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Sánchez X, Latacunga A, Cárdenas I, Jimbo-Sotomayor R, Escalante S. Antibiotic prescription patterns in patients with suspected urinary tract infections in Ecuador. PLoS One 2023; 18:e0295247. [PMID: 38033109 PMCID: PMC10688952 DOI: 10.1371/journal.pone.0295247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 11/20/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Urinary tract infections (UTI) are among the most common cause to prescribe antibiotics in primary care. Diagnosis is based on the presence of clinical symptoms in combination with the results of laboratory tests. Antibiotic therapy is the primary approach to the treatment of UTIs; however, some studies indicate that therapeutics in UTIs may be suboptimal, potentially leading to therapeutic failure and increased bacterial resistance. METHODS This study aimed to analyze the antibiotic prescription patterns in adult patients with suspected UTIs and to evaluate the appropriateness of the antibiotic prescription. This is a cross-sectional study of patients treated in outpatient centers and in a second-level hospital of the Ministry of Public Health (MOPH) in a city in Ecuador during 2019. The International Classification of Disease Tenth Revision (ICD-10) was used for the selection of the acute UTI cases. The patients included in this study were those treated by family, emergency, and internal medicine physicians. RESULTS We included a total of 507 patients in the analysis and 502 were prescribed antibiotics at first contact, constituting an immediate antibiotic prescription rate of 99.01%. Appropriate criteria for antibiotic prescription were met in 284 patients, representing an appropriate prescription rate of 56.02%. Less than 10% of patients with UTI had a urine culture. The most frequently prescribed antibiotics were alternative antibiotics (also known as second-line antibiotics), such as ciprofloxacin (50.39%) and cephalexin (23.55%). Factors associated with inappropriate antibiotic prescribing for UTIs were physician age over forty years, OR: 2.87 (95% CI, 1.65-5.12) p<0.0001, medical care by a general practitioner, OR: 1.89 (95% CI, 1.20-2.99) p = 0.006, not using point-of-care testing, OR: 1.96 (95% CI, 1.23-3.15) p = 0.005, and care at the first level of health, OR: 15.72 (95% CI, 8.57-30.88) p<0.0001. CONCLUSIONS The results of our study indicate an appropriate prescription rate of 56.02%. Recommended antibiotics such as nitrofurantoin and fosfomycin for UTIs are underutilized. The odds for inappropriate antibiotic prescription were 15.72 times higher at the first level of care compared to the second. Effective strategies are needed to improve the diagnosis and treatment of UTIs.
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Affiliation(s)
- Xavier Sánchez
- Centro de Investigación Para la Salud en América Latina (CISeAL), Facultad de Medicina, Pontificia Universidad Católica del Ecuador (PUCE), Quito, Ecuador
- Community and Primary Care Research Group – Ecuador (CPCRG-E), Quito, Ecuador
| | - Alicia Latacunga
- Postgrado de Medicina Familiar y Comunitaria, Pontificia Universidad Católica del Ecuador (PUCE), Quito, Ecuador
| | - Iván Cárdenas
- Postgrado de Medicina Familiar y Comunitaria, Pontificia Universidad Católica del Ecuador (PUCE), Quito, Ecuador
| | - Ruth Jimbo-Sotomayor
- Centro de Investigación Para la Salud en América Latina (CISeAL), Facultad de Medicina, Pontificia Universidad Católica del Ecuador (PUCE), Quito, Ecuador
- Community and Primary Care Research Group – Ecuador (CPCRG-E), Quito, Ecuador
| | - Santiago Escalante
- Centro de Investigación Para la Salud en América Latina (CISeAL), Facultad de Medicina, Pontificia Universidad Católica del Ecuador (PUCE), Quito, Ecuador
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Deacon M, Muir G. What is the medical evidence on non-therapeutic child circumcision? Int J Impot Res 2022; 35:256-263. [PMID: 34997197 DOI: 10.1038/s41443-021-00502-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 10/24/2021] [Accepted: 11/15/2021] [Indexed: 01/02/2023]
Abstract
Non-therapeutic circumcision refers to the surgical removal of part or all of the foreskin, in healthy males, where there is no medical condition requiring surgery. The arguments for and against this practice in children have been debated for many years, with conflicting and conflicted evidence presented on both sides. Here, we explore the evidence behind the claimed benefits and risks from a medical and health-related perspective. We examine the number of circumcisions which would be required to achieve each purported benefit, and set that against the reported rates of short- and long-term complications. We conclude that non-therapeutic circumcision performed on otherwise healthy infants or children has little or no high-quality medical evidence to support its overall benefit. Moreover, it is associated with rare but avoidable harm and even occasional deaths. From the perspective of the individual boy, there is no medical justification for performing a circumcision prior to an age that he can assess the known risks and potential benefits, and choose to give or withhold informed consent himself. We feel that the evidence presented in this review is essential information for all parents and practitioners considering non-therapeutic circumcisions on otherwise healthy infants and children.
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Affiliation(s)
| | - Gordon Muir
- Urology Department, King's College Hospital, London, UK.
