[Clinical evaluation of antimicrobial agents in urinary tract infections (urinary tract infections in paraplegics. II)].
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Drug Resistance, Microbial↗
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[A clinical evaluation of nalidixic acid in the urinary tract infections (urinary tract infections in paraplegics. I)].
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Drug Resistance, Microbial↗
EAU guidelines for the management of urinary and male genital tract infections. Urinary Tract Infection (UTI) Working Group of the Health Care Office (HCO) of the European Association of Urology (EAU).
A short version of the UTI Guidelines elaborated by the Urinary Tract Infection Working Group of the Health Care Office of the European Association of Urology is presented. The topics include classification, diagnosis, treatment and follow-up of uncomplicated UTI, UTI in children, UTI in diabetes mellitus, renal insufficiency, renal transplant recipients and immunosuppression, complicated UTI due to urological disorders, sepsis syndrome, urosepsis, urethritis, prostatitis, epididymitis, orchitis and principles of perioperative prophylaxis in urology.
Anti-Infective Agents, Urinary↗
Best pharmacological practice: urinary tract infections.
Urinary tract infection is the most frequent bacterial infection. Acute uncomplicated urinary infection and acute non-obstructive pyelonephritis occur in young women with normal genitourinary tracts. Empirical short-course therapy is preferred for the management of acute cystitis, but evolving resistance requires continuing reassessment of optimal antimicrobial selection. Empirical trimethoprim or trimethoprim/sulfamethoxazole has been recommended, but increasing resistance to these agents suggests that pivmecillinam, nitrofurantoin and perhaps fosfomycin trometamol should be considered. Although flouroquinolones are effective as short-course therapy, widespread empirical use of these agents should be discouraged because of potential promotion of resistance. For acute non-obstructive pyelonephritis, flouroquinolones are the empirical oral treatment of choice, although urine culture results should direct continuing therapy. Complicated urinary tract infection occurs in men or women of all ages with underlying abnormalities of the genitourinary tract. Treatment of complicated urinary infection is individualised, taking into consideration the underlying abnormality and susceptibilities of the infecting organism. Asymptomatic bacteriuria should not be treated except in pregnant women, in patients prior to undergoing an invasive surgical procedure, or renal transplant recipients in the early postrenal transplant period.
Anti-Bacterial Agents↗
New directions in the diagnosis and therapy of urinary tract infections.
Urinary tract infections are among the most common bacterial infections. To provide appropriate and cost-effective treatment, physicians need to stratify patients with urinary complaints into uncomplicated or complicated categories. This can be accomplished by the history, presenting symptoms, risk factors, and physical examination. Complicated urinary tract infections occur in patients with a history of recurrent infections, signs or symptoms of upper tract disease, or coexisting conditions such as pregnancy, immunosuppression, or structural anomalies of the urinary tract. Uncomplicated urinary tract infections occur in otherwise healthy women who have a history of lower tract symptoms of short duration. Symptoms of urinary tract infection include some combination of dysuria, frequency, urgency, hematuria, and suprapubic pain. An uncomplicated urinary tract infection is not accompanied by fever or flank pain. The microbiology of uncomplicated urinary tract infection is predictable, with Escherichia coli and other Enterobacteriaceae, Staphylococcus saprophyticus, and Enterococcus causing more than 90% of urinary tract infections. A history, brief physical examination, and urinalysis are all that is necessary to diagnose a urinary tract infection. Some of the specialized dipsticks and rapid screens are as accurate as microscopic examination in detecting urine white cells. A presumptive diagnosis can be made when a patient has clinical symptoms and some combination of pyuria, hematuria, or bacteriuria. Urine cultures are unnecessary in uncomplicated urinary tract infections and add substantially to the cost of therapy. Pitfalls in the diagnosis include other entities causing dysuria, such as vaginitis, vulvar lesions, physical or chemical irritants, and sexually transmitted diseases. Appropriate therapy requires selection of a drug and determination of the length of treatment. A minor infection should be treated with easy, safe, cost-effective therapy. For urinary tract infections, there are too many antibiotic options, ranging from a single, parenteral dose to a 14-day course of oral medication. Early optimism about single-dose oral therapy has been replaced by evidence suggesting that 3 days of therapy is probably the best. This will eradicate simple urinary tract infections in virtually all patients and decrease the incidence of relapse, whereas patients who are treatment failures usually have occult upper tract infection. Drug choices for short-course therapy include representatives from the penicillin, sulfa, and quinolone families. Selection of a specific drug requires consideration of costs, allergies, side effects, and spectrum of activity. A knowledge of local microbial sensitivity profiles and individual patient tolerance is helpful in guiding the clinician to the appropriate therapeutic regimen.
