trimethoprim--sulfamethoxazole-drug-combination and Bacteriuria

Topics: Adult; Age Factors; Aged; Anti-Bacterial Agents; Antimicrobial Stewardship; Asymptomatic Infections; Bacteriuria; beta-Lactams; Culture Techniques; Drug Resistance, Bacterial; Female; Fluoroquinolones; Fosfomycin; Humans; Lower Urinary Tract Symptoms; Middle Aged; Nitrites; Nitrofurantoin; Pregnancy; Pregnancy Complications, Infectious; Pyuria; Trimethoprim, Sulfamethoxazole Drug Combination; Urinalysis; Urinary Tract Infections

Bacteriuria is common among renal allograft recipients. It can be categorized into asymptomatic bacteriuria (ASB) and urinary tract infection (UTI). However, in medical literature, the classifications of bacteriuria are often not clear or ASB is also classified as a UTI. This contributes to difficulties in interpretation of the incidence and risk factors of these two entities. In this review, we describe the epidemiology, risk factors, management and the impact on renal allograft function of these two entities separately according to the recent literature.. Risk factors for ASB are not completely comparable to the risk factors of UTIs. Persistent ASB has been associated with development of acute rejection and allograft pyelonephritis. The available data suggest that treatment of ASB is not very effective. Prophylaxis with trimethoprim-sulfamethoxazole does not prevent UTIs such as allograft pyelonephritis. Blood stream infections and emphysematous allograft pyelonephritis are associated with renal allograft loss.. ASB is the most common manifestation of bacteriuria after renal transplantation. More effective interventions are needed to prevent bacteriuria. Renal allograft recipients with persistent ASB should be closely monitored since they could be at risk for developing not only UTIs, such as allograft pyelonephritis, but also acute rejection.

Topics: Anti-Bacterial Agents; Asymptomatic Diseases; Bacteriuria; Humans; Kidney Transplantation; Pyelonephritis; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Acute Disease; Adult; Anti-Infective Agents, Urinary; Bacteriuria; Cystitis; Diagnosis, Differential; Drug Administration Schedule; Female; Humans; Practice Guidelines as Topic; Pyelonephritis; Pyuria; Risk Factors; Secondary Prevention; Sensitivity and Specificity; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Urinary tract infections in boys and men are common causes of significant morbidity and, when coupled with urinary tract abnormalities, loss of renal function. Careful and prompt urological assessment is mandatory for proper treatment and prevention of serious and/or chronic sequelae.

Topics: 4-Quinolones; Anti-Infective Agents; Bacteriuria; Gram-Negative Bacteria; Humans; Male; Nitrofurantoin; Prostatitis; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Questions concerning the clinical picture, diagnosis and treatment of uncomplicated urinary tract infections in women related to daily practice are discussed on the basis of personal experience and a review of the literature. Indications and rationale for a single-dose therapy with Cotrimoxazole, Trimethoprim or Fosfomycin are detailed. Special considerations are given to therapeutical approaches to recurrent infection as well as special situations like asymptomatic bacteriuria, acute urethral syndrome, bacteriuria in pregnancy and nosocomial, catheter-associated infections are discussed.

Topics: Algorithms; Bacteriuria; Drug Therapy, Combination; Family Practice; Female; Fosfomycin; Humans; Pregnancy; Pregnancy Complications, Infectious; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The published studies of the use of single-dose antimicrobial therapy for the treatment of urinary tract infection have been reviewed. In women a single dose of any of several antimicrobial agents is as effective as a course of treatment for uncomplicated urinary tract infections caused by Escherichia coli. Trimethoprim or co-trimoxazole are currently the preferred agents for single-dose therapy. Fosfomycin trometamol and the 4-quinolones are promising agents. Failure of single-dose therapy may prove to be a simple guide as to the need for further urinary tract investigation or more intensive therapy. Single-dose antimicrobial therapy is now the treatment of choice for uncomplicated urinary tract infections in general practice.

Topics: Bacteriuria; Cystitis; Drug Administration Schedule; Female; Humans; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Although controversies remain regarding the definition, diagnosis, and management of urinary tract infections, such infections can pose a major risk to a child's well-being. Bacteriuria or recurrent urinary tract infections often pose difficult management problems. Symptomatic and asymptomatic bacteriuria during infancy are generally characterized by a benign outcome. In some children repeated episodes and, possibly, renal scarring result. The prognosis in young boys may be guarded if neonatal bacteriuria, with or without symptoms, occurs in the presence of anatomic defects. Although a variety of pathogens have been identified as causing urinary tract infections, Enterobacteriaceae are usually the cause of initial uncomplicated lower tract infections. Accepted therapy for such infections is reviewed, as are the combination therapies used for hospitalized patients with upper tract infections. An investigation of piperacillin, a new, extended-spectrum acylaminopenicillin, raises the hope that it may provide effective monotherapy for upper tract infections. The criteria for selecting patients who require radiologic evaluation in the management of urinary tract infections are reviewed.

Topics: Acute Disease; Adolescent; Anti-Bacterial Agents; Bacteriuria; Child; Child, Preschool; Drug Combinations; Female; Humans; Long-Term Care; Male; Piperacillin; Prognosis; Recurrence; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Bacteriuria is much more common in the elderly than in younger individuals for a variety of reasons. Women have a greater prevalence than men, but the trend to increased prevalence with age in over 65 year olds is greater in men. The acquisition rate for bacteriuria in the elderly is extremely high but information about the sequelae of bacteriuria is scanty. However there is good evidence that bacteriuria is associated with increased mortality. In clinical practice, subjects found to be bacteriuric tend to be treated and there are a variety of problems in this, not only with regard to efficacy but also in suitability of antimicrobials by virtue of resistance patterns and side effects. A small comparative study shows that norfloxacin may be a suitable drug for use in the elderly, but further studies are required to confirm this in larger numbers of unselected patients. A transient but significant rise in serum creatinine was observed in subjects on cotrimoxazole.

Topics: Aged; Anti-Infective Agents, Urinary; Bacteriuria; Drug Combinations; Female; Humans; Male; Middle Aged; Nalidixic Acid; Norfloxacin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

PURPOSE OF THE STUDY A very serious complication following joint replacement surgery is periprosthetic joint infection that can be caused by a urinary tract infection. Insertion of an indwelling urinary catheter constitutes a risk factor that may result in urinary tract infections. The aim of this prospective randomised study was to compare the occurrence of significant bacteriuria and symptomatic urinary tract infections during antibiotic prophylaxis at the time of removal of an indwelling urinary catheter by cotrimoxazole in two doses and with no administration of antibiotics. We also monitored the incidence of potential periprosthetic infection following the endoprosthesis implantation. The findings of preoperative urine tests were compared with the declared negative preoperative examination. MATERIAL AND METHODS The study included patients indicated for a total hip or knee replacement with a negative urine culture as a part of the preoperative testing. Where leukocyteria was detected, urine culture by mid-stream clean catch urine was obtained. The second part included patients, in whom an indwelling urinary catheter had to be inserted postoperatively for urine retention and/or monitoring of fluid balance and who were divided into two groups on a rota basis. No antibiotics were administered to the first group, whereas Cotrimoxazol 960 mg tablets p.o. was administered to the second group, 14 and 2 hours before the removal of the catheter. The urine culture test was performed 4 hours after the removal of the indwelling urinary catheter, in both the groups. The test was repeated after 14 days and a questionnaire was filled in to report urinary tract complications. Considered as significant bacteriuria by urinalysis was the laboratory finding of > 10x4 CFU/ml in case of a single pathogen or > 10x5 in case of multiple pathogens. The results were statistically processed by Fischer's exact test with the level of significance = 0.05. RESULTS In the first part of the study leukocyturia was detected by a test strip in 112 of the total of 478 patients. In 10 women, significant bacteriuria was found. Altogether 50 women and 50 men were randomly assigned to the second part of the study. The indwelling urinary catheter was in place for 4 days on average. In men, no statistically significant difference was detected in significant bacteriuria findings, in women a statistically significant difference of p = 0.00162 was found after the removal and after 14 days the bord

Topics: Anti-Infective Agents, Urinary; Antibiotic Prophylaxis; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Bacteriuria; Catheters, Indwelling; Device Removal; Female; Hip Prosthesis; Humans; Knee Prosthesis; Male; Postoperative Care; Prospective Studies; Prosthesis-Related Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Catheterization; Urinary Catheters; Urinary Tract Infections

Bacterial resistance to antibiotics is an increasingly threatening consequence of antimicrobial exposure for many decades now. In urinary tract infections (UTIs), antibiotic prophylaxis (AP) increases bacterial resistance. We studied the resistance patterns of positive urinary cultures in spina bifida children on clean intermittent catheterization, both continuing and stopping AP.. In a cohort of 176 spina bifida patients, 88 continued and 88 stopped using AP. During 18 months, a fortnightly catheterized urine sample for bacterial pathogens was cultured. UTIs and significant bacteriuria (SBU) were defined as a positive culture with a single species of bacteria, respectively with and without clinical symptoms and leukocyturia. We compared the percentage of resistance to commonly used antibiotics in the isolated bacteria in both groups.. In a total of 4917 cultures, 713 (14.5%) had a positive monoculture, 54.3% of which were Escherichia coli. In the group stopping AP, the resistance percentage to antibiotics in UTI / SBU bacteria was lower than in the group remaining on AP, even when excluding the administered prophylaxis.. Stopping antibiotic prophylaxis for urinary tract infections is associated with reduced bacterial resistance to antibiotics in children with spina bifida.. ISRCTN ISRCTN56278131 . Registered 20 December 2005.

Topics: Adolescent; Aminoglycosides; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacteriuria; Child; Deprescriptions; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Fluoroquinolones; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Male; Nitrofurantoin; Penicillins; Spinal Dysraphism; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Women suffering from recurrent urinary tract infections (rUTIs) are routinely treated for asymptomatic bacteriuria (AB), but the consequences of this procedure on antibiotic resistance are not fully known. The aim of this study was to evaluate the impact of AB treatment on antibiotic resistance among women with rUTIs.. The study population consisted of 2 groups of women who had previously been enrolled in a randomized clinical trial: group A was not treated, and group B was treated. All women were scheduled for follow-up visits every 6 months, or more frequently if symptoms arose. Microbiological evaluation was performed only in symptomatic women. All women were followed up for a mean of 38.8 months to analyze data from urine cultures and antibiograms.. The previous study population consisted of 673 women, but 123 did not attend the entire follow-up period. For the final analysis, 257 of the remaining 550 patients were assigned to group A, and 293 to group B. At the end of follow-up, the difference in recurrence rates was statistically significant (P < .001): 97 (37.7%) in group A versus 204 (69.6%) in group B. Isolated Escherichia coli from group B showed higher resistance to amoxicillin-clavulanic acid (P = .03), trimethoprim-sulfamethoxazole (P = .01), and ciprofloxacin (P = .03) than that from group A.. This study shows that AB treatment is associated with a higher occurrence of antibiotic-resistant bacteria, indicating that AB treatment in women with rUTIs is potentially dangerous.

