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Results for “Urinary Catheterization”

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At least 19 recordsLinked to original sources
PubMed1978

Nonvalue of neomycin instillation after intermittent urinary catheterization.

This study evaluated weekly urine cultures of patients with neurogenic bladder disease who underwent intermittent urinary catheterization for bladder retraining. One group of 53 patients in 1974 received regular instillations of 0.1% neomycin after each catheterization. A similar group of 55 patients in 1975 did not receive neomycin and constituted a control group. Distribution of age, sex, diagnosis, and duration of bladder retraining was comparable in both groups. Quantitative bacterial colony counts of 10(4) to 10(5) or greater per ml of urine were considered significant. There was no difference in the incidence of bacteriuria between the neomycin-treated group and the control group (53 versus 49%, respectively), and most patients in each group had colony counts >10(5)/ml. Escherichia coli was seen less frequently in neomycin-treated patients (43.4 versus 62.5%), but a greater percentage of infections due to Pseudomonas aeruginosa, group D streptococci, and yeasts was noted in the neomycin-treated group than in the control group (41.5 versus 22.5%).

Bacteriuria↗
PubMed2026

The catheterized urinary tract selects for MRR1-mediated efflux and fluconazole resistance in Candida albicans biofilms.

Catheter-associated urinary tract infections (CAUTIs) are the most common nosocomial infection in developed countries, and Candida species are among the most frequently isolated organisms. Despite this, little is known about the biology, host-pathogen interactions, or outcomes of these infections, and this has led to uncertain guidelines for clinical management of Candida CAUTIs. Here, we develop the first physiologically relevant artificial urine medium (AUM) that supports fungal growth in a manner similar to, but more consistent than, human urine samples. We demonstrate that human catheter-associated (CA) clinical isolates of C. albicans exhibit environment-dependent fluconazole resistance: many isolates determined to be susceptible by standard CLSI testing in RPMI (MIC ≤ 2 µg/mL) were fully resistant (MIC ≥ 128 µg/mL) when grown in pooled human urine or AUM, complicating clinical management, which is based on catheter exchange and fluconazole treatment. Transcriptomic profiling of biofilms formed in AUM revealed a remarkably convergent upregulation of efflux and detoxification processes across clinical isolates with diverse biofilm phenotypes. Whole-genome sequencing of the CA isolates identified variant alleles of transcriptional regulators of drug efflux, including MRR1, that have been previously associated with antifungal resistance. A competition assay confirmed that Mrr1 provides a fitness advantage in urine and AUM in a urea-dependent manner. Thus, we show that the urinary environment promotes a unique biofilm differentiation program and selects for adaptations that increase drug resistance and would be predicted to render standard treatment regimens ineffective.IMPORTANCECatheter-associated urinary tract infections are the most common nosocomial infection in the United States, and Candida albicans is one of the most frequently isolated organisms from these infections. Despite this high prevalence, few molecular studies have examined C. albicans biology in the urinary environment, and recommendations for clinical management lack robust evidence. Here, we show that clinical catheter-associated isolates of C. albicans identified as susceptible to fluconazole by standard clinical microbiology testing were resistant when grown in human or artificial urine. We identified transcriptional responses intrinsic to the urinary environment that produce this environment-specific resistance phenotype. Biofilm growth in the urinary environment induces cellular processes for efflux and detoxification. These findings suggest that standard susceptibility testing may not predict fluconazole efficacy in the urinary tract and underscore the need for niche-informed approaches to antifungal management of these common infections.

Candida albicans↗
PubMed1979

Staphylococcus aureus bacteriuria.

One hundred twenty-seven episodes of Staphylococcus aureus bacteriuria were reviewed retrospectively in two hospitals to establish the rate of occurrence, clinical importance, and associated predisposing factors. Staphylococcus aureus was an infrequent urinary isolate, and accounted for only about 1% of all positive urine cultures. Although almost all cases in a Veterans Hospital occurred in elderly men, episodes in a community hospital were observed in women and children as well. Patients usually had pyuria (71%) but only 39% had urinary symptoms of fever. Among predisposing factors, serious underlying diseases were uncommon, but urinary tract manipulations or abnormalities were present in nearly two thirds of patients. Fifty-five percent of cases were nosocomial, and 73% of these were associated with urinary catheterization or other invasive urinary tract procedures. Most patients (61%) were not treated for their bacteriuria, and there was a secondary bacteremia rate of 5.5% in the Veterans Hospital. Although infrequently encountered, the presence of S aureus in urine should be treated with at least as much concern as more frequently encountered bacteria.

Adolescent↗
PubMed1978

Antibiotics: how to use them in 1977-1978. Cases 21, 22, and 23.

Self-assessment case studies illustrating prudent selection of antimicrobial agents in septic shock following urinary catheterization, bacteremia and skin lesions in an immunocompromised patient, and endocarditis in a patient with a prosthetic heart valve.

Adult↗
PubMed1979

Bacteriuria during closed urinary drainage: an evaluation of top-vented versus bag-vented systems.

For a 10-month period a top-vented closed urinary drainage system was evaluted and compared to a conventional bag-vented drainage system. The study involved random assignment of either system to all adult patients who required urinary catheterization. Criteria for exclusion included acute or chronic genitourinary tract infection and surgical interference with bladder function. The end point of the study was removal of any part of the system after at least 24 hours or a positive urine culture (greater than 10,000 colonies per ml. urine). The series included 236 patients. Distributions of patient age, sex and hospital service assignment (medical or surgical), antibiotic usage and duration of catheterization were similar in both study groups. Of 113 patients with the top-vented system 16 (14.2 per cent) acquired bacteriuria, whereas 13 of 123 (10.6 per cent) with the bag-drainage system acquired bacteriuria. No significant difference was noted. Antibiotics were used in 202 of 236 patients (86 per cent). Although usage delayed the appearance of bacteriuria in both groups isolates were more frequently yeasts and gram-negative organisms other than Escherichia coli.

Adolescent↗
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↗