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In Bezug auf die Behandlung von Traumapatienten mit Verletzungen des Urogenitaltraktes bestehen unter den verschiedenen Fachdisziplinen unterschiedliche Ansichten. Die in diesem Beitrag zusammengefasste multidisziplinare Konsensusleitlinie der World Society of Emergency Surgery (WSES) und der American Association for the Surgery of Trauma (AAST), die im Herbst 2019 erschien, soll eine Entscheidungshilfe zur optimalen Versorgung von Traumapatienten mit urogenitalen Verletzungen darstellen.

Different perspectives exist among the various specialist disciplines on the treatment of trauma patients with injuries of the urogenital tract. The multidisciplinary consensus guidelines of the World Society of Emergency Surgery (WSES) and the American Association for the Surgery of Trauma (AAST), which appeared in autumn 2019, are summarized in this article. They should constitute an aid to making decisions on the optimal treatment of trauma patients with urogenital injuries.In Bezug auf die Behandlung von Traumapatienten mit Verletzungen des Urogenitaltraktes bestehen unter den verschiedenen Fachdisziplinen unterschiedliche Ansichten. Die in diesem Beitrag zusammengefasste multidisziplinäre Konsensusleitlinie der World Society of Emergency Surgery (WSES) und der American Association for the Surgery of Trauma (AAST), die im Herbst 2019 erschien, soll eine Entscheidungshilfe zur optimalen Versorgung von Traumapatienten mit urogenitalen Verletzungen darstellen.

Infectious complications following prostate biopsy are increasing and fluoroquinolone prophylaxis has recently been suspended in Germany by the national authorities.This review is intended to highlight current strategies for reducing infectious complications following prostate biopsy.The European Association of Urology (EAU) guideline group on urological infections recently published a meta-analysis in two parts based on randomized controlled trials (RCTs). The most important contents shall be presented here.Transperineal prostate biopsy is associated with significantly reduced infectious complications than transrectal biopsy. If transrectal biopsy is performed, intrarectal cleaning with povidone-iodine and antibiotic prophylaxis without fluoroquinolones should be chosen. Antibiotic prophylactic strategies include targeted prophylaxis after susceptibility testing of the rectal flora, augmented prophylaxis with multiple antibiotics and empiric monoprophylaxis with nonfluoroquinolones. Here data from RCTs are available for aminoglycosides, third generation cephalosporines, and fosfomycin trometamol.The transperineal approach is preferred to reduce prostate biopsy-related infections. Fluoroquinolones are no longer approved for prophylaxis. Thus, alternative antibiotics based on local resistance, or targeted prophylaxis, in conjunction with povidone-iodine rectal preparation are recommended for transrectal prostate biopsy.HINTERGRUND: Infektionskomplikationen nach Prostatabiopsie sind von zunehmender Relevanz und Fluorchinolone sind als perioperative Antibiotikaprophylaxe in Deutschland durch das Bundesinstitut für Arzneimittel und Medizinprodukte (BfArM) nicht mehr zugelassen.Diese Übersichtsarbeit soll aufzeigen, wie Infektionskomplikationen bei der Prostatabiopsie reduziert werden können.Die Leitliniengruppe Urologische Infektionen der Europäischen Gesellschaft für Urologie (EAU) hat kürzlich eine Metaanalyse in zwei Teilen auf der Basis randomisiert kontrollierter Studien (RCTs) veröffentlicht, deren wichtigste Inhalte hier dargestellt werden sollen.Die transperineale Prostatabiopsie ist mit signifikant weniger Infektionskomplikationen assoziiert als die transrektale Biopsie. Sollte dennoch die transrektale Biopsie gewählt 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 Monoprophylaxe mit Nicht-Fluorchinolonen in Frage. Daten aus RCTs liegen hier für Aminoglykoside, 3. Generationscephalosporine und Fosfomycin trometamol vor.Die transperineale Biopsie ist aufgrund signifikant niedrigerer Infektionen bevorzugt zu verwenden. Sollte die transrektale Biopsie weiterhin zum Einsatz kommen ist zu beachten, dass Fluorchinolone als Infektionsprophylaxe nicht mehr zugelassen sind.

