Treatment Of Urinary Tract Infections In Patients Research Articles

Bladder irrigation with tap water to reduce antibiotic use for urinary tract infections in catheter users.

To evaluate the safety and effectiveness of bladder irrigation (BI) with tap water to reduce antibiotic use for the treatment of urinary tract infections (UTIs) in patients with recurrent UTI symptoms and to assess the treatment satisfaction of BI. This prospective, observational study included patients with an indwelling catheter or performing clean intermittent catheterisation (CIC) who had recurrent UTI symptoms between July 2022 and March 2024. BI with tap water was used for the treatment of UTIs without systemic symptoms (e.g., fever, flank pain or delirium). Patients started daily irrigation at the onset of UTI symptoms and used a tapering schedule. The number of antibiotic treatments for UTIs, UTI incidence rate ratio (IRR), UTI-related hospitalisations, treatment satisfaction and quality of life (QoL) were compared between a 3-month period before and after BI with tap water. A total of 60 patients were included with a median (interquartile range) age of 64.5 (50.4-72.6) years, 66.7% were male, and 83.3% were performing CIC. Antibiotic use was decreased on average by 38.1% (IRR = 0.62; P = 0.016) and catheter-associated UTIs by 37.9% (IRR = 0.62; P = 0.005). No increase was observed in the incidence of UTIs with systemic symptoms or UTI-related hospitalisations. In addition, no differences were observed in the health-related QoL. The majority of patients were positive about the subjective effectiveness (81%), ease of use (86%) and overall satisfaction (85%) of BI with tap water. These findings emphasise the potential of BI with tap water as a promising and patient-friendly alternative for the treatment of UTIs in patients with urinary catheters. BI with tap water significantly reduces antibiotic use and UTI incidence in patients with recurrent UTIs and is a safe and patient-friendly alternative that can be easily implemented in the management of UTIs.

Analysis of Risk Factors for Urinary Tract Infection after Lumbar Interbody Fusion.

Urinary tract infection (UTI) is a common postoperative complication, so exploring its risk factors is helpful to provide a basis for clinical prevention. This study aims to analyse the risk factors for UTI after lumbar interbody fusion (LIF). A single-centre retrospective study was conducted on the clinical data of 358 patients treated with LIF from April 2020 to April 2023. In accordance with the results of postoperative urine culture, the patients were divided into UTI group (n = 19, those with UTI after LIF) and control group (n = 332, those without UTI after LIF). Binary logistic regression analysis was carried out through collecting the medical records of the two groups to probe into the risk factors for UTI after LIF. After seven patients were excluded, the remaining 351 patients were included in the analysis. In this study, 19 patients (5.41%) developed postoperative UTI, whereas 332 patients (94.59%) had no UTI. Regression analysis results showed drinking (odds ratio (OR) = 16.193, 95% confidence interval (CI): 1.017-257.860) and high preoperative C-reactive protein (CRP) level (OR = 3.237, 95% CI: 1.213-8.636) as risk factors for UTI after LIF. A high professional title of main surgeon (OR = 0.095, 95% CI: 0.010-0.932) and preoperative red blood cell (RBC) count (OR = 0.001, 95% CI: 0.000-0.198) were protective factors for UTI after LIF (p < 0.05). This study advocated strengthening the prevention and treatment of UTI in patients who had drinking history, high preoperative CRP level and low preoperative RBC count, and received LIF based on the study results. Attention should be paid to the training of physicians with low professional title.

Impact of Board Certified Psychiatric Pharmacists on improving urinary tract infection antibiotic appropriateness at an acute psychiatric hospital.

