Rate Of Urinary Tract Infection Research Articles

Risk of Urinary Infections in Veterans on Empagliflozin With Concurrent Catheter Use

There has been concern over whether to use sodium-glucose-cotransporter-2 (SGLT-2) inhibitors in patients that use catheters due to the concern for increased urinary tract infections (UTIs). The concern is that patients who use catheters are already at an increased risk for UTIs and that SGLT-2-inhibitors may promote bacterial growth due their mechanism of action, ie. increasing glycosuria. The objective of this study was to evaluate whether using empagliflozin, a SGLT-2-inhibitor, in patients who also use catheters, increases their risks for UTIs. A retrospective chart review of electronic health records at a single-center was completed of all Veterans who received an empagliflozin prescription and were also using catheters between October 1, 2015 and September 30, 2022. Veterans were included if they were using catheters for at least 2 months prior to starting empagliflozin and were on both therapies for at least 2 months concurrently. The primary outcome for this study is the number of UTIs occurring prior to and after beginning empagliflozin treatment. Additional secondary outcomes included change in A1c, change in body mass index (BMI), UTI-hospitalizations, and fungal infections. Of the 91 patients with concurrent empagliflozin and catheter-use, only 25 Veterans were included. There was an occurrence of .09 UTIs/month pre-empagliflozin compared to .07 post-empagliflozin (P = .61). There was an observed trend in Veterans with Type 2 Diabetes having an increased rate of UTIs. There was no statistically significant difference found in UTI rates when comparing catheters alone to concurrent catheter and empagliflozin-use.

A multiple logistic model for prediction of urinary tract infections in an urban community: A public health perspective

Urinary tract infection (UTI) is one of the most common infectious diseases globally. A lot of clinical research has been done on UTI patients, but a questionnaire-based study on UTI is scarce. A cross-sectional study was conducted on outpatients with a high suspicion of uncomplicated UTI in Hayes Memorial Mission Hospital at Prayagraj (Eastern part of Northern India) to find out the frequency of symptoms and predisposing factors and their relationship towards the prediction of UTI. Logistic regression analysis showed a significant association between UTI and some of the variables. Also, the factors responsible for the occurrence of UTI are “gender”, “how many times you urinate from morning till night”, “a sudden desire to urinate, which is difficult to hold”, “weakness of urinary stream”, “splitting or spraying of the urinary stream” and “fever”. A statistical model (multiple logistic model) has been also established for the prediction of UTIs with an accuracy of 82.2%. It is also observed that the prevalence rate (odds ratio) of UTI in females is 2.38 times that of males. The study created a screening questionnaire for patients suspected of having UTI. A multiple logistic model has been established for the prediction of UTI which can be instrumental for clinicians from a public health perspective in the management of Urinary Tract Infections in this era of escalating AMR.

Sodium-glucose Cotransporter 2 Inhibitors in Kidney Transplant Recipients – A Retrospective Single Center Study

Introduction: Considering the rising occurrence of posttranplant diabetes and the elevated cardiovascular burden among transplant recipients, the utilization of SGLT2 inhibitors (SGLT2i) in this group is appealing because of their cardiovascular and renoprotective benefits. Nevertheless, there is a scarcity of evidence for diabetic kidney transplant recipients (DKTRs) owing to concerns about potential renal graft damage and adverse effects. Methods: This retrospective study was devised to assess the effectiveness and safety of SGLT2i in kidney transplant recipients (KTRs). The main focus was on evaluating their impact on parameters such as haemoglobin A1c levels, body mass index (BMI), lipid panel, haemoglobin levels, renal allograft function (estimated glomerular filtration rate) and urirnary protein-to-creatinine ratio. Results: A total of 75 renal transplant patients were included in this investigation. The study spanned a median observation period of 18 (2.0–71.0) months. Median estimated glomerular filtration rate at baseline was 61,9 (26–120) mL/min/1.73 m2 and remained stable throughout the follow-up. Median HbA1c decreased from 7.5 to 7.0% (95% CI; p<0,002). A significant improvement in BMI (95% CI; p<0,001) and lipid panel (95% CI; p<0,05) were also observed. Median haemoglobin rate at baseline was 13,5g/dL and modestly improved at end of follow-up to 13,7g/dL (p=0,12). Regarding urinary protein:creatinine ratio, levels slightly but not significantly rose [+0.05 g/g (p=0,9)]. In a post-hoc subgroup analysis, the rate of urinary tract infections was low (10%). No other side effects were observed during the treatment course. Conclusions:This study demonstrates that the administration of SGLT2i is viable and well-tolerated, with no notable side effects observed in KTRs. However, the question of whether SGLT2i can effectively lower cardiovascular mortality and enhance allograft survival in these patients remains to be explored in subsequent studies.

