About 10 % of the adult women population in Sweden are treated annually for urinary tract infections. The increasing bacterial resistance towards antibiotics is classified by WHO (World Health Organization) and ECDC (European Centre for Disease Prevention and Control) as one of the greatest treats for human health in a global perspective. To find alternatives scientists are studying the possibility to use probiotics to reduce the frequency of recurring urinary tract infections. This literature study examines five randomized double blinded placebo controlled studies where different strains of Lactobacillus have been used as a prophylactic to women suffering from recurrent urinary tract infections and bacterial vaginosis. Overall the studies do not display enough promising results to recommend the use of probiotics as a prophylax or cure.

Bakgrund: Urinvägsinfektioner är en av de vanligaste vårdrelaterade infektionerna inom svensk sjukvård. Varje år drabbas 65 000 personer av en vårdrelaterad infektion, av dessa är 14 % urinvägsrelaterad. Detta medför onödigt lidande för patienten, men ger också upphov till förlängda vårdtider och ökade kostnader för hälso- och sjukvården. Syfte: Syftet var att beskriva hur sjuksköterskan kan arbeta preventivt för att minska förekomsten av vårdrelaterade urinvägsinfektioner. Metod: Studiens design var en litteraturöversikt innehållande 15 vetenskapliga artiklar, varav 13 stycken var kvantitativa och två stycken var kvalitativa. Datainsamlingen har skett via sökningar i databaserna PubMed och Cinahl, valda artiklar granskades med granskningsmallar och sammanställdes sedan i resultatet. Resultat: Resultatet visade att ett förebyggande arbete kring rutiner vid kateterisering innebar minskade risker för att drabbas av urinvägsinfektioner. Utbildning och ökad medvetenhet kring hygien visade sig ha en positiv effekt både hos patienter och bland personal. Det påvisades även ett positivt samband med ett ökat vätskeintag samt kosttillskott i form av tranbärskapslar. Slutsats: För att minska vårdrelaterade urinvägsinfektioner krävs det att sjuksköterskan har en följsamhet i det förebyggande arbetet. Utbildning bland personal och patienter, större medvetenhet kring basala hygienrutiner och korrekt rutiner vid kateterisering har en stor betydelse i det preventiva arbetet. / Background: Urinary tract infection is one of the most common nosocomial infections in Swedish health care. Each year, 65 000 people suffer from a nosocomial infection, of which 14 % are urinary tract related. This problem causes unnecessary suffering for the patient, prolonged waiting times and increased costs for health care. Aim: The aim of this study was to describe how nurses could prevent nosocomial urinary tract infections. Methods: This was a literature review based on 15 articles. Of these, 13 studies had a quantitative approach and two studies had a qualitative approach. The data collection has been done by searching in the databases PubMed and Cinahl. Chosen articles were reviewed by using reviewing templates, analyzed and were compiled in the result. Results: The result showed that proactive work regarding routines when catheterize amounted to less risks for patients suffering from urinary tract infections. Education and increased awareness around hygiene turned out to have a positive effect on patients in decreasing urinary tract infections and on staff behavior. There was also a positive correlation between an increased fluid intake and cranberry capsules as a supplement. Conclusion: To reduce nosocomial urinary tract infections it is required that the nurse is involved in the proactive work. Education for staff and patients, greater awareness around basic hygiene routines and correct routines when catheterizing has a big impact on the proactive work.