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Asymptomatic Infections; Bacteriuria; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Follow-Up Studies; Humans; Italy; Microbial Sensitivity Tests; Middle Aged; Prevalence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinalysis; Urinary Tract Infections

We conducted a double-blind, placebo-controlled randomized trial to assess the effect of single-dose prophylaxis using co-trimoxazole (960 mg) (n = 46) or ciprofloxacin (500 mg) (n = 43) vs. placebo (n = 51) before urinary catheter removal on significant bacteriuria (SBU) (primary outcome) and urinary tract infection (UTI) in surgical patients with scheduled bladder drainage for 3-14 days. SBU was determined directly after catheter removal, and UTI 12-14 days after catheter removal. After 12-14 days, incidences of SBU were 19%, 19% and 33% for patients receiving ciprofloxacin, co-trimoxazole and placebo, respectively (p ns), and incidences of UTI were 3%, 0% and 3% for patients receiving ciprofloxacin, co-trimoxazole and placebo, respectively (p ns).

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacteriuria; Catheters, Indwelling; Ciprofloxacin; Double-Blind Method; Female; Humans; Incidence; Male; Middle Aged; Placebos; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Periprostatic local anesthesia for prostate biopsy requires 2 or more extra needle punctures and injection of the local anesthetic through the highly colonized rectum. To our knowledge we report the first prospective randomized trial to assess the infectious or hemorrhagic complications associated with this method.. A total of 100 consecutive patients with sterile urine cultures underwent transrectal ultrasound guided prostate biopsy. They were randomized to receive a periprostatic nerve block or no anesthesia. Patients were evaluated for the amount of rectal and urethral bleeding, and symptoms and signs of infection after biopsy.. The amount of urethral bleeding was slight and similar in the 2 groups. Rectal bleeding was significantly less in the patients who received anesthesia. High fever (greater than 37.8C) was more frequent in the nerve block group and 2 patients in this group required rehospitalization. Bacteriuria in post-biopsy urine cultures was significantly more common in the anesthesia group.. Our results suggest that periprostatic local anesthesia for prostate biopsy does not increase the risk of urethral bleeding. It is associated with a decreased incidence of rectal bleeding, presumably due to decreased patient discomfort. The incidence of bacteriuria was significantly higher in the anesthesia group. High fever and hospitalization due to infectious complications were also more common in the local anesthesia group, although not statistically significant. Prospective randomized trials seem warranted to determine the optimum antibiotic prophylaxis regimen in patients undergoing biopsy with a periprostatic nerve block.

Topics: Aged; Anesthesia, Local; Antibiotic Prophylaxis; Bacteriuria; Biopsy, Needle; Endosonography; Fever of Unknown Origin; Gastrointestinal Hemorrhage; Hematuria; Humans; Lidocaine; Male; Middle Aged; Patient Readmission; Prostate; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination

The efficacy of ciprofloxacin was studied in the treatment of 50 women (the average age of 41.6 years) with acute noncomplicated cystitis. The drug was administered in a dose of 100 mg twice a day for 3 days. The reference group included 15 women with the same disease subjected to the routine therapy with cotrimoxazol in a dose of 8 mg and pipemidic acid in a dose of 100 mg administered twice a day. The positive results evident from the subjective clinical improvement and no veritable bacteriuria were stated in 46 patients (92 per cent). The effect was at the average observed in 36 hours in the ciprofloxacin group while in the reference group it was at the average stated in 81.2 hours from the treatment start.

Topics: Acute Disease; Adult; Anti-Infective Agents; Anti-Infective Agents, Urinary; Bacteriuria; Ciprofloxacin; Cystitis; Female; Humans; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Suppressive therapy with antibiotics has long been thought to decrease the number of complications from the neuropathic bladder in spinal cord injury patients, but it may also induce resistance to antibiotics which subsequently causes difficulties in treating symptomatic urinary tract infections. Forty-three chronic spinal cord injury patients were randomized to continue to receive daily trimethoprim-sulfamethoxazole (TMP-SMX) urinary tract prophylaxis versus discontinuing antibiotic prophylaxis. Patients were all at least 6 months after spinal cord injury. Patients were followed for a minimum of 3 months, with weekly catheter urine cultures. The difference in the colonization rate at onset and after 3 months (percent of cultures with asymptomatic bacteriuria) between the control and prophylaxis group was not statistically significant (P > 0.1). There was a significant decrease in the percentage of TMP-SMX resistant asymptomatic bacteriuria in the control group, 78.8%, compared to 94.1% in the suppressive group (P < 0.05). There was no significant difference in the number of symptomatic urinary tract infections following the withdrawal of suppressive therapy between the control group, 0.035/week, and the prophylaxis group, 0.043/week (P > 0.5). There was a larger percentage of TMP-SMX resistant symptomatic urinary tract infections in the treated group, 42.5% versus 37.5% in the control group, but the difference was not significant (P > 0.5). Irrespective of the method of bladder management, suppressive therapy with TMP-SMX did not reduce the incidence of symptomatic bacteriuria and did increase the percentage of cultures resistant to TMP-SMX in asymptomatic patients.

Topics: Adult; Aged; Aged, 80 and over; Bacteriuria; Chronic Disease; Humans; Male; Middle Aged; Spinal Cord Injuries; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

To determine the efficacy of trimethoprim-sulfamethoxazole (TMP-SMX) for prophylaxis of urinary tract infection in persons with recent spinal cord injury, during the first 4 months of intermittent catheterization.. One hundred twenty-nine adults (112 men, 17 women) with recent acute spinal cord injury participated in a randomized, double-blind, placebo-controlled trial, and were studied for up to 16 weeks. Low-dose TMP-SMX (TMP 40 mg, SMX 200 mg) or placebo was given once daily. Clinical observations, urine cultures, and cultures of rectal and urethral swabs were made weekly. Subjects who developed breakthrough bacteriuria received conventional antimicrobial therapy and prophylaxis was continued.. Sixty-six TMP-SMX recipients (57 men, 9 women) and 60 placebo recipients (52 men, 8 women) are evaluable for efficacy. Among male subjects, bacteriuria was present during 50% or more of study weeks in 30% of TMP-SMX recipients and in 56% of placebo recipients (p = 0.003). The interval to the onset of bacteriuria was prolonged in TMP-SMX recipients (p < 0.0001). TMP-SMX recipients without bacteriuria in any given week had a lower probability of having bacteriuria the subsequent week (0.26) than did placebo recipients (0.49) (p < 0.0001). At least 1 episode of definite symptomatic bacteriuria (bacteriuria and fever and at least 1 classical manifestation of urinary infection) occurred in 4 of 57 TMP-SMX-treated men and in 18 of 52 placebo-treated men (p < 0.0003). We observed similar trends in women, but differences did not reach statistical significance, perhaps because the number of females was small. Adverse events suspected to be due to medications were frequent in this population of patients with recent severe injuries and led to discontinuation of the study in 10% of the TMP-SMX group and 8% of the placebo group. Adverse events included neutropenia (TMP-SMX: two; placebo: three), pseudomembranous colitis (TMP-SMX: one), severe skin rash (TMP-SMX: two; placebo: one), and drug fever (TMP-SMX: one). The proportion of all episodes of bacteriuria that were due to TMP-SMX-resistant organisms was unexpectedly high in the placebo group (51%), and increased progressively according to year of enrollment in the study. By Year 3, all subjects in the placebo group had at least one episode of TMP-SMX-resistant bacteriuria. Gram-negative enteric bacilli resistant to TMP-SMX were recovered from rectal swabs (TMP-SMX 49%, placebo 42%) and urethral swabs (TMP-SMX 33%, placebo 26%) in similar proportions of subjects in the two study groups.. Prophylaxis with TMP-SMX significantly reduces bacteriuria and symptomatic urinary tract infection in persons with recent acute spinal cord injury during bladder retraining using intermittent catheterization. However, adverse reactions attributable to TMP-SMX are common in this population. Colonization and breakthrough bacteriuria with TMP-SMX-resistant organisms are frequent and may seriously limit the usefulness of this strategy, particularly in an institutional setting.

Topics: Adolescent; Adult; Aged; Bacteriuria; Double-Blind Method; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged; Prospective Studies; Sex Factors; Spinal Cord Injuries; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder; Urinary Catheterization; Urinary Tract Infections

To test whether longer duration of treatment of asymptomatic bacteriuria in old age could improve the efficacy of cotrimoxazole therapy, three regimens were given to 75 ambulant bacteriuric residents of a retirement home, aged greater than or equal to 68 years. The groups and regimens were: A:23 subjects (160/800 mg b.i.d. orally x 3 days). B: 24 subjects (160/800 mg i.m. x 10 days); C: 28 subjects (160/800 mg b.i.d. orally x 20 days). One week, one month and five months post-therapy urines were negative in 78.3% vs 52.9% vs 42.9% of group A, in 54.2% vs 56.5% vs 50% of group B and in 57.1% vs 60.7% vs 68% of group C subjects respectively. The data indicate that: 1) the efficacy of any schedule is only moderate irrespective of the presence of antibody-coated bacteria in urine; 2) a 3-day course appears more effective at one week post-therapy; 3) at one and five months greater than or equal to 50% of the subjects were infection-free, the 20 day treatment resulting in fewer failures; 4) subjects with long-term eradication had no mobility problem, low serum creatinine and a normal urinary tract as seen by ultrasound.

