BACKGROUND The increasing rates of antibiotic-resistance in the recent years has caused the emergence of multiple drug-resistant bacteria.Therefore,antibiotics that are recommended by the current clinical guidelines m...BACKGROUND The increasing rates of antibiotic-resistance in the recent years has caused the emergence of multiple drug-resistant bacteria.Therefore,antibiotics that are recommended by the current clinical guidelines may not be effective for the treatment of complicated urinary tract infection(UTI)and acute pyelonephritis.AIM To determine the clinical efficacy and safety of antibiotics for the treatment of complicated urinary tract infection and acute pyelonephritis.METHODS A search of three medical databases(PubMed,EMBASE and Google Scholar)were conducted for eligible articles describing the use of antibiotics in managing complicated UTI and acute pyelonephritis.The following keywords were used to perform the literature search:“urinary tract infection”,“complicated UTI”,“pyelonephritis”,“treatment”and“antibiotics”.Additional articles of interest were retrieved from the reference list of selected papers.Eligibility criteria for this systematic review were diagnosis of either complicated urinary tract infection or acute pyelonephritis and the use of antibiotics in management.Clinical trials and observational studies were included in this review while case reports and reviews were excluded.The methodological quality of clinical trials and observational studies was assessed.A descriptive approach was adopted to analyze the data due to the variation of methodology and interventions.RESULTS A total of 183 studies were screened;eight studies that matched all the eligibility criteria were included in this review.The antibiotics included in this systematic review were ceftazidime-avibactam,doripenem,levofloxacin,meropenemvaborbactam,piperacillin-tazobactam,plazomicin,tazobactam-ceftolozane and gentamicin.Two clinical trials reported that shorter duration of levofloxacin or non-fluoroquinolone antibiotics treatment was as effective as the duration of antibiotic therapy recommended by the current guidelines in treating complicated UTI and pyelonephritis.Besides that,ceftazidime-avibactam,piperacillintazobactam and tazobactam-ceftolozane can be used as an alternative to carbapenem in treating extended-spectrumβ-lactamase-producing Escherichia coli.In the included studies,the cure rates of the complicated UTI and pyelonephritis by meropenem-vaborbactam,piperacillin-tazobactam and tazobactam-ceftolozane was comparable at between 95.6%and 98.4%.Furthermore,the clinical trials showed that levofloxacin had a relatively high rate of adverse events(33.1%and 47.7%in two clinical trials)while tazobactamceftolozane had a relatively low rate of adverse events(17.5%).All studies have limitations and a potential for bias.CONCLUSION The use of novel antibiotics and combination antibiotic therapy can be considered in treating complicated UTI and acute pyelonephritis when resistance to recommended antibiotics occurs.展开更多
Background: Urinary tract infection is a common disease in Somaliland society. The predominant causative organism of Urinary tract infection is Escherichia coli. This research studies antibiotic resistance of uropatho...Background: Urinary tract infection is a common disease in Somaliland society. The predominant causative organism of Urinary tract infection is Escherichia coli. This research studies antibiotic resistance of uropathogenic E. coli in patients of Hargeisa Group Hospital. The study selected commonly prescribed antibiotics for urinary tract infection treatment. Methodology: Urine samples of patients were cultured to isolate causative organisms of the urinary tract infection. Chromo-agar media, CLED, and biochemical tests are applied to identify the type of bacteria. Antibiotic reactions to E. coli bacteria are measured to differentiate between sensitive and resistant drugs with the guidance of the Clinical and Laboratories Standard Institute (CLSI). Kirby Bauer disc diffusion method is applied to assess antimicrobial activity against E. coli. Data of patients such as age, sex, symptoms of UTI, previous UTI infection, and history of antibiotic use were recorded. SPSS and Microsoft Excel are applied to analyze and interpret data. Results: The predominant organism that caused urinary tract infection was Escherichia coli (55%), Klebsiella spp (15%), Candida spp (15%), Enterococcus spp (10%), Staph spp 2.5%, and Pseudomonas spp 2.5% while other 55% were negative. The study assessed antibiotic resistance of E. coli, which reported resistance to Tetracycline at (70%), Ampicillin (64%), and Cotrimoxazole (61%). The bacteria showed moderate resistance to Ceftriaxone (43.5%), Nalidixic acid (43%), and Ciprofloxacin (36%). The bacteria are sensitive to Amikacin (100%), Nitrofurantoin (96%), Levofloxacin (73%) and gentamicin (74%). Conclusion: The overall incidence of antibiotic resistance to E. coli is high because the bacteria show a percentage of resistance to each antibiotic except Amikacin which gives (100%) sensitivity. The research recommends public awareness of the risks associated with antibiotic use and periodic evaluation of antibiotic resistance to accomplish better managing urinary tract infections.展开更多
