Retrospective Analysis of Risk Factors for Urinary Tract Infection after Ureteral Calculi Surgery.

BACKGROUND: Ureteral calculi are a common diagnosis in the field of urology worldwide, and they represent a prevalent subtype of urolithiasis. Ureteroscopic stone surgery is the cornerstone treatment, but postoperative urinary tract infection (UTI) remains a clinical concern. Our study aims to analyse specific risk factors associated with postoperative UTIs following ureteroscopic stone surgery. METHODS: We conducted a case-control study and collected clinical data from 145 patients who underwent ureteroscopic lithotripsy at our hospital from January 2021 to January 2023. Binary logistic regression analysis was used to investigate risk factors for postoperative UTI. Receiver operating characteristic curves were plotted, and area under the curve (AUC) was calculated to evaluate the predictive value of each factor. RESULTS: Forty patients developed UTI after ureteroscopic stone surgery. Compared with the control group, the case group showed significant differences in stone size, history of diabetes mellitus and preoperative urine culture results (p < 0.05). Multivariable binary logistic regression analysis revealed that stone size (Odds Ratio (OR) = 1.952, p = 0.010), history of diabetes mellitus (OR = 2.438, p = 0.038) and preoperative urine culture (OR = 2.914, p = 0.009) were independent risk factors for postoperative UTI. The AUC values of stone size, history of diabetes mellitus and preoperative urine culture were 0.680, 0.627 and 0.630, respectively. The AUC of the combined prediction was 0.756. CONCLUSIONS: This study identified risk factors for postoperative UTI following ureteroscopic stone surgery and emphasised the importance of stone size, history of diabetes mellitus and preoperative urine culture in the diagnosis.

Factors Contributing to the Recurrence of Urinary Tract Infections and Revisit amongst Children in the Emergency Department: A Single-Centre Retrospective Study.

BACKGROUND: Urinary tract infections (UTIs) are prevalent amongst paediatric patients, and they can lead to emergency department (ED) visits. A subset of patients requires a second ED visit, creating a burden on healthcare resources. This study aimed to shed light on the clinical, laboratory, treatment-related and environmental determinants associated with the recurrence of ED visits in this specific paediatric population. METHODS: This single-centre retrospective study involved paediatric patients diagnosed with UTIs and admitted to the paediatric ED of our hospital from September 2021, to August 2023. In accordance with whether a second visit was required, the ED patients were grouped into non-second-visit group or second-visit group. The demographic, clinical, laboratory, diagnostic, and environmental factors were analysed in detail. Statistical analyses, including chi-square tests, t-tests and correlation analyses, were employed to assess the associations between various factors and subsequent ED visits. RESULTS: A total of 357 patients, including 324 patients without a second visit and 33 patients with a second visit, were included in this study. Factors significantly associated with second ED visits included fever (≥38.5 °C) at initial presentation (p = 0.034), longer symptom duration (p = 0.022), increased C-reactive protein (CRP) levels (p = 0.018), hydronephrosis (p = 0.033) and lack of oral antibiotic use before the first visit (45.45% vs. 67.9%, p = 0.017). More bubble bath exposure (p = 0.037) and lower consultation rates with paediatric urology services (p = 0.020) were associated with repeated visits. Multifactor logistic regression analysis showed that the factors significantly associated with second ED visits were longer symptoms duration, fever (≥38.5 °C) at initial presentation, presence of flank pain, increased CRP levels, hydronephrosis, renal stones, vesicoureteral reflux, underlying anatomical abnormalities, lack of oral antibiotic use before the first visit, bubble bath exposure and lower consultation rates with paediatric urology services. CONCLUSIONS: A series of clinical indicators, laboratory findings, diagnostic measures and environmental factors may be associated with the need for a second ED visit amongst paediatric patients with UTI. Early antibiotic intervention, identification of underlying anatomical anomalies and management of environmental exposures may mitigate recurrent ED visits.

Trends in urine sampling rates of general practice patients with suspected lower urinary tract infections in England, 2015-2022: a population-based study.

