Retrospektive Untersuchung der lokalen Antibiotika-Resistenzsituation von stationär behandelten Prostatitiden, Epididymitiden und Pyelonephritiden: Keimnachweis- und Resistenzraten und deren klinische Konsequenz

Hintergrund: Zunehmende Antibiotika-Resistenzen lassen eine bedenkenlosen Übernahme der Therapieempfehlungen aus Leitlinien nicht mehr zu. Vielmehr sind insbesondere größere Kliniken dazu aufgefordert, die jeweilige antibiotische Therapie dem lokalen Resistenzniveau anzupassen. Ziel der vorliegenden Arbeit war die retrospektive Erfassung der lokalen Resistenzsituation bei Pyelonephritis, Epididymitis und bakterieller Prostatitis anhand des eigenen Patientenguts. Methoden: Es wurden sämtliche Antibiogramme von Urinkulturen von 226 Patienten in die retrospektive Untersuchung aufgenommen, die in den Jahren 2012 und 2013 im Caritas-Krankenhaus St.Josef in Regensburg stationär aufgrund der oben genannten Krankheitsbilder behandelt wurden. Die Erkrankungen schlüsseln sich dabei wie folgt auf: Es wurden insgesamt 35 Patienten mit Prostatitis (Alter 31-96, Median bei 61 Jahre), 74 mit Epididymitis (Alter 16-90, Median 59 Jahre) sowie 119 Patientinnen und Patienten (Alter 16-96, Median 45 Jahre) mit Pyelonephritis stationär behandelt (100 Frauen vs. 19 Männer/84 vs. 16%). Ergebnisse: Ein Keimnachweis gelang in 117 von 226 Fällen (51,8%). In 58,5% zeigte sich ein Escherichia coli, gefolgt mit deutlichem Abstand von Enterokokkus faecalis mit 8,2% und Klebsiella pneumoniae mit 4,4%. Es zeigte sich eine gesamt-Sensibilitätsrat von Ciprofloxacin von 69,6%, von Levofloxacin 72,6%, Ceftriaxon 63%, Cefotaxim 72,6%, Piperacillin/Tazobactam 83%, Meropenem 86,7%, Imipenem 94,1. Es ergaben sich keine relevanten Änderungen der Resistenzsituation zwischen 2012 und 2013. Die genannten Erkrankungsbilder unterschieden sich nicht wesentlich hinsichtlich der Resistenzraten. Interpretation: Die Keimnachweisrate sollte optimiert werden, z.B. mittels konsequenter Gewinnung von Mittelstrahl- oder Katheterurin. Auf Basis der vorliegenden Untersuchung scheint Piperacillin/Tazobactam die optimale empirische Therapie der Wahl für die genannten Erkrankungen darzustellen. ABS-Maßnhamen bieten Möglichkeiten Diagnostik und Therapie zu verbessern

Geriatric Patients and Symptomatic Urinary Tract Infections: Analysis of Bacterial Range and Resistance Rates at a 3rd Level of Care Hospital in Germany

Background: Increasing life expectancy and demographic change result in a rising number of geriatric patients, but knowledge about geriatric treatment options and adapted diagnostic pathways is low. Simultaneously, urinary tract infections (UTIs) are common in older people and often difficult to treat. Methods: Patients with a UTI at a urological outpatient department between January 01, 2016, and December 31, 2017, were retrospectively identified in the data system. One thousand one hundred fifteen patients with “N30” and “N39” diagnosis were included in this study, 965 of which were under the age of 75 (group 1) and 150 of which 75 years or older (group 2). Results: Of 150 patients in group 2, 41.6% had nitrite-positive urine (vs. 20.9% in group 1, p < 0.05 in χ2 testing). Patients in group 2 often had indwelling devices (30.3 vs. 6.0%, p < 0.05) and presented a sterile urine culture in only 20.7% (vs. 40.1% in group 1). Regarding calculated antibiotic therapy, there were significant differences concerning prescription of ciprofloxacin (34.9 vs. 25%, p < 0.05) and fosfomycin (12.7 vs. 40.7%, p < 0.05). Conclusion: UTI in geriatric patients should be treated differently than in younger patients because antibiotic resistance is high. The group with indwelling devices is complex. Individual strategies for geriatric patients should be considered

