- Risk of Biologics and Glucocorticoids in Patients With Rheumatoid Arthritis Undergoing Arthroplasty: A Cohort Study. [Journal Article]
- AIMAnn Intern Med 2019 May 21
- CONCLUSIONS: Risks for hospitalized infection, PJI, and readmission after arthroplasty were similar across biologics. In contrast, glucocorticoid use, especially with dosages above 10 mg/d, was associated with greater risk for adverse outcomes.
- Urinary piperacillin/tazobactam pharmacokinetics in-vitro to determine the pharmacodynamic breakpoint for resistant Enterobacteriacae. [Journal Article]
- IJInt J Antimicrob Agents 2019 May 17
- CONCLUSIONS: Bactericidal activity against piperacillin/tazobactam resistant Enterobacteriaceae occurred at 49.85±16.9% fT>MIC. This suggests that highly resistant urinary organisms, including carbapenemase producers, with MICs up to 4096/512 mg/L could be treated with piperacillin/tazobactam. Further investigations are required to elucidate urinary breakpoints and explore the impact of different resistance mechanisms.
- Screening for Microscopic Hematuria in a Urogynecologic Population. [Journal Article]
- FPFemale Pelvic Med Reconstr Surg 2019 May 15
- CONCLUSIONS: Lower urinary specific gravities appear to be associated with underestimating microhematuria, likely owing to the underrepresentation of the true number of red blood cells. Urine dipstick indicators of moderate or large blood increase the likelihood the microscopy samples demonstrated greater than or equal to 3 RBCs/HPF. These findings suggest that clarification of microhematuria detection and evaluation guidelines should be considered, given both important clinical and economic consequences.
- Effective Oral Combination Treatment for Extended-Spectrum Beta-Lactamase-Producing Escherichia coli. [Journal Article]
- MDMicrob Drug Resist 2019 May 20
- CONCLUSIONS: Cefixime and amoxicillin/clavulanate combination therapy could be an effective oral outpatient treatment option for ESBL-EC. In vitro synergistic testing is simple and predictive of successful treatment.
- Biofilm Assays on Fibrinogen-coated Silicone Catheters and 96-well Polystyrene Plates. [Journal Article]
- BPBio Protoc 2019 Mar 20; 9(6)
- Biofilm formation is a well-known bacterial strategy that protects cells from hostile environments. During infection, bacteria found in a biofilm community are less sensitive to antibiotics and to th…
Biofilm formation is a well-known bacterial strategy that protects cells from hostile environments. During infection, bacteria found in a biofilm community are less sensitive to antibiotics and to the immune response, often allowing them to colonize and persist in the host niche. Not surprisingly, biofilm formation on medical devices, such as urinary catheters, is a major problem in hospital settings. To be able to eliminate such biofilms, it is important to understand the key bacterial factors that contribute to their formation. A common practice in the lab setting is to study biofilms grown in laboratory media. However, these media do not fully reflect the host environment conditions, potentially masking relevant biological determinants. This is the case during urinary catheterization, where a key element for Enterococcus faecalis and Staphylococcus aureus colonization and biofilm formation is the release of fibrinogen (Fg) into the bladder and its deposition on the urinary catheter. To recapitulate bladder conditions during catheter-associated urinary tract infection (CAUTI), we have developed a fibrinogen-coated catheter and 96-well plate biofilm assay in urine. Notably, enterococcal biofilm factors identified in these in vitro assays proved to be important for biofilm formation in vivo in a mouse model of CAUTI. Thus, the method described herein can be used to uncover biofilm-promoting factors that are uniquely relevant in the host environment, and that can be exploited to develop new antibacterial therapies.
