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1.
BMC Infect Dis ; 21(1): 388, 2021 Apr 26.
Artículo en Inglés | MEDLINE | ID: mdl-33902477

RESUMEN

BACKGROUND: One of the leading long-term complications of type 2 diabetes mellitus (T2DM) includes renal dysfunction and urinary tract infections (UTI) which are considered to be prevalent in uncontrolled diabetes. Moreover, physiological factors like age, gender, duration of diabetes, other diabetic complications like neuropathy, autonomic neuropathy and glycosuria are also considered as predisposing factors for increased prevalence of UTI in diabetes which can be symptomatic or asymptomatic. METHODS: This was a cross-sectional, multi-centre study including diabetic patients from 12 clinical sites spread across major cities of Pakistan. The inclusion criteria were adult Pakistani population of age between 18 to 75 years both genders and suffering from T2DM irrespective of duration. A detailed clinical history of the past 3 months was recorded and, biochemical investigations of blood samples were conducted. Urine culture analysis performed identified the type of pathogen present and was done only for asymptomatic patients. RESULTS: A total of 745 type 2 diabetic patients were initially screened, out of 545 patients considered for final analysis 501 (91.92%) were negative and the rest 44 (8.08%) had positive urine culture. Female gender had a significantly higher proportion of positive urine culture (77.27%, p-value< 0.001). Body mass index and mean age had insignificant distribution among the two groups of positive and negative urine culture, with age 40-59 years having higher proportion (70.45%) in the positive group. Escherichia coli was detected in most of the positive samples (52.3%). All bacterial samples were found resistant to Ciprofloxacin. CONCLUSION: Diabetic Pakistani muslim female patients are identified to be at high risk of suffering from asymptomatic UTI and age more than 40 years is an important risk factor. Escherichia coli was the most common causative organism among people living in this geographical area.


Asunto(s)
Infecciones Asintomáticas/epidemiología , Diabetes Mellitus Tipo 2/complicaciones , Infecciones por Escherichia coli/epidemiología , Infecciones por Escherichia coli/etiología , Escherichia coli/aislamiento & purificación , Islamismo , Infecciones Urinarias/epidemiología , Infecciones Urinarias/etiología , Adolescente , Adulto , Factores de Edad , Anciano , Estudios Transversales , Infecciones por Escherichia coli/microbiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pakistán/epidemiología , Prevalencia , Factores de Riesgo , Factores Sexuales , Urinálisis , Infecciones Urinarias/microbiología , Infecciones Urinarias/orina , Adulto Joven
2.
Medicine (Baltimore) ; 100(15): e25490, 2021 Apr 16.
Artículo en Inglés | MEDLINE | ID: mdl-33847659

RESUMEN

BACKGROUND: The purpose of this meta-analysis was to assess whether a urinary catheter is necessary for all patients in primary total knee arthroplasty (TKA). METHODS: PubMed, EMBASE, the Cochrane Library, Web of Science, and China National Knowledge Infrastructure were systematically searched for randomized controlled trials (RCTs). All RCTs were compared with receive either an indwelling urinary catheter or no urinary catheter in TKA. Primary outcomes were urinary retention and urinary tract infection. Secondary outcomes were the length of stay, duration of the surgery, and the first urination time. RESULTS: A total of 6 RCTs involving 1334 patients were included in the meta-analysis. No significant difference between the 2 groups was found in urinary retention (P = .52), length of stay (P = .38), duration of the surgery (P = .55). However, patients with an indwelling catheter were associated with a higher risk of urinary tract infections and longer time for the first urination than patients without indwelling catheters (P = .009 and P = .004). CONCLUSION: The available evidence indicates that patients without using the indwelling catheters could reduce urinary tract infections and the time for the first urination, without increase in the incidence of urinary retention in primary TKA. LEVEL OF EVIDENCE: Level I, therapeutic study.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/efectos adversos , Catéteres de Permanencia/efectos adversos , Complicaciones Posoperatorias/etiología , Cateterismo Urinario/instrumentación , Catéteres Urinarios/efectos adversos , Infecciones Urinarias/etiología , Anciano , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Tempo Operativo , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Riesgo , Retención Urinaria/etiología
3.
Zhongguo Dang Dai Er Ke Za Zhi ; 23(3): 279-282, 2021 Mar.
Artículo en Chino | MEDLINE | ID: mdl-33691922

RESUMEN

OBJECTIVE: To study the clinical features of vesicoureteral reflux (VUR) in children with neurogenic bladder (NB), and to provide a reference for its early diagnosis and treatment. METHODS: Clinical data were collected from 26 children with NB and urinary tract infection who were admitted to the Department of Pediatric Nephrology from January 2014 to December 2019. According to the presence or absence of VUR, the children were divided into a VUR group with 11 children and a non-VUR group with 15 children. Clinical features were compared between the two groups. RESULTS: Compared with the non-VUR group, the VUR group had a significantly higher proportion of children with non-Escherichia coli urinary tract infection, hydronephrosis (the severity of hydronephrosis increased with the grade of VUR), abnormal 99mTc-DMSA renal scanning findings, elevated ratios of urinary albumin, urinary IgG and urinary transferrin to creatinine, increased residual urine volume, and increased detrusor leak point pressure (P < 0.05). CONCLUSIONS: When NB children have the clinical manifestations of non-Escherichia coli urinary tract infection, hydronephrosis, abnormal 99mTc-DMSA renal scanning findings, glomerular proteinuria, increased bladder residual urine volume, and high detrusor leak point pressure, such children may already have VUR, and so diagnosis and intervention should be performed as early as possible.


