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1.
Urologiia ; (5): 33-36, 2020 Nov.
Artigo em Russo | MEDLINE | ID: mdl-33185343

RESUMO

INTRODUCTION: During pregnancy, therapeutic options which can be used to treat and prevent acute lower urinary tract infections are significantly limited. In this regard, new opportunities to increase time to relapse of urinary tract infections are urgently required. AIM: To evaluate the results of the use of the dietary supplements "Cystenium II" in pregnant women for the complex treatment of acute cystitis and asymptomatic bacteriuria. MATERIALS AND METHODS: The analysis of complex therapy of uncomplicated lower urinary tract infection with the use of dietary supplements "Cystenium II" in 42 pregnant women (mean age 24.5+/-4.3 years), divided into two groups depending on the presence of symptoms of the cystitis. RESULTS: Data on the clinical and microbiological cure and the absence of side effects were obtained. CONCLUSIONS: The use of dietary supplements "Cystenium II" is advisable, both in the complex antimicrobial therapy of acute cystitis, exacerbation of recurrent cystitis or asymptomatic bacteriuria in pregnant women, as well as for the prevention of recurrence of cystitis after the clinical cure.


Assuntos
Bacteriúria , Cistite , Infecções Urinárias , Adulto , Antibacterianos/efeitos adversos , Bacteriúria/tratamento farmacológico , Cistite/tratamento farmacológico , Feminino , Humanos , Preparações de Plantas/uso terapêutico , Gravidez , Infecções Urinárias/tratamento farmacológico , Adulto Jovem
2.
Urologiia ; (5): 116-120, 2020 Nov.
Artigo em Russo | MEDLINE | ID: mdl-33185358

RESUMO

The choice of antimicrobials for the treatment of urinary tract infections (UTIs) is determined by many factors, however, at present, population antibiotic resistance of uropathogens is used as one of the most important criteria. At the same time, there are cases when the clinical efficacy of an antimicrobial drug does not correlate with in vitro activity, in particular, such discordance was found for fosfomycin trometamol. Comparison of data from microbiological studies of UTI pathogens performed at different times is of great practical and scientific interest. At the same time, such comparisons have limitations, such as the use of different criteria for interpreting the sensitivity of microorganisms, the peculiarities of the formation of the studied patient population, and collection of strains in different geographical areas. Therefore, for all the seeming simplicity and clarity of the data on the sensitivity of uropathogens, their use to substantiate rational antimicrobial therapy is associated with numerous nuances that can significantly distort their objective assessment. In this connection, it is important to conduct not only microbiological, but also clinical studies to obtain data on the comparative effectiveness of the antimicrobials used.


Assuntos
Fosfomicina , Infecções Urinárias , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Resistência Microbiana a Medicamentos , Humanos , Testes de Sensibilidade Microbiana , Federação Russa , Infecções Urinárias/tratamento farmacológico
3.
BMC Infect Dis ; 20(1): 813, 2020 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-33167875

RESUMO

BACKGROUND: Uncomplicated urinary tract infections (UTIs) in women are usually managed in primary care with antibiotics. However, many women seem to prefer to handle UTI symptoms with nonsteroidal anti-inflammatory drugs (NSAIDs) and other remedies. The aim of this study was to compare UTI management as recommended by physicians with the patients' management at home. METHODS: This prospective cohort study in German primary care is based on clinical data from local practices and patient questionnaires. Participating women completed a baseline data sheet in the practice; their urine sample was tested by a dipstick in the practice and cultured by a laboratory. The women reported treatment and symptom-related impairment on an eight-item symptom questionnaire daily for 7 days. Using growth curve models, we analysed the influence of time on the total severity score to examine how symptoms changed across days. We then examined whether symptom severity and symptom course differed between patients who took antibiotics or NSAIDs. RESULTS: A total of 120 women (mean age of 43.3 ± 16.6 years) were enrolled. The urine dipstick was positive for leucocytes in 92%, erythrocytes in 87%, and nitrites in 23%. Physicians prescribed antibiotics for 102 (87%) women and recommended NSAIDs in 14 cases. According to the women's reports, only 60% (72/120) took antibiotics, while the remainder took NSAIDs and other remedies. Symptoms declined from day 0 to day 6, irrespective of whether women decided to take an antibiotic, NSAIDs, none or both, as confirmed by a significant curvilinear time effect (B = 0.06, SE = 0.005, p < .001). The symptom course, however, was moderated by taking antibiotics so that the change in symptom severity was somewhat more pronounced in women taking antibiotics (B = 0.06) than in the remainder (B = 0.04). CONCLUSION: A substantial proportion of women did not follow their physicians' treatment recommendations, and many used NSAIDs. All women had a good chance of recovery irrespective of whether they decided to take antibiotics. A sensitive listening to patient preferences in the consultation may encourage physicians to recommend and prescribe symptomatic treatment with NSAID more often than antibiotic medicines.


