Long-term Indwelling Catheters Research Articles

Conformational ensembles in Klebsiella pneumoniae FimH impact uropathogenesis

Klebsiella pneumoniae is an important pathogen causing difficult-to-treat urinary tract infections (UTIs). Over 1.5 million women per year suffer from recurrent UTI, reducing quality of life and causing substantial morbidity and mortality, especially in the hospital setting. Uropathogenic E. coli (UPEC) is the most prevalent cause of UTI. Like UPEC, K. pneumoniae relies on type 1 pili, tipped with the mannose-binding adhesin FimH, to cause cystitis. However, K. pneumoniae FimH is a poor binder of mannose, despite a mannose-binding pocket identical to UPEC FimH. FimH is composed of two domains that are in an equilibrium between tense (low-affinity) and relaxed (high-affinity) conformations. Substantial interdomain interactions in the tense conformation yield a low-affinity, deformed mannose-binding pocket, while domain-domain interactions are broken in the relaxed state, resulting in a high-affinity binding pocket. Using crystallography, we identified the structural basis by which domain-domain interactions direct the conformational equilibrium of K. pneumoniae FimH, which is strongly shifted toward the low-affinity tense state. Removal of the pilin domain restores mannose binding to the lectin domain, thus showing that poor mannose binding by K. pneumoniae FimH is not an inherent feature of the mannose-binding pocket. Phylogenetic analyses of K. pneumoniae genomes found that FimH sequences are highly conserved. However, we surveyed a collection of K. pneumoniae isolates from patients with long-term indwelling catheters and identified isolates that possessed relaxed higher-binding FimH variants, which increased K. pneumoniae fitness in bladder infection models, suggesting that long-term residence within the urinary tract may select for higher-binding FimH variants.

An in-vitro model for bacteria-related catheter encrustations.

About 50% of individuals with long-term indwelling catheters are affected by catheter encrustations and bladder stone formation. Therefore, prophylaxis of catheter encrustations is important. Currently, however, neither an established prophylaxis nor a standardized in-vitro model to test different measures exist. We have therefore developed and qualitatively evaluated an in-vitro model of catheter encrustation. Size 14 French suprapubic catheters were incubated under sterile conditions at 37 degrees Celsius in five different media: (1) sterile artificial urine (n = 16), (2) artificial urine with E. coli (n = 8), (3) with Pseudomonas aeruginosa (n = 8), (4) with Proteus mirabilis (n = 8), and (5) with a mix of these three strains (n = 8). Catheter balloons were inflated either a glycerine or a bactericidal solution. After 6 weeks, the catheters were removed from the solution, dried, and weighed, and a photometric determination of the retrieved encrustations was performed. Most frequently and pronounced encrustations were detected in the Pseudomonas group. The median weight of these encrustations (50% struvite and brushite) was 84.4mg (47.7mg / 127.3mg). Even on catheters stored in sterile urine, encrustations (69.2% struvite) were found. Bacterial growth was not affected by the medium used for catheter blockage. Although in-vitro models appear to be limited because they lack "the human factor", they are valuable for systematically assessing physico-chemical factors affecting encrustations. Therefore, our model, being reliable and cost-effective, may foster further research despite its limitations.

A qualitative approach on long-term indwelling catheter use in an outpatient setting.

A long-term indwelling catheter may be indicated in clinical situations, such as chronic diseases of the genitourinary or neurological systems. In addition to the risks of infection, trauma, and bleeding, a catheter's permanence can affect psycho-emotional and socioeconomic dimensions. We aimed to understand how the need to use a long-term indwelling catheter affects this patient's self-perception, interrelationships, and self-care. We carried out a qualitative, descriptive study based on interviews with 17 patients, and applied thematic analysis and complex thinking. The different prognoses and expectations regarding the catheter influenced self-perception, adaptation, acceptance, or denial. The presence of a catheter, whether as a curative measure or for comfort, can affect self-image and sexuality, and generate insecurities and uncertainties, which require understanding the multidimensionality of situations that suffer interference from the personal, family, and social environment, as well as health systems' capacity to deal with it. Despite the challenges, the majority of participants reported a favorable disposition towards self-care, whether to enable catheter removal or to prevent injuries in lifelong indications.

