scholarly journals A Nurse-Led Low-Cost Intervention Effectively Traces Prevalence of Catheter Associated Urinary Tract Infections at a Low-Resourced Regional Referral Hospital in Western Uganda: A Case for Policy Change

2019 ◽  
Vol 21 (1) ◽  
pp. 4-11
Author(s):  
Charles Etyang ◽  
Grace Nambozi ◽  
Laura Brennaman
Keyword(s):  
Health Care ◽  
Urinary Tract ◽  
Health System ◽  
Low Cost ◽  
Hospitalized Patients ◽  
Resource Constrained ◽  
Hospital Acquired Infections ◽  
The Government ◽  
Tract Infections ◽  
Hospital Acquired

Catheter associated urinary tract infection (CAUTI) is the most common hospital-acquired infection worldwide. Low- and middle-income countries (LMICs) with limited resources for health care have not allocated resources to adequately monitor or prevent CAUTIs. The infection is associated with several adverse clinical outcomes, including antibiotic resistance, septicemia, and prolonged hospital stays, that burden the already resource-constrained health systems in LMICs with increased morbidity, health care costs, and deaths. Owing to the lack of resource allocation, little is known about the prevalence of CAUTI in the government-owned and operated hospitals in LIMCs. The purpose of this research was to test a method of CAUTI prevalence surveillance suitable to the resource-constrained health system in a LMIC and to determine the prevalence of CAUTI among hospitalized patients at the study site. In an intermittent 4-week data collection plan, the sample of 68 catheterized adult participants was evaluated for the presence of CAUTI using the three-pronged screening criteria of American Urological Society. CAUTI prevalence in the sample was 17.6%. The high prevalence of CAUTI in this sample represents a substantial risk of consequences to hospitalized patients and to the resource-constrained health system in this LMIC. This first report of CAUTI surveillance using readily available and affordable tools provides evidence to health ministry policymakers of the need for and value of monitoring and prevention programs for hospital-acquired infections in LMICs. We recommend LMIC health policymakers to establish infection prevention teams in hospitals and provide resources to continue surveillance and prevention of CAUTI and other hospital-acquired infections.

scholarly journals Urinary tract infections in children

2018 ◽  
Vol 60 (1) ◽  
pp. 35-40
Author(s):  
Elzbieta Osuch ◽  
Andre Marais
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Recurrent Utis ◽  
Hospital Acquired Infections ◽  
Diagnostic Studies ◽  
Tract Infections ◽  
Hospital Acquired

Urinary tract infections (UTIs) are common in childhood and represent approximately 10% of hospital-acquired infections. It is clinically challenging to distinguish cystitis (lower UTI) from pyelonephritis (upper UTI) in those younger than two years. Most UTI patients can however be safely managed as outpatients if diligent follow-up procedures are in place. Recurrent UTIs in children may indicate malfunction or an anatomical defect of the urinary tract, and require specialised diagnostic studies. The proper approach for a child with UTI remains controversial, and treatment often differs according to regional or institutional empirical guidelines.

scholarly journals A Multifaceted Approach to Reduction of Catheter-Associated Urinary Tract Infections in the Intensive Care Unit With an Emphasis on “Stewardship of Culturing”

2016 ◽  
Vol 38 (2) ◽  
pp. 186-188 ◽  
Author(s):  
Katherine M. Mullin ◽  
Christopher S. Kovacs ◽  
Cynthia Fatica ◽  
Colette Einloth ◽  
Elizabeth A. Neuner ◽  
...  
Keyword(s):  
Critical Care ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Critically Ill Patient ◽  
Multifaceted Approach ◽  
Hospital Acquired Infections ◽  
Control And Prevention ◽  
Tract Infections ◽  
Hospital Acquired ◽  
Successful Reduction

