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Simon J, Kleinclauss F, Chabannes É, Bouiller K, Frontczak A. Urinary tract infection after flexible ureterorenoscopy for urolithiasis in patients with positive treated preoperative urinalysis. Urolithiasis 2024; 52:45. [PMID: 38466446 DOI: 10.1007/s00240-024-01546-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/10/2024] [Indexed: 03/13/2024]
Abstract
Prevalence of kidney stones is increasing worldwide, flexible ureterorenoscopy (f-URS) is the most common surgical treatment. Postoperative urinary tract infection (PUTI) is the primary complication. Some risk factors are classically associated with PUTI, especially preoperative positive urinalysis (POPU). We aimed to identify risk factors for PUTI after f-URS for urolithiasis in patients with treated POPU, and to identify the different pre and postoperative pathogens. Retrospective, single-center study of all f-URS for urolithiasis between January 2004 and December 2020. Procedures with treated POPU were categorized as PUTI or no PUTI (NPUTI). We examined demographics, preoperative, perioperative and postoperative characteristics in each group. Among 1934 procedures analyzed, 401 (20.7%) had POPU; these were categorized into NPUTI (n = 352, 87.8%) and PUTI (n = 49, 12.2%). By univariate analysis, only preoperative stenting duration (76.3 in NPUTI group vs 107.7 days in PUTI group, p = 0.001) was significantly associated with a higher risk of PUTI in univariate analysis. Germ distribution was similar in both groups. We compared pre- and postoperative microbiological data for interventions with PUTI, and found that only 8.7% of pathogens were identical between pre and postoperative urinalysis. Our study shows that the rate of PUTI is higher for patients with a POPU and that preoperative stent duration is the sole risk factor in patients with POPU. The low concordance rate (8.7%) between POPU and post-operative pathogens highlights the need for further research on obtaining sterile preoperative urinalysis, or performing intraoperative culture (urines, stent or stone), to treat PUTI early with an adapted antibiotic therapy.
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Affiliation(s)
- Jeanne Simon
- Department of Urology, Andrology and Renal Transplantation, University Hospital of Besançon, 25000, Besançon, France
- University of Franche-Comté, 25000, Besançon, France
| | - François Kleinclauss
- Department of Urology, Andrology and Renal Transplantation, University Hospital of Besançon, 25000, Besançon, France
- University of Franche-Comté, 25000, Besançon, France
- Nanomedicine Lab, Imagery and Therapeutics, EA 4662, Besançon, France
| | - Éric Chabannes
- Department of Urology, Andrology and Renal Transplantation, University Hospital of Besançon, 25000, Besançon, France
| | - Kevin Bouiller
- Department of Infectious Disease, University Hospital of Besançon, 25000, Besançon, France
- UMR-CNRS 6249 Chrono-Environnement, Université Bourgogne Franche-Comté, 25000, Besançon, France
| | - Alexandre Frontczak
- Department of Urology, Andrology and Renal Transplantation, University Hospital of Besançon, 25000, Besançon, France.
- University of Franche-Comté, 25000, Besançon, France.
- Nanomedicine Lab, Imagery and Therapeutics, EA 4662, Besançon, France.
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Within State Variability of Antimicrobial Susceptibility: Missouri as an Archetype to Assess Guidelines for Antimicrobial Prophylaxis for Transurethral Procedures. Urology 2023:S0090-4295(23)00187-5. [PMID: 36858319 DOI: 10.1016/j.urology.2023.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/17/2023] [Accepted: 02/12/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVE To evaluate variability among hospitals in susceptibility of common uropathogens to antimicrobial agents frequently used in transurethral procedures in order to examine whether state-based guidelines might be more appropriate than national prophylactic guidelines. METHODS Hospital-level antibiograms were requested from all hospitals throughout the state of Missouri. We studied Escherichia coli, Klebsiella, and Proteus sensitivities to evaluate common guideline recommended antimicrobials including trimethoprim sulfamethoxazole (TMP-SMX), 3rd generation cephalosporins, cefazolin, penicillin combinations, gentamicin and fluoroquinolones. We evaluated variability and association between hospital characteristics and antimicrobial sensitivities. RESULTS Data was requested from 81 hospitals across the state and 38 provided the requested data (47% response rate). Susceptibility was highest for 3rd generation cephalosporins for E coli (mean of 94%), Proteus (96%), and Klebsiella (96%). Gentamicin also had high susceptibility for the bacteria studied; 94% for E coli and 96% for Klebsiella. Current first line recommended agents showed more modest coverage for E coli (cefazolin 84%, TMP-SMX 78%), Proteus (cefazolin 82%, TMP-SMX 71%), and Klebsiella (cefazolin 90%, TMP-SMX 89%). CONCLUSION Post transurethral procedure infections are common. Rates can be limited with appropriate prophylaxis. Deciding on empirical coverage must take into account local resistance patterns. There is substantial variability among and within states in antimicrobial susceptibility for common uropathogens. When selecting antimicrobial prophylaxis, urologists should consider local- rather than state- or nation-level antibiograms, given the considerable variability. Future studies should consider the merits of very-broad spectrum prophylaxis and the potential role of molecular urinary pathogen (and pathogen-resistance) testing when selecting an optimal regimen.
