Best of AUA 2013: Infection & Inflammation

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Presented by Jeannette M Potts, MD

Private Practice, Palo Alto, CA

• The incidence of urosepsis in hospitalized patients is increasing and with a high cost and mortality burden. Between 2000 and 2010, aggregate costs for stays with a principal diagnosis of urosepsis increased sevenfold, and the in-hospital mortality rate of 15% in 2010 was eight times higher than for all other stays.

• Urinary catheter infections are also increasing and are associated with increased mortality, length of stay, and risk of sepsis. Variables associated with mortality are patient age, illness severity, development of infection during the hospital stay, and inability to identify the culpable organism.

• Admissions for urinary tract infection (UTI) and UTI-related mortality are increasing. Predictors for mortality include male gender, African-American race, Medicaid, no insurance, and advanced age, but patients aged 45 to 64 years had a higher mortality rate than older patients, even after controlling for comorbidities.

• A single-institution review of patients with sepsis associated with obstructive stones demonstrated a high rate of antibiotic resistance, including to fluoroquinolones, among isolated pathogens. The fluoroquinolone resistance rate for Escherichia coli, the most common isolate, was 40%. Only a prior history of resistance predicted antibiotic resistance, but the pattern of resistance correlated with the institution’s biogram.

• Eight percent of patients seen for UTI in the emergency room were treated and released, indicating they could have been managed in an outpatient setting at much lower cost. Relative to patients admitted, those treated and released were more likely female, younger, poorer, and on Medicaid or private insurance.

• A 12-year, single-institution chart review found a significant association between enterococcal infectious endocarditis (IE) and having a urologic procedure within the year prior to IE diagnosis. The authors suggested bacteremia leading to IE may be the result of the urologic procedure or underlying uropathology.

• Patients with elevated PSA receiving empiric antibiotic treatment for prostatitis prior to transrectal ultrasound-guided prostate biopsy had a twofold higher rate of post-biopsy infectious complications compared with their unexposed counterparts.

• High concordance between rectal cultures obtained at initial consultation and at the time of prostate biopsy (performed 24 hours after administration of prophylactic antibiotics) suggests a rectal swab at the time of consultation may be used to guide targeted prophylaxis.

• A study using state-of-the art methods for microbial detection found no significant differences in the microbiota of the lower urinary tract in patients with urologic chronic pelvic pain syndrome (UCPPS) compared with controls, suggesting there is no rationale for antibiotic treatment of UCPPS.

• The finding of bladder glomerulations in 74% of patients who underwent hydrodistention before urolithiasis surgery is a reminder that glomerulations are not specific to interstitial cystitis/bladder pain syndrome (IC/BPS).

• Patients treated for IC/BPS using an individualized approach based on UPOINT (Urinary, Psychosocial, Organ Specific, Infection, Neuropathic/non-bladder, Tenderness of the pelvic floor) categorization achieved a fairly good response, regardless of complexity or history. However, lack of appropriate access to physiotherapy may have limited their outcomes.

• Studies investigating factors affecting quality of life for patients with UCPPS indicate the importance of catastrophizing (helplessness) and support of friends. Functional status and effective coping were more powerful than symptom severity for predicting work participation and productivity in women with IC/painful bladder syndrome.

• Identification of the binding target of Proteus mirabilis fimbriae is a first step toward developing fimbriae-binding inhibitors.

• Findings from research characterizing the genes of uropathogenic E. coli are expected to play an important role in developing new strategies for UTI treatment and prevention. Studies including pathogens sequestered 20 years ago show an evolution in genetics consistent with the acquisition of virulence factors.UT

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