Bariatric Surgery and Perioperative Infections

2018 ◽  
Author(s):  
Mohammad Alsulaimy ◽  
Seyed Mohammad Kalantar Motamedi
Keyword(s):  
Bariatric Surgery ◽  
Urinary Tract ◽  
Respiratory Infections ◽  
Operative Procedure ◽  
Surgical Site Infections ◽  
Infectious Complications ◽  
Obese Patients ◽  
Preventative Measures ◽  
Increased Risk ◽  
Tract Infections

Morbid obesity is associated with an increased risk of infectious complications including surgical site, urinary tract, and pulmonary infections. Surgical site infections (SSI) are the most common, followed by urinary and respiratory infections. Various risk factors in obese patients including impaired immunity, and altered pulmonary and circulatory systems contribute to the increased susceptibility of morbid obese patients to infectious complications. Perioperative infections are defined to occur within 30 days of the initial operative procedure. Surgical site and urinary tract infections usually occur within 7–10 days post-operatively. Therefore, it is recommended that patients should be followed up between 7 to 10 days post-op to examine surgical sites, and to screen for possible urinary tract symptoms. This chapter will discuss the diagnosis, treatment, and possible preventative measures of the aforementioned infectious complications in the bariatric surgery population.

scholarly journals Predictive Risk Factors of Urinary Tract Infection Following Semirigid Ureteroscopic Lithotripsy

2020 ◽  
Author(s):  
Mehmet Çağlar Çakıcı ◽  
Özgür Kazan ◽  
Ayberk İplikçi ◽  
Muhammet Çiçek ◽  
Özgür Efiloğlu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Urinary Tract ◽  
Infectious Complications ◽  
Ureteral Stones ◽  
P Value ◽  
Ureteroscopic Lithotripsy ◽  
Increased Risk ◽  
Predictive Risk ◽  
Tract Infections ◽  
Residual Fragments

INTRODUCTION: The aim of this study is to determine the frequency and predictive factors of postoperative UTI in patients who underwent URS regarding ureteral stones. METHODS: Data from 425 patients undergoing semi-rigid ureteroscopic lithotripsy between December 2015 and December 2019 at a single center were reviewed to detect factors predicting postoperative urinary tract infections. RESULTS: Of the 425 patients, 35 were infective (8.2%). Proximal ureteral stones were the majority in infective group (48.5%); distal ureteral stones were the majority in non-infective group (42.6%)(p=0.026). Stone number and stone size were also higher in the postoperative infective group (p<0.05). UTI history and preoperative DJS insertion were higher in Group 1 (p <0.001, p = 0.001, respectively). Multivariate regression analyses revealed that history of UTI (OR=5.513, 95% CI; 2.622–11.591, p value <0.001) and presence of residual fragments (OR=4.274, 95% CI; 1.892–9.657, p value <0.001) were independent risk factors for infectious complications after URS. DISCUSSION AND CONCLUSION: Even if URS is considered an innocuous procedure, the probability of postoperative infectious complications is far from negligible. Our results showed that the presence of UTI history and residual fragments were associated with an increased risk of subsequent UTI after URS. These infectious complications also have significant morbidity, mortality and expenditure if not treated timely. Therefore, to avoid this preventable complication, all variables should be reviewed and more careful.

scholarly journals Analysis of Geriatric Infections and a Guide to Empirical Antibiotic Therapy

2021 ◽  
Vol 8 (12) ◽  
pp. 694-698
Author(s):  
Mayanka A ◽  
Vasanthan K ◽  
Vengadakrishnan K ◽  
Sudagar Singh R.B ◽  
Senthil N
Keyword(s):  
Staphylococcus Aureus ◽  
Urinary Tract ◽  
Elderly People ◽  
Respiratory Infections ◽  
Common Source ◽  
Multiorgan Dysfunction ◽  
E Coli ◽  
Common Organism ◽  
Increased Risk ◽  
Tract Infections

