Preoperative Positive Culture Research Articles

Factors associated with positive urine cultures in cats with subcutaneous ureteral bypass system implantation.

The aims of this study were to report the postoperative incidence of subcutaneous ureteral bypass (SUB)-associated bacteriuria and risk factors in a large population of UK cats, to identify the commonly implicated isolates in these cases and to report associations of positive postoperative urine cultures with device occlusion or a need for further surgery. Electronic clinical records were reviewed to identify cats with ureteral obstruction that underwent unilateral or bilateral SUB implantation between September 2011 and September 2019. In total, 118 client-owned cats were included in the study population. Information recorded included signalment, history, surgical and biochemical factors, urinalysis and culture results. Multivariable logistic regression was performed to identify variables associated with a positive postoperative culture. In total, 10 cats (8.5%) had a positive postoperative culture within 1 month postsurgery and 28 cats (23.7%) within 1 year postsurgery. Cats with a positive preoperative culture were significantly more likely to have a positive culture within 6 months postoperatively (odds ratio [OR] 4.09, 95% confidence interval [CI] 1.18-14.18; P = 0.026). Of the 14 cats with a positive preoperative culture, six (42.9%) returned a positive culture within 1 year postoperatively, and in four cases (66.7%) the same isolate was identified. Cats with a higher end-anaesthetic rectal temperature were significantly less likely to return a positive culture within 3 months (OR 0.398, 95% CI 0.205-0.772; P = 0.006) postsurgery. Cats culturing positive for Escherichia coli at any time point (OR 4.542, 95% CI 1.485-13.89; P = 0.008) were significantly more likely to have their implant removed or replaced. Perioperative hypothermia and preoperative positive culture were independent predictors of a postoperative positive culture and this should be taken into consideration when managing these cases. Positive postoperative culture rates were higher than have previously been reported.

MP75-10 TAILORING ANTIBIOTIC PROPHYLAXIS FOR URETEROSCOPIC PROCEDURES BASED ON LOCAL RESISTANCE PROFILES MAY LEAD TO REDUCED RATES OF INFECTIONS AND UROSEPSIS

You have accessJournal of UrologyStone Disease: Surgical Therapy VII1 Apr 2017MP75-10 TAILORING ANTIBIOTIC PROPHYLAXIS FOR URETEROSCOPIC PROCEDURES BASED ON LOCAL RESISTANCE PROFILES MAY LEAD TO REDUCED RATES OF INFECTIONS AND UROSEPSIS Ariel Zisman, Shadie Badaan, Alexander Kastin, Alexander Kravtsov, David Kakiashvili, Gilad E. Amiel, and Michael Mullerad Ariel ZismanAriel Zisman More articles by this author , Shadie BadaanShadie Badaan More articles by this author , Alexander KastinAlexander Kastin More articles by this author , Alexander KravtsovAlexander Kravtsov More articles by this author , David KakiashviliDavid Kakiashvili More articles by this author , Gilad E. AmielGilad E. Amiel More articles by this author , and Michael MulleradMichael Mullerad More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2158AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Post ureteroscopy UTI rate is about 4%. AUA guidelines suggest prophylaxis treatment for proximal or impacted stones. We examined whether a double drug Antibiotic Prophylaxis Treatment (APT), an aminoglycoside and penicillin based on resistant bacteria strains we encounter in our institution may reduce urosepsis post-ureteroscopy. METHODS Between February 2015 and March 2016, we performed 344 ureteroscopies. Starting September, 2015 we changed the APT for endo-urological procedures according to the bacterial resistance profile in urine cultures at our institution. Inclusion criteria were adult patients referred to ureteroscopic treatment for a urinary stone, with or without prior stenting. Exclusion Criteria included integrated procedures (with PCNL), biopsies, pediatric or pregnant patients. Sepsis was defined as fever above 38.5 degrees Celsius with additional standard criteria (International Sepsis Definitions Conference). All patients had a urine culture taken prior to APT initiation. Fisher's exact test and T-test with a two-tailed P value < 0.05 denoted statistical significance. RESULTS 57 patients were excluded. Group 1 (n=106) were the last to receive the conventional APT (PO Ciprofloxacin 500mg X 2), while the second group (n=181) were the first to receive the new regimen (IV Gentamycin 240mg & Ampicillin 1gr X 3) prior to ureteroscopy. 65 patients had a preoperative positive culture. A significant percentage of both groups had a preoperative positive urine culture (29%-group 1; 18%-group 2). Seven out of 9 septic events developed in those patients (P<0.001). Patients undergoing RIRS procedures were at increased risk for a septic event when treated with conventional APT (7/9 events; P<0.01). No significant correlation was found between preoperative kidney drainage (stent or nephrostomy tube) and sepsis. CONCLUSIONS Our study demonstrates that a significant portion of patients undergoing ureteroscopic treatment for urinary stones have positive preoperative urine culture, despite previous treatment. Standard, ‘one size fits all' APT is not sufficient according to our data. A regimen tailored to the local bacterial resistance strains can lower the rate of sepsis significantly. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1006-e1007 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Ariel Zisman More articles by this author Shadie Badaan More articles by this author Alexander Kastin More articles by this author Alexander Kravtsov More articles by this author David Kakiashvili More articles by this author Gilad E. Amiel More articles by this author Michael Mullerad More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Synovial fluid white cell count and histopathological examination of periprosthetic tissue samples (frozen and permanent sections) in the diagnosis of prosthetic knee infection

