New onset of recurrent urinary tract infection (in a low-risk patient) after a routine colonoscopy with polypectomy: A case study

Abstract

Urinary tract infections (UTIs) are prevalent nosocomial infections, contributing significantly to morbidity and healthcare costs. While colonoscopies are essential for colorectal cancer screening, they can occasionally lead to infections. This case study examines recurrent UTIs in a 77-year-old postmenopausal female following a routine colonoscopy with polypectomy. It highlights the potential role of translocated endogenous Escherichia coli. The case identifies risk factors and proposes strategies to mitigate colonoscopy-related complications, advocating for risk-identification tools to reduce morbidity. The role of Advanced Practice Registered Nurses (APRNs) in prevention and management is also explored.

Keywords

Advanced practice registered nurse / Bacterial translocation / Colonoscopy / Infection prevention / Nosocomial infection / Polypectomy / Urinary tract infection

References

[1] Squadrito FJ, Del Portal D. Nitrofurantoin. StatPearls. 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470526

[2] Vast Urinary Tract Infections (UTI) Treatment Guidelines. Infectious Diseases Management Program at UCSF. n.d. Available from: https://idmp.ucsf.edu/content/vast-urinary-tract-infections-uti-treatment-guidelines

[3] Tamma PD, Aitken SL, Bonomo RA, et al. Infectious Diseases Society of America 2023 guidance on the treatment of antimicrobial resistant gram-negative infections. Clin Infect Dis. 2023; 77(2): 361-8. PMid:37463564 https://doi.org/10.1093/cid/ciad428

[4] Sund M, Garcia-Argibay M, Garmo H, et al. Vaginal estrogen therapy and breast cancer risk in women using systemic adjuvant therapy: A nationwide cohort study. Breast Cancer Res Treat. 2023; 198(2): 361-8. PMid:36773184 https://doi.org/10.1007/s10549-023-06871-w

[5] Institute of Medicine. To Err Is Human: Building a safer health system. National Academies Press; 2000. https://doi.org/10.17226/9728

[6] Wang P, Xu T, Ngamraengphong S, et al. Rates of infection after colonoscopy and esophagogastroduodenoscopy in the USA. Gut. 2018; 67(9): 1626-36. PMid:29777042 https://doi.org/10.1136/gutjnl-2017-315308

[7] Waddingham P, Dube AK, McFerran E, et al. Colonoscopy complications: A narrative review. BMJ Open Gastroenterol. 2023; 10(1): e001193. https://doi.org/10.1136/bmjgast-2023-001193

[8] Deb B, Haboubi H, Hayee BH, et al. Endoscopy-associated infections: A brief summary of the current evidence and practice. Dig Dis Sci. 2022; 67(5): 1718-32. PMid:35262904 https://doi.org/10.1007/s10620-022-07441-8

[9] Drago L, Toscano M, De Grandi R, et al. Persisting changes of intestinal microbiota after bowel preparation and colonoscopy. Eur J Gastroenterol Hepatol. 2016; 28(5): 532-7. PMid:27015015 https://doi.org/10.1097/MEG.0000000000000581

[10] National Cancer Institute. Cancer stat facts: Colorectal cancer. n.d. Available from: https://seer.cancer.gov/statfacts/html/colorect.html

[11] Kovaleva J, Peters FT, van der Mei HC, et al. Transmission of infection by flexible gastrointestinal endoscopy and bronchoscopy. Clin Microbiol Rev. 2013; 26(2): 231-54. PMid:23554415 https://doi.org/10.1128/CMR.00085-12

[12] U.S. Preventive Services Taskforce. Colorectal cancer: Screening. 2021. Available from: https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening

[13] U.S. Preventive Services Taskforce. Grade definitions. n.d. Available from: https://www.uspreventiveservicestaskforce.org/uspstf/about-uspstf/methods-and-processes/grade-definitions

[14] Storme O, Tirán Saucedo J, Garcia-Mora A, et al. Risk factors and predisposing conditions for urinary tract infection. Ther Adv Urol. 2019; 11: 1756287218814382. PMid:31105772 https://doi.org/10.1177/1756287218814382

[15] Ingerson-Mahar M, Reid A. FAQ: E. coli: Good, bad, & deadly. American Society for Microbiology. 2011. https://doi.org/10.1128/AAMCol.1-2011

[16] Chiam TWJ, Muthukaruppan SR. Colovesical fistula. AME Surg J. 2023; 1: 6. https://doi.org/10.21037/asj-21-6

[17] Golabek T, Szyma´nska A, Szopinski T, et al. Enterovesical fistulae: A review. Cent European J Urol. 2015; 68(3): 223-8. https://doi.org/10.5173/ceju.2015.0138

[18] Reumkens A, Rondagh EJ, Bakker CM, et al. Post-colonoscopy complications: A systematic review and meta-analysis. Am J Gastroenterol. 2016; 111(8): 1092-101. PMid:27296945 https://doi.org/10.1038/ajg.2016.234

[19] American Association of Nurse Practitioners. Nurse practitioners in primary care. n.d. Available from: https://www.aanp.org/advocacy/advocacy-resource/position -statements/nurse-practitioners-in-primary-care

[20] American Association of Colleges of Nursing. The essentials: Core competencies for professional nursing education. 2021. Available from: https://www.aacnnursing.org/Portals/0/PDFs/Publications/Essentials-2021.pdf

[21] American Association of Colleges of Nursing. Adult-gerontology acute care and primary care NP competencies. 2017. Available from: https://www.aacnnursing.org/Portals/0/PDFs/Certification/AdultGeroACNPCompetencies.pdf

[22] Health Resources and Services Administration. State of the primary care workforce. 2024. Available from: https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/state-of-the-primary-care-workforce-report-2024.pdf

[23] Kucakomoldej S, Turi E, McMenamin A, et al. Primary care practice by nurse practitioners compared to physicians: A propensityscore analysis. Nurs Outlook. 2022; 70(3): 401-16. PMid:35183357 https://doi.org/10.1016/j.outlook.2021.12.008

[24] Regenbogen SE, Hirose M, Imanse JG, et al. Infectious complications of colonoscopy: A systematic review and meta-analysis. J Am Coll Surg. 2011; 213(6): 784-92. PMid:21945417 https://doi.org/10.1016/j.jamcollsurg.2011.08.013

[25] Bono MJ, Leslie SW. Uncomplicated urinary tract infections. Stat-Pearls. 2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470195/