Usefulness and problems of the urinary tract infection criteria for evaluating drug efficacy for complicated urinary tract infections

We aimed to reveal the usefulness of and problematic points with the Criteria for evaluation of clinical efficacy of antimicrobial agents on urinary tract infection (draft fourth edition) proposed by the UTI Subcommittee of the Clinical Evaluation Guidelines Committee, Japan Society of Chemotherapy, for evaluating antimicrobial agents for complicated urinary tract infections. We conducted a multicenter trial involving 159 patients with complicated urinary tract infections without indwelling urinary catheters. The antimicrobial agents used were cefcapene pivoxil and levofloxacin. "Early evaluation" took place the day after completion of 7 days of therapy; "late evaluation" took place 5-9 days after the end of treatment, and "follow-up evaluation" was done 4-6 weeks after treatment. In the early evaluation, overall clinical efficacy was judged as excellent in 52.9% of the patients, moderate in 26.1%, and poor in 21.0%, and the bacteriological response was judged as "eradicated" for 86.4% of the 198 bacterial strains isolated. Of 96 patients included in the "late evaluation" category in accordance with the draft fourth edition, the clinical outcome was judged as "cured" in 68.4% and the microbiological outcome was judged as "eradicated" in 59.4%. These rates may be low, because 25 patients in whom clinical efficacy was evaluated as "poor" at the end of treatment were separately classified as "failed" at the late evaluation. Of the 49 patients with an excellent clinical response at the end of treatment, symptoms were exacerbated in 18 at the follow-up evaluation. Overall, the draft fourth edition, with some modifications of the third edition criteria, such as the addition of a follow-up evaluation 7 days after the cessation of drug administration, has the potential to play a role in the international standards for evaluating antimicrobial drug efficacy for complicated urinary tract infections.     

UF-500i尿沉渣分析仪在诊断尿路感染中的价值研究

目的探讨UF-500i尿沉渣分析仪检测在排除患者尿路感染(UTI)中的临床价值。方法该院2013年4月至2014年3月500份尿液标本,同时进行细菌培养、UF-500i尿沉渣分析和尿干化学分析,比较UF-500i尿沉渣分析和尿干化学分析法的检测灵敏度、特异度、与细菌培养结果的符合率。结果 500份尿样中,细菌培养阳性180例。UF-500i法与细菌培养检测符合率为98.33%(177/180),干化学法与细菌培养检测符合率为91.67%(165/180),两种方法符合率比较差异有统计学意义(χ2=4.204,P<0.05)。UF-500i法检测敏感度和特异度分别为98.33%、99.06%,干化学法检测敏感度和特异度分别为为91.67%、95.31%,差异均有统计学意义(P<0.05)。结论 UF-500i法可作为疑似UTI患者的初筛项目,以为临床治疗提供及时的信息。     

帕珠沙星治疗急性泌尿系统感染的多中心随机对照临床研究

目的评价国产帕珠沙星注射液治疗急性泌尿系统感染的疗效和安全性。方法采用多中心、单盲、区组随机、平行对照试验设计，以左氧氟沙星注射液为对照药，帕珠沙星每次静滴300mg，左氧氟沙星每次静滴200mg，两药均每日用药2次，疗程7～10d。结果本研究共纳入117例，帕珠沙星组和左氧氟沙星组分别为58例和59例，其中帕珠沙星组1例因细菌培养为耐药大肠埃希菌生长而剔除，故两组进行全分析集（FAS）和符合方案分析集（PPS）分析的病例数均分别为57例和59例。疗程结束时帕珠沙星组与左氧氟沙星组的痊愈率和有效率分别为71．9％与67．8％和93．0％与83．1％，细菌清除率和阴转率均分别为97．6％与93．8％，两组比较差异无显著性。帕珠沙星组和左氧氟沙星组的不良反应发生率分别为12．1％和15．3％，差异无显著性，均主要表现为恶心、腹泻、局部刺激及血清转氨酶增高等。两组均未见严重不良事件发生。结论国产帕珠沙星注射液与左氧氟沙星注射液治疗泌尿系统中、重度急性细菌性感染均疗效确切，安全性较好。     

