Consenso Argentino intersociedades de Infección Urinaria 2018-2019 - Parte I / Consenso Argentino Intersociedades de Infección Urinaria 2018-2019 - Parte I

La Sociedad Argentina de Infectología y otras sociedades científicas han actualizado estas recomendaciones utilizando, además de información internacional, la de un estudio multicéntrico prospectivo sobre infecciones del tracto urinario del adulto realizado en Argentina durante 2016-2017. La bacteriuria asintomática debe ser tratada solo en embarazadas, a quienes también se las debe investigar sistemáticamente; los antibióticos de elección son nitrofurantoína, amoxicilina, amoxicilina-clavulánico, cefalexina y trimetoprima-sulfametoxazol. Ante procedimientos que impliquen lesión con sangrado del tracto urinario se recomienda solicitar urocultivo para pesquisar bacteriuria asintomática, y, si resultara positivo, administrar antimicrobianos según sensibilidad desde inmediatamente antes hasta 24 horas luego de la intervención. En mujeres, la cistitis puede ser tratada con nitrofurantoina, cefalexina, o fosfomicina y no se recomienda usar trimetoprima-sulfametoxazol o fluoroquinolonas; en pielonefritis puede emplearse ciprofloxacina, cefixima o cefalexina si el tratamiento es ambulatorio o ceftriaxona, cefazolina o amikacina si es hospitalario. En los hombres, las infecciones del tracto urinario se consideran siempre complicadas. Se recomienda tratamiento con nitrofurantoina o cefalexina por 7 días, o bien monodosis con fosfomicina. Para la pielonefritis en hombres se sugiere ciprofloxacina, ceftriaxona o cefixima si el tratamiento es ambulatorio y ceftriaxona o amikacina si es hospitalario. Se sugiere tratar las prostatitis bacterianas agudas con ceftriaxona o gentamicina. En cuanto a las prostatitis bacterianas crónicas, si bien su tratamiento de elección hasta hace poco fueron las fluoroquinolonas, la creciente resistencia y ciertas dudas sobre la seguridad de estas drogas obligan a considerar el uso de alternativas como fosfomicina.

The Argentine Society of Infectious Diseases and other scientific societies have updated these recommendations based on data on urinary tract infections in adults obtained from a prospective multicenter study conducted in Argentina during 2016-2017. Asymptomatic bacteriuria should be treated only in pregnant women, who should also be systematically investigated; the antibiotics of choice are nitrofurantoin, amoxicillin, clavulanic/amoxicillin, cephalexin and trimethoprim-sulfamethoxazole. In procedures involving injury to the urinary tract with bleeding, it is recommended to request urine culture and, in the presence of bacteriuria, antimicrobial treatment according to sensitivity should be prescribed from immediately before up to 24 hours after the intervention. In women, cystitis can be treated with nitrofurantoin, cephalexin or fosfomycin, while trimethoprim-sulfamethoxazole and fluoroquinolones are not recommended; pyelonephritis can be treated with ciprofloxacin, cefixime or cephalexin in ambulatory women or ceftriaxone, cefazolin or amikacin in those who are hospitalized. In men, urinary tract infections are always considered complicated; nitrofurantoin or cephalexin are recommended for 7 days, alternatively fosfomycin should be given in a single dose. In men, ciprofloxacin, ceftriaxone or cefixime are suggested for pyelonephritis on ambulatory treatment whereas ceftriaxone or amikacin are recommended for hospitalized patients. Acute bacterial prostatitis can be treated with ceftriaxone or gentamicin. Fluoroquinolones were the choice treatment for chronic bacterial prostatitis until recently; they are no longer recommended due to the increasing resistance and recent concerns regarding the safety of these drugs; alternative antibiotics such as fosfomycin are to be considered.

