Treatment of urinary tract infections in the old and fragile

Incontinence Is an Independent Risk Factor for Total Hip and Knee Arthroplasty

Background

Urinary incontinence has been linked to worse postoperative pain, decreased physical function, and reduced quality of life in patients following total joint arthroplasty. The purpose of this study was to analyze whether incontinence is associated with increased postoperative medical and joint complications following primary total hip arthroplasty (THA) and total knee arthroplasty (TKA).

Methods

A retrospective cohort study was conducted using a national insurance database. Thirty-two thousand eight hundred eleven patients with incontinence who underwent primary THA were identified and matched 1:4 with 129,073 patients without incontinence. Ninety-one thousand nine hundred thirty-five patients with incontinence who underwent primary TKA were matched 1:4 with 367,285 patients without incontinence. Medical and joint complication rates at 90 days and 2 years, respectively, were then compared for patient cohorts using multivariable logistic regressions.

Results

Patients who underwent primary THA with incontinence had statistically higher rates of dislocation, periprosthetic fracture, aseptic revisions, and overall joint complications compared to controls. Patients who underwent primary TKA with incontinence had higher rates of mechanical failure, aseptic revision, and all-cause revision compared to controls.

Conclusions

This study demonstrated an association between patients with incontinence and higher rates of dislocation, periprosthetic fractures, aseptic revisions, and overall joint complications following primary THA compared to controls. Patients with incontinence experience higher rates of mechanical failure, aseptic revision, and all-cause revision following TKA compared to controls. As such, perioperative management of urinary incontinence may help mitigate the risk of postoperative complications.

Clinical implementation of partial oral treatment in infective endocarditis: the Danish POETry study

BACKGROUND AND AIMS

In the Partial Oral Treatment of Endocarditis (POET) trial, stabilized patients with left-sided infective endocarditis (IE) were randomized to oral step-down antibiotic therapy (PO) or conventional continued intravenous antibiotic treatment (IV), showing non-inferiority after 6 months. In this study, the first guideline-driven clinical implementation of the oral step-down POET regimen was examined.

METHODS

Patients with IE, caused by Staphylococcus aureus, Enterococcus faecalis, Streptococcus spp. or coagulase-negative staphylococci diagnosed between May 2019 and December 2020 were possible candidates for initiation of oral step-down antibiotic therapy, at the discretion of the treating physician. The composite primary outcome in patients finalizing antibiotic treatment consisted of embolic events, unplanned cardiac surgery, relapse of bacteraemia and all-cause mortality within 6 months.

RESULTS

A total of 562 patients [median age 74 years (IQR, interquartile range, 65-80), 70% males] with IE were possible candidates; PO was given to 240 (43%) patients and IV to 322 (57%) patients. More patients in the IV group had IE caused by S. aureus, or had an intra-cardiac abscess, or a pacemaker and more were surgically treated. The primary outcome occurred in 30 (13%) patients in the PO group and in 59 (18%) patients in the IV group (P = .051); in the PO group, 20 (8%) patients died vs. 46 (14%) patients in the IV group (P = .024). PO-treated patients had a shorter median length of stay [PO 24 days (IQR 17-36) vs. IV 43 days (IQR 32-51), P < .001].

CONCLUSIONS

After clinical implementation of the POET regimen almost half of the possible candidates with IE received oral step-down antibiotic therapy. Patients in the IV group had more serious risk factors for negative outcomes. At 6-month follow-up, there was a numerically but not statistically significant difference towards a lower incidence of the primary outcome, a lower incidence of all-cause mortality and a reduced length of stay in the PO group. Due to the observational design of the study, the lower mortality may to some extent reflect selection bias and unmeasured confounding. Clinical implementation of PO regimens seemed feasible and safe.

The relationship between admission hyperglycaemia and urinary tract infections in geriatric patients with hip fractures

PURPOSE

This study investigated the association of admission hyperglycaemia with catheter-associated urinary tract infections (CAUTIs) and catheter-unassociated urinary tract infections (CUUTIs) in elderly patients with hip fractures.

METHODS

In an observational cohort study of elderly patients with hip fractures, glucose values were collected within 24 h of admission. Urinary tract infections were classified as CAUTIs and CUUTIs. Multivariate logistic regression analysis and propensity score matching obtained adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for urinary tract infections. Subgroup analyses were further explored to investigate the relationship between admission hyperglycemia and urinary tract infections.

