Recurrent urinary tract infection-Evidence based approachWafaa Benjamin
Recurrent UTI is a common problem encountered in many areas of clinical practice.
It is a cause of significant morbidity: urinary infection is one of the commonest indications for antibiotic prescription in community and hospital settings.
The majority of cases are uncomplicated and respond rapidly to appropriate treatment.
In the management of women with any type of UTI, it is important to have an appreciation of the pathogenesis, host and bacterial interaction, methods of diagnosis, treatment algorithms and local antibiotic sensitivities.
It should be remembered that 20-30% of women with UTI develop at least one recurrent infection
Incidence of VTE in the First Postoperative 24 Hours after Abdominopelvic Sur...semualkaira
A good number of research reports the incidence of postoperative venous thromboembolism (VTE) mostly looks at longer postoperative duration, usually days after surgery.
Recurrent urinary tract infection-Evidence based approachWafaa Benjamin
Recurrent UTI is a common problem encountered in many areas of clinical practice.
It is a cause of significant morbidity: urinary infection is one of the commonest indications for antibiotic prescription in community and hospital settings.
The majority of cases are uncomplicated and respond rapidly to appropriate treatment.
In the management of women with any type of UTI, it is important to have an appreciation of the pathogenesis, host and bacterial interaction, methods of diagnosis, treatment algorithms and local antibiotic sensitivities.
It should be remembered that 20-30% of women with UTI develop at least one recurrent infection
Incidence of VTE in the First Postoperative 24 Hours after Abdominopelvic Sur...semualkaira
A good number of research reports the incidence of postoperative venous thromboembolism (VTE) mostly looks at longer postoperative duration, usually days after surgery.
outh Africa has one of the highest incidences of human immunodeficiency virus (HIV) infection in Africa. The rollout of antiretroviral therapy (ART) in South Africa has been tremendously successful in extending the lives of HIV-infected persons. Consequently, more patients who would have died before the availability of ART are now receiving a diagnosis of HIV-associated nephropathy.1
The rates of disease progression and death in the population of HIV-positive patients with chronic kidney disease can be modified by ART, which reduces the risk of advanced chronic kidney disease among patients with HIV-associated nephropathy by approximately 60%.2,3 It has been estimated that the prevalence of chronic kidney disease among HIV-infected patients receiving treatment is between 8% and 22%4-7; among untreated patients, it is estimated to be between 20% and 27%.8,9 Confronted with a high burden of HIV disease and limited resources, South Africa faces considerable challenges in providing renal-replacement therapy for the large numbers of HIV-infected persons in whom chronic kidney disease will develop during their lifetime.
Frequency of Anastomotic Leak in Early Versus Dealyed Oral Feeding after Elec...semualkaira
Intestinal stoma is usually performed as component of other surgical intervention for small and large bowel
pathologies. Of these temporary colostomy are commonest stomas
created for de-functioning of the distal anastomotic site to minimise the chances of leak. Colostomy is usually reversed at 8 to 12
weeks and Ileostomy closure is often considered a minor procedure but it is associated with significant morbidity and mortality
Frequency of Anastomotic Leak in Early Versus Dealyed Oral Feeding after Elec...semualkaira
Intestinal stoma is usually performed as component of other surgical intervention for small and large bowel
pathologies. Of these temporary colostomy are commonest stomas
created for de-functioning of the distal anastomotic site to minimise the chances of leak. Colostomy is usually reversed at 8 to 12
weeks and Ileostomy closure is often considered a minor procedure but it is associated with significant morbidity and mortality
Recurrent bacteriuria in pregnancy is common and a serious cause of maternal and perinatal morbidity and mortality.
Clinical presentations include asymptomatic bacteriuria, acute cystitis and pyelonephritis.
Prevalence of Urinary Tract Infection among Patients with Diabetes Melitus in...MCMScience
Background: & Objectives: Urinary tract infection is one of the most commonly occurring infections among the patients with diabetes mellitus.
Methods This investigation was based to evaluate the incidence of UTI in patients with DM. Between January, 2013 to November, 1000 diabetic urine samples were collected. All urine samples were processed in the lab following standard laboratory protocol.
Results: A total of 25 UTI organisms were isolated from 361 urine samples collected from the diabetic patients attending the Department of Emergency, University Hospital Center "Mother Theresa” (QSUT) from. The incidence of UTI was recorded to 36.1%. Escherichia coli (54%) was found to be the major cause of UTI. About 5 different types of organisms isolated from the UTI samples were randomly chosen to test against the UTI antibiotics.
Interpretation & Conclusion: The antibiotic susceptibility pattern revealed that ciprofloxacin and nitrofurantoin were most effective to e.coli 79.6%, and 89.4%. These data may be used to determine trends in antimicrobial susceptibilities, to formulate local antibiotic policies and to assist clinicians in the choice of antibiotic therapy to prevent misuse, or overuse of antibiotics.
Key Words: Diabetes mellitus (DM), Urinary Tract Infection (UTI), Bacteria, antimicrobial resistance
Erectile Dysfunction treatment in Hindi | Erectile dysfunction treatment with Linear Shockwave treatment | Erectile Dysfunction treatment new treatments
In this presentation we talk about the current management of male infertility in Delhi India.
