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1.
Arch Esp Urol ; 77(8): 897-902, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-39385485

RESUMEN

OBJECTIVE: Urology patients are often placed with a catheter following surgery. Hence, a high-quality and appropriate management and removal programme can considerably reduce catheter-associated complications such as urinary tract infections and improve patient comfort. This retrospective study investigated the impact of a collaborative medical-nursing catheter removal protocol on reducing the incidence of urinary tract infections in urological surgery patients. METHODS: Patients who underwent partial nephrectomy at our hospital between January 2021 and December 2022 were enrolled and allocated to a control and an observation group based on the method of urinary catheter removal. A physician was solely responsible for monitoring, evaluating, and removing the catheter in the control group, whereas a physician and nurses performed these catheter management activities in the observation group. The two groups were compared in terms of urinary tract infections, urinary tract irritation and hematuria signs, pain levels, and catheter retention time. RESULTS: A total of 178 patients were included, among which 88 were divided into the control group and 90 into the observation group according to their corresponding urinary catheter removal method entered into the medical records system. The general characteristics of the two groups were similar (p > 0.05). However, the rates of urinary tract infections and urinary tract irritation and hematuria signs in the observation group were lower than those in the control group (1.11% vs. 9.09%, χ2 = 5.902, p = 0.037; 5.55% vs. 15.91%, χ2 = 4.159, p = 0.041, respectively). The observation group also exhibited lower levels of urinary pain within 1 h post-catheter removal and shorter total catheter retention time than the control group (t = 2.497, p = 0.013; t = 2.316, p = 0.022, respectively). CONCLUSIONS: Collaborative medical-nursing catheter removal protocols for patients undergoing partial nephrectomy may effectively alleviate urinary pain, decrease the incidence of urinary tract infections and irritation and hematuria signs, and shorten catheter retention time, underscoring the clinical significance of its implementation in this specific population.


Asunto(s)
Remoción de Dispositivos , Cateterismo Urinario , Infecciones Urinarias , Humanos , Estudios Retrospectivos , Infecciones Urinarias/prevención & control , Infecciones Urinarias/etiología , Infecciones Urinarias/epidemiología , Masculino , Incidencia , Femenino , Remoción de Dispositivos/efectos adversos , Persona de Mediana Edad , Cateterismo Urinario/efectos adversos , Infecciones Relacionadas con Catéteres/prevención & control , Infecciones Relacionadas con Catéteres/epidemiología , Infecciones Relacionadas con Catéteres/etiología , Anciano , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & control , Protocolos Clínicos , Catéteres Urinarios/efectos adversos , Nefrectomía/métodos , Nefrectomía/efectos adversos , Adulto
2.
BMC Pregnancy Childbirth ; 24(1): 694, 2024 Oct 23.
Artículo en Inglés | MEDLINE | ID: mdl-39443883

RESUMEN

PURPOSE: The purpose of this study was to examine the association between hygiene and sexual practices and the incidence of urinary tract infection (UTI) among Jordanian pregnant women. METHODS: The cross-sectional data were collected using self- administered survey from October 2018 to January 2019 in central Jordan. A total of 200 pregnant women completed the survey. All of them were married and aged between 18 and 45 years (M = 27.45; SD = 6.06). The measures used were demographics, social, hygiene and sexual practices. RESULTS: A significant association was found between the incidence of UTI and the educational level of husbands (p = 0.05), history of UTI in previous pregnancies (p = 0.02) and being in the second trimester of pregnancy (p = 0.02). Their sexual and hygiene practices also were significantly associated with the incidence of UTI. CONCLUSION: History of UTI in previous pregnancies, hygiene and sexual practices are associated with increased incidence of UTI among Jordanian pregnant women. Appropriate strategies and techniques to promote health and preventive behaviors for pregnant women with UTI should be provided to improve the quality of life among pregnant women and reduces economic burdens on health care system.


Asunto(s)
Higiene , Conducta Sexual , Infecciones Urinarias , Humanos , Femenino , Jordania/epidemiología , Embarazo , Adulto , Estudios Transversales , Infecciones Urinarias/epidemiología , Infecciones Urinarias/prevención & control , Conducta Sexual/estadística & datos numéricos , Adulto Joven , Incidencia , Adolescente , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/prevención & control , Encuestas y Cuestionarios , Persona de Mediana Edad , Mujeres Embarazadas/psicología
3.
Clin Nurse Spec ; 38(6): 303-305, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39437210

RESUMEN

ABSTRACT: External urine management devices were introduced into healthcare as a novel solution to avoid indwelling urinary catheter placement and the associated urinary tract infection risk for adult patients. These devices are favored among healthcare workers and patients. However, the downstream impacts of this device can be detrimental to patient outcomes when immobility is promoted through their use. Clinical nurse specialists are the ideal team member to evaluate the introduction of new technology to promote patient-focused care over task-focused care.


