1
|
Xing H, Dai H, Li B, Yuan X, Liu X, Cui G, Liu N, Biering-Sørensen F. Factors associated with urinary tract infection in the early phase after performing intermittent catheterization in individuals with spinal cord injury: a retrospective study. Front Med (Lausanne) 2023; 10:1257523. [PMID: 38046407 PMCID: PMC10691259 DOI: 10.3389/fmed.2023.1257523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/23/2023] [Indexed: 12/05/2023] Open
Abstract
Objectives To investigate the occurrence rate of urinary tract infections (UTIs) in the early phase after performing intermittent catheterization (IC) and to explore the possible factors associated with UTIs after performing IC among people with spinal cord injury (SCI). Setting An inpatient rehabilitation department of a teaching hospital in China. Design Retrospective chart review. Methods A retrospective chart review was carried out for traumatic and non-traumatic SCI patients after performing IC during their inpatient stay. Demographic information, comorbidity of diabetes, urine analysis results before IC, method of IC (sterile or clean), use of bladder irrigation, cessation of IC and its reasons, and UTI events were collected. Results A total of 183 adult individuals were included, of which 60 (32.8%) of them were women. The median age was 49.0 years. The median time post-injury was 2 months. The overall occurrence rate of UTI after performing IC was 1.31 (95% confidence intervals: 0.96-1.77) events per 100 days. Sixty-nine (37.7%) patients discontinued IC during hospitalization, and UTIs were the leading reason for cessation (50.7%). Female sex, use of antibiotics for infections other than UTI, and use of bladder irrigation were found to be associated with a lower occurrence rate of UTI in the early phase after performing IC, with an odds ratio of 0.38 (p = 0.019), 0.20 (p = 0.022), and 0.24 (p < 0.001), respectively. Conclusion UTI after performing IC is prevalent among people with SCI. The study indicated that antibiotic prophylaxis and routine bladder irrigation might be associated with the reduction in UTI in the early phase after performing IC. Further research is needed to provide more evidence.
Collapse
Affiliation(s)
- Huayi Xing
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China
| | - Hongyue Dai
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China
| | - Baohua Li
- Department of Nursing, Peking University Third Hospital, Beijing, China
| | - Xiaoning Yuan
- Department of Hospital-Acquired Infection Control, Peking University Third Hospital, Beijing, China
| | - Xiaoxuan Liu
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China
| | - Guoqing Cui
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China
| | - Nan Liu
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China
| | - Fin Biering-Sørensen
- Clinic for Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
2
|
CALABRÒ GIOVANNAELISA, D’AMBROSIO FLORIANA, ORSINI FRANCESCA, PAPPALARDO CIRO, SCARDIGNO ANNA, RUMI FILIPPO, FIORE ALESSANDRA, RICCIARDI ROBERTO, CICCHETTI AMERICO. Feasibility study on a new enhanced device for patients with intermittent catheterization (LUJA). JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2023; 64:E1-E89. [PMID: 38125911 PMCID: PMC10730013 DOI: 10.15167/2421-4248/jpmh2023.64.3s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Affiliation(s)
- GIOVANNA ELISA CALABRÒ
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- VIHTALI (Value In Health Technology And Academy For Leadership & Innovation), Spin Off of the Università Cattolica del Sacro Cuore, Rome, Italy
| | - FLORIANA D’AMBROSIO
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - FRANCESCA ORSINI
- Postgraduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - CIRO PAPPALARDO
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - ANNA SCARDIGNO
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - FILIPPO RUMI
- Postgraduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - ALESSANDRA FIORE
- Postgraduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - ROBERTO RICCIARDI
- VIHTALI (Value In Health Technology And Academy For Leadership & Innovation), Spin Off of the Università Cattolica del Sacro Cuore, Rome, Italy
| | - AMERICO CICCHETTI
- Postgraduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
3
|
Miller T, Lange D, Kizhakkedathu JN, Yu K, Felix D, Samejima S, Shackleton C, Malik RN, Sachdeva R, Walter M, Krassioukov AV. The Microbiological Burden of Short-Term Catheter Reuse in Individuals with Spinal Cord Injury: A Prospective Study. Biomedicines 2023; 11:1929. [PMID: 37509568 PMCID: PMC10377649 DOI: 10.3390/biomedicines11071929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
Despite the risk of developing catheter-associated urinary tract infections (CAUTI), catheter reuse is common among people with spinal cord injury (SCI). This study examined the microbiological burden and catheter surface changes associated with short-term reuse. Ten individuals with chronic SCI reused their catheters over 3 days. Urine and catheter swab cultures were collected daily for analysis. Scanning electron microscopy (SEM) and X-ray photoelectron spectroscopy (XPS) analyses were used to assess catheter surface changes. Catheter swab cultures showed no growth after 48 h (47.8%), skin flora (28.9%), mixed flora (17.8%), or bacterial growth (5.5%). Asymptomatic bacteriuria was found for most participants at baseline (n = 9) and all at follow-up (n = 10). Urine samples contained Escherichia coli (58%), Klebsiella pneumoniae (30%), Enterococcus faecalis (26%), Acinetobacter calcoaceticus-baumannii (10%), Pseudomonas aeruginosa (6%) or Proteus vulgaris (2%). Most urine cultures showed resistance to one or more antibiotics (62%). SEM images demonstrated structural damage, biofilm and/or bacteria on all reused catheter surfaces. XPS analyses also confirmed the deposition of bacterial biofilm on reused catheters. Catheter surface changes and the presence of antibiotic-resistant bacteria were evident following short-term reuse, which may increase susceptibility to CAUTI in individuals with SCI despite asymptomatic bacteriuria.
Collapse
Affiliation(s)
- Tiev Miller
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Dirk Lange
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- The Stone Centre at Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada
| | - Jayachandran N Kizhakkedathu
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Centre for Blood Research, Life Science Institute, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- The School of Biomedical Engineering, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Kai Yu
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Centre for Blood Research, Life Science Institute, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Demian Felix
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- The Stone Centre at Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada
| | - Soshi Samejima
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Claire Shackleton
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Raza N Malik
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Rahul Sachdeva
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Matthias Walter
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Department of Urology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC V5Z 2G9, Canada
| |
Collapse
|
4
|
Gupta S, McColl MA, Smith K, McColl A. Prescribing patterns for treating common complications of spinal cord injury. J Spinal Cord Med 2023; 46:237-245. [PMID: 33955832 PMCID: PMC9987774 DOI: 10.1080/10790268.2021.1920786] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The purpose of this study was to find the most and least commonly prescribed medications for treating secondary health complications associated with spinal cord injury (SCI); and determine overall polypharmacy rates and risk factors associated with it. DESIGN Observational design, cross-sectional analysis. SETTING Community; Canada. PARTICIPANTS Individuals with spinal cord injury (n = 108). RESULTS A total of 515 prescriptions were issued to the sample comprising 213 different medications to treat 10 SCI-related complications. Forty-five (45%) participants were prescribed >5 medications concurrently. No associations were found between the number of drugs taken and age, sex, level of injury, completeness of injury, time since injury, or cause of injury. The most commonly treated complications included pain (56.5%), muscle spasms (54%) and urinary tract infections (43%). Anti-convulsants (pregabalin, gabapentin), anti-spasmodics (baclofen, diazepam) and nitrofurantoins (Macrobid) were the most commonly prescribed medications to treat each of the three conditions, respectively. Thirty five percent of the total sample received a combination of two or more analgesics including fourth-line agents in the opiate class (hydromorphone, hydrocodone and morphine). Similarly, some participants were prescribed general muscle relaxants and cephalosporins for treatment of muscle spasms and urinary tract infections, respectively, that are generally not recommended in SCI patients. We compare these prescribing patterns with the available clinical practice guidelines and highlight areas where the prescriptions fall outside the recommended clinical practice while considering the complexity of medication management in SCI. CONCLUSION Medication management in SCI is complex. Tools are required that enable prescribers to choose evidence-based medical regimens and deprescribe potentially inappropriate medications for their patients with SCI.
