101
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Cai T. Recurrent uncomplicated urinary tract infections: definitions and risk factors. GMS INFECTIOUS DISEASES 2021; 9:Doc03. [PMID: 34113535 PMCID: PMC8167371 DOI: 10.3205/id000072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction: Recurrent uncomplicated urinary tract infections (UTI) have a high impact on patients’ quality of life and high direct and indirect costs for public health. Therefore, optimal management should be of high priority. Methods: Current international guidelines were reviewed, and a systematic literature search was performed in Medline, Cochrane, and Embase. Results: Several risks factors have been identified and used in everyday clinical practice to plan the correct strategy for recurrence prevention. Among all factors, the most important are: sexual intercourse, spermicide use, having a new sex partner, having a mother with a history of UTI, having had UTI during childhood, and asymptomatic bacteriuria treatment. Moreover, other risk factors such as reduced fluid intake, habitual and post-coital delayed urination, wiping from back to front after defecation, douching and wearing occlusive underwear, as well as irregular bowel function should be taken into account. Conclusions: Recurrent UTI show a high impact on clinical practice. Risk factors are generally related to both virulence of pathogens and patient’s behavior or condition. A recently developed nomogram can assist in identifying women at high risk of symptomatic recurrence that can be suitable candidates for a prophylactic strategy.
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Affiliation(s)
- Tommaso Cai
- Department of Urology, Santa Chiara Hospital, Trento, Italy
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102
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Vallée M, Bey E, Bouiller K, le Goux C, Pimpie R, Tourret-Arnaud J, Lina G, Figueiredo S, Chauvin A, Gavazzi G, Malavaud S, Sotto A, Bruyère F. Epidemiology and risk factors for ureteral stent-associated urinary tract infections in non-transplanted renal patients: a systematic review of the literature. World J Urol 2021; 39:3845-3860. [PMID: 33991215 DOI: 10.1007/s00345-021-03693-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 04/03/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Pathophysiology and risk factors for Ureteral Stent-Associated Urinary Tract Infection (USAUTI) have been poorly investigated. This situation results in highly diverse practices regarding USAUTI prevention, diagnosis and treatment. The aim of the present study was to describe the epidemiology and risk factors for USAUTI in non-transplanted patients. METHODS We conducted a systematic literature review based on a comprehensive PubMed® bibliographic strategy, between October 1998 and March 2020. The methodological quality of the studies included was analyzed according to dedicated grids. The main endpoints were the correlation between different potential risk factors and infection ureteral stent-associated urinary tract infection or colonization rate. Conclusions and their level of evidence were reported on the basis of a critical analysis of the best available scientific evidence. This work has been submitted to a national review, which enabled the potentially divergent opinions of experts to be collected, thereby ensuring adequate quality of data. RESULTS AND CONCLUSION Twenty-six studies out of the 505 articles identified, were included in the final analysis. Staphylococcus spp, E. coli, Klebsiella spp, Pseudomona aeruginosa, Enterococcus spp. and Candida spp. were the microorganisms most often responsible for asymptomatic bacteriuria (ABU) or USAUTI. Longer indwelling time, diabetes mellitus, female gender, chronic renal failure, diabetic nephropathy and cancer were identified as risk factors for ABU and ureteral stent colonization. No specific risk factor for UTI was identified in the literature studied. A causal relationship between ureteral stent colonization and USAUTI or urosepsis remains to be demonstrated.
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Affiliation(s)
- Maxime Vallée
- CHU La Milétrie, Service d'Urologie et de Transplantations rénales, CHU de Poitiers, 2 Rue de la Milétrie, 86021, Poitiers, France. .,Université de Poitiers INSERM U1070, "Pharmacologie Des Anti-Infectieux", UFR Médecine-Pharmacie, Pôle Biologie Sante, 1 rue Georges Bonnet, Bâtiment B36 TSA 51106, 86073, Poitiers Cedex 9, France.
| | - Elsa Bey
- Urology and Andrology Department, University Hospital of Nimes, Place du Professeur Debré, 30029, Nîmes Cedex, France
| | - Kevin Bouiller
- Service de Maladies Infectieuses, Centre Hospitalo-Universitaire de Besançon, Besançon, France
| | | | - Romain Pimpie
- Direction Générale-Hygiène Hospitalière, Hôpital Privé Dijon Bourgogne Ramsay Santé, 22 avenue Françoise Giroud, 21000, Dijon, France
| | - Jérome Tourret-Arnaud
- Département D'Urologie, Néphrologie Et Transplantation, Groupe Hospitalier Pitié Salpêtrière Charles Foix, Paris, France
| | - Gérard Lina
- Centre International de Recherche en Infectiologie, Institut Des Agent Infectieux, Hôpital de La Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Samy Figueiredo
- Service D'Anesthésie Réanimation Médecine Péri Opératoire, Hôpital Bicêtre. Assistance Publique-Hôpitaux de Paris, Université Paris Saclay, 78 Rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France
| | - Anthony Chauvin
- Service D'Accueil Des Urgences/SMUR, CHU Lariboisière, Paris, France
| | | | - Sandra Malavaud
- Unité de Prévention du Risque Infectieux Associé Aux Soins, CHU de Toulouse, France
| | - Albert Sotto
- Service Des Maladies Infectieuses Et Tropicales, CHU de Nîmes, France
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103
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Dokubo II, Reeves F, Cashman S, Gnanapragasam VJ. Rationalising the use of investigation for urinary tract infections: Analysis of 700 patients and proposal for a diagnostic algorithm. Int J Clin Pract 2021; 75:e13977. [PMID: 33369808 DOI: 10.1111/ijcp.13977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 12/21/2020] [Indexed: 11/28/2022] Open
Abstract
AIMS To evaluate the diagnostic yield of investigations performed on patients with a history of urinary tract infections (UTI). METHODS A retrospective review was conducted on patients who underwent cystoscopy and imaging for a history of UTI between 2014 and 2019 in a single UK teaching hospital. Data were collected on demographics, cystoscopy and radiological findings requiring further management. The cohort was stratified by age, gender and a confirmed history of recurrent UTI (rUTI). The subsequent algorithm was re-tested in a second cohort to validate its use. RESULTS Seven hundred patients were included in the primary analysis-427 female and 273 males. Three hundred and thirty-one met the criteria of rUTI. The median age was 64 years (18-97). Imaging abnormalities were equally frequent in men 6.3% (15/241) and women 8% (30/380) and the majority noted in patients aged ≥55 years, 30/45 (66.7%). Amongst those who did not meet the definition of rUTI, abnormal imaging was identified in 5%-7% regardless of age group and gender. Cystoscopy abnormalities (n = 24) were twice more likely in males, 5.5%(15/273) than females, 2%(9/427). About 88%(21/24) were identified in patients ≥55 years. There were no positive findings in women <55 years. Applying baseline imaging but confining cystoscopy to those aged ≥55 years and men with a confirmed history of rUTI would have saved 44% of procedures, missed no abnormalities with an overall diagnosis detection rate of 9.8% (69/700). This algorithm was validated in a separate cohort of 63 patients; applying it would have saved 46% (29/63) of cystoscopies with a positive diagnostic rate of 9.5% and no missed findings. CONCLUSION To our knowledge this is one of the largest studies reporting the outcomes of investigations for UTI and rUTI. Our result suggests that imaging is a useful baseline assessment, but cystoscopy should be limited to specific subgroups. We propose and validate a simple decision algorithm to manage investigations for referrals for UTI in secondary care.
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Affiliation(s)
- Ibifuro I Dokubo
- Department of Urology, Cambridge University Hospitals Trust, Cambridge, UK
| | - Felicity Reeves
- Department of Urology, Cambridge University Hospitals Trust, Cambridge, UK
| | - Sophia Cashman
- Department of Urology, Cambridge University Hospitals Trust, Cambridge, UK
| | - Vincent J Gnanapragasam
- Department of Urology, Cambridge University Hospitals Trust, Cambridge, UK
- Division of Urology, Department of Surgery, University of Cambridge, Cambridge, UK
- Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus, Cambridge, UK
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104
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El Taha L, Bazi T, Maalouf H, Hajjar R, Hasbini Y, El Ouweini H, Chamsy D. The clinical utility of intrapartum screening urinalysis for the prevention of postpartum pyelonephritis. Eur J Obstet Gynecol Reprod Biol 2021; 261:154-159. [PMID: 33940426 DOI: 10.1016/j.ejogrb.2021.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/18/2021] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Urinary tract infection (UTI) is the most common bacterial infection to complicate pregnancy. Medical authorities recommend screening for asymptomatic bacteriuria (ASB) in pregnancy; albeit there is no consensus on ideal timing and frequency for testing. Due to the persistent physiologic changes of pregnancy postpartum, a recent trend to perform urinalysis upon presentation for delivery has been adopted at our institution and various satellite hospitals to putatively minimize cases of postpartum pyelonephritis. The aim of this study is to examine whether routine testing with urinalysis and screening for ASB following suspicious urinalysis with treatment can decrease the incidence of postpartum pyelonephritis, and to determine whether certain urinalysis parameters are more predictive of a positive urine culture. STUDY DESIGN A retrospective chart review study of all term deliveries was conducted over two years at the American University of Beirut Medical Center, a university teaching hospital. A total of 2359 deliveries of women with no increased susceptibility to UTIs were reviewed. None had urinary symptoms upon presentation. Urinary parameters including time of urinalysis and urine culture collection with respect to time of delivery, corresponding results and mode of urine collection were correlated to intrapartum course, incidence of ASB and of postpartum pyelonephritis. RESULTS The incidence of ASB among women presenting for delivery was 4.83 %, with Escherichia coli as the most commonly detected pathogen. The presence of nitrite on urinalysis was significantly associated with a positive urine culture (p-value<0.001). Women with history of antenatal ASB or UTI were more likely to have ASB intrapartum with an odds ratio of 3.14 (95 % CI 1.71-5.75, p-value <0.001). Intrapartum urinalysis with subsequent diagnosis and treatment of ASB did not significantly affect the incidence of postpartum pyelonephritis (p-value 0.280). Similarly, intrapartum urinalysis in the setting of positive history of antenatal ASB or UTI did not increase the incidence of postpartum pyelonephritis compared to women with no such history (p-value 0.659). CONCLUSIONS Urinalysis screening intrapartum does not decrease the incidence of postpartum pyelonephritis. Universal urinalysis screening intrapartum is not warranted and should be reserved for women reporting urinary symptoms and/or women at high risk of UTI.
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Affiliation(s)
- Lina El Taha
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Tony Bazi
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hala Maalouf
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rima Hajjar
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Yasmin Hasbini
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Hala El Ouweini
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Dina Chamsy
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon.
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105
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Kranz J, Steffens J, Michels G, Schneidewind L. [Urological emergency management : Detection and treatment]. Med Klin Intensivmed Notfmed 2021; 116:361-372. [PMID: 33877428 DOI: 10.1007/s00063-021-00810-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/31/2021] [Accepted: 02/11/2021] [Indexed: 10/21/2022]
Abstract
As a result of the restructuring of emergency care provided by statutory health insurance companies and demographic change, the number of people presenting to emergency departments in hospitals is continuously increasing. A significant proportion of these emergencies concern the specialist discipline of urology. The clinical manifestations in emergency medical care range from trauma-related injuries to the urogenital tract and urinary transport disorders to hematuria and life-threatening infections. Due to the high incidence of urological tumors and the urogenital tract's affection in other malignant diseases, oncological patients are also frequently affected by urological emergencies. Fast and efficient diagnostic and therapeutic action is crucial in these situations to achieve an optimal treatment result.
