Preliminary report on DU-6859a for lower respiratory tract infection

The efficacy, safety, and clinical utility of DU-6859a, a novel “new quinolone” antibacterial agent, were evaluated in patients with mild-to-moderate pneumonia or chronic respiratory tract infection (RTI) in a multicenter study. DU-6859a was administered orally after meals at a dose of 50 to 100 mg, mainly twice daily, for 6 to 14 days. The clinical efficacy rate was 100% (26/26) for pneumonia and 89% (66/74) for chronic RTI, for an overall clinical efficacy rate of 92% (92/100). The overall eradication rate of causative organisms was 76% (42/55). Among the main causative organisms,Streptococcus pneumoniae, Haemophilus influenzae, andPseudomonas aeruginosa had eradication rates of 100% (14/14), 100% (13/13), and 27% (4/15), respectively. Side effects such as abdominal discomfort, soft stools, headache, or swelling of the face and lips were observed in 5.6% (6/107) of patients; most of these symptoms were mild. Abnormal laboratory test findings, such as elevation of glutamic-oxaloacetic transaminase and/or glutamic pyruvic transaminase, and eosinophilia, were noted in 16.5% (17/103) of patients; most of these abnormalities were mild. In conclusion, DU-6859a (50 to 100 mg b.i.d.) showed excellent efficacy for pneumonia and chronic RTI without causing any severe, clinically significant adverse reactions. These findings show that DU-6859a is worthy of further clinical study for the treatment of RTI.     

Antimicrobial activity of a new fluoroquinolone, DU-6859a, against quinolone-resistant clinical isolates ofPseudomonas aeruginosa with genetic alterations in the GyrA subunit of DNA gyrase and the ParC subunit of topoisomerase IV

The in vitro antimicrobial activity of DU-6859a, a new fluoroquinolone, was tested against 22 clinical isolates ofPseudomonas aeruginosa, including strains with fluoroquinolone resistance-associated alterations in the GyrA subunit of DNA gyrase and the ParC subunit of topoisomerase IV. The MICs of DU-6859a for 10 isolates with both altered GyrA and ParC and for 7 isolates with altered GyrA alone ranged from 1.56 to 25 μg/mL and from 0.78 to 6.25 μg/mL, respectively. The MIC of DU-6859a at which 90% of the strains were inhibited (MIC₉₀) of these 17 isolates was 12.5 μg/mL. However, there was no significant difference between DU-6859a and the other quinolones tested against 5 strains which did not have any alterations of either GyrA or ParC. Based on the MIC₉₀s, DU-6859a exhibited 8- to 32-fold greater activity than the currently available fluoroquinolones against strains having alterations in DNA gyrase and topoisomerase IV.     

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.     

Catheter-associated urinary tract infection: a review

Summary

• ? Catheter-associated urinary tract infection is still one of the most challenging aspects pf clinical practice, not only for professionals who work in the area of infection control, but for all who care for patients.
• ? Urethral catheters may be used to promote post-operative repair, relieve anatomical or physiological obstruction and provide an accurate measure of urinary output.
• ? Catheters also have a part to play in the management of intractable urinary incontinence, but admittedly less so than 10 years ago, as we now have alternative techniques and appliances, such as intermittent self catheterization (ISC), penile sheaths and an extensive range of incontinence pads.
• ? This paper reviews recent developments in catheterization and catheter care intended to prevent or alleviate urinary tract infections and associated problems.

     

Tamm-Horsfall protein: a multilayered defence molecule against urinary tract infection

Urinary tract infection (UTI) is the most common nonepidemic bacterial infection in humans, representing a constant danger for the host. Both innate and adaptive components of the immune system as well as stromal cells including bladder epithelium are involved in the prevention and clearance of UTI. However, the particular properties of the urogenital tract, which does not comprise typical physical barriers like a mucus or ciliated epithelium, necessitate soluble mediators with potent immunomodulatory capabilities. One candidate molecule capable of both mediating direct antimicrobial activity and alerting immune cells is the evolutionary conserved Tamm-Horsfall protein (THP). Tamm-Horsfall protein is exclusively produced by the kidney in the distal loop of Henle; however, its definite physiological function remains elusive. Mounting evidence indicates that beyond a mere direct antimicrobial activity, THP exerts potent immunoregulatory activity. Furthermore, the genetic ablation of the THP gene leads to severe infection and lethal pyelonephritis in an experimental model of UTI. Recent data are provided demonstrating that THP links the innate immune response with specific THP-directed cell-mediated immunity. In light of these novel findings we discuss the particular role of THP as a specialized defence molecule. We propose an integrated model of protective mechanisms against UTI where THP acts by two principle nonmutually exclusive mechanisms involving the capture of potentially dangerous microbes and the ability of this peculiar glycoprotein to induce robust protective immune responses against uropathogenic bacteria.     

