scholarly journals Catheter-Associated Urinary Tract Infections (CAUTIs) Reduction: A Multidisciplinary Approach

2020 ◽  
Vol 41 (S1) ◽  
pp. s154-s154
Author(s):  
Hanish Jain ◽  
Elizabeth Hartigan ◽  
Joseph Tschopp ◽  
Paul Suits ◽  
Kristopher Paolino
Keyword(s):  
Best Practice ◽  
Registered Nurse ◽  
Urine Analysis ◽  
Urine Culture ◽  
Care Center ◽  
Foley Catheter ◽  
Tertiary Care ◽  
Culture Collection ◽  
Institutional Cost ◽  
Tract Infections

Background: CAUTIs remain one of the most common hospital-acquired infections (HAIs) accounting for prolonged hospital stay and increased healthcare costs. According to the NHSN, the standardized infection ratio (SIR) at our institution was 1.6 compared to national average of 0.84 in 2018. We highlight the interventions implemented in our institution to prevent CAUTIs. These interventions have shown a reduction in the rate of CAUTIs, the SIR, Foley catheter days, and institutional cost. Methods: In addition to standard CAUTI prevention practices, we hypothesized that we could decrease CAUTIs through the daily implementation of specific practices. We developed a comprehensive interdisciplinary team which included the staff or charge registered nurse (RN), the unit manager, an infection preventionist, an advanced practice registered nurse (APRN), a pharmacist with an antimicrobial focus, and a physician from the infectious disease department who would conduct daily rounds on different units in the institution for education and assessment of catheter indications. A detailed review and analysis of the urine culture orders for patients with a Foley catheter was performed. A nurse-driven Foley catheter removal protocol before urine culture collection was initiated. We implemented a Foley catheter bundle that has guidelines for Foley insertion, best practice competency, and urinary catheter best practice algorithm and advocated alternative use of male or female external catheter. We educated physicians about ordering a reflexive urine analysis test followed by urine culture instead of testing either individually after removal of a Foley catheter. Lastly, we performed a root-cause analysis on all reported CAUTIs. These policies were implemented in a 435-bed tertiary-care center in November 2018, and we present data from 1-year before and after the interventions. Results: At our institution, we had 71 CAUTIs, with an SIR of 1.6, a standardized utilization ratio (SUR) of 0.92, 27,621 Foley days, and institutional cost of $979,303 compared to 40 CAUTIs with an SIR of 1, an SUR of 0.88, 24,193 Foley days, and institutional cost $537,927 after implementing our interventions. Conclusions: CAUTIs can be reduced by implementing specific measures that include infection control team rounds, nurse-driven protocol, and the use of Foley catheter bundles. Measures should be undertaken to prioritize these practices as part of a protocol. We advocate further studies to evaluate these measures. Education programs for healthcare professionals concerning CAUTIs and its complications can be implemented to carry out the prevention methods efficiently.Funding: NoneDisclosures: None

scholarly journals 1371. Trends in Antibiotic Resistance Among Uropathogens in the Pediatric Population: A Single Center Experience in the US

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S695-S695
Author(s):  
Leena B Mithal ◽  
Sebastian Otero ◽  
Shan Sun ◽  
Mehreen Arshad
Keyword(s):  
Antibiotic Resistance ◽  
Urine Culture ◽  
Pediatric Population ◽  
Tertiary Care ◽  
Fourth Generation ◽  
Care Hospital ◽  
Beta Lactams ◽  
Positive Urine Culture ◽  
Positive Urine ◽  
Tract Infections

Abstract Background Urinary tract infections (UTIs) are common infections in children. Overuse of antibiotics has led to an increasing prevalence of antibiotic resistance among uropathogens in adults; however, data on pediatric trends have not been previously reported. Our objective was to characterize antibiotic resistance trends in uropathogens among children at a tertiary care hospital in a diverse urban US city. Methods Positive urine culture data (>20,000 CFU/ml) from January 1st, 2010 through December 31st, 2019 were obtained from the electronic medical records (inpatient and outpatient). Yearly antibiotic agent-specific resistance rates were calculated based on culture, patient, and organism level data. Results A total of 7,512 patients had ≥1 positive urine culture, with 13,327 positive individual cultures. The average age at sample collection was 6 yrs (IQR 2-11). Overall, 66% of cultures showed resistance to at least 1 antibiotic. Ampicillin resistance (50.1% IQR: 48.2%-52.4%) was the most common and remained stable over the study period. However, resistance against amoxicillin-sulbactam, third and fourth generation cephalosporins, and fluoroquinolones has increased significantly over this period (Figure 1). There was also a corresponding increase in the prevalence of extended spectrum beta-lactamase (ESBL) Enterobacteriaceae (Figure 2). Among infants < 1 year, a similar trend in increasing resistance against beta-lactams was noted (ampicillin-sulbactam 0% to 38%, ceftriaxone 0% to 9% and cefepime 0% to 4%, Figure 3). Figure 1 Figure 2 Figure 3 Conclusion There are rising rates of antibiotic resistance to broad spectrum antibiotics, including beta-lactams and quinolones, in a pediatric population over the last 10 years, with a notable increase in resistance starting in 2015-2016. While we were not able to distinguish patients with community acquired UTI, the increase in resistance among infants < 1 year suggests a community reservoir of multi-drug resistant gram-negative bacteria. Colonization by resistant uropathogens has implications for empiric antibiotic choice, limited oral therapy options, and clinical outcomes which necessitate further study. Disclosures All Authors: No reported disclosures

