Incidence Of Urinary Tract Infection Research Articles

Urinary catheterization during laparoscopic inguinal hernia repair: Really necessary or a habit?

BackgroundDuring laparoscopic inguinal hernia repair (LIH) repair, it is common practice to insert a urinary catheter (UC) to mitigate the risk of bladder injury or acute postoperative urinary retention. However, this procedure often leads to potential complications or infections. This study aims to evaluate the implications of the UC placement during LIH repair. MethodsThis retrospective, monocentric study included patients who underwent LIH repair between 01/01/2018 to 31/12/2022. Patients were divided into two groups: UC and no-UC. Results212 patients were included: 119 (56 %) in the no-UC group and 93 (44 %) in the UC group. The UC group presented a higher prevalence of bilateral hernias (38.7 % vs. 52.7 %), (p=0.01) and a greater frequency of intraperitoneal approach (TAPP) (83.9 % vs. 100 %), (p=0.01). No intraoperative complications were attributable to the absence of the UC. Four patients in the UC group had postoperative acute urinary retention necessitating intermittent catheterization, allowing discharge (p = 0.13). Rates of readmission and reoperation rates were comparable between groups. One month post-surgery, 7.5 % of UC group patients (vs. 0.8 %) developed urinary tract infection (p=0.01). Subgroup analysis confirmed a higher incidence of urinary tract infections in unilateral hernia and in TAPP procedure. ConclusionRoutine UC insertion during LIH repair seems unnecessary; rather, it increases the risk of postoperative urinary tract infections and should thus be avoided.

Safety of Empagliflozin: An Individual Participant-Level Data Meta-Analysis from Four Large Trials.

Empagliflozin is a sodium-glucose co-transporter-2 inhibitor used to treat type 2 diabetes (T2D) to improve glycemic control, reduce risk of cardiovascular death in patients with T2D, and treat patients with symptomatic chronic heart failure (HF) and chronic kidney disease (CKD). The safety profile of empagliflozin is well documented, although adverse events (AEs) remain of interest to clinicians. This study provides an up-to-date safety evaluation of empagliflozin. Data were pooled from four long-term trials which included: patients with T2D and established cardiovascular disease (EMPA-REG OUTCOME), patients with HF, with/without diabetes (EMPEROR-Reduced and EMPEROR-Preserved), and patients with CKD, with/without diabetes (EMPA-KIDNEY). Since three of the four trials evaluated empagliflozin 10mg, the meta-analysis was restricted to this dose. Total trial medication exposure was 19,727 patient-years for patients who received empagliflozin (n = 10,472) and 19,447 patient-years for placebo (n = 10,461). The percentages of patients with serious AEs, fatal AEs, and AEs leading to discontinuation were similar for both groups. The incidences of serious urinary tract infection and serious pyelonephritis or urosepsis were similar for both groups but higher for women taking empagliflozin versus placebo. Serious genital infections were not increased with empagliflozin versus placebo. There was a slight increase in ketoacidosis and serious volume depletion in patients who received empagliflozin versus placebo. The occurrence of serious acute kidney injury was lower with empagliflozin versus placebo. Empagliflozin was not associated with an increased incidence of severe hypoglycemia, bone fractures, or lower limb amputations. Empagliflozin is therefore considered safe in people without diabetes, the elderly, patients with very low estimated glomerular filtration rate, low body mass index, and HF. Safety is unaltered by blood pressure, concomitant medication for hypertension, HF, and immunosuppression. This meta-analysis of long-term safety data extends current knowledge and confirms the safety and tolerability of empagliflozin.

Effect of a fall within three months of admission on delirium in critically Ill elderly patients: a population-based cohort study

