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van Beek J, Sobhani H, Wöllner J, Pannek J, Krebs J. Patient-reported signs and symptoms of urinary tract infections after video-urodynamic studies in individuals with neurogenic lower urinary tract dysfunction-A single-center observational study. Neurourol Urodyn 2024. [PMID: 38801121 DOI: 10.1002/nau.25516] [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: 01/29/2024] [Revised: 05/03/2024] [Accepted: 05/20/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Video-urodynamic studies (VUDS) are the recommended standard of diagnostic care to objectively assess neurogenic lower urinary tract dysfunction (NLUTD) in individuals with spinal cord injury/disease (SCI/D). This examination requires the insertion of a catheter into the bladder, which increases the risk of a urinary tract infection (UTI). Data on symptomatic UTIs after VUDS are limited. METHODS A single-center, observational study was conducted to evaluate the incidence of patient-reported UTI signs and symptoms 7 days after VUDS. No peri-interventional antibiotics were administered. The effect of sex, age, SCI/D duration, bladder evacuation method, bacteriuria, UTI prophylaxis, UTI history, or unfavorable VUDS results on the occurrence of patient-reported UTI signs or symptoms after VUDS was examined using binary logistic regression analysis. RESULTS A total of 140 individuals with a mean age of 59.1 ± 14.0 years and a median SCI/D duration of 15.0 years (6/29 years) were evaluated. Seven days (mean 7 ± 1 days) after VUDS, 42 (30%) individuals reported at least one UTI sign or symptom. In the majority, signs and symptoms resolved without the need for antibiotic treatment, which was required in seven participants (5%). Male sex significantly (p = 0.04) increased the odds (odds ratio 3.74) of experiencing UTI signs and symptoms after VUDS. CONCLUSIONS In individuals with NLUTD, 30% experienced UTI signs and symptoms 1 week after VUDS. However, these signs and symptoms were transient and only 5% required antibiotic treatment. Thus, antibiotic prophylaxis does not seem necessary in all individuals with SCI/D undergoing VUDS.
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Affiliation(s)
- Judith van Beek
- Neuro-Urology, Swiss Paraplegic Research, Nottwil, Switzerland
| | - Human Sobhani
- Neuro-Urology, Swiss Paraplegic Research, Nottwil, Switzerland
| | - Jens Wöllner
- Neuro-Urology, Swiss Paraplegic Research, Nottwil, Switzerland
- Neuro-Urology, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Jürgen Pannek
- Neuro-Urology, Swiss Paraplegic Research, Nottwil, Switzerland
- Neuro-Urology, Swiss Paraplegic Centre, Nottwil, Switzerland
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jörg Krebs
- Neuro-Urology, Swiss Paraplegic Research, Nottwil, Switzerland
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Rubilotta E, Chiarulli EF, Ammirati E, Bevacqua MC, Manodoro S, Chierchia S, Fragalà E, Masiello G, Li Marzi V, Giammò A, Musco S, Savoca F, Balzarro M, De Nunzio C, De Rienzo G, Fusco F, Lamberti G, Soligo M, De Palma L, Fasano M, Carretta A, Tumietto F, Finazzi-Agrò E, Russo E, Antonelli A, Gubbiotti M, Sampogna G, Spinelli M, Carone R, Martino L, Mancini V. Antibiotic prophylaxis in invasive urodynamics, a Delphi consensus of the Italian Society of Urodynamics (SIUD). Neurourol Urodyn 2024. [PMID: 38587242 DOI: 10.1002/nau.25463] [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: 03/18/2024] [Accepted: 03/23/2024] [Indexed: 04/09/2024]
Abstract
INTRODUCTION Although antibiotic prophylaxis (AB) demonstrated a statistically significant reduction in bacteriuria after invasive urodynamics (UDS), no significant decrease in the incidence of urinary tract infections (UTI) has been confirmed. No absolute recommendations on the use of AB in case of relevant potential risk of UTI have been reported, though some categories of patients at increased infective probability after UDS have been recognized. The aim of this study is to report the experts' consensus on the best practice for the use of AB before UDS in the main categories of patients at potential risk of developing UTI. MATERIALS AND METHODS A systematic literature review was performed on AB before UDS in males and females. A panel of experts from the Italian Society of Urodynamics, Continence, Neuro-Urology, and Pelvic Floor (SIUD) assessed the review data and decided by a modified Delphi method on 16 statements proposed and discussed by the panel. The cut-off percentage for the consensus was a ≥70% of positive responses to the survey. The study was a Delphi consensus with experts' opinions, not a clinical trial involving directly patients. RESULTS The panel group was composed of 57 experts in functional urology and UDS, mainly urologists, likewise gynaecologists, physiatrists, infectivologists, pediatric urologists, and nurses. A positive consensus was achieved on 9/16 (56.25%) of the statements, especially on the need for performing AB before UD in patients with neurogenic bladder and immunosuppression. Urine analysis and urine culture before UDS are mandatory, and in the event of their positivity, UDS should be postponed. A consensus was reached on avoiding AB in menopausal status, diabetes, age, gender, bladder outlet obstruction, high postvoid residual, chronic catheterization, previous urological surgery, lack of urological abnormalities, pelvic organ prolapse, and negative urine analysis. CONCLUSIONS Antibiotic prophylaxis is not recommended for patients without notable risk factors and with a negative urine test due to the potential morbidities that may result from antibiotic administration. However, AB can be used for risk categories such as neurogenic bladder and immunosuppression. The evaluation of urine analysis and urine culture and postponing UDS in cases of positive tests were considered good practices, as well as performing AB in the neurogenic bladder and immunosuppression.
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Affiliation(s)
- Emanuele Rubilotta
- Department of Urology, Azienda Ospedaliera Universitaria Verona, Verona, Italy
| | | | - Enrico Ammirati
- Neuro-Urologia, CTO Unità spinale unipolare, Città della Salute e della Scienza, Torino, Italy
| | - Marianna C Bevacqua
- UOC Urologia Abilitata al Trapianto, Grande Ospedale Metropolitano di Reggio Calabria, Milano, Italy
| | - Stefano Manodoro
- UO Ostetricia e Ginecologia Ospedale San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
| | - Stefania Chierchia
- Neuro-Urologia, CTO Unità spinale unipolare, Città della Salute e della Scienza, Torino, Italy
| | - Eugenia Fragalà
- UO Urologia Ospedale G.B. Morgagni - L. Pierantoni, AUSL Romagna, Forlì, Italy
| | | | - Vincenzo Li Marzi
- Unit of Urological Robotic Surgery and Renal Transplantation, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Firenze, Italy
| | | | - Stefania Musco
- Unit of Neuro-Urology, Azienda Ospedaliera Careggi, Firenze, Italy
| | | | - Matteo Balzarro
- Department of Urology, Azienda Ospedaliera Universitaria Verona, Verona, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sapienza University, Ospedale Sant'Andrea, Roma, Italy
| | - Gaetano De Rienzo
- Urology and Andrology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | | | | | - Marco Soligo
- Unit of Obstetrics and Gynecology, Ospedale Maggiore, Lodi, Italy
| | - Luisa De Palma
- UOC Medicina Fisica e Riabilitazione, Policlinico di Bari, Italy
| | - Massimo Fasano
- UO Malattie Infettive, Ospedale Perinei, Altamura, Bari, Italy
| | - Anna Carretta
- UOC Malattie Infettive, Policlinico di Foggia, Foggia, Italy
| | | | - Enrico Finazzi-Agrò
- Department of Surgical Sciences, Urology Unit, University of Rome Tor Vergata, Roma, Italy
| | - Eleonora Russo
- UO Ginecologia e Ostetricia Universitaria I Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | | | | | - Gianluca Sampogna
- Unipolar Spinal Unit and Neurourology Service, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Michele Spinelli
- Unipolar Spinal Unit and Neurourology Service, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | - Leonardo Martino
- Urology Unit and Renal Transplantation, Policlinico di Foggia, Università di Foggia, Foggia, Italy
| | - Vito Mancini
- Urology Unit and Renal Transplantation, Policlinico di Foggia, Università di Foggia, Foggia, Italy
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Pham D, Chi B, Skelton F, Huang D. Antibiotic prophylaxis with urodynamic studies in spinal cord injury: Assessing practice patterns and outcomes to guide future practice in a single center. J Spinal Cord Med 2024:1-6. [PMID: 38391262 DOI: 10.1080/10790268.2024.2311348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
CONTEXT/OBJECTIVE Despite urinary tract infections (UTIs) being a common problem in patients with spinal cord injuries (SCIs), and a well-known complication of invasive urologic procedures, little consensus exists regarding the standard of care for peri-procedural antibiotic use for SCI patients undergoing urodynamics studies (UDS). Our research seeks to evaluate local antibiotic prophylaxis pattern in SCI patients undergoing UDS, assess incidence of post-procedural UTI, describe local antibiotic resistance trends, and provide antibiotic stewardship considerations to guide future practice. DESIGN/SETTING/PARTICIPANTS Retrospective cohort study of SCI patients undergoing UDS from January 2010 to January 2020 at a Veterans Affairs SCI Center. Data on patient demographics, UTI risk factors, pre-procedural urinalysis and culture, and peri-procedural antibiotics was extracted. Incidence of post-procedural UTI was tabulated. Findings were summarized using descriptive statistics. RESULTS 331 patients were studied. Pre-procedural urine culture was done in 73% of cases, with positive results in 49%. E. coli was the most commonly isolated organism (19%). Antibiotics were used in 86% of cases, 26% of which had a negative culture. A onetime dose of intramuscular gentamicin given immediately pre-procedure was the most common practice (53%; N = 152). No cases of post-procedural UTIs were identified during the study period. CONCLUSION No post-UDS UTIs occurred under current local practice where most patients received a one-time dose of intramuscular gentamicin as prophylaxis. Though routine gentamicin prophylaxis may play a role in reducing UTI incidence, the low rate of post-UDS UTI in this population, including patients with positive cultures who received no antibiotics, suggests the possibility of refining practice patterns to improve antibiotic stewardship.
