Positive Rate Of Urine Culture Research Articles

Effect of different disinfectants on preventing asymptomatic bacteriuria and catheter-related urinary tract infection: a network meta-analysis

ObjectiveTo analyze the effect of different types of disinfectants for perineum and urethral meatus cleaning in preventing catheter-associated asymptomatic bacteriuria and catheter-associated urinary tract infection (CAUTI).MethodsChinese and English databases were searched to collect randomized controlled trials (RCTs) of different disinfectants for perineum and urethral meatus cleaning to prevent CAUTI, and the positive rates of urine culture with different cleaning methods were contrasted by network meta-analysis.ResultsA total of 18 RCTs were included in this study to analyze the effect of 10 disinfectants in preventing CAUTI. The disinfectants were 0.1% chlorhexidine (CHG), 0.5% CHG, 2% CHG, 0.1% benzalkonium bromide (DBDAB), 0.05% iodophor, 0.5% iodophor, acidic oxidizing potential water (EOW), normal saline (NS), Shehuang lotion, and sterile water. Meta-analysis showed that the positive rates of urine culture in the 0.5% CHG cluster, EOW cluster, 0.5% iodophor cluster, and Shehuang lotion cluster were remarkably lower than that in the 0.1% DBDAB cluster (P < 0.05). The positive rate of urine culture in the 0.5% CHG cluster was remarkably lower than that in the 0.05% iodophor cluster (P < 0.05), whereas the positive rates of urine culture in the 0.5% CHG cluster, 0.5% iodophor cluster, Shehuang lotion cluster, and EOW were remarkably lower than that in the normal saline cluster (P < 0.05). The positive rate of urine culture in the 0.5% CHG cluster and EOW cluster were remarkably lower than those in the sterile water cluster (P < 0.05). The results of the area under the cumulative ranking probability plot (SUCRA) analysis showed that the probability ranking of the preventive effect of different disinfectants was as follows: 0.5% CHG > Shehuang lotion > EOW > 0.5% Iodophor > 2% CHG > 0.1% CHG > 0.05% Iodophor > Sterile Water > 0.1% DBDAB > Saline. Conclusion0.5% CHG, Shehuang lotion, EOW, and 0.5% iodophor can be used to clean the perineum and urethral meatus in patients with indwelling catheters.Systematic review registrationChinese Clinical Trial Registry (ChiCTR), identifier ChiCTR2100052260.

Antibiotic Stewardship and Treatment of Uncomplicated Urinary Tract Infection (UTI) in Children and Adolescents in the Emergency Department of a Community Hospital.

A retrospective, cross-sectional study of children with suspected urinary tract infections (UTIs) 3 months to 18 years of age who had a urinalysis and urine culture (UC) during an emergency department (ED) visit between 2019 and 2020 was performed. Chi-square, Fisher exact, and independent samples T tests were used as appropriate. Median age was 6.6 years (interquartile range = 3.3-12.4). Urinalysis positivity was 92.8%, of which 81.9% of children were prescribed a first-line antibiotic. First-line antibiotic use was 82.7%. Positive UC rate was 84.7%, with 84% receiving a first-line antibiotic (P = .025). The correlation between a positive urinalysis and a positive UC was 80.8% (P < .001). Change of antibiotics based on the uropathogen of positive UCs was 6.3% (P < .001). The urinalysis and UC guided the diagnosis and treatment of UTIs. First-line antibiotics can be safely administered in the ED and prescribed for positive urinalyses. Studies are needed to evaluate the discontinuation of antibiotics with negative UCs as part of antibiotic stewardship initiatives.

The value of postoperative HLA-DR expression and high mobility group box 1 level in predictive diagnosis of sepsis in percutaneous nephrolithotomy surgery

