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Di Cola S, Gazda J, Lapenna L, Ceccarelli G, Merli M. Infection prevention and control programme and COVID-19 measures: Effects on hospital-acquired infections in patients with cirrhosis. JHEP Rep 2023; 5:100703. [PMID: 36844944 PMCID: PMC9938945 DOI: 10.1016/j.jhepr.2023.100703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/21/2023] [Accepted: 01/30/2023] [Indexed: 02/22/2023] Open
Abstract
Background & Aims Bacterial infections affect survival of patients with cirrhosis. Hospital-acquired bacterial infections present a growing healthcare problem because of the increasing prevalence of multidrug-resistant organisms. This study aimed to investigate the impact of an infection prevention and control programme and coronavirus disease 2019 (COVID-19) measures on the incidence of hospital-acquired infections and a set of secondary outcomes, including the prevalence of multidrug-resistant organisms, empiric antibiotic treatment failure, and development of septic states in patients with cirrhosis. Methods The infection prevention and control programme was a complex strategy based on antimicrobial stewardship and the reduction of patient's exposure to risk factors. The COVID-19 measures presented further behavioural and hygiene restrictions imposed by the Hospital and Health Italian Sanitary System recommendations. We performed a combined retrospective and prospective study in which we compared the impact of extra measures against the hospital standard. Results We analysed data from 941 patients. The infection prevention and control programme was associated with a reduction in the incidence of hospital-acquired infections (17 vs. 8.9%, p <0.01). No further reduction was present after the COVID-19 measures had been imposed. The impact of the infection prevention and control programme remained significant even after controlling for the effects of confounding variables (odds ratio 0.44, 95% CI 0.26-0.73, p = 0.002). Furthermore, the adoption of the programme reduced the prevalence of multidrug-resistant organisms and decreased rates of empiric antibiotic treatment failure and the development of septic states. Conclusions The infection prevention and control programme decreased the incidence of hospital-acquired infections by nearly 50%. Furthermore, the programme also reduced the prevalence of most of the secondary outcomes. Based on the results of this study, we encourage other liver centres to adopt infection prevention and control programmes. Impact and implications Infections are a life-threatening problem for patients with liver cirrhosis. Moreover, hospital-acquired infections are even more alarming owing to the high prevalence of multidrug-resistant bacteria. This study analysed a large cohort of hospitalised patients with cirrhosis from three different periods. Unlike in the first period, an infection prevention programme was applied in the second period, reducing the number of hospital-acquired infections and containing multidrug-resistant bacteria. In the third period, we imposed even more stringent measures to minimise the impact of the COVID-19 outbreak. However, these measures did not result in a further reduction in hospital-acquired infections.
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Key Words
- ALD, alcoholic liver disease
- Antibiotic resistance
- Antimicrobial stewardship
- BB, beta-blockers
- Bacterial infections
- C19MC, COVID-19 measures cohort
- CA, community acquired
- COVID-19, coronavirus disease 2019
- CRP, C-reactive protein
- EATF, empiric antibiotic treatment failure
- Empiric antibiotic failure
- HAI, hospital-acquired infection
- HCA, healthcare-associated
- IPCC, infection prevention and control cohort
- IPCP, infection prevention and control programme
- Liver cirrhosis
- MAP, mean arterial pressure
- MDR, multidrug-resistant
- MELD, model for end-stage liver disease
- Multidrug-resistant bacteria
- NASH, non-alcoholic steatohepatitis
- Nosocomial infections
- OR, odds ratio
- PDR, pandrug-resistant
- PPI, proton pump inhibitor
- SARS-CoV-2
- SBP, spontaneous bacterial peritonitis
- SMC, standard measures cohort
- UTI, urinary tract infection
- WBC, white blood cell
- XDR, extensively drug-resistant
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Affiliation(s)
- Simone Di Cola
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Jakub Gazda
- 2nd Department of Internal Medicine, Pavol Jozef Safarik University and Louis Pasteur University Hospital, Kosice, Slovakia
| | - Lucia Lapenna
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Giancarlo Ceccarelli
- Department of Internal Medicine, Endocrinology and Metabolic Science and Infectious Diseases, University Hospital Policlinico Umberto I, Rome, Italy
| | - Manuela Merli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
- Corresponding author. Address: Department of Translational and Precision Medicine, ‘Sapienza’ University of Rome, Viale dell’Universita’ 37, 00185 Rome, Italy. Tel.: +39-064-997-2001..
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Sirls E, Peters KM, Sirls LT. Intradetrusor OnabotuliniumtoxinA injection for refractory bladder spasms before vesicovaginal fistula repair. Urol Case Rep 2022; 46:102307. [PMID: 36606098 PMCID: PMC9807992 DOI: 10.1016/j.eucr.2022.102307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/14/2022] [Accepted: 12/24/2022] [Indexed: 12/26/2022] Open
Abstract
This is a report of a women who failed 2 surgical repairs of vesicovaginal fistula secondary to refractory bladder spasms. After each surgical procedure - the hysterectomy and subsequent fistula repairs - the patient reported severe bladder spasms refractory to medical management. Our treatment was intradetrusor onabotuliniumtoxinA injections 4 weeks prior to a planned surgical fistula repair. The patient had successful vaginal approach fistula repair and has not required any subsequent overactive bladder (OAB) treatment.
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Affiliation(s)
| | - Kenneth M. Peters
- Beaumont Health, Royal Oak, MI, USA
- Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Larry T. Sirls
- Beaumont Health, Royal Oak, MI, USA
- Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
- Corresponding author. 3535 W 13 Mile Road, Suite 438, Royal Oak, MI, 248 561 4625, USA.
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Kanj SS, Bassetti M, Kiratisin P, Rodrigues C, Villegas MV, Yu Y, van Duin D. Clinical data from studies involving novel antibiotics to treat multidrug-resistant Gram-negative bacterial infections. Int J Antimicrob Agents 2022; 60:106633. [PMID: 35787918 DOI: 10.1016/j.ijantimicag.2022.106633] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 06/15/2022] [Accepted: 06/26/2022] [Indexed: 11/05/2022]
Abstract
Multidrug-resistant (MDR) Gram-negative bacteria (GNB) are a critical threat to healthcare worldwide, worsening outcomes and increasing mortality among infected patients. Carbapenemase- and extended-spectrum β-lactamase-producing Enterobacterales, as well as carbapenemase-producing Pseudomonas and Acinetobacter spp., are common MDR pathogens. To address this threat, new antibiotics and combinations have been developed. Clinical trial findings support several combinations, notably ceftazidime-avibactam (CZA, a cephalosporin-β-lactamase inhibitor combination) which is effective in treating complicated urinary tract infections (cUTI), complicated intra-abdominal infections and hospital-acquired and ventilator-associated pneumonia caused by GNBs. Other clinically effective combinations include meropenem-vaborbactam (MVB), ceftolozane-tazobactam (C/T) and imipenem- relebactam (I-R). Cefiderocol is a recent siderophore β-lactam antibiotic that is useful against cUTIs caused by carbapenem-resistant Enterobacterales (CRE) and is stable against many β-lactamases. CRE are a genetically heterogeneous group that vary in different world regions and are a substantial cause of infections, among which Klebsiella pneumoniae are the most common. Susceptible CRE infections can be treated with fluoroquinolones, aminoglycosides or fosfomycin, but alternatives include CZA, MVB, I-R, cefiderocol, tigecycline and eravacycline. MDR Acinetobacter baumannii and Pseudomonas aeruginosa are increasingly common pathogens producing a range of different carbapenemases, and infections are challenging to treat, often requiring novel antibiotics or combinations. Currently, no single agent can treat all MDR-GNB infections, but new β-lactam-β-lactamase inhibitor combinations are often effective for different infection sites, and, when used appropriately, have the potential to improve outcomes. This article reviews clinical studies investigating novel β-lactam approaches for treatment of MDR-GNB infections.