Assuntos
Antibacterianos/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Infecções por Escherichia coli/tratamento farmacológico , Escherichia coli/efeitos dos fármacos , Atenção Primária à Saúde , Encaminhamento e Consulta , Infecções Urinárias/tratamento farmacológico , Adulto , Farmacorresistência Bacteriana/efeitos dos fármacos , Infecções por Escherichia coli/microbiologia , Feminino , Humanos , Pessoa de Meia-Idade , Cooperação do Paciente , Médicos/psicologia , Estudos Prospectivos , Inquéritos e Questionários , Infecções Urinárias/microbiologia
4.
Mymensingh Med J ; 29(4): 838-846, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33116085

RESUMO

Urinary tract infection (UTI) is commonly encountered in both community and hospital settings and is often associated with significant morbidity. The inappropriate administration of antibiotics to treat UTI increases the development of antimicrobial resistance to antibiotics. This cross-sectional study was conducted at the gynecology outpatient department (OPD) of Mymensingh Medical College Hospital, Bangladesh, from January 2018 to November 2019 to determine the frequency of causative micro-organisms of UTIs and their antibiotic resistance pattern. Four hundred eight women presenting with the symptoms of UTI referred with a diagnosis of UTI based on a urine routine examination, culture, and sensitivity reports to the OPD were included in the study. Antibiotic sensitivity testing was done in the microbiology department of the hospital following the Kirby-Bauer disc diffusion method. E. coli was the most common (48.5%) organism isolated, followed by Proteus (21.6%), Klebsiella (15.0%), Enterococcus spp. (4.7%), S. aureus (3.9%), Acinetobacter spp. (3.9%), and Pseudomonas (2.5%). The distribution of the causative organisms in various age groups of the patients was similar. Overall, most (>80%) of the organisms were resistant to Erythromycin (93%), Ampicillin (92%), Amoxycillin (90%), and Cefuroxime (84%); the highest sensitivity was found for Meropenem (85%), Amikacin (81%), Gentamycin (79%), and Nitrofurantoin (71%). The highest sensitivity of E. coli was found for Meropenem (90%), Amikacin (83%), Gentamycin (83%), and Nitrofurantoin (76%). E. coli were resistant to Ampicillin (100%), Amoxycillin (100%), and Erythromycin (100%), Cephalexin (85%), and Cefuroxime (85%). Proteus was highly sensitive to Meropenem (90%) and Gentamycin (82%), whereas highly resistant to most of the antibiotics. Klebsiella was found sensitive to Amikacin (90%), Gentamycin (77%), Meropenem (74%), and Ciprofloxacin (74%) and resistant to Ampicillin (100%), Erythromycin (87%), Cefixime (80%), and Cefuroxime (76%). The results of this study showed that resistance is likely to be against the most commonly used antibiotics. Most of the uropathogens showed sensitivity to injectable antibiotics, namely Meropenem, Gentamycin, and Amikacin.


Assuntos
Anti-Infecciosos , Ginecologia , Infecções Urinárias , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bangladesh/epidemiologia , Estudos Transversais , Escherichia coli , Feminino , Humanos , Testes de Sensibilidade Microbiana , Pacientes Ambulatoriais , Staphylococcus aureus , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/epidemiologia
5.
Mymensingh Med J ; 29(4): 920-925, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33116097

RESUMO

Infections are well recognized cause of morbidity and mortality in people with diabetes. This study was done to observe the pattern of infections and microorganism with sensitivity pattern in patients with diabetes admitted at a specialized referral hospital in Dhaka. This cross-sectional study was carried out in Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders (BIRDEM) General Hospital, Dhaka from March 2014 to April 2015. It included 309 patients of diabetes (male-169, female-140; age mean±SD- 49.3±14.7 years) admitted in medicine or endocrinology department, who were screened for clinical evidence of infections according to revised McGeer criteria. Culture and sensitivity pattern of responsible microorganisms were sought from clinically appropriate specimen. Among the participants 25.9% (80 out of 309) had evidence of infection. The most common of them were urinary tract infection (53.8%) and respiratory tract infection (30.0%). E. coli and Klebsiella were the most common organisms that were isolated by urine (55.3% and 13.2%) and blood culture (57.1% and 42.9%). Acinetobacter was the most common pathogen in tracheal aspirate (80%) and Klebsiella in sputum (100%). Culture of wound swab exclusively revealed growth of Staphylococcus. E. coli was fairly sensitive to meropenem (100%), amikacin (93.5%) and nitrofurantoin (93.1%), while sensitivity of Klebsiella was almost similar to that of E. coli. Acinetobacter was fully resistant to ceftazidime, nitrofurantoin and meropenem while only modestly sensitive to ciprofloxacin and amikacin (25% and 20% respectively). Pseudomonas was 100% sensitive to ceftazidime, amikacin and meropenem, but 100% resistant to ciprofloxacin and nitrofurantoin. One in four admitted diabetes patient had evidence of infection, most commonly involving urinary and respiratory tracts. E. coli and Klebsiella both fairly sensitive to common antibiotics, were common isolates from urine and blood culture; whereas Acinetobacter isolated from tracheal aspirates and urine, was only modestly sensitive.