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Chen T, Zhang Y, Dou Q, Zheng X, Wang F, Zou J, Jia R. Machine learning-assisted preoperative diagnosis of infection stones in urolithiasis patients. J Endourol 2022; 36:1091-1098. [PMID: 35369740 DOI: 10.1089/end.2021.0783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tingting Chen
- China Pharmaceutical University, 56651, School of Basic medical and Clinical pharmacy, Nanjing, Jiangsu, China
| | | | | | | | | | - Jianjun Zou
- Nanjing First Hospital, 385685, Clinical pharmarcy department, Nanjing, Nangjing, China, 210029
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Rosen GH, Kanake S, Golzy M, Malm-Buatsi E, Murray KS. Antimicrobial Selection for Transurethral Procedures Across the United States: A State-by-State Antibiogram Evaluation. Urology 2021; 159:107-113. [PMID: 34718003 DOI: 10.1016/j.urology.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/08/2021] [Accepted: 10/11/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate optimal regimens for perioperative antimicrobial prophylaxis in transurethral procedures by examining antimicrobial susceptibility patterns in the United States. MATERIALS AND METHODS Through several methods, we attempted to attain an antibiogram for each state. We focused on microbes known to cause infections after transurethral surgeries and antibiotics referred to in current or prior recommendations and compared susceptibility rates across states using Kruskal Walis tests and the Dwass, Steel, Critchlow-Fligner tests. We also examined susceptibility to (non-ceftazidime) third generation cephalosporins. RESULTS Data is included from 40 states. For each microbe studied, there was significant variability in sensitivity to antibiotics studied. Current first line recommendations for antimicrobial prophylaxis include first generation cephalosporins with 82%, 80%, and 87% mean coverage for E coli, Proteus, and Klebsiella respectively and trimethoprim-sulfamethoxazole with 74%, 80%, and 93% coverage, respectively. Susceptibility to aminoglycosides is 91%, 92%, and 96%, respectively and to third generation cephalosporin, it is 92%, 99%, and 94%. CONCLUSION Current first line recommended antimicrobials for prophylaxis in transurethral procedures provide overall poor predicted coverage based on our database of antibiograms. Alternatives exist that have higher predicted susceptibility, though clinical significance of this and risk of resultant antimicrobial resistance is unknown. Urologists should consider local patterns when selecting antimicrobial prophylaxis for their patients.
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Affiliation(s)
- Geoffrey H Rosen
- Department of Surgery, Division of Urology, University of Missouri, Columbia, MO
| | - Shubham Kanake
- School of Medicine, University of Missouri, Columbia, MO
| | - Mojgan Golzy
- Department of Family and Community Medicine, University of Missouri, Columbia, MO
| | | | - Katie S Murray
- Department of Surgery, Division of Urology, University of Missouri, Columbia, MO.
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Salari B, Khalid M, Ivan S, Ekwenna O, Petros F, Saltzman B, Sindhwani P. Urine versus stent cultures and clinical UTIs. Int Urol Nephrol 2021; 53:2237-2242. [PMID: 34327608 DOI: 10.1007/s11255-021-02964-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/23/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Current American Urological Association guidelines recommend pre-operative antimicrobial therapy based on prior urine cultures (UC); however, the role of stent culture (SC) in urologic practice is unclear. We examined whether UC and SC differed at the time of stent removal, as well as the association, microbiology, and timing of subsequent UTIs as related to SC. METHODS This was a retrospective review of 159 patients with ureteral stents for indications of urolithiasis, benign stricture, malignant obstruction, and kidney transplant. UC and SC were analyzed at the time of stent removal. Patients were followed for 12 months after stent removal for development, concordance, and timing of clinical UTIs. RESULTS In 159 patients, 15% had positive UC and 45% had positive SC. Of patients who had positive SC, 66% had negative UC. All patients with positive UC had identical micro-organisms on SC; however, 33% of these had SC with additional micro-organisms. Relative to those with both negative UC and SC, patients with negative UC and positive SC had a 5.7 odds, and those with both positive UC and SC had a 13.6 odds of developing a clinical UTI within 12 months. Concordance of SC and future UTI was highest in those with post-operative sepsis, and those with Candida species on SC. CONCLUSIONS SC was a unique risk factor for development of UTI within 12 months of stent removal. Clinicians should consider SC results when empirically treating those with post-operative sepsis or those with UTI after Candida on SC.