Influence of Gender and Age on the Willingness to Reduce Nicotine Consumption—Results of a Survey in Urological Cancer Patients (KRAUT Study)

Although it is well-known that smoking can cause lung cancer, the relationship between smoking and urologic cancers seems not as obvious and awareness is not widespread in the general population. For the KRAUT (knowledge of the relation between smoking and urological tumors among patients with a urological tumor disease) study, 258 patients with the diagnosis of urological cancer were interviewed using a questionnaire. Most (72.1%) stated that they never had a conversation regarding this topic with any doctor. Educational work in this field should be intensified to reduce the development and progression of urologic cancer. Purpose: Our objective was to investigate whether patients with urologic tumors were aware of smoking as a risk factor for the development and progression of several urologic cancers and the extent of the medical education they had received. Another aim was to investigate whether gender or age influenced patients' willingness to change their smoking habits. Materials and Methods: Patients with histologically malignant urologic tumors were enrolled in our questionnaire-based study from September 2013 to December 2014 in 2 urology departments. Patients were asked about their smoking habits and their general understanding of the relationship between smoking and the onset of cancer (urologic cancer and lung cancer). Also, the extent of information they had acquired from a physician was assessed. The descriptive and oncologic data of the patients were recorded. Results: Of 258 enrolled patients, 186 (72.1%) had never had an informational discussion with a doctor about smoking and their urologic tumor disease. Of the 160 active and former smokers, only 45 (28.1%) were planning to stop or reduce smoking because of their tumor disease. The willingness to change smoking habits was greater for women, with a statistically significant difference (odds ratio, 5.59; P = .002). Younger patients aged <58 years were also more willing to reduce or stop smoking. Conclusion: In our study, most patients with urologic cancer were unaware of smoking as the most probable cause of tumor development. The patients had not received proper counseling from doctors on smoking and the risk it poses for tumor progression. Efforts to balance compliance among the genders and age groups through risk-adapted counseling should be undertaken. (C) 2018 Elsevier Inc. All rights reserved

Increased Severe Adverse Outcomes and Decreased Emergency Room Visits for Pyelonephritis: First Report of Collateral Damage during COVID-19 Pandemic in Urology

Purpose: The coronavirus disease 2019 (COVID-19) pandemic is disrupting urology health-care worldwide. Reduced emergency room visits resulting in adverse outcomes have most recently been reported in pediatrics and cardiology. We aimed to compare patients with emergency room visits for pyelonephritis in 2019 (pre-COVID-19 era) and within the first wave of pandemic in 2020 (COVID-19 era) with regard to the number of visits and severe adverse disease outcomes. Methods: We performed a retrospective multicentre study comparing characteristics and outcomes of patients with pyelonephritis, excluding patients with hydronephrosis due to stone disease, in 10 urology departments in Germany during a 1-month time frame in March and April in each 2019 and 2020. Results: The number of emergency room visits for pyelonephritis in the COVID-19 era was lower (44 patients, 37.0%) than in the pre-COVID-19 era (76 patients, 63.0%), reduction rate: 42.1% (p = 0.003). Severe adverse disease outcome was more frequent in the COVID-19 era (9/44 patients, 20.5%) than in the pre-COVID-19 era (5/76 patients, 6.6%, p = 0.046). In detail, 7 versus 3 patients needed monitoring (15.9 vs. 3.9%), 2 versus no patients needed intensive-care treatment (4.5 vs. 0%), 2 versus no patients needed drain placement (4.5 vs. 0%), 2 versus no patients had a nephrectomy (4.5 vs. 0%), and 2 versus 1 patient died (4.5 vs. 1.3%). Conclusion: This report of collateral damage during CO-VID-19 showed that emergency room visits were decreased, and severe adverse disease outcomes were increased for patients with pyelonephritis in the COVID-19 era. Health authorities should set up information campaign programs actively encouraging patients to utilize emergency room services in case of severe symptoms specifically during the actual second wave of pandemic. (c) 2021 S. Karger AG, Base

