Rate Of Urinary Tract Infection Research Articles

Effects of Routine Catheterization on Urinary Tract Infection Rates After Minor Gynecologic Surgeries

This pilot study describes urinary tract infection (UTI) rates after routine single catheterization during minor gynecologic surgeries at a tertiary care community hospital. Records from 762 patients from 2021 were reviewed, including procedures such as hysteroscopy, loop electrosurgical excision procedure, and dilation and curettage. Findings revealed a 42.4% catheterization rate, with a significantly higher proportion of catheterized patients having UTIs (5.6%) compared with noncatheterized patients (2.5%). This study suggests that catheterization, unless medically necessary, should be avoided to reduce nosocomial infection risk. These results advocate for reconsidering current practices to enhance patient care and minimize preventable UTIs.

Perioperative outcomes and trends of transurethral surgeries for benign prostatic hyperplasia in octogenarians: a comprehensive analysis using the NSQIP database (2011-2022).

Advances in health care have resulted in an increasing octogenarian population in the United States. The prevalence of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) in this subgroup exceeds 70%. This study attempts to evaluate perioperative outcomes of different transurethral techniques in octogenarians and define their utilization trends from 2011 to 2022. We extracted data from the American College of Surgeons NSQIP for octogenarian patients who underwent prostatectomy for BPH. Procedures were categorized using CPT codes, and outcomes included postoperative complications, readmission, 30-day reoperation, and utilization trends from 2011 to 2022. A total of 21,314 octogenarians were included. TURP was the most performed procedure (53.13-71.17%), followed by PVP and HoLEP. HoLEP utilization increased reaching up to 19% by year 2022. Higher American Society of Anesthesiologists (ASA) scores were observed more frequently in the TURP group. HoLEP consistently exhibits the longest operative times. Initially relatively higher transfusion rates for HoLEP decreased to 0% by 2022. Urinary tract infection rates did not significantly differ among the procedures most years. TURP remained the most performed modality for BPH management in octogenarians amongst NSQIP-participating institutions. However, from 2011 to 2021, the utilization of HoLEP increased nearly by 2.5 folds, from 2.5 to 6.4%.

Green Cystoscopy: Does Minimizing the Use of Drapes Increase Infection Rates?

The U.S. health care system has an enormous carbon footprint made worse by the escalating use of single-use supplies. Emerging evidence suggests that smaller surgical fields ("green" draping) may represent a safe alternative to traditional draping. The aim of the study was to determine if the proportion of cases treated for culture-proven urinary tract infection (UTI) within 2 weeks of operating room cystoscopy after the green draping protocol implementation is noninferior to preprotocol cases. Secondary objectives included risk factors for UTI and waste and cost savings. A pre-post implementation noninferiority study was performed from 2021 to 2023 in a urogynecology division at an academic medical center. The green draping protocol eliminated the use of top drapes, leg drapes, and gowns; blue towels were permitted per the surgeon's discretion. All minor cystoscopy cases were included. The cohort included 240 patients. Treatment of culture-proven UTI in the green cohort was noninferior to the preprotocol group (9 [7.5%] vs 7 [5.8%], P < 0.05). The odds of a culture-proven UTI were higher with history of recurrent UTI (odds ratio = 7.02), interstitial cystitis/bladder pain syndrome (odds ratio = 4.33), and older age (odds ratio per 5-year increase = 1.21). Approximately $1,403.92 (2023 USD) was saved, and 165 pounds of waste was diverted from the landfill. A green draping protocol is noninferior to standard draping with respect to rates of postoperative culture-positive UTIs. Clinicians may use a smaller operating room field to decrease the carbon footprint without compromising quality of care.

Clinical characteristics of primary vesicoureteral reflux in children with an allergic constitution.

