Clinical efficacy of tosufloxacin on the patients with urinary tract infections]

We evaluated a newly developed quinolone agent, tosurofloxacin (TFLX), for its safety and clinical efficacy on patients with urinary tract infections (UTI). Among 138 cases satisfying the UTI criteria, 75 cases were acute simple UTI and 63 cases were chronic complicated UTI. In principle, a daily dose of 450 mg of TFLX was administered for 3 days and for 5 days for acute simple UTI and for chronic complicated UTI, respectively. Clinical efficacy of TFLX in these cases was evaluated according to the criteria of Japanese UTI committee. Bacteriologically, all 80 strains isolated from acute simple UTI were eradicated following TFLX administration. However, 2 gram positive strains and 1 gram negative strain, appeared following the treatment. In cases of chronic complicated UTI, 29 out of 32 gram positive strains and 29 out of 44 gram negative strains were eradicated. Among the isolated strains, P. aeruginosa and S. marcescens persisted, which suggests that they were less sensitive to TFLX. Overall clinical effectiveness rate of TFLX on acute simple UTI was 100%, while that on chronic complicated UTI was 73%. Adverse drug side effects were minimum, stomach discomfort and constipation was observed in one case each. These findings indicate that TFLX is a useful agent for the treatment of both simple and complicated UTI.     

Clinical reevaluation of aztreonam (AZT) on urinary tract infections

The clinical effectiveness and safety of Aztreonam (AZT) were studied in 55 patients with complicated urinary tract infections. AZT was administered at a dose of 4 g/day for 5 days. The results as evaluated by the UTI criteria were excellent in 8 cases, moderate in 26 and poor in 21. The overall effectiveness rate was 61.8%. Out of 64 strains of bacteria isolated before treatment, 50 strains (78.0%) were eradicated by the treatment. Bacteriological eradication rates for gram negative rods and gram positive cocci were 79.6% and 66.7%, respectively. There were no obvious side effects, except for a temporary elevation of glutamic oxaloacetic transaminase, glutamic pyruvic transaminase alkalinephosphatase, and total bilirubin in some patients. The results indicate that AZT tablets are useful and safe for the treatment of complicated urinary tract infections.     

Clinical studies of efficacy of imipenem/cilastatin sodium against urinary tract infections with ureterocutaneostomy]

Clinical efficacy of IPM/CS against urinary tract infections (UTI) was evaluated on 19 patients with malignancies (bladder tumor: 15, prostate cancer: 3, uterus cancer: 1) and 1 patient with a benign disorder (ureter stenosis) who had undergone ureterocutaneostomy between January, 1988 and December, 1990. Their ages ranged from 42 to 79 years. Postoperatively, they had UTI with pyuria of greater than or equal to 5/hpf and bacteriuria of greater than or equal to 10(4)/ml. IPM/CS was administered at a dose of 0.5 g (0.25g/0.25 g) twice a day through intravenous drip infusion. Its efficacy was evaluated according to the UTI criteria for clinical evaluation as ruled by the Japanese Society of Chemotherapy. Overall clinical value was rated "excellent" in 4 (20%), "moderate" in 9 (45%) and "poor" in 7 (35%) cases for a total of 65%. The efficacy by types of infection was 33% and 70.6% in the group of single infection and in the group of mixed infection, respectively. As to bacteriological efficacy 34 of the 38 strains (89.5%) isolated were eradicated following its administration. The eradication rate was 84.6% for P. aeruginosa, and 84.6% for E. faecalis. Microbes which appeared after its dosing amounted to 6 classes of 17 strains, 6 NFB strains of which were identified. As a side effect, elevation of serum GPT (5%) was noted. Regardless of the underlying conditions (malignant diseases and ureterocutaneostomy), clinical efficacy of IPM/CS was appreciable. In addition, the MIC for (P. aeruginosa, E. faecalis) of IPM/CS was lower than that of PIPC.     

