Catheter Research Articles

Impact of Bladder Management Strategies on Autonomic Dysreflexia Severity in People With Spinal Cord Injuries.

We investigated whether severity of autonomic dysreflexia (AD) was associated with more patient-reported bladder and bowel symptoms and compared AD severity by bladder management strategy in people with spinal cord injury (SCI). The Neurogenic Bladder Research Group SCI Registry is a prospective study which evaluated quality of life after SCI. Bladder and bowel symptoms were assessed through Neurogenic Bladder Symptom Score and Neurogenic Bowel Dysfunction score, respectively. AD severity was assessed with the Autonomic Dysreflexia Following Spinal Cord Injury (ADFSCI) instrument. Bladder management was classified as volitional voiding, clean intermittent catheterization (CIC), indwelling catheter (IDC), and surgery (augmentation and diversion). AD scores were identified for 1473 people. The mean age was 45. Bladder management was CIC in 754 (51%), IDC in 271 (18%), surgery in 195 (13%) and voiding in 259 (18%). On univariate analysis, higher ADFSCI scores occurred with complete injuries (3.1 vs 3.4, p = 0.03), cervical/thoracic injuries (3.8 vs 1.5, p < 0.0001), and chronic pain (3.9 vs 2.9, p = 0.0004). IDC (5.2) and surgery (4.5) had higher ADFSCI scores than CIC (3.0) and volitional voiding (2.8) (p < 0.0001). Sub-analysis showed bladder augmentation had significantly higher ADSCI scores than diversion (4.7 vs 3.7, p = 0.03). On multivariate analysis, level of injury, bladder management, and bowel and bladder symptoms remained associated with worse AD. Level of injury, age, worse bowel and bladder symptoms and bladder management type were associated with higher AD scores. Bladder management with surgery, particularly bladder augment, and IDC had associated greater AD symptoms compared to CIC or voiding. clinicaltrials.gov NTC06216081 and HSRP20153564, U.S. National Library of Medicine, wwwcf.nlm.nih.gov.

Clinical Characteristics and Short-Term Outcomes of COVID-19 Positive Hospitalized Hemodialysis Patients

Presentation of Novel Corona virus disease (COVID-19) and its clinical features and outcomes were different in maintenance hemodialysis (MHD) patients than in general population due to relative immunosuppression and high prevalence of co-morbidities in MHD patients. The aim of this study is to identify the clinical characteristics and outcome of MHD patients requiring hospitalization for COVID 19. In this retrospective observational study, a total of 100 adult patients of both sex who were on maintenance hemodialysis therapy having A-V fistula or permanent venous catheter admitted in Nephrology department of Mugda Medical College Hospital due to COVID-19 from April 21, 2020 to April 30, 2021 were included. Demographic data (age, sex, comorbidities), initial clinical presentations (fever, cough, shortness of breath, fatigue), oxygen saturation, chest radiograph and laboratory tests CBC, RBS, Serum Creatinine, SGPT, CRP, LDH, D dimer, Ferritin, Albumin at admission and during hospital stay were retrieved from patient file. Treatment of these hemodialysis patients was given and modified according to the hospital treatment committee including Nephrologist and Medicine specialist. As the patients were followed up from admission in hospital until discharge or death, so they were divided in two groups- Survived and death. All data were compiled and edited meticulously using SPSS version 27 software. The mean age of the patients was 53.8±13.3 (Range 15-90). Male and female ratio was 1.7.1. No significant difference was observed regarding age and sex of the study subjects. Most patients had HTN (78%) followed by DM (52%), IHD (42%), CLD (24%), pulmonary disease (21%) and Stroke (6%). The most common symptoms during admission in hospital were fever 65%, cough 52%, fatigue 43%, SOB 35% and diarrhea 8% respectively. Fever, cough, fatigue and SOB and in case of co-morbidities only IHD were statistically significant. Mean Oxygen saturation during admission was statistically significantly lower in death group (96.0±1.32 vs 90.2±2.9; p&lt;0.001). Regarding biochemical parameters lymphocyte count (1058.4±289.3 vs 2575.9±536.6 p &lt;0.001), albumin (3.38±0.80 vs 3.89±0.57; p&lt;0.001) were statistically significantly low and N:L ratio (10.48±2.77 vs 3.24±0.40; p&lt;0.001), creatinine (9.75±2.28 vs 6.11±2.27; p&lt;0.001), CRP (33.09±12.99 vs 13.29±5.35; p&lt;0.001), LDH (367.09±78.25 vs 294.06±58.1; p&lt;0.001) were significantly high in death group. Lung abnormalities on CXR PA view showed normal CXR in 48.7% patients in survived group and bilateral GGO in 68.2% in death group which were also statistically significant. Outcome of these admitted patients revealed total death rate 22%, ICU admission rate 18% and discharge from hospital rate was 78%. Logistic regression of these risk factors regarding mortality in COVID19 showed oxygen saturation (p=0.00), N:L ratio (p=0.00), and CRP (p=0.035) were statistically significant. In this study, we found a high mortality rate in COVID 19 positive hospitalized maintenance hemodialysis patients. Markers of inflammation neutrophil-to-lymphocyte ratio (N:L ratio), CRP and oxygen status are significant predictors of COVID 19 patients’ morbidity, highlighting the importance of monitoring these parameters for clinical management and risk stratification. Mugda Med Coll J. 2024; 7(2): 58-65