Dr Vijayant Gupta is male infertility expert in new Delhi India
We talk about
1. Non obstructive azoospermia
2. Obstructive azoospermia
3. Oligospermia
http://drvijayantgovinda.com/male-infertility-treatment-in-delhi-male-infertility-specialist/
http://drvijayantgovinda.com/male-infertility-treatment-in-delhi-male-infertility-specialist/azoospermia-treatment-in-delhi-nil-sperm-count/
Premature Ejaculation Treatment in Delhi | Clinical Management of Premature E...Vijayant Govinda Gupta
This presentation discusses clinical case scenarios for management of premature ejaculation in Delhi India.
This slides contain
1. Definition of Premature Ejacualtion
2. Management Aids
3. Clinical algorithm
4. Novel treatment modalities
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
2. Source
• American Urological Association (AUA)
BEST PRACTICE POLICY STATEMENT ON ANTIMICROBIAL PROPHYLAXIS IN UROLOGICAL SURGERY
2008
• European Urological Association (EUA)
GUIDELINES ON UROLOGICAL INFECTIONS
2011
• Campbell Walsh Urology
10TH EDITION 2011
3. “Antimicrobial prophylaxis is the periprocedural
systemic administration of an antimicrobial
agent intended to reduce the risk of
postprocedural local and systemic infections”
6. Patient Factors (AUA)
• Advanced age
• Anatomic anomalies of the urinary tract
• Poor nutritional status
• Smoking
• Chronic corticosteroid use
• Immunodeficiency
• Externalized catheters
• Colonized endogenous/exogenous material
• Distant coexistent infection
• Prolonged hospitalization
Bacteria have a basic survival strategy: to
colonize surfaces and grow as biofilm
communities embedded in a gel-like
polysaccharide matrix. The catheterized
urinary tract provides ideal conditions for
the development of enormous biofilm
populations.
Bacterial colonization on intraluminal surface of urethral catheter
The catheters had been mainly placed to monitor urine output after
urologic surgery, and their median indwelling period was 3.0 days
(range 1 to 35). The overall positive rate of catheter culture was
significantly greater than that of urine culture (53.5% and 30.2%,
respectively, P <0.01), even in patients without a recent antibacterial
agent history. The difference was observed at day 2 (60% and 13.3%,
catheter versus urine culture, respectively, P = 0.011) and days 3 to 6
(52.4% and 14.3%, respectively, P = 0.010) of the indwelling period,
but was indistinguishable at day 14 and thereafter.
Masanori Matsukawa, Yasuharu Kunishima, Satoshi Takahashi, Kou Takeyama, Taiji Tsukamoto
Urology - March 2005
10. Tentative list of essential criteria for assessment of surgical wound class/surgical field contamination level of common urological procedures: The estimated risk of infectious complication is related to the
surgical class or category (Urogenital infections, EAU/ICUD,2010, p 674-75
TURB (minor,
fulguration)
11. Costs
• Financial Costs
• Convenience
• Safety
• Society Costs
1. Cost of medicine
2. Dosage
3. Mode of administration
4. Frequency of administration1. Route of administration
2. Dosage
3. Frequency
1. Side Effect profile
2. Allergic reactions
3. Safety in special conditions eg renal
failure
Bacterial Resistance
12. Timing
Start
Within 60 minutes
of incision
(AUA)
Oral: 60 minutes
prior
IV: Time of Induction
(EUA)
Maintain
If more than 2 half
lives elapsed –
repeat dose
Stop
Within 24 hours
until indicated
In case of vancomycin and
fluoroquinolones – can be
started upto 120 minutes
before incision
To be extended beyond 24
hours:
Foreign material – eg
penile prosthesis or
externalised stents or
catheterized
2. In case of documented
infection preoperatively
or post operatively when
it is treatment and not
prophylaxis
13. Oral Antibiotics
• Oral antibiotics are as effective as iv
antibiotics when they have sufficient bio
availability and are administered at least one
hour prior to surgery
• One of the unique aspects of urological
surgery is use of oral fluoroquinolones
14. The use of oral fluoroquinolines as a
prophylactic agent in urologic endoscopic
surgery is a special situation. This
antimicrobial regimen is rarely used for
prophylaxis outside of urologic surgery
Level I evidence
Christiano AP, Hollowell CM, Kim H, Kim J, Patel R, Bales GT et al: Double-blind
randomized comparison of single-dose ciprofloxacin versus intravenous cefazolin in patients
undergoing outpatient endourologic surgery. Urology 2000; 55 -182.
One hundred patients were enrolled in a double-blind, randomized study to
receive either ciprofloxacin (500 mg) or cefazolin (1 g) before surgery. A
postoperative clinical evaluation and urine cultures were performed 5 to 10
days after surgery. Patients undergoing ureteral stent insertion or exchange,
ureteroscopy, bladder biopsy, retrograde pyelography, collagen injection, and
internal urethrotomy were included.