Collapse
Affiliation(s)
- Shikha Gupta
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Mary Ann McColl
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Karen Smith
- Department of Physical Medicine and Rehabilitation, School of Medicine, Queen's University, Kingston, Canada
| | - Alexander McColl
- Rural Clinical School in Family Medicine, University of New South Wales, Sydney, Australia
| |
Collapse
|
5
|
McColl MA, Gupta S, McColl A, Smith K. Prescriptions pour les complications courantes des lésions de la moelle épinière. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:889-892. [PMID: 36515065 PMCID: PMC9796981 DOI: 10.46747/cfp.6812889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objectif Décrire les modèles de prescriptions dans le cas de 3 complications communes associées à une lésion de la moelle épinière (LME) et proposer aux médecins de famille des stratégies pour optimiser les soins aux patients atteints d’une LME. Sources de l’information Les résultats d’une enquête nationale sur l’utilisation des médicaments d’ordonnance par des personnes atteintes d’une LME au Canada et d’une étude longitudinale des complications secondaires liées aux LME. Message principal Les fonctions neurologiques et cardiométaboliques altérées chez les patients atteints d’une LME compliquent le choix des régimes pharmacologiques optimaux chez de tels patients. Trois problèmes courants observés en soins primaires chez des patients atteints d’une LME exigent une pharmacothérapie, soit la douleur (traitée chez 57 % des répondants à l’enquête), les spasmes musculaires (54 %) et les infections des voies urinaires récurrentes (43 %). Le contrôle de la douleur peut nécessiter plusieurs médicaments, selon la source ou la nature de la douleur. Certains médicaments d’ordonnance recommandés pour le traitement de la douleur pourraient être sous-utilisés dans cette population, comme l’amitriptyline, tandis que d’autres pourraient être surutilisés chez de tels patients, comme les antibiotiques pour les infections des voies urinaires. La spasticité est souvent liée à un problème sous-jacent, comme la douleur, et le traitement des problèmes concomitants peut donc aussi réduire la spasticité. Il a été observé que des benzodiazépines à courte durée d’action ont été prescrites pour la spasticité à des taux étonnamment élevés, même si elles ne font pas partie du paradigme thérapeutique recommandé. L’étude longitudinale sur les complications secondaires associées aux LME a mené à l’élaboration de pépites exploitables, un outil novateur de transmission des connaissances à l’intention des professionnels des soins primaires. Conclusion Dans le but de prodiguer un traitement optimal des patients souffrant d’une LME, les médecins de famille sont encouragés à entamer des communications franches au sujet des médicaments d’ordonnance, y compris sur les aspects liés aux coûts, à la polypharmacie et aux substituts thérapeutiques. Les médecins de famille devraient aussi explorer l’établissement d’une collaboration interprofessionnelle avec des spécialistes des LME et d’autres professionnels de la santé afin d’offrir aux patients des stratégies non pharmacologiques adaptées à leur degré d’activité et à leurs besoins nutritionnels. L’application mobile des pépites exploitables fournit aux médecins de famille des renseignements concis, pratiques et fondés sur des données probantes portant sur les 20 principales préoccupations liées à la santé causées par une LME.
Collapse
Affiliation(s)
- Mary Ann McColl
- Professeure au Département des sciences de la santé publique et à l'École de réadaptation de l'Université Queen's à Kingston (Ontario).
| | - Shikha Gupta
- Coordonnatrice de la recherche à l'École de réadaptation de l'Université Queen's
| | - Alexander McColl
- Professeur agrégé et directeur retraité de l'École de médecine rurale de Port Macquarie de l'Université de la Nouvelle-Galles du Sud (Australie)
| | - Karen Smith
- Professeure émérite à la Faculté des sciences de la santé de l'Université Queen's
| |
Collapse
|
6
|
McColl MA, Gupta S, McColl A, Smith K. Prescribing for common complications of spinal cord injury. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:885-888. [PMID: 36515049 PMCID: PMC9796975 DOI: 10.46747/cfp.6812885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To describe prescribing patterns for 3 common complications associated with spinal cord injury (SCI) and to provide family doctors with strategies for optimizing the care of patients with SCI. SOURCES OF INFORMATION Results of a nationwide survey of prescription medication use among people with SCI in Canada and a longitudinal study of secondary complications associated with SCI. MAIN MESSAGE Altered neurologic and cardiometabolic function in patients with SCI make it difficult for family physicians to predict optimal medication regimens for these patients. Three common problems seen in primary care among patients with SCI that require pharmacologic treatment are pain (treated in 57% of survey respondents), muscle spasms (54%), and recurrent urinary tract infections (43%). Pain management may require multiple medications, depending on the source or nature of the pain. Some prescription medications recommended for treating pain may be underused in this population, such as amitriptyline, while others may be overused in this population, such as antibiotics for urinary tract infections. Spasticity is often related to an underlying problem such as pain, and treatment of concomitant conditions may also reduce spasticity. Short-acting benzodiazepines were found to have been prescribed for spasticity outside the recommended treatment paradigm at a surprisingly high rate. The longitudinal study of secondary complications associated with SCI led to the development of Actionable Nuggets, an innovative knowledge translation tool for primary care providers. CONCLUSION To provide optimal treatment to patients with SCI, family doctors are encouraged to engage in open communication with them about prescription medications, including aspects of cost, polypharmacy, and therapeutic substitutions. Family physicians should also explore interprofessional collaboration with SCI specialists and allied health providers to provide patients with nonpharmacologic strategies tailored to their activity levels and nutritional needs. The Actionable Nuggets mobile app provides family doctors with brief, actionable, evidence-based information on the top 20 health concerns associated with SCI.