Avaliar a associação entre as infecções genito-urinárias, o comprimento do colo uterino e a prematuridade é importante para determinar quais podem ser os fatores preditivos para o parto pré-termo. Foi realizado estudo tipo coorte de conveniência, prospectivo, avaliando 1370 gestantes na cidade de Ribeirão Preto, com idade gestacional entre 20 e 25 semanas. Aplicou-se questionário sócio demográfico com história reprodutiva para a identificação do histórico obstétrico, idade materna, paridade, tabagismo e antecedente de parto pré-termo. Foi realizada ultrassonografia endovaginal para a avaliação do comprimento do colo uterino segundo as diretrizes da Fetal Medicine Foundation (FMF). Foram coletadas amostras de urina e conteúdo vaginal para avaliar a presença de infecção urinária e vaginose bacteriana respectivamente. A associação entre infecções, comprimento do colo uterino e parto pré-termo (PPT) foi realizada mediante teste não paramétrico e o cálculo do Risco Relativo das diferentes variáveis, por meio do ajuste de modelos log-binomiais. Das 1370 mulheres grávidas avaliadas, 132(9,63%) cursaram com parto pré-termo (<37 semanas), sendo que 19 (14,4%) dos partos pré-termo ocorreram em mulheres com colo <= 2,5 cm. O estudo microbiológico determinou que no grupo das mulheres que cursaram com parto pré-termo, 15 apresentaram ITU, 19 apresentaram vaginose bacteriana (VB) e uma apresentou ITU e VB. Avaliando as 75 pacientes com PPT espontâneos, 10 apresentaram ITU e 14, VB. Após a análise destes dados, foi possível concluir que o colo uterino curto entre 20 e 25 semanas de gestação está associado ao PPT e que ITU e VB rastreadas nesta idade não se associaram ao encurtamento do colo nem ao PPT. No entanto a ITU, mesmo assintomática apresentou relação com o PPT espontâneo. / To evaluate the association between the genito-urinary infections, cervical length and preterm birth is important to determine which can be predictive factors for preterm birth. It was conducted cohort study of convenience, prospective, evaluating 1370 pregnant women in the city of Ribeirão Preto, with gestational age between 20 and 25 weeks. Applied socio-demographic questionnaire with reproductive history to identify the obstetric history, maternal age, parity, smoking and preterm birth (PTB) history. Transvaginal ultrasonography was performed for evaluation of cervical length in the guidelines of the Fetal Medicine Foundation (FMF). Urine and vaginal discharge samples were collected to evaluate the presence of urinary tract infection (UTI) and bacterial vaginosis (BV) respectively. The association between infections, cervical length and preterm delivery was performed using non-parametric test and calculate the relative risk of different variables, by adjusting log-binomial model. Of the 1370 evaluated pregnant women, 132 (9.63%) presenting with preterm delivery (<37 weeks), and 19 (14.4%) of preterm deliveries occurred in women with cervix <=2.5 cm. The microbiological study found that the group of women presenting with preterm birth(PTB), 15 had UTI, 19 had BV and one presented UTI and VB. Evaluating 75 patients with spontaneous PTB, 10 had UTI and 14, BV. After the analysis of these data, it was concluded that the short cervix between 20 and 25 weeks of gestation is associated with the PTB and UTI and VB screened at this age not associated to the shortening of the cervix or the PTB. However, the UTI even asymptomatic were related to the spontaneous PTB.

Catheter-associated urinary tract infections (CAUTI) significantly increases patient morbidity and mortality, length of stay, and organizational cost. In the 2 years prior to project implementation, the incidence of CAUTI increased by 15% in the local acute care, inpatient facility that served as the project site. Nursing leaders at the project site linked the increase in CAUTIs to a nursing knowledge deficit related to CAUTI prevention principles. The clinical question focused on the impact of CAUTI prevention staff training on the incidence of CAUTI, length of stay, and cost to the local acute care organization. After a review and critical appraisal of the literature, using Lewin's theory of planned change and the Iowa Model of Evidence-Based Practice Change, an evidence-based, CAUTI-prevention training program was piloted as a quality improvement initiative. The project purpose was to evaluate that initiative by tracking the incidence of CAUTI for 90 days postintervention. A 1-sample t-test of the mean incidence with a 95% confidence interval revealed no statistically significant (p = .732) decrease in the incidence of CAUTI. Similar initiatives with fewer than 12 months of evaluation data have failed to demonstrate statistically significant findings; therefore, additional data are needed to adequately assess the impact of the project. Recommendations include extending the pilot project and additional training of unlicensed nursing personnel. Proper evaluation of the project may provide support for the implementation of CAUTI-prevention training programs, promoting social change by reducing the rate of infection, improving patient outcomes, and demonstrating financial stewardship of the local acute-care organization.

