Extended-Spectrum Beta-Lactamase-Producing Bacteria in a Urology Ward: Epidemiology, Risk Factors and Antimicrobial Susceptibility Patterns.

INTRODUCTION: Our aim was to describe the incidence and risk factors associated with extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae and their resistance rate in a urological ward. MATERIAL AND METHODS: We carried out a prospective observational study from November 2011 to December 2014, reviewing healthcare-associated infections (HAIs) in our department. We evaluated the infections caused by ESBL-producing Enterobacteriaceae. RESULTS: The incidence of HAIs in our urology ward was 6.8%. Enterobacteriaceae including Escherichia coli (24.9%), Klebsiella spp. (12.1%), Enterobacter spp. (5.9%), Morganella spp. (1.5%), Proteus spp. (1.5%), and Citrobacter spp. (1.5%) represented 47.4% of the isolated pathogens. The percentage of ESBL-producing Enterobacteriaceae was 26.4. Risk factors associated with a higher incidence of ESBL-producing bacteria were prior urinary tract infection (UTI; p < 0.001), hypertension (p = 0.042), immunosuppression (p = 0.004), and urinary stone (p = 0.027). The multivariable analysis confirmed prior UTI, immunosuppression and urinary stone as risk factors. ESBL-producing strains showed resistance rates of 85.3% for fluoroquinolones and 11.8% for carbapenems. Moreover, 16.7% of ESBL-Klebsiella were resistant to carbapenems. CONCLUSIONS: ESBL-producing enterobacteria are associated with higher cross resistance to antibiotics such as quinolones. Higher resistance rates are reported in ESBL-producing Klebsiella. Among patients admitted in a urology ward, risk factors for ESBL-producing strains were previous UTI, immunosuppression, and urinary stone.

[Urinary stone imaging tests.] / Diagnóstico por imagen de la litiasis urinaria.

Imaging in urolithiasis has a wide group of techniques, with different characteristics, limitations, and indications, which together allow the management of this prevalent pathology. Plain abdominal radiography and ultrasound are very accessible and in expensive techniques that combined present an acceptable sensitivity and specificity. They are widely used for monitoring the evolution of stone disease and for evaluation after treatments (surgery or SWL). Ultrasound is the primary radiological diagnostic tool in the pediatric population and in pregnant women. CT has prevailed over IVP in the anatomical assessment of the urinary tract and the description of the characteristics of the lithiasis, although it shows a greater exposure to ionizing radiation, so the use of low and ultra-low dose CT is spreading. In this article we also discuss other imaging techniques suchas Digital to mosynthesis, Fluoroscopy and DMSA Scintigraphy.

El diagnóstico por imagen de la urolitiasis comprende un amplio grupo de técnicas, con diferentes características, limitaciones e indicaciones, que en su conjunto permiten el manejo de esta patología tan prevalente. La radiografía simple de abdomen y la ecografía son técnicas muy accesibles y económicasque combinadas presentan una aceptable sensibilidad y especificidad. Siendo ampliamente utilizadas para el seguimiento de la evolución de la enfermedad litiásica y para la valoración tras tratamientos (cirugía o LEOC). La ecografía es la técnica de elección en la población pediátrica y en gestantes. El TC se ha impuesto sobre la UIV en la valoración anatómica de la vía urinaria y la descripción de las características de la litiasis,  aunque presenta una mayor exposición a radiaciones ionizantes, por lo que se está extendiendo el uso del TC de baja y ultrabaja dosis. Tratamos también en este artículo otras técnicas como la Tomosíntesis digital, la Fluoroscopiay la Gammagrafía DMSA.

Diagnóstico por imagen de la litiasis urinaria / Urinary stone imaging tests

El diagnóstico por imagen de la urolitiasis comprende un amplio grupo de técnicas, con diferentes características, limitaciones e indicaciones, que en su conjunto permiten el manejo de esta patología tan prevalente. La radiografía simple de abdomen y la ecografía son técnicas muy accesibles y económicas que combinadas presentan una aceptable sensibilidad y especificidad. Siendo ampliamente utilizadas para el seguimiento de la evolución de la enfermedad litiásica y para la valoración tras tratamientos (cirugía o LEOC). La ecografía es la técnica de elección en la población pediátrica y en gestantes. El TC se ha impuesto sobre la UIV en la valoración anatómica de la vía urinaria y la descripción de las características de la litiasis, aunque presenta una mayor exposición a radiaciones ionizantes, por lo que se está extendiendo el uso del TC de baja y ultrabaja dosis. Tratamos también en este artículo otras técnicas como la Tomosíntesis digital, la Fluoroscopia y la Gammagrafía DMSA

Imaging in urolithiasis has a wide group of techniques, with different characteristics, limitations, and indications, which together allow the management of this prevalent pathology. Plain abdominal radiography and ultrasound are very accessible and inexpensive techniques that combined present an acceptable sensitivity and specificity. They are widely used for monitoring the evolution of stone disease and for evaluation after treatments (surgery or SWL). Ultrasound is the primary radiological diagnostic tool in the pediatric population and in pregnant women. CT has prevailed over IVP in the anatomical assessment of the urinary tract and the description of the characteristics of the lithiasis, although it shows a greater exposure to ionizing radiation, so the use of low and ultra-low dose CT is spreading. In this article we also discuss other imaging techniques such as Digital tomosynthesis, Fluoroscopy and DMSA Scintigraphy