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Affiliation(s)
- Du Pham
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Bradley Chi
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Felicia Skelton
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Spinal Cord Injury Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Donna Huang
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Spinal Cord Injury Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA
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Stangl FP, Schneidewind L, Wagenlehner FM, Schultz-Lampel D, Baeßler K, Naumann G, Schönburg S, Anheuser P, Winkelhog-Gran S, Saar M, Hüsch T, Kranz J. Do or Don't: Results of a Multinational Survey on Antibiotic Prophylaxis in Urodynamics. Antibiotics (Basel) 2023; 12:1219. [PMID: 37508315 PMCID: PMC10376729 DOI: 10.3390/antibiotics12071219] [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: 05/30/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
Antibiotic prophylaxis contributes substantially to the increase in antibiotic resistance rates worldwide. This investigation aims to assess the current standard of practice in using antibiotic prophylaxis for urodynamics (UDS) and identify barriers to guideline adherence. An online survey using a 22-item questionnaire designed according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) was circulated among urologists and gynecologists in Austria, Germany, and Switzerland between September 2021 and March 2022. A total of 105 questionnaires were eligible for analysis. Out of 105 completed surveys, most responders (n = 99, 94%) regularly perform dipstick urine analysis prior to urodynamics, but do not perform a urine culture (n = 68, 65%). Ninety-eight (93%) participants refrain from using antibiotic prophylaxis, and sixty-eight (65%) use prophylaxis if complicating factors exist. If asymptomatic bacteriuria is present, approximately 54 (52%) participants omit UDS and reschedule the procedure until antimicrobial susceptibility testing is available. Seventy-eight (78%) participants do not have a standard procedure for antibiotic prophylaxis in their department. Part of the strategy against the development of bacterial resistance is the optimized use of antibiotics, including antibiotic prophylaxis in urodynamics. Establishing a standard procedure is necessary and purposeful to harmonize both aspects in the field of urological diagnostics.
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Affiliation(s)
- Fabian P Stangl
- Department of Urology, University Hospital of Bern, 3010 Bern, Switzerland
| | - Laila Schneidewind
- Department of Urology, University Medical Centre Rostock, 18057 Rostock, Germany
| | - Florian M Wagenlehner
- Clinic for Urology, Paediatric Urology and Andrology, Justus-Liebig-University Giessen, 35390 Giessen, Germany
| | - Daniela Schultz-Lampel
- Southwest Continence Center, Schwarzwald-Baar-Klinikum, 78052 Villingen-Schwenningen, Germany
| | - Kaven Baeßler
- Continence-and Pelvic-Floor-Centre, Franziskus-Hospital Berlin, 10787 Berlin, Germany
| | - Gert Naumann
- Women's Hospital, Helios Clinic Erfurt, 99089 Erfurt, Germany
- University Women's Clinic, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Sandra Schönburg
- Department of Urology and Kidney Transplantation, Martin Luther University, 06108 Halle (Saale), Germany
| | - Petra Anheuser
- Klinik für Urologie, Asklepios Klinik Wandsbek, 22043 Hamburg, Germany
| | - Susanne Winkelhog-Gran
- Clinic for Urology and Pediatric Urology, St.-Antonius Hospital gGmbH, Academic Teaching Hospital of RWTH Aachen, 52249 Eschweiler, Germany
| | - Matthias Saar
- Department of Urology and Paediatric Urology, University Clinic RWTH Aachen, 52074 Aachen, Germany
| | - Tanja Hüsch
- Clinic for Urology and Pediatric Urology, University Medicine Johannes-Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Jennifer Kranz
- Department of Urology and Kidney Transplantation, Martin Luther University, 06108 Halle (Saale), Germany
- Department of Urology and Paediatric Urology, University Clinic RWTH Aachen, 52074 Aachen, Germany
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Current Bladder Dysfunction Reports: Antibiotic Overuse in Office-Based Lower Urinary Tract Procedures. CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-022-00672-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Prophylactic Antibiotics for Urinary Tract Infections after Urodynamic Studies: A Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6661588. [PMID: 33728337 PMCID: PMC7937458 DOI: 10.1155/2021/6661588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 01/31/2021] [Accepted: 02/23/2021] [Indexed: 12/20/2022]
Abstract
Aim We aimed to perform a meta-analysis to determine whether antibiotic prophylaxis reduces the incidence of urinary tract infections (UTIs) after urodynamic studies (UDS). Methods We conducted a systematic search of PubMed, Web of Science, Ovid, Elsevier, ClinicalKey, Embase, Cochrane Library, Medline, and Wiley Online Library. Randomized controlled trials (RCTs) comparing the effectiveness of prophylactic antibiotics with placebo or no treatment in preventing UTI after UDS were included. Two reviewers extracted data independently, and RevMan 5.3 software was used to analyze relative risk (RR) with 95% confidence intervals (CI). Heterogeneity was assessed by the Q test and I2 test. Results The final meta-analysis included 1829 patients in 13 RCTs. Compared with the placebo or no treatment group, prophylactic antibiotics could significantly reduce the risk of bacteriuria (RR = 0.42, 95% CI: 0.30-0.60) and the risk of symptomatic UTI (RR = 0.65, 95% CI: 0.48-0.88). In addition, there was no statistically significant difference in the risk of adverse events (RR = 4.93, 95% CI: 0.61-40.05). No significant heterogeneity or publication bias was found in this study. Conclusions Current evidence showed that prophylactic antibiotics could reduce the risk of asymptomatic bacteriuria and symptomatic UTI after UDS without increasing the incidence of adverse events.
