Catheter-Associated Urinary Tract Infection: Incidence Rate And Antibiotic Sensitivity Pattern Of Bacterial Isolates In Patients Admitted In I.C.U Of Tertiary Health Care Hospital Of Jammu Province
European Journal of Molecular & Clinical Medicine,
2023, Volume 10, Issue 2, Pages 1-7
AbstractHealth care-associated infections (HCAIs) are infections that occur while receiving health care developed in a hospital or other health care facility1. HAIs are associated with increase in the cost of treatment, adverse patient outcomes, social impact, morbidity and mortality. DAIs continues to be one of the major threats to the patient safety, particularly in m of low-and middle-income countries2,3,4,5. There are four major types of healthcare associated infections which were commonly encountered. Catheter associated urinary tract infections (CAUTI), Central line associated blood stream infections (CLABSI), Ventilator associated pneumonia (VAP) and surgical site infection. Among these first three are known as device associated infections (DAIs). Around, 15-25% of hospitalized patients require urinary catheterization. The risk of developing CA-bacteriuria increases with time; with an average risk of 3-10% per catheter days to 25% at the end of one week and to nearly all cases in one month6.
For the diagnosis of CAUTI, a patient with a urinary catheter in place must meet one of two criteria: one or more of the given signs and symptoms with no other recognized causes; such as fever (temperature ≥ 38 degree Celsius), urgency, suprapubic tenderness, and urine culture positive for ≥105 cfu/mL, with no more than two microorganisms isolated; and positive dipstick analysis for leukocyte esterase or nitrate and pyuria (≥10 leukocytes/mL) with no other recognized cause. Catheter-associated urinary tract infections (CAUTIs) have accounted for as much as 40% of all nosocomial infections in the United States, affecting an estimated 800,000 patients per year. The incidence of nosocomial UTI among the 25% of hospitalized patients, who have a urinary catheter, is approximately 5% per day, with virtually all patients developing bacteriuria by 30 days of catheterization7. One of the recent study found that most catheter-associated bacteriuria was asymptomatic8. But silent catheter-associated UTIs may represent a large pool of antibiotic-resistant pathogens9 and drive a great deal of generally unnecessary antibiotic therapy. These infections increase the length of stay, hospital cost, and mortality.10According to Centre for disease control and prevention-National Healthcare Safety Network-2013 report, the mean incidence of CAUTI per 1000 catheterized days was 0-5.3% in critical care units and 0-3.1% in inpatient wards11. In India the incidence of CAUTI is 1.63-2.1 per 1000 catheter days12, 13. Broad range of bacteria can cause CAUTI. In short term catheterized patients it is monomicrobial such as gram negative bacilli like Escherichia coli, Klebsiella, Serratia, Citrobacter, and Enterobacter, Pseudomonas and Acinetobacter and gram positive cocci like Coagulase negative staphylococcus and Enterococcus. In long term catheterized patients it is polymicrobial. In addition to the pathogens of short term catheterization, it is caused by Proteus, Providencia and Morganella.6The significant risk factors for CAUTI include age, uncontrolled diabetes and long hospital stay14. Other risk factors are female gender, impaired immunity and length of duration ofcatheterization15.
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