Infecções do trato urinário (ITU) de cães e gatos: etiologia e resistência aos antimicrobianos / Urinary tract infection (UTI) in dogs and cats: etiology and antimicrobial resistance

As infecções bacterianas do trato urinário (ITUs) são causa comum de doença em cães, gatos e humanos. Embora bactérias Gram positivas como Staphylococcus spp., Streptococcus spp. e Enterococcus spp., possam ocasionar ITUs, as bactérias Gram negativas (Escherichia coli, Proteus spp., Klebsiella spp., Pseudomonas spp. e Enterobacter spp.) respondem por 75% dos casos. Este estudo teve como objetivo determinar a frequência de diferentes gêneros de bactérias em ITUs em cães e gatos, bem como a sua sensibilidade aos antimicrobianos utilizados na rotina clínica. Portanto, amostras de urina de 100 cães e gatos com sinais de ITU foram coletadas assepticamente, sofrendo avaliação microbiológica por meio de métodos qualitativos e quantitativos, além de urinálise. Todos os isolados foram submetidos a testes de sensibilidade aos antimicrobianos. ITU foi confirmada em 74% dos animais, não havendo predominância quanto ao sexo. No que diz respeito à idade, 85% dos cães e 87% dos gatos tinham idades superiores a seis anos. Noventa e cinco cepas bacterianas foram isoladas, com maior frequência de Escherichia coli (55% do total) dos sorogrupos O6 e O2. Constatou-se níveis elevados de resistência a antimicrobianos nas cepas isoladas. Para as cepas Gram positivas, tetraciclina (46,1%), enrofloxacina, cotrimazol e estreptomicina (42,3% cada) foram as drogas com os maiores índices de resistência. Para as Gram negativas, amoxacilina e tetraciclina apresentaram percentuais acima de 50%. Multiresistência foi verificada em mais de 50% dos principais gêneros isolados. Considerando-se que as cepas de E. coli apresentam potencial zoonótico e forte participação na disseminação de resistência aos antimicrobianos, ressalta-se a importância do papel do médico veterinário na prevenção e controle das ITUs animais e sua contribuição para a saúde pública.

Bacterial urinary tract infections (UTIs) are a common cause of disease in dogs, cats and humans. Although Gram-positive bacteria such as Staphylococcus spp., Streptococcus spp. and Enterococcus spp. are linked with UTIs, Gram-negative bacteria (Escherichia coli, Proteus spp., Klebsiella spp., Pseudomonas spp. and Enterobacter spp.) account for 75% of the cases. This study aimed to determine the frequency of different genera of bacteria in UTIs of dogs and cats as well as their susceptibility to antimicrobials used in clinical routine. Therefore, urine samples from 100 dogs and cats suspected of UTI were collected aseptically. Samples underwent to microbiological evaluation through qualitative and quantitative methods, and urinalysis. All isolates were tested for antimicrobial susceptibility. UTI was confirmed in 74% of animals, with no predominance in one gender. With regard to age, 85% of dogs and 87% of cats were older than six years. Ninety-five bacterial strains were isolated with higher frequency of Escherichia coli (55% of total) of serogroups O6 and O2. High levels of antimicrobial resistance were found. Gram-positive strains had the highest resistance to tetracycline (46.1%), enrofloxacin, cotrimazol and streptomycin (42.3% each), while above 50% of Gram-negative were resistant to amoxicillin and tetracycline. Multidrug resistance has been observed in more than 50% of the major genera isolated. Considering the zoonotic potential of E. coli strains and its strong participation in antimicrobial resistance dissemination, the important role of the veterinarians in the prevention and control of animal UTIs and their contribution to public health must be emphasized.

Effect of allopurinol in chronic nonbacterial prostatitis: a double blind randomized clinical trial

INTRODUCTION: The exact mechanism of chronic nonbacterial prostatitis has not been yet elucidated and the outcome with the current management is dismal. In this trial, we studied the effect of allopurinol in the treatment of this disease. MATERIALS AND METHODS: In this randomized double blind controlled trial, a calculated sample size of 56 were grouped into "intervention group" who received allopurinol (100 mg tds for 3 months) with ofloxacin (200 mg tds) for 3 weeks (n = 29) and "control group" who received placebo tablets with ofloxacin (n = 27). PatientsÆ scores based on the National Institute of Health Chronic Prostatitis Symptom Score were recorded before therapy and then every month during the study. A four-glass study was performed before intervention and after 3 months. RESULTS: The 2 groups were similar regarding outcome variables. In the first month of study, a significant but similar improvement in symptom scores was observed in both groups. Microscopic examination of prostate massage and post-massage samples were also similar in both groups. No side effects due to allopurinol were observed in patients. CONCLUSION: We did not find any advantage for allopurinol in the management of chronic prostatitis versus placebo in patients receiving routine antibacterial treatment.

