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Hengky A, Tandry M, Pratama KG, Pauliana P, Kusumajaya C, Guatama A. Do urinary tract infections affect the rate of periprosthetic joint infections in patients who underwent arthroplasty surgery? A systematic review and meta-analysis. Tzu Chi Med J 2024; 36:275-283. [PMID: 38993822 PMCID: PMC11236074 DOI: 10.4103/tcmj.tcmj_309_23] [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] [Received: 12/12/2023] [Revised: 12/29/2023] [Accepted: 04/02/2024] [Indexed: 07/13/2024] Open
Abstract
Periprosthetic joint infection (PJI) is a significant issue in orthopedic surgery. Urinary tract infections (UTIs) and asymptomatic bacteriuria (ASB) have been identified as potential causes of PJI; however, evidence is inconclusive. Understanding these relationships is critical for improving therapy and patient outcomes. A systematic review was performed by conducting searches from PubMed, EBSCO, ProQuest, and manual searching with adherence to the Preferred Reporting Items for Systematic Review and Meta-Analysis 2020 guideline. Studies that reported UTI/ASB and PJI were included. Meta-analysis was conducted using a random-effects model using RevMan 5.4 software. A total of 14 studies were included with UTIs and ASB showed an overall association with increased risk of PJI (odds ratio [OR]: 1.84, 95% confidence interval [CI]: 1.14-2.99, P = 0.01). However, subgroup analysis for UTIs and ASB was not significant. Further analysis of UTIs in total hip arthroplasty (THA) surgery showed a significant association (OR: 1.76, 95% CI: 1.57-1.96) with PJI. Preoperative UTIs timing between 0 and 2 weeks before surgery showed an increased risk of PJI (OR: 1.45, 95% CI: 1.35-1.55). Antibiotic treatment in ASB did not significantly impact PJI rates. Urine and PJI sample cultures in four studies showed no correlation of microorganisms between the two sites. According to recent evidence, a statistically significant association was found between UTIs and PJI in patients who underwent THA surgery. However, ASB did not yield significant results in relation to PJI. These results should be supported by larger and well-designed studies to make proper clinical suggestion in future. For further research, it is recommended to adopt standardized criteria for outcome measurement and to involve larger sample sizes to enhance the reliability and generalizability of findings.
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Affiliation(s)
- Antoninus Hengky
- Center of Health Research, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
- Department of Emergency Medicine, Fatima General Hospital, Ketapang Regency, West Kalimantan, Indonesia
| | - Malvin Tandry
- Department of Emergency Medicine, Fatima General Hospital, Ketapang Regency, West Kalimantan, Indonesia
| | - Kevin Gracia Pratama
- Department of Emergency Medicine, Fatima General Hospital, Ketapang Regency, West Kalimantan, Indonesia
| | - Pauliana Pauliana
- Department of Emergency Medicine, Fatima General Hospital, Ketapang Regency, West Kalimantan, Indonesia
| | - Christopher Kusumajaya
- Division of Urology, Department of Surgery, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Astrawinata Guatama
- Department of Orthopedic and Traumatology, Fatima General Hospital, Ketapang Regency, West Kalimantan, Indonesia
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Stall NM, Kandel C, Reppas-Rindlisbacher C, Quinn KL, Wiesenfeld L, MacFadden DR, Johnstone J, Fralick M. Antibiotics for delirium in older adults with pyuria or bacteriuria: A systematic review. J Am Geriatr Soc 2024. [PMID: 38895992 DOI: 10.1111/jgs.18964] [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: 03/06/2024] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND It is unclear whether antibiotics impact delirium outcomes in older adults with pyuria or bacteriuria in the absence of systemic signs of infection or genitourinary symptoms. METHODS We registered our systematic review protocol with PROSPERO (CRD42023418091). We searched the Medline and Embase databases from inception until April 2023 for studies investigating the impact of antimicrobial treatment on the duration and severity of delirium in older adults (≥60 years) with pyuria (white blood cells detected on urinalysis or dipstick) or bacteriuria (bacteria growing on urine culture) and without systemic signs of infection (temperature > 37.9C [>100.2F] or 1.5C [2.4F] increase above baseline temperature, and/or hemodynamic instability) or genitourinary symptoms (acute dysuria or new/worsening urinary symptoms). Two reviewers independently screened search results, abstracted data, and appraised the risk of bias. Full-text randomized controlled trials (RCTs) and observational study designs were included without restriction on study language, duration, or year of publication. RESULTS We screened 984 citations and included 4 studies comprising 652 older adults (mean age was 84.6 years and 63.5% were women). The four studies were published between 1996 and 2022, and included one RCT, two prospective observational cohort studies, and one retrospective chart review. None of the four studies demonstrated a significant effect of antibiotics on delirium outcomes, with two studies reported a worsening of outcomes among adults who received antibiotics. The three observational studies included had a moderate or serious overall risk of bias, while the one RCT had a high overall risk of bias. CONCLUSIONS Our systematic review found no evidence that treatment with antibiotics is associated with improved delirium outcomes in older adults with pyuria or bacteriuria and without systemic signs of infection or genitourinary symptoms. Overall, the evidence was limited, largely observational, and had substantial risk of bias.
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Affiliation(s)
- Nathan M Stall
- Division of General Internal Medicine and Geriatrics, Sinai Health and the University Health Network, Toronto, Canada
- Women's Age Lab and Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Christopher Kandel
- Department of Medicine, University of Toronto, Toronto, Canada
- Michael Garron Hospital, Toronto East Health Network, Toronto, Canada
| | - Christina Reppas-Rindlisbacher
- Division of General Internal Medicine and Geriatrics, Sinai Health and the University Health Network, Toronto, Canada
- Women's Age Lab and Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Kieran L Quinn
- Division of General Internal Medicine and Geriatrics, Sinai Health and the University Health Network, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Lesley Wiesenfeld
- Division of Psychiatry, Sinai Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Derek R MacFadden
- Department of Medicine, University of Ottawa, Ottawa, Canada
- The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Jennie Johnstone
- Department of Medicine, University of Toronto, Toronto, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
- Infection Prevention and Control, Sinai Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Michael Fralick
- Division of General Internal Medicine and Geriatrics, Sinai Health and the University Health Network, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
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Shakya I, Zullo AR, Hayes KN, Joshi R, Berry SD. Risk factors for urinary tract infections among nursing home residents initiating sodium-glucose cotransporter-2 inhibitors. J Am Geriatr Soc 2024. [PMID: 38850171 DOI: 10.1111/jgs.19029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 04/29/2024] [Accepted: 05/04/2024] [Indexed: 06/10/2024]
Affiliation(s)
- Iju Shakya
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Andrew R Zullo
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Kaleen N Hayes
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Richa Joshi
- Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Sarah D Berry
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
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Nohra E, Appelbaum RD, Farrell MS, Carver T, Jung HS, Kirsch JM, Kodadek LM, Mandell S, Nassar AK, Pathak A, Paul J, Robinson B, Cuschieri J, Stein DM. Fever and infections in surgical intensive care: an American Association for the Surgery of Trauma Critical Care Committee clinical consensus document. Trauma Surg Acute Care Open 2024; 9:e001303. [PMID: 38835635 PMCID: PMC11149120 DOI: 10.1136/tsaco-2023-001303] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 04/11/2024] [Indexed: 06/06/2024] Open
Abstract
The evaluation and workup of fever and the use of antibiotics to treat infections is part of daily practice in the surgical intensive care unit (ICU). Fever can be infectious or non-infectious; it is important to distinguish between the two entities wherever possible. The evidence is growing for shortening the duration of antibiotic treatment of common infections. The purpose of this clinical consensus document, created by the American Association for the Surgery of Trauma Critical Care Committee, is to synthesize the available evidence, and to provide practical recommendations. We discuss the evaluation of fever, the indications to obtain cultures including urine, blood, and respiratory specimens for diagnosis of infections, the use of procalcitonin, and the decision to initiate empiric antibiotics. We then describe the treatment of common infections, specifically ventilator-associated pneumonia, catheter-associated urinary infection, catheter-related bloodstream infection, bacteremia, surgical site infection, intra-abdominal infection, ventriculitis, and necrotizing soft tissue infection.
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Affiliation(s)
- Eden Nohra
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Rachel D Appelbaum
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Thomas Carver
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Hee Soo Jung
- Department of Surgery, University of Wisconsin Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jordan Michael Kirsch
- Department of Surgery, Westchester Medical Center/ New York Medical College, Valhalla, NY, USA
| | - Lisa M Kodadek
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Samuel Mandell
- Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Aussama Khalaf Nassar
- Department of Surgery, Section of Acute Care Surgery, Stanford University, Stanford, California, USA
| | - Abhijit Pathak
- Department of Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jasmeet Paul
- Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Bryce Robinson
- Department of Surgery, Harborview Medical Center, Seattle, Washington, USA
| | - Joseph Cuschieri
- Department of Surgery, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA
| | - Deborah M Stein
- Department of Surgery, University of Maryland Baltimore, Baltimore, Maryland, USA
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Yu J, Varella Pereira GM, Allen-Brady K, Cuffolo R, Siddharth A, Koch M, Chua JWF, Sorrentino F, Dytko O, Ng KY, Violette P, Khullar V, Wang ZT, Cartwright R. Genetic polymorphisms associated with urinary tract infection in children and adults: a systematic review and meta-analysis. Am J Obstet Gynecol 2024; 230:600-609.e3. [PMID: 38128862 DOI: 10.1016/j.ajog.2023.12.018] [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] [Received: 08/22/2023] [Revised: 12/13/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION The lifetime risk of urinary tract infection is known from first-degree relative studies to be highly heritable. Associations have also been observed across the life course from pediatric urinary tract infection to recurrent urinary tract infection in adulthood, suggesting lifelong susceptibility factors. Candidate gene studies and genome-wide association studies have tested for genetic associations of urinary tract infection; however, no contemporary systematic synthesis of studies is available. OBJECTIVE We conducted a systematic review to identify all genetic polymorphisms tested for an association with urinary tract infection in children and adults; and to assess their strength, consistency, and risk of bias among reported associations. DATA SOURCES AND STUDY ELIGIBILITY CRITERIA PubMed, HuGE Navigator and Embase were searched from January 1, 2005 to November 16, 2023, using a combination of genetic and phenotype key words. STUDY APPRAISAL AND SYNTHESIS METHODS Fixed and random effects meta-analyses were conducted using codominant models of inheritance in metan. The interim Venice criteria were used to assess their credibility of pooled associations. RESULTS After removing 451 duplicates, 1821 studies reports were screened, with 106 selected for full-text review, 22 were included in the meta-analysis (7 adult studies and 15 pediatric studies). Our meta-analyses demonstrated significant pooled associations for pediatric urinary tract infection with variation in CXCR1, IL8, TGF, TLR4 and VDR; all of which have plausible roles in the pathogenesis of urinary tract infection. Our meta-analyses also demonstrated a significant pooled association for adult urinary tract infection with variation in CXCR1. All significant pooled associations were graded according to their epidemiological credibility, sample sizes, heterogeneity between studies, and risk of bias. CONCLUSION This systematic review provides a current synthesis of the known genetic architecture of urinary tract infection in childhood and adulthood; and should provide important information for researchers analysing future genetic association studies. Although, overall, the credibility of pooled associations was weak, the consistency of findings for rs2234671 single nucleotide polymorphisms of CXCR1 in both populations suggest a key role in the urinary tract infection pathogenesis.
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Affiliation(s)
- Jiakun Yu
- University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom.
| | - Glaucia Miranda Varella Pereira
- Department of Epidemiology and Biostatistics, Imperial College London, Norfolk Place, London, United Kingdom; Department of Urogynaecology, LNWH NHS Trust, London, United Kingdom; Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Brazil
| | - Kristina Allen-Brady
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Romana Cuffolo
- Department of Obstetrics and Gynaecology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Aditi Siddharth
- John Radcliffe Hospital, Headley Way, Headington, Oxford, United Kingdom
| | - Marianne Koch
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - John W F Chua
- Frimley Health NHS Foundation Trust, Frimley, United Kingdom
| | - Felice Sorrentino
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy
| | - Oskar Dytko
- Imperial College School of Medicine, Imperial College London, London, United Kingdom
| | - Kaa-Yung Ng
- Imperial College School of Medicine, Imperial College London, London, United Kingdom
| | - Philippe Violette
- Department of Health Research Methods, Evidence and Impact (HEI) and Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Vik Khullar
- Department of Urogynaecology, Imperial College London, United Kingdom
| | - Zhan Tao Wang
- Department of Surgery, Division of Urology, University of Western Ontario, London, Ontario, Canada
| | - Rufus Cartwright
- Department of Epidemiology and Biostatistics, Imperial College London, Norfolk Place, London, United Kingdom; Department of Urogynaecology, LNWH NHS Trust, London, United Kingdom; Department of Urogynaecology, Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
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6
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Gruba N, Sikora H, Ciesielska J, Rejmak W, Lesner A. Caspase-like activity is associated with bacterial infection of the urine in urinary tract diseases. Anal Biochem 2024; 688:115473. [PMID: 38280678 DOI: 10.1016/j.ab.2024.115473] [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] [Received: 06/20/2023] [Revised: 12/18/2023] [Accepted: 01/24/2024] [Indexed: 01/29/2024]
Abstract
Urinary tract infections (UTIs) are a serious public health problem. They can be caused by a number of pathogens, but the most common are Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis and Staphylococcus saprophyticus. Bacterial infection is diagnosed by examining a urine sample. The presence of bacteria or white blood cells is determined under a microscope or a urine culture is performed. In this study, we used a panel of chromogenic substrates for the qualitative determination of specific enzyme activity in the urine of patients with confirmed bacterial infection and/or urinary tract disease. Healthy patients were used as a control group. It turned out that in the case of Escherichia coli infection, we observed the activity of the caspase subunit of the human 20S proteasome. We did not observe similar correlations for infections with other types of bacteria.
