Infecciones de orina en pacientes sondados con patología neurológica. Estudio de las posibles causas / Urinary tract infections in patients with urinary catheterization who suffer neurological disorders. Study of the possible causes

Por estudios realizados en nuestro hospital, se observó que todos los años existía una diferencia considerable entre las infecciones de orina en pacientes sondados del servicio de Neurología con respecto a otras unidades de hospitalización. Esto nos llevó a realizar el presente estudio. Objetivo. Determinar las causas que aumentan las infecciones del tracto urinario (ITU) en el paciente sondado con patología neurológica. Metodología. Estudio observacional descriptivo prospectivo de 50 pacientes con patología neurológica ingresados en la planta de Neurología del Hospital de Cabueñes (Gijón), que precisaron sondaje vesical (SV). El trabajo de campo consistió en recoger una muestra para sedimento y cultivo de orina pre y post-SV, además de anotar las causas del sondaje, duración, edad, sexo y diagnóstico en una hoja de registro. Se descartaron aquellos pacientes sondados de urgencias, los que estaban tomando antibiótico y aquellos cuya patología no era neurológica. Resultados. De 50 pacientes estudiados que precisaron SV, el 40 % fue por retención de orina, un 40 % por orden médica y el 20 % por tratamiento con manitol. El 88 % tuvo un diagnóstico de ictus. Un 12 % ya tenía el cultivo positivo antes de ser portadores de SV. Conclusiones. El ictus es la patología neurológica que más precisa SV. Una de las causas más importantes de aquel es la retención de orina. Algunos de los pacientes sondados ya tenían ITU antes de la colocación de SV (AU)

In previous studies carried out in our hospital (Hospital de Cabueñes, Gijón, Spain) it could be noticed/stated that every year there was a considerable difference between the patients with urine catheterization in the Neurology Service and the patients in the other hospital wards. This encourages us to carry out the following research. Objectives. The purpose of this study is to determine the causes that increase the urinary infections in neurological patients with bladder catheterization compared to catheterized patients with other diseases. Analysis of sediment and urine culture before and after the urinary bladder catheterization. Methods. Retrospective, descriptive and observational study of fifty patients with neurological disorders who were hospitalized in the neurological care unit of Hospital de Cabueñes (Gijón, Spain) and who needed urinary catheterization. The fieldwork consisted of collecting a sample for sediment and culture before and after the urinary catheterization and also of registering the causes of the catheterization, the length of the treatment, age and sex of patients on a medical record sheet. Patients who were catheterized in the Emergency (A&E) unit, those who were taking antibiotics and those who did not suffer a neurological disease did not take part in this study. Results. 20 patients (40 %) out of the 50 who took part in this study and who needed urinary catheterization (UC) suffered from urinary retention, another 20 (40 %) were under medical diagnosis and supervision and the last 10 (20 %) were treated with manitol. 44 patients (88 %) were diagnosed with strokes. 12 % of them had a positive culture prior to UC placement. Conclusions. Patients who suffered stokes have a high risk of urine retention due to their functional disability. Some of them had already the urine values altered, they even had infection prior to the urinary catheter placement (AU)

Urinary tract infection analysis in a spinal cord injured population undergoing rehabilitation--how to treat?

STUDY DESIGN: Cross sectional study, including 38 outpatients. Standardized questionnaire was used and urine cultures were performed. OBJECTIVES: To study spinal cord-injured (SCI) patients bladder management, clinical aspects that symptomatic urinary tract infection (SUTI) may present and asymptomatic bacteriuria (AB) incidence with its antimicrobial susceptibility profile. SETTING: Spinal cord injury outpatient rehabilitation clinic. RESULTS: Clean intermittent catheterization is used by 71% of the patients. SUTI may have atypical clinical presentation (shivers, spasticity increase, headaches). In total, 65.7% (N=25) of the patients presented AB. Among these, the microorganisms isolated were resistant mainly to Ampicillin, Sulfamethoxazole-Trimethoprim and Norfloxacin, whose resistance rates were, respectively 73.3%, 60% and 33.3%. CONCLUSION: Special attention should be given to possible atypical symptoms for SUTI. Although a small amount of urine samples was analyzed, resistance rates against Ampicillin, Sulfamethoxazole-Trimethoprim, Ciprofloxacin and Nitrofurantoin appear to be higher among SCI patients compared to the general population, thus demonstrating the need for continuous monitoring of microorganisms susceptibility, in order to avoid therapeutic failure when dealing with this specific population.

Effects of intravaginal estriol and pelvic floor rehabilitation on urogenital aging in postmenopausal women.