Collapse
Affiliation(s)
- Mary Ann McColl
- Professor in the Department of Public Health Sciences and the School of Rehabilitation Therapy at Queen’s University in Kingston, Ont.,Correspondence Dr Mary Ann McColl; e-mail
| | - Shikha Gupta
- Research Coordinator in the School of Rehabilitation Therapy at Queen's University
| | - Alexander McColl
- Associate Professor and retired Head of Port Macquarie Rural Medical School, University of New South Wales, Australia
| | - Karen Smith
- Professor Emerita in the Faculty of Health Sciences at Queen's University
| |
Collapse
|
7
|
Barken KB, Vaabengaard R. A scoping review on the impact of hydrophilic versus non-hydrophilic intermittent catheters on UTI, QoL, satisfaction, preference, and other outcomes in neurogenic and non-neurogenic patients suffering from urinary retention. BMC Urol 2022; 22:153. [PMID: 36123663 PMCID: PMC9487088 DOI: 10.1186/s12894-022-01102-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND For patients suffering from urinary retention due to neurogenic [e.g., spinal cord injury (SCI), spina bifida (SB), multiple sclerosis (MS)] or non-neurogenic [e.g., cancer, benign prostate hypertrophy (BPH)] causes, intermittent catheterization is the primary choice for bladder emptying. This scoping review compared hydrophilic-coated intermittent catheters (HCICs) with non-hydrophilic (uncoated) catheters in neurogenic and non-neurogenic patients with respect to satisfaction, preference, adverse events, urinary tract infection (UTI), quality of life (QoL), cost effectiveness, pain, and discomfort. METHODS A systematic literature search was conducted using PubMed, Cochrane Library, Google Scholar, Embase, and available clinical practice guidelines and was limited to systematic reviews/meta-analysis and clinical studies (randomized trials, cohort and case-control studies) published in English between 2000 and 2020. A narrative synthesis was performed, comparing HCIC with non-hydrophilic catheters in each pathology. The articles where critically appraised and weighted according to their level of evidence based on the Oxford Centre for Evidence-Based Medicine Levels of Evidence grading. RESULTS Thirty seven original articles and 40 reviews were included. The comparison of HCICs versus non-hydrophilic catheters was well-documented in patients with mixed pathology, SCI, and to some extent SB. The available evidence predominantly indicates better outcomes with HCICs as reported by study authors, particularly, greater UTI reduction and improved satisfaction, cost-effectiveness, and QoL. However, SB studies in children did not report reduction in UTIs. Children complained about slippery catheters, indicating possible touching of the surface during insertion, which may compromise cleanliness of the procedure and affect outcomes such as UTI. Limited studies were available exclusively on BPH and none on MS; however, most studies performed on mixed pathologies, including BPH and MS, indicated strong preference for HCICs compared to non-hydrophilic catheters. CONCLUSIONS The findings generally support HCICs over non-hydrophilic catheters; however, most studies were fairly small, often used a mix of pathologies, and the conclusions were often based on studies with high drop-out rates that were therefore underpowered. Larger studies are needed to support the general finding that HCICs are the preferred choice in most populations. Additional training in children or redesigned catheters may be necessary for this age-group to fully benefit from the advantages of HCICs.
Collapse
|
8
|
Urinary Tract Infections Treatment/Comparative Therapeutics. Vet Clin North Am Small Anim Pract 2022; 52:581-608. [DOI: 10.1016/j.cvsm.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
9
|
Ben-David R, Carroll F, Kornitzer E, Dekalo S, Mano R, Ben-Chaim J, Cleper R, Bar-Yosef Y. Asymptomatic bacteriuria and antibiotic resistance profile in children with neurogenic bladder who require clean intermittent catheterization. Spinal Cord 2021; 60:256-260. [PMID: 34446838 DOI: 10.1038/s41393-021-00679-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 11/10/2022]
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVES To document the prevalence of asymptomatic bacteriuria and to characterize the resistance patterns to antibiotics among children with neurogenic bladder who require clean intermittent catheterization, with an emphasis on multidrug resistance. SETTING A national referral pediatric and adolescent rehabilitation facility in Jerusalem, Israel. METHODS Routine urine cultures were collected before urodynamic studies in suitable individuals during 2010-2018. None of them had symptoms of urinary tract infection at the time of specimen collection. Cultures were defined as being positive if a single bacterial species was isolated together with a growth of over 105 colony-forming units/ml. Resistance patterns were defined as extended-spectrum beta-lactamase (ESBL) and resistant to 3 antimicrobial groups (multi-drug resistant, MDR). RESULTS In total, 281 urine cultures were available for 186 participants (median age 7 years, range 0.5-18). Etiologies for CIC included myelomeningocele (n = 137, 74%), spinal cord injury (n = 16, 9%) and caudal regression syndrome (n = 9, 5%). Vesicoureteral reflux was diagnosed in 36 participants (19%), 14 of whom were treated with prophylactic antibiotics. Asymptomatic bacteriuria was present in 217 specimens (77%, 95%CI [0.72-0.82]). The bacteria species were E. coli (71%), Klebsiella (13%), and Proteus (10%). ESBL was found in 11% of the positive cultures and MDR in 9%, yielding a total of 34 (16% of positive cultures) positive for ESBL and/or MDR bacteria. CONCLUSIONS Asymptomatic bacteriuria and resistance to antimicrobials are common in pediatric individuals who require CIC.