This study was designed to compare the clinical data of vesicoureteral reflux (VUR) in children with and without an allergic constitution. The clinical data of patients hospitalized with VUR due to a urinary tract infection (UTI) between September 1, 2019, and December 31, 2020, were retrospectively analyzed. The patients were divided into two groups: an anallergic constitution group (AC group) and a non-allergic constitution (NAC group), and their UTIs and VUR were compared at baseline and during the follow-up period. (1) Between September 1, 2019, and December 31, 2020, a total of 284 children were hospitalized at Shengjing Hospital Affiliated to China Medical University due to a UTI. These children included 37 cases with primary VUR and 247 cases without VUR (including 59 cases of non-VUR urinary malformation). The proportion of children with an allergic constitution was significantly higher in the patients with VUR than it was in those without VUR or with other urinary malformations (72.97% vs. 48.18% vs. 50.85%, P = 0.005, 0.032). (2) At baseline, the levels of immunoglobulin and immunoglobulin E in the AC group were significantly higher than those in the NAC group (P = 0.042, 0.017). (3) During the follow-up period, the number of recurrent UTI cases in the AC group was significantly higher than that in the NAC group (0.70 ± 0.91 vs. 0.10 ± 0.32, P= 0.005). The difference between the two groups in the VUR remission rate was not statistically significant (40% vs. 50%, P = 0.563). (4) During the follow-up period, the differences in the remission rates of recurrent UTIs and VUR in the two groups were not statistically significant. The incidence of having an allergic constitution is high in patients with VUR, and patients with an allergic constitution present with a higher frequency of recurrent UTIs.

Clean Intermittent Catheterisation via a Mitrofanoff is superior to long term Suprapubic Catheters for Bladder Drainage.

AimSome children require long-term drainage of the bladder but do not tolerate clean intermittent catheterisation (CIC) urethrally. We aimed to compare long term suprapubic catheter (SPC) drainage vs Mitrofanoff conduit (allowing CIC) by comparing the survival of the drainage methods and rates of urinary tract infection (UTI). MethodRetrospective review of a single surgeon’s experience (2007-2023). Data collection included diagnosis, age at procedures, date of surgery, date of most recent follow-up and date and reason for unplanned surgery. For SPCs, initial insertion of SPC and then conversion to a Foley catheter under GA was taken as normal (event free survival) and only further operations were counted as complication events. For Mitrofanoffs, any subsequent operation was counted as a complication.Data were given as a number (%) or median (interquartile range) as appropriate. Data analysed by Fisher exact and Mann-Whitney U-test. Kaplan Meier (KM) survival of drainage routes was compared, P<0.05 taken as significant. ResultsThere were 45 patients (n = 86 SPC episodes) compared to 108 patients (n = 110 Mitrofanoff procedures). Data were available in 73 SPC episodes and 109 Mitrofanoff episodes, including 3 redo procedures (one from another centre). There was no difference in gender (SPC group, 67% male vs. Mitrofanoff group, 77%; N.S.). There was no difference in age at procedure [7.5 (2.9 - 11.5) years vs 8.3 (5.9 - 11.4) years respectively; N.S.)KM comparison showed that Mitrofanoff have a better event-free survival than SPC (91% vs 52% at 1 year; 80% vs. 13% at 5 years; P<0.0001). Paired data showed a significant (86%) reduction in rate of UTI with conversion from SPC to Mitrofanoff drainage in 15 patients; SPC: 0.13 (0 - 0.46) UTIs/month vs subsequent Mitrofanoff: 0.02(0 - 0.08) UTI/month, P=0.04). ConclusionSPCs had a much higher rate of unplanned surgery than Mitrofanoffs, creating a considerable unplanned burden of care for families and clinical staff. For long-term bladder drainage CIC via a Mitrofanoff conduit should be considered in preference to SPC where urethral CIC is not possible.

Efficacy and safety of onabotulinumtoxinA for the treatment of overactive bladder in men and women: A pooled analysis.