29 - Micturition recovery after HoLEP in patients with long-term indwelling catheter: A single centre experience

29 - Micturition recovery after HoLEP in patients with long-term indwelling catheter: A single centre experience

Polyzwitterion coating based on PDMAEMA-block-PAAc for catheters with antibiofilm activities

Patients with long-term indwelling urinary catheters suffer from complications like infection and encrustation, which are dealt with by catheter replacement or antibiotic therapy inevitably resulting in the emergence of drug-resistant bacteria. Development of antibiofilm catheter coatings with biocompatible materials is considered a practical way to address these issues. Therefore, in the present work, a polyzwitterion coating based on Poly(2,2-dimethylaminoethyl methacrylate)- block-Polyacrylic acid) (PDMAEMA-block-PAAc) was designed on the catheter surface. Herein, following the activation of the catheter silicone surface by UV/Ozone, it was functionalized with α-bromoisobutyryl bromide (BIBB), then 2,2-dimethylaminoethyl methacrylate and acrylic acid monomer were polymerized in situ on the surface. Coated catheters were evaluated by attenuated total reflection-fourier transform infrared (ATR-FTIR), scanning electron microscope (SEM), thermal gravimetric analysis (TGA), and atomic force microscopy (AFM). The hydrophilic PDMAEMA-block-PAAc-coated catheter was developed with high antibacterial and antibiofilm properties against Escherichia coli and Pseudomonas aeruginosa during 24 and 48 hours and also long-term biocompatibility with L929 fibroblast cells. In this study, a polyzwitterion polymer based on PDMAEMA-block-PAAc was coated on catheters to endow anti-fouling and antibacterial activity, in order to tailor the catheter surface to meet the specific requirements that support further clinical investigations.

Determining the Spiritual Care Needs of Patients with Indwelling Urinary Catheterization: A Cross-Sectional Descriptive Study in Turkey

This study was undertaken to ascertain the spiritual care requirements of patients undergoing indwelling urinary catheterization. Identifying the spiritual care needs of patients with indwelling urinary catheterization is crucial for fortifying their resilience and fostering positive health behaviors. Furthermore, it proves pivotal in devising customized nursing interventions. A descriptive cross-sectional study involving 122 participants (50 female, 72 male) undergoing indwelling urinary catheterization within the inpatient clinics of a state hospital in Turkey was conducted. Data were meticulously gathered through a participant information form and the Spiritual Care Needs Scale. The subsequent analysis employed the Kruskal-Wallis and Mann-Whitney U tests, facilitated by the SPSS 22.0 program. This study adhered to the STROBE recommendations in reporting. The findings indicated that individuals with indwelling urinary catheters exhibit spiritual care needs exceeding the norm, with heightened scores in subdimensions such as meaning and hope, caring, and respect. A statistically significant positive association was identified, revealing a difference in spiritual care needs between women and men. Similarly, a positive association, statistically significant, was observed in the spiritual care needs of patients aged 72–98 compared to those aged 41–71. Furthermore, a positive and statistically significant difference surfaced in the spiritual care needs of patients with long-term indwelling urinary catheters as opposed to those with medium and short-term urinary catheters. Therefore, it is imperative to consider the spiritual care needs of patients undergoing indwelling urinary catheterization.

