Abstract
BackgroundCritically ill patients including trauma patients are at high risk of urinary tract infection (UTI). The composition of urine in trauma patients may be modified due to inflammation, systemic stress, rhabdomyolysis, life support treatment and/or urinary catheter insertion.MethodsProspective, single-centre, observational study conducted in patients with severe trauma and without a history of UTIs or recent antibiotic treatment. The 24-hour urine samples were collected on the first and the fifth days and the growth of Escherichia coli in urine from patients and healthy volunteers was compared. Biochemical and hormonal modifications in urine that could potentially influence bacterial growth were explored.ResultsGrowth of E. coli in urine from trauma patients was significantly higher on days 1 and 5 than in urine of healthy volunteers. Several significant modifications of urine composition could explain these findings. On days 1 and 5, trauma patients had an increase in glycosuria, in urine iron concentration, and in the concentrations of several amino acids compared to healthy volunteers. On day 1, the urinary osmotic pressure was significantly lower than for healthy volunteers.ConclusionWe showed that urine of trauma patients facilitated growth of E. coli when compared to urine from healthy volunteers. This effect was present in the first 24 hours and until at least the fifth day after trauma. This phenomenon may be involved in the pathophysiology of UTIs in trauma patients. Further studies are required to define the exact causes of such modifications.
Highlights
Ill patients including trauma patients are at high risk of urinary tract infection (UTI)
Patients were not included if (i) antibiotic therapy was predicted to be necessary for clinical care when admitted to the intensive care unit (ICU), (ii) hospitalization occurred before ICU admission, (iii) the expected duration of stay in the ICU was shorter than 5 days, (iv) they were less than 18 years of age or pregnant, or (v) they had genitourinary trauma
This study demonstrates that urine of trauma patients supports E. coli growth better than urine from healthy volunteers
Summary
Ill patients including trauma patients are at high risk of urinary tract infection (UTI). Urinary tract infections (UTIs) are the most common infections acquired by hospitalized adult patients, with an estimated prevalence as high as 10%. Urinary catheterisation is a major identified risk factor of urosepsis because its presence allows bacteria to colonise the urinary tract [6]. The other identified independent risk factors for bacteriuria in the intensive care unit (ICU) are gender (female), length of ICU stay, and severity score at admission [7]. The ability of urine from seriously ill patients to support bacterial growth may play an important role in the occurrence of UTIs. But, the role of urine composition in bacterial proliferation in critically ill patients has not been studied
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