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Liu K, Liu S, Peng Z, Li N, Sun H. Construction of a nomogram for predicting catheter-related bladder discomfort in patients with end-stage renal disease after renal transplantation: a retrospective study. PeerJ 2024; 12:e17530. [PMID: 38915386 PMCID: PMC11195541 DOI: 10.7717/peerj.17530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/17/2024] [Indexed: 06/26/2024] Open
Abstract
Background The incidence of catheter-related bladder discomfort (CRBD) is relatively high in the end-stage renal disease (ESRD) patients who underwent renal transplantation (RT). This study was designed to establish a nomogram for predicting CRBD after RT among ESRD patients. Methods In this retrospective study, we collected 269 ESRD patients who underwent RT between September 2019 and August 2023 in our hospital. The patients were divided into training set (n = 215) and test set (n = 54) based on a ratio of 8:2. Univariate and multivariate logistic regression analyses were utilized to identify the risk factors associated with CRBD after RT, and then a nomogram model was constructed. Receiver operating characteristic (ROC) and calibration curve were used to evaluate the predicting efficiency of the established nomogram. Results Multivariate logistic regression analysis showed that aberrant body mass index (BMI) (underweight: OR = 5.25; 95% CI [1.25-22.15], P = 0.024; overweight: OR = 2.75; 95% CI [1.17-6.49], P = 0.021), anuria (OR = 2.86; 95% CI [1.33-5.88]) and application of double J (DJ) stent with a diameter of >5Fr (OR = 15.88; 95% CI [6.47-39.01], P < 0.001) were independent risk factors for CRBD after RT. In contrast, sufentanil utilization (>100 µg) [OR = 0.39; 95% CI [0.17-0.88], P = 0.023] was associated with decreased incidence of CRBD. A nomogram was then established based on these parameters for predicting the occurrence of CRBD after RT. Area under the ROC curve (AUC) values and calibration curves confirmed the prediction efficiency of the nomogram. Conclusion A nomogram was established for predicting CRBD after RT in ESRD patients, which showed good prediction efficiency based on AUC and calibration curves.
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Affiliation(s)
- Kao Liu
- Department of Organ Transplantation, Qilu Hospital of Shandong University, Jinan, China
| | - Shengli Liu
- Department of Organ Transplantation, Qilu Hospital of Shandong University, Jinan, China
| | - Zhiguo Peng
- Department of Organ Transplantation, Qilu Hospital of Shandong University, Jinan, China
| | - Na Li
- Department of Organ Transplantation, Qilu Hospital of Shandong University, Jinan, China
| | - Huaibin Sun
- Department of Organ Transplantation, Qilu Hospital of Shandong University, Jinan, China
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2
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Suleyman G, McCormick ME, McLenon N, Chami E, Pollak E, Dabaja AA. Urinary catheter alleviation navigator protocol (UCANP): Update to the hospital-wide implementation at a single tertiary health care center. Am J Infect Control 2024:S0196-6553(24)00537-6. [PMID: 38876167 DOI: 10.1016/j.ajic.2024.06.001] [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: 03/02/2024] [Revised: 06/04/2024] [Accepted: 06/06/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Catheter-associated urinary tract infections are commonly reported health care-associated infections. It was demonstrated that the urinary catheter alleviation navigator protocol (UCANP) pilot resulted in a reduction of catheter utilization and catheter days. METHODS Quality improvement initiative that was implemented at a single urban, tertiary health care center, focusing on early discontinuation of indwelling urinary catheters (IUCs) and avoidance of reinsertion. The protocol was expanded hospital-wide from September 2020 to April 2022. We compared IUC utilization, IUC standardized utilization ratio (SUR), and catheter-associated urinary tract infection standardized infection ratio in the preintervention period (March 2020 to August 2020) to the postintervention period (May 2022 to October 2022). RESULTS Preimplementation, 2 patients with IUC removal were placed on UCANP. Postimplementation, 835 (45%) patients with IUC removal participated in the protocol. The number of patients requiring IUC reinsertion did not differ among the 2 groups. IUC utilization was significantly decreased from 0.28 to 0.24 with a 14% reduction (P = .025). SUR decreased by 11% from 0.778 to 0.693 (P = .007) and standardized infection ratio by 84% from 0.311 to 0.049 (P = .009). CONCLUSIONS Our protocol significantly reduced IUC utilization and SUR after hospital-wide implementation. UCANP is a safe and effective strategy that can potentially decrease unnecessary IUCs in patients with transient urinary retention.
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Affiliation(s)
| | | | | | - Eman Chami
- Perform Excellence & Quality, Henry Ford Hospital, Detroit, MI
| | - Edward Pollak
- Quality Administration, Henry Ford Health, Detroit, MI
| | - Ali A Dabaja
- Department of Urology, Henry Ford Health, Detroit, MI
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Hunt BC, Brix V, Vath J, Guterman BL, Taddei SM, Learman BS, Brauer AL, Shen S, Qu J, Armbruster CE. Metabolic interplay between Proteus mirabilis and Enterococcus faecalis facilitates polymicrobial biofilm formation and invasive disease. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.03.17.533237. [PMID: 36993593 PMCID: PMC10055233 DOI: 10.1101/2023.03.17.533237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Polymicrobial biofilms play an important role in the development and pathogenesis of CAUTI. Proteus mirabilis and Enterococcus faecalis are common CAUTI pathogens that persistently co-colonize the catheterized urinary tract and form biofilms with increased biomass and antibiotic resistance. In this study, we uncover the metabolic interplay that drives biofilm enhancement and examine the contribution to CAUTI severity. Through compositional and proteomic biofilm analyses, we determined that the increase in biofilm biomass stems from an increase in the protein fraction of the polymicrobial biofilm matrix. We further observed an enrichment in proteins associated with ornithine and arginine metabolism in polymicrobial biofilms compared to single-species biofilms. We show that L-ornithine secretion by E. faecalis promotes arginine biosynthesis in P. mirabilis, and that disruption of this metabolic interplay abrogates the biofilm enhancement we see in vitro and leads to significant decreases in infection severity and dissemination in a murine CAUTI model.
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Affiliation(s)
- Benjamin C. Hunt
- Department of Microbiology and Immunology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, 14203, United States of America
| | - Vitus Brix
- Department of Microbiology and Immunology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, 14203, United States of America
| | - Joseph Vath
- Department of Microbiology and Immunology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, 14203, United States of America
| | - Beryl L. Guterman
- Department of Microbiology and Immunology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, 14203, United States of America
| | - Steven M. Taddei
- Department of Microbiology and Immunology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, 14203, United States of America
| | - Brian S. Learman
- Department of Microbiology and Immunology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, 14203, United States of America
| | - Aimee L. Brauer
- Department of Microbiology and Immunology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, 14203, United States of America
| | - Shichen Shen
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, State University of New York at Buffalo, Buffalo, NY, 14203, United States of America
| | - Jun Qu
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, State University of New York at Buffalo, Buffalo, NY, 14203, United States of America
- NYS Center of Excellence in Bioinformatics and Life Sciences, Buffalo, NY, 14203, United States of America
| | - Chelsie E. Armbruster
- Department of Microbiology and Immunology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, 14203, United States of America
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4
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Fluck D, Fry CH, Robin J, Affley B, Kakar P, Sharma P, Han TS. Impact of healthcare-associated infections within 7-days of acute stroke on health outcomes and risk of care-dependency: a multi-centre registry-based cohort study. Intern Emerg Med 2024; 19:919-929. [PMID: 38517643 PMCID: PMC11186937 DOI: 10.1007/s11739-024-03543-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/16/2024] [Indexed: 03/24/2024]
Abstract
Healthcare-associated infections (HCAIs) in patients admitted with acute conditions remain a major challenge to healthcare services. Here, we assessed the impact of HCAIs acquired within 7-days of acute stroke on indicators of care-quality outcomes and dependency. Data were prospectively collected (2014-2016) from the Sentinel Stroke National Audit Programme for 3309 patients (mean age = 76.2 yr, SD = 13.5) admitted to four UK hyperacute stroke units (HASU). Associations between variables were assessed by multivariable logistic regression (odds ratios, 95% confidence intervals), adjusted for age, sex, co-morbidities, pre-stroke disability, swallow screening, stroke type and severity. Within 7-days of admission, urinary tract infection (UTI) and pneumonia occurred in 7.6% and 11.3% of patients. Female (UTI only), older age, underlying hypertension, atrial fibrillation, previous stroke, pre-stroke disability, intracranial haemorrhage, severe stroke, and delay in swallow screening (pneumonia only) were independent risk factors of UTI and pneumonia. Compared to patients without UTI or pneumonia, those with either or both of these HCAIs were more likely to have prolonged stay (> 14-days) on HASU: 5.1 (3.8-6.8); high risk of malnutrition: 3.6 (2.9-4.5); palliative care: 4.5 (3.4-6.1); in-hospital mortality: 4.8 (3.8-6.2); disability at discharge: 7.5 (5.9-9.7); activity of daily living support: 1.6 (1.2-2.2); and discharge to care-home: 2.3 (1.6-3.3). In conclusion, HCAIs acquired within 7-days of an acute stroke led to prolonged hospitalisation, adverse health consequences and risk of care-dependency. These findings provide valuable information for timely intervention to reduce HCAIs, and minimising subsequent adverse outcomes.
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Affiliation(s)
- David Fluck
- Department of Cardiology, Ashford & St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK
| | - Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, BS8 1TD, UK
| | - Jonathan Robin
- Department of Acute Medicine, Ashford and St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK
| | - Brendan Affley
- Department of Stroke, Ashford and St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK
| | - Puneet Kakar
- Department of Stroke, Epsom and St Helier University Hospitals, Epsom, KT18 7EG, UK
| | - Pankaj Sharma
- Department of Clinical Neuroscience, Imperial College Healthcare NHS Trust, London, W6 8RF, UK
- Institute of Cardiovascular Research, Royal Holloway University of London, Egham, TW20 0EX, UK
| | - Thang S Han
- Institute of Cardiovascular Research, Royal Holloway University of London, Egham, TW20 0EX, UK.
- Department of Endocrinology, Ashford and St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK.
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5
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Bouhrour N, Nibbering PH, Bendali F. Medical Device-Associated Biofilm Infections and Multidrug-Resistant Pathogens. Pathogens 2024; 13:393. [PMID: 38787246 PMCID: PMC11124157 DOI: 10.3390/pathogens13050393] [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: 03/27/2024] [Revised: 04/29/2024] [Accepted: 05/04/2024] [Indexed: 05/25/2024] Open
Abstract
Medical devices such as venous catheters (VCs) and urinary catheters (UCs) are widely used in the hospital setting. However, the implantation of these devices is often accompanied by complications. About 60 to 70% of nosocomial infections (NIs) are linked to biofilms. The main complication is the ability of microorganisms to adhere to surfaces and form biofilms which protect them and help them to persist in the host. Indeed, by crossing the skin barrier, the insertion of VC inevitably allows skin flora or accidental environmental contaminants to access the underlying tissues and cause fatal complications like bloodstream infections (BSIs). In fact, 80,000 central venous catheters-BSIs (CVC-BSIs)-mainly occur in intensive care units (ICUs) with a death rate of 12 to 25%. Similarly, catheter-associated urinary tract infections (CA-UTIs) are the most commonlyhospital-acquired infections (HAIs) worldwide.These infections represent up to 40% of NIs.In this review, we present a summary of biofilm formation steps. We provide an overview of two main and important infections in clinical settings linked to medical devices, namely the catheter-asociated bloodstream infections (CA-BSIs) and catheter-associated urinary tract infections (CA-UTIs), and highlight also the most multidrug resistant bacteria implicated in these infections. Furthermore, we draw attention toseveral useful prevention strategies, and advanced antimicrobial and antifouling approaches developed to reduce bacterial colonization on catheter surfaces and the incidence of the catheter-related infections.
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Affiliation(s)
- Nesrine Bouhrour
- Laboratoire de Microbiologie Appliquée, Faculté des Sciences de la Nature et de la Vie, Université de Bejaia, Bejaia 06000, Algeria;
| | - Peter H. Nibbering
- Department of Infectious Diseases, Leiden University Medical Center, 2300 RC Leiden, The Netherlands;
| | - Farida Bendali
- Laboratoire de Microbiologie Appliquée, Faculté des Sciences de la Nature et de la Vie, Université de Bejaia, Bejaia 06000, Algeria;
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6
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Rosenthal VD, Yin R, Brown EC, Lee BH, Rodrigues C, Myatra SN, Kharbanda M, Rajhans P, Mehta Y, Todi SK, Basu S, Sahu S, Mishra SB, Chawla R, Nair PK, Arjun R, Singla D, Sandhu K, Palaniswamy V, Bhakta A, Nor MBM, Chian-Wern T, Bat-Erdene I, Acharya SP, Ikram A, Tumu N, Tao L, Alvarez GA, Valderrama-Beltran SL, Jiménez-Alvarez LF, Henao-Rodas CM, Gomez K, Aguilar-Moreno LA, Cano-Medina YA, Zuniga-Chavarria MA, Aguirre-Avalos G, Sassoe-Gonzalez A, Aleman-Bocanegra MC, Hernandez-Chena BE, Villegas-Mota MI, Aguilar-de-Moros D, Castañeda-Sabogal A, Medeiros EA, Dueñas L, Carreazo NY, Salgado E, Abdulaziz-Alkhawaja S, Agha HM, El-Kholy AA, Daboor MA, Guclu E, Dursun O, Koksal I, Havan M, Ozturk-Deniz SS, Yildizdas D, Okulu E, Omar AA, Memish ZA, Janc J, Hlinkova S, Duszynska W, Horhat-Florin G, Raka L, Petrov MM, Jin Z. Incidence and risk factors for catheter-associated urinary tract infection in 623 intensive care units throughout 37 Asian, African, Eastern European, Latin American, and Middle Eastern nations: A multinational prospective research of INICC. Infect Control Hosp Epidemiol 2024; 45:567-575. [PMID: 38173347 DOI: 10.1017/ice.2023.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
OBJECTIVE To identify urinary catheter (UC)-associated urinary tract infection (CAUTI) incidence and risk factors. DESIGN A prospective cohort study. SETTING The study was conducted across 623 ICUs of 224 hospitals in 114 cities in 37 African, Asian, Eastern European, Latin American, and Middle Eastern countries. PARTICIPANTS The study included 169,036 patients, hospitalized for 1,166,593 patient days. METHODS Data collection took place from January 1, 2014, to February 12, 2022. We identified CAUTI rates per 1,000 UC days and UC device utilization (DU) ratios stratified by country, by ICU type, by facility ownership type, by World Bank country classification by income level, and by UC type. To estimate CAUTI risk factors, we analyzed 11 variables using multiple logistic regression. RESULTS Participant patients acquired 2,010 CAUTIs. The pooled CAUTI rate was 2.83 per 1,000 UC days. The highest CAUTI rate was associated with the use of suprapubic catheters (3.93 CAUTIs per 1,000 UC days); with patients hospitalized in Eastern Europe (14.03) and in Asia (6.28); with patients hospitalized in trauma (7.97), neurologic (6.28), and neurosurgical ICUs (4.95); with patients hospitalized in lower-middle-income countries (3.05); and with patients in public hospitals (5.89).The following variables were independently associated with CAUTI: Age (adjusted odds ratio [aOR], 1.01; P < .0001), female sex (aOR, 1.39; P < .0001), length of stay (LOS) before CAUTI-acquisition (aOR, 1.05; P < .0001), UC DU ratio (aOR, 1.09; P < .0001), public facilities (aOR, 2.24; P < .0001), and neurologic ICUs (aOR, 11.49; P < .0001). CONCLUSIONS CAUTI rates are higher in patients with suprapubic catheters, in middle-income countries, in public hospitals, in trauma and neurologic ICUs, and in Eastern European and Asian facilities.Based on findings regarding risk factors for CAUTI, focus on reducing LOS and UC utilization is warranted, as well as implementing evidence-based CAUTI-prevention recommendations.