Hyperammonemia in a patient with obstructive urinary tract infection due to Corynebacterium urealyticum

Open Medicine ◽  
2013 ◽  
Vol 8 (5) ◽  
pp. 597-599 ◽  
Author(s):  
Tsuneaki Kenzaka ◽  
Ayako Kumabe ◽  
Yuka Urushibara ◽  
Kensuke Minami ◽  
Takeshi Ishida
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Urine Analysis ◽  
Urine Culture ◽  
Impaired Consciousness ◽  
Rapid Improvement ◽  
Urease Test ◽  
Tract Infections ◽  
Corynebacterium Urealyticum

AbstractA 93-year-old woman with neurogenic bladder was admitted to our hospital because of impaired consciousness. Her urine culture revealed urease-test-positive Corynebacterium urealyticum. She was diagnosed with hyperammonemia due to an obstructive urinary tract infection that was caused by urease-producing bacteria. The patient showed rapid improvement of impaired consciousness and hyperammonemia after urine analysis. It is necessary to consider obstructive urinary tract infection as a differential diagnosis of hyperammonemia, which commonly occurs in urinary tract infections owing to the presence of urease-producing bacteria. Relief from obstruction is the most important treatment for hyperammonemia caused by this mechanism.

scholarly journals Impact of adenotonsillectomy on acoustic parameters of voice using GRBAS scale in children

2020 ◽  
Vol 11 (SPL4) ◽  
pp. 2527-2530
Author(s):  
Adhavan I ◽  
Indu Rajkumar ◽  
Raadhika Shree N
Keyword(s):  
Surgical Procedures ◽  
Care Center ◽  
Tertiary Care ◽  
Voice Quality ◽  
Failure To Thrive ◽  
Upper Respiratory Tract ◽  
Voice Change ◽  
Adenotonsillar Hypertrophy ◽  
Maxillofacial Development ◽  
Tract Infections

Adenoids and tonsils are pharyngeal lymphoid tissue aggregation. Adenotonsillar hypertrophy is usually seen in children. Enlarged adenoid and tonsillar tissue in children causes snoring, sleeping disorders, failure to thrive, frequent upper respiratory tract infections and abnormalities in maxillofacial development. Surgical treatment performed for their removal is termed as adenotonsillectomy. This is one of the most commonly performed surgical procedures in children. The present study was conducted to compare the voice change using the GRBAS scale before and after adenotonsillectomy. This is a prospective study conducted for three months at the Department of Otorhinolaryngology in our tertiary care center. Voice of 35 children with adenotonsillar hypertrophy is analyzed by GRBAS scale in three stages before the surgery, three weeks after surgery and six weeks after surgery. The resulting voice quality improvement is noted in these children after adenotonsillectomy. This study showed that surgical procedures of adenotonsillectomy do not induce drastic adjustments in sound quality and can be performed safely in children. Post-operative voice changes are a significant concern issue among the parents of the children.

scholarly journals A clinical and microbiological profile of urinary tract infection in patients with chronic kidney diseases

2019 ◽  
Vol 6 (3) ◽  
pp. 911
Author(s):  
Siddharth Pugalendhi ◽  
Tarun Kumar Dutta ◽  
Hemachandar R. ◽  
Lokesh S.
Keyword(s):  
Urinary Tract ◽  
Urine Analysis ◽  
Kidney Diseases ◽  
Tertiary Care ◽  
Public Health Problem ◽  
Blood Analysis ◽  
Resistance Pattern ◽  
Major Public Health Problem ◽  
Care Hospital ◽  
Tract Infections

