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Background: Urinary tract infections (UTI) constitute a major public health problem, especially in developing countries such as Burkina Faso. They are commonly encountered in hospitals, particularly in patients suffering from chronic kidney disease whose management requires special measures to avoid treatment failures which are frequent. The objective of this study is to determine the microbial profiles of urinary tract infections (UTIs) in these patients. Methodology: This was a cross-sectional study of hospitalized patients with UTIs in the nephrology-haemodialysis department of the CHUB from August 1 to November 31, 2020. Socio-demographic and clinical data of selected patients were collected by a well-designed data collection form. Cytobacteriological analysis of urine (CBAU) was carried out on voided or catheter-urine sample of each patient using standard microbiological technique. The disc diffusion method in agar medium modified according to the recommendations of the 2020 CA-SFM-EUCAST was used to determine the antibiotic susceptibility of each isolate. Data were processed and analyzed using Excel 2013, IBM SPSS Statistics 25.0 and CSpro 7.5 software. Results: Urine samples were collected from a total of 77 eligible participants, 49 (63.6%) of which were CBAU positive, with 56 microbial pathogens isolated. Enterobacterales represented 58.9% (n=33), including 39.4% Escherichia coli (n=13) and 36.4% Klebsiella spp (n=12). Non-fermentative Gram-negative bacilli represented 7.1% (n=4) including Acinetobacter baumannii (n=3) and Pseudomonas aeruginosa (n=1). Staphylococcus aureus was isolated in 5.4% (n=3) and Candida spp in 28.6% (n=16). The most active antimicrobials in vitro against the bacterial pathogens were amikacin and imipenem, and clotrimazole and nystatin against the Candida spp. A total 35.7% (n=20) were multi-drug resistant bacteria with 32.1% by ESBL in Gram-negative bacteria and 66.7% (2/3) by MRSA in Grampositive bacteria. Conclusion: The high resistance of pathogens to antimicrobials, resulting in therapeutic failures, constitutes a significant challenge in the management of urinary tract infection, especially in people with chronic kidney disease. It is therefore necessary to put in place urgent measures aimed at the rational use of antimicrobials and strict compliance with good hospital hygiene practices. [ABSTRACT FROM AUTHOR]

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La résistance aux antibiotiques constitue un enjeu majeur de santé publique au vu de sa progression et du faible nombre de nouvelles molécules en cours de développement. Cette situation pourrait aboutir à une ère post antibiotique d'ici 2050, si aucune mesure n'est mise en œuvre. Les infections urinaires représentent un des principaux motifs de prescription antibiotique et concernent souvent des bactéries à bacille Gram négatif qui sont, en Europe, les plus touchées par l'antibiorésistance. Aussi il est crucial de réduire l'exposition antibiotique chez les patients présentant une infection urinaire. Outre la réduction des indications, les deux autres moyens de lutte contre la pression de sélection sont : la réduction de la durée de traitement et la désescalade antibiotique. Concernant la réduction de la durée de traitement antibiotique, celle-ci présente d'autres avantages que limiter l'émergence de résistance. En effet, elle permet aussi de réduire les effets indésirables et les coûts. Aussi les traitements courts doivent être utilisés quand ils ont été correctement évalués. Actuellement, les données sont suffisamment robustes pour proposer une durée de traitement de 5 j au cours des pyélonéphrites simples et 7 j au cours des infections urinaires masculines non fébriles. Les infections urinaires fébriles de l'homme doivent être traitées 14 j au vu des résultats d'un essai français récent. Enfin la désescalade thérapeutique doit systématiquement être pratiquée à réception des résultats microbiologiques et selon l'évolution clinique des patients même si son impact n'a pas été encore correctement évalué. Antibiotic resistance is a major public health issue given its increasing prevalence and the limited number of new molecules in development. This situation could lead to a post-antibiotic era by 2050 if no action is taken. Urinary tract infections represent one of the main reasons for antibiotic prescription and often involve Gram-negative bacilli bacteria, which in Europe are the most affected by antibiotic resistance. Therefore, it is crucial to reduce antibiotic exposure in patients with urinary tract infections. Besides reducing indications, the other two means of combating selection pressure are reducing the duration of treatment and antibiotic de-escalation. Regarding the reduction of antibiotic treatment duration, it offers additional benefits beyond limiting resistance emergence. Indeed, it also helps to reduce adverse effects and costs. Short treatments should be used when properly evaluated. Currently, data are robust enough to propose a 5-day treatment duration for uncomplicated pyelonephritis and 7 days for non-febrile male urinary tract infections. Febrile urinary tract infections in men should be treated for 14 days based on the results of a recent French trial. Finally, therapeutic de-escalation should systematically be practiced upon receipt of microbiological results and according to the clinical evolution of patients, even if its impact has not yet been adequately evaluated. [ABSTRACT FROM AUTHOR]

Acute kidney injury (AKI) of infectious aetiology is a complex condition that requires a comprehensive microbiological evaluation. This includes sepsis workup, evaluation of urinary tract infection (UTI), assessment for viral, fungal, and bacterial infections, consideration of the patient's microbiome, and vigilance towards antibiotic toxicity. Advanced molecular diagnostic tools such as metagenomic sequencing and rapid point-of-caretesting, may offer future advances in accurate and timely identification of infectious aetiologies in AKI. Careful antibiotic selection, dosing, and duration, taking into account renal function and potential toxicity, are crucial in the era of increasing antibiotic resistance. The information presented in this review were obtained through a thorough literature search using relevant search terms on various databases including PubMed, Embase, and Cochrane Library. The review identified bacterial sepsis and UTI as common infectious syndromes associated with AKI, but also emphasized the need to consider other infectious aetiologies including viral, fungal and parasitic infections in certain clinical scenarios. The review also discussed the potential role of advanced molecular diagnostic tools in identifying infectious aetiologies in AKI and the importance of careful antibiotic selection, dosing, and duration. In conclusion, a comprehensive microbiological evaluation, coupled with the use of advanced diagnostic techniques and antibiotic stewardship, is vital for the effective management of AKI from suspected infectious aetiology, which can aid optimize patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Escherichia coli is the main bacterium responsible for uncomplicated urinary tract infections (UTI). The increasing frequency of antibiotic resistance in E. coli isolates from UTI poses concern in their therapeutic management. The aim of this study is to describe the current antibiotic resistance profile of E. coli clinical isolates at the Yalgado Ouedraogo University Hospital of Ouagadougou (CHUYO), Burkina Faso, with a view to revising the treatment protocols for bacterial UTI. Methodology: This was a retrospective review and descriptive study of all E. coli isolates from febrile UTI at CHUYO from January 2010 to December 2021. During this period, two techniques were used to perform antibiotic susceptibility test; agar diffusion from 2010 to 2018 and commercial liquid susceptibility testing from 2019 to 2021 using the BD Phoenix M50 automated system. The detection of ESBLs was performed using the Expert System of the automated system or a synergy test combining an amoxicillin-clavulanic acid and a 3rd generation cephalosporin (3GC) disc. Results: A total of 2055 non-repetitive strains of E. coli were isolated from UTI over the period of study, with 62.0% (1274) of isolates resistant to 3GC. Resistance to 3GC by ESBL production was the most dominant mechanism in 83.1% of cases (1059/1274). Among the 781 (38.0%) 3GC-susceptible isolates, there were high resistance rates to ampicillin (75.2%) and cotrimoxazole (60.2%), but these isolates retained full susceptibility to imipenem (carbapenem) and fosfomycin. As for the 3GC-resistant strains, there was high resistance to cotrimoxazole (93.0%) and ciprofloxacin (90.3%) but relatively low to medium resistance to gentamicin (56.0%) and amikacin (26.3%), and low resistance to nitrofurantoin (10.0%), fosfomycin (6.1%) and imipenem (4.2%). About one third (31.7%) of all the isolates tested were resistant to both ceftriaxone and gentamicin. Conclusion: In view of the results, the implementation of rapid diagnostic tools such as the ß-lactamase test to guide empirical antibiotic therapy is essential for an early and efficient management of febrile UTI at the local level in Burkina Faso. [ABSTRACT FROM AUTHOR]

