Treatment of Positive Urine Cultures at End-of-Life and the Effect on Terminal Delirium Management

2021 ◽  
pp. 104990912110578
Author(s):  
Natalie M. Latuga ◽  
Pei C. Grant ◽  
Kathryn Levy ◽  
Debra L. Luczkiewicz
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
End Of Life ◽  
Demographic Data ◽  
Retrospective Chart Review ◽  
Medication Consumption ◽  
Hospice Patients ◽  
Organism Growth ◽  
Delirium Management

Background: The decision to initiate antibiotics in hospice patients that are very near end-of-life is a complex ethical and stewardship decision. Antibiotics may be ordered to improve urinary tract infection–related symptoms, such as delirium. However, infection symptoms may be managed using antipsychotics, antipyretics, antispasmodics, and analgesics instead. Currently, there are no studies that compare symptom management between those who receive antibiotics and those who do not. Methods: A retrospective chart review was conducted for patients admitted to a hospice inpatient unit. Charts were included if the patient was admitted for delirium and had a Palliative Performance Scale score ≤40%, the urine culture was positive for organism growth, and the patient died while in the HIU. Clinical and demographic data was collected. Medication use was tallied for the 5 days prior to the date of death. Results: Sixty-one charts met the inclusion criteria. Thirty-five patients received antibiotics (ABX+) and 26 did not (ABX−). There was no difference in any medication consumption between groups during the 5 days prior to death. The ABX+ group died 8.2 days after obtaining the urine sample vs 6 days ( P =0.046). The ABX+ group had more documented urinary tract–specific infection symptoms (66% vs 38%, P =0.042). More than half of antibiotic courses were discontinued prematurely. Conclusion: The results of this study do not show a difference in overall medication consumption between groups, which suggests that antibiotics may not help improve terminal delirium symptoms in those with a suspected urinary tract infection at end-of-life.

scholarly journals Evaluation of Urinary Tract Infection following Corticosteroid Therapy in Patients with Multiple Sclerosis Exacerbation

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Aliyeh Bazi ◽  
Seyed Mohammad Baghbanian ◽  
Monireh Ghazaeian ◽  
Sahar Fallah ◽  
Narjes Hendoiee
Keyword(s):  
Multiple Sclerosis ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Urine Analysis ◽  
Demographic Data ◽  
Oral Prednisone ◽  
Intervention Group ◽  
Control Group ◽  
Urinary Tract Symptoms

The first treatment for multiple sclerosis exacerbation is usually short-term intravenous methylprednisolone (IVMP), with or without a regimen of oral prednisone taper (OPT). This study aims to evaluate the effects of IVMP and OPT in comparison with IVMP alone in raising the risk of urinary tract infection (UTI) and posttreatment improvement of urinary tract symptoms in patients with relapsing-remitting multiple sclerosis. This double-blind randomized clinical trial was conducted on 56 people with multiple sclerosis relapse who had undergone methylprednisolone for 5 days. Patients were randomly split into two groups: oral prednisolone and placebo (tapering for 20 days). Demographic data, duration of multiple sclerosis, urinary tract symptoms, the Expanded Disability Status Scale (EDSS) score, and urine data were analyzed. The incidence of UTI in the intervention and control groups did not differ significantly ( p = 560 ). However, the improvement of urinary tract symptoms in the intervention group was significantly more favorable than in the control group ( p ≤ 0.001 ). Furthermore, administering OPT after IVMP did not increase the risk of UTI occurrence in patients with multiple sclerosis exacerbation. The urine analysis results did not show any differences at baseline and after the corticosteroid tapering regimen. Due to the risk of infection by corticosteroids, it is no longer necessary to do further urinary screening in this group of patients.

scholarly journals Clinical Course of Children and Adolescents with Primary Vesicoureteral Reflux: A retrospective study of 958 patients

2016 ◽  
Vol 14 (2) ◽  
pp. 64-66
Author(s):  
Abbas Madani ◽  
Yalda Ravanshad ◽  
Anoush Azarfar ◽  
Niloofar Hajizadeh ◽  
Nematollah Ataei ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Vesicoureteral Reflux ◽  
Medical Management ◽  
Medical Center ◽  
Retrospective Chart Review ◽  
Response To Treatment ◽  
Kidney Scars ◽  
Primary Vesicoureteral Reflux

