An open-label comparative prospective study of the clinical and laboratory efficacy and safety of Espa-Focin (fosfomycin trometamol) and Cysto-Aurin (goldenrod preparation) manufactured by Еsparma ...GmbH was performed in 126 female patients with recurrent urinary tract infections (reUTI), who were randomized into four statistically homogeneous groups. During the treatment, patients of all groups used the strategy of behavioral therapy and post-coital prophylaxis. Patients of group A (n = 32) also received Cysto-Aurin 1 tablet qid, in courses of 15 days each month for 6 months, group B (n = 34) — the same drug 2 tablets bid in courses of 15 days each month for 6 months, groups D (n = 30) — Espa-Focin 3 g once every 10 days for 6 months, patients of the comparison group C (n = 30) did not received any special therapy. Treatment efficacy was evaluated within 12 months from the start of the study, with follow-up visits in 15 days, 3, 6, 9 and 12 months from randomization. During the study, a pool of objective data was obtained, indicating a significant decrease in the number of reUTI within 6 months of treatment in patients of clinical groups, as well as during a prospective 6-month period. According to the scale of productivity, a positive clinical effect was observed in 83.3 % of Cysto-Aurin patients, in 93.3 % of persons in Espa-Focin group, and also in 20 % of the comparison group. In the active phase of treatment, anti-relapse efficacy was significantly higher among patients of group D, where the reduction in the number of relapses during the first three months of treatment was 86.8 % and the achieved rate (0.07 ± 0.09 relapses for 3 months) remained unchanged until the end of the drug administration. The corresponding dynamics in groups A and B was lower — 69.2 and 60 % for 3 months and 92.3 and 73.3 % for 6 months; in patients of the comparison group, these figures were 21.4 and 7.1 %, respectively. A significant decrease in leukocyturia in patients of clinical groups was achieved after 15 days of taking the drug, by 57.9 % in group D and by 33.9 and 27.5 % in groups A and B, and during the entire period of treatment — by 78.1, 73.4 and 44.6 %, i.e. 4.6, 3.7 and 1.8 times lower than baseline values, respectively. In the prospective follow-up period, in patients of group A and B, the level of leukocyturia remained significantly lower than the baseline values — by 49.2 and 34.2 % (p < 0.01), while among patients of the fosfomycin group, it almost returned to baseline values. The dynamics of bacteriuria and pyuria in group D was characterized by a significantly higher rate and amplitude of manifestation of peak efficacy of antibacterial activity, but faster reversion of clinical and laboratory results, compared with similar indicators after Cysto-Aurin intake. The amplitude and rate of elimination of clinical symptoms on UTISA questionnaire among patients taking Espa-Focin was significantly higher than among patients using goldenrod (ΔM = 58.15 versus 41.2 %), however, with an equally progressive reversion of reUTI clinical manifestations after discontinuation of treatment. The slower dynamics of clinical efficacy in groups A and B was combined with the moderate inversion of symptoms of the pathology. According to the amplitude of clinical efficacy, in case of reUTI, the efficacy of intermittent administration of Cysto-Aurin is comparable with that of fosfomycin. The rate of increase of the clinical effectiveness during therapy with goldenrod is 1.5 times slower, the strength of manifestations is 24.7 % lower, whereas the duration of the action after discontinuation is 1.45 times higher compared to antibiotic therapy. An increase in the frequency of Cysto-Aurin administration (per day) provides a higher clinical result with a constant duration of the effect. Comparative integral efficiency of different modes of intermittent therapy, according to key indicators of clinical, laboratory data and quality of life, allows us recommending the administration of Espa-Focin for reUTI, which is accompanied by an aggressive course, high bacteriuria and leukocyturia, a combination of different uropathogens in culture. Intermittent administration of Cysto-Aurin has priority in case of moderate bacteriuria, the necessity for a prolonged duration of anti-relapse treatment in patients with significant induction of fungal activity and reUTI associated with the persistence of C.albicans, local and systemic manifestations of dysbiosis.
