Factors associated with multidrug-resistant bacteria in a cohort of patients with asymptomatic bacteriuria who underwent urological surgery

Ramos-Castañeda, Jorge A.; Ruano-Raviña, Alberto; Salinas, Diego; Osorio-Manrique, Javier; Segura-Cardona, Ángela; Lemos, Elkin

doi:10.1016/j.ajic.2019.06.005

Cited by 5 publications

(9 citation statements)

References 29 publications

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“…We found a relatively high proportion of ASB among patients who were female, of advanced age, diabetic, and who had hypertension [ 12 ]. This is consistent with findings from other studies [ 2 , 4 , 7 , 10 ].…”

Section: Discussionsupporting

confidence: 94%

Evaluation of asymptomatic bacteruria management before and after antimicrobial stewardship program implementation: retrospective study

et al. 2021

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Background The Infectious Diseases Society of America (IDSA) recommends against screening for and/or treating asymptomatic bacteriuria (ASB). This study aims to evaluate the inappropriate use of antibiotics in ASB before and after Antimicrobial Stewardship Program (ASP) implementation and advance towards its appropriate use. Method We performed a retrospective study of patients diagnosed with ASB from 2016 to 2019 at a tertiary hospital in Saudi Arabia. This study included hospitalized patients ≥ 18 years old who had a positive urine culture with no documented signs or symptoms of urinary tract infection We excluded pregnant women, solid organ transplant patients, patient on active chemotherapy, and patients about to undergo urological surgery. Results A total of 716 patients with a positive urine culture were screened. Among these, we identified 109 patients with ASB who were included in our study. The rate of inappropriate antibiotic use was 95% during the study period. The implementation of the ASP Program was associated with a significant reduction in the use of carbapenems (P = 0.04) and an increase in the use of cephalosporins (P = 0.01). However, overprescribing antimicrobial agents was a concern in both eras. Approximately 90% of the microorganisms identified were gram-negative bacteria. Of those, 38.7% were multidrug-resistant strains. Conclusion The urine culture order in ASB is considered relatively small number; however, it showed a high rate of the inappropriate use of antibiotics when there is an order of urine culture in both era. ASP ought to focus on targeting the ordering physician, promoting awareness and/or organizational interventions that appear to reduce the incidence of overtreatment.

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Section: Discussionsupporting

confidence: 94%

Evaluation of asymptomatic bacteruria management before and after antimicrobial stewardship program implementation: retrospective study

et al. 2021

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“…We found a relatively high proportion of ASB among patients who were female, of advanced age, diabetic, and who had hypertension. This is consistent with ndings from other studies [2,4,3,8] .…”

Section: Discussionsupporting

confidence: 94%

“…A prospective study found that overtreatment of ASB was responsible for 17% of prescribed antimicrobials [9] . In fact, overtreatment of ASB led to several adverse effects, such as increased prevalence of multidrug-resistant (MDR) organisms, increased rates of Clostridium di cile infection (CDI) and long hospitalizations, all of which factors increase the costs of health care [2,4,5,6] . In addition, previous studies have shown that MDR organisms are frequently found in ASB patients, with a prevalence of 16% [3,4,7] .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Asymptomatic Bacteruria Management Before and After Antimicrobial Stewardship Program Implementation: Retrospective Study

Alghamdi

Almajed

Alalawi

et al. 2021

Preprint

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BackgroundThe Infectious Diseases Society of America (IDSA) recommends against screening for and/or treating asymptomatic bacteriuria (ASB). This study aims to evaluate the inappropriate use of antibiotics in ASB before and after Antimicrobial Stewardship Program implementation and advance towards its appropriate use. MethodWe performed a retrospective study of patients diagnosed with ASB from 2016 to 2019 at a tertiary hospital in Saudi Arabia. This study included hospitalized patients ≥18 years old who had a positive urine culture with no signs or symptoms of urinary tract infection and were on antibiotics for asymptomatic bacteriuria. We excluded pregnant women, solid organ transplant patients, patient on active chemotherapy, and patients about to undergo urological surgery.ResultsA total of 716 patients with a positive urine culture were screened . Among these, we identified 109 patients with ASB who were enrolled in our study. The rate of inappropriate antibiotic use was 95% during the study period. The implementation of the Antimicrobial Stewardship Program was associated with a significant reduction in the use of carbapenems (P = 0.04) and an increase in the use of cephalosporins (P = .099687). However, overprescribing antimicrobial agents was a concern in both eras. Approximately 90% of the microorganisms identified were gram-negative bacteria. Of those, 38.7% were multidrug-resistant strains. ConclusionThe urine culture order in ASB is considered relatively small number; however, it showed a high rate of the inappropriate use of antibiotics when there is an order of urine culture in both era. ASP ought to focus on targeting the ordering physician, promoting awareness and/or organizational interventions that appear to reduce the incidence of overtreatment.