Topics: Administration, Oral; Aged; Aged, 80 and over; Bacteriuria; Creatinine; Drug Administration Schedule; Escherichia coli; Escherichia coli Infections; Female; Humans; Injections, Intramuscular; Male; Trimethoprim, Sulfamethoxazole Drug Combination

To determine the optimal management of catheter-acquired bacteriuria after short-term catheter use in women.. Asymptomatic patients (119) with catheter-acquired bacteriuria were randomly assigned to receive no therapy, a single dose (320-1600 mg) of therapy with trimethoprim-sulfamethoxazole, or 10 days (160-800 mg twice daily) of therapy. Thirty-two patients with lower tract symptoms alone received a single dose or 10 days of therapy, and 10 patients with upper tract symptoms or signs received 10 days of therapy.. The mean and median durations of catheter use were 6 and 4 days, respectively. Bacteriuria resolved within 14 days without therapy in 15 of 42 (36%; 95% CI, 21% to 51%) asymptomatic patients. Seven of the remaining patients developed symptoms. Single-dose therapy resolved infection in 30 of 37 patients (81%; CI, 68% to 94%); 10 days of therapy resolved infection in 26 of 33 (79%; CI, 65% to 93%). For patients with lower tract symptoms alone, resolution rates with single-dose therapy or 10 days of therapy were similar (11 of 14 [79%] and 13 of 16 [81%], respectively). Ten days of therapy resolved infection in 6 of 9 (67%) patients with upper tract symptoms. Infection was resolved more often in women who were less than or equal to 65 years than in older women (62 of 70 [89%] versus 24 of 39 [62%]; P less than 0.001). Bacteriuria resolved spontaneously more frequently in younger (14 of 19 [74%] compared with 1 of 23 older women [4%]; P less than 0.001). Single-dose therapy resolved infection in 31 of 33 (94%) patients who were less than or equal to 65 years.. Asymptomatic bacteriuria after short-term catheter use frequently becomes symptomatic and should be treated. For asymptomatic patients and patients with lower tract symptoms alone, single-dose therapy was as effective as 10 days of therapy; it was very effective in women who were less than or equal to 65 years. Bacteriuria resolved spontaneously within 14 days after catheter removal more commonly in women who were less than or equal to 65 years and both types of therapy were less effective in older women.

Topics: Adult; Aged; Aged, 80 and over; Bacteriuria; Catheters, Indwelling; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Catheterization

In a prospective randomized study ofloxacin (400 mg orally once daily) versus co-trimoxazole (320/1,600 mg orally once daily) were given for 3 weeks in 30 and 22 elderly semimobile patients respectively, suffering from asymptomatic bacteriuria. From the obtained results it was evident that: (a) ofloxacin was superior to co-trimoxazole regarding eradication of bacteriuria (p less than 0.05) particularly in patients with a positive antibody-coated bacteria test; (b) a high rate of superinfections and reinfections with strains resistant to co-trimoxazole was observed in both groups indicative of hidden underlying conditions predisposing to urinary tract infections and (c) ofloxacin did not accumulate in serum during prolonged therapy but the half-life ranged between 8.3 and 10.2 h.

Topics: Aged; Aged, 80 and over; Ambulatory Care; Bacteriuria; Female; Humans; Male; Ofloxacin; Prospective Studies; Recurrence; Superinfection; Trimethoprim, Sulfamethoxazole Drug Combination

A three day oral antibiotic course was given to 71 elderly bacteriuric subjects with no or only moderate mobility problems. Seven of 17 men (41%) and 34 of 54 women (63%) had strongly positive antibody coated bacteria (ACB) in the urine. Following sensitivity tests and randomization one of the following agents was given: cefadroxil 1 g tid (13 subjects): co-trimoxazole 160/800 mg bd (23 subjects); or norfloxacin 400 mg bd (35 subjects). One week after therapy urines were negative in 13 men (76.5%) and 37 women (68.5%). Patients who were fully mobile and/or were ACB(-) responded better than those with moderate mobility problems or who were ACB(+). At six months, urines were negative in six (40%) of 15 men and 15 (33.3%) of 45 women. Two men and six women of these 21 subjects had a positive urine at one month. Of the three agents tested cefadroxil was less effective in women. The study indicates that a three day course will clear bacteriuria in about 70% of patients at one week, but only about 25% will remain free of infection at six months; these are usually patients with adequate mobility and normal renal function.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteriuria; Cefadroxil; Escherichia coli; Female; Greece; Humans; Male; Norfloxacin; Skilled Nursing Facilities; Trimethoprim, Sulfamethoxazole Drug Combination

A randomized trial, comparing a single dose treatment of fosfomycin trometamol (FT, 3 g) versus a 3-times daily regimen of cotrimoxazole (CTX, 960 mg) was carried out in women with uncomplicated urinary tract infections. Of 36 evaluable patients, 19 were treated with FT and 17 with TMP. The bacteriological results after 4 weeks of follow-up were in the FT group (n = 19): cure in 17 (89%), and failure in 2 (11%). For the CTX group (n = 17) the results were cure in 13 (76%), and failure in 4 (24%). Adverse events were reported in 3 patients on FT (2 diarrhoea, 1 epigastralgia) and in 2 on CTX (1 stain rash, 1 asthenia).

Topics: Bacteriuria; Drug Administration Schedule; Escherichia coli; Family Practice; Female; Fosfomycin; Humans; Remission Induction; Trimethoprim, Sulfamethoxazole Drug Combination

20 urologists took part in a single blind, randomized study. Female patients with acute uncomplicated UTI were recruited. The patients received either a single dose of 3 g fosfomycin trometamol versus 200 mg ofloxacin or 1.92 g co-trimoxazole. Follow-up examinations were carried out after one and four weeks. Of 562 patients 446 could be evaluated for efficacy and 496 for tolerance. Patients were analysed according to the amount of bacteriuria: "significant" (greater than or equal to 10(5)/ml), "low count" (10(2) - 10(4) ml) and "no bacteriuria" (less than or equal to 10(1)/ml), as well as according to the sensitivity of the infecting organisms: sensitive (resistant): fosfomycin trometamol less than or equal to 16 mg/l (greater than or equal to 128 mg/l), ofloxacin less than or equal to 1 mg/l (greater than or equal to 8 mg/l), co-trimoxazole less than or equal to 2/38 mg/l (greater than or equal to 16/304 mg/l). Up to one week the following results could be achieved: clinical improvement was attained in patients with "significant" bacteriuria (fosfomycin trometamol-150, ofloxacin-89, co-trimoxazole-69) in 94.7% for fosfomycin trometamol, in 95.4% for ofloxacin, and in 94% for co-trimoxazole; in patients with "low count" bacteriuria (fosfomycin trometamol-44, ofloxacin-18, co-trimoxazole-30) in 95.2% for fosfomycin trometamol, in 93.7% for ofloxacin, and in 96.4% for co-trimoxazole; and in patients with no bacteriuria (fosfomycin trometamol-11, ofloxacin-6, co-trimoxazole-4) in 81.8% for fosfomycin trometamol, in 100% for ofloxacin and in 100% for co-trimoxazole.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Aged; Bacteriuria; Drug Administration Schedule; Drug Therapy, Combination; Drug Tolerance; Escherichia coli; Female; Fosfomycin; Humans; Middle Aged; Ofloxacin; Single-Blind Method; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

A randomised clinical study was carried out on patients admitted for ESWL treatment in order to establish the requirement for prophylactic treatment with antibiotics during this procedure. Patients with clinical signs of urinary tract infection, evidence of infectious stones or a positive urine culture were excluded. All other patients were consecutively randomised into 3 groups which were given either trimethoprim + sulphamethoxazole or mecillinam (Group A), methenamine hippurate (Group B), or no treatment at all (Group C). Evaluation with respect to clinical signs of infection was done immediately after the treatment and 4 weeks later. In addition, a urine culture was performed 2 weeks after ESWL, i.e. 1 week after completing treatment with antibiotics and methenamine hippurate. With respect to infectious complications there were no differences between Groups A and C, between Groups B and C or between Group A and B+C, whereas an unexplained slightly higher infectious rate was recorded for Group B compared with Group A. In all patients the occurrence of bacteriuria was low (6.7%) despite the fact that almost 30% of patients had a ureteric catheter during the ESWL procedure. Patients with ureteric catheters did not present with more infectious complications than those without. All patients had a bladder catheter during ESWL. It was concluded that prophylactic treatment with antibiotics during ESWL treatment is unnecessary in all situations where an infectious aetiology is unlikely.

Topics: Adult; Amdinocillin; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Bacteriuria; Clinical Trials as Topic; Drug Combinations; Female; Hippurates; Humans; Lithotripsy; Male; Methenamine; Middle Aged; Premedication; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Calculi; Urinary Catheterization

Three hundred and forty-three patients with suspected bacteriuria undergoing transurethral resection of the prostate (TUR-P) were randomized to treatment with either trimethoprim-sulfamethoxazole (TMP-SMX) or norfloxacin (NF) for 5 1/2 days beginning the evening prior to operation. It was possible to analyse 165 patients for efficacy. Elimination of bacteria on days 10 to 20 was achieved in 78.1% and 78.3% in the TMP-SMX and NF group, respectively. The accumulated elimination rates for the follow up period (days 10-42) were 68.5% for the TMP-SMX group and 76.2% for the NF group. The differences were not statistically significant. No patient had any clinical signs of upper urinary tract infection or septicemia. Three hundred and twelve patients were analysed for safety. Twenty-six patients reported 32 adverse drug events (ADEs). Four reactions in the TMP-SMX group were considered severe while in the NF group all the ADEs were of mild or moderate intensity. In this study NF seems to be at least as effective and safe as TMP-SMX.

Topics: Aged; Aged, 80 and over; Bacteriuria; Humans; Male; Middle Aged; Multicenter Studies as Topic; Norfloxacin; Premedication; Prostatectomy; Randomized Controlled Trials as Topic; Trimethoprim, Sulfamethoxazole Drug Combination

In a randomized single blind study the efficiency of Trimethoprim as a monosubstance used in the therapy of urinary tract infections was compared to that of Cotrimoxazole. There was a total of 40 patients available 20 of whom were given 2 X 200 mg Trimethoprim throughout 10 days whereas the other 20 patients were given 2 X 160 mg Trimethoprim + 800 mg Sulphamethoxazole in the same period. All patients were hospitalized during treatment. The urine was bacteriologically checked at the beginning of the treatment and after 7, 14 and 28 days respectively. The therapy was equally successful in both groups, both from the clinical and the bacteriological point of view (Trimethoprim 17, Cotrimoxazole 18); a statistically significant difference was not to be proved. In the Trimethoprim group there was one relapse, in the Cotrimoxazole group there were two. Undesirable side effects occurred in both groups with a larger number of them occurring in the Cotrimoxazole group. Cotrimoxazole and Trimethoprim proved equally efficient from a clinical point of view. The proportion of side effects is more favourable for Trimethoprim alone; the cost of therapy is almost 50% lower than that of Cotrimoxazole.