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Affiliation(s)
- Victor Daniel Rosenthal
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
- International Nosocomial Infection Control Consortium, INICC Foundation, Miami, Florida, United States
| | - Ruijie Yin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Eric Christopher Brown
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
| | | | - Camilla Rodrigues
- Department of Microbiology, Pd Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Sheila Nainan Myatra
- Department of Anesthesiology, Critical Care and Pain, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, India
| | | | - Prasad Rajhans
- Deenanath Mangeshkar Hospital and Research Center Erandwane Pune, Pune, India
| | - Yatin Mehta
- Department of Critical Care and Anesthesiology, Medanta the Medicity, Haryana, India
| | - Subhash Kumar Todi
- Department of Critical Care, Advanced Medicare Research Institute Hospitals, Kolkata, India
| | - Sushmita Basu
- Advanced Medicare Research Institute Mukundapur Unit, Kolkata, India
| | | | | | - Rajesh Chawla
- Department of Critical Care, Indraprastha Apollo Hospitals, New Delhi, India
| | | | - Rajalakshmi Arjun
- Department of Critical Care, Kerala Institute of Medical Sciences Health, Trivandrum, India
| | | | - Kavita Sandhu
- Department of Critical Care, Max Super Speciality Hospital Saket Delhi, New Delhi, India
| | | | - Arpita Bhakta
- Department of Pediatric Intensive Care, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Mohd-Basri Mat Nor
- Department of Anesthesia and Critical Care, International Islamic University Malaysia, Kuantan Pahang, Malaysia
| | - Tai Chian-Wern
- Department of Critical Care, Universiti Kebangsaan Malaysia Specialist Children's Hospital, Kuala Lumpur, Malaysia
| | | | | | - Aamer Ikram
- Armed Forces Institute of Urology, Rawalpindi, Pakistan
| | - Nellie Tumu
- Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | - Lili Tao
- Department of Pneumonology, Zhongshan Hospital, Fudan University, Shanghai, China
| | | | | | | | | | | | | | | | | | - Guadalupe Aguirre-Avalos
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | | | | | | | | | | | | | | | - Lourdes Dueñas
- Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
| | - Nilton Yhuri Carreazo
- Universidad Peruana de Ciencias Aplicadas, Hospital de Emergencias Pediatricas, Lima, Peru
| | | | | | | | | | | | - Ertugrul Guclu
- Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Oguz Dursun
- Akdeniz University Medical School, Antalya, Turkey
| | - Iftihar Koksal
- Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Merve Havan
- Ankara University Faculty of Medicine, Ankara, Turkey
| | | | | | - Emel Okulu
- Ankara University Faculty of Medicine Childrens Hospital NICU, Ankara, Turkey
| | - Abeer Aly Omar
- Infection Control Directorate. Ministry of Health, Kuwait City, Kuwait
| | - Ziad A Memish
- King Saud Medical City, Ministry of Health, Riyadh, the Kingdom of Saudi Arabia
| | - Jarosław Janc
- 4th Clinical Military Hospital, Wroclaw, Poland, Europe
| | - Sona Hlinkova
- Faculty of Health, Catholic University in Ruzomberok, Central Military Hospital Ruzomberok, Ruzomberok, Slovakia
| | - Wieslawa Duszynska
- Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland
| | - George Horhat-Florin
- University of Medicine and Pharmacy Victor Babes Timisoara Emergency Clinical County Hospital Romania, Timisoara, Romania
| | - Lul Raka
- National Institute For Public Health, Prishtina, Kosovo
| | - Michael M Petrov
- Department of Microbiology, Faculty of Pharmacy, Medical University of Plovdiv, Bulgaria
| | - Zhilin Jin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
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7
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Chang KT, Lai PH, Lu IC, Huang RY, Lin CW, Huang CH. Urinary catheter placement and adverse urinary outcomes with a focus on elevated risk in men with indwelling Foley catheters. J Am Geriatr Soc 2024; 72:1166-1176. [PMID: 38401032 DOI: 10.1111/jgs.18819] [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: 11/07/2023] [Revised: 01/18/2024] [Accepted: 02/01/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Prior studies indicated a link between urinary catheter use and urinary complications, highlighting the need for comprehensive, gender-specific investigations. This study explored the association through a national retrospective cohort, emphasizing gender disparities and long-term outcomes. METHODS Our study utilized data from the entire population covered by Taiwan's National Health Insurance Research Database from 2000 to 2017. We included 148,304 patients who had undergone Foley catheter placement and their propensity-scores matched controls in the study. We evaluated urinary complications, which encompassed urinary tract cancer, urolithiasis, urethral stricture, obstructive uropathy, reflux uropathy, fistula, diverticulum, caruncle, false passage, prolapsed urethral mucosa, urinary tract rupture, and urinary tract infection. These were assessed using the Fine and Gray sub-distribution proportional hazards model to compare between the Foley and non-Foley groups. Sensitivity analyses were conducted with different matching ratios. RESULTS In the study, the non-Foley group presented a marginally higher mean age (75.24 ± 10.47 years) than the Foley group (74.09 ± 10.47 years). The mean duration of Foley catheterization was 6.1 ± 4.19 years. Men with Foley catheterization exhibited the highest adjusted sub-distribution hazard ratios for urinary tract cancer (6.57, 95% CI: 5.85-7.37), followed by women with Foley catheterization (4.48, 95% CI: 3.98-5.05), and men without catheterization (1.58, 95% CI: 1.39-1.8) in comparison with women without the procedure. Furthermore, men with Foley catheterization were found to be at the greatest risk for complications such as urolithiasis, urethral stricture, obstructive and reflux uropathy, fistula, diverticulum, caruncle, false passage, prolapsed urethral mucosa, and urinary tract rupture. Conversely, women with urinary catheterization were most susceptible to urinary tract infections. CONCLUSIONS The evidence confirms that urinary catheterization significantly increases urinary complications, particularly among men. Our study underscores the crucial need for healthcare providers to carefully evaluate the necessity of catheterization, aim to shorten its duration whenever feasible, and strictly adhere to established protocols to minimize complications.
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Affiliation(s)
- Kai-Ting Chang
- Department of Family Medicine, E-Da Dachang hospital, I-Shou University, Kaohsiung City, Taiwan
| | - Po-Husan Lai
- Department of Family Medicine and Community Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - I-Cheng Lu
- Department of Family Medicine and Community Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung City, Taiwan
- Department of Occupational Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - Ru-Yi Huang
- Department of Family Medicine and Community Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung City, Taiwan
- Department of Holistic Medicine, E-Da Hospital, Kaohsiung City, Taiwan
| | - Chi-Wei Lin
- Department of Family Medicine and Community Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung City, Taiwan
| | - Chi-Hsien Huang
- Department of Family Medicine and Community Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung City, Taiwan
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8
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Molina JJ, Kohler KN, Gager C, Andersen MJ, Wongso E, Lucas ER, Paik A, Xu W, Donahue DL, Bergeron K, Klim A, Caparon MG, Hultgren SJ, Desai A, Ploplis VA, Flick MJ, Castellino FJ, Flores-Mireles AL. Fibrinolytic-deficiencies predispose hosts to septicemia from a catheter-associated UTI. Nat Commun 2024; 15:2704. [PMID: 38538626 PMCID: PMC10973455 DOI: 10.1038/s41467-024-46974-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 03/15/2024] [Indexed: 04/04/2024] Open
Abstract
Catheter-associated urinary tract infections (CAUTIs) are amongst the most common nosocomial infections worldwide and are difficult to treat partly due to development of multidrug-resistance from CAUTI-related pathogens. Importantly, CAUTI often leads to secondary bloodstream infections and death. A major challenge is to predict when patients will develop CAUTIs and which populations are at-risk for bloodstream infections. Catheter-induced inflammation promotes fibrinogen (Fg) and fibrin accumulation in the bladder which are exploited as a biofilm formation platform by CAUTI pathogens. Using our established mouse model of CAUTI, here we identified that host populations exhibiting either genetic or acquired fibrinolytic-deficiencies, inducing fibrin deposition in the catheterized bladder, are predisposed to severe CAUTI and septicemia by diverse uropathogens in mono- and poly-microbial infections. Furthermore, here we found that Enterococcus faecalis, a prevalent CAUTI pathogen, uses the secreted protease, SprE, to induce fibrin accumulation and create a niche ideal for growth, biofilm formation, and persistence during CAUTI.
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Affiliation(s)
- Jonathan J Molina
- Integrated Biomedical Sciences, University of Notre Dame, Notre Dame, IN, 46556, USA
- Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, 46556, USA
| | - Kurt N Kohler
- Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, 46556, USA
| | - Christopher Gager
- Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, 46556, USA
| | - Marissa J Andersen
- Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, 46556, USA
| | - Ellsa Wongso
- Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, 46556, USA
| | - Elizabeth R Lucas
- Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, 46556, USA
| | - Andrew Paik
- Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, 46556, USA
| | - Wei Xu
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Center for Women's Infectious Disease Research, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Deborah L Donahue
- W. M. Keck Center for Transgene Research, University of Notre Dame, Notre Dame, IN, 46556, USA
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, 46556, USA
| | - Karla Bergeron
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Aleksandra Klim
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Michael G Caparon
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Center for Women's Infectious Disease Research, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Scott J Hultgren
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Center for Women's Infectious Disease Research, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Alana Desai
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Department of Urology, University of Washington Medical Center, Seattle, WA, 98133-9733, USA
| | - Victoria A Ploplis
- W. M. Keck Center for Transgene Research, University of Notre Dame, Notre Dame, IN, 46556, USA
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, 46556, USA
| | - Matthew J Flick
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, 27599, USA
- UNC Blood Research Center, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Francis J Castellino
- W. M. Keck Center for Transgene Research, University of Notre Dame, Notre Dame, IN, 46556, USA
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, 46556, USA
| | - Ana L Flores-Mireles
- Integrated Biomedical Sciences, University of Notre Dame, Notre Dame, IN, 46556, USA.
- Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, 46556, USA.
- W. M. Keck Center for Transgene Research, University of Notre Dame, Notre Dame, IN, 46556, USA.
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9
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Jorro-Barón F, Taffarel P. Balancing pediatric device utility and harm: navigating the challenges for safer healthcare. Pediatr Res 2024:10.1038/s41390-024-03126-2. [PMID: 38443522 DOI: 10.1038/s41390-024-03126-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 02/10/2024] [Indexed: 03/07/2024]
Abstract
This article discusses the challenges in balancing the utility and harm associated with pediatric medical devices. Takashima et al. explored the prevalence and complications of invasive devices across three Australian pediatric tertiary hospitals and reported a high prevalence of complications, particularly with vascular access devices. We also highlight the need to pay attention to the use of these devices, particularly intravenous catheters, and the importance of a culture of patient safety in healthcare systems. We emphasize the need for a nuanced approach that carefully weighs the benefits against potential risks and encourages collaboration among stakeholders to establish robust regulatory frameworks and prioritize the safety and well-being of pediatric patients. Finally, we conclude by advocating the involvement of parents and families in gathering information about hospital safety incidents and fostering a culture of safety that supports reporting, flexibility, and learning. IMPACT: Reporting adverse events and their consequences is essential in the strategy to prevent them, allowing comparison with national or international standards, and identifying indicators to optimize and harbor the possibility of determining improvement measures that pursue a multifactorial approach and are cost-effective. Our comment advocates limiting the prevalence of medical invasive devices and their consequences by reviewing their epidemiology. Although advancements in medical technology have undoubtedly improved the diagnostic and therapeutic possibilities, the delicate balance between device utility and potential harm necessitates careful consideration.
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Affiliation(s)
- Facundo Jorro-Barón
- Institute for Clinical Effectiveness and Health Policy -IECS- Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina.
- Hospital Pedro de Elizalde, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Pedro Taffarel
- Hospital Pedro de Elizalde, Ciudad Autónoma de Buenos Aires, Argentina
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10
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Campesi I, Franconi F, Serra PA. The Appropriateness of Medical Devices Is Strongly Influenced by Sex and Gender. Life (Basel) 2024; 14:234. [PMID: 38398743 PMCID: PMC10890141 DOI: 10.3390/life14020234] [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: 10/31/2023] [Revised: 01/22/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Until now, research has been performed mainly in men, with a low recruitment of women; consequentially, biological, physiological, and physio-pathological mechanisms are less understood in women. Obviously, without data obtained on women, it is impossible to apply the results of research appropriately to women. This issue also applies to medical devices (MDs), and numerous problems linked to scarce pre-market research and clinical trials on MDs were evidenced after their introduction to the market. Globally, some MDs are less efficient in women than in men and sometimes MDs are less safe for women than men, although recently there has been a small but significant decrease in the sex and gender gap. As an example, cardiac resynchronization defibrillators seem to produce more beneficial effects in women than in men. It is also important to remember that MDs can impact the health of healthcare providers and this could occur in a sex- and gender-dependent manner. Recently, MDs' complexity is rising, and to ensure their appropriate use they must have a sex-gender-sensitive approach. Unfortunately, the majority of physicians, healthcare providers, and developers of MDs still believe that the human population is only constituted by men. Therefore, to overcome the gender gap, a real collaboration between the inventors of MDs, health researchers, and health providers should be established to test MDs in female and male tissues, animals, and women.
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Affiliation(s)
- Ilaria Campesi
- Dipartimento di Scienze Biomediche, Università degli Studi di Sassari, 07100 Sassari, Italy
- Laboratorio Nazionale sulla Farmacologia e Medicina di Genere, Istituto Nazionale Biostrutture Biosistemi, 07100 Sassari, Italy;
| | - Flavia Franconi
- Laboratorio Nazionale sulla Farmacologia e Medicina di Genere, Istituto Nazionale Biostrutture Biosistemi, 07100 Sassari, Italy;
| | - Pier Andrea Serra
- Dipartimento di Medicina, Chirurgia e Farmacia, Università degli Studi di Sassari, 07100 Sassari, Italy;
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11
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Yeaman C, Lawton J, Smith C, Kamilova M, You W, Pilehvari A, Rapp DE. Urologic Consultations for Urethral Catheter Placement: A Cost Analysis. Urology 2024; 183:85-92. [PMID: 37984488 DOI: 10.1016/j.urology.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/08/2023] [Accepted: 11/02/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE To comprehensively analyze the cumulative costs associated with Foley consultations throughout their event lifespan. Urologic consultation for Foley catheter (Foley) management is common. Such consultations are heterogeneous, with some requiring only simple catheter placement. Others (eg, traumatic Foley) necessitate more complex procedural intervention and may also result in downstream care and/or intervention needs. METHODS This study analyzed a retrospective database of consecutive urologic Foley consultations at a single academic institution (2017-2019), collecting comprehensive data on patient characteristics, related procedures/materials, and downstream care (eg, hospitalization, laboratory/radiology testing, evaluation and management services). A process map and related modeling were used to assess categorical and cumulative event costs. Allocated costs and charges were utilized for materials/institutional resources and for services rendered, respectively. Statistical analysis performed using SAS and statistical inferences were based on significance level of 10%. RESULTS A total of 244 patient encounters were included in the analysis. The mean overall cost of all care related to Foley consultation was $2389.23 (±$4045.89). A total of 62 (25.4%) patients required only consultation/Foley without additional intervention, with a total cost of $738.90 (±$94.10). The remaining 182 (75.6%) patients required additional intervention and related cost (total cost $3413.27 (±$4850.41)). Traumatic catheterization was associated with higher cost compared with atraumatic cases ($3201.50 (±$6158.4) vs $1926.40 (±$1776.20), respectively, P = .05). Downstream care comprised a significant portion of overall cost. In 61 (25%) cases no nurse attempt was performed prior to consultation. CONCLUSION Urologic Foley consultation is associated with significant health system cost. Quality initiatives to optimizing Foley placement and management are critical to improving quality of care and associated downstream costs.
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Affiliation(s)
- Clinton Yeaman
- University of Virginia School of Medicine, Charlottesville, VA
| | - Jack Lawton
- Department of Urology, University of Virginia, Charlottesville, VA
| | - Caleigh Smith
- Department of Urology, University of Virginia, Charlottesville, VA
| | - Medina Kamilova
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA
| | - Wen You
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA
| | - Asal Pilehvari
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA
| | - David E Rapp
- University of Virginia School of Medicine, Charlottesville, VA.
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12
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Rosenthal VD, Yin R, Abbo LM, Lee BH, Rodrigues C, Myatra SN, Divatia JV, Kharbanda M, Nag B, Rajhans P, Shingte V, Mehta Y, Sarma S, Todi SK, Bhattacharyya M, Basu S, Sahu S, Mishra SB, Samal S, Chawla R, Jain AC, Nair PK, Kalapala D, Arjun R, Singla D, Sandhu K, Badyal B, Palaniswamy V, Bhakta A, Gan CS, Mohd-Basri MN, Lai YH, Tai CW, Lee PC, Bat-Erdene I, Begzjav T, Acharya SP, Dongol R, Ikram A, Tumu N, Tao L, Jin Z. An international prospective study of INICC analyzing the incidence and risk factors for catheter-associated urinary tract infections in 235 ICUs across 8 Asian Countries. Am J Infect Control 2024; 52:54-60. [PMID: 37499758 DOI: 10.1016/j.ajic.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Identify urinary catheter (UC)-associated urinary tract infections (CAUTI) incidence and risk factors (RF) in 235 ICUs in 8 Asian countries: India, Malaysia, Mongolia, Nepal, Pakistan, the Philippines, Thailand, and Vietnam. METHODS From January 1, 2014, to February 12, 2022, we conducted a prospective cohort study. To estimate CAUTI incidence, the number of UC days was the denominator, and CAUTI was the numerator. To estimate CAUTI RFs, we analyzed 11 variables using multiple logistic regression. RESULTS 84,920 patients hospitalized for 499,272 patient days acquired 869 CAUTIs. The pooled CAUTI rate per 1,000 UC-days was 3.08; for those using suprapubic-catheters (4.11); indwelling-catheters (2.65); trauma-ICU (10.55), neurologic-ICU (7.17), neurosurgical-ICU (5.28); in lower-middle-income countries (3.05); in upper-middle-income countries (1.71); at public-hospitals (5.98), at private-hospitals (3.09), at teaching-hospitals (2.04). The following variables were identified as CAUTI RFs: Age (adjusted odds ratio [aOR] = 1.01; 95% CI = 1.01-1.02; P < .0001); female sex (aOR = 1.39; 95% CI = 1.21-1.59; P < .0001); using suprapubic-catheter (aOR = 4.72; 95% CI = 1.69-13.21; P < .0001); length of stay before CAUTI acquisition (aOR = 1.04; 95% CI = 1.04-1.05; P < .0001); UC and device utilization-ratio (aOR = 1.07; 95% CI = 1.01-1.13; P = .02); hospitalized at trauma-ICU (aOR = 14.12; 95% CI = 4.68-42.67; P < .0001), neurologic-ICU (aOR = 14.13; 95% CI = 6.63-30.11; P < .0001), neurosurgical-ICU (aOR = 13.79; 95% CI = 6.88-27.64; P < .0001); public-facilities (aOR = 3.23; 95% CI = 2.34-4.46; P < .0001). DISCUSSION CAUTI rate and risk are higher for older patients, women, hospitalized at trauma-ICU, neurologic-ICU, neurosurgical-ICU, and public facilities. All of them are unlikely to change. CONCLUSIONS It is suggested to focus on reducing the length of stay and the Urinary catheter device utilization ratio, avoiding suprapubic catheters, and implementing evidence-based CAUTI prevention recommendations.