Microorganisms isolated from urinary tract infection and their beta-lactamase production and evaluation of clinical efficacy of sulperazone

Clinical survey of microorganisms isolated from urinary tract infection (UTI) was carried out at the four major hospitals in Mie Prefecture from May to July, 1987, and production of beta-lactamase of the microorganisms was determined by the acidimetric method, "beta-checker". Among the total of 460 strains isolated from urine samples, 135 of gram positive cocci and 325 of gram negative rods were contained. Sixty percent of the gram negative rods and 14% of gram positive cocci produced beta-lactamase. Pseudomonas aeruginosa, E. coli and Serratia marcescens were representative organisms which produced beta-lactamase. Acinetobacter, Klebsiella, Enterobacter and Citrobacter species produced beta-lactamase at a higher rate but those were not so frequently isolated. In the sensitivity test to Sulperazone, the representative organisms isolated from urine, as a whole, had a sensitivity of 74% and E. coli, Klebsiella, S. epidermidis and Pseudomonas aeruginosa were highly sensitive, while Enterobacter cloacae and Serratia marcescens showed low sensitivity. The clinical efficacy of Sulperazone was evaluated in 26 patients with complicated UTI. Overall effectiveness rate and eradication rate of beta-lactamase production organisms were 73.1 and 63%, respectively. Sulperazone is concluded to be a useful antibiotic for treating complicated UTI induced by beta-lactamase production organisms from the point of microbiology and safety.     

Clinical studies of norfloxacin in urinary tract infections

The clinical effectiveness and safety of norfloxacin were evaluated in 34 patients with urinary tract infections. Out of 13 patients with simple UTI evaluated by the UTI criteria, the results were excellent in 12 cases (92.3%) and moderate in 1 case (7.7%). For complicated UTI evaluated by the UTI criteria, the results were excellent in 7 cases (70%), moderate in 2 cases (20%) and poor in 1 case (10%). The clinical efficacy was satisfactory in the cases of 2 complicated urinary tract infections as well as simple urinary tract infection. Out of 26 strains of bacteria isolated before treatment, 25 strains (96.2%) were eradicated after treatment. There were no remarkable adverse effects. Only one patient showed slight elevation of serum transaminase transiently. From the above results, norfloxacin is considered to be useful and safe in the treatment of urinary tract infection.     

Study of the local use of amikacin

Amikacin sulfate (AMK) was used against urinary tract infections (UTI) as local administration such as bladder lavage, renal pelvic lavage and vesical instillation. Forty four patients with UTI were treated by this method, 32 patients having Foley catheter indwelling in the bladder and 12 patients having drainage catheter indwelling in the renal pelvis. The overall clinical effect under UTI judgment was 3 excellent cases, 24 good, 11 fair and 6 poor, with an efficiency of 61.4%. A total of 100 bacteria, 47 gram positive, 33 gram negative, 6 anaerobes and 14 fungi, were found in the urine and bacteriological effect was 68.8% and 57.1% in single and combined bacterial infection, respectively. The serum concentration of AMK was measured in 9 patients by radioimmunoassay, and the maximum concentration was 0.38 micrograms/ml which is a low absorption rate. There were no adverse reactions during or after treatment with AMK.     

Clinical evaluation of aztreonam (AZT) in the treatment of complicated urinary tract infections

Aztreonam (AZT, Azactam) was given to 176 patients with complicated urinary tract infections (UTI), of whom 110 cases satisfied with the "Criteria of UTI Committee for the Evaluation of Drug Efficacy in the UTI (3rd Ed.)", which was modified by adopting the midstream urine data in cases of women. Aztreonam was administered by drip infusion at a daily dose of 1 to 4 grams (mostly 2 grams) for at least five days long. The overall clinical efficacy rate of AZT in the 110 cases with the complicated UTI was 64%, estimated by the criteria cited above. The efficacy rate according to the infection type groupings was 66% for the 38 patients in the 1st group, 33% for the 3 in the 2nd group, 79% for the 19 in the 3rd group, 85% for the 21 in the 4th, 47% for the 19 in the 5th and 42% for the 12 in the 6th group. The disappearance rate of Gram negative bacilli was 87.1%. Especially 15 strains of Pseudomonas aeruginosa were eliminated out of 25 (60%) after AZT administration. Forty-six strains appeared after AZT treatment, 36 (76%) of which were Gram positive cocci. Subjective side effects and abnormal laboratory findings in a total 176 cases were: diarrhea in one, upper abdominal discomfort in one, increases in glutamic pyruvic transaminase in 8, increases in glutamic oxaloacetic transaminase in 5 and eosinophilia in 1. All of these disappeared after termination of the drug. AZT might therefore be a useful and safe antibiotic for the first choice use against complicated UTI.     

