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Kornfält Isberg H, Gröndal H, Tyrstrup M. GPs' experience with diagnosis and treatment guidelines for lower UTI in men: a qualitative interview. BJGP Open 2024:BJGPO.2023.0254. [PMID: 38621790 DOI: 10.3399/bjgpo.2023.0254] [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: 12/20/2023] [Revised: 02/23/2024] [Accepted: 02/29/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND The incidence of lower urinary tract infection (LUTI) in men visiting primary health care (PHC) is low. Hence, GPs do not diagnose and treat men with LUTI very often. Previous studies have shown that adherence to treatment guidelines regarding LUTI in men is low. There is limited knowledge concerning why guidelines are not adhered to. AIM To gain knowledge on GPs' experiences and concerns when treating men with LUTI, including their use of clinical guidelines. Furthermore, this study aimed to explore GPs' knowledge and concern regarding antibiotic resistance. DESIGN & SETTING A qualitative study based on semi-structured interviews with GPs was performed. METHOD 15 GPs from seven PHC centres (PHCC) in southern Sweden were interviewed. The interviews were conducted from September 2022 to March 2023. All interviews were audio recorded and transcribed verbatim. A thematic analysis was performed. RESULTS GPs had limited experience with and felt less certainty when diagnosing male LUTI. Extended examinations could partially relieve this feeling. GPs were well informed about the Swedish treatment guidelines for LUTI in men and felt safe to treat their patients according to the guidelines. However, GPs also acknowledged that guidelines do not cover all situations and need to be individualised. CONCLUSION Many GPs feel insecure when diagnosing male LUTI. The relatively low prevalence of this condition in PHC could contribute to this feeling. Clear and instructive guidelines regarding both the diagnostic process and adequate antibiotic choices are important to maintain good quality in the management of LUTI in men.
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Affiliation(s)
- Helena Kornfält Isberg
- Department of Clinical Sciences, Family Medicine and Community Medicine, Lund University, Malmö, Sweden
| | - Hedvig Gröndal
- Department of Biomedical Sciences and Veterinary Public Health Swedish, University of Agricultural Sciences (SLU), Uppsala, Sweden
| | - Mia Tyrstrup
- Department of Clinical Sciences, Family Medicine and Community Medicine, Lund University, Malmö, Sweden
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Moro C, Phelps C, Veer V, Jones M, Glasziou P, Clark J, Tikkinen KAO, Scott AM. Cranberry Juice, Cranberry Tablets, or Liquid Therapies for Urinary Tract Infection: A Systematic Review and Network Meta-analysis. Eur Urol Focus 2024:S2405-4569(24)00122-6. [PMID: 39030132 DOI: 10.1016/j.euf.2024.07.002] [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: 02/06/2024] [Revised: 06/07/2024] [Accepted: 07/02/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND AND OBJECTIVE With over 50% of women suffering from at least one episode of urinary tract infection (UTI) each year and an increasing prevalence of antimicrobial resistance, efforts need to be made to clearly identify the evidence supporting potential non-drug interventions. This study aims to compare the effects of cranberry juice, cranberry tablets, and increased liquids for the management of UTIs. METHODS PubMed, Embase, and Cochrane CENTRAL were searched for randomised controlled trials. The primary outcome was the number of UTIs, and the secondary outcomes were UTI symptoms and antimicrobial consumption. A risk of bias assessment was performed using the Cochrane risk of bias tool, and the certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation. KEY FINDINGS AND LIMITATIONS A total of 20 trials (3091 participants) were included, with 18 studies highlighting a 54% lower rate of UTIs with cranberry juice consumption than no treatment and a 27% lower rate than placebo liquid. Cranberry juice also resulted in a 49% lower rate of antibiotic use than placebo liquid and a 59% lower rate than no treatment, based on a network meta-analysis of six studies. The use of cranberry compounds also reduced the prevalence of symptoms associated with UTIs. CONCLUSIONS AND CLINICAL IMPLICATIONS With moderate to low certainty, the evidence supports the use of cranberry juice for the prevention of UTIs. While increased liquids reduce the rate of UTIs compared with no treatment, cranberry in liquid form provides even better clinical outcomes in terms of reduction in UTIs and antibiotic use and should be considered for the management of UTIs. PATIENT SUMMARY With the increasing prevalence of antimicrobial-resistant UTIs, alternate non-drug treatment options for its management are required. Available evidence supports the use of cranberry compounds and increases in fluid intake for managing UTIs.