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Affiliation(s)
- Natalia Gruba
- University of Gdansk, Faculty of Chemistry, Wita Stwosza 63 Street, PL 80-308, Gdańsk, Poland.
| | - Honorata Sikora
- University of Gdansk, Faculty of Chemistry, Wita Stwosza 63 Street, PL 80-308, Gdańsk, Poland
| | - Justyna Ciesielska
- University of Gdansk, Faculty of Chemistry, Wita Stwosza 63 Street, PL 80-308, Gdańsk, Poland
| | - Wiktoria Rejmak
- University of Gdansk, Faculty of Chemistry, Wita Stwosza 63 Street, PL 80-308, Gdańsk, Poland
| | - Adam Lesner
- University of Gdansk, Faculty of Chemistry, Wita Stwosza 63 Street, PL 80-308, Gdańsk, Poland
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7
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Samarawickrama SS, Illangakoon HU, Uthuman A, Saranga V, Janaka C. The Clinical Profile of Patients With Culture-Positive Urinary Tract Infections Admitting to a Tertiary Hospital in Sri Lanka. Cureus 2024; 16:e58666. [PMID: 38774169 PMCID: PMC11106549 DOI: 10.7759/cureus.58666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2024] [Indexed: 05/24/2024] Open
Abstract
Introduction Urinary tract infections (UTIs) are globally prevalent. This study explores the clinical and pathological profile of culture-positive UTI patients at Sri Jayewardenepura General Hospital. Method In this descriptive cross-sectional study conducted at Sri Jayewardenepura General Hospital from December 2020 to May 2021, we evaluated patients over 14 years with positive urine culture reports. Excluding those with HIV, undergoing chemotherapy, or pregnant, we used consecutive sampling. Data were collected via interviewer-administered questionnaires and analyzed using SPSS version 21.0 (IBM Inc., Armonk, New York), employing descriptive statistics and Fisher's exact tests to identify factors associated with urinary tract infections. Results The study involved approximately 278 participants. The mean age remained 60 ± 20.279 years, with over half of the participants being female. Common symptoms like fever and lower abdominal pain were observed in 22.30% of cases. The incidence of acute kidney injury was 30.58%. Escherichia coli (36%) and Klebsiella pneumoniae (26%) were the predominant organisms found. Indwelling catheters and other urinary tract conditions were considered risk factors. Patients with at least one risk factor were more likely to receive antibiotics before the urine culture. Similarly, males exhibited a higher prevalence of at least a risk factor than females. Conclusion UTIs are a significant clinical issue in older populations, with females being more susceptible. Fever and abdominal pain were common symptoms. Escherichia coli and Klebsiella pneumoniae were the most frequent causative agents. Further research is necessary to identify risk factors and predictors of antimicrobial resistance in UTI patients.
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Affiliation(s)
- Sincy S Samarawickrama
- Department of Medicine, Goulburn Valley Health, Shepparton, AUS
- Department of Medicine, University of Colombo, Colombo, LKA
| | | | - Ali Uthuman
- Department of Rural Health, University of Melbourne, Shepparton, AUS
- Department of General Medicine, Goulburn Valley Health, Sehpparton, AUS
| | - Vinod Saranga
- Department of Surgery, Sri Jayewardenepura General Hospital, Sri Jayewardenepura Kotte, LKA
| | - Chaminda Janaka
- Department of Medicine, Sri Jayawardenepuera Genral Hospital, Nugegoda, LKA
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8
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Raveloson H, Ben Hassen J, Koraib R, Jhouri A, Schlatter J. Appropriate prescription of cytobacteriological urine examinations in older adults. Urologia 2024:3915603241244936. [PMID: 38557329 DOI: 10.1177/03915603241244936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Cytobacteriological urine examinations (CBEU) are frequently ordered for the older adults, sometimes without straightforward indication and with the risk of prescribing empirical antibiotics. The aim of this study was to evaluate the relevance of the CBEU prescription and empiric antibiotic therapy in our geriatric hospital. Among 129 patients (mean age 84 years, sex ratio 0.69), 229 CBEU were collected with 20.9% of inappropriate indication. Cultures were sterile in 43% (n = 99) of cases and positive in 57% (n = 130) cases. Gram-negative bacilli dominated the isolated bacteria (76.9%) followed by gram-positive cocci (17.6%). In 113 patients, probabilistic antibiotic therapy was prescribed of which 68 treatments were initiated before the CBEU. Ceftriaxone and amoxicillin plus clavulanic acid were the main therapeutic option used representing 70.8% of cases. Antibiotic therapy was re-evaluated after 3 days in 74.3% of patients. Efforts to reduce the number of useless ECBUs by training doctors to follow official guidelines are a priority.
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Affiliation(s)
| | - Jihène Ben Hassen
- Assistance Publique des Hôpitaux de Paris, Hôpital Paul Doumer, Labruyère, France
| | - Rihab Koraib
- Assistance Publique des Hôpitaux de Paris, Hôpital Paul Doumer, Labruyère, France
| | - Aziza Jhouri
- Assistance Publique des Hôpitaux de Paris, Hôpital Paul Doumer, Labruyère, France
| | - Joël Schlatter
- Assistance Publique des Hôpitaux de Paris, Hôpital Paul Doumer, Labruyère, France
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Ebrahimzadeh T, Basu U, Lutz KC, Gadhvi J, Komarovsky JV, Li Q, Zimmern PE, De Nisco NJ. Inflammatory markers for improved recurrent UTI diagnosis in postmenopausal women. Life Sci Alliance 2024; 7:e202302323. [PMID: 38331474 PMCID: PMC10853434 DOI: 10.26508/lsa.202302323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/10/2024] Open
Abstract
Recurrent urinary tract infection (rUTI) severely impacts postmenopausal women. The lack of rapid and accurate diagnostic tools is a major obstacle in rUTI management as current gold standard methods have >24-h diagnostic windows. Work in animal models and limited human cohorts have identified robust inflammatory responses activated during UTI. Consequently, urinary inflammatory cytokines secreted during UTI may function as diagnostic biomarkers. This study aimed to identify urinary cytokines that could accurately diagnose UTI in a controlled cohort of postmenopausal women. Women passing study exclusion criteria were classified into no UTI and active rUTI groups, and urinary cytokine levels were measured by immunoassay. Pro-inflammatory cytokines IL-8, IL-18, IL-1β, and monocyte chemoattractant protein-1 were significantly elevated in the active rUTI group, and anti-inflammatory cytokines IL-13 and IL-4 were elevated in women without UTI. We evaluated cytokine diagnostic performance and found that an IL-8, prostaglandin E2, and IL-13 multivariable model had the lowest misclassification rate and highest sensitivity. Our data identify urinary IL-8, prostaglandin E2, and IL-13 as candidate biomarkers that may be useful in the development of immunoassay-based UTI diagnostics.
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Affiliation(s)
- Tahmineh Ebrahimzadeh
- https://ror.org/049emcs32 Department of Biological Sciences, University of Texas at Dallas, Dallas, TX, USA
| | - Ujjaini Basu
- https://ror.org/049emcs32 Department of Biological Sciences, University of Texas at Dallas, Dallas, TX, USA
| | - Kevin C Lutz
- https://ror.org/049emcs32 Department of Mathematics, University of Texas at Dallas, Dallas, TX, USA
| | - Jashkaran Gadhvi
- https://ror.org/049emcs32 Department of Biological Sciences, University of Texas at Dallas, Dallas, TX, USA
| | - Jessica V Komarovsky
- https://ror.org/049emcs32 Department of Biological Sciences, University of Texas at Dallas, Dallas, TX, USA
| | - Qiwei Li
- https://ror.org/049emcs32 Department of Mathematics, University of Texas at Dallas, Dallas, TX, USA
| | - Philippe E Zimmern
- https://ror.org/05byvp690 Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nicole J De Nisco
- https://ror.org/049emcs32 Department of Biological Sciences, University of Texas at Dallas, Dallas, TX, USA
- https://ror.org/05byvp690 Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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10
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Westcott MM, Morse AE, Troy G, Blevins M, Wierzba T, Sanders JW. Photochemical inactivation as an alternative method to produce a whole-cell vaccine for uropathogenic Escherichia coli (UPEC). Microbiol Spectr 2024; 12:e0366123. [PMID: 38315025 PMCID: PMC10913755 DOI: 10.1128/spectrum.03661-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/10/2024] [Indexed: 02/07/2024] Open
Abstract
Uropathogenic Escherichia coli (UPEC) is the primary causative agent of lower urinary tract infection (UTI). UTI presents a serious health risk and has considerable secondary implications including economic burden, recurring episodes, and overuse of antibiotics. A safe and effective vaccine would address this widespread health problem and emerging antibiotic resistance. Killed, whole-cell vaccines have shown limited efficacy to prevent recurrent UTI in human trials. We explored photochemical inactivation with psoralen drugs and UVA light (PUVA), which crosslinks nucleic acid, as an alternative to protein-damaging methods of inactivation to improve whole-cell UTI vaccines. Exposure of UPEC to the psoralen drug AMT and UVA light resulted in a killed but metabolically active (KBMA) state, as reported previously for other PUVA-inactivated bacteria. The immunogenicity of PUVA-UPEC as compared to formalin-inactivated UPEC was compared in mice. Both generated high UPEC-specific serum IgG titers after intramuscular delivery. However, using functional adherence as a measure of surface protein integrity, we found differences in the properties of PUVA- and formalin-inactivated UPEC. Adhesion mediated by Type-1 and P-fimbriae was severely compromised by formalin but was unaffected by PUVA, indicating that PUVA preserved the functional conformation of fimbrial proteins, which are targets of protective immune responses. In vitro assays indicated that although they retained metabolic activity, PUVA-UPEC lost virulence properties that could negatively impact vaccine safety. Our results imply the potential for PUVA to improve killed, whole-cell UTI vaccines by generating bacteria that more closely resemble their live, infectious counterparts relative to vaccines generated with protein-damaging methods. IMPORTANCE Lower urinary tract infection (UTI), caused primarily by uropathogenic Escherichia coli, represents a significant health burden, accounting for 7 million primary care and 1 million emergency room visits annually in the United States. Women and the elderly are especially susceptible and recurrent infection (rUTI) is common in those populations. Lower UTI can lead to life-threatening systemic infection. UTI burden is manifested by healthcare dollars spent (1.5 billion annually), quality of life impact, and resistant strains emerging from antibiotic overuse. A safe and effective vaccine to prevent rUTI would address a substantial healthcare issue. Vaccines comprised of inactivated uropathogenic bacteria have yielded encouraging results in clinical trials but improvements that enhance vaccine performance are needed. To that end, we focused on inactivation methodology and provided data to support photochemical inactivation, which targets nucleic acid, as a promising alternative to conventional protein-damaging inactivation methods to improve whole-cell UTI vaccines.
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Affiliation(s)
- Marlena M. Westcott
- Department of Microbiology and Immunology, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
| | - Alexis E. Morse
- Department of Microbiology and Immunology, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
| | - Gavin Troy
- Department of Microbiology and Immunology, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
| | - Maria Blevins
- Department of Internal Medicine, Infectious Diseases Section, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
| | - Thomas Wierzba
- Department of Internal Medicine, Infectious Diseases Section, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
| | - John W. Sanders
- Department of Internal Medicine, Infectious Diseases Section, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
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Bhasin A, Griffey RT, Ruhnke GW. Many (un)happy returns: Challenges and opportunities for potentially avoidable ED visits after discharge to a skilled nursing facility. J Hosp Med 2024; 19:77-78. [PMID: 37997187 DOI: 10.1002/jhm.13240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/04/2023] [Indexed: 11/25/2023]
Affiliation(s)
- Ajay Bhasin
- Department of Medicine, Division of Hospital Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Pediatrics, Division of Hospital-Based Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Richard T Griffey
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Gregory W Ruhnke
- Department of Medicine, Section of Hospital Medicine, University of Chicago, Chicago, Illinois, USA
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12
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Fésüs A, Matuz M, Papfalvi E, Hambalek H, Ruzsa R, Tánczos B, Bácskay I, Lekli I, Illés Á, Benkő R. Evaluation of the Diagnosis and Antibiotic Prescription Pattern in Patients Hospitalized with Urinary Tract Infections: Single-Center Study from a University-Affiliated Hospital. Antibiotics (Basel) 2023; 12:1689. [PMID: 38136723 PMCID: PMC10741002 DOI: 10.3390/antibiotics12121689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/21/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023] Open
Abstract
UTIs (urinary tract infections) are common bacterial infections with a non-negligible hospitalization rate. The diagnosis of UTIs remains a challenge for prescribers and a common source of misdiagnosis. This retrospective observational study aimed to evaluate whether recorded diagnosis by clinicians and empirical antibiotic therapy met the EAU (European Association of Urology) guideline in patients hospitalized with UTI. The study was conducted at an internal medicine unit of a tertiary care medical center in Hungary. The diagnosis was assessed based on clinical presentation, physical examination, and laboratory (including microbiological) results, considering all the potential risk factors. Diagnosis was considered misdiagnosis when not confirmed by clinical presentation or clinical signs and symptoms. Evaluation of empirical antibiotic therapy was performed only for confirmed UTIs. Empirical treatment was considered guideline-adherent when complying with the relevant recommendations. Out of 185 patients, 41.6% failed to meet EAU-based UTI diagnosis criteria, of which 27.6% were misdiagnosed and 14.1% were ABU (asymptomatic bacteriuria). The diagnosis of urosepsis recorded at admission (9.7%, 18/185) was not confirmed either by clinical or microbiological tests in five (5/18) cases. The initial empirical therapies for UTI showed a relatively low rate (45.4%) of guideline adherence regarding agent selection. The most common guideline-non-adherent therapies were combinations with metronidazole (16.7%). Dosage appropriateness assessments showed a guideline adherence rate of 36.1%, and underdosing due to high body weight was common (9.3%). Overall (agent, route of administration, dose, duration) guideline adherence was found to be substantially low (10.2%). We found a relatively high rate of misdiagnosed UTIs. Written protocols on the ward may be crucial in reducing misdiagnosis and in optimizing antibiotic use.
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Affiliation(s)
- Adina Fésüs
- Department of Pharmacology, Faculty of Pharmacy, University of Debrecen, H-4032 Debrecen, Hungary; (A.F.); (B.T.); (I.L.)
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Debrecen, H-4032 Debrecen, Hungary;
- Institute of Healthcare Industry, University of Debrecen, H-4032 Debrecen, Hungary
| | - Mária Matuz
- Clinical Pharmacy Department, Faculty of Pharmacy, University of Szeged, H-6725 Szeged, Hungary; (M.M.); (E.P.); (H.H.); (R.R.)
- Central Pharmacy, Albert Szent Györgyi Medical Center, University of Szeged, H-6725 Szeged, Hungary
| | - Erika Papfalvi
- Clinical Pharmacy Department, Faculty of Pharmacy, University of Szeged, H-6725 Szeged, Hungary; (M.M.); (E.P.); (H.H.); (R.R.)