Background: The occurrence of urinary tract infection (UTI) caused by multi-drug resistant bacteria is increasing worldwide and has become a major public health concern that requires global attention. To promote better treatment outcome of UTI and raise awareness of antibiotic resistance in the Democratic Republic of the Congo (DRC), we investigated the antimicrobial resistance profile of bacterial pathogens frequently isolated from urine samples of inpatients and outpatients with symptoms of UTI at the Monkole Hospital Center (MHC), Kinshasa from June 2017 to May 2018. Methodology: This was a retrospective review of results of uro-cultures of urine samples of both inpatients and outpatients who had clinical symptoms of UTI, over a period of one year at the MHC, Kinshasa, DRC. During this period, aerobic uro-cultures of urine were done on MacConkey agar (MAC) or Cystine-Lactose-Electrolyte-Deficient (CLED) agar media at 37oC incubation for 24 hours. Identification of bacterial isolates on the culture media and antimicrobial susceptibility to sixteen selected antibiotics were done using the integral system enterobacteria and the Vitek® 2 automated system according to the manufacturer's instructions. The R-studio software was used for statistical analysis. Results: Of the 2765 uro-cultures performed during the period of study, 809 (29.3%) were positive for bacteria with Escherichia coli being the most frequently isolated bacteria pathogens. There was no significant difference (p>0.05) in the resistance rates of both E. coli and Klebsiella pneumoniae to most of the antibiotics such as amoxicillin-clavulanic acid, piperacillin-tazobactam, amikacin, levofloxacin, norfloxacin, cefuroxime, cefotaxime, cefixime and cephalexin but resistance rates of E. coli compared to K. pneumoniae was significantly higher to cotrimoxazole (OR=2.06, p=0.0016), ofloxacin (OR=3.43, p=0.0019), ciprofloxacin (OR=1.624, p=0.044) and significantly lower to imipenem (OR=0.037, p=0.0046), nitrofurantoin (OR=0.292, p=0.0004) and fosfomycin (OR=0.311, p=0.0003). Both pathogens showed resistance rates of more than 50.0% to doxycycline, cefuroxime, cefixime and cephalexin but resistance rates of K. pneumoniae to ofloxacin and cotrimoxazole was less than 50.0%. The isolates were least resistant to imipenem, piperacillin-tazobactam and amikacin, with less than 13.0% resistance rate. Conclusion: The findings of this study showed that E. coli is the most isolated bacterial uro-pathogen amongst patients with UTI at MHC Kinshasa, DRC, but both E. coli and K. pneumoniae were resistant to most commonly prescribed antibiotics used for treatment of UTI. Amikacin, piperacillin-tazobactam and imipenem demonstrated high invitro activity and should be prioritized for antimicrobial stewardship to prevent or delay emergence of resistance to them. To guarantee optimal treatment of UTI, regular pathogen surveillance and local antibiogram reporting are required. Further studies are needed in DRC to assess the burden and factors driving antimicrobial resistance nationwide. [ABSTRACT FROM AUTHOR]

The aim of this study is to evaluate the antibacterial activity of four organic extracts: petroleum ether (PE), dichloromethane (DCM), methanol (MeOH), ethanol (EtOH) and aqueous extracts (digestion, decoction, maceration, and infusion), prepared from the leaves of the aromatic plant Myrtus communis. Phytochemical screening revealed a richness of this plant in secondary metabolites such as flavonoids, phenolic acids, anthraquinones, tannins, sterols, and terpenes. The antimicrobial activity of Myrtus communis extracts was evaluated in vitro by the agar diffusion method on two strains of bacteria commonly encountered in urinary tract infections and lithiasis: Staphylococcus aureus ATCC (25923), Proteus mirabilis reference strain ATCC (43862) and Proteus mirabilis clinical strain. All these strains were found to be sensitive to the extracts studied. The minimum inhibitory concentrations (MIC) recorded varied from 3.75 to 15 mg/ml, while the minimum bactericidal concentrations (MBC) were between 7.5 and 30 mg/ml. This activity is essentially bactericidal in nature. The analyses showed the presence of phenolic groups with antibacterial capabilities. The obtained results proved an interesting antibacterial activity of the majority of Myrtus communis extracts, translated by zones of inhibition of important diameter: extracts of methanol (28 mm), petroleum ether (28 mm) and aqueous solution (25 mm) towards Proteus mirabilis reference strain ATCC (43862), Staphylococcus aureus ATCC (25923) and Proteus mirabilis clinical strain, respectively. [ABSTRACT FROM AUTHOR]