Molecular study of hpmA and ureR genes among Proteus mirabilis isolates inpatient with urinary tract infection

The most frequently occurring human bacterial infections are urinary tract infections (UTIs). P. mirabilis is one of the common causes of UTIs in humans with complicated UTIs, the formation of stones in the kidney, and long-term indwelling catheters. This study aims to isolate, and identify Proteusmirabilis from patients with UTIs using traditional methods and 16s rRNA gene sequencing techniques, as well as detect some virulence genes (hpm A and ureR) in Proteus mirabilis by using polymerase chain reaction (PCR). A total of five isolates of Proteus mirabilis were isolated from patients with urinary tract infections in June 2022. Identification of isolates depends on microscopic and cultural characteristics and traditional biochemical tests, finally, isolates are identified by target gene 16s rRNA using PCR technique, in addition, this study investigates the genes responsible for virulence factors such as hpmA and hpmR.In this study laboratory diagnosis and molecular analysis (16s rRNA gene) revealed that the five isolates are Proteus mirabilis also this study shows the presence of the hpmAgenes by PCR techniques in the isolates 100%. Our study has shown that 16s rRNA was a strong eclectic power and an excellent method for the identification of bacteria also these study frequency ofureR and hpmA in P.mirabilis isolated from UTIs and these genes have a manifest role in the infection.

Hierarchically-structured laccase@Ba3(PO4)2 hybrid nanoflowers coating on the urinary foley catheter with high durability, biocompatibility, anti-adhesion activity, and contrasting behavior

Catheter-associated urinary tract infections (CAUTIs) are common causes of long-term indwelling urinary catheter failure. In such cases, pathogenic bacteria adhere to the urinary tract or catheter surface forming recalcitrant biofilms which may lead to secondary bloodstream infections. Today, antibiofilm coatings based on effective enzymes show promise in preventing CAUTIs. In the present study, laccase@Ba3(PO4)2•hybrid nanoflowers (HNFs) were applied as a novel infection-responsive coating for urinary catheters. Scanning electron microscopy images (SEM) exhibited a homogeneous surface of layered catheters without any broad or fine cracks. Compared to the uncoated catheter, the surface coating inhibited the adhesion of Pseudomonas aeruginosa, Escherichia coli, Bacillus subtilis, and Staphylococcus aureus by 64.8 %, 78.2 %, 86.4 %, and 75 %, respectively. Furthermore, the laccase@Ba3(PO4)2•HNFs layered catheter showed negligible release of Ba2+ (12.9 μM) after a 7-day immersion in an artificial urine medium. This durable coating produced a strong computed tomography (CT) signal which would be useful for visualizing the placement of urinary catheters in patients. The high viability of human dermal fibroblast (HDF) cells (>80 %) demonstrated the biocompatibility of the modified catheters. Therefore, it is suggested that surfaces coated with laccase@Ba3(PO4)2•HNFs hold appropriate potential for use in medical devices.

Biomimetic urine flow control can preserve bladder function in patients with indwelling catheterization.

For patients with long-term indwelling catheterization, bladder function will be affected. It is necessary to explore whether biomimetic urine flow control (BUFC) can improve bladder function in patients undergoing indwelling catheterization. A retrospective, data-only, cohort study was carried out. The patients admitted to the intensive care unit, who had retained catheter and been continuously using a urodynamic monitoring system for over 30 days were selected. They were divided into 2 groups based on whether they were using BUFC function. The urodynamic monitoring data of the 2 groups were compared and analyzed. A total of 30 patients were included in the final analysis, including 15 in the BUFC group and 15 in the unobstructed group. The Urinary Volume and maximal urinary flow rate of the unobstructed group showed a continuous downward trend, while the BUFC group remained stable, and there was a statistical difference (P < .05) between the 2 groups since day 20. The bladder ultrasound imaging showed that the bladder volume of the BUFC group did not decrease significantly on the 30th day. BUFC technology, which provided by a urodynamic monitoring system, has potential protective effects of the bladder function after indwelling catheterization.

Could transperineal interstitial laser ablation of the prostate be the right option for highly-comorbid patients with lower urinary tract symptoms due to benign prostatic obstruction? A preliminary single-center experience focusing on functional and safety outcomes.

