ABSTRACT
Background: Urinary tract infection (UTI) is one of the most common bacterial infections encountered and treated worldwide. The objective was to determine the incidence, culture-sensitivity status, prescription pattern of antibiotics and response to various antibiotics and other therapeutic considerations in patients of complicated UTI (cUTI). Methods: The observational prospective analytical study conducted in Department of Nephrology, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai. Results: A total percentage of patients having UTI was 13.08%. Of these 200 patients, 119 patients were female (60%) and 81 patients were male (41 %). Among male, the prevalence was seen more in geriatric age group and among female in adult group. Symptomatologically, fever was the most common symptom. Among male, diabetes mellitus was most commonly associated with cUTI whereas recurrent UTI were more common among female. Of the 200 patients, culture sensitivity was done in 133 patients. Escherichia coli was found to be the most common organism. Quinolones were the most commonly prescribed first line drug followed by beta-lactamase inhibitors. Combinations such as cefoperazone + linezolid were the most commonly prescribed second-line drug, followed by combination of ceftriaxone or cefoperazone with metronidazole. Paracetamol was the most common non antibiotic support given. Conclusions: The results of this study may not be representative of the general population; but UTIs are often treated empirically, and susceptibility tests are often carried out only when the patient has failed one or more courses of antibiotics.
ABSTRACT
Drug-induced nephrotoxicity is an extremely common condition and is responsible for a variety of pathological effects on the kidneys. Drug-induced acute renal failure (ARF) accounted for 20% of all ARF cases. Drugs showed to cause nephrotoxicity exert their toxic effects by one or more common pathogenic mechanisms. Although it is impossible to present all the drugs causing the nephrotoxicity, this article will summarize the mechanism of injury associated with particular common medications, discuss clinical presentations, renal markers, and evaluate strategies that prevent or minimize renal injury. Drug-induced nephrotoxicity tends to be more common among certain patients and in specific clinical situations. Therefore, successful prevention requires knowledge of pathogenic mechanisms of renal injury, patient-related risk factors, drug-related risk factors, and preemptive measures, coupled with vigilance and early intervention. General preventive measures include using alternative nonnephrotoxic drugs whenever possible; correcting risk factors, if possible; assessing baseline renal function before initiation of therapy, followed by adjusting the dosage; monitoring renal function and vital signs during therapy, and avoiding nephrotoxic drug combinations. Surprisingly, little information is available to guide us with respect to avoiding complications in critical illness; therefore, it is necessary to follow the guidelines.