Urinary Catheter Research Articles

Impact of urinary catheters including reusable catheters on quality of life and work productivity in persons with spinal cord lesion

While preventing renal damage and symptomatic urinary tract infection are of paramount importance to persons with a spinal cord lesion (SCL), patient-reported outcomes (PROs) are receiving much more attention than ever before. We performed a cross-sectional internet survey of 282 adult members of SCL patient advocacy groups and investigated, for the first time, the impact of different types of urinary catheter, including a Japanese reusable silicone catheter and a reusable intermittent balloon catheter, on PROs of persons with SCL. Intermittent self-catheterization (ISC) did not surpass continuous indwelling catheterization in terms of a disease-specific urinary quality of life. Urinary incontinence, regular ISC, and performing ISC away from home confronted these individuals. Work productivity and regular activities correlated fairly well with the disease-specific urinary quality of life. Bowel management problems affected all PROs evaluated. The absence of differences in PROs among the types of catheter used for ISC implies that Japanese reusable catheters have the potential to benefit selected persons with SCL. Further research is warranted to develop measures for maximizing work productivity by overcoming urinary as well as bowel problems.

Effectiveness of Nurse-Driven Protocols in Reducing Catheter-Associated Urinary Tract Infections: A Systematic Review and Meta-Analysis.

Catheter-associated urinary tract infections (CAUTIs) are common health care-associated infections linked to indwelling urinary catheters. Nurse-driven protocols (NDPs) empower nurses to direct care without physician orders, potentially enhancing patient outcomes and reducing infection rates. This systematic review and meta-analysis aimed to evaluate the effectiveness of NDPs for preventing CAUTIs and reducing catheter utilization rates. Databases searched included Cochrane Library, PubMed, Embase, and others. Ten studies involving 27, 965 NDP-treated patients and 30, 230 controls were reviewed, examining catheter utilization rates and CAUTI incidence. Use of NDPs significantly lowered catheter utilization rates (34.84% vs 49.40%) and CAUTI incidence (2.867% vs 6.503%). Risk ratio analysis revealed a 29.48% decrease in catheter utilization and a 55.91% reduced CAUTI risk with NDP implementation. Using NDPs demonstrate superior efficacy in reducing catheter use and CAUTI occurrence compared to traditional methods. Further research is warranted to solidify evidence-based nursing practices in this area.

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 ERAS protocol adherence and postoperative outcomes after major colorectal surgery in a community hospital

Despite widespread adoption, the efficacy of Enhanced Recovery After Surgery (ERAS) protocols in community hospital settings remains understudied. This retrospective analysis conducted at a high-volume community hospital aimed to evaluate adherence to ERAS protocols and analyze postoperative outcomes following colorectal surgery. A total of 278 adult patients undergoing elective colorectal surgery between January 2022 and January 2024 were included. Data analysis revealed time to first mobilization proved to be satisfactory in accordance with ERAS hospital guidelines (mean 1.0 ​± ​0.05 days, range 0.1–13.8 days), and furthermore demonstrated a strong positive correlation with both time to first bowel function (r ​= ​0.69, p ​< ​0.0001) and length of stay (r ​= ​0.25, p ​< ​0.0001). Time to urinary catheter removal occurred slightly after guideline-directed removal (mean 1.1 ​± ​0.05 days, range 0.5–12.9 days), however did exhibit a significant positive correlation with length of stay (r ​= ​0.33, p ​< ​0.0001). 10.9 ​% of patients experienced a postoperative complication, while the average length of stay across all procedures was 3.1 ​± ​0.17 days (range 0.9–23.3 days), and the overall 30-day readmission rate stood at 10.43 ​%. This study underscores the need for ongoing evaluation and refinement of ERAS protocols in community hospital settings to enhance surgical care and patient satisfaction.

Urethral Catheterization as a cause of Kidney Failure after Successfully Treated Hemolytic Uremic Syndrome.

Urethral Catheterization as a cause of Kidney Failure after Successfully Treated Hemolytic Uremic Syndrome.

Routine Use of Indwelling Urinary Catheters During Endovascular Abdominal Aortic Aneurysm Repair is Not Necessary.

