1
|
Shrivas S, Samaur H, Yadav V, Boda SK. Soft and Hard Tissue Integration around Percutaneous Bone-Anchored Titanium Prostheses: Toward Achieving Holistic Biointegration. ACS Biomater Sci Eng 2024; 10:1966-1987. [PMID: 38530973 DOI: 10.1021/acsbiomaterials.3c01555] [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] [Indexed: 03/28/2024]
Abstract
A holistic biointegration of percutaneous bone-anchored metallic prostheses with both hard and soft tissues dictates their longevity in the human body. While titanium (Ti) has nearly solved osseointegration, soft tissue integration of percutaneous metallic prostheses is a perennial problem. Unlike the firm soft tissue sealing in biological percutaneous structures (fingernails and teeth), foreign body response of the skin to titanium (Ti) leads to inflammation, epidermal downgrowth and inferior peri-implant soft tissue sealing. This review discusses various implant surface treatments/texturing and coatings for osseointegration, soft tissue integration, and against bacterial attachment. While surface microroughness by SLA (sandblasting with large grit and acid etched) and porous calcium phosphate (CaP) coatings improve Ti osseointegration, smooth and textured titania nanopores, nanotubes, microgrooves, and biomolecular coatings encourage soft tissue attachment. However, the inferior peri-implant soft tissue sealing compared to natural teeth can lead to peri-implantitis. Toward this end, the application of smart multifunctional bioadhesives with strong adhesion to soft tissues, mechanical resilience, durability, antibacterial, and immunomodulatory properties for soft tissue attachment to metallic prostheses is proposed.
Collapse
Affiliation(s)
- Sangeeta Shrivas
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Khandwa Road, Simrol, Indore 453552, India
| | - Harshita Samaur
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Khandwa Road, Simrol, Indore 453552, India
| | - Vinod Yadav
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Khandwa Road, Simrol, Indore 453552, India
| | - Sunil Kumar Boda
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Khandwa Road, Simrol, Indore 453552, India
| |
Collapse
|
2
|
Venkataraman R, Yadav U. Catheter-associated urinary tract infection: an overview. J Basic Clin Physiol Pharmacol 2023; 34:5-10. [PMID: 36036578 DOI: 10.1515/jbcpp-2022-0152] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/03/2022] [Indexed: 01/27/2023]
Abstract
CAUTIs (catheter-associated urinary tract infections) continue to be one of the most common health-care-related illnesses in the entire globe. CAUTIs are the cause of 40% of all hospital-acquired infections and 80% of all nosocomial urinary tract infections (UTIs). A urine catheter is implanted into a high percentage of inpatients at some point during their hospitalization, and indwelling urinary catheter adoption likely to be on the rise. Urinary catheters, made of plastic materials, inhibit the urinary tract's natural defence mechanisms and enhance the bacterial colonization or biofilm formation on the catheter surface, which may cause CAUTIs. It is associated with increased burden of disease, mortality, hospital bills and length of hospital stay. Therefore, to prevent these infections, technological innovations in catheter materials that limit biofilm formation will be required. Unfortunately, many health-care practitioners are unclear of the precise indications for bladder catheterization and accurate CAUTI criteria, which can lead to unnecessary catheterization, antibiotic overuse for asymptomatic bacteriuria and the spread of resistant organisms. As a result, we discuss CAUTIs in general, including definitions, pathophysiology, causation, indications for catheterization and a variety of effective CAUTI-fighting strategies.