PURPOSE: To assess the effects of the combination of pelvic floor rehabilitation and intravaginal estriol administration on stress urinary incontinence (SUI), urogenital atrophy and recurrent urinary tract infections in postmenopausal women. METHODS: Two-hundred-six postmenopausal women with urogenital aging symptoms were enrolled in this prospective randomized controlled study. Patients were randomly divided into two groups and each group consisted of 103 women. Subjects in the treatment group received intravaginal estriol ovules, such as 1 ovule (1 mg) once daily for 2 weeks and then 2 ovules once weekly for a total of 6 months as maintenance therapy plus pelvic floor rehabilitation. Subjects in the control group received only intravaginal estriol in a similar regimen. We evaluated urogenital symptomatology, urine cultures, colposcopic findings, urethral cytologic findings, urethral pressure profiles and urethrocystometry before, as well as after 6 months of treatment. RESULTS: After therapy, the symptoms and signs of urogenital atrophy significantly improved in both groups. 61/83 (73.49%) of the treated patients, and only 10/103 (9.71%) of the control patients referred a subjective improvement of their incontinence. In the patients treated by combination therapy with estriol plus pelvic floor rehabilitation, we observed significant improvements of colposcopic findings, and there were statistically significant increases in mean maximum urethral pressure (MUP), in mean urethral closure pressure (MUCP), as well as in the abdominal pressure transmission ratio to the proximal urethra (PTR). CONCLUSIONS: Our results showed that combination therapy with estriol plus pelvic floor rehabilitation was effective and should be considered as a first-line treatment for symptoms of urogenital aging in postmenopausal women.

Length of intravenous antibiotic therapy and treatment failure in infants with urinary tract infections.

OBJECTIVE: The goal was to determine the association between short-duration (< or =3 days) and long-duration (> or =4 days) intravenous antibiotic therapy and treatment failure in a cohort of young infants hospitalized with urinary tract infections (UTIs). METHODS: We conducted a retrospective cohort study of infants <6 months of age who were hospitalized with UTIs between 1999 and 2004 at 24 children's hospitals in the Pediatric Health Information System. Our main model adjusted for all covariates, propensity scores, and clustering according to hospital to evaluate the effect of short versus long courses of inpatient intravenous antibiotic therapy on treatment failure, defined as readmission because of UTI within 30 days. RESULTS: Of the 12,333 infants who met the inclusion criteria, 240 (1.9%) experienced treatment failure. The treatment failure rates were 1.6% for children who received short-course intravenous antibiotic treatment and 2.2% for children who received long-course treatment. Treatment courses varied substantially across hospitals and with patient-level characteristics. After multivariate adjustment, including propensity scores, there was no significant association between treatment group and outcomes, with an odds ratio for long versus short treatment of 1.02 (95% confidence interval: 0.77-1.35). Known presence of genitourinary abnormalities, but not age, predicted treatment failure. CONCLUSIONS: Treatment failure for generally healthy young infants hospitalized with UTIs is uncommon and is not associated with the duration of intravenous antibiotic treatment. Treating more infants with short courses of intravenous antibiotic therapy might decrease resource use without affecting readmission rates.

The role of uroflowmetry biofeedback and biofeedback training of the pelvic floor muscles in the treatment of recurrent urinary tract infections in women with dysfunctional voiding: a randomized controlled prospective study.

OBJECTIVES: To evaluate the efficacy of a training program with uroflowmetry biofeedback and pelvic floor relaxation biofeedback on urodynamic and voiding parameters in women with dysfunctional voiding. METHODS: Eighty-six women with recurrent urinary tract infections (UTIs) and dysfunctional voiding were randomly assigned to receive a treatment schedule as follows: uroflowmetry biofeedback (group 1), biofeedback training of the pelvic floor muscles (group 2), uroflowmetry biofeedback combined to biofeedback training of the pelvic floor muscles (group 3), no treatment (group 4). Patients were regularly evaluated by American Urological Association Symptom Index and urodynamics during the study period. All the patients were followed up for 1 year with monthly urine cultures. A further evaluation was done at month 24 by American Urological Association Symptom Index and free uroflowmetry with measurement of residual urine. RESULTS: The prevalence of storage and emptying symptoms decreased significantly at 3, 6, and 12 months in the groups 1, 2, and 3, and remained stable during the study period. Mean flow rate, flow time, voiding volume increased significantly, whereas postvoid residual urine decreased. The prevalence of UTI decreased significantly in groups 1, 2, and 3. At month 24, storage and emptying symptoms and voiding patterns were similar to the baseline values in all the patients. The incidence of UTIs was similar to baseline values in groups 1, 2, and 3. CONCLUSIONS: Training the voluntary control of the pelvic floor seems essential in obtaining control over the bladder function. These results reinforce the importance of pelvic floor therapy in the resolution of UTIs.

