Gestantes con infección urinaria pertenecientes a un área de salud del municipio Guanabacoa, La Habana / Pregnant women with urinary infection in a health area of the municipality of Guanabacoa, La Habana

RESUMEN Introducción: la infección urinaria en el embarazo constituye uno de los principales problemas de salud, que influyen de forma directa en el desarrollo del embarazo y el parto. Objetivo: caracterizar las gestantes con infección urinaria, pertenecientes al área de salud del Policlínico Universitario "Ángel Machaco Ameijeiras" de Guanabacoa, La Habana, Cuba, de enero 2019 a enero 2020. Materiales y Métodos: se realizó un estudio descriptivo y de corte transversal en 129 gestantes del área de salud y periodo de tiempo antes definidos. La información se obtuvo de las historias clínicas individuales. Las principales variables a medir fueron: edad materna, germen causal, modificaciones cervicales, y complicaciones prenatales y post natales más frecuentes. Resultados: predominó la infección urinaria en 52 pacientes (40,31 %), el grupo de edades de 26-30 años fue el más representado, con 47 casos (36,43 %), las modificaciones cervicales estuvieron presentes en 35 pacientes (67,30 %) y el germen causal más frecuente fue el staphylococcus ssp en 22 pacientes (42,30 %) y valor P=0,01. La presencia de bajo peso/ crecimiento intrauterino retardado se representó en 18 pacientes (34,61%). Conclusiones: se caracterizó las gestantes incluidas en el estudio, predominó la existencia de infección urinaria y el bajo peso fue la complicación más representada (AU).

SUMMARY Introduction: the urinary infection in pregnancy is one of the main health problems, influencing in a straight way in pregnancy development and childbirth. Objective: to characterize pregnant women with urinary infection belonging to the health are of the University Polyclinic "Ángel Machaco Ameijeiras" of Guanabacoa, La Habana, Cuba, from January 2019 to January 2020. Materials and methods: a descriptive, cross-sectional study was carried out in 129 pregnant women of the aforementioned health area during the period herein declared. The information was gathered from the individual medical records. The main variables measured were: maternal age, causal germ, cervical modifications and more frequent prenatal and postnatal complications. Results: urinary infection predominated in 52 patients (40.31 %); the 26-30 age group was the most represented one, with 47 cases (36.43 %); cervical modifications were present in 35 patients (67.30 %); and the most frequent causal germ was the Staphylococcus ssp., in 22 patients (42.30 %), P value=0.01. Low weight/IUGR was present in 18 patients (34.61 %). Conclusions: pregnant women included in the study were characterized, predominating the existence of urinary infection. Low weight was the most represented complication (AU).

Risk factors for urinary tract infection in kidney transplantation from brain death donor and its role in graft function / 中南大学学报(医学版)

OBJECTIVES@#Urinary tract infection (UTI) is the most common infection complication after kidney transplantation, and the reports of the incidence vary greatly among different centers. This study aims to explore the risk factors for UTI after kidney transplantation with the donation from brain death (DBD) and the impact on graft function, thus to provide theoretical basis for comprehensive prevention and treatment of UTI after kidney transplantation.@*METHODS@#The clinical and laboratory data of DBD kidney transplantation from January 2017 to December 2018 in Xiangya Hospital, Central South University were collected and retrospectively analyzed. Patients were assigned into an UTI group and a non-UTI group. The base line characteristics, post-transplant complications, and graft function were compared between the 2 groups. Multivariate logistic regression was used to analyze the risk factors for UTI.@*RESULTS@#A total of 212 DBD kidney transplant recipients were enrolled in this study. UTI occurred in 44 (20.75%) patients after transplantation. The female, the time of indwelling catheter, and postoperative urinary fistula were independent risk factors for UTI after DBD kidney transplantation. A total of 19 strains of gram-positive bacteria, 12 strains of gram-negative bacteria , and 10 strains of fungi were isolated from the urine of 44 UTI patients. The UTI after kidney transplantation significantly increased time of hospital stay (@*CONCLUSIONS@#UTI after DBD kidney transplantation transplantation affects the renal function at 3 months and increases the patient's economic burden.

Clinical features of neurogenic bladder with vesicoureteral reflux in children / 中国当代儿科杂志

OBJECTIVE@#To study the clinical features of vesicoureteral reflux (VUR) in children with neurogenic bladder (NB), and to provide a reference for its early diagnosis and treatment.@*METHODS@#Clinical data were collected from 26 children with NB and urinary tract infection who were admitted to the Department of Pediatric Nephrology from January 2014 to December 2019. According to the presence or absence of VUR, the children were divided into a VUR group with 11 children and a non-VUR group with 15 children. Clinical features were compared between the two groups.@*RESULTS@#Compared with the non-VUR group, the VUR group had a significantly higher proportion of children with non-@*CONCLUSIONS@#When NB children have the clinical manifestations of non-

Hidronefrosis gigante: a propósito de dos casos con distintas etologías / Giant hydronephrosis: about two cases with different etologies