尿路感染大肠埃希菌临床分布及耐药性分析

目的了解尿路感染大肠埃希菌的耐药现状,为临床合理使用抗菌药物提供试验依据。方法对该院泌尿系感染者分离出348株病原菌进行鉴定和体外药物敏感试验,采用法国生物梅里埃公司ATB鉴定系统对菌株进行鉴定,采用纸片扩散法(K-B)进行抗菌药敏感性试验。结果医院尿路感染标本分离的大肠埃希菌对常用抗菌药物表现出不同程度的耐药性,大肠埃希菌对碳青霉烯类抗菌药物亚胺培南和美洛培南敏感率为100.0%;对氨苄西林、头孢唑林、头孢呋辛和哌拉西林耐药率较高;对氟喹诺酮类抗菌药物环丙沙星、左氧氟沙星耐药率也大于60.0%。结论大肠埃希菌耐药率呈逐年上升趋势;临床应该重视病原菌的培养和药物敏感试验,根据药敏结果合理应用抗菌药物。     

Pediatric urinary tract infections: diagnosis and treatment

Urinary tract infection (UTI) is the most common serious bacterial infection in childhood. Prompt diagnosis and treatment are required for the optimal clinical outcome and the prevention of long-term morbidity and sequelae. Diagnosis and treatment of UTI may seem to be easy tasks, but they remain among the most controversial issues in pediatrics. Consequently, children suspected for UTIs are investigated and treated differently in different settings. The absence of typical clinical presentation and the uncertainties in setting the index of suspicion, collecting appropriate urine samples and interpreting results, combined with different antibiotic policies in the face of increasing resistance of uropathogens, contribute to the controversy. Recently issued guidelines have attempted to settle several thorny aspects in diagnosis and treatment, but quite a few issues still remain controversial. In this review, the authors explore the current situation on diagnosis and treatment of childhood UTI in better understanding their pathogenesis and prevalence in different child populations, discuss recently evaluated diagnostic tests and thenew management guidelines.     

Catheter-associated urinary tract infection

This guideline contains updated recommendations on the management and prevention of CAUTIs by the Urological Association of Asia and the Asian Association of Urinary Tract Infection and Sexually Transmitted Infection.     

Empiric breakpoints of antimicrobial agents in urinary tract infections

Empiric breakpoints were calculated to obtain a formula to predict the breakpoints of antimicrobial agents. Receiver operating characteristic (ROC) analysis was performed on 3 types of parameters to determine which most strongly corrected to the MIC value prior to drug administration: the overall clinical efficacy in urinary tract infections, the clinical efficacy judged by the doctor in charge, or the bacteriologic response. Results showed that the area under the ROC curve was greatest when bacteriologic response was selected for determining the empiric breakpoint. Five methods were evaluated in deciding on the method to use to determine the breakpoint. Of these, the method used for respiratory tract infections (the RTI method) best described the empiric breakpoint, as the MIC at the border where the eradication rate goes beyond 80%, when the MIC values were arranged in descending order. Therefore, this method was adopted.     

Derivation of a calculation formula for breakpoints of antimicrobial agents in urinary tract infections

The regression coefficients affecting the pharmacokinetic parameters of the breakpoints of antimicrobial agents (ie, empiric breakpoints) obtained retrospectively from clinical trial data were considered, and the pharmacokinetic parameters that were thought to strongly correlate to the empiric breakpoints were selected. The regression coefficients of the selected pharmacokinetic parameters were estimated, based on the categoric regression analysis. Estimated regression coefficients were rounded, and breakpoints were constructed using these rounded values. The breakpoint for complicated cystitis was determined, and it was decided that to obtain the breakpoint of complicated pyelonephritis, one tube (ie, one-half value) would be subtracted from the breakpoint of complicated cystitis, as calculated using the formula.     

Urinary tract infections in the elderly population

Background

Urinary tract infections (UTIs) are a common problem in the elderly population. The spectrum of disease varies from a relatively benign cystitis to potentially life-threatening pyelonephritis.

Objective

This review covers the management of asymptomatic bacteriuria, acute uncomplicated cystitis, acute uncomplicated pyelonephritis, antibiotic resistance, catheter-associated bacteriuria/symptomatic UTIs, and antibiotic prophylaxis for recurrent infections in elderly men and women.

Methods

Literature was obtained from English-language searches of MEDLINE (1966–April 2011), Cochrane Library, BIOSIS (1993–April 2011), and EMBASE (1970–April 2011). Further publications were identified from citations of resulting articles. Search terms included, but were not limited to, urinary tract infections, asymptomatic bacteriuria, acute uncomplicated cystitis, acute uncomplicated pyelonephritis, antibiotic resistance, catheter associated urinary tract infections, recurrent urinary tract infections, and elderly.