Objective To analyze the value of postoperative human leukocyte antigen-DR (HLA-DR) expression and high mobility group box 1 (HMGB1) level in predictive diagnosis of postoperative sepsis for patients with percutaneous nephrolithotomy (PCNL) surgery. Methods The present prospective observational study included 387 patients with renal calculus who received PCNL surgery from January 2017 to October 2020 in our hospital. After exclusion criteria, 33 patients with sepsis and 78 patients with no sepsis remained. All patients received PCNL surgery. Sepsis definition is according to the third international consensus definitions for sepsis and septic shock (Sepsis-3). The data of the HMGB1, c-reactive protein (CRP), interleukin-6 (IL-6), procalcitonin (PCT) and HLA-DR expression were collected within admission and 24 h and 72 h after surgery. Postoperative HMGB1 levels and HLA-DR expression at 24 h and 72 h were respectively compared between the two groups using t test. ROC cure was used to analyze the value of postoperative HLA-DR expression and HMGB1 level in predictive diagnosis of sepsis. Results The positive rate of urine culture and the time of hospitalization time in patients with sepsis were significantly higher than those in patients with no sepsis. Sepsis group had higher levels of HMGB1 at post-24 h ((93.07 ± 11.37) ng/mL vs (75.41 ± 4.85) ng/mL), p < 0.05) and 72 h ((96.58 ± 12.12) ng/mL vs (81.16 ± 8.86) ng/mL), p < 0.05) than nosepsis group. Meanwhile, sepsis group had lower expression of HLA-DR at post-24 h ((50.01 ± 7.42) % vs (69.32 ± 10.58) %), p < 0.05) and 72 h ((54.85 ± 9.45) % vs (69.98 ± 11.00) %), p < 0.05) than non-sepsis group. ROC analysis showed that the HLA-DR expression at postoperative 24 h had highest predictive value in the diagnosis of sepsis, the AUC of HLA-DR was 0.934, cutoff value 56.19%, with sensitivity 89.7%, specificity 81.8%. Conclusion Postoperative HLA-DR and HMGB1 can both be used as a predictive diagnosis of sepsis for patients with renal calculus received PCNL surgery. Highlights Sepsis group had higher levels of high mobility group box 1 at post-24 h and 72 h than nosepsis group. Sepsis group had lower expression of HLA-DR at post-24 h and 72 h than nosepsis group. Postoperative HLA-DR and HMGB1 can both be used as a predictive diagnosis of sepsis for patients with renal calculus received PCNL surgery.

The Innovative Use of Ureter Catheter in the Surgery of Obstructive Uropathy.

Purpose Relieving obstruction and protecting renal function are the main therapeutic purposes of obstructive uropathy which often involve surgical treatment, and the ureter catheter is one of the surgical instruments commonly used in surgery. We aimed to explore the innovative use of a ureter catheter in the surgery of obstructive uropathy. Methods We used a ureteral catheter to innovate the surgical procedure of the most common causes of obstructive uropathy: ureteral calculi and stricture, establishing an internal circulation system (ICS), proposing a three-step dilatation method, and reviewing their effects on patients. Furthermore, we introduced a simple real-time intrapelvic pressure measurement device to monitor intrarenal pressure during operation. Results Postoperative laboratory examination showed that blood CRP, leukocyte neutrophil level, changes in the hemoglobin, urine occult blood, and positive rate of urine culture in the ICS group are significantly lower than those in the control group, corresponding to a lower incidence of bleeding and infection-related complications clinically. A three-month follow-up revealed 1/3 rate of ureteral stricture in the ICS group comparing to the control. We applied the three-step dilatation in patients with severe stenosis in which the balloon could not pass; the overall effective rate was 90.9%. The pressure of the renal pelvis was displayed on the monitor in real time. The surgeon could estimate the degree of filling of the renal pelvis and adjust the intake volume through the data. Conclusion The innovative application of ureteral catheters in the operation of obstructive uropathy can realize the real-time monitor of intraoperative renal pelvis pressure, reduce the incidence of lithotripsy postoperative complications, and expand the indications of balloon dilatation in ureteral stricture, which has certain clinical significance.

Clinical Utilization of Blood and Urine Cultures and Incidences of Bacteremia and Bacteriuria in a Hospital in Thailand.

BackgroundTo effectively treat sepsis and urinary tract infection (UTI), blood and urine cultures should be used appropriately and relative to incidences of bacteremia and bacteriuria. This study aimed to investigate the use of blood and urine cultures and incidences of bacteremia and bacteriuria in a hospital in Thailand.Material/MethodsMedical records of patients admitted from 2016 to 2018 were randomly selected and data in the records were anonymously extracted for investigation.ResultsFrom 12 000 records, data on blood and urine cultures were extracted from 9% and 4% of them, respectively. The negative rate of blood culture was 87.48%. Bacteremia was detected in 10.22%. The positive rate of urine culture was 27.38% and the contamination rate was 31.26%. Escherichia coli was the most common cause of community-onset bacteremia and bacteriuria. Methicillin-resistant coagulase-negative staphylococci and Acinetobacter baumannii were the most common cause of hospital-acquired bacteremia while yeasts were the most common cause of hospital-acquired UTI.ConclusionsA high negative rate of blood culture may result not only from its low sensitivity but also from liberal test use to identify sepsis in some conditions. Improper urine collection is the main problem with use of urine culture.

Relationship between infectious screening and early unconjugated hyperbilirubinemia in well-appearing neonates.

