Management of recurrent urinary tract infections in adults

Many women will experience one or more urinary tract infection (UTI) during their life. The most unfortunate will have many. Men presenting with infections, and women with recurrent episodes, require further investigation. A diagnosis of a UTI is often based on a typical spectrum of symptoms, with confirmatory urine cultures lagging a few days behind. Unfortunately, symptoms of a UTI may not be typical, and other conditions can manifest similarly. Treatment of UTI with antibiotics is usually required, but there is increasing awareness of the need for antimicrobial stewardship to avoid the misuse and overuse of antibiotics, even as patients are increasingly reluctant to take them. Recurrent UTI can cause significant morbidity and disruption to daily activities yet investigations rarely demonstrate a reversible cause. There are a host of different antibiotic and non-antibiotic interventions that aim to lower the risk of further infections. However, these are not reliably effective, bring side effects of their own and are often proposed to this desperate population of patients on the back of weak evidence of efficacy.     

泌尿系感染者病原菌及耐药性分析

目的：了解近年来泌尿系细菌感染致病菌及耐药性，为合理应用抗生素，提供临床根据。方法：对泌尿系感染患者298株病原菌进行药物敏感试验。结果：大肠埃希菌仍是引发泌尿系感染的主要病原菌，占53％，其次是葡萄球菌属，占19．40％，肠杆菌属占10．06％，肠球菌属占4．70％等，各类菌属耐药情况。结论：临床医师必须关注本地病原菌分布及耐药情况，合理应用抗生素，减少耐药性播散。     

Potential preventive strategies and therapies in urinary tract infection

There are perhaps five strategies either presently advocated or under investigation for prevention of recurrent urinary tract infection (UTI): antibiotics, including natural peptides; functional foods; vaccines; probiotics; and miscellaneous, including avoidance of spermicides and maintenance of good hygiene. It is not possible to state the proportion of patients using antibiotics versus foods such as cranberry or using alternative approaches such as avoidance of spermicides. The majority of women who are referred to specialists will be prescribed long-term, low-dose antibiotics. However, given the magnitude of the problem, it is safe to state that large numbers of women are at least experimenting with alternative remedies such as drinking of cranberry juice or ingestion of herbal remedies with a view to enhancing their immune response. Vaccine development remains a long way from human use and has yet to be developed for organisms other than Escherichia coli. The use of probiotics to restore the normal vaginal flora and provide a competitive bacterial barrier to pathogens is close to becoming available as an alternative preventive approach. The next decade should see the introduction of new methods for reduction of the high incidence of UTI and better management of recurring urogenital infections.     

尿胰蛋白酶抑制剂Ulinastatin 对lewis 肺癌小鼠肿瘤生长和转移的抑制作用

 目的　探讨尿胰蛋白酶抑制剂(U TI) 在动物模型上抗肿瘤作用。方法　选用尿胰蛋白酶抑制剂乌司他丁(Ulinastatin) , Lewis 肺癌小鼠模型;雄性C57BL/ 6 小鼠40 只,接种lewis 肿瘤细胞,分成生理盐水组(对照组) 、环磷酰胺组(CTX) 、Ulinastatin 2. 5万单位组、Ulinastatin 5 万单位组、Ulinastatin 10万单位组,各8 只,接种后第6 天,开始腹腔给药,记录皮下瘤长短径变化,做生长曲线;接种14 天后处死所有小鼠,统计皮下平均瘤重和肺转移灶个数, 使用流式细胞计分析凋亡率(AR) 增值百分比(SPF) 。结果　皮下瘤重依次为(7. 92 ±2. 52 、0. 66 ±0. 50^＊＊ 、3. 47 ±1. 45^＊ 、3. 08 ±0. 81^＊＊、1. 70 ±1. 05^＊＊) g ,平均肺转移灶依次为( 8. 625 ±1. 407 、1. 125 ±1. 126^＊＊、1. 625 ±1. 302^＊＊ 、1. 00 ±0. 75^＊＊ 、0. 625 ±0. 74^＊＊) 。CTX 组(39. 3 ±4. 8) %^＊ 和Ulinastatin 10 万单位组(40. 2 ±3. 1) %^＊的AR 值明显增加,Ulinastatin 未见SPF 值明显减少。结论　Ulinastatin 对lewis 肺癌小鼠的转移瘤生长和自发性肺转移有抑制作用。     

Helicobacter pylori: Optimum Diagnosis and Test of Cure

Abstract

The fact that about 50% of the world's population is infected with Helicobacter (H.) pylori and the important role that this bacterium plays in public health have been important incentives in the search for accurate diagnostic methods. A large number of invasive and non-invasive methods have been used to diagnose H. pylori infection. Each method has its advantages and disadvantages and each practitioner should choose the best diagnostic method according to the facilities available. Non-invasive tests for the diagnosis of H. pylori infection are largely used in clinical practice and in management of patients with gastroduodenal disease. Serology is the most widespread test but its use is not advised in the post-treatment follow-up. The Urea Breath Test is a simple, safe and highly accurate method ideal for evaluating the short-term follow-up of H. pylori eradication after therapy.     

Prophylactic antibiotics for children with recurrent urinary tract infections

Prophylactic antibiotics for urinary tract infections are no longer routinely recommended. A large number of children must be given prophylaxis to prevent one infection and antibiotic resistance is a major concern when treating community-acquired urinary tract infections. The results of three recent significant studies are examined, with focus on the efficacy of prophylaxis, and recommendations are made.     

Innovations in indwelling urethral catheterisation

The indwelling urethral catheter remains an integral part of contemporary medical care, despite its significant design shortcomings. Urethral catheterisation is responsible for well-recognised complications including catheter-associated urinary tract infection (CAUTI), catheter-associated urethral injury (CAUI), catheter blockage, and bladder mucosal irritation. In this narrative review, we provide an update on current innovations in urethral catheter design, aimed at safeguarding against these complications. There is an obvious need to improve catheter technology and urologists should support the translation of innovations into clinical practice.