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Soudais B, Gallais A, Schuers M. 'Male cystitis does not exist': A qualitative study of general practitioners' experiences and management of male urinary tract infections in France. Eur J Gen Pract 2024; 30:2362693. [PMID: 38881418 PMCID: PMC11185083 DOI: 10.1080/13814788.2024.2362693] [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: 05/24/2023] [Accepted: 05/28/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND Male urinary tract infections (mUTIs) are rare in primary care. The definition of mUTIs varies across countries. The therapeutic management of mUTIs in France is based on a 14-day course of fluoroquinolones despite a high risk of antimicrobial resistance. OBJECTIVES The objective of this qualitative study was to explore general practitioners' (GPs) experiences and behaviours regarding the diagnostic and therapeutic management of mUTIs. METHODS GPs were recruited by convenience sampling in Haute Normandie (France) and interviewed individually with semi-structured guides. GPs' experiences and behaviours were recorded and analysed using an interpretive phenomenological approach. RESULTS From March 2021 to May 2022, 20 GPs were included in the study. Defining a mUTI was perceived as a diagnostic challenge. A diagnosis based on clinical evidence alone was insufficient and complementary tests were required. For GPs: 'male cystitis does not exist'. A mUTI was considered an unusual disease that could reveal an underlying condition. GPs considered fluoroquinolones to be 'potent' antibiotics and treated all patients with the same 14-day course. GPs implemented improvement strategies for antibiotic stewardship and followed the guidelines using a computerised decision support system. CONCLUSIONS GPs' experiences of mUTIs are limited due to low exposure and variable clinical presentations in primary care, representing a diagnostic and therapeutic challenge. In order to modify GPs' antibiotic prescribing behaviours, a paradigm shift in the guidelines will need to be proposed.KEY MESSAGESDefining a male urinary tract infection represents a diagnostic challenge for GPs.A diagnosis based on clinical evidence alone is insufficient and complementary tests are required.A male urinary tract infection is an unusual disease in primary care and suggests a more serious underlying condition.
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Affiliation(s)
- Benjamin Soudais
- Department of General Practice, Normandie Univ, UNIROUEN, Rouen, France
| | - Alexandre Gallais
- Department of General Practice, Normandie Univ, UNIROUEN, Rouen, France
| | - Matthieu Schuers
- Department of General Practice, Normandie Univ, UNIROUEN, Rouen, France
- Department of Biomedical Informatics, CHU Rouen, Rouen, France
- LITIS EA 4108, Normandie Univ, UNIROUEN, Rouen, France
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Lui S, Carr F, Gibson W. Diagnosis of urinary tract infections in the hospitalized older adult population in Alberta. PLoS One 2024; 19:e0300564. [PMID: 38848404 PMCID: PMC11161040 DOI: 10.1371/journal.pone.0300564] [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: 11/17/2023] [Accepted: 02/29/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Urinary tract infections (UTIs) are one of the most common infections reported in older adults, across all settings. Although a diagnosis of a UTI requires specific clinical and microbiological criteria, many older adults are diagnosed with a UTI without meeting the diagnostic criteria, resulting in unnecessary antibiotic treatment and their potential side effects, and a failure to find the true cause of their presentation to hospital. OBJECTIVE The aim of this study was to evaluate the accuracy of UTI diagnoses amongst hospitalized older adults based on clinical and microbiological findings, and their corresponding antibiotic treatment (including complications), in addition to identifying possible factors associated with a confirmed UTI diagnosis. METHODS A single-center retrospective cross-sectional study of older adult patients (n = 238) hospitalized at the University of Alberta Hospital with an admission diagnosis of UTI over a one-year period was performed. RESULTS 44.6% (n = 106) of patients had a diagnosis of UTI which was supported by documents clinical and microbiological findings while 43.3% (n = 103) of patients had bacteriuria without documented symptoms. 54.2% (n = 129) of all patients were treated with antibiotics, despite not having evidence to support a diagnosis of a UTI, with 15.9% (n = 37) of those patients experiencing complications including diarrhea, Clostridioides difficile infection, and thrush. History of major neurocognitive disorder was significantly associated with diagnosis of UTI (p = 0.003). CONCLUSION UTIs are commonly misdiagnosed in hospitalized older adults by healthcare providers, resulting in the majority of such patients receiving unnecessary antibiotics, increasing the risk of complications. These findings will allow for initiatives to educate clinicians on the importance of UTI diagnosis in an older adult population and appropriately prescribing antibiotics to prevent unwanted complications.
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Affiliation(s)
- Samantha Lui
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Frances Carr
- Division of Geriatric Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - William Gibson
- Division of Geriatric Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
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Schmiemann G, Kranz J, Mandraka F, Schubert S, Wagenlehner F, Gágyor I. The Diagnosis, Treatment, and Prevention of Recurrent Urinary Tract Infection. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024; 121:373-382. [PMID: 38686602 DOI: 10.3238/arztebl.m2024.0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 04/03/2024] [Accepted: 04/03/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Urinary tract infection has a one-year prevalence of 11% in women and ranges among the most common reasons for consulting a primary care physician and for receiving a prescription for antibiotics. In the case of recurrent urinary tract infection (rUTI), there are questions about the further work-up, treatment, and preventive measures. METHODS The systematic literature search performed for the update of the German clinical practice guideline on uncomplicated urinary tract infection (043-044) (up to February 2022) was supplemented with a selective search for clinical trials (up to August 2023). RESULTS Urine culture and ultrasonography are reasonable steps in the diagnostic evaluation of rUTI. Further invasive testing is suggested for men but is not routinely indicated for women. Antibiotics are among the most effective preventive measures (risk ratio [RR] 0.15, 95% confidence interval [0.1; 0.3]) but carry a high risk of side effects. Non-antibiotic preparations such as cranberry juice (RR 0.74 [0.5; 0.99]), mannose (RR 0.23 [0.14; 0.37]), and vaginal estrogen (RR, 0.42 [0.30; 0.59]) can also reduce the infection rate, with a low risk of side effects. Increased daily fluid intake has been shown to lower infection rates in the short term (odds ratio [OR] 0.13 [0.07; 0.25]); the use of hygienically advisable wiping techniques after passing stool or urine has been little studied but can be implemented with no risk. CONCLUSION rUTI poses a challenge for the treating physician. The measures to be taken must be considered on an individual basis. Vulnerable groups, such as older patients, need special attention.
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Affiliation(s)
- Guido Schmiemann
- Institute of Public Health and Nursing Research, Department for Health Services Research, University of Bremen; Clinic of Urology and Pediatric Urology, University Hospital Aachen; University Hospital and Department of Urology, University Hospital of Halle (Saale); Laboratory Dr. Wisplinghoff, Specialist in Internal Medicine and Infectiology, ABS-Expert (DGI), Köln; Max von Pettenkofer-Institute, Chair of Medical Microbiology and Hospital Hygiene, Ludwig-Maximilians-University (LMU) Munich; Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig-University Giessen; Departement of General Practice, Julius-Maximilians-Universität of Würzburg
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Ciudin A, Padulles B, Popescu R, Manasia P. Autovaccine-Based Immunotherapy: A Promising Approach for Male Recurrent Urinary Tract Infections. Life (Basel) 2024; 14:111. [PMID: 38255726 PMCID: PMC10821010 DOI: 10.3390/life14010111] [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: 11/28/2023] [Revised: 12/28/2023] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Recurrent Urinary Tract Infections (UTIs) in men range from 0.9 to 2.4/1000 individuals in younger men to 7.7/1000 in those over 85, significantly impacting their quality of life. Preventive strategies include autovaccines, but limited evidence exists for males. METHODS A prospective monocentric, open-label observational study was conducted from August 2018 to August 2021, with follow-up until August 2023 including patients with recurrent UTIs treated with immunotherapy. We evaluated the incidence rate of UTIs per year, the incidence rate of episodes after two or three rounds of the autovaccine, and quality of life measured with the IPSS-QoL questionnaire. RESULTS A total of 49 patients fulfilled inclusion criteria. The mean age was 72 years (±15), and the median 61. The evolution of UTIs number of episodes after the autovaccine rounds: -37.74% for the first round from 5.3 to 3.3; -33.33% for the second round from 3.3 to 2.2; -45.45% for the third round from 2.2 to 1.2. The mean IPSS score improved from 10.69 to 7.27 after the treatment (32%). The mean QoL subscore enhancement was from 4.22 to 1.92 (54%). With a mean follow-up of 3 years, only nine patients required retreatment. CONCLUSION Autovaccine treatment significantly reduced the number of UTI episodes, with a cumulative effect observed after multiple rounds of treatment, demonstrating an enhancement in QoL and with sustained effectiveness and a low need for retreatment.
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Affiliation(s)
- Alexandru Ciudin
- Urology Department, Hospital Universitari de Mollet, 08100 Barcelona, Spain; (B.P.); (P.M.)
| | - Bernat Padulles
- Urology Department, Hospital Universitari de Mollet, 08100 Barcelona, Spain; (B.P.); (P.M.)
| | - Razvan Popescu
- Urology Department, Spitalul Clinic “Prof. Dr. Th. Burghele”, 061344 Bucuresti, Romania;
| | - Pasqualino Manasia
- Urology Department, Hospital Universitari de Mollet, 08100 Barcelona, Spain; (B.P.); (P.M.)
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Dickson K, Zhou J, Lehmann C. Lower Urinary Tract Inflammation and Infection: Key Microbiological and Immunological Aspects. J Clin Med 2024; 13:315. [PMID: 38256450 PMCID: PMC10816374 DOI: 10.3390/jcm13020315] [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: 11/27/2023] [Revised: 12/13/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
The urinary system, primarily responsible for the filtration of blood and waste, is affected by several infectious and inflammatory conditions. Focusing on the lower tract, this review outlines the physiological and immune landscape of the urethra and bladder, addressing key immunological and microbiological aspects of important infectious/inflammatory conditions. The conditions addressed include urethritis, interstitial cystitis/bladder pain syndrome, urinary tract infections, and urosepsis. Key aspects of each condition are addressed, including epidemiology, pathophysiology, and clinical considerations. Finally, therapeutic options are outlined, highlighting gaps in the knowledge and novel therapeutic approaches.
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Affiliation(s)
- Kayle Dickson
- Department of Microbiology and Immunology, Dalhousie University, Halifax, NS B3H 4R2, Canada;
| | - Juan Zhou
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada;
| | - Christian Lehmann
- Department of Microbiology and Immunology, Dalhousie University, Halifax, NS B3H 4R2, Canada;
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada;
- Department of Pharmacology, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Department of Physiology and Biophysics, Dalhousie University, Halifax, NS B3H 4R2, Canada
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Toure A, Tadi R, Meagher M, Brown CT, Lam H, LaRosa S, Saint-Fort L, Syed H, Harshaw N, Moore K, Sohail N, Perea LL. There's No Place Like Home: Delirium as a Barrier in Geriatric Trauma. J Surg Res 2024; 293:89-94. [PMID: 37734296 DOI: 10.1016/j.jss.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/13/2023] [Accepted: 08/08/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Delirium is associated with a three-fold increase in frequency of 6-mo mortality following intensive care unit admission. Outside of mortality, it has been linked with severe morbidity including long-term cognitive decline, loss of autonomy, and increased risk of institutionalization. There is a paucity of literature regarding delirium and geriatric trauma patients. The aim of our study is to determine predictive factors of delirium in geriatric trauma patients. METHODS This is a retrospective review of all geriatric (>65 y) trauma patients with a documented frailty score at a Level I Trauma Center from 1/2019 to 9/2021. Univariate and multivariate logistic regressions were performed. Geriatric patients with delirium (D) and those without delirium (ND) were compared. Patients were excluded if they did not have a documented frailty score or died before admission. RESULTS One thousand three hundred and seventeen patients met criteria; 40 (3%) patients developed delirium. Neither age nor gender was different between the two groups. Frailty scores were not different between the two groups. Patients with documented delirium had a higher incidence of a positive drug screen on admission (85% versus 62.2%, P = 0.0034), higher median injury severity score (10 versus 9, P = 0.0088), and longer hospital (7 d versus 3 d, P < 0.001) and intensive care unit (1 d versus 0 d, P < 0.001) length of stay (LOS) than their ND counterparts. The D group had a higher frequency of benzodiazepine (47.5% versus 19.3%, P < 0.001) and narcotic use (77.5% versus 56.5%, P = 0.0085). Tethers nor bedrest orders were significantly associated with delirium. Incidence of urinary tract infection (12.5% versus 1%, P < 0.001) and restraint use (P < 0.001) were significantly associated with increased risk of delirium. Additionally, those with a diagnosis of delirium were more often discharged to a skilled nursing facility than those in the ND group (45% versus 30.8%, P = 0.0006). CONCLUSIONS We aimed to identify key predictive factors of delirium in our study population and found that certain factors correlated with higher frequencies of delirium in our geriatric trauma patients. Preadmission and early controlled substance use were significantly associated with delirium, as were the presence of urinary tract infection and extended intensive care unit LOS. By recognizing some of these modifiable factors, LOS may decrease while increasing the likelihood of discharge home.