The use of mobile educational tools to improve antimicrobial prescription for the treatment of acute pyelonephritis in pregnancy: A retrospective cross-sectional study / O uso de ferramentas educacionais móveis para o aperfeiçoamento da prescrição médica do tratamento de pielonefrite aguda na gestação: estudo transversal retrospectivo

Abstract Objective To analyze the prescription of antimicrobial agents for pregnant women admitted into the obstetrics service who presented with acute pyelonephritis. Methods Three cross-sectional studies were performed comparing the prescription of antimicrobials for pyelonephritis in pregnant women in the time periods evaluated (2010-2011: 99 patients evaluated; 2013: 116 patients evaluated; 2015: 107 patients evaluated), at the Hospital Fêmina, Porto Alegre, in the state of Rio Grande do Sul, Brazil. The analysis was performed before and after the promotion of an institutional protocol for the treatment of pyelonephritis during pregnancy, and on a third occasion after the introduction of a smartphone-based mobile educational tool. Results The evaluation of the prescribing physicians and the adequacy of the prescriptions between the different periods studied revealed a significant increase in appropriate conduct for the choice of antimicrobial (2010: 83.8%; 2013: 95.7%; and 2015: 100%), route of administration (2010: 97%; 2013: 100%; and 2015: 100%), and interval (2010: 91.9%; 2013: 95.7%; and 2015: 100%), following the introduction of the protocol, and again after the implementation of the softwareapplicationwithorientationsontheantimicrobial treatment. Conclusion The use of specific mobile applications should be encouraged to attain a better quality and accuracy in prescriptions and to include strategies that not only reduce the risk of negative outcomes, but also improve the quality of care and treatment for maintaining the health both of the mother and of the baby.

Resumo Objetivo Analisar a prescrição de antimicrobianos para gestantes admitidas no serviço de obstetrícia que apresentaram pielonefrite aguda. Métodos Foram realizados três estudos transversais comparando a prescrição de antimicrobianos para pielonefrite em gestantes nos períodos avaliados (2010-2011: 99 indivíduos avaliados; 2013: 116 indivíduos avaliados; 2015: 107 indivíduos avaliados), no Hospital Fêmina, Porto Alegre, RS, Brasil. A análise foi realizada antes e após a promoção de um protocolo institucional para o tratamento da pielonefrite durante a gravidez e, em uma terceira ocasião, após a introdução de uma ferramenta educacional móvel para uso por smartphone. Resultados A avaliação das prescrições médicas e a adequação das prescrições entre os diferentes períodos estudados revelaram um aumento significativo na conduta adequada para a escolha do antimicrobiano (2010: 83,8%; 2013: 95,7%; e 2015: 100%), via de administração (2010: 97%; 2013: 100%; e 2015: 100%) e intervalo (2010: 91,9%; 2013: 95,7%; e 2015: 100%), após a introdução do protocolo, e novamente após a implementação do aplicativo com orientações sobre tratamento antimicrobiano. Conclusão O uso de aplicativos móveis específicos deve ser incentivado para obter melhor qualidade e precisão nas prescrições e incluir estratégias que não apenas reduzam o risco de resultados negativos, mas que também melhorem a qualidade dos cuidados e do tratamento para manter a saúde conjunta da mãe e do bebê.

Infecção urinária multirresistente na gravidez / Multiresistant urinary infection in pregnancy

Os micro-organismos que apresentam mecanismos de resistência aos antimicrobianos, como produção de ß-lactamase de espectro estendido (ESBL), resultam em uma maior dificuldade no tratamento e exigem a utilização de antibióticos de largo espectro com frequência crescente. Assim, este estudo busca revisar a literatura sobre as infecções causadas por micro-organismos multirresistentes na gravidez. Foi realizada uma busca de artigos no PubMed, MedLine e Lilacs usando-se unitermos, incluindo-se os estudos publicados de 2000 a 2016, de línguas portuguesa e inglesa, envolvendo apenas seres humanos. Foram selecionados 59 artigos com força de evidência A e B. Os critérios para inclusão no estudo são: estarem grávidas e terem diagnóstico de infecção do trato urinário. Serão critérios de exclusão: uso de antimicrobiano a menos de duas semanas antes da coleta da amostra e portadoras de doença imunossupressora. A verdadeira prevalência de ITU em gestantes por bactérias multirresistentes é desconhecida. As ITUs por bactérias produtoras de ESBL variam entre 1% e 40%. O tratamento mais aceito para os casos mais graves (pielonefrite ou bacteremia) é com carbapenêmicos. A nitrofurantoína e a fosfomicina têm sido utilizadas para tratar a cistite com patógenos produtores de ESBL com sucesso.(AU)

