Infección urinaria en pacientes con vejiga neurógena: patrones de resistencias de los uropatógenos más frecuentes / Urinary Infection in Patients With Neurogenic Bladder: Patterns of Resistance to the Most Frequent Uropathogens

Objetivos: Analizar la etiología y resistencias de los uropatógenos más frecuentes en una población con vejiga neurógena. Material y métodos: Se incluyeron 284 pacientes a los que se practicaron un total de 284 urocultivos. De estos, 106 procedían de pacientes con lesión neurológica, 28 de grupo control no neurógeno, 75 de pacientes ingresados en la Unidad de Cuidados Intensivos (UCI) y 75 de pacientes que acudieron a Urgencias por sintomatología de infección aguda del tracto urinario. Se realizó urocultivo cuantitativo en medio cromogénico, así como identificación y estudio de resistencias de todos los urocultivos positivos para uno o dos microorganismos. Resultados: El 67% de los pacientes neurológicos presentaron urocultivos positivos, frente al25% de los pacientes control. Los urocultivos de pacientes ingresados en UCI y los del grupo Urgencias fueron positivos al 100%, ya que se seleccionaron los primeros 75 urocultivos positivos. E. coli fue el microorganismo más frecuentemente aislado en el grupo de neurológicos, al igual que en enfermos procedentes de Urgencias y del grupo control. En UCI fue Enterococcus spp. (19,4%), seguido de P. aeruginosa (16,5%). En el estudio de resistencias E. coli presentó altas tasas de resistencia a ampicilina y cotrimoxazol y, aunque en menor grado, a ciprofloxacino. Conclusiones: E. coli es el microorganismo más frecuentemente aislado entre todos los grupos, excepto en UCI, en el que es superado por Enterococcus spp. y P. aeruginosa. Las resistencias entre los 4 grupos de población estudiada tienen características diferentes, mostrando globalmente un bajo índice de resistencias a nitrofurantoína y especialmente a fosfomicina, observado en pacientes que provienen de Urgencias o ingresados en UCI y neurológicos (AU)

Purpose: To analyze the most frequent causes and resistances of the uropathogens in patients affected by neurogenic bladder. Material and methods: A total of 284 patients, in whom a total of 284 urinary cultures were performed, were included. Of these, 106 came from patients with neurological injuries, 28 from a non-neurogenic control group, 75 from patients admitted to the intensive care unit (ICU) of our Hospital and 75 patients who came into the emergency room with the symptoms of an acute urinary tract infection. A quantitative urine culture was performed in a chromogenic media and the resistances of all urine cultures that were positive for one or two micro-organisms were identified and studied. Results: A total of 67% of the patients with neurological injuries had positive urine cultures compared to 25% of control group patients. The urine cultures of patients admitted into the ICU and those of the Emergency Room group were 100% positive, since the first 75 positive urine cultures were selected for the study. E.coli was the most-frequently microorganism isolated in the group of neurological patients, as well as among the patients from the Emergency Room and from the control group. In the ICU, the most-frequently isolated micro-organism was Enterococcusspp. (19.4%), followed by P. aeruginosa (16.5%). The study of resistances in general E. coli has high rates of resistance to ampicillin and co-trimoxazole and, although to a lesser degree to ciprofloxacin. Conclusions: E. coli is the micro-organism most frequently isolated among all of the groups except in the ICU, where it is surpassed by Enterococcus spp. and P. aeruginosa. The resistances among the four population groups studied have different features, overall showing a low rate of resistance to nitrofurantoin and especially to fosfomycin, observed in patients from the Emergency Room or admitted to the ICU and neurological patients (AU)

[Urinary infection in patients with neurogenic bladder: patterns of resistance to the most frequent uropathogens]. / Infección urinaria en pacientes con vejiga neurógena: patrones de resistencias de los uropatógenos más frecuentes.