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Affiliation(s)
- Christian Moro
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.
| | - Charlotte Phelps
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Vineesha Veer
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Mark Jones
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Kari A O Tikkinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Surgery, South Karelian Central Hospital, Lappeenranta, Finland; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Anna Mae Scott
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia; Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Sætre H, Skow M, Vik I, Høye S, Emilsson L. Acute cystitis in men- a nationwide study from primary care: antibiotic prescriptions, risk factors, and complications. BJGP Open 2024; 8:BJGPO.2023.0207. [PMID: 38191188 PMCID: PMC11300979 DOI: 10.3399/bjgpo.2023.0207] [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: 10/19/2023] [Accepted: 10/31/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Research on acute cystitis in men is scarce and treatment guidelines differ between countries. Improved antibiotic stewardship is needed. AIM To analyse antibiotic prescriptions and outcomes of Norwegian men diagnosed with cystitis in primary care. DESIGN & SETTING A nationwide retrospective study was undertaken in primary care in Norway. METHOD We identified all episodes of acute cystitis in men diagnosed in Norwegian primary care during 2012-2019. Choice of antibiotic (from the Norwegian Prescription Database), treatment failure, re-prescription, and complications were stratified by age, calendar year, and risk factors. We used logistic regression to explore predefined risk factors (diabetes, prostate cancer, benign prostate hyperplasia [BPH], urinary retention, and any cancer) with complications (pyelonephritis, prostatitis, and hospitalisation) and re-prescriptions. Linear regression was used to explore time trends. RESULTS In total, 108 994 individuals contributed 148 635 episodes. Narrow-spectrum antibiotics were first-choice treatment in 71.0% of the episodes (52.5% of all prescriptions were pivmecillinam). More than 75% of the episodes with narrow-spectrum versus 82.2% of broad-spectrum treatment did not lead to any re-prescription or complication. Complications occurred in 1.8% of all episodes (0.5% prostatitis, 0.7% pyelonephritis, and 0.7% hospitalisation). BPH was associated with increased risk of complications and re-prescription. Diabetes was associated with a lower risk of re-prescriptions. Prostate cancer and urinary retention were associated with a lower risk of both complications and re-prescriptions. CONCLUSION Our results support narrow-spectrum antibiotics as first-line treatment. Risk factor analyses warrants further investigation.
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Affiliation(s)
- Håkon Sætre
- Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Emergency General Practice, Oslo Accident and Emergency Outpatient Clinic, City of Oslo Health Agency, Oslo, Norway
| | - Marius Skow
- Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Emergency General Practice, Oslo Accident and Emergency Outpatient Clinic, City of Oslo Health Agency, Oslo, Norway
| | - Ingvild Vik
- Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Emergency General Practice, Oslo Accident and Emergency Outpatient Clinic, City of Oslo Health Agency, Oslo, Norway
| | - Sigurd Høye
- Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Louise Emilsson
- Vårdcentralen Värmlands Nysäter and Centre for Clinical Research, County Council of Värmland, Värmland, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- General Practice Research Unit (AFE) & Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
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Rizvi M, Malhotra S, Agarwal J, Siddiqui AH, Devi S, Poojary A, Thakuria B, Princess I, Sami H, Gupta A, Sultan A, Jitendranath A, Mohan B, Banashankari GS, Khan F, Kalita JB, Jain M, Singh NP, Gur R, Mohapatra S, Farooq S, Purwar S, Jankhwala MS, Yamunadevi VR, Masters K, Goyal N, Sen M, Zadjali RA, Jaju S, Rugma R, Meena S, Dutta S, Langford B, Brown KA, Dougherty KM, Kanungo R, Jabri ZA, Singh S, Singh S, Taneja N, John KHS, Sardana R, Kapoor P, Jardani AA, Soman R, Balkhair A, Livermore DM. Regional variations in antimicrobial susceptibility of community-acquired uropathogenic Escherichia coli in India: Findings of a multicentric study highlighting the importance of local antibiograms. IJID REGIONS 2024; 11:100370. [PMID: 38812702 PMCID: PMC11134879 DOI: 10.1016/j.ijregi.2024.100370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/20/2024] [Accepted: 04/22/2024] [Indexed: 05/31/2024]
Abstract
