Infecciones urinarias adquiridas en la comunidad que requieren hospitalización: factores de riesgo, características microbiológicas y resistencia a antibióticos / Community-associated urinary infections requiring hospitalization: Risk factors, microbiological characteristics and patterns of antibiotic resistance

Objetivo: Las infecciones del tracto urinario (ITU) suelen manejarse ambulatoriamente. Sin embargo, un pequeño porcentaje requiere ingreso hospitalario. Nuestro objetivo fue analizar los factores de riesgo y características microbiológicas de las infecciones urinarias adquiridas en la comunidad (ITU-AC) que requieren hospitalización. Material y métodos: Realizamos un estudio prospectivo desde noviembre de 2011 a diciembre de 2013 evaluando la incidencia, factores de riesgo, patrones microbiológicos y tasas de resistencia en los pacientes con ITU-AC que requieren ingreso. Resultados: Cuatrocientos cincuenta y siete pacientes ingresaron en nuestro servicio con diagnóstico de ITU-AC. La edad media fue 56,2 ± 19,85 años, el 52,1% eran mujeres, el 19,7% portaban catéter urinario y el 11,4% habían presentado ITU en los meses previos. Los microorganismos más frecuentemente aislados fueron Escherichia coli (60,6%), Klebsiella (9,2%), Enterococcus (8,4%) y Pseudomonas (7,2%). Enterobacteriaceae diferentes a E. coli fueron más frecuentes en pacientes de mayor edad. Enterococcus fueron más frecuentemente aislados en pacientes que habían tenido ITU previa y en aquellos portadores de catéter urinario. E. coli mostró unas resistencias del 23,5% para amoxicilina/ácido clavulánico, 16,6% para cefalosporinas de tercera generación, 31,3% para quinolonas y16,7% para aminoglucósidos. Del total de E. coli 11,4% fueron productores de betalactamasas de espectro extendido (BLEE). Los Enterococcus y Pseudomonas mostraron resistencias a quinolonas del 50,0% y 61,5% respectivamente. Conclusiones: ITU-AC que requieren hospitalización se presentan más frecuentemente en varones de mayor edad, portadores de catéter urinario, litiasis urinaria y con episodios previos de ITU. Estos factores también se asocian con infecciones producidas por gérmenes diferentes a E. coli y altas tasas de resistencia

Objective: Although patients with urinary tract infections (UTIs) are usually managed as outpatients, a percentage of them requires hospitalization. To review risk factors and microbiological characteristics of community-associated UTIs (CAUTIs) requiring hospitalization has been our objective. Material and methods: A prospective observational study was carried out from November 2011 to December 2013. Incidence, microbiological characteristics and antibiotic resistance patterns in patients with CAUTIs that required hospitalization were analyzed. Risk factors (including diabetes mellitus, urolithiasis, urinary catheterization) and resistance rates of each pathogen were also analyzed. Results: Four hundred and fifty seven patients were hospitalized in our department with CAUTI. The mean age was 56.2 ± 19.85 years. Of them, 52.1% patients were women, 19.7% had urinary indwelling catheter and 11.4% have had a previous UTI. The most frequently isolated pathogens were Escherichia coli (60.6%), followed by Klebsiella (9.2%), Enterococcus (8.4%) and Pseudomonas (7.2%). Enterobacteriaceae other than E.coli were more prevalent in male and older patients. On the other side the most frequently isolated pathogen in patients with a previous UTI and a urinary catheter was Entercoccus. The resistance rates E. coli against ampicillin/amoxicillin + βlactamase inhibitor was 23.5%, against third-generation cephalosporins 16.6%, against fluoroquinolones 31.3% and 16.7% against aminoglycosides. 11.4% E. coli strains were producers of extended-spectrum Beta-lactamases (ESBL). Finally, the resistance rates of Enterococcus and Pseudomonas against quinolones were of 50.0% and 61.5%, respectively. Conclusions: CAUTIs that require hospitalization are most frequent in older age, male gender, and presence of urinary catheter, with urolithiasis and with previous episodes of UTI. These factors are also related to isolation of pathogens other than E. coli and higher resistance rates

Community-associated urinary infections requiring hospitalization: risk factors, microbiological characteristics and patterns of antibiotic resistance.

