Number Of Urinary Tract Infections Research Articles

Cost-Effectiveness of Cranberries vs Antibiotics to Prevent Urinary Tract Infections in Premenopausal Women: A Randomized Clinical Trial

BackgroundUrinary tract infections (UTIs) are common and result in an enormous economic burden. The increasing prevalence of antibiotic-resistant microorganisms has stimulated interest in non-antibiotic agents to prevent UTIs.ObjectiveTo evaluate the cost-effectiveness of cranberry prophylaxis compared to antibiotic prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX) over a 12 month period in premenopausal women with recurrent UTIs.Materials and MethodsAn economic evaluation was performed alongside a randomized trial. Primary outcome was the number of UTIs during 12 months. Secondary outcomes included satisfaction and quality of life. Healthcare utilization was measured using questionnaires. Missing data were imputed using multiple imputation. Bootstrapping was used to evaluate the cost-effectiveness of the treatments.ResultsCranberry prophylaxis was less effective than TMP-SMX prophylaxis, but the differences in clinical outcomes were not statistically significant. Costs after 12 months in the cranberry group were statistically significantly higher than in the TMP-SMX group (mean difference €249, 95% confidence interval 70 to 516). Cost-effectiveness planes and cost-effectiveness acceptability curves showed that cranberry prophylaxis to prevent UTIs is less effective and more expensive than (dominated by) TMP-SMX prophylaxis.ConclusionIn premenopausal women with recurrent UTIs, cranberry prophylaxis is not cost-effective compared to TMP-SMX prophylaxis. However, it was not possible to take into account costs attributed to increased antibiotic resistance within the framework of this randomized trial; modeling studies are recommended to investigate these costs. Moreover, although we based the dosage of cranberry extract on available evidence, this may not be the optimal dosage. Results may change when this optimal dosage is identified.Trial RegistrationISRCTN.org ISRCTN50717094

Health-care-associated infections: Risk factors and epidemiology from an intensive care unit in Northern India

Background and Aims:Health-care-associated infection is a key factor determining the clinical outcome among patients admitted in critical care areas. The objective of the study was to ascertain the epidemiology and risk factors of health-care-associated infections in Intensive Care Units (ICUs) in a tertiary care hospital.Methods:This prospective, observational clinical study included patients admitted in ICU over a period of one and a half years. Routine surveillance of various health-care-associated infections such as catheter-associated urinary tract infections (CAUTI), central-line-associated blood stream infections (CLABSI), and ventilator-associated pneumonias (VAP) was done by the Department of Microbiology through specific Infection Surveillance Proforma.Results:Out of 679 patients, 166 suffered 198 episodes of device-associated infections. The infections included CAUTI, CLABSI, and VAP. The number of urinary tract infection (UTI) episodes was found to be 73 (10.75%) among the ICU patients who had indwelling urinary catheter. In addition, for 1 year CAUTI was calculated as 9.08/1000 catheter days. The number of episodes of blood stream infection was 86 (13.50%) among ICU patients having central line catheters. Also, CLABSI was found to be 13.86/1000 central line days. A total of 39 episodes (6.15%) of VAP was found in ICU patients over 18 months and VAP present for 6.04/1000 ventilator days.Conclusions:The organisms most commonly associated with health-care-associated infections were Pseudomonas aeruginosa and Acinetobacter species. The risk factors identified as being significantly associated with device associated infections in our ICU were diabetes, COPD and ICU stay for ≥8 days (P < 0.05).

