1
|
Chou HH, Huang LC, Shen SP, Tsai ML, Chang YC, Lin HC. Neonatal jaundice is associated with increased risks of congenital anomalies of the kidney and urinary tract and concomitant urinary tract infection. Sci Rep 2024; 14:9520. [PMID: 38664452 DOI: 10.1038/s41598-024-59943-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
The link between neonatal jaundice and urinary tract infection (UTI) remains debated, with congenital kidney and urinary tract anomalies (CAKUT) potentially playing a role. This population-based study aimed to analyze the correlations between neonatal jaundice, CAKUT, and concomitant UTI. The study cohort consisted of 2,078,122 live births from 2004 to 2014. We linked several population-based datasets in Taiwan to identify infants with unexplained neonatal jaundice and their mothers. The primary outcome was the rate of CAKUT occurring within 3 years after delivery, and the presence of concomitant UTI during neonatal jaundice hospitalization. Infants with neonatal jaundice had a significantly higher risk of CAKUT (adjusted odds ratio [aOR] 1.24, 95% confidence interval [CI] 1.11-1.39) during early childhood. Among the subtypes of CAKUT, obstructive uropathy, vesicoureteral reflux and other CAKUT were associated with an increased risk of neonatal jaundice. Infants who underwent intensive phototherapy, had a late diagnosis (> 14 days of postnatal age) or underwent a prolonged duration of phototherapy (> 3 days) exhibited a higher risk of concomitant UTI compared to other infants with jaundice. Our findings indicate a notable association between neonatal jaundice and increased risks of UTIs in the context of CAKUT. This study underscore the importance of vigilant monitoring and timely interventions for neonates presenting with jaundice, while acknowledging the complexity and variability in the progression of CAKUT and its potential connection to UTIs.
Collapse
Affiliation(s)
- Hsin-Hsu Chou
- Department of Pediatrics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
| | - Lin-Chih Huang
- Department of Pediatrics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Shang-Po Shen
- Division of Neonatology, China Medical University Children's Hospital, China Medical University, No. 2 Yuh Der Road, Taichung, 404, Taiwan
| | - Ming-Luen Tsai
- Division of Neonatology, China Medical University Children's Hospital, China Medical University, No. 2 Yuh Der Road, Taichung, 404, Taiwan
| | - Yu-Chia Chang
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, No. 500, Lioufeng Road., Wufeng, Taichung, 41354, Taiwan.
- Department of Long-Term Care, College of Health and Nursing, National Quemoy University, Kinmen County, Taiwan.
| | - Hung-Chi Lin
- Division of Neonatology, China Medical University Children's Hospital, China Medical University, No. 2 Yuh Der Road, Taichung, 404, Taiwan.
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan.
- Asia University Hospital, Asia University, Taichung, Taiwan.
| |
Collapse
|
2
|
Kittipibul V, Cox ZL, Chesdachai S, Fiuzat M, Lindenfeld J, Mentz RJ. Genitourinary Tract Infections in Patients Taking SGLT2 Inhibitors: JACC Review Topic of the Week. J Am Coll Cardiol 2024; 83:1568-1578. [PMID: 38631776 DOI: 10.1016/j.jacc.2024.01.040] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/18/2024] [Accepted: 01/22/2024] [Indexed: 04/19/2024]
Abstract
Sodium-glucose cotransporter-2 inhibitors (SGLT2is) have been shown to reduce adverse cardiovascular events in patients with type 2 diabetes mellitus, all-cause mortality, and heart failure hospitalization in patients with heart failure, as well as adverse renal outcomes. However, concerns regarding the heightened risk of genitourinary (GU) infections, particularly urinary tract infections, remain a significant barrier to their wider adoption. Addressing these misconceptions using existing evidence is needed to ensure proper risk-benefit assessment and optimal utilization of this efficacious therapy. This review aims to provide a balanced perspective on the evidence-based cardiovascular and renal benefits of SGLT2is and the associated risk of GU infections. We also summarize and propose clinical practice considerations for SGLT2i-associated GU infections focusing on patients with cardiovascular disease.
Collapse
Affiliation(s)
- Veraprapas Kittipibul
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA. https://twitter.com/vkittipibul
| | - Zachary L Cox
- Department of Pharmacy Practice, Lipscomb University College of Pharmacy, Nashville, Tennessee, USA; Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Supavit Chesdachai
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mona Fiuzat
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - JoAnn Lindenfeld
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert J Mentz
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA.
| |
Collapse
|
3
|
Kelly LC, Glinsky JV, Harvey LA. A case report of three people experiencing intractable autonomic dysreflexia following instillation of Uro-Tainer ® Polyhexanide 0.02. Spinal Cord Ser Cases 2024; 10:17. [PMID: 38580624 PMCID: PMC10997763 DOI: 10.1038/s41394-024-00626-5] [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] [Received: 04/29/2023] [Revised: 02/26/2024] [Accepted: 03/05/2024] [Indexed: 04/07/2024] Open
Abstract
INTRODUCTION Historically, bladder washouts were used to instil therapeutic reagents directly into the bladder. This practice has expanded to include instillation of solutions that deal with catheter issues such as encrustation or formation of bio-film. They appear to provide a promising strategy for people with long term catheters. These products are readily available to purchase, but there is concern that people are using these solutions without a complete understanding of the purpose for the rinse and without clinical guidance to monitor response to treatment. CASE PRESENTATION These case studies include three people living with spinal cord injury (SCI) who developed severe autonomic dysreflexia (AD) when a catheter rinse was carried out using a particular solution. Each of the cases developed immediate and, in some cases, intractable AD requiring further intervention to resolve symptoms. DISCUSSION Catheter-associated urinary tract infection is a significant cause of morbidity and mortality in people living with SCI. Long-term catheters provide a vector for opportunistic micro-organisms to form bio-film and create an environment that promotes formation of struvite calculi, thus increasing the risk of chronic catheter blockage and urinary tract infection. Whilst these solutions are used to reduce these risks, they also pose additional risks to people susceptible to AD. These cases highlight the need for judicious patient selection and clinical oversight and management of adverse events when using catheter rinse solutions in certain people living with SCI. This is supported by a decision-making algorithm and a response to AD algorithm. This case report was prepared following the CARE Guidelines (supplementary file 1).
Collapse
Affiliation(s)
- Louise C Kelly
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine & Health, University of Sydney, Sydney, NSW, Australia
| | - Joanne V Glinsky
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine & Health, University of Sydney, Sydney, NSW, Australia
- Northern Sydney Local Health District, Sydney, NSW, Australia
| | - Lisa A Harvey
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine & Health, University of Sydney, Sydney, NSW, Australia.
- Northern Sydney Local Health District, Sydney, NSW, Australia.
| |
Collapse
|
4
|
Seyedolmohadesin M, Ashkani M, Ghadikolaei TS, Mirshekar M, Bostanghadiri N, Aminzadeh S. Unraveling the complex relationship: Multiple sclerosis, urinary tract infections, and infertility. Mult Scler Relat Disord 2024; 84:105512. [PMID: 38428292 DOI: 10.1016/j.msard.2024.105512] [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] [Received: 01/26/2024] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Multiple sclerosis (MS) is an immune system disorder that affects the central nervous system (CNS) and progressively damages nerve fibers and protective myelin. People with MS often experience a wide range of complications, including lower urinary tract dysfunction, urinary tract infections (UTIs) and sexual dysfunction. MS is common in young people and can lead to sexual dysfunction (SD) and infertility, which becomes more pronounced as the disease progresses. RESULTS Over the past two decades, significant advances have been made in the management of MS, which may slow the progression of the disease and alter its course. However, UTI and SD remain significant challenges for these patients. Awareness of the underlying complications of MS, such as UTIs and infertility, is crucial for prevention, early detection and appropriate treatment, as there is a causal relationship between UTIs and the use of corticosteroids during an attack. CONCLUSION This article provides an overview of potential microbial pathogens that contribute to the development of MS, as well as an assessment of people with MS who report UTIs and infertility.
Collapse
Affiliation(s)
- Maryam Seyedolmohadesin
- Department of Genetics, Faculty of Advanced Science and Technology, Tehran Medical Sciences, Azad University, Tehran, Iran
| | - Maedeh Ashkani
- Department of Biology, Central Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Taravat Sadeghi Ghadikolaei
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Maryam Mirshekar
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Narjess Bostanghadiri
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Soheila Aminzadeh
- Toxicology Research Center, Medical Basic Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Toxicology, Faculty of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| |
Collapse
|
5
|
Iio K, Mikami N, Harada R, Hamada R, Hagiwara Y, Hataya H, Sandhu A, Goldman RD. Treatment Delay of Febrile Urinary Tract Infections Among Infants With Respiratory Symptoms. Pediatr Infect Dis J 2024; 43:e121-e124. [PMID: 38134370 DOI: 10.1097/inf.0000000000004226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
OBJECTIVE To evaluate whether antibiotic treatment of febrile urinary tract infection (UTI) is delayed in febrile infants with respiratory symptoms compared with those without. STUDY DESIGN Data of infants 2-24 months of age diagnosed with UTI from March 1, 2012 to May 31, 2023 were collected from our hospital's medical charts and triage records. Patients with known congenital anomalies of the kidney and urinary tract or a history of febrile UTI were excluded. Patients were classified as having respiratory symptoms if they had any of the following symptoms or clinical signs: cough, rhinorrhea, pharyngeal hyperemia and otitis media. Time to first antibiotic treatment from fever onset was compared between patients with and without respiratory symptoms. A Cox regression model was constructed to adjust for potential confounders. RESULTS A total of 214 patients were eligible for analysis. The median age of the eligible patients was 5.0 months (interquartile range: 3.0-8.8) and 118 (55%) were male. There were 104 and 110 patients in the respiratory symptom and no respiratory symptom groups, respectively. The time to first antibiotic treatment was significantly longer in the group with respiratory symptoms (51 hours vs. 21 hours). Respiratory symptoms were significantly associated with a longer time to first treatment after adjustment for age and sex in the Cox regression model (hazard ratio = 0.63, 95% confidence interval: 0.47-0.84). CONCLUSIONS Treatment of febrile UTI infants with respiratory symptoms tends to be delayed. Pediatricians should not exclude febrile UTI even in the presence of respiratory symptoms.
Collapse
Affiliation(s)
- Kazuki Iio
- From the Division of Pediatric Emergency Medicine
| | | | | | | | | | - Hiroshi Hataya
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | | | - Ran D Goldman
- Pediatric Research in Emergency Therapeutics (PRETx) Program, Division of Emergency Medicine, Department of Pediatrics, University of British Columbia, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| |
Collapse
|
6
|
Kooner GK, Bass M, Saroha V, Gonzalez PJ, Jain S. Reducing Antibiotic Duration for Uncomplicated UTI in the Pediatric Emergency Department. Hosp Pediatr 2024; 14:265-271. [PMID: 38533560 DOI: 10.1542/hpeds.2023-007561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Short-duration (3-5 days) antibiotic treatment of uncomplicated urinary tract infection (uUTI) in children >24 months of age is equivalent to longer-duration antibiotic treatment, with added benefits of antibiotic stewardship. At our pediatric emergency department (ED), 13% of 5- to 18-year-old patients discharged with uUTI received ≤5 days of antibiotics. We aimed to increase short-duration prescriptions in patients with uUTI from 13% to >50% over 12 months. METHODS This quality improvement project was conducted from January 2021 to August 2022. Complicated UTI was excluded. Interventions included education, practice feedback, and electronic health record changes. The outcome measure, the proportion of children treated with a short antibiotic duration, was studied by using p-charts. Antibiotic days saved were calculated. Revisits with UTI within 14 days of confirmed uUTI treated with short-duration antibiotics (balancing measure) were analyzed by using Fisher's exact test. RESULTS In 1292 (n = 363 baseline, 929 post-intervention) eligible patients treated for uUTI, shorter antibiotic duration increased from 13% to 91%. We met our 50% aim within 2 months, with continued improvement leading to an additional centerline shift. Consequently, 2619 antibiotic days were saved. Two of 334 (0.6%) patients returned (P = NS) within 14 days of the index visit with a culture-positive uUTI. CONCLUSIONS By using education, feedback, and electronic health record changes, we decreased antibiotic duration in children discharged from the ED for uUTI without a significant increase in return visits with UTI. These interventions can be expanded to wider age groups and other outpatient settings.
Collapse
Affiliation(s)
- Gagandeep K Kooner
- Children's Healthcare of Atlanta, Atlanta, Georgia
- Divisions of Emergency Medicine
| | - Marissa Bass
- Children's Healthcare of Atlanta, Atlanta, Georgia
- Hospital Medicine
| | - Vivek Saroha
- Children's Healthcare of Atlanta, Atlanta, Georgia
- Neonatology, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - P J Gonzalez
- Children's Healthcare of Atlanta, Atlanta, Georgia
- Divisions of Emergency Medicine
| | - Shabnam Jain
- Children's Healthcare of Atlanta, Atlanta, Georgia
- Divisions of Emergency Medicine
| |
Collapse
|
7
|
Lv X, Ren X, Xu J, Wu H. Effect of prophylactic use of cefazolin in caesarean section on postoperative infection: A meta-analysis. Int Wound J 2024; 21:e14740. [PMID: 38522482 PMCID: PMC10961181 DOI: 10.1111/iwj.14740] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/21/2024] [Indexed: 03/26/2024] Open
Abstract
Caesarean section rate is increasing and postoperative wound infection is a major health-threatening complication after caesarean section (CS). The aim of this study was to evaluate the efficacy of Cefazolin at different time for post-caesarean delivery. The aim of this study was to compare the use of Cefazolin at different times on infections after CS. The time of antibiotic use in CS can be divided into two groups: before skin incision (SI) and after cord clamping (CC). In this study, 268 relevant articles were found in the database, and finally, 10 articles were analysed. This study included a total of 5256 cases of caesarean section. The data on wound infections, endometritis, urinary tract infections and fever were analysed. Perform an analysis of the data using RevMan 5.3. The results showed that cefazolin before SI reduced wound infection compared to after CC (odds ratio [OR], 0.51; 95% CI: 0.37-0.69; p < 0.0001). Cefazolin prophylactically used before SI reduce endometritis after CS compared to after CC (OR, 0.52; 95% CI: 0.35-0.77; p = 0.001). There was no significant difference in urinary tract infections after CS between cefazolin prophylactically used before SI and after CC (OR, 0.80; 95% CI: 0.50-11.28; p = 0.35). There was no significant difference in fever after CS between the prophylactic use of cefazolin before SI and after CC (OR, 0.60; 95% CI: 0.26-11.43; p = 0.225). Cefazolin before SI reduces wound infection and endometritis after CS.
Collapse
Affiliation(s)
- Xiangyang Lv
- Department of Reproduction and GeneticsAffiliated Hospital of Shandong University of Traditional Chinese MedicineJinanChina
| | - Xiaoshuang Ren
- Women's Health DepartmentJinan Maternal and Child Health Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Jiqun Xu
- Department of Reproduction and GeneticsAffiliated Hospital of Shandong University of Traditional Chinese MedicineJinanChina
| | - Haicui Wu
- Department of Reproduction and GeneticsAffiliated Hospital of Shandong University of Traditional Chinese MedicineJinanChina
| |
Collapse
|
8
|
Cohen B, Harris YT, Schulman-Rosenbaum R. Sodium-Glucose Cotransporter 2 Inhibitors Should Be Avoided for the Inpatient Management of Hyperglycemia. Endocr Pract 2024; 30:402-408. [PMID: 38081453 DOI: 10.1016/j.eprac.2023.11.014] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/25/2023] [Accepted: 11/14/2023] [Indexed: 12/31/2023]
Abstract
OBJECTIVE Hyperglycemia in patients with type 2 diabetes mellitus is frequently encountered in the hospital setting. The recent guidelines for the management of inpatient hyperglycemia have included the use of dipeptidyl peptidase 4 inhibitors as an alternative to standard insulin therapy in select patients. This raises the question of the inpatient use of sodium-glucose cotransporter 2 inhibitors (SGLT2i), which have gained increasing popularity in the outpatient setting because of beneficial cardiovascular and renal outcomes. This article describes the risks associated with the use of SGLT2i for the management of inpatient hyperglycemia. METHODS A literature review was performed using PubMed and Google Scholar for studies assessing the inpatient use of SGLT2i. Search terms included "SGLT2 inhibitors," "euglycemic DKA," "inpatient hyperglycemia," "DPP4 inhibitors," "hypovolemia," and "urinary tract infections." Studies not written in English were excluded. Forty-eight articles were included. RESULTS Review of the literature showed significant safety concerns with the use of SGLT2i for the inpatient management of hyperglycemia. Hospitalized patients treated with SGLT2i were at increased risk of diabetic ketoacidosis, euglycemic diabetic ketoacidosis, hypovolemia, and urinary tract infections. When compared head-to-head, SGLT2i were not more effective for inpatient glycemic control than dipeptidyl peptidase 4 inhibitors and did not reduce insulin requirements when used in combination with insulin. Although SGLT2i can be considered for the treatment of congestive heart failure, they should be started close to or at the time of discharge. CONCLUSION Although SGLT2i are a preferred pharmacotherapy class for the outpatient management of type 2 diabetes mellitus, there are considerable safety concerns when using them in a hospital setting, and avoidance is recommended.