Abstract Introduction. Vesicoureteral reflux (VUR) is the most common pediatric urologic abnormality and since it can predispose to urinary tract infection and resultant kidney scar it is an important issue in pediatric nephrourology. Methods. A retrospective chart review and follow-up of 958 patients with primary VUR was performed in the Children’s Medical Center, Tehran, Iran. Children with primary vesicoureteral reflux were included in the study and these parameters were studied: age, sex, clinical presentation, VUR grade, sonographic findings, DMSA changes, treatment modality (medical, surgical or endoscopic) and response to treatment, hypertension (presence/absence), urinary tract infection recurrence and development of new kidney scars in patients under medical treatment. Results. VUR was more prevalent in girls. Sonography was unable to detect VUR in many cases. Presence of renal scars was strongly associated with degree of reflux. Medical management was effective in a substantial percentage of patients and they experienced full resolution of reflux. This was especially true for lower degrees of VUR. 17.6% of patients developed new kidney scars on followup which was associated with higher degrees of VUR. Hypertension and breakthrough urinary tract infection was an uncommon finding in our patients. Conclusion. Medical management, which means using prophylactic antibiotics for prevention of urinary tract infection, is effective in many cases of VUR especially in cases with lower degrees of VUR. Surgical and endoscopic procedures must be reserved for patients with higher degrees of VUR unresponsive to conservative management or in whom new scars may develop.

scholarly journals Isolation of Organism and its Drug Sensitivity Pattern in Patients with Urinary Tract Infection at Kathmandu Model Hospital

2018 ◽  
Vol 13 (1) ◽  
pp. 46-50
Author(s):  
Rajesh Dhoj Joshi ◽  
Sachin Khadka ◽  
Deepak Man Joshi ◽  
Basudha Shrestha ◽  
Ganesh Dangal ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Bacterial Resistance ◽  
Demographic Data ◽  
Empirical Therapy ◽  
Polymyxin B ◽  
Drug Resistant ◽  
Sensitivity Pattern ◽  
Culture Positive

Introduction: Lack of compliance and unjustified antibiotic prescriptions has resulted in increasing bacterial resistance and is proving as a major challenge in the management of infections. Knowing the commonly isolated uropathogens and their antimicrobial susceptibility is beneficial in planning treatment protocols.Methods: A retrospective review of records of patients with urinary tract infection from January 2012 to December 2016 was conducted at Kathmandu Model Hospital. All patients who were diagnosed as having culture positive urinary tract infection in medical ward of Kathmandu Model Hospital during 5 years period were analyzed for demographic data, prevalence of organism and antibiotic susceptibility patterns.Results: A total of 315 samples were culture positive. The majority of bugs were gram negative E.coli (48.57%) followed  by multi-drug resistant E.coli (28.89%).  The other major pathogens were E. faecalis (6.03%), S. epidermidis (4.44%), K. pneumoniae (4.13%), respectively. The highest level of sensitivity in first line antibiotics was seen in nitrofurantoin (84.9%), whereas least sensitivity was shown by amoxicillin/clavulanic acid (21%). Similarly, in second line antibiotics, highest sensitivity was seen in tetracycline (100%), imipenem (91.9%) and least to meropenem (49.2%). Ceftazidime is mostly (93.3%) resistant antibiotics among uropathogens. All the third line antibiotics such as polymyxin B, tigecycline and colistin were 100% sensitive to all our isolates.Conclusions: Nitrofurantoin may be an appropriate choice for initial empirical therapy of urinary tract infection. Similarly, the multi-drug resistant E.coli is increasing but it can be tailored if antibiotics are used appropriately on the basis of susceptibility data.

scholarly journals PREVALENCE OF UTI AMONG PREGNANT WOMEN AND ITS COMPLICATIONS IN NEWBORNS AT OBSTETRICS AND GYNAECOLOGY DEPARTMENT OF SKMCH, MUZAFFARPUR, BIHAR

2021 ◽  
pp. 1-3
Author(s):  
Chanchal Kumari ◽  
Kumari Bibha ◽  
Abha Sinha ◽  
Debarshi Jana
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Pregnant Women ◽  
Bacterial Infections ◽  
Demographic Data ◽  
Newborn Infants ◽  
Winter Season ◽  
Causative Organism ◽  
Tract Infections

