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Wu X, Bai C, Tan Y, Zhang M, Wang H, Liu J, Wang W. Analysis of facilitators and barriers to early urinary catheter removal in postoperative patients by spine surgery nurses: a qualitative study based on the COM-B model in China. BMC Nurs 2025; 24:451. [PMID: 40269907 PMCID: PMC12016386 DOI: 10.1186/s12912-025-03091-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 04/10/2025] [Indexed: 04/25/2025] Open
Abstract
BACKGROUND The high utilization rate of indwelling urinary catheters in patients after spine surgery poses an increased risk for a range of associated complications. Evidence-based recommendations suggest that urinary catheters should be removed early, yet spine surgery nurses are not positive about the behavior of removing catheters early after the surgery. OBJECTIVES The aim of this study was to explore the facilitators and barriers to early catheter removal by spine surgery nurses in postoperative patients, guided by the COM-B model. METHODS This study employed a qualitative study with a descriptive research design. In-depth and semi-structured interviews were carried out to explore facilitators and barriers to early catheter removal in postoperative patients by 18 spine surgery nurses in China. Data were analyzed using traditional content analysis methods. RESULTS We identified 10 barriers and facilitators from capability, opportunity, and motivation based on the COM-B model. (1) capability: lack of knowledge, Lack of standardized protocols, Changes in workload; (2) opportunity: Increase in the demand for human and material resources, Lack of effective communication, Lack of prioritization of early catheter removal; and (3) motivation: Promote patients' early recovery, Conflicting emotions. CONCLUSIONS Nurses encountered barriers from capability, opportunity, and motivation, which were not isolated but interrelated. Future interventions need to incorporate facilitators and barriers to address the issue of early indwelling urinary catheter removal in patients after spine surgery by taking a holistic approach at multiple levels, including nurses, doctors, patients, and health systems.
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Affiliation(s)
- Xiaoyu Wu
- The Clinical Nursing Teaching and Research Section of The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, 410011, China
| | - Chunyan Bai
- The Clinical Nursing Teaching and Research Section of The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, 410011, China
| | - Ya Tan
- The Clinical Nursing Teaching and Research Section of The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, 410011, China
| | - Miaoyuan Zhang
- The Clinical Nursing Teaching and Research Section of The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, 410011, China
| | - Hua Wang
- The Clinical Nursing Teaching and Research Section of The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, 410011, China
| | - Jiayu Liu
- The Clinical Nursing Teaching and Research Section of The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, 410011, China
| | - Wenli Wang
- The Clinical Nursing Teaching and Research Section of The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, 410011, China.
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Sufriyana H, Chen C, Chiu HS, Sumazin P, Yang PY, Kang JH, Su ECY. Estimating individual risk of catheter-associated urinary tract infections using explainable artificial intelligence on clinical data. Am J Infect Control 2025; 53:368-374. [PMID: 39481544 DOI: 10.1016/j.ajic.2024.10.027] [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: 06/26/2024] [Revised: 10/23/2024] [Accepted: 10/24/2024] [Indexed: 11/02/2024]
Abstract
BACKGROUND Catheter-associated urinary tract infections (CAUTIs) increase clinical burdens. Identifying the high-risk patients is crucial. We aimed to develop and externally validate an explainable, prognostic prediction model of CAUTIs among hospitalized individuals receiving urinary catheterization. METHODS A retrospective cohort paradigm was applied for model development and validation using data from 2 hospitals and used the third hospital's data for external validation. Machine learning algorithms were applied for predictive modeling. We evaluated the calibration, clinical utility, and discrimination ability to choose the best model by the validation set. The best model was assessed for the explainability. RESULTS We included 122,417 instances from 20-to-75-year-old subjects. Fourteen predictors were selected from 20 candidates. The best model was the random forest for prediction within 6days. It detected 97.63% (95% confidence interval [CI]: ± 0.06%) CAUTI positive, and 97.36% (95% CI: ± 0.07%) of individuals that were predicted to be CAUTI negative were true negatives. Among those predicted to be CAUTI positives, we expected 22.85% (95% CI: ± 0.07%) of them to truly be high-risk individuals. We provide a web-based application and a paper-based nomogram for using this model. CONCLUSIONS Our prediction model accurately detected most CAUTI-positive cases, while most predicted negative individuals were correctly ruled out.
