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Purpose: To assess the efficacy and safety of intravesical instillation of high molecular weight sodium hyaluronate (HMW-HA) for the treatment of radiation-induced cystitis. Methods: This prospective cohort study was conducted in seven centers in France. Eligible patients with radiation-induced cystitis were recruited between April 2020 and March 2021. A sterile disposable 50 ml prefilled solution containing 0.16% (80 mg/50 mL) HMW-HA (INSTYLAN) was instilled weekly into the bladder. The treatment consisted of 6 sessions (V1 to V6). Outcomes were assessed 1 week (V7) and 4 weeks (V8) after the last session and were compared with baseline (V0). The primary endpoint was bladder pain, evaluated by a Questionnaire with 5 closed-ended response options. Secondary endpoints included changes from baseline for hematuria, urinary frequency, and the effect of urgencies on Quality of Life (QoL). Adverse events (AEs) were graded according to the CTCAE 3.0 classification. Results: A total of 30 participants were enrolled. The Intent-to-Treat analysis showed a significant reduction in pelvic pain intensity (− 45.81%, p < 0.001), hematuria (− 26.87%, p = 0.008), total 24 h voids (− 23.92%, p < 0.001) and the effect of urgencies on QoL (− 33.92%, p < 0.001) at V7. The improvement for each outcome remained stable during the post-therapeutic period between V7 and V8. Bladder instillation therapy was well-tolerated: two treatment-related AEs (6.6%) were reported corresponding to two grade 1 hematuria. Conclusions: Intravesical instillation of HMW-HA appears to be effective in the treatment of radiation-induced cystitis. Further comparative studies with longer follow-up are needed to confirm our preliminary results. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: The objective was to measure the quality of clinical practice for the management of cystitis in adult women in general practice by collaborating with quality circles and the regional centre for antibiotic counsel. Method: This descriptive cross‐sectional study was performed in 2018 in Normandy, France. A questionnaire composed of clinical vignettes was used to evaluate practices of general practitioners (GPs) with regard to cystitis classified into four categories: simple, at risk of complication, recurrent, and caused by multidrug‐resistant bacteria. The 2017 French Infectious Diseases Society's guidelines were used as a reference. Results: A total of 142 GPs participated in the study (45.5% of the solicited). Fosfomycin‐trometamol and pivmecillinam were cited as first‐line treatments for simple cystitis by 134 (94%) and 38 (27%) participants, respectively. For at risk of complication cystitis, the treatments cited were cefixime by 64 participants (45%), ofloxacin by 50 (35%), pivmecillinam by 49 (35%), fosfomycin‐trometamol by 38 (27%), nitrofurantoin by 36 (25%), and amoxicillin‐clavulanic acid by 28 (20%). Mean compliance rates were 85% for simple cystitis, 39% for at risk of complication cystitis, 60% for recurrent cystitis and 14% for cystitis caused by multidrug‐resistant bacteria. Two criteria had less than 10% of the compliant answers: comprehensive knowledge of cystitis complication risk factors (9%) and positivity thresholds of urine cultures (10%). Conclusions: In this study, diagnostic means, follow‐up testing, and simple cystitis treatment (with fosfomycin predominantly mentioned) were broadly compliant. The use of critical antibiotics was too frequent for at risk of complication cystitis. There may be a need to improve the knowledge of professionals on antibiotic resistance and appropriate antibiotic use. [ABSTRACT FROM AUTHOR]

