비뇨기과 질환으로 인한 합병 요로감염: 유럽비뇨기과학회 가이드라인
Compicated Urinary Tract Infection due to Urologic Diseases:European Urology Association Guideline
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A complicated urinary tract infection (UTI) is an infection associated with a condition, such as a structural or functional abnormality of the genitourinary tract, or the presence of an underlying disease that interferes with host defence mechanisms, which increase the risks of acquiring infection or of failing therapy. A broad range of bacteria can cause a complicated UTI. The spectrum is much larger than in uncomplicated UTIs and bacteria are more likely to be resistant to antimicrobials, especially in a treatment related complicated UTI. Enterobacteriaceae are the predominant pathogens, with Escherichia coli being the most common pathogen. However, non-fermenters (e.g. Pseudomonas aeruginosa) and Gram-positive cocci (e.g. Staphylococci and Enterococci) may also play an important role, depending on the underlying conditions. Treatment strategy depends on the severity of the illness. Treatment encompasses three goals:management of the urological abnormality, antimicrobial therapy, and supportive care when needed. Hospitalization is often required. To avoid the emergence of resistant strains, therapy should be guided by urine culture whenever possible. If empirical therapy is necessary, the antibacterial spectrum of the antibiotic agent should include the most relevant pathogens. A fluoroquinolone with mainly renal excretion, an aminopenicillin plus a β-lactam inhibitor (BLI), a Group 2 or 3a cephalosporin or, in the case of parenteral therapy, an aminoglycoside, are recommended alternatives (LE: 1b, GR: B). In case of failure of initial therapy, or in case of clinically severe infection, a broader-spectrum antibiotic should be chosen that is also active against Pseudomonas, e.g. a fluoroquinolone (if not used for initial therapy), an acylaminopenicillin (piperacillin) plus a BLI, a Group 3b cephalosporin, or a carbapenem, with or without combination with an aminoglycoside. The duration of therapy is usually 7-14 days (LE: 1b, GR: A), but has sometimes to be prolonged for up to 21 days. Until predisposing factors are completely removed, true cure without recurrent infection is usually not possible. Therefore, a urine culture should be carried out 5-9 days after the completion of therapy and also 4-6 weeks later.
Abstract
A complicated urinary tract infection (UTI) is an infection associated with a condition, such as a structural or functional abnormality of the genitourinary tract, or the presence of an underlying disease that interferes with host defence mechanisms, which increase the risks of acquiring infection or of failing therapy. A broad range of bacteria can cause a complicated UTI. The spectrum is much larger than in uncomplicated UTIs and bacteria are more likely to be resistant to antimicrobials, especially in a treatment related complicated UTI. Enterobacteriaceae are the predominant pathogens, with Escherichia coli being the most common pathogen. However, non-fermenters (e.g. Pseudomonas aeruginosa) and Gram-positive cocci (e.g. Staphylococci and Enterococci) may also play an important role, depending on the underlying conditions. Treatment strategy depends on the severity of the illness. Treatment encompasses three goals:management of the urological abnormality, antimicrobial therapy, and supportive care when needed. Hospitalization is often required. To avoid the emergence of resistant strains, therapy should be guided by urine culture whenever possible. If empirical therapy is necessary, the antibacterial spectrum of the antibiotic agent should include the most relevant pathogens. A fluoroquinolone with mainly renal excretion, an aminopenicillin plus a β-lactam inhibitor (BLI), a Group 2 or 3a cephalosporin or, in the case of parenteral therapy, an aminoglycoside, are recommended alternatives (LE: 1b, GR: B). In case of failure of initial therapy, or in case of clinically severe infection, a broader-spectrum antibiotic should be chosen that is also active against Pseudomonas, e.g. a fluoroquinolone (if not used for initial therapy), an acylaminopenicillin (piperacillin) plus a BLI, a Group 3b cephalosporin, or a carbapenem, with or without combination with an aminoglycoside. The duration of therapy is usually 7-14 days (LE: 1b, GR: A), but has sometimes to be prolonged for up to 21 days. Until predisposing factors are completely removed, true cure without recurrent infection is usually not possible. Therefore, a urine culture should be carried out 5-9 days after the completion of therapy and also 4-6 weeks later.
