The Experts below are selected from a list of 8181 Experts worldwide ranked by ideXlab platform
Lindsay E Nicolle - One of the best experts on this subject based on the ideXlab platform.
-
the paradigm shift to non treatment of asymptomatic Bacteriuria
Pathogenetics, 2016Co-Authors: Lindsay E NicolleAbstract:Asymptomatic Bacteriuria, also called asymptomatic urinary infection, is a common finding in healthy women, and in women and men with abnormalities of the genitourinary tract. The characterization and introduction of the quantitative urine culture in the 1950s first allowed the reliable recognition of asymptomatic Bacteriuria. The observations that a substantial proportion of patients with chronic pyelonephritis at autopsy had no history of symptomatic urinary infection, and the high frequency of pyelonephritis observed in pregnant women with untreated asymptomatic Bacteriuria, supported a conclusion that asymptomatic Bacteriuria was harmful. Subsequent screening and long term follow-up programs for asymptomatic Bacteriuria in schoolgirls and women reported an increased frequency of symptomatic urinary tract infection for subjects with asymptomatic Bacteriuria, but no increased morbidity from renal failure or hypertension, or increased mortality. Treatment of asymptomatic Bacteriuria did not decrease the frequency of symptomatic infection. Prospective, randomized, comparative trials enrolling premenopausal women, children, elderly populations, patients with long term catheters, and diabetic patients consistently report no benefits with antimicrobial treatment of asymptomatic Bacteriuria, and some evidence of harm. Several studies have also reported that antimicrobial treatment of asymptomatic Bacteriuria increases the short term risk of pyelonephritis. Current investigations are exploring the potential therapeutic intervention of establishing asymptomatic Bacteriuria with an avirulent Escherichia coli strain to prevent symptomatic urinary tract infection for selected patients.
-
catheter associated urinary tract infections
Antimicrobial Resistance and Infection Control, 2014Co-Authors: Lindsay E NicolleAbstract:Urinary tract infection attributed to the use of an indwelling urinary catheter is one of the most common infections acquired by patients in health care facilities. As biofilm ultimately develops on all of these devices, the major determinant for development of Bacteriuria is duration of catheterization. While the proportion of bacteriuric subjects who develop symptomatic infection is low, the high frequency of use of indwelling urinary catheters means there is a substantial burden attributable to these infections. Catheter-acquired urinary infection is the source for about 20% of episodes of health-care acquired bacteremia in acute care facilities, and over 50% in long term care facilities. The most important interventions to prevent Bacteriuria and infection are to limit indwelling catheter use and, when catheter use is necessary, to discontinue the catheter as soon as clinically feasible. Infection control programs in health care facilities must implement and monitor strategies to limit catheter-acquired urinary infection, including surveillance of catheter use, appropriateness of catheter indications, and complications. Ultimately, prevention of these infections will require technical advances in catheter materials which prevent biofilm formation.
-
asymptomatic Bacteriuria in adults
American Family Physician, 2006Co-Authors: Richard Colgan, Lindsay E Nicolle, Andrew Mcglone, Thomas M HootonAbstract:A common dilemma in clinical medicine is whether to treat asymptomatic patients who present with bacteria in their urine. There are few scenarios in which antibiotic treatment of asymptomatic bacteruria has been shown to improve patient outcomes. Because of increasing antimicrobial resistance, it is important not to treat patients with asymptomatic Bacteriuria unless there is evidence of potential benefit. Women who are pregnant should be screened for asymptomatic Bacteriuria in the first trimester and treated, if positive. Treating asymptomatic Bacteriuria in patients with diabetes, older persons, patients with or without indwelling catheters, or patients with spinal cord injuries has not been found to improve outcomes.
-
asymptomatic Bacteriuria review and discussion of the idsa guidelines
International Journal of Antimicrobial Agents, 2006Co-Authors: Lindsay E NicolleAbstract:Asymptomatic Bacteriuria is a common finding, but is usually benign. Screening and treatment of asymptomatic Bacteriuria is only recommended for pregnant women, or for patients prior to selected invasive genitourinary procedures. Healthy women identified with asymptomatic Bacteriuria on population screening subsequently experience more frequent episodes of symptomatic infection, but antimicrobial treatment of asymptomatic Bacteriuria does not decrease the occurrence of these episodes. Clinical trials in spinal-cord injury patients, diabetic women, patients with indwelling urethral catheters, and elderly nursing home residents have consistently found no benefits with treatment of asymptomatic Bacteriuria. Negative outcomes with antimicrobial treatment do occur, including adverse drug effects and re-infection with organisms of increasing resistance. Optimal management of asymptomatic Bacteriuria requires appropriate implementation of screening strategies to promote timely identification of the selected patients for whom treatment is beneficial, and avoidance of antimicrobial therapy where no benefit has been shown.
