851
|
Complicated urinary infection, including postsurgical and catheter-related infections. Infect Dis (Lond) 2010. [DOI: 10.1016/b978-0-323-04579-7.00056-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
852
|
Rice JC, Safdar N. Urinary tract infections in solid organ transplant recipients. Am J Transplant 2009; 9 Suppl 4:S267-72. [PMID: 20070689 DOI: 10.1111/j.1600-6143.2009.02919.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- J C Rice
- Department of Nephrology, Center for Organ and Cell Transplantation, Scripps Clinic and Scripps Green Hospital, La Jolla, CA, USA.
| | | | | |
Collapse
|
853
|
Enayat K, Fariba F, Bahram N. Asymptomatic bacteriuria among pregnant women referred to outpatient clinics in Sanandaj, Iran. Int Braz J Urol 2009; 34:699-704; discussion 704-7. [PMID: 19111074 DOI: 10.1590/s1677-55382008000600004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2008] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Determine the prevalence of asymptomatic urinary tract infection (AUTI) among pregnant women. We also determined the antibacterial susceptibility of the isolates to various antibiotics and associated risk factors in AUTI. MATERIALS AND METHODS One thousand five hundred and five consecutive pregnant women were included in the study. Mid-stream urine specimen for complete examination of urine was obtained. RESULTS Of 1505 pregnant women, 134 (8.9%) had bacteriuria. The mean age of the all the pregnant women included in the study was 28.40 years with a standard deviation of 6.16. Age ranged from 15 to 45 years of age. The urine culture of the asymptomatic pregnant women (1505 cases) showed growth in only 134 cases (8.9%). Escherichia coli was the commonest organism 79 (58.96%) followed by CN Staphylococcus 22 (16.8%) and S aureus 18 (13.43%). Escherichia coli, which comprised 58.96% (79) of the isolates, were 88.62%, 87.35%, and 83.55% sensitive to cefotaxime, ciprofloxacin and cefotizoxime respectively. Similarly, E. coli were 89%, 70%, and 20% resistant to ampicillin, cotrimoxazole, and nitrofurantoin respectively (OR 1.57 95% CI 1.01, 2.44). After analyzing, four variables, hemoglobin levels seem to be independently associated with asymptomatic bacteriuria (OR = 9.41 (1.65-50.38). CONCLUSION Prevalence of asymptomatic bacteriuria among pregnant women was 8.9%. The predominant organisms were Escherichia coli 79 (58.96%), followed by CN Staphylococcus 22 (16.8%). Most strains of Escherichia coli showed that they were resistant to ampicillin, tetracycline and gentamicin.
Collapse
Affiliation(s)
- Kalantar Enayat
- Department of Microbiology, School of Medicine, Sanandaj University of Medical Sciences, Sanandaj, Iran.
| | | | | |
Collapse
|
854
|
|
855
|
Antibiotic Prophylaxis for Short-Term Postoperative Transurethral Foley Catheter Use in Women. ACTA ACUST UNITED AC 2009. [DOI: 10.1097/spv.0b013e3181b8adbc] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
856
|
Drinka P. Treatment of Bacteriuria Without Urinary Signs, Symptoms, or Systemic Infectious Illness (S/S/S). J Am Med Dir Assoc 2009; 10:516-9. [DOI: 10.1016/j.jamda.2009.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Accepted: 04/15/2009] [Indexed: 01/19/2023]
|
857
|
Fosfomycin in a single dose versus a 7-day course of amoxicillin–clavulanate for the treatment of asymptomatic bacteriuria during pregnancy. Eur J Clin Microbiol Infect Dis 2009; 28:1457-64. [DOI: 10.1007/s10096-009-0805-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2009] [Accepted: 08/11/2009] [Indexed: 10/20/2022]
|
858
|
Vonberg RP, Behnke M, Rüden H, Gastmeier P. [Costs due to urinary tract infections in Germany. An estimation based on the data from the German National Nosocomial Infections Surveillance System]. Urologe A 2009; 47:54-8. [PMID: 18043904 DOI: 10.1007/s00120-007-1597-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We estimated the avoidable costs due to nosocomial urinary tract infections (UTI) based on the data of the German National Nosocomial Infections Surveillance System (KISS). METHODS The incidence of nosocomial UTI derived from KISS reference data. The overall number of patient days was obtained from the "Statistische Bundesamt" (German Federal Office of Statistics). Expected costs for a single UTI were estimated according to data published in the medical literature. RESULTS On average, there were 1.87 UTI on intensive care units (ICU) and 0.81 UTI on peripheral wards per 1,000 patient days; 4.5% of the annual 146.1 million patient days in German hospitals were contributed by ICUs. In total, there are approximately 155,000 nosocomial UTI every year. Each UTI leads to costs of about 1,000 euros; 20% of all nosocomial infections are preventable. CONCLUSIONS Just for nosocomial UTI, appropriate infection control measures may reduce the annual health care costs by 14,500 euros for every German hospital.
Collapse
Affiliation(s)
- R-P Vonberg
- Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Medizinische Hochschule Hannover, Hannover, Deutschland.
| | | | | | | |
Collapse
|
859
|
Kang Y, Crogan NL. An evidence-based review of infectious diseases. Geriatr Nurs 2009; 30:272-86. [PMID: 19673155 DOI: 10.1016/j.gerinurse.2009.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
860
|
|
861
|
Pavese P, Saurel N, Labarère J, Decouchon C, Vittoz JP, Foroni L, Maurin M, François P. Does an educational session with an infectious diseases physician reduce the use of inappropriate antibiotic therapy for inpatients with positive urine culture results? A controlled before-and-after study. Infect Control Hosp Epidemiol 2009; 30:596-9. [PMID: 19419329 DOI: 10.1086/597514] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
In this controlled before-and-after study involving 19 departments in a university-affiliated hospital, a single 1-hour educational session delivered by an infectious diseases physician reduced the use of inappropriate antibiotic therapy for inpatients with positive urine culture results. Further study is warranted to assess the long-term effect of this intervention.
