Prevalência de infeções urinárias em pessoas institucionalizadas em instituições particulares de solidariedade social / Prevalence of urinary tract infections in people institutionalized in private institutions of social solidarity / Prevalencia de infecciones urinarias en personas institucionalizadas en instituciones privadas de solidaridad social

Resumo Enquadramento: Nas pessoas idosas institucionalizadas, a infeção urinária é a mais comum, envolvendo 12% a 30% desta população, com pelo menos um episódio por ano, onde diversos fatores de risco influenciam a sua ocorrência. Objetivo: Determinar a prevalência das infeções urinárias em pessoas institucionalizadas numa instituição particular de solidariedade social e identificar os fatores de risco. Metodologia: Estudo epidemiológico observacional transversal. Os participantes são pessoas institucionalizadas numa instituição particular de solidariedade social e que pertencem a três valências diferentes. Amostra por conveniência. A colheita de dados realizou-se durante 8 meses, com registo do número total de utentes das várias valências (n = 171). Resultados: A prevalência de infeção urinária na instituição foi de 18,1%. Ocorreram mais casos em mulheres (p = 0,641) e em pessoas com idade superior a 75 anos (p = 0,269), mas sem diferenças significativas. O local de internamento demonstrou ter influência no risco de desenvolvimento de infeção urinária (p = 0,024). Conclusão: Das 171 pessoas internadas, 31 desenvolveram infeção urinária. São necessárias atitudes educativas e preventivas.

Abstract Background: In institutionalized elderly people, urinary tract infections are the most common, involving 12% to 30% of this population, with at least one episode per year, where several risk factors influence their occurrence. Objective: To determine the prevalence of urinary tract infections in older people institutionalized in a private institution of social solidarity and to identify the risk factors. Methodology: This is a cross-sectional, observational, and epidemiological study conducted on a convenience sample of people who are institutionalized in a private institution of social solidarity and belong to three different services. Data was collected over 8 months, and the number of patients in the different services was recorded (n = 171). Results: The institution had a urinary tract infection prevalence of 18.1%. Although more cases occurred in women (p = 0.641) and people older than 75 years (p = 0.269), there were no significant differences. Location of hospitalization was identified as a risk factor for developing a urinary tract infection (p = 0.024). Conclusion: Out of the 171 people who were institutionalized, 31 developed a urinary tract infection. It is important to adopt educational and preventive measures.

Resumen Marco contextual: En los ancianos institucionalizados, las infecciones del tracto urinario son las más comunes, afectando del 12% al 30% de esta población, con al menos un episodio por año, donde varios factores de riesgo influyen en su aparición. Objetivo: Determinar la prevalencia de infecciones urinarias en personas institucionalizadas en una institución privada de solidaridad social e identificar los factores de riesgo. Metodología: Estudio epidemiológico observacional transversal. Los participantes fueron personas institucionalizadas en una institución privada de solidaridad social y pertenecientes a tres servicios diferentes. Muestra de conveniencia. Los datos se recogieron durante un período de 8 meses y se registró el número total de usuarios de los distintos centros (n = 171). Resultados: La prevalencia de infección urinaria en la institución fue del 18,1%. Hubo más casos en mujeres (p = 0,641) y en mayores de 75 años (p = 0,269), pero sin diferencias significativas. Se demostró que el lugar de hospitalización influía en el riesgo de desarrollar infección urinaria (p = 0,024). Conclusión: De las 171 personas hospitalizadas, 31 desarrollaron infección urinaria. Se necesitan actitudes educativas y preventivas.

Uso y complicaciones del cateterismo urinario en salas de cuidados moderados de un hospital universitario

Introducción: El cateterismo urinario es un procedimiento frecuente y en ocasiones es utilizado por fuera de las indicaciones aceptadas para el mismo. Esto aumenta el riesgo de complicaciones vinculadas a su uso, por lo que pueden ser prevenibles. El objetivo del estudio es conocer las características del uso de cateterismo urinario en pacientes ingresados en salas de cuidados moderados de un hospital universitario del tercer nivel de atención, determinar la frecuencia, duración e indicaciones más frecuentes, así como evaluar la presencia de complicaciones asociadas al mismo Metodología: Estudio de corte transversal, realizado en salas de cuidados moderados de un hospital terciario y universitario de Montevideo, Uruguay, el 21 de diciembre de 2022. Se incluyeron pacientes hospitalizados que presentaban o presentaron catéter vesical en la presente internación y se completó la recolección de variables mediante la revisión de la historia clínica. Resultados: De 155 pacientes ingresados en salas de cuidados moderados, a 26 (16,7%) les fue colocado un catéter urinario. La mediana de edad fue 61 años, 80% eran de sexo masculino. La mediana de internación fue de 22 días. En todos los pacientes se utilizó sonda vesical y el 54% fue colocado en el Departamento de Emergencia. En el 46% de los pacientes no se encontró indicación escrita de colocación en la historia clínica. En 50% de los casos no está especificado el motivo de indicación de sonda vesical, mientras que las indicaciones identificadas más frecuentes fueron el control de diuresis (27%) y la desobstrucción de vía urinaria baja (23%). La duración de cateterismo fue de una mediana de 13,5 días, mientras que el 27% de los pacientes la usaron más de 30 días. 35% de los pacientes presentaron complicaciones vinculadas a la sonda vesical, en su mayoría no infecciosas (27%) y 15% presentaron infección urinaria. Estos pacientes tuvieron una duración de cateterismo mayor a los que no presentaron complicaciones (23 vs 10 días, p=0,411). Conclusiones: El catéter vesical fue utilizado en un porcentaje no despreciable de pacientes ingresados en salas de cuidados moderados, de forma prolongada y frecuentemente sin indicación precisa, lo cual expone a un riesgo aumentado de complicaciones vinculadas.

