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Wagenlehner F, Kresken M, Wohlfarth E, Bahrs C, Grabein B, Strohmaier WL, Naber KG. [Therapy of cystitis with nitroxoline-NitroxWin : Prospective, multicenter, non-interventional study and microbiological resistance surveillance]. Urologie 2023; 62:1186-1192. [PMID: 37650911 PMCID: PMC10630225 DOI: 10.1007/s00120-023-02167-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND According to German AWMF S3 guideline nitroxoline is recommended as one of the first-choice antibiotics for treatment of acute uncomplicated cystitis (UC) in women. Under real-world conditions the clinical efficacy of nitroxoline should be checked in a noninterventional, prospective and multicenter study (NIS) and the prevalence of nitroxoline resistance in E. coli be monitored. MATERIALS AND METHODS Female patients with UC treated with nitroxoline (recommended dosage 250 mg tid for 5 days) were included by urologists, general practitioners (GPs), and internists in family medicine throughout Germany from April-December 2022 and followed for 21-28 days. The diagnosis and course of therapy were judged by the Acute Cystitis Symptom Score (ACSS) questionnaire and laboratory investigations (leukocyturia etc). Separately, a nationwide resistance surveillance was performed during 2019-2020 in collaboration with 23 laboratories to collect urinary E. coli isolates and test their susceptibility to nitroxoline. RESULTS Of the 316 patients with mean (SD) age of 57.2 (±20.4 [median 62.5]) years who were included in the NIS, 193/248 (86.3%) in the per-protocol group and in 193/263 (81.44%) in the intention-to-treat group were clinically successful. Furthermore, 96% of the patients rated the tolerability of nitroxoline as "very good" or "good". All 272 E. coli isolates tested were susceptible to nitroxoline. CONCLUSIONS Nitroxoline showed very good clinical results in the NIS, and 100% of the tested E. coli urine isolates were susceptible to nitroxoline. Nitroxoline can still be recommended as one of the first-choice antibiotics for treatment of UC in women.
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Affiliation(s)
- Florian Wagenlehner
- Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Justus-Liebig-Universität, Gießen, Deutschland
| | | | | | - Christina Bahrs
- Institut für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena/Friedrich-Schiller-Universität, Jena, Deutschland
- Klinische Abteilung für Infektionen und Tropenmedizin, Universitätsklinik für Innere Medizin I, Medizinische Universität Wien, Wien, Österreich
| | - Beatrice Grabein
- Stabsstelle Klinische Mikrobiologie und Krankenhaushygiene, LMU Klinikum, München, Deutschland
| | | | - Kurt G Naber
- Abteilung für Urologie, Technische Universität München, München, Deutschland.
- , Karl-Bickleder-Str. 44c, 94315, Straubing, Deutschland.
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Radzhabov A, Zamuddinov M, Alidjanov JF, Pilatz A, Wagenlehner FM, Naber KG. Linguistic and Clinical Validation of the Tajik Acute Cystitis Symptom Score for Diagnosis and Patient-Reported Outcome in Acute Uncomplicated Cystitis. Medicina (Kaunas) 2023; 59:1549. [PMID: 37763668 PMCID: PMC10534607 DOI: 10.3390/medicina59091549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/15/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Acute Cystitis Symptom Score (ACSS) is a self-reporting questionnaire for clinical diagnosis and follow-up of acute uncomplicated cystitis (AC) in women. The ACSS, originally developed in Uzbek and Russian, both considered original languages, is now available in several other languages. This study aimed to translate and validate the ACSS in the Tajik language. Material and Methods: Linguistic validation was carried out according to the Linguistic Validation Manual for Patient-Reported Outcomes Instruments guidelines. Clinical validation was performed by enrolling fifty-four Tajik-speaking women. All women included in this study were first interviewed about the understandability of all questions and statements in the final Tajik ACSS and were asked to fill in form A at the first visit (diagnostics) and form B at any follow-up visit (patient-reported outcome). Results: Thirty-three women, median (range) age of 35 (18-77), were diagnosed with AC (patient group), while twenty-one women, median (range) age of 34 (20-61) (p = 0.109), were enrolled as the control group without any other urological disease. For the diagnostics of AC, a summary score of the six typical symptoms ("Typical" domain) showed the best balance between sensitivity (0.73) and specificity (0.71) at 5 and above. Cronbach's alpha [95% CI] and split-half reliability [95%] were 0.82 [0.76; 0.98] and 0.84 [0.77; 0.87], respectively. At the follow-up visit, the patients reported a significant reduction in the "Typical" domain and an improvement in the "Quality of Life" domain. Conclusion: The Tajik ACSS showed good reliability and diagnostic values and may be used as a reliable tool for the diagnosis and patient-reported outcome in women with AC in clinical and epidemiological studies and for daily practice.
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Affiliation(s)
| | - Musluhuddin Zamuddinov
- Departments of Urology, Madadi Akbar Clinic, Dushanbe 734025, Tajikistan;
- Departments of Urology, Olami Tib Clinic, Dushanbe 734060, Tajikistan
| | - Jakhongir F. Alidjanov
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University, 35392 Giessen, Germany; (J.F.A.); (A.P.); (F.M.W.)
| | - Adrian Pilatz
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University, 35392 Giessen, Germany; (J.F.A.); (A.P.); (F.M.W.)
| | - Florian M. Wagenlehner
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University, 35392 Giessen, Germany; (J.F.A.); (A.P.); (F.M.W.)
| | - Kurt G. Naber
- Department of Urology, Technical University of Munich, 80333 Munich, Germany
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Butler DS, Wagenlehner F, Höller M, Abramov-Sommariva D, Steindl H, Naber KG. Phytotherapy (BNO 1045) of Acute Lower Uncomplicated Urinary Tract Infection in Women Normalizes Local Host Responses. Urol Int 2023; 107:778-784. [PMID: 37544300 PMCID: PMC10614491 DOI: 10.1159/000531206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/13/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Acute lower uncomplicated urinary tract infection (uUTI) affects a large proportion of women. Increased antimicrobial resistance has created an urgent need for novel therapeutics and the phytotherapeutic drug BNO 1045 (Canephron® N) has previously been shown to be noninferior to standard antimicrobial stewardship. This sub-analysis from a randomized, double-blind, controlled phase III noninferiority clinical trial using BNO 1045 versus fosfomycin to treat uUTI aimed to determine how urine cytokine levels are altered by the two different treatments. METHODS Urine samples from a predefined subset of women diagnosed with uUTI (18-70 years) and treated with BNO 1045 (n = 58) or fosfomycin (n = 69) were analyzed for urine levels of IL-6 and IL-8, using analyte-to-creatinine ratios. RESULTS BNO 1045 treatment showed similar effects to fosfomycin treatment in reducing both urine IL-6 and IL-8 levels. Mean IL-6 and IL-8 levels were markedly reduced in all patients regardless of treatment. BNO 1045 treatment decreased urine IL-8 significantly (p = 0.0142) and showed a trend toward reduction of urine IL-6 (p = 0.0551). Fosfomycin treatment reduced both IL-6 and IL-8 levels significantly (p = 0.0038, <0.0001 respectively). CONCLUSION BNO 1045 is, in addition to reducing symptoms, comparable to fosfomycin treatment in reducing the local inflammatory response associated with uUTI.
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Affiliation(s)
- Daniel S.C. Butler
- Department of Microbiology and Immunology, Stanford University, Stanford, CA, USA
| | - Florian Wagenlehner
- Clinic of Urology, Pediatric Urology and Andrology, Justus-Liebig University, Giessen, Germany
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Naber KG, Wagenlehner F, Kresken M, Cheng WY, Catillon M, Duh MS, Yu L, Khanal A, Mulgirigama A, Joshi AV, Ju S, Mitrani-Gold FS. Escherichia coli resistance, treatment patterns and clinical outcomes among females with uUTI in Germany: a retrospective physician-based chart review study. Sci Rep 2023; 13:12077. [PMID: 37495602 PMCID: PMC10372039 DOI: 10.1038/s41598-023-38919-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 07/17/2023] [Indexed: 07/28/2023] Open
Abstract
Real-world data were collected to examine antimicrobial resistance (AMR) prevalence, treatment patterns, and clinical outcomes among female patients with uncomplicated urinary tract infection (uUTI) in Germany. Data were from a retrospective physician-based chart review completed by physicians treating patients with uUTI. Non-pregnant women aged ≥ 12 years, with a uUTI diagnosis, an E. coli-positive urine culture between January 2017-December 2019, and susceptibility test results for ≥ 4 drug classes were eligible. Patients were stratified into three cohorts by drug class susceptibility: susceptible to all (SUS), resistant to one or two drug classes (DR1/2), and resistant to ≥ 3 (MDR) drug classes tested. Among 386 eligible patients [SUS (67.1%); DR1/2 (29.0%); MDR (3.9%)], AMR prevalence was highest for FMIs (18.3%) and lowest for fluoroquinolones (5.2%). The most prescribed drugs were fosfomycin in SUS (44.0%), DR1/2 (41.4%), and fluoroquinolones in MDR (40.0%). Treatment for uUTI failed for 8.8% of patients; failure was more likely in MDR versus SUS [adjusted odds ratio [95% CI] = 4.21 [1.14-1.50]; P = 0.031); incidence of recurrent infection in the 6-months post-index period was higher in DR1/2 versus SUS. These findings may have implications for empiric prescribing, suggesting an unmet need for new treatments.
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Affiliation(s)
| | - Florian Wagenlehner
- Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany
| | | | | | | | | | - Louise Yu
- Analysis Group, Inc., Boston, MA, USA
| | | | | | - Ashish V Joshi
- GSK, 1250 S Collegeville Road, Collegeville, PA, 19426, USA
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Arda E, Alidjanov J, Ates S, Çek M, Piatz A, Wagenlehner FM, Naber KG. Linguistic and clinical validation of the Turkish version of Acute Cystitis Symptom Score for the diagnosis and patient-reported outcome in acute uncomplicated cystitis. Investig Clin Urol 2023; 64:279-288. [PMID: 37341008 DOI: 10.4111/icu.20230010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/11/2023] [Accepted: 03/20/2023] [Indexed: 06/22/2023] Open
Abstract
PURPOSE The Acute Cystitis Symptom Score (ACSS) was developed as a self-reporting questionnaire for diagnosing and monitoring acute uncomplicated cystitis (AC) in female patients. The study aims at the translation of the ACSS into Turkish from the original Uzbek including its linguistic, cognitive and clinical validation. MATERIALS AND METHODS After forward and backward translation of the ACSS from Uzbek to Turkish and vice versa, the cognitive assessment of the Turkish ACSS was performed on 12 female subjects to achieve the final study version. RESULTS The clinical validation was performed on a total of 120 female respondents including 64 Patients with AC and 56 controls without AC. For clinical diagnosis of AC, the predefined summary score of the typical symptoms of >6 showed high values (95% confidence interval) for sensitivity (0.88 [0.77-0.94]), specificity (0.98 [0.91-1.00]), and diagnostic accuracy (0.93 [0.86-0.97]). All patients were followed up between five to nine days after the baseline visit. Forty-four (68.75%) patients used antimicrobial treatment, whereas the rest (31.25%) preferred non-antimicrobial treatment. The severity scores of the typical symptoms and the quality of life were reduced significantly at follow-up. Using different (favored) thresholds for successful and non-successful treatment a clinical success rate between 54.7% and 64.1% (60.9%) was achieved. CONCLUSIONS After translation from the original Uzbek and cognitive assessment, the Turkish ACSS showed similar good results for clinical diagnosis and patient-reported outcome as in other languages validated so far and could therefore now be used for clinical studies as well as in everyday practice.
