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Spinal Cord Series and Cases Sep 2020
Review
Topics: Humans; Treatment Outcome; Urinary Bladder; Urinary Catheterization; Urinary Catheters; Urinary Retention
PubMed: 32999281
DOI: 10.1038/s41394-020-00342-w -
Frontiers in Cellular and Infection... 2022Catheter-associated urinary tract infections (CAUTIs) are one of the most common healthcare-associated infections in the US, accounting for over 1 million cases annually...
Catheter-associated urinary tract infections (CAUTIs) are one of the most common healthcare-associated infections in the US, accounting for over 1 million cases annually and totaling 450 million USD. CAUTIs have high morbidity and mortality rates and can be caused by a wide range of pathogens, making empiric treatment difficult. Furthermore, when urease-producing uropathogens cause symptomatic CAUTI or asymptomatic catheter colonization, the risk of catheter failure due to blockage increases. The enzyme urease promotes catheter blockage by hydrolyzing urea in urine into ammonia and carbon dioxide, which results in the formation of crystals that coat the catheter surface. If CAUTI is left untreated, the crystals can grow until they block the urinary catheter. Catheter blockage and subsequent failure reduces the quality of life for the chronically catheterized, as it requires frequent catheter exchanges and can promote more severe disease, including dissemination of the infection to the kidneys or bloodstream. Thus, understanding how urease contributes to catheter blockages and/or more severe disease among the broad range of urease-producing microbes may provide insights into better prevention or treatment strategies. However, clinical assays that detect urease production among clinical isolates are qualitative and prioritize the detection of urease from , the most well-studied uropathogenic urease producer. While urease from other known urease producers, such as , can also be detected with these methods, other uropathogens, including and , are harder to detect. In this study, we developed a high throughput, semiquantitative assay capable of testing multiple uropathogens in a rapid and efficient way. We validated the assay using Jack Bean urease, the urease producing species spp., and strains, and the non-urease producer: . This modified assay more rapidly detected urease-producing strains compared to the current clinical test, Christensen Urea Agar, and provided semiquantitative values that may be used to further investigate different aspects of urease regulation, production, or activity in these diverse species. Furthermore, this assay can be easily adapted to account for different environmental stimuli affecting urease production, including bacterial concentration, aeration, or addition of anti-urease compounds.
Topics: Escherichia coli; Humans; Quality of Life; Staphylococcus aureus; Urea; Urease; Urinary Catheters; Urinary Tract Infections
PubMed: 35392611
DOI: 10.3389/fcimb.2022.859093 -
Journal of the American Veterinary... Jun 2018OBJECTIVE To test for an association between indwelling urethral catheter placement in cats with urethral obstruction (UO) and the short-term (30-day) risk of recurrent...
OBJECTIVE To test for an association between indwelling urethral catheter placement in cats with urethral obstruction (UO) and the short-term (30-day) risk of recurrent urethral obstruction (RUO). DESIGN Prospective cohort study. ANIMALS 107 client-owned male cats with UO. PROCEDURES Owners were offered standard care for their cats, including hospitalization, placement of an indwelling urethral catheter, IV fluid therapy, and other supportive treatments (inpatient group). One-time catheterization and outpatient care were offered (outpatient group) if standard care was declined. Data regarding signalment, measures of metabolic compromise and urinalysis findings at enrollment, catheterization-related variables, and supportive treatments of interest were collected. Risk of RUO ≤ 30 days after urethral catheter removal was determined for the outpatient vs inpatient group by OR and 95% confidence interval calculation. Other variables were compared between cats that did and did not develop RUO with Fisher exact and trend tests. RESULTS 91 cats completed the study; 19 (5/46 [11%] inpatients and 14/45 [31%] outpatients) developed RUO. Risk of RUO was significantly greater for cats of the outpatient group (OR, 3.7; 95% confidence interval, 1.2 to 11.4). Among inpatients, increasingly abnormal urine color at the time of catheter removal was significantly associated with RUO. No other significant associations were identified. CONCLUSIONS AND CLINICAL RELEVANCE Hospitalization and indwelling catheterization significantly reduced the risk for RUO ≤ 30 days after treatment for the population studied. Results suggested that removal of an indwelling catheter before urine appears grossly normal may be associated with development of RUO. One-time catheterization with outpatient care was inferior to the standard care protocol but was successful in many cats and may be a reasonable alternative when clients cannot pursue standard care.
Topics: Animals; Cat Diseases; Catheters, Indwelling; Cats; Clinical Protocols; Cohort Studies; Male; New Jersey; Prospective Studies; Recurrence; Risk Factors; Urethral Obstruction; Urinary Catheterization; Urinary Catheters
PubMed: 29889636
DOI: 10.2460/javma.252.12.1509 -
International Braz J Urol : Official... 2019
Topics: Device Removal; Equipment Design; Humans; Postoperative Complications; Risk Factors; Stents; Time Factors; Urinary Catheters
PubMed: 31808394
DOI: 10.1590/S1677-5538.IBJU.2019.06.02 -
Archivio Italiano Di Urologia,... Jan 2020We investigated when an indwelling ureteral catheter should be withdrawn for infection and evaluated the importance of urinary cultures in identifying colonized... (Comparative Study)
Comparative Study Randomized Controlled Trial
OBJECTIVE
We investigated when an indwelling ureteral catheter should be withdrawn for infection and evaluated the importance of urinary cultures in identifying colonized microorganisms and define the bacterial flora encountered in the study. Moreover, this study tried to determine the clinical role of stent culture in clinical practice.