Collapse
Affiliation(s)
- Rajesh Venkataraman
- Department of Pharmacy Practice, Sri Adichunchanagiri College of Pharmacy, Adichunchanagiri University, B G Nagara , Karnataka, 517448, India
| | - Umesh Yadav
- Department of Pharmacy Practice, Sri Adichunchanagiri College of Pharmacy, Adichunchanagiri University, B G Nagara , Karnataka, 517448, India.,Department of Otorhinolaryngology and Head & Neck Surgery, Adichunchanagiri University, B G Nagara , Karnataka, 517448, India
| |
Collapse
|
3
|
Cheng K, He M, Shu Q, Wu M, Chen C, Xue Y. Analysis of the Risk Factors for Nosocomial Bacterial Infection in Patients with COVID-19 in a Tertiary Hospital. Risk Manag Healthc Policy 2020; 13:2593-2599. [PMID: 33223859 PMCID: PMC7671853 DOI: 10.2147/rmhp.s277963] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/23/2020] [Indexed: 12/14/2022] Open
Abstract
Background Infection surveillance and risk factor analysis are among the most important prerequisites for the prevention and treatment of nosocomial bacteria infections, which are the demands for both infected and non-infected patients. Purpose To explore the risk factors for nosocomial bacterial infection of patients with COVID-19, and further to provide a theoretical basis for scientific prevention and control of nosocomial bacterial infection. Methods Between 10 January 2020 and 9 March 2020, we collected data of 212 patients with COVID-19 and then explored the influence of age, gender, length of stay, use of ventilator, urinary catheterization, central venous catheterization, white blood cell (WBC) count and procalcitonin on the nosocomial bacterial infection of patients with COVID-19 by a retrospective study. Results There were 212 confirmed cases of COVID-19, of which 31 cases had nosocomial bacterial infections, with an incidence of 14.62%. The most common types of nosocomial bacterial infections were lower respiratory tract (12 cases, 38.71%), which was the most frequent site, followed by urinary tract (10 cases, 32.26%), blood stream (7 cases, 22.58%), upper respiratory tract (1 case, 3.23%) and gastrointestinal tract infection (1 case, 3.23%). The incidence of nosocomial bacterial infection was significantly correlated with age, arteriovenous catheterization, urinary catheterization, WBC count and procalcitonin. Moreover, multivariate analysis confirmed that WBC (OR 8.38, 95% CI 1.07 to 65.55), procalcitonin (OR 4.92, 95% CI 1.39 to 17.33) and urinary catheterization (OR 25.38, 95% CI 5.09 to 126.53) were independent risk factors for the nosocomial bacterial infection of patients with COVID-19. Conclusion Understanding the risk factors for nosocomial bacterial infection of patients with COVID-19 and strengthening the monitoring of various susceptible factors are helpful to control the occurrence of nosocomial bacterial infection in the COVID-19 isolation wards.
Collapse
Affiliation(s)
- Keping Cheng
- Department of Infection Management, Zhongda Hospital Affiliated to Southeast University, Nanjing 210009, People's Republic of China
| | - Miao He
- Department of Public Health, Huangshi Central Hospital, Huangshi 435000, People's Republic of China
| | - Qin Shu
- Department of Infection Prevention and Control, Huangshi Traditional Chinese Medicine Hospital, Huangshi 435004, People's Republic of China
| | - Ming Wu
- Department of Infection Prevention and Control, Huangshi Traditional Chinese Medicine Hospital, Huangshi 435004, People's Republic of China
| | - Cuifang Chen
- Department of Public Health, Huangshi Central Hospital, Huangshi 435000, People's Republic of China
| | - Yulei Xue
- Department of Infectious Diseases, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing 210029, People's Republic of China
| |
Collapse
|
4
|
Spencer TS, Flynn Makic MB, Shaw K. Decreasing Catheter-Associated Urinary Tract Infections in Urologic Oncology Patients Discharged With an Indwelling Urinary Catheter: A Quality Improvement Project. J Perianesth Nurs 2019; 34:394-402. [DOI: 10.1016/j.jopan.2018.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/27/2018] [Accepted: 07/05/2018] [Indexed: 01/04/2023]
|
5
|
Irwin NJ, McCoy CP, McCullough AR, Corbett DJ. Use of in vitro and haptic assessments in the characterisation of surface lubricity. Proc Inst Mech Eng H 2018; 233:84-90. [PMID: 29393009 DOI: 10.1177/0954411918756155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Lubricity is a key property of hydrophilic-coated urinary catheter surfaces. In vitro tests are commonly employed for evaluation of surface properties in the development of novel catheter coating technologies; however, their value in predicting the more subjective feeling of lubricity requires validation. We herein perform a range of in vitro assessments and human organoleptic studies to characterise surface properties of developmental hydrophilic coating formulations, including water wettability, coefficient of friction, dry-out kinetics and lubricity. Significant reductions of up to 40% in the contact angles and coefficient of friction values of the novel coating formulations in comparison with the control poly(vinylpyrrolidone)-coated surfaces were demonstrated during quantitative laboratory assessments. In contrast, no significant differences in the more subjective feeling of lubricity between the novel formulations and the control-coated surfaces were observed when formulations were haptically assessed by the techniques described herein. This study, importantly, highlights the need for optimisation of in vitro and human haptic assessments to more reliably predict patient preferences.
