Use Of Urinary Catheters Research Articles

Regional variation in urinary catheter use in the Netherlands from 2012 to 2021: a population-based cohort.

Our aim was to evaluate trends and regional differences in the use of indwelling and intermittent urinary catheters in the community setting in the Netherlands from 2012 to 2021. For this population-based cohort study, data on catheter use was collected from the Drug and Medical Devices Information System of the National Healthcare Institute of the Netherlands. This database contains information on the Dutch insured population, which was 100% of the total population in 2018. Users were divided into 12 provinces according to the Nomenclature of Territorial Units for Statistics codes. The number of catheter users was adjusted for the total population of the provinces by sex and age, and was expressed by users per 100,000 people. Negative binomial regression (NBR) was used to test for differences in clean intermittent catheter (CIC) and indwelling catheter (IDC) users across Dutch provinces. Between 2012 and 2021, IDC users increased by 44.6% from 41,619 to 60,172, and CIC users increased by 27.3% from 34,204 to 43,528. The greatest increases were mainly observed among IDC users over 85 years old and male CIC users over 65 years old. NBR showed significant differences for IDC and CIC users between the 12 provinces. CIC incidence was higher in Drenthe and Groningen (Northern Netherlands) compared to Zuid-Holland (Southern Netherlands). IDC incidence was higher in seven provinces dispersed throughout the Netherlands compared to Noord-Holland. CIC and IDC users have continued to increase in recent years; this was especially observed among older men. In addition, there were regional differences in the number of CIC and IDC users; CIC was more prominent in the northern region of the Netherlands, and IDC varied between multiple provinces. Practice variation in urinary catheterization may result from patient population differences or healthcare provider preferences and their alignment with guidelines.

Bloodstream Infections Caused by Multidrug Resistant Bacteria: Clinical and Microbiological Features and Mortality.

Bloodstream infections (BSI) are associated with high morbidity and mortality. The aim of our study is to determine whether there is a relationship between certain risk factors such as the underlying disease, patient's medical history, or interventional procedures and multidrug resistant (MDR) bacterial infection and to determine the risk factors for mortality. Two hundred and twenty-two outpatients and inpatients who were diagnosed with bacteremia over a 6-month period were included in the study. 232 agents from 222 patients were isolated and tested for antimicrobial susceptibility. The relationship between patients demographic and clinical data and MDR was analyzed. The most common microorganisms were Gram-negative bacteria (59.4%), Gram-positive bacteria (36.9%), Candida species (2.2%), and anaerobic bacteria (1.35%). The most common isolates were Escherichia coli 53 (22.8%), Staphylococcus aureus 35 (%15.1), Klebsiella pneumoniae 26 (11.2%), Pseudomonas spp. (n=17, 7.3%), Acinetobacter spp 17 (7.3%), and Enterococcus spp 14 (6%). Microorganisms with the highest antimicrobial resistance observed were 82.3% in Acinetobacter baumannii, 64.5% in coagulase-negative staphylococci, 60.3% in E. coli, 50% in K. pneumoniae, and 27.2% in Enterobacterales spp. Most patients with BSI caused by MDR bacteria were in the intensive care unit (64%). Sepsis diagnosis, urinary catheter use, history of surgery, and use of broad-spectrum antibiotics as well as risk factors for antibiotic-resistant bacteremia, coronary artery disease, inappropriate empirical therapy, healthcare-associated infections, urinary catheterization, and stay in the ICU were determined as risk factors for mortality. Our study identified the risk factors of BSI caused by MDR bacteria and helped to reveal the relationship between these factors and mortality.

