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Öğe Antibiotic Prophylaxis in Urology Departments, 2005-2010(Elsevier, 2013) Cek, Mete; Tandogdu, Zafer; Naber, Kurt; Tenke, Peter; Wagenlehner, Florian; van Oostrum, Edgar; Kristensen, BrianBackground: Antibiotic prophylaxis (AP) is an important measure in preventing health care-associated urinary tract infections (HAUTIs). Despite regional variations in the bacterial spectrum and antibiotic susceptibility patterns, guideline recommendations are usually given on an international level. Objective: To describe the use of AP in urology departments and relate this to relevant parameters such as country, type of hospital, and European Association of Urology guideline recommendations. Design, setting, and participants: Data from the Global Prevalence Study on Infections in Urology for the period 2005-2010 were analysed to evaluate the use of antibiotics in general and AP for urologic procedures. Of the 13 723 patients enrolled, 8178 received antibiotics on the study days. Outcome measurements and statistical analysis: Study data were imported from the Web-based survey into Microsoft Access and exported into SPSS v. 17.0. The data were then coded and analysed. The Pearson chi-Square test was used to compare categorical data and a probability level of 5% was considered significant. Multiple logistic regression analysis was used to define significantly different variables in multiple set categories. Results and limitations: Questions on AP were answered on 8370 forms and 6306 (75.3%) investigators reported their routine application of AP. Routine AP was highest in Latin America (n = 337; 84%), followed by Asia (n = 1338; 86%), Africa (n = 234; 85%), and Europe (n = 4116; 67%). The antibiotics most frequently used for AP were second-generation cephalosporins, ciprofloxacin, cefotaxime, and amoxicillin plus beta-lactamase inhibitor. Conclusions: There were significant differences between countries/regions and types of hospitals, both in using AP for clean procedures and in the types of antibiotics used. AP was not always consistent with recommended guidelines. (C) 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.Öğe Aspects of urinary tract infections and antimicrobial resistance in hospitalized urology patients in Asia: 10-Year results of the Global Prevalence Study of Infections in Urology (GPIU)(Elsevier Science Bv, 2018) Choe, Hyun-Sop; Lee, Seung-Ju; Cho, Yong-Hyun; Cek, Mete; Tandogdu, Zafer; Wagenlehner, Florian; Bjerklund-Johansen, Truls ErikObjectives: To assess Asian data from Global Prevalence Study on Infections in Urology (GPIU study) which has been performed more than 10 years. Methods: Seventeen Asian countries participated in the GPIU study between 2004 and 2013. Data for these countries were collected from the web-based GPIU database. The point prevalence of urinary tract infections (UTI) and antimicrobial susceptibility of representative pathogens were analysed for Asian geographic regions. Results: A total of 6706 patients (5271 male, 1435 female) were assessed during the study period, and 659 patients were diagnosed with a UTI (9.8%). Of these UTI patients, 436 were male and 223 were female. Mean patient age was 54.9 +/- 19.3 years. Pyelonephritis and cystitis were the most common clinical diagnoses, representing 30.7% and 29.9% of patients, respectively. Escherichia coli was the most frequently identified uropathogen (38.7%). For the patients with urinary tract infection, cephalosporins were the most frequently used antibiotics (34.4%), followed by fluoroquinolones (24.1%), aminoglycosides (16.8%). Fluoroquinolone resistance was relatively high (ciprofloxacin 54.9%, levofloxacin 39.0%), and cephalosporin resistance 42% (42.5-49.4%). Of the antibiotics evaluated, uropathogens had maintained the highest level of susceptibility to amikacin and imipenem (24.9% and 11.3% resistance rates, respectively). Conclusion: Uropathogens in many Asian countries had high resistance to broad-spectrum antibiotics. Knowledge of regional and local resistance data and prudent use of antibiotics are important for proper management of UTI in Asian countries. (c) 2017 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.Öğe Condition-specific surveillance in health care-associated urinary tract infections as a strategy to improve empirical antibiotic treatment: an epidemiological modelling study(Springer, 2020) Tandogdu, Zafer; Koves, Bela; Cai, Tommaso; Cek, Mete; Tenke, Peter; Naber, Kurt; Wagenlehner, FlorianBackground Health care-associated urinary tract infection (HAUTI) consists of unique conditions (cystitis, pyelonephritis and urosepsis). These conditions could have different pathogen diversity and antibiotic resistance impacting on the empirical antibiotic choices. The aim of this study is to compare the estimated chances of coverage of empirical antibiotics between conditions (cystitis, pyelonephritis and urosepsis) in urology departments from Europe. Methods A mathematical modelling based on antibiotic susceptibility data from a point prevalence study was carried. Data were obtained for HAUTI patients from multiple urology departments in Europe from 2006 to 2017. The primary outcome of the study is the Bayesian weighted incidence syndromic antibiogram (WISCA) and Bayesian factor. Bayesian WISCA is the estimated chance of an antibiotic to cover the causative pathogens when used for first-line empirical treatment. Bayesian factor is used to compare if HAUTI conditions did or did not impact on empirical antibiotic choices. Results Bayesian WISCA of antibiotics in European urology departments from 2006 to 2017 ranged between 0.07 (cystitis, 2006, Amoxicillin) to 0.89 (pyelonephritis, 2009, Imipenem). Bayesian WISCA estimates were lowest in urosepsis. Clinical infective conditions had an impact on the Bayesian WISCA estimates (Bayesian factor > 3 in 81% of studied antibiotics). The main limitation of the study is the lack of local data. Conclusions Our estimates illustrate that antibiotic choices can be different between HAUTI conditions. Findings can improve empirical antibiotic selection towards a personalized approach but should be validated in local surveillance studies.