This pooled analysis of randomized controlled studies investigated the safety and efficacy of onabotulinumtoxinA in male and female patients with overactive bladder (OAB). Data were pooled from four similarly designed trials in North America and Europe. Adults with idiopathic OAB for ≥6 months inadequately managed by at least one anticholinergic were randomized 1:1 or 2:1 to receive onabotulinumtoxinA 100 U or matched placebo in Cycle 1 and could request open-label retreatment with onabotulinumtoxinA 100 U at ≥12 weeks. Efficacy outcomes at Week 12 included the primary endpoint of mean urinary incontinence (UI) episodes per day and other variables, such as the proportion of patients with ≥50% reduction in daily UI episodes. Safety was assessed by monitoring treatment-emergent adverse events (TEAEs). Analyses by sex were descriptive. Males were further analyzed by benign prostatic hyperplasia (BPH) diagnosis status. In the pooled population (N = 1564), there were 194 males (12.4%) and 1370 females (87.6%). Mean number of baseline UI episodes per day was 4.9 in males and 5.5 in females. At Week 12, numerically greater mean reductions from baseline in number of daily UI episodes were observed with the onabotulinumtoxinA 100 U group (females: -3.0; males: -2.2) versus placebo (females: -1.1; males: -1.3). Achievement of ≥50% reduction in daily UI episodes was numerically greater with onabotulinumtoxinA 100 U (females: 64.8%; males: 61.2%) versus placebo (females: 30.6%; males: 44.8%), and numerically higher in males without BPH (onabotulinumtoxinA: 65.1%; placebo: 50.9%) versus with BPH (onabotulinumtoxinA: 54.3%; placebo: 36.6%). A total of 34.7% of males and 39.4% of females experienced at least one TEAE in the first 12 weeks during treatment Cycle 1. Urinary tract infection rate was 13.1% in females and 4.2% in males; incidence of hematuria was 6.8% in males and 1.1% in females. Incidence of urinary retention (defined as incomplete emptying, requiring catheterization) was 2.7% in females and 4.7% in males. OnabotulinumtoxinA 100 U was efficacious and well tolerated in men and women with OAB, including in males with and without BPH. No new safety findings were identified when data were analyzed by sex.

Comparison of Early Versus Late Foley Catheter Removal after TURP- Our Experience

Objective: To compare early versus late catheter removal after Transurethral resection of prostate for benign prostatic hyperplasia in terms of postoperative complications. Study Design: Cross sectional Study. Place and Duration of Study: Urology Department, Armed Forces Institute of Urology, Rawalpindi Pakistan from Jan 2022 to Aug 2022. Methodology: A total of 100 patients undergoing monopolar Transurethral resection of prostate fulfilling the inclusion criteria were included in study after written informed consent. They were randomized in two equal Groups (50 patients each) by lottery method, Group A-catheter removed on day 2 and Group B-catheter removed on day 5, postoperative complications including urinary retention, hematuria, urinary tract infection and urethral stricture were recorded on proforma. Results: Both Groups had no statistically difference in demographic profile. In Group-A, 4(8%) patients had urinary retention and in Group-B, 3(6%) patients had urinary retention (p-value 0.438). The number of patients that had UTI in Group A and Group B were 1(2%) and 7(14%) respectively which was statistically significant (p&lt;0.001). However, hematuria, urethral stricture and epididymo-orchitis were not statistically significant among Groups with p-values of 1.00, 0.24 and 0.36 respectively. Conclusion: Early catheter removal after Transurethral resection of prostate resulted in decreased urinary tract infection rate as compared to delayed catheter removal without any other significant postoperative complications.

Urinary Tract Infection (UTI) Prevention in Patients with Chronic Indwelling Catheters

Abstract Purpose of Review In this review, we discuss urinary tract infections in the setting of indwelling urethral foley catheters. We focus on infection prevention in setting of a chronic indwelling foley and review the recent literature findings on biofilm prevention, catheter duration and exchange intervals, prophylactic supplements, irrigation solutions, and consideration of alternative bladder management options. Recent Findings Ongoing research has found a reduction in UTI rates through the use of biofilm preventing catheters, D-mannose and Methenamine hippurate supplementation, prophylactic antibiotic use at time of catheter exchange, and intravesical antibiotic instillations within the chronically catheterized patient population. Summary Overall, research on recurrent urinary tract infections is fairly robust. However, data focusing on preventing infections in the setting of indwelling catheters is overall lacking. Continued research remains to be done to translate findings to patient care.

