Flexible cystoscopy for ureteral stent removal without antimicrobial prophylaxis. A prospective observational study.

OBJECTIVE: Flexible cystoscopy for ureteral stent removal after ureteroscopy is widely performed. In this scenario, the real need for antimicrobial prophylaxis is still uncertain. Aim of this study is to determine the urinary tract infections rate after 4 weeks from outpatient flexible cystoscopies for ureteral stent removal without antimicrobial prophylaxis. PATIENTS AND METHODS: A prospective observational study was performed between November 2017 and August 2018 in a single, high-volume Institution.Risk factors for UTIs were recorded. Immediately before cystoscopy, each patient submitted a voided urine specimen. Antibiotics were not given before or after cystoscopy. About 7 and 28 days after cystoscopy all the patients underwent abdomen US, urine analysis and culture, and clinical evaluation to assess possible symptoms of UTI. RESULTS: A total of 192 patients were enrolled in the study, 76 patients (39.2%) were female. Median age was 55 years [IQR 47- 68]. Median BMI was 24.2 [22.9-26.7]. Eighteen patients (9.4%) had asymptomatic bacteriuria before cystoscopy and 39 (20.3%) had positive culture at 7 days. About 21 patients (10.9%) were diagnosed with febrile UTI in the 28 days FU period. The 28.6 % of the Febrile patients had asymptomatic bacteriuria before the stent removal (p < 0.001), this group was slightly older (p = 0.085) and with higher BMI (p = 0.036).Forty-eight patients had positive urine culture at 7 days, of whom 27 (14.1%) were asymptomatic and were classified as asymptomatic bacteriuria. Multivariate analysis shows that only high BMI and bacteriuria before the procedure were significantly associated with developing a febrile UTI, none of the other risk factors was significant. CONCLUSION: Our data show a high rate of UTI after flexible cystoscopies for ureteral stent removal without antimicrobial prophylaxis especially in patients with asymptomatic bacteriuria, in those with high BMI and in the elderly; in these subgroups, antimicrobial prophylaxis should be recommended.

Diagnostic and therapeutic appropriateness in bone and joint infections: results of a national survey.

The impact of infectious diseases (ID) specialist consultation in the management of many types of bacterial infections has been fully demonstrated but not for bone and joint infections (BJIs). Nineteen ID Italian centres collected of data from June 2009 to May 2012. Italian guidelines (2009) were used to determine the appropriateness of the diagnostic and therapeutic process of BJIs before and after consulting an ID specialist. Data on 311 patients were collected: 111 cases of prosthetic joint infection, 99 osteomyelitis, 64 spondylodiscitis and 37 fixation device infection. A significant increase of microbiological investigations, imaging techniques and blood inflammation markers were noted after consulting the ID specialist. Moreover, inappropriateness of treatment duration, dosage, and number of administrations significantly decreased after consultation. Infectious disease specialist intervention in the management of BJIs significantly increases the appropriateness both in performing instrumental and laboratory analysis, but especially in determining the correct therapy.

Clinical and virological survey of patients with hepatitis B surface antigen in an Italian region: clinical considerations and disease burden.

The aim of this study was to determine the prevalence of hepatitis B virus (HBV) infection in an Italian region, Liguria (1,572,000 inhabitants), by means of a network of 12 referral centers for liver diseases. All patients with HBV surface antigen followed throughout 2006 were included. Personal data, infectious status with risk factors, other non-infectious risk factors for liver disease, clinical status, and treatment were the questionnaire. Four hundred forty-five patients (71% male) were evaluated. Their median age was 48 years (range 5-84), and 83.4% were of Italian origin. Community-acquired infection was the principal mode of HBV transmission (82.5%), followed by previous intravenous drug use (9.4%), perinatal transmission (6.3%), and transfusion-associated transmission (1.8%). Hepatitis B e-antigen was present in 20.4% of the patients, while co-infections with hepatitis D virus and/or hepatitis C virus and/or human immunodeficiency virus (HIV) were observed in 18.7% of the patients. Chronic active hepatitis was present in 62.5% of the patients, cirrhosis in 13.5%, hepatocellular carcinoma in 2.2%, and 21.8% of the patients were inactive carriers of HBV. In all, 42.5% of the patients were treated with interferon or lamivudine and/or adefovir-dipivoxil. Forty-nine patients were co-infected with HIV (86% on highly active antiviral therapy). Nevertheless, this study identified only 2.2% of the expected patients with HBV. Hence, it has to be reasoned that few potential infectious or treatable patients are referred to liver disease centers. HBV infection is still an underestimated health problem, and few potential infectious or treatable patients are referred to tertiary centers.