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Stærk K, Schrøder B, Jensen LK, Petersen T, Andersen TE, Nielsen LF. Catheter-associated bladder mucosal trauma during intermittent voiding: An experimental study in pigs. BJUI Compass 2024; 5:217-223. [PMID: 38371199 PMCID: PMC10869658 DOI: 10.1002/bco2.295] [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] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/23/2023] [Accepted: 09/09/2023] [Indexed: 02/20/2024] Open
Abstract
Objective The objective of this study is to characterize bladder mucosal trauma associated with intermittent catheterization with conventional eyelet catheters (CECs) and to assess if a microhole zone catheter (MHZC) design concept reduces this adverse effect. Materials and Methods A porcine model was developed to reflect human catheterization and bladder drainage. Nine pigs were randomized for catheterization with CEC (n = 6) or MHZC (n = 3). The bladder was drained repeatedly 20 times through the catheter. Cystoscopy was performed before and after the procedure, and bladders were analysed by histopathology. Two additional pigs were used for cystoscopy visualization of suction events in vivo. Cystoscopy, gross pathology, histopathological score, leucocyte infiltration, and intracatheter pressure at flow stops during voiding were compared for each group. Results A significant higher pressure gradient was measured inside the CECs compared with MHZCs during flow stop. Consequently, CECs resulted in suction events inflicting bladder trauma characterized by loss of epithelium, oedema, haemorrhage, and neutrophil tissue infiltration. No significant trauma was identified when using MHZC. Conclusions Considerable mucosal bladder trauma is inflicted by CECs which may be an overlooked risk factor for urinary tract infection. Catheters can be designed to minimize mucosal suction and reduce associated trauma. This may be a solution to reduce infection frequency and increase user comfort. Furthermore, the study demonstrates the potential of pigs as an attractive animal model for investigating urinary catheter performances.
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Affiliation(s)
- Kristian Stærk
- Department of Clinical Research University of Southern Denmark Odense Denmark
- Department of Clinical Microbiology Odense University Hospital Odense Denmark
| | - Brit Schrøder
- Preclinical, R&D, Innovation Coloplast A/S Humlebaek Denmark
| | | | - Troels Petersen
- Preclinical, R&D, Innovation Coloplast A/S Humlebaek Denmark
| | - Thomas Emil Andersen
- Department of Clinical Research University of Southern Denmark Odense Denmark
- Department of Clinical Microbiology Odense University Hospital Odense Denmark
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Teng X, Yao C, McCoy CP, Zhang S. Comparison of Superhydrophilic, Liquid-Like, Liquid-Infused, and Superhydrophobic Surfaces in Preventing Catheter-Associated Urinary Tract Infection and Encrustation. ACS Biomater Sci Eng 2024; 10:1162-1172. [PMID: 38183269 PMCID: PMC10865292 DOI: 10.1021/acsbiomaterials.3c01577] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/26/2023] [Accepted: 12/28/2023] [Indexed: 01/08/2024]
Abstract
Over the past decade, superhydrophilic zwitterionic surfaces, slippery liquid-infused porous surfaces, covalently attached liquid-like surfaces, and superhydrophobic surfaces have emerged as the most promising strategies to prevent biofouling on biomedical devices. Despite working through different mechanisms, they have demonstrated superior efficacy in preventing the adhesion of biomolecules (e.g., proteins and bacteria) compared with conventional material surfaces. However, their potential in combating catheter-associated urinary tract infection (CAUTI) remains uncertain. In this research, we present the fabrication of these four coatings for urinary catheters and conduct a comparative assessment of their antifouling properties through a stepwise approach. Notably, the superhydrophilic zwitterionic coating demonstrated the highest antifouling activity, reducing 72.3% of fibrinogen deposition and over 75% of bacterial adhesion (Escherichia coli and Staphylococcus aureus) when compared with an uncoated polyvinyl chloride (PVC) surface. The zwitterionic coating also exhibited robust repellence against blood and improved surface lubricity, decreasing the dynamic coefficient of friction from 0.63 to 0.35 as compared with the PVC surface. Despite the fact that the superhydrophilic zwitterionic and hydrophobic liquid-like surfaces showed great promise in retarding crystalline biofilm formation in the presence of Proteus mirabilis, it is worth noting that their long-term antifouling efficacy may be compromised by the proliferation and migration of colonized bacteria as they are unable to kill them or inhibit their swarming. These findings underscore both the potential and limitations of these ultralow fouling materials as urinary catheter coatings for preventing CAUTI.
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Affiliation(s)
- Xiao Teng
- School of Pharmacy, Queen’s University Belfast, Belfast BT9 7BL, U.K.
| | - Chenghao Yao
- School of Pharmacy, Queen’s University Belfast, Belfast BT9 7BL, U.K.
| | - Colin P. McCoy
- School of Pharmacy, Queen’s University Belfast, Belfast BT9 7BL, U.K.
| | - Shuai Zhang
- School of Pharmacy, Queen’s University Belfast, Belfast BT9 7BL, U.K.
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3
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Stærk K, Langhorn L, Halle B, Andersen TE. Urinary bladder catheterisation of female pigs: Influence of bladder content and Escherichia coli urinary tract infection on procedural outcome. Lab Anim 2024:236772231169344. [PMID: 38334709 DOI: 10.1177/00236772231169344] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Catheterisation of the urinary bladder is needed in many types of human disease models in pigs. Based on our extensive experience with the pig as an infection model, we here demonstrate an approach of catheterising domestic pigs (40 attempts) and Göttingen minipigs (10 attempts) using a blinded method, that is, without speculums or videoscopes to visualise the urethral opening. The procedure was tested on control animals and pigs with experimental Escherichia coli urinary tract infection (UTI) to assess the potential influence of this condition on procedural outcome. Lastly, we performed cystoscopy in three animals to visualise the route to the urethra and to localise potential anatomical obstacles. All domestic pigs were catheterised successfully in an average of 2 minutes and 23 seconds, and this was not influenced by UTI (p = 0.06) or bladder urine content at the time of catheterisation (p = 0.32). All Göttingen minipigs were successfully catheterised in an average of 4 minutes and 27 seconds. We conclude that blinded catheterisation is a fast and reliable approach that can be performed in pigs with or without UTI with minimal risk of trauma or contamination.
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Affiliation(s)
- Kristian Stærk
- Department of Clinical Microbiology, Odense University Hospital, Denmark
- Research Unit of Clinical Microbiology, University of Southern Denmark, Denmark
| | - Louise Langhorn
- Biomedical laboratory, University of Southern Denmark, Denmark
| | - Bo Halle
- Department of Neurosurgery, Odense University Hospital, Denmark
| | - Thomas Emil Andersen
- Department of Clinical Microbiology, Odense University Hospital, Denmark
- Research Unit of Clinical Microbiology, University of Southern Denmark, Denmark
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4
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Yamamoto K, Honda H, Hasegawa K, Hagiya H, Otsuka F. Penile cavernosal abscess after urethral injury. Clin Case Rep 2024; 12:e8534. [PMID: 38380380 PMCID: PMC10876920 DOI: 10.1002/ccr3.8534] [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: 12/28/2023] [Revised: 01/16/2024] [Accepted: 01/29/2024] [Indexed: 02/22/2024] Open
Abstract
We present a patient catheterized for prostatic lesions who developed sepsis of urinary origin with a penile cavernosal abscess due to urethral injury caused by catheter ballooning. Urethral injury might lead to a life-threatening penile abscess.
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Affiliation(s)
- Koichiro Yamamoto
- Department of General MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Hiroyuki Honda
- Department of General MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Kou Hasegawa
- Department of General MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Hideharu Hagiya
- Department of Infectious DiseasesOkayama University HospitalOkayamaJapan
| | - Fumio Otsuka
- Department of General MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
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5
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Munien K, Ravichandran K, Flynn H, Shugg N, Flynn D, Chambers J, Desai D. Catheter-associated meatal pressure injuries (CAMPI) in patients with long-term urethral catheters-a cross-sectional study of 200 patients. Transl Androl Urol 2024; 13:42-52. [PMID: 38404556 PMCID: PMC10891379 DOI: 10.21037/tau-23-445] [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: 08/28/2023] [Accepted: 11/22/2023] [Indexed: 02/27/2024] Open
Abstract
Background Indwelling urethral catheters (IDC) are ubiquitous to healthcare settings, and are associated with many familiar risks like haematuria, infections, bladder spasms and stones. However, a less known complication is catheter-associated meatal pressure injury (CAMPI), especially in those with long-term IDCs. The objective of this study was to explore the prevalence, associated features and management of CAMPI in adults with a long-term IDC. Methods A cross-sectional multi-centre study was undertaken of 200 adults with a long-term IDC across regional south-west Queensland, Australia between June 2019 to June 2021. The prevalence of CAMPI was determined by clinical examination, voluntary surveys completed by participants and documentation in medical records. Key IDC statistics included total duration of IDC, location of IDC changes, IDC size, type and fixation. Results Out of 200 adults with a long-term IDC, 9% (18/200) had a CAMPI. There was a higher prevalence of male CAMPI (17/169, 10%) compared to female CAMPI (1/31, 3%). The median time to identification of a CAMPI after initial IDC insertion was 12 weeks (2-136 weeks), but occurred as soon as 2 weeks. CAMPI formation was associated with IDC changes in the community, impaired mobility and congestive cardiac failure (CCF). CAMPI were mostly treated by conservative means given the frailty of the population. Conclusions Poor mobility, community-managed IDCs, and CCF were all found to have statistically significant associations with the development of CAMPI. CAMPI represents an important and underserved iatrogenic complication within urology practice, and greater awareness is needed to prevent it in vulnerable patients with long-term IDCs.
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Affiliation(s)
- Kale Munien
- Department of Urology, Toowoomba Hospital, Toowoomba, QLD, Australia
| | | | - Hannah Flynn
- Department of Urology, Toowoomba Hospital, Toowoomba, QLD, Australia
| | - Nathan Shugg
- Department of Urology, Toowoomba Hospital, Toowoomba, QLD, Australia
| | - David Flynn
- Department of Surgery, The Royal Brisbane & Women’s Hospital, Herston, QLD, Australia
| | | | - Devang Desai
- Department of Urology, Toowoomba Hospital, Toowoomba, QLD, Australia
- Department of Medical Sciences, University of Queensland, Brisbane, QLD, Australia
- Department of Medical Sciences, University of Southern Queensland, Toowoomba, QLD, Australia
- Department of Medical Sciences, Griffith University, Brisbane, QLD, Australia
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6
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Stapler SJ, Colom SM, Rajkumar D, Cleary RK. Early Urinary Catheter Removal After Colectomy for Colovesical Fistula is Not Associated With Increased Postoperative Complications. Am Surg 2023; 89:6091-6097. [PMID: 37482697 DOI: 10.1177/00031348231191179] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
BACKGROUND Management of the bladder defect during colectomy for colovesical fistula (CVF) and recommendations for duration of urinary catheter drainage are inconsistent. This study aimed to determine if urinary catheter drainage duration was associated with postoperative complications. METHODS Retrospective single institution cohort study of patients undergoing resection for diverticular CVF from 2015 through 2021. Urinary catheter drainage was defined as Early (≤7 days postoperative and then subdivided into 1-2 days, 3-5 days, 6-7 days), and Late (>7 days postoperative). Primary outcome was a composite measure of postoperative bladder leak, surgical site infection-III, sepsis, reoperation, and postoperative length-of-stay ≥7 days. RESULTS There were 73 patients-64 Early group and 9 Late group. Composite measure between groups (Early 25% vs Late 33.33%, P = .688) was not significantly different. The Late group had more patients with large bladder defects (33.3% vs 7.8%, P = .054), significantly more patients who underwent suture repair (55.6% vs 14.1%, P = .01), and significantly more patients that had an intraoperative pelvic drain (66.7% vs 15.6%, P = .003). After propensity score inverse weighting, the Late group had significantly more cystogram-detected postoperative bladder leaks (P = .002) and ileus (P = .042) than the Early group. There were no bladder leaks or ileus in those who had urinary catheter removal on postoperative days 1-2. CONCLUSIONS Early urinary catheter removal was associated with no increase in bladder leaks and fewer postoperative complications after definitive management of CVF. Further investigation is required to determine if intraoperative bladder leak testing and postoperative cystograms are useful adjuncts in decision making.
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Affiliation(s)
| | - Sara M Colom
- Biostatistics and Epidemiology Methods Consulting, BEMC, LLC, Ann Arbor, MI, USA
| | - Dixy Rajkumar
- Department of Academic Research, St Joseph Mercy Hospital, Ann Arbor, MI, USA
| | - Robert K Cleary
- Department of Surgery, St Joseph Mercy Hospital, Ann Arbor, MI, USA
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7
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Faia J, Martins AS, Martins M. Purple Urine Bag Syndrome: A Peculiar Presentation of a Urinary Tract Infection. Cureus 2023; 15:e49804. [PMID: 38161563 PMCID: PMC10757859 DOI: 10.7759/cureus.49804] [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] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 01/03/2024] Open
Abstract
Purple urine bag syndrome (PUBS) is a peculiar phenomenon and corresponds to the appearance of purplish-colored urine. It is associated with urinary tract infections occurring mainly in debilitated elderly women with constipation and long-term indwelling urinary catheters. We share a case involving PUBS in an 87-year-old female patient, explore the pathophysiology, and discuss potential management options for this uncommon syndrome.