-
infectious diseases society of america guidelines for the diagnosis and treatment of asymptomatic Bacteriuria in adults
Clinical Infectious Diseases, 2005Co-Authors: Lindsay E Nicolle, Richard Colgan, Suzanne F Bradley, James C Rice, Anthony J Schaeffer, Thomas M HootonAbstract:1. The diagnosis of asymptomatic Bacteriuria should be based on results of culture of a urine specimen collected in a manner that minimizes contamination (A-II) (table 1). • For asymptomatic women, Bacteriuria is defined as 2 consecutive voided urine specimens with isolation of the same bacterial strain in quantitative counts 10 cfu/mL (B-II). • A single, clean-catch voided urine specimen with 1 bacterial species isolated in a quantitative count 10 cfu/mL identifies Bacteriuria in men (BIII). • A single catheterized urine specimen with 1 bacterial species isolated in a quantitative count 10 cfu/mL identifies Bacteriuria in women or men (A-II). 2. Pyuria accompanying asymptomatic Bacteriuria is not an indication for antimicrobial treatment (A-II). 3. Pregnant women should be screened for Bacteriuria by urine culture at least once in early pregnancy, and they should be treated if the results are positive (A-I). • The duration of antimicrobial therapy should be
Geoffrey K Dube - One of the best experts on this subject based on the ideXlab platform.
-
epidemiology and outcomes of carbapenem resistant klebsiella pneumoniae Bacteriuria in kidney transplant recipients
Transplant Infectious Disease, 2015Co-Authors: Stephanie M Pouch, Christine J Kubin, Michael J Satlin, Demetra Tsapepas, John R Lee, Geoffrey K DubeAbstract:Background Little is known about the epidemiology of carbapenem-resistant Klebsiella pneumoniae (CRKP) Bacteriuria following kidney transplantation. We determined the incidence of post-transplant CRKP Bacteriuria in adults who underwent kidney transplant from 2007 to 2010 at 2 New York City centers. Methods We conducted a case–control study to identify factors associated with CRKP Bacteriuria compared with carbapenem-susceptible K. pneumoniae (CSKP) Bacteriuria, assessed whether CRKP Bacteriuria was associated with mortality or graft failure, and compared outcomes of treated episodes of CRKP and CSKP Bacteriuria. Results Of 1852 transplants, 20 (1.1%) patients developed CRKP Bacteriuria. Factors associated with CRKP Bacteriuria included receipt of multiple organs (odds ratio [OR] 4.7, 95% confidence interval [CI] 1.1–20.4), deceased-donor allograft (OR 5.9, 95% CI 1.3–26.8), transplant admission length of stay (OR 1.1 per day, 95% CI 1.0–1.1), pre-transplant CRKP infection or colonization (OR 18.3, 95% CI 2.0–170.5), diabetes mellitus (OR 2.8, 95% CI 1.0–7.8), and receipt of antimicrobials other than trimethoprim-sulfamethoxazole (OR 4.3, 95% CI 1.6–11.2). Conclusion Compared to CSKP Bacteriuria, CRKP Bacteriuria was associated with increased mortality (30% vs. 10%, P = 0.03) but not graft failure. Treated episodes of CRKP Bacteriuria were less likely to achieve microbiologic clearance (83% vs. 97%; P = 0.05) and more likely to recur within 3 months (50% vs. 22%, P = 0.02) than CSKP episodes. CRKP Bacteriuria after kidney transplant is associated with mortality and antimicrobial failure after treatment.
Thomas M Hooton - One of the best experts on this subject based on the ideXlab platform.