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Affiliation(s)
- Ersan Arda
- Department of Urology, Medical Faculty of Trakya University, Edirne, Türkiye
| | - Jakhongir Alidjanov
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, Giessen, Germany
| | - Sinan Ates
- Department of Gynaecology, Medical Faculty of Trakya University, Edirne, Türkiye
| | - Mete Çek
- Department of Urology, Medical Faculty of Trakya University, Edirne, Türkiye.
| | - Adrian Piatz
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, Giessen, Germany
| | - Florian M Wagenlehner
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, Giessen, Germany
| | - Kurt G Naber
- Department of Urology, Technical University of Munich, Munich, Germany
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Naber KG, Alidjanov JF, Blicharski T, Cerska M, Gadzinski W, Kawecki J, Krajewski W, Miotla P, Napora P, Paszkowski M, Poletajew S, Sieczkowski M, Zaremba M, Pilatz A, Wagenlehner FME. Polish version of the Acute Cystitis Symptom Score for patients with acute uncomplicated cystitis. Cent European J Urol 2023; 76:144-154. [PMID: 37483856 PMCID: PMC10357829 DOI: 10.5173/ceju.2023.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 11/04/2022] [Accepted: 03/07/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction The Acute Cystitis Symptom Score (ACSS) is a self-reporting questionnaire to evaluate the symptoms and quality of life in women with uncomplicated acute cystitis (AC). The aim of the current study was the additional cognitive and clinical validation of the Polish version. Material and methods Professional forward and backward translations from original Russian to Polish were performed by Mapi SAS. For cognitive assessment, women with different ages and educational levels were asked to comment on each item of the Polish ACSS to establish the final study version. The clinical validation was performed as a prospective, non-interventional cohort study. Women with AC (Patients) and those without (Controls) filled in the Polish ACSS during their visits to a physician's office and at a follow-up visit. Statistical analysis included ordinary descriptive values, calculation of reliability, validity, discriminative ability, responsiveness (sensitivity, specificity), and comparative analysis. Results The cognitive assessment was performed in 60 women with a median (range) age of 44.5 (21-88) years and different educational levels: grade school (n = 8), high school (n = 25), college (n = 22), and postgraduate education (n = 5). Forty-three patients were recruited for the clinical validation study along with 34 controls. Statistical analyses resulted in excellent values of internal consistency, discriminative ability, and validity for diagnosis of AC. At a summary score of 6 and higher in the ´Typical´ domain, positive and negative predictive values were 97% and 79%, and sensitivity and specificity were 79% and 97%, respectively. Conclusions The Polish version of the ACSS has demonstrated benefits for diagnosis and patient-reported outcome assessment. It is objective, fast, and cost-effective, and it may help to easily confirm the accurate diagnosis of AC. The Polish ASCSS can now be recommended for use in clinical and epidemiological studies, in clinical practice, or for self-diagnosis and patient-reported outcome in women with symptoms of AC.
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Affiliation(s)
- Kurt G. Naber
- Department of Urology, Technical University of Munich, Munich, Germany
| | - Jakhongir F. Alidjanov
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, Giessen, Germany
| | - Tomasz Blicharski
- Department and Clinic of Rehabilitation and Orthopedics, Medical University of Lublin, Lublin, Poland
| | - Magdalena Cerska
- First Department of Urology, Medical University of Lodz, Lodz, Poland
| | | | - Jan Kawecki
- NZOZ Specialist Hospital, Prof. E. Michalowski, Katowice, Poland
| | | | - Pawel Miotla
- Second Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | | | - Maciej Paszkowski
- Third Chair and Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - Slawomir Poletajew
- Second Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | | | - Marcin Zaremba
- Independent Public Multidisciplinary Health Care Center of the Ministry of Interior and Administration, Bydgoszcz, Poland
| | - Adrian Pilatz
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, Giessen, Germany
| | - Florian M. E. Wagenlehner
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, Giessen, Germany
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Medina-Polo J, Arrébola-Pajares A, Corrales-Riveros JG, Alidjanov JF, Lorenzo-Gómez MF, Tapia AMH, Martínez-Berganza ML, Ospina-Galeano IA, Padilla-Fernández B, Pilatz A, Naber KG, Wagenlehner FM. Validation of the Spanish Acute Cystitis Symptoms Score (ACSS) in native Spanish-speaking women of Europe and Latin America. Neurourol Urodyn 2023; 42:263-281. [PMID: 36335613 PMCID: PMC10098495 DOI: 10.1002/nau.25079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/29/2022] [Accepted: 10/17/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION AND OBJECTIVES The Acute Cystitis Symptom Score (ACSS) is a patient self-reporting questionnaire for clinical diagnostics and patient-reported outcome (PRO), which may assess the symptoms and the effect on the quality of life in women with acute cystitis (AC). The current study aimed to create a validated Spanish version of the ACSS questionnaire. MATERIAL AND METHODS The process of linguistic validation of the Spanish version of the ACSS consisted of the independent forward and backward translations, revision and reconciliation, and cognitive assessment. Clinical evaluation of the study version of the ACSS was carried out in clinics in Spain and Latin America. Statistical tests included the calculation of Cronbach's α, split-half reliability, specificity, sensitivity, diagnostic odds ratio, positive and negative likelihood ratio, and area under the receiver-operating characteristic curve (AUC). RESULTS The study was performed on 132 patients [age (mean;SD) 45.0;17.8 years] with AC and 55 controls (44.5;12.2 years). Cronbach's α of the ACSS was 0.86, and the split-half reliability was 0.82. The summary scores of the ACSS domains were significantly higher in patients than in controls, 16.0 and 2.0 (p < 0.001), respectively. The predefined cut-off point of ≥6 for a summary score of the "Typical" domain resulted in a specificity of 83.6% and a sensitivity of 99.2% for the Spanish version of the ACSS. AUC was 0.91 [0.85; 0.97]. CONCLUSIONS The validated Spanish ACSS questionnaire evaluates the symptoms and clinical outcomes of patients with AC. It can be used as a patient's self-diagnosis of AC, as a PRO measure tool, and help to rule out other pathologies in patients with voiding syndrome.
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Affiliation(s)
- José Medina-Polo
- Department of Urology, Health Research Institute i+12, Hospital Universitario 12 de Octubre, HM Hospitales & ROC Clinic, Madrid, Spain
| | - Ana Arrébola-Pajares
- Department of Urology, Health Research Institute i+12, Hospital Universitario 12 de Octubre, HM Hospitales & ROC Clinic, Madrid, Spain
| | | | - Jakhongir F Alidjanov
- Clinic for Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
| | | | - Ana-María H Tapia
- Department of Urology, Hospital Universitario Río Hortega, Valladolid, Spain
| | | | | | - Bárbara Padilla-Fernández
- Department of Urology, Neurolourology and Functional Urology Unit, Complejo Hospitalario Universitario de Canarias, Tenerife, Spain
| | - Adrian Pilatz
- Clinic for Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
| | - Kurt G Naber
- Department of Urology, Technical University of Munich, Munich, Germany
| | - Florian M Wagenlehner
- Clinic for Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
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Abstract
Introduction: Urinary tract infections (UTI) are a leading cause of bacterial infections in women. Despite acute treatment, 30-50% of women who have a UTI will experience a recurrence within 6-12 months. In this review, the focus will be on the personal psychosocial impacts of recurrent UTI. Methods: A PubMed/MEDLINE literature search was carried out from 2000 to 2020 in order to identify any recent high-quality meta-analyses or systematic reviews on these topics. Results: One systematic review was found appropriate for this manuscript. Concerning impact on quality of life (QoL) and daily activities, a reduced quality of both intimate and social relationships, self-esteem, and capacity for work was found due to recurrent UTI. Social function was substantially more reduced than physical function. In one study, the greatest reduction overall was in mental role functioning, whereas in another study, mental health reductions were not substantially greater than those of physical health. About one third of women suffered from UTI very often or often after sexual intercourse, and more than half of the patients stated that sexual relations were negatively influenced by UTI. Data from the GESPRIT study suggest that prophylaxis for recurrent UTI is underutilized, because less than 40% of the study population were offered prophylaxis after experiencing three UTI per year, despite all surveyed participants being willing to undertake at least one of the prophylactic measures listed in the survey. Conclusions: Little data on the psychosocial impact of recurrent UTI are available. Therefore, future studies must also incorporate QoL assessments as key outcome measures.
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Affiliation(s)
- Kurt G. Naber
- Department of Urology, Technical University of Munich, Germany,*To whom correspondence should be addressed: Kurt G. Naber, Department of Urology, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Str. 22, 81675 Munich, Germany, E-mail:
| | - José Tirán-Saucedo
- IMIGO/Instituto Mexicano de Infectología Ginecología y Obstetricia, Obstetrics and Gynaecology/Infectious Diseases, Monterrey, México
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Choi JB, Cho KJ, Han KH, Alidjanov JF, Pilatz AME, Wagenlehner FME, Naber KG, Choe HS, Lee SJ. Translation and validation of the Korean version of acute cystitis symptom score. Investig Clin Urol 2022; 63:221-227. [PMID: 35244997 PMCID: PMC8902427 DOI: 10.4111/icu.20210421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/18/2021] [Accepted: 01/10/2022] [Indexed: 11/22/2022] Open
Abstract
Purpose Acute Cystitis Symptom Score (ACSS) is a simple self-reporting questionnaire initially developed in Uzbek language to help diagnose acute uncomplicated cystitis (AUC). The purpose of this study was to translate the ACSS to Korean and validate the Korean version of ACSS using Korean-speaking women. Materials and Methods The original version of ACSS in Uzbek was translated into the target (Korean) version according to internationally accepted guidelines for the translation and cultural adaptation. Cognitive interviews were then conducted for five women with symptoms of AUC and five women without AUC who were native speakers of the Korean language to investigate the clarity, understandability, and acceptability of the translation. The final Korean version of the ACSS was tested in 50 women (31 AUC patients and 19 controls) for clinical validation. Results Reliability test for 9 questions (6 questions about typical symptoms of AUC, and 3 questions on quality of life) showed high values (Cronbach’s alpha=0.853). The sum score of typical symptoms showed the highest balance for diagnostic sensitivity and specificity (area under the ROC curve=0.935). Sensitivity and specificity to predict AUC were 90.3% and 89.5% at cut-off score 6 of the typical domain. Conclusions The Korean version of the ACSS showed high levels of reliability and validity, similar to other validated versions in different languages. It will play an important role in practice and/or clinical research for diagnosis and treatment efficacy monitoring of Korean-speaking women suffering from AUC.
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Affiliation(s)
- Jin Bong Choi
- Department of Urology, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kang Jun Cho
- Department of Urology, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyu Hun Han
- Department of Urology, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jakhongir F. Alidjanov
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, Giessen, Germany
| | - Adrian M. E. Pilatz
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, Giessen, Germany
| | - Florian M. E. Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, Giessen, Germany
| | - Kurt G. Naber
- Department of Urology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Hyun-Sop Choe
- Department of Urology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung-Ju Lee
- Department of Urology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Kogan MI, Ibishev KS, Naboka YL, Gudima IA, Ferzauli AK, Ismailov RS, Naber KG. Antibiotic therapy of chronic bacterial prostatitis is more effective considering antibiotic susceptibility of all pathogens isolated. Investig Clin Urol 2022; 63:325-333. [PMID: 35437957 PMCID: PMC9091822 DOI: 10.4111/icu.20210451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/14/2021] [Accepted: 01/19/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose Because of the insufficient efficacy of the current treatment of chronic bacterial prostatitis (CBP), it is justified to search for a more effective antibiotic therapy (ABT). Materials and Methods This single-centre prospective observational comparative study was conducted in 2012 to 2019 (patients: 60 men with CBP; age: 20–45 y). The clinical examination was performed on admission and at 1, 3, 6, or 12 months. All patients underwent the Meares–Stamey test to obtain expressed prostatic secretion (EPS) and/or post-massage urine (PMU) samples for extended bacteriological examination. The patients were randomly divided into 2 treatment groups (30/30 patients): group I, fluoroquinolones (FQs); group II, a combination of FQs with cephalosporins/macrolides with a treatment duration of 1 month. Results Patients of both groups had severe symptomatic CBP with an average duration of 4 years. Twenty-three microorganisms (15 aerobes, 9 anaerobes) were identified in PMU. At 3 months follow-up, a positive clinical effect was noted in both groups, which was significant (p<0.05) only in group II concerning NIH-CPSI questionnaire, leukocyturia, prostate volume, maximum urine flow, and decreased pathospermia. At 6 months follow-up, in group II the frequency of Escherichia coli and Enterococcus spp. decreased significantly. In group I aerobes changed only insignificantly from the initial level, but anaerobes increased significantly. In group II the titers of both, aerobes and anaerobes, were significantly lower (p<0.05) at 6 months follow-up as compared to initial values. Conclusions ABT targeting all taxa in EPS/PMU is a more effective alternative to standard therapeutic regimens for CBP.