Primary vesicoureteral reflux: conservative therapy or surgical intervention

The relationship between urinary tract infections and primary vesicoureteral reflux may lead to permanent renal damage. In the literature an increasing number of spontaneous cure of vesicoureteral reflux in children and the significant decrease in surgical therapy has been observed. To study the evolution of primary vesicoureteral reflux associated with recurring urinary tract infections settings in patients of the Pediatric Nephrology department of our institution, evaluating cases in which cure was achieved through conservative therapy only and those in which surgical intervention was required. We analyzed records and collected data refers to parameters: sex, age upon the diagnosis of primary urinary infection, age upon diagnosis of vesicoureteral reflux, number of urinary tract infections, vesicoureteral reflux grade; renal function, renal scaring, other malformation of urinary tract, and surgical or conservative intervention. Statistical analysis was descriptive and conducted with the SPSS program. Within the subgroup of patients with grade IV and V, 63.6% of the cases evolved to surgical intervention and 36.4% to conservative intervention. In those with grades I, II, and III, 38.5% evolved to surgical treatment against 61.5% for conservative approach. Among those with bilateral vesicoureteral reflux, 72.7% had to undergo surgical intervention. No relationship was observed between the vesicoureteral reflux grade and the presence of renal scaring. Patients with low grade vesicoureteral reflux and recurring urinary tract infections tend to experience spontaneous reflux resolution with good renal evolution in the long term in a way that surgical intervention becomes limited to high grade reflux or when followed by other clinical issues.

Factors Associated With Renal and Urological Complications in Patients Suffering From Spinal Cord Injuries During Subsequent Years of Post-Injury

Virtually all patients with a spinal cord injury (SCI) suffer from neurogenic lower urinary tract dysfunction (NLUTD). The major goal of any treatment of these patients is the preservation of renal function. Especially suprasacral SCI frequently leads to elevated bladder storage pressures which are the major risk factor for renal deterioration. Therefore, the primary objective of bladder management is to achieve low pressure urine storage and emptying. To classify NLUTD of an individual patient and to monitor treatment, regular controls of bladder function are mandatory. The authors assessed the patients with SCI by questionnaires, laboratory tests and imaging. The number of patients included (5901) is impressive. The number of urologic complications observed is rather high. It was not surprising that presence of urologic complications was associated with level of injury and time since injury. It is noteworthy, however, that these complications are depending on the living place (1). Unfortunately, but understandably, no urodynamic data were included in the analysis. It is very demanding to collect urodynamic data from such a large patient cohort. Furthermore, urodynamic examinations are merely possible in specialized centers, and I suspect that this examination was not available for all patients at every control visit. Urodynamics, however, are considered the gold standard for the assessment of the main risk factors for renal damage, namely a detrusor leak point pressure/storage pressure > 40 cm H2O and/or a low detrusor compliance (< 20 mL/cm H2O). Until today, these factors can exclusively be assessed by urodynamics. Thus, it is crucial for the evaluation of NLUTD, since significant changes in NLUTD may occur without symptoms in about 70% of patients with SCI (2). The lack of urodynamic examinations may at least be one explanation for the higher risk for renal complications in SCI patients living in rural areas. As a consequence, the more frequent use of urodynamic testing in this group of patients may in the future even improve the outcome of patients with SCI. As urodynamics are expensive, time consuming, and carry the risk of urinary tract infections, a new diagnostic parameter would be clinically helpful if it either could replace urodynamics or could be used as an additional diagnostic tool to detect SCI patients with NLUTD without risks for consecutive renal damage. Sonographic measurement of the bladder wall thickness may be a future option, but until today, this technique is not well standardized and cannot replace urodynamics yet (3). Not unexpectedly, urinary tract infections are the most common urologic complication in these patients. The frequency of urinary tract infections depends on the method used for bladder evacuation, with indwelling catheters having the highest infection rates. The study does not distinguish between the different methods of bladder management. In general, indwelling catheters should be avoided if ever possible to reduce the number of urinary tract infections (4). In summary, the authors are congratulated for their extensive study, providing the readers with important information about the impact of demographic and environmental factors on urologic complications in SCI patients. As these factors also include the coverage of medical supplies, which is world-wide dependent on living place and social status, the results also mirror the need of optimized diagnostics and treatment of SCI patients as demanded by the world health organization (5). As meticulous urodynamic diagnostics and adequate urologic treatment have been proven to dramatically decrease the rate of urologic complications after SCI (6), the nationwide access to urologic care for patients with SCI should be targeted in the future. Footnotes Financial Disclosure: I have no conflict of interest.