Objectives Evidence-based prescribing is essential to optimize patient outcomes in cystitis. This requires knowledge of local antibiotic resistance rates. Diagnostic and Antimicrobial Stewardship (DASH) to Protect Antibiotics (https://dashuti.com/) is a multicentric mentorship program guiding centers in preparing, analyzing and disseminating local antibiograms to promote antimicrobial stewardship in community urinary tract infection. Here, we mapped the susceptibility profile of Escherichia coli from 22 Indian centers. Methods These centers spanned 10 Indian states and three union territories. Antibiograms for urinary E. coli from the outpatient departments were collated. Standardization was achieved by regional online training; anomalies were resolved via consultation with study experts. Data were collated and analyzed. Results Nationally, fosfomycin, with 94% susceptibility (inter-center range 83-97%), and nitrofurantoin, with 85% susceptibility (61-97%), retained the widest activity. The susceptibility rates were lower for co-trimoxazole (49%), fluoroquinolones (31%), and oral cephalosporins (26%). The rates for third- and fourth-generation cephalosporins were 46% and 52%, respectively, with 54% (33-58%) extended-spectrum β-lactamase prevalence. Piperacillin-tazobactam (81%), amikacin (88%), and meropenem (88%) retained better activity; however, one center in Delhi recorded only 42% meropenem susceptibility. Susceptibility rates were mostly higher in South, West, and Northeast India; centers in the heavily populated Gangetic plains, across north and northwest India, had greater resistance. These findings highlight the importance of local antibiograms in guiding appropriate antimicrobial choices. Conclusions Fosfomycin and nitrofurantoin are the preferred oral empirical choices for uncomplicated E. coli cystitis in India, although elevated resistance in some areas is concerning. Empiric use of fluoroquinolones and third-generation cephalosporins is discouraged, whereas piperacillin/tazobactam and aminoglycosides remain carbapenem-sparing parenteral agents.
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Affiliation(s)
- Meher Rizvi
- Department of Microbiology and Immunology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Shalini Malhotra
- Department of Microbiology, ABVIMS and Dr RML Hospital, New Delhi, India
| | - Jyotsna Agarwal
- Department of Microbiology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | | | - Sheela Devi
- Department of Microbiology, Pondicherry Institute of Medical Sciences, Pondicherry, India
| | - Aruna Poojary
- Department of Pathology & Microbiology, Breach Candy Hospital Trust, Mumbai, India
| | - Bhaskar Thakuria
- Department of Microbiology, All India Institute of Medical Sciences Patna, Patna, India
| | | | - Hiba Sami
- Department of Microbiology, Jawaharlal Nehru Medical College and Hospital, AMU, Aligarh, India
| | - Aarti Gupta
- Agilus Diagnostics Limited, Fortis Memorial Research Institute, Gurugram, India
| | - Asfia Sultan
- Department of Microbiology, Jawaharlal Nehru Medical College and Hospital, AMU, Aligarh, India
| | - Ashish Jitendranath
- Department of Microbiology, Sree Gokulam Medical College and Research Foundation, Thiruvananthapuram, India
| | - Balvinder Mohan
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Fatima Khan
- Department of Microbiology, Jawaharlal Nehru Medical College and Hospital, AMU, Aligarh, India
| | | | - Mannu Jain
- Surat Municipal Institute of Medical Education and Research (SMIMER), Surat, India
| | - Narendra Pal Singh
- Department of Microbiology, University College of Medical Sciences & GTB Hospital, Delhi, India
| | - Renu Gur
- Department of Microbiology, Dr. Baba Saheb Ambedkar Medical College & Hospital, Delhi, India
| | - Sarita Mohapatra
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shaika Farooq
- Department of Microbiology, GMC Srinagar, Srinagar, India
| | - Shashank Purwar
- Department of Microbiology, All India Institute of Medical Sciences Bhopal, Bhopal, India
| | - Mohmed Soeb Jankhwala
- Department of Microbiology, Nootan Medical College and Research Centre, Sankalchand Patel University, Visnagar, India
| | | | - Ken Masters
- Medical Education and Informatics Department, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Nisha Goyal
- Department of Microbiology, University College of Medical Sciences & GTB Hospital, Delhi, India
| | - Manodeep Sen
- Department of Microbiology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Razan Al Zadjali
- Department of Biochemistry, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Sanjay Jaju
- Family Medicine & Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Rajendradas Rugma
- Department of Microbiology, Sree Gokulam Medical College and Research Foundation, Kerala, India
| | - Suneeta Meena
- Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sudip Dutta
- Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | - Reba Kanungo
- Department of Microbiology, Pondicherry Institute of Medical Sciences, Pondicherry, India
| | - Zaaima Al Jabri
- Department of Microbiology and Immunology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Sanjeev Singh
