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PubMed2006

[New, successful treatment of urinary tract infection caused by Pseudomonas aeruginosa].

Urinary tract infection (UTI) is common in pediatric practice and an important cause of morbidity and mortality in children. Escherichia coli remains the predominant uropathogen (80%) isolated in acute community-acquired uncomplicated infections, followed by Staphylococcus saprophyticus (10% to 15%) and Pseudomonas aeruginosa (9%) The pathogens traditionally associated with UTI are changing many of their features, particularly because of antimicrobial resistance. Reinfections and relapses of urinary tract infections caused by PA are very frequent. The aim of the study was to evaluate the efficacy of combined clarithromycine and ceftazidime in terms of eradication of PA infection. We analyzed 20 out of 264 children with UTI where PA infection was confirmed with urine culture. Those children were treated for at least 14 days with the protocol used for PA infection in patients with mucoviscidosis. Short-term eradication was achieved in all patients. Long-term study revealed relapse in 25% of children, all with serious congenital malformations. 75% of children were treated with success. No side effects were observed. Conclusion. We conclude that an empirical combination treatment of clarithromycine and ceftazidime is appropriate and effective in children with UTI caused by PA. This therapy was clinically efficacious, well tolerated, and cost effective, and should prevent unnecessary development of antimicrobial resistance.

Anti-Infective Agents, Urinary↗
PubMed2005

Practical management of recurrent urinary tract infections in premenopausal women.

Recurrent urinary tract infections (UTIs) are a major healthcare concern for premenopausal, healthy, sexually active women. A practical approach to the management and prevention of recurrent UTIs should be simple, practical, and cost effective. Low-dose or postcoital antimicrobial therapy can be effective for women with constellations of many recurrent UTIs, but for women with 2 to 4 UTIs per year, the most cost-effective and empowering management strategy is patient-initiated antimicrobial treatment.

Journal Article↗
PubMed2006

[A case of brucellosis presenting with urinary tract infection].

In this report an acute brucellosis case presenting with the symptoms of urinary tract infection (UTI) has been discussed. A 29 years old male patient was admitted to the emergency service of our hospital with the complaints of acute UTI. His complaints were persisting for five days before admission. His physical examination was normal but there were fever (39 degrees C) and costovertebral angle tenderness. His medical history revealed that multiple stones in the lower pole of the right kidney and paranchyme loss were detected by IVP two years ago. The bacteria that were isolated from blood and urine cultures were identified as Brucella melitensis by conventional methods. Rose Bengal test was found positive, and standard tube agglutination test was positive at a titer of 1/640. The patient was treated with oral ciprofloxacin (1000 mg/day) and rifampicin (600 mg/day) combination for six weeks. The aim of this presentation was to draw attention to this uncommon condition, as UTI symptoms are not the first symptoms of acute brucellosis. UTI symptoms should be carefully considered as a presentation of brucellosis especially in regions where brucellosis is endemic.

Acute Disease↗
PubMed2006

The relation of vesicoureteral reflux and renal scarring in childhood urinary tract infection.

OBJECTIVE: Assess the relation of age and sex in vesico ureteral reflux (VUR) and renal scarring and the relation of VUR and renal scarring in childhood urinary tract infection. MATERIAL AND METHOD: A descriptive study of one hundred and twenty-six children who received renal cortical scintigraphy from 1st Jan 2000 to 31st Dec 2004 in the Department of Radiology, Faculty of Medicine Siriraj Hospital, was conducted. Ninety-three (50 males, 43 females) patients were diagnosed with urinary tract infections (UTIs) but only ninety-one of them had renal cortical scintigraphic results available. The male to female ratio was 1.16:1. The mean age of the patients was 4.33 years (SD +/- 4.17, range 7 days-16 years). During the 1st year of life the male to female ratio is 2.6:1. Fever, dysuria, and poor feeding were the most presenting signs and symptoms. Eighty-five (45 males, 40 females) patients received Voiding Cysto Urethro Gram (VCUG). RESULT: The authors did not find the correlation between the age groups and sex with VCUG results on right and left side, respectively (p = 0.856, p = 0.145, p = 0.77, p = 0.75). Ninety-one (49 males, 42 females) patients received DMSA renal scintigraphy. Fifty-two patients (57.1%) had abnormal DMSA renal scan results. However; the authors did not find the correlation between age groups and sex with DMSA renal scan results on the right and left kidneys, respectively. (p = 0.202, p = 0.416, p = 0.511, p = 0.791). The authors compared times of UTIs with and DMSA renal scintigraphy in each side of the kidney. Even though the authors did find the correlation between episodes of UTIs and abnormal DMSA on the left kidneys (p = 0.017), it was not found on the right kidneys (p = 0.081). There were 80 patients who received both VCUG and DMSA renal scintigraphy. The authors found the correlation between severity of VUR and abnormal DMSA results on right and left kidneys (p = 0.001, p = 0.01). CONCLUSION: The authors recommend that all children who have repeated UTI and/or VUR, irrespective of age and sex, should receive DMSA renal scintigraphy to detect renal scarring and follow up future complications.

