Urinary Tract Instrumentation Research Articles

Literature Review : Prevalensi Jumlah Leukosit Pada Sampel Urine Pasien dengan Pemasangan Kateter

The use of urinary catheters is very common in hospitals. Urinary catheters are the most common cause of bacteriuria. Urinary tract infections are the cause of more than 1/3 of all hospital-acquired infections. Most of these infections (at least 80%) are caused by invasive procedures or urinary tract instrumentation, usually in the form of catheterization. Urine sediment examination aims to detect and identify insoluble materials in urine. The purpose of this study was to determine the prevalence of leukocyte counts in patients with catheter placement based on a literature review and to analyze the number of leukocytes in patients with catheter users based on a literature review. The method used was Systematic Literature Review (SLR). The results of this study obtained the results of the number of samples based on gender in women as many as 223 people and in men 147 people, with a total number of patients as many as 370. then the results of the number of samples based on patient age, the number of patients who were most catheterized at the age of 56-65 as many as 101 patients (27.0%), followed by age 46-55 as many as 96 patients (25.0%), age 36-45 as many as 68 patients (18.0%), age 26-35 as many as 39 patients (10.0%), age 17-25 as many as 30 patients (8.0%), and age> 65 as many as 36 patients (9.0%) with a total of 370 patients. The results of the study can be concluded that catheter installation can cause urinary tract infections.

Violation of onco-surgical principles is associated with survival outcomes in upper tract urothelial carcinomas after radical nephroureterectomy.

Disease recurrence, particularly intravesical recurrence (IVR) after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC), is common. We investigated whether violations of onco-surgical principles before or during RNU, collectively referred to as surgical violation (SV), were associated with survival outcomes. Material and methods: Data from a consecutive series of patients who underwent RNU for UTUC 2001-2012 at Skåne University Hospital Lund/Malmö were collected. Preoperative insertion of a nephrostomy tube, opening the urinary tract during surgery or refraining from excising the distal ureter were considered as SVs. Survival outcomes in patients with and without SV (IVR-free [IVRFS], disease-specific [DSS] and overall survival [OS]) were assessed using multivariate Cox regression analyses (adjusted for tumour stage group, prior or concomitant bladder cancer, comorbidity and preoperative urinary cytology). Of 150 patients, 47 (31%) were subjected to at least one SV. Overall, SV was not associated with IVRFS (HR 0.81, 95% CI 0.4-1.6) but with worse DSS (HR 1.9, 95% CI 1.03-3.7) and OS (HR 1.9, 95% CI 1.2-3) in multivariable analysis. Additional analyses with a broader definition of SV including also preoperative instrumentation of the upper urinary tract (ureteroscopy and/or double J stenting) showed similar outcomes for DSS (HR 2.1, 95% CI 1.1-4.3). Worse survival outcomes, despite no difference in IVR, for patients that were subjected to the violation of sound onco-surgical principles before or during RNU for UTUC strengthen the notion that adhering to such principles is a cornerstone in upper tract urothelial cancer surgery.

The Utility of Intraluminal Therapies in Upper Tract Urothelial Carcinoma: A Narrative Review

Nephron sparing surgery (NSS) is considered for selected cases of upper tract urothelial carcinoma (UTUC) as it maintains renal function and avoids morbidity associated with radical nephroureterectomy (RNU). The appropriate selection of patients suitable for NSS without compromising oncological outcomes can sometimes be difficult, given the limitations of diagnostic modalities. Recurrence rates for UTUC can be as high as 36 to 54% after NSS. Intraluminal adjuvant therapy can be attempted following NSS to reduce recurrence, but delivery to the upper tract is more challenging than into the bladder. Bacillus Calmette-Guerin (BCG) and chemotherapy such as Mitomycin (MMC) have been administered via nephrostomy or ureteric catheter, which requires invasive/repeated instrumentation of the upper urinary tract. Drug delivery by reflux from bladder instillation along indwelling stents has also been tried but can potentially be unreliable. Recently, a gel formulation of mitomycin has been developed for the controlled exposure of the upper urinary tract to treatment over a number of hours. Drug-eluting stents to deliver chemotherapy to the upper urinary tract have been developed but have not yet entered clinical practice. Endoluminal phototherapy utilising an intravenous photosensitising agent is another novel approach that has recently been described. Intraluminal therapies may be beneficial in decreasing recurrence rates in UTUC, but currently have some limitations in their usage.

