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Brar RK, Weiser L, Copp HL, Livingston KS. Urinary tract infections in pediatric orthopedic surgical patients: a Single Institution National Surgical Quality Improvement Program Study. J Pediatr Orthop B 2024; 33:387-391. [PMID: 38375859 DOI: 10.1097/bpb.0000000000001156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
OBJECTIVE Perioperative urinary tract infections (UTIs) are poorly studied among pediatric orthopedic surgical patients. We evaluated the incidence of and risk factors for UTI in a large volume of pediatric orthopedic surgical patients. METHODS Children <18 who underwent orthopedic surgery between March 2015 and December 2018 were analyzed using our institution's National Surgical Quality Improvement Program (NSQIP) data. Demographic, perioperative and outcome data of patients who developed a UTI within 30 days of surgery were compared to patients without UTI. RESULTS NSQIP data were available for 520 surgeries (324 girls and 196 boys). Median age at surgery was 13.5 years. A Foley was placed in 301/520 cases (88/196 boys and 213/324 girls) in 264 children. Six cases of UTI occurred within 30 days of surgery (1.2% of surgeries). The UTI rate among patients with a Foley was 2.3%, and among girls with a Foley was 2.8%. No UTIs occurred without a Foley, nor any in boys. All six occurred in the American Society of Anesthesiologists Class 2 females, ages 7-15 undergoing elective surgery with Foley for over 48 h. Factors associated with an increased odds of developing UTI included: higher BMI [OR, 1.12 (CI, 1.01-1.22; P = 0.03)], developmental delay [OR, 7.82 (CI, 1.40-43.7; P = 0.02)], structural central nervous system abnormality [OR, 17.5 (CI, 3.89-90.4; P = 0.01)], longer duration with Foley [OR, 1.68 (CI, 1.22-2.32; P = 0.002)] and hospital readmission within 30 days [OR 14.2 (CI, 2.32-87.3; P = 0.004)]. CONCLUSION Risk of UTI is low after pediatric orthopedic surgery. Girls with comorbidities including structural central nervous system abnormality, developmental delay and higher BMI with prolonged Foley catheterization may have higher postoperative UTI risk. Level of Evidence: II.
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Affiliation(s)
- Ravinder K Brar
- Department of Orthopaedic Surgery, Kaiser Permanente, San Bernadino County
| | - Lucas Weiser
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles
| | - Hillary L Copp
- Department of Urologic Surgery, University of California-San Francisco, Benioff Children's Hospital, San Francisco, California
| | - Kristin S Livingston
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
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Fitzpatrick MA, Nwafo N. Urinary Tract Infection Diagnostic and Management Considerations in People with Spinal Cord Injury and Neurogenic Bladder. Infect Dis Clin North Am 2024; 38:381-393. [PMID: 38580574 DOI: 10.1016/j.idc.2024.03.012] [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: 04/07/2024]
Abstract
Urinary tract infections (UTIs) are common complications in people with neurogenic bladder. Prevention, diagnosis, and treatment are challenging for several reasons, including a high prevalence of asymptomatic bacteriuria and catheter use, frequent ambiguous nonlocalizing signs and symptoms, increased risk for complications and difficult-to-treat pathogens, and a lack of effective preventative methods. Current research aims to improve elicitation and evaluation of signs and symptoms, implement algorithms to avoid urine cultures in asymptomatic patients and use appropriate antibiotics for UTI, and identify novel effective prevention methods.
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Affiliation(s)
- Margaret A Fitzpatrick
- Department of Medicine, Section of Infectious Diseases, VA Eastern Colorado Healthcare System, Aurora, CO, USA; Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Center, Aurora, CO, USA.
| | - Nnamdi Nwafo
- Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Center, CU Research Complex II, 12700 East 19th Avenue. Mail Stop B168, Aurora, CO 80045, USA
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Haack M, Ruckes C, Dotzauer R, Thomas A, Sparwasser MP, Fischer ND, Frey LJ, Duwe G, Haferkamp A, Tsaur I, Brandt MP. Comparative Retrospective Assessment of the Effectiveness and Risk Factors of Fluoroquinolones, Cephalosporines, and Selective Antibiotic Prophylaxis for Transrectal Prostate Biopsy. Urol Int 2024:1-8. [PMID: 38744263 DOI: 10.1159/000539028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/13/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Despite increasing resistance of enterobacteria against fluoroquinolones (FLU), they are still widely used during transrectal prostate biopsy (TRPB). This study was designed to analyse infectious complications and risk factors between FLU, cephalosporines (CEPH) and selective other antibiotics (O-AB) used during TRPB. METHODS 664 patients were included retrospectively (152 FLU, 452 CEPH and 60 O-AB). Infectious complications were defined as fever >38.0°C, the in-house definition of complicated urinary tract infection (cUTI) (if all applied: fever >38.0°C, leucocytosis >11.000/µL and positive urine dipstick) or postinterventional bacteriuria. Hospitalisation rate, duration and comorbidities were also assessed. χ2 and Fisher's exact test were used for group comparison. Multivariate regression analysis assessed the association of comorbidities with infectious complications. RESULTS FLU and CEPH were indifferent regarding infectious complications, however in the O-AB group significantly more common compared to FLU and CEPH (11.6, 13.3, 25%, p < 0.05). Duration of hospital stay in CEPH was significantly shorter compared to FLU and O-AB (4.1 vs. 6.3 vs. 8.2 days, p < 0.05). Arterial hypertension showed increased association with fever (OR 6.002 (1.178; 30.597) p = 0.031) and cUTI (OR 6.006 (1.207; 29.891) p = 0.029). CONCLUSION Infectious complications were low and indifferent between FLU and CEPH but significantly more frequent in O-AB. Arterial hypertension was significantly associated with postinterventional fever and cUTI.
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Affiliation(s)
- Maximilian Haack
- Department of Urology and Pediatric Urology, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Christian Ruckes
- Interdisciplinary Center for Clinical Trials, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Robert Dotzauer
- Department of Urology and Pediatric Urology, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Anita Thomas
- Department of Urology and Pediatric Urology, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Maximilian P Sparwasser
- Department of Urology and Pediatric Urology, Faculty of Medicine at Eberhard Karls University, Tübingen, Germany
| | - Nikita D Fischer
- Department of Urology and Pediatric Urology, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Lisa J Frey
- Department of Urology and Pediatric Urology, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Gregor Duwe
- Department of Urology and Pediatric Urology, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Igor Tsaur
- Department of Urology and Pediatric Urology, Faculty of Medicine at Eberhard Karls University, Tübingen, Germany
| | - Maximilian P Brandt
- Department of Urology and Pediatric Urology, Johannes Gutenberg University Medical Center, Mainz, Germany
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Na SH, Eom JS, Seo YB, Park SH, Kim YK, Song W, Lee E, Kim SR, Yoo HM, Chun H, Shin MJ, Kim SH, Choi JY, Cho NH, Kim JH, Son HJ, Han SH, Lee J. Impact of Infection Prevention Programs on Catheter-Associated Urinary Tract Infections Analyzed in Multicenter Study. J Korean Med Sci 2024; 39:e151. [PMID: 38742291 PMCID: PMC11091233 DOI: 10.3346/jkms.2024.39.e151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 04/14/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Catheter-associated urinary tract infections (CAUTIs) account for a large proportion of healthcare-associated infections and have a significant impact on morbidity, length of hospital stay, and mortality. Adherence to the recommended infection prevention practices can effectively reduce the incidence of CAUTIs. This study aimed to assess the characteristics of CAUTIs and the efficacy of prevention programs across hospitals of various sizes. METHODS Intervention programs, including training, surveillance, and monitoring, were implemented. Data on the microorganisms responsible for CAUTIs, urinary catheter utilization ratio, rate of CAUTIs per 1,000 device days, and factors associated with the use of indwelling catheters were collected from 2017 to 2019. The incidence of CAUTIs and associated data were compared between university hospitals and small- and medium-sized hospitals. RESULTS Thirty-two hospitals participated in the study, including 21 university hospitals and 11 small- and medium-sized hospitals. The microorganisms responsible for CAUTIs and their resistance rates did not differ between the two groups. In the first quarter of 2018, the incidence rate was 2.05 infections/1,000 device-days in university hospitals and 1.44 infections/1,000 device-days in small- and medium-sized hospitals. After implementing interventions, the rate gradually decreased in the first quarter of 2019, with 1.18 infections/1,000 device-days in university hospitals and 0.79 infections/1,000 device-days in small- and medium-sized hospitals. However, by the end of the study, the infection rate increased to 1.74 infections/1,000 device-days in university hospitals and 1.80 infections/1,000 device-days in small- and medium-sized hospitals. CONCLUSION We implemented interventions to prevent CAUTIs and evaluated their outcomes. The incidence of these infections decreased in the initial phases of the intervention when adequate support and personnel were present. The rate of these infections may be reduced by implementing active interventions such as consistent monitoring and adherence to guidelines for preventing infections.
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Affiliation(s)
- Sun Hee Na
- Division of Infectious Disease, Department of Internal Medicine, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Joong Sik Eom
- Division of Infectious Diseases, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Yu Bin Seo
- Division of Infectious Disease, Department of Internal Medicine, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Sun Hee Park
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Keun Kim
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Wonkeun Song
- Department of Laboratory Medicine, Hallym University Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Eunjung Lee
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sung Ran Kim
- Infection Control Office, Korea University Guro Hospital, Seoul, Korea
| | - Hyeon Mi Yoo
- Infection Control Office, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Heekyung Chun
- Korean Association of Infection Control Nurses, Seoul, Korea
| | - Myoung Jin Shin
- Infection Control Office, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Su Hyun Kim
- Infection Control Office, Korea University Ansan Hospital, Ansan, Korea
| | - Ji Youn Choi
- Infection Control Office, Chung-Ang University Healthcare System, Seoul, Korea
| | - Nan Hyoung Cho
- Infection Control Office, Gangnam Severance Hospital, Yonsei University, Seoul, Korea
| | - Jin Hwa Kim
- Infection Control Office, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Hee-Jung Son
- Infection Control Office, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Su Ha Han
- School of Nursing, College of Medicine, Soonchunhyang University, Cheonan, Korea
| | - Jacob Lee
- Division of Infectious Disease, Department of Internal Medicine, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea.
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Chadha J, Thakur N, Chhibber S, Harjai K. A comprehensive status update on modification of foley catheter to combat catheter-associated urinary tract infections and microbial biofilms. Crit Rev Microbiol 2024; 50:168-195. [PMID: 36651058 DOI: 10.1080/1040841x.2023.2167593] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 11/01/2022] [Accepted: 01/09/2023] [Indexed: 01/19/2023]
Abstract
Present-day healthcare employs several types of invasive devices, including urinary catheters, to improve medical wellness, the clinical outcome of disease, and the quality of patient life. Among urinary catheters, the Foley catheter is most commonly used in patients for bladder drainage and collection of urine. Although such devices are very useful for patients who cannot empty their bladder for various reasons, they also expose patients to catheter-associated urinary tract infections (CAUTIs). Catheter provides an ideal surface for bacterial colonization and biofilm formation, resulting in persistent bacterial infection and severe complications. Hence, rigorous efforts have been made to develop catheters that harbour antimicrobial and anti-fouling properties to resist colonization by bacterial pathogens. In this regard, catheter modification by surface functionalization, impregnation, blending, or coating with antibiotics, bioactive compounds, and nanoformulations have proved to be effective in controlling biofilm formation. This review attempts to illustrate the complications associated with indwelling Foley catheters, primarily focussing on challenges in fighting CAUTI, catheter colonization, and biofilm formation. In this review, we also collate scientific literature on catheter modification using antibiotics, plant bioactive components, bacteriophages, nanoparticles, and studies demonstrating their efficacy through in vitro and in vivo testing.
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Affiliation(s)
- Jatin Chadha
- Department of Microbiology, Panjab University, Chandigarh, India
| | - Navdisha Thakur
- Department of Microbiology, Panjab University, Chandigarh, India
| | - Sanjay Chhibber
- Department of Microbiology, Panjab University, Chandigarh, India
| | - Kusum Harjai
- Department of Microbiology, Panjab University, Chandigarh, India
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Boniao ELO, Gungab AGNL, Lim BXH, Sundar G, Ali MJ. Scanning electron microscopic features of lacrimal drainage silastic stents: Comparison of various Crawford and large-diameter stents. PLoS One 2023; 18:e0295285. [PMID: 38060492 PMCID: PMC10703212 DOI: 10.1371/journal.pone.0295285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/17/2023] [Indexed: 12/18/2023] Open
Abstract
PURPOSE This study aimed to examine the differences in the biofilms and physical deposits on Crawford stents compared to large-diameter stents. METHODS A prospective interventional study was performed on a series of patients undergoing external or endoscopic dacryocystorhinostomy (DCR) and endoluminal lacrimal duct recanalization (ELDR) with either Crawford or large-diameter stents. All the Crawford stents were retrieved at six weeks and the large-diameter ones at eight weeks following the surgical intervention. There was no evidence of post-operative infection in any of the patients. Following extubation, standard protocols of scanning electron microscopy were used to assess the biofilms and physical deposits on the stents. RESULTS A total of 15 stents were studied. Of these, twelve were Crawford, and three were large-diameter stents. The Crawford stents were from two different manufacturers. All the stents demonstrated evidence of biofilm formation and physical deposits. The Crawford stents showed thin biofilms and sparse physical deposits, but there were no demonstrable differences amongst stents from different manufacturers. However, the deposits and biofilms were thicker and more extensive in the large-diameter stents than the Crawford ones. The biofilms from all stents showed the presence of polymicrobial communities within the exopolysaccharide matrix. CONCLUSIONS The present study found differences in biofilms and physical deposits between Crawford and large-diameter stents. These differences can be partly explained by stent duration, size, and their tissue interactions.
