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Sugai K, Sasaki J, Wada Y, Shimizu N, Ishikawa T, Yanagi K, Hashimoto T, Tanaka A, Suwanai H, Suzuki R, Odawara M. Predictive patterns of lower urinary tract symptoms and bacteriuria in adults with type 2 diabetes. Diabetol Int 2024; 15:253-261. [PMID: 38524941 PMCID: PMC10959893 DOI: 10.1007/s13340-023-00687-1] [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] [Received: 09/12/2023] [Accepted: 12/11/2023] [Indexed: 03/26/2024]
Abstract
Background Numerous studies demonstrated the risk factors for urological complications in patients with diabetes before sodium-glucose co-transporter 2 inhibitor (SGLT2i) became commercially available. This study aimed to comprehensively investigate urological characteristics in patients with type 2 diabetes (T2DM) after SGLT2i became commercially available. Methods We examined 63 outpatients with T2DM suspected of bacteriuria based on urinary sediment examinations. Urine cultures were performed, and lower urinary tract symptoms (LUTS) were assessed via questionnaires. Patients with bacteriuria were assessed using ultrasonography to measure post-void residual volume (PVR). Utilizing demographic and laboratory data, a random forest algorithm predicted LUTS, bacteriuria, and symptomatic bacteriuria (SB). Results Thirty-two patients had LUTS and 31 had bacteriuria. High-density lipoprotein cholesterol level was crucial in predicting LUTS, while age was crucial in predicting bacteriuria. In predicting SB among patients with bacteriuria, creatinine level and estimated glomerular filtration rate were crucial. Our models had high predictive accuracy for LUTS (area under the curve [AUC] = 0.846), followed by bacteriuria (AUC = 0.770) and SB (AUC = 0.938) in receiver operating characteristic curve analysis. These predictors were previously reported as risk factors for urological complications. Although SGLT2i use was not an important predictor in our study, all SGLT2i users with bacteriuria had SB and exhibited higher PVR compared to non-SGLT2i users with bacteriuria. Conclusion This study's random forest model highlighted distinct essential predictors for each urological condition. The predictors were consistent before and after SGLT2i became commercially available. Supplementary Information The online version contains supplementary material available at 10.1007/s13340-023-00687-1.
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Affiliation(s)
- Keiji Sugai
- Department of General Internal Medicine, Toda Chuo General Hospital, 1-19-3 Honcho, Toda, Saitama 335-0023 Japan
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-Ku, Tokyo, 160-0023 Japan
| | - Junko Sasaki
- Department of General Internal Medicine, Toda Chuo General Hospital, 1-19-3 Honcho, Toda, Saitama 335-0023 Japan
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-Ku, Tokyo, 160-0023 Japan
| | - Yuki Wada
- Department of General Internal Medicine, Toda Chuo General Hospital, 1-19-3 Honcho, Toda, Saitama 335-0023 Japan
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-Ku, Tokyo, 160-0023 Japan
| | - Norihiro Shimizu
- Department of General Internal Medicine, Toda Chuo General Hospital, 1-19-3 Honcho, Toda, Saitama 335-0023 Japan
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-Ku, Tokyo, 160-0023 Japan
| | - Takuya Ishikawa
- Department of General Internal Medicine, Toda Chuo General Hospital, 1-19-3 Honcho, Toda, Saitama 335-0023 Japan
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-Ku, Tokyo, 160-0023 Japan
| | - Ketchu Yanagi
- Department of General Internal Medicine, Toda Chuo General Hospital, 1-19-3 Honcho, Toda, Saitama 335-0023 Japan
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-Ku, Tokyo, 160-0023 Japan
| | - Takeshi Hashimoto
- Department of Urology, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-Ku, Tokyo, 160-0023 Japan
| | - Akihiko Tanaka
- Department of General Internal Medicine, Toda Chuo General Hospital, 1-19-3 Honcho, Toda, Saitama 335-0023 Japan
| | - Hirotsugu Suwanai
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-Ku, Tokyo, 160-0023 Japan
| | - Ryo Suzuki
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-Ku, Tokyo, 160-0023 Japan
| | - Masato Odawara
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-Ku, Tokyo, 160-0023 Japan
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Mukai S, Nomi M, Kozawa S, Yanagiuchi A, Shigemura K, Sengoku A. The impact of the coronavirus disease 2019 pandemic on changes in antimicrobial prophylaxis and development of genito‐urinary tract infections after urodynamic study: A retrospective comparative study of a single rehabilitation hospital in Japan. Neurourol Urodyn 2022; 41:1440-1450. [PMID: 35673967 PMCID: PMC9347450 DOI: 10.1002/nau.24979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/19/2022] [Accepted: 05/21/2022] [Indexed: 11/26/2022]
Abstract
Aims To investigate the changes in the proportion of antimicrobial prophylaxis (AP) during the urodynamic study (UDS) and the frequency of posttest genito‐urinary tract infections (GUTI) before and after coronavirus disease 2019 (COVID‐19) pandemic, and evaluate this associations. Patients and Methods Patients who underwent UDS between 2015 and 2021 were targeted, and they were allocated to pre‐2020 as before the appearance of COVID‐19 and post‐2020 as after that, and propensity score matching was performed. The impact on AP was assessed by the administration rate, and that on the development of febrile GUTI after UDS was assessed for an equivalence by the GUTI‐free rate at 7 days after testing. Results After matching, 384 cases of 192 cases each were included. The frequency of AP was 58.3% in pre‐2020 and 77.1% in post‐2020, an increase of about 19%, and the rate increased significantly in post‐2020 (p < 0.001). However, the incidence of GUTI after UDS was 4.2% and 4.7%, respectively, with no significant difference. The ratio of GUTI‐free rates was within the equivalence margin, confirming an equivalence before and after the appearance of COVID‐19. Conclusions Under the influence of COVID‐19 pandemic, even though AP rate during UDS was increased by 19% from that brought by following the guideline‐based administration methods, the frequency of GUTI after UDS was similar, so it is thought to be important to use AP during UDS appropriately for high‐risk cases as recommended in the guidelines.
