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At least 1,063 records · Page 59Linked to original sources
PubMed1988

Clinical experience with ciprofloxacin in the treatment of urinary tract infections: a review.

During the clinical development of ciprofloxacin 1,519 treatments of UTI were documented. The most frequent specific diagnoses were uncomplicated UTI (46.6%), followed by non-specified UTI (21.7%), complicated UTI (19.4%), acute pyelonephritis (7.6%) and chronic pyelonephritis (4.1%). 70% of the causative organisms isolated were Enterobacteriaceae (Escherichia coli 38%, Proteus spp. 10% and Klebsiella pneumoniae 10%). Pseudomonas aeruginosa occurred in approximately 20% of the cases and the remaining 10% were gram-positive aerobes. Clinical resolution was achieved in about 90% in all specific diagnoses. The eradication rate for gram-negative Enterobacteriaceae was 93.8%, for P. aeruginosa 81.8% and for gram-positive aerobes 90.2%. Studies comparing ciprofloxacin and standard treatment have shown the high efficacy of ciprofloxacin making it a preferred agent particularly for infections caused by pathogens less susceptible to conventional drugs. According to the experience of clinical trials the recommended ciprofloxacin dose varies between 100 and 500 mg b.i.d. orally depending on the severity of clinical status and the susceptibility of the pathogen.

Adult↗
PubMedDate not supplied

Cefotaxime in urinary tract infections.

According to available studies the experience with cefotaxime in the treatment of urinary tract infections (UTI) is presented. Because of its broad spectrum antibacterial activity cefotaxime is active against most of the causative organisms, including multiresistant strains (except enterococci). Of 400 isolates cultured from 400 urological inpatients with complicated and/or hospital acquired UTI 90.2% of the gram-negatives and 87.7% of the staphylococci were inhibited by concentrations of less than or equal to 8 mg/l. As with other antibiotics in uncomplicated UTI, high cure rates could be achieved by single dose or short-term treatment. According to six non-comparative and nine comparative studies it could be demonstrated that treatment with cefotaxime achieved favorable results in patients with complicated and hospital acquired UTI even if caused by multiresistant strains. In general, in these studies cefotaxime was superior to gentamicin, cefoxitin, cefazolin and cefuroxime, but as effective as other third generation cephalosporins and aztreonam and as the combination of ampicillin and netilmicin. A good tolerance of cefotaxime was reported in all studies.

Cefotaxime↗
PubMedDate not supplied

Cephadroxil promotes vaginal colonization with Escherichia coli.

The aim of this study was to examine whether a vaginal Escherichia coli colonization, mimicking the one seen in UTI-prone females, could be induced by local cephadroxil administration. When five adult cynomolgus monkeys were given a vaginal flush with a P-fimbriated E. coli strain, none became persistently colonized. When such colonization attempts were preceded by cephadroxil administration a persistent colonization occurred in 9/10 experiments. Cephadroxil also promoted a spread of fecal E. coli strains to the vagina. Reduction of the anaerobic vaginal flora can explain the breakdown of the colonization resistance. Clinical observations suggest that accumulation of E. coli around the urethral orifice increases the risk of UTI. Therefore antibiotics which promote such colonization may increase the risk for UTI in susceptible patients. From this point of view antibiotics such as cephadroxil may be less suitable for treatment of UTI-susceptible patients.

Administration, Intravaginal↗
PubMed1985

[Clinical course and scar development in operated vesico-renal reflux in a long-term study].

62 patients (14 boys, 48 girls) representing 85 refluxive renal units (Grade 2-4) were investigated after successful operation for the development of further urinary tract infections (UTI) and renal scars (RS). The mean follow-up was 9.3 years. With the exception of one boy, none of the male patients developed any UTI or new RS. A similar result was obtained for about 45% of the girls. These two groups of patients presented with high-grade reflux before surgery. The remaining female patients (about 55%), however, presenting with lower-grade reflux before surgical treatment, developed further UTI as well as new RS despite surgical correction of their reflux. Investigations on the capacity of uroepithelial cells (UEC) to suppress bacterial growth revealed a deficient antibacterial effect of UEC in these patients. Such an UEC defect has also been shown in patients with asymptomatic bacteriuria. In conclusion, different reasons seem to be responsible for recurrent UTI and the development of RS in patients with reflux.

Adolescent↗
PubMed1993

Rational use of CT in acute pyelonephritis: findings and relationships with reflux.

