Manejo de infecciones del tracto urinario / Management of the urinary tract infections

ResumenLas infecciones del tracto urinario (ITU) suelen ser una causa frecuente de consulta a los diversos servicios de medicina general. Ciertas condiciones como el embarazo, estados de inmunosupresión, sexo masculino y/o malformaciones del aparato genitourinario favorecen la complicación de esta patología, lo que requiere un manejo oportuno y específico.Son diversos los agentes etiológicos causantes de este cuadro, donde son el orden de frecuencia la Escherichia coli, Proteus mirabilis y Klebsiella neumoniae. Para su adecuado abordaje, una completa historia clínica y un adecuado examen físico dirigido son indispensables y de forma coadyuvante diversas guías avalan la realización del urocultivo como método estándar de oro para un diagnóstico certero.En cuanto a manejo farmacológico compete, el uso de antibióticos se reserva para casos específicos, algunos como el Trimetoprim sulfametoxazol, que anteriormente era la primera línea de elección, han caído en desuso debido al aumento en la resistencia bacteriana. Por otra parte, medicamentos como la nitrofurantoína continúan dando adecuados resultados tras su utilización. Por último, drogas como la fosfomicina, betalactámicos y algunas fluoroquinolonas ofrecen respuestas variables en el manejo de las cistitis. Finalmente, condiciones específicas como la pielonefritis presentan como manejo de primera línea el uso de fluoroquinolonas por el grado de compromiso asociado. El presente artículo pretende actualizar al médico general sobre el manejo y tratamiento actual para las infecciones urinarias con el fin de asegurar la adecuada evolución de sus pacientes.

AbstractUrinary tract infections (UTI) are a common cause to visit an emergency service or general medicine, this disease is more frequently in women and it does not difference between economical status. Certain conditions such as pregnancy, immunosuppression, being male, and/or malformations in the urinary tract can lead to many complications that require an urgent an accurate management.Is well known that there are several pathogens who can produce this disease, the most commons in order of appearance are Escherichia coli, Proteus mirabilis and Klebsiella neumoniae. For an accurate management, as in all the diseases, is well know the importance of a good clinical history, a truthful physical examination, but the physician can also use many other tools such as the urine culture, which is indeed the gold standard for the diagnosis.In the pharmacological field the use of antibiotics is reserved only to certain cases. There are some drugs like the Trimethoprim sulfamethoxazole, year ago the first step to treat an UTI, that have lost their effectiveness due the rise in bacterial resistance; on the other side drugs such as nitrofurantoin are still useful, and other drugs like the fosfomycin, beta-lactams and some fluoroquinolones are able to handle some cystitis. Finally, specifics conditions such as the pyelonephritis require the use of fluoroquinolonas due the complexity of the condition. This article pretends in a short and precisely way to update the physicians in the management, diagnosis and treatment of the UTI, having as a goal guarantee the evolution of their patients.

Incidencia de infección y prácticas de uso de antimicrobianos en Urología de un hospital especializado / Incidence of infection and practices of antimicrobial use in the urology service of a specialized hospital

Introducción: el tractus urinario es la localización más frecuente de las infecciones hospitalarias, la mayor parte ocasionadas por instrumentación del tracto urinario, y los agentes antimicrobianos constituyen una intervención importante en la terapéutica. Objetivo: determinar la incidencia de infecciones y las prácticas de utilización de antimicrobianos en pacientes del Servicio de Urología de un hospital especializado. Método: estudio prospectivo, exploratorio, realizado en el período enero a junio de 2013, con observación mensual a pacientes hospitalizados en el servicio de Urología con indicación de antimicrobianos. Se obtuvo la información sobre la presencia de sepsis, diagnóstico de Infección Asociada a la Asistencia Sanitaria, procedimientos quirúrgicos y las características de la prescripción de antimicrobianos. Resultados: la enfermedad litiásica fue el antecedente patológico más reportado. Se constató la presencia de infección al ingreso en un 81,2 por ciento, en el 24,2 por ciento como infección relacionada a los procesos quirúrgicos endourológicos. Las cefalosporinas de tercera generación fueron los antimicrobianos más indicados para el control de la infección y coincidentemente para la profilaxis quirúrgica. Conclusiones: la prescripción de antimicrobianos fue empírica con elevada proporción de prescripción adecuada(AU)

Introduction: the most frequent location of nosocomial infections is the urinary tract, most of them caused by its manipulation, so antibiotic agents constitute an important therapeutic intervention. Objective: to define infectios incidence and the protocols of use of antibiotics in patients admitted to the urology service at a specialized hospital. Method: prospective and exploratory study carried out from January to June 2013, with monthly observation to hospitalized patients using antibiotics at the Urology service. Information about presence of sepsis, Health Assistance Related Infection, diagnosis, surgical procedures and antibiotics prescription characteristics was obtained. Results: personal history of nephrolithiasis was reported as the most frequently medical history. Presence of infection at admission was confirmed in 81,2 percent of the patients, 24,2 percent of them related with endourological surgical procedures. Third generation cephalosporins were the most indicated antibiotics to control infections and for surgical prophylaxis. Conclusions: antibiotics prescription was empiric with high rate of adequate prescription(AU)

[Comparative efficacy of tibolone and classic HRT on the urinary complications in menopausal women]

