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Urinary tract infections in women: etiology and treatment options
Minardi D,d'Anzeo G,Cantoro D,Conti A
International Journal of General Medicine , 2011,
Abstract: Daniele Minardi, Gianluca d'Anzeo, Daniele Cantoro, Alessandro Conti, Giovanni MuzzonigroDepartment of Clinical and Specialist Sciences, Urology, Polytechnic University of the Marche Medical School and United Hospitals, Ancona, ItalyAbstract: Urinary tract infections (UTI) are common among the female population. It has been calculated that about one-third of adult women have experienced an episode of symptomatic cystitis at least once. It is also common for these episodes to recur. If predisposing factors are not identified and removed, UTI can lead to more serious consequences, in particular kidney damage and renal failure. The aim of this review was to analyze the factors more commonly correlated with UTI in women, and to see what possible solutions are currently used in general practice and specialized areas, as well as those still under investigation. A good understanding of the possible pathogenic factors contributing to the development of UTI and its recurrence will help the general practitioner to interview the patient, search for causes that would otherwise remain undiscovered, and to identify the correct therapeutic strategy.Keywords: urinary tract infection, women, etiology, diagnosis, treatment
Urinary tract infections in women: etiology and treatment options
Minardi D, d'Anzeo G, Cantoro D, Conti A, Muzzonigro G
International Journal of General Medicine , 2011, DOI: http://dx.doi.org/10.2147/IJGM.S11767
Abstract: inary tract infections in women: etiology and treatment options Review (9077) Total Article Views Authors: Minardi D, d'Anzeo G, Cantoro D, Conti A, Muzzonigro G Published Date April 2011 Volume 2011:4 Pages 333 - 343 DOI: http://dx.doi.org/10.2147/IJGM.S11767 Daniele Minardi, Gianluca d'Anzeo, Daniele Cantoro, Alessandro Conti, Giovanni Muzzonigro Department of Clinical and Specialist Sciences, Urology, Polytechnic University of the Marche Medical School and United Hospitals, Ancona, Italy Abstract: Urinary tract infections (UTI) are common among the female population. It has been calculated that about one-third of adult women have experienced an episode of symptomatic cystitis at least once. It is also common for these episodes to recur. If predisposing factors are not identified and removed, UTI can lead to more serious consequences, in particular kidney damage and renal failure. The aim of this review was to analyze the factors more commonly correlated with UTI in women, and to see what possible solutions are currently used in general practice and specialized areas, as well as those still under investigation. A good understanding of the possible pathogenic factors contributing to the development of UTI and its recurrence will help the general practitioner to interview the patient, search for causes that would otherwise remain undiscovered, and to identify the correct therapeutic strategy.
Levofloxacin in the treatment of complicated urinary tract infections and acute pyelonephritis  [cached]
Jessina C McGregor,George P Allen,David T Bearden
Therapeutics and Clinical Risk Management , 2008,
Abstract: Jessina C McGregor, George P Allen, David T BeardenOregon State University College of Pharmacy, Portland, OR, USAAbstract: Levofloxacin is a widely used fluoroquinolone approved for the treatment of complicated urinary tract infections and acute pyelonephritis. A comprehensive review of the medical literature identified five publications evaluating levofloxacin for the treatment of either complicated urinary tract infections or acute pyelonephritis. All trials, although variable in their inclusion criteria and levofloxacin dosing strategies, reported microbiologic, clinical, and safety-related outcomes. High microbiologic eradication rates, ranging from 79.8% to 95.3%, were observed in all studies. Escherichia coli was the most commonly isolated uropathogen. Data on levofl oxacin resistance, both at baseline and after therapy, were limited. Clinical success was observed to range from 82.6% to 93% when measured after the completion of therapy. These clinical and microbiologic results were comparable to the fluoroquinolone comparators in all trials. Insufficient data are available to evaluate the outcomes in any meaningful patient subgroups, including catheterized patients, and those with other specific complicating factors. Levofloxacin was well tolerated in these studies, with headache, gastrointenstinal effects, and dizziness being the most commonly reported adverse events. The published data support the use of levofloxacin in complicated urinary tract infections and acute pyelonephritis. Further trials are necessary to evaluate levofl oxacin within specific patient sub-populations.Keywords: urinary tract infection, pyelonephritis, levofloxacin
Urinary Tract Infections in Children  [cached]
Mustafa Taskesen,Aysun Karabay Bayazit
Arsiv Kaynak Tarama Dergisi , 2009,