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Key Words
- Antibiotic resistance
- BAT, best available treatment
- BL, β-lactamase
- BL–BLI, β-lactam-β-lactamase inhibitor
- BSI, bloodstream infection
- C/T, ceftolozane–tazobactam
- CAZ, ceftazidime
- CDC, Centers for Disease Control and Prevention
- CRAB, carbapenem-resistant Acinetobacter baumannii
- CRE, carbapenem-resistant Enterobacterales
- CRKP, carbapenem-resistant K. pneumoniae
- CRPA, carbapenem-resistant Pseudomonas aeruginosa
- CZA, ceftazidime–avibactam
- Clinical trial
- DBO, diazabicyclooctane
- ESBL, extended-spectrum β-lactamase
- FDA, US Food and Drug Administration
- GNB, Gram-negative bacteria
- Gram-negative bacteria Abbreviations: AVI, avibactam
- HAP, hospital-acquired pneumonia
- IAI, intra-abdominal infection
- ICU, intensive care unit
- IDSA, Infectious Diseases Society of America
- IPM, imipenem
- I–R, imipenem–relebactam
- KPC, Klebsiella pneumoniae carbapenemase
- MBL, metallo-β-lactamase
- MDR, multidrug-resistant
- MEM, meropenem
- MIC, minimum inhibitory concentration
- MVB, meropenem–vaborbactam
- NDM, New Delhi metallo-β-lactamase
- OXA, oxacillinase
- REL, relebactam
- US, United States
- UTI, urinary tract infection
- VAB, vaborbactam
- VAP, ventilator-associated pneumonia
- VIM, Verona integron-encoded metallo-β-lactamase
- XDR, extensively drug-resistant
- cIAI, complicated intra-abdominal infection
- cUTI, complicated urinary tract infection
- β-lactam-β-lactamase inhibitor
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Affiliation(s)
- Souha S Kanj
- Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
| | - Matteo Bassetti
- Department of Health Science, University of Genoa, Italy; Infectious Diseases Clinic, Ospedale Policlinico San Martino Hospital - IRCCS, Genoa, Italy
| | - Pattarachai Kiratisin
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Camilla Rodrigues
- Department of Microbiology, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - María Virginia Villegas
- Grupo de Investigaciones en Resistencia Antimicrobiana y Epidemiología Hospitalaria (RAEH), Universidad El Bosque, Bogotá D.C., Colombia
| | - Yunsong Yu
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, Zhejiang, China
| | - David van Duin
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
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Chang Y, Chi KY, Tai TW, Cheng YS, Lee PH, Huang CC, Lee JS. Risk factors for postoperative urinary retention following elective spine surgery: a meta-analysis. Spine J 2021; 21:1802-11. [PMID: 34015508 DOI: 10.1016/j.spinee.2021.05.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/18/2021] [Accepted: 05/07/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Limited studies have investigated risk factors for postoperative urinary retention (POUR) following elective spine surgery. Furthermore, some discrepancies have been found in the results of existing observational studies. PURPOSE This study aimed to review the available literature on risk factors associated with POUR following elective spine surgery. STUDY DESIGN A systematic review with meta-analysis was performed. PATIENT SAMPLE A total of 31,251 patients (POUR=2,858, no POUR=28,393) were included in the meta-analysis. OUTCOME MEASURES Demographics, type of elective spine surgery, country, definition of POUR, and potential risk factors for POUR were evaluated. METHODS The Cochrane Library, Embase, and Medline electronic databases were searched to identify relevant studies. Binary outcomes were reported as odds ratio (OR). Weighted mean differences (WMD) or standardized mean differences (SMD), with 95% confidence intervals (CI), were used for meta-analysis of continuous outcomes. RESULTS Eleven studies (2 prospective and 9 retrospective) were included in the analysis. Patients with POUR were older than those without POUR (WMD, 7.13; 95% CI, 4.50-9.76). Male patients were found to have an increased risk of POUR (OR, 1.31; 95% CI, 1.04-1.64). The following variables were also identified as significant risk factors for POUR: benign prostatic hyperplasia (BPH; OR, 3.79; 95% CI, 1.89-7.62), diabetes mellitus (DM; OR, 1.50; 95% CI, 1.17-1.93), and previous urinary tract infection (UTI; OR, 1.70; 95% CI, 1.28-2.24). Moreover, longer operative time (WMD, 19.88; 95% CI, 5.01-34.75) and increased intraoperative fluid support (SMD, 0.37; 95% CI, 0.23-0.52) were observed in patients with POUR. In contrast, spine surgical procedures involving fewer levels (OR, 0.75; 95% CI, 0.65-0.86), and ambulation on the same day as surgery (OR, 0.65; 95% CI, 0.52-0.81) were associated with a decreased risk of POUR. CONCLUSIONS Based on our meta-analysis, older age, male gender, BPH, DM, and a history of UTI are risk factors for POUR following elective spine surgery. We also found that longer operative time and increased intravenous fluid support would increase the risk of POUR. Additionally, multi-level spine surgery may have a negative effect on postoperative voiding.
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Key Words
- CAD, coronary artery disease
- CI, confidence Interval
- DM, diabetes mellitus
- Elective surgery
- IAP, intra-abdominal pressure
- IQR, interquartile range
- Meta-analysis Abbreviations: BPH, benign prostatic hyperplasia
- OR, odds ratio
- POUR, postoperative urinary retention
- PVR, post-void residual
- Postoperative urinary retention
- Risk factor
- SD, standard deviation
- SMD, standardized mean differences
- Spine surgery
- Systematic review
- UTI, urinary tract infection
- WMD, weighted mean difference
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Thomas AA, Korienek PJ, Reid SA, Dierkhising RA, Dababneh AS, Lessard SR. Effect of Pharmacist Audit on Antibiotic Duration for Pneumonia and Urinary Tract Infection. Mayo Clin Proc Innov Qual Outcomes 2021; 5:763-769. [PMID: 34377948 PMCID: PMC8332370 DOI: 10.1016/j.mayocpiqo.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To assess the effect of clinical pharmacists in daily audits, under the direction of an antimicrobial stewardship program, of antibiotic treatment durations for the common inpatient disease states of community-acquired pneumonia (CAP) and urinary tract infection (UTI). PATIENTS AND METHODS This was a retrospective single-center cohort study that evaluated the difference in the duration of antibiotic therapy for CAP or non-catheter-associated UTI of hospitalized patients who received a daily audit by clinical pharmacists compared with patients who did not receive a daily audit. Retrospective chart review included randomly selected hospitalized patients diagnosed with CAP or UTI during preaudit and postaudit periods. RESULTS The preaudit group had 64 patients; and the postaudit group, 51 patients. The therapy duration was 7 days in the preaudit group and 6 days in the postaudit group (P=.55). Fluoroquinolone use was reduced in the postaudit group and was significantly less than in the preaudit group (24 [37.5%] vs 7 [13.7%]; P=.007). CONCLUSION The daily audits of clinical pharmacists may be an effective method to reduce the duration of antibiotic therapy and are effective in the reduction of fluoroquinolone use. Additional studies must be done to further investigate the effects of clinical pharmacist antimicrobial stewardship efforts.
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Affiliation(s)
- Ashley A. Thomas
- Pharmacy Services, Mayo Clinic Health System – Southwest Wisconsin Region, La Crosse
| | - Patrick J. Korienek
- Pharmacy Services, Mayo Clinic Health System – Southwest Wisconsin Region, La Crosse
| | - Stacy A. Reid
- Pharmacy Services, Mayo Clinic Health System – Southwest Wisconsin Region, La Crosse
| | | | | | - Sarah R. Lessard
- Pharmacy Services, Mayo Clinic Health System – Southwest Wisconsin Region, La Crosse
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Dramowski A, Pillay S, Bekker A, Abrahams I, Cotton MF, Coffin SE, Whitelaw AC. Impact of 1% chlorhexidine gluconate bathing and emollient application on bacterial pathogen colonization dynamics in hospitalized preterm neonates - A pilot clinical trial. EClinicalMedicine 2021; 37:100946. [PMID: 34195575 PMCID: PMC8225683 DOI: 10.1016/j.eclinm.2021.100946] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Chlorhexidine gluconate (CHG) body washes and emollient application may modulate bacterial pathogen colonization and prevent neonatal hospital-acquired infections. METHODS This pilot, non-randomized, open-label trial, enrolled preterm neonates (1000-1500g; day 1-3 of life) at a tertiary hospital in Cape Town, South Africa. Participants were sequentially allocated to 4 trial arms (n=20 each): 1% aqueous CHG (CHG), 1% CHG plus emollient (CHG+EM), emollient only (EM) and standard of care (SOC: no antiseptic/emollient). Trial treatment/s were applied daily for 10 days (d) post-enrolment, documenting neonatal skin condition score. Anterior nose, neck, umbilical and perianal swabs for bacterial culture were collected at d1, d3, d10 and d16 post-enrolment, (±1 day), reporting pathogen acquisition rates and semi-quantitative bacterial colony counts. (ClinicalTrials.gov identifier: NCT03896893; trial status: closed). FINDINGS Eighty preterm neonates (mean gestational age 30 weeks [SD 2]) were enrolled between 4 March and 26 August 2019. The bacterial pathogen acquisition rate (comparing d1 and d16 swabs) varied from 33·9% [95%CI 22·9-47·0] at the umbilicus, 39·3% [95%CI 27·6-52·4] at the neck, to 71·4% [95%CI 58·5-81·7] at both the nose and perianal region. At d10, CHG babies had reduced bacterial density detected from neck, umbilicus, and perianal swabs compared to other groups (see Table 3). Following intervention cessation, colonization density was similar across all trial arms, but S. aureus colonization was more prevalent among EM and CHG+EM babies. Neonatal skin condition score improved in babies receiving emollient application (EM: -0·87 [95%CI 0·69-1·06] and CHG+EM: -0·73 [0·45-0·99]), compared to the SOC and CHG arms (Table 2); no CHG-related skin reactions occurred. INTERPRETATION Bacterial colonization density was significantly reduced in babies receiving 1% CHG washes but colonization levels rebounded rapidly post-intervention. Emollient application improved skin condition but was associated with higher rates of S. aureus colonization. FUNDING South African Medical Research Council; National Institutes of Health (TW010682).