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Affiliation(s)
- João Faia
- Internal Medicine, Centro Hospitalar do Baixo Vouga E.P.E, Aveiro, PRT
| | - Ana S Martins
- Internal Medicine, Centro Hospitalar do Baixo Vouga E.P.E, Aveiro, PRT
| | - Miguel Martins
- Internal Medicine, Centro Hospitalar do Baixo Vouga E.P.E, Aveiro, PRT
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8
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Silva F, Lopes MA, Valente D, Simões IG, Arez L. Bladder Perforation in the Elderly: Unraveling the Diagnostic Challenges With Magnetic Resonance Imaging. Cureus 2023; 15:e48934. [PMID: 38106777 PMCID: PMC10725557 DOI: 10.7759/cureus.48934] [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] [Subscribe] [Scholar Register] [Accepted: 11/17/2023] [Indexed: 12/19/2023] Open
Abstract
Bladder perforation, a significant urological emergency, presents a diagnostic challenge due to its diverse etiologies and varying clinical manifestations. This paper discusses a rare case of bladder perforation in an 87-year-old woman with a history of hypertension and previous stomach and uterine cancer. The patient was admitted with a urinary tract infection and subsequently experienced mild abdominal discomfort and reduced urinary output, prompting further investigation. Imaging studies revealed bladder wall thickening and ureterohydronephrosis, raising suspicion of a bladder tumor. Intriguingly, a catheter-related bladder perforation was identified through MRI. This case emphasizes the importance of considering bladder perforation as a potential complication, especially in elderly patients with indwelling catheters. Clinicians must maintain a high index of suspicion and employ appropriate diagnostic modalities to ensure timely recognition and suitable management of this rare condition.
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Affiliation(s)
- Frederico Silva
- Internal Medicine, Centro Hospitalar Universitário do Algarve - Unidade de Portimão, Portimão, PRT
| | - Mari Angela Lopes
- Internal Medicine, Centro Hospitalar Universitário do Algarve - Unidade de Portimão, Portimão, PRT
| | - Dilia Valente
- Internal Medicine, Centro Hospitalar Universitário do Algarve - Unidade de Portimão, Portimão, PRT
| | - Inês G Simões
- Internal Medicine, Centro Hospitalar Universitário do Algarve - Unidade de Portimão, Portimão, PRT
| | - Luísa Arez
- Internal Medicine, Centro Hospitalar Universitário do Algarve - Unidade de Portimão, Portimão, PRT
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9
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Youssef N, Shepherd A, Best C, Hagen S, Mackay W, Waddell D, El Sebaee H. The Quality of Life of Patients Living with a Urinary Catheter and Its Associated Factors: A Cross-Sectional Study in Egypt. Healthcare (Basel) 2023; 11:2266. [PMID: 37628463 PMCID: PMC10454127 DOI: 10.3390/healthcare11162266] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/31/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND In Arabic countries, no research has focused on the experience of patients with indwelling urinary catheters. This cross-sectional study is the first to evaluate the catheter-specific quality of life (QoL) of patients living with a urinary catheter in Egypt. METHODS This study was conducted from April to September 2017, using a convenience sample of patients from a University Hospital. Data were collected using the International Consultation on Incontinence Questionnaire-Long-Term Catheter QoL (ICIQ-LTCQoL) instrument, along with a demographic datasheet. RESULTS 141 were enrolled, with 47.5% inpatients, 52.5% outpatients. A total of 70.9% reported problems with catheter function, and 92.2% reported that the catheter affected their daily lives. Place (inpatient or outpatient) was significantly associated with the total score of the ICIQ-LTCQoL (mean difference (MD) 6.34 (95% CI: 3.0 to 9.73)) and both subscales (catheter function subscale: MD = 4.92 (95% CI: 2.12 to 7.73) and lifestyle impact subscale: MD = 1.44 (95% CI: 0.3 to 2.63)), suggesting that outpatients have poorer QoL than inpatients. Moreover, catheter material was significantly related to the catheter function domain with Silicone Foley Catheter (100% Silicon) users experiencing poorer QoL related to catheter function than those with Latex Foley Catheter (Silicon-coated) (MD 4.43 (95% CI: 0.62 to 8.24). Workers/employees were found to have poorer QoL than those who were retired (MD = 4.94 (95% CI: 0.3 to 9.63)). CONCLUSION The results highlight the necessity of assessing function and concern regarding urinary catheter use and its impact on QoL, as well as its determinants. Evidence-based educational programs should be designed to enhance patients' self-care abilities to relieve their sense of distress and enhance their confidence in caring for their catheters.
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Affiliation(s)
- Naglaa Youssef
- Department of Medical-Surgical Nursing, College of Nursing, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Ashley Shepherd
- Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK
| | - Catherine Best
- Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK
| | - Suzanne Hagen
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - William Mackay
- School of Health and Life Sciences, University of the West of Scotland, Paisley PA1 2BE, UK
| | - Debbie Waddell
- Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK
| | - Hanan El Sebaee
- Medical-Surgical Nursing Department, Faculty of Nursing, Cairo University, Cairo 11562, Egypt
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10
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Ghazanfar NA, Rasheed A, Shah AA, Bhatti SA, Sohail H, Farooq A. Impact of Duration of Catheterization on the Success Rate of Trial Without Catheter in Acute Urinary Retention Due to Benign Prostatic Enlargement. Cureus 2023; 15:e42716. [PMID: 37654938 PMCID: PMC10466170 DOI: 10.7759/cureus.42716] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND The most common cause of acute urinary retention in men over 50 is benign prostate enlargement (BPE). Following the urethral catheterization, a trial without a catheter (TWOC) under the cover of alpha-blockers is given. The timing of TWOC varies from Day 3 to Day 7 of the retention episode. There is a need to study the improvement in the success rate of TWOC with the increasing number of days of catheterization. OBJECTIVE To measure the success rate of TWOC in acute urinary retention due to benign prostatic enlargement with increasing days of catheterization. METHOD The study was conducted in Social Security Teaching Hospital Lahore. Patients who presented with acute urinary retention due to benign prostatic enlargement were catheterized and given alpha-blockers. The patients were divided into two groups, one group having TWOC after three days and the other having TWOC after seven days. The success rate of TWOC was calculated and compared in the two groups. All patients included in the study had the first episode of acute retention with a moderately enlarged prostate and no element of second pathology or neurological deficit. RESULTS A total of 48 patients were included in the study, divided into two groups of 24 patients each. In the first group who underwent TWOC after seven days of catheterization, 15 out of 24 patients had successful TWOC with a success rate of 62.5%. In the second group of 24 patients, who had TWOC after three days of catheterization, only 11 patients had successful TWOC with a success rate of 45.8%. CONCLUSION There was a marked improvement in the success rate of TWOC with increasing days of catheterization after an acute retention episode, secondary to BPE.
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Affiliation(s)
- Noman Ali Ghazanfar
- Urology, University College of Medicine and Dentistry/Social Security Teaching Hospital, Lahore, PAK
| | - Abdur Rasheed
- Urology, Central Park Medical College and Teaching Hospital, Lahore, PAK
| | | | | | - Hassan Sohail
- Urology, University College of Medicine and Dentistry/Social Security Teaching Hospital, Lahore, PAK
| | - Abid Farooq
- Urology, Blackpool Victoria NHS (National Health Services) Trust Hospital, Blackpool, GBR
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11
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Babar M, Masoud Z, Labagnara K, Loloi J, Sayed R, Singh S, Tang K, Syed U, Ciatto M. Efficacy and safety of the Rezum system for the treatment of catheter-dependent urinary retention: Three-year real-world outcomes in a multimorbid, multiethnic population. Low Urin Tract Symptoms 2023. [PMID: 37190924 DOI: 10.1111/luts.12482] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/18/2023] [Accepted: 05/02/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVES To evaluate the long-term real-world efficacy and safety of Rezum for the treatment of catheter-dependent urinary retention in a multimorbid, multiethnic population. METHODS A single-office, retrospective study was conducted on patients treated with Rezum between 2017 and 2019. Patients were included if they had catheter-dependent urinary retention prior to treatment and at least one follow-up within 36 months postoperatively. Patient demographics, procedural characteristics, adverse events (AEs), and outcome measures, including benign prostate hyperplasia (BPH) medication usage and postvoid residual (PVR), were collected at 3, 6, 12, and/or 36 months postoperatively. Regret was assessed at 36 months using the 5-item Decisional Regret Scale (DRS). RESULTS A total of 27 patients met the inclusion criteria, with the majority being Asian (29.6%), followed by non-Hispanic Black (26.0%) and Hispanic (22.2%). Most patients (77.8%) had at least one comorbidity. Trial of void (TOV) was attempted at a median of 8 days (7, 13). Fourteen patients (51.9%) failed their initial TOV. Median time until catheter independence was 13.5 days (8.5, 28.8). Common AEs included urinary retention (51.9%), urinary tract infections (UTIs) (25.9%), and dysuria (25.9%). All cases of UTIs (7/7) and most cases of dysuria (6/7) occurred in patients who failed their initial TOV. At 36 months, there was a significant median percentage change in PVR (-100.0% [-100.0, -36.7], p = .049), and 40.4% of patients discontinued their BPH medications (p = .001). Of the 11 patients who filled out the DRS, 10 (90.9%) agreed/strongly agreed that they made the right decision. By 36 months, 4 patients (14.8%) underwent reoperation and 24 (88.9%) remained catheter-independent. CONCLUSIONS At long-term follow-up, Rezum effectively treated catheter-dependent urinary retention with minimal decisional regret. In patients with urinary retention, urologists should consider delaying TOV until 2 weeks postoperatively to maximize the likelihood of a successful TOV and minimize the risk of AEs.
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Affiliation(s)
- Mustufa Babar
- Albert Einstein College of Medicine, Bronx, New York, USA
- DSS Urology, Queens Village, New York, USA
| | - Zaki Masoud
- Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Justin Loloi
- Department of Urology, Montefiore Medical Center, Bronx, New York, USA
| | - Rahman Sayed
- Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Kevin Tang
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Umar Syed
- DSS Urology, Queens Village, New York, USA
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12
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Al-Shukri AS, Maksimova AV, Dub NI, Kostyukov SV, Manchenko AA, Mayorov ID, Ponomareva YA, Petrov SB. [Prevention of the development of catheter-associated urinary system infections in the early postoperative period]. Urologiia 2023:13-19. [PMID: 37401699] [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] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
BACKGROUND Bladder catheterization is a common medical manipulation that is associated with the risk of complications, including catheter-associated urinary tract infection (CAUTI), which accounts for 80% of all nosocomial infections of the urological profile. AIM To evaluate the combined use of the biologically active additive Uronext and ceftriaxone in the prevention of the development of CAUTI in the early postoperative period in 120 patients aged 20-80 years with a Foley indwelling catheter. MATERIALS AND METHODS The patients were divided into 2 groups: in group I (n=60), D-mannose with cranberry extract and vitamin D3 as part of Uronext dietary supplement was administered orally in the form of sachets 48 hours before surgery and after surgery until urethral catheter was placed, as well as intravenous ceftriaxone 1000 mg 2 hours before surgery and in the postoperative period within 7 days. In group II (n=60), ceftriaxone monotherapy was prescribed in a similar way. RESULTS According to the results of bacteriological examination of the removed urinary catheter on 3-7 days in Uronext group, bacterial growth was absent in 40 patients (66.67%, p<0.05), versus 23 cases (38.33%) in the control group. CONCLUSIONS The data obtained confirm the efficiency of the use of the biologically active additive Uronext in combination with an antibacterial drug, which allows to recommend this scheme in patients with an indwelling urinary catheter for the prevention of the development of CAUTI.
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Affiliation(s)
- A S Al-Shukri
- Department of Urology of FGBOU VO Pavlov First Saint Petersburg State Medical University of the Ministry of Health of the Russian Federation, Saint Petersburg, Russia
- FGBVOU VO S.M. Kirov Military Medical Academy of the Ministry of Defense of Russian Federation, Saint Petersburg, Russia
- FGBU NMRC named after V.A. Almazov of the Ministry of Health of the Russian Federation, Saint Petersburg, Russia
| | - A V Maksimova
- Department of Urology of FGBOU VO Pavlov First Saint Petersburg State Medical University of the Ministry of Health of the Russian Federation, Saint Petersburg, Russia
- FGBVOU VO S.M. Kirov Military Medical Academy of the Ministry of Defense of Russian Federation, Saint Petersburg, Russia
- FGBU NMRC named after V.A. Almazov of the Ministry of Health of the Russian Federation, Saint Petersburg, Russia
| | - N I Dub
- Department of Urology of FGBOU VO Pavlov First Saint Petersburg State Medical University of the Ministry of Health of the Russian Federation, Saint Petersburg, Russia
- FGBVOU VO S.M. Kirov Military Medical Academy of the Ministry of Defense of Russian Federation, Saint Petersburg, Russia
- FGBU NMRC named after V.A. Almazov of the Ministry of Health of the Russian Federation, Saint Petersburg, Russia
| | - S V Kostyukov
- Department of Urology of FGBOU VO Pavlov First Saint Petersburg State Medical University of the Ministry of Health of the Russian Federation, Saint Petersburg, Russia
- FGBVOU VO S.M. Kirov Military Medical Academy of the Ministry of Defense of Russian Federation, Saint Petersburg, Russia
- FGBU NMRC named after V.A. Almazov of the Ministry of Health of the Russian Federation, Saint Petersburg, Russia
| | - A A Manchenko
- Department of Urology of FGBOU VO Pavlov First Saint Petersburg State Medical University of the Ministry of Health of the Russian Federation, Saint Petersburg, Russia
- FGBVOU VO S.M. Kirov Military Medical Academy of the Ministry of Defense of Russian Federation, Saint Petersburg, Russia
- FGBU NMRC named after V.A. Almazov of the Ministry of Health of the Russian Federation, Saint Petersburg, Russia
| | - I D Mayorov
- Department of Urology of FGBOU VO Pavlov First Saint Petersburg State Medical University of the Ministry of Health of the Russian Federation, Saint Petersburg, Russia
- FGBVOU VO S.M. Kirov Military Medical Academy of the Ministry of Defense of Russian Federation, Saint Petersburg, Russia
- FGBU NMRC named after V.A. Almazov of the Ministry of Health of the Russian Federation, Saint Petersburg, Russia
| | - Yu A Ponomareva
- Department of Urology of FGBOU VO Pavlov First Saint Petersburg State Medical University of the Ministry of Health of the Russian Federation, Saint Petersburg, Russia
- FGBVOU VO S.M. Kirov Military Medical Academy of the Ministry of Defense of Russian Federation, Saint Petersburg, Russia
- FGBU NMRC named after V.A. Almazov of the Ministry of Health of the Russian Federation, Saint Petersburg, Russia
| | - S B Petrov
- Department of Urology of FGBOU VO Pavlov First Saint Petersburg State Medical University of the Ministry of Health of the Russian Federation, Saint Petersburg, Russia
- FGBVOU VO S.M. Kirov Military Medical Academy of the Ministry of Defense of Russian Federation, Saint Petersburg, Russia
- FGBU NMRC named after V.A. Almazov of the Ministry of Health of the Russian Federation, Saint Petersburg, Russia
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13
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Okeke CJ, Ogunjimi MA, Jeje EA, Obi AO, Uzoma C. Urinary Catheter Documentation in a Nigerian Teaching Hospital: Are We Recording Enough? J West Afr Coll Surg 2023; 13:45-48. [PMID: 37228889 PMCID: PMC10204908 DOI: 10.4103/jwas.jwas_288_22] [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] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/16/2022] [Indexed: 05/27/2023]
Abstract
Background Urinary catheters are an important armamentarium of urologic practice. Several indications for their use exist. A good knowledge of the details surrounding every urinary catheter inserted is necessary for the proper management of the patients. Inadequate documentation can lead to complications such as urinary tract infection or even forgotten catheters. Objectives This study aimed at auditing the practice of documentation of urinary catheter parameters in our hospital as a means to improving the standard of care and aligning with international best practices with respect to the use of urinary catheters in our hospital. Materials and Methods This study was a 3-month audit on the quality of documentation on the parameters of each urinary catheter use in Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria. The parameters included the indication for catheterisation, route of catheterisation, staff who catheterised, size of catheter, type of catheter, volume of water used for inflating catheter balloon, volume of urine drained, if aseptic technique was followed during catheterisation, informed consent and complications encountered. Data were summarised as frequencies and means. Statistical significance was pegged at P < 0.05. Results Seventy-four patients were men, whereas two were women. The mean age of the patients was 67.29 ± 15.17 years. Overall, sex (76 [100%]), age (76 [100%]) and route of catheterisation (68 [89.5%]) were the three most commonly documented information. The documentation on complications and volume of fluid instilled to inflate the catheter balloon were the least-documented parameters (6 [7.9%] and 11 [14.5%], respectively). The following parameters were better documented in the SPC arm: The staff who passed the catheter p = 0.000), the type of catheter passed (p = 0.004), asepsis (p = 0.001) and acquisition of informed consent (p = 0.043). Conclusions Documentation following urinary catheter use was noted to be poor in this study. Documentation of catheter parameters was noted to be higher in patients who had SPC than those who had urethral catheterisation.