Addressing CAUTIs with an External Female Catheter

Catheter-associated urinary tract infections (CAUTIs) can lead to complications that prolong hospital stays and result in patient discomfort as well as increased health care costs and mortality. At our academic medical center in New York City, in 2016-17, 21 of 87 CAUTI cases (24%) were in bedbound female patients in whom indwelling catheters were used for incontinence. Although condom catheters were available as an alternative to indwelling urinary catheters for male patients, there was a lack of effective products for female patients. A team of clinical nurse specialists (CNSs) conducted a literature search, reviewed internal data on CAUTI rates and catheter use, and searched for available catheter alternatives that would meet the needs of bedbound female patients. The team identified two different external female urinary catheters and piloted both with a focus on efficacy as well as stakeholder satisfaction. In 2019-20, external female catheters were used in 1,195 unique patients. Approximately 90% of external female catheter use was to avoid using an indwelling urinary catheter. With a cost avoidance of $13,786 per patient, $16,473,912 in costs to the organization were avoided. CAUTI rates in bedbound female patients decreased after implementation of the external female catheters. This initiative demonstrates that external female urinary catheters can be used at other hospitals to decrease indwelling urinary catheter use and CAUTI rates in bedbound female patients.

Racial Differences in Urinary Catheter Use Among Female Nursing Home Residents

ObjectiveTo assess racial differences in prevalence of indwelling urinary catheterization and intermittent catheterization among female NH residents in the United States (US). MethodsWe performed a cross-sectional analysis using the 2019 Minimum Data Set 3.0 and developed a multivariable logistic regression model to examine the association between catheter use and race. Moderation analyses were performed to clarify significant associations. ResultsOur study cohort was composed of 597,966 women, who were predominantly of White race with a median age of 80 years. Eight percent (n=47,799) of female residents had indwelling catheters, and 0.5% (n=2,876) used intermittent catheterization. Black residents had a 7% lower odds of having an indwelling catheter (aOR 0.93, 95% CI 0.90-0.96), and a 38% lower odds of utilizing intermittent catheterization (aOR 0.62, 95% CI 0.54-0.71) compared to White residents when controlling for common factors associated with catheter use. In moderation analyses, Black residents with age under 80 years and BMI of 35 kg/m2 or greater were less likely to have an indwelling catheter than age- and BMI-matched White residents. ConclusionRacial differences in both indwelling and intermittent catheterization prevalence exist in female NH residents. These disparities should be further clarified to reduce bias in NH care.

Burden of Prolonged Urinary Catheter Use after Urinary Retention in a Tertiary Hospital, South-South Nigeria

Background: Urinary retention is a worldwide health problem mostly noted in elderly men who may have benign prostatic hyperplasia (BPH), cancer of the prostate (Cap), urethral stricture disease or bladder tumour. It has a negative impact on the quality of life (QOL) of the sufferer as well as national or global economy. Urethral catheterization is used to relief the retention and suprapubic cystostomy where the urethral route fails or it’s contraindicated. Complications have been reported especially when catheters are worn for prolonged periods of time. The aim of this work was to study the burden of prolonged use of catheters after urinary retention. Patients and Method: The study was conducted in March 2021 and lasted for four (4) weeks to prevent data duplication since our patients change their catheters once in 4 weeks. A questionnaire was designed and completed by all patients after informed consent was obtained. Data collected were analyzed using statistical package for social science (SPSS) version 20.0 and results used for discussion. Results: Eighty two (82) patients with a mean age of 63.12±14.67 years were studied. Aetiology of urinary retention was BPH, Cap, and Urethral stricture in 58.5%, 19.5% and 23.0% respectively. More patients were in their 7th and 8th decades of life. Most patients had indwelling urethral catheter (65.9%), average duration of catheter use was 21.26 months. There was no statistical significant difference in the mean duration between those who used SPC and Urethral catheter (P= .411).Ninety-eight (98.7%) of patients had complications and 22% of them reported more than five (5) complications. Qol correlated poorly with those who had sexual issues due to prolonged catheter use. The estimated annual cost for catheter change was between N1.5million and N2.0 million in our facility. Conclusion: Prolonged catheter use is a source of concern to patients and poses serious health-related and financial burden to them.

