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1.
Maturitas ; 140: 8-13, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32972638

RESUMO

OBJECTIVES: To evaluate the relation between lower urinary tract symptoms (LUTS) and vaginal atrophy (VA) in 518 women across the menopausal age span (40-55 years of age). STUDY DESIGN: Multicentre, cross-sectional study. MAIN OUTCOME MEASURES: VA was evaluated by the contemporaneous presence of a pH > 5, vaginal dryness and at least one objective sign of VA (mucosal pallor, dryness, thinning, fragility or with petechiae)., LUTS were evaluated by the Urogenital Distress Inventory (UDI-6). Sexuality was evaluated by the Female Sexual Function Index (FSFI). RESULTS: Women were categorized by age: group 1, 40-45 years; group 2, 46-48 years; group 3, 49-51 years; and group 4, 52-55 years. Similar rates of recurrent urinary infection (RUI) were present in different age groups. RUI rate was related to VA (OR 1.703, 95 %CI 1.037, 2.799) and dyspareunia (OR 2.060, 95 %CI 1.199, 3.539). The rates of LUTS were also similar in the different age groups or in the presence of VA. The LUTS rate was related to dyspareunia (OR 1.971, 95 %CI 1.020, 3.808). Distress from LUTS was similar among different age groups and in the presence of VA. It was related to RUI (CR 7.187, 95 %CI 3.532, 10.841; p < 0.0001) and being an ex-smoker (CR 5.189, 95 %CI 1.425. 6.952; p < 0.007), and was inversely related to FSFI score (CR -0.314, 95 %CI -0.478, -0.149; p < 0.0002), CONCLUSIONS: In women across the menopausal age span, RUI, but not LUTS, is related to VA. The presence of LUTS is related to dyspareunia, and distress from LUTS is inversely related to sexuality. These results obtained in women across the menopausal age span are not applicable to older postmenopausal women.


Assuntos
Sintomas do Trato Urinário Inferior/epidemiologia , Infecções Urinárias/epidemiologia , Doenças Vaginais/epidemiologia , Adulto , Atrofia , Estudos Transversais , Feminino , Humanos , Menopausa , Pessoa de Meia-Idade , Vagina/patologia
2.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32883806

RESUMO

BACKGROUND: Catheter-associated urinary tract infections (CAUTIs) are a leading cause of health care-associated infection. Catheter insertion bundles (IBs) and maintenance bundles (MBs) have been developed to prevent CAUTIs but have not been extensively validated for use in pediatric populations. We report the CAUTI prevention efforts of a large network of children's hospitals. METHODS: Children's hospitals joined the Children's Hospitals' Solutions for Patient Safety engagement network from 2011 to 2017, using an open start time engagement approach, and elected to participate in CAUTI prevention efforts, with 26 submitting data initially and 128 at the end. CAUTI prevention recommendations were first released in May 2012, and IBs and MBs were released in May 2014. Hospitals reported on CAUTIs, patient-days, and urinary catheter-line days and tracked reliability to each bundle. For the network, run charts or control charts were used to plot CAUTI rates, urinary catheter use, and reliability to each bundle component. RESULTS: After the introduction of the pediatric CAUTI IBs and MBs, CAUTI rates across the network decreased 61.6%, from 2.55 to 0.98 infections per 1000 catheter-line days. Centerline shifts occurred both before and after the 2015 Centers for Disease Control and Prevention CAUTI definition change. Urinary catheter use rates did not decline during the intervention period. Network reliability to the IBs and MBs increased to 95.4% and 86.9%, respectively. CONCLUSIONS: IBs and MBs aimed at preventing CAUTIs were introduced across a large network of children's hospitals. Across the network, the rate of urinary tract infections among hospitalized children with indwelling urinary catheters decreased 61.6%.


Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Cateteres de Demora/efeitos adversos , Infecção Hospitalar/prevenção & controle , Pacotes de Assistência ao Paciente , Cateterismo Urinário/efeitos adversos , Infecções Urinárias/prevenção & controle , Infecções Relacionadas a Cateter/epidemiologia , Criança , Infecção Hospitalar/epidemiologia , Hospitais Pediátricos , Humanos , Segurança do Paciente , Melhoria de Qualidade/organização & administração , Reprodutibilidade dos Testes , Estados Unidos/epidemiologia , Infecções Urinárias/epidemiologia
3.
Value Health ; 23(7): 842-850, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32762985

RESUMO

OBJECTIVES: To quantify patients' maximum acceptable risk (MAR) of urinary and genital tract infections (UGTI) in exchange for benefits associated with treatments for managing type 2 diabetes mellitus (T2DM). METHODS: In a discrete choice experiment, adult patients with T2DM and currently on metformin and/or sulphonylurea (first-line treatments) were asked to choose between 2 hypothetical medications defined by 6 attributes: years of medication effectiveness in controlling blood glucose, weight reduction, UGTI risk, risk of hospitalization from heart failure, all-cause mortality risk, and out-of-pocket medication cost. We used latent class logistic regression parameters to estimate the conditional relative importance of treatment attributes and MAR of UGTI for various treatment benefits. RESULTS: A 2-class latent class model was identified as the best fit for the responses from 147 patients. The first class (49% of sample), termed as "survival-conscious," stated that they were willing to accept 46% (95% confidence interval [CI]: 2%-90%) UGTI risk in exchange for a reduction from 6% to 1% in all-cause mortality risk. The second class (51% of sample), termed as "UGTI/cost-conscious" were willing to accept significantly lower (6%; CI: 2%-11%, and 5%; CI: 2%-8%) UGTI risk in exchange for the same reduction in all-cause mortality and hospitalization risks, respectively. CONCLUSIONS: On average, patients were willing to trade higher UGTI risk for a more effective medication. Our findings suggest that physicians should present the benefits and potential side effects of all available treatments and consider patient preferences in their treatment recommendations.


