Aim of this thesis was to provide evidence for the clinical implication of biomarkers in blood and urine, as well as genetic markers, for the prediction of the severity and course of febrile UTI.... Show moreAim of this thesis was to provide evidence for the clinical implication of biomarkers in blood and urine, as well as genetic markers, for the prediction of the severity and course of febrile UTI. Furthermore, this thesis focused on optimization of antimicrobial treatment of febrile UTI. The main results are: 1. Recent hospitalization, indwelling urinary catheter and especially individual fluoroquinolone (FQ) use are independent risk factors for a FQ-resistant Escherichia coli febrile UTI. 2. Women with febrile UTI, including postmenopausal women and those with comorbidities, can be safely and successfully treated with a 7-day course of oral ciprofloxacin. In men, however, treatment duration should be at least 14 days. 3. Diabetes mellitus does not affect the clinical presentation and course of febrile UTI; concurrent illnesses and higher age of the diabetic population attribute to a more complicated course. 4. MR-proADM more accurately predicts a complicated course of disease than currently available inflammatory biomarkers. Importantly, biomarkers derived directly from host defense mechanisms are not suitable to distinguish between febrile UTI patients with and without bacteremia. 5. MP-TF activity is related to disease severity and bacteraemia in febrile E. coli UTI and may contribute to the prothrombotic state in gram-negative sepsis. Show less
Urinary tract infections (UTI) are among the most frequently reported infections among older persons. UTI not only causes several days of illness but may have more severe consequences, such as a... Show moreUrinary tract infections (UTI) are among the most frequently reported infections among older persons. UTI not only causes several days of illness but may have more severe consequences, such as a decline in functioning, as well as delirium, dehydration, urosepsis, hospitalization, or even death. Annually, 20% of all older persons visit their general practitioner for a UTI and about 50% of the residents in long-term care facilities (LTCF) get a UTI. This thesis describes the possibilities for and the effects of the prevention of UTI in vulnerable very old persons. The first part of this thesis investigates the effect of infections on functioning and explores which vulnerable very old persons would benefit most from UTI prevention. The second part of this thesis describes the results of the CRANBERRY study. A double-blind randomized placebo-controlled multicentre trial in LTCF. This study investigates the effectiveness and costs of cranberry capsule use in the prevention of clinical UTI. Show less