Microorganisms that have resistance mechanisms to antimicrobial agents, such as production of ß-lactamase extended spectrum (ESBL), result in greater difficulty in treatment and require the use of broad spectrum antibiotics with increasing frequency. This study aims to review the literature on infections caused by multiresistant microorganisms in pregnancy. A search for articles was conducted in PubMed, MedLine and Lilacs are using key words, including published studies from 2000 to 2016, Portuguese and English, involving only human. 59 articles were selected on strength of evidence A and B. The criteria for inclusion was pregnant and having diagnosed of urinary tract infection. The criteria for exclusion was: use of antimicrobial less than two weeks before sample collection and suffering from immunosuppressive disease. The true prevalence of UTI in pregnant women by multiresistant bacteria is unknown. UTIs for ESBL-producing bacteria, ranging from 1% to 40%. The treatment more acceptable for the most serious cases (pyelonephritis or bacteremia) is with carbapenems. Nitrofurantoin and fosfomycin has been used to treat successfully with cystitis ESBL producers pathogens.(AU)

Caso Clínico: Pielonefritis Enfisematosa / Case Report: Emphysematous Pyelonephritis

INTRODUCCIÓN: La pielonefritis enfisematosa (PEN) es una infección aguda grave y en ocasiones fulminante, se manifiesta con necrosis y presencia de gas en el parénquima renal y tejido perirrenal. CASO CLÍNICO: Se trata de una paciente de sexo femenino de 60 años con antecedentes de diabetes mellitus tipo 2 e hipertensión arterial; ingresa por cuadro de dolor lumbar, malestar general, astenia y nausea que llevó al vómito. Al examen físico se evidenció puño percusión izquierda positiva e hiperglicemia. Se realizaron estudios complementarios que establecieron el diagnóstico de pielonefritis enfisematosa. EVOLUCIÓN: Se inició tratamiento antibiótico de amplio espectro para Escherichia coli, posteriormente fue necesario someter a la paciente a nefrectomía total por la imposibilidad de drenaje percutáneo de lesiones intra y perirrenales. La evolución fue favorable después de una nueva intervención y rotación del esquema antibiótico. CONCLUSIÓN: Se establece la necesidad de la sospecha clínica para determinar de forma precoz el diagnóstico, mismo que puede evitar la necesidad de terapias radicales como la nefrectomía.(au)

BACKGROUND: Emphysematous pyelonephritis is a severe acute infection and fulminant sometimes. Its manifestations include necrosis and presence of gas in the kidney parenchyma and around it. CASE REPORT: This is about a 60-years old female patient with precedent diagnosis of type 2 diabetes mellitus and arterial hypertension; she was admitted because of back pain, general malaise, asthenia, nausea and vomit. Physical examination revealed positive fist percussion at right back and hyperglycemia. Complementary exams were performed and emphysematous pyelonephritis diagnosis was established. EVOLUTION: Broad spectrum antibiotic therapy was used to treat Escherichia coli and a complete nephrectomy was performed lately due to impossibility to perform a percutaneous drainage of kidney injuries. Evolution was successful after another intervention and rotation of antibiotic scheme. CONCLUSION: Need of diagnostic suspicion was established to complete an early diagnosis, which may avoid radical therapies as nephrectomy.(au)

Comparison of Second- and Third-Generation Cephalosporin as Initial Therapy for Women with Community-Onset Uncomplicated Acute Pyelonephritis

PURPOSE: This study examined the clinical effectiveness of parenteral cefuroxime and cefotaxime as empirical antibiotics for treating hospitalized women with uncomplicated acute pyelonephritis (APN). MATERIALS AND METHODS: This study was based on the clinical and microbiologic data of 255 hospitalized women with APN. Of these 255 women, 144 patients received cefuroxime and 111 received cefotaxime. RESULTS: There were no marked differences in the demographic features, clinical characteristics, and treatment duration between the populations of the cefuroxime and cefotaxime groups. The rates of defervescence showed no significant differences in the two groups at 48, 72, 96, and 120 hours. The clinical cure rates observed at the follow-up visit 4 to 14 days after the completion of antimicrobial therapy were not statistically different between the cefuroxime and cefotaxime groups [94.9% (129 of 136) versus 98.0% (100 of 102), respectively; p=0.307], and the microbiological cure rates were also not significantly different [88.3% (91 of 103) versus 95.0% (76 of 80), respectively; p=0.186]. The median hospitalization periods in the cefuroxime and cefotaxime groups were 7 (6-8) and 7 (6-8) days (p=0.157), respectively. Microbiological success rates after 72-96 hours of initial antimicrobial therapy were also not statistically different in the cefuroxime and cefotaxime groups, 89.4% (110 of 123) versus 94.9% (93 of 98; p=0.140). CONCLUSION: Cefuroxime, a second-generation cephalosporin, is an appropriate antibiotic option for the initial treatment of uncomplicated APN and its efficacy does not differ from cefotaxime, a third-generation cephalosporin, in the initial parenteral therapy for community-onset APN.