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Affiliation(s)
- Jennifer Kranz
- Klinik für Urologie und Kinderurologie, St.-Antonius Hospital gGmbH, Akademisches Lehrkrankenhaus der RWTH Aachen, Dechant-Deckers-Str. 8, 52249, Eschweiler, Deutschland. .,Universitätsklinik und Poliklinik für Urologie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland.
| | - Joachim Steffens
- Klinik für Urologie und Kinderurologie, St.-Antonius Hospital gGmbH, Akademisches Lehrkrankenhaus der RWTH Aachen, Dechant-Deckers-Str. 8, 52249, Eschweiler, Deutschland
| | - Guido Michels
- Klinik für Akut- und Notfallmedizin, St.-Antonius-Hospital gGmbH, Eschweiler, Deutschland
| | - Laila Schneidewind
- Urologische Klinik und Poliklinik, Universitätsmedizin Rostock, Rostock, Deutschland
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106
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Rodríguez-Pardo D, Del Toro MD, Guío-Carrión L, Escudero-Sánchez R, Fernández-Sampedro M, García-Viejo MÁ, Velasco-Arribas M, Soldevila-Boixader L, Femenias M, Iribarren JA, Pulido-Garcia MDC, Navarro MD, Lung M, Corona PS, Almirante B, Pigrau C. Role of asymptomatic bacteriuria on early periprosthetic joint infection after hip hemiarthroplasty. BARIFER randomized clinical trial. Eur J Clin Microbiol Infect Dis 2021; 40:2411-2419. [PMID: 33864153 DOI: 10.1007/s10096-021-04241-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/30/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE To evaluate preoperative asymptomatic bacteriuria (ASB) treatment to reduce early-periprosthetic joint infections (early-PJIs) after hip hemiarthroplasty (HHA) for fracture. METHODS Open-label, multicenter RCT comparing fosfomycin-trometamol versus no intervention with a parallel follow-up cohort without ASB. PRIMARY OUTCOME early-PJI after HHA. RESULTS Five hundred ninety-four patients enrolled (mean age 84.3); 152(25%) with ASB (77 treated with fosfomycin-trometamol/75 controls) and 442(75%) without. Despite the study closed without the intended sample size, ASB was not predictive of early-PJI (OR: 1.06 [95%CI: 0.33-3.38]), and its treatment did not modify early-PJI incidence (OR: 1.03 [95%CI: 0.15-7.10]). CONCLUSIONS Neither preoperative ASB nor its treatment appears to be risk factors of early-PJI after HHA. ClinicalTrials.gov Identifier: Eudra CT 2016-001108-47.
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Affiliation(s)
- Dolors Rodríguez-Pardo
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain. .,Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain. .,Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.
| | - María Dolores Del Toro
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Infectious Diseases Unit, Hospital Universitario Virgen Macarena, Departamento de Medicina, Universidad de Sevilla, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Laura Guío-Carrión
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Infectious Diseases Department, Hospital Universitario Cruces, Barakaldo, Vizcaya, Spain
| | - Rosa Escudero-Sánchez
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Marta Fernández-Sampedro
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Infectious Diseases Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Miguel Ángel García-Viejo
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Internal Medicine Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - María Velasco-Arribas
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Internal Medicine Department (Infectious Diseases Division), Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Laura Soldevila-Boixader
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Infectious Diseases Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Magdalena Femenias
- Orthopedic Surgery Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - José Antonio Iribarren
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Infectious Diseases Department, Hospital Universitario Donostia IIS Biodonostia, San Sebastián, Spain
| | | | - María Dolores Navarro
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Infectious Diseases Unit, Hospital Universitario Virgen Macarena, Departamento de Medicina, Universidad de Sevilla, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Mayli Lung
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Microbiology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Pablo S Corona
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Septic and Reconstructive Surgery Unit, Orthopedic Surgery Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Benito Almirante
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain
| | - Carles Pigrau
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain
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107
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Chambers A, Chen C, Brown KA, Daneman N, Langford B, Leung V, Adomako K, Schwartz KL, Moore JE, Quirk J, MacFarlane S, Cronsberry T, Garber GE. Virtual learning collaboratives to improve urine culturing and antibiotic prescribing in long-term care: controlled before-and-after study. BMJ Qual Saf 2021; 31:94-104. [PMID: 33853868 PMCID: PMC8785008 DOI: 10.1136/bmjqs-2020-012226] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 03/16/2021] [Accepted: 04/05/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Urine culturing practices are highly variable in long-term care and contribute to overprescribing of antibiotics for presumed urinary tract infections. The purpose of this study was to evaluate the use of virtual learning collaboratives to support long-term care homes in implementing a quality improvement programme focused on reducing unnecessary urine culturing and antibiotic overprescribing. METHODS Over a 4-month period (May 2018-August 2018), 45 long-term care homes were self-selected from five regions to participate in virtual learning collaborative sessions, which provided an orientation to a quality improvement programme and guidance for implementation. A process evaluation complemented the use of a controlled before-and-after study with a propensity score matched control group (n=127) and a difference-in-difference analysis. Primary outcomes included rates of urine cultures performed and urinary antibiotic prescriptions. Secondary outcomes included rates of emergency department visits, hospital admission and mortality. An 18-month baseline period was compared with a 16-month postimplementation period with the use of administrative data sources. RESULTS Rates of urine culturing and urinary antibiotic prescriptions per 1000 resident days decreased significantly more among long-term care homes that participated in learning collaboratives compared with matched controls (differential reductions of 19% and 13%, respectively, p<0.0001). There was no statistically significant changes to rates of emergency department visits, hospital admissions or mortality. These outcomes were observed with moderate adherence to the programme model. CONCLUSIONS Rates of urine culturing and urinary antibiotic prescriptions declined among long-term care homes that participated in a virtual learning collaborative to support implementation of a quality improvement programme. The results of this study have refined a model to scale this programme in long-term care.
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Affiliation(s)
| | - Cynthia Chen
- Public Health Ontario, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Kevin Antoine Brown
- Public Health Ontario, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Nick Daneman
- Public Health Ontario, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | | | | | - Kevin L Schwartz
- Public Health Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | - Gary E Garber
- Public Health Ontario, Toronto, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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108
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Kyono Y, Endo F, Shimbo M, Ohwaki K, Hattori K. Positive urine culture under indwelling urethral catheterization is a risk factor for febrile complications after holmium laser enucleation of the prostate (HoLEP). Low Urin Tract Symptoms 2021; 13:377-382. [PMID: 33847442 DOI: 10.1111/luts.12380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/16/2021] [Accepted: 03/22/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To investigate the incidence of and risk factors for febrile complications (FCs) in patients undergoing holmium laser enucleation of the prostate (HoLEP). METHODS This retrospective study enrolled 847 consecutive patients who underwent HoLEP in our hospital from June 2006 to December 2018. FCs were defined as a body temperature ≥38.0°C within 30 days after surgery. The incidence of FCs was determined and possible risk factors assessed using multivariate logistic regression analysis. RESULTS Overall, 87 (10.3%) patients presented with FCs, and 6 (0.7%) had urosepsis, with no fatal complications. Multivariate logistic regression analysis revealed that patients with preoperative positive urine culture and urethral catheterization had an increased risk of FCs compared with those with a negative culture who did not need catheterization (odds ratio [OR] 2.587, 95% confidence interval [CI] 1.307-5.121). A negative urine culture with catheterization and a positive culture without catheterization were not associated with the development of FCs (OR 0.320, 95% CI 0.040-2.553 and OR 1.370, 95% CI 0.662-2.365, respectively). Other significant risk factors included preoperative serum albumin levels (OR 0.382, 95% CI 0.173-0.846) and immediate postoperative body temperature (OR 2.559, 95% CI 1.549-4.230). CONCLUSIONS FCs are relatively common among patients after HoLEP despite preoperative prophylactic antibiotic administration. Surgeons may need to consider performing screening of urine cultures prior to HoLEP, especially in patients with urethral catheterization, even if asymptomatic. If the culture is positive, prophylactic antibiotics should be tailored according to bacterial susceptibility.
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Affiliation(s)
- Yoko Kyono
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Fumiyasu Endo
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Masaki Shimbo
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Kazuhiro Ohwaki
- Teikyo University Graduate School of Public Health, Tokyo, Japan
| | - Kazunori Hattori
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
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109
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Dexter J, Mortimore G. The management of urinary tract infections in older patients within an urgent care out-of-hours setting. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2021; 30:334-342. [PMID: 33769881 DOI: 10.12968/bjon.2021.30.6.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This article critically analyses the prevalence, assessment and management of urinary tract infections (UTIs) in patients over the age of 65, in an urgent care out-of-hours service in order to enhance care. It is undertaken from the perspective of working as an Advanced Nurse Practitioner (ANP). A synopsis of UTI is presented, examining the epidemiology and aetiology. The process of assessment, diagnosis and management of UTI in older people is appraised based on current evidence. Difficulties associated with the recognition of UTI in elderly are evaluated. Finally, recommendations are made for the improvement of future practice as an ANP.
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Affiliation(s)
- Justine Dexter
- Advanced Nurse Practitioner, Urgent Care, South Derbyshire, DHU Health Care
| | - Gerri Mortimore
- Senior Lecturer in Advanced Practice, Department of Health and Social Care, University of Derby
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110
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Çetin Z, Mercan R, Karaşahin Ö, Tufan A, Öztürk MA. Evaluation of Asymptomatic Bacteriuria and Urinary Tract Infection in Patients With Primary Sjögren's Syndrome. Arch Rheumatol 2021; 35:592-599. [PMID: 33758816 PMCID: PMC7945699 DOI: 10.46497/archrheumatol.2020.7427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 12/24/2019] [Indexed: 11/03/2022] Open
Abstract
Objectives This study aims to determine the frequency and risk factors of bacteriuria and urinary tract infection (UTI) in patients with primary Sjögren's syndrome (SS) and their differences from healthy individuals and rheumatoid arthritis (RA) patients. Patients and methods The study included 107 female primary SS patients (mean age 50.7±11.6 years; range, 23 to 76 years), 53 healthy female control subjects (mean age 46.8±15.5 years; range 21 to 80 years), and 40 females with RA (mean age 51.7±14.2 years; range, 25 to 79 years). Participants were questioned for UTI risk factors and symptoms. Middle stream urine samples were taken and cultured. All participants were examined with urinary symptom questioning survey of American Urological Association (AUA-7). Results The urine cultures were positive in 18 primary SS patients (16.8%), eight RA patients (20%), and two healthy controls (3.7%). Escherichia coli, enterococci, Klebsiella, streptococci, and candida were detected in SS patients' cultures. Extended-spectrum beta-lactamase was positive in three cultures. Asymptomatic bacteriuria was not detected in any SS patient. The highest AUA-7 score was determined in SS group (p=0.031). Nineteen SS patients had vaginal dryness symptom and their AUA-7 scores were higher than the rest of the SS group. The risk of UTI development was not different between those who had or did not have vaginal dryness. Conclusion Urinary tract infections are seen more often in SS patients rather than normal population, which may be caused by SS' urinary system effects. It is difficult to distinguish between asymptomatic bacteriuria and infection because of the underlying urinary symptoms. Clinicians must be careful in patients receiving immunosuppressive therapy due to the high frequency of UTIs.
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Affiliation(s)
- Zeynep Çetin
- Department of Endocrinology and Metabolism, Amasya University Sabuncuoğlu Şerefeddin Training and Research Hospital, Amasya, Turkey
| | - Rıdvan Mercan
- Department of Internal Medicine, Division of Rheumatology, Namık Kemal University Medical Faculty Hospital, Tekirdağ, Turkey
| | - Ömer Karaşahin
- Department of Clinical Bacteriology and Infection Diseases, Erzurum District Training and Research Hospital, Erzurum, Turkey
| | - Abdurrahman Tufan
- Department of Internal Medicine, Division of Rheumatology, Gazi University Medical Faculty Hospital, Ankara, Turkey
| | - Mehmet Akif Öztürk
- Department of Internal Medicine, Division of Rheumatology, Gazi University Medical Faculty Hospital, Ankara, Turkey
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111
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Atypical Presentation of Bacteremic Urinary Tract Infection in Older Patients: Frequency and Prognostic Impact. Diagnostics (Basel) 2021; 11:diagnostics11030523. [PMID: 33804271 PMCID: PMC8001488 DOI: 10.3390/diagnostics11030523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 11/17/2022] Open
Abstract
In older patients, urinary tract infection (UTI) often has an atypical clinical presentation, making its diagnosis difficult. We aimed to describe the clinical presentation in older inpatients with UTI-related bacteremia and to determine the prognostic impact of atypical presentation. This cohort study included all consecutive patients older than 75 years hospitalized in a university hospital in 2019 with a UTI-related gram-negative bacillus (GNB) bacteremia, defined by blood and urine cultures positive for the same GNB, and followed up for 90 days. Patients with typical symptoms of UTI were compared to patients with atypical forms. Among 3865 inpatients over 75 with GNB-positive urine culture over the inclusion period, 105 patients (2.7%) with bacteremic UTI were included (mean age 85.3 ± 5.9, 61.9% female). Among them, UTI symptoms were reported in only 38 patients (36.2%) and 44 patients (41.9%) had no fever on initial management. Initial diagnosis of UTI was made in only 58% of patient. Mortality at 90 days was 23.6%. After adjustment for confounders, hyperthermia (HR = 0.37; IC95 (0.14–0.97)) and early UTI diagnosis (HR = 0.35; IC95 (0.13–0.94)) were associated with lower mortality, while UTI symptoms were not associated with prognosis. In conclusion, only one third of older patients with UTI developing bacteremia had UTI symptoms. However, early UTI diagnosis was associated with better survival.
