Management of complicated urinary tract infections in a referral center in Mexico
Background Urinary tract infections are a common problem encountered by primary care, emergency physicians and urologists. A complicated urinary tract infection (CUTI) responds less effectively to the standard treatment. E. coli is the most common pathogen (40–70 %). In Mexico, there are ciprofloxac...
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Published in | International urology and nephrology Vol. 47; no. 2; pp. 229 - 233 |
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Main Authors | , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Dordrecht
Springer Netherlands
01.02.2015
Springer Nature B.V |
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Abstract | Background
Urinary tract infections are a common problem encountered by primary care, emergency physicians and urologists. A complicated urinary tract infection (CUTI) responds less effectively to the standard treatment.
E. coli
is the most common pathogen (40–70 %). In Mexico, there are ciprofloxacin resistance rates of 8–73 %, to trimethoprim/sulfamethoxazole 53–71 % and cephalosporins 5–18 %, with an ESBL
E. coli
prevalence of 10 %. For infections producing gas or purulent material, the percutaneous or endoscopic drainage is the standard.
Objective
To describe the management of patients with CUTIs, their specifically clinical course and eventual culture results determining the most common isolated microorganisms and their resistance.
Materials and methods
The clinical records of patients hospitalized with CUTIs from January 2012 to July 2013 were reviewed.
Results
One hundred and seventy-three patients were included. Acute pyelonephritis was the most common presentation (53.2 %). The most common microorganism was
E. coli
(83 %), with ESBL prevalence of 71.4 % and a resistance to quinolone, cephalosporin and trimethoprim of 89.7, 64.7 and 60.3 %, respectively. The most common factors associated with development of CUTIs were recent use of antibiotics (95.3 %) and obstructive uropathy (73.4 %). A total of 41 % received carbapenems and 40.5 % received minimally invasive treatments. Overall mortality was 2.9 %.
Discussion
There were a greater ESBL-producing pathogen prevalence and an over 50 % resistance to classically first-choice antibiotics. The minimally invasive treatments for complicated infections are fundamental; however, nephrectomy still has a role.
Conclusions
Wide-spectrum antimicrobial therapy and minimally invasive approaches are the most common treatments for CUTIs in our center, and a reevaluation regarding antibiotic use in Mexico needs to be done. |
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AbstractList | Urinary tract infections are a common problem encountered by primary care, emergency physicians and urologists. A complicated urinary tract infection (CUTI) responds less effectively to the standard treatment. E. coli is the most common pathogen (40-70 %). In Mexico, there are ciprofloxacin resistance rates of 8-73 %, to trimethoprim/sulfamethoxazole 53-71 % and cephalosporins 5-18 %, with an ESBL E. coli prevalence of 10 %. For infections producing gas or purulent material, the percutaneous or endoscopic drainage is the standard.
To describe the management of patients with CUTIs, their specifically clinical course and eventual culture results determining the most common isolated microorganisms and their resistance.
The clinical records of patients hospitalized with CUTIs from January 2012 to July 2013 were reviewed.
One hundred and seventy-three patients were included. Acute pyelonephritis was the most common presentation (53.2 %). The most common microorganism was E. coli (83 %), with ESBL prevalence of 71.4 % and a resistance to quinolone, cephalosporin and trimethoprim of 89.7, 64.7 and 60.3 %, respectively. The most common factors associated with development of CUTIs were recent use of antibiotics (95.3 %) and obstructive uropathy (73.4 %). A total of 41 % received carbapenems and 40.5 % received minimally invasive treatments. Overall mortality was 2.9 %.
There were a greater ESBL-producing pathogen prevalence and an over 50 % resistance to classically first-choice antibiotics. The minimally invasive treatments for complicated infections are fundamental; however, nephrectomy still has a role.
Wide-spectrum antimicrobial therapy and minimally invasive approaches are the most common treatments for CUTIs in our center, and a reevaluation regarding antibiotic use in Mexico needs to be done. BACKGROUNDUrinary tract infections are a common problem encountered by primary care, emergency physicians and urologists. A complicated urinary tract infection (CUTI) responds less effectively to the standard treatment. E. coli is the most common pathogen (40-70 %). In Mexico, there are ciprofloxacin resistance rates of 8-73 %, to trimethoprim/sulfamethoxazole 53-71 % and cephalosporins 5-18 %, with an ESBL E. coli prevalence of 10 %. For infections producing gas or purulent material, the percutaneous or endoscopic drainage is the standard.OBJECTIVETo describe the management of patients with CUTIs, their specifically clinical course and eventual culture results determining the most common isolated microorganisms and their resistance.MATERIALS AND METHODSThe clinical records of patients hospitalized with CUTIs from January 2012 to July 2013 were reviewed.RESULTSOne hundred and seventy-three patients were included. Acute pyelonephritis was the most common presentation (53.2 %). The most common microorganism was E. coli (83 %), with ESBL prevalence of 71.4 % and a resistance to quinolone, cephalosporin and trimethoprim of 89.7, 64.7 and 60.3 %, respectively. The most common factors associated with development of CUTIs were recent use of antibiotics (95.3 %) and obstructive uropathy (73.4 %). A total of 41 % received carbapenems and 40.5 % received minimally invasive treatments. Overall mortality was 2.9 %.DISCUSSIONThere were a greater ESBL-producing pathogen prevalence and an over 50 % resistance to classically first-choice antibiotics. The minimally invasive treatments for complicated infections are fundamental; however, nephrectomy still has a role.CONCLUSIONSWide-spectrum antimicrobial therapy