Risk Factors and Outcomes of Postoperative Catheter-Associated Urinary Tract Infection in Colorectal Surgery Patients: A Retrospective Cohort Study

Predictors of urinary tract infection after lower gastrointestinal surgery

BACKGROUND

Urinary tract infections (UTIs) cause postoperative morbidity in patients undergoing lower gastrointestinal (GI) surgery that can prolong postoperative hospital stays. In patients with a fever of unknown origin (FUO), clinicians ignore what to do while waiting for the results of the urine culture test. This study aimed to develop a nomogram predicting UTI in the case of postoperative FUO.

METHODS

This observational, retrospective study included all consecutive patients from 1 November 2020 to 1 November 2021 undergoing lower-GI surgery at the Chirurgia Generale 3, University Hospital of Padua, Italy. A nomogram was created and externally validated in 90 consecutive patients undergoing urine culture tests for FUO at the Chirurgia Oncologica Unit, Veneto Institute of Oncology.

RESULTS

In the development cohort, 109 (N = 109) patients performed a urine culture test for FUO, and 39 were diagnosed with UTI. In a multivariate analysis of patients who underwent urine culture tests for FUO, UTI was associated with female sex, older age, and duration of catheterization at the date of the urine culture test. We developed a nomogram to predict UTI in surgical patients with a C-index of 0.76. In the validation cohort, 90 consecutive patients, who had lower-GI surgery, underwent a urine culture test for FUO and were tested with this nomogram. In the validation cohort, the C-index of the nomogram for predicting a positive urine culture test was 0.71.

CONCLUSIONS AND RELEVANCE

UTIs are a common problem in patients undergoing lower-GI surgery. A nomogram including the major risk factors may help to reduce the inappropriate use of antibiotics during the period awaiting the result of the urine culture test.

Contextual Validation of the Prediction of Postoperative Complications of Colorectal Surgery by the "ACS NSQIP ® Risk Calculator" in a Tunisian Center

CONTEXT

Models for predicting individual risks of surgical complications are advantageous for operative decision making and the nature of postoperative management procedures.

OBJECTIVE

Validate the "ACS NSQIP® Risk Calculator" in the prediction of postoperative complications during colorectal cancer surgery, operated during the years 2015 to 2019.

METHODS

this is a prognostic validation study of the "ACS NSQIP®" applied retrospectively to patients operated on for colorectal cancer in the surgical department of Farhat Hached hospital, during the 2015 and 2019 5-year term. Three levels of adjustment. Discrimination and calibration were carried out mainly by ROC curves (AUC ⩾ 0.8).

RESULTS

In this study, 129 patients were included with a sex ratio of 1.22 and a median age of 62 years. The most common operative procedure was low segmental colectomy with colorectal anastomosis. Thirty-seven patients (28.7%) had at least one postoperative complication. The prediction and cuts-off points values of mortality (AUC = 0.858; CI95% [0.570-0.960]; Cuts-off points = 1.8%), cardiac complications (AUC = 0.824; CI95% [0.658-0.990]; Cuts-off points = 1.8%), thromboembolic complications (AUC = 0.802; CI95% [0.617-0.987]; Cuts-off point = 3.1%), and renal insufficiency (AUC = 0.802; CI95% [ 0.623-0.981]; Cuts-off point = 1.2%) were adjusted according to level 1 of the calculator.

CONCLUSION

This work contextualized the prediction of postoperative complications in colorectal surgery in the university general surgery department of Farhat Hached in Sousse (Tunisia), making it possible to improve the quality and safety of surgical care. The application of the Tunisian mini calculator is recommended as well as the generalization of validation following the development of a generic calculator for all operating procedures.

Nursing Management-Associated Factors Associated with Urinary Tract Infection in Residents from Nursing Home Based on LTCfocus Database

INTRODUCTION

The aim of the study was to identify nursing management-associated factors correlated with urinary tract infection (UTI) in residents from nursing homes.

METHODS

The data of 3,393 nursing homes were extracted from LTCfocus database. Variables statistically correlated with UTI rate were identified by Spearman correlation analysis. Tobit regression model was used for finding the factors associated with UTI rate.

RESULTS

The number of beds (β = 0.03, 95% CI: 0.02-0.05), number of occupied beds/the total number of beds (β = 0.05, 95% CI: 0.03-0.07), number of admissions/total number of beds (β = 0.27, 95% CI: 0.11-0.43), the proportions of residents whose primary support is Medicare (β = 0.03, 95% CI: 0.01-0.06), women residents (β = 0.04, 95% CI: 0.02-0.06), White residents (β = 0.02, 95% CI: 0.01-0.03), patients with bladder incontinence (β = 0.03, 95% CI: 0.02-0.05), hypertension patients (β = 0.03, 95% CI: 0.01-0.05), and long-stay residents with daily pain (β = 0.16, 95% CI: 0.12-0.19), hospitalizations per resident year (β = 0.76, 95% CI: 0.30-1.21), and average daily census (β = -0.02, 95% CI: -0.03 to 0.00) were factors associated with UTI rate.

CONCLUSIONS

Nursing homes with more females, White people, and patients with bladder incontinence, hypertension, or daily pain should be cared more and the number of occupied beds and admissions should be controlled to reduce the occurrence of UTI.