Topics: Adult; Aged; Aged, 80 and over; Bacteriuria; Clinical Trials as Topic; Drug Combinations; Female; Humans; Male; Middle Aged; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

We evaluated the following five treatment regimens for acute cystitis in nonpregnant women: cefadroxil, 1,000 mg single-dose; cefadroxil, 500 mg twice a day for three days; cefadroxil, 500 mg twice a day for seven days; trimethoprim-sulfamethoxazole (TMP-SMZ), 320-1,600 mg single-dose, and TMP-SMZ, 160-800 mg twice a day for three days. At four weeks after the end of treatment, 25%, 58%, 70%, 65%, and 88% of patients, respectively, remained cured of infection. The results indicated that three-day treatment (1) might improve cure rates (over single-dose), (2) would reduce incidence of relapse (vs. single-dose), and (3) may be as curative as seven-day treatment. The results of the antibody-coated bacteria test did not predict treatment failure or relapse.

Topics: Administration, Oral; Antibody-Coated Bacteria Test, Urinary; Bacteriuria; Cefadroxil; Cystitis; Drug Combinations; Enterobacteriaceae Infections; Female; Humans; Random Allocation; Recurrence; Staphylococcal Infections; Streptococcal Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Forty women with uncomplicated urinary tract infections were assigned randomly to receive 400 mg. norfloxacin or 160 mg. trimethoprim and 800 mg. sulfamethoxazole twice daily for 10 days. Of the 20 patients receiving norfloxacin none had bacteriuria during or 7 days after therapy and 5 patients were reinfected within 6 weeks of therapy discontinuation. Of the 20 patients receiving trimethoprim-sulfamethoxazole therapy 1 presented with a strain resistant to trimethoprim-sulfamethoxazole and was excluded from the study. The remaining 19 patients were uninfected during and 7 days after therapy, and 6 patients were reinfected 6 weeks after therapy. All documented recurrences were caused by bacteria sensitive to the initial therapeutic agent. Anal and vaginal Enterobacteriaceae maintained their sensitivity to norfloxacin. One patient on trimethoprim-sulfamethoxazole presented with and 2 patients acquired resistant anal and vaginal Enterobacteriaceae. No adverse reactions occurred in either treatment group. Norfloxacin was as effective and safe as trimethoprim-sulfamethoxazole without emergence of resistant bacteria associated with trimethoprim-sulfamethoxazole.

Topics: Adult; Anal Canal; Anti-Infective Agents, Urinary; Bacteriuria; Drug Combinations; Drug Resistance, Microbial; Enterobacteriaceae; Enterobacteriaceae Infections; Feces; Female; Humans; Nalidixic Acid; Norfloxacin; Sulfamethoxazole; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Vagina

We evaluated single-dose regimens of trimethoprim-sulfamethoxazole, amoxicillin, and cyclacillin as treatment for acute cystitis in 38 women. The trial was prematurely stopped because of frequent treatment failures. At two days after treatment, all 13 patients given trimethoprim-sulfamethoxazole were cured, while four (31%) of 13 given amoxicillin and four (33%) of 12 given cyclacillin had persistent bacteriuria. At two weeks, 11 (85%) of 13 patients given trimethoprim-sulfamethoxazole, six (50%) of 12 given amoxicillin, and three (30%) of ten given cyclacillin were cured. One patient with positive results of antibody-coated bacteria testing who was treated with cyclacillin had signs and symptoms of acute pyelonephritis three days after treatment, and two patients treated with amoxicillin and one treated with trimethoprim-sulfamethoxazole converted antibody-coated bacteria test results from negative to positive after therapy. We conclude that single-dose treatment of cystitis in unselected women with cyclacillin and amoxicillin may result in low cure rates and that progression to acute pyelonephritis may occur following ineffective single-dose therapy.

Topics: Adolescent; Adult; Amoxicillin; Antibody-Coated Bacteria Test, Urinary; Bacteriuria; Cyclacillin; Cystitis; Drug Administration Schedule; Drug Combinations; Female; Humans; Middle Aged; Penicillins; Pyelonephritis; Pyuria; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

We conducted 202 trials in 161 male hospital patients to determine if prophylactic administration of ascorbic acid or antibacterials (trimethoprim-sulfamethoxazole, nalidixic acid, methenamine hippurate or nitrofurantoin macrocrystals) would prevent bacteriuria infections in spinal cord injury patients who had had at least 1 bout of bacteriuria. None of the drugs tested appeared to be statistically effective in the doses used in preventing bacteriuria in these patients. Moreover, sensitivities were lost to several drugs other than those used prophylactically. We conclude that use of prophylactic doses of ascorbic acid or antibacterials has not proved to be beneficial in spinal cord injury patients free of indwelling catheters.

Topics: Anti-Infective Agents, Urinary; Ascorbic Acid; Bacteriuria; Clinical Trials as Topic; Drug Combinations; Humans; Male; Methenamine; Nalidixic Acid; Nitrofurantoin; Spinal Cord Injuries; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Catheterization

Patients undergoing transurethral prostate resection received a 10-day or a 20-day treatment with a combination of pivmecillinam/pivampicillin or with co-trimoxazole starting 1 day before surgery. The results were evaluated in 139 patients. Fifty-three patients had bacteriuria prior to the operation, and the bacteriological cure rate was 22 out of 25 on pivmecillinam/pivampicillin and 22 out of 28 on co-trimoxazole. Eighty-six patients had no bacteriuria pre-operatively and received treatment prophylactically. Two out of 40 patients on co-trimoxazole developed urosepsis, while pivmecillinam/pivampicillin was effective in preventing septicaemic episodes in all 46 patients treated. Tolerance was good with mild side-effects in 5 patients on pivmecillinam/pivampicillin and in 2 patients on co-trimoxazole.

Topics: Aged; Amdinocillin Pivoxil; Ampicillin; Bacteriuria; Drug Combinations; Humans; Male; Middle Aged; Penicillanic Acid; Pivampicillin; Premedication; Prostate; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

One hundred and twenty-two patients with uncomplicated urinary tract infections were treated with either 400 mg bd norfloxacin or 160/800 mg bd cotrimoxazole for 7 days. Follow-up examinations showed norfloxacin to be equally effective as cotrimoxazole in the eradication of bacteriuria and symptoms. Norfloxacin caused fewer and less severe side effects.

Topics: Anti-Infective Agents, Urinary; Bacteriuria; Drug Combinations; Female; Humans; Male; Nalidixic Acid; Norfloxacin; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

In a prospective trial, 67 women (outpatients and inpatients) with acute symptomatic infection of the lower urinary tract were randomly selected to receive either a single dose of oral co-trimoxazole or conventional five-day therapy with the same drug. Diagnostic and bacteriological problems were investigated. Both regimens showed similar effectiveness with 91% (five-day therapy) and 100% (single-dose therapy) clinical and bacteriological cure. There were no co-trimoxazole-resistant species in vitro and no therapy side effects. As in other studies, we found that in more than one-third of the cases enterococcus was the responsible bacteria for the infection. This is an important finding because of its resistance to cephalosporins.

Topics: Anti-Infective Agents, Urinary; Bacteriological Techniques; Bacteriuria; Clinical Trials as Topic; Drug Administration Schedule; Drug Combinations; Female; Humans; Prospective Studies; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Aged; Bacteriuria; Cystoscopy; Drug Combinations; Humans; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

A randomised single-blind clinical trial compared cinoxacin (500 mg every 12 hours) to co-trimoxazole (160 mg trimethoprim, 800 mg sulphamethoxazole every 12 hours) in the treatment of 63 patients with urinary tract infections. The symptomatic response was 73% for both drugs. Bacterial eradication was achieved in 81% and 100% of patients receiving cinoxacin and co-trimoxazole respectively. Three patients receiving co-trimoxazole stopped treatment because of adverse reactions. We conclude that cinoxacin is an effective and safe antibacterial agent in the treatment of urinary tract infections.

Topics: Adolescent; Adult; Aged; Anti-Infective Agents, Urinary; Bacteriuria; Cinoxacin; Clinical Trials as Topic; Cystitis; Drug Combinations; Drug Hypersensitivity; Escherichia coli Infections; Female; Humans; Male; Middle Aged; Nausea; Pyelonephritis; Pyridazines; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Amdinocillin Pivoxil; Bacteriuria; Drug Combinations; Humans; Male; Penicillanic Acid; Prostatectomy; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adolescent; Adult; Aged; Bacteriuria; Clinical Trials as Topic; Double-Blind Method; Drug Combinations; Escherichia coli; Female; Follow-Up Studies; Humans; Male; Middle Aged; Random Allocation; Sulfamethizole; Sulfamethoxazole; Sulfathiazoles; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Urinary tract infection in pregnancy is a common microbial infection. Antimicrobial resistance among uropathogens is becoming a major health problem worldwide. The antimicrobial agents used to manage urinary tract infections during pregnancy should be carefully chosen. Therefore, this study aimed to determine the bacterial profile, antibiotic susceptibility pattern, and factors associated with urinary tract infection among pregnant women at Hosanna town public health facilities. A facility-based cross-sectional study was conducted from March to August 2022 on a total of 312 pregnant women who attended antenatal care at Hosanna Town public health facilities. Sociodemographic, clinical data, and related information were collected by using a pre-tested questionnaire. In addition, mid-stream urine specimens were collected from study participants. Bacterial pathogens were identified by standard bacteriological techniques. Antibiotic susceptibility testing was performed by using the Kirby Bauer disk diffusion method. The data were analyzed by using SPSS version 25. Chi-square and odds ratios were calculated and a P-value≤0.05 at a 95% confidence interval was considered statistically significant. The results were presented with words and tables. Of a total of pregnant women, 59/312(18.9%) (95% CI: 14.7-23.7) were found to have significant bacteriuria. The predominant isolates were Escherichia coli (E. coli) 22(34.4%), followed by coagulase-negative staphylococci (CoNS) 10(15.6%), Staphylococci aureus (S. aureus) 7(10.9%), and Klebsiella pneumoniae (K. pneumoniae) 6(9.4%). Overall, 78.1% of these isolates were multidrug-resistant (MDR). Gram-negative bacteria were susceptible to meropenem (97.6%), gentamicin (85.7%), nitrofurantoin (82.1%), ciprofloxacin (73.8%), amoxicillin-clavulanic acid (73.8%) and ceftriaxone (71.8%), but highly resistant to ampicillin (95.5%), trimethoprim-sulfamethoxazole (74.4%), doxycycline (71.8%), cefuroxime (69.2%), and cephalexin (69.2%). The gram-positive bacteria were susceptible to gentamicin (86.4%), erythromycin (81.8%), and nitrofurantoin (77.3%): whereas they showed a high level of resistance to penicillin (72.7%), doxycycline (54.5%), trimethoprim-sulfamethoxazole (52.9%), and cefoxitin (52.9%). No formal education for the participant (AOR: 2.86, 95% CI: 1.03-7.98, p=0.044), family monthly income <1500 birr (AOR: 3.19, 95% CI: 1.48-6.89, p=0.003), and previous history of UTI (AOR: 4.52, 95% CI: 2.04-10.03, p=0.001) were signi

