The prevalence of multidrug resistance in uropathogens of patients admitted in the intensive care unit of a tertiary care hospital

Urinary tract infections (UTIs) are among the most common bacterial infections, posing significant public health challenges due to increasing antimicrobial resistance (AMR). This study aims to assess the prevalence, demographic characteristics, microbial profile, and antimicrobial resistance patterns in Indian patients with UTIs admitted to intensive care unit. A total of 154 patients with positive UTIs were included in this cross-sectional study. The prevalence data including demographics, microbial isolates, and antimicrobial susceptibility patterns were collected. Additionally, risk factors for multidrug resistance uropathogens were assessed using multivariate analyses. The patient cohort had diverse demographic, with a slight male predominance of 52.6% (n = 81). The most common comorbidities were hypertension 59.1% (n = 91) and diabetes mellitus 54.5% (n = 84). The microbial profile was dominated by gram-negative bacteria, particularly Escherichia coli 26.62% (n = 41) and Klebsiella pneumoniae 17.53% (n = 27). The predominant gram-positive and fungal isolate was Enterococcus faecium 7.14% (n = 11) and Candida spp. 18.83% (n = 29), respectively. Substantial resistance was noted against common antimicrobials, with variations across different pathogens. Gram-negative bacteria, particularly Escherichia coli and Klebsiella pneumoniae, exhibited high MDR rates, emphasizing the challenge of antimicrobial resistance. Multivariate logistic regression identified age groups 50-65 and over 65, and prolonged catheterization as significant risk factors for MDR infections. A significantly high resistance rate among pathogens emphasizes the need for judicious antimicrobial use. Our findings emphasize the necessity of ongoing surveillance and tailored interventions based on local pathogen prevalence and antibiogram data to effectively address the threat of AMR threat for better management of UTI management in ICU settings.

Obstructive uropathy – acute and chronic medical management

Obstructive uropathy is an important cause of acute and chronic kidney disease. Decompression of the urinary tract is an essential aspect of treatment. The cause and aetiology of obstruction typically determine the surgical approach. Acute relief of obstruction is frequently complicated by fluid and electrolyte imbalance. Standard therapeutic interventions for acute or chronic renal failure also apply for cases of obstructive uropathy. This narrative review summarises the early and long-term medical management of obstructive uropathy.

Life-Threatening Complications Associated with Bladder Decompression: A Case Report

INTRODUCTION

The clinical course of patients who present to the emergency department (ED) with urinary retention is usually uneventful. In this case, we explore the life-threatening complications of urinary retention and bladder decompression.

CASE REPORT

We report the case of a 57-year-old man who presented to the ED with difficulty voiding. A urinary catheter was placed. The patient had severe post-obstructive diuresis. He developed hematuria and became hypotensive. After aggressive resuscitation, including blood products, the patient required operative intervention for hemorrhage control.

CONCLUSION

Clinicians should be aware of and be able to manage the rare but life-threatening complications associated with urinary retention.

The Effect and Safety of Rapid and Gradual Urinary Decompression in Urine Retention: A Systematic Review and Meta-Analysis

Background and objectives: Trials to evaluate the effect and safety of rapid and gradual urinary decompression have been published for decades. Due to inconclusive results, this study aimed to assess whether rapid bladder decompression increased complications in adults with acute urinary retention. Materials and Methods: We searched the Cochrane Library, EMBASE, Google Scholar, and PubMed databases for articles published from the database inception to 31 August 2021. Studies that compared the effects and complication rates of rapid and gradual urinary decompression in adults with acute urinary retention were included. The primary outcome was post-decompression hematuria, while the secondary outcome was circulatory collapse. Meta-analyses were conducted using random effects models. Sensitivity analyses, tests for publication bias, and trial sequential analyses were conducted. The PROSPERO registration number is CRD42021233457. Results: Overall, four articles were included in the comprehensive analysis, and 435 participants met all the eligibility criteria. In the primary meta-analysis of all four study groups, rapid urinary decompression did not increase the risk of post-decompression hematuria (RR = 0.91; 95% CI: 0.62 to 1.35; p = 0.642). The I2 statistic was 0.0% (p = 0.732), indicating no substantial heterogeneity. In the meta-analysis of randomized controlled studies, the result did not change (RR = 0.89; 95% CI: 0.31 to 2.52; p = 0.824). The Egger's test and Begg test (p = 0.339 and 0.497, respectively) indicated the absence of statistical evidence of publication bias. Leave-one-out sensitivity analysis was conducted and showed the pooled results were robust. In secondary outcome, there were no reported events of circulatory collapse in the current studies. Conclusions: The currently available data suggest that rapid urinary decompression is an effective and safe method with a complication rate similar to that of gradual decompression in an acute urinary retention population. Further large-scale randomized studies are required.

