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Biomedical subjects

T Sandberg

Publications and source records attributed to T Sandberg.

At least 55 records · Page 3Linked to original sources
PubMed1991

Efficacy of long-term antimicrobial prophylaxis after acute pyelonephritis in pregnancy.

The efficacy of antimicrobial prophylaxis for recurrent urinary infection after an episode of acute febrile pyelonephritis was assessed in 27 pregnant women. Immediately following a 2-week treatment course for acute pyelonephritis, low-dose prophylaxis with a proper antimicrobial agent taken at bedtime daily was continued until 1 month after delivery. 23 women received 50 mg of nitrofurantoin, and 2 each were given 250 mg of amoxycillin and 250 mg of cephalexin, respectively. The treatment regimens were well tolerated and there were no breakthrough infections during a total of 7.8 patient-years of treatment. These results show that long-term low-dose antimicrobial prophylaxis is highly effective in this population at high risk of recurrent acute pyelonephritis.

Acute Disease↗
PubMed1991

Association between fever and reduced renal concentrating capacity.

The renal concentrating capacity was assessed in 18 adult patients with febrile infections of non-renal origin. Urine osmolatity was determined after overnight fluid deprivation for 10 hours followed by subcutaneous administration of 4 micrograms of desmopressin. All patients had a transient reduction of the concentrating capacity as compared to a subsequent test performed one month later (p less than 0.001). During the febrile disease, 12 of 18 patients could not achieve a maximal urine osmolality above the lower limit (-2 SD) of an age-related reference interval. These results suggest that in febrile patients with bacteriuria, a reduced renal concentrating capacity does not necessarily mean that the infection is localised to the kidneys but may rather be explained by fever per se.

Adolescent↗
PubMed1990

Randomised double-blind study of norfloxacin and cefadroxil in the treatment of acute pyelonephritis.

In a coordinated, double-blind multi-centre trial, adults with symptoms of acute pyelonephritis were randomly assigned to receive a two-week course of oral treatment with either 400 mg norfloxacin twice daily or 1 g cefadroxil twice daily. Of 197 patients enrolled in the study, 140 could be evaluated for drug efficacy and 193 for drug safety. Norfloxacin gave a significantly higher bacteriological cure rate than cefadroxil, both at 3 to 10 days (98% versus 65%; p less than 0.0001; 95% confidence interval (CI) for difference in proportions 21-46%) and up to eight weeks (87% versus 48%; p less than 0.0001; 95% CI 25-54%) after cessation of treatment. The differences between the two regimens were most pronounced in men and in patients with complicating factors such as diabetes mellitus and urinary tract abnormalities. The clinical response during treatment did not differ between the two groups, but symptomatic recurrences at follow-up were more common in the cefadroxil group (28% versus 3%; p less than 0.0001; 95% CI 14-36%). Adverse events were more often reported by patients receiving cefadroxil (39% versus 22%; p = 0.011; 95% CI 4-30%) and consisted mainly of gastrointestinal disturbances and vulvo-vaginitis. In terms of bacteriological and clinical efficacy and safety, a two-week course of norfloxacin was superior to a two-week course of cefadroxil for oral treatment of community-acquired acute pyelonephritis.

Acute Disease↗
PubMed1990

Antibody response to Staphylococcus saprophyticus in urinary tract infection.

The serological response towards Staphylococcus saprophyticus in young women with symptomatic urinary tract infection was measured with an enzyme-linked immunosorbent assay (ELISA) and a direct agglutination (DA) test. In both assays a marked antibody response was found in 2 of 3 patients with acute pyelonephritis caused by S. saprophyticus. Patients with acute cystitis due to S. saprophyticus or Escherichia coli showed antibody titers comparable to those of healthy controls.

Acute Disease↗
PubMed1989

Selective use of excretory urography in women with acute pyelonephritis.

The outcome of excretory urography was analyzed in 103 nonpregnant women followed prospectively after community acquired acute pyelonephritis. Radiological abnormality was found in 40 per cent of the patients (17 per cent had major abnormalities, including renal scarring, calculi and obstruction). All 5 women with surgically correctable lesions had rapid bacteriological relapse or recurrent acute pyelonephritis. Neither a history of urinary tract infection, the acute inflammatory response nor infection due to Escherichia coli with or without adhesins specific for Gal alpha 1----4Gal beta-containing receptors was efficient in predicting major radiographic lesions or the outcome of treatment. Bacteremia was detected in 27 per cent of the patients but in the absence of obstruction. These results suggest that excretory urography is dispensable in most women with acute pyelonephritis, and that those needing such investigation may be identified by failure to respond to antibiotic treatment or by the recurrence pattern.

Acute Disease↗
PubMed1989

Host response in women with symptomatic urinary tract infection.

The agreement between clinical signs and host response was analysed in 174 women with symptomatic urinary tract infection. C-reactive protein (CRP) confirmed the clinical diagnosis in that 94% of non-pregnant and 91% of pregnant women with acute pyelonephritis had serum levels greater than or equal to 30 mg/l, compared with only 5% of cystitis patients. There was a significant increase in the erythrocyte sedimentation rate (ESR) and reduction of the renal concentrating capacity in patients with acute pyelonephritis, although the overlap with the cystitis group was greater than for CRP. The transient decrease in urine osmolality was unrelated to age, as were CRP, ESR and the total white blood cell count. Pregnant women had higher ESR but lower CRP levels than non-pregnant women with acute pyelonephritis. The renal concentrating capacity was more reduced in those infected with Escherichia coli expressing adhesins specifically recognizing Gal alpha 1----4Gal beta-containing receptors on uroepithelial cells.

Adolescent↗
PubMed1989

Bacterial adhesion as an indicator of renal involvement in bacteriuria of pregnancy.

