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Hoskins C, Dempsey A, Kaley K, Brou L. Timing of Catheter Removal and Effect on Urinary Retention After Cesarean Birth. J Obstet Gynecol Neonatal Nurs 2024:S0884-2175(24)00217-X. [PMID: 39033782 DOI: 10.1016/j.jogn.2024.05.138] [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: 12/01/2023] [Revised: 04/30/2024] [Accepted: 05/13/2024] [Indexed: 07/23/2024] Open
Abstract
OBJECTIVE To determine the association between timing of indwelling catheter removal and urinary retention after cesarean. DESIGN Retrospective cohort study. SETTING Eight hospitals in suburban, rural, and urban Colorado and Montana. PARTICIPANTS Women who gave birth by cesarean from January 1, 2021, to April 30, 2022 (N = 3,493). METHODS We categorized participants who gave birth between January 1, 2021, and June 30, 2021, (before implementation of the Enhanced Recovery After Surgery initiative) into Group A and participants who gave birth between July 1, 2021, and April 30, 2022, (after implementation of the Enhanced Recovery After Surgery initiative) into Group B. We used descriptive statistics to report the proportion of participants in both groups who experienced urinary retention after birth. We performed chi-square tests to determine the association between the time of catheter removal and incidence of urinary retention. We used the Wilcoxon rank sum test to determine the association between length of stay and urinary retention. RESULTS Urinary retention rates were 5.8% in Group A and 12.6% in Group B (p < .001). In both groups, participants who received epidural anesthesia experienced significantly more urinary retention than those who received spinal anesthesia (p < .001). Participants who received epidural anesthesia and experienced urinary retention pushed 16.9% longer than those without urinary retention (p < .001). The proportion of participants who experienced urinary retention after catheter removal was 19.4% at 7 hours, 4.6% at 16 hours, and 9.9% at 12 hours after birth. Length of stay was determined to be inconclusive. CONCLUSION We determined that the optimal time of catheter removal to minimize the rate of urinary retention was 12 to 16 hours after cesarean among women who received morphine sulfate as the anesthesia.
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Mackeen AD. To drain or not to drain [the bladder during cesarean]? …That is the question. Editorial for self-bladder emptying compared with foley catheter placement for planned cesarean delivery: a randomized controlled trial. Am J Obstet Gynecol MFM 2024; 6:101367. [PMID: 38688742 DOI: 10.1016/j.ajogmf.2024.101367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/22/2024] [Accepted: 04/01/2024] [Indexed: 05/02/2024]
Affiliation(s)
- A Dhanya Mackeen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Geisinger, Danville, PA.
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Zepf J, Züger A, Vonzun L, Rüegg L, Strübing N, Krähenmann F, Meuli M, Mazzone L, Moehrlen U, Ochsenbein-Kölble N. Enhanced Recovery after Surgery in Open Fetal Spina Bifida Repair. Fetal Diagn Ther 2024; 51:267-277. [PMID: 38342082 DOI: 10.1159/000537758] [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: 08/30/2023] [Accepted: 02/01/2024] [Indexed: 02/13/2024]
Abstract
INTRODUCTION For open fetal spina bifida (fSB) repair, a maternal laparotomy is required. Hence, enhanced maternal recovery after surgery (ERAS) is paramount. A revision of our ERAS protocol was made, including changes in operative techniques and postoperative pain management. This study investigates eventual benefits. METHODS Our study included 111 women with open fSB repair at our center. The old protocol group (group 1) either received a transverse incision of the fascia with transection of the rectus abdominis muscle (RAM) or a longitudinal incision of the fascia without RAM transection, depending on placental location. The new protocol required longitudinal incisions in all patients (group 2). Postoperative pain management was changed from tramadol to oxycodone/naloxone. Outcomes of the two different protocol groups were analyzed and compared regarding the primary endpoint, the length of hospital stay (LOS) after fetal surgery, as well as regarding the following secondary endpoints: postoperative pain scores, day of first mobilization, removal of urinary catheter, bowel movement, and the occurrence of maternal and fetal complications. RESULTS Out of 111 women, 82 (73.9%) were in group 1 and 29 (26.1%) were in group 2. Women in group 2 showed a significantly shorter LOS (18 [14-23] days vs. 27 [18-39] days, p = 0.002), duration until mobilization (3 [2-3] days vs. 3 [3-4] days, p = 0.03), and removal of urinary catheter (day 3 [3-3] vs. day 4 [3-4], p = 0.004). Group 2 less often received morphine subcutaneously (0% vs. 35.4%, p < 0.001) or intravenously (0% vs. 17.1%, p = 0.02) but more often oxycodone (69.0% vs. 18.3%, p < 0.001). No significant differences were seen regarding pain scores, bowel movement, and maternal and/or fetal complications. CONCLUSION The new ERAS protocol that combined changes in surgical technique and pain medication led to better outcomes while reducing LOS. Continuous revisions of current ERAS protocols are essential to improve patient care continuously.
