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Archivos Espanoles de Urologia Jul 2021Encrusted pyelitis in an infection caused by Corynebacterium Urealyticum. The incidence has increased, specially in immunosuppressed patients and patients with...
OBJECTIVE
Encrusted pyelitis in an infection caused by Corynebacterium Urealyticum. The incidence has increased, specially in immunosuppressed patients and patients with indwelling urinary catheters.
METHODS
We are presenting a case of a 72 years old male with Bricker urinary derivation with an ureteral catheter. During the follow up, catheteral calcification and encrusted pyelitis were found in TC images and cultures were positive for Corynebacteirum Urealitycum. This condition was managed with endoscopic and medical treatment; that consisted in antibiotics and acidification of urine through nephrostomy tube using an acidifying irrigation solution and Lit-Control pH Down orally, in order to avoid new infections.
RESULTS
Treatment was effective, no new reinfections were shown with the use of Lit-Control pH Down for the maintenance.
CONCLUSIONS
The suspected diagnosis and the early treatment of encrusted pyelitis avoid complications. Antibiotics and urine acidification are key in the treatment of this disease.
Topics: Aged; Corynebacterium; Corynebacterium Infections; Humans; Male; Pyelitis; Urinary Catheters
PubMed: 34219065
DOI: No ID Found -
Annals of Internal Medicine Oct 2019Many hospitals struggle to prevent catheter-associated urinary tract infection (CAUTI). (Observational Study)
Observational Study
BACKGROUND
Many hospitals struggle to prevent catheter-associated urinary tract infection (CAUTI).
OBJECTIVE
To evaluate the effect of a multimodal initiative on CAUTI in hospitals with high burden of health care-associated infection (HAI).
DESIGN
Prospective, national, nonrandomized, clustered, externally facilitated, pre-post observational quality improvement initiative, for 3 cohorts active between November 2016 and May 2018.
SETTING
Acute care, long-term acute care, and critical access hospitals, including intensive care and non-intensive care wards.
PARTICIPANTS
Target hospitals had a high burden of Clostridioides difficile infection plus central line-associated bloodstream infection, CAUTI, or hospital-onset methicillin-resistant Staphylococcus aureus bloodstream infection, defined as cumulative attributable differences above the first tertile in the Targeted Assessment for Prevention (TAP) strategy. Some additional nonrecruited hospitals also joined.
INTERVENTION
Multimodal intervention, including Practice Change Assessment tool to identify infection prevention and control (IPC) and HAI prevention gaps; Web-based, on-demand modules involving onboarding, foundational IPC practices, HAI-specific 2-tiered approach to prioritize and implement interventions, and TAP resources; monthly webinars; state partner-led in-person meetings; and feedback. State partners made site visits to at least 50% of their enrolled hospitals, to support self-assessments and coach.
MEASUREMENTS
Rates of CAUTI and urinary catheter device utilization ratio.
RESULTS
Of 387 participating hospitals from 23 states and the District of Columbia, 361 provided CAUTI data. Over the study period, the unadjusted CAUTI rate was low and relatively stable, decreasing slightly from 1.12 to 1.04 CAUTIs per 1000 catheter-days. Catheter utilization decreased from 21.46 to 19.83 catheter-days per 100 patient-days from the pre- to the postintervention period.
LIMITATIONS
The intervention period was brief, with no assessment of fidelity. Baseline CAUTI rates were low. Patient characteristics were not assessed.
CONCLUSION
This multimodal intervention yielded no substantial improvements in CAUTI or urinary catheter utilization.
PRIMARY FUNDING SOURCE
Centers for Disease Control and Prevention.
Topics: Catheter-Related Infections; Cross Infection; Formative Feedback; Hospital Administration; Hospitals; Humans; Infection Control; Prospective Studies; Quality Improvement; United States; Urinary Catheters; Urinary Tract Infections
PubMed: 31569231
DOI: 10.7326/M18-3534 -
Ugeskrift For Laeger May 2021Catheter-related bladder discomfort is frequent in the post-perative setting, due to an indwelling urinary catheter. It clearly causes discomfort for the patient with... (Review)
Review
Catheter-related bladder discomfort is frequent in the post-perative setting, due to an indwelling urinary catheter. It clearly causes discomfort for the patient with the potential consequences of prolonging the post-operative course. Effective treatment to prevent the condition is missing, and lots of different strategies have been investigated. In this review, we aim to address the current options for treatment with the purpose to encourage focus on the topic and suggest strategies to prevent the condition in order to facilitate a better patient course.