- Department of Medicine- Infection Diseases and Epidemiology, Amrita Institute of Medical Sciences, Faridabad, India
| | - Sarman Singh
- All India Institute of Medical Sciences, Bhopal, India
| | - Neelam Taneja
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Raman Sardana
- Clinical Microbiology and Infection Control, Indraprastha Apollo Hospitals, New Delhi, India
- The IFIC, Oxford, UK
- Hospital Infection Society-India, New Delhi, India
| | - Pawan Kapoor
- National Accreditation Board for Hospitals and Healthcare Providers, New Delhi, India
| | - Amina Al Jardani
- Central Public Health Laboratories, Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | | | - Abdullah Balkhair
- Infectious Diseases Unit, Department of Medicine, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
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Redwood R, Claeys KC. The Diagnosis and Treatment of Adult Urinary Tract Infections in the Emergency Department. Emerg Med Clin North Am 2024; 42:209-230. [PMID: 38641388 DOI: 10.1016/j.emc.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Emergency medicine has been called the art of "making complicated clinical decisions with limited information." This description is particularly relevant in the case of diagnosis and treatment of urinary tract infections (UTIs). Although common, UTIs are often challenging to diagnose given the presence of non-specific signs and symptoms and over-reliance on laboratory findings. This review provides an interdisciplinary interpretation of the primary literature and practice guidelines, with a focus on diagnostic and antimicrobial stewardship in the emergency department.
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Affiliation(s)
- Robert Redwood
- Bozeman Health Emergency Department, 915 Highland Avenue, Bozeman, MT 59715, USA
| | - Kimberly C Claeys
- Department of Pharmacy Science and Health Outcomes Research, University of Maryland School of Pharmacy, 20 N Pine Street, Baltimore, MD 21201, USA.
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Fernández-García S, Moragas Moreno A, Giner-Soriano M, Morros R, Ouchi D, García-Sangenís A, Monteagudo M, Monfà R, Llor C. Urinary Tract Infections in Men in Primary Care in Catalonia, Spain. Antibiotics (Basel) 2023; 12:1611. [PMID: 37998813 PMCID: PMC10668819 DOI: 10.3390/antibiotics12111611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/03/2023] [Accepted: 11/05/2023] [Indexed: 11/25/2023] Open
Abstract
Antimicrobial resistance is a major global problem that is primarily driven by the excessive and inappropriate utilization of antibiotics. Urinary tract infections (UTIs) are frequent in primary health care (PHC) and are typically treated with antibiotics. There is ample evidence on the management of this condition in women but not in men. The aim of this study was to describe the epidemiology of UTIs in men in Catalonia, Spain. We conducted a population-based observational cohort study that included male patients diagnosed with UTI within our SIDIAP and CMBD database during the period from 2012 to 2021. UTI diagnoses were grouped into five main groups (cystitis, prostatitis, orchitis and epididymitis, urethritis, and pyelonephritis). Of the 316,762 men with at least one recorded UTI episode, the majority were registered with a diagnosis of cystitis in PHC (212,958 patients). Quinolones were the most commonly recorded treatment for UTIs (between 18.3% and 38.6%, depending on the group), except for urethritis in which a combination of antibiotics (36.7%) was most frequently used. The treatment duration period was between 9 days and 18 days, except for the prostatitis group, in which treatment was extended to 21 days. Urine cultures were documented in up to 30% in the cystitis group. Pyelonephritis was the category linked to most septicemia cases (3.0%). Conclusions: This is the first study to assess UTIs in men using a large PHC database in Spain. The sociodemographic characteristics of our sample are similar to other studies in the literature. In our setting, the use of quinolones for the treatment of UTIs is the most registered, and its duration was between 9 days and 18 days, despite the fact that resistance to quinolones exceeds 20% of the strains in our area.
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Affiliation(s)
- Silvia Fernández-García
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain; (M.G.-S.)
- Department of Medical Sciences, Universitat de Girona, 17004 Girona, Spain
- Universitat Autònoma de Barcelona, 08193 Bellaterra (Cerdanyola del Vallès), Spain
| | - Ana Moragas Moreno
- Institut Català de la Salut, Center d’Atenció Primària Jaume I, 43005 Tarragona, Spain
- CIBER en Enfermedades Infecciosas Instituto Carlos III, 28029 Madrid, Spain
- Department of Medicine and Surgery, Universitat Rovira i Virgili, 43123 Reus, Spain
| | - Maria Giner-Soriano
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain; (M.G.-S.)
