Cefazolin as a predictor of urinary cephalosporin activity in indicated Enterobacterales

Traditionally, cephalothin susceptibility results were used to predict the susceptibility of additional cephalosporins; however, in 2013-2014, the Clinical and Laboratory Standards Institute (CLSI) revisited this practice and determined that cefazolin is a more accurate proxy than cephalothin for uncomplicated urinary tract infections (uUTIs). Therefore, a cefazolin surrogacy breakpoint was established to predict the susceptibility of seven oral cephalosporins for Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis in the context of uUTIs. Clinical microbiology laboratories face several operational challenges when implementing the cefazolin surrogacy breakpoint, which may lead to confusion for the best path forward. Here, we review the historical context and data behind the surrogacy breakpoints, review PK/PD profiles for oral cephalosporins, discuss challenges in deploying the breakpoint, and highlight the limited clinical outcome data in this space.

A prospective, follow up study to assess guidelines compliance in uncomplicated urinary tract infection

Background and Aims:

The study was undertaken to assess the empirical antibiotic prescription in uncomplicated urinary tract infection (UTI) cases and compare them with the Indian council of medical research (ICMR) 2017 guidelines on antimicrobial use. The objective of this study was to study the compliance of prescriptions for uncomplicated UTI with respect to the guidelines recommended by ICMR and assess the success rates in terms of mean days taken to achieve symptomatic relief.

Methodology:

This study was conducted on patients (of age >16 years) presenting to the Urology, Medicine and Gynecology OPD with complaints of uncomplicated UTI over two months. Descriptive statistics were used to assess the results.

Results:

A total of 115 UTI patients were enrolled and followed up for symptomatic relief. 67 (58.26%) patients were prescribed antibiotics, the preferred ones were levofloxacin 500 mg O.D. in 24 (35.82%), nitrofurantoin 100 mg B.D. in 21 (31.34%) and levofloxacin 750 mg O.D. in 6 (8.95%) patients for a mean duration of 7.83 ± 2.37, 7.52 ± 2.68 and 4.33 ± 1.03 days respectively. Symptomatic relief was seen in 6 (25%), 15 (71.42%) and 4 (66.67%) cases within 5 ± 0.63 days, 4.2 ± 2.11 days and 4.5 ± 1 days, respectively.

Discussion:

23 (34.32%) prescriptions based on choice of empirical antibiotic and 17 (25.37%) prescriptions based on both choice of antibiotic and duration of therapy were found to be compliant with the (ICMR) -2017 guidelines. Results show decreased efficacy of co-trimoxazole and ciprofloxacin as empirical therapy for acute uncomplicated UTI.

Pathophysiology, Treatment, and Prevention of Catheter-Associated Urinary Tract Infection

Urinary tract infections (UTIs) are among the most common microbial infections in humans and represent a substantial burden on the health care system. UTIs can be uncomplicated, as when affecting healthy individuals, or complicated, when affecting individuals with compromised urodynamics and/or host defenses, such as those with a urinary catheter. There are clear differences between uncomplicated UTI and catheter-associated UTI (CAUTI) in clinical manifestations, causative organisms, and pathophysiology. Therefore, uncomplicated UTI and CAUTI cannot be approached similarly, or the risk of complications and treatment failure may increase. It is imperative to understand the key aspects of each condition to develop successful treatment options and improve patient outcomes. Here, we will review the epidemiology, pathogen prevalence, differential mechanisms used by uropathogens, and treatment and prevention of uncomplicated UTI and CAUTI.

Efficacy of Additional Solifenacin Succinate Therapy for Storage Symptoms in Females with Uncomplicated Lower Urinary Tract Infection: The SOLUTION Randomized Controlled Trial

BACKGROUND

urinary tract infection (UTI) is often treated in daily practice as overactive bladder (OAB) by giving anticholinergic, the recommended treatment options of OAB. However, anticholinergic application for UTI symptoms relief has never been investigated. To our knowledge, this study was the first randomized trial which investigate anticholinergic use for UTI treatment. This study aimed to evaluate whether additional anticholinergic is beneficial alongside an empiric antibiotic therapy in reducing symptoms and tolerable for females with uncomplicated UTI.

METHODS

this was a randomized double-blind controlled trial that included female aged >18 y.o with uncomplicated lower UTI. Patients were randomly assigned to either solifenacin succinate 5 mg (group 1) or placebo (group 2) in addition to empiric levofloxacin 500 mg treatment for 3 days. Those with structural and/or functional abnormalities of the urinary tract and allergic reaction history were excluded. We observed changes in overactive bladder symptom score (OABSS), patient perception of bladder condition (PPBC) score, patient-reported symptoms and adverse events.

RESULTS

a total of 126 patients, 63 for each group, initiated the trial with median age of 44 (19-67) y.o. There were no differences of age, OABSS, and PPBC score between the 2 groups at baseline. We found significant (p<0.05) reduction of OABSS and PPBC score in both groups at the end of therapy; however the amount of reduction were not different between groups. In group 1 we found 22.2% of patients complained of dry mouth and 25.4%, 4.7%, 3.2% of patients complained of nausea, somnolence and constipation respectively. In group 2 we found 20.0%, 21.7% and 3.3% patients who complained of dry mouth, nausea, and somnolence respectively. One patient in group 2 experienced allergic reaction and was dropped out.

CONCLUSION

we found no significant difference in OABSS and PPBC score reduction by adding anticholinergic to antibiotic therapy for females with uncomplicated UTI. There was no serious adverse event recorded.