文摘BACKGROUND The increasing rates of antibiotic-resistance in the recent years has caused the emergence of multiple drug-resistant bacteria.Therefore,antibiotics that are recommended by the current clinical guidelines may not be effective for the treatment of complicated urinary tract infection(UTI)and acute pyelonephritis.AIM To determine the clinical efficacy and safety of antibiotics for the treatment of complicated urinary tract infection and acute pyelonephritis.METHODS A search of three medical databases(PubMed,EMBASE and Google Scholar)were conducted for eligible articles describing the use of antibiotics in managing complicated UTI and acute pyelonephritis.The following keywords were used to perform the literature search:“urinary tract infection”,“complicated UTI”,“pyelonephritis”,“treatment”and“antibiotics”.Additional articles of interest were retrieved from the reference list of selected papers.Eligibility criteria for this systematic review were diagnosis of either complicated urinary tract infection or acute pyelonephritis and the use of antibiotics in management.Clinical trials and observational studies were included in this review while case reports and reviews were excluded.The methodological quality of clinical trials and observational studies was assessed.A descriptive approach was adopted to analyze the data due to the variation of methodology and interventions.RESULTS A total of 183 studies were screened;eight studies that matched all the eligibility criteria were included in this review.The antibiotics included in this systematic review were ceftazidime-avibactam,doripenem,levofloxacin,meropenemvaborbactam,piperacillin-tazobactam,plazomicin,tazobactam-ceftolozane and gentamicin.Two clinical trials reported that shorter duration of levofloxacin or non-fluoroquinolone antibiotics treatment was as effective as the duration of antibiotic therapy recommended by the current guidelines in treating complicated UTI and pyelonephritis.Besides that,ceftazidime-avibactam,piperacillintazobactam and tazobactam-ceftolozane can be used as an alternative to carbapenem in treating extended-spectrumβ-lactamase-producing Escherichia coli.In the included studies,the cure rates of the complicated UTI and pyelonephritis by meropenem-vaborbactam,piperacillin-tazobactam and tazobactam-ceftolozane was comparable at between 95.6%and 98.4%.Furthermore,the clinical trials showed that levofloxacin had a relatively high rate of adverse events(33.1%and 47.7%in two clinical trials)while tazobactamceftolozane had a relatively low rate of adverse events(17.5%).All studies have limitations and a potential for bias.CONCLUSION The use of novel antibiotics and combination antibiotic therapy can be considered in treating complicated UTI and acute pyelonephritis when resistance to recommended antibiotics occurs.
文摘Background: Urinary tract infection is a common disease in Somaliland society. The predominant causative organism of Urinary tract infection is Escherichia coli. This research studies antibiotic resistance of uropathogenic E. coli in patients of Hargeisa Group Hospital. The study selected commonly prescribed antibiotics for urinary tract infection treatment. Methodology: Urine samples of patients were cultured to isolate causative organisms of the urinary tract infection. Chromo-agar media, CLED, and biochemical tests are applied to identify the type of bacteria. Antibiotic reactions to E. coli bacteria are measured to differentiate between sensitive and resistant drugs with the guidance of the Clinical and Laboratories Standard Institute (CLSI). Kirby Bauer disc diffusion method is applied to assess antimicrobial activity against E. coli. Data of patients such as age, sex, symptoms of UTI, previous UTI infection, and history of antibiotic use were recorded. SPSS and Microsoft Excel are applied to analyze and interpret data. Results: The predominant organism that caused urinary tract infection was Escherichia coli (55%), Klebsiella spp (15%), Candida spp (15%), Enterococcus spp (10%), Staph spp 2.5%, and Pseudomonas spp 2.5% while other 55% were negative. The study assessed antibiotic resistance of E. coli, which reported resistance to Tetracycline at (70%), Ampicillin (64%), and Cotrimoxazole (61%). The bacteria showed moderate resistance to Ceftriaxone (43.5%), Nalidixic acid (43%), and Ciprofloxacin (36%). The bacteria are sensitive to Amikacin (100%), Nitrofurantoin (96%), Levofloxacin (73%) and gentamicin (74%). Conclusion: The overall incidence of antibiotic resistance to E. coli is high because the bacteria show a percentage of resistance to each antibiotic except Amikacin which gives (100%) sensitivity. The research recommends public awareness of the risks associated with antibiotic use and periodic evaluation of antibiotic resistance to accomplish better managing urinary tract infections.