-
asymptomatic Bacteriuria and pyuria in premenopausal women
Clinical Infectious Diseases, 2020Co-Authors: Thomas M Hooton, Pacita L Roberts, Ann E StapletonAbstract:Background Asymptomatic Bacteriuria and pyuria in healthy women often trigger inappropriate antimicrobial treatment, but there is a paucity of data on their prevalence and persistence. Methods To evaluate the prevalence and persistence of asymptomatic Bacteriuria and pyuria in women at high risk of recurrent urinary tract infection, we conducted an observational cohort study in 104 healthy premenopausal women with a history of recurrent urinary tract infection with daily assessments of Bacteriuria, pyuria, and urinary symptoms over a 3-month period. Results The mean age of participants was 22 years, and 74% were white. Asymptomatic Bacteriuria events (urine cultures with colony count ≥105 CFU/mL of a uropathogen on days with no symptomatic urinary tract infection diagnosed) occurred in 45 (45%) women on 159 (2.5%) of 6283 days. Asymptomatic Bacteriuria events were most commonly caused by Escherichia coli, which was present on 1.4% of days, with a median duration of 1 day (range, 1-10). Pyuria occurred in 70 (78%) of 90 evaluable participants on at least 1 day and 25% of all days on which no symptomatic urinary tract infection was diagnosed. The positive predictive value of pyuria for E. coli asymptomatic Bacteriuria was 4%. Conclusions In this population of healthy women at high risk of recurrent urinary tract infection, asymptomatic Bacteriuria is uncommon and, when present, rarely lasts more than 2 days. Pyuria, on the other hand, is common but infrequently associated with Bacteriuria or symptoms. These data strongly support recommendations not to screen for or treat asymptomatic Bacteriuria or pyuria in healthy, nonpregnant women.
-
asymptomatic Bacteriuria in adults
American Family Physician, 2006Co-Authors: Richard Colgan, Lindsay E Nicolle, Andrew Mcglone, Thomas M HootonAbstract:A common dilemma in clinical medicine is whether to treat asymptomatic patients who present with bacteria in their urine. There are few scenarios in which antibiotic treatment of asymptomatic bacteruria has been shown to improve patient outcomes. Because of increasing antimicrobial resistance, it is important not to treat patients with asymptomatic Bacteriuria unless there is evidence of potential benefit. Women who are pregnant should be screened for asymptomatic Bacteriuria in the first trimester and treated, if positive. Treating asymptomatic Bacteriuria in patients with diabetes, older persons, patients with or without indwelling catheters, or patients with spinal cord injuries has not been found to improve outcomes.
-
infectious diseases society of america guidelines for the diagnosis and treatment of asymptomatic Bacteriuria in adults
Clinical Infectious Diseases, 2005Co-Authors: Lindsay E Nicolle, Richard Colgan, Suzanne F Bradley, James C Rice, Anthony J Schaeffer, Thomas M HootonAbstract:1. The diagnosis of asymptomatic Bacteriuria should be based on results of culture of a urine specimen collected in a manner that minimizes contamination (A-II) (table 1). • For asymptomatic women, Bacteriuria is defined as 2 consecutive voided urine specimens with isolation of the same bacterial strain in quantitative counts 10 cfu/mL (B-II). • A single, clean-catch voided urine specimen with 1 bacterial species isolated in a quantitative count 10 cfu/mL identifies Bacteriuria in men (BIII). • A single catheterized urine specimen with 1 bacterial species isolated in a quantitative count 10 cfu/mL identifies Bacteriuria in women or men (A-II). 2. Pyuria accompanying asymptomatic Bacteriuria is not an indication for antimicrobial treatment (A-II). 3. Pregnant women should be screened for Bacteriuria by urine culture at least once in early pregnancy, and they should be treated if the results are positive (A-I). • The duration of antimicrobial therapy should be
-
a prospective study of asymptomatic Bacteriuria in sexually active young women
The New England Journal of Medicine, 2000Co-Authors: Thomas M Hooton, Pacita L Roberts, Ann E Stapleton, Delia Scholes, C Winter, Kalpana Gupta, Mansour Samadpour, Walter E StammAbstract:Background Asymptomatic Bacteriuria is common in young women, but little is known about its pathogenesis, natural history, risk factors, and temporal association with symptomatic urinary tract infection. Methods We prospectively evaluated 796 sexually active, nonpregnant women from 18 through 40 years of age over a period of six months for the occurrence of asymptomatic Bacteriuria (defined as at least 10 5 colony-forming units of urinary tract pathogens per milliliter). The women were patients at either a university student health center or a health maintenance organization (HMO). Periodic urine cultures were taken, daily diaries were kept, and regularly scheduled interviews were performed. Escherichia coli strains were tested for hemolysin, the papG genotype, and the ribosomal RNA type. Results The prevalence of asymptomatic Bacteriuria (the proportion of urine cultures with Bacteriuria in asymptomatic women) was 5 percent (95 percent confidence interval, 4 percent to 6 percent) among women in the unive...
