Prolonged Urinary Catheterization Research Articles

Lethal septic pulmonary thromboembolism in a repatriated body - a rare complication of prolonged urinary catheterization.

A case of septic pulmonary thromboembolism arising from thrombophlebitis of the prostatic venous plexus associated with long-term urinary catheterisation in a 51-year-old man is reported. Despite a previous autopsy having been conducted in the country where he had been resident overseas, a re-examination showed histological evidence of mild patchy chronic prostatitis with a florid, focally purulent, thrombophlebitis of the periprostatic venous plexus with abscess formation and evidence of bacterial overgrowth. Corresponding microscopy of the lungs showed septic microthromboemboli within small pulmonary arteries with variable degrees of necrotising acute inflammation and thrombosis. Death was not due to 'acute pulmonary oedema' as had been originally certified but to septic thromboembolism. This case demonstrates the need to carefully evaluate the prostatic venous plexus at autopsy, and also the type of problems that may arise at the time of the re-examination of repatriated remains.

The retrospective analysis of urinary tract infection in renal transplant recipients

Infection is the most common reason for admission to the emergency department in the early period after transplantation. Urinary tract infections (UTIs) in adult kidney transplant patients are common. Their incidence is significantly higher than in the general population.1 The majority of sepsis cases in this period are composed of UTIs.2 While mild UTIs generally do not affect graft function, acute pyelonephritis observed in the post-transplant period causes a decrease in graft function and an increase in mortality.3 In the literature, a small amount of data has been published regarding the incidence, epidemiological features, and risk factors of UTIs in kidney transplant recipients. In this retrospective study, we evaluated the data of 550 patients who underwent kidney transplantation between January 2006 and May 2019 at our center and analyzed UTIs' characteristics.
 Among 550 recipients, 633 episodes were detected in 200 patients (36.4%). Recurrent infection was encountered in 74 (37%) of 200 patients. We determined 1 episode in 63 (31.5%), 2 episodes in 39 (19.5%), 3 episodes in 31 (15.5%), 4 episodes in 14 (7%), 5 episodes in 10 (5%), 6 episodes in 8 (4%), and 7 or more episodes in 35 (17.5%). While 48.3% (n=306) of 633 episodes were asymptomatic bacteriuria, 51.6% (n=327) was symptomatic. The risk factors for UTI were female gender, the advanced age of transplant and advanced donor age, long-term dialysis period before transplant, prolonged urinary catheterization and hospitalization time after transplant, cytomegalovirus infection, vesicoureteral reflux, and neurogenic bladder history. At the survival analysis, a transplant from living donor, female gender, use of tacrolimus, mycophenolate mofetil and corticosteroid combination as maintenance immunosuppressive therapy, preemptive transplant compared to patients receiving peritoneal dialysis was found to be associated with longer survival; advanced age of transplant, obesity, delayed graft function, acute rejection, diabetes mellitus and a history of cytomegalovirus infection was also associated with a shorter life span. Escherichia coli (64.9%) and Klebsiella pneumonia (51.6%) were the most common causative microorganisms, and ESBL (Expanded Spectrum Beta-Lactamase) was positive in 19.9% and 67.5% of them, respectively. 
 Similarly, female gender, the advanced age of transplant, prolonged catheterization time, history of vesicoureteral reflux, neurogenic bladder, acute rejection, and deceased donor were dependent risk factors for developing of UTI in transplant recipients in other studies,4-6 but not body mass index, history of diabetes mellitus, dialysis type and duration, primary kidney disease, donor type, delayed graft function, and history of acute rejection in another study.7 UTI frequency in the female gender increases due to anatomical differences such as the shorter urethra compared to men and its relative proximity to the perianal region and vulva, as in the general population. Age-related changes in the urinary tract and existing additional diseases are important factors that predispose to bacterial colonization. Prolonged urinary catheterization and hospitalization durations facilitate pathogen entry into sterile body parts in the post-operative period. Immunosuppression, frequent hospitalizations, and surgical interventions increase the risk of nosocomial infections in dialysis patients. A history of vesicoureteral reflux facilitating bacterial invasion and a neurogenic bladder causing urinary stasis poses a UTI risk. 
 Hospitalizations for septicemia are most commonly associated with UTI.8 In our cohort, antibiotics in the carbapenem group, started in more than half of the episodes. There is an increase in trimethoprim/sulfamethoxazole, ciprofloxacin and ceftazidime resistance in Klebsiella species.9 Although the microorganism spectrum in the studies is similar all world, ESBL positivity is noticeably higher than the average in UTI episodes is an observation in parallel with the increasing antibiotic resistance both in our country and in the world in recent years. This observation was considered as a cautionary finding for the review of antibiotic selection preferences in our clinic. Finally, UTIs being a threat to graft and patient survival in the post-transplant period should be treated effectively by carefully evaluating risk factors.