Introduction: Urinary catheterization is a frequent procedure and is sometimes used outside of its accepted indications. This increases the risk of complications related to its use, so they may be preventable. The objective of this study is to know the characteristics of the use of urinary catheterization in patients admitted to moderate care wards of a tertiary care university hospital, to determine the frequency, duration and most frequent indications, as well as to evaluate the presence of associated complications. Methodology: Cross-sectional study, carried out in moderate care wards of a tertiary care and university hospital in Montevideo, Uruguay, on December 21, 2022. Hospitalized patients who present or presented a bladder catheter during the present hospitalization were included, and the collection of variables was completed by reviewing the medical history. Results: Of 155 patients admitted to moderate care wards, 26 (16.7%) had a urinary catheter placed. The median age was 61 years, 80% were male. The median hospitalization was 22 days. In all patients a bladder catheter was used and 54% were placed in the Emergency Department. In 46% of the patients, no written indication for placement was found in the clinical history. In 50% of cases, the reason for indicating the bladder catheter is not specified, while the most frequent indications identified were diuresis control (27%) and lower urinary tract obstruction (23%). The duration of catheterization was a median of 13.5 days, while 27% of the patients used it for more than 30 days. 35% of the patients presented complications related to the bladder catheter, mostly non-infectious (27%) and 15% presented urinary tract infection. These patients had a longer duration of catheterization than those without complications (23 vs 10 days, p=0,411). Conclusions: The bladder catheter was used in a non-negligible percentage of patients admitted to moderate care wards, for a long time and often without a precise indication, which exposes them to an increased risk of related complications.

Introdução: O cateterismo urinário é um procedimento frequente e às vezes é usado fora de suas indicações aceitas. Isso aumenta o risco de complicações relacionadas ao seu uso, portanto, podem ser evitáveis. O objetivo deste estudo é conhecer as características do uso do cateterismo urinário em pacientes internados em enfermarias de cuidados moderados de um hospital universitário terciário, determinar a frequência, duração e indicações mais frequentes, bem como avaliar a presença de complicações associadas ao mesmo. Metodologia: Estudo transversal, realizado em quartos de cuidados moderados de um hospital terciário e universitário em Montevidéu, Uruguai, em 21 de dezembro de 2022. Foram incluídos pacientes que apresentaram ou apresentaram sonda vesical durante a internação atual e a coleta de variáveis ​​foi concluída .revisando o histórico médico. Resultados: Dos 155 pacientes admitidos em enfermarias de cuidados moderados, 26 (16,7%) tiveram um cateter urinário colocado. A idade média foi de 61 anos, 80% eram do sexo masculino. A mediana de internação foi de 22 dias. Em todos os doentes foi utilizada sonda vesical e 54% foram internados no Serviço de Urgência. Em 46% dos pacientes, nenhuma indicação escrita para colocação foi encontrada na história clínica. Em 50% dos casos não é especificado o motivo da indicação da sonda vesical, enquanto as indicações mais frequentes identificadas foram controle da diurese (27%) e desobstrução do trato urinário inferior (23%). A duração do cateterismo foi em média de 13,5 dias, enquanto 27% dos pacientes o utilizaram por mais de 30 dias. 35% dos pacientes apresentaram complicações relacionadas ao cateter vesical, em sua maioria não infecciosas (27%) e 15% apresentaram infecção urinária. Esses pacientes tiveram uma duração mais longa de cateterismo do que aqueles sem complicações (23 vs 10 dias, p=0,411). Conclusões: A sonda vesical foi utilizada em percentual não desprezível de pacientes internados em quartos de cuidados moderados, por tempo prolongado e muitas vezes sem indicação precisa, o que os expõe a um risco aumentado de complicações associadas.

Analysis of relevant influencing factors for recurrent urinary tract infections in children: exploring predictive factors and intervention measures.

OBJECTIVE: To analyze the factors influencing recurrent urinary tract infections (UTIs) in children and explore predictive factors and intervention measures. METHODS: Data of 158 children with UTIs treated at the Longyan First Affiliated Hospital of Fujian Medical University from January 2020 to June 2023 were analyzed. Among them, 122 children without recurrent UTIs were included in a non-recurrent group, while the remaining 36 were included in a recurrent group. The quality of life prior to treatment and six weeks after treatment, the immunoglobulin A (IgA) and immunoglobulin G (IgG) levels after treatment, the relationship between the quality of life after six weeks of treatment and the levels of IgA and IgG were analyzed. Multivariate logistic regression analysis was conducted to identify factors impacting the recurrence of UTIs, and receiver operating characteristic (ROC) curves were generated to predict recurrent UTIs based on independent risk factors. RESULTS: Before treatment, no notable difference was observed in Short Form 36 Health Survey (SF-36) scores between the non-recurrent group and the recurrent group (P>0.05). After treatment, the SF-36 scores notably increased in the non-recurrent group (P<0.0001), while there was no notable increase in the recurrent group (P>0.05). However, the difference in SF-36 scores after treatment was significant between the two groups (P<0.0001). In addition, there was a significantly positive correlation between IgA levels and quality of life after 6 weeks of treatment (P<0.05). The recurrent group showed significantly lower IgA and IgG levels than the non-recurrent group (P<0.05). Multivariate logistic regression analysis identified anemia, urinary system malformation, constipation, decreased IgA level, and decreased IgG level as independent risk factors for recurrent UTIs in children. ROC curves-based analysis of independent risk factors demonstrated that urinary system malformation had a better performance in predicting recurrent UTIs in children than the other four factors. CONCLUSION: Urinary system malformation, constipation, anemia, decreased IgA and IgG levels are all identified as independent risk factors for recurrent UTIs in children, and urinary system malformation is a better predictor for recurrent UTIs in children than the other four factors.

Prevention and Management of Infectious Complications in Retrograde Intrarenal Surgery: A Comprehensive Review.

