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Junqi Z, Jie C, Jinglin W, Jinmiao L, Guoping L, Yi W, Zhiping L. A retrospective study of the efficacy and safety of levofloxacin in children with severe infection. Front Pediatr 2024; 12:1381742. [PMID: 38646513 PMCID: PMC11026612 DOI: 10.3389/fped.2024.1381742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 03/18/2024] [Indexed: 04/23/2024] Open
Abstract
Objectives Levofloxacin is widely used because of its broad-spectrum antimicrobial activity and convenient dosing schedule. However, the relevance of its use in children remains to be investigated. The purpose of this study is to investigate the efficacy and safety of levofloxacin use in children with severe infections. Methods We conducted a retrospective observational study of patients <18 years of age who received levofloxacin intravenously in the Pediatric Intensive Care Unit (PICU) of our hospital during the period between 2021 and 2022. Patient demographics, course characteristics, clinical effectiveness, and adverse event correlations were extracted through a retrospective tabular review. Results We included 25 patients treated with 28 courses of levofloxacin. The mean age of these children treated with levofloxacin was 4.41 years. Conversion of pathogenic microbiological test results to negative after levofloxacin treatment was detected in 11 courses (39.29%). A decrease in inflammatory markers, white blood cell or C-reactive protein counts, was detected in 18 courses (64.29%). A total of 57 adverse events occurred during the treatment period, of which 21 were possibly related to levofloxacin and no adverse events were probably related to levofloxacin. Conclusion The effectiveness of levofloxacin use in children with serious infections is promising, especially for the treatment of multidrug-resistant bacteria. Adverse events occurring during the initiation of levofloxacin therapy in children are reported to be relatively common, but in this study, only a small percentage of them were possibly related to levofloxacin, and none of them were highly possibly related to levofloxacin.
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Affiliation(s)
- Zhang Junqi
- Department of Clinical Pharmacy, National Children’s Medical Center, Children’s Hospital of Fudan University, Shanghai, China
| | - Cai Jie
- Department of Clinical Pharmacy, National Children’s Medical Center, Children’s Hospital of Fudan University, Shanghai, China
| | - Wang Jinglin
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lu Jinmiao
- Department of Clinical Pharmacy, National Children’s Medical Center, Children’s Hospital of Fudan University, Shanghai, China
| | - Lu Guoping
- Pediatric Intensive Care Unit, National Children’s Medical Center, Children’s Hospital of Fudan University, Shanghai, China
| | - Wang Yi
- Department of Neurology, National Children’s Medical Center, Children’s Hospital of Fudan University, Shanghai, China
| | - Li Zhiping
- Department of Clinical Pharmacy, National Children’s Medical Center, Children’s Hospital of Fudan University, Shanghai, China
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Pfäffle SP, Herz C, Brombacher E, Proietti M, Gigl M, Hofstetter CK, Mittermeier-Kleßinger VK, Claßen S, Tran HTT, Dawid C, Kreutz C, Günther S, Lamy E. A 14-Day Double-Blind, Randomized, Controlled Crossover Intervention Study with Anti-Bacterial Benzyl Isothiocyanate from Nasturtium ( Tropaeolum majus) on Human Gut Microbiome and Host Defense. Nutrients 2024; 16:373. [PMID: 38337658 PMCID: PMC10857499 DOI: 10.3390/nu16030373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/12/2024] [Accepted: 01/20/2024] [Indexed: 02/12/2024] Open
Abstract
Despite substantial heterogeneity of studies, there is evidence that antibiotics commonly used in primary care influence the composition of the gastrointestinal microbiota in terms of changing their composition and/or diversity. Benzyl isothiocyanate (BITC) from the food and medicinal plant nasturtium (Tropaeolum majus) is known for its antimicrobial activity and is used for the treatment of infections of the draining urinary tract and upper respiratory tract. Against this background, we raised the question of whether a 14 d nasturtium intervention (3 g daily, N = 30 healthy females) could also impact the normal gut microbiota composition. Spot urinary BITC excretion highly correlated with a weak but significant antibacterial effect against Escherichia coli. A significant increase in human beta defensin 1 as a parameter for host defense was seen in urine and exhaled breath condensate (EBC) upon verum intervention. Pre-to-post analysis revealed that mean gut microbiome composition did not significantly differ between groups, nor did the circulating serum metabolome. On an individual level, some large changes were observed between sampling points, however. Explorative Spearman rank correlation analysis in subgroups revealed associations between gut microbiota and the circulating metabolome, as well as between changes in blood markers and bacterial gut species.
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Affiliation(s)
- Simon P. Pfäffle
- Molecular Preventive Medicine, University Medical Center and Faculty of Medicine, University of Freiburg, Engesserstrasse 4, D-79108 Freiburg, Germany
- Institute of Pharmaceutical Sciences, Faculty of Chemistry and Pharmacy, University of Freiburg, Hermann-Herder-Strasse 9, D-79104 Freiburg, Germany
| | - Corinna Herz
- Molecular Preventive Medicine, University Medical Center and Faculty of Medicine, University of Freiburg, Engesserstrasse 4, D-79108 Freiburg, Germany
| | - Eva Brombacher
- Institute of Medical Biometry and Statistics, University Medical Center and Faculty of Medicine, University of Freiburg, Stefan-Meier-Str. 26, D-79104 Freiburg, Germany
- Faculty of Biology, University of Freiburg, Schänzlestr. 1, D-79104 Freiburg, Germany
- Spemann Graduate School of Biology and Medicine (SGBM), University of Freiburg, Albertstr. 19A, D-79104 Freiburg, Germany
- Centre for Integrative Biological Signaling Studies (CIBSS), University of Freiburg, Schänzlestr. 18, D-79104 Freiburg, Germany
| | - Michele Proietti
- Center for Chronic Immunodeficiency (CCI), Microbiome Core Facility, Breisacher Strasse 115, D-79106 Freiburg, Germany
| | - Michael Gigl
- Chair of Food Chemistry and Molecular Sensory Science, TUM School of Life Sciences, Technical University of Munich, Lise-Meitner-Strasse 34, D-85354 Freising, Germany
- Bavarian Center for Biomolecular Mass Spectrometry, TUM School of Life Sciences, Technical University of Munich, Gregor-Mendel-Strasse 4, D-85354 Freising, Germany
| | - Christoph K. Hofstetter
- Chair of Food Chemistry and Molecular Sensory Science, TUM School of Life Sciences, Technical University of Munich, Lise-Meitner-Strasse 34, D-85354 Freising, Germany
| | - Verena K. Mittermeier-Kleßinger
- Chair of Food Chemistry and Molecular Sensory Science, TUM School of Life Sciences, Technical University of Munich, Lise-Meitner-Strasse 34, D-85354 Freising, Germany
| | - Sophie Claßen
- Molecular Preventive Medicine, University Medical Center and Faculty of Medicine, University of Freiburg, Engesserstrasse 4, D-79108 Freiburg, Germany
| | - Hoai T. T. Tran
- Molecular Preventive Medicine, University Medical Center and Faculty of Medicine, University of Freiburg, Engesserstrasse 4, D-79108 Freiburg, Germany
| | - Corinna Dawid
- Chair of Food Chemistry and Molecular Sensory Science, TUM School of Life Sciences, Technical University of Munich, Lise-Meitner-Strasse 34, D-85354 Freising, Germany
- Bavarian Center for Biomolecular Mass Spectrometry, TUM School of Life Sciences, Technical University of Munich, Gregor-Mendel-Strasse 4, D-85354 Freising, Germany
| | - Clemens Kreutz
- Institute of Medical Biometry and Statistics, University Medical Center and Faculty of Medicine, University of Freiburg, Stefan-Meier-Str. 26, D-79104 Freiburg, Germany
- Centre for Integrative Biological Signaling Studies (CIBSS), University of Freiburg, Schänzlestr. 18, D-79104 Freiburg, Germany
| | - Stefan Günther
- Institute of Pharmaceutical Sciences, Faculty of Chemistry and Pharmacy, University of Freiburg, Hermann-Herder-Strasse 9, D-79104 Freiburg, Germany
| | - Evelyn Lamy
- Molecular Preventive Medicine, University Medical Center and Faculty of Medicine, University of Freiburg, Engesserstrasse 4, D-79108 Freiburg, Germany
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Deschner F, Risch T, Baier C, Schlüter D, Herrmann J, Müller R. Nitroxoline resistance is associated with significant fitness loss and diminishes in vivo virulence of Escherichia coli. Microbiol Spectr 2024; 12:e0307923. [PMID: 38063385 PMCID: PMC10782962 DOI: 10.1128/spectrum.03079-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/14/2023] [Indexed: 01/13/2024] Open
Abstract
IMPORTANCE Antimicrobial resistance (AMR) poses a global threat and requires the exploration of underestimated treatment options. Nitroxoline, an effective broad-spectrum antibiotic, does not suffer from high resistance rates in the clinics but surprisingly, it is not heavily used yet. Our findings provide compelling evidence that Nitroxoline resistance renders bacteria unable to cause an infection in vivo, thereby reinvigorating the potential of Nitroxoline in combating AMR.