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Affiliation(s)
- Chike John Okeke
- Department of Urology, Epsom and St Helier University Hospitals NHS Trust, Surrey, London
| | - Moses Adebisi Ogunjimi
- Department of Surgery of the College of Medicine of the University of Lagos/Lagos University Teaching Hospital, Idi-Araba, Surulere, Lagos, Nigeria
| | - Emmanuel Ajibola Jeje
- Department of Surgery of the College of Medicine of the University of Lagos/Lagos University Teaching Hospital, Idi-Araba, Surulere, Lagos, Nigeria
| | - Anselm Okwudili Obi
- Department of Surgery, Ebonyi State University/Alex-Ekwueme Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Chukwuebuka Uzoma
- Royal Cornwall Hospital, Ebonyi State University/Alex-Ekwueme Federal Teaching Hospital, Truro, United Kingdom
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14
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Kołodziej Ł, Jurewicz A, Gębska M. Nursing interventions reduce postoperative urinary retention in fast-track total hip arthroplasty: A pilot study. ADV CLIN EXP MED 2023; 32:497-500. [PMID: 36994688 DOI: 10.17219/acem/161723] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/18/2023] [Accepted: 02/27/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Postoperative urinary retention (POUR) is a common complication of spinal anesthesia that occurs in 10-80% of patients after total hip replacement (THR). Bladder catheterization carries risks for urinary tract infections, mechanical urethral trauma, urethral inflammation and subsequent strictures, pain, discomfort, an increased length of hospital stay, and a loss of patient dignity. OBJECTIVES We investigated whether simple postoperative nurse-driven intervention protocols, including the sound of running tap water, followed by caffeinated hot beverages (tea or coffee) and pouring warm saline on the perineal area, could reduce POUR and the need for bladder catheterization. MATERIAL AND METHODS This pilot study included 60 patients undergoing elective fast-track THR with spinal anesthesia and early patient ambulation. Patients with postoperative voiding difficulties received nursing interventions, including hearing running tap water, ingesting caffeinated beverages (tea and coffee), and warm saline poured over the perineal area. If voiding difficulties continued, bladder distention was examined by ultrasound. Catheterization was performed if the volume exceeded 500 mL or if distension caused discomfort or pain. RESULTS Seven patients (11%) were excluded from the study due to prophylactic preoperative catheterization. Among the 53 included patients, 27 (51%) experienced spontaneous voiding difficulties and received nursing interventions, which induced voiding in 24 patients (45%, p = 0.0027), while 3 (6%) required catheterization. CONCLUSION Simple nursing interventions reduced the need for bladder catheterization after fast-track THR.
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Affiliation(s)
- Łukasz Kołodziej
- Department of Orthopedic Traumatology and Musculoskeletal Oncology, Pomeranian Medical University in Szczecin, Poland
- Department of Movement Rehabilitation, Pomeranian Medical University in Szczecin, Poland
| | - Alina Jurewicz
- Department of Orthopedic Traumatology and Musculoskeletal Oncology, Pomeranian Medical University in Szczecin, Poland
| | - Magdalena Gębska
- Department of Movement Rehabilitation, Pomeranian Medical University in Szczecin, Poland
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15
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Raisin G, Cohen R, Galant O, Vaisfish M, Jaworowski S, Jaber J, Kocherov S, Chertin B. Medical clowns versus sedation for paediatric urinary catheter insertion-A randomised pilot study. Acta Paediatr 2023; 112:1319-1323. [PMID: 36853014 DOI: 10.1111/apa.16733] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/17/2023] [Accepted: 02/27/2023] [Indexed: 03/01/2023]
Abstract
AIM To investigate the potential benefits of medical clowns (MCs) in reducing anxiety and pain during paediatric urinary catheter insertion. METHODS In this prospective pilot study, 51 children who required urinary catheter insertion were randomised into two groups; the first group (n = 29) underwent the procedure in the presence of a MCs, and the second control group (n = 22) underwent the procedure using sedation. Pain and anxiety levels as well as procedural duration were recorded. All procedures were filmed and evaluated for anxiety level by a paediatric psychiatrist. General satisfaction questionnaires were filled by the medical team and parents in the clown group. RESULTS There were no differences in pain scores or anxiety levels between the two groups. Procedure duration and total hospital stay were significantly shorter in the MC group (p < 0.001). One hundred percent of the parents and the medical team were in favour of incorporating MCs during urinary catheter insertion. CONCLUSION MCs are as good as sedation in lowering anxiety and pain levels in children undergoing urinary catheter insertion. In addition, MCs reduce the duration of the procedure and elicit a high degree of overall satisfaction from the parents and medical team.
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Affiliation(s)
- Galiya Raisin
- Department of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Rachel Cohen
- Department of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Orit Galant
- Department of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Miriam Vaisfish
- Department of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Sol Jaworowski
- Department of Psychiatry, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Jawdat Jaber
- Department of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Stanislav Kocherov
- Department of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Boris Chertin
- Department of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel
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16
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Berglund DD, Parker DM, Fluck M, Dove J, Falvo A, Horsley RD, Gabrielsen J, Petrick AT, Daouadi M. Impact of Urinary Catheterization on Postoperative Outcomes After Roux-En-Y Gastric Bypass Surgery in Propensity-Matched Cohorts. Am Surg 2023; 89:280-285. [PMID: 34060921 DOI: 10.1177/00031348211023444] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND The impact of urinary catheter avoidance in bariatric enhanced recovery after surgery (ERAS) protocols is yet to be established. The purpose of the current study is to determine whether urinary catheter use in patients undergoing Roux-en-Y gastric bypass (RYGB) procedures has an effect on postoperative outcomes. METHODS An institutional database was utilized to identify adult patients undergoing primary minimally invasive RYGB surgery. Outcomes included incidence of urinary tract infection (UTI) within 30 days postoperatively, 30-day readmission rates, proportion of patients discharged after postoperative day 1 (delayed discharge), length of stay (LOS), and operating room time. These were compared between propensity-matched groups with and without urinary catheter placement. RESULTS There were no significant differences in postoperative UTI's (2.2% for both cohorts, P = .593) or 30-day readmission rates for patients with and without urinary catheters (6.6% and 4.4%, respectively, P = .260). Mean LOS (1.7 vs. 1.5 days, P = .001) and the proportion of patients having a delayed discharge (47.3% vs. 33.7%, P = .001) was greater in patients with a catheter. Operating room time was longer in the urinary catheter group (221.8 vs. 207.9 minutes, P = .002). DISCUSSION Avoidance of indwelling urinary catheters in RYGB surgical patients decreased delayed discharges and LOS without affecting readmission or reoperation rates. Therefore, we recommend that avoidance of urinary catheters in routine RYGB surgery be considered for inclusion into standardized ERAS protocols. Urinary catheters should continue to be utilized in select cases, however, as these were not shown to affect rate of UTIs.
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Affiliation(s)
| | | | | | - James Dove
- 2780Geisinger Health System, Danville, PA, USA
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17
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Umbehr MH, Wagg A, Habib MH, Antonelli JA, Chughtai B, Jang TL, Kaldany A, Saraiya B, Stephenson RD, Sze C, Wiedemann A, Jones CA, Schlögl M. Top Ten Tips Palliative Care Clinicians Should Know About Urological Care. J Palliat Med 2023; 26:264-269. [PMID: 36579919 DOI: 10.1089/jpm.2022.0467] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Patients receiving palliative care (PC) can present with or develop a host of urological needs or complications. These needs can include attention to sexual health, urinary incontinence, genitourinary bleeding, and urinary tract obstruction by benign, malignant, or urinary stone diseases. These varied conditions require that PC clinicians understand invasive and noninvasive medical, surgical, and radiation options for treatment. This article, written by a team of urologists, geriatricians, and PC specialists, offers information and guidance to PC teams in an accessible "Top Ten Tips" format to increase comfort with and skills around assessment, evaluation, and specialist referral for urological conditions common in the PC setting.
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Affiliation(s)
- Martin H Umbehr
- Department of Urology, Municipal Hospital of Zurich, Zurich, Switzerland
| | - Adrian Wagg
- Department of Medicine, Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Muhammad Hamza Habib
- Cancer Institute of New Jersey, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Jodi A Antonelli
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Bilal Chughtai
- Department of Urology, Weil Cornell Medicine-New York Presbyterian Hospital, New York, New York, USA
| | - Thomas L Jang
- Division of Urology and Section of Urologic Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Alain Kaldany
- Division of Urology and Section of Urologic Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Biren Saraiya
- Cancer Institute of New Jersey, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Ryan D Stephenson
- Cancer Institute of New Jersey, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Christina Sze
- Department of Urology, Weil Cornell Medicine-New York Presbyterian Hospital, New York, New York, USA
| | - Andreas Wiedemann
- Faculty of Health, Department of Humane Medicine, University of Witten/Herdecke, Witten, Germany.,Department of Urology, Evangelic Hospital of Witten, Witten, Germany
| | - Christopher A Jones
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mathias Schlögl
- Division of Geriatric Medicine, Clinic Barmelweid, Barmelweid, Switzerland.,University Clinic for Acute Geriatrics City Hospital Waid, Zurich, Switzerland
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18
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Marrone M, Macorano E, Lippolis G, Caricato P, Cazzato G, Oliva A, De Luca BP. Consent and Complications in Health Care: The Italian Context. Healthcare (Basel) 2023; 11:healthcare11030360. [PMID: 36766935 PMCID: PMC9914763 DOI: 10.3390/healthcare11030360] [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] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/13/2023] [Accepted: 01/26/2023] [Indexed: 02/01/2023] Open
Abstract
Informed consent is the manifestation of the will that a patient freely expresses toward a medical treatment. The physician is responsible for acquiring informed consent for both medical and nursing procedures. Informed consent represents a juridical-deontological tool that allows therapeutic choices to be shared with the user after having exhaustively explained the risks and benefits of the procedure itself. In fact, the physician has an obligation to provide the patient with clear and comprehensible information about the type of service, the methods of delivery, the benefits, the risks, even unforeseeable ones, and the complications. According to Italian legal guidelines, in cases of presumed health responsibility, the health professional accused of negligence will have to demonstrate that any complication that has arisen, although foreseeable, was not preventable. Through the analysis of a clinical case relating to the procedure of insertion of a bladder catheter performed by a nurse and a review of the literature, the authors explain the importance of the information that must be provided to the patient before carrying out any invasive procedure, even if not performed by the doctor. The authors describe the problem in the Italian context and propose a possible solution.