Topics: Catheters, Indwelling; Humans; Urinary Bladder; Urinary Catheterization; Urinary Catheters
PubMed: 33998453
DOI: No ID Found -
Revista Da Escola de Enfermagem Da U S P 2022To analyze the microbiological and microstructural part of indwelling urinary catheters and their association with urinary tract infection prevention.
OBJECTIVE
To analyze the microbiological and microstructural part of indwelling urinary catheters and their association with urinary tract infection prevention.
METHOD
This is a cross-sectional study, from June to December 2020, in which 42 indwelling urinary catheter tips and sterile urine samples were collected for analysis of crystals in optical microscopy and biofilms in scanning electron microscopy. Culture analysis and specification of the type of bacteria were performed.
RESULTS
It was found that 35.71% of the samples had mature biofilm adhered to the catheter tip. Biofilms of Proteus mirabilis, Enterococcus faecalis, Staphylococcus epidermidis, Enterococcus faecium and Enterobacter cloacae stood out. The presence of magnesium-ammonium-phosphate crystal was associated with the presence of urinary tract infection and with Proteus mirabilis. There was a significant association (p = 0.001) between the use of prophylactic antibiotics versus urine culture >105 CFU/mL.
CONCLUSION
The analyzes contributed to clinical practice, as it reinforces the development of effective and monitored strategies on cultures and urinary tract infection prevention associated with indwelling urinary catheters.
Topics: Cross-Sectional Studies; Humans; Urinary Bladder; Urinary Catheterization; Urinary Catheters; Urinary Tract Infections
PubMed: 35377389
DOI: 10.1590/1980-220X-REEUSP-2021-0552 -
The Cochrane Database of Systematic... Aug 2017Intermittent catheterisation is a commonly recommended procedure for people with incomplete bladder emptying. There are now several designs of intermittent catheter... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Intermittent catheterisation is a commonly recommended procedure for people with incomplete bladder emptying. There are now several designs of intermittent catheter (e.g. different lengths, 'ready to use' presentation) with different materials (e.g. PVC-free) and coatings (e.g. hydrophilic). The most frequent complication of intermittent catheterisation is urinary tract infection (UTI), but satisfaction, preference and ease of use are also important to users. It is unclear which catheter designs, techniques or strategies affect the incidence of UTI, which are preferable to users and which are most cost effective.
OBJECTIVES
To compare one type of catheter design versus another, one type of catheter material versus another, aseptic catheterisation technique versus clean technique, single-use (sterile) catheters versus multiple-use (clean) catheters, self-catheterisation versus catheterisation by others and any other strategies designed to reduce UTI and other complications or improve user-reported outcomes (user satisfaction, preference, ease of use) and cost effectiveness in adults and children using intermittent catheterisation for incomplete bladder emptying.
SEARCH METHODS
We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE in process, and handsearching of journals and conference proceedings (searched 30 September 2013), the reference lists of relevant articles and conference proceedings, and we attempted to contact other investigators for unpublished data or for clarification.
SELECTION CRITERIA
Randomised controlled trials (RCTs) or randomised cross-over trials comparing at least two different catheter designs, catheterisation techniques or strategies.
DATA COLLECTION AND ANALYSIS
Two review authors assessed the methodological quality of trials and abstracted data. For dichotomous variables, risk ratios and 95% confidence intervals were derived for each outcome where possible. For continuous variables, mean differences and 95% confidence intervals were calculated for each outcome. Because of trial heterogeneity, it was not always possible to combine data to give an overall estimate of treatment effect.
MAIN RESULTS
Thirty-one trials met the inclusion criteria, including 13 RCTs and 18 cross-over trials. Most were small (less than 60 participants completed), although five trials had more than 100 participants. There was considerable variation in length of follow-up and definitions of UTI. Participant dropout was a problem for several trials, particularly where there was long-term follow-up to measure incidence of UTI. Fifteen trials were more than 10 years old and focused mainly on comparing different catheterisation techniques (e.g. single versus multiple-use) on clinical outcomes whereas, several more recent trials have focused on comparing different types of catheter designs or materials, especially coatings, and user preference. It was not possible to combine data from some trials owing to variations in the catheters tested and in particular the catheter coatings. Where there were data, confidence intervals around estimates were wide and hence clinically important differences in UTI and other outcomes could neither be identified nor reliably ruled out. No study assessed cost-effectiveness.