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Affiliation(s)
- Felix Deschner
- Microbial Natural Products, Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Helmholtz Centre for Infection Research (HZI) and Department of Pharmacy Saarland University, Saarbrücken, Germany
- German Centre for Infection Research (DZIF), Braunschweig, Germany
| | - Timo Risch
- Microbial Natural Products, Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Helmholtz Centre for Infection Research (HZI) and Department of Pharmacy Saarland University, Saarbrücken, Germany
- German Centre for Infection Research (DZIF), Braunschweig, Germany
| | - Claas Baier
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School (MHH), Hannover, Germany
| | - Dirk Schlüter
- German Centre for Infection Research (DZIF), Braunschweig, Germany
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School (MHH), Hannover, Germany
| | - Jennifer Herrmann
- Microbial Natural Products, Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Helmholtz Centre for Infection Research (HZI) and Department of Pharmacy Saarland University, Saarbrücken, Germany
- German Centre for Infection Research (DZIF), Braunschweig, Germany
| | - Rolf Müller
- Microbial Natural Products, Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Helmholtz Centre for Infection Research (HZI) and Department of Pharmacy Saarland University, Saarbrücken, Germany
- German Centre for Infection Research (DZIF), Braunschweig, Germany
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Kashouris E, Joseph A, Lewis T. Nitrofurantoin: what is the evidence for current UK guidance? J Antimicrob Chemother 2023; 78:2605-2611. [PMID: 37738416 PMCID: PMC10631823 DOI: 10.1093/jac/dkad287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023] Open
Abstract
Three days of nitrofurantoin at 100 mg twice daily is recommended as first-line treatment for uncomplicated urinary tract infection (UTI) in evidence-based guidelines across the UK. A review of international guidelines shows that the evidence base has been interpreted in very different ways. UK guidelines are unusual in promoting short (3 day) courses, and we find little direct evidence to support this. Although 'short' courses of antibiotics for other agents may provide optimum balance between providing effective treatment whilst reducing selective pressure driving resistance amongst colonizing microbial flora, it remains unclear that course lengths can be extrapolated to nitrofurantoin. Three days of nitrofurantoin may indeed be a useful intervention in a large group of patients. However, without supporting evidence and because clinical response should be expected to vary widely, it is unclear that establishing and promoting an antibiotic duration for UTI is the best approach to optimizing prescribing in this important area.
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Affiliation(s)
- Eleanor Kashouris
- Department of Sociology and Criminology, University of Sussex, Falmer, Freeman Building, Brighton, BN1 9RH, UK
| | - Amelia Joseph
- Department of Clinical Microbiology, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Tom Lewis
- Department of Microbiology, Royal Devon University Hospital, Barnstaple, EX31 4JB, UK
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5
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Spek A. [D-mannose for preventing and treating urinary tract infections. A commentary]. UROLOGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00120-023-02136-y. [PMID: 37380784 DOI: 10.1007/s00120-023-02136-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 06/30/2023]
Affiliation(s)
- Annabel Spek
- Urologische Klinik, Klinikum der Universität München, Marchioninistr. 15, 81377, Großhadern, München, Deutschland.
- UroEvidence, Deutsche Gesellschaft für Urologie, 14163, Berlin, Deutschland.
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Stoltidis-Claus C, Rosenberger KD, Mandraka F, Quante X, Gielen J, Hoffmann D, Wisplinghoff H, Jazmati N. Antimicrobial resistance of clinical Enterobacterales isolates from urine samples, Germany, 2016 to 2021. Euro Surveill 2023; 28:2200568. [PMID: 37166759 PMCID: PMC10176829 DOI: 10.2807/1560-7917.es.2023.28.19.2200568] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/30/2022] [Indexed: 05/12/2023] Open
Abstract
IntroductionEmpirical therapy for the treatment of urinary tract infections should be tailored to the current distribution and susceptibility of potential pathogens to ensure optimal treatment.AimWe aimed to provide an up-to-date overview of the epidemiology and susceptibility of Enterobacterales isolated from urine in Germany.MethodsWe retrospectively analysed antimicrobial susceptibility data from 201,152 urine specimens collected between January 2016 and June 2021 from in- and outpatients. Multiple logistic regression analysis was used to evaluate the association between year of investigation and antibiotic resistance, adjusted for age, sex and species subgroup. Subgroup analyses were performed for midstream urine samples obtained from (i) female outpatients aged 15 to 50 years, (ii) female outpatients older than 50 years and (iii) male outpatients.ResultsResistance rates of less than 20% were observed for nitroxoline (3.9%), fosfomycin (4.6%), nitrofurantoin (11.7%), cefuroxime (13.5%) and ciprofloxacin (14.2%). Resistance to trimethoprim/sulfamethoxazole (SXT) (20.1%), amoxicillin-clavulanic acid (20.5%), trimethoprim (24.2%), pivmecillinam (29.9%) and ampicillin (53.7%) was considerably higher. In the subgroup of outpatient women aged 15-50 years, resistance rates were generally lower. Resistance rates of all antibiotics decreased from 2016 to 2021. Multiple logistic regression revealed the lowest adjusted odds ratio (ORadj) of 0.838 (95% confidence interval (CI): 0.819-0.858; p < 0.001) for pivmecillinam and the highest ORadj of 0.989 (95% CI: 0.972-1.007; p = 0.226) for nitrofurantoin.ConclusionsResistance has generally decreased over the past years, independent of sex, age and causative pathogen. Our data provide an important basis for empirical antibiotic recommendations in various settings and patient collectives.
