Acute urinary tract infection in patients with underlying benign prostatic hyperplasia and prostate cancer (original) (raw)
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BMC Infectious Diseases, 2018
Background: Men with urinary retention secondary to benign prostatic hyperplasia (BPH) are prone to genitourinary infections. Physicians should be aware of the current antimicrobial susceptibility pattern in this population if empirical treatment is needed. The goal of this study was to evaluate variations in prevalence, composition and antimicrobial susceptibility of bacterial flora in men with indwelling catheters subjected to surgery for BPH in chosen time periods since 1994. Necessary changes in empirical therapy were also assessed. Methods: All patients with indwelling catheters admitted to a single urological center for BPH surgery in the years 1994-1996, 2004-2006, and 2011-2015 were considered. Catheterization times and results of urine cultures from samples collected at admission were evaluated. Susceptibility for selected antimicrobials was compared separately for Gram negative and Gram positive species. For each agent and for their combinations effectiveness of empirical therapy was calculated dividing the number of patients with bacteriuria susceptible to the agents by the total number of patients with bacteriuria. Results: Bacteriuria was present in 70% of 169, 72% of 132, and 69% of 156 men in the respective time periods. The incidence of Gram-positive strains increased from 10 to 37% (P < 0.001). Their susceptibility to amoxicillin/ clavulanate was fluctuating (81, 61, 77%; P=NS). No vancomycin-resistant strain was present. Gram-negative flora composition was stable. Their susceptibility decreased to ciprofloxacin (70 to 53%; P = 0.01) and amoxicillin/ clavulanate (56 to 37%; P < 0.01) while it increased to gentamycin (64 to 88%; P < 0.001) and co-trimoxazole (14 to 62%; P < 0.001); susceptibility to amikacin remained high (> 85%). Only two cases of resistance to carbapenems in 2004-2006 were found. In vitro effectiveness of amikacin + amoxicillin/clavulanate in empirical therapy was slowly decreasing (87 to 77%; P=NS). Imipenem was found the most effective single agent (90-95%) and its efficacy was even improved by adding vancomycin (97-98%). Conclusions: Substantial rise in the incidence of Gram-positive species and fluctuations in antimicrobial susceptibility patterns were found. Empirical therapy of genitourinary infection in catheterized men with BPH should now involve antimicrobial agents effective both to Enterococci and Enterobacteriaceae. Periodic monitoring and publishing data on antimicrobial susceptibility for this population is necessary.
Bacteriology of urine specimens obtained from men with symptomatic benign prostatic hyperplasia
Nigerian Journal of Surgery, 2016
Benign prostatic hyperplasia (BPH) is a common condition in the aging male population. [1] Symptomatic BPH, a cause of significant morbidity in affected males, is characterized by both storage and voiding lower urinary tract symptoms with significant impairment in the quality of life. [2,3] Affected individuals are prone to the development of bacteriuria as a result of incomplete bladder emptying, urinary stasis, and urethral instrumentation such as cystoscopy and catheterization. [4] A reduction in the concentration of zinc-associated antimicrobial factor and increasing alkalinity of prostatic fluid with aging may also encourage bacterial colonization of the urinary tract in these patients. [5] Some cases of bacteriuria may progress to established urinary tract infection (UTI) if host's defense mechanisms are overcome. [4] The reported incidence of bacteriuria in men with symptomatic BPH prior to prostatectomy varies with different studies. [6,7] Pourmand et al. [7] noted a preoperative rate of 15% which was reduced to 3.3% after prostatectomy following antibiotic administration. The presence of bacteriuria prior to surgical inter vention has been shown to increase the risk of postoperative infective complications such as UTI and wound infection. [8] Thus, the knowledge of urine bacteriology as well as the antibiotic susceptibility pattern prevailing in the locality at a given period may play a complementary role in the management of patients
Role of Urine Bacteriology Assessment in Patients with Benign Prostatic Hyperplasia
Background:Benign prostatic hyperplasia is very common in old ages. In India,few only present with symptoms. Few were detected to have the benign enlargement when they were screened prior to surgery for inquinal hernia or so. Bacteriuria and urinary tract infections are common sequelae of benign prostatic hyperplasia(BPH). Thus, the knowledge of urine bacteriology in men with symptomatic BPH in our environment may play acomplementary role in management. Objectives: To determine the incidence of bacteriuria and the antibioticsensitivity pattern of bacterial isolates in cultured urine samples of men with symptomatic and asymptomatic BPH. Material andMethods: This was a prospective study conducted over one year in our institute. All patients who presented with lower urinary tract symptoms dueto BPH and who met the inclusion criteria were studied.and also all the old patients admitted for direct inquinal hernia surgery without clinical symptoms of BHP but whose ultrasound examination showed prostate enlargement with significant residual urine volume were included. Urine samples were obtained from the patients for microscopy, culture, and sensitivity following standard protocol. Results: Sixty two patients were studied.out of which 38 patients had symptoms of BPH and24 patients were belonging to the asymptomatic group. The age range was 53-80 years with a mean of 65.5. Bacterial isolates were noted in 28 (45.1%) patients. Escherichia coli noted in 20 out of this 28 patients(71.4%).klebsiella and other organisms were isolated in the rest.27 out of 38 symptomatic patients(71%) and one out of 24 asymptomatic patients(4%) had bactriuria. The bacterial isolates were mostly sensitive to imipenem, meropenem, and nitrofurantoin, but showed greater resistance to cefuroxime, gentamicin, and ofloxacin. There was no significant difference between the means for age (, duration of symptoms , and prostate size in the patients with andthose withoutbactriuria. Conclusion: In patientswith BPH ,71% of them have urinary infection with bactriuria in our setting. The bacterial isolates showed high level of resistance to oralcephalosporins and fluoroquinolones. There is a need to update guidelines in empiric use of antibiotics in this group of patients.