Enhanced renal CT scanners were performed in 38 children (82% girls) to rule out acute pyelonephritis. Patients were divided in 2 groups on the basis of clinical presentation and bacteriology data. In patients of group A (n = 16, preliminary study), upper urinary tract infection (UTI) was certain. CT confirmed the diagnosis in all but 3 patients (a 2-year-old child and 2 patients with UTI developed on prior obstruction). In subsequently studied patients of group B (n = 22), clinical findings or bacteriology data were negative or questionable. CT made the diagnosis of acute pyelonephritis in 11 patients. As well as DMSA scintigraphy, CT scanner can help to diagnose or to rule out upper UTIs in difficult cases. In all boys of both groups, ipsilateral vesico-ureteric reflux (VUR) was found by subsequent voiding cystourethrography (VCUG) on the side of pyelonephritis. In girls, this correlation was shown in only 7 of the 25 kidneys with pyelonephritis. This result supports the hypothesis of a gender-dependent contamination. We believe that absence of radiologic reflux cannot exclude the possibility of bacterial crossings of ureteric meatus capable to lead to genuine upper UTIs.

Acute Disease↗
PubMed1993

Staphylococcus saprophyticus urinary tract infections in children.

Staphylococcus saprophyticus commonly causes urinary tract infection (UTI) in young women; in males it is found mainly in the elderly. In this study S. saprophyticus UTI occurred in 59 children (45 girls and 14 boys) below 16 years of age, of whom 20 were less than 13 years of age. The common presentation was dysuria and flank or back pain whereas fever > or = 38.5 degrees C was rare. Radiological investigation performed in 63% of the children revealed no anomalies of importance. Children with S. saprophyticus UTI appear to constitute a group with a low frequency of urinary tract anomalies and with a low risk of UTI caused by other bacteria.

Adolescent↗
PubMed1990

Urinary tract infections in post-renal transplant patients.

The overall incidence of urinary tract infections (UTIs) in our renal transplant population was 30.9%, i.e. 0.15 episode per patient-year. UTIs occurred more often within the first 3 months (60%) of transplantation. Fifty per cent of UTIs were asymptomatic. Recurrences were common. Acute tubular necrosis and cellular rejections were important associations. UTIs had little effect on graft function and survival up to 3 years post-transplant.

Adolescent↗
PubMed1987

Microscopic estimation of bacteria and cells in urine. II. A clinical study on the application of the theoretical considerations to clinical practice.

An improved technique for diagnosing acute urinary tract infections (UTI) by means of microscopic estimation of bacteria, leucocytes, erythrocytes and epithelial cells in urine was tested clinically in a total of 1,807 samples obtained from hospital departments. Marked bacteriuria (greater than or equal to 10(5) bacteria per ml of urine) was found microscopically in 13.1% of the urines. Of these 1.9% were falsely positive. Altogether 3.5% of the samples were falsely negative. When the sample collection was controlled carefully and detailed information on possible collection errors was given regularly, sensitivity and specificity indices of the microscopic technique were 85.3 and 98.1, respectively. Microscopic finding of cocci, e.g. Enterococci and Str. agalactiae, was more difficult than that of rods. Alongside bacteriuria, finding of leucocytes (greater than 5 leucocytes per microscopic field) was of great importance for UTI diagnostics, and it strengthened further the microscopic diagnosis, while erythrocytes and epithelial cells were of very poor significance for UTI diagnosis. The results show that the microscopic technique described here is a reliable and suitable method for UTI diagnostics in routine clinical laboratories which examine daily large numbers of samples, most of them negative.

Bacteriuria↗
PubMed2007

[Urinary tract infections in infants and children -- a consensus on diagnostic, therapy and prophylaxis].

Urinary tract infections (UTI) are among the most common bacterial infections in infants and children. The early diagnosis of a pyelonephritis and its rapid, calculated antibacterial therapy are decisive for the prognosis. Urogenital anomalies, renal damage and bladder dysfunction may influence the risk of recurrences of UTI and pyelonephritic scarring. Diagnostic strategies therefore should focus on their early recognition. Pediatricians, urologists and infectiologists are cooperating in diagnostic, therapy and prophylaxis of UTI. The aim of the interdisciplinary consensus presented was to work out a concept which may help to manage childhood UTI in daily practice.

Administration, Oral↗
PubMed1997

[Transurethral laser ablation of the prostate in high risk patients with obstructive benign prostatic hyperplasia. Perioperative morbidity and 6 month outcome in 72 patients].