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Affiliation(s)
- Abdoulaziz Toure
- Department of Surgery, Arnot Ogden Medical Center, Elmira, New York
| | - Roshan Tadi
- Department of Surgery, Arnot Ogden Medical Center, Elmira, New York
| | - Mitchell Meagher
- Department of Surgery, Arnot Ogden Medical Center, Elmira, New York
| | - Catherine Ting Brown
- Division of Trauma and Acute Care Surgery, Department of Surgery, Penn Medicine Lancaster General Health, Lancaster, Pennsylvania
| | - Hoi Lam
- Division of Trauma and Acute Care Surgery, Department of Surgery, Penn Medicine Lancaster General Health, Lancaster, Pennsylvania
| | - Samantha LaRosa
- Division of Trauma and Acute Care Surgery, Department of Surgery, Penn Medicine Lancaster General Health, Lancaster, Pennsylvania
| | - Launick Saint-Fort
- Division of Trauma and Acute Care Surgery, Department of Surgery, Penn Medicine Lancaster General Health, Lancaster, Pennsylvania
| | - Huda Syed
- Division of Trauma and Acute Care Surgery, Department of Surgery, Penn Medicine Lancaster General Health, Lancaster, Pennsylvania
| | - Nathaniel Harshaw
- Division of Trauma and Acute Care Surgery, Department of Surgery, Penn Medicine Lancaster General Health, Lancaster, Pennsylvania
| | - Katherine Moore
- Division of Trauma and Acute Care Surgery, Department of Surgery, Penn Medicine Lancaster General Health, Lancaster, Pennsylvania
| | - Neelofer Sohail
- Department of Geriatric Medicine, Penn Medicine Lancaster General Health, Lancaster, Pennsylvania
| | - Lindsey L Perea
- Division of Trauma and Acute Care Surgery, Department of Surgery, Penn Medicine Lancaster General Health, Lancaster, Pennsylvania.
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Rönneikkö J, Huhtala H, Finne-Soveri H, Valvanne J, Jämsen E. The role of geriatric syndromes in predicting unplanned hospitalizations: a population-based study using Minimum Data Set for Home Care. BMC Geriatr 2023; 23:696. [PMID: 37884888 PMCID: PMC10605458 DOI: 10.1186/s12877-023-04408-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 10/15/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND The predictive accuracies of screening instruments for identifying home-dwelling old people at risk of hospitalization have ranged from poor to moderate, particularly among the oldest persons. This study aimed to identify variables that could improve the accuracy of a Minimum Data Set for Home Care (MDS-HC) based algorithm, the Detection of Indicators and Vulnerabilities for Emergency Room Trips (DIVERT) Scale, in classifying home care clients' risk for unplanned hospitalization. METHODS In this register-based retrospective study, factors associated with hospitalization among home care clients aged ≥ 80 years in the City of Tampere, Finland, were analyzed by linking MDS-HC assessments with hospital discharge records. MDS-HC determinants associated with hospitalization within 180 days after the assessment were analyzed for clients at low (DIVERT 1), moderate (DIVERT 2-3) and high (DIVERT 4-6) risk of hospitalization. Then, two new variables were selected to supplement the DIVERT algorithm. Finally, area under curve (AUC) values of the original and modified DIVERT scales were determined using the data of MDS-HC assessments of all home care clients in the City of Tampere to examine if addition of the variables related to the oldest age groups improved the accuracy of DIVERT. RESULTS Of home care clients aged ≥ 80 years, 1,291 (65.4%) were hospitalized at least once during the two-year study period. Unplanned hospitalization occurred following 15.9%, 22.8%, and 33.9% MDS-HC assessments with DIVERT group 1, 2-3 and 4-6, respectively. Infectious diseases were the most common diagnosis within each DIVERT groups. Many MDS-HC variables not included in the DIVERT algorithm were associated with hospitalization, including e.g. poor self-rated health and old fracture (other than hip fracture) (p 0.001) in DIVERT 1; impaired cognition and decision-making, urinary incontinence, unstable walking and fear of falling (p < 0.001) in DIVERT 2-3; and urinary incontinence, poor self-rated health (p < 0.001), and decreased social interaction (p 0.001) in DIVERT 4-6. Adding impaired cognition and urinary incontinence to the DIVERT algorithm improved sensitivity but not accuracy (AUC 0.64 (95% CI 0.62-0.65) vs. 0.62 (0.60-0.64) of the original DIVERT). More admissions occurred among the clients with higher scores in the modified than in the original DIVERT scale. CONCLUSIONS Certain geriatric syndromes and diagnosis groups were associated with unplanned hospitalization among home care clients at low or moderate risk level of hospitalization. However, the predictive accuracy of the DIVERT could not be improved. In a complex clinical context of home care clients, more important than existence of a set of risk factors related to an algorithm may be the various individual combinations of risk factors.
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Affiliation(s)
- Jukka Rönneikkö
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | | | - Jaakko Valvanne
- Faculty of Medicine and Health Technology and Gerontology Research Center (GEREC), Tampere University, Tampere, Finland
| | - Esa Jämsen
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Geriatrics, Helsinki University Hospital, Helsinki, Finland
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Baran C, Akan AT, Sezgin V, Boylu A, Arabaci Ç, Polat EC, Ötünçtemur A. The effect of urinary tract infection on overall mortality in elderly male patients. Folia Med (Plovdiv) 2023; 65:612-617. [PMID: 37655380 DOI: 10.3897/folmed.65.e90402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/29/2022] [Indexed: 09/01/2023] Open
Abstract
INTRODUCTION Urinary tract infections are the most common bacterial infections in the older population.
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Affiliation(s)
- Caner Baran
- University of Health Sciences, Istanbul, Turkiye
| | | | | | - Ahmet Boylu
- University of Health Sciences, Istanbul, Turkiye
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Mareș C, Petca RC, Popescu RI, Petca A, Geavlete BF, Jinga V. Uropathogens' Antibiotic Resistance Evolution in a Female Population: A Sequential Multi-Year Comparative Analysis. Antibiotics (Basel) 2023; 12:948. [PMID: 37370266 DOI: 10.3390/antibiotics12060948] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/17/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
Urinary Tract Infections (UTIs) represent a common finding among females and an important basis for antibiotic treatment. Considering the significant increase in antibiotic resistance during the last decades, this study retrospectively follows the incidence of uropathogens and the evolution of resistance rates in the short and medium term. The current study was conducted at the "Prof. Dr. Th. Burghele" Clinical Hospital, including 1124 positive urine cultures, in three periods of four months between 2018 and 2022. Escherichia coli was the most frequent uropathogen (54.53%), followed by Klebsiella spp. (16.54%), and Enterococcus spp. (14.59%). The incidence of UTIs among the female population is directly proportional to age, with few exceptions. The highest overall resistance in Gram-negative uropathogens was observed for levofloxacin 30.69%, followed by ceftazidime 13.77% and amikacin 9.86%. The highest resistance in Gram-positive uropathogens was observed for levofloxacin 2018-R = 34.34%, 2020-R = 50.0%, and 2022-R = 44.92%, and penicillin 2018-R = 36.36%, 2020-R = 41.17%, and 2022-R = 37.68%. In Gram-negative uropathogens, a linear evolution was observed for ceftazidime 2018-R = 11.08%, 2020-R = 13.58%, and 2022-R = 17.33%, and levofloxacin 2018-R = 28.45%, 2020-R = 33.33%, and 2022-R = 35.0%. The current knowledge dictates the need to continuously assess antimicrobial resistance patterns, information that is necessary for treatment recommendations. The present study aims to determine the current situation and the evolution trends according to the current locoregional situation.
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Affiliation(s)
- Cristian Mareș
- Department of Urology, "Carol Davila" University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania
- Department of Urology, "Saint John" Clinical Emergency Hospital, 13 Vitan-Barzesti Str., 042122 Bucharest, Romania
| | - Răzvan-Cosmin Petca
- Department of Urology, "Carol Davila" University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania
- Department of Urology, "Prof. Dr. Th. Burghele" Clinical Hospital, 20 Panduri Str., 050659 Bucharest, Romania
| | - Răzvan-Ionuț Popescu
- Department of Urology, "Carol Davila" University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania
- Department of Urology, "Prof. Dr. Th. Burghele" Clinical Hospital, 20 Panduri Str., 050659 Bucharest, Romania
| | - Aida Petca
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania
- Department of Obstetrics and Gynecology, Elias University Emergency Hospital, 17 Marasti Blvd., 011461 Bucharest, Romania
| | - Bogdan Florin Geavlete
- Department of Urology, "Carol Davila" University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania
- Department of Urology, "Saint John" Clinical Emergency Hospital, 13 Vitan-Barzesti Str., 042122 Bucharest, Romania
| | - Viorel Jinga
- Department of Urology, "Carol Davila" University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474 Bucharest, Romania
- Department of Urology, "Prof. Dr. Th. Burghele" Clinical Hospital, 20 Panduri Str., 050659 Bucharest, Romania
- Medical Sciences Section, Academy of Romanian Scientists, 050085 Bucharest, Romania
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GANİDAĞLI S, ÖZTÜRK E, ÖZTÜRK ZA. Recurrent lower urinary tract infections: more than an infection for older women. Turk J Med Sci 2023; 53:1395-1403. [PMID: 38813006 PMCID: PMC10763801 DOI: 10.55730/1300-0144.5706] [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: 12/29/2022] [Revised: 10/26/2023] [Accepted: 05/09/2023] [Indexed: 05/31/2024] Open
Abstract
Background/aim Older adults tend to have more urinary tract infections (UTIs). The frequency of recurrent lower urinary tract infections (rLUTIs) increases with age. rLUTIs are associated with long-term chronic effects on geriatric syndromes in older adults. We aimed to investigate possible risk factors that influence rLUTIs in older adults based on comprehensive geriatric assessment (CGA). Materials and methods This cross-sectional study included 235 older adults admitted to Gaziantep University's Geriatric Outpatient Clinic between June 1 and November 30, 2022. All patients underwent CGA. The Geriatric Depression Scale (GDS), the European Quality of Life-Five Dimension (EQ-5D) questionnaire, the Pittsburgh Sleep Quality Index (PSQI), the Katz Index of Activities of Daily Living (ADL), the Lawton and Brody Index of Instrumental Activities of Daily Living (IADL), and the Mini Nutritional Assessment (MNA) tool were,administered. Handgrip strength (HGS) and gait speed were also measured, and the number of falls in the last year was recorded. Results The mean age of the participants was 72.8 ± 6.8 years and 61.3% were female. Sixty-four patients had rLUTIs. The rLUTI group had higher frequencies of sarcopenia, hypertension, and diabetes; higher numbers of comorbidities and medications; higher GDS and PSQI scores; and more reported falls. They had lower ADL, MNA, EQ-5D, and gait speed scores. HGS was found to be lower in women with rLUTIs. Higher numbers of comorbidities and GDS scores and lower HGS were independent predictors of rLUTIs in women (p = 0.011, OR: 1.75; p = 0.018, OR: 1.14; and p = 0.042, OR: 0.91, respectively). Conclusion We revealed that decreased HGS, higher GDS, and the number of comorbidities in older women were independent risk factors for rLUTIs. Our findings offer a new perspective on the importance of CGA in diagnosing and preventing rLUTIs.
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Affiliation(s)
- Sencer GANİDAĞLI
- Department of Internal Medicine, Division of Geriatric Medicine, Faculty of Medicine, Gaziantep University, Gaziantep, Türkiye
Turkiye
| | - Ercüment ÖZTÜRK
- Department of Internal Medicine, Division of Geriatric Medicine, Faculty of Medicine, Gaziantep University, Gaziantep, Türkiye
Turkiye
| | - Zeynel Abidin ÖZTÜRK
- Department of Internal Medicine, Division of Geriatric Medicine, Faculty of Medicine, Gaziantep University, Gaziantep, Türkiye
Turkiye
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Soudais B, Ribeaucoup F, Schuers M. Guidelines for the management of male urinary tract infections in primary care: a lack of international consensus-a systematic review of the literature. Fam Pract 2023; 40:152-175. [PMID: 35833228 DOI: 10.1093/fampra/cmac068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The management of adult male urinary tract infections (mUTIs) in primary care lacks international consensus. The main objective of this study was to describe the different guidelines for the diagnosis and management of mUTIs in primary care, to assess their methodological quality, and to describe their evidence-based strength of recommendation (SoR). METHODS An international systematic literature review of the electronic databases Medline (PubMed) and EMBASE, and gray-literature guideline-focused databases was performed in 2021. The Appraisal of Guidelines for Research and Evaluation (AGREE II) assessment tool was used by 2 independent reviewers to appraise each guideline. RESULTS From 1,678 records identified, 1,558 were screened, 134 assessed for eligibility, and 29 updated guidelines met the inclusion criteria (13 from Medline, 0 from EMBASE, and 16 from gray literature). Quality assessment revealed 14 (48%) guidelines with high-quality methodology. A grading system methodology was used in 18 (62%) guidelines. Different classifications of mUTIs are described, underlining a lack of international consensus: an anatomic classification (cystitis, prostatitis, pyelonephritis) and a symptomatic classification (approach based on the intensity and tolerance of symptoms). The duration of antibiotic treatment for febrile mUTIs has been gradually reduced over the last 20 years from 28 days to 10-14 days of fluoroquinolones (FQ), which has become the international gold standard. Guidelines from Scandinavian countries propose short courses (3-5 days) of FQ-sparing treatments: pivmecillinam, nitrofurantoin, or trimethoprim. Guidelines from French-speaking countries use a watchful waiting approach and suggest treating mUTIs with FQ, regardless of fever. CONCLUSIONS This lack of scientific evidence leads to consensus and disagreement: 14 days of FQ for febrile mUTIs is accepted despite a high risk of antimicrobial resistance, but FQ-sparing treatment and/or short treatment for afebrile mUTIs is not. The definition of afebrile UTIs/cystitis is debated and influences the type and duration of antibiotic treatment recommended.
