The resistance of urinary tract pathogens to chlorhexidine bladder washouts

Isolates of Providencia stuartii, Pseudomonas aeruginosa, Proteus mirabilis, Klebsiella pneumoniae and Streptococcus faecalis from urinary-tract infections in spinally-injured patients together with Escherichia coli 10418 were challenged with chlorhexidine (200 mg l-1) in a model of a catheterized bladder under conditions which simulate the bladder washout technique. All species survived the antiseptic. Organisms growing on the wall of the bladder model appeared to be particularly resistant and electron microscopy showed that these cells were embedded in a protective glycocalyx. The effect of chlorhexidine bladder washouts on the bacterial flora in the urine of patients was also observed and shown to be minimal and temporary. Examination of urinary sediments from patients revealed the presence of micro-colonies of bacteria embedded in a polysaccharide matrix. We conclude that bladder washouts with chlorhexidine are not likely to eliminate established infections with organisms that occur in patients with indwelling bladder catheters.     

Adolescent urinary tract infections

Urinary symptoms in adolescents are common, particularly in females. Urinary tract infections (UTIs) cause many of these symptoms. For uncomplicated UTIs, both lower and upper tract, therapy is straightforward. Commonly used antibiotics are trimethoprim/sulfamethoxazole (TMP/SMX), cefixime, and ciprofloxacin (off-label use) for 3 days for lower tract infections and 10?14 days for upper tract infections. Adolescent UTIs are markers for sexual activity, just as UTIs in younger children are often markers for anatomic defects, e.g., congenital abnormalities. Adolescents with upper and lower UTIs often have concurrent sexual activity or a complication of that activity. Issues among adolescents with UTIs are more similar to those of young adults than to those of younger children. It is as important to counsel adolescents about sexual activity and its consequences as it is to treat the UTIs. All adolescents with UTIs should be queried for sexual activity; evidence of sexually transmitted diseases (STDs) should be sought; and counseling for STDs and responsible sexual activity is recommended. Complicated UTIs include those in patients who have grown into adolescence after a childhood of infections or who have anatomic abnormalities, recurrent infections, reflux and reflux nephropathy, spina bifida and neurogenic bladder, transplanted kidneys, diabetes, and urolithiasis. These patients require individualized medical programs, unique for their condition, history, and microbiology.     

Hospital-acquired urinary tract infections

Hospital-acquired urinary tract infections have a great impact on clinical medicine. They are almost exclusively complicated urinary tract infections. Clinical diagnosis in some patients. (e.g., sedated patients, paediatric or geriatric patients) might be delayed for the lack of symptoms. About 80% of urinary tract infections are catheter-associated. However, certain diseases favour urinary tract infections: diabetes mellitus or cystic renal diseases, amongst others. Each specialist field (e.g., geriatrics, gynaecology, paediatrics) encounters its own problems concerning diagnosis and treatment of urinary tract infections. Hospital-acquired urinary tract infections can merge into severe infections such as urosepsis and septic shock. The microbiological spectrum encompasses multi-resistant bacteria, thus microbiological sampling prior to therapy is mandatory. Additionally the complicating factors must be diagnosed and treated adequately. The best prophylaxis is to minimize the duration of the urinary catheter and to employ general hygienic procedures.     

医院尿路感染相关因素调查分析

目的分析医院内住院患者尿路感染的相关因素,为预防和控制尿路感染提供参考依据。方法回顾性分析205例住院患者医院内尿路感染的临床资料,并用logistic回归进行相关因素分析。结果 205例尿路感染患者中,共检出196株病原菌,革兰阴性杆菌97株,占49.49%,革兰阳性杆菌61株,占31.12%,真菌38株,占19.39%;经logistic回归分析后认为与尿路感染显著关联的因素有:年龄、留置导尿管时间、侵入性操作和白细胞数。结论及时明确医院内尿路感染的相关因素并合理控制,加强消毒隔离制度的执行,对降低尿路感染率有重要意义。     

Pseudoepidemic of urinary tract infections due to Trichosporon beigelii

During the period April, 1985 to March, 1986, Trichosporon beigelii was isolated from the urine of 15 intensive care unit patients. All of these patients had Foley catheters in place at the time of T beigelii isolation. None of them had urinary tract infections on admission, and it was initially felt that this organism was a source of infection in these critically ill individuals. Subsequent investigation revealed this to be a pseudoepidemic secondary to contamination of the urinary catheter drainage system. Urine obtained by gravity drainage from the outlet port of urimeters yielded growth of T beigelii, whereas urines obtained concurrently from the proximal tubing sampling port were negative. T beigelii was isolated from the drainage port as well as from various items used in the collection and sampling of urine specimens. It is felt that these items were the source of perpetuation of this pseudoepidemic due to the repeated contamination and colonization of the distal portion of the urine catheter collection system. In-services to nursing and housekeeping personnel in the proper collection of urine specimens and cleaning of potentially contaminated items, the replacement of metal urine graduates with disposable plastic ones and increased monitoring of personnel's activities stopped the outbreak abruptly.     