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112
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Rosado-Canto R, Parra-Avila I, Tejeda-Maldonado J, Kauffman-Ortega C, Rodriguez-Covarrubias FT, Trujeque-Matos M, Cruz-Martínez R, Maravilla-Franco E, Criollo-Mora E, Arreola-Guerra JM, Morales-Buenrostro LE, Sifuentes-Osornio J. Perioperative fosfomycin disodium prophylaxis against urinary tract infection in renal transplant recipients: a randomized clinical trial. Nephrol Dial Transplant 2021; 35:1996-2003. [PMID: 31883327 PMCID: PMC7643671 DOI: 10.1093/ndt/gfz261] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/28/2019] [Indexed: 12/17/2022] Open
Abstract
Background Symptomatic urinary tract infection (UTI) is the most common infectious complication in renal transplant recipients (RTRs). Fosfomycin (FOS) is an attractive alternative for prophylaxis because it does not interact with immunosuppressants; although 90% is excreted unchanged in the urine, it does not require adjustment for renal function for single dose prophylaxis. Methods RTRs were recruited into this randomized, double-blind, placebo-controlled trial. Participants were randomized (1:1) to receive one 4 g dose of FOS disodium intravenously 3 h (FOS group) or placebo (placebo group) before placement and removal of a urinary catheter and before removal of a double-J ureteral stent. All participants received prophylaxis with trimethoprim/sulfamethoxazole. The main outcome was a comparison of the mean number of symptomatic UTI and asymptomatic bacteriuria (AB) episodes per patient during a 7-week follow-up period. The study was registered at ClinicalTrials.gov, NTC03235947. Results Eighty-two participants were included (41 in the FOS group and 41 in placebo group). The mean number of AB or symptomatic UTI episodes per patient was lower in the FOS group [intention-to-treat (ITT) 0.29 versus 0.60, P = 0.04]. The incidence of symptomatic UTI was lower in the FOS group (ITT, 7.3% versus 36.6%, P = 0.001), and there was no difference in the incidence of AB between both groups. The incidence of adverse events was similar in both groups. Conclusions FOS addition is an effective and safe strategy to reduce the number of symptomatic UTIs during the first 7 weeks after renal transplant.
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Affiliation(s)
- Rodrigo Rosado-Canto
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, México
| | - Idalia Parra-Avila
- Department of Nephrology-Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, México
| | - Javier Tejeda-Maldonado
- Department of Nephrology-Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, México
| | - Cristopher Kauffman-Ortega
- Department of Urology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, México
| | | | - Mariedel Trujeque-Matos
- Department of Nephrology-Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, México
| | - Rodrigo Cruz-Martínez
- Department of Transplantation, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, México
| | - Ernesto Maravilla-Franco
- Laboratory of Clinical Microbiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, México
| | - Elia Criollo-Mora
- Department of Pharmacy, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, México
| | - José M Arreola-Guerra
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, México
| | - Luis E Morales-Buenrostro
- Department of Nephrology-Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, México
| | - José Sifuentes-Osornio
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, México
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Fathi A, Hennigs A, Addo MM. [Less is more… in infectious diseases]. Internist (Berl) 2021; 62:373-378. [PMID: 33580310 DOI: 10.1007/s00108-021-00967-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The increasing development of antimicrobial resistance has been identified as one of the greatest threats to public health and is caused to a relevant extent by falsely indicated antibiotic treatment. OBJECTIVE The main aim of this article is to identify areas in infectious disease diagnostics and treatment where overuse occurs and to provide recommendations on how to avoid it. MATERIAL AND METHODS The authors identified current and relevant studies on the topic of medical overuse in infectious diseases via a literature search. In particular, contributions from international "less is more" initiatives were included. The focus was on areas in which a reduction of diagnostic and therapeutic measures leads to an optimization of patient outcomes. RESULTS In many cases overuse in the context of diagnostics and treatment of infectious diseases not only leads to an unnecessary financial burden on the healthcare system and is not beneficial but can also increase the risk of development of antimicrobial resistance and have adverse consequences for patients. CONCLUSION Correct indications as well as focused selection and adequate application of antimicrobial agents is crucial to provide the best possible medical care. Diagnostic and antibiotic stewardship measures, which should be implemented in collaboration with infectious disease specialists, can help to identify and reduce areas of overuse and misuse.
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Affiliation(s)
- A Fathi
- Medizinische Klinik und Poliklinik, Sektion Infektiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
| | - A Hennigs
- Medizinische Klinik und Poliklinik, Sektion Infektiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - M M Addo
- Medizinische Klinik und Poliklinik, Sektion Infektiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
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Liu L, Jian Z, Li H, Wang K. Antibiotic prophylaxis after extraction of urinary catheter prevents urinary tract infections: A systematic review and meta-analysis. Am J Infect Control 2021; 49:247-254. [PMID: 32763348 DOI: 10.1016/j.ajic.2020.07.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate the effect of antibiotic prophylaxis for consequent urinary tract infections (UTIs) after extraction of urinary catheter and further explore the association between the outcome and clinical characteristics of patients. METHODS We systematically searched PubMed, Cochrane Library, EMBASE, and ClinicalTrials.gov databases through March 2020. Studies were included if they inquired into antibiotic prophylaxis for UTIs after extraction of a temporary (≤14 days) urinary catheter. We used fixed-effect models to obtain pooled risk ratio (RR) estimates. Heterogeneity was evaluated with I2 value. Sensitivity analysis and subgroup analysis were also conducted to assess heterogeneity. RESULTS We finally included 8 randomized controlled trials in our study. Only 2 studies showed that antibiotic prophylaxis can reduce the consequent UTIs after extraction of urinary catheters while 6 did not. Overall, antibiotic prophylaxis was associated with reduced UTIs (RR, 0.47, 95% confidence interval [CI] 0.28-0.72, P< .01, I2 = 31%). Subgroup analysis indicated that patients who are older than 60 (RR = 0.50, 95% CI: 0.33-0.76, P< .05, I2 = 29%) or received Trimethoprim/sulfamethoxazole (TMP/SMX; RR = 0.21, 95% CI: 0.09-0.48, P< .01, I2 = 0%) or indwelling catheters for more than 5 days (RR = 0.34, 95% CI: 0.19-0.63, P< .01, I2 = 0%) could get more benefit from antibiotic prophylaxis after extraction of catheters. CONCLUSIONS Patients with catheters removed might get benefit from antibiotic prophylaxis as a result of fewer consequent UTIs, and those who have advanced age (over 60 years old) or long-term catheterization (over 5 days) could get more benefit from prophylaxis. And TMP/SMX could be a good choice of prophylaxis for UTIs after extraction of urinary catheters. This approach should apply to high-risk patients (advanced age or long-term catheterization) due to the potential harm of widespread antibacterial agents such as side effects and bacterial resistance.
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Affiliation(s)
- Linhu Liu
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Zhongyu Jian
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Hong Li
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Kunjie Wang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.
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115
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Diagnostic stewardship programme for urine culture: impact on antimicrobial prescription in a multi-centre cohort. J Hosp Infect 2021; 108:81-89. [DOI: 10.1016/j.jhin.2020.10.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/23/2020] [Accepted: 10/23/2020] [Indexed: 11/20/2022]
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116
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Tinoco-Najera A, Steiner JM, Suchodolski JS, Lidbury JA. Risk factors for urinary bacterial growth in dogs with congenital portosystemic shunts: 66 cases (1997-2019). J Small Anim Pract 2021; 62:359-364. [PMID: 33491792 DOI: 10.1111/jsap.13294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To identify risk factors for urinary bacterial growth in dogs with confirmed congenital portosystemic shunts on which a quantitative urine culture was performed. MATERIALS AND METHODS Sixty-six dogs were included in this retrospective cross-sectional study. Medical records were reviewed from 1997 through 2019. Variables of interest included age, sex and sexual status, clinical signs for a urinary tract infection, blood urea concentration, urinalysis abnormalities, ultrasound abnormalities of the urinary tract, and previous treatment. Univariable and multivariable analyses were performed. RESULTS The median age of the dogs was one year (range: 0.2-11.0 years). Urinary tract ultrasound abnormalities (cystic calculi and cystic debris) were reported in 50 dogs (75.7%). Abnormalities on urinalysis included pyuria in nine dogs (13.6%), bacteriuria in 13 dogs (19.7%), and haematuria in 26 dogs (39.4%). The median urine specific gravity was 1.021 (range: 1.004-1.052). Sixteen dogs (24.2%) had a positive quantitative urine culture. Based on multivariable analysis, bacteriuria (Odds ratio, 116; 95% CI, 9.6-1393; P = < 0.001) was the only variable significantly associated with a significantly increased odds for a positive quantitative urine culture. CLINICAL SIGNIFICANCE Clinical and subclinical bacteriuria can occur in dogs with congenital portosystemic shunts. In this group of dogs, bacteriuria was a risk factor for urinary bacterial growth.
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Affiliation(s)
- A Tinoco-Najera
- Gastrointestinal Laboratory, Texas A&M University, College Station, Texas, 77843-4474, USA
| | - J M Steiner
- Gastrointestinal Laboratory, Texas A&M University, College Station, Texas, 77843-4474, USA
| | - J S Suchodolski
- Gastrointestinal Laboratory, Texas A&M University, College Station, Texas, 77843-4474, USA
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Itami Y, Miyake M, Owari T, Iwamoto T, Gotoh D, Momose H, Fujimoto K, Hirao S. Optimal timing of ureteroscopic lithotripsy after the initial drainage treatment and risk factors for postoperative febrile urinary tract infection in patients with obstructive pyelonephritis: a retrospective study. BMC Urol 2021; 21:10. [PMID: 33451332 PMCID: PMC7811216 DOI: 10.1186/s12894-020-00754-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/30/2020] [Indexed: 11/17/2022] Open
Abstract
Background A history of preoperative obstructive pyelonephritis has been reported as a risk factor for febrile urinary tract infection (fUTI) after ureteroscopic lithotripsy (URSL). But there is no clear evidence of risk factors for developing fUTI including the optimal timing of URSL after obstructive pyelonephritis treatment. Methods Of the 1361 patients, who underwent URSL at our hospital from January 2011 to December 2017, 239 patients had a history of pre-URSL obstructive pyelonephritis. The risk factors were analyzed by comparing the patients’ backgrounds with the presence or absence of fUTI after URSL. The factors examined were age, gender, body mass index, comorbidity, presence or absence of preoperative ureteral stent, stone position, stone laterality, stone size, Hounsfield unit (HU) value on computed tomography scan, history of sepsis during obstructive pyelonephritis, period from antipyresis to URSL, ureteral stenting period, operation time, and presence or absence of access sheath at URSL. In addition, the stone components and renal pelvic urinary culture bacterial species during pre-URSL pyelonephritis were also examined. Results Post-URSL fUTI developed in 32 of 239 patients (13.4%), and 11 of these 32 cases led to sepsis (34.4%). Univariate analysis showed that stone position, stone maximum HU value, presence of sepsis during obstructive pyelonephritis, period from antipyresis to URSL, pre-URSL ureteral stent placement, operation time were risk factors of fUTI. Stone components and urinary cultures during pyelonephritis were not associated with risk of fUTI. Multivariate analysis showed that renal stone position, pre-URSL ureteral stent placement > 21 days, and operation time > 75 min were independent risk factors of fUTI following the URSL. Conclusions F-UTI following the URSL could be avoided by ureteral stent placement period 21 days or less and operation time 75 min or less in patients with obstructive pyelonephritis.