Adolescent↗
PubMedDate not supplied

Diclofenac in the management of E. coli urinary tract infections.

E. coli is the main agent of uncomplicated urinary tract infections (UTIs) and accounts for more than 85% of recurrent cystitis and at least 35% of recurrent pyelonephritis. Despite the widespread availability of antibiotics, UTIs remain the most common bacterial infection in the human population. It is currently advised that the clinical administration of antibiotics against the pathogenic bacteria should be prohibitted due to the emergence of multidrug resistant (MDR) bacterial strains. Therefore, newer and more effective antimicrobials are in demand to treat such cases. One hundred and thirty six urine samples were collected from UTI patients. E. coli was isolated from 85 samples, out of which 33% were resistant to common antibiotics. The isolates were decreasingly resistant to ampicillin, tobramycin, augmentin, nalidixic acid, cefuroxime, nitrofurantoin, kanamycin, pipemidic acid, chloramphenicol, cefotaxime, cefamendol, ofloxacin, ceftizoxime, norfloxacin and amikacin. The anti-inflammatory drug diclofenac exhibited significant antibacterial activity against common bacterial strains both in vitro and in vivo. The present work was conducted to evaluate the in vitro inhibitory effect of this drug on the clinically isolated strains of E. coli in hospitals. All the isolates were sensitive to diclofenac, with MIC values ranging from 5-50 microg/mL. The MIC90 value of the drug was 25 microg/mL. Therefore, it may be suggested that diclofenac has the capacity to treat UTI caused by E. coli.

Animals↗
PubMed1991

Value of urologic investigation in a targeted group of women with recurrent urinary tract infections.

According to the conclusions of clinical studies, excretory urography and cystoscopy are of no value in managing the majority of women who have a history of recurrent urinary tract infection (UTI). Of 475 women with recurrent UTIs, 186 were prospectively targeted for evaluation by cystoscopy and ultrasonography or excretory urography from selection criteria based on the degree of complicating factors, to determine the value of urologic investigation. Thirty-nine patients had significant detectable abnormalities, and 20 of them required surgical intervention. Definite indications for urologic evaluation include hematuria (gross hematuria and persistent microscopic hematuria between infections), pyelonephritis and a presentation that is not typical for simple uncomplicated UTIs (obstructive symptoms, infection with urea-splitting bacteria, clinical impression of persistent infection or urinary calculi). Diabetes itself does not warrant urologic evaluation. The findings from this study suggest that cystoscopy and upper urinary tract evaluation do play a role in the management of a selected group of women with UTIs.

Adult↗
PubMed1991

Virulence factors of Escherichia coli in urinary isolates.

1. Escherichia coli strains isolated from 100 urine samples taken from patients with urinary tract infections (UTI) and from 20 normal fecal (NF) samples were examined for serum resistance, mannose-resistant hemagglutination of human erythrocytes (MRHA) and for production of aerobactin, hemolysin and colicin. 2. Among the UTI E. coli strains, 79% produced aerobactin, 69% showed serum resistance, 44% produced MRHA, 32% were beta-hemolytic and 22% were colicinogenic. A greater proportion of UTI E. coli strains produced aerobactin, colicin V, beta-hemolysis and MRHA when compared to NF strains. Production of MR hemagglutinins was significantly correlated with that of aerobactin and hemolysin. 3. These results suggest that the presence of aerobactin may be a significant etiological factor in UTI, and that the production of MR adhesins and of hemolysin also might contribute to the virulence of these strains.