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3
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Urinary Tract Infections. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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4
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Ambite I, Butler D, Wan MLY, Rosenblad T, Tran TH, Chao SM, Svanborg C. Molecular determinants of disease severity in urinary tract infection. Nat Rev Urol 2021; 18:468-486. [PMID: 34131331 PMCID: PMC8204302 DOI: 10.1038/s41585-021-00477-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 02/06/2023]
Abstract
The most common and lethal bacterial pathogens have co-evolved with the host. Pathogens are the aggressors, and the host immune system is responsible for the defence. However, immune responses can also become destructive, and excessive innate immune activation is a major cause of infection-associated morbidity, exemplified by symptomatic urinary tract infections (UTIs), which are caused, in part, by excessive innate immune activation. Severe kidney infections (acute pyelonephritis) are a major cause of morbidity and mortality, and painful infections of the urinary bladder (acute cystitis) can become debilitating in susceptible patients. Disease severity is controlled at specific innate immune checkpoints, and a detailed understanding of their functions is crucial for strategies to counter microbial aggression with novel treatment and prevention measures. One approach is the use of bacterial molecules that reprogramme the innate immune system, accelerating or inhibiting disease processes. A very different outcome is asymptomatic bacteriuria, defined by low host immune responsiveness to bacteria with attenuated virulence. This observation provides the rationale for immunomodulation as a new therapeutic tool to deliberately modify host susceptibility, control the host response and avoid severe disease. The power of innate immunity as an arbitrator of health and disease is also highly relevant for emerging pathogens, including the current COVID-19 pandemic.
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Affiliation(s)
- Ines Ambite
- grid.4514.40000 0001 0930 2361Department of Microbiology, Immunology and Glycobiology, Institute of Laboratory Medicine, Lund University, Lund, Sweden
| | - Daniel Butler
- grid.4514.40000 0001 0930 2361Department of Microbiology, Immunology and Glycobiology, Institute of Laboratory Medicine, Lund University, Lund, Sweden
| | - Murphy Lam Yim Wan
- grid.4514.40000 0001 0930 2361Department of Microbiology, Immunology and Glycobiology, Institute of Laboratory Medicine, Lund University, Lund, Sweden
| | - Therese Rosenblad
- grid.4514.40000 0001 0930 2361Department of Microbiology, Immunology and Glycobiology, Institute of Laboratory Medicine, Lund University, Lund, Sweden
| | - Thi Hien Tran
- grid.4514.40000 0001 0930 2361Department of Microbiology, Immunology and Glycobiology, Institute of Laboratory Medicine, Lund University, Lund, Sweden
| | - Sing Ming Chao
- Nephrology Service, Department of Paediatrics, KK Hospital, Singapore, Singapore
| | - Catharina Svanborg
- grid.4514.40000 0001 0930 2361Department of Microbiology, Immunology and Glycobiology, Institute of Laboratory Medicine, Lund University, Lund, Sweden
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5
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Ciampa ML, Chohonis JP, Otto RS, Franklin BT. Invasive Mucinous Neoplasm of the Appendix Masquerading as Recurrent Urinary Tract Infections: a Case Report. Mil Med 2020; 185:e2166-e2170. [PMID: 32716041 DOI: 10.1093/milmed/usaa179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We report on a case of a healthy male patient who was referred to Urology for recurrent persistent urinary tract infections. Investigation revealed a large intraabdominal inflammatory collection abutting the cecum and bladder suspicious for ruptured appendicitis and colovesical fistula. He was taken to the operating room for exploratory laparotomy with General Surgery and Urology and found to have a ruptured appendix secondary to mucinous appendiceal neoplasm with invasion into the cecum and the bladder wall. He then underwent systemic chemotherapy followed by hyperthermic intraperitoneal chemotherapy. He is well with stable right lower quadrant inflammatory collection and without evidence of metastatic disease 22 months following initial surgery. This case presents a rare presentation of a rare disease process that is easy to misdiagnose or be delayed in diagnosis because of its vague and often varied presentation.
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Affiliation(s)
- Maeghan L Ciampa
- Department of General Surgery, Dwight D. Eisenhower Army Medical Center, 300 East Hospital Road, Fort Gordon, GA 30905
| | - James P Chohonis
- Department of General Surgery, Dwight D. Eisenhower Army Medical Center, 300 East Hospital Road, Fort Gordon, GA 30905
| | - Richard S Otto
- Department of Urology, Martin Army Community Hospital, 6600 Van Aalst Boulevard, Fort Gordon, GA 31905
| | - Benjamin T Franklin
- Department of General Surgery, Martin Army Community Hospital, 6600 Van Aalst Boulevard, Fort Benning, GA 31905
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6
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Urinary Tract Infections. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_102-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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7
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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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8
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Abstract
Urinary tract infection (UTI) is one of the most common bacterial infections, and the incidence in women is much higher than in men. The diagnosis of a UTI can be made based on a combination of symptoms and a positive urine analysis or culture. Most UTIs are uncomplicated UTIs, defined as cystitis in a woman who is not pregnant, is not immunocompromised, has no anatomical and functional abnormalities of the urogenital tract, and does not exhibit signs of tissue invasion and systemic infection. All UTIs that are not uncomplicated are considered to be complicated UTIs. Differentiation between uncomplicated and complicated UTIs has implications for therapy because the risks of complications or treatment failure are increased for patients with a complicated UTI. Asymptomatic bacteriuria (ASB) is defined as the presence of a positive urine culture collected from a patient without symptoms of a UTI. Concerning the complicated UTI, it is possible to make a differentiation between UTI with systemic symptoms (febrile UTI) and UTI in a host, which carries an increased risk to develop complications of this UTI. Febrile UTIs are urosepsis, pyelonephritis, and prostatitis. A complicated host is defined as one that has an increased risk for complications, to which the following groups belong: men, pregnant women, immunocompromised patients, or those who have an anatomical or functional abnormality of the urogenital tract (e.g., spinal cord-injury patients, renal stones, urinary catheter).