BACKGROUNDCatheter-associated urinary tract infections (CAUTIs) are among the most common hospital-acquired infections (HAIs). Reducing CAUTI rates has become a major focus of attention due to increasing public health concerns and reimbursement implications.OBJECTIVETo implement and describe a multifaceted intervention to decrease CAUTIs in our ICUs with an emphasis on indications for obtaining a urine culture.METHODSA project team composed of all critical care disciplines was assembled to address an institutional goal of decreasing CAUTIs. Interventions implemented between year 1 and year 2 included protocols recommended by the Centers for Disease Control and Prevention for placement, maintenance, and removal of catheters. Leaders from all critical care disciplines agreed to align routine culturing practice with American College of Critical Care Medicine (ACCCM) and Infectious Disease Society of America (IDSA) guidelines for evaluating a fever in a critically ill patient. Surveillance data for CAUTI and hospital-acquired bloodstream infection (HABSI) were recorded prospectively according to National Healthcare Safety Network (NHSN) protocols. Device utilization ratios (DURs), rates of CAUTI, HABSI, and urine cultures were calculated and compared.RESULTSThe CAUTI rate decreased from 3.0 per 1,000 catheter days in 2013 to 1.9 in 2014. The DUR was 0.7 in 2013 and 0.68 in 2014. The HABSI rates per 1,000 patient days decreased from 2.8 in 2013 to 2.4 in 2014.CONCLUSIONSEffectively reducing ICU CAUTI rates requires a multifaceted and collaborative approach; stewardship of culturing was a key and safe component of our successful reduction efforts.Infect Control Hosp Epidemiol 2017;38:186–188

scholarly journals A Serendipitous Mutation Reveals the Severe Virulence Defect of a Klebsiella pneumoniae fepB Mutant

mSphere ◽  
2017 ◽  
Vol 2 (4) ◽  
Author(s):  
Michelle Palacios ◽  
Christopher A. Broberg ◽  
Kimberly A. Walker ◽  
Virginia L. Miller
Keyword(s):  
Antibiotic Resistance ◽  
Urinary Tract ◽  
Klebsiella Pneumoniae ◽  
Drug Targets ◽  
Carbapenem Resistance ◽  
Content Type ◽  
Hospital Acquired Infections ◽  
Tract Infections ◽  
Hospital Acquired ◽  
Rapid Emergence

ABSTRACT In addition to having a reputation as the causative agent of several types of hospital-acquired infections, Klebsiella pneumoniae has gained widespread attention as a pathogen with a propensity for acquiring antibiotic resistance. It is capable of causing a range of infections, including urinary tract infections, pneumonia, and sepsis. Because of the rapid emergence of carbapenem resistance among Klebsiella strains, there is a dire need for a better understanding of virulence mechanisms and identification of new drug targets. Here, we identify the periplasmic transporter FepB as one such potential target. Klebsiella pneumoniae is considered a significant public health threat because of the emergence of multidrug-resistant strains and the challenge associated with treating life-threatening infections. Capsule, siderophores, and adhesins have been implicated as virulence determinants of K. pneumoniae, yet we lack a clear understanding of how this pathogen causes disease. In a previous screen for virulence genes, we identified a potential new virulence locus and constructed a mutant (smr) with this locus deleted. In this study, we characterize the smr mutant and show that this mutation renders K. pneumoniae avirulent in a pneumonia model of infection. The smr mutant was expected to have a deletion of three genes, but subsequent genome sequencing indicated that a much larger deletion had occurred. Further analysis of the deleted region indicated that the virulence defect of the smr mutant could be attributed to the loss of FepB, a periplasmic protein required for import of the siderophore enterobactin. Interestingly, a ΔfepB mutant was more attenuated than a mutant unable to synthesize enterobactin, suggesting that additional processes are affected. As FepB is highly conserved among the members of the family Enterobacteriaceae, therapeutic targeting of FepB may be useful for the treatment of Klebsiella and other bacterial infections. IMPORTANCE In addition to having a reputation as the causative agent of several types of hospital-acquired infections, Klebsiella pneumoniae has gained widespread attention as a pathogen with a propensity for acquiring antibiotic resistance. It is capable of causing a range of infections, including urinary tract infections, pneumonia, and sepsis. Because of the rapid emergence of carbapenem resistance among Klebsiella strains, there is a dire need for a better understanding of virulence mechanisms and identification of new drug targets. Here, we identify the periplasmic transporter FepB as one such potential target.

