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Spectrum of Bacterial Pathogens in Uncomplicated and Complicated Urinary Tract Infections
INFECTIONS AND ANTIBIOTICS
3 days may be suggestive of a more invasive tissue infection that requires more intensive treatment and, perhaps, the need for radiological and/or urological investigation. The ideal situation for successful single dose treatment presupposes an appropriate antimicrobial with high urinary concentrations, infection involving only luminal or superficial tissue layers and an absence of complicating factors. Healthy women do not require routine screening for asymptomatic bacteriuria or treatment for the condition if it is noted. Antibiotic treatment is warranted for the pregnant woman with asymptomatic bacteriuria because of the possibility of acute pyelonephritis later in pregnancy and potential fetal complications. Single dose therapy appears to be as effective for an otherwise uncomplicated infection in pregnant women as conventional therapy. Since asymptomatic bacteriuria in children has a high association with underlying anatomical abnormalities, which may potentiate invasive infection and renal damage, such patients like pregnant women are treated for asymptomatic bacteriuria. There is good evidence that single dose therapy is as effective in uncomplicated infection as longer conventional courses. In the symptomatic woman with an acute uncomplicated urinary tract infection single dose therapy was first shown to be practical and efficacious. Patients who present after 6 or more days of symptoms are less likely to respond to single dose therapy. Despite the obvious advantages of single dose therapy, one must ask whether inadvertent inadequate therapy for tissue infection might allow progression of infection with serious consequences for the patient. In other words, would a patient with silent upper tract infection be more difficult to treat after relapse following single dose therapy than upon initial presentation? The answer to this question demands careful prospective studies. P. M. H. 3 tables, 20 references
Spectrum of Bacterial Pathogens in Uncomplicated and Complicated Urinary Tract Infections A. BAUERNFEIND, K. NABER AND D. SAUERWEIN, Max van Pettenkofer-I nstitut, M ilnchen; Elisabeth-Krankenhuis, Urologie, Straubing, and Werner-Wicker-Klinik, Bad Wildungen, Federal Republic of Germany
683
infections. For recommendation of antibiotics for therapy in uncomplicated urinary tract infections, data on bacterial sen sitivities according to region should be considered and kept up to date. In complicated urinary tract infections the spectrum of causative organisms and their susceptibility to antibiotics may vary greatly, making culture and sensitivity data even more crucial. P. M. H. 8 tables, 7 references
Microbiological Aspects of Chemotherapy of Lower Urinary Tract Infections R. G6MEz-Lus AND M. C. RUBIO CALVO, Faculty of Medicine, Department of Microbiology and Parasitology, University of Zaragoza, Zaragoza, Spain Eur. Urol., suppl. 1, 13: 13-16 (Jan.) 1987 Uncomplicated urinary tract infections represent an excellent model for the use of new antimicrobials or of new dosage regimens with already known antibiotics or chemotherapeutics. In the bacteriological control of urinary tract infection the culture performed on day 3 after 2 days of treatment usually is predictive, since there is a clear correlation with the final result. The authors compared the results obtained after 2 days of conventional treatment with amoxicillin, cefaclor, cefamandole and cefuroxime to the results of other studies after single dose treatment with the same drugs. They note a striking likeness between the bacteriological response after 2 days of conventional treatment and the final clinicobacteriological results obtained with a single dose of the same antibiotics. Given the importance of urinary tract infection caused by multiresistant nosocomial strains with an R plasmid, the authors suggest that single dose and short-term courses of antibiotics for acute urinary tract infection, when possible, might tend to reduce the development of resistant bacterial strains. In another study the authors evaluated 122 strains of coagulase-negative staphylococci obtained from urine specimens containing 105 bacteria per ml. Of the strains 51 per cent were Staph. epidermidis and only 10 patients had Staph. saprophyticus. P. M. H. 3 tables, 21 references
Eur. Urol., suppl. 1, 13: 9-12 (Jan.) 1987 Data from the United Kingdom and Federal Republic of Germany are examined with regard to the spectra of bacterial organisms of urinary tract infections in patients with and without abnormalities in the urinary tract (complicated and uncomplicated urinary tract infections), and with regard to antibiotic susceptibility of organisms. The spectrum of causative organisms in uncomplicated and complicated urinary tract infections is markedly different. Non-Escherichia coli organisms are more frequent in patients with abnormalities of various types. In patients with spinal injuries Pseudomonas aeruginosa may prove to be the most important causative species. Although the proportion of isolates from nonhospitalized patients with un complicated urinary tract infections susceptible to oral antibiotics is higher than from inpatients, the authors caution that therapy without an antibiotic may be inadequate in a number of cases. There are major differences in the antibiotic susceptibility of isolates from uncomplicated urinary tract infections in different countries. This may be partly owing to variations in the antibiotics usually prescribed for treatment of these
Lower Urinary Tract Infection: Rationale and Efficacy of Single-Dose Antibacterial Therapy J. D. WILLIAMS, Department of Medical Microbiology, London Hospital Medical College, London, United Kingdom Eur. Urol., suppl. 1, 13: 54-55 (Jan.) 1987 Much effort currently is spent on determining the minimum effective dose for treatment of infection. Critics of excessive antibiotic use suggest that one would not treat every patient with the maximum dose of therapy needed to produce an overall cure rate approaching 100 per cent but that therapy should be tailored to suit the individual patient. With urinary tract infection it may be possible to balance minimum therapy with acceptable failure rates given the relatively low morbidity of the process (compared to bacterial endocarditis). Ideally, it may be possible to predict which patients require prolonged therapy and in which single dose therapy might suffice. Minimum effective dose treatment has the advantages of reduced side effects, toxicity, resistance and cost, and better compliance. P.M.H.