Endovascular infra-renal abdominal aortic aneurysm repair (EVAR) has proven to be an effective, less invasive alternative to open aortic aneurysm repair with decreased 30-day mortality. Historically, urinary drainage catheters were routinely placed preoperatively before EVAR in our institution. A shift to reduced catheter placement has occurred in conjunction with percutaneous EVARs becoming more routine. Urethral catheterization carries risk of infection (UTI), urinary retention and prostatic trauma inducing hematuria. The purpose of this study was to evaluate whether avoidance of urinary catheter placement during EVAR is an effective practice to reduce cost and morbidity. This was a single-institution, retrospective review of 177 consecutive patients who underwent elective infrarenal EVAR. Ruptured aneurysms and emergent EVAR were excluded. The study end points were postoperative UTI, urinary retention, length of stay, and readmission within 30 days. Univariable analysis was performed for these four outcomes in patients with (N = 92 and without (N = 65) preoperative urinary catheter placement. A more expansive multivariable investigation for risk of urinary retention following EVAR was conducted with binary logistic regression with co-variates including age, sex, femoral cutdown, estimated blood loss (EBL), urinary catheter, congestive heart failure, diabetes, and postoperative urinary retention as co-variates. Patients who had a Urinary catheter placed had an over two fold higher event rate of urinary retention (10.9% vs 4.6%) This urinary retention trend lacked power to reach significance (OR 2.52 (.665-9.55). Placement of urinary catheter also had a strong trend towards increased rate of UTI but lacking power for significance (7.6% vs 3.10%, OR 1.96 (.556-6.57). There was no difference with or without urinary catheter placement regarding 30-day readmission (yes catheter 7.6% vs no catheter 6.2%, P = .725), or length of stay (yes catheter 2.13 days vs no catheter 1.74 days, P = .723). Urinary retention was significantly associated with the development of a UTI with 23% of patients who had retention developing UTI compared with 4.2% of patients without retention developing UTI (adjusted odds ratio = 17.98, P = .019). Increased blood loss (P = .027) was also associated with increased rate of UTI on multivariable analysis. Avoidance of preoperative urinary catheter placement displays a trend towards avoiding urinary retention and UTI. Patients who develop post EVAR urinary retention experience a significantly increased rate of UTI. Selective urinary catheter placement should be used to help reduce urinary-related complications following elective EVAR.

Signaling Molecules in Pseudomonas aeruginosa Response to Antibiotics at Sub-Inhibitory Concentrations

Signaling Molecules are N-acylhomoserine lactones (AHLs) that form the Pseudomonas aeruginosa cell information system which determines gene expressions in a population dependent manner called quorum sensing (QS). Signal molecules, which are chemically varied, control genes expressions to antibiotics resistance, pathogenicity, motility, biofilm development, bioluminescence, secondary metabolite production, and plasmid transfer. This research was aimed to identify the signaling molecules in Pseudomonas aeruginosa response to antibiotics at sub-inhibitory concentrations. One hundred and fifty (150) clinical swab specimens were collected from urinary catheter wound and ear infection of patients and the swabs inoculated using standard microbiology method. The isolates were characterized based on the bacteriological methods such as morphology and biochemical tests. The isolates were further confirmed by species specific PCR by amplification of 16S rRNA and the amplicons were analyzed by gel electrophoresis; and further genomic sequencing was done and blast with NCBI database mining. Disc diffusion method was applied for the antibiotics susceptibility pattern. The isolates cell suspensions were analyzed by Gas Chromatography-Mass Spectrometry (GC-MS). The result of the isolation showed 22(59.46%) from wound infections, 12(32.43%) from ear infections and 3(8.11%) from urinary catheter. The isolates were Gram negative, produced β-hemolysis on blood agar and the morphology is small pigmented circular in form. The isolates showed positive result to catalase, oxidase, citrate, nitrate and indole tests. The amplification of 16S rRNA gene region resulted in the band size of 1500bp PCR product and the BLAST analysis gave 99% similarity. The resistant antibiotics susceptibility showed that Pseudomonas aeruginosa is multidrug resistant bacteria. The GC-MS results obtained from urinary catheter isolates showed four (4) signaling molecules such as N-Octanoyl-L-homoserine Lactone, N-Decanoyl-DL-Homoserine Lactone, N-Dodecanoyl-DL-Homoserine Lactone and N-Tetradecanoyl-L-Homoserine Lactone. Three (3) signaling molecules such as N-Octanoyl-L-homoserine Lactone, N-Decanoyl-DL-Homoserine Lactone and N-Tetradecanoyl-L-Homoserine Lactone were obtained from wound isolates. N-Tetradecanoyl-L-Homoserine Lactone was the only signaling molecule obtained from ear isolates. Further research should be done to develop rapid tests that could be possible to detect acyl homoserine specific to Pseudomonsa aeruginosa present to human samples and deliver results in real time. Signaling molecules inhibitors (SMI) are possible potential therapeutics that could produce the subsequent class of antibacterial drugs. The fundamental role of each signal molecule in the production of biofilms and virulent factors should also be investigated, as well as whether Pseudomonas aeruginosa needs one or more signaling molecules to form quorum sensing. Identification of the signals molecules (AHLs) of P. aeruginosa and developing signaling molecules inhibitors (SMI) can have an important prognostic, diagnostic and therapeutic value in human medicine for the treatment of P. aeruginosa infections.