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9
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Bergamin PA, Kiosoglous AJ. Surgical management of recurrent urinary tract infections: a review. Transl Androl Urol 2017; 6:S153-S162. [PMID: 28791234 PMCID: PMC5522803 DOI: 10.21037/tau.2017.06.17] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
There are many causes of recurrent urinary tract infections (rUTI) which are amenable to surgical management. This usually follows a lengthy trial of conservative management. Aetiological classification of rUTI requiring surgical management may be divided into congenital or acquired. Predisposing factors are classified into two groups; those providing a source for organisms, or by maintaining favourable conditions for the proliferation of organisms. Sources of infections include calculi, fistulae or abscesses. Conditions which predispose to bacterial proliferation include malignancies, foreign bodies, high post void residuals, and neuropathic bladders. Removal of identified sources, treating the obstruction, and improving urinary drainage, are all goals of surgical management. Surgical options for rUTI management can range from minimally invasive procedures such as endoscopic or percutaneous, through to more invasive requiring laparoscopic or an open approach. Surgery remains a very important and viable solution.
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Affiliation(s)
- Paul A Bergamin
- Department of Urology, Queen Elizabeth II Jubilee Hospital, Acacia Ridge, Queensland, Australia.,University of Queensland, School of Medicine and Surgery, Brisbane, Australia
| | - Anthony J Kiosoglous
- Department of Urology, Queen Elizabeth II Jubilee Hospital, Acacia Ridge, Queensland, Australia.,University of Queensland, School of Medicine and Surgery, Brisbane, Australia
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10
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Shallcross L, Beckley N, Rait G, Hayward A, Petersen I. Antibiotic prescribing frequency amongst patients in primary care: a cohort study using electronic health records. J Antimicrob Chemother 2017; 72:1818-1824. [PMID: 28333200 PMCID: PMC5437523 DOI: 10.1093/jac/dkx048] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 11/03/2016] [Accepted: 01/20/2017] [Indexed: 11/24/2022] Open
Abstract
Background Reducing inappropriate antibiotic prescribing in primary care is a public health priority. Objectives We hypothesized that a subset of patients account for the majority of antibiotic prescriptions in primary care. We investigated the relationship between the total amount of antibiotics prescribed, individual-level antibiotic use and comorbidity. Methods This was a cohort study using electronic health records from 1 948 390 adults registered with 385 primary care practices in the UK in 2011-13. We estimated the average number of antibiotic prescriptions per patient and the association between prescribing and comorbidity. We modelled the impact on total prescribing of reducing antibiotic use in those prescribed antibiotics most frequently. Results On average 30.1% (586 194/1 948 390) of patients were prescribed at least one antibiotic per year. Nine percent (174 602/1 948 390) of patients were prescribed 53% (2 091 496/3 922 732) of the total amount of antibiotics, each of whom received at least five antibiotic prescriptions over 3 years. The presence of any comorbidity increased the prescribing rate by 44% [adjusted incidence rate ratio (IRR) 1.44, 95% CI 1.43-1.45]; rates of prescribing to women exceeded those in men by 62% (adjusted IRR 1.62, 95% CI 1.62-1.63). Conclusions Half of antibiotics prescribed to adults in primary care were for <10% of patients. Efforts to tackle antimicrobial resistance should consider the impact of this on total prescribing.
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Affiliation(s)
- Laura Shallcross
- UCL Institute of Health Informatics, 222 Euston Road, London NW1 2DA, UK
| | - Nick Beckley
- Research Department of Primary Care and Population Health, University College London Medical School, Rowland Hill Street, London NW3 2PF, UK
| | - Greta Rait
- Research Department of Primary Care and Population Health, University College London Medical School, Rowland Hill Street, London NW3 2PF, UK
| | - Andrew Hayward
- UCL Institute of Health Informatics, 222 Euston Road, London NW1 2DA, UK
| | - Irene Petersen
- Research Department of Primary Care and Population Health, University College London Medical School, Rowland Hill Street, London NW3 2PF, UK
- Department of Clinical Epidemiology, Aarhus University, Olof Palmes Alle, 8200 Aarhus N, Denmark
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11
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Allen RJ, Koutsakos M, Hurt AC, Kedzierska K. Uncomplicated Cystitis in an Adult Male Following Influenza B Virus Infection. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:190-193. [PMID: 28223680 PMCID: PMC5333716 DOI: 10.12659/ajcr.902172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Influenza B viruses cause seasonal epidemics of respiratory illness, circulating concurrently with influenza A viruses. However, virological and clinical knowledge of influenza B viruses is less well advanced than for influenza A, and in particular, complications associated with influenza B infection are not as commonly reported. Complications of influenza B infection predominantly include neurological and musculoskeletal pathologies, while a review of the literature shows that bacterial infections associated with influenza B viruses often involve Gram-positive organisms, with a smaller subset featuring Gram-negative species. CASE REPORT In this case report we highlight an uncomplicated infection of the urinary tract by Escherichia coli immediately following influenza B infection, in an otherwise healthy adult white male with no prior history of urinary tract infection or structural abnormalities of the renal tract. CONCLUSIONS Bacterial infections complicating influenza B infection may include organisms not commonly associated with the respiratory system, such as Escherichia coli. In addition, bacterial complications of influenza B infection may affect non-respiratory systems, including the genitourinary tract.
