General principles of uncomplicated cystitis therapy during pregnancy

Urinary tract infections during pregnancy are associated with severe complications. Earlier initiation of antibiotic treatment for acute uncomplicated cystitis, reduces the various complications.Objective. To assess the effectiveness of fosfomycin in the treatment of acute uncomplicated cystitis during II and III trimester of pregnancy.Material and methods. The study included 74 pregnant women who had acute uncomplicated cystitis in II or III trimesters. All patients received fosfomycin trometamol 3.754 g (equivalent to 3 g fosfomycin) as antimicrobial therapy for acute uncomplicated cystitis. The drug was prescribed to 24 pregnant women in the II, and 50 in the III trimester of pregnancy.Results. After treatment with fosfomycin signs of acute cystitis gone in all patients. At the same time, regression of clinical symptoms was noted during the next days after therapy in 95.9% (n = 71) of cases. Repeated microbiological test of the middle portion of urine was performed 7 days after the end of antibiotic therapy. In 94.6% (n = 70) cases, total elimination of the pathogen was achieved. In 5.4% (n = 4) cases, there was a significant decrease of colonization Follow-up for three months showed the absence of recurrence of acute cystitis in all pregnant women who were included in the study.Conclusion. Fosfomycin is a highly effective drug in the treatment of uncomplicated cystitis during pregnancy.

Combined antibiotic prophylaxis of infectious complications of prostate biopsy

Introduction. Biopsy of prostate is a routine urologic procedure. Nevertheless the frequency of infectious-inflammatory complications remain high, despite the recommended antibiotic prophylaxis schemes.Purpose. The evaluation of effectiveness and safety of combined antimicrobial prophylaxis: fosfomycin trometamol and fluoroquinolones of 3rd generation.Materials and methods. Our clinical study included 80 patients who underwent prostate biopsy were divided into 2 groups. The first group of 40 patients received routine prophylaxis: levofloxacin 500 mg 6 h before the biopsy and 500 mg per day during 4 days after biopsy. The second group of 40 patients, along with standard prophylaxis as in the first group, additionally after biopsy received fosfomycin trometamol 3 gr single-shot.Results. In the first group, infectious and inflammatory complications occurred in 8 (20 %) patients, 12.5 % of patients from the first group were hospitalized for parenteral antibiotic therapy. The average length of stay in hospital was 3.4 ± 1.45 days. In all cases, in the first group of patients, Escherichia coli was detected, in 70 % of cases fluoroquinolone-resistant strain of the bacterium was received. In the second group of patients no hospitalization was required. One (2.5 %) patient out of forty from this group showed signs of urinary tract infection, which was not accompanied by an increase of body temperature, as well as changes in blood and urine tests.Conclusions. Our results show good effectiveness and safety of combined antibiotic prophylaxis for transrectal prostate biopsy. Since fluoroquinolone resistance grows, it is necessary to introduce alternative schemes, as well as monitoring of nosocomial infection and controlling of antimicrobial therapy.

Prostatabiopsie 2021 – Was ist aktuell?

ZusammenfassungInfektionskomplikationen nach Prostatabiopsie nehmen zu aufgrund zunehmender Antibiotikaresistenz insbesondere gegenüber Fluorchinolonen. Fluorchinolone sind als perioperative Antibiotikaprophylaxe in Deutschland durch das Bundesinstitut für Arzneimittel und Medizinprodukte (BfArM) nicht mehr zugelassen. Die Leitliniengruppe Urologische Infektionen der Europäischen Gesellschaft für Urologie (EAU) hat kürzlich eine Meta-Analyse in zwei Teilen auf der Basis randomisiert kontrollierter Studien (RCTs) veröffentlicht. Die transperineale Prostatabiopsie ist mit signifikant weniger Infektionskomplikationen assoziiert als die transrektale Biopsie und sollte deswegen bevorzugt werden. Sollte dennoch eine transrektale Biopsie durchgeführt werden, sind eine intrarektale Reinigung mit Povidon-Jod sowie eine antibiotische Prophylaxe ohne Fluorchinolone zu verwenden. Als antibiotische Prophylaxestrategien kommen die zielgerichtete Prophylaxe nach Empfindlichkeitstestung der Enddarmflora, die augmentierte Prophylaxe mit mehreren Antibiotika und die empirische Mono-Prophylaxe mit Nicht-Fluorchinolonen in Frage. Daten aus RCTs liegen hier für Aminoglykoside, 3. Generationscephalosporine und Fosfomycin trometamol vor.

