The bacterial strains isolated from 491 patients diagnosed as having urinary tract infections (UTIs) in 13 institutions in Japan were supplied between August 2002 and July 2003. The susceptibilities of them to many kinds of antimicrobial agents were investigated. Of them, 578 strains were estimated as causative bacteria and used for the investigation. The number of them was 578 strains consisting of 177 gram-positive bacterial strains (30.6%) and 401 gram-negative bacterial strains (69.4%). Against Staphylococcus aureus, vancomycin (VCM) showed a strong activity and prevented the growth of all strains with 1 microg/mL. The susceptibility of Staphylococcus epidermidis to cephems including cefotiam (CTM) was relatively good. Against Enterococcus faecalis, ampicillin (ABPC), imipenem (IPM), and VCM showed the strongest antibacterial activity (MIC90: 2-4 microg/mL). In addition, the low sensitive strains (MIC: > or = 256 microg/mL) to clarithromycin (CAM) were detected at 48.3% but none to cefozopran (CZOP). The antibacterial activity of cephems to Escherichia coli was generally good, and especially CZOP and cefpirome (CPR) showed the highest activity (MIC90: < or = 0.125 microg/mL). Quinolone resistant E. coli was detected at frequency of 13.5%, which was higher than that in the last year. The antibacterial activity of cephems to Citrobacter freundii was generally low but CZOP and CPR had a strong acitivity (MIC90: 0.25 and 0.5 microg/mL, respectively). The antibacterial activity of cephems to Klebsiella pneumoniae was good and especially cefmenoxime (CMX), cefixime (CFIX), flomoxef (FMOX), CPR, and CZOP showed stronger activity (MIC90: < or = 0.125 microg/mL). Against Serratia marcescens, meropenem (MEPM) had the highest antibacterial activity followed by CPR and CZOP. Against Proteus mirabilis, CMX, ceftazidime (CAZ), CPR, MEPM, carumonam (CRMN), and levofloxacin (LVFX) showed the strongest activity (MC90: < or = 0.125 microg/mL). Among other cephems, CZOP and CFIX were also strong (MIC90: 0.25 microg/mL). The antibacterial activity of the drugs to Pseudomonas aeruginosa was generally low, and MIC90 of all the drugs were ranged from 64 to > or = 256 microg/mL except IPM and amikacin (AMK) having 16 microg/mL. The antibacterial activity of CZOP was relatively good (MIC50: 8 microg/mL).
"Treatment of urinary tract infections (UTIs) in adults is often riddled with challenges ranging from the inherent virulent factors of some of the implicated organisms to perpetuate their infections and acquisition of other virulent factors in the course of the infection   . Quite evident in the present day clinical practice is bacterial widespread antimicrobial resistance which has rendered several of the antibiotics in the pharmacy shops irrelevant in the management of UTIs   . This scenario creates avenue for persistent, recurrent or chronic UTIs with their obvious sequelae  . "
[Show abstract][Hide abstract] ABSTRACT: Urinary tract infection is often not assumed to be a common clinical finding among children by clinicians. The study was therefore set up to ascertain the antimicrobial susceptibility patterns of bacteria recovered from urine of pre-school children with significant bacteriuria. Pre-school children attending nursery schools from five distinct geographical locations in Calabar municipality were recruited using random sampling methods. Mid-stream urine samples were obtained, transported, stored and processed using standard laboratory procedures, while antimicrobial susceptibility tests were carried out using modified Kirby-Bauer’s disk diffusion methods. Other information such as age, sex, parents or guardians occupation were obtained using structured questionnaires; other anthropometric measurements such as weight and height were also taken. Data was analysed using Epi Info 6 statistical software. The prevalence of significant bacteriuria was 7.3% with no significant gender difference (P> 0.05). The commonest organisms isolated were Escherichia coli 36.4%, Proteus mirabilis 21.2%, and Klebsiella pneumoniae 18.2%, others were Pseudomonas aeruginosa (9.1%), Enterobacter species (6.0%) and Staphylococcus aureus (9.1%). All the isolates of Pseudomonas aeruginosa and 66.7% of Klebsiella pneumoniae were from males (P< 0.05) and 76.7% of Staphylococcus aureus from females (P< 0.05). Antibiotics with highest activity were: ceftriaxone (100%), cefuroxime (33%-100%), nalidixic acid (50-100%), and gentamicin (50%-100%); those with least activity were ampicillin (0%), co-trimoxazole (0%-33%) and augmentin (0%-17%). Urinary tract infection could occur in pre-school children with out obvious clinical features, hence surveillance through routine urine screening is recommended. Ceftriaxone, cefuroxime, nalidixic acid and gentamicin may be considered in the absence of a sensitivity report.
[Show abstract][Hide abstract] ABSTRACT: Bacterial urinary tract infections (UTIs) are frequent infections in the outpatient as well as in the nosocomial setting. The stratification into uncomplicated and complicated UTIs has proven to be clinically useful. Bacterial virulence factors on the one side and the integrity of the host defense mechanisms on the other side determine the course of the infection. In uncomplicated UTIs Escherichia coli is the leading organism, whereas in complicated UTIs the bacterial spectrum is much broader including Gram-negative and Gram-positive and often multiresistant organisms. The therapy of uncomplicated UTIs is almost exclusively antibacterial, whereas in complicated UTIs the complicating factors have to be treated as well. There are two predominant aims in the antimicrobial treatment of both uncomplicated and complicated UTIs: (i) rapid and effective response to therapy and prevention of recurrence of the individual patient treated; (ii) prevention of emergence of resistance to antimicrobial chemotherapy in the microbial environment. The main drawback of current antibiotic therapies is the emergence and rapid increase of antibiotic resistance. To combat this development several strategies can be followed. Decrease the amount of antibiotics administered, optimal dosing, prevention of infection and development of new antibiotic substances. The aim of this review is to highlight the current and to describe future treatment options for UTIs.
European Urology 03/2006; 49(2):235-44. DOI:10.1016/j.eururo.2005.12.017 · 13.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Our objectives were to compare the pharmacokinetics (PK) of carumonam, a monobactam, between cystic fibrosis (CF) patients and healthy volunteers and assess its pharmacodynamic profile. We studied 10 adult CF patients and 18 healthy volunteers of similar body size (dose: 2.166 g of carumonam as 15-min intravenous infusion). High performance liquid chromatography with ultraviolet detection (HPLC-UV) was used for drug analysis and NONMEM (ICON, Ellicot City, MD) for population PK and Monte Carlo simulation with targets between > or =20% and 100% free time above MIC (fT > MIC). Unscaled renal clearance was 24% higher in CF patients. Lean body mass and creatinine clearance explained the difference in average clearance and volume of distribution between both subject groups. For a daily dose of 6 g per 70 kg of total body weight, 15-min infusions q8h achieved robust (>90%) probabilities of target attainment (PTAs) (target, 60% fT > MIC) for MICs < or =3 mg/L in CF patients and < or =6 mg/L in healthy volunteers. At the same dose, 4-h infusions q8h achieved robust PTAs up to markedly higher MICs < or =8 to 12 mg/L in CF patients and < or =16 mg/L in healthy volunteers.
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