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Affiliation(s)
- Mikhail I. Kogan
- Department of Urology and Pediatric Urology, Rostov State Medical University, Rostov-on-Don, Russia
| | - Khalid S. Ibishev
- Department of Urology and Pediatric Urology, Rostov State Medical University, Rostov-on-Don, Russia
| | - Yulia L. Naboka
- Deparment of Microbiology and Virology, Rostov State Medical University, Rostov-on-Don, Russia
| | - Irina A. Gudima
- Deparment of Microbiology and Virology, Rostov State Medical University, Rostov-on-Don, Russia
| | - Akhmed Kh. Ferzauli
- Regional Urology Centre, Regional Clinical Hospital No. 2, Rostov-on-Don, Russia
| | - Ruslan S. Ismailov
- Department of Urology and Pediatric Urology, Rostov State Medical University, Rostov-on-Don, Russia
| | - Kurt G. Naber
- Department of Urology, Technical University of Munich School of Medicine, Munich, Germany
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Scherberich JE, Fünfstück R, Naber KG. Urinary tract infections in patients with renal insufficiency and dialysis - epidemiology, pathogenesis, clinical symptoms, diagnosis and treatment. GMS Infect Dis 2021; 9:Doc07. [PMID: 35106269 PMCID: PMC8777485 DOI: 10.3205/id000076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Epidemiological studies show an increasing number of patients worldwide suffering from chronic kidney diseases (CKD), which are associated with a risk for progression to end-stage kidney disease (ESKD). CKD patients stage 2-5, patients with regular chronic dialysis treatment (hemo- or peritoneal dialysis), and patients suffering from kidney allograft dysfunction are at high risk to develop infections, e.g. urinary tract infections (UTI) and/or sepsis (urosepsis). These groups show metabolic disturbance, chronic inflammation, and impaired immunocompetence. Escherichia coli is still the most common pathogen in UTI. A wide variety of other pathogens may be involved in UTI. Urological interventions, catheterization, as well as repeated courses of antibiotics contribute to an increased challenge of antimicrobial resistance. The diagnosis of UTI in CKD is based on standard clinical and laboratory criteria. Pyuria (≥10 leucocytes/µl) is more often observed in patients with oligoanuria and low bacterial colony counts. The treatment strategies for this population are based on the same principles as in patients with normal renal function. However, drugs cleared by the kidney or by dialysis membranes need dose adjustment. Antimicrobials with potential systemic toxicity and nephrotoxicity should be administered with caution.
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Affiliation(s)
| | | | - Kurt G. Naber
- Department of Urology, Technical University Munich, Germany
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12
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Stamatiou K, Samara E, Alidjanov JF, Pilatz AME, Naber KG, Wagenlehner FME. Clinical Validation of the Greek Version of the Acute Cystitis Symptom Score (ACSS)-Part II. Antibiotics (Basel) 2021; 10:antibiotics10101253. [PMID: 34680833 PMCID: PMC8532759 DOI: 10.3390/antibiotics10101253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/09/2021] [Accepted: 10/11/2021] [Indexed: 11/16/2022] Open
Abstract
The Acute Cystitis Symptom Score (ACSS) is a patient self-reporting questionnaire for the clinical diagnosis and patient-reported outcome (PRO) in women with acute uncomplicated cystitis (AC). The aim of the current study (part II) is the clinical validation of the Greek ACSS questionnaire. After linguistic validation according to internationally accepted guidelines and cognitive assessment (part I), the clinical validation was performed by using the Greek ACSS study version in 92 evaluable female participants including 53 patients with symptoms suspicious of AC and 39 controls. The clinical outcome using the ACSS questionnaire at different points in time after the start of treatment was demonstrated as well. The age (mean ± SD) of the 53 patients (44.7 ± 17.0 years) and 39 controls (49.3 ± 15.9 years) and their additional conditions at baseline visits, such as menstruation, premenstrual syndrome, pregnancy, menopause, diabetes mellitus, were comparable. There was, however, a significant difference (p < 0.001) between patients and controls at baseline visit regarding sum score of the ACSS domains, such as typical symptoms and quality of life. The clinical outcome of up to 7 days showed a fast reduction of the symptom scores and improvement of quality of life. The optimal thresholds for the patient-reported outcome of successful therapy could be established. The linguistically and clinically validated Greek ACSS questionnaire can now be used for clinical or epidemiological studies and also for patients' self-diagnosis of AC and as a PRO measure tool.
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Affiliation(s)
| | - Evangelia Samara
- Department of Anesthesiology and Pain Management, Tzaneio General Hospital, 18536 Piraeus, Greece;
| | - Jakhongir F. Alidjanov
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, 35392 Giessen, Germany; (J.F.A.); (A.M.E.P.); (F.M.E.W.)
| | - Adrian M. E. Pilatz
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, 35392 Giessen, Germany; (J.F.A.); (A.M.E.P.); (F.M.E.W.)
| | - Kurt G. Naber
- School of Medicine, Technical University of Munich, 81664 Munich, Germany
- Correspondence:
| | - Florian M. E. Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, 35392 Giessen, Germany; (J.F.A.); (A.M.E.P.); (F.M.E.W.)
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13
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Abstract
The purpose of the present review is to report the incidence and characteristics of healthcare-associated urinary tract infections (HAUTIs) in urology with their microbiological and resistance patterns. Urinary tract infections are the main type of healthcare-associated infection in patients hospitalized in a urology ward. Patients admitted to urology departments report a high prevalence of urinary tract catheterization, up to 75% during the hospitalization period, and up to 20% had a urinary catheter before admission. An endourological surgical procedure is another risk factor for HAUTIs. Other risk factors for HAUTIs are the presence of immunosuppression and previous urinary tract infections. In urological patients, Enterobacterales are the principal causative agent of HAUTIs, and E. coli is the most frequently isolated microorganism. However, there is also a high rate of microorganisms other than E. coli such as Klebsiella spp. and Enterococcus spp. Non-E. coli microorganisms show a higher prevalence in immunosuppressed patients and those with urinary catheters before admission. High resistance patterns are reported in patients with HAUTIs, and ESBL-producing bacteria are frequently described. Moreover, the isolation of multidrug-resistant microorganisms is more common in immunosuppressed patients, those with previous urinary tract infections, and urinary catheters into the upper urinary tract. Treatment must be tailored according to patient characteristics and patient profiles, bearing in mind the ORENUC classification for risk factors (no risk factors (O), recurrent urinary tract infections risk factors (R), extraurogenital risk factors (E), nephropathic disease (N), urological risk factors (U), permanent urinary catheter and non-resolvable urological risk factors (C)).
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Affiliation(s)
- José Medina-Polo
- Department of Urology, Health Research Institute i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Kurt G Naber
- Department of Urology, Technical University of Munich, Germany
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Piraux A, Faure S, Naber KG, Alidjanov JF, Ramond-Roquin A. Changes in the management of urinary tract infections in women: impact of the new recommendations on antibiotic prescribing behavior in France, between 2014 and 2019. BMC Health Serv Res 2021; 21:612. [PMID: 34182991 PMCID: PMC8240268 DOI: 10.1186/s12913-021-06653-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/14/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Urinary tract infections (UTIs) are among the most common infections that require antibiotic therapy. In December 2015, new guidelines for UTI management were published in France with the aim of reducing antibiotic misuse and the risk of antimicrobial resistance. OBJECTIVES To analyze changes in antibiotic prescribing behavior for acute uncomplicated UTI in women in France from 2014 to 2019. METHODS Retrospective study using data extracted from the medico-administrative database 'OpenMedic' that is linked to the French National Health Data System and collects data on the reimbursement of prescribed drugs. The analyses focused on the number of boxes of antibiotics delivered by community pharmacies, the molecule class, and the prescriber's specialty. RESULTS Overall, antibiotic dispensing by community pharmacies increased by 2% between 2014 and 2019, but with differences in function of the antibiotic class. The use of antibiotics recommended as first-line and second-line treatment increased (+ 41% for fosfomycin and + 7430% for pivmecillinam). Conversely, the dispensing of lomefloxacin and norfloxacin decreased by 80%, and that of ciprofloxacin by 26%. Some antibiotics were mostly prescribed by general practitioners (lomefloxacin, pivmecillinam) and others by secondary care physicians (ofloxacin). Dispensing increased for antibiotics prescribed by secondary care physicians (+ 13% between 2014 and 2019) and decreased for antibiotics prescribed by GPs (- 2% for the same period). CONCLUSION These data suggest that the new recommendations are followed, as indicated by the increased prescription of fosfomycin and pivmecillinam and decreased prescription of fluoroquinolones. However, the efficient transmission and implementation of new recommendations by practitioners requires time, means and dedicated tools.
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Affiliation(s)
- Arthur Piraux
- Univ Angers, Inserm, CNRS, MINT, SFR ICAT, 16 boulevard Daviers, F-49000, Angers, France.
| | - Sébastien Faure
- Univ Angers, Inserm, CNRS, MINT, SFR ICAT, 16 boulevard Daviers, F-49000, Angers, France
| | - Kurt G Naber
- Department of Urology, Technical University of Munich, Munich, Germany
| | - Jakhongir F Alidjanov
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, Giessen, Germany
| | - Aline Ramond-Roquin
- Faculté de Santé, Département de Médecine Générale, Univ Angers, F-49000, Angers, France
- Univ Angers, Univ Rennes, EHESP1, Inserm, IRSET-ESTER, SFR ICAT, F-49000, Angers, France
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Alidjanov JF, Khudaybergenov UA, Ayubov BA, Pilatz A, Mohr S, Münst JC, Ziviello Yuen ON, Pilatz S, Christmann C, Dittmar F, Mirsaidov NM, Buch-Heberling M, Naber KG, Bjerklund Johansen TE, Wagenlehner FME. Linguistic and clinical validation of the acute cystitis symptom score in German-speaking Swiss women with acute cystitis. Int Urogynecol J 2021; 32:3275-3286. [PMID: 34170341 PMCID: PMC8227360 DOI: 10.1007/s00192-021-04864-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/19/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The Global Prevalence Study of Infections in Urinary tract in Community Setting (GPIU.COM) includes epidemiological aspects of acute cystitis (AC) in women in Germany and Switzerland. The primary study relates to the German version of the Acute Cystitis Symptom Score (ACSS), a self-reporting questionnaire for self-diagnosis and monitoring the symptomatic course of AC in women. The current study aimed to analyze the validity and reliability of the German ACSS in German-speaking female patients with AC in Switzerland. METHODS Anonymized patient data were collected and analyzed from women with AC at the first visit (diagnosis) and follow-up visits as baseline and controls, respectively. Data from 97 patients with a median age of 41 years underwent analysis. Psychometric and diagnostic characteristics of the ACSS were measured and statistically analyzed. RESULTS Average internal consistency of the ACSS resulted in a Cronbach's alpha (95% CI) of 0.86 (0.83; 0.89) and did not differ significantly between the Swiss and German cohorts. Diagnostic values of the ACSS for the Swiss cohort were relatively lower than for the German cohort, possible due to discrepancies between definitions of UTI in national guidelines. CONCLUSIONS The analysis showed that the German version of the ACSS is also suitable for use in the German-speaking female population of Switzerland. Minor differences in definitions of AC between German and Swiss guidelines explain the observed discrepancies in diagnostic values of the ACSS between cohorts.
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Affiliation(s)
- Jakhongir F Alidjanov
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, Rudolph-Buchheim str. 7, 35392, Giessen, Hessen, Germany.
| | | | - Bekhzod A Ayubov
- Department of Urological Surgery, Republican Specialized Scientific-Practical Medical Center of Urology, Tashkent, Uzbekistan
| | - Adrian Pilatz
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University of Giessen, Giessen, Hessen, Germany
| | - Stefan Mohr
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Julia C Münst
- Department of Gynaecology, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
| | | | | | - Corina Christmann
- Department of Obstetrics and Gynecology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Florian Dittmar
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University of Giessen, Giessen, Hessen, Germany
| | - Nodir M Mirsaidov
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University of Giessen, Giessen, Hessen, Germany
| | - Mareike Buch-Heberling
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University of Giessen, Giessen, Hessen, Germany
| | - Kurt G Naber
- Department of Urology, Technical University of Munich, Munich, Germany
| | - Truls E Bjerklund Johansen
- Department of Urology of Oslo University Hospital, University of Oslo, Oslo, Norway.,Institute of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Florian M E Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University of Giessen, Giessen, Hessen, Germany
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16
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Alidjanov JF, Overesch A, Abramov-Sommariva D, Hoeller M, Steindl H, Wagenlehner FM, Naber KG. Acute Cystitis Symptom Score questionnaire for measuring patient-reported outcomes in women with acute uncomplicated cystitis: Clinical validation as part of a phase III trial comparing antibiotic and nonantibiotic therapy. Investig Clin Urol 2021; 61:498-507. [PMID: 32869564 PMCID: PMC7458871 DOI: 10.4111/icu.20200060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/12/2020] [Accepted: 05/24/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The Acute Cystitis Symptom Score (ACSS) used in a clinical trial comparing the phytodrug Canephron®N (BNO 1045) with an antibacterial agent (fosfomycin trometamol [FT]) in the treatment of acute uncomplicated cystitis (AC) in women was evaluated as a patient-reported outcome measure in a post hoc analysis. MATERIALS AND METHODS This double-blind, randomized, multicenter, phase III noninferiority trial was performed in 51 centers in Europe. The ACSS questionnaire was used to assess severity and course of symptoms. RESULTS The post hoc analysis included 325 patients treated with BNO 1045 and 332 patients treated with FT (total of 657 patients). The mean sum-scores of the ACSS-typical domain were comparable between groups on day 1 (BNO 1045: 10.2; FT: 10.1), and then decreased on day 4 (BNO 1045: 5.1; FT: 4.5), at end of treatment on day 8 (BNO 1045: 2.1; FT: 2.1), and at late follow-up on day 38 (BNO 1045: 0.8; FT: 0.9). Predefined thresholds using the scoring system of the ACSS could be established and validated to define "clinical cure." CONCLUSIONS Evaluating not only antibacterial but also nonantibacterial agents indicated for the treatment of AC in women, clinical criteria for diagnostics, and measures of patient-reported outcomes are more important as main objectives than microbiological criteria. In this post hoc evaluation, we showed that the ACSS questionnaire, validated in several languages, has the potential to be used as a suitable instrument for diagnostics and patient-reported outcomes in well-designed, international, clinical studies investigating different treatment modalities of uncomplicated urinary tract infections.
