Posts filed under ‘Infecciones urinarias’

REVIEW – New agents for the treatment of infections with Gram-negative bacteria: restoring the miracle or false dawn?

Clin Microbiol Infect. October 2017 V.23 N.10 P.704-712.

Wright H1, Bonomo RA2, Paterson DL3.

Abstract

BACKGROUND:

Antibiotic resistance in Gram-negative resistance has developed without a commensurate response in the successful development of antibiotic agents, though recent progress has been made.

AIMS:

This review aims to provide a summary of the existing evidence on efficacy, spectrum of activity and the development of resistance of new agents that have been licensed or have completed advanced clinical trials and that possess activity against resistant Gram-negative organisms.

SOURCES:

A review of the published literature via MEDLINE database was performed. Relevant clinical trials were identified with the aid of the clinicaltrials.gov registry. Further data were ascertained from review of abstracts from recent international meetings and pharmaceutical companies.

CONTENT:

Data on the mechanism of action, microbiological spectrum, clinical efficacy and development of resistance are reported for new agents that have activity against Gram-negative organisms. This includes the β-lactam/β-lactamase inhibitor combinations ceftazidime/avibactam, ceftolozane/tazobactam, imipenem/cilastatin/relebactam, meropenem/vaborbactam and aztreonam/avibactam; cefiderocol, a siderophore cephalosporin; plazomicin and eravacycline.

IMPLICATIONS:

The development of new agents with activity against multidrug-resistant Gram-negative pathogens has provided important therapeutic options for clinicians. Polymyxins appear to have been supplanted by new agents as first-line therapy for Klebsiella pneumoniae carbapenemase producers. Cefiderocol and ceftazidime/avibactam/aztreonam are promising options for metallo-β-lactamase producers, and cefiderocol and ceftolozane/tazobactam for multiply resistant Pseudomonas aeruginosa, but definitive data showing clinical efficacy is as yet lacking. Reports of the development of resistance early after the release and use of new agents is of concern. Orally administered options and agents active effective against Acinetobacter baumannii are under-represented in clinical development.

FULL TEXT

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(17)30495-0/fulltext

PDF

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(17)30495-0/pdf

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July 21, 2019 at 2:43 pm

No clinical benefit to treating male urinary tract infection longer than seven days: An outpatient database study.

Open Forum Infectious Diseases June 2019 V.6 N.6

Germanos GJ et al.

Background

The optimal approach for treating outpatient male urinary tract infections (UTIs) is unclear. We studied the current management of male UTI in private outpatient clinics, and we evaluated antibiotic choice, treatment duration, and the outcome of recurrence of UTI.

Methods

Visits for all male patients 18 years of age and older during 2011–2015 with International Classification of Diseases, Ninth Revision, Clinical Modification codes for UTI or associated symptoms were extracted from the EPIC Clarity Database of 2 family medicine, 2 urology, and 1 internal medicine clinics. For eligible visits in which an antibiotic was prescribed, we extracted data on the antibiotic used, treatment duration, recurrent UTI episodes, and patient medical and surgical history.

Results

A total of 637 visits were included for 573 unique patients (mean age 53.7 [±16.7 years]). Fluoroquinolones were the most commonly prescribed antibiotics (69.7%), followed by trimethoprim-sulfamethoxazole (21.2%), nitrofurantoin (5.3%), and beta-lactams (3.8%). Antibiotic choice was not associated with UTI recurrence. In the overall cohort, longer treatment duration was not significantly associated with UTI recurrence (odds ratio [OR] = 1.95; 95% confidence interval [CI], 0.91–4.21). Longer treatment was associated with increased recurrence after excluding men with urologic abnormalities, immunocompromising conditions, prostatitis, pyelonephritis, nephrolithiasis, and benign prostatic hyperplasia (OR = 2.62; 95% CI, 1.04–6.61).

Conclusions

Our study adds evidence that men with UTI without evidence of complicating conditions do not need to be treated for longer than 7 days. Shorter duration of treatment was not associated with increased risk of recurrence. Shorter treatment durations for many infections, including UTI, are becoming more attractive to reduce the risk of resistance, adverse events, and costs.

FULL TEXT

https://academic.oup.com/ofid/article/6/6/ofz216/5486159

PDF (CLIC en PDF)

June 20, 2019 at 12:22 pm

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)

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

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