Navegando por Palavras-chave "Urinary infection"
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- ItemAcesso aberto (Open Access)Abordagem diagnóstica e terapêutica na infecção do trato urinário: ITU(Associação Médica Brasileira, 2003-01-01) Heilberg, Ita Pfeferman [UNIFESP]; Schor, Nestor [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)A review about recent aspects on diagnosis and clinical management of urinary tract infection (UTI) is presented. There is a wide variation in clinical presentation of UTI which include different forms as cystitis, pyelonephritis, urethral syndrome and the clinical relevance of asymptomatic bacteriuria and low-count bacteriuria that must be distinguished from contamination. Pathogenetic aspects concerning bacterial virulence as well as host factors in susceptibility to UTI as urinary tract obstruction, vesicoureteral reflux, indwelling bladder catheters, pregnancy, diabetes mellitus, sexual activity, contraceptive methods, prostatism, menopause, advanced age and renal transplantation are discussed. Diagnostic criteria and the most common tests utilized for differentiation between lower and upper UTI have been reviewed. The authors conclude that a careful evaluation of the underlying factors is required for the correct diagnosis of UTI and to prevent recurrence and that appropriate strategies and specific therapeutic regimens may maximize the benefit while reducing costs and adverse reactions.
- ItemAcesso aberto (Open Access)Avaliação do impacto de um programa de intervenções para prevenção de infecção do trato urinário associada ao uso de sonda vesical em pacientes transplantados renais(Universidade Federal de São Paulo (UNIFESP), 2010-05-26) Regagnin, Dejanira Aparecida [UNIFESP]; Medeiros, Eduardo Alexandrino Servolo de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The urinary tract infection is one of the most ordinary complications after a renal transplant and it may lead to rejection, donor kidney failure, long hospital stay period and increased cost. Although the use of a urinary catheter as its period of stay is considered a risk factor, little has been studied about the nursing staff knowledge to prevent urinary tract infection due to a urinary catheter. Objectives: Evaluate the nursing staff practice and knowledge related to the maintenance of a urinary catheter as the risks of its use, implement an intervention guide and measure its impact on the incidence of urinary tract infection and also on the nursing assistance to patients undergoing renal transplantation. Method: A prospective interventional study was performed in a hospital in São Paulo, from August first 2008 to July 31st 2009, and divided into two phases. In the first phase, which occurred from August 2008 to January 2009, the urinary catheter insertion and the procedures for its safe maintenance were observed and a questionnaire to access the nurses’ information about the subject was applied as well. In the second phase, from February first to July 31st 2009, a group of new actions based on data collected from the first round were implemented, the same questionnaire was applied once more followed by another period of observation which the main purpose was to verify the effect and changes caused by the new guide developed. Results: The nursing professionals’ theoretical knowledge assessment showed a meaningful statistical difference between the distinct study phases such as urethral meatus hygiene procedure (p=0,007), hygiene frequency urethral meatus (p<0.001), the cleaning product used in the hygiene of the urethral meatus (p<0,001), the catheter exchange frequency (p<0,001) and HRIM infection rates (p<0,001) awareness indicating an improvement after the intervention. The practice observation also showed a hand hygiene improvement among physicians: 9,1% of frequency before procedure and 68,2% after the procedure. Among the nursing staff members again positive results were noticed: 26,7% to 48% of hand washing before procedure and 76% to 86,7% after procedure. Better adherence to the use of personal protective equipment comparing 60 to 75% in the first round against 98% to 100% in the second. There were 44 (11,33%) cases of urinary tract infection in the first phase of the study, 26 deceaseddonor while 17 living-donor, which 37 (84,09%) due to urinary catheter presence. The average time between the urinary tract infection diagnosis and the kidney transplant was 13,5 days (5 to 30 days). In both phases, there was a bacterial infection predominance being the gram-negatives responsible for 97,7% of the infections in the first round against 82,25% in the second. E. coli itself was responsible for 34 (32%) cases of infection, followed by K. pneumoniae which caused 18 (16,9%) cases of infection. Conclusions: A meaningful practice and theoretical knowledge improvement can be noticed due to the educational program. Despite all the better results achieved in the second phase of this study, with reduction of urinary tract infection associated with vesical catheter (p=0,674), any impact on decreasing urinary tract infections could be demonstrated.
- ItemAcesso aberto (Open Access)Quinolone-resistant Escherichia coli(Brazilian Society of Infectious Diseases, 2008-02-01) Ito, Carmen Antonia Sanches; Gales, Ana Cristina [UNIFESP]; Tognim, Maria Cristina Bronharo [UNIFESP]; Munerato, Patricia [UNIFESP]; Dalla Costa, Libera Maria; State University of Ponta Grossa; Universidade Federal de São Paulo (UNIFESP); Federal University of Paraná Hospital de Clínicas Bacteriology LaboratoryQuinolones (nalidixic acid - NAL, norfloxacin - NOR, ciprofloxacin - CIP and gatifloxacin - GAT) were tested against Escherichia coli isolated from urine (385 patient samples) by disk diffusion (DD) and agar dilution (AD) methods. Fifty-three samples (13.8%) were classified as resistant to at least one of the quinolones tested. CIP and NOR susceptibilities were the same (91.4%) and they were similar to GAT (92.7%). Susceptibility to NAL, detected by the disk diffusion method, was used to predict susceptibility to NOR, CIP and GAT by the agar dilution method. The sensitivity and specificity of NAL were 100% and 95%, respectively. Twelve samples were analyzed for mutations in the quinolone resistance-determining region (QRDR) of the gyrA and parC genes. Sequencing of these genes failed to find any mutations in the quinolone-sensitive isolates. However, three mutations were observed in the isolates resistant to all the quinolones tested - two in gyrA and one in parC. A single mutation in gyrA was found in the strains that were resistant to nalidixic acid but fluoroquinolone-sensitive. These findings support the suggestion that NAL could be used as a marker for susceptibility to fluoroquinolones in routine microbiology laboratories. The overall resistance rate to quinolones in the present study was 13.8%, which is higher than that observed in other studies carried out in developed countries. Our findings serve as a warning that resistance to this group of antimicrobial agents is increasing.