Sperm collection in the domestic cat: A comparison of two techniques

Semen collection in cats in the clinic setting can be difficult. However, semen analysis is vital when evaluating breeding soundness of a male. Electroejaculation (EEJ) is currently the most reliable semen collection method but requires specialized equipment and training of the operator. Chemical ejaculation followed by urethral catheterization (UC) is a technique that allows semen collection without special equipment: a catheter is placed into the urethra of a sedated tom and semen is collected passively into the catheter. Earlier studies used the sedative medetomidine at high doses for this procedure. However, medetomidine has been replaced with dexmedetomidine in some countries. This study sought to compare the results of EEJ and UC for semen collection in the domestic cat using dexmedetomidine, a potent α2-adrenoceptor agonist (α2A), as a substitute for medetomidine at the equivalent dose to that used in earlier studies. Twelve domestic cats were collected thrice at weekly intervals. All cats received intramuscular ketamine (5 mg/kg) and intramuscular dexmedetomidine (30 μg/kg) for initial cleanout via EEJ, then randomly underwent either EEJ or UC one week apart. The EEJ was performed under the same anesthetic protocol as the initial cleanout. The UC was performed using intramuscular dexmedetomidine at a dose of 60 μg/kg. Success of collection, total sperm number, sperm morphology, and motility characteristics were analyzed. Sperm was collected successfully from all 12 cats via EEJ and from 11/12 via UC. There were no significant differences in the percentage of total motile, progressively motile, or morphologically normal sperm between ejaculate types when averaged across all cats or individual cats. Although UC yielded a lower volume and higher concentration ejaculate, it consistently produced a lower total sperm number than ejaculates retrieved via EEJ (17.91 x 106 total sperm for UC versus 46.51 x 106 total sperm for EEJ). These results indicated that dexmedetomidine is a very effective sedative and performed satisfactorily in both procedures at the doses used in this study. It was also safe with no adverse effects on healthy toms. EEJ remained the most reliable in terms of assessing semen quality and retrieving semen with adequate number of sperm for breeding purposes. However, UC with dexmedetomidine at this dose demonstrated a 92 % success rate, presenting itself as a remarkably consistent alternative.

At a glance: urinary catheterisation in males and females.

Urinary catheterisation is a crucial procedure in healthcare, requiring a thorough understanding of the anatomical and physiological differences between males and females to ensure safe and effective care. This guide explores the anatomy of the urinary system, detailing the kidneys, ureters, bladder, and urethra, and highlights key differences in catheterisation techniques for men and women. Emphasising evidence-based practices, it discusses recent advancements, such as antimicrobial catheters, and underscores the importance of comprehensive training and competency assessments for healthcare providers. Additionally, the guide advocates for patient-centred approaches, multidisciplinary collaboration, and adherence to updated policies to reduce complications such as catheter-associated urinary tract infections (CAUTIs). By integrating these critical evaluations and best practices, health professionals can enhance patient outcomes and maintain high standards of care in urinary catheterisation.

