The combination of trimethoprim and sulfamethoxazole in the treatment of urinary tract infection

In a series of 52 patients the combination of trimethoprim and sulfamethoxazole was used for the treatment of urinary tract infection and the results are analyzed with respect to the clinical diagnosis and bacterial etiology. There was complete agreement between in vitro sensitivity and clinical response except in the case of one strain of Streptococcus fecalis. The combination of drugs was effective against some bacterial strains which were resistant to the commonly used antimicrobial agents.     

Treatment of Infections with Colistimethate Sodium (Coly-Mycin)

Colistimethate sodium (Coly-Mycin) was used in the treatment of 17 patients: 13 had urinary tract infections (two of these had positive blood cultures), three had respiratory tract infections, and one patient had both urinary and respiratory tract infections. In nine of the 17 a foreign body—either a carcinoma, a catheter, or a stone—complicated the infection.The dosage used was 1.1-2.3 mg./lb./day with a maximum in one case of 2.4 g. given over an eight-day period. The organisms so treated included Pseudomonas, six; Aerobacter, six and E. coli, two. Both Pseudomonas and Aerobacter were encountered in three cases.On bacteriological grounds, six patients were cured, eight relapsed, and in three the infecting agent was replaced by another organism. The best responses were obtained in those patients with Pseudomonas infection. Side effects included nausea, vomiting, vertigo, paresthesias, and pain at the site of injection.Colistimethate sodium has a place in the treatment of Gram-negative infections excluding Proteus organisms.     

Changes in Gut Flora after Cephalexin Treatment

Eighteen patients with urinary tract infection were treated with cephalexin orally. Absorption was variable, between 29 and 89% of the total daily dose being excreted in the urine in 24 hours. A significant number of patients became faecal carriers of Pseudomonas aeruginosa compared with a control group who received no antibiotics. Four of the cephalexin-treated patients acquired a strain of Ps. aeruginosa known to be present in food from the hospital diet kitchen and one developed a urinary tract infection with this strain.     

Lower urinary tract infections from external beam radiation therapy in prostate cancer: A single institution experience

External beam radiation therapy (EMRT) is effective for the treatment of localized prostate cancer. Lower urinary tract infections (LUTIs) are considered one of the main possible adverse events related to External beam radiation therapy. Here we analyzed the incidence of LUTI during EMRT. Urinary tract infection was assumed when the findings of bacteriuria exceeded 100,000 units/mL, accompanied by specific cystitis symptoms. Among the total 540 analyzed patient, 208 (38.5%) developed a LUTI. E. coli was the main microorganism involved in LUTIs (102, 49.04%) with 8 cases of a combination between E. coli and another germ. In conclusion, a risk of urinary infections in cancer patients treated with pelvic radiotherapy was observed, in order to reduce the use of antibiotic resistance, preventive treatment with non-antibiotic agents 5 are warranted.     

Comparaison de deux modes de prophylaxie de l'infection urinaire chez l'enfant avec le triméthoprime--sulfaméthoxazole.

Two types of prophylaxis of urinary tract infection with trimethoprim-sulfamethoxazole (TMP-SMZ) were studied in 72 children with recurrent urinary tract infections or vesicoureteral reflux or both. Daily prophylaxis only was used in 36 children and thrice-weekly prophylaxis only in 25 others, and 11 children received successively both types of prophylaxis. The same dosage was used in all cases: 2 mg/kg of TMP and 10 mg/kg of SMZ, given at bedtime. With daily prophylaxis the infection rate over 556 patient-months was 5.4 cases per 1000 patient-months, compared with 285.4 cases in the year before prophylaxis; side effects were noted in 11% of the patients during treatment. With thrice-weekly prophylaxis the infection rate over 381 patient-months was 15.7 cases per 1000 patient-months, compared with 313.6 cases in the year before prophylaxis; only 3% of the patients receiving this treatment had a side effect that was possibly drug-related. These results indicate that effective prophylaxis of urinary tract infection in children can be obtained with these two types of treatment.     

