Urinary tract infections (UTIs) are one of the most common bacterial diseases both in communities and in hospitalized patients, and at the same, time they are one of the most common indications for the use of antibiotics. UTI guidelines are generally available nationally or internationally, but they do not address all aspects of UTI treatment for different patient cohorts, age, gender, or comorbidities. The aim of the study was to point out the importance of stratified cumulative antibiograms at the level of individual health care facilities and the significant differences between epidemiological data, not only at the national level, but also at the local level. Our study analyses data from 383 patients with UTIs from a hospital department, General University Hospital (GUH), and 272 patients from an outpatient medical facility, Urocentrum (UC). This analysis focuses on the most common UTI causative agent, Escherichia coli, its representation as the causative agent of UTI in patients with complicated acute cystitis (N30), and its representation in complicated acute cystitis in patients with prostate cancer (C61). In addition to the frequency of occurrence, a sub-analysis of the incidence of resistance of E. coli to commonly used antibiotics by age, gender, diagnosis, and medical facility was performed. Results: The most common causative agent of UTI was E. coli. In patients with N30, it was 70% in GUH and 54% in UC, but in oncological patients with UTI, it was only 39% and 35%, respectively. In patients with UTI in C61, there was a significant difference in susceptibility of E. coli between individual health care facilities. Lower resistance was found in UC opposite to GUH isolates in ampicillin, with 29.8% vs. 65%, p = 0.001; amoxicillin/clavulanic acid, with 8.5% vs. 30%, p = 0.01; with 2.1% vs. 17.5% in pivmecillinam, p = 0.01; with 10.6% vs. 37.5% in co-trimoxazole, p = 0.003; and ciprofloxacin, with 10.6% vs. 30%, p = 0.04. The study shows significant differences in the sensitivity of urinary E. coli isolates in patients in relation to age, gender, medical devices, and the presence of comorbidities.
- MeSH
- antibakteriální látky * terapeutické užití MeSH
- bakteriální léková rezistence MeSH
- dospělí MeSH
- Escherichia coli * účinky léků izolace a purifikace MeSH
- infekce močového ústrojí * farmakoterapie mikrobiologie epidemiologie MeSH
- infekce vyvolané Escherichia coli farmakoterapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mikrobiální testy citlivosti * MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
V předloženém textu je shrnuta problematika infekcí horních cest močových především z pohledu klinického mikrobiologa. Jsou zde prezentovány základní principy diagnostiky a léčby uroinfekcí s ohledem na současnou epidemiologickou situaci. Doporučení pro antibiotickou léčbu reflektují aktuální evropské a české doporučené postupy.
The presented text summarizes the issue of upper urinary tract infections, especially from the perspective of a clinical microbiologist. The basic principles of diagnosis and treatment of urinary tract infections with regard to the current epidemiological situation are presented. Recommendations for antibiotic treatment reflect current European and Czech guidelines.
- MeSH
- diferenciální diagnóza MeSH
- Escherichia coli patogenita MeSH
- infekce močového ústrojí * diagnóza etiologie farmakoterapie klasifikace MeSH
- Klebsiella pneumoniae patogenita MeSH
- lidé MeSH
- mikrobiální testy citlivosti klasifikace metody MeSH
- náhlé příhody * klasifikace MeSH
- pyelonefritida diagnóza farmakoterapie klasifikace mikrobiologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Background: Fosfomycin (FOS) is an older antimicrobial agent newly rediscovered as a possible treatment for infections with limited therapeutic options (e.g., Gram-negative bacteria with difficult-to-treat resistance, DTR), especially in intravenous form. However, for correct usage of FOS, it is necessary to have a reliable susceptibility testing method suitable for routine practice and robust interpretation criteria. Results: The results were interpreted according to 2023 interpretation criteria provided by the European Committee on Antimicrobial Susceptibility Testing (EUCAST). DTR Gram-negatives were more likely to be resistant to FOS (45% in Enterobacterales and 20% in P. aeruginosa) than non-DTR (10% and 6.7%, resp.). All isolates of S. aureus were susceptible to FOS. In Gram-negatives, all agreement values were unacceptable. Etest® performed better in the DTR cohort (categorical agreement, CA, 80%) than in the non-DTR cohort (CA 45.7%). There were no very major errors (VREs) observed in P. aeruginosa. S. aureus had surprisingly low essential agreement (EA) rates (53% for MRSA and 47% for MSSA) for Etest®, but categorical agreement was 100%. Methods: A total of 130 bacterial isolates were tested and compared using the disc diffusion method (DD) and gradient strip method (Etest®) with the reference method (agar dilution, AD). The spectrum of isolates tested was as follows: 40 Enterobacterales (20 DTR vs. 20 non-DTR), 30 Pseudomonas aeruginosa (15 DTR vs. 15 non-DTR), and 60 Staphylococcus aureus (30 methicillin-susceptible, MSSA, vs. 30 methicillin-resistant, MRSA). Conclusions: Neither one of the tested methods was identified as a suitable alternative to AD. It would be beneficial to define more interpretation criteria, at least in some instances.
- Publikační typ
- časopisecké články MeSH
1. elektronické vydání 1 online zdroj (266 stran)
Monografie zkušených autorů vychází v novém, přepracovaném vydání a je rozšířena o kapitoly věnované léčbě mykotických a parazitárních infekcí. Kniha je určena pro každodenní klinickou praxi, má být pomocníkem především pro praktické lékaře před nasazením antiinfekční léčby a při její kontrole.
- Klíčová slova
- Lékařské obory,
- MeSH
- antibakteriální látky MeSH
- farmakoterapie MeSH
- primární zdravotní péče MeSH
- MeSH
- antibakteriální látky * farmakologie terapeutické užití MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- antibakteriální látky * škodlivé účinky MeSH
- lidé MeSH
- nežádoucí účinky léčiv MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