Topics: Ampicillin; Anti-Bacterial Agents; Bacteria; Bacteriuria; Cefuroxime; Cephalexin; Cross-Sectional Studies; Doxycycline; Drug Resistance, Bacterial; Escherichia coli; Ethiopia; Female; Gentamicins; Humans; Microbial Sensitivity Tests; Nitrofurantoin; Pregnancy; Pregnant Women; Staphylococcal Infections; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Targeted antibiotic prophylaxis (TAP) is required for patients with positive urine culture before urological surgery. Our aim was to determine the efficacy of TAP. This was a prospective single-center study performed in a urology department. All patients who underwent a programmed surgery were included. Urine culture was obtained before surgery requiring a prophylaxis: in the case of sterile urines, antibiotics were used in accordance with national recommendations; for positive urine culture, a TAP was used in accordance with susceptibility testing. The drugs were administered for 2 days before surgery until withdrawal of bladder catheter. The occurrence of healthcare-associated infections was registered until day 30 after surgery. Two hundred three patients were included for 8 non-consecutive weeks in 2020, among whom fifteen were lost of sight before day 30. Among the remaining 188 patients, most frequent surgeries were 75 prostatic diseases (40%), 50 endo-ureteral surgeries for JJ stent insertion (27%), and 23 bladder cancers (12%). One hundred forty-eight (79%) patients required a urine culture before procedure; 142/148 (96%) urine cultures were performed, leading to 74 TAP. The main isolated bacteria were 48 Enterobacteriaceae and 8 Enterococcus spp. TAP was cotrimoxazole (n = 30), aminoglycosides (n = 11), amoxicillin (n = 9), fluoroquinolones (n = 7), and others (n = 17). The rate of healthcare-associated infections was 14.8% (11/74), including six microbiologically documented antibiotic failures. The rate of healthcare-associated infection after urological surgery using TAP was high, implying to discuss the choice and the dosage of the antibiotic molecules.

Topics: Aged; Aged, 80 and over; Amoxicillin; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacteria; Bacteriuria; Female; Humans; Male; Middle Aged; Prospective Studies; Stents; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Catheters; Urinary Tract Infections; Urology

The aim of the study was to analyze the risk factors for relapse in patients with acute bacterial prostatitis (ABP), focusing on the impact of different antibiotic regimens. We conducted an observational study of all patients diagnosed with ABP (irritative and/or obstructive urinary symptoms, temperature of >37.8°C, and the presence of bacteriuria in urine culture, in the absence of data suggesting pyelonephritis) from January 2017 to December 2018. The main outcome was relapse. We performed a multivariate analysis to identify the risk factors associated with relapse. A propensity score with inverse weighting was applied to attenuate antibiotic selection bias. We included 410 patients. The mean age was 68 years; 28.8% had diabetes mellitus, and 61.1% benign prostatic hyperplasia. The most common isolated bacteria were Escherichia coli (62.4%) and Klebsiella spp. (10%). The overall resistance rate was 39.5% to quinolones. The mortality rate was 1.2%, and the relapse rate was 6.3%. The only independent risk factor for relapse was inadequate antibiotic therapy (odds ratio [OR] 12.3; 95% confidence interval [95% CI], 3.5 to 43.1). When the antibiotic was modified according to the susceptibility pattern, the rates of relapse were 1.8% in those treated with ciprofloxacin, 3.6% with intravenous beta-lactam, 9.3% with co-trimoxazole, and 9.8% with oral (p.o.) beta-lactam (

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteriuria; beta-Lactams; Chronic Disease; Drug Resistance, Bacterial; Female; Humans; Male; Middle Aged; Prostatitis; Pyelonephritis; Quinolones; Recurrence; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination

Bacterial infection of the urinary tract is among the common reasons for seeking medical attention in the community. Rapidly increasing antibiotic resistance of uropathogens is resulting in limited treatment options. Therefore, knowledge of the current uropathogens and their antibiotic susceptibility is important for better treatment of urinary tract infection.. A cross-sectional study design was conducted from February to September thirty, 2017 among students who came to Mekelle University student's clinics with symptomatic urinary tract infection during the study period.. Mid-stream urine specimens were collected from 341individuals with suspected urinary tract infection for bacteriological identification and antimicrobial susceptibility testing. Data on socio-demographic, clinical and risk factors were also collected using a structured questionnaire.. Among the 341 study participants, 72(21.1%) showed significant bacteriuria. Escherichia coli (48.6%), Coagulase-negative staphylococci (23%), Staphylococcus aureus (13.5%), and Klebsiella spp. (8.1%) were common bacterial isolates. Resistance to ampicillin (81-100%), amoxicillin/clavulanic acid (77-93.6%), co- trimoxazole (55 72.3%), nalidixic acid (57.4%) and tetracycline (46-55.5%) was seen by most isolates. Multidrug resistance was observed in 73% of the bacterial isolates, and 25.5% of the Gram-negative isolates were extended-spectrum beta-lactamase producers. Being female, a history of urinary tract infection, a history of catheterization and frequent sexual activity were found to be statistically associated with urinary tract infection.. Urinary tract infection is a problem among university students with a prevalence of 21.1%. All isolates have developed resistance to most of the commonly used antibiotics. Therefore, health education on the transmission and causes of urinary tract infection are recommended for the students.

Topics: Adolescent; Adult; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Anti-Bacterial Agents; Bacteriuria; Cross-Sectional Studies; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Ethiopia; Female; Humans; Microbial Sensitivity Tests; Prevalence; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Students; Trimethoprim, Sulfamethoxazole Drug Combination; Universities; Young Adult

Urinary tract infection is the second most common type of infection and the problem is further compounded by the emergence of drug resistance in bacterial uropathogens. The aim of this study was to determine the spectrum of bacterial uropathogens and their drug resistant pattern.. A single institutional cross-sectional study was carried out at Arsho Advanced Medical laboratory from September 2015 to May 2016. A total of 712 urine samples were collected, inoculated onto primary isolation culture media, incubated at 37 °C for 18-24 h, and significant bacteriuria was determined. Identification and the antimicrobial susceptibility testing of bacteria were determined by using the automated VITEK 2 compact system.. Out of 712 urine samples processed, 256 (36%) yielded significant bacteriuria of which 208 (81.25%) were obtained from female and 48 (18.75%) from male patients. Age group of 25-44 were more affected with the infection. Of 256 bacterial isolates recovered, Escherichia coli, was the dominant bacterium. Ampicillin and trimethoprim/sulfamethoxazole were the least effective drugs while piperacillin/tazobactam was the most effective drug against Gram-negative bacteria. Erythromycin was the least effective drug while vancomycin was the most active drug against Gram-positive bacteria.. Observation of many bacterial species causing UTI in this study warrants, a continuous epidemiological survey of UTI in health institutions across the country. High level of drug resistance to the commonly prescribed drugs necessitates a search for other options.

Topics: Adolescent; Adult; Aged; Ampicillin; Anti-Bacterial Agents; Bacteriuria; Child; Child, Preschool; Cross-Sectional Studies; Drug Resistance, Bacterial; Erythromycin; Escherichia coli; Ethiopia; Female; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Infant; Male; Microbial Sensitivity Tests; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vancomycin

Urinary tract infections (UTIs) are the commonest infectious complication in kidney transplant recipients (KTRs). No recommendations exist regarding treatment of asymptomatic bacteriuria. We aimed to identify potential risk factors and microbiological profile for UTIs, the role of treatment of asymptomatic bacteriuria, and effects on graft outcomes of bacteriuria within the first year post-transplantation.. We performed a retrospective analysis of UTIs in KTRs transplanted between January 2012 and December 2013 in 2 transplantation centers. Patients were routinely commenced on prophylactic sulfamethoxazole-trimethoprim. Clinical and microbiological data were analyzed for the first year following transplantation.. In all, 276 KTRs were evaluated; 67% were men, with a mean age of 51 years. At 12 months post-transplantation 158 (57%) KTRs had no bacteriuria, 75 (27%) had asymptomatic bacteriuria, 21 (8%) had symptomatic UTIs without further complication, and 22 (8%) with UTIs developed either pyelonephritis or urosepsis. Most frequent pathogens identified were Enterococcus faecalis and Escherichia coli, and 36% of organisms were multidrug resistant. Female sex was a risk factor for infection (P = .002), and presence of a double-J ureteral stent significantly increased the risk of asymptomatic bacteriuria and symptomatic UTIs (P = .003). Diabetes, age, and prior transplantation did not increase risk. Presence of infection was not associated with increased rejection, with similar renal function at 12 months. For episodes of bacteriuria (n = 420, asymptomatic n = 324), untreated asymptomatic bacteriuria (n = 185) followed by symptomatic UTI with the same organism was significantly higher (P = .002) compared with cases of treated asymptomatic bacteriuria (n = 139).. Bacteriuria post-kidney transplantation is common, affecting nearly half of KTRs in the first year after transplantation. Treatment of asymptomatic bacteriuria may be beneficial to prevent subsequent episodes of symptomatic UTIs.