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Affiliation(s)
- Robert J Allen
- Department of Microbiology and Immunology, University of Melbourne, at Tthe Peter Doherty Institute of Infection and Immunity, Melbourne, VIC, Australia
| | - Marios Koutsakos
- Department of Microbiology and Immunology, University of Melbourne, at The Peter Doherty Institute of Infection and Immunity, Melbourne, VIC, Australia
| | - Aeron C Hurt
- World Health Organisation (WHO) Collaborating Centre for Reference and Research on Influenza, at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Katherine Kedzierska
- Department of Microbiology and Immunology, University of Melbourne, at The Peter Doherty Institute of Infection and Immunity, Melbourne, VIC, Australia
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12
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Urinary Tract Infections. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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13
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Prostatitis, Epididymitis and Orchitis. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00058-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Abstract
ABSTRACT
Four prostatitis syndromes are recognized clinically: acute bacterial prostatitis, chronic bacterial prostatitis, chronic prostatitis/chronic pelvic pain syndrome, and asymptomatic prostatitis. Because
Escherichia coli
represents the most common cause of bacterial prostatitis, we investigated the importance of bacterial virulence factors and antimicrobial resistance in
E. coli
strains causing prostatitis and the potential association of these characteristics with clinical outcomes. A structured literature review revealed that we have limited understanding of the virulence-associated characteristics of
E. coli
causing acute prostatitis. Therefore, we completed a comprehensive microbiological and molecular investigation of a unique strain collection isolated from healthy young men. We also considered new data from an animal model system suggesting certain
E. coli
might prove important in the etiology of chronic prostatitis/chronic pelvic pain syndrome. Our human data suggest that
E. coli
needs multiple pathogenicity-associated traits to overcome anatomic and immune responses in healthy young men without urological risk factors. The phylogenetic background and accumulation of an exceptional repertoire of extraintestinal pathogenic virulence-associated genes indicate that these
E. coli
strains belong to a highly virulent subset of uropathogenic variants. In contrast, antibiotic resistance confers little added advantage to
E. coli
strains in these healthy outpatients. Our animal model data also suggest that certain pathogenic
E. coli
may be important in the etiology of chronic prostatitis/chronic pelvic pain syndrome through mechanisms that are dependent on the host genetic background and the virulence of the bacterial strain.
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Urinary Tract Infections. Fam Med 2015. [DOI: 10.1007/978-1-4939-0779-3_102-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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16
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Osborn D, Kaufman M, Reynolds WS, Dmochowski R. Prostate Related Urinary Tract Infections. CURRENT BLADDER DYSFUNCTION REPORTS 2013. [DOI: 10.1007/s11884-013-0194-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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17
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Johansen TEB, Botto H, Cek M, Grabe M, Tenke P, Wagenlehner FME, Naber KG. Critical review of current definitions of urinary tract infections and proposal of an EAU/ESIU classification system. Int J Antimicrob Agents 2011; 38 Suppl:64-70. [PMID: 22018988 DOI: 10.1016/j.ijantimicag.2011.09.009] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Classification of urinary tract infections (UTI) is important for clinical decisions, research, quality measurement and teaching. Current definitions of UTI are above all based on the concept of the two main categories, complicated and uncomplicated UTI. The category "complicated UTI" especially is very heterogeneous and not always clear. We propose the EAU/ESIU classification system ORENUC based on the clinical presentation of the UTI, categorisation of risk factors and availability of appropriate antimicrobial therapy, which finally may result in the definition of UTI severity groups.
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Affiliation(s)
- Truls E Bjerklund Johansen
- Department of Urology, Århus University Hospital, Skejby, Århus University, Brendstrupgårdvej 100, DK-8200 Århus, Denmark.
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Krieger JN, Dobrindt U, Riley DE, Oswald E. Acute Escherichia coli prostatitis in previously health young men: bacterial virulence factors, antimicrobial resistance, and clinical outcomes. Urology 2011; 77:1420-5. [PMID: 21459419 DOI: 10.1016/j.urology.2010.12.059] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 12/14/2010] [Accepted: 12/29/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To investigate clinical outcomes, bacterial virulence factors, and antimicrobial resistance in E. coli from young men presenting with acute bacterial prostatitis. METHODS Initial E. coli isolates from previously healthy young men with no factors compromising urinary tract anatomy or function were tested for virulence-associated genes by polymerase chain reaction (PCR) assays, phylogenetic grouping by triplex polymerase PCR, and antibiotic resistance. RESULTS All 18 patients responded to treatment, including 2 who required long-term therapy. E. coli were allocated to phylogenetic groups B2 (13 strains) and D (5 strains). Prostatitis isolates belonged to clones mainly represented by extraintestinal pathogenic E. coli (ExPEC) and preferentially uropathogenic E. coli and displayed marked accumulation of virulence genes (hly, cdt1, clb, pap, sfa/foc, fyuA, iroN, kpsMT(II), and traT) characteristic of highly virulent ExPEC. All phylogenetic group B2 strains coded for at least 1 toxin with carcinogenic potential (Colibactin, cytolethal distending toxins, or cytotoxic necrotizing factor). In contrast to their accumulation of virulence-associated traits, prostatitis strains were sensitive to standard antibiotics. CONCLUSIONS The phylogenetic background and accumulation of an exceptional repertoire of extraintestinal pathogenic virulence-associated genes indicate that these E. coli strains belong to a highly virulent subset of uropathogenic variants. In contrast, antibiotic resistance was minimal in these E. coli strains from previously healthy, young outpatients.