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Affiliation(s)
- Victor D Rosenthal
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, USA; Infeciton Control Department, International Nosocomial Infection Control Consortium, INICC Foundation, Miami, USA.
| | - Ruijie Yin
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, USA
| | - Lilian M Abbo
- Division of Infectious Disease, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Camilla Rodrigues
- Pd Hinduja National Hospital and Medical Research Centre, Department of Microbiology, Mumbai, India
| | - Sheila N Myatra
- Tata Memorial Hospital, Homi Bhabha National Institute, Department of Anesthesiology, Critical Care and Pain, Mumbai, India
| | | | - Mohit Kharbanda
- Deenanath Mangeshkar Hospital And Research Center Erandwane Pune, Pune, India
| | - Bikas Nag
- Deenanath Mangeshkar Hospital And Research Center Erandwane Pune, Pune, India
| | - Prasad Rajhans
- Deenanath Mangeshkar Hospital And Research Center Erandwane Pune, Pune, India
| | - Vasudha Shingte
- Deenanath Mangeshkar Hospital And Research Center Erandwane Pune, Pune, India
| | - Yatin Mehta
- Medanta The Medicity, Department of Critical Care and Anesthesiology, Haryana, India
| | - Smita Sarma
- Medanta The Medicity, Department of Critical Care and Anesthesiology, Haryana, India
| | - Subhash K Todi
- Advanced Medicare Research Institute AMRI Hospitals, Department of Critical Care, Kolkata, India
| | - Mahuya Bhattacharyya
- Advanced Medicare Research Institute AMRI Hospitals, Department of Critical Care, Kolkata, India
| | - Sushmita Basu
- Advanced Medicare Research Institute Mukundapur Unit, Kolkata, India
| | | | - Shakti B Mishra
- Critical Care Department, IMS and SUM Hospital, Bhubaneswar, India
| | - Samir Samal
- Critical Care Department, IMS and SUM Hospital, Bhubaneswar, India
| | - Rajesh Chawla
- Indraprastha Apollo Hospitals, Department of Critical Care, New Delhi, India
| | - Aakanksha C Jain
- Indraprastha Apollo Hospitals, Department of Critical Care, New Delhi, India
| | - Pravin K Nair
- Critical Care Department, Holy Spirit Hospital, Mumbai, India
| | - Durga Kalapala
- Critical Care Department, Holy Spirit Hospital, Mumbai, India
| | - Rajalakshmi Arjun
- Kerala Institute Of Med Sciences Health, Department of Critical Care, Trivandrum, India
| | - Deepak Singla
- Critical Care Department, Maharaja Agrasen Hospital, New Delhi, India
| | - Kavita Sandhu
- Max Super Speciality Hospital Saket Delhi, Department of Critical Care, New Delhi, India
| | - Binesh Badyal
- Max Super Speciality Hospital Saket Delhi, Department of Critical Care, New Delhi, India
| | | | - Arpita Bhakta
- University Malaya Medical Centre, Department of Pediatric Intensive Care, Kuala Lumpur, Malaysia
| | - Chin S Gan
- University Malaya Medical Centre, Department of Pediatric Intensive Care, Kuala Lumpur, Malaysia
| | - Mat N Mohd-Basri
- International Islamic University Malaysia, Department of Anesthesia and Critical Care, Kuantan, Pahang, Malaysia
| | - Yin H Lai
- International Islamic University Malaysia, Department of Anesthesia and Critical Care, Kuantan, Pahang, Malaysia
| | - Chian-Wern Tai
- Universiti Kebangsaan Malaysia Specialist Children's Hospital, Department of Critical Care, Kuala Lumpur, Malaysia
| | - Pei-Chuen Lee
- Universiti Kebangsaan Malaysia Specialist Children's Hospital, Department of Critical Care, Kuala Lumpur, Malaysia
| | - Ider Bat-Erdene
- Critical Care Department, Intermed Hospital, Ulaanbaatar, Mongolia
| | - Tsolmon Begzjav
- Critical Care Department, Intermed Hospital, Ulaanbaatar, Mongolia
| | - Subhash P Acharya
- Critical Care Department, Grande International Hospital, Kathmandu, Nepal
| | - Reshma Dongol
- Critical Care Department, Grande International Hospital, Kathmandu, Nepal
| | - Aamer Ikram
- Critical Care Department, Armed Forces Institute of Urology, Rawalpindi, Pakistan
| | - Nellie Tumu
- Department of Public Health Sciences, Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | - Lili Tao
- Zhongshan Hospital, Fudan University, Department of Pneumonology, Shanghai, China
| | - Zhilin Jin
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, USA
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13
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Yin R, Jin Z, Lee BH, Alvarez GA, Stagnaro JP, Valderrama-Beltran SL, Gualtero SM, Jiménez-Alvarez LF, Reyes LP, Henao Rodas CM, Gomez K, Alarcon J, Aguilar Moreno LA, Bravo Ojeda JS, Cano Medina YA, Chapeta Parada EG, Zuniga Chavarria MA, Quesada Mora AM, Aguirre-Avalos G, Mijangos-Méndez JC, Sassoe-Gonzalez A, Millán-Castillo CM, Aleman-Bocanegra MC, Echazarreta-Martínez CV, Hernandez-Chena BE, Jarad RMA, Villegas-Mota MI, Montoya-Malváez M, Aguilar-de-Moros D, Castaño-Guerra E, Córdoba J, Castañeda-Sabogal A, Medeiros EA, Fram D, Dueñas L, Carreazo NY, Salgado E, Rosenthal VD. Prospective cohort study of incidence and risk factors for catheter-associated urinary tract infections in 145 intensive care units of 9 Latin American countries: INICC findings. World J Urol 2023; 41:3599-3609. [PMID: 37823942 DOI: 10.1007/s00345-023-04645-z] [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: 05/04/2023] [Accepted: 09/16/2023] [Indexed: 10/13/2023] Open
Abstract
PURPOSE Identify urinary catheter (UC)-associated urinary tract infections (CAUTI) incidence and risk factors (RF) in Latin American Countries. METHODS From 01/01/2014 to 02/10/2022, we conducted a prospective cohort study in 145 ICUs of 67 hospitals in 35 cities in nine Latin American countries: Argentina, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Panama, and Peru. To estimate CAUTI incidence, we used the number of UC-days as the denominator, and the number of CAUTIs as numerator. To estimate CAUTI RFs, we analyzed the following 10 variables using multiple logistic regression: gender, age, length of stay (LOS) before CAUTI acquisition, UC-days before CAUTI acquisition, UC-device utilization (DU) ratio, UC-type, hospitalizationtype, ICU type, facility ownership, and time period. RESULTS 31,631 patients, hospitalized for 214,669 patient-days, acquired 305 CAUTIs. The pooled CAUTI rate per 1000 UC-days was 2.58, for those using suprapubic catheters, it was 2.99, and for those with indwelling catheters, it was 2.21. The following variables were independently associated with CAUTI: age, rising risk 1% yearly (aOR = 1.01; 95% CI 1.01-1.02; p < 0.0001 female gender (aOR = 1.28; 95% CI 1.01-1.61; p = 0.04), LOS before CAUTI acquisition, rising risk 7% daily (aOR = 1.07; 95% CI 1.06-1.08; p < 0.0001, UC/DU ratio (aOR = 1.14; 95% CI 1.08-1.21; p < 0.0001, public facilities (aOR = 2.89; 95% CI 1.75-4.49; p < 0.0001. The periods 2014-2016 and 2017-2019 had significantly higher risks than the period 2020-2022. Suprapubic catheters showed similar risks as indwelling catheters. CONCLUSION The following CAUTI RFs are unlikely to change: age, gender, hospitalization type, and facility ownership. Based on these findings, it is suggested to focus on reducing LOS, UC/DU ratio, and implementing evidence-based CAUTI prevention recommendations.
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Affiliation(s)
- Ruijie Yin
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, USA
| | - Zhilin Jin
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, USA
| | | | | | - Juan Pablo Stagnaro
- Instituto Central De Medicina, La Plata, Provincia de Buenos Aires, Argentina
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Guadalupe Aguirre-Avalos
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Julio Cesar Mijangos-Méndez
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | | | | | | | | | | | | | | | | | | | | | - Judith Córdoba
- Hospital del Niño Dr José Renán Esquivel, Panama, Panama
| | | | | | - Dayana Fram
- Hospital Sao Paulo, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Lourdes Dueñas
- Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
| | - Nilton Yhuri Carreazo
- Hospital de Emergencias Pediatricas, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Estuardo Salgado
- Department of Infection Control, Hospital Marie Curie, Quito, Ecuador
| | - Victor Daniel Rosenthal
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, USA.
- International Nosocomial Infection Control Consortium, INICC Foundation, Miami, USA.
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14
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Fluck D, Fry CH, Robin J, Affley B, Kakar P, Sharma P, Han TS. Determination of independent risk factors for early healthcare-associated infections acquired after acute stroke admission: A multi-centre registry-based cohort study. J Stroke Cerebrovasc Dis 2023; 32:107402. [PMID: 37804783 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107402] [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: 08/09/2023] [Revised: 09/20/2023] [Accepted: 09/30/2023] [Indexed: 10/09/2023] Open
Abstract
OBJECTIVE Healthcare-associated infections (HCAIs) in patients admitted with acute conditions pose a serious risk to patients and a major challenge to healthcare services. However, there is a lack of consistency in reporting aetiological risk factors, particularly in acute stroke patients. Here, we determined independent risk factors of two common HCAIs (urinary tract infection and pneumonia) acquired within 7-days of admission after an acute stroke. METHODS Data were prospectively collected (2014-2016) from the Sentinel Stroke National Audit Programme for 3,309 patients (mean age=76.2yr, SD=13.5) admitted to four UK hyperacute stroke units. Associations between variables were assessed by forward stepwise multivariable logistic regression (odds ratios, 95 % confidence intervals). RESULTS The rate of urinary tract infection and/or pneumonia occurring within 7-days of admission was 15.0 %. The risk of urinary tract infection and/or pneumonia was increased amongst women: OR = 1.35 (1.08-1.68); patients from ethnic minority backgrounds: OR = 1.77 (1.01-3.10); patients aged 70-79 years: OR = 2.08 (1.42-3.06), and ≥80 years: OR = 3.20 (2.26-4.55); history of hypertension: OR = 1.59 (1.27-1.98); history of atrial fibrillation: OR = 1.67 (1.32-2.12); pre-stroke disability: OR = 2.08 (1.44-3.00); intracranial haemorrhage: OR = 1.41 (1.07-1.86); severe stroke: OR = 3.21 (2.32-4.45); swallow screening within 4-72 h: OR = 1.42 (1.08-1.86); swallow screening beyond 72 h: OR = 1.70 (1.08-2.70). History of congestive heart failure, diabetes and previous stroke did not significantly associate with HCAIs. CONCLUSIONS A profile of independent risk factors for two common HCAIs in acute stroke was identified. These findings provide valuable information for timely intervention to reduce HCAIs, and the ability to minimise subsequent adverse outcomes.
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Affiliation(s)
- David Fluck
- Department of Cardiology, Ashford & St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK
| | - Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, BS8 1TD UK3
| | - Jonathan Robin
- Department of Acute Medicine, Ashford and St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK
| | - Brendan Affley
- Department of Stroke, Ashford and St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK
| | - Puneet Kakar
- Department of Stroke, Epsom and St Helier University Hospitals, Epsom KT18 7EG, UK
| | - Pankaj Sharma
- Department of Clinical Neuroscience, Imperial College Healthcare NHS Trust, London W6 8RF, UK; Institute of Cardiovascular Research, Royal Holloway University of London, Egham, TW20 0EX, UK
| | - Thang S Han
- Institute of Cardiovascular Research, Royal Holloway University of London, Egham, TW20 0EX, UK; Department of Endocrinology, Ashford and St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK.
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15
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Shen L, Fu T, Huang L, Sun H, Wang Y, Sun L, Lu X, Zhang J, Yang Z, Ni C. 7295 elderly hospitalized patients with catheter-associated urinary tract infection: a case-control study. BMC Infect Dis 2023; 23:825. [PMID: 38001413 PMCID: PMC10668367 DOI: 10.1186/s12879-023-08711-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/14/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Catheter-associated urinary tract infection (CAUTI) ranks second among nosocomial infections in elderly patients after lung infections. Improper treatment can lead to death. This study analysed the risk factors, pathogen distribution, clinical characteristics and outcomes of CAUTI in elderly inpatients with a large sample size to provide evidence for clinical prevention and control. METHODS Based on the HIS and LIS, a case‒control study was conducted on all hospitalized patients with indwelling urinary catheters ≥ 60 years old from January 1, 2019, to December 31, 2022, and the patients were divided into the CAUTI group and the non-CAUTI group. RESULTS CAUTI occurred in 182 of 7295 patients, and the infection rate was 3.4/per 1000 catheter days. Urine pH ≥ 6.5, moderate dependence or severe dependence in the classification of self-care ability, age ≥ 74 years, male sex, hospitalization ≥ 14 days, indwelling urinary catheter ≥ 10 days, diabetes and malnutrition were independent risk factors for CAUTI (P < 0.05). A total of 276 strains of pathogenic bacteria were detected in urine samples of 182 CAUTI patients at different times during hospitalization. The main pathogens were gram-negative bacteria (n = 132, 47.83%), followed by gram-positive bacteria (n = 91, 32.97%) and fungi (n = 53, 19.20%). Fever, abnormal procalcitonin, positive urinary nitrite and abnormal urination function were the clinical characteristics of elderly CAUTI patients (P < 0.001). Once CAUTI occurred in elderly patients, the hospitalization days were increased by 18 days, the total hospitalization cost increased by ¥18,000, and discharge all-cause mortality increased by 2.314 times (P<0.001). CONCLUSION The situation of CAUTI in the elderly is not optimistic, it is easy to have a one-person multi-pathogen infection, and the proportion of fungi infection is not low. Urine pH ≥ 6.5, moderate or severe dependence on others and malnutrition were rare risk factors for elderly CAUTI in previous studies. Our study analysed the clinical characteristics of CAUTI in the elderly through a large sample size, which provided a reliable basis for its diagnosis and identified the adverse outcome of CAUTI.
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Affiliation(s)
- Li Shen
- Department of Disease Prevention and Control, The First Affiliated Hospital of Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
- Department of Nursing, Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Ting Fu
- Department of Military Prevention Medicine, Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Luguang Huang
- Department of information, The First Affiliated Hospital of Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Huiying Sun
- Department of Disease Prevention and Control, The First Affiliated Hospital of Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Yu Wang
- Neurosurgical ICU, The First Affiliated Hospital of Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Lili Sun
- Neurological ICU, The First Affiliated Hospital of Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Xiaoyun Lu
- Department of Disease Prevention and Control, The First Affiliated Hospital of Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Jing Zhang
- Department of Disease Prevention and Control, The First Affiliated Hospital of Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Zhaoxu Yang
- Department of Disease Prevention and Control, The First Affiliated Hospital of Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China.
| | - Chunping Ni
- Department of Nursing, Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi, China.
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Meyrat R, Vivian E, Sridhar A, Gulden RH, Bruce S, Martinez A, Montgomery L, Reed DN, Rappa PJ, Makanbhai H, Raney K, Belisle J, Castellanos S, Cwikla J, Elzey K, Wilck K, Nicolosi F, Sabat ME, Shoup C, Graham RB, Katzen S, Mitchell B, Oh MC, Patel N. Development of multidisciplinary, evidenced-based protocol recommendations and implementation strategies for anterior lumbar interbody fusion surgery following a literature review. Medicine (Baltimore) 2023; 102:e36142. [PMID: 38013300 PMCID: PMC10681460 DOI: 10.1097/md.0000000000036142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/25/2023] [Indexed: 11/29/2023] Open
Abstract
The anterior lumbar interbody fusion (ALIF) procedure involves several surgical specialties, including general, vascular, and spinal surgery due to its unique approach and anatomy involved. It also carries its own set of complications that differentiate it from posterior lumbar fusion surgeries. The demonstrated benefits of treatment guidelines, such as Enhanced Recovery after Surgery in other surgical procedures, and the lack of current recommendations regarding the anterior approach, underscores the need to develop protocols that specifically address the complexities of ALIF. We aimed to create an evidence-based protocol for pre-, intra-, and postoperative care of ALIF patients and implementation strategies for our health system. A 12-member multidisciplinary workgroup convened to develop an evidence-based treatment protocol for ALIF using a Delphi consensus methodology and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system for rating the quality of evidence and strength of protocol recommendations. The quality of evidence, strength of the recommendation and specific implementation strategies for Methodist Health System for each recommendation were described. The literature search resulted in 295 articles that were included in the development of protocol recommendations. No disagreements remained once the authors reviewed the final GRADE assessment of the quality of evidence and strength of the recommendations. Ultimately, there were 39 protocol recommendations, with 16 appropriate preoperative protocol recommendations (out of 17 proposed), 9 appropriate intraoperative recommendations, and 14 appropriate postoperative recommendations. This novel set of evidence-based recommendations is designed to optimize the patient's ALIF experience from the preoperative to the postoperative period.