Collapse
Affiliation(s)
- Reuben Ben-David
- Department of Urology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Fred Carroll
- ALYN Rehabilitation Hospital for Children and Adolescents, Jerusalem, Israel
| | - Emmanuel Kornitzer
- ALYN Rehabilitation Hospital for Children and Adolescents, Jerusalem, Israel
| | - Snir Dekalo
- Department of Urology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roy Mano
- Department of Urology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Ben-Chaim
- Department of Urology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Urology, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Roxana Cleper
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Nephrology, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yuval Bar-Yosef
- Department of Urology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,ALYN Rehabilitation Hospital for Children and Adolescents, Jerusalem, Israel. .,Pediatric Urology, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
| |
Collapse
|
10
|
Marei MM, Jackson R, Keene DJB. Intravesical gentamicin instillation for the treatment and prevention of urinary tract infections in complex paediatric urology patients: evidence for safety and efficacy. J Pediatr Urol 2021; 17:65.e1-65.e11. [PMID: 33309610 DOI: 10.1016/j.jpurol.2020.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 06/29/2020] [Accepted: 08/12/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Little has been reported to date on the instillation of antimicrobials directly into the bladder in children. Children with complex urinary tract anomalies struggle frequently with recurrent urinary tract infections (UTI), with frequent emergence of antibiotic resistance. Gentamicin bladder instillation to treat and prevent UTI was described in children since 2006. OBJECTIVE We adopted gentamicin bladder instillation in 2016 and evaluate herein our intermediate-term experience with it. STUDY DESIGN AND METHODS This study is a retrospective review of a prospectively initiated database and a clinical audit of our practice. The gentamicin bladder instillation was employed in 24 cases. A treatment regime was initiated for symptomatic documented UTI when resistance patterns precluded an oral alternative (14 cases), avoiding hospitalisation for parenteral antibiotics. A prophylaxis regime (19 cases-including 9 of the 14 who received an initial treatment regime) followed at least one breakthrough UTI while receiving oral prophylactic antibiotics. Two instillation volumes (8 mg gentamicin in 20 mL 0.9% NaCl or 20 mg gentamicin in 50 mL 0.9% NaCl) were used to suit different bladder capacities. The irrigation is given twice a day for 7 days in the treatment regime or once a day, every other day, in the prophylactic regime. Gentamicin serum levels (all cases) and audiology/audiometry testing (17/24 cases) were checked to assess the safety of this method. RESULTS The median age when either the treatment course or prophylaxis regime was started was 3.8 years. The treatment regime was 86% successful (12/14) to suppress an acute UTI. The mean duration of prophylaxis was 252 days (median: 256 days). The percentage of patients on the prophylactic regime who had no breakthrough UTI was 58%. No serum gentamicin was detectable secondary to the intravesical instillation. No attributable cases of sensorineural hearing loss were detected. Gentamicin resistance emerged in one case (4.16%). DISCUSSION Intravesical administration was feasible via various routes for a spectrum of complex lower urinary tract abnormalities (see Summary Figure). Concerns regarding systemic absorption, nephrotoxicity or ototoxicity were investigated and safety ensured. Limitations include being a small series of non-identical pathologies, albeit categorically similar and being a single-arm study, however, statistical significance was proven descriptively and analytically. CONCLUSION In selected cases and with the appropriate specialist support and logistics, intravesical gentamicin instillation is well-tolerated and safe to treat and/or prevent urinary tract infections in pateints with complex bladder conditions and lower urinary tract pathologies.
Collapse
Affiliation(s)
- Mahmoud Marei Marei
- Department of Paediatric Urology and Bladder Exstrophy, The Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom; Cairo University, Faculty of Medicine (Kasr Alainy), Department of Paediatric Surgery, Cairo University Children's Hospitals, Cairo, Egypt.
| | - Raef Jackson
- Department of Paediatric Urology and Bladder Exstrophy, The Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom.
| | - David J B Keene
- Department of Paediatric Urology and Bladder Exstrophy, The Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom.
| |
Collapse
|
11
|
Xi M, Elterman DS, Welk B, Pakosh M, Chan BCF. Cost‐effectiveness of hydrophilic‐coated urinary catheters for individuals with spinal cord injury: A systematic review. BJUI COMPASS 2020; 2:71-81. [PMID: 35474888 PMCID: PMC8988762 DOI: 10.1002/bco2.63] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/17/2020] [Accepted: 11/25/2020] [Indexed: 11/09/2022] Open
Abstract
Objective To identify and critically evaluate the economic evaluations examining the cost‐effectiveness of hydrophilic‐coated vs uncoated catheters for individuals with spinal cord injury. Methods We searched MEDLINE, the Excerpta Medica database (EMBASE), Cochrane Database of Systematic Reviews, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Emcare for studies in English and French. There were no restrictions to the year of publication. Our search strategy included the following key terms: “spinal cord injury,” “catheterization,” and “cost analysis.” Results The search identified 371 studies, of which eight studies met the inclusion criteria. Five studies observed hydrophilic‐coated catheters to be cost‐effective compared to uncoated catheters. Two studies found hydrophilic‐coated catheters to be not cost‐effective compared to uncoated catheters and one study estimated that hydrophilic‐coated catheters reduced the long‐term health‐care costs compared to uncoated catheters. Conclusion The cost‐effectiveness of hydrophilic‐coated catheters was dependent on the comparator used, the consideration of long‐term effects, and the unit cost of treatment. Further studies are needed to explore the short‐term and long‐term effects of hydrophilic‐coated catheter use on urinary tract infections and clarify the impact of hydrophilic‐coated catheter use on long‐term renal function. Overall, our critical evaluation of the literature suggests that the evidence is pointing toward hydrophilic‐coated catheters being cost‐effective, particularly when a societal perspective is applied.
Collapse
Affiliation(s)
- Min Xi
- KITE ‐ Toronto Rehabilitation Institute University Health Network Toronto ON Canada
- Institute of Health Policy, Management, and EvaluationUniversity of Toronto ON Canada
| | - Dean S. Elterman
- Division of Urology Department of Surgery University Health Network Toronto ON Canada
| | - Blayne Welk
- Department of Surgery Western University London ON Canada
| | - Maureen Pakosh
- Library & Information Services University Health NetworkToronto Rehabilitation Institute Toronto ON Canada
| | - Brian C. F. Chan
- KITE ‐ Toronto Rehabilitation Institute University Health Network Toronto ON Canada
- Institute of Health Policy, Management, and EvaluationUniversity of Toronto ON Canada
| |
Collapse
|
12
|
Balhi S, Mrabet MK. Teaching patients clean intermittent self-catheterisation: key points. Br J Community Nurs 2020; 25:586-593. [PMID: 33275512 DOI: 10.12968/bjcn.2020.25.12.586] [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] [Indexed: 01/26/2023]
Abstract
Intermittent self-catheterisation (ISC) is recognised as the gold standard for the treatment of neurological bladders. ISC involves the introduction of a catheter by the patient into the bladder and its immediate removal when drainage stops. This process needs to be repeated four to six times a day. Therapeutic patient education (TPE) is commonly used nowadays to treat and care for patients with chronic disease. Community nurses can play an active role in introducing ISC to patients and teaching them to perform it. This review emphasises the important points to consider when teaching patients ISC.
Collapse
Affiliation(s)
- Salma Balhi
- Both at the Department of Epidemiology and Public Health, Faculty of Medicine of Tunis, Tunisia
| | - Mohamed Khalil Mrabet
- Both at the Department of Epidemiology and Public Health, Faculty of Medicine of Tunis, Tunisia
| |
Collapse
|
13
|
Harrer J, Dorsch R. [Bacterial urinary tract infection and subclinical bacteriuria in the dog: a current review]. TIERAERZTLICHE PRAXIS AUSGABE KLEINTIERE HEIMTIERE 2020; 48:270-284. [PMID: 32823350 DOI: 10.1055/a-1220-1950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Bacterial urinary tract infection (UTI) is a common clinical presentation in dogs and a frequent reason for the prescription of antimicrobial drugs. UTI refers to adherence, multiplication and persistence of an infectious agent within the urogenital system. This causes an associated inflammatory response as well as the pertaining clinical signs. Depending on the site of infection, UTI's may be classified as bacterial cystitis, prostatitis or pyelonephritis. In contrast, subclinical bacteriuria (SB) is defined as the presence of a significant number of bacteria in the urine of an individual not showing clinical signs referrable to UTI. UTI's typically occur as a consequence of ascending pathogen migration from the host's own fecal or distal urogenital microbial flora. The most commonly isolated pathogen in cases of UTI and SB is Escherichia coli. The diagnosis is based on clinical signs and the results of urine examination and culture. The recently revised guidelines of the International Society for Companion Animal Infectious Diseases provide detailed recommendations for diagnosis and management of different forms of bacterial UTI's in dogs. Adherence to treatment guidelines will improve treatment success and is imperative in avoiding further deterioration of the antimicrobial resistance situation.