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Affiliation(s)
- John N Krieger
- University of Washington School of Medicine, Seattle, WA 98108-1597, USA.
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20
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Prostatitis, epididymitis and orchitis. Infect Dis (Lond) 2010. [DOI: 10.1016/b978-0-323-04579-7.00054-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Abstract
The diagnosis and management of adolescent urinary tract infection (UTI) share some of the clinical features seen in infections of the young and old. Whereas most infections in the young patient demand an extensive radiologic work-up, the teenager with a UTI is not so straightforward. The clinician must balance being too aggressive with being too conservative in the diagnosis and management of these patients. UTIs occur most frequently among adolescent females and are usually uncomplicated and not associated with underlying anatomic abnormalities. Smaller numbers of adolescent males suffer from UTIs, and the need to search for underlying abnormalities is not clear. Adolescent UTI is associated with nascent sexual activity and is also more common in voiding/elimination syndromes. Future studies examining UTI, specifically in the adolescent age group, will help provide clinicians with a more focused algorithm in the diagnosis and management of adolescent UTIs.
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Naber KG, Schito G, Botto H, Palou J, Mazzei T. Surveillance study in Europe and Brazil on clinical aspects and Antimicrobial Resistance Epidemiology in Females with Cystitis (ARESC): implications for empiric therapy. Eur Urol 2008; 54:1164-75. [PMID: 18511178 DOI: 10.1016/j.eururo.2008.05.010] [Citation(s) in RCA: 198] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Accepted: 05/07/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND Uncomplicated cystitis in females is among the most frequent infections in community. OBJECTIVE To determine clinical aspects, epidemiology, and antimicrobial susceptibility of uropathogens. INTERVENTION Patients were investigated clinically and with urinalysis and urine culture. MEASUREMENTS This survey started in 2003 and ended in 2006 including 68 centres in nine European countries and in Brazil. Female patients between 18 and 65 yr with symptoms of uncomplicated cystitis were consecutively enrolled and clinically evaluated. Uropathogens were identified and their susceptibility tested for nine antimicrobials. RESULTS AND LIMITATIONS Clinical data of 4264 eligible patients were analysed. A positive urine culture was found in 74.6%. Within the 3018 pathogens, Escherichia coli (E. coli) was most frequent (76.7%), followed by Enterococcus faecalis (4.0%), Staphylococcus saprophyticus (3.6%), Klebsiella pneumoniae (3.5%), and Proteus mirabilis (3.5%). E. coli showed the highest rate of susceptibility to fosfomycin (98.1%) followed by mecillinam (95.8%), nitrofurantoin (95.2%), and ciprofloxacin (91.8%). The lowest rate was found for ampicillin (45.1%). For the total spectrum the order was fosfomycin (96.4%), mecillinam (95.9%), ciprofloxacin (90.3%), and nitrofurantoin (87.0%). In all countries a susceptibility rate to E. coli above 90% was found only for fosfomycin, mecillinam, and nitrofurantoin. The susceptibility rates varied significantly from country to country (p<0.0001), except for fosfomycin, mecillinam, and nitrofurantoin. CONCLUSIONS Despite wide cross-country variability of bacterial susceptibility/resistance rates to the other antimicrobials tested, fosfomycin, mecillinam, and nitrofurantoin have preserved their in vitro activity in all countries investigated. They may represent good options for the empiric therapy of female patients with uncomplicated cystitis.
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Etienne M, Chavanet P, Sibert L, Michel F, Levesque H, Lorcerie B, Doucet J, Pfitzenmeyer P, Caron F. Acute bacterial prostatitis: heterogeneity in diagnostic criteria and management. Retrospective multicentric analysis of 371 patients diagnosed with acute prostatitis. BMC Infect Dis 2008; 8:12. [PMID: 18234108 PMCID: PMC2254416 DOI: 10.1186/1471-2334-8-12] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Accepted: 01/30/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is currently a lack of consensus for the diagnosis, investigations and treatments of acute bacterial prostatitis (AP). METHODS The symptoms, investigations and treatments of 371 inpatients diagnosed with AP were analyzed through a retrospective study conducted in four departments - Urology (U), Infectious Diseases (ID), Internal Medicine (IM), Geriatrics (G) - of two French university hospitals. RESULTS The cause of admission, symptoms, investigations and treatments depended markedly on the department of admission but not on the hospital. In U, patients commonly presented with a bladder outlet obstruction, they had a large imaging and functional check-up, and received alpha-blockers and anti-inflammatory drugs. In ID, patients were febrile and received longer and more appropriate antibiotic treatments. In G, patients presented with cognitive disorders and commonly had post-void urine volume measurements. In IM, patients presented with a wide range of symptoms, and had very diverse investigations and antibiotic regimen.Overall, a 3:1 ratio of community-acquired AP (CA-AP) to nosocomial AP (N-AP) was observed. Urine culture isolated mainly E. coli (58% of AP, 68% of CA-AP), with venereal agents constituting less than 1%. The probabilistic antibiotic treatments were similar for N-AP and CA-AP (58% bi-therapy; 63% fluoroquinolone-based regimen). For N-AP, these treatments were more likely to be inadequate (42% vs. 8%, p < 0.001) and had a higher rate of bacteriological failure (48% vs. 19%, p < 0.001). Clinical failure at follow-up was more common than bacteriological failure (75% versus 24%, p < 0.001). Patients older than 49 had more underlying urinary tract disorders and a higher rate of clinical failure (30% versus 10%, p < 0.0001). CONCLUSION This study highlights the difficulties encountered on a daily basis by the physicians regarding the diagnosis and management of acute prostatitis.
