Kelfiprim versus co-trimoxazole in recurrent and persistent urinary tract infections: multicenter double-blind trial

Kelfiprim (KP) is a new bactericidal agent containing trimethoprim (T) and sulfametopyrazine (S), a long-acting sulfonamide (ratio 5:4). The posology is one capsule (T 250 mg + S 200 mg) daily, after a loading dose of two capsules on the first day. To evaluate the clinical value of Kelfiprim (KP) vs co-trimoxazole (CO) in urinary tract infection (UTI) a controlled multicenter double-blind trial (MDBT) was carried out in 76 patients suffering from persistent and recurrent UTIs. About 90 per cent response rate (sterile urine at the end of treatment) was obtained for KP and about 85 per cent for CO in recurrent UTI. In persistent UTI the rate of recovery was 66.8 per cent and 53 per cent for KP and CO, respectively. Safety of treatments was excellent in 97 per cent of patients treated with Kelfiprim and 87 per cent treated with co-trimoxazole. Two patients, one in each group, were dropped from the study because of adverse reactions.     

Comparison of cefixime and co-trimoxazole in acute uncomplicated urinary tract infection. A double-blind general practice study

Five hundred and twenty-eight patients with presumptive acute uncomplicated urinary tract infection (UTI) were randomly assigned to receive cefixime 400 mg once daily, cefixime 200 mg twice daily or co-trimoxazole 2 tablets twice a day for 10 days; 477 completed at least 5 days of therapy. Of the patients 342 (65%) had positive baseline urine cultures, yielding 353 pathogens. A microbiological response was determined for 280 pathogens (79%), eradication being observed in over 94% of isolates; 153 pathogens (43%) were sensitive to both cefixime and co-trimoxazole and eradication was observed in over 96% of cases. Clinical response correlated well with microbiological response. The incidence of diarrhoea and stool changes was higher (P less than 0.005) in the patients who received cefixime once daily than in the other groups. There was a significantly higher incidence of stool changes with cefixime twice daily than with co-trimoxazole (P less than 0.05), but these did not necessitate discontinuation of therapy. Nausea was commoner with co-trimoxazole (P less than 0.05). The majority of pathogens isolated were Escherichia coli, Proteus mirabilis and staphylococci. Approximately 24% of E. coli were resistant in vitro to co-trimoxazole (P less than 0.005). Cefixime 200 mg twice daily is an effective and safe alternative to co-trimoxazole in the management of acute uncomplicated UTI.     

Efficacy and tolerability of norfloxacin vs. ciprofloxacin in complicated urinary tract infection.

This prospective, open, randomized clinical study compared the efficacy and tolerability of norfloxacin and ciprofloxacin in adult patients with complicated urinary tract infection, defined as infection in the presence of an underlying anatomic or functional abnormality of the urinary tract. Seventy-two patients were randomized, 37 received norfloxacin (400 mg orally twice daily for 10-21 days) and 35 received ciprofloxacin (500 mg orally every 12 hours for 14-21 days). Patients were clinically assessed, and urine cultures were obtained following two to four days of therapy, and five to nine days and four to six weeks after discontinuation of therapy. Seventy-two percent of the norfloxacin group and 79 percent of the ciprofloxacin group were considered cured. This difference was not significant. One failure of norfloxacin therapy was associated with the emergence of resistant Pseudomonas aeruginosa. Following norfloxacin therapy, in 2 patients superinfections developed with resistant organisms (Staphylococcus epidermidis [1] and Pseudomonas maltophilia [1]). Twelve patients, 6 in each group, experienced adverse reactions, which were considered related to the study drug therapy in only four instances. Our results indicated comparable efficacy and tolerability of norfloxacin and ciprofloxacin in the treatment of complicated urinary tract infection in adults.     