Chi-Square Distribution↗
PubMed1991

Urinary tract infections--a survey.

Urinary tract infections (UTIs) occur frequently in hospitalized patients and are associated with significant morbidity. The infection control department of the Victoria General Hospital in Halifax, Nova Scotia conducted prospective hospital-wide surveillance for one month to evaluate the incidence of UTIs. There were 40 UTIs: 62.5% in patients with indwelling catheters; 20% in patients undergoing intermittent catheterization; and 17.5% in uncatheterized patients, for an attack rate of 19.9 per 1000 patient discharges. Escherichia coli was the most common organism, isolated in 47.5% of the study population. Trimethoprim-sulphamethoxazole was used to treat 57.5% of the UTIs. The findings from this survey are consistent with those of other authors in comparable institutions.

Cross Infection↗
PubMed1991

Value of single-dose ciprofloxacin in the treatment of acute uncomplicated urinary tract infection in women.

Single-dose antibiotic therapy for uncomplicated infection of the lower urinary tract (UTI) in women has resulted in high success rates. Ciprofloxacin, like other new quinolones, has shown good in vitro activity against the pathogens most frequently encountered in UTI, high concentrations in the urine and is well tolerated. The present report describes a randomized, double-blind, controlled trial of two single-dose regimens of ciprofloxacin in women with lower UTI. Thirty-six women received 250 mg and forty-two received 500 mg of ciprofloxacin as a single dose. Escherichia coli was the most frequently isolated pathogen in both groups (forty-eight patients). Clinical and bacteriological cures were attained in 81% and 93% of the 250 mg and 500 mg dose groups, respectively, 7 days after treatment. Follow-up at 4 weeks after completion of treatment disclosed that the clinical cure rate was 62% and 79% respectively. Ciprofloxacin was well tolerated. This study shows that a single dose of ciprofloxacin is an effective and safe treatment of uncomplicated UTI. Although the cure rates were higher with a single dose of 500 mg, further studies are needed for assessment to determine the optimal dose.

Acute Disease↗
PubMed1991

Intravenous ciprofloxacin versus ceftazidime for treatment of nosocomial pneumonia and urinary tract infection.

Intravenous ciprofloxacin and ceftazidime were compared for efficacy in the treatment of nosocomial pneumonia and urinary tract infection (UTI). Patients with nosocomial pneumonia were randomized to receive ciprofloxacin (as the lactate salt) 300 mg i.v. every 12 hours or ceftazidime (with sodium carbonate) 2 g i.v. every eight hours. Patients with UTI were randomized to receive ciprofloxacin 200 mg i.v. every 12 hours or ceftazidime 1 g i.v. every eight hours. Sputum and urine specimens were collected before, during, and after therapy. For patients with pneumonia, the organisms most frequently isolated before treatment began were Escherichia coli, Haemophilus influenzae, Klebsiella pneumoniae, and Proteus mirabilis. Of the 17 pneumonia patients who completed ciprofloxacin treatment, 15 (88%) had resolution of signs and symptoms or improvement. Of the 15 ceftazidime-treated pneumonia patients, 13 (87%) had resolution or improvement. Staphylococcus aureus, Streptococcus species, Acinetobacter species, and K. pneumoniae infections persisted for the ciprofloxacin treatment failures. Infections by Enterobacter cloacae and Acinetobacter species persisted for the ceftazidime treatment failures. For UTI patients, E. coli was the organism most frequently isolated before treatment. All 14 UTI patients who completed treatment showed resolution or improvement. In the ciprofloxacin group two patients were superinfected by Enterococcus species, and in the ceftazidime group there were two superinfections by Enterococcus species and one by Enterobacter cloacae. Intravenous ciprofloxacin was as effective as ceftazidime in the treatment of nosocomial pneumonia and urinary tract infection. Caution should be exercised when treating serious infections by streptococci or staphylococci.