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Key Words
- ACC, aerobic colony count
- AE, adverse event
- AMR, antimicrobial resistance
- ART, antiretroviral therapy
- BSI, bloodstream infection
- CFU, colony forming unit
- CHG, chlorhexidine gluconate
- CI, confidence interval
- EM, emollient
- ESBL, extended-spectrum B-lactamase
- HAI, healthcare-associated infection
- HIV, human immunodeficiency virus
- IPC, infection prevention and control
- KMC, kangaroo mother care
- LMIC, low-to-middle income countries
- NEC, necrotizing enterocolitis
- NICU, neonatal intensive care unit
- SD, standard deviation
- SOC, standard of care
- UIPC, Unit for Infection Prevention and Control
- UTI, urinary tract infection
- VLBW, very low birth weight
- bacterial colonization
- chlorhexidine gluconate
- d, day
- emollient
- hospital-acquired infection
- infection prevention
- nCPAP, nasal cannula positive airways pressure
- neonatal unit
- spp, species
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Affiliation(s)
- Angela Dramowski
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town 8000, South Africa
- Corresponding author.
| | - Sheylyn Pillay
- Division of Medical Microbiology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Adrie Bekker
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town 8000, South Africa
| | - Ilhaam Abrahams
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town 8000, South Africa
| | - Mark F. Cotton
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town 8000, South Africa
| | - Susan E. Coffin
- Division of Infectious Diseases, Children's Hospital of Philadelphia and Department of Paediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Andrew C. Whitelaw
- Division of Medical Microbiology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
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Nagata J, Kawasaki T, Iesato K, Sugiura T, Yamauchi K, Tsuyusaki J, Fujimura M, Kuroda F, Mikami K, Dudek SM, Tanabe N. A Case of Candidemia after Long-term Presence of Urethral Foreign Bodies. IDCases 2021; 25:e01176. [PMID: 34159054 PMCID: PMC8196048 DOI: 10.1016/j.idcr.2021.e01176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/01/2021] [Accepted: 06/07/2021] [Indexed: 11/21/2022] Open
Abstract
A 52-year-old man presented to our hospital complaining of general malaise, cough, and fever. Total body computed tomography revealed scattered pneumonia and urethral foreign bodies that had been inserted during adolescence. Candida glabrata was detected in blood and urine cultures. Based on these findings, the patient was diagnosed with candidemia that developed due to Candida urinary tract infection, complicated by septic pulmonary embolism and severe diabetes mellitus. Candidemia likely persisted despite the initiation of intravenous antifungal therapy and control of blood sugar level. Therefore, surgical removal of the urethral foreign bodies was performed, which resulted in resolution of the patient’s symptoms. Herein, we report a rare case of candidemia complicated by Candida urinary tract infection that developed due to the long-term presence of urethral foreign bodies. A multidisciplinary therapeutic approach, including surgical removal of the infected foreign bodies, is effective in such cases. This case indicates that long-term presence of foreign bodies and acquired immune dysfunction can be risk factors for candidemia. Therefore, detailed history should be obtained and systemic examination should be performed to identify the complicating risk factors on diagnosis of candidemia.
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Affiliation(s)
- Jun Nagata
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan.,Department of Respirology, Chibaken Saiseikai Narashino Hospital, Narashino, 275-8580, Japan
| | - Takeshi Kawasaki
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan
| | - Ken Iesato
- Department of Respirology, Chibaken Saiseikai Narashino Hospital, Narashino, 275-8580, Japan
| | - Toshihiko Sugiura
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan.,Department of Respirology, Chibaken Saiseikai Narashino Hospital, Narashino, 275-8580, Japan
| | - Keita Yamauchi
- Department of Respirology, Chibaken Saiseikai Narashino Hospital, Narashino, 275-8580, Japan
| | - Junichi Tsuyusaki
- Department of Respirology, Chibaken Saiseikai Narashino Hospital, Narashino, 275-8580, Japan
| | - Masaaki Fujimura
- Department of Urology, Chibaken Saiseikai Narashino Hospital, Narashino, 275-8580, Japan
| | - Fuminobu Kuroda
- Department of Respirology, Chibaken Saiseikai Narashino Hospital, Narashino, 275-8580, Japan
| | - Kazuo Mikami
- Department of Urology, Chibaken Saiseikai Narashino Hospital, Narashino, 275-8580, Japan
| | - Steven M Dudek
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, USA
| | - Nobuhiro Tanabe
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan.,Department of Respirology, Chibaken Saiseikai Narashino Hospital, Narashino, 275-8580, Japan
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Hill MS, Villela NA, LaMattina JC, Rasko YM, Phelan MW. Reno-appendiceal fistula in autosomal dominant polycystic kidney disease. Urol Case Rep 2021; 38:101701. [PMID: 34026556 PMCID: PMC8120933 DOI: 10.1016/j.eucr.2021.101701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 04/28/2021] [Indexed: 11/16/2022] Open
Abstract
We present a very rare Case of a 53-year-old female with autosomal dominant polycystic kidney disease (ADPKD) who was incidentally found to have a reno-appendiceal fistula while undergoing open bilateral nephrectomy. The mid-portion of the appendix was fistulized to a cyst in the lower pole of the right kidney. The etiology was likely due to chronic inflammation. An appendectomy was performed along with the planned right nephrectomy to ensure complete removal of the fistulous tract. The development of a fistulous communication between the kidney and intestinal tract is a rare event. These fistulas are usually a consequence of chronic, inflammatory disease of the urinary or gastrointestinal tract. There has never been a report of a reno-appendiceal fistula in a patient with ADPKD.
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Affiliation(s)
- Madison S Hill
- Department of Urology, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore MD 21201, USA
| | - Natalia Arias Villela
- Department of Urology, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore MD 21201, USA
| | - John C LaMattina
- Department of Surgery, Division of Transplant Surgery, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore MD 21201, USA
| | - Yvonne M Rasko
- Department of Surgery, Division of Plastic Surgery, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore MD 21201, USA
| | - Michael W Phelan
- Department of Urology, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore MD 21201, USA
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9
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Li J, Park A, Fulmer BR, Garg T. Leclercia adecarboxylata urinary tract infection in a patient with bladder cancer and recurrent hematuria. Urol Case Rep 2021; 36:101579. [PMID: 33643844 PMCID: PMC7889819 DOI: 10.1016/j.eucr.2021.101579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 01/20/2021] [Indexed: 01/04/2023] Open
Abstract
Leclercia adecarboxylata is an rare human pathogen, mostly affecting immunocompromised individuals or as one microbe in polymicrobial infections in immunocompetent patients. L. adecarboxylata is rarely isolated from the urinary tract. We describe a case of pan-sensitive L. adecarboxylata isolated from a polymicrobial urinary tract infection from an immunocompetent older adult with recently diagnosed bladder cancer.
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Affiliation(s)
- Jonathan Li
- Department of Urology, Geisinger, Danville, PA, USA
| | - Alyssa Park
- Department of Urology, Geisinger, Danville, PA, USA
| | | | - Tullika Garg
- Department of Urology, Geisinger, Danville, PA, USA.,Department of Population Health Sciences, Danville, PA, USA
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10
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Williams C, Robinson J, Leggio S. Potential effects of postmenopausal labial agglutination on the urinary system. Urol Case Rep 2021; 36:101565. [PMID: 33489771 PMCID: PMC7807131 DOI: 10.1016/j.eucr.2021.101565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 12/05/2022] Open
Abstract
Labial agglutination (LA) can affect prepubertal or postmenopausal women. LA commonly affects prepubertal girls, but the rate at which LA affects postmenopausal women is unknown, with only a few documented case reports. Symptoms of LA include vulvovaginal pain, dysuria, dyspareunia, and urinary incontinence/urinary symptoms. First-line treatment includes low dose estrogen cream and high dose topical steroid cream. If the creams fail, surgical lysis can be performed. The commonality between these age groups is chronic inflammation and low estrogen. It is important to keep in mind, especially in postmenopausal women, that LA can lead to urinary symptom side effects.