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Affiliation(s)
- Richard Meyrat
- Methodist Moody Brain and Spine Institute, Methodist Health System, Dallas, TX
| | - Elaina Vivian
- Performance Improvement, Methodist Dallas Medical Center, Dallas, TX
| | - Archana Sridhar
- Methodist Moody Brain and Spine Institute, Methodist Health System, Dallas, TX
| | - R. Heath Gulden
- Anesthesia Consultants of Dallas Division, US Anesthesia Partners, Dallas, TX
| | - Sue Bruce
- Clinical Outcomes Management, Methodist Dallas Medical Center, Dallas, TX
| | - Amber Martinez
- Pre-Surgery Assessment, Methodist Dallas Medical Center, Dallas, TX
| | - Lisa Montgomery
- Methodist Moody Brain and Spine Institute, Methodist Health System, Dallas, TX
| | - Donald N. Reed
- Neurosurgery Division, Methodist Health System, Dallas, TX
| | | | | | | | | | - Stacey Castellanos
- Methodist Moody Brain and Spine Institute, Methodist Health System, Dallas, TX
| | - Judy Cwikla
- Neurocritical Care Unit, Methodist Dallas Medical Center, Dallas, TX
| | - Kristin Elzey
- Pharmacy, Methodist Dallas Medical Center, Dallas, TX
| | - Kristen Wilck
- Clinical Nutrition, Methodist Dallas Medical Center, Dallas, TX
| | - Fallon Nicolosi
- Methodist Community Pharmacy – Dallas, Methodist Dallas Medical Center, Dallas, TX
| | - Michael E. Sabat
- Surgery and Recovery, Methodist Dallas Medical Center, Dallas, TX
| | - Chris Shoup
- Executive Office, Methodist Health System, Dallas, TX
| | - Randall B. Graham
- Methodist Moody Brain and Spine Institute, Methodist Health System, Dallas, TX
| | - Stephen Katzen
- Methodist Moody Brain and Spine Institute, Methodist Health System, Dallas, TX
| | - Bartley Mitchell
- Methodist Moody Brain and Spine Institute, Methodist Health System, Dallas, TX
| | - Michael C. Oh
- Methodist Moody Brain and Spine Institute, Methodist Health System, Dallas, TX
| | - Nimesh Patel
- Methodist Moody Brain and Spine Institute, Methodist Health System, Dallas, TX
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Karasiński M, Wnorowska U, Durnaś B, Król G, Daniluk T, Skłodowski K, Głuszek K, Piktel E, Okła S, Bucki R. Ceragenins and Ceragenin-Based Core-Shell Nanosystems as New Antibacterial Agents against Gram-Negative Rods Causing Nosocomial Infections. Pathogens 2023; 12:1346. [PMID: 38003809 PMCID: PMC10674730 DOI: 10.3390/pathogens12111346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 10/30/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
The growing number of infections caused by multidrug-resistant bacterial strains, limited treatment options, multi-species infections, high toxicity of the antibiotics used, and an increase in treatment costs are major challenges for modern medicine. To remedy this, scientists are looking for new antibiotics and treatment methods that will effectively eradicate bacteria while continually developing different resistance mechanisms. Ceragenins are a new group of antimicrobial agents synthesized based on molecular patterns that define the mechanism of antibacterial action of natural antibacterial peptides and steroid-polyamine conjugates such as squalamine. Since ceragenins have a broad spectrum of antimicrobial activity, with little recorded ability of bacteria to develop a resistance mechanism that can bridge their mechanism of action, there are high hopes that this group of molecules can give rise to a new family of drugs effective against bacteria resistant to currently used antibiotics. Experimental data suggests that core-shell nanosystems, in which ceragenins are presented to bacterial cells on metallic nanoparticles, may increase their antimicrobial potential and reduce their toxicity. However, studies should be conducted, among others, to assess potential long-term cytotoxicity and in vivo studies to confirm their activity and stability in animal models. Here, we summarized the current knowledge on ceragenins and ceragenin-containing nanoantibiotics as potential new tools against emerging Gram-negative rods associated with nosocomial infections.
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Affiliation(s)
- Maciej Karasiński
- Department of Medical Microbiology and Nanobiomedical Engineering, Medical University of Białystok, Mickiewicza 2C, 15-222 Bialystok, Poland; (M.K.); (U.W.); (T.D.); (K.S.)
| | - Urszula Wnorowska
- Department of Medical Microbiology and Nanobiomedical Engineering, Medical University of Białystok, Mickiewicza 2C, 15-222 Bialystok, Poland; (M.K.); (U.W.); (T.D.); (K.S.)
| | - Bonita Durnaś
- Department of Microbiology and Immunology, Institute of Medical Science, Collegium Medicum, Jan Kochanowski University in Kielce, IX Wieków Kielc 19A, 25-317 Kielce, Poland; (B.D.); (G.K.); (K.G.)
| | - Grzegorz Król
- Department of Microbiology and Immunology, Institute of Medical Science, Collegium Medicum, Jan Kochanowski University in Kielce, IX Wieków Kielc 19A, 25-317 Kielce, Poland; (B.D.); (G.K.); (K.G.)
| | - Tamara Daniluk
- Department of Medical Microbiology and Nanobiomedical Engineering, Medical University of Białystok, Mickiewicza 2C, 15-222 Bialystok, Poland; (M.K.); (U.W.); (T.D.); (K.S.)
| | - Karol Skłodowski
- Department of Medical Microbiology and Nanobiomedical Engineering, Medical University of Białystok, Mickiewicza 2C, 15-222 Bialystok, Poland; (M.K.); (U.W.); (T.D.); (K.S.)
| | - Katarzyna Głuszek
- Department of Microbiology and Immunology, Institute of Medical Science, Collegium Medicum, Jan Kochanowski University in Kielce, IX Wieków Kielc 19A, 25-317 Kielce, Poland; (B.D.); (G.K.); (K.G.)
| | - Ewelina Piktel
- Independent Laboratory of Nanomedicine, Medical University of Białystok, Mickiewicza 2B, 15-222 Białystok, Poland;
| | - Sławomir Okła
- Holy Cross Oncology Center of Kielce, Artwińskiego 3, 25-734 Kielce, Poland;
| | - Robert Bucki
- Department of Medical Microbiology and Nanobiomedical Engineering, Medical University of Białystok, Mickiewicza 2C, 15-222 Bialystok, Poland; (M.K.); (U.W.); (T.D.); (K.S.)
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18
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Jin Z, Yin R, Brown EC, Shukla B, Lee BH, Abdulaziz-Alkhawaja S, Magray TA, Agha HM, El-Sisi A, Ali El-Kholy A, Bayani V, Daboor MA, Ruzzieh MA
A, Guclu E, Olmez-Gazioglu E, Dursun O, Kara TT, Koksal I, Eroglu A, Havan M, Kendirli T, Ozturk Deniz SS, Aktas G, Yildizdas D, Horoz OO, Okulu E, Kostekci YE, Omar AA, Memish ZA, Rosenthal VD. Prospective Cohort Study of Incidence and Risk Factors for Catheter-associated Urinary Tract Infections in 212 Intensive Care Units of Nine Middle Eastern Countries. Oman Med J 2023; 38:e571. [PMID: 38283207 PMCID: PMC10822129 DOI: 10.5001/omj.2023.121] [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: 05/11/2023] [Accepted: 07/02/2023] [Indexed: 01/30/2024] Open
Abstract
Objectives To identify urinary catheter (UC)-associated urinary tract infections (CAUTI) incidence and risk factors (RF) in nine Middle Eastern countries. Methods We conducted a prospective cohort study between 1 January 2014 and 2 December 2022 in 212 intensive care units (ICUs) of 67 hospitals in 38 cities in nine Middle Eastern countries (Bahrain, Egypt, Jordan, Kuwait, Lebanon, Morocco, Saudi Arabia, Turkey, and the UAE). To estimate CAUTI incidence, we used the number of UC days as denominator and the number of CAUTIs as numerator. To estimate CAUTI RFs, we analyzed the following 10 variables using multiple logistic regression: patient sex, age, length of stay (LOS) before CAUTI acquisition, UC-days before CAUTI acquisition, UC-device utilization (DU) ratio, hospitalization type, ICU type, facility-ownership, country income level classified by World Bank, and time period. Results Among 50 637 patients hospitalized for 434 523 patient days, there were 580 cases of acquired CAUTIs. The pooled CAUTI rate per 1000 UC days was 1.84. The following variables were independently associated with CAUTI: age, rising risk 1.0% yearly (adjusted odds ratio [aOR] = 1.01, 95% CI: 1.01-1.02; p < 0.0001); female sex (aOR = 1.31, 95% CI: 1.09-1.56; p < 0.0001); LOS before CAUTI acquisition, rising risk 6.0% daily (aOR = 1.06, 95% CI: 1.05-1.06; p < 0.0001); and UC/DU ratio (aOR = 1.11, 95% CI: 1.06-1.14; p < 0.0001). Patients from lower-middle-income countries (aOR = 4.11, 95% CI: 2.49-6.76; p < 0.0001) had a similar CAUTI risk to the upper-middle countries (aOR = 3.75, 95% CI: 1.83-7.68; p < 0.0001). The type of ICU with the highest risk for CAUTI was neurologic ICU (aOR = 27.35, 95% CI: 23.03-33.12; p < 0.0001), followed by medical ICU (aOR = 6.18, 95% CI: 2.07-18.53; p < 0.0001) when compared to cardiothoracic ICU. The periods 2014-2016 (aOR = 7.36, 95% CI: 5.48-23.96; p < 0.001) and 2017-2019 (aOR = 1.15, 95% CI: 3.46-15.61; p < 0.001) had a similar risk to each other, but a higher risk compared to 2020-2022. Conclusions The following CAUTI RFs are unlikely to change: age, sex, ICU type, and country income level. Based on these findings, it is suggested to focus on reducing LOS, UC/DU ratio, and implementing evidence-based CAUTI prevention recommendations.
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Affiliation(s)
- Zhilin Jin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
| | - Ruijie Yin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
| | - Eric Christopher Brown
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
| | - Bhavarth Shukla
- Department of Medicine, University of Miami Miller School of Medicine, Miami, USA
| | | | | | | | - Hala Mounir Agha
- Department of Critical Care, Cairo University Specialized Pediatric Hospital, Cairo, Egypt
| | - Amal El-Sisi
- Department of Critical Care, Cairo University Specialized Pediatric Hospital, Cairo, Egypt
| | - Amani Ali El-Kholy
- Department of Critical Care, Dar Alfouad Hospital, 6th of October City, Egypt
| | - Victor Bayani
- Department of Critical Care, Dar Alfouad Hospital, 6th of October City, Egypt
| | | | | | - Ertugrul Guclu
- Department of Critical Care, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Esra Olmez-Gazioglu
- Department of Critical Care, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Oguz Dursun
- Department of Critical Care, Akdeniz University Medical School, Antalya, Turkey
| | - Tuğçe Tural Kara
- Department of Critical Care, Akdeniz University Medical School, Antalya, Turkey
| | - Iftihar Koksal
- Department of Critical Care, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Ahmet Eroglu
- Department of Critical Care, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Merve Havan
- Department of Critical Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Tanıl Kendirli
- Department of Critical Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | | | - Gizem Aktas
- Department of Critical Care, Pamukkale University Hospital, Denizli, Turkey
| | - Dincer Yildizdas
- Department of Critical Care, Balcali Hospital Pediatric Intensive Care Unit, Adana, Turkey
| | - Ozden Ozgur Horoz
- Department of Critical Care, Balcali Hospital Pediatric Intensive Care Unit, Adana, Turkey
| | - Emel Okulu
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
- Department of Critical Care, Salmaniya Medical Center, Manama, Bahrain
| | - Yasemin Ezgi Kostekci
- Neonatal Intensive Care Unit, Children’s Hospital, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Abeer Aly Omar
- Infection Control Directorate, Ministry of Health, Kuwait City, Kuwait
| | - Ziad A. Memish
- Department of Infection Control, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia
| | - Victor Daniel Rosenthal
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
- International Nosocomial Infection Control Consortium Foundation, Miami, USA
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19
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Lakoh S, Yi L, Russell JBW, Zhang J, Sevalie S, Zhao Y, Kanu JS, Liu P, Conteh SK, Williams CEE, Barrie U, Adekanmbi O, Jiba DF, Kamara MN, Sesay D, Deen GF, Okeibunor JC, Yendewa GA, Guo X, Firima E. High incidence of catheter-associated urinary tract infections and related antibiotic resistance in two hospitals of different geographic regions of Sierra Leone: a prospective cohort study. BMC Res Notes 2023; 16:301. [PMID: 37907960 PMCID: PMC10619308 DOI: 10.1186/s13104-023-06591-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 10/24/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVE Catheter-associated urinary tract infections (CAUTI) are common worldwide, but due to limited resources, its actual burden in low-income countries is unknown. Currently, there are gaps in knowledge about CAUTI due to lack of surveillance activities in Sierra Leone. In this prospective cohort study, we aimed to determine the incidence of CAUTI and associated antibiotic resistance in two tertiary hospitals in different regions of Sierra Leone. RESULTS The mean age of the 459 recruited patients was 48.8 years. The majority were females (236, 51.3%). Amongst the 196 (42.6%) catheterized patients, 29 (14.8%) developed CAUTI. Bacterial growth was reported in 32 (84%) patients. Escherichia coli (14, 23.7%), Klebsiella pneumoniae (10, 17.0%), and Klebsiella oxytoca (8, 13.6%) were the most common isolates. Most isolates were ESBL-producing Enterobacteriaceae (33, 56%) and WHO Priority 1 (Critical) pathogens (38, 71%). Resistance of K. pneumoniae, K. oxytoca, E. coli, and Proteus mirabilis was higher with the third-generation cephalosporins and penicillins but lower with carbapenems, piperacillin-tazobactam and amikacin. To reduce the high incidence of CAUTI and multi-drug resistance organisms, urgent action is needed to strengthen the microbiology diagnostic services and develop and implement catheter bundles that provide clear guidance for catheter insertion, care and removal.
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Affiliation(s)
- Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone.
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone.
- Infectious Disease Research Network, Freetown, Sierra Leone.
| | - Le Yi
- Tropical Infectious Disease Prevention and Control Center, Freetown, Sierra Leone
| | - James B W Russell
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Juling Zhang
- Department of Clinical Laboratory, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Stephen Sevalie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone
- 34 Military Hospital, Freetown, Sierra Leone
| | - Yongkun Zhao
- Tropical Infectious Disease Prevention and Control Center, Freetown, Sierra Leone
| | - Joseph Sam Kanu
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Peng Liu
- Department of Emergency Medicine, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Sarah K Conteh
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Christine Ellen Elleanor Williams
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Umu Barrie
- Infectious Disease Research Network, Freetown, Sierra Leone
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Darlinda F Jiba
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Matilda N Kamara
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Daniel Sesay
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Gibrilla F Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | | | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Xuejun Guo
- Tropical Infectious Disease Prevention and Control Center, Freetown, Sierra Leone.
| | - Emmanuel Firima
- Clinical Research Unit, Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- , SolidarMed, Maseru, Lesotho
- Centre for Multidisciplinary Research and Innovation, Abuja, Nigeria
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20
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Wang F, Wang X, Shi Y, Li L, Zheng Y, Liu H, Zeng M, Jiang F, Wu Z. Development of a risk nomogram predicting urinary tract infection in patients with indwelling urinary catheter after radical surgery for cervical cancer. Prog Urol 2023; 33:492-502. [PMID: 37634960 DOI: 10.1016/j.purol.2023.08.017] [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: 12/22/2022] [Revised: 07/06/2023] [Accepted: 08/01/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Cervical cancer (CC) patients receiving indwelling catheterization after radical hysterectomy (RH) are vulnerable to urinary tract infection (UTI). However, no model or method is available to predict the risk of UTIs. Therefore, our aim was to develop and verify a risk model to predict UTI for patients receiving indwelling catheterization after radical cervical cancer surgery (ICa-RCCS). METHODS We first collected clinical information of 380 patients receiving ICa-RCCS from January 2020 to December 2021 as a training cohort to develop the risk nomogram. UTI was then evaluated using 19 UTI predictor factors. The least absolute shrinkage and selection operator (LASSO) method was utilized for the extraction characteristics. Multivariable logistic regression analysis was then conducted to create the risk model for UTI prediction. The consistency coefficient and calibration curve were utilized to assess the model's fit accuracy. We performed bootstrapping with 1000 random samples for internal validation of the model, and decision curve analysis (DCA) for clinical application. RESULTS Predictors in the risk nomogram included indwelling catheterization duration, whether it is secondary indwelling catheterization, history of UTIs, age, and history of chemotherapy before surgery. The risk nomogram presented good discrimination and calibration (C-index: 0.810, 95% CI: 0.759-0.861). During interval validation, the model reached a high C-index up to 0.7930. DCA revealed the clinical utility of predictive model for UTI. Clinical benefit was initiated at the decision threshold≥3%. CONCLUSION We developed a novel UTI nomogram incorporating the age, history of chemotherapy before surgery, indwelling catheterization duration, whether it is secondary indwelling catheterization, and history of UTI to predict UTI risk for patients receiving ICa-RCCS. LEVEL OF EVIDENCE B: 3a.
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Affiliation(s)
- Fang Wang
- Chong Qing Three Gorges Medical College, Chongqing, China
| | - Xiaoli Wang
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - YuanXiang Shi
- Department of Gynecology and Obstetrics, Third Military Medical University Southwest Hospital Chongqing, Chongqing, China
| | - Ling Li
- Department of Gynecology and Obstetrics, Third Military Medical University Southwest Hospital Chongqing, Chongqing, China
| | - Yu Zheng
- Department of Gynecology and Obstetrics, Third Military Medical University Southwest Hospital Chongqing, Chongqing, China
| | - Huaying Liu
- Department of Gynecology and Obstetrics, Third Military Medical University Southwest Hospital Chongqing, Chongqing, China
| | - Min Zeng
- Department of Gynecology and Obstetrics, Third Military Medical University Southwest Hospital Chongqing, Chongqing, China
| | - Feng Jiang
- Department of Neonatology, Obstetrics and Gynecology Hospital of Fu dan University, Shanghai, China.
| | - Zhimin Wu
- Department of Gynecology and Obstetrics, Third Military Medical University Southwest Hospital Chongqing, Chongqing, China.
