Urology Ward Research Articles

Urinary tract infections and associated factors among patients with an enlarged prostate at a tertiary hospital, Dar es Salaam, Tanzania: a hospital-based cross-sectional study

ObjectivesThe objectives are to determine the prevalence of urinary tract infection (UTI) and associated factors among patients diagnosed with benign prostatic hyperplasia and prostate cancer.DesignHospital-based cross-sectional study.SettingsUrology clinic and urology...

Risk factors of urolithiasis: A hospital-based retrospective study.

Urolithiasis is the most prevalent urinary tract disease, posing a global public health concern. The escalating prevalence and recurrence rates of urolithiasis are attributed to lifestyle modifications, such as reduced physical activity and dietary habits. This retrospective study aims to explore the risk factors associated with urolithiasis among individuals diagnosed with this condition. A retrospective hospital-based study involving 60 participants meeting the inclusion criteria was conducted. The participants were selected through convenience sampling from the urology, nephrology, and medical wards at Saveetha Medical College and Hospital. Demographic variables were collected, and the risk factors were assessed using a checklist on one-to-one interviews. The study unveiled that most participants (68%) were male. Eighty percent of participants had the risk factor of decreased water intake, 74% consumed excess tomatoes, 56% had a history of recurrent urinary tract infections, 64% consumed an excessive amount of salt daily, 72% experienced a decreased urine output, 53% had a habit of alcohol consumption, and 45% included milk and milk products in their daily diet. A small percentage (5%) had a family history of urolithiasis. Additionally, 6% were undergoing Siddha treatment. The findings from this study underscore the significant factors contributing to urolithiasis. They can inform public health campaigns to raise awareness about lifestyle modifications, dietary changes, and hydration protocols contributing to kidney stone formation.

Comparative evaluation of the current preparation process of patients undergoing surgery in comparison with the clinical guidelines: A case study of the urology ward of Imam Reza education and research hospital, Tabriz University of Medical Sciences, Iran

Background. The pre-operative evaluations of patients should not cause any mental or physical harm to the patient or waste the financial resources of the patient or the public health system by unnecessary actions. Health spending is one of the issues of concern in developed and developing countries. In Iran, 5–10% of government spending is allocated to this sector. The purpose of the present study was to compare the current process of preparing surgical candidates with accepted clinical guidelines. Methods. In this cross-sectional study, sampling was performed by the judgmental/purposive method among the mentioned population; finally, 134 patients were evaluated in this study. The data were categorized as 3 x 4 tables. On one side of the table, patients were divided into small, intermediate, and large surgical groups according to surgical complexity, and on the opposite side of the table, they were assigned to four groups at low, intermediate, high, and very high risk. As a result, each patient was housed in one of the houses on a 12-hole table. The clinical findings and evaluation results before surgery were extracted and evaluated retrospectively. Results. The mean age of the patients was 49.68 ± 16.96 years, and 74.6% were male. The most common type of surgery was transurethral lithotripsy. The incidence of hypertension (21.4%) among underlying diseases and comorbidities was the highest recorded item. The procedures were selected relatively in the same population size from three groups, namely, small, intermediate, and large procedures, with a frequency of 50 (37.3%), 34 (25.4%), and 50 (37.3%) cases, respectively. Conclusion. In the present study, the majority of patients with minor surgeries did not comply with the valuations recommended by guidelines. Among the patients with intermediate surgeries, in nearly half of the cases, and in the major or complex surgery group, most of the time, the evaluations were performed in accordance with the guidelines. Practical Implications. Physicians should consider adhering to current clinical guidelines when requesting preclinical tests, which can pave the way for minimizing unnecessary costs.