Neonatal hyperbilirubinemia (NH) may be the initial and solitary sign of infectious condition in neonates. This retrospective cohort study aims to evaluate the risk of sepsis or urinary tract infection in well-appearing infants with NH below 7 days old. All neonates (n = 8779) born in Taipei Veterans General Hospital from 2013 to 2017 were evaluated retrospectively. A total of 2523 initially well-appearing babies were admitted because of NH. After being hospitalized, patients were categorized into two groups according to the initial transcutaneous bilirubin (TCB) level. Infectious screening results, which include C-reactive protein (CRP), differential count, blood culture, urinalysis, and urine culture, were analyzed. Regarding CRP, 2.7% (18/667) of neonates with NH had elevated CRP (≥1 mg/dL). Among 547 blood cultures, eight were positive, with 0.4% (2/547) non-coagulase-negative staphylococcus (CoNS) bacteremia and 1.1% (6/547) CoNS bacteremia. In urinalysis, 16.6% (182/1094) of NH neonates had pyuria, and 6.7% (25/372) had positive urine cultures. NH with a higher initial TCB level was related to an increased chance of elevated CRP (4.7% vs. 1.5%, odds ratio: 3.29, p = 0.024) and pyuria (20.6% vs. 12.6%, odds ratio: 1.79, p < 0.001). The rate of positive urine culture between the higher and lower TCB groups had no significant difference (6.6% vs. 6.9%, p > 0.99). Significant bacteriuria was more common in NH neonates admitted at later age (>2 days) (4.9% vs. 11.5%, p = 0.035). In well-appearing neonates below 7 days old, NH with a higher initial TCB is associated with an increased rate in pyuria and abnormal CRP. No difference was found in the rate of positive urine culture between higher and lower TCB levels. Significant bacteriuria was more common in older NH neonates. Septicemia is rare among well-appearing neonates with NH.

A cost-minimization analysis of treatment options for postmenopausal women with dysuria

Empiric therapy for urinary tract infection is difficult in postmenopausal women because of the higher rates of confounding lower urinary tract symptoms and differential resistance profiles of uropathogens in this population. The objective of the study was to determine the least costly strategy for treatment of postmenopausal women with the primary complaint of dysuria. We performed a cost minimization analysis modeling the following clinical options: (1) empiric antibiotic therapy followed by urine culture, (2) urinalysis with empiric antibiotic therapy only if positive nitrites and leukocyte esterase, or (3) waiting for culture prior to initiating antibiotics. For all strategies we included nitrofurantoin, trimethoprim/sulfamethoxazole, fosfomycin, ciprofloxacin, or cephalexin. Pathogens included Escherichia coli, Enterococcus faecalis, Klebsiella pneumonaie, or Proteus mirabalis. Pathogens, resistance, treatment success, and medication side effects were specific to postmenopausal women. Cost minimization modeling with TreeAge Pro assumed 73.4% of urinary tract infections were caused by Escherichia coli with 24.4% resistance to nitrofurantoin, trimethoprim/sulfamethoxazole. With our assumptions, empiric antibiotics with nitrofurantoin, trimethoprim/sulfamethoxazole was the least costly approach ($89.64/patient), followed by waiting for urine culture ($97.04/patient). Except for empiric antibiotics with fosfomcyin, empiric antibiotics was always less costly than using urinalysis to discriminate antibiotic use. This is due to the cost of urinalysis ($38.23), high rate of both urinary tract infection (91%), and positive urinalysis (69.3%) with dysuria in postmenopausal women and resultant high rate of antibiotic use with or without urinalysis. Options with fosfomycin were the most expensive because of the highest drug costs ($98/dose), and tornado analyses showed fosfomycin cost was the most impactful variable for model outcomes. Sensitivity analyses showed empiric fosfomycin became the least costly option if drug costs were $25.80, a price still more costly than almost all modeled baseline drug costs. This outcome was largely predicated on low resistance to fosfomycin. Conversely, ciprofloxacin was never the least costly option because of higher resistance and side effect cost, even if the drug cost was $0. We modeled 91% positive urine culture rate in postmenopausal women with dysuria; waiting for the urine culture prior to treatment would be the least costly strategy in a population with a predicted positive culture rate of <65%. The least costly strategy was empiric antibiotics with nitrofurantoin and trimethoprim/sulfamethoxazole, followed by waiting on culture results. Local resistance patterns will have an impact on cost minimization strategies. Empiric fosfomycin would be least costly with reduced drug costs, even at a level at which drug costs were higher than almost all other antibiotics. In a population with high posttest probability of positive urine culture, urinalysis adds unnecessary cost. Antibiotic stewardship programs should continue efforts to decrease fluoroquinolone use because of high resistance, side effects, and increased cost.

Clinical evaluation of the multifunctional suprapubic catheter in patients requiring permanent suprapubic cystostomy: A prospective randomised trial in a single centre.

