Page 14 - CUA 2020_Sexual Dysfunction and Transplant

Moderated Posters 11: Urinary Incontinence, Voiding Dysfunction, Sexual Dysfunction, Transplant

to cerebral anatomy using a magnetic pencil to bony skull landmarks MP-11.9
(Fig. 1). Voiding reduced the micromolar colorographic regional change. Temporal trends and patterns in kidney transplant surgeries in
Conclusions: fNIRS of the brain can identify the location, timing, and Ontario
magnitude of cortical activity linked to voiding; the importance of brain- Luke Witherspoon , Ali Dergham , Thomas A. Skinner , Brian D. Blew ,
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mediated signaling is now recognized. The technique described offers Jeffrey Warren 1
those interested in investigating the central pathophysiological mecha- 1 Division of Urology, Department of Surgery, The Ottawa Hospital and
nisms of OAB and UI a way to study a broader population than if they had University of Ottawa, Ottawa, ON, Canada; School of Medicine, Faculty of
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to rely fMRI alone. fNIRS is now a feasible addition to studies investigating Health Sciences, Queen’s University, Kingston, ON, Canada; Department
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voiding dysfunction. of Urology, Dalhousie University, Halifax, NS, Canada; Multi-Organ
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Transplant Program, Nova Scotia Health Authority, Halifax, NS, Canada
MP-11.8 Introduction: Studies suggest that procedures performed under fatigued
High risk of Clostridium difficile infection from the use of conditions or on weekends may be associated with worse outcomes.
antibiotics commonly used to treat urinary tract infections in Approximately 700 kidney transplants occur in Ontario per year, yet
spinal cord injury patients studies of their timing/trends are absent. We set out to determine these
Bonnie Liu , Jennifer Reid , Michael Silverman , Blayne K. Welk 1,2,4 temporal trends and patterns.
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1 Department of Surgery, Western University, London, ON, Canada; ICES, Methods: Data on all deceased donor and recipient kidney transplant
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London, ON, Canada; Division of Infectious Diseases, Western University, surgeries that occurred between April 1, 2013 and December 31, 2017
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London, ON, Canada; Department of Epidemiology and Biostatistics, were obtained from Trillium Gift of Life Network, Ontario’s organ and
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Western University, London, ON, Canada tissue donation agency. The rates and 95% confidence intervals of donor
Support: Supported by a resident research grant from the Department of and recipient transplants per unit times were calculated. To facilitate
Surgery, Western University comparison, all rates were normalized to per 30 days.
Introduction: Perceived and culture-positive urinary tract infections Results: A total of 1116 deceased donor nephrectomies and 1858 recipi-
(UTIs) are a common reason for spinal cord injury (SCI) patients to use ent kidney transplantations were performed. Significantly more recipient
antibiotics. Antibiotic use can lead to C. difficile infection (CDI), which surgeries were performed on Saturday than any other day. When com-
1,2
has high morbidity and mortality. Our objective was to characterize the paring weekend and weekdays, the weekend rate is significantly greater
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use of common UTI-relevant antibiotics after a SCI and determine the for both donor and recipient surgeries. The rate of recipient surgeries
relative risk of CDI from exposure to these antibiotics. overnight (20:00–07:00) on a weekend is greater than any other time. The
Methods: We used routinely collected data from the province of Ontario 17:00–20:00 period had the highest rate of donor and recipient surgeries
(Canada) to conduct a retrospective, cohort study. We identified people for donations after cardiac death. The overnight period had the greatest
>18 years of age who had a traumatic, non-fatal SCI between April 1, rate of donor surgeries for NDD donors. Similarly, the weekend overnight
2003 and March 31, 2017. The primary exposure was an outpatient UTI- period had the greatest rate of recipient surgeries from NDD donors. The
relevant antibiotic prescription during our observation period, and the average cold and warm ischemia times (WIT) were 10.4 hours and 40.7
primary outcome was evidence of a CDI. An adjusted Cox proportional minutes, respectively. WITs were significantly longer overnight than dur-
hazards model was used, and antibiotic exposure was modeled as a ing weekday daytime.