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Affiliation(s)
- Herdiantri Sufriyana
- Institute of Biomedical Informatics, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Chieh Chen
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hua-Sheng Chiu
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Pavel Sumazin
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Po-Yu Yang
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jiunn-Horng Kang
- Graduate Institute of Nanomedicine and Medical Engineering, Taipei Medical University, Taipei, Taiwan; Research Center for Artificial Intelligence in Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Emily Chia-Yu Su
- Institute of Biomedical Informatics, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan; Research Center for Artificial Intelligence in Medicine, Taipei Medical University, Taipei, Taiwan; Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
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Huang H, Huang L, Yan S, Wang C, Wu T, Chen D, Chen T, Chen H, Huang W, Xue A, Yang J, Chen H, Zhuang G. A bundle-based approach on catheter-associated urinary tract infection: a multi-center study in Chinese tertiary hospitals. BMC Infect Dis 2025; 25:248. [PMID: 39984831 PMCID: PMC11844056 DOI: 10.1186/s12879-025-10638-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Accepted: 02/13/2025] [Indexed: 02/23/2025] Open
Abstract
BACKGROUND Catheter-associated urinary tract infections (CAUTIs) are one of the most common types of healthcare-associated infections (HAIs). Current studies mainly focus on risk factors, but the method to control them is unresolved. We aim to give an overview of the epidemiology of CAUTIs and explore the effects of bundle intervention on intensive care unit (ICU) inpatients. METHODS A multi-center, double-blind, retrospective study was conducted in eight Xiamen medical centers over six months; we recruited ICU inpatients with indwelling urinary catheters (UC) > = 48 h. Data were analyzed using Chi-Square and student's t-test. RESULTS With bundle interventions, the CAUTI rate in ICUs decreased from 3.84 to 1.31 per 1000 UC days. The UC utilization was significantly reduced after bundles (71.29-62.70%), and the average duration of indwelling UC was reduced considerably (7,035 days vs. 6,884 days). CAUTIs in patients over 60 years old were significantly reduced after bundles. There were 45 causative organisms detected from 36 cases of CAUTIs, including 12 multidrug-resistant bacteria. CONCLUSIONS Bundles have been shown to reduce the risk of CAUTIs in patients with indwelling catheters in the ICU, especially older adults. It also significantly reduces the use of Carbapenem. Therefore, CAUTI bundles are recommended to clinicians.
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Affiliation(s)
- Huiping Huang
- School of Public Health, Health Science Center, Xi'an Jiaotong University, 76 West Yanta Road, Xi'an, 710061, China
- Department of Infection Control, the First Affiliated Hospital of Xiamen University, 55 Zhenhai Road, Xiamen, 361003, China
- Xiamen Nosocomial Infection Management Quality Control Center, 55 Zhenhai Road, Xiamen, 361003, China
| | - Lei Huang
- Department of Infection Control, the First Affiliated Hospital of Xiamen University, 55 Zhenhai Road, Xiamen, 361003, China
- Xiamen Nosocomial Infection Management Quality Control Center, 55 Zhenhai Road, Xiamen, 361003, China
| | - Sihan Yan
- Department of Infection Control, Children's Hospital of Fudan University (Xiamen Branch), Xiamen Children's Hospital, 92 Yibing Road, Xiamen, 361006, China
| | - Chuanpeng Wang
- Department of Infection Control, the First Affiliated Hospital of Xiamen University, 55 Zhenhai Road, Xiamen, 361003, China
- Xiamen Nosocomial Infection Management Quality Control Center, 55 Zhenhai Road, Xiamen, 361003, China
| | - Tingting Wu
- Department of Infection Control, Children's Hospital of Fudan University (Xiamen Branch), Xiamen Children's Hospital, 92 Yibing Road, Xiamen, 361006, China
| | - Deqin Chen
- Department of Infection Control, Xiamen Hospital of Traditional Chinese Medicine, 1739 Xianyue Road, Xiamen, 361015, China
| | - Tingting Chen
- Department of Infection Control, Xiamen Changgeng Hospital, Xiamen, 361028, China
| | - Hongbing Chen
- Department of Infection Control, Women and Children's Affiliated Hospital of Xiamen University, 10 Zhenhai Road, Xiamen, 361003, China
| | - Weimin Huang
- Department of Infection Control, Xiamen Medical College Affiliated Haicang Hospital, 89 Haiyu Road, Xiamen, 361026, China
| | - Alin Xue
- Labor Union, Zhongshan Hospital(Xiamen), Fudan University, 668 Jinhu Road, Xiamen, 361015, China
| | - Jianzhou Yang
- School of Public Health, Health Science Center, Xi'an Jiaotong University, 76 West Yanta Road, Xi'an, 710061, China
| | | | - Guihua Zhuang
- School of Public Health, Health Science Center, Xi'an Jiaotong University, 76 West Yanta Road, Xi'an, 710061, China.