In the context of refugee migrations infectious diseases are being more frequently diagnosed, which the responsible physicians as well as urologists have never seen before. This is due to the poorer health and hygiene conditions in the country of origin, during the flight and in the refugee camps. In Europe increasing incidences of tuberculosis, schistosomiasis and scabies have recently been observed. Tuberculosis and schistosomiasis are often accompanied by unspecific symptoms or can resemble normally encountered urological diseases. Due to the highly contagious nature of scabies, a screening of new arrivals is recommended. A timely differential diagnostic inclusion of these disease patterns is enormously important. Despite the reduction in the numbers of asylum applications in Germany, a higher number of unregistered migrants is generally assumed, who also elude the healthcare system and can therefore contribute to the spread of these rare infectious diseases.

Orchitis can be acutely symptomatic or chronically asymptomatic. Among the acute forms is the rarer isolated orchitis, which is of viral origin in most cases as well as the more frequent secondary orchitis, which is usually the result of an ascending bacterial epididymitis. In addition, sterile forms of orchitis are also seen in patients with systemic autoimmune comorbidities. Chronic asymptomatic orchitis is the term used to describe cellular immune infiltrates in the testes, which are observed in approximately 25% of cases of azoospermia during testicular biopsy. The etiopathogenesis of these infiltrates is largely unknown with postinfection and primary pathogen-independent autoimmune reactions being discussed. Animal experimental models of orchitis may be helpful to investigate the immunological mechanisms involved as well as the therapeutic possibilities.

Material und Methoden: 100 konsekutive Manner nach radikaler Prostatektomie mit einer Bakteriurie von 104 KBE/ml im Mittelstrahlurin wurden wahrend der fachspezifischen urologischen Anschlussheilbehandlung beobachtet und nicht therapiert. Vor Entlassung erfolgte nach durchschnittlich 15,2 Tagen eine Nachuntersuchung mit einem Urinteststreifen und einer zweiten Urinkultur. Ergebnisse: Wahrend der Beobachtungsperiode traten keine symptomatischen Harnwegsinfektionen auf. Bei unauffalligem Urinteststreifenbefund (keine Leukozyturie und keine Hamaturie und keine Nitriturie) bei der Kontrolle lag jeweils keine relevante Bakteriurie (≥105 KBE/ml) vor. Bei der Kontrollurinkultur vor Entlassung waren 54 negativ, 31 zeigten eine klinisch nicht relevante Keimzahl≤104 KBE/ml. Von 15 Patienten mit einer Keimzahl≥105 KBE/ml wurden 4 Patienten wegen eindeutiger Infektzeichen (Fieber, Schuttelfrost, Leukozytose) bei der Kontrolle erfolgreich antibiotisch behandelt. Die ubrigen 11 wurden weiterhin nur beobachtet. Schlussfolgerung: Auch wenn nach radikaler Prostatektomie fast bei allen Patienten noch Beschwerden vorliegen, die auch einer Harnwegsinfektion entsprechen konnen, sollte bei Nachweis von 104 KBE/ml im Mittelstrahlurin und fehlenden eindeutigen systemischen Infektionszeichen (Fieber, Schuttelfrost, Leukozytose) zunachst ein abwartendes Vorgehen gewahlt werden. Ein unauffalliger Urinteststreifenbefund (keine Leukozyturie und keine Hamaturie und keine Nitriturie) im Verlauf schliest eine relevante bakterielle Bakteriurie(≥105 KBE/ml) aus. Eindeutige systemische Infektionszeichen traten bei der Kontrolle nur bei 4 Patienten auf, die testentsprechend und mit Erfolg antibiotisch behandelt wurden.