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Affiliation(s)
- Shigeto Mukai
- Department of Pharmacy Hyogo Prefectural Central Rehabilitation Hospital Kobe Hyogo Japan
| | - Masashi Nomi
- Department of Urology Hyogo Prefectural Central Rehabilitation Hospital Kobe Hyogo Japan
| | - Sae Kozawa
- Department of Pharmacy Hyogo Prefectural Central Rehabilitation Hospital Kobe Hyogo Japan
| | - Akihiro Yanagiuchi
- Department of Urology Hyogo Prefectural Central Rehabilitation Hospital Kobe Hyogo Japan
- Department of Urology Hyogo Prefectural Nishi‐Harima Rehabilitation Hospital Tatsuno Hyogo Japan
| | - Katsumi Shigemura
- Department of Urology Kobe University Graduate School of Medicine Kobe Hyogo Japan
| | - Atsushi Sengoku
- Department of Urology Hyogo Prefectural Central Rehabilitation Hospital Kobe Hyogo Japan
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Takami N, Mukai S, Nomi M, Yanagiuchi A, Sengoku A, Maeda K, Yang YM, Shigemura K, Fujisawa M. Retrospective Observational Study of Risk Factors for Febrile Infectious Complications after Urodynamic Studies in Patients with Suspected Neurogenic Lower Urinary Tract Disturbance. Urol Int 2022; 106:722-729. [PMID: 35066505 DOI: 10.1159/000520563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 10/13/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We retrospectively investigated the risk factors for post-urodynamic study (UDS) infectious complications in long-term hospitalized inpatients with suspected neurogenic lower urinary tract disturbance (NLUTD) in a monocenter study, to accurately assess post-UDS urinary tract infections (UTI). METHODS We retrospectively analyzed data including background information, UDS-related data, and potential risk factors for infection from 489 NLUTD-suspected inpatients who underwent UDS from 2015 to 2019 and examined the risk factors for post-UDS infectious complications using univariate and multivariate statistical analyses. RESULTS Symptomatic post-UDS UTI occurred in 20 out of 489 (4.1%) patients, including 3 (15%) with recurrent UTI. During follow-up prior to UDS for 1 year, 220 cases were investigated by urine culture revealing Escherichia coli (n = 77), Klebsiella pneumoniae (n = 29), Enterococcus faecalis (n = 18), extended-spectrum beta-lactamase-producing E. coli (n = 17), and Pseudomonas aeruginosa (n = 9). As risk factors for post-UDS infectious complications, American Spinal Injury Association impairment scale (AIS): AIS ≧ C (A or B or C) (hazard ratio: 4.29, p = 0.0076), management method of urination (hazard ratio: 4.30, p = 0.048), and age (hazard ratio: 1.04, p = 0.025) were significantly correlated with the occurrence of post-UDS infection. CONCLUSIONS The significant risk factors for post-UDS UTI were AIS ≧ C, management method of urination, and age in the suspected NLUTD patient context. This study was originally started with the goal of reducing unnecessary antibiotics and may contribute to the proper use of antibiotics based on antimicrobial stewardship.