Urinary tract infections (UTIs) are one of the most common indications for antibiotic use; patients with psychiatric disorders have a greater risk for UTI compared with patients without these disorders. However, there is little guidance on how best to manage antibiotic therapy in psychiatric hospitals. This study assessed the impact of a Board Certified Psychiatric Pharmacist (BCPP)-driven guideline on managing UTI treatment in an acute psychiatric hospital. The guideline was developed by the psychiatric pharmacy team and distributed to internists, psychiatrists, and pharmacists. Preintervention data were assessed for patients admitted between November 30, 2019, and February 23, 2020; postintervention data were assessed from February 25, 2020, to April 24, 2020. All patients ages 13 years and older who were admitted and had orders for an antibiotic to treat a UTI were included in this study. Appropriate UTI management was defined as an appropriate agent, dose, route, and frequency per the treatment guideline. Additionally, the following criteria were to be ordered and assessed to be deemed appropriate: urinalysis, urine culture, complete blood count, basic or complete metabolic panel, temperature, and subjective symptoms. Before intervention, 19.0% of antibiotic orders were appropriate; after intervention, 46.7% of antibiotic orders were appropriate (P = .048). The implementation of a BCPP-driven treatment algorithm was associated with a significant increase in appropriate antibiotic regimens for the treatment of UTIs in patients admitted to a psychiatric hospital.

Magnitude, Associated Risk Factors, and Trend Comparisons of Urinary Tract Infection among Pregnant Women and Diabetic Patients: A Systematic Review and Meta-Analysis.

Urinary tract infection (UTI) remains the most common bacterial infection that affects millions of people around the world, especially pregnant women (PW) and people with diabetes mellitus (DM). This systematic review and meta-analysis was aimed at finding the pooled prevalence of UTI and its associated risk factors among PW and DM patients. Scientific articles written in English were recovered from PubMed, ScienceDirect, Web of Science, Google Scholar, Cochrane Library, Google Engine, and University Library Databases. "Prevalence," "urinary tract infection," "associated factors," "pregnant women," "diabetic patients," and "Ethiopia" were search terms used for this study. For critical appraisal, PRISMA-2009 was applied. Heterogeneity and publication bias were evaluated using Cochran's Q, inverse variance (I2), and funnel plot asymmetry tests. A random effect model was used to calculate the pooled prevalence of UTI and its associated factors among both patients, along with the parallel odds ratio (OR) and 95% confidence interval (CI). For this meta-analysis, a total of 7271 participants were included in the 25 eligible studies. The pooled prevalence of UTI in Ethiopia among both patients was 14.50% (95% CI: 13.02, 15.97), of which 14.21% (95% CI: 12.18, 16.25) and 14.75% (95% CI: 12.58, 16.92) were cases of DM and PW, respectively. According to the subgroup analysis, the highest prevalence was observed in the Oromia region (19.84%) and in studies conducted from 2018 to 2022 (14.68%). Being female (AOR: 0.88, and 95% CI: 0.11, 1.65, P = 0.01) and having an income level ≤ 500ETB (AOR: 4.46, and 95% CI: -1.19, 10.12, P = 0.03) were risk factors significantly associated with UTI among patients with DM and PW, respectively. Furthermore, a history of catheterization (AOR = 5.58 and 95% CI: 1.35, 9.81, P < 0.01), urinary tract infection (AOR: 3.52, and 95% CI: 1.96, 5.08, P < 0.01), and symptomatic patients (AOR: 2.32, and 95% CI: 0.57, 4.06, P < 0.01) were significantly associated with UTI in both patients. Early diagnosis and appropriate medication are necessary for the treatment of UTI in patients with DM and PW.

