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PubMed1978

Management strategies for urinary and vaginal infections.

Detailed history, physical examination, laboratory and follow-up data were obtained from 821 women coming to a primary care clinic over a two-year period with the symptoms of urinary tract (UTI) or vaginal infection. Using all available information, each patient retrospectively was given one of several mutually exclusive diagnoses. Vaginitis without UTI was diagnosed in 70% of patients, UTI without vaginitis in 12%, UTI and vaginitis in 2%. The conditional probability of the several possible diagnoses was calculated, given various combinations of clinical data; a diagnosis of vaginitis was twice as likely as a diagnosis of UTI in a patient with dysuria. On the basis of these calculations we identified efficient clinical strategies for when to perform a pelvic examination, a urinalysis, and a urine culture, and when to diagnose UTI presumptively on the basis of urinalysis.

Adult↗
PubMed1983

[Clinical studies on long acting amoxicillin in the field of urology].

Long acting amoxicillin (L-AMPC) was studied in the treatment of 40 patients with urinary tract infections. The dosage administered was 1,000 mg/day (b.i.d.) consecutively for 3 days in acute simple UTI and 5 days in chronic complicated UTI. Clinical efficacy was assessed according to the criteria established by the UTI Committee in Japan. Accordingly the response to therapy in 27 patients with acute simple cystitis was excellent in 17, moderate in 8 and poor in 2 cases and for chronic complicated UTI was excellent in 2, moderate in 3 and poor in 6 cases. Thus the overall clinical efficacy ratios for acute simple cystitis and chronic complicated UTI were 93% and 45% respectively. The bacteriological elimination ratios were 25 out of 27 of the causative organisms (93%) for acute simple cystitis and 6 out of 11 for chronic complicated UTI (55%). No side effects of significance were observed. The results obtained demonstrated the usefulness of the b.i.d. administration of L-AMPC and were considered, in the light of previous experience to be similar to those obtained with conventional amoxicillin dosage schedules.

Adult↗
PubMed1981

[Diagnosis, significance and treatment of urinary tract infections].

Although for the diagnosis of urinary tract infection (UTI) quantitative urine bacteriology is generally recommended, certain drawbacks of the method must be taken into consideration. Indications for radiological examinations in UTI are mentioned. The long-term prognosis of UTI is excellent provided the urinary tract is functionally and morphologically intact, even though recurrences may be frequent. In the presence of a pathological urinary tract UTI may lead to destruction of renal parenchyma. Uncomplicated UTI may be treated with suitable antibacterial drugs either conventionally over a one-week course or by single-dose therapy. The prevention of recurrences, which usually are due to reinfection, may be a problem. The treatment of UTI in the presence of special circumstances such as pathological urinary tract, indwelling catheter, or renal insufficiency is briefly discussed.

Anti-Infective Agents, Urinary↗
PubMed1995

Interpretation of multiple isolate urine cultures in adult male patients.

A retrospective analytical study examined the records of 220 adult males (mean age 64.9 years) to determine the relative probability that multiple urine culture isolates (MUI) represent urinary tract infection (UTI) versus contamination or colonization. Nonculture laboratory data were used to determine the likelihood of UTI. Patients were classified into three categories: group 1 (those with single isolate cultures; n = 110), group 2 (those with MUI and either symptomatic UTI or an underlying pathologic condition; n = 71) and group 3 (those with MUI and either surgically altered urinary passages or absence of UTI symptoms; n = 39). Nonculture laboratory data suggested UTI in 48.2% of patients in group 1, 46.5% in group 2, and 23.1% in group 3. Patients in groups 1 or 2 with cultures yielding isolate counts of 10(5) colony forming units/mL were 6.2 times more likely to be classified as having a UTI (by nonculture laboratory data) compared with patients having only one or more of these two criteria. This study proposes a more objective approach to interpretation of MUI cultures using the results of nonculture laboratory data, clinical profiles, and colony counts.

Aged↗
PubMed1993

Nosocomial urinary tract infection: a microbiological study.