To assess the clinical effect of the multifunctional suprapubic catheter (MSC) on occurrence of cystospasm, catheter occlusion, the catheter-related urinary tract infection and remission of overactivity bladder, by comparing with the conventional suprapubic catheter (CSC) in patients with permanent suprapubic cystostomy. The conventional suprapubic catheter usually presents with high incidence of catheter-associated complications. A prospective randomised clinical trial in a single centre. Between January 2014 and January 2015, a total of 91 consecutive patients with permanent suprapubic cystostomy were prospectively randomised into two groups: the MSC group (n=43) and CSC group (n=48). Our results showed that the total times of cystospasm in the MSC group were significantly less than that in the CSC group during the follow-up time (p<.001). In addition, the mean spasmodic duration per time in the MSC group was significantly shorter than that in the CSC group (p<.001). Besides, catheter occlusions were observed in 23 (25.27%) patients, including 5 (11.63%) in the MSC group and 18 (37.50%) in the CSC group (p=.005). The lower rate of positive urine culture was also found in the MSC group but with no significant difference (p=.540). Furthermore, the urodynamic measurement data demonstrated that the patients in the MSC group had a greater remission rate of overactivity bladder after catheter change (p<.001). The present data showed that the multifunctional suprapubic catheter could significantly reduce the incidence of catheter occlusion, ameliorate the symptom of cystospasm and relieve the overactivity bladder, but have no influence on the catheter-related urinary tract infection. The application of our self-devised multifunctional suprapubic catheter may result in better management of the patients with permanent suprapubic cystostomy.

URINARY INFECTION AT DEPARTMENT OF UROLOGY OF HUE UNIVERSITY OF MEDICINE AND PHARMACY HOSPITAL

Objectives: To investigate clinical characteristics, bacterial characteristics, drug resistance status in patients with urinary tract infections treated at Department of Urology, Hue University Hospital. Materials and Method: The study was conducted in 474 patients with urological disease treated at Department of Urology, Hue Universiry Hospital from July 2017 to April 2018. Urine culture was done in the patients with urine &gt; 25 Leu/ul who have symptoms of urinary tract disease or infection symptoms. Patients with positive urine cultures were analyzed for clinical and bacterial characteristics. Results: 187/474 (39.5%) patients had symptoms associated with urinary tract infections. 85/474 (17.9%) patients were diagnosed with urinary tract infection. The positive urine culture rate was 45.5%. Symptoms of UTI were varied, and no prominent symptoms. E. coli accounts for the highest proportion (46.67%), followed by, Staphycoccus aureus (10.67%), Pseudomonas aeruginsa (8,0%), Streptococcus faecali and Proteus (2.67%). ESBL - producing E. coli was 69.23%, ESBL producing Enterobacter spp was 33.33%. Gram-negative bacteria are susceptible to meropenem, imipenem, amikacin while gram positive are vancomycin-sensitive. Conclusions: Clinical manifestations of urinary tract infections varied and its typical symptoms are unclear. E.coli is a common bacterium (46.67%). Isolated bacteria have a high rate of resistance to some common antibiotics especially the third generation cephalosporins and quinolones. Most bacteria are resistant to multiple antibiotics at the same time. Gram (+) bacteria are susceptible to vancomycin, and gram (-) bacteria are susceptible to cefoxitin, amikacin, and carbapenem. Key words: urinary tract infection

Incidence and risk factors for positive urine culture at the time of pediatric urologic surgery.

Urinary tract infections are relatively common in pediatric patients. Unrecognized bacteriuria at the time of urologic surgery puts patients at increased risk for perioperative complications. Many pediatric urologists obtain preoperative or intraoperative urine cultures prior to surgery, but data are lacking regarding rates and risk factors for positive intraoperative urine cultures. We conducted a retrospective cohort study of patients undergoing pediatric urologic surgery to examine factors associated with positive intraoperative urine cultures. Charts of patients of age 0-18years from a single pediatric urologist with associated intraoperative urine culture results between 2008 and 2013 were retrospectively reviewed. Demographics, prior culture results, and information regarding possible risk factors of interest-history of constipation, hydronephrosis, neurogenic bladder, posterior urethral valves, ureterocele, UPJ obstruction, urolithiasis, vesicoureteral reflux, and circumcision status-were collected and analyzed. Seven hundred and fifty procedure encounters with associated intraoperative urine culture results were reviewed. Overall positive urine culture rate was 13.5%. Factors associated with increased odds of positive intraoperative urine culture included neurogenic bladder (odds ratio 26.3, p < 0.001), prior positive culture (OR 5.4, p < 0.001), female sex (OR 2.1, p 0.007), constipation (OR 2.9, p < 0.001), and urolithiasis (OR 1.58, p = 0.04). Patients without any of these risk factors had no positive intraoperative cultures (p = 0.03). Patients with neurogenic bladder, prior positive urine culture, constipation, female gender, and urolithiasis were at increased risk for positive intraoperative urine culture. This may aid in decision-making regarding obtaining preoperative or intraoperative urine cultures in pediatric urology patients.

