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Urinary Tract Infections - WHO

Urinary Tract Infections Leading cause of morbidity and health care expenditures in persons of all ages. An estimated 50 % of women report having had a UTI at some point in their lives. million office visits and more than 1 million hospitalizations, for an overall annual cost > $1 Ulleryd, Sahlgrenska University Hospital, G teborg, Sweden VirulenceHost factorsInfectionNo infectionUTIs may occur either because ofthe pathogenicity of the organism,the susceptibility of the host or acombination of both factorsVirulence factors of the gram-negative uropathogens E.

2007 by creation of a catheter management and removal policy: † nurse and care partner education † check off on sterile technique † insertion competency † strict guidelines on catheter and perineal skin care † mandatory removal of the urinary catheter at 5 days unless a counter-order was written.

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Transcription of Urinary Tract Infections - WHO

1 Urinary Tract Infections Leading cause of morbidity and health care expenditures in persons of all ages. An estimated 50 % of women report having had a UTI at some point in their lives. million office visits and more than 1 million hospitalizations, for an overall annual cost > $1 Ulleryd, Sahlgrenska University Hospital, G teborg, Sweden VirulenceHost factorsInfectionNo infectionUTIs may occur either because ofthe pathogenicity of the organism,the susceptibility of the host or acombination of both factorsVirulence factors of the gram-negative uropathogens E.

2 Coli and P. mirabilisHost defenses Host defenses Antibacterial properties of urineAntibacterial properties of urine Osmolality (extremes of high or low osmolalities inhibit bacterial growth) High urea concentration High organic acid concentration pHAntiAnti--adherence mechanismsadherence mechanisms Bacterial interference (naturally endogenous bacteria in the urethra, vagina, and periurethral region) Urinary oligosaccharides (have the potential to detach Tamm-Horsfall protein (uromucoid): coating of this protein might prevent attachmentMiscellaneousMiscellaneous Mucopolysaccharide lining of the bladder Urinary immunoglobulins Spontaneous exfoliation of uroepithelial cells with bacterial detachment Mechanical flushing of micturitionUrinary Catheterization alters these defensive mechanismsCatheterCatheter--Associated UTIA ssociated UTI Risk of bacteriuria is ~ 5%/day (long Risk of bacteriuria is ~ 5%/day (long term catheter bacteriuria is inevitable).))

3 Term catheter bacteriuria is inevitable). 40% of nosocomial infections40% of nosocomial Infections Most common source of gramMost common source of Etiology: , Proteus, Enterococcus, Etiology: , Proteus, Enterococcus, Pseudomona, Enterobacter, Serratia, Pseudomona, Enterobacter, Serratia, CandidaCandidaDuration of cahteterizationDaily Prevalence of Acquired Bacteriuria in Patients Receiving Bladder Drainage by Indwelling Urethral CathetersGaribaldi et al. Factors predisposing to bacteriuria during indwelling uretheral catheterization.

4 N Engl J Med 1974;291 Factors Associated with the Development of CAUTII ncreasing duration of catheterizationNot receiving system antibiotic therapyFemale sexDiabetes mellitusOlder ageRapidly fatal underlying diseasesNonsurgical diseasesFaulty aseptic management of the indwelling catheterBacterial colonization of drainage bagAzotemia (serum creatinine concentration > 2 mg/dlCatheter not connected to a urine meterPeriurethral colonization with uropathogensAsymptomatic Bacteriuria The best way to avoid having patients)

5 Develop IUC-related UTIs is to avoid initial catheter insertion or to minimize the duration of catheter use. UTIs are the tenth most likely reason for a Medicare patient to have an unplanned readmission to the hospitalLee EAPerm J2011CA-UTI reduction initiatives began in late2007 by creation of a catheter management and removal policy: nurse and care partner education check off on sterile technique insertion competency strict guidelines on catheter and perineal skin care mandatory removal of the Urinary catheter at 5 days unless a counter-order was UTIE.

6 &gram neg entericsEnterococcusNosocomial UTIcatheter associatedShort TermLong resistanceWith timeBy patient ageBy patient sexSmithson A EJCMID 2011 Prevalence (%) of ESBL producing isolates by species in Assistance Publique Hopitaux de Paris long-term-care facilities (2001 2005).Nicolas-Chanoine et al. CMI 2008 Risk factors for ESBL-producing Escherichia coli and Klebsiella pneumoniaeMendelson et al EJCMID 2005 Multivariate logistic regression analyses: Fluoroquinolone use days: OR ( ) P= History of UTI: OR ( ) P= Organisms in LTCF MDRGN were isolated more frequently than MRSA or VRE throughout the study period.

7 More than 80% of MDRGN isolates were resistant to ciprofloxacin, TMP/SMX, and ampicillin/sulbactam. Resistance to three, four, or more antimicrobials were identified among 122 ( ), 47 ( ), and 11 ( ) MDRGN isolates, Fallon J Gerontol. 2009 Acquisition of Multidrug-Resistant Gram-Negative Bacteria within a LTCF PopulationO Fallon E et al ICHE 2010 There were significantly higher antibiotic costs, re-consultation costs and total costs for patients whose Infections were resistant to at least one 2009 Appropriateness by Site of Infection01020304050 UrinaryRespiratoryGastrointestinalSkin/S oftTissueEar/Nose/ThroatGenitalTractOthe rAppropriateInappropriatep= ,Arch Intern Med2003.

8 163:601 What factors or conditions are likely to have determined UTI? What measures should have been put in place to prevent it?


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