Asunto(s)
Vejiga Urinaria Neurogénica , Infecciones Urinarias , Reflujo Vesicoureteral , Niño , Creatinina , Humanos , Lactante , Cintigrafía , Vejiga Urinaria Neurogénica/etiología , Infecciones Urinarias/diagnóstico por imagen , Infecciones Urinarias/etiología , Reflujo Vesicoureteral/diagnóstico , Reflujo Vesicoureteral/diagnóstico por imagen
4.
Medicine (Baltimore) ; 100(13): e25182, 2021 Apr 02.
Artículo en Inglés | MEDLINE | ID: mdl-33787599

RESUMEN

ABSTRACT: We aimed to evaluate the risk factors of febrile urinary tract infection (UTI) following retrograde intrarenal surgery (RIRS) for treating renal stones.We retrospectively reviewed the data of patients with 10 - 30 mm kidney stones who underwent RIRS from January 2014 to July 2017. Evaluation included age, gender, body mass index, stone size, stone location, and operative time. All surgeries were performed by a single surgeon and ureteral stenting was not done prior surgery. The risk factors of febrile UTI after RIRS were assessed by univariate and multivariate logistic regression analysis.A total of 150 patients were included in the present study, and 17 patients (11.3%) had febrile UTI after RIRS. Mean patient age was 56.64 ±â€Š13.91 years, and both genders were evenly distributed. Mean stone size was 14.16 ±â€Š5.89 mm. and mean operation time was 74.50 ±â€Š42.56 minutes. According to univariate analysis, preoperative pyuria was associated with postoperative febrile UTI. Multivariate logistic regression analysis showed that preoperative pyuria was the only independent risk factor of infectious complications after RIRS (odds ratios 8.311, 95% confidence intervals 1.759 - 39.275, P = .008). Age, gender, body mass index, comorbidity, preoperative bacteriuria, presence of hydronephrosis, renal stone characteristics, and operative time were not associated with febrile UTI after RIRS.Preoperative pyuria was the only risk factor of infectious complications following RIRS. Therefore, careful management after RIRS is necessary especially when preoperative urinalysis shows pyuria.


Asunto(s)
Fiebre/etiología , Cálculos Renales/cirugía , Nefrotomía/efectos adversos , Complicaciones Posoperatorias/etiología , Piuria/complicaciones , Infecciones Urinarias/etiología , Adulto , Anciano , Femenino , Humanos , Cálculos Renales/orina , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Tempo Operativo , Periodo Preoperatorio , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento
5.
Urologe A ; 60(3): 383-392, 2021 Mar.
Artículo en Alemán | MEDLINE | ID: mdl-33560463

RESUMEN

Perioperative antibiotic prophylaxis in endourology is used to reduce or avoid postoperative surgical site infections and complicated urinary tract infections. Special attention is paid to antibiotic stewardship strategies to avoid the continuing selection of antibiotics and multidrug-resistant uropathogens as well as collateral damage to the microbiome. The individual risk profile, the local resistance situation, the expected pathogen spectrum, the pharmacokinetics and the approval of each substance are important aspects to be considered in the indications and selection of perioperative antibiotic prophylaxis. Furthermore, applicable hygiene regulations and the surgical care of an intervention must be observed.


Asunto(s)
Programas de Optimización del Uso de los Antimicrobianos , Infecciones Urinarias , Antibacterianos/uso terapéutico , Profilaxis Antibiótica , Humanos , Infección de la Herida Quirúrgica/prevención & control , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/etiología , Infecciones Urinarias/prevención & control
6.
Ann Hematol ; 100(3): 753-761, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33439306

RESUMEN

Adenovirus (ADV)- or BK virus (BKV)-associated hemorrhagic cystitis (HC) is a common complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Several risk factors have been previously reported; however, it is unclear whether virus-associated HC can be transmitted. To clarify this point, we performed a retrospective cohort study on 207 consecutive patients who underwent allo-HSCT at Kyoto University Hospital between 2012 and 2018. We evaluated the incidence and risk factors of virus-associated HC and performed a phylogenetic analysis of the ADV partial sequence. The median age at transplantation was 50 (range, 17-68) years. Fifty-eight patients (28%) developed HC. ADVs were detected in 18 cases, BKVs were detected in 51, both were detected in 12, and only John Cunningham virus (JCV) was detected in 1 case. No factor was significantly associated with HC. However, both ADV- and BKV-HC occurred intensively between April 2016 and September 2017, which suggested possible nosocomial transmission of ADV and BKV. Genome sequencing of the hexon, E3, and penton regions of detected ADVs identified 7 cases of ADV type 11, 2 cases of type 35, and 3 cases of a type 79-related strain. A sequence analysis revealed that these strains in each type were almost identical, except for one case of a type 79-related strain. In conclusion, ADV-HCs with possible nosocomial transmission were described based on genotyping of the virus and partial sequencing of the viral genome. Although viral HC after allo-HSCT is thought to mainly be due to reactivation of a latent virus, nosocomial transmission of ADV or BKV should also be considered.