Renal diseases associated with multiple sclerosis: A narrative review

The mechanisms of renal pathology in multiple sclerosis (MS) can be related to the disease itself or its treatment. Although kidney disease can be associated with MS, not much has been reported in the literature; hence, our study aimed to describe the prevalence and types of renal diseases and discuss their prognosis in patients with MS. A literature search (2012-2022) was performed using the Scale for the Assessment of Narrative Review Articles. The databases searched included MEDLINE (PubMed) and EMBASE. Fourteen articles from these databases met the inclusion criteria. The inclusion criteria were as follows: publications with full-text access. Articles published in English. Original articles related to renal diseases in MS. The prevalence of renal diseases in MS from the articles obtained ranged from 0.74% to 2.49%. Interferon beta (IFN-β)-associated glomerulonephritis was common among the reviewed articles. Significant improvement and resolution of the pathology were observed after the discontinuation of the offending medication. Renal symptoms in 2 out of 4 cases with renal thrombotic microangiopathy (TMA) induced by interferon-beta progressed to chronic kidney disease, even after the drug was stopped. Other studied renal pathologies included nephrolithiasis secondary to urinary retention and urinary catheter use in patients with MS.

Factors Associated With Catheter-Associated Urinary Tract Infection in Patients in the Intensive Care Unit

Catheter-associated urinary tract infection (CAUTI) commonly occurs in intensive care units (ICU) and is associated with longer hospital stays and higher healthcare costs, morbidity, and mortality. The purpose of this study was to examine the factors associated with CAUTI in ICU patients. This study was a secondary analysis of data from a study on the usage of indwelling catheters in adult internal and surgical ICU patients at a teaching hospital in southern Taiwan conducted between January 1 and December 31, 2017. Descriptive analysis, the independent t test, chi-square test, and logistic regression were used to examine the factors associated with CAUTI. Of the 1,120 patients with an indwelling urinary catheter in the ICU, 330 revealed a positive urine culture result, indicating a 29.5% prevalence of CAUTI. The average duration of indwelling urinary catheter usage was 6.55 (SD = 4.89) days. The participants averaged 69.93 years old (SD = 15.19 years), and 627 (56.0%) were men and 493 (44.0%) were women. Being female, having diabetes, having a large indwelling urinary catheter, having a longer duration of indwelling urinary catheter usage, and being unable to remove the indwelling urinary catheter during the ICU stay were found to be associated with a significantly higher risk of CAUTI. Women and patients with diabetes are particularly vulnerable to CAUTI. Thus, urinary catheters should be used with caution. Using smaller-sized urinary catheters and reducing the duration of urinary catheter use are suggested. The results of this study may be used to guide clinical practice to help reduce the incidence of CAUTI and enhance overall healthcare service quality.

Epidemiology, species distribution, antifungal susceptibility, and outcome of candidemia in intensive care units in Isfahan, Iran.

Candidemia is known as an invasive fungal infection with high mortality. The prevalence of candidemia in intensive care unit (ICU) patients is more than in other hospital wards. Early diagnosis of candidemia in these patients is essential for disease management. This study included 250 patients suspected of candidemia. Blood samples were taken from patients and incubated. The fungal isolates were identified by PCR-RFLP method using MSP I restriction enzyme. Demographic characteristics, risk factors, underlying diseases, and laboratory analysis results were mined in this study. In total, 22 blood samples were identified as positive for Candida yeasts in culture. The most common underlying diseases in these patients were heart disease and hypertension (36.4%). Candida albicans with 12 cases (54.5%) was the most isolated species, followed by C. parapsilosis (n=5, 22.7%), C. glabrata (n=4, 18.2%), and C. tropicalis (n=1, 4.5%) in descending order. Intravenous catheter use was recognized as the most common risk factor in patients with candidemia (77.3%), and after that, the use of mechanical ventilation (68.2%) and urinary catheter (40.9%) obtained the highest frequency. Furthermore, 17 patients were prescribed at least one antifungal drug, of which fluconazole was the most used (36.4%). The mortality rate in patients in this study was 63.6%. All C. albicans isolates were susceptible to antifungal agents but in non-albicans Candida (NAC), drug resistance to fluconazole, voriconazole, and caspofungin were observed. Although C. albicans was the most common fungal species in this study, the prevalence of NAC species was high. The increasing frequency of NAC species is a concern because they have different patterns of drug resistance. Recognition of risk factors in patients admitted to ICUs can help prevent candidemia or properly manage the disease.