Urinary complications are a common disorder which affects the quality of life of women. The objective of this study was to compare the therapeutic effects of Tibolone and classic hormone replacement therapy [HRT] on the urinary complications of menopausal women. This randomized controlled trial study was conducted at Tarbiat Modarres University in 2007-2008 on 100 menopausal women which were divided into two therapeutic groups. Women in the first group used 2.5 mg tibolone plus one tablet of Ca+D daily. Women in the second group used HRT classic [0.625 mg conjugated equine estrogen and 2.5 mg medroxyprogesterone acetate] plus one tablet of Ca+D daily, for six months. Before and after each treatment, frequency, urgency, nocturia, stress and urge urine incontinence was recorded. The collected data was analyzed by the SPSS software using independent sample t-test, Mann-Whitney test, Wilcoxon test, and Fisher test. The data showed that the two groups were matched in age, menarche and menopausal age, gravid, education level, occupation and socio-economic level [P>0.05]. After six months, all of the urinary complications reduced after treatment in each group, but Wilcoxon test showed that only the reduction of nocturia was significant [P=0.007, P=0.03]. Mann-Whitney test showed that all of these complications in the HRT group reduced more in the tibolone group, but this reduction statistically wasn't significant [P>0.05]. Treatment by classic hormone replacement therapy reduces the urinary complications of menopausal women in comparison with Tibolone. Therefore care should be taken for considering of an appropriate medical approach in these cases

Early diagnosis of the urofacial syndrome is essential to prevent irreversible renal failure

INTRODUCTION: The urofacial or Ochoa syndrome is a rare disease characterized by the presence of functional obstructive uropathy associated with peculiar facial features when patients attempt to smile or laugh. Unfortunately, many of these patients remain without proper diagnosis or adequate treatment due to lack of recognition of the disease. This can ultimately result in upper tract deterioration and eventual renal failure. We present our experience with this rare syndrome. MATERIALS AND METHODS: We identified 3 patients who presented initially with acute renal failure, urinary tract infection (UTI) and severe dysfunctional elimination. All patients were thoroughly evaluated, including screening for spinal cord anomalies, and were subsequently diagnosed with urofacial syndrome. RESULTS: At the outset, the two older patients (aged 4 and 9 years) presented with the typical facial features when attempting to smile or laugh. One patient in the newborn period presented with urinary and fecal retention and septicemia and, to our knowledge, represents the youngest case of urofacial syndrome reported so far. All patients were evaluated with ultrasonography, renal scan, voiding cystourethrogram (VCUG) and urodynamics. Findings included hydronephrosis and a thick-walled, trabeculated bladder with poor compliance and detrusor hypereflexia respectively in each patient. All were subsequently treated with clean intermittent catheterization (CIC), antibiotic prophylaxis and anticholinergic therapy. One patient required appendicovesicostomy for CIC due to discomfort secondary to a sensate urethra. CONCLUSIONS: Our series demonstrates that early recognition of this rare syndrome is necessary to adequately treat and prevent upper tract deterioration in these unique individuals. Although the urofacial is difficult to diagnose in infants, cognizance must be maintained in order to prevent severe subsequent sequalae.

Infecciones del tracto urinario: microbiología y resistencia antibiótica / Urinary tract infections: microbiology and antibiotic resistance

Las infecciones del tracto urinario son la principal causa de morbilidad actualmente, por lo cual a su vez implican el mayor gasto en salud en personas de todas las edades. Nuestro estudio comprendió urocultilvos realizados en la clínica de Atenas del 5-8-02 al 17-12-03, de los cuales; un 78.43 por ciento fueron positivos para E. coli relegando a los demás agentes a una minoría, además la mayoría de las cepas de E. coli son resistentes al Trimetoprim sulfametoxazole (TMP SMX) que es actualmente el medicamento más utilizado. Como segundo agente causal más frecuente encontramos a Kliebsiella sp.

Tratamento em dose única de infecçäo do trato urinário baixo näo complicada: estudo randomizado com fosfomicina trometamol e amoxicilina / A single-dose therapy for noncomplicated low urinary tract infection: a randomized study with fosfomycin trometamol and amoxicillyn

Este estudo duplo-cego randomizado envolvendo 40 pacientes do sexo feminino procurou avaliar a eficácia dos agentes fosfomicina trometamol e amoxicilina no tratamento em dose única de infecçöes näo complicadas do trato urinário baixo. O diagnóstico de infecçäo do trato urinário foi realizado através de exame clínico e urocultura, sendo as pacientes reavaliadas uma semana e 30 dias após o tratamento. Observou-se maior sensibilidade in vitro das bactérias isoladas a fosfomicina trometamol. A negativaçäo da urocultura após sete dias do tratamento foi significativamente superior nas pacientes tratadas com fosfomicina trometamol (fosfomicina trometamol: 89,5 por cento; amoxicilina: 61,9 por cento - p < 0,05), observando-se também melhor resoluçäo dos sintomas neste grupo. Os autores concluem que a fosfomicina trometamol apresenta melhores resultados que a amoxicilina no tratamento em dose única de infecçöes näo complicadas do trato urinário baixo.

Ensayo de cuatro esquemas terapéuticos en el tratamiento de la pielonefritis aguda / Essay of 4 therapeutic schemes in the treatment of acute pyelonephritis

Con el propósito de lograr un esquema de tratamiento de similar eficacia terapéutica, pero de menor duración, vía administración más expedita y menor costo, se estudiaron 4 esquemas de antimicrobianos comparándolos con el que actualmente se utiliza