Catheter associated urinary tract infection (CAUTI) incidence continue to rise despite all prevention efforts. The state of Georgia incidence of CAUTI between 2012 and 2013 showed an increase by 350 cases. The challenge is translating CAUTI prevention knowledge into practice by all physicians. The purpose of this correlational study was to improve the epidemiological understanding of CAUTI. Looking at physicians’ perception and practice of CAUTI preventions was necessary. A total of 336 physicians from the state of Georgia completed a 26-item survey. Additionally, a pilot study was conducted on a small sample of participants. The result of the Cronbach alpha for the pilot study analysis of the 26-item survey instrument indicated excellent reliability. The analysis revealed that participants’ frequency of training on proper catheterization and their perception of CAUTI risk factors and effective implementation of CAUTI prevention bundle elements, varied significantly. It also resulted that many of the participants were not knowledgeable of certain important CAUTI prevention elements. Only a few made changes in their practice despite knowledge of the Center for Medicare and Medicaid Services reimbursement policy. Results of the Pearson’s chi-square test for independence indicated a significant correlation (p < .05) between physicians’ perception and practice of CAUTI prevention elements and CAUTI incidence. The results of this study suggest that current CAUTI prevention practice may be inefficient without the effective implementation of proven bundled element. Improved understanding of CAUTI and its relation to effective implementation of bundled prevention elements may result in improved prevention efforts, decreased morbidity, mortality, and overall healthcare cost.

<p>The urinary tract is one of the most intractable mucosal surfaces for pathogens to colonize. In addition to the natural barriers at this site, potential pathogens have to contend with the vigorous local innate immune response that is initiated by engagement of surveillance molecule TLRs. TLR4 appears to be not only exclusively expressed on superficial BECs but also critical to triggering robust local innate immune responses. TLR4 recognizes Gram-negative bacterial component LPS and initiates a series of intracellular NF-kappaB associated signaling events resulting in a cytokine response. We examined intracellular signaling events in human BECs leading to the production of IL-6, a major urinary cytokine, following activation by E. coli and isolated LPS, and observed that, in addition to the classical NF-kappaB associated pathway, BEC TLR4 triggers a distinct and more rapid signaling response involving, sequentially, Ca2+, AC3 generated cAMP, and the transcriptional factor CREB. This capacity of BECs to mobilize secondary messengers and evoke a more rapid IL-6 response might be critical in their role as first responders to microbial challenge in the urinary tract. </p><p>Here, we also report two additional distinct TLR4-mediated defense mechanisms in BECs. First, BEC TLR4 inhibits bacterial invasion, a necessary step for successful infection. TLR4-mediated suppression of bacterial invasion was linked to increased intracellular cAMP levels which negatively impacted Rac-1 mediated mobilization of the cytoskeleton. Additionally, we found that BECs continue to fight UPEC even after bacterial invasion by triggering bacterial exocytosis through a distinct TLR4-mediated mechanism following activation by LPS. In addition, we reveal that Caveolin-1, Rab27b, PKA, and MyRIP are components of the exocytic compartment and that they form a complex involved in the exocytosis of bacteria. The ability of TLR4 to mediate the rapid cytokine response, the inhibition of bacterial invasion, and the expulsion of intracellular bacteria from infected cells represents three previously unrecognized functions for this innate immune receptor.</p> / Dissertation

Catheter associated urinary tract infection (CAUTI) incidence continue to rise despite all prevention efforts. The state of Georgia incidence of CAUTI between 2012 and 2013 showed an increase by 350 cases. The challenge is translating CAUTI prevention knowledge into practice by all physicians. The purpose of this correlational study was to improve the epidemiological understanding of CAUTI. Looking at physicians' perception and practice of CAUTI preventions was necessary. A total of 336 physicians from the state of Georgia completed a 26-item survey. Additionally, a pilot study was conducted on a small sample of participants. The result of the Cronbach alpha for the pilot study analysis of the 26-item survey instrument indicated excellent reliability. The analysis revealed that participants' frequency of training on proper catheterization and their perception of CAUTI risk factors and effective implementation of CAUTI prevention bundle elements, varied significantly. It also resulted that many of the participants were not knowledgeable of certain important CAUTI prevention elements. Only a few made changes in their practice despite knowledge of the Center for Medicare and Medicaid Services reimbursement policy. Results of the Pearson's chi-square test for independence indicated a significant correlation (p < .05) between physicians' perception and practice of CAUTI prevention elements and CAUTI incidence. The results of this study suggest that current CAUTI prevention practice may be inefficient without the effective implementation of proven bundled element. Improved understanding of CAUTI and its relation to effective implementation of bundled prevention elements may result in improved prevention efforts, decreased morbidity, mortality, and overall healthcare cost.