Published studies on community-acquired urinary tract infections (UTI) often do not link microbiological findings with clinical risk factors and patient data.We retrospectively correlated clinical findings of all patients with UTI of a urological outpatient clinic with the respective microbiological analysis of their urine samples over 2 periods of time: (A: 2005-2006 and B: 2011-2012). Patients were stratified to the following risk groups: uncomplicated cystitis, diabetes mellitus type 2, nursing home resident, prostatitis/epidydimitis, permanent catheter.The incidence of Escherichia coli (p 0.001) and proteus (p 0.001) significantly decreased from period A to B, while enterococci (p = 0.003) and staphylococci (p 0.001) significantly increased. Antibiotic sensitivity to fosfomycin (p 0.001), doxycycline (p 0.001), nitrofurantoin (p 0.001), and nitroxoline increased (p 0. 001) and sensitivity to amoxicillin (p 0.001) and gentamicin decreased (p 0.001). Patients with a permanent catheter had significantly poorer sensitivity rates (50% and less) for almost all antibiotics tested compared to the overall group. The risk of a UTI with 3MRGN or MRSA bacteria was significantly higher for catheter carriers and nursing home residents.Empiric antibiotic first-line therapy with nitrofurantoin and fosfomycin for uncomplicated community acquired UTIs are well indicated in conformity with guidelines. The accumulation of multiresistant pathogens in patients with a permanent bladder catheter requires restrictive use of any permanent catheter drainage.

Different strategies have been developed to reduce infectious complications following prostate biopsy. Various technical aspects like number of biopsies, needle size, route of biopsy, periprostatic nerve blockade, rectal preparation by enema, or disinfection with povidone-iodine have to be discussed. Regarding antibiotic therapy, choosing the optimal antibiotic, the duration of prophylaxis, combination therapy, and rectal swab-based antimicrobial therapy are of major interest. The current review gives answers to the different aspects.

Harnwegsinfektionen (HWI) im Sauglings- und Kleinkindesalter verlaufen oft mit unspezifischen Symptomen. Fur die exakte mikrobiologische Diagnose ist die Art der Uringewinnung entscheidend. Sie sollte im Sauglingsalter durch eine suprapubische Blasenpunktion oder uber einen transurethralen Einmalkatheter erfolgen. Die kalkulierte Therapie bei v. a. Pyelonephritis besteht bei jungen Sauglingen aus der Kombination eines Cephalosporins der Gruppe 3a oder eines Aminoglycosids mit Ampicillin. Ab dem Kleinkindesalter kann eine perorale Behandlung mit einem Cephalosporin der Gruppe 3 bei unkomplizierter Pyelonephritis durchgefuhrt werden. Zum Ausschluss von Nieren- oder Harnwegsfehlbildungen wird bei erster Pyelonephritis eine sonographische Untersuchung empfohlen. Die Strategien zur Refluxdiagnostik und zur Erkennung von Parenchymdefekten werden kontrovers diskutiert. Die aktuellen AAP-Guidelines fur fieberhafte HWI im Sauglings- und Kleinkindalter werden voraussichtlich die noch ausstehenden evidenzbasierten Leitlinien hierzulande beeinflussen.

Infections in the urogenital tract are accepted causes of male infertility. Epidemiologic data indicate 6-10 % of all males undergoing andrological work-up for infertility having an infectious etiology.This review gives a comprehensive overview on the most important urogenital tract infections (prostatitis, epididymitis, orchitis, male accessory gland infection-MAGI) and the impact on fertility. In males suffering infertility, evidence is also presented regarding an infectious etiology.

100 consecutive cases after radical prostatectomy with a bacterial count of 10(4) CFU/ml in midstream urine were followed during urological inpatient rehabilitation without antibiotic treatment. Before discharge, a follow-up examination with a urine dipstick and a second urine culture were performed.No symptomatic urinary tract infections (UTI) occurred during the average follow-up period of 15.2 days. Patients with unremarkable urine dipstick findings at follow-up (no leukocyturia and no haematuria and no nitrituria) had no relevant bacteriuria (≥10(5) CFU/ml).54 of urine culture controls before discharge were negative, 31 showed insignificant bacterial growth (≤10(4) CFU/ml) and 15 had a bacterial count≥10(5) CFU/ml. 4 patients (27%) with 10(5) CFU/ml were successfully treated with antibiotics for clear signs of infection (fever, chills, leukocytosis); the other 11 patients were just followed further.Even though almost all patients after radical prostatectomy continue to suffer from some discomfort that might be due to UTI, patients with 10(4) CFU/ml in midstream urine samples should not receive antibiotic treatment unless they have clear systemic symptoms of an infection, e. g. fever, chills or leukocytosis. Unremarkable urine dipstick findings during the follow-up period (no leukocyturia and no erythrocyturia and no nitrituria) rule out a relevant bacteriuria (≥10(5) CFU/ml). Clear systemic signs of infection during follow-up only occurred in 4 patients, who were successfully treated with test-adapted antibiotics.

