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This article is a case report of a 69-year-old man who underwent a right total hip replacement procedure and developed a surgical site infection. Areas of concern in prevention and treatment of hip arthroplasty infection are presented, focusing on the pathophysiologic process involved. A review of the patient risk factors and the pathophysiologic action potentiating risk for infection include host immunity, nutritional status, diabetes, age, use of steroids or immunosuppressive drugs, rheumatoid arthritis, and urinary tract or other infections. The case report identifies the patient's age, multiple instrumentation of the bladder resulting in bacteriuria and the reinfusion of 400 cc of autologous shed blood via cell saver, a controversial risk subject, as the primary risk factors for surgical site infection in this patient. Readmission to the hospital on day 16 after the operation was completed on identification of 2 pathogenic organisms, methicillin-resistant Staphylococcus aureus and Acinetobacter calcoaceticus bio anitratus. The infection was successfully treated with oral ciprofloxacin and intravenous administration of tobramycin, preventing progression from superficial to deep infection and preserving the prosthesis.
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PMID:Pathophysiology of surgical site infection in total hip arthroplasty. 1058 59

A retrospective study was performed to determine the proportion of dogs with hyperadrenocorticism or diabetes mellitus or both that had urinary tract infection (UTI) and to describe clinical and laboratory findings. Dogs with these endocrine disorders were included if results of quantitative urine culture were available and dogs were not receiving antimicrobials. Dogs with positive urine cultures were considered to have UTI and dogs with negative urine cultures were used as controls. Information including history, clinical signs, physical examination findings, and results of laboratory tests and urine culture was extracted from all records. Findings in dogs with UTI were compared with control dogs. There were 101 dogs with hyperadrenocorticism or diabetes mellitus or both that met inclusion criteria; 42 (41.6%) had UTI and 59 (58.4%) did not. UTI was present in 46% of dogs with hyperadrenocorticism, 37% of dogs with diabetes mellitus, and 50% of dogs with both endocrine disorders. There was no association between endocrine group and occurrence of UTI. Escherichia coli was the most common bacteria isolated, and cultures from 29 dogs (69%) showed growth of this organism. Of dogs with UTI, <5% had stranguria, pollakiuria, or discolored urine, whereas 60% had pyuria and 69% had bacteriuria. We conclude that UTIs are common in dogs with hyperadrenocorticism, diabetes mellitus, or both diseases. Clinical signs of UTI, however, are uncommon and results of urinalysis may be normal. Therefore, it is appropriate to recommend urine culture as part of the evaluation of dogs with these endocrine disorders.
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PMID:Retrospective evaluation of urinary tract infection in 42 dogs with hyperadrenocorticism or diabetes mellitus or both. 1058 55

Urinary tract infections are accounted to serious complications, particularly in pregnancy complicated by diabetes. In this paper, cases of pregnancy have been analysed, affected by diabetes of type 1 and type 2, according to status of metabolic control and the type of urinary tract infection. In a group of 217 diabetic pregnant women, the incidence of urinary tract infections was 26.7%, 19.0% of them being recurrent. In the group with bad metabolic control, infections were statistically more frequent (17.4% vs. 37.3%, p = 0.001); bacteriuria without clinical demonstrations 10.4% vs. 19.6% (p > 0.05), pyelonephritis (7.0% vs. 17.7%, p = 0.001). The following types of pathogenic bacteria were found: E. coli--44.4%, Staphylococcous--28.9%, Enterococcocus--18.7%. A high frequency of Gram (+) bacteria was observed. A good metabolic control without chronic diabetic complications correlated with less frequent infections of the urinary tract.
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PMID:[Bacterial flora in infections of the urinary system system in pregnant women with pre-gestational diabetes]. 1061 13