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Affiliation(s)
- Jakhongir F Alidjanov
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University, Giessen, Germany
| | | | | | | | | | - Florian M Wagenlehner
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University, Giessen, Germany
| | - Kurt G Naber
- Department of Urology, Technical University of Munich, Munich, Germany.
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Loose M, Naber KG, Purcell L, Wirth MP, Wagenlehner FME. Anti-Biofilm Effect of Octenidine and Polyhexanide on Uropathogenic Biofilm-Producing Bacteria. Urol Int 2021; 105:278-284. [PMID: 33401282 DOI: 10.1159/000512370] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/04/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND A catheter allowing a release of antibacterial substances such as antiseptics into the bladder could be a new way of preventing biofilm formation and subsequent catheter-associated urinary tract infections. METHODS Minimal inhibitory and bactericidal concentration (MIC/MBC) determinations in cation-adjusted Mueller-Hinton broth and artificial urine were performed for 4 antiseptics against 3 uropathogenic biofilm producers, Escherichia coli, Pseudomonas aeruginosa, and Proteus mirabilis. Furthermore, effects of octenidine and polyhexanide against catheter biofilm formation were determined by quantification of biofilm-producing bacteria. RESULTS Sodium hypochlorite showed MIC/MBC values between 200 and 800 mg/L for all strains tested. Triclosan was efficient against E. coli and P. mirabilis (MIC ≤2.98 mg/L) but ineffective against P. aeruginosa. Octenidine and polyhexanide showed antibacterial activity against all 3 species tested (MIC 1.95-7.8 and 3.9-31.25 mg/L). Both octenidine and polyhexanide were able to prevent biofilm formation on catheter segments in a concentration dependent manner. Furthermore, adding 250 mg/L of each biocide disrupted biofilms formed by E. coli and P. mirabilis, whereas even 500 mg/L was not sufficient to completely destroy P. aeruginosa biofilms. CONCLUSION Octenidine- and polyhexanide-containing antiseptics showed a broad effect against typical uropathogenic biofilm producers even in high dilutions. This study provides a basis for further investigation of the potential of octenidine and polyhexanide as prophylaxis or treatment of catheter biofilms.
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Affiliation(s)
- Maria Loose
- Clinic for Urology, Paediatric Urology and Andrology, Justus-Liebig University of Giessen, Giessen, Germany,
| | - Kurt G Naber
- Department of Urology, Technical University of Munich, Munich, Germany
| | | | - Manfred P Wirth
- Department of Urology, Technical University of Dresden, Dresden, Germany
| | - Florian M E Wagenlehner
- Clinic for Urology, Paediatric Urology and Andrology, Justus-Liebig University of Giessen, Giessen, Germany
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18
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Naboka YL, Mavzyutov AR, Kogan MI, Gudima IA, Dzhalagoniya KT, Ivanov SN, Naber KG. The gene profile of Enterobacteriaceae virulence factors in relation to bacteriuria levels between the acute episodes of recurrent uncomplicated lower urinary tract infection. Expert Rev Anti Infect Ther 2021; 19:1061-1066. [PMID: 33338384 DOI: 10.1080/14787210.2021.1866986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The pathogenic potential of uropathogens isolated between acute episodes of recurrent lower urinary tract infection (rLUTI) is studied insufficiently. The objectives were to determine the spectrum of virulence genes of Enterobacteriaceae cultured between acute episodes of rLUTI at various levels of bacteriuria. METHODS Bacteriological examinations of 169 premenopausal women's midstream urine with rLUTI were performed between acute episodes of UTI. Sixty-two strains of Enterobacteriaceae at concentrations 102-108 CFU/ml were analyzed for the presence of papA, papE/F, papGII, afa, bmaE, iutA, feoB, fyuA, kpsMTII, and usp virulence factors genes' (VFGs) fragments. RESULTS In all strains VFGs were found with numbers from 1 to 10. Four VFGs were found at all levels of bacteriuria (from 102 to 107-8) in most strains (>50%): papGII, feoB, fyuA, usp. In total, 28 significant Pearson contingency coefficient (PCC) were determined. Each of the genes, papA, papE/F, usp, was found more often in uropathogens from patients with a higher level of leukocyturia. CONCLUSIONS The inter-episode period in rLUTI is associated with varying levels of bacteriuria of enterobacteria. Since enterobacteria virulent potential could be determined at all levels of bacteriuria, there is at all levels of bacteriuria a potential risk for recurrence of LUTI.
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Affiliation(s)
- Yulia L Naboka
- Department of Microbiology No. 1, Rostov State Medical University Hospital, Rostov-on-Don, Russia
| | - Ayrat R Mavzyutov
- Department of Fundamental and Applied Microbiology, Bashkir State Medical University, Ufa, Russia
| | - Michel I Kogan
- Department of Urology, Rostov State Medical University Hospital, Rostov-on-Don, Russia
| | - Irina A Gudima
- Department of Microbiology No. 1, Rostov State Medical University Hospital, Rostov-on-Don, Russia
| | - Kseniya T Dzhalagoniya
- Department of Microbiology No. 1, Rostov State Medical University Hospital, Rostov-on-Don, Russia
| | - Sergey N Ivanov
- Department of Urology, Rostov State Medical University Hospital, Rostov-on-Don, Russia
| | - Kurt G Naber
- Department of Urology, Technical University of Munich, Munich, Germany
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Alidjanov JF, Naber KG, Pilatz A, Wagenlehner FM. Validation of the American English Acute Cystitis Symptom Score. Antibiotics (Basel) 2020; 9:antibiotics9120929. [PMID: 33352734 PMCID: PMC7766804 DOI: 10.3390/antibiotics9120929] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/12/2020] [Accepted: 12/17/2020] [Indexed: 01/11/2023] Open
Abstract
The diagnosis of acute uncomplicated cystitis (UC) is usually based on clinical symptoms. The study aims to develop and validate the American-English Acute Cystitis Symptom Score (ACSS), a self-reporting questionnaire for diagnosis and patient-reported outcome in women with acute uncomplicated cystitis (UC). After certified translation into American-English and cognitive assessment, the clinical validation of the ACSS was performed embedded in a US phase-II trial. 167 female patients with typical symptoms of UC were included in the study following US Food and Drug Administration (FDA) guidance. At Day 1 (diagnosis), the mean (SD) sum score of the six ACSS typical symptoms reached 10.60 (2.51). Of 100 patients followed-up last time on Day 5 or 6 (End-of-treatment, EoT), 91 patients showed clinical success according to the favored ACSS criteria (sum score of typical symptoms 0.98 (1.94)). There was no correlation between the severity of symptoms on Day 1 or between clinical success rate at EoT and level of bacteriuria on Day 1. The American-English ACSS showed high predictive ability and responsiveness and excellent levels of reliability and validity. It can now be recommended as the new master version in clinical and epidemiological studies, in clinical practice, or for self-diagnosis of women with symptoms of UC.
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Affiliation(s)
- Jakhongir F. Alidjanov
- Clinic for Urology, Pediatric Urology and Andrology, Justus Liebig University, Rudolf-Buchheim-Str. 7, 35392 Giessen, Germany; (A.P.); (F.M.W.)
- Correspondence: ; Tel.: +49-176-5806-8639
| | - Kurt G. Naber
- Department of Urology, Technical University of Munich, 81675 Munich, Germany;
| | - Adrian Pilatz
- Clinic for Urology, Pediatric Urology and Andrology, Justus Liebig University, Rudolf-Buchheim-Str. 7, 35392 Giessen, Germany; (A.P.); (F.M.W.)
| | - Florian M. Wagenlehner
- Clinic for Urology, Pediatric Urology and Andrology, Justus Liebig University, Rudolf-Buchheim-Str. 7, 35392 Giessen, Germany; (A.P.); (F.M.W.)
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Naber KG, Apolikhin O, Kozlov V, Kennedy DW. Review of the Phytoneering Research & Experience Summit (PRES) 2019 “building bridges between nature’s healing potential and evidence-based medicine - 20 years of phytoneering”. Clin Phytosci 2020. [DOI: 10.1186/s40816-020-0155-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractThis brief communication summarizes the key highlights presented at the 2019 Phytoneering Research and Experience Summit held at the Palma Convention Centre and the educational finca Sa Canova (Majorca, Spain) from the 25th to the 27th of July 2019.More than 100 professionals from academia, industry and public services took part. The scientific programme included three dedicated symposium sessions and a moderated poster session. In total, 13 oral communications and 23 posters were presented.The invite-only conference, entitled: “Phytoneering Research & Experience Summit (PRES) 2019 - Building bridges between nature’s healing potential and evidence-based medicine - 20 years of phytoneering”, had participants from 20 different nations, reflecting the international character of the event. This participant group included researchers as well as clinicians with different fields of interest, e.g. gynaecology, urology, respiratory diseases and paediatrics. They all share an interest in evidence-based phytotherapy and phytoneering, which is the combination of ancient knowledge about medicinal plants and state-of-the-art technology to produce evidence-based herbal medicine. This approach offers solutions to reduce the growing number of unnecessarily prescribed antibiotics in the above-mentioned areas, with the aim of preventing further progression of antibiotic resistance. The conference was sponsored by Bionorica® SE.
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Horváth J, Wullt B, Naber KG, Köves B. Biomarkers in urinary tract infections - which ones are suitable for diagnostics and follow-up? GMS Infect Dis 2020; 8:Doc24. [PMID: 33299741 PMCID: PMC7705555 DOI: 10.3205/id000068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: Urinary tract infections (UTIs) are one of the most common infections worldwide. Under special circumstances, clinicians must rely on laboratory findings, which might have a weak predicting value, misguiding the practitioners and leading to incorrect diagnosis and overuse of antibiotics. Therefore, there is an urgent need for reliable biomarkers in UTIs. Methods: We performed a literature search for biomarkers used in UTIs from January 1999 until May 2020. We used "urinary tract infection" and "biomarker" as the main key words in the PubMed, Medline and Cochrane databases. After peer review, we excluded the duplicates and identified the suitable articles, from which we collected the data and divided the available biomarkers into 5 groups: i) conventional markers; ii) promising, thoroughly studied biomarkers; iii) promising biomarkers that need further studies; iv) biomarkers of unknown significance; v) controversial, not useful markers. Results: We found 131 articles, mostly from the paediatric population. Neutrophil gelatinase-associated lipocalin (NGAL) and interleukins (IL) have a leading role in diagnosing and differentiating UTIs based on a lot of observational, comparative trials. Heparin Binding Protein (HBP), Lactoferrin (LF), Heat-Shock Protein-70 (HSP-70), Human Defensin-5 (HD-5), Lipopolysaccharide Binding Protein (LBP) and mass spectrometry studies are promising, but confirming data are lacking. The measurable components of the innate immune system and local host cell response could be appropriate biomarkers, but their significance is currently unknown. Conclusions: Conventional biomarkers for UTIs have low specificity. The use of urinary NGAL and interleukins could improve the sensitivity and specificity of laboratory diagnosis of UTIs.
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Affiliation(s)
- József Horváth
- BKMK SZTE ÁOK Okt. Kh. Urológiai Osztálya, Kecskemét, Hungary
| | - Björn Wullt
- Division of Microbiology, Immunology and Glycobiology, Lund University, Lund, Sweden
| | - Kurt G. Naber
- Department of Urology, Technical University of Munich, Munich, Germany
| | - Béla Köves
- Jahn Ferenc Dél-pesti Kórház és Rendelőintézet, Budapest, Hungary
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Naber KG, Bonkat G, Wagenlehner FME. The EAU and AUA/CUA/SUFU Guidelines on Recurrent Urinary Tract Infections: What is the Difference? Eur Urol 2020; 78:645-646. [PMID: 32616407 DOI: 10.1016/j.eururo.2020.06.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 06/11/2020] [Indexed: 10/24/2022]
Abstract
For diagnosis of urinary tract infection (UTI), low bacterial counts in urine culture need to be considered more often. Non-antibiotic prophylaxis should be prioritized before antibiotic prophylaxis in patients with uncomplicated, recurrent UTI. Immunoprophylaxis in patients with rUTI deserves better consideration.
