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PubMed1991

[Clinical evaluation of the combination of carumonam and cefotiam in the treatment of complicated urinary tract infection].

The combination of carumonam (CRMN) and cefotiam (CTM), expected to have a broader spectrum of coverage in connection with urinary tract infections, was evaluated for its effectiveness and safety at the Department of Urology, Osaka University Hospital and 17 affiliated hospitals. CRMN and CTM were given together to 109 patients with complicated urinary tract infections (UTI), of whom 65 cases satisfied the "Criteria of UTI Committee for the Evaluation of Drug Efficacy in the UTI (3rd Ed.)", which was modified by adopting the midstream urine data for women. CRMN and CTM were administered by drip or one-shot infusion at a total daily dose of 4 g (equally mixed 1 g plus 1 g each, twice a day) for 5 consecutive days or longer. The overall clinical efficacy rate in the 65 cases of complicated UTI was 72%, estimated by the criteria cited above. The efficacy rate according to the infection type groupings was 72% for the 29 patients in the 1st group, 100% for the 1 patient in the 2nd group, 100% for the 7 patients in the 3rd group, 83% for the 6 patients in the 4th group, 50% for the 14 patients in the 5th group and 75% for the 8 patients in the 6th group. The disappearance rate of both urinary Gram positive cocci and Gram negative bacilli was 83.3%. Fifteen strains appeared after the treatment, only 4 of which were Gram positive cocci. Among the 109 patients treated with CRMN+CTM, no subjective side effects were recorded and the abnormalized laboratory findings observed were: eosinophilia in one patient, increases in both GPT and GOT in one patient, and lowered creatinine clearance in one patient. With a broader spectrum and safe regimen, the combination of CRMN/CTM is recommended as the first choice against complicated UTI.

Adult↗
PubMedDate not supplied

[Urinary tract infection in childhood--a review. 1: Diagnosis].

Urinary tract infections (UTI) are common in childhood. About 10% of children with UTI develop renal scars. Main risk factors for development of pyelonephritic scarring are obstructive malformations, vesicoureteric reflux, young age and delayed or insufficient therapy. Thus, in infants with fever one should always think of pyelonephritis. The most important objective in the management of children with UTI is the prevention of kidney damage. An early and correct diagnosis is necessary. The localisation of UTI and search for risk factors by imaging diagnostic techniques is the basis for specific therapy and follow-up. The present paper gives recommendations for the diagnostic procedure in children with UTI.

Bacteriuria↗
PubMed1989

Molecular epidemiology of Pseudomonas aeruginosa--urinary tract infections in paraplegic patients.

84 Pseudomonas aeruginosa strains from 29 paraplegic patients with urinary tract infections (UTI) and from the water reservoirs of specialized wards in two German hospitals were typed using a P. aeruginosa-specific DNA probe. P. aeruginosa strains were present in 51% of all accessible water reservoirs, including sinks of wash-basins and toilets in the wards. 14 of the 29 patients with UTI (48%) were infected by P. aeruginosa strains which were also isolated from these sources. Groups of up to four patients were infected by single strains. Some of the strains persisted in the wards and were isolated from the water reservoirs five to eight months after causing UTI. 89.5% of the investigated water samples yielded P. aeruginosa strains which were identical with strains from up to nine other sites. The wide distribution of single P. aeruginosa genotypes in the ward, the isolation of strains causing UTI from rooms inaccessible to the patients, and the outbreak of UTI caused by single, identical P. aeruginosa strains in groups of patients within short time periods, suggest that the strains are distributed by the personnel rather than by the patients who for the most part are immobile.

Cross Infection↗
PubMed1989

[Clinical evaluation of aztreonam (AZT) in the treatment of complicated urinary tract infections].