Characterizing the urobiome in geriatric males with chronic indwelling urinary catheters: an exploratory longitudinal study.

The impact of chronic indwelling urinary catheters (IUCs) on the composition and stability of the urinary microbiota remains unknown. The primary aim of this study was to describe the urinary microbiomes of geriatric males with chronic IUCs. A secondary aim was to explore clinical catheter-associated urinary tract infection (CAUTI) courses of the participants. Geriatric male patients with chronic IUCs were followed longitudinally. Catheterized urine, catheter tips, and both urethral and periurethral swabs were collected from participants at monthly intervals. Microbes were isolated and identified from each specimen using an enhanced culture method called expanded quantitative urine culture (EQUC) and targeted 16S rRNA gene DNA sequencing. Microbial outcomes were examined both in the absence of urinary symptoms and in the context of clinical diagnosis of CAUTI. Ten male participants (mean age 86 years) were enrolled. Urinary microbiomes differed for each participant. However, within each individual, microbiomes were similar over time and across niches (bladder, catheter, urethra, and periurethra). Within-niche microbiomes differed across individuals, and this was observed over time. The most abundant bacteria isolated from all niches were known uropathogens. Six of 10 individuals met diagnostic criteria for CAUTI at least once during the 12-month observation period, but no evidence of this or antibiotic treatment/response was discernable in our monthly samples. The microbiomes of each participant were unique and remained similar over time and across niches. Longitudinal EQUC or 16S rRNA gene sequencing data could be useful to clinicians when diagnosing or treating possible CAUTI.IMPORTANCECatheter-associated urinary tract infections (CAUTIs) are serious but preventable nosocomial infections. The most common risk factor for developing CAUTI is prolonged use of indwelling urinary catheters (IUCs). This study provides the first longitudinal description of the urinary microbiomes of geriatric males with chronic IUCs, in the absence of urinary signs and symptoms, as a first step toward enhancing our knowledge of the impact of chronic IUCs on the composition and stability of the urinary microbiota. This is an understudied area, particularly for males.

Decision-making around removal of indwelling urinary catheters after pituitary surgery.

Diabetes insipidus (DI) is a common complication following pituitary surgery, causing significant health issues if left untreated. As part of the diagnostic process, accurate urinary output monitoring via indwelling urinary catheters (IDUCs) is essential, despite risks such as urinary tract infections and hindered recovery. Research on IDUC removal after pituitary surgery remains scarce. To explore health professionals' perspectives on IDUC management following pituitary surgery. Employing a qualitative design, semistructured interviews were conducted with 15 professionals in the neurosurgical ward of a Dutch academic hospital. Four themes emerged: Concerns about missing identifying DI, patient-nurse dynamics, workload management, and lack of shared decision making. The findings underscore the need to balance clinical needs with patient care efficiency. There is a need for evidence-based guidelines and a multidisciplinary approach to optimise IDUC management, given the importance of patient-centred care and shared decision-making.

Does the suturing technique (barbed continuous versus conventional interrupted) impact the outcome of anastomotic urethroplasty?

To evaluate and compare continuous suture (CS) and interrupted suture (IS) techniques applied in excision and primary anastomosis (EPA) urethroplasty in terms of surgical success and complication rates. A retrospective evaluation was conducted on patients with bulbar urethral strictures measuring ≤ 2.5cm who underwent EPA between April 2020 and December 2022. Patients with a history of urethral reconstruction, multiple strictures, a history of pelvic radiotherapy, a diagnosis of Lichen sclerosis, a history of surgery due to congenital penile curvature or Peyronie's disease, and a follow-up period of less than 12months were excluded. The patients were divided into two groups according to the suture technique used (CS or IS), and the groups were compared for demographic and perioperative data. A total of 97 patients (CS n = 52, IS n = 55) were included in the sample. The mean age of the entire patient group was calculated to be 56.2years and the mean stricture length was 19.3mm. Operation time and postoperative catheter time were shorter in the CS group (94.7 ± 7.3 vs. 117.2 ± 5.7min and 9.9 ± 1.6 vs. 15.8 ± 1.9min, p < 0.001, respectively). The groups were similar regarding anatomical success, stress urinary incontinence, penile numbness, curvature, and postoperative infection (p > 0.05). No significant difference was observed in terms of success or complications between the CS and IS techniques employed during EPA urethroplasty. However, in addition to reducing the operation time, the CS technique offers the advantage of safely removing the urethral catheter earlier.