The Uzbek version of the Acute Cystitis Symptom Score (ACSS) was developed as a simple self-reporting questionnaire to improve diagnosis and therapy of women with acute cystitis (AC). The purpose of this work was to validate the ACSS in the German language.The ACSS consists of 18 questions in four subscales: (1) typical symptoms, (2) differential diagnosis, (3) quality of life, and (4) additional circumstances. Translation of the ACSS into German was performed according to international guidelines. For the validation process 36 German-speaking women (age: 18-90 years), with and without symptoms of AC, were included in the study. Classification of participants into two groups (patients or controls) was based on the presence or absence of typical symptoms and significant bacteriuria (≥ 10(3) CFU/ml). Statistical evaluations of reliability, validity, and predictive ability were performed. ROC curve analysis was performed to assess sensitivity and specificity of ACSS and its subscales. The Mann-Whitney's U test and t-test were used to compare the scores of the groups.Of the 36 German-speaking women (age: 40 ± 19 years), 19 were diagnosed with AC (patient group), while 17 women served as controls. Cronbach's α for the German ACSS total scale was 0.87. A threshold score of ≥ 6 points in category 1 (typical symptoms) significantly predicted AC (sensitivity 94.7%, specificity 82.4%). There were no significant differences in ACSS scores in patients and controls compared to the original Uzbek version of the ACSS.The German version of the ACSS showed a high reliability and validity. Therefore, the German version of the ACSS can be reliably used in clinical practice and research for diagnosis and therapeutic monitoring of patients suffering from AC.

Recurrent urinary tract infections (rUTI), defined as ≥ 3 UTIs per year, mostly affect young and postmenopausal women. Treatable predisposing factors are rare.General recommendations to reduce rUTIs lower the recurrence rate by up to approximately two thirds. Continuous long-term prophylaxis (LP) with low dose antibiotics or single postcoital doses can reduce the recurrence rate of rUTIs to as low as 5%. According to the European Association of Urology guidelines nitrofurantoin, trimethoprim and co-trimoxazole are the first-line drugs and cephalosporins or fluoroquinolones should be restricted to specific indications. Oral and parenteral immunotherapy were found to be effective in several controlled studies for prevention of rUTIs and can be combined with acute antibiotic therapy.Vaginal prophylaxis with estriol has proven its positive effect without serious gynecological side effects and there is also increasing evidence that cranberries prevent rUTIs but the exact mode of this therapy remains to be defined. There are also other promising modalities, such as phytotherapeutics, mannose, urine acidification, influencing bacterial intestinal and vaginal flora and the general immune response by e.g. acupuncture and inpatient rehabilitation, the therapeutic value of which still has to be proven.