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Affiliation(s)
- Cheau Williams
- Colquitt Regional Medical Center, Philadelphia College of Osteopathic Medicine, Moultrie, GA, USA.,Medical College of Georgia, USA.,2nd Year Resident at Colquitt Regional Medical Center, Georgia South Family Medicine Residency, Moultrie, GA, USA.,Philadelphia College of Osteopathic Medicine, USA
| | - Jermaine Robinson
- 2nd Year Resident at Colquitt Regional Medical Center, Georgia South Family Medicine Residency, Moultrie, GA, USA
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11
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Kowalski F, Adamowicz J, Jozwicki J, Grzanka D, Drewa T. The role of early diagnosis of emphysematous cystitis: A case report and literature review. Urol Case Rep 2021; 36:101581. [PMID: 33643846 PMCID: PMC7889795 DOI: 10.1016/j.eucr.2021.101581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 01/20/2021] [Indexed: 10/26/2022] Open
Abstract
Emphysematous cystitis (EC) is a rare entity caused by bacteria, which produce gas filled cysts in the bladder wall. We present a case of EC in a 72-year-old woman admitted to Vascular Surgery Department because of diabetic foot syndrome. During the hospital stay, the patient's general condition deteriorated. CT established EC diagnosis. Surgical treatment was inevitable. Salvage cystectomy was performed. Despite macroscopic removal of necrotic tissues, the condition of the patient didn't improve, 75 days past diagnosis of EC she died due to the multi-organ failure. Prompt diagnosis provided by imaging plays a key role in the treatment of EC.
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Affiliation(s)
- F Kowalski
- Department of Urology, Antoni Jurasz Memorial University Hospital, Bydgoszcz, 85094, Kujavian-Pomeranian Voivodship, Poland.,Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, 85037, Kujavian-Pomeranian Voivodship, Poland
| | - J Adamowicz
- Department of Urology, Antoni Jurasz Memorial University Hospital, Bydgoszcz, 85094, Kujavian-Pomeranian Voivodship, Poland.,Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, 85037, Kujavian-Pomeranian Voivodship, Poland
| | - J Jozwicki
- Department of Pathomorphology, Antoni Jurasz Memorial University Hospital, Bydgoszcz, 85094, Kujavian-Pomeranian Voivodship, Poland.,Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, 85037, Kujavian-Pomeranian Voivodship, Poland
| | - D Grzanka
- Department of Pathomorphology, Antoni Jurasz Memorial University Hospital, Bydgoszcz, 85094, Kujavian-Pomeranian Voivodship, Poland.,Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, 85037, Kujavian-Pomeranian Voivodship, Poland
| | - T Drewa
- Department of Urology, Antoni Jurasz Memorial University Hospital, Bydgoszcz, 85094, Kujavian-Pomeranian Voivodship, Poland.,Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, 85037, Kujavian-Pomeranian Voivodship, Poland
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12
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Takeuchi M, McDonald JS, Takahashi N, Frank I, Thompson RH, King BF, Kawashima A. Cancer Prevalence and Risk Stratification in Adults Presenting With Hematuria: A Population-Based Cohort Study. Mayo Clin Proc Innov Qual Outcomes 2021; 5:308-19. [PMID: 33997630 DOI: 10.1016/j.mayocpiqo.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To calculate the prevalence of renal cell carcinoma (RCC), upper urinary tract urothelial carcinoma (UT-UC), and lower urinary tract urothelial carcinoma (LT-UC) in patients with gross asymptomatic microhematuria (AMH) and symptomatic microhematuria (SMH). Patients and Methods This study was a population-based retrospective descriptive study. The study was approved by both the Mayo Clinic Institutional Review Board and the Olmsted Medical Center Institutional Review Board, and the population used was Olmsted County residents. A total of 4453 patients who presented with an initial episode of hematuria from January 1, 2000, through December 30, 2010, were included. Of the 4453 patients (median age, 58 years; interquartile range, 44.6-73.3 years), 1487 (33.4%) had gross hematuria, 2305 (51.8%) had AMH, and 661 (14.8%) had SMH. Results In the 1487 patients with gross hematuria, the prevalence of RCC, UT-UC, and LT-UC was 1.3%, 0.8%, and 9.0%, respectively. In the 2305 patients with AMH, the prevalence of RCC, UT-UC, and LT-UC was 0.2%, 0.3%, and 1.6%, respectively. In the 661 patients with SMH, the prevalence of RCC, UT-UC, and LT-UC was 0.6%, 0.2%, and 0.3%, respectively. Age was the most relevant risk factor for any hematuria type. Conclusion This unique cohort study reported that the prevalence of RCC or UC in patients with AMH and SMH was low, especially in the young cohort, and a large number of intense work-ups, such as cystoscopy and computed tomography urography, currently conducted could be omitted if stratified by hematuria type and age.
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Key Words
- AMH, asymptomatic microhematuria
- AUA, American Urological Association
- CT, computed tomography
- GH, gross hematuria
- LT-UC, lower urinary tract urothelial carcinoma
- OR, odds ratio
- RBC, red blood cell
- RCC, renal cell carcinoma
- REP, Rochester Epidemiology Project
- SMH, symptomatic microhematuria
- UC, urothelial carcinoma
- UT-UC, upper urinary tract urothelial carcinoma
- UTI, urinary tract infection
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13
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Carrondo MC, Moita JJ. Potentially preventable urinary tract infection in patients with type 2 diabetes - A hospital-based study. ACTA ACUST UNITED AC 2020; 17:100190. [PMID: 32289092 DOI: 10.1016/j.obmed.2020.100190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 01/25/2020] [Indexed: 11/23/2022]
Abstract
Aim To investigate the prevalence of urinary tract infections in hospitalized patients with type 2 diabetes mellitus and identify corresponding risk factors. Methods We conducted a cross-sectional study on 7.347 patients with type 2 diabetes mellitus as the principal diagnosis, using hospitalization discharge summary data from January 1 to December 31, 2015. Disease stages were classified as stages 1, 2, and 3. Results Of 7.347 patients, 16.2% had urinary tract infections. The urinary tract infection prevalence was 24.4% in 428 patients in stage 1 and 4.8% in 2.840 patients in stage 2; it was higher among patients who underwent medical procedures than among those who underwent surgery (24.4% vs 4.8%). In multivariate regression analysis, age (OR = 1.031; 95% CI = 1.02-1.04), length of hospitalization (OR = 1.018; 95% CI = 1.013-1.024), sex (woman) (OR = 2.248; 95% CI = 1.778-2.842), comorbidity of stage 3 cerebrovascular disease (OR = 1.737; 95% CI = 1.111-2.714), and comorbidity of stage 1 colorectal cancer (OR = 2.417; 95% CI = 1.152-5.074) were found to be the risk factors of urinary tract infection in the ten hospitals considered. Conclusions Our findings suggest that urinary tract infection prevalence was higher in women without evidence of organ injury and those receiving medical treatment. Comorbidities (cerebrovascular disease and colorectal cancer) were identified as risk factors.
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14
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Uinarni H, Nike F. Duplication of ureter in a 7-year-old: a case report. Radiol Case Rep 2020; 15:564-9. [PMID: 32211087 DOI: 10.1016/j.radcr.2020.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/07/2020] [Accepted: 02/14/2020] [Indexed: 12/04/2022] Open
Abstract
Duplication of ureter is one of the most common anomalies of the urinary tract. Early detection has dramatically increased due to advance in technology of imaging to detect the anomalies during antenatal period; however, numbers of undiagnosed adult still exist. It may remain asymptomatic, but may cause repeated urinary tract infections or calculi. This case report presents a case of a 7-year-old female who had duplex collecting systems. This patient has repeating symptoms throughout the years, referred to several medical specialties. Then ultrasonography and computed tomography showed that she had complete duplex collecting system on her left kidney. She was then undergone left partial nephrectomy surgery and removal of dilated left ureter. Congenital anomaly of the urogenital system should be considered in patients with chronic infection. Multimodal imaging technique such as ultrasonography, computed tomography, or magnetic resonance imaging should be done to confirm the diagnosis especially before surgical management.
