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1.
Urologiia ; (5): 60-63, 2019 Dec.
Artigo em Russo | MEDLINE | ID: mdl-31808634

RESUMO

INTRODUCTION: According to the epidemiological studies, prevalence of urolithiasis is nearly 10% worldwide. The course of the disease is often complicated by the development of pyelonephritis, the pathogenesis of which is rather multifactorial. Along with urinary tract obstruction, increasing virulence of microorganisms and immune insufficiency in patients also plays a major role. AIM: To define specific features of immune insufficiency in patients who develop pyelonephritis as a complication of urolithiasis. MATERIALS AND METHODS: A total of 150 patients with urolithiasis complicated by pyelonephritis were prospectively enrolled into our study in order to develop a novel method. All patients were divided into two clinical groups. Group I consisted of 75 patients with urolithiasis complicated by serous pyelonephritis and Group II included 75 patients with urolithiasis complicated by purulent pyelonephritis. In all patients an evaluation of the immune status with a determination of CD3, CD4, CD8, CD16, CD19 level and phagocyte activity of immune system was carried out. The state of lymphocytes plasmatic membrane was evaluated by phase contrast microscopy. RESULTS: It is established that development of pyelonephritis in patients with urolithiasis is accompanied by a lymphopenia, the decrease in relative contents T-helpers, natural killers, as well as a decrease in the immuno-regulatory index and an increase in indicators of terminal and total lymphocytes blebbing. The most pronounced changes were noted in purulent pyelonephritis, where suppressed immune status was confirmed by the high level of lymphocyte with terminal blebbing state.


Assuntos
Pielonefrite/complicações , Urolitíase/imunologia , Membrana Celular , Humanos , Linfócitos , Pielonefrite/sangue , Pielonefrite/tratamento farmacológico , Pielonefrite/etiologia , Urolitíase/sangue , Urolitíase/complicações , Urolitíase/tratamento farmacológico
2.
Urologiia ; (5): 114-118, 2019 Dec.
Artigo em Russo | MEDLINE | ID: mdl-31808644

RESUMO

The problem of urinary stone disease and acute destructive pyelonephritis remains to be relevant in the current urologic practice. The acute pyelonephritis is the most common infectious and inflammatory complication after retrograde ureteroscopy. According to data of leading urologists in Russian Federation and worldwide, the incidence of acute purulent pyelonephritis ranges from 0.1 to 0.2%. Infectious and inflammatory complications of retrograde ureteroscopy often require urgent interventions. Acute pyelonephritis can result in destructive changes in the renal parenchyma. In case of ineffective conservative measures, pyelonephritis can progress into sepsis with the development of multiple organ failure. Therefore, infectious and inflammatory complications require to start combined antibacterial, anti-inflammatory and detoxification therapy, as well as to resolve any upper urinary tract obstruction. If acute pyelonephritis leads to destructive phase with a formation of a carbuncle or an abscess in the kidney, an open surgery is indicated. Despite being minimally-invasive, retrograde ureteroscopy can lead to serious complications requiring an open surgical intervention. In some cases, the severity of the patients condition may require nephrectomy.


Assuntos
Abscesso/tratamento farmacológico , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Cálculos Renais/terapia , Litotripsia/efeitos adversos , Pielonefrite/tratamento farmacológico , Ureteroscopia/efeitos adversos , Humanos , Nefrectomia , Pielonefrite/complicações , Pielonefrite/microbiologia , Federação Russa , Índice de Gravidade de Doença , Cálculos Urinários
3.
Medicine (Baltimore) ; 98(43): e17720, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651906

RESUMO

The study aimed to determine the pattern of fever resolution among febrile patients undergoing treatment for acute pyelonephritis (APN) and prove that switching therapy based solely on persistent fever beyond 72 hours of antibiotics treatment may be unwarranted.For the purpose of this study, non-responders were defined as those patients who had a persistent fever over 72 hours after the initiation of antibiotic therapy. Responders were defined as those patients who became afebrile in less than 72 hours after the initiation of antibiotic therapy. Clinical cure was defined as the complete resolution of all symptoms during antibiotic therapy without recurrence during the follow-up period.A total of 843 female patients with uncomplicated community-acquired APN met all inclusion criteria. The non-responder group comprised of 248 patients (29%), and the remaining patients constituted the responder group. The median initial C-reactive protein level was higher (15.6 mg/dl vs 12.6 md/dl, P < .001) and bacteremia was more frequent (31% vs 40%, P = .001) in the non-responder group. Escherichia coli (E. coli) was the most common pathogen in both groups; there was no significant difference between the groups in the etiology of APN. Antimicrobial resistance and extended spectrum ß-lactamase producing strains had an increasing trend in the non-responder group but there was no significant difference between the groups.This study shows that it is difficult to identify patients at risk of uncomplicated community-acquired APN by antibiotic-resistant pathogens based exclusively on persistent fever. Patients with a prolonged fever for more than 72 hours show similar antibiotic susceptibility patterns and are not associated with adverse treatment outcomes. Therefore, switching of current antibiotics to broad-spectrum antibiotics should be reserved in this patient population until antibiotic susceptibility test results are available.