Asunto(s)
Cateterismo Urinario , Infecciones Urinarias , Humanos , Cateterismo Urinario/efectos adversos , Cateterismo Urinario/enfermería , Infecciones Urinarias/prevención & control , Enfermeras Clínicas , Hospitalización , Catéteres de Permanencia/efectos adversos , Catéteres Urinarios/efectos adversos
4.
Br J Nurs ; 33(18): S14-S20, 2024 Oct 10.
Artículo en Inglés | MEDLINE | ID: mdl-39392326

RESUMEN

Urinary catheterisation is a crucial procedure in healthcare, requiring a thorough understanding of the anatomical and physiological differences between males and females to ensure safe and effective care. This guide explores the anatomy of the urinary system, detailing the kidneys, ureters, bladder, and urethra, and highlights key differences in catheterisation techniques for men and women. Emphasising evidence-based practices, it discusses recent advancements, such as antimicrobial catheters, and underscores the importance of comprehensive training and competency assessments for healthcare providers. Additionally, the guide advocates for patient-centred approaches, multidisciplinary collaboration, and adherence to updated policies to reduce complications such as catheter-associated urinary tract infections (CAUTIs). By integrating these critical evaluations and best practices, health professionals can enhance patient outcomes and maintain high standards of care in urinary catheterisation.


Asunto(s)
Cateterismo Urinario , Humanos , Cateterismo Urinario/enfermería , Femenino , Masculino , Infecciones Urinarias/prevención & control , Infecciones Urinarias/enfermería , Factores Sexuales , Infecciones Relacionadas con Catéteres/prevención & control , Catéteres Urinarios/efectos adversos
5.
Health Technol Assess ; 28(68): 1-139, 2024 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-39432412

RESUMEN

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.


Asunto(s)
Infecciones Urinarias , Humanos , Infecciones Urinarias/prevención & control , Anciano , Casas de Salud , Hogares para Ancianos , Reino Unido , Antibacterianos/uso terapéutico
6.
Trials ; 25(1): 682, 2024 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-39407325

RESUMEN

BACKGROUND: Urinary tract catheters, including Double-J or ureteral stents, are prone to bacterial colonization forming biofilms and leading to asymptomatic bacteriuria. In the context of asymptomatic bacteriuria, endourological procedures causing mucosa-inducing lesions can lead to severe infections. Antibiotic prophylaxis is warranted, yet its efficacy is limited by biofilm formation on stents. Biofilms promote antibiotic tolerance, the capacity of genetically susceptible bacteria to survive a normally lethal dose of antimicrobial therapy. The UROPOT study evaluates the effectiveness of a first-in-type metabolism-based aminoglycoside potentiation for (i) preventing infectious complications of asymptomatic bacteriuria during mucosa lesion-inducing endourological procedures and (ii) assessing its anti-tolerance efficacy. METHODS: The UROPOT trial is a phase I/II single-center (Lausanne University Hospital (CHUV), Switzerland) randomized double-blinded trial. Over 2 years, patients with asymptomatic Escherichia coli and/or Klebsiella pneumoniae bacteriuria, undergoing endourological procedures, will be randomly allocated to one of three treatment arms (1:1:1 randomization ratio, 30 patients per group) to evaluate the efficacy of mannitol-potentiated low-dose amikacin compared to established standard treatments (ceftriaxone or amikacin standard dose). Patients will be recruited at the CHUV Urology Outpatient Clinic. The primary outcome is the comparative incidence of postoperative urinary tract infections (assessed at 48 h) between the investigational amikacin/mannitol therapy and standard (ceftriaxone or amikacin) antibiotic prophylaxis, defined by specific systemic symptoms and/or positive blood and/or urine culture. Secondary outcomes include assessing microbiological eradication through anti-biofilm activity, sustained microbiological eradication, and mannitol and antibiotics pharmacokinetics in blood and urine. Safety outcomes will evaluate the incidence of adverse events following amikacin/mannitol therapy and postoperative surgical complications at postoperative day 14. DISCUSSION: UROPOT tests a novel antimicrobial strategy based on "metabolic potentiation" for prophylaxis enabling aminoglycoside dose reduction and targeting biofilm activity. The anti-biofilm effect may prove beneficial, particularly in patients who have a permanent stent in situ needing recurrent endourological manipulations strategies in preventing infections and achieving sustained microbiological eradication in pre-stented patients. TRIAL REGISTRATION: The protocol is approved by the local ethics committee (CER-VD, 2023-01369, protocole 2.0) and the Swiss Agency for Therapeutic Products (Swissmedic, 701,676) and is registered on the NIH's ClinicalTrials.gov (trial registration number: NCT05761405). Registered on March 07, 2023.


