colistin and Bacteriuria

An open, prospective, randomised, comparative study of "Trisdine" and kanamycin-colistin bladder instillations in reducing significant bacteriuria during intermittent urethral catheterisation was conducted. Trisdine is an aqueous solution of chlorhexidine gluconate 0.01% with added ethylenediaminetetra-acetic acid disodium salt and TRIS buffer at final concentrations of 1.34 mMoles and 0.01 Molar respectively. All patients (15 males and 3 females) admitted with acute spinal cord trauma and bladder involvement requiring intermittent catheterisation for more than 5 days during a 12-month period were studied. There was no significant difference in the mean incidence of significant bacteriuria during intermittent catheterisation in the 7 males who had kanamycin-colistin bladder instillations compared with the 8 males who had Trisdine instillations. A comparison could not be made in the females because there were only 3 patients. Because Trisdine is more stable at ambient temperatures, is less likely to select antibiotic-resistant bacteria and is less expensive, it is concluded that Trisdine is preferable to kanamycin-colistin solution for bladder instillations during intermittent catheterisation.

Topics: Acute Disease; Adolescent; Adult; Anti-Infective Agents, Urinary; Bacteriuria; Chlorhexidine; Clinical Trials as Topic; Colistin; Drug Combinations; Edetic Acid; Female; Humans; Kanamycin; Male; Middle Aged; Prospective Studies; Random Allocation; Spinal Cord Injuries; Tromethamine; Urinary Catheterization

Acinetobacter baumannii strains, are opportunistic pathogens that cause severe nosocomial infections that are difficult to treat due to development of resistance to multiple antibiotics. As the antibiotic choices to be used in treatment are limited, combinations of a variety of antibiotics are used. The aims of this study were to identify the minimal inhibitory concentration (MIC) values of colistin and sulbactam against A.baumannii isolates and to determine the in vitro activity of colistin-sulbactam combination. A total of 50 A.baumannii strains isolated from different clinical specimens (32 tracheal aspirates, 10 blood, 6 urine and 2 wound samples) were included in the study. The identification of bacteria was performed by traditional methods and Vitek-2 (BioMerieux, France) automated system. Antibiotic susceptibilities were detected by Mueller-Hinton agar disk diffusion method and Vitek-2 automated system and the results were interpreted according to the CLSI standards. MIC values of colistin and sulbactam against A.baumannii strains and in vitro interactions of colistin-sulbactam combinations were determined with the E-test (BioMerieux, France). Fractional inhibitory concentration (FIC) index was used for the detection of efficacy of drug combinations. The presence of oxacillinase and metallo-beta-lactamase (MBL) genes that lead carbapenem resistance was investigated by polymerase chain reaction (PCR), and pulsed-field gel electrophoresis (PFGE) was performed for the determination of clonal relationship. In our study, all strains (100%) were detected as susceptible to colistin, 48 (96%) to trimethoprim/sulphamethoxazole and 18 to (36%) tigecyclin; however all of them were resistant to the other studied antibiotics, including sulbactam and carbapenem. When the colistin-sulbactam combination was assessed according to FIC index, all strains were found to have antagonistic effect. All of the carbapenem-resistant strains were positive for OXA-51 and OXA-23, and 3 (6%) were positive for OXA-24. Among MBLs, OXA-58, OXA-48, IPM, SPM, SIM, GIM, VIM and NDM-1 genes were not detected. In the evaluation of PFGE results it was found that the clonal distribution of the strains, except one, were all pulsotype A. In the assessment of in vitro efficacy of the colistin-sulbactam combination against A.baumannii strains with multidrug resistance, antagonistic effect was observed in all strains. In the resistance and clonal analysis it was determined that the strains bel

Topics: Acinetobacter baumannii; Acinetobacter Infections; Anti-Bacterial Agents; Bacteremia; Bacteriuria; beta-Lactamases; Carbapenems; Colistin; Drug Combinations; Drug Resistance, Bacterial; Electrophoresis, Gel, Pulsed-Field; Humans; Microbial Sensitivity Tests; Polymerase Chain Reaction; Sulbactam; Trachea; Wound Infection

The objective of this study was to evaluate the mortality of and risk factors for bacteriuria due to carbapenem-resistant Klebsiella pneumoniae (CRKp) versus carbapenem-susceptible K. pneumoniae (CSKp) producing extended spectrum β lactamase (ESBL).. This was a retrospective case-control study in which 135 case-patients with bacteriuria due to CRKp were compared with 127 control patients with CSKp producing ESBL. In a first step, multivariate Cox regression and Kaplan-Meier survival analysis models were used to determine the difference in mortality between the two groups and risk factors for mortality. In a second step, a univariate analysis was used to identify risk factors for CRKp colonization.. There were no significant demographic or clinical differences between the groups. In-hospital mortality in the study and control groups was 29 and 25 %, respectively (non-significant difference). Multivariate analysis revealed that the most important risk factor for mortality in both groups was being bed ridden [hazard ratio 2.2, 95 % confidence interval (CI) 1.23-3.93; P = 0.008]. Patients with CRKp bacteriuria had a longer hospitalization time with a mean ± standard deviation of 28 ± 33 days compared to 22 ± 28 days in the control group (P < 0.05). Several univariate risk factors for acquiring CRKp bacteriuria were identified: antibiotic use [odds ratio (OR) 1.93, 95 % CI 1.18-3.17, p = 0.008], especially colistin (OR 2.04, 95 % CI 1.04-4.02; P = 0.036), presence of a urinary catheter (OR 2.09, 95 % CI 1.2-3.63; P = 0.008), surgery (OR 3.94, 95 % CI 1.85-8.37; P = 0.0002), invasive procedures (OR 3.06, 95 % CI 1.61-5.8; P = 0.0004), and intensive care unit admission (OR 2.49, 95 % CI 1.18-5.37; P = 0.015).. Bacteriuria caused by CRKp as compared that caused by CSKp was not found to be a risk factor for death.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacteriuria; beta-Lactam Resistance; Carbapenems; Case-Control Studies; Colistin; Confidence Intervals; Female; Hospital Mortality; Humans; Intensive Care Units; Kaplan-Meier Estimate; Klebsiella Infections; Klebsiella pneumoniae; Length of Stay; Male; Middle Aged; Odds Ratio; Proportional Hazards Models; Retrospective Studies; Risk Factors; Treatment Outcome; Urinary Catheters; Young Adult