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15
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Frane N, Iturriaga C, Bub C, Regala P, Katsigiorgis G, Linn M. Risk factors for complications and in-hospital mortality: An analysis of 19,834 open pelvic ring fractures. J Clin Orthop Trauma 2020; 11:1110-1116. [PMID: 33192016 PMCID: PMC7656482 DOI: 10.1016/j.jcot.2020.08.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 08/18/2020] [Accepted: 08/22/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Open pelvic fractures are rare injuries, associated with high patient morbidity and mortality. Few studies have investigated the impact of patient demographics, comorbidities, and injury related factors on complication and mortality rates. The purpose of this study was to: (1) identify the overall incidence of complications and mortality after open pelvic fractures, (2) compare patient factors between those who did and did not develop complications, (3) identify perioperative independent risk factors for complications and mortality. METHODS A query was performed for patients with open pelvic fractures between 2007 and 2017 using the American College of Surgeons National Trauma Data Bank. Patient and injury specific variables were collected and complications were identified using International Classification of Disease Ninth and Tenth edition Codes. Patient demographic and perioperative data was compared using Fisher's exact test and chi-square test for categorical variables, and Welch's t-test for continuous variables. Using pooled data from multiple imputations, logistic regressions were used to calculate odds ratios and confidence intervals of independent risk factors for complications. RESULTS A total of 19,834 open pelvic fracture cases were identified, with 9622 patients (48.5%) developing at least one complication. Patients who developed complications were older (35.0 vs 38.1 years), and had higher Injury Severity Scores (17.7 vs 26.5), lower Glasgow Coma Scores (14.2 vs 11.7), and a larger proportion presenting with hypotension (21% vs 6.9%). After pooled regression involving 19 factors, these were the strongest independent predictors of inpatient complication and mortality. CONCLUSION We report a mortality rate of 14%, with an inclusive complication rate of 48.5%. Evaluating risk factors for morbidity and mortality for this devastating orthopaedic injury provides knowledge of an inherently sparse population. LEVEL OF EVIDENCE Level II, Retrospective study.
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Key Words
- ACS, American College of Surgeons
- ACS-NTDB, American College of Surgeons National Trauma Data Bank
- AIS, Abbreviated Injury Scale
- BP, blood pressure
- E-Code, external cause of injury
- ED, Emergency Department
- Epidemiology
- GCS, Glasgow Coma Scale
- ICD-10, International Classification of Disease Tenth
- ICD-9, International Classification of Disease Ninth
- ISS, Injury Severity Score
- MCAR, missing completely at random
- NTDB
- National trauma data bank
- Open pelvic fractures
- Orthopaedic surgery
- Orthopaedic trauma
- PE, pulmonary embolism
- Pelvic fractures
- RTS, Revised Trauma Score
- SBP, systolic blood pressure
- UTI, urinary tract infection
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Affiliation(s)
- Nicholas Frane
- Zucker School of Medicine at Hofstra/Northwell, Department of Orthopaedic Surgery, 888 Old Country Road, Plainview, New York, 11803, USA,Corresponding author. Department of Orthopaedic Surgery, 888 Old Country Road, Plainview, New York, 11803, USA.
| | - Cesar Iturriaga
- Zucker School of Medicine at Hofstra/Northwell, Department of Orthopaedic Surgery, Long Island Jewish Hospital, Northwell Health, Great Neck, NY, 11021, USA
| | - Christine Bub
- Zucker School of Medicine at Hofstra/Northwell, Department of Orthopaedic Surgery, Long Island Jewish Hospital, Northwell Health, Great Neck, NY, 11021, USA
| | - Peter Regala
- Zucker School of Medicine at Hofstra/Northwell, Department of Orthopaedic Surgery, 888 Old Country Road, Plainview, New York, 11803, USA
| | - Gus Katsigiorgis
- Zucker School of Medicine at Hofstra/Northwell, Department of Orthopaedic Surgery, 888 Old Country Road, Plainview, New York, 11803, USA
| | - Michael Linn
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Southside Hospital, Northwell Health, 217 East Main Street, Bayshore, NY, 11706, USA
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16
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Tsuchiyama K, Aoki Y, Ito H, Yoneda M, Yokoyama O. Neurogenic bladder associated with xeroderma pigmentosum type A: A case report and literature review. Urol Case Rep 2019; 27:100996. [PMID: 31467858 PMCID: PMC6713856 DOI: 10.1016/j.eucr.2019.100996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/09/2019] [Accepted: 08/13/2019] [Indexed: 12/05/2022] Open
Abstract
Xeroderma pigmentosum (XP) is a rare autosomal recessive disease caused by a defect in deoxyribonucleic acid repair. Along with cutaneous symptoms, neurological symptoms are important clinical features of XP. However, information on neurogenic bladder occurrence among XP cases is rare. Herein, we describe a case of neurogenic bladder in a patient with XP type A (XPA). In this case, low bladder compliance, impaired bladder emptying, and urethral sphincter discoordination were significant cystometric findings, and frequent febrile urinary tract infection was a clinical problem. XPA patients often cannot express their symptoms because of cognitive dysfunction. Close follow-up and assessments are necessary.
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Affiliation(s)
- Katsuki Tsuchiyama
- Division of Urology, Department of Surgery, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Yoshitaka Aoki
- Division of Urology, Department of Surgery, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Hideaki Ito
- Division of Urology, Department of Surgery, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Makoto Yoneda
- Faculty of Nursing and Social Welfare Sciences, Fukui Prefectural University, 4-1-1, Kenjojima, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1195, Japan
| | - Osamu Yokoyama
- Division of Urology, Department of Surgery, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
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17
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Galante A, Asirvatham RJ, Yeung LL. Treatment-refractory non-Hodgkin lymphoma of the prostate: A case report and review of the literature. Urol Case Rep 2019; 24:100867. [PMID: 31211077 PMCID: PMC6562310 DOI: 10.1016/j.eucr.2019.100867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/09/2019] [Accepted: 03/13/2019] [Indexed: 11/17/2022] Open
Abstract
Non-Hodgkin lymphoma of the prostate is uncommon. Prostate specific antigen and transrectal ultrasound do not aid in diagnosis. Survival and treatment options are ultimately based on immune-histologic subtype and stage. Lower urinary tract symptoms attributed to lymphoma of the prostate can be refractory to systemic treatments as well as transurethral resection. This case provides the first description of the longitudinal clinical course of treatment-refractory localized Non-Hodgkin lymphoma of the prostate.
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Affiliation(s)
- Alex Galante
- University of Florida, Department of Urology, 2000 SW Archer Rd, 3rd Floor, Gainesville, FL, 32608, USA
| | - Ruth Jaya Asirvatham
- University of Florida, Department of Pathology, Immunology, and Laboratory Medicine, 2000 SW Archer Rd, 3rd Floor, Gainesville, FL, 32608, USA
| | - Lawrence L. Yeung
- University of Florida, Department of Urology, 2000 SW Archer Rd, 3rd Floor, Gainesville, FL, 32608, USA
- Corresponding author.
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18
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Islam SB, Ahmed T, Mahfuz M, Mostafa I, Alam MA, Saqeeb KN, Sarker SA, Chisti MJ, Alam NH. The management of persistent diarrhoea at Dhaka Hospital of the International Centre for Diarrhoeal Disease and Research: a clinical chart review. Paediatr Int Child Health 2018; 38:87-96. [PMID: 28475437 DOI: 10.1080/20469047.2017.1315911] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Persistent diarrhoea (PD) is poorly recognised and it requires proper assessment and early intervention to ensure effective treatment. The International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) has been managing children with PD for more than two decades. This review focuses on different aspects of the management of PD in a hospital setting. AIM To estimate the prevalence, socio-demographic and clinical characteristics, treatment outcome and hospital course in under-5 children with persistent diarrhoea (PD). METHODS The hospital records of all children under 5 years admitted with PD to Dhaka Hospital of the International Centre for Diarrhoeal Disease Research between January 2012 and December 2013 were reviewed. Data were retrieved from the hospital's electronic database. RESULTS Of 8638 children under 5 years of age admitted with diarrhoea, 551 (6.4%) had PD and one-third had developed PD during their hospital stay. The incidence of PD was highest (228, 41.4%) in summer (April-June). Half (51%) of the children with PD had dehydration on admission. Fifty-seven (10.3%) had never been breastfed, 138 (25.1%) were severely wasted and 21 (3.8%) had bipedal oedema. Following the steps of a dietary algorithm, 224 (40.6%) patients responded to a milk-based low-lactose diet, 235 (42.6%) to a lactose-, sucrose- and milk-free diet, 48 (8.7%) to a comminuted chicken and glucose-based diet, 41 (7.4%) to exclusive breastfeeding, and 3 (0.5%) required a partially hydrolysed, semi-elemental diet. Major stool pathogens were Campylobacter species (23/59, 39%), Salmonella (10/59, 16.9%) and Shigella (10/59, 16.9%). The overall recovery rate from PD was 95.6% (527/551) and the duration of treatment until resolution of diarrhoea was 6 (3-9) days. The case-fatality rate was 2% (11/551). CONCLUSION Persistent diarrhoea remains an important public health problem in children under-5 in Bangladesh. Algorithm-based dietary management with simple clinical guidelines was effective in most cases. This treatment is appropriate in low-income settings where resources are limited.