Urinary Tract Infections (UTI) are mainly caused by the presence and growth of microorganisms in the urinary tract, which are the single commonest bacterial infections of all age groups and especially in pregnancy. The main objective of this study is to determine the Prevalence of UTI among pregnant women and complications in their newborns. An observational study was carried out over a period of 6 months from March 2019 to August 2019. A total of 120 pregnant women were enrolled. UTI was diagnosed based on urinalysis reports. With the help of data collection form demographic data were collected. Out of 120 pregnant women, 35% of them had urinary tract infection. It is mostly observed high in age group of <25yrs, Primigravida, winter season and during Third trimester of pregnancy. The commonest causative organism was found to be E.coli (50%).The weight of newborn infants of mothers afflicted with UTI were significantly not lowered compared to newborns of healthy women. The prevalence rate of urinary tract infection (UTI) during pregnancy is high. So it is important to do routine screening of all pregnant women for significant bacteriuria to reduce the complications on both maternal and fetal health.

scholarly journals MP032: Do urine cultures in the emergency department change management of young women with symptoms of uncomplicated urinary tract infection?

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S77-S77 ◽  
Author(s):  
E. Poon ◽  
L. Self ◽  
S.L. McLeod ◽  
S. Caine ◽  
B. Borgundvaag
Keyword(s):  
Emergency Department ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Change Management ◽  
Post Partum ◽  
Recurrent Infection ◽  
Retrospective Chart Review ◽  
Antibiotic Use ◽  
Uncomplicated Urinary Tract Infection

Introduction: Current guidelines do not recommend the routine use of urinary cultures in the management of uncomplicated urinary tract infection (UTI) in premenopausal, non-pregnant women. Complicating factors include atypical presentation, structural abnormalities or recent recurrent infection/antibiotic use. The objective of this study was to determine the number of urine cultures ordered for women who presented to the emergency department (ED) with symptoms of uncomplicated UTI, and whether a culture result impacted subsequent management. Methods: This was a retrospective chart review of women aged 18-39 presenting to one of two academic EDs with a discharge diagnosis of uncomplicated UTI from Jan-Dec 2014. Patients were excluded if any of the following were documented: pregnancy, fever, immunocompromised state, diabetes mellitus, absence of lower urinary tract symptoms, ED administration of intravenous antibiotics, a previous UTI treated with antibiotics in the last 90 days, two weeks post-partum or post-instrumentation. Results: Of the 512 charts included in the analysis, 494 (96.5%) patients had a urinalysis, of which 463 (93.7%) had positive leukocyte esterase and 90 (18.2%) had positive nitrites. 370 patients (72.3%) had urine cultures performed, of which 236 (63.8%) were positive. 505 (98.6%) patients received antibiotics (53.9% Macrobid; 22.6% Ciprofloxacin; 15.0% Septra; 6.7% other; 1.8% not documented). 7 (1.9%) cultures grew organisms resistant to the prescribed antibiotic; 2 (0.5%) patients received new prescriptions. Conclusion: For the majority of young female patients with uncomplicated UTI, urine cultures did not change management. Almost all of these patients had a positive leukocyte esterase and were treated with antibiotics, yet approximately 40% of the patients tested did not return positive urine cultures, suggesting that better algorithms for the diagnosis of UTI in the ED are required. Unnecessary treatment with antibiotics is expensive, contributes to the development of multidrug resistant organisms, and exposes the patient to the unnecessary risks of possible allergic reactions, drug interactions and side effects.

scholarly journals Bacteriology of urinary tract infection in pediatric patients at KIST Medical College Teaching Hospital

2014 ◽  
Vol 3 (1) ◽  
pp. 21-25 ◽  
Author(s):  
Birendra Raj Raghubanshi ◽  
Devendra Shrestha ◽  
Mahesh Chaudhary ◽  
Bal Man Singh Karki ◽  
Ajaya Kumar Dhakal
Keyword(s):  
Escherichia Coli ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Antimicrobial Susceptibility ◽  
Demographic Data ◽  
College Teaching ◽  
Susceptibility Pattern ◽  
Medical College ◽  
Antimicrobial Susceptibility Pattern

