Reduction of urinary tract infection and antibiotic use after surgery: A controlled, prospective, befor after intervention study
ABSTRACT Urinary tract infection is the most frequent health care-associated complication. We hypothesized that the implementation of a multifaceted prevention strategy could decrease its incidence after surgery.
In a controlled, prospective, before-after intervention trial with 1328 adult patients scheduled for orthopedic or abdominal surgery, nosocomial infection surveillance was conducted until hospital discharge. A multifaceted intervention including specifically tailored, locally developed guidelines for the prevention of urinary tract infection was implemented for orthopedic surgery patients, and abdominal surgery patients served as control subjects. Infectious and noninfectious complications, adherence to guidelines, and antibiotic use were monitored before and after the intervention and again 2 years later.
The incidence of urinary tract infection decreased from 10.4 to 3.9 episodes per 100 patients in the intervention group (incidence-density ratio, 0.41; 95% CI, 0.20-0.79; P=.004). Adherence to guidelines was 82.2%. Both the frequency and the duration of urinary catheterization decreased following the intervention. Recourse to antibiotic therapy after surgery dropped in the intervention group from 17.9 to 15.6 defined daily doses per 100 patient-days (P<.005) because of a reduced need for the treatment of urinary tract infection (P<.001). Follow-up after 2 years revealed a sustained impact of the strategy and a subsequent low use of antibiotics, consistent with stable adherence to guidelines (80.8%).
A multifaceted prevention strategy can dramatically decrease postoperative urinary tract infection and contribute to the reduction of the overall use of antibiotics after surgery.
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ABSTRACT: Objective: The goal of this research was to evaluate the incidence and risk factors of postoperative symptomatic bladder infection in patients undergoing gynecologic oncology surgery. Symptomatic urinary-tract infections (UTIs) following insertion of indwelling bladder catheters is a common postoperative complication. The reported incidence varies from 1.3% 6.5% and even rises up to 42% when asymptomatic bacteriuria is included. Design: This was a retrospective and prospective cohort study. Materials and Methods: The current authors investigated 152 consecutive patients who underwent major surgery (grade 3 and 4) while under gynecologic oncology care. Demographic and clinical data on patient comorbidities, timing of insertion and removal of bladder catheters, intravenous antibiotic prophylaxis, and urinary symptoms and cultures were collected and evaluated statistically. Results: An incidence of 2% symptomatic UTIs postoperatively was identified. In 66% of cases Escherichia coli was the causative microorganism. Having a bladder catheter in situ for ≥24 hours was significantly related to the occurrence of symptomatic UTI postoperatively (p<0.01). Patients' comorbidities (American Society of Anethesiologists score), reduced mobility (World Health Organization score), abdominal surgery, and admission to intensive care/high dependency care units postoperatively were additional significant risk factors for the development of symptomatic UTIs (p<0.001). Conclusions: Gynecologic oncologists need to be aware that a shorter duration of catheterization reduces the risk of UTI following major surgery. Using a minimal-access surgical approach and fostering early mobilization improve and significantly decreases the risk of postoperative bladder infections. (J GYNECOL SURG 30:204)Journal of Gynecologic Surgery 08/2014; 30(4):204-208. DOI:10.1089/gyn.2013.0117
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ABSTRACT: The reasoning that improved hand hygiene compliance contributes to the prevention of health care-associated infections is widely accepted. It is also accepted that high hand hygiene alone cannot impact formidable risk factors, such as older age, immunosuppression, admission to the intensive care unit, longer length of stay, and indwelling devices. When hand hygiene interventions are concurrently undertaken with other routine or special preventive strategies, there is a potential for these concurrent strategies to confound the effect of the hand hygiene program. The result may be an overestimation of the hand hygiene intervention unless the design of the intervention or analysis controls the effect of the potential confounders. Other epidemiologic principles that may also impact the result of a hand hygiene program include failure to consider measurement error of the content of the hand hygiene program and the measurement error of compliance. Some epidemiological errors in hand hygiene programs aimed at reducing health care-associated infections are inherent and not easily controlled. Nevertheless, the inadvertent omission by authors to report these common epidemiological errors, including concurrent infection prevention strategies, suggests to readers that the effect of hand hygiene is greater than the sum of all infection prevention strategies. Worse still, this omission does not assist evidence-based practice.Infection and Drug Resistance 8:7-18. DOI:10.2147/IDR.S62704
Edited by Asociación Colombiana de Infectología Capítulo Central, 01/2010; Asociación Colombiana de Infectología Capítulo Central., ISBN: 978-958-99588-0-3