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Alkan S, Balkan II, Surme S, Bayramlar OF, Kaya SY, Karaali R, Mete B, Aygun G, Tabak F, Saltoglu N. Urinary tract infections in older adults: associated factors for extended-spectrum beta-lactamase production. Front Microbiol 2024; 15:1384392. [PMID: 38784804 PMCID: PMC11112107 DOI: 10.3389/fmicb.2024.1384392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/17/2024] [Indexed: 05/25/2024] Open
Abstract
Objective Urinary tract infections (UTIs) due to extended-spectrum beta-lactamase (ESBL) producing Escherichia coli and Klebsiella pneumoniae are among the leading causes of morbidity and mortality in older adults. Identifying associated factors for ESBL production may contribute to more appropriate empirical treatment. Materials and methods This was a prospective observational study. Hospitalized patients of age > 65 with community-onset or hospital-acquired upper UTI due to E. coli or Klebsiella pneumoniae were included. A multivariate analysis was performed. Results A total of 97 patients were included. ESBL prevalence among UTIs with E. coli or Klebsiella pneumoniae was 69.1% (n = 67). CRP values at the time of UTI diagnosis were found to be significantly higher in the ESBL-producing group (p = 0.004). The multivariate analysis revealed that male gender (OR: 2.72, CI: 1.02-7.25), prior recurrent UTI (OR: 3.14, CI: 1.21-8.14), and the development of secondary bacteremia (OR: 4.95, CI: 1.03-23.89) were major associated factors for UTI in older adults due to ESBL-producing E. coli and Klebsiella pneumoniae. Conclusion Severe UTI in older men with a history of recurrent UTI may be a warning to the clinician for ESBL production in the setting of high ESBL prevalence. Carbapenems may be prioritized in the empirical treatment of patients with known risk factors for ESBL.
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Affiliation(s)
- Sena Alkan
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Türkiye
| | - Ilker Inanc Balkan
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Türkiye
| | - Serkan Surme
- Department of Medical Microbiology, Institute of Graduate Studies, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Osman Faruk Bayramlar
- Department of Public Health, Bakirkoy District Health Directorate, Istanbul, Türkiye
| | - Sibel Yildiz Kaya
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Türkiye
| | - Ridvan Karaali
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Türkiye
| | - Bilgul Mete
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Türkiye
| | - Gokhan Aygun
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Türkiye
| | - Fehmi Tabak
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Türkiye
| | - Nese Saltoglu
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Türkiye
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Redondo-Sánchez J, Rodríguez-Barrientos R, de-Hoyos-Alonso MDC, Muntañola-Valero C, Almendro Martínez I, Peñalver-Argüeso B, Fernández-Escobar C, Gil-de Miguel Á, del Cura-González I. Trends in hospitalisation for urinary tract infection in adults aged 18-65 by sex in Spain: 2000 to 2015. PLoS One 2024; 19:e0298931. [PMID: 38626199 PMCID: PMC11020983 DOI: 10.1371/journal.pone.0298931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/02/2024] [Indexed: 04/18/2024] Open
Abstract
OBJECTIVE To analyse trends in urinary tract infection (UTIs) hospitalisation among patients adults 18-65 aged in Spain from 2000-2015. METHODS Retrospective observational study using the Spanish Hospitalisation Minimum Data Set (CMBD), with codifications by the International Classification of Diseases (ICD-9). Variables: Type of UTIs (pyelonephritis, prostatitis, cystitis and non-specific-UTIs), sex, age (in 5 categories: 18-49 and 50-64 years in men, and 18-44, 45-55 and 56-64 years in women), comorbidity, length of stay, costs and mortality associated with admission. The incidence of hospitalisation was studied according to sex, age group and type of UTIs per 100,000. Trends were identified using Joinpoint regression. RESULTS From 2000-2015, we found 259,804 hospitalisations for UTIs (51.6% pyelonephritis, 7.5% prostatitis, 0.6% cystitis and 40.3% non-specific UTIs). Pyelonephritis predominated in women and non-specific UTIs in men. The hospital stay and the average cost (2,160 EUR (IQR 1,7872,540 were greater in men. Overall mortality (0.4%) was greater in non-specific UTIs. More women were admitted (rates of 79.4 to 81.7) than in men (30.2 to 41). The greatest increase was found in men aged 50-64 years (from 59.3 to 87). In the Joinpoint analysis, the incidence of pyelonephritis increased in women [AAPC 2.5(CI 95% 1.6;3.4)], and non-specific UTIs decreased [AAPC -2.2(CI 95% -3.3;-1.2)]. Pyelonephritis decreased in men [AAPC -0.5 (CI 95% -1.5;0.5)] and non-specific UTIs increased [AAPC 2.3 (CI 95% 1.9;2.6)] and prostatitis increased [AAPC 2.6 (CI 95% 1.4;3.7)]. CONCLUSIONS The urinary infection-related hospitalisation rate in adults in Spain increased during the period 2000-2015. Pyelonephritis predominated in women and non-specific UTIs in men. The highest hospitalisation rates occurred in the women but the greatest increase was found in men aged 65-74. The lenght of stay and cost were higher in men.
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Affiliation(s)
- Jesús Redondo-Sánchez
- Ramon y Cajal Health Care Centre, Primary Care Management, Servicio Madrileño de Salud, Alcorcón, Madrid, Spain
- Department of Medical Specialities and Public Health, Rey Juan Carlos University, Alcorcón, Madrid, Spain
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), Madrid, Spain
| | - Ricardo Rodríguez-Barrientos
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), Madrid, Spain
- Research Unit, Primary Care Management, Madrid Health Service, Madrid, Spain
- Instituto Investigación Sanitaria Gregorio Marañón IiSGM, Madrid, Spain
| | - Mª del Canto de-Hoyos-Alonso
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), Madrid, Spain
- Pedro Laín Entralgo Health Care Center, Primary Care Management, Madrid Health Service, Alcorcón, Madrid, Spain
| | - Cristina Muntañola-Valero
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), Madrid, Spain
- Research Unit, Primary Care Management, Madrid Health Service, Madrid, Spain
- Fundación para la Investigación e Innovación Biosanitaria de Atención Primaria (FIIBAP), Madrid, Spain
| | - Isabel Almendro Martínez
- Facultativa del Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Gregorio Marañón, Madrid, España
| | - Belén Peñalver-Argüeso
- Unidad Docente de Medicina Preventiva y Salud Pública, Escuela Nacional de Sanidad—Instituto de Salud Carlos III, Madrid, Spain
| | - Carlos Fernández-Escobar
- Unidad Docente de Medicina Preventiva y Salud Pública, Escuela Nacional de Sanidad—Instituto de Salud Carlos III, Madrid, Spain
| | - Ángel Gil-de Miguel
- Department of Medical Specialities and Public Health, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Isabel del Cura-González
- Department of Medical Specialities and Public Health, Rey Juan Carlos University, Alcorcón, Madrid, Spain
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), Madrid, Spain
- Research Unit, Primary Care Management, Madrid Health Service, Madrid, Spain
- Instituto Investigación Sanitaria Gregorio Marañón IiSGM, Madrid, Spain
- Karolinska Institutet and Stockholm University, Ageing Research Center, Stockholm, Sweden
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3
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Kapoor DA, Holton MR, Hafron J, Aljundi R, Zwaans B, Hollander M. Comparison of Polymerase Chain Reaction and Urine Culture in the Evaluation of Patients with Complex Urinary Tract Infections. BIOLOGY 2024; 13:257. [PMID: 38666869 PMCID: PMC11048588 DOI: 10.3390/biology13040257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024]
Abstract
To compare organism identification using polymerase chain reaction (PCR) and urine culture (UC) in patients with complex urinary tract infections (cUTIs), we reviewed the results of 3395 patients seen during 2022 with cUTI who underwent concomitant PCR and UC testing. We compared the overall positivity rates as well as the ability of each test to identify fastidious organisms (FOs) and the presence of polymicrobial infections (PMOs) and conducted concordance analysis between the tests. PCR detected 36.4% more organisms than UC and was 20 and nearly 36 times more likely to detect PMOs and FOs, respectively. PCR identified 90.6% of organisms found in UC, whereas UC identified 40.7% of organisms found in PCR testing. We found that 62.4% of organisms found in PCR were not found in urine culture, while UC found 9.4% of organisms not identified in polymerase chain reaction. All these differences were statistically significant (p < 0.05). Although we found that PCR was superior to UC in overall pathogen detection, and detection of both PMOs and FOs, both identified potentially pathogenic organisms not found in the corresponding test. Our data strongly suggest that the evaluation of patients with cUTI is best accomplished using PCR in conjunction with UC.
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Affiliation(s)
| | | | - Jason Hafron
- Michigan Institute of Urology, St. Clair Shores, MI 48081, USA; (J.H.); (R.A.); (M.H.)
| | - Rima Aljundi
- Michigan Institute of Urology, St. Clair Shores, MI 48081, USA; (J.H.); (R.A.); (M.H.)
| | - Bernadette Zwaans
- Corewell Health William Beaumont University Hospital, Royal Oak, MI 48073, USA;
| | - Mitchell Hollander
- Michigan Institute of Urology, St. Clair Shores, MI 48081, USA; (J.H.); (R.A.); (M.H.)
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Wagenlehner FM, Gasink LB, McGovern PC, Moeck G, McLeroth P, Dorr M, Dane A, Henkel T. Cefepime-Taniborbactam in Complicated Urinary Tract Infection. N Engl J Med 2024; 390:611-622. [PMID: 38354140 DOI: 10.1056/nejmoa2304748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
BACKGROUND Carbapenem-resistant Enterobacterales species and multidrug-resistant Pseudomonas aeruginosa are global health threats. Cefepime-taniborbactam is an investigational β-lactam and β-lactamase inhibitor combination with activity against Enterobacterales species and P. aeruginosa expressing serine and metallo-β-lactamases. METHODS In this phase 3, double-blind, randomized trial, we assigned hospitalized adults with complicated urinary tract infection (UTI), including acute pyelonephritis, in a 2:1 ratio to receive intravenous cefepime-taniborbactam (2.5 g) or meropenem (1 g) every 8 hours for 7 days; this duration could be extended up to 14 days in case of bacteremia. The primary outcome was both microbiologic and clinical success (composite success) on trial days 19 to 23 in the microbiologic intention-to-treat (microITT) population (patients who had a qualifying gram-negative pathogen against which both study drugs were active). A prespecified superiority analysis of the primary outcome was performed after confirmation of noninferiority. RESULTS Of the 661 patients who underwent randomization, 436 (66.0%) were included in the microITT population. The mean age of the patients was 56.2 years, and 38.1% were 65 years of age or older. In the microITT population, 57.8% of the patients had complicated UTI, 42.2% had acute pyelonephritis, and 13.1% had bacteremia. Composite success occurred in 207 of 293 patients (70.6%) in the cefepime-taniborbactam group and in 83 of 143 patients (58.0%) in the meropenem group. Cefepime-taniborbactam was superior to meropenem regarding the primary outcome (treatment difference, 12.6 percentage points; 95% confidence interval, 3.1 to 22.2; P = 0.009). Differences in treatment response were sustained at late follow-up (trial days 28 to 35), when cefepime-taniborbactam had higher composite success and clinical success. Adverse events occurred in 35.5% and 29.0% of patients in the cefepime-taniborbactam group and the meropenem group, respectively, with headache, diarrhea, constipation, hypertension, and nausea the most frequently reported; the frequency of serious adverse events was similar in the two groups. CONCLUSIONS Cefepime-taniborbactam was superior to meropenem for the treatment of complicated UTI that included acute pyelonephritis, with a safety profile similar to that of meropenem. (Funded by Venatorx Pharmaceuticals and others; CERTAIN-1 ClinicalTrials.gov number, NCT03840148.).