Background: Urinary tract infection is common in children and is an important cause of morbidity. Urinary tract infection at young age can lead to renal injury and scarring, and ultimately lead to end stage renal disease in adulthood. Objectives: The purpose of study was to identify the different species of microorganisms, along with their antimicrobial susceptibility pattern, causing urinary tract infection in paediatric patients presenting with urinary tract infection at KIST Medical College, Imadol, Lalitpur, Nepal. Methods: This retrospective study examined microbiological and antimicrobial susceptibility pattern for urine samples collected at KIST Medical College, Imadol, Lalitpur from December 2010 to November 2013. A urine sample was included in our dataset if it demonstrated pure growth of a single organism and accompanying antimicrobial susceptibility and subject demographic data were available. Results: Escherichia coli was the most common organism isolated, followed by Klebsiella species, Staphylococcus species and then by Proteus species, Enterococcus species and Citrobacter species being equal in number. Microorganisms were most susceptible to amikacin and nitrofurantoin and most resistant to ampicillin and nalidixic acid. Conclusion: Though various microorganisms are responsible for urinary tract infection in children, Escherichia coli is the most common causative agent. Antimicrobial resistance has already emerged against many antibiotics, making empiric treatment of these infections challenging. DOI: http://dx.doi.org/10.3126/jkmc.v3i1.10919Journal of Kathmandu Medical CollegeVol. 3, No. 1, Issue 7, Jan.-Mar., 2014, Page: 21-25

scholarly journals Evaluation of post–flexible cystoscopy urinary tract infection rates

2020 ◽  
Vol 77 (22) ◽  
pp. 1852-1858
Author(s):  
Jaclyn A Cusumano ◽  
Matthew Hermenau ◽  
Melissa Gaitanis ◽  
Michelle Travis ◽  
Kerry L LaPlante ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Antimicrobial Prophylaxis ◽  
Medical Center ◽  
Retrospective Chart Review ◽  
Final Analysis ◽  
Flexible Cystoscopy ◽  
Potential Risk Factors

Abstract Purpose The risk of urinary tract infection (UTI) development after flexible cystoscopy (FC) is not well described. It remains difficult to assess the role of pre-FC antimicrobial prophylaxis to reduce UTI risk. Methods In fall 2017, the urology service at the Providence Veterans Affairs Medical Center implemented routine oral antimicrobial prophylaxis in its outpatient FC clinic. Outpatients were randomly selected for a retrospective chart review to compare patients who received pre-FC antimicrobials (cefuroxime 500 mg tablet or sulfamethoxazole/trimethoprim [800 mg/160 mg] tablet) and those who underwent FC prior to fall 2017 and did not receive prophylaxis. The primary outcome was presence of symptomatic UTI within 30 days post FC. Secondary outcomes included symptomatic UTI that met colony-forming unit (CFU)/mL guideline requirements, and UTI treatment received. Potential risk factors for UTI were also assessed. Results A total of 296 patients were included in the final analysis: 139 who did not receive and 157 who received a prophylactic antimicrobial before FC. Rates of symptomatic UTI, symptomatic UTI meeting CFU/mL guideline requirements, and postprocedure treatment for UTI were similar with and without antimicrobial prophylaxis (2.5% vs 2.2% [P &gt; 0.99], 1.9% vs 1.4% [P &gt; 0.99], and 2.5% vs 4.3% [P = 0.53], respectively). The mean number of days from FC to the start of UTI treatment was 7.9 (range, 1-18 days). Age over 65 years was the only risk factor present in all patients with a post-FC UTI, irrespective of antimicrobial prophylaxis. Conclusion The rate of post-FC symptomatic UTI was lower than rates previously described in the literature. The role of antimicrobial prophylaxis prior to FC warrants further exploration.

scholarly journals Factors associated with urinary tract infection in a Nursing Home

2021 ◽  
Vol 74 (suppl 2) ◽  
Author(s):  
João Luis Almeida da Silva ◽  
Cassiane Dezoti da Fonseca ◽  
Eniva Miladi Fernandes Stumm ◽  
Roseanne Montargil Rocha ◽  
Myria Ribeiro da Silva ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Nursing Home ◽  
Urinary Tract ◽  
Tract Infection ◽  
Demographic Data ◽  
Bivariate Analysis ◽  
Institutionalized Elderly ◽  
Factors Associated ◽  
Modifiable Factors ◽  
Tract Infections