Aztreonam (AZT, Azactam) was given to 176 patients with complicated urinary tract infections (UTI), of whom 110 cases satisfied with the "Criteria of UTI Committee for the Evaluation of Drug Efficacy in the UTI (3rd Ed.)", which was modified by adopting the midstream urine data in cases of women. Aztreonam was administered by drip infusion at a daily dose of 1 to 4 grams (mostly 2 grams) for at least five days long. The overall clinical efficacy rate of AZT in the 110 cases with the complicated UTI was 64%, estimated by the criteria cited above. The efficacy rate according to the infection type groupings was 66% for the 38 patients in the 1st group, 33% for the 3 in the 2nd group, 79% for the 19 in the 3rd group, 85% for the 21 in the 4th, 47% for the 19 in the 5th and 42% for the 12 in the 6th group. The disappearance rate of Gram negative bacilli was 87.1%. Especially 15 strains of Pseudomonas aeruginosa were eliminated out of 25 (60%) after AZT administration. Forty-six strains appeared after AZT treatment, 36 (76%) of which were Gram positive cocci. Subjective side effects and abnormal laboratory findings in a total 176 cases were: diarrhea in one, upper abdominal discomfort in one, increases in glutamic pyruvic transaminase in 8, increases in glutamic oxaloacetic transaminase in 5 and eosinophilia in 1. All of these disappeared after termination of the drug. AZT might therefore be a useful and safe antibiotic for the first choice use against complicated UTI.

Adolescent↗
PubMed1989

New approaches in the treatment of urinary tract infections.

Our increased understanding of the pathophysiology of urinary tract infections (UTIs) have not only challenged our past approaches to the management of UTIs but also have enhanced our skills to diagnose and control the great majority of UTIs simply, quickly, and cost-effectively. Single-dose treatment is increasingly replacing traditional 10 to 14 days treatment for UTIs. Recurrent UTIs are better understood and becoming more manageable. Newer antibiotics are proving to be very promising and effective with minimal risk of development of resistant strains.

Anti-Bacterial Agents↗
PubMedDate not supplied

Influence of vesicoureteral reflux and urinary tract infection on renal growth in children with upper urinary tract duplication.

The growth of the renal parenchyma was examined in children with duplicated outflow systems, vesicoureteral reflux (VUR), urinary tract infection (UTI) and no sign of obstruction. Ten patients with reflux occurring only in the caudal system (group A) and 4 patients with reflux both to the caudal and the apical system (group B) were studied shortly after their first UTI (study 1) and then 1.5 to 9 years later (study 2). The frequency of UTI was relatively high during the follow-up period. At urography, renal length and renal area were normal in group A in studies 1 and 2. Parenchymal thickness of the apical pole (APT/L) did not differ from normal values in any of the studies. Parenchymal thickness of the caudal pole (CPT/L) was significantly smaller than normal in both studies. There was also a significant decrease in CPT/L between study 1 and 2. UTI during the first year of life was associated with a greater reduction in CPT/L. The determination of renal length and renal area in children with a duplicated ureter, VUR and UTI, does not identify subjects at risk of developing renal growth retardation while serial determinations of parenchymal thickness appear to be an appropriate method.

Child↗
PubMedDate not supplied

[Trypsin inhibitor in the urine of patients with glomerulonephritis].

Concentrations of urinary trypsin inhibitor (UTI) and acid stable antitryptic activity (AS-ATA) were estimated in morning urine of 50 patients with chronic glomerulonephritis and of 13 healthy persons in order to detect interrelationship between severity of kidney impairment and the content of the inhibitor in urine. In healthy persons concentrations of UTI and AS-ATA were equal to 1.05 +/- 0.15 micrograms/ml and 0.12 +/- 0.04 IU/ml, respectively. Similar values of the substances were detected in patients with latent form of glomerulonephritis and normal kidney function. Statistically distinct (P less than 0.01) increase of both these inhibitors was found in urine of patients with latent form of glomerulonephritis and impaired kidney function (4.77 +/- 1.24 micrograms/ml and 0.39 +/- 0.15 IU/ml, respectively) as well as with nephrotic form (26.17 +/- 7.55 micrograms/ml and 1.37 +/- 0.35 IU/ml, respectively) of glomerulonephritis of both primary type and caused by accompanying systemic diseases. Further increase in concentration of UTI up to 31.74 +/- 7.38 micrograms/ml and activation of AS-ATA in urine was observed in the patients with nephrotic form of glomerulonephritis at the step of chronic kidney insufficiency. The increase in UTI concentration observed did not correlate with the level of leukocyturia. Proteinases of monocytes, mast cells, fibroblasts, involved in inflammation and formation of connective tissue in kidney, but not of enzymes from polymorphonuclear leukocytes, appear to be responsible for formation of UTI out of its precursor inter-alpha-trypsin inhibitor in glomerulonephritis.