Ten reasons to use fosfomycin trometamol in daily practice

Urinary tract infections are one of the most common diseases among women. At least 50% of women will develop at least one of urinary tract infection episode during life-time. It should be also underlined that more than one-fourth of them will also develop recurrence within the half year following the initial infection and therapy. The empirical treatment of urinary tract infections should include susceptibility data based on local antimicrobial resistance rates. The effective initial treatment can be considered as an effective preventive strategy of the rapidly increasing bacterial resistance to antibiotics. Fosfomycin trometamol is a safe and highly effective antimicrobial drug which can be used in a single dose in the treatment of uncomplicated urinary tract infections.

Role of asymptomatic bacteriuria on early periprosthetic joint infection after Hip Hemiarthroplasty. BARIFER randomized clinical trial.

Purpose: To evaluate preoperative asymptomatic bacteriuria (ASB) treatment on the reduction of early-periprosthetic joint infections (early-PJIs) after hip hemiarthroplasty (HHA) for fracture.Methods: Open-label, multicentre RCT comparing 3gr of fosfomycin-trometamol with non-treatment. A parallel follow-up cohort without ASB was established. Primary outcome: early-PJI within 3 months after HHA. Results: 594 patients enrolled (mean age 84.3years); 152(25%) with ASB (77 treated with fosfomycin and 75 controls) and 442(75%) without. ASB was not a predictor of early-PJI (OR:1.06[95%CI:0.33-3.38], p=0,9228) and its treatment did not modify early-PJI incidence (OR:1.03[95%CI:0.15-7.10], p=0.9787). Conclusions: Neither preoperative ASB nor its treatment were risk factors of early-PJI after HHA. Trial Registration: Eudra CT 2016-001108-47

War and Peace: the difficult treatment of urinary tract infections and fosfomycin trometamol

The title of this review “War and peace” is not accidental and the analogies with a well-known literary masterpiece have absolutely justified ground. As in the case of Lev Tolstoy’s novel this title has a profound philosophical meaning, although at first glance it may seem quite obvious. The word «war» may well correspond to those hostile changes of microorganisms leading to the current problem of antimicrobial resistance recognized worldwide. This is the “war” we have to wage against the antibiotic-resistant bacteria today. And the «peace» in this context is considered as the world, the entire universe, all people, the whole society and its reaction to what is happening. On the other hand, the word «peace» means something opposite in meaning to the word «war». Thus, the essence of the title bears a sharp contrast between military actions and peacetime, between something that carries a threat to life and peace, or illness and recovery. Preserving original novel’s structure the authors of this review consistently consider justification of fosfomycin trometamol as a first-line drug in the treatment of acute uncomplicated cystitis in women taking into account the latest research, publications and global trends.

Therapie von Harnwegsinfektionen bei Nierentransplantierten

Harnwegsinfektionen mit gramnegativen Erregern sind auch bei Empfängern von Nierentransplantaten ein häufiges Problem. Die aktuelle Resistenzlage limitiert die zur Verfügung stehenden Substanzen. Zudem sollte der Einsatz der bisher bevorzugten Fluorochinolone aktuell wegen der damit verbundenen Nebenwirkungen kritisch geprüft werden. Fosfomycin trometamol gilt als Antibiotikum der ersten Wahl bei Patienten ohne Immunsuppression.