The prevalence of small intestinal bacterial overgrowth and methane production in patients with myelomeningocele and constipation

Prospective study. The objective of this study was to assess the prevalence of small intestinal bacterial overgrowth (SIBO), methane (CH4) production and orocecal transit time (OCTT) in children affected by myelomeningocele. This study was conducted at the Catholic University in Rome, Italy. Eighteen (6M/12F; 16.4±7.6 years) children affected by myelomeningocele were enrolled. All subjects underwent H2/CH4 lactulose breath tests to assess SIBO and OCTT. All patients performed a visual analog scale to investigate abdominal pain, bloating and flatulence, and maintained a diary of the frequency and consistency of the stool during the previous 7 days. A nephro-urological clinical evaluation of the number of urinary tract infections (UTIs) and neurogenic bowel disease score were also performed. Thirty-nine percent (7/18) of the children showed SIBO and 61% (11/18) presented a delayed OCTT. Moreover 44.4% (8/18) produced high levels of CH4. Interestingly, all myelomeningocele children who produced CH4 showed a delayed OCTT and a higher incidence of UTI, with a lower frequency of evacuation, compared with those with a normal or accelerated OCTT. The association between CH4 and constipation suggests that CH4 has an active role in the development of constipation. One of the most interesting features of our study is to identify a correlation between myelomeningocele, CH4, delayed OCTT and UTI. The intestinal decontamination with locally acting drugs in these children may reduce the number of UTIs and improve intestinal motility.

A Review of Educational Programs to Reduce UTIs Among Individuals with SCI

To evaluate the effectiveness of educational programs in reducing urinary tract infections (UTIs) in individuals with spinal cord injuries (SCI). A search of all relevant literature published up to and including July 2012 was conducted using multiple databases. Methodological quality was rated using the PEDro tool for randomized control trials (RCTs) and the Downs and Black tool for non-RCTs; levels of evidence were assigned using a modified Sackett scale. Four articles were selected for review. As a result of an education program, a level 2 prospective control trial reported a reduction in number of UTIs (p=.02), but a level 2 RCT did not. A pre-post study found a reduction in number of UTIs while a case-control study did not; however, these studies did not compute statistics. There is limited positive evidence that education programs reduce the incidence of UTIs. Optimal urinary health of individuals with SCI may be optimized via education programs that provide information and enhance skills.

Prevention of recurrent urinary tract infections by intravesical administration of heparin: a pilot study

To assess the effect of bladder instillations using heparin on the rate of urinary tract infections in women resistant to standard therapy. The medical records of all women who received bladder instillations between May 2009 and January of 2010 at the University of Wisconsin urogynecology clinic were reviewed. Eighteen women (mean age 67 years) with a history of recurrent urinary tract infections received intravesical instillations (heparin 40,000 U, 2% lidocaine 8 ml, sodium bicarbonate 4 ml) once weekly for 6 weeks. Patients were considered resistant to standard therapy if their condition failed to respond to chronic suppression antibiotic therapy; they had chronic infections and for this reason could not be placed on chronic suppression; or they were not candidates for chronic suppression due to drug allergies. The number of urinary tract infections was monitored during treatment and for 6 months after therapy. The urinary tract infection rates were compared with the rates of urinary tract infection in the 6 months before treatment. Seventy-eight percent of patients responded to therapy. Subjects were thought to have responded to therapy if there was a greater than 50% reduction in the rate of urinary tract infection. Other variables reviewed included evidence of chronic infection, hormonal status, glomerular filtration rate, age, body mass index, antibiotic allergies, diabetes, hypertension, and chronic antibiotic therapy during bladder instillations. None of these variables were found to be statistically significant. Bladder instillations decreased the rate of urinary tract infection in this pilot study; this effect persisted into the post-treatment period. More research is needed to confirm these preliminary findings.