Collapse
Affiliation(s)
- Benjamin Cohen
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Division of Endocrinology, Diabetes and Metabolism, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, New York
| | - Yael Tobi Harris
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Division of Endocrinology, Diabetes and Metabolism, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, New York
| | - Rifka Schulman-Rosenbaum
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Division of Endocrinology, Diabetes and Metabolism, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, New York.
| |
Collapse
|
9
|
Julião M, Cruz M. The color purple: Purple urine bag syndrome: Identifying the phenomenon to ease unnecessary anxiety, fear, and distress. Palliat Support Care 2024; 22:424-426. [PMID: 37435644 DOI: 10.1017/s1478951523000949] [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: 07/13/2023]
Abstract
OBJECTIVES Purple urine bag syndrome (PUBS) is a condition that causes an intense purple discoloration of the urine, predominately in frail, dependent, and bedridden persons who are chronically catheterized and have urinary tract infections. Despite being considered a benign syndrome, PUBS can cause great anxiety, fear, and distress in health professionals, chronically ill persons, and caregivers or family members who provide care. METHODS We report the case of a 98-year-old institutionalized woman with Alzheimer's dementia with a long-term urinary catheter who developed PUBS. RESULTS Although alarming and distressing for the resident and the health-care team, PUBS was resolved by treating the underlying urinary tract infection and applying good genital hygiene and catheter replacement. SIGNIFICANCE OF RESULTS Identifying PUBS and its clinical features and management proved to be significantly helpful in ameliorating the anxiety, fear, and distress around the phenomenon.
Collapse
Affiliation(s)
- Miguel Julião
- Equipa Comunitária de Suporte em Cuidados Paliativos de Sintra, Sintra, Portugal
- Inválidos do Comércio IPSS, Lisboa, Portugal
| | - Mário Cruz
- Inválidos do Comércio IPSS, Lisboa, Portugal
- Escola de Psicologia e Ciências da Vida, Universidade Lusófona, Lisboa, Portugal
- USF Tapada, ACeS Sintra, Sintra, Portugal
| |
Collapse
|
10
|
Fontes JM, Oliveira EM, Monteiro de Melo Prazeres TC, Nisya de Oliveira Cruz G, Rizzini M, Passos SD, Lisboa LL, Ferreira de Araújo G, Azevedo de Almeida V, Malacarne J, Emília de Domenico Garcia M, Linhares Barreto LC, Calado AA, Fernandes da Nóbrega L, Moura Nascimento Santos MJ, Gonçalves RP, Farache L, Feliciano da Silva M, Rizzo FV, Dias da Silva L, Maria de Jesus Amorim N, Guedes Pinheiro HC, Suely de Oliveira Melo A, de Oliveira Melo F, Moreira RD, Santos da Costa BJ, de Almeida Melo Maciel Mangueira M, Varela MC, Costa Monteiro LM. Prevalence of urologic sequelae and bladder and bowel dysfunctions in patients with congenital Zika syndrome: A multicenter evaluation of the Zika virus bladder and bowel sequelae assistance network. J Pediatr Urol 2024; 20:220.e1-220.e9. [PMID: 38097421 DOI: 10.1016/j.jpurol.2023.11.010] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 10/17/2023] [Accepted: 11/13/2023] [Indexed: 04/22/2024]
Abstract
INTRODUCTION Neurogenic bladder was first confirmed as a urological sequela of Congenital Zika Syndrome (CZS) in 2018. Further clinical-epidemiological evidence also confirmed neurogenic bowel dysfunction and cryptorchidism. To strengthen the care for these children, the Congenital Zika Virus Bladder and Bowel Sequelae Network (RASZ in Brazilian) was created, including six integrated centers in Brazil. This article represents the initial outcome of the efforts by RASZ. OBJECTIVE To evaluate the prevalence of bladder and bowel dysfunction, cryptorchidism and other urological sequelae related to CZS in cohorts attended in six Brazilian states. STUDY DESIGN Observational, prospective, multicenter study including children with CZS assisted in one of six RASZ collaborative centers between June 2016 and February 2023. Data were collected from patient's first assessment using the same protocols for urological and bowel evaluation. Categorical variables were analyzed by frequency of occurrence and numerical variables by mean, median, and standard deviation. The study was approved by the Research Ethics Committees of each center, all parents/caregivers provided written informed consent. RESULTS The study included 414 children aged 2 months to 7 years (mean 2.77 years, SD 1.73), 227 (54.8 %) were male and 140 (33,8 %) referred urological and bowel symptoms on arrival. Prevalence of both urological and bowel sequelae was 66.7 %, 51 % of children aged 4 years and older had urinary incontinence (UI). UTI was confirmed in 23.4 % (two presented toxemia) and among males, 18.1 % had cryptorchidism. Renal ultrasonography, performed in 186 children, was abnormal in 25 (13.4 %), 7 had hydronephrosis. Among the 287 children who performed urodynamics, 283 (98.6 %) were altered: 232 had a lower bladder capacity, 144 a maximum bladder pressure of ≥40 cm H2O, and 127 did not satisfactorily empty their bladder. DISCUSSION A higher prevalence of NLUTD, neurogenic bowel and cryptorchidism was confirmed in children with CZS. Early diagnosis and appropriate treatment, including a multidisciplinary approach, may reduce the risk of UTIs, UI and kidney damage. A limitation of the study was the inability of children to complete the protocol, specifically urodynamic evaluation, and ultrasonography. In both exams, the percentage of abnormal cases was higher than that expected in the normal population. CONCLUSION A 66,7 % prevalence of combined urological sequelae and bladder-bowel dysfunction related to CZS was confirmed in patients evaluated in six Brazilian cohorts. The most frequent changes were related to NLUTD, neurogenic bowel, and cryptorchidism. Prevalence may be underestimated due to access restrictions to diagnostic tests.
Collapse
Affiliation(s)
- Juliana Marin Fontes
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Ambulatório de Urodinâmica Pediátrica - Oswaldo Cruz Foundation, National Institute of Women, Children and Adolescents Health Fernandes Figueira, Pediatric Urodynamics Unit, Rio de Janeiro, RJ, Brazil.
| | | | | | - Glaura Nisya de Oliveira Cruz
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Ambulatório de Urodinâmica Pediátrica - Oswaldo Cruz Foundation, National Institute of Women, Children and Adolescents Health Fernandes Figueira, Pediatric Urodynamics Unit, Rio de Janeiro, RJ, Brazil
| | - Marta Rizzini
- Universidade Federal do Maranhão (UFMA) - Federal University of Maranhão, São Luís, MA, Brazil
| | - Saulo Duarte Passos
- Faculdade de Medicina de Jundiaí (FMJ) - Jundiai Medicine College, Jundiai, SP, Brazil
| | - Lilian Lira Lisboa
- Instituto Santos Dumont, Centro de Ensino e Pesquisa Anita Garibaldi (ISD/CEPs) - Santos Dumont Institute, Anita Garibaldi Teaching and Research Center (ISD/CEPs),Macaíba, RN, Brazil
| | - Grace Ferreira de Araújo
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Ambulatório de Urodinâmica Pediátrica - Oswaldo Cruz Foundation, National Institute of Women, Children and Adolescents Health Fernandes Figueira, Pediatric Urodynamics Unit, Rio de Janeiro, RJ, Brazil
| | - Valéria Azevedo de Almeida
- Instituto Santos Dumont, Centro de Ensino e Pesquisa Anita Garibaldi (ISD/CEPs) - Santos Dumont Institute, Anita Garibaldi Teaching and Research Center (ISD/CEPs),Macaíba, RN, Brazil
| | - Jociele Malacarne
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Ambulatório de Urodinâmica Pediátrica - Oswaldo Cruz Foundation, National Institute of Women, Children and Adolescents Health Fernandes Figueira, Pediatric Urodynamics Unit, Rio de Janeiro, RJ, Brazil
| | | | - Lilian Cagliari Linhares Barreto
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Ambulatório de Urodinâmica Pediátrica - Oswaldo Cruz Foundation, National Institute of Women, Children and Adolescents Health Fernandes Figueira, Pediatric Urodynamics Unit, Rio de Janeiro, RJ, Brazil
| | | | | | | | - Rafael Pauletti Gonçalves
- Instituto Santos Dumont, Centro de Ensino e Pesquisa Anita Garibaldi (ISD/CEPs) - Santos Dumont Institute, Anita Garibaldi Teaching and Research Center (ISD/CEPs),Macaíba, RN, Brazil
| | - Luana Farache
- Instituto Santos Dumont, Centro de Ensino e Pesquisa Anita Garibaldi (ISD/CEPs) - Santos Dumont Institute, Anita Garibaldi Teaching and Research Center (ISD/CEPs),Macaíba, RN, Brazil
| | | | - Fábio Valente Rizzo
- Faculdade de Medicina de Jundiaí (FMJ) - Jundiai Medicine College, Jundiai, SP, Brazil
| | - Luiz Dias da Silva
- Faculdade de Medicina de Jundiaí (FMJ) - Jundiai Medicine College, Jundiai, SP, Brazil
| | | | - Hannah Cavalcante Guedes Pinheiro
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), - Professor Joaquim Amorim Neto Research Institute, Campina Grande, PB, Brazil
| | - Adriana Suely de Oliveira Melo
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), - Professor Joaquim Amorim Neto Research Institute, Campina Grande, PB, Brazil
| | - Fabiana de Oliveira Melo
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), - Professor Joaquim Amorim Neto Research Institute, Campina Grande, PB, Brazil
| | - Rômulo Dias Moreira
- Universidade Federal do Maranhão (UFMA) - Federal University of Maranhão, São Luís, MA, Brazil
| | | | | | - Margareth Catoia Varela
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional Infectologia (INI), Laboratório de Pesquisa em Imunização e Vigilância em Saúde - Oswaldo Cruz Foundation (Fiocruz), Health Surveillance and Immunization Research Unit - Rio de Janeiro, RJ, Brazil
| | - Lucia Maria Costa Monteiro
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Ambulatório de Urodinâmica Pediátrica - Oswaldo Cruz Foundation, National Institute of Women, Children and Adolescents Health Fernandes Figueira, Pediatric Urodynamics Unit, Rio de Janeiro, RJ, Brazil
| |
Collapse
|
11
|
Lee J, Hwang JH, Yeom JH, Lee S, Hwang JH. Analysis of virulence profiles in clinical isolates of Klebsiella pneumoniae from renal abscesses: clinical significance of hypervirulent isolates. Front Cell Infect Microbiol 2024; 14:1367111. [PMID: 38606296 PMCID: PMC11007163 DOI: 10.3389/fcimb.2024.1367111] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/13/2024] [Indexed: 04/13/2024] Open
Abstract
Introduction Klebsiella pneumoniae can cause a wide range of infections. Hypervirulent K. pneumoniae (hvKp), particularly associated with the K1 and K2 capsular types, is an increasingly significant microorganism with the potential to cause invasive infections, including renal abscesses. Despite the rising prevalence of hvKp infections, information on renal abscesses caused by K. pneumoniae is limited, and the clinical significance of hvKp associated with specific virulence genes remains elusive. Methods This study performed at a 1200-bed tertiary hospital sought to identify the clinical and microbiological characteristics of renal abscesses caused by K. pneumoniae, focusing on various virulence genes, including capsular serotypes and multilocus sequence typing (MLST). Results Over an 8-year period, 64 patients with suspected renal abscesses were reviewed. Ten patients diagnosed with K. pneumoniae-related renal abscesses were ultimately enrolled in the study. Among the isolates from the 10 patients, capsular serotype K2 was predominant (40.0%), followed by K1 (30.0%). The most common sequence type by MLST was 23 (40.0%). In particular, six patients (60.0%) harbored specific genes indicative of hvKp: iucA, peg-344, rmpA, and rmpA2. Conclusions Our findings highlight the importance of hvKp as a pathogen in renal abscesses. Although the nature of hvKp is relatively unknown, it is widely recognized as a highly virulent pathogen that can infect relatively healthy individuals of various ages and simultaneously cause infections at multiple anatomical sites. Therefore, when treating patients with K. pneumoniae-related renal abscesses, caution is necessary when considering the characteristics of hvKp, such as potential bacteremia, multi-organ abscess formation, and metastatic spread.
Collapse
Affiliation(s)
- Jaehyeon Lee
- Department of Laboratory Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University—Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Jeong-Hwan Hwang
- Research Institute of Clinical Medicine of Jeonbuk National University—Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
- Department of Internal Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, Republic of Korea
| | - Ji Hyun Yeom
- Research Institute of Clinical Medicine of Jeonbuk National University—Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
- Department of Internal Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, Republic of Korea
| | - Sik Lee
- Research Institute of Clinical Medicine of Jeonbuk National University—Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
- Department of Internal Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, Republic of Korea
| | - Joo-Hee Hwang
- Research Institute of Clinical Medicine of Jeonbuk National University—Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
- Department of Internal Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, Republic of Korea
| |
Collapse
|
12
|
Oikawa H, Morooka Y, Furuichi M, Shinjoh M, Nozaki S, Nishi E, Yaginuma M, Inoguchi T, Tomita K, Furuno K, Takahashi T. Catheter-associated urinary tract infection and urinary tract abnormalities in young children: A retrospective study. J Infect Chemother 2024; 30:194-200. [PMID: 37805098 DOI: 10.1016/j.jiac.2023.10.004] [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] [Received: 08/07/2023] [Revised: 09/27/2023] [Accepted: 10/02/2023] [Indexed: 10/09/2023]
Abstract
INTRODUCTION Studies investigating the role of urinary tract abnormalities in the development of catheter-associated urinary tract infections (CAUTI) in young children are limited. Thus, in the present study, we aimed to determine whether there is an association between CAUTI and urinary tract abnormalities. METHODS We performed abdominal imaging studies on all patients aged <6 years with CAUTI admitted to the pediatric intensive care units (PICU) and high care unit (HCU) at Keio university or Fukuoka Children's Hospital from April 1, 2018 to July 31, 2022. Among 40 children who developed CAUTI, 13 (33 %) had abnormal urogenital images. Further, two case-control studies were conducted before and after propensity score matching, and the groups were compared using multivariable logistic regression models to analyze the effects of various factors on CAUTI development. RESULTS In the multivariate logistic regression models, abnormal urogenital images (OR 5.30 [95 % CI, 2.40-11.7] and OR 3.44 [95 % CI, 1.16-9.93]) and duration of catheterization >10 days (OR 2.76 [95 % CI, 1.28-5.96] and OR 3.44 [95 % CI, 1.16-9.93]) were found to be significantly associated with development of CAUTI, both before (39 cases, 459 controls) and after propensity score matching (36 cases, 72 controls). Further, CAUTI in young children in the PICU or HCU was significantly associated with imaging abnormalities of the urinary tract. CONCLUSIONS These results suggest that not only the presence of catheters, but also urinary tract malformations may contribute to the development of CAUTI in young children.