OBJECTIVE: Although patients with urinary tract infections (UTIs) are usually managed as outpatients, a percentage of them requires hospitalization. To review risk factors and microbiological characteristics of community-associated UTIs (CAUTIs) requiring hospitalization has been our objective. MATERIAL AND METHODS: A prospective observational study was carried out from November 2011 to December 2013. Incidence, microbiological characteristics and antibiotic resistance patterns in patients with CAUTIs that required hospitalization were analyzed. Risk factors (including diabetes mellitus, urolithiasis, urinary catheterization) and resistance rates of each pathogen were also analyzed. RESULTS: Four hundred and fifty seven patients were hospitalized in our department with CAUTI. The mean age was 56.2±19.85 years. Of them, 52.1% patients were women, 19.7% had urinary indwelling catheter and 11.4% have had a previous UTI. The most frequently isolated pathogens were Escherichia coli (60.6%), followed by Klebsiella (9.2%), Enterococcus (8.4%) and Pseudomonas (7.2%). Enterobacteriaceae other than E.coli were more prevalent in male and older patients. On the other side the most frequently isolated pathogen in patients with a previous UTI and a urinary catheter was Entercoccus. The resistance rates E. coli against ampicillin/amoxicillin + ß lactamase inhibitor was 23.5%, against third-generation cephalosporins 16.6%, against fluoroquinolones 31.3% and 16.7% against aminoglycosides. 11.4% E. coli strains were producers of extended-spectrum Beta-lactamases (ESBL). Finally, the resistance rates of Enterococcus and Pseudomonas against quinolones were of 50.0% and 61.5%, respectively. CONCLUSIONS: CAUTIs that require hospitalization are most frequent in older age, male gender, and presence of urinary catheter, with urolithiasis and with previous episodes of UTI. These factors are also related to isolation of pathogens other than E. coli and higher resistance rates.

Estudio de seguridad de la biopsia renal percutánea con aguja de calibre 16 G / Renal biopsy with 16 G needle: A safety study

Introducción y objetivo: Recientemente se vuelve a discutir sobre la implantación de la biopsia renal percutánea como procedimiento rutinario en el diagnóstico de masas renales. Sin embargo, aunque infrecuentes, esta técnica no está exenta de complicaciones y morbilidad. Nuestro objetivo es realizar un estudio descriptivo de las complicaciones y resultados de las biopsias renales ortotópicas con aguja de 16 G. Material y métodos: Llevamos a cabo una revisión retrospectiva de 180 biopsias renales ortotópicas ecodirigidas realizadas en nuestro servicio entre enero de 2008 y mayo de 2010. La técnica se realiza utilizando una aguja de diámetro 16 G acoplada a una pistola automática. Se recogen múltiples variables clínicas, así como las complicaciones tempranas derivadas del procedimiento y la actitud adoptada respecto a ellas. Se estudió la tasa de complicaciones, así como la relación entre factores de riesgo y aparición de complicaciones. Resultados: La edad media fue de 55,8 años, obteniéndose una media de 2,49 cilindros por intervención. La tasa global de complicaciones fue del 5,6%. Únicamente en 3 (1,67%) pacientes de los 180 fue necesaria una actitud intervencionista derivada de complicación del procedimiento. No hubo necesidad de intervenciones quirúrgicas ni se produjeron fallecimientos derivados del procedimiento. No se demostró relación entre HTA (p = 0,09), anticoagulación previa (p = 0,099) o antiagregación previa (p = 0,603) y complicaciones. El 2,8% de las biopsias presentaron material insuficiente para el diagnóstico. Conclusiones: La biopsia renal percutánea ecodirigida con aguja de 16 G es una técnica segura y con una rentabilidad diagnóstica elevada

Introduction and objective: The development of percutaneous renal biopsy as a routinary diagnostic procedure for renal masses is topic of discussion for the last few years. However, this technique has been associated with some complications, although infrequent, and morbidity. Our objective is to carry out a descriptive study about complications and outcomes of orthotopic kidney biopsies with 16 G needle. Material and methods: A retrospective review of 180 orthotopic ultrasound-guided renal biopsies performed in our service among January 2008 to May 2010 was carried out. The procedure was developed using an automated biopsy gun (16G needle). Multiple clinical variables, early post-procedure complications and its management were collected. Complication rates as well as the relationship between risk factors and occurrence of complications were studied. Results: Mean age was 55.8 years. The average number of biopsy cylinders per intervention was 2.49. The overall complication rate was 5.6%. An interventionist attitude derived from complication of the procedure was necessary in only 3 patients (1.67%). No surgical interventions were required and no death as consequence of procedure was registered. No relationship between hypertension (P = .09) previous anticoagulation (P = .099) or previous antiaggregation (P = .603) and complications were demonstrated. In 2.8% of biopsies the material obtained was insufficient for diagnosing. Conclusions: Percutaneous ultrasound-guided renal biopsy with 16G needle is a safe technique with high diagnostic performance

Calidad de vida en pacientes con cistectomía y conducto ileal por cáncer de vejiga / Quality of Life in Patients with Ileal Conduit Cystectomy Due to Bladder Cancer