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Affiliation(s)
- Maricla Marrone
- Section of Legal Medicine, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Enrica Macorano
- Section of Legal Medicine, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy
- Correspondence: ; Tel.: +39-3891612479
| | - Giuseppe Lippolis
- Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation-Urology, University of Bari, 70124 Bari, Italy
| | - Pierluigi Caricato
- Section of Legal Medicine, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Gerardo Cazzato
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Antonio Oliva
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Catholic University, Fondazione Policlinico “A. Gemelli” IRCCS, 00100 Rome, Italy
| | - Benedetta Pia De Luca
- Section of Legal Medicine, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy
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19
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Alhabdan N, Alyaemni A, Aljuaid MM, Baydoun A, Hamidi S. Impact of Implementing Key Performance Indicators on Catheter-Associated Urinary Tract Infection (CAUTI) Rates Among Adult ICU Patients in Saudi Arabia. Clinicoecon Outcomes Res 2023; 15:41-49. [PMID: 36700053 PMCID: PMC9869901 DOI: 10.2147/ceor.s396160] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/12/2023] [Indexed: 01/20/2023] Open
Abstract
Background The prevalence of catheter-associated urinary tract infections (CAUTIs) in hospitals characterizes one of the most significant problems in healthcare. This study aims to assess whether the implementation of impact of key performance indicators (KPIs) checklist reduces the number of CAUTI in adults present in intensive care unit (ICU) with indwelling catheters. Methods This is a retrospective analytical study conducted in a tertiary hospital in Riyadh, Saudi Arabia, from June 2020 to June 2021. One hundred and thirty-four patients with CAUTIs met the criteria and were included in the study. Socio-demographic data was collected to enable informed analysis based on personal information (age, gender, marital status, monthly income, level of education, and department) and medical history (duration of catheterization, types of organisms, history of chronic illness, and duration of hospitalization). The research also used a prevention of CAUTI checklist containing 26 items. The outcome measures were 1) the rate of CAUTIs measured pre- and post-implementing performance measurement indicators (KPI) of CAUTIs prevention practice and 2) the prevention of catheter-associated urinary tract infection in three areas: general information recording, insertion practices, and maintenance practices. Results The study found that there was compliance with the prevention of CAUTIs in terms of recording the general patient's information (72%), insertion practices (52%), and maintenance practices (50%). However, most safety practices, including poor hygiene and safety standards, patient handling, and audited protocol programs, were not strictly followed, resulting in increased risk factors for CAUTIs. Conclusion Compliance with the prevention of CAUTIs in terms of recording the general patient's information, insertion practices, and maintenance practices lies within the range of 50-75%, and the recommended practices are usually followed. A targeted education on CAUTI-prevention practices curtailing the most aggravating risk factors and adopting a safety culture driven by a patient handling and audited protocol program should be explored to reduce hospital CAUTIs.
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Affiliation(s)
- Nouf Alhabdan
- Department of Health Administration, College of Business Administration, King Saud University, Riyadh, Saudi Arabia
| | - Asma Alyaemni
- Department of Health Administration, College of Business Administration, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed M Aljuaid
- Department of Health Administration, College of Business Administration, King Saud University, Riyadh, Saudi Arabia
| | - Ali Baydoun
- School of Medicine, St. George’s University, Grenada, West Indies
| | - Samer Hamidi
- School of Health and Environmental Studies, Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates,Correspondence: Samer Hamidi, School of Health and Environmental Studies, Hamdan Bin Mohammed Smart University, Dubai Academic City, P.O.Box 71400, Dubai, United Arab Emirates, Tel +971-4-424-1089, Email
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20
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Maffucci F, Chang C, Simhan J, Cohn JA. Is There Any Benefit to the Use of Antibiotics with Indwelling Catheters after Urologic Surgery in Adults. Antibiotics (Basel) 2023; 12:156. [PMID: 36671357 PMCID: PMC9854512 DOI: 10.3390/antibiotics12010156] [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] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 01/14/2023] Open
Abstract
Antibiotic stewardship in urologic reconstruction is critically important, as many patients will require indwelling catheters for days to weeks following surgery and thus are at risk of both developing catheter-associated urinary tract infections (CAUTI) as well as multi-drug resistant (MDR) uropathogens. Accordingly, limiting antibiotic use, when safe, should help reduce antibiotic resistance and the prevalence of MDR organisms. However, there is significant heterogeneity in how antibiotics are prescribed to patients who need indwelling urethral catheters post-operatively. We performed a literature review to determine if there are benefits in the use of antibiotics for various clinical scenarios that require post-operative indwelling catheters for greater than 24 h. In general, for patients undergoing prostatectomy, transurethral resection of the prostate, and/or urethroplasty, antibiotic administration may be limited without increased risk of CAUTI. However, more work is needed to identify optimal antibiotic regimens for these and alternative urologic procedures, whether certain sub-populations benefit from longer courses of antibiotics, and effective non-antibiotic or non-systemic therapies.
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Affiliation(s)
- Fenizia Maffucci
- Department of Urology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA 19111, USA
| | | | | | - Joshua A. Cohn
- Department of Urology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA 19111, USA
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21
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Dias LD, Duarte LS, Naves PLF, Napolitano HB, Bagnato VS. Self-Disinfecting Urethral Catheter to Overcome Urinary Infections: From Antimicrobial Photodynamic Action to Antibacterial Biochemical Entities. Microorganisms 2022; 10. [PMID: 36557737 DOI: 10.3390/microorganisms10122484] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/18/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Medical-device-related infections are considered a worldwide public health problem. In particular, urinary catheters are responsible for 75% of cases of hospital urinary infections (a mortality rate of 2.3%) and present a high cost for public and private health systems. Some actions have been performed and described aiming to avoid it, including clinical guidelines for catheterization procedure, antibiotic prophylaxis, and use of antimicrobial coated-urinary catheters. In this review paper, we present and discuss the functionalization of urinary catheters surfaces with antimicrobial entities (e.g., photosensitizers, antibiotics, polymers, silver salts, oxides, bacteriophage, and enzymes) highlighting the immobilization of photosensitizing molecules for antimicrobial photodynamic applications. Moreover, the characterization techniques and (photo)antimicrobial effects of the coated-urinary catheters are described and discussed. We highlight the most significant examples in the last decade (2011-2021) concerning the antimicrobial coated-urinary catheter and their potential use, limitations, and future perspectives.
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22
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Shimoni Z, Froom P, Silke B, Benbassat J. The presence of a urinary catheter is an important predictor of in-hospital mortality in internal medicine patients. J Eval Clin Pract 2022; 28:1113-1118. [PMID: 35510815 DOI: 10.1111/jep.13694] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/17/2022] [Accepted: 04/18/2022] [Indexed: 12/01/2022]
Abstract
RATIONALE AND OBJECTIVE Mortality rates are used to assess the quality of hospital care after appropriate adjustment for case-mix. Urinary catheters are frequent in hospitalized adults and might be a marker of patient frailty and illness severity. However, we know of no attempts to estimate the predictive value of indwelling catheters for specific patient outcomes. The objective of the present study was to (a) identify the variables associated with the presence of a urinary catheter and (b) determine whether it predicts in-hospital mortality after adjustment for these variables. METHODS The study population included all acutely admitted adult patients in 2020 (exploratory cohort) and January-October 2021 (validation cohort) to internal medicine, cardiology and intensive care departments at the Laniado Hospital, a regional hospital with 400 beds in Israel. There were no exclusion criteria. The predictor variables were the presence of a urinary catheter on admission, age, gender, comorbidities and admission laboratory test results. We used bivariate and multivariate logistic regression to test the associations between the presence of a urinary catheter and mortality after adjustment for the remaining independent variables on admission. RESULTS The presence of a urinary catheter was associated with other independent variables. In 2020, the odds of in-hospital mortality in patients with a urinary catheter before and after adjustment for the remaining predictors were 14.3 (11.6-17.7) and 6.05 (4.78-7.65), respectively. Adding the presence of a urinary catheter to the prediction logistic regression model increased its c-statistic from 0.887 (0.880-0.894) to 0.907 (0.901-0.913). The results of the validation cohort reduplicated those of the exploratory cohort. CONCLUSIONS The presence of a urinary catheter on admission is an important and independent predictor of in-hospital mortality in acutely hospitalized adults in internal medicine departments.
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Affiliation(s)
- Zvi Shimoni
- Department of Internal Medicine B, Laniado Hospital, Netanya, Israel.,Ruth and Bruce Rappaport School of Medicine, Technion University, Haifa, Israel
| | - Paul Froom
- Clinical Utility Department, Sanz Medical Center, Laniado Hospital, Netanya, Israel.,School of Public Health, University of Tel Aviv, Tel Aviv-Yafo, Israel
| | - Bernard Silke
- Division of Internal Medicine, St. James' Hospital, Dublin, Ireland
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23
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Navarro S, Sherman E, Colmer-Hamood JA, Nelius T, Myntti M, Hamood AN. Urinary Catheters Coated with a Novel Biofilm Preventative Agent Inhibit Biofilm Development by Diverse Bacterial Uropathogens. Antibiotics (Basel) 2022; 11:1514. [PMID: 36358169 PMCID: PMC9686518 DOI: 10.3390/antibiotics11111514] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/22/2022] [Accepted: 10/25/2022] [Indexed: 08/03/2023] Open
Abstract
Despite the implementation of stringent guidelines for the prevention of catheter-associated (CA) urinary tract infection (UTI), CAUTI remains one of the most common health care-related infections. We previously showed that an antimicrobial/antibiofilm agent inhibited biofilm development by Gram-positive and Gram-negative bacterial pathogens isolated from human infections. In this study, we examined the ability of a novel biofilm preventative agent (BPA) coating on silicone urinary catheters to inhibit biofilm formation on the catheters by six different bacterial pathogens isolated from UTIs: three Escherichia coli strains, representative of the most common bacterium isolated from UTI; one Enterobacter cloacae, a multidrug-resistant isolate; one Pseudomonas aeruginosa, common among patients with long-term catheterization; and one isolate of methicillin-resistant Staphylococcus aureus, as both a Gram-positive and a resistant organism. First, we tested the ability of these strains to form biofilms on urinary catheters made of red rubber, polyvinyl chloride (PVC), and silicone using the microtiter plate biofilm assay. When grown in artificial urine medium, which closely mimics human urine, all tested isolates formed considerable biofilms on all three catheter materials. As the biofilm biomass formed on silicone catheters was 0.5 to 1.6 logs less than that formed on rubber or PVC, respectively, we then coated the silicone catheters with BPA (benzalkonium chloride, polyacrylic acid, and glutaraldehyde), and tested the ability of the coated catheters to further inhibit biofilm development by these uropathogens. Compared with the uncoated silicone catheters, BPA-coated catheters completely prevented biofilm development by all the uropathogens, except P. aeruginosa, which showed no reduction in biofilm biomass. To explore the reason for P. aeruginosa resistance to the BPA coating, we utilized two specific lipopolysaccharide (LPS) mutants. In contrast to their parent strain, the two mutants failed to form biofilms on the BPA-coated catheters, which suggests that the composition of P. aeruginosa LPS plays a role in the resistance of wild-type P. aeruginosa to the BPA coating. Together, our results suggest that, except for P. aeruginosa, BPA-coated silicone catheters may prevent biofilm formation by both Gram-negative and Gram-positive uropathogens.
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Affiliation(s)
- Stephany Navarro
- Department of Immunology and Molecular Microbiology, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | | | - Jane A. Colmer-Hamood
- Department of Immunology and Molecular Microbiology, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Department of Medical Education, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Thomas Nelius
- Department of Urology, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | | | - Abdul N. Hamood
- Department of Immunology and Molecular Microbiology, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
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Kanti SPY, Csóka I, Jójárt-Laczkovich O, Adalbert L. Recent Advances in Antimicrobial Coatings and Material Modification Strategies for Preventing Urinary Catheter-Associated Complications. Biomedicines 2022; 10:2580. [PMID: 36289841 DOI: 10.3390/biomedicines10102580] [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: 09/06/2022] [Revised: 09/28/2022] [Accepted: 10/06/2022] [Indexed: 11/28/2022] Open
Abstract
In recent years, we have witnessed prominent improvements in urinary catheter coatings to tackle the commonly occurring catheter-associated urinary tract infection (CAUTI) in catheterized patients. CAUTIs are claimed to be one of the most frequent nosocomial infections that can lead to various complications, from catheter encrustation to severe septicaemia and pyelonephritis. Besides general prevention hygienic strategies, antimicrobial-coated urinary catheters show great potential in the prevention of urinary catheter-associated complications. The aim of this review is to present and evaluate recent updates on the development of antimicrobial urinary catheters in the context of the aetiology of urinary malfunction. Subsequently, we shed some light on future perspectives of utilizing 3D printing and the surrounding regulatory directions.
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Iftimie S, Hernández-Aguilera A, López-Azcona AF, Castañé H, Rodríguez-Tomàs E, Baiges-Gaya G, Camps J, Castro A, Joven J. Measurement of Plasma Galectin-3 Concentrations in Patients with Catheter Infections: A Post Hoc Retrospective Cohort Study. Diagnostics (Basel) 2022; 12:diagnostics12102418. [PMID: 36292107 PMCID: PMC9599992 DOI: 10.3390/diagnostics12102418] [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: 09/07/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 11/28/2022] Open
Abstract
Catheter-related infections (CRIs) include catheter-associated urinary tract infections (CAUTIs) and central line-associated bloodstream infections (CLABSIs), and they are associated with high morbidity, mortality, and healthcare costs. The diagnosis of a CRI is made difficult by its non-specific symptoms. We aimed to investigate the factors influencing the plasma concentration of galectin-3 in catheter-bearing patients and to explore its potential usefulness as an index for CRIs. Circulating the concentrations of galectin-3, we measured the chemokine (C-C) motif ligand 2, procalcitonin, and C-reactive protein in 110 patients with a central catheter, in 165 patients with a urinary catheter, and in 72 control subjects. Catheter-bearing patients had higher concentrations (p < 0.001) of galectin-3 than the control group [central catheter: 19.1 (14.0−23.4) µg/L; urinary catheter: 17.1 (12.7−25.4) µg/L; control group: 6.1 (5.0−8.7) µg/L]. We identified chronic kidney disease as an independent determinant of galectin-3 concentrations in patients with a central catheter, and serum creatinine, cardiovascular disease, and number of days that the catheter was indwelling were identified as determinants in urinary catheter patients. We found that measuring galectin-3 concentrations in urinary catheter patients with a CRI was more accurate for diagnosis than the other parameters. We conclude that the measurement of galectin-3 concentration may be useful for assessing the inflammatory status of catheter-bearing patients and may contribute to the diagnosis of CRIs in those with a urinary catheter.