Quick to Wick: External Female Catheters and Urinary Catheter Utilization

<h3>Background</h3> Urinary tract infections (UTI) are common hospital-acquired infections (HAI), causing increased morbidity and hospital costs among patients. Over 75% of HAI UTI are associated with urinary catheters (CAUTI), and between 15-25% of hospitalized patients have urinary catheters. Avoidance of urinary catheters is a primary method to prevent CAUTIs. <h3>Methods</h3> Two community hospitals (450 and 472 licensed beds) implemented an external female urinary catheter device in an effort to decrease prolonged urinary catheterization. To facilitate implementation of the device, nursing education was provided to augment traditionally accepted indwelling catheter necessity with external devices. A retrospective review compared electronic pre-implementation data (1/2017 – 8/2018), to post-implementation data (10/2018 – 10/2019). Urinary catheter utilization measured by device utilization ratio (DUR) and CAUTI were compared using Chi-square analysis (Epi Info, CDC). Urinary catheter DUR and CAUTI were compared for both ICU and non-ICU patient populations. The impact on urinary catheter device utilization ratios (DUR) and CAUTI standardized infection ratios (SIR) were evaluated. <h3>Resultsw</h3> Hospital-wide urinary catheter DUR significantly decreased 13% (pre-DUR 0.15, post-DUR 0.13, p < 0.01). While Hospital A observed a reduced DUR in the ICU, Hospital B did not observe a reduction. Both hospitals saw 18% decrease in non-ICU urinary catheter DUR (p < 0.01). Hospital A saw a 34% reduction in CAUTI while Hospital B saw an increase in CAUTI, although neither were statistically significant. <h3>Conclusions</h3> Implementation of a female external catheter at two hospitals resulted in significant reduction of indwelling urinary catheter utilization, but no significant impact on CAUTI. Female gender and prolonged catheterization have been repeatedly cited in the literature as risk factors for CAUTI. This device may have a considerable impact on urinary catheter utilization and CAUTI, improving patient outcomes, reimbursement programs, and hospital ratings.

Temporary Perineal Urethrostomy During Holmium Laser Enucleation of the Prostate (HoLEP)

Purpose: To characterize the role of perineal urethrostomy in patients undergoing HoLEP for BPH symptom relief. Methods: We identified all patients who required the creation of a perineal urethrostomy from a prospectively maintained institutional database between 1998-2017. Patient demographics, as well as operative and postoperative records, were analyzed to evaluate differences in those patients requiring a perineal urethrostomy. Results Obtained: We identified 7 patients who underwent HoLEP and required a perineal urethrostomy. The mean age was 70 years old (range: 61-82 years old). Within this subset of patients, four had previously aborted BPH procedures; two had penile prosthesis and two were morbidly obese. The mean final prostate specimen weight was 111 grams (range: 23-319). The duration of catheterization varied from 37-600 hours. In patients with BMI ≥40kg/m2 , the average duration of catheterization was 588 hours compared 119 hours in patients with BMI &lt;40kg/m2 . At the six-month follow-up, no patient reported daytime incontinence. No strictures, fistulae, or diverticula were identified in these patients. Conclusion: Utilizing a temporary perineal urethrostomy during HoLEP, or any transurethral BPH procedure, for a small subset of patients with challenging anatomy represents an important skill in the endoscopist’s armamentarium. We note no adverse events aside from prolonged urinary catheterization. Surgeons should consider temporary perineal urethrostomy in lieu of aborting the procedure with the knowledge that it is safe and presents minimal long-term risks.

Virulence targeted inhibitory effect of linalool against the exclusive uropathogen Proteus mirabilis

Proteus mirabilis is one of the leading causes of catheter-associated UTIs (CAUTI) in individuals with prolonged urinary catheterization. Since, biofilm assisted antibiotic resistance is reported to complicate the treatment strategies of P. mirabilis infections, the present study was aimed to attenuate biofilm and virulence factor production in P. mirabilis. Linalool is a naturally occurring monoterpene alcohol found in a wide range of flowers and spice plants and has many biological applications. In this study, linalool exhibited concentration dependent anti-biofilm activity against crystalline biofilm of P. mirabilis through reduced production of the virulence enzyme urease that raises the urinary pH and drives the formation of crystals (struvite) in the biofilm. The results of q-PCR analysis unveiled the down regulation of biofilm/virulence associated genes upon linalool treatment, which was in correspondence with the in vitro bioassays. Thus, this study reports the feasibility of linalool acting as a promising anti-biofilm agent against P. mirabilis mediated CAUTI.