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Affiliation(s)
- Julia Zepf
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Anita Züger
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Ladina Vonzun
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
- The Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
| | - Ladina Rüegg
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Nele Strübing
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
- The Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
| | - Franziska Krähenmann
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
- The Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
| | - Martin Meuli
- University of Zurich, Zurich, Switzerland
- Spina Bifida Center, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Luca Mazzone
- University of Zurich, Zurich, Switzerland
- The Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
- Spina Bifida Center, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland
| | - Ueli Moehrlen
- University of Zurich, Zurich, Switzerland
- The Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
- Spina Bifida Center, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland
| | - Nicole Ochsenbein-Kölble
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
- The Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
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Salmanov AG, Artyomenko V, Susidko OM, Korniyenko SM, Voloshyn OA, Kovalyshyn OA, Golyanovskiy OV. CATHETER-ASSOCIATED URINARY TRACT INFECTIONS AFTER CAESAREAN SECTION IN UKRAINE: RESULTS A MULTICENTER STUDY (2020-2022). WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:1325-1331. [PMID: 37463364 DOI: 10.36740/wlek202306101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
OBJECTIVE The aim: To obtain the first national estimates of the current prevalence rate of catheter-associated urinary tract infections (CAUTIs) after caesarean section (CSEC) and antimicrobial resistance of causing pathogens in Ukraine. PATIENTS AND METHODS Materials and methods: Prospective multicentre surveillance was conducted from January 2020 to December 2022 in 15 women hospitals of Ukraine. Definitions of CAUTIs were adapted from the CDC/NHSN. Antibiotic susceptibility was done by the disc diffusion test as recommended by European Committee on Antimicrobial Susceptibility Testing guidelines. RESULTS Results: A total of 15,892 catheterized women undergoing primary CSEC and 13.6% CAUTI were identified. The most common uropathogen was Escherichia coli, Proteus mirabilis, and Enterococcus species followed by Providencia stuartii and Pseudomonas aeruginosa. Many uropathogens isolated from CAUTI cases were found to be multidrug resistant. CONCLUSION Conclusions: This study showed that CAUTIs in catheterized women undergoing primary CSEC in Ukraine is a common occurrence and many cases are caused by pathogens that are resistant to antibiotics. Optimizing the management and empirical antimicrobial therapy may reduce the burden of CAUTIs in catheterized women undergoing primary CSEC, but prevention is the key element.