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Donzé C, Papeix C, Lebrun-Frenay C. Urinary tract infections and multiple sclerosis: Recommendations from the French Multiple Sclerosis Society. Rev Neurol (Paris) 2020; 176:804-822. [PMID: 32900473 DOI: 10.1016/j.neurol.2020.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Establish recommendations for the management of UTIs in MS patients. BACKGROUND Urinary tract infections (UTIs) are common during multiple sclerosis (MS) and are one of the most common comorbidities potentially responsible for deaths from urinary sepsis. METHODS The recommendations attempt to answer three main questions about UTIs and MS. The French Group for Recommendations in MS (France4MS) did a systematic review of articles from PubMed and universities databases (01/1980-12/2019). The RAND/UCLA appropriateness method, which has been developed to synthesize the scientific literature and expert opinions on health care topics, was used for reaching a formal agreement. 26 MS experts worked on the full-text review and a group of 70 multidisciplinary health care specialists validated the final evaluation of summarized evidences. RESULTS UTIs are not associated with an increased risk of relapse and permanent worsening of disability. Only febrile UTIs worsen transient disability through the Uhthoff phenomenon. Some immunosuppressive treatments increase the risk of UTIs in MS patients and require special attention especially in case of hypogammaglobulinemia. Experts recommend to treat UTIs in patients with MS, according to recommendations of the general population. Prevention of recurrent UTIs requires stabilization of the neurogenic bladder. In some cases, weekly oral cycling antibiotics can be proposed after specialist advice. Asymptomatic bacteriuria should not be screened for or treated systematically except in special cases (pregnancy and invasive urological procedures). CONCLUSION Physicians and patients should be aware of the updated recommendations for UTis and MS.
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Affiliation(s)
- C Donzé
- Faculté de médecine et de maïeutique de Lille, hôpital Saint-Philibert, groupement des hôpitaux de l'institut catholique de Lille, Lomme, France.
| | - C Papeix
- Département de neurologie, CRCSEP, Sorbonne université, hôpital de la Salpêtrière, AP-HP6, Paris 13, France
| | - C Lebrun-Frenay
- URC2A, université Nice Côté-d'Azur, CRCSEP, neurologie hôpital Pasteur 2, CHU de Nice, 30, voie Romaine, 06003 Nice, France
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Preece J, Haynes A, Gupta S, Becknell B, Ching C. Implications of Bacteriuria in Myelomeningocele Patients at Time of Urodynamic Testing. Top Spinal Cord Inj Rehabil 2019; 25:241-247. [PMID: 31548791 DOI: 10.1310/sci2503-241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: To identify those myelomeningocele (MMC) patients at risk for post-urodynamic study (UDS) complications. We hypothesized that patients who manage their bladder with clean intermittent catheterization (CIC) would have a greater risk of post-instrumentation complications due to higher rates of bacteriuria compared to those who freely void (FV). Design/Methods: Urine was collected from patients with MMC without augmentation cystoplasty undergoing routine renal ultrasound or urodynamic study (UDS). Samples were divided into those with bacteriuria (urine culture ≥10,000 colony-forming units) and those without. Post-UDS complications were evaluated and compared between CIC and FV patients. Results: A total of 91 urine samples from 82 total MMC patients were included for evaluation. Significantly more patients on CIC than those who FV had bacteriuria (67% vs 33%, p = .0457). From these urine samples, 54 were obtained at time of UDS of which 45 were from patients on CIC and 9 from FV patients. More patients on CIC had bacteriuria at the time of UDS than those who FV (60% vs 33%, respectively), but this did not reach significance (p = .1416). No patient with bacteriuria on CIC had a complication after UDS while one FV patient with bacteriuria developed post-UDS pyelonephritis. Conclusion: MMC patients with bacteriuria on CIC did not have post-UDS complications. Patients with bacteriuria who FV may be at particular risk for post-instrumentation UTI, providing guidance as to which MMC patients should undergo urine testing prior to UDS in order to prevent post-instrumentation pyelonephritis.
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Affiliation(s)
- Janae Preece
- Department of Urology, Children's Hospital of Michigan, Detroit, Michigan
| | - Andria Haynes
- Division of Urology, Nationwide Children's Hospital, Columbus, Ohio
| | - Sudipti Gupta
- Division of Urology, Nationwide Children's Hospital, Columbus, Ohio.,Center for Clinical and Translational Research, Nationwide Children's Hospital, Columbus, Ohio
| | - Brian Becknell
- Center for Clinical and Translational Research, Nationwide Children's Hospital, Columbus, Ohio.,Division of Nephrology, Nationwide Children's Hospital, Columbus, Ohio
| | - Christina Ching
- Division of Urology, Nationwide Children's Hospital, Columbus, Ohio.,Center for Clinical and Translational Research, Nationwide Children's Hospital, Columbus, Ohio
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Floyd Jr MS, Khadr RN. Re: Antibiotic prophylaxis prior to urodynamic study in patients with traumatic spinal cord injury. Is there an indication? Int Braz J Urol 2019; 45:860-861. [PMID: 31184448 PMCID: PMC6837615 DOI: 10.1590/s1677-5538.ibju.2019.0193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 03/23/2019] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Rauf N. Khadr
- Southport & Ormskirk NHS Foundation Trust, United Kingdom
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da Silva MT, Barboza AL, Pijoán MM, Beraldo PSS. Antibiotic prophylaxis prior to urodynamic study in patients with traumatic spinal cord injury. Is there an indication? Int Braz J Urol 2019; 45:347-353. [PMID: 30785698 PMCID: PMC6541138 DOI: 10.1590/s1677-5538.ibju.2018.0574] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 02/10/2019] [Accepted: 11/11/2018] [Indexed: 12/23/2022] Open
Abstract
STUDY DESIGN Retrospective cohort of patients with traumatic spinal cord injury (SCI) that have been hospitalized for physical-functional rehabilitation purposes. OBJECTIVES To compare the incidence of urinary tract infection (UTI) after urodynamic study (UDS) in three hospitals that adopted different protocols with regard to the preparation of patients. SETTING Sarah Network of Rehabilitation Hospitals, Brazil. MATERIALS AND METHODS Between 2014 and 2015, 661 patients from three units of the same hospital network, one of which does not use antimicrobial prophylaxis independently of urine culture results, were evaluated after having undergone UDS. The results were compared in both univariate and multivariate analyses (logistic regression). RESULTS The global rate of UTI after UDS was that of 3.18% (IC 95% 2.1-4.8), with no differences between the units. In the univariate analysis the only variable that was associated with UTI after UDS was that of T6 injuries or above (P = 0.029). The logistic regression has confi rmed this result, with an adjusted odds ratio of 3.06 (IC 95% 1.01 to 9.26; P = 0.0476). The use of antimicrobial prophylaxis did not alter that risk. CONCLUSIONS This study has demonstrated that the use of antimicrobials does not prevent UTI after UDS. Patients with T6 traumatic SCI or above have got three times more chance of developing UTI after UDS if compared to those with a T7 injury or below, independently of the use of antimicrobials. Even in these patients the use of antimicrobials would not be justified.
