Incidence and Variation of Microbiological Profile of Catheter-Associated Urinary Tract Infection in Precise Comorbidities Associated with Tribal Sickle Cell Anemic Patients of Medical Intensive Care Unit in a Tribal Tertiary Care Center

Abstract

INTRODUCTION: Sickle cell anemia is a genetic hereditary disorder, with multifactorial cause for increase susceptibility, to bacterial infection leading to more intensive care unit (ICU) admission, morbidity, and mortality. When it is superadded by morbidities such as Type 2 diabetes mellitus (DM), chronic kidney disease (CKD), and chronic heart disease (CHD), chances of morbidity and mortality will increase multiple times in the ICU. AIM: The aim of this study was to find out the incidence, variation, and load in the microbiological profile of catheter-associated urinary tract infection (CAUTI), depending on the comorbidities associated with these sickle cell anemic tribal patients in the medical ICU (MICU) of a tribal tertiary care center. MATERIALS AND METHODS: This prospective study was conducted in MICU of a tribal tertiary care center from March 2019 to February 2020. It included diagnosed sickle cell anemic tribal patients with microbiologically confirmed cases of CAUTI following urinary catheterization for more than 48 h in the MICU. Demographic and clinical data of these patients were collected. Detailed investigations of the patients with antimicrobial susceptibility and resistance pattern of isolates were collected. RESULTS: In our study, the DAI rate in tribal sickle cell anemic patients was 8.7 per 1000 device days with an incidence of 7.8%. CAUTI was more common in female sex (86.7%), low socioeconomic status (80%), duration of urinary catheter up to first 7 days (66.7%), and age group above 40–60 years (33.3%). The most commonly associated microorganism was Staphylococcus aureus (46.6%) followed by Escherichia coli (13.3%) and Pseudomonas aeruginosa (13.3%). Associated comorbidities were Type 2 DM (20%), cerebrovascular accident (CVA) (20%), ST-segment elevation myocardial infarction (STEMI) (13.3%), CKD (13.3%), and CHD (6.6%). S. aureus 7 (46.6%) and Klebsiella pneumoniae 1 (6.6%) were found in Type 2 DM, Streptococcus pneumoniae 1 (50%) in STEMI, E. coli 2 (13.3%) in CKD and CVA, P. aeruginosa in 1 (6.6%) case each with CVA and septic shock, and Acinetobacter baumannii in 1 (6.6%) case with epilepsy. Resistant antibiotic was ceftriaxone 28.4% to S. aureus and 100% to E. coli. CONCLUSION: Our analysis precisely of this tribal population brings several important and unique findings, which will aid in the development of some new or update guidelines for the prevention of CAUTI to reduce morbidity and mortality in the MICU of a tribal tertiary care center.