RESULTS

The study included 1279 elderly patients with hip fractures, 298 (23.3%) of whom had urinary tract infections upon hospitalization (including 182 CAUTIs and 116 CUUTIs). Propensity score matching indicated that patients with glucose levels exceeding 10.00 mmol/L had significantly higher odds of developing CAUTIs (OR 3.10, 95% CI 1.65-5.82) than those with glucose levels between 4.00-6.09 mmol/L. It is worth noting that patients with blood glucose levels greater than 10.00 mmol/L have a higher susceptibility for CUUTIs (OR 4.42, 95% CI 2.09-9.33) than CAUTIs. The subgroup analyses observed significant interactions between diabetes and CAUTIs (p for interaction = 0.01) and between bedridden time and CUUTIs (p for interaction = 0.04).

CONCLUSIONS

Elderly hip fracture patients with admission hyperglycaemia have an independent association with CAUTIs and CUUTIs. The association is stronger with CUUTIs and necessitates clinician intervention if blood glucose levels at admission exceed 10 mmol/L.

Characteristics of Nationwide Urinary Tract Infection (UTI) Visits by Age and Type II Diabetes Status in Women

Background Through a national database search of office visits, we studied the contribution of two known risk factors for urinary tract infections (UTIs) in women: age and type 2 diabetes mellitus (T2DM). Methodology The National Ambulatory Medical Care Survey (NAMCS) database was queried for visits including a UTI diagnosis and a urine culture order. Data were included for all visits involving adult women for available years, 2014-2016 and 2018. Data on demographics, reason for visit, T2DM status, UTI workup, and UTI treatment were collected. Patients with Alzheimer's disease or chronic kidney disease were excluded. Descriptive statistics were displayed as weighted means with standard errors for continuous variables. The effect of age was compared based on a 65-year-old cutoff. Results One hundred sixty-seven surveyed visits were analyzed for the years 2014-2016 and 2018, representing an estimated 7.4 million visits nationwide. Women ≥65 years were more likely to be white, non-Hispanic/non-Latino, from the Midwest or West, from metropolitan areas, and on Medicare/Medicaid than their younger counterparts. T2DM and urinalysis rates did not significantly vary between the two age groups (7.7% vs. 14.6%, P = 0.3; 78% vs. 76%, P = 0.9, respectively). For urinalysis rates between patients with and without T2DM, there was no significant difference in the <65-year-old group (80% vs. 78%, P = 0.9) or the ≥65-year-old group (93% vs. 73%, P = 0.12). Antibiotic prescription rates were also similar for T2DM and non-T2DM patients (67% vs. 75%, P = 0.7). Conclusions Through a national database analysis, we reported the demographic and visit differences aged <65 years and ≥65 years who sought care for UTIs in the United States over a four-year period. T2DM rates and urinalysis did not vary between age groups, and urinalysis rates and antibiotic prescription rates did not vary between T2DM and non-T2DM groups in an age-dependent matter. More research is needed to understand the demographic makeup and risk factors of UTI patients across the nation.

The effect of urinary tract infection on overall mortality in elderly male patients

INTRODUCTION

Urinary tract infections are the most common bacterial infections in the older population.

Management of urinary tract infections in the era of antimicrobial resistance

Urinary tract infections (UTIs) are among the most common infections globally, imposing a substantial personal and economic burden on individuals and health resources. Despite international health concerns and sustained public awareness campaigns about the emergence of resistant microorganisms through the inappropriate therapeutic use of antimicrobial agents, the problem of antimicrobial resistance (AMR) is worsening, and AMR in UTIs represents a critical global healthcare issue. This narrative review summarizes evidence-based scientific material, recommendations from the current medical literature, and the latest clinical guidelines on antibiotic and antibiotic-sparing strategies for managing urological infections, including practical approaches to improve the management of patients with acute and recurrent UTIs (rUTIs) in routine clinical practice. Novel emerging therapies and prophylaxis options are described as potential alternatives to overcome the abuse and overuse of antibiotics and the practical application of the guideline recommendations and issues relating to best practice in managing UTIs.

Effect of Urogenital Infection Educational Program on Women Knowledge and Practices

Background:

Urogenital infection is generally regarded as a silent epidemic. It is one of the major public health problems among women that causes a considerable proportion of gynecological morbidity and maternal mortality in developing countries.

Aim:

The aim of this study is to evaluate the effect of an educational program on women’s knowledge and practices about urogenital infection.

Methods:

A quasi-experimental research design was utilized in this study and was implemented at El Hadaka Maternity and Children’s Hospital (MCH) in Fayoum, Egypt. A purposive sample consisting of 50 women with ages ranging from 30 to 45 years old was considered for this study.

Two tools were used to conduct this study: a structured interview questionnaire consisting of the respondents’ demographic characteristics, knowledge, and practices regarding urogenital infection and a scale that aimed to assess their lifestyle.