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Affiliation(s)
| | - André Luis Barboza
- Serviço de Urologia, Rede Sarah de Hospitais de Reabilitação, Brasília, DF, Brasil
| | - Maria Malen Pijoán
- Instituto Universitario Italiano de Rosario - Ciências Biomédicas, Rosario, Santa Fe, Argentina
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Egrot C, Dinh A, Amarenco G, Bernard L, Birgand G, Bruyère F, Chartier-Kastler E, Cosson M, Deffieux X, Denys P, Etienne M, Fatton B, Fritel X, Gamé X, Lawrence C, Lenormand L, Lepelletier D, Lucet JC, Marit Ducamp E, Pulcini C, Robain G, Senneville E, de Sèze M, Sotto A, Zahar JR, Caron F, Hermieu JF. [Antibiotic prophylaxis in urodynamics: Clinical practice guidelines using a formal consensus method]. Prog Urol 2018; 28:943-952. [PMID: 30501940 DOI: 10.1016/j.purol.2018.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 10/08/2018] [Accepted: 10/11/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aim of this work was to issue clinical practice guidelines on antibiotic prophylaxis in urodynamics (urodynamic studies, UDS). MATERIALS AND METHODS Clinical practice guidelines were provided using a formal consensus method. Guidelines proposals were drew up by a multidisciplinary experts group (pilot group = steering group), then rated by a panel of 12 experts (rating group) using a formal consensus method, and then peer reviewed by a reviewing/reading group of experts (different from the rating group). RESULTS Urine (bacterial) culture with antimicrobial susceptibility testing is recommended for all patients before UDS (strong agreement). In patients with no neurologic disease, the risk factors for tract urinary infection (UTI) after UDS are age > 70 years, recurrent UTI, and post-void residual volume > 100ml. In patients with neurologic disease, the risk factors for UTI after UDS are recurrent UTI, vesicoureteral reflux, and intermicturition pressure > 40cmH2O. If the urine culture is negative before UDS and there is no risk factor for UTI, antibiotic prophylaxis is not recommended (Strong agreement). If the urine culture is negative before UDS, but there are one or more risk factors for UTI, antibiotic prophylaxis is optional. If antibiotic prophylaxis is initiated, a single oral dose (3g) of fosfomycin-tromethamine two hours before UDS is recommended (Strong agreement). If there is bacterial colonization on UCB before UDS, antibiotic therapy is optional (Undecided). If prescribed, it should be adapted to the antimicrobial susceptibility of the identified bacterium or bacteria, started the day before and stopped after UDS (except for fosfomycin-tromethamine: a single dose the day before UDS is necessary and sufficient) (Strong agreement). In the event of UTI before UDS, the UTI should be treated and UDS postponed (Strong agreement). The proposed recommendations should not be changed for patients with a hip or knee replacement (Strong agreement). No antibiotic prophylaxis of bacterial endocarditis is necessary, including in high-risk patients with valvular heart disease (Strong agreement). CONCLUSION These new guidelines should help to harmonize clinical practice and limit exposure to antibiotics. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- C Egrot
- Service d'urologie, université Paris-7, hôpital Bichat Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France.
| | - A Dinh
- Unité de maladies infectieuses, UVSQ, hôpital Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - G Amarenco
- GRC 01, groupe de recherche clinique en neuro-urologie (GREEN), Sorbonne université, hôpital Tenon, AP-HP, 75020 Paris, France
| | - L Bernard
- Service de médecine interne et maladies infectieuses, centre hospitalier régional Bretonneau, 37000 Tours, France
| | - G Birgand
- Centre de prévention des infections associées aux soins, CHU de Nantes, 5, rue du Pr-Boquien, 44000 Nantes, France
| | - F Bruyère
- Service d'urologie, centre hospitalier régional universitaire de Tours, 37000 Tours, France
| | - E Chartier-Kastler
- Médecine Sorbonne Université, hôpital universitaire de la Pitié-Salpêtrière, 75013 Paris, France
| | - M Cosson
- Laboratoire BioTIM, école centrale de Lille, université de Lille, CHU de Lille, 59000 Lille, France
| | - X Deffieux
- Service de gynécologie obstétrique, université Paris-Sud, hôpital Antoine-Béclère, groupe hospitalier Sud, AP-HP, 92140 Clamart, France
| | - P Denys
- Service de neuro-urologie, hôpital Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - M Etienne
- Service de maladies infectieuses et tropicales, hôpital Charles-Nicolle, CHU de Rouen, 76000 Rouen, France
| | - B Fatton
- Unité d'urogynécologie, groupe hospitalier Carémeau, CHU de Nîmes, 30029 Nîmes, France
| | - X Fritel
- Service de gynécologie-obstétrique, CHU de Poitiers, 86000 Poitiers, France
| | - X Gamé
- Département d'urologie, transplantation rénale et andrologie, CHU Rangueil, TSA 50032, 31059 Toulouse, France
| | - C Lawrence
- Service microbiologie et hygiène, hôpital Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - L Lenormand
- Service d'urologie, centre fédératif de pelvipérinéologie, CHU de Nantes, place A.-Ricordeau, 44093 Nantes cedex 01, France
| | - D Lepelletier
- Service bactériologie et hygiène hospitalière, CHU de Nantes, 44093 Nantes cedex 01, France
| | - J-C Lucet
- Service de bactériologie, hygiène, virologie, parasitologie, hôpital Bichat-Claude-Bernard, AP-HP, Paris, France
| | - E Marit Ducamp
- Service de médecine physique et réadaptation, urodynamique, clinique Saint-Augustin, 33200 Bordeaux, France
| | - C Pulcini
- Infectious Diseases Department, université de Lorraine, APEMAC, CHRU de Nancy, 54000 Nancy, France
| | - G Robain
- Service de rééducation neurologique, hôpital Rothschild, AP-HP, 75012 Paris, France
| | - E Senneville
- Service universitaire des maladies infectieuses et du voyageur, centre hospitalier Gustave-Dron, CHRU de Lille, 59200 Tourcoing, France
| | - M de Sèze
- Service de médecine physique et réadaptation, urodynamique, clinique Saint-Augustin, 33200 Bordeaux, France
| | - A Sotto
- Service des maladies infectieuses et tropicales, CHU de Nîmes, place du Professeur-Robert-Debré, 30029 Nîmes cedex, France
| | - J-R Zahar
- Département de microbiologie, hôpital Avicenne, AP-HP, groupe hospitalier Paris-Seine-Saint-Denis, 93000 Bobigny, France; Unité de recherche Inserm 1137, IAME, université Paris-13, 93000 Bobigny, France
| | - F Caron
- Service des maladies infectieuses, groupe de recherche sur l'adaptation microbienne (EA2656), université de Rouen, CHU de Rouen, 76000 Rouen, France
| | - J-F Hermieu
- Service d'urologie, université Paris-7, hôpital Bichat Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
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Comparison of guideline recommendations for antimicrobial prophylaxis in urologic procedures: variability, lack of consensus, and contradictions. Int Urol Nephrol 2018; 50:1923-1937. [DOI: 10.1007/s11255-018-1971-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 08/18/2018] [Indexed: 10/28/2022]
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Przydacz M, Chlosta P, Corcos J. Recommendations for urological follow-up of patients with neurogenic bladder secondary to spinal cord injury. Int Urol Nephrol 2018; 50:1005-1016. [PMID: 29569211 DOI: 10.1007/s11255-018-1852-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 03/19/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE To review currently available guidelines and recommendations regarding urological follow-up of patients after spinal cord injury (SCI) and present an evidence-based summary to support clinicians in their clinical practice. METHODS Maximum data were collected according to different methods, including searches with multiple and specific keywords, reference checks, gray literature searches (congress reports, working papers, statement documents), and browsing-related Web site access. Obtained data were analyzed with the modified version of the Oxford grading system for recommendations using levels of evidence (LE) and grades of recommendation (GR). RESULTS Different surveillance strategies exist, but there is no consensus among authors and organizations. As a result, practice patterns vary around the world. The present review indicates that proper urological follow-up of SCI patients should consist of medical history (LE 1-4, GR B-C), clinical examination (LE 4, GR C), renal laboratory tests (LE 1-3, GR B), imaging surveillance of the upper urinary tract (LE 1-3, GR A-B), urodynamic study (LE 2-4, GR B-C), and cystoscopy/cytology (LE 1-4, GR D). Clinicians agree that SCI patients should be followed up regularly with an individually tailored approach. A 1-year follow-up schedule seems reasonable in SCI patients without additional risk factors of renal deterioration (LE 3-4, GR C). In those who manifest risk factors, report changes in bladder behavior, or present with already developed complications of neurogenic bladder dysfunction, follow-up plans should be modified with more frequent checkups (LE 4, GR C). Urodynamic study should be repeated and considered as a routine monitoring strategy. CONCLUSION Individuals with neurogenic lower urinary tract dysfunction are at increased risk of multiple complications. Nevertheless, proper follow-up after SCI improves the prognosis for these patients and their quality of life.
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Affiliation(s)
- Mikolaj Przydacz
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Canada
- Department of Urology, Jagiellonian University, Medical College, Kraków, Poland
| | - Piotr Chlosta
- Department of Urology, Jagiellonian University, Medical College, Kraków, Poland
| | - Jacques Corcos
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Canada.