Assuntos
Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Febre/tratamento farmacológico , Pielonefrite/tratamento farmacológico , Adulto , Idoso , Farmacorresistência Bacteriana/efeitos dos fármacos , Feminino , Humanos , Pessoa de Meia-Idade , República da Coreia , Estudos Retrospectivos , Resultado do Tratamento
4.
Rev Med Suisse ; 15(661): 1545-1550, 2019 Sep 04.
Artigo em Francês | MEDLINE | ID: mdl-31496187

RESUMO

Pyelonephritis is a frequent infection mostly found in women. Urine must be collected for culture before beginning antibiotherapy. The predominant pathogen identified is E coli. Ciprofloxacin may be used right away if the E. coli susceptibility to this antibiotic is at least 90% in the local population. Otherwise, a dose of ceftriaxone or amikacin (outside pregnancy) should be administered. For inpatient care, initial treatment is different according to clinical severity. In case of complication, specialists of urology and infectiology should be consulted. An antibiotic de-escalation should be considered if permitted by the clinical evolution and the antibiogram; in favor of amoxicillin in women and ciprofloxacin in men. In case of history of ESBL infection or carriage, the empirical treatment should be adapted.


Assuntos
Assistência ao Paciente , Pielonefrite/tratamento farmacológico , Antibacterianos/uso terapêutico , Escherichia coli/efeitos dos fármacos , Escherichia coli/isolamento & purificação , Escherichia coli/patogenicidade , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/microbiologia , Humanos , Testes de Sensibilidade Microbiana , Pielonefrite/microbiologia
6.
BMC Infect Dis ; 19(1): 554, 2019 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-31238896

RESUMO

BACKGROUND: The objective of this study is to describe the changes in prescribing practices of antibiotics to treat acute pyelonephritis (APN) in Korea. METHODS: The claim data base of the Health Insurance Review and Assessment Service in Korea was used to select patients with ICD-10 codes N10 (acute tubulo-interstitial nephritis) or N12 (tubulo-interstitial nephritis, not specified as acute nor chronic) as the primary discharge diagnosis during 2010-2014. Consumption of each class of antibiotics was converted to Defined Daily Dose (DDD)/event. RESULTS: Throughout the five-year period, the average antibiotic consumption were 11.3 DDD per inpatient event and 6.0 DDD per outpatient event. The annual average antibiotic consumption increased for inpatients (P = 0.002), but remained stable for outpatients (P = 0.066). The use of parenteral antibiotics increased for inpatients (P < 0.001), but decreased for outpatients (P = 0.017). As for the the antibiotic classes, 3rd generation cephalosporins (3rd CEPs) was the most commonly prescribed (41.4%) for inpatients, followed by fluoroquinolones (FQs) (28.5%); for outpatient, FQs (54.8%) was the most commonly prescribed, followed by 3rd CEPs (13.1%). The use of 3rd CEPs (P < 0.001), beta-lactam/beta-lactamase inhibitors (P = 0.007), and carbapenems (P < 0.001) increased substantially for the treatment of hospitalized APN patients. In particular, carbapenems use increased 3.1-fold over the 5 years. CONCLUSIONS: Prescription of broad-spectrum antibiotics increased much for the treatment of APN in Korea during 2010-2014.


