A Single Dose of Aztreonam in the Prevention of Urinary Tract Infections in Elderly Catheterized Patients

Summary

We have compared the effects of aztreonam and placebo in the prevention of urinary tract infections (UTI) in elderly hospitalized patients who needed urethral catheterization. 162 patients (96 males, 66 females; age range 60-91 years) were randomly allocated to receive double-blind a single dose of aztreonam (2 g i.m. 80 patients) or placebo (4 ml Iidocaine 2%, 82 patients) three hours before catheterization. All patients were followed-up for 7 days. Urine culture was performed before, at the first, third and seventh day of catheterization. At the end of follow-up 71/80 patients (88.7%) who received a single preventing dose of aztreonam had negative urine culture without clinical signs of UTI. On the contrary, in the group treated with placebo at the end of follow-up only 38/82 patients (46.3%) had negative urine without clinical signs of UTI.

In conclusion, our data suggest that a single 2g i.m. dose of aztreonam is effective in preventing UTI in elderly patients needing indwelling urethral catheterization.     

Complicated Urinary Tract Infections Treated with Extended-Release Ciprofloxacin with Emphasis on Pseudomonas aeruginosa

Abstract

This report focuses on the role of Pseudomonas aeruginosa in complicated urinary tract infections in a prospective, open-label, multicenter study designed to evaluate the safety and efficacy of extended-release ciprofloxacin (ciprofloxacin XR) 1000 mg once daily for 7-14 days for the treatment of complicated urinary tract infections. A total of 204 patients were valid for intention-to-treat analysis, of whom 130 were included in the clinical efficacy population. In the 56 microbiologically valid patients the bacteriological eradication rate was 82.1% and the clinical cure rate was 94.6%. Patients with P. aeruginosa infections valid for microbiological efficacy (n = 7) had 100% bacteriological eradication and clinical cure rates. In the intention-to-treat population, the bacteriological and clinical cure rates were 42.1% (51/121) and 55.9% (114/204), respectively. These rates were 58.3% and 75.0% respectively, for patients with P. aeruginosa infections. To achieve the desired 10 patients with P. aeruginosa for analysis, these data were pooled with data from a previous study. Treatment failure correlated with pre-therapy P. aeruginosa isolates being resistant to ciprofloxacin. On exploratory multivariate regression analysis, presence of neurogenic bladder, urinary retention owing to benign prostatic hypertrophy, prior urinary tract infection, and ischemic heart disease predicted P. aeruginosa infection.     

Clinical Results of a Multicenter Study with Sulbactam/Ampicillin for the Treatment of Patients with Lower Respiratory and Urinary Tract Infections

Summary

A total of 124 patients with lower respiratory tract (44) or urinary tract infections (80) were enrolled in an open, multicenter study to evaluate the efficacy and tolerability of sulbac-tam/ampicillin, administered at the dosage of 3 g/die by intramuscular route.

Pretreatment pathogens from patients with lower respira-tory tract infections included: Streptococcus a-haemolyticus in 8 cases, Streptococcus β-haemolyticus in 2 cases, Staphylococcus albus in 7 cases, Haemophilus influenzae in 7 cases, Staphylococcus aureus in 6 cases, Klebsiella oxytoca in 5 cases, Staphylococcus epidermidis in 3 cases, Streptococcus pneumoniae in 3 cases, Escherichia coli in 2 cases; in one subject (2.75%), no microorganisms were isolated. In vitro, 36 isolates (84%) were sensitive to SA and 7 (16%) were resistant. At the end of therapy, all the causative pathogens sensitive to sulbactam/ampicillin were eliminated. In patients with urinary tract infections, pretreatment pathogens were: E. coli in 40 cases, 5. albus in 16 cases, Proteus mirabilis in 8 cases, Enterobacter agglomerans in 6 cases, Proteus vulgaris in 3 cases, Streptococcus faecalis in 3 cases, Streptococcus liquefaciens in 2 cases, Pseudomonas aeruginosa in 2 cases. In vitro, 64 isolates (80%) were sensitive to sulbactam/ampicillin and 16 (20%) were resistant. At the end of therapy, 63 out of the 64 pathogens sensitive to sulbactam/ampicillin were eliminated; in one case the therapy was interrupted due to adverse effect.