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Affiliation(s)
- Manuel Etienne
- Infectious and Tropical Diseases department, and Groupe de Recherche sur les Antimicrobiens (GRAM-EA2656), Rouen University Hospital, Rouen, F-76031, France.
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Wagenlehner FME, Naber KG. Fluoroquinolone Antimicrobial Agents in the Treatment of Prostatitis and Recurrent Urinary Tract Infections in Men. Curr Infect Dis Rep 2005; 7:9-16. [PMID: 15610666 DOI: 10.1007/s11908-005-0018-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Chronic bacterial prostatitis is the most frequent cause for recurrent urinary tract infection in young and middle-aged men. The selection of an appropriate antimicrobial agent that has optimal pharmacokinetics for urine and prostatic secretion and tissue is important in both entities. Fluoroquinolones possess several pharmacologic characteristics that favor them for treatment of urinary tract infection and prostatitis. The pharmacokinetics of fluoroquinolones and the theoretical background of drug penetration into the prostate are outlined. Analyzing the concentrations of various fluoroquinolones in urine, prostatic and seminal fluid, and in prostatic tissue, it becomes obvious that the fluoroquinolones differ in plasma concentrations and in their concentrations at these sites. Nevertheless, overall, the concentrations at the site of infection of most of the fluoroquinolones should be sufficient for the treatment of chronic bacterial prostatitis and vesiculitis and recurrent urinary tract infection in men caused by susceptible pathogens.
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Affiliation(s)
- F M E Wagenlehner
- Urologic Clinic, Hospital St. Elisabeth Straubing, St. Elisabeth Str. 23, D-94315 Straubing, Germany.
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Wagenlehner FME, Naber KG. Fluoroquinolone antimicrobial agents in the treatment of prostatitis and recurrent urinary tract infections in men. Curr Urol Rep 2004; 5:309-16. [PMID: 15260935 DOI: 10.1007/s11934-004-0058-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Chronic bacterial prostatitis is the most frequent cause for recurrent urinary tract infection in young and middle-aged men. The selection of an appropriate antimicrobial agent that has optimal pharmacokinetics for urine and prostatic secretion and tissue is important in both entities. Fluoroquinolones possess several pharmacologic characteristics that favor them for treatment of urinary tract infection and prostatitis. The pharmacokinetics of fluoroquinolones and the theoretical background of drug penetration into the prostate are outlined. Analyzing the concentrations of various fluoroquinolones in urine, prostatic and seminal fluid, and in prostatic tissue, it becomes obvious that the fluoroquinolones differ in plasma concentrations and in their concentrations at these sites. Nevertheless, overall, the concentrations at the site of infection of most of the fluoroquinolones should be sufficient for the treatment of chronic bacterial prostatitis and vesiculitis and recurrent urinary tract infection in men caused by susceptible pathogens.
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Affiliation(s)
- F M E Wagenlehner
- Urologic Clinic, Hospital St. Elisabeth Straubing, St. Elisabeth Str. 23, D-94315 Straubing, Germany
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Manges AR. Molecular Epidemiology of Acute, Uncomplicated Urinary Tract Infections in Young Women. Curr Infect Dis Rep 2003; 5:504-509. [PMID: 14642193 DOI: 10.1007/s11908-003-0095-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Molecular biological methods, a relatively new addition to the epidemiologist's tool chest, are now applied to the study of urinary tract infection (UTI). By combining sound epidemiologic methods and the ability to genetically stratify UTI-causing Escherichia coli, recent studies have added to our understanding of UTI. These advancements include the possible identification of outbreaks of community-acquired UTI, the contribution of person-to-person transmission of E. coli to the risk for UTI in young women, and changes in the community prevalence and distribution of UTI caused by drug-resistant organisms. The application of molecular methods to future UTI research studies may yield novel approaches to UTI prevention.
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Affiliation(s)
- Amee R. Manges
- Riley Laboratory, 140 Warren Hall, School of Public Health, University of California Berkeley, Berkeley, CA 94720, USA.