RESULTS:
Postoperative urinary tract infection occurred in 7 (9.1%) of 77 patients,
including 3 (8.1%) of 37 and 4 (10.0%) of 40 of those who
received ciprofloxacin and cefazolin, respectively (P =
0.77). There were no episodes of sepsis, and no patient
with infection required hospitalization. The total cost
associated with the administration of prophylactic antibiotics in the study
population was $3657 less in those 50 patients who received ciprofloxacin
than in the 50 patients who received cefazolin.
15. Antimicrobial prophylaxis is only one
of several measures thought to
reduce SSI.
• Hand Washing
•Proper Technique
•Sterile Precautions
•Operative planning
•Preoperative patient
optimization
•Bowel preparation
16. Urethral Catheterization
The risk of infection after one-time
urethral catheterization is 1%
to 2% in healthy domiciliary women;
however, this risk rises significantly in
hospitalized patients (Turck et al,
1962; Thiel and Spuhler, 1965).
• Oral single dose of antibiotic indicated if risk
factors present (Campbell Walsh Urology).
• If documented infection by culture then full
course of therapy indicated (EUA).
17. Removal of External Urinary Catheter
The rate of bacteriuria in short term
catheterized patients is 5% to 10% for each
day the catheter is in place.
AUA recommends prophylactic antibiotics in
patients with risk factors
Prophylactic antibiotics can be empirical or
culture directed (then treatment)
No treatment if culture sterileNo antibiotics in asymptomatic patients on CIC
antimicrobial treatment
before removal of an
indwelling catheter in a
patient suspected of
having bacteriuria is not
considered prophylaxis
but rather is treatment for
a presumptive UTI
18. Post operative drainage (EUA)
• EUA recommends against prolongation of
antibiotics in cases of uncomplicated surgery
unless documented colonization or surgery
complicated by infection
• E.g. no prolonged antibiotics for indwelling
drains in cases of clean laparoscopic surgery.
19. UDS/CYSTOGRAPHY/SIMPLE
CYSTOSCOPY
• AUA is ambiguous
Antimicrobial prophylaxis for cystography,
urodynamic study, or simple cystourethroscopy is
probably not necessary if the urine culture shows
no growth
• EUA recommends against prophylaxis but for
patients with complex clinical features and
large post voids it recommends for prophylaxis
But both
recommend a single
oral dose of
antibiotic if
antibiotic indicated
20. Cystourethroscopy with manipulation
TURP/TURBT
Concurrent view is antibiotic
prophylaxis indicated in all
patients
Berry A and Barratt A: Prophylactic antimicrobial use in
transurethral prostatic resection: a meta-analysis. J Urol 2002;
167:571.
21. Transrectal Prostate Biopsy
Concurrent view is antibiotic
prophylaxis indicated in all
patients
In a three-armed RCT (231 patients) comparing placebo, a single dose of
ciprofloxacin and tinidazole, and the same combination twice a day for three
days, the incidence of all infectious complications, and specifically UTI was
significantly lower in both antimicrobial groups. Moreover, the single dose
was as effective as the three-day dosing.
Aron M, Rajeev TP and Gupta NP: Antimicrobial prophylaxis for transrectal
needle biopsy of the prostate: a randomized controlled study. BJU Int 2000;
85:682.)
22. ESWL
• AUA
“Revised recommendation to : Indicated if risk
factors – on 09/2/2012”
A recent prospective case-series of 526 shockwave lithotripsy patients, of
whom only 10 received antimicrobial prophylaxis, documented very
low rates of UTI (0.2%) and asymptomatic bacteriuria (0.8%).
Wiesenthal JD, Ghiculete D, Ordon M, Pace KT and John D'A Honey R: A Prospective Study Examining the Incidence
of Bacteriuria and Urinary Tract Infection PostShockwave Lithotripsy: The Case Against Universal Antibiotic
Prophylaxis. J Urol 2011; 185: e472.
But EUA also
recommends
antibiotics in cases of
indwelling stents/
PCN tubes/ Infected
Stones/ And
documented UTI
24. Ureteroscopy
• AUA recommends prophylaxis in all patients
• EUA differentiates:
– Recommends against for distal stone treatments
and simple diagnostic procedures
– Recommends for proximal stones and renal
interventions
25. Basis for AUA
• Diagnostic and therapeutic upper tract
studies are performed with pressurized
irrigants and may induce urothelial injury
• increased trauma to the mucosa, increased
duration and/or degree of difficulty of most
ureteroscopic procedures, increased pressure
of irrigants
27. Open or laparoscopic surgery without
entering urinary tract
prophylaxis indicated if risk factors
Radical
Nephrectomy is
also included in
this
Radical
Nephrectomy is a
clean surgery
Clean surgeries do not
require prophylaxis as
evidenced thoroughly
in general surgery
literature
EUA recommends
against prophylaxis on
this basis
28. Open or laparoscopic surgery with
entering urinary tract
Concurrent view is antibiotic
prophylaxis indicated in all
patients
29. Open or laparoscopic surgery with
use of bowel segments
Concurrent view is antibiotic
prophylaxis indicated in all
patients
30. Open or laparoscopic surgery with
implantable foreign material
Concurrent view is antibiotic
prophylaxis indicated in all
patients
