Posts filed under ‘Infecciones urinarias’

Ceftazidime/Avibactam and Ceftolozane/Tazobactam: Second-generation β-Lactam/βLI Combinations.

Clinical Infectious Diseases July 15, 2016 V.63 N.2 P.234-41.

van Duin D1, Bonomo RA2.

Abstract

Ceftolozane/tazobactam and ceftazidime/avibactam are 2 novel β-lactam/β-lactamase combination antibiotics. The antimicrobial spectrum of activity of these antibiotics includes multidrug-resistant (MDR) gram-negative bacteria (GNB), including Pseudomonas aeruginosa. Ceftazidime/avibactam is also active against carbapenem-resistant Enterobacteriaceae that produce Klebsiella pneumoniae carbapenemases. However, avibactam does not inactivate metallo-β-lactamases such as New Delhi metallo-β-lactamases. Both ceftolozane/tazobactam and ceftazidime/avibactam are only available as intravenous formulations and are dosed 3 times daily in patients with normal renal function. Clinical trials showed noninferiority to comparators of both agents when used in the treatment of complicated urinary tract infections and complicated intra-abdominal infections (when used with metronidazole). Results from pneumonia studies have not yet been reported. In summary, ceftolozane/tazobactam and ceftazidime/avibactam are 2 new second-generation cephalosporin/β-lactamase inhibitor combinations. After appropriate trials are conducted, they may prove useful in the treatment of MDR GNB infections. Antimicrobial stewardship will be essential to preserve the activity of these agents.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4928383/pdf/ciw243.pdf

 

Advertisements

June 10, 2018 at 10:52 am

Facility Guidance for Control of Carbapenem-resistant Enterobacteriaceae (CRE) – November 2015 Update CRE Toolkit

Facility Guidance for Control of Carbapenem-resistant Enterobacteriaceae (CRE) – November 2015 Update CRE Toolkit

 

PDF

https://www.cdc.gov/hai/organisms/cre/cre-toolkit/index.html

 

May 6, 2018 at 6:08 pm

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 …

Fundamento

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.

Métodos

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).

Resultados

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%).

Conclusión

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.

FULL TEXT

https://academic.oup.com/ofid/article/4/4/ofx207/4641888

PDF  (CLIC en PDF)

 

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

Highlights

  • 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.

Background

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.

Methods

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.

Results

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.

Conclusions

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.

abstract

http://www.ijidonline.com/article/S1201-9712(17)30252-7/fulltext

PDF

http://www.ijidonline.com/article/S1201-9712(17)30252-7/pdf

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.

Abstract

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.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4739987/pdf/tau-05-01-072.pdf

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.

Abstract

INTRODUCTION:

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.

DIAGNOSTICS:

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.

TREATMENT:

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.

PREVENTION:

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.

CONCLUSION:

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.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5516874/pdf/rru-9-121.pdf

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.

Abstract

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.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5522797/pdf/tau-06-S2-S163.pdf

February 4, 2018 at 4:37 pm

Older Posts


Calendar

June 2018
M T W T F S S
« May    
 123
45678910
11121314151617
18192021222324
252627282930  

Posts by Month

Posts by Category