Resistance patterns of nosocomial urinary tract infections in urology departments: 8-year results of the global prevalence of infections in urology study.

OBJECTIVE: To present the worldwide antibiotic resistance rates of uropathogens reported in nosocomial urinary tract infections (NAUTI) during the period of 2003-2010. MATERIALS AND METHODS: Data from the Global Prevalence Study of Infections in Urology from the period of 2003-2010 were analyzed to evaluate the resistance rates of pathogens causing NAUTI. The web-based application was used to record data of investigators from urology departments participating in the study every year during the days allocated in November. Each center was allowed to enter data on a single day of the study. The point prevalence data was used to find differences among geographic regions and years by utilizing multiple logistic regression analysis. RESULTS: A total of 19,756 patients were hospitalized during the study period, and in 1,866 of them, NAUTI was reported. Proof of infection was reported in 1,395 patients. Resistance rates of all antibiotics tested other than imipenem against the total bacterial spectrum were higher than 10 % in all regions. Resistance to almost all pathogens was lowest in North Europe, and there is no single year where an outbreak of resistance has been detected. CONCLUSION: The resistance rates of most of the uropathogens against the antibiotics tested did not show significant trends of increase or decrease with Asia exhibiting the highest rates in general. The only antibiotic tested with an overall resistance rate below 10 % was imipenem. Knowledge of regional and local resistance data and prudent use of antibiotics are necessary to optimize antibiotic therapy in urological patients with NAUTI.

[Brachytherapy in prostatic cancer]. / Brakyterapi ved prostatakreft.

BACKGROUND: Brachytherapy is increasingly used in the treatment of early prostate cancer, but has not been implemented as a treatment option in Norway. Recent advances in imaging techniques and the radiation technology itself has facilitated improvements in and better standardisation of brachytherapy. MATERIAL AND METHODS: An group of expert assisted the Norwegian Centre for Health Technology Assessment (SMM) in a systematic review of the evidence on the clinical effectiveness of prostate brachytherapy. The literature was identified by a defined search strategy, and assessed for relevance and validity. Only controlled or comparative studies were included in the review. RESULTS: There were no randomized controlled trials or large prospective studies. Many of the relevant studies were of poor validity. None of the included studies had sufficient follow-up for overall or disease free survival. There were no differences between brachytherapy, external beam therapy or radical prostatectomy in disease free survival (PSA measures) or in rates of complications. INTERPRETATION: There is a lack of valid data from large prospective studies on the clinical effectiveness of brachytherapy. On the other hand, the clinical effectiveness of radical prostatectomy and external beam radiotherapy is also poorly documented. Results from one large randomized controlled trial comparing radical prostatectomy with brachytherapy in the USA will not be available within the next ten years.