Collapse
Affiliation(s)
- Nicola J Irwin
- 1 School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - Colin P McCoy
- 1 School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - Amanda R McCullough
- 2 Centre for Research in Evidence-Based Practice, Bond University, Robina, QLD, Australia
| | - Dan J Corbett
- 3 China Medical University - The Queen's University of Belfast Joint College, Shenyang, China
| |
Collapse
|
6
|
Catheter-associated urinary tract infections: challenges and opportunities for the application of systems engineering. Health Syst (Basingstoke) 2017. [DOI: 10.1057/s41306-016-0017-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
|
7
|
Cooper IR, Pollini M, Paladini F. The potential of photo-deposited silver coatings on Foley catheters to prevent urinary tract infections. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2016; 69:414-20. [DOI: 10.1016/j.msec.2016.07.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 06/24/2016] [Accepted: 07/04/2016] [Indexed: 11/30/2022]
|
8
|
|
9
|
A Comparison between Foley and Nelatone Urinary Catheters in Causing Urinary Tract Infection in Animal Models. Nurs Midwifery Stud 2015. [DOI: 10.5812/nms.24363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
10
|
Nouri S, Sharif MR, Hosseinpour M, Farokhi S, Sharif MH. A Comparison Between Foley and Nelatone Urinary Catheters in Causing Urinary Tract Infection in Animal Models. Nurs Midwifery Stud 2015. [DOI: 10.17795/nmsjournal24363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
11
|
Nouri S, Sharif MR, Hosseinpour M, Farokhi S, Sharif MH. A comparison between foley and nelatone urinary catheters in causing urinary tract infection in animal models. Nurs Midwifery Stud 2015; 4:e24363. [PMID: 25830158 PMCID: PMC4377530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 01/01/2015] [Accepted: 01/13/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Urinary catheterization is one of the main measures used to treat and care for hospitalized patients. Several complications have been attributed to the presence of latex with routine Foley catheters. Therefore, some studies have recommended that Nelatone catheters be substituted for the ordinary Foley catheters to prevent these complications. OBJECTIVES This study aimed to compare the rates of urinary tract infection (UTI) in rabbits catheterized either with Foley or with Nelatone catheters. MATERIALS AND METHODS A randomized controlled trial was conducted on 60 rabbits that were randomly assigned to three groups of twenty. The first group was catheterized using Nelatone catheter; the second group was catheterized using Foley catheter and the third group was studied without performing any catheterization. After seven days, urine samples were collected using suprapubic aspiration and were sent to the laboratory for culture. Descriptive statistics were calculated. Moreover, chi-square and Fisher's exact tests were used for data analysis. RESULTS At the end of the study, four cases in the Nelatone group and 12 cases in the Foley group presented with UTI (P = 0.01). No positive urine cultures were found in the control group. CONCLUSIONS The Nelatone catheters, compared with the Foley ones, had a lower risk of UTI in the long term use. Verifying this claim by further studies can have an important role in reducing UTIs in patients using urinary catheters.
Collapse
Affiliation(s)
- Saeed Nouri
- Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Mohammad Reza Sharif
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran,Corresponding author: Mohammad Reza Sharif, Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-9123788713, Fax: +98-3155548900, E-mail:
| | - Mehrdad Hosseinpour
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Shima Farokhi
- Department of Community Health Nursing, Hamadan University of Medical Sciences, Hamadan, IR Iran
| | - Mohammad Hossein Sharif
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| |
Collapse
|
12
|
Becknell B, Schober M, Korbel L, Spencer JD. The diagnosis, evaluation and treatment of acute and recurrent pediatric urinary tract infections. Expert Rev Anti Infect Ther 2014; 13:81-90. [PMID: 25421102 DOI: 10.1586/14787210.2015.986097] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Urinary tract infection (UTI) is one of the most common bacterial infections encountered by pediatricians. Currently, the diagnosis and management of acute UTI and recurrent UTI in children remain controversial. Recently published guidelines and large clinical trials have attempted to clarify UTI diagnostic and management strategies. In this manuscript, we review the diagnosis and management of acute and recurrent UTI in the pediatric population.