In this paper, we aimed to highlight functional and safety outcomes of highly-comorbid patients undergoing transperineal laser ablation (TPLA) of prostate at a referral academic center. Patients undergoing TPLA from April 2021 and February 2023 with moderate to severe lower urinary tract symptoms (LUTS), prostate volume ranging from 30 to 100 mL, and an American Society of Anesthesiologists (ASA) Score ≥3 were included. All patients were evaluated as unfit for standard surgery. Procedures were performed in an outpatient setting using local anesthesia. Failure after the procedure was defined as the shift to other ultra-minimally invasive surgical treatment or the need for long-term indwelling catheter replacement. Overall, 23 patients were enrolled with a median age of 76 years. Median ASA Score and Charlson Comorbidity Index were 3 and 5, respectively. Of these, 11 (48%) were under antiplatelets, 4 (17%) under new oral anticoagulants (NOACs) and 3 (13%) under warfarin. Six (26%) patients had an indwelling catheter preoperatively. Median prostate volume was 42 mL. Median follow-up was 12 months. No Clavien-Dindo Grade ≥2 complications were recorded. Four/six (66%) patients with an indwelling catheter before TPLA achieved spontaneous micturition. Treatment failure occurred in 2 (8.5%) patients. Of the remaining 21 patients, 12/21 (57%) patients reported an improvement in International Prostate Symptoms Score (IPSS) symptoms class (i.e., severe to moderate, moderate to mild, etc.); all patients whose IPSS symptoms class remained stable (N.=8 [38%]) had a significant improvement of the IPSS score as compared to the preoperative period, while 1 (4.5%) patient reported worsening of LUTS. In conclusion, TPLA appears to be a safe and feasible ultra-minimally-invasive option for LUTS due to benign prostatic obstruction (BPO) in patients with significant comorbidities at high-risk for standard surgical options.

Vesicostomy: An alternative approach for complicated adult patients with urinary retention

Purpose:Patients with permanent urethral catheterization for chronic urinary retention frequently experience several complications, such as bladder stones and/or urinary tract infections. In this study, we performed vesicostomy in adult patients with urinary retention who developed complications during long-term indwelling catheterization. Methods:Patients with a permanent bladder catheter for urinary retention, and bladder stones and/or urinary tract infection between April 2019 and October 2021 were enrolled in this retrospective study. Vesicostomy and additional surgeries, such as vesicolithotomy, were performed if necessary. Residual urine volume was measured with computed tomography 7 days after the operation. We followed-up all patients 3 months postoperatively to identify complications. Results:Nine patients were included in this study; eight were male and one was female. The median age at operation was 65 (range, 23–92) years. Concurrent operations were lithotomy in five, cystostomy closure in one, removal of a bladder foreign body in one, and nephrectomy in one. The postoperative median residual urine volume in the bladder was 32 (range, 5–51) ml. Perioperative complications comprised delirium (Clavien–Dindo grade II) in two patients and stomal bleeding (Clavien–Dindo grade II) in one patient. There were no complications of bladder stones, febrile urinary tract infection, or stomal stenosis postoperatively. Conclusions:Vesicostomy for adult patients with urinary retention was useful and safe. Our results suggest that vesicostomy could be a bladder drainage option for select adult patients who are not candidates for permanent indwelling catheterization.

