Cefodizine (HR221) Versus Norfloxacin for Treatment of Urinary Tract Infections

Summary

Cefodizimc is a stable new beta-lactamase cephalosporin chemically related to cefotaxime and with a long half-life.

Its clinical efficacy and tolerability were compared with those of norfloxacin in patients with intercurrent urinary tract infections plus chronic liver diseases. Cefodizimc (2 g, once a day, i.v.) and norfloxacin (400 mg, twice a day, p.o.) were randomly given to two groups of 20 patients each with urinary tract infections caused by organisms sensitive in vitro to these drugs.

Cultures of midstream bladder urine, urinalysis and blood biochemical tests were performed before and after each antibiotic treatment.

Clinical resolution was observed in 100% of the patients at the end of the treatments, but bacteriological eradication was obtained in 90% of the patients treated with ccfodizime and 85% of those treated with norfloxacin, because of the development in five patients of asymptomatic bacteriuria (superinfections).     

Clinical impact of newer quinolones: influence on normal microflora

This review article summarizes the published data concerning the impact of ciprofloxacin and norfloxacin on the oropharyngeal and intestinal human microflora. The use of ciprofloxacin and norfloxacin for selective decontamination in compromised patients and for prophylaxis of recurrent urinary tract infections is also reviewed.     

A comparative study on aztreonam, ceftazidime and amikacin in the treatment of complicated urinary tract infections

In a prospective, randomized trial, aztreonam (1 g intravenously or intramuscularly, twice daily) was compared with ceftazidime (1 g intravenously or intramuscularly, twice daily) and amikacin (500 mg intravenously or intramuscularly, twice daily) in 76 patients aged 24 to 84 years (mean, 59.7 years) with complicated urinary tract infections. Initial pathogens included Escherichia coli (47.5%), Pseudomonas aeruginosa (22.5%), Klebsiella spp. (9%), Proteus spp. (7.5%) and Enterobacter spp (6%). In four patients initial urine cultures yielded more than one organism. All pathogens were sensitive to the three study drugs. Including performance of 4- to 6-week follow-up cultures, eradication of the pathogens occurred in 72% of patients treated with aztreonam, in 74% of those treated with ceftazidime and in 71% treated with amikacin (p greater than 0.05). Clinical success was observed in 84% of patients treated with aztreonam, in 82% of those treated with ceftazidime and in 85% treated with amikacin (p greater than 0.05). All drugs were well tolerated. It is concluded that aztreonam, ceftazidime and amikacin are equally effective and safe for the treatment of complicated urinary tract infections due to susceptible organisms.     

多发性骨髓瘤患者医院感染相关因素分析

目的：探讨多发性骨髓瘤患者医院感染的临床特点及危险因素.方法：对2009年10月-2013年2月收治的328例多发性骨髓瘤患者医院感染的临床资料进行回顾性分析.结果：328例患者中152例发生医院感染,感染率为46.3%,粒细胞缺乏组的医院感染率为91.3%,显著高于非粒细胞缺乏组（P＜0.01）.感染部位以下呼吸道、口腔、胃肠道和泌尿道等为主.致病菌以革兰氏阴性杆菌、革兰氏阳性球菌和真菌为主.MP方案化疗患者的感染率（23.9%）与VAD和BD组（68.5%和65.3%）相比有显著性差异（P＜0.01）.结论：多发性骨髓瘤患者医院感染的发生与粒细胞缺乏、化疗方案及住院时间等因素有关,应用全环境保护及粒细胞集落刺激因子可减少医院感染的发生.     

Clinical Impact of Newer Quinolones: Influence on Normal Microflora

Summary

This review article summarizes the published data concerning the impact of ciprofloxacin and norfloxacin on the oropharyngeal and intestinal human microflora. The use of ciprofloxacin and norfloxacin for selective decontamination in compromised patients and for prophylaxis of recurrent urinary tract infections is also reviewed.     