Exploring the Associations Between Women's Overweight at the Beginning of Pregnancy and Postpartum Complications in the Context of SDG 3: Ensuring Healthy Lives and Well-Being for All

Aim: The aim of this study was to investigate the associations between overweight recorded in parturient women at the beginning of pregnancy and the occurrence of postpartum complications at the Souissi maternity hospital in Rabat. Materials and Methods: This was a prospective descriptive study conducted over 9-month from March to November 2022, at the Souissi maternity hospital in Rabat. Including women who followed their pregnancy, were either normal or overweight at the beginning of pregnancy and had an uncomplicated pregnancy. Results: A total of 1,145 parturient women were recruited. With a response rate of 81.65% and using a mixed questionnaire, the number of surveyed women was 935, subdivided into two groups. Normal-weight (637 cases) and overweight parturient women (298 cases). This study showed the existence of associations between overweight at the start of pregnancy, recorded in the parturient surveyed, and the term of delivery (P=0.033), the course of delivery (P=0.031), the mode of delivery (P=0.005), the postpartum complications as urinary tract infection (P=0.002), breast engorgement (P=0.001), return of hemorrhagic layers and baby-blues (P=0.005). Discussion: This study found that 68.13% of surveyed women had a normal BMI, while 31.87% were overweight at the beginning of their pregnancy. They were more likely to have overdue deliveries (70.80% vs. 25.27% for normal-weight) and dystocic deliveries (25.50% vs. 4.24%). Overweight status was also correlated with higher rates of urinary tract infection 8.505 and 2.381 time and breast engorgement 16.331 and 3.556 time respectively in the early and last postpartum period.

Impact of an enhanced anti-infection prophylaxis strategy for pancreatoduodenectomy: a single centre analysis

Introduction Surgical site infection (SSI) after pancreatoduodenectomy (PD) is a significant concern. Targeted antibiotic prophylaxis (pAP) has been tested to mitigate antibiotic resistance patterns, especially after preoperative bile duct stenting. The aim of this study was to investigate the effect of enhanced anti-infective prophylaxis (EAP) on the incidence of superficial and intraabdominal SSI.MethodsAll patients who underwent PD at a single centre between May 2018 and May 2021 were retrospectively analysed. A control cohort of patients who received pAP with intravenous cefuroxime and metronidazole and routine intraoperative abdominal lavage according to the surgeons’ preferences. Since March 2020, pAP has been changed to piperacillin/tazobactam according to local resistance patterns and combined with routine intraoperative extended abdominal lavage (EIPL). Preoperative selective decontamination of the digestive tract (SDD) has been applied routinely since Jan 2019.ResultsIn total, 163 patients were included. The standard (n = 100) and EAP (n = 63) groups did not significantly differ with regard to pertinent patient and operative characteristics. In the EAP group, the rates of SSI (14% vs. 37%, p = 0.002, total rate: 28%) and urinary tract infection (24% vs. 8%, p = 0.011, total rate 18%) were significantly lower. Other septic complications were not significantly different. In addition, the risk of developing gastrointestinal bleeding and delayed gastric emptying was significantly lower in the EAP group. Multivariate analysis showed that an age > 67 years was a significant risk factor for SSI.ConclusionThe results indicate that enhanced anti-infective prophylaxis may significantly decrease the incidence of SSI in patients after PD.

Outpatient Versus Inpatient Total Hip and Knee Arthroplasty in Morbidly Obese Patients