Objective: The indication for prophylactic antibiotic therapy during cystomanometry to prevent urinary tract infection (UTI) has long been recommended. However, limited data support this approach. Our study aims to evaluate the incidence of UTIs following cystomanometry without prophylactic antibiotics in patients with neurogenic bladder., Materials and Methods: This prospective, monocentric study was conducted from February 2023 to March 2023 at a specialized neuro-urology center, including all consecutive patients with lower urinary tract disorders of neurogenic origin referred for cystomanometry. The occurrence of UTIs following cystomanometry was assessed via telephone follow-up on day 14., Results: A total of 100 patients were included, with a median age of 51years, with neurogenic bladder predominantly attributed to spinal cord injury (69/100). Ultimately, 11 patients reported UTIs within 14days post-cystomanometry, with only one being febrile, and none requiring hospitalization. No specific risk factors could be identified., Conclusion: According to our study, the incidence of UTIs following cystomanometry without prophylactic antibiotic therapy is 11%, which is equivalent to the incidence with antibiotic prophylaxis. These preliminary results support the lack of benefit of peri-cystomanometry antibiotic therapy., (Copyright © 2024 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Les regards s'orientent vers la médecine traditionnelle pour le traitement des infections urinaires vu les résultats satisfaisants qu'elles représentent. Dans cette optique, nous avons mené une enquête ethnobotanique descriptive et de causalité au niveau de la région de Sidi bel Abbes sur une période de 60 jours auprès de 49 herboristes. Les résultats obtenus ont permis de dresser un catalogue de 46 espèces appartenant à 24 familles dont 03 sont les plus représentées, les Lamiaceae avec une fréquence d'utilisation de (15,21%), suivis par les Apiaceae (13,04%) et les Poaceae (10,86%). Certaines de ces plantes sont utilisées dans d'autres régions du monde à des fins similaires dont, Lavandula stoechas L., Zea mays L. et Opuntia ficus-indica L.. Ces 03 espèces ont les valeurs d'usage les plus intenses; (79,59%), (48,98%) et (30,61%) respectivement. Ces informations pourraient initier les recherches de nouveaux principes actifs à propriétés antibactérienne contre les infections urinaires. [ABSTRACT FROM AUTHOR]

L'infection urinaire figure au second rang des infections bactériennes de l'enfant, après celle des voies respiratoires. L'objectif du présent travail était d'étudier l'écologie bactérienne et la sensibilité aux antibiotiques des germes isolés au cours des infections urinaires de l'enfant au Centre hospitalier universitaire pédiatrique Charles-de-Gaulle de Ouagadougou. Il s'est agi d'une étude rétrospective descriptive portant sur la période du 1er juillet 2010 au 30 juin 2015, incluant 141 enfants âgés de 0 à 15 ans, hospitalisés dans le service de pédiatrie médicale pour une infection urinaire. La fréquence hospitalière de l'infection urinaire était de 0,7 %. L'âge moyen des patients était de 43,1 mois. Les patients de sexe féminin représentaient 57,4 %, soit un sex-ratio de 0,7. Les bacilles à Gram négatif étaient souvent en cause (67,4 %) avec Escherichia Coli et les Klebsielles sp dans 35,5 % et 22 % des cas respectivement. Les principales bactéries à Gram positif étaient les staphylocoques (15,5 %), les entérocoques (11,3 %) et les streptocoques (5,6 %). Les entérobactéries isolées étaient sensibles à la nétilmicine (80 %), au chloramphénicol (76,4 %) et au furane (82,6 %). Toutes les souches de staphylocoque étaient sensibles au furane, à la gentamicine, au chloramphénicol et au céfixime. Dans 66,7 % des cas, les souches de staphylocoque isolées étaient résistantes à l'amoxicilline. L'infection urinaire est une pathologie fréquente en pédiatrie. Sa prise en charge doit être précoce et adéquate, en se basant sur la connaissance de l'écologie bactérienne afin de réduire le risque de complication rénale à long terme. Urinary tract infection is the second most common bacterial infection in children, after respiratory tract infection. The objective of this work was to study the bacterial ecology and antibiotic susceptibility of germs isolated during childhood urinary tract infections at the Paediatric University Hospital Charles-de-Gaulle in Ouagadougou. This was a descriptive retrospective study covering the period from July 1st, 2010 to June 30, 2015, including 141 children from 0 to 15 years old hospitalized in the medical paediatrics department for a urinary tract infection. The hospital frequency of urinary tract infection was 0.7%. The mean age of the patients was 43.1 months. Female patients accounted for 57.4%, a sex-ratio of 0.7. Gram-negative bacilli were often involved (67.4%) with Escherichia Coli and Klebsiella in 35.5% and 22% of cases respectively. The main Gram-positive bacteria were staphylococci (15.5%), enterococci (11.3%) and streptococci (5.6%). Enterobacteriaceae isolated were sensitive to netilmicin (80%), chloramphenicol (76.4%), and furan (82.6%). All strains of staphylococcus were susceptible to furan, gentamicin, chloramphenicol and cefixime. In 66.7% of cases, the isolated strains of staphylococcus were resistant to amoxicillin. Urinary tract infection is a common problem in pediatrics. Its management must be early and adequate based on knowledge of the bacterial ecology in order to reduce the risk of long-term renal complications. [ABSTRACT FROM AUTHOR]

Dans nos pratiques professionnelles, le problème de l'interprétation et de la gestion pratique de l'examen cytobactériologique urinaire (ECBU), avant instillation de BCG ou de MMC, se pose fréquemment. Confronté aux effets indésirables locaux (cystite chimique (MMC) ou cystite immunologique (BCG)), il peut être difficile pour le praticien de différencier les mécanismes d'action/effet secondaire ± associé à la colonisation bactérienne (très fréquente) d'une réelle infection urinaire perprotocole. Les objectifs de ce travail sont de donner les outils décisionnels utiles à la gestion pratique de l'ECBU au cours des instillations endovésicales de BCG et de MMC. In our professional practices, the problem of the interpretation and practical management of the urinary cytobacteriological examination (ECBU), before instillation of BCG or MMC, arises frequently. Confronted with local adverse effects (chemical cystitis (MMC) or immunological cystitis (BCG)), it may be difficult for the practitioner to differentiate the mechanisms of action/side effect ± associated with Bacterial Colonization (very common) from a real per-protocol urinary tract infection. The objectives of this work are to provide decision-making tools useful for the practical management of ECBU during endovesical instillations of BCG and MMC. [ABSTRACT FROM AUTHOR]

Introduction: cytobiochemical analysis of urine samples is the most requested complementary laboratory tool along with blood count. It has high predictive value in patients with urinary tract infections when it is properly done and scrupulously interpreted. The purpose of this study was to assess the rate, progression, determinants and cytobiochemical comorbidities of urinary tract infections. Methods: we conducted a documentary, descriptive, analytical and comparative study of patients referred for cytobiochemical examinations of urine to the laboratories of the University Clinics in Kinshasa (UCK) between 2011 and 2014. Results: a total of 8926 cytobiochemical tests were requested, with less than 2% of biochemical tests. The study involved more women than men (6426 women vs 2500 men), with a sex ratio of 3F: 1M. Cytobiochemical tests were more requested in the 30-39-year age group (17%; n=1517) mand during the rainy seasons 72% (n=3511), with a peak in May. Urinary tract infections accounted for 54,8% [adjusted estimates n=4892 including E. coli (n=1937), Klebsiella (n=993)] and were mainly diagnosed over the period 2012-2014. There was an independent and significant association between female sex (adjusted OR = 3.5; CI = 95%; 3.1-3.8; P<0.0001), admission during the rainy seasons (adjusted OR = 1.3; CI = 95%; 1.2-1.4; P<0.0001) and urinary tract infection. Conclusion: urinary tract infection was a major concern for female patients admitted during the rainy seasons and over the years 2012-2014 at the UCK. Urinary tract infections were rare over the Nina year 2011 after the hottest El Nino year, while the rate of urinary tract infections was the same over the years 2012-2014, which were relatively hot before the the hottest El Nino year 2015. This study highlights that there is an interaction between the hot and humid tropical climatic conditions of the city of Kinshasa and the global cold climate, in the context of climate variability, global warming, which may explain the outbreak of urinary infections in Kinshasa. [ABSTRACT FROM AUTHOR]