OBJECTIVES: Inappropriate prescribing of antibiotics is a key driver of antimicrobial resistance. This study aimed to describe urine sampling rates and antibiotic prescribing for patients with lower urinary tract infections (UTIs) in English general practice. DESIGN: A retrospective population-based study using administrative data. SETTING: IQVIA Medical Research Database (IMRD) data from general practices in England, 2015-2022. PARTICIPANTS: Patients who have consulted with an uncomplicated UTI in England general practices captured in the IMRD. OUTCOME MEASURES: Trends in UTI episodes (episodes were defined as UTI diagnosis codes occurring within 14 days of each other), testing and antibiotic prescribing on the same day as initial UTI consultation were assessed from January 2015 to December 2022. Associations, using univariate and multivariate logistic regressions, were examined between consultation and demographic factors on the odds of a urine test. RESULTS: There were 743 350 UTI episodes; 50.8% had a urine test. Testing rates fluctuated with an upward trend and large decline in 2020. Same-day UTI antibiotic prescribing occurred in 78.2% of episodes. In multivariate modelling, factors found to decrease odds of a urine test included age ≥85 years (0.83, 95% CI 0.82 to 0.84), consultation type (remote vs face to face, 0.45, 95% CI 0.45 to 0.46), episodes in London compared with the South (0.74, 95% CI 0.72 to 0.75) and increasing practice size (0.77, 95% CI 0.76 to 0.78). Odds of urine tests increased in males (OR 1.11, 95% CI 1.10 to 1.13), for those episodes without a same-day UTI antibiotic (1.10, 95% CI 1.04 to 1.16) for episodes for those with higher deprivation status (Indices of Multiple Deprivation 8 vs 1, 1.51, 95% CI 1.48 to 1.54). Compared with 2015, 2016-2019 saw increased odds of testing while 2020 and 2021 saw decreases, with 2022 showing increased odds. CONCLUSION: Urine testing for UTI in general practice in England showed an upward trend, with same-day antibiotic prescribing remaining consistent, suggesting greater alignment to national guidelines. The COVID-19 pandemic impacted testing rates, though as of 2022, they began to recover.

Unbiased identification of risk factors for invasive Escherichia coli disease using machine learning.

BACKGROUND: Invasive Escherichia coli disease (IED), also known as invasive extraintestinal pathogenic E. coli disease, is a leading cause of sepsis and bacteremia in older adults that can result in hospitalization and sometimes death and is frequently associated with antimicrobial resistance. Moreover, certain patient characteristics may increase the risk of developing IED. This study aimed to validate a machine learning approach for the unbiased identification of potential risk factors that correlate with an increased risk for IED. METHODS: Using electronic health records from 6.5 million people, an XGBoost model was trained to predict IED from 663 distinct patient features, and the most predictive features were identified as potential risk factors. Using Shapley Additive predictive values, the specific relationships between features and the outcome of developing IED were characterized. RESULTS: The model independently predicted that older age, a known risk factor for IED, increased the chance of developing IED. The model also predicted that a history of ≥ 1 urinary tract infection, as well as more frequent and/or more recent urinary tract infections, and ≥ 1 emergency department or inpatient visit increased the risk for IED. Outcomes were used to calculate risk ratios in selected subpopulations, demonstrating the impact of individual or combinations of features on the incidence of IED. CONCLUSION: This study illustrates the viability and validity of using large electronic health records datasets and machine learning to identify correlating features and potential risk factors for infectious diseases, including IED. The next step is the independent validation of potential risk factors using conventional methods.

Prevalence and risk factors for extended-spectrum ß-lactamase producing antimicrobial-resistant E. coli in urinary tract infections among inpatients in the tertiary hospitals in Zanzibar (Tanzania): a prospective cross-sectional study.

Introduction: Extended-spectrum ß-lactamase (ESBL) production among Enterobacteriaceae, such as E. coli, has been increasing worldwide, which causes treatment failure for urinary tract infections. Therefore, this study aimed to determine the prevalence and risk factors for the production of ESBL in E. coli from patients with urinary tract infections (UTI) in Zanzibar. Methods: a prospective cross-sectional study was conducted from January 2018 to December 2021 in Zanzibar. Data were retrieved from a routine bacteriological laboratory culture report from urine samples of 4306 patients at the Lancet Laboratory. In addition, the patient's social demographics and clinical data were retrieved by examining the medical records in the respective hospitals. All inpatients older than fifteen years diagnosed with urinary tract infections (UTI) and requested urine culture and sensitivity were included. The Chi-square and Fischer's exact tests were used to compare antibiotic resistance. In addition, a binary logistic regression analysis was used to predict ESBL production risk factors. Results: the prevalence of E. coli-producing ESBL was 13.4% (578/4030). Infection of ESBL. E. coli was prevalent in females 52.6% (n=304) compared to male patients, 47.4% (n=274), and the majority 38.8% (n=224), were people of young age, between 16-30 years. The average age of patients was 31.5±10.2 years, with minimum age of 16 years and a maximum age of 72 years. In multivariate analysis, results shown that previously hospitalised patients aOR: 6.35, 95% Cl 3.37-11.92; p=0.001, long hospital stays aOR: 10.34, 95% Cl 3.03-22.29; p <0.001, prior use of penicillin aOR: 7.78, 95% Cl 2.99-29.11; p < 0.001, and prior use of cephalosporin drugs aOR: 4.64, 95% Cl 2.99-9.96; p=0.001, were strongly associated with the emergence of ESBL-producing E. coli in urinary tract infection patients. ESBL E. coli showed high resistance to amoxicillin 99.5% (n=575), ampicillin 97.8.% (n=570), cotrimazaxole 86.2% (n=344), ceftriaxone 73.7% (n=344), ciprofloxacin 73.2% (n=423), and ceftaxime 59.5% (n=426). There was a less resistance to ampicillin -cloxacillin 44.3% (n=256), gentamicin 22.5% (n=22.5), and norfloxacin 18.9% (n=109) respectively. Isolates were shown to be more susceptible to meropenem at 1.6% (n=9). Conclusion: the overall prevalence of ESBL-producing E. coli is 13.4%. The risk of emergence ESBL was higher in patients with previous history of hospitalisation, long hospital stay, prior use of penicillin and cephalosporin drugs. High level of antimicrobial resistance observed against most commonly used antibiotics in treatment of urinary tract infections. The clinicians should rely on microbiological diagnosis in treatment of UTIs to reduce risk of treatment failure. Further study should be carried out to assess the prevalence and resistance pattern of other uropathogens and other risk factors.