Compliance with clean intermittent catheterization in spinal cord injury patients: a long-term follow-up study

Retrospective review of medical notes. To evaluate spinal cord injury (SCI) patients' compliance with bladder emptying method at long-term period after discharge and determine the frequency of urinary tract infections (UTIs). Inpatient rehabilitation unit of tertiary research hospital. Bladder management method of 164 new spinal cord injured patients were noted at discharge from rehabilitation center and follow-up. Patients were questioned whether they continued the initial bladder emtying method at follow-up, reasons for discontinuation and the history of treated UTIs. The most common bladder management method at discharge from inpatient rehabilitation center was clean intermittent catheterization (CIC) (63.4%). At follow-up 42% of the patients who used CIC changed their bladder emptying method. Rate of reverting to urethral indwelling catheter (IC) was 21.4%. Reasons for the patients who switched to IC application were recurrent UTIs, incontinence, nephrolithiasis, dependence on care givers and urethral strictures. For all patients, the frequency of treated UTI in 1 year was 38.8%. The number of UTIs were highest in patients using IC. Many factors, including urological complications, patient's preference, living environment, life-style and level of injury should be considered in deciding the method of bladder management in SCI patients. The CIC is a reliable and effective method in selected SCI patients. Despite changes in bladder emptying method, CIC was the most preferred method at long-term follow-up. Education of patients on catheterization technique and periodic follow-up is necessary to maintain patient compliance.

Should hormone replacement therapy be used in postmenopausal women for voiding dysfunction?

Should hormone replacement therapy be used in postmenopausal women for voiding dysfunction?

645 SONOGRAPHIC ASSESSMENT OF THE EFFECT OF VESICOURETERAL REFLUX AND URINARY TRACT INFECTIONS ON GROWTH OF THE PEDIATRIC SOLITARY KIDNEY

INTRODUCTION AND OBJECTIVES: Many papers have addressed the effect of vesicoureteral reflux (VUR) and urinary tract infections (UTIs) on renal growth. Studies have shown that patients with solitary kidneys, especially those with congenital anomalies of the kidneys and urinary tract are more likely to end up with chronic kidney disease and end stage renal disease. Based on sonographically determined renal length we evaluated the effect of VUR and UTIs on the growth of solitary kidneys. METHODS: We retrospectively reviewed a cohort of 158 patients with the diagnosis of solitary or functionally solitary kidney seen in a pediatric urology practice between 2001 and 2011. Patients between 1 month and 18 years old with at least one ultrasound renal length measurements were included in the study. A total of 751 ultrasounds were included from 42 patients with VUR and 116 without VUR. Based on a linear mixed effects model, we investigated the influence of VUR and UTIs on the renal growth rate for solitary kidneys. Interactive effects between age, VUR and UTI status were also modeled. RESULTS: The VUR subgroup had more ultrasounds on average (p 0.001). The left solitary kidney tended to be larger than the right (p 0.042). Kids with VUR did not have a statistically significant larger number of UTIs (p 0.25). Solitary kidneys started out the same size regardless of VUR status but started to cross as patients aged. A solitary kidney with neither VUR nor UTIs grew 0.49 cm per year, while a solitary kidney with VUR grew 0.40 cm per year (p 0.001) and a solitary kidney with VUR and UTIs grew 0.31 cm per year (p 0.005). CONCLUSIONS: Our analysis shows that solitary kidneys start equal in size but that VUR and UTIs independently cause a statistically significant slower growth rate. The kidneys become relatively smaller over time as compared to those without VUR and UTIs. This suggests that the effect of VUR and UTIs on the growth of the solitary kidneys persists throughout childhood. Further studies are needed to evaluate the mechanism of this effect, whether these patients eventually develop renal insufficiency and whether more aggressive early management would be warranted.

