Admissions and Mortality Related to Urinary Tract Infections in Male Veterans with Dementia

2021 ◽  
Vol 36 (12) ◽  
pp. 681-686
Author(s):  
Alicia DeRosa ◽  
Bethany A. Wattengel ◽  
Michael T. Carter ◽  
John A. Sellick ◽  
Alan J. Lesse ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Hospital Readmission ◽  
Asymptomatic Bacteriuria ◽  
Readmission Rates ◽  
Risk Of Death ◽  
Hospital Readmission Rates ◽  
Male Veterans ◽  
Increased Risk ◽  
Tract Infections

Objective To examine mortality and hospital readmission rates in male veterans with dementia diagnosed with urinary tract infection (UTI) compared with patients without dementia. Design Retrospective cohort study. Setting Veterans Healthcare Systems (VA). Participants Male inpatients with a diagnosis of UTI who were treated at any VA Healthcare Center from January 1, 2009, to December 31, 2018. Interventions None. Main Outcome Measures Mortality and hospital readmission for patients with and without dementia at 30, 60, and 90 days from UTI diagnosis. Results 262,515 veterans admitted with UTI were analyzed, and 58,940 (22.5%) had dementia. The mean age for veterans with dementia was 80.0 +/- 9.7 years. Veterans with dementia experienced less mortality than patients without dementia at 30 days (8.3% vs 8.5%; P < 0.001), but more mortality at 60-day (4.9% vs 4.7%; P < 0.001) and 90-day (3.6% vs 3.3%; P < 0.001) intervals. Death was 20% less likely at 30 days in patients with dementia. Veterans with dementia were readmitted more than those without dementia at 30-day (18.4% vs 16.0%), 60-day (4.5% vs 2.8%), and 90-day (3.4% vs 2.5%) intervals; P < 0.0001. Conclusion Though patients with dementia are at an increased risk for death long-term, risk of death is less than those without dementia shortly following UTI diagnosis. This highlights the possibility that veterans with dementia may be hospitalized and diagnosed with UTIs when in actuality they have asymptomatic bacteriuria. Patients with dementia and UTI therefore represent an important group of geriatric patients that could benefit from the oversight of a senior care pharmacist to help prevent unnecessary treatment of asymptomatic bacteriuria.

Primary vesicoureteric reflux and reflux nephropathy

2018 ◽  
Author(s):  
Heather Lambert
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Vesicoureteric Reflux ◽  
Reflux Nephropathy ◽  
Ureterovesical Junction ◽  
Increased Risk ◽  
History Of ◽  
Tract Infections

Vesicoureteric reflux (VUR) describes the flow of urine from the bladder into the upper urinary tract when the ureterovesical junction fails to perform as a one-way valve. Most commonly, VUR is primary, though it can be secondary to bladder outflow obstruction and can occur in several multiorgan congenital disorders. There is good evidence of a genetic basis with a greatly increased risk of VUR in children with a family history of VUR. VUR is a congenital disorder, which largely shows improvement or complete resolution with age. Fetal VUR may be associated with parenchymal developmental defects (dysplasia). Postnatally non-infected, non-obstructed VUR does not appear to have a detrimental effect on the kidneys. However there is an association of VUR with urinary tract infection and acquired renal parenchymal defects (scarring). The parenchymal abnormalities detected on imaging, often termed reflux nephropathy, may be as a result of reflux-associated dysplasia or acquired renal scarring or both. It is difficult to distinguish between the two on routine imaging. Higher grades of VUR are associated with more severe reflux nephropathy. The precise role of VUR in pyelonephritis and scarring is not clear and it may be that VUR simply increases the risk of acute pyelonephritis. Whilst most VUR resolves during childhood, it is associated with an increased risk of urinary tract infection and burden of acute disease. Investigation strategies vary considerably, related to uncertainties about the natural history of the condition and the effectiveness of various interventions. The long-term prognosis is chiefly related to the morbidity of reflux nephropathy leading in some cases to impairment of glomerular filtration rate, hypertension, proteinuria, and pregnancy-related conditions including hypertension, pre-eclampsia, and recurrent urinary tract infection. Management is controversial and ranges from simple observation with or without provision of rapid access to diagnosis and treatment of urinary tract infections; to long-term prophylactic antibiotics or various antireflux surgical procedures.