A Meta-analysis of Mortality Factors in Patients with Klebsiella Pneumoniae Bloodstream Infection

Objective: To systematically analyze the risk factors for bloodstream infections (BSI) of Klebsiella pneumoniae (KP) and its adverse prognosis (death), and provide theoretical basis for improving clinical prevention and control efficiency and reducing mortality. Methods: The literatures related to KP BSI risk factors and death risk factors were searched in CNKI, Wanfang, VIP, PubMed and Cochrane databases. Relevant literatures were screened according to inclusion and exclusion criteria, and the quality evaluation and data extraction were carried out for the finally included literatures. Meta-analysis was conducted by STATA12.0 software. Results: A total of 9 literatures were included with a total sample size of 2014, all of which were retrospective studies with NOS scores of 7-9.Meta analysis showed that: the history of hospitalization, history of ICU stay, high blood pressure, heart disease, kidney disease, lung disease, liver abscess, hypoalbuminemia, hemodialysis, mechanical ventilation, deep venipuncture, indwelling gastric tube, parenteral nutrition, placing a urinary catheter use radiotherapy/ chemotherapy, hormone and immune inhibitor use, antibiotics (beta lactam, carbon green alkene, quinolone, for ring element, cephalosporins) the use of the difference between groups was statistically significant (P < 0.05).Publication bias showed that ICU admission history, hypertension, and malignant tumors were biased. After the one-way study was adopted, ICU admission history and hypertension had no significant bias, which was accepted. Conclusion: the history of hospitalization, history of ICU stay, high blood pressure, heart disease, kidney disease, lung disease, liver abscess, hypoalbuminemia, hemodialysis, mechanical ventilation, deep venipuncture, indwelling gastric tube, parenteral nutrition, placing a urinary catheter use radiotherapy/ chemotherapy, hormone and immune inhibitor use, antibiotics (beta lactam, carbon green alkene, quinolone, for ring element, cephalosporins) the use of KP is the major risk factors of death in patients with bloodstream infections.

Epidemiology, species distribution, antifungal susceptibility, and outcome of candidemia in intensive care units in Isfahan, Iran

Background and Purpose: Candidemia is known as an invasive fungal infection with high mortality. The prevalence of candidemia in intensive care unit (ICU) patients is more than in other hospital wards. Early diagnosis of candidemia in these patients is essential for disease management.
 Materials and Methods: This study included 250 patients suspected of candidemia. Blood samples were taken from patients and incubated. The fungal isolates were identified by PCR-RFLP method using MSP I restriction enzyme. Demographic characteristics, risk factors, underlying diseases, and laboratory analysis results were mined in this study.
 Results: In total, 22 blood samples were identified as positive for Candida yeasts in culture. The most common underlying diseases in these patients were heart disease and hypertension (36.4%). Candida albicans with 12 cases (54.5%) was the most isolated species, followed by C. parapsilosis (n=5, 22.7%), C. glabrata (n=4, 18.2%), and C. tropicalis (n=1, 4.5%) in descending order. Intravenous catheter use was recognized as the most common risk factor in patients with candidemia (77.3%), and after that, the use of mechanical ventilation (68.2%) and urinary catheter (40.9%) obtained the highest frequency. Furthermore, 17 patients were prescribed at least one antifungal drug, of which fluconazole was the most used (36.4%). The mortality rate in patients in this study was 63.6%. All C. albicans isolates were susceptible to antifungal agents but in non-albicans Candida (NAC), drug resistance to fluconazole, voriconazole, and caspofungin were observed. 
 Conclusion: Although C. albicans was the most common fungal species in this study, the prevalence of NAC species was high. The increasing frequency of NAC species is a concern because they have different patterns of drug resistance. Recognition of risk factors in patients admitted to ICUs can help prevent candidemia or properly manage the disease.