Nosocomial urinary tract infection (UTI) is an important cause of increased morbidity and mortality in hospitalised patients. The increasing use of broad spectrum antibiotics will result in changes in the microbiological and antibiotic sensitivity pattern of pathogens isolated from nosocomial UTI. We have endeavoured to study the bacteriological pattern of nosocomial UTI and the antibiotic sensitivity patterns of the pathogens concerned. Over a period of one year, a total of 541 patients with 656 episodes of nosocomial UTI were studied. A total of 748 organisms were isolated. The two main complicating factors in nosocomial UTI were urogenital instrumentation (70.4%) and diabetes mellitus (24.2%). Klebsiella species (spp) was the predominant organism isolated (25.0%) and was significantly associated with age and diabetes mellitus. Klebsiella spp in nosocomial UTI showed an overall increase in resistance to antibiotics and multiple antibiotic resistant strains were not uncommon. Escherichia coli was isolated in 17.7% of cases. Streptococcus faecalis was isolated in 10.6% of cases and was significantly associated with instrumentation. Pseudomonas spp was isolated in 8.6% of cases and was generally sensitive to ceftazidime and amikacin. It was associated with systemic malignancies and the use of immunosuppressants.

Adolescent↗
PubMed1993

The prevention and management of urinary tract infections among people with spinal cord injuries. National Institute on Disability and Rehabilitation Research consensus statement. January 27-29, 1992.

The Urinary Tract Infection Consensus Conference brought together researchers, clinicians, and consumers to arrive at consensus on the best practices for preventing and treating urinary tract infections in people with spinal cord injuries; the risk factor and diagnostic studies that should be done; indications for antibiotic use; appropriate follow-up management; and needed future research. Urinary tract infection (UTI) was defined as bacteriuria (102 bacteria/ml of urine) with tissue invasion and resultant tissue response with signs and/or symptoms. Asymptomatic bacteriuria represents colonization of the urinary tract without symptoms or signs. Risk factors include: over-distention of bladder, vesicoureteral reflux, high pressure voiding, large post-void residuals, presence of stones in urinary tract, and outlet obstruction. Possible physiologic/structural, behavioral, and demographic risk factors were identified also, Indwelling catheterization, including suprapubic, and urinary diversion and the drainage methods most likely to lead to persistent bacteriuria. Infection risk is reduced with intermittent catheterization, but more severely disabled people who require catheterization by others are at greater risk for UTIs. Clean self-intermittent catheterization does not pose a greater risk of infection than sterile self-intermittent catheterization and is much more economic. However, care must be given to proper cleansing of reusable catheters. Quantitative urine-culture criteria for the diagnosis of bacteriuria include: catheter specimens from individuals on intermittent catheterization > or = 10(2) cfu/ml; clean-void specimens from catheter-free males using condom collection devices > or = 10(4) cfu/ml; and specimens from indwelling catheters of any detectable concentration. Dip stick screening tests may offer promise as an early warning system of UTI since they can be self-administered. Symptomatic UTI should be treated with antibiotics for 7 to 14 days. Longer courses have not been beneficial. In patients with symptomatic UTIs, it is not necessary to wait for the results of cultures before starting treatment. Asymptomatic bacteriuria need not be treated with antibiotics. There is little evidence presently to support the use of antibiotics to prevent infections. Following a recent episode of febrile UTI, possible contributing prior events should be reviewed. The upper tracts should be evaluated (imaging studies) to identify possible abnormalities. A common concern among people with spinal cord injuries is that physicians will alter bladder management programs without regard to lifestyle needs. Social/vocational flexibility may be more important to them than a state-of-the-art bladder management program. Future research should focus on obtaining more representative samples and investigate psycho-social-vocational implications as well as additional clinical-medical factors.

Anti-Bacterial Agents↗
PubMedDate not supplied

[Clinical, epidemiologic, and microbiologic study of urinary infection in patients with renal transplant at a specialized center in Argentina].

Sixty-four patients were evaluated for urinary tract infection (UTI) during the first six months after renal transplantation. Eighty per cent received the allograft from a living, related donor and 37% were female. The median age was 33.8 years. All the patients received cefazolin as perioperative antibiotic prophylaxis. No prophylaxis was given during the bladder catheterization period, which had a median duration of 5.9 days. Nineteen per cent developed predisposing urological factors (PUF). The incidence of UTI was 41% and 15% of all these patients developed bacteremia from this source. UTI was observed in 50% of the patients without PUF between the 5th and 12th days post-transplantation, and these cases had been detected by the control urine culture performed when the bladder catheter was withdrawn. This group of patients accounted for 14% of all the patients. Recurrence was present in 42% of the patients with UTI (19% had reinfection, 4% relapse and 19% both). They were more frequent in patients with PUF than in the patients without; 78% vs. 24%, respectively (p < 0.05). The overall UTI incidence was also higher; 75% vs. 33%, respectively (p < 0.05). The same was observed for the median number of episodes (3 vs. 1). The organisms most frequently isolated were E. faecalis (21%). E. cloacae (17%), and E. coli (17%). Species prevalence differs from that of other reports, probably due to the different institutional antibiotic management. Since half of the UTI episodes suffered by patients without PUF were associated to bladder catheterization, there is a need to institute antibiotic prophylaxis in our center.