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Affiliation(s)
- Florian M Wagenlehner
- From Justus Liebig University, Giessen, Germany (F.M.W.); LBG Consulting, Philadelphia (L.B.G.), and Venatorx Pharmaceuticals, Malvern (P.C.M., G.M., M.D., T.H.) - both in Pennsylvania; Fortrea, Burlington, NC (P.M.); and DaneStat Consulting, Macclesfield, United Kingdom (A.D.)
| | - Leanne B Gasink
- From Justus Liebig University, Giessen, Germany (F.M.W.); LBG Consulting, Philadelphia (L.B.G.), and Venatorx Pharmaceuticals, Malvern (P.C.M., G.M., M.D., T.H.) - both in Pennsylvania; Fortrea, Burlington, NC (P.M.); and DaneStat Consulting, Macclesfield, United Kingdom (A.D.)
| | - Paul C McGovern
- From Justus Liebig University, Giessen, Germany (F.M.W.); LBG Consulting, Philadelphia (L.B.G.), and Venatorx Pharmaceuticals, Malvern (P.C.M., G.M., M.D., T.H.) - both in Pennsylvania; Fortrea, Burlington, NC (P.M.); and DaneStat Consulting, Macclesfield, United Kingdom (A.D.)
| | - Greg Moeck
- From Justus Liebig University, Giessen, Germany (F.M.W.); LBG Consulting, Philadelphia (L.B.G.), and Venatorx Pharmaceuticals, Malvern (P.C.M., G.M., M.D., T.H.) - both in Pennsylvania; Fortrea, Burlington, NC (P.M.); and DaneStat Consulting, Macclesfield, United Kingdom (A.D.)
| | - Patrick McLeroth
- From Justus Liebig University, Giessen, Germany (F.M.W.); LBG Consulting, Philadelphia (L.B.G.), and Venatorx Pharmaceuticals, Malvern (P.C.M., G.M., M.D., T.H.) - both in Pennsylvania; Fortrea, Burlington, NC (P.M.); and DaneStat Consulting, Macclesfield, United Kingdom (A.D.)
| | - MaryBeth Dorr
- From Justus Liebig University, Giessen, Germany (F.M.W.); LBG Consulting, Philadelphia (L.B.G.), and Venatorx Pharmaceuticals, Malvern (P.C.M., G.M., M.D., T.H.) - both in Pennsylvania; Fortrea, Burlington, NC (P.M.); and DaneStat Consulting, Macclesfield, United Kingdom (A.D.)
| | - Aaron Dane
- From Justus Liebig University, Giessen, Germany (F.M.W.); LBG Consulting, Philadelphia (L.B.G.), and Venatorx Pharmaceuticals, Malvern (P.C.M., G.M., M.D., T.H.) - both in Pennsylvania; Fortrea, Burlington, NC (P.M.); and DaneStat Consulting, Macclesfield, United Kingdom (A.D.)
| | - Tim Henkel
- From Justus Liebig University, Giessen, Germany (F.M.W.); LBG Consulting, Philadelphia (L.B.G.), and Venatorx Pharmaceuticals, Malvern (P.C.M., G.M., M.D., T.H.) - both in Pennsylvania; Fortrea, Burlington, NC (P.M.); and DaneStat Consulting, Macclesfield, United Kingdom (A.D.)
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Godijk NG, McDonald SA, Altorf-van der Kuil W, Schoffelen AF, Franz E, Bootsma MCJ. New methodology to assess the excess burden of antibiotic resistance using country-specific parameters: a case study regarding E. coli urinary tract infections. BMJ Open 2023; 13:e064335. [PMID: 38110375 DOI: 10.1136/bmjopen-2022-064335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVES Antimicrobial resistant (AMR) infections are a major public health problem and the burden on population level is not yet clear. We developed a method to calculate the excess burden of resistance which uses country-specific parameter estimates and surveillance data to compare the mortality and morbidity due to resistant infection against a counterfactual (the expected burden if infection was antimicrobial susceptible). We illustrate this approach by estimating the excess burden for AMR (defined as having tested positive for extended-spectrum beta-lactamases) urinary tract infections (UTIs) caused by E. coli in the Netherlands in 2018, which has a relatively low prevalence of AMR E. coli, and in Italy in 2016, which has a relatively high prevalence. DESIGN Excess burden was estimated using the incidence-based disability-adjusted life-years (DALYs) measure. Incidence of AMR E. coli UTI in the Netherlands was derived from ISIS-AR, a national surveillance system that includes tested healthcare and community isolates, and the incidence in Italy was estimated using data reported in the literature. A systematic literature review was conducted to find country-specific parameter estimates for disability duration, risks of progression to bacteraemia and mortality. RESULTS The annual excess burden of AMR E. coli UTI was estimated at 3.89 and 99.27 DALY/100 0000 population and 39 and 2786 excess deaths for the Netherlands and Italy, respectively. CONCLUSIONS For the first time, we use country-specific and pathogen-specific parameters to estimate the excess burden of resistant infections. Given the large difference in excess burden due to resistance estimated for Italy and for the Netherlands, we emphasise the importance of using country-specific parameters describing the incidence and disease progression following AMR and susceptible infections that are pathogen specific, and unfortunately currently difficult to locate.
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Affiliation(s)
- Noortje Grejanne Godijk
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Scott A McDonald
- Centre for Infectious Disease Control, National Institute for Public Health & the Environment, Bilthoven, The Netherlands
| | - Wieke Altorf-van der Kuil
- Centre for Infectious Disease Control, National Institute for Public Health & the Environment, Bilthoven, The Netherlands
| | - Annelot F Schoffelen
- Centre for Infectious Disease Control, National Institute for Public Health & the Environment, Bilthoven, The Netherlands
| | - Eelco Franz
- Centre for Infectious Disease Control, National Institute for Public Health & the Environment, Bilthoven, The Netherlands
| | - Martin C J Bootsma
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Mathematics, Utrecht University, Utrecht, The Netherlands
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6
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Teixeira-Santos R, Gomes LC, Vieira R, Sousa-Cardoso F, Soares OSGP, Mergulhão FJ. Exploring Nitrogen-Functionalized Graphene Composites for Urinary Catheter Applications. NANOMATERIALS (BASEL, SWITZERLAND) 2023; 13:2604. [PMID: 37764632 PMCID: PMC10536687 DOI: 10.3390/nano13182604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023]
Abstract
Graphene has been broadly studied, particularly for the fabrication of biomedical devices, owing to its physicochemical and antimicrobial properties. In this study, the antibiofilm efficacy of graphene nanoplatelet (GNP)-based composites as coatings for urinary catheters (UCs) was investigated. GNPs were functionalized with nitrogen (N-GNP) and incorporated into a polydimethylsiloxane (PDMS) matrix. The resulting materials were characterized, and the N-GNP/PDMS composite was evaluated against single- and multi-species biofilms of Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Both biofilm cell composition and structure were analyzed. Furthermore, the antibacterial mechanisms of action of N-GNP were explored. The N-GNP/PDMS composite showed increased hydrophobicity and roughness compared to PDMS. In single-species biofilms, this composite significantly reduced the number of S. aureus, P. aeruginosa, and K. pneumoniae cells (by 64, 41, and 29%, respectively), and decreased S. aureus biofilm culturability (by 50%). In tri-species biofilms, a 41% reduction in total cells was observed. These results are aligned with the outcomes of the biofilm structure analysis. Moreover, N-GNP caused changes in membrane permeability and triggered reactive oxygen species (ROS) synthesis in S. aureus, whereas in Gram-negative bacteria, it only induced changes in cell metabolism. Overall, the N-GNP/PDMS composite inhibited biofilm development, showing the potential of these carbon materials as coatings for UCs.
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Affiliation(s)
- Rita Teixeira-Santos
- LEPABE—Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal; (R.T.-S.); (L.C.G.); (R.V.); (F.S.-C.)
- ALiCE—Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal;
| | - Luciana C. Gomes
- LEPABE—Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal; (R.T.-S.); (L.C.G.); (R.V.); (F.S.-C.)
- ALiCE—Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal;
| | - Rita Vieira
- LEPABE—Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal; (R.T.-S.); (L.C.G.); (R.V.); (F.S.-C.)
- ALiCE—Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal;
| | - Francisca Sousa-Cardoso
- LEPABE—Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal; (R.T.-S.); (L.C.G.); (R.V.); (F.S.-C.)
- ALiCE—Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal;
| | - Olívia S. G. P. Soares
- ALiCE—Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal;
- LSRE-LCM—Laboratory of Separation and Reaction Engineering—Laboratory of Catalysis and Materials, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - Filipe J. Mergulhão
- LEPABE—Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal; (R.T.-S.); (L.C.G.); (R.V.); (F.S.-C.)
