- Email: [email protected]
Randomized Study of Sterile Versus Non-Sterile Urethral Catheterisation
URINARY TRACT INFECTION
visit. Approaches that do not include an office visit but incorporate a patient pertormed diagnostic test would be more accurate and less costly. Anthony J. Schaeffer, M.D. Urinary Tract Infection in Pregnancy A. B. IMAcLE~,University Department Medicine, London, United Kingdom Brit. J. Urol., 80 10-13, 1997
of
Obstetrics and Gynaecology, Royal Free Hospital School of
No Abstract Editorial Comment: Urinalysis and culture are generally recommended as an initial 8c-n for asymptomatic bacteriuria during pregnancy. Since pyelonephritis o c c w in about 2 W of patients with asymptomatic bacteriuria, the majority in whom pyelonephritis develops have a negative culture initially. The author suggests that if the prevalence of asymptomatic bacteriuria is low, that is the patient population has not previously had a urinary tract infection, and there are no risk factors for infection, it may be more cost-effectivenot to analyze the midstream urine specimen for each first visit patient. The patient may be given an information sheet advising them to present for urine culture and treatment if during the pregnancy chills, fever and other signs of pyelonephritis or urinary tract infection develop. This approach may prove untenable in a more litigious environment, such as the United States. The cost of urinalysis or culture is low in the context of the cost of a pregnancy, and I would favor at least 1 screening urine culture early in the pregnancy. If this test is negative, no further studies need to be performed. If the test is positive, the patient should be treated for bacteriuria and followed for recurrence. Anthony J. Schaeffer, M.D. Randomised Study of Sterile Versus Non-Sterile Urethral Catheterisation
E. A. CARAPETI, S. M. h m w s AND P. G. BENTLEY, Kent and Sussex Hospital, Tunbridge Wells, Kent, United Kingdom Ann. Roy. Coll. Surg. Engl., 76 59-60, 1994 Indwelling urethral catheters are the most common cause of urinary tract infections (UTI), yet there is no direct evidence that technique of catheter insertion affects this. In a prospective study, 156 patients underwent preoperative urethral catheterisation, randomly allocated to “sterile’ or “cleadnon-sterile’ technique groups. There was no statistical difference between the two groups with respect to the incidence of UTI. There was a considerable cost difference between the two groups, the ‘sterile’ method being over twice as expensive as the ”clean’ method. Strict sterility is not necessary in preoperative short-term urethral catheterisation and is more expensive and time consuming. Editorial Comment: Urologists recognize the importance of a careful clean technique of inserting a urethral catheter. These authors questioned whether the use of the sterile technique, including a sterile gown and catheter pack, would reduce the incidence of postcatheterization infection. In the control group no gowns, nonsterile gloves and cleansing with tap water were used. No difference was noted in the incidence of infection between the 2 groups 3 days after catheterization. There was a considerable difference in cost between the 2 techniques. The sterile technique cost more than twice as much as the clean nonsterile technique. The sterile gown was the mGor cost. In my opinion, sterile gloves and preparation with antiseptic should be used. Sterile gowns do not seem to be warranted. Anthony J. Schaeffer, M.D. Imaging and Radiologic Management of Upper Urinary Tract Infections D. A, BAWGARTEN AND B. R. BAUMGARTNER, Department of Radiology, Division of Abdominal Imaging, Emory University School of Medicine, Atlanta, Georgia Urol. Clin. N. Amer., 24: 545-569, 1997 No Abstract
Editorial comment: Imaging of the upper urinary tract is advised for patients with febrile urinary tract infections who do not respond promptly to treatment or have co-morbidities,such as diabetes meutus, that can accentuate the infectious process. This article nicely illustrates that computerized tomography is the study of choice for diagnostic evaluation and can direct percutaneous intervention. Antimicrobial therapy plus percutaneous drainage may be used to stabilize patients before a definitive surgical procedure or may even eliminate the need for surgical intervention. Anthony J. Schaeffer, M.D.