手外科患者伤口分泌物的病原菌分布及耐药性分析

目的：对本院手外科患者伤口分泌物中病原菌的分布及其耐药性进行研究分析,为临床用药提供有利依据。方法对2012年1月—2013年5月本院手外科患者伤口分泌物的病原菌进行鉴定及药敏检测。结果本组823份伤口分泌物标本中分离培养出致病菌542份,阳性率为66%,共检测出致病菌株602株,其中包括一份标本有两种以上致病菌株。其中革兰氏阴性杆菌374株,占62%,革兰氏阳性球菌187株,占31%,真菌41株,占7%。革兰氏阴性杆菌前几位为大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌、阴沟肠杆菌;革兰氏阳性球菌以金黄色葡萄球菌为主。45%的大肠埃希菌产超广谱β-内酰胺酶（ESBLs）,对很多抗生素耐药。28%的金黄色葡萄球菌为耐甲氧西林菌株,没有耐万古霉素的金黄色葡萄球菌株。结论本院手外科患者伤口分泌物标本中以革兰氏阴性杆菌为主,耐药问题比较严重,应对抗生素的合理应用给予足够的重视。     

Clinical experience of enoxacin complicated urinary tract infection

Enoxacin (ENX) was administered to 69 patients with complicated urinary tract infections (UTI). Clinical efficacy and safety were evaluated by the criteria proposed by the UTI Committee, Japan. The overall clinical efficacy was excellent in 60.9%, moderate in 10.1% and poor in 29% of the patients. Of the 76 strains isolated from the patients 61 strains (80.3%) were eradicated. Subjective side effect was observed in one patient who complained of slight nausea. No drug-related aggravation in the laboratory test was observed. These results showed that ENX was effective and safety for the treatment of complicated urinary tract infection.     

Clinical experience of norfloxacin in urinary tract infection

Norfloxacin (NFLX) was administered to outpatients and inpatients with urinary tract infections at our department. Clinical efficacy and safety were evaluated in 50 patients by the criteria for evaluation of clinical efficacy of antimicrobial agents on urinary tract infection. Overall clinical efficacy for 17 cases with acute simple cystitis was excellent in 13 cases, moderate in 4 cases with an effectiveness rate of 100%. The overall clinical efficacy for 33 cases with chronic complicated UTI was excellent in 18 cases, moderate in 6 cases and poor in 9 cases with an effectiveness rate of 73%. The eradication rate of 21 strains from acute simple cystitis patients was 100%. Forty four out of 60 strains from chronic complicated UTI patients were eradicated and the eradication rate was 73%. Neither subjective nor objective adverse reactions were observed in 50 patients. Abnormal changes in laboratory tests were found in 8 patients, but were probably not related to NFLX administration. Judging from these results, NFLX is considered to be an effective and safe antibacterial for the treatment of UTI.     