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Su L. Effectiveness of Nurse-Driven Protocols in Reducing Catheter-Associated Urinary Tract Infections: A Systematic Review and Meta-Analysis. J Nurs Care Qual 2025; 40:39-45. [PMID: 39418341 DOI: 10.1097/ncq.0000000000000811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2024]
Abstract
BACKGROUND Catheter-associated urinary tract infections (CAUTIs) are common health care-associated infections linked to indwelling urinary catheters. Nurse-driven protocols (NDPs) empower nurses to direct care without physician orders, potentially enhancing patient outcomes and reducing infection rates. PURPOSE This systematic review and meta-analysis aimed to evaluate the effectiveness of NDPs for preventing CAUTIs and reducing catheter utilization rates. METHODS Databases searched included Cochrane Library, PubMed, Embase, and others. Ten studies involving 27, 965 NDP-treated patients and 30, 230 controls were reviewed, examining catheter utilization rates and CAUTI incidence. RESULTS Use of NDPs significantly lowered catheter utilization rates (34.84% vs 49.40%) and CAUTI incidence (2.867% vs 6.503%). Risk ratio analysis revealed a 29.48% decrease in catheter utilization and a 55.91% reduced CAUTI risk with NDP implementation. CONCLUSIONS Using NDPs demonstrate superior efficacy in reducing catheter use and CAUTI occurrence compared to traditional methods. Further research is warranted to solidify evidence-based nursing practices in this area.
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Affiliation(s)
- Liangliang Su
- Author Affiliation: Department of Medical Imaging DSA Room, Affiliated Hospital of Nantong University, Nantong City, Jiangsu Province, China
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Sadanandan B, Vijayalakshmi V, Shetty K, Rathish A, Shivkumar H, Gundreddy M, Narendra NKK, Devaiah NM. In Situ Aqueous Spice Extract-Based Antifungal Lock Strategy for Salvage of Foley's Catheter Biofouled with Candida albicans Biofilm Gel. Gels 2025; 11:23. [PMID: 39851994 PMCID: PMC11765466 DOI: 10.3390/gels11010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Revised: 12/16/2024] [Accepted: 12/28/2024] [Indexed: 01/26/2025] Open
Abstract
Candida forms a gel-like biofilm in the Foley's catheter (FC) causing tenacious biofouling and severe urinary tract infections (UTIs). For the first time, a spice extract-based antifungal lock therapy (ALT) has been developed to inhibit the Candida albicans gel matrix in FC. Aqueous extracts of garlic, clove, and Indian gooseberry were used as ALT lock solutions and tested against biofilm-forming multidrug-resistant clinical isolates of C. albicans. Reduction in the gel matrices formation in the catheter was confirmed by Point inoculation, MTT assay, CFU, and SEM analysis at 12 and 24 h of incubation. Garlic was effective in controlling both C. albicans M207 and C. albicans S470; however, clove and gooseberry effectively controlled the latter. As evidenced by CFU assay, there were 82.85% and 99.68% reductions in the growth of C. albicans M207 and S470, respectively, at 24 h of incubation. SEM revealed a switch from the biofilm to the yeast mode and a drastic reduction in cell numbers, with mostly clumped or lysed cells. The study will provide an impetus to the development of novel spice extract-based ALT, reducing the selection pressure on the pathogen and lowering antimicrobial resistance. Further research in this area has the potential to leverage clinical applications.