Prevalence and clinical management of complicated urinary tract infections in Italy: a prospective multicenter epidemiological study in urological outpatients

The objectives of the study were to evaluate the prevalence of complicated urinary tract infections among Italian patients attending the urologist's office, to describe the frequency of different complication factors, the encountered bacterial pathogens and the clinical attitude of urologists in management of complicated urinary tract infections (CUTIs). The study was a prospective, multicenter study which was undertaken by office urologists throughout Italy. During the May-June 2002 timeframe, the prevalence of each urologist's diagnosis of CUTIs was noted for a 4-week slot. The prevalence of CUTIs in over 13,000 patients observed was 10.8% (n = 1201), with a trend (not statistically significant) of higher figures in the South/Islands (12.2%) with respect to Center (11.4%) or North (8.7%) of Italy. We have confirmed the significant relevance of CUTI among the Italian patients attending the urologist office and the clinical data collected may contribute to improve the diagnosis and empiric therapy of complicated urinary tract infections.     

A Comparative Study on Aztreonam,Ceftazidime and Amikacin in the Treatment of Complicated Urinary Tract Infections

Summary

In a prospective, randomized trial, aztreonam (1 g intravenously or intramuscularly, twice daily) was compared with ceftazidime (1 g intravenously or intramuscularly, twice daily) and amikacin (500 mg intravenously or intramuscularly, twice daily) in 76 patients aged 24 to 84 years (mean, 59.7 years) with complicated urinary tract infections. Initial pathogens included Escherichia coli (47.5%), Pseudomonas aeruginosa (22.5%), Klebsiella spp. (9%), Proteus spp. (7.5%) and Enterobacter spp (6%). In four patients initial urine cultures yielded more than one organism. All pathogens were sensitive to the three study drugs. Including performance of 4- to 6-week follow-up cultures, eradication of the pathogens occurred in 72% of patients treated with aztreonam, in 74% of those treated with ceftazidime and in 71% treated with amikacin (p>0.05). Clinical success was observed in 84% of patients treated with aztreonam, in 82% of those treated with ceftazidime and in 85% treated with amikacin (p>0.05). All drugs were well tolerated. It is concluded that aztreonam, ceftazidime and amikacin are equally effective and safe for the treatment of complicated urinary tract infections due to susceptible organisms.     

Incidence of nosocomial infections in an cancer center: clinical and bacteriologic data

Over a 5 month period, a study of the incidence of nosocomial infections (NI) was carried out in the Léon Bérard Oncology Center (Lyons). It comprised 1,551 patients classified in groups according to the site of origin of the underlying malignancy. The respective frequency of the different types of nosocomial infections and the responsible agents was evaluated in each group and the incidence was calculated per day of hospitalization. The overall incidence of NI was 11.29 per 1,000 patient-days, with a maximal value of 20.04 for patients suffering from lymphomas. The most frequently encountered infections were bacteremias (22.7%), followed by urinary tract infections (20.8%) and wound infections (20.5%). The most frequent causative agents of NI were Escherichia coli (25.8%), Pseudomonas aeruginosa (13.9%), Staphylococcus aureus (9.8%) and Staphylococcus epidermidis (9.8%). The latter micro-organism together with Escherichia coli were the most frequent causative agents of bacteremias. Even though cancer patients are particularly prone to developing infections, the incidence of NI could be reduced thanks to a program of control and surveillance of infectious episodes during hospitalization.     