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Cameron AP, Campeau L, Brucker BM, Clemens JQ, Bales GT, Albo ME, Kennelly MJ. Best practice policy statement on urodynamic antibiotic prophylaxis in the non-index patient. Neurourol Urodyn 2017; 36:915-926. [PMID: 28345769 DOI: 10.1002/nau.23253] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 02/09/2017] [Indexed: 11/12/2022]
Abstract
AIMS Antibiotic prophylaxis before urodynamic testing (UDS) is widely utilized to prevent urinary tract infection (UTI) with only limited guidance. The Society of Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction (SUFU) convened a Best Practice Policy Panel to formulate recommendations on the urodynamic antibiotic prophylaxis in the non-index patient. METHODS Recommendations are based on a literature review and the Panel's expert opinion, with all recommendations graded using the Oxford grading system. RESULTS All patients should be screened for symptoms of UTI and undergo dipstick urinalysis. If the clinician suspects a UTI, the UDS should be postponed until it has been treated. The first choice for prophylaxis is a single oral dose of trimethoprim-sulfamethoxazole before UDS, with alternative antibiotics chosen in case of allergy or intolerance. Individuals who do NOT require routine antibiotic prophylaxis include those without known relevant genitourinary anomalies, diabetics, those with prior genitourinary surgery, a history of recurrent UTI, post-menopausal women, recently hospitalized patients, patients with cardiac valvular disease, nutritional deficiencies or obesity. Identified risk factors that increase the potential for UTI following UDS and for which the panel recommends peri-procedure antibiotics include: known relevant neurogenic lower urinary tract dysfunction, elevated PVR, asymptomatic bacteriuria, immunosuppression, age over 70, and patients with any indwelling catheter, external urinary collection device, or performing intermittent catheterization. Patients with orthopedic implants have a separate risk stratification. CONCLUSIONS These recommendations can assist urodynamic providers in the appropriate use of antibiotics for UDS testing. Clinical judgment of the provider must always be considered.
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Affiliation(s)
- Anne P Cameron
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | | | - Benjamin M Brucker
- New York Langone Medical Center, NYU Urology Associates, New York, New York
| | | | - Gregory T Bales
- Section of Urology, The University of Chicago, Chicago, Illinois
| | - Michael E Albo
- Division of Urology, UCSD Medical Center, San Diego, California
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Nicolle LE. Complicated Urinary Infection, Including Postsurgical and Catheter-Related Infections. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00059-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Hwang SI, Lee BS, Han ZA, Lee HJ, Han SH, Kim MO. Factors Related to the Occurrence of Urinary Tract Infection Following a Urodynamic Study in Patients With Spinal Cord Injury. Ann Rehabil Med 2016; 40:718-24. [PMID: 27606279 PMCID: PMC5012984 DOI: 10.5535/arm.2016.40.4.718] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 11/11/2015] [Indexed: 11/11/2022] Open
Abstract
Objective To analyze the factors related to urinary tract infection (UTI) occurrence after an urodynamic study (UDS) in patients with spinal cord injury (SCI). Methods We retrospectively investigated the medical records of 387 patients with SCI who underwent UDS with prophylactic antibiotic therapy between January 2012 and December 2012. Among them, 140 patients met the inclusion criteria and were divided into two groups, UTI and non-UTI. We statistically analyzed the following factors between the two groups: age, sex, level of injury, SCI duration, spinal cord independence measure, non-steroidal anti-inflammatory drug use, diabetes mellitus, the American Spinal Injury Association impairment scale (AIS), lower extremity spasticity, a history of UTI within the past 4 weeks prior to the UDS, symptoms and signs of neurogenic bladder, urination methods, symptoms during the UDS and UDS results. Results Among the 140 study participants, the UTI group comprised 12 patients and the non-UTI group comprised 128 patients. On univariate analysis, a history of UTI within the past 4 weeks prior to the UDS was significant and previous autonomic dysreflexia before the UDS showed a greater tendency to influence the UTI group. Multivariable logistic regression analysis using these two variables showed that the former variable was significantly associated with UTI and the latter variable was not significantly associated with UTI. Conclusion In patients with SCI, a history of UTI within the past 4 weeks prior to the UDS was a risk factor for UTI after the UDS accompanied by prophylactic antibiotic therapy. Therefore, more careful pre-treatment should be considered when these patients undergo a UDS.
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Affiliation(s)
- Sung-Il Hwang
- Department of Rehabilitation Medicine, Soonchunhyang University Gumi Hospital, Gumi, Korea
| | - Bum-Suk Lee
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| | - Zee-A Han
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| | - Hye-Jin Lee
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| | - Sang-Hoon Han
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| | - Myeong-Ok Kim
- Department of Physical and Rehabilitation Medicine, Inha University Hospital, Incheon, Korea
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Weglinski L, Rouzaud C, Even A, Bouchand F, Davido B, Duran C, Salomon J, Perronne C, Denys P, Chartier-Kastler E, Dinh A. Prospective evaluation of antibiotic treatment for urological procedure in patients presenting with neurogenic bladder. Med Mal Infect 2016; 46:300-7. [PMID: 27241225 DOI: 10.1016/j.medmal.2016.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/30/2015] [Accepted: 04/06/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Patients presenting with neurogenic bladder often require urological procedures (urodynamic testing and botulinum toxin injections) and a preventive antibiotic therapy. We aimed to assess the efficacy of this little known strategy in a cohort of patients. PATIENTS AND METHODS All patients presenting with neurogenic bladder who underwent urological procedure were included in the study. They received an antibiotic therapy in accordance with the urine cytobacteriological examination results. The antibiotic therapy was initiated two days before the procedure and prolonged up until two days after the procedure if the culture was positive. Patients were treated with a single dose of fosfomycin-trometamol in case of a negative culture. The main study outcome was the occurrence of urinary tract infection (UTI), defined by a positive urine culture and symptoms, up until 14 days after the procedure. RESULTS A total of 80 urological procedures were performed. Mean patient age was 47±13.1 years (sex ratio 1.22); 59 (73.8%) presented with asymptomatic bacteriuria before the procedure. Nine (11.1%) UTIs were recorded on Day 14, of which one (1.2%) was febrile. Two patients required an additional curative antibiotic therapy. No patient was hospitalized. Overall, 77.8% of UTIs were cured without antibiotic therapy. CONCLUSION Screening and treating asymptomatic bacteriuria before urological procedures seems unnecessary and vainly exposes this population at high risk of infectious diseases to antibiotic therapies. This data should be confirmed by a randomized clinical trial.
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Affiliation(s)
- L Weglinski
- AP-HP, hôpital universitaire R.-Poincaré, université Versailles-Saint-Quentin, hôpitaux Paris Île-de-France Ouest, unité d'urodynamique, 104, boulevard R.-Poincaré, 92380 Garches, France
| | - C Rouzaud
- AP-HP, hôpital universitaire R.-Poincaré, université Versailles-Saint-Quentin, hôpitaux Paris Île-de-France Ouest, unité des maladies infectieuses, 104, boulevard R.-Poincaré, 92380 Garches, France
| | - A Even
- AP-HP, hôpital universitaire R.-Poincaré, université Versailles-Saint-Quentin, hôpitaux Paris Île-de-France Ouest, unité d'urodynamique, 104, boulevard R.-Poincaré, 92380 Garches, France
| | - F Bouchand
- AP-HP, hôpital universitaire R.-Poincaré, université Versailles-Saint-Quentin, hôpitaux Paris Île-de-France Ouest, département de pharmacie, 104, boulevard R.-Poincaré, 92380 Garches, France
| | - B Davido
- AP-HP, hôpital universitaire R.-Poincaré, université Versailles-Saint-Quentin, hôpitaux Paris Île-de-France Ouest, unité des maladies infectieuses, 104, boulevard R.-Poincaré, 92380 Garches, France
| | - C Duran
- AP-HP, hôpital universitaire R.-Poincaré, université Versailles-Saint-Quentin, hôpitaux Paris Île-de-France Ouest, unité des maladies infectieuses, 104, boulevard R.-Poincaré, 92380 Garches, France
| | - J Salomon
- AP-HP, hôpital universitaire R.-Poincaré, université Versailles-Saint-Quentin, hôpitaux Paris Île-de-France Ouest, unité des maladies infectieuses, 104, boulevard R.-Poincaré, 92380 Garches, France
| | - C Perronne
- AP-HP, hôpital universitaire R.-Poincaré, université Versailles-Saint-Quentin, hôpitaux Paris Île-de-France Ouest, unité des maladies infectieuses, 104, boulevard R.-Poincaré, 92380 Garches, France
| | - P Denys
- AP-HP, hôpital universitaire R.-Poincaré, université Versailles-Saint-Quentin, hôpitaux Paris Île-de-France Ouest, unité d'urodynamique, 104, boulevard R.-Poincaré, 92380 Garches, France
| | - E Chartier-Kastler
- AP-HP, université Pierre-et-Marie-Curie, hôpital universitaire Pitié Salpêtrière, service d'urologie, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - A Dinh
- AP-HP, hôpital universitaire R.-Poincaré, université Versailles-Saint-Quentin, hôpitaux Paris Île-de-France Ouest, unité d'urodynamique, 104, boulevard R.-Poincaré, 92380 Garches, France; AP-HP, hôpital universitaire R.-Poincaré, université Versailles-Saint-Quentin, hôpitaux Paris Île-de-France Ouest, unité des maladies infectieuses, 104, boulevard R.-Poincaré, 92380 Garches, France.