With the availability of methods to quantitate microbes in urine, one has come to recognize that a certain proportion of apparently healthy individuals have bacteria in their urine in the absence of any clinical symptoms. By definition, asymptomatic bacteriuria is present, if on 1, 2 or more consecutive occasions > 100,000 colony forming units/ml are found in aseptically collected midstream urine, granted that the same microorganism is isolated. Such asymptomatic bacteriuria is found in 2.7% of women aged between 15 and 24 years and increases to 20 to 50% in women above an age of 80 years. In men the prevalence of asymptomatic bacteriuria is considerably lower, but increases to 6 to 20% above the age of 80 years. The microbe most frequently involved in asymptomatic bacteriuria is Escherichia coli, which is characterized by the expression of multiple virulence factors. In this respect they differ from bacteria found in patients with lower or upper urinary tract infections. There is a consensus that in the absence of anatomical or functional abnormalities of the urinary tract asymptomatic bacteriuria per se does not lead to renal scarring, renal dysfunction, or hypertension. The overall prevalence of asymptomatic bacteriuria in pregnancy varies between 2 and 10% with the very small risk of an acute symptomatic episode of urinary tract infection in early pregnancy, but with a substantial risk (30 to 60%) during the last trimester. There is an association between asymptomatic bacteriuria and low birth weight. Asymptomatic bacteriurias are seen in 4 to 60% of immunosuppressed renal graft recipients. The incidence of asymptomatic bacteriuria is also high among patients with diabetes mellitus; the prevalence is approximately 3 fold higher in adult women (7.9 to 11.1%). In these patients asymptomatic bacteriuria does not carry a renal risk. Renal functional prognosis in uncomplicated asymptomatic bacteriuria is excellent. Therefore asymptomatic bacteriuria should be treated during pregnancy, after renal transplantation, prior to urological interventions and in patients with frequent episodes of symptomatic urinary tract infection.
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PMID:[Asymptomatic bacteriuria]. 1080

Urinary tract infection (UTI) is a common complication of pregnancy. Approximately 20--40% of women with asymptomatic bacteriuria will develop pyelonephritis during pregnancy. All pregnant women, therefore, should have their urine cultured at their first visit to the clinic. In a clinical study comparing single-dose treatment with 3 g fosfomycin trometamol versus a 3-day course of 400 mg ceftibuten orally, the inclusion criteria were acute symptomatic lower UTI (acute cystitis), significant bacteriuria (> or =10(3) CFU/ml), pyuria and confirmed pregnancy. Excluded were patients with asymptomatic bacteriuria or acute pyelonephritis. Predisposing factors comprised a history of recurrent UTI, diabetes mellitus, analgesic nephropathy, hyperuricaemia or Fanconi's syndrome. Escherichia coli was the most frequently isolated pathogen in both groups. Therapeutic success (clinical cure and bacteriological eradication of uropathogens) was achieved in 95.2% of the patients treated with fosfomycin-trometamol versus 90.0% of those treated with ceftibuten (P, non-significant). The treatment of acute cystitis in pregnant women using a single-dose of fosfomycin trometamol was equally effective as the 3-day course of oral ceftibuten. Both regimens were well tolerated with only minor adverse effects. Long-term chemoprophylaxis should be suggested in patients with recurrent UTI or following acute pyelonephritis during pregnancy.
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PMID:Treatment of lower urinary tract infection in pregnancy. 1129 8

Urinary tract infection (UTI) is the most common infection and the first cause of bacteremia in the elderly. With increasing age the female to male ratio decreases and UTI becomes almost half as frequent in men compared to women. Significant bacteriuria exists in about 40% of institutionalized women. But asymptomatic bacteriuria is neither the cause of morbidity nor associated with a higher mortality rate and thus should not be treated. Symptomatic infection in women without complicating factors is most often caused by E. coli and may be treated with 3 or 7 day regimens of trimethoprim-sulfamethoxazole or fluoroquinolones (FQ). In the presence of symptoms of upper tract infection or complicating factors, urine culture is mandatory and will detect multiple and/or resistant microorganisms in most cases. Empirical treatment has to be adapted according to the sensitivity once established and should be administered for at least 10 days. Most of the patients above 65 and virtually all patients above 80 present either with general debility or diabetes or other factors such as bladder outflow obstruction or abnormal bladder function and have to be considered as presenting with complicated UTI. Indwelling catheters should be removed if possible, otherwise be changed.
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PMID:Management of urinary tract infections in the elderly. 1139 8