Öğe The Global Prevalence of Infections in Urology (GPUI) Study: A Worldwide Surveillance Study in Urology Patients(Elsevier, 2016) Wagenlehner, Florian; Tandogdu, Zafer; Bartoletti, Riccardo; Cai, Tommaso; Cek, Mete; Kulchavenya, Ekaterina; Koves, Bela[Abstract Not Available]Öğe The Global Prevalence of Infections in Urology Study: A Long-Term, Worldwide Surveillance Study on Urological Infections(Mdpi, 2016) Wagenlehner, Florian; Tandogdu, Zafer; Bartoletti, Riccardo; Cai, Tommaso; Cek, Mete; Kulchavenya, Ekaterina; Koeves, BelaThe Global Prevalence of Infections in Urology (GPIU) study is a worldwide-performed point prevalence study intended to create surveillance data on antibiotic resistance, type of urogenital infections, risk factors and data on antibiotic consumption, specifically in patients at urological departments with healthcare-associated urogenital infections (HAUTI). Investigators registered data through a web-based application (http://gpiu.esiu.org/). Data collection includes the practice and characteristics of the hospital and urology ward. On a certain day in November, each year, all urological patients present in the urological department at 8:00 a.m. are screened for HAUTI encompassing their full hospital course from admission to discharge. Apart from the GPIU main study, several side studies are taking place, dealing with transurethral resection of the prostate, prostate biopsy, as well as urosepsis. The GPIU study has been annually performed since 2003. Eight-hundred fifty-six urology units from 70 countries have participated so far, including 27,542 patients. A proxy for antibiotic consumption is reflected by the application rates used for antibiotic prophylaxis for urological interventions. Resistance rates of most uropathogens against antibiotics were high, especially with a note of multidrug resistance. The severity of HAUTI is also increasing, 25% being urosepsis in recent years.Öğe Healthcare-associated urinary tract infections in hospitalized urological patients-a global perspective: results from the GPIU studies 2003-2010(Springer, 2014) Cek, Mete; Tandogdu, Zafer; Wagenlehner, Florian; Tenke, Peter; Naber, Kurt; Bjerklund-Johansen, Truls ErikEuropean Section for Infections in Urology has been conducting an annual prevalence survey investigating various aspects of healthcare-associated urinary tract infections (HAUTI) since 2003. The data on various clinical categories of HAUTI, the contamination status of HAUTI patients who underwent any urological intervention with regard to microorganisms isolated, resistance status and antibiotics used to treat HAUTI will be presented. Of a total of 19,756 patients screened, 1,866 patients had HAUTI (9.4 %); 1,313 males (70.4 %) and 553 (29.6 %) females. Mean age was 59.9 +/- A 18.2. Asymptomatic bacteriuria (ASB) and cystitis were the most frequent clinical diagnoses representing 27.0 and 26 % of all HAUTI, respectively. Echerichia coli was found to be the most frequent uropathogen (544 of 1,371 isolates) (39.7 %). Fluoroquinolones were preferred in 26.6 % of cases followed by cephalosporins (23.3 %), aminoglycosides (14.1 %) and penicillins (13.8 %). High global resistance rates to ciprofloxacin (> 50 %), cephalosporins (35-50 %) and penicillins (50 %) were found in the GPIU studies 2003-2010. We showed that around 10 % of hospitalized urological patients are at risk to develop HAUTI often caused by multiresistant uropathogens. Increased antibiotic use often with broad-spectrum antimicrobials will inevitably be followed by increasing bacterial resistance. To interrupt such a vicious cycle, our results suggest (1) there is still room for improvement in surgical prophylaxis in terms of limiting exposure to antibiotics and (2) far too many patients with ASB are being treated which shows that the new proposal of classification should be adopted where ABS is regarded as colonization and not as an infection to be treated.Öğe Reply from Authors re: Riccardo Bartoletti, Tommaso Cai. Prostate Biopsies Should Be Performed According to a Standard of Care. Eur Urol 2013;63:528-9(Elsevier Science Bv, 2013) Wagenlehner, Florian; van Oostrum, Edgar; Tenke, Peter; Tandogdu, Zafer; Cek, Mete; Grabe, Magnus; Wullt, Bjorn[Abstract Not Available]Öğe Resistance patterns of nosocomial urinary tract infections in urology departments: 8-year results of the global prevalence of infections in urology study(Springer, 2014) Tandogdu, Zafer; Cek, Mete; Wagenlehner, Florian; Naber, Kurt; Tenke, Peter; van Ostrum, Edgar; Johansen, Truls BjerklundTo present the worldwide antibiotic resistance rates of uropathogens reported in nosocomial urinary tract infections (NAUTI) during the period of 2003-2010. Data from the Global Prevalence Study of Infections in Urology from the period of 2003-2010 were analyzed to evaluate the resistance rates of pathogens causing NAUTI. The web-based application was used to record data of investigators from urology departments participating in the study every year during the days allocated in November. Each center was allowed to enter data on a single day of the study. The point prevalence data was used to find differences among geographic regions and years by utilizing multiple logistic regression analysis. A total of 19,756 patients were hospitalized during the study period, and in 1,866 of them, NAUTI was reported. Proof of infection was reported in 1,395 patients. Resistance rates of all antibiotics tested other than imipenem against the total bacterial spectrum were higher than 10 % in all regions. Resistance to almost all pathogens was lowest in North Europe, and there is no single year where an outbreak of resistance has been detected. The resistance rates of most of the uropathogens against the antibiotics tested did not show significant trends of increase or decrease with Asia exhibiting the highest rates in general. The only antibiotic tested with an overall resistance rate below 10 % was imipenem. Knowledge of regional and local resistance data and prudent use of antibiotics are necessary to optimize antibiotic therapy in urological patients with NAUTI.