Assuntos
Antibacterianos/uso terapêutico , Uso de Medicamentos/tendências , Pielonefrite/tratamento farmacológico , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Gestão de Antimicrobianos/tendências , Cefalosporinas/uso terapêutico , Bases de Dados Factuais , Feminino , Fluoroquinolonas/uso terapêutico , Humanos , Revisão da Utilização de Seguros , Infecções Intra-Abdominais/tratamento farmacológico , Infecções Intra-Abdominais/epidemiologia , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Padrões de Prática Médica/tendências , Pielonefrite/epidemiologia , República da Coreia/epidemiologia , Adulto Jovem , Inibidores de beta-Lactamases/uso terapêutico
7.
J Med Case Rep ; 13(1): 154, 2019 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-31118085

RESUMO

BACKGROUND: Until now, few cases of pelvis squamous cell carcinoma in various renal anomalies have been reported. To our knowledge, primary squamous cell carcinoma arising from a pelvic ectopic kidney has never been described. In this report, we describe a case of renal pyelocalyceal squamous cell carcinoma in a patient with an ectopic kidney presenting with chronic pyelonephritis. A 73-year-old Caucasian woman presented to our hospital with pyelonephritis symptoms. Abdominopelvic computed tomography revealed heterogeneous and irregular minimal contrast enhancement in the pelvic ectopic kidney parenchyma. Radiologists reported that the images were consistent with chronic pyelonephritis. A Tc-99m dimercaptosuccinic acid renal scan demonstrated a nonfunctioning right pelvic ectopic kidney. The patient underwent open simple nephrectomy via modified Gibson incision. The whole mass was a distended, saclike structure without any grossly visible renal tissue. Pathological examination showed renal pelvis squamous cell carcinoma 8 cm in diameter infiltrating into the renal capsule and perinephritic fatty tissue. The patient was staged as T4N0M1 renal pelvis squamous cell carcinoma. The patient was being treated in the intensive care unit for respiratory distress on the seventh day after the operation. By the first-month follow-up visit, the patient had died of acute respiratory distress syndrome. CONCLUSIONS: Although rare, renal pelvis squamous cell carcinoma should be considered in the differential diagnosis of a renal mass in patients who have renal anomalies and chronic pyelonephritis.


Assuntos
Carcinoma de Células Escamosas/diagnóstico , Neoplasias Renais/diagnóstico , Rim/patologia , Pielonefrite/diagnóstico , Síndrome do Desconforto Respiratório do Adulto/fisiopatologia , Idoso , Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/patologia , Diagnóstico Diferencial , Evolução Fatal , Feminino , Humanos , Rim/anormalidades , Rim/diagnóstico por imagem , Neoplasias Renais/tratamento farmacológico , Neoplasias Renais/patologia , Nefrectomia/métodos , Pielonefrite/tratamento farmacológico , Pielonefrite/fisiopatologia , Síndrome do Desconforto Respiratório do Adulto/etiologia , Tomografia Computadorizada por Raios X
8.
Prim Care ; 46(2): 191-202, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31030820

RESUMO

Urinary tract infections, including cystitis and pyelonephritis, are the most common bacterial infection primary care clinicians encounter in office practice. Dysuria and frequency in the absence of vaginal discharge and vaginal irritation are highly predictive of cystitis. Urine culture is recommended for the diagnosis and management of pyelonephritis, recurrent urinary tract infection, and complicated urinary tract infections. Antibiotics targeted toward Escherichia coli, Proteus, Klebsiella, and Staphylococcus saprophyticus are the recommended treatment. The duration of treatment varies by specific drug and type of infection, ranging from 3 to 5 days for uncomplicated cystitis to 7 to 14 days for pyelonephritis.


Assuntos
Antibacterianos/uso terapêutico , Cistite , Pielonefrite , Cistite/diagnóstico , Cistite/tratamento farmacológico , Cistite/prevenção & controle , Disuria/etiologia , Feminino , Humanos , Pielonefrite/diagnóstico , Pielonefrite/tratamento farmacológico , Pielonefrite/prevenção & controle , Fatores de Risco , Prevenção Secundária , Infecções Urinárias/classificação
9.
Pediatr Int ; 61(6): 572-577, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30908807

