Posts filed under ‘Infecciones urinarias’

Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America

Clinical Infectious Diseases May 15, 2019 V.68 N.10 P.1611-1615

IDSA GUIDELINES

Asymptomatic bacteriuria (ASB) is a common finding in many populations, including healthy women and persons with underlying urologic abnormalities. The 2005 guideline from the Infectious Diseases Society of America recommended that ASB should be screened for and treated only in pregnant women or in an individual prior to undergoing invasive urologic procedures. Treatment was not recommended for healthy women; older women or men; or persons with diabetes, indwelling catheters, or spinal cord injury. The guideline did not address children and some adult populations, including patients with neutropenia, solid organ transplants, and nonurologic surgery. In the years since the publication of the guideline, further information relevant to ASB has become available. In addition, antimicrobial treatment of ASB has been recognized as an important contributor to inappropriate antimicrobial use, which promotes emergence of antimicrobial resistance. The current guideline updates the recommendations of the 2005 guideline, includes new recommendations for populations not previously addressed, and, where relevant, addresses the interpretation of nonlocalizing clinical symptoms in populations with a high prevalence of ASB.

FULL TEXT

https://academic.oup.com/cid/article/68/10/1611/5481760

PDF (CLIC en PDF)

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May 5, 2019 at 12:04 pm

Diagnostic value of symptoms and signs for identifying urinary tract infection in older adult outpatients: Systematic review and meta-analysis.

Journal of  Infection  November 2018 V.77 N.5 P.379-390.

Gbinigie OA1, Ordóñez-Mena JM2, Fanshawe TR3, Plüddemann A4, Heneghan C5.

Author information

1 Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom. Electronic address: oghenekome.gbinigie@phc.ox.ac.uk.

2 Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom. Electronic address: jose.ordonezmena@phc.ox.ac.uk.

3 Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom. Electronic address: thomas.fanshawe@phc.ox.ac.uk.

4 Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom. Electronic address: annette.pluddemann@phc.ox.ac.uk.

5 Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom. Electronic address: carl.heneghan@phc.ox.ac.uk.

Abstract

OBJECTIVES:

To critically appraise and evaluate the diagnostic value of symptoms and signs in identifying UTI in older adult outpatients, using evidence from observational studies.

METHODS:

We searched Medline and Medline in process, Embase and Web of Science, from inception up to September 2017. We included studies assessing the diagnostic accuracy of symptoms and/or signs in predicting UTI in outpatients aged 65 years and above. Study quality was assessed using the QUADAS-2 tool.

RESULTS:

We identified 15 eligible studies of variable quality, with a total of 12,039 participants (range 65-4259), and assessed the diagnostic accuracy of 66 different symptoms and signs in predicting UTI. A number of symptoms and signs typically associated with UTI, such as nocturia, urgency and abnormal vital signs, were of limited use in older adult outpatients. Inability to perform a number of acts of daily living were predictors of UTI: For example, disability in feeding oneself, + ve LR: 11.8 (95% CI 5.51-25.2) and disability in washing one’s hands and face, + ve LR: 6.84 (95% CI 4.08-11.5).

CONCLUSIONS:

The limited evidence of varying quality shows that a number of symptoms and signs traditionally associated with UTI may have limited diagnostic value in older adult outpatients.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6203890/pdf/main.pdf

March 15, 2019 at 3:32 pm

Diagnostic value of symptoms and signs for identifying urinary tract infection in older adult outpatients: Systematic review and meta-analysis

Journal of Infection November 2018 V.77 N.5 P.379–390

Oghenekome A. Gbinigie, José M. Ordóñez-Mena, Thomas R. Fanshawe, Annette Plüddemann, Carl Heneghan

Highlights

  • Older adults may present atypically with UTI and making a diagnosis can be difficult.
  • There is limited authoritative guidance on how older adult outpatients present with UTI.
  • Symptoms and signs traditionally associated with UTI (e.g. nocturia, urgency and abnormal vital signs) may have limited utility in diagnosing these infections in older adult outpatients.
  • Disability in performing a number of acts of daily living may be better predictors of UTI; high quality studies should be conducted in this area to confirm this

Objectives

To critically appraise and evaluate the diagnostic value of symptoms and signs in identifying UTI in older adult outpatients, using evidence from observational studies.