尿路感染常见病原菌分析

目的了解本院尿路感染常见病原菌的分布及耐药情况,为临床合理选用抗菌药物提供依据。方法对本院2008年1～12月住院及门诊患者尿培养阳性非重复分离的164株病原菌进行回顾性分析。结果尿路感染常见病原菌以革兰阴性杆菌为主,有125株（76.2%）,其中尤以大肠埃希菌分离率最高,有104株（63.5%）;革兰阳性球菌35株（21.4%）;真菌4株（2.4%）。大肠埃希菌的产超广谱β-内酰胺酶（ESBLs）检出率为60.6%（63/104）,产ESBLs株大肠埃希菌的耐药率明显高于非产ESBLs株;革兰阳性球菌耐药情况严重。结论尿路感染常见病原菌以革兰阴性杆菌为主,临床应重视病原学检查,根据药敏试验结果合理使用抗菌药物。     

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.     

导尿管相关尿路感染标准操作规程的临床应用效果观察

目的：探讨导尿管尿路感染标准操作规程的临床应用效果。方法将我院收治的186例留置导尿管的患者随机分为观察组93例和对照组93例。针对导尿管尿路感染控制重点制定相关感染预防标准操作规程。对照组予常规感染防控,观察组在常规防控的基础上,予规程指导下的感染防控强化护理干预。统计两组导尿管留置期间导尿管尿路感染的发生率。结果观察组导尿管尿路感染发生7例（7．52％）,对照组发生感染16例（17．20％）,两组比较差异有统计学意义（P＜0．05）;两组导尿管尿路感染的发生率均随导尿管留置时间的增加而增加（P＜0．05）。结论导尿管尿路感染标准操作规程指导临床护理,能有效提高导尿管留置护理管理工作的规范性,降低医院感染的发生率。     

降钙素原危急值与泌尿系感染相关性分析

目的：分析降钙素原危急值与泌尿系感染相关性,为泌尿系严重感染的临床诊疗提供一定参考价值。方法回顾2015年1月1日至2015年12月31日该院泌尿外科所有降钙素原危急值报告结果,分析其与泌尿系感染相关性。结果所查552例降钙素原中,共报告23例降钙素原危急值,其中与泌尿系结石相关共19例,占82．61％,与输尿管软镜手术相关12例,占52．17％。结论降钙素原是泌尿系严重感染较为敏感及准确的一项检验指标,其危急值的出现对临床有着极其重要的警示作用,需要引起临床医生的高度重视。     

泌尿系外伤患者导尿管留置术后并发尿路感染的危险因素分析

目的探讨泌尿系外伤患者导尿管留置术后并发尿路感染的危险因素,为制订针对性护理措施提供依据。方法回顾性分析2009年1月至2013年12月泌尿外科收治的138例泌尿外伤患者的临床资料,并对尿路感染的危险因素进行Logistic回归分析。结果 138例患者中行导尿管术后并发尿路感染42例,感染率为30.43%。年龄、损伤严重程度评分、并发糖尿病、导尿次数、导尿管留置时间、术前应用抗生素是泌尿外伤患者导尿术后并发尿路感染的独立危险因子。结论泌尿系外伤导管术后并发UTIC是由多因素共同作用引起的,对患者采用综合预防措施将有助于降低尿路感染发生风险。     

留置导尿引起尿路感染的原因及对策

介绍了留置导尿引起尿路感染的常见原因及对策,提示临床护理人员应严格掌握适应证,加强无菌观念,缩短留置尿管时间,合理使用抗生素。     

留置导尿引起尿路感染的原因及对策

介绍了留置导尿引起尿路感染的常见原因及对策。提示临床护理人员应严格掌握适应证，加强无菌念，缩短留置尿管时间。合理使用抗生素。     

导尿管相关尿路感染生物被膜菌及药敏结果分析

目的了解九江地区近2年来导尿管插管后患者尿路感染的病原菌构成,细菌耐药性和生物被膜形成情况,以便指导临床合理用药。方法于2009年8月至2011年8月选择我院住院部收治的CAUTI患者145例为对象,对其导尿管进行细菌培养,药敏试验和细菌生物被膜的检测。结果共分离出118株生物被膜菌,检出率81.4%;以大肠埃希菌为主,占46.61%;大多数生物被膜菌株有较厚的生物被膜;革兰阴性菌中大肠埃希菌等对β-内酰胺类抗生素有很高的耐药率,对阿米卡星的耐药率较低,大肠埃希菌和肺炎克雷伯菌对亚胺培南敏感率为100%。革兰阳性球菌的耐药情况也相当严重。结论针对大多数生物被膜菌株有较厚的生物被膜,要选择细菌生物被膜敏感的抗菌药物,根据菌株的药敏试验,合理地制定治疗方案,以便控制感染。     