Collapse
Affiliation(s)
- Hiroyuki Oikawa
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan, Tokyo, Japan
| | - Yuya Morooka
- Fukuoka Children's Hospital, Kashiiteriha, Fukuoka higashiku, Fukuoka, 813-0017, Japan
| | - Munehiro Furuichi
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan, Tokyo, Japan
| | - Masayoshi Shinjoh
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan, Tokyo, Japan.
| | - Shotaro Nozaki
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan, Tokyo, Japan
| | - Emiri Nishi
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan, Tokyo, Japan
| | - Mizuki Yaginuma
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan, Tokyo, Japan
| | - Tomohiro Inoguchi
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan, Tokyo, Japan
| | - Kentaro Tomita
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan, Tokyo, Japan
| | - Kenji Furuno
- Fukuoka Children's Hospital, Kashiiteriha, Fukuoka higashiku, Fukuoka, 813-0017, Japan
| | - Takao Takahashi
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan, Tokyo, Japan
| |
Collapse
|
13
|
Duncan I, Stocking A, Fitzner K, Ahmed T, Huynh N. The Prevalence of Incontinence and Its Association With Urinary Tract Infections, Dermatitis, Slips and Falls, and Behavioral Disturbances Among Older Adults in Medicare Fee-for-Service. J Wound Ostomy Continence Nurs 2024; 51:138-145. [PMID: 38527324 PMCID: PMC11008436 DOI: 10.1097/won.0000000000001054] [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: 03/27/2024]
Abstract
PURPOSE The purpose of this study was to examine the prevalence of urinary (UI), fecal (FI), and dual incontinence (DI) in older adults and their association with urinary tract infections, dermatitis, slips and falls, and behavioral disturbances based on Medicare fee-for-service (FFS) claims data. DESIGN Retrospective analysis. SUBJECTS AND SETTINGS Data from administrative claims from the CMS Medicare Limited Data Set (5% sample) for all months in 2018 were reviewed. The analysis was limited to FFS Medicare beneficiaries, with minimum of 3-month enrollment in Parts A and B who were at least 65 years old. This cohort included 1.2 million beneficiaries in the United States. METHODS We used diagnosis codes to identify members with incontinence and grouped these members into 3 categories (UI only, FI only, and DI). We also divided claims based on 4 sites of care (nursing home, skilled nursing facility, home health, and self- or family care). We then determined the prevalence of (1) urinary tract infections (UTIs), (2) dermatitis, (3) slips and falls, and (4) behavioral disturbances for each type of incontinence. RESULTS We found that 11.2% of Medicare members had a claims-based diagnosis of incontinence in 2018. On average, those diagnosed with incontinence experienced 5 times more UTIs, 2 times as many dermatitis events, more than twice as many slips and falls, and 2.8 times more behavior disturbances compared to those without an incontinence diagnosis. For those with DI, the prevalence of the 4 outcomes was significantly higher (between 22% and 185%) compared to those with UI only. CONCLUSIONS Findings show that Medicare beneficiaries diagnosed as incontinent experience a much higher prevalence of UTIs, dermatitis, slips and falls, and behavioral disturbances compared to those without a diagnosis of incontinence. Our results suggest that incontinence may be an important indicator diagnosis for multiple other conditions and, if not well-managed, may challenge the desire for those who are incontinent to age at home.
Collapse
Affiliation(s)
- Ian Duncan
- Correspondence: Ian Duncan, PhD, FSA, MAAA, Department of Statistics and Applied Probability, University of California, Santa Barbara, South Hall 5518, Santa Barbara, CA 93106 ()
| | - Andrew Stocking
- Ian Duncan, PhD, FSA, MAAA, Department of Statistics and Applied Probability, University of California, Santa Barbara
- Andrew Stocking, PhD, Principle Business Enterprises Inc, Dunbridge, Ohio
- Karen Fitzner, PhD, Santa Barbara Actuaries Inc, Santa Barbara, California
- Tamim Ahmed, PhD, MBA, Santa Barbara Actuaries Inc, Santa Barbara, California
- Nhan Huynh, PhD, Santa Barbara Actuaries Inc, Santa Barbara, California
| | - Karen Fitzner
- Ian Duncan, PhD, FSA, MAAA, Department of Statistics and Applied Probability, University of California, Santa Barbara
- Andrew Stocking, PhD, Principle Business Enterprises Inc, Dunbridge, Ohio
- Karen Fitzner, PhD, Santa Barbara Actuaries Inc, Santa Barbara, California
- Tamim Ahmed, PhD, MBA, Santa Barbara Actuaries Inc, Santa Barbara, California
- Nhan Huynh, PhD, Santa Barbara Actuaries Inc, Santa Barbara, California
| | - Tamim Ahmed
- Ian Duncan, PhD, FSA, MAAA, Department of Statistics and Applied Probability, University of California, Santa Barbara
- Andrew Stocking, PhD, Principle Business Enterprises Inc, Dunbridge, Ohio
- Karen Fitzner, PhD, Santa Barbara Actuaries Inc, Santa Barbara, California
- Tamim Ahmed, PhD, MBA, Santa Barbara Actuaries Inc, Santa Barbara, California
- Nhan Huynh, PhD, Santa Barbara Actuaries Inc, Santa Barbara, California
| | - Nhan Huynh
- Ian Duncan, PhD, FSA, MAAA, Department of Statistics and Applied Probability, University of California, Santa Barbara
- Andrew Stocking, PhD, Principle Business Enterprises Inc, Dunbridge, Ohio
- Karen Fitzner, PhD, Santa Barbara Actuaries Inc, Santa Barbara, California
- Tamim Ahmed, PhD, MBA, Santa Barbara Actuaries Inc, Santa Barbara, California
- Nhan Huynh, PhD, Santa Barbara Actuaries Inc, Santa Barbara, California
| |
Collapse
|
14
|
Akkuş E, Gökçay Canpolat A, Demir Ö, Çorapçıoğlu D, Şahin M. Asymptomatic pyuria and bacteriuria are not risk factors for urinary tract infection in women with type 2 diabetes mellitus initiated SGLT2 inhibitors. Int Urol Nephrol 2024; 56:1165-1172. [PMID: 37715859 DOI: 10.1007/s11255-023-03798-5] [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] [Received: 07/06/2023] [Accepted: 09/09/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE Asymptomatic pyuria and bacteriuria are more prevalent in diabetic patients and may be associated with urinary tract infection (UTI). The aim of this study is to investigate the association between asymptomatic pyuria/bacteriuria at the initiation of SGLT2 inhibitor and UTI risk in female patients with type 2 diabetes. METHODS The study was designed as a practical, single-center, prospective, cohort study. The female outpatients with type 2 diabetes initiated SGLT2 inhibitor were included. Patients who were symptomatic or treated in the past 3 months for urinary or genital tract infection, had a high risk for UTI were excluded. Hospitalization/antibiotic use for indications other than UTI were exclusion criteria during follow-up. All patients were followed up for 3 months. Pyuria and bacteriuria were exposure and, UTI was the outcome. Cumulative incidence and relative risk of UTI were analyzed for pyuria and bacteriuria. RESULTS 143 female patients were included among 1132 female type 2 diabetic patients. 13 patients were excluded during follow-up. 41.5% of the patients (n = 54) had pyuria and 28.5% (n = 37) had bacteriuria. The cumulative incidence of UTI was 20% in the whole cohort, 25,9% (n = 14/54) in the pyuria group and 18.9% (n = 7/37) in the bacteriuria group. The relative risk of UTI was 1.64 (95% CI: 0.82-3.26, p = 0.15) for pyuria, 0.92 (95% CI: 0.42-2.01, p = 0.84) for bacteriuria, and 1.2 (95% CI: 0.47-3.08, p = 0.69) for pyuria plus bacteriuria. Adjusted odd ratios revealed similar results. CONCLUSIONS Asymptomatic pyuria/bacteriuria at the initiation of SGLT2 inhibitors are not risk factors for UTI in women with type 2 diabetes.
Collapse
Affiliation(s)
- Erman Akkuş
- Department of Internal Medicine, Trabzon Araklı Public Hospital, Trabzon, Turkey.
- Department of Internal Medicine, Ankara University Faculty of Medicine, Ankara, Turkey.
| | - Asena Gökçay Canpolat
- Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Özgür Demir
- Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Demet Çorapçıoğlu
- Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Mustafa Şahin
- Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
15
|
Vasconcellos de Oliveira Souza N, Rouanet C, Fontoura Solla DJ, Barroso de Lima CV, Trevizo J, Rezende F, Alves MM, de Oliveira Manuel AL, Righy C, Chaddad Neto F, Frudit M, Silva GS. Impact of Medical and Neurologic Complications on the Outcome of Patients with Aneurysmal Subarachnoid Hemorrhage in a Middle-Income Country. World Neurosurg 2024; 183:e250-e260. [PMID: 38104933 DOI: 10.1016/j.wneu.2023.12.068] [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] [Received: 08/31/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE Almost two thirds of the world's aneurysmal subarachnoid hemorrhage (aSAH) are in low- and middle-income countries. Herein, we aimed to evaluate the impact of complications on the outcome of aSAH in a middle-income country. METHODS Baseline data (age, sex, World Federation of Neurosurgical Society, time ictus-treatment, treatment modality) and medical and neurologic complications from a cohort in Brazil (2016-2019) were evaluated: delayed cerebral ischemia; hydrocephalus; meningitis; seizures; intracranial hypertension; infections (pneumonia, bloodstream, urinary tract infection infection of undetermined source); sodium disturbances; acute kidney injury; and cardiac and pulmonary complications. The primary outcome was the modified Rankin scale (mRS) at hospital discharge. Univariate and multivariate models were employed. RESULTS From 212 patients (71.7% female, age 52.7 ± 12.8), 92% developed at least 1 complication (any infection-43.9%, hydrocephalus-34.4%, intracranial hypertension-33%, infection of undetermined source-20.8%, hypernatremia-20.8%, hyponatremia-19.8%, delayed cerebral ischemia-related infarction-18.7%, pneumonia-18.4%, acute kidney injury-16.5%, and seizures-11.8%). In unadjusted analysis, all but hyponatremia and urinary tract infection were associated with mRS 3-6 at discharge; however, complications explained only 12% of the variation in functional outcome (mRS). Most patients were treated by clipping (66.5%), and 15.6% (33 patients) did not receive a definitive treatment. The median time ictus-admission and ictus-treatment were 5 and 9 days, respectively. CONCLUSIONS While medical and neurologic complications are a recognized opportunity to improve aSAH care, low- and middle-income countries comprise 70% of the world population and still encounter difficulties concerning early definitive aneurysm treatment, rebleeding, and human and material resources.
Collapse
Affiliation(s)
- Natália Vasconcellos de Oliveira Souza
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Sao Paulo, Brazil; Department of Neurology and Neurosurgery, Universidade de São Paulo, Sao Paulo, Brazil; Hospital Israelita Albert Einstein, Academic Research Organization, São Paulo, Brazil.
| | - Carolina Rouanet
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | | | | | - Juliana Trevizo
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Flavio Rezende
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Maramelia Miranda Alves
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Sao Paulo, Brazil; Hospital Israelita Albert Einstein, Academic Research Organization, São Paulo, Brazil
| | - Airton Leonardo de Oliveira Manuel
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Sao Paulo, Brazil; Department of Intensive Care Medicine, Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Sultanate of Oman
| | - Cassia Righy
- Department of Neurointensive Care, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil; Laboratório de Medicina Intensiva-Instituto Nacional de Infectologia, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Feres Chaddad Neto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Sao Paulo, Brazil; Hospital Israelita Albert Einstein, Academic Research Organization, São Paulo, Brazil
| | - Michel Frudit
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Sao Paulo, Brazil; Hospital Israelita Albert Einstein, Academic Research Organization, São Paulo, Brazil
| | - Gisele Sampaio Silva
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Sao Paulo, Brazil; Hospital Israelita Albert Einstein, Academic Research Organization, São Paulo, Brazil
| |
Collapse
|
16
|
Arnaud-Borboa I, Sheth M. Do We Stop SGLT2 Inhibitor After UTI With Septic Shock? Am J Med 2024; 137:e56-e57. [PMID: 37984771 DOI: 10.1016/j.amjmed.2023.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 10/24/2023] [Accepted: 10/24/2023] [Indexed: 11/22/2023]
Affiliation(s)
- Ivan Arnaud-Borboa
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, NL, Mexico
| | - Monish Sheth
- Department of Internal Medicine, Baylor Scott and White Medical Center, Temple, Texas.
| |
Collapse
|
17
|
Hao J, Du Z, Bo Z, Zhang H, Wang X. Impact of Metabolic Syndrome on Post-Operative Infection in Patients Undergoing Flexible Ureteroscopy Lithotripsy. Surg Infect (Larchmt) 2024; 25:140-146. [PMID: 38265838 DOI: 10.1089/sur.2023.205] [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: 01/25/2024] Open
Abstract
Background: To investigate retrospectively whether metabolic syndrome (MetS) of flexible ureteroscopy (fURS) lithotripsy can be used to predict post-operative infection. Patients and Methods: After screening, 1,110 patients who received fURS lithotripsy for upper urinary tract stones in our center between January 2015 and December 2022 were analyzed retrospectively. Patients were divided into MetS-positive group and MetS-negative group. Post-operative infection was divided into fever, urosepsis, and septic shock. Relevant data during the peri-operative period were collected. Univariable and multivariable logistic regression analyses were adopted to estimate the impact of metabolic syndrome on post-operative infection in patients undergoing fURS lithotripsy. Results: Among the 1,110 patients, 427 tested positive for MetS, whereas 683 tested negative. Eighty-eight patients suffered from fever (67 patients in the MetS-positive group and 21 in the MetS-negative group). Forty-nine patients had urosepsis (29 patients in the MetS-positive group and 20 in the MetS-negative group), of whom seven patients developed septic shock. No patient developed multiple organ failure or died because of infection. The prevalence of post-operative infections in the MetS-positive group was higher than that in the MetS-negative group (p < 0.001). Multivariable logistic regression analyses showed that diabetes mellitus, MetS-positive, positive urine culture, and longer operation time were positively correlated with post-operative fever. Positive MetS, positive urine culture, and longer operation time were strongly correlated with post-operative urosepsis. Conclusions: Metabolic syndrome was found to be associated with post-operative infection in patients undergoing fURS lithotripsy, suggesting it can serve as a predictive factor.
Collapse
Affiliation(s)
- Junxiu Hao
- Department of Urology, Tangshan Gongren Hospital, Lubei District, Tangshan, Hebei Province, People's Republic of China
| | - Zhiyong Du
- Department of Urology Surgery, Dingzhou People's Hospital, Dingzhou, Hebei Province, People's Republic of China
| | - Zhiqiang Bo
- Department of Urology, Tangshan Gongren Hospital, Lubei District, Tangshan, Hebei Province, People's Republic of China
| | - Huimin Zhang
- Department of Urology, Tangshan Gongren Hospital, Lubei District, Tangshan, Hebei Province, People's Republic of China
| | - Xiuyun Wang
- Department of Urology, Tangshan Gongren Hospital, Lubei District, Tangshan, Hebei Province, People's Republic of China
| |
Collapse
|
18
|
Chan K, Keane A, Pradhan S, King T, Moroco A, Goyal N, Choi KY. Postoperative Urinary Complications in Head and Neck Free Flap Reconstructive Surgery. Ann Otol Rhinol Laryngol 2024; 133:284-291. [PMID: 37902061 PMCID: PMC10865755 DOI: 10.1177/00034894231208256] [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: 10/31/2023]
Abstract
OBJECTIVE The purpose of this study is to evaluate the postoperative urinary complications and the optimal timing of foley catheter removal in patients who underwent free flap reconstructive surgery for head and neck pathology. METHODS A retrospective case-control study of head and neck patients who underwent free flap reconstructive surgery at a single institution between January 2009 and December 2021 was conducted. Patient risk factors for postoperative urinary retention (POUR) were analyzed. Fisher Exact and Wilcoxon Rank Sum tests were used to evaluate rates of foley replacement, straight catheterization, and catheter-associated urinary tract infection (CAUTI) and associated risk factors. RESULTS Two hundred and eleven patients were included in this study. Older age, lower BMI, lower intraoperative fluid volumes, and need for straight catheterization were statistically significant for POUR requiring foley replacement. Shorter total (P = .04) and postoperative (P = .01) foley duration showed statistical significance for POUR requiring straight catheterization. About 60% of patients who had straight catheterization required a foley replacement (P < .001). Only one patient (0.5%) developed a urinary tract infection (UTI). CONCLUSION Foley catheter duration impacts the risk of POUR requiring straight catheterization and subsequently, foley replacement. Optimal timing for foley catheter removal in the postoperative period remains to be elucidated. Removal of catheters between 21 and 48 hours after surgery may decrease the risk of POUR without increasing the rate of CAUTI in patients with head and neck pathology undergoing free flap reconstructive surgery.
Collapse
Affiliation(s)
- Kimberly Chan
- Department of Otolaryngology – Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Allison Keane
- Department of Otolaryngology – Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sandeep Pradhan
- Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Tonya King
- Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Annie Moroco
- Department of Otolaryngology – Head and Neck Surgery, Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Neerav Goyal
- Department of Otolaryngology – Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Karen Y. Choi
- Department of Otolaryngology – Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| |
Collapse
|
19
|
Jamali Z, Shafie'ei M, Soltani Nejad N. Neonatal pyocele originating from a urinary tract infection: a case report. J Med Case Rep 2024; 18:111. [PMID: 38414046 PMCID: PMC10900702 DOI: 10.1186/s13256-024-04416-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/29/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND The origins of pyocele are primarily idiopathic, with reports suggesting the spread from intraperitoneal or hematogenous infection. However, we found no information in the literature regarding the pathogen's spread from the urinary tract. CASE PRESENTATION We report here a case of a 23-day-old term Iranian boy (Fars ethnicity) with complaints of new-onset fever, irritability, poor feeding, right hemiscrotal erythema, and edema. Moreover, the physical examination revealed an enlarged, erythematous, tender right hemiscrotum and edematous scrotal walls. Along with leukocytosis and elevated C-reactive protein levels, the urine culture indicated an infection with Escherichia coli. However, as the color Doppler ultrasonographic examination was inconclusive, he underwent surgical exploration on which a hydrocele sac with reddish cloudy pus fluid was noted, with its culture indicating growth with the same mentioned pathogen. Therefore, an appropriate antibiotic regimen was administered, and the patient was discharged a few days later after achieving full recovery and demonstrating no urinary tract structural abnormalities. CONCLUSION In neonatal pyocele, the spectrum of evaluating the source of the infection should also be extended to the urinary tract. Moreover, administering suitable antibiotics would produce favorable results in cases with no structural abnormalities.