Assuntos
Comportamento de Escolha , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/administração & dosagem , Preferência do Paciente , Idoso , Glicemia/efeitos dos fármacos , Feminino , Gastos em Saúde , Hospitalização/estatística & dados numéricos , Humanos , Hipoglicemiantes/efeitos adversos , Masculino , Pessoa de Meia-Idade , Infecções do Sistema Genital/epidemiologia , Infecções Urinárias/epidemiologia , Perda de Peso/efeitos dos fármacos
4.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32669403

RESUMO

BACKGROUND AND OBJECTIVES: Long-term outcomes of urinary tract infection (UTI) in childhood are not well known. Pregnancy may reveal latent renal damage caused by a UTI because of stress on the kidneys. METHODS: Our cohort included adult women with an ultrasonography taken because of a childhood UTI in 1981-1991 (N = 1175). Nine women with a severe congenital kidney malformation or urinary tract obstruction were excluded. Altogether, 260 mothers with a childhood UTI and 500 population-based control mothers without a childhood UTI matched for age, and delivery dates were compared. Our primary end point was the proportion of women with essential or gestational hypertension, preeclampsia, proteinuria, or pyelonephritis during the first pregnancy. RESULTS: The pregnancy outcomes of the women with a UTI in childhood did not differ from those of the controls because 105 of 260 (40%) patients met the primary end point compared with 204 of 500 (41%) controls (relative risk [RR] 0.99; 95% confidence interval [CI] 0.82 to 1.2; P = .91). Similarly, there were no significant differences between the 2 groups in essential hypertension (RR 1.0; 95% CI 0.65 to 1.6; P = .92), gestational hypertension (RR 0.93; 95% CI 0.74 to 1.2; P = .54), preeclampsia (RR 1.5; 95% CI 0.91 to 2.5; P = .11), proteinuria (RR 1.2; 95% CI 0.81 to 1.8; P = .36) or pyelonephritis (2 controls and none of the patients; P = .55) during the first pregnancy. CONCLUSIONS: Childhood UTIs did not increase the risk of pregnancy-related complications in this controlled population-based study. Thus, UTIs in childhood without severe urinary tract abnormalities appear to have a minimal effect on kidney health in early adulthood.


Assuntos
Infecções Urinárias/epidemiologia , Adulto , Estudos de Casos e Controles , Criança , Estudos de Coortes , Hipertensão Essencial/epidemiologia , Feminino , Finlândia/epidemiologia , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Pré-Eclâmpsia/epidemiologia , Gravidez , Proteinúria/epidemiologia , Pielonefrite/epidemiologia , Ultrassonografia , Sistema Urinário/diagnóstico por imagem , Adulto Jovem
5.
PLoS Med ; 17(7): e1003202, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32702001

RESUMO

BACKGROUND: Efforts to reduce unnecessary antibiotic prescribing have coincided with increasing awareness of sepsis. We aimed to estimate the probability of sepsis following infection consultations in primary care when antibiotics were or were not prescribed. METHODS AND FINDINGS: We conducted a cohort study including all registered patients at 706 general practices in the United Kingdom Clinical Practice Research Datalink, with 66.2 million person-years of follow-up from 2002 to 2017. There were 35,244 first episodes of sepsis (17,886, 51%, female; median age 71 years, interquartile range 57-82 years). Consultations for respiratory tract infection (RTI), skin or urinary tract infection (UTI), and antibiotic prescriptions were exposures. A Bayesian decision tree was used to estimate the probability (95% uncertainty intervals [UIs]) of sepsis following an infection consultation. Age, gender, and frailty were evaluated as association modifiers. The probability of sepsis was lower if an antibiotic was prescribed, but the number of antibiotic prescriptions required to prevent one episode of sepsis (number needed to treat [NNT]) decreased with age. At 0-4 years old, the NNT was 29,773 (95% UI 18,458-71,091) in boys and 27,014 (16,739-65,709) in girls; over 85 years old, NNT was 262 (236-293) in men and 385 (352-421) in women. Frailty was associated with greater risk of sepsis and lower NNT. For severely frail patients aged 55-64 years, the NNT was 247 (156-459) in men and 343 (234-556) in women. At all ages, the probability of sepsis was greatest for UTI, followed by skin infection, followed by RTI. At 65-74 years, the NNT following RTI was 1,257 (1,112-1,434) in men and 2,278 (1,966-2,686) in women; the NNT following skin infection was 503 (398-646) in men and 784 (602-1,051) in women; following UTI, the NNT was 121 (102-145) in men and 284 (241-342) in women. NNT values were generally smaller for the period from 2014 to 2017, when sepsis was diagnosed more frequently. Lack of random allocation to antibiotic therapy might have biased estimates; patients may sometimes experience sepsis or receive antibiotic prescriptions without these being recorded in primary care; recording of sepsis has increased over the study period. CONCLUSIONS: These stratified estimates of risk help to identify groups in which antibiotic prescribing may be more safely reduced. Risks of sepsis and benefits of antibiotics are more substantial among older adults, persons with more advanced frailty, or following UTIs.


Assuntos
Infecções/complicações , Sepse/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Estudos de Coortes , Prescrições de Medicamentos , Feminino , Idoso Fragilizado , Fragilidade , Humanos , Lactente , Recém-Nascido , Infecções/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica , Atenção Primária à Saúde , Probabilidade , Encaminhamento e Consulta , Infecções Respiratórias/complicações , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/epidemiologia , Reino Unido/epidemiologia , Infecções Urinárias/complicações , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/epidemiologia , Adulto Jovem
7.
BMC Infect Dis ; 20(1): 453, 2020 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-32600258