Methods

We searched Medline and Medline in process, Embase and Web of Science, from inception up to September 2017. We included studies assessing the diagnostic accuracy of symptoms and/or signs in predicting UTI in outpatients aged 65 years and above. Study quality was assessed using the QUADAS-2 tool.

Results

We identified 15 eligible studies of variable quality, with a total of 12,039 participants (range 65–4259), and assessed the diagnostic accuracy of 66 different symptoms and signs in predicting UTI. A number of symptoms and signs typically associated with UTI, such as nocturia, urgency and abnormal vital signs, were of limited use in older adult outpatients. Inability to perform a number of acts of daily living were predictors of UTI: For example, disability in feeding oneself, + ve LR: 11.8 (95% CI 5.51–25.2) and disability in washing one’s hands and face, + ve LR: 6.84 (95% CI 4.08–11.5).

Conclusions

The limited evidence of varying quality shows that a number of symptoms and signs traditionally associated with UTI may have limited diagnostic value in older adult outpatients.

FULL TEXT

https://www.journalofinfection.com/article/S0163-4453(18)30190-7/fulltext

PDF

https://www.journalofinfection.com/article/S0163-4453(18)30190-7/pdf

January 12, 2019 at 9:59 am

Highlights From International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases

Infectious Diseases in Clinical Practice July 2011 V.19 N.4 P.282-283

Clinical Guidelines

File, Thomas M. Jr

A panel of international experts was convened by the Infectious Diseases Society of America in collaboration with the European Society for Microbiology and Infectious Diseases to update the 1999 uncomplicated urinary tract infection (UTI) guidelines.

The focus of the recommendations is on women with uncomplicated cystitis and pyelonephritis.

Since the 1999 guideline, antimicrobial resistance among uropathogens causing urinary tract infections has increased, and newer agents and different duration of therapy have been studied.

This update reflects many of the changes since the 1999 guideline.

FULL TEXT

https://journals.lww.com/infectdis/Fulltext/2011/07000/Highlights_From_International_Clinical_Practice.15.aspx

PDF (CLIC en PDF)

 

December 7, 2018 at 9:31 am

A systematic review of randomised clinical trials for oral antibiotic treatment of acute pyelonephritis

European Journal of Clinical Microbiology & Infectious Diseases December 2018 V.37 N.12 P.2285–2291

Jonathan W. S. Cattrall, Alyss V. Robinson & Andrew Kirby

There is increasing resistance to the oral antibiotics currently recommended for the treatment of pyelonephritis, and increased healthcare costs are associated with the reliance on alternative intravenous agents.

We, therefore, performed a systematic review of randomised controlled trials to determine the clinical efficacy and safety of oral antibiotics for the treatment of pyelonephritis in adults.

A search of four major medical databases (MEDLINE, Embase+ Embase classic, CENTRAL and Cochrane Database for Systematic Reviews) in addition to manual reference searching of relevant reviews was conducted.

Clinical cure and adverse event rates were reported, and trial quality and bias were assessed. A total of 277 studies were reviewed; five studies matched all eligibility criteria and were included.

Antibiotics included were cefaclor, ciprofloxacin, gatifloxacin, levofloxacin, lomefloxacin, loracarbef, norfloxacin, rufloxacin and trimethoprim-sulfamethoxazole.

In included studies, the clinical success of the outpatient treatment of pyelonephritis by cefaclor, ciprofloxacin and norfloxacin at 4 to 6 weeks was comparable at between 83 to 95%. Relatively high rates of adverse events were noted in a trial of ciprofloxacin (24%) and trimethoprim-sulfamethoxazole (33%).