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Affiliation(s)
- Benjamin Soudais
- Department of General Practice, Normandie Univ, UNIROUEN, F-76000 Rouen, France
| | - Florian Ribeaucoup
- Department of General Practice, Normandie Univ, UNIROUEN, F-76000 Rouen, France
| | - Matthieu Schuers
- Department of General Practice, Normandie Univ, UNIROUEN, F-76000 Rouen, France.,Department of Biomedical Informatics, CHU Rouen, F-76000 Rouen, France.,Sorbonne Université, LIMICS U1142, F-75015 Paris, France
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12
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Hidad S, Kuil SD, Fischer JC, Visser CE, Geerlings SE, Leeflang MMG, Schneeberger C. C‐reactive protein, procalcitonin, and erythrocyte sedimentation rate for the diagnosis of lower urinary tract infection in older people. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2022. [PMCID: PMC9761663 DOI: 10.1002/14651858.cd014521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This is a protocol for a Cochrane Review (diagnostic). The objectives are as follows:
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Affiliation(s)
| | - Soemeja Hidad
- Department of Medical MicrobiologyAmsterdam University Medical CentersAmsterdamNetherlands
| | - Sacha D Kuil
- Department of Medical MicrobiologyAmsterdam University Medical CentersAmsterdamNetherlands
| | - Johan C Fischer
- Department of Clinical ChemistryAmsterdam University Medical CentersAmsterdamNetherlands
| | - Caroline E Visser
- Department of Medical MicrobiologyAmsterdam University Medical CentersAmsterdamNetherlands
| | - Suzanne E Geerlings
- Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and ImmunityAmsterdam University Medical CentersAmsterdamNetherlands
| | - Mariska MG Leeflang
- Department of Clinical Epidemiology, Biostatistics and BioinformaticsAmsterdam University Medical CentersAmsterdamNetherlands
| | - Caroline Schneeberger
- Center for Infectious Disease ControlNational Institute for Public Health and the Environment (RIVM)BilthovenNetherlands
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13
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López-Cruz I, Esparcia A, Madrazo M, Alberola J, Eiros JM, Artero A. Sex differences in aged 80 and over hospitalized patients with community-acquired UTI: A prospective observational study. Heliyon 2022; 8:e11131. [PMID: 36281411 PMCID: PMC9586905 DOI: 10.1016/j.heliyon.2022.e11131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/25/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
Aim This study aimed to evaluate clinically significant sex differences that could have an effect on the choice of treatment and outcomes of urinary tract infection (UTI) in aged 80 and over hospitalized patients with community-acquired UTI. Methods This was a prospective study of 161 patients aged 80 and over admitted to hospital with community-acquired UTI. Epidemiological, clinical, laboratory and microbiologic variables were compared between both sexes. Multivariate analysis was performed using logistic regression to determine the variables independently associated with sex. Results In a population of 91 (56.52%) women and 70 (43.48%) men, aged 80 and over, we found that women were more likely to have cognitive impairment (p = 0.035) and less likely to have chronic obstructive pulmonary disease (COPD) (p = 0.006) and indwelling urinary catheter (p < 0.001) than men. Levels of creatinine were higher in men than in women (p = 0.008). Septic shock at presentation was more frequent in the male group (p = 0.043). Men had a higher rate of polymicrobial infection (p = 0.035) and Pseudomonas aeruginosa infection (p = 0.003). Factors independently associated with sex by multivariate analysis were septic shock, cognitive impairment, COPD and indwelling urinary catheter. Conclusion Men aged 80 and over with community-acquired UTI had more septic shock at admission to hospital and higher rates of indwelling urinary catheter, while women had more cognitive impairment. There were no differences in outcomes between sexes.
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Affiliation(s)
- Ian López-Cruz
- Department of Internal Medicine, Dr. Peset University Hospital, Valencia, Spain
| | - Ana Esparcia
- Department of Internal Medicine, Dr. Peset University Hospital, Valencia, Spain
| | - Manuel Madrazo
- Department of Internal Medicine, Dr. Peset University Hospital, University of Valencia, Valencia, Spain
| | - Juan Alberola
- Department of Microbiology, Dr. Peset University Hospital, University of Valencia, Valencia, Spain,Corresponding author.
| | - José María Eiros
- Department of Microbiology and Parasitology, Rio Hortega University Hospital, University of Valladolid, Valladolid, Spain
| | - Arturo Artero
- Department of Internal Medicine, Dr. Peset University Hospital, University of Valencia, Valencia, Spain
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14
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Sansone GR, Bravo E. Novel Care Bundle of Established Basic and Practical Approaches Greatly Reduces Urinary Tract Infections in Nursing Facility Residents without Indwelling Catheters. Am J Infect Control 2022; 51:699-704. [PMID: 36007669 DOI: 10.1016/j.ajic.2022.08.015] [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: 06/02/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Residents in nursing facilities (NFs) are at greater risk of developing urinary tract infections (UTIs) with higher hospitalizations and costs than people living in communities. These residents also have increased likelihood of uroseptic shock and death. The objective of the study was to prevent UTIs and to reduce UTI-associated costs among NF residents. METHODS Quality assurance performance improvement initiative conducted between 4-01-2018 and 3-31-2022 at a large skilled NF. Participants were 262 residents newly diagnosed with UTIs without indwelling catheters. The initiative consisted of: a) a 12-month baseline; b) a 12-month intervention; and c) a 24-month follow-up. A novel care bundle which included staff's hand hygiene monitoring, residents' hydration status, effective incontinence and perineal care, and in-house UTI treatment was implemented during the intervention. The plan-do-study-act cycle was used to gauge its effectiveness. RESULTS Quarterly UTI rates decreased from 4.2% at baseline to 0.9% at follow-up, a 79% reduction (P<0.001). All 262 residents were treated in-house with no UTI-related hospitalizations. Antibiotic prescriptions fell from 373 at baseline down to 143 at follow-up, a 62% reduction. Facility costs decreased from $42,188 at baseline to $8,281 at follow-up (P<0.001). CONCLUSION This bundle was very effective in preventing UTIs and reducing UTI-associated costs. Its use in other NFs is encouraged to determine suitability elsewhere.
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Affiliation(s)
- Giorgio R Sansone
- Office of Healthcare Improvement, Medical and Professional Affairs, New York City Health and Hospitals, New York, NY.
| | - Emalyn Bravo
- Gouverneur Health, New York City Health and Hospitals, New York, NY
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15
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Salm J, Salm F, Arendarski P, Kramer TS. High antimicrobial resistance in urinary tract infections in male outpatients in routine laboratory data, Germany, 2015 to 2020. EURO SURVEILLANCE : BULLETIN EUROPEEN SUR LES MALADIES TRANSMISSIBLES = EUROPEAN COMMUNICABLE DISEASE BULLETIN 2022; 27. [PMID: 35904060 PMCID: PMC9336165 DOI: 10.2807/1560-7917.es.2022.27.30.2101012] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Evidence on the distribution of bacteria and therapy recommendations in male outpatients with urinary tract infections (UTI) remains insufficient. Aim We aimed to report frequency distributions and antimicrobial resistance (AMR) of bacteria causing UTI in men and to identify risk factors for resistance of Escherichia coli against trimethoprim (TMP) and ciprofloxacin (CIP). Methods We conducted a retrospective observational study using routinely collected midstream urine specimens from 102,736 adult male outpatients sent from 6,749 outpatient practices to nine collaborating laboratories from all major regions in Germany between 2015 and 2020. Resistance in E. coli was predicted using logistic regression. Results The three most frequent bacteria were E. coli (38.4%), Enterococcus faecalis (16.5%) and Proteus mirabilis (9.3%). Resistance of E. coli against amoxicillin (45.7%), TMP (26.6%) and CIP (19.8%) was common. Multiple drug resistance was high (22.9%). Resistance against fosfomycin (0.9%) and nitrofurantoin (1.9%) was low. Resistance of En. faecalis against CIP was high (29.3%). Isolates of P. mirabilis revealed high resistance against TMP (41.3%) and CIP (16.6%). The CIP and TMP resistance was significantly higher among bacteria derived from recurrent UTI (p < 0.05). Age ≥ 90 years, recurrent UTI and regions East and South were independently associated with AMR of E. coli against TMP and CIP (p < 0.05). Conclusion The most frequent UTI-causing pathogens showed high resistance against TMP and CIP, empirical therapy is therefore likely to fail. Apart from intrinsically resistant pathogens, susceptibility to fosfomycin and nitrofurantoin remains sufficient. Therefore, they remain an additional option for empirical treatment of uncomplicated UTI in men.
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Affiliation(s)
- Jonas Salm
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin School of Public Health, Berlin, Germany.,Institute of Medical Microbiology and Hygiene, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | | | - Tobias Siegfried Kramer
- LADR Laboratory Group Dr Kramer & Colleagues, Geesthacht, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute for Hygiene and Environmental Medicine, Berlin, Germany
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16
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Rastogi R, Yu PC, Deshpande A, Hashmi AZ, Herzig SJ, Rothberg MB. Treatment and outcomes among patients ≥85 years hospitalized with community-acquired pneumonia. J Investig Med 2022; 70:376-382. [PMID: 34702774 PMCID: PMC9203123 DOI: 10.1136/jim-2021-002078] [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] [Accepted: 09/15/2021] [Indexed: 02/03/2023]
Abstract
Our objective was to describe community-acquired pneumonia (CAP) among patients ≥85 years and compare them to patients aged 65-74. This was a retrospective cohort study. The study setting included 638 hospitals in the USA participating in the Premier database from 2010 to 2015. The study participants were 488,382 adults aged ≥65 years hospitalized with CAP. Patients ≥85 years were more likely to be white (79.8% vs 76.2%), female (58.1% vs 48.3%), and admitted with aspiration pneumonia (17.1% vs 7.0%) as compared with those aged 65-75 years. They had higher rates of dementia (30.4% vs 7.8%), but lower rates of diabetes (11.2% vs 17.6%) and chronic obstructive pulmonary disease (25.5% vs 54.7%). While Staphylococcus aureus (33.4%) was the most common pathogen across all age groups, patients aged ≥85 were more likely to have Escherichia coli pneumonia (16.1% vs 10.7%) compared with those aged 65-74. In adjusted models, patients aged ≥85 had greater in-hospital mortality (OR 1.14, 95% CI 1.11 to 1.18), but were less likely to be admitted to the intensive care unit (OR 0.54, 95% CI 0.53 to 0.55) and receive mechanical ventilation (OR 0.47, 95% CI 0.46 to 0.48). They also had lower rates of acute kidney injury (OR 0.95, 95% CI 0.91 to 1.00) and Clostridium difficile infection (OR 0.91, 95% CI 0.85 to 0.99), shorter lengths of stay (mean multiplier 0.93, 95% CI 0.92 to 0.93) and lower cost (mean multiplier 0.81, 95% CI 0.80 to 0.81), and were more likely to be discharged to a skilled nursing facility (OR 2.19, 95% CI 2.15 to 2.24) or hospice (OR 2.19, 95% CI 2.11 to 2.27). In conclusion, patients aged ≥85 have different comorbidities and etiologies of CAP, receive less intense treatment, and have greater mortality than patients between 65 and 75 years.
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Affiliation(s)
- Radhika Rastogi
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Pei-Chun Yu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Abhishek Deshpande
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ardeshir Z Hashmi
- Department of Internal Medicine and Geriatrics, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shoshana J Herzig
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Michael B Rothberg
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio, USA
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17
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Ryvicker M, Barrón Y, Shah S, Moore SM, Noble JM, Bowles KH, Merrill J. Clinical and Demographic Profiles of Home Care Patients With Alzheimer's Disease and Related Dementias: Implications for Information Transfer Across Care Settings. J Appl Gerontol 2022; 41:534-544. [PMID: 33749369 PMCID: PMC8450301 DOI: 10.1177/0733464821999225] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Home health care (HHC) clinicians serving individuals with Alzheimer's disease and related dementias (ADRD) do not always have information about the person's ADRD diagnosis, which may be used to improve the HHC plan of care. This retrospective cohort study examined characteristics of 56,652 HHC patients with varied documentation of ADRD diagnoses. Data included clinical assessments and Medicare claims for a 6-month look-back period and 4-year follow-up. Nearly half the sample had an ADRD diagnosis observed in the claims either prior to or following the HHC admission. Among those with a prior diagnosis, 63% did not have it documented on the HHC assessment; the diagnosis may not have been known to the HHC team or incorporated into the care plan. Patients with ADRD had heightened risk for adverse outcomes (e.g., urinary tract infection and aspiration pneumonia). Interoperable data across health care settings should include ADRD-specific elements about diagnoses, symptoms, and risk factors.
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Affiliation(s)
- Miriam Ryvicker
- Center for Home Care Policy & Research, Visiting Nurse Service of New York
- Vital Statistics Consulting
| | - Yolanda Barrón
- Center for Home Care Policy & Research, Visiting Nurse Service of New York
| | - Shivani Shah
- Center for Home Care Policy & Research, Visiting Nurse Service of New York
| | - Stanley M. Moore
- Center for Home Care Policy & Research, Visiting Nurse Service of New York
| | | | - Kathryn H. Bowles
- Center for Home Care Policy & Research, Visiting Nurse Service of New York
- University of Pennsylvania School of Nursing
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18
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Interleukin-6 mediates delirium-like phenotypes in a murine model of urinary tract infection. J Neuroinflammation 2021; 18:247. [PMID: 34711238 PMCID: PMC8554965 DOI: 10.1186/s12974-021-02304-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 10/20/2021] [Indexed: 01/06/2023] Open
Abstract
Background Urinary tract infection (UTI) is frequently implicated as a precipitant of delirium, which refers to an acute confusional state that is associated with high mortality, increased length of stay, and long-term cognitive decline. The pathogenesis of delirium is thought to involve cytokine-mediated neuronal dysfunction of the frontal cortex and hippocampus. We hypothesized that systemic IL-6 inhibition would mitigate delirium-like phenotypes in a mouse model of UTI. Methods C57/BL6 mice were randomized to either: (1) non-UTI control, (2) UTI, and (3) UTI + anti-IL-6 antibody. UTI was induced by transurethral inoculation of 1 × 108Escherichia coli. Frontal cortex and hippocampus-mediated behaviors were evaluated using functional testing and corresponding structural changes were evaluated via quantification of neuronal cleaved caspase-3 (CC3) by immunohistochemistry and western blot. IL-6 in the brain and plasma were evaluated using immunohistochemistry, ELISA, and RT-PCR. Results Compared to non-UTI control mice, mice with UTI demonstrated significantly greater impairments in frontal and hippocampus-mediated behaviors, specifically increased thigmotaxis in Open Field (p < 0.05) and reduced spontaneous alternations in Y-maze (p < 0.01), while treatment of UTI mice with systemic anti-IL-6 fully reversed these functional impairments. These behavioral impairments correlated with frontal and hippocampal neuronal CC3 changes, with significantly increased frontal and hippocampal CC3 in UTI mice compared to non-UTI controls (p < 0.0001), and full reversal of UTI-induced CC3 neuronal changes following treatment with systemic anti-IL-6 antibody (p < 0.0001). Plasma IL-6 was significantly elevated in UTI mice compared to non-UTI controls (p < 0.01) and there were positive and significant correlations between plasma IL-6 and frontal CC3 (r2 = 0.5087/p = 0.0028) and frontal IL-6 and CC3 (r2 = 0.2653, p < 0.0001). Conclusions These data provide evidence for a role for IL-6 in mediating delirium-like phenotypes in a mouse model of UTI. These findings provide pre-clinical justification for clinical investigations of IL-6 inhibitors to treat UTI-induced delirium. Supplementary Information The online version contains supplementary material available at 10.1186/s12974-021-02304-x.