Candida infections in paediatrics: Results from a prospective single‐centre study in a tertiary care children's hospital

To describe the epidemiology of invasive Candida infection in a tertiary care paediatric hospital. Prospective single‐centre survey on all Candida strains isolated from normally sterile fluids and urines in the period 2005‐2015 . A total of 299 ICI were documented in 262 patients. Urinary tract infection represented the most frequent diagnosis (62%), followed by fungaemia (34%) and peritonitis (4%). Fungaemia was most frequent in children with cancer (59%) or in low birth weight neonates (61%), while urinary tract infections were more frequent in patients with urinary tract malformation. C.albicans was the most frequently isolated species (60%) compared with C. non‐albicans, but differences were present according to the site of isolation and underlying conditions. Overall 90‐day mortality was 7%, 13% in fungaemias, 8% in peritonitis and 2% in urinary tract infections. The rates of invasive Candida infection increased during the study period. Invasive Candida infection is diagnosed with increasing frequency in children. Site of isolation and aetiology are frequently related with the presence of underlying, favouring conditions. Mortality was not negligible, especially in the presence of more invasive infections and specific underlying conditions.     

Evaluation of aztreonam in the treatment of serious gram-negative infections in a university hospital in Saudi Arabia.

The efficacy and safety of aztreonam were evaluated in an open trial at King Khalid University Hospital, Riyadh, Saudi Arabia. A total of 45 critically-ill adult patients were enrolled in the study. All patients with documented Gram-negative infection were treated with aztreonam as monotherapy. Antibiotics active against only Gram-positive and/or anaerobic organisms were allowed. Twenty cases were clinically evaluable. Eleven had lower respiratory tract infections (pneumonia), 3 had urinary tract infections, and 6 had septicemia. Clinical signs and symptoms, cultures and other laboratory profiles were assessed prior to treatment, at 4-6 days during treatment and within 2-3 days of the end of therapy (usually 7-15 days). Nineteen out of 20 (95%) had a satisfactory clinical response. All cases with septicemia and urinary tract infections were microbiologically cured. The overall microbiological response rate was 90%. Fifty-five percent of all infections were caused by Pseudomonas aeruginosa. Two patients with Gram-negative pneumonia due to P. aeruginosa did not respond microbiologically to aztreonam therapy. No serious adverse events requiring discontinuation of aztreonam therapy were reported. No mortality occurred.     

Incidence of urinary tract infections in patients requiring long-term catheterization after abdominoperineal resection for rectal carcinoma: does Betadine in the Foley drainage bag make a difference?

Twenty-three patients who underwent abdominoperineal resection for rectal adenocarcinoma were entered into a prospective study to determine the efficacy of periodic instillation of Betadine into the urinary drainage system as a prophylactic measure for catheter-associated urinary tract infections. We decided to use a control group of 33 consecutive patients done in the period just preceding the starting of this prospective study. In both groups the mean duration of the Foley catheter drainage was similar. Eight of eight female patients in the treatment group and six of seven patients in the control group developed a urinary tract infection. However, only five of 15 male patients (33%) in the treatment group whereas 16 of 26 males in the control group (61%) developed a urinary tract infection. Thus, the addition of Betadine in the drainage system of urinary indwelling catheters was associated with a 50% decrease in the incidence of urinary tract infections in males.     

Resistance of causative agents of uncomplicated urinary tract infections in Russia

A prospective epidemiological study of the spectrum of causative agents (CA) of uncomplicated urinary tract infections (UTI) in adult patients and CA resistance to antimicrobial drugs was conducted in nine cities of the Russian Federation in 2004-2005. Minimum inhibiting concentrations were ascertained by dilution in agar according to NCCLS (2000-2002) recommendations. The study has found that uncomplicated UTI are most frequently caused by E.coli (73.9%). Other CA occur much less frequently: K.pneumoniae--6.4%, E. faecalis--4.4%, S. epidermidis--4.1%, Staphylococcus spp--3.4%, others--2% patients. E. coli demonstrated high resistance to ampicilline (33.1%), co-trimoxasol (19.4%). Most active against E. coli were fluoroquinolones (norfloxacin, ciprofloxacin, levofloxacine), the resistance being 4.8%; cefalosporins of the second and third generation (cefuroxim, ceftibuten), nitrofurantoin, no resistant strains were found.     