Differences in catheter-related complications to insertion site selection for long peripheral intravenous catheters in antimicrobial therapy: a randomized controlled trial

BackgroundThe long peripheral intravenous catheter (long PIVC), a type of PIVC, has an indwelling time of 5–14 days and is one of the options for antibacterial therapy. However, there is no consensus regarding the impact of insertion site selection on the complications associated with long PIVCs.MethodsThis randomized controlled trial included 90 participants randomly assigned to either the control or experimental group, with 45 patients in each group. In the control group, long PIVCs were placed in the forearm, while in the experimental group, they were inserted in the upper arm. The primary outcome was catheter-related complications, while secondary outcomes included the first-attempt insertion success rate, total procedure time, and indwelling catheter duration.ResultsThe incidence of catheter-related complication rates was significantly lower in the experimental group (25.0%) compared to the control group (66.7%) (χ2 = 14.528, P < 0.001). The median indwelling catheter duration (interquartile range [IQR]) in the experimental and control groups were 187 [129, 286] hours and 122 [96, 188] hours, respectively, and the difference was statistically significant (Z = 3.016, P < 0.001). The first-attempt insertion success rates were comparable between the experimental group (97.7%) and the control group (97.4%). Similarly, the median total procedure times (IQR) in the experimental and control groups were 5.55 [4.93, 7.48] minutes and 6.17 [5.00, 7.33] minutes, showed no statistically significant difference (Z = 0.511, P > 0.05).ConclusionsSelecting the upper arm as the insertion site for long PIVCs reduced the incidence of thrombophlebitis and extended indwelling catheter duration during antimicrobial therapy.Trial registrationClinicalTrials.gov identifier: NCT06455228 (Initial Release: 05/30/2024).

Short-axis view at mid-left ventricular level showing the tip of the Impella’s pigtail catheter in the cavity, confirming the passage of the device through the aortic valve.

Short-axis view at mid-left ventricular level showing the tip of the Impella’s pigtail catheter in the cavity, confirming the passage of the device through the aortic valve.

Posterior Wall Box Isolation in Atrial Fibrillation Catheter Ablation

Posterior Wall Box Isolation in Atrial Fibrillation Catheter Ablation

Extended Period Outcomes of Posterior Box Isolation in 4 Randomized Atrial Fibrillation Catheter Ablation Trials

Extended Period Outcomes of Posterior Box Isolation in 4 Randomized Atrial Fibrillation Catheter Ablation Trials

P-1572. Epidemiology and Risk Factors for Altered Mental Status Induced by Urinary Tract Infections Amongst Elderly Hospitalized Patients

