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PubMed1979

Seasonal variations in the occurrence of urinary tract infections among children in an urban area in Finland.

The seasonal variations in the incidence of urinary tract infections (UTI) were studied in a series of 992 verified episodes of UTI treated between 1965 and 1974. The incidence was highest during November and lowest during the summer months. Summer episodes, moreover, tended to be the most severe. Seasonal variations were less marked among girls, than amond boys, except in the group of teenage girls in which peak incidences occurred in March and in September. Among the boys, a single peak incidence was recorded in July. The results of the analysis of weather type performed in this study showed that unseasonable types of weather, that is, cold and dry weather in autumn, warm and rainy weather in winter, and warm and dry weather in spring, were accompanied by a clear increase in the monthly number of episodes of UTIs. The difference in the monthly frequency of UTIs between the most and the least favourable types of weather was about two-fold.

Adolescent↗
PubMed1983

[Strategy of the use of immunological tests in the topographical diagnosis of urinary infections].

Assays for bacteria-specific antibodies were performed in 423 hospital patients with urinary tract infection (UTI), 184 of whom also had serodiagnosis by passive haemoagglutination with the strain responsible for the infection. The results of serodiagnosis were expressed as the difference in dilution between the antibody titres found in the patients and those found in pooled sera from healthy subjects. On the basis of this study, a rationale for immunological investigations, particularly in adults, is suggested. When bacteria-specific antibodies are lacking the probability of a lower UTI is 98%; when they are present, the probability of an upper UTI is only 74.5%, but the figure rises to 95% with a positive passive haemoagglutination serodiagnosis. In patients with negative serodiagnosis and positive bacteria-specific antibodies, a topographical diagnosis of UTI by immunological methods becomes impossible. In children, these methods are of little use owing to their poor sensitivity in detecting bacteria-specific antibodies, but the information provided by serodiagnosis is useful for determining the site of infection.

Adolescent↗
PubMed1981

[Clinical evaluation of pivmecillinam in the maintenance therapy of chronic urinary tract infection (author's transl)].

In order to evaluate the efficacy and safety of pivmecillinam (melysin tablet, PMPC), PMPC was administered to 78 chronic UTI cases in the field of obstetrics and gynecology (posthysterectomy infection, chronic cystitis, chronic pyelonephritis and etc.). In principle, daily 400 mg of PMPC was administered for 2 weeks. (1) Overall clinical efficacy judged by doctor was evaluated in 78 cases and the result was; excellent in 17, good in 37, fair in 10, poor in 13 and unknown in 1 case with the effectiveness rate of 69.2%. (2) Overall clinical efficacy judged by 'criteria for clinical evaluation in complicated UTI' recommended by UTI study member was evaluated in 54 cases and the result was; excellent in 15, good in 20 and poor in 19 cases with the overall efficacy rate of 64.8%, the result of which was similar to that of doctor's judgement. (3) Efficacy on pyuria was evaluated in 72 cases and it was cleared in 27, decreased in 25, unchanged in 20 and unknown in 6 cases. Efficacy on bacteriuria was evaluated in 72 cases and it was eliminated in 44, decreased in 9, replaced in 8, unchanged in 8 and unknown in 9 cases. (4) Side effect, considered by doctors to be caused by PMPC administration, was noticed in 3 out of 78 cases (3.8%), all of which was mild gastrointestinal disturbance and the administration of PMPC was continued. Abnormal change of laboratory finding considered by doctors to be caused by PMPC administration was noticed in 1 out of 78 cases, which was slight elevation of GOT and GPT values. It is therefore considered that PMPC appear to be useful drug for the maintenance therapy of chronic UTI in the field of obstetrics and gynecology.

Adult↗
PubMed1983

[Treatment of urinary tract infections by cefaclor, with special reference to the antibody-coated bacteria (ACB) detected by the immunoenzyme technique].

Twenty out-patients suffering from urinary tract infections (UTI) were treated with cefaclor. Cefaclor was administrated orally in daily doses of 1,500 mg for 7 days against 15 cases of simple UTI and 5 cases of complicated UTI. Of 20 cases with acute simple cystitis, acute pyelonephritis and complicated UTI, clinical responses were excellent in 10 cases, good in 6 cases and poor in 4 cases. The efficacy rate was 80%. No side effect was observed. The site of infection determined by the ACB detection method was in good agreement with that determined by clinical findings. Cefaclor appeared to be equally effective in the treatment of both ACB-positive and ACB-negative infections. The presence of absence of antibody-coated bacteria did not correlate with clinical symptoms or response to therapy.