BackgroundDelirium is common among elderly patients in the intensive care unit (ICU) and is associated with prolonged hospitalization, increased healthcare costs, and increased risk of death. Understanding the potential risk factors and early prevention of delirium is critical to facilitate timely intervention that may reverse or mitigate the harmful consequences of delirium.AimTo clarify the effects of pre-admission falls on ICU outcomes, primarily delirium, and secondarily pressure injuries and urinary tract infections. MethodsThe study relied on data sourced from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Statistical tests (Wilcoxon rank-sum or chi-squared) compared cohort characteristics. Logistic regression was employed to investigate the association between a history of falls and delirium, as well as secondary outcomes, while Kaplan–Meier survival curves were used to assess short-term survival in delirium and non-delirium patients.ResultsStudy encompassed 22,547 participants. Delirium incidence was 40%, significantly higher in patients with a history of falls (54.4% vs. 34.5%, p < 0.001). Logistic regression, controlling for confounders, not only confirmed that a history of falls elevates the odds of delirium (OR: 2.11; 95% CI: 1.97–2.26; p < 0.001) but also showed it increases the incidence of urinary tract infections (OR:1.50; 95% CI:1.40–1.62; p < 0.001) and pressure injuries (OR:1.36; 95% CI:1.26–1.47; p < 0.001). Elderly delirium patients exhibited lower 30-, 180-, and 360-day survival rates than non-delirium counterparts (all p < 0.001).ConclusionsThe study reveals that history of falls significantly heighten the risk of delirium and other adverse outcomes in elderly ICU patients, leading to decreased short-term survival rates. This emphasizes the critical need for early interventions and could inform future strategies to manage and prevent these conditions in ICU settings.

A novel score for early prediction of urinary tract infection risk in patients with acute ischemic stroke: a nomogram-based retrospective cohort study

This study aimed to construct and externally validate a user-friendly nomogram-based scoring model for predicting the risk of urinary tract infections (UTIs) in patients with acute ischemic stroke (AIS). A retrospective real-world cohort study was conducted on 1748 consecutive hospitalized patients with AIS. Out of these patients, a total of 1132 participants were ultimately included in the final analysis, with 817 used for model construction and 315 utilized for external validation. Multivariate regression analysis was applied to develop the model. The discriminative capacity, calibration ability, and clinical effectiveness of the model were evaluated. The overall incidence of UTIs was 8.13% (92/1132), with Escherichia coli being the most prevalent causative pathogen in patients with AIS. After multivariable analysis, advanced age, female gender, National Institute of Health Stroke Scale (NIHSS) score ≥ 5, and use of urinary catheters were identified as independent risk factors for UTIs. A nomogram-based SUNA model was constructed using these four factors (Area under the receiver operating characteristic curve (AUC) = 0.810), which showed good discrimination (AUC = 0.788), calibration, and clinical utility in the external validation cohort. Based on four simple and readily available factors, we derived and externally validated a novel and user-friendly nomogram-based scoring model (SUNA score) to predict the risk of UTIs in patients with AIS. The model has a good predictive value and provides valuable information for timely intervention in patients with AIS to reduce the occurrence of UTIs.

Enhanced Labor Management: Implementing WHO Recommendations in Oyo State Nursing Practice

Introduction: An increase in the incidence of Urinary tract infections due to Candida species has been observed. The higher rate of Candiduria due to Non albicans Candida is now being reported than due to Candida albicans.The emergence of drug resistance in Candida species has complicated the patient management. Aim: to observe the prevalence of Candida species in UTIs and their antifungal susceptibility pattern in a tertiary care hospital. Materials and Methods: An observational study was conducted fora period of three months in NIMS, Jaipur. Symptomatic patients belonging to all age groups were included in the study. Catheterized or clean catch midstream urine were centrifuged and the sediment was plated on Sabouraud’s Dextrose Agar slants with and without Chloramphenicol. A wet mount preparation was also made and looked for the presence of pus cells, yeast cells, pseudohyphae, etc. Yeast were identified by using germ tube, Chromogenic agar, chlamydospore formation and carbohydrate assimilation tests. Antifungalsusceptibility testing was performed on Muller Hinton Methylene Blue Agar. Result: The Candida species were isolated in only 24 (4.8%) samples. Only 8 cases yielded Candida albicans(33.33%). The highest cases were found to be of Candida tropicalis (n=14) while remaining two cases has growth of Candida krusai (n=1) and Candida glabrata (n=1). Keywords: WHO guidelines, labor management, and patient care &amp; outcomes.

