Daily meatal care for prevention of catheter-associated bacteriuria: results using frequent applications of polyantibiotic cream

OBJECTIVE: To determine the efficacy of meatal treatment with a polyantibiotic cream in the prevention of bacteriuria during transurethral bladder catheterization. DESIGN: Randomized controlled trial. SETTING: Community teaching hospital. PATIENTS: Adult patients who underwent closed urinary catheter drainage for short and intermediate durations (two to 30 days). INTERVENTION: Polyantibiotic cream containing polymyxin B sulfate, neomycin sulfate, and gramicidin was applied to the urethral meatus-catheter interface three times daily from the first day of catheterization until bacteriuria was found. The onset of bacteriuria was defined as the day the colonizing species first achieved a colony count of greater than or equal to 1000 colonies/ml. Patients randomized to the control group received routine meatal care with cleansing of the meatal surface during daily bathing. RESULTS: Among 2,923 patients who were randomly allocated to receive either the protocol meatal care or routine care, the evaluable study population consisted of 747 patients who were nonbacteriuric and who remained catheterized for more than two days. Overall, 26 (6.8%) of 383 patients given the polyantibiotic treatment acquired bacteriuria, as compared to 37 (10.1%) of 364 patients not given this treatment (p = .167). A Cox proportional hazards regression analysis showed that, among putative risk factors including lack of meatal care, only female gender, a meatal swab culture yielding gram-negative rods or enterococci, and lack of antibiotic use during catheterization were independently associated with the development of bacteriuria. CONCLUSIONS: The adverse effect of meatal care noted in earlier studies of a disinfectant ointment applied twice daily was not found in this study of an antimicrobial preparation in a cream vehicle applied three times daily. However, the results do not support meatal care as an efficacious method to prevent catheter-associated bacteriuria in all patients.     

气囊尿管外固定囊对预防男性导尿患者泌尿道感染的临床研究

目的探讨气囊尿管外固定囊对减少男性留置导尿患者泌尿道感染的作用。方法将肿瘤内科男性导尿患者按导尿先后顺序随机分为观察组（100例）和对照组（100例）。对照组患者导尿成功后只应用导尿管的气囊进行导尿管膀胱内固定，不行尿管外固定；观察组患者在使用导尿管气囊进行膀胱内固定的同时，再应用气囊尿管外固定囊进行导尿管外固定，观察并比较两组患者留置尿管后第3、5、7天泌尿道感染发生情况。结果留置尿管后第3、5、7天，观察组患者的无症状菌尿症和泌尿道感染发生率分别为1.00%、0.00%，4.00%、2.00%，9.00%、3.00%；而对照组无症状菌尿症和泌尿道感染发生率分别为7.00%、3.00%，13.00%、7.00%，21.00%、13.00%，观察组的无症状菌尿症和泌尿道感染发生率均显著低于对照组（均P＜0.01）。结论气囊尿管外固定囊用于男性留置导尿患者，可以避免导尿管移动，有效降低泌尿道感染的发生，值得临床推广。     

Could the incidence of postoperative urinary tract infection be reduced by reversing the sequence of vaginal cleansing and urethral catheterization?

Postoperative urinary tract infection (UTI) is a common hospital infection after gynaecological operations. A prospective randomized study was performed to examine whether the incidence of UTI could be reduced by reversing the sequence of vaginal cleansing and urethral catheterization. Subjects were randomly allocated to: (1) urethral catheterization before vaginal cleansing; and (2) urethral catheterization after vaginal cleansing. Urine cultures were performed immediately after the procedures as the baseline, on the day of catheter removal, and two days after catheter removal. Patients were examined daily after the operation for any urinary symptoms and fever. The incidences of preoperative asymptomatic bacteriuria were similar in both groups, seven of 84 in group 1 vs. eight of 83 in group 2. Among those with negative urine culture before the operation, 77 in group 1 and 75 in group 2, there was no significant difference in postoperative bacteriuria at catheter removal (23 vs. 22) and two days later (35 vs. 42). No significant difference was noted in the incidence of UTI (5 vs. 10, P = 0.25), with a trend towards less UTI in group 1. Voiding discomfort was more common, and fever less common in group 1. There were significant associations between urine culture results at three different occasions. Bacteriuria at catheter removal is associated with a 7.2 times risk of bacteriuria two days later, 2.4 times risk of urinary symptoms and 3.2 times risk of UTI. Routine surveillance at catheter removal is not cost-effective.We conclude that postoperative bacteriuria and UTI are common. Reversing the sequence of the procedures cannot reduce the incidence. There is no evidence to change the status quo.     