Clinical efficacy: in subjects with lower respiratory tract infections, sulbactam/ampicillin cured 32 patients (72.72%) and ameliorated the clinical status of 8 patients (18.18%; efficacy rate: 90.9%). As far as concerns the 80 subjects with urinary tract infections, clinical cure was achieved in 58 patients (72.5%) and improvement in 19 patients (23.7%; efficacy rate: 96.2%).

Withdrawal/exclusion: 1 patient (0.8%) was withdrawn because of adverse drug effects.     

A Randomized,Open-Labeled,Prospective Controlled Study to Assess the Efficacy of Frontline Empirical Intravenous Piperacillin/Tazobactam Monotherapy in Comparison with Ceftazidime Plus Amikacin for Febrile Neutropenia in Pediatric Oncology Patients

Background: Febrile neutropenia (FN) is the most common complication in pediatric oncology patients. Appropriate empirical antibiotics treatment is essential for treatment outcome. Methods: This study was a randomized prospective controlled study to demonstrate the efficacy of piperacillin/tazobactam (PIP/TZO) monotherapy compared with ceftazidime/amikacin in children with FN. Pediatric oncology patients at Chiang Mai University Hospital, diagnosed with FN, were randomized to receive either PIP/TZO 320 mg/kg/day divided every 8 hours or ceftazidime 100 mg/kg/day divided every 8 hours plus amikacin 15 mg/kg/day once daily. Treatment responses were compared between the two groups. Results: One-hundred and eighteen febrile neutropenic episodes in 70 patients (42 males and 28 females) were enrolled. The median age was 7 (3-10) years. The early response and complete response to initial treatment were achieved in 48/59 (81.4%) episodes and 41/59 (69.5%) episodes in PIP/TZO group compared with 40/59 (67.8%) episodes and 33/59 (55.9%) episodes in ceftazidime/amikacin group (p-value 0.091 and 0.128, respectively). Treatment modification in PIP/TZO group was required in 18/59 (30.5%) compared with 26/59 (44.1%) patients in ceftazidime/amikacin group (p-value 0.128). Similarly, the duration of fever, duration of neutropenia and duration of antibiotics treatment were not significantly different between two groups. No serious adverse events were observed. Conclusion: The treatment responses of PIP/TZO monotherapy and ceftazidime/amikacin therapy were not significantly different. Both therapies were effective for FN in pediatric oncology patients.     

A Single-Blind,Randomised, Comparative Study of Clarithromycin and Amoxycillin Suspensions in the Treatment of Children with Lower Respiratory Tract Infections

Summary

One hundred and forty-five children with signs and symptoms of lower respiratory tract infections were entered into this multicentre, General Practice, investigator-blind study, designed to demonstrate equivalent efficacy between clarithromycin and amoxycillin suspensions. Seventy one children were randomised to treatment with clarithromycin suspension 7.5 mg/kg bodyweight twice daily and 74 to treatment with amoxycillin suspension 125 mg (bodyweight < 25 kg) or 250 mg (bodyweight ≥ 25 kg) three times a day according to bodyweight. Duration of therapy was 5-10 days as determined by the investigator. Clinical evaluations were performed pre-treatment, during treatment and post-treatment within 72 hours of cessation of therapy. Fifty two children in the clarithromycin group and 57 in the amoxycillin group were clinically evaluable. Both study medications were effective and there were no significant differences between the groups with respect to clinical cure rate (60% for clarithromycin and 63% for amoxycillin), clinical success rate (cure plus improvement, 96% for clarithromycin and 95% for amoxycillin) or rate of resolution of clinical signs and symptoms in clinically evaluable patients. The intention to treat analysis for all patients entered similarly showed no significant differences in efficacy. The two treatment groups did not differ significantly with respect to incidence or severity of adverse events which were generally mild and associated with the gastrointestinal system. Therapy was withdrawn because of adverse events in three children on clarithromycin and one on amoxycillin. Bacteriological cure rates could not be determined because of an insufficient number of evaluable pre-treatment sputum samples. The results of this study indicate that the efficacy and tolerability of twice daily clarithromycin suspension is equivalent to that of three times daily amoxycillin suspension in the treatment of children with lower respiratory tract infections.     

