The Importance of Antimicrobial Strategies Associated with Clinical Cure and Increased Microbiological Eradication in Patients with Complicated Urinary Tract Infections and High Risk of Relapse
Background and objective: Complicated urinary tract infections (cUTIs) are serious, potentially life-threatening infections that occur in patients with an increased disease progression risk. Antimicrobial resistance represents an important health issue worldwide, contributing to relapses, which can...
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Elsevier
2025-01-01
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| Series: | European Urology Open Science |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666168324014319 |
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| author | José Medina Polo Jose Luis Alfonso Sánchez Jorge Arca-Suárez Ángel Estella Pablo González Martí Blasco Alicia Gil Leonor del Mar Periañez Párraga Francisco Javier Membrillo de Novales |
| author_facet | José Medina Polo Jose Luis Alfonso Sánchez Jorge Arca-Suárez Ángel Estella Pablo González Martí Blasco Alicia Gil Leonor del Mar Periañez Párraga Francisco Javier Membrillo de Novales |
| author_sort | José Medina Polo |
| collection | DOAJ |
| description | Background and objective: Complicated urinary tract infections (cUTIs) are serious, potentially life-threatening infections that occur in patients with an increased disease progression risk. Antimicrobial resistance represents an important health issue worldwide, contributing to relapses, which can generate further resistances. It is necessary to clarify the role of microbiological eradication as an additional objective in the management of cUTIs. Some publications suggest that relapses relate to insufficient bacterial suppression in the urinary tract. This study focuses on generating a consensus on how patients with cUTIs would benefit from effective antimicrobial agents associated with higher rates of bacterial eradication. Methods: The nominal group technique was followed: systematic literature review, development of a questionnaire, expert panel meeting to discuss results, individual review of draft consensus document, and expert panel meeting to discuss final views and finalise the consensus document. Key findings and limitations: Experts identified risk factors for cUTIs (patients with a higher risk of relapse, physiological obstruction of urinary tract, immune suppression, and previous relapse), and patients who would benefit most from a therapeutic strategy combining clinical cure and aim for microbiological eradication. While experts agreed that the scientific evidence discourages repetition of urine cultures after treatment, they proposed recommendations to prioritise antibiotics with higher evidence of microbiological eradication and close follow-up in patients with a higher risk of relapse, considering any symptoms appearing following clinical cure of the cUTI. Conclusions and clinical implications: Selection of active antimicrobial agents associated with increased microbiological eradication should be prioritised in patients with cUTIs and a high risk of relapse. Patient summary: Complicated urinary tract infections (cUTIs) occur in patients with an increased risk of disease progression or are caused by multidrug-resistant uropathogens. Antimicrobial resistance is of concern as it can result in relapses. Antimicrobial therapeutic strategies associated with increased microbiological eradication in cUTI patients with a high risk of relapse are crucial to prevent relapses and development of antibiotic resistance. |
| format | Article |
| id | doaj-art-f4d3d177e6054c57983ddaec1c0b8cb0 |
| institution | Kabale University |
| issn | 2666-1683 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | European Urology Open Science |
| spelling | doaj-art-f4d3d177e6054c57983ddaec1c0b8cb02025-01-17T04:52:22ZengElsevierEuropean Urology Open Science2666-16832025-01-0171165171The Importance of Antimicrobial Strategies Associated with Clinical Cure and Increased Microbiological Eradication in Patients with Complicated Urinary Tract Infections and High Risk of RelapseJosé Medina Polo0Jose Luis Alfonso Sánchez1Jorge Arca-Suárez2Ángel Estella3Pablo González4Martí Blasco5Alicia Gil6Leonor del Mar Periañez Párraga7Francisco Javier Membrillo de Novales8Servicio de Urología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, SpainServicio de Medicina Preventiva, Hospital General Universitario de Valencia, Valencia, Spain; Departamento de Medicina Preventiva y Salud Pública, Universidad de Valencia, Valencia, SpainServicio de Microbiología and Instituto de Investigación Biomédica A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña, Ciber de Enfermedades Infecciosas CIBERINFEC, A Coruña, SpainUnidad de Cuidados Intensivos del Hospital Universitario de Jerez, Jerez, Spain; Departamento de Medicina, Universidad de Cádiz, INIBiCA, Cádiz, SpainOmakase Consulting S.L., Barcelona, SpainOmakase Consulting S.L., Barcelona, SpainOmakase