Incidence of urinary tract infections in patients with permanent percutaneous nephrostomy after implementation of a standardized care program

Incidence of urinary tract infections in patients with permanent percutaneous nephrostomy after implementation of a standardized care program

Incidence of Asymptomatic Urinary Tract Infection in Pregnant Women in Obio Cottage Hospital, Port Harcourt, River State, Nigeria

Incidence of Asymptomatic Urinary Tract Infection in Pregnant Women in Obio Cottage Hospital, Port Harcourt, River State, Nigeria

Disposable grasper-integrated flexible cystoscope for ureteral stent removal in transplanted patients; focus on feasibility, safety, and patient experience. Results and micro-cost analysis from a tertiary referral center.

To evaluate ureteral stent removal (SR) using a grasper-integrated disposable flexible cystoscope (giFC-Isiris ®, Coloplast ®) after kidney transplantation (KT), with a focus on feasibility, safety, patient experience, and costs. All consecutive KT undergoing SR through giFC were prospectively enrolled from January 2020 to June 2023. Patient characteristics, KT and SR details, urine culture results, antimicrobial prescriptions, and the incidence of urinary tract infections (UTI) within 1 month were recorded. A micro-cost analysis was conducted, making a comparison with the costs of SR with a reusable FC and grasper. A total of 136 KT patients were enrolled, including both single and double KT, with 148 stents removed in total. The median indwelling time was 34 days [26, 47]. SR was successfully performed in all cases. The median preparation and procedure times were 4 min [3,5]. and 45 s[30, 60], respectively. The median Visual Analog Scale (VAS) score was 3 [1, 5], and 98.2% of patients expressed willingness to undergo the procedure again. Only one episode of UTI involving the graft (0.7%) was recorded. Overall, the estimated cost per SR procedure with Isiris ® and the reusable FC was 289.2€ and 151,4€, respectively. This prospective series evaluated the use of Isiris ® for SR in a cohort of KT patients, demonstrating feasibility and high tolerance. The UTI incidence was0.7% within 1 month. Based on the micro-cost analysis, estimated cost per procedure favored the reusable FC.

Urinary tract infections in pregnant women

Urinary tract infections (UTIs) are the most common pathology among pregnant women and are associated with maternal and foetal complications. According to some authors, the incidence of UTIs increased 4 times in the last decades of the 20th century. Escherichia coli is the most predominant pathogen causing up to 80% of UTIs, Klebsiella is ranked second causing up to 8% of UTIs, and pathogenic staphylococcus and mixed microflora are ranked third. To diagnose UTIs, laboratory, physical and radiological diagnostic methods are applied. According to most authors, informative value yielded by lab tests is more than 90%. The prescription of antibacterial chemotherapy should be based on the results of urine culture and sensitivity testing. Before the test results are obtained, broad-spectrum antibacterial drugs (ABs) are usually prescribed. The most commonly used therapy regimens are third-generation cephalosporins with dose adjustments, as may be necessary, after sensitivity is determined. Some authors recommend to continue treatment with urinary tract antiseptics after AB therapy is completed. The impaired urine output should be restored before AB therapy is prescribed. This review presents an analysis of the literature that was found in the databases PubMed (the National Library of Medicine), The Cochrane Library, as well as in the research citation databases (Scopus, Web of Science). The etiological factors and features of the pathogenesis of UTIs in pregnant women, as well as diagnostic standards, are described. The current guidelines for the treatment and prevention of UTIs in pregnant women are considered and antibacterial therapy regimens with current dosage forms are presented. The benefits of using cefixime dispersible forms are described in detail.

Prevalence of Urinary Tract Infection among Women in Virudhunagar, Tamil Nadu: Treatment Approach and Perspectives