Adolescent↗
PubMed1987

[Clinical study of ofloxacin (OFLX) on urinary tract infections].

Fifty-three patients with urinary tract infections (UTI) were treated with Ofloxacin, a new oral synthetic antimicrobial agent, and its clinical efficacy was studied. Ofloxacin (600 mg/day) was administered to 35 patients with acute simple cystitis for more than three days, and to 17 patients with complicated UTI for more than five days except a case in which the treatment was interrupted for side effects. Acute simple cystitis: In ten cases meeting the criteria of UTI committee, overall effectiveness rate was 100%. All of the 26 strains isolated from 26 patients disappeared after the treatment. In all of acute simple cystitis cases, 94.3% were evaluated as excellent or as moderate by attending doctors. Complicated UTI: In 11 cases treated during five or seven days, 63.6% of patients showed improvement on pyuria. Seven out of nine strains isolated from seven patients disappeared. However, two strains of P. aeruginosa and P. cepacia persisted after the treatment. In all of the complicated UTI cases, 38.9% of patients were evaluated as excellent or as moderate by attending doctors. Some slight side effects were observed in four out of 53 cases. This study showed that Ofloxacin is effective against urinary tract infections.

Acute Disease↗
PubMed1986

[Norfloxacin in the treatment of urinary tract infections].

28 patients with urinary tract infections (UTI) were treated with norfloxacin 2 X 400 mg daily for 9 days. 14 of these patients had complicated UTI (stones, obstruction). The main pathogens were E. coli and Proteus mirabilis. On the third day of treatment all bacteria were eradicated. One week after therapy all patients with uncomplicated UTI were cured and, likewise, 9 of 14 with complicated UTI. There was no laboratory evidence of adverse effects. 6 patients reported only mild side effects such as epigastric pain, dizziness and pruritus, which did not necessitate discontinuation of norfloxacin. Norfloxacin appears to be safe and effective in the treatment of UTI.

Adolescent↗
PubMed1979

Do condom catheter collecting systems cause urinary tract infection?

A study was undertaken to determine whether use of a condom catheter collection system (CCCS) is associated with urinary tract infection (UTI). No UTI developed in 79 episodes of CCCS use in patients who were cooperative or because of paralysis were unable to manipulate the collecting system (mean time per patient, 21.2 days; total number of patient days, 1,677). By contrast, in 15 patients who were identified prospectively as being uncooperative and who repeatedly manipulated the CCS, UTI developed in eight (53.3%) within a mean of 9.6 days. Urethral catheterization in cooperative patients during CCCS use was followed by development of UTI. Repeated interference with the proper use of CCCS and urethral catheterization during CCCS use are associated with an increased risk of UTI.

Humans↗
PubMedDate not supplied

[Urinary infection and pyelonephritis].

Actual concepts on urinary tract infection (UTI) and pyelonephritis have changed constantly through the years. A brief historical review has been considered in this paper, with the hope that nowadays concepts may help the clinician towards a better diagnostic and management approach of these still so common clinical disorders. Bacteriological studies were performed in 245 urine samples obtained by three different procedures, in order to evaluate the reability of each technique, which were: different procedures, in order to evaluate the reability of each technique, which were: a) suprapubic puncture; b) single culture obtained by midstream voiding technique, and c) serial cultures in three different samples, also obtained by the latter technique. E. coli was isolated in 91% of the initial diagnosed episode of UTI, and in 87% of the recurrences. Same bacteria, as well as other organisms and mixed flora were isolated from patients with predisposing factors present within the urinary tract (intra UT predisposing factor). Results show that suprapubic tap is the most reliable technique, since bacterial contamination of the sample is avoided. Fifty percent incidence of false positive results was found when a single culture by midstream voiding technique was used. A better correlation between suprapubic puncture and serial cultures obtained by midstream voiding technique was found. Both procedures are recommended. Predisposing factors, mainly within the urinary tract, were found in 68% of the cases with demonstrated UTI. Vesicoureteral reflux was found in 27% from the total number of patients studied, and in 52% of the patients with intra-UT predisposing factors. Suggestions are made in relationship with diagnostic approach and management of patients with UTI, in order to reveal the presence of predisposing factors, since they are the main feature to take into account regarding UTI, location of the site of infection, recurrences, chronic evolution, treatment and prognosis.