Morbidly obese patients undergoing total joint arthroplasty (TJA) face increased postoperative complications, yet studies assessing the safety of this surgery in the outpatient setting for this population are lacking. This study aimed to fill this gap by assessing the safety and benefits of outpatient TJA in morbidly obese patients. This study is a retrospective review of a commercial claims database. Based on the setting of the procedure, the patients were divided into four groups: inpatient-TKA (total knee arthroplasty), outpatient-TKA, inpatient-THA (total hip arthroplasty), and outpatient-THA. The two TKA groups were matched based on age, sex, and the Charlson comorbidity index (CCI). The THA groups were matched similarly. The 30- and 90-day medical and surgical complications were compared between these groups. There were 5,500 patients included in each of the outpatient and inpatient TKA groups, and 1,550 in each of the outpatient and inpatient THA groups RESULTS: Patients undergoing inpatient TKA had higher rates of pulmonary embolism, UTI (urinary tract infection), transfusions, ICU (intensive care unit) admissions, ED (emergency department) visits, readmissions at 30 days, surgical site infections, periprosthetic joint infection, prosthetic dislocations, and costs. As for the inpatient THA group, they had higher rates of pulmonary embolism, UTI, transfusions, ICU admissions, ED visits, and costs. It is well established that morbidly obese patients undergoing total joint arthroplasty have higher complication rates than normal-weight patients, and patients should be counseled before arthroplasty. This study highlights the safety and benefits of outpatient TJA in morbidly obese patients. However, one should note that this was done using an insurance database, in which results may differ if it was done in a public and lower socioeconomic setting. Therefore, future prospective studies are needed to confirm the findings before implementing outpatient TJA in morbidly obese patients.

Molecular detection of Pseudomonas aeruginosa isolated from children with urinary tract infections

The purpose of this research was to identify Pseudomonas aeruginosa from pediatric UTI samples using molecular methods. Bacteria were isolated and identified using a primary medium. Children from all around Baghdad city who were hospitalized at a private clinic between 2019 to 2022 and showed symptoms of a urinary tract infection (UTI) such as fever and vomiting, had their urine sampled. There were 132 samples of children's urine collected from kids who had UTIs. The VITEK-2 system was completed on pure bacterial isolates. DNA of these bacteria was done and two primers were used in this study for the detection of P. aeruginosa. The present study showed that the rate of infection by P. aeruginosa was 7.6%, the total Gram-positive bacteria were 22.7% and the total Gram-negative bacteria were 77.3%. It was shown that females had a greater rate of UTI (55.3% vs. 44.7%) than males. In conclusion, because of its prevalence and severity in community-acquired UTIs in children and its unique risk factors and outcomes, P. aeruginosa should be suspected in any child who has recently received or is now receiving antibiotic treatment.

Efficacy and safety of an ultra-low-dose 0.005 % estriol vaginal gel in the prevention of urinary tract infections in postmenopausal women with genitourinary syndrome of menopause: A randomized double-blind placebo-controlled trial

ObjectivesThis study evaluated the efficacy of an ultra-low-dose 0.005 % estriol vaginal gel in the prevention of urinary tract infections in postmenopausal women with genitourinary syndrome of menopause. Study designRandomized, double-blind, placebo-controlled, multicenter clinical trial conducted across 28 Spanish sites involving specialists in gynecology, urology, and primary care. A total of 108 postmenopausal women were randomly assigned in a 1:1 ratio to receive 1 g of vaginal gel with 50 micrograms of estriol or an identical moisturizing vaginal gel without estriol. Main outcome measuresThe primary outcome was the number of episodes of urinary tract infection by the end of the 24-week treatment. Secondary measures encompassed percentage of patients without recurrence, time to first recurrence, use of antibiotic treatment, vaginal pH, safety, and tolerability, among others. ResultsThe incidence rate of urinary tract infections (new cases per 100 women-year) was 26 % lower in the group that received estriol vs. the group that received placebo (32.34 vs. 43.76 (RR = 0.74) p < 0.001). The frequency of urinary tract infections fell during treatment in all patients in the estriol group. Favorable pH changes from baseline were observed in the estriol arm at all follow-up visits. ConclusionsUltra-low-dose 0.005 % estriol vaginal gel is safe and effective in preventing recurrent urinary tract infections in postmenopausal women with genitourinary syndrome of menopause, reducing the incidence and potentially decreasing the susceptibility to urogenital infections by improving vaginal pH.Study registration N°: 2018-001481-42. Date of registration: 09-04-2018.

Reduction of misdiagnosis in urinary tract infections during pregnancy: The role of adjusted urine flow cytometry parameters.

