Diagnosis of hospital acquired urinary tract infections in Gonesse PRM ward

Abstract

To assess the benefit of systematic urine cyto-bacteriological exam (UCB) screening within the 48 hours of patients’ admission in a conventional PRM ward and on day 7, to attribute the occurrence of an hospital acquired infection to the ward. A retrospective analysis of UCB results performed on entrance and on Day 7, systematically from 01/01/2013 to 12/31/2016. A questioning to look for clinical signs of urinary tract infection (UTI) was conducted. In total, 2338 UCB were performed in 1064 patients. One hundred and twenty four UCB had positive bacteriuria. Fifty-two patients have initially sterile UCB and 76 had contamination. Of 52 patients with initially sterile UCB, 3 had no control at Day 7, 19 remained sterile and 30 had positive bacteriuria. Twenty-one of the 30 patients had clinical signs of UTI (44%) and 4 of them were infected with ESBL germs (1 in 2013 and 2016, 2 in 2014). Of 76 patients with initially contamination, 17 had no control at Day 7, 45 were sterile or remained contaminated on day 7, and 14 had positive bacteriuria (24%) of which 2 had clinical signs of UTI and one of them was infected with ESBL germ (2013). Finally, 23 patients had a UTI that is to say 1% of the UCB. The systematic UCB on Day 0 and Day 7 was established to diagnose hospital acquired UTI and to determine ward accountability. This exam does not take into account the clinic although UTI diagnosis is based on clinical signs. If there is no clinical suspicion of UTI within the first 48 hours, and if the patient develops a UTI within these first 48 hours, the UTI is a hospital acquired infection and is accountable for the PRM ward, regardless of the bacterium. UCB interest dwells in germ and antibiogram analysis both for patient's treatment and for bacterial ecology monitoring of the ward and/or the establishment. The cost/benefit ratio of systematic UCB is negative: 1% of patients have an UTI associated with clinical care (clinical signs confirmed by a positive UCB). Therefore, there is no need for routine urinary screening. Clinical watchfulness must be ever-present.