Prolonged Catheterization Research Articles

(Invited) Development of Fibronectin-Modified Gold Egfet Sensor for the Detection of S. Epidermidis Biofilm and Staphylococcal 16S rRNA

Prolonged catheter implantation and placement expose patients to the risk of microbial infection and biofilm formation could lead to extensive hospitalization and mortality increase. Among frequent isolated pathogens (gram-positive bacteria (45-65%), gram-negative bacteria (25-40%) and fungi (3-6%), Staphylococcus epidermidis is the most common microbial agents, while Staphylococcus aureus is associated with more severe cases, a higher risk of hospitalization, catheter removal, and finally, death [1]. The pathogenesis of bacteria is mainly driven by their ability to colonize and form a thick multilayer biofilm on the polymer surface (plastics) leading to mild to sepsis that typically binds human matrix proteins such as fibrinogen or fibronectin [2]. Biofilm mostly consists of partially de-acetylated polymer of beta-1-6-linked N-acetylglucosamine polysaccharide intercellular adhesion (PIA) that acts as glue to stick and wrap negatively charged bacterial surface. Substantial quantity of extracellular DNA from the lysed cells is also reported to play a major role in biofilm formation [3]. Within various developed biosensor, field effect transistor (FET) sensor may offer several benefits, in particular EGFET structure with its easy fabrication, small influence of optical illumination and operation temperature, and disposable gate. The application of a commercial metal oxide semiconductor field effect transistor (MOSFET) also reduces the complexity and cost in its fabrication processes [4]. In this opportunity, we would like to demonstrate a novel protocol for bacterial biofilm detection determined by fibronectin immobilization onto Au-EGFET sensing membrane, altogether with the measurement of cellular responses toward antibiotic treatment. Besides, the detection of electronic signals from 16S rRNA of S. epidermidis and S. aureus on Au-wereconducted using new distinctive designed probe. Charge characteristics were shown by a responsive shift of Au-EGFET gate voltage. Not only effective for biofilm detection, we have also discovered that the whole gate surface modification on Au-EGFET is a powerful tool to detect specific bacteria species involved in the infection. In biofilm test, layer upon layer had been built to provide a robust adhesion of biofilm molecules to Au surface. The immersion of Au-electrode in SAMs solution and the graft of fibronectin afterwards successfully increased the surface roughness of bare Au. Fibronectin mostly hosts the adhesion of bacterial cells in human body. The structure of Au-SAMs-fibronectin gradually improved the surface topology of Au as expressed in the root mean square roughness (Rq) value at 3.22 nm, 3.82 nm and 6.32 nm for bare Au, with SAMs and with fibronectin, respectively. Subsequently, Staphylococcus epidermidis biofilm was attached onto Self Assembled Monolayers (SAMs) coated Au substrate of an extended-gate field-effect-transistor (EGFET) sensor with immobilized extracellular matrix protein, fibronectin. Biofilm mostly composed of positively charged Polysaccharide Intercellular Adhesin (PIA) significantly contributed threshold voltage (VTH) shift from -6.67 to -94 mV for biofilm yielded by 3.8x106 to 3.8x108 CFU/ml S. epidermidis and obtained Limit of Detection (LOD) of 9×105 CFU/ml S. epidermidis. SAMs-Au surface functionalization and its properties after fibronectin immobilization showed an optimal surface roughness from atomic force microscope (AFM) view [5]. The presence of biofilm on the surface was validated by (Scanning Electron Microscope) SEM screening after 1 hour incubation at 37oC. Cellular response to antibiotic treatment against biofilm achieved as contaminated dialysate was treated with and without Vancomycin. The hybridization of a highly conserved gene, 16S rRNA of S. epidermidis and S. aureus, the most leading pathogenic bacteria in peritoneal dialysis patients, was also successfully recorded. This finding does not only provide insights into aetiologies of infectious disease but also may guide the clinicians in prescribing antibiotics and determining the treatment duration and infection control procedures when pathogenic species is well identified. In the future work, the functionalities of other SAMs and nanoparticles can be applied to improve the Debye-length issue and uniformity control of biomolecules density onto the surface. Overall, Au-EGFET sensor with its advantages including its simple passivation, packaging and fabrication, and flexibility of extended area gate, opens a new niche in bacterial biochip technology providing a comprehensive biofilm and pathogenic bacteria species identification.