Adult↗
PubMed1984

[Comparative studies of antimicrobial agents against causative organisms isolated from urinary tract infections (1982). III. Secular changes in susceptibility].

In vitro susceptibilities have been investigated against several species isolated from patients with simple and complicated urinary tract infections (UTI) during 1980-1982. Antimicrobial activities of the third generation cephems against E. coli isolated from patients with complicated UTI were found to decrease slightly in 1982. And those against Klebsiella spp. isolated from patients with simple and complicated UTI were also found to decrease similarly. Against P. mirabilis, all the drugs tested have showed relatively potent activities and slight changes in the susceptibility. The marked decrease of susceptibility against Citrobacter spp. isolated from UTI have been found even in the third generation cephems. Especially, Citrobacter spp. exhibited a greater degree of resistant to CZX and CPZ. Strains of P. aeruginosa were on the whole susceptible to the drugs tested, CFS, GM, TOB and AMK, inhibiting 50-80% of the strains tested at 1.56 micrograms/ml. CTX, CZX and CMX seemed most effective against S. marcescens among the third generation cephems, inhibiting 50-90% of the strains tested at 3.13 micrograms/ml.

Anti-Bacterial Agents↗
PubMed1983

Inguinal hernia repair before and after prostatic resection.

From 1976 through 1981, 864 men had inguinal hernia repairs and 328 had prostatic resections at our Veterans Administration Hospital. Forty-four patients had symptomatic prostatic obstruction that required either transurethral or open prostatic resection within 12 months of hernia repair. Twenty-seven patients had prostatectomy prior to hernia repair, 16 had hernia repair before prostatic resection, and one had simultaneous procedures. There were no urinary tract infections (UTIs) after hernia repair in patients who had had prostatectomy first, while five patients who had hernia repair before prostatectomy developed UTI after hernia repair (P less than 0.01). The incidence of UTI after hernia repair correlated with the need for and duration of bladder catheterization as a result of prostatic obstruction. Complications after prostatectomy were similar regardless of the order of operation. There were no episodes of incarceration or strangulation in patients awaiting hernia repair after prostatectomy. These results suggest that, when an inguinal hernia and symptomatic prostatic obstruction occur together, the performance of prostectomy before hernia repair lowers the risk of morbidity by decreasing the incidence of UTI after hernia repair. This approach does not expose the patient to any additional risk related to the inguinal hernia.

Aged↗
PubMed1982

Maintenance antimicrobials in high risk urologic pediatric patients.

As an alternative to the practice of obtaining repeated laboratory cultures for patients at high risk of renal impairment from recurrent UTI, a program of bone monitoring using a mail-in culture dipspoon was started. A study involving 454 children with neurogenic bladder or other urologic abnormalities showed (1) that the incidence of UTI infection in patients for whom long term antimicrobial therapy had been prescribed was not significantly lower than that in patients who were not on antimicrobials and (2) that at least 50% of dipspoons inoculated due to presentation of UTI symptoms showed no or insignificant growth. These findings suggest that need for further assessment of the efficacy of long term prophylactic antimicrobials in preventing recurrent UTI and the advisability of obtaining a urine culture result before initiating treatment when symptoms are not severe.

Adolescent↗
PubMedDate not supplied

Sexual behavior and urinary tract infection.

A study to identify factors which put young, sexually active women at risk to develop a urinary tract infection (UTI) was done. Reported here are differences in sexual behaviors in the study and control groups. All subjects were currently sexually active. Study subjects had a urine culture of greater than 10(5) single pathogen species. Control subjects were healthy women seeking preventive health care services. Both groups completed a self-administered questionnaire consisting of demographic data, past personal and family history, health status, habits of daily living and sexual activity and behaviors. Data analysis results showed that women who develop a UTI were more sexually active than their counterparts who did not. The data also indicate that increased coital activity preceded a UTI, and that the female superior position was used more frequently. Other coital activities and related sexual behaviors tested were not significantly different in the two groups, nor were they associated with the onset of a urinary tract infection. The results of this pilot study indicate a potential need to review the content of current preventive health teaching about UTIs. The validity of these findings must be further investigated before a conclusive statement or recommendations can be made.

