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PubMed2006

Rapid detection of urinary tract infection--evaluation of flow cytometry.

AIMS: Urogenital tract infection (UTI) due to bacteria is not only a common infection but also a complication during hospitalization. Therefore, the identification and quantification of bacteria in urine samples are routinely performed methods in microbiological laboratories. To differentiate between infection and contamination it is also important to quantify the leukocyte count. In this study, we suggest a screening procedure using the flow cytometer analyzer BACSYS-40i as tool for the diagnosis of UTI. MATERIAL AND METHODS: Each urine sample was inoculated onto agar plates (MacConkey agar, sheep blood agar and enterococcosel agar (Bio Merieux, Nütingen, Germany)) within 4 hours after collection. After 24 up to 48 hours incubation at 37 degrees C, bacteria were quantified by evaluation of colony-forming units (CFU) according to the criteria given by the German recommendation [MIQ 1997]. Additionally, each sample was submitted to the BACSYS-40i analyzer. The technological principle is a fluorescence flow cytometer with a laser and a fluorescent dye to identify bacteria and leukocytes with high analytical sensitivity. RESULTS: Coefficients of variation (CV) for examination of within-run reproducibility ranged from 1.7 - 9.0% for leukocytes and from 6.2 - 24.6% for bacteria. Linearity was found to be very good, with coefficients of determination of r = 0.9998 for leukocytes, and r = 0.9994 for bacteria. Carry-over was calculated and found to be extremely low, ranging up to 0.03% for leukocytes and up to 0.002% for bacteria. The correlation coefficient for leukocyte counting is 0.979, regression y = 1.0 x + 1.0. The number of bacteria determined with the BACSYS-40i (total cell count) is higher than the number determined by culture (viable cell count). If the cut-offs of the analyzer were fixed at > or = 10(6) and < 10(5) bacteria/microl for positive, respectively negative results, 39 out of 42 patients (93%) showing unambiguous predominant clinical signs of UTI and in addition growth of bacteria involved in UTI were recognized. Six samples were questionable. CONCLUSIONS: Results obtained by the BACSYS-40i can be reported after a few minutes. Urine samples from all 57 patients with predominant clinical signs and in addition growth of bacteria isolated from urine and known as pathogens of UTI had positive results with the analyzer (100%) for elevated bacteria and leukocyte counts. Furthermore, all patients without symptoms for UTI were negative after analysis with the BACSYS-40i (44/44; 100%).

Adolescent↗
PubMed2004

Urinary tract infection in men.

OBJECTIVE: To explore the prevalence and microbiology of urinary tract infection (UTI) in symptomatic men in a primary care setting and to determine the appropriateness of patient management of these conditions by the general practitioners. METHODS: A cross-sectional survey was carried out matching documentation of symptoms and management with urine culture and results of susceptibility tests. All patients presenting with symptoms typical for a UTI in 36 teaching general practices in the area of Göttingen, Germany, were eligible for enrolment in the study. 15% (n = 90) of all patients were adult men. General practitioners (GPs) were instructed to manage patients as usual. Patient characteristics, dipstick tests and treatment were matched with results of urine cultures and susceptibility testing. RESULTS: Men presenting with symptoms indicative of UTI were predominantly elderly (median age 61 years) and 41% had additional risk factors. Antibiotics were prescribed for 36%, but these were not well-targeted. Urine culture revealed UTI in 60%, of which half had low colony counts (23% of all patients) or multiple bacterial growth (7%); 40% had sterile urine. Dipstick tests proved unhelpful: leukocytes and nitrite had sensitivities of 54% and 38%, specificities of 55% and 84%, positive predictive values of 65% and 78% and negative predictive values of 44% and 46%, respectively. Resistance levels were 53% for amoxicillin and cefaclor, 28% for cefixim, 22% for ciprofloxacin, 34% for both trimethoprim as individual substance and the combination with sulfamethoxazole (cotrimoxazole) and 25% for nitrofurantoin. CONCLUSION: Men with symptoms indicative of a UTI should not be treated empirically. A urine culture and antibiogram should be obtained before a treatment decision is made. A low-count UTI was common and should not be considered normal.

Adult↗
PubMed1997

[A clinical study on combination therapy of antimicrobial agents for complicated urinary tract infection--with special reference to combination with clarithromycin].