Asunto(s)
Infección Hospitalaria/etiología , Cistitis/virología , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Hemorragia/virología , Virosis/etiología , Adenoviridae/aislamiento & purificación , Adenoviridae/fisiología , Infecciones por Adenoviridae/epidemiología , Infecciones por Adenoviridae/etiología , Adolescente , Adulto , Anciano , Virus BK/aislamiento & purificación , Virus BK/fisiología , Estudios de Cohortes , Infección Hospitalaria/epidemiología , Cistitis/epidemiología , Cistitis/etiología , Femenino , Trasplante de Células Madre Hematopoyéticas/estadística & datos numéricos , Hemorragia/epidemiología , Hemorragia/etiología , Humanos , Virus JC/aislamiento & purificación , Virus JC/fisiología , Japón/epidemiología , Masculino , Persona de Mediana Edad , Infecciones por Polyomavirus/epidemiología , Infecciones por Polyomavirus/etiología , Estudios Retrospectivos , Factores de Riesgo , Trasplante Homólogo/efectos adversos , Trasplante Homólogo/estadística & datos numéricos , Infecciones Tumorales por Virus/epidemiología , Infecciones Tumorales por Virus/etiología , Infecciones Urinarias/epidemiología , Infecciones Urinarias/etiología , Virosis/epidemiología , Adulto Joven
7.
Medicina (Kaunas) ; 57(1)2021 Jan 09.
Artículo en Inglés | MEDLINE | ID: mdl-33435420

RESUMEN

Background and Objectives: Vesicoureteral reflux (VUR) describes a common pediatric anomaly in pediatric urology with a prevalence of 1-2%. In diagnostics, in addition to the gold standard of voiding cystourethrography (VCUG), contrast-enhanced urosonography (ceVUS) offers a radiation-free procedure, which, despite its advantages, is not yet widely used. In the present single-center study, subsequent therapeutic procedures and outcomes after ceVUS of 49 patients were investigated. The aim of the study is to investigate the efficacy of ceVUS with the intention of broader clinical implementation. Materials and Methods: Between 2016 and 2020, 49 patients were retrospectively included and received a ceVUS to evaluate VUR. With a distribution of 47:2 (95.9%), a clear female predominance was present. The age of the patients varied between 5 months and 60 years at the time of ceVUS. All examinations were all performed and subsequently interpreted by a single experienced radiologist (EFSUMB level 3). Results: Compared to intraoperative findings, ceVUS shows a sensitivity of 95.7% with a specificity of 100%. Allergic reactions to the contrast medium could not be observed. Conclusion: With its high sensitivity and intraoperative validation, ceVUS offers an excellent alternative to VCUG, the gold standard in the diagnosis of VUR. In addition, ceVUS is a radiation-free examination method with a low risk profile that offers an exceptional diagnostic tool in the diagnostic clarification of recurrent urinary tract infections with the suspected diagnosis of VUR and should also be included in the consideration of a diagnosis next to the established VCUG, especially in younger children.


Asunto(s)
Medios de Contraste , Técnicas de Diagnóstico Urológico , Ultrasonografía/métodos , Reflujo Vesicoureteral/diagnóstico por imagen , Adolescente , Adulto , Antibacterianos/uso terapéutico , Niño , Preescolar , Cistografía , Femenino , Humanos , Lactante , Inyecciones , Laparoscopía , Masculino , Persona de Mediana Edad , Fosfolípidos , Politetrafluoroetileno , Exposición a la Radiación , Recurrencia , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Hexafluoruro de Azufre , Ureteroscopía , Uretra/diagnóstico por imagen , Vejiga Urinaria/diagnóstico por imagen , Infecciones Urinarias/etiología , Infecciones Urinarias/prevención & control , Urografía , Reflujo Vesicoureteral/clasificación , Reflujo Vesicoureteral/complicaciones , Reflujo Vesicoureteral/terapia , Adulto Joven
8.
Molecules ; 26(3)2021 Jan 22.
Artículo en Inglés | MEDLINE | ID: mdl-33499241

RESUMEN

The Food and Drug Administration (FDA) approved a new class of anti-diabetic medication (a sodium-glucose co-transporter 2 (SGLT2) inhibitor) in 2013. However, SGLT2 inhibitor drugs are under evaluation due to their associative side effects, such as urinary tract and genital infection, urinary discomfort, diabetic ketosis, and kidney problems. Even clinicians have difficulty in recommending it to diabetic patients due to the increased probability of urinary tract infection. In our study, we selected natural SGLT2 inhibitors, namely acerogenin B, formononetin, (-)-kurarinone, (+)-pteryxin, and quinidine, to explore their potential against an emerging uropathogenic bacterial therapeutic target, i.e., FimH. FimH plays a critical role in the colonization of uropathogenic bacteria on the urinary tract surface. Thus, FimH antagonists show promising effects against uropathogenic bacterial strains via their targeting of FimH's adherence mechanism with less chance of resistance. The molecular docking results showed that, among natural SGLT2 inhibitors, formononetin, (+)-pteryxin, and quinidine have a strong interaction with FimH proteins, with binding energy (∆G) and inhibition constant (ki) values of -5.65 kcal/mol and 71.95 µM, -5.50 kcal/mol and 92.97 µM, and -5.70 kcal/mol and 66.40 µM, respectively. These interactions were better than those of the positive control heptyl α-d-mannopyranoside and far better than those of the SGLT2 inhibitor drug canagliflozin. Furthermore, a 50 ns molecular dynamics simulation was conducted to optimize the interaction, and the resulting complexes were found to be stable. Physicochemical property assessments predicted little toxicity and good drug-likeness properties for these three compounds. Therefore, formononetin, (+)-pteryxin, and quinidine can be proposed as promising SGLT2 inhibitors drugs, with add-on FimH inhibition potential that might reduce the probability of uropathogenic side effects.