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Affiliation(s)
- Carolin Stoltidis-Claus
- Wisplinghoff laboratories, Cologne, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany
| | - Kerstin Daniela Rosenberger
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | | | - Jörg Gielen
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany
| | | | - Hilmar Wisplinghoff
- Wisplinghoff laboratories, Cologne, Germany
- Institute for Virology and Microbiology, Witten/Herdecke University, Witten, Germany
| | - Nathalie Jazmati
- Wisplinghoff laboratories, Cologne, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany
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7
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Hoffmann AM, Wolke M, Rybniker J, Plum G, Fuchs F. Activity of the old antimicrobial nitroxoline against Mycobacterium abscessus complex isolates. J Glob Antimicrob Resist 2023; 33:1-4. [PMID: 36842457 DOI: 10.1016/j.jgar.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 01/30/2023] [Accepted: 02/07/2023] [Indexed: 02/28/2023] Open
Abstract
OBJECTIVES The old antimicrobial nitroxoline is approved to treat urinary tract infection (UTI) and is currently rediscovered for treatment of drug resistant pathogens. Mycobacteria of the Mycobacterium abscessus complex (MYABS) are rapid-growing nontuberculous mycobacteria that are associated with difficult to treat infections of the lungs in patients with pulmonary disorders such as cystic fibrosis. In this study we assessed the in vitro activity of nitroxoline against molecularly characterized drug-resistant MYABS isolates from clinical samples to address potential repurposing of nitroxoline in difficult-to-treat MYABS infection. METHODS The isolates originated from clinical samples collected between 2010 and 2019 at the University Hospital of Cologne, Germany (N=16; 10/16 M. abscessus Spp. abscessus, 4/16 M. abscessus Spp. massiliense, 2/16 M. abscessus Spp. bolletii). Nitroxoline activity was compared to standard antimicrobials recommended for treatment of MYABS infection. For drug susceptibility testing of nitroxoline and comparators broth microdilution was performed based on current Clinical and Laboratory Standards Institute (CLSI) guidelines. RESULTS Nitroxoline yielded a MIC90 of 4 mg/L (range 2-4 mg/L), which is two twofold dilutions below the current EUCAST susceptibility breakpoint of ≤ 16 mg/L (limited to uncomplicated UTI and Escherichia coli). Resistance to other antimicrobials was common in our cohort (16/16 isolates resistant to ciprofloxacin, imipenem and doxycycline; 12/16 isolates resistant to tobramycin; 9/16 isolates resistant to cefoxitin; 7/16 isolates resistant to clarithromycin; 2/16 isolates resistant to amikacin). CONCLUSION Nitroxoline has a promising in vitro activity against drug-resistant MYABS isolates. Future studies should investigate this finding with macrophage and in vivo models.
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Affiliation(s)
- Ada Marie Hoffmann
- Institute for Medical Microbiology, Immunology and Hygiene, Medical faculty and University Hospital of Cologne, Cologne, Germany
| | - Martina Wolke
- Institute for Medical Microbiology, Immunology and Hygiene, Medical faculty and University Hospital of Cologne, Cologne, Germany
| | - Jan Rybniker
- Department I of Internal Medicine, University of Cologne, Cologne, Germany; German Center for Infection Research (DZIF), partner site Bonn Cologne
| | - Georg Plum
- Institute for Medical Microbiology, Immunology and Hygiene, Medical faculty and University Hospital of Cologne, Cologne, Germany
| | - Frieder Fuchs
- Institute for Medical Microbiology, Immunology and Hygiene, Medical faculty and University Hospital of Cologne, Cologne, Germany; Department of Microbiology and Hospital Hygiene, Bundeswehr Central Hospital Koblenz, Koblenz, Germany.
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Tóth B, Jávorházy A, Nyirády P, Csupor-Löffler B, Birinyi P, Zhanel G, Naber K, Länger R, Vörhendi N, Gede N, Váncsa S, Hegyi P, Csupor D. Bea rberry in the treatment of acute unco mpl icated cystitis (BRUMI): protocol of a multicentre, randomised double-blind clinical trial. BMJ Open 2022; 12:e057982. [PMID: 35750460 PMCID: PMC9234905 DOI: 10.1136/bmjopen-2021-057982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Bearberry (Arctostaphylos uva-ursi) leaf is available as a treatment of uncomplicated cystitis in several European countries. The antimicrobial activity of its extracts and some of its individual constituents has been observed in vitro; however, the efficacy of bearberry compared with standard antimicrobial therapy has not been assessed yet. OBJECTIVE The objective of the study is to assess the safety and non-inferiority of bearberry as an alternative therapy in the treatment of acute uncomplicated cystitis in comparison with standard antibiotic therapy (fosfomycin). METHODS AND ANALYSIS This is a randomised controlled double-blinded multicentre trial. Eligible patients will be premenopausal women with a sum score of ≥6 for the typical acute uncomplicated cystitis symptoms (frequency, urgency, painful urination, incomplete emptying, suprapubic pain and visible haematuria) reported on the Acute Cystitis Symptom Score (ACSS) typical domain and pyuria. Patients will be randomly assigned to receive 3 g single dose of fosfomycin powder and two placebo tablets three times a day for 7 days or B a single dose of placebo powder and two tablets containing a dry extract of Uvae ursi folium. At least 504 patients (allocated as 1:1) will need to be enrolled to access non-inferiority with a non-inferiority limit of 14% for the primary endpoint.Improvement of symptoms of uncomplicated cystitis (based on the ACSS score) at day 7 is defined as the primary endpoint, whereas several secondary endpoints such as the number and ratio of patients with bacteriuria at day 7, frequency and severity of side effects; recurrence of urinary tract infection, concurrent use of other over the counter (OTC) medications and food supplements will be determined to elucidate more detailed differences between the groups. The number of recurrences and medications taken for treatment will be monitored for a follow-up period of 90 days (80-100 days). ETHICS AND DISSEMINATION This study has been approved by the Scientific and Research Ethics Committee of the Hungarian Medical Research Council (IV/4225-1/2021/EKU). The results will be disseminated by publication of peer-reviewed manuscripts. TRIAL REGISTRATION NUMBER NCT05055544.
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Affiliation(s)
- Barbara Tóth
- Department of Pharmacognosy, University of Szeged, Szeged, Hungary
| | - András Jávorházy
- Urology Clinic, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Nyirády
- Department of Urology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Boglárka Csupor-Löffler
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Birinyi
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
| | - George Zhanel
- Departmental of Medical Microbiology/Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kurt Naber
- Department of Urology, Technical University of Munich, Munich, Germany
| | - Reinhard Länger
- Austrian Medicines and Medical Devices Agency, Vienna, Austria
| | - Nóra Vörhendi
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Noémi Gede
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Szilárd Váncsa
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Dezső Csupor
- Department of Pharmacognosy, University of Szeged, Szeged, Hungary
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
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9
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Hoffmann AM, Wolke M, Rybniker J, Plum G, Fuchs F. In vitro Activity of Repurposed Nitroxoline Against Clinically Isolated Mycobacteria Including Multidrug-Resistant Mycobacterium tuberculosis. Front Pharmacol 2022; 13:906097. [PMID: 35721137 PMCID: PMC9198898 DOI: 10.3389/fphar.2022.906097] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
Antimicrobial treatment options for mycobacterial infections are limited due to intrinsic resistance and the emergence of acquired resistance in Mycobacterium tuberculosis. Isolates resisting first- and second line drugs are raising concerns about untreatable infections and make the development of new therapeutic strategies more pressing. Nitroxoline is an old oral antimicrobial that is currently repurposed for the treatment of urinary tract infection (UTI). In this study, we report the in vitro activity of nitroxoline against 18 clinical isolates of M. tuberculosis complex (MTBC) (M. tuberculosis N = 16, M. bovis BCG N = 1, M. bovis sp. bovis N = 1). Since nitroxoline achieves high concentrations in the urinary tract, we included all MTBC-isolates from urinary samples sent to our laboratory between 2008 and 2021 (University Hospital of Cologne, Germany). Isolates from other sources (N = 7/18) were added for higher sample size and for inclusion of drug-resistant M. tuberculosis isolates (N = 4/18). Based on our clinical routine the fluorescence-based liquid media system BACTEC MGIT 960 was used for susceptibility testing of nitroxoline and mainstay antitubercular drugs. Nitroxoline yielded a MIC90 of 4 mg/L for MTBC. In all M. tuberculosis isolates nitroxoline MICs were at least two twofold dilutions below the current EUCAST susceptibility breakpoint of ≤16 mg/L (limited to E. coli and uncomplicated UTI). In vitro activity of nitroxoline can be considered excellent, even in multidrug-resistant isolates. Future studies with in vivo models should evaluate a potential role of nitroxoline in the treatment of tuberculosis in the era of drug resistance.
