Splenectomy for Trauma Increases the Rate of Early Postoperative Infections

Little is known what effect splenectomy for trauma has on early postoperative infectious complications. Our aim was to determine if splenectomy increases early postoperative infections in trauma patients undergoing laparotomy. We reviewed all trauma patients undergoing splenectomy from June 2002 through December 2004. Each splenectomy patient was matched to a unique trauma patient who underwent laparotomy without splenectomy based on age, gender, mechanism of injury, injury severity score, and presence of colon or other hollow visceral injury. Outcomes included infectious complications including pneumonia, urinary tract infection, bacteremia, and intra-abdominal abscess, as well as mortality. There were 98 splenectomy patients and 98 controls. The splenectomy patients had more overall infectious complications (45% vs 30%, P = 0.04) trended toward more urinary tract infections (12% vs 5%, P = 0.12), and more often had pneumonia (30% vs 14%, P = 0.02). Additionally, more splenectomy patients developed multiple infections (20% vs 7%, P = 0.01). There was no difference in mortality (11% vs 8%, P = 0.63). Splenectomy is associated with an increase in infectious complications after laparotomy for trauma. More specifically, splenectomy patients more often develop pneumonia and multiple infections. This increase in infections is not associated with increased mortality.

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

International Journal of Nephrology ◽

10.1155/2012/681473 ◽

2012 ◽

Vol 2012 ◽

pp. 1-15 ◽

Cited By ~ 114

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.

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Journal club: “Racial disparities in catheter related urinary tract infections among elderly trauma patients in the US”

American Journal of Infection Control ◽

10.1016/j.ajic.2021.10.006 ◽

2022 ◽

Vol 50 (1) ◽

pp. 120-121

Author(s):

Diana Cervantes ◽

Hillary Hei

Keyword(s):

Urinary Tract ◽

Racial Disparities ◽

Urinary Tract Infections ◽

Journal Club ◽

Trauma Patients ◽

The Us ◽

Tract Infections ◽

Elderly Trauma Patients

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Short-duration treatment for catheter-associated urinary tract infections in critically ill trauma patients

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0000000000000822 ◽

2015 ◽

Vol 79 (4) ◽

pp. 649-653 ◽

Cited By ~ 5

Author(s):

Andrew S. Jarrell ◽

G. Christopher Wood ◽

Supriya Ponnapula ◽

Louis J. Magnotti ◽

Martin A. Croce ◽

...

Keyword(s):

Urinary Tract ◽

Critically Ill ◽

Short Duration ◽

Urinary Tract Infections ◽

Trauma Patients ◽

Tract Infections

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Predictive Risk Factors of Urinary Tract Infection Following Semirigid Ureteroscopic Lithotripsy

The Journal of Tepecik Education and Research Hospital ◽

10.5222/terh.2020.50465 ◽

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.

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Racial disparities in catheter related urinary tract infections among elderly trauma patients in the US

American Journal of Infection Control ◽

10.1016/j.ajic.2021.08.018 ◽

2022 ◽

Vol 50 (1) ◽

pp. 77-80

Author(s):

Ryan J. Keneally ◽

Jonathan H. Chow ◽

Raymond A. Pla ◽

Eric R. Heinz ◽

Michael A. Mazzeffi

Keyword(s):

Urinary Tract ◽

Racial Disparities ◽

Urinary Tract Infections ◽

Trauma Patients ◽

The Us ◽

Tract Infections ◽

Elderly Trauma Patients

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Urinary tract infections in obstetrics and gynecology

Journal of obstetrics and women s diseases ◽

10.17816/jowd64691-104 ◽

2015 ◽

Vol 64 (6) ◽

pp. 91-104 ◽

Cited By ~ 1

Author(s):

Elena Vasilyevna Shipitsyna ◽

Tatyana Alekseyevna Khusnutdinova ◽

Alevtina Mikhailovna Savicheva ◽

Tatyana Aykovna Ayvazyan

Keyword(s):

Urinary Tract ◽

Antimicrobial Resistance ◽

Infectious Diseases ◽

Urinary Tract Infections ◽

Clinical Manifestations ◽

Clinical Importance ◽

Infectious Complications ◽

Obstetrics And Gynecology ◽

Tract Infections ◽

In Pregnancy

Urinary tract infections (UTIs) are among the most common infectious diseases in women, and are the most frequent cause of infectious complications of pregnancy. This paper reviews current scientific and methodical literature on UTIs in obstetrics and gynecology. Aspects of clinical importance of UTIs (epidemiology, clinical manifestations, complications), their etiology, antimicrobial resistance of UTIs agents were discussed, and current recommendations on diagnostics and treatment of UTIs were summarized. Special attention was paid to UTIs in pregnancy.