Topics: Adult; Bacterial Infections; Bacteriuria; Enterococcus faecalis; Escherichia coli; Female; Humans; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Pyelonephritis; Retrospective Studies; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The international guidelines recommend the administration of trimethoprim-sulfamethoxazole (TMP-SMX) as Pneumocystis jiroveci pneumonia (PJP) prophylaxis for six months after transplantation. The aim of this study is to evaluate the influence of TMP-SMX prophylaxis on the occurrence of asymptomatic bacteriuria (ASB) and urinary tract infections (UTIs) as cystitis and allograft pyelonephritis (AGPN) and its impact on the antimicrobial resistance pattern of causative microorganisms.. We have conducted a retrospective before-after study in adult renal allograft recipients with one year follow-up after transplantation. We compared the ("after") group that received TMP-SMX as PJP prophylaxis to the ("before") group that did not receive it.. In total, 343 renal allograft recipients were analysed, of whom 212 (61.8 %) received TMP-SMX as PJP prophylaxis. In this study, 63 (18.4 %) did only develop ASB without UTI, 26 (7.6 %) developed cystitis and 43 (12.5 %) developed AGPN. The remaining 211 (61.5 %) renal allograft recipients did not develop any bacteriuria at all. Multivariable Cox proportional regression analysis indicated that TMP-SMX as PJP prophylaxis was not associated with reduced prevalence of ASB (Hazard ratio (HR) = 1.52, 95 % CI = 0.79-2.94, p = 0.213), nor with reduced incidence of cystitis (HR = 2.21, 95 % CI = 0.76-6.39, p = 0.144), nor AGPN (HR = 1.12, 95 % CI = 0.57-2.21, p = 0.751). Among the group receiving TMP-SMX as PJP prophylaxis there was a trend was observed in increase of both amoxicillin (86 % versus 70 %) and TMP-SMX (89 % versus 48 %) resistance which already appeared within the first 30 days after TMP-SMX exposure.. Among renal allograft recipients, administration of TMP-SMX as PJP prophylaxis does not prevent ASB nor UTI, however it is associated with tendency towards increased amoxicillin and TMP-SMX resistance.

Topics: Adult; Anti-Bacterial Agents; Asymptomatic Diseases; Bacteriuria; Controlled Before-After Studies; Cystitis; Drug Resistance, Bacterial; Female; Follow-Up Studies; Humans; Kidney Transplantation; Male; Middle Aged; Pneumocystis carinii; Pneumonia, Pneumocystis; Postoperative Complications; Pyelonephritis; Retrospective Studies; Transplantation, Homologous; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Escherichia coli is the most common pathogen isolated from both nosocomial and community acquired urinary tract infections. Although there are many studies from different centers concerning the antibiotic susceptibility of E.coli isolates in Turkey, the studies are quite few about class 1 and class 2 integron cassettes in clinical E.coli isolates from urinary samples. The aim of the study was to investigate the antibiotic susceptibility and the carriage of integron gene cassettes in E.coli strains isolated from urinary samples. A total of 626 E.coli strains isolated from urine cultures in microbiology laboratories located at 10 provinces from different regions of Turkey (Denizli, Ankara, Kayseri, Niğde, Şanlıurfa, Kahramanmaras, Tokat, Malatya, Konya and Trabzon) between June 2011-June 2012 were included in the study. The identification and antibiotic susceptibility testing of the isolates were studied by conventional methods as well as Vitek® 2 Compact (bioMérieux, France) and BD Phoenix™ 100 (Becton Dickinson, USA) systems. The antibiotic susceptibilities of all the isolates were retested by Kirby-Bauer disk diffusion method according to CLSI recommendations in the main center of the study in order to achive the standardization. The presence of integrons was detected with polymerase chain reaction (PCR) method by using specific primers targeting class 1 (intI1) and class 2 (intI2) integrase gene regions. After integron amplification the samples were cloned and subjected to DNA sequencing. When the antibiotic susceptibility of the isolates were evaluated, the highest resistance was observed against most commonly used empirical antibiotics namely ampicillin and trimethoprim-sulfamethoxazole (SXT) with the mean rate of 58.6% (range: 43.8%-73.2%) and 41.2% (range: 35.4%-45.8%), respectively. The most effective antibiotics detected against the isolates were imipenem and amikacin with the lowest resistance rates of 0.2% (range: 0%-1.1%) and 0.6% (range: 0%-3.2%), respectively. The frequency of positive IntI1 gene and class 1 integron gene cassettes were found as 25.8% (162/626) and 16.6% (104/626), respectively, whereas the frequency of positive intI2 gene II and class 2 integron gene cassettes were 5.1% (32/626) and 3% (19/626), respectively. The lowest intI1 gene frequency was detected in the isolates from Kayseri (16.6%) and the highest in the isolates from Kahramanmaraş (35.4%) provinces. While there was no intI2 gene in the isolates from Denizli and Kays

Topics: Amikacin; Ampicillin; Anti-Bacterial Agents; Bacteriuria; Escherichia coli Infections; Humans; Imipenem; Integrons; Microbial Sensitivity Tests; Polymerase Chain Reaction; Sequence Analysis, DNA; Streptomycin; Trimethoprim, Sulfamethoxazole Drug Combination; Turkey; Urinary Tract Infections; Uropathogenic Escherichia coli

Determination of treatment protocols for infections according to antimicrobial susceptibility test (AST) results is are important for controlling the problem of antibiotic resistance. Two standards are widely used in the world. One of them is Clinical Laboratory Standards Institute (CLSI) standards used in Turkey for many years and the other is the European Committee on Antimicrobial Susceptibility Testing (EUCAST) standards which is used in European Union member countries and came into use in 2015 in Turkey. Since the EUCAST standards had higher clinical sensitivity limits particularly for gram-negative bacilli compared to CLSI (2009) standards, there will be some changes in antibiotic resistance profiles of Turkey with the use of EUCAST. CLSI has changed zone diameters after 2009 versions and the differences between the two standards were brought to a minimum level. Knowledge of local epidemiological data is important to determine empirical therapy which will be used in urinary tract infections (UTI). The aim of this study was to determine the differences of antibiotic susceptibility zone diameters based on our local epidemiological data among uropathogenic Escherichia coli isolates according to EUCAST 2014 and CLSI 2014 standards. A total of 298 E.coli strains isolated from urine samples as the cause of uncomplicated acute UTI agents, were included in the study. Isolates were identified by conventional methods and with BBL Crystal E/NF ID System (Becton Dickinson, USA). AST was performed with Kirby Bauer disk diffusion method and results were evaluated and interpreted according to the CLSI 2014 and EUCAST 2014 standards. According to the results, susceptibility rates of isolates against amikacin (100%) and trimethoprim-sulfamethoxazole (63.09%) were identical in both standards. However, statistically significant differences were observed between CLSI and EUCAST standards in terms of susceptibilities against gentamicin (91.95% and 84.56%, respectively; p= 0.004), cefuroxime axetil (20.13% and 77.18%, respectively; p= 0.000) and levofloxacin (73.83% and 67.11%, respectively; p= 0.044). No statistically differences between two standards for ampicillin (32.89% and 36.24%, respectively; p= 0.219), ampicillin-sulbactam (65.77% and 69.13%, respectively; p= 0.216), ciprofloxacin (72.48% and 71.14%, respectively; p= 0.392) and imipenem (94.63% and 95.30%, respectively; p= 0.426) were determined. In this transitional period, continuity of cooperation between the

Topics: Amikacin; Ampicillin; Anti-Bacterial Agents; Bacteriuria; Cefuroxime; Ciprofloxacin; Disk Diffusion Antimicrobial Tests; Drug Resistance, Bacterial; Escherichia coli Infections; European Union; Gentamicins; Humans; Imipenem; Levofloxacin; Microbial Sensitivity Tests; Reference Standards; Sulbactam; Trimethoprim, Sulfamethoxazole Drug Combination; Turkey; Urinary Tract Infections; Uropathogenic Escherichia coli

Urinary tract infection (UTI) is a common health problem among pregnant women. Proper investigation and prompt treatment are needed to prevent serious life threatening condition and morbidity due to urinary tract infection that can occur in pregnant women. Recent report in Addis Ababa, Ethiopia indicated the prevalence of UTI in pregnant women was 11.6% and Gram negative bacteria was the predominant isolates and showed multi drug resistance. This study aimed to assess bacterial profile that causes urinary tract infection and their antimicrobial susceptibility pattern among pregnant women visiting antenatal clinic at University of Gondar Teaching Hospital, Northwest Ethiopia.. A cross-sectional study was conducted at University of Gondar Teaching Hospital from March 22 to April 30, 2011. Mid stream urine samples were collected and inoculated into Cystine Lactose Electrolyte Deficient medium (CLED). Colony counts yielding bacterial growth of 105/ml of urine or more of pure isolates were regarded as significant bacteriuria for infection. Colony from CLED was sub cultured onto MacConkey agar and blood agar plates. Identification was done using cultural characteristics and a series of biochemical tests. A standard method of agar disc diffusion susceptibility testing method was used to determine susceptibility patterns of the isolates.. The overall prevalence of UTI in pregnant women was 10.4%. The predominant bacterial pathogens were Escherichia coli 47.5% followed by coagulase-negative staphylococci 22.5%, Staphylococcus aureus 10%, and Klebsiella pneumoniae 10%. Gram negative isolates were resulted low susceptibility to co-trimoxazole (51.9%) and tetracycline (40.7%) whereas Gram positive showed susceptibility to ceftriaxon (84.6%) and amoxicillin-clavulanic acid (92.3%). Multiple drug resistance (resistance to two or more drugs) was observed in 95% of the isolates.. Significant bacteriuria was observed in asymptomatic pregnant women. Periodic studies are recommended to check the outcome of asymptomatic bacteriuria and also monitor any changes in the susceptibility patterns of urinary tract pathogens in pregnant women.

Topics: Adolescent; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Asymptomatic Diseases; Bacteriuria; Ceftriaxone; Colony Count, Microbial; Cross-Sectional Studies; Drug Resistance, Multiple, Bacterial; Escherichia coli; Ethiopia; Female; Hospitals, University; Humans; Klebsiella pneumoniae; Microbial Sensitivity Tests; Middle Aged; Pregnancy; Prevalence; Staphylococcus aureus; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

To investigate whether diabetes mellitus is a risk factor for resistance in Escherichia coli isolated from patients with bacteriuria.. Data were obtained from a multicentre study. A clean-voided midstream urine culture was collected from 636 women with diabetes, who were between 18 and 75-years-old, attended an out-patient department and had no symptoms of a urinary tract infection. The resistance of E. coli was determined for different antimicrobials. The results were compared with resistance data from routine isolates of E. coli, obtained from women in the same age category, time period and location.. A total of 135 E. coli were isolated from women with diabetes mellitus (mean age 57 +/- 14 years) and compared with 5907 routine isolates of E. coli obtained from female patients visiting an out-patient department (mean age 52 +/- 17 years). The resistance rates of E. coli isolated from diabetic patients and the routine isolates of E. coli to trimethoprim-sulfamethoxazole were 19% and 23%, respectively, to amoxicillin 16% and 32%, to nitrofurantoin 1% and 3%, to ciprofloxacin 0% and 4%, to ofloxacin 0% and 5%, and to norfloxacin 1% and 4%.. The resistance of uropathogenic E. coli in non-hospitalized women with diabetes mellitus is not higher than that seen in routine isolates of E. coli. This suggests that diabetes in itself is not a risk factor for resistance.