Bacteriuria and antibiotic resistance in catheter urine specimens following radical prostatectomy
Urologic Oncology: Seminars and Original Investigations, 2013
Objective: There are increasing reports of infectious complications following prostate biopsy due to fluoroquinolone resistance. To determine infectious complications at catheter removal following radical prostatectomy (RP), another setting in daily urological practice where fluoroquinolone prophylaxis is frequently used. Materials and methods: We prospectively examined urine culture results collected from 334 RP patients immediately prior to catheter removal. Patients received prophylactic antibiotics 1 day before, the day of, and for 5 days after catheter removal. Culture results were reviewed for bacterial species and antimicrobial susceptibilities. Patients with positive urine cultures resistant to the prophylactic antibiotic were switched to culture-specific antibiotic therapy and underwent follow-up culture. The frequency of urinary tract infection (UTI), complications, additional antibiotic therapy, and repeat urine cultures was determined within 60 days. Results: Of the 334 patients identified, 203 (61%) had cultures with no bacterial growth, and 48 (14%) had colony counts of Ͻ1,000 bacteria or Candida albicans and received no further antibiotics. The remaining 83 (25%) had positive culture results, of which 7% were resistant to ciprofloxacin. Twenty-four bacterial species were identified, with Pseudomonas aeruginosa (5%) Escherichia coli (4%), and Staphylococcus epidermidis (3%) being the most frequent. Only two (0.6%) men developed clinical symptoms consistent with UTI (i.e., suprapubic pain, fever) prior to catheter removal, and no serious complications occurred. Conclusions: A substantial proportion of RP patients have positive urine cultures at the time of catheter removal, despite the administration of prophylactic fluoroquinolone antibiotics. Potentially virulent organisms are commonly cultured, and ciprofloxacin resistance is frequent. However, outcomes are favorable when culture-specific oral antibiotic therapy is initiated.
Egyptian Journal of Health Care
Background: Difficulty in passing urine and increased frequency of urination are common symptoms of Benign prostatic hyperplasia (BPH), a prevalent condition among elderly males characterized by the enlargement of the prostate gland, and urinary tract infections. Patients with BPH who require catheterization are at higher risk for developing Catheter-associated urinary tract infections (CAUTIs), which makes such a group of patients in a crucial need to develop effective strategies to prevent and manage such conditions. Aims: This study aimed to evaluate the effect of self-care practice guidelines of Catheter-associated urinary tract infections (CAUTI) on patients with benign prostatic Hyperplasia (BPH). Methods: A quasi-experimental study was conducted in the urology departments at Alexandria Main University Hospital. A convenience sample of 60 adult patients with BPH was equally divided randomly into two groups: a study group (n=30) and a control group (n=30). Two tools were used for data collection: a (BPH) patients' knowledge assessment questionnaire and a (BPH) sign and symptom severity structured interview schedule. Results: The study showed a significant improvement among the study group's knowledge, international prostate symptom score (IPSS) symptom severity, quality of life, catheter care, and patients' practices for urinary tract infection-related signs and symptoms and catheter care, comparing to the control group. Conclusion: The provision of effective education had a profound impact on improving patients' knowledge and practice.
