Resistencia antibiótica de Escherichia coli y Staphylococcus saprophyticus en la infección urinaria de un hospital público / Antibiotic resistance of Escherichia coli and Staphylococcus saprophyticus in urinary tract infection in a public hospital

La resistencia de antibióticos puede llegar a causar una amplia morbilidad y complicaciones. Objetivo: Determinar el perfil de resistencia antimicrobiana de Escherichia Coli y de Staphylococcus Saprophyticus, en pacientes con infección urinaria hospitalizados en el servicio de Medicina Interna del Hospital Municipal Los Olivos. Métodos: Estudio descriptivo, retrospectivo de corte transversal. Se realizó en el servicio de Medicina Interna del Hospital Municipal los Olivos (HMLO). Participantes: historia clínica de pacientes hospitalizados con infección urinaria en el servicio de Medicina Interna. Intervenciones: Según los criterios de inclusión y exclusión se obtuvieron, 96 historias clínicas (HC) del año 2013. Se utilizó un instrumento de recolección validado. Se realizó el análisis descriptivo con software estadístico STATA versión 25. Resultados: De las 96 HC, la edad promedio fue 55,04 años, los agentes microbianos más frecuentes fueron: la Escherichia coli con 85,3%, Staphylococcus saprophyticus 4.2% y Klebsiella pneumoniae 3,1%. La prevalencia de productores de betalactamasa espectro extendido (BLEE) fue 10,4%. Los antibióticos más resistentes fueron: trimetoprim/sulfametoxazol 89,6%, ampicilina 86%, piperacilina 84,6%, tetraciclina 79,2% y ciprofloxacino 70,8%. Los antibióticos más sensibles fueron: amikacina 100%, imipenem 100%, ertapenem 98%, meropenem 96% y piperacilina/tazobactam 96%. Conclusión: El uropatógeno más frecuente en pacientes con ITU hospitalizados fue la E. coli. Los antibióticos que presentaron resistencia a la E. coli fueron: trimetoprim/sulfametoxazol, ampicilina, piperacilina, tetraciclina y ciprofloxacino, y para el S. Saprophyticus fueron: amoxicilina/ ácido clavulánico, trimetoprim/sulfametoxazol, ceftriaxona y ciprofloxacino(AU)

Resistance to antibiotics may actually cause extensive morbidity and complications. Objective: To determine the antimicrobial resistance profile of Escherichia coli and Staphylococcus saprophyticus, in patients with urinary infection hospitalized in the Internal Medicine service of the Los Olivos Municipal Hospital. Methods: Descriptive, retrospective cross-sectional study. It was carried out in the Internal Medicine service of the Los Olivos Municipal Hospital (HMLO). Participants: clinical history of hospitalized patients with urinary infection in the Internal Medicine service. Interventions: According to the inclusion and exclusion criteria, 96 clinical records (HC) from 2013 were obtained. A validated collection instrument was used. Descriptive analysis was performed with STATA version 25 statistical software. Results: Of the 96 CHs, the average age was 55.04 years, the most frequent microbial agents were: Escherichia Coli with 85.3%, Staphylococcus saprophyticus 4.2% and Klebsiella pneumoniae 3.1%. The prevalence of extended spectrum beta-lactamase producers (ESBL) was 10.4%. The most resistant antibiotics were trimethoprim / sulfamethoxazole 89.6 %, ampicillin 86 %, piperacillin 84.6 %, tetracycline 79.2 % and ciprofloxacin 70.8 %. The most sensitive antibiotics were: amikacin 100%, imipenem 100%, ertapenem 98%, meropenem 96% and piperacillin / tazobactam 96%. Conclusion: The most common uropathogen in hospitalized UTI patients was E. coli. The antibiotics that showed resistance to E. coli were: trimethoprim/sulfamethoxazole, ampicillin, piperacillin, tetracycline, and ciprofloxacin, and for S. saprophyticus they were: amoxicillin/clavulanic acid, trimethoprim / sulfamethoxazole, ceftriaxone and ciprofloxacin(AU)

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.