Asunto(s)
Adhesinas de Escherichia coli/efectos de los fármacos , Infecciones por Escherichia coli/prevención & control , Proteínas Fimbrias/efectos de los fármacos , Inhibidores del Cotransportador de Sodio-Glucosa 2/efectos adversos , Inhibidores del Cotransportador de Sodio-Glucosa 2/farmacología , Infecciones Urinarias/prevención & control , Escherichia coli Uropatógena/efectos de los fármacos , Adhesinas de Escherichia coli/química , Biología Computacional , Simulación por Computador , Cumarinas/química , Cumarinas/farmacología , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Infecciones por Escherichia coli/etiología , Proteínas Fimbrias/química , Humanos , Isoflavonas/química , Isoflavonas/farmacología , Simulación del Acoplamiento Molecular , Quinidina/química , Quinidina/farmacología , Transportador 2 de Sodio-Glucosa/química , Inhibidores del Cotransportador de Sodio-Glucosa 2/química , Infecciones Urinarias/etiología , Escherichia coli Uropatógena/patogenicidad
10.
Spine (Phila Pa 1976) ; 46(1): E23-E30, 2021 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-33065691

RESUMEN

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The purpose of this study was to utilize the National Readmission Database to determine the national estimates of complication and 90-day readmission rates associated with cervical spinal fusion in adult patients with rheumatoid arthritis (RA). SUMMARY OF BACKGROUND: RA patients who undergo cervical spine surgery are known to be at high risk for readmissions, which are costly and may not be reimbursed by Medicare. METHODS: The National Readmission Database was queried for adults (>18 years) diagnosed with RA undergoing cervical spine fusion. Patient, operative, and hospital factors were assessed in bivariate analyses. Independent risk factors for readmissions were identified using stepwise multivariate logistic regression. RESULTS: From 2013 to 2014, a total of 5597 RA patients (average age: 61.5 ±â€Š11.2 years, 70.9% female) underwent cervical spine fusion. A total of 691 (12.3%) patients were readmitted within 90 days (). Index inpatient complications included dysphagia (readmitted: 7.9% vs. non-readmitted: 5.1%; P = 0.003), urinary tract infection (UTI) (8.8% vs. 3.7%; P < 0.001), respiratory-related complications (7.6% vs. 3.4%; P < 0.001), and implant-related complications (5.4% vs. 2.7%; P < 0.001). Multivariate logistic regression demonstrated the following as the strongest independent predictors for 90-day readmission: intraoperative bleeding (odds ratio [OR]: 3.6, P = 0.001), inpatient Deep Vein Thrombosis (DVT) (OR 4.1, P = 0.004), and patient discharge against medical advice (OR 33.5, P = 0.001). CONCLUSION: Readmission rates for RA patients undergoing cervical spine surgery are high and most often due to postoperative infection (septicemia, UTI, pneumonia, wound). Potential modifiable factors which may improve outcomes include minimizing intraoperative blood loses, postoperative DVT prophylaxis, and discharge disposition. LEVEL OF EVIDENCE: 3.


Asunto(s)
Artritis Reumatoide/complicaciones , Readmisión del Paciente , Complicaciones Posoperatorias/etiología , Fusión Vertebral/efectos adversos , Adulto , Anciano , Bases de Datos Factuales , Femenino , Humanos , Pacientes Internos , Masculino , Medicare , Persona de Mediana Edad , Neumonía/etiología , Estudios Retrospectivos , Factores de Riesgo , Enfermedades de la Columna Vertebral/complicaciones , Estados Unidos , Infecciones Urinarias/etiología
11.
Bol. méd. postgrado ; 36(2): 59-62, dic.2020. ilus
Artículo en Español | LILACS, LIVECS | ID: biblio-1117902

RESUMEN

La hidronefrosis gigante se considera una entidad rara, caracterizada por la presencia de al menos 1 litro de líquido dentro del sistema pielocalicial, más frecuente en pacientes masculinos, generalmente asintomático. Se presenta el caso de una paciente femenina de 85 años de edad quien refiere desde hace 6 años dolor lumbar izquierdo y aumento de la circunferencia abdominal; en la TAC abdomino-pélvica contrastada se evidencia bolsa hidronefrótica izquierda gigante con corteza renal adelgazada que no concentra ni elimina el contraste. Se presenta el caso de paciente masculino de 85 años de edad quien refiere desde hace 5 años aumento de la circunferencia abdominal y la TAC abdomino-pélvica contrastada muestra importante dilatación del riñón y sistema colector derecho secundario a litiasis ureteral. A ambos pacientes se les practicó nefrectomía simple. Con respecto a la hidronefrosis gigante, la etiología más frecuente es la estenosis de la unión ureteropélvica seguido por la patología litiásica y tumoral; es importante considerar esta entidad como diagnóstico diferencial en caso de masas quísticas abdominales(AU)