Adolescent↗
PubMed1995

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from urinary tract infections (1990). III. Secular changes in susceptibility].

Susceptibilities of Enterococcus faecalis, Citrobacter spp., Enterobacter spp., Escherichia coli, Klebsiella spp., Proteus mirabilis, Pseudomonas aeruginosa, Serratia spp. isolated from patients with urinary tract infections (UTIs) in 10 hospitals during June 1990 to May 1991 to various antimicrobial agents were compared with those in the same period of previous years according to a classification, uncomplicated UTIs, complicated UTIs without indwelling catheter, and complicated UTIs with indwelling catheter. The susceptibilities of E. faecalis to minocycline (MINO) and ofloxacin (OFLX) has decreased. As for Citrobacter spp., Enterobacter spp. and P. mirabilis, which were detected very few in 1989 and 1990, their susceptibilities were not observed an obvious change. The susceptibilities of E. coli to MINO was observed a very clear alteration, that is, in uncomplicated UTIs and complicated UTIs, the susceptibilities has decreased. However, the susceptibilities of Klebsiella spp., P. aeruginosa and Serratia spp. were not observed an obvious variation.

Anti-Bacterial Agents↗
PubMed1996

[Use of antibiotics in primary care: treatment of urinary infection].

OBJECTIVES: To analyse the primary care therapeutic approach to urinary tract infections (UTI), and, a secondary objective, to obtain information on the microbiological profile and resistance to antibiotics in this field, with the aim of making therapeutic recommendations. DESIGN: The UTI diagnosed through systematic checking of sediment and/or culture, requests from health centres are described. SETTING: 9 Health Centres in Palma (Mallorca) during November 1992. PATIENTS AND OTHER PARTICIPANTS: Out of 2,484 requests for sediment and/or uroculture, clinical history was found in 2,033. At the end there were 232 patients whose request for analysis was for suspected UTI, among whom there were 43 recurring cases, which meant a total of 275 cases. MEASUREMENTS AND MAIN RESULTS: The most frequent germ was Escherichia coli. 68% had complicated UTI. Empirical treatment was carried out in 60.7%. Treatment of the first episode of UTI was with quinolones in 73.3% of cases, with norfloxacine in 44.1%. There was a higher percentage of resistance of Escherichia coli to cotrimoxazole (49.0%), ampicilline-sulbactam (46.4%), ampicilline (42.0%) and cephalexin (31.4%). In 50 cases there was therapeutic failure, due (among the most commonly used drugs) to norfloxacine in 12.4%, to cotrimoxazole in 28.6%, to norfloxacine in 27.3% and to pipemidic in 18.9%. CONCLUSIONS: There are many more specific than empirical treatments as well as excessive use of drugs not recommended as first choice in primary care. The level of resistance to the new quinolones is considerable and is greater still for some antimicrobial drugs used for UTI.

Adolescent↗
PubMed1996

Asymptomatic bacteriuria among diabetics attending Kenyatta National Hospital.

Significant asymptomatic bacteriuria is an important cause of pyelonephritis and gram negative septicaemia among certain predisposed individuals, such as diabetics. We investigated the incidence of asymptomatic urinary tract infections (UTIs) among our diabetic patients and the type and antibacterial sensitivity patterns of the organisms causing these UTIs. One hundred and thirty five patients submitted midstream urine specimens for culture. Fifteen patients had positive cultures showing the incidence of asymptomatic UTI to be 11.1%. There were ten female and five male patients with UTI. The commonest organism isolated was Escherichia coli at 40%. Gram negative bacilli made up 66.7% of the isolates. Isolates were poorly sensitive to the regularly available antibiotics-ampicillin (33% sensitive, cotrimoxazole (33% sensitive). Nitrofurantoin inhibited growth in 93% of the isolates. Other antimicrobials with over 80% sensitivity level included: gentamicin, ceftazidime, augmentin, cefuroxime and norfloxacin. They are expensive or require parenteral administration. The incidence of asymptomatic UTI is high among diabetics and although the organisms isolated are those usually isolated in UTIs, they are not that sensitive to the commonly available and antibacterial agents.

Adolescent↗
PubMedDate not supplied

[Risk factors and length of stay attributable to hospital infections of the urinary tract in general surgery patients].