Abstract Background Elderly patients with urinary tract infections (UTIs) often present with atypical symptoms including altered mental status (AMS). Although UTI-induced AMS is typically reversible, these patients often experience complications and a longer hospital stay. There is a paucity of data on the incidence and risk factors for UTI-induced AMS in elderly patients. The purpose of this study was to describe the epidemiology and risk factors for AMS in elderly patients hospitalized with UTIs.Table 1.Bivariate Comparison of Baseline Characteristics between Patients with and without UTI-induced Altered Mental Status (AMS) χ2 test, Student’s t-test, or Fisher’s exact test for variable comparisons. Methods A retrospective study of hospitalized patients ≥ 70 years of age with a UTI at AtlantiCare Regional Medical Center between 1/2023-12/2023 was performed. Subjects with UTI were categorized in 2 groups, those with new onset UTI-induced AMS and those without AMS. Admitting providers determined the presence of AMS defined as new onset delirium or a significant change in mental status from baseline. Patients were excluded if they displayed evidence of AMS prior to their UTI or had a new comorbid condition at admission that could precipitate AMS. Data collection included patient demographics, body mass index, weight, admission source, comorbid conditions, presence of urinary instrumentation, and concurrent medications. Bivariate analyses were completed for baseline characteristics between patients with and without UTI-induced AMS. Log-binomial regression was performed to determine factors independently associated with the presence of UTI-induced AMS.Table 2.Baseline Characteristics Associated with UTI-induced Altered Mental Status (AMS) in the Log-Binomial Regression Analysis Results In total, 100 patients met the study criteria. The mean (SD) age was 74.8 (4.8) years, 54% were female, 15% were admitted from a long-term care facility, and 24% had an indwelling urinary catheter. Comparison of baseline characteristics between patients with and without UTI-induced AMS is shown in Table 1. In the log-binomial regression, female gender [risk ratio (RR) of 4.7, 95% CI: 1.6-13.8], presence of a urinary catheter (RR of 4.5, 95% CI: 1.6-13.0), and age ≥ 80 years (RR of 2.4, 95% CI: 1.1-5.1) were independently associated with UTI-induced AMS (Table 2). Conclusion Identified risk factors for UTI-induced AMS included female gender, presence of an indwelling urinary catheter, and age 80 years or greater. Further studies are warranted to determine the clinical implications and significance of these potential risk factors. Disclosures Joseph Reilly, B.S., Pharm.D., Melinta Therapeutics: Advisor/Consultant Thomas Lodise, Jr., Pharm.D., PhD, MERCK: Advisor/Consultant

P-402. A Seven-Year Analysis of CRAB and CRE Urinary Tract Infections in Tennessee

Abstract Background Urinary tract infections (UTIs) are a prevalent health concern, affecting millions worldwide. The data collected through the Tennessee Multi-site Gram-negative Surveillance Initiative (MuGSI) was analyzed for a comparative study of UTIs caused by Carbapenem-Resistant A. baumannii complex (CRAB) and Carbapenem-Resistant Enterobacterales (CRE). We aimed to evaluate the demographics, prevalence, and clinical characteristics of patients with UTIs caused by CRAB and CRE. Methods Tennessee has participated in the Center for Disease Control and Prevention (CDC) Emerging Infections Program MuGSI project since 2014. An incident case is defined as the first CRE of E. coli, E. cloacae complex, Klebsiella species or CRAB per patient within 30 days. We analyzed CRE and CRAB incident cases of primary or recurrent UTIs reported to MuGSI during 2016–2022. Descriptive analysis and odds ratio were performed using SAS 9.4. Results From 2016–2022, 521 UTI cases were reported: 448 (86.0%) CRE and 73 (14.0%) CRAB. More males (64.4%) had CRAB infections (p&amp;lt; 0.0001); conversely, more females (68.5%) had CRE infections (p&amp;lt; 0.0001). The mean ages of patients with CRAB and CRE were 64 and 67 years, respectively. Incidence of CRAB was 8.6 in non-white and 3.3 in white per 100,000 population (p&amp;lt; 0.0001). CRE was associated with reduced odds (OR=0.17, p&amp;lt; 0.0001) of having indwelling catheters compared to CRAB. CRAB cases were 2.59 times more likely to be admitted to the intensive care unit (ICU) (p=0.0020). CRAB cases had higher odds of neurological conditions (OR=3.44, p&amp;lt; 0.0001), renal conditions (OR=2.27, p=0.0014), and diabetes (OR=1.67, p=0.0412). CRAB mortality was 6.9% compared to CRE at 2.0% (p=0.0178). Most CRAB and CRE cases were healthcare-associated infections (98.6% &amp; 67.2%). Conclusion The study marks the first multi-year evaluation of TN patients with CRE and CRAB UTIs. As expected, CRAB patients frequently needed ICU admission and were more likely to have indwelling catheters, neurological and renal conditions, and diabetes. This could be linked to ICU patient severity, but further studies are required to clarify. Additionally, significant race and sex gaps were noticed between CRAB and CRE-infected patients, prompting further investigation into these disparities. Disclosures All Authors: No reported disclosures

P-1016. A Deeper Look at an Uncommon Opportunist: Geotrichum capitatum Bloodstream Infections at a Cancer Center