Introduction: Urinary tract infections (UTIs) represent a significant health burden, particularly among women worldwide. Understanding the prevalence and associated risk factors of UTIs is crucial for effective management and treatment. This research focuses on exploring the prevalence of UTIs in women in Virudhunagar, Tamil Nadu, and identifying the microbial agents responsible for these infections. Aim: The primary objective of this study is to determine the prevalence of urinary tract infections among women in Virudhunagar, Tamil Nadu, and to investigate associated risk factors. Additionally, the research aims to evaluate the microbial agents causing UTIs in the region to inform the development of tailored and effective treatment strategies. Study Design: A Prospective Observational Study was conducted over a period of 6 months at the Outpatient and Obstetric and Gynaecological department of a Tertiary Healthcare Teaching hospital. Female patients presenting with symptoms suggestive of UTIs were recruited for participation in the study after providing informed consent. Methodology/Methods: Data collection encompassed various parameters including patient demographics, symptoms, urine culture results, prescribed antibiotics, and concurrent medications. A sample size of 480 participants was determined through an extensive review of literature. Statistical analysis was performed to analyze the collected data. Results: Out of the 480 participants, 117 individuals tested positive for UTIs, indicating a prevalence rate of [24.4%]. The age group 15-24 exhibited the highest incidence of UTIs, with a mean age of 30. Educational and marital status was found to influence infection rates. Common symptoms included increased frequency of urination and painful urination. E.coli was identified as the primary pathogen responsible for UTIs. Cephalosporin antibiotics were the most frequently prescribed treatment modality. Conclusion: Urinary tract infections are prevalent among women in Virudhunagar, Tamil Nadu, as evidenced by the findings of this study. The identification of associated risk factors and microbial agents provides valuable insights for clinical decision-making and the development of tailored treatment approaches. These findings underscore the importance of continued research in UTI management to address the global health burden posed by this infection.

Decreased incidence of urinary tract infections in febrile infants aged ≤60 days during COVID-19 pandemic.

To investigate the incidence rate of urinary tract infections (UTIs) among febrile infants aged ≤60 days before, during, and after the COVID-19 pandemic. We conducted a retrospective study in 2 Swedish paediatric emergency departments between 2014 and 2022. We included full-term infants aged ≤60 days with fever without source. We calculated the annual incidence rate of UTI per 1000 births. We included 1589 full-term infants with fever without source. In 2020, 89 infants were evaluated in the emergency department versus 203-259 in 2017-2019. In 2020, the incidence rate of UTI was 1.43 per 1000 births/year versus 2.18-2.37 in 2017-2019. The median age, sex, fever duration, and urine testing were similar between the years 2017 and 2020. The number of febrile infants who presented to the paediatric emergency department and the incidence rate of UTIs decreased in 2020. This decrease might imply a systematic misdiagnosis of UTIs in infants with febrile viral infections. A more selective urine testing approach for febrile, previously healthy, infants should be considered to mitigate UTI misdiagnosis and its potential harmful effects.

Prediction Model for Pregnancy Success in IVF Program in the Poor Prognosis Group

Introduction: An increase in the incidence of Urinary tract infections due to Candida species has been observed. The higher rate of Candiduria due to Non albicans Candida is now being reported than due to Candida albicans.The emergence of drug resistance in Candida species has complicated the patient management. Aim: to observe the prevalence of Candida species in UTIs and their antifungal susceptibility pattern in a tertiary care hospital. Materials and Methods: An observational study was conducted fora period of three months in NIMS, Jaipur. Symptomatic patients belonging to all age groups were included in the study. Catheterized or clean catch midstream urine were centrifuged and the sediment was plated on Sabouraud’s Dextrose Agar slants with and without Chloramphenicol. A wet mount preparation was also made and looked for the presence of pus cells, yeast cells, pseudohyphae, etc. Yeast were identified by using germ tube, Chromogenic agar, chlamydospore formation and carbohydrate assimilation tests. Antifungalsusceptibility testing was performed on Muller Hinton Methylene Blue Agar. Result: The Candida species were isolated in only 24 (4.8%) samples. Only 8 cases yielded Candida albicans(33.33%). The highest cases were found to be of Candida tropicalis (n=14) while remaining two cases has growth of Candida krusai (n=1) and Candida glabrata (n=1). Keywords: Infertility, prediction model, In Vitro Fertilization, Logistic Regression, Endometrial Thickness, Poor Prognosis, Clinical Pregnancy

Men with lower UTI in primary healthcare. General practitioners' experiences of diagnosis and treatment in relation to clinical guidelines. A qualitative interview-based study.

