Catheter-Associated Urinary Tract Infections in Surgical Patients: a Controlled Study on the Excess Morbidity and costs

Abstract Background Urinary tract infections (UTIs) affect 15 million women each year in the United States, with > 20% experiencing frequent recurrent UTIs. A recent placebo-controlled clinical trial found a 39% reduction in UTI symptoms among recurrent UTI sufferers who consumed a daily cranberry beverage for 24 weeks. Using metagenomic sequencing of stool from a subset of these trial participants, we assessed the impact of cranberry consumption on the gut microbiota, a reservoir for UTI-causing pathogens such as Escherichia coli, which causes > 80% of UTIs. Results The overall taxonomic composition, community diversity, carriage of functional pathways and gene families, and relative abundances of the vast majority of observed bacterial taxa, including E. coli, were not changed significantly by cranberry consumption. However, one unnamed Flavonifractor species (OTU41), which represented ≤1% of the overall metagenome, was significantly less abundant in cranberry consumers compared to placebo at trial completion. Given Flavonifractor’s association with negative human health effects, we sought to determine OTU41 characteristic genes that may explain its differential abundance and/or relationship to key host functions. Using comparative genomic and metagenomic techniques, we identified genes in OTU41 related to transport and metabolism of various compounds, including tryptophan and cobalamin, which have been shown to play roles in host-microbe interactions. Conclusion While our results indicated that cranberry juice consumption had little impact on global measures of the microbiome, we found one unnamed Flavonifractor species differed significantly between study arms. This suggests further studies are needed to assess the role of cranberry consumption and Flavonifractor in health and wellbeing in the context of recurrent UTI. Trial registration Clinical trial registration number: ClinicalTrials.govNCT01776021.

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Risk factors and associated morbidity of urinary tract infections in pediatric surgical patients: A NSQIP pediatric analysis

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2019.04.030 ◽

2020 ◽

Vol 55 (4) ◽

pp. 715-720

Author(s):

Jeremy D. Kauffman ◽

Paul D. Danielson ◽

Nicole M. Chandler

Keyword(s):

Risk Factors ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Surgical Patients ◽

Tract Infections

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Reducing catheter-associated urinary tract infections in hospitals: study protocol for a multi-site randomised controlled study

BMJ Open ◽

10.1136/bmjopen-2017-018871 ◽

2017 ◽

Vol 7 (11) ◽

pp. e018871 ◽

Cited By ~ 5

Author(s):

Brett G Mitchell ◽

Oyebola Fasugba ◽

Anne Gardner ◽

Jane Koerner ◽

Peter Collignon ◽

...

Keyword(s):

Urinary Tract ◽

Cost Effectiveness ◽

Urinary Tract Infections ◽

Controlled Trial ◽

Asymptomatic Bacteriuria ◽

Catheter Insertion ◽

Infection Prevention And Control ◽

Controlled Study ◽

Randomised Controlled ◽

Tract Infections

IntroductionDespite advances in infection prevention and control, catheter-associated urinary tract infections (CAUTIs) are common and remain problematic. A number of measures can be taken to reduce the risk of CAUTI in hospitals. Appropriate urinary catheter insertion procedures are one such method. Reducing bacterial colonisation around the meatal or urethral area has the potential to reduce CAUTI risk. However, evidence about the best antiseptic solutions for meatal cleaning is mixed, resulting in conflicting recommendations in guidelines internationally. This paper presents the protocol for a study to evaluate the effectiveness (objective 1) and cost-effectiveness (objective 2) of using chlorhexidine in meatal cleaning prior to catheter insertion, in reducing catheter-associated asymptomatic bacteriuria and CAUTI.Methods and analysisA stepped wedge randomised controlled trial will be undertaken in three large Australian hospitals over a 32-week period. The intervention in this study is the use of chlorhexidine (0.1%) solution for meatal cleaning prior to catheter insertion. During the first 8 weeks of the study, no hospital will receive the intervention. After 8 weeks, one hospital will cross over to the intervention with the other two participating hospitals crossing over to the intervention at 8-week intervals respectively based on randomisation. All sites complete the trial at the same time in 2018. The primary outcomes for objective 1 (effectiveness) are the number of cases of CAUTI and catheter-associated asymptomatic bacteriuria per 100 catheter days will be analysed separately using Poisson regression. The primary outcome for objective 2 (cost-effectiveness) is the changes in costs relative to health benefits (incremental cost-effectiveness ratio) from adoption of the intervention.DisseminationResults will be disseminated via peer-reviewed journals and presentations at relevant conferences.A dissemination plan it being developed. Results will be published in the peer review literature, presented at relevant conferences and communicated via professional networks.EthicsEthics approval has been obtained.Trial registration number12617000373370, approved 13/03/2017. Protocol version 1.1.