Escherichia coli is a major cause of community-acquired urinary tract infections (CA-UTIs). In this study, we investigated the antimicrobial resistance patterns, the distribution of phylogenetic groups, and the prevalence and characteristics of integron-bearing E. coli isolates from outpatients with CA-UTIs in El-Minia governorate, in Upper Egypt. Out of the 583 urine samples collected, 134 were positive for E. coli, from which the most resistant isolates (n = 80) were selected for further analysis. The majority of these isolates (62.5%, 50/80) showed multidrug resistance profiles. Group B2 was the most predominant phylogenetic group (52.5%), followed by group F (21.25%), Clades I or II (12.5%), and finally isolates of unknown phylogroup (13.75%). Of the 80 isolates, 7 (8.75%) carried class 1 integrons, which contained 3 different types of integrated gene cassettes, including those conferring resistance to streptomycin/spectinomycin, trimethoprim, and some open reading frames of unknown function (gcuF). In conclusion, the types and combinations of the gene cassettes in our study may reflect the specific selective pressures to which the isolates were subjected within the study region, therefore, providing valuable data for future intervention strategies that are precisely tailored to prevent the dissemination of the uropathogenic E. coli strains circulating within Upper Egypt. [ABSTRACT FROM AUTHOR]

Les travaux de Lapides sur le sondage intermittent propre ont révolutionné la prise en charge des patients ayant une rétention urinaire chronique. L'objectif de cet article était la présentation de l'éducation thérapeutique des patients au sondage intermittent propre, de la pose de son indication jusqu'au suivi nécessaire. Avis d'experts. Le sondage intermittent propre est indiqué chez l'ensemble des patients ayant une rétention urinaire chronique complète ou incomplète. L'éducation thérapeutique doit être réalisée par une personne formée et s'inscrire dans un programme dédié. Elle comporte un diagnostic éducatif, et un apprentissage de la technique avec la sonde la plus appropriée en fonctions des capacités du patient. Les patients doivent réaliser 4 à 6 sondages intermittents propres/jour avec des volumes ne dépassant pas les 400 à 500 mL. Un suivi individualisé au long cours est indispensable. L'éducation thérapeutique au sondage intermittent propre offre aux patients la maîtrise de cette technique qui permet l'amélioration de leur qualité de vie et la diminution du risque d'infections urinaires. Lapides' work in clean intermittent catheterization has revolutionized the management of patients with chronic urinary retention. The objective of this article was to present the therapeutic education of clean intermittent catheterization, from its indication to its follow-up. Expert opinion. Clean intermittent catheterization is indicated in all patients with chronic urinary retention. Therapeutic education must be conducted by a trained staff and included in a dedicated program. It consists in an educational diagnosis, the selection of the most appropriate catheter based on the patient's abilities, and the training in the technique. Patients should perform 4–6 clean intermittent catheterizations/day with volumes not exceeding 400–500 mL. Long-term personalized follow-up is essential. Therapeutic education in clean intermittent catheterization offers patients the mastery of this technique which improves their quality of life and reduces the risk of urinary tract infections. [ABSTRACT FROM AUTHOR]

Résumé: L'hypothèse selon laquelle des bactéries multirésistantes (BMR) « invisibles » pourraient se cacher dans les flores polymorphes est vraie même si leur nombre paraît peu important dans cette étude. Les flores polymorphes en revanche peuvent être en grand nombre puisqu'elles sont observées dans 24 % dans cette étude (et même dans 30 % dans une étude précédente réalisée dans les mêmes unités hospitalières). Un ECBU chez la personne âgée est non seulement un acte invasif, voire agressif, mais encore onéreux. L'objectif de l'étude était de répondre à la question suivante : faut-il faire un ECBU systématique à tous les sujets âgés hospitalisés en unités de médecine aiguë et soins de suite gériatriques ? Les résultats de cette enquête suggère que la réponse est non, d'autant plus que c'est bien la logique de la pertinence de l'ECBU qui prévaut chez les patients sondés, atteints de iatropathologie et de pathologies chroniques à l'origine de réduction des défenses immunitaires tels que le diabète, la corticothérapie au long cours, les thérapeutiques immunosuppressives, les maladies urologiques, la grabatisation chronique compliquée, etc. [ABSTRACT FROM AUTHOR]

Les aminosides sont une classe d'antibiotiques que tout urologue doit savoir utiliser dans sa pratique courante. Ils sont à réserver essentiellement aux cas d'infections urinaires sévères, d'obstruction de la voie excrétrice supérieure et aux situations d'allergies notamment aux β-lactamines. Il est actuellement recommandé de privilégier les traitements de courte durée et à posologie élevée. L'objectif est de maintenir leur efficacité liée à leurs caractéristiques pharmacologiques et au faible taux de résistance bactérienne tout en se prémunissant de toxicités potentiellement graves pour le patient. Aminoglycosides are a class of antibiotics that every urologist should know how to use in everyday practice. They are essentially reserved for severe urinary tract infections, upper tract obstruction and in cases of beta-lactam allergy. It is recommended to use higher dosages and shorter treatment duration. The objective is to maintain their effectiveness, which is linked to their pharmacologic characteristics and low rate of bacterial resistance while minimizing potential toxicity for the patient. [ABSTRACT FROM AUTHOR]

L'infection urinaire correspond à une inflammation aiguë de la vessie due, chez la femme, à la propagation ascendante de bactéries commensales de l'intestin via l'urètre favorisée par la proximité entre le méat urinaire et l'anus. Sa prise en charge doit être mise en place dès l'apparition des premiers symptômes pour soulager la patiente et éviter l'apparition de complications. Les pharmaciens pourront prochainement, sous certaines conditions, délivrer un traitement antibiotique pour soulager une cystite. Urinary tract infection is an acute inflammation of the bladder due, in women, to the upward spread of commensal bacteria from the intestine via the urethra favored by the proximity between the urinary meatus and the anus. Its management must be initiated as soon as the first symptoms appear in order to relieve the patient and to avoid any complications. Pharmacists will soon be able to dispense antibiotic treatment to relieve cystitis, under certain conditions. [ABSTRACT FROM AUTHOR]