Asunto(s)
Amicacina , Antibacterianos , Profilaxis Antibiótica , Bacteriuria , Biopelículas , Ensayos Clínicos Controlados Aleatorios como Asunto , Humanos , Método Doble Ciego , Amicacina/efectos adversos , Biopelículas/efectos de los fármacos , Bacteriuria/prevención & control , Antibacterianos/uso terapéutico , Antibacterianos/efectos adversos , Profilaxis Antibiótica/métodos , Profilaxis Antibiótica/efectos adversos , Ensayos Clínicos Fase II como Asunto , Ensayos Clínicos Fase I como Asunto , Manitol/efectos adversos , Klebsiella pneumoniae/efectos de los fármacos , Suiza , Infecciones Urinarias/microbiología , Infecciones Urinarias/prevención & control , Escherichia coli/efectos de los fármacos , Resultado del Tratamiento
7.
Curr Microbiol ; 81(10): 347, 2024 Sep 06.
Artículo en Inglés | MEDLINE | ID: mdl-39240321

RESUMEN

Management of urinary tract infections (UTI) is a highly challenging process due to the biofilm-forming ability of human-pathogenic bacteria. Here, we designed to fabricate an effective nanogel with a combination of chitosan bio-polymer and nalidixic acid to prevent biofilm-forming bacterial pathogens. Chitosan-coated nalidixic acid nanogel (NA@CS) exhibits outstanding inhibition potential against bacterial strains. In vitro, anti-bacterial analysis methods (well diffusion, colony-forming assay, and anti-biofilm assay) were performed to study the bacterial inhibition potential of prepared nanogel, which reveals that NA@CS nanogel have greater inhibition potential against selected pathogens. The combination of nalidixic acid with chitosan biopolymer decreases the virulence and pathogenicity of biofilm-forming pathogens due to their ability to membrane phospholipids penetration. Furthermore, the fabricated NA@CS nanogel showed reliable in vitro bio-compatibility on L929 fibroblast cells and in vivo compatibility with Artemia salina animal model. Overall, the results demonstrate that NA@CS nanogel could be an effective therapeutic for treating urinary tract infections and urine bladder wound healing.


Asunto(s)
Antibacterianos , Biopelículas , Quitosano , Ácido Nalidíxico , Nanogeles , Infecciones Urinarias , Infecciones Urinarias/microbiología , Infecciones Urinarias/prevención & control , Infecciones Urinarias/tratamiento farmacológico , Quitosano/química , Quitosano/farmacología , Antibacterianos/farmacología , Antibacterianos/química , Animales , Nanogeles/química , Ácido Nalidíxico/farmacología , Biopelículas/efectos de los fármacos , Ratones , Línea Celular , Bacterias/efectos de los fármacos , Pruebas de Sensibilidad Microbiana , Humanos , Artemia/efectos de los fármacos , Artemia/microbiología
8.
Br J Nurs ; 33(16): 754-760, 2024 Sep 05.
Artículo en Inglés | MEDLINE | ID: mdl-39250441

RESUMEN

Urinary incontinence is common and has many causes. A main one is urinary retention, and clean intermittent self-catheterisation is the gold standard for managing it. There are, however, complications associated with performing this, which affect patient experience, quality of life and compliance with the procedure. The most common complication is urinary tract infection (UTI), which can be debilitating and have serious consequences. On average, patients experience 2.7 UTIs a year. Infection often arises from residual urine left behind, this can be caused by mucosal suction into catheter eyelets giving the impression that the bladder has finished emptying and leading to early withdrawal of the catheter. Mucosal suction by catheter eyelets can also lead to micro-trauma. Hydrophilic catheters have long been used to prevent micro-trauma. A catheter using Micro-hole Zone Technology instead of conventional two eyelets was developed with the aim of reducing UTI risk by addressing risk factors for bladder micro-trauma and incomplete voiding. A recent evaluation of Coloplast's Luja male intermittent catheter found that 97% of nurses would recommend Luja, 96% of nurses felt confident their patients will learn how to completely empty their bladder with Luja, and 88% of nurses were less worried that their patients are at risk of getting UTIs due to incomplete bladder emptying.