Risk factors for renal scarring in children with primary vesicoureteral reflux disease

To determine the incidence of renal scarring among patients with primary vesicoureteral reflux (VUR) and the possible risk factor(s), we studied 90 children (60 girls and 30 boys) with VUR followed in the Pediatric Nephrology Unit at the Ege University Hospital from 1998 to 2003. All the patients were assessed for VUR grade by voiding cystoureterography and for presence of renal scarring by (99 m) technetium dimercapto-succinic acid scintigraphy. All infants with VUR were given low-dose prophylactic antibiotics and followed-up until resolution of the reflux. Grade of reflux and number of urinary tract infection (UTI) episodes (≥3) were found to be statistically significant risk factors for renal scarring (P <0.05). However, gender, familial history and laterality of the disease were not found to be statistically significant risk factors (P >0.05). Similarly, there was no statistically significant difference of frequency of renal scarring among the different age groups (P >0.05). We conclude that recurrences of UTI and VUR severity are significant risk factors for renal scarring in children with VUR. Therefore, identification of VUR at an early age may offer the opportunity to prevent episodes of UTI and possible formation of renal scars that may result in end-stage renal failure.

Preparation and Evaluation of Amino Acid Based Salt Forms of Model Zwitterionic Drug Ciprofloxacin

Preparation and Evaluation of Amino Acid Based Salt Forms of Model Zwitterionic Drug Ciprofloxacin Ciprofloxacin (CIP) is a quinolone derivative which is widely used for the treatment of a number of urinary tract infections. It exhibits its antimicrobial activity by inhibiting bacterial DNA gyrase enzyme. BCS classification of CIP is challenging due to the absence of any linear dose proportionality of AUC in humans. Yet, most of the studies classify CIP as a BCS IV (low solubility & low permeability drug) candidate. This study aims at exploiting the zwitterionic nature of CIP and investigates the ability of acidic and basic amino acids to form new salts with the primary aim of improving its solubility. Two salts were prepared using L-glutamic acid and L-aspartic acid as counter ions which resulted in increasing CIP solubility by 2.9x103 and 2.5x103 folds respectively. On the other hand, cationic amino acids namely (L-arginine, L-lysine & L-histidine) failed to form any salts. To investigate the absence of salt formation with the cationic amino acids, the role of inter- and intra molecular interactions between CIP and amino acids on the salt formation was studied using molecular dynamic simulation. Both the experimental and theoretical results revealed that ionic and hydrophobic interactions are essential for salt formation and that the ionic interaction and/or hydrophilic interactions between CIP and amino acids molecules should be greater than hydrophobic interactions between CIP molecules. Future work will study the effect of the salts on the permeability behaviour of CIP across Caco-2 monolayers.

Urinary tract infections in patients with rheumatoid arthritis

Co-morbidity from rheumatoid arthritis (RA) has recently focussed on outcomes of cardiovascular and pulmonary disease, but serious infections are an increasingly well-recognised complication of RA. Recent work has demonstrated how the incidence of pneumonia can be reduced in RA, but little attention has been paid to the incidence of urinary tract infection (UTI) in RA or to the associated co-morbidity. The aim of this study was to describe the incidence of UTI leading to hospitalisation in a large cohort of patients with RA and investigate which factors contributed to this. This study assessed all patients with RA hospitalised over a 12-month period with a discharge diagnosis including UTI. Patients were identified through a PAS records search in a single large centre. Historical case controls without RA matched for age and gender were identified from the literature. Clinical notes were manually examined by two observers. We recorded: age, gender, duration of RA, number of UTI, all RA therapy, co-morbidity, results of urine and blood cultures with antimicrobial sensitivities, readmission rates, treatment and outcome. We calculated the relative risk (RR) of developing UTI in patients with RA and the factors influencing this. From a population of 2,200 RA patients, the overall annual incidence of hospitalisation with UTI amongst RA patients was 2.09 %, as against 0.97 and 0.91 % for two control groups (RR = 2.16 and 2.29). Most patients (90 %) were female, and the group mean age was 76 years. The use of long-term oral steroids as sole therapy was associated with a RR of 6.8 for UTI (p = 0.002) while failure to take disease-modifying anti-rheumatic drugs (DMARDs) was associated with a similar RR of 6.7 (p = 0.001). Positive cultures for Escherichia coli were found in 51 % of RA patients. Relevant co-morbidities included permanent catheters, vaginal prolapse, cancer and diabetes. Recurrence of UTI within a year was common. RA was associated with a higher-than-expected incidence of UTI, particularly among older females. This was associated with the use of long-term oral steroids and the absence of DMARDs. Other factors included female gender, greater age and long disease duration. We recommend avoidance of long-term oral steroids but consideration of low-dose prophylactic antibiotics in those patients with recurrent UTI.