Results

The prevalence of UTIs in elderly women depends on the location in which these women are living. For elderly women living in the community, UTIs compromise the second most common infection, whereas in residents of long-term care facilities (LTCFs) and hospitalized subjects, it is the number one cause of infection. The spectrum of patient presentation varies from classic signs and symptoms in the independent elderly population to atypical presentations, including increased lethargy, delirium, blunted fever response, and anorexia. Although there are few guidelines specifically directed toward the management of UTIs in the elderly population, therapy generally mirrors the recommendations for the younger adult age groups. When choosing a treatment regimen, special attention must be given to the severity of illness, living conditions, existing comorbidities, presence of external devices, local antibiotic resistance patterns, and the ability of the patient to comply with therapy.

Conclusions

Improved guidelines for the diagnosis and management of UTIs in the elderly population are needed. Better techniques to evaluate and prevent catheter-associated bacteriuria and UTIs await improved diagnostic modalities and catheter technologies. Alternative methods for prophylaxis of patients who suffer from recurrent infections must be found while minimizing the risk of developing or propagating antibiotic resistance.     

A study of nurses' views about the prevention of nosocomial urinary tract infections

• ? This study sought to discover the contribution of nursing practice to the prevention of hospital-acquired or nosocomial urinary tract infections (NUTIs), the most commonly occurring nosocomial infection.
• ? Seventy-five per cent of such infections are associated with urethral catheters.
• ? The practices of nurses who are caring for patients on a 24 h basis would appear to be fundamental to achieving any reduction in the incidence of NUTIs.
• ? This qualitative study utilized unstructured interviews to explore the views of 12 registered nurses about three key issues: first, what care do nurses give with the aim of preventing catheter-associated NUTIs; secondly, what improvements in practice would further prevent catheter-associated NUTIs; thirdly, what do nurses see as constraints to the prevention of catheter-associated NUTIs?
• ? The nurses identified many of the measures that were cited in the literature as effective for preventing NUTIs; however, in reality, they stated that their practice differed because of a lack of time to give care and to update themselves.
• ? The consequences of under-staffing were that junior and temporary staff (whose competence in preventing NUTIs was questioned) worked unsupervised.
• ? Those interviewed identified feelings of powerlessness in effecting preventative measures, and identified not only the role of medical staff in influencing NUTIs but also their inconsistent approach to care.
• ? All these forces effectively limited the nurses' ability to prevent NUTIs.
• ? The study is concluded with recommendations for changes in practice and further research.

     

神经外科留置尿管患者发生尿路感染的相关因素分析

目的：探讨神经外科留置尿管患者发生尿路感染的相关危险因素,以减少和预防尿路感染的发生。方法回顾性分析2012年5月－2014年1月我院神经外科205例留置尿管患者的临床资料,对可能发生尿路感染的相关因素进行Logistic多元回归分析。结果205例留置尿管患者中发生尿路感染18例,发生率8．78％。Logistic多元回归分析尿路感染的相关危险因素包括：≥60岁、女性、意识障碍、留置尿管≥10 d、预防应用抗生素、尿道口清洗。结论神经外科住院患者发生尿路感染的影响因素较多,管理好老年患者,加强女性患者尿管护理,尽可能缩短尿管留置时间,控制预防性抗生素的应用,坚持尿道口清洗,可以有效预防和减少尿路感染的发生。     

尿路感染肠球菌的耐药性分析及临床分布特点

目的 了解引起尿路感染的肠球菌对常用抗菌药物的耐药情况,及其临床分布特点,为临床治疗肠球菌性尿路感染提供参考依据。 方法 对我院2008年1月至2012年12月间临床尿培养检出的肠球菌进行鉴定,采用K-B纸片扩散法进行药敏试验,用WHONET 5.6软件对药敏结果进行统计分析,用Excel表对患者的临床分布特点进行分析。 结果 从临床尿路感染患者中分离出的111株肠球菌中,屎肠球菌61株(55.0%),粪肠球菌47株(42.3%),其他种类肠球菌3株(2.7%)。药敏结果显示引起尿路感染的肠球菌对临床常用抗菌药物耐药严重,耐药率最低的是万古霉素。屎肠球菌对大多数抗菌药物的耐药率要明显高于粪肠球菌,但是氯霉素和四环素例外。肠球菌引起的尿路感染以50岁以上的患者为主,占86.5%;感染最多见于泌尿外科病房和重症医学科,分别占26.1%和22.5%。 结论 肠球菌已成为尿路感染的重要病原菌,屎肠球菌的比率已超过粪肠球菌,不同种类的肠球菌耐药性差别大,应加强对重点人群的监测和管理,并根据药敏结果、感染的严重程度合理选择适当的抗菌药物。     