Asunto(s)
Cateterismo Uretral Intermitente , Autocuidado , Infecciones Urinarias , Humanos , Masculino , Cateterismo Uretral Intermitente/instrumentación , Cateterismo Uretral Intermitente/efectos adversos , Infecciones Urinarias/prevención & control , Infecciones Urinarias/etiología , Retención Urinaria/terapia , Diseño de Equipo , Catéteres Urinarios/efectos adversos , Incontinencia Urinaria , Calidad de Vida
9.
Food Res Int ; 195: 114997, 2024 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-39277257

RESUMEN

Repeated urinary tract infections affect many people worldwide. A potential strategy to reduce the incidence of these infections is to consume probiotics and cranberry fruit regularly. In this context, this study aims to prepare fermented milk with Lactobacillus acidophilus La-5 added with concentrated cranberry juice in two concentrations (5 and 10 %, corresponding to C1 and C2 samples, respectively) and evaluate different technological aspects of the samples after production and during storage, and comparing with the control sample (C). The juice had pH 1.91, 70.09 % of solids, and total proanthocyanidins and A-type proanthocyanidins (PACs) values of 117.03 mg/100 g and 16.38 mg/100 g, respectively. The higher the juice content added to the product, the higher the acidity (1.4 and 2.6 g of lactic acid in 100 g, corresponding to C1 and C2 on day 1 (D1), respectively), the total proanthocyanidin content (1.96 and 4.01 mg/100 g on D1; and 1.31 and 3.05 mg/100 g on day 28 of storage (D28), corresponding to C1 and C2, respectively) and A-type proanthocyanidin (0.56 and 1.26 mg/100 g in Day 1; and 0.54 and 1.19 mg/100 g in D28, corresponding to C1 and C2, respectively), higher the values of the color parameters (L*a* and C*), and lower pH value, probiotic viability, and sensory acceptance. Furthermore, the rheological parameters demonstrated a stronger protein network due to the addition of cranberry. The new formulations, including samples C1 and C2, are alternatives as functional products, which regular consumption probably has the potential to minimize the recurrence of urinary tract infections.


Asunto(s)
Productos Lácteos Cultivados , Jugos de Frutas y Vegetales , Lactobacillus acidophilus , Proantocianidinas , Infecciones Urinarias , Vaccinium macrocarpon , Vaccinium macrocarpon/química , Infecciones Urinarias/prevención & control , Infecciones Urinarias/microbiología , Productos Lácteos Cultivados/microbiología , Humanos , Probióticos , Fermentación , Concentración de Iones de Hidrógeno , Recurrencia
10.
Antimicrob Resist Infect Control ; 13(1): 96, 2024 Sep 02.
Artículo en Inglés | MEDLINE | ID: mdl-39218889

RESUMEN

BACKGROUND: Catheter-associated urinary tract infection (CAUTI) remains the most significant challenge among hospital-acquired infections (HAIs), yet still unresolved. The present study aims to evaluate the preventive effectiveness of JUC Spray Dressing (name of U.S. FDA and CE certifications, while the medical device name in China is Long-acting Antimicrobial Material) alone for CAUTI without combining with antibiotics and to evaluate the impact of bacterial biofilm formation on CAUTI results on the inserted catheters of patients. METHODS: In this multicenter, randomized, double-blind study, we enrolled adults who suffered from acute urinary retention (AUR) and required catheterization in 6 hospitals in China. Participants were randomly allocated 1:1 according to a random number table to receive JUC Spray Dressing (JUC group) or normal saline (placebo group). The catheters were pretreated with JUC Spray Dressing or normal saline respectively before catheterization. Urine samples and catheter samples were collected after catheterization by trial staff for further investigation. RESULTS: From April 2012 to April 2020, we enrolled 264 patients and randomly assigned them to the JUC group (n = 132) and the placebo group (n = 132). Clinical symptoms and urine bacterial cultures showed the incidence of CAUTI of the JUC group was significantly lower than the placebo group (P < 0.01). In addition, another 30 patients were enrolled to evaluate the biofilm formation on catheters after catheter insertion in the patients' urethra (10 groups, 3 each). The results of scanning electron microscopy (SEM) showed that bacterial biofilm formed on the 5th day in the placebo group, while no bacterial biofilm formed on the 5th day in the JUC group. In addition, no adverse reactions were reported using JUC Spray Dressing. CONCLUSION: Continued indwelling urinary catheters for 5 days resulted in bacterial biofilm formation, and pretreatment of urethral catheters with JUC Spray Dressing can prevent bacterial biofilm formation by forming a physical antimicrobial film, and significantly reduce the incidence of CAUTI. This is the first report of a study on inhibiting bacterial biofilm formation on the catheters in CAUTI patients.