Achromobacter species (sp.) outbreak caused by hospital equipment containing contaminated water: risk factors for infection

Nosocomial outbreaks of urinary tract infections caused by Achromobacter spp. have been rare in recent decades. To identify the origin of an Achromobacter sp. outbreak, conduct multi-modal infection control measures, and finally to stop the outbreak. To this end, an epidemiological outbreak investigation and risk factor analysis were performed. Achromobacter sp. was detected in 22 patients in our urology wards and six environmental cultures of specimens obtained from the operating rooms. Strains isolated were submitted for antimicrobial susceptibility testing. An on-site epidemiological investigation, evaluation of patient medical records, and environmental sampling were performed to identify the source of the outbreak, and implementation of infection control intervention. A case-control study was performed to analyse the potential risk factors. Environmental sampling showed that the source of the infection for 22 patients was an ISA-IIIA-type medical pressurizer containing contaminated water. A case-control analysis showed that the risk factors for infection were: diagnosis of kidney/ureteral stones, surgery, placement of a double-J stent, and history of hospitalization in the past three months. It was concluded that the outbreak occurred in patients who underwent internal lithotripsy and double-J stent placement, due to contact transmission with the contaminated sensor and connecting tubes of the ISA-IIIA-type medical pressurizer.

Engaging, Binding and Retaining Nurses: The Success Formula of an Exemplary Ward.

Nurse staffing remains an ongoing issue in healthcare worldwide. However, a Dutch urology ward has hardly any staffing difficulties. Nevertheless, it remains challenging to grasp what exactly is the success formula of the ward. Investigating a practical example of a successful ward will facilitate a deeper understanding of the application of current knowledge. Furthermore, novel concepts offer potential solutions to current problems. There is a need of putting the knowledge into practice. The objective is to identify the factors that contribute to the success of the urology ward in engaging, binding, and retaining nurses, to provide practical insights and opportunities for other wards. The Dutch Model for Excellent Care forms the basis of a prospective, qualitative research study with focus groups. Twelve nurses were divided into three focus groups, based on work experience. They were asked about why they love working on the ward. Analysis was performed using Braun and Clarke's method for thematic analysis. Emerged themes were presented, substantiated by quotes. Four themes and twelve subthemes became apparent: (a) Supportive structures: nursing governance, professional development, and quality of leadership. (b) Optimal work environment: working with skilled nurses, a professional relationship with physicians and professional autonomy. (c) Team culture: feeling seen, good ambiance, and equality. (d) Specialty of urology: variation in work, workload, and the type of patient. Nurses are uniquely positioned to provide invaluable insight into their needs. They illuminated the crucial importance of fostering a work environment that prioritizes both professional as well as personal needs.

A Comparison of Ureterorenoscopy and Extra-Corporeal Shock Wave Lithotripsy for the Treatment Of Upper Ureteric Stone Measuring Less than 1cm.

Objective: To compare the efficacy of Extracorporeal Shock Wave Lithotripsy (ESWL) and Ureterorenoscopy (URS) in the management of upper ureteric stone measuring <1cm. Methodology: Randomized clinical trial (RCT) was conducted by targeting the patient admitted in urology ward, Jinnah Hospital Lahorethrough a period of one year. A sample size of 132 patients fulfilling inclusion criteria were selected by employing Non-probability consecutive sampling technique was employed to select 132 (sample size) patients fulfilling inclusion criteria. Patients were randomly allocated into two groups (66 in each group A&B) using lottery method. In group-A, stones were treated using ESWL, while in group-B, URS was performed, and stones were broken with pneumatic energy. Data were analyzed using SPSS version 27, and a Chi-square test was conducted to compare the proportions of qualitative variables, while an independent sample t-test was applied to assess mean differences between two groups of quantitative variables. Asignificance level of ≤0.05 was adopted for determining statistical significance. Results: The sociodemographic profile of the two groups was comparable. It was seen that stone free rate nextto first session was higher in URS (81.8%) as compared to ESWL (63.6%) which later increased to 87.7% after completion of three session. The complaint of pain in ESWL was more as compared to URS (22.7% vs 12.1% p= 0.05)while the differences betweenthe rate of complications like fever, UTI, mucosal abrasion, hematuria or perforation were not statistically significant in both group. (p> 0.05) Conclusion: ESWL outperforms URS for the treatment of upper ureteric stones measuring <1cm in terms of efficacy and safety.Although not statistically significant, ourfindings suggest that URS achieves stone-free rates earlier than ESWL. However, according to our findings, ESWL is recommended as the treatment of choice for the majority of patients due to better compliance. Keywords: Extra-corporeal Shock Wave Lithotripsy, Nephrolithiasis, Ureterorenoscopy

Positive effects of audit and feedback on antimicrobial use in hospitalized patients limited to audited patients.