PURPOSE: To analyze the most frequent causes and resistances of the uropathogens in patients affected by neurogenic bladder. MATERIAL AND METHODS: A total of 284 patients, in whom a total of 284 urinary cultures were performed, were included. Of these, 106 came from patients with neurological injuries, 28 from a non-neurogenic control group, 75 from patients admitted to the intensive care unit (ICU) of our Hospital and 75 patients who came into the emergency room with the symptoms of an acute urinary tract infection. A quantitative urine culture was performed in a chromogenic media and the resistances of all urine cultures that were positive for one or two micro-organisms were identified and studied. RESULTS: A total of 67% of the patients with neurological injuries had positive urine cultures compared to 25% of control group patients. The urine cultures of patients admitted into the ICU and those of the Emergency Room group were 100% positive, since the first 75 positive urine cultures were selected for the study. E.coli was the most-frequently microorganism isolated in the group of neurological patients, as well as among the patients from the Emergency Room and from the control group. In the ICU, the most-frequently isolated micro-organism was Enterococcus spp. (19.4%), followed by P. aeruginosa (16.5%). The study of resistances in general E. coli has high rates of resistance to ampicillin and co-trimoxazole and, although to a lesser degree to ciprofloxacin. CONCLUSIONS: E. coli is the micro-organism most frequently isolated among all of the groups except in the ICU, where it is surpassed by Enterococcus spp. and P. aeruginosa. The resistances among the four population groups studied have different features, overall showing a low rate of resistance to nitrofurantoin and especially to fosfomycin, observed in patients from the Emergency Room or admitted to the ICU and neurological patients.

[Characteristics of urinary tract infections in different patient subpopulations and depending on the bladder emptying system]. / Características de las infecciones urinarias en pacientes con vejiga neurógena según el sistema de vaciado vesical utilizado en comparación con pacientes sin vejiga neurógena.

INTRODUCTION: To analyze the prevalence and etiology of urinary tract infection in patients with neurogenic bladder depending on the bladder emptying system used as compared to a population with no neurological impairment. To assess perception of urinary tract infection by patients with neurogenic bladder. MATERIALS AND METHODS: An epidemiological and prospective study was conducted on 283 patients, in whom a total of 283 urethral cultures were performed. Of these, 106 came from patients with neurological damage, 28 from a control group with no neurological impairment, 74 from patients admitted to the intensive care unit (ICU) of our hospital, and 75 from patients who attended the emergency room for symptoms of acute urinary tract infection. The sensitivity and specificity of patient perception as indicative of urinary tract infection was analyzed using ROC curves. RESULTS: Positive urethral cultures were found in 66% of patients with neurological damage and 25% of control patients. Within the neurological group, patients with the highest rates of positive urethral cultures were those with myelomeningocele (MMC) (81.5%) and spinal cord injuries (71.7%), with a statistically significant difference (p=0.01). The microorganism most commonly found in all subgroups was Escherichia coli, followed by Enterococcus faecalis and Pseudomonas aeruginosa in the neurological subgroup, Enterococcus faecalis and Proteus mirabilis in the control subgroup, and Klebsiella pneumoniae and Staphylococcus agalactiae in the emergency room subgroup. In the ICU subgroup, the most commonly found microorganism was Enterococcus faecalis, followed by Escherichia coli and Pseudomonas aeruginosa. Sensitivity for perception by neurological patients as an indication of the presence of urinary tract infection was 97.2%, as compared to 80% in the control group. Specificity was low in both groups. CONCLUSIONS: E. coli was the microorganism found in positive urethral cultures from all subgroups, except in the ICU group. The groups with the highest urinary tract infection rates were patients with MMC and spinal cord injuries. Sensitivity and specificity (as measured using ROC curves) for perception by neurological patients as an indication of the presence of urinary tract infection was higher in neurological patients than in the non-neurological control group (p=0.0004, area: 0.643).

Características de las infecciones urinarias en pacientes con vejiga neurógena según el sistema de vaciado vesical utilizado en comparación con pacientes sin vejiga neurógena / Characteristics of urinary tract infections in different patient subpopulations and depending on the bladder emptying system