Asunto(s)
Biopelículas , Infecciones Relacionadas con Catéteres , Infecciones Urinarias , Humanos , Biopelículas/crecimiento & desarrollo , Infecciones Urinarias/prevención & control , Infecciones Urinarias/microbiología , Infecciones Relacionadas con Catéteres/prevención & control , Infecciones Relacionadas con Catéteres/microbiología , Femenino , Masculino , Persona de Mediana Edad , Método Doble Ciego , Catéteres Urinarios/efectos adversos , Catéteres Urinarios/microbiología , Cateterismo Urinario/efectos adversos , Anciano , Adulto , China , Vendajes , Infección Hospitalaria/prevención & control
11.
Am Fam Physician ; 110(3): 251-258, 2024 09.
Artículo en Inglés | MEDLINE | ID: mdl-39283848

RESUMEN

Family physicians often treat patients who require urinary management with the use of external urinary devices, clean intermittent catheterization, or indwelling urinary catheterization. External urinary devices are indicated for urinary incontinence (postvoid residual less than 300 mL), urine volume measurement for hospitalized patients, nonsterile urine diagnostic testing, improved comfort for patients in hospice or palliative care, and fall prevention for high-risk patients. Indwelling urinary catheterization is indicated for severe urinary retention or bladder outlet obstruction; wound healing in the sacrum, buttocks, or perineal area; prolonged immobilization; and as a palliative measure for patients who are terminally ill. Clean intermittent catheterization is an alternative to indwelling urinary catheterization for acute or chronic urinary retention (postvoid residual greater than 300 mL) without bladder outlet obstruction, sterile urine testing, postvoid residual volume assessment, and wound healing. Suprapubic catheter placement is considered when long-term catheterization is needed or urethral catheterization is not feasible. Urinary catheters should not be used solely for staff or caregiver convenience, incontinence-related dermatitis, urine culture procurement from a voiding patient, or initial incontinence management. Common complications of urinary catheter use include obstruction, bladder spasm, urine leakage, and skin breakdown of the sacrum, buttocks, or perineum. The risk of catheter-associated urinary tract infections increases with the duration of catheter use. Urologist referral is indicated for patients requiring urinary management who have recurrent urinary tract infections, acute infectious urinary retention, suspected urethral injury, or substantial urethral discomfort or if long-term catheterization is being considered.


Asunto(s)
Cateterismo Urinario , Catéteres Urinarios , Humanos , Cateterismo Urinario/efectos adversos , Cateterismo Urinario/métodos , Catéteres Urinarios/efectos adversos , Retención Urinaria/terapia , Retención Urinaria/diagnóstico , Retención Urinaria/etiología , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/prevención & control , Infecciones Urinarias/terapia , Catéteres de Permanencia/efectos adversos , Incontinencia Urinaria/terapia , Incontinencia Urinaria/diagnóstico
12.
JMIR Res Protoc ; 13: e60099, 2024 Sep 16.
Artículo en Inglés | MEDLINE | ID: mdl-39284176

RESUMEN

BACKGROUND: Despite the extensive use of antibiotics and the growing challenge of antimicrobial resistance, there has been a lack of substantial initiatives aimed at diminishing the prevalence of infections in nursing homes and enhancing the detection of urinary tract infections (UTIs). OBJECTIVE: This study aims to systematize and enhance efforts to prevent health care-associated infections, mainly UTIs and reduce antibiotic inappropriateness by implementing a multifaceted intervention targeting health care professionals in nursing homes. METHODS: A before-and-after intervention study carried out in a minimum of 10 nursing homes in each of the 8 European participating countries (Denmark, Greece, Hungary, Lithuania, Poland, Slovakia, Slovenia, and Spain). A team of 4 professionals consisting of nurses, doctors, health care assistants, or health care helpers are actively involved in each nursing home. Over the initial 3-month period, professionals in each nursing home are registering information on UTIs as well as infection and prevention control measures by means of the Audit Project Odense method. The audit will be repeated after implementing a multifaceted intervention. The intervention will consist of feedback and discussion of the results from the first registration, training on the implementation of infection and prevention control techniques provided by experts, appropriateness of the diagnostic approach and antibiotic prescribing for UTIs, and provision of information materials on infection control and antimicrobial stewardship targeted to staff, residents, and relatives. We will compare the pre- and postintervention audit results using chi-square test for prescription appropriateness and Student t test for implemented hygiene elements. RESULTS: A total of 109 nursing homes have participated in the pilot study and the first registration audit. The results of the first audit registration are expected to be published in autumn of 2024. The final results will be published by the end of 2025. CONCLUSIONS: This is a European Union-funded project aimed at contributing to the battle against antimicrobial resistance through improvement of the quality of management of common infections based on evidence-based interventions tailored to the nursing home setting and a diverse range of professionals. We expect the intervention to result in a significant increase in the number of hygiene activities implemented by health care providers and residents. Additionally, we anticipate a marked reduction in the number of inappropriately managed UTIs, as well as a substantial decrease in the overall incidence of infections following the intervention. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/60099.