A case-control study to evaluate urinary tract complications in radical hysterectomy

BACKGROUND: This study has evaluated urinary tract injuries and dysfunction after Radical Hysterectomy (RH) performed in patients with cervical cancer and has compared the cystometric parameters and urinary complications occurring in these patients with those occurring in patients who had undergone Simple Hysterectomy (SH). PATIENTS AND METHODS: A prospective case-control study was conducted to evaluate urinary tract injuries (intra-operative and post-operative) and dysfunction in 50 patients undergoing RH for cervical cancer and to compare them with the same parameters in 50 patients who underwent SH for benign disease. RESULTS: Mean age in the RH group was 46.3 years and in the SH group was 50.1 (p = 0.63). There were no bladder and urethral injuries in either group of patients. There was one intra-operative ureteral injury in the RH patients but none in those who underwent SH. (p < 0.05). In the two weeks after surgery, 15% of RH patients and 11% of SH patients had experienced a urinary tract infection urinary tract infection (p = 0.61). Two week after surgery 62% of RH patients had no urinary symptoms, compared to 84% in the SH group who did (p < 0.02). Urinary residual volume, first urinary sensation and maximal bladder capacity were higher in the RH group, but this was not statistically significant. The only case of a urinary fistula appeared in a patient who received 5000 cGy radiation therapy pre-operatively, but this spontaneously healed after 3 weeks of catheterization. CONCLUSIONS: Intra-operative and post-operative urinary tract complications are comparable in patients undergoing RH and SH and an expert gynaecological oncologist might be able to further decrease complications. However, radiation therapy before surgery may increase the risk of complications.     

Plasmid-Mediated Sulfamethoxazole Resistance Encoded by the sul2 Gene in the Multidrug-Resistant Shigella flexneri 2a Isolated from Patients with Acute Diarrhea in Dhaka,Bangladesh

In this study, mechanisms of plasmid-mediated sulfamethoxazole resistances in the clinical strains of multi-drug resistant (MDR) Shigella flexneri 2a were elucidated for the first time in Bangladesh. From 2006 to 2011, a total of 200 S. flexneri 2a strains were randomly selected from the stock of the Enteric and Food Microbiology Laboratory of icddr,b. Antimicrobial susceptibility of the strains showed 73%, 98%, 93%, 58%, 98%, 64% and 4% resistance to trimethoprim-sulfamethoxazole, nalidixic acid, ampicillin, erythromycin, tetracycline, ciprofloxacin and ceftriaxone respectively. Plasmid profiling revealed heterogeneous patterns and interestingly, all the trimethoprim-sulfamethoxazole resistant (SXT^R) strains yielded a distinct 4.3 MDa plasmid compared to that of the trimethoprim-sulfamethoxazole susceptible (SXT^S) strains. Curing of this 4.3 MDa plasmid resulted in the susceptibility to sulfamethoxazole alone suggesting the involvement of this plasmid in the resistance of sulfamethoxazole. Moreover, PCR analysis showed the presence of sul2 gene in SXT^R strains which is absent in SXT^S strains as well as in the 4.3 MDa plasmid-cured derivatives, confirming the involvement of sul2 in the resistance of sulfamethoxazole. Furthermore, pulsed-field gel electrophoresis (PFGE) analysis revealed that both the SXT^R and SXT^S strains were clonal. This study will significantly contributes to the knowledge on acquired drug resistance of the mostly prevalent S. flexneri 2a and further warrants continuous monitoring of the prevalence and correlation of this resistance determinants amongst the clinical isolates of Shigella and other enteric pathogens around the world to provide effective clinical management of the disease.     

Ultrasonography and abdominal radiography versus intravenous urography in investigation of urinary tract infection in men: prospective incident cohort study

ObjectivesTo compare ultrasonography and abdominal radiography with intravenous urography in the investigation of urinary tract infection in men.DesignProspective study in two hospital departments. Radiological procedures and urological assessments performed on different days by different cliniciansSettingDistrict general hospital.ParticipantsConsecutive series of men (n=114) referred to the department of urology for investigation of proved urinary tract infection.InterventionsUltrasonography and intravenous urography of renal tract and assessment of urinary flow rate. Clinical assessment, cystoscopy, urodynamic studies, and transrectal ultrasonography with biopsy.ResultsImportant abnormalities were seen in 53 of 100 fully evaluated patients, the most common being a poorly emptying bladder (34). The combination of plain radiographs of kidneys, ureter, and bladder and ultrasonography detected more abnormalities than intravenous urography alone. No important abnormality was missed by this combination (sensitivity 100% and specificity 93%).ConclusionsUltrasonography with abdominal radiography is as accurate as intravenous urography in detecting important urological abnormalities in men presenting with urinary tract infection. This combination is safer than intravenous urography and should be the initial investigation for such patients. Additional determination of urinary flow rate is useful for the assessment of an incompletely emptying bladder.

