Risk Factors For Urinary Infection Research Articles

Risk factors for urinary infection after retrograde upper urinary lithotripsy: Implication for nursing.

There are needs to evaluate the risk factors for urinary infection after retrograde upper urinary lithotripsy, to provide insights into the management and nursing care of patients with retrograde upper urinary lithotripsy.Patients who received retrograde upper urinary lithotripsy with a Foley 20 urinary tube insertion from June 1, 2019 to December 31, 2020 in our hospital were selected. Patients were grouped urinary infection and no infection group according to the culture results of urine, and the clinical data of the 2 groups of patients were collected and compared. Single factor and logistic regression analysis were used to analyze the risk factors of urinary tract infection after retrograde upper urinary lithotripsy.Four hundred ten patients with retrograde upper urinary lithotripsy were included, of whom 62 patients had the urinary tract infection, the incidence of urinary tract infection was 15.12%. There were significant differences in the gender, age, diabetes, stone diameter, duration of urinary tube insertion and duration of surgery between infection and no-infection group (all P < .05). The Escherichia coli (62.90%) was the most commonly seen bacterial in patients with urinary tract infection. Female (odds ratio [OR]: 1.602, 95% confidence interval 95% [CI]: 1.132∼2.472), age >50 years (OR: 2.247, 95% CI: 1.346∼3.244), diabetes (OR: 2.228, 95% CI: 1.033∼3.451), stone diameter ≥2 cm (OR: 2.152, 95% CI: 1.395∼3.099), duration of urinary tube insertion ≥3 days (OR: 1.942, 95% CI:1.158∼2.632), duration of surgery ≥90 minutes (OR: 2.128, 95% CI: 1.104∼3.846) were the independent risk factors for the postoperative urinary tract infection in patients with retrograde upper urinary lithotripsy (all P < .05).The incidence of urinary tract infection in patients undergoing retrograde upper urinary lithotripsy was high, counteractive measures targeted on those risk factors are needed to prevent and reduce the postoperative urinary infection in clinical settings.

Antibioprophylaxie et bilan urodynamique : recommandations de bonne pratique par consensus formalisé

The aim of this work was to issue clinical practice guidelines on antibiotic prophylaxis in urodynamics (urodynamic studies, UDS). Clinical practice guidelines were provided using a formal consensus method. Guidelines proposalswere drew up by a multidisciplinary experts group (pilot group = steering group), then rated by a panel of 12experts (rating group) using a formal consensus method, and then peer reviewed by a reviewing/reading group of experts (different from the rating group). Urine (bacterial) culture with antimicrobial susceptibility testing is recommended for all patients before UDS (strong agreement). In patients with no neurologic disease, the risk factors for tract urinary infection (UTI) after UDS are age > 70years, recurrent UTI, and post-void residual volume > 100ml. In patients with neurologic disease, the risk factors for UTI after UDS are recurrent UTI, vesicoureteral reflux, and intermicturition pressure > 40cmH2O. If the urine culture is negative before UDS and there is no risk factor for UTI, antibiotic prophylaxis is not recommended (Strong agreement). If the urine culture is negative before UDS, but there are one or more risk factors for UTI, antibiotic prophylaxis is optional. If antibiotic prophylaxis is initiated, a single oral dose (3g) of fosfomycin-tromethamine two hours before UDS is recommended (Strong agreement). If there is bacterial colonization on UCB before UDS, antibiotic therapy is optional (Undecided). If prescribed, it should be adapted to the antimicrobial susceptibility of the identified bacterium or bacteria, started the day before and stopped after UDS (except for fosfomycin-tromethamine: a single dose the day before UDS is necessary and sufficient) (Strong agreement). In the event of UTI before UDS, the UTI should be treated and UDS postponed (Strong agreement). The proposed recommendations should not be changed for patients with a hip or knee replacement (Strong agreement). No antibiotic prophylaxis of bacterial endocarditis is necessary, including in high-risk patients with valvular heart disease (Strong agreement). These new guidelines should help to harmonize clinical practice and limit exposure to antibiotics. 4.