Asunto(s)
Antibacterianos , Programas de Optimización del Uso de los Antimicrobianos , Casas de Salud , Infecciones Urinarias , Humanos , Antibacterianos/uso terapéutico , Infecciones Urinarias/prevención & control , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/epidemiología , Europa (Continente)/epidemiología , Control de Infecciones/métodos , Infección Hospitalaria/prevención & control , Infección Hospitalaria/epidemiología
14.
Infect Dis Clin North Am ; 38(4): 713-729, 2024 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-39261137

RESUMEN

Catheter-associated urinary tract infections (CAUTIs) are common and costly hospital-acquired infections, yet they are largely preventable. The greatest modifiable risk factor for developing a CAUTI is duration of catheterization, including initial indwelling catheter placement when it may not otherwise be necessary. Alternatives to indwelling urinary catheters, including intermittent straight catheterization and the use of external catheters, should be considered in applicable patients. If an indwelling urinary catheter is required, aseptic insertion technique and maintenance should be performed. Through the use of collaborative, multidisciplinary intervention efforts, CAUTI rates can be successfully reduced.


Asunto(s)
Infecciones Relacionadas con Catéteres , Catéteres de Permanencia , Cateterismo Urinario , Catéteres Urinarios , Infecciones Urinarias , Humanos , Infecciones Relacionadas con Catéteres/prevención & control , Infecciones Urinarias/prevención & control , Cateterismo Urinario/efectos adversos , Factores de Riesgo , Catéteres de Permanencia/efectos adversos , Catéteres Urinarios/efectos adversos , Infección Hospitalaria/prevención & control
15.
Infect Immun ; 92(10): e0016924, 2024 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-39297649

RESUMEN

The increase in urinary tract infections (UTI) caused by antibiotic-resistant Escherichia coli requires the development of new therapeutic agents and prophylactic vaccines. To evaluate the efficacy of new lead candidates, we implemented a cynomolgus macaque UTI challenge model that mimics human uncomplicated cystitis in response to transurethral challenge with a multidrug-resistant (MDR) E. coli serotype O25b ST131 isolate. E. coli fimbrial adhesin FimH and O-antigens are separately under clinical evaluation by others as vaccine candidates to prevent UTI and invasive urosepsis disease, respectively. Accordingly, we assessed the protective efficacy of three 50-µg intramuscular doses of a novel recombinant FimH antigen adjuvanted with liposomal QS21/MPLA compared with saline placebo in groups of nine animals. A third group was vaccinated with this FimH formulation in combination with 1 µg each of a four-valent mixture of serotype O1a, O2, O6, and O25b O-antigen CRM197 lattice glycoconjugates. Both vaccines elicited high levels of serum FimH IgG and adhesin blocking antibodies at the time of bacterial challenge and, for the combination group, O-antigen-specific antibodies. Following bacterial challenge, both vaccinated groups showed >200- and >700-fold reduction in bacteriuria at day 2 and day 7 post-infection compared with placebo, respectively. In parallel, both vaccines significantly reduced levels of inflammatory biomarkers IL-8 and myeloperoxidase in the urine at day 2 post-infection relative to placebo. Results provide preclinical proof-of-concept for the prevention of an MDR UTI infection by these new vaccine formulations.