RESUMO

BACKGROUND: Pyelonephritis caused by extended-spectrum ß-lactamase (ESBL)-producing Enterobacteriaceae is an urgent problem in pediatrics. Although carbapenem is the standard therapy for infections caused by ESBL-producing Enterobacteriaceae, some cephamycins, including cefmetazole, are stable against hydrolysis by ESBL. There are few reports, however, on the use of cefmetazole in children. The aim of this study was to evaluate the therapeutic effect of cefmetazole in pediatric pyelonephritis caused by ESBL-producing Enterobacteriaceae. METHODS: Children with pyelonephritis caused by ESBL-producing Enterobacteriaceae were enrolled between April 2010 and November 2016 at Tokyo Metropolitan Children's Medical Center. Presence of ESBL was tested for using the disk diffusion method. Medical records were reviewed for a past history of bacterial infection. The outcomes were clinical cure rate at 4 weeks and the duration of therapy in the cefmetazole and non-cefmetazole groups. RESULTS: Fifty-five patients met the criteria for pyelonephritis caused by ESBL-producing Enterobacteriaceae. The most common causative organisms were Escherichia coli (n = 51; 92.7%), Klebsiella pneumoniae (n = 3; 5.5%), and K. oxytoca (n = 1; 1.8%). Thirty-six and 19 patients were treated with cefmetazole and with other antibiotics as definitive therapy, respectively. There was no difference in the clinical cure rate (86.1% vs 89.5%; P = 0.72) or duration of therapy (median, 7.0 vs 7.0 days; P = 0.73) between the cefmetazole and non-cefmetazole groups. CONCLUSIONS: Cefmetazole was not inferior to the other antibiotics in the treatment of pyelonephritis caused by ESBL-producing Enterobacteriaceae in children. Cefmetazole is a valuable therapeutic alternative to carbapenems for treating pyelonephritis caused by ESBL-producing Enterobacteriaceae.


Assuntos
Antibacterianos/uso terapêutico , Cefmetazol/uso terapêutico , Infecções por Enterobacteriaceae/tratamento farmacológico , Enterobacteriaceae/enzimologia , Pielonefrite/tratamento farmacológico , beta-Lactamases/metabolismo , Adolescente , Biomarcadores/metabolismo , Criança , Pré-Escolar , Enterobacteriaceae/isolamento & purificação , Infecções por Enterobacteriaceae/diagnóstico , Infecções por Enterobacteriaceae/microbiologia , Feminino , Humanos , Lactente , Masculino , Pielonefrite/diagnóstico , Pielonefrite/microbiologia , Estudos Retrospectivos , Resultado do Tratamento
10.
Eur J Clin Microbiol Infect Dis ; 38(5): 937-944, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30868326

RESUMO

Extended-spectrum ß-lactamase-producing Enterobacteriales (ESBL-PE) are often associated with inappropriate empirical therapy (IAT). The aim of this study was to investigate whether IAT of acute pyelonephritis (APN) caused by ESBL-PE is related to adverse outcomes. A retrospective cohort study was performed at a tertiary-care hospital from 2014 through 2016. Patients who had APN caused by ESBL-PE and were definitely treated with appropriate antibiotics for at least 7 days were enrolled. IAT was defined as when inappropriate empirical antibiotics were given 48 h or longer after initial diagnosis of APN. Primary endpoint was treatment failure defined as clinical and/or microbiologic failure. Secondary endpoints were length of hospital stay and recurrence of APN. Propensity score matching was used to adjust heterogeneity of each group. Among 175 eligible cases, 59 patients received IAT and 116 patients received appropriate empirical antimicrobial therapy (AT). Treatment failure was observed in five (8.4%) patients and nine (7.8%) patients in each group, respectively. After matching, the treatment failure rate was similar between both groups (adjusted odd ratio [aOR] 1.05; 95% confidence index [CI] 0.26-4.15). The length of hospital stay (median 11 days in the IAT group versus 11 days in the AT group; P = 0.717) and absence of recurrence within 2 months (90.3% in IAT and 86.7% in AT; P = 0.642) were also similar. IAT did not adversely affect the clinical outcome. In this regard, clinicians should be more cautious about indiscriminate prescription of broad-spectrum antibiotics such as carbapenem empirically for treatment of APN possibly caused by ESBL-PE.