- A large bladder hematoma resulting from infectious hemorrhagic cystitis after pelvic reconstruction with transvaginal mesh: An unusual complication. [Case Reports]
- SOSAGE Open Med Case Rep 2019; 7:2050313X19846709
- A large hematoma resulting from hemorrhagic cystitis after uncomplicated pelvic reconstruction surgery with a transvaginal mesh is rare. A 66-year-old female who underwent pelvic reconstruction with …
A large hematoma resulting from hemorrhagic cystitis after uncomplicated pelvic reconstruction surgery with a transvaginal mesh is rare. A 66-year-old female who underwent pelvic reconstruction with transvaginal mesh presented with acute urinary retention and hematuria on postoperative day 10. Leukocytosis, pyuria, and hematuria were noted in the emergency room. After using cystoscopy to irrigate the coagulum, there was no mesh erosion or bladder perforation on inspection. A large bladder hematoma resulting from infectious hemorrhagic cystitis was confirmed, and uropathogenic Escherichia coli was isolated. The clinical condition improved after a 1-week treatment with an indwelling Foley catheter and oral antibiotics. Careful aseptic techniques and antibiotic prophylaxis reduce bacterial contamination only for brief periods of time, and patients may still be at risk for delayed infections. The possible modalities to prevent postoperative urinary tract infection after pelvic reconstruction surgery with transvaginal mesh include shortening the indwelling Foley catheter period and administration of an additional antibiotic during catheter removal. However, the antibiotic policies for pelvic reconstruction with transvaginal mesh demand further cost analyses.
- Appropriate use of antibiotics: an unmet need. [Review]
- TATher Adv Urol 2019 Jan-Dec; 11:1756287219832174
- Increasing bacterial resistance combined with a steady decline in the discovery of new antibiotics has resulted in a global healthcare crisis. Overuse of antibiotics, for example, in the poultry and …
Increasing bacterial resistance combined with a steady decline in the discovery of new antibiotics has resulted in a global healthcare crisis. Overuse of antibiotics, for example, in the poultry and cattle industry, and misuse and improper prescription of antibiotics are leading causes of multidrug resistance (MDR). The increasing use of antibiotics, particularly in developing countries, is a big concern for antibiotic resistance and can cause other health threats such as increased risk of recurrent infections and increased risk of cardiovascular death with chronic use of macrolides. Carbapenems are the last line of defense in many cases of resistant infection, but trends show that resistance against these agents is also increasing. This narrative review is based on relevant literature according to the experience and expertise of the authors and presents an overview of the current knowledge on antibiotic resistance, the key driving factors, and possible strategies to tackle antibiotic resistance. Collectively, studies show that hospital-wide antibiotic stewardship programs are effective in decreasing the spread of antibacterial resistance. As resistance varies according to local patterns of use, it is essential to observe the epidemiology at both a regional and an institutional level. Furthermore, adaptation of clinical guidelines is necessary, particularly for inpatient care. Future guidelines should include a justification step for continued treatment of antibiotic treatments and criteria for selection of antibiotics at the start of treatment. Nonantibiotic prevention strategies can limit infections and should also be considered in treatment plans. Vaccines against MDR organisms have shown some efficacy in phase II trials in critical care patients. Nonimmunogenic and microbiologic treatment options such as fecal transplants may be particularly important for elderly and immune-compromised patients.
- An introduction to the epidemiology and burden of urinary tract infections. [Review]
- TATher Adv Urol 2019 Jan-Dec; 11:1756287219832172
- Urinary tract infections (UTIs) are the most common outpatient infections, with a lifetime incidence of 50-60% in adult women. This is a narrative review aimed at acting as an introduction to the epi…
Urinary tract infections (UTIs) are the most common outpatient infections, with a lifetime incidence of 50-60% in adult women. This is a narrative review aimed at acting as an introduction to the epidemiology and burden of UTIs. This review is based on relevant literature according to the experience and expertise of the authors. The prevalence of UTI increases with age, and in women aged over 65 is approximately double the rate seen in the female population overall. Etiology in this age group varies by health status with factors such as catheterization affecting the likelihood of infection and the pathogens most likely to be responsible. In younger women, increased sexual activity is a major risk factor for UTIs and recurrence within 6 months is common. In the female population overall, more serious infections such as pyelonephritis are less frequent but are associated with a significant burden of care due to the risk of hospitalization. Healthcare-associated UTIs (HAUTIs) are the most common form of healthcare-acquired infection. Large global surveys indicate that the nature of pathogens varies between the community and hospital setting. In addition, the pathogens responsible for HAUTIs vary according to region making adequate local data key to infection control. UTIs create a significant societal and personal burden, with a substantial number of medical visits in the United States every year being related to UTIs. European data indicate that recurrent infections are related to increased absenteeism and physician visits. In addition, quality of life measures are significantly impacted in women suffering from recurrent UTIs. Data suggest that nonantimicrobial prophylactic strategies offer an opportunity to reduce both the rate of UTIs and the personal burden experience by patients.