Urine microbiome in individuals with an impaired immune system.

With the advent of next generation sequencing, it is now appreciated that human urine is not sterile. Recent investigations of the urinary microbiome (urobiome) have provided insights into several urological diseases. Urobiome dysbiosis, defined as non-optimal urine microbiome composition, has been observed in many disorders; however, it is not clear whether this dysbiosis is the cause of urinary tract disorders or a consequence. In addition, immunologically altered disorders are associated with higher rates of urinary tract infections. These disorders include immunoproliferative and immunodeficiency diseases, cancer, and immunosuppressant therapy in transplant recipients. In this review, we examine the current state of knowledge of the urobiome in immunologically altered diseases, its composition and metabolomic consequences. We conclude that more data are required to describe the urobiome in immune altered states, knowledge that could facilitate understanding the role of the urobiome and its pathophysiological effects on urinary tract infections and other disorders of the urinary tract.

Autovaccine-Based Immunotherapy: A Promising Approach for Male Recurrent Urinary Tract Infections.

Recurrent Urinary Tract Infections (UTIs) in men range from 0.9 to 2.4/1000 individuals in younger men to 7.7/1000 in those over 85, significantly impacting their quality of life. Preventive strategies include autovaccines, but limited evidence exists for males. A prospective monocentric, open-label observational study was conducted from August 2018 to August 2021, with follow-up until August 2023 including patients with recurrent UTIs treated with immunotherapy. We evaluated the incidence rate of UTIs per year, the incidence rate of episodes after two or three rounds of the autovaccine, and quality of life measured with the IPSS-QoL questionnaire. A total of 49 patients fulfilled inclusion criteria. The mean age was 72 years (±15), and the median 61. The evolution of UTIs number of episodes after the autovaccine rounds: -37.74% for the first round from 5.3 to 3.3; -33.33% for the second round from 3.3 to 2.2; -45.45% for the third round from 2.2 to 1.2. The mean IPSS score improved from 10.69 to 7.27 after the treatment (32%). The mean QoL subscore enhancement was from 4.22 to 1.92 (54%). With a mean follow-up of 3 years, only nine patients required retreatment. Autovaccine treatment significantly reduced the number of UTI episodes, with a cumulative effect observed after multiple rounds of treatment, demonstrating an enhancement in QoL and with sustained effectiveness and a low need for retreatment.

Characterization and Outcomes of Iatrogenic Urethral Catheterization Injuries.

Iatrogenic injury during urethral catheterization is a common reason for inpatient urologic consultation and is associated with increased morbidity and resource utilization. Literature defining the patient population, interventions, or outcomes associated with traumatic catheterization is scarce. We performed a retrospective review of consults for adult urethral catheterization at a single tertiary care center (July 2017-December 2019), with focus on patient characteristics and complications. Traumatic urethral catheterization was defined as catheterization by the primary team with at least 1 of these conditions: gross hematuria, meatal blood, or cystoscopic evidence of urethral trauma. Characteristics collected included urologic history, catheterization circumstances, procedural intervention, and subsequent visits. Three hundred urology consults for urethral catheterization were identified, including 98 (33%) traumatic events (5.3 incidents/1000 catheters placed). All traumatic catheterization consults were in men (median age 69 years). Most (71%) patients sustaining injury had significant urologic history (eg, benign prostatic hyperplasia, urethral stricture). Sixty-three (64%) consults were determined to be uncomplicated (not requiring any procedural intervention for catheter placement). Gross hematuria was the most common sequela (50% of patients). The 30-day catheter-associated urinary tract infection rate was 13%, and 2 patients developed sepsis. Complications required a total of 52 additional hospital admission days, 19 of which were intensive-care level, as well 113 outpatient urology visits. Traumatic urethral catheterization is associated with increased need for procedural intervention, risk of catheter-associated urinary tract infection, and additional resource utilization. Further studies on traumatic catheterization are needed to guide systemic efforts for minimizing injury and cost.