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19
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Redondo-Sánchez J, del Cura-González I, Díez-Izquierdo L, Rodríguez-Barrientos R, Rodríguez-Cabrera F, Polentinos-Castro E, López-Miguel M, Marina-Ono L, Llamosas-Falcón L, Gil-de Miguel Á. Trends in urinary tract infection hospitalization in older adults in Spain from 2000-2015. PLoS One 2021; 16:e0257546. [PMID: 34587191 PMCID: PMC8480842 DOI: 10.1371/journal.pone.0257546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 09/05/2021] [Indexed: 12/04/2022] Open
Abstract
Objective To analyze trends in urinary tract infection hospitalization (cystitis, pyelonephritis, prostatitis and non-specified UTI) among patients over 65 years in Spain from 2000–2015. Methods We conducted a retrospective observational study using the Spanish Hospitalization Minimum Data Set (CMBD), with codifications by the International Classification of Diseases (ICD-9). We collected data on sex, age, type of discharge, main diagnosis, comorbid diagnosis, length of stay, and global cost. All the hospitalizations were grouped by age into three categories: 65–74 years old, 75–84 years old, and 85 years old and above. In the descriptive statistical analysis, crude rates were defined as hospitalizations per 1,000 inhabitants aged ≥65. To identify trends over time, we performed a Joinpoint regression. Results From 2000–2015, we found 387,010 hospitalizations coded as UTIs (54,427 pyelonephritis, 15,869 prostatitis, 2643 cystitis and 314,071 non-specified UTI). The crude rate of hospitalization for UTIs between 2000 and 2015 ranged from 2.09 in 2000 to 4.33 in 2015 Rates of hospitalization were higher in men than in women, except with pyelonephritis. By age group, higher rates were observed in patients aged 85 years or older, barring prostatitis-related hospitalizations. Joinpoint analyses showed an average annual percentage increase (AAPC) in incidence rates of 4.9% (95% CI 3.2;6.1) in UTI hospitalizations. We observed two joinpoints, in 2010 and 2013, that found trends of 5.5% between 2000 and 2010 (95% CI 4.7;6.4), 1.5% between 2010 and 2013 (95% CI -6.0;9.6) and 6.8% between 2013 and 2015 (95% CI -0.3;14.4). Conclusions The urinary infection-related hospitalization rate in Spain doubled during the period 2000–2015. The highest hospitalization rates occurred in men, in the ≥85 years old age group, and in non-specified UTIs. There were increases in all types of urinary tract infection, with non-specified UTIs having the greatest growth. Understanding these changing trends can be useful for health planning.
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Affiliation(s)
- Jesús Redondo-Sánchez
- Ramon y Cajal Health Care Center, Alcorcón, Primary Care Management, Madrid Health Service, Madrid, Spain
- Department of Medical Specialties and Public Health, University Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Isabel del Cura-González
- Department of Medical Specialties and Public Health, University Rey Juan Carlos, Alcorcón, Madrid, Spain
- Research Unit, Primary Care Management, Madrid Health Service, Madrid, Spain
- Health Services Research on Chronic Patients Network (REDISSEC) ISCIII, Madrid, Spain
| | | | - Ricardo Rodríguez-Barrientos
- Research Unit, Primary Care Management, Madrid Health Service, Madrid, Spain
- Health Services Research on Chronic Patients Network (REDISSEC) ISCIII, Madrid, Spain
- Biosanitary Research and Innovation Foundation of Primary Care (FIIBAP), Madrid, Spain
- * E-mail:
| | | | - Elena Polentinos-Castro
- Research Unit, Primary Care Management, Madrid Health Service, Madrid, Spain
- Health Services Research on Chronic Patients Network (REDISSEC) ISCIII, Madrid, Spain
| | - Miguel López-Miguel
- Ciudades Health Care Center, Getafe, South Family and Community Care Teaching Unit, Madrid, Spain
| | | | - Laura Llamosas-Falcón
- Preventive Medicine and Public Health, 12 de Octubre University Hospital, Madrid, Spain
| | - Ángel Gil-de Miguel
- Department of Medical Specialties and Public Health, University Rey Juan Carlos, Alcorcón, Madrid, Spain
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20
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Soudais B, Lacroix-Hugues V, Meunier F, Gillibert A, Darmon D, Schuers M. Diagnosis and management of male urinary tract infections: a need for new guidelines. Study from a French general practice electronic database. Fam Pract 2021; 38:432-440. [PMID: 33340317 DOI: 10.1093/fampra/cmaa136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The definition and the treatment of male urinary tract infections (UTIs) are imprecise. This study aims to determine the frequency of male UTIs in consultations of general practice, the diagnostic approach and the prescribed treatments. METHODS We extracted the consultations of male patients, aged 18 years or more, during the period 2012-17 with the International Classification of Primary Care, version 2 codes for UTIs or associated symptoms from PRIMEGE/MEDISEPT databases of primary care. For eligible consultations in which all symptoms or codes were consistent with male UTIs, we identified patient history, prescribed treatments, antibiotic duration, clinical conditions, additional examinations and bacteriological results of urine culture. RESULTS Our study included 610 consultations with 396 male patients (mean age 62.5 years). Male UTIs accounted for 0.097% of visits and 1.44 visits per physician per year. The UTIs most commonly identified were: undifferentiated (52%), prostatitis (36%), cystitis (8.5%) and pyelonephritis (3.5%). Fever was recorded in 14% of consultations. Urine dipstick test was done in 1.8% of consultations. Urine culture was positive for Escherichia coli in 50.4% of bacteriological tests. Fluoroquinolones were the most prescribed antibiotics (64.9%), followed by beta-lactams (17.4%), trimethoprim-sulfamethoxazole (11.9%) and nitrofurantoin (2.6%). CONCLUSIONS Male UTIs are rare in general practice and have different presentations. The definition of male UTIs needs to be specified by prospective studies. Diagnostic evidence of male cystitis may reduce the duration of antibiotic therapy and spare critical antibiotics.
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Affiliation(s)
- Benjamin Soudais
- Department of General Practice, Normandy University, Rouen, France
| | - Virginie Lacroix-Hugues
- Department of Education and Research in General Practice, Côte d'Azur University, Nice, France.,Department of Public Health, Archet 1 Hospital, Nice, France
| | - François Meunier
- Department of General Practice, Normandy University, Rouen, France
| | | | - David Darmon
- Department of Education and Research in General Practice, Côte d'Azur University, Nice, France.,INSERM, IRD, SESSTIM Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Aix Marseille University, Marseille, France
| | - Matthieu Schuers
- Department of General Practice, Normandy University, Rouen, France.,CISMeF, TIBS, LITIS EA 4108, CHU Rouen, France.,INSERM U 1142, LIMICS, Paris, France
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21
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Bruxvoort KJ, Bider-Canfield Z, Casey JA, Qian L, Pressman A, Liang AS, Robinson S, Jacobsen SJ, Tartof SY. Outpatient Urinary Tract Infections in an Era of Virtual Healthcare: Trends From 2008 to 2017. Clin Infect Dis 2021; 71:100-108. [PMID: 31437269 DOI: 10.1093/cid/ciz764] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/20/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Urinary tract infections (UTIs) occur commonly, but recent data on UTI rates are scarce. It is unknown how the growth of virtual healthcare delivery affects outpatient UTI management and trends in the United States. METHODS From 1 January 2008 to 31 December 2017, UTIs from outpatient settings (office, emergency, and virtual visits) were identified from electronic health records at Kaiser Permanente Southern California using multiple UTI definitions. Annual rates estimated by Poisson regression were stratified by sex, care setting, age, and race/ethnicity. Annual trends were estimated by linear or piecewise Poisson regression. RESULTS UTIs occurred in 1 065 955 individuals. Rates per 1000 person-years were 53.7 (95% confidence interval [CI], 50.6-57.0) by diagnosis code with antibiotic and 25.8 (95% CI, 24.7-26.9) by positive culture. Compared to office and emergency visits, UTIs were increasingly diagnosed in virtual visits, where rates by diagnosis code with antibiotic increased annually by 21.2% (95% CI, 16.5%-26.2%) in females and 29.3% (95% CI, 23.7%-35.3%) in males. Only 32% of virtual care diagnoses had a culture order. Overall, UTI rates were highest and increased the most in older adults. Rates were also higher in Hispanic and white females and black and white males. CONCLUSIONS Outpatient UTI rates increased from 2008 to 2017, especially in virtual care and among older adults. Virtual care is important for expanding access to health services, but strategies are needed in all outpatient care settings to ensure accurate UTI diagnosis and reduce inappropriate antibiotic treatment.
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Affiliation(s)
- Katia J Bruxvoort
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Zoe Bider-Canfield
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Joan A Casey
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley
| | - Lei Qian
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Alice Pressman
- Research, Development, and Dissemination Department, Sutter Health, Walnut Creek, California
| | - Anna S Liang
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Sarah Robinson
- Research, Development, and Dissemination Department, Sutter Health, Walnut Creek, California
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Sara Y Tartof
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
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Vaginal Estrogen Therapy Is Associated With Decreased Inflammatory Response in Postmenopausal Women With Recurrent Urinary Tract Infections. Female Pelvic Med Reconstr Surg 2021; 27:e39-e44. [PMID: 31725016 DOI: 10.1097/spv.0000000000000790] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Vaginal estrogen therapy (VET) has been shown to decrease the risk of recurrent urinary tract infections (UTIs) in postmenopausal women, but the mechanism of action has not been fully described. Our objectives were to assess whether the postmenopausal urine inflammatory profile changes in response to VET. METHODS We prospectively enrolled postmenopausal patients into 3 groups: (1) currently using VET without a history of recurrent UTIs (rUTIs); (2) history of UTIs, currently using VET; and (3) history of rUTIs, not using VET but willing to start. We followed patients over 6 to 19 months and collected urine samples at 3 time points. We performed comprehensive cytopathologic analysis, quantitative urine inflammatory scoring, and enzyme-linked immunosorbent assay for interleukin 6. RESULTS Seventy patients were recruited (group 1, n = 30; group 2, n = 20; group 3, n = 20). Urine from patients in groups 2 and 3 demonstrated increased inflammatory cells, debris, and exfoliated urothelial cells. Quantitative urine inflammatory scores and interleukin 6 were significantly higher in postmenopausal patients with rUTIs not on VET (0.12 vs 0.93, P < 0.05) and decreased significantly after initiating VET (0.93 vs 0.38, P < 0.05). CONCLUSIONS Postmenopausal women with rUTIs on VET demonstrate decreased cell shedding, reduced urine inflammatory scores, and decreased urine interleukin 6. Modulation of the genitourinary inflammatory profile may represent one mechanism through which VET helps prevent rUTIs in postmenopausal women.
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Kornfält Isberg H, Hedin K, Melander E, Mölstad S, Cronberg O, Engström S, Lindbäck H, Neumark T, Ekman GS, Beckman A. Different antibiotic regimes in men diagnosed with lower urinary tract infection - a retrospective register-based study. Scand J Prim Health Care 2020; 38:291-299. [PMID: 32686974 PMCID: PMC7470089 DOI: 10.1080/02813432.2020.1794409] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To compare the proportion of therapy failure, recurrence and complications within 30 days after consultation between men diagnosed with lower urinary tract infection (UTI) treated with narrow-spectrum antibiotics (nitrofurantoin or pivmecillinam) and broad-spectrum antibiotics (fluoroquinolones or trimethoprim or trimethoprim/sulfamethoxazole). DESIGN A retrospective cohort study based on data derived from electronic medical records between January 2012 and December 2015. SETTING Primary health care and hospital care in five different counties in Sweden. Patients: A total of 16,555 men aged between 18 and 79 years diagnosed with lower UTI. MAIN OUTCOME MEASURES Treatment with narrow-spectrum antibiotics was compared with broad-spectrum antibiotics regarding therapy failure, recurrence and complications within 30 days. RESULTS The median age of included men was 65 IQR (51-72) years. Narrow-spectrum antibiotics were prescribed in 8457 (40%) and broad-spectrum antibiotics in 12,667 (60%) cases, respectively. Therapy failure was registered in 192 (0.9%), recurrence in 1277 (6%) and complications in 121 (0.6%) cases. Therapy failure and recurrence were more common in patients treated with narrow-spectrum antibiotics and trimethoprim (p < 0.001), but no such difference could be detected regarding complications. CONCLUSION There was no difference in incidence of complications within 30 days between men treated with narrow- or broad-spectrum antibiotics. Patients prescribed broad-spectrum antibiotics had lower odds of reconsultation because of therapy failure and recurrence. From current data, treatment with narrow-spectrum antibiotics seems to be an optimal choice regarding preventing complications when treating men with lower UTI. KEY POINTS Complications such as pyelonephritis and sepsis are uncommon in men diagnosed with lower urinary tract infection treated with antibiotics. There was no difference in incidence of complications among men diagnosed with lower urinary tract infection treated with narrow- or broad-spectrum antibiotics. In spite of higher incidence of therapy failure and recurrence, treatment with narrow-spectrum antibiotics seems to be an optimal choice regarding preventing complications when treating men diagnosed with lower UTI.