Saccharomyces cerevisiae est un champignon ascomycète ubiquitaire. C'est une levure qui est retrouvée chez l'homme sous forme commensale [1]. Elle est largement utilisée dans l'industrie agroalimentaire pour son rôle dans la fabrication de plusieurs aliments, notamment le pain et les boissons fermentées. Elle est aussi utilisée en tant que supplément nutritionnel et en tant que probiotique, notamment les souches de S. cerevisiae var. boulardii pour le traitement de divers troubles intestinaux [2]. Longtemps considérée comme inoffensive, cette levure est de plus en plus impliquée dans des cas d'infections parfois invasives, principalement des sepsis fongiques, pouvant être fatales, notamment chez des patients prédisposés [2, 3]. Nous rapportons 3 cas d'infection urinaire à S. cerevisiae diagnostiqués au niveau du laboratoire central de parasitologie et de mycologie du centre hospitalier Ibn Sina à Rabat, au Maroc. Les méthodes utilisées pour le diagnostic mycologique sont l'examen microscopique direct du culot de centrifugation des urines, la mise en culture des urines à 37°C sur les différents milieux Sabouraud (simple, additionné au chloramphénicol et additionné au chloramphénicol et à la cycloheximide) et la réalisation d'un auxanogramme (kit AuxaColorTM 2) pour l'identification biochimique des levures isolées. Un cas d'infection urinaire à S. cerevisiae a été diagnostiqué en 2015 et 2 cas en 2016. Les trois patientes étaient de sexe féminin. L'âge était compris entre 5 et 40 ans (moyenne d'âge de 26,33 ans). Deux patientes étaient suivies pour diabète sucré, une de type 2 et une de type 1. Une patiente était suivie pour un neuroblastome surrénalien opéré et sous chimiothérapie. Deux patientes, dont l'une était fébrile, ont présenté des signes urinaires à type de brûlures mictionnelles associées à une pollakiurie. Chez les 3 patientes, l'examen microscopique direct des urines a mis en évidence des levures de grande taille. Les cultures sont revenues positives après incubation à 37°C sur les milieux Sabouraud simple et additionné au chloramphénicol et négatives sur le milieu Sabouraud additionné au chloramphénicol et à la cycloheximide. Les colonies étaient blanchâtres et d'aspect lisse et crémeux. L'auxanogramme a permis d'identifier S. cerevisiae (Figure 1, Figure 2). Deux patientes ont été mises sous fluconazole avec évolution favorable et une patiente est décédée des suites d'une maladie veino-occlusive probable avant qu'un traitement antifongique n'ait pu être instauré.

Le reflux vésico-rénal (RVR) est une pathologie fréquente chez l'enfant nécessitant un suivi long pour réduire l'évolution vers l'insuffisance rénale chronique. L'objectif de notre étude est d'analyser les aspects épidémiologiques, le diagnostic, la prise en charge du reflux vésico-rénal et l'évolution à long de terme de cette pathologie. Pour cela on a mené une étude rétrospective portant sur une série de 42 patients hospitalisés au Service de Chirurgie Pédiatrique Viscérale du CHU Hassan II de Fès suspectés porteurs d'un reflux vésico-rénal (RVR) sur une période de 6 ans allant de janvier 2010 à décembre 2015. On a trouvé que l'âge médian au moment du diagnostic était de 3 ans et 2 mois. Le sex ratio était de 1,8. Le RVR était retrouvé isolé chez 81%, et secondaire ou associé chez 19%. Le principal mode de révélation était l'infection urinaire (90,4%). La fonction rénale était altérée chez 54,8 % des enfants. Le traitement a consisté une antibiothérapie des IU documentées (90,4%) et une antibio-prophylaxie si récidive, une réimplantation de type COHEN dans 97,62%. Les indications ont concerné d'emblée tous les grades IV et V (73,9%), ainsi que les reins altérés, et 26,1% après traitement médical. L'évolution postopératoire précoce et tardive était en général satisfaisante: on a noté 92,68 % de disparition du RVR. L'UHN a régressé sauf chez 9,52 % patients, 95,23% malades ont normalisé leur fonction rénale. La récurrence des IU a diminué (19,04 % après la chirurgie). La majorité des parents ont jugé positivement l'évolution de l'état général de leurs enfants (54,76 %) après la chirurgie.

L'infection urinaire (IU) constitue la deuxième cause d'infection bactérienne communautaire chez le sujet âgé. Ce diagnostic est difficile car les symptômes sont souvent atypiques. Nous présentons les caractéristiques des patients ayant une IU parmi une population gériatrique (signes fonctionnels urinaires et/ou syndrome infectieux). Nous avons également évalué la sensibilité et la spécificité de la bandelette urinaire (BU) pour le diagnostic d'IU dans cette population. Nous avons réalisé une étude observationnelle, prospective, monocentrique, d'avril 2017 à janvier 2018, incluant tous les patients hospitalisés en gériatrie, présentant des signes fonctionnels urinaires et/ou un syndrome infectieux sans point d'appel, pour lesquels un examen cytobactériologique des urines (ECBU) a été demandé. Une BU était systématiquement réalisée pour tous ces patients. Les caractéristiques cliniques et biologiques des patients ont été étudiées selon le diagnostic définitif. En outre, les résultats des BU ont été comparés à ceux des ECBU en cas de diagnostic final d'IU. Au total, 165 patients ont été inclus. Parmi eux, 67 (40,6 %) avaient une IU et 98 (59,4 %) avaient un autre diagnostic. Il y avait significativement plus de femmes (p < 0,05), et des scores de MMSE plus bas (p < 0,05) dans la population qui présentait une IU. La BU présentait une sensibilité élevée (92 %) et une VPN élevée (91 %) intéressantes dans notre population. En cas d'IU chez le sujet âgé, peu de critères sont discriminants avec une autre origine. Par ailleurs, une BU négative suggère l'absence d'IU en raison de sa bonne valeur prédictive négative. Urinary tract infections (UTI) are the second cause of community-acquired bacterial infections in the elderly. Distinguishing symptomatic UTI from asymptomatic bacteriuria is problematic, as older adults are less likely to present with localized urinary symptoms. We evaluated characteristics of patients presenting UTI among elderly with sepsis. Moreover, we aimed to evaluate the sensibility and specificity of urine dipstick tests in the diagnosis of UTI in geriatric population. We led a prospective, monocentric, observational study between April 2017 and January 2018. We included patients hospitalized in geriatric wards, who were prescribed urine culture for UTI symptoms or/and infection without primary sites for which a urine culture was prescribed. Dipstick urinalyses were performed for all patients. Clinical and biological characteristics of all patients were compared according to the final diagnosis of UTI. Moreover, results of dipstick tests were evaluated for the diagnosis of UTI in this population. Among 165 patients, 67 (40.6 %) had a UTI and 98 (59.4 %) had another diagnosis. These two groups were comparable for age and daily-living activities. In the UTI group, the proportion of women was higher than in the other group (P < 0.05), and mean MMSE score was lower (P < 0.05). Positive urine dipstick test for leukocytes and/or nitrites had high sensitivity (92 %), but low specificity (50 %). Negative predictive value of this test was high (91 %). For suspicion of UTI among elderly, few criteria are specific. Negative dipstick tests can suggest an absence of UTI due to its high negative predictive value. [ABSTRACT FROM AUTHOR]