scholarly journals Inhibiting Host Protein Deposition on Urinary Catheters Reduces Urinary Tract Infections

2021 ◽  
Author(s):  
Marissa Jeme Andersen ◽  
ChunKi Fong ◽  
Alyssa Ann La Bella ◽  
Alex Molesan ◽  
Matthew M. Champion ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Serum Proteins ◽  
Host Protein ◽  
Urinary Catheters ◽  
Hospital Acquired Infections ◽  
Protein Deposition ◽  
Tract Infections ◽  
Hospital Acquired

SummaryMicrobial adhesion to medical devices is common for hospital-acquired infections, particularly for urinary catheters. If not properly treated these infections cause complications and exacerbate antimicrobial resistance. Catheter use elicits bladder inflammation, releasing host serum-proteins, including fibrinogen, into the bladder, which deposit on the urinary catheter. Enterococcus faecalis uses fibrinogen as a scaffold to bind and persist in the bladder despite antibiotic treatments. Inhibition of fibrinogen-pathogen interaction significantly reduces infection. Here, we show deposited fibrinogen is advantageous for uropathogens, suggesting that targeting catheter protein deposition may reduce colonization creating an effective intervention. Hostprotein deposition was reduced, using liquid-infused catheters, resulting in decreased colonization on catheters, in bladders, and dissemination in vivo. Furthermore, proteomics revealed a significant decrease in deposition of host-secreted proteins on liquid-infused catheter surfaces. Our findings suggest targeting microbial binding scaffolds may be an effective antibiotic-sparing intervention for use against catheter-associated urinary tract infections and other medical device infections.

scholarly journals Bacterial Profile, Antimicrobial Susceptibility Pattern, and Associated Factors of Community- and Hospital-Acquired Urinary Tract Infection at Dessie Referral Hospital, Dessie, Northeast Ethiopia

2021 ◽  
Vol 2021 ◽  
pp. 1-14
Author(s):  
Berhanu Adugna ◽  
Bekele Sharew ◽  
Mohabaw Jemal
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Antimicrobial Susceptibility ◽  
Associated Factors ◽  
Hospitalized Patients ◽  
Diffusion Method ◽  
Bacterial Isolates ◽  
Tract Infections ◽  
Hospital Acquired

Background. Bacterial urinary tract infection is among the most common community and hospital-acquired infections. Therefore, to know the status of the community and hospital-acquired urinary tract infection, antimicrobial susceptibility patterns, and associated factors among urinary tract infection profiles are essential to physicians and health workers to implement appropriate intervention. Methods. An institution-based cross-sectional study was conducted among 422 urinary tract infection suspected patients. All isolates were identified by standard microbiological techniques, and their antibiotic susceptibility was done by the Kirby–Bauer disc diffusion method. Data were entered using EpiData version 3.1 and analyzed by SPSS software version 20. P value < 0.05 at 95% CI was considered statistically significant. Result. Of 422 urine samples processed, 100 (23.7%) yielded bacterial isolates. About 50(30.7%) and 50(19.3%) were bacterial isolates from the community and hospitalized patients, respectively. E. coli 44/103(42.7%) predominated across the two groups, followed by S. aureus 25/103(24.3%), CONs, 14/103(13.5%), Klebsiella spp. 7/103(6.78), Proteus spp. 3/103(2.91), and Enterococcus spp. 3/103 (2.91%). Pseudomonas spp. 3/103 (2.91), Citrobacter spp. 2/103(1.94%), and Acinetobacter spp. 1/103(0.999), which were isolated from only the hospitalized patients. Meropenem susceptibly was 100% in both study groups and Ampicillin resistance was documented as 83.3% to 100% and 76.9% to 100% in hospitalized and community-acquired samples, respectively. Conclusion. This study found a high prevalence of bacterial urinary tract infection in the study area and a high rate of bacterial resistance was observed to most antimicrobial drugs tested. Meropenem and nitrofurantoin were the most active drugs for urinary tract infections. Therefore, expanding routine bacterial culture and identification with antimicrobial susceptibility testing and strengthening regular surveillance systems are essential for appropriate patient care.