- Department of Emergency Medicine, Albert Szent Györgyi Medical Center, University of Szeged, H-6725 Szeged, Hungary
| | - Helga Hambalek
- Clinical Pharmacy Department, Faculty of Pharmacy, University of Szeged, H-6725 Szeged, Hungary; (M.M.); (E.P.); (H.H.); (R.R.)
| | - Roxána Ruzsa
- Clinical Pharmacy Department, Faculty of Pharmacy, University of Szeged, H-6725 Szeged, Hungary; (M.M.); (E.P.); (H.H.); (R.R.)
| | - Bence Tánczos
- Department of Pharmacology, Faculty of Pharmacy, University of Debrecen, H-4032 Debrecen, Hungary; (A.F.); (B.T.); (I.L.)
| | - Ildikó Bácskay
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Debrecen, H-4032 Debrecen, Hungary;
- Institute of Healthcare Industry, University of Debrecen, H-4032 Debrecen, Hungary
| | - István Lekli
- Department of Pharmacology, Faculty of Pharmacy, University of Debrecen, H-4032 Debrecen, Hungary; (A.F.); (B.T.); (I.L.)
| | - Árpád Illés
- Department of Internal Medicine, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary;
| | - Ria Benkő
- Clinical Pharmacy Department, Faculty of Pharmacy, University of Szeged, H-6725 Szeged, Hungary; (M.M.); (E.P.); (H.H.); (R.R.)
- Central Pharmacy, Albert Szent Györgyi Medical Center, University of Szeged, H-6725 Szeged, Hungary
- Department of Emergency Medicine, Albert Szent Györgyi Medical Center, University of Szeged, H-6725 Szeged, Hungary
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13
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Affiliation(s)
- Morten Lindbæk
- Antibiotic centre for primary care, Department of general practice, University of Oslo, Oslo, Norway
| | - Arnfinn Sundsfjord
- Norwegian National Advisory Unit on Detection of Antimicrobial Resistance, Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
- Host-Microbe-Interaction research group, Department of Medical Biology, UiT The Artic University of Norway, Tromsø, Norway
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Kofoed B, Morris J, Rich J. An Initiative to Stop Antibiotics Prescribed for Urinary Symptoms When Urine Culture Is Negative. J Healthc Qual 2023; 45:371-376. [PMID: 37919958 DOI: 10.1097/jhq.0000000000000403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
ABSTRACT Urinary symptoms pose frequent diagnostic and management challenges in the emergency department (ED). In our regional health system, we identified the problem of patients started on antibiotics for urinary symptoms in the ED without a process for eventual review or discontinuation if urine culture (UC) later resulted as negative. To address this gap, we implemented a pharmacist-driven follow-up process to discontinue antibiotics after a negative UC. After project implementation, cases reviewed by a pharmacist increased from 0% to 96.7%. Patients contacted to discontinue antibiotics increased from 0% to 40% postintervention. This process improvement is now shared across five rural departments. Our results have broad applicability in any ED environment.
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15
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Wang J, Foxman B, Rao K, Cassone M, Gibson K, Mody L, Snitkin ES. Association of patient clinical and gut microbiota features with vancomycin-resistant enterococci environmental contamination in nursing homes: a retrospective observational study. THE LANCET. HEALTHY LONGEVITY 2023; 4:e600-e607. [PMID: 37924841 DOI: 10.1016/s2666-7568(23)00188-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/22/2023] [Accepted: 08/29/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Preventing transmission is crucial for reducing infections with multidrug-resistant organisms (MDROs) in nursing homes. To identify resident characteristics associated with MDRO spread, we investigated associations between patient characteristics and contamination of their proximate room surfaces with vancomycin-resistant enterococci (VRE). METHODS In this retrospective observational study, we used demographic and clinical data (including data on comorbidities, physical independence, catheter use within the past 30 days, and antibiotic exposure within the past 30 days) and surveillance cultures of patient body sites and room surfaces at enrolment and during weekly follow-up visits within the first month, and monthly thereafter (up to 6 months), in six US nursing homes collected in a previous clinical trial (September, 2016, to August, 2018). We did 16S rRNA gene sequencing on perirectal surveillance swabs to investigate the association between the gut microbiota and the culture status of participants and their rooms. FINDINGS We included 245 participants (mean age 72·5 years [SD 13·6]; 111 [45%] were men, 134 [55%] were women, 132 [54%] were non-Hispanic white, and 112 [46%] were African American). We collected 2802 participant samples and 5592 environmental samples. At baseline, VRE colonisation was present in 49 (20%) participants, with environmental surfaces being contaminated in 36 (73%) of these patients. Hand contamination among VRE-colonised participants was more common in those with environmental contamination compared with those without (50 [51%] of 99 vs seven [13%] of 55; p<0·0001). We found a correlation between hand contamination and both groin and perirectal colonisation and contamination of various high-touch room surfaces (Cohen's κ 0·43). We found participant microbiota composition to be associated with antibiotic receipt within the past 30 days (high-risk antibiotics p=0·011 and low-risk antibiotics p=0·0004) and participant VRE colonisation status, but not environmental contamination among VRE-colonised participants (participant only vs uncolonised p=0·071, both participant and environment vs uncolonised p=0·025, and participant only vs participant and environment p=0·29). Multivariable analysis to identify independent factors associated with VRE-colonised participants contaminating their environment identified antibiotic exposure (adjusted odds ratio 2·75 [95% CI 1·22-6·16]) and male sex (2·75 [1·24-6·08]) as being associated with increased risk of environmental contamination, and physical dependence as being associated with a reduced risk of environmental contamination (0·91 [0·83-0·99]). INTERPRETATION Our data support antibiotic use and interaction with proximal surfaces by physically independent nursing home residents as under-appreciated drivers of environmental contamination among VRE-colonised residents. Integrating resident hand-hygiene education and antimicrobial stewardship will strengthen efforts to reduce MDROs in nursing homes. FUNDING US Centers for Disease Control and Prevention, National Institute of Health, Canadian Institutes of Health Research, and University of Michigan.
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Affiliation(s)
- Joyce Wang
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Betsy Foxman
- Center for Molecular and Clinical Epidemiology of Infectious Diseases, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Krishna Rao
- Division of Infectious Diseases, Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Marco Cassone
- Division of Geriatrics and Palliative Care Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Kristen Gibson
- Division of Geriatrics and Palliative Care Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Lona Mody
- Division of Geriatrics and Palliative Care Medicine, University of Michigan Medical School, Ann Arbor, MI, USA; Geriatric Research Education and Clinical Center, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Evan S Snitkin
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI, USA; Division of Infectious Diseases, Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
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Felix HC, Brown CC, Narcisse MR, Vincenzo JL, Andersen JA, Weech-Maldonado R, Bradway CW. Characteristics of Nursing Homes with High Rates of Urinary Tract Infections among Their Residents with Obesity. UROLOGIC NURSING 2023; 46:273-303. [PMID: 38774393 PMCID: PMC11105761 DOI: 10.7257/2168-4626.2023.43.6.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
Nursing home residents with obesity are at high risk for contracting urinary tract infections. In this research study, we found nursing homes in multi-facility chain organizations, for-profit status, nursing home size, obesity rate of resident population, and market competition were significantly associated with rates of urinary tract infections among residents with obesity.
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Affiliation(s)
- Holly C Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Clare C Brown
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Marie-Rachelle Narcisse
- Warren Alpert Medical School of Brown University and a Research Scientist at Bradley Hospital, Providence, RI
| | - Jennifer L Vincenzo
- College of Health Professions, University of Arkansas for Medical Sciences, Fayetteville, AR
| | - Jennifer A Andersen
- Center for Community Health and Research, College of Medicine, University of Arkansas for Medical Sciences, Fayetteville, AR
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McQuown CM, Tsivitse EK. Nonspecific Complaints in Older Emergency Department Patients. Clin Geriatr Med 2023; 39:491-501. [PMID: 37798061 DOI: 10.1016/j.cger.2023.04.007] [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: 10/07/2023]
Abstract
Nonspecific complaints such as generalized weakness and fatigue are common in older adults presenting to an emergency department. These complaints may be caused by acute or chronic medical problems, or they may be exacerbated or caused by socioeconomic risks factors. Acute causes may be related to serious medical conditions requiring prompt treatment. A thorough history and physical examination in conjunction with an interdisciplinary approach allows emergency departments to identify acute conditions as well as geriatric syndromes and unmet home needs, such as food insecurity and caregiver burden. A whole-health system approach should be used for safe transitions of care.
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Affiliation(s)
- Colleen M McQuown
- Louis Stokes Veterans Affairs Medical Center, 10701 East Boulevard. Cleveland, OH 44106, USA.
| | - Emily K Tsivitse
- Louis Stokes Veterans Affairs Medical Center, 10701 East Boulevard. Cleveland, OH 44106, USA
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18
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Wang Y, Chen T, Zhang S, Zhang L, Li Q, Lv Q, Kong D, Jiang H, Ren Y, Jiang Y, Li Y, Huang W, Liu P. Clinical evaluation of metagenomic next-generation sequencing in unbiased pathogen diagnosis of urinary tract infection. J Transl Med 2023; 21:762. [PMID: 37891586 PMCID: PMC10612365 DOI: 10.1186/s12967-023-04562-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Early availability of pathogen identification in urinary tract infections (UTIs) has critical importance in disease management. Metagenomic next-generation sequencing (mNGS) has the potential to transform how acute and serious infections are diagnosed by offering unbiased and culture-free pathogen detection. However, clinical experience with application of the mNGS test is relatively limited. METHODS We therefore established a MinION-based mNGS pathogens diagnostic platform and evaluated its potential for clinical implementation in UTIs with clinical samples. 213 urine samples from patients with suspected UTIs were included and subjected to mNGS testing using the MinION platform. mNGS results were compared to the gold standard of clinical culture and composite standard of combining clinical testing, confirmatory qPCR testing, and clinical adjudication by doctors. RESULTS The mNGS exhibited a sensitivity of 81.4% and a specificity of 92.3%, along with a positive predictive value of 96.6%, a negative predictive value of 64.9%, and an overall accuracy of 84.4%, all of which were determined based on the gold standard of routine culture results. When assessed against the composite standard, the sensitivity and specificity both increased to 89.9% and 100%, respectively, while the accuracy rose to 92.4%. Notably, the positive predictive value and negative predictive value also saw improvements, reaching 100% and 76.8%, respectively. Moreover, this diagnostic platform successfully identified dsDNA viruses. Among the 65 culture-negative samples, the viral detection rate reached 33.8% (22/65) and was subsequently validated through qPCR. Furthermore, the automatic bioinformatics pipeline we developed enabled one-click analysis from data to results, leading to a significant reduction in diagnosis time. CONCLUSION These results demonstrate that the pathogen detection performance of mNGS is sufficient for diagnostic testing in clinical settings. As the method is generally unbiased, it can improve diagnostic testing of UTIs and other microbial infections.
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Affiliation(s)
- Ye Wang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, Beijing, China
| | - Ting Chen
- Department of Critical Care Medicine, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Shengwei Zhang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, Beijing, China
| | - Lei Zhang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, Beijing, China
| | - Qian Li
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, Beijing, China
| | - Qingyu Lv
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, Beijing, China
| | - Decong Kong
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, Beijing, China
| | - Hua Jiang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, Beijing, China
| | - Yuhao Ren
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, Beijing, China
| | - Yongqiang Jiang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, Beijing, China
| | - Yan Li
- Department of Critical Care Medicine, The Fifth Medical Center of PLA General Hospital, Beijing, China.
| | - Wenhua Huang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, Beijing, China.
| | - Peng Liu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, Beijing, China.
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Khan MA, Rahman AU, Khan B, Al-Mijalli SH, Alswat AS, Amin A, Eid RA, Zaki MSA, Butt S, Ahmad J, Fayad E, Ullah A. Antibiotic Resistance Profiling and Phylogenicity of Uropathogenic Bacteria Isolated from Patients with Urinary Tract Infections. Antibiotics (Basel) 2023; 12:1508. [PMID: 37887209 PMCID: PMC10603882 DOI: 10.3390/antibiotics12101508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/16/2023] [Accepted: 09/20/2023] [Indexed: 10/28/2023] Open
Abstract
Urinary tract infections (UTIs) are healthcare problems that commonly involve bacterial and, in some rare instances, fungal or viral infections. The irrational prescription and use of antibiotics in UTI treatment have led to an increase in antibiotic resistance. Urine samples (145) were collected from male and female patients from Lower Dir, Khyber Pakhtunkhwa (KP), Pakistan. Biochemical analyses were carried out to identify uropathogens. Molecular analysis for the identification of 16S ribosomal RNA in samples was performed via Sanger sequencing. Evolutionary linkage was determined using Molecular Evolutionary Genetics Analysis-7 (MEGA-7). The study observed significant growth in 52% of the samples (83/145). Gram-negative bacteria were identified in 85.5% of samples, while Gram-positive bacteria were reported in 14.5%. The UTI prevalence was 67.5% in females and 32.5% in males. The most prevalent uropathogenic bacteria were Klebsiella pneumoniae (39.7%, 33/83), followed by Escherichia coli (27.7%, 23/83), Pseudomonas aeruginosa (10.8%, 9/83), Staphylococcus aureus (9.6%, 8/83), Proteus mirabilis (7.2%, 6/83) and Staphylococcus saprophyticus (4.8%, 4/83). Phylogenetic analysis was performed using the neighbor-joining method, further confirming the relation of the isolates in our study with previously reported uropathogenic isolates. Antibiotic susceptibility tests identified K. pneumonia as being sensitive to imipenem (100%) and fosfomycin (78.7%) and resistant to cefuroxime (100%) and ciprofloxacin (94%). Similarly, E. coli showed high susceptibility to imipenem (100%), fosfomycin (78.2%) and nitrofurantoin (78.2%), and resistance to ciprofloxacin (100%) and cefuroxime (100%). Imipenem was identified as the most effective antibiotic, while cefuroxime and ciprofloxacin were the least. The phylogenetic tree analysis indicated that K. pneumoniae, E. coli, P. aeruginosa, S. aureus and P. mirabilis clustered with each other and the reference sequences, indicating high similarity (based on 16S rRNA sequencing). It can be concluded that genetically varied uropathogenic organisms are commonly present within the KP population. Our findings demonstrate the need to optimize antibiotic use in treating UTIs and the prevention of antibiotic resistance in the KP population.