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Affiliation(s)
- Simona Iftimie
- Department of Internal Medicine, Hospital Universitari de Sant Joan, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain
| | - Anna Hernández-Aguilera
- Unitat de Recerca Biomèdica, Hospital Universitari de Sant Joan, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain
| | - Ana F. López-Azcona
- Department of Internal Medicine, Hospital Universitari de Sant Joan, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain
| | - Helena Castañé
- Unitat de Recerca Biomèdica, Hospital Universitari de Sant Joan, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain
| | - Elisabet Rodríguez-Tomàs
- Unitat de Recerca Biomèdica, Hospital Universitari de Sant Joan, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain
| | - Gerard Baiges-Gaya
- Unitat de Recerca Biomèdica, Hospital Universitari de Sant Joan, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain
| | - Jordi Camps
- Unitat de Recerca Biomèdica, Hospital Universitari de Sant Joan, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain
- Correspondence: ; Tel.: +34-977-310-300
| | - Antoni Castro
- Department of Internal Medicine, Hospital Universitari de Sant Joan, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain
| | - Jorge Joven
- Unitat de Recerca Biomèdica, Hospital Universitari de Sant Joan, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain
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Lior Y, Haim S, Katz I, Danino B, Bar-Yosef Y, Ekstein M. Postoperative Urinary Catheterization in Children Treated with or without Epidural Analgesia after Orthopedic Surgery: A Retrospective Review of Practice. Children (Basel) 2022; 9. [PMID: 36138625 DOI: 10.3390/children9091316] [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] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/16/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022]
Abstract
Epidural analgesia is effective and an accepted treatment for postoperative pain. Urinary retention is a known complication, but its description is mostly in the adult literature. Management of urinary catheter (UC) placement and removal is an important consideration in children receiving epidural analgesia. This is a single-center, retrospective observational study which examined UC management in children undergoing lower extremity orthopedic surgery under general anesthesia with or without epidural analgesia from January 2019−June 2021. Of 239 children included, epidural analgesia was used in 57 (23.8%). They were significantly younger and had more co-morbidities. In total, 75 UCs were placed in the OR, 9 in the ward, and 7 re-inserted. UC placement in the epidural group was more common (93% vs. 17%, p < 0.001) and remained longer (3 days vs. 1 day, p = 0.01). Among children without intra-operative UC, ward placement was more common in the epidural cohort (60% vs. 1.6%, p = 0.007). OR UC placement and ward re-insertion were more common in children with neuromuscular disease (61% vs. 22%, p < 0.001), (17% vs. 3%, p = 0.001), respectively. Based on these findings, we hypothesize that it is justifiable to routinely place a UC intra-operatively in children who undergo hip or lower extremity surgery and are treated with epidural analgesia, and caution is advised before early UC removal in orthopedic children with NMD.
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Yao Q, Zhang J, Pan G, Chen B. Mussel-Inspired Clickable Antibacterial Peptide Coating on Ureteral Stents for Encrustation Prevention. ACS Appl Mater Interfaces 2022; 14:36473-36486. [PMID: 35917447 DOI: 10.1021/acsami.2c09448] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Long-term indwelling catheters or stents often cause complications like infection, encrustation, hematuria, pain, and so on. The source of these problems is bacteria, which can form biofilms on the stents to reduce antibiotic sensitivity and produce urease to form encrustation by increasing the urine pH. Urinary tract infection (UTI) can aggravate the body damage and even seriously endanger lives, and the encrustation will block the stents, which can cause hydronephrosis and renal function damage. Therefore, the prevention of UTI and encrustation represents a great challenge in clinical ureteral stent uses. In this work, a clickable mussel-inspired peptide and antimicrobial peptide (AMP) were used to functionalize the commercial stents' surfaces to inhibit long-term infection and encrustation caused by bacteria. Copper (Cu) ions were used to coordinate the mussel-inspired peptide to improve the stability. The AMP with an azido group was clicked to the mussel-inspired Cu-coordinated peptide coating through click chemistry. The bio-inspired antibacterial coating was constructed with excellent stability, bactericidal properties, and improved biological compatibility. In in vitro and in vivo experiments, it was further found that the coating showed bactericidal and encrustation reduction abilities. This study thus developed an effective, safe, and stable AMP coating on urinary stents/catheters capable of long-term antibacterial and encrustation inhibition.
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Affiliation(s)
- Qin Yao
- Department of Urology, Affiliated Hospital of Jiangsu University, 438 Jiefang Road, Zhenjiang, Jiangsu 212001, P. R. China
| | - Jinyi Zhang
- Institute for Advanced Materials, School of Materials Science and Engineering, Jiangsu University, 304 Xuefu Road, Zhenjiang, Jiangsu 212013, P. R. China
| | - Guoqing Pan
- Institute for Advanced Materials, School of Materials Science and Engineering, Jiangsu University, 304 Xuefu Road, Zhenjiang, Jiangsu 212013, P. R. China
| | - Binghai Chen
- Department of Urology, Affiliated Hospital of Jiangsu University, 438 Jiefang Road, Zhenjiang, Jiangsu 212001, P. R. China
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McNaughton J, Fairley-Murdoch M. Catheter valves: are they useful in supporting patients in a trial without catheter? Br J Community Nurs 2022; 27:294-300. [PMID: 35671208 DOI: 10.12968/bjcn.2022.27.6.294] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A trial without catheter (TWOC) is a common urological procedure undertaken to remove an indwelling urinary catheter when no longer clinically indicated. An appropriately trained practitioner should undertake a TWOC in a controlled environment to ensure that a further urinary retention does not occur. Indwelling urinary catheters are commonly used with a free drainage system such as a leg bag, which continually empties the bladder. This article examines the potential benefits of using a catheter valve as an alternative to free drainage, prior to undertaking a TWOC, to optimise clinical outcomes and patient experience. This article will guide nurses to increase their knowledge of catheter valves to promote person-centred informed decision-making.
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Fu CY, Wan L, Shen PY, Wang LZ. Feasibility of immediate removal of urinary catheter after laparoscopic gynecological surgery for benign diseases: A meta-analysis of randomized controlled trials. Int J Gynaecol Obstet 2022; 159:622-629. [PMID: 35616374 DOI: 10.1002/ijgo.14283] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/09/2022] [Accepted: 05/10/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND The proper time for removing the urinary catheter after gynecologic laparoscopy is unclear. OBJECTIVES To assess the feasibility of immediate catheter removal after benign gynecologic laparoscopy. SEARCH STRATEGY PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and Wanfang Data were searched from inception to November 30, 2021. SELECTION CRITERIA Only randomized controlled trials published in English or Chinese comparing immediate versus delayed catheter removal after gynecologic laparoscopy for benign diseases were included. DATA COLLECTION AND ANALYSIS The primary outcome was the incidence of postoperative urinary retention (PUR). A random effects model was used to calculate pooled relative risk (RR) and 95% confidence interval (CI). MAIN RESULTS Six studies were included in this meta-analysis. There was no significant difference in PUR between immediate and delayed catheter removal (RR 1.51, 95% CI 0.37-6.18), but the evidence was of very low quality. Subgroup analysis according to the type of surgery showed a higher rate of PUR with immediate removal after hysterectomy than after other surgeries. Immediate removal was associated a lower incidence of urinary tract infection and a shorter time to mobilization compared with delayed removal. CONCLUSIONS Immediate removal of the urinary catheter is feasible and beneficial after benign gynecologic laparoscopy.
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Affiliation(s)
- Chun-Yan Fu
- Department of Gynecologic Nursing, Jiaxing Maternity and Children Health Care Hospital, Affiliated Women and Children Hospital, Jiaxing University, Jiaxing, Zhejiang, China
| | - Li Wan
- Department of Gynecologic Nursing, Jiaxing Maternity and Children Health Care Hospital, Affiliated Women and Children Hospital, Jiaxing University, Jiaxing, Zhejiang, China
| | - Pei-Ying Shen
- Department of Gynecologic Nursing, Jiaxing Maternity and Children Health Care Hospital, Affiliated Women and Children Hospital, Jiaxing University, Jiaxing, Zhejiang, China
| | - Li-Zhong Wang
- Department of Anesthesiology, Jiaxing Maternity and Children Health Care Hospital, Affiliated Women and Children Hospital, Jiaxing University, Jiaxing, Zhejiang, China
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Allaw F, Haddad SF, Habib N, Moukarzel P, Naji NS, Kanafani ZA, Ibrahim A, Zahreddine NK, Spernovasilis N, Poulakou G, Kanj SS. COVID-19 and C. auris: A Case-Control Study from a Tertiary Care Center in Lebanon. Microorganisms 2022; 10. [PMID: 35630454 DOI: 10.3390/microorganisms10051011] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/04/2022] [Accepted: 05/09/2022] [Indexed: 02/04/2023] Open
Abstract
Many healthcare centers around the world have reported the surge of Candida auris (C. auris) outbreaks during the COVID-19 pandemic, especially among intensive care unit (ICU) patients. This is a retrospective study conducted at the American University of Beirut Medical Center (AUBMC) between 1 October 2020 and 15 June 2021, to identify risk factors for acquiring C. auris in patients with severe COVID-19 infection and to evaluate the impact of C. auris on mortality in patients admitted to the ICU during that period. Twenty-four non-COVID-19 (COV−) patients were admitted to ICUs at AUBMC during that period and acquired C. auris (C. auris+/COV−). Thirty-two patients admitted with severe COVID-19 (COV+) acquired C. auris (C. auris+/COV+), and 130 patients had severe COVID-19 without C. auris (C. auris−/COV+). Bivariable analysis between the groups of (C. auris+/COV+) and (C. auris−/COV+) showed that higher quick sequential organ failure assessment (qSOFA) score (p < 0.001), prolonged length of stay (LOS) (p = 0.02), and the presence of a urinary catheter (p = 0.015) or of a central venous catheter (CVC) (p = 0.01) were associated with positive culture for C. auris in patients with severe COVID-19. The multivariable analysis showed that prolonged LOS (p = 0.008) and a high qSOFA score (p < 0.001) were the only risk factors independently associated with positive culture for C. auris. Increased LOS (p = 0.02), high “Candida score” (p = 0.01), and septic shock (p < 0.001) were associated with increased mortality within 30 days of positive culture for C. auris. Antifungal therapy for at least 7 days (p = 0.03) appeared to decrease mortality within 30 days of positive culture for C. auris. Only septic shock was associated with increased mortality in patients with C. auris (p = 0.006) in the multivariable analysis. C. auris is an emerging pathogen that constitutes a threat to the healthcare sector.
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Bentvelsen RG, Bruijning ML, Chavannes NH, Veldkamp KE. Reducing Inappropriate Urinary Catheter Use by Involving Patients Through the Participatient App: Before-and-After Study. JMIR Form Res 2022; 6:e28983. [PMID: 35377323 PMCID: PMC9016499 DOI: 10.2196/28983] [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: 03/20/2021] [Revised: 07/09/2021] [Accepted: 01/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background The risk of urinary tract infections is increased by the inappropriate placement and unnecessary prolongation of the use of indwelling urinary catheters. Sustained behavior change in infection prevention could be promoted by empowering patients through a smartphone app. Objective The aim of this study is to assess the feasibility and efficacy of implementation actions on patients’ use of the Participatient app on a clinical ward and to compare 3 survey methods for urinary catheter use. Methods Participatient was introduced for all admitted patients at the surgical nursing ward in a university hospital in the Netherlands. Over a period of 3 months, the number of new app users, days of use, and sessions were recorded. In a comparison of urinary catheter use before and after the implementation of the app, 3 methods for point prevalence surveys of catheter use were tested. Surveys were conducted through manual parsing of the text in patients’ electronic medical records, parsing a survey of checkbox items, and parsing nursing notes. Results In all, 475 patients were admitted to the ward, 42 (8.8%) installed the app, with 1 to 5 new users per week. The actions with the most ensuing app use were the kick-off with the clinical lesson and recruiting of the intake nurse. Between the survey methods, there was considerable variation in catheter use prevalence. Therefore, we used the standard method of manual parsing in further analyses. Catheter use prevalence decreased from 38% (36/96) to 27% (23/86) after app introduction (OR 0.61, 95% CI 0.32-1.14). Conclusions The clinical application of Participatient, the infection prevention app for patients, could be feasible when implementation actions are also used. For surveying indwelling urinary catheter use prevalence, manual parsing is the best approach.
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Affiliation(s)
- Robbert G Bentvelsen
- Department of Medical Microbiology, Leiden University Medical Center, Leiden University, Leiden, Netherlands.,Microvida Laboratory for Medical Microbiology, Amphia Hospital, Breda, Netherlands
| | - Marguerite L Bruijning
- Department of Medical Microbiology, Leiden University Medical Center, Leiden University, Leiden, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden University, Leiden, Netherlands
| | - Karin Ellen Veldkamp
- Department of Medical Microbiology, Leiden University Medical Center, Leiden University, Leiden, Netherlands
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Douglass M, Ghalei S, Brisbois E, Handa H. Potent, Broad-Spectrum Antimicrobial Effects of S-Nitroso- N-acetylpenicillamine-Impregnated Nitric Oxide-Releasing Latex Urinary Catheters. ACS Appl Bio Mater 2022; 5:700-710. [PMID: 35119808 PMCID: PMC9680922 DOI: 10.1021/acsabm.1c01130] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Although numerous prevention and intervention techniques have been developed to counteract catheter-associated urinary tract infections (CAUTIs), urinary catheters remain one of the most common sources of hospital-acquired infections. Nitric oxide (NO), a gaseous free radical responsible for regulating many physiological functions in the body, has gained immense popularity due to its potent, broad-spectrum antimicrobial activity, which is capable of combating medical device-associated infections. In this work, a straightforward solvent-swelling method was used to load the NO donor S-nitroso-N-acetyl-penicillamine (SNAP) into commercial latex catheters (SNAP-UCs) for the first time. The effects of swelling catheters with different concentrations of SNAP solutions (25-125 mg/mL SNAP in tetrahydrofuran (THF)) were studied by measuring the NO release kinetics, SNAP loading, and SNAP leaching. SNAP-UCs impregnated with a 50 mg/mL SNAP-THF solution were found to maximize the amount of SNAP loaded into the latex (0.115 ± 0.009 mg SNAP/mg catheter) and showed physiological levels of NO release (>2 × 10-10 mol min-1 cm-2) over 7 days and minimal SNAP leaching (<2%). SNAP-UCs showed impressive in vitro contact-based and diffusible antimicrobial efficacy against three CAUTI-associated pathogens, reducing the viability of adhered and planktonic Escherichia coli, Proteus mirabilis, and Staphylococcus aureus by ∼98.0 to 99.1% (adhered) and 86.3-96.3% (planktonic) compared to control latex catheters. In vitro cytotoxicity against 3T3 mouse fibroblasts using a CCK-8 assay showed that SNAP-UCs were noncytotoxic (>90% viability). In summary, SNAP-UCs show stable, noncytotoxic NO release characteristics capable of potent, broad-spectrum antimicrobial activity, demonstrating great potential for reducing the devastating effects associated with CAUTIs.