Clinical Comparative Study of Azithromycin versus Erythromycin in the Treatment of Acute Respiratory Tract Infections in Children

Summary

The efficacy and tolerability of azithromycin and erythromycin in the treatment of acute respiratory tract infections in children were compared in an open, multicenter, randomized trial. A total of 151 children, aged from 2 months to 14 years, suffering from upper airways infections (60), or lower respiratory tract infections (91), were randomized to be treated either with azithromycin, 10 mg/Kg/day per os once daily for 3 or 10 mg/Kg/day 1 and 5 mg/Kg/days 2-5 (77 patients) or with erythromycin, 50 mg/Kg/day thrice daily for at least 7 days (74 patients). The two treatment groups did not significantly differ as to sex, age, weight, type and severity of infection, and infecting pathogens.

Clinical evaluation was performed prior to therapy, on treatment days 1, 3, 5 and 7, and on day 10. Microbiological and laboratory assessment were carried out at baseline and after the end of therapeutic course. Chest X-ray and serologic assays for Mycoplasma pneumoniae infection were obtained in patients suspected to have lower respiratory tract infections. At the end of therapy, clinical cure was achieved in 73 out of 77 patients (94.8%) in the azithromycin group, and in 60/72 evaluable subjects (83.3%) in the erythromycin group. A significantly more rapid remission of several illness-related signs and symptoms was observed in patients treated with azithromycin. A total of 75 bacterial pathogens were isolated at baseline microbiological examination; at the end of the therapeutic course bacteriological eradication was obtained in 34/34 cases (100%) treated with azithromycin, and in 40/41 children (97.5%) treated with erythromycin. Both study drugs were well tolerated; transient, mild to moderate side-effects were reported in 6.5% of patients treated with azithromycin, and in 9.5% of subjects who received erythromycin. Only 2 children of the erythromycin group withdrew from the study due to adverse effects (vomiting). Significantly abnormal laboratory test values were observed in only one child treated with azithromycin (transient rise in serum AST-ALT values), and returned to normality at follow-up.

In conclusion, azithromycin once daily for 3-5 days is as safe and effective as erythromycin thrice daily for at least 7 days in the treatment of community-acquired respiratory tract infections in infants and children; no statistically significant difference was found between the two treatment groups as to overall clinical and bacteriological efficacy, and systemic tolerability. The significant advantage of a low-dose therapeutic course of azithromycin is made possible by the enhanced antimicrobial potency and the favorable pharmacokinetic properties of this novel macrolide derivative.     

Cefodizine (HR221) Versus Norfloxacin for Treatment of Urinary Tract Infections

Summary

Cefodizimc is a stable new beta-lactamase cephalosporin chemically related to cefotaxime and with a long half-life.

Its clinical efficacy and tolerability were compared with those of norfloxacin in patients with intercurrent urinary tract infections plus chronic liver diseases. Cefodizimc (2 g, once a day, i.v.) and norfloxacin (400 mg, twice a day, p.o.) were randomly given to two groups of 20 patients each with urinary tract infections caused by organisms sensitive in vitro to these drugs.

Cultures of midstream bladder urine, urinalysis and blood biochemical tests were performed before and after each antibiotic treatment.