Urinary tract infections (UTIs) pose a significant health concern, particularly among pregnant women, for whom accurate diagnosis is essential. However, the use of Urine flow cytometry (UF) for detecting UTIs in this demographic often results in misdiagnosis. The objective of this study was to explore the reasons behind these diagnostic errors and to develop a strategy to minimize the rate of UTI misdiagnosis in pregnant women. The study enrolled 1,200 women aged 18 to 40 years, categorized into pregnant and non-pregnant groups. UTIs were diagnosed using urine bacterial culture, microscopic examination, and UF, followed by statistical analysis to identify any discrepancies in diagnosis between the groups. Following the calibration of UF analyzer's parameters, the most effective CR(WBC)-CW-FSC-P Gain setting for diagnosing UTIs in pregnant women through UF was ascertained by applying the Youden index. The clinical diagnosis rate of UTIs was significantly higher in pregnant women (40.91%) compared to non-pregnant women (20.26%). However, urine microscopy and bacterial culture showed no significant difference in the rates of UTIs between the two groups, suggesting a potential for misdiagnosis. The false-positive rate for WBCs detected by UF was 30.43%, and adjusting the CR(WBC)-CW-FSC-P Gain value of UF reduced the false-positive rate to 9.45%. The incidence of UTIs in pregnant women may be overestimated because of the limitations inherent to UF. Adjusting the parameters of the UF analyzer, particularly the CR(WBC)-CW-FSC-P Gain value, can significantly reduce the rate of UTI misdiagnosis in pregnant women.

Investigating urinary characteristics and optimal urine white blood cell threshold in paediatric urinary tract infection: A prospective observational study.

While the definitive diagnosis of urinary tract infection (UTI) requires a positive urine culture, the likelihood of UTI can be determined by urinalysis that includes white blood cell (WBC) count. We aimed to determine the optimal urine WBC threshold in urinalysis to predict UTIs in children presenting at the emergency department (ED). We performed a prospective observational study in the ED at KK Women's and Children's Hospital for children below 18 years old who underwent both urine microscopy and urine cultures, between 10 January and 7 November 2022. We assessed the various urine WBC thresholds associated with culture-proven UTIs using sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and area under receiver operating characteristic curve. We found a culture-proven UTI rate of 460/1188 (38.7%) among all patients analysed, and 278/998 (27.9%) among those with nitrite-negative urine samples. Among all patients, a urinalysis WBC threshold of 100/μL had a sensitivity of 82.2% (95% confidence interval [CI] 78.4-85.5) and negative predictive value of 86.2% (95% CI 83.6-88.4). Among those who were nitrite-negative, a WBC threshold of ≥100/μL resulted in a potential missed rate of 48/278 (17.3%). By lowering the WBC threshold to ≥10/μL, the potential missed cases reduced to 6/278 (2.2%), with an estimated increase in 419 urine cultures annually. A urine microscopy WBC threshold of ≥100/μL results in a clinically significant number of missed UTIs. Implementation of various thresholds should consider both the potential missed UTI rate and the required resource utilisation.

Renal transplant nephrolithiasis: Presentation, management and follow-up with control comparisons.

To analyse the presentation, management and long-term outcomes of renal transplant patients who formed kidney stones in their allograft. The secondary aim was to identify risk factors for stone formation in this cohort. Patient information from an institutional renal transplant database was used to identify individuals who both did and did not form kidney stones following renal transplantation. Computerized tomography (CT) imaging was used to make the diagnosis of kidney stones and measure stone size. Age- and gender-matched controls never forming a stone in their allograft were used for comparative analysis to identify risk factors for stone formation in transplant patients. A total of 8835 transplant patients were included in the study, of which 128 (1.4%) formed a kidney stone in their allograft after surgery. The mean time to kidney stone identification was 6.2years, and the mean number of stones formed was 1.7, with a mean maximum size dimension on a CT scan of 5.7mm per stone. A total of 26 patients were subjected to stone-removing procedures, the most common being ureteroscopy (42.3%). The primary intervention failed in eight patients requiring a secondary intervention, and percutaneous nephrolithotomy (PCNL) had the lowest success rate (60%). A total of 164 controls were identified. In comparison to controls, stone formers had lower serum calcium (p= 0.008), lower estimated glomerular filtration rates (p= 0.019), higher lymphocyte counts (p= 0.021) and greater rate of urinary tract infection (p= 0.003). Graft failure rates were the same (p= 0.524), but time to graft failure was significantly longer in stone patients compared with controls (p= 0.008). The rate of stone formation is low in transplant patients. Success rates for stone treatment vary based on the surgery selected, with PCNL being the worst. Graft survival rates were equivocal, but survival time was better in stone patients. Our analysis calls for further investigation of this important topic.

