Effect of malnutrition on serum creatinine and cystatin C levels

The concentration of cystatin C has been shown to be independent of age, gender and height, but the effect of malnutrition has not been studied. Levels of serum creatinine and cystatin C were estimated in 77 malnourished and 77 normally nourished boys between 2 years and 6 years of age without evidence of renal disease. The mean (95% confidence interval) serum creatinine level in the malnourished boys was significantly lower than that in the normally nourished boys [0.42 (0.38–0.45) mg/dl and 0.51 (0.48–0.55)] mg/dl, respectively, (P < 0.01)]. The mean level of serum cystatin C was 1.05 (0.94–1.17) mg/l and 1.12 (1.01–1.24) mg/l, respectively, in normally nourished and malnourished boys (P = 0.35). Mean glomerular filtration rate (GFR) estimated by the Schwartz equation in the malnourished boys was significantly higher than that in normally nourished children [141.8 (123.3–160.2) ml/min per 1.73 m² body surface area and 119.4 (109.3–129.5) ml/min per 1.73 m² body surface area], respectively (P = 0.04). However, the mean cystatin C-derived GFR was similar in the malnourished and normally nourished boys [99.70 (85.8–113.5) ml/min per 1.73 m² and 109.2 (94.4–124.0) ml/min per 1.73 m²], respectively (P = 0.35). The mean bias between GFR estimates using Bland and Altman analysis was greater in the malnourished children than in the normally nourished children (32.3% and 17.6%, respectively) (P = 0.15). Serum creatinine levels are lower in malnourished children and lead to overestimation of GFR, while cystatin C levels are unaffected.     

Nutrition following gastric operations for morbid obesity.

Nutritional status after 238 gastric operations designed to reduce caloric intake and body weight to within 30% of ideal was assessed by measuring body composition using the multiple isotope dilution technique. Body cell mass (BCM) and body fat were quantitated before and at 24 months after operation. Malnutrition was defined as a total exchangeable sodium (Nae) to total exchangeable potassium (Ke) ratio greater than 1.22. Data were collected on 96 patients. All had lost a mean of 26% of preoperative weight by 24 months. Significant malnutrition occurred in 47 patients whose Nae/Ke ratio ranged from 1.23 to 2.17 (1.45 +/- 0.03). There was a 34% reduction in body fat. The malnourished patients lost 10% more BCM by 24 months than did the normally nourished group. Malnutrition resolved as the stoma enlarged in 19 patients, and dietary counselling helped eight patients. Eighteen patients required reoperation to establish a larger orifice, and endoscopic dilatation was successful in two patients. Administration of a liquid diet via the gastrostomy was required for prolonged periods in some malnourished patients. Seventeen patients who had lost weight rapidly over a short time had low vitamin B12, thiamine, and serum and RBC folate levels. One patient had a markedly decreased serum thiamine level with neuropathy. Symptoms of weakness, easy fatigability, and lassitude were found in the malnourished patients. Low thiamine and serum folate levels were also seen in patients ingesting a liquid diet of 750 kcal with a standard multivitamin supplement. Malnutrition was not seen in these patients. In the 49 patients who remained well nourished, BCM decreased by 19%, but the Nae/Ke remained normal. Weight loss was well tolerated, and no patients required reoperation or supplemental liquid diet to increase caloric or protein intake. The degree of malnutrition in patients after gastric operations is as great as following intestinal bypass but is not associated with liver failure. Malnutrition with vitamin deficiency is a great potential hazard in patients who undergo intake-limiting operations, especially if the goal of the operation is to restore near-normal weight. Current operations are successfully designed to maintain a small orifice size, so that the risks of malnutrition are likely to increase in the future.     

The gut as a portal of entry for bacteremia. Role of protein malnutrition.