Urinary tract infections in chronic kidney disease in Nephrology unit, University Hospital Center of Befelatanana, Antananarivo.

INTRODUCTION: Urinary tract infection is the leading cause of nosocomial infection worldwide. It is a factor in the progression of chronic kidney disease. AIM: To determine the epidemiological, clinical, microbiological, therapeutic and evolving profile of patients with chronic kidney disease and urinary tract infection. METHODS: This was a retrospective, descriptive study lasting 5 years, from January 2014 to december 2018 in chronic kidney disease with urinary tract infection. RESULTS: Fifty-one patients (7.15%) were retained with a mean age of 53.03 years and a sex ratio of 0.55. Chronic kidney disease was in end-stage in 45.1% (n=23). Cystitis was found in 49.02% (n=25) and gram-negative bacilli were found in 74.50% (n=38), predominantly Escherichia coli (54.90%). Third generation of cephalosporins and fluoroquinolones were frequently prescribed as probabilistic antibiotics. Resistance to beta-lactam antibiotics was 50% for Escherichia coli. Factors influencing severe infection were: advanced age, male gender, urinary lithiasis, multiple antibiotic resistance and non-enterobacterial germs. CONCLUSION: Urinary tract infection in chronic kidney disease were frequent and particularly severe.

Association of health-related quality of life with urinary tract infection among kidney stone formers.

Kidney stones and infections significantly affect patients' health-related quality of life (HRQOL); however, the relationship between urinary tract infections (UTIs) and HRQOL in patients with kidney stones remains unclear. This study aimed to investigate the relationship using the validated Chinese version of the Wisconsin Stone Quality of Life questionnaire (C-WISQOL). We prospectively recruited 307 patients with kidney stones to complete the C-WISQOL before and after stone removal. The participants were diagnosed with UTI based on the presence of pyuria or bacteriuria with or without clinical symptoms. The psychometric properties of the C-WISQOL were statistically analyzed. Multivariate linear regression was used to predict the risk factors for impaired HRQOL in patients with stones and UTIs. The questionnaire is a reliable and robust tool for evaluating HRQOL in Chinese-speaking patients with urolithiasis. The UTI and kidney stone co-occurrence was significantly associated with female sex, diabetes mellitus, more previous stone events, higher antibiotic usage, positive stone- or UTI-related symptoms, and postoperative residual stones. The preoperative C-WISQOL scores and improvement in the HRQOL after stone removal in patients clinically diagnosed with UTI were significantly inferior to those in patients without UTI. The regression analyses showed that worse HRQOL was predicted by more previous stone events and positive stone- or UTI-related symptoms. In contrast, the presence of diabetes mellitus and postoperative residual stone fragments predicted a lower improvement in the HRQOL. These findings underscore UTI's harmful impact on perioperative HRQOL in patients with kidney stones and could help strategies benefit those patients.

Bundle care approach to reduce device associated infections in post-living-donor-liver transplantation in a tertiary care hospital, Egypt.