RESUMO

INTRODUCTION: Uropathogenic E. coli is the leading cause of Urinary tract infections (UTIs), contributing to 80-90% of all community-acquired and 30-50% of all hospital-acquired UTIs. Biofilm forming Uropathogenic E. coli are associated with persistent and chronic inflammation leading to complicated and or recurrent UTIs. Biofilms provide an environment for poor antibiotic penetration and horizontal transfer of virulence genes which favors the development of Multidrug-resistant organisms (MDRO). Understanding biofilm formation and antimicrobial resistance determinants of Uropathogenic E. coli strains will provide insight into the development of treatment options for biofilm-associated UTIs. The aim of this study was to determine the biofilm forming capability, presence of virulence genes and antimicrobial susceptibility pattern of Uropathogenic E. coli isolates in Uganda. METHODS: This was a cross-sectional study carried in the Clinical Microbiology and Molecular biology laboratories at the Department of Medical Microbiology, Makerere University College of Health Sciences. We randomly selected 200 Uropathogenic E. coli clinical isolates among the stored isolates collected between January 2018 and December 2018 that had significant bacteriuria (> 105 CFU). All isolates were subjected to biofilm detection using the Congo Red Agar method and Antimicrobial susceptibility testing was performed using the Kirby disk diffusion method. The isolates were later subjected PCR for the detection of Urovirulence genes namely; Pap, Fim, Sfa, Afa, Hly and Cnf, using commercially designed primers. RESULTS: In this study, 62.5% (125/200) were positive biofilm formers and 78% (156/200) of these were multi-drug resistant (MDR). The isolates were most resistant to Trimethoprim sulphamethoxazole and Amoxicillin (93%) followed by gentamycin (87%) and the least was imipenem (0.5%). Fim was the most prevalent Urovirulence gene (53.5%) followed by Pap (21%), Sfa (13%), Afa (8%), Cnf (5.5%) and Hyl (0%). CONCLUSIONS: We demonstrate a high prevalence of biofilm-forming Uropathogenic E. coli strains that are highly associated with the MDR phenotype. We recommend routine surveillance of antimicrobial resistance and biofilm formation to understand the antibiotics suitable in the management of biofilm-associated UTIs.


Assuntos
Antibacterianos/uso terapêutico , Biofilmes/crescimento & desenvolvimento , Infecções por Escherichia coli/epidemiologia , Infecções Urinárias/epidemiologia , Escherichia coli Uropatogênica/genética , Escherichia coli Uropatogênica/patogenicidade , Estudos Transversais , Farmacorresistência Bacteriana Múltipla/genética , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/microbiologia , Humanos , Testes de Sensibilidade Microbiana , Fenótipo , Reação em Cadeia da Polimerase , Prevalência , Uganda/epidemiologia , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/microbiologia , Escherichia coli Uropatogênica/efeitos dos fármacos , Escherichia coli Uropatogênica/isolamento & purificação , Virulência/genética , Fatores de Virulência/genética
8.
Am J Obstet Gynecol ; 223(2): 265.e1-265.e13, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32497610

RESUMO

OBJECTIVE: We performed a systematic review and meta-analysis to determine whether D-mannose reduces urinary tract infection recurrence (ie, cumulative incidence) in adult women with recurrent urinary tract infection compared with other prevention agents. Secondary outcomes included side effects and compliance with D-mannose use. DATA SOURCES: Ovid Medline 1946-, Embase 1947-, Scopus 1823-, Cochrane Library, Web of Science 1900-, and ClinicalTrials.gov were searched through 4/15/2020. STUDY ELIGIBILITY CRITERIA: Systematic review inclusion: randomized controlled trials, prospective cohorts, and retrospective cohorts written in English of women ≥18 years old with recurrent urinary tract infection in which D-mannose was utilized as an outpatient prevention regimen. Systematic review exclusion: lab or animal-based research, study protocols only, and conference abstracts. Meta-analysis inclusion: stated D-mannose dose, follow-up time ≥6 months, a comparison arm to D-mannose, and data available from women ≥18 years of age. STUDY APPRAISAL AND SYNTHESIS METHODS: Two independent reviewers made abstract, full text, and data extraction decisions. Study methodologic quality was assessed using the Cochrane Risk of Bias tool. Relative risks, confidence intervals, and heterogeneity were computed. RESULTS: Searches identified 776 unique citations. Eight publications met eligibility: 2 using D-mannose only; 6 using D-mannose combined with another treatment. Seven studies were prospective: 2 randomized controlled trials, 1 randomized cross-over trial, and 4 prospective cohort studies. One retrospective cohort study was included. Three studies met meta-analysis eligibility (1 randomized controlled trial, 1 randomized cross-over trial, and 1 prospective cohort). Pooled relative risk of urinary tract infection recurrence comparing D-mannose to placebo was 0.23 (95% confidence interval, 0.14-0.37; heterogeneity=0%; D-mannose n=125, placebo n=123). Pooled relative risk of urinary tract infection recurrence comparing D-mannose to preventative antibiotics was 0.39 (95% confidence interval, 0.12-1.25; heterogeneity=88%; D-mannose n=163, antibiotics n=163). Adverse side effects were reported in 2 studies assessing D-mannose only (1 study (n=10) reported none; the other reported a low incidence (8/103 participants) of diarrhea). Two studies reported compliance, which was high. CONCLUSION: D-mannose appears protective for recurrent urinary tract infection (vs placebo) with possibly similar effectiveness as antibiotics. Overall, D-mannose appears well tolerated with minimal side effects-only a small percentage experiencing diarrhea. Meta-analysis interpretation must consider the small number of studies with varied study design and quality and the overall small sample size.


