scholarly journals Empirical Therapy of Complicated Pyelonephritis

2019 ◽  
Vol 4 (5) ◽  
pp. 26-30 ◽  
Author(s):  
V. A. Beloborodov ◽  
V. A. Vorobev ◽  
P. V. Opanasyuk
Keyword(s):  
Urinary Tract Infection ◽  
Impaired Renal Function ◽  
Multivariate Logistic Regression Analysis ◽  
Empirical Therapy ◽  
Upper Urinary Tract ◽  
Third Generation ◽  
Multivariate Logistic Regression ◽  
Close Attention ◽  
Irkutsk Region ◽  
Third Generation Cephalosporins

The aim of the research was to analyze the effectiveness of empirical therapy in patients with established complicated upper urinary tract infection (complicated pyelonephritis).Materials and methods. 51 patients who were treated in 2018 in the urological department of the Irkutsk City Clinical Hospital N 1 were subjected to a retrospective study. The average age of patients was 55.9 ± 16.9 years.Results. Successful empirical therapy was considered in the absence of correction of the treatment regimen and the normalization of clinical blood and urine tests. Of the patients included in the study, successful empirical therapy was found in 24 (47%) patients, and required correction in 27 (52.9 %) patients. Cephalosporins as monotherapy were ineffective in 24 (57.1 %) patients, carbopenems – in one (25 %), fluoroquinolones – in all (100 %). Aminoglycosides showed the best result as a combination therapy with cephalosporins – 100 % (n = 3) of success. Based on multivariate logistic regression analysis, it was established that the detection of microhematuria and uremia in clinical analyzes upon admission to the hospital increases the likelihood of empirical monotherapy with third-generation cephalosporins by 20 % and 27 %, respectively.Conclusion. It is advisable to refrain from the use of monotherapy with fluoroquinolones and third-generation cephalosporins until more information is available about the resistance of uropathogens in the population of the Irkutsk region. Patients with impaired renal function require particularly close attention of the clinician when choosing a scheme for the empirical treatment of complicated pyelonephritis.

scholarly journals Risk Factors for and Outcomes Associated with Clinical Isolates ofEscherichia coliandKlebsiellaSpecies Resistant to Extended-Spectrum Cephalosporins among Patients Admitted to Canadian Hospitals

2009 ◽  
Vol 20 (3) ◽  
pp. e43-e48 ◽  
Author(s):  
Marianna Ofner-Agostini ◽  
Andrew Simor ◽  
Michael Mulvey ◽  
Alison McGeer ◽  
Zahir Hirji ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Care Facility ◽  
P Value ◽  
Third Generation ◽  
Multivariate Logistic Regression ◽  
Extended Spectrum ◽  
Third Generation Cephalosporins

BACKGROUND: Clinical features associated with Gram-negative bacterial isolates with extended-spectrum beta-lactamase (ESBL)- and AmpC-mediated resistance identified in Canadian hospitals is largely unknown. The objective of the present study was to determine the demographics, risk factors and outcomes of patients with ESBL- or AmpC-mediated resistant organisms in Canadian hospitals.METHODS: Patients with clinical cultures ofEscherichia coliorKlebsiellaspecies were matched with patients with a similar organism but susceptible to third-generation cephalosporins. Molecular identification of the AmpC or ESBL was determined using a combination of polymerase chain reaction and sequence analysis. Univariate and multivariate logistic regression analysis was performed to identify variables associated with becoming a case.RESULTS: Eight Canadian hospitals identified 106 cases (ESBL/AmpC) and 106 controls. All risk factors identified in the univariate analysis as a predictor of being an ESBL/AmpC cases at the 0.20 P-value were included in the multivariate analysis. No significant differences in outcomes were observed (unfavourable responses 17% versus 15% and mortality rates 13% versus 7%, P not significant). Multivariate logistic regression found an association of becoming an ESBL/AmpC case with: previous admission to a nursing home (OR 8.28, P=0.01) or acute care facility (OR 1.96, P=0.03), length of stay before infection (OR 3.05, P=0.004), and previous use of first-generation cephalosporins (OR 2.38, P=0.02) or third-generation cephalosporins (OR 4.52, P=0.01). Appropriate antibiotics were more likely to be given to controls (27.0% versus 13.3%, P=0.05) and number of days to appropriate antibiotics was longer for cases (median 2.8 days versus 1.2 days, P=0.05).CONCLUSION: The importance of patient medical history, present admission and antibiotic use should be considered for allE coliorKlebsiellaspecies patients pending susceptibility testing results.