BACKGROUND: Device-associated infections (DAIs) are a significant cause of morbidity following living donor liver transplantation (LDLT). We aimed to assess the impact of bundled care on reducing rates of device-associated infections. METHODS: We performed a before-and-after comparative study at a liver transplantation facility over a three-year period, spanning from January 2016 to December 2018. The study included a total of 57 patients who underwent LDLT. We investigated the implementation of a care bundle, which consists of multiple evidence-based procedures that are consistently performed as a unified unit. We divided our study into three phases and implemented a bundled care approach in the second phase. Rates of pneumonia related to ventilators [VAP], bloodstream infections associated with central line [CLABSI], and urinary tract infections associated with catheters [CAUTI] were assessed throughout the study period. Bacterial identification and antibiotic susceptibility testing were performed using the automated Vitek-2 system. The comparison between different phases was assessed using the chi-square test or the Fisher exact test for qualitative values and the Kruskal-Wallis H test for quantitative values with non-normal distribution. RESULTS: In the baseline phase, the VAP rates were 73.5, the CAUTI rates were 47.2, and the CLABSI rates were 7.4 per one thousand device days (PDD). During the bundle care phase, the rates decreased to 33.3, 18.18, and 4.78. In the follow-up phase, the rates further decreased to 35.7%, 16.8%, and 2.7% PDD. The prevalence of Klebsiella pneumonia (37.5%) and Methicillin resistance Staph aureus (37.5%) in VAP were noted. The primary causative agent of CAUTI was Candida albicans, accounting for 33.3% of cases, whereas Coagulase-negative Staph was the predominant organism responsible for CLABSI, with a prevalence of 40%. CONCLUSION: This study demonstrates the effectiveness of utilizing the care bundle approach to reduce DAI in LDLT, especially in low socioeconomic countries with limited resources. By implementing a comprehensive set of evidence-based interventions, healthcare systems can effectively reduce the burden of DAI, enhance infection prevention strategies and improve patient outcomes in resource-constrained settings.

Bacterial profiles, antibiotic susceptibility patterns, and associated factors of symptomatic urinary tract infections among symptomatic university students at Haramaya University, Eastern Ethiopia: Cross-sectional study.

Urinary tract infection (UTI) is a highly prevalent infection that can affect individuals of all ages, posing a significant risk to global health in terms of both morbidity and mortality. The emergence of multidrug-resistant bacteria adds to the complexity of this public health issue. There is limited data on the current study area. Therefore, this study aimed to determine the bacterial profiles, antibiotic susceptibility patterns, and associated factors of UTIs among symptomatic university students at Haramaya University, Eastern Ethiopia from May 10 to June 15, 2021. A cross-sectional study was conducted among 281 Haramaya University students. A systematic random sampling technique was used to select the study participants. Data were collected using a self-administered questionnaire. Ten to 15 mL of midstream urine samples were collected aseptically from patients. Standard microbiological techniques were used for bacterial identifications and drug susceptibility testing. The association between dependent and independent variables was determined by the logistics regression model. Variables with a P-value of <.05 were considered statistically significant. The overall prevalence of UTI among university students was 18.1% (95% confidence interval [CI]: 13.5-23.1). The most frequently isolated bacteria were Escherichia coli (33.3%) and Staphylococcus epidermidis (29.4%). Gram-negative bacteria demonstrated high resistance against ceftazidime (100%), penicillin (96%), ampicillin (92%), and tetracycline (71%). Similarly, gram-positive bacteria exhibited significant resistance to ceftazidime (100%) and ampicillin (81%). Multidrug-resistant isolates constituted an overall prevalence of 35 (68.6%) (95% CI: 63.6-73.6). Furthermore, year of study (adjusted odds ratios [AOR] = 2.66; 95% CI: 1.23-5.76), history of UTI (AOR = 2.57; 95% CI: 1.10-6.00), and sexual activity (AOR = 0.08; 95% CI: 0.02-0.39) were identified as factors. In this study, university students exhibited a higher prevalence of UTI compared to previous studies conducted in Africa. The most commonly identified bacteria causing UTIs were E coli, followed by S epidermidis. Factors such as the year of the study, presence of flank pain, history of previous UTIs, and frequency of sexual activity were found to be associated with UTIs. All the isolates have acquired resistance to the majority of commonly prescribed antibiotics. It is crucial to regularly monitor UTIs and the proliferation of antibiotic-resistant bacteria among university students.

Six-year evaluation of device-associated nosocomial infections in intensive care units.

INTRODUCTION: Invasive device-associated nosocomial infections commonly occur in intensive care units (ICUs). These infections include intravascular catheter-related bloodstream infection (CRBSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infection (CAUTI). This study aimed to evaluate the factors associated with invasive device-associated nosocomial infections based on the underlying diseases of the patients and antibiotic resistance profiles of the pathogens causing the infections detected in the ICU in our hospital over a five-year period. METHODOLOGY: Invasive device-associated infections (CRBSI, VAP, and CAUTI) were detected retrospectively by the laboratory- and clinic-based active surveillance system according to the criteria of the US Centers for Disease Control and Prevention (CDC) in patients hospitalized in the ICU of the tertiary hospital between 1 January 2018 and 30 June 2023. RESULTS: A total of 425 invasive device-associated nosocomial infections and 441 culture results were detected (179 CRBSI, 176 VAP, 70 CAUTI). Out of them, 57 (13.4%) patients had hematological malignancy, 145 (34.1%) had solid organ malignancy, and 223 (52.5%) had no histopathologic diagnosis of any malignancy. An increase in extended-spectrum beta lactamase (ESBL) and carbapenem resistance in pathogens was detected during the study period. CONCLUSIONS: Antibiotic resistance of the Gram-negative bacteria associated with invasive device-associated infections increased during the study period. Antimicrobial stewardship will reduce rates of nosocomial infections, reduce mortality, and shorten hospital stay. Long-term catheterization and unnecessary antibiotic use should be avoided.