- Prevention of recurrent urinary tract infections: bridging the gap between clinical practice and guidelines in Latin America. [Review]
- TATher Adv Urol 2019 Jan-Dec; 11:1756287218824089
- The branches of the immune system work in concert to defend against pathogens and prevent tissue damage due to excessive inflammation. Uropathogens in general, and uropathogenic Escherichia coli (UPE…
The branches of the immune system work in concert to defend against pathogens and prevent tissue damage due to excessive inflammation. Uropathogens in general, and uropathogenic Escherichia coli (UPEC) in particular, have evolved a diverse range of virulence mechanisms to avoid detection and destruction by the mucosal immune system of the urinary tract. Research towards a vaccine active against UPEC continues but has yet to be successful. Orally administered immunomodulatory bacterial lysates both stimulate and modulate the immune response in the urinary tract via the integrated mucosal immune system. The 2018 European Association of Urology (EAU) guidelines on treating acute uncomplicated cystitis recommend aiming for rapid resolution of symptoms, reduction of morbidity, and prophylaxis against reinfection. Recommended short-term antibiotic therapy has the advantage of good compliance, low cost, few adverse events, and low impact on bacterial flora. Antibiotic treatment of asymptomatic bacteriuria is only indicated during pregnancy and before invasive interventions. For recurrent infection, prophylaxis using behavioral modification and counseling should be employed first, then nonantibiotic prophylaxis, and, finally, low-dose continuous or postcoital antibiotic prophylaxis. The 2018 EAU guidelines give a strong recommendation for the oral bacterial lysate immunomodulator OM-89. All other nonantibiotic prophylactic strategies require more data, except for topical estrogen for postmenopausal women. For last-resort antibiotic prophylaxis, nitrofurantoin or fosfomycin trometamol are recommended. Guidelines for Latin America are currently being drafted, taking into account the unique ethnicity, availability of medicines, prevalence of antibiotic resistance, and healthcare practices found throughout the region.
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- Risk factors and predisposing conditions for urinary tract infection. [Review]
- TATher Adv Urol 2019 Jan-Dec; 11:1756287218814382
- Understanding individual and population-specific risk factors associated with recurrent urinary tract infections (UTIs) can help physicians tailor prophylactic strategies. Frequent intercourse, vulvo…
Understanding individual and population-specific risk factors associated with recurrent urinary tract infections (UTIs) can help physicians tailor prophylactic strategies. Frequent intercourse, vulvovaginal atrophy, change of the local bacterial flora, history of UTIs during premenopause or in childhood, family history, and a nonsecretor blood type are substantiated risk factors for recurrent uncomplicated UTIs. This is a narrative review based on relevant literature according to the experience and expertise of the authors. Asymptomatic bacteriuria is generally benign; however, during pregnancy it is more common and is associated with an increased likelihood of symptomatic infection, which may harm the mother or fetus. Screening of pregnant women and appropriate treatment with antimicrobials must be balanced with the potential for adverse treatment-related outcomes; appropriate prophylaxis should be considered where possible. High-quality data are currently lacking on risks related to asymptomatic bacteriuria in pregnancy and further data in this hard-to-study population should be a primary concern for researchers. Incomplete voiding represents the primary risk factor for UTIs associated with conditions such as urinary incontinence and prolapse. Correcting the presence of residual urine remains the most effective prophylaxis in these populations. Bladder function alters throughout life; however, changes in function may be particularly profound in clinical populations at high risk of UTIs. Patients with neurogenic bladder will also likely have other evolving medical issues which increase the risk of UTIs, such as repeated catheterization and increasing residual urine volume. More aggressive antimicrobial prophylactic strategies may be appropriate in these patients. Again, the paucity of data on prophylaxis in these high-risk patients requires the attention of the research community.