Collapse
Affiliation(s)
- Zahra Jamali
- Department of Pediatrics, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Shafie'ei
- Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | | |
Collapse
|
20
|
Sharma A, Suresh A, Pirruccello J, Sullivan M. Aplastic anaemia following antibiotic use for urinary tract infection. BMJ Case Rep 2024; 17:e254547. [PMID: 38423579 PMCID: PMC10910398 DOI: 10.1136/bcr-2022-254547] [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: 03/02/2024] Open
Abstract
Aplastic anaemia is often associated with recent viral illnesses to include EBV and parvovirus along with certain medications such as anticonvulsants and sulfa containing antibiotics. We describe a case report of a female patient in her 70s who presented with pancytopenia after being treated with nitrofurantoin and ciprofloxacin for suspected urinary tract infection. She underwent an extensive workup to rule out alternative aetiologies of her pancytopenia to include a broad viral, autoimmune and malignancy evaluation which were unrevealing. Given her recent exposure to ciprofloxacin and nitrofurantoin and marrow recovery following removal of these agents, it was presumed that antibiotic exposure was the underlying cause of her aplastic anaemia.
Collapse
Affiliation(s)
- Aditya Sharma
- Internal Medicine, Dartmouth Medical School, Hanover, New Hampshire, USA
| | - Arvind Suresh
- Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
| | | | - Matthew Sullivan
- Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, New Hampshire, USA
| |
Collapse
|
21
|
Maeda H, Hashimoto K, Iwasa H, Kyozuka H, Kume Y, Go H, Sato A, Ogata Y, Murata T, Fujimori K, Shinoki K, Nishigori H, Yasumura S, Hosoya M. Association of cesarean section and infectious outcomes among infants at 1 year of age: Logistic regression analysis using data of 104,065 records from the Japan Environment and Children's Study. PLoS One 2024; 19:e0298950. [PMID: 38381764 PMCID: PMC10880998 DOI: 10.1371/journal.pone.0298950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 02/02/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND There has been a recent decrease in the prevalence of infectious diseases in children worldwide due to the usage of vaccines. However, the association between cesarean delivery and infectious diseases remains unclear. Here, we aimed to clarify the association between cesarean delivery and the development of infectious diseases. METHODS This study is a cross-sectional study. We used data from the Japan Environment and Children's Study, which is a prospective, nationwide, government-funded birth cohort study. The data of 104,065 records were included. Information about the mode of delivery, central nervous system infection (CNSI), otitis media (OM), upper respiratory tract infection (URTI), lower respiratory tract infection (LRTI), gastrointestinal infection (GI), and urinary tract infection (UTI) was obtained from questionnaires and medical records transcripts. Multiple logistic regression analysis was used to assess the association between cesarean delivery and CNSI, OM, URTI, LRTI, GI, and UTI risk. RESULTS We included a total of 74,477 subjects in this study, of which 18.4% underwent cesarean deliveries. After adjusting for the perinatal, socioeconomic, and postnatal confounding factors, children born by cesarean delivery did not have an increased risk of developing CNSI (95% confidence interval [CI] 0.46-1.35), OM (95% CI 0.99-1.12), URTI (95% CI 0.97-1.06), LRTI (95% CI 0.98-1.15), GI (95% CI 0.98-1.11), or UTI (95% CI 0.95-1.45). CONCLUSIONS This nationwide cohort study did not find an association between cesarean delivery and CNSI, OM, URTI, LRTI, GI, and UTI. However, further studies are needed to evaluate the role of cesarean delivery in the development of infectious diseases.
Collapse
Affiliation(s)
- Hajime Maeda
- Department of Pediatrics, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Koichi Hashimoto
- Department of Pediatrics, School of Medicine, Fukushima Medical University, Fukushima, Japan
- Fukushima Regional Center for the Japan Environmental and Children’s Study, Fukushima, Japan
| | - Hajime Iwasa
- Department of Public Health, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hyo Kyozuka
- Fukushima Regional Center for the Japan Environmental and Children’s Study, Fukushima, Japan
- Department of Obstetrics and Gynecology, School of Medicine, Fukushima Medical University School, Fukushima, Japan
| | - Yohei Kume
- Department of Pediatrics, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hayato Go
- Department of Pediatrics, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Akiko Sato
- Fukushima Regional Center for the Japan Environmental and Children’s Study, Fukushima, Japan
| | - Yuka Ogata
- Fukushima Regional Center for the Japan Environmental and Children’s Study, Fukushima, Japan
| | - Tsuyoshi Murata
- Fukushima Regional Center for the Japan Environmental and Children’s Study, Fukushima, Japan
- Department of Obstetrics and Gynecology, School of Medicine, Fukushima Medical University School, Fukushima, Japan
| | - Keiya Fujimori
- Fukushima Regional Center for the Japan Environmental and Children’s Study, Fukushima, Japan
- Department of Obstetrics and Gynecology, School of Medicine, Fukushima Medical University School, Fukushima, Japan
| | - Kosei Shinoki
- Fukushima Regional Center for the Japan Environmental and Children’s Study, Fukushima, Japan
| | - Hidekazu Nishigori
- Fukushima Regional Center for the Japan Environmental and Children’s Study, Fukushima, Japan
- Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Japan
| | - Seiji Yasumura
- Fukushima Regional Center for the Japan Environmental and Children’s Study, Fukushima, Japan
- Department of Public Health, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Mitsuaki Hosoya
- Department of Pediatrics, School of Medicine, Fukushima Medical University, Fukushima, Japan
- Fukushima Regional Center for the Japan Environmental and Children’s Study, Fukushima, Japan
| | | |
Collapse
|
22
|
Habuka M, Nishikiori M, Oikawa C, Takahashi M, Sakamaki Y, Ogawa A, Miyajima N, Tanabe Y, Honma K, Wakaki K, Yamamoto S, Narita I. Systemic Amyloid A Amyloidosis Secondary to Xanthogranulomatous Pyelonephritis. Intern Med 2024; 63:593-599. [PMID: 37407464 PMCID: PMC10937118 DOI: 10.2169/internalmedicine.1806-23] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/23/2023] [Indexed: 07/07/2023] Open
Abstract
The combination of systemic amyloid A (AA) amyloidosis and xanthogranulomatous pyelonephritis (XGP) resulting from a chronic urinary tract infection is extremely rare. We herein report a case of systemic AA amyloidosis secondary to XGP for which clinical remission developed after nephrectomy. To our knowledge, this is the first case report describing the clinical improvement of systemic AA amyloidosis secondary to XGP after nephrectomy in Japan. Clinicians should be aware of this uncommon combination and search for amyloid depositions in cases of XGP.
Collapse
Affiliation(s)
- Masato Habuka
- Division of Nephrology, Niigata Prefectural Shibata Hospital, Japan
| | | | - Chihiro Oikawa
- Division of Nephrology, Niigata Prefectural Shibata Hospital, Japan
| | - Megumi Takahashi
- Division of Nephrology, Niigata Prefectural Shibata Hospital, Japan
| | - Yuichi Sakamaki
- Division of Nephrology, Niigata Prefectural Shibata Hospital, Japan
| | - Asa Ogawa
- Division of Nephrology, Niigata Prefectural Shibata Hospital, Japan
| | - Norio Miyajima
- Division of Urology, Niigata Prefectural Shibata Hospital, Japan
| | - Yasuhiko Tanabe
- Division of Cardiology, Niigata Prefectural Shibata Hospital, Japan
| | - Keiichi Honma
- Division of Pathology, Niigata Prefectural Shibata Hospital, Japan
| | - Kunihiko Wakaki
- Division of Pathology, Niigata Prefectural Shibata Hospital, Japan
| | - Suguru Yamamoto
- Division of Clinical Nephrology and Rheumatology, Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences, Japan
| |
Collapse
|
23
|
Yang YJ, Feng YM, Wang TX, Wang JY, Pang QY, Liu HL. Association Between Intraoperative Noradrenaline Infusion and Outcomes in Older Adult Patients Undergoing Major Non-Cardiac Surgeries: A Retrospective Propensity Score-Matched Cohort Study. Clin Interv Aging 2024; 19:219-227. [PMID: 38352273 PMCID: PMC10863471 DOI: 10.2147/cia.s440902] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/31/2024] [Indexed: 02/16/2024] Open
Abstract
Background Noradrenaline (NA) is commonly used intraoperatively to prevent fluid overload and maintain hemodynamic stability. Clinical studies provided inconsistent results concerning the effect of NA on postoperative outcomes. As aging is accompanied with various diseases and has the high possibility of the risk for postoperative complications, we hypothesized that intraoperative NA infusion in older adult patients undergoing major non-cardiac surgeries might potentially exert adverse outcomes. Methods In this retrospective propensity score-matched cohort study, older adult patients undergoing major non-cardiac surgeries were selected, 1837 receiving NA infusion during surgery, and 1072 not receiving NA. The propensity score matching was conducted with a 1:1 ratio and 1072 patients were included in each group. The primary outcomes were postoperative in-hospital mortality and complications. Results Intraoperative NA administration reduced postoperative urinary tract infection (OR:0.124, 95% CI:0.016-0.995), and had no effect on other postoperative complications and mortality, it reduced intraoperative crystalloid infusion (OR:0.999, 95% CI:0.999-0.999), blood loss (OR: 0.998, 95% CI: 0.998-0.999), transfusion (OR:0.327, 95% CI: 0.218-0.490), but increased intraoperative lactate production (OR:1.354, 95% CI:1.051-1.744), and hospital stay (OR:1.019, 95% CI:1.008-1.029). Conclusion Intraoperative noradrenaline administration reduces postoperative urinary tract infection, and does not increase other postoperative complications and mortality, and can be safely used in older adult patients undergoing major non-cardiac surgeries.
Collapse
Affiliation(s)
- Ya-Jun Yang
- Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, People’s Republic of China
| | - Yu-Mei Feng
- Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, People’s Republic of China
| | - Tong-Xuan Wang
- Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, People’s Republic of China
| | - Jing-Yun Wang
- School of Medicine, Chongqing University, Chongqing, People’s Republic of China
| | - Qian-Yun Pang
- Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, People’s Republic of China
| | - Hong-Liang Liu
- Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, People’s Republic of China
| |
Collapse
|
24
|
Sillen U, Hansson S, Jernmark S, Sjöström S, Brandström P. Longitudinal follow-up of bladder function in children who participated in the Swedish Reflux Trial. J Pediatr Urol 2024; 20:118-126. [PMID: 37684195 DOI: 10.1016/j.jpurol.2023.08.024] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 07/31/2023] [Accepted: 08/19/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Several publications have reported the coexistence of vesicoureteral reflux (VUR) and bladder dysfunction in children. Whether this dysfunction remains in the longer term is not yet known. OBJECTIVE This study revisited children who participated in the Swedish Reflux Trial (SRT) with the primary aim of evaluating whether bladder and bowel dysfunction (BBD) in these patients persisted until adolescence. The secondary aim was to evaluate two BBD subgroups, and relations to recurrent urinary tract infections (UTI). STUDY DESIGN Of the 161 eligible children at SRT study-end, 73 children participated. Their bladder function was evaluated longitudinally using a validated BBD questionnaire with symptom score (cut-off ≥7) and uroflowmetry, at five (T2) and ten years (T3) after study-end. T1 was the SRT study-end. Besides BBD, the sub-diagnoses overactive bladder (OAB) and dysfunctional voiding symptoms (DVS) were calculated from symptom scores. RESULTS BBD was diagnosed in 37% of children at mean age 3.7 years, which decreased with age to 23% of adolescents (mean age 15.7). DVS and OAB subgroups were equally common at T1, but only DVS was identified at the last follow-up (T3) (p = 0.0008). Recurrent UTIs were seen in 17% at T3 and were more common in patients with BBD (p = 0.038). The gender distribution of BBD also changed, from being equally common at the end of the SRT to affecting mainly adolescent girls at the last follow-up (p = 0.022). Information was available regarding VUR status after repeat VCUGs during follow-up in 22 patients, 12 of them after endoscopic treatment. An improvement in VUR grade was found in the 22, but during follow-up numbers with BBD or UTI did not differ between treated and non-treated groups. DISCUSSION The prevalence of BBD decreased from 37% at 3-4 years of age to 23% in adolescence, when it was almost exclusively seen in girls. BBD and the subgroup DVS were associated with UTI. Even if epidemiological studies have established a predisposition to bladder symptoms and UTI in girls, little is known about bladder function in adolescents with a history of VUR during the first years of life. One limitation of the study was the number of patients participating. Also, the number of patients with kidney damage was more common in the cohort. CONCLUSION In this longitudinal follow-up of BBD in children with VUR, the number of children with BBD decreased with age. In adolescence, both BBD and recurrent UTIs mainly affected girls.
Collapse
Affiliation(s)
- U Sillen
- From the Pediatric Uronephrology Center, Department of Pediatrics and Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
| | - S Hansson
- From the Pediatric Uronephrology Center, Department of Pediatrics and Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
| | - S Jernmark
- From the Pediatric Uronephrology Center, Department of Pediatrics and Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
| | - S Sjöström
- From the Pediatric Uronephrology Center, Department of Pediatrics and Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
| | - P Brandström
- From the Pediatric Uronephrology Center, Department of Pediatrics and Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
| |
Collapse
|
25
|
Pyrgidis N, Chaloupka M, Ebner B, Stief C, Weinhold P, Marcon J, Schulz GB. Perioperative Outcomes of Same-Session Bilateral vs Unilateral Ureteroscopy for Stone Removal: Results from the GRAND Study. J Endourol 2024; 38:129-135. [PMID: 38019049 DOI: 10.1089/end.2023.0563] [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: 11/30/2023] Open
Abstract
Background: Same-session bilateral ureteroscopy may reduce the number of surgeries for stone removal but can lead to higher overall complication rates. We aimed to compare same-session bilateral ureteroscopy with unilateral ureteroscopy in terms of perioperative outcomes. Methods: We used the GeRmAn Nationwide inpatient Data (GRAND), provided by the Research Data Center of the Federal Bureau of Statistics (2005-2021). We assessed, through multiple patient-level analyses, severe perioperative complications, mortality, length of hospital stay, hospital revenues, intensive care unit admission, and the evolution of ureteroscopy during the last years in Germany. Results: We included 833,609 patients undergoing either same-session bilateral (n = 6914, 0.8%) or unilateral (n = 826,695, 99.2%) ureteroscopy for stone management. Patients undergoing bilateral ureteroscopy presented worse baseline characteristics. After adjusting for these characteristics, same-session bilateral ureteroscopy, compared to unilateral ureteroscopy, was significantly associated with higher odds of postoperative sepsis (odds ratio [OR]: 2.4, 95% confidence interval [CI]: 2-2.8, p < 0.001), myocardial infarction (OR: 2, 95% CI: 1.03-3.5, p = 0.024), acute kidney disease (OR: 2.8, 95% CI: 2.5-3.2, p < 0.001), transfusion (OR: 4.2, 95% CI: 3.6-4.8, p < 0.001), urinary tract infection (OR: 1.6, 95% CI: 1.5-1.7, p < 0.001), intensive care unit admission (OR: 1.9, 95% CI: 1.6-2.3, p < 0.001), and mortality (OR: 3.1, 95% CI: 2.1-4.5, p < 0.001). Similarly, the length of hospital stay was longer, and the in-hospital costs were higher (p < 0.001) after same-session bilateral ureteroscopy. Interestingly, the annual cases of ureteroscopy have undergone about a threefold increase in the last 17 years. Conclusions: The present real-world data demonstrate that same-session bilateral ureteroscopy leads to higher rates of perioperative myocardial infarction, acute kidney disease, transfusion, urinary tract infections, sepsis, and intensive care unit admission, as well as to increased length of hospital stay, costs, and inpatient mortality compared to unilateral ureteroscopy.