Most urinary tract infections in humans and dogs are caused by uropathogenic strains of , and increasing antimicrobial resistance among these pathogens has created a need for a novel approach to therapy. Bacterial iron uptake and metabolism are potential targets for novel antimicrobial therapy, as iron is a limiting factor in . growth during infection. As a trivalent metal of similar atomic size to iron (III), gallium can interact with a wide variety of biomolecules that normally contain or interact with iron. Gallium compounds disrupt bacterial iron metabolism, are known to accumulate at sites of infection and inflammation in mammals, exert antimicrobial activity against multiple bacterial pathogens in vitro, and may be good candidates as novel antimicrobial drugs. We assessed the suitability of orally administered gallium maltolate as a potential new antimicrobial therapy for urinary tract infections by evaluating its distribution into the bladder, its activity against uropathogenic . in vitro, and its pharmacokinetics and efficacy in a mouse cystitis model. Using a novel application of synchrotron-based analytical methods, we confirmed the distribution of gallium to the bladder mucosa and characterized the relationship between iron and gallium distribution in the bladder. In vitro experiments with human and canine uropathogenic . isolates demonstrated that gallium maltolate exerts antimicrobial effects in a time-dependent, bacteriostatic manner. Minimum inhibitory concentrations ranged from 0.144 µmol/mL to >9.20 µmol/mL with a median of 1.15 µmol/mL. Isolates resistant to ampicillin, ciprofloxacin, or with decreased susceptibility to cephalothin were susceptible to the antimicrobial activity of gallium maltolate, suggesting that resistance to conventional antimicrobials does not predict resistance to gallium maltolate. Pharmacokinetic studies in healthy mice and in a mouse model of urinary tract infection confirmed that gallium is absorbed into systemic circulation after oral administration of gallium maltolate. Gallium is slowly eliminated from the body, with a trend toward longer terminal half-lives in blood and bladder for infected mice relative to healthy mice. This study did not reveal any statistically significant effect of infection status on maximum blood gallium concentrations (4.46 nmol/mL, 95% confidence interval 2.75 nmol/mL – 6.18 nmol/mL and 4.80 nmol/mL, 95% confidence interval 2.53 nmol/mL – 7.06 nmol/mL in healthy and infected mice, respectively) or total gallium exposure in blood and kidney as represented by area under the concentration vs. time curves. Gallium exposure in the bladder was significantly greater for mice with urinary tract infections than for healthy mice. The investigation of gallium distribution within tissues represented a novel application of synchrotron-based analytical techniques to antimicrobial pharmacokinetics. Prior to analysing tissue samples, a library of x-ray absorption spectra was assembled for gallium compounds in both the hard and soft x-ray ranges. The suitability of hard x-ray fluorescence imaging and scanning and transmission x-ray microscopy for localizing and speciating trace elements in tissues was subsequently assessed. Of these methods, only hard x-ray microprobe analysis was well-suited to the analysis and was successfully used for this application. This approach confirmed that gallium arrives at the bladder mucosa after oral administration of gallium maltolate. Furthermore, comparison of iron and gallium distribution within the bladder mucosa indicated that these elements are similarly but not identically distributed and that they do not significantly inhibit one another’s distribution. This finding suggests that gallium may be distributed in part via pathways that do not involve iron. Despite the favorable distribution characteristics of gallium and the persistence of gallium in target tissues following the oral administration of gallium maltolate, its efficacy in a mouse model of urinary tract infection was disappointing. In this study, no statistically significant difference was detected between gallium maltolate, ciprofloxacin and sham treatments in their ability to eliminate bacteria in the urinary tracts. The failure of ciprofloxacin treatment to render bladder tissue culture-negative for an organism that is classified as ciprofloxacin-susceptible in vitro is consistent with observations from other research groups. The similar lack of efficacy observed for gallium maltolate may be related to the large gap between minimum inhibitory concentrations observed in vitro and gallium concentrations observed in tissues from treated mice, but may also be related to the small study size if the effect size of