Antimicrobial Resistance of Uropathogenic Escherichia coli from Elderly Patients at a General Hospital, Argentina

Background:Urinary Tract Infection (UTI) is a common cause of morbidity and mortality in older adults.Objective:To investigate antimicrobial resistance of uropathogenicEscherichia colifrom elderly patients in a General Hospital, Argentina.Method:During the period July 2011-July 2015, patients over 70 years old with urinary tract infections, without urinary catheters and with no antimicrobial therapy the previous week before sampling, were included. Phenotypic characterization was carried out.In vitroqualitative and quantitative antimicrobial resistances were investigated. Antimicrobials assayed: ampicillin, amoxicillin-clavulanate, cefazolin, cefuroxime, cefoxitin, cefotaxime, ceftazidime, cefepime, imipenem, ertapenem, gentamicin, nalidixic acid, ciprofloxacin, trimethoprim-sulfamethoxazole (TMS) and nitrofurantoin. Patients’ medical records were produced, and risk factors were analyzed by multivariate analysis.Results:768 bacterial isolates were identified asE. coli. Resistances to ampicillin (80.5%), nalidixic acid (61.7%), ciprofloxacin (42.8%), TMS (37.6%), amoxicillin-clavulanate (28.6%), cefazolin (21.6%), cefuroxime (20.7%), gentamicin (13.8%), cefotaxime (9.7%), ceftazidime (9.7%), cefepime (8.4%), cefoxitin (3.1%) and nitrofurantoin (2.3%) were observed. Resistance to carbapenems was not expressed. Production of extended spectrum β-lactamases was detected (7.6%) in community acquired (96%) and healthcare associated (4%) isolates. The independent risk factors for urinary infections produced by multi-resistantE. coliwere: diabetes mellitus, recurrent infections, hospitalization during the last year and exposure to β-lactams in the last 3 months.Conclusion:A high prevalence of resistance to β-lactams and to other antimicrobials was observed. Detection of antimicrobial multi-resistant isolates highlights the need of antimicrobial resistance surveillance in elderly patients with urinary tract infections.

Genetic Diversity of Uropathogenic &lt;i&gt;Escherichia coli&lt;/i&gt; Isolated from Human T Lymphotropic Virus Type I (HTLV-I) Infected Individuals

Urinary tract infection (UTI) is a frequent pathology among HTLV-I+ individuals being capable of severely compromising the kidneys and bladder. Molecular characteristics of uropathogenic Escherichia coli (UPEC) from HTLV-I+ infected individuals are unknown. UPEC isolates from HTVL-I+ individuals, with and without clinical symptoms of myelopathy, were submitted to genetic typing seeking to infer bacterial diversity and potential virulence. 71 bacterial isolates were characterized according to random amplified polymorphic DNA and phylotypes. Phylotyping classified E. coli into four phylogenetic groups: A (18.3%), B1 (16.9%), B2 (39.4%), and D (25.3%) and 8 phylotypes according to the presence of the genetic sequences chuA, yjaA and the DNA fragment TSPE4.C2: ﹣﹣﹣ (5.6%) and ﹣+﹣ (12.6%) in phylogroup A, ﹣﹣+ (7.0%) and ﹣++ (9.8%) in B1, +++ (32.3%) and ++﹣ (7.0%) in B2, +﹣﹣ (15.4%) and +﹣+ (9.8%) in D. The B2 phylogroup was the most prevalent among HTLV﹣ associated myelopathy and asymptomatic individuals. RAPD-PCR typing revealed a high degree of bacterial polymorphism indicating a non-clonal origin. Genotypes were not found to be distributed according to clinical status or epidemiological features. Our results lead us to suggest that the neurological impairment in HTLV-I+ individuals can be a risk factor for urinary infections due E. coli which are caused by distinct bacterial lineages.