What is already known on this topic

Ultrasonography alone is the primary investigation of choice for urinary tract infection in children and womenUltrasonography has limited sensitivity for renal stones and poor sensitivity for ureteric stonesUrinary infection is less common in men than women and the risk factors are different

What this study adds

Ultrasonography is as effective as intravenous urography in men with urinary tract infection only when it is combined with plain radiographyIn men aged over 50 an incompletely emptying bladder is the most common abnormalityIn such patients determination of urinary flow rate is particularly helpful     

Chlamydia trachomatis infections in women with urogenital symptoms.

Chlamydia trachomatis was isolated from 30 to 100 women attending a family physician''s office with dysuria, frequency or vaginal discharge, compared with 2 of 30 asymptomatic women. Multiple infections were common: C. trachomatis coexisted with Gardnerella vaginalis, Candida albicans, Trichomonas vaginalis or a bacterial cause of urinary tract infection in 15 patients. C. trachomatis was isolated alone from 15 symptomatic women. The source of the positive culture was not always the site of symptoms. C. trachomatis was isolated from both the cervix and the urine of 9 patients, either simultaneously or sequentially. The probability of finding a chlamydial infection was 30% in young women with vaginal discharge alone, 33% in those with dysuria and frequency alone and 53% in those with abdominal or pelvic pain in addition to lower urogenital tract symptoms.     

Double-Blind, Multicenter Evaluation of Lansoprazole and Amoxicillin Dual Therapy for the Cure of Helicobacter pylori Infection

Background Treatment with amoxicillin plus omeprazole results in disappointing cure rates of Helicobacter pylori infection. The minimal inhibitory concentration of lansoprazole for H. pylori in vitro is lower than that for omeprazole, prompting interest in treatment with amoxicillin plus lansoprazole.
Materials and Methods. H. pylori -infected patients with endoscopically documented duodenal ulcer either currently or within the past year were randomized to 14 days of (1) lansoprazole, 30 mg bid, plus amoxicillin, 1 gm tid; (2) lansoprazole, 30 mg tid, plus amoxicillin, 1 gm tid; (3) lansoprazole, 30 mg tid alone; or (4) amoxicillin, 1 gm tid alone. Endoscopy was done at enrollment and at 4 to 6 weeks after completion of treatment or for recurrent symptoms. H. pylori status was assessed by culture and histology. Ulcer prevalence was evaluated at follow-up endoscopy.
Results. Two hundred sixty-two patients met enrollment criteria and were treated. By per-protocol analysis, H. pylori infection was cured in 57% of those treated with lansoprazole twice daily plus amoxicillin and in 67% of those treated with lansoprazole three times daily plus amoxicillin, compared with 0% treated with lansoprazole alone or amoxicillin alone ( p < .001 for dual therapy versus either monotherapy). Amoxicillin resistance was not observed. At follow-up endoscopy, ulcer prevalence was 17% in patients treated with lansoprazole twice daily plus amoxicillin, 23% in those treated with lansoprazole three times daily plus amoxicillin, 33% in those treated with lansoprazole alone, and 35% in those treated with amoxicillin alone ( p = .024; lansoprazole twice daily plus amoxicillin versus amoxicillin alone).
Conclusions. Treatment with amoxicillin plus lansoprazole, 30 mg tid, led to cure of H. pylori infection in 67% of patients with active or recently healed duodenal ulcer.     