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Affiliation(s)
- Kurt G Naber
- Department of Urology, Technical University of Munich, Munich, Germany.
| | | | - Florian M E Wagenlehner
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, Giessen, Germany
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Di Vico T, Morganti R, Cai T, Naber KG, Wagenlehner FM, Pilatz A, Alidjanov J, Morelli G, Bartoletti R. Acute Cystitis Symptom Score (ACSS): Clinical Validation of the Italian Version. Antibiotics (Basel) 2020; 9:E104. [PMID: 32131404 PMCID: PMC7148481 DOI: 10.3390/antibiotics9030104] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 02/20/2020] [Accepted: 02/24/2020] [Indexed: 01/19/2023] Open
Abstract
Acute Cystitis Symptom Score (ACSS) is an 18-item self-reporting questionnaire for clinical diagnosis and follow-up of acute uncomplicated cystitis (AUC) in women. The ACSS, originally developed in Uzbek and Russian languages, is now available in several languages. The purpose of the study was to validate the ACSS questionnaire in the Italian language. Linguistic validation was carried out according to Linguistic Validation Manual for Patient-Reported Outcomes Instruments guidelines. Clinical validation was carried out by enrolling one hundred Italian-speaking women. All women were asked to fill in the ACSS questionnaire during their medical visit. Fifty-four women, median age 36 (Inter Quartile Range 28-49), were diagnosed with AUC, while 46 women, median age 38 (IQR 29-45), were enrolled as the control group attending the hospital's fertility center for couples. The most frequently isolated pathogen in AUC was Escherichia coli (40; 74.0%) followed by Enterococcus faecalis (7; 13.0%) and Staphylococcus saprophyticus (3; 5.6%). Receiver operating characteristic (ROC) curve analysis performed at the first diagnostic visit on a typical symptoms domain cut-off score of 6 revealed a sensitivity of 92.5% and specificity of 97.8%. The Italian version of the ACSS has proved to be a reliable tool with a high accuracy in diagnosis and follow-up in women with AUC. The ACSS may also be useful for clinical and epidemiological studies.
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Affiliation(s)
- Tommaso Di Vico
- Department of Translational Research and New Technologies, University of Pisa, 56126 Pisa, Italy
| | - Riccardo Morganti
- SOD Clinical Trial Statistical Support, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy
| | - Tommaso Cai
- Urology Unit, S. Chiara Regional Hospital, 38122 Trento, Italy
| | - Kurt G. Naber
- Department of Urology, Technical University of Munich, 80333 Munich, Germany
| | - Florian M.E. Wagenlehner
- Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, 35390 Giessen, Germany
| | - Adrian Pilatz
- Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, 35390 Giessen, Germany
| | - Jakhongir Alidjanov
- Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, 35390 Giessen, Germany
| | - Girolamo Morelli
- Department of Critical Medicine, University of Pisa, 56126 Pisa, Italy
| | - Riccardo Bartoletti
- Department of Translational Research and New Technologies, University of Pisa, 56126 Pisa, Italy
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Loose M, Naber KG, Coates A, Wagenlehner FME, Hu Y. Effect of Different Media on the Bactericidal Activity of Colistin and on the Synergistic Combination With Azidothymidine Against mcr-1-Positive Colistin-Resistant Escherichia coli. Front Microbiol 2020; 11:54. [PMID: 32063896 PMCID: PMC7000358 DOI: 10.3389/fmicb.2020.00054] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 01/13/2020] [Indexed: 01/01/2023] Open
Abstract
Antimicrobial susceptibility testing (AST) performed according to defined guidelines is important to identify resistance and to predict the clinical success or failure of specific antibiotic therapy. However, these guidelines do not cover all physiological conditions that can have a tremendous impact on in vivo resistance. In this study, we tested the susceptibility of thirteen mcr-1-positive Escherichia coli strains against colistin, one of the last resort antibiotics for treating multi-drug resistant pathogens, in media recommended for ASTs as well as – physiologically more relevant – in human serum and artificial urine (AU). Minimal inhibitory concentration (MIC) values in heat-inactivated human serum were similar to those in cation-adjusted Mueller-Hinton broth (CAMHB), but reduced in native serum for almost all strains that could grow in this media. In AU MIC values for mcr-1 positive E. coli were increased significantly up to 16-fold compared to that in CAMBH, which did not apply to the colistin-susceptible E. coli strains tested. Although different growth media could affect the MIC of colistin alone, their impact on the synergistic effect of the combination with the antiviral drug azidothymidine was minimal. The higher divalent cation concentration combined with acidic pH values is most likely responsible for the increased MIC values of the mcr-1 harboring E. coli strains tested against colistin in AU compared to that in CAMHB. Antimicrobial susceptibility screening procedures for colistin using CAMHB only could lead to an underestimation of resistance under different physiological conditions. Therefore, not only pharmacokinetic but also pharmacodynamic studies in urine are as important as in serum or plasma.
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Affiliation(s)
- Maria Loose
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University Giessen, Giessen, Germany
| | - Kurt G Naber
- Department of Urology, Technical University of Munich, Munich, Germany
| | - Anthony Coates
- Institute for Infection and Immunity, St George's, University of London, London, United Kingdom.,Helperby Therapeutics Ltd., London, United Kingdom
| | - Florian M E Wagenlehner
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University Giessen, Giessen, Germany
| | - Yanmin Hu
- Institute for Infection and Immunity, St George's, University of London, London, United Kingdom
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Abstract
AbstractUrinary tract infections (UTI) are one of the most common problems in urology clinics. The European Association of Urology (EAU) has been pioneering in its efforts to disseminate the latest clinical findings through the organization of the annual EAU congresses. At this year’s congress (EAU Barcelona 2019), various satellite symposia were organized, focusing on specific issues in the field of urology. "UTI − quo vadis? New alternatives to treat uncomplicated urinary tract infections" was one of the industry-sponsored symposia, organized with the aim of evaluating the current scenario and also throwing light on the paradigm shift in the treatment of acute, uncomplicated lower urinary tract infections (uUTI). Several interlinking topics were presented during this symposium. The topics covered antibiotic resistance, involving a presentation of the current data from the Global Prevalence Study on Infections in Urology (GPIU-study). This discussion was followed by case reports on the impact of antibiotic resistance on the management of patients with UTI/uUTI and treatment options for UTI/uUTI according to current guidelines. The highlight of the symposium was the presentation of very recent data from a gold standard phase III clinical trial (double-blind, double-dummy randomized study), demonstrating the non-inferiority of a herbal medicine (BNO 1045) versus antibiotic therapy (fosfomycin trometamol (FT), as a single dose = 3 g) for the treatment of acute, uncomplicated cystitis.
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Affiliation(s)
- Florian M Wagenlehner
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University, Giessen, Germany.
| | - Kurt G Naber
- Department of Urology, Technical University of Munich, Munich, Germany.
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Alidjanov JF, Pilatz A, Abdufattaev UA, Wiltink J, Weidner W, Naber KG, Wagenlehner F. [New questionnaire for the German validation of the Acute Cystitis Symptom Score]. Urologe A 2019; 56:364-366. [PMID: 28150016 DOI: 10.1007/s00120-017-0327-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J F Alidjanov
- Department of Outpatient Urology, JSC Republican Specialized Center of Urology, Tashkent, Usbekistan
| | - A Pilatz
- Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Justus-Liebig-Universität Gießen, Universitätsklinikum Gießen und Marburg GmbH, Gießen, Deutschland
| | - U A Abdufattaev
- Department of Urology, Tashkent Medical Academy, Tashkent, Usbekistan
| | - J Wiltink
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Johannes Gutenberg-Universität, Mainz, Deutschland
| | - W Weidner
- Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Justus-Liebig-Universität Gießen, Universitätsklinikum Gießen und Marburg GmbH, Gießen, Deutschland
| | - K G Naber
- Technische Universität München, München, Deutschland. .,, Karl-Bickleder-Str. 44c, 94315, Straubing, Deutschland.
| | - F Wagenlehner
- Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Justus-Liebig-Universität Gießen, Universitätsklinikum Gießen und Marburg GmbH, Gießen, Deutschland
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Ortega Martell JA, Naber KG, Milhem Haddad J, Tirán Saucedo J, Domínguez Burgos JA. Prevention of recurrent urinary tract infections: bridging the gap between clinical practice and guidelines in Latin America. Ther Adv Urol 2019; 11:1756287218824089. [PMID: 31105773 PMCID: PMC6502980 DOI: 10.1177/1756287218824089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 12/03/2018] [Indexed: 12/16/2022] Open
Abstract
The branches of the immune system work in concert to defend against pathogens and
prevent tissue damage due to excessive inflammation. Uropathogens in general,
and uropathogenic Escherichia coli (UPEC) in particular, have
evolved a diverse range of virulence mechanisms to avoid detection and
destruction by the mucosal immune system of the urinary tract. Research towards
a vaccine active against UPEC continues but has yet to be successful. Orally
administered immunomodulatory bacterial lysates both stimulate and modulate the
immune response in the urinary tract via the integrated mucosal
immune system. The 2018 European Association of Urology (EAU) guidelines on
treating acute uncomplicated cystitis recommend aiming for rapid resolution of
symptoms, reduction of morbidity, and prophylaxis against reinfection.
Recommended short-term antibiotic therapy has the advantage of good compliance,
low cost, few adverse events, and low impact on bacterial flora. Antibiotic
treatment of asymptomatic bacteriuria is only indicated during pregnancy and
before invasive interventions. For recurrent infection, prophylaxis using
behavioral modification and counseling should be employed first, then
nonantibiotic prophylaxis, and, finally, low-dose continuous or postcoital
antibiotic prophylaxis. The 2018 EAU guidelines give a strong recommendation for
the oral bacterial lysate immunomodulator OM-89. All other nonantibiotic
prophylactic strategies require more data, except for topical estrogen for
postmenopausal women. For last-resort antibiotic prophylaxis, nitrofurantoin or
fosfomycin trometamol are recommended. Guidelines for Latin America are
currently being drafted, taking into account the unique ethnicity, availability
of medicines, prevalence of antibiotic resistance, and healthcare practices
found throughout the region.
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Affiliation(s)
- José Antonio Ortega Martell
- Universidad Autónoma del Estado de Hidalgo, Carr. Pachuca - Actopan, Campo de Tiro, 42039, Pachuca de Soto, Mexico
| | | | | | - José Tirán Saucedo
- Instituto Mexicano de Infectología, Ginecología y Obstetricia, Universidad de Monterrey, Monterrey, Mexico
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Alidjanov JF, Naber KG, Pilatz A, Radzhabov A, Zamuddinov M, Magyar A, Tenke P, Wagenlehner FM. Evaluation of the draft guidelines proposed by EMA and FDA for the clinical diagnosis of acute uncomplicated cystitis in women. World J Urol 2019; 38:63-72. [PMID: 31004204 PMCID: PMC6954149 DOI: 10.1007/s00345-019-02761-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/04/2019] [Indexed: 12/18/2022] Open
Abstract
Purpose To reassess the diagnostic values of the “draft” guidelines for the clinical diagnosis of acute uncomplicated cystitis (AC), recently proposed by US Food and Drug Administration (FDA) and European Medicines Agency (EMA). Methods The data of 517 female respondents (patients with acute cystitis and controls) derived from the e-USQOLAT database were analyzed and used for the validation of proposed “draft” guidelines of FDA and EMA, compared to the Acute Cystitis Symptom Score (ACSS) questionnaire. The diagnostic values of the proposals concerning signs, symptoms and their severity were assessed and compared. Results The six “typical” symptoms of the ACSS were strongly associated with the diagnosis of AC. The number of positive “typical” symptoms differed significantly between patients and controls: median 5 (IQR 4–6) vs 1 (IQR 0–3) respectively. Scored severity of “typical” symptoms also differed significantly between groups of patients and controls: median (IQR) 10 (7–13) vs 1 (0–4), respectively. The best balance between sensitivity and specificity is shown by the ACSS cut-off value of 6 scores and more of the “Typical” domain, followed by an approach proposed by FDA and EMA, justifying ACSS to be used as a diagnostic criterion for the clinical diagnosis of AC. Conclusions Not only the presence but also the severity of the symptoms is important for an accurate diagnosis of AC. The ACSS, even without urinalysis is at least as favourable as the draft diagnostic proposals by FDA and EMA. The ACSS can be recommended for epidemiological and interventional studies, and allows women to establish self-diagnosis of AC, making the ACSS also cost-effective for healthcare. Electronic supplementary material The online version of this article (10.1007/s00345-019-02761-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jakhongir F Alidjanov
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University, Rudolph-Buchheim Str.7, 35392, Giessen, Germany.