Salvage robot assisted radical prostatectomy: A propensity matched study of perioperative, oncological and functional outcomes

BackgroundTo report the perioperative, functional and oncological outcomes of salvage robot-assisted laparoscopic prostatectomy (s-RARP) in a propensity score-matched analysis. Study design53 patients underwent s-RARP at our institution. Perioperative, functional and oncological outcomes were compared between propensity matched cohorts. ResultsPatients in the s-RARP group were at significantly higher risk based on the D'Amico classification system (p = 0.010). Estimated blood loss, complication rate, hospital stay, BCR risk, persistent cancer and time to return of potency were similar between groups (full nerve spare [NS] n = 22). In the s-RARP cohort there was a higher prevalence of lymphovascular invasion (26.4% versus 13.2%; p = 0.032), time to catheter removal and a higher prevalence of anastomotic leaks in the postoperative period (34.0% vs 5.7%, p < 0.010). The hazard ratio for return to potency regardless of nerve sparing in the s-RARP group was 0.47 (95% CI 0.25–0.88). Significantly more patients undergoing primary RARP with partial nerve sparing (NS) recovered continence (p < 0.001) and potency (p = 0.043) compared to partial NS s-RARP patients. The return to continence and potency did not differ between full NS cases (n = 22; p = 0.616). ConclusionsSalvage RARP patients undergoing surgery have more high risk disease. Patients should be counseled that they are more likely to demonstrate anastomotic leakage on cystogram, and prolonged catheterization times. The time to potency and continence in s-RARP undergoing partial and no NS was significantly delayed (n = 49). The proportion of patients returning to potency and continence was also lower in our s-RARP group.

Obesity in regional anesthesia--a risk factor for peripheral catheter-related infections.

Obesity is believed to increase the risk of surgical site infections and possibly increase the risk of catheter-related infections in regional anesthesia. We, therefore, analyzed the influence of obesity on catheter-related infections defined within a national registry for regional anesthesia. The German Network for Regional Anesthesia database with 25 participating clinical centers was analyzed between 2007 and 2012. Exactly, 28,249 cases (13,239 peripheral nerve and 15,010 neuraxial blocks) of patients ≥14years were grouped in I: underweight (BMI 13.2-18.49kg/m(2) , n=597), II: normal weight (BMI 18.5-24.9kg/m(2) , n=9272), III: overweight (BMI 25.0-29.9kg/m(2) , n=10,632), and IV: obese (BMI 30.0-70.3kg/m(2) , n=7,744). The analysis focused on peripheral and neuraxial catheter-related infections. Differences between the groups were tested with non-parametric ANOVA and chi-square (P<0.05). Binary logistic regression was used to compare obese, overweight, or underweight patients with normal weight patients. Odds ratios (OR and 95% confidence interval) were calculated and adjusted for potential confounders. Confounders with significant influence on the risk for catheter-related infections were gender, age, ASA score, diabetes, preoperative infection, multiple skin puncture, and prolonged catheter use. The incidence (normal weight: 2.1%, obese: 3.6%; P<0.001) and the risk of peripheral catheter-related infection was increased in obese compared to normal weight patients [adjusted OR: 1.69 (1.25-2.28); P<0.001]. In neuraxial sites, the incidence of catheter-related infections differed significantly between normal weight and obese patients (normal weight: 3.2%, obese: 2.3%; P=0.01), whereas the risk was comparable [adjusted OR: 0.95 (0.71-1.28); P=0.92]. This retrospective cohort study suggests that obesity is an independent risk factor for peripheral, but not neuraxial, catheter-related infections.