Assuntos
Antibacterianos/uso terapêutico , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/microbiologia , Enterobacteriaceae/enzimologia , Pielonefrite/tratamento farmacológico , Pielonefrite/microbiologia , beta-Lactamases/biossíntese , Doença Aguda , Idoso , Antibacterianos/efeitos adversos , Antibacterianos/farmacologia , Enterobacteriaceae/efeitos dos fármacos , Enterobacteriaceae/isolamento & purificação , Infecções por Enterobacteriaceae/diagnóstico , Feminino , Humanos , Tempo de Internação , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Pielonefrite/diagnóstico , República da Coreia , Estudos Retrospectivos , Centros de Atenção Terciária , Falha de Tratamento , Resultado do Tratamento
11.
PLoS One ; 14(3): e0214572, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30921411

RESUMO

BACKGROUND: Urinary tract infection (UTI) is common in primary care and leads to a high number of antibiotic prescriptions. Antimicrobial resistance is a global health problem; better antimicrobial prescribing is one way to limit antimicrobial resistance. We aimed to describe the number of consultations for patients diagnosed with lower urinary tract infection (LUTI) and pyelonephritis and changes in prescribing of antibiotics to men and women with LUTI and pyelonephritis in Swedish PHC between the years 2008 and 2013. METHODS: We performed a descriptive study of changes in UTI diagnosis and antibiotic prescribing in UTI for the years 2008, 2010 and 2013. The Primary Care Record of Infections in Sweden, a database regarding diagnosis linked antibiotic prescribing in primary care, was analyzed concerning data for men and women of all ages regarding UTI visits and antibiotic prescribing. The results were analyzed in relation to current national guidelines. RESULTS: There was a variability in consultation incidence for LUTI with an increase between 2008 and 2010 and a decrease between 2010 and 2013, resulting in a slight rise in consultation incidence between 2008 and 2013. The use of recommended nitrofurantoin or pivmecillinam in LUTI in women increased from 54% in 2008 to 69% in 2013. Fluoroquinolones or trimethoprim were prescribed in 24% of LUTI cases in women in 2008 and in 7% of cases in 2013. Prescriptions of pivmecillinam or nitrofurantoin in male LUTI cases increased from 13% in 2008 to 31% in 2013. Fluoroquinolones or trimethoprim were prescribed in 54% of male LUTI cases in 2008 and 32% in 2013. CONCLUSIONS: Swedish GPs seem to follow national guidelines in the treatment of LUTI in women. In male LUTI cases, the prescriptions of fluoroquinolones remain high and further research is needed to follow prescription patterns and enhance more prudent prescribing to this group of patients.


Assuntos
Guias como Assunto , Cooperação do Paciente/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Infecções Urinárias/tratamento farmacológico , Adolescente , Adulto , Idoso , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Pielonefrite/tratamento farmacológico , Estudos Retrospectivos , Adulto Jovem
12.
Future Microbiol ; 14: 461-475, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30854892

RESUMO

Fosfomycin is a bactericidal antibiotic available since the 1970s whose intravenous formulation has been available in many countries outside the USA. Given the rise in drug-resistant bacteria, its introduction into the US market has become a necessity for addressing these organisms. This review provides an overview of the microbiology, clinical pharmacology and initial clinical experiences of the intravenous fosfomycin product (ZTI-01) that is undergoing clinical development in the USA for the treatment of complicated urinary tract infections and acute pyelonephritis.


Assuntos
Antibacterianos/uso terapêutico , Fosfomicina/uso terapêutico , Injeções/métodos , Infecções Urinárias/tratamento farmacológico , Administração Intravenosa , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Antibacterianos/farmacologia , Bactérias/efeitos dos fármacos , Infecções Bacterianas/tratamento farmacológico , Combinação de Medicamentos , Farmacorresistência Bacteriana/efeitos dos fármacos , Fosfomicina/administração & dosagem , Fosfomicina/efeitos adversos , Fosfomicina/farmacologia , Hospitalização , Humanos , Testes de Sensibilidade Microbiana , Pielonefrite/tratamento farmacológico , Resultado do Tratamento , Estados Unidos
13.
Rev Bras Ginecol Obstet ; 41(2): 97-101, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30786306

RESUMO

OBJECTIVE: To analyze the prescription of antimicrobial agents for pregnant women admitted into the obstetrics service who presented with acute pyelonephritis. METHODS: Three cross-sectional studies were performed comparing the prescription of antimicrobials for pyelonephritis in pregnant women in the time periods evaluated (2010-2011: 99 patients evaluated; 2013: 116 patients evaluated; 2015: 107 patients evaluated), at the Hospital Fêmina, Porto Alegre, in the state of Rio Grande do Sul, Brazil. The analysis was performed before and after the promotion of an institutional protocol for the treatment of pyelonephritis during pregnancy, and on a third occasion after the introduction of a smartphone-based mobile educational tool. RESULTS: The evaluation of the prescribing physicians and the adequacy of the prescriptions between the different periods studied revealed a significant increase in appropriate conduct for the choice of antimicrobial (2010: 83.8%; 2013: 95.7%; and 2015: 100%), route of administration (2010: 97%; 2013: 100%; and 2015: 100%), and interval (2010: 91.9%; 2013: 95.7%; and 2015: 100%), following the introduction of the protocol, and again after the implementation of the software application with orientations on the antimicrobial treatment. CONCLUSION: The use of specific mobile applications should be encouraged to attain a better quality and accuracy in prescriptions and to include strategies that not only reduce the risk of negative outcomes, but also improve the quality of care and treatment for maintaining the health both of the mother and of the baby.