留置导尿管患者尿路感染的相关危险因素分析与护理措施探讨

目的探讨留置导尿管相关尿路感染（UTI）的危险因素分析及最佳护理措施。方法入选我院留置尿管患者100例,对中段尿（或膀胱尿）及尿道口处尿进行不同时段的采样及细菌培养,分析出现菌尿症的情况。结果留置导尿管期间,出现菌尿症67例,发生率为67％。导尿管不同留置时间UTI发生率差异有统计学意义（P〈0．05）。结论高龄、留置尿管时间过长是发生UTI的高危因素．规范留置导尿管管理、尽量缩短留置尿管时间、严格遵守无菌操作原则是留置导尿管相关尿路感染的重要护理及预防措施。     

UTI patients have pre-existing antigen-specific antibody titers against UTI vaccine antigens

Urinary tract infection (UTI) is most frequently caused by uropathogenic Escherichia coli (UPEC). Our laboratory has been developing an experimental vaccine targeting four UPEC outer membrane receptors involved in iron acquisition – IreA, FyuA, IutA, and Hma – to elicit protection against UTI. These vaccine targets are all expressed in humans during UTI. In the murine model, high titers of antigen-specific serum IgG or bladder IgA correlate with protection against transurethral challenge with UPEC. Our aim was to measure levels of pre-existing serum antibodies to UTI vaccine antigens in our target population. To accomplish this, we obtained sera from 64 consenting female patients attending a clinic for symptoms of cystitis. As a control, we also collected sera from 20 healthy adult male donors with no history of UTI. Total IgG and antigen-specific IgG titers were measured by ELISA. Of the 64 female patients, 29 had significant bacteriuria (>10⁴ cfu/ml urine) and uropathogenic E. coli (UPEC). Thirty-five patients had non-significant bacteriuria (<10⁴ cfu/ml). Antigen-specific IgG titers did not correlate with the presence or absence of the gene encoding the antigen in the infecting strain (when present), but rather titers were proportional to prevalence of genes encoding antigens among representative collections of UPEC isolates. Surprisingly, we obtained similar results when sera from healthy male patients without history of UTI were tested. Thus, unvaccinated adults have non-protective levels of pre-existing antibodies to UTI vaccine antigens, establishing an important baseline for our target population. This suggests that a UTI vaccine would need to boost pre-existing humoral responses beyond these background levels to protect from infection.     

尿液肝素结合蛋白检测在尿路感染中的诊断价值

目的探讨尿液肝素结合蛋白(U-HPB)水平检测在尿路感染(UTI)中的诊断价值及临床意义。方法2016年1月-2018年6月本院收治的158例患者,包括89例UTI患者、24例疑似UTI患者、45例非UTI患者,另有同期50例健康体检者作为对照组,检测各组尿液HPB、白细胞介素-6(IL-6)、尿常规和尿有形成份,并对检测结果统计分析。结果UTI组U-HPB水平明显高于其他组,差异有统计学意义(P<0.05)。U-HPB、U-IL-6、尿液白细胞酯酶(U-LE)、尿液亚硝酸盐(U-NIT)和尿液白细胞(U-WBC)计数的曲线下面积(AUC)分别为0.917、0.798、0.670、0.743和0.852。以32.0 ng/ml为界值U-HPB诊断UTI的灵敏度和特异度分别为92.1%和88.6%。结论U-HBP能有效区分UTI和疑似UTI患者组,U-HPB检测具有简便、快速、敏感性、特异性,可作为尿路感染的诊断指标。     