Assuntos
Diabetes Mellitus , Infecções Urinárias , Antibacterianos/uso terapêutico , Bangladesh/epidemiologia , Estudos Transversais , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/epidemiologia , Escherichia coli , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Centros de Atenção Terciária , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/epidemiologia
6.
BMC Infect Dis ; 20(1): 781, 2020 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-33081714

RESUMO

BACKGROUND: It is important to understand clinical features of bacteremic urinary tract infection (bUTI), because bUTI is a serious infection that requires prompt diagnosis and antibiotic therapy. Escherichia coli is the most common and important uropathogen. The objective of our study was to characterize the clinical presentation of E coli bUTI. METHODS: Retrospective cohort study of consecutive adult patients admitted for community acquired E. coli bacteremia from January 1, 2015 to December 31, 2016 was conducted at 4 acute care academic and community hospitals in Toronto, Ontario, Canada. Logistic regression models were developed to identify E coli bUTI cases without urinary symptoms. RESULTS: Of 462 patients with E. coli bacteremia, 284 (61.5%) patients had a urinary source. Of these 284 patients, 161 (56.7%) had urinary symptoms. In a multivariable model, bUTI without urinary symptoms were associated with older age (age < 65 years as reference, age 65-74 years had OR of 2.13 95% CI 0.99-4.59 p = 0.0523; age 75-84 years had OR of 1.80 95% CI 0.91-3.57 p = 0.0914; age > =85 years had OR of 2.95 95% CI 1.44-6.18 p = 0.0036) and delirium (OR of 2.12 95% CI 1.13-4.03 p = 0.0207). Sepsis by SIRS criteria was present in 274 (96.5%) of all bUTI cases and 119 (96.8%) of bUTI cases without urinary symptoms. CONCLUSION: The majority of patients with E. coli bacteremia had a urinary source. A significant proportion of bUTI cases had no urinary symptoms elicited on history. Elderly and delirious patients were more likely to have bUTI without urinary symptoms. In elderly and delirious patients with sepsis by SIRS criteria but without a clear infectious source, clinicians should suspect, investigate, and treat for bUTI.


Assuntos
Bacteriemia/epidemiologia , Bacteriemia/fisiopatologia , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/fisiopatologia , Escherichia coli/isolamento & purificação , Infecções Urinárias/epidemiologia , Infecções Urinárias/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/fisiopatologia , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/microbiologia , Feminino , Humanos , Tempo de Internação , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/microbiologia
7.
BMC Infect Dis ; 20(1): 785, 2020 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-33087051

RESUMO

BACKGROUND: Literature is scarce regarding oral step down to beta-lactams in bacteremic urinary tract infections. Oral fluoroquinolones are an accepted and common step down for bacteremic urinary tract infections; however, their use is associated with mounting safety concerns. We compared clinical cure in patients with E. coli bacteremic urinary tract infections who were stepped down to oral beta-lactams compared to oral fluoroquinolones. METHODS: This multicentre retrospective cohort study included patients with first positive concurrent urine and blood cultures from January 2016 to December 2016. Patients were included if they received empiric intravenous beta-lactam therapy with step down to either oral beta-lactam or fluoroquinolone for treatment completion. The primary outcome was clinical cure. Secondary outcomes were length of hospitalization, all-cause mortality and C. difficile infection. Multivariate analysis and propensity score were used to control for confounding. RESULTS: A total of 207 patients were identified with bacteremic E.coli urinary tract infections. Clinical cure was achieved in 72/77 (94%) in the oral beta-lactam group versus 127/130 (98%) in the oral fluoroquinolone group (absolute difference - 4.2, 95% confidence interval [CI] -10.3 to 1.9%, p = 0.13). The adjusted odds ratio (OR) for clinical cure with oral beta-lactams was 0.31 (95% CI 0.05-1.90, p = 0.21); propensity score adjusted analysis showed a similar result. There was no statistically significant difference in secondary outcomes. CONCLUSIONS: Oral beta-lactams appear to be a safe and effective step down option in bacteremic E. coli urinary tract infections compared to oral fluoroquinolones.


Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Infecções por Escherichia coli/tratamento farmacológico , Escherichia coli/isolamento & purificação , Fluoroquinolonas/uso terapêutico , Infecções Urinárias/tratamento farmacológico , beta-Lactamas/uso terapêutico , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Bacteriemia/microbiologia , Hemocultura , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/microbiologia , Clostridium difficile/isolamento & purificação , Infecções por Escherichia coli/microbiologia , Feminino , Fluoroquinolonas/administração & dosagem , Fluoroquinolonas/efeitos adversos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Infecções Urinárias/microbiologia , beta-Lactamas/administração & dosagem , beta-Lactamas/efeitos adversos
8.
Rev Med Suisse ; 16(710): 1906-1911, 2020 Oct 14.
Artigo em Francês | MEDLINE | ID: mdl-33058575

RESUMO

Cephalosporins belong to the betalactam group and are frequently prescribed in both out and inpatient settings. Their broad spectrum of activity allows a varied use in most medical specialties, ranging from preoperative prophylaxis to treatment of febrile agranulocytosis. There are currently five generations of cephalosporins, mainly differentiated according to their structure, spectrum of activity and side-effect profile. So-called siderophore cephalosporins are active against many multiresistant bacteria, especially in cases of complicated urinary tract infections or ventilator-associated pneumonia. This article intends to review some general clinical principles in prescription and monitoring of patients treated with cephalosporins.


Assuntos
Cefalosporinas/uso terapêutico , Bactérias/efeitos dos fármacos , Cefalosporinas/farmacologia , Humanos , Prescrições , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/microbiologia
9.
PLoS One ; 15(10): e0237365, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33075076

RESUMO

BACKGROUND: Urinary tract infections caused by extended-spectrum beta-lactamase producing Enterobacterales (ESBL-EB) are a problem increasing in our clinical practice. OBJECTIVES: The aim of this study was to evaluate the clinical outcome in patients who received short (≤ 7 days) versus long courses (>7 days) of antimicrobial therapy for complicated ESBL-EB urinary tract infections. METHODS: This is a retrospective and observational study. Positive urine cultures for ESBL-EB in our hospital between March 2015 and July 2017 were identified. Patients with complicated urinary tract infection were included. Differences between treatment groups (7 days or less vs more than 7 days) were analyzed according to baseline characteristics and severity of clinical presentation. Primary outcome was all cause 30-day mortality. Secondary outcome was a combined item of all cause mortality and reinfection by the same enterobacteria at 30 days. RESULTS: 273 urine cultures were positive for ESBL-EB during the study period. 75 episodes were included, 40 in the long treatment group and 35 in the short treatment group. Mean treatment duration in short and long treatment groups was 6,1 and 13,8 days respectively. Mortality at 30 days was 5,7% in the short treatment group and 5% in the long treatment group without significant differences (P = 0,8). Mortality or reinfection by the same ESBL-EB at 30 days was 8,6% in the short treatment group and 10% in the long treatment group, without significant differences (P = 0,8). CONCLUSIONS: Short courses of antimicrobial treatment seems to be effective as treatment of complicated urinary tract infections by ESBL-EB.


Assuntos
Antibacterianos/administração & dosagem , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/microbiologia , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/microbiologia , Idoso , Idoso de 80 Anos ou mais , Enterobacteriáceas Resistentes a Carbapenêmicos/efeitos dos fármacos , Farmacorresistência Bacteriana Múltipla , Duração da Terapia , Enterobacteriaceae/efeitos dos fármacos , Infecções por Enterobacteriaceae/mortalidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha/epidemiologia , Infecções Urinárias/mortalidade , Resistência beta-Lactâmica
11.
Urologiia ; (4): 124-130, 2020 Sep.
Artigo em Russo | MEDLINE | ID: mdl-32897026

RESUMO

The review describes large-scale microbiological studies performed in Russia over the past 20 years to study urinary tract infections (UTIs). The article analyzes data on the structure of UTI pathogens, as well as on the antibiotic resistance of the main uropathogens, compares the data with similar foreign studies. From 1999 year, 7 large multicenter microbiological studies were carried out in Russia to obtain the data of the antimicrobial resistance of uropathogens caused community-acquired UTIs. An analysis of the data allows described trends in antimicrobial resistance - high level of resistance of uropathogens to aminopenicillins, co-trimoxazole, fluoroquinolones, an increase antimicrobial resistance to amoxicillin / clavulanate, and third generation cephalosporins. In review discussed a critical assessment of various approaches to the use of data on the sensitivity of uropathogens to antimicrobial drugs when antimicrobial therapy is provided. The necessity of comparing not only microbiological data obtained from different sources, but also clinical data, characteristics of pharmacodynamics and pharmacokinetics of antimicrobial drugs is discussed. The review discusses the difficulties associated with the clinical interpretation of data on the sensitivity of microorganisms, primarily in the limited objective information describing the correlation of in vitro data with the clinical efficacy of therapy. The publication substantiates the need for a wider conduct of not only microbiological, but also clinical studies to obtain data on the comparative efficacy of the used antimicrobial drugs.