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Abarbanel J, Engelstein D, Lask D, Livne PM. Urinary tract infection in men younger than 45 years of age: is there a need for urologic investigation? Urology 2003; 62:27-9. [PMID: 12837416 DOI: 10.1016/s0090-4295(03)00146-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To determine in a prospective study whether urinary tract infection (UTI) in men younger than 45 years of age is associated with anomalies of the genitourinary tract that necessitate additional urologic evaluation. UTI in young men is uncommon. In these patients, it is customary to follow the same policy as that for children or older men and to routinely perform urologic investigations. METHODS Twenty-nine consecutive, otherwise healthy, male patients aged 16 to 45 years (mean 30.5) were hospitalized for a first event of acute UTI. All patients underwent an imaging evaluation, including ultrasonography and intravenous urography. Those with macroscopic hematuria underwent cystoscopy. Uroflowmetry was performed at least 1 month after recovery, and patients with a maximal flow rate of less than 15 mL/s underwent a pressure flow study. RESULTS Significant urethral stricture was excluded in all patients. Twenty-seven patients (93%) had a postvoid residual urine volume of less than 20 mL, and only two had values of 120 and 200 mL. The imaging and cystoscopic evaluation demonstrated a normal urinary tract in all patients. The maximal urinary flow rate was greater than 15 mL/s in 22 patients (76%) and lower than 15 mL/s in 7 patients (24%). In the latter group, urodynamic investigations, including free flowmetry and/or pressure flow study, revealed normal lower urinary tract function in 6 patients and a bladder outflow obstruction in 1 (3%). CONCLUSIONS A first event of UTI in men younger than 45 years is usually not associated with significant structural or functional urinary tract abnormalities. Therefore, no radiologic, endoscopic, or urodynamic investigation is required.
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Abstract
Urinary tract infections (UTIs) are considered to be the most common bacterial infection. According to the 1997 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, UTI accounted for nearly 7 million office visits and 1 million emergency department visits, resulting in 100,000 hospitalizations. Nevertheless, it is difficult to accurately assess the incidence of UTIs, because they are not reportable diseases in the United States. This situation is further complicated by the fact that accurate diagnosis depends on both the presence of symptoms and a positive urine culture, although in most outpatient settings this diagnosis is made without the benefit of culture. Women are significantly more likely to experience UTI than men. Nearly 1 in 3 women will have had at least 1 episode of UTI requiring antimicrobial therapy by the age of 24 years. Almost half of all women will experience 1 UTI during their lifetime. Specific subpopulations at increased risk of UTI include infants, pregnant women, the elderly, patients with spinal cord injuries and/or catheters, patients with diabetes or multiple sclerosis, patients with acquired immunodeficiency disease syndrome/human immunodeficiency virus, and patients with underlying urologic abnormalities. Catheter-associated UTI is the most common nosocomial infection, accounting for >1 million cases in hospitals and nursing homes. The risk of UTI increases with increasing duration of catheterization. In noninstitutionalized elderly populations, UTIs are the second most common form of infection, accounting for nearly 25% of all infections. There are important medical and financial implications associated with UTIs. In the nonobstructed, nonpregnant female adult, acute uncomplicated UTI is believed to be a benign illness with no long-term medical consequences. However, UTI elevates the risk of pyelonephritis, premature delivery, and fetal mortality among pregnant women, and is associated with impaired renal function and end-stage renal disease among pediatric patients. Financially, the estimated annual cost of community-acquired UTI is significant, at approximately $1.6 billion.
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Urinary Tract Infections. Fam Med 2003. [DOI: 10.1007/978-0-387-21744-4_95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Urinary tract infections (UTIs) are considered to be the most common bacterial infection. According to the 1997 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, UTI accounted for nearly 7 million office visits and 1 million emergency department visits, resulting in 100,000 hospitalizations. Nevertheless, it is difficult to accurately assess the incidence of UTIs, because they are not reportable diseases in the United States. This situation is further complicated by the fact that accurate diagnosis depends on both the presence of symptoms and a positive urine culture, although in most outpatient settings this diagnosis is made without the benefit of culture. Women are significantly more likely to experience UTI than men. Nearly 1 in 3 women will have had at least 1 episode of UTI requiring antimicrobial therapy by the age of 24 years. Almost half of all women will experience 1 UTI during their lifetime. Specific subpopulations at increased risk of UTI include infants, pregnant women, the elderly, patients with spinal cord injuries and/or catheters, patients with diabetes or multiple sclerosis, patients with acquired immunodeficiency disease syndrome/human immunodeficiency virus, and patients with underlying urologic abnormalities. Catheter-associated UTI is the most common nosocomial infection, accounting for >1 million cases in hospitals and nursing homes. The risk of UTI increases with increasing duration of catheterization. In noninstitutionalized elderly populations, UTIs are the second most common form of infection, accounting for nearly 25% of all infections. There are important medical and financial implications associated with UTIs. In the nonobstructed, nonpregnant female adult, acute uncomplicated UTI is believed to be a benign illness with no long-term medical consequences. However, UTI elevates the risk of pyelonephritis, premature delivery, and fetal mortality among pregnant women, and is associated with impaired renal function and end-stage renal disease among pediatric patients. Financially, the estimated annual cost of community-acquired UTI is significant, at approximately $1.6 billion.
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Affiliation(s)
- Betsy Foxman
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor 48109-2029, USA
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Bishop MC. Selective urological evaluation in men with febrile urinary tract infection. BJU Int 2001; 88:445-6. [PMID: 11564043 DOI: 10.1046/j.1464-410x.2001.02377-5.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ulleryd P, Zackrisson B, Aus G, Bergdahl S, Hugosson J, Sandberg T. Selective urological evaluation in men with febrile urinary tract infection. BJU Int 2001; 88:15-20. [PMID: 11446838 DOI: 10.1046/j.1464-410x.2001.02252.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the prevalence and clinical importance of urological abnormalities in men with community-acquired febrile urinary tract infection (UTI). PATIENTS AND METHODS In this prospective study, 85 men (median age 63 years, range 18--86) were followed for 1 year after an episode of febrile UTI. They were investigated by excretory urography, cysto-urethroscopy, uroflowmetry, digital rectal examination and measurement of postvoid residual urine volume by abdominal ultrasonography. RESULTS The radiological examination of the upper urinary tract in 83 patients revealed 22 abnormal findings in 19 men. Relevant clinical abnormalities leading to surgical intervention were found in only one patient who had renal calyceal stones. The lower urinary tract investigation disclosed 46 findings in 35 men. In all, surgically correctable disorders were found in 20 patients, of whom 15 had previously unrecognized abnormalities. All patients who required surgery were identified either by a history of voiding difficulties, acute urinary retention at the time of infection, the presence of microscopic haematuria at follow-up after one month, or early recurrent symptomatic UTI. CONCLUSION Routine imaging studies of the upper urinary tract seem dispensable in men with febrile UTI. To reveal abnormalities of clinical importance, any urological evaluation should primarily be focused on the lower urinary tract.