Population structure and molecular genetic characterization of clinical Candida tropicalis isolates from a tertiary-care hospital in Kuwait reveal infections with unique strains.

Candida tropicalis is a frequently isolated yeast species causing bloodstream, urinary tract and other infections particularly in patients admitted to intensive care units (ICUs) and those requiring prolonged urinary catheterization (UC) or receiving broad-spectrum antibiotics (BSA). This study investigated clinical characteristics and genetic relatedness among C. tropicalis strains isolated from patients at Al-Amiri Hospital in Kuwait. C. tropicalis strains (n = 63) isolated from blood, genito-urinary, respiratory (RT) and digestive (GIT) tracts and wound sites from 54 patients were used. All isolates were phenotypically identified and tested against six antifungal drugs by using Vitek 2 system. Molecular identification was performed by PCR amplification of rDNA. Fingerprinting was achieved by 6-loci-based multilocus sequence typing (MLST) and data were analyzed by BioNumerics software for phylogenetic relationships. Patients mean age was >65 years and >20% patients were hospitalized in ICUs. Most patients had underlying conditions that included UC, BSA, diabetes and RT/GIT abnormalities. Most candiduria cases had UC, ureteric stent or suprapubic catheters. All isolates were identified as C. tropicalis by Vitek 2 and by species-specific PCR. Sixty-two isolates were susceptible to all tested antifungal drugs. MLST identified 59 diploid sequence types (DSTs) including 54 newly-identified DSTs. C. tropicalis isolates from multiple sites of same patient usually belonged to different DSTs. Interestingly, 56 of 57 isolates from 48 patients belonged to unique genotypes. Only six isolates from six patients belonged to three DSTs (clusters), however, C. tropicalis strains in each cluster were isolated >3 months apart. Our data show diverse origins of C. tropicalis infections in Kuwait as most isolates were unique strains. There was no obvious correlation between cluster isolates with time of isolation and/or hospital ward of their origin. This study presents the first MLST analysis of C. tropicalis isolates from Middle East and may be useful for studying genetic relationships among global C. tropicalis strains.

Is ERAS in laparoscopic surgery for colorectal cancer changing risk factors for delayed recovery?

There is evidence that implementation of enhanced recovery after surgery (ERAS) protocols into colorectal surgery reduces complication rate and improves postoperative recovery. However, most published papers on ERAS outcomes and length of stay in hospital (LOS) include patients undergoing open resections. The aim of this pilot study was to determine the factors affecting recovery and LOS in patients after laparoscopic colorectal surgery for cancer combined with ERAS protocol. One hundred and forty-three consecutive patients undergoing elective laparoscopic resection were prospectively evaluated. They were divided into two subgroups depending on their reaching the targeted length of stay—LOS (75 patients in group 1—≤4 days, 68 patients in group 2—>4 days). A univariate and multivariate logistic regression analysis was performed to assess for factors (demographics, perioperative parameters, complications and compliance with the ERAS protocol) independently associated with LOS of 4 days or longer. The median LOS in the entire group was 4 days. The postoperative complication rate was higher (18.7 vs. 36.7 %), and the compliance with ERAS protocol was lower (91.2 vs. 76.7 %) in group 2. There was an association between the pre- and postoperative compliance and the subsequent complications. In uni- and multivariate analysis, the lack of balanced fluid therapy (OR 3.87), lack of early mobilization (OR 20.74), prolonged urinary catheterization (OR 4.58) and use of drainage (OR 2.86) were significantly associated with prolonged LOS. Neither traditional patient risk factors nor the stage of the cancer was predictive of the duration of hospital stay. Instead, compliance with the ERAS protocol seems to influence recovery and LOS when applied to laparoscopic colorectal cancer surgery.

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.

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.