The current studies were performed to determine the influence of malnutrition alone or in combination with endotoxemia in promoting bacterial translocation from the gastrointestinal tract. Bacterial translocation did not occur in control, starved (up to 72 hours), or protein-malnourished (up to 21 days) mice not receiving endotoxin. Bacterial translocation to the mesenteric lymph nodes (MLNs) occurred in 80% of control mice 24 hours after receiving endotoxin (p less than 0.01). However, the combination of malnutrition plus endotoxin was associated with a higher incidence of translocation to the systemic organs (p less than 0.01), and higher numbers of bacteria per organ (p less than 0.01), than was seen in normally nourished mice receiving endotoxin. Additionally, mice that were protein malnourished were more susceptible to the lethal effects of endotoxin than were control animals, and the mortality rate was directly related to the degree of malnutrition (R2 = 0.93) (p less than 0.05). Histologically, endotoxin in combination with protein malnutrition resulted in mechanical damage to the gut mucosal barrier to bacteria. Thus, in the mice that were protein malnourished the spread of bacteria from the gut could not be controlled nor could translocated bacteria be cleared as well as normally nourished mice receiving endotoxin. These results support the concept that under certain circumstances the gut may serve as a clinically important portal of entry for bacteria.     

普外科住院患者营养状况评价及预后分析

目的探讨外科住院患者营养状况与手术后并发症发生率及死亡率的关系。方法采用多项营养评价指标测定4012例普外科非急诊住院患者营养状况,分析患者营养状况与死亡率、并发症关系。结果各项营养指标检测的营养不良发生率分别是:体重指数21.3%,三头肌皮褶厚度50.6%,上臂围20.5%,上臂肌围21.2%,主观全面评价法38.0%,微型营养评价法20.8%,ALB24.2%,PA35.4%,TLC55.8%。>60岁组老年患者、消化道疾病患者及恶性肿瘤患者营养不良发生率分别高于≤60岁、消化道外疾病及良性疾病患者,差异具有统计学意义(P<0.05)。营养不良患者的并发症发生率及死亡率均明显高于营养状况良好者(P<0.01),而且住院时间明显延长(P<0.05)。结论营养不良患者的手术后死亡率、并发症发生率和住院时间均高于营养状况良好者。     

Infecciones del tracto urinario en pacientes con esclerosis múltiple y los diferentes sistemas de vaciado vesical

Introduction and objectivesTo evaluate the incidence and course of urinary tract infections (UTI) in patients with multiple sclerosis (MS) and their relationship to the method of bladder evacuation.Materials and methodsPatients with neurogenic bladder dysfunction due to MS (n = 111) were enrolled in the study. During one-year follow-up, clinical examination with urine culture was performed every 4 months or whenever symptoms occurred. The control group included patients with symptomatic UTI, without neurological or autoimmune disease. Incidence of symptomatic and asymptomatic bacteriuria, the effect of urine drainage on UTI incidence, and the effect of antibiotics were statistically evaluated.ResultsFifty-four MS patients completed the protocol. The mean incidence of symptomatic and asymptomatic bacteriuria in the MS group was 12.5% and 29.6%, respectively. A decreasing trend in the incidence of symptomatic, and an increasing trend in the incidence of asymptomatic bacteriuria was observed. Eradication of UTI in symptomatic MS patients was significantly lower than in controls (37.75% vs. 92.93%, P < .05). Causative agents significantly differed in both groups (P = .0005). The hypothesis that the incidence of UTIs in MS patients is independent of the method of bladder evacuation was not rejected (P > .99 at visit 0, 1 and 3, P = .078 at visit 2).ConclusionsThere is a significant difference between the causative agents of UTI in both groups. Eradication of bacteriuria in symptomatic MS patients is difficult when compared to the normal population. We have insufficient evidence to confirm the relationship between the incidence of UTI and the method of bladder evacuation.     

Urinary tract infection and antibiotic susceptibility in malnourished children

In this study, 31 (30%) cases of urinary tract infection(UTI) of 103 patients with malnutrition, who were admitted to ourhospital, were investigated prospectively. Our purpose was to determinethe frequency of UTI, species of bacteria caused toinfection and their antibiotic susceptibility in infants withmalnutrition. The mean age of the patients with UTI was 11.5 ±7.6 months (ranging 50 days-30 months). The main symptoms were fever,vomiting, diarrhea, cough, and seizures. The mean body weight was 5.8± 1.9 kg (2–10 kg), and height was 67.5 ± 7.8 cm(58–85 cm). Seven of them had mild, 11 had moderate, and 13 hadsevere malnutrition. The most common isolated microorganism from urinecultures was Escherichia coli (54.8%). Most strains ofEscherichia coli were resistant to co-trimoxazole(82.3%), ceftriaxone (17.6%), cefotaxime (17.6%),and ciprofloxacine (17.6%), but none of them were resistant togentamicin. In conclusion, we would like to emphasize that UTIpredominantly by gram negative microorganisms are frequent in theinfants with malnutrition, and these microorganisms are mostly resistantto co-trimoxazole which is used commonly in practical medicine andprophylaxis. This revised version was published online in August 2006 with corrections to the Cover Date.     