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Affiliation(s)
- Nozomi Takami
- Infection Control Team, Hyogo Prefectural Central Rehabilitation Hospital, Kobe, Japan
| | - Shigeto Mukai
- Infection Control Team, Hyogo Prefectural Central Rehabilitation Hospital, Kobe, Japan
| | - Masashi Nomi
- Infection Control Team, Hyogo Prefectural Central Rehabilitation Hospital, Kobe, Japan.,Department of Urology, Hyogo Prefectural Central Rehabilitation Hospital, Kobe, Japan
| | - Akihiro Yanagiuchi
- Department of Urology, Hyogo Prefectural Nishi-Harima Rehabilitation Hospital, Tatsuno, Japan
| | - Atsushi Sengoku
- Department of Urology, Hyogo Prefectural Central Rehabilitation Hospital, Kobe, Japan
| | - Koki Maeda
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Young-Min Yang
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Katsumi Shigemura
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.,Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Masato Fujisawa
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
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Prevalence, incidence, and risk factors of urinary tract infection among immobile inpatients in China: a prospective, multi-centre study. J Hosp Infect 2019; 104:538-544. [PMID: 31790744 DOI: 10.1016/j.jhin.2019.11.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/24/2019] [Accepted: 11/25/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Immobile inpatients have a high risk of urinary tract infection (UTI). Additional epidemiological data regarding UTIs among immobile inpatients are needed. AIM To investigate the prevalence and incidence of, and risk factors for, UTIs among immobile patients in 25 hospitals throughout China. METHODS This was a national multi-centre cross-sectional investigation. We recruited six tertiary hospitals, 12 non-tertiary hospitals, and seven community hospitals. We obtained data regarding demographics, clinically related variables, and UTI-specific variables from immobile patients during their hospitalization. We performed univariate and multivariable analyses, and binary logistic regression analysis was used to identify risk factors. FINDINGS Among 23,985 immobile patients, 393 had a UTI. The prevalence and incidence of UTIs in hospitalized immobile patients was 1.64% (393/23 985) and 0.69 per 1000 patient-days, respectively. The infection rate of catheter-associated UTI was 2.25 per 1000 urinary catheter-days. We found that a greater number of bedridden days, longer length of hospital stay, being in a medical ward, the presence of an indwelling urethral catheter, prolonged duration of an indwelling catheter, use of glucocorticoids, female sex, diabetes mellitus, and older age were independent risk factors of UTI. CONCLUSION Immobile patients had similar risk factors for UTI as the general population, as well as some additional risk factors. Greater attention is needed in the management of UTIs among the population of immobile hospitalized patients.
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Ng ATL, Lam W. The Argument For and Against the Use of Multichannel Urodynamics in the Assessment of Post-Prostatectomy Incontinence. CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00526-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Furukawa H, Ishikawa K, Tsuchiya S, Nishimi S, Sasaki M, Onodera C, Takada A, Oyama K, Chida S. Validity of a disposable catheter to drain urine overnight in neurogenic bladder. Pediatr Int 2019; 61:706-711. [PMID: 30779413 DOI: 10.1111/ped.13806] [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] [Received: 01/22/2018] [Revised: 12/05/2018] [Accepted: 12/28/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Overnight catheter drainage (OCD) is introduced to avoid overdistention of the bladder at night-time when clean intermittent catheterization proves ineffective for daytime management of neurogenic bladder. We adopted OCD using disposable silicone no-balloon (DSnB) catheters, with the distal end outside the body opening into diapers. OCD using DSnB catheter, however, had risks of retrograde bacterial contamination. Therefore, in this study, the validity of equipping DSnB catheters with check valves to prevent retrograde bacterial contamination was examined. METHODS For the in vitro study, excised saline-filled swine bladders were drained using DSnB catheters with or without check valves, and the time required for intravesical pressure to reach 5 cmH2 O was measured. For the in vivo study, in cross-over experiments comparing DSnB catheters with and without check valves, OCD using DSnB catheters for 10 h was performed in rabbits under analgesia. Bacterial growth from urine samples before and after OCD and residual urine volume were examined. RESULTS For the in vitro experiment, the median drainage time was 368.2 s (range, 88-1,085 s) and 344.7 s (range, 28-840 s) with and without check valves, respectively (n = 6), which was not significantly different. For the in vivo experiment, in cross-over experiments (n = 8) new bacterial growth rates after OCD did not differ, and median residual urine volume was 17.1 mL (range, 0-75 mL) and 1.2 mL (range, 0-5 mL) with and without check valves, respectively (P = 0.055). CONCLUSIONS Installing a check valve in the DSnB catheter did not decrease new bacterial growth, while tending to increase residual urine volume. DSnB catheters without check valves appear to be better for continuous drainage of urine from bladder.
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Affiliation(s)
- Hiromi Furukawa
- Department of Pediatrics, Iwate Medical University, School of Medicine, Morioka, Iwate, Japan
| | - Ken Ishikawa
- Department of Pediatrics, Iwate Medical University, School of Medicine, Morioka, Iwate, Japan
| | - Shigekuni Tsuchiya
- Department of Pediatrics, Iwate Medical University, School of Medicine, Morioka, Iwate, Japan
| | - Saeko Nishimi
- Department of Pediatrics, Iwate Medical University, School of Medicine, Morioka, Iwate, Japan
| | - Makoto Sasaki
- Department of Pediatrics, Iwate Medical University, School of Medicine, Morioka, Iwate, Japan
| | - Chinatsu Onodera
- Department of Pediatrics, Iwate Medical University, School of Medicine, Morioka, Iwate, Japan
| | - Akira Takada
- Department of Pediatrics, Iwate Medical University, School of Medicine, Morioka, Iwate, Japan
| | - Kotaro Oyama
- Department of Pediatrics, Iwate Medical University, School of Medicine, Morioka, Iwate, Japan
| | - Shoichi Chida
- Department of Pediatrics, Iwate Medical University, School of Medicine, Morioka, Iwate, Japan
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