Clinical Trial of Dried Cranberry Consumption to Reduce Urinary Tract Infection Incidence in Susceptible Women

Recurrent urinary tract infections (UTIs) occur in up to ten percent of women and are a significant source of patient morbidity and health care costs. A variety of cranberry products have been used for UTI prevention, but no previous studies have examined whether consumption of dried cranberries will decrease the incidence of UTIs in susceptible patients. We conducted a clinical trial in which 20 women with a history of recurrent UTIs consumed one serving of sweetened, dried cranberries daily for two weeks. Patients reported the dates of UTIs in the six‐month periods pre‐and post‐treatment. The efficacy of dried cranberry consumption in reducing UTI occurrence was determined by comparing pre‐and post‐treatment infection rates. Of the 17 patients who completed the study, nine (53%) did not experience any UTIs within six months after treatment, and the UTI rate per six months decreased significantly from 2.8 to 1.2 (p=0.005). Kaplan‐Meier analysis compared the incidence of UTIs in study patients to patients receiving placebo in a previous UTI vaccine trial. Women in the two trials had equivalent UTI histories. This analysis showed a significant reduction in the number of UTIs in the six months post‐treatment (p=0.02). Based on these two clinical evaluations, there appears to be a beneficial effect to consuming dried cranberries in reducing recurrent UTIs in susceptible women.Supported by Ocean Spray Cranberries, Inc

Study of factors affecting resolution of urinary tract infection following treatment of constipation in Iranian children who visited a tertiary referral hospital

Aim: The aim of this study was to evaluate the effect of sex, age, number of urinary tract infections, and duration of con stipation on resolution of urinary tract infection (UTI) follow ing treatment of constipation in Iranian children referred to pediatric gastroenterology and pediatric nephrology clinics. Material and methods: This study was conducted in Mofid Children’s Hospital. Duration of the study was from 1 October 2010 to 31 June 2011. In this study every child who visited due to urinary tract infection or constipation was asked about the other condition. Data were analyzed by SPSS ver. 16.0 (Chica go, IL, USA). χ 2 and t-test were used for comparison. Results: In this study, 550 children visited the hospital due to urinary tract infection or constipation. Finally 380 patients with constipation and UTI were detected. Among 220 patients with UTI > 2 times, 90 (40.90%) showed UTI resolu tion after treatment of constipation. Of 160 patients with ≤ 2 UTIs, 85 (53.12%) showed UTI improvement following treatment of constipation ( p = 0.018). In children younger than 1 year, treatment of UTI after treatment of constipation was more effective than in other ages ( p < 0.001). There was no significant difference between males and females. In chil dren with constipation duration less than 6 months, most cases of urinary tract infection resolved after treatment of constipation ( p < 0.001). Conclusions: The UTI resolution after treatment of constipa tion was higher in children < 1 year old. If the patient has a history of more than 2 UTIs, improvement of UTI following treatment of constipation will be decreased.