Between November 1993 and September 1995, we carried out visual laser ablation of the prostate (VLAP) in 72 high-risk patients (ASA 3-4; severe cardiovascular and/or pulmonary diseases) aged 60-88 years (mean 76.7 years); the prostate volume was 22-136 ml (mean 56 ml). The urinary peak flow rates (Qmax.) ranged from 2 to 15 ml/s (mean 4.4 ml/s) preoperatively; 42 patients (58.3%) suffered from acute urinary retention for up to 2 weeks and had an indwelling catheter. The residual urinary volume (RUV) was 0-320 ml (mean 142.3 ml) in those 30 patients with spontaneous micturition. The International Prostate Symptom Score (IPSS) ranged from 10 to 33 (mean 21.8). In the first 37 patients, pressure-flow studies were carried out only in cases of doubt to verify obstruction. In the last 35 patients, pressure-flow studies were carried out in every case. Perioperatively, there was no appearance of blood loss of absorption of irrigation fluid. None of our patients needed transfusions or intensive care perioperatively. Further complications were not severe and could be handled without problems. In two patients with large benign prostate hypertrophy (BPH) a second operation (VLAP, no conventional transurethral prostatectomy) was necessary. After 6 weeks, 29.4% of the patients suffered from symptomatic urinary tract infections (UTI). After 6 months, only 7.1% of the patients had symptomatic UTI. After 6 weeks (n = 61), Qmax. was 6-34 ml/s (mean 15.3 ml/s), RUV was 0-230 ml (mean 51.5 ml), and the IPSS was 12.3 (8-28). After 3 months (n = 54), Qmax. was 9-45 ml/s (mean 19.8 ml/s), RUV was 0-96 ml (mean 31.6 ml), and the IPSS was 1-23 (mean 7.4). After 6 months (n = 52) Qmax. was 12-33 ml/s (mean 20.4 ml), RUV was 0-53 ml (mean 26.4 ml), and the IPSS was 1-12 (mean 4.1). VLAP provided no further risks for our high-risk patients, while Qmax., RUV, and IPSS were improved noticeably (improvement of more than 75%). It represents a step forward in the treatment of obstructive BPH in high-risk patients. Particularly in high-risk patients with cardiac diseases, this procedure lessens the perioperative risk. Despite the minimal appearance of UTI after 6 months, UTI seemed to be the most important complication during the first few weeks after VLAP by virtue of the bothersome symptoms.

Aged↗
PubMed2003

A continuous quality-improvement program reduces nosocomial infection rates in the ICU.

OBJECTIVE: To assess the impact of a continuous quality-improvement program on nosocomial infection rates. DESIGN AND SETTING: Prospective single-center study in the medical-surgical ICU of a tertiary care center. PATIENTS. We admitted 1764 patients during the 5-year study period (1995-2000); 55% were mechanically ventilated and 21% died. Mean SAPS II was 37+/-21 points and mean length of ICU stay was 9.7+/-16.1 days. INTERVENTIONS: Implementation of an infection control program based on international recommendations. The program was updated regularly according to infection and colonization rates and reports in the literature. MEASUREMENTS AND RESULTS: Prospective surveillance showed the following rates per 1000 procedure days: ventilator-associated pneumonia (VAP) 8.7, urinary tract infection (UTI) 17.2, central venous catheter (CVC) colonization 6.1, and CVC-related bacteremia and 2.0; arterial catheter colonization did not occur. In the 5 years following implementation of the infection control program there was a significant decline in the rate per patient days of UTI, CVC colonization, and CVC-related bacteremia but not VAP. Between the first and second 2.5-year periods the time to infection increased significantly for UTI and CVC-related colonization. CONCLUSIONS: A continuous quality-improvement program based on surveillance of nosocomial infections in a nonselected medical-surgical ICU population was associated with sustained decreases in UTI and CVC-related infections.

Cross Infection↗
PubMed2006

Incidence and risk factors of device-associated infections and associated mortality at the intensive care in the Dutch surveillance system.

