Posts filed under ‘Infecciones urinarias’

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


  • 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


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


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.


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).


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.




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.




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.



November 21, 2018 at 12:29 pm


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:

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.


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.


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.


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.



October 14, 2018 at 10:44 am

Biofilms: survival mechanisms of clinically relevant microorganisms.

Clinical Microbiology Reviews April 2002 V.15 N.2 P.167-93.

Donlan RM1, Costerton JW.

1 Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.


Though biofilms were first described by Antonie van Leeuwenhoek, the theory describing the biofilm process was not developed until 1978. We now understand that biofilms are universal, occurring in aquatic and industrial water systems as well as a large number of environments and medical devices relevant for public health. Using tools such as the scanning electron microscope and, more recently, the confocal laser scanning microscope, biofilm researchers now understand that biofilms are not unstructured, homogeneous deposits of cells and accumulated slime, but complex communities of surface-associated cells enclosed in a polymer matrix containing open water channels. Further studies have shown that the biofilm phenotype can be described in terms of the genes expressed by biofilm-associated cells. Microorganisms growing in a biofilm are highly resistant to antimicrobial agents by one or more mechanisms. Biofilm-associated microorganisms have been shown to be associated with several human diseases, such as native valve endocarditis and cystic fibrosis, and to colonize a wide variety of medical devices. Though epidemiologic evidence points to biofilms as a source of several infectious diseases, the exact mechanisms by which biofilm-associated microorganisms elicit disease are poorly understood. Detachment of cells or cell aggregates, production of endotoxin, increased resistance to the host immune system, and provision of a niche for the generation of resistant organisms are all biofilm processes which could initiate the disease process. Effective strategies to prevent or control biofilms on medical devices must take into consideration the unique and tenacious nature of biofilms. Current intervention strategies are designed to prevent initial device colonization, minimize microbial cell attachment to the device, penetrate the biofilm matrix and kill the associated cells, or remove the device from the patient. In the future, treatments may be based on inhibition of genes involved in cell attachment and biofilm formation.


October 14, 2018 at 10:41 am

Biofilm formation: a clinically relevant microbiological process.

Clinical Infectious Disseases October 15, 2001 V.33 N.8 P.1387-92.

Donlan RM1.

1 Biofilm Laboratory, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.


Microorganisms universally attach to surfaces and produce extracellular polysaccharides, resulting in the formation of a biofilm. Biofilms pose a serious problem for public health because of the increased resistance of biofilm-associated organisms to antimicrobial agents and the potential for these organisms to cause infections in patients with indwelling medical devices. An appreciation of the role of biofilms in infection should enhance the clinical decision-making process.




October 14, 2018 at 10:39 am

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