Background: Urinary tract infections (UTIs) are a major public health problem in terms of morbidity and financial cost in CKD patients in India. The resistance pattern of community acquired uropathogens in CKD patients has not been extensively studied. Thus, knowledge of local antimicrobial susceptibility patterns of common uropathogens is essential for prudent empiric therapy of community acquired UTIs.Methods: It is a cross sectional study conducted in a tertiary care hospital involving 65 chronic kidney disease patients with UTI who attended general medicine OPD and those admitted in wards after fulfilling the inclusion and exclusion criteria, after obtaining written informed consent. Blood sample and urine samples were collected from these patients and sent for blood analysis, urine analysis and urine culture and sensitivity.Results: Among 65 CKD participants with UTI who were studied, E. coli (47.7%) and K. pneumoniae (15.4%) were the most common isolates which were sensitive in order of colistin, polymyxin B, meropenem (carbapenem) and less sensitive to other commonly used antibiotics.Conclusions: The main purpose of this study was to find the various common local uropathogens in CKD patients and their antibiotic profile which will help in formulating antibiotic therapies. As previously stated, there are very few studies regarding profile and management of UTI in CKD patients. Hence this study can throw some light into this area.

scholarly journals Bacteriological Profile and Antibiotic Sensitivity Pattern in Patients with Urinary Tract Infection in Janakpurdham, Nepal

2021 ◽  
Vol 8 (10) ◽  
pp. 5692-5697
Author(s):  
Dr. Digbijay Kumar Thakur ◽  
Dr. Rameshwar Mahaseth ◽  
Dr. Shambhu Kumar Sah
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Urine Culture ◽  
Tertiary Care ◽  
Antibiotic Sensitivity ◽  
Cross Sectional ◽  
Bacteriological Culture ◽  
Sensitivity Pattern ◽  
Culture And Sensitivity ◽  
Tract Infections

Background: Urinary tract infections are most common bacterial infection in routine clinical practice. It is also most common nosocomial infection in many hospitals. Antibiotics are usually given empirically before urine culture reports available and treatment failure rate used to be significantly high. Study of causative agents and their antimicrobial sensitivity pattern are important factors helping formulating antibiotic policy. Generally, most common uropathogene is Escherichia Coli. Tertiary care hospitals, catering of already partially treated or mal treated patients as major chunk, may have varying etiologies and different sensitivity patterns. Objective: To study the culture and sensitivity patterns of urinary tract infections in patients presenting with urinary symptoms in local hospitals. Study design: A cross sectional study Materials and methods: Study was conducted at Madanta Research Clinic Private Limited from 12th march 021 to 12th September 021. Urine from cases suspected to have symptoms suggestive of UTI were send for bacteriological culture and sensitivity. Demographic profiles of each participant along with pathogen isolated, culture sensitivity pattern was documented. Data analysis was done in IBM spss 25. Results: A total 200 samples were selected for bacteriological culture and sensitivity out of which 32% were male and 68% were female. Around 50% of participants were in age group 20-40. There was no growth in 64% sample. Among positive samples (36%), E. coli (most common) was detected in 91.66%, Klebsiella was detected in 6.94%. Gentamicin, Amikacin and Nitrofurantoin were most common antibiotics sensitive to organisms in culture and Cephalosporins group of antibiotics are commonly resistant. Conclusions: coli is the most common organism isolated in urine culture in our region Janakpur. Cephalosporins are resistant in majority of cases where as Aminoglycosides like Amikacin, Gentamicin and Nitrofurantoin are found to be highly sensitive in most of positive cases.

scholarly journals A study of risk factors for bacteremia caused by urinary tract infections

2018 ◽  
Vol 9 (5) ◽  
pp. 25-30
Author(s):  
Muralidhar Varma ◽  
Sravan Kumar Peravali ◽  
Vandana KE ◽  
Asha Kamath ◽  
Rahul Singh
Keyword(s):  
Risk Factors ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Urine Culture ◽  
Tertiary Care ◽  
Blood Cultures ◽  
Medical Sciences ◽  
E Coli ◽  
Tract Infections ◽  
Control Study