Adult↗
PubMed1978

Urinary tract infections in children: a review.

Urinary tract infections (UTIs) in children are a common and challenging problem for the primary care physician and continue to be a cause of significant morbidity. Except for the neonatal period, UTIs occur most frequently in girls. The symptoms of UTI in the child may be obscure, and often a high index of suspicion is required. Diagnosis ultimately depends on the urine culture. Current concepts in the diagnosis and therapy of UTIs in children include the use of urine culture for initial diagnosis and home cultures for follow-up. Evidence fully supports the concept that even a single episode of documented bacteriuria, symptomatic or asymptomatic, should be investigated with an intravenous pyelogram (IVP) and voiding cystourethrogram (VCUG).

Anti-Bacterial Agents↗
PubMed1995

An audit of the clinical management of urinary tract infection in childhood.

Urinary tract infection (UTI), is one of the commonest bacterial diseases in childhood, and may cause significant morbidity, inconvenience and anxiety for patients and their families and result in considerable consumption of resources. Although most clinicians would agree on the general principles of management, it is recognised that considerable variation exists in their application. The aim of this study was to assess the in-patient and out-patient management practice in infants and children with documented symptomatic UTI in several clinical areas in the Royal Hospital for Sick Children (RHSC) Glasgow. A total of 1,826 patient episodes were analysed, 1,592 of which were first referrals over a 29 month study period. The analysis highlighted a definite variation in a number of aspects of the management of UTI within the clinical services reviewed. In a significant number of in-patients, the diagnosis was made both in the absence of microbiological confirmation, and following the use of inappropriate urine specimens. An under-use of urine microscopy in the in-patient services was documented as well as an inappropriate use in out-patients, since the result in this latter group did not seem to influence the need for urine culture. Urinary tract imaging protocols varied widely between in-patient services and among in-patient and out-patient services with a continued over-reliance on urinary tract ultrasound and an under-use of more sensitive radio-isotopic techniques. These data reveal a continuing lack of uniformity in management practices in children with UTI and demonstrate the need for a wider application of practice guidelines.

Ambulatory Care↗
PubMed1995

[Antibiotic treatment of complicated urinary tract infections].

The diagnosis of an urinary tract infection (UTI) is proved by the identification of a significant leucocyturia and bacteriuria of the mid-stream urine analysis in men and catheter urine in women. A diagnostical localisation is possible by the case history as well as clinical, sonographical and laboratory tests (leucocytes, CRP) to classify into a cystitis and infection of the parenchyma, respectively an uncomplicated or complicated UTI. Untreated complicated urinary tract infections have a bad prognosis. The therapy consists of bed rest, normalization of the urinary flow, a specific antibiotic therapy corresponding to the antibiotic sensitivity pattern and the administration of a prostaglandin-synthesis-inhibitor. Every physician should choose one of the many antibiotics and must get acquainted with the pharmacokinetics and side-effects. In severe acute infections, a calculated antibiotic therapy in certain combinations is necessary until the bacteriological findings are known. Corresponding to the spectrum of bacteria in complicated UTI, one should select a fluoro-chinolone, a broad-spectrum penicilline in combination with a beta-lactamase-inhibitor, a cephalosporine of the second and third generation with a relative stability against beta-lactamase as well as an aminoglycoside. Reserve-antibiotics for special indications are for example, cefsulodine. Less effective than the drugs mentioned above is cotrimoxazole, which was favourized before. In complicated UTI, the older gyrase-inhibitors like nalidixic acid, pipemidic acid, cinoxacin and nitrofurantoin are not longer indicated. There is only one indication for the application of doxycyclin: the treatment of bacterial prostatitis. A lower dosage of antibiotics and a drug therapy of 7-10 days are sufficient.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Bacterial Agents↗
PubMed1995

Recurrent urinary tract infections in otherwise healthy adult women. Rational strategies for work-up and management.