Assuntos
Antibacterianos/uso terapêutico , Manose/uso terapêutico , Infecções Urinárias/prevenção & controle , Adulto , Quimioprevenção , Diarreia/induzido quimicamente , Feminino , Humanos , Adesão à Medicação/estatística & dados numéricos , Recidiva , Infecções Urinárias/epidemiologia
9.
Am J Obstet Gynecol ; 223(2): 260.e1-260.e9, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32502559

RESUMO

BACKGROUND: Rates of postoperative incomplete bladder emptying vary significantly after pelvic reconstructive surgery. With enhanced recovery protocols the paradigm is shifting towards same-day discharge and the rates of incomplete bladder emptying are expected to increase. The optimal length of time for postoperative catheter drainage has not been clearly established. There are no current studies that assess the optimal timing of a repeat voiding trial in women who have unsuccessful same day voiding trials. OBJECTIVE: This study aimed to compare the outcomes of a second voiding trial performed 2-4 days (earlier group) vs 7 days (later group) postoperatively in women with incomplete bladder emptying after vaginal prolapse surgery. Secondary aims included postoperative urinary tract infection rates, total days with a catheter, and patient-reported catheter bother between groups. STUDY DESIGN: Across 2 sites, women undergoing multicompartment vaginal repair were enrolled. Within 6 hours postoperatively, subjects had an active retrograde voiding trial. Those who passed this voiding trial exited the study; those who had persistent incomplete bladder emptying (postvoid residual >100 mL) had a transurethral indwelling catheter placed and were randomized to return for an earlier (postoperative day 2-4) vs later (postoperative day 7) follow-up office voiding trial. Subjects were followed for 6 weeks after surgery. The primary outcome was the rate of unsuccessful repeat office voiding trial. Secondary outcomes included rates of urinary tract infection, total days with a catheter, and subjective catheter bother. A power calculation based on a projected 31% difference, a power of 0.8, and an alpha of 0.05 revealed that 30 subjects were needed in each group. RESULTS: A total of 102 subjects were enrolled; 38 exited on postoperative day 0, leaving 64 subjects for randomization (4 of whom withdrew after randomization). A comparison of data revealed that randomization was effective, with no differences between the earlier and later groups in terms of demographic data or surgical procedures. Using an intention-to-treat analysis, women in the earlier group were more likely to be unsuccessful in their follow-up office voiding trial (23.3%) than the later group (3.3%), with a risk difference of 20% (95% confidence interval, 3.56-36.44) and a relative risk of 7.00 (95% confidence interval, 0.92-53.47; P=.02). A number-needed-to-treat calculation found that for every 5 patients using a catheter for 7 days postoperatively, 1 case of persistent postoperative incomplete bladder emptying was prevented. Rates of catheter bother did not differ between groups at the time of the follow-up office voiding trial or at 6 weeks (P=.09 and P=.20, respectively). Urinary tract infection rates were higher in the earlier group but did not reach statistical significance (23% vs 7%, P=.07). Regression analysis revealed that subjects who required additional pain medication refills were 9.6 times (95% confidence interval, 1.24-73.77) more likely to have persistent incomplete bladder emptying after the follow-up office voiding trial. CONCLUSION: Women with incomplete bladder emptying after multicompartment prolapse repair had a 7-fold higher risk of an unsuccessful repeat office voiding trial if performed within 4 days of surgery than when performed within 7 days of surgery. In addition, requiring additional prescriptions for analgesia increased the risk of an unsuccessful follow-up office voiding trial.


Assuntos
Procedimentos Cirúrgicos em Ginecologia , Prolapso de Órgão Pélvico/cirurgia , Complicações Pós-Operatórias/fisiopatologia , Procedimentos Cirúrgicos Reconstrutivos , Recuperação de Função Fisiológica , Cateterismo Urinário , Retenção Urinária/fisiopatologia , Vagina/cirurgia , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Slings Suburetrais , Fatores de Tempo , Cateteres Urinários , Retenção Urinária/diagnóstico , Infecções Urinárias/epidemiologia
10.
PLoS One ; 15(6): e0233215, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32520937

RESUMO

OBJECTIVE: To evaluate the efficacy of noble-metal coated catheters in reducing catheter-associated urinary tract infections (CAUTI) in adult patients requiring short term catheterization. METHODS: An electronic literature search of PubMed, BioMed Central, Embase, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials) and Google scholar was carried out from inception to 10th October 2019. Any prospective study or randomized controlled trial (RCT) on adult patients comparing noble-metal coated urinary catheters with any standard catheter and evaluating the incidence of CAUTI or bacteriuria was included. RESULTS: A total of 13 studies were included in the systematic review. 12 were RCTs and one was a prospective cross-over trial. Catheters employed in the study group were grouped into two sub-groups: Silver alloy coated or Noble metal alloy-coated (Gold, Silver, and Palladium) catheters. Bacteriuria was the most commonly studied outcome variable across trials. Meta-analysis indicated that silver alloy-coated catheters (RR 0.63, 95%CI 0.44-0.90, P = 0.01; I2 = 72%) and noble metal alloy catheters (RR 0.58, 95%CI 0.41-0.81, P = 0.001; I2 = 0%) significantly reduce the risk of bacteriuria. Sub-group analysis based on the duration of catheterization demonstrated that silver alloy catheters reduce the risk of bacteriuria with >1week of catheterization (RR 0.46, 95%CI 0.26-0.81, P = 0.007; I2 = 63%). Symptomatic CAUTI was evaluated only in four studies with variable results. The quality of the included studies was not high. CONCLUSIONS: Our review indicates that bacteriuria may be reduced with the use of noble metal-coated catheters during short-term catheterization of adults, however, the quality of evidence is not high. It is not clear if these catheters reduce the risk of symptomatic CAUTI. Further homogenous RCTs are needed to provide clarity.


Assuntos
Metais/uso terapêutico , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/métodos , Bacteriúria/complicações , Bacteriúria/etiologia , Infecções Relacionadas a Cateter/etiologia , Ouro , Humanos , Paládio , Prata , Cateteres Urinários/tendências , Infecções Urinárias/epidemiologia
11.
Am Fam Physician ; 101(12): 721-729, 2020 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-32538597