Collapse
Affiliation(s)
- Julia Harrer
- Medizinische Kleintierklinik, Ludwig-Maximilians-Universität München
| | - Roswitha Dorsch
- Medizinische Kleintierklinik, Ludwig-Maximilians-Universität München
| |
Collapse
|
14
|
Bernardi M, Fedullo AL, Bernardi E, Munzi D, Peluso I, Myers J, Lista FR, Sciarra T. Diet in neurogenic bowel management: A viewpoint on spinal cord injury. World J Gastroenterol 2020; 26:2479-2497. [PMID: 32523306 PMCID: PMC7265150 DOI: 10.3748/wjg.v26.i20.2479] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/14/2020] [Accepted: 05/12/2020] [Indexed: 02/06/2023] Open
Abstract
The aim of this review is to offer dietary advice for individuals with spinal cord injury (SCI) and neurogenic bowel dysfunction. With this in mind, we consider health conditions that are dependent on the level of lesion including skeletal muscle atrophy, autonomic dysreflexia and neurogenic bladder. In addition, SCI is often associated with a sedentary lifestyle, which increases risk for osteoporosis and diseases associated with chronic low-grade inflammation, including cardiovascular and chronic kidney diseases. The Mediterranean diet, along with exercise and dietary supplements, has been suggested as an anti-inflammatory intervention in individuals with SCI. However, individuals with chronic SCI have a daily intake of whole fruit, vegetables and whole grains lower than the recommended dietary allowance for the general population. Some studies have reported an increase in neurogenic bowel dysfunction symptoms after high fiber intake; therefore, this finding could explain the low consumption of plant foods. Low consumption of fibre induces dysbiosis, which is associated with both endotoxemia and inflammation. Dysbiosis can be reduced by exercise and diet in individuals with SCI. Therefore, to summarize our viewpoint, we developed a Mediterranean diet-based diet and exercise pyramid to integrate nutritional recommendations and exercise guidelines. Nutritional guidelines come from previously suggested recommendations for military veterans with disabilities and individuals with SCI, chronic kidney diseases, chronic pain and irritable bowel syndrome. We also considered the recent exercise guidelines and position stands for adults with SCI to improve muscle strength, flexibility and cardiorespiratory fitness and to obtain cardiometabolic benefits. Finally, dietary advice for Paralympic athletes is suggested.
Collapse
Affiliation(s)
- Marco Bernardi
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Rome 00185, Italy
- Italian Paralympic Committee, Rome 00191, Italy
- Federazione Italiana Pallacanestro In Carrozzina (FIPIC), Rome 00188, Italy
| | - Anna Lucia Fedullo
- Federazione Italiana Pallacanestro In Carrozzina (FIPIC), Rome 00188, Italy
| | - Elisabetta Bernardi
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari "Aldo Moro", Bari 70121, Italy
| | - Diego Munzi
- Joint Veteran Center, Scientific Department, Army Medical Center, Rome 00184, Italy
| | - Ilaria Peluso
- Research Centre for Food and Nutrition, Council for Agricultural Research and Economics (CREA-AN), Rome 00178, Italy
| | - Jonathan Myers
- VA Palo Alto Health Care System and Stanford University, Cardiology Division, Palo Alto, CA 94025, United States
| | | | - Tommaso Sciarra
- Joint Veteran Center, Scientific Department, Army Medical Center, Rome 00184, Italy
| |
Collapse
|
15
|
Barriers and facilitators to optimising inpatient bladder management after spinal cord injury. Spinal Cord 2020; 58:1291-1300. [PMID: 32457515 DOI: 10.1038/s41393-020-0487-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Qualitative survey. OBJECTIVES Examine clinicians' perspectives on adherence to published evidence-based guidelines and clinician-perceived barriers, and facilitators to optimising inpatient bladder management within one Spinal Cord Injury (SCI) service. SETTING Surgical Hospital (acute care) and SCI Unit (sub-acute, rehabilitation) in Western Australia (WA). METHODS Clinicians reviewed an 'Evidence Matrix' summarising published clinical practice guidelines and recommendations for SCI bladder management. Focus groups examined the extent to which current practice adhered to recommendations and identified perceived barriers and facilitators to optimal management. Data were analysed thematically using a deductive approach. RESULTS Current management closely mirrors published recommendations. Key facilitators included long-standing prioritisation of rapid progression from urethral indwelling (IDC) to a 6 hourly intermittent catheterisation (IC) protocol; regular competency audits of catheterisation technique; and a Spinal Urology Clinical Nurse Consultant (CNC) position. Barriers included limited resources/staffing; restricted access to Neuro-urology consultation; inter-disciplinary communication gaps; and delays in determining and implementing long-term bladder management. CONCLUSIONS Inpatient SCI bladder care in WA closely emulates published evidence, although adherence at other sites may reveal different practices. Bladder management was found to have been facilitated by a strong culture of practice led by Neuro-urologists, informed by evidence and embraced by Senior Clinicians. Further reduction in duration of initial IDC, provision of early and ongoing Neuro-urology consultations as part of standard care, increased interdisciplinary communication and dedicated SCI Urology theatre lists would further optimise management.
Collapse
|
16
|
Averbeck MA, Rantell A, Ford A, Kirschner-Hermanns R, Khullar V, Wagg A, Cardozo L. Current controversies in urinary tract infections: ICI-RS 2017. Neurourol Urodyn 2019; 37:S86-S92. [PMID: 30133791 DOI: 10.1002/nau.23563] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 02/18/2018] [Indexed: 02/03/2023]
Abstract
AIMS The current definition of urinary tract infection (UTI) relies on laboratory and clinical findings, which may or may not be relevant, depending upon the patient group under consideration. This report considers the utility of current definitions for UTI in adults with and without underlying neurological conditions in order to identify gaps in current understanding and to recommend directions for research. METHODS This is a consensus report of the proceedings of Think Tank TT3: "How do we define and when do we treat UTI in neurological and non-neurological adult patients?" from the annual International Consultation on Incontinence-Research Society (ICI-RS), June 8-10, 2017 (Bristol, UK). RESULTS Evidence considering the definitions of UTI in patients with and without neurological diseases was reviewed and synthesized. We examined research on laboratory methods and clinical definitions, focusing on specific cut-off values for the quantification of significant bacteriuria, and leucocyturia. Several areas were identified, mostly related to the lack of evidence-based definitions of significant bacteriuria for different patient groups, as well as uncertainties about the role of inflammatory biomarkers, and non-specific symptoms and signs. CONCLUSIONS One of the biggest challenges in clinical practice is to discriminate between asymptomatic bacteriuria and symptomatic UTI. Future research should concentrate on risk factors for developing symptomatic UTI in different patient groups. Targeted investigations for specific populations, such as the frail elderly, and patients with neurogenic bladder dysfunction, are still needed.