Topics: Adolescent; Adult; Aged; Amoxicillin; Anti-Infective Agents; Bacteriuria; Ciprofloxacin; Diabetes Complications; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Humans; Middle Aged; Nitrofurantoin; Norfloxacin; Ofloxacin; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination

We wanted to investigate the antimicrobial susceptibility of urinary tract pathogens in uncomplicated lower urinary tract infections in adult women in Norway.. Urine samples from 312 adult women with symptoms of uncomplicated urinary tract infections from eight general practices were included.. Significant bacteriuria was found in 187 samples (60%). E coli was isolated from 153 (82%) of these samples. Other isolated uropathogens were S saprophyticus 18 (10%), Proteus spp 6 (3%), Klebsiella spp 4 (2%), Enterobacter spp 2 (1%), enterococci 1 (0.5%) and other Gram-positive bacteria 3 (1,5%). No fungi were isolated. Of the E coli isolates, 1 %, 1 % and 9 % were resistant to nitrofurantoin, mecillinam and trimetoprim respectively. All S saprophyticus isolates were sensitive to nitrofurantoin and trimetoprim.. Antibiotic resistance of urinary tract pathogens causing uncomplicated urinary tract infections in adult women in general practice is still low in Norway.

Topics: Adult; Aged; Amdinocillin; Ampicillin; Ampicillin Resistance; Anti-Infective Agents, Urinary; Bacteriuria; Ciprofloxacin; Drug Resistance, Bacterial; Female; Gram-Positive Bacterial Infections; Humans; Middle Aged; Nitrofurantoin; Penicillins; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

One of the more perplexing aspects of urinary tract infections (UTIs) is their high propensity to recur. It has been proposed that recurrent infections are a result of the reintroduction of bacteria from the gastrointestinal tract (GIT) to the urinary tract (UT); however, since a significant subset of recurrent UTIs are caused by an identical bacterial strain, it has been challenging to formally prove this hypothesis for same-strain recurrences by using epidemiologic approaches. We present data here obtained by using a mouse model of UTIs in which it was shown that 36% (5 of 14) of mice infected with uropathogenic Escherichia coli (UPEC) will have at least one bacteriuric recurrence, with 21% (3 of 14) having more than one recurrence during a 6-week period after an acute UTI. Intraurethrally infected mice develop UPEC reservoirs in both their feces and their bladders. Ten days of trimethoprim-sulfamethoxazole (SXT) therapy reduces urinary recurrences and eradicates fecal colonization, whereas 3 days of SXT treatment has no effect over a twenty-eight-day observation period despite clearing fecal colonization acutely. Interestingly, SXT is unable to eradicate bacteria from the bladder reservoir even after a 10-day treatment regimen, thus demonstrating that the bladder reservoir can persist even in the face of long-term antibiotic therapy.

Topics: Animals; Anti-Infective Agents, Urinary; Bacteriuria; Disease Models, Animal; Escherichia coli; Escherichia coli Infections; Feces; Female; Mice; Mice, Inbred C57BL; Recurrence; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder; Urinary Tract Infections

Urinary tract infection is one of the most common bacterial infections. Since antibiotics are given empirically, it is necessary to assess the distribution and susceptibility of the microorganisms in each case.. To evaluate the demographic characteristics of ambulatory patients with UTI, the distribution and susceptibility of uropathogens, and the risk factors associated with trimethoprim-sulfamethoxazole resistant bacteria in women.. During 12 days in August 1997 all the urine cultures sent to the Tel-Hanan Laboratory (Haifa) were evaluated. Demographic characteristics of the patients, their underlying diseases and the previous use of antibiotics were obtained.. During the 12 day survey 6,495 cultures were sent for evaluation. Of the 1,075 (17%) that were positive 950 were included in the study; 83.7% were from females, of whom 57% were > or = 50 years old. Escherichia coli was the most common pathogen, with 74.7% in the female and 55% in the male population; 86.2% of the E. coli were resistant to amoxicillin, 38.8% to cephalexin and 46.8% to TMP-SMX. Cefuroxime (4.2%), ofloxacin (4.8%), ciprofloxacin (4.8%) and nitrofurantoin (0.4%) showed the lowest rates of resistance. By a multivariant analysis, post-menopause and recurrent UTI were found to be independent factors related to TMP-SMX resistance in women.. In northern Israel, ampicillin, cephalexin and TMP-SMX cannot be used empirically in the treatment of community-acquired UTI. Post-menopause and recurrent UTI are independent factors associated with TMP-SMX resistant pathogens in women.

Topics: Adolescent; Adult; Aged; Amoxicillin; Bacteriuria; Cephalexin; Child; Child, Preschool; Community-Acquired Infections; Drug Resistance, Microbial; Escherichia coli; Female; Humans; Infant; Israel; Male; Middle Aged; Ofloxacin; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Antibiotic Prophylaxis; Bacteriuria; Ciprofloxacin; Female; Humans; Kidney Transplantation; Postoperative Complications; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urography; Vesico-Ureteral Reflux

Topics: Adult; Age Factors; Aged; Bacteriuria; Escherichia coli Infections; Female; Humans; Male; Middle Aged; Prostatitis; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

300 consecutive TUR were prospectively examined bacteriologically. We used, lacking contraindications, Co-Trimoxazol as antibiotic prophylaxis, when urine at admittance was sterile, otherwise we treated the urinary infection. The antibiotics were applied from the beginning of the intervention until the catheter was removed. Of the 49 patients with a indwelling catheter 28 (57%) had an urinary infection. All but one were cured. 2 of 64 (3%) patients undergoing resection of a bladder tumour acquired asymptomatic nosocomial infection. 198 patients underwent TUR of the prostate with initially sterile urine. 7 patients suffered from fever in the postoperative course, in 6 cases the origin remained unclear. 3 patients showed an asymptomatic nosocomial infection. Overall, with antibiotic prophylaxis we found an infection rate of 2-5% for the TUR of the prostate and of 3% for the TUR of bladder. Primarily infected urine, in this study, did not elevate the risk for infectious complications.

Topics: Amoxicillin; Anti-Bacterial Agents; Bacteriuria; Clavulanic Acid; Clavulanic Acids; Drug Therapy, Combination; Humans; Male; Premedication; Prospective Studies; Prostatectomy; Prostatic Hyperplasia; Surgical Wound Infection; Trimethoprim, Sulfamethoxazole Drug Combination

To evaluate the in vitro sensitivities of trimetoprim (TMP) in our area and to compare them with those to co-trimoxazole (CMX) a prospective study was carried out in females with uncomplicated lower urinary tract infection (UCLUTI), as a preliminary step for the possible use of a monodose of TMP in these patients. Fifty-five cases of UCLUTI were included. Escherichia coli was the predominating organism (70.9%). The general sensitivity to CMX was 80% and that to TMP 76.4%. The E. coli sensitivity to CMX was 79.5%, and 76.9% to TMP. The difference in the sensitivities to both antimicrobials was not statistically significant (p = 0.5). The routine introduction of TMP in the antibiogram would permit to evaluate the resistance to this antimicrobial in each area and, on the basis of the results, to assess the effectiveness of TMP in the treatment of UCLUTI.

Topics: Adolescent; Adult; Aged; Bacteria; Bacteriuria; Female; Humans; Microbial Sensitivity Tests; Middle Aged; Prospective Studies; Spain; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

To study the relation of preoperative infected urine and postprostatectomy wound infection in patients with and without indwelling bladder catheters.. Patients undergoing prostatectomy were evaluated for the presence of infected urine prior to prostatectomy and postoperative wound infection. They were further divided into patients with indwelling urinary catheter and catheter-free patients. All had received antibiotic prophylaxis.. One hundred fifty consecutive patients undergoing open prostatectomy--mean age was 67 years; 100 patients with an indwelling catheter for a mean period of 50 days; 50 catheter-free patients.. Wound infection was found in 19 of 81 (23.5%) and in 6 of 69 (8.7%) patients with infected and sterile urine, respectively (p = .028). In patients with indwelling catheters prior to operation, wound infection was 22.4% when urine was infected and 8.3% when it was not. In patients without catheters, infected urine was associated with 40% of wound infections, as compared with 8.9% of wound infections in patients with sterile urine. Organisms obtained from infected wound and urine were identical in 84% of cases. These results were obtained despite antibiotic prophylaxis.. Wound infection has been demonstrated to be a postprostatectomy complication directly related to the presence of urinary infection at surgery; thus, elective prostatectomy should be deferred until urine becomes sterile.

Topics: Aged; Aged, 80 and over; Anti-Infective Agents, Urinary; Bacteriuria; Enterobacteriaceae; Humans; Male; Middle Aged; Prospective Studies; Prostatectomy; Risk Factors; Surgical Wound Infection; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

We searched the susceptibility of E. coli strains isolated from urine cultures of sick children with urinary tract infections to Nitrofurantoin, Co-trimoxazole, Gentamicin, Ampicillin and Amoxillin-Clavulonic acid. In our study, we compared the results of Farabi Hospital of Black Sea Technical University Medical Faculty, Hacettepe University Medical Faculty Children Hospital and Glasgow Royal Hospital for sick children and tried to show their regional and national differences for antibiotic susceptibility.

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Anti-Bacterial Agents; Bacteriuria; Child; Clavulanic Acids; Drug Therapy, Combination; Escherichia coli; Escherichia coli Infections; Gentamicins; Humans; Multicenter Studies as Topic; Nitrofurantoin; Scotland; Trimethoprim, Sulfamethoxazole Drug Combination; Turkey; Urinary Tract Infections

The authors analysed the results of bacteriological examinations of 600 urine samples with special regard to the sensitivity of the different pathogenic agents to Sumetrolim (400 mg sulphamatoxazole + 80 mg trimethoprim per each tablet). Their observations were also summarized in tables. The effectiveness of Sumetrolim treatment (for 5 days daily 2 x 3 tablets, from the subsequent 10 days daily 2 x 1 tablet) used in 100 chronic prostatitis patients and in 100 patients suffering temporarily from chronic infection (who had undergone prostatectomy) has been analyzed. Sumetrolim has been found to be valuable in the urological practice especially in the treatment of chronic infections of long duration. Teh eventual side-effects of Sumetrolim have been discussed on the basis of references and own observations referring to the treatment of 200 patients. The therapy had to be discontinued in 21 cases, in 1 case because of toxicoderma responding well to therapy, in 3 cases because of mild cutaneous alteration, in 10 cases due to intensive diarrhoea, and in 7 cases because of other side-effects.