PURPOSE: To confirm the clinical efficacy of the combined therapy to complicated urinary tract infection (UTI), we conducted a comparative clinical study of the combined therapy with ciprofloxacin (CPFX) and clarithromycin (CAM) acting an biofilm elimination or CPFX alone in patients with complicated UTI. PATIENTS AND METHODS: The study was carried out in patients with complicated UTI having WBCs with 5/hpf or more in urinary sediment and bacteriuria at least 10(4) CFU/ml. The combined therapy was CPFX and CAM, each 600 mg/day, for 14 days, and the single therapy group CPFX, 600 mg/day, for 14 days. On Day 7 and 14, the eradication rate and efficacy rate (according to the criteria of the Japanese UTI committee) were determined. In the patients with indwelling catheter, the surface of the catheter tip was observed under a scanning electron microscope (SEM) on Day 14. RESULTS: In both cases with and without catheters, clinical efficacy was higher in the combined therapy group than in the single therapy group. In particular, the efficacy rates at 14 Day were significantly higher in the former group. Furthermore, we investigated the therapeutic effect in the below MIC breakpoint of CPFX in complicated UTI. The combined therapy group showed a higher clinical efficacy in both cases with and without indwelling catheter than the single therapy group, although there was not statistically significant. Biofilm on the surface of the catheter tip was eliminated in 75% of the combined therapy group. However, none of the biofilm was eliminated in the single therapy group. CONCLUSION: From the above results, we surmise that the combined use of CPFX and CAM will show some degree of efficacy in eliminating both the causative organism and its biofilm in the complicated UTI.

Adult↗
PubMed1998

Reducing urinary tract infections in catheterized patients.

To compare the effectiveness of two drainage systems in controlling urinary tract infections (UTIs), 65 elderly home care patients with indwelling urinary catheters participated in a retrospective intervention study. The patients first used a Foley drainable bag (DB) system, followed by a nondrainable one (NDB). Both systems used a Foley catheter. Data were obtained from physicians, nurses, caregivers, and patients regarding the number of UTIs and hospitalizations that occurred when using each system. Using the DB, 65 patients had 1,395 UTIs, 27 of which required hospitalization. Using the NDB, 2 patients had 71 UTIs, 2 of which required hospitalization. The cost for the non-hospitalization UTIs with DBs was estimated at $1,153,665 compared to $57,890 with NDBs. The hospital costs with DBs were estimated at $274,170 and $15,540 with NDBs. Because DBs were used longer than NDBs (mean = 44.4 months and 8.8 months, respectively), patients who used each bag for the same period of time were compared. When these patients used NDBs they had significantly fewer UTIs (56, with one hospitalization for 7 days) than when they used DBs (242, with 10 hospitalizations for 37 days). Although the cost of purchasing the non-replaceable NDBs is greater, the use of NDBs drastically reduced levels of infection as well as the overall cost to maintain catheterized patients.

Adult↗
PubMed1998

Use of rapid dipstick tests to exclude urinary tract infection in children.

Children presenting with symptoms attributable to urinary tract infection (UTI) are not uncommonly referred to paediatric departments for assessment. The aim of this study was to evaluate the use of rapid dipstick tests in the diagnosis of urinary tract infection in children. Urine was collected from 375 children admitted to a general paediatric ward, in whom UTI was a possibility on clinical grounds. Of these, 124 were less than one year old. Urine was tested with a dipstick for the presence of nitrite and leucocyte esterase. Bacterial culture and examination for white cells, red cells and other formed elements were performed. The results of the dipstick tests, microscopy and culture were correlated with the clinical details. Combination of a negative dipstick test for nitrite and leucocyte esterase showed a negative predictive value for UTI of 96.9% and a specificity of 98.7%. In children less than a year old these values were 96.7% and 99.2% respectively. The leucocyte esterase strip test showed a negative predictive value for pyuria of 94.3% with a specificity of 86.9%. In children less than a year old these values were 93.1% and 84.4% respectively. The use of dipsticks for the detection of urinary nitrate and leucocyte esterase in daily clinical practice is recommended. In children, the absence of both nitrite and leucocyte esterase in urine indicates that UTI is unlikely; however, positive dipstick tests for nitrite and/or leucocyte esterase are not specific indicators of UTI, and should not be used in place of laboratory examination. The dipstick method is most likely to be useful as a screening test to exclude UTI in children, but may be less suitable for infants. It should not be used to diagnose urinary tract infection.