Purple Urine Bag Syndrome in a Woman with Squamous Cell Cervical Cancer

Purple urine bag syndrome is a rare phenomenon whose striking presentation can lead to earlier recognition and treatment of a potentially serious medical condition. This is a unique condition of long11 term indwelling catheter associated urinary tract infection with distinct, purple-colored urine caused by bacterial metabolites. This infrequent occurrence was seen in a patient with stage IIIb squamous cervical cancer who presented to the emergency department with symptoms of a urinary tract infection in setting of indwelling bilateral percutaneous nephrostomy tubes. The patient’s physical exam was notable for left costovertebral tenderness, purple urine in bilateral nephrostomy bags and urine culture significant for proteus mirabalis. The patient was treated with intravenous antibiotics and fluid resuscitation. She unfortunately left against medical advice shortly after being admitted. She re presented to an outside hospital with fevers and non-draining nephrostomy tubes notable to have purulent discharge at the nephrostomy sites. The scant urine through the nephrostomy tubes was also noted to have a purple hue. She was found to have another urinary tract infection with Enterobacter cloacae and subsequently treated with intravenous antibiotics. During this admission, she underwent bilateral nephrostograms notable for significant clogging of tubes and bilateral ureteral patency. After the study, she underwent removal of the long-term indwelling catheters and was able to continue voiding spontaneously. She was discharged in good condition on a ten-day course of oral antibiotics. The occurrence of purple urine is highly associated with urinary tract infections. This process is thought to be caused by a metabolism of dietary tryptophan by intestinal bacteria to indole that is then absorbed into the circulation and then converted to indoxyl sulfate by hepatic enzymes. This substrate returns to circulation and is excreted in the urine where in the presence of bacteria with sulfatase and phosphatase activity converts indoxyl sulfate to indigo and indirubin resulting in the characteristic purple hue of the urine. Catheter associated urinary tract infections require antibiotic treatment and timely removal of catheter when appropriate to prevent complications including pyelonephritis and sepsis.

LBA01-07 MULTI-DISCIPLINARY DEVELOPMENT AND IMPLEMENTATION OF A TRIAL OF VOID ALGORITHM TO REDUCE INDWELLING URETHRAL CATHETER USE

You have accessJournal of UrologyCME1 Apr 2023LBA01-07 MULTI-DISCIPLINARY DEVELOPMENT AND IMPLEMENTATION OF A TRIAL OF VOID ALGORITHM TO REDUCE INDWELLING URETHRAL CATHETER USE David Han, Lovie Amolo, Hersy Contreras, Maureen Lowers Roach, Bridgette Bennett, Maria Sofia Luga, Shelly-Anne Layne, Coraima Rihan Veliz, Subhash Krishnamoorthy, David Weiner, Christopher Anderson, and Gina Badalato David HanDavid Han More articles by this author , Lovie AmoloLovie Amolo More articles by this author , Hersy ContrerasHersy Contreras More articles by this author , Maureen Lowers RoachMaureen Lowers Roach More articles by this author , Bridgette BennettBridgette Bennett More articles by this author , Maria Sofia LugaMaria Sofia Luga More articles by this author , Shelly-Anne LayneShelly-Anne Layne More articles by this author , Coraima Rihan VelizCoraima Rihan Veliz More articles by this author , Subhash KrishnamoorthySubhash Krishnamoorthy More articles by this author , David WeinerDavid Weiner More articles by this author , Christopher AndersonChristopher Anderson More articles by this author , and Gina BadalatoGina Badalato More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003360.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prolonged indwelling catheter use is a risk factor for catheter-associated urinary tract infections (CAUTIs). To reduce catheter use among post-operative patients, we sought to create and implement a novel algorithm to standardize the removal of indwelling Foley catheters. METHODS: We partnered with nursing leadership and the General Surgery Department to develop an evidence-based trial of void algorithm for a surgical Step-Down Unit at an urban teaching hospital [Figure 1A]. Our cohort included post-operative patients treated with intraabdominal, thoracic, vascular, and gynecologic surgeries; patients having urologic surgeries with an imperative indication for a long-term indwelling urethral catheter were excluded from the algorithm but included in analysis. The primary outcome was mean cumulative indwelling urethral catheter days (ex. if 2 patients had catheters for 3 and 7 days, then cumulative catheter days would be 10). We also measured mean total patient days (as a surrogate for patient volume), mean daily number of patients with catheters, and the number of CAUTIs, which are all nationally reported outcomes from the Centers for Disease Control and Prevention. Another surgical unit where the algorithm was not implemented was used as a natural control. We analyzed changes in relevant outcomes 90 days before and after algorithm implementation. RESULTS: The mean number of hospitalized patient days before and after algorithm introduction did not differ on the Step-Down Unit (32.2 vs. 32.0, p=0.60). After implementation, mean cumulative catheter days decreased (14.8 vs. 9.9, p<0.01), as did mean daily number of patients with catheters (3.7 vs. 3.1, p=0.02). Measures of catheter use variation also decreased [Figure 1B]. There was one CAUTI before and after algorithm implementation, the latter deemed potentially associated with algorithm non-adherence on root cause analysis. Measures of catheter use in the surgical floor control group did not differ for any outcome (p>0.05) over the same time-period. CONCLUSIONS: A multi-disciplinary approach to standardize catheter care with an evidence-based trial of void algorithm is feasible and effective in reducing catheter use. Further expansion of this pilot is needed to establish an impact on the associated rate of CAUTI. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1178 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Han More articles by this author Lovie Amolo More articles by this author Hersy Contreras More articles by this author Maureen Lowers Roach More articles by this author Bridgette Bennett More articles by this author Maria Sofia Luga More articles by this author Shelly-Anne Layne More articles by this author Coraima Rihan Veliz More articles by this author Subhash Krishnamoorthy More articles by this author David Weiner More articles by this author Christopher Anderson More articles by this author Gina Badalato More articles by this author Expand All Advertisement PDF downloadLoading ...