Abstract Background Opportunistic non-Candida yeasts such as Geotrichum capitatum have been increasingly encountered in cancer patients (pts). Clinical and microbiological characteristics of this uncommon pathogen have not been studied. Comparison of virulence between Geotrichum capitatum and Candida albicans using survival analysis in Toll-deficient fruit flies (Drosophila melanogaster) infection model (Mantel Cox Log-rank test) Methods We retrospectively reviewed all G. capitatum bloodstream infections (BSIs) in adult pts with hematologic malignancies at MD Anderson Cancer Center (2013–2022). We also compared in-vitro biofilm production and virulence of two available G. capitatum bloodstream isolates versus Candida albicans (control) in a Toll-deficient (Tl-) fruit fly infection model. Results Fifteen pts had G. capitatum BSIs. All pts were neutropenic (neutrophil count &amp;lt; 500/µL) and had an indwelling catheter but only one episode was deemed to be catheter-associated. All BSIs were breakthrough infections to prior antifungals, mostly caspofungin-based regimens (n=8, 53%). Incidence rate was 0.095/1,000 pt-days in 2022, with an average 1.58-fold annual increase since 2013 (p=0.001). Most pts (n=13, 87%) presented with septic shock/sepsis at the onset of BSI and 73% (n=11) developed multiorgan failure during the course. Gastrointestinal mucosal barrier injury (MBI; n=11, 73%) and dissemination (n=13, 87%) (i.e., septic emboli, hepatosplenic involvement) were common. Forty-two-day mortality was 60%. Neutrophil recovery was observed in all 6 survivors but only in 44% (4/9) of non-survivors (p=0.086). Minimum inhibitory concentrations were 2–8, 0.03–0.25, 0.125–1, 4, 0.5–4, and 0.5–2 µg/mL for fluconazole, voriconazole, posaconazole, caspofungin, anidulafungin, and amphotericin B, respectively. In 6 of 8 pts tested, serum β-D-Glucan was &amp;gt;80 pg/mL (median 352, range 95–500). G. capitatum infection of Tl- flies resulted in lower 7-day mortality than C. albicans infection (22 vs. 74%, p&amp;lt; 0.001) (Fig). G. capitatum strains produced biofilms in vitro, albeit less than C. albicans at the same inoculum. There was inter-strain variability in both virulence and biofilm production. Conclusion G. capitatum BSIs are increasing and are commonly associated with breakthrough nature, neutropenia, and MBI. Lower virulence compared to C. albicans in the fly model and the correlation of pts survival with neutrophil recovery point to host-driven factors as important determinants of outcome. Disclosures Sebastian Wurster, MD, MSc, Astellas Pharma: Grant/Research Support|Gilead Sciences: Grant/Research Support Dimitrios P. Kontoyiannis, MD, AbbVie: Advisor/Consultant|Astellas Pharma: Advisor/Consultant|Astellas Pharma: Grant/Research Support|Astellas Pharma: Honoraria|Cidara Therapeutics: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|Gilead Sciences: Honoraria|Knight: Advisor/Consultant|Merck: Advisor/Consultant|Scynexis: Advisor/Consultant

P-363. Containing an Outbreak of Carbapenemase-producing Organisms in a Singapore Hospital

Abstract Background Tan Tock Seng Hospital is a 1700-bed academic teaching hospital in Singapore. Active surveillance using rapid PCR for the detection of asymptomatic carriage of carbapenemase-producing organisms (CPO) is routinely performed (Fig. 1). Where available, identified carriers are cohorted or isolated under contact precautions. We describe a hospital-wide multispecies OXA-48-like and NDM outbreak, findings from epidemiological investigations and the subsequent infection prevention and control (IPC) measures. Existing and intensified CPO screening strategies Methods Initial response included additional intensified contact tracing (Fig. 1), expansion of isolation bed capacity and audits of IPC practices. Case-control analysis involved 280 cases and 995 controls. Universal admission screening was conducted to validate the accuracy of existing high risk screening (HRS) criteria. Wards with high transmission underwent environmental sampling. Results The CPO screening positivity rate was observed to be on a steady increase during 2022/23, from a baseline of 1.3-1.7% in 2020/21, peaking at 6.5% in June 2023 (Fig. 2). Spot audits demonstrated a decrease in hand hygiene compliance, improper cleaning of shared equipment, and poor IPC practices especially during diaper changes. Isolates were predominantly Klebsiella pneumoniae and sequence type 307. OXA was the commonest carbapenemase, followed by NDM. Risk factors for acquisition were presence of an indwelling urinary catheter for OXA (adjusted odds ratio [AOR] 1.62, 95% CI 1.02-2.48, p = 0.028), exposure to third-generation cephalosporins for NDM (AOR 3.83, 95% CI, 1.86-7.92, p &amp;lt; 0.001) and length of stay of 15-21 days for both (AOR 3.19, 95% CI, 2.05-4.96, p &amp;lt; 0.001). 4.8% of OXA carriers developed clinical infection within a median of 17 days (Fig. 3). Sensitivity of HRS criteria was 70%, though compliance to screening was only 60-80%. Periods of higher transmission were associated with lower rates of CPO cohorting (Fig. 4). CPO was found in 6.9% (9/130) of environmental samples. Rate and time to onset of clinical infection for asymptomatic carriers according to CPO genotype Conclusion Drivers of the outbreak were lower rates of CPO cohorting/isolation, a decrease in IPC standards, the inadequate compliance to HRS and the introduction of a highly transmissible bacterial clone. Early detection coupled with isolation remains a key strategy to control the spread of CPO. Epidemiologic curve of the CPO outbreak in relation to cohorting efforts (%) Disclosures Darius Beh, MBBS (S'pore) MMed (Int Med) MRCP (UK), AstraZeneca: Conference Sponsorship|Gilead: Conference Sponsorship

