Status of Nosocomial Urinary Tract Infections in the ICU: Molecular Epidemiology of Imipenem Resistant P. aeruginosa / 간호학회지

PURPOSE: This retrospective study was done to evaluate the status of nosocomial urinary tract infections and to determine the risk factors andtransmission route of causal IRPA through molecular epidemiology. METHOD: Two hundred ninety-nine of 423 patients admitted to the internal medicine and surgery ICU at a university hospital incity B had a positiveurine culture. Twelve of the 299 patients who had a urinary tract infection had IRPA strains. The data was collected from November 1, 2004 to January 31, 2005. The following results were obtained after the data was analyzed using percentile and UPGMA. RESULT: The rate of nosocomial urinary tract infections in the ICU was 10.8%. Therewere 16.8 cases of infection based on the period of hospitalization. There were 16.9 cases of infection based on the use of a foley catheter. The rate of nosocomial urinary tract infection in the ICU and urinary tract infections related to IRPA were higher in patients with the following characteristics: men, old age, admission through the emergency room, longer than seven days admission, severity of admitting causes, disturbance of consciousness, hydration less than 300cc in 24hours, a long course of antibiotics, a long period of foley catheterization and perineal care. Most of the microorganisms that caused the urinary tract infection were gram negative bacilli, among which P. aeruginosa was found in 70 patients (18.5%) and IRPA in 12 (4.0%). Among the 12 IRPA strains that were tested with PFGE, eight showed a dice coefficient higher than 80%, suggesting a genetic relationship. They were related with the period of hospitalization in the same ICU. These patients all received direct care for a urinary tract infection. CONCLUSION: Through these results, IRPA can be consideredas a contributing factors to urinary tract infections thus, active preventative measures are needed by the medical staff.

Effect of Nosocomial Infection ControI on Urinary Tract Infection in the Intensive Care Unit / 병원감염관리

BACKGROUND: Nosocomial urinary tract infection (UTI) is the most frequent nosocomial infection and could be prevented through the intensive nosocomial infection control (NIC) or restricting the use of indwelling urinary catheter. The efficiency of the intensive NIC to prevent UTI for the patients with indwelling urinary catheter was investigated. METHODS: Study population consisted of 296 patients with indwelling urinary catheter in the intensive care unit (lCU) who didn't have UTI on admission. The incidence rates of nosocomial UTI were compared between 146 patients being provided with ordinary NIC from March 15 to July 31, 1995 (control group) and 150 patients being provided with intensive NIC from January 16 to October 31, 1996 (NIC group). RESULTS: There was significant decrease in the incidence of nosocomial UTI in the NIC group (35 UTI among 150 patients, 23.8%) than in me control group (68 UTI among 146 patients, 46.6%) (P<0.01). But there were no differences in age distribution, sex, admission route to the ICU and underlying diagnoses between two groups. Interval between insertion of urinary catheter and development of UTI was significantly prolonged in the NIC group (10.0 +/- 3.5 days) than in the control group(7.6 +/- 3.9 days) (p < 0.01) despite there were no differences in the duration of urinary catheterization in two groups. The most common organism isolated from the urine of the patients was Candida tropicalis in both groups and the other organisms were in the order of Enterococcus faecium, Pseudomonas putida, Staphylococcus epidermidis in the control group and in the order of Staphylococcus aureus, Acinetobacter baumannii, Enterococcus faecalis in the NIC group. Four of five Staphylococcus aureus isolated in NIC group were MRSA. CONCLUSION: This study result confirms the efficiency of intensive NIC fur decrease in the incidence of nosocomial UTI in patients with indwelling urinary catheter. But the incidence of nosocomial UTI should be decreased further through the continuous emphasis on NIC and it seems to be necessary to study the effect of each component of NIC with proper control of the risk factors for the development of nosocomial UTI in the future.