Statistical studies on bacteria isolated from urinary tract infections(report 5)

We examined bacteria isolated from urine of patients in our urological department from 1985 through 1987. A total of 2,566 strains were isolated from outpatients. They were 834 strains of gram-positive coccus (32.5%). E. coli (20.8%) was isolated most frequently, followed by Proteus sp. (12.6%), Enterococcus (9.6%), P. aeruginosa (6.7%), S. epidermidis (5.5%), and K. pneumoniae (3.7%) and others. A total of 784 strains were isolated from inpatients. They were 313 strains of gram-positive coccus (39.9%). Enterococcus (22.6%) was isolated most frequently, followed by P. aeruginosa (10.1%), S. marcescens (9.7%), E. coli (8.2%), S. epidermidis (7.9%), and K. pneumoniae (4.3%) and others. Gram-positive bacterium occupied a larger proportion of the total-isolates from both outpatients and inpatients, than in our previous examination. Fewer P. aeruginosa and Enterococcus were isolated from outpatients, and fewer P. aeruginosa from inpatients than previously. More S. marcescens were isolated from inpatients than previously. S. marcescens, E. cloacae, C. freundii, S. epidermidis, and S. aureus all isolated from outpatients showed a higher sensitivity to all drugs we tested than those isolated from inpatients.     

Statistical studies on bacteria isolated from urinary tract infections (report 4)

The statistics and drug sensitivity tests of bacterial florae isolated from the urinary tract in 1983 and 1984 were reviewed. Of the 2,222 strains isolated from outpatients, 593 (26.7%) were gram positive cocci, 21.4% were E. coli, 11.3% were Enterococcus, 10.4% were Proteus sp., 10.0% were P. aeruginosa, 5.6% were Alcaligenes sp., 4.2% were S. epidermidis and the rest were others. Of the 507 strains isolated from hospitalized patients, 107 (33.5%) were gram positive cocci, 20.3% were Enterococcus, 16.2% were P. aeruginosa, 9.1% were E. coli, 7.7% were Enterobacter sp. 7.5% were S. epidermidis, 4.9% were Proteus sp., S. marcescence and the rest were others. The percentage of E. coli, K. pneumoniae and S. epidermidis detected in the isolates from the outpatients and that of K. pneumoniae, Proteus sp. and S. epidermidis detected from the inpatients were lower than in previous reports. The percentage of P. aeruginosa and Enterococcus detected in the isolates from both groups of patients were higher than in previous reports. The major isolates (9 species) from the outpatients were more susceptible to the antimicrobial agents tested than those from the inpatients. The susceptibility of gentamicin, tetracycline and nalidixic acid to the major isolates was lower than in previous reports. During the past 2 years, we have been routinely using on inpatients the so-called new generation cefem antibiotics to treat urinary tract infections. This might be why the number of isolates of Enterococcus has increased especially in the isolates from inpatients.     

Comparison of bacteria isolated from urinary tract infections in patients on transplant versus urologic wards

Objective

Urinary tract infections (UTI) are the most common hospital infections. Complications include sepsis and shock. Immunosuppressed transplant surgery patients may experience loss of the graft due to UTI. The purpose of this study was to determine the main microorganisms responsible for UTIs among patients of transplant wards compared to urologic wards. Additionally, drug susceptibility profiles of the most frequent microorganisms were analyzed.

Materials and Methods

We analyzed the results of positive urine cultures from patients on 2 transplant versus 1 urologic ward in 2010.

Results

The most common pathogen in urine samples from all 3 wards was Escherichia coli. Often, other Gram-negative bacilli of the genus Klebsiella spp, were cultured as well as Gram-positive cocci (Enterococcus spp). Yeasts of the genus Candida were only found in urine of patients of transplant wards. The percentage of resistant bacteria was much higher among bacteria from transplant patients.

Conclusions

The high level of antimicrobial resistance of microorganisms isolated from the urine of transplant patients and the relatively high incidence of fungal infections, demand an especially quick, accurate microbiological diagnosis for this group of patients.     

Clinical and fundamental studies on ceftriaxone (CTRX) against urinary tract infections

Clinical efficacy of ceftriaxone (CTRX) against complicated urinary tract infections in 20 patients was examined, and the serum CTRX level was also measured in the patients with chronic renal failure (CRF). CTRX was administered at a dose of 1.0 g once a day for 5 to 10 days. The overall clinical efficacy was rated excellent in 4 cases (20%), moderate in 13 cases (65%) and poor in 3 cases (15%) with a total efficacy of 85%. Seventeen out of 27 strains (62.8%) isolated were eradicated after CTRX administration. In the patients with CRF, serum levels were very high and showed a plateau 4 hours after the injection. Furthermore, CTRX may not be removed by usual hemodialysis treatment. There were no severe side effects due to CTRX in these patients.     