Antibiotic Prophylaxis for Urinary Tract Infections in Children With Spina Bifida on Intermittent Catheterization

Antibiotic prophylaxis (low dose chemoprophylaxis) has been prescribed since the introduction of clean intermittent catheterization in children with spina bifida. We hypothesized that stopping low dose chemoprophylaxis does not increase the number of urinary tract infections in these patients. A total of 176 patients with spina bifida participated in a randomized controlled trial (ISRCTN trial number 56278131) of either continuation or discontinuation of low dose chemoprophylaxis. During the 18-month study period biweekly urine samples were evaluated for leukocyturia and bacteriuria with dipsticks and cultures. Asymptomatic significant bacteriuria (positive culture results without clinical symptoms) and urinary tract infections (significant bacteriuria with clinical symptoms and leukocyturia) were analyzed. Discontinuation of low dose chemoprophylaxis resulted in higher rates of asymptomatic significant bacteriuria (incidence rate ratio 1.23, 95% CI 1.08-1.40, p = 0.002) and urinary tract infection (IRR 1.44, 95% CI 1.13-1.83, p = 0.003). For urinary tract infection the number needed to harm was 2.2, that is if 2 patients discontinued low dose chemoprophylaxis for a year, 1 extra urinary tract infection would result. Febrile urinary tract infection occurred once in every 30 patient-years and slightly more often in the discontinuation group (relative risk 2.0, 95% CI 0.38-10.6, p = 0.4). Of 88 patients allocated to discontinuation of low dose chemoprophylaxis 38 (43%) switched back to chemoprophylaxis. The urinary tract infection rate was nonsignificantly higher in the presence of vesicoureteral reflux. Male gender and a low pre-study rate of urinary tract infection predicted successful discontinuation. Patients with spina bifida on clean intermittent catheterization and antibiotic prophylaxis for urinary tract infections can safely discontinue this prophylaxis, in particular males, patients with low urinary tract infection rates and patients without vesicoureteral reflux.

Can a multifaceted educational intervention targeting both nurses and physicians change the prescribing of antibiotics to nursing home residents? A cluster randomized controlled trial

To assess the impact of a multifaceted educational intervention concerning treatment of infections in the nursing home setting. We used a cluster randomized controlled trial. Fifty-eight nursing homes in Sweden were randomly assigned either to educational intervention or control. The intervention consisted of small educational group sessions with nurses and physicians, feedback on prescribing, presentation of guidelines and written materials. The primary outcome was the proportion of quinolones prescribed for lower urinary tract infection (UTI) in women. Secondary outcomes were for all infections: number of UTIs per resident, proportion of recorded infections treated with an antibiotic, proportion of infections handled by physicians as 'wait and see', and for lower UTI in women, proportion of nitrofurantoin. Of the 58 nursing homes, 46 completed the study. A total of 702 and 540 infections were recorded pre- and post-intervention. The proportion of quinolones decreased significantly in the intervention and control groups, by -0.196 (9/93 to 36/123) and -0.224 (4/66 to 31/109), respectively [95% confidence interval (CI) -0.338, -0.054 and -0.394, -0.054], but the difference between intervention and control groups was not significant, with an absolute risk reduction of 0.028 (95% CI -0.193, 0.249). The changes in proportion of infections treated with antibiotics and proportion of infections handled by physicians as 'wait and see' was significant in comparison with controls: -0.124 (95% CI -0.228, -0.019) and 0.143 (95% CI 0.047, 0.240). No intervention effect could be seen for the other outcomes. The educational intervention had no effect on the primary outcome, but decreased the overall prescribing of antibiotics.