On Low-Value Nursing Care: Part 2, De-implementing Practices in Your Unit.

On Low-Value Nursing Care: Part 2, De-implementing Practices in Your Unit.

Risk factors for mortality over 18 years in 317 ICUs in 9 Asian countries: The impact of healthcare-associated infections.

To identify risk factors for mortality in intensive care units (ICUs) in Asia. Prospective cohort study. The study included 317 ICUs of 96 hospitals in 44 cities in 9 countries of Asia: China, India, Malaysia, Mongolia, Nepal, Pakistan, Philippines, Sri Lanka, Thailand, and Vietnam. Patients aged >18 years admitted to ICUs. In total, 157,667 patients were followed during 957,517 patient days, and 8,157 HAIs occurred. In multiple logistic regression, the following variables were associated with an increased mortality risk: central-line-associated bloodstream infection (CLABSI; aOR, 2.36; P < .0001), ventilator-associated event (VAE; aOR, 1.51; P < .0001), catheter-associated urinary tract infection (CAUTI; aOR, 1.04; P < .0001), and female sex (aOR, 1.06; P < .0001). Older age increased mortality risk by 1% per year (aOR, 1.01; P < .0001). Length of stay (LOS) increased mortality risk by 1% per bed day (aOR, 1.01; P < .0001). Central-line days increased mortality risk by 2% per central-line day (aOR, 1.02; P < .0001). Urinary catheter days increased mortality risk by 4% per urinary catheter day (aOR, 1.04; P < .0001). The highest mortality risks were associated with mechanical ventilation utilization ratio (aOR, 12.48; P < .0001), upper middle-income country (aOR, 1.09; P = .033), surgical hospitalization (aOR, 2.17; P < .0001), pediatric oncology ICU (aOR, 9.90; P < .0001), and adult oncology ICU (aOR, 4.52; P < .0001). Patients at university hospitals had the lowest mortality risk (aOR, 0.61; P < .0001). Some variables associated with an increased mortality risk are unlikely to change, such as age, sex, national economy, hospitalization type, and ICU type. Some other variables can be modified, such as LOS, central-line use, urinary catheter use, and mechanical ventilation as well as and acquisition of CLABSI, VAE, or CAUTI. To reduce mortality risk, we shall focus on strategies to reduce LOS; strategies to reduce central-line, urinary catheter, and mechanical ventilation use; and HAI prevention recommendations.

Determinants and prognostic value of in-hospital infection in patients waiting for permanent pacemaker implantation

BackgroundIn-hospital delays in permanent cardiac pacemaker (PPM) implantation are common and may result in in-hospital infection among patients waiting for PPM implantation (pre-PPM-HI). This study investigated the predictors and prognostic impact of these events. MethodsWe retrospectively evaluated 905 consecutive patients (68.2 ± 16.0 years; 54% males) who underwent PPM implantation. Clinical characteristics, pre-PPM-HI and 30-day mortality were recorded and a risk score for pre-PPM-HI was generated using multivariable logistic regression coefficients. ResultsEigthy-nine patients (10% of the sample) developed pre-PPM-HI. Multivariable logistic regression analysis identified urinary catheter use, complete atrioventricular block, implantation of temporary pacemaker and diabetes mellitus as independent predictors of pre-PPM-HI. The generated score (range 0–10.1) played a better role in predicting pre-PPM-HI than individual factors, yielding an area under the curve [95%CI] of 0.754 [0.705–0.803]. Patients with score ≥ 7.5 had 18-fold greater risk of developing pre-PPM-HI than those with score < 2.5. Furthermore, multivariable Cox-regression analysis showed that patients who developed pre-PPM-HI had greater 30-day mortality after PPM implantation (hazard ratio [95%CI] = 2.90 [1.18–7.16], p = 0.021) compared with their counterparts. ConclusionsThis study reveals that pre-PPM-HI is an independent predictor of early mortality after PPM implantation. In addition, a clinical score developed from simple clinical variables accurately identified patients at high risk of pre-PPM-HI. In scenarios where delays in PPM implantation are unavoidable, such as reference hospitals with high demand, the use of this tool can potentially help in the hierarchy of patients and in the reduction of this adverse event.

