5.5 Conclusions

Until predisposing factors are completely removed, true cure (i.e. without recurrent infection) is usually not possible. Correction of these abnormalities must be performed, whenever possible, as an essential part of treatment. Recurrent infection is the rule when the underlying urological abnormality cannot be removed: either relapse (e.g. with the same micro-organism) or a re-infection (e.g. with a new micro-organism). For this reason, a urine culture has to be carried out 5-9 days after the completion of therapy and also 4-6 weeks later.

5.6 References

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Evaluation of new anti-infective drugs for the treatment of UTI. Clin Infect Dis 1992; 15 (Suppl 1): 216-227.

2. Rubin RH, Shapiro ED, Andriole VT, Davis RJ, Stamm WE, with modifications by a European Working Party.

General guidelines for the evaluation of new anti-infective drugs for the treatment of UTI. Taufkirchen, Germany: The European Society of Clinical Microbiology and Infectious Diseases, 1993; 240-310.

3. Kumazawa J, Matsumoto T.

Complicated UTIs. In: UTIs. Infectiology, Vol. 1. Bergan T (ed). Basel: Karger, 1997; 19-26.

4. Naber KG.

Experience with the new guidelines on evaluation of new anti-infective drugs for the treatment of UTIs. Int J Antimicrob Agents 1999; 11:189-196.

5. Sharifi R, Geckler R, Childs S.

Treatment of UTIs: selecting an appropriate broad-spectrum antibiotic for nosocomial infections. Am J Med 1996; 100 (Suppl 6A): 76-82.

6. Frankenschmidt A, Naber KG, Bischoff W, Kullmann K.

Once-daily fleroxacin versus twice-daily ciprofloxacin in the treatment of complicated UTIs. JUrol1997; 158:1494-1499.

7. Nicolle LE.

A practical guide to the management of complicated UTI. Drugs 1997; 53: 583-592.

8. Cox CE, Holloway WJ, Geckler RW.

A multicenter comparative study of meropenem and imipenem/cilastatin in the treatment of complicated UTIs in hospitalized patients. Clin Infect Dis 1995; 21: 86-92.

9. Dobardzic AM, Dobardzic R.

Epidemiological features of complicated UTI in a district hospital of Kuwait. Eur J Epidemiol 1997; 13: 465-470.

10. Emori TG, Gaynes RP.

An overview of nosocomial infections, including the role of the microbiology laboratory. Clin Microbiol Rev 1993; 6: 428-442.

11. Parsons CL, Stauffer C, Mulholland SF, Griffith DP.

Effect of ammonium on bacterial adherence in bladder transitional epithelium. JUrol 1984; 132: 365-366.

12. Dumanski AJ, Hedelin H, Edin-Liljergen A, Beauchemin D, McLean RJ.

Unique ability of the Proteus mirabilis capsule to enhance mineral growth in infectious urinary calculi. Infect Immun 1994; 62: 2998.

13. Stamm WE, Hooton TM.

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14. US Department of Health and Human Services, Food and Drug Administration.

Center for Drug Evaluation and Research (CDER). Guidance for Industry. Complicated UTIs and Pyelonephritis-Developing Antimicrobial Drugs for Treatment. Clin-Anti. Rockville, MD: Drug Information Branch. Division of Communications Management, July 1998.

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6. SEPSIS SYNDROME IN UROLOGY (UROSEPSIS)

6.1 SUMMARY

Patients with urosepsis should be diagnosed at an early stage, especially in the case of a complicated UTI.Systemic inflammatory response (fever or hypothermia, tachycardia, tachypnoea, hypotension, oliguria, leucocyturia or leucopenia) is recognized as the first event in a cascade to multi-organ failure.

Urosepsis treatment calls for the combination of adequate life-supporting care, appropriate antibiotic therapy, adjunctive measures (e.g. sympathomimetic amines, corticosteroids, anticoagulation, granulocyte-colony stimulating factor [G-CSF] or granulocyte-macrophage-colony stimulating factor [GM-CSF], naloxone), and the optimal management of urinary tract disorders.

Urologists are recommended to treat patients in collaboration with intensivie care specialists.

Much urosepsis can be avoided by measures used to prevent nosocomial infection, e.g. reduction of hospital stay, early removal of indwelling urethral catheters, avoidance of unnecessary urethral catheterizations, correct use of closed catheter systems and attention to simple daily techniques in order to avoid cross-infection.