Asunto(s)
Adhesinas de Escherichia coli , Modelos Animales de Enfermedad , Infecciones por Escherichia coli , Vacunas contra Escherichia coli , Escherichia coli , Proteínas Fimbrias , Macaca fascicularis , Infecciones Urinarias , Animales , Adhesinas de Escherichia coli/inmunología , Adhesinas de Escherichia coli/genética , Infecciones por Escherichia coli/prevención & control , Infecciones por Escherichia coli/inmunología , Infecciones por Escherichia coli/microbiología , Infecciones Urinarias/prevención & control , Infecciones Urinarias/microbiología , Infecciones Urinarias/inmunología , Proteínas Fimbrias/inmunología , Proteínas Fimbrias/genética , Vacunas contra Escherichia coli/inmunología , Vacunas contra Escherichia coli/administración & dosificación , Escherichia coli/genética , Escherichia coli/inmunología , Anticuerpos Antibacterianos/sangre , Anticuerpos Antibacterianos/inmunología , Femenino
16.
Langenbecks Arch Surg ; 409(1): 265, 2024 Aug 30.
Artículo en Inglés | MEDLINE | ID: mdl-39212789

RESUMEN

PURPOSE: The purpose of this randomized controlled trial was to evaluate whether early urinary catheter removal is feasible during epidural anesthesia during gastrointestinal surgery in male patients at high risk for urinary retention. METHODS: Male patients who underwent radical surgery for gastric or colon cancer were enrolled in this randomized controlled trial. Patients were randomized 1:1 into 2 groups: the early group, in which the urinary catheter was removed before removal of the epidural catheter on the second or third postoperative day, and the late group, in which the urinary catheter was removed after removal of the epidural catheter. The randomization adjustment factors were age (≥ 65 or < 65 years) and operative site (gastric or colon). The primary endpoint was urinary retention. The secondary endpoints were the incidence of urinary tract infection and length of postoperative hospital stay. RESULTS: Seventy-three patients were enrolled between March 2020 and February 2024 and assigned to the Early (n = 37) and Late (n = 36) groups. Four patients withdrew their consent after randomization. The intention-to-treat analysis showed that urinary retention occurred in 4 patients (11.1%) in the early group and 1 patient (3.0%) in the late group (P = 0.20). Urinary tract infection occurred in 1 patient (3.0%) in the late group. The median postoperative hospital stay was 9 days in both groups. CONCLUSION: Early urinary catheter removal in male patients undergoing gastrointestinal surgery with epidural anesthesia could increase urinary retention within the expected acceptable range. TRIAL REGISTRATION NUMBER: UMIN000040468, Date of registration: May 21, 2020.


Asunto(s)
Anestesia Epidural , Remoción de Dispositivos , Retención Urinaria , Humanos , Masculino , Anestesia Epidural/efectos adversos , Persona de Mediana Edad , Anciano , Retención Urinaria/etiología , Catéteres Urinarios/efectos adversos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Factores de Tiempo , Infecciones Urinarias/etiología , Infecciones Urinarias/prevención & control , Tiempo de Internación , Cateterismo Urinario/efectos adversos , Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Neoplasias Gástricas/cirugía , Neoplasias del Colon/cirugía
18.
Urolithiasis ; 52(1): 123, 2024 Aug 28.
Artículo en Inglés | MEDLINE | ID: mdl-39196385

RESUMEN

A JJ stent placed before retrograde intrarenal surgery (RIRS) may ease the procedure. However, it is important to note that a prolonged duration of double J stent (DJS) placement before RIRS may increase the risk of postoperative urinary tract infection (UTI). Various publications have established this association, although the duration of the DJS before surgery is scarce. Our study investigates the relationship between the pre-stenting period and postoperative UTI and establishes a cut-off period to minimize this risk. We included a total of 500 cases with preoperative DJS prior to RIRS. The patients were divided into five groups according to their preoperative stenting duration (Group 1: 0-15 days; Group 2: 16-30 days; Group 3: 31-45 days; Group 4: 46-60 days; Group 5: >60 days). Demographic and clinical data of the patients, stone properties, operation data, perioperative and postoperative complications (including fever and UTI), hospitalization time, and stone-free rates (SFR) were compared. The groups contained 53, 124, 102, 63, and 158 patients. The demographics of the patients in each group were similar. There was no statistically significant difference between DJS duration, perioperative/postoperative complications, and SFR, except for the ureteral access sheath (UAS) insertion rate. (p = 0.001). The postoperative fever/UTI rate was the lowest in Group 1 (p = 0.046) compared to other durations. Stent duration does not impact SFR. Longer stents enhance UAS insertion success but increase postoperative infection risk. Our results suggest that RIRS should be performed within two weeks, ideally 20 days following stent insertion, to minimize postoperative infection risk.