An Observational Study on Impact of COVID-19 in Pregnancy: Clinical Profiles and Foetomaternal Outcomes in Caesarean Section Cases at a Tertiary Care Centre, Gujarat, India

Introduction: The Coronavirus Disease 2019 (COVID-19) pandemic, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, has resulted in a crippled healthcare system worldwide. In this unprecedented situation, it is important to analyse the impact on the vulnerable population of pregnant women, especially those with high-risk pregnancies and those undergoing a Caesarean section (CS). Aim: To analyse the clinical profile, foetomaternal outcomes, and co-morbidities in COVID-19-affected pregnancy cases undergoing a CS. Materials and Methods: This was a retrospective observational study conducted at the Department of Obstetrics and Gynaecology, Government Medical College, and New Civil Hospital in Surat, Gujarat, India during the first wave of the COVID-19 pandemic from April 2020 to December 2020. The study included a total of 65 cases of COVID-19-positive mothers undergoing a C-section. Demographic parameters such as age, obstetric history, details of the C-section (like gestational age at the time of the procedure, indication, and category of the C-section), associated co-morbidities, severity of COVID-19- related symptoms and treatment, neonatal parameters {such as birth weight, Appearance, Pulse, Grimace, Activity and Respiration (APGAR) score, and COVID-19 status of the baby at birth} were analysed. Additionally, a comparison of the C-section rate and complications such as the development of severe anaemia requiring blood transfusion, postoperative development of urinary tract infections, surgical site infections, and the association of hypertensive disorders of pregnancy was conducted between COVID-19-affected and unaffected pregnancies undergoing a C-section during the study period. Data on COVID-19 negative cases were obtained from the monthly labour room statistics submitted to the department. The Chi-square test and Fisher’sexact test were used to compare parameters of the COVID-19 positive and negative groups and a p-value of less than 0.05 was considered statistically significant. Results: Out of a total of 6246 deliveries conducted at the institute during the study period, the CS rate among affected and non affected women was 44.5% (65 out of 146) vs. 32.8% (2006 out of 6100) {p=0.003, Relative Risk (RR) 1.3, 95% Confidence Interval (CI) 1.12-1.62}. The mean age of women with COVID19 undergoing a CS was 25.3 years. The difference in the rate of blood transfusion requirement in COVID-19-affected cases was 9 out of 65 (13.8%) vs. 120 out of 2006 (6%) in COVID-19 negative pregnancies (RR 2.3, 95% CI: 1.2-4.3). The difference in the rate of urinary tract infections in the postoperative period was statistically significant in COVID-19-infected patients, 5 out of 65 (7.7%) vs. 58 out of 2006 (2.9%) in non infected patients (p=0.0451, RR 2.6, 95% CI 1.1-6.4). The prevalence of hypertensive disorders among COVID-19 positive and negative mothers undergoing CS was very high in the present study (16 out of 65, 24.6% vs. 160 out of 2006, 8.1%, RR 3.08, 95% CI 1.9-4.8). Neonatal parameters like low APGAR score at birth were seen in 5 cases (8%), low birth weight in 20 cases (30%), and 3 babies (4.5%) were COVID-19 positive at birth. Conclusion: Higher rates of caesarean sections, increased prevalence of hypertensive disorders of pregnancy, anaemia requiring blood transfusion, and postoperative development of urinary tract infections among COVID-19-affected mothers undergoing a caesarean section.

Effect of a Collaborative Medical-Nursing Catheter Removal Protocol on Incidence of Urinary Tract Infections in Urology Patients: A Retrospective Study.

Urology patients are often placed with a catheter following surgery. Hence, a high-quality and appropriate management and removal programme can considerably reduce catheter-associated complications such as urinary tract infections and improve patient comfort. This retrospective study investigated the impact of a collaborative medical-nursing catheter removal protocol on reducing the incidence of urinary tract infections in urological surgery patients. Patients who underwent partial nephrectomy at our hospital between January 2021 and December 2022 were enrolled and allocated to a control and an observation group based on the method of urinary catheter removal. A physician was solely responsible for monitoring, evaluating, and removing the catheter in the control group, whereas a physician and nurses performed these catheter management activities in the observation group. The two groups were compared in terms of urinary tract infections, urinary tract irritation and hematuria signs, pain levels, and catheter retention time. A total of 178 patients were included, among which 88 were divided into the control group and 90 into the observation group according to their corresponding urinary catheter removal method entered into the medical records system. The general characteristics of the two groups were similar (p > 0.05). However, the rates of urinary tract infections and urinary tract irritation and hematuria signs in the observation group were lower than those in the control group (1.11% vs. 9.09%, χ2 = 5.902, p = 0.037; 5.55% vs. 15.91%, χ2 = 4.159, p = 0.041, respectively). The observation group also exhibited lower levels of urinary pain within 1 h post-catheter removal and shorter total catheter retention time than the control group (t = 2.497, p = 0.013; t = 2.316, p = 0.022, respectively). Collaborative medical-nursing catheter removal protocols for patients undergoing partial nephrectomy may effectively alleviate urinary pain, decrease the incidence of urinary tract infections and irritation and hematuria signs, and shorten catheter retention time, underscoring the clinical significance of its implementation in this specific population.

