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At least 37 records · Page 2Linked to original sources
PubMed1978

Prolonged outbreak of nosocomial urinary tract infection with a single strain of Pseudomonas aeruginosa.

Sixty-six hospitalized patients became infected with a single strain of multiply resistant Pseudomonas aeruginosa over a 22-month period. The catheterized urinary tract was the site of the infection in 59 patients (89%). The outbreak was confined to a urology ward until an infected patient from this ward spent 2 weeks in the surgical intensive care unit (SICU). Subsequently patients who acquired the infection in the SICU were discharged to surgical wards throughout the hospital. Urine measuring containers and urometers used in the SICU were the reservoir of the P. aeruginosa; daily sterilization of this equipment terminated the outbreak. Urometers appeared to be the reservoir of the epidemic strain in subsequent outbreaks. Five patients were still infected when they were readmitted 3 to 12 months after the first admission, and therefore represented an additional reservoir of infection.

Cross Infection↗
PubMed1978

Diagnostic catheterization and bacteriuria in women with urinary incontinence.

The risk of single catheterisation in females with urinary incontinence and/or genital prolapse was studied in patients referred for urodynamic examination. Two hundred and eighty-six catheterisations were performed followed by a mid-streem specimen 1 week later, and in 31 of these the initial specimen contained more than 10(5) bacteria. Following catheterisation bacteriuria occurred in 5 (2%) of the patients with initially sterile urine. The phenomenon of "asymptomatic bacteriuria", "transient significant bacteriuria" and "bladder defence mechanism" is discussed. The risk of introducing urinary tract infection in urodynamic studies is low.

Adult↗
PubMed1976

Quantitative urinalysis. Diagnosing urinary tract infection in men.

Using a hemocytometer, we determined the number of white blood cells (WBCs) per milliliter in uncentrifuged urine specimens. Uninfected urine usually contained less than or equal to 10(3) WBCs per milliliter, although up to 8 X 10(3) WBCs per milliliter were observed. Infected urine regularly contained greater than 10(4) WBCs per milliliter, and the mean WBC count per millimeter for urine from infected patients was 3.1 X 10(5). The absence of pyuria thus provides strong evidence against the presence of urinary tract infection. Similar results were obtained in patients who had indwelling catheters, suggesting that bacteriuria reflects the presence of infection rather than colonization. Valid data are easily obtainable by quantitative urinalysis of uncentrifuged urine specimens. There are obvious differences in WBCs per milliliter, with little overlap between infected and uninfected urine. This method of analysis should replace traditional means of counting WBCs per visual field in a centrifuged, resuspended urine sediment.

Adult↗
PubMed1977

Nosocomial bacteremia. Potential for prevention of procedure-related cases.

During a six-month period, 187 inpatients had bacteremia associated with community-acquired infection and 91 patients had bacteremia from a nosocomial infection. The most frequently identified sites of infection in both types of bacteremia were the respiratory and urinary tracts. Escherichia coli and Diplococcus pneumoniae were the organisms most frequently isolated from cultures of patients with community-acquired bacteremia, and E coli, Staphylococcus aureus, and Klebsiella were most frequently isolated from patients with nosocomial bacteremia. Bacteremic nosocomial infections were related to urinary catheters, respiratory and intravenous therapy, or hyperalimentation in 32 of the 91 cases. Even assuming the unproved hypotheses that rigid adherence to current guidelines would prevent all of these procedure-related cases, 59 cases of bacteremia would still have occurred. This emphasizes the need for further research into prevention of nosocomial infection.

Adult↗
PubMed1976

Indwelling catheter and risk of urinary infection: a clinical investigation with a new closed-drainage system.

A new device for the drainage of an indwelling urethral catheter is described. The disposable one-piece-set includes the connector to the catheter, the tubing, and a cylinder to collect a urine aliquot up to 150 ml. Disconnection is impossible. The urine passes through a siphon which prevents air bubbles rising along the tubing. Aurine sample for bacteriological culture can be withdrawn from the closed system by sterile puncture of this siphon. The calibration of the cylinder enables accurate measuring of urine flow rate even in oliguric patients. The apparatus was tested in 250 patients (1386 patient-days) by daily bacteriological cultures. Compared to the literature it is at the moment the most effective system preventing urinary infection during catheter drainage.

Catheters, Indwelling↗
PubMed1979

Effect of short-term high-dose treatment with methenamine hippurate on urinary infection in geriatric patients with an indwelling catheter. IV. Clinical evaluation.

An evaluation has been made of the clinical and laboratory effects of short-term (34 days), high-dose (2g x 3 daily) treatment with methenamine hippurate (MH) of 14 geriatric patients with an indwelling catheter and clinical features of urinary tract infection. During MH treatment the number of catheter changes was halved, each catheter remaining in situ for an average of 12.0 days as compared to 6.2 days in the pre-treatment control period and 5.2 days in the post-treatment control period; the difference is significant (p = 0.008; Friedman two-way analysis of variance). Urine pH was reduced (pH 7.0--6.5--7.0; p = 0.01) and the standard bicarbonate in blood was slightly elevated (24.1--25.7--25.0 mmol/l; p= 0.008) during the MH treatment period, when compared to pre- and post-treatment control periods. It is suggested that MH treatment reduced the complications associated with indwelling catheters due to reduction in urine pH, bacteriuria, and pyuria. Blockage of catheters is thought to be due to intraluminal salt precipitations with trapping of clumps, and is primarily not correlated with urine viscosity.