P-1615. Inappropriate Urine Cultures: The Order Stops Here

Abstract Background Our most frequently missed bundle element from catheter-associated urinary tract infection (CAUTI) case reviews was that the urine culture did not meet evidence-based criteria for testing. Possible harm to the patient from an inappropriate urine culture and subsequent treatment includes unnecessary antibiotics, diagnostic anchoring, Clostridioides difficile infection, and longer length of stay. Risks to the organization include artificially inflated infection rates, associated lower quality and safety scores, and reduced federal reimbursements.Figure 1:Catheter-Associated Urinary Tract Infection (CAUTI) Rate CAUTI rate before (0.61 cases per 1,000 catheter days) and after (0.22 cases per 1,000 catheter days) diagnostic stewardship intervention in March 2022 (p=0.005). Methods In March 2022 an automated report was built in a third-party software system using data from the electronic health record to identify urine cultures ordered in a patient hospitalized for two or more days with an indwelling urinary catheter (IUC), or who had an IUC removed in the previous two days. When a qualifying culture was identified, laboratory personnel held results and contacted the Antimicrobial Stewardship (AMS) Pharmacist. The case was discussed at AMS rounds with an Infectious Disease provider and the decision made whether to release the results. In cases where the culture was not appropriate, the patient’s provider was notified that the result would not be finalized and released. The infection rate pre- and post-intervention was calculated, and statistical analysis conducted with the Student’s T-test. Results In the 11 months prior to implementation of the urine culture review protocol, the average CAUTI rate was 0.61 cases per 1,000 IUC days. In the 23 months since the intervention, the average CAUTI rate was 0.22 cases per 1,000 IUC days, a 63.9% reduction in the infection rate (p=0.005). 19% of orders reviewed were determined to be appropriate. The AMS team reports the volume of culture reviews is manageable. When notified that the culture results would not be released, ordering providers responded favorably to the decision and no objections or adverse patient outcomes have been observed. Conclusion Our non-traditional intervention of enlisting the expertise of the AMS team for a diagnostic stewardship review has been successful in preventing unnecessary treatments to patients and has saved the institution from reportable CAUTI cases that did not meet clinical indication for testing. Disclosures All Authors: No reported disclosures

P-872. Clinical and Microbiological Trends in Citrobacter Bacteremia: A Study from South India

Abstract Background Citrobacter spp are anaerobic Gram-negative bacilli, accounting for approximately 0.8% of all Gram-negative infections. This study aims to elucidate the clinical manifestations and drug susceptibility in Citrobacter infections. Clinical features of patients with Citrobacter bacteremia and comparison between Citrobacter koseri and other Citrobacter spp Methods We conducted a retrospective analysis of Citrobacter spp. bacteremia cases from 2016 to 2022. We assessed clinical profile, species, antimicrobial susceptibility and 28-day outcome. Blood cultures were processed using the BacT/ALERT, Vitek 2 system was employed for bacterial identification and antimicrobial susceptibility testing and reported as per CLSI criteria. Isolates with intermediate susceptibility were classified as non-susceptible. Comparison of antibiotic susceptibility between C Koseri and other Citrobacter spp Results Over the 7 year study period, 25 cases of Citrobacter bacteremia were identified, 60% were males. The median age was 52.5 years (IQR: 46 – 75), with 2 pediatric cases. The annual incidence of Citrobacter bacteremia displayed an upward trend, from 12% in 2016 to 24% in 2022. C. koseri emerged as the predominant species (72%), followed by C. freundii (24%) and C. farmeri (4%). The majority of patients (72%) had diabetes, 16% had chronic liver disease, 12% had malignancy. Risk factors for Citrobacter bacteremia included the presence of an indwelling bladder catheter (76%) and a central venous catheter (44%). Urinary tract was the most frequent source (56%), followed by abdominal (20%) and soft tissue (8%); a newborn had meningitis with brain abscess. The mean for Pitt’s bacteremia score was 1.52±2.6. The mean Charlson’s co-morbidity index was 2.76±2.3. Clinical features for the entire cohort and comparative results between C Koseri and other Citrobacter spp (grouped as non-koseri) is depicted in figure 1. Ciprofloxacin susceptibility was higher among C koseri (94%) as compared to other spp (71%). Antibiotic susceptibility for ceftriaxone was almost similar between the 2 groups. Susceptibility rates for other antibiotics and comparison between C Koseri and other spp are shown in figure 2. All isolates were susceptible to ertapenem, imipenem and amikacin. The overall 28-day mortality rate was 12%. Conclusion We found C. koseri more commonly, urinary source as the most common source and device presence as a significant risk factor. Antibiotic susceptibility was better for C. koseri compared to others. Disclosures All Authors: No reported disclosures