Malnutrition and inflammation are associated with impaired pulmonary function in patients with chronic kidney disease.

BACKGROUND: Inflammation and malnutrition are common findings in patients with chronic kidney disease (CKD). We hypothesized that in inflamed and malnourished patients, respiratory and peripheral muscle dysfunction may have significant consequences on pulmonary function. The aim of this study was to investigate possible associations between pulmonary function and inflammation and malnutrition in patients with CKD. METHODS: We studied 109 patients (63% males; 53+/-12 years) at the initiation of dialysis treatment (GFR 7.5+/-2.5 ml/min). Pulmonary function tests [forced expiratory volume in 1 s (FEV(1)), forced vital capacity (FVC) and peak expiratory flow (PEF)] were performed and the percentages of predicted values were calculated (%FEV(1), %FVC and %PEF). Systemic inflammation, assessed by high-sensitivity C-reactive protein (hsCRP) and nutritional status assessed by subjective global assessment (SGA), lean body mass (LBM) (estimated with dual energy X-ray absorptiometry) and hand-grip strength (HGS), were evaluated at the same time. RESULTS: Significant negative correlations were found between hsCRP and the percent predicted values for all pulmonary function tests [%FEV(1) (Rho = -0.45), %FVC (Rho = -0.43) and %PEF (Rho = -0.38)], respectively. Malnourished patients defined as SGA >or=2 had lower %FEV(1) (64+/-19 vs 82+/-23%; P<0.001) and %FVC (67+/-18 vs 83+/-21%; P<0.001) than well nourished patients. Significant correlations were observed between HGS and %FVC (Rho = 0.38; P <0.001), %FEV(1) (Rho = 0.37; P<0.001) and %PEF (Rho = 0.22; P<0.05) and between LBM and %PEF (Rho = 0.20; P<0.05). Multivariate Cox analysis showed that cardiovascular disease and low %FVC were associated with poor survival. CONCLUSIONS: Impaired pulmonary function is associated with malnutrition and inflammation, and predicts mortality in CKD patients. This may reflect an impact of malnutrition and inflammation on respiratory muscle performance, leading to pulmonary dysfunction, which could influence the clinical outcome.     

The effect of malnutrition on morbidity after Surgery for chronic pancreatitis

Protein-energy malnutrition is a notable problem in the management of patients with chronic pancreatitis. The effect of malnutrition on pancreatic surgery is not well known. The records of 313 consecutive patients who underwent lateral pancreaticojejunostomy (LPJ, n = 152), pancreaticoduodenectomy (PD, n = 78), or distal pancreatectomy (DP, n = 83) for chronic pancreatitis were retrospectively reviewed and analyzed. Subjective Global Assessment, Nutritional Risk Index, and Instant Nutritional Assessment were used to assess the nutritional state. An average of all three nutritional indexes was established, and patients were categorized into well nourished (n = 101) as well as mild (n = 91), moderate (n = 94), and severe malnourished (n = 27). Poor nutritional state was associated with an increase in postoperative complication rate (LPJ: well nourished 14%, mild 25%, moderate 31%*, severe 50%*; PD: well nourished 44%, mild 44%, moderate 60%, severe 88%*; DP: well nourished 17%, mild 13%, moderate 30%, severe 55%*; *P < 0.045 vs well nourished). Low serum albumin levels also increased operative morbidity. The increase in morbidity was reflected by a higher rate of infectious complications as well as increased ICU stay. Body mass index and weight loss did not contribute to change in outcome. Malnutrition was associated with a higher incidence of postoperative complications after surgery for chronic pancreatitis. An increase in operative morbidity might be related to decreased protein synthesis and impaired immunocompetence.     

Assessment of nutritional status in hemodialysis patients using patient-generated subjective global assessment.