[Parkinson's disease influences the perioperative risk profile in trauma patients]. / Der Einfluss des Morbus Parkinson auf das perioperative Risikoprofil unfallchirurgischer Patienten.

AIM: Parkinson's disease (PD) is one of the most common degenerative diseases of the central nervous system affecting elderly patients with increasing demographic prevalence. The aim of this study was to define the perioperative risk profile in trauma patients suffering from Parkinson's disease in order to improve treatment options in these patients. METHOD: Over a period of 13 years, 16 patients suffering from Parkinson's disease treated in the department of trauma surgery were retrospectively compared using matched-pair analysis with 16 controls not affected by PD. Both groups of patients were assessed regarding morbidity, length of treatment and rehabilitation. RESULTS: Trauma patients suffering from Parkinson's disease showed an increase in morbidity risk. Postoperative falls occurred significantly, infections of the urinary tract and pneumonia tendentiously more often in PD patients. Postoperative stay and length of treatment were significantly longer in patients with PD. These patients also tended to stay longer preoperatively and remained longer in intensive care. PD patients required on-ward rehabilitation significantly more often. CONCLUSION: Concomitant Parkinson's disease is a significant factor of perioperative morbidity in trauma patients. Perioperative morbidity in PD patients may be influenced by early diagnostic and therapeutic measures.

Manejo kinésico del piso pelviano en infecciones urinarias a repetición / Pelvic floor kinesis for the treatment of recurrent urinary tract infections

Evaluar la terapia de reeducación miccional en pacientes con infección urinaria (ITU) a repetición portadores de disinergia entre la micción y la actividad esfinteriana uretral externa y con presencia de residuo postmiccional elevado, independiente de si presentan o no síntomas de disfuncional miccional. Material y Método: Estudio retrospectivo de pacientes portadores de ITU a repetición, sin malformaciones de la vía urinaria, que en su estudio demostraran signos de disfunción miccional con disinergia entre la micción y la actividad electromiográfica, y que tuvieran residuo postmiccional elevado. Todos fueron sometidos a terapia kinésica del piso pelviano y reeducación de hábitos miccionales. Los parámetros para medir los resultados fueron: 1. Nuevos episodios de infección urinaria. 2. Presencia o ausencia de disinergia mediante una flujometría (FM) con electromiografía (EMG) con electrodos de superficieperineales. 3. Medición del residuo postmiccional Resultados: 18 pacientes cumplieron con el criterio de ingreso al estudio. La edad promedio al iniciar la terapia fue de 8 años 9 meses, con un promedio de 4 episodios de ITU por paciente, en un tiempo promedio de evolución de 4 años. Destaca que el 33 por ciento de nuestros pacientes que no relataban síntomas de disfunción miccional al ingreso al estudio, igualmentepresentaron disinergia y residuo elevado. El promedio de residuo postmiccional fue de 58 por ciento antes deiniciar el tratamiento. Éste consistió en ejercicios de kinesiología del piso pelviano y educación sobre la dinámica urinaria. Cuatro pacientes presentaron ITU posterior al tratamiento, todas afebriles, 3 pacientes con sólo 1 episodio. Respecto a la disinergia todos los pacientes lograron adecuada relajación del esfínter uretral externo durante la micción y el promedio de residuo postmiccional fue de 6 por ciento. Conclusiones: Frente a la ITU a repetición, aun en ausencia de síntomas de disfunción miccional, se deben buscar elementos...

To evaluate the therapy of voiding retraining in patients with recurrent urinary tract infections (UTI) whit dyssynergia to relax the urinary sphincter during micturition and large volume post-void residualurine. Material and Method: Retrospective study of patients with recurrent UTI, without malformations of the urinary tract, that in their study demonstrated signs of voiding dysfunction with dyssynergia between the voiding and electromyography activity, and large volume post-void residual urine. All patients were underwent to pelvic floor muscle retraining and behavioral therapy. The parameters to measure the outcomes were: 1. New episodes of urinary tract infections. 2. Presence or absence of dyssynergia evaluated by uroflowmetry (FM) with concomitant electromyography (EMG) 3. Measurement of post-void residual urine. Results: Study enrollment criteria were fulfilled by 18 patients. The mean age was 8 years 9 months,with 4 episodes of UTI by patient (average). There were 33 percent of the patients without symptoms of voiding dysfunction, but with dyssynergia and large volume post-void residual. The volume post-void residual was 58 percent before the treatment. Post treatment, 4 patients developed UTI without fever (3 of them patients developed 1 episode). All patients obtained to relax the urinary sphincter during micturition and the volume post-void residual was 6 percent (average) after treatment. Conclusions: The recurrent UTI, even in absence of symptoms of voiding dysfunction, we recommended to study with voiding diary, FM/EMG and volume post-void residual. In the patients with recurrent urinary tract infections and voiding dysfunction,the pelvic floor muscle retraining and behavioral therapy is an important therapeutic tool. This treatment allows to obtain a normal synergia detrusor-sphincter and to improve the volume post-void residual, both factors, that when they are altered facilitate development of UTI.