Clinical and Molecular Characterizations of Carbapenem-Resistant Klebsiella pneumoniae Causing Bloodstream Infection in a Chinese Hospital.

ABSTRACTBloodstream infection (BSI) caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) is a serious and urgent threat for hospitalized patients. This study aims to describe the clinical and molecular characteristics of CRKP causing BSI in a tertiary-care hospital in Beijing, China. A total of 146 CRKP strains and 39 carbapenem-susceptible K. pneumoniae (CSKP) strains collected in the hospital from 2017 to 2020 were sent for whole-genome sequencing. Univariate and multivariate analyses were used to evaluate risk factors for in-hospital mortality of CRKP-BSI cases. Thirty (20.5%) of 146 CRKP-BSI patients and three (7.7%) of 39 CSKP-BSI patients died at discharge (χ2 = 3.471, P = 0.062). Multivariate logistic regression analysis indicated that age and use of urinary catheters were independent risk factors for the death of CRKP-BSI. The 146 CRKP isolates belonged to 9 sequence types (STs) and 11 serotypes, while the 39 CSKP isolates belonged to 23 STs and 27 serotypes. The mechanism of carbapenem resistance for all the CRKP strains was the acquisition of carbapenemase, mainly KPC-2 (n = 127). There were 2 predominant serotypes for ST11 CRKP, namely, KL47 (n = 82) and KL64 (n = 42). Some virulent genes, including rmpA2, iucABCD and iutA, and repB gene, which was involved in plasmid replication, were detected in all ST11-KL64 strains. Evolutionary transmission analysis suggested that ST11 CRKP strains might have evolved from KL47 into KL64 and were accompanied by multiple outbreak events. This study poses an urgent need for enhancing infection control measures in the hospital, especially in the intensive care unit where the patients are at high-risk for acquiring CRKP-BSI.IMPORTANCE CRKP-BSI is demonstrated to cause high mortality. In this study, we demonstrated that ST11 CRKP strains might carry many virulent genes. Meanwhile, outbreak events occurred several times in the strains collected. Carbapenemase acquisition (mainly KPC-2 carbapenemase) was responsible for carbapenem resistance of all the 146 CRKP strains. As 2 predominant strains, all ST11-KL64 strains, but not ST11-KL47 strains, carried rmpA2, iucABCD, iutA, as well as a plasmid replication initiator (repB). Our study suggested that the occurrence of region-specific recombination events manifested by the acquisition of some virulence genes might contribute to serotype switching from ST11-KL47 to ST11-KL64. The accumulation of virulent genes in epidemic resistant strains poses a great challenge for the prevention and treatment of BSI caused by K. pneumoniae in high-risk patients.

Indwelling Bladder Catheter Using in Cesarean Section: Is It Really Necessary?

Aim: This study aimed to evaluate the safety of cesarean section (CS) without an indwelling bladder catheter. We also aimed to compare the differences of clinical and voiding characteristics in patients with or without the urinary catheter after CS.&#x0D; &#x0D; Materials and Methods: This case-control study was conducted retrospectively in Gazi University Faculty of Medicine Hospital between April and September 2021. A total of 40 patients having an elective CS were reviewed. Among these patients, two groups were analyzed according to urinary catheter use: Patients without the urinary catheter (Group 1 / Study) and patients with the urinary catheter (Group 2 / Control). Outcome measures were postoperative urination, postoperative mobilization, and the discharge time of the patients. &#x0D; &#x0D; Results: While cesarean duration was significantly longer in group 1, postoperative urination, postoperative mobilization, and the hospital discharge times were significantly longer in group 2 (p

Comparison of subcutaneous analgesic system and epidural analgesia for postoperative pain control in open pediatric oncology operations: A randomized controlled trial