Urinary Tract Infections in Women

2016 ◽  
Author(s):  
Arjun S. Chanmugam ◽  
Gino Scalabrini
Keyword(s):  
Urinary Tract ◽  
Pregnant Women ◽  
Urinary Tract Infections ◽  
Asymptomatic Bacteriuria ◽  
Upper Urinary Tract ◽  
Increased Risk ◽  
Resistance Patterns ◽  
Amoxicillin Clavulanic Acid ◽  
Tract Infections ◽  
Antibiotic Resistance Patterns

Urinary tract infections (UTIs) refer to a urine culture yielding a minimum of 100 to 10,000 bacteria units/mm of urine usually from a clean catch midstream sample. This can result from infection of the lower urinary tract involving the bladder (cystitis) or an infection of the upper urinary tract involving the kidneys (pyelonephritis). Uncomplicated UTIs occur in healthy, pre-menopausal, non-pregnant women with a normal urinary tract who have a high likelihood to respond favorably to treatment, but consider local antibiotic resistance patterns. Complicated UTIs occur in women with coexisting pathology, anatomical abnormality, underlying comorbidity, or immunocompromise. Untreated UTIs can progress to pyelonephritis and urosepsis. Asymptomatic bacteriuria for pregnant women can progress very quickly; pyelonephritis carries increased risk of perinatal and neonatal mortality. Pregnant patients should be treated with cephalexin, amoxicillin, or amoxicillin-clavulanic acid (avoiding fluoroquinolones).

Chronic Urinary Tract Infections in Children: A Double-Blind Study of Medical Management

PEDIATRICS ◽  
1970 ◽  
Vol 45 (3) ◽  
pp. 456-461
Author(s):  
C. George RAY ◽  
Yi-Chuan Ching ◽  
David B. Shurtleff ◽  
Margaret L. Hill ◽  
Julian S. Ansell ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Medical Management ◽  
Asymptomatic Bacteriuria ◽  
Double Blind Study ◽  
Careful Evaluation ◽  
Double Blind ◽  
Continuous Therapy ◽  
Tract Infections

Nine children with nonobstructive urinary tract infections, 10 children with neurogenic bladders secondary to meningomyeloceles, and 2 children with ileal bladders have been studied in a double-blind program of medical management for recurrent urinary tract infections. Observations indicate that some patients with nonobstructive recurrent UTI's may benefit from long-term chemoprophylaxis; however, the effective drug may vary from patient to patient. Furthermore, not all patients need continuous therapy, although initial clinical differentiation is not currently possible. In all patients, the essence of management consists of frequent, careful evaluation, with periodic assessment of anatomic and functional status of the urinary tract. Among children with anatomic and physiologic abnormalities of the urinary tract, neither continuous chemotherapy nor therapy of asymptomatic bacteriuria appears beneficial.

A Multi-Component Transition of Care Improvement Project to Reduce Hospital Readmissions Following Ischemic Stroke

2021 ◽  
pp. 194187442110366
Author(s):  
Ann M. Leonhardt-Caprio ◽  
Craig R. Sellers ◽  
Elizabeth Palermo ◽  
Thomas V. Caprio ◽  
Robert G. Holloway
Keyword(s):  
Ischemic Stroke ◽  
Hospital Readmission ◽  
Hospital Readmissions ◽  
Cost Of Care ◽  
Post Discharge ◽  
Readmission Rates ◽  
Improvement Project ◽  
Risk Of Death ◽  
Hospital Readmission Rates ◽  
Number Of Patients