Retrograde intrarenal surgery (RIRS) is a minimally invasive procedure increasingly used to treat renal stones and other intrarenal pathologies due to its reduced risk of complications, shorter recovery time, and lower postoperative pain compared to more invasive surgical techniques. However, despite its advantages, RIRS is associated with a significant risk of infectious complications, ranging from simple urinary tract infections (UTIs) to severe systemic infections such as urosepsis, which can lead to increased morbidity, prolonged hospitalization, and, in severe cases, mortality. This review aims to summarize the current knowledge on preventing and managing infectious complications associated with RIRS. By exploring the pathophysiology of these infections, identifying patient and procedural risk factors, and evaluating evidence-based strategies for prevention and management, this review provides comprehensive insights into minimizing infection risks in RIRS. A thorough literature review was conducted, examining studies and clinical trials that address the incidence, risk factors, prevention strategies, and management protocols for infections in RIRS. This review also assesses current guidelines from professional organizations and recent infection control technologies and practices advancements. The review identifies multiple risk factors contributing to infections in RIRS, including patient-specific factors such as comorbidities and procedural factors like the duration of surgery and use of instrumentation. Effective prevention strategies include preoperative antibiotic prophylaxis, stringent aseptic techniques during surgery, and careful postoperative monitoring. The review also highlights the importance of a multidisciplinary approach involving urologists, infectious disease specialists, and microbiologists in managing complex cases of infection. Infectious complications remain a significant concern in RIRS, necessitating a comprehensive approach to prevention and management. By adhering to evidence-based guidelines and utilizing a multidisciplinary strategy, healthcare professionals can significantly reduce the incidence of infections, thereby improving patient outcomes and the overall safety of RIRS. Future research should focus on advancing infection control technologies and developing novel prophylactic and therapeutic approaches to further enhance the safety and effectiveness of RIRS.

Determinants of Healthcare-Associated Infections in King Abdulaziz Specialized Hospital in Taif, Saudi Arabia.

BACKGROUND: Healthcare-associated infections (HAIs) represent a significant challenge in hospital settings, contributing to increased morbidity, mortality, and healthcare costs. This study aimed to estimate the prevalence and socio-demographic and clinical determinants of HAIs at the King Abdulaziz Specialized Hospital (KAASH) in Taif, Saudi Arabia. METHODOLOGY: A hospital-based cross-sectional study was conducted from March 2023 to January 2024 targeting inpatients aged 18 and above in all units and wards. Data were collected using the National Healthcare Safety Network (NHSN) criteria for definitions of surveillance. A structured questionnaire gathered socio-demographic and clinical data from patients or next of kin if the patient was not fully oriented. Descriptive statistics were performed, and analytical methods used included Pearson chi-square test, Pearson correlation, independent t-test, and one-way analysis of variance. RESULTS: Among 318 participants included in this study, the mean age of participants was 56.44 years, with a slight female predominance (n=164, 51.6%). Hypertension (n=162, 50.9%) and diabetes (n=126, 39.6%) were the most prevalent comorbidities. Pneumonia (n=60, 26.8%) and trauma (n=55, 17.4%) were the leading causes of admission. The two most common HAIs included catheter-associated urinary tract infections (CAUTI) (n=124, 39%) and central line-associated bloodstream infections (CLABSI) (n=74, 23.3%). The primary causative organisms were Klebsiella pneumoniae (n=96, 30.2%) and Acinetobacter baumannii (n=32, 10.1%). The most significant predictors of HAIs were as follows: For CLABSI, risk factors include having three or more comorbidities, fever above 37.8°C, chills or rigors, hypotension, and positive blood culture. For CAUTI, key predictors were urinary tract infection (UTI), positive urine culture, acute pain or swelling of the testes, suprapubic tenderness, visible hematuria, and leukocytosis. Significant predictors of bloodstream infections (BSI) include having a BSI, positive blood culture, chills or rigors, and hypotension. Fever and hypotension increased CLABSI and BSI risk but reduced the CAUTI risk. CONCLUSION: The study highlights a significant burden of HAIs at the KAASH, with multiple predictors. The findings underscore the need for robust infection control measures and targeted interventions to reduce HAI incidence and improve patient outcomes.

BCG-osis: a complication after intravesical BCG immunotherapy.

BCG, or live attenuated Mycobacterium bovis, intravesical immunotherapy is now an established component of the standard of care for bladder cancer following transurethral resection of bladder tumour. The following case demonstrates the rare complication of disseminated BCG (BCG-osis) that may arise after the aforementioned therapy. Patients at increased risk of this complication include those who are immunocompromised, above the age of 70 and patients who have had traumatic catheterisation. Diagnosis can be made with or without microbiology and management includes a multidrug regimen. It is important to recognise the signs and symptoms of BCG-osis and postpone future intravesical instillation of BCG if there is traumatic catheterisation. Future instillation should be completely discontinued if a patient develops disseminated M. bovis.

Implementation of a tailored multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for urinary tract infections in frail older adults (ImpresU) in four European countries: a process evaluation alongside a pragmatic cluster randomized controlled trial.

