Urological Survey Infection and Inflammation of the Genitourinary Tract Re: Acute Bacterial Prostatitis in Humans: Current Microbiological Spectrum, Sensitivity to Antibiotics and Clinical Findings V. Nagy and D. Kubej  arik  University, Medical Faculty and L. Pasteur University Hospital, Kosice,  Department of Urology, P.J. Saf Slovak Republic Urol Int 2012; 89: 445e450.

Permission to Publish Abstract Not Granted Editorial Comment: In this nice single institution review from Europe the authors describe their experience with acute bacterial prostatitis. This condition is 1 of the 4 categories of prostatitis defined by the National Institutes of Health. Most patients presented with difficulty of urination or acute retention. Men also often had fevers. Escherichia coli was the predominant species of bacteria found in these men, with Pseudomonas and Klebsiella being the most common secondary subtypes. In this series about 7.3% of men had progression to urosepsis. The most common antibiotics that demonstrated activity against the infectious bacteria were ciprofloxacin, trimethoprim-sulfamethoxazole and cephalosporins. We cannot use this single institution review to pick appropriate antibiotics to treat men at our own clinics, but this review nicely emphasizes that it is critical to know local drug resistant patterns when treating men at individual sites for acute prostatitis. Edward M. Schaeffer, MD, PhD

Renal Transplantation and Renovascular Hypertension Re: The Use of Fosfomycin to Treat Urinary Tract Infections in Kidney Transplant Recipients G. E. Reid, S. A. Grim, J. E. Layden, S. Akkina, I. Tang, M. Campara and N. M. Clark Section of Infectious Diseases, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois Transplantation 2013; 96: e12ee14.

No Abstract Editorial Comment: This article appeared as a short publication bringing attention to a relatively new antibiotic. Due to complex host issues (urological reconstruction, stents/catheters and immunosuppression), kidney transplant recipients are at risk for urinary tract infections (UTIs). Within the first several months after transplant UTI is the most common bacterial infection. These infections increasingly involve multidrug resistant organisms. Fosfomycin in a single dose of 3 gm is approved for uncomplicated UTI. This agent covers most urinary pathogens and is well tolerated. The drug may be useful in circumstances of multidrug resistant UTIs where the only alternatives are extended

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parenteral therapy. It is worth discussing with local infectious disease and microbiology specialists to include this agent on a panel of sensitivity testing for common uropathogens. David A. Goldfarb, MD

Geriatrics Re: American Geriatrics Society Identifies Five Things that Healthcare Providers and Patients Should Question AGS Choosing Wisely Workgroup American Geriatrics Society, New York, New York J Am Geriatr Soc 2013; 61: 622e631.

Abstract available at http://jurology.com/ Editorial Comment: The Choosing WiselyÒ campaign is an initiative recently developed by the ABIM Foundation. Numerous professional medical organizations were asked to identify 5 tests, medications or treatments commonly used in their specialty where evidence on risks of safety or lack of efficacy outweighs the potential benefits. The choice of items was left to each organization but had to fall within its clinical purview and comply with criteria on costs, potential risks and sufficient evidence. The American Geriatrics Society is a nonprofit organization of more than 6,000 health care professionals dedicated to improving care for all older adults, including those with complex or multiple health disorders. Among the 5 things identified by the American Geriatrics Society to specifically avoid or question is use of antimicrobial agents to treat bacteriuria in older adults unless specific urinary tract symptoms are present. The decision to include this directive was based on a strong body of published literature that recommends avoidance of treating asymptomatic bacteriuria in the geriatric population. Rates of this condition are high in community dwelling and institutionalized older adults. Antibiotic therapy has shown no short or long-term benefits, and treatment can be associated with substantial negative outcomes, such as adverse drug reactions and reinfection with drug resistant organisms. The panel did note that geriatric patients with asymptomatic bacteriuria should receive prophylactic antibiotics before invasive urological procedures. Tomas L. Griebling, MD, MPH

Re: the use of fosfomycin to treat urinary tract infections in kidney transplant recipients.

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