Recurrent urinary tract infections (UTIs) are common, but clinicians unfamiliar with the natural history or pathogenesis may order unnecessarily expensive tests and provide unsubstantiated advice to their patients. A large body of literature indicates that recurrent UTIs do not progress to permanent kidney damage or end-stage renal disease. The vast number of UTIs are due to the interplay between minor weaknesses in host defenses and bacterial virulence factors. Sexual intercourse and diaphragm/spermicide use are the two behavioral factors most consistently associated with UTIs. Basic history, physical exam, and urinalysis are able to identify the few patients likely to benefit from invasive urologic workups, which usually have a very low yield when ordered routinely. Effective management options include daily or post-coital antimicrobial prophylaxis, or patient-initiated treatment. Patients can be reassured of an excellent prognosis. There is no evidence validating proscription of personal preferences, such as soda pop, tight clothing, or direction of perineal cleansing after defecation.

Adult↗
PubMed1995

Detection of M2 antibodies in patients with recurrent urinary tract infection using an ELISA and purified PBC specific antigens. Evidence for a molecular mimicry mechanism in the pathogenesis of primary biliary cirrhosis?

Primary Biliary Cirrhosis (PBC) is a chronic liver disease of unknown aetiology. The main characteristic feature of the disease is the presence of circulating antimitochondrial antibodies (AMA) to components (collectively named M2) of the mitochondrial 2-oxo-acid multienzyme complexes; pyruvate, oxoglutarate and branched chain oxo-acid dehydrogenase complexes. As these enzymes are phylogenetically conserved, AMA also exhibit reactivity against a range of microorganisms. PBC patients have an increased incidence of recurrent urinary tract infection (UTI) compared to other chronic liver disease controls. Interestingly, we have recently detected low titre AMA in patients with a history of recurrent UTI but normal liver function using crude bovine heart mitochondrial preparations and immunoblotting techniques. Here we confirm these findings using purified M2 antigens and ELISA. We found that 52% of "normal" subjects with a history of recurrent UTI had AMA specifically to M2 antigens. The percentage was significantly higher than that found for chronic liver disease (19%, p < 0.01) and normal controls (4%, p < 0.001). These results support our hypothesis for molecular mimicry in PBC. We propose that a bacterial trigger, possibly resulting from recurrent UTIs, is responsible for initiating an autoimmune response in a predisposed host because of a cross-reactivity between mitochondrial and bacterial antigens.

Antibody Specificity↗
PubMedDate not supplied

[Gardnerella vaginalis as urinary pathogen].

AIM: To study the significance of Gardnerella vaginalis in urine by comparing urine culture results, leucocytes count and clinical findings. METHODS: A total of 1,365 urine specimens submitted consecutively were inoculated on Bilayer media. G. vaginalis was recovered from 76 urine specimens with the following distribution: in 12 samples G. vaginalis was isolated as the only organism, 9 with counts > 10(5) CFU/ml and 3 between 10(5)-10(3); in the remaining 64 samples G. vaginalis was always found in counts > 10(5) CFU/ml but associated in 13 occasions with another organism and in 51 occasions with 2 or more organisms from the periurethral and vaginal flora. RESULTS: G. vaginalis in pure cultures corresponded to 8 women and 4 males whose ages ranged from 20 to 86 years. Six patients complained of symptoms of lower urinary tract infection (UTI), 3 had fever and in 3 the urine culture was practised as a control. Seven patients presented predisposing factors to UTI and 2 were pregnant. In only 2 cases pyuria was detected. Of 12 patients with pure cultures, only 3 were found to have G. vaginalis UTI. CONCLUSIONS: Our data indicate that G. vaginalis in urine not always implies an UTI and that this organism is found most often in patients with predisposing factors.

Adult↗
PubMed1994

Efficacy of single-dose therapy of urinary tract infection in infants and children: a review.

The role of single-dose therapy was evaluated by pooling data on 320 infants and children included in 12 clinical trials that differed from each other in many variables. Single-dose therapy achieved an overall cure rate of 89%, but varied with different antimicrobial agents. Intramuscular aminoglycosides were the best (cure rate: 96%) closely followed by trimethoprim-sulfamethoxazole or a sulfa drug with a cure rate of 90%. The cure rate with amoxicillin (75%) was significantly less. Single-dose therapy was most effective (cure rate: 90%) in well-documented lower urinary tract infections (UTIs) and slightly less effective (cure rate: 89%) among those in whom upper UTI could not be excluded. In patients with a normal urinary tract, single-dose therapy was significantly more effective (cure rate: 93%) than in the group of 36 patients with a urinary tract malformation (cure rate: 69%). Single-dose therapy can be used with confidence in patients with lower UTIs and in those with normal urinary tracts. In patients with abnormal urinary tracts and lower UTIs, single-dose therapy may be used with caution, preferably using aminoglycosides. Further studies are required to establish a definitive role of single-dose therapy in patients with urinary tract malformation.