Abstract The aim of the study was to determine prospectively the importance of synovial fluid white cell count and intraoperative frozen and permanent sections analysis (number of polymorphonuclear leukocytes per high-power field) in the diagnosis of septic total knee arthroplasty. There were studied prospectively 72 patients who needed a revision total knee arthroplasty between 2013-2015. 30 patients were diagnosed with prosthetic joint infection due to high rates of ESR (93%) and CRP (90%) and preoperative positive culture from aspirated synovial fluid and 42 patients were considered to have aseptic failure according to negative preoperative culture from joint aspirate. For all the patients was analysed synovial fluid white cell count and histopathological aspect of intraoperative frozen and permanent sections of periprosthetic tissue. The results showed a median value of 13800 of sinovial white cells count for infected knee and 92 for noninfected knee. 90% of the patients with joint infection had more than 5 polymorphonuclear leukocytes per high power field on intraoperative frozen sections and 83% on permanent sections. None of the patients from aseptic group had more than 5 polymorphonuclear leukocytes per field on permanent sections. The erythrocyte sedimentation rate and C-reactive protein level can be supplemented with cultures of aspirated joint fluid and fluid white cell count to confirm the diagnosis of periprosthetic infection. When the preoperative diagnosis remain unclear, the histological examination of frozen or permanent sections of periprosthetic tissue with at least 5 polymorphonuclear leukocytes per high power field, is predictive for the presence of infection.

Elbow Resection for Deep Infection After Total Elbow Arthroplasty: Surgical Technique.

Deep infection at the site of a total elbow arthroplasty is best managed with definitive removal of the components with resection arthroplasty in selected patients. Use a previous skin incision when possible, keep the subcutaneous flaps as thick as possible, and avoid inadvertent iatrogenic injury to the ulnar nerve. The location of the ulnar nerve may be unpredictable, and the radial nerve may be at risk in two different locations. Access the implants through windows on the medial and lateral aspects of the triceps; whenever possible, consider an extended olecranon osteotomy when the ulnar component and cement are well fixed. Removal of all retained cement after removal of the humeral component is critical. The ulna is much more delicate and fragile than the humerus and is prone to iatrogenic fracture. Send three separate samples for culture when there was at least one preoperative positive culture, and five samples when there were no positive preoperative cultures. Use the nozzles of cement guns to create cylinders of cement to be inserted in the ulna and humerus. For patients with compromised soft tissues, we often consult with a plastic surgeon prior to surgery to contemplate improved coverage with rotation or free flaps at the time of the resection arthroplasty. Early motion in an articulated brace may be allowed with a "stable" resection; unstable resections with substantial bone loss are best protected longer with no motion and may require a static brace. We recently reviewed the Mayo Clinic experience with resection arthroplasty for the treatment of infection after total elbow replacement. IndicationsContraindicationsPitfalls & Challenges.