and minimally invasive approaches are the most common treatments for CUTIs in our center, and a reevaluation regarding antibiotic use in Mexico needs to be done. Urinary tract infections are a common problem encountered by primary care, emergency physicians and urologists. A complicated urinary tract infection (CUTI) responds less effectively to the standard treatment. E. coli is the most common pathogen (40-70 %). In Mexico, there are ciprofloxacin resistance rates of 8-73 %, to trimethoprim/sulfamethoxazole 53-71 % and cephalosporins 5-18 %, with an ESBL E. coli prevalence of 10 %. For infections producing gas or purulent material, the percutaneous or endoscopic drainage is the standard. To describe the management of patients with CUTIs, their specifically clinical course and eventual culture results determining the most common isolated microorganisms and their resistance. The clinical records of patients hospitalized with CUTIs from January 2012 to July 2013 were reviewed. One hundred and seventy-three patients were included. Acute pyelonephritis was the most common presentation (53.2 %). The most common microorganism was E. coli (83 %), with ESBL prevalence of 71.4 % and a resistance to quinolone, cephalosporin and trimethoprim of 89.7, 64.7 and 60.3 %, respectively. The most common factors associated with development of CUTIs were recent use of antibiotics (95.3 %) and obstructive uropathy (73.4 %). A total of 41 % received carbapenems and 40.5 % received minimally invasive treatments. Overall mortality was 2.9 %. There were a greater ESBL-producing pathogen prevalence and an over 50 % resistance to classically first-choice antibiotics. The minimally invasive treatments for complicated infections are fundamental; however, nephrectomy still has a role. Wide-spectrum antimicrobial therapy and minimally invasive approaches are the most common treatments for CUTIs in our center, and a reevaluation regarding antibiotic use in Mexico needs to be done. Background Urinary tract infections are a common problem encountered by primary care, emergency physicians and urologists. A complicated urinary tract infection (CUTI) responds less effectively to the standard treatment. E. coli is the most common pathogen (40–70 %). In Mexico, there are ciprofloxacin resistance rates of 8–73 %, to trimethoprim/sulfamethoxazole 53–71 % and cephalosporins 5–18 %, with an ESBL E. coli prevalence of 10 %. For infections producing gas or purulent material, the percutaneous or endoscopic drainage is the standard. Objective To describe the management of patients with CUTIs, their specifically clinical course and eventual culture results determining the most common isolated microorganisms and their resistance. Materials and methods The clinical records of patients hospitalized with CUTIs from January 2012 to July 2013 were reviewed. Results One hundred and seventy-three patients were included. Acute pyelonephritis was the most common presentation (53.2 %). The most common microorganism was E. coli (83 %), with ESBL prevalence of 71.4 % and a resistance to quinolone, cephalosporin and trimethoprim of 89.7, 64.7 and 60.3 %, respectively. The most common factors associated with development of CUTIs were recent use of antibiotics (95.3 %) and obstructive uropathy (73.4 %). A total of 41 % received carbapenems and 40.5 % received minimally invasive treatments. Overall mortality was 2.9 %. Discussion There were a greater ESBL-producing pathogen prevalence and an over 50 % resistance to classically first-choice antibiotics. The minimally invasive treatments for complicated infections are fundamental; however, nephrectomy still has a role. Conclusions Wide-spectrum antimicrobial therapy and minimally invasive approaches are the most common treatments for CUTIs in our center, and a reevaluation regarding antibiotic use in Mexico needs to be done. |
Author | Trujillo-Ortiz, Luis Garza-Sáinz, Gerardo Sedano-Basilio, Jorge E. Cornejo-Dávila, Victor Mayorga-Gómez, Edgar Palmeros-Rodríguez, Mario A. Cantellano-Orozco, Mauricio Morales-Montor, Jorge G. Pacheco-Gahbler, Carlos Osornio-Sánchez, Victor Uberetagoyena-Tello de Meneses, Israel Martínez-Arroyo, Carlos |
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Cites_doi | 10.1016/j.ucl.2007.09.010 10.1590/S0036-36342009000200012 10.1016/j.aju.2011.09.002 10.1016/j.asjsur.2013.01.003 10.1016/S1607-551X(09)70035-X 10.1007/s11255-006-9033-5 10.1016/j.ijantimicag.2012.08.003 10.1016/j.juro.2008.01.019 10.1590/S0036-36342007000500003 10.1007/s00268-006-0162-x 10.1016/j.jinf.2011.05.015 10.1016/j.urology.2007.12.095 |
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Urinary tract infections are a common problem encountered by primary care, emergency physicians and urologists. A complicated urinary tract... Urinary tract infections are a common problem encountered by primary care, emergency physicians and urologists. A complicated urinary tract infection (CUTI)... BACKGROUNDUrinary tract infections are a common problem encountered by primary care, emergency physicians and urologists. A complicated urinary tract infection... |
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SubjectTerms | Abscess - microbiology Abscess - therapy Acute Disease Adolescent Adult Aged Aged, 80 and over Anti-Bacterial Agents - therapeutic use beta-Lactamases - metabolism Drug Resistance, Multiple, Bacterial Epididymitis - microbiology Epididymitis - therapy Escherichia coli - metabolism Escherichia coli Infections - diagnosis Escherichia coli Infections - drug therapy Escherichia coli Infections - microbiology Female Humans Length of Stay Male Medicine Medicine & Public Health Mexico Middle Aged Nephrology Orchitis - microbiology Orchitis - therapy Prostatitis - microbiology Prostatitis - therapy Pyelonephritis - microbiology Pyelonephritis - therapy Pyonephrosis - microbiology Pyonephrosis - therapy Risk Factors Stents Urinary Tract Infections - complications Urinary Tract Infections - drug therapy Urinary Tract Infections - microbiology Urology Urology – Original Paper Young Adult |
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Title | Management of complicated urinary tract infections in a referral center in Mexico |
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