BACKGROUND: Urinary tract infection (UTI) is the second frequent site of infection in surgical patients; nevertheless, its study has been frequently neglected. The main objective of this report is the analysis of risk factors for ITU in general surgery. METHODS: A prospective study on 1,483 patients admitted at a service of general surgery for a 20-month study period has been carried out. The criteria used for diagnosing nosocomial were those of the CDC. Crude and adjusted for by logistic regression relative risks and its 95% confidence interval were estimated. To assess the length of stay attributable to UTI, infected patients were 1:1 matched with non-infected patients for surgical procedure, ASA score, age (+/- 10 years), emergency surgery, pre-operative stay, and urinary catheter. RESULTS: 33 patients (2.2%) developed UTI. In crude analysis, UTI risk was significantly associated with urethral catheter (and its duration), advanced age, severity of illness (McCabe-Jackson scale, ASA score, number of diagnoses), type of surgical wound, intrinsic risk of infection (measured by the SENIC and NNIS indices). Stepwise logistic regression analysis selected three independent predictors: urethral catheter, age and pre-operative stay. All urinary drain-ages were open. UTI prolonged hospital stay 4.7 days (95% Cl 3.4-6.2). The use of closed drain-age systems would eliminate 6 UTIs. Assuming a cost per day of hospital stay of $250 the use of closed systems would save $7,000 (IC 95%, 5300-9300). CONCLUSION: The use of closed systems for urethral catheters is cost-saving.

Adult↗
PubMed1998

Evaluation and treatment of urinary tract infections in children.

Urinary tract infections (UTIs) are among the most common bacterial infections encountered by primary care physicians. Although UTIs do not occur with as great a frequency in children as in adults, they can be a source of significant morbidity in children. For reasons that are not yet completely understood, a minority of UTIs in children progress to renal scarring, hypertension and renal insufficiency. Clinical presentation of UTI in children may be nonspecific, and the appropriateness of certain diagnostic tests remains controversial. The diagnostic work-up should be tailored to uncover functional and structural abnormalities such as dysfunctional voiding, vesicoureteral reflux and obstructive uropathy. A more aggressive work-up, including renal cortical scintigraphy, ultrasound and voiding cystourethrography, is recommended for patients at greater risk for pyelonephritis and renal scarring, including infants less than one year of age and all children who have systemic signs of infection concomitant with a UTI. Antibiotic prophylaxis is used in patients with reflux or recurrent UTI who are at greater risk for subsequent infections and complications.

Child↗
PubMed1997

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from patients with urinary tract infections (1995). I. Susceptibility distribution].