Case-control study of self reported genitourinary infections and risk of gastroschisis: findings from the national birth defects prevention study, 1997-2003

Objective To assess the association between genitourinary infections in the month before conception to the end of the first trimesterand gastroschisis.Design Case-control study with self reported infections from a computer assisted telephone interview.Setting National birth defects prevention study, a multisite, population based study including 10 surveillance systems for birth defects in the United States.Participants Mothers of 505 offspring with gastroschisis and 4924 healthy liveborn infants as controls.Main outcome measure Adjusted odds ratios for gastroschisis with 95% confidence intervals.Results About 16% (n=81) of case mothers and 9% (n=425) of control mothers reported a genitourinary infection in the relevant time period; 4% (n=21) and 2% (n=98) reported a sexually transmitted infection and 13% (n=67) and 7% (n=338) reported a urinary tract infection, respectively. Case mothers aged <25 years reported higher rates of urinary tract infection alone and in combination with a sexually transmitted infection compared with control mothers. In women who reported both types of infection, there was a greater risk of gastroschisis in offspring (adjusted odds ratio 4.0, 95% confidence interval 1.4 to 11.6).Conclusion There is a significant association between self reported urinary tract infection plus sexually transmitted infection just before conception and in early pregnancy and gastroschisis.     

索利那新治疗双"J" 管置入后尿路感染症状的疗效观察

目的:观察琥珀酸索利那新对经皮肾镜碎石取石术患者术后留置双"J"管期间发生泌尿系统感染的疗效。方法:回顾性分析133例成功行经皮肾镜碎石取石术并常规留置双"J"管的患者,随机分为治疗组(n=67)和对照组(n=66)。治疗组给予索利那新片治疗,对照组仅给予饮水、休息等常规治疗。所有患者在置管5周后(拔管前一天)均随访并完成血、尿常规检验。结果:治疗组血、尿常规白细胞计数均低于对照组,治疗组均较对照组的泌尿系统的感染发生率低(P0.05)。结论:口服索利那新能有效降低泌尿系统感染的可能性,降低患者在置管期间出现尿频、尿急、血尿、腰部疼痛、发热等并发症的概率,提高患者的生活质量,值得临床推广应用。     

泌尿系统结石合并感染患者尿路病原菌分布及危险因素分析

目的 分析泌尿系统结石合并感染患者尿路病原菌分布及其危险因素,为后续研究提供参考。 方法 收集2016年1月至2019年1月我院诊治的430例泌尿系统结石患者为研究对象,根据患者是否发生感染分为感染组(n=34)和非感染组(n=396)。分析两组患者的临床特征和感染组患者病原菌分布情况,同时对影响患者感染的高危因素进行Logistic回归分析。 结果 感染组患者共计检出84株病原菌,其中革兰阳性球菌20株(23.81%),革兰阴性杆菌60株(71.43%),其他4株(4.76%)。两组患者白细胞水平、尿路梗阻情况、血肌酐水平、尿pH>7.0比例、血尿素氮水平、合并肾积水情况、结石位置、结石直径、抗菌药物使用种类差异均有统计学意义(均P9个/L)、尿pH(>7.0)、血尿素氮(≥7.15 mmol/L)、结石位置(上尿路)、抗菌药物使用种类(≥3种)均为泌尿系统结石合并尿路感染的高危因素,而血肌酐水平,结石直径与泌尿系统结石合并尿路感染无明显相关性。 结论 泌尿系统结石患者易并发尿路感染,其病原菌以革兰阴性杆菌为主。导致尿路感染的因素较多,临床上应提前制定预防措施,降低结石患者尿路感染发生率。     

Effect of antibiotic treatment on receptivity of uroepithelial cells to uropathogens

