Catheter associated urinary tract infections in intensive care units patients in a tertiary care hospital

Introduction: Catheter associated urinary tract infections (CAUTI) is the most common health care associated infection (HAI), accounting for 40% of all HAIs in particularly in patients admitted to intensive care units (ICU) due to their more frequent necessity of urinary catheterization and longer duration of catheter use. Knowledge about Microbiological profile and antimicrobial sensitivity pattern of CAUTI is essential to implement the infection control system in a proper manner.Aims and objectives: To study the rate and microbiological profile of catheter associated urinary tract infections and in patients admitted in Intensive Care Units.Materials and methods: A one-year prospective study was conducted in which urine samples were collected from patients admitted in Medical ICUs on indwelling urinary catheter for >48 hours and processed in Microbiology Department according to standard procedures. CA-UTI rate was calculated and their microbiological profile and various resistance patterns were studied as per CLSI guidelines.Results: Out of 1406 enrolled patients, 64 patients developed CAUTI. Overall CAUTI rate was 4.06/1000 catheter days. Most common isolate in CAUTI cases was Klebsiella spp. (32.3%), followed by Escherichia coli (24.6%). Gram negative isolates showed higher sensitivity to aminoglycosides, imipenam and nitrofurantoin as compared to cephalosporins The Enterococcus spp. were 100% sensitive to linezolid and 71.4% sensitive to both vancomycin and teicoplanin.Conclusion: CAUTI rate in our ICUs was high compared to the benchmarks. Antibiotic sensitivity pattern of the pathogens involved was also low. This study provides the data of predisposing risk factors and its causative microbial flora for CAUTI in our tertiary care.

Catheter associated urinary tract infection in an acute care setting of a tertiary care centre in South India

Background: Catheter associated UTI is a serious cause of morbidity and mortality in intensive care unit (ICU) patients. Hence, authors undertook the present study to know the prevalence of catheter associated urinary tract infections (CAUTI) in medical ICU patients of tertiary care centre and to know the antibiotic resistance pattern of the causative organisms.Methods: A one-year prospective study was carried out from September 2015 to August 2016. Demographic data from the catheterized patients were collected daily and scrutinized for the signs and symptoms as per CDC criteria for confirmation as CAUTI. Relevant antimicrobial resistance data of etiologic agents were also collected to ascertain the prevalent resistance pattern.Results: The overall incidence of CAUTI was 14.69 per 1000 catheterized days in the present study. Out of the 37 diagnosed CAUTI cases, 12 (32.4%) were males and 25 (67.6%) were females with maximum patients being between 40 to 60 years of age. The commonest uropathogens was Escherichia coli (n=26) followed by K. pneumoniae (n=5). Both Escherichia coli and Klebsiella pneumoniae isolates were found to be 100% resistant to cefotaxime, ceftazidime and cefuroxime. Pseudomonas aeruginosa and Acinetobacter species were least common etiological culprits and demonstrated complete resistance to all the tested antibiotics.Conclusions: In the present study the prevalence of CAUTI is much higher which needs to be rectified by continuous monitoring and training of the staff in implementation of infection control practices in a proactive manner.

Study of biofilm formation and its correlation with highly drug resistant uropathogens in catheter-associated urinary tract infection

Aims and objectives: 1. To put culture and sensitivity of urine samples from catheterised patients withsymptomatic and asymptomatic bacteriuria. 2. To detect the biofilm formation by tube adherence and tissueculture plate method. 3. To compare the antibiotic sensitivity between biofilm and non-biofilm formingorganisms. Materials and Methods: The study was conducted in the Department of Microbiology of YenepoyaMedical College and Hospital, Mangalore, India. A total of 100 bacterial isolates obtained from urine samples ofcatheterised patients were included in the study. The processing of the samples (culture and sensitivity) weredone according to standard microbiological techniques. The biofilm formation was done by tube adherence andtissue culture plate method. Results: Out of 100 uropathogens isolated, 96(96%) were Gram negative bacilli.Four isolates were Gram positive cocci. Amongst the Gram negative bacilli, E.coli were 69%, Klebsiellapneumoniae 19%, Acinetobacter species 5% and Pseudomonas aeruginosa 3%. All gram positive cocci wereEnterococci (4%). In the tube adherence method, the number of isolates showing biofilm formation was 51%and non-biofilm producers was 49%. By tissue culture plate method, the number of isolates showing biofilmformation was 63% and non-biofilm producers was 37%.The predominant organism showing biofilm formationwere K.pneumoniae(89%) followed by Acinetobacter spp. (40%).There was significant correlation betweenbiofilm formation and multi-drug resistance. Conclusion: Significant correlation between biofilm productionand multi-drug resistance was observed in our study. The study will help the clinician to take a call on nonresponding uropathogens and decide on better therapeutic options amongst those available in CAUTIs.