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Affiliation(s)
- Muhammad Ajmal Khan
- Centre for Biotechnology and Microbiology, University of Peshawar, Peshawar 25000, Khyber Pakhtunkhwa, Pakistan; (M.A.K.); (J.A.)
| | - Atta Ur Rahman
- Leprosy Laboratory, Department of Parasite Biology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil;
| | - Bakhtawar Khan
- Institute of Brain Disorders, Department of Physiology, Dalian Medical University, Dalian 116044, China
| | - Samiah Hamad Al-Mijalli
- Department of Biology, College of Sciences, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia;
| | - Amal S. Alswat
- Department of Biotechnology, College of Sciences, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia; (A.S.A.); (E.F.)
| | - Aftab Amin
- Center for Cancer Research, and State Key Lab of Molecular Neuroscience, Division of Life Science, Hong Kong University of Science and Technology, Hong Kong, China;
| | - Refaat A. Eid
- Department of Pathology, College of Medicine, King Khalid University, P.O. Box 62529, Abha 12573, Saudi Arabia;
| | - Mohamed Samir A. Zaki
- Anatomy Department, College of Medicine, King Khalid University, P.O. Box 62529, Abha 61413, Saudi Arabia;
| | - Sadia Butt
- Department of Microbiology, Shaheed Benazir Bhutto Women University Peshawar, Peshawar 25000, Khyber Pakhtunkhwa, Pakistan;
| | - Jamshaid Ahmad
- Centre for Biotechnology and Microbiology, University of Peshawar, Peshawar 25000, Khyber Pakhtunkhwa, Pakistan; (M.A.K.); (J.A.)
| | - Eman Fayad
- Department of Biotechnology, College of Sciences, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia; (A.S.A.); (E.F.)
| | - Amin Ullah
- Department of Health & Biological Sciences, Abasyn University Peshawar, Peshawar 25000, Khyber Pakhtunkhwa, Pakistan
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20
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Zhou Y, Singh H, Hamilton W, Archer S, Tan S, Brimicombe J, Lyratzopoulos G, Walter FM. Improving the diagnostic process for patients with possible bladder and kidney cancer: a mixed-methods study to identify potential missed diagnostic opportunities. Br J Gen Pract 2023; 73:e575-e585. [PMID: 37253628 PMCID: PMC10242858 DOI: 10.3399/bjgp.2022.0602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/03/2023] [Accepted: 02/28/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Patients with bladder and kidney cancer may experience diagnostic delays. AIM To identify patterns of suboptimal care and contributors of potential missed diagnostic opportunities (MDOs). DESIGN AND SETTING Prospective, mixed-methods study recruiting participants from nine general practices in Eastern England between June 2018 and October 2019. METHOD Patients with possible bladder and kidney cancer were identified using eligibility criteria based on National Institute for Health and Care Excellence (NICE) guidelines for suspected cancer. Primary care records were reviewed at recruitment and at 1 year for data on symptoms, tests, referrals, and diagnosis. Referral predictors were examined using logistic regression. Semi-structured interviews were undertaken with 15 patients to explore their experiences of the diagnostic process, and these were analysed thematically. RESULTS Participants (n = 940) were mostly female (n = 657, 69.9%), with a median age of 71 years (interquartile range 64-77 years). In total, 268 (28.5%) received a referral and 465 (48.5%) had a final diagnosis of urinary tract infection (UTI). There were 33 (3.5%) patients who were diagnosed with cancer, including prostate (n = 17), bladder (n = 7), and upper urothelial tract (n = 1) cancers. Among referred patients, those who had a final diagnosis of UTI had the longest time to referral (median 81.5 days). Only one-third of patients with recurrent UTIs were referred despite meeting NICE referral guidelines. Qualitative findings revealed barriers during the diagnostic process, including inadequate clinical examination, female patients given repeated antibiotics without clinical reviews, and suboptimal communication of test results to patients. CONCLUSION Older females with UTIs might be at increased risk of MDOs for cancer. Targeting barriers during the initial diagnostic assessment and follow-up might improve quality of diagnosis.
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Affiliation(s)
- Yin Zhou
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, US
| | | | - Stephanie Archer
- Department of Public Health and Primary Care, University of Cambridge, Cambridge and Department of Psychology, University of Cambridge, Cambridge, UK
| | - Sapphire Tan
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - James Brimicombe
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare and Outcomes (ECHO), Department of Behavioural Science and Health, Institute of Epidemiology and Health Care (IEHC), University College London, London, UK
| | - Fiona M Walter
- Department of Public Health and Primary Care, University of Cambridge, Cambridge and Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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21
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Veillette JJ, Waters CD, Olson J, Vargyas G, Ingalls EM, Hutton MA, Tinker N, May SS, Foster RA, Stallsmith J, Vento TJ. Outcomes of patients with bacteriuria/pyuria of clinically undetermined significance (BPCUS) treated with antibiotics in 23 community hospital emergency departments. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e114. [PMID: 37502236 PMCID: PMC10369435 DOI: 10.1017/ash.2023.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 07/29/2023]
Abstract
The optimal management of bacteriuria/pyuria of clinically undetermined significance (BPCUS) is unknown. Among 220 emergency department patients prescribed antibiotics for BPCUS, we found frequent readmissions, which were mitigated by outpatient follow-up visits. Observation and follow-up for an unknown diagnosis should be emphasized over antibiotics due to high likelihood of readmissions.
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Affiliation(s)
- John J. Veillette
- Infectious Diseases Telehealth Service, Intermountain Healthcare, Murray, UT, USA
- Department of Pharmacy, Intermountain Medical Center, Murray, UT, USA
| | | | - Jared Olson
- Department of Pharmacy, Primary Children’s Hospital, Salt Lake City, UT, USA
- Division of Infectious Diseases, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - George Vargyas
- Utah Emergency Physicians, Intermountain Medical Center Emergency Department, Murray, UT, USA
| | - Emily M. Ingalls
- Department of Pharmacy, Intermountain Medical Center, Murray, UT, USA
| | - Mary A. Hutton
- Department of Pharmacy, Utah Valley Medical Center, Provo, UT, USA
| | - Nick Tinker
- Department of Pharmacy, Intermountain Medical Center, Murray, UT, USA
| | - Stephanie S. May
- Infectious Diseases Telehealth Service, Intermountain Healthcare, Murray, UT, USA
- Department of Pharmacy, Intermountain Medical Center, Murray, UT, USA
| | - Rachel A. Foster
- Department of Pharmacy, Intermountain Medical Center, Murray, UT, USA
| | - Jena Stallsmith
- Department of Pharmacy, Primary Children’s Hospital, Salt Lake City, UT, USA
- Division of Infectious Diseases, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Todd J. Vento
- Infectious Diseases Telehealth Service, Intermountain Healthcare, Murray, UT, USA
- Division of Clinical Epidemiology and Infectious Diseases, Intermountain Medical Center, Murray, UT, USA
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22
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Morales G, Abelson B, Reasoner S, Miller J, Earl AM, Hadjifrangiskou M, Schmitz J. The Role of Mobile Genetic Elements in Virulence Factor Carriage from Symptomatic and Asymptomatic Cases of Escherichia coli Bacteriuria. Microbiol Spectr 2023; 11:e0471022. [PMID: 37195213 PMCID: PMC10269530 DOI: 10.1128/spectrum.04710-22] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 05/01/2023] [Indexed: 05/18/2023] Open
Abstract
Uropathogenic Escherichia coli (UPEC) is extremely diverse genotypically and phenotypically. Individual strains can variably carry diverse virulence factors, making it challenging to define a molecular signature for this pathotype. For many bacterial pathogens, mobile genetic elements (MGEs) constitute a major mechanism of virulence factor acquisition. For urinary E. coli, the total distribution of MGEs and their role in the acquisition of virulence factors is not well defined, including in the context of symptomatic infection versus asymptomatic bacteriuria (ASB). In this work, we characterized 151 isolates of E. coli, derived from patients with either urinary tract infection (UTI) or ASB. For both sets of E. coli, we catalogued the presence of plasmids, prophage, and transposons. We analyzed MGE sequences for the presence of virulence factors and antimicrobial resistance genes. These MGEs were associated with only ~4% of total virulence associated genes, while plasmids contributed to ~15% of antimicrobial resistance genes under consideration. Our analyses suggests that, across strains of E. coli, MGEs are not a prominent driver of urinary tract pathogenesis and symptomatic infection. IMPORTANCE Escherichia coli is the most common etiological agent of urinary tract infections (UTIs), with UTI-associated strains designated "uropathogenic" E. coli or UPEC. Across urinary strains of E. coli, the global landscape of MGEs and its relationship to virulence factor carriage and clinical symptomatology require greater clarity. Here, we demonstrate that many of the putative virulence factors of UPEC are not associated with acquisition due to MGEs. The current work enhances our understanding of the strain-to-strain variability and pathogenic potential of urine-associated E. coli and points toward more subtle genomic differences distinguishing ASB from UTI isolates.
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Affiliation(s)
- Grace Morales
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, Tennessee, USA
| | - Benjamin Abelson
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Seth Reasoner
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, Tennessee, USA
| | - Jordan Miller
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, Tennessee, USA
| | - Ashlee M. Earl
- Infectious Disease and Microbiome Program, Broad Institute, Cambridge, Massachusetts, USA
| | - Maria Hadjifrangiskou
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, Tennessee, USA
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Institute for Infection, Immunology, and Inflammation, Vanderbilt University, Nashville, Tennessee, USA
| | - Jonathan Schmitz
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, Tennessee, USA
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Institute for Infection, Immunology, and Inflammation, Vanderbilt University, Nashville, Tennessee, USA
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23
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Washam C. Using Only as Needed: California Limits on Agricultural Antibiotics May Bring Relief from Resistant Infections. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:64003. [PMID: 37363825 DOI: 10.1289/ehp12902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
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24
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Maione A, Galdiero E, Cirillo L, Gambino E, Gallo MA, Sasso FP, Petrillo A, Guida M, Galdiero M. Prevalence, Resistance Patterns and Biofilm Production Ability of Bacterial Uropathogens from Cases of Community-Acquired Urinary Tract Infections in South Italy. Pathogens 2023; 12:pathogens12040537. [PMID: 37111423 PMCID: PMC10145297 DOI: 10.3390/pathogens12040537] [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: 02/23/2023] [Revised: 03/23/2023] [Accepted: 03/28/2023] [Indexed: 04/29/2023] Open
Abstract
Community-acquired urinary tract infections represent the most common infectious diseases in the community setting. Knowing the antibiotic resistance patterns of uropathogens is crucial for establishing empirical treatment. The aim of the current study is to determine the incidence of the causative agents of UTIs and their resistance profiles. Patients of all ages and both sexes were enrolled in the study, and admitted to San Ciro Diagnostic Center in Naples between January 2019 and Jun 2020. Bacterial identification and antibiotic susceptibility testing were carried out using Vitek 2 system. Among the 2741 urine samples, 1702 (62.1%) and 1309 (37.9%) were negative and positive for bacterial growth, respectively. Of 1309 patients with infection, 760 (73.1%) were females and 279 (26.9%) were males. The greatest number of positive cases were found in the in the elderly (>61 years). Regarding uropathogens, 1000 (96.2%) were Gram-negative while 39 (3.8%) were Gram-positive strains. The three most isolated pathogenic strains were Escherichia coli (72.2%), Klebsiella pneumoniae (12.4%), and Proteus mirabilis (9.0%). Strong biofilm formation ability was observed in about 30% of the tested isolates. The low resistance rates recorded against nitrofurantoin, fosfomycin, piperacillin-tazobactam, and gentamicin could suggest them as the most appropriate therapies for CA-UTIs.
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Affiliation(s)
- Angela Maione
- Department of Biology, University of Naples 'Federico II', Via Cinthia, 80126 Naples, Italy
| | - Emilia Galdiero
- Department of Biology, University of Naples 'Federico II', Via Cinthia, 80126 Naples, Italy
| | - Luigi Cirillo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", 80131 Naples, Italy
| | - Edvige Gambino
- Department of Biology, University of Naples 'Federico II', Via Cinthia, 80126 Naples, Italy
| | | | - Francesca Paola Sasso
- Department of Dermatology and Venereology, University of Rome "La Sapienza", 00161 Rome, Italy
| | | | - Marco Guida
- Department of Biology, University of Naples 'Federico II', Via Cinthia, 80126 Naples, Italy
| | - Marilena Galdiero
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", 81100 Naples, Italy
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25
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Matthiopoulou G, Ioannou P, Mathioudaki A, Papadakis JA, Daraki VN, Pappas A, Souris S, Maraki S, Stathopoulou C, Kofteridis DP. Asymptomatic Bacteriuria in Patients with Type 2 Diabetes Mellitus. Infect Dis Rep 2023; 15:43-54. [PMID: 36648859 PMCID: PMC9887587 DOI: 10.3390/idr15010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 01/09/2023] Open
Abstract
Objectives: Asymptomatic bacteriuria (ASB) is a common finding in patients with diabetes. Moreover, patients with diabetes and ASB have a greater risk for symptomatic urinary tract infections and associated severe complications. The aim of this study was to estimate the prevalence of ASB, as well as to identify independent risk factors and related pathogens associated with ASB in female and male patients with type 2 diabetes mellitus (T2D). Methods: This prospective case-control study was performed at the University hospital, and the Venezeleion General Hospital, Heraklion, Greece between 2012 and 2019. All patients with T2D attending the diabetes and hypertension outpatient clinics at both hospitals were enrolled, and data regarding their medical history and clinical and laboratory profiles were recorded. Asymptomatic patients with positive urine cultures were assigned as cases while those with negative urine cultures were designated as controls. Results: A total of 437 adult patients of which 61% were female and 39% were male patients with a mean age of 70.5 ± 9.6 years, were enrolled. The prevalence of ASB was 20.1%, in total. ASB was noted in 27% of female participants and 9.4% of male participants. Higher glycated hemoglobin (OR = 3.921, 95%CI: 1.521−10.109, p < 0.001) and urinary tract infection within the previous year (OR = 13.254, 95%CI: 2.245−78.241, p < 0.001) were independently positively associated with ASB, while higher levels of vitamin B12 were independently negatively associated with ASB (OR = 0.994 per ng/mL, 95%CI: 0.989−0.999, p < 0.001). Conclusions: Development of ASB was associated with specific factors, some of which may be modifiable. Interestingly, high B12 was found to be negatively associated with ASB.
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Affiliation(s)
- Georgia Matthiopoulou
- First Department of Internal Medicine, Venezeleion General Hospital of Heraklion, 714 09 Heraklion, Greece
- School of Medicine, University of Crete, 700 13 Heraklion, Greece
| | - Petros Ioannou
- School of Medicine, University of Crete, 700 13 Heraklion, Greece
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, 711 10 Heraklion, Greece
- Correspondence: (P.I.); (D.P.K.)
| | - Anna Mathioudaki
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, 711 10 Heraklion, Greece
| | - John A. Papadakis
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, 711 10 Heraklion, Greece
| | - Vasiliki N. Daraki
- Department of Endocrinology, University Hospital of Heraklion, 711 10 Heraklion, Greece
| | - Angelos Pappas
- Diabetes Unit, Venezeleion General Hospital of Heraklion, 714 09 Heraklion, Greece
| | - Sotiris Souris
- First Department of Internal Medicine, Venezeleion General Hospital of Heraklion, 714 09 Heraklion, Greece
| | - Sofia Maraki
- Department of Microbiology, University Hospital of Heraklion, 711 10 Heraklion, Greece
| | - Chrysoula Stathopoulou
- Laboratory of Rheumatology, Autoimmunity and Inflammation, Institute of Molecular Biology and Biotechnology, 700 13 Heraklion, Greece
| | - Diamantis P. Kofteridis
- School of Medicine, University of Crete, 700 13 Heraklion, Greece
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, 711 10 Heraklion, Greece
- Correspondence: (P.I.); (D.P.K.)