Clinical resolution was observed in 100% of the patients at the end of the treatments, but bacteriological eradication was obtained in 90% of the patients treated with ccfodizime and 85% of those treated with norfloxacin, because of the development in five patients of asymptomatic bacteriuria (superinfections).     

Antimicrobial Resistance among Uropathogens Responsible for Community-Acquired Urinary Tract Infections in an Italian Community

Abstract

This study aimed to establish the pattern of the antimicrobial resistance among the leading uropathogens causing community-acquired UTIs in an area of the region of Apulia, Southern Italy.

Twenty-one thousand and two hundred outpatients, 6,893 males and 14,307 females, were enrolled. Urinary isolates were identified by conventional methods and the susceptibility to 18 antimicrobials determined. Recognized uropathogens Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis were isolated from 3175 positive samples, E. coli accounting for 68.04% of positive cultures. Most overall resistance was to ampicillin, while the resistance rate to cephalothin was higher than that of third generation cephalosporins. Although to a different degree, all the bacteria had an overall good susceptibility rate to quinolones as well as to fosfomycin but increased resistance to sulfamethoxazole/trimethoprim.

Our results confirm that E. coli is the leading uropathogen and provide information about the antimicrobial susceptibility patterns of the main pathogens causing community- acquired UTIs. These findings should be taken into account to help maintain the safety and efficacy of treatment for community-acquired UTIs.     

Risk Factors in Community-Acquired/Onset Urinary Tract Infections Due to Extended-Spectrum Beta-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae

Abstract

We investigated the risk factors for community acquired/onset urinary tract infections due to extended spectrum beta-lactamase (ESBL)-positive Escherichia coli or Klebsiella pneumoniae in 62 patients who were followed-up from August 1, 2003 to September 1, 2006. Sixty patients with community-acquired urinary tract infections caused by ESBL-negative E. coli or K. pneumoniae who were followed-up during the same dates were included as a control group. Age (≥65 or <65 years old), sex, bladder cancer, benign prostate hypertrophy (BPH), prostate cancer, urolithiasis, urethral catheter, previous urological operation, diabetes mellitus, use of antibiotics during the last 3 months and hospitalization during the last 3 months were investigated as risk factors. The presence of previous urological operation and quinolone or cephalosporin use for any infection during the last 3 months were found to be independent risk factors. Knowing the risk factors for community acquired/onset urinary tract infections caused by ESBL-positive E. coli or K. pneumoniae is of great importance in planning empirical antibiotic therapy.     

Comparison of Trimethoprim-Sulfamethoxazole,Cephadroxil and Cefprozil as Prophylaxis for Recurrent Urinary Tract Infections in Children

Abstract

The aim of this study was to compare the efficacy of prophylactic trimethoprimsulfamethoxazole (TMP/SMZ), cefprozil and cephadroxil treatments in children who have recurrent urinary tract infection, but no urinary tract pathology. After acute urinary tract infections (UTIs) were treated, the patients were divided into 3 groupsrandomly and TMP/SMZ was given to 21 patients, cephadroxil was given to 25 patients and cefprozil was given to 34 patients for 3 months—one dose at night. All patients were followed for 6 months following prophylaxis. The frequency of symptomatic UTIs among groups during prophylaxis was not statistically different, however the number of symptomatic UTIs in the cephadroxil group was lower than the other groups. Asymptomatic bacteriuria episodes were detected in TMP/SMZ and cefprozil groups, whereas no asymptomatic bacteriuria episodes were seen in the cephadroxil group. The number of patients with symptomatic UTI during the follow-up period was not different between groups, however all the asymptomatic bacteriuria episodes were encountered in the cefprozil group. In conclusion, in this study cephadroxil was found to be slightly superior to TMP/SMZ and cefprozil in preventing asymptomatic bacteriuria episodes and symptomatic UTIs in children with recurrent UTI and normal urinary tract system.     

