Complicated urinary tract infection

Urinary tract infection is the second commonest infection encountered in both the community and the hospital setting. In order to avoid complications and to minimize the unnecessary use of antibiotics, it is essential to have a useful and rapid screening test to identify urinary tract infection. The presence of nitrite and leukocyte esterase on urinalysis is such a test. Symptomatic bacteriuria requires prompt treatment and pyelonephritis should be treated for 10-14 days, whereas asymptomatic catheter and non-catheter bacteriuria should not be treated, except in the setting of pregnancy and in childhood.     

Viral lower urinary tract infections

Lower urinary tract infections (UTIs) are common among the general population and are most often caused by bacterial pathogens. Viruses are an uncommon cause of UTIs in an immunocompetent host; however, viruses are increasingly recognized as the cause of lower UTI, especially hemorrhagic cystitis, among immunocompromised patients. BK virus, adenovirus, and cytomegalovirus are predominant pathogens involved in hemorrhagic cystitis after stem cell and solid organ transplantation, and their early diagnosis and treatment may prevent significant morbidity of hemorrhagic cystitis. The diagnosis of viral lower UTI is based on molecular techniques, and real-time polymerase chain reaction is often the method of choice because it allows for quantification of viral load. Cidofovir is becoming a drug of choice in viral UTIs because it is active against the most common viral pathogens. This review discusses the epidemiology, pitfalls in diagnosis, and current treatment of viral UTIs.     

Cefotaxime in urinary tract infections

Summary According to available studies the experience with cefotaxime in the treatment of urinary tract infections (UTI) is presented. Because of its broad spectrum antibacterial activity cefotaxime is active against most of the causative organisms, including multiresistant strains (except enterococci). Of 400 isolates cultured from 400 urological inpatients with complicated and/or hospital acquired UTI 90.2% of the gramnegatives and 87.7% of the staphylococci were inhibited by concentrations of 8 mg/l. As with other antibiotics in uncomplicated UTI, high cure rates could be achieved by single dose or short-term treatment. According to six non-comparative and nine comparative studies it could be demonstrated that treatment with cefotaxime achieved favorable results in patients with complicated and hospital acquired UTI even if caused by multiresistant strains. In general, in these studies cefotaxime was superior to gentamicin, cefoxitin, cefazolin and cefuroxime, but as effective as other third generation cephalosporins and aztreonam and as the combination of ampicillin and netilmicin. A good tolerance of cefotaxime was reported in all studies.

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Cefotaxim bei der Behandlung von Harnwegsinfektionen

Zusammenfassung Aufgrund vorliegender Studie wird über die Erfahrung mit Cefotaxim bei der Behandlung von Harnwegsinfektionen (HWI) berichtet. Wegen seines breiten antibakteriellen Spektrums ist Cefotaxim aktiv gegenüber den meisten Erregern (außer Enterokokken) von HWI, multiresistente Stämme eingeschlossen. Von 400 Erregern, angezüchtet aus dem Urin von 400 urologischen Patienten mit komplizierten und/oder im Krankenhaus erworbenen HWI konnte Cefotaxim bis zu einer Konzentration von 8 mg/l 90,2% der gramnegativen Erreger und 87,7% der Staphylokokken hemmen. Wie mit anderen Antibiotika auch, konnten bei unkomplizierten HWI mit der Einmal- bzw. Kurzzeittherapie ausgezeichnete Ergebnisse erzielt werden. In sechs nicht vergleichenden und in neun vergleichenden Studien konnte gezeigt werden, daß bei der Behandlung von Patienten mit komplizierten und nosokomialen HWI auch bei multiresistenten Erregern gute Ergebnisse mit Cefotaxim zu erreichen sind. Im allgemeinen war in diesen Studien Cefotaxim überlegen im Vergleich zu Gentamicin, Cefoxitin und Cefuroxim, aber etwa gleich wirksam wie andere Cephalosporine der dritten Generation, Aztreonam, und die Kombination Ampicillin und Netilmicin. In allen Studien wurde über eine gute Verträglichkeit von Cefotaxim berichtet.

     

Biofilms and catheter-associated urinary tract infections

Urinary catheter-related infections are commonly seen in several different patient populations and lead to substantial morbidity. The overall health care costs caused by these infections are sizable given how often urinary catheters are used in acute care settings, extended care facilities, and in persons with injured spinal cords. Recent attention has appropriately focused on biofilm development on the catheter surface because biofilm has important implications for the pathogenesis, treatment, and prevention of catheter-related infection. Because the most important risk factor for infection is duration of catheterization, indwelling urethral catheterization should be avoided or at least limited whenever possible. Additional methods to prevent this infection include aseptic insertion and maintenance use of a closed drainage system, anti-infective catheters in patients at high-risk for infection, and systemic antibiotics in select patients. Alternative urinary collection strategies may be appropriate in certain patient groups. Specifically, condom catheters should be considered in men likely to be adherent with this urinary collection method, suprapubic catheters should be considered in patients requiring long-term indwelling drainage, and intermittent catheterization seems appropriate in patients with injured spinal cords. Future research should focus on additional methods for preventing this common infection.