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Affiliation(s)
- Bindu Sadanandan
- Department of Biotechnology, M S Ramaiah Institute of Technology, Bengaluru 560054, Karnataka, India; (V.V.); (A.R.); (H.S.); (M.G.); (N.K.K.N.); (N.M.D.)
| | - Vaniyamparambath Vijayalakshmi
- Department of Biotechnology, M S Ramaiah Institute of Technology, Bengaluru 560054, Karnataka, India; (V.V.); (A.R.); (H.S.); (M.G.); (N.K.K.N.); (N.M.D.)
| | - Kalidas Shetty
- Department of Plant Sciences, North Dakota State University, Fargo, ND 58105, USA;
| | - Adithya Rathish
- Department of Biotechnology, M S Ramaiah Institute of Technology, Bengaluru 560054, Karnataka, India; (V.V.); (A.R.); (H.S.); (M.G.); (N.K.K.N.); (N.M.D.)
| | - Harshala Shivkumar
- Department of Biotechnology, M S Ramaiah Institute of Technology, Bengaluru 560054, Karnataka, India; (V.V.); (A.R.); (H.S.); (M.G.); (N.K.K.N.); (N.M.D.)
| | - Malavika Gundreddy
- Department of Biotechnology, M S Ramaiah Institute of Technology, Bengaluru 560054, Karnataka, India; (V.V.); (A.R.); (H.S.); (M.G.); (N.K.K.N.); (N.M.D.)
| | - Nikhil Kumar Kagganti Narendra
- Department of Biotechnology, M S Ramaiah Institute of Technology, Bengaluru 560054, Karnataka, India; (V.V.); (A.R.); (H.S.); (M.G.); (N.K.K.N.); (N.M.D.)
| | - Nethra Machamada Devaiah
- Department of Biotechnology, M S Ramaiah Institute of Technology, Bengaluru 560054, Karnataka, India; (V.V.); (A.R.); (H.S.); (M.G.); (N.K.K.N.); (N.M.D.)
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Wu J, Yan J, Xu S, Zou X, Xu Y, Jin X, Lu X, Gui S. Novel Nano Drug-Loaded Hydrogel Coatings for the Prevention and Treatment of CAUTI. Adv Healthc Mater 2024; 13:e2401745. [PMID: 39180266 PMCID: PMC11616261 DOI: 10.1002/adhm.202401745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 08/13/2024] [Indexed: 08/26/2024]
Abstract
Catheter-associated urinary tract infection (CAUTI) is a prevalent type of hospital-acquired infection, affecting approximately 15% to 25% of patients with urinary catheters. Long-term use of the catheter can lead to colonization of microorganisms and biofilm formation, and may develop into bacterial CAUTI. However, the frequent replacement of catheters in clinical settings can result in tissue damage, inflammation, ulceration, and additional complications, causing discomfort and pain for patients. In light of these challenges, a novel nanodrug-supported hydrogel coating called NP-AM/FK@OMV-P/H has been developed in this study. Through in vitro experiments, it is confirmed that OMV nano-loaded liquid gel coating has an effective reaction against E.coli HAase and releases antibacterial drugs. This coating has also demonstrated strong inhibition of E.coli and has shown the ability to inhibit the formation of bacterial biofilm. These findings highlight the potential of the OMV nanoparticle gel coating in preventing and treating bacterial infections. Notably, NP-AM/FK@OMV-P/H has exhibited greater efficacy against multidrug-resistant E.coli associated with UTIs compared to coatings containing single antimicrobial peptides or antibiotics. Additionally, it has demonstrated good biosecurity. In conclusion, the NP-AM/FK@OMV-P/H coating holds great potential in providing benefits to patients with CAUTI.