BACKGROUND Elderly people have increased susceptibility to infection and are at significantly increased risk of morbidity and mortality due to various common infections. Urinary tract and respiratory tract infections predominate in elderly people. Gram negative pathogens especially E. coli are commonly observed pathogens. In gram positive infections, staphylococcus is usually isolated from skin and soft tissue infections. METHODS Data was collected prospectively between the months of March 2015 and August 2016. Patient demographics and clinical data were recorded from oral questionnaires and hospital records. 219 patients satisfied the inclusion criteria. All patients were subjected to basic investigations with blood and urine cultures at the time of admission. Other cultures like respiratory or pus cultures were collected as and when needed. Specific investigations such as ultrasound abdomen, computed tomography kidneys, ureters and bladder (CT KUB), CT thorax, echocardiography, neuroimaging and procalcitonin were done in certain patients when required. RESULTS Of the 219 patients included in this study, 127 (58 %) were males and 92 (42 %) were females. Mean age of the study population was 72.40. The most common source of bacteraemia was urinary in 33 % and was unknown in 25 %. The most common organism isolated in blood culture was Staphylococcus aureus followed by E. coli. Respiratory infections had unidentified pathogens in 81 % of patients. The most common organism isolated from respiratory secretions was klebsiella followed by acinetobacter and pseudomonas. 11 % of patients developed multi organ dysfunction syndrome of which urinary and respiratory systems were the most common primary sources of infection. CONCLUSIONS A significant incidence of unidentified source of infection was observed. Staphylococcus bacteraemia was a significant observation as E. coli is reported to be common. Urinary tract and respiratory infections were seen to be associated with increased incidence of multiorgan dysfunction. KEYWORDS Elderly, Febrile Illness, Staphylococcus aureus, Escherichia coli, Multiorgan Dysfunction

scholarly journals Role of UropathogenicEscherichia coliVirulence Factors in Development of Urinary Tract Infection and Kidney Damage

2012 ◽  
Vol 2012 ◽  
pp. 1-15 ◽  
Author(s):  
Justyna Bien ◽  
Olga Sokolova ◽  
Przemyslaw Bozko
Keyword(s):  
Urinary Tract ◽  
Signaling Pathways ◽  
Virulence Factors ◽  
Host Response ◽  
Defense Mechanisms ◽  
Inflammatory Responses ◽  
Infectious Complications ◽  
Mucosal Barrier ◽  
Urological Complications ◽  
Tract Infections

UropathogenicEscherichia coli(UPEC) is a causative agent in the vast majority of urinary tract infections (UTIs), including cystitis and pyelonephritis, and infectious complications, which may result in acute renal failure in healthy individuals as well as in renal transplant patients. UPEC expresses a multitude of virulence factors to break the inertia of the mucosal barrier. In response to the breach by UPEC into the normally sterile urinary tract, host inflammatory responses are triggered leading to cytokine production, neutrophil influx, and the exfoliation of infected bladder epithelial cells. Several signaling pathways activated during UPEC infection, including the pathways known to activate the innate immune response, interact with calcium-dependent signaling pathways. Some UPEC isolates, however, might possess strategies to delay or suppress the activation of components of the innate host response in the urinary tract. Studies published in the recent past provide new information regarding how virulence factors of uropathogenicE. coliare involved in activation of the innate host response. Despite numerous host defense mechanisms, UPEC can persist within the urinary tract and may serve as a reservoir for recurrent infections and serious complications. Presentation of the molecular details of these events is essential for development of successful strategies for prevention of human UTIs and urological complications associated with UTIs.

scholarly journals Emerging Role of Microbiome in the Prevention of Urinary Tract Infections in Children

2022 ◽  
Vol 23 (2) ◽  
pp. 870
Author(s):  
Anna Kawalec ◽  
Danuta Zwolińska
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Urinary Tract Infections ◽  
Pediatric Population ◽  
Urologic Diseases ◽  
Increased Risk ◽  
Tract Infections ◽  
The Impact

The microbiome of the urinary tract plays a significant role in maintaining health through the impact on bladder homeostasis. Urobiome is of great importance in maintaining the urothelial integrity and preventing urinary tract infection (UTI), as well as promoting local immune function. Dysbiosis in this area has been linked to an increased risk of UTIs, nephrolithiasis, and dysfunction of the lower urinary tract. However, the number of studies in the pediatric population is limited, thus the characteristic of the urobiome in children, its role in a child’s health, and pediatric urologic diseases are not completely understood. This review aims to characterize the healthy urobiome in children, the role of dysbiosis in urinary tract infection, and to summarize the strategies to modification and reshape disease-prone microbiomes in pediatric patients with recurrent urinary tract infections.