Background: Ischemic stroke (IS) is a common cause of hospitalization which carries a significant economic burden and leads to high rates of death and disability. Readmission in the first 30 days after hospitalization is associated with increased healthcare costs and higher risk of death and disability. Efforts to decrease the number of patients returning to the hospital after IS may improve quality and cost of care. Methods: Improving care transitions to reduce readmissions is amenable to quality improvement (QI) initiatives. A multi-component QI intervention directed at IS patients being discharged to home from a stroke unit at an academic comprehensive stroke center using IS diagnosis-driven home care referrals, improved post-discharge telephone calls, and timely completion of discharge summaries was developed. The improvement project was implemented on July 1, 2019, and evaluated for the 6 months following initiation in comparison to the same 6-month period pre-intervention in 2018. Results: Following implementation, a statistically significant decrease in 30-day all-cause same-hospital readmission rates from 7.4% to 2.8% ( p = .031, d = 1.61) in the project population and from 6.6% to 3% ( p = .010, d = 1.43) in the overall IS population was observed. Improvement was seen in all process measures as well as in patient satisfaction scores. Conclusions: An evidence-based bundled process improvement intervention for IS patients discharged to home was associated with decreased hospital readmission rates following IS.

scholarly journals Beyond Expert Opinion: A Comparison of Antibiotic Regimens for Infectious Urinary Tract Pathology in Pregnancy

2020 ◽  
Vol 10 (04) ◽  
pp. e352-e356
Author(s):  
Madison K. Krischak ◽  
Heather A. Rosett ◽  
Sarika Sachdeva ◽  
Kristin E. Weaver ◽  
Robert Phillips Heine ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Expert Opinion ◽  
Asymptomatic Bacteriuria ◽  
Obstetric Outcomes ◽  
Acute Cystitis ◽  
First Line Therapy ◽  
Line Therapy ◽  
Increased Risk ◽  
Tract Infections ◽  
In Pregnancy

Abstract Objective Outside pregnancy, nitrofurantoin, ciprofloxacin and sulfamethoxazole-trimethoprim (SMZ-TMP) are first-line therapy (FLT) for lower urinary tract infections (LUTIs). Optimal antibiotics for LUTI have been extrapolated based on expert opinion. Progression to pyelonephritis and adverse obstetric outcomes were compared between women who received FLT and those given alternative antibiotics. Methods This study includes a retrospective cohort of women with LUTI, including asymptomatic bacteriuria and acute cystitis at single health care system from July 2013 to May 2019. Women receiving FLT, defined as nitrofurantoin or SMZ-TMP, were compared with those receiving nonfirst-line therapy (nFLT). Primary outcome was progression to pyelonephritis. Secondary outcomes included pyelonephritis-related anemia, sepsis, length of stay, preterm birth (PTB), and low birth weight (LBW). Logistic regression was used to calculate odds of outcomes. Results Of 476 women, 336 (70.6%) received FLT and 140 (29.4%) received nFLT. Women receiving FLT were more likely having BMI ≥ 40 (p = 0.04). Progression to pyelonephritis did not differ (5.8 vs. 8.2%; p = 0.44), nor did other pyelonephritis-related outcomes. After controlling for confounders, no difference in odds of progression to pyelonephritis was seen (adjusted odds ratio [aOR] 1.02, 95% confidence interval [CI] 0.42, 2.49). FLT was not associated with PTB or LBW (aOR 0.60, 95% CI 0.29, 1.26) after controlling for confounders. Conclusion Receipt of antibiotics other than nitrofurantoin or SMZ-TMP for LUTI in pregnancy was not associated with increased risk of progression to pyelonephritis, PTB, or LBW.

scholarly journals Antenatally detected urinary tract dilatation: a 12–15-year follow-up