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Affiliation(s)
- Helena Kornfält Isberg
- Department of Clinical Sciences, Family Medicine Malmö, Lund University, Malmö, Sweden
- CONTACT Helena Kornfält Isberg Department of Clinical Sciences, Family Medicine Malmö, Lund University, Malmö, Sweden
| | - Katarina Hedin
- Department of Clinical Sciences, Family Medicine Malmö, Lund University, Malmö, Sweden
- Futurum, Region Jönköping County and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Eva Melander
- Regional Center for Communicable Disease Control, Malmö, Sweden
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Sigvard Mölstad
- Department of Clinical Sciences, Family Medicine Malmö, Lund University, Malmö, Sweden
| | - Olof Cronberg
- Department of Clinical Sciences, Family Medicine Malmö, Lund University, Malmö, Sweden
- Department of Research and Development, Region Kronoberg, Växjö, Sweden
| | - Sven Engström
- Futurum, Region Jönköping County and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Heidi Lindbäck
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Thomas Neumark
- Regional Executive Officer's Staff – Coordination of Health Care, Kalmar, Sweden
| | | | - Anders Beckman
- Department of Clinical Sciences, Family Medicine Malmö, Lund University, Malmö, Sweden
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Rodriguez-Mañas L. Urinary tract infections in the elderly: a review of disease characteristics and current treatment options. Drugs Context 2020; 9:dic-2020-4-13. [PMID: 32699546 PMCID: PMC7357682 DOI: 10.7573/dic.2020-4-13] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 12/15/2022] Open
Abstract
Urinary tract infections (UTIs) are common in the elderly, and cover a range of conditions from asymptomatic bacteriuria to urosepsis. Risk factors for developing symptomatic UTIs include immunosenescence, exposure to nosocomial pathogens, multiple comorbidities, and a history of UTIs. European guidelines on urological infections recommend antimicrobial treatment only for symptomatic UTIs. Non-antimicrobial options to treat and prevent UTIs include among others cranberry products, OM-89 Escherichia coli bacterial lysate vaccine, and estrogen therapy in postmenopausal women, although evidence for their efficacy is weak. Another non-antimicrobial option to control and prevent UTIs is a medical device (Utipro Plus®) containing xyloglucan, gelatin, propolis, and extracts of Hibiscus sabdariffa. The device acts in the intestine as a mechanical barrier to protect against invasion by uropathogenic E. coli strains. A randomized controlled trial of Utipro Plus® in patients with uncomplicated UTIs provided good-quality evidence of its efficacy compared with placebo. In an observational study of Utipro Plus® in patients with recurrent UTIs, more than 80% women reported a return to their pre-UTI clinical status and about 30% transitioned from symptomatic UTIs to asymptomatic bacteriuria. New treatment strategies that offer a safe and effective non-antimicrobial means of managing UTIs could have an important role in the elderly.
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25
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Chibelean CB, Petca RC, Mareș C, Popescu RI, Enikő B, Mehedințu C, Petca A. A Clinical Perspective on the Antimicrobial Resistance Spectrum of Uropathogens in a Romanian Male Population. Microorganisms 2020; 8:microorganisms8060848. [PMID: 32516902 PMCID: PMC7357063 DOI: 10.3390/microorganisms8060848] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 01/29/2023] Open
Abstract
Considering urinary tract infections (UTIs), a significant public health problem with negligible recent research, especially on the male eastern European population, we aimed to determine the antimicrobial resistance rates of uropathogens for the most commonly used antibiotics in urological practice in our country. We conducted a multicenter retrospective study in two different teaching hospitals in Romania, analyzing urine samples from 7719 patients to determine the frequency of incriminating pathogens and their resistance to different antibiotics, in a comparative approach. We determined Escherichia coli (35.98%) to be the most common pathogen with the highest sensitivity to amikacin (S = 91.72%), meropenem (S = 97.17%) and fosfomycin (S = 86.60%) and important resistance to amoxicillin-clavulanic ac. (R = 28.03%) and levofloxacin (R = 37.69%), followed by Klebsiella spp. (22.98%) with the highest sensitivity to amikacin (S = 78.04%) and meropenem (S = 81.35%) and important resistance to amoxicillin-clavulanic ac. (R = 65.58%) and levofloxacin (R = 45.36%); the most frequent Gram-positive pathogen was Enterococcus spp. (19.73%) with the highest sensitivity for vancomycin (S = 93.75%) and fosfomycin (S = 87.5%) and considerable resistance to penicillin (R = 33.52%) and levofloxacin (R = 42.04%). The findings are an important tool in managing UTIs and should be acknowledged as reference research not only for clinicians from Romania but for all physicians treating male UTIs.
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Affiliation(s)
- Călin Bogdan Chibelean
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu-Mures, 38 Gheorghe Marinescu str., 540139 Targu-Mures, Romania; (C.B.C.); (B.E.)
- Department of Urology, Mureș County Hospital, 1st Gheorghe Marinescu str., 540136 Targu-Mures, Romania
| | - Răzvan-Cosmin Petca
- “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari blvd., 050474 Bucharest, Romania; (C.M.); (A.P.)
- Department of Urology, “Prof. Dr. Th. Burghele” Clinical Hospital, 20 Panduri str., 050659 Bucharest, Romania;
- Correspondence: or (R.-C.P.); (C.M.); Tel.: +40-722-224492 (R.-C.P.); +40-745-383552 (C.M.)
| | - Cristian Mareș
- Department of Urology, “Prof. Dr. Th. Burghele” Clinical Hospital, 20 Panduri str., 050659 Bucharest, Romania;
- Correspondence: or (R.-C.P.); (C.M.); Tel.: +40-722-224492 (R.-C.P.); +40-745-383552 (C.M.)
| | - Răzvan-Ionuț Popescu
- Department of Urology, “Prof. Dr. Th. Burghele” Clinical Hospital, 20 Panduri str., 050659 Bucharest, Romania;
| | - Barabás Enikő
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu-Mures, 38 Gheorghe Marinescu str., 540139 Targu-Mures, Romania; (C.B.C.); (B.E.)
- Department of Laboratory Medicine, Mureș County Hospital, 1st Gheorghe Marinescu str., 540136 Targu-Mures, Romania
| | - Claudia Mehedințu
- “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari blvd., 050474 Bucharest, Romania; (C.M.); (A.P.)
- Department of Obstetrics and Gynecology, Nicolae Malaxa Clinical Hospital, 12 Vergului str., 022441 Bucharest, Romania
| | - Aida Petca
- “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari blvd., 050474 Bucharest, Romania; (C.M.); (A.P.)
- Department of Obstetrics and Gynecology, Elias University Emergency Hospital, 17 Marasti blvd., 011461 Bucharest, Romania
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Bruyere F, Goux L, Bey E, Cariou G, Cattoir V, Saint F, Sotto A, Vallée M. [Urinary tract infections in adults: Comparison of the French and the European guidelines]. Prog Urol 2020; 30:472-481. [PMID: 32418735 DOI: 10.1016/j.purol.2020.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 02/15/2020] [Accepted: 02/26/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Acute urinary tract infections (UTIs) in adult are now a major public health issue in terms of morbidity, mortality and in terms of costs for society. The latest French guidelines and the European Association of Urology guidelines differ in some points. The aim of this article is to compare the guidelines of these two societies in order to highlight their differences but also their common points in the management of UTIs. METHODS A comparative analysis of the latest French and European guidelines was carried out. The authors defined the following sub-sections: terminology, pyelonephritis, male UTIs, pregnancy urinary tract infections and cystitis. RESULTS AND CONCLUSION The guidelines of these two societies are not very different in terms of diagnostic and therapeutic management. The major differences are in the duration of antibiotic therapies, where French guidelines continue to recommend long term treatments where EAU sometimes recommends only 5 days of antibiotics, as in the case of simple acute pyelonephritis. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- F Bruyere
- Service d'urologie, CHRU de Bretonneau, 2, boulevard Tonnellé, 37044 Tours cedex, France; Service d'urologie, CHU de Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France.
| | - Le Goux
- Service d'urologie, CHU de Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Unité d'épidémiologie et hygiène hospitalière, CHU de Toulouse-Rangueil, 1, avenue Jean-Poulhès, 31059 Toulouse cedex 9, France
| | - E Bey
- Service d'urologie et de la transplantation rénale, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France
| | - G Cariou
- Cabinet d'urologie, 18, rue Fabre-d'Eglantine, 75012 Paris, France
| | - V Cattoir
- Service de bactériologie-hygiène hospitalière, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France
| | - F Saint
- Service d'urologie et de transplantation, CHU d'Amiens-Picardie, 80054 Amiens, France
| | - A Sotto
- Service des maladies infectieuses et tropicales, CHU de Nîmes, place du Pr-Debré, 30029 Nîmes cedex 09, France
| | - M Vallée
- Service d'urologie et de transplantations rénales, CHU La Milétrie, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France; Inserm U1070, UFR médecine-pharmacie, pharmacologie des anti-infectieux, pôle biologie santé, université de Poitiers, 1, rue Georges-Bonnet, bâtiment B36 TSA 51106, 86073 Poitiers cedex 9, France
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Hsiao CY, Chen TH, Lee YC, Hsiao MC, Hung PH, Wang MC. Risk factors for uroseptic shock in hospitalized patients aged over 80 years with urinary tract infection. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:477. [PMID: 32395521 PMCID: PMC7210120 DOI: 10.21037/atm.2020.03.95] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background The purpose of this study was to compare clinical characteristics and outcomes in individuals of different age groups with urinary tract infection (UTI), and to identify the relationships among advanced age and uroseptic shock. Methods This retrospective study compared clinical characteristics and outcomes in patients in different age groups with UTI and identified relationships between advanced age and uroseptic shock among hospitalized patients with UTI in an acute hospital care setting from January 2006 to October 2018. Patients were divided into young (age below 65 years), old (65–80 years), and very old (above 80 years) groups. Results Of 1,043 participants, 269 (25.8%) were very old and 200 (19.2%) developed uroseptic shock. Very old age [odds ratio (OR) 1.99, 95% confidence interval (CI): 1.25–3.19, P=0.004], male (OR 1.54, 95% CI: 1.07–2.24, P=0.022), presented flank pain (OR 1.54, 95% CI: 1.05–2.24, P=0.025), congestive heart failure (CHF) (OR 2.54, 95% CI: 1.27–5.06, P=0.008), acute kidney injury (AKI) (OR 4.19, 95% CI: 2.78–6.30, P<0.001), bacteremia (OR 1.78, 95% CI: 1.25–2.53, P=0.001), and multiple drug-resistant (MDR) bacteria (OR 1.43, 95% CI: 1.02–2.00, P=0.039) were associated with an increased risk of uroseptic shock in patients with UTI. In very old patients with UTI, bacteremia (OR 2.54, 95% CI: 1.38–4.69, P=0.003) and AKI (OR 4.37, 95% CI: 2.15–8.90, P<0.001) were independently associated with uroseptic shock. Conclusions Very old patients with UTI had a higher risk of developing uroseptic shock than younger patients. Bacteremia was an independent risk factor for uroseptic shock in very old patients with UTI.
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Affiliation(s)
- Chih-Yen Hsiao
- Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi.,Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan
| | - Tsung-Hsien Chen
- Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi
| | - Yi-Chien Lee
- Department of Internal Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei.,School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei
| | - Meng-Chang Hsiao
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Peir-Haur Hung
- Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi.,Department of Applied Life Science and Health, Chia Nan University of Pharmacy and Science, Tainan
| | - Ming-Cheng Wang
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
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28
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Treatment of urinary tract infections in the old and fragile. World J Urol 2020; 38:2709-2720. [PMID: 32221713 DOI: 10.1007/s00345-020-03159-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 03/04/2020] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Urinary tract infection (UTI) is highly prevalent in the frail elderly population. This review aimed to outline the diagnostic, treatment, and prevention of UTI in the frail aging population. METHODS Pubmed and Web of Science search to identify publications until March 2019 relating to the management of UTI in the elderly population was performed. A narrative review of the available literature was performed. RESULTS 64 publications were considered as relevant and included in this review. The diagnosis of symptomatic UTI in the old and fragile could be challenging. Routine screening and antimicrobial therapy for asymptomatic bacteriuria should not be recommended for frail elderly patients. Cautious choice of antibiotics should be guided by uropathogen identified by culture and sensitivity. Understanding local antibiotic resistance rates plays a fundamental part in selecting appropriate antimicrobial treatment. Impact of associated adverse effect, in particular those with effects on cognitive function, should be considered when deciding choice of antibiotics for symptomatic UTI in the elderlies. Optimal management of comorbidities such as diabetes mellitus, adequate treatment of urinary incontinence, and judicious use of urinary catheter is essential to reduce the development of UTI. CONCLUSION UTI is a significant but common problem in elderly population. Physicians who care for frail elderly patients must be aware of the challenges in the management of asymptomatic UTI, and identifying symptomatic UTI in this population, and their appropriate management strategies. There is strong need in studies to evaluate nonantimicrobial therapies in the prevention of UTI for the frail elderly population.
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Skow MAH, Vik I, Høye S. Antibiotic switch after treatment with UTI antibiotics in male patients. Infect Dis (Lond) 2020; 52:405-412. [DOI: 10.1080/23744235.2020.1736329] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Marius A. H. Skow
- The Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Ingvild Vik
- The Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Sigurd Høye
- The Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
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Fallon R, Farrell K, Leon G, Rajan A, Duane S, FitzGerald C, Tierney M, Vellinga A. GPs' attitudes towards the diagnosis and treatment of male urinary tract infections: a qualitative interview study in Ireland. BJGP Open 2019; 3:bjgpopen19X101667. [PMID: 31615788 PMCID: PMC6995865 DOI: 10.3399/bjgpopen19x101667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 07/16/2019] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND In general practice, males represent around 20% of the total number of urinary tract infection (UTI) consultations. The majority of UTI research focuses on the diagnosis and treatment of women with UTIs but there is little evidence on how male UTIs are treated. AIM To better understand GPs' attitudes towards the diagnosis and treatment of male UTIs. This research aimed to support future investigations to determine best practice in diagnosis and treatment of male UTI. DESIGN AND SETTING A qualitative interview study was carried out with 15 GPs across Ireland. METHOD A topic guide was created to ensure consistency in interviews. The interviews were audiorecorded and transcribed verbatim. Transcripts were analysed using thematic analysis. RESULTS Fifteen interviews with GPs were completed. Analysis indicated that GPs' knowledge of guidelines and implementation of them varied widely when deciding a treatment plan for a male presenting with UTI symptoms. There was clear consensus that male UTIs were uncommon and complicated to diagnose. Three GPs reported never treating a male UTI, while others reported treating <5 patients in their careers. There was an assumption that sexually transmitted infections (STI) take precedence in young males when presenting with similar symptoms. The use of antimicrobial treatment guidelines varied widely, in line with the interpretation of the origin and severity of symptoms. CONCLUSION Male UTIs are perceived by GPs as rare and complicated. GPs expressed that patient age, resources, and guidelines available limited their confidence in diagnosing and treating male UTIs.