Assuntos
Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Urinárias/tratamento farmacológico , Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana/efeitos dos fármacos , Resistência Microbiana a Medicamentos/efeitos dos fármacos , Humanos , Testes de Sensibilidade Microbiana , Federação Russa
12.
PLoS Biol ; 18(9): e3000856, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32941420

RESUMO

Antibiotic combination therapies are important for the efficient treatment of many types of infections, including those caused by antibiotic-resistant pathogens. Combination treatment strategies are typically used under the assumption that synergies are conserved across species and strains, even though recent results show that the combined treatment effect is determined by specific drug-strain interactions that can vary extensively and unpredictably, both between and within bacterial species. To address this problem, we present a new method in which antibiotic synergy is rapidly quantified on a case-by-case basis, allowing for improved combination therapy. The novel CombiANT methodology consists of a 3D-printed agar plate insert that produces defined diffusion landscapes of 3 antibiotics, permitting synergy quantification between all 3 antibiotic pairs with a single test. Automated image analysis yields fractional inhibitory concentration indices (FICis) with high accuracy and precision. A technical validation with 3 major pathogens, Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus, showed equivalent performance to checkerboard methodology, with the advantage of strongly reduced assay complexity and costs for CombiANT. A synergy screening of 10 antibiotic combinations for 12 E. coli urinary tract infection (UTI) clinical isolates illustrates the need for refined combination treatment strategies. For example, combinations of trimethoprim (TMP) + nitrofurantoin (NIT) and TMP + mecillinam (MEC) showed synergy, but only for certain individual isolates, whereas MEC + NIT combinations showed antagonistic interactions across all tested strains. These data suggest that the CombiANT methodology could allow personalized clinical synergy testing and large-scale screening. We anticipate that CombiANT will greatly facilitate clinical and basic research of antibiotic synergy.


Assuntos
Antibacterianos/administração & dosagem , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Sinergismo Farmacológico , Testes de Sensibilidade Microbiana/métodos , Algoritmos , Andinocilina/administração & dosagem , Andinocilina/farmacologia , Antibacterianos/farmacologia , Quimioterapia Combinada/métodos , Quimioterapia Combinada/normas , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/microbiologia , Humanos , Testes de Sensibilidade Microbiana/instrumentação , Nitrofurantoína/administração & dosagem , Nitrofurantoína/farmacologia , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/isolamento & purificação , Reprodutibilidade dos Testes , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação , Trimetoprima/administração & dosagem , Trimetoprima/farmacologia , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/microbiologia
13.
PLoS Med ; 17(9): e1003336, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32956399

RESUMO

BACKGROUND: Research has questioned the safety of delaying or withholding antibiotics for suspected urinary tract infection (UTI) in older patients. We evaluated the association between antibiotic treatment for lower UTI and risk of bloodstream infection (BSI) in adults aged ≥65 years in primary care. METHODS AND FINDINGS: We analyzed primary care records from patients aged ≥65 years in England with community-onset UTI using the Clinical Practice Research Datalink (2007-2015) linked to Hospital Episode Statistics and census data. The primary outcome was BSI within 60 days, comparing patients treated immediately with antibiotics and those not treated immediately. Crude and adjusted associations between exposure and outcome were estimated using generalized estimating equations. A total of 147,334 patients were included representing 280,462 episodes of lower UTI. BSI occurred in 0.4% (1,025/244,963) of UTI episodes with immediate antibiotics versus 0.6% (228/35,499) of episodes without immediate antibiotics. After adjusting for patient demographics, year of consultation, comorbidities, smoking status, recent hospitalizations, recent accident and emergency (A&E) attendances, recent antibiotic prescribing, and home visits, the odds of BSI were equivalent in patients who were not treated with antibiotics immediately and those who were treated on the date of their UTI consultation (adjusted odds ratio [aOR] 1.13, 95% CI 0.97-1.32, p-value = 0.105). Delaying or withholding antibiotics was associated with increased odds of death in the subsequent 60 days (aOR 1.17, 95% CI 1.09-1.26, p-value < 0.001), but there was limited evidence that increased deaths were attributable to urinary-source BSI. Limitations include overlap between the categories of immediate and delayed antibiotic prescribing, residual confounding underlying differences between patients who were/were not treated with antibiotics, and lack of microbiological diagnosis for BSI. CONCLUSIONS: In this study, we observed that delaying or withholding antibiotics in older adults with suspected UTI did not increase patients' risk of BSI, in contrast with a previous study that analyzed the same dataset, but mortality was increased. Our findings highlight uncertainty around the risks of delaying or withholding antibiotic treatment, which is exacerbated by systematic differences between patients who were and were not treated immediately with antibiotics. Overall, our findings emphasize the need for improved diagnostic/risk prediction strategies to guide antibiotic prescribing for suspected UTI in older adults.


Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/etiologia , Infecções Urinárias/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Registros Eletrônicos de Saúde , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Pacientes , Padrões de Prática Médica/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Fatores de Risco
14.
Rev Fac Cien Med Univ Nac Cordoba ; 77(3): 155-160, 2020 08 21.
Artigo em Espanhol | MEDLINE | ID: mdl-32991113

RESUMO

Introduction: Uncomplicated urinary tract infections(UC-UTI) represent a frequent reason for consultation. Most cases are empirically treated, but the antimicrobial susceptibility of the causative microorganisms has changed over the past years. The objectives of this study where to determine UC-UTI causative microorganism and their antimicrobial susceptibility profiles in adult women. Methods: A prospective analytic study was conducted in two hospital in Córdoba, Argentina, between November/2016 and October/2017. From the identification of positive urine cultures, urinary tract infections (UTI) in women ≥18 years without risk factors for complicated UTIs were included, excluding asymptomatic bacteriurias. Results: A total of 610 UC-UTI were identified and 62.6% of them in patients younger than 50 years; 73.3% of cases were cystitis, being more frequent in older women. Escherichia coli was isolated in 89.2% of UTI and negative coagulase Staphylococcus in 4.2%. As regards Escherichia coli, its resistance against ciprofloxacin was 18.8%; 4.4% against ceftriaxone and 1.8% against nitrofurantoin. There was an elevated resistance against ampicillin, trimethoprim­sulfamethoxazole and ampicillin­sulbactam. Main conclusion: The most frequent isolated microorganism was Escherichia coli, consistent with global epidemiology. This microorganism showed less than 20% total resistance against ciprofloxacin, ceftriaxone and nitrofurantoin.


Assuntos
Cistite , Infecções Urinárias , Antibacterianos/uso terapêutico , Argentina/epidemiologia , Cistite/tratamento farmacológico , Feminino , Humanos , Estudos Prospectivos , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/epidemiologia
15.
Expert Opin Pharmacother ; 21(15): 1805-1811, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32820669

RESUMO

INTRODUCTION: The addition of the ß-lactamase inhibitor relebactam to imipenem restores the antibacterial activity against the majority of multidrug resistant Gram-negative bacteria. Complicated urinary tract infections (UTIs) are predominantly caused by Gram-negative uropathogens. The rise in antibiotic resistance, including to carbapenems, is an increasing challenge in daily practice. AREAS COVERED: In the current review, the use of imipenem/relebactam in complicated UTI is evaluated by discussing its chemistry, pharmacokinetics/dynamics, microbiology, safety, and clinical efficacy. The authors also provide their expert perspectives onto its use and its future place in the treatment armamentarium. EXPERT OPINION: With respect to complicated UTI, it should be noted that, to our knowledge, there are no data yet upon the clinical efficacy of imipenem/relebactam in patients with severe urosepsis or men with suspected prostatitis. Further studies upon these specific groups of UTI patients are needed including additional pharmacokinetic studies upon its tissue penetration of the prostate which is currently unknown. However, in our opinion, imipenem/relebactam can be used in complicated UTI when other treatment options are limited.


Assuntos
Antibacterianos/uso terapêutico , Compostos Azabicíclicos/uso terapêutico , Cilastatina/uso terapêutico , Imipenem/uso terapêutico , Infecções Urinárias/tratamento farmacológico , Antibacterianos/administração & dosagem , Antibacterianos/farmacocinética , Compostos Azabicíclicos/administração & dosagem , Compostos Azabicíclicos/farmacocinética , Cilastatina/administração & dosagem , Cilastatina/farmacocinética , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Quimioterapia Combinada , Bactérias Gram-Negativas/efeitos dos fármacos , Humanos , Imipenem/administração & dosagem , Imipenem/farmacocinética , Masculino , Testes de Sensibilidade Microbiana , Infecções Urinárias/microbiologia
16.
PLoS Pathog ; 16(8): e1008856, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32845936