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Lila ASA, Rajab AAH, Abdallah MH, Rizvi SMD, Moin A, Khafagy ES, Tabrez S, Hegazy WAH. Biofilm Lifestyle in Recurrent Urinary Tract Infections. LIFE (BASEL, SWITZERLAND) 2023; 13:life13010148. [PMID: 36676100 PMCID: PMC9865985 DOI: 10.3390/life13010148] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/27/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023]
Abstract
Urinary tract infections (UTIs) represent one of the most common infections that are frequently encountered in health care facilities. One of the main mechanisms used by bacteria that allows them to survive hostile environments is biofilm formation. Biofilms are closed bacterial communities that offer protection and safe hiding, allowing bacteria to evade host defenses and hide from the reach of antibiotics. Inside biofilm communities, bacteria show an increased rate of horizontal gene transfer and exchange of resistance and virulence genes. Additionally, bacterial communication within the biofilm allows them to orchestrate the expression of virulence genes, which further cements the infestation and increases the invasiveness of the infection. These facts stress the necessity of continuously updating our information and understanding of the etiology, pathogenesis, and eradication methods of this growing public health concern. This review seeks to understand the role of biofilm formation in recurrent urinary tact infections by outlining the mechanisms underlying biofilm formation in different uropathogens, in addition to shedding light on some biofilm eradication strategies.
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Affiliation(s)
- Amr S. Abu Lila
- Department of Pharmaceutics, College of Pharmacy, University of Ha’il, Ha’il 81442, Saudi Arabia
- Molecular Diagnostics and Personalized Therapeutics Unit, University of Ha’il, Ha’il 81442, Saudi Arabia
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt
- Correspondence: (A.S.A.L.); (W.A.H.H.)
| | - Azza A. H. Rajab
- Department of Microbiology and Immunology, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt
| | - Marwa H. Abdallah
- Department of Pharmaceutics, College of Pharmacy, University of Ha’il, Ha’il 81442, Saudi Arabia
- Molecular Diagnostics and Personalized Therapeutics Unit, University of Ha’il, Ha’il 81442, Saudi Arabia
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt
| | - Syed Mohd Danish Rizvi
- Department of Pharmaceutics, College of Pharmacy, University of Ha’il, Ha’il 81442, Saudi Arabia
- Molecular Diagnostics and Personalized Therapeutics Unit, University of Ha’il, Ha’il 81442, Saudi Arabia
| | - Afrasim Moin
- Department of Pharmaceutics, College of Pharmacy, University of Ha’il, Ha’il 81442, Saudi Arabia
- Molecular Diagnostics and Personalized Therapeutics Unit, University of Ha’il, Ha’il 81442, Saudi Arabia
| | - El-Sayed Khafagy
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Suez Canal University, Ismailia 41522, Egypt
| | - Shams Tabrez
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Wael A. H. Hegazy
- Department of Microbiology and Immunology, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt
- Pharmacy Program, Department of Pharmaceutical Sciences, Oman College of Health Sciences, Muscat 113, Oman
- Correspondence: (A.S.A.L.); (W.A.H.H.)
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27
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[Urinary tract infections in older adults: Etiology and antimicrobial susceptibilities in a southern area of Spain]. Rev Esp Geriatr Gerontol 2023; 58:22-26. [PMID: 36707356 DOI: 10.1016/j.regg.2022.12.006] [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: 08/22/2022] [Revised: 12/20/2022] [Accepted: 12/25/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Urinary tract infection (UTI) is one of the most prevalent diseases in clinical practice and increases in patients older than 65years compared to middle-aged patients. In order to improve empirical treatment, the etiology and antibiotic sensitivity profile of the most frequent bacteria that produce UTIs in older people have been studied. MATERIAL AND METHODS Cross-sectional, descriptive and retrospective study in which isolated micro-organisms with significant counts in urine samples from patients with UTI were included. The global etiology and according to sex were analyzed. Only one urine sample per patient and UTI episode was considered. RESULTS Regarding the origin of the sample, the highest proportion was in primary care with 4853 urine cultures (51.6% of positive urine cultures), followed by hospital care with 3565 urine cultures (46.4% of positive urine cultures) and 94 urine cultures in nursing homes elderly (2% positive urine cultures). Escherichia coli was the most isolated micro-organism both in the population as a whole (54%) and in each of the analyzed groups. It was observed that E.coli isolated in women was significantly higher than in men (χ2, P=.044). Their sensitivity was: 80% fosfomycin and 75% amoxicillin-clavulanic acid. CONCLUSIONS E.coli continues to be the most frequently isolated micro-organism in UTI. Empirical treatment of UTI in our environment should include fosfomycin or amoxicillin-clavulanic acid, regardless of the health care unit and gender.
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Pabjańczyk I, Owczuk R, Kutaj-Wąsikowska H, Fronczek J, Węgrzyn K, Jasińska M, Jarocki P, Mudyna W, Mastalerz-Migas A, Pilecki Z, Czubak J, Marczyński WJ, Nowak S, Czuczwar M, Szczeklik W. Standards of perioperative management in total knee and hip arthroplasty procedures. A survey-based study. Part I: Preoperative management. Anaesthesiol Intensive Ther 2023; 55:262-271. [PMID: 38084570 PMCID: PMC10691462 DOI: 10.5114/ait.2023.132832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/14/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Recent years have seen an increasing number of elective total knee (TKA) and hip arthroplasty (THA) procedures. Since a wide variety of methods and procedures are used in perioperative management, a survey-based study was carried out to identify the patterns of practice in Polish hospitals. MATERIAL AND METHODS With the help of the LimeSurvey application, questionnaires for anaesthesio-logists and orthopaedists were prepared to gain insight into the preparation of patients for TKA and THA procedures and perioperative care. Questionnaires included both single and multiple-choice questions concerning among other things type of laboratory tests, additional examinations and consultations performed on a routine basis before elective TKA and THA procedures. RESULTS A total of 162 medical centres took part in the study. Questionnaire responses were obtained from 93 (57%) orthopaedics teams and 112 (69%) anaesthesiology teams. A mean (standard deviation, SD) of 7.2 (3.5) laboratory tests are routinely ordered before surgery. For example, 47% of orthopaedists and 20% of anaesthesiologists order urinalysis, while 53% of orthopaedists and 26% of anaesthesiologists order a CRP test. Seventy-nine per cent of orthopaedists refer patients for at least one specialist consultation before the procedure. Dental consultation is requested by 40%, gynaecological consultation by 27%. Patient preoperative education is provided by 85% of orthopaedists and preoperative rehabilitation is prescribed by 46% of them. A total of 56% surveyed anaesthesiologists perform pre-anaesthetic evaluation upon patients' hospital admission. CONCLUSIONS The study found that the number of examinations and specialist consultations conducted in Polish hospitals exceeded the scope of recommendations of scientific societies. Furthermore, the authors identified a need to standardise perioperative management in the form of Polish guidelines or recommendations, with the intention to improve patient safety and optimize health care expenses.
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Affiliation(s)
- Izabela Pabjańczyk
- Department of Intensive Care and Anaesthesiology, 5 Military Hospital with Polyclinic, Cracow, Poland
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Radosław Owczuk
- Department of Anaesthesiology and Intensive Care, Medical University of Gdańsk, Poland
| | | | - Jakub Fronczek
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Krzysztof Węgrzyn
- Department of Anaesthesiology and Intensive Care, Ludwik Rydygier Specialist Hospital in Cracow, Poland
| | - Monika Jasińska
- Department of Intensive Care and Anaesthesiology, 5 Military Hospital with Polyclinic, Cracow, Poland
| | - Paweł Jarocki
- Department of Medical Education, Jagiellonian University Medical College, Cracow, Poland
| | - Wojciech Mudyna
- Department of Anaesthesiology and Intensive Care, Ludwik Rydygier Specialist Hospital in Cracow, Poland
| | | | | | - Jarosław Czubak
- Department of Orthopaedics, Paediatric Orthopaedics and Traumatology of the Centre of Postgraduate Medical Education, Adam Gruca Public Research and Teaching Hospital in Otwock, Poland
| | | | - Sebastian Nowak
- Orthopaedic and Trauma Surgery Clinic, 5 Military Hospital with Polyclinic (Independent Public Health Care Institution) in Cracow, Poland
| | - Mirosław Czuczwar
- 2 Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Poland
| | - Wojciech Szczeklik
- Department of Intensive Care and Anaesthesiology, 5 Military Hospital with Polyclinic, Cracow, Poland
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Cracow, Poland
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29
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Hidad S, Kuil SD, Fischer JC, Visser CE, Geerlings SE, Leeflang MMG, Schneeberger C. C‐reactive protein, procalcitonin, and erythrocyte sedimentation rate for the diagnosis of lower urinary tract infection in older people. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2022. [PMCID: PMC9761663 DOI: 10.1002/14651858.cd014521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This is a protocol for a Cochrane Review (diagnostic). The objectives are as follows:
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Affiliation(s)
| | - Soemeja Hidad
- Department of Medical MicrobiologyAmsterdam University Medical CentersAmsterdamNetherlands
| | - Sacha D Kuil
- Department of Medical MicrobiologyAmsterdam University Medical CentersAmsterdamNetherlands
| | - Johan C Fischer
- Department of Clinical ChemistryAmsterdam University Medical CentersAmsterdamNetherlands
| | - Caroline E Visser
- Department of Medical MicrobiologyAmsterdam University Medical CentersAmsterdamNetherlands
| | - Suzanne E Geerlings
- Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and ImmunityAmsterdam University Medical CentersAmsterdamNetherlands
| | - Mariska MG Leeflang
- Department of Clinical Epidemiology, Biostatistics and BioinformaticsAmsterdam University Medical CentersAmsterdamNetherlands
| | - Caroline Schneeberger
- Center for Infectious Disease ControlNational Institute for Public Health and the Environment (RIVM)BilthovenNetherlands
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30
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Muacevic A, Adler JR, Paul S, Abbas MS, Nassar ST, Tasha T, Desai A, Bajgain A, Ali A, Mohammed L. Urinary Tract Infection Induced Delirium in Elderly Patients: A Systematic Review. Cureus 2022; 14:e32321. [PMID: 36632270 PMCID: PMC9827929 DOI: 10.7759/cureus.32321] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/08/2022] [Indexed: 12/13/2022] Open
Abstract
Urinary tract infection (UTI) is common in older adults, mainly due to several age-related risk factors. Symptoms of UTI are atypical in the elderly population, like hypotension, tachycardia, urinary incontinence, poor appetite, drowsiness, frequent falls, and delirium. UTI manifests more commonly and specifically for this age group as delirium or confusion in the absence of a fever. This systematic review aims to highlight the relationship between UTI and delirium in the elderly population by understanding the pathologies individually and collectively. A systematic review is conducted by searching PubMed with regular keywords and major Medical Subject Heading (MeSH) keywords, Science Direct, and Google Scholar. The inclusion criteria consisted of studies based on male and female human populations above the age of 65 in the English language, available in full text published between 2017 and 2022. However, the exclusion criteria were animal studies, clinical trials, literature published before 2017, and papers published in any other language except English. A total of 106 articles were identified, and nine final studies were selected after a quality assessment, following which a valid relationship between delirium and UTI was identified in this systematic review.
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31
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Eecen C, Vreeswijk R, Souverein D, Euser SM, Kalisvaart KJ. The role of Dutch guidelines in the diagnostic outcomes and treatment decisions of hospitalised older adults with a suspected urinary tract infection: a retrospective cohort study. Eur Geriatr Med 2022; 13:1391-1401. [PMID: 36309951 DOI: 10.1007/s41999-022-00708-3] [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] [Received: 07/03/2022] [Accepted: 10/11/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Urinary tract infections (UTIs) are highly prevalent and difficult to diagnose in older adults. We aimed to evaluate the applicability of Dutch Association of Urology (NVU) and Dutch Association of Elderly Care Physicians (Verenso) guidelines in terms of diagnostic outcomes and treatment decisions in hospitalised older adults with suspected UTIs. METHODS A retrospective cohort study was conducted on 225 geriatric patients with a urine culture taken in 2019, to determine conformity of the studied population to NVU and Verenso. RESULTS Of 225 patients with suspected UTI (mean age 86 years; 56.4% female), 67.6% had urinary tract-related symptoms, of whom 96 received antibiotics, including those with a negative urine dipstick (n = 12) or urine culture (n = 28). Hundred seventy-seven and 147 patients were assessed and treated conforming to the NVU and Verenso guidelines, respectively. The 38 patients who were assessed and treated non-conforming to NVU, including patients with negative urine diagnostics, received antibiotics more often compared with 177 patients treated conforming to NVU (p < 0.001). A large number of patients with negative urine tests were treated conforming to Verenso and antibiotics were withheld in 75.5% of the patients. The non-conforming Verenso-treated patients with prescribed antibiotics had significantly more negative dipstick results (p = 0.05), fewer urinary tract-related symptoms (p < 0.001) and more often a different infectious focus (p < 0.001). CONCLUSION The common practice performed on the studied geriatric population was more in accordance with the NVU guideline than Verenso. The results indicated that compliance with the guidelines might lead to fewer antibiotic prescriptions in the study population.
