x

¿Aún no está registrado?

Cree su cuenta. Regístrese en Elsevier y obtendrá: información relevante, máxima actualización y promociones exclusivas.

Registrarme ahora
Ayuda - - Regístrese - Teléfono 902 888 740
Buscar en

FI 2015

0,964
© Thomson Reuters, Journal Citation Reports, 2015

Indexada en:

Science Citation Index Expanded, Journal of Citation Reports, Index Medicus/MEDLINE, Scopus, EMBASE/Excerpta Medica, IBECS

Métricas

  • Factor de Impacto: 0,964(2015)
  • 5-años Factor de Impacto: 0,947
  • SCImago Journal Rank (SJR):0,34
  • Source Normalized Impact per Paper (SNIP):0,612
doi: 10.1016/S0210-4806(07)73719-1
Características epidemiológicas, clínicas y microbiológicas de las infecciones nosocomiales urinarias en las lesiones medulares espinales
Epidemiologic, clinical and microbiological characteristics of nosocomial urinary infection in the spinal cord lesioned patient
E. Hernández González,1, , F. Zamora Pérez, M. Martínez Arroyo**, M. Valdez Fernández, E. Alberti Amador
* Centro Internacional de Restauración Neurológica,
** Departamento de Microbiología. Centro de Investigaciones Médico-Quirúrgicas. Habana, Cuba
Recibido 01 septiembre 2006, Aceptado 01 mayo 2007
Resumen

Las infecciones urinarias constituyen una de las más importantes causas de infecciones intrahospitalarias. En la clínica de atención a pacientes lesionados medulares espinales (LME) observamos que las mismas alcanzan una alta incidencia como consecuencia de múltiples factores de riesgo asociados con la vejiga neurogénica como son: reflujo vésico-ureteral, litiasis renal o vesical, divertículos y pseudodivertículos, estenosis uretral y el uso de catéteres vesicales permanentes o intermitentes.

Objetivos

Describimos las formas clínicas de presentación de las Infecciones del Tracto Urinario (ITU) en pacientes con lesiones medulares espinales con vejiga neurogénica así como el comportamiento microbiológico de las mismas.

Pacientes y Método

Realizamos un estudio descriptivo, de tipo retrospectivo a 28 pacientes hospitalizados por afección medular espinal y que se encontraban en evaluación para realizar tratamiento neuro- restaurativo. A los mismos se les realizó evaluación clínica y estudios imagenológicos y microbiológicos del tracto urinario y urocultivo, exudado vaginal y uretra para determinar los factores de riesgo, formas de presentación de la infección así como complicaciones asociadas además del comportamiento microbiológico.

Resultados

La forma más frecuente de presentación de las ITU fueron: bacteriuria sintomática recurrente, bacteriuria asintomática, uretritis bacteriana, vaginosis bacteriana y pielonefritis aguda. Los gérmenes aislados fueron: E. coli en el 60% de los aislamientos, seguido por P. mirabilis en el 14%, K. pneumoniae 10% y Staphylococcus sp en el 4% así como otras enterobacterias. La sensibilidad a los aminoglucósidos se mantiene alta, aunque se observa una creciente resistencia a las sulfas (>70%) y a las fluoroquinolonas (>45%) además de incrementarse la circulación de uropatógenos multirresistentes.

Conclusiones

Las particularidades clínicas de las UTI en pacientes con vejiga neurogénica por lesión de la médula espinal necesita adecuadas estrategias para el manejo clínico, microbiológico y epidemiológico de las mismas.

Abstract

Urinary infections constitute one of the main causes of intrahospitalary infections. At the Clinic for the attention of spinal cord injured (SCI) patients, we observed that these can be the causes of high incidence rates as a consequence of multiple risk factors associated with the neurogenic bladder as: vesical urethral reflux, vesicle lithiasis, diverticula and pseudodiverticula, urethral stenosis and permanent or intermittent catheterization.

Objectives

To describe forms of presentation of urinary tract infections (UTI) in spinal cord lesioned patients with neurogenic bladder as well as their microbiological behavior.

Patients and Method

We performed a descriptive, retrospective-type study on 28 patients in order to schedule a neurorestorative treatment for the affectation of the SCI for six months. They all received clinical, imaging test and bacteriologic assessment, that is, urocultures, uretheral and vaginal exudates to determine risk factors, forms of presentation of the infection, as well as associated complications and microbiological behavior.

Results

The most frequent forms of presentation of infections are: recurrent symptomatic bacteriuria, asymptomatic bacteriuria, bacterial urethritis, bacterial vaginosis and acute pyelonephrites. Most acute germs are: E.coli (for a 60% of isolation), followed by P. mirabilis (14%), K pneumoniae (l0%), Staphylococcus sp. (4%), and other enterobacteria. Sensitiveness to aminoglycosides was kept high, where we observed a growing resistance to sulphas (>70%) and fluoroquinolones (>45%) as well as the frequent circulation of multirresistant microorganisms.