RESUMO

Copper and superoxide are used by the phagocytes to kill bacteria. Copper is a host effector encountered by uropathogenic Escherichia coli (UPEC) during urinary tract infection in a non-human primate model, and in humans. UPEC is exposed to higher levels of copper in the gut prior to entering the urinary tract. Effects of pre-exposure to copper on bacterial killing by superoxide has not been reported. We hypothesized that copper-replete E. coli is more sensitive to killing by superoxide in vitro, and in activated macrophages. We utilized wild-type UPEC strain CFT073, and its isogenic mutants lacking copper efflux systems, superoxide dismutases (SODs), regulators of a superoxide dismutase, and complemented mutants to address this question. Surprisingly, our results reveal that copper protects UPEC against killing by superoxide in vitro. This copper-dependent protection was amplified in the mutants lacking copper efflux systems. Increased levels of copper and manganese were detected in UPEC exposed to sublethal concentration of copper. Copper activated the transcription of sodA in a SoxR- and SoxS-dependent manner resulting in enhanced levels of SodA activity. Importantly, pre-exposure to copper increased the survival of UPEC within RAW264.7 and bone marrow-derived murine macrophages. Loss of SodA, but not SodB or SodC, in UPEC obliterated copper-dependent protection from superoxide in vitro, and from killing within macrophages. Collectively, our results suggest a model in which sublethal levels of copper trigger the activation of SodA and SodC through independent mechanisms that converge to promote the survival of UPEC from killing by superoxide. A major implication of our findings is that bacteria colonizing copper-rich milieus are primed for efficient detoxification of superoxide.


Assuntos
Cobre/farmacologia , Infecções por Escherichia coli/tratamento farmacológico , Interações Hospedeiro-Patógeno/efeitos dos fármacos , Superóxido Dismutase/metabolismo , Superóxidos/toxicidade , Infecções Urinárias/tratamento farmacológico , Escherichia coli Uropatogênica/efeitos dos fármacos , Animais , Infecções por Escherichia coli/induzido quimicamente , Infecções por Escherichia coli/microbiologia , Feminino , Regulação Bacteriana da Expressão Gênica , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Endogâmicos CBA , Superóxido Dismutase/genética , Infecções Urinárias/induzido quimicamente , Infecções Urinárias/microbiologia
17.
Wiad Lek ; 73(7): 1360-1364, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32759420

RESUMO

OBJECTIVE: The aim: To study the prevalence of ABR among children with UTI over the past 10 years, with an assessment of the sensitivity of E. Coli to common antibiotics in dynamics. PATIENTS AND METHODS: Materials and methods: The study involved 1,044 children with UTI aged from 1 month to 18 years. Examination of patients and interpretation of the results was performed in accordance with the provisions of the Declaration of Helsinki of Human Rights. According to the design, the study included 3 comparison groups: Group 1 - children of the 2009 follow-up year (n = 337), Group 2 - of 2014 (n = 328) and Group 3 - of 2019 (n = 379). RESULTS: Results: Escherichia coli is recognized as the leading uropathogen in all study groups: its percentage in Group 1 was 47 % (158/337), in Group 2 - 64 % (210/328) and in Group 3 - 66.5 % (252/379). The prevalence of antibacterial resistance of E. coli strains and the high dynamics of its growth are shown. So the level of resistance of E. Coli in 2019 was 70 ± 4.06 % (176/252). This was 11 % more compared to 2014 and 18.8 % more compared to 2009. The percentage of multiresistant strains tended to increase and amounted to 28 ± 9.97 % (70/252) among patients with UTI and 40 ± 9.12 % (70/176) in the structure of resistance in 2019. The relative risk of ABR increased by 1.6 times in 2019 compared to 2014 (RR2019 = 2.208 ± 0.207 [1.473;3.310], р < 0.05 vs RR2014 = 1.375 ± 0.209 [0.913;2.063]) and by 3 times compared to 2009 (RR2009 = 0.727 ± 0.209 [0.483;1.095]). Ampicillin and amoxicillin showed an equally low sensitivity level (3.5 ± 32.14 % (9/252)). Only every second child confirmed sensitivity to cefuroxime (53.6 ± 5.76 (135/252)). Ceftazidime and ciprofloxacin showed a relatively high sensitivity level - 77.4 ± 3.34 (195/252) and 83 ± 2.81 (209/252), and at the same time the rapidly growing resistance rates - almost twice as high over the past 5 years. Furazidin K showed a high sensitivity level of 85.7 ± 2.53% (216/252), the lowest level of overall resistance of 14.3 ± 15.15 % (36/252) and a slow rate of its formation. An unfavourable prognosis of an increase in the relative risk of ABR by 2.9-3.7 times in the next 5-10 years was determined among patients with UTI, provided that the existing diagnostic and treatment approaches are maintained. CONCLUSION: Conclusions: The study results are important for understanding the clinical decision on the benefits of antibacterial therapy and optimizing its empirical choice for a patient with UTI.