2020 ◽  
Vol 35 (11) ◽  
pp. 2129-2135 ◽  
Author(s):  
Maria Herthelius ◽  
Rimma Axelsson ◽  
Karl-Johan Lidefelt
Keyword(s):  
Urinary Tract ◽  
Kidney Damage ◽  
Long Term Outcome ◽  
Urinary Tract Dilatation ◽  
Normal Bladder ◽  
Increased Risk ◽  
Bladder Pathology ◽  
Tract Infections

Abstract Background Antenatally diagnosed urinary tract dilatation (UTD) still burdens healthcare providers and parents. This study was conducted to establish long-term outcome in an unselected group of children with antenatally detected UTD. Methods Seventy-one out of 103 children born in 2003–2005 and diagnosed with antenatal UTD agreed to participate in a 12–15-year follow-up including blood and urine samples, a kidney ultrasound exam, and kidney scintigraphy. The records were searched for previous urinary tract infections. Results Among children with an anteroposterior diameter (APD) ≤ 7 mm and no calyceal, kidney, ureteral, or bladder pathology in the early postnatal period, no one tested had reduced estimated glomerular filtration rate (eGFR), albuminuria, or UTD at the follow-up at a mean age of 13.6 years. One child had kidney damage not affecting kidney function. Among children with postnatal APD > 7 mm and/or kidney, calyceal, ureteral, or bladder pathology, 15% had persistent UTD and 32–39% (depending on the method used) had kidney damage. Major postnatal urinary tract ultrasound abnormalities and a congenital anomalies of the kidney and urinary tract (CAKUT) diagnosis were factors associated with an increased risk for permanent kidney damage (odds ratios 8.9, p = 0.016; and 14.0, p = 0.002, respectively). No one had reduced eGFR. One child (1/71, 1%) had a febrile urinary tract infection after the age of 2. Conclusions We conclude that in children with postnatal APD ≤ 7 mm, no calyceal dilatation, normal bladder, ureters, and kidney parenchyma, the outcome is excellent. There is no need for long-term follow-up in these patients.

scholarly journals Dementia and Hospital Readmission Rates: A Systematic Review

2017 ◽  
Vol 7 (3) ◽  
pp. 346-353 ◽  
Author(s):  
Sabrina Pickens ◽  
Aanand D. Naik ◽  
Angela Catic ◽  
Mark E. Kunik
Keyword(s):  
Systematic Review ◽  
Hospital Readmission ◽  
Patient Discharge ◽  
Community Dwelling ◽  
Case Control Studies ◽  
Readmission Rates ◽  
Absolute Increase ◽  
Hospital Readmission Rates ◽  
Increased Risk ◽  
Comparison Groups

Background: Although community-dwelling persons with dementia have an increased risk of hospital readmission, no systematic review has examined the contribution of dementia to readmissions. Summary: We examined articles in English, with no restrictions on publication dates, from Medline, PubMed, PsycINFO, CINAHL, and EMBASE. Keywords used were dementia, Alzheimer disease, frontotemporal lobar degeneration, elderly, frontotemporal dementia, executive function, brain atrophy, frontal lobe atrophy, cognitive impairment, readmission, readmit, rehospitalization, patient discharge, and return visit. Of 404 abstracts identified, 77 articles were retrieved; 12 were included. Four of 5 cohort studies showed significantly increased readmission rates in patients with dementia. On average the absolute increase above the comparison groups was from 3 to 13%. Dementia was not associated with readmission in 7 included case-control studies. Key Message: Findings suggest a small increased risk of hospital readmission in individuals with dementia. More study is needed.

scholarly journals Risk Indicators for Urinary Tract Infections in Low Risk Pregnancy and the Subsequent Risk of Preterm Birth

Antibiotics ◽  
2021 ◽  
Vol 10 (9) ◽  
pp. 1055
Author(s):  
Dominique E. Werter ◽  
Brenda M. Kazemier ◽  
Caroline Schneeberger ◽  
Ben W. J. Mol ◽  
Christianne J. M. de Groot ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Preterm Birth ◽  
Urinary Tract ◽  
Tract Infection ◽  
Urinary Tract Infections ◽  
Asymptomatic Bacteriuria ◽  
Risk Indicators ◽  
Recurrent Urinary Tract Infections ◽  
Increased Risk ◽  
Tract Infections