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Affiliation(s)
- Yoshitaka Itami
- Department of Urology, Hirao Hospital, 6-28 Hyobu-cho, Kashihara, Nara, 634-0076, Japan.,Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Takuya Owari
- Department of Urology, Hirao Hospital, 6-28 Hyobu-cho, Kashihara, Nara, 634-0076, Japan.,Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Takashi Iwamoto
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Daisuke Gotoh
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Hitoshi Momose
- Department of Urology, Hirao Hospital, 6-28 Hyobu-cho, Kashihara, Nara, 634-0076, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Shuya Hirao
- Department of Urology, Hirao Hospital, 6-28 Hyobu-cho, Kashihara, Nara, 634-0076, Japan
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Jindai K, Kusama Y, Gu Y, Honda H, Ohmagari N. Narrative Review: The Process of Expanding the Manual of Antimicrobial Stewardship by the Government of Japan. Intern Med 2021; 60:181-190. [PMID: 32713913 PMCID: PMC7872805 DOI: 10.2169/internalmedicine.4760-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/03/2020] [Indexed: 12/11/2022] Open
Abstract
The Ministry of Health, Labour and Welfare has published the Manual of Antimicrobial Stewardship (1st edition) in June 2017 to improve the prescribing practice of antimicrobials for immunocompetent adult and pediatric (both school-aged and older children) patients. Due to the increasing demand for further promoting outpatient antimicrobial stewardship, we conducted a literature and national guideline review to identify the area of need. The results of our review revealed a high antimicrobial prescription rate in the Japanese pediatric population. Furthermore, although the Japanese clinical guidelines/guidance covered the fields of almost all infectious diseases, no system exists to estimate the incidence and treatment patterns of important infectious diseases such as asymptomatic bacteriuria, skin and soft tissue infections, and dental practices in Japan. Therefore, addressing the issues of both establishing surveillance systems and the implementation of guidelines/guidance can be the next step to promote further outpatient antimicrobial stewardship.
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Affiliation(s)
- Kazuaki Jindai
- Department of Healthcare Epidemiology, School of Public Health, Kyoto University, Japan
| | - Yoshiki Kusama
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Japan
| | - Yoshiaki Gu
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Japan
| | - Hitoshi Honda
- Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Japan
| | - Norio Ohmagari
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Japan
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Brown KA, Daneman N, Schwartz KL, Langford B, McGeer A, Quirk J, Diong C, Garber G. The Urine-culturing Cascade: Variation in Nursing Home Urine Culturing and Association With Antibiotic Use and Clostridiodes difficile Infection. Clin Infect Dis 2021; 70:1620-1627. [PMID: 31197362 DOI: 10.1093/cid/ciz482] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/13/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Rates of antibiotic use vary widely across nursing homes and cannot be explained by resident characteristics. Antibiotic prescribing for a presumed urinary tract infection is often preceded by inappropriate urine culturing. We examined nursing home urine-culturing practices and their association with antibiotic use. METHODS We conducted a longitudinal, multilevel, retrospective cohort study based on quarterly nursing home assessments between April 2014 and January 2017 in 591 nursing homes and covering >90% of nursing home residents in Ontario, Canada. Nursing home urine culturing was measured as the proportion of residents with a urine culture in the prior 14 days. Outcomes included receipt of any systemic antibiotic and any urinary antibiotic (eg, nitrofurantoin, trimethoprim/sulfonamides, ciprofloxacin) in the 30 days after the assessment and Clostridiodes difficile infection in the 90 days after the assessment. Adjusted Poisson regression models accounted for 14 resident covariates. RESULTS A total of 131 218 residents in 591 nursing homes were included; 7.9% of resident assessments had a urine culture in the prior 14 days; this proportion was highly variable across the 591 nursing homes (10th percentile = 3.4%, 90th percentile = 14.3%). Before and after adjusting for 14 resident characteristics, nursing home urine culturing predicted total antibiotic use (adjusted risk ratio [RR] per doubling of urine culturing, 1.21; 95% confidence interval [CI], 1.18-1.23), urinary antibiotic use (RR, 1.33; 95% CI, 1.28-1.38), and C. difficile infection (incidence rate ratio, 1.18; 95% CI, 1.07-1.31). CONCLUSIONS Nursing homes have highly divergent urine culturing rates; this variability is associated with higher antibiotic use and rates of C. difficile infection.
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Affiliation(s)
- Kevin Antoine Brown
- Public Health Ontario, Canada.,Institute for Clinical Evaluative Sciences, Canada.,Dalla Lana School of Public Health, University of Toronto, Canada
| | - Nick Daneman
- Public Health Ontario, Canada.,Institute for Clinical Evaluative Sciences, Canada.,Sunnybrook Research Institute, Division of Infectious Diseases, Canada.,The Institute for Health Policy, Management, and Evaluation, University of Toronto, Canada
| | - Kevin L Schwartz
- Public Health Ontario, Canada.,Institute for Clinical Evaluative Sciences, Canada.,Dalla Lana School of Public Health, University of Toronto, Canada.,St Joseph's Health Centre, Canada
| | | | - Allison McGeer
- Dalla Lana School of Public Health, University of Toronto, Canada.,Mount Sinai Hospital, Toronto, Canada
| | | | | | - Gary Garber
- Public Health Ontario, Canada.,Ottawa Research Institute, Canada
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Scott C, Arora G, Dickson K, Lehmann C. Iron Chelation in Local Infection. Molecules 2021; 26:molecules26010189. [PMID: 33401708 PMCID: PMC7794793 DOI: 10.3390/molecules26010189] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 12/16/2022] Open
Abstract
Iron is an essential element in multiple biochemical pathways in humans and pathogens. As part of the innate immune response in local infection, iron availability is restricted locally in order to reduce overproduction of reactive oxygen species by the host and to attenuate bacterial growth. This physiological regulation represents the rationale for the therapeutic use of iron chelators to support induced iron deprivation and to treat infections. In this review paper we discuss the importance of iron regulation through examples of local infection and the potential of iron chelation in treating infection.
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Affiliation(s)
- Cassidy Scott
- Department of Anesthesia Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS B3H4H7, Canada; (G.A.); (K.D.); (C.L.)
- Department of Pharmacology, Dalhousie University, Halifax, NS B3H4H7, Canada
- Correspondence: ; Tel.: +1-(902)-494-1287
| | - Gaurav Arora
- Department of Anesthesia Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS B3H4H7, Canada; (G.A.); (K.D.); (C.L.)
- Department of Medicine, Dalhousie University, Halifax, NS B3H4R2, Canada
| | - Kayle Dickson
- Department of Anesthesia Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS B3H4H7, Canada; (G.A.); (K.D.); (C.L.)
- Department of Microbiology and Immunology, Dalhousie University, Halifax, NS B3H4H7, Canada
| | - Christian Lehmann
- Department of Anesthesia Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS B3H4H7, Canada; (G.A.); (K.D.); (C.L.)
- Department of Pharmacology, Dalhousie University, Halifax, NS B3H4H7, Canada
- Department of Medicine, Dalhousie University, Halifax, NS B3H4R2, Canada
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Maternal and Microorganism Characteristics Cannot Predict Adverse Outcome in Pregnancies Complicated With Urinary Tract Infection. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2021. [DOI: 10.1097/ipc.0000000000000900] [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]
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Alavudeen SS, Asiri AA, Fageeh SA, Aljarie AA, Iqbal MJ, Khan NA, Tabassum F, Rahamathulla M, Hani U, Akhtar MS. Evaluation of Antibiotic Prescribing Practices and Antimicrobial Sensitivity Patterns in Urinary Tract Related Infectious Diseases in Pediatric Patients. Front Pediatr 2021; 9:740106. [PMID: 35004535 PMCID: PMC8734635 DOI: 10.3389/fped.2021.740106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Complications of urinary tract infections (UTIs) like kidney failure and septicaemia develop once infections spread from the upper urinary tract to other parts of the body by haematogenous dissemination and they pose great health and economic burden to the countries. This retrospective study was conducted among 132 patients with bacterial UTIs in the inpatient department of tertiary care hospital in Abha, Saudi Arabia. During the study period, Escherichia coli (E. coli) and Klebsiella pneumonia (K. pneumonia) along with other 15 different bacteria were isolated. A significant difference (P < 0.05) was observed between the male and female children population in different age groups. We observed fever (84.09%) as a major symptom (P < 0.05), and seizure (9%) was reported as a major concomitant condition among UTI cases. Around 31.82% of E. coli was found to be the most common uropathogens in pediatric cases followed by 25% in K. pneumoniae. E. coli was observed to be more susceptible (92.86%) to amikacin, ceftriaxone, levofloxacin, ertapenem, gentamycin, meropenem, piperacillin-tazobactam, tigecycline, and ceftazidime. However, meropenem, tigecycline, and amikacin were observed to be effective in 100% of cases of K. pneumoniae. Meanwhile, cephalosporins were the most commonly prescribed drug category among different classes of drugs. Almost 99% of pediatric cases, based on their age, were admitted to the ward, and drugs were administered intravenously. We concluded that microbiology laboratory evidence on the causative organisms and choice of treatment together allows tailoring appropriate treatment regimens in conjunction with clinical experiences.
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Affiliation(s)
- Sirajudeen S Alavudeen
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Anas Ali Asiri
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | | | - Ahmed Abdoh Aljarie
- Department of Paediatrics, Pediatric Infectious Diseases, Abha Maternity and Children Hospital, Abha, Saudi Arabia
| | - Mir Javid Iqbal
- Department of Pharmaceutical Sciences, Northeastern University, Boston, MA, United States
| | - Noohu Abdulla Khan
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Fauzia Tabassum
- Department of Pharmacology, Santosh Medical College and Hospital, Ghaziabad, India
| | - Mohamed Rahamathulla
- Department of Pharmaceutics, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Umme Hani
- Department of Pharmaceutics, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Md Sayeed Akhtar
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
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Laway BA, Nabi T, Bhat MH, Fomda BA. Prevalence, clinical profile and follow up of asymptomatic bacteriuria in patients with type 2 diabetes-prospective case control study in Srinagar, India. Diabetes Metab Syndr 2021; 15:455-459. [PMID: 33601179 DOI: 10.1016/j.dsx.2020.12.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/30/2020] [Accepted: 12/31/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS Asymptomatic bacteriuria (ASB) is more prevalent in diabetes mellitus (DM) patients than non diabetics, but its significance is not fully known. This study was done to estimate the prevalence, clinical profile, risk factors and follow up of ASB in type 2 diabetes (T2D) patients compared with matching healthy controls. METHODS Prospective, case-control study involving 400 T2D patients without symptoms of urinary tract infection (UTI) and 200 age and sex matched healthy controls. Apart from clinical and biochemical parameters, samples for urine examination and culture were taken from all the subjects. ASB was defined as ≥105 colony-forming units/ml of one or two organisms in the absence of symptoms of UTI. RESULTS The prevalence of ASB was significantly higher in T2D (17.5%) as compared to controls (10%). E. coli was the most common organism. On multivariate analysis, postmenopausal state, prior history of UTI, uncontrolled diabetes and longer duration of disease were associated with increased risk of ASB. Presence of ASB was significantly associated with symptomatic UTI at the 6-month follow up without deterioration of renal parameters. CONCLUSIONS Asymptomatic bacteriuria was more prevalent in people with diabetes than those without diabetes. The presence of ASB may be considered a risk factor for subsequent symptomatic UTI on follow up but has no adverse effect on kidney function.
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Affiliation(s)
- Bashir A Laway
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
| | - Tauseef Nabi
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Moomin H Bhat
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Bashir A Fomda
- Department of Endocrinology and Microbiology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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Baer RJ, Nidey N, Bandoli G, Chambers BD, Chambers CD, Feuer S, Karasek D, Oltman SP, Rand L, Ryckman KK, Jelliffe-Pawlowski LL. Risk of Early Birth among Women with a Urinary Tract Infection: A Retrospective Cohort Study. AJP Rep 2021; 11:e5-e14. [PMID: 33489437 PMCID: PMC7813589 DOI: 10.1055/s-0040-1721668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 10/02/2020] [Indexed: 11/20/2022] Open
Abstract
Objective The aim of the study is to evaluate the risk of preterm birth (PTB, <37 weeks) and early term (37 and 38 weeks) birth among women with an emergency department (ED) visit or hospitalization with a urinary tract infection (UTI) by trimester of pregnancy. Methods The primary sample was selected from births in California between 2011 and 2017. UTIs were identified from the ED or hospital discharge records. Risk of PTB, by subtype, and early term birth were evaluated by trimester of pregnancy and by type of visit using log-linear regression. Risk ratios were adjusted for maternal factors. Antibiotic usage was examined in a population of privately insured women from Iowa. Results Women with a UTI during pregnancy were at elevated risk of a birth <32 weeks, 32 to 36 weeks, and 37 to 38 weeks (adjusted risk ratios [aRRs] 1.1-1.4). Of the women with a diagnostic code for multiple bacterial species, 28.8% had a PTB. A UTI diagnosis elevated risk of PTB regardless of antibiotic treatment (aRR 1.4 for treated, aRR 1.5 for untreated). Conclusion UTIs are associated with early birth. This association is present regardless of the trimester of pregnancy, type of PTB, and antibiotic treatment.