Reduction in Catheter Associated Urinary Tract Infection Rates and Device Utilization in a Medical Unit and a Respiratory Stepdown Unit

Among urinary tract infections acquired in the hospital, approximately 75% are associated with a urinary catheter. The lack of a framework for daily inter-disciplinary communication of catheter necessity and the monitoring of maintenance bundle practices can lead to prolonged catheter utilization that results in an increased risk for catheter associated urinary tract infections (CAUTIs). The objective of this project is to demonstrate that the daily use of effective communication strategies and monitoring tools will decrease CAUTI rates and device utilization on both a medical and a respiratory step down unit. We chose a medical unit and a pulmonary step down unit that had fluctuating CAUTI rates, standardized infection ratios (SIR), and device utilization rates prior to the start of this study. Patients with indwelling urinary catheters on each of these units were followed on a daily basis for a period of one year. All rates, SIRs, and percentiles were compared to NHSN benchmarks using the “Rate Table for Catheter-Associated UTI Data” and the “SIR for All Catheter-Associated UTI Data” in NHSN. A year's data was analyzed for this study. SIRs, infection rates and device utilization ratios were calculated and compared to the results of the same NHSN analysis performed for these units for the baseline year prior to the start of the project. Please see Table 1. We found that the implementation of daily interdisciplinary communication strategies and bundle monitoring tools led to a decrease in CAUTI rates, SIRs, and device utilization on both units. Tools that guide health care providers to ensure compliance with maintenance bundles and removal of urinary catheters in a timely manner leads to the prevention of CAUTIs in hospitalized patients.

The stuck catheter: a hazardous twist to the meaning of permanent catheters.

Permanent central venous catheter use is associated with significant complications that often require their timely removal. An uncommon complication is resistant removal of the catheter due to adherence of the catheter to the vessel wall. This occasionally mandates invasive interventions for removal. The aim of this study is to describe the occurrence of this "stuck catheter" phenomenon and its consequences. A retrospective review of all the removed tunneled hemodialysis catheters from July 2005 to December 2014 at a single academic-based hemodialysis center to determine the incidence of stuck catheters. Data were retrieved from a prospectively maintained computerized vascular access database and verified manually against patient charts. In our retrospective review of tunneled hemodialysis catheters spanning close to a decade, we found that 19 (0.92%) of catheters were retained, requiring endovascular intervention or open sternotomy. Of these, three could not be removed, with one patient succumbing to catheter-related infection. Longer catheter vintage appeared to be associated with 'stuck catheter'. Retention of tunneled central venous catheters is a rare but important complication of prolonged tunneled catheter use that nephrologists should be aware of. Endoluminal balloon dilatation procedures are the initial approach, but surgical intervention may be necessary.

Complications of peripherally inserted central catheters in adults with cystic fibrosis or bronchiectasis.

Peripherally inserted central catheters (PICCs) are increasingly used in patients with cystic fibrosis (CF) or with non-CF bronchiectasis, but little data exist on catheter-related complications in this setting. Prospective follow-up of consecutive PICCs inserted for intravenous (IV) antibiotics in adults with CF or with non-CF bronchiectasis at Cochin Hospital (Paris, France). Between March 2009 and December 2011, 182 PICCs were prescribed in 117 adults (67 CF and 50 non-CF patients). Ultrasound-guided placement of catheter was successful in 174/182 (95.6%) procedures; no insertion complication occurred. The mean ± SD catheter dwell time was 15 ± 9 days. No catheter-associated bloodstream infection occurred; main complications were symptomatic upper limb deep vein thrombosis (2%), catheter obstruction (18%) and persistent pain after catheter insertion (18%). Patients' satisfaction was high and PICC could be used to perform antibiotic courses in most patients. PICCs were generally safe for performing IV antibiotic courses in patients with CF or non-CF bronchiectasis, but prolonged pain and/or catheter obstruction occurred in approximately 20% of cases.