RESUMO

Despite dramatic reductions in the rates of bacteremia and meningitis since the 1980s, febrile illness in children younger than 36 months continues to be a concern with potentially serious consequences. Factors that suggest serious infection include age younger than one month, poor arousability, petechial rash, delayed capillary refill, increased respiratory effort, and overall physician assessment. Urinary tract infections are the most common serious bacterial infection in children younger than three years, so evaluation for such infections should be performed in those with unexplained fever. Abnormal white blood cell counts have poor sensitivity for invasive bacterial infections; procalcitonin and C-reactive protein levels, when available, are more informative. Chest radiography is rarely recommended for children older than 28 days in the absence of localizing signs. Lumbar puncture is not recommended for children older than three months without localizing signs; it may also be considered for those from one to three months of age with abnormal laboratory test results. Protocols such as Step-by-Step, Laboratory Score, or the Rochester algorithms may be helpful in identifying low-risk patients. Rapid influenza testing and tests for coronavirus disease 2019 (COVID-19) may be of value when those diseases are circulating. When empiric treatment is appropriate, suggested antibiotics include ceftriaxone or cefotaxime for infants one to three months of age and ampicillin with gentamicin or with cefotaxime for neonates. For children three months to three years of age, azithromycin or amoxicillin is recommended if pneumonia is suspected; for urinary infections, suggested antibiotics are cefixime, amoxicillin/clavulanate, or trimethoprim/sulfamethoxazole. Choice of antibiotics should reflect local patterns of microbial resistance.


Assuntos
Tomada de Decisão Clínica , Febre/etiologia , Influenza Humana/diagnóstico , Pneumonia Bacteriana/diagnóstico , Infecções Urinárias/diagnóstico , Algoritmos , Combinação Amoxicilina e Clavulanato de Potássio , Antibacterianos/uso terapêutico , Betacoronavirus , Hemocultura , Proteína C-Reativa/metabolismo , Pré-Escolar , Técnicas de Laboratório Clínico , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Técnicas de Cultura , Humanos , Lactente , Recém-Nascido , Influenza Humana/complicações , Influenza Humana/tratamento farmacológico , Influenza Humana/epidemiologia , Contagem de Leucócitos , Pandemias , Pneumonia Bacteriana/complicações , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Bacteriana/epidemiologia , Pneumonia Viral , Pró-Calcitonina/metabolismo , Radiografia Torácica , Punção Espinal , Combinação Trimetoprima e Sulfametoxazol , Urinálise , Infecções Urinárias/complicações , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/epidemiologia
12.
Med Clin North Am ; 104(4): 663-679, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32505259

RESUMO

Hospital-acquired infections increase cost, morbidity, and mortality for patients across the United States and the world. Principal among these infections are central line-associated bloodstream infection, catheter-associated urinary tract infection, Clostridioides difficile, and methicillin-resistant Staphylococcus aureus colonization and infections. This article provides succinct summaries of the background, epidemiology, diagnosis, and treatment of these conditions. In addition, novel prevention strategies, including those related to recent national interventions, are reviewed.


Assuntos
Bacteriemia/prevenção & controle , Infecções Relacionadas a Cateter/epidemiologia , Infecções por Clostridium/epidemiologia , Infecções Estafilocócicas/epidemiologia , Infecções Urinárias/epidemiologia , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Bacteriemia/terapia , Infecções Relacionadas a Cateter/diagnóstico , Infecções Relacionadas a Cateter/prevenção & controle , Infecções Relacionadas a Cateter/terapia , Cateteres de Demora/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/prevenção & controle , Infecções por Clostridium/terapia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/prevenção & controle , Humanos , Incidência , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/prevenção & controle , Infecções Estafilocócicas/terapia , Estados Unidos/epidemiologia , Infecções Urinárias/diagnóstico , Infecções Urinárias/prevenção & controle , Infecções Urinárias/terapia
13.
PLoS One ; 15(5): e0232903, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32407346

RESUMO

BACKGROUND: Recent UK antibiotic stewardship policies have resulted in significant changes in primary care dispensing, but whether this has impacted antimicrobial resistance is unknown. AIM: To evaluate associations between changes in primary care dispensing and antimicrobial resistance in community-acquired urinary Escherichia coli infections. METHODS: Multilevel logistic regression modelling investigating relationships between primary care practice level antibiotic dispensing for approximately 1.5 million patients in South West England and resistance in 152,704 community-acquired urinary E. coli between 2013 and 2016. Relationships presented for within and subsequent quarter drug-bug pairs, adjusted for patient age, deprivation, and rurality. RESULTS: In line with national trends, overall antibiotic dispensing per 1000 registered patients fell 11%. Amoxicillin fell 14%, cefalexin 20%, ciprofloxacin 24%, co-amoxiclav 49% and trimethoprim 8%. Nitrofurantoin increased 7%. Antibiotic reductions were associated with reduced within quarter same-antibiotic resistance to: amoxicillin, ciprofloxacin and trimethoprim. Subsequent quarter reduced resistance was observed for trimethoprim and amoxicillin. Antibiotic dispensing reductions were associated with increased within and subsequent quarter resistance to cefalexin and co-amoxiclav. Increased nitrofurantoin dispensing was associated with reduced within and subsequent quarter trimethoprim resistance without affecting nitrofurantoin resistance. CONCLUSIONS: This evaluation of a national primary care stewardship policy on antimicrobial resistance in the community suggests both hoped-for benefits and unexpected harms. Some increase in resistance to cefalexin and co-amoxiclav could result from residual confounding. Randomised controlled trials are urgently required to investigate causality.


Assuntos
Antibacterianos/administração & dosagem , Gestão de Antimicrobianos/legislação & jurisprudência , Prescrições de Medicamentos/normas , Farmacorresistência Bacteriana/efeitos dos fármacos , Infecções por Escherichia coli/tratamento farmacológico , Escherichia coli/efeitos dos fármacos , Infecções Urinárias/tratamento farmacológico , Adolescente , Adulto , Criança , Pré-Escolar , Uso de Medicamentos , Inglaterra/epidemiologia , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica/normas , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/normas , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologia , Adulto Jovem
14.
Spine (Phila Pa 1976) ; 45(11): 747-754, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32384411