P-227. Strategy for the accurate identification of CAUTIs in the ICU at a Tertiary Care Hospital

Abstract Background The rates of CA-UTIs increased significantly after the COVID-19 pandemic. Many of these infections were considered "definitional infections", in which cases, they were considered reportable infections based on NHSN criteria, however, not conclusive by clinical presentation. The IDSA recommends removing and replacing indwelling catheters that have been in place for more than 14 days before obtaining a new urinary sample to evaluate for presence of UTI. This is currently not routinely performed. Methods In order to improve the yield of evaluating non-contaminated urine specimens for true infection, we developed a protocol that triggered a catheter exchange if the catheter has remained in place for more than 3 days. The protocol consists of removal and replacement of urinary catheter before processing the urine sample and obtaining a culture. Results A significant reduction in the number of UTIs was observed after 12 months of use and surveillance of our strategy despite a stable rate of use of urinary catheters. Our intervention was initiated in February 2023 and only 3 CA-UTIs were identified during this time period. It is important to mention that multiple other strategies were deployed during the COVID-19 pandemic in order to decrease the number of CA-UTIs, including an ED lead initiative to decrease the use of new Foley insertion for patients going to ICU and the use of GCH based perineal care (Pericare). In 2022 a significant decline in CA-UTIs was noted (5 CA-UTIs) and 3 cases in 2023. Currently, we are processing data and additional variables to help us adjusting our findings for potential confounders. Conclusion The implementation of a catheter-exchange program for the accurate identification of catheter associated UTIs in the ICU setting, together with the use of GCH based pericare, are effective strategies to decrease the incidence of Catheter associated UTIs. Disclosures All Authors: No reported disclosures

Long term abdominal drains as a therapeutic option in refractory ascites – a systematic review

Introduction: Refractory ascites (RA) is the most common complication of end-stage liver disease (ESLD) with a significant burden in terms of symptoms and overall quality of life (QoL). There are limited therapeutic options available for this population and most ultimately undergo serial large-volume paracentesis (LVP). Long-term abdominal drains (LTAD) are commonly used for malignant ascites drainage but not for ascites related to ESLD, due to concerns about kidney injury and infection. Objectives: This review aims to describe the safety, effectiveness, and impact on the QoL of LTAD in ESLD-related ascites. Methods: Using systematic review methodology, PubMed-MEDLINE, Embase and Google Scholar databases were searched for studies published between January 1, 2001, to June 1, 2024, combining medical subject headings (MeSH) [(«cirrhosis» OR «chronic liver disease») AND «refractory ascites» AND («permanent-tunneled peritoneal catheter» OR «tunneled catheter» OR «indwelling catheter» OR «long-term abdominal drains»)]. Inclusion and exclusion criteria were applied to the results. Results: One hundred thirty-nine studies were identified, with 16 deemed eligible for final analysis, including three randomized clinical trials. The studies varied in design, included different types of LTAD, and were generally of low quality, with many lacking statistical power due to small sample sizes. In terms of effectiveness, technical success was 100%, and as long as LTAD remains in situ, no need for additional LVP is required. Overall, the catheters remained in situ for periods ranging from 3 to 436 days. In terms of safety, kidney injury occurred in 17 to 50% of patients, but only if &gt;1.5 liters/day were drained. Infections including cellulitis and peritonitis, occurred in 7 to 58% of patients and were generally resolved with antibiotic therapy and/or device removal. LTAD do not appear to have a negative impact on mortality. Regarding QoL, the data are contradictory with most studies reporting an overall neutral effect. Conclusion: LTAD should be considered as an option in RA from ESLD in the future, but more quality studies are needed to confirm their safety and benefits in controlling symptoms. This could be an important step in terms of improving the palliative needs of this population.