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Affiliation(s)
- Jibin Wu
- Intensive Care Unit, Shenzhen Second People's Hospitalthe First Affiliated Hospital of Shenzhen UniversityShenzhen518031P. R. China
- Shenzhen Center for Disease Control and PreventionShenzhen518055P. R. China
- Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, Institute of Pharmaceutical Bioactive Substances, School of Basic Medical SciencesGuangdong Pharmaceutical UniversityGuangzhou510006P. R. China
| | - Jianling Yan
- Intensive Care Unit, Shenzhen Second People's Hospitalthe First Affiliated Hospital of Shenzhen UniversityShenzhen518031P. R. China
- Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, Institute of Pharmaceutical Bioactive Substances, School of Basic Medical SciencesGuangdong Pharmaceutical UniversityGuangzhou510006P. R. China
| | - Sijia Xu
- Intensive Care Unit, Shenzhen Second People's Hospitalthe First Affiliated Hospital of Shenzhen UniversityShenzhen518031P. R. China
- Shenzhen Center for Disease Control and PreventionShenzhen518055P. R. China
- Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, Institute of Pharmaceutical Bioactive Substances, School of Basic Medical SciencesGuangdong Pharmaceutical UniversityGuangzhou510006P. R. China
| | - Xuan Zou
- Shenzhen Center for Disease Control and PreventionShenzhen518055P. R. China
| | - Yinghua Xu
- Key Laboratory of the Ministry of Health for Research on Quality and Standardization of Biotech ProductsNational Institutes for Food and Drug ControlBeijing102629P. R. China
| | - Xiaobao Jin
- Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, Institute of Pharmaceutical Bioactive Substances, School of Basic Medical SciencesGuangdong Pharmaceutical UniversityGuangzhou510006P. R. China
| | - Xuemei Lu
- Shenzhen Center for Disease Control and PreventionShenzhen518055P. R. China
- Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, Institute of Pharmaceutical Bioactive Substances, School of Basic Medical SciencesGuangdong Pharmaceutical UniversityGuangzhou510006P. R. China
| | - Shuiqing Gui
- Intensive Care Unit, Shenzhen Second People's Hospitalthe First Affiliated Hospital of Shenzhen UniversityShenzhen518031P. R. China
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Yu XL, Zhou LY, Huang X, Li XY, Pan QQ, Wang MK, Yang JS. Urgent call for attention to diabetes-associated hospital infections. World J Diabetes 2024; 15:1683-1691. [PMID: 39192868 PMCID: PMC11346093 DOI: 10.4239/wjd.v15.i8.1683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/14/2024] [Accepted: 06/07/2024] [Indexed: 07/25/2024] Open
Abstract
In this editorial, we discuss the recent article by Zhao et al published in the World Journal of Diabetes, which highlights the importance of recognizing the risk indicators associated with diabetes mellitus (DM). Given the severe implications of healthcare-associated infections (HAIs) in hospitalized individuals- such as heightened mortality rates, prolonged hospitalizations, and increased costs- we focus on elucidating the connection between DM and nosocomial infections. Diabetic patients are susceptible to pathogenic bacterial invasion and subsequent infection, with some already harboring co-infections upon admission. Notably, DM is an important risk factor for nosocomial urinary tract infections and surgical site infections, which may indirectly affect the occurrence of nosocomial bloodstream infections, especially in patients with DM with poor glycemic control. Although evidence regarding the impact of DM on healthcare-associated pneumonias remains inconclusive, attention to this potential association is warranted. Hospitalized patients with DM should prioritize meticulous blood glucose management, adherence to standard operating procedures, hand hygiene pra-ctices, environmental disinfection, and rational use of drugs during hospitalization. Further studies are imperative to explore the main risk factors of HAIs in patients with DM, enabling the development of preventative measures and mitigating the occurrence of HAIs in these patients.