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Affiliation(s)
- Megan Douglass
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia 30602, United States
| | - Sama Ghalei
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia 30602, United States
| | - Elizabeth Brisbois
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia 30602, United States
| | - Hitesh Handa
- School of Chemical, Materials and Biomedical Engineering, College of Engineering and Pharmaceutical and Biomedical Sciences Department, College of Pharmacy, University of Georgia, Athens, Georgia 30602, United States
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Ganesan V, Sundaramurthy R, Thiruvanamalai R, Sivakumar VA, Udayasankar S, Arunagiri R, Charles J, Chavan SK, Balan Y, Sakthivadivel V. Device-Associated Hospital-Acquired Infections: Does Active Surveillance With Bundle Care Offer a Pathway to Minimize Them? Cureus 2021; 13:e19331. [PMID: 34909294 PMCID: PMC8651063 DOI: 10.7759/cureus.19331] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2021] [Indexed: 11/22/2022] Open
Abstract
Background and objective The prevalence of hospital-acquired infections (HAIs) is underreported in developing nations due to a lack of systematic active surveillance. This study reports the burden of device-associated HAIs (DA-HAIs) based on two years of active surveillance with in situ bundle care in closed intensive care units (ICUs) of a tertiary care hospital. Materials and methods A prospective surveillance study was carried out in 140-bedded ICUs (2,100-bed hospital) of a tertiary care private medical college hospital. Daily active surveillance for catheter-associated urinary tract infection (CAUTI), ventilator-associated event (VAE), and central line-associated bloodstream infection (CLABSI) was done by trained infection control nurses (ICNs) along with quality champion nurses with HAI surveillance forms with bundle care auditing, which was attached to the case sheets of all patients on devices. The surveillance definitions of DA-HAIs were adapted from the Centers for Disease Control and Prevention (CDC)’s National Healthcare Safety Network (CDC-NHSN) 2017 surveillance criteria. Data were analyzed at the end of every month to generate the cumulative device-associated infection (DAI) rates and device utilization ratio (DUR). These data were compared with NHSN and International Nosocomial Infection Control Consortium (INICC) - India HAI rates and communicated to corresponding ICUs and also presented at the hospital infection control committee (HICC) meeting. Results The surveillance data were reported over 71,877 patient days during the study period. The DUR of urinary catheters, ventilator, and central line were 0.53, 0.16, and 0.22, respectively. CAUTI, VAE, and CLABSI rates were 0.97, 10.5, and 0.43 per 1,000 device days, respectively. Among 166 DA-HAIs reported, 182 pathogens were identified. Klebsiella pneumoniae was the most common organism isolated, accounting for 37.4% of all DA-HAI cases, followed by Acinetobacter baumanii (30.8%). Most of the Gram-negative organisms were carbapenem-resistant (153/175; 87.4%). Vancomycin resistance rate in Enterococcus was 28.5% (2/7). Conclusion DUR and CAUTI, VAE, CLABSI rates were less/on par with the benchmarks of INICC and CDC-NHSN in almost all ICUs of our tertiary care unit. Gram-negative pathogen with 87.4% carbapenem resistance worsened the scenario. Proper active surveillance with bundle care and training by ICNs made a significant difference in all DA-HAI rates, especially VAE, which decreased to 10.5 from 23.6 per 1,000 ventilator days. Sustained active surveillance of HAI and bundle care auditing by a trained infection prevention team with a stringent antibiotic policy are the need of the hour to combat DAIs.
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Affiliation(s)
- Vithiya Ganesan
- Department of Microbiology, Velammal Medical College Hospital and Research Institute, Madurai, IND
| | - Raja Sundaramurthy
- Department of Microbiology, All India Institute of Medical Sciences - Bibinagar, Hyderabad, IND
| | - Rajendran Thiruvanamalai
- Department of Microbiology, Velammal Medical College Hospital and Research Institute, Madurai, IND
| | - Vijay Anand Sivakumar
- Department of Anaesthesiology, Velammal Medical College Hospital and Research Institute, Madurai, IND
| | - Sridhurga Udayasankar
- Department of Paediatrics, Velammal Medical College Hospital and Research Institute, Madurai, IND
| | - Ramesh Arunagiri
- Department of Microbiology, Velammal Medical College Hospital and Research Institute, Madurai, IND
| | - Jhansi Charles
- Department of Microbiology, Velammal Medical College Hospital and Research Institute, Madurai, IND
| | - Sunil Kumar Chavan
- Department of Microbiology, All India Institute of Medical Sciences - Bibinagar, Hyderabad, IND
| | - Yuvaraj Balan
- Department of Biochemistry, All India Institute of Medical Sciences - Bibinagar, Hyderabad, IND
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Abstract
The purpose of the present review is to report the incidence and characteristics of healthcare-associated urinary tract infections (HAUTIs) in urology with their microbiological and resistance patterns. Urinary tract infections are the main type of healthcare-associated infection in patients hospitalized in a urology ward. Patients admitted to urology departments report a high prevalence of urinary tract catheterization, up to 75% during the hospitalization period, and up to 20% had a urinary catheter before admission. An endourological surgical procedure is another risk factor for HAUTIs. Other risk factors for HAUTIs are the presence of immunosuppression and previous urinary tract infections. In urological patients, Enterobacterales are the principal causative agent of HAUTIs, and E. coli is the most frequently isolated microorganism. However, there is also a high rate of microorganisms other than E. coli such as Klebsiella spp. and Enterococcus spp. Non-E. coli microorganisms show a higher prevalence in immunosuppressed patients and those with urinary catheters before admission. High resistance patterns are reported in patients with HAUTIs, and ESBL-producing bacteria are frequently described. Moreover, the isolation of multidrug-resistant microorganisms is more common in immunosuppressed patients, those with previous urinary tract infections, and urinary catheters into the upper urinary tract. Treatment must be tailored according to patient characteristics and patient profiles, bearing in mind the ORENUC classification for risk factors (no risk factors (O), recurrent urinary tract infections risk factors (R), extraurogenital risk factors (E), nephropathic disease (N), urological risk factors (U), permanent urinary catheter and non-resolvable urological risk factors (C)).
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Affiliation(s)
- José Medina-Polo
- Department of Urology, Health Research Institute i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Kurt G Naber
- Department of Urology, Technical University of Munich, Germany
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Takayama S, Takura K. Home Oxygen Therapy-Induced Bladder Rupture. Cureus 2021; 13:e16975. [PMID: 34540385 PMCID: PMC8423322 DOI: 10.7759/cureus.16975] [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] [Accepted: 08/07/2021] [Indexed: 11/05/2022] Open
Abstract
An 84-year-old man taking home oxygen therapy (HOT) for chronic obstructive pulmonary disease (COPD) was brought to our emergency department because of cardiopulmonary arrest after connecting an oxygen cylinder to a urinary catheter at home. On physical examination, subcutaneous emphysema and abdominal distension were noted. The oxygen stored in the abdominal cavity seemed to induce abdominal compartment syndrome, so we decided to drain the oxygen. Advanced cardiac life support protocol and drainage were performed, followed by the return of spontaneous circulation. The number of patients on HOT for COPD is expected to increase because COPD is a common disease globally. This patient had a urinary catheter due to urinary retention caused by benign prostatic hyperplasia (BPH). BPH is a benign tumor of the prostate gland that is the most common cause of dysuria in older men. COPD and BPH are very common diseases, so similar medical accidents may occur. We report this case to prevent a recurrence.
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Affiliation(s)
| | - Kohei Takura
- Surgery, Nagoya Tokushukai General Hospital, Nagoya, JPN
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Liu C, Feng S, Ma L, Sun M, Wei Z, Wang J, Chen Z, Guo Y, Shi J, Wu Q. An Amphiphilic Carbonaceous/Nanosilver Composite-Incorporated Urinary Catheter for Long-Term Combating Bacteria and Biofilms. ACS Appl Mater Interfaces 2021; 13:38029-38039. [PMID: 34357763 DOI: 10.1021/acsami.1c07399] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Biofilms formed on urinary catheters remain a major headache in the modern healthcare system. Among the various kinds of biocide-releasing urinary catheters that have been developed to prevent biofilm formation, Ag nanoparticles (AgNPs)-coated catheters are of great promising potential. However, the deposition of AgNPs on the surface of catheters suffers from several inherent shortcomings, such as damage to the urethral mucosa, uncontrollable Ag ion kinetics, and unexpected systematic toxicity. Here, AgNPs-decorated amphiphilic carbonaceous particles (ACPs@AgNPs) with commendable dispersity in solvents of different polarities and broad-spectrum antibacterial activity are first prepared. The resulting ACPs@AgNPs exert good compatibility with silicone rubber, which enables the easy fabrication of urinary catheters using a laboratory-made mold. Therefore, ACPs@AgNPs not only endow the urinary catheter with forceful biocidal activity but also improve its mechanical properties and surface wettability. Hence, the designed urinary catheter possesses excellent capacity to resist bacterial adhesion and biofilm formation both in vitro and in an in vivo rabbit model. Specifically, a long-term antibacterial study highlights its sustainable antibacterial activity. Of note, no obvious toxicity or inflammation in rabbits was triggered by the designed urinary catheter in vivo. Overall, the hybrid urinary catheter may serve as a promising biocide-releasing urinary catheter for antibacterial and antibiofilm applications.
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Affiliation(s)
- Chaoqun Liu
- College of Pharmacy, Institutes of Environment and Medicine, Henan University, Kaifeng 475004, China
| | - Shan Feng
- College of Pharmacy, Institutes of Environment and Medicine, Henan University, Kaifeng 475004, China
| | - Longyu Ma
- College of Pharmacy, Institutes of Environment and Medicine, Henan University, Kaifeng 475004, China
| | - Mengyao Sun
- College of Pharmacy, Institutes of Environment and Medicine, Henan University, Kaifeng 475004, China
| | - Zhihong Wei
- College of Pharmacy, Institutes of Environment and Medicine, Henan University, Kaifeng 475004, China
| | - Jiaqi Wang
- College of Pharmacy, Institutes of Environment and Medicine, Henan University, Kaifeng 475004, China
| | - Zhaowei Chen
- Institute of Food Safety and Environment Monitoring, College of Chemistry, Fuzhou University, Fuzhou 350108, China
| | - Yuheng Guo
- Institute of Food Safety and Environment Monitoring, College of Chemistry, Fuzhou University, Fuzhou 350108, China
| | - Jiahua Shi
- Key Laboratory of Natural Medicine and Immuno-Engineering of Henan Province, Henan University, Kaifeng 475004, China
| | - Qiang Wu
- College of Pharmacy, Institutes of Environment and Medicine, Henan University, Kaifeng 475004, China
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Zhang L, Yang X, Tian Y, Yu Q, Xu Y, Zhou D, Wu Z, Zhao X. The feasibility and advantages of immediate removal of urinary catheter after lobectomy: A prospective randomized trial. Nurs Open 2021; 8:2942-2948. [PMID: 34329541 PMCID: PMC8510769 DOI: 10.1002/nop2.1006] [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: 04/17/2021] [Revised: 06/05/2021] [Accepted: 07/10/2021] [Indexed: 11/19/2022] Open
Abstract
Aim This study aims to evaluate the feasibility and advantages of immediate urinary catheter removal compared with prolonged indwelling catheterization in lung cancer lobectomy. Design This study was designed as a prospective, single‐centre, randomized and open‐label clinical study. Methods People with lung cancer undergoing lobectomy/pneumonectomy were recruited and randomly allocated to two groups. One group had their urinary catheter removed immediately while the other group had it removed 48 hr after surgery. Results No significant difference in the incidence of postoperative urinary retention (POUR) was observed between the two groups. However, the incidence of postoperative catheter‐associated urinary tract infection (CAUTI) in the immediate removal group (6.7%) was lower than the control group (17.2%) (p = .030). Furthermore, the incidence of catheter‐associated emergence agitation (CAEA) in the control group (25.3%) was higher than the immediate removal group (8.9%) (p = .007). The average length of hospital stay of the immediate removal group [6.51(4–11) days] was shorter than the control group [7.20(5–12) days] (p = .002). Immediate removal of urinary catheter appeared to have fewer complications and shorter hospital stay than delayed removal.
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Affiliation(s)
- Lei Zhang
- Department of Thoracic Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Xueying Yang
- Department of Thoracic Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Ye Tian
- Department of Thoracic Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Qian Yu
- Department of Thoracic Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Yang Xu
- Department of Thoracic Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Di Zhou
- Department of Thoracic Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Zhuo Wu
- Department of Thoracic Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Xitong Zhao
- Department of Thoracic Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
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Stærk K, Grønnemose RB, Palarasah Y, Kolmos HJ, Lund L, Alm M, Thomsen P, Andersen TE. A Novel Device-Integrated Drug Delivery System for Local Inhibition of Urinary Tract Infection. Front Microbiol 2021; 12:685698. [PMID: 34248906 PMCID: PMC8267894 DOI: 10.3389/fmicb.2021.685698] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 03/25/2021] [Accepted: 05/26/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Catheter-associated urinary tract infection (CAUTI) is a frequent community-acquired infection and the most common nosocomial infection. Here, we developed a novel antimicrobial catheter concept that utilizes a silicone-based interpenetrating polymer network (IPN) as balloon material to facilitate a topical slow-release prophylaxis of antibacterial agents across the balloon to the urinary bladder. Methods: The balloon material was achieved by modifying low shore hardness silicone tubes with a hydrogel interpenetrating polymer in supercritical CO2 using the sequential method. Release properties and antibacterial efficacy of the IPN balloon treatment concept was investigated in vitro and in a porcine CAUTI model developed for the study. In the latter, Bactiguard Infection Protection (BIP) Foley catheters were also assessed to enable benchmark with the traditional antimicrobial coating principle. Results: Uropathogenic Escherichia coli was undetectable in urinary bladders and on retrieved catheters in the IPN treatment group as compared to control that revealed significant bacteriuria (>105 colony forming units/ml) as well as catheter-associated biofilm. The BIP catheters failed to prevent E. coli colonization of the bladder but significantly reduced catheter biofilm formation compared to the control. Conclusion: The IPN-catheter concept provides a novel, promising delivery route for local treatment in the urinary tract.
