Treatment Duration of Febrile Urinary Tract Infections

Starre, Willize E. van der; Dissel, Jaap T. van; Nieuwkoop, Cees van

doi:10.1007/s11908-011-0211-y

Cited by 21 publications

(12 citation statements)

References 34 publications

(59 reference statements)

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“…Another observation is the shorter length of antimicrobial treatment in HCA-FUTI probably related to the higher frequency of multi-resistant microorganisms with fewer oral antimicrobials options. However, the length of antimicrobial therapy in males with FUTI is still under debate and 2 weeks of therapy seems to be as efficacious as 4 weeks when FQ are used [37].…”

Section: Discussionmentioning

confidence: 99%

Differential characteristics of healthcare-associated compared to community-acquired febrile urinary tract infections in males

Smithson

Ramos

Bastida

et al. 2015

Eur J Clin Microbiol Infect Dis

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The objective of this study was to analyse the characteristics of healthcare-associated febrile urinary tract infection (HCA-FUTI) compared to community-acquired FUTI (CA-FUTI) in men. An ambispective cross-sectional study in which we recorded clinical and microbiology data and outcomes from males with FUTI attended in the Emergency Department was carried out. A total of 479 males with FUTI, 162 (33.8%) HCA-FUTI and 317 (66.2%) CA-FUTI, were included. HCA-FUTI patients were older (p < 0.001), had higher Charlson scores (p < 0.001) and received previous antimicrobial treatment more frequently (p < 0.001) compared to CA-FUTI patients. HCA-FUTI was less likely caused by Escherichia coli (p < 0.001) and more frequently by Klebsiella spp. (p = 0.02), Enterobacter spp. (p < 0.001) and Pseudomonas aeruginosa (p < 0.001). Resistance to ceftriaxone (p = 0.006), gentamicin (p < 0.001), quinolones (p < 0.001), co-trimoxazole (p = 0.001) and fosfomycin (p = 0.009) was higher among E. coli strains isolated from males with HCA-FUTI and so was the prevalence of extended-spectrum beta-lactamase and AmpC E. coli and Klebsiella spp.-producing strains (p = 0.012). Inadequate antimicrobial treatment and all-cause in-hospital mortality was associated with HCA-FUTI (p < 0.001 and p = 0.004, respectively). Independent factors for mortality were severe sepsis or septic shock [odds ratio (OR) 29; 95% confidence interval (CI): 3.9-214] and cirrhosis (OR 23.7; 95% CI: 1.6-350.6). Male patients with HCA-FUTI have different clinical characteristics, outcomes and microbiological features compared to CA-FUTI patients. Previous contact with the healthcare system has to be taken into consideration when deciding the optimal antimicrobial treatment in males with FUTI.

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Section: Discussionmentioning

confidence: 99%

Differential characteristics of healthcare-associated compared to community-acquired febrile urinary tract infections in males

Smithson

Ramos

Bastida

et al. 2015

Eur J Clin Microbiol Infect Dis

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“…If the patient had flank pain and self-reported fever but CRP < 40 mg/l, she was characterized as having a febrile UTI. Pyelonephritis is sometimes also classified as a febrile UTI [ 22 ], but in this study we use the term febrile UTI to classify a UTI with less severe systemic impact than pyelonephritis. In the trial by Gagyor et al, they left this classification to the discretion of the GP.…”