Collapse
Affiliation(s)
- Patricia Pavese
- Department of Infectious Diseases and Tropical Medicine, Grenoble University Hospital, Grenoble, France
| | | | | | | | | | | | | | | |
Collapse
|
862
|
|
863
|
Regal RE, Pham CQD, Bostwick TR. Urinary Tract Infections in Extended Care Facilities: Preventive Management Strategies. ACTA ACUST UNITED AC 2009; 21:400-9. [PMID: 16824004 DOI: 10.4140/tcp.n.2006.400] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To provide health care professionals with an overview of interventions that may be done to reduce the incidence of urinary tract infections (UTIs) in elderly patients, especially those residing in extended care facilities. DATA SOURCES A Medline search of the English literature was performed from 1980 to January 2006 to find literature relevant to urinary tract prophylaxis. Further references were hand-searched from relevant sources. STUDY SELECTION When assessing the effectiveness of various clinical interventions for reducing the incidence of UTIs in the elderly, preference was given to more recent, double-blind, placebo-controlled randomized studies, but studies of less robust design also were included in the discussions when the former were lacking. DATA EXTRACTION Where possible, recent publications were favored over older studies. References were all reviewed by the authors and chosen to present key citations. DATA SYNTHESIS Data selection was prioritized to address specific subtopics. CONCLUSION Though still frequent in occurrence and quite costly in terms of morbidity, mortality, and cost to the health care system, numerous measures may be taken to ameliorate the incidence of UTIs in elderly, institutionalized residents. First and foremost, establishing and adhering to good infection-control practices by health care givers and minimizing the use of indwelling catheters are essential. Adequate staffing and training are germane to this effort. Reasonably well-designed clinical studies also give credence to the use of topical estrogens and lactobacillus "probiotics" for female subgroups and cranberry juice for a wider array of patients. Vitamin C is of no proven benefit. With regard to antibiotics, with the relative paucity of data available for this patient population, concerns for resistance proliferation must be balanced against perceived gains in UTI reduction.
Collapse
Affiliation(s)
- Randolph E Regal
- Adult Internal Medicine and Infectious Diseases, University of Michigan Hospitals and College of Pharmacy, Ann Arbor, 48109-0008, USA.
| | | | | |
Collapse
|
864
|
|
865
|
|
866
|
High KP, Bradley SF, Gravenstein S, Mehr DR, Quagliarello VJ, Richards C, Yoshikawa TT. Clinical practice guideline for the evaluation of fever and infection in older adult residents of long-term care facilities: 2008 update by the Infectious Diseases Society of America. J Am Geriatr Soc 2009; 57:375-94. [PMID: 19278394 PMCID: PMC7166905 DOI: 10.1111/j.1532-5415.2009.02175.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Residents of long‐term care facilities (LTCFs) are at great risk for infection. Most residents are older and have multiple comorbidities that complicate recognition of infection; for example, typically defined fever is absent in more than one‐half of LTCF residents with serious infection. Furthermore, LTCFs often do not have the on‐site equipment or personnel to evaluate suspected infection in the fashion typically performed in acute care hospitals. In recognition of the differences between LTCFs and hospitals with regard to hosts and resources present, the Infectious Diseases Society of America first provided guidelines for evaluation of fever and infection in LTCF residents in 2000. The guideline presented here represents the second edition, updated by data generated over the intervening 8 years. It focuses on the typical elderly person institutionalized with multiple chronic comorbidities and functional disabilities (e.g., a nursing home resident). Specific topic reviews and recommendations are provided with regard to what resources are typically available to evaluate suspected infection, what symptoms and signs suggest infection in a resident of an LTCF, who should initially evaluate the resident with suspected infection, what clinical evaluation should be performed, how LTCF staff can effectively communicate about possible infection with clinicians, and what laboratory tests should be ordered. Finally, a general outline of how a suspected outbreak of a specific infectious disease should be investigated in an LTCF is provided.
Collapse
Affiliation(s)
- Kevin P High
- Section on Infectious Diseases, Wake Forest University Health Sciences, Winston Salem, North Carolina 27157-1042, USA.
| | | | | | | | | | | | | | | |
Collapse
|
867
|
Bacteriuria in a geriatric hospital: impact of an antibiotic improvement program. J Am Med Dir Assoc 2009; 9:605-9. [PMID: 19083296 DOI: 10.1016/j.jamda.2008.04.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Revised: 03/31/2008] [Accepted: 04/01/2008] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To prospectively evaluate a management approach to bacteriuria including advice from an infectious diseases consultant (IDC) in geriatric inpatients. DESIGN Prospective study from July 1, 2003, to June 30, 2004. SETTING A 205-bed geriatric university-affiliated hospital. PARTICIPANTS Consecutive hospitalized patients with positive urine cultures. INTERVENTION The hospital's infection control department developed recommendations about antimicrobial use for bacteriuria, which were discussed at staff meetings. Treatments for bacteriuria prescribed by ward physicians were reviewed by an IDC, who suggested changes where appropriate. Physicians were free to follow or to disregard the IDC's suggestions. MEASUREMENTS Patients with positive urine cultures (UC) were classified as having asymptomatic bacteriuria (AB), urinary tract infection (UTI) or pyelonephritis (PN). Prescribed and actual treatments were compared. RESULTS Of 252 consecutive positive UCs in 181 patients, 124 (49%) were classified as AB, 88 (35%) as UTI, and 38 (15%) as PN; 2 cases of prostatitis were excluded. The total number of prescribed antimicrobial days before IDC advice was 729 and the actual number (after IDC advice) was 577, for a 152-day (21%) reduction. Most of the reduction was generated by shortening the treatment duration. CONCLUSION Intervention of an IDC resulted in reduced antimicrobial use in older inpatients with bacteriuria.
