Complicated urinary tract infection in a patient with severe COVID-19

Introduction. At the end of 2019, the world faced a pandemic of infection caused by the SARS-CoV-2 coronavirus. The disease caused by this virus is referred to as COVID-19, and is characterized by multiorgan lesion. The leading syndrome is the syndrome of immune response disregulation or the «cytokine storm». According to the studies, which were used as the basis of patient management clinical protocols, antiinterleukin-6 agents, and glucocorticosteroids, are the most effective in stopping the «cytokine storm». At the same time, the use of immunosuppressive drugs increases the risk of secondary infectious complications not associated with the COVID-19 viral infection.The aim of the study was to present a successful case of treating a secondary bacterial infection in a patient with a severe new coronavirus infection in the context of a limited choice of antimicrobial therapy.Materials and methods. The report presents a clinical case of a complicated urinary tract infection associated with an extremely resistant Kl.pneumoniae strain in a 58-year-old patient hospitalized with severe COVID-19. Due to comorbidity, combined with long-term hospitalization, the need in immunosuppressive therapy, and long-term catheterization of the urinary tract, the patient got affected by Kl.pneumoniae. This pathogen demonstrated microbiological and clinical resistance to all studied classes of antibiotics, including carbapenems, aminoglycosides and polymyxins. The patient developed an abscess of the prostate, and orchiepididymitis, which required repeated surgical interventions.Results and Discussion. The multidisciplinary approach to patient treatment, as well as the use of local and regional epidemiological data made it possible to choose the most effective drug therapy. The combination of adequate surgical debridement and combined antibiotic therapy (ceftazidime/avibactam and aztreonam) led to regression of the complicated urinary tract infection manifestations and clinical recovery.Conclusions. The use of ceftazidime/avibactam and aztreonam combination is a promising therapeutic option for the treatment of infections caused by extremely resistant strains of Enterobacterales, in which the combined production of serine proteases and metallobetalactamases is expected.

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Fosfomycin for Injection (ZTI-01) Versus Piperacillin-tazobactam for the Treatment of Complicated Urinary Tract Infection Including Acute Pyelonephritis: ZEUS, A Phase 2/3 Randomized Trial

Clinical Infectious Diseases ◽

10.1093/cid/ciz181 ◽

2019 ◽

Vol 69 (12) ◽

pp. 2045-2056 ◽

Cited By ~ 30

Author(s):

Keith S Kaye ◽

Louis B Rice ◽

Aaron L Dane ◽

Viktor Stus ◽

Olexiy Sagan ◽

...

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Acute Pyelonephritis ◽

Therapeutic Option ◽

Elevated Serum ◽

Complicated Urinary Tract Infection ◽

The United States ◽

Success Rates ◽

Gram Negative

Abstract Background ZTI-01 (fosfomycin for injection) is an epoxide antibiotic with a differentiated mechanism of action (MOA) inhibiting an early step in bacterial cell wall synthesis. ZTI-01 has broad in vitro spectrum of activity, including multidrug-resistant Gram-negative pathogens, and is being developed for treatment of complicated urinary tract infection (cUTI) and acute pyelonephritis (AP) in the United States. Methods Hospitalized adults with suspected or microbiologically confirmed cUTI/AP were randomized 1:1 to 6 g ZTI-01 q8h or 4.5 g intravenous (IV) piperacillin-tazobactam (PIP-TAZ) q8h for a fixed 7-day course (no oral switch); patients with concomitant bacteremia could receive up to 14 days. Results Of 465 randomized patients, 233 and 231 were treated with ZTI-01 and PIP-TAZ, respectively. In the microbiologic modified intent-to-treat (m-MITT) population, ZTI-01 met the primary objective of noninferiority compared with PIP-TAZ with overall success rates of 64.7% (119/184 patients) vs 54.5% (97/178 patients), respectively; treatment difference was 10.2% (95% confidence interval [CI]: −0.4, 20.8). Clinical cure rates at test of cure (TOC, day 19–21) were high and similar between treatments (90.8% [167/184] vs 91.6% [163/178], respectively). In post hoc analysis using unique pathogens typed by pulsed-field gel electrophoresis, overall success rates at TOC in m-MITT were 69.0% (127/184) for ZTI-01 versus 57.3% (102/178) for PIP-TAZ (difference 11.7% 95% CI: 1.3, 22.1). ZTI-01 was well tolerated. Most treatment-emergent adverse events, including hypokalemia and elevated serum aminotransferases, were mild and transient. Conclusions ZTI-01 was effective for treatment of cUTI including AP and offers a new IV therapeutic option with a differentiated MOA for patients with serious Gram-negative infections. Clinical Trial Registration NCT02753946