PurposeChildren undergoing open oncologic surgery can have significant post-operative pain. The purpose of this trial was to compare a surgeon-placed subcutaneous analgesic system (SAS) to epidural analgesia. MethodsSingle center randomized controlled trial including children ≤18 years undergoing open tumor resection between October 2018 and April 2021. Randomization to SAS or epidural was done preoperatively and perioperative pain management was standardized. Families were blinded to the modality. Comparisons of oral morphine equivalents (OME) and pain scores for three postoperative days, clinical outcome parameters, and parental satisfaction following unblinding were completed using non-parametric analyses. ResultsOf 36 patients (SAS 18, Epidural 18), median age was 5 years (range <1–17). The Epidural cohort had less OME demand on postoperative day one (SAS 0.76 mg/kg, Epidural 0.11 mg/kg; p<0.01) and two (SAS 0.48 mg/kg, Epidural 0.07 mg/kg, p = 0.03). Pain scores were similar on postoperative days 1–3 (0–2 in both groups). The Epidural cohort had more device complications (SAS 11%, Epidural 50%; p = 0.03) and higher urinary catheter use (SAS 50%, Epidural 89%; p = 0.03). More than 80% of parents would use the same device in the future (SAS 100%, Epidural 84%, p = 0.23). ConclusionFor children undergoing open oncologic abdominal or thoracic surgery, early post-operative pain control appears to be better with epidural analgesia; however, SAS has decreased incidence of device complications and urinary catheter use. Parental satisfaction is excellent with both modalities. SAS could be considered as an alternative to epidural, especially in settings when epidural placement is not available or contraindicated. Type of studyTreatment study, Randomized controlled trial. Level of evidenceLevel 1.

Trends in Urinary Catheter Use by Indication in US Emergency Departments, 2002-2019

This retrospective study examines trends in urinary catheter use in US emergency departments between 2002 and 2019.

Pediatric Candidemia in the Indian Subcontinent, and in Parts of the Middle East, Africa, and South America

Candidemia is defined as the isolation of Candida species from at least one blood culture with the presence of symptoms of sepsis. It is the main cause of fungal nosocomial bloodstream infections with its resultant mortality in children ranging from 5% to 71% and sometimes over 80%. A thorough search of the literature in Google, PubMed, Med Facts, using different sets of keywords, viz. candidemia, bloodstream Candida infections, neonates, children, and developing countries showed that candidemia in neonates and children is caused by a variety of species, viz. Candida albicans, C. auris, C. famata, C. glabrata, C. guilliermondii, C. krusei, C. ortholopsis, C. parapsilosis, and C. tropicalis. The predominant etiological agents vary in different countries. Risk factors in most of the reports included prematurity, mechanical ventilation, prolonged use of antibiotic and steroid urinary catheter, hH 2 blockers, neutropenia, leukemia, and malnourishment. The underlying diseases included sepsis, pyogenic meningitis, encephalitis, pneumonia, acute reparatory distress syndrome, chronic liver disease, and kidney disease, etc. A noteworthy observation in the literature is that several investigators employed MALD-TOFE, PCR, and molecular methods including DNA sequencing in addition to the study of phenotypic features for the characterization of Candida species. Antifungal therapy in most studies used liposomal amphotericin B, caspofungin, azoles, or combination therapies The epidemiology of pediatric candidemia varies in different countries. Surveillance of candidaemia in different regions is necessary, especially in neonates and children. Rapid and precise detection of Candida species isolated from the bloodstream by polymerase chain reaction, restriction fragment length polymorphism technique can help in better management of candidemia. The strategies for the prevention of candidemia include improved hand hygiene, optimal catheter placement and care, and prudent hygiene. Prophylactic antifungal therapy is recommended for patients who have not yet been diagnosed with candidemia but are at a high risk of acquiring Candida infections.

Carbapenem-resistant Enterobacteriaceae bloodstream infections: A case-control study from a pediatric referral hospital in Argentina.