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Affiliation(s)
- Ada Marie Hoffmann
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Medical Faculty and University Hospital of Cologne, Cologne, Germany
| | - Martina Wolke
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Medical Faculty and University Hospital of Cologne, Cologne, Germany
| | - Jan Rybniker
- Department I of Internal Medicine, Faculty of Medicine and University of Cologne, Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn Cologne, Cologne, Germany
| | - Georg Plum
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Medical Faculty and University Hospital of Cologne, Cologne, Germany
| | - Frieder Fuchs
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Medical Faculty and University Hospital of Cologne, Cologne, Germany
- Department of Microbiology and Hospital Hygiene, Bundeswehr Central Hospital Koblenz, Koblenz, Germany
- *Correspondence: Frieder Fuchs, , orcid.org/0000-0001-7075-5378
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10
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In Vitro Activity of Nitroxoline in Antifungal-Resistant Candida Species Isolated from the Urinary Tract. Antimicrob Agents Chemother 2022; 66:e0226521. [PMID: 35543103 DOI: 10.1128/aac.02265-21] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Infections by drug-resistant fungi are increasingly reported worldwide; however, only few novel antifungals are being developed. The old antimicrobial nitroxoline is currently repurposed for oral treatment of bacterial urinary tract infections (UTI). Previously, antifungal activity has been demonstrated and in contrast to many antifungals nitroxoline reaches high urinary concentrations. In this study, the activity of nitroxoline was assessed in vitro in a collection of yeasts from the German National Reference Centre for Invasive Fungal Infections. Susceptibility was determined by broth microdilution (BMD) and disk diffusion (DD). The collection comprised 45 Candida isolates originating from the urinary tract. MICs of amphotericin, anidulafungin and azoles were analyzed using EUCAST BMD. Among the collection isolates, resistance to antifungals was common, e.g., for fluconazole the MIC50/90 was 16/>64 mg/L; in contrast MIC50/90 of nitroxoline was 2/2 mg/L (MIC range 0.25-4 mg/L), which is at least two dilutions below the EUCAST breakpoint for uncomplicated UTI defined for E. coli (susceptible ≤ 16mg/L). Activity of nitroxoline was high irrespective of resistance to other agents. As BMD is labor-intensive, DD was investigated as an alternative method using three different agars. Nitroxoline disks produced large inhibition zones on all agars (≥19mm), but the correlation of MICs and zone diameters was low, with the highest correlation recorded for the CLSI recommended agar for antifungal DD (Pearson's r = -0,52). In conclusion, isolates of different Candida species are highly susceptible to nitroxoline, which could be a promising antimicrobial to treat candiduria caused by multidrug resistant yeasts.
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Fuchs F, Becerra-Aparicio F, Xanthopoulou K, Seifert H, Higgins PG. In vitro activity of nitroxoline against carbapenem-resistant Acinetobacter baumannii isolated from the urinary tract. J Antimicrob Chemother 2022; 77:1912-1915. [PMID: 35411393 DOI: 10.1093/jac/dkac123] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/21/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The old antimicrobial nitroxoline is currently repurposed for oral treatment of uncomplicated urinary tract infections (UTIs). OBJECTIVES To investigate the in vitro activity of nitroxoline against carbapenem-resistant Acinetobacter baumannii (CRAb). METHODS From an international collection of previously well-characterized clinical A. baumannii isolates, 34 isolates from urinary tract sources with different carbapenem-resistance mechanisms were selected. Nitroxoline activity was analysed with broth microdilution (BMD), disc diffusion (DD) and within an in vitro biofilm model. MICs of meropenem and imipenem were assessed with BMD. Susceptibility to ciprofloxacin and trimethoprim/sulfamethoxazole was investigated using DD. Escherichia coli ATCC 25922 and A. baumannii NCTC 13304 were used for quality control. RESULTS All isolates were carbapenem resistant (MIC90 >32 mg/L for meropenem and imipenem) and most isolates were resistant to ciprofloxacin (33/34) and trimethoprim/sulfamethoxazole (31/34). Nitroxoline yielded MIC50/90 values of 2/2 mg/L (MIC range 1-2 mg/L) and inhibition zone diameters ranging from 20 to 26 mm. In contrast, for definite eradication of biofilm-associated CRAb in vitro, higher nitroxoline concentrations (≥16 to ≥128 mg/L) were necessary for all isolates. CONCLUSIONS Nitroxoline showed excellent in vitro activity against a collection of CRAb despite high resistance rates to other antimicrobials for parental and oral therapy of A. baumannii UTI. Currently, nitroxoline is recommended for the treatment of uncomplicated UTI in Germany with a EUCAST breakpoint limited to uncomplicated UTI and E. coli (S ≤16 mg/L). Nitroxoline could be a promising drug for oral treatment of lower UTI caused by CRAb. More data are warranted to correlate these findings with in vivo success rates.
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Affiliation(s)
- Frieder Fuchs
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Medical Faculty and University Hospital of Cologne, Cologne, Germany.,Department of Microbiology and Hospital Hygiene, Bundeswehr Central Hospital Koblenz, 56070 Koblenz, Germany
| | - Federico Becerra-Aparicio
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Kyriaki Xanthopoulou
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Medical Faculty and University Hospital of Cologne, Cologne, Germany.,German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
| | - Harald Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Medical Faculty and University Hospital of Cologne, Cologne, Germany.,German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
| | - Paul G Higgins
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Medical Faculty and University Hospital of Cologne, Cologne, Germany.,German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
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Loose M, Sáez Moreno D, Mutti M, Hitzenhammer E, Visram Z, Dippel D, Schertler S, Tišáková LP, Wittmann J, Corsini L, Wagenlehner F. Natural Bred ε 2-Phages Have an Improved Host Range and Virulence against Uropathogenic Escherichia coli over Their Ancestor Phages. Antibiotics (Basel) 2021; 10:1337. [PMID: 34827275 PMCID: PMC8614997 DOI: 10.3390/antibiotics10111337] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/20/2021] [Accepted: 10/27/2021] [Indexed: 12/22/2022] Open
Abstract
Alternative treatments for Escherichia coli infections are urgently needed, and phage therapy is a promising option where antibiotics fail, especially for urinary tract infections (UTI). We used wastewater-isolated phages to test their lytic activity against a panel of 47 E. coli strains reflecting the diversity of strains found in UTI, including sequence type 131, 73 and 69. The plaquing host range (PHR) was between 13 and 63%. In contrast, the kinetic host range (KHR), describing the percentage of strains for which growth in suspension was suppressed for 24 h, was between 0% and 19%, substantially lower than the PHR. To improve the phage host range and their efficacy, we bred the phages by mixing and propagating cocktails on a subset of E. coli strains. The bred phages, which we termed evolution-squared ε2-phages, of a mixture of Myoviridae have KHRs up to 23% broader compared to their ancestors. Furthermore, using constant phage concentrations, Myoviridae ε2-phages suppressed the growth of higher bacterial inocula than their ancestors did. Thus, the ε2-phages were more virulent compared to their ancestors. Analysis of the genetic sequences of the ε2-phages with the broadest host range reveals that they are mosaic intercrossings of 2-3 ancestor phages. The recombination sites are distributed over the whole length of the genome. All ε2-phages are devoid of genes conferring lysogeny, antibiotic resistance, or virulence. Overall, this study shows that ε2-phages are remarkably more suitable than the wild-type phages for phage therapy.