Giant hydronephrosis is considered a rare entity, characterized by the presence of at least 1 liter of fluid within the pielocalicial system; is more frequent in males and often asymptomatic. We present an 85-year-old female patient who has a 6-year complain of left lumbar pain associated with increase in abdominal circumference. On CT scan, a giant left hydronephrotic pouch is evidenced, with a thinned renal wall that does not concentrate or eliminate contrast. We present a 61 year-old male who refers a 5-year asymptomatic increase in abdominal circumference. The CT scan reveals significant dilatation of the kidney and right collecting system secondary to ureteral lithiasis. Both patients undergo simple nephrectomy. The most frequent etiology of giant hydronephrosis is ureteropelvic junction stenosis followed by lithiasic and tumor pathology. It is important to consider this entity as a differential diagnosis in the case of abdominal cystic masses(AU)


Asunto(s)
Humanos , Masculino , Femenino , Infecciones Urinarias/etiología , Tomografía Computarizada por Rayos X , Ultrasonografía , Pielocistitis/fisiopatología , Hidronefrosis/etiología , Enfermedades Urológicas , Nefrectomía
12.
Artículo en Inglés | MEDLINE | ID: mdl-33339194

RESUMEN

We aim to examine the incidences, clinical characteristics, and in-hospital outcomes of type 2 diabetes (T2DM) patients hospitalized with urinary tract infections (UTIs) in Spain and to identify the factors associated with in-hospital mortality (IHM). A retrospective observational study was carried out with a sample that included all adult patients who were hospitalized for UTIs between 2001 and 2018 and collected in the Spanish National Health System Hospital Discharge Database. We identified 850,276 patients with UTIs (25.49% with T2DM). The incidence of UTIs increased in patients with and without diabetes from 290.76 and 74.79 cases per 100,000 inhabitants in the period from year 2001 to year 2003 to 568.45 and 144.0 in the period from 2016 to 2018, respectively (p < 0.001). Adjusted incidence of UTIs was higher in T2DM patients (incidence rate ratio (IRR) 4.36; 95% CI 4.35-4.39). The multivariable analysis showed a significant reduction in the IHM over time for men and women with T2DM. In T2DM, patients' higher IHM was associated with older age, comorbidities, and Staphylococcus aureus isolation. Women with T2DM had a higher risk of dying than men. The risk of IHM with an episode of UTIs was independent of the presence of T2DM (odds ratio (OR) 0.97; 95% CI 0.91-1.01). We conclude that the incidence of UTIs was over four times higher in T2DM than nondiabetic patients and has increased over time.


Asunto(s)
Diabetes Mellitus Tipo 2 , Hospitalización , Infecciones Urinarias , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Comorbilidad , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Mortalidad Hospitalaria , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , España/epidemiología , Infecciones Urinarias/epidemiología , Infecciones Urinarias/etiología , Adulto Joven
13.
PLoS One ; 15(12): e0243741, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33315921

RESUMEN

Rising incidence of extended- spectrum beta-lactamase (ESBL) induced urinary tract infections (UTIs) is an increasing concern worldwide. Thus, it is of paramount importance to investigate novel approaches that can facilitate the identification and guide empiric antibiotic therapy in such episodes. The study aimed to evaluate the usability of antecedent ESBL-positive urine culture to predict the pathogenic identity of future ones. Moreover, the study evaluated the accuracy of selected empiric therapy in index episodes. This was a retrospective study that included 693 cases with paired UTI episodes, linked to two separate hospital admissions within 12 month-period, and a conditional previous ESBL positive episode. Pertinent information was obtained by reviewing patients' medical records and computerized laboratory results. Multivariate analysis showed that shorter interval between index and previous episodes was significantly associated with increased chance of ESBL-positive results in current culture (OR = 0.912, 95CI% = 0.863-0.963, p = 0.001). Additionally, cases with ESBL-positive results in current culture were more likely to have underlying urological/surgical condition (OR = 1.416, 95CI% = 1.018-1.969, p = 0.039). Investigations of the accuracy of current empirical therapy revealed that male patients were less accurately treated compared to female patients (OR = 0.528, 95CI% = 0.289-0.963, p = 0.037). Furthermore, surgical patients were treated less accurately compared to those treated in internal ward (OR = 0.451, 95CI% = 0.234-0.870, p = 0.018). Selecting an agent concordant with previous microbiologic data significantly increased the accuracy of ESBL-UTIs therapy (p<0.001). A quick survey of the previous ESBL urine culture results can guide practitioners in the selection of empiric therapy for the pending current culture and thus improve treatment accuracy.


Asunto(s)
Bacterias/metabolismo , Infecciones Urinarias/microbiología , Infecciones Urinarias/orina , beta-Lactamasas/metabolismo , Adulto , Anciano , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Bacterias/efectos de los fármacos , Bacterias/aislamiento & purificación , Farmacorresistencia Bacteriana , Femenino , Hospitalización , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Estudios Retrospectivos , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/etiología
14.
Rev. chil. infectol ; 37(5): 509-514, nov. 2020. tab
Artículo en Español | LILACS | ID: biblio-1144244