Evaluation of a New Design of Antireflux-biodegradable Ureteral Stent in Animal Model

To determine the effects in urinary tract of a new antireflux-biodegradable ureteral stent. Thirty six ureters belonging to 24 pigs were used. The study began with endoscopic, nephrosonographic, and fluoroscopic assessments. Three study groups of ureters (n = 12) were then specified. In group I, a biodegradable antireflux ureteral stent (BDG-ARS) was inserted in the right ureter of 12 pigs. Group II comprised the left ureter of the same animals, in which a double-pigtail stent was placed for 6 weeks. Group III ureters, belonging to 12 additional animals, were subjected to a ureteropelvic junction obstruction model that was then treated by endopyelotomy and stenting with BDG-ARS. Follow-ups were performed at 3-6 weeks and at 5 months. None of the ureters receiving the BDG-ARS showed any evidence of vesicoureteral reflux (VUR). BDG-ARS degradation took place in a controlled and predictable fashion from the third to the sixth weeks, and no obstructive fragments appeared. No differences were found between groups I and II regarding passive ureteral dilation, but significant differences were found regarding VUR and ureteral orifice damage. BDG-ARS always maintained distal ureteral peristalsis. BDG-ARS in group III showed a 50% positive urine culture rate and a 16.6% migration rate in both BDG-ARS groups. BDG-ARS avoided VUR and bladder trigone irritation. In addition, this polymer combination and stent-braided design achieved a consistent biodegradation rate with no obstructive fragments and with uniform degradation between the third and the sixth weeks. Consequently, morbidity associated with ureteral stents might be reduced.

Bladder debris on ultrasound as a predictor for positive urine culture in a pediatric population

Debris within the bladder is commonly seen on ultrasound. The etiology of bladder debris is varied and the likelihood that urinary debris represents positive urine culture is under investigation. We hypothesize that bladder debris will increase the likelihood that a urine culture is positive compared to those without bladder debris. We performed a retrospective review on children aged 0-17 years who had a voiding cystourethrogram with a catheterized urinalysis or urine culture, and who also had a renal and bladder ultrasound up to 1 week prior, the day of, or up to 2 days after their urine studies. Presence of bladder debris and debris severity was recorded. Positive urine culture was defined as a single bacterial strain ≥50,000cfu/mL. Demographic information, including findings of reflux and hydronephrosis were compared. Sensitivity, specificity, and risk ratios were calculated for predicting positive urine culture in patients with urinary debris on ultrasound. A total of 445 patients met inclusion criteria between January and December 2014. The positive urine culture rate was 20%, and the rate of bladder debris was 22%. The mean age for those with and without bladder debris was 6.6 and 5.5 years, respectively (p=0.02). 23% of girls had bladder debris, compared to 12% of boys (p=0.04, see resultstable). The sensitivity and specificity for bladder debris in detecting positive urine cultures was 52% and 86%, respectively. Forty-seven percent of those with bladder debris had positive cultures, compared with 12% of those without debris (p<0.01). The relative risk of positive urine culture if debris is present is 3.90 (95% CI 2.73-5.55). Hydronephrosis or vesicoureteral reflux did not affect the relationship between bladder debris and positive urine cultures. Nearly half of pediatric patients undergoing urological evaluation found to have bladder debris on ultrasound will have a positive urine culture. Debris is noted more commonly in girls and at a slightly higher age. The presence of debris is associated with a fourfold increase in detecting a positive urine culture, regardless of debris severity, hydronephrosis, or vesicoureteral reflux. Given this, it is of value to routinely document and look for the presence of any amount of bladder debris seen on ultrasound, as this finding can be used to augment clinical decision-making and warrants strong consideration for obtaining urine culture.

Clinical analysis of urine bacteria culture in children with urolithiasis

Objective To study the correlation between age, gender, stone size, bilateral or unilateral urinary calculi, anatomical location of calculi and the positive rate of urine culture, and to investigate the pathogenic bacteria and drug resistance in children with urolithiasis. Methods Files of patients from department of urology in People′s Hospital of Xinjiang Uygur Autonomous Region from January 2013 to March 2017 were reviewed. The observed indexes included age, gender, stone size, bilateral or unilateral renal involvement, anatomical location of calculi, and the results of urine culture and drug susceptibility test.Only those patients with calculi and less than 12 years were studied.All files of patients with documented urological procedures prior to urinary tract infection occurrence were excluded from the study. CT technique was used to determine stone size and location.Collected urine samples were screened for urinary tract infection. Results A total of 107 patients were studied. The mean age was (4.37±2.97) years.Seventy-four cases (69.2%) were males; 33 cases(30.8%) were females. Urinary tract infection was found in 27 cases(25.2%). The most common pathogenic bacteria found on our culture plate of urinary tract infection positive patients was Escherichia coli (48.1%; 13/27). Gram negative bacteria were most sensitive to imipenem(100.0%; 24/24), cefoxitin (88.2%; 15/17), and Piperacillin/Tazobactam(87.5%; 21/24). Gram negative bacteria had a high resistance rate to ampicillin (84.2%; 16/19), cefazolin(81.0%; 17/21), cefuroxime(80.0%; 16/20), TMP-SMX(77.3%; 17/22)and ceftriaxone(73.9%; 17/23) in our center. Conclusions There was no association between these parameters(age, sex, stone size, bilateral or unilateral renal involvement, and anatomical location of calculi) and positive rate of urine culture in children with urolithiasis. Escherichia coli was the most common causative agent of urinary tract infection in children with urolithiasis.Gram negative bacteria had a high resistance rate to ampicillin, cefazolin, and cefuroxime in our center. Key words: Child; Urinary tract infections; Urinary calculi; pathogenic bacteria; antimicrobial resistance