The Long-term Incidence of Urinary Tract Infection After Endoscopic Management of Vesicoureteral Reflux

To evaluate the long-term urinary tract infection (UTI) rates after endoscopic correction of vesicoureteral reflux and the possible risk factors for urinary infection. A retrospective study of patients who underwent endoscopic management of vesicoureteral reflux at a single institution from 2001 to 2011 was performed. Patients were followed up for a minimum of 1 year. Voiding cystourethrograms were completed 3 months postoperatively. UTI questionnaire pertaining to the patient's UTI history before and after the surgery was mailed to each patient. Data were first evaluated looking only at culture-confirmed UTIs, and a second analysis included all patient-reported and culture-confirmed urinary infections. Factors considered in the analysis included sex, age, preoperative dimercaptosuccinic acid (DMSA) scan, reflux on postoperative voiding cystourethrogram, voiding dysfunction, and preoperative reflux grade. Data on 175 patients for a minimum of 1 year were collected. There were 34 of 175 confirmed UTIs after endoscopic management, and 11 confirmed febrile UTIs. There were no significant predictors of febrile or afebrile UTIs in this group. Fifty-three of 175 patients (30%) experienced any UTI, 19 of which were febrile (10%). In this group, recurrent reflux was the only significant predictor of UTI (P=.03) and febrile UTIs (P=.04). Patients with more UTIs preoperatively were more likely to have a postoperative febrile UTI. Rates of UTI and febrile UTI in endoscopic management are similar and no better than those for open ureteral reimplantation. Longer follow-up suggests an association of recurrent reflux and preoperative UTI rates as predictors of postoperative febrile UTIs. These patients benefit from closer postoperative observation.

Risk factors analysis for occurrence of asymptomatic bacteriuria after endourological procedures.

Introduction:Endourological procedures are performed according to the principles of aseptic techniques, jet still in certain number of patients urinary tract infections may occur. Considering the risk of urinary tract infection, there is no unique opinion about the prophylactic use of antibiotics in endourological procedures.Goal:The objective of this study was to determine the connection between endourological procedures and occurrence of urinary infections and to analyze the risk factors of urinary infection for patients who were hospitalized at the Urology Clinic of the Clinical Center University of Sarajevo CCUS.Materials and Methods:The research was conducted as a prospective study on a sample of 208 patients of both genders, who were hospitalized at the Urology Clinic of the CCUS and to whom some endourological procedure was indicated for diagnostic or therapeutic purposes. We analyzed data from patient’s histories of illness, laboratory tests taken at admission and after endourological procedures, also surgical programs for endoscopic procedures. All patients were clinically examined prior to endoscopic procedures while after the treatment attention was focused to the symptoms of urinary tract infections.Results:Statistical analysis of the tested patients indicates that there is no significant difference in the presence of postoperative, compared to preoperative bacteriuria, which implies that the endourological procedures are safe procedures in terms of urinary tract infections. Preoperatively, the most commonly isolated bacteria was Escherichia coli (30.9%) and postoperatively, Enterococcus faecalis (25%). Statistically significant effect on the occurrence of postoperative bacteriuria has preoperative bacteriuria, duration of postoperative catheterization, and duration of hospitalization.Conclusion:In everyday urological practice, it is very important to identify and control risk factors for the development of urinary infection after endourological procedures, with main objective to minimize occurrence of infectious complications.

The connection between endourological procedures and occurrence of urinary infections.

Introduction:Endoscopic surgery and endourological procedures imply the use of special instruments that are introduced into the urinary system through the urethra and percutaneous techniques that allow ante grade access to the urinary tract. The risk of urinary tract infection after endourological procedures and the use of antibiotic prophylaxis for these procedures is a question about which there is no unique opinion.Goal:The objective of this study was to determine the connection between endourological procedures and occurrence of urinary infections and to analyze the risk factors of urinary infection for patients who were hospitalized at the Urology Clinic of the Clinical Center University of Sarajevo (CCUS).Material and methods:The research was conducted as a prospective study on a sample of 208 patients of both genders, who were hospitalized at the Urology Clinic of the CCUS and to whom one of endourological procedures was indicated either for diagnostic or therapeutic purposes. All patients were clinically examined prior to endoscopic procedures and after the treatment attention was focused on the symptoms of urinary tract infections.Results:Analysis of the presence of postoperative bacteriuria shows that it has been more common in men or in 48 cases (28.1%) compared to women with 8 cases (21.6%) (p>0.05). Preoperative catheterization was statistically significantly more present in patients who have had a postoperative bacteriuria (16 or 28.6%) compared to those without bacteriuria (8 or 5.3%) (p<0.05). Analysis of the average duration of postoperative catheterization shows that patients with postoperative bacteriuria had longer duration of postoperative cauterization of 1.97±0.14 days (range 1-20 days) compared to those without postoperative bacteriuria with 1.4±0.4 days (range 0-5 days) and with a statistically significant difference (p<0.05). Antibiotic prophylaxis in relation to the occurrence of postoperative bacteriuria did not show a statistically significant difference (p> 0.05). Analysis of the correlation coefficient indicates that a statistically significant effect on the occurrence of postoperative bacteriuria have preoperative bacteriuria, duration of postoperative catheterization and duration of hospital stay, as well as the total duration of hospitalization before and after endourological treatment (p<0.05).Conclusion:It is important to emphasize that the endourological procedures are safe procedures in terms of urinary tract infections. This study should lay pathway to establishment of guidelines for the application of antibiotic prophylaxis in endourological procedures. This would standardize the perioperative use of antibiotics, taking into account the local prevalence of pathogens and antibiotic resistance, but keeping the individual approach to each patient, considering all risk factors for the development of urinary infection after endourological procedures..