Correlation of Total Serum Prostate Specific Antigen and Prostate Specific Antigen Density with subclinical inflammation in Benign Prostatic Hyperplasia

Background Serum PSA is an important tumor marker for diagnosis of prostate cancer. However, it can rise in some other benign conditions like benign prostatic hyperplasia (BPH), prostatitis, prostatic infarct, instrumentation, prostate manipulations like examination, transurethral resection and urinary tract infection (UTI). The aim of this study was to find correlation of total serum PSA and PSAD with extent and aggressiveness of subclinical inflammation in BPH.MethodsThis cross-sectional study was conducted on 25 cases of transurethral resection of prostate and open prostatectomy specimens diagnosed with BPH received in time period of July 2022 to June 2023. Cases with clinical signs and symptoms of prostatitis, positive urine culture, diagnosed as prostate cancer, cases with history of previous surgery of prostate and history of instrumentation of urinary tract were excluded. Total serum PSA and prostate weight were measured. PSAD was calculated. Histological inflammation was graded with respect to extent and aggressiveness. PSA and PSAD were correlated with extent and aggressiveness of inflammation.ResultsThere was no statistically significant correlation between inflammation extent score and total serum PSA (p = 0.318). Also, there was no correlation between inflammation extent score and PSAD (p = 0.308). However, there was significant correlation between inflammation aggressiveness score and total serum PSA (p = 0.011). Similarly, there was also correlation between inflammation aggressiveness score and PSAD (p = 0.010).Conclusions Repeat unnecessary biopsies may be avoided in cases with high total serum PSA in presence of glandular epithelial disruption in histological prostatitis.

A CROSS SECTIONAL STUDY OF ASYMPTOMATIC BACTERIURIA IN TYPE 2 DIABETES MELLITUS AND THEIR ANTIBIOTIC SUSCEPTIBILITY

Background: Diabetes is a metabolic disease characterized by hyperglycemia because of defect in insulin secretion or action or both. Asymptomatic bacteriuria (ASB) is common in diabetics and elderly which predisposes them to severe urinary tract infections. Reports on prevalence, etiology, antibiotic susceptible pattern are sparse in southern India. This study aimed to determine the prevalence of asymptomatic bacteriuria in patients with type 2 Diabetes mellitus Material & Method: This cross sectional study was conducted among the diabetic patients presenting to inpatient and outpatient ward in department of general medicine AVMC&H with ailments other than urinary tract infection were included. patients with symptoms of UTI, vulvovaginitis, pregnancy, recent history of hospitalization, recent urinary tract instrumentation, use of antimicrobial in last 14 days or UTI in recent past were excluded. Mid stream urine samples were collected from consented subjects. Urine samples were processed and examined for the various pathogens using the standard microbiological procedures. The spectrum of organisms causing asymptomatic bacteriuria and their antibiotic susceptibility prole. All data were collected by the investigator and was analysed statistically to nd the level of signicance of the study using SPSS v21. Results: In the present study total of 150 diabetic patients fullling inclusion criteria are included, with mean age of 55.6±10yrs, among them 66 were female and 84 were male patients. The isolates found to be in 50 patients (33.33%) out of 150 patients. Among the isolates, majority were with Escherichia Coli 52%, followed with 22% showing Klebsiella pneumoniae, 16% with Enterococcus species, 6% with proteus and 2% with Coagulase negative staphylococcus. Conclusion:The present study document 33.33% of the patients showing the asymptomatic bacteriuria. Among the isolates Escherichia coli was the most common organism among the patients with ASB. The presence of isolates was also correlated with the poor glycaemic control among the study participants, as one of the risk factor for ASB. Most isolates showed multiple resistance, indicating the need to speed up sensitization against antibiotic abuse

Clinical results of a phase 1 study of intravesical EG-70 in patients with BCG-unresponsive NMIBC.

512 Background: enGene is developing non-viral gene therapy platforms to deliver nucleic acids (plasmids) to epithelial mucosal tissues such as urothelium of urinary bladder. EG-70 is a nanoparticle formulation of plasmids that activates both innate and adaptive immune responses to activate the immune system within the bladder. The plasmid encodes both IL-12 and activators of the innate immune receptor RIG-I. EG-70 is administered intravesically to elicit local stimulation of anti-tumor immune responses providing durable efficacy in high grade non-muscle invasive bladder cancer (NMIBC) while avoidingsystemic toxicities. Methods: In the Phase 1 study(LEGEND; NCT04752722), escalating doses of EG-70 were administered intravesically to patients with BCG-unresponsive Carcinoma in situ (CIS) NMIBC on weeks 1 and 2 or weeks 1, 2, 5, 6 of 12-week treatment cycle. At the week 12 assessment, patients with stable disease (SD) or complete response (CR), as assessed by urine cytology, cystoscopy, and bladder biopsy, were allowed electively to remain on EG-70 for up to 3 additional 12-week cycles. Results: To date, 19 patients have been treated. There have been no DLTs. AEs (48 GR1, 17 GR 2 and 1 GR3) have been largely consistent with urinary tract instrumentation, and were not dose related. Eighteen patients have completed one cycle of EG-70, and 67% have achieved CR. Fifteen patients with CR or SD at the end of cycle 1 elected to receive additional treatment cycles (continuation rate of 15/18 ( 83%)). Durable CRs were seen at all dose levels. Patients who receive additional cycles are followed for durability of response (Table). Complete Response. Conclusions: These results demonstrate the safety, tolerability and durable therapeutic potential of intravesical EG-70 in patients with BCG-unresponsive CIS. A Phase 2 study will proceed in 2023. Clinical trial information: NCT04752722 . [Table: see text]