Bacteria↗
PubMed1984

[Clinical evaluation of ceftizoxime in the treatment of complicated urinary tract infections].

Ceftizoxime (CZX) was given clinically to 80 patients with urogenital tract infections, in which 34 cases of complicated UTI satisfied the criteria of the UTI committee. CZX was administered for at least five days at a daily dose of 1 to 4 g in two divided doses by intravenous drip infusion. The overall clinical efficacy of CZX in 34 cases of complicated UTI was 59%, estimated by the criteria of the UTI committee. The overall clinical efficacy rate according to group of infection was: 64% for the 11 patients in the 1st group, 56% for the 9 patients in the 2nd group, 100% for the 5 patients in the 3rd group, 50% for the 4 patients in the 4th group and 20% for the 5 patients in the 5th group. No serious side effects were observed in the clinical or laboratory findings except for slight elevation in GOT & GPT values in two cases (2.5%), which returned to normal after CZX treatment. It is therefore suggested that CZX is a clinically useful and safe drug in the treatment of complicated UTI.

Adolescent↗
PubMed1984

[A clinical observation on pyeloplasty in obstruction of the ureteropelvic junction. Special consideration on Anderson-Hynes pyeloplasty].

Thirty-three patients (thirty-five kidneys) underwent pyeloplasty for hydronephrosis due to obstruction of ureteropelvic junction between 1963 and 1982 in our department. Renal function was judged to have improved in 68 and 67% of the patients from the radiogram and radioisotope renogram, respectively, Anderson-Hynes pyeloplasty was performed on 27 kidneys. In these kidneys, the improvement of renal function as judged from the radiogram and radioisotope renogram was 74 and 71%, respectively. Postoperative results were compared according to age, preoperative urinary tract infection (UTI), indwelling periods of nephrostomy and splint catheter, and duration of postoperative UTI. In addition the relationship between indwelling periods of nephrostomy catheter and the duration of postoperative UTI are discussed. Infants under 10 years old had the best improvement. Preoperative UTI and indwelling periods of nephrostomy and splint catheter were not directly related with post operative results. The cases with nephrostomy catheter which could be removed within the 16th day after operation had excellent improvement on UTI and also in renal function.

Adolescent↗
PubMed1984

Characteristics of urinary tract infection caused by coagulase-negative Staphylococcus in a group of young women.

Of 147 young women, aged 17 to 34 years, with signs, symptoms and bacteriological evidence of urinary tract infection (UTI), 23 (15.6%) had an infection caused by coagulase-negative Staphylococcus (coag- neg Staph). All patients with coag- neg Staph UTI were sexually active, in contrast to 84.7% of those with UTI of other causes (one-tailed P = 0.03). The former had a higher rate of vaginal discharge (60.9 vs. 25.8% in the latter group, P = 0.003), but fewer of them used tampons as menstrual protection or oral contraceptives. A high percentage of women with coag- neg Staph UTI had commenced sexual activity recently, as compared with the rest of the group (P = 0.03). In a stepwise logistic regression analysis, the only variables that were significantly associated with coag- neg Staph UTI were vaginal discharge and recent onset of sexual activity.

Adolescent↗
PubMed1983

Urinary tract care: improvement through patient education.

The purpose of this study was to determine if a special program of patient and family education in urinary tract care would result in improved control of urinary tract infection (UTI) by spinal cord injury patients at home. The Williamson Functional Impairment Scale, modified to measure outcomes of impairment due to UTI, was applied to 54 patients in 1975 and to 21 in 1979. Patients in the latter group had completed a special urinary tract care education program of classes, reading material, written examinations, and demonstrations of acquired skills. At follow-up, only 32% of the patients in the 1975 group were asymptomatic of UTI, compared with 71% of the 1979 group. Only 5% of the patients in the 1979 group lost time from their usual daily activities, compared with 23% of the 1975 group. The improvements in impairment outcomes were not related to a reduction in the incidence of confirmed or suspected UTI (found in 63% of patients in the 1975 group and 62% of patients in the 1979 group). It is concluded that the 1979 group recognized symptoms earlier and took definitive action which resulted in less impairment and time lost due to UTI. The patient education program did result in improved urinary tract care after discharge.