Antibiotic-laced urinary catheter helps prevent costly infections

Treating urinary tract infections at the source: Urinary tract infection is a common problem in hospitals, particularly among patients who require long-term management with indwelling urinary catheters. A new Foley catheter, made of silicon imbedded with a broad-spectrum antibiotic, shows a 10-fold reduction in UTI within three days of use. Its maker claims hospitals can save $68,000 to $438,000 per 1,000 catheters.     

尿路结石与尿路感染的相关性研究

目的 分析尿路结石与尿路感染的相关性。方法 选择2010年2月至2013年10月唐山市工人医院收治的300例尿路结石患者,检测尿常规、中段尿阳性、术中结石附近棉拭子蘸液、尿路结石、术后尿路感染等情况,并分析感染性结石与非感染性结石的主要成分。结果 300例中发现感染性结石96例（32%）,菌分离培养表明主要为大肠埃希菌（35例,36.5%）、表皮葡萄球菌（28例,29.2%）、奇异变形杆菌（15例,15.6%）;感染性结石组患者尿常规检查异常、中段尿阳性、术中棉拭子阳性和尿路感染的发生率均显著高于非感染性结石组,差异均有统计学意义（χ2＝8.203、73.99、178.9、24.26,P<0.05）;感染性结石组中六水磷酸镁铵、碳酸磷灰石和羟基磷灰石结石的发生率显著高于非感染性结石组,而草酸钙结石和尿酸结石的发生率显著低于非感染性结石组,差异均有统计学意义（χ2＝167.6、21.00、8.586、73.17、48.79,P<0.05）。结论 泌尿系统细菌感染可引起尿路结石,而后者亦会引起泌尿系统的进一步感染。尿路结石患者应做细菌培养检测,术后亦应避免泌尿系统感染。     

Managing urinary tract infections in men

Despite the obvious genitourinary differences between the sexes, management of lower urinary tract infections in men is based largely on standards developed from studies in women. This has helped foster misconceptions that, among other problems, add needless complexity and expense to diagnosis and treatment of male patients.     

Cephazolin treatment of pneumococcal pneumonia and urinary tract infections.

Ten cases of pneumococcal pneumonia were treated with cephazolin 500 mg. q8h for at least 5 days. In every case therapy was accompanied by clinical improvement and eradication of the organism. Ten patients with E. coli bacteriuria (5 symptomatic) were treated with cephazolin 500 mg. q12h for 7 to 10 days. In every case the pathogen was eliminated during therapy but in one case bacteriologic relapse occurred following cessation of therapy. In 10 cases of bacteriuria caused by P. mirabilis, Klebsiella sp, Enterobacter, and Enterococcus, the urine became sterile during treatment, but relapse was common. Initial and final creatinine clearances obtained in 29 patients who received an average of 12.9 g. of cephazolin showed no tendency toward loss of renal function. Serial serum levels of cephazolin were determined following the first 500 mg. dose in 18 patients. The peak serum level occurred at one hour with a serum half life of approximately 2.2 hours. For 13 of these 18 patients serial serum levels were also obtained following the last dose of cephazolin. At this time the mean peak level occurred at 2 hours but again the serum half life was approximately 1.9 hours.     

Recurrent urinary tract infections in women

The financial, emotional, and personal costs of dealing with urinary tract infections are tremendous. However, these expenditures are multiplied when the infections become recurrent. The categorization, pathogenesis, and treatment strategies of recurrent urinary tract infections have developed significantly during the past 10 years. Clearly, those with recurrent urinary tract infections have differences at the cell surface level that render them more susceptible. Treatment is changing direction from combatting bacteria with antimicrobials to bolstering host defenses.     

Candidate vaccine against urinary tract infections

Urinary tract infections (UTIs) are an important medical problem for women. The most common uropathogen is Escherichia coli. The adherence of E. coli to the uroepithelium is mediated by the FimH adhesin, a minor component of type-1 fimbriae. This is the initial step in the pathogenesis of UTIs. Recently, a candidate vaccine has been developed, based on this FimH adhesin. In animal studies and in a phase 1 study, this vaccine has proven to be both immunogenic and safe. In this era of increasing resistance to antibiotics, such a method of prevention is of high importance.     

聚维酮碘消毒减少导尿管相关性尿路感染的临床观察

目的 探讨导尿时尿道注入聚维酮碘消毒,对减少导尿管相关性尿路感染的作用.方法 196例术前需留置导尿的患者随机分为对照组及试验组各98例,对照组行常规尿道外口及其周围器官皮肤消毒,按常规无菌操作技术行导尿,试验组在常规消毒的基础上,加用注射器从尿道外口注入0.5％聚维酮碘行全尿道消毒,余操作同对照组;两组均定期留取尿液标本做细菌培养及尿常规检查.结果 第5、7、10天试验组尿路感染发生率分别为2.27％、7.69％及22.73％,明显低于对照组的10.11％、25.49及66.67％,差异有统计学意义(P＜0.05);而留置导尿管第2、13、＞16天的尿路感染发生率两组差异无统计学意义.结论 尿道注入聚维酮碘消毒对减少早期导尿管相关性尿路感染是一种简便有效的方法.