2234. Clinical Significance of Staphylococcus aureus Bacteriuria without Bacteremia

Abstract Background Staphylococcus aureus urinary tract infection (UTI) is uncommon. Staphylococcus aureus bacteriuria (SABU) can occur in patients with urinary tract instrumentation, urinary calculi, or S. aureus bacteremia (SAB) and is associated with development of invasive diseases and death. Thus, SABU is often treated with a prolonged course of antimicrobial therapy similar to SAB. However, little is known about the significance of SABU in patients without SAB and recent urinary tract instrumentation. Methods We conducted a retrospective study of patients with SABU in the Veterans Affairs (VA) system nation-wide from 2017 to 2019. Patients with concomitant SAB, recent history of urinary tract instrumentation, or overt urologic abnormalities were excluded. The primary outcome was development of invasive S. aureus infections or death within 12 months. The secondary outcome was recurrent SABU within 12 months. Results 133 patients met the inclusion criteria. 102 patients (76%) received antimicrobial treatment for SABU. The duration of treatment ranged from 3-30 (mean = 8.5) days. Compared with the non-treated group, patients treated with antimicrobials had significantly more urinary tract symptoms (p = 0.0001), microscopic pyuria (p = 0.002), and hematuria (p = 0.035). Of those treated, 11 (7.3%) died within 12 months of SABU compared to 4 patients (13%) who did not receive treatment (p = 0.749). Three percent of patients from both groups (n = 3 vs 1) developed invasive S. aureus infections within 12 months (p = 1.00). 16% of patients in the treatment group (n = 17) and non-treatment group (n = 5) were found to have recurrent SABU within 12 months (p = 1.00). Conclusion Patients without recent urinary tract instrumentation, overt urologic abnormalities, and SAB who were treated for SABU did not have significant differences in death, invasive diseases, or recurrent SABU at 12 months compared to those who did not receive treatment. Untreated patients did not appear to have frequent complications; however, our numbers were small and our analysis did not take confounding into account. Further analysis into SABU treatment may be warranted. Disclosures All Authors: No reported disclosures.

2236. Effectiveness of TBP-PI-HBr in Patients with Instrumentation, Anatomic or Functional Abnormalities: Secondary Analysis from ADAPT-PO