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21
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Locey KJ, Webb TA, Weinstein RA, Hota B, Stein BD. Random variation drives a critical bias in the comparison of healthcare-associated infections. Infect Control Hosp Epidemiol 2023; 44:1396-1402. [PMID: 36896667 DOI: 10.1017/ice.2022.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
OBJECTIVE To evaluate random effects of volume (patient days or device days) on healthcare-associated infections (HAIs) and the standardized infection ratio (SIR) used to compare hospitals. DESIGN A longitudinal comparison between publicly reported quarterly data (2014-2020) and volume-based random sampling using 4 HAI types: central-line-associated bloodstream infections, catheter-associated urinary tract infections, Clostridioides difficile infections, methicillin-resistant Staphylococcus aureus infections. METHODS Using 4,268 hospitals with reported SIRs, we examined relationships of SIRs to volume and compared distributions of SIRs and numbers of reported HAIs to the outcomes of simulated random sampling. We included random expectations into SIR calculations to produce a standardized infection score (SIS). RESULTS Among hospitals with volumes less than the median, 20%-33% had SIRs of 0, compared to 0.3%-5% for hospitals with volumes higher than the median. Distributions of SIRs were 86%-92% similar to those based on random sampling. Random expectations explained 54%-84% of variation in numbers of HAIs. The use of SIRs led hundreds of hospitals with more infections than either expected at random or predicted by risk-adjusted models to rank better than other hospitals. The SIS mitigated this effect and allowed hospitals of disparate volumes to achieve better scores while decreasing the number of hospitals tied for the best score. CONCLUSIONS SIRs and numbers of HAIs are strongly influenced by random effects of volume. Mitigating these effects drastically alters rankings for HAI types and may further alter penalty assignments in programs that aim to reduce HAIs and improve quality of care.
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Affiliation(s)
- Kenneth J Locey
- Center for Quality, Safety and Value Analytics, Rush University Medical Center, Chicago, Illinois
| | - Thomas A Webb
- Center for Quality, Safety and Value Analytics, Rush University Medical Center, Chicago, Illinois
| | - Robert A Weinstein
- Division of Infectious Diseases, Rush Medical College, Chicago, Illinois
| | - Bala Hota
- Tendo Systems, Inc, Hinsdale, Illinois
| | - Brian D Stein
- Center for Quality, Safety and Value Analytics, Rush University Medical Center, Chicago, Illinois
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22
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Romijn ASC, Rastogi V, Marcaccio CL, Dorken-Gallastegi A, Giannakopoulos GF, Jongkind V, Bloemers FW, Verhagen HJM, Schermerhorn ML, Saillant NN. Sex Related Outcomes Following Thoracic Endovascular Aortic Repair for Blunt Thoracic Aortic Injury. Eur J Vasc Endovasc Surg 2023; 66:261-268. [PMID: 37088462 DOI: 10.1016/j.ejvs.2023.04.015] [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: 08/12/2022] [Revised: 04/06/2023] [Accepted: 04/14/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVE Current literature suggests that thoracic endovascular aortic repair (TEVAR) in older patients with aortic aneurysms results in higher peri-operative mortality and lower long term survival in females compared with males. However, sex related outcomes in younger patients with blunt thoracic aortic injury (BTAI) undergoing TEVAR remain unknown. This study examined the association between sex and outcomes after TEVAR for BTAI. METHODS A retrospective cohort study was performed of all patients who underwent TEVAR for BTAI in the American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) between 2016 and 2019. The primary outcome was in hospital death. Secondary outcomes were peri-operative complications. Multivariable logistic regression was used to adjust for demographics, comorbidities, injury severity score, and aortic injury grade. RESULTS Two thousand and twenty-two patients were included; 26% were female. Compared with males, females were older (46 [IQR 30, 62] vs. 39 [IQR 28, 56] years; p < .001), more often obese (41% vs. 33%; p = .005), had lower rates of alcohol use disorder (4.1% vs. 8.9%; p < .001) and a higher prevalence of hypertension (29% vs. 22%; p = .001). The injury severity was comparable between females and males (Injury Severity Score ≥ 25; 84% vs. 80%; p = .11) and there was no difference in aortic injury grades when comparing females with males (grade 1, 33% vs. 33%; grade 2, 24% vs. 25%; grade 3, 43% vs. 40%; grade 4, 0.8% vs. 1.3%; p = .53). Multivariable logistic regression demonstrated no difference for in hospital mortality between females and males (OR 1.02; 95% CI 0.67 - 1.53, p = .93). Compared with males, females were at lower risk of acute kidney injury (AKI) (OR 0.33; 95% CI 0.17 - 0.64; p = .001) and ventilator associated pneumonia (VAP) (OR 0.50; 95% CI 0.28 - 0.91; p = .023). CONCLUSION This study did not demonstrate a sex related in hospital mortality difference following TEVAR for BTAI. However, female sex was associated with a lower risk of AKI and VAP. Future studies should evaluate sex differences and long term outcomes following TEVAR in patients with BTAI.
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Affiliation(s)
- Anne-Sophie C Romijn
- Department of Surgery, Division of Trauma & Emergency Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Surgery, Division of Trauma & Emergency Surgery, Amsterdam University Medical Centre, location AMC, Amsterdam, The Netherlands.
| | - Vinamr Rastogi
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA, USA; Department of Surgery, Division of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Christina L Marcaccio
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA, USA
| | - Ander Dorken-Gallastegi
- Department of Surgery, Division of Trauma & Emergency Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Georgios F Giannakopoulos
- Department of Surgery, Division of Trauma & Emergency Surgery, Amsterdam University Medical Centre, location AMC, Amsterdam, The Netherlands
| | - Vincent Jongkind
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, Microcirculation, Amsterdam, The Netherlands
| | - Frank W Bloemers
- Department of Surgery, Division of Trauma & Emergency Surgery, Amsterdam University Medical Centre, location AMC, Amsterdam, The Netherlands
| | - Hence J M Verhagen
- Department of Surgery, Division of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Marc L Schermerhorn
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA, USA
| | - Noelle N Saillant
- Department of Surgery, Division of Trauma & Emergency Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Liu M, Li C, Liu J, Wan Q. Risk factors of early bacterial infection and analysis of bacterial composition, distribution and drug susceptibility after cadaveric liver transplantation. Ann Clin Microbiol Antimicrob 2023; 22:63. [PMID: 37525234 PMCID: PMC10391978 DOI: 10.1186/s12941-023-00616-9] [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: 04/26/2023] [Accepted: 07/23/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND This study provided a theoretical basis for the clinical diagnosis and treatment of bacterial infection after liver transplantation through analyzing the pathogenic distribution, drug sensitivity and risk factors of bacterial infection after liver transplantation. METHODS We collected clinical data from 207 recipients undergoing liver transplantation of graft from donation after citizens' death donors in the Third Xiangya Hospital of Central South University from January 2019 to December 2021 and analyzed the composition and distribution of bacterial pathogens, drug resistance and risk factors of infection. RESULTS A total of 90 bacterial infections occurred in 55 recipients within two months after liver transplantation, and the incidence of bacterial infection was 26.6% (55/207). The gram-negative bacteria (46/90, 51.1%) were more prevalent than gram-positive bacteria (44/90, 48.9%). Common sites of infection were the abdominal/biliary tract (26/90, 28.9%), lung (22/90, 22.4%) and urinary tract (22/90, 22.4%). Fourteen cases (6.8%) died after liver transplantation. Klebsiella pneumoniae (17/90, 18.9%) was the most frequent gram-negative bacteria causing infection in liver transplant recipients and 58.7%, 50%, 80.4% and 89.1% of gram-negative bacteria were sensitive to amikacin, minocycline, tigecycline and polymyxin B, respectively. The most common gram-positive bacteria was Enterococcus faecium (30/90, 33.3%) and 97.7%, 100%, 86.4%, 100% and 100% of gram-positive bacteria were sensitive to vancomycin, teicoplanin, daptomycin, tigecycline and linezolid, respectively. Univariate analysis revealed that bacterial infection was associated with female, age (≥ 50 years old), preoperative albumin (≤ 30 g/L), operation duration (≥ 400 min), intraoperative blood loss (≥ 3000 ml) and postoperative ventilator support. Binary Logistic regression analysis showed that female (OR = 3.149, 95% CI: 1.418-6.993, P = 0.005), operation duration (≥ 400 min) (OR = 2.393, 95% CI: 1.202-4.765, P = 0.013) and intraoperative blood loss (≥ 3000 ml) (OR = 2.052, 95% CI: 1.007-4.183, P = 0.048) were independent risk factors for bacterial infection after liver transplantation. CONCLUSION The incidence of early bacterial infection after liver transplantation was high, and the infection sites were mainly abdominal/biliary tract, respiratory tract and urinary tract. The most common pathogenic bacterium was gram-negative bacterium. Our study also identified several independent risk factors for bacterial infection after liver transplantation, including female gender, operation duration of 400 min or more, and intraoperative blood loss of 3000 ml or more. By addressing these risk factors, such as implementing strategies to optimize surgical procedures and minimize blood loss, healthcare professionals can work towards reducing the incidence of bacterial infections following liver transplantation.
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Affiliation(s)
- Min Liu
- Department of Transplant Surgery, the Third Xiangya Hospital, Central South University, 410013, Changsha, China
- Engineering and Technology Research Center for Transplantation Medicine of National Health Commission, the Third Xiangya Hospital, Central South University, 410013, Changsha, China
| | - Cuiying Li
- Department of Transplant Surgery, the Third Xiangya Hospital, Central South University, 410013, Changsha, China
- Engineering and Technology Research Center for Transplantation Medicine of National Health Commission, the Third Xiangya Hospital, Central South University, 410013, Changsha, China
| | - Jing Liu
- Department of Transplant Surgery, the Third Xiangya Hospital, Central South University, 410013, Changsha, China
- Engineering and Technology Research Center for Transplantation Medicine of National Health Commission, the Third Xiangya Hospital, Central South University, 410013, Changsha, China
| | - Qiquan Wan
- Department of Transplant Surgery, the Third Xiangya Hospital, Central South University, 410013, Changsha, China.
- Engineering and Technology Research Center for Transplantation Medicine of National Health Commission, the Third Xiangya Hospital, Central South University, 410013, Changsha, China.
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Goodfellow M, Thompson ER, Tingle SJ, Wilson C. Early versus late removal of urinary catheter after kidney transplantation. Cochrane Database Syst Rev 2023; 7:CD013788. [PMID: 37449968 PMCID: PMC10347544 DOI: 10.1002/14651858.cd013788.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND The optimal treatment for end-stage kidney disease is kidney transplantation. During the operation, a catheter is introduced into the bladder and remains in place postoperatively to allow the bladder to drain. This decreases tension from the cysto-ureteric anastomosis and promotes healing. Unfortunately, urinary catheters can pose an infection risk to patients as they allow bacteria into the bladder, potentially resulting in a urinary tract infection (UTI). The longer the catheter remains in place, the greater the risk of developing a UTI. There is no consensus approach to the time a catheter should remain in place post-transplant. Furthermore, the different timings of catheter removal are thought to be associated with different incidences of UTI and postoperative complications, such as anastomotic breakdown. OBJECTIVES This review aimed to compare patients who had their catheter removed < 5 days post-transplant surgery to those patients who had their catheter removed ≥ 5 days following their kidney transplant. Primary outcome measures between the two groups included: the incidence of symptomatic UTIs, the incidence of asymptomatic bacteriuria and the incidence of major urological complications requiring intervention and treatment. SEARCH METHODS We searched the Cochrane Kidney and Transplant Register of Studies up to 13 April 2023 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA All randomised controlled trials (RCTs) and quasi-RCTs comparing timing of catheter removal post-transplantation were eligible for inclusion. All donor types were included, and all recipients were included regardless of age, demographics or type of urinary catheter used. DATA COLLECTION AND ANALYSIS Results from the literature search were screened by two authors to identify if they met our inclusion criteria. We designated removal of a urinary catheter before five days (120 hours) as an 'early removal' and anything later than this as a 'late removal.' The studies were assessed for quality using the risk of bias tool. The primary outcome of interest was the incidence of asymptomatic bacteriuria. Statistical analyses were performed using the random effects model, and results were expressed as relative risk (RR) with 95% confidence intervals (CI). Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. MAIN RESULTS Two studies (197 patients) were included in our analysis. One study comprised a full-text article, and the other was a conference abstract with very limited information. The risk of bias in the included studies was generally either high or unclear. It is uncertain whether early versus late removal of the urinary catheter made any difference to the incidence of asymptomatic bacteriuria (RR 0.89, 95% Cl 0.17 to 4.57; participants = 197; I2 = 88%; very low certainty evidence). Data on other outcomes, such as the incidence of UTI and the incidence of major urological complications, were lacking. Furthermore, the follow-up of patients across the studies was short, with no patients being followed beyond one month. AUTHORS' CONCLUSIONS A high-quality, well-designed RCT is required to compare the effectiveness of early catheter removal versus late catheter removal in patients following a kidney transplant. At the present time, there is insufficient evidence to suggest any difference between early and late catheter removal post-transplant, and the studies investigating this were generally of poor quality.
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Affiliation(s)
- Michael Goodfellow
- Institute of Transplantation, The Freeman Hospital, Newcastle upon Tyne, UK
| | - Emily R Thompson
- Institute of Transplantation, The Freeman Hospital, Newcastle upon Tyne, UK
| | - Samuel J Tingle
- Institute of Transplantation, The Freeman Hospital, Newcastle upon Tyne, UK
| | - Colin Wilson
- Institute of Transplantation, The Freeman Hospital, Newcastle upon Tyne, UK
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Sharma S, Mohler J, Mahajan SD, Schwartz SA, Bruggemann L, Aalinkeel R. Microbial Biofilm: A Review on Formation, Infection, Antibiotic Resistance, Control Measures, and Innovative Treatment. Microorganisms 2023; 11:1614. [PMID: 37375116 DOI: 10.3390/microorganisms11061614] [Citation(s) in RCA: 46] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
Biofilm is complex and consists of bacterial colonies that reside in an exopolysaccharide matrix that attaches to foreign surfaces in a living organism. Biofilm frequently leads to nosocomial, chronic infections in clinical settings. Since the bacteria in the biofilm have developed antibiotic resistance, using antibiotics alone to treat infections brought on by biofilm is ineffective. This review provides a succinct summary of the theories behind the composition of, formation of, and drug-resistant infections attributed to biofilm and cutting-edge curative approaches to counteract and treat biofilm. The high frequency of medical device-induced infections due to biofilm warrants the application of innovative technologies to manage the complexities presented by biofilm.
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Affiliation(s)
- Satish Sharma
- Department of Urology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14260, USA
| | - James Mohler
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA
| | - Supriya D Mahajan
- Department of Medicine, Division of Allergy, Immunology, and Rheumatology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA
| | - Stanley A Schwartz
- Department of Urology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14260, USA
- Department of Medicine, Division of Allergy, Immunology, and Rheumatology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA
- Department of Medicine, VA Western New York Healthcare System, Buffalo, NY 14215, USA
| | - Liana Bruggemann
- Department of Biomedical Informatics, University at Buffalo, Buffalo, NY 14260, USA
| | - Ravikumar Aalinkeel
- Department of Urology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14260, USA
- Department of Medicine, Division of Allergy, Immunology, and Rheumatology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA
- Department of Medicine, VA Western New York Healthcare System, Buffalo, NY 14215, USA
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Garcell HG, Al-Ajmi J, Arias AV, Abraham JC, Garmendia AMF, Hernandez TMF. Catheter-associated urinary tract infection and urinary catheter utilization ratio over 9 years, and the impact of the COVID-19 pandemic on the incidence of infection in medical and surgical wards in a single facility in Western Qatar. Qatar Med J 2023; 2023:14. [PMID: 37521093 PMCID: PMC10373895 DOI: 10.5339/qmj.2023.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/02/2023] [Indexed: 08/01/2023] Open
Abstract
INTRODUCTION Catheter-associated urinary tract infection (CAUTI) is a frequently reported healthcare-associated infection in critical and non-critical patients. Limited data are available about CAUTI incidence in non-critical patients. We aim to describe the incidence of CAUTI over 9 years and evaluate the impact of the pandemic on the incidence in non-critical acute care patients. METHODS A retrospective observational study of CAUTI in medical-surgical and maternity wards was carried out at a public hospital in the west of the State of Qatar. Data collected included the annual CAUTI incidence (per 1,000 device days), urinary catheter utilization ratio (UC-UR), etiology, and antimicrobial resistance. RESULTS 115,238 patient days and 6,681 urinary catheters (UC) days were recorded over the study period, and 9 and 4 CAUTI were confirmed in medical-surgical and maternity wards, respectively. The infection rate was 1.9 per 1,000 UC days, and the UC-UR was 0.06. The CAUTI rate was higher in medical-surgical wards over the COVID-19 period (2.4 × 1,000 UC days) in comparison with the non-COVID-19 period (1.7 × 1,000 UC days) (RR 1.46; 1.12-1.80). However, in the maternity ward, the result was 0 and 2.5 × 1,000 UC days during these periods, respectively. No differences were observed in the infection rate among periods for all patients (RR 1.06; 0.81-1.31). Multidrug-resistant organisms were identified in 7 patients, and non-multidrug-resistant in 6 cases. CONCLUSION The study findings describe a lower CAUTI risk over 9 years in non-critical acute care patients. The impact of COVID-19 on the CAUTI risk is mainly related to medical patients who had previously been admitted to critical care. The infection control program should consider these data as a benchmark for quality improvement.
