Incidence Of Infection-related Complications Research Articles

Microbiology of infection-related complications after transrectal ultrasound-guided prostate biopsy.

The objective of this study was to describe the incidence, microbiology, and risk factors related to infectious complications after transrectal prostate biopsies. This was a single-center, retrospective cohort study of patients undergoing prostate biopsies. Throughout the study period, the institutional standard for antibiotic prophylaxis was cephalexin and ciprofloxacin. Due to the desire to limit fluoroquinolone use, the ciprofloxacin duration of therapy was reduced from 48 to 24 hours in the middle of the study period. The primary outcome was the incidence of infection-related complications, defined as a urinary tract infection or bacteremia within 30 days post-procedure. A total of 1471 transrectal prostate biopsies were included. All patients received antibiotic prophylaxis, with 86.1% (1268/1472) of patients receiving both ciprofloxacin and cephalexin. The incidence of infection-related complications was 1.6% (24/1471). Four patients experienced bacteremia, all of which were due to E. coli and all of these patients had received antibiotic prophylaxis with an active antibiotic. The use of ciprofloxacin was associated with a lower risk of infection-related complications (odds ratio [OR] 0.20, 95% confidence interval [CI] 0.07, 0.55). Bacteriuria within one year prior to the procedure was associated with increased risk of infection-related complications (OR 4.77, 95% CI 1.34, 16.93). Four (0.3%) patients experienced an antibiotic-related adverse event. We observed a low rate of infection-related complications and antibiotic-related adverse events in the setting of antibiotic prophylaxis with ciprofloxacin and cephalexin for 24 hours, without pre-procedure rectal culture screening. Investigation into procedural or host factors may uncover opportunities to further reduce infection-related complications.

Comparison of the effectiveness of two adjustable negative pressure ureteral access sheaths combined with flex ureteroscopy for ≤ 2cm renal stones.

To compare the safety and effectiveness of the combination of intelligent intrarenal pressure control platforms (IPCP) and flexible ureteral access sheath (FUAS) combined with retrograde intrarenal surgery (RIRS) for the treatment of renal stones less than 2cm. We retrospectively collected 383 patients with renal stones who underwent RIRS in our department from June 2022 to October 2023. Inclusion criteria: stone length or the sum of multiple stone lengths ≤ 2cm. Finally, 99 cases were included and divided into an IPCP group (n = 40) and FUAS group (n = 59) based on surgical methods. The main endpoint was the stone-free rate (SFR) at third months after surgery, with no residual stones or stone fragments less than 2mm defined as stone clearance. The secondary endpoints were surgical time and perioperative complications, including fever, sepsis, septic shock, and perirenal hematoma. There was no statistically significant difference in general information between the two groups, including age, gender, body mass index, comorbidities, stone side, stone location, stone length, urine bacterial culture, and hydronephrosis. The operation time for IPCP group and FUAS group was 56.83 ± 21.33 vs 55.47 ± 19.69min (p = 0.747). The SFR of IPCP group and FUAS group on the first postoperative day was 75.00% vs 91.50% (p = 0.024). The SFR was 90.00% vs 94.90% in the third month (p = 0.349).In IPCP group, there were 11 cases with stones located in the lower renal calyces and 17 cases in FUAS group. The SFR of the two groups on the first day and third months after surgery were 45.50% vs 88.20% (p = 0.014) and 63.60% vs 94.10% (p = 0.040), respectively, with statistical differences. For kidney stones ≤ 2cm, there was no difference in SFR and the incidence of infection-related complications between IPCP and FUAS combined with RIRS, both of which were superior to T-RIRS. For lower renal caliceal stones, FUAS has a higher SFR compared to IPCP.

Managing recurrent urinary tract infections in kidney transplant recipients using smartphone assisted urinalysis test.

Urinary tract infection is the most frequent infectious complication in allograft recipients with poor outcomes. The study aimed to assess the effect of self-testing urine dipsticks at home, with the assistance of smartphone technology, on the occurrence of urinary tract infection (UTI)-associated complications and frequency and length of hospital admissions. We performed a retrospective cohort study of kidney transplant recipients with a history of recurrent UTI who used a newly introduced smartphone-assisted dipsticks urinalysis test for self-monitoring. Participants self-administered the home urinalysis test with symptom onset. Antibiotics were prescribed if an infection was suspected, and home urinalysis was positive. The incidence of urinary infections, hospitalisations, and complications was evaluated before and during the home urinalysis period. Remote and face-to-face interactions with healthcare personnel were also assessed (cases acted as their controls). Nineteen participants were included in the study. A total of 89.5% were females. Ninety home urinalysis tests were conducted over a mean period of 7 months. Sixty-one of these were pre-antibiotic. A total of 42.2% of all tests and 47.5% of the pre-antibiotic tests were positive. UTI-related hospitalisations were lower by 75% during the home urinalysis period; mean 1.26 (0.8-1.6) versus 0.32 (-0.01-0.6). The incidence of infection-related complications was also 65% lower; mean 1.52 (0.8-2.2) versus 0.52 (-0.2-1.2) during the same period. The number of face-to-face interactions was slightly lower; mean 1.9 (1.1-2.2) versus 1.7 (0.6-2.8), with more remote interactions; mean 6.0 (3.7-8.5) versus 10.4 (6.5-14.3), during smartphone urinalysis. Fifty per cent of antibiotic-treated UTI episodes had antibiotics within 24 h, rising to 82% within 48 h of a test. Smartphone-assisted home urinalysis enabled remote management of UTI in a high-risk population. Outcomes point to a reduction in UTI complications and hospitalisations.