Adolescent↗
PubMed2000

[Guidelines for diagnosis and treatment of acute urinary tract problems in women].

BACKGROUND: Available guidelines for the management of symptoms of lower urinary tract infections (UTI) in women give conflicting recommendations. MATERIAL AND METHODS: We searched The Cochrane Library, Medline and other sources for evidence that met explicit inclusion criteria for the relevant options and outcomes identified. The validity of included studies was assessed. Draft recommendations were widely circulated and discussed in focus groups with patients and physician assistants. RESULTS: The probability that a woman with dysuria or frequency has bacteriuria, is 80%. The probability of UTI given a negative result of a dipstick test is 50%. Evidence suggests that antibiotics will rapidly relieve symptoms, but there are limited data from placebo-controlled randomised trials. Population based studies show that many women do not visit physicians for symptoms of UTI. Women with symptoms of UTI can be treated with antibiotics without examination of the urine. Women with earlier episodes of UTI can be offered treatment by telephone. Antibiotics for three days is sufficient based on eradication of bacteriuria. Women should be seen by a physician if the symptoms are atypical. INTERPRETATION: Implementing these guidelines could result in better service to women with UTIs. More evidence about the effects of antibiotics and other treatments is needed.

Anti-Bacterial Agents↗
PubMed2000

[Dominant etiological factors of urinary tract infections in various hospital departments and their resistance to chemotherapeutic agents].

PURPOSE: The purpose of this study was the determination of the incidence of urinary tract infection (UTI) in patients hospitalized in specific wards, and the analysis of the factors influencing the incidence of infection. METHODS: 329,608 hospital infection registration cards taken from the Polish national program for registration of hospital infections were analysed. This programme is based on a unified registration card system and on the definitions of particular types of hospital-acquired infections provided by the CDC (Centers for Disease Control, Atlanta, Georgia, USA). Statistical analysis was performed using the Statistica programme. RESULTS: 1,422 cases of hospital-acquired UTI, making up 21% of total hospital-acquired infections, were found. Six hundred sixty-six microbes were isolated from this total number of cases. The dominant pathogens were: Escherichia coli (31%), followed by Pseudomonas aeruginosa (13%), and Enterococcus sp. (12%). Hospital-acquired UTI occurred most often in maternity wards, gynaecology departments and intensive care units. Microbiological confirmation was obtained for only 45% of the clinically diagnosed cases of UTI. A disquieting increase of Pseudomonas aeruginosa resistant to chinolones was observed as well as extremely high resistance to aminoglycosides in Enterococcus sp. CONCLUSIONS: Urinary tract infections (UTIs) are the second most common form of hospital-acquired infection. Causal agents of hospital-acquired UTIs differed, depending upon the specific ward to which the patient is admitted. The most frequently isolated pathogens were Escherichia coli, Pseudomonas aeruginosa and Enterococcus sp. Microbiological confirmation of the clinically diagnosed cases of urinary tract infection is absolutely necessary, as well as a better cooperation between practicing physicians and microbiologists in the detection of hospital-acquired infection and interpretation of results.

Bacteria↗
PubMed2001

[Epidemiology of urinary infections in the Menzel-Bourguiba region: 933 cases].

The author presents a study about épidémiology of urinary tract infection (UTI) diagnosed in Menzel-Bourguiba hospital laboratory. These UTI are fréquent (933 in 18 months) and often concern ambulatory practice (63.4%). UTI in hospital (36.6%) are most fréquent in internal medicine unit (15.9%) and in pédiatric unit (7.2%). The UTI are most fréquent in female gender (sex ratio F/H = 3.0). The most fréquent isolates are Enterobacteriacae family (91.7%), and E. coli the major species (73.7%). Resistances to beta-lactams are fréquent either concerning hospital strains or ambulatory patients strains. Beta-lactams family are the most used antibiotics (80% of prescriptions). In hospital, some isolates were shown to possess extended spectrum betalactamase, but these strains became confined in the unit where appear because of the architectural conception of the hospital (pavilion system). Aminoglycosids and fluoroquinolones are very active antibiotics, but cotrimoxazole resistance is frequent. Consequently, before any prescription, it would be necessary an antimicrobial susceptibility study, either for hospital UTI, or for UTI in ambulatory practice.