OBJECTIVE: To evaluate the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in hemodialysis patients. DESIGN: A cross-sectional observational study assessing the nutritional status of hemodialysis patients. SETTING: Private tertiary Australian hospital. SUBJECTS: Sixty patients, ages 63.9 +/- 16.2 years. INTERVENTION: Scored PG-SGA questionnaire, comparison of PG-SGA score > or =9 with subjective global assessment (SGA), albumin, corrected arm muscle area, and triceps skinfold. RESULTS: According to SGA, 80% of patients were well nourished and 20% of patients were malnourished. Patients classified as well nourished (SGA-A) attained a significantly lower median PG-SGA score compared with those rated as moderately malnourished or at risk of malnutrition (SGA-B). A PG-SGA score > or =9 had a sensitivity of 83% and a specificity of 92% at predicting SGA classification. There were significant correlations between the PG-SGA score and serum albumin, PG-SGA score, and percentage weight loss over the past 6 months. There was no association between PG-SGA score and body mass index or anthropometric measurements. CONCLUSION: The scored PG-SGA is an easy-to-use nutrition assessment tool that allows quick identification of malnutrition in hemodialysis patients.     

Malnutrition among pediatric burn patients: A consequence of delayed admissions

Early definitive burn treatment is assumed to improve prognosis, in part because open wounds rapidly stimulate muscle catabolism and systemic inflammation. This study describes the incidence and management of injury associated malnutrition among pediatric burn patients transferred for definitive care 21–166 days following burn injury. Medical records of patients admitted to our hospital between January 2003 and January 2009, at least 3 weeks after burn injury, were retrospectively reviewed. Only children with an initial total body surface area (TBSA) burn of ≥20% were included in this study (n = 36). Patients were classified as acutely well nourished or malnourished by the medical team. All patients were admitted with chronic open wounds (31 ± 16% TBSA). Sixty-one percent (n = 22) of patients were diagnosed with malnutrition. These patients had a significantly longer delay to transfer (26–166 days) than well nourished patients who transferred at 21–138 days (p < 0.05). Average protein (2.8 ± 0.18 g/kg), and kilocalorie (1.6 ± 0.1% basal metabolic rate) provision did not differ between groups. Incidence of infection was not different between well nourished and malnourished patients. Malnutrition occurs frequently among pediatric burn patients with delayed admissions. Adequate surgical care, infection control, and nutrition are required for wound healing.     

Female urodynamics and lower urinary tract infection

OBJECTIVES: To determine the incidence of unsuspected urinary tract infection (UTI) before cystometry, to evaluate reports of a greater tendency to abnormal cystometry in the presence of asymptomatic bacteriuria, and to determine the incidence of iatrogenic significant bacteriuria after cystometry. PATIENTS AND METHODS: A prospective study was carried out in the gynaecology department of a district general hospital in collaboration with the medical microbiology department of a university teaching hospital. The period of investigation was 1 year and the study population was a sample of women undergoing urodynamic investigations during this period. Data were collected on age, menopausal status, parity, cystometric diagnosis and voiding dysfunction. RESULTS: In all, 117 patients provided a urine sample before cystometry; 12 of these patients had a positive culture, giving an incidence of 10.3% for unsuspected asymptomatic bacteriuria before cystometry. There was a significant association between age and the presence of UTI before cystometry (P = 0.003) and between this UTI and sensory urgency (P = 0.01). There was no similar significant association with detrusor instability or genuine stress incontinence. Nineteen of the 97 patients who had negative bacteriology before cystometry had a positive urine culture afterward. Compared with patients who had a negative sample, there was no significant association with age, parity, menopausal status, abnormal cystometry or voiding dysfunction. CONCLUSION: These results do not support a policy of universal screening for bacteriuria before urodynamic investigation. Asymptomatic bacteriuria did not influence the urodynamic outcome except in patients with sensory urgency. However, we recommend that screening and treatment be considered individually in older women who are being investigated for irritative bladder symptoms. About 20% of the present patients developed UTI after the urodynamic investigation. This information should be included in the counselling before urodynamic investigation and should be incorporated into the patient information leaflet as part of good clinical practice.     