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Affiliation(s)
- Humberto Guanche Garcell
- Infection Control Department, The Cuban Hospital, Hamad Medical Corporation, Doha, Qatar. E-mail: ORCID: https://orcid.org/0000-0001-7279-0062
| | - Jameela Al-Ajmi
- Corporate Infection Control Department, Hamad Medical Corporation, Doha, Qatar
| | - Ariadna Villanueva Arias
- Infection Control Department, The Cuban Hospital, Hamad Medical Corporation, Doha, Qatar. E-mail: ORCID: https://orcid.org/0000-0001-7279-0062
| | - Joji C Abraham
- Corporate Infection Control Department, Hamad Medical Corporation, Doha, Qatar
| | - Angel M Felipe Garmendia
- Infection Control Department, The Cuban Hospital, Hamad Medical Corporation, Doha, Qatar. E-mail: ORCID: https://orcid.org/0000-0001-7279-0062
| | - Tania M Fernandez Hernandez
- Infection Control Department, The Cuban Hospital, Hamad Medical Corporation, Doha, Qatar. E-mail: ORCID: https://orcid.org/0000-0001-7279-0062
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Brandi G, Gambon-Mair A, Berther LS, Bögli SY, Unseld S. Sex-related differences in extracranial complications in patients with traumatic brain injury. Front Neurol 2023; 14:1095009. [PMID: 37153664 PMCID: PMC10155273 DOI: 10.3389/fneur.2023.1095009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/14/2023] [Indexed: 04/08/2023] Open
Abstract
Background Extracranial complications after traumatic brain injury (TBI) are common. Their influence on outcome is uncertain. Furthermore, the role of sex on the development of extracranial complications following TBI remains poorly investigated. We aimed to investigate the incidence of extracranial complications after TBI with particular focus on sex-related differences with regard to complications and their influence on outcome. Methods This retrospective, observational study was conducted in a level I universitary swiss trauma center. Consecutive patients with TBI admitted to the intensive care unit (ICU) between 2018 and 2021 were included. Patients' and trauma characteristics, in-hospital complications (i.e., cardiovascular, respiratory, renal, metabolic, gastrointestinal, hematological, and infectious) as well as functional outcome 3 months after trauma were analyzed. Data was dichotomized by sex or by outcome. Univariate as well as multivariate logistic regression was performed to reveal possible associations between sex, outcome and complications. Results Overall, 608 patients were included (male n = 447, 73.5%). Extracranial complications occurred most frequently in cardiovascular, renal, hematological and infectious systems. Men and women suffered similarly from extracranial complications. While men needed correction of coagulopathies more often (p = 0.029), women suffered more frequently from urogenital infections (p = 0.001). Similar results were found in a subgroup of patients (n = 193) with isolated TBI. A multivariate analysis did not show extracranial complications to be independent predictors of unfavorable outcome. Conclusion Extracranial complications following TBI occur frequently during the ICU-stay, can affect almost all organ systems but are not independent predictors of unfavorable outcome. The results suggest that sex-specific strategies for early recognition of extracranial complications might not be needed in patients with TBI.
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Affiliation(s)
- Giovanna Brandi
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Alma Gambon-Mair
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Lara Selina Berther
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Stefan Yu Bögli
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Simone Unseld
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
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Obaid NA, Abuhussain SS, Mulibari KK, Alshnqiti F, Malibari SA, Althobaiti SS, Alansari M, Muneef E, Almatrafi L, Alqarzi A, Alotaibi N, Mostafa AM, Hagag A. Antimicrobial-resistant pathogens related to catheter-associated urinary tract infections in intensive care units: A multi-center retrospective study in the Western region of Saudi Arabia. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2023. [DOI: 10.1016/j.cegh.2023.101291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Mercadel AJ, Holloway SB, Saripella M, Lea JS. Risk factors for catheter-associated urinary tract infections following radical hysterectomy for cervical cancer. Am J Obstet Gynecol 2023:S0002-9378(23)00135-7. [PMID: 36863644 DOI: 10.1016/j.ajog.2023.02.019] [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: 09/15/2022] [Revised: 02/19/2023] [Accepted: 02/23/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Radical hysterectomy is the mainstay of treatment for early-stage cervical cancer. Urinary tract dysfunction is one of the most common complications after radical hysterectomy, and prolonged catheterization has previously been defined as a significant risk factor for catheter-associated urinary tract infections. OBJECTIVE This study aimed to determine the rate of catheter-associated urinary tract infections after radical hysterectomy for cervical cancer, and to identify additional risk factors for developing catheter-associated urinary tract infections in this population. STUDY DESIGN We reviewed patients who underwent radical hysterectomy for cervical cancer from 2004 to 2020 after institutional review board approval. All patients were identified from institutional Gynecologic Oncology surgical and tumor databases. The inclusion criterion was radical hysterectomy for early-stage cervical cancer. Exclusion criteria included inadequate hospital follow-up, insufficient records of catheter use in the electronic medical record, urinary tract injury, and preoperative chemoradiation. Catheter-associated urinary tract infection was defined as an infection diagnosed in a catheterized patient or within 48 hours of catheter removal, with significant bacteriuria (>103 cfu/mL) and symptoms or signs attributable to the urinary tract. Data analysis was performed using comparative analysis and univariate and multivariable logistic regression using Excel, GraphPad Prism, and IBM SPSS Statistics. RESULTS Of the 160 included patients, 12.5% developed catheter-associated urinary tract infections. In univariate analysis, catheter-associated urinary tract infection was significantly associated with current smoking history (odds ratio, 3.76; 95% confidence interval, 1.39-10.08), minimally invasive surgical approach (odds ratio, 5.24; 95% confidence interval, 1.91-16.87), estimated surgical blood loss >500 mL (odds ratio, 0.18; 95% confidence interval, 0.04-0.57), operative time >300 minutes (odds ratio, 2.92; 95% confidence interval, 1.07-9.36), and increased duration of catheterization (odds ratio, 18.46; 95% confidence interval, 3.67-336). After adjusting for interactions and controlling for potential confounders with multivariable analysis, current smoking history and catheterization for >7 days were identified as independent risk factors for development of catheter-associated urinary tract infections (adjusted odds ratio, 3.94; 95% confidence interval, 1.28-12.37; adjusted odds ratio, 19.49; 95% confidence interval, 2.78-427). CONCLUSION Preoperative smoking cessation interventions for current smokers should be implemented to decrease risk for postoperative complications, including catheter-associated urinary tract infections. In addition, catheter removal within 7 postoperative days should be encouraged in all women undergoing radical hysterectomy for early-stage cervical cancer in an effort to decrease infection risk.
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Affiliation(s)
- Alyssa J Mercadel
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX; Parkland Memorial Hospital, Dallas, TX
| | - Steven B Holloway
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Monica Saripella
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jayanthi S Lea
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX; Harold C. Simmons Comprehensive Cancer Center, Dallas, TX.
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Capper-Parkin KL, Nichol T, Smith TJ, Lacey MM, Forbes S. Antimicrobial and cytotoxic synergism of biocides and quorum-sensing inhibitors against uropathogenic Escherichiacoli. J Hosp Infect 2023; 134:138-146. [PMID: 36801429 DOI: 10.1016/j.jhin.2023.02.004] [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: 11/29/2022] [Revised: 02/10/2023] [Accepted: 02/11/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND Uropathogenic Escherichia coli (UPEC) are a primary cause of catheter-associated urinary tract infections (CAUTIs), often forming mature recalcitrant biofilms on the catheter surface. Anti-infective catheter coatings containing single biocides have been developed but display limited antimicrobial activity due to the selection of biocide-resistant bacterial populations. Furthermore, biocides often display cytotoxicity at concentrations required to eradicate biofilms, limiting their antiseptic potential. Quorum-sensing inhibitors (QSIs) provide a novel anti-infective approach to disrupt biofilm formation on the catheter surface and help prevent CAUTIs. AIM To evaluate the combinatorial impact of biocides and QSIs at bacteriostatic, bactericidal and biofilm eradication concentrations in parallel to assessing cytotoxicity in a bladder smooth muscle (BSM) cell line. METHODS Checkerboard assays were performed to determine fractional inhibitory, bactericidal, and biofilm eradication concentrations of test combinations in UPEC and combined cytotoxic effects in BSM cells. FINDINGS Synergistic antimicrobial activity was observed between polyhexamethylene biguanide, benzalkonium chloride or silver nitrate in combination with either cinnamaldehyde or furanone-C30 against UPEC biofilms. However, furanone-C30 was cytotoxic at concentrations below those required even for bacteriostatic activity. A dose-dependent cytotoxicity profile was observed for cinnamaldehyde when in combination with BAC, PHMB or silver nitrate. Both PHMB and silver nitrate displayed combined bacteriostatic and bactericidal activity below the half-maximum inhibitory concentration (IC50). Triclosan in combination with both QSIs displayed antagonistic activity in both UPEC and BSM cells. CONCLUSION PHMB and silver in combination with cinnamaldehyde display synergistic antimicrobial activity in UPEC at non-cytotoxic concentrations, suggesting potential as anti-infective catheter-coating agents.
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Affiliation(s)
- K L Capper-Parkin
- Biomolecular Sciences Research Centre, Sheffield Hallam University, Sheffield, UK
| | - T Nichol
- Biomolecular Sciences Research Centre, Sheffield Hallam University, Sheffield, UK
| | - T J Smith
- Biomolecular Sciences Research Centre, Sheffield Hallam University, Sheffield, UK
| | - M M Lacey
- Biomolecular Sciences Research Centre, Sheffield Hallam University, Sheffield, UK
| | - S Forbes
- Biomolecular Sciences Research Centre, Sheffield Hallam University, Sheffield, UK.
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Weintraub MT, Yang J, Nam D, Greenspoon JA, DeBenedetti A, Karas V, Mehta N, Della Valle CJ. Short-Term Indwelling Foley Catheters Do Not Reduce the Risk of Postoperative Urinary Retention in Uncomplicated Primary THA and TKA: A Randomized Controlled Trial. J Bone Joint Surg Am 2023; 105:312-319. [PMID: 36729534 DOI: 10.2106/jbjs.22.00759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The purpose of this randomized controlled trial was to determine whether a short-term Foley catheter (inserted in the operating room and removed upon arrival to the orthopaedic floor) would reduce the risk of postoperative urinary retention (POUR) in patients undergoing primary total hip (THA) and total knee arthroplasty (TKA). METHODS Three hundred and eighty-eight patients undergoing inpatient primary TKA (n = 228) or THA (n = 160) with spinal anesthesia were randomized to receive a short-term Foley catheter (n = 194) or no Foley (n = 194). There were 143 male and 245 female patients. The primary outcome was POUR, defined as requiring ≥2 straight catheterizations or the placement of an indwelling urinary catheter when indicated by retention of ≥450 mL on bladder scans. Secondary outcomes included urinary tract infections (UTIs) within 3 weeks and the need for ≥1 straight catheterization. A power analysis determined that 194 patients per group were required to detect a 7% minimal clinically important difference in POUR rates at 80% power and alpha of 0.05. Intention-to-treat and as-treated analyses were performed (2 patients received the non-allocated treatment). Outcomes were compared between the groups using univariate and multivariate analyses, with alpha < 0.05. RESULTS Nine patients developed POUR: 4 in the short-term Foley group and 5 in the control group (2.1% versus 2.6%; p = 1.00). Of those who developed POUR, 8 were male and 1 was female (88.9% versus 11.1%; p = 0.002). Twenty-four patients required ≥1 straight catheterization: 10 in the Foley group and 14 in the control group (5.2% versus 7.2%; p = 0.40). Four patients developed UTIs: 3 in the Foley group and 1 in the control group (1.5% versus 0.5%; p = 0.62) on intention-to-treat analysis, and 4 in the Foley group and none in the control group (2.1% versus 0.0%; p = 0.12) on as-treated analysis. CONCLUSIONS The use of a short-term Foley catheter inserted in the operating room and removed on arrival to the orthopaedic floor does not decrease the rate of POUR. LEVEL OF EVIDENCE Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Matthew T Weintraub
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - JaeWon Yang
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Denis Nam
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Joshua A Greenspoon
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Anne DeBenedetti
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Vasili Karas
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Neal Mehta
- Department of Anesthesia, Rush University Medical Center, Chicago, Illinois
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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Wangjian W, Tianyi L, Xiaoqian M, Di Z, Chuan Z, Chao W, Zijian D, Tongtong J, Fenghai Z. Application of enhanced recovery after surgery in partial nephrectomy for renal tumors: A systematic review and meta-analysis. Front Oncol 2023; 13:1049294. [PMID: 36845687 PMCID: PMC9947501 DOI: 10.3389/fonc.2023.1049294] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/19/2023] [Indexed: 02/11/2023] Open
Abstract
Objectives In recent years, enhanced recovery after surgery (ERAS) has been widely used in the field of urology, especially in radical cystectomy and radical prostatectomy, and has demonstrated its advantages. Although studies on the application of ERAS in partial nephrectomy for renal tumors are increasing, the conclusions are mixed, especially in terms of postoperative complications, etc, and its safety and efficacy are questionable. We conducted a systematic review and meta-analysis to assess the safety and efficacy of ERAS in the application of partial nephrectomy for renal tumors. Methods Pubmed, Embase, Cohrance library, Web of science and Chinese databases (CNKI, VIP, Wangfang and CBM) were systematically searched for all published literature related to the application of enhanced recovery after surgery in partial nephrectomy for renal tumors from the date of establishment to July 15, 2022, and the literature was screened by inclusion/exclusion criteria. The quality of the literature was evaluated for each of the included literature. This Meta-analysis was registered on PROSPERO (CRD42022351038) and data were processed using Review Manager 5.4 and Stata 16.0SE. The results were presented and analyzed by weighted mean difference (WMD), Standard Mean Difference (SMD) and risk ratio (RR) at their 95% confidence interval (CI). Finally, the limitations of this study are analyzed in order to provide a more objective view of the results of this study. Results This meta-analysis included 35 literature, including 19 retrospective cohort studies and 16 randomized controlled studies with a total of 3171 patients. The ERAS group was found to exhibit advantages in the following outcome indicators: postoperative hospital stay (WMD=-2.88, 95% CI: -3.71 to -2.05, p<0.001), total hospital stay (WMD=-3.35, 95% CI: -3.73 to -2.97, p<0.001), time to first postoperative bed activity (SMD=-3.80, 95% CI: -4.61 to -2.98, p < 0.001), time to first postoperative anal exhaust (SMD=-1.55, 95% CI: -1.92 to -1.18, p < 0.001), time to first postoperative bowel movement (SMD=-1.52, 95% CI: -2.08 to -0.96, p < 0.001), time to first postoperative food intake (SMD=-3.65, 95% CI: -4.59 to -2.71, p<0.001), time to catheter removal (SMD=-3.69, 95% CI: -4.61 to -2.77, p<0.001), time to drainage tube removal (SMD=-2.77, 95% CI: -3.41 to -2.13, p<0.001), total postoperative complication incidence (RR=0.41, 95% CI: 0.35 to 0.49, p<0.001), postoperative hemorrhage incidence (RR=0.41, 95% CI: 0.26 to 0.66, p<0.001), postoperative urinary leakage incidence (RR=0.27, 95% CI: 0.11 to 0.65, p=0.004), deep vein thrombosis incidence (RR=0.14, 95% CI: 0.06 to 0.36, p<0.001), and hospitalization costs (WMD=-0.82, 95% CI: -1.20 to -0.43, p<0.001). Conclusion ERAS is safe and effective in partial nephrectomy of renal tumors. In addition, ERAS can improve the turnover rate of hospital beds, reduce medical costs and improve the utilization rate of medical resources. Systematic review registration https://www.crd.york.ac.uk/PROSPERO, identifier CRD42022351038.
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Affiliation(s)
- Wu Wangjian
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Lu Tianyi
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, China
| | - Ma Xiaoqian
- Department of Pediatrics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Zhang Di
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, China
| | - Zhou Chuan
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Wang Chao
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Da Zijian
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Jin Tongtong
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Zhou Fenghai
- The First Clinical Medical College of Lanzhou University, Lanzhou, China,The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, China,Department of Urology, Gansu Provincial Hospital, Lanzhou, China,*Correspondence: Zhou Fenghai,
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Shamseddine J, Sadeq A, Yousuf K, Abukhater R, Yahya LO, Espil MA, Hassan ME, Fadl RE, Ahmed RTE, Elkonaissi I, Abdelsalam AE, Naqbi AA, Nuaimi NA, Hosani MA, Marri RA, Abdouli AA, Alakhras AM, Masri NIA, O’Sullivan S, Everett D, Babiker ZOE. Impact of antimicrobial stewardship interventions on days of therapy and guideline adherence: A comparative point-prevalence survey assessment. FRONTIERS IN TROPICAL DISEASES 2023. [DOI: 10.3389/fitd.2022.1050344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BackgroundAntimicrobial stewardship (AMS) is a crucial tool for rationalizing the use of antimicrobial agents and reducing the burden of antimicrobial resistance. We aimed to assess the impact of AMS interventions on antimicrobial utilization and adherence to antimicrobial guidelines.MethodsWe conducted a prospective quasi-experimental study at a major tertiary hospital in the United Arab Emirates. Using standardized World Health Organization’s methodology, point-prevalence surveys (PPS) were performed in November 2019 and January 2022. Core AMS interventions consisted of proactive bloodstream infection service, proactive and reactive infectious diseases consult service, prospective audit and feedback by clinical pharmacists, development of antimicrobial guidelines based on cumulative antibiograms, and implementation of induction programs for new clinical staff. Days of therapy (DOT) per 1000 patient days present and rate of compliance with antimicrobial guidelines were compared before and after the core interventions. Multiple logistic regression analysis was carried out to adjust for the potential confounding effects of age, gender, hospitalization within 90 days, central or peripheral line insertion, urinary catheterization, and mechanical ventilation. P-value<0.05 was considered statistically significant.ResultsPre- and post-intervention PPSs included 292 and 370 patients, respectively. Both had similar age and gender distribution. Patients receiving antimicrobials were 51% (149/292) in 2019 and 45% (166/370) in 2022 (p 0.12). Univariate analysis showed a reduced post-intervention DOT per 1000 patients present (6.1 +/- 16.2 vs 2.4 +/-5.1, p<0.01) and an improved post-intervention guideline compliance (59% vs 67%, p 0.23). Following multiple logistic regression, the reduction in post-intervention DOT remained statistically significant (co-efficient -0.17 (95% CI -8.58 to -1.94, p<0.01), and the improvement in guideline adherence became statistically significant (adjusted odds ratio 1.91 (95% CI 1.05 to 3.45, p 0.03).ConclusionCoordinated and sustained AMS interventions have a significant impact on improving antimicrobial utilisation and adherence to guidelines.