Bacterial Uropathogen among Benign Prostatic Hyperplasia Patients at a Tertiary Hospital in Nigeria
Open Journal of Medical Microbiology, 2015
As the lumen of the prostatic urethra becomes compromised by fibroadenomatous growth in the periurethral region of the prostate of men with Benign prostatic hyperplasia (BPH), urine outflow is obstructed progressively resulting in incomplete bladder empting causing stasis and may predispose patients to infection. Mid stream urine samples were collected from 94 BPH patients. Macroscopy, microscopy, culture and antibiotic susceptibility test were carried out on isolated uropathogens. Isolated bacteria were characterized using biochemical tests. Isolated bacterial pathogens include Proteus mirabilis, Escherichia coli, Pseudomonas aeruginosa, Klebsiella oxytoca, Morgarella morgani, K. pneumonia and Enterococcus faecalis in order of frequency. The isolates show highest resistance of 87.1% to Ciprofloxacin and least resistance of 12.9% to Imipenem. The isolates were found to be multi-drug resistant and the 12.9% resistance to Imipenem suggests presence of Carbapenemase producing bacteria among the isolates.
ASSOCIATION BETWEEN BENIGN PROSTATIC HYPERPLASIA AND URINARY TRACT INFECTION
Benign prostatic hyperplasia is a progressive condition characterized by prostate enlargement. It has an estimated prevalence of 50% in men aged 50-60 and 90% in men over 80 years. Scottish Intercollegiate Guidelines Network, using urodynamic techniques, revealed significant underlying lower urinary tract abnormalities, mainly involving bladder out flow obstruction in 80% of adult males presenting with simple or recurrent urinary tract infection. Mid stream urine samples were collected from 94 BPH patients and 94 age-matched non BPH patients. Samples were processed within one hour of production. Based on evidence of pyuria on wet preparation and significant bacteriuria on culture, samples were considered to be positive for UTI.UTI prevalence was higher among BPH patients (33.0%) than their control (23.4%). Odd ratio 0.33 with p-value 0.2 was obtained for ages 50-59 while odd ratio 4.4 with p-value 0.03 was obtained for ages 80 and above. Prevalence of UTI was higher among BPH patients than men without BPH. Significant association between BPH and UTI was found among ages 80 years and above.
Bacterial uro-pathogens of urinary tract association with urinary catheterization
2017
Urinary tract infection (UTI) is a very common problem in clinical care. It is diagnosed by the finding of significant bacteria. This study was carried out in the urology department at Al-Hussein Teaching Hospital, Thi-Qar province, south of Iraq. The bacteriological investigations were performed in the bacteriological laboratory of the hospital. Urine samples were aseptically collected from catheterised patients. Each sample was followed by the health information for patients including heath history, gender, and age. A total 104 patients with urinary catheters were studied; 86 (82.6%) patients were males, while 18 (17.3%) patients were females. The most common cause for using urinary catheter was benign prostatic hypertrophy (61.5%), postoperative (21.1%) and cardiovascular diseases (17.3%). The common pathogens were isolated were Escherichia coli (27.2%) and Klebsiella spp. (23.6%). A high antibiotic resistance against bacterial isolates such as Ampicillin (100%) and Cephalexin (1...
Sierra Leone Journal of Biomedical Research, 2010
The indwelling urinary catheter (IUC) is the most significant risk factor for developing nosocomial urinary tract infections (UTIs). In order to determine the spectrum of bacterial etiology and antibiotic resistance pattern of uropathogens causing catheter associated UTI, a convenient sample size of ninety-two (92) patients on urethral catheter was investigated. Ethical approval for the study was obtained from the OAUTHC research and ethical committee. Catheter stream urine samples were obtained from all patients and cultured on appropriate culture media. Suspected isolates were identified by a combination of standard tests and using MICROBACT GNA12A/B/E. Susceptibility of the isolates against thirteen (13) antibiotics was performed by the disc diffusion method. Significant bacteriuria was observed in 60.9% (56) catheter specimen urine (CSU) received, while 39.1% (36) were culture negative. Of the 56 positive culture, the predominant organisms were Klebsiella oxytoca, 28.6 %( 16), Proteus vulgaris, 23.2% (13) and Staphylococcus aureus, 12.5% (7). Overall, the antimicrobial susceptibility results showed that all the isolates were highly resistant to the antibiotics tested. Over 50% resistance was recorded for trimethoprim/sulfamethoxazole, gentamicin and amoxicillin/clavulanic acid. More than 25% of the isolates were resistant to nitrofurantoin. This study indicates that catheter stream UTI caused by multiply resistant bacteria are common in our hospital. There is a need to establish standard guidelines on the care of catheter for all units in the hospital with a view to preventing nosocomial infections associated with the use of the catheter in patients. We also advocated prudent use of antibiotics.