- Universitat Autònoma de Barcelona, 08193 Bellaterra (Cerdanyola del Vallès), Spain
| | - Rosa Morros
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain; (M.G.-S.)
- Universitat Autònoma de Barcelona, 08193 Bellaterra (Cerdanyola del Vallès), Spain
- CIBER en Enfermedades Infecciosas Instituto Carlos III, 28029 Madrid, Spain
- Spanish Clinical Research Network, UIC IDIAPJGol, 08007 Barcelona, Spain
| | - Dan Ouchi
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain; (M.G.-S.)
- Universitat Autònoma de Barcelona, 08193 Bellaterra (Cerdanyola del Vallès), Spain
| | - Ana García-Sangenís
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain; (M.G.-S.)
- CIBER en Enfermedades Infecciosas Instituto Carlos III, 28029 Madrid, Spain
- Spanish Clinical Research Network, UIC IDIAPJGol, 08007 Barcelona, Spain
| | - Mònica Monteagudo
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain; (M.G.-S.)
- Universitat Autònoma de Barcelona, 08193 Bellaterra (Cerdanyola del Vallès), Spain
| | - Ramon Monfà
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain; (M.G.-S.)
- Universitat Autònoma de Barcelona, 08193 Bellaterra (Cerdanyola del Vallès), Spain
- Spanish Clinical Research Network, UIC IDIAPJGol, 08007 Barcelona, Spain
| | - Carl Llor
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain; (M.G.-S.)
- CIBER en Enfermedades Infecciosas Instituto Carlos III, 28029 Madrid, Spain
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, 5230 Odense, Denmark
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Soudais B, Ribeaucoup F, Schuers M. Guidelines for the management of male urinary tract infections in primary care: a lack of international consensus-a systematic review of the literature. Fam Pract 2023; 40:152-175. [PMID: 35833228 DOI: 10.1093/fampra/cmac068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The management of adult male urinary tract infections (mUTIs) in primary care lacks international consensus. The main objective of this study was to describe the different guidelines for the diagnosis and management of mUTIs in primary care, to assess their methodological quality, and to describe their evidence-based strength of recommendation (SoR). METHODS An international systematic literature review of the electronic databases Medline (PubMed) and EMBASE, and gray-literature guideline-focused databases was performed in 2021. The Appraisal of Guidelines for Research and Evaluation (AGREE II) assessment tool was used by 2 independent reviewers to appraise each guideline. RESULTS From 1,678 records identified, 1,558 were screened, 134 assessed for eligibility, and 29 updated guidelines met the inclusion criteria (13 from Medline, 0 from EMBASE, and 16 from gray literature). Quality assessment revealed 14 (48%) guidelines with high-quality methodology. A grading system methodology was used in 18 (62%) guidelines. Different classifications of mUTIs are described, underlining a lack of international consensus: an anatomic classification (cystitis, prostatitis, pyelonephritis) and a symptomatic classification (approach based on the intensity and tolerance of symptoms). The duration of antibiotic treatment for febrile mUTIs has been gradually reduced over the last 20 years from 28 days to 10-14 days of fluoroquinolones (FQ), which has become the international gold standard. Guidelines from Scandinavian countries propose short courses (3-5 days) of FQ-sparing treatments: pivmecillinam, nitrofurantoin, or trimethoprim. Guidelines from French-speaking countries use a watchful waiting approach and suggest treating mUTIs with FQ, regardless of fever. CONCLUSIONS This lack of scientific evidence leads to consensus and disagreement: 14 days of FQ for febrile mUTIs is accepted despite a high risk of antimicrobial resistance, but FQ-sparing treatment and/or short treatment for afebrile mUTIs is not. The definition of afebrile UTIs/cystitis is debated and influences the type and duration of antibiotic treatment recommended.
