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CATHETER ASSOCIATED URINARY TRACT INFECTION IN THE INTENSIVE CARE UNIT: INCIDENCE, RISK FACTORS AND MICROBIOLOGIC PROFILE.
ABSTRACT
Patients in the intensive care units often require the insertion of various invasive devices such as peripheral venous lines, urinary catheters and tracheal tubes for therapy and monitoring. These devices predispose them to a high risk of acquiring nosocomial infections. Catheter-associated urinary tract infection (CAUTI) is one of the commonest types of hospital-acquired infection (HAI) in the ICU, and increases cost, morbidity and mortality. This prospective observational study was aimed at determining the incidence of catheter- associated urinary tract infection with its risk factors and microbiologic profile among critically ill patients in two Intensive care units in South East Nigeria. The study was conducted over a seven -month period in the Intensive Care Units of University of Nigeria Teaching Hospital (UNTH) Ituku Ozalla , Enugu State and Federal Medical Centre(FMC), Umuahia, Abia State. Both hospitals have four- bedded ICUs but UNTH also has a four-bedded High Dependency Unit (HDU). Patients admitted into these ICUs with indwelling urinary catheters inserted in the Emergency room(ER), Operating Room (OR) or ICU who met the inclusion criteria were enrolled for the study.
The first catheter urine sample was collected aseptically from each patient and sent for microscopy, culture and sensitivity (mcs) to ascertain the baseline urine status. The patients whose base line samples had microbial growth were excluded as the study was aimed at UTI acquired in the ICU. A total of ninety six patients were enrolled, 26 patients either had microbial growth in their first samples or demised before the collection of the second sample and had to be excluded from the study. Seventy patients concluded the study. A total of 25 (35.71%) of the 70 subjects had microbial growth in their second or third sample giving an incidence of 36%.Four (13.79%) of 29 whose duration of admission/catheterization was 48 hours to 72 hours had CAUTI, while 21(51.22%) of 41 whose duration of admission was up to 5-7days had CAUTI. Twenty eight (28) organisms were isolated and include Candida species, 12(42.87); Staphylococcus aureus, 4(14.29);Klebsiella species,3(10.71%); Escherichia coli 2(7.14%); others
7(25.00%). The bacterial isolates were mostly susceptible to Nitrofurantoin. The organisms showed a high resistance to the antibiotics tested.
The most predominant organism grown from ICU fomites was Staphylococcus aureus and the fomite most affected was the suction machine. This study showed a high incidence of CAUTI in ICU with duration of admission /catheterization as the only statistically significant risk factor. It also confirmed the presence of pathogens on ICU fomites which could be continuous sources of cross-infection affecting both patients and health care givers. Institution guidelines for the care and monitoring of urethral catheterization are therefore desirable and urinary catheters should be removed once they are no longer needed. Nitrofurantoin can be used for the empirical treatment of UTI in our environment while awaiting urine microscopy, culture and sensitivity results.
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