In a prospective study including 137 consecutive catheterised patients in a medical intensive care unit, the following variables were analysed as possible risk factors for catheter-associated bacteriuria, defined as a quantitative culture with > or = 10(5) organisms/ml: age, sex, simplified acute and physiologic score at admission, duration of catheterisation, diabetes mellitus, immunosuppression, neurologic disorders and prior systemic antibiotic exposure during hospitalisation. The frequency of catheter-associated bacteriuria was 30.7%. By multivariate analysis, female sex (odds ratio [OR], 5.1; 95% confidence interval [CI], 1.9-13.5; P=0.001) and a duration of catheterisation >11 days (OR, 19.4; 95% CI, 5.5-68.7; P=0.0001) were risk factors for catheter-associated bacteriuria, and prior antibiotic exposure was a protective factor (OR, 0.06; 95% CI, 0.019-0.21; P=0.0001).
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PMID:Risk factors for catheter-associated bacteriuria in a medical intensive care unit. 1139 16

Women with diabetes mellitus (DM) have asymptomatic bacteriuria (ASB) and urinary tract infections (UTIs) more frequently than women without DM. For type 1 diabetes mellitus, risk factors for asymptomatic bacteriuria include a longer duration of diabetes, peripheral neuropathy and macroalbuminuria. For type 2 diabetes, the risk factors are higher age, macroalbuminuria and a recent symptomatic UTI. Poorly-controlled diabetes and residual urine after urination are no risk factors. The most important risk factor for a UTI in type 1 diabetes patients is sexual intercourse. In type 2 diabetes patients the major risk factor is the presence of asymptomatic bacteriuria. This higher prevalence does not appear to be based on a difference in virulence of the causative microorganism. Differences in host response may explain this higher prevalence: E. coli with type 1 fimbriae adhere better to uroepithelial cells in women with DM than to those in women without DM; women with DM and ASB have lower urinary cytokine concentrations and leukocyte counts compared to women without DM and ASB; in vitro studies show that E. coli grow better when glucose is present in urine. There is no consensus on whether ASB should be treated in these patients. There are indications that UTIs in diabetes patients should be treated as complicated UTIs.
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PMID:[Urinary tract infections in women with diabetes mellitus]. 1159 85

The purpose of this prospective and case controlled study is to determine the effectiveness and safety of antibiotic prophylaxis with Tercef (ceftriaxone) in women undergoing cesarean section and to compare the results with those of 24 hours regiment of Cefazolin and also with a group without prophylaxis. The study includes 122 cases of elective and emergency CS: 41 with a single intravenous dose of 1.0 g Tercef after clamping of the umbilical cord; 41 cases of antibiotic prophylaxis with Cefazolin three times 2.0 g for 24 hours and 40 low infectious risk CS without antibiotic prophylaxis. We take in account the existing before the CS risk factors for postoperative infectious complications as: hours of PROM; length of labor, number of vaginal examinations before CS, previous sections, duration of the operation, anemia, bacteriuria and diabetes. For post CS infection-related complications we take: febrile morbidity, endometritis, wound infections, infection of urinary tract. The results show infection complication in the three groups as follow: 14.6% for tercef, 17.1% for cefazolin and 20.0% for the group without antibiotic. There is not statistically significant difference. According our study in cases of CS with increased risk of post-operative infectious complications the antibiotic prophylaxis reduce the rate of infection-related complications even below that of CS with low infectious risk. The single dose of 1 g tercef i.v. is effective and suitable in comparison with 24 hours regiment of cefazolin.
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PMID:[Prophylaxis with tercef of infection-related complications after cesarean section]. 1179 56

Low-grade inflammatory activity is strongly associated with age-associated diseases such as atherosclerosis, dementia, type-2 diabetes, sarcopenia, and osteoporosis and predicts mortality risk in elderly populations. The aim of the current study was to investigate if asymptomatic bacteriuria in elderly humans was associated with inflammation. Midstream clean-catch urine culture was collected from consecutive, elderly patients at admission to a department of internal medicine due to functional disability. Forty patients (age 70-91 years) were selected and included in the current study; 20 subjects had positive urine culture and 20 sex- and age-matched subjects had negative urine culture. Inclusion criteria were temperature below 37.8 degrees C, no clinical signs of infection and no current antibiotic treatment. Patients with asymptomatic bacteriuria had significantly increased levels of circulating tumor necrosis factor receptors (sTNFR-I) and a higher number of neutrophils in the blood compared to the group without bacteriuria. Thus, the present study provides some support for the hypothesis that asymptomatic urinary infections are associated with low-grade immune activity in frail, elderly humans.
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PMID:Asymptomatic bacteriuria in elderly humans is associated with increased levels of circulating TNF receptors and elevated numbers of neutrophils. 1264 Nov 28


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