PD22-10 HYPOSPADIAS REPAIR OF 223 ADOLSCENTS AND ADULTS: LESSONS LEARNED

You have accessJournal of UrologyTrauma/Reconstruction: Urethral Reconstruction (including Stricture) III1 Apr 2015PD22-10 HYPOSPADIAS REPAIR OF 223 ADOLSCENTS AND ADULTS: LESSONS LEARNED Moneer Hanna and Gina Cambareri Moneer HannaMoneer Hanna More articles by this author and Gina CambareriGina Cambareri More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1452AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Hypospadias repair in adults is divided into 3 groups, the first group include primary hypospadias cases, the second are patients who have had prior hypospadias repair during childhood and present with late complication, and the third group are patients who had undergone multiple failed surgeries (hypospadias cripples). Herein we report on the management and outcome of treatments of the first and second groups METHODS We reviewed the records and photographs of 223 patients (18-39 years old) treated between 1981 and 2013. 10 patients with primary hypospadias underwent Thiersch-Duplay repair. In the second group 41 patients complained of penile curvature of whom 11 had a urethral fistula. Their repairs were Nesbitt procedure (16 pts), Baskin modification (10 pts) and two stage corporal-dermal grafting (15 pts). 172 patients presented with micturitional abnormalities (straining, spraying or leakage) and or cosmetic concerns of whom 36 pts had urethral stricture, 11 pts had BXO, 5 developed hairy urethra of whom 2 had urethral stone, and 3 pts had urethral diverticulum. 117 patients complained of spraying of urine and/or had esthetic concerns RESULTS 186 patients underwent one stage surgical repair, and staged repair was performed in 37 pts. The follow up of 31 pts was 2 weeks and in 192 pts the follow up varied between three months to five years with a median of 18 months. Early in the series we encountered wound infections in 12 patients resulting in dehiscence of the repair. The early and late complication rates were: 21/186 (11%) of the one stage repair group,and 10/37 (27%) in the multi-staged repair group CONCLUSIONS Complications of childhood hypospadias repair may present later in life and it would appear that some urethroplasties deteriorate with time. Urethral strictures may appear many years later and penile curvature can recur in some cases of proximal hypospadias. Furthermore esthetics acquire greater importance during adolescence and spraying from a sub-terminal or irregular meatus accounted for more than 50% of the complaints in this series. We have recommended to the parents of repaired hypospadias children especially for those with proximal hypospadias to come for follow up as their child transitions to adolescence. The patients are advised to use antiseptic soap the evening prior to and the morning of surgery. Currently we avoid prolonged catheterization which in conjunction with nocturnal erections can cause shearing movements between the sutured margins and the catheter. We therefore prefer using urine drainage via suprapubic cystotomy and brief urethral stenting for the more extensive repairs © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e479-e480 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Moneer Hanna More articles by this author Gina Cambareri More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD22-11 DONOR SITE COMPLICATIONS FOLLOWING URETHROPLASTY WITH ORAL MUCOSAL GRAFT: ANALYSIS OF 442 PATIENTS WITH URETHRAL STRICTURE

Baskin modification (10 pts) and two stage corporal-dermal grafting (15 pts). 172 patients presented with micturitional abnormalities (straining, spraying or leakage) and or cosmetic concerns of whom 36 pts had urethral stricture, 11 pts had BXO, 5 developed hairy urethra of whom 2 had urethral stone, and 3 pts had urethral diverticulum. 117 patients complained of spraying of urine and/or had esthetic concerns RESULTS: 186 patients underwent one stage surgical repair, and staged repair was performed in 37 pts. The follow up of 31 pts was 2 weeks and in 192 pts the follow up varied between three months to five years with a median of 18 months. Early in the series we encountered wound infections in 12 patients resulting in dehiscence of the repair. The early and late complication rates were: 21/186 (11%) of the one stage repair group,and 10/37 (27%) in the multi-staged repair group CONCLUSIONS: Complications of childhood hypospadias repair may present later in life and it would appear that some urethroplasties deteriorate with time. Urethral strictures may appear many years later and penile curvature can recur in some cases of proximal hypospadias. Furthermore esthetics acquire greater importance during adolescence and spraying from a sub-terminal or irregular meatus accounted for more than 50% of the complaints in this series. We have recommended to the parents of repaired hypospadias children especially for those with proximal hypospadias to come for follow up as their child transitions to adolescence. The patients are advised to use antiseptic soap the evening prior to and the morning of surgery. Currently we avoid prolonged catheterization which in conjunction with nocturnal erections can cause shearing movements between the sutured margins and the catheter. We therefore prefer using urine drainage via suprapubic cystotomy and brief urethral stenting for the more extensive repairs

Pleural controversies: indwelling pleural catheter vs. pleurodesis for malignant pleural effusions.

