Bacteriuria in the catheterized surgical intensive care patient

Martínez, Octavio; Civetta, Joseph M.; Anderson, Kristine L.; Roger, Sonia; Murtha, Mary; Malinin, Theodore I.

doi:10.1097/00003246-198603000-00003

Cited by 41 publications

(19 citation statements)

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“…We observed an incidence density of ICU-acquired UTI of 9.6 per 1000 ICU days that is comparable to that observed in other studies that evaluated nosocomial UTIs in ICUs [2,9,10,17]. However, an important strength of this study is that all patients admitted to adult ICUs (both academic-based and community-based) in a large region were included.…”

Section: Discussionsupporting

confidence: 81%

Intensive care unit-acquired urinary tract infections in a regional critical care system

et al. 2005

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Introduction Few studies have evaluated urinary tract infections (UTIs) specifically acquired within intensive care units (ICUs), and the effect of such infections on patient outcome is unclear. The objectives of this study were to describe the occurrence, microbiology, and risk factors for acquiring UTIs in the ICU and to determine whether these infections independently increase mortality. Methods A surveillance cohort study was conducted among all adults admitted to multi-system and cardiovascular surgery ICUs in the Calgary Health Region (CHR, population about 1 million) between 1 January 2000 and 31 December 2002. Results During the 3 years, 4465 patients were admitted 4915 times to a CHR ICU for 48 hours or more. A total of 356 ICU-acquired UTIs (defined as at least 10 5 colony-forming units/ml of one or two organisms 48 hours or more after ICU admission) occurred among 290 (6.5%) patients, yielding an overall incidence density of ICU-acquired UTIs of 9.6 per 1000 ICU days. Four bacteremic/fungemic ICU-acquired UTIs occurred (0.1 per 1000 ICU days). Development of an ICU-acquired UTI was more common in women (relative risk [RR] 1.58; 95% confidence interval [CI] 1.43-1.75; P < 0.0001) and in medical (9%) compared with non-cardiac surgical (6%), and cardiac surgical patients (2%). The most common organisms isolated were Escherichia coli (23%), Candida albicans (20%), and Enterococcus species (15%). Antibiotic-resistant organisms were identified among 14% isolates. Although development of an ICU-acquired UTI was associated with significantly higher crude inhospital mortality (86/290 [30%] vs. 862/4167 [21%]; RR = 1.43; 95% CI 1.19-1.73; P < 0.001); an ICU-acquired UTI was not an independent predictor for death. Conclusions Development of an ICU-acquired UTI is common in critically ill patients. Although a marker of increased morbidity associated with critical illness, it is not a significant attributable cause of mortality.

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Section: Discussionsupporting

confidence: 81%

Intensive care unit-acquired urinary tract infections in a regional critical care system

et al. 2005

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“…146,147 Infection Urinary infection can be a direct complication of persistent POUR (consequence of bladder hypotonia and the inability to completely empty the bladder) or an indirect complication of bladder catheterization. 148 Higher mortality rate has been reported in hospitalized patients who developed nosocomial urinary tract infection after indwelling bladder catheterization. 149 The incidence of bactremia after single catheterization has been reported to be as high as 8%.…”

Section: Autonomic Responsementioning

confidence: 99%

Postoperative Urinary Retention

Baldini¹,

Bagry²,

et al. 2009

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Urinary retention is common after anesthesia and surgery, reported incidence of between 5% and 70%. Comorbidities, type of surgery, and type of anesthesia influence the development of postoperative urinary retention (POUR). The authors review the overall incidence and mechanisms of POUR associated with surgery, anesthesia and analgesia. Ultrasound has been shown to provide an accurate assessment of urinary bladder volume and a guide to the management of POUR. Recommendations for urinary catheterization in the perioperative setting vary widely, influenced by many factors, including surgical factors, type of anesthesia, comorbidities, local policies, and personal preferences. Inappropriate management of POUR may be responsible for bladder overdistension, urinary tract infection, and catheter-related complications. An evidence-based approach to prevention and management of POUR during the perioperative period is proposed.

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“…[94][95][96][97][98] These opioid-induced effects on the lower urinary tract can lead to secondary complications including bladder overdistension and reduced contractility, urinary tract infections, autonomic responses, such as hypertension, bradycardia, and cardiac dysrhythmias, increased hospital stay and costs, as well as increased morbidity in human patients. [99][100][101][102] Nonetheless, experimental and early clinical evidence suggests that opioids, such as tramadol which is a weak mu-receptor agonist, U-50488 which is a kappa-receptor agonist and morphine which is a pure mu-and kappa-receptor agonist, can mitigate detrusor overactivity and detrusor-sphincter dyssynergia and improve voiding efficiency. [81][82][83][84] Other potential therapeutic agents that target various sites within the peripheral and central micturition neuromodulatory pathways are mostly still at the experimental or early clinical stages of drug development.…”

Section: Medical Management Of Neurogenic Lower Urinary Tract Dysfuncmentioning

confidence: 99%

Pathophysiology, Clinical Importance, and Management of Neurogenic Lower Urinary Tract Dysfunction Caused by Suprasacral Spinal Cord Injury

Granger

Jeffery

2016

Veterinary Internal Medicne

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Management of persistent lower urinary tract dysfunction resulting from severe thoracolumbar spinal cord injury can be challenging. Severe suprasacral spinal cord injury releases the spinal cord segmental micturition reflex from supraspinal modulation and increases nerve growth factor concentration in the bladder wall, lumbosacral spinal cord, and dorsal root ganglion, which subsequently activates hypermechanosensitive C‐fiber bladder wall afferents. Hyperexcitability of bladder afferents and detrusor overactivity can cause urine leaking during the storage phase. During urine voiding, the loss of supraspinal control that normally coordinates detrusor contraction with sphincter relaxation can lead to spinal cord segmental reflex‐mediated simultaneous detrusor and sphincter contractions or detrusor‐sphincter dyssynergia, resulting in inefficient urine voiding and high residual volume. These disease‐associated changes can impact on the quality of life and life expectancy of spinal‐injured animals. Here, we discuss the pathophysiology and management considerations of lower urinary tract dysfunction as the result of severe, acute, suprasacral spinal cord injury. In addition, drawing from experimental, preclinical, and clinical medicine, we introduce some treatment options for neurogenic lower urinary tract dysfunction that are designed to: (1) prevent urine leakage arising because of detrusor overactivity during bladder filling, (2) preserve upper urinary tract integrity and function by reducing intravesical pressure and subsequent vesicoureteral reflux, and (3) prevent urinary tract and systemic complications by treating and preventing urinary tract infections.

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Bacteriuria in the catheterized surgical intensive care patient

Cited by 41 publications

References 0 publications

Intensive care unit-acquired urinary tract infections in a regional critical care system

Intensive care unit-acquired urinary tract infections in a regional critical care system

Postoperative Urinary Retention

Pathophysiology, Clinical Importance, and Management of Neurogenic Lower Urinary Tract Dysfunction Caused by Suprasacral Spinal Cord Injury

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