Collapse
|
868
|
High KP, Bradley SF, Gravenstein S, Mehr DR, Quagliarello VJ, Richards C, Yoshikawa TT. Clinical practice guideline for the evaluation of fever and infection in older adult residents of long-term care facilities: 2008 update by the Infectious Diseases Society of America. J Am Geriatr Soc 2009. [PMID: 19278394 DOI: 10.1111/j.1532‐5415.2009.02175.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Residents of long-term care facilities (LTCFs) are at great risk for infection. Most residents are older and have multiple comorbidities that complicate recognition of infection; for example, typically defined fever is absent in more than one-half of LTCF residents with serious infection. Furthermore, LTCFs often do not have the on-site equipment or personnel to evaluate suspected infection in the fashion typically performed in acute care hospitals. In recognition of the differences between LTCFs and hospitals with regard to hosts and resources present, the Infectious Diseases Society of America first provided guidelines for evaluation of fever and infection in LTCF residents in 2000. The guideline presented here represents the second edition, updated by data generated over the intervening 8 years. It focuses on the typical elderly person institutionalized with multiple chronic comorbidities and functional disabilities (e.g., a nursing home resident). Specific topic reviews and recommendations are provided with regard to what resources are typically available to evaluate suspected infection, what symptoms and signs suggest infection in a resident of an LTCF, who should initially evaluate the resident with suspected infection, what clinical evaluation should be performed, how LTCF staff can effectively communicate about possible infection with clinicians, and what laboratory tests should be ordered. Finally, a general outline of how a suspected outbreak of a specific infectious disease should be investigated in an LTCF is provided.
Collapse
Affiliation(s)
- Kevin P High
- Section on Infectious Diseases, Wake Forest University Health Sciences, Winston Salem, North Carolina 27157-1042, USA.
| | | | | | | | | | | | | | | |
Collapse
|
869
|
Arinzon Z, Peisakh A, Shuval I, Shabat S, Berner YN. Detection of urinary tract infection (UTI) in long-term care setting: Is the multireagent strip an adequate diagnostic tool? Arch Gerontol Geriatr 2009; 48:227-31. [DOI: 10.1016/j.archger.2008.01.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2007] [Revised: 01/13/2008] [Accepted: 01/16/2008] [Indexed: 11/26/2022]
|
870
|
Kane SF, Cohen MI. Evaluation of the Asymptomatic Athlete With Hepatic and Urinalysis Abnormalities. Curr Sports Med Rep 2009; 8:77-84. [DOI: 10.1249/jsr.0b013e31819e0b8d] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
|
871
|
Abstract
OBJECTIVE A dipslide is a plastic paddle coated with agar that is attached to a plastic cap that screws onto a sterile plastic vial. Our objective was to estimate the diagnostic accuracy of the dipslide culture technique to detect asymptomatic bacteriuria during pregnancy and to evaluate the accuracy of nitrate and leucocyte esterase dipslides for screening. METHODS This was an ancillary study within a trial comparing single-day with 7-day therapy in treating asymptomatic bacteriuria. Clean-catch midstream samples were collected from pregnant women seeking routine care. Positive and negative likelihood ratios and sensitivity and specificity for the culture-based dipslide to detect and chemical dipsticks (nitrites, leukocyte esterase, or both) to screen were estimated using traditional urine culture as the "gold standard." RESULTS : A total of 3,048 eligible pregnant women were screened. The prevalence of asymptomatic bacteriuria was 15%, with Escherichia coli the most prevalent organism. The likelihood ratio for detecting asymptomatic bacteriuria with a positive dipslide test was 225 (95% confidence interval [CI] 113-449), increasing the probability of asymptomatic bacteriuria to 98%; the likelihood ratio for a negative dipslide test was 0.02 (95% CI 0.01-0.05), reducing the probability of bacteriuria to less than 1%. The positive likelihood ratio of leukocyte esterase and nitrite dipsticks (when both or either one was positive) was 6.95 (95% CI 5.80-8.33), increasing the probability of bacteriuria to only 54%; the negative likelihood ratio was 0.50 (95% CI 0.45-0.57), reducing the probability to 8%. CONCLUSION A pregnant woman with a positive dipslide test is very likely to have a definitive diagnosis of asymptomatic bacteriuria, whereas a negative result effectively rules out the presence of bacteriuria. Dipsticks that measure nitrites and leukocyte esterase have low sensitivity for use in screening for asymptomatic bacteriuria during gestation. CLINICAL TRIAL REGISTRATION ISRCTN, isrctn.org, 1196608 LEVEL OF EVIDENCE II.