Malignant pleural effusions (MPE) are frequent consequences of malignant disease and significantly impair the quality of life (QoL) of patients. There are two main options for the palliation of MPE-related symptoms: obliterating the pleural space by pleurodesis to prevent further fluid reaccumulation, or chronically draining the pleural fluid with an indwelling pleural catheter (IPC). There is controversy as to which approach is superior each having advantages and drawbacks. Pleurodesis offers a higher chance of rapid resolution of the pleural effusion with an intervention that is time limited but at the expense of a more invasive procedure, the need for a hospital stay and a higher need for repeat procedures. IPC offers an outpatient solution which is less invasive but at the cost of prolonged catheter drainages and care in a significant portion of patients who will not achieve pleurodesis. Impact on QoL, symptom relief and costs do not appear to be significantly different between the two options. Treatment of MPE should be tailored to the patient's functional status, comorbidities, prognosis and personal preferences as well as local expertise. Hybrid approaches using pleurodesis techniques and IPC concomitantly may come into play in the near future to further improve patient care.

Risk factors for catheter-associated urinary tract infections in critically ill patients with subarachnoid hemorrhage.

Catheter-associated urinary tract infections (CAUTIs) are preventable adverse outcomes that cause increased morbidity, mortality, and financial burdens to hospitals. These are particularly prevalent in intensive care units (ICUs). Patients with subarachnoid hemorrhage (SAH) in neurological ICUs have extended lengths of stay and may be at higher risk for CAUTIs. The purpose of this study was to assess the prevalence of and risk factors for CAUTIs among patients with SAH in the neurological ICU of a large urban teaching hospital in the eastern United States. This is a retrospective analysis using the Columbia University SAH Outcomes Project data set collected between 2005 and 2012. Logistic regression is used to identify predictors of CAUTI. Catheterized adult patients (n = 242) with SAH over the 8-year period were included. The rate of CAUTIs was 20.7 per 1,000 catheter days, six times higher than the reported national average. Variables significantly associated with CAUTI were older age (odds ratio [OR] = 1.06, 95% confidence interval [CI] [1.01, 1.11]), blood sugar > 200 mg/dl (OR = 13.0, 95% CI [1.28, 107.4]), and anemia requiring transfusion (OR = 3.78, 95% CI [0.977, 14.67]). Higher CAUTI rates in this study were likely associated with prolonged catheterization. On the basis of these findings, careful assessment of the need for catheterization and increased vigilance regarding urinary catheter care in patients with SAH is indicated, particularly among those who are older, with anemia requiring transfusion and elevated blood glucose levels.

Late evaluation of upper limb arterial flow in patients after long radial (PiCCO™) catheter placement.

BackgroundThe purpose of the study was to assess blood flow in the upper limb arteries after prolonged catheterization with long radial artery catheters (LRC) which reach the subclavian artery compared to catheterization with standard short radial artery catheters (SRC) and a group of upper limb flow without any catheter placement (NOCATH), with both SRC and NOCATH as control groups.MethodsProspective observational study with 20 patients admitted to ICU (40 upper limbs) with LRC and/or SRC inserted >48 h for hemodynamic monitoring. More than 45 days after catheter withdrawal, patients underwent a Doppler ultrasound study of both upper limbs. Arterial flows of arms with LRC (FlowLRC) were compared with arterial flows of arms with SRC (FlowSRC) and those without any catheter (FlowNOCATH).ResultsFlow in the ulnar, brachial, and subclavian arteries did not show any significant difference between the two types of catheters. The only significant difference was in the radial arteries, showing a lower mean flow in the arms with LRC than in the arms with SRC (2.2 vs. 8.5 cc/min; p = 0.041). Flow reduction in the radial artery (74%) in the arms with LRC compared to the SRC arms showed a tendency to increase ulnar flow as a compensatory mechanism. None of the patients with LRC included in our study had any ischemic events, in spite of observing complete flow occlusion in three radial arteries (18%) from the Doppler study.ConclusionsIn this sample, the use of PiCCO long radial catheters reaching the subclavian artery did not produce chronic significant changes in brachial or subclavian flows. However, LRC produces a significant reduction in radial flow and a tendency to increase ulnar flow. When comparing these blood flow changes with those produced by SRC use, only the radial flow reduction was significantly lower, whereas the other arterial flow changes did not significantly differ.