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Affiliation(s)
- Rebecca J. Baer
- Department of Pediatrics, University of California San Diego, La Jolla, California
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California
- The California Preterm Birth Initiative, University of California San Francisco, San Francisco, California
| | - Nichole Nidey
- Department of Epidemiology, University of Iowa, Iowa City, Iowa
| | - Gretchen Bandoli
- Department of Pediatrics, University of California San Diego, La Jolla, California
| | - Brittany D. Chambers
- The California Preterm Birth Initiative, University of California San Francisco, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | | | - Sky Feuer
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California
- The California Preterm Birth Initiative, University of California San Francisco, San Francisco, California
| | - Deborah Karasek
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California
- The California Preterm Birth Initiative, University of California San Francisco, San Francisco, California
| | - Scott P. Oltman
- The California Preterm Birth Initiative, University of California San Francisco, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Larry Rand
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California
- The California Preterm Birth Initiative, University of California San Francisco, San Francisco, California
| | - Kelli K. Ryckman
- Department of Epidemiology, University of Iowa, Iowa City, Iowa
- Department of Pediatrics, University of Iowa, Iowa City, Iowa
| | - Laura L. Jelliffe-Pawlowski
- The California Preterm Birth Initiative, University of California San Francisco, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
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125
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Zitek T, Shir A, Ataya R, Santos L. Abnormal Urinalysis Results in Asymptomatic Individuals Are Common. Acad Emerg Med 2021; 28:107-109. [PMID: 32333428 DOI: 10.1111/acem.13995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/17/2020] [Accepted: 04/21/2020] [Indexed: 01/23/2023]
Affiliation(s)
- Tony Zitek
- From the Dr. Kiran C. Patel College of Allopathic Medicine Nova Southeastern University Fort Lauderdale FL USA
- and the Department of Emergency Medicine Kendall Regional Medical Center Miami FL USA
| | - Adam Shir
- From the Dr. Kiran C. Patel College of Allopathic Medicine Nova Southeastern University Fort Lauderdale FL USA
| | - Ramsey Ataya
- and the Department of Emergency Medicine Kendall Regional Medical Center Miami FL USA
| | - Liuba Santos
- and the Department of Emergency Medicine Kendall Regional Medical Center Miami FL USA
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Abasiattai A, Inwang I, Umoh A, Onwuezobe I. Asymptomatic bacteriuria in a university teaching hospital in Southern Nigeria: Prevalence, uropathogens, and antibiotic susceptibility. NIGERIAN JOURNAL OF MEDICINE 2021. [DOI: 10.4103/njm.njm_14_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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127
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Ross RK, Gerber JS, Willis ZI, Hersh AL, Kinlaw AC. Outpatient Fluoroquinolone Use in Children, 2000-2018. J Pediatric Infect Dis Soc 2020; 10:576-585. [PMID: 33377490 PMCID: PMC8599880 DOI: 10.1093/jpids/piaa156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 11/30/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND While fluoroquinolones are commonly used in adults, the use in children has been low. Since 2000, there were 3 US Food and Drug Administration (FDA) Boxed warnings regarding fluoroquinolones (2008, 2013, and 2016). Our objective was to describe the use of fluoroquinolones in children and assess the impact of 3 recent FDA warnings on fluoroquinolone use. METHODS From 2000 to 2018, we assessed claims for all outpatient prescription fills to measure the use of systemic fluoroquinolones and other broad-spectrum antibiotics in children less than 18 years old in the MarketScan Commercial Claims and Encounters database. We describe demographics, indication for antibiotic, and clinical characteristics. To assess the impact of FDA warnings on fill rates, we conducted an interrupted time-series analysis. RESULTS The cohort included 34.6 million unique beneficiaries less than 18 years old with 441 062 fluoroquinolone fills (5.5 fills per 1000 person-years). The fluoroquinolone fill rate was highest among children > 11 years old. Urinary tract infection was the most common associated diagnosis (21.8%). Since 2008, the fluoroquinolone fill rate has declined. By the end of the study period in December 2018, in the (counterfactual) absence of the FDA warnings, fluoroquinolone fill rate would have been 7.5 (95% confidence interval [CI]: 5.2-9.7); however, the corresponding rate in observed data was 2.8 (95% CI: 1.7-3.9). CONCLUSIONS Fluoroquinolone use was low compared with other common broad-spectrum antibiotics and declining trends over time were associated with FDA warnings, even though these warnings were not pediatric specific. Future work should assess the adverse events at issue in these warnings in children.
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Affiliation(s)
- Rachael K Ross
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA,Corresponding Author: Rachael K. Ross, MPH, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Dr McGavran-Greenberg Hall CB 7435 Chapel Hill, NC 27599, USA. E-mail:
| | - Jeffrey S Gerber
- Department of Pediatrics, Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zachary I Willis
- Department of Pediatrics, Division of Pediatric Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Adam L Hersh
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah, Salt Lake City, Utah, USA
| | - Alan C Kinlaw
- Division of Pharmaceutical Outcomes and Policy, School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA,Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, USA
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128
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Partridge J, Daly M, Hemsley C, Shah Z, Sathanandan K, Mainwaring C, Dhesi J. Using implementation science to develop and implement a guideline to reduce unnecessary preoperative testing for asymptomatic bacteriuria prior to elective arthroplasty. J Bone Jt Infect 2020; 6:57-62. [PMID: 33552879 PMCID: PMC7852403 DOI: 10.5194/jbji-6-57-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/01/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction: Guidelines and consensus statements do not support routine preoperative testing for asymptomatic bacteriuria (ASB) prior to elective arthroplasty. Despite this, urine testing remains commonplace in orthopaedic practice. This mixed methods stepwise quality improvement project aimed to develop and implement a guideline to reduce unnecessary preoperative testing for asymptomatic bacteriuria prior to elective arthroplasty within a single centre. Methods: Step 1 - description of current practice in preoperative urine testing prior to arthroplasty within a single centre; Step 2 - examination of the association between preoperative urine culture and pathogens causing prosthetic joint infection (PJI); Step 3 - co-design of a guideline to reduce unnecessary preoperative testing for asymptomatic bacteriuria prior to elective arthroplasty; Step 4 - implementation of a sustainable guideline to reduce unnecessary preoperative testing for asymptomatic bacteriuria prior to elective arthroplasty. Results: Retrospective chart review showed inconsistency in mid-stream urine (MSU) testing prior to elective arthroplasty (49 % preoperative MSU sent) and in antimicrobial prescribing for urinary tract infection (UTI) and ASB. No association was observed between organisms isolated from urine and joint aspirate in confirmed cases of PJI. Co-design of a guideline and decision support tool supported through an implementation strategy resulted in rapid uptake and adherence. Sustainability was demonstrated at 6 months. Conclusion: In this stepwise study, implementation science methodology was used to challenge outdated clinical practice, achieving a sustained reduction in unnecessary preoperative urine testing for ASB prior to elective arthroplasty.
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Affiliation(s)
- Judith S. L. Partridge
- Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Division of Primary Care and Public Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Madeleine Daly
- Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Carolyn Hemsley
- Department of Infection Diseases, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Zameer Shah
- Department of Trauma and Orthopaedics, Guy's
and St Thomas' NHS Foundation Trust, London, UK
| | | | - Cathryn Mainwaring
- Department of Geriatric Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Jugdeep K. Dhesi
- Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Division of Primary Care and Public Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Division of Surgery and Interventional Science,
University College London, London, UK
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129
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Eldridge GR, Hughey H, Rosenberger L, Martin SM, Shapiro AM, D'Antonio E, Krejci KG, Shore N, Peterson J, Lukes AS, Starks CM. Safety and immunogenicity of an adjuvanted Escherichia coli adhesin vaccine in healthy women with and without histories of recurrent urinary tract infections: results from a first-in-human phase 1 study. Hum Vaccin Immunother 2020; 17:1262-1270. [PMID: 33325785 PMCID: PMC8078672 DOI: 10.1080/21645515.2020.1834807] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Antibiotic resistance among gram-negative bacteria continues to rise globally at an alarming rate. New vaccines that prevent bacterial infections and reduce antibiotic use could provide a potential solution to these problems. This study focused on development of an investigational vaccine to prevent recurrent urinary traction infections (UTI) caused by gram-negative bacteria that use type 1 pili to adhere to, invade, and colonize human bladders. The vaccine antigen is FimH, an adhesin protein on the tip of type 1 pili with a lectin binding domain that enables attachment to glycoproteins on mammalian bladders. This was a phase 1, open-label, dose escalation study evaluating the vaccine in 67 healthy women with and without histories of recurrent UTI. The objectives of the study were to evaluate the safety, tolerability, and immunogenicity of different dosages of the antigen and adjuvant of the vaccine. All dosages were well-tolerated and a low incidence of systemic reactions occurred. No serious adverse events related to the vaccine were reported. The vaccine induced both binding and functional antibodies. The women with histories of recurrent UTI demonstrated greater than 150-fold increases in antibodies against the N-terminal region of FimH. Based on the results of this phase 1 study, this vaccine is proceeding to a double-blind, randomized, placebo-controlled phase 2 study. If this vaccine is successful in future studies, it could potentially prevent millions of recurrent UTI globally and reduce the development of antibiotic resistance.
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Affiliation(s)
| | | | - Lois Rosenberger
- LBR Regulatory and Clinical Consulting Services, Inc, Florence, KY, USA
| | | | | | | | | | - Neal Shore
- Atlantic Urology Clinics, Myrtle Beach, SC, USA
| | | | - Andrea S Lukes
- Women's Wellness Clinic, Carolina Women's Research and Wellness Center (CWRWC), Durham, NC, USA
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130
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Abstract
Urinary tract infections (UTIs) are among the most common bacterial infections in Germany, both in outpatient and inpatient settings. The clinical spectrum is heterogeneous and ranges from benign, often self-limiting, uncomplicated infections to complicated urinary tract infections (cUTIs) with life-threatening courses. Complicated urinary tract infections have a higher risk of chronicity, recurrence and/or progression than uncomplicated infections and may be associated with severe disease progression. Stratification of patients with urinary tract infections is, therefore, of utmost importance. Host factors rather than pathogen attributes determine the pathophysiology and therapy of complicated urinary tract infections and pyelonephritis. Complicated UTIs and pyelonephritis are also associated with high rates of antimicrobial resistance in the causative pathogens, so they should be given particular emphasis.
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Affiliation(s)
- J Kranz
- Klinik für Urologie und Kinderurologie, St.-Antonius Hospital gGmbH, Akademisches Lehrkrankenhaus der RWTH Aachen, Dechant-Deckers-Str. 8, 52249, Eschweiler, Deutschland. .,Universitätsklinik und Poliklinik für Urologie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland.
| | - F M E Wagenlehner
- Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Universitätsklinikum Gießen und Marburg GmbH, Justus-Liebig-Universität Gießen, Gießen, Deutschland
| | - L Schneidewind
- Urologische Klinik und Poliklinik, Universitätsmedizin Rostock, Rostock, Deutschland
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131
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Donzé C, Papeix C, Lebrun-Frenay C. Urinary tract infections and multiple sclerosis: Recommendations from the French Multiple Sclerosis Society. Rev Neurol (Paris) 2020; 176:804-822. [PMID: 32900473 DOI: 10.1016/j.neurol.2020.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Establish recommendations for the management of UTIs in MS patients. BACKGROUND Urinary tract infections (UTIs) are common during multiple sclerosis (MS) and are one of the most common comorbidities potentially responsible for deaths from urinary sepsis. METHODS The recommendations attempt to answer three main questions about UTIs and MS. The French Group for Recommendations in MS (France4MS) did a systematic review of articles from PubMed and universities databases (01/1980-12/2019). The RAND/UCLA appropriateness method, which has been developed to synthesize the scientific literature and expert opinions on health care topics, was used for reaching a formal agreement. 26 MS experts worked on the full-text review and a group of 70 multidisciplinary health care specialists validated the final evaluation of summarized evidences. RESULTS UTIs are not associated with an increased risk of relapse and permanent worsening of disability. Only febrile UTIs worsen transient disability through the Uhthoff phenomenon. Some immunosuppressive treatments increase the risk of UTIs in MS patients and require special attention especially in case of hypogammaglobulinemia. Experts recommend to treat UTIs in patients with MS, according to recommendations of the general population. Prevention of recurrent UTIs requires stabilization of the neurogenic bladder. In some cases, weekly oral cycling antibiotics can be proposed after specialist advice. Asymptomatic bacteriuria should not be screened for or treated systematically except in special cases (pregnancy and invasive urological procedures). CONCLUSION Physicians and patients should be aware of the updated recommendations for UTis and MS.