Percutaneous Jejunostomy

AbstractDirect percutaneous jejunostomy placement is an often underutilized procedure that can allow for supplemental enteral nutrition in a certain subset of patients, in which percutaneous gastrostomy is not technically feasible, or in patients who require post-pyloric feeding. Percutaneous jejunostomy catheter placement was first described in the 1980s; since that time there have been minimal case series on the procedural technique and outcomes. At our institution, we perform percutaneous jejunostomy placement as a planned two-stage procedure. During the initial stage, direct jejunostomy is performed under a combination of fluoroscopic and ultrasound guidance, after distending the jejunum through a nasojejunal tube. After confirming intraluminal access, at least one Cope suture anchor is deployed, and guidewire access is maintained. Subsequently, the track is serially dilated, and a 14-Fr pigtail catheter is placed into the jejunum. Approximately 4 to 6 weeks later, the patient returns for conversion of the pigtail drain into a formal jejunostomy catheter with retention balloon, under fluoroscopic guidance. Several of the prior larger studies on the technique have noted major complications to occur in 12% of patients and minor complications to occur in 9.8% of patients. While percutaneous jejunostomy placement is not a frequently performed procedure, technical success and complication rates are comparable to that of surgical jejunostomy.

Functional disorders of the lower urinary tract in diabetes mellitus

Type2 diabetes mellitus is awell-known metabolic disease with increasing prevalence. Diabetic-related complications lead to different types of organ damage, some of which some of which are less well-known. In the lower urinary tract, acomplex interplay of neuronal, myogenic, and urothelial dysfunction leads to functional disorders of the lower urinary tract, with disorders of bladder storage and bladder emptying being in the forefront. In Germany, the number of patients with diabetes mellitus is estimated at over 8million, with up to 2million undiagnosed cases. Exact figures on diabetes-related dysfunction of the lower urinary tract are not available, partly because the early phase is often asymptomatic. Symptomatic patients often initially report symptoms of urgency, but later reduced sensitivity and ultimately afeeling of residual urine and urinary retention. Treatment options are limited, not always evidence-based, and often only evaluated in patients without diabetes. Behavioral therapy measures, drug therapy, peripheral neuromodulation, and catheter use such as single-use catheterization or permanent catheter diversion are used. In order to ensure optimal diagnosis and therapy, an understanding of the underlying pathologies and functional diagnostics is necessary.

Related factors of postoperative half-year care utilization for health status and recovery in older adults with hip fracture: A retrospective study of Osaka National Health Insurance Data.

The aim of this study was to investigate the relationship between preoperative patient factors and postoperative half-year health care utilization reflecting recovery, common complications, comorbidities, and significant health concerns, identifying strong risk and protective factors. This retrospective cohort study utilized linear, quantile, and ordinal regressions to analyze Osaka National Health Insurance data from 26 606 elderly patients who underwent hip fracture surgery between 2012 and 2018. The key factors associated with multiple postoperative care utilizations (P < 0.001) included: 1 Compared with men, women were strongly negatively correlated with postoperative length of stay (LOS) at q90, diabetes prescriptions or drip injections, while showing strong positive associations with postoperative antihypertensive, antiosteoporosis, and antidementia prescriptions. 2 Age has a strong negative correlation with antiosteoporosis or diabetes prescriptions but strongly positive associations with indwelling urinary catheters or drip injections. 3 The preoperative 1-year LOS correlated positively with the postoperative LOS or indwelling urinary catheters, and the strongest associations were observed at q25 with the postoperative LOS. It was significantly and negatively associated with antihypertensive or antidementia prescriptions. 4 Many preoperative care utilizations were positive factors, and some were strong factors at q25 of the LOS. Nuanced relationships between the female sex; preoperative LOS; antidementia, antiosteoporosis, antihypertensive and constipation prescriptions; indwelling catheters, and postoperative LOS were elucidated. These are key risks during shorter postoperative LOS, while male subgroups are at a higher risk during longer LOS duration. Patients with extended preoperative diabetes prescriptions or drip injections are at high risk of multiple postoperative care. Geriatr Gerontol Int 2025; ••: ••-••.