Anti-Infective Agents, Urinary↗
Urinalysis in the diagnosis of urinary tract infections.
Urinary tract infection is the commonest human bacterial infection. Bacteriuria alone does not appear to produce progressive renal damage or hypertension. However, it can produce considerable morbidity. Urinalysis is a simple, relatively sensitive, and reliable way of diagnosing urinary tract infection. It is not clear that routine screening should be performed in all patients, but pregnant females, patients with known anatomic abnormalities, and patients with recent genitourinary instrumentation should be screened. The major determinant of therapeutic success in patients with urinary tract infections is the anatomic site of infection. Superficial mucosal infection of the bladder is well treated with a single dose of an appropriate antibiotic, whereas deep tissue infection of the kidney or prostate should be treated with a prolonged and intensive course of therapy. Urinalysis is an insensitive tool in the localization of infection. However, the presence of white cell casts on the examination of the urinary sediment is pathognomonic of upper tract infection and would lead one to pursue an aggressive course of therapy. Examination of the concentrating ability is of limited help in this regard because of the wide range of overlap of concentrating ability in patients with upper and lower tract infections. In selected instances, urinalysis is of help in guiding therapy of urinary tract infections. This is particularly true of the patients with acute urethral syndrome where therapy is guided by the presence or absence of pyuria. Urinalysis, a simple front-line test, is of paramount importance in the evaluation and management of the patient with urinary tract infection.
Antibody-Coated Bacteria Test, Urinary↗
Intravaginal instillation of lactobacilli for prevention of recurrent urinary tract infections.
Urinary tract infections remain a common problem, particularly in the female population. New methods are required to manage recurrent cystitis, and extensive research to date has suggested that restoration of the lactobacilli flora of the urogenital tract may prevent these infections. In this study, five females suffering from recurrent urinary tract infections were treated twice weekly with intravaginal and perineal implantation of Lactobacillus casei GR-1. These organisms colonized the epithelium and prevented the emergence of coliform bacteria in most instances, but did not appear to affect enterococcal colonization. In vitro studies showed that L. casei GR-1 inhibited the growth of the coliforms but did not inhibit enterococci. Each of the five patients had infection-free periods ranging from 4 weeks to 6 months. The treatment was well tolerated, had no side effects, led to an improved well-being, and was preferred to antibiotic treatment by all of the patients. These human studies, albeit of a limited nature, are the first to examine the potential for lactobacillus therapy in the prevention of urinary tract infections. The results show that lactobacilli therapy, using carefully selected organisms to treat patients who are closely followed, may be effective in the prevention of recurrent urinary tract infections.
Adolescent↗
Single-dose amikacin treatment of first childhood E. coli lower urinary tract infections.
Urinary tract infection in children is usually treated with orally administered antibiotics for 10 to 14 days. Because of the unreliability of patient compliance with prescribed medications and because single-dose aminoglycoside therapy has been shown to be effective in women with cystitis, we assessed the efficacy of single-dose amikacin for treatment of first episodes of Escherichia coli lower urinary tract infection in girls. Upper and lower urinary tract infections were presumptively differentiated by simple criteria such as clinical symptoms, fever, and erythrocyte sedimentation rate. Fifty-four girls (ages 1 to 12 years) with two positive urine cultures (greater than 10(5) CFU/ml E. coli) were assigned by a table of random numbers to receive treatment with either sulfisoxazole 150 mg/kg/day orally for 10 days or a single dose of amikacin 7.5 mg/kg intramuscularly. Six of 23 patients (26%) in the amikacin group and four of 21 (19%) in the sulfisoxazole group had at least one positive urine culture within 40 days after completion of therapy. This difference was not statistically significant (P greater than 0.5). This suggests that a single dose of amikacin is as effective as a 10-day course of sulfisoxazole in the treatment of presumed first lower urinary tract infection in girls. Additional potential advantages of single-dose therapy are fewer side effects and less toxicity, excellent compliance, and reduced potential for selecting resistant organisms.
