Management of febrile urinary tract infection among spinal cord injured patients

Dinh, Aurélien; Toumi, A.; Blanc, Constance; Descatha, Alexis; Bouchand, Frédérique; Salomon, Jérôme; Hanslik, Thomas; Bernuz, B.; Denys, Pierre; Bernard, Louis

doi:10.1186/s12879-016-1484-4

Cited by 20 publications

(20 citation statements)

References 16 publications

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“…In older adults, who are particularly susceptible to antibiotic-related adverse events, the risk-benefit calculus of antibiotic treatment favors shorter lengths of therapy. Mounting evidence demonstrates that clinical cure can be effective achieved for CAUTI using a short course of antibiotics (≤7 days) when the catheter is removed if the patient is responding rapidly to initial therapy [80–82]. Similarly, longer lengths of therapy (>7 days) do not prevent recurrent UTIs and instead are associated with increased C. difficile infection [18].…”

Section: Treatment Of Utismentioning

confidence: 99%

Urinary Tract Infection and Asymptomatic Bacteriuria in Older Adults

Cortés-Penfield

Trautner

Jump

2017

Infectious Disease Clinics of North America

159

105

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Synopsis Urinary tract infections (UTIs) are a significant cause of morbidity among older adults; however, antibiotic prescriptions for clinically suspected UTIs are often inappropriate. Healthcare providers frequently struggle to differentiate UTI from asymptomatic bacteriuria, particularly in patients presenting with nonspecific symptoms. Patients with baseline cognitive impairments that limit history-taking can be particularly challenging. Here, we review the epidemiology and pathogenesis of UTI in older adults. We also discuss an approach to the diagnosis and treatment of UTIs, focusing on recognizing patients who would likely benefit from antibiotic treatment and on identifying patients for whom empiric antibiotic therapy should not be given.

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Section: Treatment Of Utismentioning

confidence: 99%

Urinary Tract Infection and Asymptomatic Bacteriuria in Older Adults

Cortés-Penfield

Trautner

Jump

2017

Infectious Disease Clinics of North America

159

105

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“…Longer durations of therapy are required for more severe (febrile) UTIs that indicate involvement of the upper urinary tract, or in patients with a delayed response. 8,9,15 There was no difference in the recurrence rate of UTI between patients in the acute and chronic phases of SCI, either at W3 (4/14 vs 7/56) or at W6 (5/13 vs 18/48). Thus, there is no rationale for a longer duration of treatment in the acute phase.…”

Section: Treatment Durationmentioning

confidence: 91%

“…In a recent retrospective study of 112 patients, Dinh et al 15 found no difference in cure rates for febrile UTI treated with o10 days, between 10 and 15 days, and more than 15 days of ATBs. The results suggested that a treatment duration of 8 days was appropriate in the case of febrile UTI.…”

Section: Treatment Durationmentioning

confidence: 97%

A 5-day antibiotic course for treatment of intermittent catheter-associated urinary tract infection in patients with spinal cord injury

Prévinaire

Berre

Hode

et al. 2017

Spinal Cord Ser Cases

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Fifty-seven patients underwent 111 5-day courses of antibiotics. The two main bacteria involved were and. Most commonly prescribed antibiotics were cephalosporins, cotrimoxazole, fluoroquinolones and nitrofurantoins. On day 4 of the antibiotic course, bacteria were eradicated in 99% of cases. Clinical cure occurred in all patients by day 5 (end of treatment). After treatment, recurrence of UTI occurred in 16% of patients at week 3, 38% at week 6 and 50% at week 9. This rate was not significantly different from patients initially treated for aBact (20%, 35% and 44%, respectively). The UTI-free period was significantly shorter after treatment for aBact (45.5 days) than after treatment for UTI (53.7 days). None of the following characteristics were found to be risk factors for UTI: level or severity of lesion, gender, voiding mode, use of anticholinergic drugs and time since lesion. Results of this study support the use of a short 5-day course of antibiotics to treat mild UTI in patients with spinal cord injury, and provide further evidence against treatment of aBact.

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“…Usually, even in patients with febrile UTI, a monotherapy is sufficient. There is no difference in the cure rate comparing treatment with a single substance versus dual therapy 15. In hospitalized patients with severe infection suspicious for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin is an option.…”

Section: Uti Treatmentmentioning

confidence: 99%

Management of urinary tract infections in patients with neurogenic bladder: challenges and solutions

Pannek¹,

Wöllner²

2017

RRU

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IntroductionUrinary tract infections (UTIs) are one of the most common morbidities in persons with neurogenic lower urinary tract dysfunction (NLUTD). They are associated with a significant morbidity and mortality, and they affect the quality of life of the affected patients. Diagnosis and treatment of UTI in this group of patients are challenging. In this review, the current strategies regarding diagnosis, treatment, and prevention are summarized.Diagnosticsit is important to correctly diagnose a UTI, as treatment of bacteriuria should strictly be avoided. A UTI is defined as a combination of laboratory findings (leukocyturia and bacteriuria) and symptoms. Laboratory findings without symptoms are classified as asymptomatic bacteriuria. Routine urine screening is not advised.TreatmentOnly UTI should be treated; treatment of asymptomatic bacteriuria is not indicated. Prior to treatment, urine for a urine culture should be obtained. Antibiotic treatment for ~7 days is advised.PreventionIn recurrent UTI, bladder management should be optimized and morphologic causes for UTI should be excluded. If UTIs persist, medical prophylaxis should be considered. Currently, no prophylactic measure with evidence-based efficacy exists. Long-term antibiotic prophylaxis should be used merely as an ultimate measure. Among the various mentioned innovative approaches for UTI prevention, bacteriophages, intravesical instillations, complementary and alternative medicine techniques, and probiotics seem to be most promising.ConclusionRecently, several promising innovative options for UTI prophylaxis have been developed which may help overcome the current therapeutic dilemma. However, further well designed studies are necessary to evaluate the safety and efficacy of these approaches.

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Management of febrile urinary tract infection among spinal cord injured patients

Cited by 20 publications

References 16 publications

Urinary Tract Infection and Asymptomatic Bacteriuria in Older Adults

Urinary Tract Infection and Asymptomatic Bacteriuria in Older Adults

A 5-day antibiotic course for treatment of intermittent catheter-associated urinary tract infection in patients with spinal cord injury

Management of urinary tract infections in patients with neurogenic bladder: challenges and solutions

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