Comparison of Early Complication Rates After High Tibial Osteotomy Versus Unicompartmental Knee Arthroplasty for Knee Osteoarthritis.

Although both high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) can be utilized to treat unicompartmental osteoarthritis (OA) in select patients, the early complication rates between the 2 procedures are not well understood. Understanding of the complication profiles for both procedures would help clinicians counsel patients with unicompartmental knee OA who may be eligible for either treatment option. To compare the 30-day complication rates after HTO versus UKA for the treatment of knee OA using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Cohort study; Level of evidence, 3. NSQIP registries between 2006 and 2019 were queried using Current Procedural Terminology codes to identify patients undergoing HTO and UKA for knee OA. Patients >60 years of age were excluded. Patient demographics, preoperative comorbidities, and intraoperative data were collected. Postoperative 30-day complications, including venous thromboembolism (VTE), urinary tract infection (UTI), transfusion, surgical-site infection (SSI), and reoperations were recorded. Complication rates between treatment groups were compared using a multivariate logistic regression model adjusted for sex, age, body mass index, steroid use, respiratory status (smoking/dyspnea/chronic obstructive pulmonary disease), diabetes, and hypertension. A total of 156 patients treated with HTO and 4755 patients treated with UKA for knee OA were identified. Mean patient ages were 46 years for the HTO group and 53.4 years for the UKA group. Operative time was significantly longer in the HTO group versus the UKA group (112 minutes vs 90 minutes; P < .001). Multivariate analyses found no significant differences in VTE (1.3% vs 0.6%), UTI (0.6% vs 0.3%), transfusion (0.6% vs 0.2%), deep SSI (0.6% vs 0.1%), and reoperation (1.3% vs 1%) rates between HTO and UKA groups. The HTO group had a higher rate of superficial SSI compared with the UKA group (2.6% vs 0.6%; P = .006) (adjusted odds ratio, 4.2; 95% CI, 1.4-12.5; P = .01). There were no differences in 30-day VTE, UTI, transfusion, deep SSI, and reoperation rates for HTO versus UKA in the treatment of knee OA. HTO was associated with a higher rate of superficial SSI compared with UKA. These findings serve to guide clinicians in counseling patients regarding the early risks after HTO and UKA.

Outcome of children with multicystic dysplastic kidney: Does involved side matter?

Multicystic dysplastic kidney (MCDK) is a common anomaly detected on antenatal ultrasound. We aimed to assess the profile of children with MCDK and to investigate whether the involved side has any effect on outcome. Thirty-nine patients with MCDK and 20 controls were enrolled. Patients who estimated glomerular filtration rate (eGFR) values over 90 mL/min/1.73 m2 were compared with controls. Comparison was made between the involved sides. MKDB was right-sided in 20 (51.3%) and left-sided in 19 (48.7%) patients. 33.3% had additional urinary tract abnormality, 10.2% had systemic abnormality. 82% showed contralateral kidney enlargement. 48.7% involuted, 17.9% underwent nephrectomy. 35.8% suffered from urinary tract infection (UTI). 5.1% had renal scarring (RS). 30% developed microalbuminuria. 12.8% complicated with hypertension. 17.9% progressed to chronic kidney disease (CKD). Hypertension was independent risk factor for developing CKD. Blood pressure, cystatin C and urine microalbumin/creatinine levels were increased, and eGFR values were decreased in patients compared to controls. No significant difference was found between the two sides for rates of involution, UTI, RS, nephrectomy, and additional abnormality. Cystatin C levels were higher on the right than left sides (p = .033). Children with MCDK predispose to renal deterioration even at normal eGFR values. Although cystatin C levels tended to increase in right-sided patients, the involved side seemed to have no significant effect on renal outcome. Hypertension was main determinant for progression to CKD in MCDK.