Collapse
|
872
|
Baglioni P. Comment on: Urinary tract infection in hospitalized elderly patients in the United Kingdom: the importance of making an accurate diagnosis in the post broad-spectrum antibiotic era. J Antimicrob Chemother 2009; 63:846; author reply 846-7. [DOI: 10.1093/jac/dkp022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
873
|
Moura A, Nicolau A, Hooton T, Azeredo J. Antibiotherapy and pathogenesis of uncomplicated UTI: difficult relationships. J Appl Microbiol 2009; 106:1779-91. [PMID: 19210569 DOI: 10.1111/j.1365-2672.2008.04115.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
In a time when conventional antibiotics are becoming increasingly less effective for treatment of infections, the relationship between bacteria and antimicrobial resistance is becoming more and more complicated. This paper provides a current review of studies reported in the literature pertaining to the antibiotherapy of human urinary tract infections (UTI), in a way that helps the reader direct a bibliographic search and develop an integrated perspective of the subject. Highlights are given to (bio)pathogenesis of uncomplicated cystitis. Features associated with the antibiotherapy of UTI such as development of resistance are presented in the text systematically. This review discusses recent advances in the understanding of how the predominant uropathogen Escherichia coli interacts with its host and leads to infection; so one can understand some of the reasons behind antibiotherapy failures.
Collapse
Affiliation(s)
- A Moura
- IBB - Institute for Biotechnology and Bioengineering, Centre of Biological Engineering, Universidade do Minho, Campus de Gualtar, P-4710-057 Braga, Portugal
| | | | | | | |
Collapse
|
874
|
Abstract
In the long-term care setting The diagnosis of infection is primarily based from the clinical assessment. Infection is a common cause of fever, when present, and acute change in functional status. Infection can often present atypically; usual symptoms, physical findings, and diagnostic abnormalities may be lacking. Evaluation of fever and suspected infection should initially focus on the most common clinical syndromes. Treatment should initially focus on the most common organisms that are present at the most likely suspect site of infection.
Collapse
|
875
|
High KP, Bradley SF, Gravenstein S, Mehr DR, Quagliarello VJ, Richards C, Yoshikawa TT. Clinical practice guideline for the evaluation of fever and infection in older adult residents of long-term care facilities: 2008 update by the Infectious Diseases Society of America. Clin Infect Dis 2009; 48:149-71. [PMID: 19072244 DOI: 10.1086/595683] [Citation(s) in RCA: 178] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Residents of long-term care facilities (LTCFs) are at great risk for infection. Most residents are older and have multiple comorbidities that complicate recognition of infection; for example, typically defined fever is absent in more than one-half of LTCF residents with serious infection. Furthermore, LTCFs often do not have the on-site equipment or personnel to evaluate suspected infection in the fashion typically performed in acute care hospitals. In recognition of the differences between LTCFs and hospitals with regard to hosts and resources present, the Infectious Diseases Society of America first provided guidelines for evaluation of fever and infection in LTCF residents in 2000. The guideline presented here represents the second edition, updated by data generated over the intervening 8 years. It focuses on the typical elderly person institutionalized with multiple chronic comorbidities and functional disabilities (e.g., a nursing home resident). Specific topic reviews and recommendations are provided with regard to what resources are typically available to evaluate suspected infection, what symptoms and signs suggest infection in a resident of an LTCF, who should initially evaluate the resident with suspected infection, what clinical evaluation should be performed, how LTCF staff can effectively communicate about possible infection with clinicians, and what laboratory tests should be ordered. Finally, a general outline of how a suspected outbreak of a specific infectious disease should be investigated in an LTCF is provided.
Collapse
Affiliation(s)
- Kevin P High
- Section on Infectious Diseases, Wake Forest University Health Sciences, Winston Salem, 100 Medical Center Blvd., Winston Salem, NC 27157-1042, USA.
| | | | | | | | | | | | | |
Collapse
|
876
|
Prasad A, Cevallos ME, Riosa S, Darouiche RO, Trautner BW. A bacterial interference strategy for prevention of UTI in persons practicing intermittent catheterization. Spinal Cord 2009; 47:565-9. [PMID: 19139758 PMCID: PMC2705471 DOI: 10.1038/sc.2008.166] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Study Design Non-randomized pilot trial Objectives Determine whether Escherichia coli 83972-coated urinary catheters in persons with spinal cord injury (SCI) practicing an intermittent catheterization program (ICP) could (1) achieve bladder colonization with this benign organism, and (2) decrease the rate of symptomatic urinary tract infection (UTI). Setting Outpatient SCI clinic in a Veterans Affairs hospital (USA) Methods Participants had neurogenic bladders secondary to SCI, were practicing ICP, had experienced at least 1 UTI, and had documented bacteruria within the past year. All subjects received a urinary catheter that had been pre-inoculated with E. coli 83972. The catheter was left in place for 3 days then removed. Subjects were followed with urine cultures and telephone calls weekly for 28 days and then monthly until E. coli 83972 was lost from the urine. Outcome measures were (1) the rate of successful bladder colonization, defined as the detection (≥102 cfu/ml) of E. coli 83972 in urine cultures for > 3 days after catheter removal and (2) the rate of symptomatic UTI while colonized with E. coli 83972. Results Thirteen subjects underwent 19 insertions of study catheters. Eight subjects (62%) became successfully colonized for > 3 days after catheter removal. In these 8 subjects, the rate of UTI while colonized was 0.77 per patient-year, in comparison to the rate of 2.27 UTI per patient-year prior to enrollment. Conclusions E. coli 83972-coated urinary catheters are a viable means to achieve bladder colonization with this potentially protective strain in persons practicing ICP.