Complicated urinary tract infections treated with extended-release ciprofloxacin with emphasis on Pseudomonas aeruginosa

This report focuses on the role of Pseudomonas aeruginosa in complicated urinary tract infections in a prospective, open-label, multicenter study designed to evaluate the safety and efficacy of extended-release ciprofloxacin (ciprofloxacin XR) 1000 mg once daily for 7-14 days for the treatment of complicated urinary tract infections. A total of 204 patients were valid for intention-to-treat analysis, of whom 130 were included in the clinical efficacy population. In the 56 microbiologically valid patients the bacteriological eradication rate was 82.1% and the clinical cure rate was 94.6%. Patients with P. aeruginosa infections valid for microbiological efficacy (n = 7) had 100% bacteriological eradication and clinical cure rates. In the intention-to-treat population, the bacteriological and clinical cure rates were 42.1% (51/121) and 55.9% (114/204), respectively. These rates were 58.3% and 75.0% respectively, for patients with P. aeruginosa infections. To achieve the desired 10 patients with P. aeruginosa for analysis, these data were pooled with data from a previous study. Treatment failure correlated with pre-therapy P. aeruginosa isolates being resistant to ciprofloxacin. On exploratory multivariate regression analysis, presence of neurogenic bladder, urinary retention owing to benign prostatic hypertrophy, prior urinary tract infection, and ischemic heart disease predicted P. aeruginosa infection.     

Clinical comparative study of azithromycin versus erythromycin in the treatment of acute respiratory tract infections in children.

The efficacy and tolerability of azithromycin and erythromycin in the treatment of acute respiratory tract infections in children were compared in an open, multicenter, randomized trial. A total of 151 children, aged from 2 months to 14 years, suffering from upper airways infections (60), or lower respiratory tract infections (91), were randomized to be treated either with azithromycin, 10 mg/Kg/day per os once daily for 3 or 10 mg/Kg/day 1 and 5 mg/Kg/days 2-5 (77 patients) or with erythromycin, 50 mg/Kg/day thrice daily for at least 7 days (74 patients). The two treatment groups did not significantly differ as to sex, age, weight, type and severity of infection, and infecting pathogens. Clinical evaluation was performed prior to therapy, on treatment days 1, 3, 5 and 7, and on day 10. Microbiological and laboratory assessment were carried out at baseline and after the end of therapeutic course. Chest X-ray and serologic assays for Mycoplasma pneumoniae infection were obtained in patients suspected to have lower respiratory tract infections. At the end of therapy, clinical cure was achieved in 73 out of 77 patients (94.8%) in the azithromycin group, and in 60/72 evaluable subjects (83.3%) in the erythromycin group. A significantly more rapid remission of several illness-related signs and symptoms was observed in patients treated with azithromycin. A total of 75 bacterial pathogens were isolated at baseline microbiological examination; at the end of the therapeutic course bacteriological eradication was obtained in 34/34 cases (100%) treated with azithromycin, and in 40/41 children (97.5%) treated with erythromycin.(ABSTRACT TRUNCATED AT 250 WORDS)     

恶性肿瘤化疗患者医院真菌感染的临床分析

目的：了解恶性肿瘤化疗患者医院真菌感染的临床特点。方法：对我院2006年10月-2008年10月68例发生医院真菌感染的恶性肿瘤化疗患者资料资料进行回顾性分析。结果：恶性肿瘤化疗患者医院真菌感染率为3．1％,真菌感染发生部位依次为呼吸道（60．3％）、消化道（22％）、泌尿道（10．3％）等,病原体主要为白色假丝酵母菌（63．2％）、热带假丝酵母菌（14．7％）、光滑假丝酵母菌（7．3％）、克柔假丝酵母菌（5．8％）。结论：恶性肿瘤化疗后患者真菌感染以呼吸道部位最多、白色假丝酵母菌为主要病原体。     