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Alhabdan N, Alyaemni A, Aljuaid MM, Baydoun A, Hamidi S. Impact of Implementing Key Performance Indicators on Catheter-Associated Urinary Tract Infection (CAUTI) Rates Among Adult ICU Patients in Saudi Arabia. CLINICOECONOMICS AND OUTCOMES RESEARCH 2023; 15:41-49. [PMID: 36700053 PMCID: PMC9869901 DOI: 10.2147/ceor.s396160] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/12/2023] [Indexed: 01/20/2023] Open
Abstract
Background The prevalence of catheter-associated urinary tract infections (CAUTIs) in hospitals characterizes one of the most significant problems in healthcare. This study aims to assess whether the implementation of impact of key performance indicators (KPIs) checklist reduces the number of CAUTI in adults present in intensive care unit (ICU) with indwelling catheters. Methods This is a retrospective analytical study conducted in a tertiary hospital in Riyadh, Saudi Arabia, from June 2020 to June 2021. One hundred and thirty-four patients with CAUTIs met the criteria and were included in the study. Socio-demographic data was collected to enable informed analysis based on personal information (age, gender, marital status, monthly income, level of education, and department) and medical history (duration of catheterization, types of organisms, history of chronic illness, and duration of hospitalization). The research also used a prevention of CAUTI checklist containing 26 items. The outcome measures were 1) the rate of CAUTIs measured pre- and post-implementing performance measurement indicators (KPI) of CAUTIs prevention practice and 2) the prevention of catheter-associated urinary tract infection in three areas: general information recording, insertion practices, and maintenance practices. Results The study found that there was compliance with the prevention of CAUTIs in terms of recording the general patient's information (72%), insertion practices (52%), and maintenance practices (50%). However, most safety practices, including poor hygiene and safety standards, patient handling, and audited protocol programs, were not strictly followed, resulting in increased risk factors for CAUTIs. Conclusion Compliance with the prevention of CAUTIs in terms of recording the general patient's information, insertion practices, and maintenance practices lies within the range of 50-75%, and the recommended practices are usually followed. A targeted education on CAUTI-prevention practices curtailing the most aggravating risk factors and adopting a safety culture driven by a patient handling and audited protocol program should be explored to reduce hospital CAUTIs.
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Affiliation(s)
- Nouf Alhabdan
- Department of Health Administration, College of Business Administration, King Saud University, Riyadh, Saudi Arabia
| | - Asma Alyaemni
- Department of Health Administration, College of Business Administration, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed M Aljuaid
- Department of Health Administration, College of Business Administration, King Saud University, Riyadh, Saudi Arabia
| | - Ali Baydoun
- School of Medicine, St. George’s University, Grenada, West Indies
| | - Samer Hamidi
- School of Health and Environmental Studies, Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates,Correspondence: Samer Hamidi, School of Health and Environmental Studies, Hamdan Bin Mohammed Smart University, Dubai Academic City, P.O.Box 71400, Dubai, United Arab Emirates, Tel +971-4-424-1089, Email
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Du P, Guo J, Zhu Y, Cui Y, Li J, Feng Z, Hou Z, Zhang Y. Incidence and risk factors associated with postoperative surgical site infection in younger adults with hip fractures: a case-control study. INTERNATIONAL ORTHOPAEDICS 2022; 46:2953-2962. [PMID: 36222882 DOI: 10.1007/s00264-022-05607-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/05/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE Hip fracture is associated with high morbidity and mortality. The most common complication after hip fracture is surgical site infection (SSI). The goal was to investigate risks associated with SSI in young adults who underwent surgery for hip fractures. METHODS We conducted a case-control study enrolling 1243 patients from Jan 2015 to Dec 2019. This study investigated the multifaceted factors including demographics, lifestyles, comorbidities, surgical variables, and laboratory test results. Patients were divided into the case group (developed SSI) and control group (not developed SSI). Univariate analyses and multivariate logistic regression analyses were used to identify the risk factors independently associated with SSI. RESULTS A total of 25 patients including 16 (1.8%) in femoral neck fracture and nine (2.5%) in intertrochanteric fracture developed SSI post-operatively, with an accumulated incidence rate of 2.0%. Among them, four cases (1.6%) were deep SSI and 21 cases (98.4%) were superficial SSI. In most cases, Staphylococcus aureus caused the infections. Diabetes mellitus (OR 4.05, 95%CI: 1.08-15.23, P = 0.038), cerebrovascular disease (OR 3.71, 95%CI: 1.14-12.03, P = 0.029), heart disease (OR 6.23, 95%CI: 1.81-21.48, P = 0.004), and operative time (OR 1.01, 95%CI: 1.01-1.02, P = 0.002) in femoral neck fractures while ALP (> upper limit) (OR 33.39, 95%CI: 2.21-504.89, P = 0.011) and CK (> upper limit) (OR 40.97, 95%CI: 1.70-989.31, P = 0.022) in intertrochanteric fractures were found to be significantly associated with SSI. CONCLUSION Targeted pre-operative management, depending on the patients' fracture type and risk factors, should be developed to reduce post-operative SSI rates of younger adults with hip fracture.
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Affiliation(s)
- Pei Du
- Department of Infection Control and Prevention, The Third Hospital of Hebei Medical University, Shijiazhuang, China
- Department of Epidemiology and Statistics, Hebei Key Laboratory of Environment and Human Health, School of Public Health, Hebei Medical University, Shijiazhuang, China
| | - Junfei Guo
- Department of Orthopaedics Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
- Orthopaedic Institute of Hebei Province, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Yanbin Zhu
- Department of Orthopaedics Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
- Orthopaedic Institute of Hebei Province, Shijiazhuang, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Yi Cui
- Department of Infection Control and Prevention, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jianmei Li
- Department of Infection Control and Prevention, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhongjun Feng
- Department of Infection Control and Prevention, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhiyong Hou
- Department of Orthopaedics Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China.
- Orthopaedic Institute of Hebei Province, Shijiazhuang, China.
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China.
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang, China.
| | - Yingze Zhang
- Department of Orthopaedics Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China.
- Orthopaedic Institute of Hebei Province, Shijiazhuang, China.
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China.
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang, China.
- Chinese Academy of Engineering, Beijing, China.
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Shahriar A, Rob Siddiquee MF, Ahmed H, Mahmud AR, Ahmed T, Mahmud MR, Acharjee M. Catheter-associated urinary tract infections: Etiological analysis, biofilm formation, antibiotic resistance, and a novel therapeutic era of phage. INTERNATIONAL JOURNAL OF ONE HEALTH 2022. [DOI: 10.14202/ijoh.2022.86-100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Urinary tract infection (UTI) caused by uropathogens has put global public health at its utmost risk, especially in developing countries where people are unaware of personal hygiene and proper medication. In general, the infection frequently occurs in the urethra, bladder, and kidney, as reported by the physician. Moreover, many UTI patients whose acquired disorder from the hospital or health-care center has been addressed previously have been referred to as catheter-associated UTI (CAUTI). Meanwhile, the bacterial biofilm triggering UTI is another critical issue, mostly by catheter insertion. In most cases, the biofilm inhibits the action of antibiotics against the UTI-causing bacteria. Therefore, new therapeutic tools should be implemented to eliminate the widespread multidrug resistance (MDR) UTI-causing bacteria. Based on the facts, the present review emphasized the current status of CAUTI, its causative agent, clinical manifestation, and treatment complications. This review also delineated a model of phage therapy as a new therapeutic means against bacterial biofilm-originated UTI. The model illustrated the entire mechanism of destroying the extracellular plyometric substances of UTI-causing bacteria with several enzymatic actions produced by phage particles. This review will provide a complete outline of CAUTI for the general reader and create a positive vibe for the researchers to sort out alternative remedies against the CAUTI-causing MDR microbial agents.
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Affiliation(s)
- Asif Shahriar
- Department of Microbiology, Stamford University Bangladesh, Dhaka, Bangladesh
| | | | - Hossain Ahmed
- Department of Biotechnology and Genetic Engineering, University of Development Alternative, Dhaka 1208, Bangladesh
| | - Aar Rafi Mahmud
- Department of Biochemistry and Molecular Biology, Mawlana Bhashani Science and Technology University, Tangail-1902, Bangladesh
| | - Tasnia Ahmed
- Department of Microbiology, Stamford University Bangladesh, Dhaka, Bangladesh
| | - Md. Rayhan Mahmud
- Department of Microbiology, Stamford University Bangladesh, Dhaka, Bangladesh
| | - Mrityunjoy Acharjee
- Department of Microbiology, Stamford University Bangladesh, Dhaka, Bangladesh
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Plasma-induced nanostructured metallic silver surfaces: study of bacteriophobic effect to avoid bacterial adhesion on medical devices. Heliyon 2022; 8:e10842. [PMID: 36217459 PMCID: PMC9547212 DOI: 10.1016/j.heliyon.2022.e10842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/20/2022] [Accepted: 09/26/2022] [Indexed: 12/17/2022] Open
Abstract
Biofilm formation in medical devices represents one of the major problems for the healthcare system, especially those that occur on implantable silicone-based devices. To provide a general solution to avoid biofilm formation in the first stages of development, this work studied how nanostructured metallic silver coatings hinder bacteria-surface interaction by preventing bacteria adhesion. The three studied silver nanostructures (“Sharp blades”, “Thick blades” and “Leaves”) combined superhydrophobic behavior with a physical impediment of the coating nanostructure that produced a bacteriophobic effect avoiding the adhesion mechanism of different bacterial strains. These silver nanostructures are immobilized on stretchable substrates through a polymeric thin film of plasma–polymerized penta-fluorophenyl methacrylate. The control over the nanostructures and therefore its bacteriophobic—bactericidal effect depends on the plasma polymerization conditions of the polymer. The characterization of this bacteriophobic effect through FE-SEM microscopy, live/dead cell staining, and direct bacterial adhesion counts, provided a complete mapping of how bacteria interact with the surface in each scenario. Results revealed that the bacterial adhesion was reduced by up to six orders of magnitude in comparison with uncoated surfaces thereby constituting an effective strategy to avoid the formation of biofilm on medical materials.
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Muacevic A, Adler JR. Catheter-Associated Urinary Tract Infection (CAUTI). Cureus 2022; 14:e30385. [PMID: 36407206 PMCID: PMC9668204 DOI: 10.7759/cureus.30385] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/17/2022] [Indexed: 01/25/2023] Open
Abstract
One of the most prevalent health-related illnesses globally is catheter-associated urinary tract infection (CAUTI). CAUTIs account for almost half of all hospital-acquired diseases. Most of the healthcare-acquired urinary tract infections result from catheter tubes implantation. These tubes connect a collecting system and the urinary bladder via the urethra. These are known as indwelling urinary catheters. The length of catheterization has a key role in starting bacteriuria since biofilm eventually forms on all of these devices. Despite the low percentage of people with bacteriuria who start showing symptoms, there is nevertheless a significant burden associated with these contamination due to the repeated use of indwelling urinary devices. Minimizing indwelling device usage and stopping the catheter as soon as medically possible are the two most crucial preventative measures for bacteriuria and infection when device use is required. Efforts to avoid catheter-acquired urinary infections must be implemented and monitored by infection control guidelines in healthcare institutions. These approaches include monitoring device use, the suitability of device justifications, and problems. Ultimately, technological advancements in device substances that inhibit colony generation will be necessary to avoid these infestations. There is still some way by which we can bring down the increased phenomenon of catheter-associated urinary tract contamination by maintaining hygiene while handling the catheter and patients and keeping the infected patients away or isolated from unaffected patients as a precaution. This article mainly focuses on an overview that helps with discussing prevention, risk factors, diagnosis, control and management of CAUTI.
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Risk Factors for Catheter-Associated Urinary Tract Infections (CA-UTI) in the Pediatric Intensive Care Unit. Indian Pediatr 2022. [DOI: 10.1007/s13312-022-2573-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Clawson A, Zahir SF, Stewart S, Torr S, Hempenstall N, Vernon C, Subedi S. Characteristics and outcomes of hospitalised inpatients with indwelling urinary catheter-a retrospective study from a large regional hospital in queensland. Infect Dis Health 2022; 27:219-226. [PMID: 35739035 DOI: 10.1016/j.idh.2022.05.004] [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: 10/17/2021] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Indwelling urinary catheters (IDCs) are a common invasive device in hospitalised patients. Their use is associated with increased risks of developing catheter associated urinary tract infections (CAUTI), and blood stream infections (BSI). AIMS To examine the characteristics and outcomes of adult inpatients with an IDC inserted in hospital and identify risk factors for developing CAUTI and BSI. METHODS We performed a retrospective observational study of 430 patients with IDC admitted to medical and surgical units of a leading (tertiary) hospital between Nov 2019 till April 2020. Multiple logistic regression analysis was performed to determine independent risk factors for developing urinary tract infection and blood stream infection. RESULTS The prevalence of CAUTI in our study was 7.4%. Results of multiple logistic regression indicated that with each day of IDC in situ, the likelihood of UTI development increased by 9% (OR 1.09; 95% CI 1.00 to 1.18; p = 0.03). Age, gender, and catheter reinsertion were not associated with UTI development. CONCLUSIONS Longer duration of IDC was associated with elevated risk of developing CAUTI. CAUTI rates were higher than some of those previously published. There was no statistical significance in frequency of CAUTI between medical and surgical patients. No statistically significant variables that contributed to the development of BSI were found. Interventions targeted at reducing catheter days should be used to improve CAUTI rates.
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Affiliation(s)
- A Clawson
- Sunshine Coast University Hospital, 6 Doherty Street, Birtinya, QLD, 4551, Australia; Griffith University School of Medicine and Dentistry, Sunshine Coast Health Institute, 6 Doherty Street, Birtinya, QLD, 4551, Australia.
| | - S F Zahir
- Queensland Cyber Infrastructure Foundation (QCIF), QCIF Facility for Advanced Bioinformatics, Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - S Stewart
- Sunshine Coast University Hospital, Infection Management Services, 6 Doherty Street, Birtinya, QLD, 4551, Australia
| | - S Torr
- Sunshine Coast University Hospital, Surgical Services Group, 6 Doherty Street, Birtinya, QLD, 4551, Australia
| | - N Hempenstall
- Sunshine Coast University Hospital, Infection Management Services, 6 Doherty Street, Birtinya, QLD, 4551, Australia
| | - C Vernon
- Sunshine Coast University Hospital, Department of Urology, 6 Doherty Street, Birtinya, QLD, 4551, Australia
| | - S Subedi
- Sunshine Coast University Hospital, Department of Infectious Diseases, 6 Doherty Street, Birtinya, QLD, 4551, Australia
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Musco S, Giammò A, Savoca F, Gemma L, Geretto P, Soligo M, Sacco E, Del Popolo G, Li Marzi V. How to Prevent Catheter-Associated Urinary Tract Infections: A Reappraisal of Vico's Theory-Is History Repeating Itself? J Clin Med 2022; 11:jcm11123415. [PMID: 35743487 PMCID: PMC9225510 DOI: 10.3390/jcm11123415] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/16/2022] [Accepted: 06/06/2022] [Indexed: 02/01/2023] Open
Abstract
New, contextualized modern solutions must be found to solve the dilemma of catheter-associated urinary infection (CAUTI) in long-term care settings. In this paper, we describe the etiology, risk factors, and complications of CAUTI, explore different preventive strategies proposed in literature from the past to the present, and offer new insights on therapeutic opportunities. A care bundle to prevent CAUTI mainly consists of multiple interventions to improve clinical indications, identifying a timeline for catheter removal, or whether any alternatives may be offered in elderly and frail patients suffering from chronic urinary retention and/or untreatable urinary incontinence. Among the various approaches used to prevent CAUTI, specific urinary catheter coatings according to their antifouling and/or biocidal properties have been widely investigated. Nonetheless, an ideal catheter offering holistic antimicrobial effectiveness is still far from being available. After pioneering research in favor of bladder irrigations or endovesical instillations was initially published more than 50 years ago, only recently has it been made clear that evidence supporting their use to treat symptomatic CAUTI and prevent complications is needed.