Collapse
Affiliation(s)
- A Prasad
- Department of Internal Medicine, New York Medical College-Westchester Medical Center, Westchester, NY, USA
| | | | | | | | | |
Collapse
|
877
|
Tratamiento empírico de las infecciones en el adulto. FMC : FORMACION MEDICA CONTINUADA EN ATENCION PRIMARIA 2009; 14:7-58. [PMID: 32288493 PMCID: PMC7144493 DOI: 10.1016/s1134-2072(07)71960-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
|
878
|
Nursing Interventions to Reduce the Risk of Catheter-Associated Urinary Tract Infection. J Wound Ostomy Continence Nurs 2009; 36:23-34. [DOI: 10.1097/01.won.0000345173.05376.3e] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
879
|
Rodhe N, Löfgren S, Strindhall J, Matussek A, Mölstad S. Cytokines in urine in elderly subjects with acute cystitis and asymptomatic bacteriuria. Scand J Prim Health Care 2009; 27:74-9. [PMID: 19247873 PMCID: PMC3410465 DOI: 10.1080/02813430902757634] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE Searching for useful diagnostic tools to discriminate between asymptomatic bacteriuria (ASB) and acute cystitis, this study compared urinary levels of cytokines/chemokines and leukocyte esterase in three groups of elderly subjects; those with acute cystitis, those with ASB, and those without bacteriuria. DESIGN Comparative laboratory. SETTING Primary care. SUBJECTS A total of 16 patients with acute cystitis, 24 subjects with ASB, and 20 controls without bacteriuria, all of whom were aged 80 or over. MAIN OUTCOME MEASURES Urinary levels of IL-1 beta, TNF-alpha, IL-12, IL-18, CXCL1 (GRO-alpha), CXCL8 (IL-8), CCL2 (MCP-1), IL-6, IL-10, and leukocyte esterase. RESULTS Urinary levels of CXCL1, CXCL8, and IL-6 were significantly higher in acute cystitis patients than in the ASB group. The sensitivities and specificities for CXCL8, IL-6, and leukocyte esterase to discriminate between acute cystitis and ASB were 63% (95% CI 36-84) and 96% (95% CI 77-100) (cut-off > 285 pg/mg creatinine), 81% (95% CI 54-95) and 96% (95% CI 77-100) (cut-off > 30 pg/mg creatinine), and 88% (95% CI 60-98) and 79% (95% CI 57-92) (cut-off > 2, on a scale of 0-4), respectively. CONCLUSIONS The results indicate that measurement of urinary cytokines, and also leukocyte esterase, when using a cut-off value > 2, could be useful in clinical practice to discriminate between symptomatic and asymptomatic urinary tract infections in the elderly. A combination of IL-6 and leukocyte esterase could be even more useful. This needs to be evaluated in prospective studies on the diagnosis and treatment of urinary tract infections in an elderly population.
Collapse
Affiliation(s)
- Nils Rodhe
- Centre for Clinical Research, Dalarna, Sweden.
| | | | | | | | | |
Collapse
|
880
|
Rodhe N, Löfgren S, Matussek A, André M, Englund L, Kühn I, Mölstad S. Asymptomatic bacteriuria in the elderly: high prevalence and high turnover of strains. ACTA ACUST UNITED AC 2008; 40:804-10. [PMID: 18609196 DOI: 10.1080/00365540802195242] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Asymptomatic bacteriuria (ASB) was followed in repeated prevalence surveys in a cohort of non-institutionalized residents (n=330), aged>or=80 y. Urine samples were collected at baseline, and at 6, and at 18 months. Phenotyping (PhenePlate) was performed on isolates of Escherichia coli to evaluate strain relatedness. ASB occurred in 19.0, 19.4, and 19.9% in women, and in 9.4, 9.6 and 7.9% in men, at baseline and at the 6- and 18-months follow-up, respectively, and ASB was found at least once in 37% of women and in 20% of men. Of those with ASB at baseline, 60% also had ASB in the 2 subsequent surveys. Among those with persisting E. coli bacteriuria, 76% and 40%, respectively, carried the same strain at the 6- and 18-months follow-ups. In women, we found that the risk of developing a symptomatic urinary tract infection within 24 months was higher among those with ASB at baseline than in those without bacteriuria (p=0.019). ASB is common and often persistent, but we found a high turnover of strains, indicating a high rate of recolonization.
Collapse
Affiliation(s)
- Nils Rodhe
- Centre for Clinical Research, Dalarna, Falun, Sweden.
| | | | | | | | | | | | | |
Collapse
|
881
|
Pigrau C, Rodríguez-Pardo MD. [Infections associated with the use of indwelling urinary catheters. Infections related to intrauterine devices]. Enferm Infecc Microbiol Clin 2008; 26:299-310. [PMID: 18479647 DOI: 10.1157/13120419] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Hospital-acquired urinary tract infections (UTI) are mainly associated with indwelling urinary catheter use. In this chapter, the pathogenesis of hospital-acquired UTI in catheterized patients, the mechanisms by which microorganisms reach the urinary tract and are able to adhere and form biofilms, and the influence of other risk factors, such as time since catheter insertion and catheter composition, are reviewed. A wide variety of infecting microorganisms can affect patients with urinary catheters, making the choice of an adequate empirical antimicrobial course complex, particularly in cases of suspected multiresistant microorganisms. Moreover, the clinical symptoms are less characteristic in catheter infection and the diagnosis may be difficult. Treatment should be stratified according to the clinical features, which can vary from asymptomatic bacteriuria that may not require treatment, to severe septic episodes that need wide antibiotic coverage. The prevention measures for UTI in permanently catheterized patients are reviewed. Infections of the female genital tract associated with foreign bodies are mainly related to the use of intrauterine devices (IUDs). The epidemiology, microbiology profile, antimicrobial treatment, and prophylaxis of pelvic inflammatory disease related to IUD use in women are also reviewed.