Treatment of recurrent urinary tract infection with norfloxacin versus trimethoprim-sulfamethoxazole

Norfloxacin, a broad-spectrum antimicrobial analog of nalidixic acid, was evaluated by comparing it to trimethoprim-sulfamethoxazole in 93 office patients with recurrent urinary tract infections. In this prospective randomized study, norfloxacin and trimethoprim-sulfamethoxazole were given on the same dosage schedule with the former drug given as a 400-mg tablet twice daily and the latter drug given as a double strength tablet twice daily. Overall, 50 patients received norfloxacin and 43 patients received trimethoprim-sulfamethoxazole with a cure rate of 96 percent and 79 percent, respectively. Whether a patient had one infection or multiple previous infections, norfloxacin appeared to be superior to trimethoprim-sulfamethoxazole. Only minor side effects were noted in either group, and no patient withdrew from this study as a direct result of these side effects. Minor complaints of nausea, dizziness, and headache were found in the norfloxacin group (24%) and in the trimethoprim-sulfamethoxazole group (16%). Both agents are effective in treating urinary tract infections but norfloxacin is superior to trimethoprim-sulfamethoxazole in patients with either recurrent complicated infections or one previous uncomplicated urinary tract infection.     

Vesicoureteral reflux in the renal transplantation candidate.

The incidence and severity of urinary tract infection episodes were evaluated in two groups of renal transplantation patients. Group 1 consisted of 11 patients transplanted following successful surgical correction of a noninfected vesicoureteral reflux in native kidneys, and group 2 of 28 patients transplanted with a noninfected vesicoureteral reflux. An increased incidence of acute urinary tract infection episodes was noted in group 2 as compared to group 1 (42.8 vs. 18%), with a mean of 2.6 +/- 1.4 episodes per patient in group 2 and 0.5 +/- 0.32 in group 1. Asymptomatic bacteriuria was not statistically different in the two groups (36.4 vs. 25%). In group 2, the incidence of urinary tract infection episodes increased in patients presenting high-grade (3 and 4) reflux in native kidneys. Despite the relatively low number of patients involved, our observations indicate that high-grade vesicoureteral reflux in native kidneys must be operated before transplantation, even when there is no history of urinary tract infections and urine cultures are sterile.     

肾移植术后泌尿系感染的特点分析

目的探讨肾移植术后泌尿系感染的特点。方法回顾性分析2009年1月至12月在暨南大学附属第一医院进行肾移植的38例患者(男性24例,女性14例)的临床资料,对其术后1年内尿常规、尿培养结果及其他临床资料进行总结分析。结果 38例患者肾移植术后1年内共查尿常规次数787例次,其中尿常规阴性结果为633例次,标本污染53例次,细菌尿次数101例次,其中71例次发生肾移植术后半年内。101例次泌尿系感染中,无症状性菌尿为68例次,上尿路感染19例次,下尿路感染14例次,并发脓毒血症者3例次。38例患者中,共有25例(男14例、女11例)患者出现细菌尿,有19例患者出现不少于2次泌尿系感染。最常见的致病菌为大肠埃希菌(36例次),其次是粪肠球菌(26例次)。肾移植术前血液透析患者术后感染率为70%。36例术后7d内拔出尿管和双J管的患者肾移植术后感染率64%,而2例肾移植术后7d后拔出尿管和双J管患者均发生感染。术后出现膀胱输尿管反流的3例患者均出现泌尿系感染。结论肾移植术后泌尿系感染具有高发性、反复发作的特点,最常见的致病菌为大肠埃希菌。女性、尿管和双J管的长时间留置、术后膀胱输尿管反流、术前长时间血液透析等都会诱发肾移植术后的泌尿系感染。     

Prophylactic co-trimoxazole and trimethoprim in the management of urinary tract infection in children