Clinical study of ofloxacin (OFLX) on urinary tract infections

Fifty-three patients with urinary tract infections (UTI) were treated with Ofloxacin, a new oral synthetic antimicrobial agent, and its clinical efficacy was studied. Ofloxacin (600 mg/day) was administered to 35 patients with acute simple cystitis for more than three days, and to 17 patients with complicated UTI for more than five days except a case in which the treatment was interrupted for side effects. Acute simple cystitis: In ten cases meeting the criteria of UTI committee, overall effectiveness rate was 100%. All of the 26 strains isolated from 26 patients disappeared after the treatment. In all of acute simple cystitis cases, 94.3% were evaluated as excellent or as moderate by attending doctors. Complicated UTI: In 11 cases treated during five or seven days, 63.6% of patients showed improvement on pyuria. Seven out of nine strains isolated from seven patients disappeared. However, two strains of P. aeruginosa and P. cepacia persisted after the treatment. In all of the complicated UTI cases, 38.9% of patients were evaluated as excellent or as moderate by attending doctors. Some slight side effects were observed in four out of 53 cases. This study showed that Ofloxacin is effective against urinary tract infections.     

Clinical experience of norfloxacin (Baccidal) in the urological field

The clinical effectiveness of a new synthetic pyridoncarboxylic acid derivative, norfloxacin (NFLX: Baccidal) was studied in the urological field. NFLX was given clinically to 50 patients with urogenital tract infections; 40 cases were acute simple cystitis and 10 cases were complicated UTI satisfied the criteria of the UTI committee. Thirty two bacterial strains were isolated from the group of acute simple cystitis and 10 bacterial strains were isolated from the group of complicated UTI. Susceptibility of NFLX by the method of distribution and disk sensitivity was 97% in the former group and 89% in the latter group. The overall clinical efficacy rate estimated by the criteria of the UTI committee in 32 cases with acute simple cystitis was 97% and in 10 cases with complicated UTI was 60%. The incidence of side effect was 8.0% (4/50). All of these side effects which were nausea, abdominal fullness and headache may be attributable to the administration of NFLX. No abnormal laboratory findings were observed except for elevation in GOT and GPT values in 1 case (4.0%), which returned to normal after NFLX treatment. Therefore NFLX is suggested to be a clinically useful and safe drug in the treatment of UTI.     

腹腔手术后医院内下呼吸道感染分析

目的分析腹腔手术后患者医院内下呼吸道感染的常见病原菌及药物敏感情况。方法回顾性分析2002年1月~2007年1月246例腹腔手术后下呼吸道感染患者的痰菌培养结果。结果246例住院患者分离出261株病原菌,其中革兰氏阴性杆菌183株(70.1%),主要为铜绿假单胞菌、流感嗜血杆菌、不动杆菌、副流感嗜血杆菌和克雷伯菌;革兰阳性球菌60株(23.0%),主要为表皮葡萄球菌、肺炎链球菌及金黄色葡萄球;真菌18株(6.8%)。铜绿假单胞菌、不动杆菌、克雷伯菌对美洛培南、舒普深、头孢吡肟敏感;葡萄球菌对万古霉素均敏感;肺炎链球菌对美洛培南、左氟沙星敏感率高,对青霉素大部分耐药。结论下呼吸道感染以革兰氏阴性杆菌感染为主,且常见病原菌耐药性明显,应根据药敏试验规范使用抗生素,减少耐药菌的产生。     

Clinical evaluation of cefixime (CFIX) in the treatment of urinary tract infection

Cefixime (CFIX, Cefspan), a new oral cephem, was used in the treatment of urinary tract infections, and was evaluated for its therapeutic effectiveness and safety at the Department of Urology, Osaka University Hospital and 16 affiliated hospitals. A total of 238 patients were administered daily doses of 200 or 400 mg. Clinical efficacy was assessed on 92 female patients with acute uncomplicated cystitis and 42 patients with complicated UTI according to the Criteria for Clinical Evaluation of Antimicrobial Agents in UTI (3rd ed.) recommended by the Japan UTI Committee, to which we added our own minimum modification. Clinical efficacy was evaluated as excellent in 57 of the acute uncomplicated cystitis cases, moderate in 33 and poor in 2, with an overall clinical effectiveness rate of 98%. Clinical efficacy was evaluated as excellent in 12 of the complicated UTI cases moderate in 12 and poor in 18, with an overall clinical effectiveness rate of 57%. In one case of uncomplicated pyelonephritis, CFIX showed an excellent efficacy. Of the total of 102 bacterial strains isolated from uncomplicated UTIs, 95 (93%) were eradicated by CFIX, while 36 (72%) eradicated in 50 strains isolated from complicated UTIs. Subjective adverse reactions were seen in 4 cases (1.7%) of the 236 patients, as generalized pruritus and upper gastrointestinal discomforts. Abnormal laboratory findings were recorded in 6 out of 141 cases. They were increases in serum GPT, GOT, alkaline phosphatases, total bilirubin, as well as increases in peripheral leukocytes. These adverse symptoms and abnormal laboratory findings disappeared after the termination of CFIX administration. CFIX might therefore be considered as a clinically useful oral antibiotic in the treatment of UTI.     