The incidence of lower urinary tract infection (LUTI) in men visiting primary health care (PHC) is low. Hence, GPs do not diagnose and treat men with LUTI very often. Previous studies have shown that adherence to treatment guidelines regarding LUTI in men is low. There is limited knowledge concerning why guidelines are not adhered to. To gain knowledge on GPs' experiences and concerns when treating men with LUTI, including their use of clinical guidelines. Furthermore, to explore GPs' knowledge and concern regarding antibiotic resistance. A qualitative study based on semi-structured interviews with GPs was performed. 15 GPs from seven PHC centres in southern Sweden were interviewed. The interviews were conducted from September 2022 to March 2023. All interviews were audio recorded and transcribed verbatim. A thematic analysis was performed. GPs had limited experience with and felt uncertain when diagnosing male LUTI. Extended examinations could partially relieve this feeling. GPs were well informed about the Swedish treatment guidelines for LUTI in men and felt safe to treat their patients according to the guidelines. However, GPs also acknowledged that guidelines do not cover all situations and need to be individualised. Many GPs feel insecure when diagnosing male LUTI. The relatively low prevalence of this condition in PHC could contribute to this feeling. Clear and instructive guidelines regarding both the diagnostic process and adequate antibiotic choices are important to maintain good quality in the management of LUTI in men.

To Assess the Effectiveness of Structured Teaching Program on Knowledge Regarding the Prevention of Urinary Tract Infection among Adolescent Girls

Urinary Tract Infection (UTI) is common affecting throughout their life. It occurs in all populations from neonates to geriatric patients but it has a particular impact on females of all ages especially during the adolescent period. UTIs are much more common in adults than in children but about 1-2% of children do get UTIs. A short urethra in women is mostly responsible for the high incidence of UTI among them. This study examines the effectiveness of structured teaching programs in the prevention of UTI among adolescent girls. The objectives of the study were, to identify the knowledge regarding the prevention of UTI among adolescent girls, to provide &amp; evaluate the effectiveness of structured teaching programs on the prevention of UTI among adolescent girls &amp; to determine the association between knowledge regarding the prevention of UTI among adolescent girls and selected demographic variables. This study was conducted at Nehru College of Nursing Panyoor post-Vaniyamkulam. The research design adopted for the study was a pre-experimental one-group pre-test post-test design. A sample of 40 students in the age group of thirteen to nineteen years was selected conveniently for the study. The data was collected by using a socio-demographic profile and a structured knowledge questionnaire regarding UTI following which, a planned teaching program on “prevention of UTI” was administered to adolescent girls on the second day. In the pretest score, about of sample 15% had good knowledge in pretest, 75% had average knowledge, and 10% had poor knowledge. After the teaching program (posttest) 87.5% had good knowledge and 12.5% had average knowledge. The previous episodes of UTI and previous knowledge regarding UTI are significant. As it is a problem focused on adolescent girls might support reducing the occurrence of UTIs.

Effect of transcutaneous electrical acupoint stimulation on postoperative urinary function in elderly patients undergoing total hip arthroplasty.

To observe the effect of transcutaneous electrical acupoint stimulation (TEAS) on postoperative urinary function in elderly patients undergoing total hip arthroplasty (THA). One hundred and eighty elderly patients undergoing unilateral THA without indwelling urinary catheters were randomly assigned to a TEAS group (90 cases, 3 cases dropped out, 4 cases were eliminated) and a sham TEAS group (90 cases, 1 case dropped out, 4 cases were eliminated). Both groups received fascia iliac block and subarachnoid block anesthesia under ultrasound guidance. The patients in the TEAS group were treated with TEAS at Zhongji (CV 3), Guanyuan (CV 4), and bilateral Huiyang (BL 35), Ciliao (BL 32) 30 minutes before anesthesia initiation, with dissperse-dense wave, frequency of 2 Hz/100 Hz, until 30 minutes after surgery. The patients in the sham TEAS group underwent the same procedure with the device applied at the same acupoints but without electrical stimulation. The incidence of postoperative urinary retention (POUR), time to first void, voiding threshold, urinary adenosine triphosphate (ATP) level, postoperative abnormal voiding status (bladder residual volume, re-catheterization rate, nocturia occurrence), and postoperative incidence of urinary tract infection (UTI) and prosthetic joint infection (PJI) were observed in both groups. The incidence of POUR in the TEAS group was lower than that in the sham TEAS group (P<0.05); the time to first void in the TEAS group was shorter than that in the sham TEAS group (P<0.05); the voiding threshold in the TEAS group was lower than that in the sham TEAS group (P<0.05); the urinary ATP level in the TEAS group was higher than that in the sham TEAS group (P<0.05); the bladder residual volume in the TEAS group was lower than that in the sham TEAS group (P<0.05); the nocturia occurrence in the TEAS group was lower than that in the sham TEAS group (P<0.05). However, there was no statistically significant difference in re-catheterization rate, incidence of UTI, and incidence of PJI between the two groups (P>0.05). TEAS could effectively reduce the occurrence of postoperative urinary retention and improve the postoperative urinary function in elderly patients undergoing THA, which might be related with increasing the urinary ATP level.

