Management of urinary tract infections associated with nephrolithiasis.

Nephrolithiasis is a common clinical entity, and the incidence of renal stones appears to be increasing in the United States. Infection with uropathogens that produce urease can lead to the development of stones (infection stones), which serve as a continued source of recurrent infection and can lead to chronic kidney disease. Other than treating infection, medical management has little role in the treatment of infection stones; complete eradication of the stones with percutaneous nephrolithotomy or extracorporeal shock wave lithotripsy is required.

Surgery for infective endocarditis.

Infective endocarditis (IE) is estimated to have an incidence of five to seven cases per 100,000 person-years. Although not a common clinical entity, IE is associated with substantial morbidity and risk of mortality. IE, especially infections due to Staphylococcus aureus, are increasingly healthcare-associated infections.

The utility of deep soft-tissue cultures in diagnosing the causative agent of sternal osteomyelitis following median sternotomy.

Background: The authors' goal was to determine whether the bacteria cultured from the mediastinal deep soft tissues matched those identified by the sternal bone cultures in cases of mediastinitis with clinically suspected sternal osteomyelitis, in hopes of eliminating the need for sternal bone biopsy.

Methods: The authors retrospectively reviewed the charts of 27 Detroit Medical Center patients who underwent median sternotomy and developed mediastinitis with clinical suspicion of osteomyelitis between 1996 and 2004.

Results: Although only 18 of 27 of the authors' patients had positive bone cultures, they demonstrate that in 94 percent (17 of 18) of these patients, the organisms cultured from the mediastinal deep soft-tissue cultures matched those cultured from the positive sternal bone cultures.

Ciprofloxacin for the management of urinary tract infection.

Urinary tract infections are common, especially among women. A number of agents are available for the treatment of urinary tract infections but emerging resistance to commonly used first-line therapies has impacted the selection of empirical therapy. Ciprofloxacin was the first member of the fluoroquinolone class of antibiotics to be widely available and is effective for the management of urinary tract infections.

Antimicrobial Selection in the Treatment of Pyelonephritis.

Pyelonephritis is a common clinical entity, although accurate data regarding the true prevalence of this infection are lacking. Acute pyelonephritis is associated with significant morbidity and even mortality. There are very few randomized controlled clinical trials that have addressed the optimal management strategies and antimicrobial therapy for this infection.

Adherence to guidelines for community-acquired pneumonia: does it decrease cost of care?

Community-acquired pneumonia (CAP) is a common diagnosis and care of CAP is responsible for significant healthcare expenditures, the majority of which are for patients who require hospitalisation. Studies have shown that significant variation exists among institutions with respect to antibacterial costs and length of stay (LOS) for CAP. These variations do not appear to be associated with significant differences in patient outcomes.

Impact of Changing Patterns of Antimicrobial Resistance in Uropathogens: Emerging Treatment and Strategies.

Urinary tract infection (UTI) is common, especially in women, and the microbiology of UTI is predictable. Over the past decade, numerous reports have documented increasing resistance among uropathogens to first-line agents for the treatment of UTI, especially trimethoprim/sulfamethoxazole (TMP/SMX). It is recommended that TMP/SMX should not be administered as empiric therapy for UTI in communities where resistance rates exceed 20%.

Acute pyelonephritis in US hospitals in 1997: hospitalization and in-hospital mortality.

Purpose: To describe the 1997 incidence of hospitalization for acute pyelonephritis in the US and the risk factors for in-hospital mortality associated with acute pyelonephritis.

Methods: Cases were defined as those with ICD9-CM codes corresponding to acute pyelonephritis in the 1997 Health Care Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS). Frequencies and calculations were weighted to produce either national or state estimates.

Urinary Tract Infections in Renal Transplant Recipients.

Infection of the urinary tract is the most common infectious complication of renal transplantation. The microbiology of post-transplant urinary tract infections is similar to what is seen in the general population, although transplant patients may develop infections due to unusual or opportunistic pathogens. The optimal management of urinary tract infections in renal transplant recipients is poorly studied, but recommendations for treatment are available.

Infective endocarditis in the injection drug user.

Although infective endocarditis is certainly not the most common infection seen in injecting drug users, it is the infection that clinicians most commonly think of when they consider infectious complications of injected drug use. The microbiology of infective endocarditis in injection drug users has remained relatively stable over the last several decades. Tricuspid valve endocarditis has been associated most frequently with injection drug use, but recent reports have suggested that involvement of left-sided valves is seen more often now than in the past.

Skin and Soft Tissue Infections in Injection Drug Users.

Skin and soft tissue infections (SSTIs) are common among injection drug users (IDUs). Subcutaneous and intramuscular injection ("skin-popping") and the injection of "speedballs" (a mixture of heroin and cocaine) are important risk factors for SSTIs in this patient population. Female IDUs appear to be at greater risk of SSTIs than male IDUs, probably because of more difficult venous access.

Prevalence and predictors of trimethoprim-sulfamethoxazole resistance among uropathogenic Escherichia coli isolates in Michigan.

Resistance among uropathogenic Escherichia coli to trimethoprim-sulfamethoxazole (TMP-SMX) has increased. Risk factors for resistance and the impact on clinical failure have been poorly described. We performed a retrospective cohort study of women with acute uncomplicated cystitis seen at a university health center and at primary care clinics in southeastern Michigan from 1992 to 1999.

Diagnostic Investigation of Pyelonephritis.

Urinary tract infections are common, especially among women, and cause significant morbidity. While prognosis is probably more dependent on whether or not an episode of urinary tract infection is complicated (ie, associated with functional, metabolic, or anatomic abnormalities of the urinary tract) or uncomplicated, anatomic localization of infection has important implications for therapy. Pyelonephritis is difficult to diagnose with a high degree of accuracy based on clinical findings alone.