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Affiliation(s)
- Bijan Salari
- Department of Urology, University of Toledo College of Medicine, 3000 Arlington Ave., Toledo, OH, 43614, USA.
| | - Muhamad Khalid
- Department of Urology, University of Toledo College of Medicine, 3000 Arlington Ave., Toledo, OH, 43614, USA
| | - Samuel Ivan
- Department of Urology, University of Toledo College of Medicine, 3000 Arlington Ave., Toledo, OH, 43614, USA
| | - Obinna Ekwenna
- Department of Urology, University of Toledo College of Medicine, 3000 Arlington Ave., Toledo, OH, 43614, USA
| | - Firas Petros
- Department of Urology, University of Toledo College of Medicine, 3000 Arlington Ave., Toledo, OH, 43614, USA
| | - Barbara Saltzman
- University of Toledo School of Population Health, 2801 W. Bancroft St., Toledo, OH, 43606, USA
| | - Puneet Sindhwani
- Department of Urology, University of Toledo College of Medicine, 3000 Arlington Ave., Toledo, OH, 43614, USA
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Vallée M, Bey E, Bouiller K, le Goux C, Pimpie R, Tourret-Arnaud J, Lina G, Figueiredo S, Chauvin A, Gavazzi G, Malavaud S, Sotto A, Bruyère F. Epidemiology and risk factors for ureteral stent-associated urinary tract infections in non-transplanted renal patients: a systematic review of the literature. World J Urol 2021; 39:3845-3860. [PMID: 33991215 DOI: 10.1007/s00345-021-03693-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 04/03/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Pathophysiology and risk factors for Ureteral Stent-Associated Urinary Tract Infection (USAUTI) have been poorly investigated. This situation results in highly diverse practices regarding USAUTI prevention, diagnosis and treatment. The aim of the present study was to describe the epidemiology and risk factors for USAUTI in non-transplanted patients. METHODS We conducted a systematic literature review based on a comprehensive PubMed® bibliographic strategy, between October 1998 and March 2020. The methodological quality of the studies included was analyzed according to dedicated grids. The main endpoints were the correlation between different potential risk factors and infection ureteral stent-associated urinary tract infection or colonization rate. Conclusions and their level of evidence were reported on the basis of a critical analysis of the best available scientific evidence. This work has been submitted to a national review, which enabled the potentially divergent opinions of experts to be collected, thereby ensuring adequate quality of data. RESULTS AND CONCLUSION Twenty-six studies out of the 505 articles identified, were included in the final analysis. Staphylococcus spp, E. coli, Klebsiella spp, Pseudomona aeruginosa, Enterococcus spp. and Candida spp. were the microorganisms most often responsible for asymptomatic bacteriuria (ABU) or USAUTI. Longer indwelling time, diabetes mellitus, female gender, chronic renal failure, diabetic nephropathy and cancer were identified as risk factors for ABU and ureteral stent colonization. No specific risk factor for UTI was identified in the literature studied. A causal relationship between ureteral stent colonization and USAUTI or urosepsis remains to be demonstrated.
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Affiliation(s)
- Maxime Vallée
- CHU La Milétrie, Service d'Urologie et de Transplantations rénales, CHU de Poitiers, 2 Rue de la Milétrie, 86021, Poitiers, France. .,Université de Poitiers INSERM U1070, "Pharmacologie Des Anti-Infectieux", UFR Médecine-Pharmacie, Pôle Biologie Sante, 1 rue Georges Bonnet, Bâtiment B36 TSA 51106, 86073, Poitiers Cedex 9, France.
