Hospital-acquired urinary tract infections (UTI) are mainly associated with indwelling urinary catheter use. In this chapter, the pathogenesis of hospital-acquired UTI in catheterized patients, the mechanisms by which microorganisms reach the urinary tract and are able to adhere and form biofilms, and the influence of other risk factors, such as time since catheter insertion and catheter composition, are reviewed. A wide variety of infecting microorganisms can affect patients with urinary catheters, making the choice of an adequate empirical antimicrobial course complex, particularly in cases of suspected multiresistant microorganisms. Moreover, the clinical symptoms are less characteristic in catheter infection and the diagnosis may be difficult. Treatment should be stratified according to the clinical features, which can vary from asymptomatic bacteriuria that may not require treatment, to severe septic episodes that need wide antibiotic coverage. The prevention measures for UTI in permanently catheterized patients are reviewed. Infections of the female genital tract associated with foreign bodies are mainly related to the use of intrauterine devices (IUDs). The epidemiology, microbiology profile, antimicrobial treatment, and prophylaxis of pelvic inflammatory disease related to IUD use in women are also reviewed.
[Show abstract][Hide abstract] ABSTRACT: To develop a new nano-composite of multi-walled carbon nanotubes (MWNTs) with enhanced antimicrobial activity.
A novel antimicrobial nanocomposite [MWNT-epilson-polylysine (MEPs)] was synthesized via covalent attachment of epilson-polylysine on MWNTs with hexamethylene diisocyanate (HDI) as the coupling agent. UV-visible spectra and Fourier transform infrared spectra (FT-IR) investigations indicate that MEPs is stable, with epilson-polylysine leaching effectively eliminated. When compared to MWNTs, the new nano-composite MEPs exhibits enhanced antimicrobial activities. In 20 mg l(-1) suspensions, significant increases of 72·1, 64·5 and 69% against Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus can be observed. The deposited film of MEPs also shows improved antibacterial activities and excellent antiadhensive efficacies against Ps. aeruginosa and Staph. aureus.
Epilson-polylysine functionalization of MWNTs with HDI as the bridge was found to be useful for improving the biocidal activity of MWNTs.
The new nano-composite MEPs with improved antimicrobial activity will substantially facilitate the application of MWNTs as the antimicrobial material such as medical device, food, pharmaceutical process and package.
[Show abstract][Hide abstract] ABSTRACT: Surgical site infection (SSI) can be a challenging complication after posterior spinal fusion and instrumentation (PSFI). An increasing rate of SSI by gram-negative bacteria (GNB) has been observed. Current guideline recommendations have not been effective for preventing infection by these microorganisms.
Retrospective cohort study comparing two consecutive groups of patients undergoing PSFI at a single institution. Cohort A includes 236 patients, operated between January 2006 and March 2007, receiving standard preoperative antibiotic prophylaxis with cefazolin (clindamycin in allergic patients). Cohort B includes 223 patients operated between January and December 2009, receiving individualized antibiotic prophylaxis and treatment based on preoperative urine culture. Cultures were done 3-5 days before surgery in patients meeting one of the following risk criteria for urinary tract colonization: hospitalization longer than 7 days, indwelling catheter, neurogenic bladder, history of urinary incontinence, or history of recurrent urinary tract infection.
Twenty-two (9.3%) patients in cohort A developed SSI, 68.2% due to GNB. 38 (17%) patients in cohort B were considered at risk for GNB colonization; preoperative urine culture was positive in 14 (36%). After adjusted antibiotic prophylaxis, 15 (6.27%) patients in cohort B developed SSI, 33.4% due to GNB. A statistically significant reduction in GNB SSI was seen in cohort B (Fisher's exact test, p = 0.039).
Higher preoperative GNB colonization rates were found in patients with neurogenic bladder or indwelling catheters. Preoperative bacteriological screening, treatment for bacteriuria, and individualized antibiotic prophylaxis were effective for reducing GNB SSI.
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