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Affiliation(s)
- Kristian Stærk
- Research Unit of Clinical Microbiology, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Rasmus Birkholm Grønnemose
- Research Unit of Clinical Microbiology, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Yaseelan Palarasah
- Department of Cancer and Inflammation Research, University of Southern Denmark, Odense, Denmark
| | - Hans Jørn Kolmos
- Research Unit of Clinical Microbiology, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Lars Lund
- Research Unit of Urology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | | | - Thomas Emil Andersen
- Research Unit of Clinical Microbiology, University of Southern Denmark and Odense University Hospital, Odense, Denmark
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Lan SM, Lin JY, Su ZX, Hsu HW, Lee CE, Hsu MP. [Improve the Integrity Rate of Response and Teaching for Tube Care Administered by the Primary Caregiver]. Hu Li Za Zhi 2021; 68:73-80. [PMID: 34013508 DOI: 10.6224/jn.202106_68(3).10] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND & PROBLEM The need to use an indwelling nasogastric tube, urinary catheter, or tracheostomy tube (the so-called "three tubes") because of illness or prolonged bedrest is increasing. The functions and effectiveness of these tubes may be maintained only with correct care. Improper care, slippage, obstruction, or infection may in severe cases cause septic shock or even death. PURPOSE To increase the completeness of the reverse demonstration of three tubes care instructions by primary caregivers to further improve related care quality. RESOLUTION Between February 10th and March 31st, 2019, the completeness rates of reverse demonstration of nasogastric tube, urinary catheter, and tracheostomy tube care instructions among the primary caregivers participating in this study were shown to be low, at 42.5%, 38%, and 58.3%, respectively. The plausible causes were: 1. Human: Poor communication, forgetting the care steps, having no time for learning, and fear of performing nasogastric tube rotation; 2. Instrument: Lack of graphic demonstrations in health education materials; 3. Policy: Lack of standards and auditing. The implemented intervention involved creating innovative health-education instruments, videos and flash cards about three tubes care in multiple languages, and straps for holding the urinary catheter and developing standards and an auditing system for the reverse demonstration of three tube care instructions by primary caregivers. RESULTS The completeness rates for the reverse demonstration of nasogastric tube, urinary catheter, and tracheostomy tube care instructions among the primary caregivers improved to 97.3%, 96.3%, and 95%, respectively. CONCLUSIONS Using the innovative health-education aids and improvements introduced in this study, the ability of primary caregivers to correctly perform the care steps should improve significantly.
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Affiliation(s)
- Shiang-Mei Lan
- BSN, RN, Department of Nursing, Far Eastern Memorial Hospital, Taiwan, ROC
| | - Jing-Yun Lin
- MSN, RN, Head Nurse, Department of Nursing, Far Eastern Memorial Hospital, Taiwan, ROC.
| | - Zhi-Xuan Su
- BSN, RN, Department of Nursing, Far Eastern Memorial Hospital, Taiwan, ROC
| | - Hsiu-Wen Hsu
- BSN, RN, Department of Nursing, Far Eastern Memorial Hospital, Taiwan, ROC
| | - Cheng-En Lee
- ADN, RN, Department of Nursing, Far Eastern Memorial Hospital, Taiwan, ROC
| | - Meng-Ping Hsu
- MSN, RN, Supervisor, Department of Nursing, Far Eastern Memorial Hospital, Taiwan, ROC
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Farsi AH. Risk Factors and Outcomes of Postoperative Catheter-Associated Urinary Tract Infection in Colorectal Surgery Patients: A Retrospective Cohort Study. Cureus 2021; 13:e15111. [PMID: 34159014 PMCID: PMC8212576 DOI: 10.7759/cureus.15111] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction Catheter-associated urinary tract infection (CAUTI) is a relatively common cause of postoperative morbidity in colorectal surgery patients. It has been associated with increased length of stay and mortality. Methods We performed a retrospective cohort study of 620 colorectal surgeries to assess the prevalence of CAUTI and its relationship with preoperative and operative factors. We also sought to identify its association with postoperative outcomes. Results We found that CAUTI occurred in 20.6% of colorectal procedures. We found that CAUTI was associated with older patient age, female gender, higher BMI, higher American Society of Anesthesiologists (ASA) classification, lower hemoglobin, higher creatinine, lower albumin, urgent procedures, bilateral ureteric stent placement, usage of double-J (DJ) stents, postoperative abdominal sepsis, and perioperative steroid usage. CAUTI was also associated with the presence of underlying medical conditions such as hypertension, ischemic heart disease, chronic kidney disease, cerebrovascular disease, and diabetes. With regards to postoperative outcomes, it was associated with postoperative stroke, myocardial infarction, prolonged length of stay, Intensive care unit stay, and mortality. Conclusion CAUTI remains a significant cause of morbidity in colorectal patients. Our patient population had a significantly higher risk of CAUTI compared to other series. Though sometimes labelled a minor postoperative complication, its occurrence is associated with other more significant postoperative complications, including death.
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Affiliation(s)
- Ali H Farsi
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
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41
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Backman C, Wooller KR, Hasimja-Saraqini D, Demery Varin M, Crick M, Cho-Young D, Freeman L, Delaney L, Squires JE. Intervention to reduce unnecessary urinary catheter use in a large academic health science centre: A one-group, pretest, posttest study with a theory-based process evaluation. Nurs Open 2021; 9:1432-1444. [PMID: 33988900 PMCID: PMC8859062 DOI: 10.1002/nop2.920] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 02/17/2021] [Accepted: 03/15/2021] [Indexed: 11/13/2022] Open
Abstract
Aim To evaluate an intervention to reduce unnecessary urinary catheter use and prevent catheter‐associated urinary‐tract infections (CAUTI) in hospitalized patients across an academic health science centre. Methods We conducted a one‐group, pretest, posttest study with a theory‐based process evaluation. Phase 1 consisted of a pre/postintervention to test the impact of a CAUTI protocol. Audits on four units were conducted, and data were analysed descriptively. Phase 2 consisted of a theory‐based process evaluation to understand the barriers/enablers to the implementation. Semistructured interviews were conducted and then analysed using a systematic approach. Results In Phase 1, all inpatients with urinary catheters admitted to the units (N = 4) during the study period (N = 99, pre) and (N = 99, post) were included. CAUTI prevalence rate was 18.2% pre versus 14.1% post (p = .563). In Phase 2, participants (N = 18) who worked on the units were interviewed, and a total of 13 barriers and 19 enablers were found.
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Affiliation(s)
- Chantal Backman
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada
| | | | | | - Melissa Demery Varin
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Michelle Crick
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Danielle Cho-Young
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Lisa Freeman
- The Ottawa Hospital, Civic Campus, Ottawa, ON, Canada
| | - Lori Delaney
- The Ottawa Hospital, Civic Campus, Ottawa, ON, Canada
| | - Janet E Squires
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Tarabal VS, Silva FG, Sinisterra RD, Gonçalves D, Silva J, Granjeiro JM, Speziali M, Granjeiro PA. Impact of DMPEI on Biofilm Adhesion on Latex Urinary Catheter. Recent Pat Biotechnol 2021; 15:51-66. [PMID: 33588743 DOI: 10.2174/1872208315666210215084127] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/25/2020] [Accepted: 12/31/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Microorganisms can migrate from the external environment to the patient's organism through the insertion of catheters. Despite being indispensable medical device, the catheter surface can be colonized by microorganisms and become a starting point for biofilm formation. Therefore, new technologies are being developed in order to modify surfaces to prevent the adhesion and survival of microorganisms. Patents with the use of DMPEI have been filed. OBJECTIVE In the present work, we coated latex catheter surfaces with 2 mg mL-1 DMPEI in different solvents, evaluated the wettability of the surface and the anti- biofilm activity of the coated catheter against Escherichia coli, Staphylococcus aureus, and Candida albicans. METHODS We coated the inner and outer catheter surfaces with 2 mg mL-1 of DMPEI solubilized in butanol, dimethylformamide, and cyclohexanone and the surfaces were analyzed visually. Contact angle measurement allowed the analysis of the wettability of the surfaces. The CFU mL-1 count evaluated E. coli, S. aureus, and C. albicans adhesion onto the control and treated surfaces. RESULTS The contact angle decreased from 50.48º to 46.93º on the inner surface and from 55.83º to 50.91º on the outer surface of latex catheters coated with DMPEI. The catheter coated with DMPEI showed anti-biofilm activity of 83%, 88%, and 93% on the inner surface and 100%, 92%, and 86% on the outer surface for E. coli, S. aureus, and C. albicans, respectively. CONCLUSION Latex catheter coated with DMPEI efficiently impaired the biofilm formation both on the outer and inner surfaces, showing a potential antimicrobial activity along with a high anti-biofilm activity for medical devices.
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Affiliation(s)
- Vinícius S Tarabal
- Campus Centro-Oeste, Federal University of São João del-Rei, Divinópolis, Minas Gerais, Brazil
| | - Flávia G Silva
- Chemistry Department, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ruben D Sinisterra
- Chemistry Department, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Daniel Gonçalves
- Campus Centro-Oeste, Federal University of São João del-Rei, Divinópolis, Minas Gerais, Brazil
| | - Jose Silva
- Campus Centro-Oeste, Federal University of São João del-Rei, Divinópolis, Minas Gerais, Brazil
| | - Jose M Granjeiro
- National Institute of Metrology, Quality and Technology, Duque de Caxias, Rio de Janeiro, Brazil
| | - Marcelo Speziali
- Chemistry Department, Federal University of Ouro Preto, Minas Gerais, Brazil
| | - Paulo A Granjeiro
- Campus Centro-Oeste, Federal University of São João del-Rei, Divinópolis, Minas Gerais, Brazil
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Zhang S, Liang X, Gadd GM, Zhao Q. Marine Microbial-Derived Antibiotics and Biosurfactants as Potential New Agents against Catheter-Associated Urinary Tract Infections. Mar Drugs 2021; 19:255. [PMID: 33946845 PMCID: PMC8145997 DOI: 10.3390/md19050255] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/27/2021] [Accepted: 04/27/2021] [Indexed: 11/26/2022] Open
Abstract
Catheter-associated urinary tract infections (CAUTIs) are among the leading nosocomial infections in the world and have led to the extensive study of various strategies to prevent infection. However, despite an abundance of anti-infection materials having been studied over the last forty-five years, only a few types have come into clinical use, providing an insignificant reduction in CAUTIs. In recent decades, marine resources have emerged as an unexplored area of opportunity offering huge potential in discovering novel bioactive materials to combat human diseases. Some of these materials, such as antimicrobial compounds and biosurfactants synthesized by marine microorganisms, exhibit potent antimicrobial, antiadhesive and antibiofilm activity against a broad spectrum of uropathogens (including multidrug-resistant pathogens) that could be potentially used in urinary catheters to eradicate CAUTIs. This paper summarizes information on the most relevant materials that have been obtained from marine-derived microorganisms over the last decade and discusses their potential as new agents against CAUTIs, providing a prospective proposal for researchers.
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Affiliation(s)
- Shuai Zhang
- School of Mechanical and Aerospace Engineering, Queen’s University Belfast, Belfast BT9 5AH, UK;
| | - Xinjin Liang
- The Bryden Center, School of Chemical and Chemistry Engineering, Queen’s University Belfast, Belfast BT7 1NN, UK;
- School of Life Sciences, University of Dundee, Dundee DD1 5EH, UK;
| | | | - Qi Zhao
- School of Science and Engineering, University of Dundee, Dundee DD1 4HN, UK
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Singh R, Singh A, Pratts R, Jain A, Singh M. A Rare Cause of Apparent Anuria After Caesarean Section: A Case Report. Cureus 2021; 13:e14400. [PMID: 33981513 PMCID: PMC8108723 DOI: 10.7759/cureus.14400] [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: 12/03/2022] Open
Abstract
Development of anuria in the setting of post-caesarean section is a cause of concern for surgeons, and it requires rapid evaluation for detecting its possible etiology and the initiation of appropriate treatment. When the cause of anuria is not immediately apparent in a hemodynamically stable patient, one must rule out other possible differentials as part of the diagnostic process. In this report, we present a rare case of a patient undergoing a trial of labour after a caesarean section, who had a Foley catheter accidentally placed and inflated in the right ureter, instead of the bladder. This led to apparent anuria, which was not identified until the patient's caesarean section had been completed. We also seek to shed light on a method for safely removing a ureteral Foley with a blocked inflation channel.