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Affiliation(s)
- Shoeb Bin Islam
- a Dhaka Hospital, Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research , Bangladesh.,b Nutrition and Clinical Services Division , International Centre for Diarrhoeal Disease Research , Dhaka , Bangladesh
| | - Tahmeed Ahmed
- a Dhaka Hospital, Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research , Bangladesh.,b Nutrition and Clinical Services Division , International Centre for Diarrhoeal Disease Research , Dhaka , Bangladesh
| | - Mustafa Mahfuz
- b Nutrition and Clinical Services Division , International Centre for Diarrhoeal Disease Research , Dhaka , Bangladesh
| | - Ishita Mostafa
- b Nutrition and Clinical Services Division , International Centre for Diarrhoeal Disease Research , Dhaka , Bangladesh
| | - Mohammed Ashraful Alam
- b Nutrition and Clinical Services Division , International Centre for Diarrhoeal Disease Research , Dhaka , Bangladesh
| | - Kazi Nazmus Saqeeb
- a Dhaka Hospital, Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research , Bangladesh.,b Nutrition and Clinical Services Division , International Centre for Diarrhoeal Disease Research , Dhaka , Bangladesh
| | - Shafiqul Alam Sarker
- a Dhaka Hospital, Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research , Bangladesh.,b Nutrition and Clinical Services Division , International Centre for Diarrhoeal Disease Research , Dhaka , Bangladesh
| | - Mohammod Jobayer Chisti
- a Dhaka Hospital, Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research , Bangladesh.,b Nutrition and Clinical Services Division , International Centre for Diarrhoeal Disease Research , Dhaka , Bangladesh
| | - Nur Haque Alam
- a Dhaka Hospital, Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research , Bangladesh.,b Nutrition and Clinical Services Division , International Centre for Diarrhoeal Disease Research , Dhaka , Bangladesh
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AlSweed A, Alghamdi A, Tufenkeji H, Al-Hajjar S. The first case of Raoultella planticola infective endocarditis in a 4 year old child: A case report and review of literature. Int J Pediatr Adolesc Med 2018; 5:28-30. [PMID: 30805529 PMCID: PMC6363258 DOI: 10.1016/j.ijpam.2017.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 12/24/2017] [Accepted: 12/31/2017] [Indexed: 12/02/2022]
Abstract
Infective endocarditis is a complication of bacteremia that can lead to serious morbidity and even mortality if not appropriately treated, well known organisms commonly lead to this condition in many repeated scenarios so they are usually recognized and treated, but if it was caused by other organisms its detection and treatment can be harder. Raoultella planticola, a low virulent organism used to be part of the Klebsiella species, has been found in many reports to cause multiple human conditions. In this article, a novel case of R. planticola is reported, and the organism was reviewed in many aspects for clinician to be able to recognize this infection and manage it in a more effective way.
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Affiliation(s)
- Abdulrahman AlSweed
- Department of Pediatrics, Section of Infectious Disease, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdulrahman Alghamdi
- Department of Pediatrics, Section of Infectious Disease, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Haysam Tufenkeji
- Department of Pediatrics, Section of Infectious Disease, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Sami Al-Hajjar
- Department of Pediatrics, Section of Infectious Disease, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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20
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Jain M, Varghese J, Michael T, Kedarishetty CK, G B, Swaminathan S, Venkataraman J. An Insight into Antibiotic Resistance to Bacterial Infection in Chronic Liver Disease. J Clin Exp Hepatol 2017; 7:305-309. [PMID: 29234194 PMCID: PMC5715483 DOI: 10.1016/j.jceh.2017.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 05/02/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND End stage liver disease leads to immune dysfunction which predisposes to infection. There has been a rise in antibiotic resistant infections in these patients. There is scanty data f from India or idea regarding the same. AIM OF THE STUDY The present study was undertaken to determine the type of infection acquired and the prevalence of antibiotic resistant infections in cirrhotic patients at a tertiary referral center in South India. MATERIALS AND METHODS In this retrospective study, all consecutive cirrhotic patients hospitalized between 2011 and 2013 with a microbiologically-documented infection were enrolled. Details of previous admission and antibiotics if received were noted. In culture positive infections, the source of infection (ascites, skin, respiratory tract: sputum/endotracheal tube aspirate, pleural fluid; urine and blood) and microorganisms isolated and their antibiotic susceptibility was noted. RESULTS A total of 92 patients had 240 culture positive samples in the study period. Majority were Klebseilla followed by Escherichia coli and Enterococcus in nosocomial and health care associated infections. However, Enteroccocus was followed by E. coli and Klebsiella in community acquired infections. The antibiotic sensitivity pattern was analyzed for the major causative organisms such as E. coli, Klebsiella and Enterococcus. Most common resistant strains were extended spectrum beta lactamase producing enterobacteriacae (ESBL) followed by carbapenemase producing Klebsiella and methicillin resistant Staphylococcus aureus. CONCLUSION Noscomial infection is the most common type, with Klebsiella and E. coli and there is significant rise in ESBL producing organism.
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Key Words
- CAI, community-acquired infection
- CPK, carbapenemase producing Klebsiella
- ESBL, beta lactamase producing enterobacteriacae
- ESLD, end stage liver disease
- HAI, hospital acquired infection
- MRSA, methicillin-resistant Staphylococcus aureus
- SBP, spontaneous bacterial peritonitis
- TGC, third generation cephalosporins
- UTI, urinary tract infection
- VRE, vancomycin-resistant Enterococcus
- antibiotics
- cirrhosis liver
- microbial resistance
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Affiliation(s)
- Mayank Jain
- Institute of Liver Disease and Transplantation, Global Health City, Chennai 600100, India
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Taneja S, Kumar P, Gautam V, Duseja A, Singh V, Dhiman RK, Chawla Y. Spontaneous Bacterial Peritonitis by Burkholderia cepacia Complex: A Rare, Difficult to Treat Infection in Decompensated Cirrhotic Patients. J Clin Exp Hepatol 2017; 7:102-6. [PMID: 28663673 DOI: 10.1016/j.jceh.2016.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 08/12/2016] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Burkholderia cepacia complex (Bcc) is non-fermenting Gram-negative bacillus and has been rarely reported to cause spontaneous bacterial peritonitis (SBP) in decompensated cirrhosis. OBJECTIVE This study was done to evaluate the clinical presentation of cirrhotic patients with SBP due to Bcc and to determine its impact on clinical outcome. METHODS This is a retrospective, observational study conducted during the period from 1st January 2013 through 31st March 2015. Medical records and microbiology laboratory files were reviewed to identify all cases of Bcc associated SBP among patients hospitalized at the liver intensive care unit and analyzed. RESULTS During the study period, out of 252 SBP patients, 11 (4.3%) patients with a positive ascitic fluid culture for Bcc were identified. Pain abdomen was the predominant symptom present in 9 (81%) patients followed by hepatic encephalopathy in 7 (63%) patients. Acute kidney injury (AKI) was universally present, seen in 6 (54%) patients at the time of presentation and 4 (36%) patients developed AKI during hospital stay. The mean CTP score was 11.2 ± 1.1 (10-13), and the mean MELD was 24.3 ± 5.9 (14-35). The mean SOFA and APACHE II score at presentation were 11 ± 4.2 (4-18) and 19.4 ± 5.2 (11-28), respectively. A total of 8 (72%) patients (6-ACLF, 2-NASH) succumbed to the illness during hospitalization due to severe sepsis and multiorgan dysfunction and 3 (27%) patients are doing well on follow-up after 3 months. CONCLUSION SBP caused by Bcc has been rarely reported in cirrhotic patients. This organism is intrinsically resistant to third generation cephalosporins, which are the initial antibiotic of choice for SBP patients, hence associated with multi organ failure and high mortality rates.