The Effects of Methylene Blue on Hemodynamic Parameters and Cytokine Levels in Refractory Septic Shock

BACKGROUND: Endogenous nitric oxide (NO) induces the peripheral vasodilation via the activation of guanylate cyclase in patients with septic shock. The purpose of this study was to assess the acute effects of methylene blue (MB), which is an inhibitor of guanylate cyclase, on the hemodynamics and on the production of pro-inflammatory cytokines and nitric oxide (NO) in patients with refractory septic shock. METHODS: Twenty consecutive patients with refractory septic shock, which was defined as shock refractory to a dopamine infusion of more than 20 microgram/kg/min with the appropriate use of antibiotics and adequate volume replacement, received MB infusion of 1 mg/kg intravenously. The hemodynamic and respiratory variables were measured at baseline, 30, 60 and 120 min after an infusion of MB (1 mg/kg). The blood levels of NO, IL-1, IL-10 and TNF-alpha were measured at baseline, 30 and 120 min after MB infusion. RESULTS: The administration of MB induced an increase in the systemic vascular resistance (SVR) that resulted in an increase of the mean arterial pressure (MAP) in patients with refractory septic shock, and this was without a decrease in cardiac output. The administered MB induced an increase in pulmonary vascular resistance (PVR) that resulted in an increase of pulmonary arterial pressure (PAP), without any deterioration of gas exchange. However, the increases in SVR and PVR were not associated with the alteration of endogenous production of NO, IL-1, IL-10 and TNF-alpha. CONCLUSION: MB transiently elevated the MAP by increasing the SVR without altering the endogenous productions of NO, IL-1, IL-10 and TNF-alpha during the study period in patients with refractory septic shock.

Intramuscular antibiotic treatment of urinary tract infection.

OBJECTIVE: This study had been carried out to investigate the effects of intramuscular daily single dose antibiotic treatment during five days in the outpatient clinics in children having lower UTI and to observe the effects to the disease course in infants and toddlers. METHODOLOGY: 36 children (12 boys) at the ages of between 5-68 months were enrolled into the study. Regarding the antibiogram suitability, single dose ceftriaxon or amikacin is prescribed to the patients for five days. RESULT: In the urine cultures E. coli was most commonly isolated. There was correlation between leukocytosis and insufficient weight gain (p< 0.05). A correlation was also noted between recurrence of the disease and urinary tract abnormalities detected on the ultrasonography (p< 0.05). Re-infections were detected in 1 of the infants and in 2 of the older children. There was no correlation between the recurrence and the therapy given. CONCLUSION: We consider that five-day intramuscular antibiotic therapy could be effective in the treatment of lower UTI and it can be recommended as a safe treatment modality in patients representing unwillingness to come to follow-up visits.

Eficacia y seguridad de la cefodizima en el tratamiento de pacientes con infección complicada de las vías urinarias o pielonefritis aguda no complicada / Efficiency and safeness of cefodizime in the treatment of patients with complicated urinary tract infection or acute uncomplicated pielonephritis

Se presentan los resultados de un estudio clínico abierto binacional, no controlado, llevado a cabo en 85 pacientes hospitalizados con infección complicada del tracto genitourinario o pielonefritis aguda no complicada, tratados con 1 g de cefodizima una vez al día, administrada parenteralmente por inyección intramuscular o intravenosa o perfusión, durante siete a 10 días (mínimo cinco días y máximo 14). El objetivo principal fue evaluar la eficacia y seguridad del tratamiento. La tasa de curación clínica fue alcanzada en el 92.7 por ciento de los pacientes tratados con cefodizima, observando una marcada remisión de los signos y síntomas clínicos al final del tratamiento. La erradicación bacteriológica fue observada en 95.9 por ciento de los enfermos. El microorganismo aislado con mayor frecuencia fue Eschirichia coli (80.2 por ciento). La cefodizima fue bien tolerada, con escasos y leves eventos adversos. Se concluye que 1 g de cefodizima administrada parenteralmente una vez al día en pacientes hospitalizados con infección complicada de vías urinaria con pielonefritis aguda no complicada es un tratamiento eficaz y seguro

Enfermedad inflamatoria pélvica / Pelvic inflammatory disease

La enfermedad inflamatoria pélvica es una de las infecciones más frecuentes y serias de la mujer en edad reproductiva, la cual está asociada a microorganismos adquiridos por transmisión sexual. Su patogénesis está relacionada con la propagación por vía ascendente de microorganismos provenientes de la vagina y cérvix. Existen múltiples factores de riesgo tales como la edad, la promiscuidad y dispositivos intrauterinos. Es una infección polimicrobiana sin síntomas específicos. El tratamiento tiene por objeto además de administrar antibióticos con el fin de eliminar el cuadro inflamatorio agudo, el prevenir las secuelas a largo plazo

Infecçäo do trato urinário na gravidez: aspectos terapêuticos / Urinary tract infection in pregnancy: therapeutic aspects

A infecçäo do trato urinário é a infecçäo mais freqüente na gestaçäo. Acomete, aproximadamente, 10 por cento das mulheres durante a gravidez. Ressaltam-se os fatores predisponentes, como as modificaçöes anatômicas e funcionais decorrentes da gestaçäo; é de suma importância a urocultura de rotina no pré-natal. O tratamento deve ser imediato quando se faz o diagnóstico clínico ou laboratorial. A farmacocinética das drogas deve ser conhecida pelo clínico, bem como seus efeitos sobre o binômio materno-fetal. Os dados säo conflitantes em relaçäo ao melhor esquema terapêutico, quer seja dose única, de curta duraçäo (três dias) ou longa duraçäo (sete a 14 dias). Todavia, o uso de dose única é restrito às infecçöes utinárias näo-complicadas. A pielonefrite exige terapêutica parenteral, seguida por esquema oral de longa duraçäo e, por vezes, por antibioticoprofilaxia até o puerpério imediato. Independente do esquema, o seguimento destas pacientes, com urocultura até o puerpério, é imprescindível para a profilaxia das recidivas ou recorrências.