Adult↗
PubMed1990

Special properties associated with virulence of urinary Escherichia coli.

Escherichia coli (E. coli) isolated from 53 urine and 26 stool samples of patients with urinary tract infection (UTI) and 50 stool samples of normal individuals were studied to see their hemolytic, hemagglutinating and 'O' antigenic properties which might be related to virulence of the organism. Significantly higher number of E. coli isolated from urine of UTI patients were found to possess hemolytic, hemagglutinating properties and more frequently belonged to certain "O" antigenic groups either singly or in combination as compared to those isolated from stool of both UTI patients and normal individuals. Hemagglutinating property appeared to be most frequently associated with UTI.

Escherichia coli↗
PubMed1989

[P-fimbriated Escherichia coli and serum antibody responses to P-fimbriae in pregnant women with urinary tract infections and their children].

Escherichia coli (E. coli) is still a major pathogen in urinary tract infections (UTI). It was found that 15 out of 20 cases (75%) of E. coli related UTI were caused by P-fimbriated E. coli, compared to the mere 15% of E. coli isolated from urine and 22% from the stool of healthy controls that were P-fimbriated. All patients studied were pregnant women and their delivered children. Antibody responses to P-fimbriae in the sera of these patients were detected with enzyme-linked immunosorbent assay (ELISA) using purified P-fimbriae. Positive antibody responses were observed at titers of 800-6400 in 8 out of 9 cases of UTI of pregnant women caused by P-fimbriated E. coli. The high level of antibody titers persisted for one month on average and then decreased. These antibodies to P-fimbriae were essentially IgG and transmitted to delivered children from UTI mothers. Therefore, the protective role of these antibodies from P-fimbriated E. coli infections in new born children has been suggested.

Antibodies, Bacterial↗
PubMed1989

Efficacy and safety of cefotetan in the treatment of complicated urinary tract infections: clinical experience in a selective and single study.

A single, selective study was performed in order to evaluate the efficacy and safety of cefotetan in the treatment of complicated urinary tract infections (UTI). Of 34 pre-treatment isolated strains, 60% were pluri-resistant to other antibiotics (ampicillin, carbenicillin, piperacillin, cefalotin, aztreonam) but only 21.2% to cefotetan. Pseudomonas aeruginosa and enterococci were resistant to cefotetan. Escherichia coli was the common strain isolated (50%). Nineteen adult patients, with complicated UTI caused by sensitive organisms, were treated with a 1 g intramuscular (i.m.) daily dose. Duration of treatment ranged from 5-15 days, with a mean of 13.75 days. Within 24-48 h and 30 days post-therapy, the infection was cured in 84% and 52% of patients, respectively. Reinfection, relapse or super-infection occurred in 42% of the cases. In only one patient, the infecting organism did not respond to treatment. The clinical response was evaluated in only seven patients with symptomatic UTI. Six of them (85.7%) were cured after therapy and the cure persisted at follow-up. In most cases, the adverse reactions were local, mild and negligible. In only 15.8% and 10.5% of patients, side-effects (diarrhoea, headache, abdominal pain, tachycardia, chill, pain and erythema in the injection site) were severe and moderate. In these cases, the adverse reactions were reversible when the therapy was discontinued. The relationship between treatment and side-effects was doubtful in two cases. It is concluded that cefotetan, administered at 1 g i.m. daily dose, is effective in treating complicated UTI caused by sensitive organisms, pluri-resistant to other antibiotics.

Adult↗
PubMed1989

Sultamicillin versus trimethoprim/sulfamethoxazole in the treatment of urinary tract infections.