Correlation between Arterial and Central Venous Blood Gas Values in Critically Ill Patients

Manuscript History: Arterial blood gas (ABG) analysis is a commonly and golden standard performed procedure that is often used to assess the acid-base status along with adequacy of ventilation and oxygenation among predominantly critically/acutely ill patients. Unfortunately, prolonged arterial catheterization or repeated direct blood sampling from the artery is associated with rare, but serious, complications to the patient as well as the health care providers. Patients who require frequent blood gas testing often have indwelling central venous catheters for the administration of intravenous medications or the monitoring of central vascular pressures, allowing for repeated central venous blood gas (VBG) analysis. Venous blood gas analysis requires fewer punctures, is a relatively safer procedure for both the patient and health care provider, and may be alternative to ABG analysis (Walkey et al., 2010), (Lorente et al., 2006), Scheer et al., 2002), (Valentine et al., 2005).This study was aimed to determine the correlation between arterial and central venous blood gas measurements for monitoring of acid-base balance & oxygenation in the critically ill patients. Prospective comparative study of 90 samples from 45 patients with diverse medical& surgical conditions was conducted. Arterial and venous values for pressure of hydrogen (pH), partial pressure of carbon dioxide (PCO2), bicarbonate (HCO3), partial pressure of oxygen (PO2), and oxygen saturation (SO2)were obtained simultaneously from each patient. Identity plot was used to check the perfect agreement between the paired measurements. The strength of the relationship between the arterial and venous gas values was assessed with the Pearson product-moment correlation coefficient test. Arterial pH and venous pH were found to be correlated significantly (Pearson correlation coefficient r = 0.93, 95% confidence limits of r = 0.90 to 0.96, P 0.05) &(r = -0.08, 95% confidence limits of r = -0.28 - 0.13, P >0.05) respectively. Conclusion: there was a perfect correlation between the arterial and central venous measurements of acid - base (pH, PCO2, HCO3-) in the critically ill patients. While, it is difficult to conclude at least a basic agreement between the arterial and central venous measurements of oxygenation (PO2 & SO2).

Purple Urine Bag Syndrome.

Purple urine bag syndrome (PUBS) is a rare disorder seen in elderly persons, wherein the urinary bag and the tubing turn in to purple colour. It is usually seen in patients who are on urinary catheters for a long time. Purple coloured urine occurs due to the accumulation of indigo and indirubin, which are the end products of tryptophan metabolism due to the action of sulfatases and phosphatases formed by bacteria like Providencia, Citrobacter, Enterobacter, Klebsiella etc. We present this interesting phenomenon of purple urine in a young male who was on prolonged urinary catheterization. The urine culture was positive for Providencia and constipation was an added risk factor for the purple urine. The urinary catheter and tubing was changed along with a course of antibiotics which lead to the normalization of the urine colour.

Internal Jugular Vein Thrombosis following Oropharyngeal Infection.

Internal jugular vein thrombosis (IJVT) is a rare condition which may lead to life-threatening complications such as sepsis and pulmonary embolism. Prolonged central venous catheterization, intravenous (IV) drug use, trauma, and radiotherapy are the most frequent causes of the IJVT. IJVT that develops after the oropharyngeal infection is a quite rare situation today. In this paper, a 37-year-old woman was presented; swelling occurred on her neck after acute tonsillitis and she was diagnosed with IJVT through Doppler ultrasonography and magnetic resonance imaging and managed without complications. Early diagnosis and conservative treatment with broad-spectrum IV antibiotics and anticoagulant agents have a critical importance for the prevention of fatal complications.