Urinary tract infections (UTI) are a common problem in medical practice, the etiology and susceptibility that produce the UTI may vary over time. It was conducted a study of no-experimental ...descriptive in order to detect the causative organisms of urinary tract infections and antimicrobial susceptibility in older adults residing in a health center of Carabobo state. They were evaluated 57 urine samples for bacteriological culture and the recovered microorganisms underwent susceptibility testing by disk diffusion method in agar (Kirby-Bauer). The most frequently isolated microorganisms in the ITU were Escherichia coli (53.84% and Klebsiella pneumoniae (15.40%), among others. In the antimicrobial susceptibility testing, the antibiotics that showed better antimicrobial activity were nitrofurantoin and amikacin (84.62%) each one, followed by gentamicin (76.92%) for all the Gramnegative bacilli recovered. The greater resistance was observed in ampicillin (61.54%), followed by trimethoprim-sulfamethoxazole (53.85%) and ciprofloxacin (46.15%), in enteric Gram-negative bacilli. In the present study was found a greater presence of Escherichia coli in the UTI as well as better antimicrobial activity of nitrofurantoin, amikacin and gentamicin against all the bacteria recovered. Resumen: Las infecciones del tracto urinario (ITU) representan un problema común en la práctica médica, la etiología y susceptibilidad que la producen pueden variar a través del tiempo. Se realizó un estudio de tipo descriptivo, no experimental con el objetivo de detectar los microorganismos causales de infecciones urinarias y susceptibilidad antimicrobiana en adultos mayores que residen en un centro de salud del Estado Carabobo. Fueron evaluadas 57 muestras de orina por cultivo bacteriológico, y a los microorganismos recuperados se les practico las pruebas de susceptibilidad por el método de difusión con discos en agar (Kirby-Bauer). Los microorganismos aislados con mayor frecuencia en las ITU fueron Escherichia coli (53,84%) y Klebsiella pneumoniae (15,40%) entre otros. En la prueba de susceptibilidad antimicrobiana, los antibióticos que mostraron mejor actividad antimicrobiana fueron nitrofurantoína y amikacina (84,62%) cada uno, seguido de gentamicina (76,92%) para todos los bacilos Gram-negativos recuperados. La mayor resistencia se observó en ampicilina (61,54%), seguido de trimetoprim-sulfametoxazol (53,85%) y ciprofloxacina (46,15%), en bacilos entéricos Gram-negativos. En el presente trabajo se encontró una mayor presencia de Escherichia coli en las ITU así como mejor actividad antimicrobiana de nitrofurantoina, amikacina y gentamicina frente a todas las bacterias recuperadas.
Bacterial resistance to antibiotics is one of the largest medical concerns worldwide.One of the bacteria of critical priority is E. coli, since it presents different resistance mechanisms and some of ...its strains have evolved resistance to beta-lactam antibiotics. We characterized 32 antibiotic resistant bacterial isolates from confirmed cases of urinary tract infections from an array of patients in Nariño, southern Colombia. Macro and microscopic descriptions of the 32 clinical isolates were conducted. Resistance profiles, biochemical, and molecular characterization (via 16S rRNA gene sequencing, ERIC-PCR, and resistance genes) were performed. All the isolates were identified as E. coli and had resistance to beta-lactams, aminoglycosides, and fluoroquinolones. This resistance was related to plasmids carryingthebla TEM, blaSHV1, and blaCTXM1genes.There were significant differences between the resistance proportions of the samples (p value:0.0000), mainly to penicillin, cefotoxin, and imipenem. Using ERIC-PCR, four clonal states were evidenced that corroborate a degree of genetic differentiation with in the isolate set.Antibiotic resistance observed in the isolates is associated with resistance genes present in the bacterial chromosome and plasmids.
Introduction The aim of this study was to determine the prevalence of GBS colonization in pregnant women in a public health service. Methods A study of 496 pregnant women at 35-37 gestational weeks ...was conducted from September 2011 to March 2014 in 21 municipalities of the 18th Health Region of Paraná State. Vaginal and anorectal samples of each woman were plated on sheep blood agar, and in HPTH and Todd-Hewitt enrichment broths. Results Of the 496 pregnant women, 141 (28.4%) were positive for GBS based on the combination of the three culture media with vaginal and anorectal samples. The prevalence was 23.7% for vaginal samples and 21.9% for anorectal ones. Among the variables analyzed in this study, only urinary infection was a significant factor (0.026) associated with GBS colonization in women. Conclusions Based on these results, health units should performs universal screening of pregnant women and hospitals should provide adequate prophylaxis, when indicated.
Las infecciones urinarias son causadas mayormente por Escherichia coli (E. coli), el uso indiscriminado de antibióticos ha originado un aumento de infecciones por cepas productoras de betalactamasas ...de espectro extendido (BLEE). Con el objetivo de determinar la sensibilidad a fosfomicina se realizó un estudio en cepas de E. coli productoras de BLEE aisladas de urocultivos provenientes de un hospital de Perú. Se recolectaron 266 cepas de E. coli identificadas por métodos convencionales como productoras de BLEE. Se determinó la sensibilidad de fosfomicina por concentración inhibitoria mínima mediante el método de dilución en agar y por el método de disco difusión. Se encontró 192 (72,2 %) cepas de E. coli productora de BLEE sensibles a fosfomicina. Se concluye que la fosfomicina presenta actividad antimicrobiana frente a cepas de E. coli productoras de BLEE, y podría ser considerada una buena opción terapéutica frente a cepas resistentes.