Consenso Argentino intersociedades de Infección Urinaria 2018-2019 - Parte II / Argentine Intersociety Consensus on Urinary Infection 2018-2019 - Part II

La segunda parte del Consenso Argentino Intersociedades de Infección Urinaria incluye el análisis de situaciones especiales. En pacientes con sonda vesical se debe solicitar urocultivo solo cuando hay signo-sintomatología de infección del tracto urinario, antes de instrumentaciones de la vía urinaria o como control en pacientes post-trasplante renal. El tratamiento empírico recomendado en pacientes sin factores de riesgo es cefalosporinas de tercera generación o aminoglucósidos. Las infecciones del tracto urinario asociadas a cálculos son siempre consideradas complicadas. En caso de obstrucción con urosepsis, deberá realizarse drenaje de urgencia por vía percutánea o ureteral. En pacientes con stents o prótesis ureterales, como catéteres doble J, el tratamiento empírico deberá basarse en la epidemiología, los antibióticos previos y el estado clínico. Antes del procedimiento de litotricia extracorpórea se recomienda pesquisar la bacteriuria y, si es positiva, administrar profilaxis antibiótica según el antibiograma. Cefalosporinas de primera generación o aminoglúcosidos son opciones válidas. Se recomienda aplicar profilaxis antibiótica con cefalosporinas de primera generación o aminoglúcosidos antes de la nefrolitotomía percutánea. La biopsia prostática trans-rectal puede asociarse a complicaciones infecciosas, como infecciones del tracto urinario o prostatitis aguda, principalmente por Escherichia coli u otras enterobacterias. En pacientes sin factores de riesgo para gérmenes multirresistentes y urocultivo negativo se recomienda realizar profilaxis con amikacina o ceftriaxona endovenosas. En pacientes con urocultivo positivo, se realizará profilaxis según antibiograma, 24 horas previas a 24 horas post-procedimiento. Para el tratamiento dirigido de la prostatitis post-biopsia trans-rectal, los carbapenémicos durante 3-4 semanas son el tratamiento de elección.

The second part of the Inter-Society Argentine Consensus on Urinary Tract Infection (UTI) includes the analysis of special situations. In patients with urinary catheter, urine culture should be requested only in the presence of UTI symptomatology, before instrumentation of the urinary tract, or as a post-transplant control. The antibiotics recommended for empirical treatment in patients without risk factors are third-generation cephalosporins or aminoglycosides. UTIs associated with stones are always considered complicated. In case of obstruction with urosepsis, an emergency drainage should be performed via a percutaneous nefrostomy or ureteral stenting. In patients with stents or ureteral prostheses, such as double J catheters, empirical treatment should be based on epidemiology, prior antibiotics, and clinical status. Before the extracorporeal lithotripsy procedure, bacteriuria should be investigated and antibiotic prophylaxis should be administered in case of positive result, according to the antibiogram. First generation cephalosporins or aminoglycosides are valid alternatives. The use of antibiotic prophylaxis with first-generation cephalosporins or aminoglycosides before percutaneous nephrolithotomy is recommended. Transrectal prostatic biopsy can be associated with infectious complications, such as UTI or acute prostatitis, mainly due to Escherichia coli or other enterobacteria. In patients without risk factors for multiresistant bacteria and negative urine culture, prophylaxis with intravenous amikacin or ceftriaxone is recommended. In patients with positive urine culture, prophylaxis will be performed according to the antibiogram, from 24 hours before to 24 hours post-procedure. For the targeted treatment of post-transrectal biopsy prostatitis, carbapenems for 3-4 weeks are the treatment of choice.

Antimicrobial Susceptibility Pattern and ESBL Production among Uropathogenic Escherichia coli Isolated from UTI Children in Pediatric Unit of a Hospital in Kerman, Iran.

Aims: Emergence of antibiotic resistance and extended spectrum β- lactamase (ESBL) among uropathogens in the pediatric unit of hospitals created serious health care concern. This study deals with antimicrobial susceptibility and ESBL analysis of uropathogenic Escherichia coli isolated from children hospitalized in pediatric unit of a university hospital in Kerman, Iran. Methodology: Fifty-five uropathogens positive samples were recovered from one hundred thirty five samples collected from urine of the children hospitalized with sign of UTI in pediatric unit of a hospital, in Kerman, Iran from April 2011 to November 2012. Preliminary antimicrobial susceptibility testing was carried out using agar disk-diffusion breakpoint assay and minimum inhibitory concentrations (MICs) of different antibiotics were determined by agar dilution method. ESBL production was detected by a double disk synergy test and confirmed by a phenotypic confirmatory test. Results: Of fifty-five positive samples isolated, Escherichia coli (69%) was the leading uropathogen followed by Klebsiella spp. (18.8%), Proteus (7.27%), Staphylococcus aureus (3.63%), Citrobacter (1.8%), Enterobacter spp. (1.81%) and Enterococcus (1.8%). Antimicrobial susceptibility tests revealed that almost all uropathogenic E. coli were sensitive to carbapenems (100%) and amikacin (94.4%), while, 100% of the strains were resistant to ampicillin (MIC range ±32 μg/mL), 63.8% were resistant to amoxicillin/clavulanic acid (MIC range ±32μg/mL), 33% were resistant to trimethoprim- sulfamethoxazole (MIC range ±64.2μg/mL) and 61.1% of the strains were resistant to third generation of cephalosporins (MIC range ±8.0μg/mL) (P=0.05). The ESBL confirmatory test for uropathogenic E. coli isolates resistant to third generation of cephalosporins revealed that only 20% were produced detectable ESBL enzymes. Conclusion: From above results it can be concluded that E. coli was the most common nosocomial pathogen associated with UTI among hospitalized children in our hospital and amikacin, carbapenems were very effective drugs for treatment of UTI in these age group, while, care must be taken when third generation of cephalosporins and trimethoprimsulfamethoxazole are administered.