Cefepime Versus Ceftazidime in the Treatment of Lower Respiratory Tract Infections

Abstract

The objective of the study was to compare the safety and efficacy of cefepime and ceftazidime in the treatment of community acquired lower respiratory tract infections of moderate intensity. Eighty-six patients were randomized at a 2:1 ratio to receive respectively cefepime 1 g b.i.d. or ceftazidime 1 g t.i.d. The drugs were well tolerated and the occurrence of adverse events in each group was comparable. The rates of satisfactory clinical response were 96% (49/51) for cefepime and 89% (24/27) for ceftazidime. A total of 73 pathogens were isolated and pathogen eradication rates were 98% and 96% respectively for the cefepime and ceftazidime treatment groups. In conclusion, the data confirmed that cefepime could be a good alternative to ceftazidime.     

尿路移行细胞癌微转移的检测

目的 探讨尿路移行细胞癌患者外周血CK20的表达及临床意义.方法 采用逆转录聚合酶链反应(RT-PCR)检测47例尿路移行细胞癌患者和14例健康志愿者以及18例非肿瘤患者外周血CK20的表达.以GAPDH作为内参照.结果 14例健康志愿者和18例非肿瘤患者外周血CK20的表达均为阴性;47例尿路移行细胞癌患者外周血CK20阳性表达率为21.3%(10/47):T1为0(0/29),T2为20%(2/10),T3为100%(4/4),T4为100%(4/4).随访12个月,6例(T2～T3)外周血CK20阳性的尿路移行细胞癌有3例(T3G2膀胱癌1例,TaG2和T3G2输尿管癌各1例)发生远处转移.结论 检测外周血CK20表达,可以提示癌细胞的血行播散,对判断预后以及指导治疗具有一定临床价值.     

上尿路同时性和异时性上皮肿瘤的组织学和临床特征

目的：分析上尿路上皮肿瘤的组织学和临床特征及预后因素。方法：对60例同时性和异时性上尿路上皮肿瘤，进行回顾性总结及统计学分析。结果：单发肿瘤50例，多发10例，表浅型肿瘤18例（30．0％），浸润型42例（70．0％）。复发23例（38．3％），频率为0．76（0．15－1．71）次／年，平均间隔16．5个月。局部淋巴结转移3例，远处转移4例，其原发肿瘤均为浸润型。浸润型肿瘤或远处转移者预后较差，复发者中远期生存率较低。结论：尿路上皮肿瘤具有多发性和复发性的特点，应加强早期发现、早期诊断方面的研究。建议首次膀胱镜检查应在初诊后的第4个月，第二次间隔8个月，以后每年一次，持续10年。每两次膀胱镜检查之间，行超声波检查。     

Enterobacter spp. Infections Complicating the Course of HIV Disease

Abstract

Through a retrospective review of clinical and laboratory data of 2517 consecutive patients with HIV disease hospitalized since 1991, 13 patients were identified (0.52%), who suffered from a confirmed Enterobacter spp. infection (urinary tract disease in 7 cases, sepsis in 4 patients, and pneumonia in 2 cases). A severe immunodeficiency was recognized in all cases, as expressed by a mean CD4+ lymphocyte count <60 cells/μL, and frequently, a prior diagnosis of AIDS. Bloodstream infection proved linked to a lower mean CD4+ cell count, a more frequent occurrence of leukopenia-neutropenia, and nosocomial origin of the infecting pathogen. Hospital-acquired Enterobacter spp. disease was more frequent than community-acquired, and was significantly associated with leukopenia-neutropenia, and a diagnosis of AIDS. Antibiotic susceptibility assays showed a resistance rate to ampicillin and cephalothin involving >90% of tested strains, and a higher (but varied) sensitivity to other ß-lactams, aminoglycosides, fluoroquinolones, and cotrimoxazole. Adequate chemotherapy provided clinical and bacteriological success in all evaluated patients, in the absence of mortality or relapses. Only 34 episodes of HIV-associated Enterobacter spp. infection have been reported to date in 11 different literature studies. Our data point out that also Enterobacter spp. organisms may have an appreciable pathogenic potential in patients with HIV disease, especially in those with a low CD4+ lymphocyte count, leukopenia-neutropenia, who are hospitalized. Despite the unpredictable antibiotic susceptibility profile of these organisms, HIV-related Enterobacter spp. disease may be properly managed through rapid identification and timely and appropriate antimicrobial treatment.     