1419
visit. Approaches that do not include an office visit but incorporate a patient pertormed diagnostic test would be more accurate and less costly. Anthony J. Schaeffer, M.D. Urinary Tract Infection in Pregnancy A. B. IMAcLE~,University Department Medicine, London, United Kingdom Brit. J. Urol., 80 10-13, 1997
of
Obstetrics and Gynaecology, Royal Free Hospital School of
No Abstract Editorial Comment: Urinalysis and culture are generally recommended as an initial 8c-n for asymptomatic bacteriuria during pregnancy. Since pyelonephritis o c c w in about 2 W of patients with asymptomatic bacteriuria, the majority in whom pyelonephritis develops have a negative culture initially. The author suggests that if the prevalence of asymptomatic bacteriuria is low, that is the patient population has not previously had a urinary tract infection, and there are no risk factors for infection, it may be more cost-effectivenot to analyze the midstream urine specimen for each first visit patient. The patient may be given an information sheet advising them to present for urine culture and treatment if during the pregnancy chills, fever and other signs of pyelonephritis or urinary tract infection develop. This approach may prove untenable in a more litigious environment, such as the United States. The cost of urinalysis or culture is low in the context of the cost of a pregnancy, and I would favor at least 1 screening urine culture early in the pregnancy. If this test is negative, no further studies need to be performed. If the test is positive, the patient should be treated for bacteriuria and followed for recurrence. Anthony J. Schaeffer, M.D. Randomised Study of Sterile Versus Non-Sterile Urethral Catheterisation
E. A. CARAPETI, S. M. h m w s AND P. G. BENTLEY, Kent and Sussex Hospital, Tunbridge Wells, Kent, United Kingdom Ann. Roy. Coll. Surg. Engl., 76 59-60, 1994 Indwelling urethral catheters are the most common cause of urinary tract infections (UTI), yet there is no direct evidence that technique of catheter insertion affects this. In a prospective study, 156 patients underwent preoperative urethral catheterisation, randomly allocated to “sterile’ or “cleadnon-sterile’ technique groups. There was no statistical difference between the two groups with respect to the incidence of UTI. There was a considerable cost difference between the two groups, the ‘sterile’ method being over twice as expensive as the ”clean’ method. Strict sterility is not necessary in preoperative short-term urethral catheterisation and is more expensive and time consuming. Editorial Comment: Urologists recognize the importance of a careful clean technique of inserting a urethral catheter. These authors questioned whether the use of the sterile technique, including a sterile gown and catheter pack, would reduce the incidence of postcatheterization infection. In the control group no gowns, nonsterile gloves and cleansing with tap water were used. No difference was noted in the incidence of infection between the 2 groups 3 days after catheterization. There was a considerable difference in cost between the 2 techniques. The sterile technique cost more than twice as much as the clean nonsterile technique. The sterile gown was the mGor cost. In my opinion, sterile gloves and preparation with antiseptic should be used. Sterile gowns do not seem to be warranted. Anthony J. Schaeffer, M.D. Imaging and Radiologic Management of Upper Urinary Tract Infections D. A, BAWGARTEN AND B. R. BAUMGARTNER, Department of Radiology, Division of Abdominal Imaging, Emory University School of Medicine, Atlanta, Georgia Urol. Clin. N. Amer., 24: 545-569, 1997 No Abstract
Editorial comment: Imaging of the upper urinary tract is advised for patients with febrile urinary tract infections who do not respond promptly to treatment or have co-morbidities,such as diabetes meutus, that can accentuate the infectious process. This article nicely illustrates that computerized tomography is the study of choice for diagnostic evaluation and can direct percutaneous intervention. Antimicrobial therapy plus percutaneous drainage may be used to stabilize patients before a definitive surgical procedure or may even eliminate the need for surgical intervention. Anthony J. Schaeffer, M.D.
1419