Activities of Daily Living↗
PubMed1993

[Antibiotic prophylaxis for transurethral resection of the prostate--comparison of oral administration therapy with intravenous administration therapy].

To compare the prophylactic effect of oral and intravenous antibiotics against postoperative fever and urinary tract infection (UTI) after transurethral resection of the prostate (TUR-P), we conducted a multi-center prospective randomized study. The incidence of pyrexia over 38 degrees C was defined as the primary endpoint. One hundred and fifty patients with sterile urine before TUR-P were entered into this study. The patients were allocated randomly into the two arms; arm A cefotiam 4 g a day for 7 days, arm B tosufloxacin 300 mg a day for 7 days, based on the stratification into the 4 groups determined with/without preoperative indwelling catheters and with/without the history of preoperative UTI. Of these patients, 143 were eligible. We divided 124 patients without preoperative UTI and without indwelling catheters as the "low risk group", and the other 19 patients with preoperative UTI and/or with indwelling catheters as the "high risk group". In the low risk group, 9 patients out of 63 (14.3%) in arm A and 6 out of 61 (9.8%) in arm B had pyrexia during 7 postoperative days. The incidence of fever in arm B was 4.4% less than that in arm A and the 95% confidence limit was from -7% to 16%. In the high risk group, 4 out of 11 (36.4%) patients in arm A and none of 8 in arm B had fever but the difference was not significant. The incidence of post operative UTI in the low risk group on the 4 to 5, 9 to 12, 23 to 26 and 37 to 40 postoperative days was 8.3, 16.4, 25.0 and 23.9% in arm A and 6.7, 16.7, 29.6 and 36.7% in arm B, respectively. The prophylactic effect of oral administration of tosufloxacin is equivalent to that of the intravenous administration of cefotiam. The use of oral antibiotics is beneficial to reducing the cost of medication.

Administration, Oral↗
PubMedDate not supplied

[Urinary infections in adults: clinical approach and therapeutic indications].

Urinary tract infections (UTI) are the most common of all the bacterial infections affecting humans during their life span. In adult patients, UTI may be categorized into the following groups: acute uncomplicated cystitis, acute uncomplicated pyelonephritis, recurrent bacterial UTI infections, asymptomatic bacteriuria, complicated UTI, acute and chronic bacterial prostatitis. In patients with uncomplicated cystitis, short-course (3 days) empirical therapy is more effective than single dose therapy. Recurrent cystitis can be effectively managed by continuous antimicrobial prophylaxis. Acute pyelonephritis in patients with anatomically normal urinary tracts should be treated with antimicrobial therapy for 10 to 14 days. Complicated infections require a full 10- to 14-day course of antimicrobial therapy. Urologic evaluation in patients with acute pyelonephritis or recurrent infections should not be routinely performed. Screening for asymptomatic bacteriuria is unnecessary in adults, except in particular circumstances. There is little evidence that UTI in adult patients lead to progressive chronic renal injury, unless complicating factors are concurrently present.

Acute Disease↗
PubMed1993

[A clinical study of lomefloxacin on the patients with urinary tract infections--focused on lomefloxacin-induced photosensitivity reaction].

Between April and October 1990, photosensitivity reactions were observed in 19 out of 338 patients who were administered lomefloxacin (LFLX) for the treatment of urinary tract infections (UTI) in our hospital. To certify the effectiveness and safety of LFLX to UTI, we carried out a controlled study with fixed dosages and durations. Patients with acute uncomplicated UTI and chronic complicated UTI were enrolled and LFLX dosages of 200 mg b.i.d. for 7 days and 14 days, respectively, were administered. The overall efficacy rates were 100% and 84% respectively. Concerning the bacteriological effect, Escherichia coli and Klebsiella pneumoniae were eliminated in every case, while 3 strains of Enterococcus faecalis 2 strains of Pseudomonas aeruginosa and one strain of Enterobacter cloacae persisted. No photosensitivity reaction or noteworthy severe adverse reactions were observed among 200 cases enrolled in this study of restricted dosages and durations. We, urologists, need to be well-informed about photosensitivity reactions induced by quinolone antimicrobial agents. LFLX was proven to be effective in UTI without showing any photosensitivity reactions when administered by our fixed dosages and durations.

Adolescent↗