Bladder control training in girls with lower urinary tract dysfunction

Purpose To evaluate the efficacy of standard and biofeedback bladder control training (BCT) on the resolution of dysfunctional elimination syndrome (primary outcome), and on the reduction of urinary tract infections (UTI) and the use of medications such as antibacterial prophylaxis and/or anticholinergic/alpha-blockers (secondary outcome) in girls older than aged least 5 years. Materials and Methods 72 girls, median age of 8 years (interquartile range, IQR 7-10) were subjected to standard BCT (cognitive, behavioural and constipation treatment) and 12 one-hour sessions of animated biofeedback using interactive computer games within 8 weeks. Fifty patients were reevaluated after median 11 (IQR, 6-17) months. Effectiveness of BCT was determined by reduction of dysfunctional voiding score (DVS), daytime urinary incontinence (DUI), constipation, UTI, nocturnal enuresis (NE), post void residual (PVR), and improvements in bladder capacity and uroflow/EMG patterns. Results BCT resulted in significant normalization of DUI, NE, constipation, bladder capacity, uroflow/EMG, while decrease of PVR didn't reach statistical significance. In addition, the incidence of UTI, antibacterial prophylaxis and medical urotherapy significantly decreased. There were no significant differences in DVS, DUI, NE, bladder capacity and voiding pattern at the end of the BCT and at the time of reevaluation. The success on BCT was supported by parenteral perception of the treatment response in 63.9% and full response in additional 15.3% of the patients. Conclusion Combination of standard and biofeedback BCT improved dysfunctional elimination syndrome and decreased UTI with discontinuation of antibacterial prophylaxis and/or anticholinergic/alpha-blockers in the majority of the patients. Better training results are expected in patients with higher bladder wall thickness as well as in those with vesicoureteral reflux, ...

Antibacterial resistance and trend of urinary tract pathogens to commonly used antibiotics in Kashmir Valley / Resistencia antibacteriana y tendencia de los patógenos de las vías urinarias frente a los antibióticos comúnmente usados en el Valle de Cachemira

OBJECTIVE: Increase in resistance pattern of urinary tract pathogens to conventional antimicrobial agents used for urinary tract infections (UTIs) is gaining the attention of many microbiologists worldwide in respect to treatment of UTIs. The aim of the present study was to obtain data on resistance patterns of pathogens responsible for UTIs to currently used antimicrobial agents in Sher-I-Kashmir Institute of Medical Sciences (tertiary healthcare hospital). METHOD: A total of 2842 samples were collected from both outpatient and inpatient departments. The majority of samples in this study were midstream urine specimens, others included catheterized urine samples. Standard parameters were followed for isolation and identification of clinical isolates and further antimicrobial susceptibility test was done by Kirby Bauer disk diffusion method. RESULTS: Out of 2842 samples, 1980 (67%) were culture positive. Escherichia coli (E coli) was the most prevalent isolate (OP 63%, IP 45.5%) followed by Klebsiella pneumonia (K pneumonia) as the second commonest UTI-causing agent (OP 15.9%, IP 21.7%). High percentage of isolates showed resistance to sulfa drugs such as cotrimoxazole. First generation cephalosporins were ineffective, while aminoglycosides and third generation cephalosporins were effective against E coli, K pneumoniae, Pseudomonas aeruginosa (P aeruginosa), Enterococcus faecalis and Staphyococcus aureus (Staph aureus). Furthermore, this study noticed that glycopeptide drugs such as vancomycin are highly effective against E faecalis and Staph aureus UTIs. CONCLUSION: This study reveals the increased trend in resistance pattern of uropathogens in the valley region. These data may aid health professionals in choosing the appropriate treatment for patients with UTI in the region and hopefully will prevent the misuse of antibiotics.

OBJETIVO: El aumento del patrón de resistencia de los patógenos de las vías urinarias frente a los agentes antimicrobianos convencionales usados para las infecciones de las vías urinarias (IVU) está ganando la atención de muchos microbiólogos a nivel mundial, en relación con el tratamiento de las IVU. El objetivo del presente estudio fue obtener datos sobre los patrones de resistencia de los patógenos responsables de las IVU en el Instituto de Ciencias Médicas Sher-I-Cachemira (hospital de atención terciaria a la salud) frente a los agentes antimicrobianos de uso común. MÉTODO: Se recogieron un total de 2842 muestras provenientes de los departamentos de pacientes externos e internos. La mayoría de las muestras en este estudio fueron especimenes de orina de mitad de micción; otros incluyeron muestras de orina cateterizada. Se siguieron los parámetros estándar para el aislamiento y la identificación de los aislados clínicos, y posteriormente se realizó la prueba de susceptibilidad antimicrobiana mediante el método Kirby-Bauer de difusión por disco. RESULTADOS: De 2842 muestras, 1980 (67%) fueron cultivos positivos. Escherichia coli (E coli) fue el aislado más frecuente (OP 63%, IP 45.5%) seguido por Klebsiella pneumonia (K pneumonia) como el segundo agente más común causante de IVU (OP 15.9%, IP 21.7%). Un alto porcentaje de aislados mostró resistencia a los medicamentos de sulfa, por ejemplo el cotrimoxazole. Las cefalosporinas de primera fueron ineficaces, mientras que los aminoglucósidos y las cefalosporinas de tercera generación fueron efectivas frente a E coli, K pneumoniae, Pseudomonas aeruginosa (P aeruginosa), Enterococcus faecalis y Staphyococcus aureus (Staph aureus). Además, en este estudio se observó que los medicamentos glicopéptidos, tales como la vancomicina, son altamente efectivos frente a las IVU por E faecalis y Staph aureus. CONCLUSIÓN: Este estudio revela un aumento en la tendencia del patrón de resistencia de los uropatógenos en la región del Valle. Estos datos pueden ayudar a los profesionales de la salud a escoger el tratamiento apropiado para los pacientes con IVU en la región, y es de esperar que asimismo ayuden a prevenir el uso inadecuado de antibióticos.

Antibiotic resistance patterns of pediatric community-acquired urinary infections

Knowledge about antimicrobial resistance patterns of the etiological agents of urinary tract infections (UTIs) is essential for appropriate therapy. Urinary isolates from symptomatic UTI cases attended at Santa Casa University Hospital of São Paulo from August 1986 to December 1989 and August 2004 to December 2005 were identified by conventional methods. Antimicrobial resistance testing was performed by Kirby Bauer's disc diffusion method. Among the 257 children, E. coli was found in 77 percent. A high prevalence of resistance was observed against ampicillin and TMP/SMX (55 percent and 51 percent). The antibiotic resistance rates for E. coli were: nitrofurantoin (6 percent), nalidixic acid (14 percent), 1st generation cephalosporin (13 percent), 3rd generation cephalosporins (5 percent), aminoglycosides (2 percent), norfloxacin (9 percent) and ciprofloxacin (4 percent). We found that E. coli was the predominant bacterial pathogen of community-acquired UTIs. We also detected increasing resistance to TMP/SMX among UTI pathogens in this population.

Advances in management of urinary tract infections.

Urinary Tract Infections (UTI) are a common bacterial infection in children. The diagnosis of UTI is very often missed in young children due to minimal and non-specific symptoms. The developing renal cortex in young children is vulnerable to renal scarring resulting in hypertension and chronic renal failure. A clinically suspected case of UTI should be defined and documented with urine culture report. After the diagnosis of UTI, its category should be defined. It will guide for proper radioimaging evaluation, choice of antimicrobial agent, duration of treatment, need of chemoprophylaxis etc. Even a single confirmed UTI should be taken seriously. Rational use of modern radioimaging for proper evaluation is essential. UTI in neonates, nosocomial UTI and UTI due to ESBL producing organisms are special situations, to be identified and managed with advanced therapy promptly and appropriately.

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.

Choice of antibiotic for empirical therapy of acute cystitis in a setting of high antimicrobial resistance.

BACKGROUND: A high prevalence of antimicrobial resistance among urinary isolates in the Garhwal region of Uttaranchal. AIMS: To identify the most appropriate antibiotic for empirical treatment of community-acquired acute cystitis on the basis of local antimicrobial sensitivity profile. SETTINGS AND DESIGN: A prospective clinico-microbiological study including all clinically diagnosed patients with community acquired acute cystitis attending a tertiary care teaching hospital over a period of three years. METHODS AND MATERIAL: Clean-catch midstream urine specimens, from 524 non-pregnant women with community-acquired acute cystitis, were subjected to semi-quantitative culture and antibiotic susceptibility by the Kirby- Bauer disc diffusion method. A survey was also conducted on 30 randomly selected local practitioners, to know the prevalent prescribing habits in this condition. STATISTICAL ANALYSIS: The difference between the susceptibility rates of E. coli isolates to Nitrofurantoin and the other commonly prescribed antibiotics was analysed by applying the z test for proportion. RESULTS: 354 (67.5%) specimens yielded significant growth of E. coli.> 35% of the urinary E.coli isolates were resistant to the fluoroquinolones, which were found to be the most commonly used empirical antibiotics in acute cystitis. Resistance was minimum against Nitrofurantoin (9.3%, 33) and Amikacin (11.0%,39).> 80% of the fluoroquinolone-resistant strains were found to be sensitive to Nitrofurantoin. CONCLUSION: The best in vitro susceptibility profile in our study has been shown by Nitrofurantoin and a significantly high proportion of the urinary E. coli isolates have already developed resistance to the currently prescribed empirical antibiotics, viz. the fluoroquinolones. In view of these in vitro susceptibility patterns, a transition in empirical therapy appears imminent.

Reporte del primer caso de infección por Enterococcus faecalis resistente a vancomicina en un servicio de medicina interna / Report of first ERV infection in an internal medicine service

El presente trabajo describe la primera infección por ERV en un paciente inmunodeprimido pesquisado en el Servicio de Medicina del Hospital San José, de Santiago. Su tratamiento y el manejo epidemiológico con las medidas que se adoptaron para la no ocurrencia de nuevos casos.

This paper describes the first ERV infection in an immunocompromised patient detected in the Internal Medicine Service of San José Hospital in Santiago, Chile. We report on the therapy given, the endemiologic measures taken to avoiding the emergence of new cases.

Tratamento das infecçöes do trato urinário näo complicadas da mulher, com dose única de antibiótico / Treatment of uncomplicated urinary tract infection in women with single-dose

A antibioticoterapia desenhada para grupos especiais de pacientes com infecçöes do trato urinário (ITUs) possibilita maximizar o sucesso terapêutico, ao mesmo tempo que permite reduzir o custo e a incidência de reaçöes adversas. No presente trabalho, a administraçäo via oral de 3,0 g de fosfomicina trometamol ou 800 mg de norfloxacina ou 1,0 g de cefatamet pivoxil determinou a erradicaçäo bacteriana em 89 por cento, 82 por cento e 70 por cento, respectivamente, dos episódios de ITUs näo complicadas da mulher. Näo houve diferença estatística significante (p>0,05) entre os regimes terapêuticos empregados. Das 30 pacientes incluídas no trabalho, 24 (80 por cento) responderam ao tratamento com dose única. Como antecipado, a E. coli foi a bactéria mais frequentemente isolada. A terapêutica antimicrobiana com dose única mostrou-se eficaz, de boa tolerabilidade, baixo custo e deveria ser considerada no tratamento empírico das ITUs näo complicadas da mulher.

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

Improvement of semen quality in infected asymptomatic infertile male after bacteriological cure

Bacteriological etiology was investigated in 29 infected asymptomatic infertile males. The localization of the infection and the effect of a long term antibiotic therapy on semen parameters were evaluated. The most frequent etiological agent isolated was Enterococcus faecalis. Positive bacteriological culture was obtained in prostatic fluid in 16 patients and in semen in 13. Bacteriological cure was achieved in 24 cases and it was associated with improved seminal parameters: sperm concentration, motility, viability and total motile sperm per ejaculate. In 5 patients without bacteriological cure there was no change in semen analysis after antibiotic therapy. In 45 percent of the infected patients there were less than 0.5 x 10(6)/ml seminal polymorphonuclear leukocytes. In view of these findings granulocyte concentration seems to be a poor marker to predict infection.

Oxibutinina intravesical / Intravesical oxybutynin

Os autores apresentam o caso de uma criança com bexiga neurogênica hiper-reflexa secundária a mielomeningocele, tratada inicialmente com oxibutinina por via oral e cateterismo intermitente, com bons resultados durante 18 meses. Após este período, a paciente desenvolveu náuseas e constipaçäo intestinal severa. A substituiçäo da medicaçäo oral pela via intravesical obteve bons resultados terapêuticos, com o desaparecimento dos efeitos colaterais

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