Hospital-acquired urinary tract infection

2017 ◽  
Author(s):  
Roger Bayston
Keyword(s):  
Urinary Tract ◽  
Enteric Bacteria ◽  
Prophylactic Antibiotics ◽  
Evidence Based ◽  
National Surveillance ◽  
Aseptic Technique ◽  
Surveillance Studies ◽  
Hospital Acquired Infections ◽  
Tract Infections ◽  
Hospital Acquired

Urinary tract infections (UTIs) account for the majority of hospital-acquired infections (HAI), and most of these occur in catheterized patients. However, for most the presence of bacteria in the urine (bacteriuria) is asymptomatic, yet in many institutional and national surveillance studies it is still attributed as ‘infection’. Although guidance is that only symptomatic UTI should be treated, except in pregnancy, bacteriuria in catheterized patients is frequently overinvestigated and antibiotics overused. Most infections are caused by enteric bacteria such as Escherichia coli, but other bacteria such as Proteus mirabilis and staphylococci are more prominent in HAI. Aseptic technique for catheter insertion and during subsequent catheter care together with minimizing catheter duration are very important to prevent catheter-associated UTI (CAUTI). Prophylactic antibiotics should be avoided. National and international action to adopt evidence-based consensus protocols for management of catheterized patients and judicial use of antimicrobial chemotherapy promise to be of greatest benefit.

scholarly journals The Metal Ion-Dependent Adhesion Site Motif of the Enterococcus faecalis EbpA Pilin Mediates Pilus Function in Catheter-Associated Urinary Tract Infection

mBio ◽  
2012 ◽  
Vol 3 (4) ◽  
Author(s):  
Hailyn V. Nielsen ◽  
Pascale S. Guiton ◽  
Kimberly A. Kline ◽  
Gary C. Port ◽  
Jerome S. Pinkner ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Enterococcus Faecalis ◽  
Molecular Basis ◽  
Metal Ion ◽  
Content Type ◽  
Hospital Acquired Infections ◽  
Tract Infections ◽  
Hospital Acquired ◽  
Adhesion Site

ABSTRACT Though the bacterial opportunist Enterococcus faecalis causes a myriad of hospital-acquired infections (HAIs), including catheter-associated urinary tract infections (CAUTIs), little is known about the virulence mechanisms that it employs. However, the endocarditis- and biofilm-associated pilus (Ebp), a member of the sortase-assembled pilus family, was shown to play a role in a mouse model of E. faecalis ascending UTI. The Ebp pilus comprises the major EbpC shaft subunit and the EbpA and EbpB minor subunits. We investigated the biogenesis and function of Ebp pili in an experimental model of CAUTI using a panel of chromosomal pilin deletion mutants. A nonpiliated pilus knockout mutant (EbpABC− strain) was severely attenuated compared to its isogenic parent OG1RF in experimental CAUTI. In contrast, a nonpiliated ebpC deletion mutant (EbpC− strain) behaved similarly to OG1RF in vivo because it expressed EbpA and EbpB. Deletion of the minor pilin gene ebpA or ebpB perturbed pilus biogenesis and led to defects in experimental CAUTI. We discovered that the function of Ebp pili in vivo depended on a predicted metal ion-dependent adhesion site (MIDAS) motif in EbpA’s von Willebrand factor A domain, a common protein domain among the tip subunits of sortase-assembled pili. Thus, this study identified the Ebp pilus as a virulence factor in E. faecalis CAUTI and also defined the molecular basis of this function, critical knowledge for the rational development of targeted therapeutics. IMPORTANCE Catheter-associated urinary tract infections (CAUTIs), one of the most common hospital-acquired infections (HAIs), present considerable treatment challenges for physicians. Inherently resistant to several classes of antibiotics and with a propensity to acquire vancomycin resistance, enterococci are particularly worrisome etiologic agents of CAUTI. A detailed understanding of the molecular basis of Enterococcus faecalis pathogenesis in CAUTI is necessary for the development of preventative and therapeutic strategies. Our results elucidated the importance of the E. faecalis Ebp pilus and its subunits for enterococcal virulence in a mouse model of CAUTI. We further showed that the metal ion-dependent adhesion site (MIDAS) motif in EbpA is necessary for Ebp function in vivo. As this motif occurs in other sortase-assembled pili, our results have implications for the molecular basis of virulence not only in E. faecalis CAUTI but also in additional infections caused by enterococci and other Gram-positive pathogens.