Asunto(s)
Complicaciones Posoperatorias , Stents , Uréter , Infecciones Urinarias , Humanos , Stents/efectos adversos , Femenino , Masculino , Persona de Mediana Edad , Uréter/cirugía , Factores de Tiempo , Infecciones Urinarias/etiología , Infecciones Urinarias/epidemiología , Infecciones Urinarias/prevención & control , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Adulto , Estudios Retrospectivos , Cálculos Renales/cirugía , Anciano , Resultado del Tratamiento , Cuidados Preoperatorios/métodos
19.
PLoS One ; 19(8): e0306558, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39137210

RESUMEN

OBJECTIVE: The impact of self-efficacy and health literacy skills on pregnant women's adherence to urinary tract infection (UTI) preventive behaviors is inadequately investigated. Thus, the present study explored whether an educational intervention based on self-efficacy and health literacy skills managed to improve UTI preventive behaviors among pregnant women. METHODS: A quasi-experimental study was conducted from January to July 2021 among pregnant women residing in Mashhad, Iran. To this aim, 110 pregnant women at a gestational age of 12-18 weeks were randomly assigned to a control (n = 55) and an intervention group (n = 55) and completed all questionnaires during the intervention and the 3-month follow-up. The intervention group received the full training program, comprising six 2-hourly training sessions. RESULTS: Most women were from low-income families (69.1%), were housewives (74.5%) with high school education or lower (63.6%). The theory-based intervention had a significant effect (P < 0·05) on UTI preventive behavior outcomes (i.e., clothing habits, nutrition, urination, health, and sexual behaviors) in the intervention group compared with the control group after intervention, and in their variation from baseline to follow-up in all scores. CONCLUSIONS: An educational intervention based on health literacy skills and self-efficacy could be an effective theory-based intervention to improve UTI preventive behaviors and reduce recurrent UTI and complications.


Asunto(s)
Alfabetización en Salud , Autoeficacia , Infecciones Urinarias , Humanos , Femenino , Infecciones Urinarias/prevención & control , Embarazo , Adulto , Irán/epidemiología , Conductas Relacionadas con la Salud , Mujeres Embarazadas/psicología , Conocimientos, Actitudes y Práctica en Salud , Encuestas y Cuestionarios , Adulto Joven
20.
Front Cell Infect Microbiol ; 14: 1401462, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39091675

RESUMEN

Introduction: Bacterial urinary tract infections (UTI) are among the most common infectious diseases worldwide. The rise of multidrug-resistant (MDR) uropathogenic Escherichia coli (UPEC) UTI cases is a significant threat to healthcare systems. Several probiotic bacteria have been proposed as an alternative to combat MDR UTI. Lactic acid bacteria in the genus Limosilactobacillus are some of the most studied and used probiotics. However, strain-specific effects play a critical role in probiotic properties. L. reuteri KUB-AC5 (AC5), isolated from the chicken gut, confers antimicrobial and immunobiotic effects against some human pathogens. However, the antibacterial and immune modulatory effects of AC5 on UPEC have never been explored. Methods: Here, we investigated both the direct and indirect effects of AC5 against UPEC isolates (UTI89, CFT073, and clinical MDR UPEC AT31) in vitro. Using a spot-on lawn, agar-well diffusion, and competitive growth assays, we found that viable AC5 cells and cell-free components of this probiotic significantly reduced the UPEC growth of all strains tested. The human bladder epithelial cell line UM-UC-3 was used to assess the adhesion and pathogen-attachment inhibition properties of AC5 on UPEC. Results and discussion: Our data showed that AC5 can attach to UM-UC-3 and decrease UPEC attachment in a dose-dependent manner. Pretreatment of UPEC-infected murine macrophage RAW264.7 cells with viable AC5 (multiplicity of infection, MOI = 1) for 24 hours enhanced macrophage-killing activity and increased proinflammatory (Nos2, Il6, and Tnfa) and anti-inflammatory (Il10) gene expression. These findings indicate the gut-derived AC5 probiotic could be a potential urogenital probiotic against MDR UTI.


Asunto(s)
Limosilactobacillus reuteri , Macrófagos , Probióticos , Escherichia coli Uropatógena , Probióticos/farmacología , Escherichia coli Uropatógena/efectos de los fármacos , Escherichia coli Uropatógena/inmunología , Limosilactobacillus reuteri/fisiología , Animales , Ratones , Macrófagos/inmunología , Macrófagos/microbiología , Humanos , Urotelio/microbiología , Infecciones Urinarias/microbiología , Infecciones Urinarias/prevención & control , Línea Celular , Infecciones por Escherichia coli/microbiología , Infecciones por Escherichia coli/prevención & control , Células RAW 264.7 , Células Epiteliales/microbiología , Pollos , Adhesión Bacteriana/efectos de los fármacos
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