Antibiotic prophylaxis in invasive urodynamics, a Delphi consensus of the Italian Society of Urodynamics (SIUD).

Although antibiotic prophylaxis (AB) demonstrated a statistically significant reduction in bacteriuria after invasive urodynamics (UDS), no significant decrease in the incidence of urinary tract infections (UTI) has been confirmed. No absolute recommendations on the use of AB in case of relevant potential risk of UTI have been reported, though some categories of patients at increased infective probability after UDS have been recognized. The aim of this study is to report the experts' consensus on the best practice for the use of AB before UDS in the main categories of patients at potential risk of developing UTI. A systematic literature review was performed on AB before UDS in males and females. A panel of experts from the Italian Society of Urodynamics, Continence, Neuro-Urology, and Pelvic Floor (SIUD) assessed the review data and decided by a modified Delphi method on 16 statements proposed and discussed by the panel. The cut-off percentage for the consensus was a ≥70% of positive responses to the survey. The study was a Delphi consensus with experts' opinions, not a clinical trial involving directly patients. The panel group was composed of 57 experts in functional urology and UDS, mainly urologists, likewise gynaecologists, physiatrists, infectivologists, pediatric urologists, and nurses. A positive consensus was achieved on 9/16 (56.25%) of the statements, especially on the need for performing AB before UD in patients with neurogenic bladder and immunosuppression. Urine analysis and urine culture before UDS are mandatory, and in the event of their positivity, UDS should be postponed. A consensus was reached on avoiding AB in menopausal status, diabetes, age, gender, bladder outlet obstruction, high postvoid residual, chronic catheterization, previous urological surgery, lack of urological abnormalities, pelvic organ prolapse, and negative urine analysis. Antibiotic prophylaxis is not recommended for patients without notable risk factors and with a negative urine test due to the potential morbidities that may result from antibiotic administration. However, AB can be used for risk categories such as neurogenic bladder and immunosuppression. The evaluation of urine analysis and urine culture and postponing UDS in cases of positive tests were considered good practices, as well as performing AB in the neurogenic bladder and immunosuppression.

Outcomes of Bladder Washout for the Treatment of Recurrent Urinary Tract Infections After Renal Transplantation.

Background Current literature suggests that anywhere from 2.9-27% of renal transplant recipients (RTR) will develop recurrent urinary tract infections (UTIs) (≥2 UTIs over six months or ≥3 UTIs over 12 months). Recurrent UTIs are of particular importance to RTR given its increased risk for allograft fibrosis and overall patient survival. Alternative solutions are needed for the management of recurrent UTIs, especially given the vulnerability of RTR to UTIs. We hypothesize that bladder washout (BW) reduces the incidence and recurrence of UTIs in RTR. Methods This is a retrospective study evaluating the utility of BW procedures on RTR diagnosed with recurrent UTIs between December 2013 and July 2021 at a single center. Results A total of 106 patients were included in the study with a total of 118 BW performed. 69% of patients were successfully treated with BW, meaning they no longer met the criteria for recurrent UTIs (<1 UTI) in the six-month post-BW period. The mean number of UTIs was 2.76 (range 2-7) before the BW and 1.16 (range 0-5) after the BW. On average, there were 1.60 fewer UTIs in the post-BW period compared to the pre-BW period (p<0.0001). There is no statistically significant difference in success rates stratified by bacterial class (p=1) or antimicrobial resistance class (p=0.6937). Conclusion BWdecreased the incidence of UTIs in the six-month post-operative period as nearly 70% of patients did not have UTI recurrence. This data provides evidence that BW may have utility in transplant recipients with recurrent UTIs. We hope this will stimulate further prospective randomized studies in this area.