Symptomatic urinary tract infections are associated with preterm birth. However, data on risk indicators for urinary tract infections are limited and outdated. The research is a secondary analysis. The study was a prospective multicenter cohort study of low-risk pregnant women. Logistic regression was used to identify risk indicators for urinary tract infections. The incidence of urinary tract infections was 9.4%. Multivariate logistic regression showed that a history of recurrent urinary tract infections and the presence of asymptomatic bacteriuria in the present pregnancy were associated with urinary tract infections (resp. OR 3.14, 95%CI 1.40–7.02 and OR 1.96 95%CI 1.27–3.03). Women with a urinary tract infection were at increased risk of preterm birth compared to women without a urinary tract infection (12 vs. 5.1%; adjusted HR 2.5 95%CI 1.8–3.5). This increased risk was not found in women with the identified risk indicators (resp. 5.3% vs. 5.1%, adjusted HR 0.35 95%CI 0.00–420 and adjusted HR 1.5 95CI% 0.59–3.9). In conclusion, in low-risk pregnant women, risk indicators for urinary tract infections are: a history of recurrent urinary tract infections and the presence of asymptomatic bacteriuria. The risk of preterm birth is increased in women with a urinary tract infection in this pregnancy. However, women with recurrent urinary tract infections and asymptomatic bacteriuria this pregnancy appear not to be at increased risk of preterm birth.

scholarly journals 2046. A Qualitative Study on Perceived Barriers and Facilitators of Implementing an Antimicrobial Stewardship Intervention in the Management of Urinary Tract Infections in a Long-Term Care Setting

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S688-S689
Author(s):  
April Chan ◽  
Denis O’Donnell ◽  
Benjamin Kaasa ◽  
Annalise Mathers ◽  
Nicoleta Paraschiv ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Antimicrobial Stewardship ◽  
Long Term Care ◽  
Structured Interview ◽  
Barriers And Facilitators ◽  
Antibiotic Prescribing ◽  
Term Care ◽  
Increased Risk ◽  
Tract Infections

Abstract Background 50% of antibiotic courses in long-term care facilities (LTCFs) are unnecessary, leading to increased risk of harm such as Clostridiodes difficile infection and antibiotic-resistant organisms. Antimicrobial stewardship (AS) interventions play an important role in optimizing antibiotic use. Most studies addressing strategies to improve antibiotic prescribing in LTCFs showed modest and unsustained results. We aimed to identify facilitators, barriers and strategies in implementing a urinary tract infection (UTI)-focused AS intervention at an LTCF in Toronto. Methods A qualitative approach using conventional content analysis was used. Through purposeful sampling, we recruited different LTCF healthcare providers and administrators at Kensington Gardens. Interviewees attended focus groups or one-on-one interviews. Data were collected using a semi-structured interview guide. Data were analyzed inductively using a codebook modified in an iterative analytic process. Barriers and facilitators with potential strategies were summarized and mapped using the COM-B (capability, opportunity, motivation and behavior) model (Mitchie et al.) and emerging themes identified. Results Sixteen participants were interviewed. The most common barriers were family pressure, lack of access and test result delay while the barrier themes were lack of access, inadequate communication, lack of time and lack of knowledge of both HCPs and resident’s families. These can be addressed by the most common facilitators and facilitator themes, which included good communication between healthcare professionals (HCPs), education for HCPs and families and collaboration between HCPs. Most barriers and facilitators were mapped to the opportunities domain of the COM-B model. Conclusion Strategies for improved UTI-focused antimicrobial stewardship intervention in LTC setting should focus on increasing opportunities and innovative formats for education, communication and collaboration among HCPs and with families although barriers and facilitators in all aspects of the COM-B model were identified. Disclosures All authors: No reported disclosures.

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