참고문헌 (25)
- Rubin RH, "Evaluation of new anti-infective drugs for the treatment of urinary tract infection. Infectious Diseases Society of America and the Food and Drug Administration", Clin Infect Dis, 15(Suppl 1), pp.S216~S227 (1992)
- Rubin RH, "General guidelines for the evaluation of new anti-infective drugs for the treatment of UTI", The European Society of Clinical Microbiology and Infectious Diseases, 240~310 (1993)
- Kumazawa J, "Complicated UTIs, In Infectiology. Vol 1", pp.19~26 (1997), Karger
- Naber KG, "Experience with the new guidelines on evaluation of new anti-infective drugs for the treatment of urinary tract infections", Int J Antimicrob Agents, 11(3-4), pp.189~196 (1999)
- Sharifi R, "Treatment of urinary tract infections: selecting an appropriate broadspectrum antibiotic for nosocomial infections", Am J Med, 100(6A), pp.76S~82S (1996)
- Frankenschmidt A, "Once-daily fleroxacin versus twicedaily ciprofloxacin in the treatment of complicated urinary tract infections", J Urol, 158(4), pp.1494~1499 (1997)
- Nicolle LE, "A practical guide to the management of complicated urinary tract infection", Drugs, 53(4), pp.583~592 (1997)
- Cox CE, "A multicenter comparative study of meropenem and imipenem", cilastatin in the treatment of complicated urinary tract infections in hospitalized patients, 1995, pp.21(1), 86~92
- Dobardzic AM, "Epidemiological features of complicated UTI in a district hospital of Kuwait", Eur J Epidemiol, 13(4), pp.465~470 (1997)
- Emori TG, "An overview of nosocomial infections, including the role of the microbiology laboratory", Clin Microbiol Rev, 6(4), pp.428~442 (1993)
- Parsons CL, "Effect of ammonium on bacterial adherence to bladder transitional epithelium", J Urol, 132(2), pp.365~366 (1984)
- Dumanski AJ, "Unique ability of the Proteus mirabilis capsule to enhance mineral growth in infectious urinary calculi", Infect Immun, 62(7), pp.2998~3003 (1994)
- Stamm WE, "Management of urinary tract infections in adults", N Engl J Med, 329(18), pp.1328~1334 (1993)
- US Department of Health and Human Services, Food and Drug Administration. Center for Drug Evaluation and Research (CDER), "Guidance for Industry. Complicated urinary tract infections and pyelonephritis-developing antimicrobial drugs for treatment. Clin-Anti", Drug Information Branch. Division of Communications Management, ~ (1998)
- Reid G, "Biofilms in infectious disease and on medical devices", Int J Antimicrob Agents, 11(3-4), pp.223~226 (1999)
- Sahm DF, "Antimicrobial resistance profiles among Escherichia (EC) urinary tract isolates in the United States: a current view", Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) (1999)
- Wells WG, "Treatment of complicated urinary tract infection in adults: combined analysis of two randomized, double-blind, multicentre trials comparing ertapenem and ceftriaxone followed by an appropriate oral therapy", J Antimicrob Chemother, 53(Suppl 2), pp.ii67~ii74 (2004)
- Lerner SA, "Microbiological studies of fosfomycin trometamol against urinary isolates in vitro. In: New trends in urinary tract infections", pp.121~129 (1988), Karger
- Carson C, "Role of fluoroquinolones in the treatment of serious bacterial urinary tract infections", Drugs, 64(12), pp.1359~1373 (2004)
- Griffith DP, "Infection (urease) stones", Miner Electrolyte Metab, 13(4), pp.278~285 (1987)
- Beck EM, "The fate of residual fragments after extracorporeal shock wave lithotripsy monotherapy of infection stones", J Urol, 145(11), pp.6~9 (1991)
- Alling B, "Effect of consecutive antibacterial therapy on bacteriuria in hospitalized geriatric patients", Scand J Infect Dis, 7(3), pp.201~207 (1975)
- Warren JW, "Cephalexin for susceptible bacteriuria in afebrile, long term catheterized patients", JAMA, 248(4), pp.454~458 (1982)
- Yoshikawa TT, "Management of complicated urinary tract infection in older patients", J Am Geriatr Soc, 44(10), pp.1235~1241 (1996)
- National Institute on Disability and Rehabilitation Research, "The prevention and management of urinary tract infections among people with spinal cord injuries. National Institute on Disability and Rehabilitation Research Consensus Statement. January 27-29, 1992", J Am Paraplegia Soc, 15(3), pp.194~204 (1992)