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Mrkobrada M, Ying I, Mokrycke S, Dresser G, Elsayed S, Bathini V, Boyce E, Luke P. CUA Guidelines on antibiotic prophylaxis for urologic procedures. Can Urol Assoc J 2015; 9:13-22. [PMID: 25737749 DOI: 10.5489/cuaj.2382] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Marko Mrkobrada
- Department of Medicine, Schulich School of Medicine, London Health Science Centre, London, ON
| | - Ivan Ying
- Department of Medicine, Schulich School of Medicine, London Health Science Centre, London, ON
| | - Stephanie Mokrycke
- Department of Medicine, Schulich School of Medicine, London Health Science Centre, London, ON
| | - George Dresser
- Department of Medicine, Schulich School of Medicine, London Health Science Centre, London, ON
| | - Sameer Elsayed
- Department of Medicine, Schulich School of Medicine, London Health Science Centre, London, ON
| | - Varunkumar Bathini
- Department of Surgery, Schulich School of Medicine, London Health Science Centre, London, ON
| | - Erin Boyce
- Department of Medicine, Schulich School of Medicine, London Health Science Centre, London, ON
| | - Patrick Luke
- Department of Surgery, Schulich School of Medicine, London Health Science Centre, London, ON
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[Antibiotic prophylaxis in urology]. Urologia 2014; 81:209-17. [PMID: 25532466 DOI: 10.5301/uro.5000098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2014] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Antibiotic prophylaxis (AP) is used to minimize infectious complications resulting from interventions. Due to high rates of development of bacterial resistance and side effects, the use of antibiotics must be weighed on the basis of high levels of evidence. The main endpoints of urology AP are the prevention of symptomatic urogenital infections, urosepsis and wound infections. The purpose of this review is to bring objectives, principles and recommendations on urology AP according to the latest scientific evidence. METHODS We carried out a systematic search of MEDLINE, EMBASE and the Cochrane Library using keywords such as AP, prophylaxis, antibiotics, urological surgery, urogenital surgery and the names of the urologic procedures. The results of studies on the AP for each procedure were classified according to the levels of evidence and grades of recommendation from the European Association of Urology. RESULTS There are a number of good quality studies on AP about endoscopic resection of the prostate (TURP), urodynamic studies and transrectal prostate biopsies (trPB). The majority of the studies about other procedures have several limitations (sample size, consistency of definitions, statistics and trial design). Lack of consistency in the definitions of infectious complications does not allow comparison between different studies. CONCLUSIONS The AP is evidence-based is indicated only for TURP and trPB. It is desirable to perform randomized, prospective and controlled trials in order to rationalize the use of antibiotics, improve the cost/benefit ratio and reduce bacterial antibiotic resistances.
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Clement KD, Lapitan MCM, Omar MI, Glazener CMA. Urodynamic studies for management of urinary incontinence in children and adults. Cochrane Database Syst Rev 2013; 2013:CD003195. [PMID: 24166676 PMCID: PMC6599826 DOI: 10.1002/14651858.cd003195.pub3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Urodynamic tests are used to investigate people who have urinary incontinence or other urinary symptoms in order to make a definitive, objective diagnosis. The aim is to help select the treatment most likely to be successful. The investigations are invasive and time consuming. OBJECTIVES The objective of this review was to determine if treatment according to a urodynamic-based diagnosis, compared to treatment based on history and examination, led to more effective clinical care of people with urinary incontinence and better clinical outcomes.The intention was to test the following hypotheses in predefined subgroups of people with incontinence:(i) urodynamic investigations improve the clinical outcomes;(ii) urodynamic investigations alter clinical decision making;(iii) one type of urodynamic test is better than another in improving the outcomes of management of incontinence or influencing clinical decisions, or both. SEARCH METHODS We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and MEDLINE In-Process, handsearching of journals and conference proceedings (searched 19 February 2013), and the reference lists of relevant articles. SELECTION CRITERIA Randomised and quasi-randomised trials comparing clinical outcomes in groups of people who were and were not investigated using urodynamics, or comparing one type of urodynamic test against another were included. Trials were excluded if they did not report clinical outcomes. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. MAIN RESULTS Eight trials involving around 1100 people were included but data were only available for 1036 women in seven trials, of whom 526 received urodynamics. There was some evidence of risk of bias. The four deaths and 12 dropouts in the control arm of one trial were unexplained.There was significant evidence that the tests did change clinical decision making. Women in the urodynamic arms of three trials were more likely to have their management changed (proportion with change in management compared with the control arm 17% versus 3%, risk ratio (RR) 5.07, 95% CI 1.87 to 13.74), although there was statistical heterogeneity. There was evidence from two trials that women treated after urodynamic investigations were more likely to receive drugs (RR 2.09, 95% CI 1.32 to 3.31). On the other hand, in five trials women undergoing treatment following urodynamic investigation were not more likely to undergo surgery (RR 0.99, 95% CI 0.88 to 1.12).There was no statistically significant difference however in the number of women with urinary incontinence if they received treatment guided by urodynamics (37%) compared with those whose treatment was based on history and clinical findings alone (36%) (for example, RR for the number with incontinence after the first year 1.02, 95% CI 0.86 to 1.21). It was calculated that the number of women needed to treat was 100 women (95% CI 86 to 114 women) undergoing urodynamics to prevent one extra individual being incontinent at one year.One trial reported adverse effects and no significant difference was found (RR 1.10, 95% CI 0.81 to 1.50). AUTHORS' CONCLUSIONS While urodynamic tests did change clinical decision making, there was some evidence that this did not result in better outcomes in terms of a difference in urinary incontinence rates after treatment. There was no evidence about their use in men, children, or people with neurological diseases. Larger definitive trials are needed in which people are randomly allocated to management according to urodynamic findings or to management based on history and clinical examination to determine if performance of urodynamics results in higher continence rates after treatment.
