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PubMed2000

[Is dysuria useful for the diagnosis of infection of the urinary tract?].

OBJECTIVE: To assess the validity of criterion and predictive value of dysuria for the diagnosis of UTI. DESIGN: Cross-sectional study to assess a symptom. SETTING: Six general medicine clinics (four urban clinics and two rural clinics) in the 11th Health Area in Madrid. PATIENTS: The sample consists of 232 patients aged above fourteen who consulted during six consecutive months (116 of them reported having dysuria and 116 were asymptomatic). MEASUREMENTS AND MAIN RESULTS: The diagnosis of urinary tract infections (UTI) was achieved through positive urine cultures or bacteriuria and leukocyturia in the centrifuged urine sediment. The sensitivity (S) of dysuria analysis for the diagnosis of UTI, its specificity (E), its predictive value (VP), and its probability coefficient (CP) were considered. Average age of the sample was 54 years old (range 19-82); 73% of the patients were female. No statistically significative difference of sex and age was found between cases and non-cases (p > 0.1). Dysuria showed a 96% of sensitivity (95% CI, 86-98%), a 69% of E (95% CI, 61-76%) and 3.1 of CPP (95% CI, 2.7-3.5) for UTI diagnosis. In the women subgroup there was 95% of sensitivity (95% CI, 84-99%) and 67% of E (95% CI, 58-75%). A positive predictive value of 30% (95% CI, 22-40) and a negative predictive value of 99% (95% CI, 95-100) were estimated for this symptom. CONCLUSIONS: The diagnosis of urinary tract infections is unlikely in the absence of dysuria, but to treat all dysuria patients as UTI entails a high rate of overtreatment.

Case-Control Studies↗
PubMed2002

Haemolytic Escherichia coli isolated from dogs with diarrhea have characteristics of both uropathogenic and necrotoxigenic strains.

Twenty-four haemolytic Escherichia coli strains were isolated from dogs with diarrhea. The strains were serotyped and analysed by polymerase chain reaction (PCR) for genes encoding virulence factors associated with E. coli that cause diarrhea in animals. Adhesion antigen production was deduced from haemagglutination experiments. Sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) of heat extracts was also used as an indication for the production of adhesive structures. The majority of the strains was shown to produce this type of virulence factor. Adhesion and invasion tests of the strains and Caco-2 cells showed that all strains adhered and that two were invasive. The two invasive strains were positive in the intimin PCR and one of them also contained genes encoding CS31A. The PCR for heat stable toxin (ST) was positive in only four strains, as was the presence of F17 fimbrial genes. Surprisingly, 19 strains had intact P fimbrial operons, coding for an adhesin involved in urinary tract infection (UTI). The cytotoxic necrotising factor 1 (CNF1) gene, also mainly found in UTI was likewise detected in these 19 strains. Cytolethal distending toxin (Cdt) genes were found in five strains. The high number of strains positive for CNF1 and P fimbriae prompted us to test the strains in a multiplex PCR used to test E. coli isolated from UTI in various species for 30 virulence associated genes. The data showed that the majority of the diarrhea isolates have virulence factor profiles highly similar to UTI E. coli isolates from dogs. This raises the question whether these isolates are real intestinal pathogens or "innocent bystanders". However, since CNF1 producing necrotoxic E. coli (NTEC) strains isolated from humans, pigs and calves with diarrhea appear to be highly related to our strains, it might be that in dogs this type of isolate is capable of causing not only UTI, but also diarrhea. If this is the case and this type of isolate is "bifunctional", domestic animals likely constitute a reservoir of NTEC strains which can be also pathogenic for humans.

Adhesins, Bacterial↗
PubMed2003

The host response to urinary tract infection.

The authors use the UTI model to identify basic mechanisms of disease pathogenesis, host response induction, and defense. Their studies hold the promise to provide a molecular and genetic explanation for susceptibility to UTI, and to offer more precise tools for diagnosis and therapy of these infections. There are few infections where the host response is understood in such detail and where pathologic host responses can be linked to distinct disease states. The susceptibility to UTI varies greatly in the population. The studies suggest that distinct molecular defects can cause the clinical entity of acute pyelonephritis with renal scarring, and suggest that the susceptibility to UTI in certain patient groups may have a genetic basis. In addition, the distinct signal transduction pathways explain the development of symptoms, and propose that defects in those signaling mechanisms may occur in patients with ABU. In the future, it may be useful to include these host response parameters in the diagnostic arsenal, to help in early detection of patients susceptible to recurrent UTI and renal scarring. These patients may then be offered therapies that strengthen their defense, and be offered close surveillance for recurrences and other complications.