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Affiliation(s)
- Aidyn G Salmanov
- SHUPYK NATIONAL HEALTHCARE UNIVERSITY OF UKRAINE, KYIV, UKRAINE; INSTITUTE OF PEDIATRICS, OBSTETRICS AND GYNECOLOGY OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE, KYIV, UKRAINE
| | | | | | | | | | - Orusia A Kovalyshyn
- SHUPYK NATIONAL HEALTHCARE UNIVERSITY OF UKRAINE, KYIV, UKRAINE; KYIV REGIONAL MATERNITY HOSPITAL, KYIV, UKRAINE
| | - Oleg V Golyanovskiy
- SHUPYK NATIONAL HEALTHCARE UNIVERSITY OF UKRAINE, KYIV, UKRAINE; KYIV REGIONAL MATERNITY HOSPITAL, KYIV, UKRAINE
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Effect of urinary catheter removal at different times after caesarean section: A systematic review and network meta-analysis. Eur J Obstet Gynecol Reprod Biol 2023; 280:160-167. [PMID: 36502759 DOI: 10.1016/j.ejogrb.2022.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To assess the optimal time for removal of a urinary catheter (UC) following caesarean section (CS). METHODS Several electronic databases were searched from inception to 31 December 2021 regarding the timing of UC removal following CS. The effect of UC removal at different times following CS was calculated using odds ratio (OR) or standardized mean difference and 95% confidence interval (CI). The surface under the cumulative ranking curve (SUCRA) was used to determine the best time for UC removal. All analyses were performed using Stata Version 14.0. RESULTS In total, 19 studies including 3086 women were included in this review. Compared with UC removal 0-6 h after CS, UC removal 6.1-12 h, 12.1-24 h and > 24 h after CS were more likely to result in urinary tract infection (UTI), with pooled OR of 5.95 (95 % CI 1.58-22.38), 11.26 (95 % CI 2.99-42.44) and 27.25 (95 % CI 6.82-108.90), respectively. UC removal > 24 h after CS was more favourable to prevent urinary retention than immediate UC removal (OR 0.05, 95 % CI 0.00-0.64). UC removal 0-6 h after CS was the optimal timing to prevent UTI and frequent urination, and reduce length of hospital stay as well as time to first ambulation, with maximum SUCRA values of 92.30 %, 85.00 %, 80.60 % and 72.60 %, respectively. CONCLUSION UC removal 0-6 h after CS may be the optimal timing to prevent several complications in the absence of a clear indication for UC removal after CS. This study may provide a scientific basis for the timing of UC removal after CS.
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Clawson A, Zahir SF, Stewart S, Torr S, Hempenstall N, Vernon C, Subedi S. Characteristics and outcomes of hospitalised inpatients with indwelling urinary catheter-a retrospective study from a large regional hospital in queensland. Infect Dis Health 2022; 27:219-226. [PMID: 35739035 DOI: 10.1016/j.idh.2022.05.004] [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: 10/17/2021] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Indwelling urinary catheters (IDCs) are a common invasive device in hospitalised patients. Their use is associated with increased risks of developing catheter associated urinary tract infections (CAUTI), and blood stream infections (BSI). AIMS To examine the characteristics and outcomes of adult inpatients with an IDC inserted in hospital and identify risk factors for developing CAUTI and BSI. METHODS We performed a retrospective observational study of 430 patients with IDC admitted to medical and surgical units of a leading (tertiary) hospital between Nov 2019 till April 2020. Multiple logistic regression analysis was performed to determine independent risk factors for developing urinary tract infection and blood stream infection. RESULTS The prevalence of CAUTI in our study was 7.4%. Results of multiple logistic regression indicated that with each day of IDC in situ, the likelihood of UTI development increased by 9% (OR 1.09; 95% CI 1.00 to 1.18; p = 0.03). Age, gender, and catheter reinsertion were not associated with UTI development. CONCLUSIONS Longer duration of IDC was associated with elevated risk of developing CAUTI. CAUTI rates were higher than some of those previously published. There was no statistical significance in frequency of CAUTI between medical and surgical patients. No statistically significant variables that contributed to the development of BSI were found. Interventions targeted at reducing catheter days should be used to improve CAUTI rates.
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Affiliation(s)
- A Clawson
- Sunshine Coast University Hospital, 6 Doherty Street, Birtinya, QLD, 4551, Australia; Griffith University School of Medicine and Dentistry, Sunshine Coast Health Institute, 6 Doherty Street, Birtinya, QLD, 4551, Australia.