Zusammenfassung In den Jahren 1994–2001 wurden alle Uropathogene von stationaren, urologischen Patienten identifiziert und die Empfindlichkeit gegenuber 14 Antibiotika (Trimethoprim (TMP)/Sulfamethoxazol (SMZ), Ciprofloxacin, Ampicillin, Mezlocillin, Ampicillin/Sulbactam, Piperacillin/Tazobaktam, Cefuroxim, Cefpodoxim, Cefotaxim, Ceftazidim, Gentamicin, Penicillin, Oxacillin und Vancomycin) getestet. Erregerduplikate wurden eliminiert. Dabei fanden sich folgende Ergebnisse: 1. Wahrend des Beobachtungszeitraumes gab es keinen generellen Trend einer Resistenzzunahme, auser bei E. coli gegenuber TMP/SMZ (25,1% in 2000) und Ciprofloxacin (10,4% in 2000). 2. Vancomycin-intermediare Staphylokokken oder -resistente Enterokokken spielten keine Rolle. 3. Die geringste Resistenz gegenuber allen Erregern wurde fur Piperacillin/Tazobaktam (8,4% in 2001) gefunden; Carbapeneme wurden nicht getestet. 4. Wenn man Uropathogene in grampositive und gramnegative Bakterien einteilt, ist fur die orale Applikation Ciprofloxacin bei HWI mit gramnegativen Erregern und Ampicillin/Sulbaktam bei grampositiven Erregern das jeweilige Antibiotikum mit der niedrigsten Resistenzrate. 5. Bei weiterer Differenzierung der Erreger mit einfachen Tests, die schon nach Bebrutung der Kultur uber Nacht moglich sind, kann die empirische Antibiotikatherapie differenzierter durchgefuhrt werden.Um daraus die richtigen Schlusse ziehen zu konnen, muss der Urologe entweder selbst in den Analysenablauf eingebunden sein oder ihm mussen die Zwischenergebnisse zeitnah mitgeteilt werden.

A possible approach to objectively classify complex patterns in tumor tissue is a mathematical and statistical investigation of the distribution of cell nuclei as a geometric representation of cancer cells by fractal dimensions. Both the existence and changes in the fractal structure of tumor tissue have important consequences for the objective system of tumor grading. In addition, the complexity of growth in different carcinomas or their intercellular interactions can be compared to each other.We present a theoretical introduction into fractal geometry as well as in the computer algorithms based upon the Rényi family of fractal dimensions. Finally, a geometric model of prostate cancer is introduced and the relationship between geometric patterns of prostate tumor and the fractal dimensions of the Rényi family are explained.

Significant intra- and interobserver variability ranging between 40 and 80% is observed in tumor grading of prostate carcinoma. By combining geometric and statistical methods, an objective system of grading can be designed.The distributions of cell nuclei in two-dimensional patterns of prostate cancer classified subjectively as Gleason score 3+3, 3+4, 4+3, 4+4, 4+5, 5+4, and 5+5 were analyzed with algorithms measuring the global fractal dimensions of the Rényi family and with the algorithm for the local connected fractal dimension (LCFD).The dimensions for global fractal capacity, information, and correlation (standard deviation) were 1.470 (045), 1.528 (046), and 1.582 (099) for homogenous Gleason grade 3 (n = 16), 1.642 (034), 1.678 (041), and 1.673 (084) for homogenous Gleason grade 4 (n=18), and 1.797 (042), 1.791 (026), and 1.854 (031) for homogenous Gleason grade 5 (n=12), respectively. The LCFD algorithm can be used to distinguish both qualitatively and quantitatively between mixed and heterogeneous patterns, such as Gleason score 3+4=7a (intermediate risk cancer) and Gleason score 4+3=7b (high-risk cancer). Sensitivity of the method is 89.3%, and specificity 84.3%.The method of fractal geometry enables both an objective and quantitative grading of prostate cancer.

Cytokines are cellular messengers which play a key role in many biological conditions such as immune defence and reproduction. During recent years analysis of seminal cytokines has become of increasing interest in various pathologies. To evaluate the current role of seminal cytokines we performed a systematic literature search within the framework of our focus group "Male Infertility during Infection and Inflammation - MIBIE". Out of 581 manuscripts we identified 124 original articles which investigated a total of 31 different cytokines. These studies can be categorized according to the following three topics: infertility, infections and chronic prostatitis. The current analysis demonstrates that seminal cytokine profiles are not associated with either semen quality or fertility; however, cytokines might be beneficial for diagnosis and monitoring therapy in patients with urogenital infections/inflammation. Further studies are needed to clarify if a single cytokine or a combination of different cytokines is necessary to evaluate different pathologies.