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Affiliation(s)
| | | | - Muhammad Imran Omar
- University of AberdeenAcademic Urology UnitHealth Sciences Building (second floor)ForesterhillAberdeenScotlandUKAB25 2ZD
| | - Cathryn MA Glazener
- University of AberdeenHealth Services Research Unit3rd Floor, Health Sciences BuildingForesterhillAberdeenScotlandUKAB25 2ZD
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Foon R, Toozs-Hobson P, Latthe P. Prophylactic antibiotics to reduce the risk of urinary tract infections after urodynamic studies. Cochrane Database Syst Rev 2012; 10:CD008224. [PMID: 23076941 DOI: 10.1002/14651858.cd008224.pub2] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND There is a risk that people who have invasive urodynamic studies (cystometry) will develop urinary tract infections or bacteria in the urine or blood. However, the use of prophylactic antibiotics before or immediately after invasive cystometry or urodynamic studies is not without risks of adverse effects and emergence of resistant microbes. OBJECTIVES To assess the effectiveness and safety of administering prophylactic antibiotics in reducing the risk of urinary tract infections after urodynamic studies. The hypothesis was that administering prophylactic antibiotics reduces urinary tract infections after urodynamic studies. SEARCH METHODS We searched the Cochrane Incontinence Group Specialised Trial Register, MEDLINE (January 1966 to January 2009), CINAHL (January 1982 to January 2009), EMBASE (January 1966 to January 2009), PubMed (1 January 1980 to January 2009), LILACS (up to January 2009), TRIP database (up to January 2009), and the UK NHS Evidence Health Information Resources (searched 10 December 2009). We searched the reference lists of relevant articles, the primary trials and the proceedings of the International Urogynaecological Association International Continence Society and the American Urological Association for the years 1999 to 2009 to identify articles not captured by electronic searches. There were no language restrictions. SELECTION CRITERIA All randomized controlled trials and quasi-randomized trials comparing the use of prophylactic antibiotics versus a placebo or no treatment in patients having urodynamic studies were selected. Two authors (PL and RF) independently performed the selection of trials for inclusion and any disagreements were resolved by discussion. DATA COLLECTION AND ANALYSIS All assessments of the quality of trials and data extraction were performed independently by two authors of the review (PL and RF) using forms designed according to Cochrane guidelines. We attempted to contact authors of the included trials for any missing data. Data were extracted on characteristics of the study participants including details of previously administered treatments, interventions used, the methods used to measure infection and adverse events.Statistical analyses were performed according to Cochrane Collaboration guidelines. Data from intention-to-treat analyses were used where available. For the dichotomous data, results for each study were expressed as a risk ratio (RR) with 95% confidence interval (CI) and combined for meta-analysis using the Mantel-Haenszel method.The primary outcome was urinary tract infection. Heterogeneity was assessed by the P value and I(2) statistic. MAIN RESULTS Nine randomized controlled trials involving the prophylactic use of antibiotics in patients having urodynamic studies were identified and these included 973 patients in total; one study was an abstract. Two further trials were excluded from the review. The methods of the included trials were poorly described.The primary outcome in all trials was the rate of developing significant bacteriuria, defined as the presence of more than 100,000 bacteria per millilitre of a mid-stream urine sample on culture and sensitivity testing. The other outcomes included pyrexia, haematuria, dysuria and adverse reactions to antibiotics.The administration of prophylactic antibiotics when compared to a placebo reduced the risk of significant bacteriuria (4% with antibiotics versus 12% without, risk ratio (RR) 0.35, 95% CI 0.22 to 0.56) in both men and women. The administration of prophylactic antibiotics also reduced the risk of haematuria (RR 0.46, 95% CI 0.23 to 0.91). However, there was no statistically significant difference in the primary outcome, risk of symptomatic urinary tract infection (40/201, 20% versus 59/214, 28%; RR 0.73, 95% CI 0.52 to 1.03); or in the risk of fever (RR 5.16, 95% CI 0.94 to 28.16) or dysuria (RR 0.83, 95% CI 0.5 to 1.36). Only two of 135 people had an adverse reaction to the antibiotics. The number of patients needed to treat with antibiotics to prevent bacteriuria was 12.3. Amongst women, the number needed to treat to prevent bacteriuria was 13.4; while amongst men it was 9.1 (number needed to treat = 1/ absolute risk reduction). AUTHORS' CONCLUSIONS Prophylactic antibiotics did reduce the risk of bacteriuria after urodynamic studies but there was not enough evidence to suggest that this effect reduced symptomatic urinary tract infections. There was no statistically significant difference in the risk of fever, dysuria or adverse reactions. Potential benefits have to be weighed against clinical and financial implications, and the risk of adverse effects.
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Affiliation(s)
- Richard Foon
- Obstetrics and Gynaecology, Royal Shrewsbury hospital, Shrewsbury, UK.
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Böthig R, Fiebag K, Thietje R, Faschingbauer M, Hirschfeld S. Morbidity of urinary tract infection after urodynamic examination of hospitalized SCI patients: the impact of bladder management. Spinal Cord 2012; 51:70-3. [PMID: 22964752 DOI: 10.1038/sc.2012.107] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Non-interventional, descriptive-observational cohorts study. OBJECTIVES To assess the incidence of urinary tract infection (UTI) after urodynamic examination in patients with spinal cord injury (SCI) according to bladder management. SETTING Level 1 trauma center. METHODS Between January and December 2010 a total of 133 consecutive, hospitalized SCI patients were included and classified according to their bladder management. Urine specimen was obtained at the beginning of the urodynamic studies (UDS) and 3-5 days thereafter. 'Significant bacteriuria' (SBU) is defined by a CBU per ml level ≥10(5) in a urine culture. UTI thus is defined as a combination of a SBU and ≥100 leukocytes per μl in urine analysis. RESULTS The overall incidence of UTI post UDS was 15.79%. In patients with sterile urine prior to urodynamics UTI was ascertained in 8.6% (de-novo-UTI). In contrast, 32.5% of the patients with SBU prior to UDS showed UTI 3 days later. There were only minor differences in the incidence of de-novo-UTIs in SCI patients who emptied their bladder by intermittent self catheterization or intermittent catheterization by attendant (8.82% and 6.67%, respectively). In SCI patients with reflex voiding however, the frequency of de-novo-UTIs was twice as high (14.28%). CONCLUSION The recommendation of antibiotic prophylaxis for all SCI patients undergoing urodynamic examination is not commonly accepted and according to our data not justified. However, the analysis of subgroups revealed that SCI patients with unsuspected SBU prior to UDS and patients with reflex voiding are possibly at higher risk to acquire post-UDS infection.
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Affiliation(s)
- R Böthig
- Department Neuro-Urology, BG Trauma Hospital Hamburg, Hamburg, Germany.
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23
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Glazener CMA, Lapitan MCM. Urodynamic studies for management of urinary incontinence in children and adults. Cochrane Database Syst Rev 2012; 1:CD003195. [PMID: 22258952 DOI: 10.1002/14651858.cd003195.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Urodynamic tests are used to investigate people who have urinary incontinence or other urinary symptoms in order to make a definitive objective diagnosis. The aim is to help to select the treatment most likely to be successful. The investigations are invasive and time consuming. OBJECTIVES The objective of this review was to discover if treatment according to a urodynamic-based diagnosis, compared to treatment based on history and examination, led to more effective clinical care of urinary incontinence and better clinical outcomes. SEARCH METHODS We searched the Cochrane Incontinence Group Specialised Trials Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and CINAHL, and handsearching of journals and conference proceedings (searched 24 May 2011), and the reference lists of relevant articles. SELECTION CRITERIA Randomised and quasi-randomised trials comparing clinical outcomes in groups of people who were and were not investigated using urodynamics, or comparing one type of urodynamics against another. Trials were excluded if they did not report clinical outcomes. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed trial quality and extracted data. MAIN RESULTS Seven small trials involving around 400 people were included but data were only available for 385 women in five trials, of whom 197 received urodynamics. There was some evidence of risk of bias. The four deaths and 12 dropouts in the control arm of one trial were unexplained.There was some evidence that the tests did change clinical decision making. There was evidence from two trials that women treated after urodynamic investigations were more likely to receive drugs (RR 2.09, 95% CI 1.32 to 3.31) but not, in three trials, surgery (RR 1.75, 95% CI 0.39 to 7.75). Women in the urodynamic arms of two trials were more likely to have their management changed but this did not quite reach statistical significance (proportion with no change in management 76% versus 99%, RR 0.79, 95% CI 0.57 to 1.10).However, there was not enough evidence to demonstrate whether or not this resulted in a clinical benefit. For example there was no statistically significant difference in the number of women with urinary incontinence if they received treatment guided by urodynamics (70%) versus those whose treatment was based on history and clinical findings alone (62%) (e.g. RR for number with incontinence after first year 1.23, 95% CI 0.60 to 2.55).No trials reported whether or not there were any adverse effects. AUTHORS' CONCLUSIONS While urodynamic tests may change clinical decision making, there was not enough evidence to suggest whether this would result in better clinical outcomes. There was no evidence abut their use in men, children or people with neurological diseases. Larger definitive trials are needed, in which people are randomly allocated to management according to urodynamic findings or to standard management based on history and clinical examination.
