Search

BACKGROUND: Urinary tract infections (UTI) are among the leading reasons for treatment in adult primary care medicine, accounting for a considerable percentage of antibiotic prescriptions. Because this problem is so common and so significant in routine clinical practice, a high level of diagnostic accuracy is essential. Antibiotics should not be prescribed excessively, particularly in view of the increasing prevalence of antibiotic resistance. METHOD: Systematic review of relevant articles that were retrieved by a search of the Medline, Embase, and Cochrane Library databases. The recommendations of selected international guidelines were also taken into account, as were the German national quality standards for microbiological diagnosis. RESULTS: The diagnosis of UTI by clinical criteria alone has an error rate of approximately 33%. The use of refined diagnostic algorithms does not completely eliminate uncertainty. CONCLUSION: With the aid of a small number of additional diagnostic criteria, antibiotic treatment for UTI can be provided more specifically and thus more effectively. Differentiating UTI from asymptomatic bacteriuria, which usually requires no treatment, can lower the frequency of unnecessary antibiotic prescriptions. [ABSTRACT FROM AUTHOR]

In the 1940s, oleothorax (paraffin oil instillation) was widely used to treat patients with apical tuberculosis. The oil plombage should have been removed after a few years; however, since oleothoraces were usually asymptomatic, removal was uncommon. These in the meantime elderly patients are at risk of late complications, such as rupture of the oleothorax and aspiration of oil. We report the case of a 69-year-old man with a spontaneous rupture of an oleothorax leading to oil aspiration, lipid pneumonia and culture-proven disseminated tuberculosis with fatal outcome. Unexpected positive PCR for M. tuberculosis-DNA in tracheal secretions was one of the leading signs in this case. Thus oil plombage in patients with oleothorax may be "time bombs". Primary physicians should be aware of this life-threatening complication.