Acute renal failure in patients with malnutrition following mitral valve replacement

A retrospective study of 161 consecutive patients undergoing mitral valve replacement with or without other valve surgery was undertaken to examine the relation between cardiac cachexia and postoperative acute renal failure. The preoperative nutritional state was assessed according to percent of the ideal body weight (W/IW). There were 37 malnourished patients (W/IW<0.80) and 124 normally nourished patients (W/IW>=0.80). In nineteen in the malnourished group (51 per cent) and 37 of normal-nourished (28 per cent), postoperative acute renal failure developed. Malnourished patients showed a severe clinical picture preoperatively a complicated operative procedures had to be carried out. To match these clinical factors between the two groups, the observation was limited to the high risk patients who showed severe New York Heart Association Functional Class (III or IV) large cardiothoracic ratio (more than 65 per cent), and long cardio-pulmonary bypass time (exceeding 120 minutes). Even in this subgroup, malnourished patients were susceptible to renal failure (64 per centVersus 20 per cent, malnourishedversus normalnourished repectively). Thus when malnutrition is superimposed on diminished cardiac performance, acute renal failure may ensure.     

Utilization of extended donor criteria liver allograft: Is the elevated risk of failure independent of the model for end-stage liver disease score of the recipient?

BACKGROUND: The role of asymptomatic bacteriuria in kidney transplant recipients is unknown. There is no clear evidence of its effect on transplanted kidney. METHODS: We studied urine cytokines profile among kidney transplant recipients with bacteriuria found in screening examination. Urine cultures were collected in 269 patients with stable graft function and serum creatinine level <2 mg/dl, during their routine visits. Interleukin (IL)-6 and IL-8 levels were measured in urine samples from patients with asymptomatic bacteriuria, symptomatic urinary tract infection and patients without bacteriuria (control group). Changes in serum creatinine level in patients with asymptomatic bacteriuria and in the control group were observed during 12 months follow up. RESULTS: Urinary tract infection (UTI) was diagnosed in five patients and asymptomatic bacteriuria in 22 patients. Urine IL-6 level was significantly higher in symptomatic UTI group (median 15.71 pg/mg) but there were no differences between group of patients with asymptomatic bacteriuria (3.92 pg/mg) and control group (2.54 pg/mg). Urine IL-8 level was higher in symptomatic UTI group (median 146.8 pg/mg) and was also significantly higher in asymptomatic bacteriuria group (33.49 pg/mg) in comparison to control group (2.97 pg/mg; P=0.0002). During 1-year follow up, incidence of UTI was higher in the asymptomatic bacteriuria group than in the control group but graft function was not different in both groups. CONCLUSIONS: Elevated urine IL-8 level in kidney transplant patients with asymptomatic bacteriuria may reflect impaired immune response to bacterial infection and occult inflammatory process in urinary tract.     

The effect of perioperative exogenous growth hormone on wound bursting strength in normal and malnourished rats

Patients with significant malnutrition secondary to underlying disease may require major surgical intervention on an urgent basis. Nutritional restoration using enteral or intravenous alimentation requires a delay of 10 to 14 days and is frequently not practical. With the availability of human growth hormone (GH) produced by recombinant DNA technology, this study was undertaken to evaluate the effect of exogenous GH on wound tensile strength in a rat model. Fifty-four animals were divided into three groups: group I, normal nourished control; group II, malnourished; group III, malnourished, rat GH treated (1 mg GH administered 3 days preoperative and 5 days postoperative celiotomy). Wound tensile strength was measured at 6 days postoperatively. Wound strengths in malnourished rats were significantly less than in normal controls (P less than .001). With the administration of growth hormone in group III, wound strength was significantly improved when slightly improved over normally nourished controls (P less than .05). A dose response curve demonstrated progressive improvement in wound tensile strength from 0.01 mg/d to 1.0 mg/d. Thus growth hormone administration to malnourished animals significantly enhances wound strength. With the availability of recombinant produced human GH these observations may be clinically applicable.     

Trimethoprim versus gentamicin for the prevention of bacteriuria following transrectal biopsy of the prostate--do patients need additional anaerobic cover?