MATERIALS AND METHODS
The study was conducted between June 2018 and February 2019. Patients with ureteral stent implantation after endoscopic ureteral stone treatment were divided into two groups and each group consisted of 45 patients. Ureteral catheter was removed 15 and 30 days after ureteral stone treatment in group 1 and 2, respectively, and transferred for microbiological examination. The urine culture was obtained before and after ureteral stent implantation. The groups were compared in terms of demographics, urine and catheter cultures results. Urine analysis and catheter culture results were also compared.
RESULTS
Demographic data of patients were similar in both groups. 3 patients in group 1 and 12 patients in group 2 had positive urine culture before catheter retraction; 2 of 45 and 6 of 45 patients had positive catheter culture in group 1 and 2, respectively. Although 2 patients in group 1 and 4 patients in group 2 had urine culture sterile, they had growth in catheter culture. In Group 1, 1 of the microorganisms was E. fecalis and 1 was E. coli. In Group 2, 2 cases were E. fecalis, 3 were E. coli and 1 was MRSE. There was no significant difference between the urine analysis results of the patients before catheter retraction and catheter culture positivity.
CONCLUSIONS
Pre-operative urine culture does not exclude catheter colonization, and the prolonged duration of the catheter associated with greater colonization and may be associated urinary tract infection. Ureteral catheter should be removed as early as possible.
Topics: Adult; Aged; Bacteria; Catheters, Indwelling; Device Removal; Female; Humans; Male; Middle Aged; Prospective Studies; Stents; Time Factors; Ureteral Calculi; Urinary Catheters; Urinary Tract Infections; Urine; Young Adult
PubMed: 31937088
DOI: 10.4081/aiua.2019.4.237 -
Nursing Open Mar 2023To evaluate healthcare workers' knowledge, attitudes and practices level of prevention and management of catheter-associated urinary tract infection. (Review)
Review
AIM
To evaluate healthcare workers' knowledge, attitudes and practices level of prevention and management of catheter-associated urinary tract infection.
DESIGN
A mixed-methods systematic review.
METHODS
Searches were conducted in CINAHL, Cochrane Library, EMBASE, Medline, PubMed and Web of Science databases. Limited literatures published in English before 20 June 2021. Data were analysed and synthesized using thematic analysis by two authors.
RESULTS
Thirty-four articles were included. Healthcare workers' unbalanced varied knowledge level, positive attitudes, undesirable practices of catheter-associated urinary tract infection's prevention and control were identified. Barriers of healthcare workers' knowledge, attitudes and practices level of infection prevention included heavy workload, understaffing, physician variability in indwelling urinary catheter (IUC) practice by diagnosis, nursing variability in IUC placement technique, poor relationship and nurse's poor documentation. Leadership, better education, teamwork, technique training and information technology support, advocacy for nurse-driven protocol and IUC removal reminder were considered as facilitators.
Topics: Humans; Catheters, Indwelling; Health Knowledge, Attitudes, Practice; Health Personnel; Urinary Catheters; Urinary Tract Infections
PubMed: 36519497
DOI: 10.1002/nop2.1384 -
Nature Communications May 2023Urethral stricture secondary to urethral injury, afflicting both patients and urologists, is initiated by excessive deposition of extracellular matrix in the submucosal...
Urethral stricture secondary to urethral injury, afflicting both patients and urologists, is initiated by excessive deposition of extracellular matrix in the submucosal and periurethral tissues. Although various anti-fibrotic drugs have been applied to urethral stricture by irrigation or submucosal injection, their clinical feasibility and effectiveness are limited. Here, to target the pathological state of the extracellular matrix, we design a protein-based nanofilm-controlled drug delivery system and assemble it on the catheter. This approach, which integrates excellent anti-biofilm properties with stable and controlled drug delivery for tens of days in one step, ensures optimal efficacy and negligible side effects while preventing biofilm-related infections. In a rabbit model of urethral injury, the anti-fibrotic catheter maintains extracellular matrix homeostasis by reducing fibroblast-derived collagen production and enhancing metalloproteinase 1-induced collagen degradation, resulting in a greater improvement in lumen stenosis than other topical therapies for urethral stricture prevention. Such facilely fabricated biocompatible coating with antibacterial contamination and sustained-drug-release functionality could not only benefit populations at high risk of urethral stricture but also serve as an advanced paradigm for a range of biomedical applications.
Topics: Animals; Rabbits; Urethral Stricture; Urinary Catheters; Collagen; Fibrosis; Extracellular Matrix; Drug Delivery Systems
PubMed: 37198161
DOI: 10.1038/s41467-023-38282-2 -
Urology Dec 2020To present a novel urethral catheter design with a pilot balloon to reduce intraurethral retention balloon inflation pressures and to provide a visual alert during...