- ALiCE—Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal;
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Whelan S, Lucey B, Finn K. Uropathogenic Escherichia coli (UPEC)-Associated Urinary Tract Infections: The Molecular Basis for Challenges to Effective Treatment. Microorganisms 2023; 11:2169. [PMID: 37764013 PMCID: PMC10537683 DOI: 10.3390/microorganisms11092169] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
Urinary tract infections (UTIs) are among the most common bacterial infections, especially among women and older adults, leading to a significant global healthcare cost burden. Uropathogenic Escherichia coli (UPEC) are the most common cause and accounts for the majority of community-acquired UTIs. Infection by UPEC can cause discomfort, polyuria, and fever. More serious clinical consequences can result in urosepsis, kidney damage, and death. UPEC is a highly adaptive pathogen which presents significant treatment challenges rooted in a complex interplay of molecular factors that allow UPEC to evade host defences, persist within the urinary tract, and resist antibiotic therapy. This review discusses these factors, which include the key genes responsible for adhesion, toxin production, and iron acquisition. Additionally, it addresses antibiotic resistance mechanisms, including chromosomal gene mutations, antibiotic deactivating enzymes, drug efflux, and the role of mobile genetic elements in their dissemination. Furthermore, we provide a forward-looking analysis of emerging alternative therapies, such as phage therapy, nano-formulations, and interventions based on nanomaterials, as well as vaccines and strategies for immunomodulation. This review underscores the continued need for research into the molecular basis of pathogenesis and antimicrobial resistance in the treatment of UPEC, as well as the need for clinically guided treatment of UTIs, particularly in light of the rapid spread of multidrug resistance.
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Affiliation(s)
- Shane Whelan
- Department of Biological Sciences, Munster Technological University, Bishopstown, T12 P928 Cork, Ireland;
| | - Brigid Lucey
- Department of Biological Sciences, Munster Technological University, Bishopstown, T12 P928 Cork, Ireland;
| | - Karen Finn
- Department of Analytical, Biopharmaceutical and Medical Sciences, Atlantic Technological University Galway City, Dublin Road, H91 T8NW Galway, Ireland
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8
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Kim DS, Lee JW. Urinary Tract Infection and Microbiome. Diagnostics (Basel) 2023; 13:diagnostics13111921. [PMID: 37296773 DOI: 10.3390/diagnostics13111921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/23/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
Urinary tract infection is one of the most common bacterial infections and can cause major burdens, not only to individuals but also to an entire society. Current knowledge of the microbial communities in the urinary tract has increased exponentially due to next-generation sequencing and expanded quantitative urine culture. We now acknowledge a dynamic urinary tract microbiome that we once thought was sterile. Taxonomic studies have identified the normal core microbiota of the urinary tract, and studies on the changes in microbiome due to sexuality and age have set the foundation for microbiome studies in pathologic states. Urinary tract infection is not only caused by invading uropathogenic bacteria but also by changes to the uromicrobiome milieu, and interactions with other microbial communities can also contribute. Recent studies have provided insights into the pathogenesis of recurrent urinary tract infections and antimicrobial resistance. New therapeutic options for urinary tract infections also show promise; however, further research is needed to fully understand the implications of the urinary microbiome in urinary tract infections.
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Affiliation(s)
- Dong Soo Kim
- Department of Urology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul 02447, Republic of Korea
| | - Jeong Woo Lee
- Department of Urology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul 02447, Republic of Korea
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9
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Baker H, Avey B, Overbeck Rethmeier L, Mealing S, Lynge Buchter M, Averbeck MA, Thiruchelvam N. Cost-effectiveness analysis of hydrophilic-coated catheters in long-term intermittent catheter users in the UK. Curr Med Res Opin 2023; 39:319-328. [PMID: 36444510 DOI: 10.1080/03007995.2022.2151734] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To estimate the cost-effectiveness of single-use hydrophilic-coated intermittent catheters (HCICs) versus single-use uncoated intermittent catheters (UICs) for urinary catheterization. METHODS The evaluation took a UK national health service (NHS) perspective. The population of interest were people using intermittent catheters, with either a spinal cord injury or multiple sclerosis. A Markov model was developed that estimated costs and clinical evidence over the lifetime of a hypothetical cohort and applied health-related quality-of-life estimates. Model inputs were sourced from published evidence, including a network meta-analysis to inform the treatment effect (reduction in catheter-associated urinary tract infections [CAUTIs]), and were supported by expert opinion. The model outputs included per-patient lifetime costs, quality-adjusted life years (QALYs), and the incremental cost effectiveness ratio (ICER). Event counts were also produced. RESULTS Using HCICs instead of UICs could prevent seven CAUTI events per patient over a lifetime horizon (1.8 requiring secondary care). Overall, lifetime use of HCICs is £3,183 more expensive than use of UICs per patient. However, for these additional costs, 0.55 QALYs are gained. The ICER is £5,755 per additional QALY gained. Key drivers of the model results were identified and subject to sensitivity analyses. The results were found to be robust to parameter uncertainty. CONCLUSION HCICs are likely to be a cost-effective alternative to UICs, a result driven by substantial reductions in the number of CAUTIs. Their adoption across clinical practice could avoid a substantial number of infections, freeing up resources in the NHS and reducing antibiotic use in urinary catheter users.
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Affiliation(s)
| | | | | | | | | | | | - Nikesh Thiruchelvam
- Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK
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10
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Obstructing Ureteral Calculi and Presumed Infection: Impact of Antimicrobial Duration and Time From Decompression to Stone Treatment in Developing Urosepsis. Urology 2023; 172:55-60. [PMID: 36334770 DOI: 10.1016/j.urology.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/13/2022] [Accepted: 10/12/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine whether the duration of antibiotic treatment and timing between urgent renal decompression and stone intervention impacts the risk of developing urosepsis following definitive stone treatment. MATERIALS & METHODS A retrospective review of patients who were diagnosed with obstructive urolithiasis and underwent urgent decompression with a ureteral double J stent or percutaneous nephrostomy at our institution between 2012 and 2018 was performed. We narrowed our analysis to the subset of patients who had suspected infection and received definitive stone treatment at our institution. Demographic, infection and antimicrobial data, and initial admission to stone treatment characteristics were collected. Factors associated with developing urosepsis were analyzed. RESULTS We identified 872 patients who were treated with urgent renal decompression, of which 215 were analyzed that had suspected infection and also received definitive stone removal at our institution. Thirty-three had fevers, 64.2% had a positive urine culture, and 45.6% had urosepsis at the initial presentation. The median antibiotics duration post decompression was 13 days (IQR 8-18). The median duration from decompression to stone treatment was 17 days (IQR 12-27). Of all, 4.6% of the patients developed urosepsis post ureteroscopy and 5% post percutaneous nephrolithotomy. No factors were associated with developing urosepsis post stone treatment on logistic regression analyses. CONCLUSION In patients requiring urgent decompression for obstructing urolithiasis and suspected infection, the time between decompression and stone treatment and the length of antibiotic exposure did not impact rates of postoperative urosepsis. This highlights the importance of maintaining high clinical suspicion for prolonged use of antibiotics, to prevent overtreatment and possible exacerbation of antibiotic resistance.
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Zhang W, Yan CY, Li SR, Fan TT, Cao SS, Cui B, Li MY, Fan BY, Ji B, Wang L, Cui F, Cui J, Wang L, Guan Y, Wang JW. Efficacy and safety of piperacillin-tazobactam compared with meropenem in treating complicated urinary tract infections including acute pyelonephritis due to extended-spectrum β-lactamase-producing Enterobacteriaceae. Front Cell Infect Microbiol 2023; 13:1093842. [PMID: 37207190 PMCID: PMC10188998 DOI: 10.3389/fcimb.2023.1093842] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/14/2023] [Indexed: 05/21/2023] Open
Abstract
Introduction Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae pose a huge threat to human health, especially in the context of complicated urinary tract infections (cUTIs). Carbapenems and piperacillin-tazobactam (PTZ) are two antimicrobial agents commonly used to treat cUTIs. Methods A monocentric retrospective cohort study focused on the treatment of cUTIs in adults was conducted from January 2019 to November 2021. Patients with a positive urine culture strain yielding ≥ 103 colony-forming units per milliliter (CFU/mL), and sensitive to PTZ and carbapenems, were included. The primary endpoint was clinical success after antibiotic therapy. The secondary endpoint included rehospitalization and 90-day recurrence of cUTIs caused by ESBL-producing Enterobacteriaceae. Results Of the 195 patients included in this study, 110 were treated with PTZ while 85 were administered meropenem. The rate of clinical cure was similar between the PTZ and meropenem groups (80% vs. 78.8%, p = 0.84). However, the PTZ group had a lower duration of total antibiotic use (6 vs. 9; p < 0.01), lower duration of effective antibiotic therapy (6 vs. 8; p < 0.01), and lower duration of hospitalization (16 vs. 22; p < 0.01). Discussion In terms of adverse events, the safety of PTZ was higher than that of meropenem in the treatment of cUTIs.
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Affiliation(s)
- Wei Zhang
- Department of Pharmacy, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Chun-Yu Yan
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Shu-Rui Li
- Department of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ting-Ting Fan
- Department of Pharmacy, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Shan-Shan Cao
- Department of Pharmacy, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Bin Cui
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Meng-Ying Li
- Department of Endocrinology, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Bo-Yuan Fan
- Department of Cardiology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Bo Ji
- Department of Pharmacy, Yan’an University Affiliated Hospital, Yan’an, China
| | - Li Wang
- Department of Pharmacy, Yan’an University Affiliated Hospital, Yan’an, China
| | - Fei Cui
- Department of Pharmacy, Luoyang First People’s Hospital, Luoyang, China
| | - Jia Cui
- Department of Pharmacy, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Lei Wang
- Department of Pharmacy, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Yue Guan
- Department of Pharmacy, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
- *Correspondence: Yue Guan, ; Jing-Wen Wang,
| | - Jing-Wen Wang
- Department of Pharmacy, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
- *Correspondence: Yue Guan, ; Jing-Wen Wang,
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12
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Neretljak I, Jurinčić M, Smojver H, Jurenec F, Vuković J, Orešković J, Šanjek-Muren T, Sučić M. Antibiotic prophylaxis prior to transrectal prostate biopsy in Croatia: A national survey. Urologia 2022:3915603221143419. [DOI: 10.1177/03915603221143419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objectives: Transrectal ultrasound guided prostate biopsy (TRUSPB) is the standard of care for diagnosis of prostate cancer. Increased antibiotic resistance has led to the suspension of indication for fluoroquinolones use in prostate biopsy prophylaxis. Several classes of antibiotics have been recommended for routine use. Unequivocal consensus regarding antibiotic prophylaxis has not been made to date. The objective of the study was to assess the diversity of antimicrobial prophylaxis among Croatian urologists. Materials and methods: An online questionnaire was designed using Google Forms® and distributed to 19 urology public hospital’s departments. Answers regarding infection risk assessment, type and duration of antimicrobial prophylaxis were accumulated. Descriptive statistical analysis was preformed using Statistica 10.0® analytics software. Results: Twelve urology departments answered the questionnaire, representing 63% of urology departments in Croatia. Six different antibiotic protocols have been reported. Fluoroquinolones were the most commonly prescribed class of antibiotics (84%). Antibiotic prophylaxis started 1 day before the procedure (92%). Average duration of antibiotic prophylaxis was 5 days (75%). In case of increased risk of urinary tract infection, 42% of departments changed the type, and 8% changed the duration of antibiotic prophylaxis. Neither department performed a rectal swab prior to prostate biopsy. Conclusions: Various antimicrobial prophylaxis protocols are currently being used among Croatian urology departments. Lack of uniform guidelines contributes to protocol diverseness that inevitably leads to further increase in antibiotic resistance. New high quality studies are needed to reverse this trend and to facilitate the establishment of a uniform antimicrobial stewardship strategy.