Collapse
Affiliation(s)
- Nikolaos Pyrgidis
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Michael Chaloupka
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Benedikt Ebner
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Christian Stief
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Philipp Weinhold
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Julian Marcon
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | | |
Collapse
|
26
|
Kilgore CB, Ran KR, Kalluri AL, Nair SK, Kim JE, Caplan JM, Jackson CM, Gonzalez LF, Huang J, Tamargo RJ, Xu R. Perioperative Infection After Aneurysmal Subarachnoid Hemorrhage: Risk Factors, Causative Pathogens, and Long-Term Outcomes. Neurosurgery 2024; 94:325-333. [PMID: 37706782 DOI: 10.1227/neu.0000000000002676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 07/17/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Nosocomial infections are the most common complication among critically ill patients and contribute to poor long-term outcomes. Patients with aneurysmal subarachnoid hemorrhage (aSAH) are highly susceptible to perioperative infections, yet it is unclear what factors influence infection onset and functional recovery. The objective was to investigate risk factors for perioperative infections after aSAH and relate causative pathogens to patient outcomes. METHODS Clinical records were obtained for 194 adult patients with aSAH treated at our institution from 2016 to 2020. Demographics, clinical course, complications, microbiological reports, and outcomes were collected. χ 2 , univariate, and multivariate logistic regression analyses were used to analyze risk factors. RESULTS Nearly half of the patients developed nosocomial infections, most frequently pneumonia and urinary tract infection. Patients with infections had longer hospital stays, higher rates of delayed cerebral ischemia, and worse functional recovery up to 6 months after initial hemorrhage. Independent risk factors for pneumonia included male sex, comatose status at admission, mechanical ventilatory use, and longer admission, while those for urinary tract infection included older age and longer admission. Staphylococcus , Klebsiella , and Enterococcus spp. were associated with poor long-term outcome. Certain pathogenic organisms were associated with delayed cerebral ischemia. CONCLUSION Perioperative infections are highly prevalent among patients with aSAH and are related to adverse outcomes. The risk profiles for nosocomial infections are distinct to each infection type and causative organism. Although strong infection control measures should be universally applied, patient management must be individualized in the context of specific infections.
Collapse
Affiliation(s)
- Collin B Kilgore
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
- Medical Scientist Training Program, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Kathleen R Ran
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Anita L Kalluri
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Sumil K Nair
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Jennifer E Kim
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Justin M Caplan
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Christopher M Jackson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - L Fernando Gonzalez
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Rafael J Tamargo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Risheng Xu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| |
Collapse
|
27
|
Suarez Arbelaez MC, Khanna K, Raymo A, Weber A, Lerendegui L, Nackeeran S, Gosalbez R, Labbie AS, Castellan MA, Nassau DE, Alam A. Does preoperative screening VCUG affect the outcomes and complications of pyeloplasty in patients with ureteropelvic junction obstruction? J Pediatr Urol 2024; 20:76.e1-76.e7. [PMID: 37839944 DOI: 10.1016/j.jpurol.2023.09.016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 09/17/2023] [Accepted: 09/23/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION The role of voiding cystourethrogram (VCUG) in evaluating vesicoureteral reflux (VUR) in patients with known ureteropelvic junction obstruction (UPJO) remains unclear. While VCUG is frequently performed, the incidence of concomitant VUR and UPJO is low, and VUR is often low-grade with high rates of spontaneous regression. OBJECTIVE To analyze the clinical relevance of VCUG in patients with UPJO by determining its incidence and studying the difference in clinical outcomes between patients with known, unknown, and negative VUR. STUDY DESIGN Retrospective review of patients with UPJO who underwent pyeloplasty from 2012 to 2020 with <18 years-old, unilateral UPJO, postoperative follow-up of ≥2 months and had at least 1 renal ultrasound (US) after pyeloplasty. Results were compared among 3 groups: patients who underwent VCUG before pyeloplasty and were found to have VUR (group 1), patients who underwent VCUG before pyeloplasty without VUR (group 2), and patients who did not have a VCUG before pyeloplasty (group 3). RESULTS A total of 275 patients met the inclusion criteria, of which 21 patients were classified in group 1, 166 patients in group 2, and 88 patients in group 3 (Table). The age at preoperative VCUG was 14.7 ± 32.9 months in group 1 and 15.17 ± 35.8 months in group 2 (p = 0.960). Overall, the incidence of concomitant UPJO and VUR was 11.2%. In group 1 the initial VUR grade was 5 in 2 patients, 4 in 3, 3 in 5, 2 in 7, and 1 in 4 patients. Of these, only 1 patient required ureteral reimplantation after pyeloplasty. Post-pyeloplasty, no significant differences were observed in complications (p = 0.7436), length of follow up (p = 0.3212), SFU grade 4 hydronephrosis (p = 0.2247), postoperative UTIs (p = 0.1047) and pyeloplasty success rate (p = 0.4206) among the 3 groups. Despite the use of antibiotic prophylaxis being significantly different amongst the three groups (p < 0.001), it was not associated with a lower incidence of postoperative UTIs (group 1 p = 0.068, group 2 p = 0.486, group 3 p = 1). In patients with reflux, an increase in age was associated with a decrease in the rates of complications (p = 0.019). CONCLUSION We found no significant difference in the outcomes in patients who had a preoperative VCUG as compared to those who did not. The preoperative diagnosis of VUR by VCUG changed the management in less than 1% of the study population and thus its role in patients with UPJO should be reevaluated.
Collapse
Affiliation(s)
| | - Kashish Khanna
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Adele Raymo
- Department of Pediatric Urology, Jackson Memorial Hospital, Miami, FL, USA
| | - Alexander Weber
- Desai Sethi Urology Institute, University of Miami, Miami, FL, USA
| | - Luciana Lerendegui
- Department of Pediatric Urology, Jackson Memorial Hospital, Miami, FL, USA
| | - Sirpi Nackeeran
- Department of Urology, University of California, San Diego, CA, USA
| | - Rafael Gosalbez
- Department of Pediatric Urology, Jackson Memorial Hospital, Miami, FL, USA; Department of Pediatric Urology, Nicklaus Children's Hospital, Miami, FL, USA
| | - Andrew S Labbie
- Department of Pediatric Urology, Jackson Memorial Hospital, Miami, FL, USA; Department of Pediatric Urology, Nicklaus Children's Hospital, Miami, FL, USA
| | - Miguel A Castellan
- Department of Pediatric Urology, Jackson Memorial Hospital, Miami, FL, USA; Department of Pediatric Urology, Nicklaus Children's Hospital, Miami, FL, USA
| | - Daniel E Nassau
- Department of Pediatric Urology, Jackson Memorial Hospital, Miami, FL, USA; Department of Pediatric Urology, Nicklaus Children's Hospital, Miami, FL, USA
| | - Alireza Alam
- Department of Pediatric Urology, Jackson Memorial Hospital, Miami, FL, USA
| |
Collapse
|
28
|
Hernández-Bou S, Trenchs V, Diego P, Seguí A, Luaces C. Bacterial coinfection in young febrile infants with SARS-CoV-2 infection. Eur J Pediatr 2024; 183:281-288. [PMID: 37872349 DOI: 10.1007/s00431-023-05212-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 10/25/2023]
Abstract
We aimed to assess the prevalence of serious bacterial infections (SBIs) in febrile infants < 90 days of age with SARS-CoV-2 infection versus SARS-CoV-2-negative febrile infants. A retrospective cohort study was conducted in a tertiary pediatric emergency department between March 2020 and October 2022. Febrile infants < 90 days of age who underwent SARS-CoV-2 testing were included. SBIs were defined as urinary tract infection (UTI), bacteremia, and/or bacterial meningitis; bacteremia and bacterial meningitis were considered invasive bacterial infections (IBIs). SBIs rates were compared between SARS-CoV-2-positive and negative infants and stratified by age. We included 779 infants: 221 (28.4%) SARS-CoV-2-positive and 558 (71.6%) SARS-CoV-2-negative. The SBI rate in the SARS-CoV-2-positive group was 5.9% vs 22.9% in the SARS-CoV-2-negative group (p < 0.001; relative risk (RR) 0.26; [95% CI 0.15-0.44]); the most common infections were UTI (5.4% vs 22.0%; p < 0.001). The IBI rate was 0.5% in the SARS-CoV-2-positive group vs. 3.2% in the negative group (p = 0.024; RR 0.14 [95% CI 0.02-1.04]). There were no cases of bacterial meningitis in the positive infants. SARS-CoV-2-positive infants > 28 days of age had a decreased likelihood of SBI (RR 0.22 [95% CI 0.11-0.43]), with no cases of IBI identified. Conclusions: Febrile infants < 90 days of age with SARS-CoV-2 infection are at significantly lower risk of SBIs than those who are SARS-CoV-2-negative. Nevertheless, the rate of UTI remains considerable in SARS-CoV-2-positive infants. SARS-CoV-2 detection may be relevant in considering IBI risk for well-appearing febrile infants 29-89 days of age. What is Known: • Febrile infants with laboratory-confirmed viral infections have a significantly lower risk of serious bacterial infections when compared to those without them. Data focusing on very young febrile infants with a SARS-CoV-2 infection is still limited. What is New: • Young febrile infants with SARS-CoV-2 infection are at significantly lower risk of serious bacterial infections than those who are SARS-CoV-2-negative. Nevertheless, the rate of urinary tract infection remains considerable. SARS-CoV-2 detection may be relevant in considering invasive bacterial infection risk for well-appearing febrile infants 29-89 days of age.
Collapse
Affiliation(s)
- Susanna Hernández-Bou
- Pediatric Emergency Department, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08940, Esplugues de Llobregat, Barcelona, Spain
- Infectious Diseases and Microbiome, Institut de Recerca Sant Joan de Déu (IRSJD), Barcelona, Spain
| | - Victoria Trenchs
- Pediatric Emergency Department, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08940, Esplugues de Llobregat, Barcelona, Spain.
- University of Barcelona, Barcelona, Spain.
- Environment Effects on Child/Adolescent Well-being, Institut de Recerca Sant Joan de Déu (IRSJD), Barcelona, Spain.
| | - Patricia Diego
- Pediatric Emergency Department, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08940, Esplugues de Llobregat, Barcelona, Spain
| | - Aina Seguí
- Pediatric Emergency Department, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08940, Esplugues de Llobregat, Barcelona, Spain
| | - Carles Luaces
- Pediatric Emergency Department, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08940, Esplugues de Llobregat, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- Environment Effects on Child/Adolescent Well-being, Institut de Recerca Sant Joan de Déu (IRSJD), Barcelona, Spain
| |
Collapse
|
29
|
Fwu CW, Barthold JS, Mendley SR, Bennett K, Chan K, Wilkins KJ, Parsa A, Norton JM, Eggers PW, Kimmel PL, Schulman IH, Kirkali Z. Epidemiology of Infantile Ureteropelvic Junction Obstruction in the US. Urology 2024; 183:185-191. [PMID: 37802192 PMCID: PMC10843281 DOI: 10.1016/j.urology.2023.09.024] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVE To describe sex- and diagnosis-specific comorbidities, outcomes, and secular trends associated with ureteropelvic junction obstruction (UPJO) in a large, real-world population diagnosed with hydronephrosis in infancy. MATERIALS AND METHODS We identified all infants ≤1 year old with ≥1 claim in the Optum Clinformatics 2007-2020 nationwide population database and used univariable and multivariable Cox regression analyses to estimate associations of demographic and clinical characteristics of infants with a UPJO diagnosis with surgical status. RESULTS Of 22,349 infants with hydronephrosis (1.1% of infants; males-1.4%, females-0.7%), 1722 (7.7%; 7.9%-males, 7.2%-females) had UPJO. Follow-up was ≥1 year in 1198 (70%) and ≥3 years in 555 (32%) cases, and UPJO repair was performed in 542 children (31.5%; 32.3%-males, 29.5%-females); 77.7% within 1 year and 97.3% within 3 years. UPJO repair was associated with prior urinary tract infection (UTI) (hazard ratio (HR) 1.41, 95% confidence interval (CI) 1.12-1.76) and South (HR 1.42, 95% CI 1.14-1.78) or Midwest (HR 1.60, 95% CI 1.26-2.04) geographic region but did not change over time. CONCLUSION This population-based study provides a real-world view of postnatally diagnosed hydronephrosis, focusing on UPJO, for which 522 cases (∼1/3) had ≥3 years continuous coverage. UPJO-associated comorbidities were more common in females, and the frequencies of UPJO-associated surgery and comorbidities were higher than in other studies. Other than UTI, no other associated kidney or urinary tract diagnoses were associated with UPJO repair. We identified unique sex- and diagnosis-specific differences in associated comorbidities and interventions in children diagnosed with UPJO in the first year of life.
Collapse
Affiliation(s)
- Chyng-Wen Fwu
- Division of Public Health Research, Social & Scientific Systems, Inc., a DLH Holdings Corp Company, Atlanta, GA.
| | - Julia S Barthold
- Division of Kidney, Urologic & Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
| | - Susan R Mendley
- Division of Kidney, Urologic & Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
| | - Kara Bennett
- Division of Public Health Research, Social & Scientific Systems, Inc., a DLH Holdings Corp Company, Atlanta, GA.
| | - Kevin Chan
- Division of Kidney, Urologic & Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
| | - Kenneth J Wilkins
- Biostatistics Program, Office of the Director, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
| | - Afshin Parsa
- Division of Kidney, Urologic & Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
| | - Jenna M Norton
- Division of Kidney, Urologic & Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
| | - Paul W Eggers
- Division of Kidney, Urologic & Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
| | - Paul L Kimmel
- Division of Kidney, Urologic & Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
| | - Ivonne H Schulman
- Division of Kidney, Urologic & Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
| | - Ziya Kirkali
- Division of Kidney, Urologic & Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
| |
Collapse
|
30
|
Patel J, Politis MD, Howley MM, Browne ML, Bolin EH, Ailes EC, Johnson CY, Magann E, Nembhard WN. Fever and antibiotic use in maternal urinary tract infections during pregnancy and risk of congenital heart defects: Findings from the National Birth Defects Prevention Study. Birth Defects Res 2024; 116:e2281. [PMID: 38093546 DOI: 10.1002/bdr2.2281] [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: 07/21/2023] [Revised: 10/21/2023] [Accepted: 11/22/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Previous studies report an association between prenatal maternal urinary tract infections (UTI) and specific congenital heart defects (CHDs); however, the role of fever and antibiotic use on this association is poorly understood. Using data from the National Birth Defects Prevention Study, we examined whether the relationship between maternal UTIs during the periconceptional period and occurrence of CHDs is modified by the presence of fever due to UTI and corresponding antibiotic use among 11,704 CHD case infants and 11,636 live-born control infants. METHODS Information on UTIs, fever associated with UTI and antibiotic use (sulfonamides, nitrofurantoin, cephalosporins, penicillin, macrolides, and quinolones) during pregnancy were obtained using a computer-assisted telephone interview. Using unconditional multivariable logistic regression, we calculated adjusted odds ratios (ORs) to determine the association between maternal UTIs and subtypes of CHDs. Analyses were stratified by the presence of fever and medication use associated with UTI. RESULTS The prevalence of UTIs during the periconceptional period was 7.6% in control mothers, and 8.7% in case mothers. In the absence of fever, UTI was associated with secundum atrial septal defects (ASD) (OR 1.3; 95% confidence interval [CI] 1.1-1.5) and in the absence of antibiotics, UTI was associated with conotruncal defects as a group and for four specific CHDs. When fever and UTI occurred concomitantly, no significantly elevated odds ratios were noticed for any subtypes of CHD. Among women with UTIs who used antibiotics, an elevated but statistically non-significant estimate was observed for secundum ASD (OR 1.4; 95% CI 1.0-2.0). CONCLUSION Findings in the present study suggest that fever due to UTI and corresponding maternal antibiotic use do not substantially modify the association between maternal UTIs and specific CHDs in offspring. Further studies with larger sample sizes are warranted to guide clinical management of UTIs during the periconceptional period.