-
escherichia coli Bacteriuria and contraceptive method
JAMA, 1991Co-Authors: Thomas M Hooton, Pacita L Roberts, Sharon L Hillier, Carolyn Johnson, Walter E StammAbstract:We evaluated the effects of contraceptive method on the occurrence of Bacteriuria and vaginal colonization with Escherichia coli in 104 women who were evaluated prior to having sexual intercourse, the morning after intercourse, and 24 hours later. After intercourse, the prevalence of E coli Bacteriuria increased slightly in oral contraceptive users but dramatically in both foam and condom users and diaphragm-spermicide users. Twenty-four hours later, the prevalence of Bacteriuria remained significantly elevated only in the latter two groups. Similarly, vaginal colonization with E coli was more dramatic and persistent in users of diaphragm-spermicide and foam and condoms. Vaginal colonization with Candida species, enterococci, and staphylococci also increased significantly in diaphragm-spermicide users after intercourse. We conclude that use of the diaphragm with spermicidal jelly or use of a spermicidal foam with a condom markedly alters normal vaginal flora and strongly predisposes users to the development of vaginal colonization and Bacteriuria with E coli.
John W Warren - One of the best experts on this subject based on the ideXlab platform.
-
catheter associated urinary tract infections
International Journal of Antimicrobial Agents, 2001Co-Authors: John W WarrenAbstract:Nosocomial urinary tract infection (UTI) is the most common infection acquired in both hospitals and nursing homes and is usually associated with catheterization. This infection would be even more common but for the use of the closed catheter system. Most modifications have not improved on the closed catheter itself. Even with meticulous care, this system will not prevent Bacteriuria. After Bacteriuria develops, the ability to limit its complications is minimal. Once a catheter is put in place, the clinician must keep two concepts in mind: keep the catheter system closed in order to postpone the onset of Bacteriuria, and remove the catheter as soon as possible. If the catheter can be removed before Bacteriuria develops, postponement becomes prevention.
-
catheter associated urinary tract infections
Infectious Disease Clinics of North America, 1997Co-Authors: John W WarrenAbstract:Millions of urethral catheters are used each year. This device subverts several host defenses to allow bacterial entry at the rate of 3% to 10% incidence per day, and its presence encourages the organism's persistent residence in the urinary tract. Most catheter-associated Bacteriurias are asymptomatic. The complications in short-term catheterized patients include fever, acute pyelonephritis, bacteremia, and death; patients with long-term catheters in place are at risk for these complications and catheter obstruction, urinary tract stones, local periurinary infections, chronic renal inflammation, chronic pyelonephritis, and, over years, bladder cancer. The closed catheter system has been a magnificant step forward in the prevention of catheter-associated Bacteriuria. Indeed, only two catheter principles are universally recommended: keep the closed catheter system closed and remove the catheter as soon as possible. Most modifications of the closed catheter system have not improved markedly on its ability to postpone Bacteriuria. On first inspection, systemic antibiotics seem to be an exception to this rule, but their use results in infection of the bladder with resistant organisms, including candida. This and the effect of side effects on the patient and emergence of resistant bacteria in the medical unit have led most authorities to conclude that antibiotics are not useful for prevention of Bacteriuria, nor for treatment of Bacteriuria in the asymptomatic catheterized patient. For symptomatic patients, usually with fever or signs of sepsis, treatment of Bacteriuria with appropriate systemic antibiotics and removal or replacement of the urethral catheter are indicated. Gloves, hand washing, and segregation of catheterized patients can minimize nosocomial clusters. Because clinicians can only postpone Bacteriuria, and once it occurs, clinicians seem unable to prevent its complications, methodologies other than urethral catheters should be used for urine drainage assistance whenever possible. These options include condom, intermittent, suprapubic, and intraurethral catheterization for appropriate patients. The few data available suggest that each one of these catheterization options yields a lower incidence of Bacteriuria-and its consequent complications-than urethral catheterization.
Frederike J Bemelman - One of the best experts on this subject based on the ideXlab platform.
-
asymptomatic Bacteriuria and urinary tract infections among renal allograft recipients
Current Opinion in Infectious Diseases, 2015Co-Authors: Ramandeep Singh, Suzanne E Geerlings, Frederike J BemelmanAbstract:Purpose of reviewBacteriuria is common among renal allograft recipients. It can be categorized into asymptomatic Bacteriuria (ASB) and urinary tract infection (UTI). However, in medical literature, the classifications of Bacteriuria are often not clear or ASB is also classified as a UTI. This contri
