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Infectious disease AND Urinary tract infection [keywords]
- Beyond malaria--causes of fever in outpatient Tanzanian children. [Journal Article, Research Support, Non-U.S. Gov't]
- N Engl J Med 2014 Feb 27; 370(9):809-17.
As the incidence of malaria diminishes, a better understanding of nonmalarial fever is important for effective management of illness in children. In this study, we explored the spectrum of causes of fever in African children.We recruited children younger than 10 years of age with a temperature of 38°C or higher at two outpatient clinics--one rural and one urban--in Tanzania. Medical histories were obtained and clinical examinations conducted by means of systematic procedures. Blood and nasopharyngeal specimens were collected to perform rapid diagnostic tests, serologic tests, culture, and molecular tests for potential pathogens causing acute fever. Final diagnoses were determined with the use of algorithms and a set of prespecified criteria.Analyses of data derived from clinical presentation and from 25,743 laboratory investigations yielded 1232 diagnoses. Of 1005 children (22.6% of whom had multiple diagnoses), 62.2% had an acute respiratory infection; 5.0% of these infections were radiologically confirmed pneumonia. A systemic bacterial, viral, or parasitic infection other than malaria or typhoid fever was found in 13.3% of children, nasopharyngeal viral infection (without respiratory symptoms or signs) in 11.9%, malaria in 10.5%, gastroenteritis in 10.3%, urinary tract infection in 5.9%, typhoid fever in 3.7%, skin or mucosal infection in 1.5%, and meningitis in 0.2%. The cause of fever was undetermined in 3.2% of the children. A total of 70.5% of the children had viral disease, 22.0% had bacterial disease, and 10.9% had parasitic disease.These results provide a description of the numerous causes of fever in African children in two representative settings. Evidence of a viral process was found more commonly than evidence of a bacterial or parasitic process. (Funded by the Swiss National Science Foundation and others.).
- Distribution of strain type and antimicrobial susceptibility of Escherichia coli causing meningitis in a large urban setting in Brazil. [JOURNAL ARTICLE]
- J Clin Microbiol 2014 Feb 12.
The clinical management of meningitis caused by Escherichia coli is greatly complicated when the organism becomes resistant to broad-spectrum antibiotics. We sought to characterize the antimicrobial susceptibility, sequence type (ST), and presence of known drug resistance genes of E. coli that caused meningitis between 1996 and 2011 in Salvador, Brazil. We then compared these findings to E. coli isolates from community acquired urinary tract infections (UTI) that occurred during the same time period and in the same city. We found 19% of E. coli from cases of meningitis and less than 1% of isolates from UTI to be resistant to third-generation cephalosporins. The sequence types of E. coli from cases of meningitis included ST131, ST69, ST405, and ST62, which were also found among isolates from UTI. Additionally, among the E. coli isolates that were resistant to third-generation cephalosporins we found genes that encode the extended-spectrum beta-lactamases CTX-M-2, CTX-M-14, and CTX-M-15. These observations demonstrate that compared to E. coli isolated from cases of community acquired UTI, those isolated from cases of meningitis are more resistant to third-generation cephalosporins even though the same sequence types are shared between the two forms of extraintestinal infections.
- Biapenem versus meropenem in the treatment of bacterial infections: a multicenter, randomized, controlled clinical trial. [Journal Article]
- Indian J Med Res 2013 Dec; 138(6):995-1002.
Background & objectives: Biapenem is a newly developed carbapenem to treat moderate and severe bacterial infections. This multicenter, randomized, parallel-controlled clinical trial was conducted to compare the clinical efficacy, bacterial eradication rates and safety of biapenem and meropenem in the treatment of bacterial lower respiratory tract infections and urinary tract infections (UTIs) at nine centres in China.
Methods:Patients diagnosed with bacterial lower respiratory tract infections or UTIs were randomly assigned to receive either biapenem (300 mg every 12 h) or meropenem (500 mg every 8 h) by intravenous infusion for 7 to 14 days according to their disease severity. The overall clinical efficacy, bacterial eradication rates and drug-related adverse reactions of biapenem and meropenem were analyzed.
Results:A total of 272 enrolled cases were included in the intent-to-treat (ITT) analysis and safety analysis. There were no differences in demographics and baseline medical characteristics between biapenem group and meropenem group. The overall clinical efficacies of biapenem and meropenem were not significantly different, 94.70 per cent (125/132) vs. 93.94 per cent (124/132). The overall bacterial eradication rates of biapenem and meropenem showed no significant difference, 96.39 per cent (80/83) vs. 93.75 per cent (75/80). Drug-related adverse reactions were comparable in biapenem and meropenem groups with the incidence of 11.76 per cent (16/136) and 15.44 per cent (21/136), respectively. The most common symptoms of biapenem-related adverse reactions were rash (2.2%) and gastrointestinal distress (1.5%). Interpretation & conclusions: Biapenem was non-inferior to meropenem and was well-tolerated in the treatment of moderate and severe lower respiratory tract infections and UTIs.