In a prospective study of low-dose antibacterial prophylaxis of childhood urinary tract infection (UTI), co-trimoxazole and trimethoprim (TMP) have been compared for efficacy in preventing UTI, for their effect on the rectal flora and for secular selection of TMP-resistant organisms.Between 1979 and 1986, 334 children who had proven infection of an unobstructed urinary tract complied in a regimen of low-dose prophylaxis together with measures to eliminate residual urine for at least 6 months. Of these children, 167 had vesico-ureteric reflux and 27 had renal scarring. There was no difference between the two drugs in compliance, which was very good, or in the occurrence of side-effects, which were minimal. Recurrence rates of further infection were 1 per 22 child years for the 226 children receiving cotrimoxazole and 1 per 18 child years for the 108 receiving TMP. All but one of these urinary pathogens were resistant to TMP and reinfection of the urinary tract generally occurred following lapses in attention to complete bladder emptying. Neither a secular increase in recurrent infections during this period, nor a significant change in the proportions of TMP-resistant faecal coliform organisms, was observed. TMP and co-trimoxazole appeared to be equally effective prophylactic agents.     

Urinary tract infection in percutaneous surgery for renal calculi

Percutaneous extraction of renal stones is associated with a risk of infection, which sometimes can be severe as a result of the intraoperative introduction of a ureteral catheter, the nephroscopy itself and the fact that a nephrostomy tube sometimes is left in place. It generally is accepted that patients with a preoperative urinary tract infection should be covered during the operation by an appropriate antibiotic. However, the need for routine prophylactic antibiotic treatment in patients with sterile urine preoperatively still is a subject of debate. We report the bacteriological results of 126 cases of percutaneous extraction of renal stones. Of the patients 107 had sterile urine preoperatively and deliberately did not receive prophylactic antibiotics so that the mechanisms of urinary tract infection after percutaneous nephrolithotomy could be studied. Of these patients 37 (35 per cent) suffered a postoperative urinary tract infection, usually owing to Escherichia coli, streptococcus or staphylococcus. The responsible organism was isolated in the bladder urine only in 22 cases, in the nephrostomy tube in 2 and in both sites in 13. Eleven patients (10 per cent) presented with a fever of 38.5C or more. All of the infected patients received appropriate antibiotic therapy and there were only 2 bacteriological failures on long-term followup (5 per cent). A total of 19 patients had a urinary tract infection preoperatively. All 19 patients received appropriate antibiotic therapy starting at least 24 hours preoperatively and continuing for a minimum of 3 weeks. Five patients (26 per cent) presented with a fewer but there were no serious septic complications. All of the patients were discharged from the hospital with sterile urine and there was only 1 long-term bacteriological failure (5 per cent). Both patients with Pseudomonas infection were cured. The risk of clinical infection following percutaneous nephrolithotomy is low despite the fact that 35 per cent of the patients have bacteriuria postoperatively, provided a careful bacteriological examination is performed preoperatively and the patients with urinary tract infection are treated appropriately. These results are in favor of short-term prophylactic antibiotics adapted to the bacterial ecology.     

Treatment of complicated urinary tract infections: Comparative study of sisomicin and gentamicin

The efficacy and safety of the two aminoglycoside antibiotics, sisomicin and gentamicin, were investigated in a prospective randomized study of 100 elderly male patients with complicated urinary tract infections. Both drugs were administered intramuscularly, sisomicin twice daily and gentamicin three times daily according to body weight. All bacteria isolated from the urine were sensitive to both antibiotics by disk sensitivity method. Seventy per cent of the patients treated with sisomicn and 63 per cent of those treated with gentamicin were cured of infection. There was no apparent toxicity noted from either drug. The twice daily sisomicin administration appeared to be as effective and safe as the three times daily administration of gentamicin in the treatment of complicated urinary tract infections.     

Unconventional bacteria in urinary tract disease: Gardnerella vaginalis

Bladder aspirate urine samples (N = 190) were cultured for the presence of fastidious microorganisms. These samples were obtained from patients with urinary tract disease in whom standard bacteriologic investigation had failed to indicate infection. Gardnerella vaginalis was recovered alone, or in association with Ureaplasma urealyticum from the bladder urine of 33% of patients with reflux scarring. G. vaginalis was localized to the upper urinary tract in 75% of these patients with bladder counts greater than 10(3) colony-forming units per milliliter. The results show that two fastidious microbial species, not conventionally associated with urinary tract infection, are recoverable from the upper urinary tracts of patients with so-called sterile pyelonephritis.     

