Introduction Infections of the urinary tract (UTIs) pose a serious health problem for patients at high cost for society. UTIs are also the most frequent healthcare associated infections. E. coli is the predominating pathogen in uncomplicated UTIs while other Enterobacteriaceae and Enterococcus spp are isolated in higher frequency in patients with urological diseases. The present state of microbial resistance development is alarming and the rates of resistance are related to the amount of antibiotics used in the different countries. Particularly worrisome is the increasing resistance to broad spectrum antibiotics. It is thus essential to limit the use of antibiotics in general and fluoroquinolones and cephalosporins in particular, especially in uncomplicated infections and asymptomatic bacteriuria.

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Guidelines on Urological Infections

We reevaluated conventional criteria for diagnosing coliform infection of the lower urinary tract in symptomatic women by obtaining cultures of the urethra, vagina, midstream urine, and bladder urine. The traditional diagnostic criterion, greater than or equal to 10(5) bacteria per milliliter of midstream urine, identified only 51 per cent of women whose bladder urine contained coliformis. We found the best diagnostic criterion to be greater than or equal to 10(2) bacteria per milliliter (sensitivity, 0.95; specificity, 0.85). Although isolation of less than 10(5) coliforms per milliliter of midstream urine has had a low predictive value of previous studies of asymptomatic women, the predictive value of the criterion of greater than or equal to 10(2) per milliliter was high (0.88) among symptomatic women the prevalence of coliform infection exceeded 50 per cent. In view of these findings, clinicians and microbiologists should alter their approach to the diagnosis and treatment of women with acute symptomatic coliform infection of the lower urinary tract.

Diagnosis of Coliform Infection in Acutely Dysuric Women

Aminoglycoside antibiotics have had a major impact on our ability to treat bacterial infections for the past half century. Whereas the interest in these versatile antibiotics continues to be high, their clinical utility has been compromised by widespread instances of resistance. The multitude of mechanisms of resistance is disconcerting but also illuminates how nature can manifest resistance when bacteria are confronted by antibiotics. This article reviews the most recent knowledge about the mechanisms of aminoglycoside action and the mechanisms of resistance to these antibiotics.

Versatility of Aminoglycosides and Prospects for Their Future

UTI: absence of dysuria (summary negative LR, 0.5; 95% CI, 0.3-0.7), absence of back pain (LR, 0.8; 95% CI, 0.7-0.9), history of vaginal discharge (LR, 0.3; 95% CI, 0.10.9), history of vaginal irritation (LR, 0.2; 95% CI, 0.1-0.9), and vaginal discharge on examination (LR, 0.7; 95% CI, 0.5-0.9). Of all individual diagnostic signs and symptoms, the 2 most powerful were history of vaginal discharge and history of vaginal irritation, which significantly decreased the likelihood of UTI when present (LRs, 0.3 and 0.2, respectively). One study examined combinations of symptoms, and the resulting LRs were more powerful (24.6 for the combination of dysuria and frequency but no vaginal discharge or irritation). One study of patients with recurrent UTI found that self-diagnosis significantly increased the probability of UTI (LR, 4.0). Conclusions In women who present with 1 or more symptoms of UTI, the probability of infection is approximately 50%. Specific combinations of symptoms (eg, dysuria and frequency without vaginal discharge or irritation) raise the probability of UTI to more than 90%, effectively ruling in the diagnosis based on history alone. In contrast, history taking, physical examination, and dipstick urinalysis are not able to reliably lower the posttest probability of disease to a level where a UTI can be ruled out when a patient presents with 1 or more symptoms. JAMA. 2002;287:2701-2710 www.jama.com

https://jamanetwork.com/journals/jama/articlepdf/194952/JRC10003.pdf

Does This Woman Have an Acute Uncomplicated Urinary Tract Infection

https://infeccion-urinaria.com.ar/trabajos_cientificos/ADULTOS/EAUGUIDELINES2008.pdf

EAU guidelines for the management of urinary and male genital tract infections. Urinary Tract Infection (UTI) Working Group of the Health Care Office (HCO) of the European Association of Urology (EAU).

Presentation, diagnosis, and treatment of urinary-tract infections in general practice

CLINICAL AND LABORATORY STUDIES WITH CARBENICILLIN: A New Penicillin Active against Pseudomonas pyocyanea

Serum-antibody levels as an indication of clinically inapparent pyelonephritis.

SUMMARY: The development of resistance to ampicillin (aminophenylacetamidopenicillanic acid) and penicillin G was investigated by selecting resistant variants of strains of Escherichia coli. Resistance occurred in stepwise manner. The parent strains contained minute amounts of penicillinase and production of the enzyme by resistant variants increased in relation to increase in resistance. Evidence was obtained that production of penicillinase was responsible for this increase in resistance. By using resistant variants and naturally occurring ampicillin-resistant organisms, it was found that production of only small amounts of penicillinase was sufficient to confer a high degree of resistance to the Gram-negative bacteria examined. In contrast, Gram-positive bacteria required much greater quantities of penicillinase for high grade resistance. It is suggested that an important reason for this difference is the complex lipid-containing cell wall of Gram-negative bacteria, which slows penetration by penicillin and enables small amounts of penicillinase to protect the cell. The penicillinase of all the Gram-negative organisms investigated was found to be a β-lactamase and to be more active against penicillin G than against ampicillin. This provides one explanation for the greater activity of ampicillin against Gram-negative bacteria.

A. Percival

Papers

Presentation, diagnosis, and treatment of urinary-tract infections in general practice

CLINICAL AND LABORATORY STUDIES WITH CARBENICILLIN: A New Penicillin Active against Pseudomonas pyocyanea

Serum-antibody levels as an indication of clinically inapparent pyelonephritis.

The Role of Penicillinase in Determining Natural and Acquired Resistance of Gram-Negative Bacteria to Penicillins

Eradication of bacteriuria in pregnancy by a short course of chemotherapy.