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A prospective analysis of urinary tract infections among elderly trauma patients

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0000000000000796 ◽

2015 ◽

Vol 79 (4) ◽

pp. 638-642 ◽

Cited By ~ 7

Author(s):

Martin D. Zielinski ◽

Melissa M. Kuntz ◽

Stephanie F. Polites ◽

Andy Boggust ◽

Heidi Nelson ◽

...

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Prospective Analysis ◽

Trauma Patients ◽

Tract Infections ◽

Elderly Trauma Patients

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The Use of Sulfadiazine in Urinary Tract Infections and Gonorrhea and as a Prophylactic to Prevent Postoperative Infections

The Journal of Urology ◽

10.1016/s0022-5347(17)70900-7 ◽

1941 ◽

Vol 46 (1) ◽

pp. 101-109 ◽

Cited By ~ 2

Author(s):

Richard W. Satterthwaite ◽

Justina H. Hill ◽

Hugh H. Young

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Postoperative Infections ◽

Tract Infections

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Urinary Tract Infections After Combat-related Genitourinary Trauma

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.825 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S345-S345

Author(s):

Brendan Jackson ◽

Stephen Y Liang ◽

Janis Kuhn ◽

Faraz Shaikh ◽

Dana M Blyth ◽

...

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Infectious Complications ◽

Urethral Injury ◽

Urologic Complications ◽

Genitourinary Trauma ◽

Severity Scores ◽

Initial Injury ◽

Tract Infections

Abstract Background Genitourinary (GU) trauma accounted for 5% of combat-related injuries sustained by U.S. military personnel during Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF). Incidence and risk factors for long-term infectious complications, including urinary tract infections (UTI), have not been described in this unique population. Methods Demographics, injury patterns, initial and long-term medical care, urologic complications, and infectious complications involving the urinary tract for enrollees within the Trauma Infectious Disease Outcomes Study (TIDOS) were collected from Department of Defense (DOD) and Department of Veterans Affairs (VA) data sources. Statistical analyses were conducted to identify candidate predictors for UTIs after GU trauma. Results Among the 530 TIDOS enrollees who entered VA care, 90 (17%) sustained GU trauma. Blast injury (93.3%), injury during dismounted operations (56.7%), and lower extremity amputation (56.7%) were common characteristics among those with GU trauma. Higher median injury severity scores (ISS) were associated with GU trauma vs. non-GU trauma [33 (IQR: 21–38) vs. 17 (IQR: 9–26), P < 0.001]. Of those with GU trauma, 21 (23.3%) had ≥1 UTI (range 1–9) during DOD-VA care. A total of 42 unique UTI episodes were identified, with 11 (26.2%) occurring during initial DOD care, 19 (45.2%) during subsequent DOD care after initial hospital discharge, and 12 (28.6%) during VA care. The median time to first UTI episode was 49 days (IQR: 40.5–171.8). Having an UTI was associated with bladder (P = 0.002) and posterior urethral injury (P = 0.002), pelvic fracture (P < 0.001), urinary catheterization (P = 0.001), and urologic complications, including urinary retention or incontinence (P = 0.001) and stricture (P = 0.007). Pseudomonas aeruginosa (61.5%) was commonly isolated in urine cultures obtained within 6 months of the initial injury. Conclusion UTIs are a common infectious complication after combat genitourinary trauma, particularly in the setting of severe injury and urologic sequelae. Episodes of UTIs typically occur early on after the initial injury while in DOD care; however, recurrent infections may continue well into long-term VA care. Disclosures All authors: No reported disclosures.

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