Urological Survey Infection and Inflammation of the Genitourinary Tract Re: Types of Indwelling Urethral Catheters for Short-Term Catheterisation in Hospitalised Adults T. B. Lam, M. I. Omar, E. Fisher, K. Gillies and S. MacLennan Academic Urology Unit, University of Aberdeen, Foresterhill, Aberdeen, Scotland, United Kingdom Cochrane Database Syst Rev 2014; 9: CD004013.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.01.024 available at http://jurology.com/ Editorial Comment: I am often stopped in the hall by infection control officers and asked which catheter is most effective at reducing catheter associated urinary tract infections. My feeling is that the best way to decrease these infections is to avoid the use of catheters completely, a process in which our hospital is actively engaged. This Cochrane article is an excellent resource to review when addressing this question. Edward M. Schaeffer, MD, PhD
Re: Septic Shock and Adequacy of Early Empiric Antibiotics in the Emergency Department S. K. Flaherty, R. L. Weber, M. Chase, A. F. Dugas, A. M. Graver, J. D. Salciccioli, M. N. Cocchi and M. W. Donnino Department of Emergency Medicine, Department of Anesthesia Critical Care, Division of Critical Care and Department of Medicine, Division of Pulmonary/Critical and Critical Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, and Department of Emergency Medicine, Johns Hopkins Medicine, Baltimore, Maryland J Emerg Med 2014; 47: 601e607.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.01.025 available at http://jurology.com/ Editorial Comment: Why did I pick an article about septic shock? Well, as we all know, bacterial resistance is on the increase and several urological procedures (eg transurethral ultrasound guided biopsy and cystoscopy) can introduce bacteria into urological organs. Emergency room physicians may ask for advice about antimicrobial “coverage” suggestions. This single institution, retrospective study evaluated cases that presented in septic shock, assessing presumptive source of infection and the “success” of empirical antibiotic coverage. Interestingly the group presenting with urinary tract infections (UTIs) had the most inadequate empirical antibiotic coverage (ie most highly resistant strains)dmost patients were treated empirically with a quinolone and subsequently required much broader coverage. All of these patients had recent health care exposures (nursing facility, hospitalization). I do not believe the take home message of this article should be that patients with UTIs are at greatest risk for shock with resistant Escherichia coli, as this study neglected the true denominator in this regard. (The authors did not survey all patients
0022-5347/15/1934-0001/0 THE JOURNAL OF UROLOGY® © 2015 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
AND
RESEARCH, INC.
http://dx.doi.org/10.1016/j.juro.2015.01.024 Vol. 193, 1-2, April 2015 Printed in U.S.A.
www.jurology.com
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INFECTION AND INFLAMMATION OF THE GENITOURINARY TRACT
presenting to the emergency department with UTI, but only evaluated the extremely sick ones.) Rather, this report is another reminder that urinary isolates can be quite potent, and when there is a suggestion that a patient may be ill after one of our procedures, aggressive up-front treatment is prudent. Edward M. Schaeffer, MD, PhD
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.01.024 available at http://jurology.com/ Editorial Comment: I am often stopped in the hall by infection control officers and asked which catheter is most effective at reducing catheter associated urinary tract infections. My feeling is that the best way to decrease these infections is to avoid the use of catheters completely, a process in which our hospital is actively engaged. This Cochrane article is an excellent resource to review when addressing this question. Edward M. Schaeffer, MD, PhD
Re: Septic Shock and Adequacy of Early Empiric Antibiotics in the Emergency Department S. K. Flaherty, R. L. Weber, M. Chase, A. F. Dugas, A. M. Graver, J. D. Salciccioli, M. N. Cocchi and M. W. Donnino Department of Emergency Medicine, Department of Anesthesia Critical Care, Division of Critical Care and Department of Medicine, Division of Pulmonary/Critical and Critical Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, and Department of Emergency Medicine, Johns Hopkins Medicine, Baltimore, Maryland J Emerg Med 2014; 47: 601e607.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.01.025 available at http://jurology.com/ Editorial Comment: Why did I pick an article about septic shock? Well, as we all know, bacterial resistance is on the increase and several urological procedures (eg transurethral ultrasound guided biopsy and cystoscopy) can introduce bacteria into urological organs. Emergency room physicians may ask for advice about antimicrobial “coverage” suggestions. This single institution, retrospective study evaluated cases that presented in septic shock, assessing presumptive source of infection and the “success” of empirical antibiotic coverage. Interestingly the group presenting with urinary tract infections (UTIs) had the most inadequate empirical antibiotic coverage (ie most highly resistant strains)dmost patients were treated empirically with a quinolone and subsequently required much broader coverage. All of these patients had recent health care exposures (nursing facility, hospitalization). I do not believe the take home message of this article should be that patients with UTIs are at greatest risk for shock with resistant Escherichia coli, as this study neglected the true denominator in this regard. (The authors did not survey all patients
0022-5347/15/1934-0001/0 THE JOURNAL OF UROLOGY® © 2015 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
AND
RESEARCH, INC.
http://dx.doi.org/10.1016/j.juro.2015.01.024 Vol. 193, 1-2, April 2015 Printed in U.S.A.
www.jurology.com
j
1
2
INFECTION AND INFLAMMATION OF THE GENITOURINARY TRACT
presenting to the emergency department with UTI, but only evaluated the extremely sick ones.) Rather, this report is another reminder that urinary isolates can be quite potent, and when there is a suggestion that a patient may be ill after one of our procedures, aggressive up-front treatment is prudent. Edward M. Schaeffer, MD, PhD