OBJECTIVE: To examine the incidence of and risk factors for device-associated infections and associated mortality. DESIGN AND SETTING: Prospective surveillance-based study in ICUs of 19 hospitals in The Netherlands. PATIENTS: The study included 2,644 patients without infection at admission during 1997-2000, staying in the ICU for at least 48 h. MEASUREMENTS AND RESULTS: The occurrence of ventilator-associated pneumonia (VAP), central venous catheter (CVC) related bloodstream infection (CR-BSI), urinary catheter-associated urinary tract infection (CA-UTI) and risk factors was monitored. Of the ventilated patients 19% developed pneumonia (25/1,000 ventilator days); of those with a central line 3% developed CR-BSI (4/1,000 CVC days,) and of catheterized patients 8% developed CA-UTI (9/1,000 catheter days). Longer device use increased the risk for all infections, especially for CR-BSI. Independent risk factors were sex, immunity, acute/elective admission, selective decontamination of the digestive tract, and systemic antibiotics at admission, dependent upon the infection type. Crude mortality significantly differed in patients with and without CR-BSI (31% vs. 20%) and CA-UTI (27% vs. 17%) but not for VAP (26% vs. 23%). Acquiring a device-associated infection was not an independent risk factor for mortality. Being in need of ventilation or a central line, and the duration of this, contributed significantly to mortality, after adjusting for other risk factors. CONCLUSIONS: Device use was the major risk factor for acquiring VAP, CR-BSI and CA-UTI. Acquiring a device-associated infection was not an independent risk factor for mortality, but device use in itself was.

Adult↗
PubMed2006

Prophylactic single-dose prulifloxacin for catheter-associated urinary tract infection after tension-free vaginal tape procedure.

The purpose of the study was to evaluate whether antibiotic prophylaxis with a single dose of prulifloxacin after tension-free vaginal tape (TVT) procedure decreases catheter-associated urinary tract infections (UTIs). Patients undergoing TVT procedure receiving a single dose of prulifloxacin (600 mg) 10 h before catheter removal (n=54) were compared with historical controls who have had no treatment (n=60). All patients had an indwelling urethral catheter in situ for 24 h. Urine specimens for culture were collected preoperatively, before Foley removal, and 7 days postoperatively in both groups. Main outcome measures were significant bacteriuria and symptomatic UTI at catheter removal and 1 week postoperatively. No patient had a positive urine culture in the prulifloxacin group compared with 14 (23.3%) in the control group at catheter removal (P=0.0001). Ten out of 14 (71.4%) women with a positive catheter urine culture had a symptomatic UTI. One week after surgery no difference was found in the rate of significant bacteriuria between groups. Our data suggest that a prophylactic single dose of prulifloxacin could help to reduce the rate of symptomatic and asymptomatic UTIs after short-term urethral catheterization in women undergoing TVT procedure.

Adult↗
PubMed1999

The diagnostic value of intrarenal colour duplex Doppler ultrasonography in children with lower urinary tract infection.

BACKGROUND: The diagnostic value of Doppler US in infectious disease of the kidney is well documented. Previous studies have demonstrated high resistive indices, especially in tubulo-interstitial diseases. OBJECTIVE: To evaluate the role of intrarenal colour duplex Doppler US in lower urinary tract infections (UTI). MATERIALS AND METHODS: This prospective study was carried out in 111 children (222 kidneys) (age range 1-180 months). Of the children, 78 were healthy while 33 presented with lower UTI. The resistive indices (RI) were measured from the spectral waveforms obtained from interlobar arteries. RESULTS: No statistically significant difference was found between RI of right and left kidneys in both groups. The mean RI was 0.75 +/- 0.07 in patients with lower UTI and 0.71 +/- 0.1 in the control group (P < 0.05). In the control group there was an inverse correlation between age and RI (P < 0.05). CONCLUSIONS: High RI may be found in lower UTI.

Child↗
PubMed2004

Urinary tract infection in infants and children: an update with special regard to the changing role of reflux.

The aim of this study was to present current theories of pathogenesis and prognosis in urinary tract infection (UTI) and renal scarring during infancy and childhood, with special regard to new insights concerning the role of vesico-ureteral reflux (VUR). For a long time VUR and UTI were considered the only risk factors for renal scarring in childhood. Now a wider spectrum of contributing conditions is commonly accepted, which all may pose different clinical consequences and require different imaging approaches. Particularly bilateral renal scarring causes long-term sequalae; therefore, renal involvement in UTI with potential scarring has become the clinical and imaging focus, and proper diagnosis of UTI as the key factor for further management has become even more important. The VUR still remains one issue on a list of important factors such as treatment onset and response, bacterial virulence, immunological factors, genetic disposition, anatomical variants, and lower urinary tract dysfunction. Recent advances in knowledge leading to changed patho-physiological concepts, and new imaging techniques, may consecutively impact the presently established standard imaging algorithms. New, advanced imaging techniques offer improved and accelerated comprehensive imaging of the paediatric urinary tract. At present, this is complimentary to the established gold standard techniques. Strong research efforts have to be made before suggesting significant changes of current imaging concepts; however, based on recent technical advances and new insight on the natural history of paediatric urological diseases, potential changes of established imaging algorithms need to be discussed and evaluated.