Conclusions

Clinical peculiarities of urinary infections in the patient with neurogenic bladder, allow to perform more adequate strategies for treatment as to the clinical, microbiological and epidemiologic criteria.

Palabras clave
Infección urinaria, Paraplejia, Lesión medular espinal, E coli, Vejiga neurogénica
Key words
Urinary tract infections, Spinal cord injures, E coli, Neurogenic bladder
El Texto completo solo esta disponible en PDF
Referencias
1.
Prevalencia de infecciones nosocomiales en hospitales españoles, Estudio EPINE. [Sitio en Internet] Disponible en: Con acceso el 26 de abril de 2005
2.
Harrop JS, Sharan AD, Przybylski GJ. Epidemiology of Spinal Cord Injury After Acute Odontoid Fractures. Neurosurg Focus 8(6)
3.
J.C. Nickel,J.W. Costerton,R.J. McLean
Bacterial biofilms: influence on the pathogenesis, diagnosis and treatment of urinary tract infections
J Antimicrob Chemother, 33 (1994), pp. 31-41
4.
R.H. Kennedy
The new viewpoint toward spinal cord injuries
Ann Surg, 124 (1946), pp. 1057-1065
5.
E.H. Kass
Chemotherapeutic and antibiotic drugs in the management of infections of the urinary tract
Am J Med, 18 (1955), pp. 764-781
6.
J. Surkin,M. Smith,A. Penman,M. Currier,H.L. Harkey III,Y.F. Chang
Spinal Cord Injury Incidence in Mississippi: A Capture-Recapture Approach
J Trauma, 45 (1998), pp. 502-504
7.
M.J. Gribble,N.M. McCallum,M.T. Schechter
Evaluation of diagnostic criteria for bacteriuria in acutely spinal cord injured patients undergoing intermittent catheterization
Diagn Microbiol Infect Dis, 9 (1988), pp. 197-206
8.
R.P. Stark,D.G. Maki
Bacteriuria in the catheterized patient: what quantitative level of bacteriuria is relevant?
N Engl J Med, 311 (1984), pp. 560-564
9.
National Institute on Disability and Rehabilitation. The prevention and management of urinary tract infections among people with spinal cord injuries: National Institute on Disability and Rehabilitation Research Consensus Statement
J Am Paraplejia Soc, 15 (1992), pp. 194-204
10.
A. Esclarín De Ruz,E. García Leoni,R. Herruzo Cabrera
Epidemiology and Risk factor for urinary tractus infeccion in patients with spinal cord injure
J Urol, 164 (2000), pp. 1285-1289
11.
B. Foxman
Epidemiology of urinary tract infections: incidence, morbidity, and economic costs
Am J Med, 113 (2002), pp. 5S-13S
12.
J. Penders,A.A. Huylenbroeck,K. Everaert,M. Van Laere,G.L. Verschraegen
Urinary infections in patients with spinal cord injury
Spinal Cord, 41 (2003), pp. 549-552
13.
J.M. Kaufman,B. Fam,S.C. Jacobs,F. Gabilondo,S. Yalla,J.P. Kane,A.B. Rossier
Bladder cancer and squamous metaplasia in spinal cord injury patients
J Urol, 118 (1977), pp. 967-997
14.
Subramanian Vaidyanathan,Paul Mansour,M. Bakul Soni,Gurpreet Singh,Pradipkumar Sett
The method of bladder drainage in spinal cord injury patients may influence the histological changes in the mucosa of neuropathic bladder -a hypothesis
BMC Urology, 2 (2002), pp. 5
15.
O.R. Contreras,G. Roura,D. Fernandez
Diagnosis from urine culture in 4 hours using the DIRAMIC-03 system
Rev Latinoam Microbiol, 34 (1992), pp. 83-86
16.
R.C. Alarcón,F.T. Ruiz,A.Z. Tamayo,G.R. Carmona,E.A. Varela,G.T. Ochoa,N.R. Frómeta
Mycrob-1000: an alternative for the rapid determination of urine culture in the primary health level]
Rev Cubana Med Trop, Mayo-ago, 56 (2004), pp. 135-138
17.
P.S. Shah,J.P. Cannon,C.L. Sullivan,B. Nemchausky,C.T. Pachucki
Controlling Antimicrobial Use and Decreasing Microbiological Laboratory Tests for Urinary Tract Infections in Spinal-CordInjury Patients with Chronic Indwelling Catheters
Am J Health-Syst Pharm, 62 (2005), pp. 74-77
18.
WHO/CDS/CSR/EPH/2002. Prevención de las infecciones nosocomiales. Guia Práctica. [Sitio en Internet] Disponible en: http://www.who.int/csr/resources/publications/drugresist/en/PISpanish3.pdf. Con acceso el 14 de julio de 2005