Analysis of Risk Factors for Urinary Tract Infections in Pregnant Women: A Retrospective Study.

OBJECTIVE: Urinary tract infections (UTIs) are the most common bacterial infection during pregnancy. This study aimed to investigate the risk factors of UTI during pregnancy. METHODS: In this study, pregnant women who underwent prenatal examination in our hospital from October 2019 to October 2023 were divided into UTI group and non-UTI group in accordance with whether or not they had a UTI. The general data, clinical data and laboratory indicators of the participants were collected. Multivariate logistic regression was used to analyse the influencing factors of UTI in pregnant women, and the results were shown with odds ratio (OR) and 95% confidence interval (95% CI). RESULTS: A total of 600 pregnant women were included in the study. The results found that 56 women (9.33%) had a combined UTI. The results of midstream urinary bacterial culture in the UTI group showed that Gram-negative bacteria accounted for 60.71% of all detected pathogenic bacteria, and Escherichia coli and Staphylococcus aureus were common strains, accounting for 46.43% and 23.21%, respectively. The proportions of patients in the UTI group who were ≥35 years old, had a high school education or below, had a history of abortion, had gestational diabetes, had ≥three vaginal and anal examinations, had a history of UTI and had urinary tract stones were significantly higher than the non-UTI group (p < 0.05). Multivariate logistic regression analysis showed that age ≥35 years (OR = 9.127; 95% CI: 4.668-17.810; p < 0.001), educational level of high school or lower (OR = 4.184; 95% CI: 2.448-7.160; p < 0.001), gestational diabetes (OR = 3.494; 95% CI: 1.789-6.803; p < 0.001), UTI history (OR = 2.074; 95% CI: 1.114-3.834; p < 0.001) and haemoglobin (Hb) <100 g/L (OR = 8.022; 95% CI: 4.532-14.325; p < 0.001) are risk factors for UTI in pregnant women. CONCLUSIONS: The common pathogenic bacteria of pregnant women with UTI are mainly Gram-negative bacteria. Older pregnant women, low educational level, gestational diabetes mellitus, history of UTI and anaemia may be risk factors for UTI in pregnant women.

Correlation Analysis between Urinary Catheter Indwelling Time and Nosocomial Urinary Tract Infection.

OBJECTIVES: Indwelling urinary catheter is closely associated with the occurrence of urinary tract infection (UTI). Herein, we further explored the correlation of urinary catheter indwelling time and UTI. METHODS: Retrospectively, the medical data of nosocomial patients (n = 681) were collected during two quarters of April 2023 to June 2023 (the second quarter, 23.4-23.6, n = 330) and July 2023 to September 2023 (the third quarter, 23.7-23.9, n = 351). The baseline data and incidence of catheter-related UTI were analysed. The total hospitalisation days and indwelling urinary catheter days of patients in five departments were assessed, namely, coronary care unit (CCU), respiratory intensive care unit (RICU), surgical intensive care unit (SICU), neurology intensive care unit (NICU) and cardiac surgical intensive care unit (CSICU) departments. The correlation between hospitalisation days/indwelling urinary catheter days and the occurrence of UTI was evaluated by Spearman correlation analysis. RESULTS: In the CCU, RICU, SICU, NICU and CSICU departments, the number of patients was 463, 83, 29, 91 and 15, respectively. During 23.4-23.6, the incidence of catheter-associated UTI (CAUTI) was 0, 2.85, 6.12, 0 and 12.99 per 1000 urinary catheter days in CCU, RICU, SICU, NICU and CSICU, respectively. During 23.7-23.9, the incidence of CAUTI was 2.98, 6.13, 8.66, 0 and 0 per 1000 urinary catheter days in CCU, RICU, SICU, NICU and CSICU, respectively. Notably, hospitalisation days/indwelling urinary catheter days were positively correlated with the occurrence of CAUTI in each quarter (p < 0.05). CONCLUSIONS: There was a positive correlation between urinary catheter indwelling time and the occurrence of UTI.

Impact of the COVID-19 pandemic on extended-spectrum ß-lactamase producing Escherichia coli in urinary tract and blood stream infections: results from a nationwide surveillance network, Finland, 2018 to 2022.

