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Öğe Antibiotic Stewardship: A Call for Action by the Urologic Community(Elsevier, 2013) Wagenlehner, Florian M. E.; Bartoletti, Ricardo; Cek, Mete; Grabe, Magnus; Kahlmeter, Gunnar; Pickard, Robert; Bjerklund-Johansen, Truls E.[Abstract Not Available]Öğe Antimicrobial resistance in urosepsis: outcomes from the multinational, multicenter global prevalence of infections in urology (GPIU) study 2003-2013(Springer, 2016) Tandogdu, Zafer; Bartoletti, Ricardo; Cai, Tomasso; Cek, Mete; Grabe, Magnus; Kulchavenya, Ekaterina; Koves, BelaPrimary objective was to identify the (1) relationship of clinical severity of urosepsis with the pathogen spectrum and resistance and (2) appropriateness of using the pathogen spectrum and resistance rates of health-care-associated urinary tract infections (HAUTI) as representative of urosepsis. The secondary objective was to provide an overview of the pathogens and their resistance profile in patients with urosepsis. A point prevalence study carried out in 70 countries (2003-2013). Population studied included; 408 individuals with microbiologically proven urosepsis, 1606 individuals with microbiological proof of HAUTI and 27,542 individuals hospitalised in urology wards. Main outcomes are pathogens and resistance identified in HAUTIs and urosepsis including its clinical severity. A statistical model that included demographic factors (study year, geographical location, hospital setting) was used for analysis. Amongst urology practices, the prevalence of microbiologically proven HAUTI and urosepsis was 5.8 and 1.5 %, respectively. Frequent pathogens in urosepsis were E. coli (43 %), Enterococcus spp. (11 %), P. aeruginosa (10 %) and Klebsiella spp. (10 %). Resistance to commonly prescribed antibiotics was high and rates ranged from 8 % (imipenem) to 62 % (aminopenicillin/beta lactamase inhibitors); 45 % of Enterobacteriaceae and 21 % of P. aeruginosa were multidrug-resistant. Resistance rates in urosepsis were higher than in other clinical diagnosis of HAUTI (Likelihood ratio < 0.05). It is not appropriate to use the pathogen spectrum and resistance rates of other HAUTIs as representative of urosepsis to decide on empirical treatment of urosepsis. Resistance rates in urosepsis are high, and precautions should be made to avoid further increase.Öğe Infective Complications After Prostate Biopsy: Outcome of the Global Prevalence Study of Infections in Urology (GPIU) 2010 and 2011, A Prospective Multinational Multicentre Prostate Biopsy Study(Elsevier, 2013) Wagenlehner, Florian M. E.; van Oostrum, Edgar; Tenke, Peter; Tandogdu, Zafer; Cek, Mete; Grabe, Magnus; Wullt, BjornBackground: Infection is a serious adverse effect of prostate biopsy (P-Bx), and recent reports suggest an increasing incidence. Objective: The aim of this multinational multicentre study was to evaluate prospectively the incidence of infective complications after P-Bx and identify risk factors. Design, setting, and participants: The study was performed as an adjunct to the Global Prevalence Study of Infections in Urology (GPIU) during 2010 and 2011. Men undergoing P-Bx in participating centres during the 2-wk period commencing on the GPIU study census day were eligible. Outcome measurements and statistical analysis: Baseline data were collected and men were questioned regarding infective complications at 2 wk following their biopsy. The Fisher exact test, Student t test, Mann-Whitney U test, and multivariate regression analysis were used for data analysis. Results and limitations: A total of 702 men from 84 GPIU participating centres worldwide were included. Antibiotic prophylaxis was administered prior to biopsy in 98.2% of men predominantly using a fluoroquinolone (92.5%). Outcome data were available for 521 men (74%). Symptomatic urinary tract infection (UTI) was seen in 27 men (5.2%), which was febrile in 18 (3.5%) and required hospitalisation in 16 (3.1%). Multivariate analysis did not identify any patient subgroups at a significantly higher risk of infection after P-Bx. Causative organisms were isolated in 10 cases (37%) with 6 resistant to fluoroquinolones. The small sample size per participating site and in compared with other studies may have limited the conclusions from our study. Conclusions: Infective complications after transrectal P-Bx are important because of the associated patient morbidity. Despite antibiotic prophylaxis, 5% of men will experience an infective complication, but none of the possible factors we examined appeared to increase this risk. Our study confirms a high incidence of fluoroquinolone resistance in causative bacteria. (C) 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.Öğe Preoperative assessment of the patient and risk factors for infectious complications and tentative classification of surgical field contamination of urological procedures(Springer, 2012) Grabe, Magnus; Botto, Henry; Cek, Mete; Tenke, Peter; Wagenlehner, Florian M. E.; Naber, Kurt G.; Johansen, Truls E. BjerklundPurpose To assess the patient and identify the risk factors for infectious complications in conjunction with urological procedures and suggest a model for classification of the procedures. Method Review of literature, critical analysis of data and tentative model for reducing infectious complications. Results Risk factors are bound to the patient and to the procedure itself and are associated with the environment where the healthcare is provided. Assuming a clean environment and sterile operation Weld, a five-level assessment ladder related to the patient and type of surgery is useful, considering: (1) the ASA score, (2) the general risk factors, (3) the individual endogenous and exogenous risk factors, (4) the class of surgery and the potential bacterial contamination burden and (5) the level of severity and difficulty of the surgical intervention. A cumulative approach will identify the level of risk for each patient and define preventive measures, such as the type of antibiotic prophylaxis or therapeutic measures before surgery. There are data suggesting that the higher the ASA score, the higher is the risk of infectious complication. Age, dysfunction of the immune system, hypo-albuminaemia/malnutrition and overweight, uncontrolled blood glucose level and smoking are independent general risk factors, whilst bacteriuria, indwelling catheter treatment, urinary tract stone disease, urinary tract obstruction and a history of urogenital infection are specific urological risk factors. There is inconclusive evidence for most other reported risk factors. The level of contamination of the surgical Weld is of utmost importance as are the procedure-related factors, and the sum of these have to be reflected on for the subsequent perioperative management of the patient. Conclusions It is essential to identify and control risk factors to minimize infectious complications in conjunction with urological procedures. Our knowledge is limited and clinical research and quality registries analysing risk factors must be undertaken. We propose a working basis for assessment of patients' risk factors and classification of urological procedures.Öğe Reply from Authors re: Riccardo Bartoletti, Tommaso Cai. Prostate Biopsies Should Be Performed According to a Standard of Care. Eur Urol 2013;63:528-9(Elsevier Science Bv, 2013) Wagenlehner, Florian; van Oostrum, Edgar; Tenke, Peter; Tandogdu, Zafer; Cek, Mete; Grabe, Magnus; Wullt, Bjorn[Abstract Not Available]
