Details
Category: Volume 07 Issue 10 October 2019
Hits: 1522

Title: Catheter Associated Urinary Tract Infection (CAUTI)– Incidence and Microbiological Evaluation in a Tertiary Care Hospital in Kota Region, an ICU Based Study

Authors: Dr Dinesh Verma, Dr Anita Sharma, Dr Ghanshyam Soni, Dr Saurabh Sharma

 DOI: https://dx.doi.org/10.18535/jmscr/v7i10.140

Abstract

Background: Catheter-associated urinary tract infections (CAUTIs) are the most common nosocomial infection affecting all age groups and are a leading cause of morbidity and mortality in hospitalized patients. The etiological agents are often multidrug resistant.

Objectives: 1. To find the incidence of CAUTI in intensive care unit (ICU) patients. 2. To identify etiological agents responsible for CAUTI. 3. To determine antimicrobial susceptibility pattern for bacterial agents obtained.

Methods: Urine samples from 210 clinically suspected cases of CAUTI were obtained from patients with urinary catheters admitted in ICUs. Urine samples were subjected to wet mount, culture and sensitivity testing. Responsible pathogens and their antimicrobial susceptibility pattern were obtained based on CSLI standards.

Results: The incidence of CAUTI in the present study was 16%. Higher incidence of CAUTI (55%) was found in male sex as compared to females (45%). Incidence of CAUTI was found higher as the days of catheterisation increased. Most predominant etiological agents responsible for CAUTI were E.coli  (69.69%) followed by klebsiella species (15.15%) .25% isolates among Enterobacteriaciae were ESBL producing. Uropathogens isolated from CAUTI are more resistant to antimicrobials.

Conclusions & Prevention: It is must to implement following strategy for reducing the risk of infection due to indwelling catheters: 1. reducing the duration of catheterization 2. early removal of catheters, 3. aseptic insertion 4.  maintenance of a closed urinary drainage system.5 Strict infection control measures

References

  1. Clark, A. Remarks on catheter fever. Lancet (1883). ii:1075−1077.
  2. Beeson, P. B. The case against the catheter. Am J Med (1958).
  3. Haley, R, Culver, D, White, J, Morgan, W. M, &Emori, T. G. The nationwide nosocomial infection rate: A new need for vital statistics. Am J Epidemiol (1985).
  4. Kamat US, Fereirra A, Motghare DD, Kulkarni MS. Epidemiology of hospital acquired urinary tract infections in a medical college hospital in Goa. Indian J Urology 2009; 25(1):76-80.
  5. NATIONAL CENTRE FOR DISEASE CONTROL Directorate General of Health Services Ministry of Health & Family Welfare Government of India Draft version 2017
  6. Gokula RR, Hickner JA, Smith MA. Inappropriate use of urinary catheters in elderly patients at a Midwestern community teaching hospital. Am J Infect Cont. 2004;32(4):196-9.
  7. Saint S, Lipsky BA, Goold SD. Indwelling urinary catheters: a one-point restraint Ann Intern Med. 2002;137(2):125-7.
  8. Smith J. Indwelling catheter management: From habit-based to evidence-based practice. Ostomy Wound Management. 2003;49:34-45.
  9. Kang CI, Chung DR, Son JS, Ko KS, Peck KR, Song JH, et al. Korean network for study of infectious diseases. Clinical significance of nosocomial acquisition in urinary tract-related bacteremia caused by gram-negative bacilli. Am J Infect Cont. 2011;39(2):135-40.
  10. Collee JG, Duguid JP, Fraser AG, Marmion BP, Simmons A. Laboratory strategy in the diagnosis of infective syndromes. In: Collee JG, Fraser AG, Marmion BP and Simmons A, editors. Mackey and McCartney Practical Medical Microbiology. 14thed. Churchill Livingstone, Elsevier;2006. 53-94.
  11. Forbes BA, Sahm DF, Weissfeld AS. Bailey and Scott’s Diagnostic Microbiology. 12th ed. Philadelphia; Mosby Elsevier; 2007.
  12. Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing, 25th informational supplement M100-S25. Wayne, PA, USA: CLSI; 2015.
  13. leticakriegel AS, salmasian H, Vawdrey DK et al. identifying the risk factors for catheter associated UTI; a large cross sectional study of six hospitals. BMJ open 2019; 9; e022137.doi;101136/2018.
  14. Kakaria BA et al. Int J Res Med Sci. 2018 May;6(5):1730-1733
  15. Vinoth M et al. Int J Res Med Sci. 2017 Jun;5(6):2367-2372.
  16. Sangamithra, V., Sneka, Shabana Praveen and Manonmoney. 2017. Incidence of Catheter Associated Urinary Tract Infection in Medical ICU in a Tertiary Care Hospital. Int. J. Curr. Microbiol. App.Sci. 6(4): 662-669. doi: https://doi.org/10.20546/ijcmas.2017.604.081.
  17. Benton, J., J. Chawla, S. Parry, and D. Stickler. 1992. Virulence factors in Escherichia coli from urinary tract infections in patients with spinal injuries. J. Hosp. Infect. 22:117–127.

Corresponding Author

Dr Saurabh Sharma

Assistant Professor, Department of Microbiology, Government Medical College, Kota