Using clinical decision support to improve urine testing and antibiotic utilization.

Urine cultures collected from catheterized patients have a high likelihood of false-positive results due to colonization. We examined the impact of a clinical decision support (CDS) tool that includes catheter information on test utilization and patient-level outcomes. This before-and-after intervention study was conducted at 3 hospitals in North Carolina. In March 2021, a CDS tool was incorporated into urine-culture order entry in the electronic health record, providing education about indications for culture and suggesting catheter removal or exchange prior to specimen collection for catheters present >7 days. We used an interrupted time-series analysis with Poisson regression to evaluate the impact of CDS implementation on utilization of urinalyses and urine cultures, antibiotic use, and other outcomes during the pre- and postintervention periods. The CDS tool was prompted in 38,361 instances of urine cultures ordered in all patients, including 2,133 catheterized patients during the postintervention study period. There was significant decrease in urine culture orders (1.4% decrease per month; P < .001) and antibiotic use for UTI indications (2.3% decrease per month; P = .006), but there was no significant decline in CAUTI rates in the postintervention period. Clinicians opted for urinary catheter removal in 183 (8.5%) instances. Evaluation of the safety reporting system revealed no apparent increase in safety events related to catheter removal or reinsertion. CDS tools can aid in optimizing urine culture collection practices and can serve as a reminder for removal or exchange of long-term indwelling urinary catheters at the time of urine-culture collection.

CASE SERIES OF EMERGING NOSOCOMIAL MULTIPLE DRUG RESISTANT PATHOGEN PROVIDENCIA RETTGERI CAUSING URINARY TRACT INFECTION

We report Case Series of Emerging Nosocomial Multiple Drug Resistant Pathogen Providencia rettgeri causing Urinary Tract Infections. The most common cause of catheter-associated urinary tract infections (CAUTI), especially with long-term indwelling urinary catheters in elders, are P. rettgeri and P. stuartii. We are reporting 4 cases of UTI, which are hospital-acquired and CAUTI. These cases are admitted to MICU for treatment purposes and later develop fever spikes after a few days and are evaluated and urine culture showed multi-drug-resistant Providencia rettgeri by VITEK. The empirical therapy was discontinued, managed with fosfomycin, and discharged later with follow-up. The various reports showed P. rettgeriis susceptible for amikacin, gentamicin, tobramycin and ciprofloxacin. In our case series, we isolated multi-drug-resistant strains of P. rettgeri that showed resistance to piperacillin-tazobactam, cefuroxime, ceftriaxone, cefepime, ertapenem, imipenem, meropenem, gentamicin, tobramycin, ciprofloxacin, tigecycline, amikacin, colistin and sensitive only to fosfomycin. The significance of P. rettgeri in association with catheter-related bloodstream infections (CRBSI) and catheter-associated urinary tract infections (CAUTI) was unclear. Hence isolation of Providencia species twice from the clinical samples was considered for association with catheter infections. The proper selection of empirical antimicrobials, antibiotic sensitivity testing, avoiding misuse of antibiotics and implementing proper drug holiday and local antibiotic policy are considered appropriate combination protocol for managing emerging multi-drug-resistant nosocomial Providencia rettgeri strains.

