Posts filed under ‘Infecciones urinarias’

Inappropriate Management of Asymptomatic Patients With Positive Urine Cultures: A Systematic Review and Meta-analysis

Open Forum Infectious Diseases Fall 2017 V.4 N.4

Myrto Eleni Flokas; Nikolaos Andreatos; Michail Alevizakos; Alireza Kalbasi; Pelin Onur …


La mala gestión de pacientes asintomáticos con cultivos de orina positivos (denominada bacteriuria asintomática [ASB] en la literatura) promueve la resistencia a los antimicrobianos y da como resultado eventos adversos innecesarios relacionados con los antimicrobianos y mayores costos de atención médica.


Llevamos a cabo una revisión sistemática y un metanálisis de estudios que informaron sobre la tasa de tratamiento ASB inapropiado publicado entre 2004 y agosto 2016. La idoneidad de la administración de antimicrobianos se basó en las guias publicadas por la Sociedad de Enfermedades Infecciosas de América (IDSA).


Se identificaron 2142 artículos no duplicados, y entre ellos 30 cumplieron nuestros criterios de inclusión. La prevalencia combinada del tratamiento antimicrobiano entre 4129 casos que no requirieron tratamiento fue del 45% (IC 95%, 39-50). Aislamiento de BGN (odds ratio [OR], 3,58; IC del 95%, 2,12-6,06), piuria (OR, 2,83; IC del 95%, 1,9-4,22), positividad del nitrito (OR, 3,83; IC del 95%; 2.24-6.54), y el sexo femenino (OR, 2.11, IC 95%, 1.46-3.06) aumentaron las probabilidades de recibir tratamiento. Las tasas de tratamiento fueron más altas en estudios con valores de corte de ≥ 100 000 ufc/ml en comparación con < 10 000 ufc/ml para el crecimiento bacteriano (P, 0,011). La implementación de intervenciones educativas y organizacionales diseñadas para eliminar el sobretratamiento de ASB resultó en una reducción media del riesgo absoluto del 33% (rangeARR, 16-36%, medianaRRR, 53%; rangeRRR, 25-80%).


La mala gestión de ASB sigue siendo extremadamente frecuente. El sexo femenino y la sobreinterpretación de ciertos datos de laboratorio (nitritos positivos, piuria, aislamiento de bacterias gramnegativas y cultivos con mayor recuento microbiano) están asociados con el sobretratamiento. Incluso las intervenciones simples de mayordomía pueden ser particularmente efectivas, y los programas de administración de antimicrobianos deben enfocarse en el desafío de diferenciar la infección verdadera del tracto urinario de ASB.





April 9, 2018 at 1:13 pm

Staphylococcus saprophyticus: Which beta-lactam?

International Journal of Infectious Diseases December 2017 V.65 N. P.63–66

Hélène Pailhoriès, Viviane Cassisa, Rachel Chenouard, Marie Kempf, Matthieu Eveillard, Carole Lemarié


  • The treatment of Staphylococcus saprophyticus urinary tract infections is difficult.
  • This study analysed the epidemiology of S. saprophyticus urinary tract infections.
  • Susceptibility of S. saprophyticus to ceftriaxone was studied.
  • A high rate of ineffective empirical antibiotic therapy for S. saprophyticus was noted.
  • High ceftriaxone minimum inhibitory concentrations were noted for methicillin-susceptible S. saprophyticus.


Staphylococcus saprophyticus is resistant to the drugs most often used for the empirical treatment of urinary tract infections (UTI). The adequacy of antimicrobial treatments prescribed for UTI due to S. saprophyticus is not usually questioned. This study described the epidemiology of such infections and assessed the susceptibility of S. saprophyticus to ceftriaxone and amoxicillin–clavulanic acid.


Methicillin-susceptible S. saprophyticus (MSSS) isolated from clinical samples between November 2014 and July 2016 were included. Clinical data were recorded. The minimum inhibitory concentrations (MICs) of amoxicillin–clavulanic acid and ceftriaxone were measured for these MSSS strains and for 17 randomly selected methicillin-susceptible Staphylococcus aureus (MSSA) strains.


Of the S. saprophyticus isolates from urine, 59.5% were associated with a diagnosis of cystitis and 33.3% with pyelonephritis. Sixty percent of S. saprophyticus cystitis cases and 25% of pyelonephritis cases were given an inappropriate antibiotic regimen. The MICs of ceftriaxone ranged from 4 to >32 μg/ml for MSSS, and from 1.5 to 4 μg/ml for MSSA.