Adolescent↗
PubMed1994

[The efficacy and tolerance of Bay-o-9867 (ciprofloxacin) in the treatment of infections of the urinary tract and of the lower respiratory tract].

A clinical trial was performed to evaluate efficacy and tolerability of Bay-o-9867 in the treatment of UTI and LRTI. 40 patients were admitted to the study: 27 affected with LRTI, mainly exacerbations of COPD, and 15 affected with UTI. Two patients were affected concomitantly with a UTI and LRTI. The patients were treated with Bay-o-9867 (ciprofloxacin) administered orally at a daily dosage of 500 mg (250 q 12 h) in 30 patients and of 1000 mg (500 q 12 h) in 10 patients, depending on the severity of infection. Clinical results were extremely favourable as complete clinical resolution of infective episode was achieved in 38 patients (15/15 in UTI patients; 25/27 in LRTI patients), whereas improvement was achieved in 2 (in LRTI). Overall clinical efficacy was therefore successful in 100% of cases. Concerning bacteriological results, 38 pathogens were isolated from infective sites before starting treatment, and all were eradicated (eradication rate: 100%). Tolerability was assessed as good: no adverse event was observed.

Adult↗
PubMed1993

Cefpirome: efficacy in the treatment of urinary and respiratory tract infections and safety profile.

The efficacy and safety of cefpirome was reviewed from the documentation of comparative pivotal trials in patients with urinary tract or lower respiratory tract infections UTIs and LRTIs, respectively). A majority of patients with UTIs had pyelonephritis and/or complicated UTIs. Most patients with LRTIs had community acquired pneumonia. Studies of UTI included 865 patients treated with cefpirome 1 g bid and 443 patients allocated to ceftazidime 1 g bid. Satisfactory clinical outcome was reported in 87% and 83%, respectively. Eradication of organisms causing bacteriuria was achieved in 87% and 86%, respectively. In the LRTI trials 199 patients received cefpirome 1 g bid and in 653 patients it was dosed 2 g bid. Comparators were ceftazidime 2 g bid (N = 197) or 2 g tid (N = 296) or ceftriaxone 1 g bid (N = 77). With all treatments unsatisfactory clinical or bacteriological outcome was recorded in < 15% of the patients. The safety of cefpirome and comparators was evaluated in pivotal phase II and III studies and deaths were analysed in all clinical trials for which data were available by June 30th 1991. Cefpirome did not differ from comparators in terms of frequencies or distribution within body systems of adverse events. Death rates were 3.9% in 9189 patients receiving cefpirome and 5.1% in 3162 receiving a comparator. The deaths were in an absolute majority of cases not considered related to study drug given. The most common cause of death was infection, indicating that the trial samples were selected from populations of patients with serious infections. Cefpirome was as safe and efficaceous as its comparators and is a new injectable cephalosporin with broader spectrum than ceftazidime. It should be a suitable alternative for empiric treatment of serious infections in hospitalised patients.

Adolescent↗
PubMed1993

[Clinical evaluation of Augpenin (clavulanic acid-ticarcillin) in urinary tract infections: especially against beta-lactamase producing strains].

Augpenin contains ticarcillin (TIPC) and clavulanic acid (CVA), at a ratio of 15:1. The beta-lactamase inhibitor, CVA, has been added to protect the TIPC from inactivation by beta-lactamase. To investigate the drug efficacy and safety against urinary tract infections (UTI), Augpenin was administered to 33 patients with chronic complicated UTI and 7 patients with acute pyelonephritis. Thirty two cases were evaluable by the UTI criteria. Excellent results were obtained in 6 of the cases of acute pyelonephritis, and moderate results in 1 case, with an overall effectiveness rate of 100%. Excellent results were obtained in 14 of the cases of chronic complicated UTI, moderate results in 9 cases, and poor results in 2 cases, with an overall effectiveness rate of 92%. No adverse reactions were noted, but a transient elevation of glutamic oxaloacetic transaminase and glutamic pyruvic transaminase levels was observed in 2 cases.

Adolescent↗