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Affiliation(s)
- Maria Loose
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University Giessen, 35392 Giessen, Germany; (M.L.); (D.D.)
| | - David Sáez Moreno
- PhagoMed Biopharma GmbH, A-1110 Vienna, Austria; (D.S.M.); (M.M.); (E.H.); (Z.V.); (L.P.T.)
| | - Michele Mutti
- PhagoMed Biopharma GmbH, A-1110 Vienna, Austria; (D.S.M.); (M.M.); (E.H.); (Z.V.); (L.P.T.)
| | - Eva Hitzenhammer
- PhagoMed Biopharma GmbH, A-1110 Vienna, Austria; (D.S.M.); (M.M.); (E.H.); (Z.V.); (L.P.T.)
| | - Zehra Visram
- PhagoMed Biopharma GmbH, A-1110 Vienna, Austria; (D.S.M.); (M.M.); (E.H.); (Z.V.); (L.P.T.)
| | - David Dippel
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University Giessen, 35392 Giessen, Germany; (M.L.); (D.D.)
| | - Susanne Schertler
- DSMZ—German Collection of Microorganism and Cell Cultures GmbH, Leibniz Institute, 38124 Braunschweig, Germany; (S.S.); (J.W.)
| | - Lenka Podpera Tišáková
- PhagoMed Biopharma GmbH, A-1110 Vienna, Austria; (D.S.M.); (M.M.); (E.H.); (Z.V.); (L.P.T.)
- DSMZ—German Collection of Microorganism and Cell Cultures GmbH, Leibniz Institute, 38124 Braunschweig, Germany; (S.S.); (J.W.)
| | - Johannes Wittmann
- DSMZ—German Collection of Microorganism and Cell Cultures GmbH, Leibniz Institute, 38124 Braunschweig, Germany; (S.S.); (J.W.)
| | - Lorenzo Corsini
- PhagoMed Biopharma GmbH, A-1110 Vienna, Austria; (D.S.M.); (M.M.); (E.H.); (Z.V.); (L.P.T.)
| | - Florian Wagenlehner
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University Giessen, 35392 Giessen, Germany; (M.L.); (D.D.)
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Fuchs F, Hof H, Hofmann S, Kurzai O, Meis JF, Hamprecht A. Antifungal activity of nitroxoline against Candida auris isolates. Clin Microbiol Infect 2021; 27:1697.e7-1697.e10. [PMID: 34245904 DOI: 10.1016/j.cmi.2021.06.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 06/15/2021] [Accepted: 06/22/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To investigate the in vitro activity of nitroxoline against a molecularly characterized collection of clinical Candida auris isolates. METHODS Thirty-five clinical isolates of C. auris from diverse sources representing all five different C. auris clades were included in the study. Nitroxoline activity was assessed using broth microdilution. Additionally, susceptibility testing by disc diffusion was assessed on RPMI-1640 and Müller-Hinton agar plates. Minimal inhibitory concentrations of the antifungals fluconazole, voriconazole, amphotericin B and anidulafungin were determined. RESULTS Nitroxoline MICs ranged from 0.125 to 1 mg/L (MIC50/90 0.25/0.5 mg/L). Compared with amphotericin B (MIC >1 mg/L in 4/35 isolates), anidulafungin (MIC >0.06 mg/L in 26/35 isolates) and fluconazole (MIC >4 mg/L in 31/35 isolates), in vitro activity of nitroxoline was high. Isolates belonging to clade I had marginally lower nitroxoline MICs (range 0.125-0.5 mg/L, mean MIC 0.375 mg/L) compared with clade III (range 0.5-1 mg/L, mean MIC 0.7 mg/L; p = 0.0094). The correlation of MIC and inhibition zones by disc diffusion was good when using RPMI-agar for disc diffusion, with a Pearson's correlation coefficient of -0.74 (95% CI -0.86 to -0.54). CONCLUSIONS Nitroxoline has excellent in vitro activity against C. auris isolates, with MICs of 0.125-1 mg/L (for comparison, the EUCAST breakpoint for uncomplicated urinary tract infection with Escherichia coli is ≤ 16 mg/L). It is an approved, well-tolerated antimicrobial that achieves high urinary concentrations after oral administration and could be a useful treatment option in C. auris candiduria.
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Affiliation(s)
- Frieder Fuchs
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Medical Faculty and University Hospital of Cologne, Cologne, Germany
| | - Herbert Hof
- MVZ Labor Limbach und Kollegen, Heidelberg, Germany
| | | | - Oliver Kurzai
- National Reference Centre for Invasive Fungal Infections (NRZMyk), Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, Jena, Germany; Institute for Hygiene and Microbiology, University Wuerzburg, Wuerzburg, Germany
| | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases, Excellence Centre for Medical Mycology (ECMM), Centre of Expertise in Mycology Radboudumc/CWZ, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands; Bioprocess Engineering and Biotechnology Graduate Programme, Federal University of Paraná, Curitiba, Brazil
| | - Axel Hamprecht
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Medical Faculty and University Hospital of Cologne, Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany; Institute for Medical Microbiology and Virology, University of Oldenburg, Oldenburg, Germany.
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Fuchs F, Ahmadzada A, Plambeck L, Wille T, Hamprecht A. Susceptibility of Clinical Enterobacterales Isolates With Common and Rare Carbapenemases to Mecillinam. Front Microbiol 2021; 11:627267. [PMID: 33510739 PMCID: PMC7835630 DOI: 10.3389/fmicb.2020.627267] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 12/11/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose: To investigate the susceptibility of carbapenemase-producing Enterobacterales (CPE) to mecillinam based on the recently updated European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints for uncomplicated Urinary Tract Infection (uUTI). Methods: The challenge collection consisted of 105 molecularly characterized Enterobacterales [Klebsiella spp. (N = 49), Escherichia coli (N = 30), Enterobacter cloacae (n = 13), Citrobacter freundii (N = 9), Proteus mirabilis (N = 3), and Raoultella ornithinolytica (N = 1)]. Isolates produced OXA-48 (N = 18), OXA-48-like (N = 18), VIM (N = 22), NDM (N = 22), KPC (N = 12), IMI (N = 9), IMP (N = 6), GES (N = 1), OXA-58 (N = 2) or combinations thereof (N = 5). MICs of carbapenems were determined by agar gradient diffusion (AGD). MICs of mecillinam were assessed by agar dilution (reference method) and compared to disk diffusion (DD) and AGD. Results: Overall 23/105 CPE (21.9%) were susceptible to mecillinam. Susceptibility was observed in E. coli (N = 12), E. cloacae (N = 7), and Klebsiella pneumoniae (N = 4) producing IMI, OXA-48, OXA-48-like, and NDM-1 carbapenemases. MIC50 for mecillinam in all isolates was 128 mg/L while MIC50 for meropenem was 8 mg/L. Lower MICs for mecillinam were found in IMI (MIC50 8 mg/L) and OXA-48-like (MIC50 16 mg/L) producers. The comparison of the different susceptibility methods showed very major errors of 12.2% with AGD and 8.5% with disk diffusion when compared to the reference method. Conclusion: Mecillinam susceptibility was restricted to isolates producing IMI-, OXA-48-like, and NDM-1 carbapenemases and was documented despite high carbapenem MICs in some isolates. Mecillinam could be a promising oral antimicrobial in uUTI caused by E. coli and E. cloacae isolates carrying IMI- and OXA-48-like carbapenemases; however, susceptibility testing by AGD and disk diffusion remains problematic.