The association of bacterial virulence with the host response to bacteriuria was evaluated in 70 pregnant women with acute pyelonephritis or bacteriuria detected at screening. Patients infected with Escherichia coli attaching to Gal alpha 1----4Gal beta-containing receptors, had significantly higher levels of C-reactive protein and lower renal concentrating capacity than patients infected with strains lacking this specificity. The renal concentrating capacity ranged from 419-1151 mOsm/kg in the women with bacteriuria on screening. 5/11 women with a renal concentrating capacity less than or equal to 784 mOsm/kg were infected with Gal alpha 1----4Gal beta-specific bacteria, compared to 0/16 of patients who concentrated the urine greater than 784 mOsm/kg. According to earlier studies the risk for progression to pyelonephritis and recurrences during pregnancy was increased in bacteriuric women with a reduced renal concentrating capacity. The present study demonstrates that this risk group can be identified in part by the properties of the infecting E. coli strains.

Bacterial Adhesion↗
PubMed1988

Virulence of Escherichia coli in relation to host factors in women with symptomatic urinary tract infection.

The relationship between bacterial characteristics and the severity of urinary tract infection in adults has not been clarified. In this study, Escherichia coli strains (n = 178) were prospectively collected from women with community-acquired urinary tract infection. The isolates were identified by O:K:H serotype and characterized for adherence, hemolysin production, and serum bactericidal resistance. The patients had acute pyelonephritis with or without complicating factors and acute cystitis. Nine serotypes (O1:K1:H7, O1:K1:H-, O2:K1:H-, O4:K12:H1, O7:K1:H-, O9:K34:H-, O16:K1:H6, O16:K1:H-, and O75:K5:H-) comprised 65% of the strains in uncomplicated pyelonephritis, but were significantly less often encountered in complicated pyelonephritis or cystitis. Adherence was the single property most characteristic of the pyelonephritogenic clones. Adhesins specifically recognizing Gal alpha 1----4Gal beta-containing receptors occurred in 80% of strains in uncomplicated pyelonephritis, in 50% of strains in complicated infections, and in 37% of cystitis strains. Hemolysin production and serum resistance did not correlate with any disease pattern. Advanced age did not seem to reduce the selection of virulent E. coli to cause pyelonephritis. These results demonstrate in women a relationship between E. coli virulence and the severity of urinary tract infection analogous to that previously observed in pediatric populations and also illustrate the balance between host resistance and bacterial virulence in the urinary tract.

Acute Disease↗
PubMed1988

Variable in vitro activity of cefaclor, cephalothin and cefadroxil against Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis.

The in vitro activity of cefaclor, cephalothin and cefadroxil to 50 Escherichia coli, 23 Klebsiella pneumoniae and 20 Proteus mirabilis strains was tested with the disc diffusion and microdilution plate techniques. Cefaclor was more active than cefadroxil, while cephalothin was intermediate. The differences seriously affected the classification into the routine SIR system. For susceptibility testing we question the use of cephalothin as a class representative of oral cephalosporins.

Cefaclor↗
PubMed1987

Virulence factors of Escherichia coli in urinary isolates from pregnant women.

Urinary isolates from 24 pregnant women with acute pyelonephritis and from 37 pregnant women with bacteriuria detected at screening were characterized for O:K:H serotype, electrophoretic type, adherence, hemolysin production, and serum resistance. Between the two diagnostic groups, only three clones were identical. For the remaining isolates, both the identification markers and virulence traits differed significantly. The strains from pregnant women with pyelonephritis did not significantly differ from those from non-pregnant women. Thus, pregnancy was shown not to abolish the difference in virulence between Escherichia coli causing acute pyelonephritis and asymptomatic bacteriuria.

Acute Disease↗
PubMed1987

Association between fever and the antibody response to Tamm-Horsfall protein in urinary tract infection.

The usefulness of measuring serum antibodies to Tamm-Horsfall protein (THP) for diagnosing the level of acute urinary tract infections in adult women was evaluated. There was a significant (p less than 0.001) elevation of IgG and IgA anti-THP in pregnant and non-pregnant women with acute pyelonephritis compared to women with acute cystitis. The changes in anti-THP antibody titre among patients with acute pyelonephritis varied considerably, limiting the value of determining such antibodies for diagnostic purposes. Patients with febrile infections of non-renal origin demonstrated an antibody response comparable to the pyelonephritis patients. One explanation for these results could be that fever is associated with transient rental tubular damage, thus exposing THP to the immune system. Polyclonal antibody activation seems less likely since neither an IgM antibody response to THP, nor an increase in antibody titre to poliovirus could be demonstrated.

Adult↗
PubMed1986

Diagnostic potential of urinary enzymes and beta 2-microglobulin in acute urinary tract infection.

Urinary excretions of beta 2-microglobulin (beta 2M), N-acetyl-beta-D-glucosaminidase (NAG), alanine aminopeptidase, beta-glucuronidase, acid and neutral alpha-glucosidase as indicators of proximal tubular dysfunction were measured in patients with acute upper and lower urinary tract infection (UTI) and fever of non-renal origin. The sensitivity of beta 2M was 67% and of NAG 49% as assessed in more than 100 episodes of acute pyelonephritis. Combined use of beta 2M and NAG increased the sensitivity to 75%. The degree of beta 2-microglobulinuria and enzymuria was comparable in patients with acute pyelonephritis and fever due to non-renal infections. The excretion of beta 2M and the various enzymes was too variable and unpredictable in individual cases to be useful as diagnostic indicator. In localizing an acute UTI, tests for proximal tubular dysfunction seem to be of no more clinical value than properly measured body temperature.

Acetylglucosaminidase↗