Search Results (243)

Background: Despite being a pillar of heart failure (HF) management, the guideline-directed initiation of sodium-glucose cotransporter-2 inhibitors (SGLT2is) may be challenging due to the barrier of associated urinary tract infections (UTIs). Although there is a known risk, it remains unclear whether UTI incidence differs between patients with and without a prior history of UTIs. Methods: This study aimed to evaluate the risk–benefit profile of initiating an SGLT2i in patients with a history of UTIs. This retrospective, single-center healthcare system cohort analysis included adult patients hospitalized and taking an SGLT2i between 1 January 2020, and 31 August 2024. The included patients were divided into two cohorts: patients with and without a history of UTI pre-SGLT2i (described in this study as UTI-naive). Patients with urogenital structural abnormalities, indwelling catheters, or high-risk profiles were excluded. The primary outcome was the incidence of UTIs post-SGLT2i initiation. Secondary outcomes included the number of UTIs within 30, 60, and 90 days after starting an SGLT2i. Results: A total of 280 patients were evaluated for this study, of which 250 were included for analysis. Of those, 197 were UTI-naive, and 53 had a history of UTI pre-SGLT2i use. The most utilized SGLT2i was empagliflozin (75.6%). Amongst the cohorts, 20.4% of the UTI-naive patients developed a UTI post-SGLT2i versus 30.2% in patients with a historical UTI (p = 0.13). Conclusions: There was no significant difference in UTIs developed up to 90 days post-SGLT2i initiation, regardless of previous infections, suggesting that a history of UTI should not be a barrier to differing first-line therapy. Full article

Urinary tract infections (UTIs) and urolithiasis exhibit a complex bidirectional relationship in which microbial colonization and urinary obstruction may mutually reinforce each other. This retrospective observational study evaluated clinical and microbiological factors associated with UTI in patients with urolithiasis using a large institutional dataset. A total of 23,241 urine cultures obtained from 12,708 unique patients were analyzed, comparing individuals with and without urolithiasis. In stone-forming patients, demographic variables, urine pH, hydronephrosis, ureteral double J stent presence and indwelling duration, urinary anomalies, and stone characteristics were assessed. Logistic regression identified independent associations, and ROC analysis defined optimal risk thresholds. UTI were more frequent in the stone group (34.5%) compared with non-stone forming patients (28.9%, p < 0.001). Escherichia coli was the most common uropathogen overall, whereas Klebsiella pneumoniae, Enterococcus faecalis, and Pseudomonas aeruginosa were significantly enriched in patients with stones. Elevated urine pH (OR: 6.37; CI: 2.67–15.19; p = 0.001) and hydronephrosis (OR: 9.14; CI: 3.74–22.35; p = 0.001) were independently associated with UTI. A stent dwell time above 29.5 days was associated with infection with 85% sensitivity and 54% specificity (AUC: 0.70; CI: 0.68–0.73), and urine pH 6.2 or higher was associated with infection with 86% sensitivity and 67% specificity (AUC: 0.77; CI: 0.75–0.80). These findings underscore that urine alkalinity, obstruction, and prolonged stenting are key factors associated with infection risk, supporting the need for careful stent management and timely microbiological evaluation in patients with urolithiasis. Full article

Background and Clinical Significance: Cerebral candidiasis (Candida albicans meningoencephalitis) is a rare but severe central nervous system (CNS) infection, usually associated with neurosurgical procedures or indwelling devices. Diagnosis is challenging due to frequent negativity of cerebrospinal fluid (CSF) cultures, and mortality remains high despite antifungal therapy. Case Presentation: We describe a 64-year-old woman who underwent retrosigmoid resection of a left vestibular schwannoma. The early postoperative course was complicated by fever, neurological deterioration, and hydrocephalus requiring external CSF drainage. Multiple lumbar punctures revealed inflammatory CSF profiles but persistently negative cultures. One month post-surgery, intraoperative samples from mastoid repair material grew Candida albicans, prompting antifungal therapy. Despite treatment, the patient experienced fluctuating neurological status and required multiple external ventricular drains. Three months after surgery, she clinically deteriorated and died. Autopsy showed diffuse meningeal thickening and purulent exudates at the brain base and posterior fossa. Histopathology confirmed chronic lympho-histiocytic meningitis with necrotizing foci containing Candida albicans. Conclusions: This case underscores the diagnostic and therapeutic challenges of post-neurosurgical Candida CNS infections. Repeatedly negative CSF cultures delayed diagnosis, emphasizing the value of ancillary tests such as β-d-glucan and molecular assays. Even with antifungal therapy, prognosis is poor. Autopsy remains essential for uncovering fatal healthcare-associated fungal infections and informing clinical vigilance and medico-legal assessment. Full article

