Abstract and purpose The intent of this document is to highlight practical recommendations in a concise format designed to assist physicians, nurses, and infection preventionists at acute-care hospitals in implementing and prioritizing their catheter-associated urinary tract infection (CAUTI) prevention efforts. This document updates the Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute-Care Hospitals published in 2014. It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission. 

Strategies to prevent catheter-associated urinary tract infections in acute-care hospitals: 2022 Update

Between 26% and 52% of adults with intellectual disability experience urinary incontinence (UI). Little is known about the implications of urinary tract infections (UTIs) for this group. The aim was to screen for UTIs in a sample of adults with intellectual disability and UI. 

Urinary Tract Infections Amongst Adults With Intellectual Disabilities With Urinary Incontinence

Abstract Aims To describe women's experiences with a range of bladder self‐care practices. Design We conducted a secondary, directed content analysis of qualitative data from the Study of Habits, Attitudes, Realities and Experiences, a multisite focus group study designed to explore adolescent and adult women's experiences, perceptions, beliefs, knowledge and behaviours related to bladder health. This study was conducted by the National Institute of Diabetes and Digestive and Kidney Diseases' Prevention of Lower Urinary Tract Symptoms Research Consortium. Study methods were informed by the Consortium's conceptual framework, based on a social ecological model adapted from Glass and McAtee's Society‐Behavior‐Biology Nexus. Methods Participants were recruited at seven geographically diverse United States research centres between July 2017 and April 2018. Data for the current analysis were collected using a semi‐structured discussion group with 36 focus groups involving 316 community‐dwelling adult women aged 18–93 years. Coded text was re‐examined according to eight self‐care behavioural domains identified through literature review and expert opinion as potentially influencing bladder health. Results Participants described many self‐care practices they had adopted to prevent bladder problems or manage existing symptoms and conditions. Eight themes were identified: ‘Choosing fluids, foods and medications’; ‘Dressing for bladder health’; ‘Promoting bodily cleanliness’; ‘Managing toileting environments’; ‘Timing when to void’; ‘Exercising pelvic floor muscles for bladder control’; ‘Limiting physical activities that challenge the bladder’ and ‘Staying home and navigating when away’. Thirteen subthemes were derived from five of the eight themes. Conclusion Women use a broad array of self‐care practices related to their bladder health. Research is needed to examine the efficacy of self‐care behaviours for preventing or managing bladder symptoms and conditions, and to discern potential risks. Results have important implications for development of bladder health promotion interventions and public health messaging around women's bladder health. Implications for the Profession and/or Patient Care This study provides a comprehensive framework for understanding women's bladder self‐care practices, which can be used by clinicians and public health professionals in designing interventions to promote bladder health and function. Impact Women with and without lower urinary tract symptoms use a broad range of self‐care practices that may affect their bladder health, including some that may be harmful. Because of the high prevalence of bladder symptoms in women, this study may help patient assessment and counselling regarding self‐care practices. Reporting Method This study was reported according to the Standards for Reporting Qualitative Research (SRQR). Patient or Public Contribution No patient or public contribution. 

Exploring women's bladder self‐care practices: A qualitative secondary analysis

Urinary infections are defined as the presence of microorganisms in any part of the urinary system, with the exception of the distal urethra. The majority are uncomplicated infections, resolved on an outpatient basis, with empirical therapy. The objectives of this work were to study the sociodemographic characteristics of patients, analyze associated strains and examine the response of the main microorganisms to antibiotics. A retrospective observational study of all positive urine cultures between 2018 and 2022 was carried out in an Institution (8340 samples). Sociodemographic data were also collected. 61.3% were women, with an average age of 63.4 years, 43.2% from the Emergency Department. 13.5% were fitted, 56% of whom were women. 95.9% were not taking any antibiotics and among the individuals who were taking antibiotics, 50% were injected. Escherichia coli (53.5%) and Klebsiella pneumoniae (13,8%) are identified as the most prevalent strains. In the time periods analyzed, Escherichia coli decreased its resistance to 11 antibiotics and increased to 5 antibiotics, while Klebsiella pneumoniae decreased to 7 and increased to 7, with emphasis on the presence of 3 antibiotics with a resistance rate of 100 % to all Klebsiella pneumoniae strains identified in 2022. 

Urinary Infections in a Hospital Unit in Central Portugal – 5-Year Analysis

Using antibiotics without medical guidance (non-prescription antibiotic use) may contribute to antimicrobial resistance. Hispanic individuals are a growing demographic group in the United States (US) with a high prevalence of non-prescription antibiotic use. We investigated the effects of acculturation and subjective norms on Hispanic individuals' intentions to use antibiotics without a prescription from the following sources: (1) markets in the United States (not legal), (2) other countries (abroad), (3) leftovers from previous prescriptions, and (4) friends/relatives. We surveyed self-identified Hispanic outpatients in eight clinics from January 2020 to June 2021 using the previously validated Short Acculturation Scale for Hispanics (SASH). Of the 263 patients surveyed, 47% reported previous non-prescription use, and 54% expressed intention to use non-prescription antibiotics if feeling sick. Individuals with lower acculturation (Spanish-speaking preferences) expressed greater intentions to use antibiotics from abroad and from any source. Individuals with more friends/relatives who obtain antibiotics abroad were over 2.5 times more likely to intend to use non-prescription antibiotics from friends/relatives (p = 0.034). Other predictors of intention to use non-prescription antibiotics included high costs of doctor visits and perceived language barriers in the clinic. Antibiotic stewardship interventions in Hispanic communities in the United States should consider the sociocultural and healthcare barriers influencing non-prescription use and promote language-concordant healthcare. 