Child↗
PubMed2002

The role of DMSA scans in evaluation of the correlation between urinary tract infection, vesicoureteric reflux, and renal scarring.

The correlation between urinary tract infection (UTI), vesicoureteric reflux (VUR) and renal scarring was studied in 89 patients (177 renal units; 1 solitary kidney) during the period 1997-2000. There were 63 males and 26 females; ages ranged from neonates to 14 years. UTI was diagnosed on the basis of a positive urine culture, VUR was diagnosed and graded by micturating cystourethrogram (MCU), and renal scarring was assessed by technetium 99 m Tc-dimercaptosuccinic acid (DMSA) scan. Ultrasonography (US) was done to evaluate renal tract dilatation and other structural abnormalities. A follow up DMSA scan was performed approximately 6 months after the initial scan. VUR was present in 106 of the 171 renal units in which it was studied and absent in 65 units. The majority of the VUR was grade V. Renal scars were seen in 90 of 177 renal units at presentation and in 72 of the 163 renal units studied at follow-up. Some information was lacking in 31 patients; hence, the correlation between UTI, VUR, and renal scarring was done in 58 patients. The majority of the suspected scars at presentation were not seen at follow-up, but most of the established scars persisted. Only 2 renal units showed scars for the first time on follow-up. On US, approximately 50% of normal kidneys showed either suspicious or established scars on DMSA scan, and patients with bilateral abnormality on US showed renal scars. Renal scars were seen in 15 of 23 children without VUR, 17 of 18 with unilateral VUR, and 16 of 17 with bilateral VUR. Thus, there is a cause-and-effect relationship between UTI and renal scarring that is made worse by VUR. DMSA scans have been shown to be the most reliable method of assessing renal scarring, and an abnormal US scan showing upper-tract dilatation or a structural abnormality may have a predictive value in the detection of renal scarring.

Adolescent↗
PubMed2000

Concentrative relationship between polymorphonuclear elastase and urinary trypsin inhibitor in amniotic fluid.

In the amniotic fluid, urinary trypsin inhibitor (UTI) seems to inhibit polymorphonuclear elastase (PMNE) activity. The PMNE and UTI concentrations in normal amniotic fluid at 16-20 and 38-40 gestational weeks were measured. The PMNE concentration increased significantly at 38-40 weeks, whereas UTI concentration decreased significantly. According to concentrative relationships between both substances, PMNE may be activated more at the full term pregnancy. Since PMNE-induced tissue injury potentially causes degradation of amniotic collagen, the present result suggests that the quotient of PMNE and UTI concentrations is a reliable index to estimate the occurrence of rupture of the membranes.

Abortion, Induced↗
PubMed2002

Febrile urinary tract infection: Escherichia coli susceptibility to oral antimicrobials.

Empirical treatment is indicated for young children with febrile urinary tract infection (UTI). In this clinical setting, oral antibiotics are as safe and effective as intravenous therapy. The aim of this study was to investigate in children with febrile UTI whether there were longitudinal changes in the prevalence of bacteria and in the pattern of Escherichia coli susceptibility to oral antimicrobial agents. Two hundred and eighty-seven positive urine cultures from children (1 month to 12 years) with febrile UTI collected over three periods (1986-1989, 1990-1991, and 1997) were studied. E. coli was the most-prevalent microorganism in all three study-periods ( n=228). The susceptibility pattern of E. coli to nitrofurantoin (92%, 95%, 94%) and nalidixic acid (85%, 92%, 95%) did not present any statistically significant differences ( P>0.05) over time. There was a significant increase ( P<0.05) in E. coli susceptibility to cephalexin (65%, 54%, 81%). The E. coli susceptibility to trimethoprim-sulfamethoxazole (40%, 85%, 40%) behaved differently. Initially there was a significant rise ( P<0.05), followed by a significant decrease ( P<0.05). Empirical oral treatment with nitrofurantoin or nalidixic acid can safely be started in children with febrile UTI seen in the Emergency Department, Hospital de Clínicas de Porto Alegre, Brazil.

Administration, Oral↗