Background/Objectives: Patients with acute severe neurological disorders often receive a transurethral indwelling catheter (TUIC) during their initial treatment. These TUICs often remain in place until the transfer to a rehabilitation or a long-term care facility. There are no systematic concepts for bladder management and no data regarding the impact on the catheter associated, health-related quality of life (HRQoL) in this patient group. The aim of this study was to investigate the impact of successful TUIC removal on the HRQoL of those affected and to contribute to the development of systematic bladder management. Methods: A prospective longitudinal study was conducted on 33 patients treated at a neurological rehabilitation centre due to acute severe neurological disorders. The HRQoL was assessed using the SF-36 Health Survey prior to and following the TUIC removal. The influence of urinary incontinence was analysed. The mean differences were determined using a one-sample t-test adjusted for age and gender. Results: TUIC removal was successful in 61.8% (21/33). The SF-36 Health Survey showed the following improvements (adj. mean diff., 95% CI, p-value): Mental Component Summary measure (4.36, 0.34; 8.38, p = 0.035), Role-Emotional (20.89, 0.54; 41.24, p = 0.045), Physical Functioning (10.03, 3.18; 16.88, p = 0.007). The comparison between incontinent and continent patients showed a poorer HRQoL for the incontinent group. Conclusions: Successful TUIC removal has a positive influence on psychological/emotional aspects and physical functioning. Structured bladder management that considers the physical and psychological aspects of patients and nursing staff, as well as medical and economic aspects, should be pursued with vigour. Full article

(1) Background: Indwelling pleural catheters (IPCs) with vacuum-based drainage can cause pain, especially in patients with a non-expandable lung (NEL). This evaluation assessed whether the Passio™ digital drainage system offers a viable alternative for patients experiencing pain during IPC drainage. (2) Methods: All IPC patients between November 2023 and April 2024 completed questionnaires assessing pain severity on a 10-point visual analogue scale (VAS) at four points during drainage. Patients reporting drainage-related pain at the 2-week post-IPC appointment had their existing valve replaced with a Passio™ valve (n = 5). (3) Results: Twenty-seven patients (59% male) were included in this analysis. The mean VAS scores for pain with a standard vacuum bottle were not statistically different at mid-drainage and the end of drainage compared with pre-drainage. Patients who experienced pain with the vacuum bottle (n = 5) had higher mean VAS scores at mid-drainage (51.68 mm ± 16.29; p = 0.13), end of drainage (46.68 mm ± 19.45; p = 0.19), and 10 min post-drainage (61.38 mm ± 9.81; p = 0.06) compared with pre-drainage (9.16 mm ± 4.01). Post-Passio™ valve replacement (n = 5), patients had a lower VAS pain score mid-drainage (20.15 mm ± 9.34; p = 0.25), end of drainage (27.28 mm ± 12.69; p = 0.84), and 10 min post-drainage (14.81 mm ± 3.33; p = 0.0079) when compared with vacuum bottle drainage. There were no complications with the Passio™ drainage system. (4) Conclusions: Controlled pleural drainage using a digital drainage device such as Passio™ may have a role in IPC patients who experience pain with vacuum bottle drainage, especially in those with an NEL. Full article

Background: Catheter-related bloodstream infections (CRBSIs) caused by environmental organisms are uncommon, and polymicrobial cases are even rarer. Methods: We describe the first case of catheter-related bloodstream infection caused by two infrequent environmental organisms—Rhizobium radiobacter and Pseudomonas oryzihabitans—occurring as a co-infection. Results: The patient’s occupation involved frequent exposure to moist, soil-contaminated environments. Although these bacteria are often considered contaminants, they are capable of causing invasive infections such as bacteremia, which can be life-threatening. Conclusions: This case underscores the emerging pathogenic potential of R. radiobacter and P. oryzihabitans co-infection, particularly in patients with underlying malignancies or end-stage renal disease who have indwelling vascular devices, and highlights the importance of considering occupational and environmental exposures in the differential diagnosis of unusual pathogens. Full article