Resultados de dois esquemas de tratamento da pielonefrite durante a gravidez e correlação com o desfecho da gestação / Results of two treatment regimens for pyelonephritis during pregnancy and correlation with pregnancy outcome

OBJETIVO: Determinar o perfil epidemiológico das gestantes internadas por infecção do trato urinário, bem como verificar os agentes mais prevalentes e a resposta à antibioticoterapia. MÉTODOS: Estudo retrospectivo, que incluiu 106 gestantes internadas para tratamento de infecção do trato urinário no período entre janeiro de 2007 a dezembro de 2010. A avaliação constituiu-se de análise de prontuários dessas gestantes, observando-se informações sobre a internação e a gestação, bem como seu desfecho. Foi realizada a análise estatística por meio do programa Statistical Package for the Social Science, versão 15.0. Foram utilizados, para análise dos dados, o teste bilateral exato de Fisher e o teste t de Student, bem como métodos de estatística descritiva. RESULTADOS: Uroculturas positivas foram encontradas em 60,5% das gestantes internadas por infecção do trato urinário. O agente infeccioso mais frequente foi Escherichia coli e não houve diferença quanto à resistência, à recorrência ou a complicações entre os agentes etiológicos mais frequentes. Gestantes com infecção do trato urinário prévia tiveram maior risco de recorrência (OR=10,8; p<0,05). Os antibióticos mais frequentemente utilizados na internação foram ampicilina e cefazolina. Troca de esquema terapêutico por resistência bacteriana ocorreu em 11,9% das pacientes que usaram cefazolina e em 20% das que usaram ampicilina (OR=5,5; p<0,05). O índice de complicações gestacionais foi igual nos dois tratamentos. Não houve diferença entre as médias do número de dias de internação para os dois tratamentos. CONCLUSÃO: A ampicilina esteve associada a maior índice de resistência bacteriana que a cefazolina, necessitando de maior número de trocas do esquema terapêutico, sem resultar em diferença nos desfechos clínicos e tempo de internação.

PURPOSE: To determine the epidemiological profile of women admitted for urinary tract infection as well as to verify the most prevalent agents and response to antibiotic therapy. METHODS: A retrospective study of 106 pregnant women admitted to a university hospital for urinary tract infection treatment during the period between January 2007 to December 2010. The evaluation was based on analysis of the medical records of these pregnant women, with the observation of hospitalization and pregnancy data, as well as its outcome. Statistical analysis was performed using Statistical Package for the Social Science, version 15.0. The bilateral Fisher exact test and Student's t test were used for data analysis, as well as descriptive statistical methods. RESULTS: Positive urine cultures were observed in 60.5% of pregnant women admitted due to urinary tract infection. The most frequent infectious agent was Escherichia coli and no difference in resistance, recurrence or complications was observed between the most frequent etiologic agents. Pregnant women with previous UTI had a higher recurrence risk (OR=10.8; p<0.05). The antibiotics most commonly used during hospitalization were ampicillin and cefazolin. Change of therapeutic agent due to bacterial resistance occurred in 11.9% of patients who took cefazolin and in 20% of patients who took ampicillin (OR=5.5; p<0.05). The rate of gestational complications was the same for both treatments. There was no difference in mean number of days of hospitalization between the treatments. CONCLUSION: In the studied population ampicillin showed a higher rate of bacterial resistance than cefazolin, requiring a larger number of treatment regimen exchanges, without resulting in differences in clinical outcome or time of hospitalization.