留置导尿并发尿路感染的原因分析及护理对策

目的 :探讨留置导尿并发尿路感染的原因及护理对策。方法 :回顾分析留置导尿 16 0例的临床资料 ,按尿管留置时间、集尿袋更换时间以及有无膀胱冲洗分组 ,就各组感染率进行比较。结果 :留置尿管时间越长、集尿袋更换越频繁 ,尿路感染发生率越高 ;膀胱冲洗与否 ,尿路感染的发生率无明显差异。结论 :严格掌握留置导尿的适应证 ,尽量缩短留置导尿时间 ,集尿袋的更换以 1周为宜 ;膀胱冲洗不能有效降低尿路感染的发生率。     

UF-100尿液分析仪在尿路感染诊断中的应用

目的探讨UF-100尿液分析仪定量计数尿液中细菌在尿路感染诊断中的作用。方法将183份中段尿标本分别做尿细菌培养，同时用UF-100检测每份标本的细菌数，将两种方法得到的结果进行比较分析。结果以UF-100尿液分析仪细菌计数〉6000／μl作为尿路感染的判断标准，与细菌培养比较，两者差异无统计学意义（P〉0．05），其敏感性为73．68％，特异性为97．93％，阳性预期值为90．32％，阴性预期值为93．42％，准确度为92．94％。结论应用UF-100尿液分析仪对中段尿细菌数进行定量分析不失为尿路感染诊断一个快速、有效的方法。     

膀胱全切术后泌尿系感染的危险评估及护理干预对策

目的探讨膀胱全切术后泌尿系感染的危险评估及护理干预对策。方法选取泌尿外科收治的86例膀胱全切术患者作为研究对象,分析泌尿系感染情况并对感染患者的临床资料进行单因素和多因素logistic回归分析。结果 86例患者中,19例患者术后出现泌尿系感染;年龄、性别、前列腺增生、糖尿病、使用抗菌药物、肝肾功能不全、住院时间是影响泌尿系感染的危险因素(P0.05)。经logistic回归分析发现,年龄、糖尿病、未使用抗菌药、住院时间长是术后泌尿感染的独立危险因素(P0.05)。结论膀胱全切术后泌尿系感染的发生率较高,危险因素较多,应采取有针对性的干预对策,减少术后泌尿系感染的发生。     

导尿管细菌生物膜相关性尿路感染的预防

介绍了导尿管细菌生物膜的组成、结构、形成、致病机制,以及导尿管材质对细菌生物膜形成、生长、繁殖的影响.提出减少尿管相关性尿路感染的关键在于预防,防止细菌生物膜的形成,改进导尿管生物材料,加强护理.     

导尿管细菌生物膜相关性尿路感染的预防

介绍了导尿管细菌生物膜的组成、结构、形成、致病机制，以及导尿管材质对细菌生物膜形成、生长、繁殖的影响。提出减少尿管相关性尿路感染的关键在于预防，防止细菌生物膜的形成，改进导尿管生物材料，加强护理。     

Cefaclor versus ampicillin for outpatient treatment of urinary tract infections

An unblinded, randomized, prospective clinical trial of cefaclor, 250 mg twice daily, versus ampicillin, 500 mg four times daily, for a total of ten days of therapy, was conducted with 100 patients presenting to an emergency department with signs, symptoms, and urinalysis results suggestive of urinary tract infection (UTI). Eighty patients had a UTI proven by pre-therapy urine culture. Significantly more of the bacteria isolated were sensitive to cefaclor (96.3%) than to ampicillin (78.0%), P < 0.01. Seventy-one patients returned for all follow-up visits and urine cultures. The overall success rate in the cefaclor group was 75.7% and in the ampicillin group 79.4%. There was a 10% failure rate in treating clinical cystitis with both regimens, and the satisfactory outcome rate for pyelonephritis and cystitis was similar in both treatment groups.     

微创经皮肾镜治疗上尿路结石并感染

目的 探讨微创经皮肾镜治疗榆尿管上段结石及肾结石并感染的疗效.方法 对感染较轻的肾、输尿上段结石并感粢者,经控制感染后Ⅰ期行微创经皮肾镜术9例;合并较严重感染者先期行经皮肾造痿、Ⅱ期微创经皮肾镜碎石取石术32例.结果 Ⅰ期行微创经皮肾铰碎石取石术9例中,2例术后出现高热(＞39℃).2例术后体温为38-390C,其余5例术后体温＜38℃.Ⅱ期经皮肾镜碎石取石术32例.所有病例Ⅱ期经痿道碎石取石术后体温均＜38℃.结论 对于榆尿管上段及肾结石并感染患者,经抗炎治疗后复查,血象、体温正常、无腰痛、估计手术时间不长者,选择Ⅰ期经皮肾镜碎石取石术;反之,选择Ⅱ期经皮肾镜术.