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Affiliation(s)
- C Eecen
- Department of Geriatrics, Spaarne Gasthuis, Location Haarlem-Zuid, Boerhaavelaan 22, 2035 RC, Haarlem, The Netherlands.
| | - R Vreeswijk
- Department of Geriatrics, Spaarne Gasthuis, Location Haarlem-Zuid, Boerhaavelaan 22, 2035 RC, Haarlem, The Netherlands
| | - D Souverein
- Department of Epidemiology, Regional Public Health Laboratory Kennemerland, Boerhaavelaan 26, 2035 RC, Haarlem, The Netherlands
| | - S M Euser
- Department of Epidemiology, Regional Public Health Laboratory Kennemerland, Boerhaavelaan 26, 2035 RC, Haarlem, The Netherlands
| | - K J Kalisvaart
- Department of Geriatrics, Spaarne Gasthuis, Location Haarlem-Zuid, Boerhaavelaan 22, 2035 RC, Haarlem, The Netherlands
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Castañeda NR, Doodlesack A, Fyfe W, Edlow J, Grossman SA. The data and the reality: urine cultures and emergency medicine physicians. Intern Emerg Med 2022; 17:2349-2355. [PMID: 36308584 DOI: 10.1007/s11739-022-03032-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 06/13/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVES The IDSA has published guidelines for the treatment of urinary tract infections, recommending limiting treatment to symptomatic patients and pregnant females. Our objective is to elucidate current practice patterns among emergency physicians (EPs) in treating positive urine cultures in various clinical situations. METHODS This study employed a cross-sectional design utilizing a questionnaire addressing nine common scenarios encountered by EPs in the follow-up of a positive urine culture. The questionnaire was conducted using RedCap and distributed via email to current and former physicians and residents across our hospital network. Demographic information included years of training and practice setting. For each of nine clinical scenarios, Physicians were asked if they would treat with antibiotics. Results were then analyzed by tabulating percentage of responses and 95% confidence intervals. RESULTS Of 120 respondents, 40.8% worked in academic centers with emergency medicine residencies, 37.5% in large community hospitals, and 20.67% in small community hospitals. Responses came from 14 residents, 33 attendings < 5 years out of training, 23 attendings 5-9 years out of training, 37 attendings 10-20 years out of training, and 13 attendings > 20 beyond training. Asymptomatic young women were treated by 34.2% (95% CI 25.91-43.46%) while asymptomatic elderly women were treated by 50% (95% CI 40.79-59.21%) of EPs. All EPs (95% CI 96.13-100%) chose to treat a symptomatic male and 99.2% (95% CI 94.77-99.96%) chose to treat an asymptomatic pregnant female. Elderly females after a fall were treated by 63.3% (95% CI 54-71.8%) of EPs while elderly males with confusion and a fall were treated by 96.7% (95% CI 91.18-98.93%). Asymptomatic males with a chronic Foley catheter were treated by 28.2% (95% CI 20.67-37.4%) of EPs and 46.7% (95%CI 37.59-55.97%) would treat an asymptomatic middle-aged female with diabetes. Finally, 92.5% (95% CI 85.85-96.3%) of EPs chose to treat an asymptomatic kidney transplant patient. CONCLUSION EPs in varied training stages and practice settings have significant practice variation in the treatment of positive urine cultures, particularly in the geriatric population, often prescribing antibiotics to patients where clear, specific and data-driven IDSA guidelines suggest treatment is unnecessary and potentially harmful.
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Affiliation(s)
- Nicolette Rachel Castañeda
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, One Deaconess Road, Boston, MA, USA.
| | - Amanda Doodlesack
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, One Deaconess Road, Boston, MA, USA
| | - William Fyfe
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, One Deaconess Road, Boston, MA, USA
| | - Jonathan Edlow
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, One Deaconess Road, Boston, MA, USA
| | - Shamai A Grossman
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, One Deaconess Road, Boston, MA, USA
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Wilson E, Jones A, Brandt NJ. Sodium-Glucose Cotransporter-2 Inhibitors: Risks vs. Rewards When Caring for Older Adults. J Gerontol Nurs 2022; 48:7-13. [PMID: 36169298 DOI: 10.3928/00989134-20220908-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Managing multiple comorbidities is common in older adults. Thus, when a medication class, such as sodium-glucose cotransporter-2 (SGLT2) inhibitors, can potentially treat multiple conditions and prevent progression of chronic kidney disease, multiple guidelines must be followed when using these agents. The current article discusses risks and benefits of SGLT2 inhibitors, especially in the context of new evidence, and presents a case example. [Journal of Gerontological Nursing, 48(10), 7-13.].
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Szmulik M, Trześniewska-Ofiara Z, Mendrycka M, Woźniak-Kosek A. A novel approach to screening and managing the urinary tract infections suspected sample in the general human population. Front Cell Infect Microbiol 2022; 12:915288. [PMID: 36093203 PMCID: PMC9455924 DOI: 10.3389/fcimb.2022.915288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background Automated urine technology providing standard urinalysis data can be used to support clinicians in screening and managing a UTI-suspected sample. Fully automated urinalysis systems have expanded in laboratory practice. Commonly used were devices based on digital imaging with automatic particle recognition, which expresses urinary sediment results on an ordinal scale. There were introduced fluorescent flow cytometry analyzers reporting all parameters quantitatively. There is a need to harmonize the result and support comparing bacteria and WBC qualitative versus semiquantitative results. Methods A total of 1,131 urine samples were analyzed on both automated urinalysis systems. The chemical components of urinalysis (leukocyte esterase and nitrate reductase) and the sediment results (leukocytes and bacteria) were investigated as potential UTI indicators. Additionally, 106 specimens were analyzed on UF-5000 and compared with culture plating to establish cut-offs that can be suitable for standard urinalysis requirements and help to guide on how to interpret urinalysis results in the context of cultivation reflex. Results The medians of bacteria counts varies from 16.2 (absence), 43.0 (trace), 443.5 (few), 5,389.2 (moderate), 19,356.6 (many) to 32,545.2 (massive) for particular digital microscopic bacteriuria thresholds. For pyuria thresholds, the medians of WBC counts varies from 0.8 (absence), 2.0 (0-1), 7.7 (2-3), 21.3 (4-6), 38.9 (7-10), 61.3 (11-15) to 242.2 (>30). Comparing the culture and FFC data (bacterial and/or WBC counts) was performed. Satisfactory sensitivity (100%), specificity (83.7%), negative predictive value (100%), and positive predictive value (75%) were obtained using indicators with the following cut-off values: leukocytes ≥40/µl or bacteria ≥300/µl. Conclusions Accurate urinalysis gives information about the count of bacteria and leukocytes as useful indicators in UTIs, in general practice it can be a future tool to cross-link clinical and microbiology laboratories. However, the cut-off adjustments require individual optimization.
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Affiliation(s)
- Magdalena Szmulik
- Sysmex Poland Ltd, Scientific Aspect Prepared in Cooperation with Department of Laboratory Diagnostics, Military Institute of Medicine, Warsaw, Poland
- *Correspondence: Magdalena Szmulik, ; Agnieszka Woźniak-Kosek,
| | | | - Mariola Mendrycka
- Department of Nursing, Faculty of Medical Sciences and Health Sciences, Kazimierz Pulaski University of Technology and Humanities, Radom, Poland
| | - Agnieszka Woźniak-Kosek
- Department of Laboratory Diagnostics, Military Institute of Medicine, Warsaw, Poland
- *Correspondence: Magdalena Szmulik, ; Agnieszka Woźniak-Kosek,
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Maślak E, Miśta W, Złoch M, Błońska D, Pomastowski P, Monedeiro F, Buszewski B, Mrochem-Kwarciak J, Bojarska K, Gabryś D. A New Approach to Imaging and Rapid Microbiome Identification for Prostate Cancer Patients Undergoing Radiotherapy. Biomedicines 2022; 10:biomedicines10081806. [PMID: 36009352 PMCID: PMC9405325 DOI: 10.3390/biomedicines10081806] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/18/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Little is known about the impact of urinary microflora, in particular, its effects on side effects after radiotherapy. The use of mass spectrometry identification method (MALDI) may bring a new look at the issue of the composition and significance of the urinary microbiome. This study aimed to use the mass spectrometry identification method (MALDI) to identify the microbiome of urine samples collected from 50 irradiated prostate cancer patients. (2) Methods: Blood and urine samples were collected before gold marker implantation, at the start and last day of radiotherapy, 1, 4 months after. Patients do not always collect the urine from the midstream; therefore, samples were collected from the first void and midstream in 12 patients for MALDI analysis; in the remaining 38 patients—from the midstream void for MALDI and biochemical analysis. (3) Results: Microorganisms were present in 140/181 urine samples. We found 33 different species 3G(−) and 30G(+). The most frequently isolated strains were: Staphylococcus haemolyticus, Staphylococcus epidermidis, Staphylococcus hominis, Enterococcus faecalis, and Micrococcus luteus. When comparing the type of urine samples, bacteria were more common in samples from the first-void urine than from the midstream one. The absence of bacteria was found in 12.2% of samples from the first-void urine and in 24.7% from the midstream. There was no difference in the total incidence of species between streams (p = 0.85). Before fiducial implantation, the total number of detected bacterial species was significantly higher in comparison to the end of radiotherapy (p = 0.038), indicating that the administered therapy resulted in depleting the local microbiome. One month after radiotherapy, an increase in the number of isolated bacteria was observed. The number of bacterial species in urine did not correlate with blood parameters. The presence of leukocytes (p = 0.013) and proteins (p = 0.004) in urine was related to a greater variety of bacteria found in urine specimens. (4) Conclusions: We obtained a similar spectrum of bacteria from the initial and middle urine streams. We also showed that there is a change in bacteria species affected by the treatment of prostate cancer patients, with both antibiotics before gold fiducial implantation and radiotherapy.
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Affiliation(s)
- Ewelina Maślak
- Centre for Modern Interdisciplinary Technologies, Nicolaus Copernicus University, Wileńska 4 Str., 87-100 Toruń, Poland; (E.M.); (M.Z.); (D.B.); (P.P.); (F.M.); (B.B.)
- Department of Environmental Chemistry and Bioanalytics, Faculty of Chemistry, Nicolaus Copernicus University, Gagarina 7 Str., 87-100 Toruń, Poland
| | - Wioletta Miśta
- Radiotherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeże Armii Krajowej 15 Str., 44-102 Gliwice, Poland;
| | - Michał Złoch
- Centre for Modern Interdisciplinary Technologies, Nicolaus Copernicus University, Wileńska 4 Str., 87-100 Toruń, Poland; (E.M.); (M.Z.); (D.B.); (P.P.); (F.M.); (B.B.)
| | - Dominika Błońska
- Centre for Modern Interdisciplinary Technologies, Nicolaus Copernicus University, Wileńska 4 Str., 87-100 Toruń, Poland; (E.M.); (M.Z.); (D.B.); (P.P.); (F.M.); (B.B.)
- Department of Environmental Chemistry and Bioanalytics, Faculty of Chemistry, Nicolaus Copernicus University, Gagarina 7 Str., 87-100 Toruń, Poland
| | - Paweł Pomastowski
- Centre for Modern Interdisciplinary Technologies, Nicolaus Copernicus University, Wileńska 4 Str., 87-100 Toruń, Poland; (E.M.); (M.Z.); (D.B.); (P.P.); (F.M.); (B.B.)
| | - Fernanda Monedeiro
- Centre for Modern Interdisciplinary Technologies, Nicolaus Copernicus University, Wileńska 4 Str., 87-100 Toruń, Poland; (E.M.); (M.Z.); (D.B.); (P.P.); (F.M.); (B.B.)
| | - Bogusław Buszewski
- Centre for Modern Interdisciplinary Technologies, Nicolaus Copernicus University, Wileńska 4 Str., 87-100 Toruń, Poland; (E.M.); (M.Z.); (D.B.); (P.P.); (F.M.); (B.B.)
- Department of Environmental Chemistry and Bioanalytics, Faculty of Chemistry, Nicolaus Copernicus University, Gagarina 7 Str., 87-100 Toruń, Poland
| | - Jolanta Mrochem-Kwarciak
- Analytics and Clinical Biochemistry Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeże Armii Krajowej 15 Str., 44-102 Gliwice, Poland; (J.M.-K.); (K.B.)
| | - Katarzyna Bojarska
- Analytics and Clinical Biochemistry Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeże Armii Krajowej 15 Str., 44-102 Gliwice, Poland; (J.M.-K.); (K.B.)
| | - Dorota Gabryś
- Radiotherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeże Armii Krajowej 15 Str., 44-102 Gliwice, Poland;
- Correspondence: ; Tel.: +48-32-278-80-51
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Bradley ES, Schell B, Ward DV, Bucci V, Zeamer A, Haran JP. The Urinary Microbiome of Older Adults Residing in a Nursing Home Varies With Duration of Residence and Shows Increases in Potential Pathogens. J Gerontol A Biol Sci Med Sci 2022; 77:1313-1320. [PMID: 34791238 PMCID: PMC9653004 DOI: 10.1093/gerona/glab345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Indexed: 11/13/2022] Open
Abstract
The community of bacteria that colonize the urinary tract, the urinary microbiome, is hypothesized to influence a wide variety of urinary tract conditions. Older adults who reside in nursing homes are frequently diagnosed and treated for urinary tract conditions such as urinary tract infection. We investigated the urinary microbiome of older adults residing in a nursing home to determine if there are features of the urinary microbiome that are associated with specific conditions and exposure in this population. We were also interested in the stability of urinary microbiome over time and in similarities between the urinary and gastrointestinal microbiome. Urine samples were prospectively collected over a period of 10 months from a cohort of 26 older adults (aged >65 years) residing in a single nursing home located in Central Massachusetts. Serial samples were obtained from 6 individuals over 10 months and 5 participants were concurrently enrolled in a study of the gastrointestinal microbiome. Information collected on participants included demographics, medical history, duration of residence in the nursing home, frailty, dementia symptoms, urinary symptoms, antibiotic treatment, urinary catheterization, and hospitalizations over a 10-month period. Clean catch, midstream urine samples were collected and stored at -80°C. DNA was extracted and 16S rRNA gene sequencing was performed. The length of stay in the nursing facility and the Clinical Frailty Scale correlated with significant changes in microbiome composition. An increase in the relative abundance of a putative urinary pathogen, Aerococcus urinae, was the largest factor influencing change that occurred over the duration of residence.
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Affiliation(s)
- Evan S Bradley
- Department of Emergency Medicine, UMass Memorial Medical Center and University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Program in Microbiome Dynamics, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Brent Schell
- Department of Emergency Medicine, UMass Memorial Medical Center and University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Doyle V Ward
- Program in Microbiome Dynamics, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Department of Microbiology and Physiological Systems, Center for Microbiome Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Vanni Bucci
- Program in Microbiome Dynamics, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Department of Microbiology and Physiological Systems, Center for Microbiome Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Abigail Zeamer
- Department of Microbiology and Physiological Systems, Center for Microbiome Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - John P Haran
- Department of Emergency Medicine, UMass Memorial Medical Center and University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Program in Microbiome Dynamics, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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Johnson MD, Davis AP, Dyer AP, Jones TM, Spires SS, Ashley ED. Top Myths of Diagnosis and Management of Infectious Diseases in Hospital Medicine. Am J Med 2022; 135:828-835. [PMID: 35367180 DOI: 10.1016/j.amjmed.2022.03.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 11/01/2022]
Abstract
Antimicrobial agents are among the most frequently prescribed medications during hospitalization. However, approximately 30% to 50% or more of inpatient antimicrobial use is unnecessary or suboptimal. Herein, we describe 10 common myths of diagnosis and management that often occur in the hospital setting. Further, we discuss supporting data to dispel each of these myths. This analysis will provide hospitalists and other clinicians with a foundation for rational decision-making about antimicrobial use and support antimicrobial stewardship efforts at both the patient and institutional levels.