Change of Antimicrobial Susceptibility among Escherichia coli Strains Isolated from Female Patients with Community-Onset Acute Pyelonephritis

PURPOSE: There is a concern on which antimicrobials are appropriate as empirical agents for community-onset acute pyelonephritis (APN) in regions where the fluoroquinolone resistance rate is high, such as in Korea. MATERIALS AND METHODS: Three hundred and two strains of E. coli in 2001-2002 and 349 strains in 2008-2009 were isolated from the urine cultures of female adult APN patients, and the antimicrobial susceptibility was compared according to each study period. All the patients were classified as uncomplicated or complicated APN, and a subgroup analysis was done thereafter. RESULTS: The E. coli strains isolated in 2008-2009 showed improved susceptibility to trimethoprim-sulfamethoxazole compared to those isolated in 2001-2002. However, the third generation cephalosporin and gentamicin susceptibility was worsened. Of the 232 isolates from the uncomplicated APN patients, there was no difference between the two different time periods. On the other hand, of the 419 isolates from the complicated APN patients, the susceptibility to third generation cephalosporin, gentamicin and ciprofloxacin was significantly worsened. CONCLUSION: The antimicrobial susceptibility of E. coli changed over the study period, however, this change occurred mainly in the complicated APN patients. In Korea, ciprofloxacin is still useful as an empirical agent for uncomplicated APN patients, but this is not the case for patients with complicated APN because of high resistance rate to ciprofloxacin in these patients. For the complicated APN patients, the rate of resistance to ciprofloxacin is already more than 30%.

Emphysematous pyelonephritis: a case report

Emphysematous pyelonephritis is a severe, acute necrotizing renal parenchymal and perirenal infection with formation of gas. Emphysematous pyelonephritis predominantly affects females with uncontrolled diabetes and can occur in insulin-dependent as well as non-insulin dependant patients. CT scan is the modality of choice for the staging of the parenchymal gas and to rule out obstruction. We present a case of 83-year old female with uncontrolled diabetes mellitus who presented with dysu-rea and right flank pain in the emergency department. She was diagnosed as a case of emphysematous pyelonephritis. She was treated successfully in the urology department by antibiotics and percutaneous drainage

Pielonefritis aguda en el embarazo y susceptibilidad antimicrobiana de uropatógenos: comparación de dos décadas / Acute pyelonephritis in pregnancy and antimicrobial susceptibility of uropathogens: comparison of two decades

ANTECEDENTES: La infección de tracto urinario (ITU) es la patología infecciosa bacteriana más frecuente del embarazo. Los esfuerzos por lograr una detección precoz y tratamiento adecuado se basan en la toma sistemática de urocultivo al inicio del embarazo, estudiando los agentes causales y la sensibilidad de éstos a los antibióticos recomendados durante la gestación. OBJETIVO: Describir los cuadros clínicos y microbio-lógicos de los casos de ITU registrados en embarazadas atendidas en nuestra institución durante el año 2007 y compararlos con los reportes de 1988 y 2001. MÉTODOS: Se revisaron las historias clínicas de 112 embarazadas que cursaron ITU durante 2007, determinando la frecuencia de pielonefritis aguda (PNA), agente infeccioso y susceptibilidad a los antimicrobianos. Se compararon estos datos con los registrados en 2001 y 1988 mediante el cálculo de Odds Ratios. RESULTADOS: La proporción de PNA mostró una tendencia decreciente entre 1988, 2001 y 2007 (p<0,001). Escherichia coli fue el agente infeccioso más frecuente, sin embargo, su frecuencia disminuyó entre 2001 y 2007 (OR 0,32; IC95% 0,17-0,58). Se observó un aumento de ITU por Streptococcus agalactiae (SGB) (OR 3,98; 1,85-8,67) durante igual período. La sensibilidad antimicrobiana a ampicilina, gentamicina, nitrofurantoina y cotrimoxazol no presentó diferencias significativas entre 2001-2007. CONCLUSIÓN: Se documentó un cambio en el perfil clínico y microbiológico de las ITU en embarazadas, reduciéndose la proporción de PNA e ITU por Escherichia coli.