OBJECTIVES: To study the incidence of aerobic and anaerobic bacteriuria in patients undergoing transrectal ultrasound-guided biopsies of the prostate. A comparative assessment of efficacy of trimethoprim with gentamicin for the prevention of bacteriuria following the transrectal biopsy of the prostate. To assess the need for additional prophylaxis against anaerobes for patients undergoing transrectal biopsies of the prostate gland. PATIENTS AND METHODS: In a pilot study during 1995-1997, all the patients undergoing transrectal ultrasound-guided biopsy of the prostate were randomised to receive either trimethoprim or gentamicin prophylaxis prior to the procedure. Midstream urine (MSU) samples were taken just prior to biopsy and 72 h later. A patient questionnaire to determine the symptoms of urinary tract infection (UTI) accompanied the 72-hour MSU request form. Urine samples were cultured aerobically, using a semiquantitative technique if dipstick analysis revealed the presence of blood, pus cell or nitrite. In addition to the routine aerobic culture, post-biopsy samples were also cultured for anaerobes by direct and enrichment methods. Bacteriuria was defined as a pure or mixed growth of 10(5) colony-forming units/ml. Fisher's test of exact probability was used for statistical analysis. RESULTS: 115 patients were available for final analysis. 53 had received gentamicin and 62 trimethoprim. Four patients had pre-existing bacteriuria (3.5%), 3 in the trimethoprim group and 1 in the gentamicin group. Post-operative bacteriuria developed in 5 patients given gentamicin (9.4%) and 1 given trimethoprim (1.6%). This difference was not statistically significant (p = 0.085). Post-procedure bacteriuria was asymptomatic in all but 1 case. Anaerobes were detected in only 5 MSUs (4.3%) post-biopsy. CONCLUSION: Though there was no statistical significant difference in the rates of bacteriuria following administration of trimethoprim and gentamicin, data appear to favour trimethoprim prophylaxis. Further studies are warranted. Transrectal biopsy of the prostate is associated with a low incidence of anaerobic UTI. In view of the very low incidence of anaerobic bacteriuria, routine antibacterial prophylaxis against anaerobes does not appear to be justified.     

经皮肾镜取石术治疗鹿角形结石术前抗生素使用的对比研究

【摘要】 目的 探讨经皮肾镜取石术(PCNL)治疗鹿角形结石术前抗生素的使用,预防术后感染。方法〓选择96例无合并泌尿系感染的鹿角形肾结石拟行PCNL术的患者,分成两组,预防性用药组术前1小时给予抗生素,治疗性用药组术前予以头孢菌素治疗3天,对比术后菌尿、发热的发生率。结果〓预防性用药组49例,术后菌尿发生率18.4%,术后发热发生率26.5%;治疗性用药组47例,术后菌尿发生率4.3%,术后发热发生率10.6%,均低于预防性用药组(P<0.05)。结论〓对于无临床及实验室感染证据的鹿角形结石患者行PCNL术前应用抗生素3天,可有效降低术后菌尿及发热的发生率。     

Urinary tract infection caused by nontyphoidal Salmonella: report of 30 cases.

Thirty cases of nontyphoidal Salmonella bacteriuria were identified by review of cultures performed at the Mayo Clinic (Minn.) from 1985 to 1989 and at the Federal Public Health Laboratory Innsbruck (Austria) from 1979 to 1989. All patients had symptoms of an acute urinary tract infection (UTI). In 24 cases nontyphoidal Salmonella was the sole pathogen isolated. Only 1 patient presented with concomitant gastroenteritis and 2 had experienced episodes of diarrhea during the weeks before the UTI, but 15 patients had positive stool cultures in the absence of a gastrointestinal illness. Among all positive urine cultures at the Mayo Microbiology Laboratory, 0.015% were positive for nontyphoidal Salmonella; at the Federal Public Health Laboratory Innsbruck, 0.024% of organisms cultured from urine were nontyphoidal salmonellae. In the majority of our patients, Salmonella UTI did not differ clinically from UTI caused by other members of the Enterobacteriaceae; only in renal transplant recipients was the course of genitourinary salmonellosis more serious. While some urinary isolates of nontyphoidal Salmonella may be fecal contaminants, all 30 isolates recovered from urine during this study were considered to be the cause of symptomatic UTI.     