Genitourinary Emergencies in Older Adults

Older adults are frequently seen in the emergency department for genitourinary complaints, necessitating that emergency physicians are adept at managing a myriad of genitourinary emergencies. Geriatric patients may present with acute kidney injury, hematuria, or a urinary infection and aspects of how managing these presentations differs from their younger counterparts is emphasized. Older adults may also present with acute urinary retention or urinary incontinence as a result of genitourinary pathology or other systemic etiologies. Finally, genital complaints as they pertain to older adults are briefly highlighted with emphasis on emergent management and appropriate referrals.

Post-obstructive diuresis; underlying causes and hospitalization

Objective: This paper aims to estimate the incidence of post-obstructive diuresis (POD) among patients with urinary retention, explore possible underlying causes and identify patients who need hospitalization.Material and methods: This retrospective study includes patients admitted for urinary retention in Zealand University Hospital, Denmark. We collected demographic characteristics, health information and laboratory results from patients' charts and analyzed data statistically.Results: We assessed 64 patients, and POD occurred in 29.7%. A significant correlation was observed between POD and residual urine, serum creatinine, serum urea and systolic and diastolic blood pressure. We identified increased residual urine volume as an independent predictor of POD by OR 1.21 (95% CI: 1.06-1.40), p = 0.006 per 100 mL and creatinine of >120 umol/L is an independent predictor of POD by OR 7.17 (95% CI; 1.63-31.37), p = 0.009. Patients with residual urine at the time of diagnosis of more than 1150 ml will suffer POD with a probability of area under curve (AUC) 0.874 (p < 0.001) with 84% sensitivity and 78% specificity. Patients with creatinine >120 umol/L will suffer POD with a probability of AUC 0.774 (p < 0.001) with 68% sensitivity and 82% specificity.Conclusion: In this small retrospective study residual urine of more than 1150 mL and elevated creatinine are independent predictors of POD in patients with urinary retention. However, larger prospective studies are needed to confirm these findings.

Urinary Retention

Urinary retention is a common problem encountered in the emergency department. Acute urinary retention (AUR) presents as a sudden inability to voluntarily void, and is typically associated with lower abdominal pain. Its etiology can be varied and multifactorial. Treatment of AUR aims to relieve the obstruction and mitigate the underlying cause of retention. This can generally be accomplished in the emergency department without immediate urologic consultation; however, certain clinical features may require specialist involvement. This article provides an overview of the common causes of urinary retention, as well as emergency department evaluation, treatment, and disposition of patients with acute retention.

Urinary Retention in Surgical Patients

Urinary retention is an important and potentially avoidable postoperative complication. Identifying risk factors for retention is important given expedient bladder decompression is important for long-term outcomes. Age, benign prostatic hyperplasia, and lower urinary tract symptoms are patient factors that predispose to retention. Surgery-related factors include operative time, intravenous fluid administration, type of anesthesia, and procedure type. The mainstay for treatment in the acute setting is Foley catheter placement. Starting alpha-blockers in men is also indicated as they increase voiding trial success. Long-term solutions for chronic retention include a variety of surgeries, with transurethral prostatectomy as the gold standard.