Collapse
Affiliation(s)
- Marcio A Averbeck
- Department of Urology, Moinhos de Vento Hospital, Porto Alegre, Brazil
| | - Angela Rantell
- Department of Urogynaecology, King's College Hospital, London, United Kingdom
| | - Abigail Ford
- Department of Urogynaecology, St Mary's Hospital, London, United Kingdom
| | - Ruth Kirschner-Hermanns
- Department of Neuro-Urology/Urology, University Clinic, Friedrich-Wilhelms University, Bonn and Neurological Rehabilitation Center 'Godeshöhe' e.V., Bonn, Germany
| | - Vik Khullar
- Department of Urogynaecology, St Mary's Hospital, London, United Kingdom
| | - Adrian Wagg
- Department of Geriatric Medicine, University of Alberta, Edmonton, Canada
| | - Linda Cardozo
- Department of Urogynaecology, King's College Hospital, London, United Kingdom
| |
Collapse
|
17
|
Intermittent Catheterization and Urinary Tract Infection: A Comparative Study Between Germany and Brazil. J Wound Ostomy Continence Nurs 2019; 45:521-526. [PMID: 30260906 DOI: 10.1097/won.0000000000000476] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to describe and compare factors that affect urinary tract infection (UTI) rates in people with spina bifida (SB) and neurogenic bladder dysfunction before and following initiation of intermittent catheterization (IC). DESIGN A quantitative, descriptive, correlational study. SUBJECTS AND SETTING The study included people who were from Germany, a high-income nation, and Brazil, a middle-income nation. Brazilian participants were recruited from a public rehabilitation hospital in the state of Minas Gerais. German participants were drawn from different regions of the country. The study sample included 200 participants; participants were either individuals diagnosed with SB and neurogenic bladder dysfunction and using IC, or caregivers of persons using IC for bladder management. METHODS Data were collected through a survey questionnaire developed for urological follow-up of SB patients. A translated and validated version of the form was used to collect data in Germany. To evaluate annual episodes of UTI, we considered the number of symptomatic UTI before and after IC. RESULTS Participants from Brazil were significantly younger than German patients (median age 9 vs 20 years, P < .001). Brazilians predominately used assisted catheterization (63.0%), whereas most Germans performed self-catheterization (61.0%). Use of IC greatly reduced the incidence of UTI in both groups (mean 2.8 episodes per year before IC vs mean 1.1 episodes after starting IC, P < .001). Women had a higher number of UTI, both before and after IC, but enjoyed greater reduction in UTI after initiating IC than men. Self-catheterization also promoted a greater reduction of UTI than assisted IC (P = .022). CONCLUSIONS Intermittent catheterization reduced annual episodes of UTI in both samples despite differences in catheterization technique. Patients practicing and performing self-catheterization achieved a greater reduction than those who relied on assisted IC. Comparative studies among additional countries with varying median income levels are needed to better understand the needs of individuals with SB and their families, and to plan and implement safe nursing interventions.
Collapse
|
18
|
International Society for Companion Animal Infectious Diseases (ISCAID) guidelines for the diagnosis and management of bacterial urinary tract infections in dogs and cats. Vet J 2019; 247:8-25. [PMID: 30971357 DOI: 10.1016/j.tvjl.2019.02.008] [Citation(s) in RCA: 190] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 02/19/2019] [Accepted: 02/21/2019] [Indexed: 02/08/2023]
Abstract
Urinary tract disease is a common clinical presentation in dogs and cats, and a common reason for antimicrobial prescription. This document is a revision and expansion on the 2011 Antimicrobial Use Guidelines for Treatment of Urinary Tract Disease in Dogs and Cats, providing recommendations for diagnosis and management of sporadic bacterial cystitis, recurrent bacterial cystitis, pyelonephritis, bacterial prostatitis, and subclinical bacteriuria. Issues pertaining to urinary catheters, medical dissolution of uroliths and prophylaxis for urological procedures are also addressed.
Collapse
|
19
|
Intermittent Catheters for Chronic Urinary Retention: A Health Technology Assessment. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2019; 19:1-153. [PMID: 30847008 PMCID: PMC6395058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND People with chronic urinary retention typically require intermittent catheterization. This review evaluates the effectiveness, safety, patient preference, cost-effectiveness, and budget impact of different types of intermittent catheter (IC). Specifically, we compared prelubricated catheters (hydrophilic, gel reservoir) and noncoated catheters, as well as their single use versus reuse (multiple use). METHODS We performed a systematic literature search and included randomized controlled trials, cohort, and case-control studies that examined any type of single-use versus multiple-use IC, hydrophilic single-use versus noncoated single-use, or gel reservoir single-use versus noncoated single-use. The outcomes of interest were symptomatic urinary tract infection (UTI), hematuria, other serious adverse events, and patient satisfaction. The quality of the body of evidence was examined according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group criteria. We also completed an economic evaluation, using the perspective of the Ontario Ministry of Health and Long-Term Care, to determine the cost-effectiveness of various intermittent catheters used in Ontario. We determined the budget impact of fully and partially funding various intermittent catheters for outpatients with chronic urinary retention. To understand patient experiences with intermittent catheterization, we interviewed 34 adults and parents of children affected by chronic urinary retention. RESULTS We found 14 randomized controlled trials that met the inclusion criteria. When comparing any type of single-use or multiple-use IC, we found no difference in UTI (RR = 0.98, 95% CI 0.70-1.39), hematuria, or serious adverse events, and inconclusive evidence on patient satisfaction.Our meta-analysis of studies on people living in the community showed that hydrophilic ICs may result in fewer UTIs than single-use noncoated ICs, but given the nature of the studies, we were uncertain about this conclusion.The nature of the available evidence also did not allow us to make definitive conclusions regarding whether one type of catheter was likely to result in less hematuria, fewer serious adverse events, or greater patient satisfaction.Our economic evaluation found that owing to small differences in quality-adjusted life-years and moderate to large incremental cost differences, the lowest-cost ICs-noncoated multiple-use (using one catheter per week or one catheter per day)-have the highest probability of being cost-effective. In a subpopulation of those clinically advised not to reuse ICs, single-use noncoated ICs have the highest probability of being cost-effective. As current funding is limited in the outpatient setting, publicly funding noncoated multiple-use catheters (one per day) would result in a total additional cost of $93 million over the first 5 years. People who use ICs reported that the high ongoing cost of purchasing catheters was a financial burden. Almost all said they would prefer not to reuse catheters sold as "single use" but could not afford to do so. CONCLUSIONS Given the overall low quality of evidence in available studies, we are uncertain whether any specific type of IC (coated or noncoated, single- or multiple-use) significantly reduces symptomatic UTI, hematuria, or other serious adverse clinical events, or whether a specific type improves patient satisfaction. Therefore, the lowest-cost IC is likely the most cost-effective.