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Affiliation(s)
- Melissa D Johnson
- Duke Antimicrobial Stewardship Outreach Network (DASON), Duke University Medical Center, Durham, NC.
| | - Angelina P Davis
- Duke Antimicrobial Stewardship Outreach Network (DASON), Duke University Medical Center, Durham, NC
| | - April P Dyer
- Duke Antimicrobial Stewardship Outreach Network (DASON), Duke University Medical Center, Durham, NC
| | - Travis M Jones
- Duke Antimicrobial Stewardship Outreach Network (DASON), Duke University Medical Center, Durham, NC
| | - S Shaefer Spires
- Duke Antimicrobial Stewardship Outreach Network (DASON), Duke University Medical Center, Durham, NC
| | - Elizabeth Dodds Ashley
- Duke Antimicrobial Stewardship Outreach Network (DASON), Duke University Medical Center, Durham, NC
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Silva A, Costa E, Freitas A, Almeida A. Revisiting the Frequency and Antimicrobial Resistance Patterns of Bacteria Implicated in Community Urinary Tract Infections. Antibiotics (Basel) 2022; 11:antibiotics11060768. [PMID: 35740174 PMCID: PMC9220357 DOI: 10.3390/antibiotics11060768] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 05/27/2022] [Accepted: 06/02/2022] [Indexed: 02/01/2023] Open
Abstract
Urinary tract infections (UTIs) are one of the most common infectious diseases at the community level. The continue misuse of antimicrobials is leading to an increase in bacterial resistance, which is a worldwide problem. The objective of this work was to study the incidence and pattern of antimicrobial resistance of the main bacteria responsible for UTI in the community of central and northern Portugal, and establish an appropriate empirical treatment. The urine samples were collected in Avelab—Laboratório Médico de Análises Clínicas over a period of 5 years (2015−2019). The urine cultures were classified as positive when bacterial growth was equal to or higher than 105 CFU/mL, and only for these cases, an antimicrobial susceptibility test was performed. Of the 106,019 samples analyzed, 15,439 had a urinary infection. Urinary infections were more frequent in females (79.6%) than in males (20.4%), affecting more elderly patients (56.9%). Escherichia coli (70.1%) was the most frequent uropathogen, followed by Klebsiella pneumoniae (8.9%). The bacteria responsible for UTI varied according to the patient’s sex, with the greatest differences being observed for Enterococcus faecalis and Pseudomonas aeruginosa, these being more prevalent in men. In general, there was a growth in bacterial resistance as the age of the patients increased. The resistance of bacteria in male patients was, in most cases, statistically different (Chi-Square test, p < 0.05) from that observed for bacteria isolated from female patients, showing, in general, higher resistance in male patients. Although E. coli was the most responsible uropathogen for UTI, it was among the bacteria most susceptible to antibiotics. The isolates of K. pneumoniae, Proteus vulgaris and Enterobacter showed high resistance to the tested antimicrobials. The most common multidrug-resistant (MDR) bacteria implicated in UTI were K. pneumoniae (40.4%) and P. aeruginosa (34.7%), but E. coli, the most responsible bacteria for UTI, showed a MDR of 23.3%. When we compared our results with the results from 10 years ago for the same region, in general, an increase in bacterial resistance was observed. The results of this study confirmed that urinary tract infections are a very common illness, caused frequently by resistant uropathogens, for which the antibiotic resistance profile has varied over a short time, even within a specific region. This indicates that periodically monitoring the microbial resistance of each region is essential in order to select the best empirical antibiotic therapy against these infections, and prevent or decrease the resistance among uropathogenic strains.
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Affiliation(s)
- Andreia Silva
- Department of Biology & CESAM, University of Aveiro, 3810-193 Aveiro, Portugal;
- Clinical Analysis Laboratory Avelab, Rua Cerâmica do Vouga, 3800-011 Aveiro, Portugal; (E.C.); (A.F.)
| | - Elisabeth Costa
- Clinical Analysis Laboratory Avelab, Rua Cerâmica do Vouga, 3800-011 Aveiro, Portugal; (E.C.); (A.F.)
| | - Américo Freitas
- Clinical Analysis Laboratory Avelab, Rua Cerâmica do Vouga, 3800-011 Aveiro, Portugal; (E.C.); (A.F.)
| | - Adelaide Almeida
- Department of Biology & CESAM, University of Aveiro, 3810-193 Aveiro, Portugal;
- Correspondence: ; Tel.: +351-234370200
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Screening Biomarkers and Constructing a Predictive Model for Symptomatic Urinary Tract Infection and Asymptomatic Bacteriuria in Patients Undergoing Cutaneous Ureterostomy: A Metagenomic Next-Generation Sequencing Study. DISEASE MARKERS 2022; 2022:7056517. [PMID: 35531475 PMCID: PMC9072028 DOI: 10.1155/2022/7056517] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/02/2022] [Indexed: 11/17/2022]
Abstract
Objectives. To investigate the clinical diagnostic value of differential flora as biomarkers in patients with symptomatic urinary tract infection (UTI) and asymptomatic bacteriuria (ASB) undergoing cutaneous ureterostomy based on metagenomic next-generation sequencing and construct predictive models to provide a scientific reference for clinical diagnosis and treatment. Material and Methods. According to standard procedures, samples were taken from each patient for routine tests (urine, ureteral stent, and skin swab around the stoma). Cytokine levels in the blood were also detected. Urinary microflora were measured by mNGS, and potential biomarkers for distinguishing UTI and ASB were identified by differential flora. Finally, we generated the predictive models for ASB and UTI using the Lasso method and cytokine levels. Results. Urine culture was performed for 50 patients with cutaneous ureterostomy; 44 of these patients developed bacteriuria. The incidence of symptomatic bacteriuria was 54.55%. Biomarker analysis showed that Propionimicrobium lymphophilum, Staphylococcus haemolyticus, Stenotrophomonas maltophilia, Ralstonia insidiosa, and Aspergillus sydowii all had good predictive performance and were combined in a single model. The predictive model exhibited good prediction performance (area under the curve
,
,
, and
). We also identified a significant negative correlation between the weight sum of the abundance for these five characteristic pathogens (Sum_weighted_Reads) and levels of the cytokine IL-6 and IL-1β (
). Conclusion. mNGS had a higher positive detection rate for pathogens in urine samples. The selected differential bacteria can be used as biomarkers of ASB and UTI, and the prediction model has good predictive performance. Analysis also showed that the occurrence of symptoms was related to individual immunity. Combined with the Sum_weighted_Reads cutoff and cytokine levels (IL-6 and IL-1β) of differential flora, it was possible to judge the severity of symptoms in cutaneous ureterostomy patients with bacteriuria and provide new insights for the treatment and intervention of ASB and UTI.
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Hogg E, Frank S, Oft J, Benway B, Rashid MH, Lahiri S. Urinary Tract Infection in Parkinson’s Disease. JOURNAL OF PARKINSON'S DISEASE 2022; 12:743-757. [PMID: 35147552 PMCID: PMC9108555 DOI: 10.3233/jpd-213103] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Urinary tract infection (UTI) is a common precipitant of acute neurological deterioration in patients with Parkinson’s disease (PD) and a leading cause of delirium, functional decline, falls, and hospitalization. Various clinical features of PD including autonomic dysfunction and altered urodynamics, frailty and cognitive impairment, and the need for bladder catheterization contribute to an increased risk of UTI. Sepsis due to UTI is a feared consequence of untreated or undertreated UTI and a leading cause of morbidity in PD. Emerging research suggests that immune-mediated brain injury may underlie the pathogenesis of UTI-induced deterioration of PD symptoms. Existing strategies to prevent UTI in patients with PD include use of topical estrogen, prophylactic supplements, antibiotic bladder irrigation, clean catheterization techniques, and prophylactic oral antibiotics, while bacterial interference and vaccines/immunostimulants directed against common UTI pathogens are potentially emerging strategies that are currently under investigation. Future research is needed to mitigate the deleterious effects of UTI in PD.
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Affiliation(s)
- Elliot Hogg
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Samuel Frank
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jillian Oft
- Department of Infectious Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Brian Benway
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Shouri Lahiri
- Departments of Neurology, Neurosurgery, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Chartier-Kastler E, Chapple C, Schurch B, Saad M. A Real-world Data Analysis of Intermittent Catheterization, Showing the Impact of Prelubricated Versus Hydrophilic Catheter Use on the Occurrence of Symptoms Suggestive of Urinary Tract Infections. EUR UROL SUPPL 2022; 38:79-87. [PMID: 35495281 PMCID: PMC9051966 DOI: 10.1016/j.euros.2022.02.008] [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] [Accepted: 02/16/2022] [Indexed: 11/30/2022] Open
Abstract
Background Systematic reviews have highlighted the lack of evidence on choosing the type of intermittent urinary catheter (IUC) with regard to the occurrence of urinary tract infections (UTIs). Objective To describe the incidence and frequency of symptoms suggestive of UTIs (ssUTIs) for prelubricated versus hydrophilic IUCs. Design, setting, and participants An observational study of a patient database compiled by UK general practitioners was conducted. Outcome measurements and statistical analysis The primary outcome measures were the proportion of patients with at least one ssUTI (prescription of a nonspecific antibiotic with a UTI-related diagnosis, or prescription of a UTI-specific antibiotic) and the mean number of ssUTIs per affected patient in the 12 mo following the index IUC prescription. Comparable prelubricated (“PRELUBE”) and hydrophilic (“HYDRO”) catheter groups were obtained with 1:1 propensity score matching (PSM). Results and limitations A total of 5296 patients were included (prelubricated: n = 458; hydrophilic: n = 4838). After PSM, the two groups had similar proportions of patients with ssUTIs at baseline. The proportion of patients with ssUTIs during exposure was similar in the PRELUBE (36.9%) and HYDRO groups (41.5%; p = 0.155). However, among patients having used the same type of catheter throughout the exposure period, the proportion with ssUTIs was significantly lower in the PRELUBE group (44.6%, vs 55.0% for HYDRO; p = 0.015), as was the number of ssUTIs per patient (1.3 vs 1.8; p = 0.036). Conclusions When choosing a coated IUC, physicians and patients should not rule out PRELUBE IUCs for safety reasons alone. Patient summary Using real-world data compiled by UK general practitioners, we described the incidence and frequency of symptoms suggestive of urinary tract infection in people who were using various types of intermittent urinary catheters. When the same type of prelubricated catheter was used throughout the study period, the incidence of these symptoms was lower than for hydrophilic catheters.
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Jomehzadeh N, Saki M, Ahmadi K, Zandi G. The prevalence of plasmid-mediated quinolone resistance genes among Escherichia coli strains isolated from urinary tract infections in southwest Iran. Mol Biol Rep 2022; 49:3757-3763. [PMID: 35301647 DOI: 10.1007/s11033-022-07215-5] [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: 11/04/2021] [Revised: 01/25/2022] [Accepted: 01/31/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The extensive and inappropriate use of quinolones, which are frequently used as an effective treatment for urinary tract infection (UTI) patients, has led to resistance to these antibiotics. This study was designed to determine the prevalence of quinolones resistance and the presence of plasmid-mediated quinolone resistance (PMQR) genes among extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli isolates. METHODS One hundred and fourteen E. coli isolates were collected from patients' urine samples. The susceptibility of isolates to selected antibiotics was tested by the Kirby-Bauer disk diffusion method. ESBL-producing isolates were identified phenotypically using a combination disk test. Using specific primers, the frequency of aac (6')-Ib, qnrA, qnrB, qnrC, qnrD, qnrS, and qepA genes was investigated by polymerase chain reaction (PCR). RESULTS Among 26 ESBL-producing isolates, the highest resistance rate was observed toward nalidixic acid (80.8%) and ciprofloxacin (61.5%), respectively. Ninety-seven (85%) of all isolates harbored at least one PMQR gene, the most frequent one being aac(6')-Ib-cr variant (47.4%). Coexistence of aac(6')-Ib-cr variant and qnrB were the most broadly distributed genotype among quinolone resistance isolates. Notably, none of the isolates contained the qnrC, qnrD, and qepA genes. CONCLUSIONS Our results highlight the significant prevalence of PMQR genes in ESBL-producing E. coli isolates in this region. Also, the aac (6')-Ib-cr variant was the most frequent gene, particularly in ESBL positive isolates. A regular periodic monitoring program is needed to control and hinder the more spread of antibiotic resistance phenomenon and contributed genes among UTI-causing E. coli isolates.
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Affiliation(s)
- Nabi Jomehzadeh
- Department of Microbiology, School of Medicine, Abadan University of Medical Sciences, Abadan, Iran.
| | - Morteza Saki
- Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Khadijeh Ahmadi
- Department of Microbiology, School of Medicine, Abadan University of Medical Sciences, Abadan, Iran
| | - Golshan Zandi
- Department of Microbiology, School of Medicine, Abadan University of Medical Sciences, Abadan, Iran
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Manseck AS, Otto W, Schnabel M, Denzinger S, Burger M, Spachmann PJ. Geriatric Patients and Symptomatic Urinary Tract Infections: Analysis of Bacterial Range and Resistance Rates at a 3rd Level of Care Hospital in Germany. Urol Int 2022; 106:298-303. [PMID: 34175852 PMCID: PMC8985023 DOI: 10.1159/000516677] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/11/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Increasing life expectancy and demographic change result in a rising number of geriatric patients, but knowledge about geriatric treatment options and adapted diagnostic pathways is low. Simultaneously, urinary tract infections (UTIs) are common in older people and often difficult to treat. METHODS Patients with a UTI at a urological outpatient department between January 01, 2016, and December 31, 2017, were retrospectively identified in the data system. One thousand one hundred fifteen patients with "N30" and "N39" diagnosis were included in this study, 965 of which were under the age of 75 (group 1) and 150 of which 75 years or older (group 2). RESULTS Of 150 patients in group 2, 41.6% had nitrite-positive urine (vs. 20.9% in group 1, p < 0.05 in χ2 testing). Patients in group 2 often had indwelling devices (30.3 vs. 6.0%, p < 0.05) and presented a sterile urine culture in only 20.7% (vs. 40.1% in group 1). Regarding calculated antibiotic therapy, there were significant differences concerning prescription of ciprofloxacin (34.9 vs. 25%, p < 0.05) and fosfomycin (12.7 vs. 40.7%, p < 0.05). CONCLUSION UTI in geriatric patients should be treated differently than in younger patients because antibiotic resistance is high. The group with indwelling devices is complex. Individual strategies for geriatric patients should be considered.
