Posts filed under ‘Infecciones urinarias’

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

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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

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. gromero@althaia.cat

Abstract

PURPOSE:

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

MATERIAL AND METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

  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.

abstract

http://www.elsevier.es/es-revista-actas-urologicas-espanolas-292-linkresolver-infeccion-urinaria-pacientes-con-vejiga-S0210480611003755

PDF (CLIC en PDF)

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.

abstract

http://aac.asm.org/content/62/2/e01391-17.abstract?etoc

PDF

http://aac.asm.org/content/62/2/e01391-17.full.pdf+html

 

January 27, 2018 at 3:12 pm

Candiduria: A Randomized, Double-Blind Study of Treatment with Fluconazole and Placebo

Clinical Infectious Diseases January 2000 V.30 N.1 P.19-24

D. Sobel, C. A. Kauffman, D. McKinsey, M. Zervos, J. A. Vazquez, A. W. Karchmer, J. Lee, C. Thomas, H. Panzer, W. E. Dismukes, and the National Institute of Allergy and Infectious Diseases (NIAID) Mycoses Study Group

1Wayne State University, Detroit, Michigan

2University of Michigan and Veterans Affairs Medical Center, Ann Arbor, Michigan

3Infectious Disease Associates of Kansas City, Kansas City, Missouri

4Harvard Medical School, Boston, Massachusetts

5University of Alabama at Birmingham, Birmingham, Alabama

6Pfizer, Inc., Groton, Connecticut

Management of candiduria is limited by the lack of information about its natural history and lack of data from controlled studies on the efficacy of treating it with antimycotic agents.

We compared fungal eradication rates among 316 consecutive candiduric (asymptomatic or minimally symptomatic) hospitalized patients treated with fluconazole (200 mg) or placebo daily for 14 days.

In an intent-to-treat analysis, candiduria cleared by day 14 in 79 (50%) of 159 receiving fluconazole and 46 (29%) of 157 receiving placebo (P < .001), with higher eradication rates among patients completing 14 days of therapy (P < .0001), including 33 (52%) of 64 catheterized and 42 (78%) of 54 noncatheterized patients.

Pretreatment serum creatinine levels were inversely related to candiduria eradication.

Fluconazole initially produced high eradication rates, but cultures at 2 weeks revealed similar candiduria rates among treated and untreated patients.

Oral fluconazole was safe and effective for short-term eradication of candiduria, especially following catheter removal. Long-term eradication rates were disappointing and not associated with clinical benefit.

PDF

http://cid.oxfordjournals.org/content/30/1/19.full.pdf

December 2, 2017 at 7:56 am

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