The impact of ureteral stent indwelling time on the treatment of acute infection caused by ureteral calculi.

Ureteric stenting is an effective drainage method in patients with acute urinary tract infection caused by ureteral calculi; however, the optimal ureteral stent indwelling time has not been clearly defined. The aim of this study was to evaluate the effect of ureteric stent indwelling time on the treatment of acute infection secondary to urinary tract calculi. A total of 142 patients with acute infection caused by urinary tract calculi were identified retrospectively from January 2011 to August 2015 at our institution. 63 patients were with ureteric stenting for 7 days (A group) and 79 patients with ureteric stenting for more than 7 days (B group). The patient characteristics of two groups were analyzed and the clinical data before and after stenting were compared. The postoperative complication outcomes were collected and analyzed. Effective drainage obtained from ureteral stenting clearly abated the infection after stenting for 7days; WBC count, WBCs in urine, and positive rate of urine culture were significantly decreased compared with the condition of immediate stenting. Both groups showed similar stone clearance rates (96.8% vs. 96.2%, p = 0.841), and there was no significant difference in the rate of postoperative complications, especially related to urinary tract infection (6.3% vs. 6.3%, p = 1.000). It is safe and effective for patients with acute urinary tract infection secondary to urinary tract calculi to be treated by ureteroscopic lithotripsy after stenting for one week. Prolonging the stenting period achieves no added benefit for patients.

Preoperative Urine Culture Results Correlate Poorly With Bacteriology of Urologic Prosthetic Device Infections

IntroductionAlthough preoperative negative urine culture results and treatment of urinary tract infections are generally advised before artificial urinary sphincter (AUS) and penile prosthesis (PP) surgery to prevent device infection, limited evidence exists to support this practice. AimTo evaluate the relation between preoperative urine culture results and the bacteriology of prosthetic device infections. MethodsMen undergoing AUS and/or PP placement at a tertiary referral center from 2007 through 2015 were analyzed. A total of 713 devices were implanted in 681 patients (337 AUSs in 314 patients and 376 PPs in 367 patients), of whom 259 (36%) did not have preoperative urine culture and were excluded. The remaining 454 patients received standard broad-spectrum perioperative antibiotics. Two patient groups were identified based on preoperative urine cultures: group 1 had negative urine culture results and group 2 had untreated asymptomatic positive urine culture results identified postoperatively. Main Outcome MeasuresDevice infection was diagnosed clinically and cultures obtained from the explanted device and tissue spaces were compared with preoperative urine culture results. ResultsAlthough multivariate analysis showed that patients undergoing AUS placement had a 4.5-fold greater risk of positive urine culture results (114 of 250, 45%) compared with those undergoing PP placement (36 of 204, 18%; P < .001), infection rates between device types were similar (8 of 250 for AUSs [3%] and 7 of 204 for PPs [3%]; P = .89). At a median follow-up of 15 months, device infection occurred in 15 of 454 devices (3%) implanted and no differences in infection rates were noted between urine culture groups (10 of 337 in group 1 [3.3%] and 5 of 117 in group 2 [4.3%]; P = .28). Remarkably, only 1 of 15 device infections (7%) had the same organism present at preoperative urine culture. ConclusionsDespite the finding that patients with AUS placement had a 4.5 times higher rate of positive urine culture results than patients with PP placement, preoperative urine culture results appeared to show little correlation with the bacteriology of prosthetic device infections.

Usefulness of Urinoculture to Patients With Dementia and Femoral Neck Fracture at Admission to Hospital: Preliminary Results.