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Affiliation(s)
- Xue-Lu Yu
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Li-Yun Zhou
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Xiao Huang
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Xin-Yue Li
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Qing-Qing Pan
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Ming-Ke Wang
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Ji-Shun Yang
- Medical Care Center, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
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Banerjee I, Robinson J, Banerjee I. Medicated Foley Catheters Do Not Prevent Catheter-Associated Urinary Tract Infection: A Systematic Review of Randomized Controlled Trials. Cureus 2024; 16:e66235. [PMID: 39238721 PMCID: PMC11375116 DOI: 10.7759/cureus.66235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2024] [Indexed: 09/07/2024] Open
Abstract
Infections of the urinary tract are among some of the most common infections treated in clinical practice. Numerous risk factors play an intrinsic role in the development of such infections, namely: age, sexual intercourse, prolonged use of feminine hygiene products, instrumentation, pregnancy, sexually transmitted infections, obstructive uropathy such as prostatic enlargement or urethral strictures, compromised immunity, and constipation. A major cause of urinary tract infections (UTIs) in hospitalized patients is catheter-associated urinary tract infections (CAUTIs). This systematic review aims to identify the causative agents and risk factors and to determine whether nitrofurazone, silver alloy, or zinc oxide-impregnated or coated/medicated Foley catheters, or non-medicated (standard) Foley catheters, can reduce the incidence of CAUTIs. A systematic review was conducted on the following databases: PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Trip medical database, and Google Scholar. A combination of keywords and Boolean operators was used ((((urinary tract infections) OR (urinary catheterization)) OR (prevention AND control)) ) AND (catheter-associated infections) for data extraction. All the randomized controlled clinical trials (RCTs) completed and available between January 1, 2005, and June 30, 2024, which focused on the prevention of CAUTIs, were screened thoroughly and were included in this systematic review. The Cochrane risk-of-bias tool for randomized trials (RoB 2) tool was used for risk of bias assessment. The Robvis visualization tool (McGuinness, LA, Higgins, JPT. Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualizing risk-of-bias assessments. Res Syn Meth. 2020; 1-7) was used for development of traffic light plots and weighted bar plots for risk of bias. The literature search conducted produced 41,909 articles. Among these 19,076 were noted as duplicates and were excluded in the initial analysis; 22,833 manuscripts were thus screened after deduplication. Abstracts, case studies, reports, editorials, viewpoints, cross-sectional studies, cohort studies, case-control studies, case series, and letters to the editor/correspondence manuscripts (n = 22,745) were additionally excluded. A total of 88 full-text articles were assessed for eligibility. An in-depth evaluation and analysis further excluded 82 articles from the analysis quality assessment based on inclusion and exclusion criteria. Six RCTs were finally assessed regarding the prevention of CAUTIs and were ultimately included in the systematic review. The primary causative agents involved in the CAUTIs were found to be mainly Gram-negative bacteria such as Escherichia coli, Pseudomonas aeruginosa, and Enterococcus faecalis. The risk factors noted for the development of these CAUTIs ranged from urethral trauma, overdistention of the bladder, prolonged catheterization, to improper handling of the urine bag. No significant advantage was noted between the use of medicated and non-medicated standard Foley catheters. The aseptic technique and indications followed for the catheterization play a vital role in the prevention of CAUTIs, and more cognizance thereof will aid in the reduction of the development of CAUTIs.
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Affiliation(s)
- Indraneel Banerjee
- Department of Urology and Robotic Surgery, Penn Highlands Healthcare, Dubois, USA
| | - Jared Robinson
- Department of Surgery, Sir Seewosagur Ramgoolam Medical College, Belle Rive, MUS
| | - Indrajit Banerjee
- Department of Pharmacology, Sir Seewosagur Ramgoolam Medical College, Belle Rive, MUS
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Kim KH, Chung KJ. Improving Foley Catheter Insertion Procedure by Developing Foley Introducer: A 100-Year Overdue Innovation. Int Neurourol J 2023; 27:S34-39. [PMID: 37280758 DOI: 10.5213/inj.2346098.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/17/2023] [Indexed: 06/08/2023] Open
Abstract
PURPOSE Foley catheter (FC) insertion is very basic yet one of the most widely performed procedures all across the fields of medicine. Since FC was first introduced in 19020's, no significant improvement has been made in view of methodology, despite the inconvenience associated with cumbersome preparation, procedure, and the patients' discomfort with having to have their genitalia exposed. We developed a new, easy-to-use FC insertion device, Quick Foley, that provides an innovative approach to introducing FC while simplifying and minimizing time spent without compromising the sterility. METHODS We developed an all-in-one disposable FC introducer contains all the necessary components in a single-device-kit. Minimal plastic components are necessary to keep accuracy and consistency, but the rest are made of the paper to minimize plastic waste. The preparation is done by connecting to the drainage bag, spurring the lubricant gel through gel insert, separating the tract, and connecting with the ballooning syringe. For the insertion, after sterilizing the urethral orifice, rotate the control knob to feed FC to the end of the urethra. After ballooning, dissembling of the device is done only by opening and removing the module, then only the FC remains. RESULTS As the device is all-in-one, there is no need to prearrange the FC tray, simplifies the FC preparation and catheterization procedure. This device not only makes it convenient for the practitioner, but ultimately, it will reduce the psychological discomfort experienced by patient by truncating perineal exposure time. CONCLUSION We have successfully developed a novel device that reduces the cost and burden of using FC for practitioners while maintaining an aseptic technique. Furthermore, this all-in-one device allows the entire procedure to be completed much more quickly compared to the current method, so this minimizes perineal exposure time. Both practitioners and patients can benefit by this new device.