Already used in various countries, trimethoprim (TMP) was withdrawn from the French market in 1990, but should be soon available again. This article reviews the experience of TMP use around the world and its current use in Europe. Label use and guidelines only recommend the use of TMP for the treatment of urinary tract infections (UTI). Compared with co-trimoxazole (Co-T), a combination of TMP and sulfamethoxazole (SMX), TMP has (a) a similar resistance rate among Escherichia coli strains (estimated between 10 and 20% in uncomplicated cystitis), (b) a similar clinical efficacy for cystitis prevention and treatment, (c) a lower toxicity (as severe toxicity adverse effects of Co-T come from its sulfonamide component), (d) limited data for the treatment of pyelonephritis and male UTIs, and (e) an important impact on the microbiota. TMP should thus be indicated in the third-line empirical treatment of acute uncomplicated cystitis (sparing fluoroquinolones and nitrofurantoin), in the prevention of recurrent acute cystitis when an antibiotic prophylaxis is required (possibly in first line), and in the treatment of documented acute cystitis at risk of complications. Updated data on the epidemiology of resistance to TMP per clinical pictures is now required. The bactericidal effect of TMP should also be confirmed on recent strains (although limited recent data suggests a bactericidia similar to that of Co-T) and its clinical efficacy should be evaluated in pyelonephritis and male UTI. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Uncomplicated cystitis is one of the most frequent community infections. We report the French results of the international ARESC study on the clinical aspects, epidemiology, and antimicrobial susceptibility of uropathogens. Patient and methods: Female patients between 18 and 65 years of age, with symptoms of uncomplicated cystitis, were investigated clinically with urinalysis and urine culture. Uropathogens were identified and their susceptibility was tested with nine antimicrobials. Results: Four thousand and four hundred patients were included, 871 in France, forming the largest national cohort. Urine culture was positive (cfu≥104/ml) in 550 (63.1%); 533 (96.9%) presented with a single bacterium infection. 488 uropathogens, collected from 479 patients, were analyzed. The most frequent were: Escherichia coli (83.8%), Staphylococcus saprophyticus (4.3%), Proteus mirabilis (3.1%), enterococci (1.2%), and Klebsiella pneumoniae (1.0%). E. coli was highly susceptible to fosfomycin (99.0%) (97.1%), nitrofurantoin (97.3%), and ciprofloxacin (98.3%). The lowest susceptibility rates were found for ampicillin (60.9%) and cotrimoxazole (87.8%). Fosfomycin (97.8%), ciprofloxacin (98.3%), and nitrofurantoin (91.5%) had the highest susceptibility rate. The lowest susceptibility rates were observed with ampicillin (61.4%) and cotrimoxazole (86.5%). Conclusions: Fosfomycin, pivmecillinam (not available in France), and nitrofurantoin have preserved their in vitro activity and are suitable for empiric therapy. Cotrimoxazole (trimethoprim+sulfamethoxazole) and fluoroquinolones are not usually recommended as first intention drugs for the empiric therapy of uncomplicated cystitis, because of increasing resistance rates. [Copyright &y& Elsevier]

The article discusses a study to assess hemorrhagic cystitis and urinary tract cancer incidence and predictors in cyclophosphamide (CYC)–treated patients with systemic necrotizing vasculitis (SNV). Findings reveal that CYC treatment of SNV is associated with a five-fold higher risk of developing urinary tract cancer. Results prove that urotoxicity risk in SNV is associated with the cumulative CYC dose and its oral administration.

Background Enterobacteriaceae is the main pathogens of UTI. It is important to be aware the local epidemiological data for an appropriate initial treatment. Resistance to antimicrobial agents has increased, especially to first-choice antibiotics in the treatment of cystitis. Our objective is to asses the antimicrobial susceptibility profile from uropathogens isolated in community and evaluated the dissemination of extended-spectrum ß lactamase (ESBL), in E. coli and K. pneumoniae in south of Brazil. Methods From June 2016 to June 2017, all urine samples collected in the Basic Health Units and Emergency Departments were sent to a Central Laboratory. Identification and susceptibility tests were performed on the VITEK® 2 (bioMérieux, France) system. Clinical Laboratory Standards Institute (CLSI) breakpoints were used for the interpretation of susceptibility. Positive cultures were defined as those demonstrating ≥105 CFU / mL (colony-forming units). The presence of ESBL was also subjected to the Chrom ID BLEE® agar plate test (bioMérieux- Marcyl'Etoile, France). PCR technique uses specific primers for genes bla TEM and bla SHV. Detection of the bla CTX-M genes was performed by multiplex PCR. Results A total of 56,555 microbiologic tests were performed, 8189 were positive. Women were responsible for 89.4%, and 10% were pregnant. Table 1 shows uropathogens isolated. Graphic 1 shows antimicrobial susceptibility. Extended-spectrum ß lactamase production was present in 6.7% (n = 489). People older than 60 years had ESBL more frequent (P < 0.05) as well as being pregnant is not related to ESBL (P < 0.05). Table 2 shows the distribution of the bla genotypes. Table 3: Distribution of blaCTX-M. Among bla CTX-M1 genotype, bla CTX-M15 was the most frequent. Conclusion In this study, the most frequent uropathogen isolated was E. coli followed by K. pneumoniae. Cotrimoxazol had high rates of resistance and nitrofurantoin the lowest. Quinolone resistance is more than 10%. Sensitivity to aminoglycosides and carbapenems remains high.We found relevant frequency of ESBL, CTX-M-1-group most commonly found. Among CTX-M-1, bla CTX-M15 was the most isolated. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Simple Summary: Stereotactic body radiation therapy remains an understudied treatment option for local recurrence in the prostate bed after prostatectomy followed by radiation therapy. Ablative treatment of local recurrence could avoid or delay androgen deprivation therapy or next-generation antiandrogens. This study suggests that this treatment modality could be a valuable option if confirmed by a prospective study, but long-term toxicity may be a significant limitation. Prostate cancer recurrence in patients previously treated with radical prostatectomy and radiation therapy is challenging. Re-irradiation could be an option, but data regarding efficacy and safety are lacking. We retrospectively evaluated salvage re-irradiation for local recurrence after prostatectomy and external beam radiation therapy. We collected data from 48 patients who underwent salvage reirradiation with stereotactic radiation therapy for local prostate cancer recurrence in the prostatic bed at four French centers. Fifteen patients (31%) were on androgen deprivation therapy during stereotactic radiotherapy. Biochemical response and relapse-free survival were analyzed, and post-treatment toxicities were assessed according to the Common Terminology of Adverse Events criteria. Five patients had grade 3 late bladder toxicity (cystitis), three had grade 3 late incontinence, and one had grade 3 late chronic pain. At three months, 83% of patients had a positive biochemical response. The median follow-up was 22 months. At the end of the follow-up, 21 patients (43%) had a biochemical relapse. The median time to biologic relapse was 27 months. The biochemical relapse rates at 1 and 2 years were 80% and 52%, respectively. In conclusion, salvage re-irradiation for recurrent prostate cancer in the prostate bed may generate significant toxicity rates, and a prospective study with appropriate patient selection is needed to evaluate its effectiveness. [ABSTRACT FROM AUTHOR]