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Affiliation(s)
- Ivan Neretljak
- Department of Urology, University Hospital Merkur, Zagreb, Croatia
| | - Mario Jurinčić
- Department of Urology, University Hospital Merkur, Zagreb, Croatia
| | - Hrvoje Smojver
- Department of Urology, University Hospital Merkur, Zagreb, Croatia
| | - Franjo Jurenec
- Department of Urology, University Hospital Merkur, Zagreb, Croatia
- Faculty of Medicine, Department of Urology, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Jurica Vuković
- Department of Urology, University Hospital Merkur, Zagreb, Croatia
| | - Janko Orešković
- Department of Urology, University Hospital Merkur, Zagreb, Croatia
| | | | - Mario Sučić
- Department of Urology, University Hospital Merkur, Zagreb, Croatia
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13
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Ten Doesschate T, Kuiper S, van Nieuwkoop C, Hassing RJ, Ketels T, van Mens SP, van den Bijllaardt W, van der Bij AK, Geerlings SE, Koster A, Koldewijn EL, Branger J, Hoepelman AIM, van Werkhoven CH, Bonten MJM. Fosfomycin Vs Ciprofloxacin as Oral Step-Down Treatment for Escherichia coli Febrile Urinary Tract Infections in Women: A Randomized, Placebo-Controlled, Double-Blind, Multicenter Trial. Clin Infect Dis 2022; 75:221-229. [PMID: 34791074 PMCID: PMC8689999 DOI: 10.1093/cid/ciab934] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We aimed to determine the noninferiority of fosfomycin compared to ciprofloxacin as an oral step-down treatment for Escherichia coli febrile urinary tract infections (fUTIs) in women. METHODS This was a double-blind, randomized, controlled trial in 15 Dutch hospitals. Adult women who were receiving 2-5 days of empirical intravenous antimicrobials for E. coli fUTI were assigned to step-down treatment with once-daily 3g fosfomycin or twice-daily 0.5g ciprofloxacin for 10 days of total antibiotic treatment. For the primary end point, clinical cure at days 6-10 post-end of treatment (PET), a noninferiority margin of 10% was chosen. The trial was registered on Trialregister.nl (NTR6449). RESULTS After enrollment of 97 patients between 2017 and 2020, the trial ended prematurely because of the coronavirus disease 2019 pandemic. The primary end point was met in 36 of 48 patients (75.0%) assigned to fosfomycin and 30 of 46 patients (65.2%) assigned to ciprofloxacin (risk difference [RD], 9.6%; 95% confidence interval [CI]: -8.8% to 28.0%). In patients assigned to fosfomycin and ciprofloxacin, microbiological cure at days 6-10 PET occurred in 29 of 37 (78.4%) and 33 of 35 (94.3%; RD, -16.2%; 95% CI: -32.7 to -0.0%). Any gastrointestinal adverse event was reported in 25 of 48 (52.1%) and 14 of 46 (30.4%) patients (RD, 20.8%; 95% CI: 1.6% to 40.0%), respectively. CONCLUSIONS Fosfomycin is noninferior to ciprofloxacin as oral step-down treatment for fUTI caused by E. coli in women. Fosfomycin use is associated with more gastrointestinal events. CLINICAL TRIAL REGISTRATION Trial NL6275 (NTR6449).
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Affiliation(s)
- Thijs Ten Doesschate
- Department of Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sander Kuiper
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands.,Department of Infectious Diseases, Leiden University Medical Center, The Hague, The Netherlands
| | - Cees van Nieuwkoop
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands
| | - Robert Jan Hassing
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - Tom Ketels
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - Suzan P van Mens
- Department of Medical Microbiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Akke K van der Bij
- Department of Medical Microbiology, Diakonessenhuis, Utrecht, The Netherlands
| | - Suzanne E Geerlings
- Department of Infectious Diseases, University of Amsterdam, Amsterdam, The Netherlands
| | - Ad Koster
- Department of Internal Medicine, Viecuri Medical Center, Venlo, The Netherlands
| | - Evert L Koldewijn
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlandsand
| | - Judith Branger
- Department of Internal Medicine, Flevohospital, Almere, The Netherlands
| | - Andy I M Hoepelman
- Department of Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cornelis H van Werkhoven
- Department of Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marc J M Bonten
- Department of Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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14
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Impact of urinary catheter on resistance patterns and clinical outcomes on complicated urinary tract infection. Int Urogynecol J 2022:10.1007/s00192-022-05320-4. [PMID: 35994069 DOI: 10.1007/s00192-022-05320-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 07/20/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Complicated urinary tract infection (cUTI) is highly prevalent and costly for health systems. The impact of the indwelling urinary catheter on etiologic agents and clinical outcomes has been poorly studied in Latin America. METHODS Cross-sectional study including patients with cUTI, with positive urine culture, treated at Hospital Universitario San Ignacio, Bogotá (Colombia) between 2017 and 2020. Clinical and microbiologic characteristics, treatments and outcomes are explored, comparing those with and without indwelling urinary catheter. RESULTS Seven hundred thirty-five patients with non-catheter-associated cUTI (NC-cUTI) and 165 with catheter-associated cUTI (CAUTI) were included. CAUTI group had a higher proportion of recurrent UTI (18% vs 33.3%, p < 0.001), ICU requirement (2.7% vs 8.5%, p < 0.001), longer hospital stay (6 vs 10 days, p < 0.001) and > 30 days unplanned readmission rate (5.8% vs 10.3%, p < 0.001). In the same group, we found a higher frequency of Pseudomonas spp (2.6% vs 9.4%, p < 0.001), Enterococcus spp. (2.4% vs 3.3%, p = 0.016), Serratia marcescens (0.6% vs 3.3%, p < 0.001) and Citrobacter freundii (0.5% vs 5.7%, p < 0.001). It implied a higher number of patients treated with fourth-generation cephalosporins (1.4% vs 4.8%, p = 0.004), ertapenem (32.9% vs 41.8%, p = 0.027) and carbapenems associated with a second antibiotic (1.9% vs 8.5%, p < 0.001). CONCLUSIONS Patients with CAUTI have a higher frequency of resistant germs, require greater use of resources and have worse clinical outcomes than patients who do not require such devices. Measures should be strengthened to minimize its use, in both the hospital and outpatient setting.
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15
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Zilberberg MD, Nathanson BH, Sulham K, Shorr AF. Descriptive Epidemiology and Outcomes of Hospitalizations With Complicated Urinary Tract Infections in the United States, 2018. Open Forum Infect Dis 2022; 9:ofab591. [PMID: 35036460 PMCID: PMC8754377 DOI: 10.1093/ofid/ofab591] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/18/2021] [Indexed: 11/26/2022] Open
Abstract
Background Hospitalizations with complicated urinary tract infection (cUTI) in the United States have increased. Though most often studied as a subset of cUTI, catheter-associated UTI (CAUTI) afflicts a different population of patients and carries outcomes distinct from non-CA cUTI (nCAcUTI). We examined the epidemiology and outcomes of hospitalizations in these groups. Methods We conducted a cross-sectional multicenter study within the 2018 National Inpatient Sample (NIS) database, a 20% stratified sample of discharges from US community hospitals, to explore characteristics and outcomes of patients discharged with a UTI diagnosis. We divided cUTI into mutually exclusive categories of nCAcUTI and CAUTI. We applied survey methods to develop national estimates. Results Among 2 837 385 discharges with a UTI code, 500 400 (17.6%, 19.8% principal diagnosis [PD]) were nCAcUTI and 126 120 (4.4%, 63.8% PD) were CAUTI. Though similar in age (CAUTI, 70.1 years; and nCAcUTI, 69.7 years), patients with nCAcUTI had lower comorbidity (mean Charlson, 4.3) than those with CAUTI (mean Charlson, 4.6). Median (interquartile range [IQR]) length of stay (LOS) was 5 (3–8) days in nCAcUTI and 5 (3–9) days in CAUTI. Overall median (IQR) hospital costs were similar in nCAcUTI ($9713 [$5923–$17 423]) and CAUTI ($9711 [$5969–$17 420]). Though low in both groups, hospital mortality was lower in nCAcUTI (2.8%) than in CAUTI (3.4%). Routine discharges home were higher in nCAcUTI (41.5%) than CAUTI (22.1%). Conclusions There are >626 000 hospital admissions with a cUTI, comprising ~1.8% of all annual admissions in the United States; 4/5 are nCAcUTI. Because CAUTI is frequently the reason for admission, preventive efforts are needed beyond the acute care setting.
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Affiliation(s)
| | | | - Kate Sulham
- Spero Therapeutics, Cambridge, Massachusetts, USA
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16
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Jacobs K, Roman E, Lambert J, Moke L, Scheys L, Kesteloot K, Roodhooft F, Cardoen B. Variability drivers of treatment costs in hospitals: A systematic review. Health Policy 2021; 126:75-86. [PMID: 34969532 DOI: 10.1016/j.healthpol.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 12/08/2021] [Accepted: 12/14/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Studies on variability drivers of treatment costs in hospitals can provide the necessary information for policymakers and healthcare providers seeking to redesign reimbursement schemes and improve the outcomes-over-cost ratio, respectively. This systematic literature review, focusing on the hospital perspective, provides an overview of studies focusing on variability in treatment cost, an outline of their study characteristics and cost drivers, and suggestions on future research methodology. METHODS We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane Handbook for Systematic Reviews of Interventions. We searched PubMED/MEDLINE, Web of Science, EMBASE, Scopus, CINAHL, Science direct, OvidSP and Cochrane library. Two investigators extracted and appraised data for citation until October 2020. RESULTS 90 eligible articles were included. Patient, treatment and disease characteristics and, to a lesser extent, outcome and institutional characteristics were identified as significant variables explaining cost variability. In one-third of the studies, the costing method was classified as unclear due to the limited explanation provided by the authors. CONCLUSION Various patient, treatment and disease characteristics were identified to explain hospital cost variability. The limited transparency on how hospital costs are defined is a remarkable observation for studies wherein cost variability is the main focus. Recommendations relating to variables, costs, and statistical methods to consider when designing and conducting cost variability studies were provided.