Results:

The results revealed that 96% of the women have unsatisfactory knowledge about urogenital infection during the pre-intervention stage, 94% of them have satisfactory knowledge post-intervention, and 90% of them have satisfactory knowledge at follow-up, with a highly statistically significant difference at p-value < 0.01. The results also showed that 82% of the respondents have unsatisfactory practices at pre-intervention, 96% have satisfactory practices at post-intervention, and 98% of them have satisfactory practices at follow-up, with a highly statistically significant difference at p-value < 0.01.

Conclusion:

There was a significant improvement in women's knowledge and practices related to urogenital infection post-intervention and at follow-up with a p-value < 0.01. Likewise, a high positive correlation between total lifestyle, level of knowledge, and practices was noted during the pretest with a p-value < 0.01.

There is a need to provide different educational programs regarding knowledge and self-care practices for women with urogenital infection in different women's care settings.

Effect of Urogenital Infection Educational Program on Women Knowledge and Practices

Background:

Urogenital infection is generally regarded as a silent epidemic. It is one of the major public health problems among women that causes a considerable proportion of gynecological morbidity and maternal mortality in developing countries.

Aim:

The aim of this study is to evaluate the effect of an educational program on women’s knowledge and practices about urogenital infection.

Methods:

A quasi-experimental research design was utilized in this study and was implemented at El Hadaka Maternity and Children’s Hospital (MCH) in Fayoum, Egypt. A purposive sample consisting of 50 women with ages ranging from 30 to 45 years old was considered for this study.

Two tools were used to conduct this study: a structured interview questionnaire consisting of the respondents’ demographic characteristics, knowledge, and practices regarding urogenital infection and a scale that aimed to assess their lifestyle.

Results:

The results revealed that 96% of the women have unsatisfactory knowledge about urogenital infection during the pre-intervention stage, 94% of them have satisfactory knowledge post-intervention, and 90% of them have satisfactory knowledge at follow-up, with a highly statistically significant difference at p-value < 0.01. The results also showed that 82% of the respondents have unsatisfactory practices at pre-intervention, 96% have satisfactory practices at post-intervention, and 98% of them have satisfactory practices at follow-up, with a highly statistically significant difference at p-value < 0.01.

Conclusion:

There was a significant improvement in women's knowledge and practices related to urogenital infection post-intervention and at follow-up with a p-value < 0.01. Likewise, a high positive correlation between total lifestyle, level of knowledge, and practices was noted during the pretest with a p-value < 0.01.

There is a need to provide different educational programs regarding knowledge and self-care practices for women with urogenital infection in different women's care settings.

Urinary Tract Infections in Elderly Patients: A 10-Year Study on Their Epidemiology and Antibiotic Resistance Based on the WHO Access, Watch, Reserve (AWaRe) Classification

The ageing of the population—especially in developed countries—has brought on many societal challenges and has significantly contributed to the burden on healthcare infrastructures worldwide. Elderly persons (aged ≥ 65 years) are at higher risk for developing UTIs, due to a range of intrinsic and extrinsic risk factors, and they often delay seeking treatment. A retrospective observational study was performed regarding the epidemiology and resistance of UTIs in elderly patients. Identification of the isolates was carried out using VITEK 2 ID/AST and MALDI-TOF mass spectrometry. Antibiotic resistance in these isolates was assessed based on EUCAST guidelines, and were grouped into the WHO AWaRe (Access, Watch, Reserve) classification of antimicrobials. During the 10-year study period, n = 4214 (421.4 ± 118.7/year) and n = 4952 (495.2 ± 274.6) laboratory-confirmed UTIs were recorded in inpatients and outpatients, respectively. The causative agents showed differentiation among outpatients and inpatients: Escherichia coli (48.14% vs. 25.65%; p = 0.001), Enterococcus spp. (20.15% vs. 21.52%; p > 0.05), Klebsiella spp. (16.28% vs. 16.26%; p > 0.05), Pseudomonas spp. (4.40%vs. 13.36%; p = 0.001); Proteus-Providencia-Morganella group (4.56% vs. 10.96%; p = 0.001); Candida spp. (0.53% vs. 5.98%; p = 0.001); Citrobacter-Enterobacter-Serratia group (1.90% vs. 2.71%; p < 0.05). Significantly higher resistance rates were observed in inpatient isolates for many Access and Watch antibiotics compared to isolates of outpatient origin; in addition, resistance rates were higher in these uropathogens compared to the previously recorded rates in the region. More care should be taken for the diagnosis and treatment of UTIs affecting elderly patients, as they represent a particularly vulnerable patient population.