“Close-loop Urethral Stricture:" A Variant of Multiple Urethral Stricture Disease - Its Description, Management and Outcome: A Case Report

Abstract Urethral stricture disease is an abnormal narrowing and loss of distensibility of the urethra due to spongiofibrosis. It is commoner in young adult males. The management of this condition is diverse with various factors influencing the choice of treatment. However, length of the stricture is a major determinant of the choice of treatment. Two or more stricture sites close together are also treated as long segment stricture. Our aim is to describe a variant of multiple urethral strictures consisting of two short segment complete strictures involving the proximal bulbar urethral and urethral meatus with intervening significant length of normal urethra "close-loop stricture" in a 46-year old man who had traumatic urethral catheterization and was referred to the urology clinic six months following suprapubic tube cystostomy. KeywordsStricture, Meatotomy, Urethroplasty, Catheterization, Bouginage

Factors related to the use of physical restraints and hand restraints among older adults receiving home care services.

Physical restraints and hand restraints are used in medical settings to provide protection and control. However, few studies have investigated their use among community-dwelling older adults. The study explored variables associated with the use of physical restraints and hand restraints among older adults receiving home care services and the reasons behind their use. This cross-sectional study recruited 128 older adults receiving home care services and with catheters. Data were collected regarding demographic characteristics; activities of daily living (ADLs); muscle strength; family function; the use of nasogastric tubes, urinary catheters, and tracheal tubes; and the type and duration of restraint use and the reasons behind such use. Among the participants, 76% experienced the use of physical restraints, and 34% experienced the use of hand restraints. The variables related to physical restraints were ADLs (adjusted odds ratio [AOR] = 0.95, p = .02) and the presence of a paid caregiver (AOR = 3.33, p = .02). The variables related to hand restraints were ADLs (AOR = 0.93, p = .03), use of a nasogastric tube (AOR = 13.46, p = .03) and the presence of a paid caregiver (AOR = 6.38, p = .02). The primary reasons behind restraint use were to prevent fall and extubation events. The use of physical restraints among older adults with catheters may be affected by their functioning in ADLs and the presence of paid caregivers to ensure their safety. Thus, implementing interventions that target functional capabilities and caregiving skills may help reduce the use of restraints.

Investigating the Anti-Biofilm Ability of Synergistic Drug Coated Urinary Catheters: In vitro Study

Investigating the Anti-Biofilm Ability of Synergistic Drug Coated Urinary Catheters: In vitro Study

Adherence to Evidence-Based Guidelines and ImplicationsWhen Designing Electronic Documentation for Urinary Catheters.

The aim of this study was to investigate the point prevalence and the rate of adherence to evidence-based guidelines for patients who had indwelling urinary catheters in three Australian acute care hospitals. A cross-sectional observational design was used. A multisite cross-sectional observational design was utilised in three acute hospitals across Australia. Data were collected from each site in a single day directly from observation of the patient, the bedside notes and medical records. The data collected included observations of clinical care and scrutiny of the documentation of the insertion details and catheter care using best practice guidelines. Of the 1730 patients audited, 47% were female. The mean point prevalence of catheters insitu across three sites was 12.9%. Correct documentation compliance was reported to be, on average, 40%. Documentation was significantly better when a template was available to guide information recorded: this was regardless of whether it was hard copy or electronic. Overall, clinical care compliance with best practices was 77%. Of note for improvement was the fixing of the urinary catheter to the thigh in highly dependent patients. It was identified that there is a need for improvement across all three sites: specifically regarding securement of the urinary catheter to the patient's thigh within the ICU. In addition, it was identified that there is a need for documentation of the urine bag change in ward areas. Documentation may be improved by incorporating templates into healthcare documentation systems in the future. Further work is needed to ensure nurses are aware of the adverse effects of urinary catheters and thus, the need to adhere to best practice guidelines. There has been no patient or public contribution. We have adhered to the STROBE guidelines for reporting.