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Affiliation(s)
- Karel Jacobs
- KU Leuven, Faculty of Medicine, LIGB (Leuven Institute for Health Policy), Leuven, Belgium; KU Leuven, Faculty of Medicine, IORT (Institute for Orthopaedic Research and Training), Leuven, Belgium; Vlerick Business School, Ghent, Belgium.
| | - Erin Roman
- Vlerick Business School, Ghent, Belgium; KU Leuven, Faculty of Economics and Business, Leuven, Belgium
| | - Jo Lambert
- Ghent University Hospital, department of Dermatology, Ghent, Belgium
| | - Lieven Moke
- KU Leuven, Faculty of Medicine, IORT (Institute for Orthopaedic Research and Training), Leuven, Belgium
| | - Lennart Scheys
- KU Leuven, Faculty of Medicine, IORT (Institute for Orthopaedic Research and Training), Leuven, Belgium
| | - Katrien Kesteloot
- KU Leuven, Faculty of Medicine, LIGB (Leuven Institute for Health Policy), Leuven, Belgium
| | - Filip Roodhooft
- Vlerick Business School, Ghent, Belgium; KU Leuven, Faculty of Economics and Business, Leuven, Belgium
| | - Brecht Cardoen
- Vlerick Business School, Ghent, Belgium; KU Leuven, Faculty of Economics and Business, Leuven, Belgium
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Dadi NCT, Radochová B, Vargová J, Bujdáková H. Impact of Healthcare-Associated Infections Connected to Medical Devices-An Update. Microorganisms 2021; 9:2332. [PMID: 34835457 PMCID: PMC8618630 DOI: 10.3390/microorganisms9112332] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/06/2021] [Accepted: 11/08/2021] [Indexed: 01/12/2023] Open
Abstract
Healthcare-associated infections (HAIs) are caused by nosocomial pathogens. HAIs have an immense impact not only on developing countries but also on highly developed parts of world. They are predominantly device-associated infections that are caused by the planktonic form of microorganisms as well as those organized in biofilms. This review elucidates the impact of HAIs, focusing on device-associated infections such as central line-associated bloodstream infection including catheter infection, catheter-associated urinary tract infection, ventilator-associated pneumonia, and surgical site infections. The most relevant microorganisms are mentioned in terms of their frequency of infection on medical devices. Standard care bundles, conventional therapy, and novel approaches against device-associated infections are briefly mentioned as well. This review concisely summarizes relevant and up-to-date information on HAIs and HAI-associated microorganisms and also provides a description of several useful approaches for tackling HAIs.
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Affiliation(s)
| | - Barbora Radochová
- Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, 84215 Bratislava, Slovakia; (N.C.T.D.); (J.V.)
| | | | - Helena Bujdáková
- Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, 84215 Bratislava, Slovakia; (N.C.T.D.); (J.V.)
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Redondo-Sánchez J, del Cura-González I, Díez-Izquierdo L, Rodríguez-Barrientos R, Rodríguez-Cabrera F, Polentinos-Castro E, López-Miguel M, Marina-Ono L, Llamosas-Falcón L, Gil-de Miguel Á. Trends in urinary tract infection hospitalization in older adults in Spain from 2000-2015. PLoS One 2021; 16:e0257546. [PMID: 34587191 PMCID: PMC8480842 DOI: 10.1371/journal.pone.0257546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 09/05/2021] [Indexed: 12/04/2022] Open
Abstract
Objective To analyze trends in urinary tract infection hospitalization (cystitis, pyelonephritis, prostatitis and non-specified UTI) among patients over 65 years in Spain from 2000–2015. Methods We conducted a retrospective observational study using the Spanish Hospitalization Minimum Data Set (CMBD), with codifications by the International Classification of Diseases (ICD-9). We collected data on sex, age, type of discharge, main diagnosis, comorbid diagnosis, length of stay, and global cost. All the hospitalizations were grouped by age into three categories: 65–74 years old, 75–84 years old, and 85 years old and above. In the descriptive statistical analysis, crude rates were defined as hospitalizations per 1,000 inhabitants aged ≥65. To identify trends over time, we performed a Joinpoint regression. Results From 2000–2015, we found 387,010 hospitalizations coded as UTIs (54,427 pyelonephritis, 15,869 prostatitis, 2643 cystitis and 314,071 non-specified UTI). The crude rate of hospitalization for UTIs between 2000 and 2015 ranged from 2.09 in 2000 to 4.33 in 2015 Rates of hospitalization were higher in men than in women, except with pyelonephritis. By age group, higher rates were observed in patients aged 85 years or older, barring prostatitis-related hospitalizations. Joinpoint analyses showed an average annual percentage increase (AAPC) in incidence rates of 4.9% (95% CI 3.2;6.1) in UTI hospitalizations. We observed two joinpoints, in 2010 and 2013, that found trends of 5.5% between 2000 and 2010 (95% CI 4.7;6.4), 1.5% between 2010 and 2013 (95% CI -6.0;9.6) and 6.8% between 2013 and 2015 (95% CI -0.3;14.4). Conclusions The urinary infection-related hospitalization rate in Spain doubled during the period 2000–2015. The highest hospitalization rates occurred in men, in the ≥85 years old age group, and in non-specified UTIs. There were increases in all types of urinary tract infection, with non-specified UTIs having the greatest growth. Understanding these changing trends can be useful for health planning.
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Affiliation(s)
- Jesús Redondo-Sánchez
- Ramon y Cajal Health Care Center, Alcorcón, Primary Care Management, Madrid Health Service, Madrid, Spain
- Department of Medical Specialties and Public Health, University Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Isabel del Cura-González
- Department of Medical Specialties and Public Health, University Rey Juan Carlos, Alcorcón, Madrid, Spain
- Research Unit, Primary Care Management, Madrid Health Service, Madrid, Spain
- Health Services Research on Chronic Patients Network (REDISSEC) ISCIII, Madrid, Spain
| | | | - Ricardo Rodríguez-Barrientos
- Research Unit, Primary Care Management, Madrid Health Service, Madrid, Spain
- Health Services Research on Chronic Patients Network (REDISSEC) ISCIII, Madrid, Spain
- Biosanitary Research and Innovation Foundation of Primary Care (FIIBAP), Madrid, Spain
- * E-mail:
| | | | - Elena Polentinos-Castro
- Research Unit, Primary Care Management, Madrid Health Service, Madrid, Spain
- Health Services Research on Chronic Patients Network (REDISSEC) ISCIII, Madrid, Spain
| | - Miguel López-Miguel
- Ciudades Health Care Center, Getafe, South Family and Community Care Teaching Unit, Madrid, Spain
| | | | - Laura Llamosas-Falcón
- Preventive Medicine and Public Health, 12 de Octubre University Hospital, Madrid, Spain
| | - Ángel Gil-de Miguel
- Department of Medical Specialties and Public Health, University Rey Juan Carlos, Alcorcón, Madrid, Spain
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Bandyopadhyay D, Singh G, Mukherjee M, Akhter Y. Computational approach towards the design of novel inhibitor against universal stress protein A to combat multidrug resistant uropathogenic Escherichia coli. J Mol Struct 2021. [DOI: 10.1016/j.molstruc.2021.130379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Current antibiotic resistance patterns of rare uropathogens: survey from Central European Urology Department 2011-2019. BMC Urol 2021; 21:61. [PMID: 33849512 PMCID: PMC8042353 DOI: 10.1186/s12894-021-00821-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 03/24/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND While the resistance rates of commonly detected uropathogens are well described, those of less frequent Gram-negative uropathogenic bacteria have seldom been reported. The aim of this study was to examine the resistance rates of less frequent uropathogenic Gram-negatives in a population of patients treated in a Department of Urology of a tertiary referral centre in Central Europe over a period of 9 years. METHODS Data on all positive urine samples from urological in- and out-patients were extracted form the Department of Clinical Microbiology database from 2011 to 2019. Numbers of susceptible and resistant isolates per year were calculated for these uropathogens: Acinetobacter spp. (n = 74), Citrobacter spp. (n = 60), Enterobacter spp. (n = 250), Morganella morganii (n = 194), Providencia spp. (n = 53), Serratia spp. (n = 82) and Stenotrophomonas maltophilia (n = 27). Antimicrobial agents selected for the survey included: ampicillin, amoxicillin/clavulanic acid, piperacillin/tazobactam; cefuroxime, cefotaxime, ceftazidime and cefepime; ciprofloxacin and ofloxacin; gentamicin and amikacin; ertapenem, meropenem and imipenem; trimethoprim-sulfamethoxazole (co-trimoxazole), nitrofurantoin and colistin. RESULTS Penicillin derivatives have generally poor effect except piperacillin/tazobactam. Cefuroxime is not efficient unlike cefotaxime (except against Acinetobacter spp. and S. maltophilia). Susceptibility to fluoroquinolones is limited. Amikacin is somewhat more efficient than gentamicine but susceptibilities for both safely exceed 80%. Nitrofurantoin shows virtually no efficiency. Cotrimoxazole acts well against Citrobacter spp., Serratia spp. and it is the treatment of choice for S. maltophilia UTIs. Among carbapenems, ertapenem was less efficient than meropenem and imipenem except for S. maltophilia whose isolates were mostly not suceptible to any carbapenems. CONCLUSIONS Uropathogenic microorganisms covered in this report are noteworthy for their frequently multi-drug resistant phenotypes. Knowledge of resistance patterns helps clinicians choose the right empirical antibiotic treatment when the taxonomical assignment of the isolate is known but sensitivity results are pending.