Asymptomatic bacteriuria in institutionalized elders in Israel

OBJECTIVES: To document the prevalence of asymptomatic bacteriuria in patients in one large long-term care facility, and describe clinical outcomes in initially bacteriuric and nonbacteriuric residents during prospective observation encompassing one year. METHODS: Patients enrolled in the study were residents of the Haim-Shoham Geriatric Center, a long-term care institute with 800 inhabitants. Twenty patients were related randomly for study enrollment on each of the ten wards. A urine culture was obtained from the enrolled patients. A second culture was obtained within one week if the initial culture grew >or= 10(5) colony-forming units per milliliter (cfu/ml) of at least one uropathogen. Demographic data and comorbidities, as well as most recent laboratory results, were recorded for all patients enrolled. Subjects were followed prospectively for one year or until death. Clinical events and usage of antibiotics were recorded. In patients with asymptomatic bacteriuria, repeated urine cultures were obtained every two months. RESULTS: Eighty-five (43.3%) of a total of 196 elder residents screened presented asymptomatic bacteriuria. There were no differences between patients with and without asymptomatic bacteriuria in age, gender, and underlying diseases. Patients with asymptomatic bacteriuria were significantly more bed-ridden (91.7% vs. 82.1%, P = 0.05); demented (78.8% vs. 59.8%, P = 0.03); and incontinent of urine (93% vs. 71.4%, P < 0.0001) and bowel (85.8% vs. 59.3%). During one year of prospective observation, bacteriuric patients had a mortality rate of 25.9%, compared to 7.1% for nonbacteriuric (P < 0.0001). Mortality in the group with bacteriuria was higher due to both urinary infection and other causes. CONCLUSIONS: In our population, asymptomatic bacteriuria was associated with increased functional impairment and increased mortality over 12 months. The increased mortality, however, was not fully attributable to urinary infection.     

Does catheter-associated urinary tract infection increase mortality in critically ill patients?

OBJECTIVE: To produce an accurate estimate of the association between catheter-associated urinary tract infection (UTI) and intensive care unit (ICU) and hospital mortality, controlling for major confounding factors. DESIGN: Nested case-control study in a multicenter cohort (the OutcomeRea database). SETTING: Twelve French medical or surgical ICUs. METHODS: All patients admitted between January 1997 and August 2005 who required the insertion of an indwelling urinary catheter. Patients who developed catheter-associated UTI (ie, case patients) were matched to control patients on the basis of the following criteria: sex, age (+/- 10 years), SAPS (Simplified Acute Physiology Score) II score (+/- 10 points), duration of urinary tract catheterization, and presence or absence of diabetes mellitus. The association of catheter-associated UTI with ICU and hospital mortality was assessed by use of conditional logistic regression. RESULTS: Of the 3,281 patients who had an indwelling urinary catheter, 298 (9%) developed at least 1 episode of catheter-associated UTI. The incidence density of catheter-associated UTI was 12.9 infections per 1,000 catheterization-days. Crude ICU mortality rates were higher among patients with catheter-associated UTI, compared with those without catheter-associated UTI (32% vs 25%, P=.02); the same was true for crude hospital mortality rates (43% vs 30%, P<.01). After matching and adjustment, catheter-associated UTI was no longer associated with increased mortality (ICU mortality: odds ratio [OR], 0.846 [95% confidence interval {CI}, 0.659-1.086]; P=.19 and hospital mortality: OR, 0.949 [95% CI, 0.763-1.181]; P=.64). CONCLUSION: After carefully controlling for confounding factors, catheter-associated UTI was not found to be associated with excess mortality among our population of critically ill patients in either the ICU or the hospital.     

Urinary tract infections in women with diabetes mellitus

Women with diabetes mellitus (DM) have asymptomatic bacteriuria (ASB) and urinary tract infections (UTIs) more frequently than women without DM. For type 1 diabetes mellitus, risk factors for asymptomatic bacteriuria include a longer duration of diabetes, peripheral neuropathy and macroalbuminuria. For type 2 diabetes, the risk factors are higher age, macroalbuminuria and a recent symptomatic UTI. Poorly-controlled diabetes and residual urine after urination are no risk factors. The most important risk factor for a UTI in type 1 diabetes patients is sexual intercourse. In type 2 diabetes patients the major risk factor is the presence of asymptomatic bacteriuria. This higher prevalence does not appear to be based on a difference in virulence of the causative microorganism. Differences in host response may explain this higher prevalence: E. coli with type 1 fimbriae adhere better to uroepithelial cells in women with DM than to those in women without DM; women with DM and ASB have lower urinary cytokine concentrations and leukocyte counts compared to women without DM and ASB; in vitro studies show that E. coli grow better when glucose is present in urine. There is no consensus on whether ASB should be treated in these patients. There are indications that UTIs in diabetes patients should be treated as complicated UTIs.     