Abstract Background Tebipenem pivoxil hydrobromide (TBP-PI-HBr) is an oral carbapenem with activity against Enterobacterales uropathogens, including drug resistant strains. The ADAPT-PO trial demonstrated the non-inferiority of oral TBP-PI-HBr vs. intravenous (IV) ertapenem (ERT) in treating patients with cUTI and/or acute pyelonephritis (AP). Patients with certain anatomical disorders, functional (metabolic or neurological) disorders and/or urinary tract instrumentation (i.e., indwelling catheters) are at increased risk for poor outcomes and recurrent bacteriuria. This secondary analysis of ADAPT-PO evaluated outcomes in patients with various cUTI risk factors. Methods ADAPT-PO was a Phase 3 multinational, double-blind, double-dummy trial evaluating oral TBP-PI-HBr vs. IV ERT in 1372 hospitalized adult patients with cUTI/AP. Patients were randomized 1:1 to oral TBP-PI-HBr or IV ERT for 7-10 days. The primary efficacy endpoint was overall response (composite favorable clinical and microbiologic response) in the microbiological intent-to-treat (micro-ITT) population. Overall outcomes were assessed among patients with identified with at least one cUTI risk factor at baseline. Results At baseline, 382/449 (85.1%) and 361/449(86.2%) of patients in the TBP-PI-HBr and ERT arms, respectively had ≥1 risk factor and 289 (64.4%) and 268 (64.2%) had ≥2 risk factors. Anatomical abnormalities and/or urinary track instrumentation were present in 252 (56.1%) TBP-PI-HBr and 242 (57.8%) ERT patients; functional abnormalities were present in 90 (20.0%) and 85(20.3%) respectively). Among patients with ≥1 risk factor, overall response at TOC was 56.3% and 59.6% with TBP-PI-HBr and ERT, respectively, vs. 73.1% and 74.1% among those with no risk factors. Clinical response rates at TOC were high and similar in both arms in patients with (≥92.9%) and without (≥91.4%) risk factors whereas microbiologic responses were more variable between the 2 subsets. Conclusion In cUTI patients with ≥1 risk factor for complicated disease at baseline, outcomes were comparable between oral TBP-PI-HBr and IV ERT. As expected, these patients were at higher risk for recurrent bacteriuria. Overall responses in both groups were higher among patients without these risk factors. Disclosures Angela K. Talley, MD, Spero Therapeutics: Employee|Spero Therapeutics: Stocks/Bonds Paul B. Eckburg, MD, AN2 Therapeutics: Stocks/Bonds|Spero Therapeutics: Advisor/Consultant Ian A. Critchley, PhD, Spero Therapeutics: Employee|Spero Therapeutics: Stocks/Bonds Ian A. Critchley, PhD, Spero Therapeutics: Employee|Spero Therapeutics: Stocks/Bonds Gary E. Moore, PhD, Spero Therapeutics: Advisor/Consultant Nivedita Bhatt, PhD, Spero Therapeutics: Employee|Spero Therapeutics: Stocks/Bonds Lori A. Muir, B.Sc., Spero Therapeutics: Employee|Spero Therapeutics: Stocks/Bonds Lori A. Muir, B.Sc., Spero Therapeutics: Employee|Spero Therapeutics: Stocks/Bonds David Melnick, MD, Spero Therapeutics: Employee|Spero Therapeutics: Stocks/Bonds.

178. Impact of a microbiology comment nudge on the diagnostic evaluation of Staphylococcus aureus bacteriuria

Abstract Background Staphylococcus aureus is a relatively uncommon cause of urinary tract infections. S. aureus bacteriuria is thought to result most commonly from urinary tract instrumentation (ascending infection) or via hematogenous seeding of the genitourinary tract (descending infection). Given the devastating impact of invasive S. aureus infection and awareness that S. aureus bacteriuria is often a marker for S. aureus bacteremia, growth of S. aureus from urine cultures should prompt urgent clinical assessment, including blood culture collection. In April 2021, a comment nudge was added to the microbiology culture and susceptibility report for all S. aureus isolated from urine cultures performed at the Atlantic Consolidated Laboratory (ACL) at Atlantic Health System. The purpose of this study is to assess the impact of a comment nudge on the diagnostic evaluation of S. aureus bacteriuria. S. aureus bacteriuria comment nudge Methods All patients with S. aureus bacteriuria were retrospectively identified from the ACL microbiology database. The primary endpoint was collection of blood cultures within 96 hours of positive urine culture during the 6-month period pre-comment (October 2020 – April 2021) compared to 6-month period post comment (May 2021 – November 2021). In addition, incidence of S. aureus bacteremia among the patients with collected blood cultures was also evaluated. Results S. aureus bacteriuria was identified in 122 patients during the Pre-Comment period and 188 patients in the Post-Comment period. Blood cultures were collected more frequently in the Post-Comment period compared to the Pre-Comment period (64% vs. 51%, p=0.018). Among patients for whom blood cultures were collected, 29% had concomitant S. aureus bacteremia in the Pre-Comment period compared to 16% in the Post-Comment period (p=0.03). Conclusion The addition of a comment nudge to the microbiology report of urine cultures growing S. aureus significantly improved follow-up blood culture collection. Health systems may consider implementation of similar interventions, particularly in resource-limited settings, to avoid delayed recognition of S. aureus bacteremia. Disclosures All Authors: No reported disclosures.