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Iskandar K, Rizk R, Matta R, Husni-Samaha R, Sacre H, Bouraad E, Dirani N, Salameh P, Molinier L, Roques C, Dimassi A, Hallit S, Abdo R, Hanna PA, Yared Y, Matta M, Mostafa I. Economic Burden of Urinary Tract Infections From Antibiotic-Resistant Escherichia coli Among Hospitalized Adult Patients in Lebanon: A Prospective Cohort Study. Value Health Reg Issues 2021; 25:90-98. [PMID: 33852980 DOI: 10.1016/j.vhri.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The rising incidence of urinary tract infections (UTIs) attributable to Escherichia coli resistant isolates is becoming a serious public health concern. Although global rates of infection vary considerably by region, the growing prevalence of this uropathogen has been associated with a high economic burden and health strain. This study aims: (1) to estimate the differences in clinical and economic outcomes between 2 groups of adult hospitalized patients with UTIs from E. coli resistant and susceptible bacteria and (2) to investigate drivers of this cost from a payer's perspective. METHODS A prospective multicenter cohort study was conducted in 10 hospitals in Lebanon. The cost analysis followed a bottom-up microcosting approach; a linear regression was constructed to evaluate the predictors of hospitalization costs and a Cox proportional hazards model was used to estimate the impact of resistance on length of stay (LOS) and in-hospital mortality. RESULTS Out of 467 inpatients, 250 cases were because of resistant E. coli isolates. Results showed that patients with resistant uropathogens had 29% higher mean total hospitalization costs ($3429 vs $2651; P = .004), and an extended median LOS (6 days vs 5 days; P = .020) compared with susceptible cohorts. The selection of resistant bacteria and the Charlson comorbidity index predicted higher total hospitalization costs and in-hospital mortality. CONCLUSION In an era of increased pressure for cost containment, this study showed the burden of treating UTIs resulting from resistant bacteria. The results can inform cost-effectiveness analyses that intend to evaluate the benefit of a national action plan aimed at decreasing the impact of antibiotic resistance.
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Affiliation(s)
- Katia Iskandar
- Department of Mathématiques Informatique et Télécommunications, Université Toulouse III, Paul Sabatier, INSERM, UMR, Toulouse, France; INSPECT-LB: Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon; Lebanese University, Beirut, Lebanon.
| | - Rana Rizk
- INSPECT-LB: Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon; Department of Health Services Research, School CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | | | - Rola Husni-Samaha
- School of Medicine, Lebanese American University, Byblos, Lebanon; Infection Control Department, Lebanese American University Medical Center, Beirut, Lebanon
| | - Hala Sacre
- INSPECT-LB: Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon; Drug Information Center, Order of Pharmacists of Lebanon, Beirut, Lebanon
| | - Etwal Bouraad
- School of Pharmacy, Pharmacy Practice Department, Lebanese International University, Beirut, Lebanon
| | - Natalia Dirani
- Department of Infectious Diseases, Dar El Amal University Hospital, Baalbeck, Lebanon
| | - Pascale Salameh
- INSPECT-LB: Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon; Lebanese University, Beirut, Lebanon; Lebanese University, Beirut, Lebanon
| | - Laurent Molinier
- Department of Medical Information, Centre Hospitalier Universitaire, INSERM, UMR, Université Paul Sabatier Toulouse III, Toulouse, France
| | - Christine Roques
- Department of Bioprocédés et Systèmes Microbiens, Laboratoire de Génie Chimique, Université Paul Sabatier Toulouse III, UMR, Toulouse, France; Department of Bactériologie-Hygiène, Centre Hospitalier Universitaire, Hôpital Purpan, Toulouse, France
| | | | | | - Souheil Hallit
- INSPECT-LB: Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon; Holy Spirit University of Kaslik, Jounieh, Lebanon
| | - Rachel Abdo
- INSPECT-LB: Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon; Department of Medical Information, Centre Hospitalier Universitaire, INSERM, UMR, Université Paul Sabatier Toulouse III, Toulouse, France
| | | | - Yasmina Yared
- Clinical Pharmacy Department, Geitaoui Hospital, Beirut, Lebanon
| | - Matta Matta
- Saint Joseph University, Beirut, Lebanon; Department of Infectious Diseases, Bellevue Medical Center, Mount Lebanon, Lebanon; Department of Infectious Diseases, Mounla Hospital, Tripoli, Lebanon
| | - Inas Mostafa
- Quality and Safety Department, Nabatieh Governmental Hospital, Nabatieh, Lebanon
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Iskandar K, Rizk R, Matta R, Husni-Samaha R, Sacre H, Bouraad E, Dirani N, Salameh P, Molinier L, Roques C, Dimassi A, Hallit S, Abdo R, Hanna PA, Yared Y, Matta M, Mostafa I. Economic Burden of Urinary Tract Infections From Antibiotic-Resistant Escherichia coli Among Hospitalized Adult Patients in Lebanon: A Prospective Cohort Study. Value Health Reg Issues 2021; 24:38-46. [PMID: 33494034 DOI: 10.1016/j.vhri.2020.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/06/2020] [Accepted: 01/22/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The rising incidence of urinary tract infections (UTIs) attributable to Escherichia coli resistant isolates is becoming a serious public health concern. Although global rates of infection vary considerably by region, the growing prevalence of this uropathogen has been associated with a high economic burden and health strain. This study aims: (1) to estimate the differences in clinical and economic outcomes between 2 groups of adult hospitalized patients with UTIs from E. coli resistant and susceptible bacteria and (2) to investigate drivers of this cost from a payer's perspective. METHODS A prospective multicenter cohort study was conducted in 10 hospitals in Lebanon. The cost analysis followed a bottom-up microcosting approach; a linear regression was constructed to evaluate the predictors of hospitalization costs and a Cox proportional hazards model was used to estimate the impact of resistance on length of stay (LOS) and in-hospital mortality. RESULTS Out of 467 inpatients, 250 cases were because of resistant E. coli isolates. Results showed that patients with resistant uropathogens had 29% higher mean total hospitalization costs ($3429 vs $2651; P = .004), and an extended median LOS (6 days vs 5 days; P = .020) compared with susceptible cohorts. The selection of resistant bacteria and the Charlson comorbidity index predicted higher total hospitalization costs and in-hospital mortality. CONCLUSION In an era of increased pressure for cost containment, this study showed the burden of treating UTIs resulting from resistant bacteria. The results can inform cost-effectiveness analyses that intend to evaluate the benefit of a national action plan aimed at decreasing the impact of antibiotic resistance.
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Affiliation(s)
- Katia Iskandar
- Department of Mathématiques Informatique et Télécommunications, Université Toulouse III, Paul Sabatier, INSERM, UMR, Toulouse, France; INSPECT-LB: Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon; Lebanese University, Beirut, Lebanon.
| | - Rana Rizk
- INSPECT-LB: Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon; Department of Health Services Research, School CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | | | - Rola Husni-Samaha
- School of Medicine, Lebanese American University, Byblos, Lebanon; Infection Control Department, Lebanese American University Medical Center, Beirut, Lebanon
| | - Hala Sacre
- INSPECT-LB: Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon; Drug Information Center, Order of Pharmacists of Lebanon, Beirut, Lebanon
| | - Etwal Bouraad
- School of Pharmacy, Pharmacy Practice Department, Lebanese International University, Beirut, Lebanon
| | - Natalia Dirani
- Department of Infectious Diseases, Dar El Amal University Hospital, Baalbeck, Lebanon
| | - Pascale Salameh
- INSPECT-LB: Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon; Lebanese University, Beirut, Lebanon; Lebanese University, Beirut, Lebanon
| | - Laurent Molinier
- Department of Medical Information, Centre Hospitalier Universitaire, INSERM, UMR, Université Paul Sabatier Toulouse III, Toulouse, France
| | - Christine Roques
- Department of Bioprocédés et Systèmes Microbiens, Laboratoire de Génie Chimique, Université Paul Sabatier Toulouse III, UMR, Toulouse, France; Department of Bactériologie-Hygiène, Centre Hospitalier Universitaire, Hôpital Purpan, Toulouse, France
| | | | - Souheil Hallit
- INSPECT-LB: Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon; Holy Spirit University of Kaslik, Jounieh, Lebanon
| | - Rachel Abdo
- INSPECT-LB: Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon; Department of Medical Information, Centre Hospitalier Universitaire, INSERM, UMR, Université Paul Sabatier Toulouse III, Toulouse, France
| | | | - Yasmina Yared
- Clinical Pharmacy Department, Geitaoui Hospital, Beirut, Lebanon
| | - Matta Matta
- Saint Joseph University, Beirut, Lebanon; Department of Infectious Diseases, Bellevue Medical Center, Mount Lebanon, Lebanon; Department of Infectious Diseases, Mounla Hospital, Tripoli, Lebanon
| | - Inas Mostafa
- Quality and Safety Department, Nabatieh Governmental Hospital, Nabatieh, Lebanon
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Critchley IA, Cotroneo N, Pucci MJ, Jain A, Mendes RE. Resistance among urinary tract pathogens collected in Europe during 2018. J Glob Antimicrob Resist 2020; 23:439-444. [PMID: 33212286 DOI: 10.1016/j.jgar.2020.10.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/07/2020] [Accepted: 10/27/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis are urinary tract infection (UTI) pathogens and extended spectrum β-lactamase (ESBL)-producing pathogens exhibit co-resistance to oral fluoroquinolones (FQ) and trimethoprim-sulphamethoxazole (TMP-SMX). This study assessed the prevalence of ESBL phenotypes and co-resistance to FQ and TMP-SMX. METHODS In total, 766 E. coli, 260 K. pneumoniae and 104 P. mirabilis from UTIs in 18 countries were evaluated for susceptibility in the SENTRY surveillance programme, and results interpreted using EUCAST criteria. RESULTS E. coli, K. pneumoniae and P. mirabilis accounted for 57.1%, 11.3% and 7.8%, respectively, of the isolates. Among E. coli, resistance to levofloxacin and TMP-SMX ranged from 21.8% to 32.7% for all isolates increasing to 66.5-67.0% among those with a ESBL phenotype (17.9% of all UTI E. coli from Europe were ESBL phenotypes). In contrast, all E. coli were susceptible to meropenem. For K. pneumoniae, resistance rates for levofloxacin and TMP-SMX were 32.2-40.0% increasing to 69.1-78.6% for ESBL phenotypes. Meropenem was the most active agent, with 7.7% resistance. Among P. mirabilis resistance to levofloxacin and TMP-SMX was 26-38.5% and increased to 100% for ESBL phenotypes. No meropenem-resistant P. mirabilis were reported. CONCLUSIONS High co-resistance rates were observed for oral antibiotics among ESBL phenotypes raising concerns regarding empiric use of FQ and TMP-SMX for treating resistant UTIs outside of the hospital. In contrast, intravenous carbapenems retain activity against resistant UTI pathogens. New oral options with the spectrum of the carbapenems would address an unmet need for managing resistant UTIs.