In infants and young children, urinary tract infections (UTI) often present with unspecific symptoms. Appropriate techniques of urine sampling play an important role for accurate microbiological diagnosis. In infants urine sampling by bladder puncture or transurethral catheter is recommended. In young infants with suspected pyelonephritis, calculated antibiotic treatment should be initiated parenterally with a combination of a third generation cephalosporin or an aminoglycoside with ampicillin. After the age of 3-6 months group 3 oral cephalosporins can be used in uncomplicated pyelonephritis. With the first febrile UTI early sonography is recommended to provide information about renal parenchymal involvement and to exclude malformations of the kidneys and urinary tract. Strategies for the recognition of vesicoureteral reflux and renal damage are under discussion. Recently published guidelines by the American Academy of Pediatrics for the diagnosis and management of UTI in febrile children and infants aged 2-24 months will most likely influence the still pending German guidelines.

The aim of this prospective observational study was to present relevant data on the efficacy and safety of levofloxacin in the treatment of chronic bacterial prostatitis (NIH-II) in the daily clinical routine of urologists in their practices. In total, 243 patients were treated, including 62 patients with a microbiologically confirmed diagnosis -based on expressed prostatic secretion (EPS). The current evaluation is based on these patients. Their median age was 53 years. The patients were treated with levofloxacin 500 mg / day for 29 days (median) which is in accordance to the -registered recommendation for this indication. Clinical symptoms were assessed using a standardised questionnaire. The clinical symptoms dysuria, painful ejaculation, perineal pain, urinary obstruction, increased urgency, prostate pain during palpation as well as CRP and number of leukocytes showed statistically significant improvements at the end of therapy with levofloxacin as compared to baseline. At the end of treatment 93.5 % (n = 58 / 62, 95 % confidence interval: 84.5 %-97.8 %) of the patients were cured or improved. The patients were able to resume their regular activities after 10 days (median). 93.5 % (n = 58 / 62) of the patients and 95.2 % (n = 59 / 62) of the doctors were satisfied or very satisfied with this treatment. In all 62 patients the diagnosis was microbiologically confirmed based on EPS. In 39 patients (62.9 %) E. coli was identified. At the end of therapy microbiological testing was performed in 62.9 % (n = 39 / 62) of the patients, in 29 cases including EPS. In 37 of these 39 patients (94.9 %) no pathogen was identified. In 2 cases (5.1 %) a pathogen was identified (Proteus mirabilis and Staphylococcus species). In 181 patients without microbiological confirmation -based on EPS comparable clinical results were found. In the total population of 243 patients 5 adverse drug reactions were reported in 3 patients (incidence 1.2 %, n = 3 / 243), The results of this study confirm the efficacy and safety of levofloxacin in the treatment of chronic bacterial prostatitis in daily clinical practice.

The symptom complex"overactive bladder" (OAB) affects more than 10% of adult individuals. The etiopathology is complex and multifactorial. Foremost, urinary tract infection, bladder cancer, foreign bodies, and history of radiation or intravesical instillation of chemotherapeutics must be excluded. In many cases, OAB is caused by neurogenic disorders that activate involuntary detrusor contractions (detrusor overactivity, DO). Also, non-neurogenic disorders such as bladder outlet obstruction or dysfunctions of the female pelvic floor/slack ligaments that affect the urothelium, suburothelium, detrusor and bladder afferents are substantially involved in the pathogenesis of OAB. Until now, circulatory disorders have not been adequately taken into consideration but seem to be another etiological factor that causes OAB. Henceforth, molecular changes of bladder afferents and circulatory disorders in patients suffering from OAB have to be investigated in more detail.