RESUMO

STUDY DESIGN: Retrospective review. OBJECTIVE: Compare postoperative infection rates and 30-day outcomes in spine surgery patients with and without a preoperative urinary tract infection (UTI). SUMMARY OF BACKGROUND DATA: There is mixed evidence regarding safety and risks when operating on spine patients with a preoperative UTI. METHODS: Using data from the American College of Surgeons National Surgical Quality Improvement Program, we identified all adult patients undergoing spine surgery between 2012 and 2017 with a preoperative UTI. Patients with other preoperative infections were excluded. Our primary outcome was any postoperative infection (pneumonia, sepsis, surgical site infection, and organ space infection). Our secondary outcomes included surgical site infections, non-infectious complications, return to operating room, and 30-day readmission and mortality. We used univariate, then multivariate Poisson regression models adjusted for demographics, comorbidities, laboratory values, and case details to investigate the association between preoperative UTI status and postoperative outcomes. RESULTS: A total of 270,371 patients who underwent spine surgery were analyzed. The most common procedure was laminectomy (41.9%), followed by spinal fusion (31.7%) and laminectomy/fusion (25.6%). Three hundred fourty one patients had a preoperative UTI (0.14%). Patients with a preoperative UTI were more likely to be older, female, inpatients, emergency cases, with a higher American Society of Anesthesiologists score, and a longer operating time (for all, P < 0.001). Patients with a preoperative UTI had higher rates of infectious and non-infectious complications, return to operating room, and unplanned readmissions (for all, P < 0.001). However, there was no significant difference in mortality (0.6% vs. 0.2%, P = 0.108). Even after controlling for demographics, comorbidities, labs, and case details, preoperative UTI status was significantly associated with more postoperative infectious complications (incidence rate ratio [IRR]: 2.88, 95% confidence interval [CI]: 2.25-3.70, P < 0.001). CONCLUSION: Preoperative UTI status is significantly associated with postoperative infections and worse 30-day outcomes. Spine surgeons should consider delaying or cancelling surgery in patients with a UTI until the infection has cleared to reduce adverse outcomes. LEVEL OF EVIDENCE: 3.


Assuntos
Readmissão do Paciente/tendências , Complicações Pós-Operatórias/epidemiologia , Cuidados Pré-Operatórios/tendências , Infecções Urinárias/epidemiologia , Adulto , Idoso , Comorbidade , Estudos Transversais , Feminino , Humanos , Laminectomia/efeitos adversos , Laminectomia/tendências , Masculino , Pessoa de Meia-Idade , Morbidade , Complicações Pós-Operatórias/diagnóstico , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Fusão Vertebral/tendências , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/epidemiologia , Infecções Urinárias/diagnóstico , Adulto Jovem
15.
J Pediatr ; 221: 132-137.e2, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32446472

RESUMO

OBJECTIVE: To assess the prevalence of serious infections and mortality among infants ≤90 days of age presenting to the emergency department with hypothermia. STUDY DESIGN: We performed a cross-sectional cohort study of infants ≤90 days presenting to any of 40 EDs in the Pediatric Health Information Systems between January 1, 2009, and December 31, 2018. Infants with an International Classification of Diseases, ninth or tenth edition, admission/discharge diagnosis code of hypothermia were included. We determined the prevalence of serious bacterial infection (urinary tract infection, bacteremia, and/or bacterial meningitis), pneumonia, herpes simplex virus (HSV) infection, and emergency department/hospital mortality. RESULTS: We included 3565 infants (1633 male [50.9%] and 3225 ≤30 days of age [90.5%]). Most (65.0%) presented in the first week of life. There were 389 infants (10.8%) with a complex chronic condition. The prevalence of serious bacterial infection was 8.0% (n = 284), including 2.4% (n = 87) with urinary tract infection, 5.6% (n = 199) with bacteremia, and 0.3% (n = 11) with bacterial meningitis. There were 7 patients (0.2%) with neonatal HSV and 9 (0.3%) with pneumonia; 0.2% (n = 6) died. The presence of a complex chronic condition was associated with the presence of serious bacterial infection (P < .001) and was present in 3 of 6 patients who died. In a sensitivity analysis including patients with any diagnosis code of hypothermia (n = 8122), 14.9% had serious bacterial infection, 0.6% had HSV, and 3.3% had pneumonia; 2.0% died. CONCLUSIONS: Of infants with hypothermia ≤90 days of age, 8.3% had serious bacterial infections or HSV. Compared with literature from febrile infants, hypothermia is associated with a high mortality rate. Complex chronic conditions were particularly associated with poor outcomes. Additional research is required to risk stratify young infants with hypothermia.


Assuntos
Serviço Hospitalar de Emergência , Hipotermia/epidemiologia , Bacteriemia/epidemiologia , Doença Crônica/epidemiologia , Estudos de Coortes , Estudos Transversais , Feminino , Herpes Simples/epidemiologia , Mortalidade Hospitalar , Humanos , Lactente , Recém-Nascido , Tempo de Internação/estatística & dados numéricos , Masculino , Meningites Bacterianas/epidemiologia , Admissão do Paciente/estatística & dados numéricos , Pneumonia/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Estudos Retrospectivos , Estados Unidos/epidemiologia , Infecções Urinárias/epidemiologia
16.
Crit Care Resusc ; 22(2): 126-132, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32389104

RESUMO

BACKGROUND: To determine the temporal trends of incidence and outcome based on different sources of sepsis using a nationwide administrative database. METHODS: From 2002 to 2012, the entire Taiwan's health insurance claims data of emergency-treated and hospital-treated sepsis were analysed for incidence and mortality trends. The information about patients with sepsis and sources of sepsis was identified using a set of validated International Classification of Diseases, ninth revision, clinical modification (ICD-9-CM) codes. The 30-day all-cause mortality was verified by linked death certificate database. RESULTS: A total of 1 259 578 episodes of sepsis were identified during the 11-year study period. Lower respiratory tract infection is the most common source of sepsis in patients, with the highest mortality rate. The incidence of genitourinary tract infection has the fastest growing rate. The sepsis mortality was declining at different rates for each source of sepsis. Co-infections in patients with sepsis are associated with higher mortality rate. CONCLUSION: The temporal trends of sepsis incidence and mortality varied among different sources of sepsis, with lower respiratory tract being the highest burden among patients with sepsis. Furthermore, sources of sepsis and the presence of co-infection are independent predictors of mortality. Our results support source-specific preventive and treatment strategies for future sepsis management.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Mortalidade Hospitalar/tendências , Sepse/etiologia , Feminino , Doenças Urogenitais Femininas/epidemiologia , Doenças Urogenitais Femininas/etiologia , Humanos , Incidência , Classificação Internacional de Doenças , Masculino , Doenças Urogenitais Masculinas/epidemiologia , Doenças Urogenitais Masculinas/etiologia , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/etiologia , Sepse/epidemiologia , Sepse/mortalidade , Taiwan/epidemiologia , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia
17.
Am J Trop Med Hyg ; 103(1): 472-479, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32342843