Nurse-Driven Process for the Successful Removal of Urinary Catheters Among Elderly Patients After Hip Fracture Surgery: A Quality Improvement Project.

Hip fracture is a major health concern and the use of an indwelling urinary catheter (IUC) constitutes a significant burden on elderly patients undergoing hip fracture surgery. The institution had a high rate of urinary tract infection (UTI) and IUC reinsertion after hip fracture surgery. A pre/post-implementation design was used for this quality improvement initiative. A nurse-driven process was developed and implemented to improve the successful removal of IUC among patients after hip fracture surgery. There was a significant reduction in post-operative urinary retention (P =.042), UTI rate (P =.047), and IUC reinsertion (P =.042) in the post-implementation group. IUC duration decreased by 1.1days, however this was not significant (P =.206). Nurse compliance with following the new process was 93.3%. The nurse-driven process designed for elderly patients following hip fracture surgery presents a promising approach to reducing IUC reinsertion rates and UTI.

Knee fusion versus above knee amputation as two options to deal with knee periprosthetic joint infection.

Periprosthetic joint infection (PJI) poses a significant challenge in total knee arthroplasty (TKA), with recurrence rates as high as 14-28%, leading to substantial morbidity and treatment costs. When conventional treatments fail, knee fusion and above-the-knee amputation (AKA) emerge as alternative options. Existing literature offers conflicting views on the efficacy and impact of knee fusion versus AKA with varied outcomes and limitations. This retrospective national study spanning 2010-2022 investigates Knee Fusion and AKA as options for addressing Knee PJI. Utilizing PearlDiver Patient Records Database, procedural, and reimbursement data on over 100million individuals from all the US was evaluated. Readmission rates, costs, and complications of the mentioned procedures were assessed using ICD-9 and ICD-10 codes within a 90-day period and one-year post-operation. Statistical analyses, including chi-square tests and regression models, were conducted using integrated R software. The study reveals a substantial escalation (p < 0.0001) in the proportion of patients opting for AKA compared to arthrodesis. While age as a demographic factor showed no significant difference, arthrodesis patients exhibited lower comorbidity scores (3.6 ± 2.9 vs. 4.6 ± 3.4, p < 0.001). Arthrodesis correlated with higher 90-day thromboembolism rates (9.2% vs. 7.3%, p < 0.001), blood transfusion requirements (23.2% vs. 14.4%, p < 0.001), and acute renal failure incidence (p = 0.008) but demonstrated lower rates of urinary tract infections (p = 0.047) and cerebrovascular accidents (p < 0.001). At 1 year, arthrodesis was associated with higher infection rates (38.7% vs. 36.4%, p < 0.001). Arthrodesis patients had significant increased 90-day and 1-year readmission rates and hospitalization costs ($12,732 vs. $18,826, p < 0.001). We found higher rates of 1-year thromboembolism, infection, acute renal failure, and readmission in the arthrodesis group. AKA patients had more sepsis and cerebrovascular accidents. A patient-centered conversation is best for persistent infections and failed revision TKA. Considering the patient's quality of life, goals, and health status, this discussion should cover each procedure's risks and complications.