Life with an Indwelling Urinary Catheter: Experiences from Male Patients Attending the Urology Clinic at a Tertiary Hospital in Northwestern Tanzania-A Qualitative Study.

Experiences from patients living with a long-term indwelling urinary catheter (IUC) at home among men attending urology clinics have not been reported. Evidence-based information on such experiences is important for improving nursing care in low- and middle-income countries such as Tanzania. Using a descriptive phenomenological qualitative research design, we observed two main themes: "Adjustments to positive living with a catheter at home", denoting that social interaction and psychological and spiritual support are important to positively live with the catheter, and "The home environment influences negative or positive living", considering intimacy and altered body image to significantly influence the ability to practice sex, leading to wives' self-sacrifice. Respondents experienced difficulties in living with a long-term IUC at home due to a lack of information from healthcare professionals on how to manage their catheters and urine bags. In adjusting to positive or negative living with a catheter at home, respondents had to figure out strategies to minimize psychological and emotional trauma and hasten the adjustment process. A clear guideline or checklist is needed to ensure that all important information is provided by health professionals at the time of discharge and during subsequent visits to patients on how to care for the catheter insertion sites and help them adjust to living with a long-term IUC.

Diagnosis and Management of Malignant Pleural Effusion: A Narrative Literature Review

Malignant pleural effusion (MPE) is defined as an effusion that occurs in association with malignancy, as evidenced by the finding of malignant cells on pleural fluid cytology or pleural biopsy. The pathophysiology of MPE is not yet clear, but several hypotheses have been developed to explain the mechanism of MPE. Accumulation of effusion in the pleural cavity occurs due to increased vascular permeability due to the inflammatory reaction caused by the infiltration of cancer cells in the parietal and/or visceral pleura. Other possible mechanisms are the direct invasion of the tumor adjacent to the pleura, obstruction of the lymph nodes, hematogenous spread, and primary pleural tumor. Pleural fluid from a malignant process is usually an exudate. To distinguish between exudate and transudate is to assess the protein and LDH levels of the pleural fluid. Hemorrhagic pleural fluid with a red blood cell count &gt;100,000/mm3 suggests an MPE. Pleural fluid glucose levels at low &lt; 60 mg/dl at about 15-20% MPE. The definitive diagnosis of MPE is by finding malignant cells in the pleural fluid (cytology) or pleural tissue (pathological histology). Management of malignant pleural effusions is principally palliative. Management that is often done in cases of MPE is therapeutic thoracentesis, pleurodesis, drainage with long-term indwelling catheter, manufacture of the pleuroperitoneal shunt, intrapleural therapy, and radiotherapy.

Mussel-Inspired Clickable Antibacterial Peptide Coating on Ureteral Stents for Encrustation Prevention.

Long-term indwelling catheters or stents often cause complications like infection, encrustation, hematuria, pain, and so on. The source of these problems is bacteria, which can form biofilms on the stents to reduce antibiotic sensitivity and produce urease to form encrustation by increasing the urine pH. Urinary tract infection (UTI) can aggravate the body damage and even seriously endanger lives, and the encrustation will block the stents, which can cause hydronephrosis and renal function damage. Therefore, the prevention of UTI and encrustation represents a great challenge in clinical ureteral stent uses. In this work, a clickable mussel-inspired peptide and antimicrobial peptide (AMP) were used to functionalize the commercial stents' surfaces to inhibit long-term infection and encrustation caused by bacteria. Copper (Cu) ions were used to coordinate the mussel-inspired peptide to improve the stability. The AMP with an azido group was clicked to the mussel-inspired Cu-coordinated peptide coating through click chemistry. The bio-inspired antibacterial coating was constructed with excellent stability, bactericidal properties, and improved biological compatibility. In in vitro and in vivo experiments, it was further found that the coating showed bactericidal and encrustation reduction abilities. This study thus developed an effective, safe, and stable AMP coating on urinary stents/catheters capable of long-term antibacterial and encrustation inhibition.