P161 Epidemiological trends of Candida species in urine culture— a retrospective study in a tertiary care hospital in Punjab

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMObjectivesThe presence of Candida species in the urine (Candiduria) is a typical clinical observation, especially in hospitalized patients. It is more common in immunocompromised persons, in bone marrow transplant unit (BMTU) patients, and in those who are in intensive care units (ICUs). Urinary tract infections (UTIs) can be caused by any Candida species. Now, non-albicans Candida species prevail in many locations around the world. Urinary tract instrumentation, past antibiotic usage, lengthy hospital stay, extremes of age, diabetes mellitus, female gender, and immunosuppressive medication are all risk factors for candiduria. Candiduria represents colonization in the majority of adult patients in critical care settings, and antifungal medication is not necessary. The presence of yeast in the urine, on the other hand, can indicate a widespread illness. Candiduria often indicates widespread candidiasis in severely unwell newborns and is followed by blocking fungus ball development in the urinary tract.MethodsA retrospective study was conducted at Christian Medical College and Hospital, Ludhiana from March 1, 2020 to March 31, 2022. The acquired urine samples were promptly processed in the microbiological laboratory using a semi-quantitative culture technique in accordance with normal protocols. All of the yeast isolates were processed further on Corn meal agar (CMA) for further speciation.ResultsOut of the 9729 urine samples received, there was culture growth for Candida species in 511 (5.25%) samples. Amongst the patients who had candiduria, 180 (35.22%) patients were immunocompromised. Out of 511 Candida isolates, 122 (23.87%) were Candida albicans and 389 (76.12%) were non-albicans Candida. Further speciation of non-albicans Candida indicated the prevalence of C. glabrata, C. tropicalis, C. krusei, C. parapsilosis, and C. guielliermondii as 98 (19.17%), 89 (17.41%), 78 (15.26%), 78 (15.26%) and 46 (9%) respectively.ConclusionThe most prevalent healthcare-associated infection is nosocomial UTI. Candida species is becoming a more common cause of nosocomial urinary tract infections. C. albicans was the most common species isolated from the urinary system for many years. Now, non-albicans Candida species have emerged as a result of the introduction and widespread usage of fluconazole. These non-albicans species may be more difficult to remove than C. albicans because they are more adapted to the kidney and collecting system. With controlling underlying diabetes, daily assessment of need of urinary catheterization, early removal of catheter, surgical removal of obstruction of urinary tract and timely de-escalation of antibiotics can prevent candiduria in most of the cases. Thus, we can avoid antifungal therapy which may contribute to the resistance.

Calibre of the External Urethral Meatus in Indian Population: A Cross-sectional Study

Introduction: Transurethral resection instruments are designed as per western standards and are often found to be larger for Indian patients, leading to urethral trauma during instrumentation or higher incidence of urethral strictures postoperatively. Aim: To assess and record the calibre of the External Urethral Meatus (EUM) among Indian male and female population. Materials and Methods: This cross-sectional study was done at a tertiary health care centre over a period of one and half years from July 2016 to December 2017. All male and female patients above the age of 12 years undergoing lower urinary tract instrumentation at the institute underwent assessment for EUM calibre. A total of 1,127 males and 182 females were enrolled in the study. Descriptive statistics (mean, Standard Deviation, and range) were performed for age, height and the EUM in males and females. Linear regression analysis was used to analyse the correlation between EUM calibre and age; and EUM calibre and body height. The correlation was considered statistically significant when p<0.05. Results: The mean EUM calibre of the male population was observed to be 23.23±1.60 Fr and that of the female population was 23.58±2.00 Fr. On linear regression analysis, a significant but weak correlation was found between EUM calibre and body height in male (R2 value: 0.024, p-value<0.0001). On the other hand, no correlation was observed between EUM calibre and body height in females (R2 value: 0.009, p-value= 0.196). Conclusion: The average calibre of the EUM in Indian males was 23.23 Fr which is about 3 Fr smaller than the standard transurethral resectoscope sheath. Thus, use of larger sized sheaths may result in urethral stricture in narrow calibre urethra.

Gas-Containing Kidney Stones: A Case Report

Gas-containing kidney stones are rare cases. The available literature about gas in the kidneys, usually only discusses and distinguishes between two things, namely emphysematous pyelonephritis and emphysematous pyelitis, after getting rid of recent upper urinary tract instrumentation and the presence of fistula with the gastrointestinal tract. To date, there have been only 11 cases of gas-containing kidney stones. We report the 12th case of gas-containing kidney stones (the first from the field of radiology), which is a 69-year-old female with bilateral flank pain, no fever, and no history of other diseases. Physical examination revealed bilateral costovertebral angle tenderness. The plain abdominal radiograph showed a staghorn stone in the right kidney. The non-enhanced CT abdomen showed gas-containing staghorn stones in the right kidney accompanied by hydronephrosis. The patient underwent percutaneous nephrolithotomy. Kidney stone analysis showed oxalate, phosphate, ammonium, calcium, and uric acid components. The etiology and relationship of gas-containing kidney stones with other gas entities in the kidney is still unclear, making it difficult to determine their clinical significance. Radiological examination, especially CT scan, plays a very important role in determining the entity of gas in the kidney.