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Affiliation(s)
- Stefania Musco
- Unit of Neuro-Urology, Azienda Ospedaliera Careggi, 50134 Florence, Italy; (S.M.); (G.D.P.)
| | - Alessandro Giammò
- Unit of Neuro-Urology, Orthopaedic Trauma Center (CTO)-Spinal Unit Hospital, Città Della Salute e Della Scienza, 10126 Turin, Italy; (A.G.); (P.G.)
| | | | - Luca Gemma
- Unit of Urological Robotic Surgery and Renal Transplantation, Azienda Ospedaliera Careggi, 50134 Florence, Italy;
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
| | - Paolo Geretto
- Unit of Neuro-Urology, Orthopaedic Trauma Center (CTO)-Spinal Unit Hospital, Città Della Salute e Della Scienza, 10126 Turin, Italy; (A.G.); (P.G.)
| | - Marco Soligo
- Unit of Obstetrics and Gynecology, Ospedale Maggiore di Lodi, 26900 Lodi, Italy;
| | - Emilio Sacco
- Unit of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Giulio Del Popolo
- Unit of Neuro-Urology, Azienda Ospedaliera Careggi, 50134 Florence, Italy; (S.M.); (G.D.P.)
| | - Vincenzo Li Marzi
- Unit of Urological Robotic Surgery and Renal Transplantation, Azienda Ospedaliera Careggi, 50134 Florence, Italy;
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
- Correspondence: ; Tel.: +39-333-3145739
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Mangal S, Carter E, Arcia A. Developing an educational resource for parents on pediatric catheter-associated urinary tract infection (CAUTI) prevention. Am J Infect Control 2022; 50:400-408. [PMID: 34543706 PMCID: PMC8959581 DOI: 10.1016/j.ajic.2021.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Pediatric catheter-associated urinary tract infection (CAUTI) prevention guidelines encourage family engagement; however, there is a dearth of research on parent-facing CAUTI prevention resources. We aimed to meet the learning needs of parents about CAUTI prevention in the hospital by developing and refining an educational pamphlet with parents. METHODS Phase 1: We compiled existing evidence from CAUTI prevention guidelines and conducted a focus group with parents to form learning objectives. Phase 2: We developed prototype design elements, tested initial designs with a survey, and conducted qualitative participatory design sessions with parents to iteratively refine the pamphlet until design saturation was reached. RESULTS We identified the following key themes and preferences: (1) Clear boundaries for engagement (e.g., parents would not be emptying the catheter); (2) Positive, actionable framing (e.g., what should proper catheter positioning look like?); (3) What to expect (e.g., is the catheter painful for my child?); (4) Parents considered both their and their child's comprehension of the content when providing feedback. CONCLUSIONS Overall, we demonstrated the utility of remote participatory design methods in developing and refining a CAUTI prevention resource based on parents' preferences. Future research should consider adapting these methods and implementing formal evaluation for comprehension for eventual integration into clinical practice.
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Affiliation(s)
- Sabrina Mangal
- Columbia University School of Nursing, New York, NY; Weill Cornell Medicine, Department of Population Health Sciences, Division of Health Informatics, New York, NY.
| | - Eileen Carter
- Columbia University School of Nursing, New York, NY; University of Connecticut School of Nursing, Storrs, CT
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Ndomba ALM, Laisser RM, Silago V, Kidenya BR, Mwanga J, Seni J, Mshana SE. Urinary Tract Infections and Associated Factors among Patients with Indwelling Urinary Catheters Attending Bugando Medical Centre a Tertiary Hospital in Northwestern Tanzania. Microorganisms 2022; 10:microorganisms10020473. [PMID: 35208927 PMCID: PMC8879566 DOI: 10.3390/microorganisms10020473] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 12/10/2022] Open
Abstract
Complications of indwelling urinary catheterization (IUC) are associated with significant morbidity and mortality, thus affecting patient's well-being. Understanding the magnitude and factors associated with complications is crucial in designing appropriate preventive strategies. A cross-sectional study was conducted at Bugando Medical Centre, involving patients with long-term and short-term IUC from December 2016 to September 2017. The data were analyzed by STATA 13.0. Catheter-associated urinary tract infection (CA-UTI) was the leading (56.8%; 250/440) complication among patients with IUC. Gram-negative bacteria were predominantly isolated (98.1%, 252/257), whereas E. coli (30.7%, 79/257) and Klebsiella spp. (29.6%, 76/257) were the leading pathogens. CA-UTI was significantly higher among out-patients than in-patients (82.2% v 35.3%, p < 0.001). Older age (OR: 1.3, (95%CI: 1.1-1.5), p < 0.001), level of education (OR: 1.8, (95%CI: 1.1-3.1), p = 0.029) and catheter duration of ≥6 weeks (OR: 2.43, (95%CI: 1.1-5.5), p = 0.031) independently predicted CA-UTI among outpatients, while female gender (OR: 2.1, (95%CI: 1.2-3.7), p = 0.014), catheter bags not freely hanging (OR: 0.4, (95%CI: 0.2-0.7), p = 0.002) and residing outside Mwanza region (OR: 0.4, (95%CI: 0.2-0.6), p < 0.001) predicted CA-UTI among in-patients. CA-UTI is the common complication among patients with IUC, significantly higher in out-patients than in-patients. We recommend involving patients and carers in infection prevention and control measures in out-patients living with IUC.
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Affiliation(s)
- Asteria L. M. Ndomba
- Archbishop Anthony Mayala School of Nursing, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania;
- Correspondence:
| | - Rose M. Laisser
- Archbishop Anthony Mayala School of Nursing, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania;
| | - Vitus Silago
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (V.S.); (J.S.); (S.E.M.)
| | - Benson R. Kidenya
- Department of Biochemistry and Molecular Biology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania;
| | - Joseph Mwanga
- Department of Biostatistics, Epidemiology and Behavioral Sciences, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania;
| | - Jeremiah Seni
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (V.S.); (J.S.); (S.E.M.)
| | - Stephen E. Mshana
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (V.S.); (J.S.); (S.E.M.)
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Nasrollahian S, Halaji M, Hosseini A, Teimourian M, Armaki MT, Rajabnia M, Gholinia H, Pournajaf A. Genetic Diversity, Carbapenem Resistance Genes, and Biofilm Formation in UPEC Isolated from Patients with Catheter-Associated Urinary Tract Infection in North of Iran. Int J Clin Pract 2022; 2022:9520362. [PMID: 36187911 PMCID: PMC9507725 DOI: 10.1155/2022/9520362] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/24/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Infections due to carbapenem-resistant Enterobacteriaceae (CRE) are associated in patients with urinary catheters alarming rate of emergency status. The aim of this study is to investigate the molecular causes of carbapenem resistance among UPEC as well as antimicrobial resistance trends. Additionally, the potential of isolates to produce biofilms, in addition to their clonal and genetic diversity, was investigated. Material and Methods. A cross-sectional study was accomplished on a collection of 76 non-duplicate UPEC isolates obtained from CAUTIs from May 2021 to September 2021. The modified carbapenem inactivation method (mCIM) and EDTA-modified carbapenem inactivation method (eCIM) test was performed for the detection of carbapenemase and metallo-beta-lactamase activity. Also, the presence of carbapenemase genes was determined using PCR assays. In 96-well microtiter plates, biofilm development was evaluated. ERIC-PCR was used to investigate the clonal and genetic variety of isolates. RESULTS A total of 76 confirmed UPEC isolates were obtained from patients mentioned to teaching hospitals in Babol, Iran. The results of antibiotic susceptibility testing revealed a high rate of antibiotic resistance against nalidixic acid (81.6%) and trimethoprim-sulfamethoxazole (80.3%). Among UPEC isolates, 63.2% and 13.2% of UPEC isolates were positive for MBL production. The frequencies of the studied genes are in order of bla NDM (14.5%), bla OXA-23 (2.6%), and bla OXA-48 (2.6%). Forty-two isolates (55.3%) were positive for biofilm formation. ERIC-PCR revealed that UPEC isolates could be categorized into nine clusters A-I and five isolates were categorized as a singleton. CONCLUSION The high prevalence of MDR and carbapenemase-producing isolates among the UPEC strain in this investigation is concerning. Moreover, the bla NDM was the most frequent cause of producing metallo-beta-lactamase and carbapenemase. Also, analysis revealed a partial genetic similarity among the studied isolates, indicating that the same UPEC clones may have spread to other hospital units.
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Affiliation(s)
- Sina Nasrollahian
- Department of Medical Microbiology and Biotechnology, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Mehrdad Halaji
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Akramasadat Hosseini
- Department of Pathology, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Mohammad Teimourian
- Department of Urology, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Mojtaba Taghizadeh Armaki
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mehdi Rajabnia
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Hemmat Gholinia
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Abazar Pournajaf
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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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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Urinary catheter alleviation navigator protocol (UCANP): Overview of protocol and review of initial experience. Am J Infect Control 2022; 50:81-85. [PMID: 34273463 DOI: 10.1016/j.ajic.2021.06.019] [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: 05/08/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Given the associated morbidity, mortality, and financial consequences of catheter associated urinary tract infections (CAUTIs), efforts should be made to mitigate the risk. We sought to describe, and report results for a post-catheter removal bladder management protocol focused on decreasing catheter reinsertion, catheter days, and overall CAUTI risk. METHODS This was a quality improvement initiative implemented over a 3-month period at a single urban, tertiary health care center. Patients with an indwelling urinary catheter deemed eligible for removal were followed and cared for according to the study protocol. Rates of catheter reinsertion, catheter days, and assessment of CAUTI risk were compared between cohorts. RESULTS A total of 173 patients were eligible for protocol enrollment. Catheter reinsertion rate was 16% during the pilot, compared to 21% and 27% for the historical cohorts, (P = .02). The mean number of catheter day's during the study was 1.4 days, compared to 9.5 and 5.6 days in the historical cohorts (P = .004). Catheter hours (OR 1.010 95% CI 1.005 - 1.015 P < .0001.) was a predictor of catheter reinsertion during the pilot. CONCLUSIONS Our protocol resulted in a reduction of catheter reinsertion rates and number of catheter days. Expansion of this protocol to a larger patient cohort is required.
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Dadi NCT, Radochová B, Vargová J, Bujdáková H. Impact of Healthcare-Associated Infections Connected to Medical Devices-An Update. Microorganisms 2021; 9:2332. [PMID: 34835457 PMCID: PMC8618630 DOI: 10.3390/microorganisms9112332] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/06/2021] [Accepted: 11/08/2021] [Indexed: 01/12/2023] Open
Abstract
Healthcare-associated infections (HAIs) are caused by nosocomial pathogens. HAIs have an immense impact not only on developing countries but also on highly developed parts of world. They are predominantly device-associated infections that are caused by the planktonic form of microorganisms as well as those organized in biofilms. This review elucidates the impact of HAIs, focusing on device-associated infections such as central line-associated bloodstream infection including catheter infection, catheter-associated urinary tract infection, ventilator-associated pneumonia, and surgical site infections. The most relevant microorganisms are mentioned in terms of their frequency of infection on medical devices. Standard care bundles, conventional therapy, and novel approaches against device-associated infections are briefly mentioned as well. This review concisely summarizes relevant and up-to-date information on HAIs and HAI-associated microorganisms and also provides a description of several useful approaches for tackling HAIs.
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Affiliation(s)
| | - Barbora Radochová
- Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, 84215 Bratislava, Slovakia; (N.C.T.D.); (J.V.)
| | | | - Helena Bujdáková
- Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, 84215 Bratislava, Slovakia; (N.C.T.D.); (J.V.)
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Chen SF, Wang PH, Kuo SC, Chen YC, Sia HJ, Lee PH, Yang JH, Kao S. Early and Standard Urinary Catheter Removal After Gynecological Surgery for Benign Lesions: A Quasi-Experimental Study. Clin Nurs Res 2021; 31:489-496. [PMID: 34514876 DOI: 10.1177/10547738211044500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients undergoing gynecological surgery commonly receive indwelling transurethral Foley catheters, however duration of catheterization is associated with risk of urinary tract infections and other adverse effects. Early removal of catheters is encouraged, however optimal timing postsurgery remains unclear. This quasi-experimental study compared outcomes for women after removal of a Foley catheter at two different times following benign gynecological surgery. Participants received either early catheter removal, within 6 hours of surgery (n = 38) or standard catheter removal, within 12 to 24 hours of surgery (n = 45). There were no significant differences in outcomes for discomfort scores or re-catheterization rates between groups. However, the early removal group had a significantly shorter time to first ambulation and shorter hospital stays. Early removal of Foley catheters in patients who underwent gynecological surgery did not increase adverse events. Early removal of catheters after gynecological surgery may decrease re-catheterization rates and increase patient satisfaction.
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Affiliation(s)
- Shu Fen Chen
- Taipei Veterans General Hospital, Taipei.,Graduate Institute of Life Sciences, National Defense Medical Center, Taipei
| | - Peng-Hui Wang
- Taipei Veterans General Hospital, Taipei.,National Yang Ming Chiao Tung University, Taipei.,China Medical University Hospital, Taichung.,The Female Cancer Foundation, Taipei
| | - Shu-Chen Kuo
- Taipei Veterans General Hospital, Taipei.,National Yang Ming Chiao Tung University, Taipei
| | | | | | | | | | - Senyeong Kao
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei
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Mangal S, Pho A, Arcia A, Carter E. Patient and Family Engagement in Catheter-Associated Urinary Tract Infection (CAUTI) Prevention: A Systematic Review. Jt Comm J Qual Patient Saf 2021; 47:591-603. [PMID: 34215555 PMCID: PMC8506981 DOI: 10.1016/j.jcjq.2021.05.009] [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: 01/12/2021] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Catheter-associated urinary tract infections (CAUTIs) are detrimental to health and are largely preventable with adherence to CAUTI prevention guidelines. Patient and family engagement in CAUTI prevention is often encouraged in these guidelines; however, little is known about how this engagement is operationalized in practice. A systematic review was conducted to synthesize the content, format, and outcomes of interventions that engage patients and/or families in CAUTI prevention. METHODS Two reviewers independently screened records from four databases up to March 2021 and searched reference lists of final articles. Included articles were primary research, tested an intervention, involved indwelling urinary catheters, and described at least one patient and/or family engagement method. Articles were appraised for quality using the Downs and Black checklist. RESULTS After 720 records were screened, 12 were included. Study quality ranged from good to poor, scoring lowest in internal validity. The most common formats of patient/family engagement were flyers/handouts (83.3%) and verbal education (58.3%). Common content areas were urinary catheter care and maintenance strategies. Most study outcomes (83.3%) measured CAUTI rates, and half measured patient/family-related outcomes. Improvements were seen in at least one outcome across all studies, but less than half (41.7%) showed statistically significant results. CONCLUSION The researchers found that most interventions lacked sufficient detail on the content, delivery, and/or outcome measurement of patient/family engagement, which limits transferability. More high-quality, generalizable trials are warranted in this area. Future research should focus on integrating publicly available resources into practice that can be tested for comprehension and revised based on feedback from target audiences.
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Affiliation(s)
- Sabrina Mangal
- Columbia University School of Nursing, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA (Present affiliation)
| | - Anthony Pho
- Columbia University School of Nursing, New York, NY, USA
- Stanford University School of Medicine, Stanford, CA, USA (Present affiliation)
| | - Adriana Arcia
- Columbia University School of Nursing, New York, NY, USA
| | - Eileen Carter
- Columbia University School of Nursing, New York, NY, USA
- University of Connecticut School of Nursing, Storrs, CT, USA (Present affiliation)
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Oumer Y, Regasa Dadi B, Seid M, Biresaw G, Manilal A. Catheter-Associated Urinary Tract Infection: Incidence, Associated Factors and Drug Resistance Patterns of Bacterial Isolates in Southern Ethiopia. Infect Drug Resist 2021; 14:2883-2894. [PMID: 34335034 PMCID: PMC8318706 DOI: 10.2147/idr.s311229] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/16/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Catheter-associated urinary tract infections (CAUTIs) are the most common nosocomial infection and a leading cause of morbidity. The aim of this study was to determine the prevalence, associated factors and antibiogram of the bacterial isolates among CAUTIs patients. Methods A facility-based, cross-sectional study was conducted from March to December 2019 at Arba Minch General Hospital, Southern Ethiopia. Clinical and socio-demographic data were obtained using a questionnaire. Clean catch midstream urine samples were collected and inoculated onto blood agar, MacConkey agar, and cysteine lactose electrolyte deficient agar (CLED). The inoculated culture media were incubated in an aerobic atmosphere at 37°C for 24 h. After overnight incubation, the bacterial growth on the respective media was inspected visually and graded for the presence of significant bacteriuria. A significant bacteriuria was considered, if pure culture at a concentration of ≥105 colony forming unit (CFU)/mL. All isolates were further identified using colony morphology and biochemical tests. Antimicrobial sensitivity was determined by modified Kirby–Bauer disc diffusion method. Data were analyzed using SPSS version 25. P-value less than 0.05 was used as statistical significance. Results The overall incidence of symptomatic CAUTIs was 39/231 (16.8%). Independent predictors of CAUTIs were prolonged (≥7 days) catheterization (AOR = 3.6, 95% CI = 1.0–12.2), diabetes mellitus (AOR = 5.3, 95% CI = 1.4–19.6) and insertion of catheter in surgical ward (AOR = 3.6, 95% CI = 1.08–12.28). The most common bacterial isolates were E. coli 17/42 (40.5%), Klebsiella species 9/42 (21.4%) and Enterococcus species 5/42 (11.9%). High (>80%) drug resistance was observed against cotrimoxazole, cefoxitin and tetracycline. Ciprofloxacin and nitrofurantoin were the most active drugs. The overall prevalence of MDR among isolates was 37/42 (88.1%). Most bacterial isolates 30/42 (71.4%) were biofilm producers. Conclusion High levels of drug resistance were observed to commonly used antibiotics. In our study, biofilm-producing bacterial isolates were the predominant cause of CAUTIs. Therefore, continuous surveillance of antimicrobial resistance patterns is necessary to help physicians in treatment and management of CAUTIs.
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Affiliation(s)
- Yisiak Oumer
- Department of Medical Microbiology, Arba Minch University, Arba Minch, Ethiopia
| | | | - Mohamed Seid
- Department of Medical Microbiology, Arba Minch University, Arba Minch, Ethiopia
| | - Gelila Biresaw
- Department of Hematology and Immunohematology, Arba Minch University, Arba Minch, Ethiopia
| | - Aseer Manilal
- Department of Medical Microbiology, Arba Minch University, Arba Minch, Ethiopia
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