scholarly journals 406. Incidence of Community and Hospital Acquired Infections in Critically Ill COVID-19 Patients in the Dominican Republic

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S304-S305
Author(s):  
Rita Alexandra Rojas-Fermin ◽  
Anel E Guzman ◽  
Ann Sanchez ◽  
Edwin Germosen ◽  
Cesar Matos ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Dominican Republic ◽  
Critically Ill ◽  
Urinary Tract Infections ◽  
Bloodstream Infections ◽  
Central Venous ◽  
Health Crisis ◽  
Hospital Acquired Infections ◽  
Tract Infections ◽  
Hospital Acquired

Abstract Background The disease caused by SARS-CoV-2, COVID-19, has caused a global public health crisis. COVID-19 causes lower respiratory tract infection (LRTI) and hypoxia. There is a paucity of data on bacterial and fungal coinfection rates in patients with COVID-19 at low and middle income countries (LMICs). Our objective is to describe the clinical characteristics of critically ill patients with COVID-19 in the Dominican Republic (DR) Methods We performed a retrospective review of patients admitted to the ICU with COVID-19 from March 14th to December 31st 2020, at a 296-bed tertiary care level and teaching Hospital in the Dominican Republic. Demographic and clinical information was collected and tabulated. Laboratory confirmed bacterial and fungal infections were defined as community acquired infections (CAI) if diagnosed within 48 hours of admission and hospital acquired infections (HAI) when beyond 48 hours. Microbiologic data was tabulated by source and attribution. Results Our cohort had 382 COVID-19 patients. Median age was 64 and most were male (64.3%) and 119 (31.1%) were mechanically ventilated and 200 (52%) had central venous catheters. A total of 28 (7%) laboratory confirmed community acquired infections and 55 (14%) HAIs occurred. Community acquired infections included 13 (46%) bloodstream infections (BSIs), 11 (39%) urinary tract infections (UTI) and 6 (21%) LRTIs. HAIs included 39 (70%) BSIs, 11 (20%) UTIs and 6 (11%) ventilator associated pneumonias (VAP). Causal organisms of community and hospital acquired BSI and UTI are in Figure 1 and Figure 2 respecively. All-cause mortality was 35.3% (135/382) in our cohort, and 100% mortality (76) in those with coinfections. Figure 1. Community acquired and hospital acquired bloodstream infections in COVID-19 patients admitted to the ICU Figure 2. Community acquired and hospital acquired urinary tract infections in COVID-19 patients admitted to the ICU Conclusion Community and hospital acquired infections were common and in the ICU and likely contributed to patient outcomes. More than two thirds of HAIs in the ICU were BSIs. Central venous catheter device utlization and maintenance may play a role in BSIs, along with immunosuppression from COVID-19 therapeutics and translocation from mucosal barrier injury. Mortality in patients with coinfections was higher than those without. Infection prevention strategies to reduce device utilization during COIVD-19 in LMICs may have an impact on HAIs. Disclosures All Authors: No reported disclosures

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