Assuntos
Antibacterianos/uso terapêutico , Infecções Urinárias , Adolescente , Criança , Pré-Escolar , Farmacorresistência Bacteriana , Escherichia coli , Humanos , Lactente , Testes de Sensibilidade Microbiana , Nefrologia , Infecções Urinárias/tratamento farmacológico
19.
J Assoc Physicians India ; 68(5): 30-31, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32610862

RESUMO

Introduction: Although, urinary tract infections (UTI) remain the most common cause of mortality and morbidity in renal allograft recipients, there is scarce data from India on the etiology and antibiogram of UTI post kidney transplantation. Therefore, the current study was undertaken to evaluate the prevalence, etiology and the antibiogram of pathogens causing UTI in this cohort. Methods: Renal allograft recipients enrolled during the study period were screened for UTI by standard microscopy and routine culture on the day of admission and subsequently every 3rd day post-surgery till discharge. If UTI was present, the etiological agent and its antibiogram were recorded along with the demographic details of the patients. Results: The prevalence of UTI post-transplantation at our centre was 30%. E.coli and Klebsiella pneumoniae were the most common organisms isolated in 42% and 39% cases, respectively. Majority of patients developed UTI on Day 6 (36.6%) and Day 9 (36.6%) post-transplant. Our study revealed a high percentage of resistance to commonly used 1st and 2nd line antibiotics like third generation cephalosporins (96.6%), fluoroquinolones (96.6%), and aminoglycosides (56.7%) and carbapenems (55.2%). Conclusion: Considering the high prevalence of UTI and antibiotic resistance rates in kidney transplant patients in our study, there is an urgent need for developing hospital based local antibiogram for appropriate management of UTI. Fosfomycin as an empirical therapy might be a useful choice for adequate coverage of potential pathogens at our centre. Further multi-centric studies on a larger sample size are recommended from India for formulating antibiotic policy.


Assuntos
Transplante de Rim , Infecções Urinárias/tratamento farmacológico , Antibacterianos/uso terapêutico , Humanos , Índia , Testes de Sensibilidade Microbiana , Prevalência , Centros de Atenção Terciária
20.
BMC Infect Dis ; 20(1): 453, 2020 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-32600258

RESUMO

INTRODUCTION: Uropathogenic E. coli is the leading cause of Urinary tract infections (UTIs), contributing to 80-90% of all community-acquired and 30-50% of all hospital-acquired UTIs. Biofilm forming Uropathogenic E. coli are associated with persistent and chronic inflammation leading to complicated and or recurrent UTIs. Biofilms provide an environment for poor antibiotic penetration and horizontal transfer of virulence genes which favors the development of Multidrug-resistant organisms (MDRO). Understanding biofilm formation and antimicrobial resistance determinants of Uropathogenic E. coli strains will provide insight into the development of treatment options for biofilm-associated UTIs. The aim of this study was to determine the biofilm forming capability, presence of virulence genes and antimicrobial susceptibility pattern of Uropathogenic E. coli isolates in Uganda. METHODS: This was a cross-sectional study carried in the Clinical Microbiology and Molecular biology laboratories at the Department of Medical Microbiology, Makerere University College of Health Sciences. We randomly selected 200 Uropathogenic E. coli clinical isolates among the stored isolates collected between January 2018 and December 2018 that had significant bacteriuria (> 105 CFU). All isolates were subjected to biofilm detection using the Congo Red Agar method and Antimicrobial susceptibility testing was performed using the Kirby disk diffusion method. The isolates were later subjected PCR for the detection of Urovirulence genes namely; Pap, Fim, Sfa, Afa, Hly and Cnf, using commercially designed primers. RESULTS: In this study, 62.5% (125/200) were positive biofilm formers and 78% (156/200) of these were multi-drug resistant (MDR). The isolates were most resistant to Trimethoprim sulphamethoxazole and Amoxicillin (93%) followed by gentamycin (87%) and the least was imipenem (0.5%). Fim was the most prevalent Urovirulence gene (53.5%) followed by Pap (21%), Sfa (13%), Afa (8%), Cnf (5.5%) and Hyl (0%). CONCLUSIONS: We demonstrate a high prevalence of biofilm-forming Uropathogenic E. coli strains that are highly associated with the MDR phenotype. We recommend routine surveillance of antimicrobial resistance and biofilm formation to understand the antibiotics suitable in the management of biofilm-associated UTIs.


Assuntos
Antibacterianos/uso terapêutico , Biofilmes/crescimento & desenvolvimento , Infecções por Escherichia coli/epidemiologia , Infecções Urinárias/epidemiologia , Escherichia coli Uropatogênica/genética , Escherichia coli Uropatogênica/patogenicidade , Estudos Transversais , Farmacorresistência Bacteriana Múltipla/genética , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/microbiologia , Humanos , Testes de Sensibilidade Microbiana , Fenótipo , Reação em Cadeia da Polimerase , Prevalência , Uganda/epidemiologia , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/microbiologia , Escherichia coli Uropatogênica/efeitos dos fármacos , Escherichia coli Uropatogênica/isolamento & purificação , Virulência/genética , Fatores de Virulência/genética
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