Collapse
Affiliation(s)
- Brian Becknell
- Department of Pediatrics, Division of Nephrology, Nationwide Children's Hospital, Columbus, OH, USA
| | | | | | | |
Collapse
|
13
|
Davis KF, Colebaugh AM, Eithun BL, Klieger SB, Meredith DJ, Plachter N, Sammons JS, Thompson A, Coffin SE. Reducing catheter-associated urinary tract infections: a quality-improvement initiative. Pediatrics 2014; 134:e857-64. [PMID: 25113293 DOI: 10.1542/peds.2013-3470] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Catheter-associated urinary tract infections (CAUTIs) are among the most common health care-associated infections in the United States, yet little is known about the prevention and epidemiology of pediatric CAUTIs. METHODS An observational study was conducted to assess the impact of a CAUTI quality improvement prevention bundle that included institution-wide standardization of and training on urinary catheter insertion and maintenance practices, daily review of catheter necessity, and rapid review of all CAUTIs. Poisson regression was used to determine the impact of the bundle on CAUTI rates. A retrospective cohort study was performed to describe the epidemiology of incident pediatric CAUTIs at a tertiary care children's hospital over a 3-year period (June 2009 to June 2012). RESULTS Implementation of the CAUTI prevention bundle was associated with a 50% reduction in the mean monthly CAUTI rate (95% confidence interval: -1.28 to -0.12; P = .02) from 5.41 to 2.49 per 1000 catheter-days. The median monthly catheter utilization ratio remained unchanged; ∼90% of patients had an indication for urinary catheterization. Forty-four patients experienced 57 CAUTIs over the study period. Most patients with CAUTIs were female (75%), received care in the pediatric or cardiac ICUs (70%), and had at least 1 complex chronic condition (98%). Nearly 90% of patients who developed a CAUTI had a recognized indication for initial catheter placement. CONCLUSIONS CAUTI is a common pediatric health care-associated infection. Implementation of a prevention bundle can significantly reduce CAUTI rates in children.
Collapse
Affiliation(s)
- Katherine Finn Davis
- University of Pennsylvania School of Nursing, Philadelphia Pennsylvania; Department of Nursing, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Ann M Colebaugh
- Department of Nursing, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Benjamin L Eithun
- Department of Nursing, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | | | | | - Natalie Plachter
- Department of Nursing, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Julia Shaklee Sammons
- Department of Nursing, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Division of Infectious Diseases, Department of Infection Prevention and Control and Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Allison Thompson
- Department of Nursing, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Susan E Coffin
- Department of Nursing, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Division of Infectious Diseases, Department of Infection Prevention and Control and Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| |
Collapse
|
14
|
Strategies for Prevention of Urinary Tract Infections in Neurogenic Bladder Dysfunction. Phys Med Rehabil Clin N Am 2014; 25:605-18, viii. [DOI: 10.1016/j.pmr.2014.04.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
15
|
Yi WM, Chen Q, Liu CH, Hou JY, Chen LD, Wu WK. Acupuncture for preventing complications after radical hysterectomy: a randomized controlled clinical trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2014; 2014:802134. [PMID: 24839455 PMCID: PMC4009289 DOI: 10.1155/2014/802134] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 03/25/2014] [Indexed: 12/21/2022]
Abstract
We aimed to investigate the preventive effects of acupuncture for complications after radical hysterectomy. A single-center randomized controlled single-blinded trial was performed in a western-style hospital in China. One hundred and twenty patients after radical hysterectomy were randomly allocated to two groups and started acupuncture from sixth postoperative day for five consecutive days. Sanyinjiao (SP6), Shuidao (ST28), and Epangxian III (MS4) were selected with electrical stimulation and Zusanli (ST36) without electrical stimulation for thirty minutes in treatment group. Binao (LI14) was selected as sham acupuncture point without any stimulation in control group. The main outcome measures were bladder function and prevalence of postoperative complications. Compared with control group, treatment group reported significantly improved bladder function in terms of maximal cystometric capacity, first voiding desire, maximal flow rate, residual urine, and bladder compliance, and decreased bladder sensory loss, incontinence, and urinary retention on fifteenth and thirtieth postoperative days. Treatment group showed significant advantage in reduction of urinary tract infection on thirtieth postoperative day. But no significant difference between groups was observed for lymphocyst formation. By improving postoperative bladder function, early intervention of acupuncture may provide a valuable alternative method to prevent bladder dysfunctional disorders and urinary tract infection after radical hysterectomy.