Introduction et objectifs: Comparer le potentiel de virulence de souches d’Escherichia coli isolées au cours de bactériuries asymptomatiques (BA), de cystites (C) et de pyélonéphrites (PN) chez des femmes enceintes. Matériels et méthodes: Des femmes enceintes ayant une BA, C ou PN àE. coli ont été incluses prospectivement du 1/01/07 au 31/12/07 dans le service de gynécologie du CHU de Nîmes. Pour chaque souche, le potentiel de virulence a été analyséin vitro (détection de 18 gènes par PCR) et in vivo (modèle de nématodes C. elegans avec établissement de courbes de survie). L’origine et la clonalité des souches ont été déterminées par groupage phylogénétique et sérotypage (PCR) et électrophorèse en champ pulsé (ECP). La comparaison a été effectuée gène par gène et par agrégation des gènes par un test exact de Fisher ou un Test de Khi2. L’analyse multivariée a utilisé un modèle logistique avec établissement de courbe ROC. Résultats: 37 souches de BA, 26 de C et 14 de PN ont été étudiées. Le profil in vitro de virulence des souches isolées de BA étaient similaires à celui des C mais différent des PN (papGIII, cnf1, sfa marqueurs de C et papGII, irp2, papA, papC, papE marqueurs de PN) (p <0,01). L’origine génétique des souches a confirmé que les souches isolées de BA étaient réparties de façon similaire à celles isolées de C (phylotype B2 et sérotype O : 157 prédominants). Aucun clone n’a été objectivé par ECP. L’étude in vivo a démontré que les souches isolées au cours de BA avaient le même potentiel de virulence que les souches isolées de C (DL50 3,6 j±0,4 (BA) vs 3,1 j±0,1 (C) (p = non significatif)). Conclusion: Notre étude suggère que les souches isolées de BA ont le même potentiel de virulence que les souches responsables de C. Cela confirme la nécessité de traiter toutes les BA. [Copyright &y& Elsevier]

Introduction et objectifs: En Franche-Comté, des recommandations pour le traitement des infections urinaires (IU) ont été diffusées sous la forme d’un guide de prescription aux médecins de ville (MV) et médecins hospitaliers (MH). Il s’agit d’un guide argumenté et « engagé » privilégiant le recours à des antibiotiques (AB) à faible impact écologique comme la fosfomycine (unidose) (FOS) ou la nitrofurantoïne (NF) et excluant la norfloxacine (5 jours) (NOR) pour le traitement des cystites. L’objectif de cette étude était de mesurer l’impact de la diffusion de ce guide sur les consommations d’AB ciblé principalement sur les cystites. Matériels et méthodes: Une analyse des prescriptions des MV et des prescriptions externes des MH a été réalisée avant et après la diffusion du guide (premier trimestre 2007 et premier trimestre 2008). Les indicateurs de suivi, étaient la prescription de NOR (en DDJ et nombre de patients traités), le rapport FOS + NF/NOR et la prescription des fluoroquinolones autres que NOR. Résultats: 2 183 et 1 866 prescriptions ont respectivement été analysée sur les 2 périodes. Une diminution de consommation de 39 % de NOR a été observée (en DDJ comme en nombre de patients traités) plus marquée pour les prescriptions des MH (63 %) que celles des MV (36 %). Pendant cette même période le rapport FOS + NF/NOR est passé de 1,06 à 4,24 en DDJ. Le rapport DDJ/nombre de patients traités par NOR n’a pas varié de façon significative. Par contre les prescriptions par les MV de fluoroquinolones ‘autres''sous forme’ unidose’ont légèrement augmenté. Conclusion: Dans le traitement des IU et notamment des cystites, la recommandation de privilégier des AB à faible impact écologique a reçu un accueil favorable des MV et MH. Ce travail sera suivi d’une évaluation de l’impact de cette approche sur les résistances bactériennes. [Copyright &y& Elsevier]