Collapse
Affiliation(s)
- Jenil Patel
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, Texas, USA
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Arkansas Center for Birth Defects Research and Prevention, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Maria D Politis
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Arkansas Center for Birth Defects Research and Prevention, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Meredith M Howley
- Birth Defects Registry, New York State Department of Health, Albany, New York, USA
| | - Marilyn L Browne
- Birth Defects Registry, New York State Department of Health, Albany, New York, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York, USA
| | - Elijah H Bolin
- Department of Pediatrics, Section of Pediatric Cardiology, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Elizabeth C Ailes
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Candice Y Johnson
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
| | - Everett Magann
- Department of Obstetrics and Gynecology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Wendy N Nembhard
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Arkansas Center for Birth Defects Research and Prevention, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| |
Collapse
|
31
|
Son Y, Dalton R, Daidone C, Lince K, Flemming J, Wu E, Serpico S, Thomas B, Scali J, Earnshaw L, Patel B, Akanda S, Weldekidan B, Alzubaidi M, Dean G. Preoperative and Intraoperative Urine Cultures and Its Association With Postoperative Infection After Ureteroneocystostomy. Urology 2024; 183:176-184. [PMID: 37774848 DOI: 10.1016/j.urology.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/05/2023] [Accepted: 09/12/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVE To unveil this association, we hypothesize that preoperative and intraoperative urinary tract infection (UTI) will be correlated with postoperative UTI and sepsis occurrence. PATIENTS AND METHODS The 2020 National Surgical Quality Improvement Program Pediatric (NSQIP-P) data was analyzed for patients undergoing ureteroneocystostomy (UNC) for vesicoureteral reflux (VUR). Patients that underwent UNC for treatment of VUR with urine culture obtained within 2weeks preoperatively or on the day of surgery were identified. The patients were divided into 3 groups: no bacterial growth, bacterial growth with UTI, and bacterial growth polymicrobial growth. Patient demographics and preoperative variables were evaluated. RESULTS The postoperative urinary tract infection rate of the three groups were 2.0%, 9.2%, and 9.9% for group A, B, C, respectively (P < .001). Postoperative sepsis was noted to be 0.5%, 1.3%, and 3.6% for group A, B, C (P < .01). Additionally, there was a difference between mean operative time (P < .001), mean length of stay (P = .03), and mean days from operation to discharge (P < .01). On adjusted analysis, both groups B and C had higher rates of UTI compared to group A. Group C was also seen to have greater rates of sepsis on adjusted analysis. CONCLUSION The association found between preoperative UTI with less than 2 species of microorganisms (group B) and postoperative UTI indicates that UTI treatment and antibiotic prophylaxis should be considered when undergoing UNC for VUR. The results of this study may lead to more careful consideration of the use of preoperative and intraoperative urine culture as well as treatment of UTI in pediatric patients with VUR undergoing UNC.
Collapse
Affiliation(s)
- Young Son
- Jefferson New Jersey Urology, Stratford, NJ; Philadelphia College of Osteopathic Medicine, Philadelphia, PA.
| | - Raeann Dalton
- Rowan University School of Osteopathic Medicine, Stratford, NJ
| | | | - Kimberly Lince
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX
| | - Joseph Flemming
- Rowan University School of Osteopathic Medicine, Stratford, NJ
| | - Edward Wu
- Alabama College of Osteopathic Medicine, Dothan, AL
| | - Scott Serpico
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA
| | - Brian Thomas
- Rowan University School of Osteopathic Medicine, Stratford, NJ
| | | | | | - Bhavik Patel
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA
| | | | | | | | - Gregory Dean
- Temple University, Department of Urology, Philadelphia, PA
| |
Collapse
|
32
|
Montini G, Tessitore A, Console K, Ronfani L, Barbi E, Pennesi M. Short Oral Antibiotic Therapy for Pediatric Febrile Urinary Tract Infections: A Randomized Trial. Pediatrics 2024; 153:e2023062598. [PMID: 38146260 DOI: 10.1542/peds.2023-062598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Febrile urinary tract infection (fUTI) in well-appearing children is conventionally treated with a standard 10-day course of oral antibiotic. The objective of this study is to determine the noninferiority (5% threshold) of a 5-day amoxicillin-clavulanate course compared with a 10-day regimen to treat fUTIs. METHODS This is a multicenter, investigator-initiated, parallel-group, randomized, controlled trial. We randomly assigned children aged 3 months to 5 years with a noncomplicated fUTI to receive amoxicillin-clavulanate 50 + 7.12 mg/kg/day orally in 3 divided doses for 5 or 10 days. The primary end point was the recurrence of a urinary tract infection within 30 days after the completion of therapy. Secondary end points were the difference in prevalence of clinical recovery, adverse drug-related events, and resistance to amoxicillin-clavulanic acid and/or to other antibiotics when a recurrent infection occurred. RESULTS From May 2020 through September 2022, 175 children were assessed for eligibility and 142 underwent randomization. The recurrence rate within 30 days of the end of therapy was 2.8% (2/72) in the short group and 14.3% (10/70) in the standard group. The difference between the 2 groups was -11.51% (95% confidence interval, -20.54 to -2.47). The recurrence rate of fUTI within 30 days from the end of therapy was 1.4% (1/72) in the short group and 5.7% (4/70) in the standard group (95% confidence interval, -10.4 to 1.75). CONCLUSIONS This study demonstrates that a 5-day course is noninferior to a 10-day course of oral amoxicillin-clavulanate.
Collapse
Affiliation(s)
- Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
- Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| | - Antimo Tessitore
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Karen Console
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Luca Ronfani
- Department of Clinical Epidemiology, Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italy
| | - Egidio Barbi
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Marco Pennesi
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| |
Collapse
|
33
|
Fatokun TB, Swartz SE, Ebeid A, Cordes SA, Gimovsky AC, Sparks AD, Amdur RL, Ahmadzia HK. Venous Thromboembolism Risk Factors in Women With Obesity Who Undergo Cesarean Delivery. Clin Appl Thromb Hemost 2024; 30:10760296241247203. [PMID: 38619922 PMCID: PMC11020749 DOI: 10.1177/10760296241247203] [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] [Received: 11/01/2023] [Revised: 03/27/2024] [Accepted: 03/29/2024] [Indexed: 04/17/2024] Open
Abstract
Venous thromboembolism (VTE) is a leading cause of maternal mortality. Obesity and cesarean delivery are established risk factors for pregnancy-related VTE. We identified additional risk factors among patients with obesity who underwent a cesarean delivery to identify those who need VTE prophylaxis. We conducted a secondary analysis of data from the Maternal-Fetal Medicine Units Network (MFMU) Cesarean Registry Database using a case-control design. Cases were identified as women with obesity having a pre-pregnancy body mass index of >30 kg/m2, who underwent cesarean delivery and subsequently developed deep venous thrombosis (DVT) or pulmonary embolism (PE). These women were compared to a control group of women with obesity who underwent cesarean delivery but did not develop DVT or PE. Analysis of risk factors associated with VTE was performed using Chi-Square test and Fisher's exact test. We identified 43 VTE cases and 172 controls in the MFMU database. Increased risk of VTE was noted in women with endometritis (OR of 4.58 [95% CI: 1.86-11.2, P = .0004]), receiving a blood transfusion (OR 17.07 [95% CI: 4.46-65.3, P = .0001]), having a coagulopathy (OR 27.73 [95% CI: 3.24-237.25, P = .0003]), and urinary tract infection (OR 2.39 [95% CI: 1.08-5.28, P = .03]). Important risk factors for VTE in women with obesity who undergo cesarean delivery include endometritis, intra- or post-operative transfusion, coagulopathy, and urinary tract infection. The presence of one or more of these factors may help guide provider decision-making regarding whether to administer thromboprophylaxis.
Collapse
Affiliation(s)
- Tolulope B. Fatokun
- Department of Obstetrics and Gynecology, Cumberland Regional Hospital, Somerset, KY, USA
| | - Sarah E. Swartz
- Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Ahmed Ebeid
- Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Sophia A. Cordes
- Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Alexis C. Gimovsky
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brown University, Providence, RI, USA
| | - Andrew D. Sparks
- Department of Biomedical Statistics, University of Vermont, Burlington, VT, USA
| | - Richard L. Amdur
- Department of Surgery, Medical Faculty Associate, Washington, DC, USA
| | - Homa K. Ahmadzia
- Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| |
Collapse
|
34
|
Yavuz S, Kıyak A, Sander S. Outcome of children with multicystic dysplastic kidney: Does involved side matter? Birth Defects Res 2024; 116:e2297. [PMID: 38158777 DOI: 10.1002/bdr2.2297] [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] [Received: 05/13/2023] [Revised: 09/26/2023] [Accepted: 12/12/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Multicystic dysplastic kidney (MCDK) is a common anomaly detected on antenatal ultrasound. We aimed to assess the profile of children with MCDK and to investigate whether the involved side has any effect on outcome. METHODS Thirty-nine patients with MCDK and 20 controls were enrolled. Patients who estimated glomerular filtration rate (eGFR) values over 90 mL/min/1.73 m2 were compared with controls. Comparison was made between the involved sides. RESULTS MKDB was right-sided in 20 (51.3%) and left-sided in 19 (48.7%) patients. 33.3% had additional urinary tract abnormality, 10.2% had systemic abnormality. 82% showed contralateral kidney enlargement. 48.7% involuted, 17.9% underwent nephrectomy. 35.8% suffered from urinary tract infection (UTI). 5.1% had renal scarring (RS). 30% developed microalbuminuria. 12.8% complicated with hypertension. 17.9% progressed to chronic kidney disease (CKD). Hypertension was independent risk factor for developing CKD. Blood pressure, cystatin C and urine microalbumin/creatinine levels were increased, and eGFR values were decreased in patients compared to controls. No significant difference was found between the two sides for rates of involution, UTI, RS, nephrectomy, and additional abnormality. Cystatin C levels were higher on the right than left sides (p = .033). CONCLUSION Children with MCDK predispose to renal deterioration even at normal eGFR values. Although cystatin C levels tended to increase in right-sided patients, the involved side seemed to have no significant effect on renal outcome. Hypertension was main determinant for progression to CKD in MCDK.
Collapse
Affiliation(s)
- Sevgi Yavuz
- Division of Pediatric Nephrology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Aysel Kıyak
- Division of Pediatric Nephrology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Serdar Sander
- Division of Pediatric Urology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
35
|
Radu VD, Vicoveanu P, Cărăuleanu A, Adam AM, Melinte-Popescu AS, Adam G, Onofrei P, Socolov D, Vasilache IA, Harabor A, Melinte-Popescu M, Scripcariu IS, Mihalceanu E, Stuparu-Cretu M, Harabor V. Pregnancy Outcomes in Patients with Urosepsis and Uncomplicated Urinary Tract Infections-A Retrospective Study. Medicina (Kaunas) 2023; 59:2129. [PMID: 38138232 PMCID: PMC10744995 DOI: 10.3390/medicina59122129] [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] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/26/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: Urinary tract infections (UTIs) are an important cause of perinatal and maternal morbidity and mortality. The aim of this study was to describe and compare the main pregnancy outcomes among pregnant patients with complicated and uncomplicated UTIs; Materials and Methods: This retrospective study included 183 pregnant patients who were evaluated for uncomplicated UTIs and urosepsis in the Urology Department of 'C.I. Parhon' University Hospital, and who were followed up at a tertiary maternity hospital-'Cuza-voda' from Romania between January 2014 and October 2023. The control group (183 patients) was randomly selected from the patient's cohort who gave birth in the same time frame at the maternity hospital without urinary pathology. Clinical and paraclinical data were examined. Descriptive statistics and a conditional logistic regression model were used to analyze our data. Results: Our results indicated that patients with urosepsis had increased risk of premature rupture of membranes (aOR: 5.59, 95%CI: 2.02-15.40, p < 0.001) and preterm birth (aOR: 2.47, 95%CI: 1.15-5.33, p = 0.02). We could not demonstrate a statistically significant association between intrauterine growth restriction and pre-eclampsia with the studied urological pathologies. Conclusions: Careful UTI screening during pregnancy is needed for preventing maternal-fetal complications.
Collapse
Affiliation(s)
- Viorel-Dragos Radu
- Urology Department, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania (P.O.)
| | - Petronela Vicoveanu
- Department of Mother and Child Care, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.S.); (I.S.S.); (E.M.)
| | - Alexandru Cărăuleanu
- Department of Mother and Child Care, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.S.); (I.S.S.); (E.M.)
| | - Ana-Maria Adam
- Clinical and Surgical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800216 Galati, Romania; (A.-M.A.); (A.H.)
| | - Alina-Sinziana Melinte-Popescu
- Department of Mother and Newborn Care, Faculty of Medicine and Biological Sciences, ‘Ștefan cel Mare’ University, 720229 Suceava, Romania;
| | - Gigi Adam
- Department of Pharmaceutical Sciences, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800216 Galati, Romania; (G.A.); (M.S.-C.)
| | - Pavel Onofrei
- Urology Department, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania (P.O.)
| | - Demetra Socolov
- Department of Mother and Child Care, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.S.); (I.S.S.); (E.M.)
| | - Ingrid-Andrada Vasilache
- Department of Mother and Child Care, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.S.); (I.S.S.); (E.M.)
| | - AnaMaria Harabor
- Clinical and Surgical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800216 Galati, Romania; (A.-M.A.); (A.H.)
| | - Marian Melinte-Popescu
- Department of Internal Medicine, Faculty of Medicine and Biological Sciences, ‘Ștefan cel Mare’ University, 720229 Suceava, Romania
| | - Ioana Sadiye Scripcariu
- Department of Mother and Child Care, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.S.); (I.S.S.); (E.M.)
| | - Elena Mihalceanu
- Department of Mother and Child Care, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.S.); (I.S.S.); (E.M.)
| | - Mariana Stuparu-Cretu
- Department of Pharmaceutical Sciences, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800216 Galati, Romania; (G.A.); (M.S.-C.)
| | - Valeriu Harabor
- Clinical and Surgical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800216 Galati, Romania; (A.-M.A.); (A.H.)
| |
Collapse
|
36
|
DeWitt-Foy ME, Albersheim J, Grove S, Hamid L, Berryman S, Freese R, Elliott SP. Impact of Virtual Care on Outpatient Urinary Tract Infection Management. Urology 2023; 182:40-47. [PMID: 37708981 DOI: 10.1016/j.urology.2023.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 08/17/2023] [Accepted: 08/23/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE To examine the effect of virtual care on urine testing, antibiotic prescription patterns, and outcomes of care in urinary tract infection (UTI) management. METHODS We conducted retrospective analysis of adults treated for UTI in an ambulatory setting across a large health system from March 2020-2021. Outcomes included urine testing, antibiotic prescription, and retreatment or hospitalization, stratified by in-person vs virtual visit. Multivariable logistic regression was performed to examine factors contributing to outcomes. RESULTS Significantly fewer patients seen virtually had urine testing as compared to those seen in-person (19% vs 69%, P <.001). On multivariable logistic regression analysis, virtual visit was the most significant predictor of urine testing, associated with an 86% reduction in the odds of urine testing (odds ratio (OR) 0.14, P <.001). Having a complicated UTI did not affect the likelihood of urine testing (OR 1.0, P = .95). Patients seen virtually were more likely to have a subsequent repeat ambulatory UTI visit (OR 1.16) or repeat antibiotic prescription (1.06) more than 2 weeks after the index encounter, though no more likely to be hospitalized for UTI (OR 1.00). CONCLUSION Virtual care for UTI is associated with a significant reduction in urine testing and an increase in repeat UTI encounters and additional antibiotics among patients with complicated and uncomplicated UTIs.
Collapse
Affiliation(s)
- Molly E DeWitt-Foy
- Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Department of Urology, Cleveland, OH.
| | | | - Shawn Grove
- University of Minnesota, Department of Urology, Minneapolis, MN
| | - Lina Hamid
- University of Minnesota, Infectious Diseases and Antimicrobial Stewardship Clinical Pharmacy, Minneapolis, MN
| | - Sally Berryman
- University of Minnesota, Department of Internal Medicine, Minneapolis, MN
| | - Rebecca Freese
- University of Minnesota Clinical and Translational Science Institute, Minneapolis, MN
| | - Sean P Elliott
- University of Minnesota, Department of Urology, Minneapolis, MN
| |
Collapse
|
37
|
Fasig K, Tyan K, Mason W, Zdziarski-Horodyski L, Baker A, Coombs J. Antibiotic prescribing practices for treating uncomplicated UTIs at a hospital ED. JAAPA 2023; 36:1. [PMID: 37989177 DOI: 10.1097/01.jaa.0000994960.35397.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Affiliation(s)
- Karina Fasig
- At the time this abstract was written, Karina Fasig, Kevin Tyan, Whitney Mason, and Laura Zdziarski-Horodyski were students in the PA program at the University of Utah in Salt Lake City. Alden Baker is a PA in the University of Utah Hospital ED. Jennifer Coombs is a professor and director of graduate studies in the PA program at the University of Utah. The authors have disclosed no potential conflicts of interest, financial or otherwise
| | | | | | | | | | | |
Collapse
|
38
|
Zhou G, Jiang M, Zhu W, Liu X, Sun J, Li S. Association of Renal Function (Estimate Glomerular Filtration Rate) with the Number of Febrile Urinary Tract Infections in Children with Neurogenic Bladder. Eur J Pediatr Surg 2023; 33:499-502. [PMID: 36720248 PMCID: PMC10732697 DOI: 10.1055/s-0043-1760823] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 11/29/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Our objective was to evaluate whether renal function, assessed as the estimated glomerular filtration rate (eGFR), is associated with the number of febrile urinary tract infections (FUTIs) in children diagnosed with neurogenic bladder (NB). MATERIALS AND METHODS Clinical information of patients diagnosed with NB was prospectively collected between January 2013 and January 2022. Episodes of FUTI were recorded during the follow-up period, and the eGFR was calculated based on the serum cystatin C level. Grading (G1-G5) of chronic kidney disease (CKD) was conducted as described by the eGFR. RESULTS In total, 463 children were included in the final analysis (265 males and 198 females; mean age: 23 months). The median follow-up time was 51 months. A total of 302 children had four or more FUTIs and 161 children had none to three FUTIs. The incidence of developing CKD G3 to G5 gradually increased from the first to third (1.3-2.4%) episodes of FUTI and drastically increased after four episodes (≥ 22.5%), with the incidence recorded to be 100% after eight FUTIs. The odds of CKD G3 to G5 in children with four FUTIs were 17.3 and 43.7 times greater after four and six FUTIs, respectively, than in children with one FUTI. CONCLUSION This study showed that recurrent FUTIs are common in children with NB and that the risk of rapid progression to CKD G3 to G5 increases substantially after four or more FUTIs episodes.