| | - S F Zahir
- Queensland Cyber Infrastructure Foundation (QCIF), QCIF Facility for Advanced Bioinformatics, Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - S Stewart
- Sunshine Coast University Hospital, Infection Management Services, 6 Doherty Street, Birtinya, QLD, 4551, Australia
| | - S Torr
- Sunshine Coast University Hospital, Surgical Services Group, 6 Doherty Street, Birtinya, QLD, 4551, Australia
| | - N Hempenstall
- Sunshine Coast University Hospital, Infection Management Services, 6 Doherty Street, Birtinya, QLD, 4551, Australia
| | - C Vernon
- Sunshine Coast University Hospital, Department of Urology, 6 Doherty Street, Birtinya, QLD, 4551, Australia
| | - S Subedi
- Sunshine Coast University Hospital, Department of Infectious Diseases, 6 Doherty Street, Birtinya, QLD, 4551, Australia
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Validation and Clinical Utility of the Korean Version of the Obstetric Quality-of-Recovery Score (ObsQoR-11) Following Elective Cesarean Section: A Prospective Observational Cohort Study. Diagnostics (Basel) 2022; 12:diagnostics12020291. [PMID: 35204382 PMCID: PMC8871019 DOI: 10.3390/diagnostics12020291] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 11/27/2022] Open
Abstract
The Obstetric Quality of Recovery (ObsQoR-11) score is a new scoring tool that assesses maternal recovery after cesarean section (CS). We aimed to validate the translated Korean version of ObsQoR-11 (ObsQoR-11K) after elective CS. We validated ObsQoR-11K between March 2021 to August 2021. Validity (convergent, discriminant, and construct), reliability (Cronbach’s α, inter-item, split-half, and test-retest correlation), responsiveness, and clinical feasibility (recruitment rate and time for ObsQoR-11K completion) of ObsQoR-11K were evaluated. One hundred and twenty women completed the ObsQoR-11K 24 h after CS, and 24 women repeated it 25 h after CS. We found good convergent validity between the ObsQoR-11K score and the global health numerical rating scale (NRS) (ρ = 0.73 (95% CI 0.64 to 0.81); p < 0.001). The ObsQoR-11K score discriminated well between good (NRS ≥ 70 mm, n = 68, 69.6 ± 13.7) and poor recovery (NRS < 70 mm, n = 52, 50.6 ± 12.6, p < 0.001). The ObsQoR-11K score showed acceptable internal consistency (Cronbach’s α = 0.78), split-half reliability (0.89), intra-class correlation > 0.4, and no floor or ceiling effect. Of the participants, 100% completed the ObsQoR-11K and median (IQR) time for ObsQoR-11K completion was 81 s (66–97.5 s). ObsQoR-11K is a valid and reliable scoring tool for assessing maternal recovery after elective CS in Korean women.
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Jeziorczak PM, Frenette RS, Aprahamian CJ. Liposomal Bupivacaine Injection in Nuss Procedure Allows Narcotic Avoidance and Improved Outcomes. J Laparoendosc Adv Surg Tech A 2021; 31:1384-1388. [PMID: 34748425 DOI: 10.1089/lap.2021.0357] [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] [Indexed: 11/12/2022] Open
Abstract
Background: The Nuss procedure has provided a minimally invasive surgical solution for pectus excavatum with excellent long-term outcomes. However, opioid avoidance, cost reduction, and length of stay (LOS) still offer room for improvement. The focus of this study is to identify the impact of Bupivacaine liposome injectable suspension (Exparel) on outcomes. Methods: A retrospective review at a Pediatric specialty hospital from October 1, 2014 to December 31, 2019 was performed. All patients underwent a Nuss procedure (n = 19) for pectus excavatum. The cohort comprised a control group that did not use liposomal Bupivacaine (Standard, n = 9) and an interventional group that received liposomal Bupivacaine (n = 10). Nonparametric Wilcoxon rank-sum tests and chi-squared or Fisher's exact tests were used to assess significance (P < .05). Results: Overall, the entire population was 68.4% male and had an average age of 15 years. There was a significant difference between the Standard and Liposomal Bupivacaine groups for total cost ($60,746 versus $13,289), total Morphine Milligram Equivalents (MME) (282 versus 76.8 MME) and Epidural Catheter usage (100% versus 0%). There was also a significant difference between groups for LOS (5.00 days versus 3.00 days) and Foley catheter usage (100% versus 20%). Conclusions: There is a significant impact of liposomal Bupivacaine usage on epidural catheter avoidance and opioid administration correlating with a significantly decreased total cost and decreased LOS. While more study is necessary, liposomal Bupivacaine for Nuss procedure offers improvement of postoperative patient outcomes and drastic cost savings.