Human papillomaviruses (HPV) are the most frequent pathogens of sexually transmitted diseases. They have been associated with an increased incidence of several anogenital tumors. Whether oncogenic HPV are involved in the pathogenesis of prostate cancer has been a subject of great controversy. This study's purpose was to investigate the association between HPV infection and prostate cancer (PCA).The study included 213 consecutive patients with an average age of 65.7 (+/-8.4) years. Within the framework of transrectal, ultrasonic-guided multibiopsy of the prostate, one additional core was examined by means of polymerase chain reaction (PCR) in relation to bacterial, fungal, and viral (including HPV) DNA, with subsequent DNA sequencing. The collected data were correlated with the histological results and with diverse clinical variables. The influence of several predictors for the existence of PCA was verified with a logistic regression model.No general bacterial DNA (16S rDNA) was detected. Of the 213 patients, 145 (68.1%) showed HPV DNA. In 64% (n=137), high-risk HPV DNA were depicted; these were 18% of the total in each case of HPV genotypes 16 and 18. From our examinations, no significant positive correlation existed between the HPV evidence and the histologically verified PCA that was found in 23.5% of the patients (n=50; odds ratio 1.45; 95% confidence interval 0.71-2.91). The BK virus was not found in any of the cores confirmed through PCR.Although no positive correlation between HPV infection and PCA existed in our study, data from the literature suggest an influence of the papillomavirus on PCA oncogenesis. Future studies should highlight to what extent HPV DNA is inserted in the genome of prostate cells and is able to cause subsequent malignant transformation of particular genes.

Acute uncomplicated cystitis and acute uncomplicated pyelonephritis are two frequently encountered urinary tract infections (UTI) in premenopausal, healthy females. Recent epidemiological investigations showed that the incidence of these infections is higher than expected. Surveys on healthcare practices in North America revealed a high variability in the therapy of uncomplicated UTI. Standardized criteria for diagnosis and therapy of uncomplicated UTIs therefore are important in order to achieve sufficient sensitivity and specificity in clinical practice. The Infectious Diseases Society of America (IDSA) developed evidence-based guidelines for the treatment of acute uncomplicated cystitis and acute uncomplicated pyelonephritis, which were recently updated by other expert groups.

The minimum inhibitory concentrations (MIC) of ciprofloxacin were determined for 441 uropathogens from patients with complicated and/or hospital acquired urinary tract infections (UTI). None of the Enterobacteriaceae was resistant (MICor = 4 mg/l), but 21.7% of enterococci, 28.3% of Pseudomonas spp. and 38.5% of staphylococci were. Subtyping of the strains revealed that with staphylococci there was no clonal spread of resistant strains. In the case of enterococci and Pseudomonas spp., however, cross infections played a major role (46% and 40% respectively). In a retrospective analysis of 370 UTI episodes caused by Pseudomonas aeruginosa (74), enterococci (185) or staphylococci (111) there was no difference between sensitive and resistant strains with respect to clinical aspects and rates of elimination by appropriate anti-bacterial therapy. The rates of spontaneous disappearance without antibacterial therapy ranged from 28% in the case of P. aeruginosa up to 63% in the case of coagulase-negative staphylococci. This implies that especially in UTI caused by gram-positive cocci an indication for antibacterial therapy should be weighted thoroughly and fluoroquinolones should only be used in accordance with sensitivity testing.

A collection of 20 complete and published sequences were obtained from the NCBI Genbank. Then, an « electronic PCR » was realised for the sequences using the universal primer set S-D-Bact-0008-a-S-20 and S-D-Bact-1495-a-A-20 which target the conserved regions of the 16S ribosomal DNA gene. The In silico enzymatic restriction of amplified products by 180 restriction enzymes allowed the selection of AluI, MspI, and RsaI as the most discriminative restriction enzymes. Sixty isolates were collected from 10 different meat samples (chicken, turkey hen, sheep, pig, dromedary, cow, horse, fish, and ostrich). Preliminary morphological identification delimited the range of the concerned genera. Thus, the studied strains were assigned to one of the following genera: Klebsiella, Enterobacter, Salmonella, Proteus, Escherichia, Yesinia and Shigella spp. Enzymatic restriction of the 16S rDNA gene of the isolated strains using the same enzymes chosen for the theoretical restriction gave 12 ARDRA groups. Comparison of theoretical and experimental ARDRA profiles, using length and number analyses of the restricted fragments, confirm and identify each strain at the genus level, and sometimes up to species level. Epidemiological investigations can optimally be performed by the ARDRA technique, employing restriction enzymes designed electronically through public databases.