Introduction:While preoperative urinary tract infection (UTI) has the potential to cause bacteremia and postsurgical acute prosthetic joint infections (APJIs), the influence of asymptomatic bacteriuria (AB) in these infections remains unclear. So the majority of guidelines not recommend the treatment of AB prior to the surgery. However, as patients with dementia usually cannot explain the symptoms of dysuria, the differential diagnosis between AB and UTI may be very difficult in this group of patients. The principal aim of the study was to compare the rate of positive urine culture at admission in patients with femoral neck fracture with and without dementia and secondarily try to assess the connection of positive urinoculture and postoperative acute gram-negative PJI.Methods:All patients with a femoral neck fracture underwent a urine culture on hospital admission and were prospectively recorded. Variables such as sex, age, institutionalization, dementia and other comorbidities, PJI rate, and in-hospital death were collected. The results of cultures were retrospectively revised. Patients who received postoperative antibiotics or had been diagnosed with UTI during hospital stay were excluded. Statistical comparisons between patients with and without dementia were performed using SPSS software version 17.Results:A total of 148 patients were included (52 with dementia). The rate of positive urine culture was 32% (n = 16) in patients with dementia and 11.5% in patients without dementia (P = .003). Of these 16 patients with dementia and positive urine culture, 2 (12.5%) developed an acute gram-negative PJI, whereas there were no cases in the group without dementia (P = .011).Discussion:The only difference between UTI and AB is the expression of symptoms by the patient. However, as patients with dementia have difficulties to explain UTI symptoms, some UTI may be underdiagnosed.Conclusion:Patients with dementia have a statistically higher rate of presurgical positive urine culture compared with patients without dementia.

P143: Retrospective review of microbiology results in adult patients presenting to the emergency department with acute epididymitis

Introduction: North American practice guidelines for empiric antibiotic selection in the treatment of epididymitis are based on very small studies. These guidelines recommend antibiotic selection based on age. This study’s objective was to determine if culture results in a Canadian emergency department population with acute epididymitis support these guidelines. Methods: We conducted an electronic health records review ED patients with a discharge diagnosis of epididymitis. All patients who presented to two emergency department sites of the Ottawa Hospital from 2012 through 2014 were included. Data collected were patient age, urine culture results, results of urine or urethral swab nucleic acid amplification test (NAAT) for gonorrhea or chlamydia, and results of scrotal ultrasound. Ultrasound radiology reports were independently reviewed by two authors and classified as positive, negative, or indeterminate. Results: We identified 379 cases of epididymitis. There were 169 patients aged 18-35 years, and 202 patients over 35 years. The rates of positive urine culture, in the under 35 and over 35 population respectively, were 5% and 42% (p&lt;.0001). The rates of positive NAAT were 10% and 4% (p=.43). Ultrasound was performed in 252 patients; 160 (63%) were positive. There was no significant difference in the rates of positive urine culture or NAAT between the ultrasound-positive patients and patients who had negative, indeterminate, or no ultrasound. Conclusion: Our findings are not concordant with clinical practice guidelines. While the over 35 age group had a statistically higher rate of positive urine culture, the rate of positive NAAT was not different from the younger group. Both urine culture and NAAT are usually negative in the under 35 group. Positive culture rates are not higher in the subgroup of ultrasound “proven” epididymitis. Physicians should exercise clinical judgement in selecting empiric antibiotics for patients with epididymitis; basing choice on patient age alone may not be appropriate.

Clinical Data of Urine Culture and Antimicrobial Sensitivity Tests according to the Voiding Method over 15 Years in Patients with Spinal Cord Injury

Purpose To analyze the results of urine cultures and antimicrobial sensitivity tests according to the voiding methods in patients with spinal cord injury (SCI) over a 15-year period. Materials and Methods A total of 1,579 urine culture samples, obtained from January 2000 to December 2014, for 73 SCI patients were analyzed according to the voiding method. We analyzed the following: positive urine culture rate, colony counts, isolated number of organism, major organisms, and antimicrobial sensitivity tests. The voiding methods were categorized into four methods: clean intermittent catheterization (CIC), suprapubic catheterization (SPC), urethral Foley catheter, and spontaneous voiding (SV). Results Among the 1,579 urine samples, 1,250 (79.2%) were positive. The CIC group showed the lowest rate of bacteriuria (p＜0.001), colony counts (p＜0.001), and polymicrobial infection (p＜0.001). Causative organisms were mostly gram-negative bacteria (86.7%). Pseudomonas aeruginosa (22.7%) was most common pathogen followed by Escherichia coli (22.3%), Klebsiella species (9.5%), Providencia species (4.4%), and Serratia marcescens (4.2%). Major pathogens and antimicrobial sensitivity tests were different according to the voiding method. Conclusions CIC is the best voiding method to reduce urinary tract infection (UTI) in SCI patients. To treat UTI in in SCI patients, empirical antibiotics can be chosen according to the voiding method based on the reference of our study prior to the availability of antimicrobial sensitivity results.