Clinical evaluation of the combination of carumonam and fosfomycin in the treatment of complicated urinary tract infection

Carumonam (CRMN), the first monobactam antibiotic in Japan, has excellent activity against gram-negative bacteria and is useful in the treatment of urinary tract infections. However, it may be insufficient in the treatment of complicated urinary tract infections because of the increase in isolation of gram-positive bacteria, and it may be necessary to co-administer antibiotics active against gram-positive organisms to achieve a broader spectrum of coverage in connection with severe infections. The combination of CRMN and fosfomycin (FOM) was evaluated for its effectiveness and safety at the Department of Urology, Yamagata University Hospital and 7 affiliated hospitals. Clinical efficacy was assessed on 64 patients with complicated urinary tract infection according to the Criteria for Clinical Evaluation of Antimicrobial Agents in UTI (3rd. ed.) recommended by the Japan UTI Committee. Clinical efficacy was evaluated as excellent in 16, moderate in 32, poor in 16, with an overall clinical effectiveness rate of 75.0%, which is superior compared with CRMN alone. Of the total of 92 bacterial strains isolated, 66 (71.7%) were eradicated. Subjective adverse reaction was seen in 1 patient (1.4%), as nausea and anorexia. Slight increases in serum GOT and GPT ware recorded in 5 patients (7.1%). These findings disappeared after the termination of administration without treatment. The combination of CRMN and FOM might therefore be useful in the treatment of complicated urinary tract infections.     

A clinical evaluation of MK-0787/MK-0791 for long-term administration in urological infections

MK-0787 (Imipenem)/MK-0791 (Cilastatin sodium), a new compound of Thienamycin, was administered in treatment of 35 patients (36 cases) with chronic complicated UTI or for prevention of serious infections with much complicated factors. The patients were principally treated at a daily dose of 1 g for over 10 days. The efficacy rate of 26 patients who were evaluable in the early phase (4-7 days) was 88.5%, while it became up to 92.3% in the final phase judgment. As for clinical usefulness, the result was obtained to be as high as that of the clinical efficacy. In bacteriological study, 35 strains were clinically isolated including 7 strains of P. aeruginosa from UTI. All the strains disappeared with an eradication rate of 100% after treatment. Strains appearing after Imipenem/Cilastatin sodium treatment mainly consisted of fungi. Usefulness judgements tended to be greater in the final phase than in the early phase. As for side effects, vomiting was recorded in one case, in which the administration was discontinued. In laboratory findings there were 3 cases with elevated GPT, 2 cases with elevated GOT, one case with elevated gamma-GTP, one with thrombocytopenia, and one with eosinophilia each, but these abnormal values were slight and transient. In summary our clinical study showed that Imipenem/Cilastatin sodium was a very effective antibiotic in treatment on moderate or serious UTI or preventive use for infections in compromised hosts. Considering the features of this agent, it might be more effective and useful for clinical use in treatment on polymicrobial infections including stubborn organisms than any other antimicrobial compounds. Furthermore, it was safe and well tolerable in a long term treatment.     