Renal function in children with congenital neurogenic bladder

AIMS:Preservation of renal function in children with congenital neurogenic bladder is an important goal of treatment for the disease. This study analyzed the evolution of renal function in patients with congenital neurogenic bladder.METHODS:We reviewed the records of 58 pediatric patients with respect to the following attributes: gender, age, etiology of neurogenic bladder, reason for referral, medical/surgical management, episodes of treated urinary tract infections, urodynamics, DMSA scintigraphy, weight, height, blood pressure, glomerular filtration rate, microalbuminuria and metabolic acidosis. Statistical analysis was performed, adopting the 5% significance level.RESULTS:The mean age at presentation was 4.2 ± 3.5 years. Myelomeningocele was the most frequent etiology (71.4%). Recurrent urinary tract infection was the reason for referral in 82.8% of the patients. Recurrent urinary tract infections were diagnosed in 84.5% of the patients initially; 83.7% of those patients experienced improvement during follow‐up. The initial mean glomerular filtration rate was 146.7 ± 70.1 mL/1.73 m2/min, and the final mean was 193.6 ± 93.6 mL/1.73 m2/min, p = 0.0004. Microalbuminuria was diagnosed in 54.1% of the patients initially and in 69% in the final evaluation. Metabolic acidosis was present in 19% of the patients initially and in 32.8% in the final assessment.CONCLUSIONS:Patient referral to a pediatric nephrologist was late. A reduction in the number of urinary tract infections was observed with adequate treatment, but microalbuminuria and metabolic acidosis occurred frequently despite adequate management.

RCT of urethral versus suprapubic catheterization

To compare the use of intermittent urethral catheterization with indwelling suprapubic catheterization in women undergoing surgery for urodynamic stress incontinence or uterovaginal prolapse. Randomized controlled trial. Tertiary referral urogynaecology unit. Women undergoing surgery for pelvic organ prolapse and/or stress urinary incontinence. Women were randomized into one of two groups. Group 1 had bladder drainage using a suprapubic catheter inserted in theatre. The catheter was left on free drainage for 48 hours post-operatively before clamping. Group 2 was catheterized intermittently post-operatively. Length of post-operative hospital stay: time to resume normal voiding (defined as voided volumes greater than 200 mls and residual urine volumes less than 100 mls on three occasions); number of urinary tract infections (UTIs); catheterization costs; patient experience (determined from questionnaire); and a pain score. 75 women were randomized; 38 to suprapubic catheterization; 37 to intermittent catheterization. Three were withdrawn from study, leaving 36 women in each group. Groups were closely matched for age and type of surgery undertaken. Length of hospital stay and total duration of catheterization were both significantly shorter for the intermittent catheterization group; although there was no difference in the rate of UTI between the two groups. There was no clear patient preference for a specific catheterization method. The use of intermittent catheterization following urogynaecological surgery is associated with a more rapid return to normal micturition and a shorter hospital stay, although the clinical significance of the difference is perhaps limited.

Surgically Corrected Urethral Diverticula: Long-term Voiding Dysfunction and Reoperation Rates

To present the largest reported cohort of women with urethral diverticula and to evaluate the surgical outcomes and long-term voiding symptoms after urethral diverticulectomy. Studies evaluating the outcomes after urethral diverticulectomy have been limited by small patient numbers and short-term follow-up. Women who had undergone diverticulectomy at our institution from 1996 to 2008 were mailed surveys. Urinary bother was assessed using the Urogenital Distress Inventory 6-item questionnaire, and patients were asked to report subsequent urethral or vaginal surgery and the number of urinary tract infections within the previous year. To determine the rate of surgical recurrence, the charts of women not responding to the survey were reviewed. A total of 122 women were identified as having undergone urethral diverticulectomy during the study period. Of these, 13 (10.7%) had an eventual recurrence that required repeat surgical excision. Patients with a proximal diverticulum, multiple diverticula, or previous pelvic or vaginal surgery (excluding previous diverticulectomy) were more likely to develop recurrence (P = .01, P = .03, and P < .001, respectively). For the 61 women (50%) responding to our survey, the mean follow-up was 50.4 months. Of these 61 women, 24 (39.3%) had had a urinary tract infection within the previous year, with 14 (23%) women having had ≥3 within the previous year. Also, 16 (26.2%) had persistent pain or discomfort with urination. The mean ± SD total Urogenital Distress Inventory-6 score was 31.1 ± 25.5 for the survey responders. To our knowledge, our study represents the largest study with the longest follow-up after urethral diverticulectomy. Patients with proximal or multiple diverticula and those with previous pelvic surgery should be counseled appropriately regarding the risks of recurrence and persistent voiding dysfunction.