À l'heure de la multirésistance bactérienne, en particulier des entérobactéries sécrétrices de bêtalactamase à spectre étendu (E-BLSE), rendant souvent difficile un traitement per os, et dans le but de pouvoir éviter des hospitalisations prolongées, il existe à ce jour de multiples options pour envisager l'antibiothérapie parentérale à domicile en particulier dans la prise en charge des infections urinaires. Elle s'élabore généralement en partenariat avec l'urologue et le référent infectiologue de l'établissement. Nowadays, multidrug bacterial resistance, predominantly harbored by Extended-spectrum Beta-lactamases (ESBL) producing enterobacteriaceae, restricts the resort to oral antibiotic treatment. In order to limit prolonged hospital stays, many convenient options are available to consider outpatient parenteral antibiotic therapy (OPAT), particularly in urinary tracts infections (UTIs) management. Those therapeutic strategies are usually designed within a partnership between both urologist infectious diseases specialist hospital advisers. [ABSTRACT FROM AUTHOR]

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Résumé L'infection urinaire (IU) est une des infections bactériennes les plus fréquentes en pédiatrie, l'antibiothérapie probabiliste ciblée nécessite une connaissance actualisée des données bactériologiques locales. Objectif : Actualiser l'écologie microbienne de l'IU chez l'en-fant et suivre l'évolution du profil de sensibilité aux antibio-tiques des bactéries uropathogènes. Méthodes : Étude descriptive sur 5 ans (de janvier 2013 à décembre 2017) concernant les examens cytobactériologiques des urines, réalisés chez les enfants hospitalisés dans les services du pôle pédiatrique du CHU Mohammed VI de Marrakech. Résultat : 4 769 échantillons ont été traités. Une IU a été rete-nue dans 23 % des cas. La moyenne d'âge était de 45 mois, le sexe ratio était de 1,04 garçon/fille. Escherichia coli a dominé le profil épidémiologique (39 %) suivi de Klebsiella pneumoniae (21 %). Escherichia coli était résistante à l'amoxicilline dans 80 % des cas, à l'association amoxicilline acide clavulanique dans 59 % des cas, aux céphalosporines de troisième génération dans 33 %, aux fluoroquinolones dans 15 % et au cotrimoxazole dans 55 % des cas. La production de bêtalactamases à spectre étendu au sein des entérobactéries isolées était de 39 % et la prévalence globale de bactéries multirésistantes était de 32,9 % parmi les-quelles le chef de file était le Klebsiella pneumoniae (47 %). Conclusion : Ces résultats confirment le caractère évolutif et inquiétant de la résistance aux antibiotiques des germes uropathogènes, ce qui impose une surveillance continue de ses résistances ainsi qu'une prescription rationnelle des antibiotiques et le respect des mesures d'hygiène. Abstract Urinary tract infection is one of the most common bacterial infections in pediatric patients. A targeted empirical antibiotic therapy requires an updating of local bacteriological data. Objective : To propose updated microbial ecology data of urinary tract infection in children and evolution of the antibiotic sensitivity profile of uropathogenic germs. Methods : A descriptive study was made over a period of 5 years (from January 2013 to December 2017). It includes all cyto-bacteriological examinations of urine performed in child-ren hospitalized in various departments of the Pediatric center of Mohammed VI University Hospital in Marrakech. Results : 23% of the 4 769 tested samples presented characteristics of a Urinary tract infection. Mean patient age was 45 months. Sex ratio M/F was 1,04. Escherichia. Coli was the dominant pathogen (39%) followed by Klebsiella. pneumoniae (21 %). Escherichia. Coli was resistant to amoxicillin in 80% of cases, to the association amoxicillin + clavulanic acid in 59 %, to third gene-ration cephalosporins in 33%, to fluoroquinolones in 15%, and to the cotrimoxazole in 55 % of cases; 39 % of Enterobacteria produced an extended-spectrum beta-lactamase and the overall prevalence of multidrug-resistant bacteria was 32.9%, especially Klebsiella pneumoniae (47 %). Conclusion : These results confirm the evolutionary and worrying character of the antibiotic resistance of uropathogenic bacteria, which requires a continuous monitoring of its resistance, a rational prescription of antibiotics and respect for hygiene. [ABSTRACT FROM AUTHOR]

Highlights • Studies on urinary tract infections are scarce in the Amazon region. • Extended-spectrum beta-lactamases (ESBL) were observed in 3.1% of Escherichia coli and 31.6% of Klebsiella pneumoniae strains isolated from UTI patients managed in the emergency department. • The susceptibility of E. coli strains to ampicillin, amoxicillin-clavulanic acid, trimethoprim-sulfamethoxazole, fluoroquinolones, and furans was significantly lower than in metropolitan France. • Staphylococci sp. were involved in 18.3% of cystitis cases including 12.2% of Staphylococcus saprophyticus and 3.7% of S. aureus. Abstract Objectives Urinary tract infections (UTIs) have rarely been studied in the Amazon region. We aimed to describe the epidemiology of bacteria causing UTIs in French Guiana. Patients and methods We performed a monocenter retrospective study of adults consulting at the emergency department of Cayenne Hospital in 2014 with a diagnosis of UTI. The bacterial species and resistance profile were described. Results Two-hundred-and-eighty-nine patients presenting with UTI were included: 82 (28.4%) presented with cystitis, 166 (57.4%) with pyelonephritis, and 41 (14.2%) with male UTI. E. coli was predominant (74.1%), and had decreased susceptibility to ampicillin, amoxicillin-clavulanic acid, fluoroquinolones, co-trimoxazole, and furans compared with data from metropolitan France. Extended-spectrum beta-lactamases (ESBL) was isolated in 3.1% of E. coli and 31.6% of K. pneumoniae. Conclusions Antibiotic susceptibility in UTI is lower than reported in metropolitan France without evidence for an excessive consumption of antibiotics. [ABSTRACT FROM AUTHOR]

Objective To evaluate clinical practices for ESBL-producing urinary tract infection (UTI) in France. Methods We performed an observational, retrospective, cross-sectional, hospital-based study in 22 pediatric departments of university or secondary care hospitals. We collected data of the last five patients presenting with ESBL-producing UTI in 2012 and the physicians’ therapeutic approach to two case vignettes of acute non-septic ESBL-producing pyelonephritis (7-month-old girl) and cystitis (30-month-old girl). The adequacy of the therapeutic decision was analyzed by a panel of independent infectious disease experts. Results A total of 80 case patients of ESBL-producing UTI were collected: 54 with acute pyelonephritis (mean age: 28 months, female: 66%), of whom 98% received an intravenous ESBL-adapted antibiotic treatment and 55% a two-drug antibiotic therapy. Carbapenems were used in 56% of cases and aminoglycosides in 36%. Of the 26 cystitis patients (mean age: 5 years, female: 73%), 85% were treated with antibiotics, including three intravenously (carbapenems = 2). For the case vignettes, physicians ( n = 85) would have treated the pyelonephritis patient with carbapenems (76%) and/or aminoglycosides (68%); 71% would have used a two-drug antibiotic treatment. The cystitis patient would have been treated intravenously by 29% of physicians; 8% would have used a two-drug antibiotic treatment, 16% would have prescribed carbapenems, and 11% aminoglycosides. Antibiotic treatments were deemed appropriate in 37% of cases. Conclusions Antimicrobial treatment for ESBL-producing UTI greatly varies, and carbapenems are excessively prescribed. Specific guidelines for ESBL infections are required. [ABSTRACT FROM AUTHOR]