A study of risk factors for catheter associated urinary tract infection

Background: Catheter associated urinary tract infections (CAUTIs) are the most common causes of UTIs in postoperative cases. Many risk factors are associated with its incidence. The present study was conducted with the aim to determine the related risk factors and to identify the causative agents contributing to the urinary tract infection.Methods: This prospective study was conducted on 210 patients meeting the requirements of inclusion criteria during September 2012 to February 2014. Detailed history of the patients was recorded. Urine culture was done at different time intervals to identify the causative agent suggestive to CAUTI. Univariate analyses of the association of each variable with CAUTI and multivariable logistic regression were done to predict CAUTI outcome.Results: The mean age of study participants was 51.61 years. Among them 141 were males and 69 were female patients. On univariate analysis purpose for urine catheterization, place of catheterization, breach in the closed system of drainage, duration of catheterization, hemoglobin value less than 10, raised renal parameters with serum creatinine more than 1.5 were all significantly associated with development of CAUTI (p value 0.000). Sex of the patient (p value 0.279) and catheter size (p value 0.279) was not found to have a significant correlation with increased risk of CAUTI. On multivariate analysis, age, catheter size, diabetes, duration of catheterization, a breach in the closed system of catheter drainage and sex were found to be the significant risk factors associated with CAUTI (p<0.05).Conclusion: An understanding of the risk factors in development of CAUTI, significantly helps in reducing the additional burden on the health care system. Measures such as shortening the duration of catheterization, strict control of diabetes and sterile precautions in insertion and maintenance of indwelling catheters can help in prevention CAUTI.

Research Progress on Artifcial Conduits for Urological Application with Antibacterial Function / 中国医疗器械杂志

Artificial conduits, including ureteral stents and catheters, are used widely as drainage tools in the urinary system. However, various bacteria in the urine and long duration of insertion can arouse the biofilm formation on the pipeline surface, which calls for effective antibacterial strategy. In this article, the mechanism of Catheter Associated Urinary Tract Infections (CAUTI) is explained from the perspective of etiology. Then, the biofilm formation conditions and the features of urine are analyzed, the antibacterial agents and approaches suitable for ureteral stents and catheters are introduced and their pros and cons are discussed respectively.

Study of incidence and risk factors of urinary tract infection in catheterized patients admitted at tertiary care hospital, Nizamabad, Telangana State, India