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Affiliation(s)
- C Donzé
- Faculté de médecine et de maïeutique de Lille, hôpital Saint-Philibert, groupement des hôpitaux de l'institut catholique de Lille, Lomme, France.
| | - C Papeix
- Département de neurologie, CRCSEP, Sorbonne université, hôpital de la Salpêtrière, AP-HP6, Paris 13, France
| | - C Lebrun-Frenay
- URC2A, université Nice Côté-d'Azur, CRCSEP, neurologie hôpital Pasteur 2, CHU de Nice, 30, voie Romaine, 06003 Nice, France
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132
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Latour K, Lepeleire JD, Jans B, Buntinx F, Catry B. Diagnosis, prevention and control of urinary tract infections: a survey of routine practices in Belgian nursing homes. J Infect Prev 2020; 21:182-188. [PMID: 33193820 DOI: 10.1177/1757177420921914] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 02/03/2020] [Indexed: 11/15/2022] Open
Abstract
Background Urinary tract infections (UTIs) are one of the most frequently reported infections in older adults and the most common reason for antimicrobial prescribing in nursing homes (NHs). In this vulnerable population, both a good diagnosis and prevention of these infections are crucial as overuse of antibiotics can lead to a variety of negative consequences including the development of multidrug-resistant organisms. Objective To determine infection prevention and control (IPC) and diagnostic practices for UTIs in Belgian NHs. Methods Local staff members had to complete an institution-level questionnaire exploring the availability of IPC practices and resources and procedures for UTI surveillance, diagnosis, and urinary catheter and incontinence care. Results UTIs were the second most common infections in the 87 participating NHs (prevalence: 1.0%). Dipstick tests and urine cultures were routinely performed in 30.2% and 44.6% of the facilities, respectively. In non-catheterised residents, voided or midstream urine sampling was most frequently applied. Protocols/guidelines for urine sampling, urinary catheter care and incontinence care were available in 43.7%, 45.9% and 31.0% of the NHs, respectively. Indwelling catheters were uncommon (2.3% of the residents) and urinary retention (84.9%) and wound management (48.8%) were the most commonly reported indications. Only surveillance was found to significantly impact the UTI prevalence: 2.2% versus 0.8% in NHs with or without surveillance, respectively (P < 0.001). Discussion This survey identified key areas for improving the diagnosis and prevention of UTIs, such as education and training regarding the basics of urine collection and catheter care.
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Affiliation(s)
- Katrien Latour
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Jan De Lepeleire
- Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Béatrice Jans
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Frank Buntinx
- Academic Centre for General Practice, KU Leuven, Leuven, Belgium.,Department of General Practice, Maastricht University, Maastricht, The Netherlands
| | - Boudewijn Catry
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Faculty of Medicine, Université libre de Bruxelles, Brussels, Belgium
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Evaluation of urinary inflammatory index in rapid screening of urinary tract infection. Sci Rep 2020; 10:19306. [PMID: 33168850 PMCID: PMC7652836 DOI: 10.1038/s41598-020-76352-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/19/2020] [Indexed: 12/18/2022] Open
Abstract
The objective of this study was to assess the diagnosis value of urinary inflammatory index (UII) and systemic immune-inflammation index (SII) for UTI. Nine inflammatory indexes including neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, SII and six UIIs were calculated for Receiver operating characteristic curve analysis to select which one is suitable for the screening of UTIs or distinguishing the types of bacteria. UII3, which calculated from leucocyte esterase (LE), nitrite, white blood cells and bacteria, was preferentially used as an indicator for the diagnosis of UTI when the threshold was set at 0.53. UII2 was more suitable for the distinction between groups when the cutoff is set to 0.94. Appropriate urinary inflammation index calculated by rapid urinalysis of urine dipstick and urine sediment can help us to predict urinary tract infection and bacterial type, and reduce the workload and costs of urine culture.
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134
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Kiel A, Catalano A, Clark CM, Wattengel BA, Mason J, Sellick J, Mergenhagen KA. Antibiotic prescribing in the emergency department versus primary care: Implications for stewardship. J Am Pharm Assoc (2003) 2020; 60:789-795.e2. [DOI: 10.1016/j.japh.2020.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 03/13/2020] [Accepted: 03/17/2020] [Indexed: 01/04/2023]
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135
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Goebel MC, Trautner BW, Wang Y, Van JN, Dillon LM, Patel PK, Drekonja DM, Graber CJ, Shukla BS, Lichtenberger P, Helfrich CD, Sales A, Grigoryan L. Organizational readiness assessment in acute and long-term care has important implications for antibiotic stewardship for asymptomatic bacteriuria. Am J Infect Control 2020; 48:1322-1328. [PMID: 32437753 DOI: 10.1016/j.ajic.2020.04.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Prior to implementing an antibiotic stewardship intervention for asymptomatic bacteriuria (ASB), we assessed institutional barriers to change using the Organizational Readiness to Change Assessment. METHODS Surveys were self-administered on paper in inpatient medicine and long-term care units at 4 Veterans Affairs facilities. Participants included providers, nurses, and pharmacists. The survey included 7 subscales: evidence (perceived strength of evidence) and six context subscales (favorability of organizational context). Responses were scored on a 5-point Likert-type scale. RESULTS One hundred four surveys were completed (response rate = 69.3%). Overall, the evidence subscale had the highest score; the resources subscale (mean 2.8) was significantly lower than other subscales (P < .001). Scores for budget and staffing resources were lower than scores for training and facility resources (P < .001 for both). Pharmacists had lower scores than providers for the staff culture subscale (P = .04). The site with the lowest scores for resources (mean 2.4) also had lower scores for leadership and lower pharmacist effort devoted to stewardship. CONCLUSIONS Although healthcare professionals endorsed the evidence about nontreatment of ASB, perceived barriers to antibiotic stewardship included inadequate resources and leadership support. These findings provide targets for tailoring the stewardship intervention to maximize success.
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Burns KW, Johnson KM, Pham SN, Egwuatu NE, Dumkow LE. Implementing outpatient antimicrobial stewardship in a primary care office through ambulatory care pharmacist-led audit and feedback. J Am Pharm Assoc (2003) 2020; 60:e246-e251. [DOI: 10.1016/j.japh.2020.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/21/2020] [Accepted: 08/01/2020] [Indexed: 12/19/2022]
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Sullivan LK, Ellison J, Wong S, Mai Y, Choi R. Evaluation of pharmacist-led strategy to reduce outpatient fluoroquinolone prescribing from the emergency department. J Am Pharm Assoc (2003) 2020; 60:804-808. [DOI: 10.1016/j.japh.2020.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/21/2020] [Accepted: 03/27/2020] [Indexed: 11/27/2022]
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Olson A, Feih J, Feldman R, Dang C, Stanton M. Involvement of pharmacist-reviewed urine cultures and sexually transmitted infections in the emergency department reduces time to antimicrobial optimization. Am J Health Syst Pharm 2020; 77:S54-S58. [PMID: 32426834 DOI: 10.1093/ajhp/zxaa064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To streamline workflow of the culture review process in the emergency department (ED), a transition from a nurse-driven to a pharmacist-initiated process was implemented. METHODS This was a single-center retrospective study conducted at an adult urban level 1 trauma academic medical center. The pharmacist-initiated culture review process was compared to the previous nurse-initiated process. The primary objective was time from final culture result to patient contact by an advanced practice provider. Secondary objectives included incidence of treatment failure and hospital admission within 30 days of ED visit. RESULTS A total of 283 patients met inclusion criteria: 144 patients in the pre-intervention group and 139 patients in the postintervention group. Patients were contacted a median time of 15.7 hours (95% confidence interval [CI], 9.88-18.83) earlier for definitive urinary tract infection antibiotic therapy and 46.7 hours (95% CI, 33.34-61.62) earlier for definitive sexually transmitted infection therapy in the pharmacist-initiated workflow compared to the nurse-initiated workflow (P < 0.001). Treatment failure occurred in 0.01% of patients in the postintervention group and 6.3% in the pre-intervention group (P = 0.01). Hospital admission within 30 days of the ED visit occurred in 0% of patients in the postintervention group and 4.2% in the pre-intervention group (P = 0.03). CONCLUSION Pharmacist-initiated culture review in the ED at an academic medical center reduced time from final culture to patient contact for optimal antibiotic therapy and decreased hospital admission and treatment failure rates. A change in the culture review workflow involving pharmacists appears to have a positive impact on clinical outcomes.
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Affiliation(s)
- Amber Olson
- Department of Pharmacy, M Health Fairview Southdale Hospital, Edina, MN
| | - Jessica Feih
- Department of Pharmacy, Froedtert Hospital and the Medical College of Wisconsin, Milwaukee, WI
| | - Ryan Feldman
- Department of Pharmacy, Froedtert Hospital and the Medical College of Wisconsin, Milwaukee, WI
| | - Cathyyen Dang
- Department of Pharmacy, Froedtert Hospital and the Medical College of Wisconsin, Milwaukee, WI
| | - Matthew Stanton
- Department of Pharmacy, Froedtert Hospital and the Medical College of Wisconsin, Milwaukee, WI
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White J, Ory J, Lantz Powers AG, Ordon M, Kroft J, Cox A. Urological issues in pregnancy: A review for urologists. Can Urol Assoc J 2020; 14:352-357. [PMID: 32432535 PMCID: PMC7716830 DOI: 10.5489/cuaj.6526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Urological issues in the pregnant patient present a unique clinical dilemma. These patients may be challenging to treat due to risks associated with medications and surgical procedures. This review aims to provide an update on the physiological changes and surgical risks in pregnancy. In addition, we review the approach for management of urolithiasis and urinary tract infections in pregnancy. Lastly, we highlight the importance of a multidisciplinary approach to placenta percreta, a condition not commonly addressed in urological education.
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Affiliation(s)
- Joshua White
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Jesse Ory
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | | | - Michael Ordon
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Jamie Kroft
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada
| | - Ashley Cox
- Department of Urology, Dalhousie University, Halifax, NS, Canada
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Mizrahi A, Naouri D, Hobson C, Amzalag J, Pilmis B, Couzigou C, Ganansia O, Le Monnier A. Impact of the beta-lacta test on the management of urinary tract infections at the emergency department. Infect Dis (Lond) 2020; 53:52-60. [PMID: 32960659 DOI: 10.1080/23744235.2020.1822543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Rapid detection of extended-spectrum β-lactamases is essential. In this study, we evaluated the potential impact of β-lacta test on both the times to appropriate antibiotic therapy and to the implementation of patient isolation measures. PATIENTS AND METHODS We included prospectively all the patients admitted to the emergency department for clinical suspicion of urinary tract infection. Compared with physician's decision, we analysed the potential impact of β-lacta test on the initial antibiotic therapy and on the implementation of hygiene measures. This study has been registered under number NCT02897609. RESULTS We included 203 patients, 43% with acute pyelonephritis and 21% with acute prostatitis. The β-lacta test had a 95.2% sensitivity and a 99.5% specificity to detect extended-spectrum β-lactamases. Taking the β-lacta test results into account would have decreased significantly both the times to appropriate therapy and to isolation measures from 54 to 2.7 h and from 55.2 to 2.6 h, respectively. CONCLUSION The β-lacta test could reduce significantly the times to appropriate therapy and implementation of isolations measures.