Consulting S.L., Barcelona, Spain; Corresponding author. Omakase Consulting S.L., Barcelona, Spain. Tel. +34 663 310 046.Servicio de Farmacia Hospitalaria, Hospital Universitari Son Espases, CIBER de Enfermedades Infecciosas CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain; Instituto de Investigación Sanitaria Illes Balears (IdISBa), Palma de Mallorca, SpainUnidad NRBQ-Infecciosas, Sección de Infecciosas, Unidad de Aislamiento de Alto Nivel, Hospital Central de la Defensa Gómez Ulla, Madrid, SpainBackground and objective: Complicated urinary tract infections (cUTIs) are serious, potentially life-threatening infections that occur in patients with an increased disease progression risk. Antimicrobial resistance represents an important health issue worldwide, contributing to relapses, which can generate further resistances. It is necessary to clarify the role of microbiological eradication as an additional objective in the management of cUTIs. Some publications suggest that relapses relate to insufficient bacterial suppression in the urinary tract. This study focuses on generating a consensus on how patients with cUTIs would benefit from effective antimicrobial agents associated with higher rates of bacterial eradication. Methods: The nominal group technique was followed: systematic literature review, development of a questionnaire, expert panel meeting to discuss results, individual review of draft consensus document, and expert panel meeting to discuss final views and finalise the consensus document. Key findings and limitations: Experts identified risk factors for cUTIs (patients with a higher risk of relapse, physiological obstruction of urinary tract, immune suppression, and previous relapse), and patients who would benefit most from a therapeutic strategy combining clinical cure and aim for microbiological eradication. While experts agreed that the scientific evidence discourages repetition of urine cultures after treatment, they proposed recommendations to prioritise antibiotics with higher evidence of microbiological eradication and close follow-up in patients with a higher risk of relapse, considering any symptoms appearing following clinical cure of the cUTI. Conclusions and clinical implications: Selection of active antimicrobial agents associated with increased microbiological eradication should be prioritised in patients with cUTIs and a high risk of relapse. Patient summary: Complicated urinary tract infections (cUTIs) occur in patients with an increased risk of disease progression or are caused by multidrug-resistant uropathogens. Antimicrobial resistance is of concern as it can result in relapses. Antimicrobial therapeutic strategies associated with increased microbiological eradication in cUTI patients with a high risk of relapse are crucial to prevent relapses and development of antibiotic resistance.http://www.sciencedirect.com/science/article/pii/S2666168324014319Complicated urinary tract infectionsMicrobiological eradicationConsensus document |
| spellingShingle | José Medina Polo Jose Luis Alfonso Sánchez Jorge Arca-Suárez Ángel Estella Pablo González Martí Blasco Alicia Gil Leonor del Mar Periañez Párraga Francisco Javier Membrillo de Novales The Importance of Antimicrobial Strategies Associated with Clinical Cure and Increased Microbiological Eradication in Patients with Complicated Urinary Tract Infections and High Risk of Relapse European Urology Open Science Complicated urinary tract infections Microbiological eradication Consensus document |
| title | The Importance of Antimicrobial Strategies Associated with Clinical Cure and Increased Microbiological Eradication in Patients with Complicated Urinary Tract Infections and High Risk of Relapse |
| title_full | The Importance of Antimicrobial Strategies Associated with Clinical Cure and Increased Microbiological Eradication in Patients with Complicated Urinary Tract Infections and High Risk of Relapse |
| title_fullStr | The Importance of Antimicrobial Strategies Associated with Clinical Cure and Increased Microbiological Eradication in Patients with Complicated Urinary Tract Infections and High Risk of Relapse |
| title_full_unstemmed | The Importance of Antimicrobial Strategies Associated with Clinical Cure and Increased Microbiological Eradication in Patients with Complicated Urinary Tract Infections and High Risk of Relapse |
| title_short | The Importance of Antimicrobial Strategies Associated with Clinical Cure and Increased Microbiological Eradication in Patients with Complicated Urinary Tract Infections and High Risk of Relapse |
| title_sort | importance of antimicrobial strategies associated with clinical cure and increased microbiological eradication in patients with complicated urinary tract infections and high risk of relapse |
| topic | Complicated urinary tract infections Microbiological eradication Consensus document |
| url | http://www.sciencedirect.com/science/article/pii/S2666168324014319 |
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