Post-discharge surveillance of urinary tract infections in patients following hip and knee arthroplasty: Identifying targets for infection prevention and control

This population-based study aimed to evaluate the incidence of urinary tract infections (UTIs) following hip and knee arthroplasty (HPRO and KPRO) and to identify UTI risk factors among Polish patients. Analysis included data from 83,525 patients, with incidence rates of 0.7% and 0.49% after HPRO and KPRO, respectively. We identified women, individuals over 65 years old, residents of long-term care facilities, patients with chronic circulatory, endocrine, or digestive diseases, and those operated on due to trauma as targets for infection prevention and control.

Factors Associated With Onabotulinum Toxin-A Discontinuation in a Diverse Urban Population.

Although overactive bladder (OAB) is a common condition, affecting 16% of Americans, few patients continue on to advanced therapies. Furthermore, procedural therapies like intravesical onabotulinum toxin-A (BTX-A), which require ongoing repeat treatments, have discontinuation rates ranging from 25% to 51%. This study sought to investigate factors associated with dis-continuation of BTX-A injections for idiopathic OAB among a diverse urban population. This was a retrospective review of adults 18 years and older who underwent BTX-A injection for idiopathic OAB. Patient demographics, past medical history, symptoms, and postprocedural outcomes such as subjective improvement, urinary retention, and incidence of urinary tract infection were compared between groups. Onabotulinum toxin-A injections were administered to 246 patients who met study criteria, of whom 211 (85.7%) were women. One hundred (40.7%) patients discontinued BTX-A therapy. Patients discontinuing BTX-A therapy were more likely to have developed postprocedural urinary retention (18.4% vs 9.7%, P < 0.05) and had a higher median income by zip code ($59,000 vs $50,000; P < 0.01). Patients were significantly more likely to continue BTX-A therapy if they reported preprocedural nocturia (57.2% vs 36.8%, P < 0.01) or urgency urinary incontinence (UUI) (78.1% vs 64.6%, P < 0.05). Adverse outcomes, such as postprocedural urinary retention, are associated with discontinuation of BTX-A therapy. Patients who reported nocturia and UUI before injection were more likely to continue BTX-A suggesting more severe OAB is more responsive to this therapy. Given the large proportion (>40%) of patients who discontinued BTX-A treatment, further research is needed to identify barriers to continuation of care.

Short‐term urinary catheter usage in endoscopic skull base surgery and impact on urinary tract infection and reconstructive outcomes

AbstractObjectivesHospital‐acquired catheter‐associated urinary tract infections (UTIs) have been regarded as preventable adverse events, yet their risk in endoscopic skull base surgery (ESBS) has not been well described despite common use. We determine the incidence of UTI following ESBS and identify contributing clinical factors.MethodsRetrospective review was conducted for a cohort of 229 consecutive adult patients who underwent endoscopic endonasal surgery for treatment of any skull base pathology between July 2018 and June 2022 at a tertiary academic skull base surgery program. Postoperative UTI comprised the primary outcome. Independent variables included patient demographics, use and length of urinary catheterization, and pre‐existing genitourinary conditions.ResultsNosocomial UTIs were identified in 1.3% (3/229) of patients, occurring on postoperative days 2, 9, and 14, respectively; all were catheter‐associated. Overall, 86.0% (197/229) of patients received urinary catheters (mean duration 2.2 ± 1.8 days). Compared to those without, patients with UTI were older (70.0 ± 15.4 vs. 52.2 ± 16.8 years, p = 0.034), had lengthier stays (94.7 ± 126.8 vs. 5.9 ± 8.4 days, p &lt; 0.001), and had prolonged catheterizations (9.3 ± 5.5 vs. 2.1 ± 1.5 days, p &lt; 0.001). Preoperative genitourinary conditions were also associated with UTI development, namely, chronic urinary retention/obstruction (66.7% vs. 4.0%, p = 0.006), urinary incontinence (66.7% vs. 6.2%, p = 0.013), prostate disease (100.0% vs. 17.8%, p = 0.035), and renal dysfunction (100.0% vs. 9.7%, p = 0.001). Among intraoperative cerebrospinal fluid leak patients, postoperative CSF leak incidence was not associated with catheter use versus nonuse (3.3% vs. 12.5%, p = 0.276).ConclusionAlthough UTIs are uncommon in ESBS patients, advanced age, length of stay, duration of indwelling urinary catheterization, and comorbid genitourinary conditions may elevate risk.