The management of female patients with recurrent urinary tract infections still remains a problem, and long-term prophylactic or short intermittent courses of antibiotics are the standard forms of therapy. In this report, 10 patients were examined for the effects of long- and short-term treatment with trimethoprim-sulfamethoxazole (TMP-SMX) antibiotics on the receptivity of uroepithelial cells to bacterial adherence. The urine of all patients was sterile while on antibiotic therapy. Few bacteria were found adherent to the cells from adult patients (group 1, mean age 36 years) on long-term antibiotics, but the cells were highly receptive to uropathogens in vitro, especially for Escherichia coli expressing mannose-resistant adhesins. Controls of age-matched adult females were included and in vitro adherence levels were found to be higher for those women with a history of urinary tract infection compared with those with no past record of infection. In the second group, elderly patients (mean age 87 years) presented with bacteriuria, and their uroepithelial cells were found to be colonized by uropathogens to a significantly greater extent than their controls. The adherent population was reduced during 7-day TMP-SMX antibiotic treatment, but increased posttherapy, particularly in two patients who subsequently became reinfected. The in vitro results showed that uroepithelial cells retain their receptivity to uropathogenic adherence, both during and after treatment. Although antibiotics eradicate uropathogens from the urinary tract, patients remain susceptible to recolonization by uropathogens and are at risk of reinfection after completion of therapy.     

Possible Trichosporon asahii urinary tract infection in a critically ill COVID-19 patient

BackgroundTrichosporon asahii, an emerging fungal pathogen, has been frequently associated with invasive infections in critically ill patients.Case reportA 74-year-old male patient diagnosed with COVID-19 was admitted to an Intensive Care Unit (ICU). During hospitalization, the patient displayed episodes of bacteremia by Staphylococcus haemolyticus and a possible urinary tract infection by T. asahii. While the bacterial infection was successfully treated using broad-spectrum antibiotics, the fungal infection in the urinary tract was unsuccessfully treated with anidulafungin and persisted until the patient died.ConclusionsWith the evolving COVID-19 pandemic, invasive fungal infections have been increasingly reported, mainly after taking immunosuppressant drugs associated with long-term broad-spectrum antibiotic therapy. Although Candida and Aspergillus are still the most prevalent invasive fungi, T. asahii and other agents have emerged in critically ill patients. Therefore, a proper surveillance and diagnosing any fungal infection are paramount, particularly in COVID-19 immunocompromised populations.     

内毒素和降钙素原在妇科术后尿路感染中的鉴别诊断价值

目的评价中段尿内毒素和血清降钙素原在妇科术后不同种类细菌尿路感染中的鉴别诊断价值。方法收集临床1205例妇科术后患者中段尿进行细菌培养及内毒素检测,同时对患者进行血清降钙素原检测,比较结果对尿路感染的鉴别诊断价值。结果1205份标本中尿培养出阳性350例,感染率为29．04％,其中298例为均存在留置导尿管,而在剩余400例尿培养阴性的患者中仅仅120例留置导尿管。两组之间差异有统计学意义（χ2=26．78,P〈0．05）。其中革兰阴性杆菌189例（54％）,革兰阳性菌112例（32％）,真菌49例（14％）。在三组患者中,中段尿内毒素在革兰阴性菌引起的术后尿路感染较革兰阳性菌和真菌的患者中明显升高,差异均有统计学意义（P〈0．05）。而对于血清降钙素原在革兰阴性菌和革兰阳性菌感染的患者明显高于真菌尿路感染的患者,差异均有统计学意义（P〈0．05）。而在革兰阴性菌和革兰阳性菌感染的患者中差异无统计学意义（P〉0．05）。结论妇科术后尿路感染与留置导尿管密切相关,革兰阴性菌是引起妇科术后尿路感染的主要致病菌,中段尿内毒素有助于鉴别诊断出革兰阴性菌引起尿路感染,而血清PCT升高时则有助于排除真菌尿路感染。     

The Ability of Virulence Factor Expression by Pseudomonas aeruginosa to Predict Clinical Disease in Hospitalized Patients

Background

Pseudomonas aeruginosa is an opportunistic pathogen that frequently causes hospital acquired colonization and infection. Accurate identification of host and bacterial factors associated with infection could aid treatment decisions for patients with P. aeruginosa cultured from clinical sites.

Methods

We identified a prospective cohort of 248 hospitalized patients with positive P. aeruginosa cultures. Clinical data were analyzed to determine whether an individual met predefined criteria for infection versus colonization. P. aeruginosa isolates were tested for the expression of multiple phenotypes previously associated with virulence in animal models and humans. Logistic regression models were constructed to determine the degree of association between host and bacterial factors with P. aeruginosa infection of the bloodstream, lung, soft tissue and urinary tract.