Risk factors and treatment of urinary tract infections in elderly people

Introduction. The aim of the retrospective part of this research was to present the risk factors, etiology, clinical picture, therapy and outcome of urinary infections in elderly patients treated at the Department of Infectious Diseases in Novi Sad. The prospective part was aimed at establishing the most common risk factors for urinary infections among users in the Gerontology Center "Novi Sad? and determining the appropriate preventive measures by using an assessment questionnaire. Material and Methods. The retrospective research included 81 patients diagnosed with urinary infection. The patients were over 65 years of age and were treated at the Department of Infectious Diseases in the period from 2010 to September 2012. Within the prospective part of research, a poll was conducted among users of Gerontology Center ?Novi Sad? by applying an "Urination Disorder Test? questionnaire. Results. The average age of participants was 75.47 years (min 65, max 96, SD 6.86), and the female patients predominated in the patient population (F:M = 58%:42%). Associated diseases were recorded in 53 (65.4%) patients, and 24 (29.6%) of them had hypertension history. Escherichia coli were isolated in 12 (46.2%) patients. The majority of patients had preserved consciousness at admission whereas febrility and signs of intoxication were recorded in 60 (75.95%) and 33 (41.8%) patients, respectively. The patients reported the following problems: dysuria - 23 (29.1%) patients, pollakiuria - 9 (11.4%), suprapubic pain - 8 (10.1%) and pain in the lumbar region - 7 (8.9%) patients. Antibiotic therapy included ceftiaxone and ciprofloxacin, which were administered to 43 (56.6%) and 33 (43.3%) patients, respectively. Favorable disease outcome was recorded in 79 (97.5%) patients, whereas lethal outcome occurred in 2 (2.5%) patients and was associated with severe comorbidity. Frequent urinary infections, nocturia and incontinence, being the most frequent diseases among the users of Gerontology Center, were reported by 9 (22.5%), 25 (62.5%) and 16 (40%) users, respectively. The most frequent associated diseases were diabetes mellitus and therapeutic procedures on the prostate and bladder in 7 (17.5%) and stroke in 5 (12.5%) participants. Conclusion. Urinary infections in the elderly remain a highly challenging issue from both diagnostics and treatment standpoint. An update of guidelines to the relevant antimicrobial therapy is a prerequisite in order to decrease the uncritical administration of antibiotics in asymptomatic bacteriuria and to prevent the spreading of multiresistant organisms.

