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UP-01.012 Sonication of Suprapubic Catheters: Frequency and Characteristics of Colonizing Bacterial Biofilms
UNMODERATED POSTER SESSIONS
(1.2% endoscopic / 4.8% retroperitoneal / transperitoneal 7%) compared to 4.5% (0.73% / 1.25% / 2.52%) in the control group (p ⫽ 0.003). Major complications that increased ICU addmitance or hospitalization time occurred in 23.24% of cases, respectively 5.03% (p ⫽ 0.002). Hemoglobin ⬍8 g/dL, hemodialysis in immediate p.o. are independent negative prognostic factors. MELD score ⬎14 and a Child score C were found to be major risk factors in open surgery. Conclusions: The presence of liver cirrhosis is not a major contraindication in urologic surgery. The necessity of hemodialysis in immediate postoperative (⬍48h) and plasma hemoglobin levels lower than 8 g/dL were found to be independent predictors of poor outcome. Endoscopic interventions appear to have the smallest impact on imparing the liver function in patients with cirrhosis with Child A or MELD score ⬍10. UP-01.012 Sonication of Suprapubic Catheters: Frequency and Characteristics of Colonizing Bacterial Biofilms: Bonkat G1, Rieken M1, Priller J1, Rentsch C1, Ebinger-Mundorff N1, Wyler S1, Gasser T1, Frei R2, Widmer A3, Bachmann A1 1 Dept. of Urology; 2Clinical Microbiology Laboratory; 3Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland Introduction and Objective: Catheter associated urinary tract infection (CAUTI) is the most common type of nosocomial infection and comprises a large reservoir of multiresistent pathogens. Suprapubic catheters (SC) are used to minimize the risk of CAUTI. However, like other medical devices SC are frequently covered by a biofilm containing multiple pathogens. The exact spectrum of microbial suprapubic catheter colonization (MSCC) is unknown. The aim of this prospective sonication study was: (i) to assess the frequency of MSCC, (ii) to identify the responsible pathogens and (iii) to characterize the microbial diversity of MSCC. Materials and Methods: A total of 177 suprapubic catheters from 102 patients were enrolled. Median indwelling time was 47 days (range 1-417 days). After removal under aseptic conditions the catheters were placed in sterile tubes and transported immediately to the microbiology laboratory. Sonication was performed in an ultrasound bath to dislodge adherent
S188
bacteria. The resulting sonicate-fluid was cultured and microorganisms identified. Microbial growth of ⱖ 102 colony forming units per ml was defined as significant catheter colonisation. Results: Sonicate-fluid culture (SFC) resulted in a high detection rate of significant MSCC (96.6%). SFC was able to identify a total of 422 microorganisms; i.e., on average 2.5 microorganisms per colonised catheter. Fifty-four percent were gramnegative while 43% were gram-positive and 3% fungi, respectively. SFC observed single microbial growth in 13.6% and multiple growths in 84.4%. Enterobacteriaceae were most commonly isolated (38.2%), followed by Enterococcus spp. (22.5%) and Pseudomonas aeruginosa (8.5%). Escherichia coli (51.6%), Klebsiella pneumoniae (14.9%) and Proteus spp. (11.2%) were the most frequent detected pathogens within the group of Enterobacteriaceae. Conclusions: Microbial suprapubic catheter colonisation (MSCC) is common. Technical innovations to prevent MSCC associated UTI are most likely to be effective if they are based on a solid understanding of the pathogens involved. Therefore the detailed findings of our sonication study may be helpful to improve (i) the development of new biomaterials that reduce biofilm formation, (ii) the addition or impregnation of antimicrobial agents on catheter materials and (iii) the use of probiotics to delay or prevent MSCC and associated complications.