Quality of life among out-patients with long-term indwelling urinary catheter attending Urology Clinic at a Tertiary Hospital in Northwestern Tanzania

BackgroundThis study aimed to determine quality of life (QoL) among patients living with long-term indwelling urinary catheter (IUC) at home in the Northwestern Tanzania. To the best of our knowledge for the first time in Africa, we report on quality of life for patients living with a long-term IUC at home.MethodsThis was a descriptive cross‑sectional study conducted between December 2016 and September 2017. A total of 202 out-patients aged 18 years and above living with a long-term IUC were conveniently recruited. The QoL was determined using WHOQOL‑BREF tool. Quantitative data were entered into Microsoft Excel for cleaning and coding, then into STATA software version 13.0 for analysis. Descriptive statistics were used to compute means and standard deviations for numerical variables as well as frequencies for nominal and ordinal variables. Significance of association between various variables and QoL were tested using t test with equal variances. Inferential statistics applied included an independent sample’s t‑test for comparing numerical socio-demographic variables. A P-value < 0.05 was considered statistically significant. The mean score indicating good QoL according to our study is a mean score of 50 and above. The higher the score the higher the QoL.ResultsMedian age of participants was 69 (IQR 61–77) years. Majority of participants were males (195, 96.5%), married (187, 92.6%), and having primary education (116, 57.3%). Generally, the QoL was poor in all the domains: mean score for physical health being 36.67 ± 0.89, psychological 29.54 ± 0.87, social relationship 49.59 ± 1.61, and environment 26.05 ± 0.63. Married participants were slightly better under social domain 51.1 ± 1.6 than singles 31.1 ± 5.4; P-value 0.001. Those with primary education & above were slightly better in environmental domain 26.1 ± 0.7 than those with no formal education 23.5 ± 1.5; P-value 0.039.ConclusionQoL of participants with a long-term IUC in Northwestern Tanzania is generally poor in all domains. Those with primary education & above and the married were slightly better in environmental and social domains respectively. We recommend on the needs of improved social economic status and the importance of close follow up at home for the married participants living with long-term IUC.

Catechol-modified chitosan hydrogel containing PLGA microspheres loaded with triclosan and chlorhexidine: a sustained-release antibacterial system for urinary catheters

Blockage and infection are common in hospitals, especially with long-term indwelling catheters, due to bacterial adhesion, colonization, and other reasons. A drug-sustained-release antibacterial coating for urinary catheters was described in this paper. Chlorhexidine (CHX) and triclosan (TCS) were encapsulated in poly(lactic-co-glycolic acid) microspheres and mixed with a modified chitosan hydrogel deposited on the surface of silicone rubber. The results showed that drugs can be released continuously more than 35 days. Catechol-modified chitosan (Chi-C) hydrogel was successful synthesized according to FT-IR and UV spectrophotometry, as well as 1H NMR. Furthermore, the coating with CHX and TCS presented stable antibacterial ability compared to the other groups. The results of CCK-8 revealed that the coating was cytotoxic-free and had a wide range of applications. The findings could provide a new drug sustained-release system and hydrogel-microsphere assembly for urinary catheters. Highlights The microspheres presented a sustained release more than 40 days with a remarkable initial burst release. The microspheres/catechol-modified chitosan (Chi-C)/silicon rubber system emerged stable binding ability in liquid environment more than 14 days. The Chi-C/chlorhexidine (CHX)+triclosan (TCS) microspheres system presented better antimicrobial property for entire experiment period. The coated samples showed no significant difference for relative growth rate (RGR) compared to different groups.