BACKGROUND: We previously performed a pragmatic cluster randomized controlled trial (RCT) in general practices and older adult care organizations in Poland, the Netherlands, Norway, and Sweden. We found that a multifaceted antibiotic stewardship intervention (ASI) substantially reduced antibiotic use for suspected urinary tract infections (UTIs) in frail older adults compared with usual care. We aimed to evaluate the implementation process of the ASI to provide recommendations for clinical practice. METHODS: We conducted a process evaluation alongside the cluster RCT. The ASI consisted of a decision-tool and a toolbox, which were implemented using a participatory-action-research (PAR) approach with sessions for education and evaluation. We documented the implementation process of the intervention and administered a questionnaire to health care professionals (HCPs) from participating organizations in the intervention and usual care clusters. We evaluated the multiple components of the intervention and its implementation following a structured framework. RESULTS: The questionnaire was completed by 254 HCPs from the 38 participating clusters. All components were largely delivered according to plan and evaluated as useful. The decision-tool and toolbox materials were reported to facilitate decision-making on UTIs. Regarding the PAR approach, educational sessions focusing on the distinction between UTIs and asymptomatic bacteriuria were held in all 19 intervention clusters. In 17 out of these 19 clusters, evaluation sessions took place, which were reported to help remind HCPs to implement the ASI. During both sessions, HCPs valued the reflection that took place and the resulting awareness of their behavior. It allowed them to explore implementation barriers and to tailor their local implementation process to overcome these. For example, HCPs organized extra educational sessions or revised local policies to incorporate the use of the decision-tool. Various HCPs took key roles in implementation. Staff changes and the COVID-19 pandemic were important contextual barriers. CONCLUSIONS: We found each component of the multifaceted ASI and its implementation to have added value in the process to improve antibiotic prescribing for suspected UTIs in a heterogeneous older adult care setting. We recommend using a multifaceted, multidisciplinary approach that enables HCPs to reflect on their current practice and accordingly tailor local implementation. TRIAL REGISTRATION: ClinicalTrials.gov NCT03970356. Registered on May 31, 2019.

Budget impact analysis on the use of Sysmex PA-100 AST system as a point of care for uncomplicated urinary tract infections detection and treatment in Spanish females.

OBJECTIVE: Efficient diagnostic methods, such as the Sysmex PA-100, provide rapid antimicrobial susceptibility test results directly from urine samples with high sensitivity and specificity, and improve treatment recommendations. Our study analyzes the economic impact of integrating the Sysmex PA-100 to assess its potential benefits and cost implications for uncomplicated urinary tract infection (uUTI) management in Spain. METHODOLOGY: A budget impact model was developed using a decision tree framework to compare current UTI management practices with a new scenario incorporating the Sysmex PA-100. The clinical inputs were extracted from published literature. The model, representing adult females with uUTIs, assessed direct medical and indirect costs over three years, including diagnostic procedures, treatment costs, staff time costs, and productivity loss. The cost data was captured from two Spanish hospitals. Two scenario analyses were conducted in the model: scenario A included costs for antimicrobial resistance (AMR) emergence in patients receiving unnecessary empirical antibiotics, whereas scenario B assumed no AMR costs. RESULTS: In scenario A, 100% implementation of PA-100 within various Spanish healthcare settings over one year resulted in total cost savings of EUR 323,657,712 (EUR 119.10 per patient per year). The total overall cost savings attributable to the implementation of PA-100 over three years were EUR 970,973,137. In scenario B, the total annual savings were EUR 4,254,795 (EUR 1.57 per patient per year), and the 3-year savings were EUR 12,764,385. CONCLUSION: The adoption of this point-of-care system results in overall cost savings, driven by reductions in direct and indirect costs related to UTI management. The model highlights potential savings over three years owing to appropriate rapid management (reduction in time to diagnosis and treatment, which leads to fewer complications and secondary infections) and reduced staff time and productivity loss costs. These findings support the potential benefits of adopting the Sysmex PA-100 to enhance UTI management and allocate healthcare resource utilization in Spain.

Association between body mass index and urinary tract infections: A cross-sectional investigation of the PERSIAN Guilan cohort study.

Introduction: There is a relationship between excess body weight and the risk of a number of infectious diseases, including urinary tract infections (UTIs). This study aimed to investigate the correlation between body mass index (BMI) and UTIs among Prospective Epidemiological Research Studies of the Iranian Adults (PERSIAN) Guilan Cohort Study (PGCS) population. Methods: This cross-sectional study was conducted on 10,520 individuals aged 35-70 years from PGCS. The demographical data and clinical characteristics of the participants were recorded. Microscopic examination of the urine samples was performed to detect the presence of bacteria or white blood cells (WBC) as indicators of infection. UTI was defined as the presence of bacteria in the urine (Few, moderate, and many) and a value of ≥10 WBC/high power field (HPF) by light microscopy. Results: The prevalence of UTIs in this study was 8.8%, with a higher incidence in females compared to males (12.2% vs. 4.7%, p < 0.001). Among participants, the prevalence of UTIs across different weight categories was as follows: underweight/normal weight, 7.1%; overweight, 8.1%; and obesity, 10.9%. According to the unadjusted model, subjects with obesity were at significantly higher odds for UTIs than subjects with underweight/normal BMI (OR = 1.62, 95% CI: 1.35-1.93, p < 0.001). However, this association was no longer significant after adjusting for demographic and clinical variables. Conclusion: The findings of this study provide evidence supporting a higher prevalence of UTIs among individuals with obesity.

Decision-making around removal of indwelling urinary catheters after pituitary surgery.

BACKGROUND: Diabetes insipidus (DI) is a common complication following pituitary surgery, causing significant health issues if left untreated. As part of the diagnostic process, accurate urinary output monitoring via indwelling urinary catheters (IDUCs) is essential, despite risks such as urinary tract infections and hindered recovery. Research on IDUC removal after pituitary surgery remains scarce. AIM: To explore health professionals' perspectives on IDUC management following pituitary surgery. METHODS: Employing a qualitative design, semistructured interviews were conducted with 15 professionals in the neurosurgical ward of a Dutch academic hospital. FINDINGS: Four themes emerged: Concerns about missing identifying DI, patient-nurse dynamics, workload management, and lack of shared decision making. CONCLUSION: The findings underscore the need to balance clinical needs with patient care efficiency. There is a need for evidence-based guidelines and a multidisciplinary approach to optimise IDUC management, given the importance of patient-centred care and shared decision-making.

