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Background To develop and validate the American-English version of the self-reporting Acute Cystitis Symptom Score (ACSS), a suitable tool for diagnosis and patient-reported outcome in female patients with acute uncomplicated cystitis (UC). Methods After certified translation into American-English and cognitive assessment, the clinical validation of the ACSS was performed as an embedded study in a US phase II trial (ClinicalTrials.gov Identifier: NCT03129295). Results A total of 167 female patients with typical symptoms of UC were included in the study following FDA guidance. At Day 1 (diagnosis) the mean(SD) sum score of the six ACSS typical symptoms reached 10.60(2.51). Of 100 patients followed-up last time on Day 5 or 6 (End-of-treatment, EoT), 91 patients showed clinical success according to the favoured ACSS criteria (sum score of typical symptoms 0.98(1.94)). There was no correlation between the severity of symptoms on Day 1 or between clinical success rate at EoT and level of bacteriuria on Day 1. Conclusion The American-English ACSS showed high predictive ability and responsiveness, and excellent levels of reliability and validity. It can now be recommended as the new master version in clinical and epidemiological studies, in clinical practice or for self-diagnosis of women with symptoms of UC.

Harnwegsinfektionen gehoren auf der ganzen Welt zu den haufigsten Infektionskrankheiten. Ihre Therapie verursacht einen enormen Antibiotikaverbrauch, der wiederum fur den weltweiten Anstieg resistenter Erreger hauptverantwortlich gemacht wird. Um den Resistenzanstieg zumindest zu verlangsamen und den konzeptionellen Anderungen bei Diagnostik und Therapie gerecht zu werden, sind heute mehr denn je die Grundprinzipien des Antibiotic Stewardship zu beachten. Dazu zahlen Strategien und Masnahmen, welche die Qualitat der Antiinfektivabehandlung sichern, um das beste klinische Behandlungsergebnis zu erreichen.

Die aktualisierte AWMF-S3-Leitlinie zu unkomplizierten Harnwegsinfektionen bei Erwachsenen enthalt uberarbeitete Empfehlungen unter anderem zur antibiotischen Therapie unkomplizierter Harnwegsinfektionen sowie zur asymptomatischen Bakteriurie bei Schwangeren. Wesentlichen Einfluss auf die Anderungen hatten neben den Ergebnissen neuester Studien die Grundprinzipien der rationalen Antiinfektivaverordnung.

The increasing multidrug resistance among gram-negative uropathogens necessitates new treatments for serious infections. Plazomicin is an aminoglycoside with bactericidal activity against multidrug-resistant (including carbapenem-resistant) Enterobacteriaceae.We randomly assigned 609 patients with complicated urinary tract infections (UTIs), including acute pyelonephritis, in a 1:1 ratio to receive intravenous plazomicin (15 mg per kilogram of body weight once daily) or meropenem (1 g every 8 hours), with optional oral step-down therapy after at least 4 days of intravenous therapy, for a total of 7 to 10 days of therapy. The primary objective was to show the noninferiority of plazomicin to meropenem in the treatment of complicated UTIs, including acute pyelonephritis, with a noninferiority margin of 15 percentage points. The primary end points were composite cure (clinical cure and microbiologic eradication) at day 5 and at the test-of-cure visit (15 to 19 days after initiation of therapy) in the microbiologic modified intention-to-treat population.Plazomicin was noninferior to meropenem with respect to the primary efficacy end points. At day 5, composite cure was observed in 88.0% of the patients (168 of 191 patients) in the plazomicin group and in 91.4% (180 of 197 patients) in the meropenem group (difference, -3.4 percentage points; 95% confidence interval [CI], -10.0 to 3.1). At the test-of-cure visit, composite cure was observed in 81.7% (156 of 191 patients) and 70.1% (138 of 197 patients), respectively (difference, 11.6 percentage points; 95% CI, 2.7 to 20.3). At the test-of-cure visit, a higher percentage of patients in the plazomicin group than in the meropenem group were found to have microbiologic eradication, including eradication of Enterobacteriaceae that were not susceptible to aminoglycosides (78.8% vs. 68.6%) and Enterobacteriaceae that produce extended-spectrum β-lactamases (82.4% vs. 75.0%). At late follow-up (24 to 32 days after initiation of therapy), fewer patients in the plazomicin group than in the meropenem group had microbiologic recurrence (3.7% vs. 8.1%) or clinical relapse (1.6% vs. 7.1%). Increases in serum creatinine levels of 0.5 mg or more per deciliter (≥40 μmol per liter) above baseline occurred in 7.0% of patients in the plazomicin group and in 4.0% in the meropenem group.Once-daily plazomicin was noninferior to meropenem for the treatment of complicated UTIs and acute pyelonephritis caused by Enterobacteriaceae, including multidrug-resistant strains. (Funded by Achaogen and the Biomedical Advanced Research and Development Authority; EPIC ClinicalTrials.gov number, NCT02486627.).

Sowohl die Therapie komplizierter als auch die unkomplizierter Harnwegsinfektionen wird heute durch zunehmende Resistenzen gegenuber Antibiotika erschwert. Im Folgenden soll die Problematik der steigenden Antibiotikaresistenz anhand der Harnweginfektionen erlautert werden.

