RESUMEN
A rise in efficacy of the treatment of acute infection affecting the lower urinary tract (LUTI) and prolongation of recurrence-free interval in chronic LUTI can be achieved only by an optimal antibacterial treatment. The study was made of 987 community-acquired strains of uropathogens from the patients living in 20 cities of the Russian Federation, Belarus and Kazakhstan (of them, 903 strains were from Russia). Enterobacteriaceae comprised 83.5%. E. coli infection of LUTI was found in 63.5% patients. The incidence of this infection was about the same both in uncomplicated and complicated cases (64.6 and 62.1%, respectively). Most active oral drugs against E.coli were phosphomycin (98.4%), furasidin (95.7%), nitrofurantoin (94.1%) and oralcefalosporins of the third generation (ceftibuten and cefixim). As to Enterobacteriaceae, only phosphomycin had activity against these bacteria above 90%, i.e. 91.5%. Furasidin and nitrofurantoin activity was 86.3 and 76.8%, respectively. From parenteral drugs, most active against E. coli were carbapenems (ertapenem, meropenem, imipenem. Strains resistant to them were not isolated. High in vitro activity was demonstrated also by cefoperason/sulbactam (97.4%), piperacillin/tasobactam (95.7%), cefalosporins of the third/fourth generation and amikacin (98.9%). Carbapenems were also highly active against Enterobacteroaceae. Empiric treatment of uncomplicated urinary infection should be performed with medicines which are not used for other indications.
Asunto(s)
Antibacterianos/uso terapéutico , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Infecciones por Enterobacteriaceae/microbiología , Enterobacteriaceae/aislamiento & purificación , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/microbiología , Farmacorresistencia Bacteriana/efectos de los fármacos , Enterobacteriaceae/crecimiento & desarrollo , Infecciones por Enterobacteriaceae/epidemiología , Femenino , Humanos , Kazajstán/epidemiología , Masculino , República de Belarús/epidemiología , Federación de Rusia/epidemiología , Infecciones Urinarias/epidemiologíaRESUMEN
A total of 656 female patients from Russia aged between 18 to 65 years with uncomplicated cystitis entered the international ARESC trial, of them 647 were eligible for final analysis. Positive cultural urine tests ( > 10(4) CFU/ml) were in 419 (64.7%) patients, 393 (93.8%) patients had monoinfection. The central laboratory of Genoa (to which the isolated samples were sent) has tested 416 uropathogens from 399 patients. The following pathogens were isolated: E. coli (72.6%), enterococcus (7.0%), Klebsiella pneumoniae (4.6%), Staphylococcus saprophyticus (3.6%), Proteus mirabilis (2.4%) and Staphylococcus aureus (1.7%). E. coli was most sensitive to phosphomycin (99.3%), mecillinam (97.3%), nitrofurantoin (94.7%), ciprofloxacin (87.4%). The lowest sensitivity was to ampicillin (42.1%) and cotrimoxasol (69.4%). As to the whole bacterial spectrum, the highest sensitivity was found to phosphomycin (96.5%), nitrofurantoin (85.6%) and citrofloxacin (82.8%), the less sensitivity--to ampicyllin (44.3%) and co-trimoxasol (70.1%). Phosphomycin, mecillinam (not registered in Russia) and nitrofurantoin showed activity in vitro and can be considered as drugs of choice for empiric therapy of cystitis. Because of high resistance of pathogens, co-trimoxasol (trimetoprim) and fluoroquinalones are not recommended as first-line treatment for uncomplicated cystitis in females.
Asunto(s)
Antibacterianos/uso terapéutico , Bacterias/crecimiento & desarrollo , Bacterias/aislamiento & purificación , Cistitis/tratamiento farmacológico , Cistitis/microbiología , Farmacorresistencia Bacteriana/efectos de los fármacos , Adolescente , Adulto , Anciano , Antibacterianos/farmacología , Europa (Continente) , Femenino , Humanos , Persona de Mediana EdadRESUMEN
The term complicated urinary infections (CUIs) includes infections developing in the presence of anatomic anomalies, metabolic or hormonal disorders, immunodeficiency or infection with atypical microorganisms. Complicating factors diminish efficiency of antibiotic treatment, raise probability of recurrence. CUIs account for 45.2% of all cases of outpatient urinary infections in adults in Russia. Nephroliths, diabetes mellitus and renal cysts are most prevalent complicating factors. CUIs causative agents' spectrum is wider and resistance bacteria isolation is more frequent compared to uncomplicated urinary infections. In addition to antibiotic therapy, CUIs treatment should be focused on detection and elimination of the complicating factor. If complicating factors are unremovable, antibiotic therapy should be directed to management of clinical symptoms of urinary infection, prevention of complications and damage to renal parenchyma. CUIs demand longer courses of antibiotics than uncomplicated urinary infections: 7-14 days in infection of the lower urinary tracts, at least 14 days in infection of the upper urinary tracts and 4-6 weeks in failure of the standard course. Fluoroquinolones are drugs of choice in adults.
Asunto(s)
Antibacterianos/uso terapéutico , Antiinfecciosos Urinarios/uso terapéutico , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Urinarias/complicaciones , Infecciones Urinarias/tratamiento farmacológico , Adulto , Anciano , Atención Ambulatoria , Infecciones Bacterianas/complicaciones , Farmacorresistencia Microbiana , Femenino , Fluoroquinolonas/uso terapéutico , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana EdadRESUMEN
E. coli is the most frequent agent causing urinary infection (UI) both in adults and children. E. coli of UI outpatients is often resistant to ampicilline, amoxicilline and co-trimoxasol. The study of phosphomycin in UI outpatients showed its highest efficacy against E. coli. Phosphomycin in a single daily dose of 3 g is a drug of choice in acute uncomplicated cystitis. The results of the study also demonstrate that phosphomycin can be used for prevention of pyoinflammatory complications before endoscopic manipulations and operations as well as open operations on the lower urinary tracts and genital organs.