Significant heterogeneity between all aspects of the trial designs was identified, with all studies having a potential for bias.

This review demonstrates a need for high-quality clinical trials into the oral antibiotic treatment of pyelonephritis, with more consistent designs and reporting of outcomes.

There are data to support further research into oral norfloxacin and cefaclor for the outpatient treatment of pyelonephritis in adults.

PDF

https://link.springer.com/content/pdf/10.1007%2Fs10096-018-3371-y.pdf

 

November 21, 2018 at 12:29 pm

INFECCIÓN del TRACTO URINARIO ASOCIADA a SONDA VESICAL. ACTUALIZACIÓN Y RECOMENDACIONES INTERSOCIEDADES

Medicina (B Aires). 2018;78(4):258-264.

An update on catheter-associated urinary tract infection. Inter-Society recommendations.

[Article in Spanish]

Cornistein W1, Cremona A2, Chattas AL3, Luciani A4, Daciuk L5, Juárez PA6, Colque AM7.

Author information

1 Hospital Universitario Austral, Buenos Aires, Argentina. E-mail: wandacornistein@gmail.com.

2 Hospital Italiano de La Plata, La Plata, Argentina.

3 Hospital Dr. Ignacio Pirovano, Buenos Aires, Argentina.

4 Hospital de Clínicas José de San Martín, Buenos Aires, Argentina.

5 Hospital Prof. Dr. Alejandro Posadas, El Palomar, Argentina.

6 Hospital de la Madre y el Niño, La Rioja, Argentina.

7 Complejo Médico Churruca Visca, Buenos Aires, Argentina.

Abstract

Representatives of the Argentine Society of Infectious Diseases (SADI) and the Argentine Society of Intensive Therapy (SATI) issued the present recommendations on diagnosis, treatment, and prevention of catheter associated urinary tract infection (CA-UTI). Articles published during 2006-2016 were analyzed in the light of experts’ opinion and local data. This document aims to offer basic strategies to optimize the diagnosis based on clinical and microbiological criteria, provide guidance in empirical and targeted antibiotic schemes, and promote effective measures to reduce the risk of CA-UTI. The joint work of both societies highlights the experts’ concern about the mismanagement of CA-UTI, which is associated to the indiscriminate use of antimicrobials, and the importance of improving daily practices of CA-UTI management. Through these recommendations, local guidelines are established to optimize the diagnosis, treatment and prevention of CAUTI in order to reduce morbimortality, days of hospitalization, costs and antibiotic resistance due to the misuse of antimicrobials.

PDF

http://www.medicinabuenosaires.com/PMID/30125253.pdf

November 3, 2018 at 10:40 am

Understanding the Mechanism of Bacterial Biofilms Resistance to Antimicrobial Agents.

Open Microbiol J. 2017 Apr 28;11:53-62.

Singh S1, Singh SK2, Chowdhury I3, Singh R2.

1 Department of Kriya Sharir, Institute of Medical Sciences, Banaras Hindu University, Varanasi- 221 005 UP India.

2 Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA, USA.

3 Department of Obstetrics and Gynecology; Morehouse School of Medicine, Atlanta, GA, USA.

Abstract

A biofilm is a group of microorganisms, that causes health problems for the patients with indwelling medical devices via attachment of cells to the surface matrix. It increases the resistance of a microorganism for antimicrobial agents and developed the human infection. Current strategies are removed or prevent the microbial colonies from the medical devices, which are attached to the surfaces. This will improve the clinical outcomes in favor of the patients suffering from serious infectious diseases. Moreover, the identification and inhibition of genes, which have the major role in biofilm formation, could be the effective approach for health care systems. In a current review article, we are highlighting the biofilm matrix and molecular mechanism of antimicrobial resistance in bacterial biofilms.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5427689/pdf/TOMICROJ-11-53.pdf

 

October 14, 2018 at 10:44 am

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