UP-01.013 On Functional Vesical Disturbances After Toxicants Haerlin U1,2,3, Neu E1,3, Hofstetter A2, Welscher U1, Seidenbusch W1,3, Michailov M1 1 Inst. Umweltmedizin C/o ICSD E.V. & Univ. Erl. Nuernberg, Germany; 2Faculy of Medicine, Univ. Munich, Munich, Germany; 3Faculy of Mathematics Inform., Physics, Inst. Exp.Physics, University of Innsbruck, Innsbruck, Austria Introduction and Objective: Urinary bladder has a central position in male/ female genito-urology: Vesical pathophysiological reactions can cause disturbances via functional interdependency of organs leading to incontinence, overactive bladder, etc.— disposition for inflammatory (cystitis, pyelonephritis), oncological diseases (incl. radiocystitis), nephrolithiasis. Materials and Methods: Spontaneous phasic fast detrusor (SPC:3.84⫾0.95/min,
n⫽61) and tonic slow trigone (STC: 0.13⫾0.55/min, n⫽26) contractions, also to neurogenic (TTX-blockade) detrusor electrical-stimulation (CES:10 &100Hz, 0.3ms/3s/3min) of isolated guinea-pig vesical preparations (McEwen-solution, 37°C) were isotonically recorded. Toxicant-effects of cypermethrin (CYP), pentachlorophenol (PCP) (stock-solution 10mM in 100% ethanol), mercury (HgCl2) were investigated [Härlin, Neu, Hofstetter et al.: Basic&Clin. Pharm.&Tox. 107:320-2010; Neu et al.: Urol. 68/5A:78/79-2006; Chin.J. Pathophysiol. 22/13(Suppl.):2282006; Tox.&Appl.Pharm. 197:297-2004]. Results: CYP/PCP induced strong semireversible inhibition - negative chrono-/ inotropic effects on detrusor-SPC and -CES-decrease, e.g. recovery for CES-10Hz for CYP-100M only to 75.3⫾27.3% and for PCP-100M 49.4⫾8.8% after washing out; weak ethanol-effect (0.1-1.0%) was completely reversible - 103.3⫾21.2% (table, n⫽168). Further observations (together with D.Hüting, J.Milbradt, J.Stiglmayr, M.Wirth): CYP (10-100M) had strong negative chronotropic effect on trigone – STC-frequency decreased up to 50% without changes in contractile-amplitudes. Contrary to this mercury (10M) had positive chrono-/inotropic effects: SPC-/STC-frequency&litudes, also detrusor-CES-amplitudes increased (n⫽51). Conclusions: Recent and earlier investigations demonstrate evidently various (incl. irreversible) kinds of pathophysiological motor reactions of vesical preparations to toxicants (pyrethroids/chlorophenols/Hg). Prophylaxis/therapy acc. to medical moral-philosophy needs support of further systematic investigations, not only on isolated preparations, but also on organs, e.g. cystotonometry in toto et in vitro, also in vivo (clinical relevancy) as well as on isolated human surgical tissue and observations on patients (human relevancy). Regular application of vesical (also other urogenital) preparations as indicators for pathophysiological reactions could help for prophylaxis and counteract increased human exposition to toxicants, i.e. support UNO-Agenda21 for better health, ecology, etc. in all countries.
UP-01.014 Effect of Testosterone Ablation on Cardiac Muscle Electrophysiology: A New Insight to Side Effects Caused by Castration Ayaz M1, Kulaksizoglu H2 1 Dept. of Biophysics; 2Dept. of Urology, Selcuk University Selcuklu Medical Faculty, Konya, Turkey
UROLOGY 78 (Supplement 3A), September 2011
(1.2% endoscopic / 4.8% retroperitoneal / transperitoneal 7%) compared to 4.5% (0.73% / 1.25% / 2.52%) in the control group (p ⫽ 0.003). Major complications that increased ICU addmitance or hospitalization time occurred in 23.24% of cases, respectively 5.03% (p ⫽ 0.002). Hemoglobin ⬍8 g/dL, hemodialysis in immediate p.o. are independent negative prognostic factors. MELD score ⬎14 and a Child score C were found to be major risk factors in open surgery. Conclusions: The presence of liver cirrhosis is not a major contraindication in urologic surgery. The necessity of hemodialysis in immediate postoperative (⬍48h) and plasma hemoglobin levels lower than 8 g/dL were found to be independent predictors of poor outcome. Endoscopic interventions appear to have the smallest impact on imparing the liver function in patients with cirrhosis with Child A or MELD score ⬍10. UP-01.012 Sonication of Suprapubic Catheters: Frequency and Characteristics of Colonizing Bacterial Biofilms: Bonkat G1, Rieken M1, Priller J1, Rentsch C1, Ebinger-Mundorff N1, Wyler S1, Gasser T1, Frei R2, Widmer A3, Bachmann A1 1 Dept. of Urology; 2Clinical Microbiology Laboratory; 3Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland Introduction and Objective: Catheter associated urinary tract infection (CAUTI) is the most common type of nosocomial infection and comprises a large reservoir of multiresistent pathogens. Suprapubic catheters (SC) are used to minimize the risk of CAUTI. However, like other medical devices SC are frequently covered by a biofilm containing multiple pathogens. The exact spectrum of microbial suprapubic catheter colonization (MSCC) is unknown. The aim of this prospective sonication study was: (i) to assess the frequency of MSCC, (ii) to identify the responsible pathogens and (iii) to characterize the microbial diversity of MSCC. Materials and Methods: A total of 177 suprapubic catheters from 102 patients were enrolled. Median indwelling time was 47 days (range 1-417 days). After removal under aseptic conditions the catheters were placed in sterile tubes and transported immediately to the microbiology laboratory. Sonication was performed in an ultrasound bath to dislodge adherent
S188
bacteria. The resulting sonicate-fluid was cultured and microorganisms identified. Microbial growth of ⱖ 102 colony forming units per ml was defined as significant catheter colonisation. Results: Sonicate-fluid culture (SFC) resulted in a high detection rate of significant MSCC (96.6%). SFC was able to identify a total of 422 microorganisms; i.e., on average 2.5 microorganisms per colonised catheter. Fifty-four percent were gramnegative while 43% were gram-positive and 3% fungi, respectively. SFC observed single microbial growth in 13.6% and multiple growths in 84.4%. Enterobacteriaceae were most commonly isolated (38.2%), followed by Enterococcus spp. (22.5%) and Pseudomonas aeruginosa (8.5%). Escherichia coli (51.6%), Klebsiella pneumoniae (14.9%) and Proteus spp. (11.2%) were the most frequent detected pathogens within the group of Enterobacteriaceae. Conclusions: Microbial suprapubic catheter colonisation (MSCC) is common. Technical innovations to prevent MSCC associated UTI are most likely to be effective if they are based on a solid understanding of the pathogens involved. Therefore the detailed findings of our sonication study may be helpful to improve (i) the development of new biomaterials that reduce biofilm formation, (ii) the addition or impregnation of antimicrobial agents on catheter materials and (iii) the use of probiotics to delay or prevent MSCC and associated complications.