Audit and feedback is an antimicrobial stewardship (AMS) strategy, with the potential to also optimize antimicrobial use in non-audited patients. This study aimed to determine whether audit and feedback reduce antimicrobial use in both audited and non-audited patients. Before-after trial with a 1-year intervention period and 2.5-year historical cohort. 750-bed community hospital in the Netherlands. All patients admitted to the urology wards during the 3.5-year study period were observed. Patients were classified as using antimicrobials if any antimicrobial was used for therapeutic reasons. Patients using antimicrobials prophylactically were excluded from measurements. The AMS team provided audit and feedback on antimicrobial use for patients using antimicrobials for 2 days. Retrospectively, antimicrobial use and length of stay (LOS) were compared with the historical cohort. Audits modified antimicrobial treatment in 52.8% of the cases. De-escalating, stopping, and switching from intravenous to oral treatment accounted for 72% of these modifications. Compared to patients from the cohort, who also used antimicrobials for 2 days, antimicrobial use decreased from 14.21 DDD/patient (95% CI, 13.08-15.34) to 11.45 DDD/patient (95% CI, 8.26-14.64; P = .047) for audited patients. Furthermore, mean LOS decreased from 7.42 days (95% CI, 6.79-8.06) to 6.13 days (95% CI, 5.38-6.89; P = .031). However, looking at all patients admitted to the urology wards, the percentage of patients using antimicrobials and total antimicrobial use remained unchanged. Audit and feedback reduce antimicrobial use and LOS, but only for audited patients. Positive effects are not automatically transferred to patients for whom no audits have been performed.

Prevalence of Anatomical Anomalies in Pediatric Patients Hospitalized with UTIs in a Tertiary Care Center's Urology and Nephrology Ward

Background: Urinary tract infections (UTIs) are a significant pediatric health concern, often linked to anatomical anomalies of the urinary tract. Understanding the prevalence and characteristics of these anomalies in children with UTIs is crucial for effective diagnosis and management. Objective: This study aimed to investigate the prevalence and nature of anatomical anomalies in children diagnosed with UTIs, focusing on age and gender distribution, and to identify common anomalies associated with UTIs in pediatric patients. Methods: A retrospective cross-sectional study was conducted at the Children's Medical Center in Tehran, from March to September 2022. The study included pediatric patients admitted with UTIs, excluding those over 18 years of age. Convenience sampling was used to target at least 70 patients with definitive anatomical anomalies. Data collection involved reviewing medical records and laboratory results, focusing on variables such as age, sex, paraclinical tests, and types of anatomical anomalies. Statistical analysis was performed using SPSS software version 25, employing Fisher’s exact or χ2 tests for categorical variables, and the student’s t-test, ANOVA, and Chi-Square tests for continuous variables. Results: The average age of patients was 29.61 months (SD = 35.28), with a median of 12.50 months (IQR = 36). The average number of UTI episodes was 3.43 (SD = 2.31), ranging from 1 to 10 episodes. Bilateral hydronephrosis was observed in 15 patients (21.7%), while neurogenic bladder and Reflux Grade 4 or 5 were identified in 11 (15.9%) and 14 (20.3%) patients, respectively. VCUG was performed in 63 patients (91.3%). Unilateral hydronephrosis was the most common imaging finding, observed in 33 patients (47.8%). Conclusion: The study concludes that children around 29 months of age, particularly females, are more prone to have anatomical anomalies associated with UTIs. Bilateral hydronephrosis was a prevalent anomaly. However, limitations such as potential data unavailability or misinterpretation, errors in laboratory data, and patient comorbidities must be considered when interpreting these findings.

Promoting post discharge telephone follow-up of patients with transurethral resection for bladder cancer: a best practice implementation project.

Telephone follow-up (TFU) is a method that can be recommended for patients with chronic disease, including patients with nonmuscle-invasive bladder cancer (NMIBC) after transurethral resection of the bladder (TURB). This project aimed to improve postdischarge TFU of patients with TURB in a tertiary care system and referral system in Tabriz, Iran. This evidence implementation project used the JBI evidence implementation framework. Two audit criteria were used. A baseline audit was conducted, followed by the implementation of multiple strategies. The project was finalized with a follow-up audit to evaluate changes in practice. The aggregated data collated from the urology ward demonstrated that all criteria had achieved 0% compliance in the baseline audit round. Strategies such as patient education about TFU, educational pamphlets developed according to the latest validated guidelines, and a mobile app for education material about bladder cancer, diagnosis, management, and follow-up were implemented. The Phase 3 follow-up showed an 88% increase in compliance with staff education about the postdischarge TFU as a component of comprehensive discharge planning and a 22% achievement of timely patient follow-up by telephone. A clinical audit is an effective approach to promoting postdischarge TFU in bladder cancer cases following TURB. TFU for bladder cancer patients who underwent TURB is an optimal goal that is easily achieved through patient, nursing staff, and residents' education using the latest guidelines.