gallium maltolate treatment is small. Given the magnitude of the difference between tissue concentrations and minimum inhibitory concentrations, it may not be possible to increase the dose sufficiently to achieve therapeutic concentrations without causing toxicity. While the results of these experiments suggest that orally administered gallium maltolate may not be a reasonable antimicrobial drug candidate for treating urinary tract infections caused by uropathogenic . , it may be useful for other applications. Other bacterial pathogens may be more susceptible to the antimicrobial effects of gallium maltolate, and local or topical administration could produce much higher concentrations than we observed following oral administration. Continued development of the synchrotron-based analytical techniques used in these experiments could provide new and important opportunities to investigate antimicrobial distribution and metabolism within cells and tissues, particularly for metal-based drugs.

Bakgrund: Urinvägsinfektion är den vanligast förekommande vårdrelaterade infektionen och innebär förekomst av bakterier i urinen med eller utan symtom. Det finns ett flertal faktorer som gör att äldre är en riskgrupp för att drabbas av urinvägsinfektion bland annat samsjuklighet och funktionsnedsättningar. Urinvägsinfektioner leder till lidande hos den äldre individen och stora kostnader för samhället. Sjuksköterskan har ett ansvar att förebygga sjukdom och minska lidande. Syfte: Syftet var att beskriva sjuksköterskans omvårdnadsåtgärder, upplevda effekter samt effekter av dessa, för att förebygga uppkomst av urinvägsinfektion hos äldre samt att beskriva de inkluderade artiklarnas urvalsmetod och undersökningsgrupp. Metod: En litteraturstudie med deskriptiv design. Studien baseras på 14 vetenskapliga artiklar. Av dessa var 12 stycken skrivna med kvantitativ ansats och två med kvalitativ ansats. Resultatet analyserades deduktivt utifrån Orems fem hjälpmetoder och subkategorierna framkom efter en induktiv analys. Huvudresultat: Resultatet sammanställdes i följande kategorier: Att göra något eller handla för en annan person med subkategorierna; God hygien, Specifika åtgärder relaterade till kateter, Ökat vätskeintag samt Profylaktiska läkemedel och tillskott. Att handleda en annan person, Att ge fysiskt och psykologiskt stöd, Att skapa en miljö som främjar utveckling samt Att undervisa. Slutsats: Sjuksköterskorna i studien använde sig av ett flertal olika omvårdnadsåtgärder för att förebygga urinvägsinfektion. Att förkorta tid med kateter samt att undvika att sätta kateter var de mest effektiva åtgärderna för att förebygga urinvägsinfektion. Sjuksköterskorna i studien upplevde att utbildning av patienter, omvårdnadspersonal och anhöriga samt ett ökat vätskeintag reducerade incidens av urinvägsinfektion. / Background: Urinary tract infection is the most common nosocomial infection and involves the presence of bacteria in the urine with or without symptoms. There are several factors that make that the elderly are at increased risk of suffering from urinary tract infection among other comorbidity and functional impairments. Urinary tract infections lead to suffering among elderly individuals and high costs for the society. The nurse has a responsibility to prevent disease and reduce suffering. Aim:The aim was to describe nursing care measures, perceived effects and the effects of these, in order to prevent the occurrence of urinary tract infection in the elderly and to describe the included articles in the sampling methodology and survey group. Method: A literature study with descriptive design. The study is based on 14 scientific articles. Of these, 12 studies with a quantitative approach and two studies with a qualitative approach. The results were analyzed deductively based on Orem´s five methods of helping. Subcategories emerged after an inductive analysis Main results: The results were compiled in the following categories: To do something or act for another person with subcategories; Good hygiene, Specific actions related to the indwelling urinary catheter, Increased fluid intake and Prophylactic agents / supplements. To mentor another person, To give physically and psychological support, To create an environment conducive to development and To educate. Conclusion: The nurses in the study used a variety of nursing interventions for preventing UTI. To shorten the time with the indwelling urinary catheter and to avoid inserting indwelling urinary catheter were the most effective methods to prevent urinary tract infections. The nurses in the study considered that education of patients, nursing staff and relatives and an increased fluid intake decreased incidence of urinary tract infections.