Collapse
Affiliation(s)
- Carlos Pigrau
- Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Barcelona, España
| | | |
Collapse
|
882
|
Abstract
Symptomatic and asymptomatic bacteriuria is common in pregnant women. A history of previous urinary tract infections and low socioeconomic status are risk factors for bacteriuria in pregnancy. Escherichia coli is the most common aetiologic agent in both symptomatic and asymptomatic infection and quantitative culture is the gold standard for diagnosis. Treatment of asymptomatic bacteriuria has been shown to reduce the rate of pyelonephritis in pregnancy and therefore screening for and treatment of asymptomatic bacteriuria has become a standard of obstetrical care. Antibiotic treatment of asymptomatic bacteriuria is associated with a decrease in the incidence of low birth weight, but the methodological quality of the studies limits the strength of the conclusions that can be drawn. Debate exists in the literature as to whether treated pyelonephritis is associated with adverse fetal outcomes. There is no clear consensus in the literature on antibiotic choice or duration of therapy for infection. With increasing antibiotic resistance, consideration of local resistance rates is necessary when choosing therapy.
Collapse
Affiliation(s)
- J Schnarr
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | | |
Collapse
|
883
|
Smith PW, Bennett G, Bradley S, Drinka P, Lautenbach E, Marx J, Mody L, Nicolle L, Stevenson K. SHEA/APIC guideline: infection prevention and control in the long-term care facility, July 2008. Infect Control Hosp Epidemiol 2008; 29:785-814. [PMID: 18767983 PMCID: PMC3319407 DOI: 10.1086/592416] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Philip W Smith
- Professor of Infectious Diseases, Colleges of Medicine and Public Health, University of Nebraska Medical Center, Omaha, Nebraska 68198-5400, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
884
|
Zabarsky TF, Sethi AK, Donskey CJ. Sustained reduction in inappropriate treatment of asymptomatic bacteriuria in a long-term care facility through an educational intervention. Am J Infect Control 2008; 36:476-80. [PMID: 18786450 DOI: 10.1016/j.ajic.2007.11.007] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2007] [Revised: 11/13/2007] [Accepted: 11/16/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND In long-term care facilities, treatment of asymptomatic bacteriuria (ASB) is common. However, randomized, controlled trials suggest that such treatment offers no benefit and may promote antimicrobial resistance. METHODS For 3 months before and 30 months after instituting an educational intervention, we monitored the appropriateness of urine culture collection and antibiotic treatment based on published guidelines and examined the effect on total antimicrobial use. The intervention included education of nursing staff to discourage the collection of urine cultures in the absence of symptoms suggestive of urinary tract infection and of primary care practitioners to not treat ASB. RESULTS In preintervention period, 23 of 38 (61%) antibiotic regimens prescribed for urinary tract indications were for ASB. In the 6 months after the intervention, inappropriate submission of urine cultures decreased from 2.6 to 0.9 per 1000 patient-days (P < .0001), overall rate of treatment of ASB was reduced from 1.7 to 0.6 per 1000 patient-days (P = .0017), and total antimicrobial days of therapy were reduced from 167.7 to 117.4 per 1000 patient-days (P < .001). These reductions were maintained for 30 months after beginning the intervention. CONCLUSION Educational interventions requiring minimal resources can result in sustained reductions in inappropriate treatment of ASB in long-term care and decreased total antimicrobial use. Education of the nursing staff regarding appropriate criteria for requesting urine cultures should be a component of such interventions.
Collapse
Affiliation(s)
- Trina F Zabarsky
- Infection Control Department, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | | |
Collapse
|
885
|
Smith PW, Bennett G, Bradley S, Drinka P, Lautenbach E, Marx J, Mody L, Nicolle L, Stevenson K. SHEA/APIC Guideline: Infection prevention and control in the long-term care facility. Am J Infect Control 2008; 36:504-35. [PMID: 18786461 PMCID: PMC3375028 DOI: 10.1016/j.ajic.2008.06.001] [Citation(s) in RCA: 135] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2007] [Revised: 05/07/2008] [Accepted: 05/19/2008] [Indexed: 01/09/2023]
Affiliation(s)
- Philip W Smith
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska 68198-5400, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
886
|
Abstract
Urinary tract infection (UTI), with its diverse clinical syndromes and affected host groups, remains one of the most common but widely misunderstood and challenging infectious diseases encountered in clinical practice. Antimicrobial resistance is a leading concern, with few oral options available to treat infections caused by Gram-negative organisms resistant to trimethoprim-sulfamethoxazole and fluoroquinolones, especially for patients with upper tract disease. Efforts should be made not to detect or treat asymptomatic bacteriuria and funguria; to ensure an appropriate duration of therapy for symptomatic infections; and to limit the use of broad-spectrum agents, especially fluoroquinolones, if narrower spectrum agents are available. Further research is needed regarding rapid diagnosis of UTI, accurate presumptive identification of patients with resistant pathogens, and development of new antimicrobials for drug-resistant UTI.
