Journal Article

Demographic, Clinical, and Treatment Parameters Influencing the Outcome of Acute Cystitis

Roger M. Echols, Robert L. Tosiello, Daniel C. Haverstock and Alan D. Tice

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 29, issue 1, pages 113-119
Published in print July 1999 | ISSN: 1058-4838
Published online July 1999 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/520138
Demographic, Clinical, and Treatment Parameters Influencing the Outcome of Acute Cystitis

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A meta-analysis of six double-blinded clinical trials was undertaken to identify risk factors associated with bacteriologic outcome in 3,108 women with acute cystitis. Eleven antibiotic regimens were used, including ciprofloxacin, ofloxacin, norfloxacin, trimethoprim-sulfamethoxazole, and nitrofurantoin. Entry criteria for all studies were identical. Among 2,409 patients who were defined to be valid for efficacy analysis, pathogens included Escherichia coli (78.6%), Staphylococcus saprophyticus (4.4%), Klebsiella pneumoniae (4.3%), Proteus mirabilis (3.7%), and “other” (9%). Causative bacteria were eradicated at the end of treatment in 93% of patients. The following parameters were associated with successful bacteriologic outcome: not using a diaphragm (P = .0041), treatment for ⩾3 days (P = .0043), pathogen not “other” (P = .0043), symptom duration of <2 days (P = .0096), and African American race (P = .0147). K. pneumoniae (P = .0496) and “other” pathogens (P = .0018) were associated with increased probability of bacteriologic treatment failure. The presence of pyuria (⩾10 WBCs per high-power field) did not correlate with outcome and was inversely correlated with the finding of ⩾105 bacterial colony-forming units per mL of urine (P < .001). This large database identifies new parameters associated with treatment outcomes of acute cystitis and calls into question current clinical trial guidelines.

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Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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