P25 An opportunity for antimicrobial stewardship? Assessing the diagnosis and treatment of lower urinary tract infections among inpatients aged 65 and older in a large English teaching hospital

BackgroundBetween 2015 and 2019 the rate of bacteraemias reported in the UK increased by 16.9% along with an increase of 32.5% of resistant organisms associated with bloodstream infections. This increase appears to be driven by a high number of Gram-negative bloodstream infections (GNBSI). There were 312 GNBSI within Leeds Teaching Hospital NHS Trust (LTHT) for the financial year (FY) of 2019–20 and 275 in FY 2020–21. Escherichia coli has been identified as the most common Gram-negative organism associated with bacteraemias. Urinary tract infections (UTIs) have been consistently highlighted as a primary source of E. coli infections, alongside other Gram-negative infections, therefore justifying a review of practice within LTHT regarding diagnosis and treatment of UTI in patients over the age of 65. This quality improvement work aimed to build on the foundations laid by NHS England's Commissioning for Quality and Innovations (CQUIN) scheme 2019–20, which had a focus on the treatment of UTIs in patients over the age of 65. This interventional prospective project was carried out to assess the impact of an antimicrobial stewardship (AMS) pharmacist-led review of patients prescribed antimicrobial treatment for UTIS.ObjectivesTo assess the impact of a pharmacist led clinical review of the diagnosis and treatment of UTIs in patients over the age of 65.StandardsEighty percent compliance was expected in the following standards: (i) patients having symptoms of a UTI documented in their clinical notes; (ii) a urine dipstick is not used as part pf the diagnosis pathway; (iii) have a had a midstream urine sample sent; and (iv) if appropriate, an antibiotic prescribed that complies with NICE/Trust guidelines.MethodsA prospective study of 87 inpatients prescribed antimicrobials for lower UTI (LUTI) was conducted from September 2020 to November 2020. The study aimed to evaluate if LUTI was diagnosed in accordance with PHE guidance, treated as per Trust guidelines and the impact an AMS pharmacist interventions had on treatment. Patients were identified using a daily antimicrobial list; searching and filtering based on indication for antimicrobial prescribed. Online medical notes were reviewed for information relating to the standards, where no information could be found wards were contacted with recommendations or further questions. If a patient was identified as requiring an intervention, for example a change of treatment, this was communicated with the ward team by an appropriate route as well as documenting in the medical notes. Inclusion criteria: >65 years old, prescribed an antibiotic for the treatment of LUTI or catheter associated UTI. Exclusion criteria: <65 years old, complicated UTI, upper UTI, urosepsis.ResultsEighty-seven patients were audited against the criteria: documentation of UTI symptoms = 74%; urine dipstick was not used to diagnose UTI = 69%; urine sample requested = 82%; appropriate antimicrobial was prescribed = 76% (Figures 1 and 2). As a treatment pathway 32% (28 patients) met all four criteria required to accomplish compliance to the diagnosis and treatment of LUTI. Of the 24% of antimicrobial prescriptions deemed inappropriate common themes included: not prescribing appropriate first line antibiotic; no clear indication for antibiotics; resistant to antibiotic prescribed; and inappropriate IV antibiotic prescribing (Figure 3). After an AMS pharmacist contacted the clinical teams to discuss the 24% of inappropriate antimicrobials it resulted in 92% of the antimicrobials being amended to appropriate antimicrobial choices. Increasing appropriate antimicrobials prescribed from 76% to 99%.Figure 1.Graph showing the percentage of datasets meeting the standard.Figure 2.Pie chart showing the percentage of inappropriate versus appropriate antimicrobial prescriptions.Figure 3.Bar chart showing the number of inappropriate antimicrobials and the reasons associated with them being inappropriate.ConclusionsThe results show that whilst most patients met some of the criteria expected to diagnose a LUTI, most did not meet all four. This warrants further quality improvement work to improve the recognition and adherence of the diagnosis and treatment of LUTIs with the aim to embed the processes across all age groups. The interventions of an AMS pharmacist positively impacted the prescribing of antimicrobials in LUTI and appears to be significant, particularly with regards to stopping inappropriate antimicrobials and recommending better treatment choices. These decisions included: promoting oral antibiotics instead of IV; recommending effective treatment based on renal impairment; acting on urine culture sensitivities; and choosing more narrow spectrum antibiotics. This provides a new potential tool for targeted AMS in relation to the treatment of LUTI within a large scale teaching hospital.