Collapse
Affiliation(s)
- Dimitri M Drekonja
- Minneapolis Veterans Affairs Medical Center, Infectious Diseases (111F), 1 Veterans Drive, Minneapolis, MN 55417, USA.
| | | |
Collapse
|
887
|
Warren JW, Brown V, Jacobs S, Horne L, Langenberg P, Greenberg P. Urinary tract infection and inflammation at onset of interstitial cystitis/painful bladder syndrome. Urology 2008; 71:1085-90. [PMID: 18538691 DOI: 10.1016/j.urology.2007.12.091] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Revised: 12/20/2007] [Accepted: 12/21/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Interstitial cystitis/painful bladder syndrome (IC/PBS) is a chronic disease primarily in women that is of low incidence and unknown etiology and manifests as bladder pain and urinary symptoms. Acute urinary tract infection (UTI) is of high incidence in women, presents as dysuria and urinary symptoms, and is caused by uropathogenic bacteria. We hypothesized that UTI is present at the onset of IC/PBS in some women. METHODS For a case-control study seeking risk factors for IC/PBS, women with IC/PBS symptoms of 12 months or less were recruited and evaluated by interview and medical record review. The date of symptom onset was identified by a six-step process. Three evidence-based methods using culture, urinalysis, and symptoms were used separately and in combination to diagnose UTI at IC/PBS onset. RESULTS Of 1177 screened women, 314 with recent-onset IC/PBS, including numerous confirming characteristics, were enrolled in the study; 98% of the requested medical records were obtained and reviewed. Evidence of a UTI at the onset of IC/PBS was found in 18% to 36% of women. Common UTI features not used in its diagnosis (short interval to medical care, hematuria, antibiotic treatment, and improvement after antibiotics) were significantly more common in those with onset UTI than in those without. CONCLUSIONS These retrospective data suggest that a proportion, probably a minority, of women at IC/PBS onset had evidence of UTI or inflammation. Our results indicate that UTI is present at the onset of IC/PBS in some women and might reveal clues to IC/PBS pathogenesis.
Collapse
Affiliation(s)
- John W Warren
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
| | | | | | | | | | | |
Collapse
|
888
|
Maternal urinary tract infections and selected cardiovascular malformations. ACTA ACUST UNITED AC 2008; 82:464-73. [DOI: 10.1002/bdra.20460] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
889
|
Abstract
Urinary tract infections are more frequent in diabetic patients than in non-diabetics, or take a more severe course. The difference is more pronounced in women both in symptomatic infections and asymptomatic bacteriuria. The spectrum of pathogens is similar to that of non-diabetic patients. In case of cystitis, the treatment strategy the same that is recommended in non-diabetic patients (due to lack of clinical trials) but because of the more frequent renal involvement a highly effective antibiotic therapy is suggested. In pyelonephritis, parenteral therapy and close observation are recommended that may require hospitalisation. The administration of doxycycline or cotrimoxazole is not recommended in empiric therapy because of the high resistance rate of E. coli , but even the choice of amoxycillin/clavulanic acid or a fluoroquinolone is questionable for empiric therapy in severe infections. At present, the most effective oral antibiotics are the 3. generation cephalosporins. Routine screening of bacteriuria is not recommended in diabetic patients, the administration of antibiotic does not prevent the further symptomatic episodes.
Collapse
Affiliation(s)
- Endre Ludwig
- Egyesített Szent István és Szent László Kórház, Semmelweis Egyetem, Altalános Orvostudományi Kar Infektológiai Tanszékcsoport Budapest Nagyvárad tér 1. 1096.
| |
Collapse
|
890
|
Urinary Tract Infections: Diagnosis and Management in the Emergency Department. Emerg Med Clin North Am 2008; 26:413-30, ix. [DOI: 10.1016/j.emc.2008.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
891
|
Petit JS, Delahaye JM, Malinovsky JM. Prise en charge périopératoire des traumatisés médullaires à la phase chronique. ACTA ACUST UNITED AC 2008; 27:416-25. [DOI: 10.1016/j.annfar.2008.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2007] [Accepted: 03/04/2008] [Indexed: 10/22/2022]
|
892
|
Shea K, Hilburger E, Baroco A, Oldfield E. Successful Treatment of Vancomycin-Resistant Enterococcus Faecium Pyelonephritis with Daptomycin During Pregnancy. Ann Pharmacother 2008; 42:722-5. [DOI: 10.1345/aph.1k561] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective: To report successful treatment using daptomycin for pyelonephritis associated with van cornycin-resistant Enterococcus faecium (VRE) in a 27-week pregnant woman. Case Summary: A 20-year-old 27-week pregnant patient with a history of spina bifida, neurogenic bladder, and multiple hospitalizations for recurrent urinary tract infections (UTIs) was diagnosed with pyelonephritis. She was treated with daptomycin 260 mg (4 mg/kg) daily for 14 days on the basis of a urine culture that revealed E. faecium resistant to ampicillin, nitrofurantoin, and vancomycin. All cultures following treatment revealed no growth, and the patient as well as the neonate displayed no adverse effects. Discussion: VRE UTIs can be treated safely in pregnancy with nitrofurantoin, if the organism is susceptible. Other viable options in the treatment of VRE, including linezolid, doxycycline, and quinupristin/dalfopristin, have lower urinary concentrations, teratogenic risk, or limited findings regarding their safety in pregnancy. Daptomycin was selected in this case due to its efficacy in the treatment of VRE, high urinary concentrations, pregnancy category B, and one case report indicating its successful use in pregnancy. Conclusions: Treatment of VRE in pregnancy can be challenging due to the teratogenicity or unknown safety of available options. The use of daptomycin in our patient enabted a successful outcome of multidrug-resistant E. faecium in a complicated pregnant patient without observed neonatal abnormalities.