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Affiliation(s)
- Cathryn M A Glazener
- Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building,Foresterhill, Aberdeen, Scotland, AB25 2ZD, UK.
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24
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Complicated urinary infection, including postsurgical and catheter-related infections. Infect Dis (Lond) 2010. [DOI: 10.1016/b978-0-323-04579-7.00056-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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25
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Pannek J, Nehiba M. Morbidity of urodynamic testing in patients with spinal cord injury: is antibiotic prophylaxis necessary? Spinal Cord 2007; 45:771-4. [PMID: 17710104 DOI: 10.1038/sj.sc.3102114] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Prospective, non-randomized study. OBJECTIVES To assess the incidence of urinary tract infection after urodynamics in patients with spinal cord injury. SETTING Outpatient clinic of a university hospital in Germany. METHODS Urinary tract infection and clinical symptoms in 109 consecutive outpatients with spinal cord injury following urodynamic evaluation were studied. RESULTS Data from 72 patients were evaluable. Of these, seven patients (9.7%) developed a significant urinary tract infection. Five of these were symptomatic. Pre-existing asymptomatic bacteriuria was not associated with a higher risk for post-interventional infection. The technique of the bladder management did not correlate with urinary tract infection rates. CONCLUSION In this study, symptomatic urinary tract infections after cystometry were not infrequent. Therefore, it seems that antibiotic prophylaxis cannot be omitted in patients with spinal cord injury undergoing urodynamic investigation.
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Affiliation(s)
- J Pannek
- Division of Neuro-Urology, Department of Urology and Neuro-Urology, Ruhr-Universität Bochum, Marienhospital Herne, Germany
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26
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de Sèze M, Shao É, Joseph P. Infections urinaires nosocomiales en médecine physique et réadaptation : particularités des vessies neurologiques. Med Mal Infect 2003. [DOI: 10.1016/s0399-077x(03)00175-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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27
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Joseph P, de Sèze M, Soyeur L. Qui traiter, quand traiter, comment traiter chez les patients ayant une vessie neurologique ? Med Mal Infect 2003. [DOI: 10.1016/s0399-077x(03)00146-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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28
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Biering-Sørensen F, Bagi P, Høiby N. Urinary tract infections in patients with spinal cord lesions: treatment and prevention. Drugs 2002; 61:1275-87. [PMID: 11511022 DOI: 10.2165/00003495-200161090-00004] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Even though the mortality due to urinary tract complications has decreased dramatically during the last decades in individuals with spinal cord lesions (SCL), urinary tract infections (UTI) still cause significant morbidity in this population. Complicated UTI are caused by a much wider variety of organisms in individuals with SCL than in the general population and are often polymicrobial. Escherichia coli, Pseudomonas spp., Klebsiella spp., Proteus spp., Serratia spp., Providencia spp., enterococci, and staphylococci are the most frequently isolated bacteria in urine specimens taken from individuals with SCL. There is no doubt that the greatest risk for complicated UTI in these individuals is the use of an indwelling catheter. Intermittent catheterisation during the rehabilitation phase has been shown to lower the rate of UTI, and virtually eliminate many of the complications associated with indwelling catheters. Persons with SCL should only be treated for bacteriuria if they have symptoms. Generally, it is advisable to use antibacterial agents with little or no impact on the normal flora. Single agent therapy - in accordance with antimicrobial susceptibility test - is preferred. We advise extending treatment to at least 5 days, and in those with reinfection or relapsing UTI, at least 7 to 14 days, depending on the severity of the infection. The diagnosis of structural and/or functional risk factors is essential in order to plan an optimal treatment for UTI in individuals with SCL, which should include treatment of simultaneously occurring predisposing factors. The treatment of structural risk factors follows general urological principles, aiming for sufficient outlet from the bladder with minimal residual urine and low pressure voiding. For prevention of UTI, general cleanliness and local hygiene should be encouraged. If the patient has a reinfection or relapsing symptomatic UTI, it is important to check for inadequately treated infection and complications, which need special attention, in particular residual urine and urinary stones. No reliable evidence exists of the effectiveness of cranberry juice and other cranberry products. Prophylactic antibacterials should only be used in patients with recurrent UTI where no underlying cause can be found and managed, and in particular if the upper urinary tract is dilated. Antibacterials should not be used for the prevention of UTI in individuals with SCL and indwelling catheters. However, the use of prophylactic antibacterials for individuals with SCL using intermittent catheterisation or other methods of bladder emptying is controversial.
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Affiliation(s)
- F Biering-Sørensen
- Clinic for Para- and Tetraplegia, Copenhagen University Hospital, Rigshospitalet, Denmark.
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29
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Abstract
Complicated urinary tract infection occurs in the setting of a functionally or structurally abnormal genitourinary tract. Many different abnormalities may lead to a designation of complicated urinary tract infection, and these abnormalities will have different influences on the frequency of infection and likelihood of relapse or reinfection. The microbiology of complicated urinary tract infection is characterised by a greater variety of organisms and increased likelihood of antimicrobial resistance compared with acute uncomplicated urinary tract infection. Appropriate management requires a urine specimen for culture prior to institution of antimicrobial therapy, and ensuring that the underlying abnormality is fully characterised to determine whether it can be corrected. A wide variety of antimicrobial agents are effective for treatment, and are usually given for 7 to 14 days. If the underlying abnormality can be corrected, subsequent infections may be prevented. However, if the underlying abnormality cannot be corrected a high recurrence rate of infection, approaching 50% by 4 to 6 weeks, is expected. Further study of complicated urinary tract infection is necessary, including determination of when asymptomatic bacteriuria warrants treatment, and exploration of nonantimicrobial approaches to management.
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Affiliation(s)
- L E Nicolle
- Department of Internal Medicine, University of Manitoba, Health Sciences Centre, Winnipeg, Canada.
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30
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Shekarriz B, Upadhyay J, Freedman AL, Fleming P, Barthold JS, González R. Lack of morbidity from urodynamic studies in children with asymptomatic bacteriuria. Urology 1999; 54:359-61; discussion 362. [PMID: 10443739 DOI: 10.1016/s0090-4295(99)00214-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Patients on clean intermittent catheterization (CIC) have a high rate of asymptomatic bacteriuria. Although prophylactic antibiotics for routine surgical procedures in patients with bacteriuria is common practice, the role of prophylaxis for invasive diagnostic procedures remains unclear. The aim of this study was to investigate the morbidity associated with urodynamic evaluation in patients with asymptomatic bacteriuria. METHODS Routine urodynamic evaluation was performed in 69 pediatric patients (mean age 10 years). Ninety-six percent had a neurogenic bladder, and most were on CIC. Routine urine cultures were obtained at the time of the cystometrogram. Forty-six patients had positive urine cultures, and 23 patients with sterile urine served as a comparison. Patients were evaluated subjectively for symptoms of a urinary tract infection (UTI) within 1 week of the procedure. The results of the cystometrograms were compared between the patients with and without bacteriuria. RESULTS No patient developed symptomatic UTI after the urodynamic studies. Overall, 65% of the patients with and 52% of the patients without bacteriuria had adequate capacity and compliance, and there was no difference in the urodynamic findings between the patients with and without bacteriuria (P = 0.4). CONCLUSIONS Urodynamic studies were performed safely in the presence of asymptomatic bacteriuria in the present study. Therefore, routine use of urine cultures or prophylactic antibiotics before urodynamic studies in pediatric patients with a neurogenic bladder does not appear to be indicated.
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Affiliation(s)
- B Shekarriz
- Department of Urology, Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit 48201, USA
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