Ureteric Stone-Related Escherichia coli Bacteraemia Associated with Spondylodiscitis

Escherichia coli (E. coli)-related urosepsis associated with a ureteric stone has been shown to cause a systemic bacteraemia that can spread to other parts of the body. Hematogenous spread of infection is the most common cause of pyogenic spondylodiscitis. A 74-year-old female presented with acute left-sided flank pain and was found to have an obstructing 9 mm distal ureteric stone. After initial management involving ureteric stent insertion, the patient deteriorated and developed an E. coli associated bacteraemia, which proved difficult to treat. Further investigations revealed a subsequent spondylodiscitis, which required a 6-week course of antibiotics and no additional intervention. This case presents the likely association of stone-related bacteraemia, complicated by urinary tract instrumentation leading to spondylodiscitis, and demonstrates the importance of clinicians’ awareness of other causes of unresolving sepsis in an elderly patient.

Bacteriology and Antibiotic Sensitivity Patterns of Urine in Urology Patients with Indwelling Urinary Catheters at the University Teaching Hospital in Lusaka, Zambia

Introduction: Catheter-associated urinary tract infection (CAUTI) is the most common nosocomial infection in hospitals worldwide, and the incidence has been reported to be up to 35%. The growing antibiotic resistance amongst the uropathogens isolated from CAUTI makes it challenging to manage. In Zambia, prolonged catheter use is a burden, particularly in patients awaiting definitive surgery, the elderly and the socioeconomically challenged. Bacterial colonisation following catheterisation is inevitable, with reports estimating the risk to be around 5-10% per day. By day 10, virtually all patients with urinary tract instrumentation have healthcare-associated UTI, with the duration of catheterisation the most important factor. Methodology: The study was a descriptive cross-sectional study conducted at UTH over a period of 10 months from July 2015 to May 2016. The cases were inpatients and outpatients with indwelling catheters in situ for not less than three calendar days. Simple random sampling was used to select candidates who were inpatients awaiting definitive surgery and outpatients in the same category as they attended clinics. Data collection and collection of specimens were done by the principal investigator, which was analysed by the microbiologist based at the UTH microbiology laboratory. The patients were recruited at one point, and the data collection exercise employed a questionnaire to collect socioeconomic demography and clinical information. The variables were collected using the data collection sheet for each participant. The data was then entered into SPSS software to clean and analyse data. The categorical variables were presented as proportions. The main concerns arising during specimen collection were the duration between the time of specimen collection and transfer to and processing at the main laboratory, which was kept within one hour. Specimens received within two hours of the collection were accepted. Results: A total of 228 patients were enrolled from both outpatient and inpatient departments. Approximately 75% yielded growth of bacteria, and 25.0% were negative. The pure growth yielded Klebsiella Pneumoniae 28.0% and E. coli 25.2%, as the most isolated pathogens. The antibiotic susceptibility testing revealed the highest resistance of the above isolates to ampicillin, nalidixic acid, norfloxacin, ciprofloxacin, levofloxacin, and borderline with cotrimoxazole. The organisms were least resistant to amikacin, imipenem, nitrofurantoin, and gentamycin. Acetinobacter and Citrobacter species were also highly resistant to the above drugs with nitrofurantoin in addition but least resistant to ampicillin. Conclusion: The study revealed a high prevalence of CAUTI in the urology section of the UTH, and practices such as poor hand hygiene, open catheter drainage, non-aseptic methods of catheter insertion and poor catheter care are possible contributing factors. There is an association between the insertion of indwelling catheters and subsequent development of CAUTI, and the strongest factors noted are the size of the catheters used and the patient's level of education. High resistance to antibiotics to many organisms of concern was noted.

Genitourinary non-tuberculous mycobacterial (GU-NTM) infections: A single institution experience in South India

Non-tuberculous mycobacterial (NTM) infections are rarely reported, and more so with genitourinary infections. This retrospective study was designed to understand the proportion and behaviour of genitourinary non-tuberculous mycobacterial (GU-NTM) infections compared with genitourinary mycobacterial tuberculosis (GU-MTB) treated at a tertiary care hospital in South India. The hospital records of every bacteriologically proved GU-MTB and GU-NTM infections treated at this centre from 2010 to 2016 were retrospectively reviewed. There were ten patients of GU-NTM and 15 patients of GU-MTB. There was no significant difference in presentation other than lesser frequency of irritative lower urinary tract symptoms (LUTS) among patients with GU-MTB. Urine smear for AFB was positive in 60% and 47% of GU-NTM and GU-MTB patients. 40% of GU-NTM patients had history of urinary tract instrumentation. Mycobacterium abscessus was grown in four patients and one had Mycobacterium fortuitum/chelonae complex; all the rest were rapid growers. No patient had multi-drug resistant tuberculosis. Imaging studies of GU-NTM patients were indistinguishable from GU-MTB with renal, ureteral and bladder involvements, and stone formation. The drug sensitivities varied among the NTM patients but all showed sensitivity to clarithromycin uniformly. Need for varieties of surgeries in the early and late phases were also comparable. GU-MTB and GU-NTM infections are indistinguishable from their clinical presentation and imaging studies. All cases of suspected genitourinary mycobacterial infections must be subjected to nucleic acid testing. Treatments based on clinical and radiological features without culture studies may misdiagnose GU-NTM infections as MDR GU-MTB, thereby delaying the appropriate treatment.