RESUMO

There are scarce data describing the etiology and clinical sequelae of sepsis in low- and middle-income countries (LMICs). This study describes the prevalence and etiology of sepsis among critically ill patients at a referral hospital in Malawi. We conducted an observational prospective cohort study of adults admitted to the intensive care unit or high-dependency unit (HDU) from January 29, 2018 to March 15, 2018. We stratified the cohort based on the prevalence of sepsis as defined in the following three ways: quick sequential organ failure assessment (qSOFA) score ≥ 2, clinical suspicion of systemic infection, and qSOFA score ≥ 2 plus suspected systemic infection. We measured clinical characteristics and blood and urine cultures for all patients; antimicrobial sensitivities were assessed for positive cultures. During the study period, 103 patients were admitted and 76 patients were analyzed. The cohort comprised 39% male, and the median age was 30 (interquartile range: 23-40) years. Eighteen (24%), 50 (66%), and 12 patients (16%) had sepsis based on the three definitions, respectively. Four blood cultures (5%) were positive, two from patients with sepsis by all three definitions and two from patients with clinically suspected infection only. All blood bacterial isolates were multidrug resistant. Of five patients with urinary tract infection, three had sepsis secondary to multidrug-resistant bacteria. Hospital mortality for patients with sepsis based on the three definitions ranged from 42% to 75% versus 12% to 26% for non-septic patients. In summary, mortality associated with sepsis at this Malawi hospital is high. Bacteremia was infrequently detected, but isolated pathogens were multidrug resistant.


Assuntos
Bacteriemia/epidemiologia , Farmacorresistência Bacteriana Múltipla , Sepse/epidemiologia , Infecções Urinárias/epidemiologia , Adulto , Antibacterianos/uso terapêutico , Antifúngicos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Infecções por Burkholderia/tratamento farmacológico , Infecções por Burkholderia/epidemiologia , Infecções por Burkholderia/microbiologia , Infecções por Burkholderia/mortalidade , Candida glabrata , Candidíase Invasiva/tratamento farmacológico , Candidíase Invasiva/epidemiologia , Candidíase Invasiva/microbiologia , Candidíase Invasiva/mortalidade , Ceftriaxona/uso terapêutico , Estudos de Coortes , Estado Terminal , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/microbiologia , Infecções por Escherichia coli/mortalidade , Feminino , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/epidemiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Infecções por Bactérias Gram-Positivas/mortalidade , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/epidemiologia , Infecções por Klebsiella/microbiologia , Infecções por Klebsiella/mortalidade , Malaui/epidemiologia , Masculino , Metronidazol/uso terapêutico , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Infecções por Proteus/tratamento farmacológico , Infecções por Proteus/epidemiologia , Infecções por Proteus/microbiologia , Infecções por Proteus/mortalidade , Sepse/tratamento farmacológico , Sepse/microbiologia , Sepse/mortalidade , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/epidemiologia
18.
Ann Biol Clin (Paris) ; 78(2): 139-146, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-32319942

RESUMO

The pre-analytical step of the cytobacteriological examination of urine (CBEU) is one of the most critical in microbiology. The objectives of our study were to determine the rate of urinary contamination and to analyze the factors that would facilitate this in order to propose solutions to this problem. METHOD: This is a 26-month descriptive study including all CBEU requests to our laboratory. Urine was treated in accordance with the recommendations of the medical microbiology recommendations. Urine was considered contaminated in the case of polymorphic culture with at least three different types of germs with a count from 103 CFU/mL. RESULTS: We collected 16,412 CBEU requests. Urine was contaminated in 4,830 cases (29.43%). Of the contaminated urine, 39.23% (n=1,895) was from emergency departments, 79.44% (n=3,837) was collected in the middle of the stream, 69.83% (n=3,373) was from a female patient and 16.34% (n=789) was from children under the age of 5. DISCUSSION AND CONCLUSION: To reduce urine contamination, quality instructions describing sampling procedures should be available and samples in the middle of the stream and through the collection adhesive bags should be replaced by sus-pubic puncture samples in children, whenever the profit/risk ratio of this method is favourable.


Assuntos
Urinálise/normas , Infecções Urinárias/diagnóstico , Coleta de Urina/normas , Urina/microbiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Reações Falso-Positivas , Feminino , Hospitais Universitários , Humanos , Lactente , Recém-Nascido , Masculino , Técnicas Microbiológicas/métodos , Técnicas Microbiológicas/normas , Pessoa de Meia-Idade , Marrocos/epidemiologia , Fase Pré-Analítica/normas , Fase Pré-Analítica/estatística & dados numéricos , Estudos Retrospectivos , Fatores Sexuais , Urinálise/métodos , Urinálise/estatística & dados numéricos , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologia , Coleta de Urina/métodos , Coleta de Urina/estatística & dados numéricos , Adulto Jovem
19.
Rev. méd. panacea ; 9(1): 43-49, ene.-abr. 2020.
Artigo em Espanhol | LILACS, LIPECS | ID: biblio-1121544