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Key Words
- AKI, acute kidney injury
- APACHE II, Acute Physiology and Chronic Health Evaluation (APACHE)
- APASL, Asia Pacific Association for the Study of Liver
- Bcc, Burkholderia cepacia complex
- CSLI, The Clinical and Laboratory Standards Institute
- CTP, Child Turcotte Pugh Score
- HCV, Hepatitis C virus
- ICU, intensive care unit
- NASH, non-alcoholic steatohepatitis
- PGIMER, Postgraduate Institute of Medical Education and Research
- SBP, spontaneous bacterial infection
- SIRS, systemic inflammatory response syndrome
- SOFA, The Sequential Organ Failure Assessment
- UTI, urinary tract infection
- cirrhosis
- infection
- spontaneous bacterial peritonitis
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Gupta T, Dhiman RK, Rathi S, Agrawal S, Duseja A, Taneja S, Chawla Y. Impact of Hepatic and Extrahepatic Insults on the Outcome of Acute-on-Chronic Liver Failure. J Clin Exp Hepatol 2017; 7:9-15. [PMID: 28348465 PMCID: PMC5357711 DOI: 10.1016/j.jceh.2016.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 10/22/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To study the differences in outcome and predictors of mortality in acute-on-chronic liver failure (ACLF) precipitated by hepatic or extrahepatic insults. METHODS Consecutive patients of cirrhosis with acute decompensation were prospectively included and followed up for 90 days from admission. ACLF was defined based on chronic liver failure (CLIF) acute-on-chronic liver failure in cirrhosis (CANONIC study) criteria. Acute worsening due to acute viral hepatitis A and E, hepatitis B flare, alcoholic hepatitis, autoimmune hepatitis flare, or drug-induced liver injury were categorized as hepatic ACLF and that due to bacterial infection, upper gastrointestinal bleed or surgery as extrahepatic ACLF. Patients with both hepatic and extrahepatic insults were included in combined insult group. RESULTS Of 179 patients of acute decompensation, 122 had ACLF (hepatic insults 47 and extrahepatic insults 51). Alcohol (64.8%) was the most common etiology of cirrhosis while infection (36%) was the most common acute insult followed by alcoholic hepatitis (24.6%). Higher proportion of extrahepatic ACLF patients had history of prior decompensation than hepatic ACLF patients (62.7% vs. 27.7%, P < 0.001). There was no difference in mortality among hepatic and extrahepatic ACLF groups at 28 and 90 days (53.2% vs. 56.9%, P = 0.715 and 85% vs. 74.5%, P = 0.193, respectively). Area under receiver-operating curve (AUROC) for 28-day mortality in extrahepatic ACLF group was 0.788, 0.724, 0.718, 0.634, and 0.726 and in hepatic-ACLF group was 0.786, 0.625, 0.802, 0.761, and 0.648 for chronic liver failure-sequential organ failure assessment (CLIF-SOFA), model for end stage liver disease (MELD), integrated MELD score (iMELD), acute physiology and chronic health evaluation score (APACHE-II), and Child-Turcotte-Pugh score scores, respectively. CONCLUSION There is no difference in mortality among hepatic and extrahepatic ACLF groups at 28 and 90 days. iMELD and CLIF-SOFA have highest AUROC to predict 28-day mortality in hepatic and extrahepatic ACLF groups, respectively.
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Key Words
- ACLF, acute-on-chronic liver failure
- APACHE-II, acute physiology and chronic health evaluation score
- APASL, Asian Pacific Association for the Study of Liver
- AUROC, area under receiver-operating characteristics
- CANONIC study, chronic liver failure (CLIF) acute-on-chronic liver failure in cirrhosis
- CLIF-SOFA, chronic liver failure-sequential organ failure assessment
- CTP, Child–Turcotte–Pugh score
- EASL, European Association for the Study of Liver
- HE, hepatic encephalopathy
- MELD, model for end-stage liver disease
- SBE, spontaneous bacterial empyema
- SBP, spontaneous bacterial peritonitis
- SIRS, systemic inflammatory response syndrome
- UTI, urinary tract infection
- acute-on-chronic liver failure
- extrahepatic insult
- hepatic insult
- iMELD, integrated MELD score
- mortality
- organ failure
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Affiliation(s)
| | - Radha K. Dhiman
- Address for correspondence: Radha K. Dhiman, Department of Hepatology, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India. Tel.: +91 7087009337/1722744401.Department of Hepatology, Postgraduate Institute of Medical Education & ResearchChandigarh160012India
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Srougi V, Duarte RJ, Srougi M, Yu L. Laparoscopic Kidney Denervation for Refractory Loin Pain: Can We Predict Outcomes? Urol Case Rep 2016; 8:31-3. [PMID: 27419076 PMCID: PMC4930338 DOI: 10.1016/j.eucr.2016.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 06/09/2016] [Indexed: 11/24/2022] Open
Abstract
A 19-year-old female patient presented refractory disabling loin pain associated with mild kidney atrophy (split renal function of 33%). Investigation revealed elevated serum renin level; a therapeutic test with oral renin inhibitor was tried, obtaining important pain control. Aiming to resolve the symptom while preserving the patient kidney and attributing the pain mechanism to be associated with the abnormal renin production, a laparoscopic kidney denervation was performed with no complications and complete pain resolution.
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Affiliation(s)
- Victor Srougi
- Division of Urology, Hospital das Clinicas, University of São Paulo, School of Medicine, Sao Paulo, Brazil
| | - Ricardo J Duarte
- Division of Urology, Hospital das Clinicas, University of São Paulo, School of Medicine, Sao Paulo, Brazil
| | - Miguel Srougi
- Division of Urology, Hospital das Clinicas, University of São Paulo, School of Medicine, Sao Paulo, Brazil
| | - Luis Yu
- Division of Nephrology, Hospital das Clinicas, University of São Paulo, School of Medicine, Sao Paulo, Brazil
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Gounder PP, Seeman SM, Holman RC, Rarig A, McEwen MK, Steiner CA, Bartholomew ML, Hennessy TW. Potentially preventable hospitalizations for acute and chronic conditions in Alaska, 2010-2012. Prev Med Rep 2016; 4:614-621. [PMID: 27920972 PMCID: PMC5129160 DOI: 10.1016/j.pmedr.2016.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 03/30/2016] [Accepted: 03/31/2016] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE The U.S. Agency for Healthcare Research and Quality's Prevention Quality Indicators comprise acute and chronic conditions for which hospitalization can be potentially prevented by high-quality ambulatory care. The Healthy Alaska 2020 initiative (HA2020) targeted reducing potentially preventable hospitalizations (PPH) for acute and chronic conditions among its health indicators. We estimated the PPH rate for adults aged ≥ 18 years in Alaska during 2010-2012. METHODS We conducted a cross-sectional analysis of state-wide hospital discharge data obtained from the Healthcare Cost and Utilization Project and the Indian Health Service. We calculated average annual PPH rates/1000 persons for acute/chronic conditions. Age-adjusted rate ratios (aRRs) were used for evaluating PPH rate disparities between Alaska Native (AN) and non-AN adults. RESULTS Among 127,371 total hospitalizations, 4911 and 6721 were for acute and chronic PPH conditions, respectively. The overall crude PPH rate was 7.3 (3.1 for acute and 4.2 for chronic conditions). AN adults had a higher rate than non-AN adults for acute (aRR: 4.7; p < 0.001) and chronic (aRR: 2.6; p < 0.001) PPH conditions. Adults aged ≥ 85 years had the highest PPH rate for acute (43.5) and chronic (31.6) conditions. Acute conditions with the highest PPH rate were bacterial pneumonia (1.8) and urinary tract infections (0.8). Chronic conditions with the highest PPH rate were chronic obstructive pulmonary disease (COPD; 1.6) and congestive heart failure (CHF; 1.3). CONCLUSION Efforts to reduce PPHs caused by COPD, CHF, and bacterial pneumonia, especially among AN people and older adults, should yield the greatest benefit in achieving the HA2020 goal.
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Key Words
- AHRQ, Agency for Healthcare Research and Quality
- AI/AN, American Indian/Alaska Native
- AN, Alaska Native
- CHF, congestive heart failure
- COPD, chronic obstructive pulmonary disease
- HA2020, Healthy Alaskans 2020
- HDDS, Hospital Discharge Data Set
- Health services research
- Healthcare disparities
- IHS, Indian Health Service
- NPIRS, National Patient Information Reporting System
- Native American
- PQIs, Prevention Quality Indicators
- Quality of health care
- RR, age-specific rate ratio
- SE, standard error
- SID, State Inpatient Database
- UTI, urinary tract infection
- aRR, age-adjusted rate ratio
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Affiliation(s)
- Prabhu P Gounder
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Anchorage, AK, United States
| | - Sara M Seeman
- Division of High-Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, GA, United States
| | - Robert C Holman
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Anchorage, AK, United States
| | - Alice Rarig
- Division of Public Health, Alaska Department of Health and Social Services, Juneau, AK, United States
| | - Mary K McEwen
- Division of Public Health, Alaska Department of Health and Social Services, Juneau, AK, United States
| | - Claudia A Steiner
- Healthcare Cost and Utilization Project, Center for Delivery, Organization and Markets, Agency for Healthcare and Research and Quality, Rockville, MD, United States
| | - Michael L Bartholomew
- Division of Epidemiology and Disease Prevention, Indian Health Service, Rockville, MD, United States
| | - Thomas W Hennessy
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Anchorage, AK, United States
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Medows M, Nijres BM, Elbakoush F, Alali A, Patel R, Mohammad S. Can urinary nitrites or other urinalysis findings be a predictor of bacterial resistance of uncomplicated urinary tract infections? Int J Pediatr Adolesc Med 2016; 3:12-17. [PMID: 30805462 PMCID: PMC6372408 DOI: 10.1016/j.ijpam.2016.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 01/12/2016] [Accepted: 01/19/2016] [Indexed: 11/09/2022]
Abstract
Background and objectives To evaluate whether initial urinalysis (UA) and urinary nitrite results can be used as a proxy for choosing empiric antibiotic therapy. Materials and methods A retrospective study was conducted in an urban inner city community hospital in New York City (NYU Woodhull Medical Center). We reviewed the charts of patients seen in the Emergency Department and Pediatric Clinic who had a diagnosis of urinary tract infection (UTI) during a 3 year time period (January 2010–December 2012). Statistical analysis was performed using SPSS 20.0 statistical software. Results Between January 2010 and December 2012, a total of 378 patients had a diagnosis of UTI. Seventy-five (19.8%) were males and 203 (80.2%) were females. Of the 378 patients with a diagnosis of UTI, the most common isolated pathogen was Escherichia coli, which was detected in 283 (74.9%) isolates. Other bacteria included Klebsiella spp 30 (7.9%), Proteus 21 (5.6%), Enterococcus 14 (3.7%), and others 30 (7.9%). The resistance rate was higher in the nitrite positive group for the following antibiotics: TMP/SMX and ampicillin with or without sulbactam. No significant correlation was found with the remaining studied antibiotics. No significant correlation was found between leukoesterase and the resistance patterns in all of the studied antibiotics, except cefazolin. Conclusion Urinary nitrite results are not helpful in choosing an initial antibiotic to treat a UTI. Leukocytosis in the blood or urine or the presence of a fever cannot be used to predict bacterial resistance. The use of nitrofurantoin or cephalexin for the treatment of cystitis was optimum, and in the presence of negative leukoesterase, nitrofurantoin was preferable to cephalexin.