头孢地秦对肺癌患者细胞免疫系统的影响

目的 探讨头孢地秦对肺癌患者细胞免疫的增强作用。方法 选择肺癌并发呼吸系统感染患者４５例,同期选择呼吸系统感染患者１０例。检测各组外周血和肺泡局部细胞免疫指标。结果 （１）用头孢地秦的肺癌患者外周血中性粒细胞的硝基四唑氮蓝（ＮＢＴ）阳性率、ＮＫ细胞计数、ＣＤ４＾＋细胞计数、ＣＤ４＾＋／ＣＤ８＾＋比值、肺泡巨噬细胞（ＡＭ）吞噬中性红的吸光度（Ａ,旧称光密度ＯＤ）以及支气管肺泡灌洗液中ＩＬ－１β浓度均     

A randomised double-blind placebo-controlled trial to determine the effect of cranberry juice on decreasing the incidence of urinary symptoms and urinary tract infections in patients undergoing radiotherapy for cancer of the bladder or cervix

AimsRadical pelvic radiotherapy is one of the main treatment modalities for cancers of the bladder and cervix. The side-effects of pelvic radiotherapy include urinary symptoms, such as urinary frequency and cystitis. The therapeutic effects of cranberry juice in the prevention and treatment of urinary tract infections in general are well documented. The purpose of this study was to evaluate the effectiveness of cranberry juice on the incidence of urinary tract infections and urinary symptoms in patients undergoing pelvic radiotherapy for cancer of the bladder or cervix.Materials and methodsThe study was a placebo-controlled, double-blind design. Participants were randomised to receive cranberry juice, twice a day (morning and night) for the duration of their radiotherapy treatment and for 2 weeks after treatment (6 weeks in total) or a placebo beverage, for the same duration.ResultsThe incidence of increased urinary symptoms or urinary tract infections was 82.5% on cranberry and 89.3% on placebo (P = 0.240, adjusted odds ratio [cranberry/placebo] 0.48, 95% confidence interval 0.14–1.63).ConclusionsThe power of the study to detect differences was limited by the below target sample size and poor compliance. Further research is recommended, taking cognisance of the factors contributing to the limitations of this study.     

Clinical Comparative Study of Azithromycin versus Erythromycin in the Treatment of Acute Respiratory Tract Infections in Children

Summary

The efficacy and tolerability of azithromycin and erythromycin in the treatment of acute respiratory tract infections in children were compared in an open, multicenter, randomized trial. A total of 151 children, aged from 2 months to 14 years, suffering from upper airways infections (60), or lower respiratory tract infections (91), were randomized to be treated either with azithromycin, 10 mg/Kg/day per os once daily for 3 or 10 mg/Kg/day 1 and 5 mg/Kg/days 2-5 (77 patients) or with erythromycin, 50 mg/Kg/day thrice daily for at least 7 days (74 patients). The two treatment groups did not significantly differ as to sex, age, weight, type and severity of infection, and infecting pathogens.

Clinical evaluation was performed prior to therapy, on treatment days 1, 3, 5 and 7, and on day 10. Microbiological and laboratory assessment were carried out at baseline and after the end of therapeutic course. Chest X-ray and serologic assays for Mycoplasma pneumoniae infection were obtained in patients suspected to have lower respiratory tract infections. At the end of therapy, clinical cure was achieved in 73 out of 77 patients (94.8%) in the azithromycin group, and in 60/72 evaluable subjects (83.3%) in the erythromycin group. A significantly more rapid remission of several illness-related signs and symptoms was observed in patients treated with azithromycin. A total of 75 bacterial pathogens were isolated at baseline microbiological examination; at the end of the therapeutic course bacteriological eradication was obtained in 34/34 cases (100%) treated with azithromycin, and in 40/41 children (97.5%) treated with erythromycin. Both study drugs were well tolerated; transient, mild to moderate side-effects were reported in 6.5% of patients treated with azithromycin, and in 9.5% of subjects who received erythromycin. Only 2 children of the erythromycin group withdrew from the study due to adverse effects (vomiting). Significantly abnormal laboratory test values were observed in only one child treated with azithromycin (transient rise in serum AST-ALT values), and returned to normality at follow-up.