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Affiliation(s)
- Paul M Jeziorczak
- OSF Healthcare-Children's Hospital of Illinois, Peoria, Illinois, USA.,Department of Surgery, University of Illinois College of Medicine Peoria, Peoria, Illinois, USA
| | - Riley S Frenette
- OSF Healthcare-Children's Hospital of Illinois, Peoria, Illinois, USA.,Kirksville College of Osteopathic Medicine, AT Still University, Kirksville, Missouri, USA
| | - Charles J Aprahamian
- OSF Healthcare-Children's Hospital of Illinois, Peoria, Illinois, USA.,Department of Surgery, University of Illinois College of Medicine Peoria, Peoria, Illinois, USA
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Mangala JK, Remadevi C, Loganathan P, R S, Gopukrishnan, Vasudevan A. Enhanced Recovery Pathway as a Tool in Reducing Post-operative Hospital Stay After Caesarean Section, Compared to Conventional Care in COVID Era-A Pilot Study. J Obstet Gynaecol India 2021; 71:12-17. [PMID: 34602773 DOI: 10.1007/s13224-021-01461-6] [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: 12/19/2020] [Accepted: 01/29/2021] [Indexed: 11/24/2022] Open
Abstract
Objectives To study the implementation of ERAS (Enhanced recovery after surgery) pathway and its effect on duration of post-operative hospital stay and various phases of post-operative care in comparison with conventional care group. Materials and Method Prospective study conducted in Amrita institute of medical sciences, Kochi, Kerala. Women planned for elective and scheduled caesarean section were included in the study from September 2020 to October 2020 and compared with women who underwent caesarean section in the same period receiving standard perioperative care. Women who underwent emergency and urgent caesarean section and patients with medical or surgical comorbidities were excluded. Surgical procedure was the same in both arms. Intravenous hydration was goal directed. Oral feeding was started with liquids after 2 hours, solids were given after 4 hours. Intravenous paracetamol and diclofenac were given routinely. Intravenous tramadol and fentanyl were given if needed apart from these analgesics. Foleys catheter was removed after 12 hours. Conventional care group observed 6 h of fasting pre- and post-operatively. Catheter was retained for 24 h, 2500 ml IV fluids were infused on the first day followed by 1000 ml on the second day. The duration of hospital stay was based on clinical criteria and care providers decision. Results In ERAS arm, post-operative hospital stay was significantly reduced in comparison with conventional care group. (53.91 vs 77.71 h-p = 0.00) Early feeding, early ambulation, early catheter removal, multimodal and preemptive analgesia all contributed to early recovery of the patient. Conclusion In ERAS pathway length of post-operative stay was significantly reduced as compared to conventional care. Supplementary Information The online version contains supplementary material available at 10.1007/s13224-021-01461-6.
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Affiliation(s)
- Janu Kanthi Mangala
- Department of OBG, Amrita Institute of Medical Sciences, Amrita Viswavidyapeetham, Ponekkara, Kochi, Kerala 682041 India
| | - Chithra Remadevi
- Department of OBG, Amrita Institute of Medical Sciences, Amrita Viswavidyapeetham, Ponekkara, Kochi, Kerala 682041 India
| | - Pragalya Loganathan
- Department of OBG, Amrita Institute of Medical Sciences, Amrita Viswavidyapeetham, Ponekkara, Kochi, Kerala 682041 India
| | - Sandra R
- Department of OBG, Amrita Institute of Medical Sciences, Amrita Viswavidyapeetham, Ponekkara, Kochi, Kerala 682041 India
| | - Gopukrishnan
- Department of OBG, Amrita Institute of Medical Sciences, Amrita Viswavidyapeetham, Ponekkara, Kochi, Kerala 682041 India
| | - Anu Vasudevan
- Department of Biostatistics, Amrita Institute of Medical Sciences, Amrita Viswavidyapeetham, Ponekkara, Kochi, Kerala 682041 India
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Carvalho FM, Teixeira-Santos R, Mergulhão FJM, Gomes LC. Effect of Lactobacillus plantarum Biofilms on the Adhesion of Escherichia coli to Urinary Tract Devices. Antibiotics (Basel) 2021; 10:antibiotics10080966. [PMID: 34439016 PMCID: PMC8388885 DOI: 10.3390/antibiotics10080966] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/05/2021] [Accepted: 08/07/2021] [Indexed: 01/12/2023] Open
Abstract
Novel technologies to prevent biofilm formation on urinary tract devices (UTDs) are continually being developed, with the ultimate purpose of reducing the incidence of urinary infections. Probiotics have been described as having the ability to displace adhering uropathogens and inhibit microbial adhesion to UTD materials. This work aimed to evaluate the effect of pre-established Lactobacillus plantarum biofilms on the adhesion of Escherichia coli to medical-grade silicone. The optimal growth conditions of lactobacilli biofilms on silicone were first assessed in 12-well plates. Then, biofilms of L. plantarum were placed in contact with E. coli suspensions for up to 24 h under quasi-static conditions. Biofilm monitoring was performed by determining the number of culturable cells and by confocal laser scanning microscopy (CLSM). Results showed significant reductions of 76%, 77% and 99% in E. coli culturability after exposure to L. plantarum biofilms for 3, 6 and 12 h, respectively, corroborating the CLSM analysis. The interactions between microbial cell surfaces and the silicone surface with and without L. plantarum biofilms were also characterized using contact angle measurements, where E. coli was shown to be thermodynamically less prone to adhere to L. plantarum biofilms than to silicone. Thus, this study suggests the use of probiotic cells as potential antibiofilm agents for urinary tract applications.