Assuntos
Antibacterianos/uso terapêutico , Aplicativos Móveis , Obstetrícia/educação , Complicações Infecciosas na Gravidez/tratamento farmacológico , Pielonefrite/tratamento farmacológico , Doença Aguda , Brasil , Telefone Celular , Protocolos Clínicos , Estudos Transversais , Prescrições de Medicamentos/normas , Educação Médica/métodos , Feminino , Hospitalização , Humanos , Padrões de Prática Médica/normas , Gravidez , Qualidade da Assistência à Saúde , Estudos Retrospectivos , Infecções Urinárias/tratamento farmacológico
15.
PLoS One ; 14(1): e0211094, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30673763

RESUMO

OBJECTIVE: The primary objective was to determine if initial empirical intravenous dosing of gentamicin improved patient's outcomes in pyelonephritis/urosepsis compared with alternative IV antibiotic management. DESIGN: Retrospective cross-sectional descriptive study. SETTING: Public TertiaryTeaching Hospital serving adults in an urban centre. PARTICIPANTS: All adult patient records with a recorded diagnosis of any of pyelonephritis/urosepsis, urinary tract infection, UTI, complicated urinary tract infection, bacteriuria, symptomatic bacteriuria and asymptomatic bacteriuria from 2nd February 2012 to 10th May 2014 were reviewed. Only patients treated with an empirical regimen of one or more IV antibiotics were included in the study. MAIN OUTCOMES: The primary outcomes were: duration of IV antibiotic treatment, time to resolution of symptoms and length of hospital stay (LOS). Secondary end points were: compliance with Therapeutic Guidelines: Antibiotic (electronic version) (eTG) for severe pyelonephritis/urosepsis and appropriateness of gentamicin use. DATA ANALYSIS: Univariate and multivariable associations between baseline and demographic variables and the main outcomes were performed using Chi-square tests and a General Linear Model using the SAS version 9.2 software. RESULTS: Of 295 patients reviewed 152 were prescribed one or more IV antibiotics and included in the study. Approximately half of the patients (n = 73, 48%) were prescribed IV piperacillin/tazobactam (Tazocin), while gentamicin was prescribed for 66 patients (43.4%). Of the 152 patients evaluated, 49 (32%) were given gentamicin first. Multivariable regression analysis showed that duration of IV treatment was shorter for those aged over 70 (40.2 hours vs 85.5 hours for those aged up to 70; p = 0.0074), and those who received gentamicin as first line treatment (41.3 hours vs 89.8 hours for those not receiving any gentamicin; p = 0.0312). After adjustment for age and gentamicin administration, there appeared to be no significant difference in duration of IV treatment for any other independent variables. No significant associations between the independent variables (gentamicin, age, gender, comorbidities, and eTG compliance) and either time to resolution of symptoms (median: 68 hours) or hospital LOS (median: 5 days) were observed. CONCLUSIONS: Neither time to resolution of abnormal symptoms nor length of stay were significantly influenced by an initial dose of gentamicin when the data were subjected to multivariable analysis. The age of the patient and pattern of gentamicin treatment were the dominant factors associated with duration of IV antibiotics. Piperacillin/tazobactam is not recommended in treatment guidelines for pyelonephritis/urosepsis but was the most commonly prescribed IV antibiotic. This requires review by the appropriate hospital clinicians.