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Affiliation(s)
- Róisín Fallon
- Research Assistant, Department of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
- Health Research Board Primary Care, Clinical Trials Network, Ireland
| | - Karen Farrell
- Research Assistant, Department of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
- Health Research Board Primary Care, Clinical Trials Network, Ireland
| | - Genevieve Leon
- House officer, Grade UD41Department of General Practice, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Aparna Rajan
- House officer, Grade UD41Department of General Practice, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Sinead Duane
- Post Doctoral Researcher, Health Research Board Trials Methodology Research Network, College of Medicine, Nursing & Health Sciences, National University of Ireland, Galway, Ireland
| | - Christine FitzGerald
- Research Assistant, School of Business and Economics, National University of Ireland, Galway, Ireland
| | - Marie Tierney
- Postdoctoral Researcher, Health Research Board Primary Care Clinical Trials Network, National University of Ireland, Galway, Ireland
- Department of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
| | - Akke Vellinga
- Epidemiologist and Senior Lecturer, Health Research Board Primary Care Clinical Trials Network, National University of Ireland, Galway, Ireland
- Department of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
- Discipline of Bacteriology, School of Medicine, National University of Ireland, Galway, Ireland
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Filshtein TJ, Brenowitz WD, Mayeda ER, Hohman TJ, Walter S, Jones RN, Elahi FM, Glymour MM. Reserve and Alzheimer's disease genetic risk: Effects on hospitalization and mortality. Alzheimers Dement 2019; 15:907-916. [PMID: 31327391 PMCID: PMC7049165 DOI: 10.1016/j.jalz.2019.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 03/05/2019] [Accepted: 04/03/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Cognitive reserve predicts delayed diagnosis of Alzheimer's disease (AD) and faster postdiagnosis decline. The net impact of cognitive reserve, combining both prediagnosis and postdiagnosis risk, on adverse AD-related outcomes is unknown. We adopted a novel approach, using AD genetic risk scores (AD-GRS), to evaluate this. METHODS Using 242,959 UK Biobank participants age 56+ years, we evaluated whether cognitive reserve (operationalized as education) modified associations between AD-GRS and mortality or hospitalization (total count, fall-related, and urinary tract infection-related). RESULTS AD-GRS predicted mortality and hospitalization outcomes. Education did not modify AD-GRS effects on mortality, but had a nonsignificantly (interaction P = .10) worse effect on hospitalizations due to urinary tract infection or falls among low education (OR = 1.07 [95% CI: 1.02, 1.12]) than high education (OR = 1.01 [0.95, 1.07]) individuals. DISCUSSION Education did not convey differential survival advantages to individuals with higher genetic risk of AD, but may reduce hospitalization risk associated with AD genetic risk.
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Affiliation(s)
- Teresa Jenica Filshtein
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Willa D Brenowitz
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Elizabeth Rose Mayeda
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Timothy J Hohman
- Vanderbilt Memory & Alzheimer's Center, Department of Neurology and Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stefan Walter
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA; Hospital Universitario de Getafe, Madrid, Spain
| | - Rich N Jones
- Department of Neurology, Brown University, Providence, RI, USA; Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Fanny M Elahi
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
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Olbert PJ, Netsch C, Schoeb DS, Leyh H, Gross AJ, Miernik A, Rassweiler JJ, Westphal J, Häcker A, Homberg R, Klein J, Sievert KD, Herrmann TRW. Urologische Infektionen und Antibiotikamanagement bei geriatrischen Patienten. Urologe A 2019; 58:809-820. [DOI: 10.1007/s00120-019-0974-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Germanos GJ, Trautner BW, Zoorob RJ, Salemi JL, Drekonja D, Gupta K, Grigoryan L. No Clinical Benefit to Treating Male Urinary Tract Infection Longer Than Seven Days: An Outpatient Database Study. Open Forum Infect Dis 2019; 6:ofz216. [PMID: 31249844 PMCID: PMC6580996 DOI: 10.1093/ofid/ofz216] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 05/03/2019] [Indexed: 12/22/2022] Open
Abstract
Background The optimal approach for treating outpatient male urinary tract infections (UTIs) is unclear. We studied the current management of male UTI in private outpatient clinics, and we evaluated antibiotic choice, treatment duration, and the outcome of recurrence of UTI. Methods Visits for all male patients 18 years of age and older during 2011–2015 with International Classification of Diseases, Ninth Revision, Clinical Modification codes for UTI or associated symptoms were extracted from the EPIC Clarity Database of 2 family medicine, 2 urology, and 1 internal medicine clinics. For eligible visits in which an antibiotic was prescribed, we extracted data on the antibiotic used, treatment duration, recurrent UTI episodes, and patient medical and surgical history. Results A total of 637 visits were included for 573 unique patients (mean age 53.7 [±16.7 years]). Fluoroquinolones were the most commonly prescribed antibiotics (69.7%), followed by trimethoprim-sulfamethoxazole (21.2%), nitrofurantoin (5.3%), and beta-lactams (3.8%). Antibiotic choice was not associated with UTI recurrence. In the overall cohort, longer treatment duration was not significantly associated with UTI recurrence (odds ratio [OR] = 1.95; 95% confidence interval [CI], 0.91–4.21). Longer treatment was associated with increased recurrence after excluding men with urologic abnormalities, immunocompromising conditions, prostatitis, pyelonephritis, nephrolithiasis, and benign prostatic hyperplasia (OR = 2.62; 95% CI, 1.04–6.61). Conclusions Our study adds evidence that men with UTI without evidence of complicating conditions do not need to be treated for longer than 7 days. Shorter duration of treatment was not associated with increased risk of recurrence. Shorter treatment durations for many infections, including UTI, are becoming more attractive to reduce the risk of resistance, adverse events, and costs.
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Affiliation(s)
- George J Germanos
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Barbara W Trautner
- Section of Health Services Research, Departments of Medicine and Surgery, Baylor College of Medicine, Houston, Texas.,Houston VA Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Texas
| | - Roger J Zoorob
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Jason L Salemi
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Dimitri Drekonja
- Department of Medicine, Infectious Diseases, Minneapolis Veterans Affairs Health Care System, Minnesota
| | - Kalpana Gupta
- Section of Infectious Diseases, Department of Medicine, Boston Veterans Affairs Healthcare System and Boston University School of Medicine, Massachusetts
| | - Larissa Grigoryan
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
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Ahmed H, Farewell D, Francis NA, Paranjothy S, Butler CC. Impact of antibiotic treatment duration on outcomes in older men with suspected urinary tract infection: Retrospective cohort study. Pharmacoepidemiol Drug Saf 2019; 28:857-866. [PMID: 31050078 DOI: 10.1002/pds.4791] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/08/2019] [Accepted: 04/01/2019] [Indexed: 11/10/2022]
Abstract
PURPOSE Clinical guidelines recommend at least 7 days of antibiotic treatment for older men with urinary tract infection (UTI). There may be potential benefits for patients, health services, and antimicrobial stewardship if shorter antibiotic treatment resulted in similar outcomes. We aimed to determine if treatment duration could be reduced by estimating risk of adverse outcomes according to different prescription durations. METHODS This retrospective cohort study included men aged greater than or equal to 65 years old with a suspected UTI. We compared outcomes in men prescribed 3, 5, 7, and 8 to 14 days of antibiotic treatment in a multivariable logistic regression analysis and 3 versus 7 days in a propensity-score matched analysis. Our outcomes were reconsultation and represcription (proxy for treatment failure), hospitalisation for UTI, sepsis, or acute kidney injury (AKI), and death. RESULTS Of 360 640 men aged greater than or equal to 65 years, 33 745 (9.4%) had a UTI. Compared with 7 days, men prescribed 3-day treatment had greater odds of reconsultation and represcription (adjusted OR 1.48; 95% CI, 1.25-1.74) but lower odds of AKI hospitalisation (adjusted OR 0.66; 95% CI, 0.45-0.97). We estimated that treating 150 older men with 3 days instead of 7 days of antibiotics could result in four extra reconsultation and represcriptions and one less AKI hospitalisation. We estimated annual prescription cost savings at around £2.2 million. CONCLUSIONS Antibiotic treatment for older men with suspected UTI could be reduced to 3 days, albeit with a small increase in risk of treatment failure. A definitive randomised trial is urgently needed.
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Affiliation(s)
- Haroon Ahmed
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Daniel Farewell
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Nick A Francis
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Shantini Paranjothy
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Christopher C Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Gbinigie OA, Ordóñez-Mena JM, Fanshawe T, Plüddemann A, Heneghan CJ. Limited evidence for diagnosing bacterial skin infections in older adults in primary care: systematic review. BMC Geriatr 2019; 19:45. [PMID: 30777025 PMCID: PMC6380032 DOI: 10.1186/s12877-019-1061-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 02/11/2019] [Indexed: 11/29/2022] Open
Abstract
Background Older adults with bacterial skin infections may present with atypical symptoms, making diagnosis difficult. There is limited authoritative guidance on how older adults in the community present with bacterial skin infections. To date there have been no systematic reviews assessing the diagnostic value of symptoms and signs in identifying bacterial skin infections in older adults in the community. Methods We searched Medline and Medline in process, Embase and Web of Science, from inception to September 2017. We included cohort and cross-sectional studies assessing the diagnostic accuracy of symptoms and signs in predicting bacterial skin infections in adults in primary care aged over 65 years. The QUADAS-2 tool was used to assess study quality. Results We identified two observational studies of low-moderate quality, with a total of 7991 participants, providing data to calculate the diagnostic accuracy of 5 unique symptoms in predicting bacterial skin infections. The presence of wounds [LR+: 7.93 (CI 4.81–13.1)], pressure sores [LR+: 4.85 (CI 2.18–10.8)] and skin ulcers [LR+: 6.26 (CI 5.49–7.13)] help to diagnose bacterial skin infections. The presence of urinary incontinence does not help to predict bacterial skin infections (LR + ‘s of 0.99 and 1.04; LR-‘s of 0.96 and 1.04). Conclusions Currently, there is insufficient evidence to inform the diagnosis of bacterial skin infections in older adults in the community; clinicians should therefore rely upon their clinical judgement and experience. Evidence from high quality primary care studies in older adults, including studies assessing symptoms traditionally associated with bacterial skin infections (e.g. erythema and warmth), is urgently needed to guide practice. Electronic supplementary material The online version of this article (10.1186/s12877-019-1061-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Oghenekome A Gbinigie
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
| | - José M Ordóñez-Mena
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Thomas Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Annette Plüddemann
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Carl J Heneghan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
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Shih WY, Chang CC, Tsou MT, Chan HL, Chen YJ, Hwang LC. Incidence and Risk Factors for Urinary Tract Infection in an Elder Home Care Population in Taiwan: A Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16040566. [PMID: 30781460 PMCID: PMC6406410 DOI: 10.3390/ijerph16040566] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/07/2019] [Accepted: 02/12/2019] [Indexed: 11/16/2022]
Abstract
Urinary tract infection (UTI) is a common infection worldwide. Numerous studies have demonstrated risk factors for UTI in facilities and communities. In this study, we aimed to identify risk factors for UTI in home care patients. Patients who received home care for at least three months in 2017 were included. A UTI episode was defined by admission for UTI treatment, and/or a visit to an outpatient department for UTI and receiving antibiotic prescription. A total of 598 patients aged 81.9 years were included. Overall 47% (281) had at least one UTI episode. After analysis, urinary catheter indwelling was the most important risk factor (odds ratio (OR), 3.21). Underlying diseases (coronary artery disease (CAD), chronic kidney disease (CKD), diabetes mellitus (DM)) were related to UTI with OR ranging from 1.46 to 1.79. Higher Alb (albumin) (OR 0.68) and Hb (hemoglobin) (OR 0.91) were inversely related to UTI. Polypharmacy (OR 1.84) and lower Barthel index scores (OR 1.62) were also related to UTI by different degrees. In conclusion, apart from the unmodifiable factors, avoiding prolonged urinary catheter placement, unnecessary prescriptions, and keeping good nutritional status may help to prevent UTI in home care patients.
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Affiliation(s)
- Wei-Yi Shih
- Department of Family Medicine, MacKay Memorial Hospital No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City 104, Taiwan.
| | - Chia-Chen Chang
- Department of Family Medicine, MacKay Memorial Hospital No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City 104, Taiwan.
| | - Meng-Ting Tsou
- Department of Family Medicine, MacKay Memorial Hospital No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City 104, Taiwan.
| | - Hsin-Lung Chan
- Department of Family Medicine, MacKay Memorial Hospital No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City 104, Taiwan.
| | - Ying-Ju Chen
- Telehealth and Home Care Center, MacKay Memorial Hospital No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City 104, Taiwan.
| | - Lee-Ching Hwang
- Department of Family Medicine, MacKay Memorial Hospital No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City 104, Taiwan.
- Department of Medicine, MacKay Medical College No. 46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City 252, Taiwan.