time-varying variable. Conclusions: We set out to determine the temporal trends of kidney trans-
Results: We identified 2528 patients with SCI that met our inclusion cri- plants across Ontario. As hypothesized, most kidney transplant surger-
teria; 1642 (65%) were exposed at least once to an antibiotic of interest ies are occurring at inopportune times where resources are limited and
during followup. The most commonly prescribed UTI-related antibiotic medical staff may be fatigued. This study raises questions about how to
was a fluoroquinolone (34%). Most patients did not receive investigations best optimize renal transplant timing, and whether the majority should
for a UTI prior to use of any of the different antibiotic classes. A small be occurring at times when resources are at their minimum, and staff
number of patients (138, 5%) were started on a chronic (>3 months) burnout may occur.
course of a UTI-relevant antibiotic. The overall proportion of patients
diagnosed with CDI was 7.4% (188), with a rate of 9.3/10 000 patient MP-11.10
days. Exposure to UTI-relevant antibiotics was associated with an adjusted Predictors of perioperative complications in pediatric renal
hazard ratio of 2.9 (98% confidence interval 2.0–4.3; p<0.01) for CDI. transplantation: A long-term retrospective study
Conclusions: A significant proportion of patients with SCI are exposed Cyrus Chehroudi , Alexander Danechi , Andrew E. MacNeily , Kourosh
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to UTI-relevant antibiotics, and most do not have UTI-related investiga- Afshar 1
tions carried out. The rate of CDI in this population is similar to that of 1 Department of Urologic Sciences, University of British Columbia,
hospitalized patients. Given the increased risk for CDI in SCI patients Vancouver, BC, Canada
exposed to UTI-relevant antibiotics, efforts to reduce unnecessary UTI- Introduction: Renal transplantation is the treatment of choice for pediatric
related antibiotic use should continue. end-stage renal disease (ESRD). However, the fragility of children, size
References discrepancy between adult kidneys and pediatric recipients, and greater
1. Salomon J, Denys P, Merle C, et al. Prevention of urinary tract infec- prevalence of urinary tract anomalies make pediatric renal transplanta-
tion in spinal cord-injured patients: Safety and efficacy of a weekly tion more prone to surgical complications. Small sample sizes also make
oral cyclic antibiotic (WOCA) program with a 2-year followup it difficult to study pediatric renal transplantation and factors associated
— an observational prospective study. J Antimicrob Chemother with perioperative morbidity. Here, we report our perioperative outcomes
2006;57:784-8. https://doi.org/10.1093/jac/dkl010 for pediatric renal transplant over 12 years.
1. Evans CT, Fitzpatrick MA, Jones MM, et al. Prevalence and fac- Methods: We conducted a retrospective chart review of renal transplant
tors associated with multidrug-resistant gram-negative organisms recipients from 2007–2019 at BC Children’s Hospital. Perioperative com-
in patients with spinal cord injury. Infect Control Hosp Epidemiol plications were assessed within eight weeks of transplantation. Surgical
2017;38:1464-71. https://doi.org/10.1017/ice.2017.238 complications were defined as vascular, urinary, or wound complications
2. Burke KE, Lamont JT. Clostridium difficile infection: A worldwide dis- requiring intervention. Fisher’s exact test and Student’s t-test were used to
ease. Gut Liver 2014;8:1-6. https://doi.org/10.5009/gnl.2014.8.1.1 assess statistical significance. A p<0.05 was taken as significant.
Results: Eighty-nine renal transplants were performed over 12 years with
median age 13 and 64% in male patients. The most common causes of
ESRD were posterior urethral valves (n=13), focal segmental glomeru-
losclerosis (n=11), and glomerulonephritis/vasculitis (n=8). Ten patients
had previous transplants. Mean vascular anastomosis time and surgical
CUAJ • June 2020 • Volume 14, Issue 6(Suppl2) S145