Many UTIs were treated with an empirical antibiotic therapy that was ineffective for S. saprophyticus, revealing that S. saprophyticus is an aetiology that is insufficiently considered in UTI. High MICs for ceftriaxone in MSSS were observed, which raises questions about the use of this antibiotic in UTIs due to S. saprophyticus.



February 9, 2018 at 1:27 pm

Urinary tract infection in the neurogenic bladder.

Transl Androl Urol. 2016 Feb;5(1):72-87.

Vigil HR1, Hickling DR1.

1 Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.


There is a high incidence of urinary tract infection (UTI) in patients with neurogenic lower urinary tract function. This results in significant morbidity and health care utilization. Multiple well-established risk factors unique to a neurogenic bladder (NB) exist while others require ongoing investigation. It is important for care providers to have a good understanding of the different structural, physiological, immunological and catheter-related risk factors so that they may be modified when possible. Diagnosis remains complicated. Appropriate specimen collection is of paramount importance and a UTI cannot be diagnosed based on urinalysis or clinical presentation alone. A culture result with a bacterial concentration of ≥10(3) CFU/mL in combination with symptoms represents an acceptable definition for UTI diagnosis in NB patients. Cystoscopy, ultrasound and urodynamics should be utilized for the evaluation of recurrent infections in NB patients. An acute, symptomatic UTI should be treated with antibiotics for 5-14 days depending on the severity of the presentation. Antibiotic selection should be based on local and patient-based resistance patterns and the spectrum should be as narrow as possible if there are no concerns regarding urosepsis. Asymptomatic bacteriuria (AB) should not be treated because of rising resistance patterns and lack of clinical efficacy. The most important preventative measures include closed catheter drainage in patients with an indwelling catheter and the use of clean intermittent catheterization (CIC) over other methods of bladder management if possible. The use of hydrophilic or impregnated catheters is not recommended. Intravesical Botox, bacterial interference and sacral neuromodulation show significant promise for the prevention of UTIs in higher risk NB patients and future, multi-center, randomized controlled trials are required.


February 4, 2018 at 4:39 pm

Management of urinary tract infections in patients with neurogenic bladder: challenges and solutions.

Res Rep Urol. 2017 Jul 11;9:121-127.

Pannek J1, Wöllner J1.

1 Neuro-Urology, Swiss Paraplegic Center, Nottwil, Switzerland.



Urinary tract infections (UTIs) are one of the most common morbidities in persons with neurogenic lower urinary tract dysfunction (NLUTD). They are associated with a significant morbidity and mortality, and they affect the quality of life of the affected patients. Diagnosis and treatment of UTI in this group of patients are challenging. In this review, the current strategies regarding diagnosis, treatment, and prevention are summarized.


it is important to correctly diagnose a UTI, as treatment of bacteriuria should strictly be avoided. A UTI is defined as a combination of laboratory findings (leukocyturia and bacteriuria) and symptoms. Laboratory findings without symptoms are classified as asymptomatic bacteriuria. Routine urine screening is not advised.


Only UTI should be treated; treatment of asymptomatic bacteriuria is not indicated. Prior to treatment, urine for a urine culture should be obtained. Antibiotic treatment for ~7 days is advised.


In recurrent UTI, bladder management should be optimized and morphologic causes for UTI should be excluded. If UTIs persist, medical prophylaxis should be considered. Currently, no prophylactic measure with evidence-based efficacy exists. Long-term antibiotic prophylaxis should be used merely as an ultimate measure. Among the various mentioned innovative approaches for UTI prevention, bacteriophages, intravesical instillations, complementary and alternative medicine techniques, and probiotics seem to be most promising.


Recently, several promising innovative options for UTI prophylaxis have been developed which may help overcome the current therapeutic dilemma. However, further well designed studies are necessary to evaluate the safety and efficacy of these approaches.


February 4, 2018 at 4:38 pm

Recurrent urinary tract infections in patients with incomplete bladder emptying: is there a role for intravesical therapy?

Transl Androl Urol. 2017 Jul;6(Suppl 2):S163-S170.

Dray EV1, Clemens JQ1.