Guías de manejo de las 10 principales causas de morbilidad en Manizales (Primera entrega) / Guides of handling of the 10 main causes of morbidity in Manizales (First delivery)

La Universidad de Manizales, en desarrollodel convenio con Assbasalud E.S.E. (instituciónde primer nivel), en la cátedra de Ruralito, yhaciendo parte del entrenamiento que realizael médico general en la generación de estrategiasde apoyo al crecimiento institucional, presentóante la gerencia de dicha empresa, unapropuesta de revisión de literatura científica delas primeras 10 causas de morbilidad que sepresentaron en ella, en el primer semestre delaño 2005, correspondiente a población delRégimen Subsidiado y Vinculado, en los dossexos y todas las edades, incluyéndose en dichotrabajo las diferencias en las consideracionesclínicas y en la evaluación terapéuticaentre adultos y niños en algunas patologías querequieren dicha especificación.El propósito es que a partir de esta revisiónse adicionen los aportes institucionales, deacuerdo a las normas internas, las experienciasy el enriquecimiento de grupos de trabajo,para así abordar la construcción de un manualque estandarice la atención en salud de laspatologías que enfrenta con mayor frecuenciael médico, teniendo en cuenta los ajustes quese requieran desarrollar en la dinámica de lasvariaciones de los perfiles epidemiológicos dela población que se atiende y los cambios normativosque se diseñen desde el ente rectordel sector salud. Así mismo, se pretende compartiresta experiencia a otras empresas delprimer nivel en salud del municipio de Manizalesy del departamento de Caldas, las cuales tienegran similitud en las patologías de mayormorbilidad

[Variables influencing duration of hospitalization for urinary tract infection]. / Variables que influyen en la duración de la hospitalización por infección del tracto urinario.

BACKGROUND: The need for hospitalization and its duration in children with urinary tract infections (UTI) are controversial. OBJECTIVE: To analyze the effect of certain clinical factors from the medical records of children hospitalized with UTI to determine which factors have the greatest influence on length of hospital stay. MATERIAL AND METHODS: A retrospective study of the medical records of 93 patients admitted to our department with a diagnosis of UTI between May 1998 and June 2000 was carried out. All cases were confirmed by bacteriological analysis. The variables analyzed included age, sex, duration of fever before and during admission, temperature, length of intravenous antibiotic therapy, administration of aminoglycosides, presence of urinary tract malformations, previous episodes of UTI, and length of hospital stay. RESULTS: The variables with the greatest influence on a length of hospital stay of more than 7 days were age, especially an age of less than 24 months (OR 3.42; 95 % CI 1.2-9) and the number of days with fever during hospitalization (more than 2 days: OR 2.73; 95 % CI 1.07-7.6). CONCLUSION: Patient age significantly influences length of hospital stay in children with UTI. To optimize resources, ambulatory treatment of children with UTI should be encouraged, even in those younger than 2 years.

The effect of labeling on perceived ability to recover from acute illnesses and injuries.

BACKGROUND: The process of giving a patient a diagnosis may cause harm. The adverse effects of labeling, best documented for the diagnosis of hypertension, include increased absenteeism from work and lower earnings, increased depressive symptoms, and reduced quality of life. We tried to determine whether the diagnosis of hypertension affects perceptions about the time required to recover from common acute medical problems. METHODS: In an academic family practice clinic, equal numbers of patients with and without hypertension were asked to estimate how long it would take them to recover from an upper respiratory tract infection (URI), a urinary tract infection (UTI), and an ankle sprain now and 5 years ago (before the diagnosis of hypertension). RESULTS: Compared with patients who did not have hypertension, patients with hypertension estimated that it would take them twice as long, on average, to recover from a URI now (11.7 vs 6.0 days, P=.002) and in the past (10 vs 5.5 days, P=.02). These differences persisted after controlling for age, sex, race, and education. No significant differences were found for estimated recovery times for UTI or ankle sprain. CONCLUSIONS: The diagnosis of hypertension may affect patients' perceptions of their ability to recover from unrelated acute illnesses. This may have implications for the way physicians choose to present information to patients.

