Incidence Of Significant Bacteriuria Research Articles

A comparison of the efficacy of normal saline and Savlon solutions in periurethral cleaning to reduce catheter-associated bacteriuria: A randomized control trial

ObjectiveCatheter-associated urinary tract infection (CAUTI) is a common nosocomial infection. However, there has been no randomized control trial (RCT) comparing the efficacy of periurethral cleaning solutions for reducing CAUTI. This study aimed to compare the efficacy of normal saline solution (NSS) and Savlon solution. MethodsA non-inferiority cross-over RCT was conducted to compare the 2 solutions by the incidence of significant bacteriuria (SB) on day 5 after Foley catheterization. Patients admitted to a tertiary referral hospital from June 2018 to August 2019 participated in the study. The acceptable prespecified non-inferiority margin was 10%. ResultsThere were 265 and 275 patients in the NSS and Savlon groups, respectively. The incidence of CAUTI was 2.65/1000 catheter-days, and the median duration of catheterization was 5 days (IQR 4, 7). There was no significant difference between the incidence of SB in the NSS and Savlon groups, as indicated by the adjusted difference of 0.6 (95% CI: -3.1-4.2). ConclusionThis study was the first RCT in patients from multiple hospital units to compare the efficacy of the 2 solutions in the periurethral cleaning process. The study demonstrated non-inferiority of NSS to Savlon solution. Thai Clinical Trials Registry Study IDTCTR20180518001.

Urinary Effects of Routine Urethral Catheterisation during Elective Caesarean Section in Enugu, Nigeria: A Randomised Controlled Study

Introduction: Routine urinary catheterisation during elective caesarean section is a common practice. However, this practice involves some urinary bladder morbidities. Aim: To determine the effect of non-catheterisation of the urinary bladder on the incidence of significant bacteriuria and other perioperative urinary bladder morbidities during elective caesarean section in Enugu, Nigeria. Materials and Methods: A multicentre, non-inferiority randomised controlled study was conducted. The study centres were the University of Nigeria Teaching Hospital (UNTH), Mother of Christ Specialist Hospital (MOCSH), and Blessed Assurance Specialist Hospital (BASH), all in Enugu State, Southeast Nigeria. A total of 264 eligible consenting term pregnant women who had a caesarean section in these three specialist centres in Enugu, Nigeria over a one-year period were recruited and they completed the study and their results were analysed. Study group (A) did not receive urethral catheterisation while the control group (B) had urethral catheterisation on the operating table and the catheters were removed 24 hours after the surgery. Clean catched urine samples were collected from each participant 72 hours after the surgery for urine microscopy and culture. The primary outcome measure was the incidence of significant bacteriuria 72 hours postoperatively while the secondary outcome measures included incidence of intraoperative bladder injury (accidental cystostomy), primary postpartum haemorrhage and urinary retention. Results: Nine (6.8%) women in the non-catheter group (n=132) had significant bacteriuria as against 17 (12.9%) women in the catheter group (n=132), (Relative Risk (RR)=0.5 (95% CI: 0.24-1.14) p=0.098). Urinary retention was observed in 10.6% (14/132) of the non-catheter group while there was no case of urinary retention in the control group (p<0.001). There was neither a case of accidental cystostomy nor postpartum haemorrhage in either group. Conclusion: Non-catheterisation of the urinary bladder during elective caesarean section had no significant relationship with the incidence of significant bacteriuria in Enugu, Nigeria. Rather, it was associated with postoperative urinary retention when compared to women who had a urinary catheter.

Incidence of Significant Bacteriuria among Pregnant Women in a Teaching Hospital of Rural Setup

Incidence of Significant Bacteriuria among Pregnant Women in a Teaching Hospital of Rural Setup

