Nosocomial urinary tract infection in intensive care unit patients

ABSTRACT

Catheter related nosocomial urinary tract infection is considered as one of the most important hospital acquired infections. This study was designed to determine the causative organisms causing catheter associated urinary tract infection in ICU patients as well to test the pattern of the antimicrobial sensitivity of the isolated organisms. Sixty patients admitted to ICUs in Ain Shams University Hospitals over the period from February to August 2007, were enrolled in this study. A significant urinary viable count >/= 10[3] CFU/ml was revealed from 37 cases, comprising 61.7%. On the other hand, fourteen patients [23.3%] provided insignificant count and nine [15%] showed no growth. Candida was the most common isolated organism 45.7% of all isolates followed by Enterococci 18.8%, Klebsiella pneumoniae spp 16.9%, thereafter E.coli, Pseudomonas aeruginosa and Enterobacter cloaca 4.2%, each. Proteus mirabilis, Providencia stuartii and Acinetrobacter baumannii were the least isolated organisms 2%. All Enterococci isolates were highly sensitive to norfloxacin followed by gentamicin, streptomycin, vancomysin and nitrofurantoin, respectively, and were highly resistant to ampicillin, and 22.2% of isolates were resistant to vancomycin. Klebsiella pneumoniae isolates were highly sensitive to cefotaxime-calvulonic acid, ceftazidime-clavulonic acid and imipenem followed by amikacin and were highly resistant to ampicillin, ciprofloxacin, norfloxacin, ticarcillin and piperacillin followed by amoxicillin-clavulonic acid, cephalothin, cefuroxime and azteronam and then cefotaxime, ceftazidime, gentamicin, nalidixic acid and nitrofurantoin. Isolates of E.coli were sensitive to ciprofloxacin, norfloxacin, nalidixic acid, nitrofurantoin, imipenem and amikacin but resistant to ampicllin, ticarcillin and tetracycline. Isolates of Pseudomonas aeruginosa were resistant to most antimicrobials except gentamicin and aztreonam. The incidence of extended spectrum beta-lactamse production by the Gram-negative bacilli was 41.1%. Seventy five percent of Klebsiella pneumoniae isolates were ESbetaL producers. The duration of catheterization was considered as an important risk factor for catheter related nosocomial urinary tract infection and there was higher prevalence of infection among cases with catheter duration more than 4 days