UP-01.013 On Functional Vesical Disturbances After Toxicants Haerlin U1,2,3, Neu E1,3, Hofstetter A2, Welscher U1, Seidenbusch W1,3, Michailov M1 1 Inst. Umweltmedizin C/o ICSD E.V. & Univ. Erl. Nuernberg, Germany; 2Faculy of Medicine, Univ. Munich, Munich, Germany; 3Faculy of Mathematics Inform., Physics, Inst. Exp.Physics, University of Innsbruck, Innsbruck, Austria Introduction and Objective: Urinary bladder has a central position in male/ female genito-urology: Vesical pathophysiological reactions can cause disturbances via functional interdependency of organs leading to incontinence, overactive bladder, etc.— disposition for inflammatory (cystitis, pyelonephritis), oncological diseases (incl. radiocystitis), nephrolithiasis. Materials and Methods: Spontaneous phasic fast detrusor (SPC:3.84⫾0.95/min,
n⫽61) and tonic slow trigone (STC: 0.13⫾0.55/min, n⫽26) contractions, also to neurogenic (TTX-blockade) detrusor electrical-stimulation (CES:10 &100Hz, 0.3ms/3s/3min) of isolated guinea-pig vesical preparations (McEwen-solution, 37°C) were isotonically recorded. Toxicant-effects of cypermethrin (CYP), pentachlorophenol (PCP) (stock-solution 10mM in 100% ethanol), mercury (HgCl2) were investigated [Härlin, Neu, Hofstetter et al.: Basic&Clin. Pharm.&Tox. 107:320-2010; Neu et al.: Urol. 68/5A:78/79-2006; Chin.J. Pathophysiol. 22/13(Suppl.):2282006; Tox.&Appl.Pharm. 197:297-2004]. Results: CYP/PCP induced strong semireversible inhibition - negative chrono-/ inotropic effects on detrusor-SPC and -CES-decrease, e.g. recovery for CES-10Hz for CYP-100M only to 75.3⫾27.3% and for PCP-100M 49.4⫾8.8% after washing out; weak ethanol-effect (0.1-1.0%) was completely reversible - 103.3⫾21.2% (table, n⫽168). Further observations (together with D.Hüting, J.Milbradt, J.Stiglmayr, M.Wirth): CYP (10-100M) had strong negative chronotropic effect on trigone – STC-frequency decreased up to 50% without changes in contractile-amplitudes. Contrary to this mercury (10M) had positive chrono-/inotropic effects: SPC-/STC-frequency&litudes, also detrusor-CES-amplitudes increased (n⫽51). Conclusions: Recent and earlier investigations demonstrate evidently various (incl. irreversible) kinds of pathophysiological motor reactions of vesical preparations to toxicants (pyrethroids/chlorophenols/Hg). Prophylaxis/therapy acc. to medical moral-philosophy needs support of further systematic investigations, not only on isolated preparations, but also on organs, e.g. cystotonometry in toto et in vitro, also in vivo (clinical relevancy) as well as on isolated human surgical tissue and observations on patients (human relevancy). Regular application of vesical (also other urogenital) preparations as indicators for pathophysiological reactions could help for prophylaxis and counteract increased human exposition to toxicants, i.e. support UNO-Agenda21 for better health, ecology, etc. in all countries.
UP-01.014 Effect of Testosterone Ablation on Cardiac Muscle Electrophysiology: A New Insight to Side Effects Caused by Castration Ayaz M1, Kulaksizoglu H2 1 Dept. of Biophysics; 2Dept. of Urology, Selcuk University Selcuklu Medical Faculty, Konya, Turkey
UROLOGY 78 (Supplement 3A), September 2011