Effect of nitrofurantoin and methenamine hippurate prophylaxis on bacteria and yeasts in the urine of patients with an indwelling catheter

Nitrofurantoin or methenamine hippurate was given prophylactically to elderly patients without urinary tract infection at the beginning of long-term catheterization (mean 81 days), but it only delayed the appearance of bacteriuria. Escherichia coli was most frequently the first species to appear (≥10⁴/ml) in the urine of 40 patients given methenamine hippurate as well as in the control group (41 patients), whereas in 42 patients treated with nitrofurantoin more resistant species, such as Proteus mirabilis, Providencia spp. and Pseudomonas aeruginosa most often appeared first. Weekly tests made during the course of catheterization showed that E. coli disappeared from the nitrofurantoin-treated patients, while pseudomonas increased in this group and providencia in the control group. Pseudomonas was isolated more frequently in the nitrofurantoin than other groups. With the exception of klebsiellae, the bacterial strains isolated from the nitrofurantoin group were as sensitive to various antibiotics as were those from other groups. Significantly more samples with growth of yeasts (≥10⁴/ml) were obtained from nitrofurantoin treated than from methenamine hippurate treated patients. Candida albicans was the species of yeasts most often isolated.     

Screening for and treating asymptomiatic bacteriuria not useful in women with diabetes

Women with diabetes mellitus should not be screened or treated for asymptomatic bacteriuria. Unlike other clinical conditions in which screening for asymptomatic urinary tract infection (UTI) has proved valuable (pregnancy, urologic surgery, renal transplantation), women with diabetes derive no meaningful benefit. Previous recommendations by the US Preventive Services Task Force neither recommended for or against screening or treatment of asymptomatic bacteriuria in diabetic women.     

Comparative in vitro activity of antiseptics and disinfectants versus clinical isolates of Candida species.

OBJECTIVE: To evaluate the in vitro activity of antiseptics and detergents against Candida. DESIGN: One strain each of Candida albicans, Candida tropicalis, Candida lusitaniae, Candida parapsilosis, Candida kefyr, Candida glabrata, and an American Type Culture Collection strain of Escherichia coli (control) were studied. Clinical isolates were obtained from patients in a bone marrow unit of a large tertiary hospital. Antiseptic and disinfectant agents studied were used in the hospital where isolates were identified for cleaning of inanimate surfaces or hand washing. In vitro susceptibility was determined using a broth macrodilution method with exposure times to antiseptic or disinfectant agent of 15 seconds to 4 minutes and concentrations of agents that ranged from undiluted to 1:10,000 dilution. SETTING: A 900-bed teaching hospital. RESULTS: Of disinfectants tested, Vestal and Sparquat inhibited growth of all species at dilutions of < or = 1:100 at all contact times for all species. Clorox showed inhibition of growth at 1:100 dilution after 30 seconds of contact time for all isolates. Of antiseptics studied, Hibiclens inhibited growth of all species except C tropicalis at dilutions of < or = 1:100 at all contact times and for C tropicalis after 60 seconds. Clinidine inhibited growth of all species at dilutions of < or = 1:100 at all contact times for all species with the exception of Cglabrata and C tropicalis, which grew at the undiluted concentration. Ultradex failed to demonstrate killing of any species for any dilutions tested. CONCLUSIONS: The results of this study show varying degrees of in vitro inhibition of growth by a variety of antiseptics and disinfectants against clinical isolates of Candida species from hospitalized patients.     

探讨尿液pH值变化对导尿引起尿道感染的影响

目的 探讨通过护理措施改变尿液pH值,观察尿液pH值的变化对导尿相关尿道感染的影响.方法 将80例尿检阳性的骨科术后患者,随机分成试验组和对照组,两组患者在年龄、性别、手术、营养、住院天数、抗菌药物用量及疗程、留置导尿时间差异均无统计学意义;对照组按常规护理措施进行治疗,试验组在常规护理的基础上增加饮食控制、膀胱冲洗液的变化及尿道口护理后温清水冲洗;比较两组患者尿道感染的疗效.结果 试验组的治疗有效率为82.5％,对照组有效率为52.5％,两组差异有统计学意义(P＜0.05).结论 通过护理措施使患者尿道呈弱碱性环境,可以抑制细菌增长,从而提高尿道感染的治疗效果.     