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Kuiper S, Leegwater E, Wilms E, van Nieuwkoop C. Evaluating imipenem + cilastatin + relebactam for the treatment of complicated urinary tract infections. Expert Opin Pharmacother 2020; 21:1805-1811. [DOI: 10.1080/14656566.2020.1790525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- S.G. Kuiper
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, Netherlands
| | - E. Leegwater
- Department of Hospital Pharmacy, Haga Teaching Hospital, The Hague, Netherlands
- Apotheek Haagse Ziekenhuizen, The Hague, Netherlands
| | - E.B. Wilms
- Department of Hospital Pharmacy, Haga Teaching Hospital, The Hague, Netherlands
- Apotheek Haagse Ziekenhuizen, The Hague, Netherlands
| | - C. van Nieuwkoop
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, Netherlands
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Current Antibiotic Resistance Trends of Uropathogens in Central Europe: Survey from a Tertiary Hospital Urology Department 2011-2019. Antibiotics (Basel) 2020; 9:antibiotics9090630. [PMID: 32971752 PMCID: PMC7559630 DOI: 10.3390/antibiotics9090630] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/17/2020] [Accepted: 09/20/2020] [Indexed: 12/18/2022] Open
Abstract
Monitoring of pathogen resistance profiles is necessary to guide empirical antibiotic therapy before culture and sensitivity results become available. The aim of this study was to describe current antibiotic resistance patterns of five most frequent causative uropathogens in a Department of Urology of a tertiary referral centre in Central Europe over a period of nine years. The Hospital Department of Clinical Microbiology database was used to extract data on all positive urine samples from inpatients in the Department of Urology between 2011 and 2019. Numbers of susceptible and resistant isolates per year were calculated for five most frequent uropathogens: Escherichia coli, Enterococcus spp., Klebsiella spp., Pseudomonas aeruginosa, and Proteus spp. Antimicrobial agents selected for the survey included: ampicillin, amoxicillin/clavulanic acid, piperacillin/tazobactam; cefuroxime, cefotaxime, ceftazidime and cefepime; ciprofloxacin and ofloxacin; gentamicin and amikacin; ertapenem, meropenem and imipenem; trimethoprim-sulfamethoxazole (co-trimoxazole), nitrofurantoin, colistin, and vancomycin. High resistance rates of Gram-negative uropathogens were demonstrated to most common antimicrobials, with statistically significant increasing or decreasing trends in some cases. No carbapenem-resistant Enterobacteriaceae were isolated. Vancomycin-resistant Enterococcus spp. strains were rare in our population.
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Rodriguez-Mañas L. Urinary tract infections in the elderly: a review of disease characteristics and current treatment options. Drugs Context 2020; 9:dic-2020-4-13. [PMID: 32699546 PMCID: PMC7357682 DOI: 10.7573/dic.2020-4-13] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 12/15/2022] Open
Abstract
Urinary tract infections (UTIs) are common in the elderly, and cover a range of conditions from asymptomatic bacteriuria to urosepsis. Risk factors for developing symptomatic UTIs include immunosenescence, exposure to nosocomial pathogens, multiple comorbidities, and a history of UTIs. European guidelines on urological infections recommend antimicrobial treatment only for symptomatic UTIs. Non-antimicrobial options to treat and prevent UTIs include among others cranberry products, OM-89 Escherichia coli bacterial lysate vaccine, and estrogen therapy in postmenopausal women, although evidence for their efficacy is weak. Another non-antimicrobial option to control and prevent UTIs is a medical device (Utipro Plus®) containing xyloglucan, gelatin, propolis, and extracts of Hibiscus sabdariffa. The device acts in the intestine as a mechanical barrier to protect against invasion by uropathogenic E. coli strains. A randomized controlled trial of Utipro Plus® in patients with uncomplicated UTIs provided good-quality evidence of its efficacy compared with placebo. In an observational study of Utipro Plus® in patients with recurrent UTIs, more than 80% women reported a return to their pre-UTI clinical status and about 30% transitioned from symptomatic UTIs to asymptomatic bacteriuria. New treatment strategies that offer a safe and effective non-antimicrobial means of managing UTIs could have an important role in the elderly.
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Koguchi D, Murakami Y, Ikeda M, Dobashi M, Ishii J. Cefaclor as a first-line treatment for acute uncomplicated cystitis: a retrospective single-center study. BMC Urol 2020; 20:38. [PMID: 32252747 PMCID: PMC7137291 DOI: 10.1186/s12894-020-00605-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 03/25/2020] [Indexed: 11/24/2022] Open
Abstract
Background Wide-spectrum antibiotics have been favored to treat acute uncomplicated cystitis (AUC) for a long time, leading to the emergence of multi-drug resistant bacteria. We hypothesize that narrow-spectrum antibiotics might mitigate the issue and aim to investigate the clinical efficacy of cefaclor in patients with AUC. Methods We retrospectively reviewed the clinical data of female outpatients with AUC treated with cefaclor and evaluated the safety and clinical efficacy. Clinical cure was defined as the elimination of clinical symptom under 4 white blood cells (WBCs) per high power field on microscopy. Results Overall, 223 women with AUC were enrolled. Escherichia coli was the dominant pathogen (n = 160; 68.6%), followed by Klebsiella species and E. coli-extended spectrum β-lactamase (ESBL) (n = 19; 8.1% and n = 18; 7.7%). Overall success rate was 94.0% (n = 219) and susceptibility rate of cefazolin was 84.1%, which was close to that of levofloxacin (82.9%). Ampicillin showed the lowest rate of 63.7% with a significantly greater resistance rate of 35.3% among all antibiotics (P < 0.001). In the subgroup analysis, the success rate in patients with resistance to levofloxacin or cefazolin was 100% (n = 24) or 93.3% (n = 14). The rate in patients with resistance to both antibiotics was 60.0% (n = 9), and the pathogens in the other 40.0% (n = 6) of patients with treatment failure were E. coli-ESBL. Conclusion Cefaclor showed excellent efficacy in AUC patients, even in those with in vitro resistance to cefazolin or levofloxacin. Cefaclor may be considered as a first-line option in patients with AUC and a second-line option for those with levofloxacin treatment failure.
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Affiliation(s)
- Dai Koguchi
- Department of Urology, International University of Health and Welfare Atami Hospital, 13-1 Higashikaiganchou Atami, Shizuoka, 413-0012, Japan.
| | - Yasukiyo Murakami
- Department of Urology, International University of Health and Welfare Atami Hospital, 13-1 Higashikaiganchou Atami, Shizuoka, 413-0012, Japan
| | - Masaomi Ikeda
- Department of Urology, International University of Health and Welfare Atami Hospital, 13-1 Higashikaiganchou Atami, Shizuoka, 413-0012, Japan
| | - Masato Dobashi
- Department of Urology, International University of Health and Welfare Atami Hospital, 13-1 Higashikaiganchou Atami, Shizuoka, 413-0012, Japan
| | - Junichiro Ishii
- Department of Urology, International University of Health and Welfare Atami Hospital, 13-1 Higashikaiganchou Atami, Shizuoka, 413-0012, Japan
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Toh SL, Lee BB, Simpson JM, Rice SA, Kotsiou G, Marial O, Ryan S. Effect of probiotics on multi-resistant organism colonisation in persons with spinal cord injury: secondary outcome of ProSCIUTTU, a randomised placebo-controlled trial. Spinal Cord 2020; 58:755-767. [PMID: 31953482 DOI: 10.1038/s41393-020-0420-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 01/03/2020] [Accepted: 01/09/2020] [Indexed: 12/25/2022]
Abstract
STUDY DESIGN Randomised double-blind placebo-controlled trial. OBJECTIVES Multi-resistant organism (MRO) colonisation is common in people with SCI. We aimed to determine whether Lactobacillus reuteri RC-14 + Lactobacillus GR-1 (RC14-GR1) and/or Lactobacillus rhamnosus GG + Bifidobacterium BB-12 (LGG-BB12) are effective in preventing or clearing MRO colonisation. SETTING New South Wales, Australia. METHODS The 207 SCI participants were randomised to one of four arms: (i) RC14-GR1 + LGG-BB12, (ii) RC14-GR1 + placebo, (iii) LGG-BB12 + placebo or (iv) double placebos for 6 months. Microbiological samples of nose, groin, urine and bowel were taken at baseline, 3 and 6 months. Analysis was conducted for the presence of methicillin-resistant Staphylococcus aureus (MRSA), multi-resistant gram-negative organisms (MRGNs) and vancomycin-resistant enterococcus (VRE). The outcomes were clearance of, or new colonisation with MRSA, MRGN, VRE or MROs and whether participants remained free of MRSA, MRGN, VRE or MROs throughout the study. Risk factors associated with an outcome were adjusted for using nominal or binary logistic regression. RESULTS There was a significant reduction in new MRGN colonisation compared with placebo for participants treated with RC14-GR1 (OR 0.10, 95% CI, 0.01-0.88, P = 0.04), after allowing that inpatients were more likely to be newly colonised (OR 21.41, 95% CI, 3.98-115.13, P < 0.0001). Participants who intermittent self-catheterised (IMC) were more likely to remain MRO-free than those utilising SPC or IDCs (OR 2.80, 95% CI, 1.41-5.54, P = 0.009). CONCLUSIONS Probiotics are ineffective at clearing MROs in people with SCI. However, RC14-GR1 is effective at preventing new colonisation with MRGNs. The use of IMC significantly improves the chance of remaining MRO-free.
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Affiliation(s)
- Swee-Ling Toh
- Department of Spinal and Rehabilitation Medicine, Prince of Wales Hospital, Sydney, NSW, Australia. .,Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
| | - Bonsan Bonne Lee
- Department of Spinal and Rehabilitation Medicine, Prince of Wales Hospital, Sydney, NSW, Australia.,Neuroscience Research Australia (NeuRA) and UNSW Sydney, Sydney, NSW, Australia
| | - Judy M Simpson
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Scott A Rice
- Singapore Centre for Environmental Life Sciences Engineering and the School of Biological Sciences, Nanyang Technological University, Nanyang, Singapore.,The ithree Institute, University of Technology Sydney, Sydney, NSW, Australia
| | - George Kotsiou
- Department of Infectious Diseases and Microbiology, NSW Health Pathology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Obaydullah Marial
- Neuroscience Research Australia (NeuRA) and UNSW Sydney, Sydney, NSW, Australia
| | - Suzanne Ryan
- Neuroscience Research Australia (NeuRA) and UNSW Sydney, Sydney, NSW, Australia
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Öztürk R, Murt A. Epidemiology of urological infections: a global burden. World J Urol 2020; 38:2669-2679. [PMID: 31925549 DOI: 10.1007/s00345-019-03071-4] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 12/28/2019] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Urinary tract infections (UTIs) are among the most frequent infections in clinical practice worldwide. Their frequency and burden must be higher than available data suggest because they are not among mandatory diseases to be notified. CLASSIFICATION OF URINARY INFECTIONS Although there are many different proposals for classifying UTIs, classifications based on acquisition settings and complication status are more widely used. These include community- acquired UTIs (CAUTIs) or healthcare-associated UTIs (HAUTIs) and uncomplicated or complicated UTIs. EPIDEMIOLOGY OF UROLOGICAL INFECTIONS AND GLOBAL BURDEN As the most frequently seen infectious disease, CAUTIs affect more than 150 million people annually. Complicated UTIs in particular constitute a huge burden on healthcare systems as a frequent reason for hospitalization. The prevalence of HAUTIs ranges between 1.4% and 5.1%, and the majority of them are catheter-related UTIs. Community-onset HAUTIs have gained importance in recent years. CONCLUSION As frequent infectious diseases, UTIs create clinical and economic burdens on healthcare systems, and they also affect quality of life determinants.