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Ellahi A, Stewart F, Kidd EA, Griffiths R, Fernandez R, Omar MI. Strategies for the removal of short-term indwelling urethral catheters in adults. Cochrane Database Syst Rev 2021; 6:CD004011. [PMID: 34184246 PMCID: PMC8240009 DOI: 10.1002/14651858.cd004011.pub4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Urinary catheterisation is a common procedure, with approximately 15% to 25% of all people admitted to hospital receiving short-term (14 days or less) indwelling urethral catheterisation at some point during their care. However, the use of urinary catheters is associated with an increased risk of developing urinary tract infection. Catheter-associated urinary tract infection (CAUTI) is one of the most common hospital-acquired infections. It is estimated that around 20% of hospital-acquired bacteraemias arise from the urinary tract and are associated with mortality of around 10%. This is an update of a Cochrane Review first published in 2005 and last published in 2007. OBJECTIVES To assess the effects of strategies for removing short-term (14 days or less) indwelling catheters in adults. SEARCH METHODS We searched the Cochrane Incontinence Specialised Register, which contains trials identified from CENTRAL, MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, CINAHL, ClinicalTrials.gov, WHO ICTRP, and handsearching of journals and conference proceedings (searched 17 March 2020), and reference lists of relevant articles. SELECTION CRITERIA We included all randomised controlled trials (RCTs) and quasi-RCTs that evaluated the effectiveness of practices undertaken for the removal of short-term indwelling urethral catheters in adults for any reason in any setting. DATA COLLECTION AND ANALYSIS Two review authors performed abstract and full-text screening of all relevant articles. At least two review authors independently performed risk of bias assessment, data abstraction and GRADE assessment. MAIN RESULTS We included 99 trials involving 12,241 participants. We judged the majority of trials to be at low or unclear risk of selection and detection bias, with a high risk of performance bias. We also deemed most trials to be at low risk of attrition and reporting bias. None of the trials reported on quality of life. The majority of participants across the trials had undergone some form of surgical procedure. Thirteen trials involving 1506 participants compared the removal of short-term indwelling urethral catheters at one time of day (early morning removal group between 6 am to 7 am) versus another (late night removal group between 10 pm to midnight). Catheter removal late at night may slightly reduce the risk of requiring recatheterisation compared with early morning (RR 0.71, 95% CI 0.53 to 0.96; 10 RCTs, 1920 participants; low-certainty evidence). We are uncertain if there is any difference between early morning and late night removal in the risk of developing symptomatic CAUTI (RR 1.00, 95% CI 0.61 to 1.63; 1 RCT, 41 participants; very low-certainty evidence). We are uncertain whether the time of day makes a difference to the risk of dysuria (RR 2.20; 95% CI 0.70 to 6.86; 1 RCT, 170 participants; low-certainty evidence). Sixty-eight trials involving 9247 participants compared shorter versus longer durations of catheterisation. Shorter durations may increase the risk of requiring recatheterisation compared with longer durations (RR 1.81, 95% CI 1.35 to 2.41; 44 trials, 5870 participants; low-certainty evidence), but probably reduce the risk of symptomatic CAUTI (RR 0.52, 95% CI 0.45 to 0.61; 41 RCTs, 5759 participants; moderate-certainty evidence) and may reduce the risk of dysuria (RR 0.42, 95% CI 0.20 to 0.88; 7 RCTs; 1398 participants; low-certainty evidence). Seven trials involving 714 participants compared policies of clamping catheters versus free drainage. There may be little to no difference between clamping and free drainage in terms of the risk of requiring recatheterisation (RR 0.82, 95% CI 0.55 to 1.21; 5 RCTs; 569 participants; low-certainty evidence). We are uncertain if there is any difference in the risk of symptomatic CAUTI (RR 0.99, 95% CI 0.60 to 1.63; 2 RCTs, 267 participants; very low-certainty evidence) or dysuria (RR 0.84, 95% CI 0.46 to 1.54; 1 trial, 79 participants; very low-certainty evidence). Three trials involving 402 participants compared