Short- versus standard-course antibiotic therapy for urinary tract infection in children: a systematic review and meta-analysis.

BACKGROUND: Urinary tract infections are prevalent among children and are responsible for a significant healthcare burden. Antibiotic therapy is the cornerstone of treatment, but the optimal treatment duration remains elusive. OBJECTIVES: This systematic review and meta-analysis aimed to explore the optimal duration of antibiotic therapy for urinary tract infection (UTI) in pediatric patients. DATA SOURCES: A comprehensive search was performed, including MEDLINE, Embase, and Cochrane Library databases. STUDY ELIGIBILITY CRITERIA: We included only randomized controlled trials (RCTs) comparing short-course (2 to 5 days) and standard-course (≥ 7 days) antibiotic treatment in patients < 18 years of age. STUDY APPRAISAL AND SYNTHESIS METHODS: We performed this systematic review and meta-analysis following Cochrane Collaboration recommendations using a random-effects model. Effect estimate was calculated using the risk ratio (RR) with 95% confidence interval (95% CI) for dichotomous and mean difference (MD) with 95% CI for continuous endpoints. Significance was regarded at p-value < 0.05. Statistical analysis was performed using Review Manager 5.4.1. RESULTS: Data from 12 RCTs, encompassing 1442 children, were included. Follow-up ranged from 1 to 12 months. The mean age was 5.9 years, with approximately 87% female patients. E. coli was the most common pathogen isolated from urine cultures. There was a significant difference in cure rates (RR 0.97; 95% CI 0.95-0.99; p = 0.01) between the groups when only studies that included febrile UTI were analyzed together, favoring 7 days or more of treatment, but with high heterogeneity. Otherwise, there was no significant difference in cure rates (RR 0.99; 95% CI 0.91-1.08; p = 0.80) in children with afebrile UTI or recurrence of UTI at any time in children with afebrile (RR 0.98; 95% CI 0.84-1.15; p = 0.80) or febrile UTI (RR 0.52; 95% CI 0.10-2.83; p = 0.45). Also, there was no significant difference in failure rates in children with urinary tract abnormalities and afebrile UTI (RR 0.79; 95% CI 0.47-1.32; p = 0.36), between the short- and the standard-course treatment groups. LIMITATIONS: This analysis was limited by the moderate heterogeneity and the small subgroup of children with urinary tract abnormalities, which could have underpowered our results. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: The primary outcome of this analysis suggests that a short course of antibiotic therapy is feasible in children with afebrile UTI, but more studies are warranted to safely establish an optimal treatment duration for children with febrile UTI. SYSTEMATIC REVIEW REGISTRATION NUMBER: The study protocol was registered in the PROSPERO platform under the number CRD42023489094.

Estrogen-stimulated uropathogenic E. coli mediate enhanced neutrophil responses.

Urinary tract infection (UTI) is one of the most common bacterial infections worldwide and the most common cause is uropathogenic Escherichia coli (UPEC). Current research is mostly focused on how UPEC affects host factors, whereas the effect of host factors on UPEC is less studied. Our previous studies have shown that estrogen alters UPEC virulence. However, the effect of this altered UPEC virulence on neutrophils is unknown. The aim of the present study was to investigate how the altered UPEC virulence mediated by estrogen modulates neutrophil responses. We found that estradiol-stimulated CFT073 increased neutrophil phagocytosis, NETs formation and intracellular ROS production. We observed that the total ROS production from neutrophils was reduced by estradiol-stimulated CFT073. We also found that estradiol-stimulated CFT073 induced less cytotoxicity in neutrophils. Additionally, we found that several cytokines and chemokines like IL-8, IL-1ß, CXCL6, MCP-1 and MCP-4 were increased upon estradiol-stimulated CFT073 infection. In conclusion, this study demonstrates that the estrogen-mediated alterations to UPEC virulence modulates neutrophil responses, most likely in a host-beneficial manner.

Efficacy of a pharmacist care protocol to manage uncomplicated female cystitis in community pharmacies: an open-label, multicenter, randomized, controlled, cluster study: the PharmaCyst' protocol.

BACKGROUND: Urinary tract infections are common affections, especially for women. Difficult access to a general practitioner to obtain a prescription has led France to offer dispensing under protocol by community pharmacists. The primary objective of this study is to evaluate the effectiveness of a pharmacist care protocol provided to manage women with urinary tract infection symptoms. This objective will be assessed using the Acute Cystitis Symptom Score. METHODS: PharmaCyst' is an open-label, multicenter, controlled, cluster-randomized study conducted in the Loire region, France. Women aged between 18 and 65 years presenting to a pharmacy complaining of at least one symptom of an uncomplicated urinary tract infection present over the last 3 days (including burning pain during micturition, dysuria, pollakiuria, urgent urination) will be considered for inclusion. All patients will be contacted on day 3, 10, and month 3. A total of 480 patients need to be recruited for the 24 clusters participating in the research. The quantitative data will be described using means and standard deviations and compared using Student's t-test. The qualitative data will be described using numbers and percentages and compared using chi2 test (or Fisher's exact test if necessary). The primary and secondary outcomes analyses will consider the intention-to-treat population. DISCUSSION: PharmaCyst' is the first clinical trial conducted in France only by community pharmacists. Its results could lead to an extension of the protocol. TRIAL REGISTRATION: The protocol has been approved by the French ethics committee on 2022/12/02 and is registered under the number 49RC22_0240 on ClinicalTrials.gov.

Elucidation of the mechanisms of fluconazole resistance and repurposing treatment options against urinary Candida spp. isolated from hospitalized patients in Alexandria, Egypt.

