Reduction of urinary tract infection and antibiotic use after surgery: a controlled, prospective, before-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.
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ABSTRACT: Catheter-associated urinary tract infections (CAUTI) are common in surgical patients. CAUTI are associated with adverse patient outcomes, and negatively affects public safety reporting and reimbursement. Inappropriate catheter use and prolonged catheter duration are major risk factors for CAUTI. CAUTI pathogenesis and treatment are complicated by the presence of biofilms. Prevention strategies include accurate identification and tracking of CAUTIs, and the development of institutional guidelines for the appropriate use, duration, alternatives, and removal of indwelling urinary catheters. Copyright © 2014 Elsevier Inc. All rights reserved.Surgical Clinics of North America 12/2014; · 1.93 Impact Factor
- Edited by Asociación Colombiana de Infectología Capítulo Central, 01/2010; Asociación Colombiana de Infectología Capítulo Central., ISBN: 978-958-99588-0-3