国外导管相关性尿路感染防控现状及对我国的启示

文章归纳了国外导管相关性尿路感染的防控现状,包括发病原因、防控实施基础、危险因素及预防策略等,探讨我国导管相关性尿路感染预防新思路,对我国导管相关性尿路感染防控的研究前景进行了展望。     

2005-2006年中国社区呼吸道感染细菌耐药性监测

目的调查2005—2006年社区呼吸道感染常见病原菌对头孢克洛及其他5种抗菌药物的耐药性。方法收集2005年10月—2006年8月全国6个地区6所医院社区呼吸道感染患者中分离的流感嗜血杆菌(280株)、肺炎链球菌(105株)、卡他莫拉菌(61株)、β溶血链球菌(30株)和MSSA(30株)共506株。菌株统一由北京医院作复检并用E试验测定头孢克洛等6种抗菌药物的MIC。结果流感嗜血杆菌是社区获得性肺炎(CAP)和慢性支气管炎急性发作(AECB)等感染的最重要的病原菌。分别占CAP56.9%(202株)和AECB64.5%(93株)。药敏结果显示,青霉素敏感的肺炎链球菌(PSSP)为50.5%,青霉素中介肺炎链球菌(PISP)为31.4%,青霉素耐药肺炎链球菌(PRSP)为18.1%。青霉素不敏感率以上海和广州最高(78.6%),其他依次为四川(50%)、天津(46.7%)、浙江(37.5%)和北京(21.1%)。有21.1%的流感嗜血杆菌和93.4%的卡他莫拉菌产生β内酰胺酶。流感嗜血杆菌对头孢克洛、头孢丙烯、阿奇霉素、氨苄西林和莫西沙星分别有98.6%、97.8%、98.6%、85.8%和100%的敏感率。阿奇霉素对肺炎链球菌、β溶血链球菌和MSSA耐药率分别高达94.3%、60%和56.7%。头孢克洛对流感嗜血杆菌和卡他莫拉菌的MIC值低于头孢丙烯1/2。结论与2003年监测结果比较,肺炎链球菌对青霉素的耐药率有较快的增长;流感嗜血杆菌和卡他莫拉菌的产酶率呈上升趋势;肺炎链球菌、β溶血链球菌和MSSA3种革兰阳性球菌对阿奇霉素的耐药率升高;头孢克洛对社区呼吸道感染常见病原菌保持70%~100%的敏感性,提示仍可作为轻中度社区呼吸道感染的选用药物。     

Pathogenesis of urinary tract infections: a review

Pathogenesis of urinary tract infections (UTIs) is not well-understood. In this paper, we review the current understanding of UTIs, particularly in relationship to individuals using intermittent catheterization. Relationships exist between the human host, infectious agent and the environment. In the human host, the urethra connects the bladder to potential infectious agents on the perineum. A high-pressure zone exists within the urethra at a point where the urethra passes through the urogenital diaphragm. This zone creates a natural barrier to ascent of organisms colonized in the distal urethra and the bladder itself has natural defences against invading organisms. The interaction of host defences with bacteria (infectious agent) determines whether or not the bacteria persist. A small number of bacteria and some types of bacteria are controlled more effectively by natural bladder defence mechanisms and frequent bladder emptying than a large number of bacteria. Escherichia coli, coliforms and enterococci are considered common bacterial causes of UTIs and are found in high numbers on the perineum. Intermittent catheterization is an effective way of bladder emptying but as an invasive procedure it remains a risk factor in the development of UTI.     

Plazomicin: an intravenous aminoglycoside antibacterial for the treatment of complicated urinary tract infections

ABSTRACT

Introduction

Antimicrobial resistance continues to be a major public health concern due to the emergence and spread of multi-drug resistant (MDR) organisms, including extended spectrum ß-lactamase (ESBL) and carbapenemase producing Enterobacterales. Plazomicin is a novel aminoglycoside that demonstrates activity against MDR gram-negatives, including those producing ESBLs and most carbapenemases, and retains activity against aminoglycoside modifying enzymes as a result of structural modifications. The information discussed is meant to assist in identifying plazomicin’s place in therapy and to expand the clinician’s armamentarium.