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Affiliation(s)
- Khae Hawn Kim
- Department of Urology, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Korea
| | - Kyung Jin Chung
- Department of Urology, Gachon University, Gil Medical Center, Gachon University School of Medicine, Incheon, Korea
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10
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Lila ASA, Rajab AAH, Abdallah MH, Rizvi SMD, Moin A, Khafagy ES, Tabrez S, Hegazy WAH. Biofilm Lifestyle in Recurrent Urinary Tract Infections. LIFE (BASEL, SWITZERLAND) 2023; 13:life13010148. [PMID: 36676100 PMCID: PMC9865985 DOI: 10.3390/life13010148] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/27/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023]
Abstract
Urinary tract infections (UTIs) represent one of the most common infections that are frequently encountered in health care facilities. One of the main mechanisms used by bacteria that allows them to survive hostile environments is biofilm formation. Biofilms are closed bacterial communities that offer protection and safe hiding, allowing bacteria to evade host defenses and hide from the reach of antibiotics. Inside biofilm communities, bacteria show an increased rate of horizontal gene transfer and exchange of resistance and virulence genes. Additionally, bacterial communication within the biofilm allows them to orchestrate the expression of virulence genes, which further cements the infestation and increases the invasiveness of the infection. These facts stress the necessity of continuously updating our information and understanding of the etiology, pathogenesis, and eradication methods of this growing public health concern. This review seeks to understand the role of biofilm formation in recurrent urinary tact infections by outlining the mechanisms underlying biofilm formation in different uropathogens, in addition to shedding light on some biofilm eradication strategies.
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Affiliation(s)
- Amr S. Abu Lila
- Department of Pharmaceutics, College of Pharmacy, University of Ha’il, Ha’il 81442, Saudi Arabia
- Molecular Diagnostics and Personalized Therapeutics Unit, University of Ha’il, Ha’il 81442, Saudi Arabia
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt
- Correspondence: (A.S.A.L.); (W.A.H.H.)
| | - Azza A. H. Rajab
- Department of Microbiology and Immunology, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt
| | - Marwa H. Abdallah
- Department of Pharmaceutics, College of Pharmacy, University of Ha’il, Ha’il 81442, Saudi Arabia
- Molecular Diagnostics and Personalized Therapeutics Unit, University of Ha’il, Ha’il 81442, Saudi Arabia
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt
| | - Syed Mohd Danish Rizvi
- Department of Pharmaceutics, College of Pharmacy, University of Ha’il, Ha’il 81442, Saudi Arabia
- Molecular Diagnostics and Personalized Therapeutics Unit, University of Ha’il, Ha’il 81442, Saudi Arabia
| | - Afrasim Moin
- Department of Pharmaceutics, College of Pharmacy, University of Ha’il, Ha’il 81442, Saudi Arabia
- Molecular Diagnostics and Personalized Therapeutics Unit, University of Ha’il, Ha’il 81442, Saudi Arabia
| | - El-Sayed Khafagy
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Suez Canal University, Ismailia 41522, Egypt
| | - Shams Tabrez
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Wael A. H. Hegazy
- Department of Microbiology and Immunology, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt
- Pharmacy Program, Department of Pharmaceutical Sciences, Oman College of Health Sciences, Muscat 113, Oman
- Correspondence: (A.S.A.L.); (W.A.H.H.)
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