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Affiliation(s)
- Assaf Mizrahi
- Service de Microbiologie clinique, Groupe Hospitalier Paris Saint-Joseph, Paris, France.,Institut Micalis UMR 1319, Université Paris-Saclay, INRAe, AgroParisTech, Châtenay Malabry, France
| | - Diane Naouri
- Service des Urgences, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Claire Hobson
- Equipe mobile de Microbiologie clinique, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Jonas Amzalag
- Service de Microbiologie clinique, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Benoît Pilmis
- Institut Micalis UMR 1319, Université Paris-Saclay, INRAe, AgroParisTech, Châtenay Malabry, France.,Equipe mobile de Microbiologie clinique, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Carine Couzigou
- Equipe mobile de Microbiologie clinique, Groupe Hospitalier Paris Saint-Joseph, Paris, France.,Comité de Lutte contre les Infections Nosocomiales, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Olivier Ganansia
- Comité de Lutte contre les Infections Nosocomiales, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Alban Le Monnier
- Service de Microbiologie clinique, Groupe Hospitalier Paris Saint-Joseph, Paris, France.,Institut Micalis UMR 1319, Université Paris-Saclay, INRAe, AgroParisTech, Châtenay Malabry, France
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Hendrickson JA, Spitznogle SL, Gonzales-Luna AJ, Babic JT, Britt RS, Knight JM, Pham SN, McDaneld PM. Significant Publications on Infectious Diseases Pharmacotherapy in 2019. J Pharm Pract 2020; 34:800-813. [PMID: 32935641 DOI: 10.1177/0897190020951348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To provide a summary of the most prominent peer-reviewed infectious diseases (ID) pharmacotherapy and Human Immunodeficiency Virus (HIV)-related articles published in 2019. SUMMARY Houston Infectious Diseases Network (HIDN) members were asked to nominate articles that they believed were most influential within the ID and HIV pharmacotherapy science communities. A total of 48 general ID and 6 HIV-related articles were nominated. Following nominations, an online survey was distributed via e-mail to Society of Infectious Diseases Pharmacists (SIDP) members, with a total of 156 and 54 members voting for general ID and HIV-related articles, respectively. The results of this survey were ranked to determine the top 10 general ID and top HIV articles. The top articles were then summarized by HIDN members, including residents, fellows, and clinical pharmacists. CONCLUSION This review covers many of the most influential ID articles published in 2019, including 3 practice guideline updates. Due to the high rate of ID literature published each year, this review continues to help summarize these articles for the ID community, allowing clinicians to remain up-to-date on practice-changing publications in ID and HIV pharmacotherapy.
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Affiliation(s)
- Joshua A Hendrickson
- Department of Pharmacy Practice and Translational Research, 15507University of Houston College of Pharmacy, Houston, TX, USA
| | - Sarah L Spitznogle
- Division of Pharmacy, 4002The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anne J Gonzales-Luna
- Department of Pharmacy Practice and Translational Research, 15507University of Houston College of Pharmacy, Houston, TX, USA
| | - Jessica T Babic
- Department of Pharmacy, 23464Memorial Hermann-Texas Medical Center, Houston, TX, USA
| | - Rachel S Britt
- Department of Pharmacy, 12338The University of Texas Medical Branch, Galveston, TX, USA
| | - Joshua M Knight
- Department of Pharmacy, 23534Houston Methodist Hospital, Houston, TX, USA
| | - Selena N Pham
- Department of Pharmacy, 20116Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Patrick M McDaneld
- Division of Pharmacy, 4002The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Hong C, Egan G, Sherk B. Burning for Treatment: Impact of Staff Education on Asymptomatic Bacteriuria Management in the Elderly. Can Geriatr J 2020; 23:257-263. [PMID: 32904781 PMCID: PMC7458596 DOI: 10.5770/cgj.23.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Studies indicate that elderly patients are often inappropriately treated with antimicrobials for asymptomatic bacteriuria (ASB). Interprofessional education may help improve the assessment and management of ASB. Methods Retrospective chart audits were conducted on two cohorts of positive urine cultures (n = 201) obtained from a geriatric acute care unit to determine the incidence of treated ASB. The first cohort (n = 101) was analyzed from January to July 2017. Education was provided to unit staff (e.g., nurses, physicians, pharmacists) in Fall 2017. The second cohort (n = 100) was analyzed from January to July 2018. Descriptive statistics were used to summarize and compare the results from the cohorts. Results 152 patients (n = 201 positive urine cultures) were reviewed: 74% (159) of positive urine cultures were ASB and 21% (42) were urinary tract infections. The incidence of treated ASB was 15% (30) and untreated ASB was 65% (129). The incidence of UTI, treated ASB, and untreated ASB were not significantly different between the two cohorts examined. Conclusion The implementation of education did not result in lasting changes in ASB management. Our study suggests that future systemic solutions are necessary to reduce the incidence of treated ASB in the geriatric population.
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Affiliation(s)
- Casara Hong
- Department of Medicine (Acute Care for Elders Unit), Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC
| | - Gregory Egan
- Department of Medicine (Acute Care for Elders Unit), Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC.,Department of Pharmaceutical Sciences, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC
| | - Byron Sherk
- Department of Medicine (Acute Care for Elders Unit), Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC
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143
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Epidemiology, definition and treatment of complicated urinary tract infections. Nat Rev Urol 2020; 17:586-600. [PMID: 32843751 DOI: 10.1038/s41585-020-0362-4] [Citation(s) in RCA: 118] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2020] [Indexed: 11/08/2022]
Abstract
UTIs are amongst the most frequent bacterial infections. However, the clinical phenotypes of UTI are heterogeneous and range from rather benign, uncomplicated infections to complicated UTIs (cUTIs), pyelonephritis and severe urosepsis. Stratification of patients with UTIs is, therefore, important. Several classification systems exist for the description and classification of UTIs, with the common rationale that cUTIs have a higher risk of recurrence or chronification, progression or severe outcome than uncomplicated UTIs. The pathophysiology and treatment of cUTIs and pyelonephritis are driven more by host factors than by pathogen attributes. cUTIs and pyelonephritis are associated with high antimicrobial resistance rates among causative pathogens. However, antimicrobial resistance rates can differ substantially, depending on the population being studied and whether the data being analysed are from surveillance studies, registry data or interventional studies, in which specific inclusion and exclusion criteria are used for patient selection. For example, antibiotic resistance rates are higher in patients with urosepsis than in those with less severe infections. Thus, treatment outcomes differ substantially among studies, ranging from 50% to almost 100% clearance of infection, depending on the patient population analysed, the UTI entities included and the primary outcome of the study. Pyelonephritis and cUTIs have emerged as infection models for the study of novel antibiotics, including extensive investigation of novel substances active against Gram-negative bacteria.
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The prevalence of positive urine dipstick testing and urine culture in the asymptomatic pregnant woman: A cross-sectional study. Eur J Obstet Gynecol Reprod Biol 2020; 253:103-107. [PMID: 32862029 DOI: 10.1016/j.ejogrb.2020.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/14/2020] [Accepted: 08/20/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Pregnancy induces unique physiological changes to the urinary tract, leaving pregnant women more susceptible to pyelonephritis. Urinary tract infections are generally diagnosed using urine sampling and testing with reagent sticks (dipstick) or laboratory culture. This study aimed to establish the prevalence of positive urine reagent strip and urine culture in asymptomatic pregnant women. STUDY DESIGN This was a cross-sectional study of 300 women attending routine antenatal clinics. Samples were analysed using an automated urine dipstick analyser for the presence of glucose, protein, leucocyte esterase, blood, and nitrites. All samples were cultured. Multinomial logistic regression was performed to investigate risk factors for urine contamination and infection. Sensitivities and specificities were calculated for common dipstick findings for positive and mixed urine culture. RESULTS One-in-three (37.0 % [111/300], 95 % CI 31.6-42.8 %) women had at least one positive finding on reagent strip testing. Ten per cent ([29/300], 95 % CI 6.7-13.7 %) of samples had a positive culture for a single organism, whereas 46.7 % ([140/300], 95 % CI 40.9-52.5 %) of samples were positive for multiple organisms (mixed culture). 43.7 % ([131/300], 95 % CI 38.0-49.5 %) of samples had a negative culture. Organisms cultured were similar to previous reports from high-income countries. BMI was identified on regression analysis as a risk factor for contamination. CONCLUSIONS There is a high prevalence of positive urine dipstick and contaminated culture in asymptomatic pregnant women. BMI is a risk factor for urine culture contamination and further research into this topic is essential given trends in obesity worldwide.
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Abstract
OBJECTIVE Administration of antimicrobials to patients with asymptomatic bacteriuria (ASB) is a common error that can lead to worse outcomes. However, controlled analyses quantifying the commonality and impact of this practice are lacking. We analyzed the independent predictors for antimicrobials misuse in ASB and quantified the impact of this practice on clinical outcomes. DESIGN Retrospective case-control and cohort analyses for calendar year 2017. SETTING Tertiary-care, university-affiliated medical center. PATIENTS The study included adult (>18 years) patients with positive urine culture. Pregnant women, renal transplant recipients, and patients who underwent urologic procedures were excluded. METHODS ASB was determined according to US Centers for Disease Control and Prevention (CDC) criteria. Multivariable logistic regression models were constructed to analyze predictors and outcomes associated with antimicrobial use for patients with ASB. RESULTS The study included 1,530 patient-unique positive urine cultures. Among these patients, 610 patients (40%) were determined to have ASB. Of the 696 isolates, 219 (36%) were multidrug-resistant organisms (MDROs). Also, 178 (29%) patients received antimicrobials specifically due to the ASB. Independent predictors for improper administration of antimicrobials were dependent functional status (adjusted odds ratio [aOR], 2.3; 95% CI, 1.4-3.6) and male sex (aOR, 2; 95% CI, 1.25-2.6). Use of antimicrobials was independently associated with re-hospitalizations (aOR, 1.7; 95% CI, 1.1-2.6) and later, acute Clostridioides difficile infections (CDI) in the following 90 days (aOR, 4.5; 95% CI, 2-10.6). CONCLUSIONS ASB is a common condition, frequently resulting from an MDRO. Male sex and poor functional status were independent predictors for mistreatment, and this practice was independently associated with rehospitalizations and CDI in the following 90 days.
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Hiyama Y, Sato T, Takahashi S, Yamamoto S, Fukushima Y, Nakajima C, Suzuki Y, Yokota SI, Masumori N. Sitafloxacin has a potent activity for eradication of extended spectrum β-lactamase-producing fluoroquinolone-resistant Escherichia coli forming intracellular bacterial communities in uroepithelial cells. J Infect Chemother 2020; 26:1272-1277. [PMID: 32768340 DOI: 10.1016/j.jiac.2020.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/04/2020] [Accepted: 07/19/2020] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Eradication of asymptomatic bacteriuria (ASB) before urological procedures is important to reduce the risk for infectious complications after surgery. However, the appropriate regimen for antimicrobial treatment has not been fully determined. We experienced continuous (over 10 months) isolation of extended spectrum β-lactamase (ESBL)-producing fluoroquinolone-resistant Escherichia coli from urine of an asymptomatic patient. The four isolates obtained (SMESC1 to 4) were international high-risk clones of O25b:H4-ST131-H30R, and originated from one strain, as revealed by the whole genome sequences. Although the patient received meropenem (MEPM) and fosfomycin (FOM), to which the strains were susceptible before the urological procedures, they could not be eradicated. METHODS To explore the reason for the continuous isolation even after MEPM and FOM administration, antimicrobial killing of adherent and/or intracellular bacterial communities (IBC) formed by coculture of the E. coli cells and T24 bladder epithelial cells were examined. RESULTS FOM and levofloxacin did not decrease viable E. coli cells compared with gentamicin. MEPM partly decreased them, and sitafloxacin (STFX) decreased them most potently. These observations indicate that E. coli can survive in the urinary tract under antimicrobial administration, and some antimicrobials such as FOM and MEPM cannot eradicate E. coli in uroepithelial cells. Adhesion on urinary epithelial cells and/or IBC formation might result in continuous isolation from the urinary tract and recurrence of ASB and urinary tract infections. CONCLUSIONS The present study suggests that STFX is a promising optional agent for the eradication of ESBL-producing fluoroquinolone-resistant E. coli in the urinary tract before urological procedures.