Key Clinical Message
Renal ectopia is a relatively rare situation which may complicate the diagnosis. In cases with renal ectopia, the normal route of the urinary tract alters and may be associated ...with increased incidence of infections or coexist with other malformations. We report a female patient with unobstructed pelvic renal ectopia complicated by urinary tract infection. After presenting our diagnostic and therapeutic dilemmas and strategy, we discuss the existing diagnostic and treating options including conservative and surgical approaches.
Renal ectopia is a relatively rare situation which may complicate the diagnosis. In cases with renal ectopia, the normal route of the urinary tract alters and may be associated with increased incidence of infections or coexist with other malformations. We report a female patient with unobstructed pelvic renal ectopia complicated by urinary tract infection. After presenting our diagnostic and therapeutic dilemmas and strategy, we discuss the existing diagnostic and treating options including conservative and surgical approaches.
To evaluate epidemiological aspects of urinary tract infection in older patients with urinary incontinence living in long-term care institutions in Belo Horizonte. Method: Concurrent cohort held from ...April 1st to October 1st, 2015. The study was conducted in two long-term care institutions in the city of Belo Horizonte, Minas Gerais, with 84 incontinent older people.
Cumulative incidence of urinary tract infection was 19% (95% CI: 7.83-23.19) and the incidence density was 3.6 cases/100 people-month of follow-up period. The variables Bacteriuria and Institution presented statistical association with the occurrence of urinary tract infection.
It is observed that the incidence of urinary tract infection in the study was smaller than in other similar international and national studies, however this is an important world health problem for the older population, with impact on mortality of these individuals.
Avaliar aspectos epidemiológicos da infecção do trato urinário em pacientes idosos com incontinência urinária, residentes em instituições de longa permanência, de Belo Horizonte.
Coorte concorrente realizada no período de 01 de abril a 01 de outubro de 2015. O estudo foi realizado em duas instituições de longa permanência, na cidade de Belo Horizonte, MG, com 84 idosos incontinentes.
A incidência acumulada de infecção do trato urinário foi de 19% (IC 95%: 7,83-23,19) e a densidade de incidência foi de 3,6 casos/100 pessoas-mês de seguimento. As variáveis Bacteriúria e Instituição apresentaram associação estatística com a ocorrência de infecção do trato urinário.
Observa-se que a incidência de infecção do trato urinário no estudo foi menor que em outros estudos nacionais e internacionais semelhantes, no entanto trata-se de um importante problema de saúde mundial para os idosos, com impacto na mortalidade desses indivíduos.
This study describes and analyzes Acinetobacter baumannii antibiotic susceptibly profile in Aleppo, Syria, thus providing vital information for guiding treatment of A baumannii infections. Two ...hundred sixty nonrepetitive A baumannii isolates were studied over 3.5 years. Resistance rates are at the higher end of globally reported levels. Newer cephalosporins and β-lactamase-resistant agents are becoming practically ineffective. Better activity is limited to carbapenems and colistin, which elicited the highest susceptibility levels.
With attention to the fact that after anterior colporrhaphy surgery and stitches on vaginal mucus, inserting urinary catheter is requested, according to scientific references and in order to prevent ...from urinary retention, it has been said that the catheter should be inserted for 3 days. But inserting the catheter leads to infections of bladder and pain. So, in the present study, we compared the removal of the catheter 24 hours versus 72 hours after the surgery, considering urinary infections, urinary retention, patient's ease and hospitalization. Within two groups of 70 patients, which has been assimilated based on basic factors (devided into two groups accidently with excel table) urinary catheter fixed for 1 and 3 days. After that, patients were compared considering urinary retention, urinary infections and the rate of patient satisfaction. Urinary retention was 28.6% in the test group and 22.9% in a controlling group which was not statistically meaningful (P = 0.78). Urinary infections were 22.9% in the test group and 34.3% in the controlling group (P = 0.42) and the rate of patient's satisfactions was 57.1% in the test group and 40% in controlling group (P = 0.23). The hospitalization period in the test group and in the control group was 2.91 ± 0.61 and 3.94 ± 0.59 days respectively with a significant difference (P = 0.001). The results showed that short time catheterization is more satisfactory in comparison long catheterizations.
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