Incidence of bacteraemia after urodynamic study

The aim of the present study was to determine the incidence of bacteraemia after urodynamic study (UDS) in patients with lower urinary tract symptoms, and to evaluate the role of bacteraemia as a morbidity factor related to UDS. A total of 57 patients (mean age: 52.8 years, range: 8-76 years) were evaluated by UDS. Prophylactic antibiotics were not administered to any of the patients before the procedure. Before UDS, urine cultures were examined for the presence of infection of the urinary tract (UTI). Venous blood was taken before and just after performing UDS. There was no bacterial growth in blood cultures of any patients before the UDS. Of the 57 patients, two had bacteriuria before study. After UDS, bacteraemia was determined in four (7%) out of 55 patients. The two patients with a bacteriuria before the procedure also had positive blood cultures. Infectious complications are the most important morbidity factors related to the UDS. Despite the use of strict aseptic techniques, bacteraemia may occur in patients undergoing UDS. The results of the present study may help when counselling patients who are to undergo UDS.     

Impact of concurrent antimicrobial therapy on catheter-associated urinary tract infection.

Results of a survey in two Dutch district hospitals which investigated the impact of concurrent administration of antibiotics on the incidence of catheter-associated urinary tract infection (UTI), showed that 61% of catheterized patients received antibiotics at some stage during bladder drainage. The use of antibiotics within 48 hours prior to catheter removal reduced the risk of bacteriuria fivefold. Multivariate analysis of patients who were catheterized for 3-14 days indicated that, apart from the duration of catheter employment, the use of antibiotics was the only variable significantly and independently associated with the development of bacteriuria. The power of this association varied inversely with increasing duration of catheterization but remained significant throughout the 3-14-day interval. Patients with bacteriuria at the time of catheter removal were more likely to have a febrile illness compared to those who remained free of catheter-associated UTI.     

重症监护室医院获得性泌尿道感染病原菌分析

目的了解重症监护室(ICU)医院获得性泌尿道感染及病原菌情况,为预防和控制ICU患者泌尿道医院感染提供科学依据。方法对2013年32所医院ICU泌尿道医院感染目标监测资料进行分析。结果共监测ICU住院患者23 680例,发生医院获得性泌尿道感染157例,医院获得性泌尿道感染率为0.66%;导尿管使用率为80.83%,导尿管相关泌尿道感染发病率为1.25‰。共检出菌株162株,其中真菌66株,占40.74%;革兰阴性(G-)菌51株,占31.48%;革兰阳性(G+)菌45株,占27.78%。结论 ICU医院获得性泌尿道感染病原菌以真菌为主,医院应尽早采取综合干预措施,控制ICU医院获得性泌尿道感染。     

Socio-biological correlates of bacteriuria in Saudi pregnant women

Prevalence and socio-biological correlates of bacteriuria in Saudi pregnant women were investigated at King Fahd Hospital of the University, Al-Khobar, Saudi Arabia. Midstream sample specimens of urine were used for identification of significant bacteriuria (greater than or equal to 10.5 organisms of single species per milliliter of urine). The prevalence of bacteriuria was found to be 14.2%. It was more common in women below 20 years of age and among the parous as against the nullipara women. Bacteriuria was significantly associated with socio-economic conditions. It was higher in those with a low family income, of large family size (10+) and living in over-crowded conditions. Only one-fourth (25.8%) of bacteriuric women were symptomatic. Almost half (45.8%) had a past history of urinary tract infection. To identify the problem of urinary tract infection in a vulnerable group of women, as well as to reduce the load on laboratory facilities, it is suggested that routine antenatal screening for bacteriuria should be advocated on a selective basis, i.e. for the young teenage parous women, those coming from disadvantaged socio-economic conditions and in patients with a past history of urinary tract infection.     