Predictive factors for Enterococcus faecalis in complicated community-acquired urinary tract infections in older patients.

Risk factors for complicated community acquired Enterococcus faecalis urinary tract infection (UTI) in older patients are not well known. We identified the predictive factors for E. faecalis on a cohort of 659 older patients admitted to hospital with complicated UTI. We also examined the adequacy of empirical antimicrobial therapy and outcomes in E. faecalis UTI. Multivariable logistic regression was used to identify predictors of E. faecalis UTI. A total of 87 (13.2%) patients had E. faecalis UTI; of these 63.2% were men, their mean age was 82.3 years and they had a great number of comorbidities. Severe sepsis or septic shock was present in 50.5%, and bacteremia was present in 26%. Indwelling urinary catheter and previous urinary instrumentation were risk factors for E. faecalis UTI by multivariate analysis (OR 2.05; 95% CI 1.15-3.65 and OR 2.16; 95% CI 1.08-4.34, respectively). Inadequate empirical antimicrobial therapy was higher in E. faecalis UTI than in UTI caused by Gram-negative microorganisms (66.6% vs 19%, P < 0.001). No significant differences in length of hospital stay or mortality were noted between E. faecalis and Gram-negative UTI. In older patients admitted to hospital with complicated community-acquired UTI, E. faecalis should be considered for empirical treatment if the patient has a urinary catheter or previous urinary tract instrumentation in order to avoid inadequate empirical antibiotic therapy. Geriatr Gerontol Int 2019; ••: ••-••.

The utility of preoperative and intraoperative cultures for guiding urosepsis empirical treatment

Objective: Endoscopic upper urinary tract instrumentation is a common urological procedure; often associated with prior ureteric stenting and postoperative urosepsis. This study aimed to explore the clinical utility of preoperative urine and intraoperative urine and ureteric stent cultures in the management of urosepsis post upper urinary tract instrumentation. Methods: Prospective study involving pre-stented patients whose upper urinary tract was instrumented at a single centre between 2017 and 2018. Five cultures were collected per patient. Patients were tracked for development of postoperative urosepsis. Results: The study included 227 patients, with a 5.7% postoperative urosepsis rate. Risk of urosepsis was significantly associated with female gender, steroid use and having a colonized preoperative urine culture, intraoperative bladder urine or stent-end culture, or kidney urine culture. Patients with a colonized intraoperative bladder urine were 11 times more likely to develop urosepsis and were colonized with the same organism isolated from urosepsis cultures for 50% of cases. Conclusions: To our knowledge this is the largest cohort study which analyses five different urinary tract cultures and the relationship with postoperative urosepsis. A positive intraoperative bladder urine culture is an independent predictor of postoperative urosepsis development and causative organism, which could guide antibiotic management for these patients. Level of Evidence 3-b

Prostate abscess: A comprehensive review of the literature

Prostate abscess (PA) is a rare but serious infection of the prostate gland. Traditionally a complication of urethral gonococcal infection, the majority of PAs are now seen in the older or immunosuppressed populations, in men with existing prostatic disease, or those who have undergone recent instrumentation of the lower urinary tract. Aetiological organisms are diverse, often with non-specific presentations posing a diagnostic challenge. Multiple management options have been described, however no consensus exists on what is the best practice. This comprehensive review examines the literature surrounding this condition in detail, with a focus on diagnostic and surgical treatment options. Recommendations for practice are made where appropriate. This article aims to edge towards a national guideline for the management of PA and inspire more research in the field.Level of evidence - 3a

Candiduria; a review article with specific data from Iran.