| | - Elsa Bey
- Urology and Andrology Department, University Hospital of Nimes, Place du Professeur Debré, 30029, Nîmes Cedex, France
| | - Kevin Bouiller
- Service de Maladies Infectieuses, Centre Hospitalo-Universitaire de Besançon, Besançon, France
| | | | - Romain Pimpie
- Direction Générale-Hygiène Hospitalière, Hôpital Privé Dijon Bourgogne Ramsay Santé, 22 avenue Françoise Giroud, 21000, Dijon, France
| | - Jérome Tourret-Arnaud
- Département D'Urologie, Néphrologie Et Transplantation, Groupe Hospitalier Pitié Salpêtrière Charles Foix, Paris, France
| | - Gérard Lina
- Centre International de Recherche en Infectiologie, Institut Des Agent Infectieux, Hôpital de La Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Samy Figueiredo
- Service D'Anesthésie Réanimation Médecine Péri Opératoire, Hôpital Bicêtre. Assistance Publique-Hôpitaux de Paris, Université Paris Saclay, 78 Rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France
| | - Anthony Chauvin
- Service D'Accueil Des Urgences/SMUR, CHU Lariboisière, Paris, France
| | | | - Sandra Malavaud
- Unité de Prévention du Risque Infectieux Associé Aux Soins, CHU de Toulouse, France
| | - Albert Sotto
- Service Des Maladies Infectieuses Et Tropicales, CHU de Nîmes, France
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Huang X, Hu Z, Yue X, Cui Y, Cui J. Expression of Inflammatory Factors in Critically Ill Patients with Urosepticemia and the Imaging Analysis of the Severity of the Disease. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:6659435. [PMID: 33688422 PMCID: PMC7914102 DOI: 10.1155/2021/6659435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/06/2021] [Accepted: 02/15/2021] [Indexed: 11/17/2022]
Abstract
Urine sepsis is a complex inflammatory response of the body to infection with a high fatality rate. It is one of the main causes of death in noncardiovascular intensive care units. Nevertheless, in daily clinical practice, early sepsis is often not detected. In this paper, discharged cases of urinary sepsis from the Department of Urology and Critical Care Medicine of a university hospital were collected as the observation group, and common urinary tract infection cases were selected as the control group. We sorted and summarized the discharged case information of the observation group and the control group. The results of the study showed that, after renal pelvis perfusion, the expression of HMGB1 protein and mRNA increased, and the expression of TLR4 increased; inhibiting HMGB1 can reduce the expression of inflammatory factors caused by perfusion and reduce the infiltration of neutrophils and macrophages caused by perfusion. In addition, r HMGB1 treatment can promote the expression of inflammatory factors caused by perfusion and aggravate the infiltration of neutrophils and macrophages caused by perfusion. We found that inhibition of HMGB1 can inhibit the expression of TLR4/My D88 signaling molecules and r HMGB1 treatment can enhance the expression of TLR4/My D88 signaling molecules.
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Affiliation(s)
- Xia Huang
- Department of Critical Care Medicine Neurosurgery, Chongqing University Three Gorges Hospital, Wanzhou, Chongqing 404000, China
| | - Zongjun Hu
- Department of Critical Care Medicine Neurosurgery, Chongqing University Three Gorges Hospital, Wanzhou, Chongqing 404000, China
| | - Xi Yue
- Department of Critical Care Medicine Neurosurgery, Chongqing University Three Gorges Hospital, Wanzhou, Chongqing 404000, China
| | - Yong Cui
- Department of Critical Care Medicine Neurosurgery, Chongqing University Three Gorges Hospital, Wanzhou, Chongqing 404000, China
| | - Jiwen Cui
- Department of Critical Care Medicine Neurosurgery, Chongqing University Three Gorges Hospital, Wanzhou, Chongqing 404000, China
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Petrosillo N, Granata G, Boyle B, Doyle MM, Pinchera B, Taglietti F. Preventing sepsis development in complicated urinary tract infections. Expert Rev Anti Infect Ther 2019; 18:47-61. [PMID: 31795788 DOI: 10.1080/14787210.2020.1700794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Introduction: Urinary tract infections (UTIs) are the most prevalent infections in the community and the most common reason for antimicrobial prescribing in ambulatory care. A UTI is defined as complicated when urinary tract anatomical abnormalities or urinary devices are present, when it is recurrent and when associated with immunodeficiency. Complicated UTIs (cUTIs) have a higher risk of treatment failure and often require longer antimicrobial treatment courses. cUTIs, especially those which are healthcare-associated, are often due to multidrug resistant organisms (MDROs).Areas covered: This article will review the available evidence in relation to prevention of sepsis in cUTI, evaluating the risk factors associated with sepsis development. Published articles from January 2005 to September 2019 on UTIs and sepsis prevention in complicated UTIs were identified by using MEDLINE (National Library of Medicine Bethesda MD) and by reviewing the references of retrieved articles.Expert opinion: Prevention of sepsis relies on prompt and timely diagnosis of cUTI, early identification of the causative organism, removal of obstructions and source control, proper and adequate empirical/targeted antimicrobial treatment. In particular, source control, i.e. removal of urinary obstructions, infected stents, urinary catheters, nephrostomies, and drainage of hydronephrosis/abscess, is essential for preventing the development and progression of sepsis.
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Affiliation(s)
- Nicola Petrosillo
- Systemic and Immunocompromised Host Infection Unit, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy
| | - Guido Granata
- Systemic and Immunocompromised Host Infection Unit, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy
| | - Breida Boyle
- Department of Clinical Microbiology, St. James Hospital, Dublin, Ireland and Trinity College Dublin, Ireland
| | - Maeve M Doyle
- Consultant Microbiologist, University Hospital Waterford, Waterford, Ireland.,Ireland and Royal College of Surgeons, University College Cork, Cork, Ireland
| | - Biagio Pinchera
- Clinic of Infectious Diseases, University "Federico II", Naples, Italy
| | - Fabrizio Taglietti
- Systemic and Immunocompromised Host Infection Unit, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy
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