- Antibiotic use in Dutch primary care: relation between diagnosis, consultation and treatment. [JOURNAL ARTICLE]
- J Antimicrob Chemother 2014 Feb 12.
Countries generally present their overall use of antibiotics as an indicator of antibiotic prescribing quality. Additional insight is urgently needed for targeted improvement recommendations: first, data on specific clinical indications for which antibiotics are used, and second, on distinguishing whether changes in patient consultation or changes in physician prescribing drive changing antibiotic use for particular indications. The aim of this study was to describe the antibiotic management of infectious diseases in the clinical context, by analysing prescribing by physicians and patient consultation incidences per indication over time.A database with all contact data for infectious diseases from 45 primary care practices in the Netherlands (2007-10) was used. Consultation incidences, prescribing rates and choice of antibiotic were analysed per International Classification of Primary Care (ICPC) chapter and relevant ICPC codes.Antibiotics were prescribed in ∼25% of infectious disease episodes, mainly respiratory infections, urinary infections and ear and skin infections. Overall, this resulted in 300 prescribed courses of antibiotics per 1000 patient-years. Given a stable prescription rate, a 19% increase in the number of consultations explained the increased antibiotic prescribing for urinary tract infections. Given a stable consultation incidence, an 8% reduction in prescribing rate explained the decreased antibiotic prescribing for respiratory tract infections. Macrolides were predominantly prescribed for respiratory disease (∼66%), amoxicillin/clavulanate for respiratory disease (∼42%) and urinary illness (∼25%), and fluoroquinolones for urinary and genital indications.Insight into the reasons for the decreased prescribing for respiratory tract infections and the increased prescribing for urinary tract infections was provided by a detailed analysis of incidences and prescribing rates. For respiratory disease, the second- and third-choice antibiotics were overused. Complete data on infectious disease management, with respect to patient and physician behaviour, are crucial for understanding changes in antibiotic use, and in defining strategies to reduce inappropriate antibiotic use.
- Recommendations for the empirical treatment of complicated urinary tract infections using surveillance data on antimicrobial resistance in the Netherlands. [Journal Article]
- PLoS One 2014; 9(1):e86634.
Complicated urinary tract infections (c-UTIs) are among the most common nosocomial infections and a substantial part of the antimicrobial agents used in hospitals is for the treatment of c-UTIs. Data from surveillance can be used to guide the empirical treatment choices of clinicians when treating c-UTIs. We therefore used nation-wide surveillance data to evaluate antimicrobial coverage of agents for the treatment of c-UTI in the Netherlands.We included the first isolate per patient of urine samples of hospitalised patients collected by the Infectious Disease Surveillance Information System for Antibiotic Resistance (ISIS-AR) in 2012, and determined the probability of inadequate coverage for antimicrobial agents based on species distribution and susceptibility. Analyses were repeated for various patient groups and hospital settings.The most prevalent bacteria in 27,922 isolates of 23,357 patients were Escherichia coli (47%), Enterococcus spp. (14%), Proteus mirabilis (8%), and Klebsiella pneumoniae (7%). For all species combined, the probability of inadequate coverage was <5% for amoxicillin or amoxicillin-clavulanic acid combined with gentamicin and the carbapenems. When including gram-negative bacteria only, the probability of inadequate coverage was 4.0%, 2.7%, 2.3% and 1.7%, respectively, for amoxicillin, amoxicillin-clavulanic acid, a second or a third generation cephalosporin in combination with gentamicin, and the carbapenems (0.4%). There were only small variations in results among different patient groups and hospital settings.When excluding Enterococcus spp., considered as less virulent, and the carbapenems, considered as last-resort drugs, empirical treatment for c-UTI with the best chance of adequate coverage are one of the studied beta-lactam-gentamicin combinations. This study demonstrates the applicability of routine surveillance data for up-to-date clinical practice guidelines on empirical antimicrobial therapy, essential in patient care given the evolving bacterial susceptibility.
- Diagnosis, Management, and Prevention of Catheter-Associated Urinary Tract Infections. [REVIEW]
- Infect Dis Clin North Am 2014 Mar; 28(1):105-119.
Catheter-associated urinary tract infection (CAUTI) is common, costly, and causes significant patient morbidity. CAUTIs are associated with hospital pathogens with a high propensity toward antimicrobial resistance. Treatment of asymptomatic patients with CAUTI accounts for excess antimicrobial use in hospitals and should be avoided. Duration of urinary catheterization is the predominant risk for CAUTI; preventive measures directed at limiting placement and early removal of urinary catheters have an impact on decreasing CAUTI rates. The use of bladder bundles and collaboratives, coupled with the support and active engagement from both hospital leaders and followers, seem to help prevent this common problem.
- Diagnosis and Management of Fungal Urinary Tract Infection. [REVIEW]
- Infect Dis Clin North Am 2014 Mar; 28(1):61-74.