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Mayne S, Bowden A, Sundvall PD, Gunnarsson R. The scientific evidence for a potential link between confusion and urinary tract infection in the elderly is still confusing - a systematic literature review. BMC Geriatr 2019; 19:32. [PMID: 30717706 PMCID: PMC6360770 DOI: 10.1186/s12877-019-1049-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 01/24/2019] [Indexed: 12/30/2022] Open
Abstract
Background Non-specific symptoms, such as confusion, are often suspected to be caused by urinary tract infection (UTI) and continues to be the most common reason for suspecting a UTI despite many other potential causes. This leads to significant overdiagnosis of UTI, inappropriate antibiotic use and potential harmful outcomes. This problem is particularly prevalent in nursing home settings. Methods A systematic review of the literature was conducted assessing the association between confusion and UTI in the elderly. PubMed, Scopus and PsychInfo were searched with the following terms: confusion, delirium, altered mental status, acute confusional state, urinary tract infection, urine infection, urinary infection and bacteriuria. Inclusion criteria and methods were specified in advance and documented in the protocol, which was published with PROSPERO (registration ID: CRD42015025804). Quality assessment was conducted independently by two authors. Data were extracted using a standardised extraction tool and a qualitative synthesis of evidence was made. Results One thousand seven hunderd two original records were identified, of which 22 were included in the final analysis. The quality of these included studies varied, with frequent poor case definitions for UTI or confusion contributing to large variation in results and limiting their validity. Eight studies defined confusion using valid criteria; however, no studies defined UTI in accordance with established criteria. As no study used an acceptable definition of confusion and UTI, an association could not be reliably established. Only one study had acceptable definitions of confusion and bacteriuria, reporting an association with the relative risk being 1.4 (95% CI 1.0–1.7, p = 0.034). Conclusions Current evidence appears insufficient to accurately determine if UTI and confusion are associated, with estimates varying widely. This was often attributable to poor case definitions for UTI or confusion, or inadequate control of confounding factors. Future well-designed studies, using validated criteria for UTI and confusion are required to examine the relationship between UTI and acute confusion in the elderly. The optimal solution to clarify this clinical issue would be a randomized controlled trial comparing the effect of antibiotics versus placebo in patients with new onset or worsening confusion and presence of bacteriuria while lacking specific urinary tract symptoms.
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Affiliation(s)
- Sean Mayne
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, PO Box 902, Cairns, Queensland, 4870, Australia.
| | - Alexander Bowden
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, PO Box 902, Cairns, Queensland, 4870, Australia.,Cairns Hospital, Queensland Health, Cairns, Queensland, Australia
| | - Pär-Daniel Sundvall
- Research and Development Unit, Primary Health Care in Southern Älvsborg County, Sven Eriksonsplatsen 4, SE-503 38, Borås, Sweden.,Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Ronny Gunnarsson
- Research and Development Unit, Primary Health Care in Southern Älvsborg County, Sven Eriksonsplatsen 4, SE-503 38, Borås, Sweden.,Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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Enshaeifar S, Zoha A, Skillman S, Markides A, Acton ST, Elsaleh T, Kenny M, Rostill H, Nilforooshan R, Barnaghi P. Machine learning methods for detecting urinary tract infection and analysing daily living activities in people with dementia. PLoS One 2019; 14:e0209909. [PMID: 30645599 PMCID: PMC6333356 DOI: 10.1371/journal.pone.0209909] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 12/13/2018] [Indexed: 12/23/2022] Open
Abstract
Dementia is a neurological and cognitive condition that affects millions of people around the world. At any given time in the United Kingdom, 1 in 4 hospital beds are occupied by a person with dementia, while about 22% of these hospital admissions are due to preventable causes. In this paper we discuss using Internet of Things (IoT) technologies and in-home sensory devices in combination with machine learning techniques to monitor health and well-being of people with dementia. This will allow us to provide more effective and preventative care and reduce preventable hospital admissions. One of the unique aspects of this work is combining environmental data with physiological data collected via low cost in-home sensory devices to extract actionable information regarding the health and well-being of people with dementia in their own home environment. We have worked with clinicians to design our machine learning algorithms where we focused on developing solutions for real-world settings. In our solutions, we avoid generating too many alerts/alarms to prevent increasing the monitoring and support workload. We have designed an algorithm to detect Urinary Tract Infections (UTI) which is one of the top five reasons of hospital admissions for people with dementia (around 9% of hospital admissions for people with dementia in the UK). To develop the UTI detection algorithm, we have used a Non-negative Matrix Factorisation (NMF) technique to extract latent factors from raw observation and use them for clustering and identifying the possible UTI cases. In addition, we have designed an algorithm for detecting changes in activity patterns to identify early symptoms of cognitive decline or health decline in order to provide personalised and preventative care services. For this purpose, we have used an Isolation Forest (iForest) technique to create a holistic view of the daily activity patterns. This paper describes the algorithms and discusses the evaluation of the work using a large set of real-world data collected from a trial with people with dementia and their caregivers.
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Affiliation(s)
- Shirin Enshaeifar
- Department of Electrical and Electronic Engineering, Centre for Vision, Speech and Signal Processing (CVSSP), University of Surrey, Surrey, United Kingdom
| | - Ahmed Zoha
- Department of Electrical and Electronic Engineering, Centre for Vision, Speech and Signal Processing (CVSSP), University of Surrey, Surrey, United Kingdom
| | - Severin Skillman
- Department of Electrical and Electronic Engineering, Centre for Vision, Speech and Signal Processing (CVSSP), University of Surrey, Surrey, United Kingdom
| | - Andreas Markides
- Department of Electrical and Electronic Engineering, Centre for Vision, Speech and Signal Processing (CVSSP), University of Surrey, Surrey, United Kingdom
| | - Sahr Thomas Acton
- Department of Electrical and Electronic Engineering, Centre for Vision, Speech and Signal Processing (CVSSP), University of Surrey, Surrey, United Kingdom
| | - Tarek Elsaleh
- Department of Electrical and Electronic Engineering, Centre for Vision, Speech and Signal Processing (CVSSP), University of Surrey, Surrey, United Kingdom
| | - Mark Kenny
- Surrey and Borders Partnership NHS Foundation Trust, Leatherhead, Surrey, United Kingdom
| | - Helen Rostill
- Surrey and Borders Partnership NHS Foundation Trust, Leatherhead, Surrey, United Kingdom
| | - Ramin Nilforooshan
- Surrey and Borders Partnership NHS Foundation Trust, Leatherhead, Surrey, United Kingdom
| | - Payam Barnaghi
- Department of Electrical and Electronic Engineering, Centre for Vision, Speech and Signal Processing (CVSSP), University of Surrey, Surrey, United Kingdom
- * E-mail:
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Amarsy R, Guéret D, Benmansour H, Flicoteaux R, Berçot B, Meunier F, Mougari F, Jacquier H, Pean de Ponfilly G, Clermont O, Denamur E, Teixeira A, Cambau E. Determination of Escherichia coli phylogroups in elderly patients with urinary tract infection or asymptomatic bacteriuria. Clin Microbiol Infect 2019; 25:839-844. [PMID: 30648603 DOI: 10.1016/j.cmi.2018.12.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/16/2018] [Accepted: 12/20/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Distinguishing between urinary tract infection (UTI) and asymptomatic bacteriuria (ABU) is difficult in the geriatric population since specific symptoms are often lacking. Escherichia coli is the most frequent UTI pathogen in this population but also a common urine colonizer. We hypothesized that detecting E. coli phylogroups B2 or D, which were previously associated with virulent strains responsible for extra-intestinal infections outside elderly patients, could help in distinguishing UTI from ABU. METHODS Consecutive cases of E. coli bacteriuria diagnosed in hospitalized patients >75 years old during 3 months were investigated for E. coli phylogroups. Multiplex PCR was used to search for several virulence genes as previously described. Characteristics of UTI and ABU cases, assessed retrospectively according to definitions and geriatric expertise, were compared. RESULTS Out of 233 bacteriuria cases, 60 were assessed to be UTI and 163 to be ABU, with 10 cases unclassified. E. coli strains belonging to the phylogroups B2 and D were significantly more frequent in UTI (48/60, 80%) than in ABU (101/163, 62%) by univariate and multivariate analyses (OR 3.05, 1.44-6.86, p 0.005). Out of all the host and bacterial characteristics studied, falls (p 0.032), comorbidities (p 0.041), and altered autonomy evaluated by a low activity of daily living score (p 0.027) were also associated with UTI using univariate and multivariate analysis. CONCLUSIONS Determination of the E. coli phylogroup, in addition to some host characteristics, can help to distinguish UTI from ABU in elderly patients with bacteriuria. If this hypothesis is confirmed by prospective studies, then inappropriate use of antibiotics may be reduced in ABU cases.
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Affiliation(s)
- R Amarsy
- APHP, Groupe Hospitalier Lariboisière-Fernand Widal, Equipe Opérationnelle d'Hygiène, Paris, France; Université Paris Diderot, INSERM, Sorbonne Paris Cité, IAME UMR 1137, Paris, France
| | - D Guéret
- Service de SSR Gériatrique, Centre Hospitalier de la Côte Fleurie, Equemauville, France
| | - H Benmansour
- AP-HP, Groupe Hospitalier Lariboisière-Fernand Widal, Service de Bactériologie-Virologie, Paris, France
| | - R Flicoteaux
- Biostatistics and Medical Information Team, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, France; ECSTRA Team, Paris Diderot University, Sorbonne Paris Cité, Inserm UMR-1153, Epidemiology and Biostatistics Sorbonne Paris Cite Research Centre (CRESS), Paris, France
| | - B Berçot
- Université Paris Diderot, INSERM, Sorbonne Paris Cité, IAME UMR 1137, Paris, France; AP-HP, Groupe Hospitalier Lariboisière-Fernand Widal, Service de Bactériologie-Virologie, Paris, France
| | - F Meunier
- AP-HP, Groupe Hospitalier Lariboisière-Fernand Widal, Service de Bactériologie-Virologie, Paris, France
| | - F Mougari
- Université Paris Diderot, INSERM, Sorbonne Paris Cité, IAME UMR 1137, Paris, France; AP-HP, Groupe Hospitalier Lariboisière-Fernand Widal, Service de Bactériologie-Virologie, Paris, France
| | - H Jacquier
- Université Paris Diderot, INSERM, Sorbonne Paris Cité, IAME UMR 1137, Paris, France; AP-HP, Groupe Hospitalier Lariboisière-Fernand Widal, Service de Bactériologie-Virologie, Paris, France
| | - G Pean de Ponfilly
- AP-HP, Groupe Hospitalier Lariboisière-Fernand Widal, Service de Bactériologie-Virologie, Paris, France
| | - O Clermont
- Université Paris Diderot, INSERM, Sorbonne Paris Cité, IAME UMR 1137, Paris, France
| | - E Denamur
- Université Paris Diderot, INSERM, Sorbonne Paris Cité, IAME UMR 1137, Paris, France
| | - A Teixeira
- Service de Gériatrie, Hôpitaux Universitaires Saint Louis Lariboisière Fernand, Paris, France
| | - E Cambau
- Université Paris Diderot, INSERM, Sorbonne Paris Cité, IAME UMR 1137, Paris, France; AP-HP, Groupe Hospitalier Lariboisière-Fernand Widal, Service de Bactériologie-Virologie, Paris, France.
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Fusco A, Savio V, De Filippis A, Tufano A, Donnarumma G. Induction of Different Apoptosis Pathways by Two Proteus mirabilis Clinical Isolates Strains in Prostatic Epithelial Cells. Front Physiol 2018; 9:1855. [PMID: 30618851 PMCID: PMC6306403 DOI: 10.3389/fphys.2018.01855] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 12/07/2018] [Indexed: 12/11/2022] Open
Abstract
Bacterial prostatitis is believed to be the leading cause of recurrent urinary tract infections (UTIs) in men under 50 years of age and occurs both as an acute febrile disease responsive to antibiotics and as a chronic infection that is often unresponsive to antibiotic treatment. Proteusmirabilis is more commonly associated with UTIs in these abnormalities, especially in patients undergoing catheterisation. This pathogen is able to colonise the host’s tissues and to cause disease thanks to the production of many virulence factors such as fimbriae, flagella, immune avoidance, host-damaging factors, and the ability to form crystalline biofilms. In addition, Proteus lipid A may exhibit apoptotic activity and induce desquamation of epithelial cells. The aim of this work was to evaluate the ability of two clinically isolated strains of P. mirabilis that are phenotypically different, named PM1 of PM2, respectively, to induce apoptosis in human prostatic adenocarcinoma PC-3. Our results demonstrate that PM1 and PM2 are able to activate two different apoptotic pathways, and this different behaviour is confirmed by the expression level of the ZapA gene, molecular fingerprinting and different spectrum of antibiotic resistance. The identification and knowledge of relations between the microorganism and host may provide the basis for new solutions to clinical problems with regard to diagnosis and therapy.
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Affiliation(s)
- Alessandra Fusco
- Department of Experimental Medicine, Section of Microbiology and Clinical Microbiology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Vittoria Savio
- Department of Experimental Medicine, Section of Microbiology and Clinical Microbiology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Anna De Filippis
- Department of Experimental Medicine, Section of Microbiology and Clinical Microbiology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Antonio Tufano
- Urology School, Sapienza University of Rome, Rome, Italy
| | - Giovanna Donnarumma
- Department of Experimental Medicine, Section of Microbiology and Clinical Microbiology, University of Campania Luigi Vanvitelli, Naples, Italy
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Gbinigie OA, Ordóñez-Mena JM, Fanshawe TR, Plüddemann A, Heneghan C. Diagnostic value of symptoms and signs for identifying urinary tract infection in older adult outpatients: Systematic review and meta-analysis. J Infect 2018; 77:379-390. [PMID: 29964141 PMCID: PMC6203890 DOI: 10.1016/j.jinf.2018.06.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 06/22/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To critically appraise and evaluate the diagnostic value of symptoms and signs in identifying UTI in older adult outpatients, using evidence from observational studies. METHODS We searched Medline and Medline in process, Embase and Web of Science, from inception up to September 2017. We included studies assessing the diagnostic accuracy of symptoms and/or signs in predicting UTI in outpatients aged 65 years and above. Study quality was assessed using the QUADAS-2 tool. RESULTS We identified 15 eligible studies of variable quality, with a total of 12,039 participants (range 65-4259), and assessed the diagnostic accuracy of 66 different symptoms and signs in predicting UTI. A number of symptoms and signs typically associated with UTI, such as nocturia, urgency and abnormal vital signs, were of limited use in older adult outpatients. Inability to perform a number of acts of daily living were predictors of UTI: For example, disability in feeding oneself, + ve LR: 11.8 (95% CI 5.51-25.2) and disability in washing one's hands and face, + ve LR: 6.84 (95% CI 4.08-11.5). CONCLUSIONS The limited evidence of varying quality shows that a number of symptoms and signs traditionally associated with UTI may have limited diagnostic value in older adult outpatients.