Assuntos
Gentamicinas/administração & dosagem , Pielonefrite/tratamento farmacológico , Sepse/tratamento farmacológico , Infecções Urinárias/tratamento farmacológico , Fatores Etários , Idoso , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pielonefrite/complicações , Pielonefrite/microbiologia , Sepse/etiologia , Infecções Urinárias/complicações
16.
Complement Ther Med ; 42: 429-437, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30670279

RESUMO

INTRODUCTION: It is believed that tubulointerstitial inflammation plays a role in the formation of renal scarring secondary to acute pyelonephritis (APN). Vitamin A is an anti-inflammatory agent that is involved in the re-epithelialization of damaged mucosal surfaces. OBJECTIVE: The aim of this study was to evaluate the efficacy of vitamin A supplementation in combination with antibiotics for improving urinary tract infections (UTIs) symptoms and preventing renal scarring in girls with APN. STUDY DESIGN: This randomized, double-blind, placebo-controlled clinical trial was conducted on 90 girls aged 2 to 12 years old between 2015 and 2017. Patients with UTIs and first episode of APN diagnosed based on 99 mTc-DMSA scintigraphy (uptake defect) were assessed for eligibility. Patients were randomly divided into two groups that either received 10 days of oral vitamin A (intervention group) or 10 days of placebo (control group) in addition to antibiotics during the acute phase of infection. The clinical response was considered as the primary outcome [duration (positive days) of UTI symptoms during trial treatment period] and secondary outcomes (no change, improving and or worsening of 99 mTc-DMSA scan results 6 months after treatment from baseline). P < 0.05 was considered to be statistically significant. RESULTS: Seventy-four patients (vitamin A group: 36 patients, placebo: 38 patients) were included in the analysis. The mean age was 5.25 ± 1 year old. Three patients (7.89%) in the placebo group and 2 patients (5.55%) in the vitamin A group had vesicoureteral reflux (VUR) (p = 0.114). Duration of fever (vitamin A group: 1.8 days, placebo: 3.1 days, p = 0.0026), urinary frequency (1.3 days vs. 2.8 days, p = 0.003) and poor feeding (2.3 days vs. 4.2 days, p = 0.005) were significantly lower in the vitamin A group. Following the second 99 mTc-DMSA scan, worsening of lesions was observed among 8 (22.2%) and 17 (44.7%) patients in the vitamin A and placebo groups, respectively (p = 0.003). 63.8% (23 patients) of the vitamin A group and 21% (8 patients) of placebo group showed lesion improving in the photopenic region. (P < 0.0001) There was no evidence of vitamin A intolerance. DISCUSSION: Our results show the efficacy of vitamin A supplementation on reducing renal scarring secondary to APN and on fever, urinary frequency and poor feeding duration in girls with APN. CONCLUSION: Vitamin A supplementation is effective for improving the clinical symptoms of UTI and reducing renal injury and scarring following APN in girls with first APN. However, larger randomized clinical trials (RCTs) with longer follow up are needed to confirm these effects.


Assuntos
Cicatriz/prevenção & controle , Suplementos Nutricionais , Rim/efeitos dos fármacos , Pielonefrite/tratamento farmacológico , Infecções Urinárias/tratamento farmacológico , Vitamina A/uso terapêutico , Vitaminas/uso terapêutico , Doença Aguda , Criança , Pré-Escolar , Cicatriz/etiologia , Método Duplo-Cego , Comportamento Alimentar/efeitos dos fármacos , Feminino , Febre/prevenção & controle , Humanos , Lactente , Rim/patologia , Pielonefrite/complicações , Resultado do Tratamento , Infecções Urinárias/complicações , Micção/efeitos dos fármacos , Vitamina A/farmacologia , Vitaminas/farmacologia
17.
Infect Dis Health ; 24(2): 75-81, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30598405

RESUMO

BACKGROUND: Urinary tract infections are one of the most common infections encountered in ambulatory care and the inpatient setting. Antibiotic resistance is a growing concern in healthcare worldwide and has been described by the World Health Organisation as one of the key global health issues facing our generation. The objective of this study was to evaluate antibiotic prescribing adherence to national therapeutic guidelines for patients with uncomplicated urinary tract infection. METHODS: A single centre, retrospective study of patients with uncomplicated urinary tract infections presenting to the Gold Coast University Hospital in May 2015. Infections were categorised according to male cystitis, female cystitis, mild pyelonephritis and severe pyelonephritis, with antibiotic prescribing assessed against the Australian Therapeutic Guidelines. RESULTS: 103 patients met the inclusion criteria, 47 (45.6%) received treatment that adhered to the Australian Therapeutic Guidelines. Eight (7.8%) did not adhere but the decision of non-adherence was justified. 48 (46.6%) received treatment that did not adhere to the Australian Therapeutic Guidelines. The most common reason for non-adherence were incorrect dose followed by incorrect duration. There was a lack of fluoroquinolone use in this study. CONCLUSIONS: These results highlight the poor adherence to guidelines in uncomplicated urinary tract infection. Non-adherent duration of treatment is likely contributed by inappropriate number of tablets being dispensed in boxes.