Sultamicillin, a novel compound in which ampicillin and the beta-lactamase inhibitor sulbactam are linked as a double ester, was compared with trimethoprim/sulfamethoxazole with regard to in vitro activity, therapeutic efficacy and safety in the treatment of UTIs. The MICs of ampicillin and ampicillin in combination with sulbactam (10 micrograms), trimethoprim and trimethoprim in combination with sulfamethoxazole (1:19) were determined for 400 isolates causing UTI using an agar dilution technique (multipointer, cfu = 10(4]. The organisms isolated consisted of about one-third E. coli, one-third other Gram-negative strains and one-third Gram-positive strains. About half of the Gram-positive strains were enterococci and the other half staphylococci. A concentration of 8 micrograms/ml ampicillin inhibited 76% of the isolates while ampicillin in combination with sulbactam inhibited 86%. A concentration of 4 micrograms/ml trimethoprim inhibited 77% of the isolates, while trimethoprim in combination with sulfamethoxazole inhibited 83%. In a prospectively randomized clinical trial, 38 patients with UTI were treated orally with either sultamicillin (375 mg) or trimethoprim/sulfamethoxazole (160 mg/800 mg) twice daily for 7 d. Sultamicillin eradicated bacteriuria during therapy and up to 1 to 2 weeks after therapy in 63% and trimethoprim/sulfamethoxazole in 50% of evaluable patients. Side effects were reported for 2 sultamicillin (gastric pain, diarrhea) and 2 trimethoprim/sulfamethoxazole patients (gastric pain, exanthema), with the latter 2 being withdrawn after 6 days of therapy. Sultamicillin appeared as effective and safe as trimethoprim/sulfamethoxazole in the treatment of UTI.

Adolescent↗
PubMed1989

[Rapid typing of Escherichia coli K antigens using bacteriophages].

E. coli capsular (K) antigens are important virulence factors contributing to the development of urinary tract infections (UTI). Serotyping of these antigens is laborious and depends on the availability of respective antisera which are difficult to prepare because of the low immunogenicity of these polysaccharide antigens. The application of specific K phages are a big advantage. Two collections of E. coli strains (500 from Rostock, 214 from Erfurt) isolated from patients with UTI have been investigated with a set of ten K specific bacteriophages including phi 1, phi 2, phi 5, phi 7, phi 9, phi 12, phi 13, phi 20, phi 30 and phi 36. The K1 antigen has been found to be the most frequent capsular antigen (16.4% in Rostock; 12.2% in Erfurt) followed by K13/K20 in Erfurt (8.9%) and K5 in Rostock (8%) and Erfurt (7.5%). The collection of phages proved to be suitable for the detection of UTI associated K antigens covering the most common O serogroups found in UTI. The method appears to be simple, non-laborious and applicable for routine use.

Antigens, Bacterial↗
PubMed1989

[Treatment of urinary tract infection with cefixime].

Cefixime (CFIX) was administered orally in the treatment of 59 cases of urinary tract infection (UTI). According to the response criteria defined by the Japanese UTI committee, the rate of clinical efficacy for 26 cases of uncomplicated cystitis was 96.2%. The rate of clinical effectiveness of five patients with complicated UTI and five with uncomplicated pyelonephritis was 80.0%. In the other 23 cases which did not meet the response criteria, the efficacy rate was also high. The results indicated that CFIX was an effective drug for the treatment of UTI.

Anti-Infective Agents, Urinary↗
PubMed1986

Urinary calculi and urinary tract infection. A clinical and microbiological study.