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Affiliation(s)
- Frieder Fuchs
- Institute for Medical Microbiology, Immunology and Hygiene, Medical Faculty and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Aysel Ahmadzada
- Institute for Medical Microbiology, Immunology and Hygiene, Medical Faculty and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Lars Plambeck
- Institute for Medical Microbiology, Immunology and Hygiene, Medical Faculty and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Thorsten Wille
- Institute for Medical Microbiology, Immunology and Hygiene, Medical Faculty and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Axel Hamprecht
- Institute for Medical Microbiology, Immunology and Hygiene, Medical Faculty and University Hospital of Cologne, University of Cologne, Cologne, Germany.,German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.,Institute for Medical Microbiology and Virology, University of Oldenburg, Oldenburg, Germany
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15
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Anti-Bacterial Effects of Essential Oils against Uropathogenic Bacteria. Antibiotics (Basel) 2020; 9:antibiotics9060358. [PMID: 32630444 PMCID: PMC7344393 DOI: 10.3390/antibiotics9060358] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 12/11/2022] Open
Abstract
Given the increasing antimicrobial resistance in urinary tract infections (UTI), alternative strategies need to be investigated. Determination of minimal inhibitory and bactericidal concentrations of essential oils from cajeput, lemongrass, tea tree, and thyme in artificial urine, revealed bactericidal activity of all four tested essential oils against seven uropathogenic species with values ranging between 0.78–50 mg/mL. Tea tree and thyme essential oils were more efficient than lemongrass and cajeput. In addition, antibiotic-resistant strains showed similar susceptibility as antibiotic-sensitive strains, suggesting no cross-resistance between antibiotics and these essential oils. Checkerboard assays revealed a synergistic activity of the combination of thyme and tea tree. Furthermore, the combination with thyme and tea tree essential oils increased the activity of fosfomycin and pivmecillinam, but not nitrofurantoin, against Escherichia coli. This study provides a basis for further investigation of the potential of thyme and tea tree oil as an alternative or additional treatment of UTI.
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Eisenhardt A, Schneider K, Hirche H, Lax H, Hadaschik B, Rehme C, van Gool J. Diagnosis and Empirical Treatment of Urinary Tract Infections in Urologic Outpatients. Urol Int 2020; 104:617-624. [DOI: 10.1159/000507267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/13/2020] [Indexed: 11/19/2022]
Abstract
<b><i>Introduction:</i></b> Due to a continuing increase of bacterial resistance in common uropathogens, we wanted to revisit our standards for the diagnosis and treatment of lower urinary tract infections, in the setting of urological outpatient care in a conurbation in Germany. <b><i>Patients and Methods:</i></b> All subjects presenting with significant bacteriuria at our urology clinics in Mülheim, Germany, in 2011 were included. Comorbidity, bacterial species, urinary tract symptoms, and empirically prescribed antibiotics were taken from the patients’ records. <b><i>Results:</i></b> In 2011, a total of 1,324 patients were included (793 female, 531 male). Of the 771 patients with symptomatic bacteriuria, 647 received antibiotic treatment, as well as 116 of 409 patients with asymptomatic bacteriuria. <i>Escherichia coli</i> was identified in 60% of the included patients. In 427 <i>E. coli</i> infections, bacterial resistance was found in 14% of 316 cases treated with quinolone, in 21% of 53 cases treated with co-trimoxazole, and in only 3% of 58 cases treated with nitrofurantoin. <b><i>Conclusions:</i></b> We found a high use of fluoroquinolones for empirical first-line antibiotics in the treatment of lower urinary tract infections. In our regional setting, antibiotic stewardship needs to be promoted, along national and international guidelines, to avoid unnecessary prescription of fluoroquinolones for empirical treatment.
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Fuchs F, Wille J, Hamprecht A, Parcina M, Lehmann C, Schwarze-Zander C, Seifert H, Higgins PG. In vitro activity of mecillinam and nitroxoline against Neisseria gonorrhoeae - re-purposing old antibiotics in the multi-drug resistance era. J Med Microbiol 2019; 68:991-995. [PMID: 31162022 DOI: 10.1099/jmm.0.001014] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
In 2018, the European Centre for Disease Prevention and Control reported the first cases of extensively drug-resistant Neisseria gonorrhoeae infections in Europe. Seeking new options for antimicrobial therapy we investigated the susceptibility of N. gonorrhoeae to nitroxoline (NIT) and mecillinam (MCM), both of which are currently only indicated to treat uncomplicated urinary tract infections. Clinical N. gonorrhoeae isolates with non-susceptibility to penicillin from two German medical centres were included (n =27). Most isolates were also non-susceptible to a range of other anti-gonococcal antimicrobials (cefotaxime, ciprofloxacin, azithromycin, tetracycline). All isolates were further characterized by multi-locus sequence typing. MICs of penicillin and cefotaxime were determined by agar gradient diffusion. Production of penicillinase was tested by cefinase disk test. Susceptibility of MCM was investigated by agar dilution, NIT by agar dilution and disk diffusion. Penicillin MICs ranged from 0.125 to 64 mg l-1 and MICs of cefotaxime ranged from < 0.016 to 1 mg l-1 . Five isolates were penicillinase-producers. MICs of MCM ranged from 16 to > 128 mg l-1 whereas MICs of NIT ranged from 0.125 to 2 mg l-1 . NIT disk diffusion (median zone diameter 32 mm) correlated well with results from agar dilution. We demonstrated excellent in vitro activity of NIT against clinical N. gonorrhoeae isolates with non-susceptibility to standard anti-gonococcal antibiotics. MCM activity was unsatisfactory. Correlation of agar dilution and disk diffusion in NIT susceptibility testing is an important aspect with potential clinical implications.