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“…11 Estudios han descrito que la tasa de complicación global posterior al procedimiento urológico en pacientes con litiasis renal se encuentra entre el 7,4% y el 12%, siendo la de tipo infecciosa la más frecuente. 21,22 En el estudio, la tasa de complicación infecciosa fue 4,00% inferior a lo reportado en los estudios. Eso se podría deber a dos factores.…”

Section: Discussionunclassified

“…Como un factor de riesgo para la complicación infecciosa posoperatoria, se encontró el hecho de tener un cálculo con una longitud mayor de 20 mm, aspecto que ha sido descrito en otros estudios principalmente como un importante predictor de la persistencia global de la urolitiasis, junto con la litiasis múltiple y la bilateralidad. 20,23 Estudios han reportado como factores de riesgo a infección, la bacteriuria asintomática por microorganismo multirresistente, 22,24 el tiempo del procedimiento y la presencia de dispositivo urinario. Por lo tanto, el tamaño del cálculo es un criterio que se debe tener en cuenta para la selección del procedimiento urológico, y se podría considerar un factor de riesgo tanto para la complicación infecciosa posoperatoria como para la litiasis recurrente.…”

Section: Discussionunclassified

Factores asociados a complicaciones infecciosas posoperatorias en pacientes con urolitiasis

Osorio-Manrique¹,

Ramos-Castañeda²,

Garcia-Landazabal³

et al. 2021

Revista Urología Colombiana / Colombian Urology Journal

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Resumen Introducción Se encuentran múltiples tratamientos para la urolitiasis, los cuales dependen en gran medida del tamaño y la ubicación de la litiasis. Dentro de las opciones terapéuticas se encuentran la expulsión activa, utilización de ondas de choque, las ureterolitotomias, y procedimientos endoscópicos, todas con diferentes tasas de efectividad y riesgo de complicación infecciosa. El objetivo del estudio fue evaluar los factores asociados a la complicación infecciosa posterior al procedimiento urológico en pacientes con urolitiasis. Métodos Estudio de casos y controles anidado a una cohorte de pacientes programados para procedimientos urológicos como tratamiento para la urolitiasis durante el periodo 2015 - 2019. Se consideraron casos, aquellos con complicación infecciosa posoperatoria dentro de los 30 días posteriores al procedimiento urológico. Los controles se seleccionaron de la cohorte inicial y fueron los pacientes que no presentaron complicación infecciosa. Resultados En el periodo de estudio, fueron atendidos 350 pacientes con litiasis renal, con un total de 1258 cálculos. El número promedio de cálculos por paciente fue de 3,59; la prevalencia de litiasis bilateral fue del 57%, siendo similar la cantidad de cálculos en el lado izquierdo (promedio = 1,4) y en el derecho (promedio = 1,44).La tasa de complicación infecciosa posquirúrgica fue del 4% (n= 14) y se asoció con la presencia de al menos un cálculo mayor de 20 mm (OR 4,49 IC95% 1,39–14,52). Conclusión La tasa de complicación infecciosa posoperatoria en pacientes con urolitiasis y programados para procedimientos urológicos es baja. Una longitud del cálculo mayor de 20 mm es un factor asociado a la infección posoperatoria.

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Factors associated with multidrug-resistant bacteria in a cohort of patients with asymptomatic bacteriuria who underwent urological surgery

Cited by 5 publications

References 29 publications

Evaluation of asymptomatic bacteruria management before and after antimicrobial stewardship program implementation: retrospective study

Evaluation of asymptomatic bacteruria management before and after antimicrobial stewardship program implementation: retrospective study

Evaluation of Asymptomatic Bacteruria Management Before and After Antimicrobial Stewardship Program Implementation: Retrospective Study

Factores asociados a complicaciones infecciosas posoperatorias en pacientes con urolitiasis

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