Prolonged urinary catheterization, a factor associated with intensive care infections and deaths

Background and aimHealth Care Associated Infection (HCAI), especially nosocomial infection (NCI) in intensive care units (ICUs), has remained a major cause of mortality and morbidity. In this study, the rate of HCAI and the factors associated with both NCIs and deaths in ICUs were assessed in a large teaching hospital complex in Tehran, IR Iran. Materials and methodsIn this cross sectional study, 300 patients hospitalized in six different ICUs of a large teaching hospital located in Tehran were assessed from January to March 2013. Nosocomial infection was defined as the presence of clinical signs and symptoms of infection in patients at least 48h after their hospitalization, confirmed by positive cultures of specimens taken from the patients’ blood, urine, wounds, respiratory secretions and other body fluids. The risk factors of NCIs were assessed by a researcher – produced checklist consisting of 109 questions. ResultsAccording to the findings, NCIs were observed in 59 (19.7%) (CI 95%=15.2–24.2%) patients and the overall mortality rate was 23 (7.7%) (CI 95%=4.7–10.7%), and the highest infection rate belonged to general ICU-1. The factors associated with the higher rate of NCI and/or mortality were as follows: lower education levels, increased length of stay in ICU, increased duration of antibiotic use, combined antibiotic therapy, long time inserted catheters, anemia, and immunosuppression or chronic diseases. Multivariate analysis showed an independent statistically significant association between prolonged urinary catheterization and both NCIs and deaths. ConclusionIt seems that patients with prolonged catheterization are prone to NCIs and deaths, so they should be treated intensively.

Robot-assisted laparoscopy for deep infiltrating endometriosis: international multicentric retrospective study

This study aimed to assess the interest in robot-assisted laparoscopy for deep infiltrating endometriosis and to investigate the perioperative results. From November 2008 to April 2012, 164 women with stage 4 endometriosis who underwent robot-assisted laparoscopy (da Vinci Intuitive Surgical System) were included by to eight international participating clinical centers. This study evaluated the procedures performed, the duration of the intervention, the complications, the recurrence, and the impact on fertility. The average operative time was 180 min. The main complications were laparotomy (n = 1, 0.6%), sutured bowel injury (n = 2, 1.2%), transfusion for a 2,300-ml bleed (n = 1), prolonged urinary catheterization (n = 1, 0.6%), ureter-bladder anastomotic leak (n = 1, 0.6%), and ureteral fistula after ureterolysis (n = 2, 1.2%). The reoperation rate was 1.8% (n = 3). The mean follow-up period was 10.2 months. A full recovery was experienced by 86.7% (98/113) of the patients. After surgery, 41.2% (42/102) of the patients had a desire for pregnancy, and 28.2% (11/39) of them became pregnant. This study analyzed the largest series of robot-assisted laparoscopies for deep infiltrating endometriosis published in the literature. No increase in surgical time, blood loss, or intra- or postoperative complications was observed. The interest in robot-assisted laparoscopy for deep infiltrating endometriosis seems to be promising.

P267: Current aspects of acquired infection in maternity Issaka Gazobi hospital – Niamey, Niger

Results After analyzing the data, it appears that: The prevalence of nosocomial infections was 7.2%, including 0.7% of endometritis, urinary tract infection 0.7% and 5.8% of surgical site infection distributed as follows: 3.5% and 2.2% of deep and superficial infections respectively. Nearly eight out of 10 patients were from the urban community of Niamey and 70% of infected patients are housewives. Prolonged urinary catheterization, as well as antibiotic misuse were the main contributing factors. In newborns, the prevalence of nosocomial infections was 5% of which 1.4% were skin infections and 3.6% eye infections, no umbilical cord infection was recorded. The mortality rate of newborns was 14.4%. Nosocomial infections are and remain a public health problem.

Purple Urine Bag Syndrome

Purple urine bag syndrome (PUBS) is a rare condition, in which the patient has a purple-colored urine tubes or bags following urinary catheterization for hours to months. It is usually associated with elderly females, prolonged urinary catheterization, some bacterial infections that produce sulphatase/phosphatase, chronic debilitated state, and chronic constipation. We present a case report of this rare phenomenon occurring in a 73-year-old woman.

Purple urine bag syndrome in elderly woman with nutritional supplements

The purple urine bag syndrome is a rare entity which typically affects elderly women with prolonged urinary catheterization and weakening chronic diseases. Other predisposing factors are previous urologic pathology, immobility syndrome and chronic constipation. The purple color is due to the presence of high loads of bacteria with sulphatase--phosphatase activity which develop in an alkaline environment as well as the presence of other factors. In the case we present the administration of nutritional supplements containing tryptophan conditioned the generation of this syndrome.