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Affiliation(s)
- Frieder Fuchs
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Faculty of Medicine and University Hospital Cologne, Goldenfelsstraße 19-21, 50935 Cologne, Germany
| | - Julia Wille
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Faculty of Medicine and University Hospital Cologne, Goldenfelsstraße 19-21, 50935 Cologne, Germany
- German Centre for Infection Research, partner site Bonn-Cologne (DZIF), Cologne, Germany
| | - Axel Hamprecht
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Faculty of Medicine and University Hospital Cologne, Goldenfelsstraße 19-21, 50935 Cologne, Germany
- German Centre for Infection Research, partner site Bonn-Cologne (DZIF), Cologne, Germany
| | - Marijo Parcina
- Institute of Medical Microbiology, Immunology and Parasitology, Bonn University Hospital, Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Clara Lehmann
- German Centre for Infection Research, partner site Bonn-Cologne (DZIF), Cologne, Germany
- Department I for Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Carolynne Schwarze-Zander
- Department of Medicine I, Bonn University Hospital, Bonn, Sigmund-Freud-Straße 25, 53127 Bonn, Germany
| | - Harald Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Faculty of Medicine and University Hospital Cologne, Goldenfelsstraße 19-21, 50935 Cologne, Germany
- German Centre for Infection Research, partner site Bonn-Cologne (DZIF), Cologne, Germany
| | - Paul G Higgins
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Faculty of Medicine and University Hospital Cologne, Goldenfelsstraße 19-21, 50935 Cologne, Germany
- German Centre for Infection Research, partner site Bonn-Cologne (DZIF), Cologne, Germany
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Results from a Prospective In Vitro Study on the Mecillinam (Amdinocillin) Susceptibility of Enterobacterales. Antimicrob Agents Chemother 2019; 63:AAC.02402-18. [PMID: 30917983 DOI: 10.1128/aac.02402-18] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 01/22/2019] [Indexed: 02/01/2023] Open
Abstract
The activity of mecillinam (amdinocillin) was assessed in Enterobacterales (n = 420) isolated from urine samples between 2016 and 2017. Mecillinam susceptibilities were 97.4% in Escherichia coli isolates (294/302), 89.7% in Klebsiella spp. isolates (52/58), and 93.3% in Proteus mirabilis isolates (28/30). Among extended-spectrum β-lactamase (ESBL) producers, 95.2% (99/104) were mecillinam susceptible, including two OXA-48-producing Klebsiella pneumoniae isolates. In Enterobacter spp. and Citrobacter spp., MICs were low (MIC50 = 0.5 mg/liter). In conclusion, the activity of mecillinam was high in Enterobacterales, even among multidrug-resistant isolates.
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Concia E, Bragantini D, Mazzaferri F. Clinical evaluation of guidelines and therapeutic approaches in multi drug-resistant urinary tract infections. J Chemother 2018; 29:19-28. [PMID: 29271735 DOI: 10.1080/1120009x.2017.1380397] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Antibiotic resistance represents a real health emergency worldwide, mostly due to the lack of new antibiotics active against multidrug-resistant Enterobacteriaceae. Considering the global epidemiological situation in several infections, including urinary tract infections (UTIs), some antibiotics, such as fluoroquinolones and trimethoprim/sulphamethoxazole, can no longer be used for empiric treatment due to high resistance rates. However, some old antibiotics maintain high microbiological activity against UTI pathogens: according to many recent guidelines, fosfomycin trometamol, nitrofurantoin and pivmecillinam are recommended for the first-line treatment of uncomplicated UTIs. This article provides an overview of the therapeutic management of UTIs, especially uncomplicated and recurrent cystitis, as well as complicated UTIs such as catheter-related UTIs, and UTIs in males, post-menopausal women and diabetic patients, based on the main international guidelines.
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Affiliation(s)
- Ercole Concia
- a Infectious Diseases and Tropical Medicine Section, Department of Diagnostic and Public Health , University of Verona , Verona , Italy
| | - Damiano Bragantini
- a Infectious Diseases and Tropical Medicine Section, Department of Diagnostic and Public Health , University of Verona , Verona , Italy
| | - Fulvia Mazzaferri
- a Infectious Diseases and Tropical Medicine Section, Department of Diagnostic and Public Health , University of Verona , Verona , Italy
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Reducing antibiotic use for uncomplicated urinary tract infection in general practice by treatment with uva-ursi (REGATTA) - a double-blind, randomized, controlled comparative effectiveness trial. Altern Ther Health Med 2018; 18:203. [PMID: 29970072 PMCID: PMC6029138 DOI: 10.1186/s12906-018-2266-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 06/22/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Uncomplicated urinary tract infections (UTI) are common in general practice and usually treated with antibiotics. This contributes to increasing resistance rates of uropathogenic bacteria. A previous trial showed a reduction of antibiotic use in women with UTI by initial symptomatic treatment with ibuprofen. However, this treatment strategy is not suitable for all women equally. Arctostaphylos uva-ursi (UU, bearberry extract arbutin) is a potential alternative treatment. This study aims at investigating whether an initial treatment with UU in women with UTI can reduce antibiotic use without significantly increasing the symptom burden or rate of complications. METHODS This is a double-blind, randomized, and controlled comparative effectiveness trial. Women between 18 and 75 years with suspected UTI and at least two of the symptoms dysuria, urgency, frequency or lower abdominal pain will be assessed for eligibility in general practice and enrolled into the trial. Participants will receive either a defined daily dose of 3 × 2 arbutin 105 mg for 5 days (intervention) or fosfomycin 3 g once (control). Antibiotic therapy will be provided in the intervention group only if needed, i.e. for women with worsening or persistent symptoms. Two co-primary outcomes are the number of all antibiotic courses regardless of the medical indication from day 0-28, and the symptom burden, defined as a weighted sum of the daily total symptom scores from day 0-7. The trial result is considered positive if superiority of initial treatment with UU is demonstrated with reference to the co-primary outcome number of antibiotic courses and non-inferiority of initial treatment with UU with reference to the co-primary outcome symptom burden. DISCUSSION The trial's aim is to investigate whether initial treatment with UU is a safe and effective alternative treatment strategy in women with UTI. In that case, the results might change the existing treatment strategy in general practice by promoting delayed prescription of antibiotics and a reduction of antibiotic use in primary care. TRIAL REGISTRATION EudraCT: 2016-000477-21 . Clinical trials.gov: NCT03151603 (registered: 10 May 2017).
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Nitroxoline in geriatric patients with lower urinary tract infection fails to achieve microbiologic eradication: a noncomparative, prospective observational study. Clin Microbiol Infect 2018; 24:434-435. [DOI: 10.1016/j.cmi.2017.11.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 11/02/2017] [Accepted: 11/04/2017] [Indexed: 11/21/2022]
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Mareković I, Bošnjak Z, Jurić K, Ćorić M, Popović-Grle S. Susceptibility of Escherichia coli to nitroxoline, an option for uncomplicated urinary tract infections – the first report from Croatia. J Chemother 2018; 30:189-191. [DOI: 10.1080/1120009x.2018.1452585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Ivana Mareković
- Department of Clinical and Molecular Microbiology, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Zrinka Bošnjak
- Department of Clinical and Molecular Microbiology, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Karla Jurić
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Mario Ćorić
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Gynaecology and Obstetrics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Sanja Popović-Grle
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Pulmonary Diseases Jordanovac, University Hospital Centre Zagreb, Zagreb, Croatia
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Urinary concentrations and antimicrobial activity of tobramycin in healthy volunteers receiving a single oral dose of a novel formulation for improved absorption. Int J Antimicrob Agents 2018; 51:422-426. [DOI: 10.1016/j.ijantimicag.2017.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/09/2017] [Indexed: 11/22/2022]
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Hitzenbichler F, Simon M, Holzmann T, Iberer M, Zimmermann M, Salzberger B, Hanses F. Antibiotic resistance in E. coli isolates from patients with urinary tract infections presenting to the emergency department. Infection 2018; 46:325-331. [PMID: 29368165 DOI: 10.1007/s15010-018-1117-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 01/19/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Escherichia coli urine isolates from patients presenting to the emergency department at a German tertiary care hospital were retrospectively analyzed from January 2015-March 2017 to determine antibiotic resistance patterns and patient risk factors for resistance. METHODS Uncomplicated urinary tract infection (UTI) was defined as UTI in the otherwise healthy patient without relevant co-morbidities and complications. Patients were assumed to have UTI if diagnosis was made by the attending physician with conclusive dipstick results. For subgroup analysis, only patients with symptoms suggestive for UTI documented in their records were included. RESULTS 228 patients with a UTI diagnosed by the attending physician with E. coli isolated in urine culture were included. 154/228 patients had documented symptomatic UTI, 57/154 had uncomplicated infection, 76/154 patients had cystitis, and 124/154 were female. Resistance rates of uncomplicated UTI in symptomatic patients were: ciprofloxacin 10.5%, cotrimoxazole 15.8%, amoxicillin/clavulanic acid 5.3%, nitrofurantoin 0% (CLSI MICs). Previous hospitalization in the last 3 months (including patients living in a long-term care facility) was significantly correlated with resistance to ciprofloxacin, cotrimoxazole and amoxicillin/clav. Previous hospitalization was a strong predictor of resistance to ciprofloxacin and cotrimoxazole in multivariate analysis also. Other risk factors correlated with resistance were hematological malignancy (for cotrimoxazole) and renal transplantation (for ciprofloxacin). CONCLUSIONS Cotrimoxazole is still an alternative for treating uncomplicated cystitis. Previous hospitalization in the last 3 months was a strong predictor of resistance to cotrimoxazole and ciprofloxacin. Other risk factors which might help guide empirical therapy are hematological malignancy and renal transplantation.