Drug Resistance, Microbial↗
PubMedDate not supplied

Incidence of urinary tract infection during pregnancy.

Incidence of urinary tract infection (UTI) during pregnancy among Pakistani women was examined. Midstream urine was collected from 250 pregnant and 100 control women and streaked on blood agar and incubated. Growth was considered significant if > or = 10(5)/mL bacteria were present. Among the pregnant women, 28.5% had UTI; 30.0% of controls had UTI. Among the pregnant and control women, 24.4% and 20.0% respectively had UTI symptoms, such as incontinence, nocturia and urgency. Symptoms did not correlate with incidence. Socioeconomic status, personal hygiene, education level, pregnancy duration, postcoital washing, contraceptive use and use of underclothing had no significant association with UTI occurrence. A history of past urological problems was associated with an increased incidence of UTI in pregnancy.

Clothing↗
PubMed2002

[Variables influencing duration of hospitalization for urinary tract infection].

BACKGROUND: The need for hospitalization and its duration in children with urinary tract infections (UTI) are controversial. OBJECTIVE: To analyze the effect of certain clinical factors from the medical records of children hospitalized with UTI to determine which factors have the greatest influence on length of hospital stay. MATERIAL AND METHODS: A retrospective study of the medical records of 93 patients admitted to our department with a diagnosis of UTI between May 1998 and June 2000 was carried out. All cases were confirmed by bacteriological analysis. The variables analyzed included age, sex, duration of fever before and during admission, temperature, length of intravenous antibiotic therapy, administration of aminoglycosides, presence of urinary tract malformations, previous episodes of UTI, and length of hospital stay. RESULTS: The variables with the greatest influence on a length of hospital stay of more than 7 days were age, especially an age of less than 24 months (OR 3.42; 95 % CI 1.2-9) and the number of days with fever during hospitalization (more than 2 days: OR 2.73; 95 % CI 1.07-7.6). CONCLUSION: Patient age significantly influences length of hospital stay in children with UTI. To optimize resources, ambulatory treatment of children with UTI should be encouraged, even in those younger than 2 years.

Aminoglycosides↗
PubMed2002

Urinary tract infections in adult general practice patients.

Urinary tract infections (UTIs) are symptomatic infections of the urinary tract, mainly caused by the bacterium Escherichia coli. One in two women suffers from a UTI at least once in her life. The young and sexually active are particulaly affected, but it is also seen in elderly, postmenopausal women. The likelihood of recurrence is high. Diagnosis is made with regard to typical complaints and the presence of leucocytes and nitrites in the urine. A culture is unnecessary in most cases. Uncomplicated UTI should be distinguished from complicated UTI, which has a risk of severe illness. The treatment of choice--short-term therapy with trimethoprim or nitrofurantoin--is successful in over 80% of the cases. Co-trimoxazol fluoroquinolones or cephalsporins are not considered first-choice drugs. There are indications that general practitioners' (GPs') management of UTI is not always optimal, specifically concerning diagnostic tests, the application of second-choice antibiotics, and the length of prescribed treatment courses. Many points relevant to GPs requirefurther research, such as epidemiology and resistance of urinary pathogens in the community and natural history of UTI, as well as optimal management in elderly or complicated patients and men.

Adult↗
PubMed2002

The management of childhood urinary tract infections.

Urinary tract infections can result in significant morbidity and represent one of the most common urological conditions that the pediatrician and family practitioner encounter in the pediatric patient population. The prevalence of UTI in girls may be as high as 8.1%. UTIs also represent the most commonly identified serious bacterial infection in infants presenting with a febrile illness. Of febrile infants aged 2-3 months, 3-10% have a documented UTI. While the majority of the UTIs are not associated with any significant underlying conditions, the mere presence of a UTI is worrisome to most parents. An appropriate evaluation will determine which of these patients need referral. A brief summary is therefore presented to assist the primary care physician in the evaluation and management of childhood UTIs.

Anti-Bacterial Agents↗
PubMed2002

[Risk factors for permanent kidney damage in children with urinary tract infection].