Background and Objectives: Catheter-related bloodstream infections (CRBSIs) are one of the most severe complications in children with intestinal failure (IF) who require long-term parenteral nutrition (PN). Taurolidine–citrate solution (TCS), with proven antimicrobial and antibiofilm properties, has been proposed as a promising alternative to heparin locks for preventing infection. The aim is to evaluate the efficacy and safety of the TCS in reducing the rates of CRBSI and pathogen-specific infections in pediatric patients with indwelling central venous catheters (CVCs) who are receiving PN. Materials and Methods: This retrospective study included 48 pediatric IF patients treated at an intestinal rehabilitation and transplantation center in Türkiye. Patients received either TCS or heparinized saline (0.9% saline solution containing 100 IU of heparin) as a catheter lock. Infection data were extracted from medical records and expressed as events per 1000 catheter days. Group comparisons were performed using non-parametric tests, and Poisson regression was applied to calculate rate ratios (RRs) and 95% confidence intervals (CIs). Adjusted rate ratios were obtained from a Poisson regression model that included the following variables: age, sex, diagnosis category, ostomy status, catheter type, and follow-up duration. Log(catheter-days) was incorporated as an offset term. Overdispersion was assessed and not detected. Results: The crude CRBSI rate was lower in the TCS group than in the heparinized saline group (29.4 vs. 42.8 per 1000 catheter days), though this difference was not statistically significant (p = 0.383). However, after adjustment by Poisson regression, TCS use was significantly associated with reduced infection rates (adjusted RR = 0.78, 95% CI = 0.70–0.87, p < 0.001). TCS use was also significantly associated with reduced rates of Gram-positive (RR = 0.78, p = 0.006), Gram-negative (RR = 0.48, p < 0.001) and fungal (RR = 0.63, p < 0.001) infections. No adverse events were observed among the TCS group. Conclusions: Standardized TCS lock therapy effectively and safely reduces CRBSIs in pediatric patients with IF, particularly those caused by Gram-negative and fungal organisms. These results support the use of TCS as a prophylactic option for preventing infection in long-term CVC use. Full article

Introduction: Chest drainage is central to thoracic surgery, pleural medicine, and emergency care, yet practice remains heterogeneous in tube caliber, access, suction, device selection, and removal thresholds. This narrative review aims to synthesize evidence and translate it into guidance. Materials and Methods: We performed a narrative review with PRISMA-modeled transparency. Using backward citation from recent comprehensive overviews, we included randomized trials, meta-analyses, guidelines/consensus statements, and high-quality observational studies. We extracted data on indications, technique, tube size, analog versus digital drainage, suction versus water-seal drainage, removal criteria, and key pleural conditions. Due to heterogeneity in device generations, suction targets, and outcomes, we synthesized the findings qualitatively according to converged evidence. Results: After lung resection, single-drain strategies, early use of water-seal, and standardized removal at ≤300–500 mL/day reduce pain and length of stay without increasing the need for reintervention; digital systems support objective removal using sustained low-flow thresholds (approximately 20–40 mL/min). Small-bore (≤14 Fr) Seldinger catheters perform comparably to larger tubes for secondary and primary pneumothorax and enable ambulatory pathways. In trauma, small-bore approaches can match large-bore drainage in stable patients when paired with surveillance and early escalation of care. For pleural infection, image-guided drainage, combined with fibrinolytics or surgery, is key. Indwelling pleural catheters provide relief comparable to talc in dyspnea associated with malignant effusions in patients with non-expandable lungs. Complications are mitigated by ultrasound guidance and avoiding abrupt high suction after chronic collapse; however, these strategies must be balanced against risks of malposition, occlusion or retained collections, prolonged air leaks, and device complexity, which demand protocolized escalation and team training. Conclusions: Practice coalesces around three pillars—right tube, right system, proper criteria. Adopt standardized pathways, device-agnostic thresholds, and volume or airflow criteria. Trials should harmonize “seal” definitions and validate telemetry-informed removal strategies. Full article