Should Antibiotics Be Given Prior to Outpatient Cystoscopy? A Plea to Urologists to Practice Antibiotic Stewardship

BackgroundAntimicrobial resistance is a major health problem, caused primarily by overuse of antibiotics in clinical situations in which they are not necessary. Practice guidelines recommend that antibiotics be given before outpatient cystoscopy to prevent symptomatic urinary tract infection (UTI).ObjectiveTo determine the frequency of febrile UTI after outpatient flexible cystoscopy in antibiotic-naive bladder tumor patients.Design, setting, and participantsA total of 2010 consecutive outpatients with bladder tumors were entered into a prospective registry study. All patients underwent cystoscopy after they submitted a voided urine sample for culture. Significant bacteriuria was defined as >10⁴ colony-forming units per milliliter with a single organism. Patients were stratified for known risk factors for UTI.InterventionPatients underwent flexible cystoscopy and received no antibiotics immediately before or after cystoscopy. They were followed for 30 d for onset of febrile UTI.Outcome measurements and statistical analysisThe end point was incidence of febrile UTI within 30 d of cystoscopy. Febrile UTI was defined as temperature >38 °C and dysuria, or having received antibiotics from an outside physician for urinary symptoms.Results and limitationsOf the 2010 patient cystoscopies, 489 (24%) had asymptomatic bacteriuria, and 1521 (76%) had sterile urine. Thirty-nine patients (1.9%) developed febrile UTI ≤30 d after cystoscopy—4.5% in colonized patients and 1.1% in uninfected patients (p = 0.02). All UTIs resolved in ≤12–24 h with oral antibiotics. None of the patients was admitted for bacterial sepsis. Limitations of the study are that it is a single-surgeon experience in one institution, and results may not apply to other patient populations.ConclusionsAntibacterial therapy before outpatient flexible cystoscopy does not appear necessary in bladder tumor patients who have no clinical signs or symptoms of acute UTI, including asymptomatic bacteriuria. Antibiotic stewardship is the responsibility of all urologists.     

Urinary tract infections and bacteriuria after gynecological surgery: Experience with 24-hour foley catheterization

The risks of urinary tract infection (UTI) and asymptomatic bacteriuria (AB) associated with short-term catheterization have not yet been established. A prospective observational study was carried out to determine the rates of UTI and AB when transurethral Foley catheterization was used for 24 hours. The study population was 193 women undergoing routine gynecologic surgery. All had negative preoperative urine cultures, and prohylactic antibiotics were not used.Postoperative UTI developed in 16 patients (8.3%), i.e. in only 14 of 86 with a positive culture on day 1 after surgery, and in 2 of 107 with a negative culture on day 1. These 16 women received antibiotics; 79 (40.9%) who had transient AB were not treated. There were no cases of upper UTI. Among 31 women discharged with AB, none developed UTI.Although 49.2% of patients in this study had postoperative bacteriuria as measured by midstream culture, only 8.3% of patients actually developed a symptomatic infection requiring treatment. As only a minority (11.3%) of patients with postoperative AB actually developed UTI, it appears that to treat all cases of bacteriuria >100 000 cfu/ml is unnecessary.     

Urodynamic studies in women with stress urinary incontinence: Significant bacteriuria and risk factors

AIM: A prospective study was performed to determine the incidence of significant bacteriuria and to identify the risk factors for bacteriuria after urodynamic studies (UDSs) in women with urodynamic stress urinary incontinence (SUI). METHODS: A total of 225 women with urodynamic SUI were evaluated. All women were negative on double-screened urine cultures, in clean-catch midstream urine (MSU) specimens, before UDS. Another urine specimen was obtained for urinalysis and culture at 3-7 days after UDS. Urinary culture with 10(5) CFU/ml or more was regarded as significant bacteriuria. To identify the risk factors for significant bacteriuria, the clinical characteristics of all patients including age, BMI, parity, medical and operation history, degree of pelvic organ prolapse, results of urinalysis, and UDS were evaluated. RESULTS: The prevalence of significant bacteriuria was 6.2%. The most common identified microorganism was Escherichia coli (57.1%). Univariate analysis demonstrated that a history of recurrent urinary tract infection (UTI; P = 0.002) and urological surgery or procedure (P = 0.02) were significant predictors of significant bacteriuria. On multiple logistic regression analysis the past history of recurrent UTI was the only significant independent risk factor (OR = 28.5, 95% CI = 4.309-188.488, P = 0.009). CONCLUSIONS: This study suggests that for most women with SUI it may be unnecessary to use preventive prophylactic antibiotics in UDS. However, our results suggest that in patients with a previous history of recurrent UTI or urologic surgery the risk for significant bacteriuria is increased and use of prophylactic antibiotics should be considered.