La hidronefrosis gigante se considera una entidad rara, caracterizada por la presencia de al menos 1 litro de líquido dentro del sistema pielocalicial, más frecuente en pacientes masculinos, generalmente asintomático. Se presenta el caso de una paciente femenina de 85 años de edad quien refiere desde hace 6 años dolor lumbar izquierdo y aumento de la circunferencia abdominal; en la TAC abdomino-pélvica contrastada se evidencia bolsa hidronefrótica izquierda gigante con corteza renal adelgazada que no concentra ni elimina el contraste. Se presenta el caso de paciente masculino de 85 años de edad quien refiere desde hace 5 años aumento de la circunferencia abdominal y la TAC abdomino-pélvica contrastada muestra importante dilatación del riñón y sistema colector derecho secundario a litiasis ureteral. A ambos pacientes se les practicó nefrectomía simple. Con respecto a la hidronefrosis gigante, la etiología más frecuente es la estenosis de la unión ureteropélvica seguido por la patología litiásica y tumoral; es importante considerar esta entidad como diagnóstico diferencial en caso de masas quísticas abdominales(AU)

Giant hydronephrosis is considered a rare entity, characterized by the presence of at least 1 liter of fluid within the pielocalicial system; is more frequent in males and often asymptomatic. We present an 85-year-old female patient who has a 6-year complain of left lumbar pain associated with increase in abdominal circumference. On CT scan, a giant left hydronephrotic pouch is evidenced, with a thinned renal wall that does not concentrate or eliminate contrast. We present a 61 year-old male who refers a 5-year asymptomatic increase in abdominal circumference. The CT scan reveals significant dilatation of the kidney and right collecting system secondary to ureteral lithiasis. Both patients undergo simple nephrectomy. The most frequent etiology of giant hydronephrosis is ureteropelvic junction stenosis followed by lithiasic and tumor pathology. It is important to consider this entity as a differential diagnosis in the case of abdominal cystic masses(AU)

Factores de riesgo para infección del tracto urinario asociado al uso de catéter urinario permanente en pacientes adultos hospitalizados / Risk factors for urinary tract infection associated with the use of urinary catheters in hospitalized adult

Resumen La infección del tracto urinario asociada al catéter urinario permanente (ITU/CUP) es un problema relevante en los centros de salud por su alta frecuencia. Objetivo: Identificar factores de riesgo de ITU en pacientes adultos con CUP. Material y Método: Estudio caso control efectuado entre los años 2010-2016 en el Hospital Militar de Santiago. Se realizó un análisis estadístico univariado y multivariado por medio del modelo de regresión logística binaria, con variables como edad, duración e indicación del dispositivo, algunas comorbilidades y la instalación del dispositivo luego de 15 días hospitalización. Resultado: Se obtuvo un total de 63 casos y 123 controles. Fueron variables predictoras de ITU/CUP la duración del CUP desde el séptimo día en adelante (OR 2,6 IC 1,4-4,9, p = 0,004) y la instalación del CUP con una estadía de hospitalización previa de 15 días y más (OR 7,8 IC 2,920,9 p = 0,000). No se encontró asociación con la edad mayor de 80 años, comorbilidades como diabetes y vejiga neurogénica e indicación de instalación. Conclusiones: Los resultados permiten focalizar las intervenciones, evaluando la necesidad real de indicación de CUP en pacientes con estadía hospitalaria previa de dos semanas y fomentar el retiro de CUP antes del séptimo día de uso.

Abstract Catheter-associated urinary tract infection (CAUTI) is a relevant problem in health centers because of its high frequency. Objective: To identify UTI risk factors in adult patients with urinary catheter. Material and Method: Control case study carried out between the years 2010-2016 at the Military Hospital of Santiago, Chile. Univariate and multivariate statistical analysis were performed using the binary logistic regression model, variables such as age, duration and indication of the device, some comorbidities and the installation of the device after 15 days of hospitalization. Result: A total of 63 cases and 123 controls were obtained. Predictive variables of CAUTI for the duration of the urinary catheter from the 7th day onwards (OR 2.6 IC 1.4-4.9, p = 0.004) and the installation of the urinary catheter with a previous hospital stay of 15 days and more (OR 7.8 CI 2.9-20.9 p = 0.000). No association was found in age over 80 years, comorbidities such as diabetes and neurogenic bladder and indication. Conclusions: The results permitted to focus the interventions, evaluating the real need for indication of CUP in patients with previous hospital statistics of 2 weeks and encouraging the withdrawal of CUP before the 7th day of use.

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.

Urinary tract infection in pediatrics: an overview / Infecção do trato urinário em pediatria: uma visão geral

Abstract Objective This review aimed to provide a critical overview on the pathogenesis, clinical findings, diagnosis, imaging investigation, treatment, chemoprophylaxis, and complications of urinary tract infection in pediatric patients. Source of data Data were obtained independently by two authors, who carried out a comprehensive and non-systematic search in public databases. Summary of findings Urinary tract infection is the most common bacterial infection in children. Urinary tract infection in pediatric patients can be the early clinical manifestation of congenital anomalies of the kidney and urinary tract (CAKUT) or be related to bladder dysfunctions. E. coli is responsible for 80-90% of community-acquired acute pyelonephritis episodes, especially in children. Bacterial virulence factors and the innate host immune systems may contribute to the occurrence and severity of urinary tract infection. The clinical presentation of urinary tract infections in children is highly heterogeneous, with symptoms that can be quite obscure. Urine culture is still the gold standard for diagnosing urinary tract infection and methods of urine collection in individual centers should be determined based on the accuracy of voided specimens. The debate on the ideal imaging protocol is still ongoing and there is tendency of less use of prophylaxis. Alternative measures and management of risk factors for recurrent urinary tract infection should be emphasized. However, in selected patients, prophylaxis can protect from recurrent urinary tract infection and long-term consequences. According to population-based studies, hypertension and chronic kidney disease are rarely associated with urinary tract infection. Conclusion Many aspects regarding urinary tract infection in children are still matters of debate, especially imaging investigation and indication of antibiotic prophylaxis. Further longitudinal studies are needed to establish tailored approach of urinary tract infection in childhood.