Office-based Magnetic Resonance Imaging–guided Transperineal Prostate Biopsy Without Antibiotic Prophylaxis: A Real-world Clinical Utility Study

Background and objectiveAdvances in for magnetic resonance imaging (MRI)-guided transperineal biopsy (TPBx) techniques have facilitated outpatient prostate biopsies under local anaesthesia to lower postbiopsy infection rates. However, there is debate regarding antibiotic prophylaxis because of concerns regarding antibiotic resistance and interactions. Our objective was to assess the transition from office-based transrectal biopsy to TPBx performed under local anaesthesia without antibiotic prophylaxis despite potential risk factors for infectious complications. MethodsWe conducted a prospective assessment of 665 men undergoing office-based MRI-guided TPBx. The primary outcome was the rate of urosepsis or febrile urinary tract infections requiring hospitalisation and/or antibiotics within 2 wk after biopsy. Secondary outcomes included patient-reported procedure tolerability and the prostate cancer detection rate. Key findings and limitationsTPBx using a median of nine cores per patient (range 4–15) detected prostate cancer in 534/665 men (80%). Only four men (0.6%) were hospitalised for suspected postbiopsy infection; no patient experienced urosepsis. The TPBx procedure was well tolerated, with low pain scores (median Visual Analogue Scale score of 2, interquartile range [IQR] 1–3) and positive patient ratings (median rating 1 [no problem], IQR 1–2). Limitations include the single-centre analysis and lack of randomisation for antibiotic prophylaxis. Conclusions and clinical implicationsAn office-based TPBx strategy under local anaesthesia without antibiotic prophylaxis is well tolerated and has a very low risk of side effects. This approach should be considered as the standard of care. Further studies may determine if a subgroup of predisposed men could benefit from antibiotic prophylaxis. Patient summaryFor prostate biopsy the sampling needle can be inserted through the rectum or through the perineum, which is the skin between the rectum and the scrotum. Our study confirms that in everyday clinical practice, prostate biopsy via the perineum can be carried out under local anaesthetic and without routine use of antibiotics because of its lower risk of infection. Patients reported low pain scores and positive ratings for the overall experience.

Frequency of Catheter induced urinary tract infection in patients undergoing major gynecological and obstetrical surgeries at a local tertiary care hospital.

Objective: The aim of this study was to determine the frequency of catheter associated urinary tract infections in patients undergoing major gynecological &amp; obstetrical surgeries.Methodology: This cross-sectional study was conducted in the Department of Obstetrics &amp; Gynecology, Liaquat National Hospital &amp; Medical College, Karachi. Duration of this study was six months from 1st December 2018 till 31st May 2019. A total of 246 patients were included in the study. Sample collection was done using non probability consecutive sampling technique. Patients who had routine catheter insertion for duration of 1-2 days during major gynecological and obstetrical surgeries were included in this study. Results: A total of 246 patients who met the inclusion and exclusion criteria were included in the study. Patients were divided according to the duration of post-operative catheter exposure days (1 &amp; 2). Sixty five patients were reported to have catheter induced urinary tract infection (UTI) with an overall infection rate of 26.4%.The highest rate of urinary tract infection (47.5%) was reported in patients who had their catheters removed on post-operative day 2. Most prevalent organism causing catheter induced UTI was reported to be E coli (22.4%). Chi Square test showed statistical significant association with p value 0.001 with the duration of catheterization removal and catheter induced UTI. Conclusion: Prolonged duration of indwelling Foley catheter in post-operative Gynecology patients was associated with an increased incidence of Urinary Tract Infection. Multiparous women are more prone to get CAUTI as compared to nulliparous women.

Bladder management is the top health concern among adults with a spinal cord injury.

Individuals with spinal cord injury (SCI) commonly experience secondary complications though it is not known how they prioritize these different health domains. Using the Neurogenic Bladder Research Group (NBRG) SCI registry, our objective was to identify the top health concerns of individuals with SCI and identify factors that may be associated with these choices with particular focus on urologic issues that participants face. Participants in the NBRG registry were asked: "What are the top 3 problems that affect you on a daily basis?" Urinary symptoms and QoL were assessed with the Neurogenic Bladder Symptom Score (NBSS). Multivariate regression was used to identify factors related to selecting a top ranked health issue. Among our 1461 participants, 882 (60.4%) were men and the median age was 45.1 years (IQR 25.3-64.9). Bladder management was the most commonly top ranked primary issue (39%) followed by pain (16.4%) and bowel management (11.6%). Factors associated with ranking bladder management as the primary concern included years since injury (OR 1.01 [1.00-1.02], p = 0.042), higher (worse) total NBSS (OR 1.05 [1.03-1.06], p < 0.001), and higher (worse) NBSS QoL (OR 1.25 [1.12-1.41], p < 0.001). Reporting chronic pain on a daily basis was associated with ranking pain as the primary health concern (OR 41.7 [15.7-170], p < 0.001). In this cohort, bladder management was ranked as the top health issue and increasing time from injury was associated with increased concern over bladder management. More bladder symptoms were also associated with ranking bladder management as a primary concern while bladder management method and urinary tract infections rate were not.