Impact of E-Cadherin and β-Catenin as Prognostic Factor in Renal Cell Carcinoma with Tumor Thrombus of the Vena Cava

Purpose: Renal cell carcinoma (RCC) forming tumor thrombus (TT) of vena cava (VC) is characterized by poor prognosis. Nevertheless, the outcome of patients after radical surgery varies. To date only limited data concerning prognostic biomarkers in this RCC subgroup are available. Methods: Out of 159 patients with pT3b/c RCC, 95 patients without synchronous distant metastases at time of diagnosis were included in the study cohort. After immunohistochemical (IHC) evaluation of E-cadherin and beta-Catenin expression, association with clinical, histopathological and survival was assessed by univariate analysis, multivariate analysis, and Kaplan-Meier-analysis. Cancer-specific survival (CSS) rates and overall survival (OS) rates were estimated using Kaplan-Meier analysis and compared using Log rank test. Results: We found a significant correlation between E-cadherin overexpression and initial lymph node metastasis (rho = 0.300, p = 0.003), positive surgical margins (rho = 0.210, p = 0.043), and the development of distant metastases (rho = 0.258, p = 0.012). Furthermore, we observed a significant correlation of beta-Catenin overexpression with higher tumor stage pT3c (rho = 0.230, p = 0.028) and initial lymph node metastases (rho = 0.236, p = 0.025). Survival analysis revealed a statistically significant association of both E-cadherin and beta-Catenin overexpression with worse CSS (p < 0.001 and p = 0.007, respectively) and OS (p < 0.001 and p = 0.041, respectively). Multivariate analysis revealed initial lymph node metastasis as the only predictive factor for worse OS (HR 4.54, 95% CI 2.30-8.93; p < 0.001). E-Cadherin and beta-Catenin expression failed to be significant in multivariable analysis for OS and CSS. Conclusions: In a large series of RCC with TT of VC high IHC expression of E-cadherin and beta-Catenin was associated with initial lymph node metastasis and with both worse OS and worse CSS. This might help to identify patients at risk for recurrence who might benefit from adjuvant therapy or stricter follow-up. (c) 2019 S. Karger AG, Base

Increased severe adverse outcomes and decreased emergency room visits for pyelonephritis

$\bf Purpose:$ The coronavirus disease 2019 (COVID-19) pandemic is disrupting urology health-care worldwide. Reduced emergency room visits resulting in adverse outcomes have most recently been reported in pediatrics and cardiology. We aimed to compare patients with emergency room visits for pyelonephritis in 2019 (pre-COVID-19 era) and within the first wave of pandemic in 2020 (COVID-19 era) with regard to the number of visits and severe adverse disease outcomes. $\bf Methods:$ We performed a retrospective multicentre study comparing characteristics and outcomes of patients with pyelonephritis, excluding patients with hydronephrosis due to stone disease, in 10 urology departments in Germany during a 1-month time frame in March and April in each 2019 and 2020. $\bf Results:$ The number of emergency room visits for pyelonephritis in the COVID-19 era was lower (44 patients, 37.0%) than in the pre-COVID-19 era (76 patients, 63.0%), reduction rate: 42.1% ($\it p$ = 0.003). Severe adverse disease outcome was more frequent in the COVID-19 era (9/44 patients, 20.5%) than in the pre-COVID-19 era (5/76 patients, 6.6%, $\it p$ = 0.046). In detail, 7 versus 3 patients needed monitoring (15.9 vs. 3.9%), 2 versus no patients needed intensive-care treatment (4.5 vs. 0%), 2 versus no patients needed drain placement (4.5 vs. 0%), 2 versus no patients had a nephrectomy (4.5 vs. 0%), and 2 versus 1 patient died (4.5 vs. 1.3%). $\bf Conclusion:$ This report of collateral damage during CO­VID-19 showed that emergency room visits were decreased, and severe adverse disease outcomes were increased for patients with pyelonephritis in the COVID-19 era. Health authorities should set up information campaign programs actively encouraging patients to utilize emergency room services in case of severe symptoms specifically during the actual second wave of pandemic