Biofilms are structured microbial communities that adhere to biotic and abiotic surfaces embedded in an autonomous extracellular matrix. These structures contribute to persistent infections, especially in patients with indwelling medical devices, due to their resistance to antimicrobial agents; they have evolved to evade host immune responses. Despite advances in antimicrobial therapies, biofilm-associated infections remain a major challenge in clinical infectious diseases. This perspective explores the underlying mechanisms of biofilm resilience and immune evasion, emphasizing the limitations of conventional treatments and the need to develop pre-emptive measures that focus on preventing biofilm formation rather than implementing a treatment. This work discusses emerging strategies, such as quorum-sensing inhibition, hormonal modulation, matrix-degrading enzymes, anti-adhesive surface modifications, and nanotechnology-based drug delivery, that offer promising avenues to disrupt biofilm formation and maturation. Also offers a shift from the paradigm, looking into proactive prevention rather than treatment, emphasizing clinical translation, scalability, and biocompatibility. Embedding these strategies into routine care could significantly reduce healthcare-associated infections, improve patient outcomes, and mitigate the development of antimicrobial resistance. Our analysis highlights biofilm prevention as a critical frontier in the future of infectious disease management. Full article

Background/Objectives: Pelvic organ prolapse (POP) is a common condition affecting women. When conservative treatment fails, surgical correction is indicated. Anterior colporrhaphy (AC) is a standard procedure for anterior vaginal wall prolapse repair. Postoperatively, an indwelling urinary catheter (IUC) is typically inserted to prevent urinary retention; however, prolonged catheterization is a known risk factor for urinary tract infection (UTI). This study aimed to evaluate whether postoperative catheterization can be safely shortened from 4 days to 24 h after vaginal POP surgery, and to compare the incidence of urinary retention and UTI between the two groups. Methods: A prospective randomized controlled trial was conducted, including 119 patients scheduled for AC for POP repair. All patients received an IUC after surgery and were randomized to catheter removal after either 24 h (group 1) or 4 days (group 2). Urinary retention was defined as a postvoid residual volume > 200 mL after IUC removal. UTI was diagnosed based on typical symptoms and a positive urine culture (≥10⁵ CFU/mL). Results: Data from 80 patients were analyzed. There were no statistically significant differences in catheter reinsertion rates (15% in group 1 vs. 7.5% in group 2, p = 0.288). The incidence of urinary retention was not influenced by the use of Kelly sutures, concomitant procedures, or patient age. No UTIs were confirmed in either group. Median hospital stay was significantly shorter in group 1 (3 [2–4] days vs. 4 [4–4] days, p < 0.001). Conclusions: Short-term catheterization following anterior colporrhaphy is not associated with increased risk of urinary retention or infection. Reducing catheterization duration results in a shorter hospital stay, which may lower healthcare costs and improve patient throughput. Full article

VATS talc poudrage is the standard treatment for recurrent pleural effusion, but it is not feasible when the lung does not re-expand, or for fragile patients who are unfit for general anesthesia. In these situations, indwelling pleural catheters (IPC) are a valuable option to offer long-term symptom relief and reduce hospitalization, with the only limitation being that an external portion of the device is needed in the majority of available devices. This study evaluates the efficacy and safety of a fully implantable pleural catheter in managing recurrent pleural effusion in patients who are unfit for traditional treatments. A retrospective, single-center analysis was conducted from April 2018 to August 2024, involving 150 patients that underwent Celsite^® DRAINAPORT implantation. The study measured the percentage of procedures with complications, the type of follow up, six months survival rate, cause of death, and the number of oncological treatments administered after implantation. Results indicated a complication rate of 12%, of which most were mild and manageable. Over half of the patients were successfully managed by home nursing services. Nearly 50% of the patients survived after six months, whereas 28.7% received subsequent oncological treatments. This suggests that this type of device is a safe and effective alternative for managing recurrent pleural effusion in patients with limited treatment options. Full article

