The Binding of Urinary Components and Uropathogens to a Silicone Latex Urethral Catheter

The adhesion of uropathogens to urethral catheters initiates the infectious process which causes morbidity in a large patient population. Catheters were examined by X-ray photoelectron spectroscopy after use in three patients and following incubation in vitro with human urine, urea and creatinine, and found to have adsorbed a conditioning film containing carbon, nitrogen and in some cases phosphorous, calcium and sodium containing components. The binding of three strains of uropathogenic bacteria to the catheter surface was significantly influenced by the suspending fluid composition

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 may help downregulate TNF-alpha, IL-6, IL-8, IL-10 and IL-12 (p70) in the neurogenic bladder of spinal cord injured patient with urinary tract infections: A two-case study

The ability of organisms to adhere to and form biofilms on fibrous materials is believed to be an important initiating step in the induction of several diseases, such as toxic shock syndrome. Using an in vitro assay, a moderately hydrophobic strain of Staphylococcus aureus (water contact angle 35°) and a hydrophilic Candida albicans (shown by a hexadecane test) were highly adherent to commercial diaper fibers. The lumen side of the diaper was porous and the fibers were very hydrophobic (\u3e140°), but the internal section was very hydrophilic (0°), presumably for adsorption purposes. There was evidence that adhesion of the pathogens was inhibited when one of five Lactobacillus strains was present. Surfaces precoated with lactobacilli inhibited staphylococcal adhesion by 26-97%, and candida by 0-67%. When the lactobacilli were used to challenge adherent pathogens, there was 99% displacement of the S. aureus and up to 91% displacement of C. albicans. Hydrophobic L. acidophilus 76 (54°) and T-13 (80°) were the most effective of five Lactobacillus isolates tested at interference by precoating. The moderately hydrophilic L. casei var rhamnosus GR-1 (33°) was the most effective at displacing the yeast. Experiments with uroepithelial cells also showed that the lactobacilli could significantly interfere with the adhesion of both pathogens to the cells. The results demonstrate the rapidity with which two pathogens adhered to fibers and epithelial cells, and raised the possibility that members of the normal female urogenital flora might interfere with infections caused by these organisms. © 1995 Society for Industrial Microbiology

Short Versus Long InterTAN Fixation for Geriatric Intertrochanteric Hip Fractures: A Multicentre Head-to-Head Comparison

Objective: To determine if geriatric intertrochanteric hip fracture patients achieve equivalent postoperative functional status after management with either a short (180-200 mm) or a long (260-460 mm) InterTAN intramedullary device. Design: Retrospective review of a prospective randomized control trial. Setting: Four Level I Trauma Centers. Patients/ Participants: One hundred eight patients with OTA/ AO classification 31A-1 and 31A-2 intertrochanteric hip fractures were included in the study. Intervention: Internal fixation using an IT device. Main Outcomes Measures: Primary outcomes included Functional Independence Measure and Timed Up and Go. Secondary outcomes included blood loss, surgical time, length of stay, adverse events, and mortality. Results: Seventy-one short and 37 long IT patients met study inclusion criteria. Demographics were similar between groups. There was no difference in Functional Independence Measure or Timed Up and Go scores between the 2 IT groups at any of the time points collected. Mean operative time was lower in the short IT group than in the long IT group (60 vs. 73 minutes; P = 0.021). A higher proportion of long IT patients had reamed constructs (95% vs. 48% short IT, P, 0.001). Postoperative blood loss was significantly higher in the long IT group without a significant influence on the number of patients requiring transfusion (P = 0.582) or average units transfused (P = 0.982). There was no significant difference in the proportion of postoperative adverse events between the 2 cohorts despite a higher number of peri-implant femur fractures in the short IT group than in the long IT group (5 vs. 1, P = 0.350). Conclusions: Postoperative functional status was not influenced by the length of IT device in the management of geriatric intertrochanteric hip fractures

Uropathogenic Escherichia coli adhere to urinary catheters without using fimbriae

Five well-characterized urinary and fecal isolates of Escherichia coli were found to be hydrophilic irrespective of their serotypes and their ability to express fimbriae. All the strains were able to adhere to silicone latex urinary catheters, although strain 917, which expressed type P fimbriae as its only adhesin, adhered poorly. Although specific adhesins, particularly fimbriae, have been shown to mediate adhesion of E. coli to uroepithelial cells, they do not mediate specific adhesion onto urinary catheter material. The overall surfaces of the strains, tested using microelectrophoresis as a function of pH and X-ray photoelectron spectroscopy, were not significantly different, thus suggesting more non-specific adhesion mechanisms to urinary catheters

Receptivity for probiotic products among premenopausal female students in an African university

As a follow up to our first study of 10 spinal cord injured patients, a further 8 patients were investigated over 2 months for biofilm formation on their bladder epithelial cells and for evidence that these uropathogens damage the host bladder. All the patients were found to be colonized with uropathogens, regardless of whether or not they were receiving antibiotics. Using vital staining, it was discovered that there was a significant reduction (33%) in bladder cell viability in the presence of bacterial biofilms compared to controls. This was not associated with cell turnover rates. In vitro tests showed a similar reduction in cell viability when uropathogens were incubated with bladder cells. In addition, white cell counts were significantly elevated in the patients’ urine, indicative of an infectious and/or inflamed state. There was no difference between symptomatic and asymptomatic patients in their mean bacterial adhesion counts. Patients were just as likely to be symptomatic as asymptomatic when on antibiotics. In summary, the presence of virulent organisms in the bladder does adversely affect the host, even when the patient has insignificant signs and symptoms of infection, thereby raising concerns over the decision not to treat the patient. Unless specific antibiotics are used which eradicate adherent biofilms from the bladder, the treatment of symptomatic patients will only impact upon the signs and symptoms in some patients, and not alter their susceptibility to reinfection. © 1993 International Medical Society of Paraplegia