The frequencies of isolation and susceptibilities to antimicrobial agents were investigated on 704 bacterial strains isolated from patients with urinary tract infections (UTIs) in 11 hospitals during the period of June 1995 to May 1996. Of the above bacterial isolates, Gram-positive bacteria accounted for 29.8% and a majority of them were Enterococcus faecalis. Gram-negative bacteria accounted for 70.2% and most of them were Escherichia coli. Susceptibilities of several isolated bacteria to antimicrobial agents were as followed; 1. Enterococcus faecalis Ampicillin (ABPC) and imipenem (IPM) showed the highest activities against E. faecalis isolated from patients with UTIs. The MIC90S of them were 1 microgram/ml. Vancomycin (VCM) and piperacillin (PIPC) were also active with the MIC90S of 2 micrograms/ml and 4 micrograms/ml, respectively. The others had low activities with the MIC90S of 16 micrograms/ml or above. 2. Staphylococcus aureus including MRSA VCM showed the highest activities against S. aureus isolated from patients with UTIs. Its MIC90 was 1 microgram/ml against both S. aureus and MRSA. Arbekacin (ABK) was also active with the MIC90 of 2 micrograms/ml. The other except minocycline (MINO) had very low activities with the MIC90S of 64 micrograms/ml or above. 3. Staphylococcus epidermidis ABK and MINO showed the strongest activities against S. epidermidis isolated from patients with UTIs. The MIC90S of them were 0.25 microgram/ml. VCM was also active with the MIC90 of 1 microgram/ml. The MIC90S of cephems ranged from 2 micrograms/ml to 16 micrograms/ml in 1994, but they ranged from 8 micrograms/ml to 128 micrograms/ml in 1995. These results indicated that some resistances existed among S. epidermidis to cephems. 4. Streptococcus agalactiae All drugs except gentamicin (GM) were active against S. agalactiae. ABPC, cefmenoxime (CMX), IPM, erythromycin (EM), clindamycin (CLDM) and clarithromycin (CAM) showed the highest activities. The MICs for all strains were lower than 0.125 microgram/ml. The MIC90S of the others were 2 micrograms/ml or below. 5. Citrobacter freundii IPM showed the highest activity against C. freundii isolated from patients UTIs. Its MIC90 was 1 microgram/ml. GM was also active with the MIC90 of 2 micrograms/ml. Cefpirome (CPR), cefozopran (CZOP) and amikacin (AMK) were also active with the MIC90S of 4 micrograms/ml. Penicillins and cephems except CMX, CPR and CZOP showed low activities with MIC90S of 256 micrograms/ml or above. 6. Enterobacter cloacae IPM showed the highest activity against E. cloacae. The MICs for all strains were equal to or lower than 1 microgram/ml. MINO and tosufloxacin (TFLX) were also active with the MIC90S of 8 micrograms/ml. Penicillins and cephems except CPR and CZOP showed lower activities with the MIC90S of 256 micrograms/ml or above. 7. Escherichia coli. Most of the antimicrobial agents were active against E. coli. Particularly CPR, CZOP and IPM showed the highest activities against E. coli. The MICs for all strains were equal to or lower than 0.5 microgram/ml. CMX and TFLX were also active with the MIC90S of 0.125 microgram/ml or below. Penicillins were slightly active with MIC90S of 128 micrograms/ml or above. 8. Klebsiella pneumoniae K. pneumoniae was susceptible to all drugs except penicillins, with MIC90S of 2 micrograms/ml or below. Carumonam (CRMN) had the strongest activity against K. pneumoniae, the MICs for all strains were equal to or lower than 0.125 microgram/ml. Comparing with the result of 1994, the sensitivities of K. pneumoniae against all drugs had obviously changed into a better state. For example, the MIC90S of cephems ranged from 0.25 microgram/ml to 16 micrograms/ml in 1994, but they were all lower than 2 micrograms/ml in 1995. 9. Proteus mirabilis P. mirabilis was susceptible to a majority of drugs. CMX, ceftazidime (CAZ), cefixime (CFIX), and CRMN showed the highest activities against P. mirabilis isolated from patients with UTIs. MICs of CRMN for all

Anti-Bacterial Agents↗
PubMed1998

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from patients with urinary tract infections (1996), III. Secular changes in susceptibility].

Susceptibilities to various antimicrobial agents were examined for Enterococcus faecalis, Staphylococcus aureus, Escherichia coli, Klebsiella spp., and Pseudomonas aeruginosa that were isolated from patients with urinary tract infections (UTIs) in 10 hospitals during June 1996 to May 1997, and the results were compared with those obtained during the same period in earlier years. 1. E. faecalis Among E. faecalis strains, those with high susceptibilities to ampicillin and minocycline appeared to have decreased in the latest study period. 2. S. aureus To almost antimicrobial agents, S. aureus isolated from uncomplicated UTIs showed low susceptibilities. But the MIC50s of those agents for S. aureus from complicated UTIs have changed better state. Particularly, the MIC50s of imipenem and clindamycin were 0.125 microgram/ml or below in the latest period for the first time in our history. 3. E. coli The susceptibilities to piperacillin and quinolones of E. coli isolated from uncomplicated UTIs were better than those isolated from complicated UTIs. 4. Klebsiella spp. The susceptibilities to almost antimicrobial agents of Klebsiella spp. have been better during the latest period, compared to those during period of 1995-1996, but to ofloxacin and ciprofloxacin have appeared to have been lower. 5. P. aeruginosa The susceptibilities to quinolones of P. aeruginosa have been better during the latest period compared those during periods of 1995-1996. But, the susceptibilities to cefozopran, carbapenems and monobactams of P. aeruginosa isolated from complicated UTIs appeared to have been lower. These susceptibility changes should be utilized in determining clinical treatments.

Anti-Bacterial Agents↗
PubMed1998

Update on childhood urinary tract infections and reflux.