The necessity of prophylactic antibiotics during extracorporeal shock wave lithotripsy

In this study we treated 340 patients with renal and ureteric stones. They all underwent ESWL with the HM-4 lithotriptor. The patients were divided into two groups, the first one including 250 patients and the second 90. The first group consisted of patients with sterile urine prior to ESWL. These patients did not receive any antibiotic prophylaxis, while 5.2% of them developed infectious problems which were followed by significant bacteriuria in only 2% of the cases. The 90 patients of the second group had urinary tract infection on the preoperative cultures and received antibiotic treatment. Of these patients 27.8% developed infectious problems which were followed by significant bacteriuria in 21.1% of the cases. Evaluating the above results, we estimate that the administration of prophylactic antibiotics in the case of patients with sterile urine before ESWL is not required while it may prove to be useful in the case of patients with urinary tract infection prior to ESWL.     

Low dosage treatment with propiono-hydroxamic acid in paraplegic patients

Severe urinary tract infections due to urease-producing bacteria are frequently associated with neurourologic pathologies and complicated by infected nephrolithiasis. Hydroxamic acids, acting as urease inhibitors, can effectively reduce lithiasic risk, normalizing the urinary environment, as well as enhancing the action of antibiotic treatments. A low dosage propiono-hydroxamic acid (PHA) treatment, 60 mg twice a day for 7 days and then 60 mg/day, was used in 15 patients affected with neurourologic pathologies for 3 months. Nine patients were stone-free and 6 stone-bearers. Urinary pH and ammonium decreased in both groups. Halving the PHA dose did not cause any variation in urinary pH or ammonium trends. In the stone-bearing group an increase in these parameters was correlated with urinary infection recurrences. Complete sterilization was achieved in 11 of 14 patients who completed the trial. In the stone-free group no patient had an infectious recurrence after the first month. Two patients in the stone-bearing group had repeated recurrences. One patient dropped out after 45 days due to a decrease in platelets. The efficacy of such low dose treatment makes even long-term or repeated therapies possible, as is often needed by neurourologic patients.     

Complicated urinary tract infection caused by Pseudomonas aeruginosa in a single institution (1999–2003)

BACKGROUND: Pseudomonas aeruginosa has been an important uropathogen that causes complicated urinary tract infection. We investigated the clinical characteristics of complicated urinary tract infection caused by Pseudomonas aeruginosa in a single institution. METHODS: We studied those patients who had basal disease in their urinary tract that was diagnosed as urinary tract infection caused by more than 10(4) colony forming units (CFU)/mL of Pseudomonas aeruginosa isolated from their urine. In those patients, we analysed infectious risk factors, treatment methods including the use of antimicrobial agents, the presence of a urinary tract catheter, and the relationship between febrile infection and urinary tract catheter. In addition, we examined the various antimicrobial susceptibilities against Pseudomonas aeruginosa. RESULTS: We studied 76 patients (59 men and 17 women). Of their basal diseases of the urinary tract, bladder tumor was the most prevalent (42.1%). Of the 39 patients who had an indwelling urinary tract catheter, 26 (66.7%) experienced a high-grade fever, a higher rate than that of the 37 patients who were not catheterized (40.5%). Seven patients were treated with anticancer chemotherapy drugs and 31 cases of urinary tract infection caused by Pseudomonas aeruginosa were diagnosed in the perioperative period. Piperacillin showed lower susceptibility against Pseudomonas aeruginosa in these 2 years (P<0.05). CONCLUSIONS: Our results indicated that those patients with urinary tract catheterization had a higher incidence of fever than patients without catheterization. Therefore, we must improve not only the antimicrobial treatment of Pseudomonas aeruginosa but also our management of catheters.     