Collapse
Affiliation(s)
- Guanglun Zhou
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, China
| | - Man Jiang
- Department of Infectious Diseases, Department of Urology and Laboratory of Pelvic Floor Muscle Function, and Department of Clinical Laboratory, Shenzhen Children's Hospital, Shenzhen, China
| | - Wenbin Zhu
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, China
| | - Xiaodong Liu
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, China
| | - Junjie Sun
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, China
| | - Shoulin Li
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, China
| |
Collapse
|
39
|
Overland MR, Trandem K, Allen IE, Copp HL. Revisiting the utility of prenatal ultrasound in the routine workup of first febrile UTI: A systematic review and meta-analysis of the negative predictive value of prenatal ultrasound for identification of urinary tract abnormalities after first febrile urinary tract infection in children. J Pediatr Urol 2023; 19:754-765. [PMID: 37704528 DOI: 10.1016/j.jpurol.2023.08.020] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/06/2023] [Accepted: 08/17/2023] [Indexed: 09/15/2023]
Abstract
CONTEXT The current EAU/ESPU and recently retired AAP pediatric UTI guidelines recommend renal bladder ultrasound after first febrile UTI in children to screen for structural abnormalities, regardless of findings on prenatal ultrasound. OBJECTIVE Test the hypothesis that a normal prenatal ultrasound could rule out urinary tract abnormality on post-UTI ultrasound. DATA SOURCES Medline, Embase, Cochrane Library. STUDY SELECTION Studies including pediatric patients with first febrile UTI who had both prenatal and post-UTI ultrasound. DATA EXTRACTION Anatomical abnormalities detected by prenatal and post-UTI ultrasound as reported per individual study criteria were extracted. Meta-analyses of 9 studies (2981 patients) were performed using a random-effects model and composite estimates of the negative predictive value (NPV) of prenatal ultrasound were calculated. RESULTS Overall summary NPV of prenatal ultrasound for all pediatric patients was 77%, with heterogeneity score (I2) 97.9%. Summary NPV of prenatal ultrasound for all patients under two years of age was similar at 75%, with I2 98.2% For the 4 studies to which we could apply a more stringent definition of abnormality, summary NPV was 85% and I2 97.5% for prediction of moderate post-UTI ultrasound abnormalities and summary NPV was 93% and I2 90.4% for severe abnormalities. DISCUSSION While we calculated an 85% NPV for a normal prenatal ultrasound to rule out significant postnatal abnormality as defined within individual studies, substantial heterogeneity amongst publications limited the precision of our estimates. This highlights the need for more rigorous investigations with attention to timing of ultrasound and the application of clinically meaningful definitions for abnormal prenatal and post-UTI studies. This may allow judicious use of prenatal ultrasound to guide clinical management for children with first febrile UTI and minimize redundant imaging with potential for false positive results. Until then, the current guidelines are justified based on the limited and heterogenous data from the currently available published studies.
Collapse
Affiliation(s)
- Maya R Overland
- Department of Urology, University of California San Francisco, United States
| | - Kathryn Trandem
- Department of Urology, University of California San Francisco, United States
| | - Isabel Elaine Allen
- Department of Epidemiology and Biostatistics, University of California San Francisco, United States
| | - Hillary L Copp
- Department of Urology, University of California San Francisco, United States.
| |
Collapse
|
40
|
Batie SF, Ashbrook CQ, Coco CT, Baker LA, Stanasel I. Urologic manifestations of hypotonia, ataxia, and delayed development syndrome (HADDS), a rare neurodevelopmental disorder. J Pediatr Urol 2023; 19:751.e1-751.e9. [PMID: 37718233 DOI: 10.1016/j.jpurol.2023.08.023] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/14/2023] [Accepted: 08/19/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Early B-cell factor 3 (EBF3) is a transcription factor involved in neuronal differentiation and maturation. Pathogenic variants are associated with hypotonia, ataxia, and delayed development syndrome (HADDS) (MIM#617330). Urologic manifestations are common and may have implications regarding long term renal function. OBJECTIVE To review all known patients with pathogenic variants of the EBF3 gene resulting in HADDS with urologic manifestations. We hypothesize a high rate of bladder dysfunction secondary to the EBF3 variant's impact on relaxation of the urinary sphincter leading to detrusor sphincter dyssynergia (DSD). METHODS The PubMed database was queried for publications of the EBF3 mutation between January 2017 and January 2023. Search terms were "EBF3 mutation OR HADDS AND urology OR phenotype". Retrospective analysis of HADDS patients cared for in our institution was performed. Demographic and clinical information was collected. RESULTS We identified 52 patients (33F:19M) through literature (28F:18M) and retrospective review (5F:1M). There was a high prevalence of genitourinary physical exam abnormalities, history of urinary tract infection, vesicoureteral reflux (VUR), and diagnosis of neurogenic bladder. Within the literature review cohort, 67% had a urologic diagnosis. Females were disproportionately affected with urologic manifestations. In our cohort, four of six children were diagnosed with VUR and severe voiding dysfunction consistent with neurogenic bladder (67%). These children were managed with a vesicostomy. Five children had bowel dysfunction requiring therapy. Urodynamics suggested a high prevalence of external sphincter dyssynergia. Less severe forms of DSD were felt to be implicated in the abnormal voiding parameters in children who presented later in life based on non-invasive flow studies. DISCUSSION There is significant variability in the phenotypic presentation of patients with HADDS. While EBF3 plays a clear role in neurodevelopment, it also impacts muscle development and may impact muscle relaxation. The location of the genetic variant may impact the degree of DSD, with more severe forms leading to earlier presentations. Initial work-up should include a renal ultrasound (RUS) and post void residual (PVR). Consideration can be given to obtaining a VCUG, DMSA scan or urodynamic studies. Yearly screening should be pursued with an RUS and PVR in those with an initial unremarkable work-up given the variable timing and severity of presentation. CONCLUSION Urologic manifestations of HADDS include high rates of bladder dysfunction secondary to DSD, vesicoureteral reflux, urinary tract infection, and cryptorchidism. These patients are at risk of renal deterioration if urinary abnormalities are not properly diagnosed and managed.
Collapse
Affiliation(s)
- Shane F Batie
- Division of Pediatric Urology, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Caleb Q Ashbrook
- Division of Pediatric Urology, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Caitlin T Coco
- Division of Pediatric Urology, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Linda A Baker
- Division of Pediatric Urology, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA; Nationwide Children's Hospital, Columbus, OH, USA
| | - Irina Stanasel
- Division of Pediatric Urology, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
41
|
Izumi N, Kitta T, Mitsui T. Importance of Regular Examination and Follow-up in Pediatric Patients with Neurogenic Bladder: 24-Month Follow-up Study Using a Japanese Health Insurance Database. Adv Ther 2023; 40:5519-5535. [PMID: 37843724 PMCID: PMC10611833 DOI: 10.1007/s12325-023-02692-x] [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: 08/01/2023] [Accepted: 09/19/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION Data on the long-term management of neurogenic bladder (NGB) are scarce. We evaluated the current status of NGB management in Japanese children over 24-month follow-up using the JMDC database. METHODS In this descriptive, observational, retrospective cohort study, patients (≤ 17 years) with NGB were included. Patient characteristics and their management status were investigated. A multivariate analysis evaluating the potential risk factors for the development of urinary tract infection (UTI) was performed. The diagnosis of spina bifida, demographics, baseline comorbidities, and early use of clean intermittent catheterization (CIC) and/or overactive bladder (OAB) drugs were used as independent variables. RESULTS Of 883 eligible children, 39.3% had spina bifida. Over 12/24-month post-index periods, renal urinary tract ultrasound and urinalysis were performed at least once in > 35%/> 45% patients, respectively, while specific tests (urodynamics, cystourethrography, scintigraphy) were performed in substantially fewer (< 11%/< 13%) patients. Over 24 months, 21.5% patients used OAB medications (mostly anticholinergics) and 10.8% underwent CIC, alone or with medications; 1.2% patients underwent surgery. Lower UTI (23.3%), urinary incontinence (9.7%), and hydronephrosis (7.0%) were the most common incident complications. Multivariate analysis evaluating risk factors for UTI showed significantly higher odds ratios with point estimates of ≥ 2 for CIC (5.70), presence of spina bifida (2.86), and constipation (2.07). Overall, urodynamic assessments were inadequately performed. CONCLUSION Patients with use of CIC and/or having spina bifida and constipation had a higher risk of UTI, suggesting the need for careful follow-up. More guideline-compliant and diligent patient management is necessary in Japanese children with NGB.
Collapse
Affiliation(s)
- Naoko Izumi
- Internal Medicine and Hospital Medical Affairs, Pfizer Japan, Inc., 3-22-7 Yoyogi, Shibuya-ku, Tokyo, 151-8589, Japan.
| | - Takeya Kitta
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, 078-8510, Japan
| | - Takahiko Mitsui
- Department of Urology, University of Yamanashi Graduate School of Medical Sciences, Chuo, 409-3898, Japan
| |
Collapse
|
42
|
Haq K, Ghaly M, Pelland KT, Dogbey P. Malakoplakia presenting with urinary tract infection, acute kidney injury, and bilateral renal enlargement in an immunocompetent patient. J Nephrol 2023; 36:2641-2643. [PMID: 37924475 DOI: 10.1007/s40620-023-01796-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/26/2023] [Indexed: 11/06/2023]
Affiliation(s)
- Kanza Haq
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Medhat Ghaly
- Yale University School of Medicine, New Haven, CT, USA.
- Department of Medicine, Waterbury Hospital, Waterbury, CT, USA.
| | - Kevin T Pelland
- Department of Pathology, Waterbury Hospital, Waterbury, CT, USA
| | - Pia Dogbey
- Yale University School of Medicine, New Haven, CT, USA
- Department of Medicine, Waterbury Hospital, Waterbury, CT, USA
| |
Collapse
|
43
|
Li Y, Stern N, Wang PZ, Braga LH, Dave S. Systematic review and meta-analysis to study the outcomes of proactive versus delayed management in children with a congenital neurogenic bladder. J Pediatr Urol 2023; 19:730-741. [PMID: 37726188 DOI: 10.1016/j.jpurol.2023.08.033] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 08/22/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE To review the urological outcomes of proactive versus delayed management of children with a neurogenic bladder (NB). METHODS We performed a literature search on EMBASE, MEDLINE, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials between January 1, 2000 to August 21, 2023 for studies investigating the management of spina bifida-associated NB in pediatric patients (0-18 years of age). Proactive management was defined as use of clean intermittent catheterization, and/or anticholinergics at presentation, or based on initial high-risk urodynamic findings by 1 year of age. Delayed management was defined as beginning management after 1 year of age or no intervention. Outcomes included incidence or diagnosis of secondary vesicoureteral reflux (VUR), urinary tract infection (UTI), and renal deterioration, which included renal scarring, loss of differential renal function on a nuclear scan, or a decrease in renal function defined by glomerular filtration rate or serum creatinine estimation. Forest plots were synthesized using the Inverse Variance method with random-effect model. The Risk of Bias was assessed using the ROBINS-I tool. RESULTS We included 8 observational studies on 652 pediatric patients with spina bifida-associated NB (mean follow-up - 7 years). Proactive management following initial assessment was associated with significantly lower risks of secondary VUR (OR 0.37 [0.19, 0.74], p = 0.004), non-febrile UTI (OR 0.35 [0.19, 0.62], p = 0.0004), and renal deterioration (OR 0.31 [0.20, 0.47], p < 0.00001). DISCUSSION Delayed management of NB potentially has 3 times higher risks of secondary VUR, non-febrile UTI, and renal deterioration. However, the evidence is limited by the high risk of bias due to lack of randomization and standardized reporting in observational studies. CONCLUSION While further well-defined prospective studies with long-term follow-up should be conducted to confirm this finding, this study supports the EAU/ESPU recommendations for early intervention in children with NB.
Collapse
Affiliation(s)
- Yilong Li
- Western University Schulich School of Medicine and Dentistry, London ON, N6A 5C1, Canada.
| | - Noah Stern
- Western University Schulich School of Medicine and Dentistry, Division of Urology, London ON, N6A 5W9, Canada.
| | - Peter Zhantao Wang
- Western University Schulich School of Medicine and Dentistry, Department of Surgery and Pediatrics, Division of Urology, London ON, N6A 5W9, Canada.
| | - Luis H Braga
- McMaster University Michael G. DeGroote School of Medicine, Department of Surgery, Division of Urology, Hamilton ON, L8N 3Z5, Canada.
| | - Sumit Dave
- Western University Schulich School of Medicine and Dentistry, Department of Surgery and Pediatrics, Division of Urology, London ON, N6A 5W9, Canada.
| |
Collapse
|
44
|
Curelaru S, Samuel N, Chayen G, Jacob R. Outcomes of Infants Who Are Febrile Aged 29-90 Days Discharged from the Emergency Department. J Pediatr 2023; 263:113714. [PMID: 37659589 DOI: 10.1016/j.jpeds.2023.113714] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/22/2023] [Accepted: 08/29/2023] [Indexed: 09/04/2023]
Abstract
OBJECTIVE To evaluate the characteristics and outcomes of infants aged 29-90 days who are febrile discharged from the pediatric emergency department (ED). STUDY DESIGN This was a multicenter, retrospective cohort study of infants aged 29-90 days who visited any of the 7 Clalit Health Services pediatric EDs in Israel between January 1, 2019, and March 31, 2022. Infants who were febrile discharged from the ED after having blood and urine cultures taken were included. The primary outcome measure was the incidence of return visit (RV) to an ED. Secondary outcome measures were the incidence of invasive bacterial infection, urinary tract infection, pediatric intensive care unit admissions, and deaths. We assessed variables associated with the primary outcomes. RESULTS A total of 1647 infants were included. Their median (IQR) age at ED visit was 58.5 (47.7, 72.7) days, 53.1% were male. A total of 329 patients (20%) returned to the ED within 120 hours. Overall, 7.8% of discharged infants had a positive urine culture, 4 (0.2%) had a positive blood culture, and none had meningitis. One patient was admitted to the pediatric intensive care unit, and there was no death. Abnormal C-reactive protein was associated with RV among 61- to 90-day-old infants. CONCLUSIONS Infants aged 29-90 days who were febrile and discharged following a protocol-driven pathway from the pediatric ED had a relatively high RV rate. However, the rate of urinary tract infection was relatively low, and rate of invasive bacterial infection was extremely low. There were no deaths or serious sequelae.