Cost-minimization analysis of drugs used for empirical treatment of urinary tract infection in a tertiary care hospital

Background: Urinary tract infections (UTIs) are one of the commonly encountered infections and a large number of drugs are indicated in UTI ranging from oral conventional drugs to most advanced injectable drugs. Cost-minimization analysis (CMA) is employed to project the least costly drug when two treatments are shown to be therapeutic equivalents. Aims and Objectives: This study aims to perform a CMA at a tertiary care center to determine the least expensive drug for UTI and to project a cheapest alternative from available options based on the results of CMA. Materials and Methods: This was a cross-sectional study conducted over duration of 3 months in the clinical departments on patients diagnosed to have UTI and prescribed empirical antimicrobial treatment. The approval of Institutional Ethics Committee was sought before beginning the study. Pattern of drug prescription and average cost incurred in the treatment of patients with empirical antimicrobial therapy was calculated. CMA included the projection of the least expensive drug based on average cost incurred per patient in outpatients and inpatients respectively. Results: A total of 59 patients of UTI given empirical treatment were included in the study. Fluoroquinolones and cephalosporins were commonly used drugs for empirical treatment of UTI. Nitrofurantoin (average cost of 11–14 Rs. per patient) can be projected as the cheapest drug for empirical treatment of UTI on outpatient basis as well as a drug to supplement injectables in indoor patients. Injectable ciprofloxacin can be projected as the most inexpensive alternative for empirical treatment of UTI in patients of the inpatient department. Conclusion: Nitrofurantoin for oral treatment and ciprofloxacin in injectable form are cheapest among available alternatives for empirical treatment of UTI. To prevent treatment failures and increase in cost of treatment, correlation of results of CMA with local antimicrobial sensitivity pattern is important.

TRATAMIENTO DE LA INFECCIÓN DEL TRACTO URINARIO EN PACIENTES CON DIABETES E INSUFICIENCIA RENAL

El tratamiento de la infección del tracto urinario (ITU) en pacientes con diabetes mellitus (DM) depende de factores como la presencia de síntomas, de anormalidades urológicas, el nivel anatómico, la severidad de la ITU y la función renal.Como regla general el tratamiento de la ITU en pacientes con DM es similar al tratamiento de los pacientes sin DM. La elección del antibiótico deberá guiarse, además de las características del paciente, por los patrones de resistencia local a los uropatógenos. No existe indicación para tratar la bacteriuria asintomática en el paciente con diabetes.

Treatment of Complicated Urinary Tract Infections in Individuals with Chronic Neurogenic Lower Urinary Tract Dysfunction: Are Antibiotics Mandatory?

Introduction: Urinary tract infections (UTI) in patients with neurogenic lower urinary tract dysfunction (NLUTD) are defined as complicated UTI requiring antibiotic treatment. As the emergence of multiresistant strains is a serious problem, we assessed the feasibility of nonantibiotic treatment of UTI in patients with NLUTD. Materials and Methods: In a prospective study evaluating the usefulness of UTI prophylaxis, participants could opt for either antibiotic or nonantibiotic treatment of breakthrough UTI. If either symptoms persisted for 48 h or a febrile UTI occurred, antibiotic treatment based on microbiological testing was mandatory. Treatment efficacy, complications, and emergency hospital visits were assessed. Results: Within the observation period (1 year), the 25 participants developed 206 UTI. Seven febrile UTI required immediate antibiotic treatment. Of the remaining 199 UTI, patients chose antibiotic treatment in 104 events, whereas in 95 events, patients chose either nonantibiotic interventions (n = 80) or no treatment at all (n = 15). Success rates were 78.8% for antibiotic treatment, 67.5% with nonantibiotic treatments, and 26% without therapy. Of the 7 patients with initially febrile UTI, 2 required hospitalization due to septicemia. Conclusions: Nonantibiotic treatment seems to be a feasible alternative to antibiotic therapy in patients with complicated UTI as well, provided there is no fever.