BACKGROUND: Before the COVID-19 pandemic there has been a constant increase in antimicrobial resistance (AMR) of Escherichia coli, the most common cause of urinary tract infections and bloodstream infections. The aim of this study was to investigate the impact of the COVID-19 pandemic on extended-spectrum ß-lactamase (ESBL) production in urine and blood E. coli isolates in Finland to improve our understanding on the source attribution of this major multidrug-resistant pathogen. METHODS: Susceptibility test results of 564,233 urine (88.3% from females) and 23,860 blood E. coli isolates (58.8% from females) were obtained from the nationwide surveillance database of Finnish clinical microbiology laboratories. Susceptibility testing was performed according to EUCAST guidelines. We compared ESBL-producing E. coli proportions and incidence before (2018-2019), during (2020-2021), and after (2022) the pandemic and stratified these by age groups and sex. RESULTS: The annual number of urine E. coli isolates tested for antimicrobial susceptibility decreased 23.3% during 2018-2022 whereas the number of blood E. coli isolates increased 1.1%. The annual proportion of ESBL-producing E. coli in urine E. coli isolates decreased 28.7% among males, from 6.9% (average during 2018-2019) to 4.9% in 2022, and 28.7% among females, from 3.0 to 2.1%. In blood E. coli isolates, the proportion decreased 32.9% among males, from 9.3 to 6.2%, and 26.6% among females, from 6.2 to 4.6%. A significant decreasing trend was also observed in most age groups, but risk remained highest among persons aged ≥ 60 years. CONCLUSIONS: The reduction in the proportions of ESBL-producing E. coli was comprehensive, covering both specimen types, both sexes, and all age groups, showing that the continuously increasing trends could be reversed. Decrease in international travel and antimicrobial use were likely behind this reduction, suggesting that informing travellers about the risk of multidrug-resistant bacteria, hygiene measures, and appropriate antimicrobial use is crucial in prevention. Evaluation of infection control measures in healthcare settings could be beneficial, especially in long-term care.

Genitourinary infection and gastroschisis: A systematic review and meta-analysis.

BACKGROUND: Gastroschisis is a congenital anomaly of the umbilical ring with increasing prevalence, especially amongst younger mothers. There is increasing evidence that exposure to genitourinary infections (GUTI) may play an important role in the etiology of gastroschisis. This systematic review and meta-analysis aimed to identify, appraise, and summarize the literature on exposure to GUTI and gastroschisis. METHODS: Six electronic databases (MEDLINE, EMBASE, Web of Science, Scopus, Cochrane Library electronic databases, and Prospero) were searched using a comprehensive search strategy. Citations and cited articles for all included studies were searched. Peer-reviewed, quantitative studies reporting an association of urinary tract infections (UTI) and/or sexually transmitted infections (STI) with gastroschisis were included. Prospero registration CRD42022377420. RESULTS: A total of 2392 papers were identified via the searches of which 15 met our inclusion criteria and were included after title and abstract and full text screening. The study period for included studies ranged from 1995 to 2016, most were from the USA. Four studies considering exposure to STIs and five to UTIs were eligible to progress to meta-analysis. Meta-analysis identified a significantly increased risk of gastroschisis in association with periconceptional exposure to UTI [OR 1.54 (95% CI 1.29, 1.8)], STI [OR 1.4 (95% CI 1.01, 1.79)]. CONCLUSIONS: Periconceptional exposure to GUTI is associated with an increased risk of gastroschisis. The prevention and timely treatment of GUTI amongst women of childbearing age may help to reduce the occurrence of gastroschisis.

Analysis of com plication s af te r out-of-ho sp i ta l cardiac a rr est of tar ge t temperat ure management.

OBJECTIVE: To analyse the preva lence of complications related to out-of-hospital cardiac arrest patients achieving target temperature management within 360 minutes compared to those taking more than 360 minutes. METHODS: The retrospective study was conducted at a medical centre in Taiwan, and comprised data from Januar y 1, 2014, to December 31, 2020. Data was retrieved using the International Classification of Diseases version 10 codes I46.2, I46.8 and I46.9 related to adult patients of either gender presenting to the Emergenc y Medicine department with out-of-hospital cardiac arrest. Data included gender, age, medical histor y, body mass index, acute physiology and chronic health evaluation II score, blood glucose levels, electrocardiogram results, and complications occurring within the target temperature management timeframe. Data was divided into group A having patients who achieved target temperature management within 360 minutes, and group B having patients with delayed TTM of more than 360 minutes. Data was analysed using SPSS 22. RESULTS: Of the 127 patients, 76(59%) were males, 51(41%) were females,, 47(37%) were aged >75 years, and 13(10.3%) were aged <50 years. Of the total, 65(51.2%) patients were in group A, and 62(48.8%) were in group B. Pneumonia, urinary tract infection, septic shock and gastrointestinal bleeding had lower incidence rates in group A than group B (p<0.05). The odds of death were 2.879 times high er in group B patients than group A (95% confidence interval: 1.908-8.916). CONCLUSIONS: Hypothermia tre atment should be sta rted as soon as pos sible to achieve target temp erature management within 360 minutes to reduce the risk of complications and mortality.