Prostatitis and prostate carcinoma are both frequent entities of prostatic diseases. Epidemiological studies show significant associations between infection and inflammation and prostatic carcinoma. However, because of various confounding factors the results of these studies are inconclusive. Further findings are therefore needed to confirm the hypothesis that prostatic infection and inflammation might be a cause of prostatic carcinoma. We reviewed selected reports on the role of inflammation and infection in the pathogenesis of prostate carcinoma. Extensive genetic analyses show that several gene products, e.g. 2'-5'-oligoadenylate (2-5 A)-dependent Rnase, macrophage scavenger receptor 1 and Toll-like receptor-4, influence the susceptibility of prostate cells to infectious agents. Proliferative inflammatory atrophy (PIA) could be a connection between prostatitis and prostatic carcinoma. In the transition from PIA to prostatic intraepithelial neoplasia, the function of cellular detoxification is gradually lost by silencing of glutathione-S transferase, a detoxifying enzyme. This cellular feature leads to an increased susceptibility of the prostatic epithelial cells to genomic damage by inflammatory oxidants or nutritional carcinogens. Consecutive somatic genome damage might then arise which modulates the further pathogenesis of prostate carcinoma. Summarising these epidemiological, genetic and cell biological aspects, infectious prostatitis might have a causative role in the complex and multifactorial process of prostate carcinogenesis.

Sexually transmitted infections are caused by a wide variety of bacteria, viruses, and parasites that are communicated from one human being to another primarily by vaginal, anal, or oral sexual contact. Different sexually transmitted infections (STIs) can be present or be transmitted simultaneously, and the presence of any such infection increases the risk of contracting other types of STI. Sexually transmitted infections are often oligo- or asymptomatic. According to the World Health Organization (WHO), sexually transmitted infections are one of the five types of disease for which adults around the world most commonly seek medical help (1). The current state of the data on the prevalence of sexually transmitted infections in Germany does not permit any reliable conclusions about infection rates, except for those of two diseases: human immunodeficiency virus (HIV) and syphilis (2). Sexually transmitted infections can cause severe fetal and neonatal damage, genital neoplasia, and infertility. A number of diagnostic strategies and tests, of variable quality, are available for the individual pathogens. Definition According to the WHO, sexually transmitted infections are one of the five types of disease for which adults around the world most commonly seek medical help. The diagnostic and therapeutic algorithms can generally be tailored to the leading clinical manifestations (if the patient is symptomatic). Thus, sexually transmitted infections can usefully be classified by their presenting features, as follows: Genital, anal, perianal, or oral ulcers Urethral or vaginal discharge Genital warts HIV or hepatitis C virus (HCV) infection. If the availability of diagnostic tests is limited, effective treatment can also be initiated without any testing on the basis of the clinical findings alone, if these are clearly typical of a particular sexually transmitted disease. Asymptomatic infections are common, however, and only detectable by testing. Up to 90% of sexually transmitted infections are asymptomatic. The likelihood that an infection will be asymptomatic depends both on the site of infection and on the responsible pathogen. For example, the probability of asymptomatic rectal infection with C. trachomatis and N. gonorrhoeae is 85% in men who have sex with men (MSM) (e1). 30% of pregnant girls in Tanzania have an asymptomatic type 2 herpes simplex virus (HSV-2) infection (3). In the United States, about 85% of T. vaginalis infections in women are asymptomatic; so are 77% in men (4). The treatment of sexually transmitted infections has the following objectives: To cure the infection in the individual patient as rapidly as possible, and to eliminate contagiousness as rapidly as possible in order to interrupt the chain of transmission; To prevent reinfection and recurrent infection. The treatment of sexual partners is important as well. Bacterial infections and trichomoniasis can now be cured with systemic treatment (1, 5, 6). Viral infections due to HIV, HSV, and human papillomaviruses cannot be cured, but they can be weakened or modulated with systemic treatment (1, 5, 6).

Healthcare-associated urinary tract infections (HAUTIs) are the most frequent healthcare-associated infections in general hospitals. They are almost exclusively complicated UTIs, although complicating factors are very heterogenous. HAUTIs are mainly catheter associated. Most of them are asymptomatic and do not need antimicrobial therapy. However, cross-contamination and cross-infection may contribute to distribution of resistant uropathogens. The bacterial spectrum of HAUTI is broad, and antibiotic resistance is common.The authors reviewed the literature from 2000 to 2010 to determine the epidemiology, prevention and best treatment strategies for HAUTI. The recommendations were summarized by determining the level of evidence and grading each recommendation.The treatment for HAUTI encompasses treatment for complicating factors as well as antimicrobial chemotherapy. At least in serious UTI, adequate initial antibiotic therapy results in lower mortality. Therefore, the initial antibiotic regimen must provide sufficient antibiotic coverage. This can only be achieved if the local or regional bacterial spectrum and antibiotic resistance patterns of uropathogens are followed continuously. Provisional microbiological findings, such as reports on Gram-stain or certain biochemical results, can lead to early stratification of pathogens and allow a more tailored empiric antibiotic therapy. Antibiotic therapy of HAUTI has to consider therapeutic success in the individual patient and prevention of emergence of antibiotic-resistant mutants. For both aspects, adequate drug selection and dosing are paramount.Antibiotic treatment for HAUTI should follow prudent antibiotic use to prevent emergence of antibiotic resistance.