Abstract: Urinary tract infections (UTI) are frequent conditions in children. Untreated urinary tract infections can lead to serious kidney problems that could threaten the life of the child. Therefore, early detection and treatment of urinary tract infection is important. In older children, urinary tract infections may cause obvious symptoms such as stomach ache and disuria. In infants and young children, UTIs may be harder to detect because of less specific symptoms. Recurrences are common in children with urinary abnormalities such as neurogenic bladder, vesicourethral reflux or those with very poor toilet and hygiene habits. This article reviews the diagnostic approach and presents the current data related to the roles of radiologic imaging, surgical correction and antibiotic prophylaxis of UTIs in children. [Archives Medical Review Journal 2009; 18(2.000): 57-69]
Treatment of Upper Respiratory Tract Infections in Primary Care: A Randomized Study Using Aromatic Herbs
Eran Ben-Arye,Nativ Dudai,Anat Eini,Moshe Torem,Elad Schiff,Yoseph Rakover
Evidence-Based Complementary and Alternative Medicine , 2011, DOI: 10.1155/2011/690346
Abstract: This study is a prospective randomized double-blind controlled trial whose aim was to investigate the clinical effects of aromatic essential oils in patients with upper respiratory tract infections. The trial was conducted in six primary care clinics in northern Israel. A spray containing aromatic essential oils of five plants (Eucalyptus citriodora, Eucalyptus globulus, Mentha piperita, Origanum syriacum, and Rosmarinus officinalis)as applied 5 times a day for 3 days and compared with a placebo spray. The main outcome measure was patient assessment of the change in severity of the most debilitating symptom (sore throat, hoarseness or cough). Sixty patients participated in the study (26 in the study group and 34 in the control group). Intention-to-treat analysis showed that 20 minutes following the spray use, participants in the study group reported a greater improvement in symptom severity compared to participants in the placebo group (=.019). There was no difference in symptom severity between the two groups after 3 days of treatment (=.042). In conclusion, spray application of five aromatic plants reported in this study brings about significant and immediate improvement in symptoms of upper respiratory ailment. This effect is not significant after 3 days of treatment.
Recommendations for the Empirical Treatment of Complicated Urinary Tract Infections Using Surveillance Data on Antimicrobial Resistance in the Netherlands  [PDF]
Maike Koningstein, Akke K. van der Bij, Marlieke E. A. de Kraker, Jos C. Monen, Jan Muilwijk, Sabine C. de Greeff, Suzanne E. Geerlings, Maurine A. Leverstein- van Hall, on behalf of the ISIS-AR Study Group
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0086634
Abstract: Background Complicated urinary tract infections (c-UTIs) are among the most common nosocomial infections and a substantial part of the antimicrobial agents used in hospitals is for the treatment of c-UTIs. Data from surveillance can be used to guide the empirical treatment choices of clinicians when treating c-UTIs. We therefore used nation-wide surveillance data to evaluate antimicrobial coverage of agents for the treatment of c-UTI in the Netherlands. Methods We included the first isolate per patient of urine samples of hospitalised patients collected by the Infectious Disease Surveillance Information System for Antibiotic Resistance (ISIS-AR) in 2012, and determined the probability of inadequate coverage for antimicrobial agents based on species distribution and susceptibility. Analyses were repeated for various patient groups and hospital settings. Results The most prevalent bacteria in 27,922 isolates of 23,357 patients were Escherichia coli (47%), Enterococcus spp. (14%), Proteus mirabilis (8%), and Klebsiella pneumoniae (7%). For all species combined, the probability of inadequate coverage was <5% for amoxicillin or amoxicillin-clavulanic acid combined with gentamicin and the carbapenems. When including gram-negative bacteria only, the probability of inadequate coverage was 4.0%, 2.7%, 2.3% and 1.7%, respectively, for amoxicillin, amoxicillin-clavulanic acid, a second or a third generation cephalosporin in combination with gentamicin, and the carbapenems (0.4%). There were only small variations in results among different patient groups and hospital settings. Conclusions When excluding Enterococcus spp., considered as less virulent, and the carbapenems, considered as last-resort drugs, empirical treatment for c-UTI with the best chance of adequate coverage are one of the studied beta-lactam-gentamicin combinations. This study demonstrates the applicability of routine surveillance data for up-to-date clinical practice guidelines on empirical antimicrobial therapy, essential in patient care given the evolving bacterial susceptibility.
URINARY TRACT INFECTIONS IN PREGNANCY
KY Loh,N Sivalingam
Malaysian Family Physician , 2007,
Abstract: Urinary tract infections frequently affect pregnant mothers. This problem causes significant morbidity and healthcare expenditure. Three common clinical manifestations of UTIs in pregnancy are: asymptomatic bacteriuria, acute cystitis and acute pyelonephritis. Escherichia coli remains the most frequent organism isolated in UTIs. All pregnant mothers should be screened for UTIs in pregnancy and antibiotics should be commenced without delay. Urine culture and sensitivity is the gold standard in diagnosing UTIs. Without treatment, asymptomatic bacteriuria in pregnancy is associated with preterm delivery, intrauterine growth retardation, low birth weight, maternal hypertension, pre-eclampsia and anaemia. Acute pyelonephritis can lead to maternal sepsis. Recurrent UTIs in pregnancy require prophylactic antibiotic treatment.