Glutathione S-Transferase Expression in Upper Urinary Tract Urothelial Carcinomas: a Taiwan Study

Objectives: Glutathione S-transferase (GST) isoenzymes play important roles in resistance to cell apoptosisand carcinogenesis. We aimed to establish the relationship between GST expression and the prognosis of upperurinary tract urothelial carcinoma (UTT-UC) in Taiwan. Methods: This study retrospectively reviewed 46patients with pathologically confirmed UUT-UC at Kaohsiung Medical University Hospital. In each patient,expression of GSTT1 and GSTP1 was compared between urothelial carcinoma and normal urothelial cells byWestern blotting. Results: GSTP1 expression in the UUT-UC cells was significantly higher than that in normalurothelial cells (1.6 fold, p<0.001). Expression of GSTT1 was significantly associated with the invasiveness ofthe carcinoma (p=0.006). Conclusions: In UUT-UC, GSTP1 might be a potential tumor marker, whereas highGSTT1 expression could be used as an indicator of cancer progression. This study is the first to demonstratepotential applications of different GST isoenzymes for biomolecular analysis of UUT-UCs in Taiwan.     

Comparative Study of Cefixime Alone Versus Intramuscular Ceftizoxime Followed by Cefixime in the Treatment of Urinary Tract Infections in Children

Abstract

Urinary tract infections (UTI) can cause acute morbidity and may result in severe problems, including hypertension and reduced renal function. Diagnosis of UTI is extremely important since prompt treatment may prevent damage. In the present study we compared the efficacy of oral cefixime to initial intramuscular ceftizoxime followed by cefixime for the treatment of UTI in children. Fifty-four children were studied. They were randomized to receive either oral cefixime 8 mg/kg/day for 10 days or initial intramuscular ceftizoxime (Cef?zox) 50 mg/kg twice a day for 2 days followed by oral cefixime for 8 days. Treatment groups were comparable regarding age, sex, clinical, and laboratory findings. Escherichia coli was isolated from 80% of patients. Repeat urine cultures were sterile within 24 hours in all children. Cure rates were comparable in both groups (92% vs 86% at the end of treatment). No serious adverse effects were observed. We concluded that oral cefixime is a safe and effective alternative treatment.     

Combined Screening of Cervical Cancer,Breast Cancer and Reproductive Tract Infections in Rural China

Objectives: To investigate the current prevalence and knowledge of cervical cancer, breast cancer andreproductive tract infections (RTIs) in rural Chinese women, and to explore the acceptance and feasibility ofimplementing a combined screening program in rural China. Methods: A population-based, cross-sectionalstudy was conducted among women aged 30 to 59 years old in Xiangyuan County, Shanxi Province from 2009 to2010. Socio-demographic characteristics, knowledge of cervical cancer, breast cancer and RTIs, and the attitudetoward single or combined screening were collected by an interview questionnaire. Each participant receiveda clinical examination of the cervix, breast and reproductive tract. Examinations included visual inspection,mammography, laboratory tests and pathological diagnosis. Results: A total of 1,530 women were enrolled inthis study. The prevalence of cervical precancerous lesions, suspicious breast cancer, suspicious benign breastdisease and RTIs was 1.4%, 0.2%, 14.0% and 54.3%, respectively. Cervicitis, trichomonas vaginitis, and bacterialvaginitis were the three most common RTIs among our participants. Television, radio broadcast, and publiceducation during screening were the major source of healthcare knowledge in rural China. Moreover 99.7%of women expressed great interest in participating in a combined screening project. The affordable limit forcombined screening project was only 50 RMB for more than half of the rural women. Conclusion: A combinedscreening program would be more effective and popular than single disease screening projects, while appropriateaccompanied education and a co-pay model for its successful implementation need to be explored, especially inlow-resource settings.     

