Nosocomial Urinary Tract Infections Research Articles

Frequency and antibiotic resistance pattern in gram positive uropathogenes isolated from hospitalized patients with urinary tract infection in Tehran, Iran

Background: Urinary tract infection (UTI) is one of the most frequent types of nosocomial infections. The main purpose of this study was to determinate the frequency of gram positive cocci in urine obtained from hospitalized patients and their susceptibility patterns to antimicrobial agents. Material & Methods: During a 12 months study, 316 clinical isolates of gram positive cocci were recovered from 765 urine specimens of hospitalized patients with UTI. In vitro susceptibility of gram positive cocci isolates to 10 antimicrobial agents Ampicilin; Cephalothin; Ceftriaxone; Nitofurantoin; Erythromycin; Norfloxacin; Gentamicin; Vancomycin; Sulfamethoxazole-trimethoprim and Chloramphenicol was performed using the Kirby-Bauer’s Disk diffusion method according to Clinical and Laboratory Standards Institute (CLSI) criteria. Results: Out of 3233 urine samples of hospitalized patients 765 (23.7%) patients were showed to be urine culture positive. The frequency of Staphylococcus aureus, Enterococcus spp, Coagulase-negative staphylococci (CoNS) and Streptococcus group B were 24.7%; 8.7%, 4.1% and 3.6%. All of gram-positive cocci with the exception of Enterococcus spp (11.9%) were sensitive to vancomycin. All of Streptococcus group B and CoNS isolates were sensitive to nitrofurantoin. Conclusion: The present study exhibited that Staphylococcus aureus is the most common causative agents of nosocomial UTI. Vancomycin and nitrofurantoin seem to be the most effective drugs for treatment of gram positive cocci causing UTI.

Characterization of Escherichia coli Isolates from Hospital Inpatients or Outpatients with Urinary Tract Infection

Uropathogenic Escherichia coli (UPEC) is the most common cause of community- and hospital-acquired urinary tract infections (UTIs). Isolates from uncomplicated community-acquired UTIs express a variety of virulence traits that promote the efficient colonization of the urinary tract. In contrast, nosocomial UTIs can be caused by E. coli strains that differ in their virulence traits from the community-acquired UTI isolates. UPEC virulence markers are used to distinguish these facultative extraintestinal pathogens, which belong to the intestinal flora of many healthy individuals, from intestinal pathogenic E. coli (IPEC). IPEC is a diarrheagenic pathogen with a characteristic virulence gene set that is absent in UPEC. Here, we characterized 265 isolates from patients with UTIs during inpatient or outpatient treatment at a hospital regarding their phylogenies and IPEC or UPEC virulence traits. Interestingly, 28 of these isolates (10.6%) carried typical IPEC virulence genes that are characteristic of enteroaggregative E. coli (EAEC), Shiga toxin-producing E. coli (STEC), and atypical enteropathogenic E. coli (aEPEC), although IPEC is not considered a uropathogen. Twenty-three isolates harbored the astA gene coding for the EAEC heat-stable enterotoxin 1 (EAST1), and most of them carried virulence genes that are characteristic of UPEC and/or EAEC. Our results indicate that UPEC isolates from hospital patients differ from archetypal community-acquired isolates from uncomplicated UTIs by their spectrum of virulence traits. They represent a diverse group, including EAEC, as well as other IPEC pathotypes, which in addition contain typical UPEC virulence genes. The combination of typical extraintestinal pathogenic E. coli (ExPEC) and IPEC virulence determinants in some isolates demonstrates the marked genome plasticity of E. coli and calls for a reevaluation of the strict pathotype classification of EAEC.

Probiotic Use and Prevalence of Candidemia and Candiduria in a PICU

To compare the prevalence of candidemia and candiduria before and after the introduction of routine use of probiotics in children who received broad-spectrum antibiotics in a PICU. Retrospective "before and after" study. A 12-bed PICU of a teaching hospital in India. Children 3 months to 12 years old, admitted to the PICU over two 9 months' time periods, who received broad-spectrum antibiotics for more than 48 hours. Three hundred forty-four patients enrolled between November 2008 and July 2009 after the introduction of routine use of probiotics served as the "probiotic group"; they had received one sachet twice a day of a probiotic mix (EUGI [Wallace Pharma, Goa, India] containing Lactobacillus acidophillus, Lactobacillus rhamnosum, Bifidobacterium longum, Bifidobacterium bifidum, Saccharomyces boulardii, and Streptococcus thermophilus) for 7 days. Three hundred seventy-six children enrolled between February 2007 and October 2007 served as "controls." Blood was sent for bacterial and fungal cultures if clinically indicated and urine catheter/bag specimen was submitted for bacterial and fungal culture twice a week as per unit's protocol. Primary outcome was growth of Candida in blood (candidemia), and secondary outcomes were growth of Candida in urine (candiduria), nosocomial bloodstream infections, and urinary tract infections. Data were retrieved from the case records. Candidemia was seen in four of 344 patients (1.2%) in the probiotic group and in 14 of 376 (3.7%) in the control group (relative risk, 0.31; 95% CI, 0.10-0.94; p = 0.03). Candiduria was noted in 37 of 344 patients (10.7%) in the probiotic group and 83 of 376 (22%) in the control group (relative risk, 0.48; 95% CI, 0.34-0.7; p = 0.0001). The prevalence of nosocomial bloodstream infection and urinary tract infection in the probiotic and control groups was 20.3% and 26% (p = 0.07) and 14.2% and 19.1% (p = 0.08), respectively. Routine use of a mix of probiotics in patients who receive broad-spectrum antibiotics could be a useful strategy to reduce the prevalence of candidemia and candiduria in the PICU.

