Abstract
BackgroundUpdating the pathogenesis of catheter-associated bacteriuria (CA-bacteriuria) in the intensive care unit (ICU) is needed to adapt prevention strategies. Our aim was to determine whether the main pathway of CA-bacteriuria in ICU patients was endoluminal or exoluminal.In a prospective study, quantitative urine cultures were sampled from catheter sampling sites, collector bags and the catheter outer surface near the meatus from days 1 to 15 after catheterization. The endoluminal pathway was CA-bacteriuria (defined as 102 CFU/mL) first in collector bags and then in catheters. The exoluminal pathway was CA-bacteriuria first in catheters, on day 1 in early cases and after day 1 in late cases.ResultsOf 64 included patients, 20 had CA-bacteriuria. Means of catheterization days and incidence density were 6.81 days and 55.2/1000 catheter-days. Of 26 microorganisms identified, 12 (46.2%) were Gram positive cocci, 8 (30.8%) Gram negative bacilli and 6 yeasts. Three (11.5%) CA-bacteriuria were endoluminal and 23 (88.5%) exoluminal, of which 10 (38.5%) were early and 13 (50%) late. Molecular comparison confirmed culture findings. A quality audit showed good compliance with guidelines.ConclusionThe exoluminal pathway of CA-bacteriuria in ICU patients predominated and surprisingly occurred early despite good implementation of guidelines. This finding should be considered in guidelines for prevention of CA-bacteriuria.
Highlights
Updating the pathogenesis of catheter-associated bacteriuria (CA-bacteriuria) in the intensive care unit (ICU) is needed to adapt prevention strategies
CA-bacteriuria was identified in 20 patients (31.2%), of whom 15 were monomicrobial and 5 polymicrobial, corresponding to an incidence density of 55.2 per 1000 urinary catheter-days
There was no difference in patient characteristics between those with CAbacteriuria and those without, except for the sex/ratio and for the number of prescriptions of anti-infective therapy before catheterization or during patient followup (Table 1)
Summary
Updating the pathogenesis of catheter-associated bacteriuria (CA-bacteriuria) in the intensive care unit (ICU) is needed to adapt prevention strategies. Our aim was to determine whether the main pathway of CAbacteriuria in ICU patients was endoluminal or exoluminal. The endoluminal pathway was CA-bacteriuria (defined as 102 CFU/mL) first in collector bags and in catheters. Exoluminal CA-bacteriuria involves endogenous flora from the urinary meatus. Up-to-date knowledge of these pathways is needed to improve the prevention of CA-bacteriuria and CA-UTI [1, 2, 4, 19], which is one of the most frequent nosocomial infections in the ICU and is associated with a heavy health burden [1, 2, 19, 21, 22]
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call