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A Cooperative Controlled Study of the Use of Trimethoprim-Sulfamethoxazole in Chronic Urinary Tract Infections

The Journal of Infectious Diseases ◽

10.1093/infdis/128.supplement_3.s647 ◽

1973 ◽

Vol 128 (Supplement 3) ◽

pp. S647-S651 ◽

Cited By ~ 15

Author(s):

R. A. Gleckman

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Controlled Study ◽

Tract Infections

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Urinary Tract Infections in Surgical Patients

Surgical Clinics of North America ◽

10.1016/j.suc.2014.08.007 ◽

2014 ◽

Vol 94 (6) ◽

pp. 1351-1368 ◽

Cited By ~ 12

Author(s):

Rajesh Ramanathan ◽

Therese M. Duane

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Surgical Patients ◽

Tract Infections

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Medical and social risk factors for recurrent vulvovaginitis in girls with urinarysystem infections

Nephrology (Saint-Petersburg) ◽

10.36485/1561-6274-2020-24-5-72-79 ◽

2020 ◽

Vol 24 (5) ◽

pp. 72-79

Author(s):

Z. A. Kostoeva ◽

Yu. Yu. Chebotareva ◽

L. N. Bogatyreva ◽

T. B. Imieva

Keyword(s):

Risk Factors ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Rural Areas ◽

Interdisciplinary Approach ◽

Controlled Study ◽

Social Risk ◽

Uncomplicated Urinary Tract Infection ◽

Social Risk Factors ◽

Tract Infections

BACKGROUND. The leading role in the development of vulvovaginitis in girls of pre-school age belongs to the extragenital diseases, including recurrent urinary tract infections. The study of medical and social factors that affect the development of reproductive health disorders is of urgent importance. THE AIM: to study the medical and social risk factors for recurrent vulvovaginitis in preschool girls suffering from urinary tract infections. PATIENTS AND METHODS. A prospective controlled study was conducted in 107 girls aged 3-6 years, including group 1 (n=45) - patients with vulvovaginitis against the background of recurrent uncomplicated urinary tract infection; group 2 (n=32) - patientswith an isolated form of vulvovaginitis; group 3(n=30) - girls of health groups 1 and 2. The main parameters of social and biological anamnesis are analyzed. Statistical analysis was performed using the program "SPSS Statistics V. 17.0" ("SPSS Inc. IBM Company", USA). RESULTS. Patients with a combined form of vulvovaginitis, in comparison with patients with isolated vulvovaginitis, more often lived in rural areas, were from large families, belonged to the group of preschool children who do not attend preschool educational institutions, in their families, the monetary income was lower than the subsistence minimum (p<0.001). The lowest level of hygiene was observed in patientswith isolated forms of vulvovaginitis. In patientswith combined forms of vulvovaginitis, in comparison with patientswith isolated vulvovaginitis, gestational complications were significantly higher: 22.2% had gestational pyelonephritis, 13.6% had a premature birth, and 22.2% had a cesarean section (p <0.05). CONCLUSION. Patients with vulvovaginitis and recurrent UTI have a burdened social and biological history. In dispensary management, an interdisciplinary approach is required, taking into account the identified medical and social risk factors.

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