Evaluation of Urinary Tract Infection in Children With Gastroenteritis

Background: Urinary tract infection (UTI) is the second most common bacterial infection in infancy and childhood with peaking in infancy and toilet training. Objectives: The current study aimed to investigate UTI in patients with diarrhea. Patients and Methods: This case-control study was conducted on 200 participants, 100 were patients with acute gastroenteritis and the other 100 were controls who referred to the clinic for routine checkup. UTI was defined as two positive urine cultures with > 10 5 cfu/mL. If white blood cells were more than 10/mm 3 in un-centrifuged urine it would be considered pyuria and more than one microorganism in 10 oil immersion fields as bacteriuria. Analysis was conducted using SPSS ver. 16 with application of chi-square test and 0.05 as significant levels. Results: The distribution of these 200 children were 115 (57.5%) and 85 (42.5%) for females and males respectively. The gender and age distribution in case and control groups showed non-significant association. In urine culture it was observed that 27 individuals were positive and there were seven healthy children. The number of children with positive urine culture was higher than that of their counterparts significantly (P = 0.0001). Relationship between urine culture and age groups showed that the number of participants with positive urine culture was higher in children with age of two months to two years but it was not significant (P = 0.54). Conclusions: It was demonstrated that, considerable percentage of UTI existed in the gastroenteritis diseases. Early treatment of UTI in patients would reduce UTI complications.

Treatment for Urinary Tract Infection After Midurethral Sling

This is a retrospective cohort study comparing the risk of treatment for postoperative urinary tract infection (UTI) in patients who receive short-term postoperative catheterization versus those who pass a void trial on the day of surgery after midurethral sling with or without concomitant pelvic surgery. We compared two cohorts to determine our primary outcome: treatment for UTI, culture proven or empiric, within three weeks after surgery. 138 patients, were included in the study of which 80 (58%) received postoperative catheterization. The baseline characteristics of the catheterized and noncatheterized groups were similar except that the catheterized group had a lower mean body mass index (28 ± 5 vs 30 ± 5 kg/m(2); P = 0.01), were more likely to have undergone concomitant pelvic surgery (51% vs 20%; P < 0.01), had higher estimated blood loss (92 ± 87 vs 47 ± 49 mL; P < 0.01), and had longer operative times (108 ± 75 vs 62 ± 47 min; P < 0.01). Overall, 19.6% of the patients received treatment for UTI. Patients in the catheterized group were more likely to receive treatment for UTI (24/80 [30%] catheterized vs 3/58 [5%] noncatheterized; P < 0.01). This significant difference in treatment for UTI persisted when examining patients who underwent midurethral sling only without concomitant pelvic surgery (6/29 [20.7%] catheterized vs 1/38 [2.6%] noncatheterized; P = 0.04). In a logistic regression model adjusting for age, body mass index, concomitant surgery, and postoperative catheterization, only postoperative catheterization remained significantly associated with treatment for UTI (OR, 6.6; 95% confidence interval, 1.8-24.5; P < 0.01). Treatment for postoperative UTI is significantly higher in patients who receive short-term postoperative catheterization after midurethral sling with or without concomitant pelvic surgery.

Treatment of urinary tract infection in persons with spinal cord injury: guidelines, evidence, and clinical practice

