Urinary Tract Infections and Associated Factors among Patients with Indwelling Urinary Catheters Attending Bugando Medical Centre a Tertiary Hospital in Northwestern Tanzania.

Asteria L M Ndomba,Jeremiah Seni,Rose M Laisser,Vitus Silago,Benson R Kidenya,Stephen E Mshana,Joseph Mwanga

doi:10.3390/microorganisms10020473

Asteria L M Ndomba, Jeremiah Seni + Show 5 more

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https://doi.org/10.3390/microorganisms10020473

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Abstract

Complications of indwelling urinary catheterization (IUC) are associated with significant morbidity and mortality, thus affecting patient’s well-being. Understanding the magnitude and factors associated with complications is crucial in designing appropriate preventive strategies. A cross-sectional study was conducted at Bugando Medical Centre, involving patients with long-term and short-term IUC from December 2016 to September 2017. The data were analyzed by STATA 13.0. Catheter-associated urinary tract infection (CA-UTI) was the leading (56.8%; 250/440) complication among patients with IUC. Gram-negative bacteria were predominantly isolated (98.1%, 252/257), whereas E. coli (30.7%, 79/257) and Klebsiella spp. (29.6%, 76/257) were the leading pathogens. CA-UTI was significantly higher among out-patients than in-patients (82.2% v 35.3%, p < 0.001). Older age (OR: 1.3, (95%CI: 1.1–1.5), p < 0.001), level of education (OR: 1.8, (95%CI: 1.1–3.1), p = 0.029) and catheter duration of ≥6 weeks (OR: 2.43, (95%CI: 1.1–5.5), p = 0.031) independently predicted CA-UTI among outpatients, while female gender (OR: 2.1, (95%CI: 1.2–3.7), p = 0.014), catheter bags not freely hanging (OR: 0.4, (95%CI: 0.2–0.7), p = 0.002) and residing outside Mwanza region (OR: 0.4, (95%CI: 0.2–0.6), p < 0.001) predicted CA-UTI among in-patients. CA-UTI is the common complication among patients with IUC, significantly higher in out-patients than in-patients. We recommend involving patients and carers in infection prevention and control measures in out-patients living with IUC.

Highlights

Complications of indwelling urinary catheterization (IUC) affect patients’ well-being, mostly physically, psychologically and socially [1]
Participants with long-term IUC were older than those with short-term IUC. This is due to the underlying physiological changes in the prostate gland that occur in older men, as is evidenced in this study, which shows that the majority had benign prostatic hypertrophy; they were elderly and above 60 years old, and had longterm catheterization, which subjected them to develop urinary tract infections (UTIs)
This study found that formal education level was associated with the development of complications among participants with long-term IUC

Summary

Introduction

Complications of indwelling urinary catheterization (IUC) affect patients’ well-being, mostly physically, psychologically and socially [1]. Common complications documented in several studies include catheter blockages, leakage, urethral hemorrhage, urethritis, bladder spasms, bladder calculi, vesicoureteral reflux and over the years bladder cancer [2,3]. The most frequent and serious complication is the catheter-associated urinary tract infection (CA-UTI), which is associated with reduced quality of life, increased risk of hospitalization and increased mortality [4]. CA-UTI accounts for up to 25% of healthcare-associated infections and is the most common complication for both patients with short- and long-term IUCs [5–7]. Gram-negative bacteria (GNB), notably Escherichia coli, Klebsiella species (i.e., K. aerogenes), Proteus mirabilis. Microorganisms 2022, 10, 473 and Pseudomonas aeruginosa, and Gram positive bacteria (GPB), mostly Staphylococcus aureus and Enterococcus species, are predominantly isolated causing CA-UTI [8–11].

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