Candiduria in Catheter Associated Urinary Tract Infection with Special Reference to Biofilm Production

Urinary tract infections as a result of Candida species are becoming increasingly common in hospital settings. The association is higher in patients with prolonged urinary catheterization and also various pre-disposing factors. This study was done to look into the significance of candiduria in the catheterized patients and to perform microbial catheterization of yeast and biofilm detection by tube method to guide treatment protocol. This is a prospective study. One hundred urine samples were collected over a period of 3 months. Specimens included were those of patients presenting with nosocomial Urinary tract infection (UTI) after 72 hours of hospitalization. The urine samples obtained were immediately processed in microbiology laboratory by semi-quantitative method as per standard protocol. All yeast isolates were stored for further microbial characterization. Biofilm production was detected by tube method. In the present study we observed that out of 100 samples obtained from catheterized patients presenting with nosocomial UTI 26% were caused by Candida species. Among the 26 Candida isolates 16 (61.53%) were non albicans Candida and 10(38.47%) were Candida albicans. Out 26 Candida isolates, 14(53.84%) of the candida isolates were found to produce biofilm. Biofilm production was found to occur more frequently among non albicans Candida 10(62.5%) than Candida albicans 4(40.0%). The present study reiterates the presence of candiduria in catheterized patients. Non-albicans candida speices are replacing candida albicans as the predominant pathogen for nosocomial UTI. It was also observed that Biofilm formation is seen more frequently with non albicans candida species than with Candida albicans.

Predictors of postoperative acute urinary retention in women undergoing minimally invasive sacral colpopexy.

Our aim was to determine predictors of acute urinary retention in women undergoing laparoscopic and robotic sacral colpopexy. Records from all minimally invasive sacral colpopexies performed from 2009 to 2012 were reviewed. All women had a retrograde fill voiding trial (RGVT) on postoperative day 1, except in cases of intraoperative bladder injury or chronic urinary retention. Patient demographics, medical comorbidities, and surgical factors were compared between women who did and did not pass the RGVT. Univariable and multivariable logistic regression analyses were used to identify predictors of postoperative voiding dysfunction. Three hundred two subjects met the inclusion criteria, but 12 were excluded because of planned prolonged catheterization. Of the remaining 290 subjects, 211 (72.8%) passed the RGVT. The mean (SD) for the duration of urinary retention in those who failed was 3.7 (4.2) days. The mean (SD) for age was 58.5 (8.6) years, and the median preoperative prolapse was Pelvic Organ Prolapse Quantification stage III (76.1% with ≥ stage III) with mean Ba = +2.3. There were no significant independent risk factors identified on multivariable logistic regression to predict RGVT failure, with only concurrent midurethral sling approaching significance (6.1% vs 12.5%; adjusted odds ratio, 2.25; 95% confidence interval, 0.93-5.45; P = 0.07). No significant predictors of acute urinary retention were identified among women undergoing minimally invasive sacral colpopexy. In contrast to published analyses of vaginal prolapse repairs, large preoperative cystocele and concurrent midurethral sling were not significantly associated with retention. Given the inability to predict who will have postoperative urinary retention, all patients should be counseled about the potential need for catheterization.

The Tied Double J Stent: A Novel Method for Preventing Early Ureteric Complications in Renal Transplantation

Context: The value of the double J stent in renal transplantation is controversial. However prolonged stenting is associated with major urological complications including sepsis, encrustation, migration and forgotten stents. Aim: This study reviewed our retrospective experience of 672 renal transplants in which the tied double J stent was used and removed five to six days post transplantation. Settings and Design: Retrospective analysis of all consecutive renal transplants done at our centre. Material and Methods: 672 consecutive renal transplants in which the tied double J stent was used. The incidence of major urological complications and infections was evaluated on a follow up of six months. Results: The urinary leak rate was .01% and the incidence of symptomatic urinary tract infection was 10.6%. Six out of seven leaks responded to radiological intervention in the form of per cutaneous nephrostomy ante-grade stenting and pig tail catheter drainage. The remaining one responded to prolonged catheterisation. Conclusion: The tied double J stent is an attractive alternative to routine stenting in renal transplant recipients.

Lower incidence of post-dural puncture headache with spinal catheterization after accidental dural puncture in obstetric patients.