Antibiotic Prophylaxis After Uncomplicated Ureteroscopic Stone Treatment: Is There a Difference?

We evaluated the risk of development of a symptomatic urinary tract infection (UTI) based on the antibiotic prophylaxis given to a patient during and after uncomplicated ureteroscopy (URS) for urolithiasis. We retrospectively reviewed the charts of patients who underwent URS, laser lithotripsy, and stent placement for the management of stones from 2004/2005 (group 1) and 2009/2010 (group 2). We excluded all patients with preoperative positive cultures, preoperative antibiotics, urinary diversion, who underwent concomitant percutaneous nephrolithotomy, or had strings attached to the stents. All patients received a first-generation intravenous cephalosporin or fluoroquinolone at the time of initial intervention and had ureteral stents placed intraoperatively. Group 1 received an oral fluoroquinolone for 1 week postoperatively. Group 2 received an oral first-generation cephalosporin antibiotic peri-stent removal only. Antibiotics were appropriately changed according to the local resistance patterns. All stents were removed within 5 to 7 days. Our primary end point was symptomatic UTI. After the exclusion criteria, group 1 had 48 patients, group 2 had 49. There was no statistical difference in the incidence of symptomatic UTI between the two groups; each group had one UTI (2% risk) (P=0.988). There were no cases of readmission, pyelonephritis, UTI, surgical reintervention, or Clostridium difficile. The UTI in group 1 was secondary to Escherichia coli and in group 2, Staphylococcus species; both were managed with oral antibiotics. The use of oral peri-stent removal antibiotic prophylaxis is sufficient to prevent symptomatic UTIs in patients who have undergone uncomplicated URS for urolithiasis. The judicious use of antibiotics in uncomplicated cases may help lower the incidence of resistant organisms and other complications related to the widespread use of antibiotics.

Methicillin resistant Staphylococcus aureus infections following cardiac surgery: incidence, impact and identifying adverse outcome traits☆

To assess the incidence and impact of Methicillin-resistant Staphylococcus aureus (MRSA) infections on cardiac surgery outcomes and to identify adverse outcome traits. Retrospective analysis of prospectively collected data from cardiac surgical and microbiology databases between April 2000 and March 2005. The overall and yearly incidence of positive MRSA cultures was examined along with the distribution of clinical infections and the associated mortality. Pre-operative patient characteristics were analysed between non-survivors and survivors of MRSA infections. Multivariate logistic regression was used to assess the relationship between pre-operative patient characteristics and in-hospital mortality in patients with MRSA. A comparison of post-operative outcomes between non-survivors and survivors of MRSA infections was also carried out and included in the logistic regression analysis. There were 319 patients with positive MRSA cultures during the study period with an overall incidence of 3.9%. Yearly incidence ranged from 2.4% to 5.2%. There were 120 carriers with pre-operative positive cultures of which 25 developed clinical surgical infections leaving 224 patients as the study group. Overall mortality in patients with MRSA during the study period was 12.9%(41/319). Mortality in the study group was 17.8% (40/224). Mortality comparison between MRSA and non-MRSA mediastinitis was 26.7%(8/30) and 17.1%(13/76), respectively (p=0.26). Mortality between MRSA and non-MRSA septicaemia was 46.9% (15/32) and 52.9% (37/70) (p=0.57). Applying the logistic EuroSCORE to the MRSA patients revealed that non-survivors had a significantly higher pre-operative risk of 10.4% compared to survivors with a pre-operative risk of 6.2% (p=0.003). Renal dysfunction and poor ejection fraction were found to be pre-operative factors associated with mortality in MRSA patients following the multivariate logistic regression analysis. Non-survivors had longer stays on intensive care, longer ventilation times, and were more likely to require support with balloon pumps and haemofiltration. MRSA septicaemia and length of ventilation were significantly associated with mortality in MRSA patients ahead of pre-operative characteristics. The incidence of MRSA is low, but carries a high mortality. MRSA septicaemia and mediastinitis have the highest associated mortality; however, this is not significantly different from non-MRSA infections. Patients with MRSA who die have higher pre-operative risk and have a poorer post-operative course than survivors.