Aged↗
PubMed1975

Development of the upper urinary tract in myelomeningocele and consequent urological care.

The findings in the upper urinary tract of 58 patients with MMC and neurogenic bladder dysfunction are discussed and therapeutical consequences are considered. In a group of 28 neonates, investigated within the first three months of life, only 10% showed some abnormalities of the upper urinary tract and (or) reflux, in a second group of 21 children, over the age of 2 years when first seen, the occurrence rate of dilatation of the upper urinary tract and of pyelonephritis signs was already doubled, whereas adults with operated MMC showed in 75% severe pathological changes. The situation of neonates born with MMC may be in some aspects compared to patients suffering from acute traumatic cord lesion with neurogenic bladder dysfunction. It was already shown that, in spite of neurogenic bladder dysfunction, it is possible in parapegics by appropiate and mainly conservative treatment to prevent progressive destruction of the upper urinary tract, once considered to be unavoidable. The key to better results in the children with MMC should therefore be early and prompt care and close follow-up. The importance of regular bladder emptying, low dosage, long-term antibiotic treatment and measures like forced urethral dilatation and sphincterotomy is stressed. Our results so far in neonatal urological care of children with MMC are encouraging.

Adult↗
PubMed1978

[Urethro-cystometry: a comparison between open-end catheters with flow and microtransducer catheters (author's transl)].

In 40 women a comparative urethrocystometric study between microtransducer catheters and open-end catheters was performed. Analysis of resting and cough urethrapressure profile concerned clinical and practical value as well as reproducibility. All of these aspects can better be achieved by microtransducer catheters compared to the open-end catheter system. Best results were obtained when measuring with microtransducers in standing position.

Female↗
PubMed1979

Patient factors contributing to the emergence of gentamicin-resistant Serratia marcescens.

One hundred forty nosocomial Serratia marcescens infections (including 76 cases of bacteremia) were identified by prospective surveillance from 1975 through 1977 and retrospective chart review from 1968 through 1974. Thirty-four cases (24 per cent) involved gentamicin-resistant strains. All gentamicin-resistant strains appeared after 1974. Ninety per cent of the patients had undergone surgery, and 88 per cent had received prior antimicrobial therapy. The emergence of gentamicin-resistant S. marcescens paralleled the increase in usage of gentamicin. Prior use of gentamicin for more than two days in an individual patient was a significant risk factor (P = 0.0002) for being infected with a Serratia that was gentamicin-resistant. Other factors which separated gentamicin-resistant Serratia infections from gentamicin-sensitive Serratia infections were (1) urinary site of infection (P = 0.0005), (2) urinary catheter (P = 0.002), (3) endotracheal tube or tracheotomy (P = 0.03) and (4) increasing duration of hospitalization (P less than 0.05). Thirty-three of 34 (97 per cent) patients with gentamicin-resistant strains had urinary catheters. Specific measures to control infection were effective in decreasing the incidence of infections caused by gentamicin-resistant Serratia.

Adolescent↗
PubMed1975

Further experience with suprapubic drainage by trocar catheter.

In 1972 a preliminary report described the use of a large-bore (Nos. 12 and 16 Fr.) vinyl catheter, which contained a steel trocar within its lumen, in repair of cystourethrocele in 86 patients. Further experience in an additional 158 patients undergoing cystourethrocele repair, and a variety of other gynecologic procedures, is now evaluated. The prototype of a sharp, beveled, cutting-edge trocar tip proved to increase substantially the ease of insertion. Problems of design and production of the catheter were encountered and corrected. Two points of technique, (1) insertion of the catheter prior to the surigcal procedure and (2) use of the two-hand method, are advocated. The trocar catheter was found to be a simple, practical, and safe instrument for suprapubic bladder drainage.

Female↗
PubMed1979

Postoperative bladder training.

A group of 87 women who had either a retropubic suspension or anterior colporraphy with or without hysterectomy were studied to determine an optimal method of postoperative bladder training to facilitate recovery of normal bladder function. All patients received suprapubic catheters but 43 women had their catheters on constant open drainage while the remaining 44 patients were placed on an intermittent clamping regimen which was begun on the first postoperative day. The method of catheter management was selected randomly. Subgroups based on the operative procedure performed, patient age, and the presence or absence of postoperative infection were examined. In all groups of patients studied, those undergoing early intermittent clamping resumed normal micturition earlier than those who did not. It is recommended that this technique be utilized routinely in this group of patients to shorten the interval of time during which bladder drainage is required.

Adult↗