Copyright of Phytothérapie is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective Non-typhi Salmonella enterica urinary tract infections (UTIs) are not frequent and rarely reported in the literature. We aimed to characterize clinical presentations and risk factors for the infection. Patients and methods We performed a retrospective study of non-typhi Salmonella enterica strains isolated from urine cytobacteriological examinations (UCBE) collected between January 1, 1996 and October 30, 2014 and analyzed by the microbiology laboratories of the university hospitals of the western part of Île-de-France and of Paris, France. Results Twenty UCBEs positive for non-typhi Salmonella enterica were analyzed. The sex ratio was 0.53 and the average age of patients was 57 years. Clinical presentations were acute pyelonephritis, acute cystitis, and prostatitis. Eight cases of bacteremia were identified. Diarrhea was observed in half of patients, either before the UTI or simultaneously. No patient required to be transferred to the intensive care unit. Immunodeficiency and/or diabetes were observed in eight patients. Three patients presented with a uropathy. Prescribed antibiotics were third generation cephalosporins and fluoroquinolones. The average treatment duration was 20 days. A spondylitis and a purulent pleurisy were observed and deemed related to the UTI. Patient outcome was always favorable following treatment prescription. Conclusion Non-typhi Salmonella enterica UTIs are rare. They are mainly observed in elderly patients presenting with immunodeficiency or an underlying urological disorder. [ABSTRACT FROM AUTHOR]

Objective Although urinary tract infections are the second leading cause of infections among patients aged above 65 years, data on bacterial epidemiology of urinary specimens in these patients is scarce. Our aim was to describe the main bacterial species found at significant levels in urine specimens of the elderly and to determine their antimicrobial resistance profiles. Methods From October 2012 to October 2015, all urinary specimens (catheter-related or not) received at the laboratory of microbiology of the university hospital of Caen (France) were retrospectively studied. Results were compared to those of urinary specimens of patients aged 18–64 years. Bacterial identification was performed using MALDI-TOF mass spectrometry and antimicrobial susceptibility testing was performed as per CA-SFM guidelines. Results Out of 33,302 urine cytobacteriological examinations (UCBE) performed in patients aged above 65 years, 13,450 microorganisms were identified. Escherichia coli was the most frequent species (41.8%) followed by Enterococcus faecalis (9.7%), Pseudomonas aeruginosa (5.7%), Proteus mirabilis (4.6%), and Klebsiella pneumoniae (4.2%). Around 9% of E. coli isolates were resistant to third-generation cephalosporins, including 8.2% by production of extended-spectrum β-lactamase (ESBL). This prevalence was significantly higher than that observed in urinary specimens of patients aged 18–74 years (4.9%, P < 0.001). Conclusion The bacterial epidemiology of urines collected from the elderly is diverse and significantly different from that of urine specimens of younger patients, with a higher proportion of multidrug-resistant bacteria (particularly ESBL-producing E. coli ). [ABSTRACT FROM AUTHOR]

Background: Efficacy of oral treatment in infants and young children with acute pyelonephritis has recently been shown. No systematic data regarding the frequency of potentialy limiting factors of oral treatment are available. Aims: To characterize patients with a first episode of pyelonephritis in -egard to factors limiting oral treatment. Methods: Retrospective chart review of 108 inpatients with a first episode of acute pyelonephritis, divided in two age groups (A: 2-6 months, B: 7-36 months). Results: Older patients (B) had more fever (o <0.01) prior to admission, higher CRP values (p <0.01) and had a .onge'time to defervescence (p <0,001). Multiple vomiting was found i n 9 % (A = B), antimicrobial resistance in 2%, and persisting fever day 3) in 19% (B »A )of patients. Conclusions: Persistent vomiting and fever may limit oral treatment in pediatric patients with acute pyelonephritis. [ABSTRACT FROM AUTHOR]

Nous rapportons deux cas d'infection à Pseudomonas aeruginosa: un cas de méningite et un cas d'infection urinaire. Les auteurs rappellent qu'à côté des étiologies classiques des méningites et des infections urinaires, des germes résistants comme Pseudomonas aeruginosa peuvent être responsables d'infections à localisation méningées et urinaires et dont il faut connaître pour une bonne prise en charge. Le traitement de ces infections requiert un antibiogramme au regard de la grande capacité de résistance de Pseudomonas aeruginosa en milieu hospitalier. La limitation des gestes invasifs et l'application rigoureuse des mesures de prévention des infections en milieu hospitalier contribueront à lutter efficacement contre ces infections en milieu de soins.

Copyright of Gériatrie et Psychologie Neuropsychiatrie du Vieillissement is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background Urinary tract infections (UTIs) are a major recurrent problem for spinal cord injury (SCI) patients. Repeated antibiotic treatments contribute to the emergence of multidrug-resistant bacteria (MDRB). We evaluated the use of weekly oral cycling antibiotics (WOCA) in the prevention of UTIs over a mean follow-up period of 53 months (median follow-up period: 57 months) and analyzed the risk of MDRB emergence. Methods We conducted a cross-sectional study of adult SCI patients with neurogenic bladder who were receiving the WOCA regimen. Results We included 50 patients, mainly men (60%), with a mean age of 51 ± 13.5 years. Overall, 66% of patients had been paraplegic or tetraplegic for 19.4 ± 14.3 years; 92% underwent intermittent catheterization; and 36% had no postvoid residual. The number of febrile and non-febrile UTIs significantly reduced after WOCA initiation (9.45 non-febrile UTIs before WOCA initiation vs . 1.57 after; 2.25 febrile UTIs before WOCA initiation vs . 0.18 after; P = 0.0001). Only one adverse event was reported during the follow-up period. The number of MDRB-colonized patients decreased from 9/50 to 4/50 during the follow-up period. Conclusion WOCA is an effective and safe strategy to prevent UTIs in SCI patients with neurogenic bladder. WOCA does not lead to the emergence of MDRB resistance and even seems to reduce MDRB carriage. [ABSTRACT FROM AUTHOR]