Animals↗
PubMed1996

The cost-effectiveness of placing urinary tract infection treatment over the counter.

We use cost-effectiveness analysis to estimate the economic and health implications of approving the over-the-counter sale of oral antibiotics for treatment of urinary tract infection (UTI). We consider two alternatives for over-the-counter availability and examine the reduced economic cost from avoided doctors' visits, along with the potential additional costs associated with higher over-the-counter treatment prices or increased use due to greater access. We also consider important noneconomic costs such as reduced symptom days, restricted activity days, and growing resistance to antibiotics. Our analysis covers a 20-year time horizon to capture the long-term effects, from a societal perspective, of a policy decision to place UTI treatment over the counter today. In addition, we present sensitivity analyses to test the effects of the assumptions in our model. We estimate that the economic costs of placing UTI treatment over the counter outweigh the benefits, unless there is extensive patient education and a mechanism for allowing patients to properly self-diagnose to reduce markedly the number of doctors' visits, mistreated symptoms, and threat of resistance to antibiotics. Only if doctors' visits were reduced to 64.6% of current levels would the economic benefits of over-the-counter treatment begin to be realized. UTI is one of the most common complaints among women and accounts for a large number of doctor visits each year. However, the costs of over-the-counter distribution of UTI treatment, particularly those due to the risk of decreasing the time until standard treatments become ineffective due to bacterial resistance, outweigh the short-term gains of decreased symptom days and increased access to treatment.

Adolescent↗
PubMed2001

Host pathogenesis in urinary tract infections.

Urinary tract infections (UTIs) are the result of an interaction between bacterial virulence and host defense factors that compete to invade or protect the host, respectively. Research over the past 30 years has demonstrated that vaginal colonization with uropathogens precedes most UTIs. Receptivity of the vaginal mucosa for uropathogens is an essential initial step in vaginal mucosa colonization. When vaginal and buccal epithelial cells were collected from patients susceptible to reinfection and compared with such cells obtained from controls resistant to UTIs, the strains that caused cystitis adhered much more avidly to the epithelial cells from susceptible women. These genotypic traits for epithelial cell receptivity may be a major susceptibility factor in UTIs. The presence or absence of blood group determinants on the surface of uroepithelial cells may influence an individual's susceptibility to UTIs. The protective effect in women with the secretor phenotype may be due to fucosylated structures at the cell surface which decrease the availability of putative receptors for Escherichia coli. Susceptibility among women who do not secrete blood group antigens may be due to specific E. coli-binding glycolipids that are absent in women who secrete blood group antigens. Recent studies have shown that the vaginal fluid, which forms an interface between uropathogens and epithelial cells, also influences vaginal colonizations.

Bacterial Adhesion↗
PubMed2002

Correlation between pharmacokinetic/pharmacodynamic parameters and efficacy for antibiotics in the treatment of urinary tract infection.

Antibiotic treatment of urinary tract infection (UTI) depends on the antibiotic being able to inhibit the growth or to kill the bacteria present in the urinary tract. The pharmacokinetics of antibiotics in the urinary tract including the kidneys, the bladder and the prostate are briefly reviewed. The conclusion is that high urinary antibiotic concentrations can eradicate bacteria in the urine, but in the kidney tissue levels must surpass the MIC of the infecting pathogen to achieve effect. Pharmacodynamic studies in UTI are relatively scarce, but recent studies have shown, that as for other types of infections, beta-lactam antibiotic treatment of UTI depends on the T(>MIC), i.e. the time the antibiotic concentration remains above the MIC. This counts for activity against bacteria in the kidneys as well as in the urine. Bacterial counts in the bladder are curiously resistant to the activity of most antibiotics. For drugs with concentration dependent time-kill activity such as the fluoroquinolones and the aminoglycosides, the effect in UTIs is dependent on the peak/MIC ratio or AUC/MIC ratio. The aminoglycosides are difficult to evaluate in this context, since they are bound in high concentrations to the renal cortex. For clinical studies the author reviews the literature for aminopenicillins (ampicillin and amoxycillin) as representatives of beta-lactam antibiotics. Data from 16 studies of uncomplicated UTI encompassing 20 treatment groups showed a significant correlation between the cumulative T(>MIC) and bacteriological cure, such that a cumulative T(>MIC) of 30 h was necessary for a maximal cure rate of 80-90%. Incorporating these data including the T(>MIC) for the aminopenicillins, the optimal dose with minimal consumption of drug can be calculated, i.e. for amoxycillin 500 mg TID for 4 days. Further research is needed to calculate optimal dosages for other types of antibiotics, especially in order to prevent development of resistance.