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Affiliation(s)
- Florian Hitzenbichler
- Infectious Diseases Unit, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
| | - Michaela Simon
- Institute for Clinical Microbiology and Hygiene, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Thomas Holzmann
- Institute for Clinical Microbiology and Hygiene, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Michael Iberer
- Infectious Diseases Unit, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Markus Zimmermann
- Emergency Department, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Bernd Salzberger
- Infectious Diseases Unit, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Frank Hanses
- Infectious Diseases Unit, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
- Emergency Department, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
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Sobke A, Makarewicz O, Baier M, Bär C, Pfister W, Gatermann SG, Pletz MW, Forstner C. Empirical treatment of lower urinary tract infections in the face of spreading multidrug resistance: in vitro study on the effectiveness of nitroxoline. Int J Antimicrob Agents 2017; 51:213-220. [PMID: 29111434 DOI: 10.1016/j.ijantimicag.2017.10.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/18/2017] [Accepted: 10/21/2017] [Indexed: 10/18/2022]
Abstract
The spread of antimicrobial resistance challenges the empirical treatment of urinary tract infections (UTIs). Among others, nitrofurantoin is recommended for first-line treatment, but acceptance among clinicians is limited due to chronic nitrofurantoin-induced lung toxicity and insufficient coverage of Enterobacteriaceae other than Escherichia coli. Nitroxoline appears to be an alternative to nitrofurantoin owing to its favourable safety profile, however data on its current in vitro susceptibility are sparse. In this study, susceptibility to nitroxoline was tested against 3012 urinary clinical isolates (including multidrug-resistant bacteria and Candida spp.) by disk diffusion test and/or broth microdilution. At least 91% of all Gram-negatives (n = 2000), Gram-positives (n = 403) and yeasts (n = 132) had inhibition zone diameters for nitroxoline ≥18 mm. Except for Pseudomonas aeruginosa, nitroxoline MIC90 values were ≤16 mg/L and were 2- to >16-fold lower compared with nitrofurantoin. In extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae and methicillin-resistant Staphylococcus aureus (MRSA), MIC90 values of nitroxoline were two-fold higher compared with non-ESBL-producing enterobacteria and methicillin-susceptible S. aureus (MSSA). The in vitro efficacies of nitroxoline and nitrofurantoin against ATCC strains of E. coli, Enterococcus faecalis and Proteus mirabilis were compared by time-kill curves in Mueller-Hinton broth and artificial urine. Nitroxoline was non-inferior against E. coli, P. mirabilis and E. faecalis in artificial urine. In conclusion, nitroxoline showed a broad antimicrobial spectrum, with inhibition zone diameters and MICs of nitroxoline well below the EUCAST breakpoint for E. coli for most organisms, and thus may also be a target for therapy of uncomplicated UTIs.
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Affiliation(s)
- A Sobke
- Institute of Medical Microbiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - O Makarewicz
- Center for Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - M Baier
- Institute of Medical Microbiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - C Bär
- Institute of Medical Microbiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - W Pfister
- Institute of Medical Microbiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - S G Gatermann
- Department of Medical Microbiology, Ruhr-University Bochum, Universitätsstraße 150, 44801, Bochum, Germany
| | - M W Pletz
- Center for Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - C Forstner
- Center for Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany; Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Magyar A, Alidjanov J, Pilatz A, Nagy K, Arthanareeswaran VKA, Póth S, Bécsi A, Wagenlehner FME, Naber KG, Tenke P, Köves B. The role of the Acute Cystitis Symptom Score questionnaire for research and antimicrobial stewardship. Validation of the Hungarian version. Cent European J Urol 2017; 71:134-141. [PMID: 29732220 PMCID: PMC5926636 DOI: 10.5173/ceju.2018.1530] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 01/17/2018] [Accepted: 01/20/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction The Acute Cystitis Symptom Score (ACSS) is a new self-reporting tool to evaluate the symptoms of uncomplicated acute cystitis (AC) in women. The linguistic and clinical validation process of the Hungarian version used in this study may serve as a guide for the validation of the ACSS in other languages. Material and methods In this prospective cohort study, women with AC (Patients) and those without (Controls) filled in the Hungarian ACSS version, during their visits to physician's office. Statistical analysis included ordinary descriptive values, calculation of reliability, validity, discriminative ability, responsiveness (sensitivity, specificity) and comparative analysis. Results Thirty-one patients were recruited for validation along with 37 controls. Statistical analyses resulted in excellent values of internal consistency, discriminative ability and validity for diagnosis of AC. At the cut-off at a score of 6 in the 'typical' domain, positive and negative predictive values were 97% and 92%, sensitivity and specificity were 90% and 97%, respectively. Conclusions The ACSS has demonstrated benefits for diagnosis and patient-reported outcome assessment. It is objective, fast, and cost-effective, and may help to easily confirm the accurate diagnosis of AC. Therefore, it may be especially important for clinical and epidemiological studies on AC in women.
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Affiliation(s)
- András Magyar
- Department of Urology, Jahn Ferenc South Pest Teaching Hospital, Köves, Hungary
| | - Jakhongir Alidjanov
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University, Giessen, Germany
| | - Adrian Pilatz
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University, Giessen, Germany
| | - Károly Nagy
- Department of Urology, Jahn Ferenc South Pest Teaching Hospital, Köves, Hungary
| | | | - Sándor Póth
- Department of Urology, Jahn Ferenc South Pest Teaching Hospital, Köves, Hungary
| | - András Bécsi
- Department of Urology, Jahn Ferenc South Pest Teaching Hospital, Köves, Hungary
| | - Florian M E Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University, Giessen, Germany
| | | | - Péter Tenke
- Department of Urology, Jahn Ferenc South Pest Teaching Hospital, Köves, Hungary
| | - Béla Köves
- Department of Urology, Jahn Ferenc South Pest Teaching Hospital, Köves, Hungary
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