| | | | - Adrian Pilatz
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University, Rudolph-Buchheim Str.7, 35392, Giessen, Germany
| | - Abdukhamid Radzhabov
- Treatment and Diagnostic Center "Olami Tib", J.Rasulov 29 Street., 734060, Dushanbe, Tajikistan.,Sankt-Katharinen Hospital, Seckbacher Landstr. 65E, 60389, Frankfurt, Germany
| | | | - András Magyar
- Department of Urology, Jahn Ferenc South Pest Teaching Hospital, Köves út 1, Budapest, 1204, Hungary
| | - Peter Tenke
- Department of Urology, Jahn Ferenc South Pest Teaching Hospital, Köves út 1, Budapest, 1204, Hungary
| | - Florian M Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University, Rudolph-Buchheim Str.7, 35392, Giessen, Germany
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Magri V, Boltri M, Cai T, Colombo R, Cuzzocrea S, De Visschere P, Giuberti R, Granatieri CM, Latino MA, Larganà G, Leli C, Maierna G, Marchese V, Massa E, Matteelli A, Montanari E, Morgia G, Naber KG, Papadouli V, Perletti G, Rekleiti N, Russo GI, Sensini A, Stamatiou K, Trinchieri A, Wagenlehner FME. Multidisciplinary approach to prostatitis. ACTA ACUST UNITED AC 2019; 90:227-248. [PMID: 30655633 DOI: 10.4081/aiua.2018.4.227] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Indexed: 01/01/2023]
Abstract
The modern clinical research on prostatitis started with the work of Stamey and coworkers who developed the basic principles we are still using. They established the segmented culture technique for localizing the infections in the males to the urethra, the bladder, or the prostate and to differentiate the main categories of prostatitis. Such categories with slight modifications are still used according to the NIH classification: acute bacterial prostatitis, chronic bacterial prostatitis, Chronic Pelvic Pain Syndrome (CPPS) and asymptomatic prostatitis. Prostatic inflammation is considered an important factor in influencing both prostatic growth and progression of symptoms of benign prostatic hyperplasia and prostatitis. Chronic inflammation/neuroinflammation is a result of a deregulated acute phase response of the innate immune system affecting surrounding neural tissue at molecular, structural and functional levels. Clinical observations suggest that chronic inflammation correlates with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and benign prostatic hyperplasia (BPH) and an history of clinical chronic prostatitis significantly increases the odds for prostate cancer. The NIHNIDDK classification based on the use of the microbiological 4- glasses localization test or simplified 2-glasses test, is currently accepted worldwide. The UPOINT system identifies groups of clinicians with homogeneous clinical presentation and is used to recognize phenotypes to be submitted to specific treatments. The UPOINTS algorithm implemented the original UPOINT adding to the urinary domains (U), psycho-social (P), organspecific (O), infection (I), neurological (N), muscle tension and tenderness (T) a further domain related to sexuality (S). In fact sexual dysfunction (erectile, ejaculatory, libido loss) has been described in 46-92% of cases with a high impact on the quality of life of patients with CP/CPPS. Prostatic ultrasound represents the most popular imaging test in the work-up of either acute and chronic prostatitis although no specific hypo-hyperechoic pattern has been clearly associated with chronic bacterial prostatitis and CPPS. Use of a digital-processing software to calculate the extension of prostatic calcification area at ultrasound demonstrated a higher percentage of prostatic calcification in patients with chronic bacterial prostatitis. Multiparametric Magnetic Resonance Imaging (mpMRI) is the current state-of-the art imaging modality in the assessment of patients with prostate cancer although a variety of benign conditions, including inflammation, may mimic prostate cancer and act as confounding factors in the discrimination between neoplastic and non-neoplastic lesions. Bacteria can infect prostate gland by: ascending the urethra, reflux of urine into the prostatic ducts, direct inoculation of bacteria through inserted biopsy needles or hematogenous seeding. Enterobacteriaceae are the predominant pathogens in acute and chronic bacterial prostatitis, but an increasing role of Enterococci has been reported. Many strains of these uropathogens exhibit the ability to form biofilm and multidrug- resistance. Sexually Transmitted Infections (STI) agents, in particular Chlamydia trachomatis and Mycoplasma genitalium, have been also considered as causative pathogens of chronic bacterial prostatitis. On the contrary the effective role in genital diseases of other "genital mycoplasmas" is still a much debated issue. Sexually Transmitted Infections agents should be investigated by molecular methods in both patient and sexual partner. "Next generation" investigations, such as cytokine analysis, cytological typing of immune cells could help stratifying the immune response. Epigenetic dysregulation of inflammatory factors should be investigated according to systemic and compartment-specific signals. The search for biomarkers should also include evaluation of hormonal pathways, as measurement of estrogen levels in semen. Antimicrobials are the first line agents for the treatment of bacterial prostatitis. The success of antimicrobial treatment depends on the antibacterial activity and the pharmacokinetic characteristics of the drug which must reach high concentrations in prostate secretion and prostate tissue. Acute bacterial prostatitis can be a serious infection with a potential risk for urosepsis For iInitial treatment of severely ill patients, intravenous administration of high doses of bactericidal antimicrobials, such as broad-spectrum penicillins, third-generation cephalosporins or fluoroquinolones, is recommended in combination with an aminoglycoside. Use of piperacillin-tazobactam and meropenem is justified in presence of multiresistant gramnegative pathogens. The antibiotic treatment of chronic prostatitis is currently based on the use of fluoroquinolones that, given for 2 to 4 weeks, cured about 70% of men with chronic bacterial prostatitis. For the treatment of Chlamydial prostatitis macrolides were shown to be more effective than fluoroquinolones, whereas no differences were observed in microbiological and clinical efficacy between macrolides and tetracyclines for the treatment of infections caused by intracellular pathogens. Aminoglycosides and fosfomycin could be considered as a therapeutic alternative for the treatment of quinolone resistant prostatitis. Use of alpha-blockers in CP/CPPS patients with urinary symptoms and analgesics +/- non steroidal anti-inflammatory drugs (NSAID), in presence of pain demonstrated a reduction of symptoms reduction and an improvement of quality of life, although long term use of NSAID is limited by side effect profile. However, the multimodal therapeutic regimen by contemporary use of alphablockers, antibiotics and anti-inflammatory showed a better control of prostatitis symptoms than single drug treatment. Novel therapeutic substances for the treatment of pain, such as the cannabinoid anandamide would be highly interesting to test. An alternative for the treatment of chronic prostatitis/chronic pelvic pain syndrome is phytotherapy, as primary therapy or in association with other drugs. Quercetin, pollen extract, extract of Serenoa repens and other mixtures of herbal extracts showed a positive effect on symptoms and quality of life without side effects. The association of CP/CPPS with alterations of intestinal function has been described. Diet has its effects on inflammation by regulation of the composition of intestinal flora and direct action on the intestinal cells (sterile inflammation). Intestinal bacteria (microbiota) interacts with food influencing the metabolic, immune and inflammatory response of the organism. The intestinal microbiota has protective function against pathogenic bacteria, metabolic function by synthesis of vitamins, decomposition of bile acids and production of trophic factors (butyrate), and modulation of the intestinal immune system. The alteration of the microbiota is called "dysbiosis" causing invasive intestinal diseases pathologies (leaky gut syndrome and food intolerances, irritable bowel syndrome or chronic inflammatory bowel diseases) and correlating with numerous systemic diseases including acute and chronic prostatitis. Administration of live probiotics bacteria can be used to regulate the balance if intestinal flora. Sessions of hydrocolontherapy can represent an integration to this therapeutic approach. Finally, microbiological examination of sexual partners can offer supplementary information for treatment.
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Wagenlehner FME, Naber KG. Cefiderocol for treatment of complicated urinary tract infections. Lancet Infect Dis 2019; 19:22-23. [PMID: 30587289 DOI: 10.1016/s1473-3099(18)30722-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 11/12/2018] [Indexed: 01/16/2023]
Affiliation(s)
- Florian M E Wagenlehner
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, 35390 Giessen, Germany.
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Naber KG, Wagenlehner FM. Novel Antibiotics in the Treatment of Urinary Tract Infections. Eur Urol Focus 2019; 5:10-12. [DOI: 10.1016/j.euf.2018.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022]
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Storme O, Tirán Saucedo J, Garcia-Mora A, Dehesa-Dávila M, Naber KG. Risk factors and predisposing conditions for urinary tract infection. Ther Adv Urol 2019; 11:1756287218814382. [PMID: 31105772 PMCID: PMC6502981 DOI: 10.1177/1756287218814382] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 10/27/2018] [Indexed: 12/16/2022] Open
Abstract
Understanding individual and population-specific risk factors associated with recurrent urinary tract infections (UTIs) can help physicians tailor prophylactic strategies. Frequent intercourse, vulvovaginal atrophy, change of the local bacterial flora, history of UTIs during premenopause or in childhood, family history, and a nonsecretor blood type are substantiated risk factors for recurrent uncomplicated UTIs. This is a narrative review based on relevant literature according to the experience and expertise of the authors. Asymptomatic bacteriuria is generally benign; however, during pregnancy it is more common and is associated with an increased likelihood of symptomatic infection, which may harm the mother or fetus. Screening of pregnant women and appropriate treatment with antimicrobials must be balanced with the potential for adverse treatment-related outcomes; appropriate prophylaxis should be considered where possible. High-quality data are currently lacking on risks related to asymptomatic bacteriuria in pregnancy and further data in this hard-to-study population should be a primary concern for researchers. Incomplete voiding represents the primary risk factor for UTIs associated with conditions such as urinary incontinence and prolapse. Correcting the presence of residual urine remains the most effective prophylaxis in these populations. Bladder function alters throughout life; however, changes in function may be particularly profound in clinical populations at high risk of UTIs. Patients with neurogenic bladder will also likely have other evolving medical issues which increase the risk of UTIs, such as repeated catheterization and increasing residual urine volume. More aggressive antimicrobial prophylactic strategies may be appropriate in these patients. Again, the paucity of data on prophylaxis in these high-risk patients requires the attention of the research community.
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Affiliation(s)
- Oscar Storme
- Padre Hurtado Hospital, Universidad del
Desarrollo, Calle Esperanza 2150, Paradero 28, Santa Rosa, San Ramón,
Chile
| | - José Tirán Saucedo
- Instituto Mexicano de Infectología, Ginecología
y Obstetrica, Universidad de Monterrey, Monterrey, Mexico
| | - Arturo Garcia-Mora
- Instituto Nacional de Ciencias Médicas y
Nutrición Salvador Zubirán, Mexico City, Mexico
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Loose M, Naber KG, Hu Y, Coates A, Wagenlehner FM. Serum bactericidal activity of colistin and azidothymidine combinations against mcr-1-positive colistin-resistant Escherichia coli. Int J Antimicrob Agents 2018; 52:783-789. [DOI: 10.1016/j.ijantimicag.2018.08.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 08/07/2018] [Accepted: 08/12/2018] [Indexed: 11/30/2022]
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Alidjanov JF, Naber KG, Abdufattaev UA, Pilatz A, Wagenlehner FM. Reliability of Symptom-Based Diagnosis of Uncomplicated Cystitis. Urol Int 2018; 102:83-95. [PMID: 30419565 DOI: 10.1159/000493509] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 09/03/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Acute uncomplicated cystitis (AC) is common among women. Acute onset of specific typical symptoms may serve as reliable criteria for developing a cost-effective strategy to make an accurate diagnosis of AC. We aimed to evaluate the diagnostic values of most common symptoms and signs of AC depending on their presence and severity. METHODS The current trial was designed as a case-control study. Data derived from the Acute Cystitis Symptom Score (ACSS) database were analyzed. Diagnostic values of the symptoms and their severity were assessed via the calculations of the sensitivity and specificity, odds ratio, positive and negative likelihood ratios. The strength of associations was estimated by the coefficient of correlation (Pearson's R). RESULTS Data from 819 female subjects (423 Patients, 396 controls) with the mean age of 37.1 ± 15.3 were analyzed. Highest diagnostic values for AC in this study belonged to dysuria, urgency, and frequency. Interestingly, complaints of vaginal discharge was not found to decrease the odds for having AC in the study population. CONCLUSIONS The severity of the symptom is even more essential than just its presence for an accurate diagnosis. The ACSS is an accurate tool and may be recommended for clinical practice and studies for diagnosis of AC in women. Further studies and unification of terms are need.