Background: Catheter-associated urinary tract infections (CAUTIs) are the most common hospital acquired infections and a leading cause of morbidity and mortality in hospitalized patients with various life threatening complications. Hence, this study was aimed to determine the incidence, risk factors of CAUTI in a tertiary care hospital so as to find out better preventive measures to reduce the prevalence of CAUTI and their complications so as to reduce the hospital stay and mortality. Materials and methods: Present study included 200 adult patients who received indwelling urethral foley’s catheter and urinary drainage system in various wards in Government General Hospital, Nizamabad from Jan 2015 - May 2016. Patients were diagnosed to have CAUTI according to CDC guidelines to study its incidence and associated risk factors which were analyzed using multi variate analysis. Results: Overall incidence of CAUTI was 59%. The incidence of CAUTI was maximum (70.58%) in the age group of 51-70 years. The incidence of CAUTI was more (69.44%) in females and was directly proportional to the duration of catheterization. The high incidence in the present study reflects the practice of frequent disconnections of urinary closed systems. Multi-variate analysis shows age, duration of catheterization, catheter- tubing disconnections, absence of antibiotic use and renal Md. Yousuf Khan, C. Venkateshwarlu, G. Sreenivas, P. Rahul. Study of incidence and risk factors of urinary tract infection in catheterized patients admitted at tertiary care hospital, Nizamabad, Telangana State, India. IAIM, 2016; 3(8): 83-92. Page 84 insufficiencies as important risk factors for CAUTI. 88.66% of CAUTIs were asymptomatic among 75 clinically evaluable CAUTIs. Conclusion: CAUTI is an important preventable hospital acquired infection seen in all age groups however incidence increases with age, common in both sexes, incidence can be reduced by minimizing the catheter procedures, taking the maximum aseptic precautions, reducing the duration of catheterization and avoiding frequent disconnections, this becomes more significant in patients with underlying renal disease , prophylactic antibiotics prevent CAUTI. As most of the CAUTI are asymptomatic, all catheterized patients should be screened for CAUTI and be treated depending upon antibiotic sensitivity of uropathogens.

Prevention effect of CAUTI by long-acting antibacterial material JUC : a meta-analysis / 中华泌尿外科杂志

Objective The prevention effect of CAUTI by long-acting antibacterial material JUC was evaluated by meta analysis.Methods China digital hospital library full-text database,Chinese biomedical literature CD database,China hosptial knowledge database (CHKD) in China national knowledge internet (CNKI),VIP information Chinese science and technology periodical database were retrieved to fully collect the literature from 1995 to 2012 regarding JUC's prevention effect of CAUTI.The inclusion and exclusion standard of literature was made,and the effect index was made from the literature.Two researchers collected the literatures independently,and the included literatures were meta-analyzed by Review Manager 4.2 software,and the risk difference of infection rate and 95％ CI were calculated in both the treatment group and control group.Those literatures which could not be meta-analyzed were performed descriptive analysis to evaluate the efficacy of JUC objectively.Results 20 related articles were retrieved,including 1 multicenter randomized control study,18 monocentric randomized control studies,and 1 uncontrolled study.3172 cases were included with 1526 cases in control group (usual care) and 1646 cases in treatment group (usual care with JUC).The difference between the two groups is significant (RD =-0.15,95％ CI:-0.18 ～-0.13,P ＜ 0.05).Conclusions Long-acting antibacterial material JUC can diminish the incidence of CAUTI significantly.

Short Term Urinary Catheterized Patients in Intensive Care Unit (ICU) – A Need to Screen.

Catheter-Associated Urinary Tract Infection (CAUTI) is the second most commonly reported healthcare associated infection, accounting for upto 40% of all nosocomial infections. Silent catheter associated bacteriuria comprises a huge reservoir of resistant organism in hospitals particularly in critical care units. We prospectively studied 100 newly short term catheterized patients in a tertiary care hospital. Samples collected on day three and daily thereafter for semi quantitative urine culture and pus cell count. Antibiotic sensitivity was tested using Kirby-Bauer disc diffusion method. Out of hundred patients, 32 showed growth on fifth day and remaining 68 samples were culture negative up to seventh day. None of the culture positive samples had pus cells. Escherichia coli (35%) was the predominant isolate followed by Pseudomonas aeruginosa, Klebsiella pneumoniae, Enterococcus faecium, Candida spp (15% each) and Coagulase negative Staphylococcus (5%). Among the Gram negative organisms, four strains of Escherichia coli and two strains of Klebsiella pneumonia were Extended Spectrum Beta Lactamases (ESBL) producers and 33.3% were Multidrug resistant Pseudomonas aeruginosa. Multidrug resistant pathogens in an asymptomatic short term catheterized patient are a major reservoir in hospitals. This emphasizes the importance of periodic surveillance for nosocomial infections in hospital and the periodic screening will also help us to frame antibiotic policy in a new tertiary care hospital.