Pharmacokinetic/Pharmacodynamic Target Attainment of Continuous Infusion Piperacillin-Tazobactam or Meropenem and Microbiological Outcome among Urologic Patients with Documented Gram-Negative Infections.

(1) Objectives: To describe the relationship between pharmacokinetic/pharmacodynamic (PK/PD) target attainment of continuous infusion (CI) piperacillin-tazobactam or meropenem monotherapy and microbiological outcome in a case series of urological patients with documented Gram-negative infections. (2) Methods: Patients admitted to the urology ward who were treated with CI piperacillin-tazobactam or meropenem monotherapy for documented Gram-negative infections and underwent real-time therapeutic drug monitoring (TDM)-guided expert clinical pharmacological advice (ECPA) program from June 2021 to May 2023 were retrospectively retrieved. Average steady-state (Css) piperacillin-tazobactam and meropenem concentrations were determined, and the free fractions (fCss) were calculated. Optimal PK/PD target attainments were defined as an fCss/MIC ratio >4 for CI meropenem and an fCss/MIC ratio of piperacillin >4 coupled with an fCss/CT ratio for tazobactam >1 for piperacillin-tazobactam (joint PK/PD target). The relationship between beta-lactam PK/PD targets and microbiological outcome was explored. (3) Results: Sixteen urologic patients with documented Gram-negative infections (62.5% complicated urinary tract infections (cUTI)) had 30 TDM-guided ECPAs. At first TDM assessment, beta-lactam dosing adjustments were recommended in 11 out of 16 cases (68.75%, of which 62.5% decreases and 6.25% increases). Overall, beta-lactam dosing adjustments were recommended in 14 out of 30 ECPAs (46.6%). Beta-lactam PK/PD target attainments were optimal in 100.0% of cases. Microbiological failure occurred in two patients, both developing beta-lactam resistance. (4) Conclusion: A TDM-guided ECPA program may allow for optimizing beta-lactam treatment in urologic patients with documented Gram-negative infections, ensuring microbiological eradication in most cases.

Bladder diary for illiterates: A novel method.

Bladder diary is an integral part of urologic evaluation of lower urinary tract symptoms. One of its limitations is the requirement of a literate patient or attendant to complete it. We propose a novel method for recording bladder diary in illiterate individuals, with the aid of easily available materials from hospital, without any expenditure from the patients. Forty-nine patients, who were required to fill the bladder diary as a part of their urological assessment, and were either illiterate or not literate enough to complete it themselves, were enrolled and admitted in the urology ward for 1 and a half days. Patients were provided with two 500 mL empty normal saline bottles for collection of each void, and a chart separately for day and night with diagrams of saline bottles to mark the corresponding level of urine. The amount of urine and frequency was also noted simultaneously by nursing staff each time for 24 h. The investigator interpreted the data marked on the charts by the patient and compared it with the data collected by the nursing officers. No statistically significant difference was found between the data collected by the nursing staff and patient data interpreted by the investigators, which included 24-h urine volume(p = 0.562), nocturnal output (p = 0.941), average voided volume (p = 0.709), maximum voided volume (p = 0.369), fluid intake (p = 0.401), frequency, nocturia and episodes of urgency and incontinence (p = 1). This method of recording bladder diary is a feasible, genuine, reliable and cost-free method which can be used in illiterates.