19.
Bennett CJ, Young MN, Darrington H. Differences in urinary tract infections in male and female spinal cord injury patients on intermittent catheterisation. Paraplegia. 199; 33(2):69-72
20.
K.B. Waites,K.C. Canupp,M.J. DeVivo
Microbiology of the urethra and perineum and its relationship to bacteriuria in community-residing men with spinal cord injury, 27 (2004), pp. 448-452
21.
D. Delavierre
Orchi-epididymitis
Ann Urol (Paris), 37 (2003), pp. 322-338
22.
B. Ozkan,O. Demirkesen,H. Durak,N. Uygun,V. Ismailoglu,B. Cetinel
Which factors predict upper urinary tract deterioration in overactive e neurogenic bladder dysfunction?
Urology, 66 (2005), pp. 99-104
23.
Ken Waites. Epidemiology of Antimicrobial Resistance in Spinal Cord Injury. Volume 16, Number 2: Summer, 1998. 619 19th St S, Birmingham, AL 35249-7330
24.
D.F. Sahm,C. Thornsberry,D.C. Mayfield,M.E. Jones,J.A. Karlowsky
Multidrug-resistant urinary tract isolates of Escherichia coli: prevalence and patient demographics in the United States in 2000
Antimicrob Agents Chemother, 45 (2001), pp. 1402-1406
25.
G. Jacoby,G. Archer
New Mechanisms of Bacterial Resistance to Antimicrobial Agents
New Engl J Med, 324 (1991), pp. 601
26.
R.R. Muder,C. Brennen,S.D. Drenning,J.E. Stout,M.M. Wagener
Multiple antibiotic-resistant gram-negative bacilli in a long-term-care facility: a case-control study of patient risk factors and prior antibiotic use
Infect Control Hosp Epidemiol, 18 (1997), pp. 809-813
27.
H. Yoshida,M. Bogaki,M. Nakamura,S. Nakamura
Quinolone resistance-determining region in the DNA gyrase gyrA gene of Escherichia coli. Antimicrob
Agents Chemother, 34 (1990), pp. 1271-1972
28.
A.J. Schaeffer
Review of norfloxacin in complicated and recurrent urinary tract infections
Eur Urol, 17 (1990), pp. 19-23
29.
Estrategia mundial OMS de contención de la resistencia a los antimicrobianos - Resumen. WHO/CDS/CSR/DRS/ 2001.2a
30.
R. Erik,M.D. Dubberke,J. Victoria,M.D. Fraser
Cycling and Other Strategies to Slow and Reverse Antibiotic Resistance, Washington University School of Medicine, St Louis Infect Med, 21 (2004), pp. 544-556
31.
J. Stelling,K. Travers,R. Jones,P.J. Philip,T. O’Brien,S.B. Levy
Integrating Escherichia coli Antimicrobial Susceptibility Data from Multiple Surveillance Programs. Emerging Infectious Diseases
Current Issue, 11 (2005), pp. 873-882
32.
W. Goettsch,W. van Pelt,N. Nagelkerke,M.G. Hendrix,A.G. Buiting,P.L. Petit
Increasing resistance to fluoroquinolones in Escherichia coli from urinary tract infections in the Netherlands
J Antimicrob Chemother, 46 (2000), pp. 223-228
33.
Yamane K, Wachino J, Doi Y, Kurokawa H and Arakawa Y. Global Spread of Multiple Aminoglycoside Resistance Genes. Vol. 11, No. 6 June 2005 Emerging Infectious Diseases Vol. 11, No. 6, June 2005. [Sitio en internet]. con acceso 9 de marzo 2006]
34.
D.M. Shlaes,D.N. Gerding,J.F. John,W.A. Craig,D.L. Bornstein,R.A. Duncan
Society for Healthcare Epidemiology of America and Infectious Diseases Society of America Joint Committee on the Prevention of Antimicrobial Resistance: guidelines for the prevention of antimicrobial resistance in hospitals
Clin Infect Dis, 25 (1997), pp. 584-599
35.
S.K. Fridkin
Routine cycling of antimicrobial agents as an infection-control measure
Clin Infect Dis, 36 (2003), pp. 1438-1444
36.
Lindsay E.Thomas M. Wanda K. Fisher C;Fourcroy C, Gupta K, et al. Managing Acute Uncomplicated Cystitis in the Era of Antibiotic Resistance. [Sitio en Internet] Medscape. Disponible en: http://www.medscape.com/iewprogram/2634_pnt.con acceso 10 de mayo 2005.
Correspondencia autora: Dr. E. Hernández Fernández Specialist of Spinal Cord Injure Clinic, Infectologist Ave 25 No15805, e/ 158 y 160. Cubanacan, Playa, CH Cuba CP 11300. Tel.: 53-7 273 6777, 6778
Copyright © 2007. Asociación Española de Urología (AEU)