Indwelling catheter vs intermittent catheterization: is there a difference in UTI susceptibility?

BACKGROUND: Patients with neurogenic lower urinary tract dysfunction (NLUTD) often rely on some type of catheterization for bladder emptying. Intermittent catheterization (IC) is considered the gold standard and is preferred over continuous catheterization, since it is considered to cause fewer urinary tract infections (UTIs) than indwelling catheterization. The main objective of our study was to describe UTI prevalence (at visit) and incidence (within the last 12 months) and urine culture characteristics between patients using an indwelling catheter versus (vs) those performing IC. METHODS: In this cross-sectional study, we prospectively evaluated from 02/2020 to 01/2021 patients with NLUTD undergoing urine cultures for prophylactic reasons or due to UTI symptoms. At visit, all patients underwent a standardized interview on current UTI symptoms as well as UTI history and antibiotic consumption within the past year. Patients using an indwelling catheter (n = 206) or IC (n = 299) were included in the analysis. The main outcome was between-group differences regarding UTI characteristics. RESULTS: Patients using an indwelling catheter were older (indwelling catheter vs IC: median 66 (Q1-Q3: 55-77) vs 55 (42-67) years of age) and showed a higher Charlson comorbidity index (indwelling catheter vs IC: median 4 (Q1-Q3: 2-6) vs 2 (1-4) (both p < 0·001). A total of 40 patients from both groups were diagnosed with a UTI at visit (indwelling catheters vs IC: 8% (16/206) vs 8% (24/299); p = 0·782), and the number of UTIs within the past 12 months was not significantly different between groups. Overall, Escherichia coli (21%), Enterococcus faecalis (17%), and Klebsiella spp. (12%) were the most frequently detected bacteria. CONCLUSIONS: In this cohort of patients with NLUTD, we did not find relevant differences in UTI frequency between groups. These results suggest that UTI-related concerns should not be given undue emphasis when counseling patients for catheter-related bladder emptying methods.

CLINICAL FEATURES OF THE HIV INFECTION COURSE AND THE DEPENDENCE OF CHANGES IN LABORATORY PARAMETERS ON THE CLINICAL STAGE AND ON THE CD4 LYMPHOCYTES LEVEL.

OBJECTIVE: The aim: Is to determine the features of the HIV infection and changes in indicators of endogenous intoxication and immunoreactivity depending on the clinical stage and the level of CD4 lymphocytes. PATIENTS AND METHODS: Materials and methods: 72 HIV-patients were examined. Comparison group included 40 healthy blood donors. Clinical and laboratory examination was performed. Indicators of endogenous intoxication, nonspecific reactivity and inflammatory activity were calculated. RESULTS: Results:Main opportunistic infections were: oropharyngeal candidiasis; tuberculosis of different localization, more often pulmonary tuberculosis; and brain toxoplasmosis (p<0,05). Indices of endogenous intoxication and immunoreactivity are important objective criteria for diagnosis. In groups where the distribution of patients depended on the level of CD4 cells - HIV (CD4≥500) and HIV (CD4≤499-200), index changes were more pronounced than in the HIV I and HIV III groups. The most significant changes in indexes were in the HIV IV clinical group and the HIV (CD4≤199) group: endogenous intoxication indexes were increased by 1,2-7,5 and 1,9-13,7 times in both groups respectively. Non-specific reactivity indexes were decreased by 1,2-1,6 and 1,3-1,6 times, respectively; nuclear index (NI) in groups was 3 and 3,4 times higher (p<0,05-0,001). Changes in indexes of inflammatory activity were observed (p<0,05-0,001). CONCLUSION: Conclusions: Main diagnosed opportunistic infections were: oropharyngeal candidiasis; tuberculosis of different localization; and brain toxoplasmosis (p<0,05). Indices of endogenous intoxication and immunoreactivity are important objective criteria for diagnosis. The most significant changes in indexes were in the HIV IV clinical group and the HIV (CD4≤199) group (p<0,05-0,001).

Hematological changes of endogenic intoxication, non-specific reactivity and inflammation activity indices in hiv-infected patients.

OBJECTIVE: The aim: To establish changes in hematological parameters of endogenous intoxication, nonspecific reactivity, activity of inflammation in HIV-infected persons, to improve verification of the clinical stage of the disease. PATIENTS AND METHODS: Materials and methods: Anamnestic, clinical, laboratory data. The statistical processing was performed in the Microsoft Office Excel 2010 and IBM SPSS Statistic 23 computer software, variational statistics processing (Student's t-criteria). RESULTS: Results: 51 HIV-infected were examined (main group) and 44 clinically anamnestic healthy blood donors (comparison group). The study included 46 patients (5 were withdrawn due to failure to meet criteria - severe septic condition). All patients were divided into three groups: A1 - all patients, 46 persons, men 76.0%, women - 24.0%; A2 - 11 people with I-III stages of HIV infection, men 72,7%, women - 27,3%; A3 - 35 HIV infected with stage IV disease, men 76.0%, women - 24.0%. All patients had an increase in intoxication indices and sex-dependent changes. Nonspecific reactivity indices in group A1 were above the norm, independent of gender except the index of neutrophils and lymphocyte (NLR). Below the norm is the immunoreactivity index (IR), the lymphocyte-monocyte ratio index (LMR), the lymphocyte index (Ilymph), the index of allergization (IA). Indices of nonspecific reactivity of A2 patients exceeded the norm and were independent of sex, with the exception of IR, Ilymph, IA, which were reduced. Non-specific reactivity indices are increased in HIV-infected group A3. Below the norm were IR, LMR, Ilymph, IA. Analyzing the activity indexes of inflammation, it became clear that the Krebs index (KI) was increased in all groups of patients; lymphocyte-granulocyte index (ILG) in groups A1 and A3 is less than normal, unlike patients in group A2, where it remained within the normal range. The leukocyte ratio and erythrocyte sedimentation rate (ILESR) in A1 and A3 have increased rates, unlike in A2, where the index is smaller. CONCLUSION: Conclusions: Men are predominantly HIV positive. The systemic immune response is more pronounced in women. There is a progressive impairment of immunological reactivity, indicating an immunodeficiency of the cell type with a decrease in nonspecific anti-infective protection. Patients with stage IV of HIV infection have moderate and severe inflammatory reactions, impaired reactivity, and are more pronounced in women.