Clinical characteristics and risk factors for septic shock in patients receiving emergency drainage for acute pyelonephritis with upper urinary tract calculi

Background

Guideline recommendations on therapy in urinary tract infections are based on antibiotic resistance rates. Due to a lack of surveillance data, little is known about resistance rates in uncomplicated urinary tract infection (UTI) in general practice in Germany. In a prospective observational study, urine cultures of all women presenting with urinary tract infections in general practice were analysed. Resistance rates against antibiotics recommended in German guidelines on UTI are presented.

Methods

In a prospective, multi-center observational study general practitioner included all female patients?≥?18 years with clinically suspected urinary tract infection. Only patients receiving an antibiotic therapy within the last two weeks were excluded.

Results

40 practices recruited 191 female patients (mean age 52 years; range 18–96) with urinary tract infections. Main causative agent was Escherichia coli (79%) followed by Enterococcus faecalis (14%) and Klebsiella pneumoniae (7.3%). Susceptibiliy of E.coli as the main causative agent was highest against fosfomycin and nitrofurantoin, with low resistance rates of 4,5%; 2,2%. In 17,5%, E.coli was resistant to trimethoprim and in 8,5% to ciprofloxacin.

Conclusions

Resistance rates of uropathogens from unselected patients in general practice differ from routinely collected laboratory data. These results can have an impact on antibiotic prescribing and treatment recommendations.     

酸性氧化电位水预防留置导尿患者尿路感染研究

目的探讨酸性氧化电位水用于留置尿管患者预防尿路感染的效果。方法将100例留置尿管患者分为观察组和对照组各50例,观察组用酸性氧化电位水、对照组用0．5％碘伏每日擦洗会阴及尿管近端2次,比较两组会阴护理后第3、7、10天中段尿细菌培养结果和尿道口的不良反应。结果留置尿管第3、7、10天,观察组中段尿细菌培养阳性率与对照组比较,差异无统计学意义（均P〉0．05）,尿道口不良反应发生率显著低于对照组（P〈0．01）。结论酸性氧化电位水和0．5％碘伏用于预防尿路感染的效果相当,但酸性氧化电位水可显著降低尿道口的不良反应,提高患者的满意度。     

Perioperative urinary catheterisation in conjunction with epidural anaesthesia for hip and knee arthroplasty. Is it safe?

The place of indwelling urinary catheterisation following epidural anaesthesia to prevent acute retention of urine after hip and knee arthroplasty is controversial. Even with the use of aseptic techniques and closed sterile drainage, bacteriuria has been reported in 10-27% of catheterised patients. A prospective trial was carried out in 68 consecutive patients undergoing knee or hip joint arthroplasty with epidural anaesthesia to investigate the perioperative complications of short term urinary catheterisation. Following establishment of combined epidural and general anaesthesia, all patients underwent urinary catheterisation under aseptic technique by a member of the surgical team. Prophylactic antibiotics were given prior to insertion and continued for 24-48h postoperatively to minimise the risk of prosthetic infection. The mean indwelling urinary catheter (IDC) period was 3.6 days (range 2-14). There were three (4.4%) urinary tract infections (UTIs) all of which resolved with appropriate antibiotics. Two were detected upon removal of the urinary catheter and one was detected on the seventh postoperative day when symptoms were detected. No patient required recatheterisation. There was no other infective morbidity or wound infection. Our findings suggest the use of IDC for short periods combined with prophylactic antibiotics is safe in the perioperative phase of joint arthroplasty.     

Clinical experience with T-2588 in complicated urinary tract infections

The clinical effectiveness and safety of T-2588 were evaluated in 21 patients with complicated urinary tract infections. Six hundred mg of T-2588 per day was administered orally in three divided doses for 14 days. The results were excellent in 7 cases (33.3%), moderate in 8 cases (38.1%) and poor in 6 cases (28.6%), and the effectiveness rate was 71.4%. The effectiveness rates of the single infection group and mixed infection group were 91.7% and 44.4%, respectively. The overall bacteriological eradication rate obtained was 77.1%, and those of gram-positive cocci and gram-negative rods were 62.5% and 81.5%, respectively. None of the 21 cases, had any significant side effects and abnormal laboratory findings. From the above results, T-2588 is considered to be a useful antibiotic in the treatment of complicated urinary tract infections.     