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Affiliation(s)
- Jakhongir F Alidjanov
- Clinic of Urology, Paediatric Urology and Andrology, Justus-Liebig-University, Giessen, Germany,
| | | | - Ulugbek A Abdufattaev
- State Institution "Republican Specialized Scientific-Practical Medical Center of Urology, Tashkent, Uzbekistan
| | - Adrian Pilatz
- Clinic of Urology, Paediatric Urology and Andrology, Justus-Liebig-University, Giessen, Germany
| | - Florian M Wagenlehner
- Clinic of Urology, Paediatric Urology and Andrology, Justus-Liebig-University, Giessen, Germany
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Wagenlehner FM, Abramov-Sommariva D, Höller M, Steindl H, Naber KG. Non-Antibiotic Herbal Therapy (BNO 1045) versus Antibiotic Therapy (Fosfomycin Trometamol) for the Treatment of Acute Lower Uncomplicated Urinary Tract Infections in Women: A Double-Blind, Parallel-Group, Randomized, Multicentre, Non-Inferiority Phase III Trial. Urol Int 2018; 101:327-336. [PMID: 30231252 DOI: 10.1159/000493368] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 08/28/2018] [Indexed: 01/10/2023]
Abstract
INTRODUCTION This randomized, controlled, Phase III non-inferiority clinical trial aimed to determine whether herbal therapy with Canephron® N (BNO 1045) is non-inferior to fosfomycin trometamol (FT) in treating acute lower uncomplicated urinary tract infections (uUTIs). MATERIALS AND METHODS Women aged 18-70 years with typical symptoms of newly diagnosed acute lower uUTIs were randomized to BNO 1045 (n = 325) or FT (n = 334), with corresponding matched placebo. The primary endpoint was the proportion of patients who received additional antibiotics (ABs) to treat uUTIs between Days 1 and 38 ±3. RESULTS Between Days 1 and 38, 238 (83.5%) patients in the BNO 1045 group and 272 (89.8%) patients in the FT group received no additional ABs. At a 15% non-inferiority margin, BNO 1045 was non-inferior to FT in treating uUTIs (non-AB rate difference: -6.26%; 95% CI -11.99 to -0.53%; 2-sided p = 0.0014). Adverse event rates were similar between groups, with higher rates of gastrointestinal disorders in the FT group and pyelonephritis in the BNO 1045 group. During the trial, no patient died or discontinued due to a treatment-related adverse event. CONCLUSIONS BNO 1045 has the potential to reduce outpatient use of ABs for uUTIs and thus may have a significant impact on antimicrobial stewardship strategies. TRIAL REGISTRATION NCT02639520, EudraCT number 2013-004529-99.
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Affiliation(s)
- Florian M Wagenlehner
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University, Giessen, Germany
| | | | | | | | - Kurt G Naber
- Technical University of Munich, Straubing, Germany
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Alidjanov JF, Naber KG, Abdufattaev UA, Pilatz A, Wagenlehner FM. Reevaluation of the Acute Cystitis Symptom Score, a Self-Reporting Questionnaire. Part II. Patient-Reported Outcome Assessment. Antibiotics (Basel) 2018; 7:E43. [PMID: 29883423 PMCID: PMC6022869 DOI: 10.3390/antibiotics7020043] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 05/12/2018] [Accepted: 05/16/2018] [Indexed: 11/16/2022] Open
Abstract
This study aimed to reevaluate the Acute Cystitis Symptom Score (ACSS). The ACSS is a self-reporting questionnaire for the clinical diagnosis of acute uncomplicated cystitis (AC) and the assessment of symptomatic changes after therapy in female patients with AC. The part II of the present study was to reevaluate the utility of the different domains of the ACSS after therapy. The applicability of these domains in assessing changes in symptoms, as a function of time, in this population was investigated. The ACSS was evaluated in 48 female patients (mean age 31.1 ± 10.6) in the Uzbek and Russian languages, who returned after therapy and filled in part B of the ACSS, which corresponds to part A with the additional “Dynamics” domain. Descriptive statistics were used, where suitable. The reduction of typical symptoms and quality of life assessment between first and follow-up visit correlated significantly with answers in the “Dynamics” domain. Success/Cure and Non-success/Failure could be clearly differentiated by the scores obtained in “Typical” and “Quality of Life” domains. The ACSS has proven to be a useful instrument to clinically diagnose AC in women. It is also a suitable instrument for patient-reported outcome measures, with applicability both in daily practice and clinical studies. Slight modifications in the “Dynamics” domain will even increase the applicability.
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Affiliation(s)
- Jakhongir F Alidjanov
- State Institution "Republican Specialized Scientific-Practical Medical Center of Urology", Tashkent 100109, Uzbekistan.
- Clinic of Urology, Pediatric Urology, and Andrology, Justus Liebig University, 35392 Giessen, Germany.
| | - Kurt G Naber
- Department of Urology, School of Medicine, Technical University of Munich, 80333 Munich, Germany.
| | - Ulugbek A Abdufattaev
- State Institution "Republican Specialized Scientific-Practical Medical Center of Urology", Tashkent 100109, Uzbekistan.
| | - Adrian Pilatz
- Clinic of Urology, Pediatric Urology, and Andrology, Justus Liebig University, 35392 Giessen, Germany.
| | - Florian M Wagenlehner
- Clinic of Urology, Pediatric Urology, and Andrology, Justus Liebig University, 35392 Giessen, Germany.
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Wagenlehner F, Wullt B, Ballarini S, Zingg D, Naber KG. Social and economic burden of recurrent urinary tract infections and quality of life: a patient web-based study (GESPRIT). Expert Rev Pharmacoecon Outcomes Res 2017; 18:107-117. [PMID: 28737469 DOI: 10.1080/14737167.2017.1359543] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Uncomplicated lower urinary tract infections (UTIs) occur in approximately 50% of women, and 20-30% experience recurrent UTI. Data on UTIs and quality of life (QoL) in Europe are limited. METHODS This was an anonymous, self-administered web-based survey conducted in 5 countries (Germany, Switzerland, Poland, Russia and Italy), on adult women who had experienced recurrent UTI and were affected by acute UTI currently or within 4 weeks of study entry. Questions covered disease course; management; social and economic burden; education, income, and health insurance status. QoL was evaluated using the SF-12v2. RESULTS Participants reported a mean of 5.15 UTI symptoms, ranging from 4.85 - 5.38 in Russia and Germany. There was a mean of 2.78 doctor visits per year (1.74 - 3.71 in Russia and Germany; p < 0.0001). 80.3% of participants had been treated with antibiotics, mean prescriptions ranged from 2.17 (Poland) to 3.36 (Germany) per person per year. A mean of 3.09 days sick leave due to UTIs, and 3.45 days of limited activities, were reported. Although 73.8% of participants had tried prophylaxis recurrence was common and associated with mental stress for a high proportion of women. CONCLUSIONS Our results indicate that recurrent UTIs have a significant impact on QoL of women in Europe.
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Affiliation(s)
- Florian Wagenlehner
- a Clinic for Urology, Pediatric Urology and Andrology , Justus-Liebig University , Giessen , Germany
| | - Björn Wullt
- b Section of MIG , Lund University , Lund , Sweden
| | | | | | - Kurt G Naber
- d Technical University of Munich , Munich , Germany
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Wagenlehner FME, Naber KG. A new way to prevent urinary tract infections? The Lancet Infectious Diseases 2017; 17:467-468. [DOI: 10.1016/s1473-3099(17)30107-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 02/10/2017] [Indexed: 01/09/2023]
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Naber KG, Kogan M, Wagenlehner FME, Siener R, Gessner A. How the microbiome is influenced by the therapy of urological diseases: standard versus alternative approaches. Clin Phytosci 2017. [DOI: 10.1186/s40816-017-0045-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Kranz J, Helbig S, Mandraka F, Schmidt S, Naber KG. The revival of old antibiotics for treatment of uncomplicated urinary tract infections in the era of antibiotic stewardship. Curr Opin Urol 2017; 27:127-132. [DOI: 10.1097/mou.0000000000000365] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Magyar A, Alidjanov J, Pilatz A, Nagy K, Arthanareeswaran VKA, Póth S, Bécsi A, Wagenlehner FME, Naber KG, Tenke P, Köves B. The role of the Acute Cystitis Symptom Score questionnaire for research and antimicrobial stewardship. Validation of the Hungarian version. Cent European J Urol 2017; 71:134-141. [PMID: 29732220 PMCID: PMC5926636 DOI: 10.5173/ceju.2018.1530] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 01/17/2018] [Accepted: 01/20/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction The Acute Cystitis Symptom Score (ACSS) is a new self-reporting tool to evaluate the symptoms of uncomplicated acute cystitis (AC) in women. The linguistic and clinical validation process of the Hungarian version used in this study may serve as a guide for the validation of the ACSS in other languages. Material and methods In this prospective cohort study, women with AC (Patients) and those without (Controls) filled in the Hungarian ACSS version, during their visits to physician's office. Statistical analysis included ordinary descriptive values, calculation of reliability, validity, discriminative ability, responsiveness (sensitivity, specificity) and comparative analysis. Results Thirty-one patients were recruited for validation along with 37 controls. Statistical analyses resulted in excellent values of internal consistency, discriminative ability and validity for diagnosis of AC. At the cut-off at a score of 6 in the 'typical' domain, positive and negative predictive values were 97% and 92%, sensitivity and specificity were 90% and 97%, respectively. Conclusions The ACSS has demonstrated benefits for diagnosis and patient-reported outcome assessment. It is objective, fast, and cost-effective, and may help to easily confirm the accurate diagnosis of AC. Therefore, it may be especially important for clinical and epidemiological studies on AC in women.