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Affiliation(s)
- Rahul Singh
- Accident and Emergency, Dr. Balwant Singh's Hospital, Georgetown, GUY
| | - Abhishek Singh
- Obstetrics and Gynaecology, Dr. Balwant Singh's Hospital, Georgetown, GUY
| | - Rafael Pratts
- Urology, Dr. Balwant Singh's Hospital, Georgetown, GUY
| | | | - Madhu Singh
- Obstetrics and Gynaecology, Dr. Balwant Singh's Hospital, Georgetown, GUY
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Bentvelsen RG, Veldkamp KE, Chavannes NH. A Smartphone App for Engaging Patients With Catheter-Associated Urinary Tract Infections: Protocol for an Interrupted Time-Series Analysis. JMIR Res Protoc 2021; 10:e28314. [PMID: 33755026 PMCID: PMC8086777 DOI: 10.2196/28314] [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] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 03/03/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Catheter-associated urinary tract infections (CAUTIs) are the main cause of health care-associated infections, and they increase the disease burden, antibiotic usage, and hospital stay. Inappropriate placement and unnecessarily prolonged usage of a catheter lead to an elevated and preventable risk of infection. The smartphone app Participatient has been developed to involve hospitalized patients in communication and decision-making related to catheter use and to control unnecessary (long-term) catheter use to prevent CAUTIs. Sustained behavioral changes for infection prevention can be promoted by empowering patients through Participatient. OBJECTIVE The primary aim of our multicenter prospective interrupted time-series analysis is to reduce inappropriate catheter usage by 15%. We will evaluate the efficacy of Participatient in this quality improvement study in clinical wards. Our secondary endpoints are to reduce CAUTIs and to increase patient satisfaction, involvement, and trust with health care services. METHODS We will conduct a multicenter interrupted time-series analysis-a strong study design when randomization is not feasible-consisting of a pre- and postintervention point-prevalence survey distributed among participating wards to investigate the efficacy of Participatient in reducing the inappropriate usage of catheters. After customizing Participatient to the wards' requirements, it will be implemented with a catheter indication checklist among clinical wards in 4 large hospitals in the Netherlands. We will collect clinical data every 2 weeks for 6 months in the pre- and postintervention periods. Simultaneously, we will assess the impact of Participatient on patient satisfaction with health care services and providers and the patients' perceived involvement in health care through questionnaires, and the barriers and facilitators of eHealth implementation through interviews with health care workers. RESULTS To reduce the inappropriate use of approximately 40% of catheters (currently in use) by 15%, we aim to collect 9-12 data points from 70-100 patients per survey date per hospital. Thereafter, we will conduct an interrupted time-series analysis and present the difference between the unadjusted and adjusted rate ratios with a corresponding 95% CI. Differences will be considered significant when P<.05. CONCLUSIONS Our protocol may help reduce the inappropriate use of catheters and subsequent CAUTIs. By sharing reliable information and daily checklists with hospitalized patients via an app, we aim to provide them a tool to be involved in health care-related decision-making and to increase the quality of care. TRIAL REGISTRATION Netherlands Trial Register NL7178; https://www.trialregister.nl/trial/7178. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/28314.
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Affiliation(s)
- Robbert Gerard Bentvelsen
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands.,Microvida Laboratory for Medical Microbiology, Amphia Hospital, Breda, Netherlands
| | - Karin Ellen Veldkamp
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
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Kotásková I, Syrovátka V, Obručová H, Vídeňská P, Zwinsová B, Holá V, Blaštíková E, Růžička F, Freiberger T. Actinotignum schaalii: Relation to Concomitants and Connection to Patients' Conditions in Polymicrobial Biofilms of Urinary Tract Catheters and Urines. Microorganisms 2021; 9:microorganisms9030669. [PMID: 33807120 PMCID: PMC8004716 DOI: 10.3390/microorganisms9030669] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/05/2021] [Accepted: 03/11/2021] [Indexed: 12/30/2022] Open
Abstract
Actinotignum schaalii is an emerging, opportunistic pathogen and its connection to non-infectious diseases and conditions, such as prostate or bladder cancer, or chronic inflammation has been proposed. Here, we analyzed 297 urine, ureteral and urinary catheter samples from 128 patients by Polymerase Chain Reaction followed by Denaturing Gradient Gel Electrophoresis and Sequencing (PCR-DGGE-S), and culture, and 29 of these samples also by 16S rRNA Illumina sequencing, to establish A. schaalii’s prevalence in urinary tract-related samples, its relation to other bacteria, and its potential association with patients’ conditions and samples’ characteristics. A. schaalii-positive samples were significantly more diverse than A. schaalii negative and between-group diversity was higher than intra-group. Propionimicrobium lymphophilum, Fusobacterium nucleatum, Veillonella sp., Morganella sp., and Aerococcus sp. were significantly more often present in A. schaalii-positive samples; thus, we suggest these species are A. schaalii’s concomitants, while Enterobacter and Staphylococcaceae were more often identified in A. schaalii-negative samples; therefore, we propose A. schaalii and these species are mutually exclusive. Additionally, a significantly higher A. schaalii prevalence in patients with ureter stricture associated hydronephrosis (p = 0.020) was noted. We suggest that A. schaalii could be an early polybacterial biofilm colonizer, together with concomitant species, known for pro-inflammatory features.
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Affiliation(s)
- Iva Kotásková
- Molecular Genetics Laboratory, Centre for Cardiovascular Surgery and Transplantation, 61600 Brno, Czech Republic; (I.K.); (H.O.); (E.B.)
- Department of Clinical Immunology and Allergology, Medical Faculty, Masaryk University, 61600 Brno, Czech Republic
- Research Centre for Toxic Compounds in the Environment, Masaryk University, 61600 Brno, Czech Republic; (P.V.); (B.Z.)
| | - Vít Syrovátka
- Department of Botany and Zoology, Faculty of Science, Masaryk University, 61600 Brno, Czech Republic;
| | - Hana Obručová
- Molecular Genetics Laboratory, Centre for Cardiovascular Surgery and Transplantation, 61600 Brno, Czech Republic; (I.K.); (H.O.); (E.B.)
| | - Petra Vídeňská
- Research Centre for Toxic Compounds in the Environment, Masaryk University, 61600 Brno, Czech Republic; (P.V.); (B.Z.)
| | - Barbora Zwinsová
- Research Centre for Toxic Compounds in the Environment, Masaryk University, 61600 Brno, Czech Republic; (P.V.); (B.Z.)
| | - Veronika Holá
- Institute of Microbiology, Faculty of Medicine, St. Anne’s University Hospital, Masaryk University, 61600 Brno, Czech Republic; (V.H.); (F.R.)
| | - Eva Blaštíková
- Molecular Genetics Laboratory, Centre for Cardiovascular Surgery and Transplantation, 61600 Brno, Czech Republic; (I.K.); (H.O.); (E.B.)
| | - Filip Růžička
- Institute of Microbiology, Faculty of Medicine, St. Anne’s University Hospital, Masaryk University, 61600 Brno, Czech Republic; (V.H.); (F.R.)
| | - Tomáš Freiberger
- Molecular Genetics Laboratory, Centre for Cardiovascular Surgery and Transplantation, 61600 Brno, Czech Republic; (I.K.); (H.O.); (E.B.)
- Department of Clinical Immunology and Allergology, Medical Faculty, Masaryk University, 61600 Brno, Czech Republic
- Correspondence:
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Lungu O, Grigoras I, Dorneanu OS, Lunca C, Vremera T, Copacianu SB, Ivanov I, Iancu LS. Indwelling Device-Associated Biofilms in Critically Ill Cancer Patients-Study Protocol. Pathogens 2021; 10:306. [PMID: 33800769 DOI: 10.3390/pathogens10030306] [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] [Received: 01/29/2021] [Revised: 02/28/2021] [Accepted: 03/03/2021] [Indexed: 11/26/2022] Open
Abstract
Health care-associated infections are a leading cause of inpatient complications. Rapid pathogen detection/identification is a major challenge in sepsis management that highly influences the successful outcome. The current standard of microorganism identification relies on bacterial growth in culture, which has several limitations. Gene sequencing research has developed culture-independent techniques for microorganism identification, with the aim to improve etiological diagnosis and, therefore, to change sepsis outcome. A prospective, observational, non-interventional, single-center study was designed that assesses biofilm-associated pathogens in a specific subpopulation of septic critically ill cancer patients. Indwelling device samples will be collected in septic patients at the moment of the removal of the arterial catheter, central venous catheter, endotracheal tube and urinary catheter. Concomitantly, clinical data regarding 4 sites (nasal, pharyngeal, rectal and skin) of pathogen colonization at the time of hospital/intensive care admission will be collected. The present study aims to offer new insights into biofilm-associated infections and to evaluate the infection caused by catheter-specific and patient-specific biofilm-associated pathogens in association with the extent of colonization. The analysis relies on the two following detection/identification techniques: standard microbiological method and next generation sequencing (NGS). Retrospectively, the study will estimate the clinical value of the NGS-based detection and its virtual potential in changing patient management and outcome, notably in the subjects with missing sepsis source or lack of response to anti-infective treatment.
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Su C, Ye Y, Qiu H, Zhu Y. Solvent-Free Fabrication of Self-Regenerating Antibacterial Surfaces Resisting Biofilm Formation. ACS Appl Mater Interfaces 2021; 13:10553-10563. [PMID: 33617220 DOI: 10.1021/acsami.0c20033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Biofilm formation on indwelling medical devices is a major cause of hospital-acquired infections. Monofunctional antibacterial surfaces have been developed to resist the formation of biofilms by killing bacteria on contact, but the adsorption of killed bacterial cells and debris gradually undermines the function of these surfaces. Here, we report a facile approach to produce an antibacterial surface that can regenerate its function after contamination. The self-regenerating surface was achieved by sequential deposition of alternating antibacterial and biodegradable layers of coating using a solvent-free initiated chemical vapor deposition method. As the top antibacterial layer gradually loses its killing ability due to the accumulation of debris, the underlying biodegradable layer degrades, shedding off the top surface layers and exposing another fresh antibacterial surface. Urinary catheters coated with monofunctional and self-regenerating antibacterial coatings both showed more than 99% bacterial killing ability at the initial antibacterial test, but the monofunctional surface lost its killing ability after continued exposure to concentrated bacterial solution, whereas the self-regenerating surfaces regained strong bacterial killing ability after prolonged exposure. Employing poly(methacrylic anhydride) and its copolymers with varied composition as the degrading layer, the degradation kinetics can be well-tailored and the self-regeneration duration spanned from minutes to days. The designed self-regenerating antibacterial surfaces could provide an effective approach to resist biofilm formation and extend the service life of indwelling medical devices.
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Affiliation(s)
- Cuicui Su
- Department of Materials Science and Engineering, Faculty of Materials Science and Chemical Engineering, Ningbo University, Ningbo 315211, China
| | - Yumin Ye
- Department of Materials Science and Engineering, Faculty of Materials Science and Chemical Engineering, Ningbo University, Ningbo 315211, China
| | - Haofeng Qiu
- The Medical School of Ningbo University, Ningbo University, Ningbo 315211, China
| | - Yabin Zhu
- The Medical School of Ningbo University, Ningbo University, Ningbo 315211, China
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Behera B, Jena J, Mahapatra A, Biswala J. Impact of modified CDC/NHSN surveillance definition on the incidence of CAUTI: a study from an Indian tertiary care hospital. J Infect Prev 2020; 22:162-165. [PMID: 34295377 DOI: 10.1177/1757177420982048] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 11/08/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction Catheter-associated urinary tract infections (CAUTIs) are one of the most common infections encountered in healthcare settings. Candida spp. were excluded as the causative agents of CAUTIs as per Centres for Disease Control and Prevention (CDC) and National Healthcare Safety Network (NHSN) definitions in 2015. Aim To determine the impact of the 2015 definition change on the CAUTI rate of patients admitted to medical and surgical intensive care units (ICUs) of a tertiary care and teaching hospital in India. Method CAUTI rates were compared in both the ICUs over a period of two years with inclusion and exclusion of Candida spp. Results Out of the total 116 CAUTI episodes during the study period, a mean of 9.08 CAUTIs per 1000 catheter days were observed in both the ICUs when Candida spp. were included, but the mean CAUTI rate was reduced to 4.78/1000 catheter days when Candida spp. were excluded. Discussion/Conclusion The mean CAUTI rate decreased by 46.03% solely by excluding Candida spp. This significant reduction in CAUTI rates may be applicable to institutions having high rates of candiduria in catheterised patients, but may not be applicable in centres where the incidence of candiduria is already low. Disregarding Candida as a causative agent of CAUTI did not impact rates of central line-associated bloodstream infections during the study period.
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Affiliation(s)
- Bijayini Behera
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Jayanti Jena
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Ashoka Mahapatra
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Jyoti Biswala
- Hospital Infection Control Supervisor, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Wang W, Xia P, Pan L, Xu J, Lv W, Hu J. A Novel Tubeless Urinary Catheter Protocol Enhanced Recovery After Minimally Invasive Lung Surgery. Front Surg 2020; 7:584578. [PMID: 33304922 PMCID: PMC7693547 DOI: 10.3389/fsurg.2020.584578] [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: 08/12/2020] [Accepted: 09/22/2020] [Indexed: 01/24/2023] Open
Abstract
Objectives: Although previous studies have shown the feasibility of non-intubated techniques, it is unknown whether avoiding urinary catheters can enhance recovery. This study aimed to determine whether the tubeless urinary catheter protocol is feasible and beneficial for minimally invasive lung surgery. Methods: Patients were randomized to the control group, completely tubeless group, and partially tubeless group. A propensity score–matched (PSM) analysis was performed to balance the non-random baseline characteristics. Complications and postoperative recovery were compared. Regression analysis was performed to identify the independent predictors of complications. A nomogram for predicting the risk of non-automatic micturition was constructed and internally validated. Results: One hundred fifty-nine patients were enrolled. The incidence rates of urinary irritation and urinary tract infection (UTI) were significantly lower in the tubeless groups (74.4 vs. 39.5%, p < 0.001; 28.2 vs. 8.6%, p = 0.001, respectively). The tubeless group had a higher proportion of 0-degree discomfort (81.5 vs. 30.8%, p = 0.001) and shorter duration of postoperative hospital stay than the control group (4.59 vs. 5.53 days, p < 0.001). No difference was observed in terms of urination retention and urinary incontinence between the tubeless group and the control group. After PSM, the advantages of the tubeless group still existed, and comparing to the partially tubeless group, the completely tubeless group was of even less UTI and more 0-degree discomfort (18.5 vs. 0.0%, p = 0.019; 96.3 vs. 59.3%, p = 0.002). The tubeless protocol was the only independent protective factor of urinary complications. A nomogram was constructed and showed good predictive ability. Conclusions: The tubeless catheterization protocol led to fewer complications, better compliance, and shorter hospital length of stay. The advantages were more significant with the completely tubeless protocol. The utility of our nomogram can assist clinicians in avoiding risks in performing the tubeless protocol.
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Affiliation(s)
- Weidong Wang
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Pinghui Xia
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Liang Pan
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jinming Xu
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wang Lv
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jian Hu
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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