BACKGROUND: The incidence of fungal urinary tract infections (UTIs) has dramatically increased in the past decades, with Candida arising as the predominant etiological agent. Managing these infections poses a serious challenge to clinicians, especially with the emergence of fluconazole-resistant (FLC-R) Candida species. In this study, we aimed to determine the mechanisms of fluconazole resistance in urinary Candida spp. isolated from hospitalized patients in Alexandria, Egypt, assess the correlation between fluconazole resistance and virulence, and explore potential treatment options for UTIs caused by FLC-R Candida strains. RESULTS: Fluconazole susceptibility testing of 34 urinary Candida isolates indicated that 76.5% were FLC-R, with a higher prevalence of resistance recorded in non-albicans Candida spp. (88.9%) than in Candida albicans (62.5%). The calculated Spearman's correlation coefficients implied significant positive correlations between fluconazole minimum inhibitory concentrations and both biofilm formation and phospholipase production. Real-time PCR results revealed that most FLC-R isolates (60%) significantly overexpressed at least one efflux pump gene, while 42.3% significantly upregulated the ERG11 gene. The most prevalent mutation detected upon ERG11 sequencing was G464S, which is conclusively linked to fluconazole resistance. The five repurposed agents: amikacin, colistin, dexamethasone, ketorolac, and sulfamethoxazole demonstrated variable fluconazole-sensitizing activities in vitro, with amikacin, dexamethasone, and colistin being the most effective. However, the fluconazole/colistin combination produced a notable reduction (49.1%) in bladder bioburden, a 50% decrease in the inflammatory response, and tripled the median survival span relative to the untreated murine models. CONCLUSIONS: The fluconazole/colistin combination offers a promising treatment option for UTIs caused by FLC-R Candida, providing an alternative to the high-cost, tedious process of novel antifungal drug discovery in the battle against antifungal resistance.

Strategies for older people living in care homes to prevent urinary tract infection: the StOP UTI realist synthesis.

Background: Urinary tract infection is the most diagnosed infection in older people. It accounts for more than 50% of antibiotic prescriptions in care homes and is a frequent reason for care home residents being hospitalised. Objective: This realist review developed and refined programme theories for preventing and recognising urinary tract infection, exploring what works, for whom and in what circumstances. Design: The review used realist synthesis to explore existing literature on the detection and prevention of urinary tract infection, complemented by stakeholder consultation. It applies to the UK context, although other healthcare systems may identify synergies in our findings. Data sources: Bibliographic databases searched included MEDLINE, CINAHL, EMBASE, Cochrane Library, Web of Science Core Collection (including the Social Sciences Citation Index), Sociological Abstracts, Bibliomap and National Institute for Health and Care Research Journals Library. Data selection and extraction: Title and abstract screening were undertaken by two researchers independently of each other. Selection and assessment were based on relevance and rigour and cross-checked by a second researcher. Data extracted from the included studies were explored for explanations about how the interventions were considered to work (or not). Evidence tables were constructed to enable identification of patterns across studies that offered insight about the features of successful interventions. Data analysis and synthesis: Programme theories were constructed through a four-stage process involving scoping workshops, examination of relevant extant theory, analysis and synthesis of primary research, teacher-learner interviews and a cross-system stakeholder event. A process of abductive and retroductive reasoning was used to construct context-mechanism-outcome configurations to inform programme theory. Results: The scoping review and stakeholder engagement identified three theory areas that address the prevention and recognition of urinary tract infection and show what is needed to implement best practice. Nine context-mechanism-outcome configurations provided an explanation of how interventions to prevent and recognise urinary tract infection might work in care homes. These were (1) recognition of urinary tract infection is informed by skills in clinical reasoning, (2) decision-support tools enable a whole care team approach to communication, (3) active monitoring is recognised as a legitimate care routine, (4) hydration is recognised as a care priority for all residents, (5) systems are in place to drive action that helps residents to drink more, (6) good infection prevention practice is applied to indwelling urinary catheters, (7) proactive strategies are in place to prevent recurrent urinary tract infection, (8) care home leadership and culture fosters safe fundamental care and (9) developing knowledgeable care teams. Limitations: We adapted our approach and work to online interactions with stakeholders and as a research team because of COVID-19. This also had an impact on bringing stakeholders together at a face-to-face event at the end of the project. Studies focusing on the prevention of urinary tract infection in care home settings were predominantly from the USA and Europe where the regulatory and funding systems for the long-term care of the elderly have some differences, particularly in the USA where national reporting plays a significant role in driving improvements in care. Conclusions: Care home staff have a vital role in the prevention and recognition of urinary tract infection, which can be enabled through integration and prioritisation within the systems and routines of care homes and delivery of person-centred care. Promoting fundamental care as a means of facilitating a holistic approach to prevention and recognition of urinary tract infection helps staff to recognise how they can contribute to antimicrobial stewardship and recognition of sepsis. Challenging assumptions made by staff about the presentation of urinary tract infection is complex and requires education that facilitates 'unlearning' and questioning of low-value practices. Programmes to prevent urinary tract infection need to be co-designed and supported through active and visible leadership by care home managers with support from specialist practitioners. Future work: We will focus on co-designing tools that facilitate implementation of our findings to ensure they fit with the care home context and address some of the challenges faced by care home leaders. This will underpin action at care home and system levels. Further research is needed to better understand the perspectives of residents and family carers, the effectiveness of non-pharmacological, pharmacological and specialist practitioner interventions and non-traditional approaches to training and educating the workforce in care home settings. Study registration: This study is registered as PROSPERO CRD42020201782. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR130396) and is published in full in Health Technology Assessment; Vol. 28, No. 68. See the NIHR Funding and Awards website for further award information.