Clean Intermittent Catheterization in Children under 12 Years Does Not Have a Negative Impact on Long-Term Graft Survival following Pediatric Kidney Transplantation.

Congenital anomalies of the kidneys and urinary tract (CAKUTs) are one of the most prevalent primary causes of end-stage renal disease (ESRD) in young children, and approximately one-third of these children present with lower urinary tract dysfunction (LUTD). Many children with LUTD require therapy with clean intermittent catheterization (CIC). CIC commonly leads to bacteriuria, and considerations have arisen regarding whether CIC in immunosuppressed children is safe or whether repeated febrile urinary tract infections (UTIs) may lead to the deterioration of kidney graft function. We retrospectively reviewed all cases of primary kidney transplantation performed in our center between 2001 and 2020 in recipients aged less than twelve years. The number of episodes of febrile UTIs as well as the long-term kidney graft survival of children undergoing CIC were compared to those of children with urological causes of ESRD not undergoing CIC, as well as to those of children with nonurological causes of ESRD. Following successful kidney transplantation in 41 children, CIC was needed in 8 of these patients. These 8 children undergoing CIC had significantly more episodes of febrile UTIs than did the 18 children with a nonurological cause of ESRD (p = 0.04) but not the 15 children with a urological cause of ESRD who did not need to undergo CIC (p = 0.19). Despite being associated with a higher rate of febrile UTIs, CIC was not identified as a risk factor for long-term kidney graft survival, and long-term graft survival did not significantly differ between the three groups at a median follow-up of 124 months. Our study demonstrates that, under regular medical care, CIC following pediatric transplantation is safe and is not associated with a higher rate of long-term graft loss.

Antimicrobial Prophylaxis in Robot-Assisted Laparoscopic Radical Prostatectomy: A Systematic Review.

It remains unclear whether antibiotic prophylaxis (AP) should be recommended or discouraged in robot-assisted laparoscopic radical prostatectomy (RALP) for prostate cancer (PCa). The development of microbial resistance and side effects are risks of antibiotic use. This systematic review (SR) investigates the evidence base for AP in RALP. A systematic literature search was conducted until 12 January 2023, using Embase, MEDLINE, Cochrane CENTRAL, Cochrane CDSR (via Ovid) and CINAHL for studies reporting the effect of AP on postoperative infectious complications in RALP. Of 436 screened publications, 8 studies comprising 6378 RALP procedures met the inclusion criteria. There was no evidence of a difference in the rate and severity of infective complications within 30 days after RALP surgery between different AP protocols. No studies omitted AP. For patients who received AP, the overall occurrence of postoperative infectious complications varied between 0.6% and 6.6%. The reported urinary tract infection (UTI) rates varied from 0.16% (4/2500) to 8.9% (15/169). Wound infections were reported in 0.46% (4/865) to 1.12% (1/89). Sepsis/bacteraemia and hyperpyrexia were registered in 0.1% (1/1084) and 1.6% (5/317), respectively. Infected lymphoceles (iLC) rates were 0.9% (3 of 317) in a RALP cohort that included 88.6% pelvic lymph node dissections (PLND), and 3% (26 of 865) in a RALP cohort where all patients underwent PLND. Our findings underscore that AP is being administered in RALP procedures without scientifically proven evidence. Prospective studies that apply consistent and uniform criteria for measuring infectious complications and antibiotic-related side effects are needed to ensure the comparability of results and guidance on AP in RALP.

Evaluation of the Diagnosis and Antibiotic Prescription Pattern in Patients Hospitalized with Urinary Tract Infections: Single-Center Study from a University-Affiliated Hospital.