High Rate of Per Oral Mecillinam Treatment Failure in Community-Acquired Urinary Tract Infections Caused by ESBL-Producing Escherichia coli  [PDF]
Arne S?raas, Arnfinn Sundsfjord, Silje Bakken J?rgensen, Knut Liest?l, P?l A. Jenum
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0085889
Abstract: A population-based study was performed to investigate the efficacy of mecillinam treatment of community-acquired urinary tract infections (CA-UTI) caused by extended-spectrum β-lactamase (ESBL) producing Escherichia coli. The study was conducted in South-Eastern Norway. Data from patients with CA-UTI caused by ESBL-producing and non-producing (random controls) E. coli were collected through interviews, questionnaires, medical records and the Norwegian Prescription Database. Treatment failure was defined as a new antibiotic prescription appropriate for UTI prescribed within two weeks after the initial antimicrobial therapy. Multivariable logistic regression analysis was performed to identify treatment agents and patient- or bacterial traits associated with treatment failure. A total of 343 patients (mean age 59) were included, of which 158 (46%) were treated with mecillinam. Eighty-one patients (24%, mean age 54) had infections caused by ESBL producing E. coli, and 41 of these patients (51%) received mecillinam as the primary treatment. Mecillinam treatment failure was observed in 18 (44%) of patients infected by ESBL-producing strains and in 16 (14%) of patients with a CA-UTI caused by ESBL non-producing strains. Multivariable analysis showed that ESBL status (odds ratio (OR) 3.2, 95% confidence interval (CI) 1.3–7.8, p = 0.009) and increased MIC of mecillinam (OR 2.0 for each doubling value of MIC, CI 1.4–3.0, p<0.001) were independently associated with mecillinam treatment failure. This study showed a high rate of mecillinam treatment failure in CA-UTIs caused by ESBL producing E. coli. The high failure rate could not be explained by the increased MIC of mecillinam alone. Further studies addressing the use of mecillinam against ESBL-producing E. coli, with emphasis on optimal dosing and combination therapy with β-lactamase inhibitors, are warranted.
Urinary tract infections and related symptoms in patients with gynecological
Serra KAMER,?zlem AKAGüNDüZ,Zeynep ?ZSARAN,Mustafa ESASSOLAK
Turkish Journal of Oncology , 2008,
Abstract: OBJECTIVES: The purpose of this study was to evaluate the genitourinary symptoms and the risk of urinary tract infections in patients with gynecological malignancy treated with radiotherapy. METHODS: Mid-stream specimens of urine were collected and urine cultures were performed in 45 patients with gynecological malignancy; genitourinary symptoms were recorded during pelvic radiotherapy. RESULTS: Before the treatment, urinary tract infections were detected in four patients, while during the treatment seven patients had positive urine cultures. Dysuria was recorded in five patients before radiotherapy, and at the end of treatment, 40 cases experienced grade 1 or 2 dysuria. No significant relationship was detected between urinary tract infection and clinical genitourinary symptoms. CONCLUSION: The most effective method to define urinary tract infection in patients with gynecologic malignancies is urine culture during the treatment. Routine prophylactic antibiotherapy is not recommended because of the low risk of infection during radiotherapy.
Urinary tract nosocomial infections at the Clinical centre in Kragujevac  [PDF]
?or?evi? Zorana,Ili? Milena
Srpski Arhiv za Celokupno Lekarstvo , 2012, DOI: 10.2298/sarh1204184d
Abstract: Introduction. Urinary tract infections are the most frequent hospital infections and account for about 40% of total hospital infections. The main risk factor for their development is the use of catheters. Objective. Assessment of basic epidemiological and etiological characteristics of nosocomial urinary tract infections (NUTIs) and investigation of differences in risk factors among the patients with NUTIs with and without the urinary catheter. Methods. The study comprised patients treated in chosen units/ of the Clinical Center in Kragujevac, in whom NUTI was registered during 2009. Differences in risk factors for NUTIs between the catheterized and uncatheterized patients were tested by the logistic regression analysis. Results. NUTIs was registered in 162 patients whose average age was 66.2±13.5 years with approximately equal gender participation (51.2% men and 48.8% women). Almost three quarters of the patients with NUITs had indwelling urinary catheter, 12.0±7.7 days on average (from 1 to 39 days). In the patients with urinary catheter, the risk for NUITs was significantly positively associated with emergency admission to hospital treatment (p=0.0185). The uncatheterized patients had a significant frequency of malignant tumours comparing to the patients with a urinary catheter (p=0.039). The compared groups did not differ in other risk factors. The most frequently isolated microbial agents was Klebsiella spp (37.3%), then Pseudomonas aeruginosa (14.1%) and Proteus mirabilis (11.9%). Most of the bacteria showed a great level of resistance to frequently used antibacterial drugs, even up to 100%. Conclusion. It is necessary to define national recommendations for the prevention and control of NUTIs in the future.
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