Infectious complications in patients with chronic bacteriuria undergoing major urologic surgery

Congenital causes of neurogenic bladder and the transition to adult care

The population of patients with congenital genitourinary disorders has unique healthcare demands that require an additional interpersonal and medical skillset. Adults with congenital neurogenic bladder may have complex urinary anatomy, abnormal bladder function and atypical voiding mechanisms. While initial surgery and care of these patients is typically managed by a pediatric urologist, growth and development into adulthood necessitates transition of care to an adult care team. Failure of transition to adult care has been demonstrated to result in lower quality healthcare and increased risk of developing preventable complications.

Variation in definitions of urinary tract infections in spina bifida patients: a systematic review

OBJECTIVE

Urinary tract infections (UTIs) are a common source of morbidity among children with spina bifida (SB) and are a frequently reported outcome in studies of this patient population. However, the criteria for a diagnosis of UTI are often not stated. We evaluated the literature on SB patients for the criteria that authors use to define parameters in reporting UTI outcomes.

METHODS

Embase and Medline were queried with the medical subject heading terms “spinal dysraphism,” “myelomeningocele,” “infection,”and “urinary tract infection.” A second search with the exploded term“spina bifida” and “urinary tract infection” was performed. Original research studies reporting a UTI outcome in SB patients were included and evaluated by 2 independent reviewers for the presence of a UTI definition and diagnostic criteria.

RESULTS

We identified 872 publications, of which 124 met inclusion criteria. Forty-five of 124 (36.3%) studies reporting UTI as an outcome provided a definition of UTI. Of 124 studies, 28 (22.6%) were published in pediatric journals and 69 (55.6%) in urology journals. A definition of UTI was provided in 11 (39.3%) and 26 (37.7%) studies, respectively. “Fever,culture, and symptoms” defined a UTI in 17 of 45 studies. Journal category and presence of UTI definitions did not correlate (P = .71).

CONCLUSIONS

Explicit definitions for UTI are heterogeneous and infrequently applied in studies of SB patients, limiting study reliability and estimates of true UTI rates in this population. Future studies will benefit from the development and application of a standard definition for UTI in this population.

[Incidence of surgical site infections in a urology department]

OBJECTIVES

To determine the incidence of surgical site infections (SSI) in the urology wards as well as the SSI incidence in relation to the ASA score and surgical site contamination class.

MATERIALS AND METHODS

One-year prospective cohort study was conducted in the Urologic department, General hospital, Sabac. The patients were daily examined and their diagnoses were made according to the definition of hospital infections using concurrently the ASA score and surgical site contamination class.

RESULTS

Out of 241 operated patients, 32 patients were diagnosed with 33 SSI. The overall incidence rate of patients with SSI was 5.9% while incidence rate of SSI was 6.1%. There were not the differences in the incidence rates according to the ASA score of patients (p > 0.05). The incidence of SSI was 5.0% in the clan wounds, 11.2% in the clean-contaminated, and 20.7% in the contaminated wounds (Chi2 = 8.2 DF = 2 p < 0.016). The patients with SSIs were hospitalized approximately 2 times longer than the patients without SSI (t = -6.28; df = 239; p < 0.001).

CONCLUSION

This study suggests that it is necessary to maintain continuous surveillance of surgicical site infections and to implement the preventive measures, especially for clean and clean-contaminated surgery.