299 Identifying risk factors for urinary infections caused by Extended-Spectrum Beta-Lactamase (ESBL) producing agents: Implications for treatment

299 Identifying risk factors for urinary infections caused by Extended-Spectrum Beta-Lactamase (ESBL) producing agents: Implications for treatment

FINHYST, a prospective study of 5279 hysterectomies: complications and their risk factors

Hysterectomy guidelines highlight an increase in urinary tract injuries with laparoscopic hysterectomy (LH). This national survey analyses complications of LH, abdominal hysterectomy (AH) and vaginal hysterectomy (VH). A prospective cohort undergoing hysterectomy for benign indications during 2006 was drawn from 53 hospitals in Finland; all communal hospitals participated. Detailed questionnaires covered surgical data and intra- and post-operative major and minor complications, for which risk factors were analysed by a multivariate logistic regression model adjusted for surgical data and patient characteristics. Major complications rates in AH (n= 1255, 24%), LH (1679, 32%) and VH (2345, 44%) were 4.0, 4.3 and 2.6%, and total complications rates were 19.2, 15.4 and 11.7%, respectively. Logistic regression showed no statistically significant differences between approaches for any organ injuries or other major complications. Most bladder and bowel injuries (88 and 83%), but not ureter injuries (10%), were recognized intra-operatively. The ureter injury rate was low after LH (0.3%), as it was after other types of hysterectomy. Compared with LH, AH increased the odds of wound infection, and was an independent risk factor for urinary infections and febrile events. Compared with AH, LH and VH both presented a higher risk for pelvic infection; surgically treated equally often regardless of the type of hysterectomy. No differences in complications emerged between LH and VH. Obesity was a risk factor for many infections. Surgical adhesiolysis [odds ratio (OR) 2.41, 95% confidence interval (CI) 1.38-4.21] was the strongest single risk factor for major complications as a whole. Bladder injury was associated with a history of caesarean section (OR 4.01, 95% CI 2.06-7.83) and with a large uterus ≥500 g (OR 2.88, 95% CI 1.05-7.90), while bowel injury was associated with adhesiolysis (OR 29.07, 95% CI 7.17-117.88). FINHYST is a large prospective hysterectomy study illustrating actual complications. Whenever possible, hysterectomy should be minimally invasive.

Managing recurrent urinary tract infections in women

Recurrent urinary infections are a common problem for women of all ages. Risk factors for urinary infection differ for pre- and postmenopausal women. Management strategies are well established, and include treatment of the acute symptomatic episode, and decreasing the frequency of subsequent episodes. This update focuses on the management of acute uncomplicated urinary infection, the most common bacterial infection in women.

Managing Recurrent Urinary Tract Infections in Women

Recurrent urinary infections are a common problem for women of all ages. Risk factors for urinary infection differ for pre- and postmenopausal women. Management strategies are well established, and include treatment of the acute symptomatic episode, and decreasing the frequency of subsequent episodes. This update focuses on the management of acute uncomplicated urinary infection, the most common bacterial infection in women.

Etiology of urinary tract infection in scholar children

To prospectively assess the prevalence of vesicourethral dysfunction in children over 3 years old, comparing it with the occurrence rate for other potential factors that cause urinary infection in this age range. 36 girls and 9 boys were assessed, with mean age of 6.4 years, ranging from 3 to 13.9 years. These children were prospectively assessed regarding the presence of symptoms of lower urinary tract dysfunction. These data were compared with the retrospective assessment of other potential risk factors for urinary infection. Ultrasonography was performed in 28 children and voiding cystourethrogram was performed in 26 patients. Vesicourethral dysfunction was diagnosed in 39 (87%) of the 45 children with urinary infection. Among these 39 patients, all had voiding urgency, 30 (77%) had urinary incontinence, 12 (31%) pollakiuria and 3 (8%) presented infrequent voiding. Vaginal discharge was evidenced in 8 (22%) girls and phimosis in 2 (22%) boys. Obstipation was diagnosed in 10 (22%) cases. Significant post-voiding residue was detected in 4 (13%) of the 28 cases assessed. Vesicoureteral reflux was evidenced in 5 (19%) of the 26 patients who underwent voiding cystourethrogram. In only 2 (4%) cases there was not an apparent cause for the infection. Vesicourethral dysfunction is a major cause of urinary infection in children with ages above 3 years old. In cases where voiding dysfunction in not present, other predisposing factors must be assessed. However, only 4% of the patients did not present an apparent urologic cause for the infection.

Vesicourethral Dysfunction and Urodynamic Findings in Multiple Sclerosis: A Study of 149 Cases

Vesicourethral Dysfunction and Urodynamic Findings in Multiple Sclerosis: A Study of 149 Cases