Introducción: La infección urinaria es una patología muy frecuente en las disfunciones miccionales neurógenas. Existen pocos trabajos sobre dicha problemática y menos respecto al sistema de vaciado vesical empleado en estos casos (sonda vesical permanente, colector permanente, cateterismos intermitentes). El objetivo de este estudio fue analizar la prevalencia y la etiología de la infección urinaria en pacientes afectados de vejiga neurógena según su sistema de vaciado vesical en comparación con una población no neurógena, así como valorar la percepción de la infección urinaria en los pacientes afectados de vejiga neurógena. Material y métodos: Se realizó un estudio epidemiológico y prospectivo consecutivo en el que se incluyó a 283 pacientes a los que se les practicó un total de 283 urocultivos. De éstos, 106 procedían de pacientes con lesión neurológica, 28 de un grupo control no neurógeno, 74 de pacientes ingresados en la Unidad de Cuidados Intensivos (UCI) de nuestro hospital y 75 de pacientes que acudieron a urgencias por sintomatología de infección aguda del tracto urinario. Se analizó la sensibilidad y la especificidad que tiene la percepción del propio paciente como indicativo de infección urinaria mediante las curvas ROC. Resultados: El 66% de los pacientes con lesión neurológica presentó urocultivos positivos respecto al 25% de los controles. Dentro del grupo neurológico, el colectivo con más urocultivos positivos fueron pacientes con mielomeningocele (81,5%) y con lesión medular (71,7%), con una significación estadística (p=0,01). El microorganismo más frecuente en todos los subgrupos fue Escherichia coli en primer lugar, seguido de Enterococcus faecalis y Pseudomonas aeruginosa en el subgrupo neurológico, de E. faecalis y Proteus mirabillis en el subgrupo control y de Klebsiella pneumoniae y Streptococcus agalactiae en el subgrupo de urgencias. En el subgrupo de la UCI, el microorganismo más frecuente en primer lugar fue E. faecalis, seguido de E. coli y P. aeruginosa. La sensibilidad para la percepción del paciente neurológico como indicativa de tener una infección urinaria fue del 97,2 respecto al 80% en el grupo control. Las especificidades fueron bajas en ambos grupos. Conclusiones: El microorganismo hallado en los urocultivos positivos en todos los subgrupos fue E. coli, excepto en los de la UCI. Los colectivos con más infecciones urinarias fueron mielomeningocele y lesión medular. La sensibilidad y la especificidad (medidas con la curva ROC) para la percepción del paciente neurológico como indicativas de tener una infección urinaria fueron más altas en los pacientes neurológicos respecto al grupo control no neurológico (p=0,0004; área: 0,643) (AU)

Introduction: To analyze the prevalence and etiology of urinary tract infection in patients with neurogenic bladder depending on the bladder emptying system used as compared to a population with no neurological impairment. To assess perception of urinary tract infection by patients with neurogenic bladder. Materials and methods: An epidemiological and prospective study was conducted on 283 patients, in whom a total of 283 urethral cultures were performed. Of these, 106 came from patients with neurological damage, 28 from a control group with no neurological impairment, 74 from patients admitted to the intensive care unit (ICU) of our hospital, and 75 from patients who attended the emergency room for symptoms of acute urinary tract infection. The sensitivity and specificity of patient perception as indicative of urinary tract infection was analyzed using ROC curves. Results: Positive urethral cultures were found in 66% of patients with neurological damage and 25% of control patients. Within the neurological group, patients with the highest rates of positive urethral cultures were those with myelomeningocele (MMC) (81.5%) and spinal cord injuries (71.7%), with a statistically significant difference (p=0.01). The microorganism most commonly found in all subgroups was Escherichia coli, followed by Enterococcus faecalis and Pseudomonas aeruginosa in the neurological subgroup, Enterococcus faecalis and Proteus mirabilis in the control subgroup, and Klebsiella pneumoniae and Staphylococcus agalactiae in the emergency room subgroup. In the ICU subgroup, the most commonly found microorganism was Enterococcus faecalis, followed by Escherichia coli and Pseudomonas aeruginosa. Sensitivity for perception by neurological patients as an indication of the presence of urinary tract infection was 97.2%, as compared to 80% in the control group. Specificity was low in both groups. Conclusions: E. coli was the microorganism found in positive urethral cultures from all subgroups, except in the ICU group. The groups with the highest urinary tract infection rates were patients with MMC and spinal cord injuries. Sensitivity and specificity (as measured using ROC curves) for perception by neurological patients as an indication of the presence of urinary tract infection was higher in neurological patients than in the non-neurological control group (p=0.0004, area: 0.643) (AU)