Urinary tract infections (UTIs) are a common and potentially serious source of morbidity in infants and children. In the absence of identifiable structural and/or functional abnormality of the urinary tract that would predispose to UTI, such as vesicoureteric reflux (VUR), significant and permanent injury to the renal parenchyma (pyelonephritic scarring) from UTI is uncommon. However, those patients with such predisposing conditions are at risk for adverse long-term outcomes of pyelonephritic scarring such as hypertension and/or impairment of glomerular filtration rate (GFR). Although the acute symptomatology usually responds promptly to proper antibiotic therapy, the treating physician must be concerned with a number of intermediate and long-term health outcomes. Specifically, is bacteriuria associated with renal parenchymal inflammation? If so, will it heal with restoration of normal architecture (and function), or will there be replacement of formerly healthy renal tissue with fibrosis? How can future UTIs, each with their attendant risk of pyelonephritic scarring, be prevented? What combination of initial diagnostic tests and follow-up management are best suited for which patients to minimize such adverse outcomes? The approach to the diagnostic evaluation for structural and functional disturbances in the urinary tract that would predispose to UTI has evolved to answer these questions. This review will focus on the recent advances in the detection and management of uropathology associated with UTI, particularly that of vesicoureteral reflux (VUR).

Causality↗
PubMed1998

Urinary tract infections in children: why they occur and how to prevent them.

Urinary tract infections (UTIs) usually occur as a consequence of colonization of the periurethral area by a virulent organism that subsequently gains access to the bladder. During the first few months of life, uncircumcised male infants are at increased risk for UTIs, but thereafter UTIs predominate in females. An important risk factor for UTIs in girls is antibiotic therapy, which disrupts the normal periurethral flora and fosters the growth of uropathogenic bacteria. Another risk factor is voiding dysfunction. Currently, the most effective intervention for preventing recurrent UTIs in children is the identification and treatment of voiding dysfunction. Imaging evaluation of the urinary tract following a UTI should be individualized, based on the child's clinical presentation and on clinical judgment. Both bladder and upper urinary tract imaging with ultrasonography and a voiding cystourethrogram should be obtained in an infant or child with acute pyelonephritis. Imaging studies may not be required, however, in older children with cystitis who respond promptly to treatment.

Algorithms↗
PubMed1998

Screening for urinary tract infection in children with cancer.

Neutropaenia and immunosuppression place children on treatment for malignancies at a high risk for infections. We undertook to determine the prevalence of urinary tract infection (UTI) in children on treatment for cancer at the Kenyatta National Teaching and Referral hospital. With the understanding that many laboratories in the rural areas of the country lack appropriate facilities for confirmation of UTI, it was also important to evaluate simple and inexpensive screening methods against a "gold standard" in this cross sectional study. One hundred and eighty six children between the ages of five and 14 years admitted in Kenyatta hospital with leukaemia or lymphoma were enrolled. Besides clinical evaluation, urinalysis and culture and sensitivity were performed on all the subjects. Urine culture was considered the "gold standard" for diagnosis for UTI. The prevalence of UTI was 8.1% (CI = 6.1, 10.1). Only five out of 15 patients were symptomatic. E. coli and klebsiella spp. were responsible for 93.4% of the infections. Presence of pyuria, defined as five or more pus cells per high power field, had a sensitivity of 80.0%, specificity of 97.1% and a positive predictive value of 70.6% while comparative values associated with a positive nitrite test were 60%, 97.7% and 96%. Other clinical and laboratory tests had low sensitivity. UTI is a relatively frequent infection in children on cancer treatment. Screening for pyuria is simple, inexpensive and an accurate method of diagnosing UTI in children on treatment for lymphohaematopoietic malignancies in situations where facilities for urine culture are unavailable.

Adolescent↗
PubMed1999

Preventing catheter-related bacteriuria: should we? Can we? How?

Up to 25% of hospitalized patients undergo urinary catheterization, and about 5% develop bacteriuria each day of catheterization. Catheter-related bacteriuria is associated with increased morbidity and mortality. We performed an evidence-based synthesis of the literature on preventing catheter-associated urinary tract infections (UTIs) to develop recommendations for clinicians. Catheterization should be avoided when not required and when needed, should be terminated as soon as possible. Use of suprapubic and condom catheters may be associated with a lower risk of UTI than use of urethral catheters. Aseptic catheter insertion and a properly maintained closed drainage system are crucial to reducing the risk of bacteriuria. Instillation of antimicrobial agents into the bladder or urinary drainage bag and rigorous meatal cleansing seem to be of little benefit. Use of urinary catheters coated with silver alloy may reduce the risk of UTI. Systemic antimicrobial drug therapy seems to prevent UTIs, but primarily for patients catheterized for 3 to 14 days. Antibiotic drug prophylaxis is especially valuable in patients undergoing transurethral resection of the prostate or renal transplantation. Using these methods, urinary catheter-associated UTI can often be prevented for weeks, but not longer terms.

Anti-Infective Agents, Urinary↗