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Affiliation(s)
- Oghenekome A Gbinigie
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom.
| | - José M Ordóñez-Mena
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom.
| | - Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom.
| | - Annette Plüddemann
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom.
| | - Carl Heneghan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom.
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Abstract
Antipsychotic drugs are frequently prescribed to older adults, but they may be associated with serious adverse effects. The objective was to investigate the association between use of antipsychotics in older adults and the risk of urinary tract infections (UTIs).This study was designed as a cohort study.Data were obtained from the Clinical Practice Research Datalink from January 1, 2000, to September 29, 2016.Primary care patients 65 years or older in the United Kingdom with a first prescription for an oral antipsychotic were included in the study.Incidence of UTIs was calculated for periods with and without exposure to antipsychotic drugs in one cohort. Cox proportional hazard regression analysis with Andersen-Gill extension for recurrent events was used to calculate hazard ratios (HRs) with 95% confidence interval (CI).During the study period, 191,827 individuals with a first prescription for an oral antipsychotic drug were identified. Current use of antipsychotics was associated with an increased risk of UTI compared with past use (adjusted HR, 1.31; 95% CI, 1.28-1.34). This effect was strongest in the first 14 days of use (adjusted HR, 1.83; 95% CI, 1.73-1.95) and in individuals who used more than one antipsychotic drug concomitantly (adjusted HR, 1.64; 95% CI, 1.45-1.87). The risk was slightly higher for typical antipsychotics than for atypical antipsychotics. Stratification by sex showed that risk estimates were slightly higher in men than in women.Use of antipsychotics was associated with an increased risk of UTIs in both men and women, particularly in the first weeks after the start of treatment.
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Ahmed H, Farewell D, Jones HM, Francis NA, Paranjothy S, Butler CC. Incidence and antibiotic prescribing for clinically diagnosed urinary tract infection in older adults in UK primary care, 2004-2014. PLoS One 2018; 13:e0190521. [PMID: 29304056 PMCID: PMC5755802 DOI: 10.1371/journal.pone.0190521] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 12/15/2017] [Indexed: 11/18/2022] Open
Abstract
Urinary tract infections (UTI) are an important cause of morbidity and antibiotic use in older adults but there are little data describing disease burden in primary care. The aim of this study was to estimate the incidence of clinically diagnosed UTI and examine associated empirical antibiotic prescribing. We conducted a retrospective observational study using linked health records from almost one million patients aged ≥65 years old, registered with 393 primary care practices in England. We estimated incidence of clinically diagnosed UTI between March 2004 and April 2014, and used multilevel logistic regression to examine trends in empiric antibiotic prescribing. Of 931,945 older adults, 196,358 (21%) had at least one clinically diagnosed UTI over the study period. In men, the incidence of clinically diagnosed UTI per 100 person-years at risk increased from 2.81 to 3.05 in those aged 65–74, 5.90 to 6.13 in those aged 75–84, and 8.08 to 10.54 in those aged 85+. In women, incidence increased from 9.03 to 10.96 in those aged 65–74, 11.35 to 14.34 in those aged 75–84, and 14.65 to 19.80 in those aged 85+. Prescribing of broad-spectrum antibiotics decreased over the study period. There were increases in the proportion of older men (from 45% to 74%) and women (from 55% to 82%) with UTI, prescribed a UTI specific antibiotic. There were also increases in the proportion of older men (42% to 69%) and women (15% to 26%) prescribed antibiotics for durations recommended by clinical guidelines. This is the first population-based study describing the burden of UTI in UK primary care. Our findings suggest a need to better understand reasons for increasing rates of clinically diagnosed UTI and consider how best to address this important clinical problem.
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Affiliation(s)
- Haroon Ahmed
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, United Kingdom
- * E-mail:
| | - Daniel Farewell
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Hywel M. Jones
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Nick A. Francis
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Shantini Paranjothy
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Christopher C. Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Hall G, Alenljung S, Forsgren-Brusk U. Identification of Key Odorants in Used Disposable Absorbent Incontinence Products. J Wound Ostomy Continence Nurs 2017; 44:269-276. [PMID: 28328644 PMCID: PMC5417576 DOI: 10.1097/won.0000000000000325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to identify key odorants in used disposable absorbent incontinence products. DESIGN Descriptive in vitro study SUBJECTS AND SETTING:: Samples of used incontinence products were collected from 8 residents with urinary incontinence living in geriatric nursing homes in the Gothenburg area of Sweden. Products were chosen from a larger set of products that had previously been characterized by descriptive odor analysis. METHODS Pieces of the used incontinence products were cut from the wet area, placed in glass bottles, and kept frozen until dynamic headspace sampling of volatile compounds was completed. Gas chromatography-olfactometry was used to identify which compounds contributed most to the odors in the samples. Compounds were identified by gas chromatography-mass spectrometry. RESULTS Twenty-eight volatiles were found to be key odorants in the used incontinence products. Twenty-six were successfully identified. They belonged to the following classes of chemical compounds: aldehydes (6); amines (1); aromatics (3); isothiocyanates (1); heterocyclics (2); ketones (6); sulfur compounds (6); and terpenes (1). CONCLUSION Nine of the 28 key odorants were considered to be of particular importance to the odor of the used incontinence products: 3-methylbutanal, trimethylamine, cresol, guaiacol, 4,5-dimethylthiazole-S-oxide, diacetyl, dimethyl trisulfide, 5-methylthio-4-penten-2-ol, and an unidentified compound.
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Affiliation(s)
- Gunnar Hall
- Gunnar Hall, PhD, Sensory and Flavor Science, SP Technical Research Institute of Sweden, Food and Bioscience, Gothenburg, Sweden
- Susanne Alenljung, MSc, Hygiene and Odor, SCA Hygiene Products AB, Gothenburg, Sweden
- Ulla Forsgren-Brusk, MSc, Hygiene and Odor, SCA Hygiene Products AB, Gothenburg, Sweden
| | - Susanne Alenljung
- Correspondence: Susanne Alenljung, MSc, Hygiene and Odor, SCA Hygiene Products AB, SE-405 03 Gothenburg, Sweden ()
| | - Ulla Forsgren-Brusk
- Gunnar Hall, PhD, Sensory and Flavor Science, SP Technical Research Institute of Sweden, Food and Bioscience, Gothenburg, Sweden
- Susanne Alenljung, MSc, Hygiene and Odor, SCA Hygiene Products AB, Gothenburg, Sweden
- Ulla Forsgren-Brusk, MSc, Hygiene and Odor, SCA Hygiene Products AB, Gothenburg, Sweden
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Dasgupta M, Brymer C, Elsayed S. Treatment of asymptomatic UTI in older delirious medical in-patients: A prospective cohort study. Arch Gerontol Geriatr 2017. [PMID: 28624753 DOI: 10.1016/j.archger.2017.05.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Despite clinical practice guidelines, asymptomatic bacteriuria (ASB) in older people is frequently treated. A common reason for treating ASB is a change in mental status. OBJECTIVE To determine how often asymptomatic UTI is treated in older medically ill delirious individuals and its association with functional recovery. METHODS Consecutive older medical in-patients were screened for delirium, and followed in hospital. Treatment for asymptomatic UTI was defined as documented treatment for a possible urinary tract infection with antibiotics, without concurrent infectious or urinary symptoms. The primary outcome was functional recovery at discharge or 3 months post-discharge. Poor functional recovery was defined by any one of death, new permanent long-term institutionalization or decreased ability to perform activities of daily living. RESULTS The study sample comprised 343 delirious in-patients, of which 237 (69%) had poor functional recovery. Ninety two (27%) delirious in-patients were treated for asymptomatic UTI. Treatment for asymptomatic UTI was associated with poor functional recovery compared to other delirious in-patients (RR 1.30, 95% CI: 1.14-1.48 overall). Similar results were seen when the analysis was restricted to only bacteriuric delirious individuals. Seven (7.5%) individuals treated for asymptomatic UTI developed Clostridium difficile infection compared to eight (3.2%) in the remainder of the delirious cohort (OR 2.45, 95% CI: 0.86-6.96). CONCLUSIONS These results suggest that treatment of asymptomatic UTI in older medical in-patients with delirium is common, and of questionable benefit. Further research is needed to establish guidelines to minimize over-treatment of UTI in older delirious in-patients.
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Affiliation(s)
- Monidipa Dasgupta
- Division of Geriatric Medicine, Department of Medicine, Shulich School of Medicine, Western University, University Hospital (London Health Sciences Centre), 339 Windermere Road, London, Ontario, N6A 5A5, Canada; Lawson Health Research Institute, Canada.
| | - Chris Brymer
- Division of Geriatric Medicine, Department of Medicine, Shulich School of Medicine, Western University, University Hospital (London Health Sciences Centre), 339 Windermere Road, London, Ontario, N6A 5A5, Canada
| | - Sameer Elsayed
- Division of Infectious Diseases, Department of Medicine, Shulich School of Medicine, Western University, Victoria Hospital (London Health Sciences Centre), 800 Commissioner's Road, London, Ontario, N6A 5W9, Canada; Department of Pathology and Laboratory Medicine, Division of Microbiology, Western University, Canada
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Lee SH, Suh J, Kim HS, Lee YJ, Lee SR, Kim KH, Jeong CW. Prevalence and management status of urologic diseases in geriatric hospitals in South Korea: A field research. Investig Clin Urol 2017; 58:70-76. [PMID: 28097271 PMCID: PMC5240285 DOI: 10.4111/icu.2017.58.1.70] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 11/18/2016] [Indexed: 11/18/2022] Open
Abstract
PURPOSE We aimed to investigate the current management status of urologic diseases in geriatric hospitals in South Korea. MATERIALS AND METHODS Questionnaire surveys and in-depth person-to-person interviews were conducted at 13 hospitals within the Seoul and Incheon areas. RESULTS The study was carried out from July to December 2014; 75.6% of patients (1,858/2,458) and 77.5% (779/1,031) of medical personnel responded to our survey. All surveys and interviews were performed by urology specialists, fellows, residents, or nurses. The hospitals included in the study had an average of 215.2 beds (range, 110-367), 189.1 patients (range, 90-345), and 40.2 nurses (range, 10-83). The average number of physicians was 6.2 (range, 3-11), but none of these were certified urologists. Only 4 hospitals provided consultation services for urological disorders. In total, 64% of patients had urological disorders, although only 20.7% of patients were receiving medication. Most patients were being treated using urological interventions; diapers (49.7%), indwelling catheters (19.5%), clean intermittent catheters (12.2%), and external collection urinary drainage (7.9%). However, most interventions were inadequately implemented, and only 17% of the patients had been examined by a certified urologist. Urological complications were found in 20.2% of patients, and secondary complications occurred in 18.8%. Excluding redundant cases, the total prevalence of urological complications was 39.0%. CONCLUSIONS Urologic diseases are poorly managed, and no certified urologists work in geriatric hospitals. Therefore, more designated urologists are needed in geriatric hospitals.
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Affiliation(s)
- Sang Heon Lee
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Jungyo Suh
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyung Suk Kim
- Department of Urology, Dongguk University Ilsan Medical Center, Goyang, Korea
| | - Young Ju Lee
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Rim Lee
- Community Nursing Science, Seoul National University College of Nursing, Seoul, Korea
| | - Khae Hawn Kim
- Department of Urology, Gachon University Gil Medical Center, Incheon, Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
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Abstract
Waning immunity and declining anatomic and physiologic defenses render the elder vulnerable to a wide range of infectious diseases. Clinical presentations are often atypical and muted, favoring global changes in mental status and function over febrile responses or localizing symptoms. This review encompasses early recognition, evaluation, and appropriate management of these common infections specifically in the context of elders presenting to the emergency department. With enhanced understanding and appreciation of the unique aspects of infections in the elderly, emergency physicians can play an integral part in reducing the morbidity and mortality associated with these often debilitating and life-threatening diseases.
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Affiliation(s)
- Stephen Y Liang
- Division of Emergency Medicine, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8072, St Louis, MO 63110, USA; Division of Infectious Diseases, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8051, St Louis, MO 63110, USA.
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49
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Abstract
Urinary tract infections (UTIs) and asymptomatic bacteriuria are frequent in elderly patients. Distinguishing UTI from asymptomatic bacteriuria in older adults, particularly those living in long-term care facilities, might be a challenge for physicians due to the presence of confounding factors, such as an overactive bladder, prostate enlargement, and an indwelling bladder catheter. The absence of standards in the definition and treatment of UTI in the elderly frequently leads to overtreatment. Consequently, antibiotic selection pressure increases and as a result multidrug-resistant organisms might arise. On the other hand, insufficient treatment can result in prolonged and complicated courses of infections or increased morbidity. This review covers the definition, prevalence, diagnosis and management of UTI in older adults.
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Affiliation(s)
- N Mirsaidov
- Klinik für Urologie, Kinderurologie und Andrologie, Universitätsklinikum Gießen und Marburg GmbH, Rudolf-Buchheim-Straße 7, 35392, Gießen, Deutschland
| | - F M E Wagenlehner
- Klinik für Urologie, Kinderurologie und Andrologie, Universitätsklinikum Gießen und Marburg GmbH, Rudolf-Buchheim-Straße 7, 35392, Gießen, Deutschland.
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