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Affiliation(s)
- András Magyar
- Department of Urology, Jahn Ferenc South Pest Teaching Hospital, Köves, Hungary
| | - Jakhongir Alidjanov
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University, Giessen, Germany
| | - Adrian Pilatz
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University, Giessen, Germany
| | - Károly Nagy
- Department of Urology, Jahn Ferenc South Pest Teaching Hospital, Köves, Hungary
| | | | - Sándor Póth
- Department of Urology, Jahn Ferenc South Pest Teaching Hospital, Köves, Hungary
| | - András Bécsi
- Department of Urology, Jahn Ferenc South Pest Teaching Hospital, Köves, Hungary
| | - Florian M E Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University, Giessen, Germany
| | | | - Péter Tenke
- Department of Urology, Jahn Ferenc South Pest Teaching Hospital, Köves, Hungary
| | - Béla Köves
- Department of Urology, Jahn Ferenc South Pest Teaching Hospital, Köves, Hungary
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Abrahamian FM, Aldape MJ, Aldasoro E, Allen UD, Al-Sum H, Anadkat MJ, Anders K, Angelakis E, Angus BJ, Antoniadou A, Arena F, Arends JE, Arribas JR, Artenstein AW, Atherton JC, Aucott JN, Aw TC, Babcock HM, Bailey R, Bailey TC, Banks AZ, Barillo DJ, Barrette EP, Bauer MP, Bayston R, Beard CB, Beardsley J, Beeching NJ, Bégué RE, Beldi G, Benson CA, Berbari EF, Berenger JM, Berger C, Bernardino JI, Bille J, Billioux AC, Bitnun A, Blair I, Blanche S, Bleck TP, Bleeker-Rovers CP, Bleijenberg G, Bloch KC, Blum J, Blumberg EA, Bonomo RA, Bonten MJ, Bourayou R, Bouza E, Brandt KA, Bretelle F, Brisse S, Britton WJ, Brook I, Brouwer MC, Browne SK, Bryant AE, Bühler S, Bulger EM, Buller RML, Burke LA, Burri C, Butler MW, Calandra T, Calfee DP, Calvo-Cano A, Cameron DW, Carcillo JA, Carson G, Chambers ST, Charrel RN, Nguyen VCV, Chevaliez S, Chiller TM, Christaki E, Chung KK, Clifford DB, Clumeck N, Cohen J, Collinge J, Conlon CP, Conrad C, Cooke FJ, Cope JR, Corey GR, Cross JH, Cunha BA, Cunha CB, D'Journo B, Daikos GL, Daniels JM, Davidson RN, Day NP, De Cock KM, de Silva TI, de Vries HJ, de Wit S, Delaloye J, Denning DW, Dennis DT, Dhanireddy S, Dielubanza EJ, Diemert DJ, Doganay M, Doherty T, Dolecek C, Dondorp AM, Douglas A, Drancourt M, Dubourg G, Dudley MN, Durand G, Eckhardt BJ, Efstratiou A, Ekkelenkamp MB, Eranki A, Erdem H, Escota GV, Evans HL, Eziefula AC, Fenollar F, Fenwick A, Fierer J, Finch RG, Fleckenstein JM, Forstner C, Foschi F, Fournier PE, French MA, Gage KL, Garcia LS, Gascon J, Gastañaduy AS, Gautret P, Geisler WM, Ghanem KG, Giani T, Giannella M, Gilliam BL, Gilliet M, Glaser CA, Glupczynski Y, Gnann JW, Goldstein EJ, Gottstein B, Gouriet F, Gravitt PE, Green MD, Green ST, Groll AH, Gulick RM, Gupta A, Habib G, Harbarth S, Harris M, Hayden FG, Hetem DJ, Hill PC, Hirschel B, Hodowanec AC, Hoffart L, Hoffmann C, Holland SM, Horby PW, Horne DJ, Hraiech S, Hull MW, Huttner A, Ingram RJ, Islam J, Ison MG, James SH, Jenkins C, Jenkins SG, Jensen JS, Johnston C, Jones TB, Jordan SJ, Julian KG, Kato Y, Kauffman CA, Kaye KS, Keane MP, Keeney J, Kelly P, Kent SJ, Kern WV, Keynan Y, Kim AA, Koné-Paut I, Kosmidis C, Kroes AC, Kroon FP, Ksiazek TG, Kuhlmann FM, Kuijper EJ, Kwon JH, Kyei GB, Lacombe K, Lagacé-Wiens P, Lagier JC, Lamagni T, Landraud L, Lanternier F, LaPlante KL, Lawn SD, Lawrence SJ, Leblebicioglu H, Lee N, Leggett JE, Lehours P, Levy PY, Leyh RG, Lillis RA, Limmathurotsakul D, Lin J, Lindquist HA, Lipsky BA, Liscynesky C, Looney D, Lortholary O, Lowy FD, Luft BJ, Mackowiak PA, MacPherson PA, Maghraoui-Slim V, Mallon PW, Mangino JE, Manuel O, Marchetti O, Marks KM, Marr KA, Marrazzo J, Marschall J, Martin DH, Matonti F, Matulewicz RS, Mayer KH, McCulloh RJ, McGready R, Mdodo R, Mead S, Mégraud F, Meintjes G, Metcalf SC, Michaels MG, Migliori GB, Miles MA, Miller A, Mimiaga MJ, Mingeot-Leclercq MP, Misch EA, Mitreva M, Montaner JS, Moore CB, Muñoz P, Muñoz J, Murray CK, Musso D, Mutengo M, Mutizwa MM, Naber KG, Natarajan P, Neme S, Newton PN, Nichols RA, Nicolle LE, Nosten F, Notarangelo LD, Nutman TB, Nyirjesy P, O'Connell PR, Opal SM, Ormerod LP, Osmon DR, Pankert MB, Pantaleo G, Papazian L, Parente DM, Parola P, Parsaei S, Pascual MA, Patel R, Patrozou E, Pawlotsky JM, Peacock SJ, Pechère JC, Pelegrin I, Peters BS, Peters EJ, Petersen JM, Petersen LR, Petraitis V, Pham LL, Picado A, Pilatz A, Pilmis B, Pinazo MJ, Pletz MW, Pogue JM, Polgreen EL, Polgreen PM, Posfay-Barbe KM, Powderly WG, Presti R, Prod'hom G, Puolakkainen M, Quinn TC, Raoult D, Razonable RR, Read RC, Redfield RR, Rentenaar RJ, Reynolds SJ, Ribi C, Richardson MD, Ritter ML, Roch A, Rockstroh JK, Rojek A, Romero JR, Rooijakkers SH, Rosenbluth D, Rosenzweig SD, Rossolini GM, Rubinstein E, Ryan G, Safren SA, Sahasrabuddhe VV, Saikku PA, Sajadi MM, Salvaggio MR, Santos CA, Satlin MJ, Schaeffer AJ, Schimmer C, Schooley RT, Schumacher RF, Sha BE, Shapiro DS, Sheehan G, Shlaes DM, Shoham S, Simmons CP, Simon DW, Simon MS, Simonsen KA, Slack MP, Smith TT, Sobel JD, Souli M, Sridhar S, Steckelberg JM, Stevens DL, Strah H, Sturm AW, Sungkanuparph S, Tabrizi SJ, Tacconelli E, Tan CS, Taplitz RA, Thomas G, Thomas LD, Thuny F, Thwaites G, Tissot F, Tønjum T, Torriani FJ, Toso C, Tulkens PM, Tunkel AR, Turner CE, Ustianowski AP, van Bambeke F, van Crevel R, van de Beek D, van Delden C, van der Eerden MM, van der Meer JW, van der Poll T, van Ingen J, van Putten J, Vaudaux BP, Vermund SH, Viscidi RP, Visvanathan K, Visvesvara GS, von Seidlein L, Wagenlehner FM, Wald A, Walsh TJ, Warhurst DC, Warnock DW, Warrell DA, Warrell MJ, Warris A, Watkins RR, Weatherall DJ, Weber R, Weidner W, White JR, White PJ, Whitehorn J, Whitley RJ, Whitty CJ, Wiersinga WJ, Wilcox MH, Williams TN, Wilson CC, Wilson ME, Wisplinghoff H, Wood R, Wunderink RG, Wyles D, Yang ZT, Yoder JS, Zaidi NA, Zimmer AJ, Zuckerman JN, Zumla A. List of Contributors. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00234-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Alidjanov JF, Abdufattaev UA, Makhsudov SA, Pilatz A, Akilov FA, Naber KG, Wagenlehner FME. The Acute Cystitis Symptom Score for Patient-Reported Outcome Assessment. Urol Int 2016; 97:402-409. [PMID: 27591987 DOI: 10.1159/000448591] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 07/12/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The Acute Cystitis Symptom Score (ACSS) was developed as a self-reporting questionnaire for clinical diagnosis of acute uncomplicated cystitis (AUC) and symptomatic changes in female patients. The aim of the present study was to assess the utility of the different domains of ACSS including the 'dynamics' domain after therapy. The applicability of these domains in assessing changes in symptoms, as a function of time, in this population was investigated. MATERIALS AND METHODS During the validation process of the ACSS in Uzbek and Russian languages, a subgroup of patients (n = 63) returned after therapy and filled in part B of ACSS. Descriptive statistics were used, where suitable. RESULTS The reduction of typical symptoms and quality of life (QoL) assessment between first and follow-up visit correlated significantly with answers in the 'dynamics' domain. Success/cure and non-success/failure could be clearly differentiated by the scores obtained in 'typical' and 'QoL' domains. CONCLUSION The ACSS has proven to be a useful instrument to clinically diagnose AUC in women. It is also a suitable instrument for patient-reported outcome assessment, with applicability in both daily practice and in clinical studies. Slight modifications in the 'dynamics' domain will even increase the applicability.
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Affiliation(s)
- Jakhongir F Alidjanov
- Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
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Naber KG, Alidjanov JF. [Are there alternatives to antimicrobial therapy and prophylaxis of uncomplicated urinary tract infections?]. Urologiia 2016:37-44. [PMID: 28247617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The acute uncomplicated cystitis in women is one of the most frequently diagnosed bacterial infection. A clinically symptomatic urinary tract infection must be differentiated from the asymptomatic bacteriuria, which is not considered an infection but rather a colonization which should not be treated. For the antimicrobial therapy according to the European guidelines the old oral antibiotics (fosfomycin trometamol, nitrofurantoin, pivmecillinam) should be prescribed, against which E. coli is still susceptible in over 90%. With new therapeutic concepts not mainly the elimination of bacteria but rather the treatment of the inflammatory (over)reaction of the host is highlighted. To establish the significance of these therapeutic options as compared to the standard antibiotic therapy, the results of the ongoing and planned phase 3 studies need to be awaited. Thus reliable clinical measuring parameters for diagnostics and outcome are needed. The acute cystitis symptom score (ACSS) was developed and validated in Russian and Uzbec languages. Because of its high reliability, validity and predictive value it can be used not only in daily practice but also for clinical studies for the diagnosis of an acute uncomplicated cystitis in women.
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Affiliation(s)
- K G Naber
- Technical University of Munich, Munich, Germany
| | - J F Alidjanov
- Republican Specialized Center of Urology, Tashkent, Uzbekistan
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Alidjanov JF, Pilatz A, Abdufattaev UA, Wiltink J, Weidner W, Naber KG, Wagenlehner F. [German validation of the Acute Cystitis Symptom Score]. Urologe A 2016; 54:1269-76. [PMID: 26113302 DOI: 10.1007/s00120-015-3873-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The Uzbek version of the Acute Cystitis Symptom Score (ACSS) was developed as a simple self-reporting questionnaire to improve diagnosis and therapy of women with acute cystitis (AC). The purpose of this work was to validate the ACSS in the German language. MATERIALS AND METHODS The ACSS consists of 18 questions in four subscales: (1) typical symptoms, (2) differential diagnosis, (3) quality of life, and (4) additional circumstances. Translation of the ACSS into German was performed according to international guidelines. For the validation process 36 German-speaking women (age: 18-90 years), with and without symptoms of AC, were included in the study. Classification of participants into two groups (patients or controls) was based on the presence or absence of typical symptoms and significant bacteriuria (≥ 10(3) CFU/ml). Statistical evaluations of reliability, validity, and predictive ability were performed. ROC curve analysis was performed to assess sensitivity and specificity of ACSS and its subscales. The Mann-Whitney's U test and t-test were used to compare the scores of the groups. RESULTS Of the 36 German-speaking women (age: 40 ± 19 years), 19 were diagnosed with AC (patient group), while 17 women served as controls. Cronbach's α for the German ACSS total scale was 0.87. A threshold score of ≥ 6 points in category 1 (typical symptoms) significantly predicted AC (sensitivity 94.7%, specificity 82.4%). There were no significant differences in ACSS scores in patients and controls compared to the original Uzbek version of the ACSS. CONCLUSION The German version of the ACSS showed a high reliability and validity. Therefore, the German version of the ACSS can be reliably used in clinical practice and research for diagnosis and therapeutic monitoring of patients suffering from AC.
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Affiliation(s)
- J F Alidjanov
- Department of Outpatient Urology, JSC "Republican Specialized Center of Urology, Tashkent, Uzbekistan
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Wagenlehner FME, Naber KG. Studying ceftazidime-avibactam in selected populations. Lancet Infect Dis 2016; 16:621-623. [PMID: 27107459 DOI: 10.1016/s1473-3099(16)30025-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 03/29/2016] [Indexed: 06/05/2023]
Affiliation(s)
- Florian M E Wagenlehner
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University, 35392 Giessen, Germany.
| | - Kurt G Naber
- Department of Urology, Technical University of Munich, Munich, Germany
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Ivanov D, Abramov-Sommariva D, Moritz K, Eskötter H, Kostinenko T, Martynyuk L, Kolesnik N, Naber KG. An open label, non-controlled, multicentre, interventional trial to investigate the safety and efficacy of Canephron® N in the management of uncomplicated urinary tract infections (uUTIs). Clin Phytosci 2015. [DOI: 10.1186/s40816-015-0008-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Despite of increasing prevalence of bacterial resistance to antibiotics and possible adverse drug reactions (ADRs), uncomplicated lower urinary tract infections (uUTIs) are usually treated with antibiotics. Canephron® N, a herbal medicinal product, was now investigated for safety and efficacy in women suffering from uUTI.
Methods
In an open-label, non-randomized, multicentre clinical trial 125 Caucasian female patients suffering from uUTI with a sum score of at least 6 for the symptoms dysuria, frequency and urgency (each rated 0–4) were enrolled. Patients were treated with 3x2 tablets Canephron® N for seven days. Symptom assessment was performed by the patient on a daily basis and by the investigator at Day 0, Day 7, Day 37. Primary endpoint was the incidence of ADRs during the treatment. Secondary endpoints were clinical cure (none of the main symptoms scored as worse than mild (“1”)) on Day 7, severity of uUTI symptoms on Day 7 and Day 37, patients requiring antibiotic treatment until Day 7, duration of uUTI symptoms and patients with early recurrence. Changes in safety data (dipstick analysis of urine; analysis of blood and urine in a central laboratory) were analysed descriptively. Further post hoc analyses were performed.
Results
None of 19 adverse events within the study period was considered as drug-related or serious. The responder rate was 71.2 % on Day 7 and 85.6 % on Day 37 (FAS, N = 125) with a significant improvement of all symptoms (all: p < 0.001). Only 2.4 % of patients required antibiotics during the treatment period and none of the patients met the definition of recurrence until Day 37. The mean changes of the main symptoms on Day 7 and Day 37 compared to Day 0 were: −1.9/-2.3 (dysuria); −1.8/-2.4 (frequency); −1.6/-1.9 (urgency). Symptomatic improvement was accompanied by decreased nitrite, leukocytes as well as erythrocyte levels from Day 0 to Day 7 and Day 37.
Conclusions
This trial emphasises the safe usage and efficacious opportunity of a non-antibiotic therapy approach with Canephron® N and fully justifies a large-scale controlled clinical trial.
Trial registration
Eudra CT nr. 2011-000838-11. ClinicalTrials.gov Identifier NCT01478620
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