Risk factors for nursing- and healthcare-associated urinary tract infection

Risk Factors and the Impact of Multidrug-Resistant Bacteria on Community-Acquired Urinary Sepsis

Risk factors for multidrug-resistant bacteria (MDRB) in nosocomial urinary tract infection (UTI) have been widely studied. However, these risk factors have not been analyzed in community-acquired urinary sepsis (US), nor have its outcomes been studied. The aim of our study is to determine risk factors for MDRB in community-acquired US and its influence on outcomes. Prospective observational study of patients with community-acquired US admitted to a university hospital. We compared epidemiological and clinical variables and outcomes of US due to MDRB and non-MDRB. Independent risk factors for MDRB were analyzed using logistic regression. A total of 193 patients were included, 33.7% of them with US due to MDRB. The median age of patients was 82 years. Hospital mortality was 17.6%, with no difference between the MDRB and non-MDRB groups. The length of hospital stay was 5 (4-8) days, with a non-significant tendency to longer hospital stays in the MDRB group (6 (4-10) vs. 5 (4-8) days, p = 0.051). Healthcare-associated US was found to be an independent risk factor for MDR bacteria by multivariate analysis. In conclusion, the impact of MDR bacteria on the outcomes of community-acquired urinary sepsis was mild. Healthcare-associated US was an independent risk factor for MDR bacteria.

[An analysis of the outbreak situation and background risk factors for drug-resistant urinary tract infection in nursing homes]

AIM

The present study clarified the outbreak situation and background risk factors for drug-resistant bacteria infection in nursing homes.

METHODS

Subjects were 48 elderly individuals with urinary tract infections in 3 nursing homes during the 12-month period from January to December 2020. We analyzed the drug resistance of cultured bacteria using medical records.

RESULTS

Escherichia coli was the most frequently cultured bacteria (37.1%), and extended-spectrum β-lactamase (ESBL) -producing E. coli accounted for 26.1% of specimens. E. coli susceptibility to levofloxacin (LVFX) was seen in 47.8%, resistance in 47.8%, and intermediate response in 4.4%. E. coli susceptibility to ceftriaxone (CTRX) was seen in 73.9%, and resistance in 26.1%. E. coli susceptibility to sulfamethoxazole trimethoprim (ST) mixture was seen 81.8%, while resistance was seen in 18.2%. In addition, among ESBL-producing E. coli, susceptibility to LVFX was seen in 0% and resistance in 83.3%, and an intermediate response was seen in 16.7%, while susceptibility to ST mixture was seen in 83.3% and resistance in 16.7%. No marked differences in background risk factors were seen between the groups with LVFX-resistant and LVFX-susceptible E. coli. However, the body mass index was significantly lower (p=0.0389), and significantly more patients were treated with antimicrobial agents during the 1-year period preceding the sample acquisition and analysis (p=0.0418) in the group with CTRX-resistant E. coli than in the group with CTRX-susceptible E. coli.

CONCLUSION

In the nursing homes examined, LVFX-resistant E. coli were highly prevalent, and ESBL-producing bacteria were also common. When we treat urinary tract infections, refraining from the use of LVFX is desirable, and antimicrobials should be chosen with care.

Epidemiology and Prevention of Healthcare-Associated Infections in Geriatric Patients: A Narrative Review

Demographic studies show that life expectancy is increasing in developed countries; increased longevity has also increased the share of the older population with often concomitant chronic conditions. An ageing population and increased comorbidities lead to more complex pharmacological therapies (polypharmacy). The particular picture provided by chronic conditions and polypharmacy can lead to longer hospital stays and a greater need for healthcare. Elderly patients are identified as being in the high-risk group for the development of healthcare-associated infections (HAIs) due to the age-related decline of the immune system, known as immunosenescence. Comorbid conditions can often complicate infections, diminishing our ability to treat them effectively. Respiratory tract infections are the most common healthcare-associated infections, followed by urinary tract infections. HAIs in geriatric patients are responsible for longer hospital stays, extended antibiotic therapy, significant mortality, and higher healthcare costs. This is because the microorganisms involved are multidrug-resistant and, therefore, more difficult to eliminate. Moreover, geriatric patients are frequently transferred from one facility (nursing homes, skilled nursing facilities, home care, and other specialty clinics) to another or from one hospital ward to another; these transitions cause care fragmentation, which can undermine the effectiveness of treatment and allow pathogens to be transferred from one setting to another and from one person to another. Multifactorial efforts such as early recognition of infections, restricted use of invasive devices, and effective infection control measures (surveillance, isolation practices, hand hygiene, etc.) can contribute to significant reduction of HAIs in geriatric patients.

Perioperative nursing care of a patient with urogenital sinus malformation who underwent vaginal calculus removal and correction: a case report

Cases of urogenital sinus malformation with a huge calculus are complex and rare. Improper nursing care of these cases can lead to a series of problems. We report here a 23-year-old married woman who was admitted to hospital because of primary amenorrhea and failed sexual intercourse for 5 years. Through combined diagnosis and treatment of radiology, ultrasound, urology, gynecology, and other disciplines, the patient was diagnosed with urogenital sinus malformation, a vaginal calculus, and primary amenorrhea. After full preparation, the patient underwent an operation for extraction of the vaginal calculus, urethroplasty, vaginoplasty, and hysteroscopy. The calculus of the patient was removed and the vagina was returned to its normal anatomy. Patients with urogenital sinus malformation and a huge calculus have complex care requirements and experience a particular state of vulnerability during the diagnostic phase. By establishing good communication with patients and providing proper perioperative nursing, physiological and psychological rehabilitation of these patients can be achieved.