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Affiliation(s)
- Emmanuel Lee Ong Boniao
- Orbit, Oculofacial Surgery, Department of Ophthalmology, National University Hospital Singapore, Singapore, Singapore
| | | | - Blanche Xiao Hong Lim
- Orbit, Oculofacial Surgery, Department of Ophthalmology, National University Hospital Singapore, Singapore, Singapore
| | - Gangadhara Sundar
- Orbit, Oculofacial Surgery, Department of Ophthalmology, National University Hospital Singapore, Singapore, Singapore
| | - Mohammad Javed Ali
- Orbit, Oculofacial Surgery, Department of Ophthalmology, National University Hospital Singapore, Singapore, Singapore
- Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, India
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Zhang Y, Wang L, Wang Y, Li L, Zhou J, Dou D, Wu Z, Yu L, Fan Y. Degradable Antimicrobial Ureteral Stent Construction with Silver@graphdiyne Nanocomposite. Adv Healthc Mater 2023; 12:e2300885. [PMID: 37256720 DOI: 10.1002/adhm.202300885] [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: 03/19/2023] [Revised: 05/18/2023] [Indexed: 06/02/2023]
Abstract
In the surgical treatment of urinary diseases, ureteral stents are commonly used interventional medical devices. Although polymer ureteral stents with polyurethane as the main constituent are widely used in the clinic, the need for secondary surgery to remove them and their propensity to cause bacterial infections greatly limit their effectiveness. To satisfy clinical requirements, an electrospinning-based strategy to fabricate PLGA ureteral stents with silver@graphdiyne is innovated. Silver (Ag) nanoparticles are uniformly loaded on the surface of graphdiyne (GDY) flakes. It is found that the incorporation of Ag nanoparticles into GDY markedly increases their antibacterial properties. Subsequently, the synthesized and purified Ag@GDY is homogeneously blended with poly(lactic-co-glycolic acid) (PLGA) as an antimicrobial agent, and electrospinning along with high-speed collectors is used to make tubular stents. The antibacterial effect of Ag@GDY and the porous microstructure of the stents can effectively prevent bacterial biofilm formation. Furthermore, the stents gradually decrease in toughness but increase in strength during the degradation process. The cellular and subcutaneous implantation experiments demonstrate the moderate biocompatibility of the stents. In summary, considering these performance characteristics and the technical feasibility of the approach taken, this study opens new possibilities for the design and application of biodegradable ureteral stents.
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Affiliation(s)
- Yang Zhang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China
| | - Lizhen Wang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China
| | - Yan Wang
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, 999077, China
| | - Linhao Li
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China
| | - Jin Zhou
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China
| | - Dandan Dou
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China
| | - Zebin Wu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China
| | - Lu Yu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China
| | - Yubo Fan
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China
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Tran NN, Morrisette T, Jorgensen SCJ, Orench-Benvenutti JM, Kebriaei R. Current therapies and challenges for the treatment of Staphylococcus aureus biofilm-related infections. Pharmacotherapy 2023; 43:816-832. [PMID: 37133439 DOI: 10.1002/phar.2806] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/10/2023] [Accepted: 03/16/2023] [Indexed: 05/04/2023]
Abstract
Staphylococcus aureus is a major cause of nosocomial and community-acquired infections and contributes to significant increase in morbidity and mortality especially when associated with medical devices and in biofilm form. Biofilm structure provides a pathway for the enrichment of resistant and persistent phenotypes of S. aureus leading to relapse and recurrence of infection. Minimal diffusion of antibiotics inside biofilm structure leads to heterogeneity and distinct physiological activity. Additionally, horizontal gene transfer between cells in proximity adds to the challenges associated with eradication of biofilms. This narrative review focuses on biofilm-associated infections caused by S. aureus, the impact of environmental conditions on biofilm formation, interactions inside biofilm communities, and the clinical challenges that they present. Conclusively, potential solutions, novel treatment strategies, combination therapies, and reported alternatives are discussed.
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Affiliation(s)
- Nikki N Tran
- Department of Pharmacy, The Ohio State University Wexner Medical Center - The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, USA
| | - Taylor Morrisette
- Department of Clinical Pharmacy and Outcomes Sciences, Medical University of South Carolina College of Pharmacy, Charleston, South Carolina, USA
- Department of Pharmacy Services, Medical University of South Carolina Shawn Jenkins Children's Hospital, Charleston, South Carolina, USA
| | - Sarah C J Jorgensen
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - José M Orench-Benvenutti
- P3 Research Laboratory, Division of Outcomes and Translational Sciences, College of Pharmacy, The Ohio State University, Columbus, Ohio, USA
| | - Razieh Kebriaei
- P3 Research Laboratory, Division of Outcomes and Translational Sciences, College of Pharmacy, The Ohio State University, Columbus, Ohio, USA
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Cieslinski J, Ribeiro VST, de Lima CK, Kraft L, Suss PH, Tuon FF. Sonication as a tool for disrupting biofilms and recovering microorganisms in bladder catheters. J Bras Nefrol 2023; 45:373-377. [PMID: 37158483 PMCID: PMC10697159 DOI: 10.1590/2175-8239-jbn-2022-0129en] [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: 08/29/2022] [Accepted: 03/09/2023] [Indexed: 05/10/2023] Open
Abstract
INTRODUCTION Urinary catheter-related infection is commonly associated with bacterial biofilm. The impact of anaerobes is unknown, but their detection in the biofilm on this device has not been previously reported. This study aimed to evaluate the capability to recovery strict, facultative, and aerobic microorganisms in patients using bladder catheters from ICUs using conventional culture, sonication, urinary analysis, and mass spectrometry. METHODS Parallel, sonicated bladder catheters from 29 critically ill patients were compared with their routine urine culture. Identification was performed using matrix-assisted laser desorption/ionization with time-of-flight mass spectrometry. RESULTS The positivity rate in urine (n = 2, 3.4%) was lower than that in sonicated catheters (n = 7, 13.8%). CONCLUSION Bladder catheter sonication showed more positive culture results than urine samples for anaerobic and aerobic microorganisms. The role of anaerobes in urinary tract infection and catheter biofilm is discussed.
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Affiliation(s)
- Juliette Cieslinski
- Pontifícia Universidade Católica do Paraná, Escola de Medicina,
Laboratório de Doenças Infecciosas Emergentes, Curitiba, PR, Brazil
| | - Victoria Stadler Tasca Ribeiro
- Pontifícia Universidade Católica do Paraná, Escola de Medicina,
Laboratório de Doenças Infecciosas Emergentes, Curitiba, PR, Brazil
| | - Camila Kowodzeichak de Lima
- Pontifícia Universidade Católica do Paraná, Escola de Medicina,
Laboratório de Doenças Infecciosas Emergentes, Curitiba, PR, Brazil
| | - Letícia Kraft
- Pontifícia Universidade Católica do Paraná, Escola de Medicina,
Laboratório de Doenças Infecciosas Emergentes, Curitiba, PR, Brazil
| | - Paula Hansen Suss
- Pontifícia Universidade Católica do Paraná, Escola de Medicina,
Laboratório de Doenças Infecciosas Emergentes, Curitiba, PR, Brazil
| | - Felipe Francisco Tuon
- Pontifícia Universidade Católica do Paraná, Escola de Medicina,
Laboratório de Doenças Infecciosas Emergentes, Curitiba, PR, Brazil
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10
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Kamei J, Fujimura T. Urinary tract infection in patients with lower urinary tract dysfunction. J Infect Chemother 2023:S1341-321X(23)00110-1. [PMID: 37149001 DOI: 10.1016/j.jiac.2023.04.019] [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: 03/21/2023] [Revised: 04/18/2023] [Accepted: 04/30/2023] [Indexed: 05/08/2023]
Abstract
Lower urinary tract dysfunction (LUTD) is becoming more common in aging societies worldwide. In patients with LUTD, the risk of urinary tract infection (UTI) rises due to several distinct mechanisms, including easy bacterial access to the urinary tract, impaired bacterial washout, and an impaired innate defense system. The pathophysiology of LUTD varies depending on whether it is neurogenic or non-neurogenic, as well as by gender; therefore, the etiology and characteristics of UTI differ according to the type of LUTD. Patients with neurogenic LUTD, especially those with spinal cord injury, have a high risk of febrile UTI, and strict bladder management is required to prevent UTI. Clean intermittent catheterization with or without appropriate pharmacological therapy is also strongly recommended for patients with neurogenic LUTD at risk of febrile UTI, unable to void, or with high post-void residual volume. In contrast, both male and female patients with non-neurogenic LUTD have a lower risk of symptomatic UTI. There is insufficient evidence for non-neurogenic LUTD regarding the association between symptomatic UTI but not asymptomatic bacteriuria and LUTD severity, including the presence of post-void residual volume, or whether therapeutic intervention for LUTS reduces the incidence of UTI, particularly in male patients. In this narrative review, we aimed to highlight the pathogenesis, epidemiology, and management of UTI in patients with LUTD.
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Affiliation(s)
- Jun Kamei
- Department of Urology, Jichi Medical University, Tochigi, Japan.
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Breyer GM, Saggin BF, de Carli S, da Silva MERJ, da Costa MM, Brenig B, Azevedo VADC, Cardoso MRDI, Siqueira FM. Virulent potential of methicillin-resistant and methicillin-susceptible Staphylococcus pseudintermedius in dogs. Acta Trop 2023; 242:106911. [PMID: 36965612 DOI: 10.1016/j.actatropica.2023.106911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/14/2023] [Accepted: 03/22/2023] [Indexed: 03/27/2023]
Abstract
Staphylococcus pseudintermedius is a zoonotic pathogen responsible for several infectious diseases in pet animals, yet its pathogenic potential is not fully understood. Thus, this study aims to unravel the virulence profile of S. pseudintermedius from canine origin. Methicillin-resistant (MRSP) and methicillin-susceptible (MSSP) strains were isolated from different infection sites and their genotypic and phenotypic features were compared to determine the clinical implications of MRSP and MSSP strains. Bacterial identification was performed using MALDI-TOF and 16S-rDNA sequencing. In addition, we used multilocus sequence typing (MLST) for strains' sequence type (ST) determination and phylogenetic relationship. The strains were screened for toxin genes, including cytotoxins (lukS, lukF), exfoliative toxin (siet), enterotoxins (sea, seb, sec, secCanine, sel, sem, and seq) and toxic shock syndrome toxin (tst-1). In vitro phenotypic analyses assessing antimicrobial susceptibility profile, biofilm formation ability, and expression of extracellular matrix components were performed. The investigated S. pseudintermedius strains belong to 17 unique ST, most of which were classified as ST71. MSSP and MRSP strains shared siet, lukS, and lukF virulence markers. Our findings showed that some MSSP strains also harbored sel, seq, and sem enterotoxin genes, suggesting a more diverse virulence profile. All MRSP strains and 77% of MSSP strains were classified as multidrug resistant (MDR). Moreover, all investigated S. pseudintermedius strains showed strong biofilm formation ability. In summary, our findings highlight the wide spread of highly virulent and drug-resistant zoonotic S. pseudintermedius strains, being a potential concern for One Health issues.