Results

One host factor (i.e. diabetes mellitus), and one bacterial factor, a Type 3 secretion system positive phenotype, were significantly associated with P. aeruginosa infection in our cohort. Subgroup analysis of patients with P. aeruginosa isolated from the urinary tract revealed that the presence of a urinary tract catheter or stent was an additional factor for P. aeruginosa infection.

Conclusions

Among hospitalized patients with culture-documented P. aeruginosa, infection is more likely to be present in those with diabetes mellitus and those harboring a Type 3 secretion positive bacterial strain.     

Human alpha defensin 5 expression in the human kidney and urinary tract

Background

The mechanisms that maintain sterility in the urinary tract are incompletely understood. Recent studies have implicated the importance of antimicrobial peptides (AMP) in protecting the urinary tract from infection. Here, we characterize the expression and relevance of the AMP human alpha-defensin 5 (HD5) in the human kidney and urinary tract in normal and infected subjects.

Methodology/Principal Findings

Using RNA isolated from human kidney, ureter, and bladder tissue, we performed quantitative real-time PCR to show that DEFA5, the gene encoding HD5, is constitutively expressed throughout the urinary tract. With pyelonephritis, DEFA5 expression significantly increased in the kidney. Using immunoblot analysis, HD5 production also increased with pyelonephritis. Immunostaining localized HD5 to the urothelium of the bladder and ureter. In the kidney, HD5 was primarily produced in the distal nephron and collecting tubules. Using immunoblot and ELISA assays, HD5 was not routinely detected in non-infected human urine samples while mean urinary HD5 production increased with E.coli urinary tract infection.

Conclusions/Significance

DEFA5 is expressed throughout the urinary tract in non-infected subjects. Specifically, HD5 is expressed throughout the urothelium of the lower urinary tract and in the collecting tubules of the kidney. With infection, HD5 expression increases in the kidney and levels become detectable in the urine. To our knowledge, our findings represent the first to quantitate HD5 expression and production in the human kidney. Moreover, this is the first report to detect the presence of HD5 in infected urine samples. Our results suggest that HD5 may have an important role in maintaining urinary tract sterility.     

Vesicoureteral reflux and other urinary tract malformations in mice compound heterozygous for Pax2 and Emx2

Congenital anomalies of the kidney and urinary tract (CAKUT) are the most common cause of chronic kidney disease in children. This disease group includes a spectrum of urinary tract defects including vesicoureteral reflux, duplex kidneys and other developmental defects that can be found alone or in combination. To identify new regulators of CAKUT, we tested the genetic cooperativity between several key regulators of urogenital system development in mice. We found a high incidence of urinary tract anomalies in Pax2;Emx2 compound heterozygous mice that are not found in single heterozygous mice. Pax2^+/−;Emx2^+/− mice harbor duplex systems associated with urinary tract obstruction, bifid ureter and a high penetrance of vesicoureteral reflux. Remarkably, most compound heterozygous mice refluxed at low intravesical pressure. Early analysis of Pax2^+/−;Emx2^+/− embryos point to ureter budding defects as the primary cause of urinary tract anomalies. We additionally establish Pax2 as a direct regulator of Emx2 expression in the Wolffian duct. Together, these results identify a haploinsufficient genetic combination resulting in CAKUT-like phenotype, including a high sensitivity to vesicoureteral reflux. As both genes are located on human chromosome 10q, which is lost in a proportion of VUR patients, these findings may help understand VUR and CAKUT in humans.     

Volunteer and clinical studies with carfecillin: a new orally administered ester of carbenicillin.

Blood and urine levels of carbenicillin were measured in 10 healthy volunteers and four patients with renal failure after single and multiple oral dose of carfecillin. Urinary levels after 1000-mg doses in healthy subjects were considered sufficient for treatment of Pseudomonas aeruginosa urinary infections, but the serum levels were too low for chemotherapy of systemic infections with this organism even in severe renal failure. Urinary infections were treated in 35 inpatients with a seven-day course of carfecillin. The infection was eradicated in 21 cases (60%). In 12 cases the pathogen was Ps. aeruginosa, which was eradicated from eight patients (67%). Many patients had severe urinary tract disease. Side effects were virtually absent.