Amikacin↗
Laboratory findings in urinary tract infections.
Urinary tract infection should be considered in a differential diagnosis on the basis of history, physical examination, and urinalysis. To definitively diagnose urinary tract infection, significant bacteriuria must be found by quantitative bacterial culture. The absolute definition of significant numbers of bacteria varies with the method of collection because of the possibility of contamination with the normal bacterial flora of the lower genitourinary tract. Numbers of bacteria are also influenced by the manner in which urine samples are handled, by urine concentration, and by frequency of voiding. Quantitative and qualitative urine cultures should also be used to monitor the efficacy of treatment in chronic and recurrent infections. Cultures should be repeated three to five days after the termination of antimicrobial therapy to ensure elimination of infection. If feasible, cultures should also be repeated two to three days after begining therapy to ensure the antimicrobial agent selected is effective. Remission of clinical signs should not be used to judge efficacy of treatment, especially in chronic or recurrent infections, since infections can persist without causing clinical signs, particularly if bacterial numbers are temporarily reduced. Determination of the minimum inhibitory concentration of an antibiotic for a particular bacteria is preferable to Kirby-Bauer antibiotic sensitivity testing in urinary tract infection because of the difference in serum and urine concentrations of most antibiotics. Bacteria are not sensitive or resistant to an antibiotic but rather to a concentration of that antibiotic. If Kirby-Bauer sensitivity testing is used for urinary tract infection, results must be interpreted carefully since drugs reported as ineffective may be effective in vivo.
Animals↗
Pyelonephritis and female urinary tract infection.
Urinary tract infections are a common problem for women and frequently result in a visit to the Emergency Department. Most of these infections are easily diagnosed and treated; however, subclinical pyelonephritis is a recently recognized entity and signs of upper tract involvement should always be sought, especially in compromised hosts and patients who are at risk for developing complicated infections. Each of these situations demands a more thorough evaluation and more prolonged and aggressive treatment to minimize the possibility of renal damage. Fortunately, there is a narrow spectrum of organisms responsible for most urinary tract infections, and they respond well to a wide range of commonly used antibiotics. Newer diagnostic techniques, the acceptance of short-course therapy for lower tract infections, and the development of new antibiotics have increased our diagnostic and therapeutic options. Further developments in these areas, as well as the possibility of nonantibiotic prevention of urinary tract infections, predict a brighter future for patients with complicated or frequently recurring urinary tract infections.
Anti-Bacterial Agents↗
The impact of resistance on the management of urinary tract infections.
Urinary tract infections requiring treatment are extremely common. It is estimated that between 20 and 50% of adult women will have had at least one symptomatic urinary tract infection. When considering the optimal therapy of any infection, patient factors, organism factors, drug factors (e.g. pharmacokinetics), side-effects and cost as well as antimicrobial resistance all need to be considered. This paper deals with the impact of increasing antibiotic resistance on the management of urinary tract infections.
Anti-Bacterial Agents↗
[Can we prevent late complications of urinary tract infections?].
Urinary tract infections are one of the most common renal diseases sometimes leading to renal injury and in consequence to chronic renal failure. The most frequent causative pathogen responsible for this infection is Escherichia coli. There are several factors which increase the risk of infection including vesicoureteral reflux, cystic renal disease, urinary calculi, obstruction and other anatomical and functional abnormalities of urinary tract as well as neurological bladder dysfunction, long term indwelling catheters, mechanical vaginal diaphragms and intensive sexual intercourse. This paper will highlight general view on the treatment of different manifestations of urinary tract infections including asymptomatic bacteriuria, urethritis, cystitis, prostatitis as well as acute and chronic pyelonephritis. The details of those problems will be elucidated in another paper.
Adolescent↗
Carcinoma of the breast metastatic to the ureter presenting with flank pain and recurrent urinary tract infection.