Background: Urinary tract infections are not only one of the most common infections, but also one of the most common sources of bacteremia in both the general population and hospitalized patients.Aims and Objectives: The objective of this study was to identify risk factors for bacteremia caused by urinary tract infections.Materials and Methods: This was a prospective case control study conducted from October 2012 to July 2014in a tertiary care teaching hospital in southern India. Urinary tract infections were diagnosed based on the CDC criteria.Patients witha set of blood cultures and urine culture isolating same organism were grouped as cases while patients with urine culture alone isolating organism with sterile blood cultures were identified as controls.Results: Out of the 198 patientsin the study, 66 were cases while 132 were controls. E coli was the most organism isolated (81% of cases and 66% of controls). Risk factors for bacteremia based on univariate and multivariate analysis were diabetes mellitus with uncontrolled sugars (univariate: p=0.001; OR=5.250 [2.044-13.582]; and multivariate: p=0.01; OR= 6.023 [1.52-23.51]) and pyelonephritis (univariate: p=0.001; OR=6.56 [2.87-1.48]; and multivariate: p=0.047; OR=4.95 [1.02-24.12]).Conclusion: Upper UTI and complicated UTI patients should be evaluated for bacteremia since prompt and targeted treatment may be required.Asian Journal of Medical Sciences Vol.9(5) 2018 25-30

scholarly journals Self-medication among pregnant women attending antenatal clinic at Tertiary Care Center of Nepal

2020 ◽  
Vol 8 (2) ◽  
pp. 5-10
Author(s):  
Ajit Kumar Sah ◽  
Anish Giri ◽  
Anjan Palikhey ◽  
Roshan Kumar Chaurasiya ◽  
Sudeep Kumar Yadav
Keyword(s):  
Pregnant Women ◽  
Care Center ◽  
Tertiary Care ◽  
Antenatal Clinic ◽  
Cross Sectional Study ◽  
Reproductive Age ◽  
Tertiary Care Center ◽  
Self Medication ◽  
Cross Sectional ◽  
Tract Infections

Background and Objectives: Self-medication can cause significant challenges for the individuals and community, especially in women during pregnancy. The aim of this study was to evaluate the prevalence of self-medication among the pregnant women attending antenatal clinic in a tertiary care center of Nepal. Material and Methods: In this cross-sectional study, a total of 225 pregnant women were evaluated for the prevalence of self-medication during pregnancy. Descriptive statistics and chi-square tests were used for statistical analysis of data. Results: The results showed that the prevalence of self-medication, in pregnant women was 41.3%. The leading illness/ symptoms which led to self-medication among pregnant women attending clinic were to relieve headaches 29 (31.2%), cough 21 (22.6%), vomiting 13 (14%), treat fever 11 (11.8%), urinary tract infections 11 (11.8%) and drugs commonly reported for self-medication were paracetamol (30.10%), cough remedies (19.30%), antiemetics (16.13%), analgesics (10.75%). Conclusion: Prevalence of self-medication among pregnant women is high in Nepal. This is a threat to the safety of the developing foetus and the pregnant woman. Therefore, it seems necessary to provide public trainings for all women of reproductive age and train them about the dangers and side effects of self-medication.

scholarly journals Microbiological Analysis of Urine Cultures in Women after Pelvic Reconstructive Surgery

2017 ◽  
Vol 11 (4) ◽  
pp. 212-217 ◽  
Author(s):  
Melissa L. Dawson ◽  
Meagan S. Cramer ◽  
Dana R. Thompson ◽  
Babak Vakili
Keyword(s):  
Urinary Tract ◽  
Reconstructive Surgery ◽  
Care Center ◽  
Foley Catheter ◽  
Tertiary Care ◽  
Microbiological Analysis ◽  
Pelvic Reconstructive Surgery ◽  
E Coli ◽  
Common Organism ◽  
Urinary Tract Symptoms

Background/Aims: The rate of urinary tract infection (UTI) after pelvic reconstructive surgery ranges from 9 to 48% and the most common uropathogen is Escherichia coli (E. coli). The aim of the study is to identify the predominant uro-pathogen from urine cultures in women undergoing pelvic reconstructive surgery. Methods: A retrospective review was conducted on women who underwent pelvic reconstructive surgery at a tertiary care center from July 2013 to June 2015. Data was collected from each postoperative visit to evaluate urinary tract symptoms, culture results and treatment in the 3-month postoperative interval. Results: There were 880 cases reviewed (mean age of 59.6 years) during the study period. The most common organism in positive cultures was E. coli after surgery. The total UTI rate was 11.3%. Patients discharged with a Foley catheter had a UTI rate of 65.6% (p = 0.003). Diabetes, neurologic disease, tobacco use, recurrent UTIs and breast or gynecologic cancers had no significant association with UTI after surgery. Conclusion: The most common organism identified is E. coli. Almost 12% of patients will develop a UTI after pelvic reconstructive surgery. The results of this study can influence management of lower urinary tract symptoms in the postoperative period.

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