scholarly journals Reducing the Use of Indwelling Urinary Catheters During Cesarean Deliveries

2017 ◽  
Vol 1 (2) ◽  
pp. 1-5
Author(s):  
Michelle Borland
Keyword(s):  
Urinary Tract ◽  
Needs Assessment ◽  
Cesarean Delivery ◽  
Small Community ◽  
Urinary Catheters ◽  
Indwelling Catheter ◽  
Indwelling Catheters ◽  
Cesarean Deliveries ◽  
Increased Risk ◽  
Tract Infections

One concern for medical professionals and women experiencing cesarean deliveries is the use of indwelling urinary catheters, which is associated with a delay in first void time, slower ambulation time, increased discomfort, longer hospital stays, and an increased risk for urinary tract infections. The purpose of this project was to determine if a practice change regarding the use of urinary catheters among pregnant women decreases the number of women receiving a catheter prior to having a cesarean section in a small community hospital. The knowledge to action and Rosswurm and Larabee’s models were used to guide this project, which was comprised of 2 phases. Phase 1 included a team of 10 experts that created the needs assessment that would establish hemodynamic stability using a 4-point scale. The items for inclusion in the needs assessment included primary cesarean, repeat cesarean, no urinary tract infection present, no fetal distress present, no systemic disorders present, no hypertensive disorders present, and no contraindications for anesthesia. Phase 2 was the implementation and evaluation of the needs assessment and new practice guidelines. Statistical analysis was performed using the Mann Whitney U test. There was 98% compliance (p < 0.001.) with the use of the assessment in women undergoing a cesarean delivery and a 64% reduction in the length of time an indwelling catheter was left in place. However, there was no significant change in the number of women receiving a catheter prior to cesarean delivery after a needs assessment was performed (p = 0.805). This project has potential implications that would support social change by reducing the use of indwelling catheters among hemodynamically stable women undergoing cesarean deliveries. Key words: Indwelling catheter, Urinary catheter, Foley, Cesarean, C-section

Health Care–Associated Infections

2012 ◽  
pp. 458-463
Author(s):  
Rodney L Thompson ◽  
Priya Sampathkumar
Keyword(s):  
Health Care ◽  
Home Health Care ◽  
Bloodstream Infections ◽  
Surgical Site Infections ◽  
Infectious Complications ◽  
Health Care Associated Infections ◽  
Health Care Associated Infection ◽  
Tract Infections ◽  
And Control ◽  
And Training

Health care–associated infection (HAI) is an infection that occurs in hospitals, nursing homes, clinics, or home health care programs. Infection control departments have been constituted to prevent and control infectious complications in health care settings. Prevention and control require combinations of education and training, procedures and policies, surveillance and reporting, and interventions that include isolation and teamwork. Common HAIs (nosocomial infections) include urinary tract infections, surgical site infections, bloodstream infections, and ventilator-associated pneumonia. Diagnosis and treatment of each type of infection are reviewed.

scholarly journals Use of sodium-glucose cotransporter-2 inhibitors and urinary tract infections in type 2 diabetes patients: a systematic review

2019 ◽  
Vol 65 (2) ◽  
pp. 246-252 ◽  
Author(s):  
Izabela Rodrigues Figueiredo ◽  
Sara Cardoso Paes Rose ◽  
Nathália Bandeira Freire ◽  
Marina Stabile Patrocínio ◽  
Natália Pierdoná ◽  
...  
Keyword(s):  
Systematic Review ◽  
Type 2 Diabetes ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Randomized Clinical Trials ◽  
Oral Antidiabetic Agents ◽  
Sodium Glucose Cotransporter ◽  
Increased Risk ◽  
Tract Infections

SUMMARY Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are drugs that act by maintaining glycosuria. Recent studies have shown promising effects of these in the treatment of type 2 diabetes mellitus (DM2). However, there may be an increased risk of developing urinary tract infections (UTIs) in patients treated with these. Our study aims to analyze the association between the risk of UTI in patients treated with SGLT2i. A systematic review of the literature was carried out by randomized clinical trials, totalizing at the end of the selection 23 articles that were statistically evaluated. The incidence of UTI was generally demonstrated in articles and in different subgroups: patients on SGLT2i monotherapy or on combination therapy; according to specific comorbidities of each sample or according to the drug used. They noticed an increase in the chance of UTI in the SGLT2i groups compared to the control groups on placebo or other oral antidiabetic agents. This increased chance was found predominantly with the use of Dapagliflozin, Canagliflozin, and Tofogliflozin, regardless of the dosing. Lastly, stands out that the dimension of UTI chances for DM2 patients who use SGLT2i remains to be more strictly determined.