Collapse
Affiliation(s)
- Katherine Shea
- Department of Pharmacy, Sentara Norfolk General Hospital,
Norfolk, VA; now, Infectious Diseases Pharmacy Resident, Department of Pharmacy,
Clarian Health Partners, Indianapolis, IN
| | - Esther Hilburger
- Clinical Pharmacy Coordinator/Internal Medicine/Infectious
Diseases Specialist, Department of Pharmacy, Sentara Careplex Hospital, Hampton,
VA
| | - Allison Baroco
- Department of Internal Medicine, Eastern Virginia Medical
School, Norfolk, VA
| | - Edward Oldfield
- Department of Medicine, Division of Infectious Diseases,
Department of Internal Medicine, Eastern Virginia Medical School
| |
Collapse
|
893
|
Monkey see, monkey do: Adhering to scientific principles*. Crit Care Med 2008; 36:1374-5. [DOI: 10.1097/ccm.0b013e31816a1044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
894
|
|
895
|
[Nosocomial urinary tract infections in the geriatric hospital - pathogen spectrum and resistancies]. Z Gerontol Geriatr 2008; 42:99-107. [PMID: 18327687 DOI: 10.1007/s00391-008-0523-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Accepted: 01/09/2008] [Indexed: 10/22/2022]
Abstract
We examined 834 isolates of urinary cultures (26 fungi and 808 isolates from 28 bacteria) in an academic geriatric teaching hospital for microbial spectrum and resistance analysis. Of the bacteria, 90% were associated to ten species. Detection rate of MRSA and ESBL was 1%, detection rate for pseudomonas aeruginosa, proteus species, coagulase negative staphylococci and klebsiella species were higher than in an university clinic (p < 0.001). Resistency rates were high for the 10 most frequent bacteria: 53.3% of cross-tabulations between bacterium and antibiotic agent (sulfamethoxazol-trimethoprim, amoxicillin-clavulanate, ciprofloxacin, moxifloxacin, cefuroxim, imipenem) showed resistency rate higher than 10%. We assume that specific factors of geriatric sample taking have an impact to our 2-year resistogram results. It is necessary to combine data analysis from comprehensive geriatric assessment and microbiological methods.
Collapse
|
896
|
Abstract
Urinary tract infections (UTI) are the most common bacterial infectious diseases seen in the community, in most cases caused by E. coli. The treatment strategy differs depending on localization (lower vs. upper UT), acute uncomplicated vs. complicated infection, as well as for chronic disease and asymptomatic bacteriuria, the known or susceptible causative uropathogen with the (local) resistance pattern and the morbidity of the patient. There is a considerable worrying increase in the resistance rate of E. coli to TMP/SMX, quinolones and others. Most patients with uncomplicated, in the community acquired UTI are treated safely and effectively as out-patients. The available data support a short-course therapy with 3 days as the current standard therapy for lower UTI, but with a 7-14 days treatment for upper and complicated UTI. Recurrent UTI is best managed by low-dose antimicrobial prophylaxis for 3-6 (12 ore more) months. Besides that, new approaches to preventive strategies must prove their value in specific patient groups.
Collapse
Affiliation(s)
- G Stein
- Klinikum der Friedrich-Schiller-Universität, Erlanger Allee 101, 07740, Jena, Germany.
| | | |
Collapse
|
897
|
Urinary tract infection in the renal transplant patient. ACTA ACUST UNITED AC 2008; 4:252-64. [PMID: 18334970 DOI: 10.1038/ncpneph0781] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2007] [Accepted: 01/30/2008] [Indexed: 11/09/2022]
Abstract
Urinary tract infection (UTI) is the most common type of bacterial infection contracted by recipients of renal allografts in the post-transplantation period. Fungi and viruses can also cause UTIs, but infections caused by these organisms are less common than those caused by bacteria. Both the lower and upper urinary tract (encompassing grafted or native kidneys) can be affected. Factors that might contribute to the development of UTIs include excessive immunosuppression, and instrumentation of the urinary tract (e.g. urethral catheters and ureteric stents). Antimicrobials are the mainstays of treatment and should be accompanied by minimization of immunosuppression when possible. The use of long-term antimicrobial prophylaxis is controversial, however, as it might increase the likelihood of infective organisms becoming resistant to treatment. There are conflicting data on the associations of post-transplantation UTI with graft and patient survival.
Collapse
|
898
|
FitzGerald M, Mueller E, Brubaker L, Dalaza L, Abraham T, Schreckenberger P. Chronic lower urinary symptoms do not predict bacteriuria. Int J Gynaecol Obstet 2008; 101:302-3. [PMID: 18289540 DOI: 10.1016/j.ijgo.2008.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2007] [Revised: 12/21/2007] [Accepted: 01/02/2008] [Indexed: 11/25/2022]
Affiliation(s)
- Mary FitzGerald
- Division of Female Pelvic Medicine and Reconstructive Surgery, Loyola University Medical Center, Maywood, IL 60153, USA.
| | | | | | | | | | | |
Collapse
|
899
|
Abstract
Health care-acquired infections present a tremendous challenge to the care of hospitalized patients. Unfortunately, the risk of acquiring a health care-associated infection (HAI) is rising. The vast majority of HAI are of four types: urinary tract infections, surgical site infections, bloodstream infections, and pneumonia. This chapter aims to provide current data and strategies relating to the prevention of HAIs among hospitalized patients.
Collapse
Affiliation(s)
- Leanne B Gasink
- Department of Medicine, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
| | | |
Collapse
|
900
|
Rice LB. The Maxwell Finland Lecture: For the Duration-- Rational Antibiotic Administration in an Era of Antimicrobial Resistance and Clostridium difficile. Clin Infect Dis 2008; 46:491-6. [DOI: 10.1086/526535] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
|