3 days may be suggestive of a more invasive tissue infection that requires more intensive treatment and, perhaps, the need for radiological and/or urological investigation. The ideal situation for successful single dose treatment presupposes an appropriate antimicrobial with high urinary concentrations, infection involving only luminal or superficial tissue layers and an absence of complicating factors. Healthy women do not require routine screening for asymptomatic bacteriuria or treatment for the condition if it is noted. Antibiotic treatment is warranted for the pregnant woman with asymptomatic bacteriuria because of the possibility of acute pyelonephritis later in pregnancy and potential fetal complications. Single dose therapy appears to be as effective for an otherwise uncomplicated infection in pregnant women as conventional therapy. Since asymptomatic bacteriuria in children has a high association with underlying anatomical abnormalities, which may potentiate invasive infection and renal damage, such patients like pregnant women are treated for asymptomatic bacteriuria. There is good evidence that single dose therapy is as effective in uncomplicated infection as longer conventional courses. In the symptomatic woman with an acute uncomplicated urinary tract infection single dose therapy was first shown to be practical and efficacious. Patients who present after 6 or more days of symptoms are less likely to respond to single dose therapy. Despite the obvious advantages of single dose therapy, one must ask whether inadvertent inadequate therapy for tissue infection might allow progression of infection with serious consequences for the patient. In other words, would a patient with silent upper tract infection be more difficult to treat after relapse following single dose therapy than upon initial presentation? The answer to this question demands careful prospective studies. P. M. H. 3 tables, 20 references
Spectrum of Bacterial Pathogens in Uncomplicated and Complicated Urinary Tract Infections A. BAUERNFEIND, K. NABER AND D. SAUERWEIN, Max van Pettenkofer-I nstitut, M ilnchen; Elisabeth-Krankenhuis, Urologie, Straubing, and Werner-Wicker-Klinik, Bad Wildungen, Federal Republic of Germany
683
infections. For recommendation of antibiotics for therapy in uncomplicated urinary tract infections, data on bacterial sen sitivities according to region should be considered and kept up to date. In complicated urinary tract infections the spectrum of causative organisms and their susceptibility to antibiotics may vary greatly, making culture and sensitivity data even more crucial. P. M. H. 8 tables, 7 references
Microbiological Aspects of Chemotherapy of Lower Urinary Tract Infections R. G6MEz-Lus AND M. C. RUBIO CALVO, Faculty of Medicine, Department of Microbiology and Parasitology, University of Zaragoza, Zaragoza, Spain Eur. Urol., suppl. 1, 13: 13-16 (Jan.) 1987 Uncomplicated urinary tract infections represent an excellent model for the use of new antimicrobials or of new dosage regimens with already known antibiotics or chemotherapeutics. In the bacteriological control of urinary tract infection the culture performed on day 3 after 2 days of treatment usually is predictive, since there is a clear correlation with the final result. The authors compared the results obtained after 2 days of conventional treatment with amoxicillin, cefaclor, cefamandole and cefuroxime to the results of other studies after single dose treatment with the same drugs. They note a striking likeness between the bacteriological response after 2 days of conventional treatment and the final clinicobacteriological results obtained with a single dose of the same antibiotics. Given the importance of urinary tract infection caused by multiresistant nosocomial strains with an R plasmid, the authors suggest that single dose and short-term courses of antibiotics for acute urinary tract infection, when possible, might tend to reduce the development of resistant bacterial strains. In another study the authors evaluated 122 strains of coagulase-negative staphylococci obtained from urine specimens containing 105 bacteria per ml. Of the strains 51 per cent were Staph. epidermidis and only 10 patients had Staph. saprophyticus. P. M. H. 3 tables, 21 references
Eur. Urol., suppl. 1, 13: 9-12 (Jan.) 1987 Data from the United Kingdom and Federal Republic of Germany are examined with regard to the spectra of bacterial organisms of urinary tract infections in patients with and without abnormalities in the urinary tract (complicated and uncomplicated urinary tract infections), and with regard to antibiotic susceptibility of organisms. The spectrum of causative organisms in uncomplicated and complicated urinary tract infections is markedly different. Non-Escherichia coli organisms are more frequent in patients with abnormalities of various types. In patients with spinal injuries Pseudomonas aeruginosa may prove to be the most important causative species. Although the proportion of isolates from nonhospitalized patients with un complicated urinary tract infections susceptible to oral antibiotics is higher than from inpatients, the authors caution that therapy without an antibiotic may be inadequate in a number of cases. There are major differences in the antibiotic susceptibility of isolates from uncomplicated urinary tract infections in different countries. This may be partly owing to variations in the antibiotics usually prescribed for treatment of these
Lower Urinary Tract Infection: Rationale and Efficacy of Single-Dose Antibacterial Therapy J. D. WILLIAMS, Department of Medical Microbiology, London Hospital Medical College, London, United Kingdom Eur. Urol., suppl. 1, 13: 54-55 (Jan.) 1987 Much effort currently is spent on determining the minimum effective dose for treatment of infection. Critics of excessive antibiotic use suggest that one would not treat every patient with the maximum dose of therapy needed to produce an overall cure rate approaching 100 per cent but that therapy should be tailored to suit the individual patient. With urinary tract infection it may be possible to balance minimum therapy with acceptable failure rates given the relatively low morbidity of the process (compared to bacterial endocarditis). Ideally, it may be possible to predict which patients require prolonged therapy and in which single dose therapy might suffice. Minimum effective dose treatment has the advantages of reduced side effects, toxicity, resistance and cost, and better compliance. P.M.H.