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Affiliation(s)
- Benjamin Soudais
- Department of General Practice, Normandie Univ, UNIROUEN, F-76000 Rouen, France
| | - Florian Ribeaucoup
- Department of General Practice, Normandie Univ, UNIROUEN, F-76000 Rouen, France
| | - Matthieu Schuers
- Department of General Practice, Normandie Univ, UNIROUEN, F-76000 Rouen, France.,Department of Biomedical Informatics, CHU Rouen, F-76000 Rouen, France.,Sorbonne Université, LIMICS U1142, F-75015 Paris, France
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8
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Sun W, Ma L, Li Y, Xu Y, Wei J, Sa L, Chen X, Su J. In vitro Studies of Non-Diphtheriae Corynebacterium Isolates on Antimicrobial Susceptibilities, Drug Resistance Mechanisms, and Biofilm Formation Capabilities. Infect Drug Resist 2022; 15:4347-4359. [PMID: 35971555 PMCID: PMC9375566 DOI: 10.2147/idr.s376328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/29/2022] [Indexed: 11/30/2022] Open
Abstract
Objective This study aimed to investigate the antimicrobial susceptibilities, drug resistance mechanisms, and biofilm formation capacities of non-diphtheriae Corynebacterium strains isolated from sterile midstream urine of hospitalized patients with clinical urinary tract infections (UTIs). Methods A total of 45 non-diphtheriae Corynebacterium isolates were recovered from sterile midstream urine. The available data of 45 patients were collected. Minimum inhibitory concentrations (MICs) of 10 commonly used antibiotics were determined. Meanwhile, the molecular resistance mechanisms of each agent were performed through PCR with specific primers. Moreover, the biofilm formation capability of each isolate on abiotic surfaces was detected with the MTT method. Results In this study, the most prevalent three species were C. striatum (15/45, 33.3%), C. glucuronolyticum (9/45, 20.0%) and C. urealyticum (8/45, 17.8%). These three species also accounted for most renal and ureteral calculi cases. Male patients older than 50 years, especially those with underlying diseases, were more susceptible to non-diphtheriae Corynebacterium infection. All the 45 isolates were 100% susceptible to vancomycin and linezolid, but highly resistant to macrolide–lincosamide–streptogramin B (MLSB), fluoroquinolones, tetracyclines and β-lactams with corresponding mechanisms. The detection rate of multidrug–resistant (MDR) non-diphtheriae Corynebacterium is 91.1%. All isolates are able to form biofilm on abiotic surfaces, except those of C. urealyticum, C. tuberculostearicum and C. jeikeium. Isolates of C. glucuronolyticum and C. Striatum possessed the strongest biofilm formation capacity. C. amycolatum could form biofilm, but varied greatly among different isolates. Conclusion C. striatum, C. glucuronolyticum and C. urealyticum were the most prevalent species relevant to UTIs. The high occurrence of MDR isolates and high diversities in resistance profiles, and the distinctive abilities of biofilm formation highlighted the urgency for identification to species level. We should pay more attention to the drug resistance profiles of non-diphtheriae Corynebacterium, which would help improve empirical antibiotic therapy and reduce drug resistance transmission.
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Affiliation(s)
- Wei Sun
- Department of Clinical Laboratory, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Liyan Ma
- Department of Clinical Laboratory, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Yana Li
- Department of Clinical Laboratory, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Ying Xu
- Department of Clinical Laboratory, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Jingjuan Wei
- Department of Clinical Laboratory, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Lei Sa
- Department of Clinical Laboratory, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Xinxin Chen
- Department of Clinical Laboratory, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Jianrong Su
- Department of Clinical Laboratory, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
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9
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Salm J, Salm F, Arendarski P, Kramer TS. High antimicrobial resistance in urinary tract infections in male outpatients in routine laboratory data, Germany, 2015 to 2020. EURO SURVEILLANCE : BULLETIN EUROPEEN SUR LES MALADIES TRANSMISSIBLES = EUROPEAN COMMUNICABLE DISEASE BULLETIN 2022; 27. [PMID: 35904060 PMCID: PMC9336165 DOI: 10.2807/1560-7917.es.2022.27.30.2101012] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Evidence on the distribution of bacteria and therapy recommendations in male outpatients with urinary tract infections (UTI) remains insufficient. Aim We aimed to report frequency distributions and antimicrobial resistance (AMR) of bacteria causing UTI in men and to identify risk factors for resistance of Escherichia coli against trimethoprim (TMP) and ciprofloxacin (CIP). Methods We conducted a retrospective observational study using routinely collected midstream urine specimens from 102,736 adult male outpatients sent from 6,749 outpatient practices to nine collaborating laboratories from all major regions in Germany between 2015 and 2020. Resistance in E. coli was predicted using logistic regression. Results The three most frequent bacteria were E. coli (38.4%), Enterococcus faecalis (16.5%) and Proteus mirabilis (9.3%). Resistance of E. coli against amoxicillin (45.7%), TMP (26.6%) and CIP (19.8%) was common. Multiple drug resistance was high (22.9%). Resistance against fosfomycin (0.9%) and nitrofurantoin (1.9%) was low. Resistance of En. faecalis against CIP was high (29.3%). Isolates of P. mirabilis revealed high resistance against TMP (41.3%) and CIP (16.6%). The CIP and TMP resistance was significantly higher among bacteria derived from recurrent UTI (p < 0.05). Age ≥ 90 years, recurrent UTI and regions East and South were independently associated with AMR of E. coli against TMP and CIP (p < 0.05). Conclusion The most frequent UTI-causing pathogens showed high resistance against TMP and CIP, empirical therapy is therefore likely to fail. Apart from intrinsically resistant pathogens, susceptibility to fosfomycin and nitrofurantoin remains sufficient. Therefore, they remain an additional option for empirical treatment of uncomplicated UTI in men.