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Affiliation(s)
- Gabriela Merker Breyer
- Laboratório de Bacteriologia Veterinária (LaBacVet), Universidade Federal do Rio Grande do Sul (UFRGS), Departamento de Patologia Veterinária, Porto Alegre, Brazil; Programa de Pós-Graduação em Ciências Veterinárias, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Bianca Fagundes Saggin
- Laboratório de Bacteriologia Veterinária (LaBacVet), Universidade Federal do Rio Grande do Sul (UFRGS), Departamento de Patologia Veterinária, Porto Alegre, Brazil; Programa de Pós-Graduação em Ciências Veterinárias, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Silvia de Carli
- Laboratório de Bacteriologia Veterinária (LaBacVet), Universidade Federal do Rio Grande do Sul (UFRGS), Departamento de Patologia Veterinária, Porto Alegre, Brazil; Programa de Pós-Graduação em Ciências Veterinárias, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Maria Eduarda Rocha Jacques da Silva
- Laboratório de Bacteriologia Veterinária (LaBacVet), Universidade Federal do Rio Grande do Sul (UFRGS), Departamento de Patologia Veterinária, Porto Alegre, Brazil; Programa de Pós-Graduação em Ciências Veterinárias, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Mateus Matiuzzi da Costa
- Departamento de Zootecnia, Universidade Federal do Vale do São Francisco (UNIVASF), Petrolina, Brazil
| | - Bertram Brenig
- Institute of Veterinary Medicine, Department of Molecular Biology of Livestock, Georg August University Göttingen, 37077 Göttingen, Germany
| | - Vasco Ariston de Carvalho Azevedo
- Laboratório de Genética Molecular e Celular (LGCM), Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Marisa Ribeiro de Itapema Cardoso
- Programa de Pós-Graduação em Ciências Veterinárias, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Laboratório de Medicina Veterinária Preventiva, Universidade Federal do Rio Grande do Sul (UFRGS), Departamento de Patologia Veterinária, Porto Alegre, Brazil
| | - Franciele Maboni Siqueira
- Laboratório de Bacteriologia Veterinária (LaBacVet), Universidade Federal do Rio Grande do Sul (UFRGS), Departamento de Patologia Veterinária, Porto Alegre, Brazil; Programa de Pós-Graduação em Ciências Veterinárias, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
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Tesini BL, Dumyati G. Health Care-Associated Infections in Older Adults: Epidemiology and Prevention. Infect Dis Clin North Am 2023; 37:65-86. [PMID: 36805015 DOI: 10.1016/j.idc.2022.11.004] [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: 02/17/2023]
Abstract
Health care-associated infections (HAIs) are a global public health threat, which disproportionately impact older adults. Host factors including aging-related changes, comorbidities, and geriatric syndromes, such as dementia and frailty, predispose older individuals to infection. The HAI risks from medical interventions such as device use, antibiotic use, and lapses in infection control follow older adults as they transfer among a network of interrelated acute and long-term care facilities. Long-term care facilities are caring for patients with increasingly complex needs, and the home-like communal environment of long-term care facilities creates distinct infection prevention challenges.
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Affiliation(s)
- Brenda L Tesini
- Division of Infectious Diseases, Department of Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, USA.
| | - Ghinwa Dumyati
- Division of Infectious Diseases, Department of Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, USA
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Claeys KC, Johnson MD. Leveraging diagnostic stewardship within antimicrobial stewardship programmes. Drugs Context 2023; 12:dic-2022-9-5. [PMID: 36843619 PMCID: PMC9949764 DOI: 10.7573/dic.2022-9-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/16/2022] [Indexed: 02/17/2023] Open
Abstract
Novel diagnostic stewardship in infectious disease consists of interventions that modify ordering, processing, and reporting of diagnostic tests to provide the right test for the right patient, prompting the right action. The interventions work upstream and synergistically with traditional antimicrobial stewardship efforts. As diagnostic stewardship continues to gain public attention, it is critical that antimicrobial stewardship programmes not only learn how to effectively leverage diagnostic testing to improve antimicrobial use but also ensure that they are stakeholders and leaders in developing new diagnostic stewardship interventions within their institutions. This review will discuss the need for diagnostic and antimicrobial stewardship, the interplay of diagnostic and antimicrobial stewardship, evidence of benefit to antimicrobial stewardship programmes, and considerations for successfully engaging in diagnostic stewardship interventions. This article is part of the Antibiotic stewardship Special Issue: https://www.drugsincontext.com/special_issues/antimicrobial-stewardship-a-focus-on-the-need-for-moderation.
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Affiliation(s)
- Kimberly C Claeys
- University of Maryland School of Pharmacy, Department of Practice Science and Health Outcomes Research, Baltimore, MD, USA
| | - Melissa D Johnson
- Division of Infectious Diseases & International Health, Duke University School of Medicine, Durham, NC, USA,Duke Antimicrobial Stewardship Outreach Network (DASON), Duke University Medical Center Durham, NC, USA
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Moore JV, Kim D, Irwin NJ, Rimer JD, McCoy CP. Tetrasodium EDTA for the prevention of urinary catheter infections and blockages. RSC Adv 2023; 13:2202-2212. [PMID: 36741142 PMCID: PMC9832581 DOI: 10.1039/d2ra06418a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/29/2022] [Indexed: 01/13/2023] Open
Abstract
Long-term catheterised individuals are at significant risk of developing catheter-associated urinary tract infections (CAUTIs), with up to 50% of patients experiencing recurrent episodes of catheter encrustation and blockage. Catheter blockage is a result of accumulation of carbonate apatite and struvite formed upon precipitation of ions within urine due to an infection-induced rise in pH. The aim of this study was to investigate the antimicrobial and anti-encrustation activities of tetrasodium ethylenediaminetetraacetic acid (tEDTA) to evaluate its potential efficacy in preventing CAUTIs and catheter blockages. The antimicrobial activity of tEDTA against uropathogens was assessed using time kill assays performed in artificial urine (AU). Crystallisation studies and in vitro bladder model assays were conducted to investigate the effect of tEDTA on struvite crystallisation and catheter blockage. tEDTA displayed bacteriostatic activity against Proteus mirabilis and prevented precipitation of ions in the AU. Crystallisation studies confirmed tEDTA inhibits struvite nucleation and growth via Mg2+ chelation with 7.63 mM tEDTA, equimolar to the concentration of divalent cations in AU, preventing the formation of crystalline deposits and blockage of Foley catheters for ≥168 h. The promising chelating abilities of low tEDTA concentrations could be exploited to inhibit encrustation and blockage of indwelling catheters. The fundamental research presented will inform our future development of an effective tEDTA-eluting catheter coating aimed at preventing catheter encrustation.
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Affiliation(s)
- Jessica V. Moore
- School of Pharmacy, Queen's University Belfast97 Lisburn RoadBelfast BT9 7BLNorthern IrelandUK
| | - Doyoung Kim
- Department of Chemical and Biomolecular Engineering, University of HoustonHoustonTX 77204USA
| | - Nicola J. Irwin
- School of Pharmacy, Queen's University Belfast97 Lisburn RoadBelfast BT9 7BLNorthern IrelandUK
| | - Jeffrey D. Rimer
- Department of Chemical and Biomolecular Engineering, University of HoustonHoustonTX 77204USA
| | - Colin P. McCoy
- School of Pharmacy, Queen's University Belfast97 Lisburn RoadBelfast BT9 7BLNorthern IrelandUK
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15
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Yao Q, Wu C, Yu X, Chen X, Pan G, Chen B. Current material engineering strategies to prevent catheter encrustation in urinary tracts. Mater Today Bio 2022; 16:100413. [PMID: 36118951 PMCID: PMC9474921 DOI: 10.1016/j.mtbio.2022.100413] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 11/19/2022] Open
Abstract
Catheters and ureteric stents have played a vital role in relieving urinary obstruction in many urological conditions. With the increasing use of urinary catheters/stents, catheter/stent-related complications such as infection and encrustation are also increasing because of their design defects. Long-term use of antibiotics and frequent replacement of catheters not only increase the economic burden on patients but also bring the pain of catheter replacement. This is unfavorable for patients with long indwelling catheters or stents but inconvenient to replace. In recent years, some promising technologies and mechanisms have been used to prevent infection and encrustation, mainly drug loading coatings, functional coatings, biodegradable polymers and metallic materials for urinary devices. Obvious effects in anti-encrustation and anti-infection experiments of the above strategies in vivo or in vitro have been conducted, which is very helpful for further clinical trials. This review mainly introduces catheter/stent technology and mechanisms in the past ten years to address the potential impact of anti-encrustation coating of catheter/stent materials for the prevention of encrustation and to analyze the progress made in this field.
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Affiliation(s)
- Qin Yao
- Department of Urology, Affiliated Hospital of Jiangsu University, 438 Jiefang Road, Zhenjiang, Jiangsu, 212001, PR China
| | - Chengshuai Wu
- Department of Urology, Affiliated Hospital of Jiangsu University, 438 Jiefang Road, Zhenjiang, Jiangsu, 212001, PR China
| | - Xiaoyu Yu
- Department of Urology, Affiliated Hospital of Jiangsu University, 438 Jiefang Road, Zhenjiang, Jiangsu, 212001, PR China
| | - Xu Chen
- Institute for Advanced Materials, School of Materials Science and Engineering, Jiangsu University, 304 Xuefu Road, Zhenjiang, Jiangsu, 212013, PR China
| | - Guoqing Pan
- Institute for Advanced Materials, School of Materials Science and Engineering, Jiangsu University, 304 Xuefu Road, Zhenjiang, Jiangsu, 212013, PR China
| | - Binghai Chen
- Department of Urology, Affiliated Hospital of Jiangsu University, 438 Jiefang Road, Zhenjiang, Jiangsu, 212001, PR China
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Park K, Kim S, Jo Y, Park J, Kim I, Hwang S, Lee Y, Kim SY, Seo J. Lubricant skin on diverse biomaterials with complex shapes via polydopamine-mediated surface functionalization for biomedical applications. Bioact Mater 2022; 25:555-568. [PMID: 37056251 PMCID: PMC10088055 DOI: 10.1016/j.bioactmat.2022.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/08/2022] [Accepted: 07/17/2022] [Indexed: 12/28/2022] Open
Abstract
Implantable biomedical devices require an anti-biofouling, mechanically robust, low friction surface for a prolonged lifespan and improved performance. However, there exist no methods that could provide uniform and effective coatings for medical devices with complex shapes and materials to prevent immune-related side effects and thrombosis when they encounter biological tissues. Here, we report a lubricant skin (L-skin), a coating method based on the application of thin layers of bio-adhesive and lubricant-swellable perfluoropolymer that impart anti-biofouling, frictionless, robust, and heat-mediated self-healing properties. We demonstrate biocompatible, mechanically robust, and sterilization-safe L-skin in applications of bioprinting, microfluidics, catheter, and long and narrow medical tubing. We envision that diverse applications of L-skin improve device longevity, as well as anti-biofouling attributes in biomedical devices with complex shapes and material compositions.
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Affiliation(s)
- Kijun Park
- School of Electronic and Electronic Engineering, Yonsei University, Seoul, 03722, Republic of Korea
| | - Seunghoi Kim
- Center for Biomaterials, Biomedical Research Institute, Korea Institute of Science and Technologies, Seoul, 02792, Republic of Korea
| | - Yejin Jo
- School of Electronic and Electronic Engineering, Yonsei University, Seoul, 03722, Republic of Korea
| | - Jae Park
- School of Electronic and Electronic Engineering, Yonsei University, Seoul, 03722, Republic of Korea
| | - Inwoo Kim
- Center for Theragnosis, Biomedical Research Institute, Korea Institute of Science and Technologies, Seoul, 02792, Republic of Korea
| | - Sooyoung Hwang
- School of Electronic and Electronic Engineering, Yonsei University, Seoul, 03722, Republic of Korea
| | - Yeontaek Lee
- School of Electronic and Electronic Engineering, Yonsei University, Seoul, 03722, Republic of Korea
| | - So Yeon Kim
- Center for Theragnosis, Biomedical Research Institute, Korea Institute of Science and Technologies, Seoul, 02792, Republic of Korea
| | - Jungmok Seo
- School of Electronic and Electronic Engineering, Yonsei University, Seoul, 03722, Republic of Korea
- Corresponding author.
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Firoozeh N, Agah E, Bauer ZA, Olusanya A, Seifi A. Catheter-Associated Urinary Tract Infection in Neurological Intensive Care Units: A Narrative Review. Neurohospitalist 2022; 12:484-497. [PMID: 35755214 PMCID: PMC9214946 DOI: 10.1177/19418744221075888] [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] [Indexed: 12/02/2023] Open
Abstract
Catheter-associated urinary tract infection (CAUTI) is among the most common types of healthcare-associated infection (HAI), which is associated with poor outcomes and prolonged hospitalization in critically ill patients. Previous studies have mentioned that patients admitted to neurological ICUs are at higher risk of CAUTI compared to patients in other ICU settings. This review paper aims to review studies published during the last decade that evaluated the incidence, risk factors, causative pathogens, and preventive strategies and treatment in neuro-critically ill patients.
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Affiliation(s)
- Negar Firoozeh
- Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elmira Agah
- Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zaith Anthony Bauer
- Department of Pulmonary Critical Care, Brooke Army Medical Center, San Antonio, TX, USA
| | - Adedeji Olusanya
- Department of Physical Medicine and Rehabilitation, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Ali Seifi
- Department of Neurosurgery, Division of Neurocritical Care, University of Texas Health, San Antonio, TX, USA
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Peng HM, Tong BD, Li Y, Wang W, Li WL, Gao N. Mitigation of postoperative urinary retention among total joint replacement patients using the ERAS protocol and applying risk-stratified catheterization. ANZ J Surg 2022; 92:2235-2241. [PMID: 35716163 DOI: 10.1111/ans.17847] [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: 11/12/2021] [Revised: 04/08/2022] [Accepted: 05/27/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUNDS We intended to identify the incidence and risk factors (RFs) for Postoperative urinary retention (POUR) after applying a risk-stratified catheterization optimization method in enhanced recovery after surgery (ERAS)-total joint arthroplasty (TJA). METHODS A total of 381 patients were prospectively monitored for POUR. POUR diagnosis was done by a perioperative specialist. Data on potential risk factors (RFs) for POUR were accumulated. Univariate analysis (UA) was conducted to identify possible indicators of POUR, followed by multivariate analysis (MA) of identified indicators. RESULTS POUR occurred in 5.5% of cases, including 8 (3.4%) patients underwent total knee arthroplasty and 13 (10.4%) patients underwent total hip arthroplasty. In UA, age, sex, American Society of Anesthesiologists (ASA) score, and the type of operation were significantly different on UA (P = 0.046, P = 0.022, P = 0.000 and P = 0.049, respectively). Other additional predictors, including body mass index (BMI), international prostate symptom score (IPSS) score, preoperative haemoglobin (Hb), duration of operation, estimated intraoperative blood loss, intraoperative fluid volume, fluid infusion volume within 24 h postoperatively were not associated with POUR (P > 0.05). MA results demonstrated that age, ASA score, type of operation and standard intraoperative placement of an indwelling bladder catheter (SIP-IBC) were strongly associated with POUR development risk (P < 0.05). CONCLUSION Overall, we had a low POUR incidence in our study cohort. However, with the shift from non-ERAS TJA to ERAS TJA protocol, it is crucial to closely monitor the male gender, advanced age, THA and SIP-IBC, as these variables can markedly enhance POUR risk.
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Affiliation(s)
- Hui-Ming Peng
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Bing-du Tong
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Ye Li
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Wei Wang
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Wen-Li Li
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Na Gao
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
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Camacho-Cordovez F, Henzel MK, Bauer L, Chakhtoura NGE, Leili K, Perez F, Vida-Clough JA, Klonowski B, Kiefer P, Donskey CJ, Navas ME. Bacterial urine profile and optimal urine specimen collection timing in asymptomatic chronically catheterized adults with spinal cord injuries and disorders. Am J Infect Control 2022; 50:690-694. [PMID: 34543709 DOI: 10.1016/j.ajic.2021.09.007] [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: 08/19/2021] [Accepted: 09/10/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Adults with spinal cord injuries and disorders (SCI/D) require chronic indwelling catheterization which is associated with an increased risk of catheter-associated (CA) adverse events. METHODS We studied urine samples (culture and urinalysis) from 2 cohorts of chronically catheterized males with SCI/D. Cohort 1 included 28 participants; 3 samples per patient were collected (before, after, and 7 days after catheter change). Cohort 2 included 21 participants; 7 samples per patient were collected (before, immediately after, 30 minutes, 1 hour, 1 day, 2 days, and 7 days after catheter change). RESULTS A statistically significant decrease in the post catheter change percentage of "significant cultures" was found in both our cohorts (P<.05). Additionally, our second cohort demonstrated a significant decrease in the number of organisms growing at 100.000 cfu/mL (median=-1, mean=-1.5, P=.0006) and in urinalysis bacterial numbers (median=-0.5, mean=-1, P=.006) from pre- to 1-hour post catheter removal. CONCLUSIONS Although there appears to be an improvement of organism burden seen after catheter change, this is only temporary, and its significance in chronically catheterized patients is still unknown. Our second cohort demonstrated an optimal time for sample collection at the 1-hour post-catheter change sample, but further research is required for the extrapolation of these findings.
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Huang Z, Zhang D, Gu Q, Miao J, Cen X, Golodok RP, Savich VV, Ilyushchenko AP, Zhou Z, Wang R. One-step coordination of metal-phenolic networks as antibacterial coatings with sustainable and controllable copper release for urinary catheter applications. RSC Adv 2022; 12:15685-15693. [PMID: 35685702 PMCID: PMC9132196 DOI: 10.1039/d2ra01675c] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/17/2022] [Indexed: 02/05/2023] Open
Abstract
Catheter-associated urinary tract infections (CAUTIs) draw great concern due to increased demand for urinary catheters in hospitalization. Encrustation caused by urinary pathogens, especially Proteus mirabilis, results in blocking of the catheter lumen and further infections. In this study, a facile and low-cost surface modification strategy of urinary catheters was developed using one-step coordination of tannic acid (TA) and copper ions. The copper content of the coating could be manipulated by the number of TA-Cu (TC) layers, and the coating released copper in a pH-responsive manner. The coating exhibited high antibacterial efficiency (killed >99% of planktonic bacteria, and reduced biofilm coverage to <1% after 24 h) due to the synergistic antimicrobial effect of TA and copper ions. In vivo study with a rabbit model indicated that with two TC layers, the coated catheter could effectively inhibit bacterial growth in urine and colonization on the surface, and reduce encrustation formation. In addition, the TC-coated catheter exhibited better tissue compatibility compared to the unmodified catheter, probably due to the antibacterial performance of the coating. Such a straightforward coating strategy with good in vitro and in vivo antibacterial properties and biocompatibility holds great promise for combating CAUTIs in clinical practice.
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Affiliation(s)
- Zhimao Huang
- Zhejiang International Scientific and Technological Cooperative Base of Biomedical Materials and Technology, Zhejiang Engineering Research Center for Biomedical Materials, Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences Ningbo 315300 China
| | - Dawei Zhang
- Department of Urology, The Southwest Hospital, Army Medical University No. 30 Gaotanyan Street, Shapingba District Chongqing 400038 China
| | - Qinwei Gu
- Zhejiang International Scientific and Technological Cooperative Base of Biomedical Materials and Technology, Zhejiang Engineering Research Center for Biomedical Materials, Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences Ningbo 315300 China
| | - Jiru Miao
- Zhejiang International Scientific and Technological Cooperative Base of Biomedical Materials and Technology, Zhejiang Engineering Research Center for Biomedical Materials, Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences Ningbo 315300 China
| | - Xiao Cen
- Zhejiang International Scientific and Technological Cooperative Base of Biomedical Materials and Technology, Zhejiang Engineering Research Center for Biomedical Materials, Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences Ningbo 315300 China
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Department of Temporomandibular Joint, West China Hospital of Stomatology, Sichuan University No. 14, 3rd Section, South Renmin Road Chengdu 610041 China
| | - Robert Petrovich Golodok
- SSI O V Roman Powder Metallurgy Institute, National Academy of Sciences of Belarus Minsk 220005 Belarus
| | - Vadim Victorovich Savich
- SSI O V Roman Powder Metallurgy Institute, National Academy of Sciences of Belarus Minsk 220005 Belarus
| | | | - Zhansong Zhou
- Department of Urology, The Southwest Hospital, Army Medical University No. 30 Gaotanyan Street, Shapingba District Chongqing 400038 China
| | - Rong Wang
- Zhejiang International Scientific and Technological Cooperative Base of Biomedical Materials and Technology, Zhejiang Engineering Research Center for Biomedical Materials, Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences Ningbo 315300 China
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Stampas A, Hua J, Naumann H, Martinez C, Roberts D, Pedroza C. Quality improvement project of a closed catheter system to reduce catheter-associated urinary tract infections during acute inpatient rehabilitation using stepped-wedge design. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2022. [DOI: 10.4103/jisprm.jisprm-000142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Polan RM, Barber EL. Association between cystoscopy at the time of hysterectomy performed by a gynecologic oncologist and delayed urinary tract injury. Int J Gynecol Cancer 2022; 32:62-68. [PMID: 34732516 PMCID: PMC9087478 DOI: 10.1136/ijgc-2021-003073] [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: 08/31/2021] [Accepted: 10/19/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Guidance regarding the use of cystoscopy at the time of hysterectomy is lacking in gynecologic oncology. We compare the rate of delayed urinary tract injury in women who underwent cystoscopy at the time of hysterectomy performed by a gynecologic oncologist for benign or malignant indication with those who did not. METHODS This was a retrospective cohort study of patients who had a hysterectomy performed by a gynecologic oncologist recorded in the National Surgical Quality Improvement Program between January 2014 and December 2017. The primary outcome was delayed urinary tract injury in the 30-day post-operative period. Secondary outcomes were operative time and urinary tract infection rate. The exposure of interest was cystoscopy at the time of hysterectomy and bivariable tests were used to examine associations. RESULTS We identified 33 355 women who underwent hysterectomy for benign (41%; n=13 621) or malignant (59%; n=19 734) indications performed by a gynecologic oncologist. Surgical approach was open (39%; n=12 974), laparoscopic or robotic-assisted laparoscopic (55%; n=18 272), and vaginal or vaginally-assisted (6%; n=2109). Overall, 12% of women (n=3873) underwent cystoscopy at the time of surgery; cystoscopy was more commonly performed in laparoscopic (15%; n=2829) and vaginal (12%; n=243) approaches than with open hysterectomy (6%; n=801) (p<0.001). There was no difference in the rate of delayed urinary tract injury in patients who underwent cystoscopy at the time of surgery compared with those who did not (0.4% vs 0.3%, p=0.32). However, patients who underwent cystoscopy were more likely to be diagnosed with a urinary tract infection (3% vs 2%, RR 1.3, 95% CI 1.1 to 1.6). In cases where cystoscopy was performed, median operative time was increased by 9 min (137 vs 128 min, p<0.001). CONCLUSION Cystoscopy at the time of hysterectomy performed by a gynecologic oncologist does not result in a lower rate of delayed urinary tract injury compared with no cystoscopy.
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Affiliation(s)
- Rosa Miller Polan
- Gynecologic Oncology, Karmanos Cancer Center, Detroit, Michigan, USA
| | - Emma L Barber
- Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Li Y, Jiang ZW, Liu XX, Pan HF, Gong GW, Zhang C, Li ZR. Avoidance of urinary drainage during perioperative period of open elective colonic resection within enhanced recovery after surgery programme. Gastroenterol Rep (Oxf) 2021; 9:589-594. [PMID: 34925856 PMCID: PMC8677522 DOI: 10.1093/gastro/goab006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 06/20/2020] [Accepted: 07/22/2020] [Indexed: 12/04/2022] Open
Abstract
Background Urinary catheterization (UC) is a conventional perioperative measure for major abdominal operation. Optimization of perioperative catheter management is an essential component of the enhanced recovery after surgery (ERAS) programme. We aimed to investigate the risk factors of urinary retention (UR) after open colonic resection within the ERAS protocol and to assess the feasibility of avoiding urinary drainage during the perioperative period. Methods A total of 110 colonic-cancer patients undergoing open elective colonic resection between July 2014 and May 2018 were enrolled in this study. All patients were treated within our ERAS protocol during the perioperative period. Data on patients’ demographics, clinicopathologic characteristics, and perioperative outcomes were collected and analysed retrospectively. Results Sixty-eight patients (61.8%) underwent surgery without any perioperative UC. Thirty patients (27.3%) received indwelling UC during the surgical procedure. Twelve (10.9%) cases developed UR after surgery necessitating UC. Although patients with intraoperative UC had a lower incidence of post-operative UR [0% (0/30) vs 15% (12/80), P = 0.034], intraoperative UC was not testified as an independent protective factor in multivariate logistic analysis. The history of prostatic diseases and the body mass index were strongly associated with post-operative UR. Six patients were diagnosed with post-operative urinary-tract infection, among whom two had intraoperative UC and four were complicated with post-operative UR requiring UC. Conclusion Avoidance of urinary drainage for open elective colonic resection is feasible with the implementation of the ERAS programme as the required precondition. Obesity and a history of prostatic diseases are significant predictors of post-operative UR.
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Affiliation(s)
- Yun Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China.,Jiangxi Institute of Digestive surgery, Nanchang, Jiangxi 330006, P.R. China
| | - Zhi-Wei Jiang
- Department of General Surgery, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P.R. China
| | - Xin-Xin Liu
- Department of General Surgery, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P.R. China
| | - Hua-Feng Pan
- Department of General Surgery, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P.R. China
| | - Guan-Wen Gong
- Department of General Surgery, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P.R. China
| | - Cheng Zhang
- Department of General Surgery, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, P.R. China
| | - Zheng-Rong Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China.,Jiangxi Institute of Digestive surgery, Nanchang, Jiangxi 330006, P.R. China
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Abstract
Catheter-associated urinary tract infection (CAUTI) remains one of the most prevalent, but preventable, health care-associated infections and predominantly occurs in patients with indwelling urinary catheters. Duration of urinary catheterization is the most important modifiable risk factor for development of CAUTI. Alternatives to indwelling catheters should be considered in appropriate patients. If indwelling catheterization is necessary, proper aseptic practices for catheter insertion and maintenance and use of a closed catheter collection system are essential for preventing CAUTI. The use of intervention bundles and collaboratives helps in the effective implementation of CAUTI prevention measures.
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Affiliation(s)
- Carol E Chenoweth
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, F4141 South University Hospital, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5226, USA.
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25
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Bobbadi S, Chinnam BK, Reddy PN, Kandhan S. Analysis of antibiotic resistance and virulence patterns in Klebsiella pneumoniae isolated from human urinary tract infections in India. Lett Appl Microbiol 2021; 73:590-598. [PMID: 34331358 DOI: 10.1111/lam.13544] [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: 04/10/2021] [Revised: 07/23/2021] [Accepted: 07/23/2021] [Indexed: 11/27/2022]
Abstract
In this study, 504 urine samples collected from patients suffering from urinary tract infection (UTIs) were screened for the presence of Klebsiella pneumoniae. The overall occurrence of Klebsiella spp. and K. pneumoniae was found to be 23·2% (117/504) and 16·8% (85/504) respectively. Antibiotic susceptibility testing of 85 K. pneumoniae isolates was carried out by disc diffusion which revealed alarming levels of antibiotic resistance (ABR). Antimicrobial resistance was prominently observed against cefpodoxime (76·47%) followed by ampicillin (70·59%), ceftriaxone (52·94%), cefoxitin (50·59%), amoxyclav (48·24%), ofloxacin (45·88%), cefotaxime (44·71%), cefepime (43·53%) and doxycycline hydrochloride (40%). A small percentage of strains also exhibited resistance to other antimicrobials in the range of 7-35%. Around 77·6% of the isolates were found to be resistant to three or more antibiotic classes and 66·7% of the isolates had multiple antibiotic resistance index values >0·2. Screening of virulence genes in 85 K. pneumoniae isolates revealed that uge gene was the most predominant (11/85, 12·9%), followed by rmpA (9/85, 10·5%), kfu (4/85, 4·7%) and aerobactin genes (2/85, 2·35%). Further, the overall percentage of biofilm producers were found to be 17·65% (15/85). This study warrants hospitals and health care centres to reduce misuse of antibiotics and manage UTI with appropriate treatment after performing antibiotic susceptibility testing.
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Affiliation(s)
- S Bobbadi
- Department of Biotechnology, Vignan's Foundation for Science, Technology and Research (Deemed to be University), Vadlamudi, Guntur district, Andhra Pradesh, India
| | - B K Chinnam
- Department of Veterinary Public Health and Epidemiology, NTR College of Veterinary Science, Gannavaram, Andhra Pradesh, India
| | - P N Reddy
- Department of Biotechnology, Vignan's Foundation for Science, Technology and Research (Deemed to be University), Vadlamudi, Guntur district, Andhra Pradesh, India
| | - S Kandhan
- Division of Veterinary Public Health, ICAR - Indian Veterinary Research Institute, Izatnagar, Uttar Pradesh, India
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26
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Gad MH, AbdelAziz HH. Catheter-Associated Urinary Tract Infections in the Adult Patient Group: A Qualitative Systematic Review on the Adopted Preventative and Interventional Protocols From the Literature. Cureus 2021; 13:e16284. [PMID: 34422457 PMCID: PMC8366179 DOI: 10.7759/cureus.16284] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2021] [Indexed: 11/12/2022] Open
Abstract
Catheter-associated urinary tract infections (CA-UTIs) are among the most common nosocomial infections acquired by patients in health care settings. A significant risk factor for CA-UTIs is the duration of catheterization. To summarize the current strategies and interventions in reducing urinary tract infections associated with urinary catheters, use and the need for re-catheterization on the rate of CA-UTIs, we performed a systematic review. A rapid evidence analysis was carried out in the Medline (via Ovid) and the Cochrane Library for the periods of January 2005 till April 2021. The main inclusion criterion required to be included in this review was symptomatic CA-UTI in adults as a primary or secondary outcome in all the included studies. Only randomized trials and systematic reviews were included, reviewed, evaluated, and abstracted data from the 1145 articles that met the inclusion criteria. A total of 1145 articles were identified, of which 59 studies that met the inclusion criteria were selected. Studies of relevance to CA-UTIs were based on: duration of catheterization, indication for catheterization, catheter types, UTI prophylaxis, educational proposals and approaches, and mixed policies and interventions. The duration of catheterization is the contributing risk factor for CA-UTI incidence; longer-term catheterization should only be undertaken where needed indications. The indications for catheterization should be based on individual base to base cases. The evidence for systemic prophylaxis instead of when clinically indicated is still equivocal. However, antibiotic-impregnated catheters reduce the risk of symptomatic CA-UTIs and bacteriuria and are more cost-effective than other impregnated catheter types. Antibiotic resistance, potential side effects and increased healthcare costs are potential disadvantages of implementing antibiotic prophylaxis. Multiple interventions and measures such as reducing the number of catheters in place, removing catheters at their earliest, clinically appropriate time, reducing the number of unnecessary catheters inserted, decrease antibiotic administration unless clinically needed, raising more awareness and provide training of nursing personnel on the latest guidelines, can effectively lower the incidence of CA-UTIs.
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Affiliation(s)
- Mohamed H Gad
- Surgery, The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, GBR
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27
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Yu Y, Singh H, Tsitrin T, Bekele S, Lin YH, Sikorski P, Moncera KJ, Torralba MG, Morrow L, Wolcott R, Nelson KE, Pieper R. Urethral Catheter Biofilms Reveal Plasticity in Bacterial Composition and Metabolism and Withstand Host Immune Defenses in Hypoxic Environment. Front Med (Lausanne) 2021; 8:667462. [PMID: 34249966 PMCID: PMC8260951 DOI: 10.3389/fmed.2021.667462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 05/06/2021] [Indexed: 11/18/2022] Open
Abstract
Biofilms composed of multiple microorganisms colonize the surfaces of indwelling urethral catheters that are used serially by neurogenic bladder patients and cause chronic infections. Well-adapted pathogens in this niche are Escherichia coli, Proteus, and Enterococcus spp., species that cycle through adhesion and multilayered cell growth, trigger host immune responses, are starved off nutrients, and then disperse. Viable microbial foci retained in the urinary tract recolonize catheter surfaces. The molecular adaptations of bacteria in catheter biofilms (CBs) are not well-understood, promising new insights into this pathology based on host and microbial meta-omics analyses from clinical specimens. We examined catheters from nine neurogenic bladder patients longitudinally over up to 6 months. Taxonomic analyses from 16S rRNA gene sequencing and liquid chromatography-tandem mass spectrometry (LC-MS/MS)-based proteomics revealed that 95% of all catheter and corresponding urinary pellet (UP) samples contained bacteria. CB biomasses were dominated by Enterobacteriaceae spp. and often accompanied by lactic acid and anaerobic bacteria. Systemic antibiotic drug treatments of patients resulted in either transient or lasting microbial community perturbations. Neutrophil effector proteins were abundant not only in UP but also CB samples, indicating their penetration of biofilm surfaces. In the context of one patient who advanced to a kidney infection, Proteus mirabilis proteomic data suggested a combination of factors associated with this disease complication: CB biomasses were high; the bacteria produced urease alkalinizing the pH and triggering urinary salt deposition on luminal catheter surfaces; P. mirabilis utilized energy-producing respiratory systems more than in CBs from other patients. The NADH:quinone oxidoreductase II (Nqr), a Na+ translocating enzyme not operating as a proton pump, and the nitrate reductase A (Nar) equipped the pathogen with electron transport chains promoting growth under hypoxic conditions. Both P. mirabilis and E. coli featured repertoires of transition metal ion acquisition systems in response to human host-mediated iron and zinc sequestration. We discovered a new drug target, the Nqr respiratory system, whose deactivation may compromise P. mirabilis growth in a basic pH milieu. Animal models would not allow such molecular-level insights into polymicrobial biofilm metabolism and interactions because the complexity cannot be replicated.
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Affiliation(s)
- Yanbao Yu
- J. Craig Venter Institute, Rockville, MD, United States
| | | | | | | | - Yi-Han Lin
- J. Craig Venter Institute, Rockville, MD, United States
| | | | | | | | - Lisa Morrow
- Southwest Regional Wound Care Center, Lubbock, TX, United States
| | - Randall Wolcott
- Southwest Regional Wound Care Center, Lubbock, TX, United States
| | - Karen E. Nelson
- J. Craig Venter Institute, Rockville, MD, United States
- J. Craig Venter Institute, La Jolla, CA, United States
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Periinterventional inflammation and blood transfusions predict postprocedural delirium after percutaneous repair of mitral and tricuspid valves. Clin Res Cardiol 2021; 110:1921-1929. [PMID: 34061227 PMCID: PMC8639541 DOI: 10.1007/s00392-021-01886-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/27/2021] [Indexed: 12/27/2022]
Abstract
Objectives The aim of this study was to examine predictors and impact of postoperative delirium (POD) on outcome after percutaneous repair of mitral and tricuspid valves. Background POD is common in elderly patients and contributes to increased health care costs and worse outcome. Predictors of POD in percutaneous mitral or tricuspid valve procedures are unclear. Methods In a prospective single-center study, patients were screened for POD using the Confusion Assessment Method on the first and second postprocedural days, and up until 7 days in patients with clinical suspicion of delirium. Associations of POD with baseline characteristics, periprocedural outcome and mid-term mortality were examined. Results One hundred and seventy-seven patients were included (median age 78 years [72–82], 41.8% female) and median (IQR) follow-up was 489 (293–704) days. Patients developing POD (n = 16, 9%) did not differ in baseline and procedural characteristics but more often received postinterventional blood transfusions (37.5% vs. 9.9%, p value = 0.007) and suffered from infections (43.8% vs. 9.9%, p value = 0.001). Patients with POD showed worse survival (HR: 2.71 [1.27–5.78]; p = 0.01), with an estimated 1-year survival of 46 ± 13% compared to 80 ± 3% in patients without POD (log-rank p value 0.007). In multivariate Cox regression, POD remained a significant predictor of mid-term mortality (HR 4.75 [1.97–11.5]; p = 0.001). Conclusion After percutaneous mitral or tricuspid valve repair, POD was independently associated with worse mid-term survival. Procedure- rather than patient-associated characteristics such as blood transfusions and infections emerged as important risk factors for development of POD. Considering the substantial prognostic impact of POD, further studies on its prevention are warranted to improve patient outcome.
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29
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Brill FHH, Hambach J, Utpatel C, Mogrovejo DC, Gabriel H, Klock JH, Steinmann J, Arndt A. Biofilm reduction potential of 0.02% polyhexanide irrigation solution in several types of urethral catheters. BMC Urol 2021; 21:58. [PMID: 33836738 PMCID: PMC8034122 DOI: 10.1186/s12894-021-00826-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 03/29/2021] [Indexed: 11/23/2022] Open
Abstract
Background Long-term use of urethral catheters is associated with high risk of urinary tract infection (UTI) and blockage. Microbial biofilms are a common cause of catheter blockage, reducing their lifetime and significantly increasing morbidity of UTIs. A 0.02% polyhexanide irrigation solution developed for routine mechanical rinsing shows potential for bacterial decolonization of urethral catheters and has the potential to reduce or prevent biofilm formation. Methods Using an in vitro assay with standard market-leading types of catheters artificially contaminated with clinically relevant bacteria, assays were carried out to evaluate the biofilm reduction and prevention potential of a 0.02% polyhexanide solution versus no intervention (standard approach) and irrigation with saline solution (NaCl 0.9%). The efficiency of decolonization was measured through microbial plate count and membrane filtration. Results Irrigation using a 0.02% polyhexanide solution is suitable for the decolonization of a variety of transurethral catheters. The effect observed is significant compared to irrigation with 0.9% saline solution (p = 0.002) or no treatment (p = 0.011). No significant difference was found between irrigation with 0.9% saline solution and no treatment (p = 0.74). Conclusions A 0.02% polyhexanide solution is able to reduce bacterial biofilm from catheters artificially contaminated with clinically relevant bacteria in vitro. The data shows a reduction of the viability of thick bacterial biofilms in a variety of commercially available urinary catheters made from silicone, latex-free silicone, hydrogel-coated silicone and PVC. Further research is required to evaluate the long-term tolerability and efficacy of polyhexanide in clinical practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12894-021-00826-3.
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Affiliation(s)
- Florian H H Brill
- Dr. Brill + Partner GmbH Institute for Hygiene and Microbiology, Stiegstück 34, 22339, Hamburg, Germany.
| | - Julia Hambach
- Dr. Brill + Partner GmbH Institute for Hygiene and Microbiology, Stiegstück 34, 22339, Hamburg, Germany.,Institute of Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Utpatel
- Molecular and Experimental Mycobacteriology, Research Center Borstel - Leibniz Lung Center, Borstel, Germany
| | - Diana C Mogrovejo
- Dr. Brill + Partner GmbH Institute for Hygiene and Microbiology, Stiegstück 34, 22339, Hamburg, Germany
| | - Henrik Gabriel
- Dr. Brill + Partner GmbH Institute for Hygiene and Microbiology, Stiegstück 34, 22339, Hamburg, Germany
| | - Jan-Hendrik Klock
- Dr. Brill + Partner GmbH Institute for Hygiene and Microbiology, Stiegstück 34, 22339, Hamburg, Germany
| | - Joerg Steinmann
- Klinikum Nürnberg, Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Paracelsus Medical University, Nuremberg, Germany
| | - Andreas Arndt
- Department of Research and Development, B. Braun Medical Ltd., Sempach, Switzerland
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30
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Biofilm-Producing Bacteria and Risk Factors (Gender and Duration of Catheterization) Characterized as Catheter-Associated Biofilm Formation. Int J Microbiol 2021; 2021:8869275. [PMID: 33688348 PMCID: PMC7920707 DOI: 10.1155/2021/8869275] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/31/2021] [Accepted: 02/08/2021] [Indexed: 12/19/2022] Open
Abstract
Background A catheter-associated urinary tract infection (CA-UTI) is preceded by biofilm formation, which is related to several risk factors such as gender, age, diabetic status, duration of catheterization, bacteriuria before catheterization, virulence gene factor, and antibiotic usage. Aims This study aims to identify the microbial composition of catheter samples, including its corresponding comparison with urine samples, to determine the most important risk factors of biofilm formation and characterize the virulence gene factors that correlate with biofilm formation. Methods A longitudinal cross-sectional study was conducted on 109 catheterized patients from September 2017 to January 2018. The risk factors were obtained from the patients' medical records. All catheter and urine samples were cultured after removal, followed by biomass quantification. Isolate identification and antimicrobial susceptibility testing were performed using the Vitex2 system. Biofilm-producing bacteria were identified by the Congo Red Agar (CRA) method. A PCR test characterized the virulence genes of dominant bacteria (E. coli). All data were collected and processed for statistical analysis. Results Out of 109 catheterized patients, 78% of the catheters were culture positive, which was higher than those of the urine samples (37.62%). The most common species isolated from the catheter cultures were Escherichia coli (28.1%), Candida sp. (17.8%), Klebsiella pneumoniae (15.9%), and Enterococcus faecalis (13.1%). E. coli (83.3%) and E. faecalis (78.6%) were the main isolates with a positive CRA. A statistical analysis showed that gender and duration prior to catheterization were associated with an increased risk of biofilm formation (p < 0.05). Conclusion E. coli and E. faecalis were the most common biofilm-producing bacteria isolated from the urinary catheter. Gender and duration are two risk factors associated with biofilm formation, therefore determining the risk of CAUTI. The presence of PapC as a virulence gene encoding pili correlates with the biofilm formation. Biofilm-producing bacteria, female gender, duration of catheterization (more than five days), and PapC gene presence have strong correlation with the biofilm formation. To prevent CAUTI, patients with risk factors should be monitored by urinalysis tests to detect earlier the risk of biofilm formation.
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31
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Siqueira FM, De Carli S, Lopes CE, Machado L, Vieira TR, Pöppl ÁG, Cardoso MRI, Zaha A. Non-lactose-fermenting uropathogenic Escherichia coli from dogs: virulence profile characterization. Lett Appl Microbiol 2021; 72:596-603. [PMID: 33524173 DOI: 10.1111/lam.13454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 11/30/2022]
Abstract
Non-lactose-fermenting Escherichia coli (NLFEC) has a few descriptive studies restricted to human infections. In the present study, isolates of NLFEC obtained from urine samples of dogs with hyperadrenocorticism were characterized regarding their virulence ability, biofilm formation capacity and antimicrobial susceptibility profile. Escherichia coli lactose-fermenting strains from urinary infection in dogs with the same conditions were analysed to provide comparisons. The non-lactose-fermenting E. coli strains were classified as belonging to clade I E. coli, whereas the lactose-fermenting strains were classified in phylogroup B2. All strains presented virulence markers to adhesion, iron acquisition, toxins, colicin and cytotoxin production, and biofilm regulation. Components of the extracellular matrix in addition to the in vitro biofilm formation ability were observed in the strains. Multidrug resistance (MDR) profiles were observed by in vitro susceptibility tests to all NLFEC strains. In summary, non-lactose-fermenting uropathogenic E. coli from dogs behaves similar to lactose-fermenting E. coli, exhibiting MDR profile, and pathogenic potential of promote animal infections.
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Affiliation(s)
- F M Siqueira
- Laboratory of Veterinary Bacteriology, Faculty of Veterinary Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - S De Carli
- Laboratory of Veterinary Bacteriology, Faculty of Veterinary Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - C E Lopes
- Laboratory of Veterinary Bacteriology, Faculty of Veterinary Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - L Machado
- Veterinary Clinical Hospital, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - T R Vieira
- Laboratory of Veterinary Preventive Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Á G Pöppl
- Veterinary Clinical Hospital, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - M R I Cardoso
- Laboratory of Veterinary Preventive Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - A Zaha
- Center of Biotechnology, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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32
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Management of Chronic Bacteriuria in Neurogenic Bladders. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00611-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Gyesi-Appiah E, Brown J, Clifton A. Short-term urinary catheters and their risks: an integrated systematic review. Br J Community Nurs 2020; 25:538-544. [PMID: 33161748 DOI: 10.12968/bjcn.2020.25.11.538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This thematic review was part of a bigger literature review into the effects of short-term urinary catheters on patients who are discharged home from an acute hospital. This integrated review examined the risks associated with short-term urinary catheters. The MEDLINE, British Nursing Index and CINAHL databases were searched for studies published between 2013 and 2018 that researched the effects of short-term urinary catheters on patients. Twelve research studies were included, which showed the presence of short-term indwelling urinary catheters increased the risk of infection, length of hospital stay and mortality rates. Short-term urinary catheters should be strictly monitored and removed as soon as they are not required.
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Affiliation(s)
- Evelyn Gyesi-Appiah
- Research Student, De Montfort University, Leicester, and Nurse, University Hospitals of Leicester NHS Trust
| | - Jayne Brown
- Professor of Nursing (Older People), School of Nursing and Midwifery, De Montfort University, Leicester
| | - Andrew Clifton
- Associate Professor, Mental Health Nursing, School of Nursing and Midwifery, De Montfort University, Leicester
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34
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Frontera JA, Wang E, Phillips M, Radford M, Sterling S, Delorenzo K, Saxena A, Yaghi S, Zhou T, Kahn DE, Lord AS, Weisstuch J. Protocolized Urine Sampling is Associated with Reduced Catheter-associated Urinary Tract Infections: A Pre- and Postintervention Study. Clin Infect Dis 2020; 73:e2690-e2696. [DOI: 10.1093/cid/ciaa1152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 07/31/2020] [Indexed: 12/21/2022] Open
Abstract
Abstract
Background
Standard urine sampling and testing techniques do not mitigate against detection of colonization, resulting in false positive catheter-associated urinary tract infections (CAUTI). We aimed to evaluate whether a novel protocol for urine sampling and testing reduces rates of CAUTI.
Methods
A preintervention and postintervention study with a contemporaneous control group was conducted at 2 campuses (test and control) of the same academic medical center. The test campus implemented a protocol requiring urinary catheter removal prior to urine sampling from a new catheter or sterile straight catheterization, along with urine bacteria and pyuria screening prior to culture. Primary outcomes were test campus CAUTI rates, compared between each 9-month pre- and postintervention epoch. Secondary outcomes included the percent reductions in CAUTI rates, compared between the test campus and a propensity score–matched cohort at the control campus.
Results
A total of 7991 patients from the test campus were included in the primary analysis, and 4264 were included in the propensity score–matched secondary analysis. In the primary analysis, the number of CAUTI cases per 1000 patients was reduced by 77% (6.6 to 1.5), the number of CAUTI cases per 1000 catheter days was reduced by 63% (5.9 to 2.2), and the number of urinary catheter days per patient was reduced by 37% (1.1 to 0.69; all P values ≤ .001). In the propensity score–matched analysis, the number of CAUTI cases per 1000 patients was reduced by 82% at the test campus, versus 57% at the control campus; the number of CAUTI cases per 1000 catheter days declined by 68% versus 57%, respectively; and the number of urinary catheter days per patient decreased by 44% versus 1%, respectively (all P values < .001).
Conclusions
Protocolized urine sampling and testing aimed at minimizing contamination by colonization was associated with significantly reduced CAUTI infection rates and urinary catheter days.
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Affiliation(s)
- Jennifer A Frontera
- Department of Neurology, New York University School of Medicine, New York, New York, USA
| | - Erwin Wang
- Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - Michael Phillips
- Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - Martha Radford
- Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - Stephanie Sterling
- Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - Karen Delorenzo
- Department of Nursing, New York University School of Medicine, New York, New York, USA
| | - Archana Saxena
- Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - Shadi Yaghi
- Department of Neurology, New York University School of Medicine, New York, New York, USA
| | - Ting Zhou
- Department of Neurology, New York University School of Medicine, New York, New York, USA
| | - D Ethan Kahn
- Department of Neurology, New York University School of Medicine, New York, New York, USA
| | - Aaron S Lord
- Department of Neurology, New York University School of Medicine, New York, New York, USA
| | - Joseph Weisstuch
- Department of Medicine, New York University School of Medicine, New York, New York, USA
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35
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Gyesi-Appiah E, Brown J, Clifton A. Short-term urinary catheters and their risks: an integrated systematic review. ACTA ACUST UNITED AC 2020; 29:S16-S22. [DOI: 10.12968/bjon.2020.29.9.s16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background:This thematic review was part of a bigger literature review into the effects of short-term urinary catheters on patients who are discharged home from an acute hospital.Aims:This integrated review examined the risks associated with short-term urinary catheters.Methods:The MEDLINE, British Nursing Index and CINAHL databases were searched for studies published between 2013 and 2018 that researched the effects of short-term urinary catheters on patients.Findings:Twelve research studies were included, which showed the presence of short-term indwelling urinary catheters increased the risk of infection, length of hospital stay and mortality rates.Conclusion:Short-term urinary catheters should be strictly monitored and removed as soon as they are not required.
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Affiliation(s)
- Evelyn Gyesi-Appiah
- Research Student, De Montfort University, Leicester, and Nurse, University Hospitals of Leicester NHS Trust
| | - Jayne Brown
- Professor of Nursing (Older People), School of Nursing and Midwifery, De Montfort University, Leicester
| | - Andrew Clifton
- Associate Professor, Mental Health Nursing, School of Nursing and Midwifery, De Montfort University, Leicester
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Treatment of urinary tract infections in the old and fragile. World J Urol 2020; 38:2709-2720. [PMID: 32221713 DOI: 10.1007/s00345-020-03159-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 03/04/2020] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Urinary tract infection (UTI) is highly prevalent in the frail elderly population. This review aimed to outline the diagnostic, treatment, and prevention of UTI in the frail aging population. METHODS Pubmed and Web of Science search to identify publications until March 2019 relating to the management of UTI in the elderly population was performed. A narrative review of the available literature was performed. RESULTS 64 publications were considered as relevant and included in this review. The diagnosis of symptomatic UTI in the old and fragile could be challenging. Routine screening and antimicrobial therapy for asymptomatic bacteriuria should not be recommended for frail elderly patients. Cautious choice of antibiotics should be guided by uropathogen identified by culture and sensitivity. Understanding local antibiotic resistance rates plays a fundamental part in selecting appropriate antimicrobial treatment. Impact of associated adverse effect, in particular those with effects on cognitive function, should be considered when deciding choice of antibiotics for symptomatic UTI in the elderlies. Optimal management of comorbidities such as diabetes mellitus, adequate treatment of urinary incontinence, and judicious use of urinary catheter is essential to reduce the development of UTI. CONCLUSION UTI is a significant but common problem in elderly population. Physicians who care for frail elderly patients must be aware of the challenges in the management of asymptomatic UTI, and identifying symptomatic UTI in this population, and their appropriate management strategies. There is strong need in studies to evaluate nonantimicrobial therapies in the prevention of UTI for the frail elderly population.
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Kranz J, Schmidt S, Wagenlehner F, Schneidewind L. Catheter-Associated Urinary Tract Infections in Adult Patients. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:83-88. [PMID: 32102727 PMCID: PMC7075456 DOI: 10.3238/arztebl.2020.0083] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 07/22/2019] [Accepted: 11/18/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Urinary tract infections are among the more common types of nosocomial infection in Germany and are associated with catheters in more than 60% of cases. With increasing rates of antibiotic resistance worldwide, it is essential to distinguish catheter-associated asymptomatic bacteriuria from catheter-associated urinary tract infection (CA-UTI). METHODS This review is based on publications from January 2000 to March 2019 that were retrieved by a selective search in Medline. Randomized clinical trials and systematic reviews in which the occurrence of CA-UTI in adult patients was a primary or secondary endpoint were included in the analysis. Two authors of this review, working independently, selected the publications and extracted the data. RESULTS 508 studies were identified and 69 publications were selected for analysis by the prospectively defined criteria. The studies that were included dealt with the following topics: need for catheterization, duration of catheterization, type of catheter, infection prophylaxis, education programs, and multiple interventions. The duration of catheterization is a determinative risk factor for CA-UTI. The indications for catheterization should be carefully considered in each case, and the catheter should be left in place for the shortest possible time. The available data on antibiotic prophylaxis do not permit any definitive conclusion, but they do show a small benefit from antibiotic-impregnated catheters and from systemic antibiotic prophylaxis. CONCLUSION Various measures, including careful consideration of the indication for catheterization, leaving catheters in place for the shortest possible time, and the training of nursing personnel, can effectively lower the incidence of CA-UTI. The eous in some respects, and thus no recommendations can be given on certain questions relevant to CA-UTI.
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Affiliation(s)
- Jennifer Kranz
- Department of Urology and Pediatric Urology, St. Antonius Hospital Eschweiler, Academic Teaching Hospital of RWTH Aachen, Eschweiler, Germany; UroEvidence, Deutsche Gesellschaft für Urologie, Berlin, Germany; Department of Urology and Kidney Transplantation, Martin Luther University, Halle (Saale), Germany; Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University Giessen, Germany; Department of Urology, University Medicine Rostock, Germany
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Manohar J, Hatt S, DeMarzo BB, Blostein F, Cronenwett AEW, Wu J, Lee KH, Foxman B. Profiles of the bacterial community in short-term indwelling urinary catheters by duration of catheterization and subsequent urinary tract infection. Am J Infect Control 2020; 48:178-183. [PMID: 31540834 DOI: 10.1016/j.ajic.2019.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/07/2019] [Accepted: 08/07/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Urinary catheterization, even of short duration, increases the risk of subsequent urinary tract infection (UTI). Whether the bacteria found on the surface of catheters placed for <3 days are associated with UTI risk is unknown. METHODS We screened the biofilms found on the extraluminal surface of 127 catheters placed for <3 days in women undergoing elective gynecologic surgery, using targeted quantitative polymerase chain reaction and an untargeted 16S rRNA taxonomic screen. RESULTS Using quantitative polymerase chain reaction, Enterococcus spp were found on virtually all catheters and lactic acid bacteria in most catheters regardless of duration, but neither genus was associated with UTI development during follow-up. Enterococcus, Streptococcus, and Staphylococcus were the most commonly identified genera in the taxonomic screen but were not associated with subsequent UTIs. Although the most common cause of UTI following catheter removal was Escherichia coli, detectable E coli on the catheter surface was not associated with subsequent UTIs. CONCLUSIONS Our analysis does not suggest that the presence of bacteria on the surface of catheters placed for <3 days leads to subsequent UTIs. Other aspects of catheter care are likely more important than preventing bacterial colonization of the catheter surface for preventing UTIs following short-term catheter placement.
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Affiliation(s)
- Jyothi Manohar
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
| | - Savannah Hatt
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
| | - Brigette B DeMarzo
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
| | - Freida Blostein
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
| | - Anna E W Cronenwett
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
| | - Jianfeng Wu
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
| | - Kyu Han Lee
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
| | - Betsy Foxman
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI.
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Singu PS, Kanugala S, Dhawale SA, Kumar CG, Kumbhare RM. Synthesis and Pharmacological Evaluation of Some Amide Functionalized 1
H
‐Benzo[
d
]imidazole‐2‐thiol Derivatives as Antimicrobial Agents. ChemistrySelect 2020. [DOI: 10.1002/slct.201903380] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Padma S. Singu
- Department of Fluoro-AgrochemicalsCSIR-Indian Institute of Chemical Technology, Tarnaka Hyderabad 500007 India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad India
| | - Sirisha Kanugala
- Department of Organic Synthesis and Process ChemistryCSIR-Indian Institute of Chemical Technology, Tarnaka Hyderabad 500007, Telangana India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad India
| | - Sachin A. Dhawale
- Department of Pharmaceutical ChemistryY. B. Chavan College of PharmacyDr. Rafiq Zakaria Campus Aurangabad- 431001 India
| | - C. Ganesh Kumar
- Department of Organic Synthesis and Process ChemistryCSIR-Indian Institute of Chemical Technology, Tarnaka Hyderabad 500007, Telangana India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad India
| | - Ravindra M. Kumbhare
- Department of Fluoro-AgrochemicalsCSIR-Indian Institute of Chemical Technology, Tarnaka Hyderabad 500007 India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad India
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Reducing the Risk of Indwelling Catheter–Associated Urinary Tract Infection in Female Patients by Implementing an Alternative Female External Urinary Collection Device. J Wound Ostomy Continence Nurs 2020; 47:50-53. [DOI: 10.1097/won.0000000000000601] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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41
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Urinary Catheter Coating Modifications: The Race against Catheter-Associated Infections. COATINGS 2019. [DOI: 10.3390/coatings10010023] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Urinary catheters are common medical devices, whose main function is to drain the bladder. Although they improve patients’ quality of life, catheter placement predisposes the patient to develop a catheter-associated urinary tract infection (CAUTI). The catheter is used by pathogens as a platform for colonization and biofilm formation, leading to bacteriuria and increasing the risk of developing secondary bloodstream infections. In an effort to prevent microbial colonization, several catheter modifications have been made ranging from introduction of antimicrobial compounds to antifouling coatings. In this review, we discuss the effectiveness of different coatings in preventing catheter colonization in vitro and in vivo, the challenges in fighting CAUTIs, and novel approaches targeting host–catheter–microbe interactions.
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Santana MMPD, Hoffmann-Santos HD, Dias LB, Tadano T, Karhawi ASK, Dutra V, Cândido SL, Hahn RC. Epidemiological profile of patients hospitalized with candiduria in the Central-Western region of Brazil. Rev Iberoam Micol 2019; 36:175-180. [PMID: 31699523 DOI: 10.1016/j.riam.2019.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 03/07/2019] [Accepted: 04/15/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Candida yeasts are considered the main agents of nosocomial fungal infections. AIMS This study aimed to establish the epidemiological profile of patients with candiduria hospitalized in the capital of the State of Mato Grosso, in the Central-Western region of Brazil. METHODS Patients from three private hospitals and a public hospital participated in the study. This was an observational and cross-sectional study including analysis of patients mortality. It was carried out from March to August 2015. RESULTS A total of 93 patients with candiduria were evaluated. Candida tropicalis was found most commonly (37.6%; n=35), followed by Candida albicans (36.6%; n=34), Candida glabrata (19.3%; n=18), psilosis complex (4.3%; n=4), Candida lusitaniae (1.1%; n=1) and Candida krusei (1.1%; n=1). Antibiotic therapy (100%) and the use of an indwelling urinary catheter (89.2%; n=83) were the most frequent predisposing factors. Antifungal treatment was given to 65.6% of the patients, and anidulafungin was the most used antifungal. Mortality rates were 48% higher among patients with candiduria who had renal failure. Micafungin was the antifungal most prescribed among the patients who died. Candidemia concomitant with candiduria occurred in eight (8.6%; n=8) cases. Considering the species recovered in the blood and urine, only one patient had genetically distinct clinical isolates. CONCLUSIONS Non-C. albicans Candida species were predominant, with C. tropicalis being the most responsible for most cases of candiduria.
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Affiliation(s)
- Milena Melges Pesenti de Santana
- Laboratory of Investigation - Laboratory of Mycology, Faculty of Medicine, Federal University of Mato Grosso (UFMT), Cuiabá, Mato Grosso, Brazil
| | - Hugo Dias Hoffmann-Santos
- Laboratory of Investigation - Laboratory of Mycology, Faculty of Medicine, Federal University of Mato Grosso (UFMT), Cuiabá, Mato Grosso, Brazil
| | - Luciana Basili Dias
- Laboratory of Investigation - Laboratory of Mycology, Faculty of Medicine, Federal University of Mato Grosso (UFMT), Cuiabá, Mato Grosso, Brazil
| | - Tomoko Tadano
- University Hospital Júlio Muller (HUJM), Federal University of Mato Grosso (UFMT), Cuiabá, Mato Grosso, Brazil
| | - Abdon Salam Khaled Karhawi
- University Hospital Júlio Muller (HUJM), Federal University of Mato Grosso (UFMT), Cuiabá, Mato Grosso, Brazil
| | - Valéria Dutra
- Molecular Biology Laboratory, Faculty of Veterinary Sciences, Federal University of Mato Grosso (UFMT), Cuiabá, Mato Grosso, Brazil
| | - Stephano Luiz Cândido
- Molecular Biology Laboratory, Faculty of Veterinary Sciences, Federal University of Mato Grosso (UFMT), Cuiabá, Mato Grosso, Brazil
| | - Rosane Christine Hahn
- Laboratory of Investigation - Laboratory of Mycology, Faculty of Medicine, Federal University of Mato Grosso (UFMT), Cuiabá, Mato Grosso, Brazil.
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Streamlining to Oral β-Lactam Versus Fluoroquinolone as Definitive Therapy for Enterobacteriaceae Bacteremia. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2019. [DOI: 10.1097/ipc.0000000000000781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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A Pilot Study of Postoperative Animal Welfare as a Guidance Tool in the Development of a Kidney Autotransplantation Model With Extended Warm Ischemia. Transplant Direct 2019; 5:e495. [PMID: 31773049 PMCID: PMC6831118 DOI: 10.1097/txd.0000000000000941] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 07/18/2019] [Accepted: 08/12/2019] [Indexed: 01/10/2023] Open
Abstract
This pilot study aimed to maintain acceptable animal welfare in the development of a porcine autotransplantation model with severe and incremental renal ischemic injury, a model for usage in future intervention studies. Secondary aims were to develop and test methods to collect blood and urine without the need to restrain or use sedative and avoid transportation to optimize welfare of the pig.
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Majeed A, Sagar F, Latif A, Hassan H, Iftikhar A, Darouiche RO, Mohajer MA. Does antimicrobial coating and impregnation of urinary catheters prevent catheter-associated urinary tract infection? A review of clinical and preclinical studies. Expert Rev Med Devices 2019; 16:809-820. [PMID: 31478395 DOI: 10.1080/17434440.2019.1661774] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction: Catheter-associated urinary tract infection (CAUTI) is one of the most common nosocomial infections in hospitals, accounting for 36% of all health care-associated infections. Areas covered: We aimed to address the potential impact of antimicrobial coating of catheter materials for the prevention of CAUTI and to analyze the progress made in this field. We conducted literature searches in the PubMed, Embase, and Cochrane Library databases, and found 578 articles. Data from 60 articles in either the preclinical or clinical stage were analyzed in this expert review. Expert opinion: The literature review revealed many promising methods for preventing CAUTI. Recent studies have suggested the combination of silver-based products and antibiotics, owing to their synergistic effect, to help address the problem of antibiotic resistance. Other coating materials that have been tested include nitric oxide, chlorhexidine, antimicrobial peptides, enzymes, and bacteriophages. Because of heterogeneity among studies, it is difficult to reliably comment on the clinical efficacy of different coating materials. Future research should focus on double-blind randomized clinical trials for evaluating the role of these potential coating agents.
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Affiliation(s)
- Aneela Majeed
- Division of Infectious Diseases, Department of Medicine, Stanford University , Stanford , CA , USA
| | - Fnu Sagar
- Department of Medicine, University of Arizona , Tucson , AZ , USA
| | - Azka Latif
- Department of Medicine, Creighton University , Omaha , NE , USA
| | - Hamza Hassan
- Department of Medicine, Rochester General Hospital , Rochester , NY , USA
| | - Ahmad Iftikhar
- Department of Medicine, University of Arizona , Tucson , AZ , USA
| | - Rabih O Darouiche
- Section of Infectious Diseases, Michael E. DeBakey Veterans Affairs Medical Center Baylor College of Medicine , Houston , TX , USA.,Section of Infectious Diseases, Baylor College of Medicine , Houston , TX , USA
| | - Mayar Al Mohajer
- Section of Infectious Diseases, Baylor College of Medicine , Houston , TX , USA
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Abstract
Older adults, specifically those in nursing facilities, are more susceptible to developing chronic open nonhealing wounds. Chronic open nonhealing wounds severely impact an individual’s quality of life and can lead to other comorbidities, such as infection. Recent evidence suggests that the open wound bacterial community can influence wound healing and repair. It is important to understand all sources of open wound contamination to improve preventative infection measures and treatment protocols. In this pilot study, we investigated if bacterial species isolated from urine can also be isolated from open wounds located between the levels of the umbilicus and mid-thigh in the same patient at the same point in time. A growing body of evidence suggests that urine can harbor a microbial community, even in asymptomatic individuals, and older adults are more prone to urinary incontinence. This is the first study to investigate bacterial species concordance between these two anatomical sites. We found, using both culture-dependent and -independent methods, that the same bacterial species can colonize both the urine and wound in one patient at one point in time. Further studies are needed to investigate if these species are of the same lineage and if the urinary microbiota are able to seed colonization of these types of open wounds. Nursing home residents are at a greater risk of developing pressure injuries that develop into an open wound, which can become colonized with bacteria. Understanding the factors that influence microbial colonization of open wounds can lead to the prevention of infections. The relationship between bacteria found in urine and those in open wounds is currently unknown. To determine if bacterial species colonizing open wounds are also found in the urine, we conducted a pilot study with nursing home residents, comparing bacterial species present in the urine with those present in wounds between the umbilicus and mid-thigh. To identify microbial species that were present in both urine and open wound at one time point in one patient, standard clinical bacteriologic culture techniques followed by matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) were used, as well as 16S rRNA-encoding gene amplicon sequencing. We found some bacterial species detected in urine were also detected in open wounds in one individual at one time point, using both culture-dependent and -independent techniques. Bacterial species that were more often detected, using culture-dependent and -independent methods, at both sites included Enterococcus faecalis, Proteus mirabilis, Escherichia coli, and Providencia stuartii. This pilot study provides evidence that bacterial species identified within the urine can also be identified in open wounds in the same patient at one point in time. Further studies are needed to investigate if these species are of the same lineage and if the urinary microbiota are able to seed colonization of open wounds below the umbilicus. IMPORTANCE Older adults, specifically those in nursing facilities, are more susceptible to developing chronic open nonhealing wounds. Chronic open nonhealing wounds severely impact an individual’s quality of life and can lead to other comorbidities, such as infection. Recent evidence suggests that the open wound bacterial community can influence wound healing and repair. It is important to understand all sources of open wound contamination to improve preventative infection measures and treatment protocols. In this pilot study, we investigated if bacterial species isolated from urine can also be isolated from open wounds located between the levels of the umbilicus and mid-thigh in the same patient at the same point in time. A growing body of evidence suggests that urine can harbor a microbial community, even in asymptomatic individuals, and older adults are more prone to urinary incontinence. This is the first study to investigate bacterial species concordance between these two anatomical sites. We found, using both culture-dependent and -independent methods, that the same bacterial species can colonize both the urine and wound in one patient at one point in time. Further studies are needed to investigate if these species are of the same lineage and if the urinary microbiota are able to seed colonization of these types of open wounds.
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Iribarnegaray V, Navarro N, Robino L, Zunino P, Morales J, Scavone P. Magnesium-doped zinc oxide nanoparticles alter biofilm formation of Proteus mirabilis. Nanomedicine (Lond) 2019; 14:1551-1564. [PMID: 31166149 DOI: 10.2217/nnm-2018-0420] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Aim: Proteus mirabilis biofilms colonize medical devices, and their role in microbial pathogenesis is well established. Magnesium-doped zinc oxide nanoparticles (ZnO:MgO NPs) have potential antimicrobial properties; thus, we aimed at evaluating the antibiofilm activity of ZnO:MgO NPs against P. mirabilis biofilm. Materials & methods: After synthesis and characterization of ZnO:MgO NPs and their addition to a polymer film, we evaluated the stages of P. mirabilis biofilm development over glass coverslip covered by different concentrations of ZnO:MgO NPs. Results: Low concentrations of ZnO:MgO NPs affect the development of P. mirabilis biofilm. Descriptors showed reduced values in bacterial number, bacterial volume and extracellular material. Conclusion: Our results highlight this new application of ZnO:MgO NPs as a potential antibiofilm strategy in medical devices.
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Affiliation(s)
- Victoria Iribarnegaray
- Departamento de Microbiología, Instituto de Investigaciones Biológicas Clemente Estable, Av. Italia 3318, PC 11600, Montevideo, Uruguay
| | - Nicolas Navarro
- Departamento de Ciencias y Tecnologías Farmacéuticas, Facultad de Ciencias Químicas y Farmacéuticas, Universidad de Chile, Santos Dumont 964, Independencia, Santiago, Chile.,Advanced Center for Chronic Diseases, Santiago, Chile
| | - Luciana Robino
- Departamento de Bacteriología y Virología, Facultad de Medicina, Universidad de la República, Alfredo Navarro 3051, PC 11600, Montevideo, Uruguay
| | - Pablo Zunino
- Departamento de Microbiología, Instituto de Investigaciones Biológicas Clemente Estable, Av. Italia 3318, PC 11600, Montevideo, Uruguay
| | - Javier Morales
- Departamento de Ciencias y Tecnologías Farmacéuticas, Facultad de Ciencias Químicas y Farmacéuticas, Universidad de Chile, Santos Dumont 964, Independencia, Santiago, Chile.,Advanced Center for Chronic Diseases, Santiago, Chile
| | - Paola Scavone
- Departamento de Microbiología, Instituto de Investigaciones Biológicas Clemente Estable, Av. Italia 3318, PC 11600, Montevideo, Uruguay
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Shareef MA, Sirisha K, Khan I, Sayeed IB, Jadav SS, Ramu G, Kumar CG, Kamal A, Babu BN. Design, synthesis, and antimicrobial evaluation of 1,4-dihydroindeno[1,2- c]pyrazole tethered carbohydrazide hybrids: exploring their in silico ADMET, ergosterol inhibition and ROS inducing potential. MEDCHEMCOMM 2019; 10:806-813. [PMID: 31191871 PMCID: PMC6540956 DOI: 10.1039/c9md00155g] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 03/29/2019] [Indexed: 11/21/2022]
Abstract
A series of new 1,4-dihydroindeno[1,2-c]pyrazole tethered carbohydrazide hybrids (5a-u) were designed, synthesized and evaluated for their antimicrobial activity. Compounds 5d, 5g, 5j, 5k and 5q demonstrated significant activity against the entire panel of test pathogens. Further, compounds 5d and 5g exhibited significant anti-Candida activity. These potential hybrids (5d and 5g) also exhibited promising ergosterol biosynthesis inhibition against Candida albicans, which was further validated through molecular docking studies. Furthermore, compounds 5d and 5g caused intracellular ROS accumulation in C. albicans MTCC 3017 and were non-toxic to normal human lung cell line MRC5. In silico studies revealed that they demonstrated drug likeness and an appreciable pharmacokinetic profile. Overall, the findings demonstrate that 5d and 5g may be considered as promising leads for further development of new antifungal drugs.
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Affiliation(s)
- Mohd Adil Shareef
- Department of Fluoro-Agrochemicals , CSIR-Indian Institute of Chemical Technology , Tarnaka , Hyderabad , India .
- Academy of Scientific and Innovative Research , New Delhi 110 025 , India
| | - K Sirisha
- Academy of Scientific and Innovative Research , New Delhi 110 025 , India
- Organic Synthesis and Process Chemistry Division , CSIR-Indian Institute of Chemical Technology , Tarnaka , Hyderabad 500007 , India
| | - Irfan Khan
- Academy of Scientific and Innovative Research , New Delhi 110 025 , India
- Organic Synthesis and Process Chemistry Division , CSIR-Indian Institute of Chemical Technology , Tarnaka , Hyderabad 500007 , India
| | - Ibrahim Bin Sayeed
- Academy of Scientific and Innovative Research , New Delhi 110 025 , India
- Organic Synthesis and Process Chemistry Division , CSIR-Indian Institute of Chemical Technology , Tarnaka , Hyderabad 500007 , India
| | - Surender Singh Jadav
- Department of Fluoro-Agrochemicals , CSIR-Indian Institute of Chemical Technology , Tarnaka , Hyderabad , India .
| | - Gopathi Ramu
- Department of Fluoro-Agrochemicals , CSIR-Indian Institute of Chemical Technology , Tarnaka , Hyderabad , India .
- Academy of Scientific and Innovative Research , New Delhi 110 025 , India
| | - C Ganesh Kumar
- Organic Synthesis and Process Chemistry Division , CSIR-Indian Institute of Chemical Technology , Tarnaka , Hyderabad 500007 , India
| | - Ahmed Kamal
- School of Pharmaceutical Education and Research , Jamia Hamdard University , New Delhi 110062 , India .
| | - Bathini Nagendra Babu
- Department of Fluoro-Agrochemicals , CSIR-Indian Institute of Chemical Technology , Tarnaka , Hyderabad , India .
- Academy of Scientific and Innovative Research , New Delhi 110 025 , India
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Khan I, Kanugala S, Shareef MA, Ganapathi T, Shaik AB, Shekar KC, Kamal A, Kumar CG. Synthesis of new bis‐pyrazole linked hydrazides and their in vitro evaluation as antimicrobial and anti‐biofilm agents: A mechanistic role on ergosterol biosynthesis inhibition inCandida albicans. Chem Biol Drug Des 2019; 94:1339-1351. [DOI: 10.1111/cbdd.13509] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 01/19/2019] [Accepted: 02/09/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Irfan Khan
- Department of Organic Synthesis and Process Chemistry CSIR‐Indian Institute of Chemical Technology Hyderabad India
- Academy of Scientific and Innovative Research Ghaziabad India
| | - Sirisha Kanugala
- Department of Organic Synthesis and Process Chemistry CSIR‐Indian Institute of Chemical Technology Hyderabad India
- Academy of Scientific and Innovative Research Ghaziabad India
| | - Mohd. Adil Shareef
- Department of Organic Synthesis and Process Chemistry CSIR‐Indian Institute of Chemical Technology Hyderabad India
- Academy of Scientific and Innovative Research Ghaziabad India
| | - Thipparapu Ganapathi
- Stem Cell Research DivisionDepartment of Biochemistry ICMR‐National Institute of Nutrition Hyderabad India
| | - Anver Basha Shaik
- Department of Organic Synthesis and Process Chemistry CSIR‐Indian Institute of Chemical Technology Hyderabad India
| | - Kunta Chandra Shekar
- Department of Organic Synthesis and Process Chemistry CSIR‐Indian Institute of Chemical Technology Hyderabad India
| | - Ahmed Kamal
- Department of Organic Synthesis and Process Chemistry CSIR‐Indian Institute of Chemical Technology Hyderabad India
- Academy of Scientific and Innovative Research Ghaziabad India
- School of Pharmaceutical Education and Research Jamia Hamdard University New Delhi India
| | - Chityal Ganesh Kumar
- Department of Organic Synthesis and Process Chemistry CSIR‐Indian Institute of Chemical Technology Hyderabad India
- Academy of Scientific and Innovative Research Ghaziabad India
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Dinh A, Davido B, Duran C, Bouchand F, Gaillard JL, Even A, Denys P, Chartier-Kastler E, Bernard L. Urinary tract infections in patients with neurogenic bladder. Med Mal Infect 2019; 49:495-504. [PMID: 30885540 DOI: 10.1016/j.medmal.2019.02.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 09/04/2018] [Accepted: 02/21/2019] [Indexed: 01/24/2023]
Abstract
Urinary tract infections (UTIs) in patients with neurogenic bladder are a major public health issue due to their high incidence and major consequences. Despite their frequency and potential severity, their physiopathology and management are poorly known. We provide a narrative literature review on the epidemiology, physiopathology, diagnostic criteria, microbiology, antimicrobial management, and prevention. UTIs among patients with neurogenic bladder are associated with high morbidity and healthcare utilization. Risk factors for UTI among this population are: indwelling catheter, urinary stasis, high bladder pressure, and bladder stones. Their diagnosis is a major challenge as clinical signs are often non-specific and rare. A urinary sample should be analyzed in appropriate conditions before any antibiotic prescription. According to most guidelines, a bacterial threshold≥103CFU/ml associated with symptoms is acceptable to define UTI in patients with neurogenic bladder. The management of acute symptomatic UTI is not evidence-based. A management with a single agent and a short antibiotic treatment of 10 days or less seems effective. Antibiotic selection should be based on the patient's resistance patterns. Asymptomatic bacteriuria should not be treated to avoid the emergence of bacterial resistance. Regarding preventive measures, use of clean intermittent catheterization, intravesical botulinum toxin injection, and prevention using antibiotic cycling are effective. Bacterial interference is promising but randomized controlled trials are needed. Large ongoing cohorts and randomized controlled trials should soon provide more evidence-based data.
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Affiliation(s)
- A Dinh
- Service des maladies infectieuses et tropicales, hôpital R. Poincaré, hôpitaux universitaires Paris Île de France Ouest (HU-PIFO), AP-HP, UVSQ, 104, boulevard R.-Poincaré, 92380 Garches, France.
| | - B Davido
- Service des maladies infectieuses et tropicales, hôpital R. Poincaré, hôpitaux universitaires Paris Île de France Ouest (HU-PIFO), AP-HP, UVSQ, 104, boulevard R.-Poincaré, 92380 Garches, France
| | - C Duran
- Service des maladies infectieuses et tropicales, hôpital R. Poincaré, hôpitaux universitaires Paris Île de France Ouest (HU-PIFO), AP-HP, UVSQ, 104, boulevard R.-Poincaré, 92380 Garches, France
| | - F Bouchand
- Pharmacie, hôpital R.-Poincaré, hôpitaux universitaires Paris Île de France Ouest, AP-HP, UVSQ, 92380 Garches, France
| | - J-L Gaillard
- Laboratoire de microbiologie, hôpital R.-Poincaré, hôpitaux universitaires Paris Île de France Ouest, AP-HP, UVSQ, 92380 Garches, France
| | - A Even
- Service de neuro-urologie, hôpital R.-Poincaré, hôpitaux universitaires Paris Île de France Ouest, AP-HP, UVSQ, 92380 Garches, France
| | - P Denys
- Service de neuro-urologie, hôpital R.-Poincaré, hôpitaux universitaires Paris Île de France Ouest, AP-HP, UVSQ, 92380 Garches, France
| | - E Chartier-Kastler
- Service d'urologie, hôpital Pitié Salpêtrière, AP-HP, université Paris VI, 75013 Paris, France
| | - L Bernard
- Département des maladies infectieuses et tropicales, hôpital Bretonneau, université F.-Rabelais, 37000 Tours, France
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