Simplified antibiotic guidelines in urology are associated with decreased multidrug-resistant Enterobacterales

PurposeA simplified therapeutic guideline (STG) was established in our urology ward in 2019 for urinary infections. Our aim was to describe the level of physician adherence to STG and the impact of a limited number of antibiotic compounds on the rate of multidrug-resistant (MDR) bacteria. As guidelines should improve patient care, unfavorable outcomes were also reported. MethodsThe STG for community-acquired and nosocomial urinary infections, including six antibiotics, was established in November 2019 and has been officially applied since January 2020. Treatment duration has to be ≤14 days. We conducted a before-after study to measure physician adherence to the STG for bacteremia treatment between January 2017 and December 2022. Adherence was defined as exclusive use of STG antibiotics. All isolated bacteria from blood cultures were recorded, including MDR Enterobacterales, defined as AmpC β-lactamase- or ESBL-producing strains. Unfavorable outcomes were defined as uncontrolled infection, a second surgical procedure, ICU requirement, and/or death. ResultsSeventy-six cases of bacteremia occurred between January 2017 and December 2019, and ninety between January 2020 and December 2022. The main comorbid condition was urological cancer (46%). The main reason for surgery was ureteral stent (32%). Antibiotic management in accordance with STG increased from 18% to 52%, p < 0.001, and treatments > 14 days decreased from 53% to 28%, p < 0.001. MDR Enterobacterales bacteremia was reduced from 52% to 35%, p = 0.027. The rate of unfavorable outcomes was unchanged. ConclusionSTG adherence in urology was satisfactory and associated with reduced MDR Enterobacterales bacteremia.

Urological hospitalization reasons and outcomes of octogenarians and nonagenarians: does age really matter?

Since some urological diseases are age-dependent, these patients are admitted to urology wards for treatment more frequently as an inevitable result of aging. In this study, the urological hospitalization reasons and outcomes patients in octogenarian and nonagenarian age groups were evaluated in comparison with younger adult patients. After examining a total of 5615 urology ward admissions of individuals aged 18-99years, we included 443 (7.7%) patients aged 80-89years in the octogenarian group and 32 (0.6%) patients in the nonagenarian group. Ten percent of the remaining 5150 adults were randomly selected to form the control group. The mean ages of the control, octogenarian, and nonagenarian groups were 55.4 ± 16, 83.3 ± 2.6, and 91.9 ± 1.8years, respectively. The most frequent reasons for the hospitalization were a history of or active bladder tumors in the octogenarian and nonagenarian groups [117 (38.5%) and 3 (21.4%), respectively]. The incidences of any complication in the control, octogenarian, and nonagenarian groups were 61 (12.2%), 63 (15.7%), and 12 (42.9%), respectively. Mortality was seen in five (1%) patients in the control group, 11 (2.5%) in the octogenarians, and five (15.6%) in the nonagenarians. The complication and mortality rates of the nonagenarian group were statistically significantly higher than the remaining two groups (p < 0.001). Due to additional problems that increase with aging, the urology hospitalizations of octogenarian and nonagenarian patients result in more complications. Mortality rates also increase with age. It is aimed to contribute to the literature by revealing the needs and outcomes of octogenarian and nonagenarian patients in the urology clinic.

A feasibility study of urinary catheter removal protocol following transurethral prostatectomy procedure in older patients

AbstractWe hypothesized that older patients who underwent a urinary catheter removal protocol would not have an increased risk of postoperative complications. We further hypothesized that the revised protocol would be more suitable for clinical application. This study aimed to develop a urinary catheter removal protocol after Transurethral Resection of the Prostate and to assess the feasibility of the protocol to support catheter removal and promote recovery of self‐voiding function. Delayed catheter removal after Transurethral Resection of the Prostate was associated with urinary tract infection and longer hospital stays. However, no strategy has been described to promote recovery of self‐voiding function after catheter removal after Transurethral Resection of the Prostate. The urinary catheter removal protocol was developed through expert consensus, including strategies for caring for urinary catheters, assessment of urinary catheter removal, and strategies after urinary catheter removal. Moreover, a quasi‐experimental design was adopted in the urology ward of a tertiary care medical centre in southern Taiwan. Patients aged ≥65 years who underwent Transurethral Resection of the Prostate were included. A total of 13 patients (intervention = 5; control = 8) were included in the feasibility evaluation. A urinary catheter removal protocol after Transurethral Resection of the Prostate was developed and the consensus among experts on the urinary catheter removal protocol was 99%. There were no significant differences in terms of bleeding, urine retention, urinary tract infection, or re‐catheterization between the two groups. However, in the intervention group, the pain score decreased significantly on the second day after Transurethral Resection of the Prostate. This revised urinary catheter removal protocol after Transurethral Resection of the Prostate may be suitable for clinical applications. However, small size reduces the statistical power of the findings and further studies are needed to examine the current protocol does not have an increased risk of postoperative complications.