Anti-Bacterial Agents↗
PubMed2003

Pivmecillinam--therapy of choice for lower urinary tract infection.

Pivmecillinam is the pro-drug of mecillinam, a beta-lactam antibiotic with a novel site of action and with specific and high activity against Gram-negative organisms such as Escherichia coli and other Enterobacteriaceae. Since its introduction, it has been widely used for the treatment of acute lower urinary tract infections (UTI), primarily in the Nordic countries. In contrast to the increasing resistance of urinary pathogens to other beta-lactams particularly ampicillin/amoxycillin and to other UTI antibiotics such as trimethoprim and trimethoprim/sulphamethoxazole (TMP/SMX), the level of resistance has remained on a low level. Less than 2% of E. coli community isolates are resistant to mecillinam. This paper reviews the clinical data on pivmecillinam with a special focus on the safety aspects. A large number of studies from the 70s to 80s have proven the clinical efficacy and safety of pivmecillinam for empirical treatment of acute cystitis. More recent studies confirm short-term treatment with pivmecillinam results in clinical and bacteriological cure rates similar to those obtained with other UTI agents. Both clinical studies in pregnant women with UTI and large epidemiological studies have confirmed the safety of pivmecillinam used in pregnancy. In the Nordic countries pivmecillinam has been the most widely used agent for treatment of UTI in pregnancy for many years. Ecological aspects of antibiotic treatment are important both with regard to adverse effects and development of resistance due to disturbance of the normal micro flora. Studies have shown that pivmecillinam has a very minor impact on the normal oropharyngeal, intestinal and skin microflora. The clinical implications of this are a low frequency of diarrhoea and Candida vaginitis as confirmed in the clinical studies. The high and increasing level of resistance among E. coli to currently recommended first-line agents for acute cystitis requires a re-evaluation of treatment guidelines. With the low resistance, its proven efficacy and favourable safety profile, pivmecillinam is a suitable first-line agent for empirical treatment of acute cystitis.

Amdinocillin Pivoxil↗
PubMed1999

Urinary tract infection in geriatric patients.

Elderly patients with urinary tract infection (UTI) are believed less likely to be cured by antimicrobial therapy than younger patients. The reasons for this poorer outcome have not yet been clarified. We have investigated the effect of antimicrobial therapy in elderly patients with complicated UTI. Four-hundred and eighty patients, 244 men and 236 women, who had complicated UTI (266 symptomatic and 236 asymptomatic) and were 20-79 years of age, were treated with one of three different drugs; one was a newer quinolone and two were oral cephems. Multivariate logistic regression analysis of treatment outcome revealed that the clinical response was significantly related to general underlying diseases and diseases of the urinary tract, but not to age, symptomatic or asymptomatic UTI, or infection site such as the kidney or bladder. We concluded that the clinical effectiveness of an antimicrobial agent was not directly related to age, and that urological examination for underlying diseases and control of them is quite important for effective treatment and control of complicated UTIs, especially in elderly patients.

4-Quinolones↗
PubMed2003

Evaluation of Proteus mirabilis structural fimbrial proteins as antigens against urinary tract infections.

Proteus mirabilis is a common cause of urinary tract infection (UTI) and produce several types of different fimbriae, including mannose-resistant/Proteus-like fimbriae, uroepithelial cell adhesin (UCA), and P. mirabilis fimbriae (PMF). Different authors have related these fimbriae with different aspects of P. mirabilis pathogenesis, although the precise role of fimbriae in UTI has not yet been elucidated. In this work we expressed and purified recombinant structural fimbrial proteins of these fimbriae (MrpA, UcaA, and PmfA) and assessed their role as protective antigens using an ascending and a haematogenous model of UTI in the mouse. MrpA protected subcutaneously immunised mice in both models, suggesting that it could be taken into account as a promising vaccine candidate against P. mirabilis UTI. UcaA could also be an interesting subunit to be studied although it only protected mice that were challenged intravenously. All subunits elicited a strong specific serum IgG response but there was no significant correlation between antibody levels and protection. Only PmfA-immunised mice elicited a significant urinary antibody response but this protein was unable to confer protection against P. mirabilis experimental challenges. These results may contribute to the development of vaccines against P. mirabilis, an important cause of complicated UTI.