The problem of urinary calculi in association with urinary tract infection (UTI) was investigated. Fifty-two (7%) of 796 patients attending our outpatient stone clinic had UTI which was considered of pathogenic importance for their stone formation. Proteus was the most common microorganism. Metabolic disorders were found in one third and anatomical and functional abnormalities in two thirds of the patients. The infected patients had lower urinary calcium excretion and higher serum creatinine than idiopathic stone formers and had a higher frequency of stone operations. The prevalence of staghorn calculi as a cause of urimia was low (1.5% of 481 dialysis patients). Eight such patients were studied and six of them had metabolic and anatomical disorders. The time taken for the uremia to develop was 7.4 +/- 2.0 (SD) years. In 535 patients treated surgically for renal calculi, about one third had positive urine culture at the time of operation and E. coli was the most common bacterial strain (35%). Proteus was found in 28% and these patients had the highest frequency of UTI episodes, most of which occurred before hospitalization. Patients infected with E. coli had a higher frequency of phosphate-containing calculi than non-infected patients, in whom the highest frequency of calcium oxalate calculi was found. A new broad-spectrum cephalosporin, ceftazidime, was used as perioperative prophylaxis in 15 patients operated upon for renal calculi and UTI. Ten had bacterial growth in the renal pelvis and all strains were eradicated. Bacterial growth was found in two out of six cultured stones from patients with bacterial growth in the pelvis. The pharmacokinetics of the drug was studied and the decreases in the ceftazidime levels in serum and renal tissue seemed to be parallel. Bacterial binding of urinary isolates to hydroxyapatite (HAP) particles was studied. Two E. coli strains (A5089 and E7704) and one Proteus mirabilis strain (A5076), all obtained from stone patients, were compared with two E. coli strains (2683 and M7810) with well defined cell-surface properties. Hemagglutination tests were performed and the cell-surface hydrophobicity was determined by a salt-aggregating test. When the strains were cultured at 37 degrees C to promote fimbriae formation they hemagglutinated erythrocytes and displayed hydrophobic cell-surface properties, and showed higher capacity for binding to HAP than when cultured at 18 degrees C to suppress fimbriae formation, when they showed almost complete absence of hemagglutination and low cell-surface hydrophobicity. Bacterial cell-surface properties seem to influence the binding of uropathogens to HAP particles.

Acute Kidney Injury↗
PubMed1986

[Comparative studies of antimicrobial agents against causative organisms isolated from urinary tract infections (1984). III. Secular changes in susceptibility].

Cases with infections of urinary tracts were divided into 3 groups of the simple infections, and complicated infections without indwelling of catheter, and complicated infections with indwelling of catheter. Susceptibilities to antimicrobial agents of Escherichia coli, Klebsiella spp., Proteus spp., Citrobacter spp., Enterobacter spp., Pseudomonas aeruginosa and Serratia marcescens which were isolated from patients with these infections were determined. There was no tendency of decline in the susceptibilities of E. coli isolated from the patients with simple urinary tract infections (UTI). Susceptibilities of E. coli isolated from the patients with complicated UTI without and with indwelling of catheter to cephem antibiotics of the third generation were examined. The susceptibility of E. coli strains isolated from patients with complicated UTI without and with indwelling of catheter remained the same. More specifically, cefmenoxime (CMX) at a concentration of less than 0.10 microgram/ml inhibited the growth of E. coli isolated from cases without: with catheter at 74.1%: 78.3% in 1982, 75.4%: 73.3% in 1983, and 81.3%: 84.8% in 1984. Also, ceftizoxime (CZX) at a concentration of less than 0.10 microgram/ml inhibited the growth at 83.3%: 95.7% in 1982, 89.2%: 86.7% in 1983, and 91.7%: 97.0% in 1984. Latamoxef (LMOX) at less than 0.10 microgram/ml inhibited the growth at 59.3%: 43.5% in 1982, 47.7%: 40.0% in 1983, and 47.9%: 42.4% in 1984. The antibacterial effect of penicillin against Klebsiella spp. was found to be poor, while those of oral cephem antibiotics, cephalexin (CEX), cefaclor (CCL), and cefazolin (CEZ) which is the cephem antibiotics of the so-called first generation and cefotiam (CTM) among other cephem antibiotics of the so-called second generation were relatively good. A study of susceptibilities of Klebsiella spp. isolated from patients with complicated UTI without and with indwelling of catheter revealed inhibition of growth by CTM at a concentration of 0.39 microgram/ml at 84.0%: 75.9% in 1982, 70.6%: 75.0% in 1983, and 95.8%: 77.8% in 1984. Cefmetazole (CMZ) at a concentration of 0.39 microgram/ml showed a relatively lower rate of growth inhibition of Klebsiella spp., while at 0.78 microgram/ml it inhibited the growth at 88.0%: 72.4% in 1982, 52.9%: 50.0% in 1983, and 70.8%: 66.7% in 1984. The antibacterial effects of both CTM and CMZ against Klebsiella spp. isolated from patients with indwelling of catheter were found to be poor, and some of the bacterial strains showed a MIC over than 100 micrograms/ml.(ABSTRACT TRUNCATED AT 400 WORDS)

Anti-Bacterial Agents↗