Objetivo: Determinar las variables que influyen en la calidad de vida de pacientes tratados mediante cistectomía radical y conducto ileal. Material y método: Analizamos la calidad de vida utilizando el cuestionario EQ-5D-3L, que valora movilidad, cuidado personal, actividades cotidianas, dolor/malestar, ansiedad/depresión y una escala de autoevaluación del estado de salud. Comparamos los resultados con variables demográficas (sexo, edad, situación laboral, estudios, ingresos, pareja) y clínicas (clasificación ASA, estadio tumoral, tiempo desde la realización de la cistectomía, quimioterapia adyuvante, recidiva y complicaciones del estoma). El análisis estadístico incluyó estudio descriptivo, análisis univariante y multivariante. Resultados: Cincuenta y nueve pacientes incluidos, con una media de edad de 69 años (47-84). El tiempo medio desde la cistectomía es de 43 meses (12-83), con un porcentaje de complicaciones asociadas al estoma del 61%.Las complicaciones del estoma se relacionaron con limitaciones en el cuidado personal, dolor/malestar, ansiedad, depresión y calidad de vida en general. El sexo femenino se asocia con limitaciones en las actividades cotidianas y la quimioterapia adyuvante lo hace con la ansiedad/depresión y con la calidad de vida en general. El resto de variables no alcanzaron significación estadística en el análisis multivariante. Conclusiones: Las limitaciones en la calidad de vida en pacientes con cistectomía y conducto ileal se asocian con las complicaciones asociadas al estoma. Otras variables relacionadas son el sexo femenino y la administración de quimioterapia adyuvante

Objective: To determine the variables that affect quality of life of patients treated by radical cystectomy with ileal conduit. Material and method: We analyzed quality of life using the EQ-5D-3L questionnaire. This questionnaire evaluates mobility, personal care, daily activities, pain/discomfort, anxiety/depression and a self-rating scale of the health condition. We compared the result with demographic variables (gender, age, work situation, studies, income, partner) and clinical variables (ASA classification, tumor stage, time since cystectomy was performed, adjuvant chemotherapy, recurrent and complications of the stoma). The statistical analysis included a descriptive study, univariate and multivariate analysis. Results: A total of 59 patients were included in the study, with a mean age of 69 years (47-84). Mean time from cystectomy was 43 months (12-83), with 61% complications associated to the stoma. Stoma complications were related with limitations in personal care, pain/discomfort, anxiety, depression and quality of life in general. Female gender was associated with limitations in daily activities and adjuvant chemotherapy with anxiety/depression and quality of life in general. The rest of the variables were not statistically significant in the multivariate analysis. Conclusions: The limitations in quality of life in patients with cystectomy and ileal conduit are associated with the stoma-associated complications. Other related variables are female gender and administration of adjuvant chemotherapy

Renal biopsy with 16G needle: a safety study.

INTRODUCTION AND OBJECTIVE: The development of percutaneous renal biopsy as a routinary diagnostic procedure for renal masses is topic of discussion for the last few years. However, this technique has been associated with some complications, although infrequent, and morbidity. Our objective is to carry out a descriptive study about complications and outcomes of orthotopic kidney biopsies with 16 G needle. MATERIAL AND METHODS: A retrospective review of 180 orthotopic ultrasound-guided renal biopsies performed in our service among January 2008 to May 2010 was carried out. The procedure was developed using an automated biopsy gun (16G needle). Multiple clinical variables, early post-procedure complications and its management were collected. Complication rates as well as the relationship between risk factors and occurrence of complications were studied. RESULTS: Mean age was 55.8 years. The average number of biopsy cylinders per intervention was 2.49. The overall complication rate was 5.6%. An interventionist attitude derived from complication of the procedure was necessary in only 3 patients (1.67%). No surgical interventions were required and no death as consequence of procedure was registered. No relationship between hypertension (P=.09) previous anticoagulation (P=.099) or previous antiaggregation (P=.603) and complications were demonstrated. In 2.8% of biopsies the material obtained was insufficient for diagnosing. CONCLUSIONS: Percutaneous ultrasound-guided renal biopsy with 16G needle is a safe technique with high diagnostic performance.

Quality of life in patients with ileal conduit cystectomy due to bladder cancer.

OBJECTIVE: To determine the variables that affect quality of life of patients treated by radical cystectomy with ileal conduit. MATERIAL AND METHOD: We analyzed quality of life using the EQ-5D-3L questionnaire. This questionnaire evaluates mobility, personal care, daily activities, pain/discomfort, anxiety/depression and a self-rating scale of the health condition. We compared the result with demographic variables (gender, age, work situation, studies, income, partner) and clinical variables (ASA classification, tumor stage, time since cystectomy was performed, adjuvant chemotherapy, recurrent and complications of the stoma). The statistical analysis included a descriptive study, univariate and multivariate analysis. RESULTS: A total of 59 patients were included in the study, with a mean age of 69 years (47-84). Mean time from cystectomy was 43 months (12-83), with 61% complications associated to the stoma. Stoma complications were related with limitations in personal care, pain/discomfort, anxiety, depression and quality of life in general. Female gender was associated with limitations in daily activities and adjuvant chemotherapy with anxiety/depression and quality of life in general. The rest of the variables were not statistically significant in the multivariate analysis. CONCLUSIONS: The limitations in quality of life in patients with cystectomy and ileal conduit are associated with the stoma-associated complications. Other related variables are female gender and administration of adjuvant chemotherapy.