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Affiliation(s)
- Jonas Salm
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin School of Public Health, Berlin, Germany.,Institute of Medical Microbiology and Hygiene, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | | | - Tobias Siegfried Kramer
- LADR Laboratory Group Dr Kramer & Colleagues, Geesthacht, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute for Hygiene and Environmental Medicine, Berlin, Germany
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10
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Tandan M, Thapa P, Maharjan P, Bhandari B. Impact of Antimicrobial Stewardship Program on Antimicrobial Resistant and Prescribing in Nursing Home: A Systematic Review and Meta-analysis. J Glob Antimicrob Resist 2022; 29:74-87. [DOI: 10.1016/j.jgar.2022.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/25/2022] [Accepted: 02/06/2022] [Indexed: 11/29/2022] Open
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11
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Alanazi MQ. Clinical Efficacy and Cost Analysis of Antibiotics for Treatment of Uncomplicated Urinary Tract Infections in the Emergency Department of a Tertiary Hospital in Saudi Arabia. Ther Clin Risk Manag 2021; 17:1209-1217. [PMID: 34848965 PMCID: PMC8615137 DOI: 10.2147/tcrm.s334886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/07/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Uncomplicated urinary tract infections (uUTIs) are one of the main reasons for emergency department (ED) visits. Many antibiotics can be used for uUTI treatment. Currently, no data concerning uUTIs and cost-effectiveness have been reported in Saudi Arabia. This study aimed to investigate antibiotic and cost-effectiveness of beta-lactams, fluoroquinolones, and nitrofurantoin as first-line uUTI treatment. Patients and Methods This study was a retrospective cohort based on a five-arm comparative outcome analysis. A cost-effectiveness analysis and comparative group of uUTI treatments in the ED at King Abdulaziz Medical City (KAMC) in Saudi Arabia over a three-month follow-up period was done. The patient group consisted of those presenting to the ED with uUTIs who were treated initially with one of five antibiotics: (1) amoxicillin/clavulanic acid, (2) cefuroxime, (3) ciprofloxacin, (4) nitrofurantoin, or (5) norfloxacin. The main outcomes were effectiveness in terms of cure rates, symptom-free days (SFDs), and estimations of cost-effectiveness among this group. Results A total of 865 adult patients who presented with uUTIs were enrolled. Most patients (89.5%) completely recovered, whereas 10.5% of patients were readmitted to the ED with recurrent infections. Effectiveness in terms of the highest cure rate was observed with nitrofurantoin and amoxicillin/clavulanic acid (93.2% and 92.2%, respectively) followed by norfloxacin, cefuroxime, and ciprofloxacin; no significant differences in cure rates were found among these antibiotics. Antibiotic effectiveness in terms of SFDs showed that nitrofurantoin produced the longest SFD period (76 days) followed by amoxicillin/clavulanic acid (69 days). A cost-effectiveness analysis in terms of uUTI cure rates and number of SFDs indicated that nitrofurantoin presented the highest cost-effectiveness followed by amoxicillin/clavulanic acid, norfloxacin, ciprofloxacin, and cefuroxime. Conclusion A comparison of five antibiotics for uUTI treatment did not yield clinically significant differences in cure rates. Nitrofurantoin was more cost-effective than the other antibiotics.
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Affiliation(s)
- Menyfah Q Alanazi
- Drug Policy and Economics Center, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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