In conclusion, azithromycin once daily for 3-5 days is as safe and effective as erythromycin thrice daily for at least 7 days in the treatment of community-acquired respiratory tract infections in infants and children; no statistically significant difference was found between the two treatment groups as to overall clinical and bacteriological efficacy, and systemic tolerability. The significant advantage of a low-dose therapeutic course of azithromycin is made possible by the enhanced antimicrobial potency and the favorable pharmacokinetic properties of this novel macrolide derivative.     

Complicated Urinary Tract Infections Treated with Extended-Release Ciprofloxacin with Emphasis on Pseudomonas aeruginosa

Abstract

This report focuses on the role of Pseudomonas aeruginosa in complicated urinary tract infections in a prospective, open-label, multicenter study designed to evaluate the safety and efficacy of extended-release ciprofloxacin (ciprofloxacin XR) 1000 mg once daily for 7-14 days for the treatment of complicated urinary tract infections. A total of 204 patients were valid for intention-to-treat analysis, of whom 130 were included in the clinical efficacy population. In the 56 microbiologically valid patients the bacteriological eradication rate was 82.1% and the clinical cure rate was 94.6%. Patients with P. aeruginosa infections valid for microbiological efficacy (n = 7) had 100% bacteriological eradication and clinical cure rates. In the intention-to-treat population, the bacteriological and clinical cure rates were 42.1% (51/121) and 55.9% (114/204), respectively. These rates were 58.3% and 75.0% respectively, for patients with P. aeruginosa infections. To achieve the desired 10 patients with P. aeruginosa for analysis, these data were pooled with data from a previous study. Treatment failure correlated with pre-therapy P. aeruginosa isolates being resistant to ciprofloxacin. On exploratory multivariate regression analysis, presence of neurogenic bladder, urinary retention owing to benign prostatic hypertrophy, prior urinary tract infection, and ischemic heart disease predicted P. aeruginosa infection.     

Point prevalence survey on antibiotic use in a Croatian Infectious Disease Hospital

Abstract

Antibiotic use is the driving force for increasing antibiotic resistance. A large proportion of antibiotics in hospitals are used inadequately. The objective of this study was to evaluate antibiotic use at the Hospital for Infectious Diseases through point-prevalence surveys conducted in 2006, 2008, and 2009. Point prevalence surveys were part of the European Surveillance on Antimicrobial Consumption (ESAC) Hospital Care Subproject and patients’ data were collected following ESAC protocol. Additionally, the adequacy of antimicrobial therapy and administration of the first line antibiotic according to the local guidelines were assessed by an infectious disease doctor and a clinical microbiologist. In the study period among the 599 patients admitted to hospital, 352 (58·8%) received antibiotics. Out of 448 antimicrobial treatments, 313 (69·9%) were administered parenterally and 135 (30·1%) orally. Altogether in years 2006, 2008, and 2009 the most commonly prescribed antibiotics were ceftriaxone (19·9%), co-amoxiclav (15·4%), ciprofloxacin (12·3%), narrow spectrum penicillins (6·5%), and penicillinase resistant penicillins (5·6%). Most (82·6%) of the treated infections were community acquired infections. The predominating diagnoses were urinary tract infections and infections with no primary site defined, followed by skin, soft tissue and bone and joint infections. The overall adequacy of antimicrobial therapy was 82% and the first line antibiotic according to the local guidelines was administered with high frequency for central nervous system and cardiovascular infections (100%), and low for ear, nose, and throat infections, urinary tract infections, lower respiratory tract and bone and joint infections (23·0%, 51·6%, 52·5%, 65·0%, respectively) which indicates a significant overuse of antibiotics for diagnoses listed. The results of an individual point prevalence survey provided reliable and representative data for the hospital. Point-prevalence surveys proved to be a valuable method for detecting targets for antibiotic prescribing improvement and they clearly showed that our local hospital guidelines offered too many choices of antibiotic treatment for each clinical indication and needed revision.