RESUMEN

Resumen La infección del tracto urinario asociada al catéter urinario permanente (ITU/CUP) es un problema relevante en los centros de salud por su alta frecuencia. Objetivo: Identificar factores de riesgo de ITU en pacientes adultos con CUP. Material y Método: Estudio caso control efectuado entre los años 2010-2016 en el Hospital Militar de Santiago. Se realizó un análisis estadístico univariado y multivariado por medio del modelo de regresión logística binaria, con variables como edad, duración e indicación del dispositivo, algunas comorbilidades y la instalación del dispositivo luego de 15 días hospitalización. Resultado: Se obtuvo un total de 63 casos y 123 controles. Fueron variables predictoras de ITU/CUP la duración del CUP desde el séptimo día en adelante (OR 2,6 IC 1,4-4,9, p = 0,004) y la instalación del CUP con una estadía de hospitalización previa de 15 días y más (OR 7,8 IC 2,920,9 p = 0,000). No se encontró asociación con la edad mayor de 80 años, comorbilidades como diabetes y vejiga neurogénica e indicación de instalación. Conclusiones: Los resultados permiten focalizar las intervenciones, evaluando la necesidad real de indicación de CUP en pacientes con estadía hospitalaria previa de dos semanas y fomentar el retiro de CUP antes del séptimo día de uso.


Abstract Catheter-associated urinary tract infection (CAUTI) is a relevant problem in health centers because of its high frequency. Objective: To identify UTI risk factors in adult patients with urinary catheter. Material and Method: Control case study carried out between the years 2010-2016 at the Military Hospital of Santiago, Chile. Univariate and multivariate statistical analysis were performed using the binary logistic regression model, variables such as age, duration and indication of the device, some comorbidities and the installation of the device after 15 days of hospitalization. Result: A total of 63 cases and 123 controls were obtained. Predictive variables of CAUTI for the duration of the urinary catheter from the 7th day onwards (OR 2.6 IC 1.4-4.9, p = 0.004) and the installation of the urinary catheter with a previous hospital stay of 15 days and more (OR 7.8 CI 2.9-20.9 p = 0.000). No association was found in age over 80 years, comorbidities such as diabetes and neurogenic bladder and indication. Conclusions: The results permitted to focus the interventions, evaluating the real need for indication of CUP in patients with previous hospital statistics of 2 weeks and encouraging the withdrawal of CUP before the 7th day of use.


Asunto(s)
Humanos , Adulto , Anciano de 80 o más Años , Infecciones Urinarias/etiología , Infecciones Urinarias/epidemiología , Infecciones Relacionadas con Catéteres/epidemiología , Catéteres Urinarios/efectos adversos , Cateterismo Urinario/efectos adversos , Chile/epidemiología , Infección Hospitalaria/epidemiología , Factores de Riesgo
15.
Arch Esp Urol ; 73(7): 634-642, 2020 Sep.
Artículo en Inglés, Español | MEDLINE | ID: mdl-32886078

RESUMEN

OBJECTIVE: Ureteroscopic lithotripsy (URS) is the current standard choice of treatment for both ureteral and adequate renal stones. Although it is known to be a safe procedure, postoperative febrile urinary tract infection (UTI) is not rare. Especially in diabetic patients, rate of urinary tract infection is higher. Therefore, we aimed to describe the risk factors for UTI following URS in diabetics. MATERIALS AND METHODS: Between January 2017and April 2019, 546 patients who under went ureteroscopic lithotripsy for ureteral and/or renal stones were included. A matched-pair analysis was performed to compare postoperative UTI rates between diabetics and nondiabetics. We retrospectively reviewed the medical records including age, gender, BMI, comorbidities, UTI history, hemoglobin A1c (HbA1c), operating time, stone size and hounsfield unit (HU), preoperative hydronephrosis, ureteroscopic methods and ureteral stenting. Logistic regression analysis was done to determine the risk factors for postoperative UTI in diabetics. RESULTS: In diabetic patients rate of postoperative UTI was 29% (13/45). After matched-pair analysis within the group of non-diabetics, incidence was 11% (5/44) (p=0.04). In univariate analysis, preoperative ureteral stent, UTI history and HbA1c level were the risk factors for UTI after URS in diabetics. UTI history and HbA1clevel were the independent risk factors for developing postoperative UTI in diabetic patients. HbA1c threshold 6.9% afforded 75% sensitivity and 67% specificity for predicting postoperative UTI in diabetics. CONCLUSIONS: Diabetic patients are under greater risk to develop postoperative UTI following URS. Those patients with UTI history and HbA1c level higher than 6.9% must be followed carefully.


Asunto(s)
Diabetes Mellitus/epidemiología , Litotricia/efectos adversos , Cálculos Ureterales/cirugía , Infecciones Urinarias/etiología , Humanos , Estudios Retrospectivos , Resultado del Tratamiento , Ureteroscopía
16.
Arch. esp. urol. (Ed. impr.) ; 73(7): 634-642, sept. 2020. tab, graf
Artículo en Inglés | IBECS | ID: ibc-195961