UTIs (urinary tract infections) are common bacterial infections with a non-negligible hospitalization rate. The diagnosis of UTIs remains a challenge for prescribers and a common source of misdiagnosis. This retrospective observational study aimed to evaluate whether recorded diagnosis by clinicians and empirical antibiotic therapy met the EAU (European Association of Urology) guideline in patients hospitalized with UTI. The study was conducted at an internal medicine unit of a tertiary care medical center in Hungary. The diagnosis was assessed based on clinical presentation, physical examination, and laboratory (including microbiological) results, considering all the potential risk factors. Diagnosis was considered misdiagnosis when not confirmed by clinical presentation or clinical signs and symptoms. Evaluation of empirical antibiotic therapy was performed only for confirmed UTIs. Empirical treatment was considered guideline-adherent when complying with the relevant recommendations. Out of 185 patients, 41.6% failed to meet EAU-based UTI diagnosis criteria, of which 27.6% were misdiagnosed and 14.1% were ABU (asymptomatic bacteriuria). The diagnosis of urosepsis recorded at admission (9.7%, 18/185) was not confirmed either by clinical or microbiological tests in five (5/18) cases. The initial empirical therapies for UTI showed a relatively low rate (45.4%) of guideline adherence regarding agent selection. The most common guideline-non-adherent therapies were combinations with metronidazole (16.7%). Dosage appropriateness assessments showed a guideline adherence rate of 36.1%, and underdosing due to high body weight was common (9.3%). Overall (agent, route of administration, dose, duration) guideline adherence was found to be substantially low (10.2%). We found a relatively high rate of misdiagnosed UTIs. Written protocols on the ward may be crucial in reducing misdiagnosis and in optimizing antibiotic use.

Clinical Characteristics and Molecular Epidemiology of ST23 Klebsiella pneumoniae in China.

In clinical settings, CG23 Klebsiella pneumoniae (Kp) is the most virulent clonal group of Kp. Continuous fusions of hypervirulent (Hv) and highly resistant strains have been reported; however, few studies have analysed the molecular epidemiology and clinical characteristics of CG23 strains, especially MDR-sequence type ST23 strains. In this study, we investigated the molecular characteristics of ST23 Kp and analysed the clinical characteristics of ST23 Kp infections in a large teaching hospital of the third class in China. ST23 Kp isolates were screened using whole-genome sequencing data from a large single centre. We compared the clinical characteristics of ST23 strains isolated from community-acquired infections (CAI) and hospital acquired infection (HAI). In addition, the infection characteristics of MDR and poor-prognosis isolates were investigated. We analysed genetic characteristics of ST23 Kp and further investigated the evolutionary relationship based on single-nucleotide polymorphism phylogenetic trees. We detected 184 ST23 strains between 2013 and July of 2018. There were no significant differences between the isolation rates of pulmonary, bloodstream, urinary tract, and cutaneous soft tissue infections in the community and hospitals, except for abscess infections. MDR strains primarily cause pulmonary infections and abscesses; infections with a poor prognosis are typically bloodstream and pulmonary infections. Fourteen MDR strains producing extended-spectrum or class C beta-lactamases, resulting in resistance to third-generation cephalosporins. In 3.8% of ST23 Kp strains, the clb locus was absent. The phylogenetic tree revealed that the isolates were primarily divided into three clades, and based on clinical data, it is inferred that three clonal transmission events have occurred, mainly in ICU causing lung infection. This study demonstrates that virulence and drug-resistance fusion events of ST23 strains occur gradually, and that the hypervirulent clones facilitate the widespread dissemination of CAI and HAI, particularly pulmonary. Monitoring genomics and developing antivirulence strategies are essential.

Gender Disparities in Outcomes of Autoimmune Hemolytic Anemia Admissions: An Analysis of the National Inpatient Sample