The effect of Parkinson's disease on Chinese geriatric patients with intertrochanteric fracture: A propensity score-matched analysis

BACKGROUND

Currently, few studies focus on the treatment of Parkinson's disease (PD) patients after a fracture. The effect of PD on geriatric patients with intertrochanteric fracture remains unclear. Therefore, we performed a study to focus on two questions as follow: (1) would PD increase the operation difficulty and perioperative complications in Chinese elderly patients with intertrochanteric fracture? (2) is there any difference between the clinical outcome of patients with and without PD?

HYPOTHESIS

PD would increase perioperative complications and influence the postoperative rehabilitation in elderly patients with intertrochanteric fracture.

MATERIALS AND METHODS

There were 445 elderly intertrochanteric fracture patients treated with proximal femoral nail anti-rotation during January 2010 and December 2017. After propensity score matching, twenty-four geriatric intertrochanteric fracture patients with PD and forty-eight geriatric intertrochanteric fracture patients without PD were enrolled in this retrospective study. Intraoperative and postoperative comparison were conducted between patients with and without PD.

RESULTS

Compared with 63 months for geriatric intertrochanteric fracture patients without PD, patients with PD had a median survival time of 31 months. The Harris Hip Score and Barthel Index of patients with PD were significantly lower than that of patients without PD. In addition, the Depression subscale score of patients with PD were significantly higher that of patients without PD.

DISCUSSION

The effect of PD on geriatric patients with intertrochanteric fracture is not the operation itself, but the postoperative rehabilitation. In addition, multi-disciplinary treatment, personal rehabilitation training, more intensive outpatient care, and meticulous nursing were recommended in treatment for elderly patients with intertrochanteric fracture and PD.

LEVEL OF EVIDENCE

III, Cohort comparative study.

A risk prediction model of urinary tract infections for patients with neurogenic bladder

Objectives: To develop a nomogram to evaluate the risk of urinary tract infections (UTI) in patients with neurogenic bladder (NGB)Methods: A retrospective analysis was conducted on 337 patients with NGB admitted to three hospitals. Collected data included clinical symptoms, patients' general characteristics, laboratory examinations and imaging findings. Multivariate logistic regression analysis was conducted to develop the risk prediction nomogram of UTIs for NGB patients. C index was used for the internal and external validation of that model.Results: The occurrence of UTIs was 45.7% (154 of 337), 52.6% (102 of 194), and 36.4% (52 of 143) in the overall, training and validation data sets, respectively. The prediction nomogram was developed with 5 prognostic factors which included white blood cell (WBC) in blood, Leukocyte (LEU) in urine, Urinary pH, length of stay and urination mode. The nomogram presented good discrimination with a C-index value of 0.921 (95% confidence interval: 0.87396 - 0.96804) and good calibration. The C-index values of the interval validation and external validation were 0.8905541 and 0.817, respectively. The results of decision curve analysis (DCA) demonstrated that the model was clinically useful.Conclusions: The prediction nomogram we developed is a simple and accurate tool for early prediction of UTIs in patients with NGB. This tool can assess risk of UTIs early, allowing for timely initiation of appropriate preventive measures.

Risk Factors Analysis for Catheter-Associated Urinary Tract Infection in Medan, Indonesia

BACKGROUND

Catheter-associated urinary tract infection (CAUTI) is one of the most common infections in health care caused by several risk factors.

AIM

This study aims at analysing the risky factors triggering CAUTI.

METHODS

This research was designed by applying prospective study. It was conducted from July to November 2018 by involving 82 patients attached to the catheter and treated in the General Hospital of Medan as the sample. The study instrument used observational sheets by measuring the occurrence of urinary tract infection using urine culture analysis ≥ 105 CFU/ml.

RESULTS

The results showed that there was a relationship (p < 0.05) amongs age (p = 0.01; RR = 0.51), diabetes mellitus (p = 0.00; RR = 7.61), duration of catheterization (p = 0.00; RR = 0.01), indications for catheter use (p = 0.00; RR = 0.34) with CAUTI, and there were not significant relationship (p > 0.05) amongs genre (p = 0.06; RR = 1.72), drainage system (p = 0.43; RR = 0.43) and catheter care (p = 0.08; RR = 0.50) with CAUTI. Diabetes mellitus (p = 0.00; OR = 8.92 95% CI = 1.02-11.83) and duration of catheterization (p = 0, 00; OR = 32.84 95% CI = 3.81-322.74) were the most significant factor related to CAUTI.

CONCLUSION

CAUTI is influenced by various factors, and it can be controlled by understanding those factors so that the right interventions to prevent the infections can be taken and the quality of nursing care can be increased as well.