Objectives Patients presenting with neurogenic bladder often require urological procedures (urodynamic testing and botulinum toxin injections) and a preventive antibiotic therapy. We aimed to assess the efficacy of this little known strategy in a cohort of patients. Patients and methods All patients presenting with neurogenic bladder who underwent urological procedure were included in the study. They received an antibiotic therapy in accordance with the urine cytobacteriological examination results. The antibiotic therapy was initiated two days before the procedure and prolonged up until two days after the procedure if the culture was positive. Patients were treated with a single dose of fosfomycin-trometamol in case of a negative culture. The main study outcome was the occurrence of urinary tract infection (UTI), defined by a positive urine culture and symptoms, up until 14 days after the procedure. Results A total of 80 urological procedures were performed. Mean patient age was 47 ± 13.1 years (sex ratio 1.22); 59 (73.8%) presented with asymptomatic bacteriuria before the procedure. Nine (11.1%) UTIs were recorded on Day 14, of which one (1.2%) was febrile. Two patients required an additional curative antibiotic therapy. No patient was hospitalized. Overall, 77.8% of UTIs were cured without antibiotic therapy. Conclusion Screening and treating asymptomatic bacteriuria before urological procedures seems unnecessary and vainly exposes this population at high risk of infectious diseases to antibiotic therapies. This data should be confirmed by a randomized clinical trial. [ABSTRACT FROM AUTHOR]

Background and objectives Infections caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) have become a major public health issue worldwide. Cefoxitin is a second-generation cephalosporin and is associated with a strong in vitro activity against ESBL. Patients and methods We conducted a prospective monocentric cohort study from 2012 to 2015 to evaluate the clinical efficacy and safety of cefoxitin in 15 patients treated for urinary tract infection (UTI) caused by ESBL-E, without any severity criteria. Results We included 15 patients; 11 were male patients with defined risk factors for ESBL-E. Ten patients presented with male UTI, three with pyelonephritis, and two with cystitis. Escherichia coli was the predominant pathogen. All patients had a positive outcome with a good tolerance (a skin rash without any sign of severity was observed in one patient). Microbiological cure was obtained in 9 patients out of 10 at the end of treatment. Conclusion Cefoxitin is an alternative treatment to carbapenems for urinary tract infections caused by ESBL-producing Enterobacteriaceae. [ABSTRACT FROM AUTHOR]

Résumé Les urologues sont de plus en plus souvent confrontés à des infections urinaires à bactéries multirésistantes et notamment les entérobactéries productrices d'une β-lactamase à spectre étendu (E-BLSE). La témocilline est une β-lactamine à spectre relativement étroit qui conserve une efficacité sur une majorité de ces entérobactéries productrice de BLSE/ou E-BLSE et représente une alternative intéressante aux carbapénèmes pour le traitement des infections urinaires parenchymateuses documentées liées à ce type de bactéries. Nous fournissons ici un référentiel simple permettant une utilisation de cette molécule en pratique clinique courante. Summary Urologists are increasingly confronted with multi-drug resistant bacterial urinary tract infections, including enterobacteriaceae producing extended spectrum β-lactamase (ESBL). Temocillin is a β-lactam that retains efficacy on a majority of ESBL producing bacteria and represents an interesting alternative for the treatment of documented urinary tract infections associated with these bacteria. We provide here a simple reference allowing the use of this molecule in clinical practice. [ABSTRACT FROM AUTHOR]

Résumé Shigella spp est un agent d'infections gastro-intestinales rarement impliqué dans les infections urinaires. Observation : infection des voies urinaires à Shigella sonnei chez une fillette de 2 ans sans antécédent de gastro-entérite ou de reflux vésico-urétéral reéue aux urgences pédiatriques pour une fièvre qui dure depuis plus de 8 jours, avec présence de brûlures mictionnelles et syndrome dysentérique très marqué. Bilan biologique : CRP à 20 mg/L, ECBU sur un échantillon matinal, l'aspect macroscopique retrouve des urines louches, l'examen microscopique a révélé un taux de GB supérieur à 104 éléments/mL. L'antibiogramme a révélé une résistance uniquement aux trimethoprime-sulfamethoxazone. Coproculture : Elle était monomorphe à Shigella sonnei. L'antibiogramme a montré le même phénotype de sensibilité que la souche isolée dans les urines. Abstract Shigella spp. is usually responsible for gastrointestinal infections. It causes rarely urinary tract infections. Case report : urinary tract infection caused by Shigella sonnei in a 2-year-old girl with no history of gastroenteritis or vesico-ureteral reflux who presented to pediatric emergencies for a fever lasting more than 8 days, with mictional burns, with a very marked dysenteric syndrome Biological assessment : CRP 20 mg/L, CBEU on a morning sample, the macroscopic appearance found cloudy urine, microscopic examination revealed a high level of WBC greater than 104 elements/mL. Seeding is quantitative by the technique of loop calibrated at 10 ìL on a CLED-type medium and incubated at 37°C for 24 h. The culture was monomorphic with bacterial growth at 105 CFU/mL. The antibiogram revealed resistance only to trimethoprim-sulfamethoxazone while the bacterium was sensitive to others antibiotics tested The stool culture : The culture was monomorphic with the presence of a Shigella sonnei. The antibiogram found the same sensitivity phenotype as the isolated strain in the urine. [ABSTRACT FROM AUTHOR]

Résumé Le syndrome de la poche à urines violette est une affection rare, qui survient chez les patients porteurs de sondes urinaires à demeure de façon prolongée et fréquemment associées à une infection urinaire. Il est caractérisé par l’apparition d’une coloration violette de la sonde et/ou de la poche de recueil des urines. Nous rapportons un premier cas en Afrique de l’ouest survenu chez une patiente de 47 ans en encéphalopathie urémique et porteuse d’une sonde urinaire qui a présenté une coloration violette de la tubulure ainsi que de la poche à urine, associée à une infection urinaire. L’évolution a été favorable sous une antibiothérapie. De nombreux patients bénéficient de la pose de sondes urinaires pour divers motifs et la survenue de ce syndrome devrait amener l’équipe médicale à rechercher systématiquement une infection urinaire sous-jacente afin d’éviter, si possible, des bilans paracliniques coûteux à nos patients généralement sans couverture médicale dans nos pays en voie de développement. Purple urine-bag syndrome is a rare condition that occurs in patients with indwelling urinary catheters carried over a long period and frequently associated with a urinary tract infection. It is characterized by the appearance of a violet coloration of the probe and/or the urine collection bag. We report the first case in West Africa that occurred in a 47-year-old woman in uremic encephalopathy and carrier of a urinary catheter, which presented a violet color of the tubing and urine-bag associated with a urinary tract infection. The outcome was favorable under antibiotic therapy. Many patients benefit from the installation of urinary catheters for various reasons and the occurrence of this syndrome should lead the medical team to systematically seek an underlying urinary tract infection to avoid if possible paraclinical assessments generally costly to our patients without medical coverage in our developing countries. [ABSTRACT FROM AUTHOR]