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Complicated urinary tract infection with Extensive Drug resistant Klebsiella pneumoniae treated with combinatorial therapy of CSE-1034 along with Carbapenems. A case report and the review of literature

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2018.v11i11.26782 ◽

2018 ◽

Vol 11 (11) ◽

pp. 4

Author(s):

Sanjith Saseedharan

Keyword(s):

Urinary Tract Infection ◽

Case Report ◽

Urinary Tract ◽

Tract Infection ◽

Klebsiella Pneumoniae ◽

Therapeutic Option ◽

Complicated Urinary Tract Infection ◽

Review Of Literature ◽

Present Case Report ◽

Carbapenem Resistant

Colistin is considered one of the last available therapeutic options to treat infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP).However, with an increase in the use of colistin to treat CRKP infections, colistin resistance is emerging and there are no standard treatment regimensfor these type of infections. In the present case report, we are discussing a case of 64-year-old male patient having complicated urinary tract infection(cUTI) by CRKP, treated successfully with ceftriaxone+sulbactam+EDTA (CSE-1034) and carbapenem combination therapy. Conclusively, CSE-1034 incombination with or without carbapenems could be a successful therapeutic option for the treatment of CRKP cUTI cases.

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Risk factors for hospital readmission following complicated urinary tract infection

Scientific Reports ◽

10.1038/s41598-021-86246-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Tanya Babich ◽

Noa Eliakim-Raz ◽

Adi Turjeman ◽

Miquel Pujol ◽

Jordi Carratalà ◽

...

Keyword(s):

Risk Factors ◽

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Medical Condition ◽

Hospital Readmissions ◽

Multivariable Analysis ◽

Significant Risk ◽

Complicated Urinary Tract Infection ◽

Negative Influence

AbstractHospital readmissions following severe infections are a major economic burden on the health care system and have a negative influence on patients' quality of life. Understanding the risk factors for readmission, particularly the extent to which they could be prevented, is of a great importance. In this study we evaluated potentially preventable risk factors for 60-day readmission in patients surviving hospitalization for complicated urinary tract infection (cUTI). This was a multinational, multicentre retrospective cohort study conducted in Europe and the Middle East. Our cohort included survivors of hospitalization due to cUTI during the years 2013–2014. The primary outcome was 60-day readmission following index hospitalization. Patient characteristics that could have influenced readmission: demographics, infection presentation and management, microbiological and clinical data; were collected via computerized medical records from infection onset up to 60 days after hospital discharge. Overall, 742 patients were included. The cohort median age was 68 years (interquartile range, (IQR) 55–80) and 43.3% (321/742) of patients were males. The all-cause 60-day readmission rate was 20.1% (149/742) and more than half were readmitted for infection [57.1%, (80/140)]. Recurrent cUTI was the most frequent cause for readmission [46.4% (65/140)]. Statistically significant risk factors associated with 60-day readmission in multivariable analysis were: older age (odds ratio (OR) 1.02 for an one-year increment, confidence interval (CI) 1.005–1.03), diabetes mellitus (OR 1.63, 95% CI 1.04–2.55), cancer (OR 1.7, 95% CI 1.05–2.77), previous urinary tract infection (UTI) in the last year (OR 1.8, 95% CI: 1.14–2.83), insertion of an indwelling bladder catheter (OR 1.62, 95% CI 1.07–2.45) and insertion of percutaneous nephrostomy (OR 3.68, 95% CI 1.67–8.13). In conclusion, patients surviving hospitalization for cUTI are frequently re-hospitalized, mostly for recurrent urinary infections associated with a medical condition that necessitated urinary interventions. Interventions to avoid re-admissions should target these patients.

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