Radiological Imaging of Urinary Tract Infection in Malaysian Children -A Private Hospital Experience

The results of radiological investigations performed on 81 children with urinary tract infection (UTI) were reviewed. Investigations included 91 voiding cys-tourethrograms (VCU), 59 intravenous urograms (IVU) and 36 ultrasonograms (US). The aim was to study the local spectrum of renal tract abnormalities in childhood UTI and to compare the diagnostic yield of combining US and VCU against IVU and VCU. Renal tract abnormalities were detected in 37%. Vesico-ureteric reflux (VUR) was the commonest, detected in 26%, with renal scarring found in 9% of refluxing units. Ultrasound should replace IVU in the initial diagnostic work-up of these children.     

Antimicrobial Susceptibility Patterns of Contemporary Pathogens from Uncomplicated Urinary Tract Infections Isolated in a Multicenter Italian Survey: Possible Impact on Guidelines

Abstract

During 2004 four Italian Laboratories assessed the prevalence of antimicrobial resistance among uropathogens causing acute uncomplicated cystitis in female outpatients. A total of 600 urine samples from individuals aged 18-65 were studied. The overall prevalence of Escherichia coli was 85.3%. Klebsiella pneumoniae, Staphylococcus saprophyticus, Proteus mirabilis, Enterococcus faecalis and other rarer species were far less represented. Determination of the antibiotic susceptibility pattern of the entire collection of E. coli (512 organisms) revealed that among the drugs analyzed ampicillin was the least active molecule with only 62.5% of the strains being inhibited. Amoxicillin-clavulanate and cefuroxime displayed a higher potency (87.7% and 89.2% respectively). Cotrimoxazole inhibited only 70.1% of the uropathogens. The three fluoquinolones tested had comparable activity ranging from 83.0% for ciprofloxacin, to 83.6% for levofloxacin and 84.9% for prulifloxacin, indicating an identical spectrum of cross resistance. Nitrofurantoin (96.7%) and fosfomycin (98.6%) were the most potent drugs. Against the whole collection of uropathogens, only cefuroxime, nitrofurantoin and fosfomycin overcame the threshold of 90% activity, with the fluoroquinolones and amoxicillin-clavulanate suffering from about 15% resistance. The results of this survey strongly support the conclusions of recent Italian guidelines concerning the best empiric treatment of UTI in this country today.     

后腹腔镜联合经尿道电切镜治疗上尿路肿瘤效果观察

目的探讨后腹腔镜联合经尿道电切镜与开放手术处理输尿管末端,治疗上尿路肿瘤疗效,为上尿路肿瘤手术治疗提供依据。 方法收集2011年11月至2014年11月青海红十字医院治疗的85例尿路恶性肿瘤患者的临床资料,其中采用传统开放手术40例设为对照组;采用后腹腔镜联合经尿道电切镜45例设为观察组。比较两组患者的手术时间、术中出血量、引流量以及住院时间等指标;采用视觉模拟评分法（VAS）评价术后1 h、12 h、24 h、48 h疼痛程度;随访3年记录两组患者局部复发率、远处转移率、生存率、无瘤生存率以及病死率。 结果观察组手术时间、术中出血量、术后胃肠功能恢复时间、住院时间均低于对照组（均P＜005）。两组拔除引流管,时间、引流量差异无统计学意义（P＞005）。观察组术后1 h、12 h、24 h的VAS评分低于对照组（P＜005）。两组3年局部复发率、远处转移率、生存率、无瘤生存率以及病死率,差异无统计学意义（均P＞005）。 结论后腹腔镜联合经尿道电切镜治疗上尿路移行细胞癌,既能达到微创治疗要求,又能完整切除癌肿。手术安全有效,符合肿瘤根治外科学原则。