BackgroundAntibiotic-resistant gram-negative bloodstream infections (BSI) remain a leading cause morbidity and mortality in pediatric patients with a high impact on the public health system. Data in resource-limited countries, including those in Latin America and the Caribbean region, are scarce. The aim of the study was to identify risk factors for acquiring carbapenem-resistant Enterobacteriaceae (CRE) bacteremia in children and to assess the use of resources.MethodsA retrospective case-control study was conducted to analyze demographic, epidemiological, clinical, microbiological, and outcome data as well as the use of resources between 2014 and 2019. Univariate and logistic regression analysis was performed in order to identify risk factors associated with CRE-BSI. The R software version 4.1.2 was used.ResultsA total of 46 cases with CRE-BSI and 92 controls with gram-negative non-CRE-BSI were included. No statistical difference was observed regarding: median age (36 months; IQR, 11.2–117 vs. 48 months, IQR 13–119), male sex (50 vs. 60%), and underlying disease (98 vs. 91%) in cases vs. controls, respectively. The most frequent mechanism of CRE bacteremia were: KPC in 74%, OXA in 15%, and NDM in 6.5%. A total of 54.3% of cases vs. 32.6 % (p = 0.016) of controls were admitted to the pediatric intensive care unit (PICU), and 48 vs. 21% (p = 0.001) required mechanical ventilation. Bacteremia secondary to intra-abdominal infection was observed in 56.5% of cases vs. 35% of controls (p = 0.032). Previous colonization with CRE was detected in 76% of cases vs. 8% of controls. Combination antimicrobial treatment was most frequent in cases vs. control (100 vs. 56.5%). No difference was observed in median length of hospital stay (22 days; IQR, 19–31 in cases vs. 17.5 days; IQR, 10–31 in controls; p = 0.8). Overall case fatality ratio was 13 vs. 5.5%, respectively. The most statistically significant risk factors included previous PICU stay (OR, 4; 95%CI, 2–8), invasive procedures/surgery (OR, 3; 95%CI, 1–7), central venous catheter placement (OR, 6.5; 95%CI, 2–19), urinary catheter placement (OR, 9; 95%CI 4–20), mechanical ventilation (OR, 4; 95%CI, 2–10), liver transplantation (OR, 8; 95%CI, 2–26), meropenem treatment (OR, 8.4; 3.5–22.6) in univariate analysis. The logistic regression model used for multivariate analysis yielded significant differences for previous meropenem treatment (OR, 13; 95%CI, 3-77; p = 0.001), liver transplantation (OR, 13; 95%CI, 2.5–100; p = 0.006), and urinary catheter placement (OR, 9; 95%CI, 1.4–94; p = 0.03).ConclusionCRE-BSI affects hospitalized children with underlying disease, mainly after liver transplantation, with previous urinary catheter use and receiving broad-spectrum antibiotics, leading to high PICU requirement and mortality. These risk factors will have to be taken into account in our region in order to establish adequate health policies and programs to improve antimicrobial stewardship.

Clinical Score for Predicting the Risk of Poor Ambulation at Discharge in Fragility Femoral Neck Fracture Patients: A Development Study.

Surgical treatment in patients with fragility femoral neck fractures often leads to a longer length of hospital stay (LOS) and higher costs. Intensive rehabilitation is one of the choices to reduce LOS, but patient selection criteria are controversial. We intended to develop a clinical score to predict the risk of poor ambulation at discharge. This study was based on a retrospective cohort of patients diagnosed with fragility femoral neck fractures surgically managed from January 2010 to December 2019 at Chiang Mai University (CMU) Hospital. Pre-, intra-, and post-operative factors that affect rehabilitation training were candidate predictors. All patients were categorized into able or unable groups based on their ability to bear self-weight at discharge. Logistic regression was used for score derivation. Five hundred and nine patients were included in this study. Male sex, end-stage kidney disease (ESRD), cerebrovascular disease, psychiatric disorders, pre-fracture ambulation with gait aids, concomitant fracture, post-operative intensive care unit (ICU) admission or ventilator use, and urinary catheter use at second day post-operation were identified as the prognostic factors. The score showed an AuROC of 0.84 with good calibration. The score can be used for risk stratification on the second day post-operation. External validation is encouraged before clinical implementation.