Background/Objectives: Renal colic poses a significant burden on patients and healthcare systems. Negative ureteroscopy in the setting of stented patients is reported at up to 14%, resulting in unnecessary surgeries and inefficiencies. While ureteral stents have demonstrated efficacy in relieving obstruction, their exact effect on spontaneous stone passage (SSP) is unclear. Hence, a systematic evaluation of the literature was performed to identify the impact of ureteral stents on spontaneous stone passage rates. Methods: A systematic search was conducted in MEDLINE, Embase, and PubMed (January 1989–February 2025) to identify studies investigating indwelling ureteric stents and SSP. Two independent reviewers screened the abstracts and full texts, with a third resolving conflicts. Quality assessment was conducted using The Risk Of Bias In Non-randomized Studies—of Interventions (ROBINS-I) and Cochrane Risk of Bias 2 (RoB-2) tools. Results: A total of 2437 patients in 14 studies investigating SSP in stented patients were included. One included study was a randomised controlled trial, but the rest were observational (n = 13). Three studies compared stented and control groups, whereas 11 studies only investigated patients with stents. Mean/median overall stone sizes ranged from 4.7 to 7.8 mm in diameter. Overall, SSP rates with stents varied significantly, ranging from 1.7 to 42.3%, in the setting of variable stone size, location, duration of follow-up, and method of stone passage detection. When comparing stented and non-stented patients, two studies demonstrated impaired SSP rates in stented patients (13.9% vs. 26.8% and 14% vs. 20%), but only one of these differences was statistically significant. Three studies comparing patients with retrograde ureteral stents and nephrostomies found increased SSP rates in nephrostomy cohorts (p < 0.001). Conclusions: Stone passage rates with stents vary widely due to heterogeneity in study design, patient characteristics, and follow-up. Some studies suggest that stents may impair passage; however, evidence remains inconclusive due to the limited availability of high-quality comparative data. This study underscores the need for larger prospective trials to clarify the actual impact of stenting on stone passage. Full article

Background and Clinical Significance: Corynebacterium striatum is an emerging multidrug-resistant pathogen increasingly implicated in infections among immunocompromised patients and patients with indwelling medical devices. Case Presentation: We report the probable first case of pseudomembranous inflammation associated with C. striatum infection in a 53-year-old male with an implanted left ventricular assist device (LVAD) awaiting heart transplantation. The patient experienced recurrent episodes of C. striatum bacteremia despite multiple courses of targeted antibiotic therapy, including vancomycin, linezolid, tedizolid, teicoplanin, and dalbavancin. During urgent heart transplantation, pseudomembranous tissue surrounding the LVAD driveline was observed, and cultures confirmed C. striatum device infection. Histopathological analysis revealed necrotic elements and Gram-positive organisms consistent with pseudomembranous inflammation. Conclusions: The case describes the diagnosis and treatment of this rare infection, highlighting the pathogenic potential of C. striatum, its role in device-related infections, and the histopathological evidence of pseudomembrane formation. Full article

Based on the imago Dei theory, this essay attempts to establish a correspondence between the union of natures in Christ and the relationship between man and creation, focusing attention on the communication of idioms and reciprocal indwelling. It compares the dominion that man is called to exercise over nature by divine vocation as an image of the hypostatic union, with the despotic dominion, so widespread in modern times, that reflects the fall and is characterized by conflict and not by harmony. Finally, it is maintained that the form of dominion inspired by the application of the Christological doctrine inserts man in necessity and the cosmic rhythms, favoring the development of a human community aligned with the liturgical cycle and founded on peace. Full article

Background/Objectives: Lower urinary tract symptoms (LUTSs) due to benign prostatic obstruction (BPO) represent a common condition affecting aging men. Transurethral resection of the prostate represents the gold standard surgical treatment but is not without complications such as retrograde ejaculation, bleeding and urinary retention. The temporary implantable nitinol device (iTIND) is considered a minimally invasive surgical technique, designed to treat LUTS while preserving erectile and ejaculatory function. Herein we report the results of a multi-center, real-world assessment of the iTIND procedure. Methods: Data from five international centers treating LUTS with the iTIND device were collected. We recorded changes through an International Prostatic Symptom Score (IPSS) questionnaire with Quality of Life (QoL), International Index of Erectile Function (IIEF5) questionnaire, antegrade ejaculatory function, maximum flow (QMax), post voiding residual volume (PVR) and freedom from repeat intervention. Results: A total of 74 subjects were enrolled; median follow-up was 12 months. IPSS and QoL changed from a median of 23 and 4 points at baseline to 11 and 2 points, respectively, at the last follow-up. A mean improvement in Qmax and PVR from 9 mL/s and 56 mL at baseline to 13 mL/s and 40 mL was noticed at the last follow-up. Total median operative time was 10 min, and the median time of iTIND indwell time was 7 days. The median device removal time was 5 min. There were no changes in IIEF5 scores and antegrade ejaculation rate. No intraoperative complications were reported, and non-serious postoperative complications occurred in six patients (two urinary retention, two mild haematuria, two urinary tract infection). Finally, four patients underwent reoperation during the follow-up period. All procedures were performed as outpatient day cases. Conclusions: Our results confirms that treatment with the iTIND is effective and safe in terms of improving urinary symptoms and quality of life without impacting sexual function. Longer follow-up is required to better define the durability of this minimally invasive procedure. Full article