Acculturation and Subjective Norms Impact Non-Prescription Antibiotic Use among Hispanic Patients in the United States

Prevalence and predictors of urine culture contamination in primary care: A cross-sectional study.

BACKGROUND
Use of antibiotics without a prescription is potentially unsafe and may increase the risk of antimicrobial resistance. We evaluated the effect of patient, health system, and clinical encounter factors on intention to use antibiotics without a prescription: (1) purchased in the United States (U.S.), (2) obtained from friends or relatives, (3) purchased abroad, or 4) from any of these sources.


METHODS
Survey was performed January 2020 - June 2021 in six publicly-funded primary care clinics and two private emergency departments in Texas, U.S. Participants included adult patients visiting one of the clinical settings. Non-prescription use was defined as use of antibiotics without a prescription, and intended use was professed intention for future non-prescription antibiotic use.


RESULTS
Of 564 survey respondents (33% Black and 47% Hispanic or Latino), 246 (43.6%) reported prior use of antibiotics without a prescription, and 177 (31.4%) reported intent to use antibiotics without a prescription. If feeling sick, respondents endorsed that they would take antibiotics: obtained from friends/relatives (22.3% of 564), purchased in the U.S. without a prescription (19.1%), or purchased abroad without a prescription (17.9%). Younger age, lack of health insurance and a perceived high cost of doctor visits were predictors of intended use of non-prescription antibiotics from any of the source. Other predictors of intended use were lack of transportation for medical appointments, language barrier to medical care, Hispanic or Latino ethnicity and being interviewed in Spanish.


CONCLUSIONS
Patients without health insurance who report a financial barrier to care are likely to pursue more dangerous non-prescription antimicrobials. This is a harm of the fragmented, expensive healthcare system that may drive increasing antimicrobial resistance and patient harm.

Antibiotic use without a Prescription: A multi-site Survey of Patient, Health System, and Encounter Characteristics.

Closing the Defense Innovation Readiness Gap

BACKGROUND
Risk factors for ciprofloxacin or MDR in primary care urine specimens are not well defined.


OBJECTIVES
We created a primary care-specific antibiogram for Escherichia coli isolates from cases with complicated and uncomplicated urinary tract infection (UTI) and evaluated risk factors for ciprofloxacin, trimethoprim/sulfamethoxazole and MDR among Enterobacterales.


METHODS
We conducted a cross-sectional study to determine resistance and risk factors by collecting urine cultures from all patients (≥18 years) presenting with provider-suspected UTI at two primary care, safety-net clinics in Houston, TX, USA between November 2018 and March 2020.


RESULTS
Among 1262 cultures, 308 cultures grew 339 uropathogens. Patients with Enterobacterales (n = 199) were mostly female (93.5%) with a mean age of 48.5 years. E. coli was the predominant uropathogen isolated (n = 187/339; 55%) and had elevated trimethoprim/sulfamethoxazole (43.6%) and ciprofloxacin (29.5%) resistance, low nitrofurantoin (1.8%) resistance, and no fosfomycin resistance. Among E. coli, 10.6% were ESBL positive and 24.9% had MDR. Birth outside the U.S.A., prior (2 year) trimethoprim/sulfamethoxazole resistance, and diabetes mellitus were associated with trimethoprim/sulfamethoxazole resistance. Prior (60 day) fluoroquinolone use, prior ciprofloxacin resistance and both diabetes mellitus and hypertension were strongly associated with ciprofloxacin resistance. Prior fluoroquinolone use and a history of resistance to any studied antibiotic were associated with MDR, while pregnancy was protective.


CONCLUSIONS
We found elevated resistance to UTI-relevant antimicrobials and novel factors associated with resistance; these data can be incorporated into clinical decision tools to improve organism and drug concordance.

Determining a urinary-specific antibiogram and risk factors of trimethoprim/sulfamethoxazole, ciprofloxacin and multidrug resistance among Enterobacterales in primary care.

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Prevalence and predictors of urine culture contamination in primary care: A cross-sectional study.

Antibiotic use without a Prescription: A multi-site Survey of Patient, Health System, and Encounter Characteristics.

Closing the Defense Innovation Readiness Gap

Determining a urinary-specific antibiogram and risk factors of trimethoprim/sulfamethoxazole, ciprofloxacin and multidrug resistance among Enterobacterales in primary care.