Collapse
Affiliation(s)
- Shiri Curelaru
- Pediatric Department, Ha'Emek Medical Center, Afula, Israel
| | - Nir Samuel
- Emergency Department, Schneider Children's Medical Center, Petakh Tikva, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gilad Chayen
- Pediatric Emergency Department, Ha'Emek Medical Center, Afula, Israel
| | - Ron Jacob
- Pediatric Emergency Department, Ha'Emek Medical Center, Afula, Israel; Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel.
| |
Collapse
|
45
|
Gkiourtzis N, Glava A, Moutafi M, Vasileiadou T, Delaporta T, Michou P, Printza N, Makedou K, Tramma D. The efficacy and safety of corticosteroids in pediatric kidney scar prevention after urinary tract infection: a systematic review and meta-analysis of randomized clinical trials. Pediatr Nephrol 2023; 38:3937-3945. [PMID: 36943468 PMCID: PMC10584697 DOI: 10.1007/s00467-023-05922-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Acute pyelonephritis (APN) in pediatric patients may lead to kidney scarring and is one of the main causes of permanent kidney damage. The incidence of kidney scarring after one febrile urinary tract infection (UTI) is reported to range from 2.8 to 15%, with the percentage rising to 28.6% after ≥ 3 febrile UTIs. Corticosteroids may have a role in the reduction of kidney scar formation and urine cytokine levels. The possible benefit of adjuvant corticosteroid administration in the reduction of kidney scar formation in children with APN has been recently examined in randomized controlled trials (RCTs). OBJECTIVES The aim of this meta-analysis was to provide a summary of the current literature about the efficacy and safety of adjuvant corticosteroid administration in the reduction of kidney scar formation in children with APN. DATA SOURCES An extensive literature search through major databases (PubMed/MEDLINE and Scopus) was carried out for RCTs from inception until October 12, 2022, investigating the efficacy and safety of adjuvant corticosteroids in preventing kidney scarring in children with APN. A risk ratio with 95% CI was used for dichotomous outcomes. RESULTS In total, 5 RCTs with 918 pediatric patients with APN were included in the study. Adjuvant corticosteroid treatment revealed a statistically significant reduction in kidney scarring (95% CI 0.42-0.95, p = 0.03), without increasing the risk of adverse events like bacteremia, prolonged hospitalization, or recurrence of UTI. LIMITATIONS There were limitations regarding sample size (n = 498 children), different classes of corticosteroids (methylprednisolone or dexamethasone), different routes of corticosteroid administration (intravenous or oral), and different day courses (3-day or 4-day course). CONCLUSIONS Adjuvant corticosteroid administration seems to have a beneficial effect on kidney scar reduction in children with APN. Future studies should focus on the evaluation of the efficacy and safety of corticosteroids in kidney scarring reduction after APN to strengthen the results of our study. A higher resolution version of the Graphical abstract is available as Supplementary information.
Collapse
Affiliation(s)
- Nikolaos Gkiourtzis
- 4th Department of Pediatrics, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Agni Glava
- 4th Department of Pediatrics, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Moutafi
- 4th Department of Pediatrics, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theopisti Vasileiadou
- 4th Department of Pediatrics, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodora Delaporta
- 4th Department of Pediatrics, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiota Michou
- Pediatric Department, G. Gennimatas General Hospital, Thessaloniki, Greece
| | - Nikoleta Printza
- 1st Department of Pediatrics, Ippokrateio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kali Makedou
- Laboratory of Biochemistry, School of Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Despoina Tramma
- 4th Department of Pediatrics, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
46
|
Hewitt IK, Roebuck DJ, Montini G. Conflicting views of physicians and surgeons concerning pediatric urinary tract infection: a comparative review. Pediatr Radiol 2023; 53:2651-2661. [PMID: 37776490 PMCID: PMC10698093 DOI: 10.1007/s00247-023-05771-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND A first febrile urinary tract infection (UTI) is a common condition in children, and pathways of management have evolved over time. OBJECTIVE To determine the extent to which pediatricians and surgeons differ in their investigation and management of a first febrile UTI, and to evaluate the justifications for any divergence of approach. MATERIALS AND METHODS A literature search was conducted for papers addressing investigation and/or management following a first febrile UTI in children published between 2011 and 2021. Searches were conducted on Medline, Embase, and the Cochrane Controlled Trials Register. To be eligible for inclusion, a paper was required to provide recommendations on one or more of the following: ultrasound (US) and voiding cystourethrogram (VCUG), the need for continuous antibiotic prophylaxis and surgery when vesicoureteral reflux (VUR) was detected. The authorship required at least one pediatrician or surgeon. Authorship was categorized as medical, surgical, or combined. RESULTS Pediatricians advocated less imaging and intervention and were more inclined to adopt a "watchful-waiting" approach, confident that any significant abnormality, grades IV-V VUR in particular, should be detected following a second febrile UTI. In contrast, surgeons were more likely to recommend imaging to detect VUR (p<0.00001), and antibiotic prophylaxis (p<0.001) and/or surgical correction (p=0.004) if it was detected, concerned that any delay in diagnosis and treatment could place the child at risk of kidney damage. Papers with combined authorship displayed intermediate results. CONCLUSION There are two distinct directions in the literature regarding the investigation of an uncomplicated first febrile UTI in a child. In general, when presented with a first febrile UTI in a child, physicians recommend fewer investigations and less treatment, in contrast to surgeons who advocate extensive investigation and aggressive intervention in the event that imaging detects an abnormality. This has the potential to confuse the carers of affected children.
Collapse
Affiliation(s)
- Ian K Hewitt
- Department of Pediatric Nephrology, Perth Children's Hospital, Nedlands, 6009, Australia
| | - Derek J Roebuck
- Division of Pediatrics, Medical School, University of Western Australia, Crawley, 6009, Australia.
- Department of Medical Imaging, Perth Children's Hospital, Nedlands, 6009, Australia.
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione Ca' Granda IRCCS, Policlinico di Milano, Milan, Italy
- Giuliana and Bernardo Caprotti Chair of Pediatrics, Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| |
Collapse
|
47
|
Alonso-Cadenas JA, Sancosmed Ron M, Herrero B, Lera Carballo E, Lassaletta A, Rodrigo R, de la Torre M. Role of urine culture in paediatric patients with cancer with fever and neutropenia: a prospective observational study. Arch Dis Child 2023; 108:982-986. [PMID: 37553208 DOI: 10.1136/archdischild-2023-325992] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/26/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE To evaluate the need for routine urine studies in children with febrile neutropenia with cancer. DESIGN A prospective, observational study was conducted in two hospitals between November 2019 and October 2021. PATIENTS We recruited 205 patients in total. MAIN OUTCOME MEASURES The primary outcome was presence of positive urine culture (UC). Urinary tract infection (UTI) was defined as urinary signs/symptoms and positive UC with or without pyuria. A descriptive analysis of data is provided.We conducted a prospective study of paediatric patients with cancer with urinary continence. Data were analysed using descriptive statistics. The diagnostic performance of urinalysis was calculated using positive UC as the gold standard. RESULTS Positive UC was found in 7 of the 205 patients (3.4%; 95% CI 1.4% to 6.9%), 2 presenting urinary symptoms. UTI prevalence was 1.0% (95% CI 0.1% to 3.5%). A 23.8% prevalence of positive UC was found in patients with urinary symptoms and/or history of urinary tract disease (95% CI 8.2% to 47.2%) as compared with 1.1% of those without symptoms or history (95% CI 0.1% to 3.9%) (p<0.001). The sensitivity, specificity, negative predictive value, and area under the curve for urinalysis were 16.7% (95% CI 3.0% to 56.4%), 98.4% (95% CI 95.3% to 99.4%), 97.3% (95% CI 93.9% to 98.9%), and 0.65 (95% CI 0.51 to 0.79), respectively. CONCLUSIONS UTI is an infrequent cause of infection in these patients. Urinalysis is indicated only in children with febrile neutropenia with urinary signs/symptoms and in asymptomatic patients with a history of urinary tract disease or unknown history. When urine is collected, UC should be requested regardless of the result of the urinalysis.
Collapse
Affiliation(s)
- Jose Antonio Alonso-Cadenas
- Pediatric Emergency Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital La Princesa, Madrid, Spain
| | | | - Blanca Herrero
- Paediatric Oncology Department, Hospital Universitario Niño Jesús, Madrid, Spain
| | | | - Alvaro Lassaletta
- Pediatric Neuro-oncology Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Rocio Rodrigo
- Paediatric Emergency Medicine, Hospital Vall d'Hebron, Barcelona, Spain
| | - Mercedes de la Torre
- Pediatric Emergency Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital La Princesa, Madrid, Spain
| |
Collapse
|
48
|
Liao S, Xu X, Yuan Y, Tang K, Wei G, Lu Z, Xiong L. A comparative study of flexible ureteroscopic lithotripsy for upper urinary tract stones in patients with prior urosepsis following emergency drainage via retrograde ureteral stent or percutaneous nephrostomy. BMC Urol 2023; 23:196. [PMID: 38017464 PMCID: PMC10685477 DOI: 10.1186/s12894-023-01369-5] [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] [Received: 08/04/2023] [Accepted: 11/14/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Patients with urosepsis associated with upper urinary tract stones require further stone management after emergency drainage. OBJECTIVE To evaluate the safety and efficacy of elective flexible ureteroscopic lithotripsy (F-URSL) for upper urinary tract stones in patients with prior urosepsis who have undergone emergency drainage using retrograde ureteral stent(RUS) or percutaneous nephrostomy (PCN). METHOD Between January 2017 and December 2021, clinical data were collected for 102 patients who underwent elective F-URSL following emergency drainage for urosepsis caused by upper ureteral or renal stones. The patients were categorized into two groups based on the drainage method used: the RUS group and the PCN group. The collected data included patient demographics, stone parameters, infection recovery after emergency drainage, and clinical outcomes post F-URSL. Subsequently, the data underwent statistical analysis. RESULTS A total of 102 patients were included in the statistical analysis, with 58 (56.86%) in the RUS group and 44 (43.14%) in the PCN group. Among the patients, 84 (82.35%) were female and 18 (17.65%) were male, with an average age of 59.36 years. Positive urine cultures were observed in 71 (69.61%) patients. Successful drainage was achieved in all patients in both groups, and there were no significant differences in the time required for normalization of white blood cell count (WBC) and body temperature following drainage. Additionally, all patients underwent F-URSL successfully, and no statistically significant differences were observed between the two groups in terms of operative time, stone-free rates, postoperative fever, and postoperative hospital stay. CONCLUSION Both RUS and PCN have been established as effective approaches for managing urosepsis caused by upper urinary tract stones. Furthermore, the impact of these two drainage methods on the subsequent management of stones through elective F-URSL has shown consistent outcomes.
Collapse
Affiliation(s)
- Sucai Liao
- Department of Urology, The University of Hong Kong-Shenzhen Hospital, 1 Haiyuan First Road, Futian District, Shenzhen, Guangdong, 518053, China
| | - Xiang Xu
- Department of Urology, The University of Hong Kong-Shenzhen Hospital, 1 Haiyuan First Road, Futian District, Shenzhen, Guangdong, 518053, China
| | - Yuan Yuan
- Department of Urology, The University of Hong Kong-Shenzhen Hospital, 1 Haiyuan First Road, Futian District, Shenzhen, Guangdong, 518053, China
| | - Keiyui Tang
- Department of General Surgery, University Hospitals Plymouth NHS Trust, Derriford Hospital, Plymouth, UK
| | - Genggeng Wei
- Department of Urology, The University of Hong Kong-Shenzhen Hospital, 1 Haiyuan First Road, Futian District, Shenzhen, Guangdong, 518053, China
| | - Zhengquan Lu
- Department of Urology, The University of Hong Kong-Shenzhen Hospital, 1 Haiyuan First Road, Futian District, Shenzhen, Guangdong, 518053, China
| | - Lin Xiong
- Department of Urology, The University of Hong Kong-Shenzhen Hospital, 1 Haiyuan First Road, Futian District, Shenzhen, Guangdong, 518053, China.
| |
Collapse
|
49
|
Anan G, Kikuchi D, Omae K, Hirose T, Okada K, Mori T. Sodium-glucose cotransporter-2 inhibitors increase urinary tract infections?-a cross sectional analysis of a nationwide Japanese claims database. Endocr J 2023; 70:1103-1107. [PMID: 37673640 DOI: 10.1507/endocrj.ej23-0317] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
Sodium-glucose cotransporter-2 (SGLT2) inhibitors are a novel class of antidiabetic drugs. Guidelines for the proper use of SGLT2 inhibitors recommend caution regarding urinary tract infections (UTIs). However, little evidence has been reported on the relationship between SGLT2 inhibitors and UTIs in large epidemiological studies. We investigated (1) the relationship between diabetes mellitus (DM) and UTIs and (2) the relationship between SGLT2 inhibitor prescriptions and the likelihood of developing UTIs in patients with DM, using a nationwide Japanese health insurance claims database by MDV analyzer®. We found that the incidence of UTIs was significantly higher among patients with DM than among those without DM (odds ratio (OR), 1.71; 95% confidence interval (CI), 1.69-1.72, for male; OR, 1.90; 95% CI, 1.89-1.92 for female). In contrast, in male patients with DM, the prescription of SGLT2 inhibitors was negatively associated with the likelihood of developing UTIs (OR, 0.74; 95% CI, 0.72-0.75). Among female patients with DM, there was no significant difference in the incidence of UTIs with or without an SGLT2 inhibitor prescription (OR, 0.99; 95% CI, 0.96-1.01). Subgroup analyses by age confirmed similar relationships between SGLT2 inhibitor prescriptions and UTIs, except for female patients aged ≤39 years, in whom SGLT2 inhibitor prescription was negatively associated with the likelihood of developing UTIs. In conclusion, our analysis of a nationwide claims database found no evidence that SGLT2 inhibitors increase UTIs in Japanese patients with DM, regardless of sex or age.
Collapse
Affiliation(s)
- Go Anan
- Department of Urology, Yotsuya Medical Cube, Tokyo 102-0084, Japan
- Tohoku Medical and Pharmaceutical University, Faculty of Medicine, Sendai 983-8536, Japan
| | - Daisuke Kikuchi
- Department of Pharmacy, Tohoku Medical and Pharmaceutical University Hospital, Sendai 983-8512, Japan
| | - Kenji Omae
- Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukushima 960-1295, Japan
| | - Takuo Hirose
- Division of Nephrology and Endocrinology, Tohoku Medical and Pharmaceutical University, Sendai 983-8536, Japan
- Department of Endocrinology and Applied Medical Science, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
| | - Kouji Okada
- Department of Pharmacy, Tohoku Medical and Pharmaceutical University Hospital, Sendai 983-8512, Japan
- Division of Clinical Pharmaceutics and Pharmacy Practice, Tohoku Medical and Pharmaceutical University, Sendai 981-8558, Japan
| | - Takefumi Mori
- Division of Nephrology and Endocrinology, Tohoku Medical and Pharmaceutical University, Sendai 983-8536, Japan
| |
Collapse
|
50
|
Ren C, Li Z, Meng F, Du Y, Sun H, Guo B. Endogenous endophthalmitis caused by urinary tract infection: A case report. Medicine (Baltimore) 2023; 102:e36139. [PMID: 37986372 PMCID: PMC10659675 DOI: 10.1097/md.0000000000036139] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/25/2023] [Indexed: 11/22/2023] Open
Abstract
RATIONALE Endogenous endophthalmitis is a vision-threatening intraocular infection caused by hematogenous spread of infectious organisms from distant sites. PATIENT CONCERNS A 71-year-old man with a history of fever and dysuria 5 days prior to presentation presented with sudden loss of vision in his left eye. The patient had no history of ocular surgery or trauma, and ocular examination revealed a large amount of exudative plaque covering the pupil. Therefore, fundus examination was not feasible. B-scan ultrasonography revealed a dome-shaped subretinal mass with an exudative retinal detachment. DIAGNOSIS Endogenous endophthalmitis was diagnosed on the basis of these findings. INTERVENTIONS The patient underwent pars plana vitrectomy and the early postoperative course was favorable. OUTCOMES Vitreous cultures grew gram-negative bacilli, identified as Klebsiella pneumonia. Urinalysis revealed white blood cells (++) and urinary tract infection was the only identifiable risk factor for endogenous endophthalmitis. LESSONS Urinary tract infection is an independent risk factor for endogenous endophthalmitis.
Collapse
Affiliation(s)
- Cong Ren
- Shandong University of Traditional Chinese Medicine, Jinan, China
- Eye Hospital Affiliated to Shandong University of Traditional Chinese Medicine, Jinan, China
- Shandong Academy of Eye Disease Prevention and Therapy/Shandong Provincial Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Eye Disease, Jinan, China
| | - Zhongen Li
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Fan Meng
- Shandong University of Traditional Chinese Medicine, Jinan, China
- Department of Ophthalmology, The Fourth Affiliated Hospital of China Medical University, Eye Hospital of China Medical University, Shenyang, China
| | - Yongle Du
- Shandong University of Traditional Chinese Medicine, Jinan, China
- Eye Hospital Affiliated to Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Hao Sun
- Shandong University of Traditional Chinese Medicine, Jinan, China
- Lanling People’s Hospital of Linyi City, Linyi, China
| | - Bin Guo
- Shandong University of Traditional Chinese Medicine, Jinan, China
- Eye Hospital Affiliated to Shandong University of Traditional Chinese Medicine, Jinan, China
- Shandong Academy of Eye Disease Prevention and Therapy/Shandong Provincial Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Eye Disease, Jinan, China
- Postdoctoral Station of Shandong University of Traditional Chinese Medicine, Jinan, China
| |
Collapse
|