Current perioperative care in patients undergoing a beyond total mesorectal excision procedure for rectal cancer: What are the differences with the colorectal enhanced recovery after surgery protocol?

Patients requiring a beyond total mesorectal excision (bTME) procedure for locally advanced rectal cancer (LARC) and locally recurrent rectal cancer (LRRC) will probably benefit from enhanced recovery after surgery (ERAS) protocols. However, implementation of ERAS protocols in such groups of patients is considered challenging. The aims of this study were to evaluate ERAS-related outcomes of patients with LARC or LRRC undergoing bTME and to investigate the possibility of designing a tailored ERAS protocol. This study was divided into four phases. Phase one consisted of a literature study to compare functional recovery and postoperative outcomes in patients undergoing bTME. In phase two, outcomes on ERAS care elements in bTME were retrospectively evaluated. In phase three, differences in ERAS-related outcomes and compliance of the colorectal ERAS protocol in patients who had undergone bTME were studied. In phase four, multidisciplinary team meetings were held to develop an ERAS protocol for bTME patients. Seven studies reported on ERAS-related outcomes in patients undergoing bTME. Median length of hospital stay was 9-19 days, median stay in the intensive care unit was 2-4 days and 30-day postoperative major complication rates were 22.6%-61.3%. Seventy-five bTME patients were included for retrospective analysis. In these patients, length of stay was 9.0 days and major postoperative complications were observed in 40.0%. The overall ERAS compliance was 44.4%. Compared with the colorectal ERAS protocol, the largest differences in management were observed in the use of epidural anaesthesia, the postoperative use of urethral catheters, oral intake and mobilization. Patients undergoing bTME for LARC or LRRC are substantially different from patients treated with the colorectal ERAS protocol, regarding ERAS-related outcomes. A tailored, multimodal ERAS protocol with specific modifications was developed by an expert multidisciplinary team for patients undergoing bTME for LARC or LRRC.

Plasma procalcitonin and urine interleukin-8, neutrophil gelatinase–associated lipocalin, and calprotectin in the diagnostic process of a urinary tract infection at the emergency department

ObjectivesThis study aimed to assess the usefulness of plasma procalcitonin and urine IL-8 (interleukin-8), NGAL (neutrophil gelatinase–associated lipocalin), and calprotectin for diagnosis of urinary tract infections (UTIs) at the emergency department (ED). MethodsIn adults presenting at the ED with UTI suspicion, biomarker performance was compared with that of routine diagnostics (urine dipstick, automated urinalysis). Patients with a urine catheter, leukopenia, or neither (standard) were analyzed separately. ResultsA UTI was clinically diagnosed in 91 of 196 episodes (46.4%) (standard: 29/67 [43.2%]; catheter: 46/73 [63.0%]; leukopenia: 17/60 [28.3%]; four patients had both). Procalcitonin did not discriminate between UTI and no UTI. Urinary biomarker levels were elevated in UTI episodes (median, µg/mmol creatinine: NGAL, 7.8 vs 46.3; IL-8, 6.1 vs 76.6; calprotectin, 23.9 vs 265.4); the three subgroups also had higher levels. Biomarker cut-off values (90% sensitivity) showed low specificity (range 20.8-64.9%) and moderate accuracy (58.6-75.4%). The biomarkers performed similarly to routine diagnostics, except for patients with leukopenia, who exhibited nonsignificantly higher area under the curve values. All urinary biomarkers correlated positively with urine leukocyte count. ConclusionPlasma procalcitonin could not accurately diagnose UTI. Urine IL-8, NGAL, and calprotectin showed no additional value relative to routine diagnostics, except a minor improvement in patients with leukopenia. These urine biomarkers seem to predominantly reflect leukocyturia.

Identification of Burkholderia cepacia Complex: Comparing Conventional, Automated, and Molecular Methods in a Tertiary Care Center.