Surgical and medical co-management optimizes surgical outcomes in older patients with chronic diseases undergoing robot-assisted laparoscopic radical prostatectomy

Introduction While robotic-assisted laparoscopic radical prostatectomy (RRP) is a standard mode for localized prostate cancer (PC), the risk of complications in older patients with chronic diseases and complex medical conditions can be a deterrent to surgery. Surgical and medical co-management (SMC) is a new strategy to improve patients’ healthcare outcomes in surgical settings. Methods We reviewed the clinical data of older patients with chronic diseases who were cared for with SMC undergoing RRP in our hospital in the past 3 years and compared them with the clinical data from the general urology ward. Preoperative conditions and related indicators of recovery, and incidence of postoperative complications with the Clavien Grade System were compared between these two groups. Results The indicators of recovery were significantly better, and the incidence rates of complications were significantly reduced in the SMC group at grades I–IV (p < 0.05), as compared to the general urology ward group. Conclusions The provision of care by SMC for older patients focused on early identification, comorbidity management, preoperative optimization, and collaborative management would significantly improve surgical outcomes. The SMC strategy is worthy of further clinical promotion in RRP treatment in older men with chronic diseases and complex medical conditions.

The Impact of Sociodemographic Factors on the Rationing of Nursing Care in Urology Wards

The problem of care rationing is widespread all over the world and results from many factors affecting nurses. These factors may result from the environment in which the nurses work, e.g., the atmosphere at work, or may not be related to work, e.g., place of residence. The aim of this study was to examine the impact of sociodemographic factors (place of residence, satisfaction with the financial situation, number of forms of postgraduate education, work system, number of patients per nurse, number of diseases) on care rationing, job satisfaction and quality of nursing care. The study is a cross-sectional study which includes 130 nurses from all over Poland who work in urology wards. The criteria for inclusion were consent to the examination, practicing the profession of a nurse, work in the urology department and work experience of at least 6 months, regardless of the number of hours worked (full-time/part-time). The study was conducted using the standardized PIRNCA (Perceived Implicit Rationing of Nursing Care) questionnaire. The average rationing nursing care was 1.11/3 points which means nursing care was rarely rationed. The average job satisfaction was 5.95/10 points, and the assessment of the quality of patient care was 6.88/10 points, which means a medium level of the job satisfaction and the quality of patient care. The rationing of care was affected by the number of nurse illnesses; job satisfaction was influenced by the place of residence and satisfaction with the financial situation, while the quality of care was not influenced by any of the analyzed factors. The result of care rationing is at a similar level as the results in Poland and abroad. Despite the rare rationing of care, employers should take corrective action, especially in terms of increasing the staff and health prevention of nurses.

Trends in the age of hospitalized patients with urological cancers: A17-year experience.

To investigate the impact of global aging on the trends in the age of hospitalized patients with a urological cancer diagnosis. We retrospectively evaluated a cumulative total of 10 652 cases of referred patients (n=6637) with a urological disease who were hospitalized in our institution between January 2005 and December 2021. We compared age and the proportion of patients aged ≥80 years among patients who were hospitalized in the urological ward between the period of 2005-2013 and that of 2014-2021. We identified 8168 hospitalized patients with urological cancer. The median age was significantly increased in patients with urological cancer between the periods of 2005-2013 and 2014-2021. The proportion of hospitalized patients with urological cancer aged ≥80 years was significantly increased between the periods of 2005-2013 (9.3%) and 2014-2021 (13.8%). The median ages of the patients with urothelial cancer (UC) and renal cell carcinoma (RCC), but not the median age of those with prostate cancer (PC), were significantly increased between the study periods. The proportion of hospitalized patients with UC, but not the proportions of those with PC and RCC, aged ≥80 years was significantly increased between the study periods. The age of patients with urological cancer who were hospitalized in the urological ward and the proportion of patients with UC aged ≥80 years significantly increased over the entire study period.

Prevalence of uropathogens in catheter associated urinary tract infections and their antimicrobial susceptibility.