Restriction of Central Line Insertion and Prophylactic Antibiotics Usage in Moderate and Late Preterm Infants from a Quality Improvement Perspective

Objective: The care provided to moderate and late preterm (MLPT) infants is an area of significant practice variation and most of the quality improvement initiations are for very low birth weight infants. The objective of this study was to analyze hospital outcome changes in MLPT infants with central line insertion and prophylactic antibiotics usage restriction as a quality improvement method. Methods: This was a retrospective cohort study for MLPT infants who were admitted at Kangwon National University Hospital neonatal intensive care unit during 2013-2016. The groups were divided into period I (from 2013 to 2014) and period II (from 2015 to 2016) based on the changes in clinical practices. Since period II, feeding protocol was changed to rapid full-feeding and central line insertion practice was restricted to cases with feeding intolerance over 3 days of life. Prophylactic antibiotics were restricted to ampicillin with gentamycin except for special cases and indications were restricted depending on maternal factors plus clinical symptoms after birth. Results: Gestational age was lower and respiratory distress syndrome was frequent at period II. Central line insertion was reduced from period I to II (83% [147/177] vs. 36% [75/207]). Antibiotics exposures were less at period II (584 vs. 206 days per 1,000 patient-days). Clinical sepsis and central line associated bloodstream infection was significantly decreased at period II. Conclusion: Quality improvement for reducing central line insertion and prophylactic antibiotics usage in MLPT infants may be effective to reduce the incidence of infection related complications, especially sepsis.

Microbiome Medicine: This Changes Everything

Microbiome Medicine: This Changes Everything

The role of antibiotic prophylaxis for tubal microsurgery.

Antibiotic prophylaxis is effective in preventing postoperative wound infections and pelvic cellulitis for a variety of gynecologic procedures. Though frequently used, there is no uniform agreement and little data descriptive of the efficacy of antibiotic prophylaxis for infertility surgery. The purpose of the present study was to determine the incidence of postoperative infection-related complications after microsurgical tubal repair for infertility and to assess the possible role (if any) of antibiotic prophylaxis for tubal surgery. Retrospective; non-comparative; descriptive. Three hundred and forty-eight tubal procedures were performed over a 3 1/2 year period and included tubal reanastomosis (n = 194), distal salpingostomy (n = 107), fimbrioplasty (n = 15), and tubal reimplantation and cornual isthmic anastomosis (n = 32). All procedures were performed under general anesthesia using standard microsurgical techniques. No prophylactic antibiotics were given. When used, the operating microscope was not draped. Patients were monitored postoperatively for any infection-related complications to include postoperative febrile morbidity, wound infections, and pelvic cellulitis. A computer search of discharge diagnoses and chart review was made to determine the postoperative outcome and hospital course. There were 3 cases of febrile morbidity without localizing signs (0.8%), 3 wound infections (0.8%), 2 incisional seromas (0.5%), and one case of pelvic cellulitis (0.2%). There were no cases of bacteremia, septic shock, or septic pelvic vein thrombophlebitis. All patients responded promptly to incisional drainage or combination antibiotic therapy. Data of the present study suggest that the incidence of infection-related complications after tubal surgery without antibiotic prophylaxis is very low. These data suggest that for tubal microsurgery where hemostasis is precise and tissue handling gentle, prophylactic antibiotics may not be necessary. Antimicrobials for prophylaxis, in these circumstances, may offer no advantage in reducing infectious complications that are already extremely low and may in fact cause unfavorable selective processes on endogenous flora and untoward side effects in selected individuals.

Impact of burn unit routine on outcome: A 5-year experience

Background: The burn unit, like any high dependency, unit is awash with multi-antibiotic resistant microbes, and the clinician is in a constant battle to prevent such infections from becoming established. After the elimination of hypovolemic shock as a cause of death, infections constitute the leading cause of morbidity and mortality in burn patients. Aims and Objectives: This study aimed to determine the incidence of infection in our burn unit and to demonstrate how our burn unit routine leads to a low incidence of infection in our setting. Materials and Methods: This is a retrospective review of the records of patients attended to between 2009 and 2013 in the burn unit of Federal Teaching Hospital, Gombe, Nigeria. Details of the treatment and follow-up data were obtained from patients' case files using a predesigned pro forma. All patients were within 24 h of burn and had wounds cleaned under general anesthesia before admission to the unit. In addition, all patients with major burns received infusion of glucose, potassium, and insulin (GKI). Antibiotics use was strictly regulated and was guided by known antimicrobial and sensitivity patterns. Results: Thirty-three patients were admitted within the study period, of whom 27 patients had complete information and were analyzed. The mean age of the burn patients was 11 ± 16.7 (SD) years. There were 16 (59.3%) males and 11 (40.7%) females. Scalding and flame burns accounted for 20 (74.1%) and seven (25.9%) patients, respectively. Only four (14.8%) patients developed wound infection on admission (three were in the age range of 11 years and below, while one was 57 years old) and one patient had gastrointestinal tract (GIT) infection. One patient died from suspected thromboembolism within 24 h of burn, and 14 (51.8%) and 12 (44.4%) patients were discharged with and without residual burn wounds, respectively. The average burn surface area was 18.9%. The average length of stay (LOS) was 18.65 days and the average LOS per patient per percentage burn surface was 0.98 days. On follow-up at 2 weeks after discharge, four (14.8%) patients had delayed wound healing and seven (25.9%) patients developed hypertrophic scars.Conclusion: Our findings indicate a low incidence of infection related complications and it appears that our burn unit routine may play a significant role.