Collapse
Affiliation(s)
- Wei-min Yi
- Department of Traditional Chinese Medicine and Acupuncture, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China
- Department of Traditional Chinese Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510635, China
| | - Qing Chen
- Department of Gynecology Oncology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China
| | - Chang-hao Liu
- Department of Gynecology Oncology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China
| | - Jia-yun Hou
- Department of Traditional Chinese Medicine and Acupuncture, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China
| | - Liu-dan Chen
- Department of Traditional Chinese Medicine and Acupuncture, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China
| | - Wei-kang Wu
- Department of Traditional Chinese Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510635, China
- Institute of Integrated Traditional Chinese and Western Medicine, Sun Yat-sen University, Guangzhou 510080, China
| |
Collapse
|
16
|
Krein SL, Saint S. Preventing catheter-associated urinary tract infection: a happy marriage between implementation and healthier patients. ACTA ACUST UNITED AC 2014. [DOI: 10.1071/hi13047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
17
|
Hospital-Acquired Infection Underlies Poor Functional Outcome in Patients with Prolonged Length of Stay. ACTA ACUST UNITED AC 2013; 2013. [PMID: 24377056 PMCID: PMC3873143 DOI: 10.1155/2013/312348] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction Prolonged length of stay (pLOS) following ischemic stroke inflates cost, increases risk for hospital-acquired complications, and has been associated with worse prognosis. Methods Acute ischemic stroke patients admitted between July 2008 and December 2010 were retrospectively analyzed for pLOS, defined as a patient stable for discharge hospitalized for an additional ≥24 hours. Results Of 274 patients included, 106 (38.7%) had pLOS (median age 65 years, 60.6% female, 69.0% black). Patients with pLOS had higher admission NIHSS than patients without pLOS (9 versus 5, P = 0.0010). A larger proportion of patients with pLOS developed an infection (P < 0.0001), and after adjusting for covariates, these patients had greater odds of poor short-term functional outcome (OR = 2.25, 95% CI 1.17–4.32, P = 0.0148). Adjusting for infection, the odds of patients with pLOS having poor short-term functional outcome were no longer significant (OR = 1.68, 95% CI 0.83–3.35, P = 0.1443). Conclusions The contraction of a hospital-acquired infection was a significant predictor of pLOS and a contributor of poor short-term outcome following an ischemic stroke. Whether the cause or the consequence of pLOS, hospital-acquired infections are largely preventable and a target for reducing length of stay.
Collapse
|
18
|
Darouiche RO, Al Mohajer M, Siddiq DM, Minard CG. Short versus long course of antibiotics for catheter-associated urinary tract infections in patients with spinal cord injury: a randomized controlled noninferiority trial. Arch Phys Med Rehabil 2013; 95:290-6. [PMID: 24035770 DOI: 10.1016/j.apmr.2013.09.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 08/29/2013] [Accepted: 09/02/2013] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess the applicability of a short-course regimen of antibiotics for managing catheter-associated urinary tract infection (CA-UTI) in patients with spinal cord injury (SCI). DESIGN Randomized, controlled, noninferiority trial. SETTING Medical center. PARTICIPANTS Patients with SCI who had CA-UTI (N=61). INTERVENTIONS Patients were randomized to receive either a 5-day regimen of antibiotics after catheter exchange (experimental group) or a 10-day regimen of antibiotics with catheter retention (control group). Noninferiority was prespecified with a margin of 10%. MAIN OUTCOME MEASURE Clinical cure at the end of therapy. RESULTS Of the 61 patients enrolled in this study, 6 patients were excluded because of bacteremia or absence of urinary symptoms. All patients (100%) achieved clinical cure at the end of therapy. The rates of microbiologic response were 82.1% in the experimental group and 88.9% in the control group (upper boundary 95% confidence interval (CI) for difference, 26%). The rates of resolution of pyuria were 89.3% in the experimental group and 88.9% in the control group (upper boundary 95% CI for difference, 16%). Patients in the experimental group had higher rates of CA-UTI recurrence than the control group. The rates of new CA-UTI, diarrhea, and Clostridium difficile colitis were similar in the 2 treatment arms. CONCLUSIONS The primary endpoint of the study was met, indicating that the 5-day regimen with catheter exchange was noninferior to the 10-day regimen with catheter retention on the basis of clinical cure. Criteria for noninferiority on the basis of microbiologic response and resolution of pyuria were not met.
Collapse
Affiliation(s)
- Rabih O Darouiche
- Spinal Cord Injury Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Section of Infectious Diseases, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX; Department of Medicine, Baylor College of Medicine, Houston, TX
| | | | - Danish M Siddiq
- Section of Infectious Diseases, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Charles G Minard
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX
| |
Collapse
|