Morbidity and Significant Bacteriuria after Urodynamic Studies

Introduction: Urodynamic pressure flow studies (PFS) are increasingly utilised in assessing patients with lower urinary tract (LUT) dysfunction. Although minimally invasive, there is theoretical risk of morbidity and infection. This paper looks at the morbidity, the incidence and natural history of significant bacteriuria (SBU) occurring after PFS. Materials and Methods: Patients undergoing PFS in a General Hospital and meeting entry criteria were enrolled with informed consent. Each had urine culture specimens collected at the time of PFS (D0), 3 (D3) and 7 (D7) days after PFS and a 7-day symptom log. Results: Ninety-three patients (44 males and 49 females), with a mean age of 52.2 years (range, 17 to 89) were evaluated. Twenty-five per cent (23/93) developed irritative LUT symptoms after PFS, but only 2/23 had a positive urine culture. All symptoms in culture-negative patients resolved within 5 days and none had sought medical treatment. The overall incidence of SBU was 13.9% (13/93) of whom 11/13 (95.7%) were asymptomatic. Majority of SBUs were detected on D3 but 30% developed late (D7). All asymptomatic SBUs were treated expectantly and 70% (7/11) resolved spontaneously by D14. 81.8% of organisms cultured were coliforms, and 18.2% enterococcus. There was no statistically significant correlation between age, sex, post-void residual and bladder outlet obstruction (diagnosed by PFS) and post-PFS morbidity or SBU. Conclusion: Symptoms occurring after PFS are mild, transient and rarely associated with infection. SBU after PFS is largely asymptomatic and self-resolving. Given the extremely low rate of symptomatic infection, antibiotic prophylaxis is not necessary.

Prevalence of Bacteria in Diabetics and Non-Diabetics

The study was carried out to determine the prevalence of bacteriuria in diabetic and non-diabetic patients attending the University of Port-Harcourt Teaching Hospital and the Diabetic Association of Nigeria, Rivers State Chapter. A total of 257 (132 diabetic and 125 non-diabetic) mid-stream urine samples were collected and cultured on cystine lactose electrolyte deficient (CLED) agar medium using the standard wire loop technique. Forty-nine (37.2%) of the non-diabetics had significant bacteriuria. Among diabetics 32 (65.31%) females and 17 (34.69%) males had significant bacteriuria while 15 (68.25%) females and 7 (31.75%) males in non-diabetics had significant bacteriuria .In both groups studied, the incidence of significant bacteriuria was highest in the age range of 18-39 years for both groups, 55.11% in the diabetics and 68.25% in non-diabetics. Escherichia coli and Staphylococcus aureus were the most frequently isolated bacteria in the two groups, statistical analysis showed a significant prevalence of bacteriuria in diabetics compared with non-diabetics (P Key words: Bacteriuria, Diabetics, Non-Diabetics, Age, Sex [Mary Slessor Jnl of Medicine Vol.3(1) 2003: 52-54]

Prostaglandins for Enhancing Detrusor Function after Surgery for Stress Incontinence in Women

Sixty-nine women with a clinically and urodynamically proven diagnosis of genuine stress incontinence underwent urethropexy in the form of the revised Pereyra procedure (n = 28) or Burch colposuspension (n = 41). Postoperatively the patients were assigned randomly to one of three study groups. Group 1 received a daily saline injection to the bladder (control group, n = 24), group 2 received daily intravesical injections of 250 mg of prostaglandin F2 alpha (PGF2 alpha) (n =23), and group 3 received a daily 10-mg PGE2 (PGE2) vaginal suppository (n = 22). The patients' suprapubic catheter was removed once the postvoiding residual urine volume was less than or equal to 50 mL. Both PGE2 and PGF2 significantly reduced the length of time required for postoperative bladder drainage after both the Burch and Pereyra procedures as compared to that in the control group (P less than .05). Hospital stay and bacteriuria were reduced as well in women receiving postoperative prostaglandins as compared to the control group. Clinically there were no differences between PGE2 and PGF2 alpha. Both produced no side effects, were well tolerated by the patients and were effective in reducing both the number of days required for bladder catheterization and the incidence of significant bacteriuria when administered after the surgical procedures.

The value of kanamycin-colistin bladder instillations in reducing bacteriuria during intermittent catheterisation of patients with acute spinal cord injury.

Two groups of patients with acute spinal cord trauma had initial bladder management by standard non-touch techniques of intermittent catheterisation. Twenty-two patients (17 males and 5 females) had kanamycin-colistin solution instilled into the bladder at the end of each catheterisation, and 25 patients (21 males and 4 females) were not given these instillations. The incidence of significant bacteriuria during intermittent catheterisation of both males and females receiving the instillations was only half the incidence of those not receiving the instillations. Also, a significantly higher proportion of males receiving the instillations did not have any episodes of significant bacteriuria compared with those not receiving the instillations, and the same trend was evident in the small number of female patients. It is recommended that patients should have kanamycin-colistin bladder instillations when they are being intermittently catheterised.