Section: Methodsmentioning

confidence: 99%

Ibuprofen versus pivmecillinam for uncomplicated urinary tract infection in women—A double-blind, randomized non-inferiority trial

et al. 2018

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BackgroundAlthough uncomplicated urinary tract infections (UTIs) are often self-limiting, most patients will be prescribed antibiotic treatment. We assessed whether treatment with ibuprofen was non-inferior to pivmecillinam in achieving symptomatic resolution by day 4, with a non-inferiority margin of 10%.Methods and findingsThis was a randomized, controlled, double-blind non-inferiority trial. We recruited patients from 16 sites in a general practice setting in Norway, Sweden, and Denmark. Non-pregnant women aged 18–60 years presenting with symptoms of uncomplicated UTI were screened for eligibility from 11 April 2013 to 22 April 2016. Patients with informed consent were randomized (1:1 ratio) to treatment with either 600 mg ibuprofen or 200 mg pivmecillinam 3 times a day for 3 days. The patient, treating physician, and study personnel were blinded to treatment allocation. The primary outcome was the proportion of patients who felt cured by day 4, as assessed from a patient diary. Secondary outcomes included the proportion of patients in need of secondary treatment with antibiotics and cases of pyelonephritis. A total of 383 women were randomly assigned to treatment with either ibuprofen (n = 194, 181 analyzed) or pivmecillinam (n = 189, 178 analyzed). By day 4, 38.7% of the patients in the ibuprofen group felt cured versus 73.6% in the pivmecillinam group. The adjusted risk difference with 90% confidence interval was 35% (27% to 43%) in favor of pivmecillinam, which crossed the prespecified non-inferiority margin. Secondary endpoints were generally in favor of pivmecillinam. After 4 weeks’ follow-up, 53% of patients in the ibuprofen group recovered without antibiotic treatment. Seven cases of pyelonephritis occurred, all in the ibuprofen group, giving a number needed to harm of 26 (95% CI 13 to 103). Five of these patients were hospitalized and classified as having serious adverse events; 2 recovered as outpatients. A limitation of the study was the extensive list of exclusion criteria, eliminating almost half of the patients screened. We did not register symptoms in the screening process; hence, we do not know the symptom burden for those who declined to participate. This might make our results less generalizable.ConclusionsIbuprofen was inferior to pivmecillinam for treating uncomplicated UTIs. More than half of the women in the ibuprofen group recovered without antibiotics. However, pyelonephritis occurred in 7 out of 181 women using ibuprofen. Until we can identify those women who will develop complications, we cannot recommend ibuprofen alone as initial treatment to women with uncomplicated UTIs.Trial registrationClinicalTrials.gov NCT01849926EU Clinical Trials Register (EU-CTR), EudraCT Number 2012-002776-14

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“…Treatments for acute uncomplicated pyelonephritis are mostly outpatient-based treatments [ 96 97 ]. In a recent study, only 7% of female patients with acute pyelonephritis required inpatient care [ 96 ].…”

Section: Clinical Practice Guidelines By Specific Diseasesmentioning

confidence: 99%

Clinical Practice Guidelines for the Antibiotic Treatment of Community-Acquired Urinary Tract Infections

et al. 2018

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Urinary tract infections (UTIs) are infectious diseases that commonly occur in communities. Although several international guidelines for the management of UTIs have been available, clinical characteristics, etiology and antimicrobial susceptibility patterns may differ from country to country. This work represents an update of the 2011 Korean guideline for UTIs. The current guideline was developed by the update and adaptation method. This clinical practice guideline provides recommendations for the diagnosis and management of UTIs, including asymptomatic bacteriuria, acute uncomplicated cystitis, acute uncomplicated pyelonephritis, complicated pyelonephritis related to urinary tract obstruction, and acute bacterial prostatitis. This guideline targets community-acquired UTIs occurring among adult patients. Healthcare-associated UTIs, catheter-associated UTIs, and infections in immunocompromised patients were not included in this guideline.

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Treatment Duration of Febrile Urinary Tract Infections

Cited by 21 publications

References 34 publications

Differential characteristics of healthcare-associated compared to community-acquired febrile urinary tract infections in males

Differential characteristics of healthcare-associated compared to community-acquired febrile urinary tract infections in males

Ibuprofen versus pivmecillinam for uncomplicated urinary tract infection in women—A double-blind, randomized non-inferiority trial

Clinical Practice Guidelines for the Antibiotic Treatment of Community-Acquired Urinary Tract Infections

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