BACKGROUND: In children, urinary tract infection (UTI) is a very common disease, and can cause permanent kidney damage. AIM: To determine risk factors for permanent kidney damage, in children with UTI. PATIENTS AND METHODS: In 337 children with UTI (237 female, mean age 4.2 years) a static renal scintigraphy was performed to assess the presence of permanent kidney damage. The history of vesicoureteral reflux and number of episodes of UTI was obtained. RESULTS: One hundred three children had a history of one episode of infection and the rest had recurrent infections. Permanent kidney damage was observed in 161 children (48%). This damage was observed in 39% of children of less than one year of age, in 43% of children aged 1 to 5 years of age and in 58% of children older than 5 years (p = 0.02). Sixty three percent of 122 children with vesicoureteral reflux had permanent kidney damage, compared with 27% of children without this condition (p < 0.001). Likewise, damage was observed in 36% of children with one episode of infection and 47% of children with recurrent infections (p < 0.01). No gender differences were observed. CONCLUSIONS: Vesicoureteral reflux, recurrence of UTI and age are associated with permanent renal damage in children with UTI.

Age Distribution↗
PubMed2003

[Changes of urinary tripsin inhibitor in blood and urine, as well as serum cytokines in living related liver transplantation].

BACKGROUND: Living related liver transplantation induces the production of many inflammatory and anti-inflammatory cytokines. Urinary tripsin inhibitor (UTI) is produced in the liver and wellknown as one of the markers of surgical stress. METHODS: To clarify the significance of UTI in blood and urine and serum cytokines in living related liver transplantation, we examined the changes of UTI, polymorphonuclear elastase (PMNE), interleukin (IL)-6, IL-1 ra and IL-10 perioperatively. RESULTS: UTI in blood increased gradually after operation. It increased from 5.2 +/- 2.2 U.ml-1 at the end of operation to 19.4 +/- 7.5 U.ml-1 on the 10 th postoperative day (POD). Similarly, UTI in urine increased after operation and the peak was on the 7th POD. Cytokines including IL-6, IL-1 ra and IL-10 showed similar changes in general gastrointestinal surgery, but the peak values in liver transplantation were lower. CONCLUSION: These results demonstrate that the recovery of the transplanted liver function require certain time after operation and UTI in urine could be an important marker whether the liver is working or not. The immunosuppressive drugs, like steroid, administered during and after operation would suppress the production of cytokines.

Adult↗
PubMed1992

[Urinary tract infections during the 1st month after kidney transplantation].

The incidence and the predisposal factors of urinary tract infections (UTI) in the first month post-transplant were studied in 255 kidney transplantations (252 patients). UTI episodes were demonstrated in 73.7% of the grafts. The most common organisms were: Escherichia coli (35.8%), Staphylococcus (33.6%), Streptococcus D (11.2%), Klebsiella (5.3%). The infectious episodes were recurrent in 39% of the cases. The majority of the UTIs were asymptomatic but 7% of the infections led to septicaemia. Etiology of end-stage renal disease, pre-graft binephrectomy, asymptomatic vesicoureteral reflux into the patient's own kidneys, type of immunosuppressive treatment, acute tubular necrosis, rejection episodes, urological complications, coexistent other infections were not predisposal factors. Bacteriuria was more frequent in female than in male patients. The incidence of UTI was found to be statistically increased with history of UTI preoperatively (p = 0.039) and the use of ureteral catheter (p = 0.018). Occurrence of UTI was less common when the donor was treated by antibiotics before brain death (p-0.025). These results provide additional support for regular monitoring of urine cultures in the first month post-transplant. They should help to identify means of reduction of this infectious risk.

Adult↗
PubMed1992

Toward improved empiric management of moderate to severe urinary tract infections.