Prevention of urinary tract infection following spinal cord injury.

Immediately following spinal cord injury there is a phase of spinal shock during which time the bladder is paralysed and becomes overdistended unless emptied by catheterisation. If the bladder wall is overstretched there is initial loss of contractility, followed by interstitial fibrosis within the detrusor muscle. However, if overdistension and infection are avoided during the immediate and early period after injury to the spinal cord, most patients develop satisfactory compensatory mechanisms of bladder emptying.There are two possible regimes of catheterisation, either indwelling or intermittent, both of which are associated with infection. The probability of infection with indwelling catheters is too high to be acceptable. Intermittent catheterisation also carried a considerable risk, but ways have been devised which make this method satisfactory. A trial of management techniques for the prevention and control of urinary tract infection during intermittent catheterisation was conducted on 36 acute traumatic paraplegics and tetraplegics admitted to the Royal Perth Hospital Spinal Injuries Unit during 23 consecutive months. Precautions were taken to ensure that the technique of catheterisation was of a very high standard, but this in itself did not prevent urethral bacteria from being carried into the bladder. To eradicate these micro-organisms, two bactericidal antibiotics (kanamycin and Colistin) were injected into the bladder via the catheter immediately prior to withdrawal.During the acute phase of management a total of 3036 catheterisations were performed on 27 male patients and in this time 16 episodes of significant bacteriuria occurred. The incidence of significant bacteriuria in the male patients was 1 per 190 catheterisations (0.5 per cent.). A total of 1547 catheterisations were carried out on nine female patients, resulting in nine episodes of significant bacteriuria. The incidence of significant bacteriuria in the female patients was 1 per 172 catheterisations (0.6 per cent.).Ninety-one per cent. of patients discharged were catheter-free with low residual urines and without bacteriuria and have generally remained so during follow-up.

Prevention of urinary tract infection in paraplegic patients

If the bladder is protected from overdistension and infection during the immediate and early period after injury to the spinal cord, most patients will develop satisfactory compensatory mechanisms of bladder emptying. The author considered the 2 possible regimes of catheterization, indwelling or intermittent. The risk of infection was so high with the indwelling catheter that it was found to be unacceptable. Intermittent catheterization also carried a high risk of infection, but to overcome this, techniques were devised which had reduced infection to a minimum. A trial of management techniques for the prevention and control of urinary infection during intermittent catheterization was conducted on 36 acute traumatic paraplegics and quadriplegics admitted to the Spinal Injuries Unit of the Royal Perth Hospital during the 22 mth. from 1 February 1968, to 30 November 1969. General measures were taken to ensure that the technique of catheterization was of a very high standard, but this in itself did not prevent urethral bacteria from being carried into the bladder when the catheter was passed. To eradicate these micro-organisms, a high con-centration of 2 bactericidal antibiotics (kanamycin and colistin) were injected into the bladder, before the catheter was withdrawn, and left there. 3,036 catheterizations were performed on the 27 male patients, during which time 16 episodes of significant bacteriuria occurred. The incidence of significant bacteriuria was 1/190 catheterizations (0.53%) for male patients. 1,547 catheterizations were done on 9 female patients, resulting in 9 episodes of significant bacteriuria. The incidence of significant bacteriuria was 1/172 catheterizations (0.58%) for female patients. Three patients died in hospital from causes unrelated to the urinary tract. Of the remaining 33 patients, all but 2 were discharged without catheters, with low residual urines and free from urinary infection.

Study of childhood urinary tract infection in general practice.

A study of bacteriuria was conducted among 426 of the 436 children under the age of 13 in a general practice in north-west London. Three girls and one boy were found to have asymptomatic bacteriuria, and a further girl with bacteriuria presented with abdominal pain and fever. The calculated incidence of urinary tract infection was 1.4% per annum. Most of the childhood urinary infections in this practice occurred before the age of 5 years, and the incidence of significant bacteriuria in this age group was 4.9% per annum. Five other children (four girls and one boy) in the practice were known to have had proved urinary tract infection. Of the total of eight children known to have had significant bacteriuria and investigated radiologically, three girls and two boys had radiological abnormalities in the urinary tract.Pyuria and proteinuria did not prove to be useful in the prediction of asymptomatic bacteriuria. Urinary tract infection with renal tract abnormality was found in this practice to be at least five times as common as diabetes in childhood.