Two groups of patients with acute spinal cord trauma had initial bladder management by standard non-touch techniques of intermittent catheterisation. Twenty-two patients (17 males and 5 females) had kanamycin-colistin solution instilled into the bladder at the end of each catheterisation, and 25 patients (21 males and 4 females) were not given these instillations. The incidence of significant bacteriuria during intermittent catheterisation of both males and females receiving the instillations was only half the incidence of those not receiving the instillations. Also, a significantly higher proportion of males receiving the instillations did not have any episodes of significant bacteriuria compared with those not receiving the instillations, and the same trend was evident in the small number of female patients. It is recommended that patients should have kanamycin-colistin bladder instillations when they are being intermittently catheterised.

Topics: Acute Disease; Bacteria; Bacteriuria; Colistin; Drug Combinations; Female; Humans; Kanamycin; Male; Microbial Sensitivity Tests; Solutions; Spinal Cord Injuries; Urinary Bladder; Urinary Catheterization

Hospitalized patients with urinary tract infections caused by Pseudomonas aeruginosa or other bacterial pathogens are frequently treated with parenteral antibiotics such as gentamicin. Many of these organisms are shown by Kirby-Bauer disk sensitivity testing to be resistant to tetracycline. One hundred seventy-one such tetracycline-resistant bacterial isolates were studied; 84% were found to be sensitive to achievable urinary concentrations of tetracycline. Two patients with long-standing chronic urinary tract infection with Pseudomonas were treated with tetracycline for a year and a half with excellent results. In a pilot clinical trial, eight of 12 hospitalized patients with urinary tract infection were treated successfully with tetracycline without regard to disk sensitivity data. Institution of tetracycline as soon as the microscopic diagnosis of urinary tract infection is made might be an acceptable empiric approach to the treatment of urinary infection in hospitalized patients who do not show evidence of sepsis.

Topics: Bacteriuria; Carbenicillin; Colistin; Gentamicins; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Nephrectomy; Penicillin Resistance; Proteus mirabilis; Pseudomonas aeruginosa; Pseudomonas Infections; Tetracycline; Urinary Tract Infections

Topics: Ampicillin; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Bacteriuria; Chloramphenicol; Colistin; Drug Resistance, Microbial; Enterococcus faecalis; Escherichia coli; Escherichia coli Infections; Humans; Hungary; Kanamycin; Klebsiella; Microbial Sensitivity Tests; Nalidixic Acid; Neomycin; Nitrofurantoin; Penicillin Resistance; Polymyxins; Proteus; Proteus Infections; Proteus mirabilis; Pseudomonas aeruginosa; Streptomycin; Tetracycline; Time Factors; Urinary Tract Infections; Urine

Topics: Adolescent; Adult; Aged; Bacteriuria; Cephalothin; Chloramphenicol; Chronic Disease; Colistin; Drug Resistance, Microbial; Escherichia coli Infections; Female; Gentamicins; Humans; Kanamycin; Male; Methacycline; Middle Aged; Oxytetracycline; Proteus Infections; Rifampin; Sulfamethoxypyridazine; Urinary Tract Infections

Topics: Ampicillin; Anti-Bacterial Agents; Bacteria; Bacteriuria; Cephalothin; Chloramphenicol; Colistin; Enterococcus faecalis; Escherichia coli; Gentamicins; Humans; Kanamycin; Nalidixic Acid; Nitrofurantoin; Penicillin Resistance; Proteus; Pseudomonas aeruginosa; Pyelonephritis; Staphylococcus; Streptococcus; Tetracycline; Urologic Diseases

Topics: Animals; Anti-Bacterial Agents; Bacteriuria; Cephaloridine; Cephalothin; Colistin; Escherichia coli Infections; Female; Gentamicins; Kidney; Models, Biological; Naphthacenes; Proteus Infections; Pyelonephritis; Rats

Topics: Animals; Anti-Bacterial Agents; Bacteriuria; Cephaloridine; Cephalothin; Colistin; Female; Gentamicins; Pyelonephritis; Rats; Tetracycline

Topics: Anti-Bacterial Agents; Bacteriuria; Colistin; Corynebacterium; Enterobacteriaceae; Female; Humans; Kanamycin; Male; Penicillin Resistance; Penicillins; Pseudomonas; Sex Factors; Staphylococcus; Streptococcus

Topics: Bacteriuria; Colistin; Cystitis; Escherichia coli Infections; Humans; Pseudomonas Infections; Pyelonephritis; Sulfonic Acids; Urethritis

Topics: Anti-Bacterial Agents; Bacteriological Techniques; Bacteriuria; Colistin; Enterobacteriaceae; Escherichia coli Infections; Klebsiella; Proteus Infections; Pseudomonas; Pseudomonas Infections; Staphylococcal Infections; Streptococcal Infections; Urinary Tract Infections; Urine

Topics: Bacteriuria; Colistin; Drug Resistance; Drug Resistance, Microbial; Drug Therapy; Humans; Neomycin; Pyelonephritis