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Affiliation(s)
- Marsha Medows
- New York University School of Medicine, Department of Pediatrics, New York, NY, USA.,Woodhull Medical and Mental Health Center, Department of Pediatrics, Brooklyn, NY, USA
| | - Bassel Mohammad Nijres
- New York University School of Medicine, Department of Pediatrics, New York, NY, USA.,Woodhull Medical and Mental Health Center, Department of Pediatrics, Brooklyn, NY, USA
| | - Faesal Elbakoush
- New York University School of Medicine, Department of Pediatrics, New York, NY, USA.,Woodhull Medical and Mental Health Center, Department of Pediatrics, Brooklyn, NY, USA
| | - Abdulrazak Alali
- New York University School of Medicine, Department of Pediatrics, New York, NY, USA.,Woodhull Medical and Mental Health Center, Department of Pediatrics, Brooklyn, NY, USA
| | - Rifali Patel
- New York University School of Medicine, Department of Pediatrics, New York, NY, USA.,Woodhull Medical and Mental Health Center, Department of Pediatrics, Brooklyn, NY, USA
| | - Sami Mohammad
- New York University School of Medicine, Department of Pediatrics, New York, NY, USA.,Woodhull Medical and Mental Health Center, Department of Pediatrics, Brooklyn, NY, USA
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Ciesielczuk H, Betts J, Phee L, Doumith M, Hope R, Woodford N, Wareham DW. Comparative virulence of urinary and bloodstream isolates of extra-intestinal pathogenic Escherichia coli in a Galleria mellonella model. Virulence 2016; 6:145-51. [PMID: 25853733 DOI: 10.4161/21505594.2014.988095] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Extra-intestinal pathogenic Escherichia coli (ExPEC) are a significant cause of urinary tract infections and bacteraemia worldwide. Currently no single virulence factor or ExPEC lineage has been identified as the sole contributor to severe extra-intestinal infection and/or urosepsis. Galleria mellonella has recently been established as a simple model for studying the comparative virulence of ExPEC. In this study we investigated the virulence of 40 well-characterized ExPEC strains, in G. mellonella, by measuring mortality (larvae survival), immune recognition/response (melanin production) and cell damage (lactate dehydrogenase production). Although mortality was similar between urinary and bloodstream isolates, it was heightened for community-associated infections, complicated UTIs and urinary-source bacteraemia. Isolates of ST131 and those possessing afa/dra, ompT and serogroup O6 were also associated with heightened virulence.
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Affiliation(s)
- Holly Ciesielczuk
- a Antimicrobial Research Group; Center for Immunology and Infectious Disease; Blizard Institute, Barts and the London School of Medicine and Dentistry; Queen Mary; University of London ; London , UK
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Clark P, O'Connor SC. Megacystis-Microcolon-Intestinal Hypoperistalsis Syndrome. Radiol Case Rep 2007; 2:26. [PMID: 27303483 DOI: 10.2484/rcr.2007.v2i4.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
We report a case of megacystis-microcolon-intestinal hypoperistalsis syndrome (MMIHS) in a newborn female infant who presented with an abdominal mass, absent bowel sounds, and feeding intolerance with bilious emesis. MMIHS is a rare congenital bowel and bladder defect requiring surgery and chronic total parenteral nutrition in an attempt to sustain life. With few exceptions, it is predominately fatal within the first six months of life. We describe the relevant clinical and radiologic findings with ultrasound correlation of this case followed by a brief review of literature included in the discussion.
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Hannan TJ, Roberts PL, Riehl TE, van der Post S, Binkley JM, Schwartz DJ, Miyoshi H, Mack M, Schwendener RA, Hooton TM, Stappenbeck TS, Hansson GC, Stenson WF, Colonna M, Stapleton AE, Hultgren SJ. Inhibition of Cyclooxygenase-2 Prevents Chronic and Recurrent Cystitis. EBioMedicine 2014; 1:46-57. [PMID: 26125048 PMCID: PMC4457352 DOI: 10.1016/j.ebiom.2014.10.011] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 10/21/2014] [Accepted: 10/21/2014] [Indexed: 01/05/2023] Open
Abstract
The spread of multidrug-resistant microorganisms globally has created an urgent need for novel therapeutic strategies to combat urinary tract infections (UTIs). Immunomodulatory therapy may provide benefit, as treatment of mice with dexamethasone during acute UTI improved outcome by reducing the development of chronic cystitis, which predisposes to recurrent infection. Here we discovered soluble biomarkers engaged in myeloid cell development and chemotaxis that were predictive of future UTI recurrence when elevated in the sera of young women with UTI. Translation of these findings revealed that temperance of the neutrophil response early during UTI, and specifically disruption of bladder epithelial transmigration of neutrophils by inhibition of cyclooxygenase-2, protected mice against chronic and recurrent cystitis. Further, proteomics identified bladder epithelial remodeling consequent to chronic infection that enhances sensitivity to neutrophil damage. Thus, cyclooxygenase-2 expression during acute UTI is a critical molecular trigger determining disease outcome and drugs targeting cyclooxygenase-2 could prevent recurrent UTI.
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Key Words
- ASB, asymptomatic bacteriuria
- CD, clusters of differentiation
- COX, cyclooxygenase
- COX-2
- Chronic infection
- G-CSF or CSF3, granulocyte colony-stimulating factor
- GRO-α or CXCL1, growth-regulated alpha protein
- IBC, intracellular bacterial community
- IL-8 or CXCL8, interleukin-8
- Immunomodulatory therapy
- Immunopathology
- M-CSF or CSF1, macrophage colony-stimulating factor
- MAb, monoclonal antibody
- MCP-1 or CCL2, monocyte chemotactic protein 1
- Mucosal immunology
- NSAID, non-steroidal anti-inflammatory drug
- UPEC
- UPEC, uropathogenic E. coli
- UTI, recurrent infection
- UTI, urinary tract infection
- Urinary tract infection
- Uropathogenic E. coli
- rUTI, recurrent urinary tract infection
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Affiliation(s)
- Thomas J Hannan
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO 63110, USA ; Department of Molecular Microbiology and Center for Women's Infectious Disease Research, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Pacita L Roberts
- Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Terrence E Riehl
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Sjoerd van der Post
- Department of Medical Biochemistry, University of Gothenburg, 40530 Gothenburg, Sweden
| | - Jana M Binkley
- Department of Molecular Microbiology and Center for Women's Infectious Disease Research, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Drew J Schwartz
- Department of Molecular Microbiology and Center for Women's Infectious Disease Research, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Hiroyuki Miyoshi
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Matthias Mack
- Department of Internal Medicine, University of Regensburg, 93053 Regensburg, Germany
| | - Reto A Schwendener
- Institute of Molecular Cancer Research, University of Zurich, 8091 Zurich, Switzerland
| | - Thomas M Hooton
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Thaddeus S Stappenbeck
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Gunnar C Hansson
- Department of Medical Biochemistry, University of Gothenburg, 40530 Gothenburg, Sweden
| | - William F Stenson
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Marco Colonna
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Ann E Stapleton
- Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Scott J Hultgren
- Department of Molecular Microbiology and Center for Women's Infectious Disease Research, Washington University School of Medicine, St. Louis, MO 63110, USA
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