The epidemiology of urinary tract infection (UTI) in the population of Vännäs (8 000 inhabitants) was studied during one year. The annual incidence increased from 0.5% in the first decade of life to more than 10% in the age group 90-100 years. Male UTI comprised only 13% of the episodes, increased after middle age and contributed 4 0% by &gt; 80 years of age. At 17 PHC centres (PHCCs) a prevalence study (McPHC) of mainly uncomplicated UTI was performed. Most episodes were acutely symptomatic (lower 75%, upper 5%). Microscopy of wet-stained urinary sediment with a minimum of moderate amount of bacteria and/or 5 leukocytes per high power field (4 00 x) as breakpoint resulted in a desired high sensitivity (97%) and 86% efficacy in acutely symptomatic patients. Diagnosis of bacteriuria using Uricult dipslides yielded acceptable results with an overall efficacy of 88%. Nitrite test and Uriglox showed an unacceptable low mean sensitivity ofR56 and 69%, respectively. A positive nitrite, sediment or Uricult , when used in combination, was optimal in diagnosing UTI with a sensitivity of 98% in acutely symptomatic patients during their office visits. The average risk of drug resistance was 17% in the Vännäs study. Sensicult satisfactorily predicted drug sensitivity (93%) but not bacterial drug resistance (50%). Using Uricult with classification of bacteriuria by Gram-grouping, lactose and catalase reactions for targeting UTI therapy, according to local guidelines, resulted in a similar low risk (6 %) of prescribing drugs to which the organisms were resistagt as when using Sensicult (7%). This development of the Uricult method is simple and can be recommended for office practice in PHC. The spectrum of bacteria causing UTI and their drug resistance was more associated with the selection of patients, sex and age than with symptoms. The pattern of drug resistance was little influenced by UTI history and the mean pretherapy resistance for the seven drugs tested in McPHC was low (7%). Drug resistance was increased in failure (mean 24%) but not in early or repeated recurrence. In McPHC therapy resulted in 8% bacteriological failure and 12% early recurrence, irrespective of whether the bacteria were classified as sensitive or resistant in vitro to the drug given. Thus, in order to be of prognostic value for therapy of uncomplicated UTI, high-level breakpoints focusing more on peak urinary drug concentrations need to be studied. UTI symptoms in McPHC were eradicated in only 2/3 of the bacterio- logically cured episodes and in 1/3 of the failures at control 1-3 days posttherapy showing that symptoms are an unreliable indicator of UTI. From current literature, it seems unlikely that asymptomatic bacteriuria (ABU) plays a major role in the development of uremia due to chronic pyelonephritis. With the exception of ABU in pregnancy, therapy seems to yield no benefit. Omitting posttherapy bacteriuria controls in patients with symptoms eradicated, at least in women with uncomplicated UTI, would lead to considerable savings both for patients and the health care system. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1988, härtill 6 uppsatser.</p> / digitalisering@umu