Annual changes of bacteria isolated from urinary tract infections and their susceptibility to new quinolone agents]

Statistical analyses were conducted on bacterial strains isolated from the urine of patients with urinary tract infections (UTI) in the Department of Urology at Aichi Medical University from January 1988 through December 1991. The drug sensitivity of the bacterial strains isolated from patients with complicated UTI between 1988 and 1991 was analyzed and compared. Among the outpatients with uncomplicated UTI, a total of 352 strains were isolated. E. coli was isolated the most frequently (90.1%). Among the outpatients with complicated UTI, a total of 829 strains were isolated. Enterococcus sp. was isolated the most frequently (21.2%). P. aeruginosa and S. aureus showed a tendency to increase. Among the inpatients with complicated UTI, a total of 671 strains were isolated. Enterococcus sp. was isolated the most frequently (22.5%). P. aeruginosa and S. aureus showed a tendency to increase, while E. coli and Enterobacter sp. showed a tendency to decrease. E. coli was highly sensitive to all drugs except ampicillin (ABPC). Proteus sp. and Klebsiella sp. were highly sensitive to norfloxacin (NFLX). P. aeruginosa was highly sensitive to gentamicin (GM). The frequency of NFLX-sensitive P. aeruginosa significantly dropped from 84.6% to 40.9% among the outpatients (P < 0.01), and from 75.0% to 44.4% among inpatients (P < 0.05). S. aureus was highly sensitive only to minocycline (MINO). The frequency of NFLX-sensitive S. aureus significantly dropped from 66.6% to 23.3% among inpatients (P < 0.05). Enterococcus sp. was highly sensitive to ABPC and MINO. Of the new quinolones, tosufloxacin (TFLX) had the strongest antimicrobial activity followed by (ciprofloxacin) CPFX on all the bacterial strains tested.     

Clinical studies on ceftriaxone in complicated urinary tract infections

Ceftriaxone (CTRX) was clinically evaluated in 20 cases of complicated urinary tract infections. CTRX was administered for 5 days at the dose of either 1 g or 2 g once a day by intravenous injection into 10 cases. The clinical efficacy was excellent in 8 cases, moderate in 9 and poor in 3 to make an overall clinical efficacy was 91% in 11 cases with catheter indwelt. Bacteriologically, 18 out of 21 causative pathogens disappeared with an eradication rate of 86%. Neither subjective nor objective adverse reactions were observed in any case. CTRX administration once a day is effective for complicated urinary tract infections.     

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.     

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 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.     

Chronological changes in bacteria isolated from the urinary tract and their drug sensitivities

Statistical studies were performed on bacterial strains isolated from the urine of patients with various urological disease in our Urological Department between January, 1983 and December, 1987. In 1987, sensitivity tests of antibiotics to various pathogens were carried out. From the outpatients, 5,725 bacterial strains were isolated. S. epidermidis was isolated most frequently (23.8%), followed by Enterococcus species (16.5%), E. coli (14.7%), Streptococcus species (12.6%), Proteus species (5.3%), other GNR (4.6%), P, aeruginosa (4.5%), Klebsiella species (4.4%), and others. From the inpatients, 4,747 bacterial strains were isolated. Enterococcus species was isolated most frequently (23.1%), followed by S. epidermidis (18.7%), Fungi (12.9%), P. aeruginosa (8.0%), other GNR (6.8%), Streptococcus species (5.4%), Enterobacter species (4.8%), E. coli (4.1%), S. aureus (4.1%) and others. Annual change of distribution of organisms indicated that S. aureus from outpatients had a tendency to increase and Streptococcus species had a tendency to decrease. Whereas from inpatients, E. coli, other GNR, Pseudomonas species and Enterobacter species had a tendency to increase, and Streptococcus species, P. aeruginosa, Proteus species and Klebsiella species had a tendency to decrease. S. epidermidis showed a high sensitivity to minocycline and cephalothin, and Enterococcus showed a high sensitivity to ampicillin and minocycline, but did not show good sensitivity to cefoperazone and latamoxef. E. coli showed a high sensitivity to all drug we tested. P. aeruginosa showed a high sensitivity to gentamycin and norflaxacin, but did not show good sensitivity to other many drugs we tested.     

住院患者尿路感染病原菌分布及耐药性监测

目的通过调查和分析住院患者尿路感染病原菌的分布及耐药状况,为抗菌药物的合理应用提供参考。方法对浙江萧山医院2009年1月～2011年12月住院患者尿培养阳性样本中分离的1033株菌株进行回顾性分析,尿液采用经典型浸片Urieult培养,药敏试验用K—B法进行,采用WHONET5．6软件对药敏试验结果进行分析。结果1033株阳性菌株中,革兰阴性菌681株（65．9％）,革兰阳性菌197株（19．1％）,真菌155株（15．0％）。分离株位居前三位的是大肠埃希菌402株（38．9％）,肺炎克雷伯菌74株（7．2％）和白假丝酵母菌64株（6．2％）。大肠埃希菌和肺炎克雷伯菌中产超广谱β-内酰胺酶（ESBLs）检出率分别为60．7％（244／402）和45．9％（34／74）。亚胺培南、美罗培南、头孢哌酮／舒巴坦、哌拉西林／他唑巴坦和阿米卡星对大肠埃希菌和肺炎克雷伯菌显示较高的抗菌活性;肠球菌属、葡萄球菌对万古霉素、利奈唑胺和呋哺妥因耐药率低;假丝酵母菌对氟胞嘧啶、伏立康唑和两性霉素B有较高的敏感率。结论本组住院患者尿路感染病原菌以革兰阴性菌为主,尤以大肠埃希菌居多,监测和分析病原菌种类及其耐药性对指导临床合理用药具有重要意义。