Introduction Autoimmune hemolytic anemia (AIHA) is a condition characterized by the immune destruction of red blood cells, which can necessitate hospitalization in severe cases. The purpose of this study is to compare outcomes of AIHA hospitalizations between genders. Methods We utilized the International Classification of Diseases (ICD) codes to identify all hospitalizations with the primary diagnosis of AIHA in the National Inpatient Sample (NIS) from 2002 to 2019. We excluded all pediatric (age &amp;lt; 18 years) and elective hospitalizations. We described the baseline characteristics of both groups including demographics and comorbidities. We fitted multivariable logistic regression models to compare outcomes between males and females while adjusting for age, race, and comorbidities. Results A total of 60,529 met the inclusion and exclusion criteria. The majority of these were females (59.1% vs 40.1%, p &amp;lt; 0.001). Males were older (median age 67 vs. 66 years, p &amp;lt; 0.001) and had more white race (73.4% vs. 67.9%, p &amp;lt; 0.001). The distribution of associated comorbidities also differed different between both groups ( (Table 1). On adjusted analysis, males had higher in-hospital mortality rates. They also had higher rates of most secondary outcomes; including rates of circulatory shock, need for mechanical ventilation, bacterial pneumonia, acute myocardial infarction, deep vein thrombosis, hemorrhagic stroke, acute kidney injury, and requiring new hemodialysis. Females had higher rates of urinary tract infections. No significant differences were found in the rates of requiring blood transfusions, sepsis, acute heart failure, pulmonary embolism, ischemic stroke, encephalopathy, and gastrointestinal bleeding (Figure 1). Furthermore, male hospitalizations were associated with higher costs (median [IQR] of $11,400 [6,700-20,500] vs. $10,000 [6,000- 17,200]) despite similar length of stay (median [IQR] of 4 days [3-7] vs. 4 days [3-7]). Conclusion Male patients hospitalized with AIHA experience poorer in-hospital compared to females. More research is essential to understand the underlying causes for these disparities and to tailor management to improve outcomes for both male and female AIHA patients.

Perioperative outcomes of penile prosthesis implantation in Germany: results from the GRAND study.

We aimed to assess the recommended annual hospital volume for inflatable penile prosthesis implantation (PPI) and to provide evidence on perioperative outcomes of semi-rigid and inflatable PPI in Germany. We used the GeRmAn Nationwide inpatient Data (GRAND) from 2005 to 2021 and report the largest study to date with 7,222 patients. 6,818 (94.4%) patients underwent inflatable and 404 (5.6%) semi-rigid PPI. Inflatable PPI was significantly associated with shorter length of hospital stay (difference of 2.2 days, 95%CI: 1.6-2.7, p < 0.001), lower odds of perioperative urinary tract infections (5.5% versus 9.2%; OR: 0.58, 95%CI: 0.41-0.84, p = 0.003) and surgical wound infections (1% versus 2.5%; OR: 0.42, 95%CI: 0.22-0.88, p = 0.012) compared to semi-rigid PPI. Overall, 4255 (62.4%) inflatable PPIs were undertaken in low- ( < 20 PPI/year) and 2563 (37.6%) in high-volume ( ≥ 20 PPI/year) centers. High-volume centers were significantly associated with shorter length of hospital stay (difference of 1.4 days, 95%CI: 1.2-1.7, p < 0.001) compared to low-volume centers. Our findings suggest that inflatable PPI leads to a shorter length of hospital stay and lower rates of perioperative urinary tract and surgical wound infections compared to semi-rigid PPI. Patients undergoing surgery in high-volume centers for inflatable PPI are discharged earlier from the hospital.

Factors associated with urinary tract infection in the early phase after performing intermittent catheterization in individuals with spinal cord injury: a retrospective study.

To investigate the occurrence rate of urinary tract infections (UTIs) in the early phase after performing intermittent catheterization (IC) and to explore the possible factors associated with UTIs after performing IC among people with spinal cord injury (SCI). An inpatient rehabilitation department of a teaching hospital in China. Retrospective chart review. A retrospective chart review was carried out for traumatic and non-traumatic SCI patients after performing IC during their inpatient stay. Demographic information, comorbidity of diabetes, urine analysis results before IC, method of IC (sterile or clean), use of bladder irrigation, cessation of IC and its reasons, and UTI events were collected. A total of 183 adult individuals were included, of which 60 (32.8%) of them were women. The median age was 49.0 years. The median time post-injury was 2 months. The overall occurrence rate of UTI after performing IC was 1.31 (95% confidence intervals: 0.96-1.77) events per 100 days. Sixty-nine (37.7%) patients discontinued IC during hospitalization, and UTIs were the leading reason for cessation (50.7%). Female sex, use of antibiotics for infections other than UTI, and use of bladder irrigation were found to be associated with a lower occurrence rate of UTI in the early phase after performing IC, with an odds ratio of 0.38 (p = 0.019), 0.20 (p = 0.022), and 0.24 (p < 0.001), respectively. UTI after performing IC is prevalent among people with SCI. The study indicated that antibiotic prophylaxis and routine bladder irrigation might be associated with the reduction in UTI in the early phase after performing IC. Further research is needed to provide more evidence.