Topics: Bacteriuria; Humans; Male; Postoperative Complications; Prostatectomy; Prostatitis; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The susceptibility of 40 Escherichia coli and 35 Klebsiella spp. urinary isolates to trimethoprim/sulphamethoxazole (cotrimoxazole) was determined. The determination was based on the activity of the standard multodiscs-cotrimoxazole (25 micrograms), (Oxoid); sulphafurazole (500 micrograms), (Mastring-S); and the minimum inhibitory concentration of trimethoprim and sulphamethoxazole singly against the isolates. Thirty-two (80%) of 40 isolates of Escherichia coli, and 26 (74%) of 35 isolates of Klebsiella spp. were resistant to cotrimoxazole. All the isolates were resistant to more than 500 mg/l sulphamethoxazole. Twenty of the 32 (62%) cotrimoxazole-resistant E. coli strains and 18 of the 26 (69%) cotrimoxazole-resistant Klebsiella strains were resistant to more than 2000 mg/l trimethoprim. These high level trimethoprim-resistant strains invariably carried transferable resistance to at least the sulphonamides, ampicillin and tetracycline, which could be transferred en bloc to known sensitive recipients by the process of conjugation. The high incidence of the R-plasmid-mediated resistance to high levels of trimethoprim suggests the presence of a selective pressure from the increased, and probably the uncontrolled, use of trimethoprim/sulphonamide proprietary formulations in the society.

Topics: Anti-Infective Agents, Urinary; Bacteriuria; Drug Combinations; Drug Resistance, Microbial; Escherichia coli; Humans; Klebsiella; R Factors; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Twenty-six elderly (mean age 83.3 +/- 8.7 years) institutionalized women with asymptomatic bacteriuria were treated with antibiotic therapy, including initial single-dose and subsequent 2 weeks' therapy, then 6 weeks' therapy if relapse occurred. Forty-seven courses of single-dose, 30 of 2 weeks', and 10 of 6 weeks' therapy were given during a 1-year period. At 8 weeks of follow-up, 57% of single-dose courses, 52% of 2-week, and 29% of 6-week had been followed by relapse, and 32%, 24%, and 29%, respectively, by reinfection. Outcome with single-dose therapy did not correlate with infecting organism, antimicrobial therapy, or presence of pyuria with the infection. However, residents who persistently relapsed following single-dose therapy appeared to be a less-well population, as evidenced by a significantly greater age, number of chronic disease diagnoses and medications, as compared to those who were cured by single-dose therapy. Thus, recurrent infection, including both relapse and reinfection is the usual short-term outcome following therapy for asymptomatic bacteriuria in this population. Differences in patient characteristics may prove useful in predicting which individuals may respond to minimal therapy.

Topics: Age Factors; Aged; Anti-Infective Agents; Bacteriuria; Drug Combinations; Female; Homes for the Aged; Humans; Nursing Homes; Prospective Studies; Random Allocation; Recurrence; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

We analyzed the antibiotic susceptibility of 5,348 urinary isolates of Escherichia coli, "Klebsiella aerogenes," and Proteus mirabilis grown in three laboratories from 1980 to 1985. A continuous rise in resistance to trimethoprim-sulfamethoxazole was observed; 63% of the strains from inpatients in 1984 and 51% of those from outpatients in 1985 were resistant to this drug. Isolates from outpatients in 1985 were mostly susceptible to nitrofurantoin (mean susceptibility, 92%) and to oral cephalosporins (mean susceptibility, 84%). As for isolates from inpatients, none of the antimicrobial agents now used was satisfactory for initial chemotherapy, indicating a need for new antibacterial strategies.

Topics: Ampicillin; Anti-Infective Agents, Urinary; Bacteriuria; Cephalosporins; Drug Combinations; Enterobacteriaceae; Escherichia coli; Humans; Klebsiella; Nitrofurantoin; Penicillin Resistance; Proteus mirabilis; Sulfamethoxazole; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Aminoglycosides; Bacteriuria; Catheters, Indwelling; Cephalosporins; Drug Combinations; Humans; Male; Methenamine; Nitrofurantoin; Prognosis; Spinal Cord Injuries; Sulfamethoxazole; Tetracyclines; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder; Urinary Catheterization

Topics: Adult; Ampicillin; Bacteriuria; Drug Combinations; Female; Humans; Magnesium; Magnesium Compounds; Phosphates; Pregnancy; Pregnancy Complications, Infectious; Recurrence; Staphylococcal Infections; Staphylococcus; Struvite; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Ureteral Calculi

Urinary malakoplakia may pursue an aggressive clinical course with persistent infection, despite seemingly appropriate antibiotic therapy. The authors studied seven adult females with urinary malakoplakia. Specific immunocytochemical staining demonstrated intracellular Escherichia coli in malakoplakia tissue in four patients. In two of the four patients, the bacteria were present despite antibiotic-induced sterile urines at time of biopsy. Cessation of therapy consistently lead to recurrent bacteriuria in these patients. In one such patient, the intracellular bacilli were confirmed as E. coli by culture of crushed malakoplakia tissue and electron microscopic study; the organisms were a routine E. coli strain susceptible to multiple previously administered antibiotics. Only sequential treatment with bethanechol chloride and trimethoprim-sulfamethoxazole, however, eliminated the infection; all three drugs are thought to be capable of enhancing intracellular killing of bacteria. Conventional antibiotic therapy failed to halt progression of disease in other malakoplakia patients. The data indicate that intracellular bacteria may serve as a reservoir of persistent/recurrent infection in urinary malakoplakia. Optimal therapy should include therapeutic agents that may control intracellular organisms.

Topics: Adult; Aged; Bacteriological Techniques; Bacteriuria; Bethanechol; Bethanechol Compounds; Drug Combinations; Escherichia coli; Escherichia coli Infections; Female; Humans; Immunoenzyme Techniques; Malacoplakia; Male; Middle Aged; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urologic Diseases

The bacterial flora in the urine samples of 15 nursing home patients with long-term, indwelling catheters were examined monthly for one year. There was a rapidly changing polymicrobial flora averaging 2.0 changes per month in species with colony counts greater than 100,000/mL, and 3.2 changes per month when changes in species, biogram, and quantity of bacteria were considered. The flora changed significantly more frequently, and cultures of Pseudomonas aeruginosa, Providencia stuartii, and Citrobacter diversus were significantly more frequent in those receiving sulfamethoxazole and trimethoprim prophylaxis than in those who did not. There was no difference in incidence of urinary tract infection (UTI) between those patients who received sulfamethoxazole and trimethoprim prophylaxis and those who did not. Ampicillin or gentamicin was effective against 99% of species cultured that are of established UTI pathogenicity. Owing to the rapidity of bacterial flora changes, routine monthly cultures are of little predictive value in patients with indwelling catheters. This study does not support the efficacy of sulfamethoxazole and trimethoprim prophylaxis in such patients.

Topics: Adult; Aged; Anti-Infective Agents, Urinary; Bacteriuria; Catheters, Indwelling; Citrobacter; Drug Combinations; Enterobacteriaceae Infections; Female; Humans; Male; Middle Aged; Nursing Homes; Prospective Studies; Providencia; Streptococcal Infections; Sulfamethoxazole; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Catheterization

A total of 50 patients with recent spinal cord injury secondary to trauma participated in a prospective study of urinary complications during an interval of clean intermittent catheterization at initial hospitalization in a spinal cord injury unit. Patients were assigned randomly to groups receiving or not receiving a prophylactic antibacterial preparation. Both groups were divided further into subgroups in which laboratory infections (bacteriuria more than 100,000 organisms per ml.) were treated with definitive antibiotics or in which antibiotic treatment was given only for clinical infections (fever more than 100F or urethral discharge and bacteriuria). Antibacterial prophylaxis significantly reduced the probability of laboratory infection but not the probability of clinical infection, although a trend was noted toward fewer clinical infections. No significant reduction was noted in the probability of clinical infection in subgroups treated promptly for laboratory infection.

Topics: Anti-Infective Agents, Urinary; Bacteriuria; Drug Combinations; Female; Hospitalization; Humans; Male; Prospective Studies; Random Allocation; Self Care; Spinal Cord Injuries; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder, Neurogenic; Urinary Catheterization

Topics: Acute Disease; Aminoglycosides; Anti-Bacterial Agents; Bacteriuria; Cystitis; Drug Combinations; Female; Fetus; Folic Acid; Humans; Male; Obstetric Labor, Premature; Pregnancy; Pregnancy Complications, Infectious; Pyelonephritis; Recurrence; Sulfamethoxazole; Tetracycline; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Bacteriuria; Cephaloridine; Drug Combinations; Drug Therapy, Combination; Female; Humans; Nitrofurantoin; Pregnancy; Pregnancy Complications, Infectious; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

A better understanding of the pathophysiology of urinary infection has markedly altered treatment programs. Single-dose therapy should be used for infections limited to the bladder. In contrast, treatment periods of 4-6 wk are needed to yield the best cure rates in upper tract infections. TMP/SMX thrice weekly has proved to be a successful prophylactic program for women with recurrent urinary infection. In contrast to the female, young children and men require longer therapy periods for urinary infection and should always have a detailed radiologic and urologic evaluation to eliminate the possibility of structural abnormalities.

Topics: Adolescent; Adult; Age Factors; Aged; Anti-Bacterial Agents; Bacteriuria; Child; Child, Preschool; Drug Combinations; Drug Therapy, Combination; Enterobacteriaceae Infections; Female; Humans; Infant; Infant, Newborn; Male; Middle Aged; Sex Factors; Staphylococcal Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Acute Disease; Adult; Bacteriuria; Diagnosis, Differential; Drug Combinations; Enterobacteriaceae Infections; Humans; Lymphogranuloma Venereum; Male; Nitrofurantoin; Pain; Pain Management; Prostatectomy; Prostatic Diseases; Prostatitis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Aged; Anti-Infective Agents, Urinary; Bacteriuria; Catheters, Indwelling; Cross Infection; Drug Combinations; Female; Humans; Male; Middle Aged; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Catheterization; Urinary Incontinence

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Bacteriuria; Child; Child, Preschool; Drug Combinations; Female; Humans; Infant; Infant, Newborn; Male; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections