Effect of antiseptic agents on skin flora of the perineum of men with spinal cord injury

Bacterial Vaginosis: Risk Factors Among Kenyan Women and Their Male Partners

OBJECTIVES

To simultaneously examine associations of bacterial vaginosis (BV) with potential risk factors in both the female and her male partner.

STUDY DESIGN

We recruited women 18-45 years of age and their male partners from clinics in Nairobi, Kenya. All underwent face-to-face standardized interview physical examination, human immunodeficiency virus (HIV)-1 and syphilis serologic testing, endocervical cultures for Neisseria gonorrhoeae, and vaginal swabs for diagnosis of BV by Gram stain and trichomoniasis by culture.

RESULTS

Of 219 women, 97 (44%) had BV. BV was significantly associated by univariate analyses with women's own risk factors (young age, being unmarried, early sexual debut, more than 1 sexual partner, lifetime, rectal sex, trichomoniasis, HIV infection, and by principal components analysis, with low socioeconomic status [SES]) and also with male partners' characteristics (HIV infection, and by principal components analysis, low SES, and poor hygiene). In multivariate analysis including risk factors from both genders, the odds of having BV was 5.7 times higher if either partner was HIV seropositive, 13.2 times higher if the female had trichomoniasis, 2.5 times higher if the female had more than 1 sex partner ever, and decreased with increasing age of the female.

CONCLUSION

In this population, characteristics of males and of females were independently associated with BV. Close association of male hygiene and male HIV status precluded distinguishing the influence of male hygiene on partner's BV.

Catheter-associated infections: pathogenesis affects prevention

Intravascular catheters and urinary catheters are the 2 most commonly inserted medical devices in the United States, and they are likewise the two most common causes of nosocomially acquired bloodstream infection. Biofilm formation on the surfaces of indwelling catheters is central to the pathogenesis of infection of both types of catheters. The cornerstone to any preventive strategy of intravascular catheter infections is strict attention to infection control practices. Antimicrobial-impregnated intravascular catheters are a useful adjunction to infection control measures. Prevention of urinary catheter-associated infection is hindered by the numbers and types of organisms present in the periurethral area as well as by the typically longer duration of catheter placement. Antimicrobial agents in general have not been effective in preventing catheter-associated urinary tract infection in persons with long-term, indwelling urethral catheters. Preventive strategies that avoid the use of antimicrobial agents may be necessary in this population.

Pathogenesis of bacteriuria and infection in the spinal cord injured patient

Spinal cord injury (SCI) produces profound alterations in lower urinary tract function. Incontinence, elevated intravesical pressure, reflux, stones, and neurological obstruction, commonly found in the spinal cord-injured population, increase the risk of urinary infection. The overall rate of urinary infection in SCI patient is about 2.5 episodes per patient per year. Despite improved methods of treatment, urinary tract morbidity still ranks as the second leading cause of death in the SCI patient.SCI removes the ability of the pontine micturition center and higher centers in the brain to inhibit, control, or coordinate the activity of the vesicourethral unit. As a result, a patient with complete quadriplegia is typically unaware of bladder activity. Bladder contraction is accompanied by vesicosphincter dyssynergia instead of sphincter relaxation. It is widely accepted that intermittent catheterization, when compared with indwelling catheters, reduces the risk of urinary tract infection (UTI) in SCI patients and is the preferred method of bladder drainage in this patient population. Attempts at eliminating bacteriuria associated with indwelling or intermittent catheters have generally been unsuccessful. There is now appreciation of the fact that a creeping adherent biofilm of bacteria frequently ascends through the luminal and external surfaces of an indwelling catheter, often within 8 to 24 hours, leading to bacterial adherence to the bladder surface and correlating with symptomatic infection. The use of antimicrobial agents to clear or prevent bacteriuria in patients on indwelling or intermittent catheterization has had mixed success. Treatment for asymptomatic bacteriuria in SCI patients remains controversial. SCI patients with symptomatic urinary infections should be treated with the most specific, narrowest spectrum antibiotics available for the shortest possible time. Guidelines for selecting antimicrobial agents in SCI patients are similar to guidelines for the treatment of complicated urinary infections in the general population. Characteristics of the quinolones make them well suited to treating UTI in the SCI patient.

The effects of antiperspirant on the perineal skin flora of patients with spinal cord injury

The relationship of pH and moisture to Pseudomonas aeruginosa and Klebsiella pneumoniae colonization of the perineal skin was studied in male patients with spinal cord injury. The increased pH of the perineal skin was significantly associated with the presence of P. aeruginosa but not other bacterial species. No correlation between colonization and moisture or pH and moisture was found. An antiperspirant produced a significant reduction in the number of total aerobic bacteria, total gram-negative bacilli, P. aeruginosa and K. pneumoniae over a 24-h period. Long-term use of the antiperspirant for 10 days did not alter the persistence of P. aeruginosa of the same serotypes on the perineum.

Klebsiella pneumoniae colonization in patients with spinal cord injury

Klebsiella pneumoniae colonization of 53 patients with spinal cord injury was studied. Cultures of multiple body sites from patients, the environment, food, and hospital personnel were obtained. K. pneumonaie was cultured from one or more body sites in 46% of male patients. Significant bacteriuria was found in 10% of male patients. Positive cultures of the urethra and perineum for K. pneumoniae were significantly associated with the use of the external condom catheter (p less than 0.05, Fisher's exact test). K. pneumoniae colonization increased with length of stay in the hospital. Serotype 64, the predominant serotype found, was isolated only from patients who had been in the hospital for at least 4 wk and primarily in those patients using the external condom catheter. Urinary drainage bags were frequently colonized with K. pneumoniae at a time when the patients did not have significant bacteriuria. Colonized male patients were found to be the primary reservoir of K. pneumoniae and may serve as the major source for cross-contamination.