BACKGROUND: Urinary tract infection (UTI) is the most frequent bacterial infectious pathology during pregnancy. Efforts to accomplish an early detection and treatment are based on universal urine culture during pregnancy, study of etiologic agents and their susceptibility to antimicrobials prescripted during pregnancy. OBJECTIVE: To describe the clinical and microbiological characteristics of cases of UTI in pregnant women attended in our institution during 2007 and compare them with the reports of 1988 and 2001. METHODS: Clinical records of 112 pregnant women who presented UTI were reviewed, establishing the frequency of acute pyelonephritis (APN), infectious agent and antimicrobial susceptibility. Data were compared statistically with the records of 2001 and 1988 by calculating odds ratios. RESULTS: The proportion of APN showed a decreasing trend between 1988, 2001 and 2007 (p<0.001). Escherichia coli was the most frequent infectious agent, although its frequency reduced between 2001 and 2007 (OR 0.32; IC95% 0.17-0.58). On the other hand, the frequency of UTI caused by Streptococcus agalactiae (GBS) increased during the same period of time (OR 3.98; 1.85-8.67). Antimicrobial susceptibility to ampicillin, gentamicin, nitrofurantoin y cotrimoxazole did not present significant differences between 2001-2007. CONCLUSION: A change in the clinical and microbiological characteristics of UTI in pregnant women was documented. The proportion of APN and UTI caused by Escherichia coli were reduced.

A prospective study of ceftriaxone treatment in acute pyelonephritis caused by extended-spectrum beta-lactamase-producing bacteria.

BACKGROUND: Much controversy exists as to whether cephalosporin treatment is appropriate for infections caused by ESBL-producing organisms because no randomized controlled studies have been performed. OBJECTIVE: Evaluate the therapeutic outcomes of ceftriaxone treatment in acute pyelonephritis caused by ESBL-producing Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis. MATERIAL AND METHOD: The authors performed a prospective study in female patients hospitalized with acute pyelonephritis caused by ESBL-producing or ESBL-nonproducing E. coli, K. pneumoniae, or P. mirabilis in four hospitals in Thailand from 2004 to 2006. The clinical and microbiological outcomes were evaluated at 72 hours after empirical ceftriaxone treatment. RESULTS: One hundred eleven patients with the mean age of 65.29 years participated in this study. There were no differences in demographic and clinical characteristics and laboratory data between the ESBL-producing and ESBL-nonproducing groups except the higher rates of previous antibiotic use and urinary tract infection; and the lower frequency of costovertebral angle tenderness in the ESBL-producing group. Both clinical (65% and 93%) and microbiological (67.5% and 100%) responses at 72 hours after ceftriaxone treatment were poorer in the ESBL-producing group than in the ESBL-nonproducing group (p < 0.0002). CONCLUSION: To the authors' knowledge, this is the first prospective study to evaluate the outcomes of ceftriaxone treatment in acute pyelonephritis caused by ESBL-producing Enterobacteriaceae. The present study confirms that acute pyelonephritis in the female patients caused by ESBL-producing strains could not be treated with ceftriaxone.

Pielonefritis enfisematosa aguda bilateral: un desafío terapéutico / Acute bilateral emphysematous pyelonephritis: a therapeutic challenge

La pielonefritis enfisematosa es una forma poco común de infección renal, caracterizada por la presencia de bacterias coliformes productoras de gas que afecta preferentemente a los pacientes diabéticos. Comunicamos el caso de una mujer diabética de 57 años de edad que ingresó en el hospital por un shock séptico, signos de pielonefritis enfisematosa aguda bilateral y cetoacidosis diabética. En los cultivos de las muestras de orina y sangre desarrolló Escherichia coli. La paciente fue tratada exitosamente con antibióticos de amplio espectro por un tiempo prolongado, control diabético y medidas de sostén solamente. No fue necesario el drenaje con catéteres o la nefrectomía para superar esta situación potencialmente letal.

Emphysematous pyelonephritis is a rare form of kidney infection characterized by the presence of gas-forming coliform bacteria which affects more frequently diabetic subjects. We report the case of a 57-years-old diabetic woman, who was admitted in septic shock, signs of acute bilateral emphysematous pyelonephritis, and diabetic ketoacidosis. Both blood and urine cultures yielded Escherichia coli. The patient was successfully treated using longterm broad-spectrum antibiotics, diabetic control and supportive measures alone. Catheter drainage and nephrectomy were not necessary to overcome this life threatening situation.

Pielonefritis aguda complicada durante el embarazo / Complicated acute pyelonephritis during pregnancy

Se presentan dos casos de pielonefritis aguda complicada. El primero de ellos evolucionó con un Síndrome de Distress respiratorio del adulto; el segundo inicialmente simuló un cuadro de abdomen agudo, evolucionando también con algún grado de compromiso respiratorio.

In this oportunity we analize two cases of acute pyelonephritis during pregnancy that happened in the Hospital Barros Luco, the first case got complicated with an adult respiratory distress syndrome, the second case inicially was diagnosed as an acute abdomen, and throughout its evolution got complicated as well with a respiratory compromise.