An update on purple urine bag syndrome

Purple urine bag syndrome is characterized by the urinary drainage bag turning purple in patients on prolonged urinary catheterization, especially those in the bedridden state. It is associated with bacterial urinary tract infections caused by indigo-producing and indirubin-producing bacteria, usually affects women, and is associated with alkaline urine, constipation, and a high bacterial load in the urine. Almost all patients with purple urine bag syndrome are catheterized due to significant disability, and the urinary pH is 7.0 or more. In general, intensive treatment with antibiotics is not recommended. Purple urine bag syndrome per se almost always appears to be asymptomatic and harmless. However, caution is needed, because some cases have been reported to show progression to severe disease states, so further research into the morbidity and mortality of this infection is warranted.

Urinary tract colonization and infection in critically ill patients

Urinary tract infections (UTIs) account for 20–50% of all hospital-acquired infections occurring in the Intensive Care Unit (ICU). In some reports UTI was found to be more frequent than hospital-acquired pneumonia and intravascular device bacteremia, with a greater incidence in developing countries. The risk factors associated with the appearance of UTI include the severity of illness at the time of admission to the ICU, female status, prolonged urinary catheterization or a longer ICU stay and poor urinary catheter management - mainly disconnection of the closed system. The present study offers data on the epidemiology of UTI in the ICU, the identified risk factors, etiology, diagnosis, impact upon morbidity and mortality, and the measures to prevent its appearance.

Colonización e infección de la vía urinaria en el paciente críticamente enfermo

Urinary tract infections (UTIs) account for 20-50% of all hospital-acquired infections occurring in the intensive care unit (ICU). In some reports UTI was found to be more frequent than hospital-acquired pneumonia and intravascular device bacteremia, with a greater incidence in developing countries. The risk factors associated with the appearance of UTI include the severity of illness at the time of admission to the ICU, female status, prolonged urinary catheterization or a longer ICU stay and poor urinary catheter management - mainly disconnection of the closed system. about the present study offers data on the epidemiology of UTI in the ICU, the identified risk factors, etiology, diagnosis, impact upon morbidity and mortality, and the measures to prevent its appearance.

Purple Urine Bag Syndrome: An Alarming Hue? A Brief Review of the Literature

Purple urine bag syndrome (PUBS) is a unique disease entity characterized by an alarming purple discoloration of the urine secondary to recurrent urinary tract infections with indigo- and indirubin-producing bacteria. It is usually associated with prolonged urinary catheterization and chronic debilitated states. We hereby present a concise review of this rare phenomenon with historic perspectives, epidemiology, emphasizing on current concepts of etiology, pathogenesis, relevant clinical associations, treatment modalities, prognosis, and future directions in PUBS. In addition, we highlight an interesting occurrence of this intriguing phenomenon in a 39-year-old gentleman at our institution.

Urinary Bladder Catheter Drainage Following Pelvic Surgery—Is It Necessary for That Long?

Urinary bladder drainage for several days after pelvic surgery is a common surgical practice, despite insufficient evidence supporting its routine use. The aim of this study was to prospectively evaluate the utility of urinary bladder drainage after pelvic colorectal surgery. Patients undergoing pelvic surgery were prospectively randomly assigned to 3 groups. In group A, the Foley catheter was removed on postoperative day 1, and in groups B and C it was removed on postoperative days 3 and 5, respectively. Male patients with severe prostatic symptoms were excluded from the study. The main outcome criterion was acute urinary retention requiring reinsertion of the Foley catheter. A total of 118 patients (68 males) at a mean age of 55 years were included in this study (group A, 41 patients; group B, 38; and group C, 39). Overall, urinary retention after removal of the Foley catheter occurred in 12 (10%) of the patients: 6 (14.6%) in group A, 2 (5.3%) in group B, and 4 (10.5%) in group C (P = .39). Symptomatic urinary tract infection was diagnosed in 5 patients in group A, 3 in group B, and 9 in group C, but this difference did not reach statistical significance. Likewise, there were no significant differences in anastomotic leak and intra-abdominal abscess rates among the 3 groups. Routine prolonged urinary bladder catheterization after pelvic surgery may not be required, and the Foley catheter may be safely removed on postoperative day 1. Larger studies are needed to confirm the findings of this study.

Purple Urine Bag Syndrome

Purple urine bag syndrome (PUBS) is a rare condition, in which the patient has a purple-colored urine tubes or bags following urinary catheterization for hours to months. It is usually associated with elderly females, prolonged urinary catheterization, some bacterial infections that produce sulphatase/phosphatase, chronic debilitated state, and chronic constipation. We present a case report of this rare phenomenon occurring in a 73-year-old woman.