the use of prophylactic alpha blockers versus no intervention or placebo. We are uncertain if prophylactic alpha blockers before catheter removal has any effect on the risk of requiring recatheterisation (RR 1.18, 95% CI 0.58 to 2.42; 2 RCTs, 184 participants; very low-certainty evidence) or risk of symptomatic CAUTI (RR 0.20, 95% CI 0.01 to 4.06; 1 trial, 94 participants; very low-certainty evidence). None of the included trials investigating prophylactic alpha blockers reported the number of participants with dysuria. AUTHORS' CONCLUSIONS There is some evidence to suggest the removal of indwelling urethral catheters late at night rather than early in the morning may reduce the number of people who require recatheterisation. It appears that catheter removal after shorter compared to longer durations probably reduces the risk of symptomatic CAUTI and may reduce the risk of dysuria. However, it may lead to more people requiring recatheterisation. The other evidence relating to the risk of symptomatic CAUTI and dysuria is too uncertain to allow us to draw any conclusions. Due to the low certainty of the majority of the evidence presented here, the results of further research are likely to change our findings and to have a further impact on clinical practice. This systematic review has highlighted the need for a standardised set of core outcomes, which should be measured and reported by all future trials comparing strategies for the removal of short-term urinary catheters. Future trials should also study the effects of short-term indwelling urethral catheter removal on non-surgical patients.
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Affiliation(s)
| | - Fiona Stewart
- c/o Cochrane Incontinence, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Emily A Kidd
- c/o Cochrane Incontinence, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Rhonda Griffiths
- School of Nursing and Midwifery, University of Western Sydney, Penrith South DC, Australia
| | - Ritin Fernandez
- School of Nursing, University of Wollongong, Wollongong, Australia
| | - Muhammad Imran Omar
- Guidelines Office, European Association of Urology, Arnhem, Netherlands
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
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Igbodike EP, Awowole IO, Kuti OO, Ajenifuja KO, Eleje GU, Olateju SO, Olopade BO, Ijarotimi OA, Irek EO, Igbodike NT, Ayegbusi OE, Ikechebelu JI, Okpala BC, Loto OM, Fehintola AO, Ajiboye AD, Fajobi O, Abuchi CS, Onwudiegwu UU, Fasubaa OB, Orji EO, Makinde ON, Owolabi AT, Adeyemi AB. Eight-hour versus 24-h urethral catheter removal following elective caesarean section for reducing significant bacteriuria: A randomized controlled trial. WOMEN'S HEALTH 2021; 17:17455065211060637. [PMID: 34812114 PMCID: PMC8628312 DOI: 10.1177/17455065211060637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background: There is no consensus on the preferred time to remove urethral catheter post caesarean section. Aim: To compare rate of significant bacteriuria and urinary retention following 8-h (study) and 24-h urethral catheter removal (control) post elective caesarean section. Methods: A randomized controlled trial of eligible participants that underwent elective caesarean section under spinal anaesthesia between March 2019 and November 2019 was conducted. Participants (150 in each arm) were randomly assigned (1:1 ratio) to either 8-h or 24-h group. Primary outcome measures included rates of significant bacteriuria 48-h post-operatively and acute urine retention 6-h post urethral catheter removal. Analysis was by Intention-to-treat. (www.pactr.org:PACTR202105874744483) Results: There were 150 participants randomized into each arm and data collection was complete. Significant bacteriuria was less in 8-h group (3% versus 6.0%; risk ratio (RR): 0.85 CI: 0.60 to 5.66; p = 0.274), though not significant. Acute urinary retention requiring repeat catheterisation was significantly higher in 8-h group (11(7.3%) versus 0(0.0%); RR: 0.07; CI: 0.87 to 0.97; p = 0.001). Mean time until first voiding was slightly higher in 8-h group (211.4 ± 14.3 min versus 190.0 ± 18.3 min; mean difference (MD): 21.36; CI: −24.36 to 67.08; p = 0.203); but patient in this group had a lower mean time until ambulation (770.0 ± 26.1 min versus 809 ± 26.2 min; MD: −38.8; CI: −111.6 to 34.0; p = 0.300). The 8-h group were significantly more satisfied (82/150 (54.7%) versus 54/150 (36.0%); p = 0.001) Conclusions: An 8-h group was associated with significant clinical satisfaction and acute urine retention compared to 24-h removal. The timing of urethral catheter removal did not affect rate of significant bacteriuria and other outcomes