Impact of antibiotic prophylaxis on urinary tract infection recurrence in children

Introduction: Given the potential consequences associated with urinary tract infections (UTI), it has become standard practice to use continuous antibiotic prophylaxis (CAP) in children, even if controversial. We reviewed the effectiveness of CAP on recurrent UTI in a pediatric population to determine if equipoise remains and allow for a placebo control group to study the effectiveness of the vaccine MV140. Method: We completed a rapid review. We searched Medline, Embase and the Cochrane Library and data extraction was completed by a single reviewer. Our search criteria were 2005–2022, English and French language, randomized controlled trials (RCTs) and systematic reviews only. The population was 19 years and younger, including: vesicoureteral reflux (VUR), congenital anomalies of the kidneys and urinary tracts (CAKUT), and bladder and bowel dysfunction (BBD). Results: Three RCTs and three systematic reviews found a benefit for CAP, mostly for a population with VUR, and those with severe VUR have more benefit. Most studies were not able to show a difference in the rate of UTIs or new renal scars (NRS). Three RCTs found a deleterious effect with CAP. Other studies were able to prove a benefit for patients with dilatation of the urinary tract without obstruction and high-grade VUR combined with BBD. The major adverse event found was antimicrobial resistance. Conclusions: High-risk patients benefit from CAP. The potential consequences of UTIs makes it unethical to use a placebo-only control group for them; however, CAP use seems difficult to justify in a low-risk population.

Bacterial species cultured after electrofulguration in women with a history of antibiotic-recalcitrant urinary tract infections frequently compare with pre-fulguration findings: a pilot study.

Electrofulguration (EF) of areas of chronic cystitis in women with antibiotic-recalcitrant recurrent urinary tract infections (RUTIs) can result in improvement of their urinary tract infections (UTIs). We compared urine culture (UC) findings in patients before and after EF, as well as how they vary with cystitis stage at the time of EF, to evaluate for persistent species. After obtaining institutional review board approval, we retrospectively reviewed a prospectively maintained database of EF patients for those with positive UC findings in the 3-6 months preceding EF. Patient pre-EF UC was then compared with first positive UC after EF prompted by a new symptomatic UTI episode, with the hypothesis that the same species will be identified before and after EF. Exclusion criteria included UC from outside institution, neurogenic bladder, and need for catheterization. Ninety-nine women with pre- or post-EF UC-recorded organisms met the study criteria. The median age was 65 years (interquartile range 64-74), with a median time to first positive culture following fulguration of 9.7 months. For 26 patients with positive cultures both pre- and post-EF, the same organism was present in both cultures in 73% of the patients, with predominantly Escherichia coli. EF was effective at reducing the rate of UTIs in this population. For women undergoing EF for antibiotic-recalcitrant RUTIs and associated chronic cystitis lesions, 73% of those with a UC obtained at the time of a first symptomatic recurrent UTI episode post-EF expressed the same organism as before EF. Further study is needed to better understand the evolution of the microbiome post-EF.IMPORTANCEAmong women who experience a recurrent urinary tract infection after a fulguration procedure on areas of chronic cystitis in their bladder, there are no data available on whether the bacterial species found in urine cultures are the same or different from those present before fulguration. By removing the inflamed surface layer of cystitis during fulguration, it is possible that the procedure unmasks deep-seated bacteria. The bacterial kingdom in the bladder wall of these chronically infected women may be different from what is expressed sporadically in urine cultures. Confirming prior studies, we found that fulguration in women with antibiotic-recalcitrant recurrent urinary tract infections and cystitis lesions was effective at reducing the rate of urinary tract infections. At the time of a first symptomatic recurrent UTI episode post-fulguration, 73% expressed the same organism in urine culture as before fulguration. Further study is needed to better understand the evolution of the microbiome post-EF. This article evaluates persistent infections after electrofulguration of areas with chronic cystitis in post-menopausal women with antibiotic-recalcitrant recurrent urinary tract infections. Pre-fulguration urine cultures were compared with the first positive urine culture prompted by a new symptomatic UTI episode after electrofulguration, with the hypothesis that the same species will be identified before and after the fulguration procedure. Electrofulguration was effective at reducing the rate of UTIs in this population. However, 73% of those with a urine culture obtained at the time of a first symptomatic recurrent UTI episode post-electrofulguration expressed the same organism (predominantly Escherichia coli) as before the fulguration procedure. Further study is needed to better understand the evolution of the microbiome after electrofulguration.