Collapse
|
20
|
Saadat SH, Shepherd S, Van Asseldonk B, Elterman DS. Clean intermittent catheterization: Single use vs. reuse. Can Urol Assoc J 2019; 13:64-69. [PMID: 30138101 PMCID: PMC6363567 DOI: 10.5489/cuaj.5357] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Intermittent catheterization (IC) is one of the fundamental aspects of managing patients with chronic urinary retention. Although reuse of catheters has been allowed to be chosen as the first option for IC, the optimal method of IC and the type of catheter has been a long-standing debate. We conducted a literature review regarding risk of urinary tract infection (UTI) and the costs associated with different methods and catheters. METHODS A MEDLINE search via PubMed, EMBASE, and EBSCO host was conducted in March 2018. The date of publication was limited to 2014 to present/current. RESULTS Single use of catheters (hydrophilic-coated [HC] or uncoated [UC]) was considered to impose a lower risk of UTI in all studies, except in one study that included children, but did not test their dexterity to handle HC catheters. Cost-effectiveness of single-use catheters was confirmed by all studies during this period. CONCLUSIONS Reuse of catheters exposes the patient to a plethora of possible cleaning techniques and duration of catheter use. Patient adherence to cleaning method cannot be predicted and this further amplifies the risk of complications and their burden on the healthcare system. We recommend a patient-centred approach to consider HC catheters as the first option, while considering the patient's/caregiver's ability to accommodate the usage technique. Single-use UC catheters, and finally reuse of catheters are considered as next options if HC catheters are found difficult to handle (especially in children doing self-catheterization). Larger trials investigating this matter are required.
Collapse
Affiliation(s)
- Seyed Hossein Saadat
- Division of Urology, Department of Surgery, University Health Network, Toronto, ON, Canada
| | - Shaun Shepherd
- Division of Urology, Department of Surgery, University Health Network, Toronto, ON, Canada
| | | | - Dean S. Elterman
- Division of Urology, Department of Surgery, University Health Network, Toronto, ON, Canada
| |
Collapse
|
21
|
Koeter I, Stensröd G, Hunsbedt Nilsen A, Lund R, Haslam C, De Sèze M, Sriram R, Heesakkers J. User perception of a new hydrophilic-coated male urinary catheter for intermittent use. Nurs Open 2019; 6:116-125. [PMID: 30534401 PMCID: PMC6279713 DOI: 10.1002/nop2.193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 05/29/2018] [Accepted: 07/02/2018] [Indexed: 11/12/2022] Open
Abstract
AIMS This study investigated user perception and adherence related to a hydrophilic-coated urinary catheter (LoFric® Origo™), available for male patients who practice intermittent catheterization. DESIGN The study had a prospective observational design, including patients from 19 European hospitals. METHODS A total of 416 patients were eligible for the study; 179 experienced catheter users and 237 de novo. Two questionnaires were filled out, one describing background data and a second, 8 weeks later, evaluating catheter features. RESULTS The response rate for the second questionnaire was 88% (365 patients). Patients evaluating the new catheter showed a general satisfaction rate of 81% and 72% kept using it. The hygienic grip of the catheter was appreciated by 85% and the foldable feature by 67%. The results show that convenience, ease of use, and hygienic factors are patient-preferred features for a urinary catheter. These factors were confirmed for the evaluated hydrophilic-coated catheter.
Collapse
Affiliation(s)
| | - Gro Stensröd
- Urodynamisk laboratoriumSunnaas Sykehus HFNesoddtangenNorway
| | | | - Rigmor Lund
- Urologisk poliklinikkAkershus Universitetssykehus HFLørenskogNorway
| | - Colette Haslam
- National Hospital for Neurology and Neurosurgery, Queens SquareLondonUK
| | - Marianne De Sèze
- Cabinet de Neuro‐Urologie, Pelvipérinéologie et UrodynamiqueGroupe Urologique de la Clinique Saint AugustinBordeauxFrance
| | - Rajagopalan Sriram
- University Hospitals Coventry and Warwickshire NHS Trust, Walsgrave HospitalCoventryUK
| | | | | |
Collapse
|
22
|
McColl MA, Gupta S, Smith K, McColl A. Promoting Long-Term Health among People with Spinal Cord Injury: What's New? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E1520. [PMID: 29211040 PMCID: PMC5750938 DOI: 10.3390/ijerph14121520] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 11/29/2017] [Accepted: 12/02/2017] [Indexed: 11/30/2022]
Abstract
A key ingredient to successful health promotion is a primary care provider who can offer an informed first response to lifestyle issues, emerging problems and chronic challenges. This article aims to assist family physicians to play their role in promoting the health of people with SCI, by summarizing the latest evidence in the management of spinal cord injury in primary care. This study used a scoping review methodology to survey peer-reviewed journal articles and clinical guidelines published between January 2012 to June 2016. This search strategy identified 153 articles across 20 topics. A prevention framework is used to identify five primary, nine secondary, four tertiary, and two quaternary prevention issues about which family physicians require current information. Major changes in the management of SCI in primary care were noted for 8 of the 20 topics, specifically in the areas of pharmacological management of neuropathic pain and urinary tract infection; screening for bowel and bladder cancer; improvements in wound care; and clarification of dietary fibre recommendations. All of these changes are represented in the 3rd edition of Actionable Nuggets-an innovative tool to assist family physicians to be aware of the best practices in primary care for spinal cord injury.
Collapse
Affiliation(s)
- Mary Ann McColl
- School of Rehabilitation Therapy, Queen's University, Kingston, ON K7L 3N6, Canada.
| | - Shikha Gupta
- School of Rehabilitation Therapy, Queen's University, Kingston, ON K7L 3N6, Canada.
| | - Karen Smith
- Providence Continuing Care Centre, Kingston, ON K7L 4X3, Canada.
| | - Alexander McColl
- Department of Family Medicine, University of New South Wales, Port Macquarie, NSW 2444, Australia.