This study was about how interventions to prevent and recognise urinary tract infections might work in care homes to reduce urinary tract infection in older people. We used an approach called realist synthesis. This aims to understand everything that influences how care is delivered to find out what works in particular situations and settings. We did this by talking to care home staff, residents, family carers and other experts about how to reduce urinary tract infection in older people living in care homes. We combined their experiences and ideas with the evidence from the research literature. From this, we developed three areas of focus: care approaches to support accurate recognition of urinary tract infection care approaches to prevent urinary tract infection/catheter-associated urinary tract infection making best practice happen. Our research shows that care staff are best placed to recognise subtle changes in a resident's behaviour or well-being which might indicate an infection. There are several things care staff can do to proactively help residents from developing a urinary tract infection such as prioritising residents' hydration needs and addressing poor fluid intake. Putting in place infection prevention measures such as caring for, or where possible, removing a urinary catheter can also help. Actively monitoring residents to determine reasons for changes in behaviour can increase the focus on preventative activities and help avoid inappropriate treatment. The detection and prevention of urinary tract infection in older people could be improved in several ways, including: education tailored to the roles and work of care home staff leaders of care homes providing a culture of safety and improvement where urinary tract infection is recognised as something preventable rather than unavoidable having a safe and supportive environment where staff are confident to communicate their concerns all care team members, residents and their families and other professionals linked with the home having a common language and shared goals in the recognition, prevention and diagnosis of urinary tract infection. The COVID-19 pandemic required us to adapt our approach and work mainly online both in our interactions with stakeholders and as a research team. While this provided opportunities to extend our reach to a wider group of stakeholders, it also limited some of our engagement work.

Acetabular Bone Cement Extension Leading to Bladder Obstruction: An Orthopedic Surgical Complication.

Polymethyl methacrylate, commonly known as bone cement, is widely used for implant fixation in orthopedic and trauma surgery due to its excellent adhesive properties and biocompatibility. However, complications such as bone cement extrusion, although rare, can lead to significant morbidity. We present the case of an 86-year-old Hispanic female who presented to the emergency department (ED) with tachycardia, hypertension, and respiratory distress. Her medical history included Parkinson's disease, hiatal hernia, osteoarthritis, colon cancer, and a complex post-hip fracture surgical history. Despite being bedridden, she had been previously in stable health. A computed tomography (CT) scan revealed a significant hiatal hernia, minimal remaining left lung tissue, a right lung nodule, hydronephrosis, and a large radiopaque mass in the right pelvis extending from the acetabular area. This radiopaque mass was later determined to be bone cement, with a portion extruding into the bladder. The patient was diagnosed with sepsis secondary to a urinary tract infection and hyponatremia; a urology consultation recommended a conservative approach to avoid potential antibiotic resistance. This case report highlights a rare complication of total hip arthroplasty involving bone cement extrusion into the bladder, which led to hydronephrosis and a urinary tract infection (UTI). Although such complications can be asymptomatic, they should be considered in patients with a history of arthroplasty.

Catheter-associated urinary tract infections in critically Ill patients with COVID-19: a retrospective cohort study.

Background: Catheter-associated urinary tract infections (CA-UTIs) pose a significant challenge in intensive care unit (ICU) patients with COVID-19. Objective: The study aims to assess the prevalence of CA-UTIs, identify the causative pathogens and their resistance profiles, and determine the risk factors and outcomes associated with CA-UTIs in ICU patients with COVID-19. Design: Single-center, retrospective cohort study. Methods: The study included 201 adult ICU patients diagnosed with COVID-19 between March 2020 and July 2021. Patients were categorized into CA-UTI (n = 56) and non-CA-UTI (n = 145) groups. Data on demographic characteristics, clinical course, treatment, and outcomes were collected. Logistic regression analysis was used to identify risk factors for CA-UTI. Results: CA-UTIs developed in 28% of patients (n = 56). Incidence density of 15.8 episodes per 1000 catheter days. The average onset occurrence is 7.2 days after ICU admission. Patients with CA-UTI had longer ICU stays (18.8 days vs 10.5 days, p < 0.001) and more elevated mortality rates (75.0% vs 54.5%, p = 0.010), higher mechanical ventilation (MV) usage (98.2% vs 88.3%, p = 0.027), a longer average duration of MV (16.6 days vs 9.1 days, p < 0.001). Longer ICU and hospital stays were significant risk factors for CA-UTI. Other factors, such as the use of corticosteroids, chronic organ insufficiency or immunocompromized status, female sex, age, diabetes mellitus, and the duration of urinary catheterization, did not show significant associations with CA-UTI risk in this cohort. Gram-negative bacteria, particularly Klebsiella pneumoniae (28 cases), was the most common pathogen, with a high prevalence of multidrug resistance (38.8%) with type ESBL, MBL, NDM, and OXA-48. The occurrence of multidrug resistant (MDR) organisms was 68.8%. Conclusion: The findings of this study underscore the prevalence of CA-UTIs in ICU patients with COVID-19, significantly impacting patient outcomes. Effective infection control and targeted antimicrobial therapy are crucial to managing these infections.

Implementation of an Algorithm for Testing, Diagnosis, and Antibiotic Stewardship of Asymptomatic Bacteriuria in Pregnancy.