scholarly journals Predictors of Mortality in Bloodstream Infections Caused by Pseudomonas aeruginosa and Impact of Antimicrobial Resistance and Bacterial Virulence

2019 ◽  
Vol 64 (2) ◽  
Author(s):  
Raúl Recio ◽  
Mikel Mancheño ◽  
Esther Viedma ◽  
Jennifer Villa ◽  
María Ángeles Orellana ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Antimicrobial Resistance ◽  
Multivariate Logistic Regression Analysis ◽  
Empirical Therapy ◽  
Bloodstream Infections ◽  
Multivariate Logistic Regression ◽  
Related Factors ◽  
Content Type ◽  
Crude Mortality ◽  
The Impact

ABSTRACT Whether multidrug resistance (MDR) is associated with mortality in patients with Pseudomonas aeruginosa bloodstream infections (BSI) remains controversial. Here, we explored the prognostic factors of P. aeruginosa BSI with emphasis on antimicrobial resistance and virulence. All P. aeruginosa BSI episodes in a 5-year period were retrospectively analyzed. The impact in early (5-day) and late (30-day) crude mortality of host, antibiotic treatment, and pathogen factors was assessed by multivariate logistic regression analysis. Of 243 episodes, 93 (38.3%) were caused by MDR-PA. Crude 5-day (20%) and 30-day (33%) mortality was more frequent in patients with MDR-PA (34.4% versus 11.3%, P < 0.001 and 52.7% versus 21.3%, P < 0.001, respectively). Early mortality was associated with neutropenia (adjusted odds ratio [aOR], 9.21; 95% confidence interval [CI], 3.40 to 24.9; P < 0.001), increased Pitt score (aOR, 2.42; 95% CI, 1.34 to 4.36; P = 0.003), respiratory source (aOR, 3.23; 95% CI,2.01 to 5.16; P < 0.001), inadequate empirical therapy (aOR, 4.57; 95% CI, 1.59 to 13.1; P = 0.005), shorter time to positivity of blood culture (aOR, 0.88; 95% CI, 0.80 to 0.97; P = 0.010), an exoU-positive genotype (aOR, 3.58; 95% CI, 1.31 to 9.79; P = 0.013), and the O11 serotype (aOR, 3.64; 95% CI, 1.20 to 11.1; P = 0.022). These risk factors were similarly identified for late mortality, along with an MDR phenotype (aOR, 2.18; 95% CI, 1.04 to 4.58; P = 0.040). Moreover, the O11 serotype (15.2%, 37/243) was common among MDR (78.4%, 29/37) and exoU-positive (89.2%, 33/37) strains. Besides relevant clinical variables and inadequate empirical therapy, pathogen-related factors such as an MDR phenotype, an exoU-positive genotype, and the O11 serotype adversely affect the outcome of P. aeruginosa BSI.

scholarly journals Community acquired urinary tract infection: etiology and bacterial susceptibility

2003 ◽  
Vol 18 (suppl 5) ◽  
pp. 33-36 ◽  
Author(s):  
José Anastácio Dias Neto ◽  
Antonio Carlos Pereira Martins ◽  
Leonardo Dias Magalhães da Silva ◽  
Ricardo Brianezi Tiraboschi ◽  
André Luis Alonso Domingos ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Severe Disease ◽  
Antibacterial Drug ◽  
Third Generation ◽  
Antibacterial Susceptibility ◽  
Tract Infections ◽  
Epidemiological Characteristics ◽  
Third Generation Cephalosporins