1 Department of Urology, University of Michigan Health Science Center, Ann Arbor, Michigan, USA.


The goal of this review article is to discuss the etiology of recurrent urinary tract infections (UTIs) in individuals with impaired bladder emptying, evaluate existing studies regarding UTI prevention strategies in this population, and explore the published experiences with intravesical therapy for the prevention and treatment of recurrent UTIs in patients performing clean intermittent catheterization (CIC). We will also describe the intravesical antibiotic protocol utilized at our institution.


February 4, 2018 at 4:37 pm

Urinary infection in patients with neurogenic bladder: patterns of resistance to the most frequent uropathogens.

Actas Urol Esp. 2012 Sep;36(8):474-81. Epub 2012 Jan 21.

[Article in Spanish]

Romero-Cullerés G1, Planells-Romeo I, Martinez de Salazar-Muñoz P, Conejero-Sugrañes J.

1 Servicio de Medicina Física y Rehabilitación, Fundación ALTHAIA, Manresa, Barcelona, España.



To analyze the most frequent causes and resistances of the uropathogens in patients affected by neurogenic bladder.


A total of 284 patients, in whom a total of 284 urinary cultures were performed, were included. Of these, 106 came from patients with neurological injuries, 28 from a non-neurogenic control group, 75 from patients admitted to the intensive care unit (ICU) of our Hospital and 75 patients who came into the emergency room with the symptoms of an acute urinary tract infection. A quantitative urine culture was performed in a chromogenic media and the resistances of all urine cultures that were positive for one or two micro-organisms were identified and studied.


A total of 67% of the patients with neurological injuries had positive urine cultures compared to 25% of control group patients. The urine cultures of patients admitted into the ICU and those of the Emergency Room group were 100% positive, since the first 75 positive urine cultures were selected for the study. E.coli was the most-frequently microorganism isolated in the group of neurological patients, as well as among the patients from the Emergency Room and from the control group. In the ICU, the most-frequently isolated micro-organism was Enterococcus spp. (19.4%), followed by P. aeruginosa (16.5%). The study of resistances in general E. coli has high rates of resistance to ampicillin and co-trimoxazole and, although to a lesser degree to ciprofloxacin.


  1. coli is the micro-organism most frequently isolated among all of the groups except in the ICU, where it is surpassed by Enterococcus spp. and P. aeruginosa. The resistances among the four population groups studied have different features, overall showing a low rate of resistance to nitrofurantoin and especially to fosfomycin, observed in patients from the Emergency Room or admitted to the ICU and neurological patients.



February 4, 2018 at 4:36 pm

Population Pharmacokinetic Analysis of Cefiderocol, a Parenteral Siderophore Cephalosporin, in Healthy Subjects, Subjects with Various Degrees of Renal Function, and Patients with Complicated Urinary Tract Infection or Acute Uncomplicated Pyelonephritis

Agents and Chemotherapy February 2018 V.62 N.2

Nao Kawaguchi, Takayuki Katsube, Roger Echols and Toshihiro Wajima

aProject Management Department, Shionogi & Co., Ltd., Osaka, Japan

bInfectious Disease Drug Development Consulting, LLC, Easton, Connecticut, USA

Cefiderocol, a novel parenteral siderophore cephalosporin, exhibits potent efficacy against most Gram-negative bacteria, including carbapenem-resistant strains.

The aim of this study was to perform a population pharmacokinetic (PK) analysis based on plasma cefiderocol concentrations in healthy subjects, subjects with various degrees of renal function, and patients with complicated urinary tract infection (cUTI) or acute uncomplicated pyelonephritis (AUP) caused by Gram-negative pathogens and to calculate the fraction of the time during the dosing interval where the free drug concentration in plasma exceeds the MIC (fTMIC).

Population PK models were developed with three renal function markers, body surface area-adjusted estimated glomerular filtration rate (eGFR), absolute eGFR, and creatinine clearance, on the basis of 2,571 plasma concentrations from 91 subjects without infection and 238 patients with infection.

The population PK models with each renal function marker adequately described the plasma cefiderocol concentrations. Clear relationships of total clearance (CL) to all renal function markers were observed.

Body weight and disease status (with or without infection) were also significant covariates. The CL in patients with infection was 26% higher than that in subjects without infection.

The fTMIC values were more than 75% in all patients (and were 100% in most patients), suggesting that a sufficient exposure to cefiderocol was provided by the tested dose regimens (2 g every 8 h as the standard dose regimen) for the treatment of cUTI or AUP caused by Gram-negative pathogens.




January 27, 2018 at 3:12 pm

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