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Affiliation(s)
- Emeka Philip Igbodike
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Ibraheem Olayemi Awowole
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Olufemi O Kuti
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Kayode Olusegun Ajenifuja
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - George Uchenna Eleje
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | | | - Bolatito Opeyemi Olopade
- Department of Medical Microbiology and Parasitology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Omotade Adebimpe Ijarotimi
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Emmanuel Oladayo Irek
- Department of Medical Microbiology and Parasitology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | | | - Oluwole Ekundayo Ayegbusi
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | | | | | - Olabisi Morebisi Loto
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Akintunde Olusegun Fehintola
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Akinyosoye Deji Ajiboye
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Olusola Fajobi
- Department of Community Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Chima Stephene Abuchi
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Uchenna Uchenna Onwudiegwu
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Olusola Benjamin Fasubaa
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Ernest Okechukwu Orji
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Olufemiwa Niyi Makinde
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Alexander Tuesday Owolabi
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Adebanjo Babalola Adeyemi
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
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Huang H, Dong L, Gu L. The timing of urinary catheter removal after gynecologic surgery: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2020; 99:e18710. [PMID: 31914080 PMCID: PMC6959902 DOI: 10.1097/md.0000000000018710] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The present study aimed to assess the effect of removing an indwelling urinary catheter at different times on urinary retention and urinary infection in patients undergoing gynecologic surgery.Electronic databases including PubMed, EMbase, the Cochrane Central Register of Controlled Trials, and Ovid from inception to June 2018 were searched. Relevant randomized controlled trials (RCTs) of removal the indwelling urinary catheter in different time were included.Eight RCTs were included. Data were analyzed by RevMan 5.3 version. There was significant difference in urinary retention (relative risk [RR] 2.46, 95% confidence intervals [CIs] 1.10-5.53), P = .03) between the ≤6 hours and >6 hours indwelling urinary catheter removal groups, while no significant differences were found in the gynecologic surgery excluded the vaginal surgery group and vaginal surgery group. When compared with >6 hours indwelling urinary catheter removal group, the incidence of urinary infection was significantly reduced at the ≤6 hours removal group (RR = 0.66, 95% CI 0.48-0.89, P = .007). The urinary catheter removal time at ≤6 hours also significantly reduced the incidence of urinary retention (RR = 5.06, 95%CI 1.74-14.69, P = .003), and did not statistically increase the incidence of urinary infection (RR = 0.30, 95%CI 0.08 to 1.20, P = .09), compared with immediate urinary catheter removal after surgery.Removal time of the urinary catheter at ≤6 hours postoperatively seems to be more beneficial than immediate or >6 hours for patients undergoing gynecologic surgery which excluded the vaginal surgery.
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Affiliation(s)
- Hui Huang
- Department of Nursing, The Second Affiliated Hospital of Soochow University, Suzhou
| | - Li Dong
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
| | - Lan Gu
- Department of Senior Cadres Ward, The First Affiliated Hospital of Soochow University, Suzhou, China
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