Objective: To assess the bacterial profile for catheter associated UTI and the antimicrobial sensitive to most commonly used antibiotics in Sheikh Zayed Hospital, Rahim Yar Khan. Study Design: Cross-sectional study. Setting: Urology Ward of Sheikh Zayed Medical College/Hospital Rahim Yar Khan. Period: 01 February, 2021 to 31 July, 2021. Material &amp; Methods: The urine samples were collected from 100 patients. Clinical and microbiological data were analyzed from patients with CAUTI. Results: A total of 100 patients were included in the study in which 82 samples were positive for bacterial growth and 18 samples did not show growth. Out of 82 strains, E. coli (46) was the most frequently isolated pathogen followed by Klebsiella pneumonia (17), Pseudomonas (10), Proteus (4), Candida (3) and Staphylococci (2). Conclusion: Study concluded that most common cause of UTI was E. coli in catheter associated patients while the meropenem and colistin were the most sensitive drugs of choice.

A rare complication of Escherichia coli induced urosepsis; is Guillain-Barre syndrome

Guillain Barre syndrome (GBS) is the most common neurological cause of acute flaccid paralysis worldwide. Early diagnosis and treatment of GBS are vital due to possible deadly consequences. Awareness of the silent neurological symptoms in patients preparing for upcoming surgery may have critically crucial for a urologist. Developing GBS after relieving urosepsis is rarely addressed in the literature. Therefore, this report presents an infrequent complication of Escherichia coli (E. coli)-induced urosepsis, GBS. A 47-year-old female patient was admitted to the emergency department in a septic state. During the intensive care unit management with the preliminary diagnosis of sepsis-related hypovolemic shock, a nephrostomy catheter was placed in an obstructed left kidney due to impacted upper ureteral calculus with 1.5 cm in size. Following the improvement of the patient’s condition in intensive care unit with proper management, the patient was transferred to the urology ward for definitive treatment. During the follow-up, however, the patient showed some neurological signs and symptoms considering GBS. An obtained cerebral spinal fluid analysis revealed an albumin-cytologic dissociation and examining the patient underpinned the diagnosis. The patient was treated with intravenous immunoglobulin for five days, according to the guidlines. After the treatment, the patient’s condition improved rapidly following two weeks. The left obstructed ureteral stones were removed with ureteroscopy. A stone-free status was achieved the following month. GBS is the most common cause of acute flaccid paralysis worldwide, and proper management is essential due to poor prognosis. GBS after a uroseptic condition is sporadic, but any surgery on patients who experience active GBS would bode for severe consequences, so awareness of the silent neurological symptoms in patients prepared for upcoming surgery is vital for a urologist. We aimed to remind with this report of the possibility of GBS for a patient who expresses neurological symptoms following a septic state.

DIVERSITY OF BACTERIAL CONTAMINATION ON IN-ANIMATE SURFACES OF A TERTIARY CARE HOSPITAL AND THEIR SENSITIVITY TO DISINFECTANTS

Healthcare-associated infections are major causes of morbidity and mortality amonghospitalized patients. These infections are associated with frequent in-animate surface contamination inhospitals. In the present study antibacterial activity of three commercially available disinfectantsincluding Benzalkonium chloride (BZK), Polyhexamethylene biguanide (PHMB) and Glutaral C11-C15 Pareth 9 against Escherichia coli, Pseudomonas spp., Serratia spp. and Vibrio spp. isolated frominanimate surfaces of urology ward were evaluated. Efficacy of disinfectants was determined byminimum inhibitory concentration (MIC) and agar well diffusion. Mean zones of inhibition (ZOI) ofBZK against the isolates ranged from 23.8 to 26mm followed by PHMB 23.3 to 27.4mm and GlutaralC11-C19 Pareth 9 12 to 13mm. The MIC ranges were 2.5-20µL/mL for BZK; 1-16 µL/mL for PHMBand 8-64 µL/mL for Glutaral C11-C19 Pareth 9. It was concluded that Glutaral C11-C19 Pareth 9 hadminimum efficacy against E. coli, Pseudomonas spp. and Serratia spp. while Vibrio spp. were leastsusceptible to BZK. The mean MIC value of PHMB against E. coli, Pseudomonas spp. Vibrio spp. andSerratia spp. was the lowest among the disinfectants.