RESUMO

Introducción: La infección urinaria en diabéticos constituye uno de los problemas importantes caracterizado por su unidad clínica y pluralidad etiológica. Objetivo: Generar conocimiento sobre las características, epidemiológicas, clínicas y terapéuticas de infección urinaria en diabéticos.. Materiales y métodos: Es un estudio descriptivo de búsqueda bibliografía y se ha realizado en Pubmed, Medline, Scielo, bibliotecas de universidades nacionales e internacionales. Resultados: El 40.74% de casos fueron varones y 59.26% mujeres. Los malos hábitos de higiene, la presencia de cálculos renales, un tiempo de enfermedad mayor de 10 años, vejiga neurogénica, uso de corticoides, infección urinaria previa están asociadas a infección urinaria en la población de diabéticos. Casi el 30% de los pacientes presentaron bacteriuria asintomática. El síntoma más frecuente fue la fiebre. Los síntomas presentes en el 75,7%. La incontinencia de esfuerzo 45.3%, de urgencia 40.6%, síntomas obstructivos 25%, irritativos 10.1%. Predominó Escherichia coli (57.41%), seguido de Enterobacter (8.33%) y Klebsiella pneumoniae (6.48%). La resistencia de E. coli fue elevada contra clindamicina, ácido nalidíxico, ácido pipemídico (100%) y cefuroxima (90.91%), amoxicilina clavulanato (81.25%), ampicilina (78.57%) y cefalotina (72.22%); buena sensibilidad para imipenem (76.92%), cefepime (72.73%), amikacina (72.41%), nitrofurantoína (70.37%), ceftriaxona (63.79%) y ceftazidima (61.11%). Conclusión: Las infecciones urinarias en los pacientes diabéticos son frecuentes y ocasionadas con más frecuencia por E. coli, con patrones de resistencia y sensibilidad que requieren medidas de intervención. La resistencia a los antibióticos se incrementa por el uso indiscriminado en pacientes con inadecuado control de su enfermedad. (AU)


Introduction: Urinary infection in diabetics is one of the important problems characterized by its clinical unit and etiological plurality. Objective: To generate knowledge about the characteristics, epidemiological, clinical and therapeutic of urinary infection in diabetics. Materials and methods: It is a descriptive study of literature search and has been carried out in Pubmed, Medline, Scielo, libraries of national and international universities. Results: 40.74% of cases were male and 59.26% female. Bad hygiene habits, the presence of kidney stones, a disease time of more than 10 years, neurogenic bladder, corticosteroid use, previous urinary infection is associated with urinary infection in the diabetic population. Almost 30% of the patients presented asymptomatic bacteriuria. The most frequent symptom was fever. The symptoms present in 75.7%. Stress incontinence 45.3%, emergency 40.6%, obstructive symptoms 25%, irritative 10.1%. Escherichia coli (57.41%) predominated, followed by Enterobacter (8.33%) and Klebsiella pneumoniae (6.48%). The resistance of E. coli was high against clindamycin, nalidixic acid, pipemidic acid (100%) and cefuroxime (90.91%), amoxicillin clavulanate (81.25%), ampicillin (78.57%) and cephalothin (72.22%); Good sensitivity for imipenem (76.92%), cefepime (72.73%), amikacin (72.41%), nitrofurantoin (70.37%), ceftriaxone (63.79%) and ceftazidime (61.11%). Conclusions: Urinary infections in diabetic patients are frequent and more frequently caused by E. coli, with resistance and sensitivity patterns that require intervention measures. Antibiotic resistance is increased by indiscriminate use in patients with inadequate control of their disease. (AU)


Assuntos
Humanos , Masculino , Feminino , Infecções Urinárias , Infecções Urinárias/terapia , Infecções Urinárias/epidemiologia , Diabetes Mellitus , Epidemiologia Descritiva
20.
N Z Med J ; 133(1512): 15-21, 2020 04 03.
Artigo em Inglês | MEDLINE | ID: mdl-32242174

RESUMO

BACKGROUND: This is a baseline clinical audit looking at indwelling urinary catheter (IDC) use and trial removal of catheter (TROC) in stroke patients. We collected data on stroke patients admitted to North Shore Hospital between 26 November 2018-24 May 2019, who underwent insertion of an IDC as an inpatient. A minority of patients had TROC within the recommended guideline period. A high incidence of urinary tract infection (UTI) was found in this patient population. Insufficient documentation and inappropriate indications for IDC insertion were features noted during this audit. Daily electronic reminders and prompting by all members of the rehabilitation team concerning TROC are important to reduce catheter days and reduce UTI rates. AIMS: To identify if the trial removal of indwelling urinary catheters (TROC) in stroke patients complies with the 2016 American Heart Association/American Stroke Association (AHA/ASA) AHSA guidelines, and to identify any precipitating factors that prevent compliance with the guidelines. METHODS: We performed a clinical baseline audit that identified patients who were admitted to the acute stroke ward at North Shore Hospital with a diagnosis of stroke from 26 November 2018-24 May 2019 and had an indwelling urinary catheter (IDC) inserted during their admission. The audit consisted of both retrospective and prospective components. Data was collected on patient demographics, the documented indication for IDC insertion, total number of catheter days, the incidence of UTIs and the outcomes after catheter removal. RESULTS: A total of 49 patients were included. 4.1% of patients had catheters removed within 24 hours (95% confidence interval: 0.011-0.137). The average number of catheter days before removal of IDC was approximately five days. 24.5% of our patient sample went on to develop a urinary tract infection. CONCLUSIONS: Insufficient documentation and inappropriate indications for IDC insertion were features noted during this audit. Daily electronic reminders and prompting concerning TROC are important to reduce catheter days and reduce infection rates. Indwelling catheters and associated infections impact the length of hospitalisation, mortality and morbidity of stroke patients.


Assuntos
Cateteres de Demora , Remoção de Dispositivo , Acidente Vascular Cerebral , Cateterismo Urinário , Auditoria Clínica , Feminino , Fidelidade a Diretrizes , Hospitais , Humanos , Masculino , Nova Zelândia/epidemiologia , Estudos Prospectivos , Estudos Retrospectivos , Infecções Urinárias/epidemiologia
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