Accidental dural puncture (ADP) and post-dural puncture headache (PDPH) are important complications of obstetric regional anesthesia. Inserting the catheter intrathecally after ADP to prevent PDPH has gained popularity. Nonetheless, data on the effect of an intrathecal catheter on PDPH and epidural blood patch (EBP) rates are mixed. Our primary objective was to examine if spinal catheterization reduces the incidence of PDPH after ADP in obstetric patients. Anesthetic records of 29,749 regional blocks performed between January 1997 and July 2013 were analyzed retrospectively. In all blocks containing an epidural component, 18-gauge epidural needles were used. All patients who experienced a witnessed ADP or PDPH without ADP were identified. Data from patients with or without a prolonged spinal catheter were compared. There were 128 events of witnessed ADP (0.43%). Following known ADP, 39 women had an epidural catheter placed at a different level and 89 had an intrathecal catheter (20-gauge) for at least 24 h. Sixty-one patients developed PDPH after observed ADP (48%). Prolonged intrathecal catheter placement significantly reduced the incidence of PDPH after ADP to 42% compared with 62% in those who have the catheter re-sited epidurally [odds ratio = 2.3 (95% confidence interval 1.04-4.86); P = 0.04]. The incidence of ADP, PDPH and blood patching is similar with previously published studies. After witnessed ADP, inserting the epidural catheter intrathecally significantly reduced the incidence of PDPH.

Early removal of urinary catheter after surgery requiring thoracic epidural: a prospective trial.

To prevent urinary retention, urinary catheters commonly are removed only after thoracic epidural discontinuation after thoracotomy. However, prolonged catheterization increases the risk of infection. The purpose of this study was to determine the rates of urinary retention and catheter-associated infection after early catheter removal. This study described a prospective trial instituting an early urinary catheter removal protocol compared with a historic control group of patients. The protocol was instituted at a single, academic thoracic surgery unit. The study group was comprised of patients undergoing surgery requiring thoracotomy who received an intraoperative epidural for postoperative pain control. An early urinary catheter removal protocol was instituted prospectively, with all catheters removed on or before postoperative day 2. Urinary retention was determined by bladder ultrasound and treated with recatheterization. The primary outcomes were urinary retention rate, defined as bladder volume>400 mL, and urinary tract infection rate. Results were compared with a retrospective cohort of 210 consecutive patients who underwent surgery before protocol initiation. Among the 101 prospectively enrolled patients, urinary retention rate was higher (26.7% v 12.4%, p = 0.003), while urinary tract infection rate improved moderately (1% v 3.8%, p = 0.280). Early removal of urinary catheters with thoracic epidurals in place is associated with a high incidence of urinary retention. However, an early catheter removal protocol may play a role in a multifaceted approach to reducing the incidence of catheter-associated urinary tract infections.

Prevalence and antibiotic resistance patterns of Proteus mirabilis isolated from catheter-associated urinary tract infection.

The aim of this study was to determine the frequency of the bacterial agents that cause urinary tract infection in catheterized patients at Zagazig University Hospital and to assess the antimicrobial resistance pattern of Proteus mirabilis isolates against various antimicrobial agents used for treating urinary tract infections in the spate of its recorded increasing resistance patterns.Urine specimens were obtained from catherized patients suffering from a urinary tract infection (UTI). The different isolates obtained were identified by conventional microbiological methods.The antibiotic susceptibility profile of Proteus mirabilis isolates was determined by agar dilution method. Patient's medical records showed significant increase in incidence of catheter associated urinary tract infection (CA-UTI) upon prolonged catheterization, among immunocompromised patients and patients with concomitant chronic diseases, elderly patients and female gender. The frequency of the obtained isolates was Eschersheia coli (33%), Klebsiella pneumoniae (14%), Enterococcus faecalis (13%), Proteus species (10.2%), Pseudomonas aeruginosa (10%), Staphylococcus aureus (10 %) and unidentified gram positive cocci (9.8%). 90% of the Proteus isolates were Proteus mirabilis. The resistance of P. mirabilis isolates were highest against Nalidixic acid, Ampicillin/Sulbactam, Amoxicillin/clavulanic acid, ceftazidime and cefuroxime (95.5%-57.8%). Lower resistance rates of P. mirabilis were found against amikacin, levoflxacin, ciporofloxacin and gentamicin (2.2 % -17.8 %). While P.mirabilis isolates were 100% sensitive to Imipenem. In conclusion, Imipenem is recommended to be used as an empirical treatment of CA-UTI caused by P. mirabilis.