Urinary tract infection in the female patient is not an uncommon finding. Flank pain associated with urinary tract infection is usually due to calculus disease or pyelonephritis. In patients with history of breast carcinoma, metastasis to the periureteral area with resulting obstruction should be considered. The incidence of metastatic breast carcinoma presenting in this fashion is as high as 7.8 per cent. This case shows a patient with metastatic lobular carcinoma of the breast with ureteral obstruction, causing flank pain and recurrent urinary tract infection. This report emphasizes the importance of long-term follow-up in patients with history of breast cancer, especially invasive lobular carcinoma, and the high degree of suspicion required to diagnose and institute proper therapy.
Aged↗
Antimicrobial agents in urinary tract infections.
Urinary tract infections are commonly encountered in clinical practice and are usually readily treatable. Although many antimicrobial agents that have been available for some time remain effective in the eradication of bacteriuria, the recent introduction of the fluoroquinolone norfloxacin represents an important addition to the therapeutic armamentarium. The efficacy of single-dose therapy with antimicrobial agents such as trimethoprim-sulfamethoxazole or amoxicillin has been shown to be similar to that with conventional (7- to 10-day) treatment in women with uncomplicated lower urinary tract infections. The long-term administration of agents such as trimethoprim-sulfamethoxazole or nitrofurantoin in low doses is usually effective for suppression or prophylaxis of recurrent bacteriuria.
Acute Disease↗
[Epidemiology and pathogen spectrum of urinary tract infections].
Urinary tract infections still are a diagnostic as well as a therapeutical problem. The knowledge on the frequency of the causative organisms and their sensitivity to antibiotics and the different modes of urinary tract infections as well are very important, especially because of remaining organizational and medical-technical problems to identify the organisms. E. coli-bacteria are up to now the most frequent pathogens of urinary tract infections, with a resistance rate of 30% against aminopenicillins. An increase of resistant Enterobacter- and Pseudomonas-aeruginosa-strains against quinolones is known and could be observed also in our hospital. The demand for knowledge of sensitivity pattern of the causative organisms still remain for a successful antibiotic therapy.
Adolescent↗
Treatment of urinary tract infections.
Urinary tract infections (UTIs) are common conditions in clinical practice. For uncomplicated UTIs, the causative organisms and their antimicrobial susceptibility profiles are generally predictable, and empiric short course (3 day) antibiotic therapy after an abbreviated laboratory workup is advocated. Acute pyelonephritis requires a 2 week antibiotic course, often with initial parenteral therapy. Women with frequent recurrences of UTIs may require intermittent self-treatment or continuous or postcoital antibiotic prophylaxis. Catheter-associated UTIs generally only require treatment if the patient shows signs of systemic infection. Treatment of asymptomatic bacteriuria is only recommended in certain circumstances. Careful consideration of the clinical circumstances, the patient's known or predicted urinary tract anatomy, and the antibiotic susceptibility of the bacterial pathogen(s) are critical factors in the choice of appropriate therapy for urinary tract infections.
Adult↗
Definitions, classification, and clinical presentation of urinary tract infections.
Urinary tract infections encompass a spectrum of clinical and pathologic conditions involving various parts of the urinary tract. Each syndrome has its own unique epidemiology, natural history, and clinical manifestations. Basic terminology used in describing urinary tract infections is defined in this article. A classification of these infections and their clinical features is presented.
Bacterial Infections↗
[Nephrology-part 3: Urinary tract infections].
Urinary tract infections are one of the most common bacterial infectious diseases in humans. Depending on the localization and the effectiveness of pathogenetic factors, various clinical pictures (lower urinary tract infection, pyelonephritis, asymptomatic bacteriuria) have to be differentiated. There are virulence factors of microorganisms on the one hand and defense mechanisms on the other, which influence the manifestation and the course of disease. The process of bacterial attachment to the epithelial cells of the boundary layer, the internalization and invasion of bacteria could be important for acute and chronic disease. Disturbances of local defense mechanisms, such as increased urinary glucose concentration in diabetes or variations of Tamm-Horsfall protein and defensin levels, may influence the course of infection. On the basis of microbiological and laboratory findings as well as the results of clinical and ultrasound procedures, the decision on the therapeutic strategy should be made. There are different treatment recommendations for acute uncomplicated and complicated cases as well as for chronic diseases. Future investigations should focus on effective therapeutic options for special immunocompromised patients in relation to the microbiological aspects and defense mechanisms of the host.
Anti-Bacterial Agents↗