The use of noxythiolin (Noxyflex 'S') as an antiseptic irrigant in upper urinary tract drainage following percutaneous nephrolithotomy

Percutaneous nephrostomy drainage for the relief of obstruction or stone removal has become a common procedure. Despite the routine use of prophylactic antibiotics, nephrostomy urine frequently becomes infected (approximately 30% of cases). Noxythiolin irrigation has been used to prevent and treat bladder infections. A double-blind, placebo controlled study was carried out in 20 patients undergoing a single-stage percutaneous nephrolithotomy to evaluate the use of noxythiolin as an upper urinary tract antiseptic. In the patients whose nephrostomy tubes were irrigated with a 2.5% solution of noxythiolin, significant bacterial infection was eliminated from the nephrostomy urine and colonisation of the catheter tip was markedly reduced. Noxythiolin also rendered pre-operative infected bladder urine sterile. There were no untoward local or systemic sequelae in either group of patients. This study indicates that irrigation of the upper urinary tract with noxythiolin solution is safe and may be a useful adjunct to reduce the risk of sepsis in patients undergoing percutaneous drainage procedures.     

Clinical evaluation of combination therapy with Fortimicin and Cefotax in the treatment of complicated urinary tract infections

Clinical efficacy of combination therapy using Fortimicin (ASTM) and Cefotax (CTX) was studied in 63 patients with complicated urinary tract infections. The patients received 200 mg of ASTM i.m. and 1 g of CTX i.v. twice a day. The overall clinical efficacy of the treatment was evaluated by criteria proposed by the Japanese UTI Committee. The overall clinical efficacy rate was 68.3%. The rate was 67.3% in the patients with single bacterial infection and 72.7% in those with mixed infections. Subjective side effects were observed in one of the patients. Drug related aggravation in laboratory tests was observed in 8 items in 8 patients, but these were mild changes. We concluded that combination therapy with ASTM and CTX was useful for the treatment of complicated urinary tract infections.     

Antibiotic prophylaxis for transrectal needle biopsy of the prostate: a randomized controlled study

OBJECTIVES: To determine the effect of antibiotic prophylaxis on infective complications after transrectal needle biopsy of the prostate. PATIENTS AND METHODS: Between June 1996 and September 1998, 231 patients who satisfied the inclusion and exclusion criteria entered the study; the patients were randomized into three groups. Each patient underwent transrectal needle biopsy of the prostate after a cleansing enema at 06:00 hours. Patients in group 1 (75) then received a placebo tablet twice a day for 3 days; those in group 2 (79) were given a single dose of ciprofloxacin (500 mg) and tinidazole (600 mg), while those in group 3 (77) were given the same combination twice a day for 3 days. Urine cultures were obtained 48 h after the biopsy and blood cultures only from patients who developed fever. The complications (categorized as infective or noninfective) occurring in the three groups were compared using the chi-square test. RESULTS: Noninfective complications included were lower urinary tract symptoms, rectal bleeding, haematuria and perineal pain. The infective complications included urinary tract infection and fever. There was no significant difference among the three groups in noninfective complications (27, 29 and 31 in groups 1-3, respectively) but the incidence of infective complications (19, six and eight, respectively) was significantly higher in group 1 (P = 0.003). However, the difference was significant only for urinary tract infection (P = 0.01) and not for fever. CONCLUSIONS: In selected patients a single dose of ciprofloxacin-tinidazole is adequate prophylaxis for transrectal needle biopsy of the prostate. The present urinary infection rate was higher if no antibiotics were used. Continuing the antibiotic prophylaxis for 3 days offered no benefit over single-dose prophylaxis.