Clinical experience with cefbuperazone in complicated urinary tract infection

Cefbuperazone (CBPZ) was administered to inpatients with complicated urinary tract infections (UTI) at our department. Clinical efficacy and safety were evaluated in 22 chronic cases by the criteria for evaluation of clinical of antimicrobial agents on urinary tract infection. Overall clinical efficacy was excellent in 8 cases, moderate in 9 cases and poor in 5 cases with an effectiveness rate of 77%. Twenty-four of the 34 strains isolated from the patients were eradicated and eradication rate was 71%. Neither subjective nor objective adverse reactions were observed. Abnormal changes in laboratory tests were found in 9 patients, but were probably not related to CBPZ administration. Judging from these results, CBPZ is considered to be an effective and safe antibacterial for the treatment of complicated UTI.     

Clinical efficacy of T-3262, a new quinolone compound, on urinary tract infection in 1988

A newly developed quinolone compound, T-3262, was administered in the treatment of 36 cases of urinary tract infection (UTI) between June and August in 1988. Thirteen cases of acute uncomplicated cystitis (AUC) were evaluated with the Japanese UTI criteria at a dose of 300 mg a day for 3 days after the administration of the drug. The clinical efficacy was obtained as 92.3%. Twenty two cases of chronic complicated UTI (CC-UTI) were evaluated with the criteria, the clinical efficacy rate was 86.4% at a dose of 300-450 mg a day for 5 days administration. The clinical efficacy judged by doctor in charge was evaluated as effective for 100% on AUC and for 90.9% on CC-UTI. Minimum inhibitory concentration (MIC) of new quinolones for clinical strains isolated in the clinical study was compared with that of the strains isolated from CC-UTI at our and other institutes in the last two years. There were no significant differences in in vitro activity found among the three groups. Comparing the efficacy rate on CC-UTI with that of the open trial in Japan in 1987, despite a general tendency for increase of resistant strains to new quinolones, a high effectiveness such as 82.3% in CC-UTI that was almost similar to the open trial was achieved. Neither side reactions except for mild and transient gastric discomfort in 2 patients nor significant clinical abnormal values were encountered. In conclusion, T-3262 is an effective and useful antimicrobial drug in the treatment of UTI, and its effectiveness is still almost comparable to the result of clinical studies that have been carried out in the last two years.     

Treatment of complicated urinary tract infections by ofloxacin

To study the treatment effects of ofloxacin (OFLX) on the patients with complicated urinary tract infections (UTI), OFLX at a daily dose of 600 mg divided into either two or three doses per day, was administered for 14 days to 114 patients with complicated UTI. Among the 114 patients, 67 patients satisfied the criteria for clinical evaluation of complicated UTI. One hundred and one organisms were isolated from these patients' urine. Among them, 82 organisms were eliminated following OFLX administration. Twenty organisms appeared newly by the replacement of organisms. Among them, 6 organisms belonged to Candida sp. As to the overall efficacy of OFLX, an excellent response was seen in 37.3% and sum of efficacy rate was 65.7%. Side effects were observed in 3 of the 114 patients. These results indicate that OFLX is both safe and effective enough to be used for the treatment of the patients associated with complicated UTI.     

Treatment of urinary tract infections by cefaclor, with special reference to the antibody-coated bacteria (ACB) detected by the immunoenzyme technique

Twenty out-patients suffering from urinary tract infections (UTI) were treated with cefaclor. Cefaclor was administrated orally in daily doses of 1,500 mg for 7 days against 15 cases of simple UTI and 5 cases of complicated UTI. Of 20 cases with acute simple cystitis, acute pyelonephritis and complicated UTI, clinical responses were excellent in 10 cases, good in 6 cases and poor in 4 cases. The efficacy rate was 80%. No side effect was observed. The site of infection determined by the ACB detection method was in good agreement with that determined by clinical findings. Cefaclor appeared to be equally effective in the treatment of both ACB-positive and ACB-negative infections. The presence of absence of antibody-coated bacteria did not correlate with clinical symptoms or response to therapy.