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Öğe Antibiotic Prophylaxis in Urology Departments, 2005-2010(Elsevier, 2013) Cek, Mete; Tandogdu, Zafer; Naber, Kurt; Tenke, Peter; Wagenlehner, Florian; van Oostrum, Edgar; Kristensen, BrianBackground: Antibiotic prophylaxis (AP) is an important measure in preventing health care-associated urinary tract infections (HAUTIs). Despite regional variations in the bacterial spectrum and antibiotic susceptibility patterns, guideline recommendations are usually given on an international level. Objective: To describe the use of AP in urology departments and relate this to relevant parameters such as country, type of hospital, and European Association of Urology guideline recommendations. Design, setting, and participants: Data from the Global Prevalence Study on Infections in Urology for the period 2005-2010 were analysed to evaluate the use of antibiotics in general and AP for urologic procedures. Of the 13 723 patients enrolled, 8178 received antibiotics on the study days. Outcome measurements and statistical analysis: Study data were imported from the Web-based survey into Microsoft Access and exported into SPSS v. 17.0. The data were then coded and analysed. The Pearson chi-Square test was used to compare categorical data and a probability level of 5% was considered significant. Multiple logistic regression analysis was used to define significantly different variables in multiple set categories. Results and limitations: Questions on AP were answered on 8370 forms and 6306 (75.3%) investigators reported their routine application of AP. Routine AP was highest in Latin America (n = 337; 84%), followed by Asia (n = 1338; 86%), Africa (n = 234; 85%), and Europe (n = 4116; 67%). The antibiotics most frequently used for AP were second-generation cephalosporins, ciprofloxacin, cefotaxime, and amoxicillin plus beta-lactamase inhibitor. Conclusions: There were significant differences between countries/regions and types of hospitals, both in using AP for clean procedures and in the types of antibiotics used. AP was not always consistent with recommended guidelines. (C) 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.Öğe Condition-specific surveillance in health care-associated urinary tract infections as a strategy to improve empirical antibiotic treatment: an epidemiological modelling study(Springer, 2020) Tandogdu, Zafer; Koves, Bela; Cai, Tommaso; Cek, Mete; Tenke, Peter; Naber, Kurt; Wagenlehner, FlorianBackground Health care-associated urinary tract infection (HAUTI) consists of unique conditions (cystitis, pyelonephritis and urosepsis). These conditions could have different pathogen diversity and antibiotic resistance impacting on the empirical antibiotic choices. The aim of this study is to compare the estimated chances of coverage of empirical antibiotics between conditions (cystitis, pyelonephritis and urosepsis) in urology departments from Europe. Methods A mathematical modelling based on antibiotic susceptibility data from a point prevalence study was carried. Data were obtained for HAUTI patients from multiple urology departments in Europe from 2006 to 2017. The primary outcome of the study is the Bayesian weighted incidence syndromic antibiogram (WISCA) and Bayesian factor. Bayesian WISCA is the estimated chance of an antibiotic to cover the causative pathogens when used for first-line empirical treatment. Bayesian factor is used to compare if HAUTI conditions did or did not impact on empirical antibiotic choices. Results Bayesian WISCA of antibiotics in European urology departments from 2006 to 2017 ranged between 0.07 (cystitis, 2006, Amoxicillin) to 0.89 (pyelonephritis, 2009, Imipenem). Bayesian WISCA estimates were lowest in urosepsis. Clinical infective conditions had an impact on the Bayesian WISCA estimates (Bayesian factor > 3 in 81% of studied antibiotics). The main limitation of the study is the lack of local data. Conclusions Our estimates illustrate that antibiotic choices can be different between HAUTI conditions. Findings can improve empirical antibiotic selection towards a personalized approach but should be validated in local surveillance studies.Öğe Healthcare-associated urinary tract infections in hospitalized urological patients-a global perspective: results from the GPIU studies 2003-2010(Springer, 2014) Cek, Mete; Tandogdu, Zafer; Wagenlehner, Florian; Tenke, Peter; Naber, Kurt; Bjerklund-Johansen, Truls ErikEuropean Section for Infections in Urology has been conducting an annual prevalence survey investigating various aspects of healthcare-associated urinary tract infections (HAUTI) since 2003. The data on various clinical categories of HAUTI, the contamination status of HAUTI patients who underwent any urological intervention with regard to microorganisms isolated, resistance status and antibiotics used to treat HAUTI will be presented. Of a total of 19,756 patients screened, 1,866 patients had HAUTI (9.4 %); 1,313 males (70.4 %) and 553 (29.6 %) females. Mean age was 59.9 +/- A 18.2. Asymptomatic bacteriuria (ASB) and cystitis were the most frequent clinical diagnoses representing 27.0 and 26 % of all HAUTI, respectively. Echerichia coli was found to be the most frequent uropathogen (544 of 1,371 isolates) (39.7 %). Fluoroquinolones were preferred in 26.6 % of cases followed by cephalosporins (23.3 %), aminoglycosides (14.1 %) and penicillins (13.8 %). High global resistance rates to ciprofloxacin (> 50 %), cephalosporins (35-50 %) and penicillins (50 %) were found in the GPIU studies 2003-2010. We showed that around 10 % of hospitalized urological patients are at risk to develop HAUTI often caused by multiresistant uropathogens. Increased antibiotic use often with broad-spectrum antimicrobials will inevitably be followed by increasing bacterial resistance. To interrupt such a vicious cycle, our results suggest (1) there is still room for improvement in surgical prophylaxis in terms of limiting exposure to antibiotics and (2) far too many patients with ASB are being treated which shows that the new proposal of classification should be adopted where ABS is regarded as colonization and not as an infection to be treated.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]Öğe Resistance patterns of nosocomial urinary tract infections in urology departments: 8-year results of the global prevalence of infections in urology study(Springer, 2014) Tandogdu, Zafer; Cek, Mete; Wagenlehner, Florian; Naber, Kurt; Tenke, Peter; van Ostrum, Edgar; Johansen, Truls BjerklundTo present the worldwide antibiotic resistance rates of uropathogens reported in nosocomial urinary tract infections (NAUTI) during the period of 2003-2010. Data from the Global Prevalence Study of Infections in Urology from the period of 2003-2010 were analyzed to evaluate the resistance rates of pathogens causing NAUTI. The web-based application was used to record data of investigators from urology departments participating in the study every year during the days allocated in November. Each center was allowed to enter data on a single day of the study. The point prevalence data was used to find differences among geographic regions and years by utilizing multiple logistic regression analysis. A total of 19,756 patients were hospitalized during the study period, and in 1,866 of them, NAUTI was reported. Proof of infection was reported in 1,395 patients. Resistance rates of all antibiotics tested other than imipenem against the total bacterial spectrum were higher than 10 % in all regions. Resistance to almost all pathogens was lowest in North Europe, and there is no single year where an outbreak of resistance has been detected. The resistance rates of most of the uropathogens against the antibiotics tested did not show significant trends of increase or decrease with Asia exhibiting the highest rates in general. The only antibiotic tested with an overall resistance rate below 10 % was imipenem. Knowledge of regional and local resistance data and prudent use of antibiotics are necessary to optimize antibiotic therapy in urological patients with NAUTI.Öğe Transurethral Resection of the Prostate: are We Following the Guidelines?-Outcomes from the Global Prevalence of Infections in Urology (GPIU) Study(Taylor & Francis Ltd, 2019) Koves, Bela; Tenke, Peter; Tandogdu, Zafer; Cai, Tommaso; Bogenhard, Florian; Wullt, Bjorn; Naber, KurtTransurethral resection of the prostate (TURP) is one of the most common urological procedures. With the increasing rate of multiresistant infections including urosepsis, it is essential for all surgeons to adhere to the relevant international guidelines to prevent infectious complications. The aim of this prospective, multinational, multicentre study was to evaluate compliance with recommended infection control measures regarding TURP procedures. The study was performed as a side questionnaire to the annual Global Prevalence Study of Infections in Urology (GPIU) between 2006 and 2009. Patients that had undergone TURP were eligible. Baseline data about hospitals and patients were collected. The questionnaire contained questions regarding preoperative microbiological investigations, catheter care and performance of perioperative antibiotic prophylaxis. A total of 825 men were included from 138 participating centres from Africa, Asia, Europe and South America. Only 50.1% of the patients received perioperative antibiotic prophylaxis with a median duration of 3 days (interquartile range [IQR] = 1-7 days). Preoperative urine culture was taken in 59.2%. The catheter was replaced in 1 week prior to the surgery only in 38.3% of cases. Compliance with the recommended infection control measures regarding TURP were only moderate, despite high grade recommendations in relevant international Guidelines. Stronger guideline adherence is necessary to improve patient care decrease antibiotic consumption in line with antibiotic stewardship in surgical practices.