Assuntos
Antibacterianos/uso terapêutico , Fidelidade a Diretrizes/estatística & dados numéricos , Padrões de Prática Médica , Infecções Urinárias/tratamento farmacológico , Assistência Ambulatorial , Gestão de Antimicrobianos , Austrália , Cistite/tratamento farmacológico , Resistência Microbiana a Medicamentos , Feminino , Gana , Hospitais Universitários/estatística & dados numéricos , Humanos , Prescrição Inadequada , Masculino , Pielonefrite/tratamento farmacológico , Estudos Retrospectivos
18.
Enferm Infecc Microbiol Clin ; 37(2): 140-141, 2019 02.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29631929
19.
Transpl Infect Dis ; 21(2): e13032, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30472777

RESUMO

Ureaplasma urealyticum is a bacterial species correlated with urethritis in healthy individuals and invasive infections in immunocompromised patients. We describe a 20-year-old female with a history of remote heart transplant on everolimus, mycophenolate, and rituximab presenting with progressive urinary tract symptoms, renal failure, and neurologic symptoms. An extensive workup ultimately identified U urealyticum infection, and the patient successfully recovered after a course of azithromycin and doxycycline.


Assuntos
Disuria/microbiologia , Doenças do Sistema Nervoso/microbiologia , Pielonefrite/complicações , Pielonefrite/diagnóstico , Insuficiência Renal/microbiologia , Infecções por Ureaplasma/complicações , Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Doxiciclina/uso terapêutico , Disuria/etiologia , Feminino , Humanos , Hospedeiro Imunocomprometido , Masculino , Doenças do Sistema Nervoso/etiologia , Pielonefrite/tratamento farmacológico , Pielonefrite/microbiologia , Insuficiência Renal/etiologia , Infecções por Ureaplasma/microbiologia , Ureaplasma urealyticum , Adulto Jovem
20.
J Infect Chemother ; 25(2): 104-110, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30420153

RESUMO

We report efficacy and safety results for a combination of a novel cephalosporin class antibiotic and a ß-Lactamase inhibitor, tazobactam/ceftolozane (1:2) at a dose of 1.5 g intravenously every 8 h in Japanese patients with uncomplicated pyelonephritis and complicated urinary tract infection. This study design was a nonrandomized, multicenter, open-label trial, and the treatment period was 7 days. Of 115 patients enrolled in this study, 114 received tazobactam/ceftolozane, and 90 were included in the efficacy analyses. Ninety-nine isolates (bacterial count ≥105 CFU/mL) were identified by urine culture. The main baseline uropathogens were Escherichia coli (80 isolates), Klebsiella pneumoniae (8 isolates), and Proteus mirabilis (3 isolates). Of these, 13 isolates were ESBL-producers. The favorable per-patient microbiological response rate at 7 days after the final administration of tazobactam/ceftolozane was 80.7% (71/88). The response rate in uncomplicated pyelonephritis was 90.0% (36/40), complicated pyelonephritis 63.6% (14/22), and complicated cystitis 80.8% (21/26). The favorable clinical response rate was 96.6% (86/89), and composite response rate (based on microbiological and clinical response) was 80.7% (71/88). The eradication rate by uropathogen was 83.5% (66/79) in E. coli, 42.9% (3/7) in K. pneumoniae, and 100% (3/3) in P. mirabilis. The incidence of drug-related adverse events was 17.5% (20/114 patients). The most common drug-related adverse events were diarrhea and alanine aminotransferase increased in 5.3% (6/114 patients each). Drug-related serious adverse events and deaths were not observed. These results support the safety and efficacy of tazobactam/ceftolozane and suggest it will be a useful treatment for uncomplicated pyelonephritis and complicated urinary tract infection.


Assuntos
Antibacterianos/efeitos adversos , Cefalosporinas/efeitos adversos , Pielonefrite/tratamento farmacológico , Tazobactam/efeitos adversos , Infecções Urinárias/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Cefalosporinas/uso terapêutico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Tazobactam/uso terapêutico , Resultado do Tratamento
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