2 cases, both Staphylococcus aureus. Conclusions and Relevance: The findings of this study suggest that receipt of antimicrobial therapy with activity against ASB organisms identified in preoperative urine cultures was not associated with reductions in the risk for postoperative infections, including UTI and SSI; such findings suggest there is evidence for discontinuing the practice of screening and treatment for preoperative ASB.


Assuntos
Bacteriúria/microbiologia , Procedimentos Cirúrgicos Operatórios , Infecção da Ferida Cirúrgica/microbiologia , Veteranos , Idoso , Antibacterianos/uso terapêutico , Bacteriúria/tratamento farmacológico , Bacteriúria/epidemiologia , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Período Pré-Operatório , Estados Unidos/epidemiologia
17.
Eur Urol Focus ; 5(1): 13-14, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29909953

RESUMO

Asymptomatic bacteriuria (ABU) should be treated only in pregnant women and before urological procedures that breach the mucosa. In all other clinical settings, treatment of ABU is not beneficial and only contributes to antibiotic-associated morbidity and the selection of antibiotic resistance; therefore, screening and treatment are not recommended.


Assuntos
Antibacterianos/uso terapêutico , Bacteriúria/diagnóstico , Complicações Infecciosas na Gravidez/microbiologia , Infecções Assintomáticas/epidemiologia , Bacteriúria/tratamento farmacológico , Bacteriúria/microbiologia , Europa (Continente)/epidemiologia , Feminino , Humanos , Programas de Rastreamento/métodos , Guias de Prática Clínica como Assunto , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto
19.
Eur Urol Focus ; 5(1): 15-16, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30030090

RESUMO

Symptom-free bacterial colonization of the lower urinary tract in an otherwise healthy individual was long misunderstood. Our current understanding is based on solid research proving that asymptomatic bacteriuria (ABU) is harmless and even protective against symptomatic urinary tract infection episodes. Thus, ABU should not be treated in patients with the exception of before endosurgery and, until we have accumulated more knowledge, in pregnant women.


Assuntos
Bacteriúria/tratamento farmacológico , Bacteriúria/genética , Infecções Urinárias/tratamento farmacológico , Anti-Infecciosos/efeitos adversos , Anti-Infecciosos/uso terapêutico , Doenças Assintomáticas/epidemiologia , Bacteriúria/epidemiologia , Feminino , Humanos , Masculino , Microbiota/efeitos dos fármacos , Guias de Prática Clínica como Assunto , Gravidez , Recidiva , Fatores de Risco , Infecções Urinárias/epidemiologia , Infecções Urinárias/genética
20.
Can Fam Physician ; 64(11): 821-824, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30429177

RESUMO

Question I am aware of how common pediatric urinary tract infection (UTI) is, and of the potential long-term sequelae if left untreated. Therefore, in our practice we treat every child who presents with symptomatic UTI with antibiotics. However, should the same practice be applied to children with bacteriuria that is asymptomatic?Answer Historically, asymptomatic bacteriuria (ABU) was treated with antibiotics in all populations, including in children. However, more recent evidence has shown no benefit and often harm associated with the use of antibiotics to treat pediatric ABU. Some studies suggest that owing to the different microbiology associated with ABU it should not be considered in the spectrum of UTI. These children should not be treated with antibiotics unless they have received a renal transplant or have undergone invasive urologic procedures.


Assuntos
Antibacterianos/uso terapêutico , Infecções Assintomáticas/terapia , Bacteriúria/tratamento farmacológico , Antibacterianos/efeitos adversos , Criança , Humanos , Transplante de Rim , Medição de Risco
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