Introduction Burkholderia cepacia complex(BCC) is one of the most common polymyxin-resistant Gram-negative bacilli isolated in the clinical microbiological laboratory. They are often underreported when conventional biochemicals are used for identification, due to their similarity to other non-fermenting bacilli. It is essential to identify BCC using simple biochemical tests with good reliability to ease the identification of BCC in resource-limited settings and initiate treatment. Objectives We aim to identify isolates belonging to BCC from other non-fermentersusing simple conventional biochemical tests, automated methods, and polymerase chain reaction (PCR) and analyze antibiotic profiles and treatment outcomes in patients with BCC infection. Materials and methods All samples received at the clinical microbiology laboratory for bacterial culture from March 2023 to March 2024 were included in this study. Samples that grew non-lactose fermenting colonies on MacConkey agar, which were resistant to polymyxin B 300 (PB300) units, were further identified using conventional biochemicals, and lysine decarboxylase test, ornithine decarboxylase test, arginine dihydrolase test, ortho-nitrophenyl-β-galactoside (ONPG) test, urea hydrolysis, triple disc screening test (polymyxin B 300 units, amoxicillin-clavulanic acid 20/10 mcg (AMC20/10), and gentamicin 10 mcg (GEN10)),VITEK MS (bioMérieux, Marcy-l'Etoile, France), VITEK 2 Gram-Negative (GN) Identification (ID) Card(bioMérieux), and PCR targeting groEL sequence was performed for Burkholderia isolates. The antibiotic susceptibility pattern was analyzed using VITEK AST (bioMérieux). Basic patient details were collected from the medical records. Results Using conventional biochemicals and automated methods, 60 isolates were identified belonging to the genus Burkholderia, among which 46 (76.6%) belonged to Burkholderia cepacia complex. The concordance for genus-level identification of Burkholderia with conventional biochemicals, VITEK MS, VITEK 2, and groEL PCRwas found to be 100%. Species-level identification using the listed conventional biochemicals was 28.2% as compared to VITEK MS.All the isolates were susceptible to ceftazidime (n=46,100%). Risk factors included diabetes mellitus (n=19, 41.3%) and indwelling devices such as central venous catheters (CVCs), urinary catheters, and mechanical ventilation. Recovery was seen in 40 (86.9%)patients on treatment with recommended antibiotics. Conclusion Our study shows that the identification of the genus Burkholderia by conventional biochemicals was as efficient as automated and molecular methods. Species identification of BCC was better with automated systems. Infections with BCC commonly occurred in patients with diabetes mellitus and indwelling devices. Treatment with recommended antibiotics showed high recovery rates.

Ag quantum dots-doped poly (vinyl alcohol)/chitosan hydrogel coatings to prevent catheter-associated urinary tract infections

The prevention of catheter-associated urinary tract infections (CAUTIs) significantly impacts the reduction of morbidity and mortality associated with the use of indwelling urinary catheters. This study focused on developing an antibacterial double network hydrogel coating for latex urinary catheters, which incorporated Ag quantum dots (Ag QDs) in a polyvinyl alcohol (PVA)-chitosan (CS) double network hydrogel matrix. The PVA-CS-Ag QDs, referred to as the PCA hydrogel coating exhibited excellent mechanical and physiochemical properties with controlled release of Ag QDs. The antibacterial properties of the PCA hydrogel-coated urinary catheters were studied against both gram-negative Escherichia coli (E. coli, ATCC25922) and gram-positive Staphylococcus aureus (S. aureus, ATCC29213). The continuous release of CS oligomers and Ag QDs from the hydrogel coating contributed to the synergistic antibacterial and antiadhesion effects. Measurements of the Ag release rate revealed that even after 30 days, the concentration of Ag QDs from the PCA hydrogel-coated urinary catheters remained significantly higher than the effective antibacterial concentration of the total Ag (0.1 μg·L−1). These results indicated that the PCA hydrogel coating not only efficiently prevented bacteria attachment, but also exhibited long-term antibacterial activity, thereby inhibiting biofilm formation. Furthermore, the PCA hydrogel-coated urinary catheter demonstrated excellent biocompatibility and hemocompatibility. Overall, this novel PCA hydrogel-coated urinary catheter, with its exceptional antibacterial properties, holds great potential in reducing the incidence of CAUTIs.