Although, several categories of nosocomial infections are presented during the recent years, urinary tract infections (UTIs) considered as one of the most important systemic infections. The presence of Candida species in the urinary tract system (Candiduria) is seen in only 10-15% of the cases with UTI, however candiduria has been considered as more problematic infection for patients, laboratory workers and physicians. Due to increasing numbers of several predisposing factors, such as antibacterial agents, urinary tract instrumentation, diabetes mellitus, invasive therapies, and prolonged hospital stay, candiduria develops among the hospitalized patients, especially hospitalized in intensive care units (ICUs) and neonatal intensive care units (NICUs). According to the epidemiological studies, Candida albicans is the most common isolated species from candiduric patients. However, during the recent years, due to increasing resistance to antifungal drugs, non-albicans Candida species including, C. glabrata, C. krusei, C. parapsilosis and C. tropicalis have been also implicated. We found that the mean prevalence of candiduria among Iranian patients was lower (16.5%) than worldwide ratio and also males were more frequently affected than females (M:F, 1.2:1). Similar to other countries, C. albicans was most common infectious agent followed by non-albicans Candida species including, C. glabrata, C. tropicalis and C. krusei.

PD25-09 RISK FACTORS FOR TECHNICAL FAILURE OF RENAL AUTOTRANSPLANT: RESULTS OF 103 CASES FROM A SINGLE INSTITUTION

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery I1 Apr 2018PD25-09 RISK FACTORS FOR TECHNICAL FAILURE OF RENAL AUTOTRANSPLANT: RESULTS OF 103 CASES FROM A SINGLE INSTITUTION Mohamed Eltemamy, Ahmed Elshafei, Rathika Ramkumar, Alvin Wee, Stuart Flechner, and Venkatesh Krishnamurthi Mohamed EltemamyMohamed Eltemamy More articles by this author , Ahmed ElshafeiAhmed Elshafei More articles by this author , Rathika RamkumarRathika Ramkumar More articles by this author , Alvin WeeAlvin Wee More articles by this author , Stuart FlechnerStuart Flechner More articles by this author , and Venkatesh KrishnamurthiVenkatesh Krishnamurthi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1336AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Renal autotransplantation (RA) is an accepted therapeutic option for select indications. We sought to analyze factors associated with technical failure in RA patients. METHODS We reviewed 103 patients who underwent RA from 2004 to 2017. Satisfactory outcome (SO) was defined as post-operative patent vasculature on ultrasound and/ or normal nuclear scan. Unsatisfactory outcomes (UO) included Compromised grafts (CG) (partial infarction on radiographic studies more than 20%) and lost grafts (LG) (nephrectomy or absent perfusion on radiographic studies). RESULTS Median age was 39 years (IQR: 32-47). Females were 71 (69%) and males were 32 (31%). Median follow up time was 9.5 months (IQR: 2.5-30) Indications for RA were renovascular diseases (n=27), Ureteric pathology (n=30), intractable nephrolithiasis (n=30), flank pain (n= 15) and pancreatic neoplasm (n=1). 89 (86.4%) patients had a SO while 14 (13.6%) had a UO (CG= 7, LG= 7). There was no statistically significant difference between UO and SO in median preoperative creatinine (p=0.2), preoperative positive urine culture (p=0.32), history of stone disease (P=0.27) and prior urinary tract instrumentation (p=0.11). However, presence of ureteric stent or nephrostomy tube (PCN) at time of RA was significantly higher in UO (42.9% vs. 16.9%, p=0.04). Also, multiple arterial anastomoses were more frequent in UO (42.9% vs 18.2%, p=0.03). Other operative variables including median blood loss (p=0.23) and type of urinary reconstruction (p=0.6) were not significantly different. Median creatinine at last follow up was higher in UO compared to SO (1.08 mg/dl vs 0.86 mg/dl, p= 0.005). On logistic regression model, the presence of a stent or PCN at time of surgery (OR 4.19, 95% CI 1.2-14.71, p=0.03) and multiple arterial anastomoses (OR 3.89, 95 CI 1.11-13.63, p=0.03) were independent predictors of UO. CONCLUSIONS The presence of a stent or PCN at time of surgery and multiple arterial anastomoses were associated with graft compromise or loss. While the correlation between number of arteries and outcomes is sound, the stronger correlation of stents and PCN at time of surgery with worse outcomes is unclear. Our hypothesis is that ureteric stents and PCNs harbor infections despite appropriate antibiotic treatment. Consequently, these kidneys are more prone to technical failure after RA suggesting the need for an alternative approach with respect to those indwelling devices. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e549-e550 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Mohamed Eltemamy More articles by this author Ahmed Elshafei More articles by this author Rathika Ramkumar More articles by this author Alvin Wee More articles by this author Stuart Flechner More articles by this author Venkatesh Krishnamurthi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...