Comparative study of HoLEP in elderly patients with indwelling catheters: a retrospective dual-center study.

This study aimed to evaluate the safety and efficacy of HoLEP in patients aged > 85 years with indwelling catheter (IDC). We retrospectively analyzed our bicentric HoLEP database to identify consecutive patients with IDC and trial without catheter (TWOC) failure who underwent surgery between June 2012 and April 2020. Our primary focus was on the population over 85 years of age; Patients under 70 years of age were used as controls. We evaluated the rate of postoperative spontaneous micturition, adverse events and mortality, as well as catheterization duration, hospital stay, and rate of urinary incontinence. In total, 144 patients were included, with 71 (49.3%) and 73 (50.8%) in the ≥ 85 and control group, respectively. The median [IQR] prostatic volume and Charlson score was 90 [70-130] vs. 90 [65-120] mL and 6 [5-7] vs. 3 [2-4] in the ≥ 85 and control groups, respectively. Postoperatively, the rates of major complications (2% vs. 3%) and transfusion (11% vs. 9%) were not significantly different. The median length of stay (2 [1-3] vs. 1 [1-2]; p = 0.03) and rate of TWOC failure during hospitalization (24% vs. 5%, p < 0.001) were significantly higher in the ≥ 85 group. At 3 months and one year follow-up visits, 0 and 10 patients (14.1%) in the ≥ 85 group and 0 and 2 patients (3%) in the control group died, respectively. One year after surgery, 69 (97%) and 73 (100%) (p = 0.2) patients in the ≥ 85 and control groups, respectively, could void spontaneously. HoLEP is a safe and effective procedure for elderly patients with indwelling catheters. At one year, 97% of patients achieved spontaneous voiding, while the urinary incontinence rate was 11%. The 1-year mortality rate was 14%, comparable to that of the general male population of the same age.

Isolated Continuous Lumbar Plexus Block Infusion for Hip Fractures: Their Role as Sole Analgesic and Anaesthetic Modality—A Retrospective Observational Study

Background and Aims: India is one of the advancing ageing societies of the world; with this, the country’s demographic structure also changes. The incidence of lower limb fractures is high in this population, and it threatens their health both physically and mentally. Therefore, an effective anaesthesia and analgesia regimen is crucial for smooth and stable surgery and perioperative care. Methods: In this retrospective study, we aimed to describe the use of lumbar plexus block with an indwelling catheter as a sole anaesthetic technique intra-operatively and for providing peri-operative pain relief for 54 patients with intertrochanteric fracture posted for proximal femoral nailing or dynamic hip screw fixation from October 2020 to October 2023. Results: It was found that pain scores remained less than 1 for the majority of the study duration. Most patients underwent surgery within the first day of admission in our hospital and surgery lasted for one to two hours. All patients were discharged within five days of hospitalisation. There were no failures of the blocks before and during the surgical procedures. There were no records of any complications related to the technique. No supplement opioid was used during the procedure. Conclusion: With adequate monitoring, expertise, knowledge and familiarity with the procedure, lumbar plexus block with continuous infusion via a perineural catheter supplemented with periprocedural sedation can be used as a safe and effective anaesthetic technique for hip and proximal femur fracture reduction surgeries.

Removal of Spontaneously Fractured Leads with Their Proximal Ends in the Heart and Vasculature—Description of Different Approaches and Tools

Background: Removal of spontaneously fractured leads with their proximal ends migrated into the vascular space has not been analysed in detail thus far. The study aimed to compare the effectiveness of different approaches and auxiliary tools for removing fractured leads with migrated proximal ends. Methods: Retrospective analysis of 72 cases from a database containing 3847 TLEs (transvenous lead extraction). Results: Most of the leads were passive, especially unipolar. Procedure complexity in such cases was high but with satisfying effectiveness (procedural success rate 93.06%) and independent of the position of the proximal end. The rate of major complications was 2.78%, which may be attributed to long implant duration (152.2 months). Extraction of such leads did not influence long-term survival. The femoral approach was most often used (62.50%). In 79.16% of leads, mechanical dissection was required. In 66.7%, proximal ends were strongly attached to the wall, and a loop had to be applied. In 15.28% of procedures, the lead was wrapped around a pig-tail catheter (“spaghetti twisting technique”). Conclusions: (1) Spontaneous lead fracture with the proximal ends migrated into the vascular space is a rare finding (1.87% of the TLE). (2) Removal of such leads requires the use of different approaches as well as dedicated and non-dedicated tools. (3) Despite a high level of procedure complexity, its effectiveness is high, with an acceptable rate of major complications.