Animals↗
PubMed1990

The value and significance of routine urine cultures in patients referred for radiation therapy of prostatic malignancy.

Radiation therapy of the prostate requires a simulator visit when a urinary catheter and rectal balloon are used for field determination. Radiation changes combined with the previous instrumentation, surgery and therapy makes diagnosing urinary tract infection (UTI) difficult. For this study a UTI was defined as the isolation of the same organism(s) at any concentration in two of three sequential urine samples. Urine cultures were obtained prior to radiation therapy (during and after the simulator visit) and while receiving radiation treatments. The study of 291 patients revealed a UTI in 20 (6.9%) prior to undergoing simulator evaluation and in an additional 13 patients at the first visit after to give an incidence of 11.34% prior to receiving radiation. The bacterial isolates in the 13 patients were more suggestive of reactivated chronic infection than catheter associated UTI. During radiation therapy approximately 1%-2% of patients developed a UTI per week. This study justified the use of routine urine cultures in these patients and suggests that further investigations should be done to reduce the incidence of infections occurring both prior to and during radiation therapy.

Bacteria↗
PubMed2004

Pathogenesis of urinary tract infections with normal female anatomy.

Recurrent urinary tract infections (UTIs) are common among girls and young women who are healthy and have anatomically normal urinary tracts. These infections are a main source of morbidity and health-care costs in this population. The interaction between specific infecting bacteria and urinary tract epithelium characteristics underlies the pathogenesis of this disease. Several pathogen-related factors predispose people to recurrent UTI, including periurethral bacterial colonisation and Escherichia coli virulence. Host behavioural risk factors include voiding dysfunction, high intercourse frequency, and oral contraceptive and spermicide use. The role of vesicoureteral reflux in recurrent childhood UTI is probably overestimated in the medical literature and is important only in a small group of children with high-grade reflux. Family pedigree analysis suggests a familial genetic predisposition for UTI among young females. Animal models show the multigenic nature of recurrent UTI. Putative candidate genes for the disease include ABH blood groups, interleukin-8 receptor (CXCR1), the human leucocyte antigen locus, toll-like receptors, tumour necrosis factor, and Tamm-Horsfall protein.

Bacterial Infections↗
PubMed2006

Asymptomatic bacteriuria among the institutionalized elderly.

BACKGROUND: Urinary tract infections (UTI) are the most common type of infection among residents of long-term care facilities (LTCFs). The presence of asymptomatic bacteriuria among LTCF residents brings challenges to onsite health professionals. The aim of this study was to explore the prevalence and related factors of aymptomatic bacteriuria among the institutionalized elderly in Taiwan. METHODS: In 2002, residents of 2 private LTCFs participated in this study. History taking, anthropometric measurements, and urine and blood samplings were performed by experienced research staff. Urine bacterial culture was performed by a standard procedure; subjects with symptoms indicating UTI were excluded. Repeated urine bacterial culture was performed 1 week after screening tests. Bacteriuria was defined as 1 or more organisms isolated from 2 consecutive urine specimens (> or =10(5) CFU [colony-forming units]/mL). Asymptomatic bacteriuria was defined as identical microorganisms isolated from 2 urine culture specimens taken at 1-week intervals from a subject who was free of UTI symptoms. The presence of asymptomatic bacteriuria and its related factors, such as age, sex, nutritional status, and long-term placement of urinary catheter, were evaluated. RESULTS: A total of 64 institutionalized Chinese elderly (mean age, 76.2 +/- 9.1 years; male:female, 48:16) were collected. The prevalence of asymptomatic bacteriuria was 57.8% (37/64), and was not associated with age, sex, functional status, long-term foley catheter, or previous UTI history. The most commonly isolated organisms were Escherichia coli (29.7%), Klebsiella pneumoniae (21.6%), Providentia stuartii (16.2%), and Pseudomonas aeruginosa (13.5%). Moreover, 21.6% of them showed multiple organisms. Nutritional status (body mass index, serum levels of albumin, total cholesterol, total lymphocyte count, and hemoglobin) was similar between subjects with or without bacteriuria (p > 0.05). CONCLUSION: Asymptomatic bacteriuria is common among Chinese residents in LTCFs. Escherichia coil was the most commonly cultured bacterium. Presence of asymptomatic bacteriuria was not associated with age, sex, functional status, catheter indwelling, previous history of UTI, or nutritional status of residents in LTCFs.