| |
Collapse
|
23
|
Alavinia SM, Omidvar M, Farahani F, Bayley M, Zee J, Craven BC. Enhancing quality practice for prevention and diagnosis of urinary tract infection during inpatient spinal cord rehabilitation. J Spinal Cord Med 2017; 40:803-812. [PMID: 28872426 PMCID: PMC5778944 DOI: 10.1080/10790268.2017.1369216] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES To reduce the incidence of Urinary Tract Infection (UTI) in subacute SCI individuals admitted for tertiary inpatient rehabilitation. DESIGN A quality improvement team was assembled to improve UTI prevention/diagnosis. To plan data collection, UTI-related factors were mapped in an Ishikawa (fishbone) driver diagram. Data including patient demographics, presence and frequency of signs and/or symptoms of UTI and antibiotic initiation from August to December 2015 were recorded. Sensitivity, Specificity, Positive and Negative Predictive Values (PPV, NPV), and Likelihood Ratios (LR) were calculated for each sign and symptom. SETTING Tertiary SCI Rehabilitation Results: Among 55 inpatients with subacute SCI who had signs/symptoms prompting urine culture and sensitivity (C&S), 32 (58.18%) were diagnosed with a UTI. The most frequent symptoms were foul smelling urine (41%), change in urine color (31%), and incontinence (25%), and the most common sign was fever (34%). Most UTIs (81%) occurred among individuals using Clean Intermittent Catheterization (CIC), with 46% of catheterizations performed by nurses. Foul smelling urine had the highest sensitivity (0.50, 95% CI: 0.31-0.69), and new incontinence had the highest specificity (0.88, 95% CI: 0.69-0.97) for UTI diagnosis. The highest PPV belonged to the cloudy urine (0.71, 95% CI: 0.42-0.92). The combination of cloudy and foul smelling urine increased the PPV to 78% (95% CI: (0.40-0.97). CONCLUSIONS The concurrent presence of cloudy and foul smelling urine is predicted of UTI diagnosis inpatients tertiary setting. SCI inpatients are susceptible to UTI when learning CIC technique from nurses.
Collapse
Affiliation(s)
- Seyed Mohammad Alavinia
- Neural Engineering and Therapeutic Team, Lyndhurst Centre, UHN-Toronto Rehabilitation Institute
| | - Maryam Omidvar
- Neural Engineering and Therapeutic Team, Lyndhurst Centre, UHN-Toronto Rehabilitation Institute
| | - Farnoosh Farahani
- Neural Engineering and Therapeutic Team, Lyndhurst Centre, UHN-Toronto Rehabilitation Institute
| | - Mark Bayley
- Neural Engineering and Therapeutic Team, Lyndhurst Centre, UHN-Toronto Rehabilitation Institute
- Department of Physical Medicine and Rehabilitation, University of Toronto
| | - Joana Zee
- Toronto Rehabilitation Institute-University Health Network
| | - Beverley Catharine Craven
- Neural Engineering and Therapeutic Team, Lyndhurst Centre, UHN-Toronto Rehabilitation Institute
- Department of Physical Medicine and Rehabilitation, University of Toronto
| |
Collapse
|
24
|
Rafatpanah Baigi S, Vaden S, Olby NJ. The Frequency and Clinical Implications of Bacteriuria in Chronically Paralyzed Dogs. J Vet Intern Med 2017; 31:1790-1795. [PMID: 29031032 PMCID: PMC5697206 DOI: 10.1111/jvim.14854] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/11/2017] [Accepted: 09/14/2017] [Indexed: 11/30/2022] Open
Abstract
Background Paralysis is a known risk factor for urinary tract infections (UTI), sepsis, and death in paralyzed people, but there are no data available on diagnostic criteria for UTI versus bacteriuria, their frequency, or clinical implications in chronically paralyzed dogs. Hypothesis/Objectives That chronically paralyzed dogs suffer frequent bacteriuria causing reduced duration of survival. We documented the frequency of bacteriuria, associated clinical signs, and survival rate in chronically paralyzed dogs. Animals Forty‐seven client‐owned dogs paralyzed with no pelvic limb pain perception for >3 months and at least one urine culture (UC) performed. Methods Retrospective, observational study. Medical records of dogs meeting inclusion criteria were reviewed for results of UC, urinalysis, and clinical signs. Outcome was compared between dogs with and without bacteriuria. Results Thirty‐five of 47 dogs had at least 1 positive UC, and 13 had recurrent bacteriuria. Rectal temperature and urinalysis results were extracted from records. Fever was present at time of UC in 5 of 68 observations, 2 with and 3 without bacteriuria. Pyuria was significantly associated with positive cultures (P < 0.001), cloudiness was not (P = 0.076). Survival data in 35 dogs (8 dead) showed no association between bacteriuria and survival (P = 0.69). Conclusions and Clinical Importance Bacteriuria is common in paralyzed dogs but does not cause fever; diagnostic criteria of UTI are unclear. We did not detect an association of bacteriuria with survival, but this needs further confirmation.
Collapse
Affiliation(s)
- S Rafatpanah Baigi
- Department of Surgery and Radiology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - S Vaden
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC.,Comparative Medicine Institute, North Carolina State University, Raleigh, NC
| | - N J Olby
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC.,Comparative Medicine Institute, North Carolina State University, Raleigh, NC
| |
Collapse
|
25
|
Abstract
PURPOSE OF REVIEW This review aims to analyze and discuss all recently published articles associated with neurogenic voiding discussion providing readers with the most updated knowledge and trigger for further research. RECENT FINDINGS They include the proposal of a novel classification system for the pathophysiology of neurogenic lower urinary tract dysfunction (NLUTD) which combines neurological defect in a distinct anatomic location, and data on bowel dysfunction, autonomic dysreflexia and urine biomarkers; review of patient-reported outcome measures in NLUTD; review of the criteria for the diagnosis of clinically significant urinary infections; novel research findings on the pathophysiology of NLUTD; and review of data on minimally and more invasive treatments. SUMMARY Despite the extended evidence base on NLUTD, there is a paucity of high-quality new research concerning voiding dysfunction as opposed to storage problems. The update aims to inform clinicians about new developments in clinical practice, as well as ignite discussion for further clinical and basic research in the aforementioned areas of NLUTD.
Collapse
|
26
|
Compton S, Trease L, Cunningham C, Hughes D. Australian Institute of Sport and the Australian Paralympic Committee position statement: urinary tract infection in spinal cord injured athletes. Br J Sports Med 2015; 49:1236-40. [PMID: 25869093 DOI: 10.1136/bjsports-2014-094527] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2015] [Indexed: 12/25/2022]
Abstract
Patients with spinal cord injuries are at increased risk of developing symptomatic urinary tract infections. Current evidence-based knowledge regarding prevention and treatment of urinary tract infection in the spinal cord injured population is limited. There are currently no urinary tract infection prevention and management guidelines specifically targeted towards elite spinal cord injured athletes. This position statement represents a set of recommendations intended to provide clinical guidelines for sport and exercise medicine physicians and other healthcare providers for the prevention and treatment of urinary tract infection in spinal cord injured athletes. It has been endorsed by the Australian Institute of Sport (AIS) and the Australian Paralympic Committee (APC).
Collapse
Affiliation(s)
- Stacey Compton
- Sports Medicine, Australian Institute of Sport, Bruce, Australia
| | | | | | - David Hughes
- Sports Medicine, Australian Institute of Sport, Canberra, Australia
| |
Collapse
|
27
|
Håkansson MÅ. Reuse versus single-use catheters for intermittent catheterization: what is safe and preferred? Review of current status. Spinal Cord 2014; 52:511-6. [DOI: 10.1038/sc.2014.79] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 03/31/2014] [Accepted: 04/13/2014] [Indexed: 01/21/2023]
|