RESUMEN

OBJECTIVE: Ureteroscopic lithotripsy (URS) is the current standard choice of treatment for both ureteral and adequate renal stones. Although it is known to be a safe procedure, postoperative febrile urinary tract infection (UTI) is not rare. Especially in diabetic patients, rate of urinary tract infection is higher. Therefore, we aimed to describe the risk factors for UTI following URS in diabetics. MATERIALS AND METHODS: Between January 2017 and April 2019, 546 patients who underwent ureteroscopic lithotripsy for ureteral and/or renal stones were included. A matched-pair analysis was performed to compare postoperative UTI rates between diabetics and nondiabetics. We retrospectively reviewed the medical records including age, gender, BMI, comorbidities, UTI history, hemoglobin A1c (HbA1c), operating time, stone size and hounsfield unit (HU), preoperative hydronephrosis, ureteroscopic methods and ureteral stenting. Logistic regression analysis was done to determine the risk factors for postoperative UTI in diabetics. RESULTS: In diabetic patients rate of postoperative UTI was 29% (13/45). After matched-pair analysis within the group of non-diabetics, incidence was 11% (5/44) (p = 0.04). In univariate analysis, preoperative ureteral stent, UTI history and HbA1c level were the risk factors for UTI after URS in diabetics. UTI history and HbA1c level were the independent risk factors for developing postoperative UTI in diabetic patients. HbA1c threshold 6.9% afforded 75% sensitivity and 67% specificity for predicting postoperative UTI in diabetics. CONCLUSIONS: Diabetic patients are under greater risk to develop postoperative UTI following URS. Those patients with UTI history and HbA1c level higher than 6.9% must be followed carefully


OBJETIVO: La litotricia ureteroscópica (URS) es la opción estándar actual de tratamiento para cálculos renales tanto ureterales como adecuados. Aunque se sabe que es un procedimiento seguro, la infección urinaria febril posoperatoria (ITU) no es rara. Especialmente en pacientes diabéticos, la tasa de infección del tracto urinario es mayor. Por lo tanto, nuestro objetivo fue describir los factores de riesgo de IU después de la URS en diabéticos. MATERIALES Y MÉTODOS: Entre enero de 2017 y abril de 2019, se incluyeron 546 pacientes que se sometieron a litotricia ureteroscópica por cálculos ureterales y/o renales. Se realizó un análisis de pares emparejados para comparar las tasas de ITU postoperatorias entre diabéticos y no diabéticos. Revisamos retrospectivamente los registros médicos. Se realizó un análisis de regresión logística para determinar los factores de riesgo de infección urinaria postoperatoria en diabéticos. RESULTADOS: En pacientes diabéticos, la tasa de ITU postoperatoria fue del 29% (13/45). Después del análisis de pares emparejados dentro del grupo de no diabéticos, la incidencia fue del 11% (5/44) (p = 0,04). En el análisis univariado, el historial de ITU y el nivel de HbA1c fueron los factores de riesgo de ITU después de la URS en diabéticos. El historial de ITU y el nivel de HbA1c fueron los factores de riesgo independientes para desarrollar ITU postoperatoria en pacientes diabéticos. El umbral de HbA1c del 6,9% proporcionó una sensibilidad del 75% y una especificidad del 67% para predecir la infección urinaria postoperatoria en diabéticos. CONCLUSIONES: Los pacientes diabéticos tienen un mayor riesgo de desarrollar ITU postoperatoria después de la URS. Los pacientes con antecedentes de ITU y un nivel de HbA1c superior al 6,9% deben ser seguidos cuidadosamente


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Infecciones Urinarias/etiología , Fiebre/etiología , Litotricia/efectos adversos , Complicaciones de la Diabetes/complicaciones , Complicaciones Posoperatorias/etiología , Factores de Riesgo , Diabetes Mellitus/prevención & control , Análisis por Apareamiento , Estadísticas no Paramétricas , Curva ROC , Análisis Multivariante
17.
Med. clín (Ed. impr.) ; 155(4): 171-177, ago. 2020. ilus, tab
Artículo en Español | IBECS | ID: ibc-195763

RESUMEN

Las infecciones urinarias son muy prevalentes entre las mujeres y cuando son recurrentes conllevan malestar a las pacientes, un elevado coste sanitario y representan una de las causas más frecuentes de uso de antibióticos. Para prevenirlas existen varias opciones que incluyen tanto tratamientos antibióticos (profilaxis antibiótica continua o poscoital) como medidas no antibióticas (medidas higiénicas, vitamina D, arándanos, D-manosa, probióticos, estrógenos, vacunas, instilaciones intravesicales), pero con diferente nivel de evidencia y, a veces, de mala calidad, por lo que se necesitan nuevos estudios aleatorizados y comparativos que permitan diseñar la mejor estrategia de prevención


Urinary tract infections are highly prevalent among women and when they are recurrent they can lead to patient discomfort and high healthcare costs, and they represent one of the most frequent causes of antibiotic consumption. There are several options to prevent RUTI which include both antibiotic treatment (continuous or postcoital antibiotic prophylaxis) and non-antibiotic measures (hygienic measures, vitamin D, blueberries, D-mannose, probiotics, oestrogens, vaccines, intravesical instillations), but with different levels of evidence, sometimes of poor quality, and therefore new randomized and comparative studies are needed to choose the best strategy


Asunto(s)
Humanos , Infecciones Urinarias/patología , Infecciones Urinarias/prevención & control , Recurrencia , Infecciones Urinarias/etiología , Factores de Riesgo , Posmenopausia , Acidificación , Profilaxis Antibiótica , Infecciones Urinarias/tratamiento farmacológico , Probióticos/uso terapéutico
18.
J Urol ; 204(6): 1263-1269, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-32614256