Empleo de medicamentos para el tratamiento de infecciones urinarias / Employment of drugs for the treatment of urinary infections

El presente artículo se refiere a las alternativas más comunes de tratamiento farmacológico para las infecciones urinarias. Detalla también las características de los principios activos de las drogas utilizadas como antibioticoterapia

Estudio prospectivo, randomizado, comparativo de la eficacia, seguridad y costos de cefuroxima vs cefradina en la pielonefritis aguda del embarazo / Efficacy, safety and cost of cefuroxime compared with cephradine in the treatment of acute pyelonephritis during pregnancy

Background: Second generation cephalosporins (CFPs) are more active in the treatment of acute pyelonephritis during pregnancy but their cost is considerably higher than their predecessors. Cefuroxime, a second generation CFP with oral and parenteral presentations, might offer significant advantages and become a first choice antimicrobial in this setting. Aim: To compare the efficacy, safety and cost of cefuroxime and cephradine in the treatment of acute pyelonephritis in pregnancy. Patients and methods: Hospitalized women with 12 to 34 weeks of pregnancy, with clinical and bacteriological diagnosis of acute pyelonephritis, were randomly assigned to receive cefuroxime (Curocef (r), GlaxoWellcome) 750 mg t.i.d, i.v or cephradine 1 g q.i.d., i.v. If the isolated organism was resistant to the assigned drug the patient was excluded. Once patients were afebrile, they were switched to an oral form of the same antimicrobial. They were discharged according to the clinical status and treated for a total of 14 days. Laboratory tests, including urine culture were requested during controls and at the end of follow-up at 28 days. Results: One hundred and one patients were randomized: 49 to receive cephradine and 52 to receive cefuroxime. Patients in the cefuroxime group had fewer febrile days (mean 1.7 vs 2.2, p<0.05), faster clinical recovery (mean 2.7 vs 3.1 days, p<0.05), a higher rate of bacteriological cure at 28 days (78.8 percent and 59.2 percent, p<0.05) and lower rate of failure (21.2 percent vs 40.8 percent p<0.05). The rate of resistance of isolated uropathogens was l4 percent to cephradine and 1 percent to cefuroxime. Conclusions: Cefuroxime can be considered as a first choice option in the treatment of acute pyelonephritis during pregnancy due to its tolerance, microbiological activity and efficacy

Protocol for evaluation and management of urinary tract infection in adults

Urinary Tract Infections in adults are quite commonly encountered in General Practice. It remains a significant cause of morbidity. Categorization of the infection by clinical syndrome and by host helps the physician to determine the appropriate diagnostic and management strategies. Clinical judgement should dictate whether urine culture is needed or not. The most effective therapy for an uncomplicated infection is a three-day course of trimethoprim-sulfomethoxozole [Co-Trimoxazole]. Nitrofurantoin can also be used. Complicated infections require a more prolonged course of therapy. Quinolones or third generation cephalosporins can be used for at least 10 to 14 days

Tratamiento de la infección del tracto urinario no complicada en el adulto

Las infecciones no complicadas del tracto urinario son un motivo de consulta frecuente de la mujer y en mucha menor proporción del hombre joven. Se deben considerar la cistitis aguda y la pielonefritis aguda como no complicadas en mujeres premenopáusicas, sexualmente activas, no embarazadas, con inicio reciente de la disuria, frecuencia o urgencia urinaria, o, dolor en flancos asociado a fiebre mayor de 39 grados C que no hayan sido recientemente instrumentadas del tracto urinario o que no hayan recibido antibióticos y que no tengan historia de alteraciones anatomicas, funcionales o metabólicas del tracto urinario. La mayoría de estas infecciones son causadas por cepas uropatógenas de Escherichia coli que son suceptibles a la mayoría de antibióticos orales. la revisión de la literatura sugiere que un tratamiento de tres días es efectivo para la cistitis aguda mientras que para la pielonefritis aguda se necesita un mínimo de 14 días. Se prefiere el uso de antibióticos que alcancen altas concentraciones renales como el trimetropinsulfametoxazol, las fluoroquinonas o los aminoglucósidos. En los hombres estas infecciones son poco frecuentes pero como son producidas por los mismos gérmenes el tratamiento antibiótico es semejante