OBJECTIVE
To present a novel urethral catheter design with a pilot balloon to reduce intraurethral retention balloon inflation pressures and to provide a visual alert during catheter placement.
METHODS
We manufactured our pilot balloon prototype from both molded and extruded silicone components. Various pilot balloon thicknesses were tested in order to determine the ideal compliance. We studied the filling pressures of the retention balloon of our prototype in a mechanical urethral model. The prototype catheter was then tested in ex-vivo human penis specimens obtained from gender affirming surgery and changes in the size of the retention balloon were measured under fluoroscopy.
RESULTS
The thickness of the pilot balloon was directly related to the inflation pressure of the retention balloon in the mechanical urethral model. The thickness chosen for the pilot balloon in our prototype was based on a retention balloon pressure of 70 kPa. In the ex-vivo human penis model, the presence of the pilot balloon resulted in a 40% reduction in the cross-sectional area of the retention balloon compared to a standard urinary catheter.
CONCLUSION
The prototype urinary catheter appears to decrease the filling pressure and size of an improperly positioned retention balloon inside a urethra. This can potentially reduce the risk of iatrogenic urethral catheter injuries. In addition, the prototype urinary catheter may act as a visual warning sign for the healthcare practitioner.
Topics: Equipment Design; Humans; In Vitro Techniques; Male; Penis; Urethra; Urinary Catheters
PubMed: 32888984
DOI: 10.1016/j.urology.2020.08.035 -
Experimental and Therapeutic Medicine Jan 2021The present study aimed to compare the effects of various catheter fix sites on catheter-associated lower urinary tract symptoms (CALUTS) in 450 patients who underwent...
The present study aimed to compare the effects of various catheter fix sites on catheter-associated lower urinary tract symptoms (CALUTS) in 450 patients who underwent surgical removal of upper urinary calculi 24 h earlier. All patients had 16 French Foley catheters inserted and the balloons were filled. In group A, the catheters were fixed on the top one-third of the thigh. In group B, the catheters were fixed on the abdominal wall. Patients in whom the catheters were neither fixed on the thigh nor abdominal wall were designated as controls. There were 150 patients in each group. CALUTS, such as frequency, urgency, burning during micturition, odynuria, bladder pain and other symptoms, including urethral discharge, a red and swollen external urethral orifice, catheter traction or blockage and catheter-associated discomfort were recorded. Patients in group A compared with the control group had a significantly lower incidence of frequency, urgency, odynuria, urethral discharge, catheter traction and catheter-associated discomfort (P<0.05). Patients in group B were observed to have a significantly lower incidence of urgency, urethral discharge, catheter traction and catheter-associated discomfort compared with the control group (P<0.05), but a higher incidence of odynuria, urethral pain, urethral discharge and a red and swollen external urethral orifice compared with group A (P<0.05). An additional catheter fixation site for bedridden patients was necessary and an additional fix site on the thigh was preferred to the abdominal wall, which may further reduce catheter-associated lower urinary tract symptoms.
PubMed: 33273975
DOI: 10.3892/etm.2020.9478 -
Radiation Oncology (London, England) Dec 2019To determine the best method to contour the planning organ at risk volume (PRV) for the urethra, this study aimed to investigate the displacement of a Foley catheter in...
PURPOSE
To determine the best method to contour the planning organ at risk volume (PRV) for the urethra, this study aimed to investigate the displacement of a Foley catheter in the urethra with a soft and thin guide-wire.
METHODS
For each patient, the study used two sets of computed tomography (CT) images for radiation treatment planning (RT-CT): (1) set with a Foley urethral catheter (4.0 mm diameter) plus a guide-wire (0.46 mm diameter) in the first RT-CT and (2) set with a guide-wire alone in the second CT recorded 2 min after the first RT-CT. Using three fiducial markers in the prostate for image fusion, the displacement between the catheter and the guide-wire in the prostatic urethra was calculated. In 155 consecutive patients treated between 2011 and 2017, 5531 slices of RT-CT were evaluated.
RESULTS
Assuming that ≥3.0 mm of difference between the catheter and the guide-wire position was a significant displacement, the urethra with the catheter was displaced significantly from the urethra with the guide-wire alone in > 20% of the RT-CT slices in 23.2% (36/155) of the patients. The number of patients who showed ≥3.0 mm anterior displacement with the catheter in ≥20% RT-CT slices was significantly larger at the superior segment (38/155) than at the middle (14/155) and inferior segments (18/155) of the prostatic urethra (p < 0.0167).
CONCLUSIONS
The urethral position with a Foley catheter is different from the urethral position with a thin and soft guide-wire in a significant proportion of the patients. This should be taken into account for the PRV of the urethra to ensure precise radiotherapy such as in urethra-sparing radiotherapy.
Topics: Aged; Aged, 80 and over; Brachytherapy; Humans; Male; Middle Aged; Prognosis; Prostatic Neoplasms; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted; Retrospective Studies; Urethra; Urinary Catheters
PubMed: 31831045
DOI: 10.1186/s13014-019-1424-8