Aged↗
PubMed2002

[Urinary tract infections and antibiotic resistance].

Urinary tract infections (UTI) are diseases which differ considerably regarding pathogenesis, natural history and management. Complicated UTI as well as uncomplicated acute pyelonephritis in women are managed with pretherapy urine and, possibly, blood culture. This is not the case, however, with the most frequent UTI, acute uncomplicated cystitis in women. Empirical management strategies, without pretherapy culture, are well established and widely used. The treatment of choice is trimethoprim-sulfamethoxazole (TMP-SMZ) and fluoroquinolones. E. coli cause the vast majority of these infections, and resistance to TMP-SMZ has been observed to increase considerably during the last decade. Data from Europe and Switzerland regarding resistance of etiologic agents causing acute uncomplicated cystitis are very limited. Indeed, these empirical management strategies have resulted in poor microbiological information, since only selected groups of women with UTI undergo urine culture. Data derived from laboratory isolates usually lack the necessary clinical and epidemiological correlations. Preliminary data allow some estimates of the clinical and microbiological success rates when treating TMP-SMZ resistant uropathogens with TMP-SMZ. TMP-SMZ should probably no longer be used if the prevalence of TMP-SMZ resistance among uropathogens causing acute uncomplicated cystitis is 20% or higher. In these cases, a fluoroquinolone during three days, amoxicillin-clavulanate during three to five days or nitrofurantoin during seven days should be given empirically. Non-antibiotic means of preventing UTI, such as increasing colonization resistance with lactobacilli, or the use of vaccines which provide inhibition of adherence of uropathogens to uroepithelial cells, show very promising experimental results. In order to survey and correct the value of our empirical strategies, more appropriate data on antimicrobial resistance and risk factors in the community are needed. This data can only be produced by a strong collaboration effort with networks of general practitioners.

Anti-Infective Agents, Urinary↗
PubMed1997

Prevention of urinary tract infection in patients with spinal cord injury--a microbiological review.

The importance of urinary tract infection (UTI) in patients with spinal cord injury cannot be understated. Many patients with significant bacteriuria are considered to be colonised rather than infected, and treatment should be reserved for those with clinical symptoms or other signs of infection. Published research on the prevention and management of UTI in patients with spinal cord injury often has limitations due to differences in definitions of UTI, studies on groups using different urinary drainage appliances, the mixture of newly injured and longstanding injured patients and studies being carried out predominantly on male patients. The complications due to UTI and the difficulties in treating established infection mean that prevention is essential. Close urological follow-up is crucial in ensuring that adequate bladder drainage is achieved avoiding the use of long term indwelling urinary catheters if at all possible. For those patients who require long term urinary appliances patient education and strict attention to hygiene and catheter care policies is important. The role of antiseptic/ antibiotics is strictly limited in preventing UTI in patients with spinal cord injury and may even be harmful. Further study into which groups of patients may benefit from the use of antiseptics or antibiotics is urgently required. Continued research into different methods of prevention eg by vaccination, immunotherapy, the use of receptor analogues and bladder interference should also be encouraged.

Anti-Bacterial Agents↗
PubMed1997

Limited vs full microbiological investigation for the management of symptomatic polymicrobial urinary tract infection in adult spinal cord-injured patients.

Spinal cord-injured (SCI) patients often suffer from symptomatic polymicrobial urinary tract infection (UTI). The objective of this study was to evaluate the clinical outcome and cost-savings associated with antibiotic therapy based on limited vs full microbiological investigation of urine cultures in adult SCI patients with symptomatic polymicrobial UTI (> or = 2 organisms growing in urine cultures). In the first part of the study, a total of 40 evaluable patients were prospectively randomized in a single-blinded fashion to receive antibiotic therapy based on either limited (21 patients) or full microbiologic investigation (19 patients) of urine cultures. The practicality of a limited microbiological investigation was further examined in the second part of the study where 12 consecutive patients with symptomatic polymicrobial UTI initially had only limited microbiological investigation of urine cultures and received antibiotic therapy accordingly. When analyzing all patients in the study, the likelihood of adequate clinical response was not significantly different between those who received antibiotic therapy based on limited (28/33 = 85%) vs full (18/19 = 95%) microbiological investigation of urine cultures (P = 0.40). An average of 183 US dollars could be saved per patient by managing symptomatic polymicrobial UTI based on a limited vs a full microbiological investigation. These results suggest that in adult SCI patients with symptomatic polymicrobial UTI antibiotic therapy guided by a limited microbiological investigation may be practical, adequate and cost-saving.