BACKGROUND: Guidelines to show whether a patient hospitalized because of a urinary tract infection (UTI) has a severe infection, and whether he or she is at high risk for harboring a multiresistant pathogen, are scant. The aims of the present study were to find (1) clinical and laboratory variables known within 24 hours of admission that, combined in a logistic model, will point to a high or low probability of bacteremia and (2) variables that can be used to define patients at high risk for the subsequent isolation of a multiresistant uropathogen. METHODS: In a set of patients consecutively admitted to a department of medicine because of UTI, we compared bacteremic vs nonbacteremic patients, and patients with a multiresistant uropathogen vs others, on logistic regression analysis. The logistic models derived were validated in a second set of patients with UTI. RESULTS: Among 247 patients with UTI (median age, 75 years), 80 of them with bacteremia, five factors were significantly and independently associated with bacteremia: serum creatinine level, leukocyte count, temperature, diabetes mellitus, and low serum albumin level. A logistic model incorporating those factors was used to divide the patients into three groups with increasing prevalence of bacteremia (6%, 39%, and 69%) and of death (3%, 6%, and 20%). Three factors were predictive of the subsequent isolation of a resistant uropathogen: use of antibiotics before admission, advanced age, and male gender. The combination of those factors was used to divide patients into two groups, with resistance to cefuroxime of 9% vs 28%, to gentamicin of 7% vs 20%, and to sulfamethoxazole-trimethoprim of 30% vs 50%. In a second set of 144 patients with UTI, the percentages of bacteremia in the three groups were 5%, 16%, and 55%, and those of death, 2%, 6%, and 17%. When divided by the second model, the resistance to cefuroxime in the two groups was 16% vs 30%; to gentamicin, 16% vs 28%; and to sulfamethoxazole-trimethoprim, 28% vs 59%. CONCLUSIONS: If prospectively validated in other settings, the models can be used to define groups of patients with UTI at low and high risk for bacteremia, and to help in the choice of empiric antibiotic treatment.

Adolescent↗
PubMed1992

[Sequential parenteral and oral therapy with ofloxacin in urogenital infections].

125 hospitalized patients (56 men and 69 women) suffering from urinary tract infection (UTI) and 15 women with endometritis or pelvic inflammatory disease were treated with ofloxacin 6 mg/kg/d i.v. divided into 2 doses. Two thirds of the patients were switched to oral ofloxacin using the same dose regimen after 4 days. The median duration of treatment was 10 days. 98 patients were evaluable for efficacy: 45 had complicated lower UTI, 32 had upper UTI (75% of them with complications), 13 had endometritis and 8 an uncomplicated lower UTI. The most frequent complications of UTI were: obstruction (n = 27), indwelling catheters (n = 23), urinary concrements (n = 12), residual urine (n = 8) and a neurogenic bladder (n = 6). 22 patients had diabetes mellitus. A total of 103 pathogens was isolated from the urine of 85 patients, the most frequent being E. coli, Proteus spp. and Enterococcus faecalis. 98% of patients with UTI and 85% of patients with endometritis were clinically cured. Adverse drug events were observed in 6 patients.

Adolescent↗
PubMed2004

Resistance rates to commonly used antimicrobials among pathogens of both bacteremic and non-bacteremic community-acquired urinary tract infection.

This study examined the distribution of organisms and their antimicrobial resistance in patients admitted due to acute bacteremic and non-bacteremic community-acquired urinary tract infection (UTI). During a period of 1 year and 1 month, a total of 201 patients and 253 bacterial isolates were studied. Fever higher than 38.5 degrees C was significantly more common in the bacteremic group than the non-bacteremic group (68% vs 48%; p<0.05). Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Proteus mirabilis were the most common organisms isolated. E. coli was the leading pathogen and it was significantly more predominant in bacteremic UTI than non-bacteremic UTI (73% vs 49%; p<0.01). Bacteria other than E. coli (i.e., K. pneumoniae, P. aeruginosa, Proteus spp., Morganella morganii, Enterobacter cloacae, Citrobacter spp., Acinetobacter baumannii, Serratia marcescens, and Providencia spp.) were more common in non-bacteremic UTI than bacteremic UTI (44% vs 22%; p<0.01). E. coli isolated from both bacteremic and non-bacteremic patients had a high rate of resistance to ampicillin (80%), cephalothin (59%), gentamicin (29%), piperacillin (61%), trimethoprim-sulfamethoxazole (56%), amoxicillin-clavulanic acid (34%), and ticarcillin-clavulanic acid (36%). Isolates of P. aeruginosa, K. pneumoniae, and Proteus spp. from the non-bacteremic group showed a higher proportion of resistance to extended-spectrum cephalosporins, aminoglycosides (netilmicin and amikacin) and ciprofloxacin. The emergence of a high rate of resistance to commonly used antimicrobials (ampicillin, cephalothin, gentamicin, trimethoprim-sulfamethoxazole, piperacillin, amoxicillin-clavulanic acid and ticarcillin-clavulanic acid) may have an impact on the antibiotic treatment of patients admitted due to acute community-acquired bacteremic or non-bacteremic UTI in Taiwan. Further studies are needed to clarify the impact of antimicrobial resistance on the outcome in these conditions.

Adult↗