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Affiliation(s)
- Recep Öztürk
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, School of Medicine, Istanbul, Turkey.
| | - Ahmet Murt
- Department of Internal Medicine, Nephrology Unit, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
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Gomila A, Carratalà J, Eliakim-Raz N, Shaw E, Tebé C, Wolkewitz M, Wiegand I, Grier S, Vank C, Cuperus N, Van den Heuvel L, Vuong C, MacGowan A, Leibovici L, Addy I, Pujol M. Clinical outcomes of hospitalised patients with catheter-associated urinary tract infection in countries with a high rate of multidrug-resistance: the COMBACTE-MAGNET RESCUING study. Antimicrob Resist Infect Control 2019; 8:198. [PMID: 31827779 PMCID: PMC6892205 DOI: 10.1186/s13756-019-0656-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/20/2019] [Indexed: 11/10/2022] Open
Abstract
Background Although catheter-associated urinary tract infection (CA-UTI) is a major healthcare-related problem worldwide, there is a scarcity of current data from countries with high antimicrobial resistance rates. We aimed to determine the clinical outcomes of patients with CA-UTI compared to those of patients with other sources of complicated urinary tract infection (cUTI), and to assess the impact of antimicrobial resistance. We also aimed to identify the factors influencing 30-day mortality among patients with CA-UTI. Methods This was a multicentre, multinational retrospective cohort study including hospitalised adults with cUTI between January 2013 and December 2014 in twenty hospitals from eight countries from southern Europe, Turkey and Israel. The primary endpoint was 30-day mortality. The secondary endpoints were length of hospital stay, symptom improvement after 7 days' treatment, symptom recurrence at 30 days and readmission 60 days after hospital discharge. Results Of the 807 cUTI episodes, 341 (42.2%) were CA-UTIs. The time from catheter insertion to cUTI diagnosis was less than 2 weeks in 44.6% of cases. Overall, 74.5% of cases had hospital or healthcare-acquired CA-UTI. Compared to patients with other cUTI aetiologies, those with CA-UTI had the following characteristics: they were more frequently males, older, admitted for a reason other than cUTI and admitted from a long-term care facility; had higher Charlson's comorbidity index; and more frequently had polymicrobial infections and multidrug-resistant Gram-negative bacteria (MDR-GNB). Patients with CA-UTI also had significantly higher 30-day mortality rates (15.2% vs 6%) and longer hospital stay (median 14 [interquartile range -IQR- 7-27] days vs 8 [IQR 5-14] days) than patients with cUTI of other sources. After adjusting for confounders, CA-UTI was not independently associated with an increased risk of mortality (odds ratio, 1.40; 95% confidence interval, 0.77-2.54), and neither was the presence of MDR-GNB. Conclusions CA-UTI was the most frequent source of cUTI, affecting mainly frail patients. The mortality of patients with CA-UTI was high, though this was not directly related to the infection.
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Affiliation(s)
- Aina Gomila
- 1Department of Infectious Diseases, Hospital Universitari de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Institut Català de la Salut (ICS-HUB), Barcelona, Spain.,2Corporació Sanitària Parc Taulí, Barcelona, Spain.,3Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Jordi Carratalà
- 1Department of Infectious Diseases, Hospital Universitari de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Institut Català de la Salut (ICS-HUB), Barcelona, Spain.,4University of Barcelona, Barcelona, Spain
| | - Noa Eliakim-Raz
- 5Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah-Tiqva; and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Evelyn Shaw
- 1Department of Infectious Diseases, Hospital Universitari de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Institut Català de la Salut (ICS-HUB), Barcelona, Spain
| | - Cristian Tebé
- 6Institut d'Investigació Biomèdica de Bellvitge (IDIBELL) and Department of Basic Sciences, Universitat Rovira i Virgili, Tarragona, Spain
| | - Martin Wolkewitz
- 7Institute of Medical Biometry and Statistics, University of Freiburg, Freiburg, Germany
| | - Irith Wiegand
- AiCuris Anti-infective Cures GmbH, Wuppertal, Germany
| | - Sally Grier
- 9Department of Medical Microbiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | | | - Nienke Cuperus
- 10Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Leonard Van den Heuvel
- 10Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Cuong Vuong
- AiCuris Anti-infective Cures GmbH, Wuppertal, Germany
| | - Alasdair MacGowan
- 9Department of Medical Microbiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Leonard Leibovici
- 5Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah-Tiqva; and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ibironke Addy
- AiCuris Anti-infective Cures GmbH, Wuppertal, Germany
| | - Miquel Pujol
- 1Department of Infectious Diseases, Hospital Universitari de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Institut Català de la Salut (ICS-HUB), Barcelona, Spain
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Malmros K, Huttner BD, McNulty C, Rodríguez-Baño J, Pulcini C, Tängdén T. Comparison of antibiotic treatment guidelines for urinary tract infections in 15 European countries: Results of an online survey. Int J Antimicrob Agents 2019; 54:478-486. [PMID: 31229671 DOI: 10.1016/j.ijantimicag.2019.06.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 06/04/2019] [Accepted: 06/15/2019] [Indexed: 11/17/2022]
Abstract
Appropriate antibiotic use for urinary tract infections (UTIs) is important in order to provide effective and safe treatment while minimising the risk of antimicrobial resistance development. This survey was carried out to compare existing national guidelines for UTIs in Europe. Experts in 37 European countries were asked to participate. An electronic questionnaire was used to obtain information on treatment recommendations, factors considered important when setting guidelines, acceptable resistance rates for empirical therapy, evidence grading, and existing resistance surveillance for uropathogens. Treatment guidelines and antimicrobial susceptibility data were collected. In total, 22 experts (59%) responded to the survey. National guidelines were missing in four countries and data were incomplete in three cases. Fifteen national guidelines published between 2004 and 2017 were included in the analysis. Great variability was found between guidelines in the selection of antibiotics, dosing regimens and treatment duration. For example, 10 different antibiotics were recommended as first-line therapy for uncomplicated cystitis. National surveillance data on antimicrobial susceptibility of uropathogens were available in 13 of 15 countries. Resistance epidemiology could not explain the observed differences between guidelines, and comparison of resistance rates was hampered by variations in methods. This study revealed major differences in treatment guidelines for UTIs within Europe, indicating that there are opportunities for improvement. More clinical research and a more systematic and stratified approach to resistance surveillance, including also antibiotics that are currently not available in all countries, is needed.
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Affiliation(s)
- Karin Malmros
- ReAct Europe, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Benedikt D Huttner
- Division of Infectious Diseases and Infection Control Program, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland; ESCMID Study Group for Antimicrobial Stewardship (ESGAP) of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID)
| | | | - Jesús Rodríguez-Baño
- ESCMID Study Group for Antimicrobial Stewardship (ESGAP) of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID); Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Seville, Spain; Departamento de Medicina, Universidad de Sevilla, Seville, Spain
| | - Céline Pulcini
- ESCMID Study Group for Antimicrobial Stewardship (ESGAP) of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID); Université de Lorraine, APEMAC and Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, Nancy, France
| | - Thomas Tängdén
- ReAct Europe, Department of Medical Sciences, Uppsala University, Uppsala, Sweden; ESCMID Study Group for Antimicrobial Stewardship (ESGAP) of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID).
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Burgos RM, Rodvold KA. ZTI-01 (fosfomycin for injection) in the treatment of hospitalized patients with complicated urinary tract infections. Future Microbiol 2019; 14:461-475. [PMID: 30854892 DOI: 10.2217/fmb-2018-0303] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Fosfomycin is a bactericidal antibiotic available since the 1970s whose intravenous formulation has been available in many countries outside the USA. Given the rise in drug-resistant bacteria, its introduction into the US market has become a necessity for addressing these organisms. This review provides an overview of the microbiology, clinical pharmacology and initial clinical experiences of the intravenous fosfomycin product (ZTI-01) that is undergoing clinical development in the USA for the treatment of complicated urinary tract infections and acute pyelonephritis.
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Affiliation(s)
- Rodrigo M Burgos
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Keith A Rodvold
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, 60612, USA.,Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, IL, 60612, USA
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Abstract
The global threat of the spread of carbapenem resistance in Enterobacteriaceae has led to the search for new antibacterials. Intravenous meropenem/vaborbactam (Vabomere™) is the first carbapenem/β-lactamase inhibitor combination approved in the USA for use in patients with complicated urinary tract infections (cUTIs), including pyelonephritis. Vaborbactam is a potent inhibitor of class A serine carbapenemases, which, when combined with the antibacterial meropenem, restores the activity of meropenem against β-lactamase producing Enterobacteriaceae, particularly Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae. Meropenem/vaborbactam demonstrated excellent in vitro activity against Gram-negative clinical isolates, including KPC- and extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae. In the phase 3, noninferiority TANGO I trial in patients with cUTIs, intravenous meropenem/vaborbactam was noninferior to intravenous piperacillin/tazobactam for overall success (composite of clinical cure and microbial eradication; FDA primary endpoint) and microbial eradication (EMA primary endpoint). In subsequent superiority testing, meropenem/vaborbactam was superior to piperacillin/tazobactam for overall success. Meropenem/vaborbactam was generally well tolerated, with a tolerability profile generally similar to that of piperacillin/tazobactam. TANGO I did not assess the efficacy of meropenem/vaborbactam for the treatment of infections caused by carbapenem-resistant Enterobacteriaceae and meropenem/vaborbactam is currently not indicated for these patients. Available evidence indicates that meropenem/vaborbactam is a useful treatment option for patients with cUTIs.
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Affiliation(s)
- Sohita Dhillon
- Springer, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
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