Suprapubic versus transurethral catheterization for bladder drainage in male rectal cancer surgery (GRECCAR10), a randomized clinical trial.

BACKGROUND: Bladder drainage is systematically used in rectal cancer surgery; however, the optimal type of drainage, transurethral catheterization (TUC) or suprapubic catheterization (SPC), is still controversial. The aim was to compare the rates of urinary tract infection on the fourth postoperative day (POD4) between TUC and SPC, after rectal cancer surgery regardless of the day of removal of the urinary drain. METHODS: This randomized clinical trial in 19 expert colorectal surgery centers in France and Belgium was performed between October 2016 and October 2019 and included 240 men (with normal or subnormal voiding function) undergoing mesorectal excision with low anastomosis for rectal cancer. Patients were followed at postoperative days 4, 30, and 180. RESULTS: In 208 patients (median age 66 years [IQR 58-71]) randomized to TUC (n = 99) or SPC (n = 109), the rate of urinary infection at POD4 was not significantly different whatever the type of drainage (11/99 (11.1%) vs. 8/109 (7.3%), 95% CI, - 4.2% to 11.7%; p = 0.35). There was significantly more pyuria in the TUC group (79/99 (79.0%) vs. (60/109 (60.9%), 95% CI, 5.7-30.0%; p = 0.004). No difference in bacteriuria was observed between the groups. Patients in the TUC group had a shorter duration of catheterization (median 4 [2-5] vs. 4 [3-5] days; p = 0.002). Drainage complications were more frequent in the SPC group at all followup visits. CONCLUSIONS: TUC should be preferred over SPC in male patients undergoing surgery for mid and/or lower rectal cancers, owing to the lower rate of complications and shorter duration of catheterization. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT02922647.

Clinical and uterine cervix characteristics of women with Mycoplasma and Ureaplasma in genital discharge.

OBJECTIVE: The objective of this study was to assess the clinical and uterine cervix characteristics of patients displaying vaginal discharge with positive results for Mycoplasma sp. and/or Ureaplasma spp. METHODS: An analytical cross-sectional study involving women aged 18-45 years was conducted. Microbiological assessments included Ureaplasma and Mycoplasma cultures, as well as human papillomavirus hybrid capture using ecto and endocervix swabs. All tests were two-tailed, and significance was set at p<0.05. RESULTS: Among 324 women, Ureaplasma prevalence was 17.9%, and Mycoplasma prevalence was 3.1%. The Ureaplasma-positive group exhibited a higher frequency of urinary tract infections (39.1 vs. 19%, p=0.002) and human papillomavirus (39.7 vs. 12.8%, p≤0.001) compared with controls. The Mycoplasma-positive group showed a higher frequency of non-contraceptive use compared with controls (66.2 vs. 30.0%, p=0.036). Abnormal colposcopic findings were more prevalent in the Mycoplasma/Ureaplasma-positive group than in controls (positive: 65% vs. control: 35%, p=0.001). Pap smear findings did not differ between the groups. CONCLUSION: Ureaplasma spp. was associated with urinary tract infections and human papillomavirus, while the presence of Mycoplasma sp. was linked to reduced contraceptive use. When analyzing both pathogens together, a higher frequency of abnormal colposcopic findings was observed, with no difference in cytological findings in the positive group.

Prevalence of and Risks for Bacterial Infections in Hospitalized Children With Bronchiolitis.

BACKGROUND AND OBJECTIVES: Viral bronchiolitis is a common pediatric illness. Treatment is supportive; however, some children have concurrent serious bacterial infections (cSBIs) requiring antibiotics. Identifying children with cSBI is challenging and may lead to unnecessary treatment. Improved understanding of the prevalence of and risk factors for cSBI are needed to guide treatment. We sought to determine the prevalence of cSBI and identify factors associated with cSBI in children hospitalized with bronchiolitis. METHODS: We performed a retrospective cohort study of children <2 years old hospitalized with bronchiolitis at a free-standing children's hospital from 2012 to 2019 identified by International Classification of Diseases codes. cSBI was defined as bacteremia, urinary tract infection, meningitis, or pneumonia. Risk factors for cSBI were identified using logistic regression. RESULTS: We identified 7871 admissions for bronchiolitis. At least 1 cSBI occurred in 4.2% of these admissions; with 3.5% meeting our bacterial pneumonia definition, 0.4% bacteremia, 0.3% urinary tract infection, and 0.02% meningitis. cSBI were more likely to occur in children with invasive mechanical ventilation (odds ratio [OR] 2.53, 95% confidence interval [CI] 1.78-3.63), a C-reactive protein ≥4 mg/dL (OR 2.20, 95% CI 1.47-3.32), a concurrent complex chronic condition (OR 1.67, 95% CI 1.22-2.25) or admission to the PICU (OR 1.46, 95% CI 1.02-2.07). CONCLUSIONS: cSBI is uncommon among children hospitalized with bronchiolitis, with pneumonia being the most common cSBI. Invasive mechanical ventilation, elevated C-reactive protein, presence of complex chronic conditions, and PICU admission were associated with an increased risk of cSBI.