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Affiliation(s)
- Yoshiki Hiyama
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan; Department of Microbiology, Sapporo Medical University School of Medicine, Sapporo, Japan; Department of Infection Control and Laboratory Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toyotaka Sato
- Department of Microbiology, Sapporo Medical University School of Medicine, Sapporo, Japan.
| | - Satoshi Takahashi
- Department of Infection Control and Laboratory Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Soh Yamamoto
- Department of Microbiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yukari Fukushima
- Division of Bioresources, Hokkaido University Research Center for Zoonosis Control, Sapporo, Japan
| | - Chie Nakajima
- Division of Bioresources, Hokkaido University Research Center for Zoonosis Control, Sapporo, Japan; Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan
| | - Yasuhiko Suzuki
- Division of Bioresources, Hokkaido University Research Center for Zoonosis Control, Sapporo, Japan; Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan
| | - Shin-Ichi Yokota
- Department of Microbiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Naoya Masumori
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
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147
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Gupta K, O'Brien W, Gallegos-Salazar J, Strymish J, Branch-Elliman W. How Testing Drives Treatment in Asymptomatic Patients: Level of Pyuria Directly Predicts Probability of Antimicrobial Prescribing. Clin Infect Dis 2020; 71:614-621. [PMID: 31504317 DOI: 10.1093/cid/ciz861] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 08/28/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Urinalysis is a readily available test often used for screening. Pyuria is a common finding in asymptomatic patients; however, it is unknown how often identification of pyuria in the absence of confirmatory cultures leads to antimicrobial prescribing. The objective of this study was to measure the association between pyuria and antimicrobial initiation during the perioperative period and assess harms versus benefits of treatment. METHODS A retrospective cohort of preoperative patients within the national healthcare system during the period 1 October 2008-30 September 2013 who had a urinalysis performed during the 30-day preoperative period was created; patients with positive urine cultures were excluded. The primary exposure was pyuria on preoperative urinalysis. The primary outcome was antimicrobial initiation. Secondary outcomes included postoperative surgical site (SSI), urinary tract (UTI), and Clostridioides difficile infections. Trend and logistic regression analyses were performed. RESULTS Among 41 373 patients, 3617 had pyuria. 887 (24.5%) patients with pyuria received antimicrobials versus 1918 (5.1%) patients without pyuria. As the degree of pyuria increased, the odds of receiving antimicrobials also increased linearly (low, 14.7%; moderate, 24.0%; high pyuria, 37.4%). Preoperative pyuria was associated with postoperative C. difficile infections (aOR, 1.7; 95% CI, 1.2-2.4); risk was higher in patients who received antimicrobials (aOR, 2.4; 1.7-3.4). Pyuria was not associated with SSI but was associated with increases in UTI after orthopedic and vascular procedures; this risk was not mitigated by antimicrobial therapy. CONCLUSIONS Urine screening during the preoperative period is a low-value intervention that increases antimicrobial exposure but does not improve postoperative outcomes.
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Affiliation(s)
- Kalpana Gupta
- Veterans Affairs (VA) Boston Healthcare System, Department of Medicine, Boston, Massachusetts, USA.,Boston University School of Medicine, Department of Medicine, Boston, Massachusetts, USA.,VA Center for Healthcare Organization and Implementation Research (CHOIR) Boston, Massachusetts, USA
| | - William O'Brien
- VA Center for Healthcare Organization and Implementation Research (CHOIR) Boston, Massachusetts, USA
| | - Jaime Gallegos-Salazar
- Boston University School of Medicine, Department of Medicine, Boston, Massachusetts, USA
| | - Judith Strymish
- Veterans Affairs (VA) Boston Healthcare System, Department of Medicine, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Westyn Branch-Elliman
- Veterans Affairs (VA) Boston Healthcare System, Department of Medicine, Boston, Massachusetts, USA.,VA Center for Healthcare Organization and Implementation Research (CHOIR) Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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148
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Nicolle LE, Gupta K, Bradley SF, Colgan R, DeMuri GP, Drekonja D, Eckert LO, Geerlings SE, Köves B, Hooton TM, Juthani-Mehta M, Knight SL, Saint S, Schaeffer AJ, Trautner B, Wullt B, Siemieniuk R. Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America. Clin Infect Dis 2020; 68:e83-e110. [PMID: 30895288 DOI: 10.1093/cid/ciy1121] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 12/27/2018] [Indexed: 12/22/2022] Open
Abstract
Asymptomatic bacteriuria (ASB) is a common finding in many populations, including healthy women and persons with underlying urologic abnormalities. The 2005 guideline from the Infectious Diseases Society of America recommended that ASB should be screened for and treated only in pregnant women or in an individual prior to undergoing invasive urologic procedures. Treatment was not recommended for healthy women; older women or men; or persons with diabetes, indwelling catheters, or spinal cord injury. The guideline did not address children and some adult populations, including patients with neutropenia, solid organ transplants, and nonurologic surgery. In the years since the publication of the guideline, further information relevant to ASB has become available. In addition, antimicrobial treatment of ASB has been recognized as an important contributor to inappropriate antimicrobial use, which promotes emergence of antimicrobial resistance. The current guideline updates the recommendations of the 2005 guideline, includes new recommendations for populations not previously addressed, and, where relevant, addresses the interpretation of nonlocalizing clinical symptoms in populations with a high prevalence of ASB.
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Affiliation(s)
- Lindsay E Nicolle
- Department of Internal Medicine, School of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Kalpana Gupta
- Division of Infectious Diseases, Veterans Affairs Boston Healthcare System and Boston University School of Medicine, West Roxbury, Massachusetts
| | | | - Richard Colgan
- Department of Family and Community Medicine, University of Maryland, Baltimore
| | - Gregory P DeMuri
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Dimitri Drekonja
- Division of Infectious Diseases, University of Minnesota, Minneapolis
| | - Linda O Eckert
- Department of Obstetrics and Gynecology and Department of Global Health, University of Washington, Seattle
| | - Suzanne E Geerlings
- Department of Internal Medicine, Amsterdam University Medical Center, The Netherlands
| | - Béla Köves
- Department of Urology, South Pest Teaching Hospital, Budapest, Hungary
| | - Thomas M Hooton
- Division of Infectious Diseases, University of Miami, Florida
| | | | - Shandra L Knight
- Library and Knowledge Services, National Jewish Health, Denver, Colorado
| | - Sanjay Saint
- Department of Internal Medicine, Veterans Affairs Ann Arbor and University of Michigan, Ann Arbor
| | | | - Barbara Trautner
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Bjorn Wullt
- Division of Microbiology, Immunology and Glycobiology, Lund, Sweden
| | - Reed Siemieniuk
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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149
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Greissman S, Mattiazzi A, Mendoza M, Natori Y, Grady M, Quinonez J, Zukerman R, Camargo JF, Morris MI, Simkins J, Guerra G, Abbo LM. Antimicrobial resistance and recurrent bacterial urinary tract infections in hospitalized patients following kidney transplantation: A single-center experience. Transpl Infect Dis 2020; 22:e13337. [PMID: 32452596 DOI: 10.1111/tid.13337] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/02/2020] [Accepted: 05/13/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE The burden of urinary tract infections (UTIs) and risk factors for developing infections with multidrug resistant organisms (MDROs) post-kidney transplantation (KT) are poorly understood. METHODS Single-center retrospective cohort study (January 2015-December 2017) evaluating first and recurrent episodes of bacteriuria and subsequent analysis of episodes caused by MDROs up to 6 months post-KT. Donor and recipient variables were reviewed. RESULTS A total of 743 adults underwent single KT during the study period, and 106 patients were hospitalized with bacteriuria. 45% were asymptomatic in their first episode. 73.6% had a single episode, and 26.4% had 2 or more episodes. A total of 28 patients had recurrent episodes; 64.3% had an MDRO on the first episode and 78.6% on the second episode. Escherichia coli was the most common organism isolated, 88.5% were resistant to trimethoprim-sulfamethoxazole (TMP-SMX), 9.3% were extended-spectrum beta-lactamase (ESBL) producers, and 38.1% were MDROs. Body mass index ≥30 was significantly associated with the presence of MDROs in both univariate and multivariate analyses (RR 1.37, 95% CI 1.01-1.88; OR 3.26, CI 1.29-8.25). A total of 12 donors had bacteremia or bacteriuria and 6 (50%) with E coli. A total of 10 KT recipients received antibiotic prophylaxis to prevent donor-derived infections. CONCLUSIONS Our results suggest that a significant proportion of patients develop recurrent bacteriuria post-transplantation; of those, more than half caused by MDROs. There is a possible association between obesity and MDROs in KT recipients that merits further investigation. With the global crisis in antimicrobial resistance, innovative strategies are needed to prevent and treat UTIs in KT patients.
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Affiliation(s)
| | - Adela Mattiazzi
- Division of Nephrology and Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Maria Mendoza
- Department of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Yoichiro Natori
- Division of Infectious Diseases and Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mackenzie Grady
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jose Quinonez
- University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ryan Zukerman
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jose F Camargo
- Division of Infectious Diseases and Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michele I Morris
- Division of Infectious Diseases and Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jacques Simkins
- Division of Infectious Diseases and Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Giselle Guerra
- Division of Nephrology and Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lilian M Abbo
- Division of Infectious Diseases and Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Infection Control and Prevention, Jackson Health System, Miami, FL, USA
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150
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Biset S, Moges F, Endalamaw D, Eshetie S. Multi-drug resistant and extended-spectrum β-lactamases producing bacterial uropathogens among pregnant women in Northwest Ethiopia. Ann Clin Microbiol Antimicrob 2020; 19:25. [PMID: 32493343 PMCID: PMC7268622 DOI: 10.1186/s12941-020-00365-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 05/25/2020] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Above 80% of urinary tract infections are caused by enteric bacteria, which are known for years by their drug-resistant ability. Though the prevalence of drug-resistant strains is increasing in the world, it is not well known in low-income countries. The aim of this study was to assess the prevalence of Multi-drug resistance, Extended-spectrum β-lactamases production, and associated risk factors among pregnant women in Northwest Ethiopia. METHODS A hospital-based cross-sectional study was conducted among pregnant women from March to May 2017. A total of 384 clean-catch midstream urine sample was collected from study participants. Bacterial identification and drug susceptibility testing were done following standard microbiological techniques; Extended-spectrum β-lactamase production was screened using a disc diffusion test and confirmed by a combination disc test. The data were entered and analyzed by using SPSS version 20, and a p-value of less than 0.05 was considered as statistically significant. RESULT The overall prevalence of urinary tract infection was 15.9% (95% CI 12.8-20.1%). E. coli (49.2%), CoNS (27.9%), and S. aureus (18%) were the main uropathogens. The prevalence of MDR uropathogens was 60.65%. The prevalence of ESBLs production among cases caused by Enterobacteriaceae was 18.2%. The drug resistance rate of Gram-negative isolates was higher for ampicillin (90.9%), cephalothin (84.8%), and augmentin (57.6%). The drug nitrofurantoin showed the highest activity (100%) against Gram-negative isolates. Gram-positive isolates were showed low susceptibility to penicillin (89.3%) and cotrimoxazole (75%); however highest susceptibility rate for gentamicin (100%), amikacin (100%), and nitrofurantoin (98.36%) was recorded. Prior antibiotic therapy (AOR = 5.46, 95% CI 1.38-21.65) was a risk factor for the presence of multi-drug resistant bacteria. CONCLUSION AND RECOMMENDATION The multi-drug resistance prevalence was high among uropathogen, thus treatment of urinary tract infection during pregnancy; should be based on the antibacterial susceptibility testing result. The isolation of drug-resistant strains like Extended-spectrum β-lactamases in this study calls for the need of periodic and continuous follow-up of antibiotic usage among pregnant women. Nitrofurantoin, gentamicin, amikacin, and ciprofloxacin/norfloxacin showed higher activity against bacterial uropathogen.
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Affiliation(s)
- Sirak Biset
- Department of Medical Microbiology, College of Medicine and Health Sciences, University of Gondar, P.O. Box: 196 Gondar, Ethiopia
| | - Feleke Moges
- Department of Medical Microbiology, College of Medicine and Health Sciences, University of Gondar, P.O. Box: 196 Gondar, Ethiopia
| | - Demeke Endalamaw
- Department of Medical Microbiology, College of Medicine and Health Sciences, University of Gondar, P.O. Box: 196 Gondar, Ethiopia
| | - Setegn Eshetie
- Department of Medical Microbiology, College of Medicine and Health Sciences, University of Gondar, P.O. Box: 196 Gondar, Ethiopia
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