AUTHORS' CONCLUSIONS
Despite a total of 31 trials, there is still no convincing evidence that the incidence of UTI is affected by use of aseptic or clean technique, coated or uncoated catheters, single (sterile) or multiple-use (clean) catheters, self-catheterisation or catheterisation by others, or by any other strategy. Results from user-reported outcomes varied. The current research evidence is weak and design issues are significant. More well-designed trials are strongly recommended. Such trials should include analysis of cost-effectiveness because there are likely to be substantial differences associated with the use of different catheter designs, catheterisation techniques and strategies.
Topics: Adult; Child; Equipment Reuse; Female; Humans; Male; Patient Dropouts; Urinary Catheterization; Urinary Catheters; Urinary Retention; Urinary Tract Infections
PubMed: 28796279
DOI: 10.1002/14651858.CD006008.pub4 -
Acta Biomaterialia Mar 2017More than 75% of hospital-acquired or nosocomial urinary tract infections are initiated by urinary catheters, which are used during the treatment of 15-25% of... (Review)
Review
UNLABELLED
More than 75% of hospital-acquired or nosocomial urinary tract infections are initiated by urinary catheters, which are used during the treatment of 15-25% of hospitalized patients. Among other purposes, urinary catheters are primarily used for draining urine after surgeries and for urinary incontinence. During catheter-associated urinary tract infections, bacteria travel up to the bladder and cause infection. A major cause of catheter-associated urinary tract infection is attributed to the use of non-ideal materials in the fabrication of urinary catheters. Such materials allow for the colonization of microorganisms, leading to bacteriuria and infection, depending on the severity of symptoms. The ideal urinary catheter is made out of materials that are biocompatible, antimicrobial, and antifouling. Although an abundance of research has been conducted over the last forty-five years on the subject, the ideal biomaterial, especially for long-term catheterization of more than a month, has yet to be developed. The aim of this review is to highlight the recent advances (over the past 10years) in developing antimicrobial materials for urinary catheters and to outline future requirements and prospects that guide catheter materials selection and design.
STATEMENT OF SIGNIFICANCE
This review article intends to provide an expansive insight into the various antimicrobial agents currently being researched for urinary catheter coatings. According to CDC, approximately 75% of urinary tract infections are caused by urinary catheters and 15-25% of hospitalized patients undergo catheterization. In addition to these alarming statistics, the increasing cost and health related complications associated with catheter associated UTIs make the research for antimicrobial urinary catheter coatings even more pertinent. This review provides a comprehensive summary of the history, the latest progress in development of the coatings and a brief conjecture on what the future entails for each of the antimicrobial agents discussed.
Topics: Animals; Anti-Bacterial Agents; Coated Materials, Biocompatible; Humans; Urinary Catheters; Urinary Incontinence; Urinary Tract Infections
PubMed: 27916738
DOI: 10.1016/j.actbio.2016.11.070 -
Investigative and Clinical Urology Mar 2018Placement of pre-operative ureteral catheters for colorectal surgery can aid in the identification of ureteral injuries. This study investigates whether simultaneous... (Observational Study)
Observational Study
PURPOSE
Placement of pre-operative ureteral catheters for colorectal surgery can aid in the identification of ureteral injuries. This study investigates whether simultaneous ureteral catheterization with surgery skin preparation can minimize operating room times without increasing post-operative complications.
MATERIALS AND METHODS
Patients undergoing simultaneous colorectal surgery skin preparation and placement of pre-operative ureteral catheters (n=21) were compared to those who underwent these events sequentially (n=28). Operative time-points of anesthesia ready (AR), surgery procedure start (PS), dorsal lithotomy and catheter insertion (CI) times were compared to assess for differences between groups. Complications were compared between groups.
RESULTS
There were no differences in age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA), comorbidities, current procedure terminology (CPT) or International Classification of Diseases, 9th revision (ICD-9) codes between groups. Simultaneous catheterization saved 11.82 minutes of operative time between CI to PS (p=0.005, t-test). There was a significant difference in mean time between CI to PS (11.82 minutes, p=0.008) between simultaneous and sequential ureteral catheterization groups in a linear regression multivariate analysis controlling for age, BMI, CPT and ICD-9 codes. There were 4 complications in the simultaneous (19%) and 3 in the sequential group (11%) (p=0.68).