Educational interventions to prevent urinary infections in institutionalized elderly people. Quasi-experimental Study.

Objective: To analyze the effectiveness of an educational intervention among nursing professionals and caregivers to prevent urinary tract infections in institutionalized elderly people. Methods: this is a quasi-experimental study carried out with 20 people (7 nurses and 13 formal caregivers). A questionnaire was applied during the pre-intervention stage, then professional training was carried out and finally, the questionnaire was reapplied 6 months after the intervention. The prevalence profile and factors associated with urinary infections in 116 elderly people was evaluated before and after the educational interventions. Statistical analysis was performed using association and correlation tests, logistic regression model comparison and prevalence rates. Results: The average number of correct answers by the nursing professionals and caregivers after the educational intervention increased from the pre to the post-test by 52% regarding signs of urinary infection, 32% regarding its symptoms, 72.5% regarding its treatment, 40% regarding personal/behavioral and morbidity-related risk factors, 59% regarding conditional factors and 43.8% regarding its preventive measures. The team of caregivers showed a greater gain in knowledge compared to the nursing team in almost every question (p<0.05). The length of time working in elderly care showed no positive correlation with any variable (R< p>0.05). The prevalence of urinary tract infection in the pre-intervention period was 33.62%, and 20% in the post-intervention period. Conclusion: The educational intervention was effective in preventing urinary tract infections in the elderly. The increased knowledge acquired by nurses and caregivers was associated with a reduction in the infection rate and an improvement in the most prevalent modifiable factors for the development of this type of pathology.

Epidemiology of Citrobacter spp. infections among hospitalized patients: a systematic review and meta-analysis.

BACKGROUND: Infections due to Citrobacter species are increasingly observed in hospitalized patients and are often multidrug-resistant. Yet, the magnitude and burden of Citrobacter spp. resistance in the hospital setting have not been reported. We aimed to evaluate the epidemiology of Citrobacter spp. infections among hospitalized patients, their main resistance patterns and Citrobacter spp. involvement in hospital outbreaks. METHODS: We conducted a systematic review and meta-analysis of published literature (PROSPERO registration Jan-2023, CRD42023390084). We searched Embase, Medline and grey literature for studies on hospitalized patients diagnosed with Citrobacter spp. infections, and nosocomial outbreaks due to Citrobacter spp. published during the years 2000-2022. We included observational, interventional, surveillance studies and outbreak reports. Outcomes of interest were the frequency of Citrobacter spp. infections among hospitalized patients and 3rd generation cephalosporin and/or carbapenem resistance percentages in these infections. We used random-effects models to generate pooled outcome estimates and evaluated risk of bias and quality of reporting of outbreaks. RESULTS: We screened 1609 deduplicated publications, assessed 148 full-texts, and included 41 studies (15 observational, 13 surveillance and 13 outbreak studies). Citrobacter spp. urinary tract- and bloodstream infections were most frequently reported, with Citrobacter freundii being the main causative species. Hospital-acquired infection occurred in 85% (838/990) of hospitalized patients with Citrobacter infection. After 2010, an increasing number of patients with Citrobacter spp. infections was reported in observational studies. Pooled frequency estimates for Citrobacter spp. infections could not be generated due to lack of data. The pooled prevalence of ESBL and carbapenemase producers among Citrobacter isolates were 22% (95%CI 4-50%, 7 studies) and 18% (95%CI 0-63%, 4 studies), respectively. An increased frequency of reported Citrobacter outbreaks was observed after 2016, with an infection/colonization ratio of 1:3 and a case-fatality ratio of 7% (6/89 patients). Common outbreak sources were sinks, toilets, contaminated food and injection material. Implemented preventive measures included environmental cleaning, isolation of positive patients and reinforcement of hand hygiene. Only seven out of 13 outbreaks (54%) were definitively controlled. CONCLUSION: This review highlights the clinical importance of endemic and epidemic Citrobacter spp. in healthcare settings. As an emerging, multidrug­resistant nosocomial pathogen it requires heightened awareness and further dedicated surveillance efforts.