Adult↗
PubMed2006

Spinal-injured neuropathic bladder antisepsis (SINBA) trial.

OBJECTIVE: To determine whether Methenamine Hippurate (MH) or cranberry tablets prevent urinary tract infections (UTI) in people with neuropathic bladder following spinal cord injury (SCI). STUDY DESIGN: Double-blind factorial-design randomized controlled trial (RCT) with 2 year recruitment period from November 2000 and 6 month follow-up. SETTING: In total, 543 eligible predominantly community dwelling patients were invited to participate in the study, of whom 305 (56%) agreed. METHODS: Eligible participants were people with SCI with neurogenic bladder and stable bladder management. All regimens were indistinguishable in appearance and taste. The dose of MH used was 1 g twice-daily. The dose of cranberry used was 800 mg twice-daily. The main outcome measure was the time to occurrence of a symptomatic UTI. RESULTS: Multivariate analysis revealed that patients randomized to MH did not have a significantly longer UTI-free period compared to placebo (HR 0.96, 95% CI: 0.68-1.35, P=0.75). Patients randomized to cranberry likewise did not have significantly longer UTI-free period compared to placebo (HR 0.93, 95% CI: 0.67-1.31, P=0.70). CONCLUSION: There is no benefit in the prevention of UTI from the addition of MH or cranberry tablets to the usual regimen of patients with neuropathic bladder following SCI.

Adolescent↗
PubMed2001

A European perspective on nosocomial urinary tract infections I. Report on the microbiology workload, etiology and antimicrobial susceptibility (ESGNI-003 study). European Study Group on Nosocomial Infections.

OBJECTIVES: To obtain information on the microbiology workload, etiology and antimicrobial susceptibility of urinary tract infection (UTI) pathogens isolated in European hospitals. MATERIALS AND METHODS: We collected data available in the microbiology units of a large sample of European hospitals regarding the laboratory workload, diagnostic criteria, and etiology and antimicrobial resistance of the urinary isolates collected on one day (the study day). RESULTS: Data were received from a total of 228 hospitals from 29 European countries. The average rate of urine samples cultured per 1000 admissions in 1999 was 324. The criteria to consider a positive urine culture as significant were quite variable; > or =10(4) colony-forming units (CFU)/mL for bacteria or > or =10(3) CFU/mL in the case of yeasts were the most used cut-off points. On the study day, a total of 607 micro-organisms from 522 patients with nosocomial UTI were isolated. The six most commonly isolated micro-organisms were, in decreasing order: Escherichia coli (35.6%), Enterococci (15.8%), Candida (9.4%), Klebsiella (8.3%), Proteus (7.9%) and Pseudomonas aeruginosa (6.9%). Pseudomonas was isolated more frequently in non-EU countries. The study data reveal high rates of antimicrobial resistance in UTI pathogens, especially in non-EU countries, where Pseudomonas aeruginosa presented rates of aminoglycoside resistance as high as 72% to gentamicin, 69.2% to tobramycin and 40% to amikacin. CONCLUSIONS: Nosocomial UTI accounts for an important proportion of the workload in microbiology laboratories. A consensus on the practice and interpretation of urine cultures in Europe is needed. The levels and patterns of resistance of UTI pathogens must be a serious cause for concern and a clear reason for stricter guidelines and regulations in antimicrobial policy.

Anti-Bacterial Agents↗
PubMed2002

Intermittent versus indwelling catheters for older patients with hip fractures.

Nursing staff identified postoperative urinary tract infection (UTI) in patients with hip fracture as an increasing problem. A quality improvement project was carried out to investigate the problem and to reduce the incidence. The aim of the study was to describe the occurrence of UTI among patients with hip fracture before and after surgery, to assess whether the decision to use intermittent catheters instead of indwelling catheters was adopted and to test the hypothesis that hospital stay is significantly longer for patients with UTI than for those without infection. One hundred and forty-four patients were investigated for bacteriuria before the first catheterization and 1 week after the last catheterization. Positive urine cultures on admission to hospital were found in 38% of patients. Among those free from bacteria on admission, 61% had a positive urine culture after indwelling catheterization compared with 32% in the group treated with intermittent catetherization. A significantly longer hospital stay (P </= 0.05) was found among patients with UTI. The reason for using an indwelling catheter was not found in any medical or nursing documentation for 29% of the patients. The study points to the necessity for systematic assessment to detect and prevent UTI among older patients with hip fracture.

Age Factors↗