ABSTRACT Objective: to analyze the factors associated with urinary tract infection occurrence in institutionalized elderly. Methods: this is a cross-sectional, analytical, quantitative study with 116 elderly people from a Nursing Home. Urinary tract infection diagnosis was carried out through urine culture and clinical assessment. Demographic data and associated factors were obtained from medical records. Statistical analysis included bivariate analysis and logistic regression models. Results: the factors associated with urinary tract infection (p<0.05) were being female; wheelchair user; diaper use; diuretic use; urinary and bowel incontinence; type 1 diabetes; benign prostatic hyperplasia; dehydration. Conclusion: this study revealed that it is important to consider non-modifiable factors such as sex and clinical comorbidities; however, dehydration, a modifiable factor, increased the chances of developing urinary tract infections by 40 times among institutionalized elderly and demands greater attention from the health team.

scholarly journals Is stratification of antibiotic susceptibility of urinary pathogens useful in the Emergency Department?

2020 ◽  
Vol 33 (5) ◽  
pp. 379-382
Author(s):  
Yolanda Hernández-Hermida ◽  
Nerea López-Muñoz ◽  
Juan-Ignacio Alós ◽  
Keyword(s):  
Escherichia Coli ◽  
Emergency Department ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Antibiotic Treatment ◽  
Antibiotic Susceptibility ◽  
Demographic Data ◽  
Local Resistance ◽  
Treatment Results

Objective. The aim of the study wat to analyze the antibiotic susceptibility of the pathogens causing urinary tract infection (UTI) and to stratify the results in function of patient´s clinical and demographic dates. Material and methods. The susceptibility of the pathogens isolated in the urine of 144 patients with UTI randomly chosen was analyzed. The results were stratified in function of sex, age, type of UTI, previous UTI and previous antibiotic treatment. Results. The susceptibility of the all isolates and of the Escherichia coli isolates was analyzed. There were significant differences between groups in function of sex (fluoroquinolones), age (cefuroxime, ertapenem and gentamicin), type of UTI (cefuroxime, cefotaxime, ertapenem and fluoroquinolones), previous UTI and previous antibiotic treatment (cefotaxime, fluoroquinolones and fosfomycin). Conclusions. The use of clinical and demographic data according to population and local resistance epidemiology of the pathogen causing UTI may help to select an adequate empirical treatment for UTI.

scholarly journals Clinical and bacteriological profile of urinary tract infection in children at a tertiary care hospital

2021 ◽  
Author(s):  
Bikash Chandra Nag ◽  
M. Mizanur Rahman ◽  
Mehdi Pervez ◽  
Ashis Kumar Halder ◽  
M. Mujibur Rahman ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Demographic Data ◽  
Tertiary Care ◽  
Care Hospital ◽  
College Hospital ◽  
E Coli ◽  
Bacteriological Profile ◽  
Stage Renal Disease

Background: Urinary tract infection (UTI) is common in children and is an important cause of morbidity. UTI at young age can lead to renal injury and scarring, and ultimately lead to end stage renal disease in adulthood. Aim of the study The objectives of this study were to study the clinical and bacteriological profile of UTI in children.Methods: This prospective study was done in Sher-E-Bangla medical college hospital, Barishal from January 2018 to July 2019. A urine sample was included in our dataset if it demonstrated pure growth of a single organism and accompanying antimicrobial susceptibility and subject demographic data were available.Result: UTI was more common in female (70.0%) than in male (33.0%). Half were in the age group 1-5 years. Fever was the most common presentation (64.0%) followed by abdominal pain (42.0%), dysuria /increased frequency (34%), decreased appetite (28%). Escherichia coli was the most common (64%) bacterial isolate followed by Klebsiella sp. (20.0%) and Proteus sp. (14.0%). E. coli was highly sensitive to ofloxacin, cefotaxime and amikacin (94.0%). Klebsiella was 100% sensitive to ciprofloxacin and amikacin. Greater degree of resistance was seen to ampicillin, cotrimoxazole and nalidixic acid.Conclusions: Though various microorganisms are responsible for UTI in children, E. coli is the most common causative agent. Antimicrobial resistance has already emerged against many antibiotics, making empiric treatment of these infections challenging.

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