PURPOSE: Urinary tract infections (UTI) are one of the most common infectious diseases diagnosed. UTI account for a large proportion of antibacterial drug consumption and have large socio-economic impacts. Since the majority of the treatments begins or is done completely empirically, the knowledge of the organisms, their epidemiological characteristics and their antibacterial susceptibility that may vary with time is mandatory. OBJECTIVE: The aim of this study was to report the prevalence of uropathogens and their antibiotic susceptibility of the community acquired UTI diagnosed in our institution and to provide a national data. METHODS: We analyzed retrospectively the results of urine cultures of 402 patients that had community acquired urinary tract infection in the year of 2003. RESULTS: The mean age of the patients in this study was 45.34 ± 23.56 (SD) years. There were 242 (60.2%) females and 160 (39.8%) males. The most commonly isolated organism was Escherichia coli (58%). Klebsiella sp. (8.4%) and Enterococcus sp.(7.9%) were reported as the next most common organisms. Of all bacteria isolated from community acquired UTI, only 37% were sensitive to ampicillin, 51% to cefalothin and 52% to trimethoprim/sulfamethoxazole. The highest levels of susceptibility were to imipenem (96%), ceftriaxone (90%), amikacin (90%), gentamicin (88%), levofloxacin (86%), ciprofloxacin (73%), nitrofurantoin (77%) and norfloxacin (75%). CONCLUSION: Gram-negative agents are the most common cause of UTI. Fluoroquinolones remains the choice among the orally administered antibiotics, followed by nitrofurantoin, second and third generation cephalosporins. For severe disease that require parenteral antibiotics the choice should be aminoglycosides, third generation cephalosporins, fluoroquinolones or imipenem, which were the most effective.

Prescribing Practice of Third Generation Cephalosporins in Medical Wards at Hospital Queen Elizabeth II (HQEII)

2021 ◽  
pp. 25-36
Author(s):  
Nur Fairuz Sabrina Hashim ◽  
Qishtina Mizan ◽  
Hong Tshun Kuan ◽  
Dina Cyla Danny ◽  
Lai Shuhua ◽  
...  
Keyword(s):  
Prospective Observational Study ◽  
Empirical Therapy ◽  
Third Generation ◽  
Prescribing Pattern ◽  
Pharmacy Department ◽  
Patients With Diabetes ◽  
Prescribing Practice ◽  
The Mean ◽  
Medical Wards ◽  
Third Generation Cephalosporins

Cephalosporins are amongst the most used antibiotics in hospital settings worldwide. The antibiotic report collated by the Pharmacy Department from Hospital Queen Elizabeth II(HQEII) in 2018 reflected high usage of third generation cephalosporins in medical wards, and indeed HQE II was one of the top users nationwide. This study aimed to evaluate the prescribing pattern of third-generation cephalosporins in medical wards as per National Antimicrobial Guidelines (NAG) 2019. A prospective, observational study was conducted in medical wards from June 2019 till January 2020. Patients who were started with third-generation cephalosporins (ceftazidime, ceftriaxone, cefotaxime, cefoperazone/sulbactam)were recruited, where 137 patients were enrolled with 60.6% were males. The mean age of patients was 53+16.8 years old. Antibiotics were initiated as per NAG recommendation. Cultures were taken before antibiotic initiation. Respiratory-related infections (n = 54, 39.4%) were the main indication and, antibiotics were continued as definite therapy in 38 patients (27.7%). The median duration of antibiotic treatment was 5 days (interquartile range = 3). Ceftazidime (n = 85, 62%) was most prescribed followed by ceftriaxone (n = 48, 35%)and cefotaxime (n = 4, 2.9%) respectively. It was worth noting that ceftazidime was primarilyused as empirical therapy for melioidosis (n = 64, 75.3%), particularly in patients with diabetes mellitus (n = 40, 62.5%), chronic kidney disease (n = 27, 42.2%), and/or occupational exposure (n = 4, 6.3%). The mean ceftazidime duration for empirical melioidosis was 3.2+1.6 days. Overall, third-generation cephalosporins were appropriately prescribed in medical wards as per NAG 2019. Further exploration of ceftazidime usage in empirical melioidosis is warranted.  

scholarly journals Retrospective 8-Year Study on the Antibiotic Resistance of Uropathogens in Children Hospitalised for Urinary Tract Infection in the Emilia-Romagna Region, Italy

Antibiotics ◽  
2021 ◽  
Vol 10 (10) ◽  
pp. 1207
Author(s):  
Susanna Esposito ◽  
Giuseppe Maglietta ◽  
Margherita Di Costanzo ◽  
Martina Ceccoli ◽  
Gianluca Vergine ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Antibiotic Resistance ◽  
Urinary Tract ◽  
Tract Infection ◽  
Third Generation ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
Amoxicillin Clavulanate ◽  
Third Generation Cephalosporins