RESUMEN

PURPOSE: Management of pregnancy and delivery in women with lower urinary tract reconstruction is challenging and the currently available literature is insufficient to guide clinical practice. We report pregnancy and delivery outcomes in this specific population. MATERIALS AND METHODS: We conducted a national multicenter retrospective study (16 centers) including 68 women with 96 deliveries between 1998 and 2019. These women had at least 1 successful pregnancy and delivery after augmentation enterocystoplasty, catheterizable channel creation and/or artificial urinary sphincter implantation. Maternal and fetal complications during pregnancy and delivery were reported, as well as postpartum functional outcomes, according to the delivery mode. The chi-square test and Student's t-test were used to compare categorical and continuous variables, respectively. RESULTS: Overall 32% of reported pregnancies were complicated by febrile urinary tract infections, 13.5% by renal colic and 14.6% required upper urinary tract diversion. In addition, 10% of patients reported transient self-catheterization difficulties and 13.5% reported de novo or increased urinary incontinence. The preterm delivery rate was 35.3%. Elective C-section was performed in 61% of pregnancies. Twenty complications occurred during delivery (20%), including 19 during elective C-section. Urinary continence at 1 year was unchanged for 93.5% of deliveries. Delivery mode (p=0.293) and multiparity (p=0.572) had no impact on urinary continence. CONCLUSIONS: In this population C-section appeared to be associated with a high risk of complications. In the absence of any obstetric or neurological contraindications, vaginal delivery should be proposed as the first line option to the majority of these women.


Asunto(s)
Cesárea/efectos adversos , Complicaciones Posoperatorias/epidemiología , Complicaciones del Embarazo/epidemiología , Nacimiento Prematuro/epidemiología , Procedimientos Quirúrgicos Reconstructivos/efectos adversos , Adolescente , Adulto , Cesárea/estadística & datos numéricos , Femenino , Francia/epidemiología , Humanos , Esclerosis Múltiple/cirugía , Complicaciones Posoperatorias/etiología , Embarazo , Complicaciones del Embarazo/etiología , Complicaciones del Embarazo/cirugía , Nacimiento Prematuro/etiología , Cólico Renal/epidemiología , Cólico Renal/etiología , Estudios Retrospectivos , Traumatismos de la Médula Espinal/cirugía , Disrafia Espinal/cirugía , Vejiga Urinaria/anomalías , Vejiga Urinaria/cirugía , Derivación Urinaria/estadística & datos numéricos , Incontinencia Urinaria/epidemiología , Incontinencia Urinaria/etiología , Esfínter Urinario Artificial/efectos adversos , Infecciones Urinarias/epidemiología , Infecciones Urinarias/etiología , Adulto Joven
19.
Medicine (Baltimore) ; 99(26): e20852, 2020 Jun 26.
Artículo en Inglés | MEDLINE | ID: mdl-32590783

RESUMEN

RATIONALE: Either malacoplakia or xanthogranulomatous cystitis (XC) is a rare chronic infection disease of urinary bladder, which often mimics bladder masses undifferentiated from malignance and results in severe lower urinary tract symptoms. The malacoplakia combined with XC is even rarer in the literature. PATIENT CONCERNS: A 64-year-old female, who presented with nocturia, frequency of micturition, severe urgency with occasional urinary incontinence, and recurrent hematuria for >2 years, was diagnosed with azotemia and anemia. In addition, two 1.0 × 1.0 cm masses of bladder were detected by computer tomography. DIAGNOSES: Malacoplakia combined with xanthogranulomas cystitis was diagnosed histologically. Video urodynamic test showed poor bladder compliance (9 mL/comH2O), markedly decreased maximum bladder capacity (120 mL), and right vesicoureteral reflux at a low intravesical pressure level (25 cmH2O). INTERVENTIONS: Transurethral resection of bladder masses was carried out after treatment of urinary infection by intravenous piperacillin-tazobactam. Oral Ciprofloxacin and Tolterodine were postoperatively used to prevent recurrent lower urinary tract infections and alleviate detrusor overactivity. OUTCOMES: The treatment did not alleviate azotemia, frequency, urgency with incontinence, and bilateral hydroureteronephrosis, but the patient refused to undergo bladder augmentation on account of her poor economic status. LESSONS: Malacoplakia or/and xanthogranulomas cystitis may lead to poor bladder compliance and video urodynamic study should be considered in patients with refractory chronic lower urinary tract symptoms.


Asunto(s)
Cistitis/complicaciones , Malacoplasia/complicaciones , Vejiga Urinaria/anomalías , Cistitis/fisiopatología , Femenino , Humanos , Malacoplasia/fisiopatología , Persona de Mediana Edad , Nocturia/etiología , Tomografía Computarizada por Rayos X/métodos , Vejiga Urinaria/fisiopatología , Incontinencia Urinaria/etiología , Infecciones Urinarias/etiología , Infecciones Urinarias/fisiopatología
20.
Anticancer Res ; 40(6): 3065-3069, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32487600

RESUMEN

Endometrial cancer is the most common gynecologic malignancy. The mainstay of treatment for endometrial cancer is total hysterectomy with bilateral salpingo-oophorectomy. Radiation and chemotherapy accompanied with progestins can also play a significant role in treatment. Lower urinary tract symptoms (LUTS) following therapy for endometrial cancer are an extremely difficult and challenging condition that deteriorates patients' quality of life. Current literature remains rather scarce regarding LUTS after therapy for endometrial cancer. This review aimed to investigate the incidence of LUTS in endometrial cancer treatment.


Asunto(s)
Tratamiento Conservador/métodos , Neoplasias Endometriales/complicaciones , Neoplasias Endometriales/cirugía , Infecciones Urinarias/etiología , Neoplasias Endometriales/patología , Femenino , Humanos , Incidencia , Sistema Urinario/patología
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