MP54-08 INCIDENCE AND RISK FACTORS FOR POSITIVE URINE CULTURE AT THE TIME OF PEDIATRIC UROLOGIC SURGERY

You have accessJournal of UrologyPediatrics: Urinary Tract Infections/Vesicoureteral Reflux1 Apr 2015MP54-08 INCIDENCE AND RISK FACTORS FOR POSITIVE URINE CULTURE AT THE TIME OF PEDIATRIC UROLOGIC SURGERY Michael A Maccini, David Chalmers, and Jeffrey B. Campbell Michael A MacciniMichael A Maccini More articles by this author , David ChalmersDavid Chalmers More articles by this author , and Jeffrey B. CampbellJeffrey B. Campbell More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2031AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urinary tract infections (UTI) are common in pediatric urology populations. Unrecognized bacteriuria at the time of urologic surgery may put patients at risk for complications. Many providers obtain preoperative and/or intraoperative urine cultures when performing surgery on the urinary tract, but there are no data in the literature documenting the overall rate of positive urine culture at the time of pediatric urologic surgery. We hypothesized that there are risk factors associated with an increased likelihood of positive urine culture at the time of pediatric urologic surgery. METHODS We identified all patients less than 18 years of age undergoing endoscopic urologic procedure or surgery on the collecting system from 01/01/08 through 12/31/13 with a single pediatric urologist (JBC) who routinely sends intraoperative urine cultures. We performed a retrospective chart review, collecting demographic information, intraoperative urine culture results (defined as positive if >100,000 or 10-100,000 CFU of a single pathogenic organism), circumcision status, and suspected risk factors from problem/diagnosis lists (hydronephrosis, vesicoureteral reflux, UPJ obstruction, urolithiasis, neurogenic bladder, posterior urethral valves, ureterocele, and constipation). We also examined all prior urine culture results in our electronic medical record. We then analyzed each item for relative risk of positive urine culture at the time of surgery. RESULTS A total of 838 procedure records (470 unique patients) were reviewed. 717 had associated intraoperative urine culture results (85.6%) and were further analyzed. Overall, 97 (13.5%) cultures were positive. Factors associated with increased relative risk included neurogenic bladder (p<0.0001), prior UTI (p<0.0001), constipation (p<0.0001), female gender, (p=0.001), and urolithiasis (p<0.05). The absence of any of the selected diagnoses was associated with a reduced risk of positive culture (p<0.05). CONCLUSIONS Patients with neurogenic bladder, prior UTI, constipation, female gender, and urolithiasis have an increased likelihood of bacteriuria at the time of pediatric urologic surgery. This information may be helpful in tailoring the acquisition of preoperative and/or intraoperative urine cultures, which may result in significant cost savings. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e667-e668 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael A Maccini More articles by this author David Chalmers More articles by this author Jeffrey B. Campbell More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP54-09 ANTIMICROBIAL EXPOSURE AND UROPATHOGEN RESISTANCE: AN ANALYSIS OF INDIVIDUAL PATIENT DATA FROM RCTS ON ANTIBIOTIC PROPHYLAXIS AND THE PREVENTION OF UTI

bacteriuria at the time of urologic surgery may put patients at risk for complications. Many providers obtain preoperative and/or intraoperative urine cultures when performing surgery on the urinary tract, but there are no data in the literature documenting the overall rate of positive urine culture at the time of pediatric urologic surgery. We hypothesized that there are risk factors associated with an increased likelihood of positive urine culture at the time of pediatric urologic surgery. METHODS: We identified all patients less than 18 years of age undergoing endoscopic urologic procedure or surgery on the collecting system from 01/01/08 through 12/31/13 with a single pediatric urologist (JBC) who routinely sends intraoperative urine cultures. We performed a retrospective chart review, collecting demographic information, intraoperative urine culture results (defined as positive if >100,000 or 10100,000 CFU of a single pathogenic organism), circumcision status, and suspected risk factors from problem/diagnosis lists (hydronephrosis, vesicoureteral reflux, UPJ obstruction, urolithiasis, neurogenic bladder, posterior urethral valves, ureterocele, and constipation). We also examined all prior urine culture results in our electronic medical record. We then analyzed each item for relative risk of positive urine culture at the time of surgery. RESULTS: A total of 838 procedure records (470 unique patients) were reviewed. 717 had associated intraoperative urine culture results (85.6%) and were further analyzed. Overall, 97 (13.5%) cultures were positive. Factors associated with increased relative risk included neurogenic bladder (p<0.0001), prior UTI (p<0.0001), constipation (p<0.0001), female gender, (p1⁄40.001), and urolithiasis (p<0.05). The absence of any of the selected diagnoses was associated with a reduced risk of positive culture (p<0.05). CONCLUSIONS: Patients with neurogenic bladder, prior UTI, constipation, female gender, and urolithiasis have an increased likelihood of bacteriuria at the time of pediatric urologic surgery. This information may be helpful in tailoring the acquisition of preoperative and/or intraoperative urine cultures, which may result in significant cost savings.