The development and spread of antibiotic resistance is an increasingly important global public health problem, even in paediatric urinary tract infection (UTI). In light of the variability in the data, it is necessary to conduct surveillance studies to determine the prevalence of antibiotic resistance in specific geographical areas to optimize therapeutic management. In this observational, retrospective, multicentre study, the medical records of 1801 paediatric patients who were hospitalised for UTI between January 1st, 2012, and June 30th, 2020, in Emilia-Romagna, Italy, were analysed. Escherichia coli was the most frequently detected pathogen (75.6%), followed by Klebsiella pneumoniae (6.9%) and Pseudomonas aeruginosa (2.5%). Overall, 840 cases (46.7%) were due to antimicrobial-resistant uropathogens: 83 (4.7%) extended spectrum beta-lactamase (ESBL)-producing, 119 (6.7%) multidrug resistant (MDR) and 4 (0.2%) extensively drug resistant (XDR) bacteria. Empirical antibiotic therapy failed in 172 cases (9.6%). Having ESBL or MDR/XDR uropathogens, a history of recurrent UTI, antibiotic therapy in the preceding 30 days, and empirical treatment with amoxicillin or amoxicillin/clavulanate were significantly associated with treatment failure, whereas first-line therapy with third-generation cephalosporins was associated with protection against negative outcomes. In conclusion, the increase in the resistance of uropathogens to commonly used antibiotics requires continuous monitoring, and recommendations for antibiotic choice need updating. In our epidemiological context, amoxicillin/clavulanate no longer seems to be the appropriate first-line therapy for children hospitalised for UTI, whereas third-generation cephalosporins continue to be useful. To further limit the emergence of resistance, every effort to reduce and rationalise antibiotic consumption must be implemented.

Epidemiology of pediatric hydrocephalus in Haiti: analysis of a surgical case series

2019 ◽  
Vol 23 (5) ◽  
pp. 568-576
Author(s):  
Michael Ragheb ◽  
Ashish H. Shah ◽  
Sarah Jernigan ◽  
Tulay Koru-Sengul ◽  
John Ragheb
Keyword(s):  
Public Health ◽  
Logistic Regression ◽  
Head Circumference ◽  
Rainy Season ◽  
Statistical Tests ◽  
Multivariate Logistic Regression Analysis ◽  
Case Series ◽  
Multivariate Logistic Regression ◽  
Surgical Case ◽  
Operative Notes

OBJECTIVEHydrocephalus is recognized as a common disabling pediatric disease afflicting infants and children disproportionately in the developing world, where access to neurosurgical care is limited and risk of perinatal infection is high. This surgical case series describes the Project Medishare Hydrocephalus Specialty Surgery (PMHSS) program experience treating hydrocephalus in Haiti between 2008 and 2015.METHODSThe authors conducted a retrospective review of all cases involving children treated for hydrocephalus within the PMHSS program in Port-au-Prince, Haiti, from 2008 through 2015. All relevant epidemiological information of children treated were prospectively collected including relevant demographics, birth history, hydrocephalus etiology, head circumference, and operative notes. All appropriate associations and statistical tests were performed using univariate and multivariate logistic regression analyses.RESULTSAmong the 401 children treated within PMHSS, postinfectious hydrocephalus (PIH) accounted for 39.4% (n = 158) of cases based on clinical, radiographic, and endoscopic findings. The majority of children with hydrocephalus in Haiti were male (54.8%, n = 197), born in the rainy season (59.7%, n = 233), and born in a coastal/inland location (43.3%, n = 61). The most common surgical intervention was endoscopic third ventriculostomy with choroid plexus cauterization (ETV/CPC) (45.7%, n = 175). Multivariate logistic regression analysis yielded coastal birth location (OR 3.76, 95% CI 1.16–12.18) as a statistically significant predictor of PIH. Increasing head circumference (adjusted OR 1.06, 95% CI 0.99–1.13) demonstrated a slight trend toward significance with the incidence of PIH.CONCLUSIONSThis information will provide the foundation for future clinical and public health studies to better understand hydrocephalus in Haiti. The 39.4% prevalence of PIH falls within observed rates in Africa as does the apparently higher prevalence for those born during the rainy season. Although PIH was the most frequent etiology seen in almost all birth locations, the potential relationship with geography noted in this series will be the focus of further research in an effort to understand the link between climate and PIH in Haiti. The ultimate goal will be to develop an appropriate public health strategy to reduce the burden of PIH on the children of Haiti.

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