Behaviour modification group-treatment of children with recurrent lower urinary tract infections.

It has long been recognized that infrequent micturition and incomplete emptying of the bladder in children represent important factors in the causation of incontinence during the day, and of urinary tract infections (UTI). Behaviour modification is well documented, both as an individual- and a group intervention. The purpose of our study was to develop a programme for group intervention with children, with the aim of improving the children's micturition habits and thereby changing the frequency of wettings, the amount of residual urine, and the UTI frequency. The children responded quickly to the intervention. The amount of residual urine was unaffected, but there are methodological problems in measuring this. There were, however, significant reductions in incontinence and UTI, although there was a tendency to relapse of incontinence over time, probably because of lack of continued follow-up. It is tentatively concluded that the described behavioural intervention seemed effective in improving children's micturition habits, thereby changing the frequency of wettings, and the frequency of urinary tract infections. The treatment seems to be suitable for nursing intervention, either within a hospital setting, or on an outpatient, primary care basis.

[The use of physiotherapy and antibacterial preparations in urogenital infections]. / Primenenie fizioterapii i antibakterial'nykh preparatov pri urogenital'nykh infektsiiakh.

Antibacterial antibiotics only, antibiotics in combination with immunostimulators, antibiotics plus immunostimulators plus physiotherapy were administered in 132 patients with urethroprostatitis caused by mixed infection (18, 45 and 69 patients, respectively). A complete recovery was achieved only in patients who had been treated with the antibiotics, immunostimulators and physiotherapy. After antibiotics, residual infection was registered in 11.1% of the patients, clinical symptoms persisted in 6 patients; after antibiotics combined with immunostimulators in 6.7% and 4 patients, respectively.

Tratamiento de la infección del tracto urinario no complicada en el adulto

Las infecciones no complicadas del tracto urinario son un motivo de consulta frecuente de la mujer y en mucha menor proporción del hombre joven. Se deben considerar la cistitis aguda y la pielonefritis aguda como no complicadas en mujeres premenopáusicas, sexualmente activas, no embarazadas, con inicio reciente de la disuria, frecuencia o urgencia urinaria, o, dolor en flancos asociado a fiebre mayor de 39 grados C que no hayan sido recientemente instrumentadas del tracto urinario o que no hayan recibido antibióticos y que no tengan historia de alteraciones anatomicas, funcionales o metabólicas del tracto urinario. La mayoría de estas infecciones son causadas por cepas uropatógenas de Escherichia coli que son suceptibles a la mayoría de antibióticos orales. la revisión de la literatura sugiere que un tratamiento de tres días es efectivo para la cistitis aguda mientras que para la pielonefritis aguda se necesita un mínimo de 14 días. Se prefiere el uso de antibióticos que alcancen altas concentraciones renales como el trimetropinsulfametoxazol, las fluoroquinonas o los aminoglucósidos. En los hombres estas infecciones son poco frecuentes pero como son producidas por los mismos gérmenes el tratamiento antibiótico es semejante

[The significance of urinary tract infections in patients with cerebrovascular diseases during clinical rehabilitation]. / Die Bedeutung von Harnwegsinfekten bei Patienten mit zerebrovaskulären Erkrankungen während der klinischen Rehabilitation.

In 361 patients with cerebral stroke a study of medical and neurological complications was undertaken. Among a total of 131 complications (36.2%) a striking incidence of urinary tract infections was seen: 83 cases (22.9%). Patients without complications had an average stay of 61.2 days in hospital, those with urinary tract infections had 77 days (p < 0.05). In patients with cerebrovascular accidents voiding dysfunctions are common. Great care must be taken to prevent complications: indwelling catheters should be used only over short periods of time. In case urinary drainage is needed over a long period of time, suprapubic catheterization should be preferred.

[The effect of therapeutic mud on the viability and persistence properties of bacteria]. / Vliianie lechebnoi griazi na zhiznesposobnost' i persistentnye svoistva bakterii.

The influence of therapeutic salt mud on the viability and some biological properties of bacteria, responsible for their survival in the macroorganisms, was shown. Therapeutic mud had low bactericidal properties, and enterobacteria were, on the whole, even less sensitive to these properties than staphylococci. Therapeutic mud inhibited the capacity of bacteria for inactivating complement, lysozyme and the bactericidal component of the preparation of interferon and also reduced the hydrophobic properties of bacterial cells. At the same time Escherichia were found to be more susceptible to the modifying action of the mud than staphylococci. The greatest effect on the hydrophobic properties and anticomplement activity of bacteria was observed after their incubation in mud solution.