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Affiliation(s)
- P Ulleryd
- Department of Infectious Diseases, Sahlgrenska University Hospital, Göteborg, Sweden.
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Stamm WE, Norrby SR. Urinary tract infections: disease panorama and challenges. J Infect Dis 2001; 183 Suppl 1:S1-4. [PMID: 11171002 DOI: 10.1086/318850] [Citation(s) in RCA: 366] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- W E Stamm
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, WA 98195, USA.
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Riley DE, Berger RE, Miner DC, Krieger JN. Diverse and related 16S rRNA-encoding DNA sequences in prostate tissues of men with chronic prostatitis. J Clin Microbiol 1998; 36:1646-52. [PMID: 9620394 PMCID: PMC104894 DOI: 10.1128/jcm.36.6.1646-1652.1998] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Treatment of chronic prostatitis/chronic pelvic pain syndrome is often empirical because clinical culture methods fail to detect prostate-associated pathogens in >90% of patients. Previously, we tested a variety of specific-microorganism PCRs and began a DNA sequence study after we found that 77% of prostatitis patients were PCR positive for prokaryotic rRNA-encoding DNA sequences (rDNAs) despite negative cultures using optimal techniques. In the present study, 36 rDNA clones from 23 rDNA-positive patients were sequenced. This study represents more than twice the total rDNA sequence and more than twice the number of patients in the previous study. The increased number of patients and clones sequenced allowed enhanced phylogenetic analyses and refinements in our view of rDNA species inhabiting the prostate. A continuum of related rDNAs that might be arbitrarily described as two major groups of rDNAs and several minor groups was found. Sequences termed Pros A, identified in 8 (35%) of 23 rDNA-positive patients, grouped with Aeromonas spp. in phylogenetic studies. Sequences termed Pros B, identified in 17 (74%) of 23 rDNA-positive patients, were distinct from previously reported sequences, although all were >90% similar to known gram-negative bacteria. Of the nine patients for whom multiple rDNAs were sequenced, six had biopsy specimens containing rDNAs from more than one species. Four (17%) patients had rDNAs different from those of the Pros A and Pros B groups. Of these four, one patient had rDNA similar to that of Flavobacterium spp., another had rDNA similar to that of Pseudomonas testosteroni, and two patients had rDNAs <70% similar to known rDNAs. These findings suggest that the prostate can harbor bacteria undetectable by traditional approaches. Most of these diverse sequences are not reported in environments outside the prostate. The sequence similarities suggest adaptation of limited groups of bacteria to the microenvironment of the prostate. Further studies may elucidate the relationship of prostate-associated bacteria to chronic prostatitis/chronic pelvic pain syndrome.
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Affiliation(s)
- D E Riley
- Department of Urology, School of Medicine, University of Washington, Seattle 98195, USA.
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Bailey BL. Urinary Tract Infections. Fam Med 1998. [DOI: 10.1007/978-1-4757-2947-4_95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Acute uncomplicated urinary tract infection is one of the most common problems for which young women seek medical attention and accounts for considerable morbidity and health care costs. Acute cystitis or pyelonephritis in the adult patient should be considered uncomplicated if the patient is not pregnant or elderly, if there has been no recent instrumentation or antimicrobial treatment, and if there are no known functional or anatomic abnormalities of the genitourinary tract. Most of these infections are caused by E. coli, which are susceptible to many oral antimicrobials, although resistance is increasing to some of the commonly used agents. Review of the published data suggests that a 3-day regimen is more effective than a single-dose regimen for all antimicrobials tested. Regimens with trimethoprim-sulfamethoxazole seem to be more effective than those with beta lactams, regardless of the duration. Because of increasing resistance to trimethoprim-sulfamethoxazole, an alternative regimen such as nitrofurantoin (in a 7-day regimen), a fluoroquinolone, or an oral third-generation cephalosporin may be a better empiric choice in some areas. Acute pyelonephritis caused by highly virulent uropathogens in an otherwise healthy woman may be considered an uncomplicated infection. The optimal treatment duration for acute uncomplicated pyelonephritis has not been established, but 10- to 14-day regimens are recommended. We prefer to use antimicrobials that attain high renal tissue levels, such as a fluoroquinolone, trimethoprim-sulfamethoxazole, or an aminoglycoside, for pyelonephritis. Acute uncomplicated cystitis or pyelonephritis in healthy adult men is uncommon but is generally caused by the same spectrum of uropathogens with the same antimicrobial susceptibility profile as that seen in women.
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Affiliation(s)
- T M Hooton
- Department of Medicine, University of Washington School of Medicine, Seattle, USA
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