Costs of ambulatory pediatric healthcare-associated infections: Central-line–associated bloodstream infection (CLABSIs), catheter-associated urinary tract infection (CAUTIs), and surgical site infections (SSIs)

2020 ◽  
Vol 41 (11) ◽  
pp. 1292-1297
Author(s):  
Michael L. Rinke ◽  
Suzette O. Oyeku ◽  
William J. H. Ford ◽  
Moonseong Heo ◽  
Lisa Saiman ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Ambulatory Surgery ◽  
Bloodstream Infections ◽  
Surgical Site Infections ◽  
Central Line ◽  
Healthcare Associated Infections ◽  
Retrospective Case ◽  
Additional Costs ◽  
Tract Infections ◽  
Healthcare Associated

AbstractObjective:Ambulatory healthcare-associated infections (HAIs) occur frequently in children and are associated with morbidity. Less is known about ambulatory HAI costs. This study estimated additional costs associated with pediatric ambulatory central-line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTI), and surgical site infections (SSIs) following ambulatory surgery.Design:Retrospective case-control study.Setting:Four academic medical centers.Patients:Children aged 0–22 years seen between 2010 and 2015 and at risk for HAI as identified by electronic queries.Methods:Chart review adjudicated HAIs. Charges were obtained for patients with HAIs and matched controls 30 days before HAI, on the day of, and 30 days after HAI. Charges were converted to costs and 2015 USD. Mixed-effects linear regression was used to estimate the difference-in-differences of HAI case versus control costs in 2 models: unrecorded charge values considered missing and a sensitivity analysis with unrecorded charge considered $0.Results:Our search identified 177 patients with ambulatory CLABSIs, 53 with ambulatory CAUTIs, and 26 with SSIs following ambulatory surgery who were matched with 382, 110, and 75 controls, respectively. Additional cost associated with an ambulatory CLABSI was $5,684 (95% confidence interval [CI], $1,005–$10,362) and $6,502 (95% CI, $2,261–$10,744) in the 2 models; cost associated with a CAUTI was $6,660 (95% CI, $1,055, $12,145) and $2,661 (95% CI, −$431 to $5,753); cost associated with an SSI following ambulatory surgery at 1 institution only was $6,370 (95% CI, $4,022–$8,719).Conclusions:Ambulatory HAI in pediatric patients are associated with significant additional costs. Further work is needed to reduce ambulatory HAIs.

scholarly journals Increased human pathogenic potential of Escherichia coli from polymicrobial urinary tract infections in comparison to isolates from monomicrobial culture samples

2011 ◽  
Vol 60 (1) ◽  
pp. 102-109 ◽  
Author(s):  
Gemma Croxall ◽  
Vivienne Weston ◽  
Susan Joseph ◽  
Georgina Manning ◽  
Phil Cheetham ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Elderly Patients ◽  
Urinary Tract Infections ◽  
Standard Procedure ◽  
Bacterial Species ◽  
Cell Infection ◽  
Pathogenic Potential ◽  
Increased Risk ◽  
Tract Infections

The current diagnostic standard procedure outlined by the Health Protection Agency for urinary tract infections (UTIs) in clinical laboratories does not report bacteria isolated from samples containing three or more different bacterial species. As a result many UTIs go unreported and untreated, particularly in elderly patients, where polymicrobial UTI samples are especially prevalent. This study reports the presence of the major uropathogenic species in mixed culture urine samples from elderly patients, and of resistance to front-line antibiotics, with potentially increased levels of resistance to ciprofloxacin and trimethoprim. Most importantly, the study highlights that Escherichia coli present in polymicrobial UTI samples are statistically more invasive (P<0.001) in in vitro epithelial cell infection assays than those isolated from monomicrobial culture samples. In summary, the results of this study suggest that the current diagnostic standard procedure for polymicrobial UTI samples needs to be reassessed, and that E. coli present in polymicrobial UTI samples may pose an increased risk to human health.

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