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Affiliation(s)
- Ann-Sera Manseck
- Department of Urology Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Wolfgang Otto
- Department of Urology Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany,Urologie im Gesundheitsforum, Regensburg, Germany,Nierenzentrum Eichstätt, Ambulanz für Urologie, Eichstätt, Germany
| | - Marco Schnabel
- Department of Urology Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Stefan Denzinger
- Department of Urology Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Maximilian Burger
- Department of Urology Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Philipp Julian Spachmann
- Department of Urology Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany,*Philipp Julian Spachmann,
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Agarwal M, Estrada LV, Gracner T, Dick AW, Stone PW. Nursing Home Antibiotic Stewardship Policy and Antibiotics Use: 2013-2017. J Am Med Dir Assoc 2022; 23:482-487. [PMID: 34297980 PMCID: PMC8776896 DOI: 10.1016/j.jamda.2021.06.031] [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: 03/08/2021] [Revised: 06/09/2021] [Accepted: 06/27/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Reducing inappropriate nursing home (NH) antibiotic usage by implementing stewardship programs is a national priority. Our aim is to evaluate the influence of antibiotic stewardship programs on antibiotic use rates in NHs over time. DESIGN Retrospective, repeated cross-sectional analysis. SETTING AND PARTICIPANTS Long-term residents not receiving hospice care in freestanding NHs that participated in 1 or both surveys in 2013 and 2017. METHODS Survey data were merged with the Minimum Data Set and the Certification and Survey Provider Enhanced Reporting data. Our outcome was a binary indicator for antibiotic use. The main predictor was the NH antibiotic stewardship policy intensity. Using multivariate linear regression models adjusting for resident and facility characteristics that differed between the 2 years, we calculated antibiotic use rates in 2013 and 2017 for all residents, those with Alzheimer's disease, and those with any infection including urinary tract infections (UTIs). RESULTS Our sample included 317,003 resident assessments from 2013 and 267,537 assessments from 2017, residing in 953 and 872 NHs, respectively. NH antibiotic stewardship policy intensity increased from 2013 to 2017 (P < .01) and among all NH residents, including those with Alzheimer's disease, antibiotic use rate decreased (P < .05), with 45% of the decline attributable to strengthening stewardship programs. For most residents, policy intensity was associated with decreased usage in residents with UTI. However, among Alzheimer's disease residents with a UTI, this association did not persist. CONCLUSIONS AND IMPLICATIONS Although there was a decrease in antibiotic use in 2017, more time is needed to see the full impact of antibiotic stewardship policy into practice. Adjustments to programs that directly address barriers to implementation and appropriate UTI antibiotic use for residents with Alzheimer's disease are necessary to continue strengthening NH antibiotic stewardship and improve care.
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Affiliation(s)
- Mansi Agarwal
- Columbia University School of Nursing, Center for Health Policy, New York, NY USA
| | - Leah V. Estrada
- Columbia University School of Nursing, Center for Health Policy, New York, NY USA
| | - Tadeja Gracner
- Economics, Sociology & Statistics, RAND Corporation, Washington, DC USA
| | - Andrew W. Dick
- Economics, Sociology & Statistics, RAND Corporation, Boston, MA USA
| | - Patricia W. Stone
- Columbia University School of Nursing, Center for Health Policy, New York, NY USA
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Applying Diagnostic Stewardship to Proactively Optimize the Management of Urinary Tract Infections. Antibiotics (Basel) 2022; 11:antibiotics11030308. [PMID: 35326771 PMCID: PMC8944608 DOI: 10.3390/antibiotics11030308] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 02/05/2022] [Accepted: 02/17/2022] [Indexed: 02/06/2023] Open
Abstract
A urinary tract infection is amongst the most common bacterial infections in the community and hospital setting and accounts for an estimated 1.6 to 2.14 billion in national healthcare expenditure. Despite its financial impact, the diagnosis is challenging with urine cultures and antibiotics often inappropriately ordered for non-specific symptoms or asymptomatic bacteriuria. In an attempt to limit unnecessary laboratory testing and antibiotic overutilization, several diagnostic stewardship initiatives have been described in the literature. We conducted a systematic review with a focus on the application of molecular and microbiological diagnostics, clinical decision support, and implementation of diagnostic stewardship initiatives for urinary tract infections. The most successful strategies utilized a bundled, multidisciplinary, and multimodal approach involving nursing and physician education and feedback, indication requirements for urine culture orders, reflex urine culture programs, cascade reporting, and urinary antibiograms. Implementation of antibiotic stewardship initiatives across the various phases of laboratory testing (i.e., pre-analytic, analytic, post-analytic) can effectively decrease the rate of inappropriate ordering of urine cultures and antibiotic prescribing in patients with clinically ambiguous symptoms that are unlikely to be a urinary tract infection.
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Resistência microbiana a medicamentos em uma Instituição de Longa Permanência para Idosos. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ao03751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Garofalo L, Nakama C, Hanes D, Zwickey H. Whole-Person, Urobiome-Centric Therapy for Uncomplicated Urinary Tract Infection. Antibiotics (Basel) 2022; 11:218. [PMID: 35203820 PMCID: PMC8868435 DOI: 10.3390/antibiotics11020218] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 02/04/2023] Open
Abstract
A healthy urinary tract contains a variety of microbes resulting in a diverse urobiome. Urobiome dysbiosis, defined as an imbalance in the microbial composition in the microenvironments along the urinary tract, is found in women with uncomplicated urinary tract infection (UTI). Historically, antibiotics have been used to address UTI. An alternative approach to uncomplicated UTI is warranted as the current paradigm fails to take urobiome dysbiosis into account and contributes to the communal problem of resistance. A whole-person, multi-modal approach that addresses vaginal and urinary tract dysbiosis may be more effective in reducing recurrent UTI. In this review, we discuss strategies that include reducing pathogenic bacteria while supporting commensal urogenital bacteria, encouraging diuresis, maintaining optimal pH levels, and reducing inflammation. Strategies for future research are suggested.
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Affiliation(s)
- Luciano Garofalo
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, WA 98195, USA
| | - Claudia Nakama
- National University of Natural Medicine, Portland, OR 97201, USA; (C.N.); (D.H.); (H.Z.)
| | - Douglas Hanes
- National University of Natural Medicine, Portland, OR 97201, USA; (C.N.); (D.H.); (H.Z.)
- Helfgott Research Institute, NUNM, Portland, OR 97201, USA
| | - Heather Zwickey
- National University of Natural Medicine, Portland, OR 97201, USA; (C.N.); (D.H.); (H.Z.)
- Helfgott Research Institute, NUNM, Portland, OR 97201, USA
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Ganguly A, Ebrahimzadeh T, Zimmern P, De Nisco NJ, Prasad S. Label-Free, Novel Electrofluidic Capacitor Biosensor for Prostaglandin E2 Detection toward Early and Rapid Urinary Tract Infection Diagnosis. ACS Sens 2022; 7:186-198. [PMID: 34928577 DOI: 10.1021/acssensors.1c01951] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Urine Prostaglandin E2 (PGE2) has been identified as an attractive diagnostic and prognostic biomarker for urinary tract infection (UTI). This work demonstrates the use of PGE2 as a biomarker for rapid and label-free testing for UTI. In this work, we have developed a novel electrofluidic capacitor-based biosensor that can used for home-based UTI management with high accuracy in less than 5 min for small volume urine samples (<60 μL). The PGE2 biosensor works on the principle of affinity capture using highly specific monoclonal PGE2 antibody and relies on non-faradaic electrical impedance spectroscopy (EIS) and Mott-Schottky (MS) for quantifying subtle variations in PGE2 levels expressed in human urine (pH 5-8). Dynamic light scattering experiments were performed to characterize surface charge properties and the impact of bulk interferents on the interfacial modulation of electrical properties due to binding and urine pH variations. Binding chemistry between the key elements of the immunosensor stack was validated using attenuated total reflectance-Fourier transform infrared spectroscopy and surface plasmon resonance studies. Linear calibration dose responses were obtained for PGE2 for both EIS and MS. The sensor reliably distinguished between UTI negative and UTI positive cases for both artificial (pH 5-8) and pooled human urine samples. The sensor was not found to cross-react with Prostaglandin D2, a structurally similar interferent, and other abundant urine interferents (urea and creatinine). Human subject studies confirmed the validity of the sensor for robust and accurate UTI diagnosis. This work can be extended to achieve easy, reliable, and rapid home-based UTI management, which can consequently help physicians with timely and appropriate administration of therapy to improve patient outcomes and treatment success.
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Affiliation(s)
- Antra Ganguly
- Department of Bioengineering, University of Texas at Dallas, Richardson, Texas 75080, United States
| | - Tahmineh Ebrahimzadeh
- Department of Biological Sciences, University of Texas at Dallas, Richardson, Texas 75080, United States
| | - Philippe Zimmern
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas 75390, United States
| | - Nicole J. De Nisco
- Department of Biological Sciences, University of Texas at Dallas, Richardson, Texas 75080, United States
| | - Shalini Prasad
- Department of Bioengineering, University of Texas at Dallas, Richardson, Texas 75080, United States
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Lead acetate versus cadmium sulfate in the modulation of main physiological pathways controlling detrusor muscle contractility in rat. Saudi Pharm J 2022; 30:306-316. [PMID: 35498220 PMCID: PMC9051969 DOI: 10.1016/j.jsps.2022.01.012] [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: 11/21/2021] [Accepted: 01/13/2022] [Indexed: 11/22/2022] Open
Abstract
Heavy metals have a deleterious effect on lower urinary tract functions. Scant data has been reported about metals’ effect on altering detrusor muscle contractility. Rats were given lead acetate (3, 30 mg/kg), cadmium sulfate (0.1, 1 mg/kg) or ferrous sulfate-iron overload-(3, 30 mg/kg), in a subacute toxicity study (21 days, ip). In-vitro tension experiments were conducted using isolated rat detrusor muscle. Measurement of heavy metal concentrations in blood and tissue homogenates was performed, as well as histopathological examinations. Subacute toxicity induced by treatment with lead and cadmium was manifested as a decrease in EFS, ACh, and ATP-mediated contraction of isolated detrusor muscle. Iron overload only decreased EMAX of EFS and ACh-mediated contraction. Lead (30 mg/kg) caused an upward shift in the dose response curve of isoprenaline-induced relaxation, with a significant decrease in EMAX. Lead (30 mg/kg) or cadmium (1 mg/kg) inhibited adenosine (10−5 M)-induced relaxation. Comparisons to control tissues showed a selective accumulation of metals in the detrusor muscle. Histopathological examinations revealed edema and inflammation in the urinary bladder. Directly added lead (10 mM) inhibited detrusor muscle contraction in-vitro, and its effect was decreased in presence of atropine, and potentiated in presence of TEA, L-NAME, or MB. Cadmium's (0.1 mM) inhibitory effect was reduced in presence of nifedipine or trifluoperazine. In conclusion, lead, cadmium, or iron induce detrusor hypoactivity: The inhibitory effect of lead may be mediated by modulating muscarinic receptors but not the K+/NO/cGMP pathway, whereas cadmium inhibitory effect may be mediated by inhibiting the Ca2+/calmodulin pathway.
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50
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Tannou T, Menand E, Veillard D, Contreras JB, Slekovec C, Daucourt V, Somme D, Corvol A. Geriatric Choosing Wisely choice of recommendations in France: a pragmatic approach based on clinical audits. BMC Geriatr 2021; 21:705. [PMID: 34911444 PMCID: PMC8672546 DOI: 10.1186/s12877-021-02619-7] [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] [Received: 06/06/2021] [Accepted: 11/09/2021] [Indexed: 12/02/2022] Open
Abstract
Background The international Choosing Wisely campaign seeks to improve the appropriateness of care, notably through large campaigns among physicians and users designed to raise awareness of the risks inherent in overmedication. Methods In deploying the Choosing Wisely campaign, the French Society of Geriatrics and Gerontology chose early operationalization via a tool for clinical audit over a limited area before progressive dissemination. This enabled validation of four consensual recommendations concerning the management of urinary tract infections, the prolonged use of anxiolytics, the use of neuroleptics in dementia syndromes, and the use of statins in primary prevention. The fifth recommendation concerns the importance of a dialogue on the level of care. It was written by patient representatives directly involved in the campaign. Results The first cross-regional campaign in France involved 5337 chart screenings in 43 health facilities. Analysis of the results showed an important variability in practices between institutions and significant percentage of inappropriate prescriptions, notably of psychotropic medication. Discussion The high rate of participation of target institutions shows that geriatrics professionals are interested in the evaluation and optimization of professional practices. Frequent overuse of psychotropic medication highlights the need of campaigns to raise awareness and encourage deprescribing.
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Affiliation(s)
- T Tannou
- Centre Hospitalier et Universitaire de Besançon, Service de Gériatrie, F-25000, Besançon, France. .,Centre Hospitalier et Universitaire de Besançon, INSERM CIC 1431, équipe "Ethique et progrès médical", F-25000, Besançon, France. .,Université de Franche-Comté, UFR des Sciences de la Santé, Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive, F-25000, Besançon, France. .,Centre de recherche, Institut Universitaire de Gériatrie, Montréal, QC, Canada. .,Service de gériatrie, CHU de Besançon, Boulevard Fleming, 25030, Besancon, France.
| | - E Menand
- Univ Rennes, CHU Rennes, Service de Gériatrie, F-35000, Rennes, France
| | - D Veillard
- CAPPS, structure régionale d'appui à la qualité des soins et la sécurité des patients, Rennes, France.,Univ Rennes, CHU Rennes, Service de Santé Publique, F-35000, Rennes, France
| | - J Berthou Contreras
- OMéDIT, Observatoire du Médicament des Dispositifs médicaux et des Innovations Thérapeutiques, CHU de Besançon, Besançon, France
| | - C Slekovec
- CPIAS, Centre d'appui pour la Prévention des Infections Associées aux Soins Bourgogne-Franche-Comté, CHU de Besançon, Besançon, France
| | - V Daucourt
- RéQua, Structure régionale d'appui à la qualité des soins et la sécurité des patients, Besançon, France
| | - D Somme
- Univ Rennes, CHU Rennes, Service de Gériatrie, F-35000, Rennes, France.,Univ Rennes, CHU Rennes, CNRS, ARENES, UMR 6051, F-35000, Rennes, France
| | - A Corvol
- Univ Rennes, CHU Rennes, Service de Gériatrie, F-35000, Rennes, France.,Univ Rennes, CHU Rennes, CNRS, ARENES, UMR 6051, F-35000, Rennes, France
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