CONCLUSIONS
Ureteral catheterization and colorectal surgery skin preparation in a simultaneous fashion decreases the time between CI and PS without significant increase in complications. Mean time saved with simultaneous ureteral catheterization was 11.82 minutes per case. Simultaneous ureteral catheterization may be an option in colorectal surgery and may result in cost savings without additional complications.
Topics: Adult; Colonic Diseases; Colorectal Surgery; Comorbidity; Female; Humans; Male; Middle Aged; Operative Time; Outcome and Process Assessment, Health Care; Postoperative Complications; Preoperative Care; United States; Urinary Catheterization; Urinary Catheters
PubMed: 29520388
DOI: 10.4111/icu.2018.59.2.119 -
Virulence Apr 2016Bloodstream infections (BSIs) are both common and fatal in older patients. We describe data from studies evaluating older patients hospitalized with BSIs. Most older... (Review)
Review
Bloodstream infections (BSIs) are both common and fatal in older patients. We describe data from studies evaluating older patients hospitalized with BSIs. Most older patients with BSIs present "typically" with either fever or leukocytosis. The most common source of BSI in older patients is the urinary tract, and accordingly, Gram-negative organisms predominate. A significant part of these BSIs may thus be preventable by removal of unnecessary urinary catheters. Increased long term mortality is reported following BSIs in older patients, however, data on other long-term outcomes, including functional capacity, cognitive decline and others are lacking. Management of BSIs may include less invasive procedures due to the fragility of older patients. This approach may delay the diagnosis and treatment in some cases. Older patients are probably under-represented in clinical trials assessing treatment of bacteremia. Physicians treating older patients should consider the relevance of these studies' outcomes.
Topics: Age Factors; Aged; Aged, 80 and over; Bacteremia; Catheter-Related Infections; Cognitive Dysfunction; Communicable Diseases; Cross Infection; Female; Fever; Gram-Negative Bacteria; Hospitalization; Humans; Leukocytosis; Male; Risk Factors; Time; Urinary Catheters; Urinary Tract Infections
PubMed: 26684392
DOI: 10.1080/21505594.2015.1132142 -
Maedica Dec 2023Double J stents are commonplace tools used in modern urology, serving as a vital aid in the drainage of the upper urinary system. Along with the numerous advantages of...
Double J stents are commonplace tools used in modern urology, serving as a vital aid in the drainage of the upper urinary system. Along with the numerous advantages of these catheters, numerous negative consequences have also been addressed throughout time. Among the most common symptoms associated with ureteral catheters are those associated with LUTS (lower urinary tract symptoms), such as dysuria, urinary urgency, pollakiuria, the feeling of incomplete emptying of the bladder, urinary incontinence, or even urinary tract infections (UTIs). Complications associated with sexual dysfunction, including dyspareunia and pain during sex, which can lead to erectile dysfunction or loss of orgasm, are less discussed in the literature. This small review tries to focus on the most important aspects of low urinary symptoms that affect the general quality of life and those related to the quality of sexual life, which are less discussed but of particular importance in the lifestyle of any patient with such ureteral device.
PubMed: 38348063
DOI: 10.26574/maedica.2023.18.4.679 -
Urologia Internationalis 2021Proteus mirabilis (PM) is a Gram-negative rod-shaped bacterium and widely exists in the natural environment, and it is most noted for its swarming motility and urease... (Review)
Review
Proteus mirabilis (PM) is a Gram-negative rod-shaped bacterium and widely exists in the natural environment, and it is most noted for its swarming motility and urease activity. PM is the main pathogen causing complicated urinary tract infections (UTIs), especially catheter-associated urinary tract infections. Clinically, PM can form a crystalline biofilm on the outer surface and inner cavity of the urethral indwelling catheter owing to its ureolytic biomineralization. This leads to catheter encrustation and blockage and, in most cases, is accompanied by urine retention and ascending UTI, causing cystitis, pyelonephritis, and the development of bladder or kidney stones, or even fatal complications such as septicemia and endotoxic shock. In this review, we discuss how PM is mediated by a catheter into the urethra, bladder, and then rose to the kidney causing UTI and the main virulence factors associated with different stages of infection, including flagella, pili or adhesins, urease, hemolysin, metal intake, and immune escape, encompassing both historical perspectives and current advances.
Topics: Catheter-Related Infections; Humans; Proteus Infections; Proteus mirabilis; Urinary Catheters; Urinary Tract Infections
PubMed: 33691318
DOI: 10.1159/000514097