Objectives: To investigate current clinical practice in the treatment of urinary tract infections (UTIs) in persons with spinal cord injury (SCI) in SCI centers where German is spoken and to compare it with current guidelines and evidence-based standards evaluated by a literature review.Methods: A standardized questionnaire was mailed to 16 SCI rehabilitation centers. The results were compared with a literature reviewResults: Of the 16 centers, 13 responded. Indications for UTI treatment, medications, and treatment duration differed substantially among the individual centers and from the existing guidelines. Antibiotic treatment is regarded as the method of choice. Compared with the existing literature, patients in two center were undertreated, whereas they were overtreated in seven centers.Conclusion: Even in specialized centers, treatment of UTI in patients with SCI is based more on personal experience of the treating physicians than on published evidence. This may at least partly be due to the paucity of evidence-based data. The observed tendency toward overtreatment with antibiotics carries substantial future risks, as this strategy may well lead to the induction of multiresistant bacterial strains. Therefore, developing guidelines would be an important step toward a unification of the different treatment strategies, thus reducing unnecessary antibiotic treatment. Furthermore, evidence-based studies evaluating the success of antibiotic treatment as well as the usefulness of alternative strategies are urgently needed.

Management of bacterial urinary tract infections in adult patients with diabetes mellitus.

Urinary tract infections (UTIs) are more common and tend to have a more complicated course in patients with diabetes mellitus than in the general population. The mechanisms that potentially contribute to the increased prevalence of both asymptomatic and symptomatic bacteriuria in these patients are defects in the local urinary cytokine secretions and an increased adherence of the microorganisms to the uroepithelial cells. The need for treatment of asymptomatic bacteriuria remains controversial. No evidence is available on the optimal treatment of acute cystitis and pyelonephritis in patients with diabetes. Because of the frequent (asymptomatic) upper tract involvement and the possible serious complications, many experts recommend a 7- to 14-day oral antibacterial regimen for bacterial cystitis in these patients, with an antibacterial agent that achieves high concentrations both in the urine and in urinary tract tissues. The recommended treatment of acute pyelonephritis does not differ from that in patients without diabetes. Clinical trials specifically dealing with the treatment of UTIs in patients with diabetes, comparing the optimal duration and choice of antibacterial agent, are needed. In addition, new approaches to preventive strategies must prove their value in this specific patient group.

Fluconazole dose recommendation in urinary tract infection.

To identify the most appropriate dose of fluconazole for the treatment of symptomatic fungal urinary tract infection (UTI). Primary literature identified through MEDLINE (1990-June 2000). Key search terms included fluconazole and urinary tract infection. Fluconazole is approved for the treatment of candidal UTIs, but dosage recommendations are not consistent. An evaluation of clinical studies of fluconazole for the treatment of candidal UTI was performed. Questions remain about the optimal dosing of fluconazole, including the most appropriate dose in non-albicans species of candida as well as the optimal duration of therapy. Until further studies are performed, a fluconazole 200-mg loading dose followed by 100 mg/d for at least four days appears to be the most appropriate dose for the treatment of symptomatic candidal UTI in patients without systemic fungal infection or severe renal failure.

Comparative Studies of Fluoroquinolones in the Treatment of Urinary Tract Infections

The results of comparative trials of fluoroquinolones for the treatment of uncomplicated and complicated urinary tract infections (UTI) were reviewed. Several randomized, comparative trials showed that in uncomplicated UTI norfloxacin, ciprofloxacin, and ofloxacin were at least as effective as trimethoprim-sulfamethoxazole (TMP-SMZ) and amoxicillin and usually more effective than nalidixic acid, pipemidic acid, and nitrofurantoin. Comparative trials of single-dose regimens have, however, been limited. A few randomized, comparative trials have shown that in complicated UTI norfloxacin, ciprofloxacin, and ofloxacin were at least as effective as amoxicillin and TMP-SMZ and usually more effective than pipemidic acid. Moreover, preliminary results indicate that fluoroquinolones might be effective for the oral treatment of complicated UTI that are difficult to treat, especially those due to Pseudomonas aeruginosa. Comparative trials are needed to establish the value of fluoroquinolones for chronic bacterial prostatitis. There are no conclusive data on fluoroquinolone treatment of UTI in patients with renal failure. Emergence of resistant pathogens during therapy with fluoroquinolones has been infrequent but might be more frequent in complicated UTI caused by P aeruginosa.