When the terms funguria or fungal urinary tract infection are used, most physicians are referring to candiduria and urinary tract infections due to Candida species. Other fungi, including yeasts and molds can involve the kidney during the course of disseminated infection, but rarely cause symptoms referable to the urinary tract. Candida species appear to be unique in their ability to both colonize and cause invasive disease in the urinary tract. This overview focuses only on candiduria and Candida urinary tract infection because they are common and many times present perplexing management issues.
- Diagnosis and Management of Urinary Tract Infection in the Emergency Department and Outpatient Settings. [REVIEW]
- Infect Dis Clin North Am 2014 Mar; 28(1):33-48.
Emergency physicians encounter urinary tract infections (UTIs) in a wide spectrum of disease severity and patient populations. The challenges of managing UTIs in an emergency department include limited history, lack of follow-up, and lack of culture and susceptibility results. Most patients do not require an extensive diagnostic evaluation and can be safely managed as outpatients with oral antibiotics. The diagnostic approach to and treatment of adults presenting to emergency departments with UTIs are reviewed.
- Candiduria in children and susceptibility patterns of recovered Candida species to antifungal drugs in Ahvaz. [Journal Article]
- J Nephropathol 2013 Apr; 2(2):122-8.
Background:Candiduria presents as an increasingly common nosocomial infection, which may involves urinary tract. Spectrum of disease is varying from asymptomatic candiduria to clinical sepsis. Disease is most commonly caused by Candida albicans.
Objectives:The aim of the present study was to determine the frequency of candiduria in children attending Abuzar Pediatrics Hospital. Patients and
Methods:Urine samples were collected from 402 patients attending to the Abuzar Pediatrics Hospital, Ahvaz. 10µl of each urine sample was cultured on CHROMagar Candida plates and incubated at 37°C. Ketoconazole, amphotericine B, clotrimazole, fluconazole, miconazole and nystatin disks were used for determination of susceptibility.
Results:In the present study, 402 patients with the age range <1-14 years were sampled (59.2% males and 40.8% females). Prevalence of Candida among enrolled patients was found to be 5.2% (71.4% males and 28.6% females). In our study C. albicans was identified in 19 cases as the most common yeast followed by nine C. glabrata and one C. krusei. Urine cultures were yielded more than 10000 CFU/ml in 14.3% of the cases followed by 600-10000 CFU/ml (28.5%) and 100-600 CFU/ml (57.2%). Antifungal susceptibility testing revealed that only one isolate of C. glabrata and seven isolates of C. albicans were resistant to nystatin and ketoconazole, respectively. However, all tested isolates were resistance to fluconazole.
Conclusion:Asymptomatic candiduria is relatively more prevalent among children in Ahvaz and the most common agent is C. albicans. In addition, isolated Candida species were sensitive to use antifungals, with exception to fluconazole.
- Prevalence of human papillomavirus infection in the oropharynx and urine among sexually active men: a comparative study of infection by papillomavirus and other organisms, including Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma spp., and Ureaplasma spp. [Journal Article]
- BMC Infect Dis 2014.:43.
Oropharyngeal squamous cell carcinoma (OSCC) has shown a gradual increase in male predominance due to the increasing incidence of human papillomavirus (HPV)-associated OSCC. However, the mode of HPV transmission to the oral cavity is poorly understood, and little is known about the epidemiology of oral HPV infection in men. The prevalence rates of HPV, Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma spp., and Ureaplasma spp. were compared in the oropharynx (oral cavity) and urine of male Japanese patients attending a sexually transmitted disease clinic.The study population consisted of 213 men aged 16 - 70 years old (mean: 34.4 years old). Oropharyngeal gargles and urine were collected, and sedimented cells were preserved in liquid-based cytology solution. After DNA extraction, β-globin and infectious organisms were analyzed by a PCR-based method. The HPV genotype was determined by HPV GenoArray test.β-Globin was positive in 100% and 97.7% of oral and urine samples, respectively. HPV detection rates were 18.8% and 22.1% in oral and urine samples, respectively, suggesting that the prevalence of HPV infection in the oral cavity was similar to that in the urinary tract. N. gonorrhoeae was more prevalent in oral (15.6%) than urine samples (9.1%), whereas C. trachomatis was detected more frequently in urine (15.9%) than oral samples (4.2%). The detection rates of M. genitalium, M. hominis, and Ureaplasma spp. were 5.2%, 10.3%, and 16.0% in oral samples, and 7.7%, 6.3%, and 19.2% in urine, respectively. There were no significant differences in the detection rates of Mycoplasma spp. and Ureaplasma spp. between anatomical locations. The distribution of HPV types were similar in oral and urine samples, and HPV16 was the most common type. The majority of men with HPV infection in both the oral cavity and urine had concordant oral and urinary HPV infection. The presence of urinary HPV infection was an independent risk factor of oral HPV infection, with an odds ratio of 3.39 (95% CI: 1.49 - 7.71), whereas oral gonococcal infection was inversely correlated with oral HPV infection (odds ratio: 0.096; 95% CI: 0.01 - 0.77).Oral HPV infection commonly occurs in sexually active men, and is significantly correlated with urinary HPV infection.