Resumo Objetivo Esta revisão teve como objetivo fornecer uma visão crítica da patogênese, achados clínicos, diagnóstico, investigação por imagem, tratamento, quimioprofilaxia e complicações da infecção do trato urinário em pacientes pediátricos. Fonte de dados Os dados foram obtidos de forma independente por dois autores que fizeram uma pesquisa abrangente e não sistemática em bancos de dados públicos. Síntese dos achados A infecção do trato urinário é a infecção bacteriana mais comum em crianças. Em pacientes pediátricos, pode ser a manifestação clínica precoce de anomalias congênitas do rim e trato urinário (CAKUT) ou estar relacionada a disfunções da bexiga. A E. coli é responsável por 80-90% dos episódios agudos de pielonefrite adquirida na comunidade, principalmente em crianças. Os fatores de virulência bacteriana e o sistema imunológico inato do hospedeiro podem contribuir para a ocorrência e gravidade da infecção do trato urinário. A apresentação clínica de infecções do trato urinário em crianças é altamente heterogênea, com sintomas que podem ser bastante obscuros. A cultura de urina ainda é o padrão-ouro para o diagnóstico de infecção do trato urinário e os métodos de coleta de urina em centros individuais devem ser determinados com base na precisão das amostras coletadas. O debate sobre o protocolo de imagem ideal ainda está em andamento e há uma tendência a um menor uso da profilaxia. Medidas opcionais e o manejo dos fatores de risco para infecção do trato urinário recorrente devem ser enfatizados. Entretanto, em pacientes selecionados, a profilaxia pode proteger contra infecção do trato urinário recorrente e consequências em longo prazo. Segundo estudos populacionais, hipertensão e doença renal crônica raramente são associadas à infecção do trato urinário. Conclusão Muitos aspectos relacionados à infecção do trato urinário em crianças ainda são motivo de debate, principalmente a investigação por imagem e a indicação de profilaxia com antibióticos. Estudos longitudinais adicionais são necessários para estabelecer uma abordagem personalizada da infecção do trato urinário na população pediátrica.

Perfil de resistência, etiologia e prevalência de patógenosisolados em uroculturas de gestantes atendidas em umlaboratório de análises clínicas da cidade de Veranópolis,Rio Grande do Sul / Resistance profile and prevalence of isolated pathogens from urine cultures of pregnant women attended in a clinical analysis laboratory in the Veranópolis city, Rio Grande do Su

Objetivo: O objetivo deste estudo foi determinar a prevalência de ITU, analisando a faixa etária bem como o perfil de resistência aos antimicrobianos a partir da urocultura de gestantes. Métodos: Foi realizado um estudo observacional, descritivo e transversal por meio da análise de 538 laudos de urocultura de gestantes atendidas em um laboratório de análises clínicas da cidade de Veranópolis, Rio Grande do Sul, no período de abril de 2014 a abril de 2017. Os dados foram coletados a partir do sistema laboratorial Jalis e transcritos para uma planilha utilizando o programa Microsoft Office Excel® 2010. Resultados: Dos 538 laudos de uroculturas de gestantes analisados, 137 (25,5%) apresentaram crescimento bacteriano. Analisando a prevalência dos microrganismos, Escherichia coli foi o agente predominante (65%), apresentando maior resistência a ampicilina (53,4%) e a sulfametoxazol + trimetoprim (22,5%). Conclusão: A realização da urocultura durante o pré-natal é de extrema importância para garantir um diagnóstico precoce de ITU e iniciar uma antibioticoterapia adequada, a fim de evitar complicações maternas e fetais.

Objective:The objective of this study was to determine the prevalence of UTI, analyzing the age range as well as the profile of antimicrobial resistance from the urine culture of pregnant women. Methods: An observational, descriptive and transversal study was carried out through analysis of 538 urine culture exam reports of pregnant women attended in a laboratory of clinical analyses in the city of Veranópolis, Rio Grande do Sul, in the period from April 2014 to April 2017. The data were collected from the laboratorial system Jalis and transcribed to a spreadsheet using the Microsoft Office Excel® 2010 program. Results: Of 538 reports of pregnant women urine cultures analyzed, 137 (25,5%) presented bacterial growth. Analyzing the prevalence of the microorganisms, Escherichia coli was the predominant agent (65%), showing a higher resistance to ampicillin (53,4%) and to sulfametoxazol + trimetoprim (22,5%). Conclusion: The urine culture realization during the prenatal is of extreme importance to guarantee an early diagnosis of UTI and to begin an appropriate antibiotic therapy, in order to avoid maternal and fetal complications.

Use of sodium-glucose cotransporter-2 inhibitors and urinary tract infections in type 2 diabetes patients: a systematic review

SUMMARY Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are drugs that act by maintaining glycosuria. Recent studies have shown promising effects of these in the treatment of type 2 diabetes mellitus (DM2). However, there may be an increased risk of developing urinary tract infections (UTIs) in patients treated with these. Our study aims to analyze the association between the risk of UTI in patients treated with SGLT2i. A systematic review of the literature was carried out by randomized clinical trials, totalizing at the end of the selection 23 articles that were statistically evaluated. The incidence of UTI was generally demonstrated in articles and in different subgroups: patients on SGLT2i monotherapy or on combination therapy; according to specific comorbidities of each sample or according to the drug used. They noticed an increase in the chance of UTI in the SGLT2i groups compared to the control groups on placebo or other oral antidiabetic agents. This increased chance was found predominantly with the use of Dapagliflozin, Canagliflozin, and Tofogliflozin, regardless of the dosing. Lastly, stands out that the dimension of UTI chances for DM2 patients who use SGLT2i remains to be more strictly determined.

RESUMO Os inibidores do cotransportador de sódio-glicose do tipo 2 (SGLT2i) são medicamentos que atuam mantendo a glicosúria. Estudos recentes têm demonstrado efeitos promissores desses no tratamento de diabetes mellitus tipo 2 (DM2). No entanto, pode haver um risco aumentado de desenvolver infecções do trato urinário (UTI) em pacientes tratados com essa classe de medicação. Nosso estudo tem como objetivo analisar a associação entre o risco de desenvolver UTI em pacientes tratados com SGLT2i. Uma revisão sistemática da literatura foi realizada por ensaios clínicos randomizados, totalizando, ao final da seleção, 23 artigos que foram avaliados estatisticamente. A incidência de UTI foi demonstrada genericamente de acordo com os dados dos artigos e em diferentes subgrupos: pacientes em monoterapia com SGLT2i ou em terapia combinada, de acordo com as comorbidades específicas de cada amostra ou de acordo com a droga utilizada. Verificou-se um aumento na chance de UTI nos grupos SGLT2i em comparação com os grupos de controle em placebo ou outros agentes antidiabéticos orais. Essa chance aumentada foi encontrada predominantemente com uso de Dapagliflozina, Canagliflozina e Tofoglifozina, independentemente da dosagem. Por fim, ressaltou-se que as chances de UTI em pacientes com DM2 em uso de SGLT2i ainda precisam ser mais bem determinadas.

Caracterización de gestantes con urosepsis y resistencia antimicrobiana de Escherichia coli, Hospital General Docente Dr. Agostinho Neto, Guantánamo / Caracterização de gestantes portadoras de urossepse e resistência antimicrobiana de Escherichia coli, Hospital Dr. Agostinho Neto, Guantánamo / Characterization of pregnant women with urosepsis and antimicrobial resistance of Escherichia coli, Hospital Dr. Agostinho Neto, Guantánamo

Introducción: la resistencia combinada a múltiples antibióticos en algunas de las principales bacterias patógenas en humanos está aumentando en los últimos años y está generando una importante amenaza para la salud pública. Objetivo: caracterizar a las gestantes con urosepsis que presentaron resistencia antimicrobiana de Escherichia coli aislada en urocultivos y atendidas en el Hospital General Docente "Dr. Agostinho Neto" de Guantánamo durante el periodo enero-junio de 2017. Método: se realizó un estudio descriptivo, transversal y retrospectivo en el Hospital General Docente Dr. Agostinho Neto de Guantánamo, en el periodo enero a junio 2017. El universo de estudio quedó constituido por 58 gestantes. Las variables estudiadas fueron: edad, paridad, factores de riesgo y resistencia. Se utilizó como medida de resumen la frecuencia absoluta y la frecuencia relativa (por ciento). Resultados: el mayor número de gestantes con urosepsis causada por Escherichia coli se encontraban en el grupo de edades entre los 19 y 29 para un 48,3 por ciento. La urosepsis en etapas anteriores al embarazo se identificó en el 48,3 por ciento de las multíparas, solo 11 de las primíparas (19,0 por ciento). La anemia se diagnosticó en 28 gestantes (48,3 por ciento), la diabetes mellitus tipo II en 11 pacientes para un 19,0 por ciento. En 33 gestantes (57 por ciento), se presentó resistencia al ácido nalidíxico, en 28 al sulfaprim (48,2 por ciento) y en el 40 por ciento a la amoxicilina+ácido clavulánico un total de 23 pacientes. Conclusiones: la urosepsis por Escherichia coli predominó en gestantes comprendidas entre los 19 y 29 años, multíparas, con esta entidad en etapas anteriores al embarazo, anemia, multigestas y con diabetes mellitus. Se presentó resistencia al ácido nalidíxico, sulfaprim, amoxicilina + ácido clavulánico y cefalexina(AU)

Introduction: the combined resistance to multiple antibiotics in some of the main pathogenic bacteria in humans is increasing in recent years and is generating a major threat to public health. Objective: to characterize pregnant women with urosepsis who presented antimicrobial resistance of Escherichia coli isolated in urocultures and treated in the General Teaching Hospital Dr. Agostinho Neto of Guantanamo during the period from January to June 2017. Method: a descriptive study was carried out, transversal and retrospective in the General Teaching Hospital "Dr. Agostinho Neto" of Guantánamo, in the period January to June 2017. The universe of study was constituted by 58 pregnant women. The variables studied were: age, parity, risk factors and resistance. The absolute frequency and the relative frequency (percent) were used as a summary measure. Results: the greater number of pregnant women with urosepsis caused by Escherichia coli were in the age group between 19 and 29 for 48.3 percent. Urosepsis in stages prior to pregnancy was identified in 48.3 percent of the multiparous women, only 11 of the primiparous women (19.0 percent). Anemia was diagnosed in 28 pregnant women (48.3 percent), diabetes mellitus type II in 11 patients for 19.0 percent. In 33 pregnant women (57 percent), there was resistance to nalidixic acid, in 28 to sulfaprim (48.2 percent) and in 40 percent to amoxicillin + clavulanic acid a total of 23 patients. Conclusions: Urosepsis due to Escherichia coli predominated in pregnant women between 19 and 29 years of age, multiparous, with this condition in stages before pregnancy, anemia, multigesta and with diabetes mellitus. There was resistance to nalidixic acid, sulfaprim, amoxicillin + clavulanic acid and cephalexin(AU)

Introdução: a resistência combinada a múltiplos antibióticos em algumas das principais bactérias patogénicas em seres humanos está a aumentar nos últimos anos e está gerando uma ameaça significativa para a saúde pública. Objectivo: Para caracterizar as mulheres grávidas com urosepsis apresentando resistência antimicrobiana de E. coli isoladas a partir de culturas de urina e tratados no geral Ensino Dr. Agostinho Neto Hospital Guantánamo durante o período de Janeiro a Junho de 2017. Métodos: Um estudo descritivo, transversal e retrospectivo, no geral Ensino Dr. Agostinho Neto Hospital Guantánamo, no período de janeiro a junho de 2017. o grupo de estudo foi composto por 58 mulheres grávidas. As variáveis estudadas foram: idade, paridade, fatores de risco e resistência. A frequência absoluta e a frequência relativa (por cento) foram usadas como uma medida resumida. Resultados: o maior número de mulheres grávidas com urosepsis causada por E. coli foram no grupo de idade entre 19 e 29-48,3 por cento. Urosepsis em fases anteriores de gravidez foi identificada em 48,3 por cento dos multíparas, apenas 11 primíparas (19,0 por cento). Anemia foi diagnosticada em 28 mulheres grávidas (48,3 por cento), diabetes mellitus do tipo II em 11 pacientes de 19,0 por cento. Em 33 mulheres grávidas (57 por cento), ácido nalidíxico resistência é apresentado na sulfaprim 28 (48,2 por cento) e 40 por cento de Amoxicilina um total de 23 pacientes. Conclusões: urosepsis por E. coli predominou em mulheres grávidas entre 19 e 29 anos de idade, multíparas, com esta entidade em estágios iniciais da gravidez, anemia, diabetes mellitus e multigravidas. Houve resistência ao ácido nalidíxico, sulfaprim, amoxicilina + ácido clavulânico e cefalexina(AU)

Resistencia antimicrobiana de la Escherichia coli en pacientes con infección del tracto urinario / Resistência antimicrobiana de Escherichia coli em pacientes com infecção do trato urinário / Antimicrobial resistance of Escherichia coli in patients with urinary tract infection

Introducción: en el municipio Guantánamo no se ha esclarecido la sensibilidad de la bacteria Escherichia coli a los diferentes antimicrobianos que se utilizan en las infecciones del tracto urinario. Objetivo: determinarlos patrones de resistencia antimicrobiana de esta bacteria aisladas en urocultivos de pacientes adultos ambulatorios con esta infección en el municipio Guantánamo. Método: se realizó un estudio descriptivo y transversal de enero a marzo de 2019 en el Laboratorio de Microbiología del Centro Provincial de Higiene, Epidemiología y Microbiología de Guantánamo. El universo se conformó por el total de pacientes (N=567) con urocultivos positivos, de los que se seleccionó una muestra constituida por aquellos con urocultivo positivo en los que se aisló la bacteria Escherichia coli (n=341). Resultados: las cepas de Escherichia coli mostraron una resistencia menor del 18,0 por ciento para la cefalexina, gentamicina, kanamicina, ciprofloxacina y la nitrofurantoina. Los antibióticos betalactámicos (ampicillin y amoxicilina) y macrólidos (azitromicina) mostraron resistencia de 61,6, 64,6 y 54,5 por ciento , respectivamente. La resistencia del cotrimoxazol y ácido nalidíxico osciló entre 25,0 al 28,6 por ciento . Fue alta la sensibilidad de Escherichia coli a la nitrofurantoína (92,9 por ciento ). Se encontraron patrones de ultirresistencia en 57 cepas (16,6 por ciento ). Conclusiones: en el territorio guantanamero, la prescripción de antimicrobianos del tipo de la cefalexina, la gentamicina, la kanamicina, la ciprofloxacina y la nitrofurantoina parecen ser las opciones más beneficiosas para la terapia de las ITU por Escherichia coli(AU)

Introduction: the sensitivity of the Escherichia coli bacteria to the different antimicrobials used in urinary tract infections has not been clarified in the Guantanamo municipality. Objective: to determine the antimicrobial resistance patterns of this bacterium isolated in urine cultures of outpatient adults with this infection in the municipality of Guantanamo. Method: a descriptive and cross-sectional study was carried out from January to March 2019 in the Microbiology Laboratory of the Provincial Center of Hygiene, Epidemiology and Microbiology of Guantanamo. The universe was formed by the total number of patients (N=567) with positive urine cultures, from which a sample consisting of those with positive urine culture was selected in which the Escherichia coli bacteria were isolated (n=341). Results: Escherichia coli strains showed a resistance less than 18.0 percent for cephalexin, gentamicin, kanamycin, ciprofloxacin and nitrofurantoin. The beta-lactam antibiotics (ampicillin and amoxicillin) and macrolides (azithromycin) showed resistance of 61.6, 64.6 and 54.5 percent, respectively. The resistance of cotrimoxazole and nalidixic acid ranged from 25.0 to 28.6 percent. The sensitivity of Escherichia coli to nitrofurantoin was high (92.9 percent). Multiresistance patterns were found in 57 strains (16.6 percent). Conclusions: in the Guantanamo territory, the prescription of antimicrobials of the type of cephalexin, gentamicin, kanamycin, ciprofloxacin and nitrofurantoin seem to be the most beneficial options for the therapy of UTIs by Escherichia coli(AU)

Introdução: a sensibilidade da bactéria Escherichia coli aos diferentes antimicrobianos utilizados nas infecções do trato urinário não foi esclarecida no município de Guantánamo. Objetivo: determinar os padrões de resistência antimicrobiana desta bactéria isolada em urinas de adultos ambulatoriais com esta infecção no município de Guantánamo. Método: um estudo descritivo e transversal foi realizado de janeiro a março de 2019 no Laboratório de Microbiologia do Centro Provincial de Higiene, Epidemiologia e Microbiologia de Guantánamo. O universo foi formado pelo número total de pacientes (N=567) com culturas de urina positivas, das quais foi selecionada uma amostra composta por pacientes com cultura de urina positiva, na qual as bactérias Escherichia coli foram isoladas (n=41). Resultados: as cepas de Escherichia coli apresentaram resistência inferior a 18,0 por cento para cefalexina, gentamicina, canamicina, ciprofloxacina e nitrofurantoína. Os antibióticos beta-lactâmicos (ampicilina e amoxicilina) e os macrólidos (azitromicina) apresentaram resistência de 61,6, 64,6 e 54,5 por cento, respectivamente. A resistência do cotrimoxazol e ácido nalidíxico variou de 25,0 a 28,6 por cento. A sensibilidade de Escherichia coli à nitrofurantoína foi alta (92,9 por cento). Padrões de multirresistência foram encontrados em 57 cepas (16,6 por cento). Conclusões: no território de Guantánamo, a prescrição de antimicrobianos do tipo de cefalexina, gentamicina, canamicina, ciprofloxacina e nitrofurantoína parece ser a opção mais benéfica para o tratamento de ITU por Escherichia coli(AU)

Infección del tracto urinario asociada a sonda vesical: Actualización y recomendaciones intersociedades / An update on catheter-associated urinary tract infection. Inter-Society recommendations

Representantes de la Sociedad Argentina de Infectología (SADI) y la Sociedad Argentina de Terapia Intensiva (SATI) acordaron la elaboración de recomendaciones de diagnóstico, tratamiento y prevención de la infección del tracto urinario asociada a sonda vesical (ITU-SV). La metodología utilizada fue el análisis de la bibliografía publicada en 2006-2016, complementada con la opinión de expertos y datos epidemiológicos locales. En este documento se pretende ofrecer herramientas básicas de optimización de diagnóstico en base a criterios clínicos y microbiológicos, orientación en los esquemas antibióticos empíricos y dirigidos, y promover las medidas efectivas para reducir el riesgo de ITU-SV. Se destaca la preocupación por el control y tratamiento inadecuados de la ITU-SV, en particular el uso indiscriminado de antimicrobianos y la importancia de garantizar la mejora en las prácticas diarias. Se establecen pautas locales para mejorar la prevención, optimizar el diagnóstico y tratamiento de la ITU-SV, y así disminuir la morbimortalidad, los días de internación, los costos y la resistencia a antibióticos debidos al mal uso de los antimicrobianos.

Representatives of the Argentine Society of Infectious Diseases (SADI) and the Argentine Society of Intensive Therapy (SATI) issued the present recommendations on diagnosis, treatment, and prevention of catheter associated urinary tract infection (CA-UTI). Articles published during 2006-2016 were analyzed in the light of experts' opinion and local data. This document aims to offer basic strategies to optimize the diagnosis based on clinical and microbiological criteria, provide guidance in empirical and targeted antibiotic schemes, and promote effective measures to reduce the risk of CA-UTI. The joint work of both societies highlights the experts' concern about the mismanagement of CA-UTI, which is associated to the indiscriminate use of antimicrobials, and the importance of improving daily practices of CA-UTI management. Through these recommendations, local guidelines are established to optimize the diagnosis, treatment and prevention of CAUTI in order to reduce morbimortality, days of hospitalization, costs and antibiotic resistance due to the misuse of antimicrobials.

Efecto de la lactancia en las infecciones pediátricas frecuentes: estudio de cohorte prospectivo de cinco años / Effect of breastfeeding on common pediatric infections: a 5-year prospective cohort study

Introducción. En los estudios realizados se encontró que la duración de la lactancia tiene un efecto reductor sobre las infecciones frecuentes en los niños durante el período de lactancia. Objetivo. El objetivo de este estudio fue abordar la asociación entre la duración de la lactancia y las enfermedades infecciosas frecuentes en los niños hasta los 5 años de edad para demostrar los efectos protectores de la leche materna. Población y métodos. Se incluyeron 411 lactantes nacidos en Rize, Turquía, entre enero de 2011 y diciembre de 2011. Este estudio de cohorte, prospectivo duró cinco años; en este período, se realizaron 11 entrevistas con cada madre de los lactantes. Se dividió a los lactantes en dos grupos: amamantados durante más y menos de 12 meses, y se estudió la asociación entre la lactancia y las infecciones, como otitis media aguda, gastroenteritis aguda, infección respiratoria aguda e infección urinaria. Resultados. De los 411 nacimientos, se incluyeron 270 lactantes, 193 (71,5%) recibieron lactancia durante más de 12 meses y 77 (28,5%), durante menos de 12 meses. Los lactantes del primer grupo tuvieron menos casos de otitis media aguda y gastroenteritis aguda (n = 77; 28,52%) en comparación con los lactantes amamantados durante menos de 12 meses en el período de cinco años (p < 0,05). Conclusiones. Con este estudio se detectó que la lactancia durante más de 12 meses reduce significativamente las infecciones frecuentes durante la niñez, como la otitis media y la gastroenteritis durante los primeros cinco años de vida.

Introduction.The studies conducted revealed that breastfeeding duration has a reducing effect on common infectious diseases in the children during breastfeeding period. Objective. The aim of the present study was to address the association between breastfeeding duration and common infectious diseases in the children until 5 years of age to show long-term protective effects of the breast milk. Material and methods. The study included 411 infants who were born in Rize (Turkey) between January 2011 and December 2011. The present prospective-cohort study lasted for 5 years and 11 interviews were conducted with each mother of the infants during this period. The infants were divided into two groups as those who were breastfed more and less than 12 months and the association between breastfeeding and infections such as acute otitis media, acute gastroenteritis, acute respiratory tract infections and acute urinary system infections was investigated. Results. Of 270 infants 193 (71.5%) were breastfed longer than 12 months and 77 (28.5%) were breastfed less than 12 months. Infants in the first group had less acute otitis media and acute gastroenteritis (n= 77, 28.52%) when compared with the infants breastfed less than 12 months during 5-year period (p <0.05). Conclusion. The present study detected that breastfeeding duration longer than 12 months significantly reduces the common childhood infections such as otitis media and gastroenteritis during the first 5 years of life.

Risk factors for urinary tract infection in children with urinary urgency

ABSTRACT Purpose To identify which independent variable would be strong predictor of febrile urinary tract infection (UTI) in children and adolescents with overactive bladder. Materials and Methods A search was made of the institute's database for all patients diagnosed with overactive bladder over the preceding four years. Children and adolescents under 18 years of age with overactive bladder and no neurological or anatomical alterations of the lower urinary tract were included in the study. The independent variables were: sex, age, ethnicity (Brazilians of African descendence/others), the presence of urinary urgency, daytime incontinence, enuresis, frequent urination, infrequent voiding (≤3 voids/day), nocturia, holding maneuvers, straining to void, intermittent urinary flow, constipation and encopresis. An analysis was conducted to identify patients with febrile UTI and subsequently determine predictors of this condition. Univariate and multivariate analyses were performed. Results Overall, 326 patients (214 girls/112 boys) were evaluated. The mean age of the patients was 7.7±3.19 years (± standard deviation). The incidence of febrile UTI was 39.2%. Being female and infrequent voiding were factors significantly associated with febrile UTI, both in the univariate and multivariate analyses. Conclusions These results show that being female and infrequent voiding constituted significant risk factors for a diagnosis of febrile UTI in these children.

Intra-hospital complications in acute traumatic spinal cord injury / Complicações intra-hospitalares em pacientes com lesão medular traumática aguda

There is scarce data about intra-hospital complications in acute traumatic spinal cord injury (TSCI). Objective: To report characteristics of complications in patients with TSCI in a major trauma center. Method: This is a cross-sectional study with 434 patients with acute TSCI from 2004 to 2014. Outcomes were frequency and description of complications, length of hospital stay (LOS), and causes of increased LOS. Results: Patients presented at least 1 complication in 82.2% of the cases: urinary tract infection (UTI) = 64.4%, pressure ulcers (PU) = 50.6%, and pneumonia = 23.7%. Pneumonia, intubation and cases of surgical corrections for PU were independently associated with increased LOS. Conclusion: UTIs and PUs were the most frequent complications. Investigating its causes and consequences is paramount in the care of patients with SCI. Possible reasons for such complications could comprise time, and frequency of repositioning in bed. Investigating intra-hospital complications is paramount in SCI centers.

Há poucos dados sobre complicações hospitalares em pacientes com LMT aguda. Objetivo: Reportar as características de complicações em pacientes com LMT em um grande centro de trauma. Método: Estudo transversal com 434 pacientes com LMT aguda de 2004 a 2014. Os desfechos foram a frequência e característica das complicações, o tempo de internação (TDI), e fatores associados com seu aumento. Resultados: Incidência de complicações foi 82,2%, sendo as mais frequentes: infecção do trato urinário (ITU)=64,4%, úlcera de pressão (UP)= 50,6% e pneumonia= 23,7%. Pneumonia, intubação, e ser submetido a qualquer cirurgia para UP foram independentemente associados com aumento do TDI. Conclusão: ITUs e UP foram as complicações mais prevalentes, e devem ser melhor estudadas para melhor atenção a LMT. As investigações sobre as complicações na lesão medular traumática devem ser mandatórias nos centros e unidades dedicadas ao tratamento da Lesão Medular.

Can hydrophilic coated catheters be beneficial for the public healthcare system in Brazil? - A cost-effectiveness analysis in patients with spinal cord injuries

ABSTRACT Introduction Detrusor sphincter dyssynergia affects 70% to 80% of all spinal cord injury patients, resulting in increased risk of urinary tract infections (UTIs) and potential exposure to antimicrobial resistance. In Brazil, local guidelines recommend intermittent catheterization as the best method for bladder emptying, and two catheter types are available: the conventional uncoated PVC and the hydrophilic coated catheters. Objective To evaluate the cost-effectiveness of two types of catheters for intermittent catheterization from the perspective of the Brazilian public healthcare system. Materials and Methods A Markov model was used to evaluate cost-effectiveness in those with spinal cord injuries. A primary analysis was conducted on all possible adverse events, and a secondary analysis was performed with urinary tract infections as the only relevant parameter. The results were presented as cost per life years gained (LYG), per quality-adjusted life years (QALY) and per number of urinary tract infections (UTIs) avoided. Results The base scenario of all adverse events shows a cost-effective result of hydrophilic coated catheters compared to uncoated PVC catheters at 57,432 BRL (Brazilian Reais) per LYG and 122,330 BRL per QALY. The secondary scenario showed that the use of hydrophilic coated catheters reduces the total number of UTIs, indicating that an additional cost of hydrophilic coated catheters of 31,240 BRL over a lifetime will reduce lifetime UTIs by 6%. Conclusions Despite the higher unit value, the use of hydrophilic coated catheters is a cost-effective treatment from the perspective of the Brazilian public healthcare system.

Epidemiología de las infecciones urinarias asociadas a catéter y no asociadas a catéter en un hospital universitario de tercer nivel / Nosocomial urinary tract infection: an analysis beyond urinary catheterization

Resumen Introducción: Las infecciones urinarias asociadas a la atención de la salud (ITU-AAS) representan un importante problema sanitario, siendo poco conocidas sus características cuando no están asociadas a cateterización urinaria u ocurren fuera de unidades de cuidados intensivos (UCI). Objetivos: Determinar las características de los pacientes con ITU-AAS, etiología y susceptibilidad antimicrobiana de las mismas, tanto asociadas a catéter (ITU-C) como no asociadas a catéter (ITU-noC), en UCI y en sala general. Materiales y Métodos: Se realizó un estudio analítico retrospectivo de corte transversal entre 2009 y 2013 en un hospital universitario de tercer nivel. Se identificaron todos los episodios de ITU-AAS, diferenciándolas en ITU-C e ITU-noC. Resultados: Se incluyeron 253 episodios de ITU-AAS, siendo más frecuentes las ITU-C (60,9%) respecto a ITU-noC. Un 37,4% de ITU-noC y 59,7% de ITU-C ocurrieron en UCI. Los microorganismos aislados más frecuentemente fueron Escherichia coli, Klebsiella pneumoniae y Enterococcus sp. El 19% de los bacilos gramnegativos fueron productores de β-lactamasa de espectro extendido, siendo su frecuencia similar en ambos grupos. Conclusión: Las co-morbilidades de los pacientes con ITU-AAS, los agentes etiológicos responsables y sus correspondientes espectros de sensibilidad, fueron similares en los grupos de ITU-C e ITU-noC, tanto en sala general como en UCI.

Introduction: Nosocomially acquired urinary tract infections (NAUTI) represent an important public health issue, but its characteristics when they are not catheter associated (CA-UTI) or when they take place outside intensive care units (ICU) are poorly understood. Objectives: To determine the patients' characteristics, etiology and antimicrobial susceptibility of NAUTI, both CA-UTI and no CA-UTI, in general ward and ICU. Methods: We conducted a retrospective analytic cross-sectional study, between 2009 and 2013, in a third level universitary hospital. All NAUTI episodes were identified, classifying them as CA-UTI and no CA-UTI. Results: We included 253 episodes of NAUTI, being CA-UTI (60,9%) more frequent than no CA-UTI. A 37,4% of no CA-UTI and 59,7% of CA-UTI were identified in ICU. The most frequently isolated microorganisms were Escherichia coli, Klebsiella pneumoniae and Enterococcus sp. A 19% of extended spectrum betalactamase producing gram negative bacilli were found, without differences between groups. Conclusion: Patients's comorbidities, microorganisms associated to NAUTI and its antimicrobial susceptibility were similar in CA-UTI and no CA-UTI, as in general ward and ICU.