输尿管镜术后泌尿道感染发病率及其危险因素

目的探讨输尿管镜术后感染的发病率及其危险因素。方法回顾性分析2002—2011年某院接受输尿管镜检查或输尿管镜下碎石术患者,收集其年龄、性别、既往史、合并症、尿常规、尿培养、血常规、是否留置导尿管或输尿管内支架以及抗菌药物的使用等临床资料,对所得数据进行分析。结果输尿管镜术后泌尿道感染的发病率为3.77%（20/531）,其中输尿管镜检查术后泌尿道感染的发病率为5.84%（9/154）,高于输尿管镜碎石术后的2.92%（11/377）（χ2=5.47,P=0.02）。术后感染患者以肾盂肾炎最常见（15例）,分离主要病原菌为大肠埃希菌（6株）。预防性使用不同种类抗菌药物者泌尿道感染发病率差异无统计学意义（P=0.185）。菌尿症、肾积水、留置导尿管、术后无内支架管置入、未预防性使用抗菌药物患者泌尿道感染发病率较高（均P＜0.05）。结论菌尿症、肾积水、留置导尿管、术后无内支架管置入、输尿管镜检查术、未预防性使用抗菌药物是输尿管镜术后泌尿道感染的危险因素。     

Infections urinaires nosocomiales chez l’immunocompétent en milieu médical : qui traiter,quand traiter et comment traiter ?

Guidelines for the treatment of nosocomial urinary tract infections (NUTI) have to take into account: i) the high prevalence of catheter-associated bacteriuria; ii) the lack of important clinical studies; iii) a variable bacterial count (between 10³ and 10⁵ mL^–1) considered as significant by authors. NUTI without catheterization are clinically similar to UTI in outpatients, but more frequently due to multi-resistant bacteria. Among catheterized patients, the incidence of dysuria, pain, and urgency is not different between patients who develop bacteriuria and those who do not. However, fever has a high positive diagnostic value. Systematic treatment of NUTI is not recommended despite the morbidity because it reduces neither the incidence of febrile episodes, nor the rate of complications. Moreover, it promotes the selection of resistant bacteria. Exceptions to these recommendations are: treatment of asymptomatic NUTI in patients at high risk of severe complications (neutropenic patients, pregnant women, immunosuppressed patients, patients with diabetes mellitus), as part of a plan to control a cluster of multiresistant infections, before surgery (implantation of a prosthesis, urinary tract procedures), or persistent bacteriuria after catheter removal. All febrile NUTI should be treated given their specific morbidity and mortality. Empirical treatment depends on the local prevalence of resistant bacteria. In febrile NUTI, a 7 to 10 day antibiotic treatment is recommended, combined with the removal or the replacement of the catheter (immediately or after 48h of treatment). A longer treatment is necessary for complicated pyelonephritis or bacteremia, according to bacteria dissemination and urinary tract impairment.     

Hospitalization for urinary tract infections and the quality of preventive health care received by people with spina bifida

BackgroundThe preventive health care needs of people with disabilities often go unmet, resulting in medical complications that may require hospitalization. Such complications could be due, in part, to difficulty accessing care or the quality of ambulatory care services received.ObjectiveTo use hospitalizations for urinary tract infections (UTIs) as a marker of the potential quality of ambulatory care services received by people affected by spina bifida.MethodsMarketScan inpatient and outpatient medical claims data for 2000 through 2003 were used to identify hospitalizations for UTI, which is an ambulatory care sensitive condition, for people affected by spina bifida and to calculate inpatient discharge rates, average lengths of stay, and average medical care expenditures for such hospitalizations.ResultsPeople affected by spina bifida averaged 0.5 hospitalizations per year, and there were 22.8 inpatient admissions with UTI per 1000 persons with spina bifida during the period 2000–2003, in comparison to an average of 0.44 admission with UTI per 1000 persons for those without spina bifida. If the number of UTI hospitalizations among people affected by spina bifida were reduced by 50%, expenditures could be reduced by $4.4 million per 1000 patients.ConclusionsConsensus on the evaluation and management of bacteriuria could enhance clinical care and reduce the disparity in UTI discharge rates among people affected by spina bifida compared to those without spina bifida. National evidence-based guidelines are needed.