BACKGROUND: Asymptomatic bacteriuria (ASB) affects 2-15% of pregnant women, with 20-40% developing symptoms later. Symptomatic urinary tract infections (UTIs) are more common in pregnancy, with a prevalence of 33%, posing risks like preterm delivery, low birth weight, and maternal pyelonephritis. The gold standard for UTI detection is a urine culture, but point-of-care urinalysis dipsticks are frequently performed as screens during regular obstetric visits. Leukocyte esterase has been used to justify treatment in the asymptomatic, even with low sensitivity and specificity. Confirmatory tests are crucial to avoid false positives and ensure optimal outcomes. Current guidelines for urinalysis dipstick interpretation and the decision to treat ASB in pregnancy are limited. It remains unclear if an evidence-based algorithm can improve test utilization, diagnosis, and treatment decisions for ASB in pregnancy. OBJECTIVES: The primary objective of our study is to develop, implement, and evaluate an evidence-based algorithm to guide urinalysis interpretation, culturing, diagnosis, and antibiotic stewardship of asymptomatic bacteriuria in pregnant patients during routine obstetric visits. STUDY DESIGN: The project involves both retrospective and quasi-experimental prospective chart reviews of pregnant patients aged 18 and older, beyond 20 weeks gestation, from routine obstetric visits with urinalysis dipstick tests. A doctorate in clinical laboratory sciences student developed an educational algorithm to guide urinalysis dipstick interpretation, culturing necessity, and treatment decisions based on evidence-based practice. Our study considered patient records from February 1 - 28, 2022 as retrospective (pre-algorithm implementation) data and January 24 - February 22, 2023, as prospective (post-algorithm implementation) data. Data collected from the electronic medical record included de-identified patient information, urinalysis results, culture dates and outcomes, antibiotic prescriptions, UTI or ASB diagnoses, provider details, adverse pregnancy outcomes, and demographics. Data analysis using SPSS version 29 involved chi-square tests, likelihood ratios, and effect size calculations, with P-values <0.05 considered statistically significant. RESULTS: In our study, we examined a total of 1,176 patient records. Pre-implementation data included 440 records, with 224 abnormal and 216 normal urinalyses. Post-implementation data encompassed 736 records, of which 255 were abnormal and 481 were normal. The patient demographics predominantly featured White (87%), with a median maternal age of 27 years and a gestational age of 32 weeks. Our pre-implementation analyses revealed significant associations between algorithm deviations with both culture utilization (P <.001) and antibiotic stewardship (P <.001). However, no significant associations were observed between algorithm deviations and adverse patient outcomes. Culture underutilization decreased significantly from 43.0% (189/440) pre-implementation to 29.5% (217/736) post-implementation (P < .001). The overall reduction in ASB prevalence from 16.3% (8/49) to 6.7% (10/67) suggests a decrease of nearly 60%. Additionally, antibiotic overprescription decreased significantly from 1.6% (4/258) pre-implementation to 0.8% (4/522) post-implementation (P = .003), with a reduction from 7.1% (3/42) to 2.4% (1/41) among abnormal urinalyses. CONCLUSION: Our findings show a strong alignment between the use of the algorithm and subsequent clinical decisions, underscoring its potential to enhance patient care and management in obstetric settings. Notably, adherence to the algorithm was higher among providers displaying prudent antibiotic use.

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.

OBJECTIVES: The objectives are to determine the prevalence of urinary tract infection (UTI) and associated factors among patients diagnosed with benign prostatic hyperplasia and prostate cancer. DESIGN: Hospital-based cross-sectional study. SETTINGS: Urology clinic and urology ward at Muhimbili National Hospital, which is the main tertiary hospital in Tanzania's largest city. PARTICIPANTS: Patients with benign prostate hyperplasia and prostate cancer presenting with genitourinary symptoms. MAIN OUTCOME MEASURE: The primary outcome was the occurrence of UTI and factors associated with UTI in patients with benign prostatic hyperplasia and prostate cancer. RESULTS: 402 participants were enrolled, with a median age of 68 years and IQR of 61-75 years. The proportion of UTI was 46.5% (95% CI 41.56% to 51.53%). UTI was more prevalent among inpatients, patients with indwelling urinary catheters, patients with prostate size>80 cm3 and those with residual urine volume of >100 mL. In multivariate analysis, age>60 years (adjusted OR (aOR)=2.0, 95% CI 1.13 to 3.55, p=0.018), post-void residual urine volume>100 mL (aOR 1.32, 95% CI 0.67 to 2.59 p=0.001), patient with incomplete bladder emptying (aOR=2.57, 95% CI 1.44 to 4.59, p=0.001) and prolonged catheter duration (aOR=1.24, 95% CI 1.11 to 1.38, p=0.005) were significantly associated with UTI. CONCLUSION: Almost half of the patients with an enlarged prostate and genitourinary symptoms had a laboratory-confirmed UTI. The risk of UTI increases with age, incomplete bladder emptying and increased duration of catheterisation. A 1-day increase in the duration of catheterisation increased the risk of UTI by 24%.

Knowledge, attitudes and practices around urinary tract infections of general practitioners in the Netherlands: a cross-sectional internet survey.

OBJECTIVES: Urinary tract infections (UTIs) are the most common reason for women to consult a general practitioner (GP). Current diagnostic tests are inadequate, complicating diagnosis and treatment decisions for GPs. To understand how this influences GPs in managing UTI, we aimed to determine GPs' knowledge, attitudes, and practices around UTI care. DESIGN: Cross-sectional internet-based survey. SETTING: General practice in the Netherlands between December 2021 and February 2022. PARTICIPANTS: We distributed invitations to participate via email to 126 practices. Additionally, we distributed invitations via social media and newsletters. OUTCOMES: The survey included 15 questions covering GPs' sociodemographic information, knowledge, attitudes and practices. Data analysis was based on frequencies and descriptive statistics. RESULTS: Among the 190 eligible respondents, 172 (90.5%) chose dysuria and 140 (73.7%) chose urinary frequency as a symptom likely indicating UTI in healthy women. One in three GPs would diagnose a UTI based on non-specific complaints with positive leucocyte and erythrocyte tests, discordant with established guidelines. GPs indicated that better point-of-care diagnostics would help improve antibiotic prescribing (72.6%) and would conserve time (60.0%). GPs considered a positive test result the most important factor to prescribe antibiotics while patient expectation was considered least important. Half of GPs indicated that the most urgent need in UTI care is improved diagnostics. CONCLUSION: GPs often act in discordance with established guidelines, rely on non-specific symptoms for the diagnosis of UTI and rank patient expectation as less important in comparison to symptom recognition and culture result when deciding on antibiotic treatment.