Türkiye’de İdrar Kültürlerinden İzole Edilen Escherichia coli Suşlarının Antibiyotiklere Direnç Durumu: Bir Meta-Analiz

Escherichia coli is the most frequently isolated microorganism from both community-acquired and nosocomial urinary tract infections in Turkey. A large number of studies concerning antibiotic susceptibility of E.coli have been published from different centers throughout the country. The aim of this study was to evaluate the antibiotic resistance patterns of E.coli strains isolated from urine cultures by a meta-analysis in published medical literature between the years of 1996-2012 in Turkey. The study was planned and conducted in accordance with the declaration of PRISMA and describes the methods of literature search, the determining criteria for inclusion and evaluation of articles, data collection and statistical analysis. To find the published series Google Scholar and PubMed international databases were used to access published manuscripts evaluated according to the determined criteria for acceptance and rejection. For each study, general data and antibiotic resistance rates were collected as a common unit. Publications considered as lacking in appropriate content was eliminated from the study. Statistical analysis of the data obtained were 95% confidence intervals, and p≤ 0.05 value was considered as significant difference. A total of 228 articles were found to be published during 1996-2012 period, while 101 of them were included in the meta-analysis according to the eligibility criteria. The analyses indicated that nitrofurantoin and piperacillin resistance rates have been decreased, whereas ciprofloxacin, cefepime, co-trimoxazole and extended-spectrum beta-lactamase (ESBL) positivity rates have been increased during the study period. The increases in the rates of ciprofloxacin and cefepime resistance and and ESBL production were statistically-significant (p< 0.05). A significant reduction in resistance rates for ampicilin, amoxicillin-clavulanate, and amikacin was noted in pediatric patients between 2002-2012. Ceftriaxone, imipenem, gentamicin and amikacin resistance were not homogenous between the geographical regions, and statistically significant differences were observed for amoxicillin-clavulanate, cefuroxime and ciprofloxacin resistance rates (p< 0.05). Antibiotic resistance rates, except for imipenem, in bacterial strains, isolated from hospitalized patients were found significantly higher in strains obtained from outpatients. The differences between those groups were significant in terms of ampicilin, amoxicillin-clavulanate, cefuroxime, ceftriaxone, trimethoprim-sulfamethoxazole, gentamicin, ciprofloxacin, amikacin and cefepime resistances (p< 0.05). It has been noted that antibiotic resistance patterns of E.coli strains isolated from urine cultures between 1996-2012 demonstrated significant variability, and many studies were based only on laboratory data. The results of this meta-analysis demonstrated that the resistance rates in commonly-used antibiotics for empirical therapy were high. In conclusion, information obtained by systematic evaluation of national data will be valuable for the determination of optimal antibiotic regimens and in prevention of unnecessary antibiotic use.

English

Enterococcal UTI is a well-known source of fatal bacteraemia & endocarditis. OBJECTIVE: Identification of different species of Enterococci causing nosocomial urinary tract infection in a tertiary care hospital along with antibiotic susceptibility pattern. METHODS: Admitted patients developing symptoms of UTI atleast after 48 hours of admission were included in this study over a period from January-June 2013.Urine samples collected in appropriate sterile manner were screened for pus cells and bacteria followed by speciation according to Facklam-Collins scheme. Enterococcal isolates were preserved in CTA until tested by VITEK2 (bioMerieux) with AES to confirm the speciation. Antibiogram was performed by disk diffusion method (modified Kirby -Bauer technique) on Muller-Hinton agar and blood agar media. MIC of the tested antibiotics was detected by VITEK 2 with AES which provides accurate fingerprint recognition of bacterial resistance. RESULTS: Out of total 187 urine samples, 34 were culture positive (18%) of which Enterococci were isolated in 9 cases (26.4%); E nterococ cus f aec alis & Enteroc occ us f aec ium four each along with one E nteroc occ us gallinarum strain. Isolated E nterococc us gallinarum and all isolated E nterococc us f aec alis were sensitive to Penicillin group of drugs, although all isolated Enterococcus faecium were resistant to them. None of the Enterococcal isolates produced β- lactamase. In isolated Enterococcus gallinarum and one Enterococcus faecalis isolate, MIC value of Ampicillin was double that of Benzyl-penicillin. Isolated Enterococcus gallinarum was the only Vancomycin resistant Enterococcus strain. According to VITEK2 AEC, it was of vanA type with MIC ≥32μg/ml. All four Enterococcus faecalis isolates were resistant to Quinupristin & Dalfopristin whereas isolated Enterococcus faecium were sensitive to those antimicrobials. All of the isolates were sensitive to Nitrofurantoin except one Enterococcus faecium isolate (MIC value 64μg/ml) and Enterococcus gallinarum isolate (MIC value 64μg/ml), both of which were intermediately susceptible to the drug. CONCLUSION: Four E nterococ cal isolates were susceptible to Ampicillin and Aminoglycosides (high level synergy) suggesting use of combination therapy of Ampicillin and Aminoglycosides for treatment. Vancomycin and Linezolid are the only available drugs for treatment of isolates resistant to both or any one of the drugs Ampicillin and Aminoglycosides (high level synergy). To treat VRE, Linezolid may be prescribed.

Cranberry-derived proanthocyanidins prevent formation of Candida albicans biofilms in artificial urine through biofilm- and adherence-specific mechanisms

Candida albicans is a common cause of nosocomial urinary tract infections (UTIs) and is responsible for increased morbidity and healthcare costs. Moreover, the US Centers for Medicare & Medicaid Services no longer reimburse for hospital-acquired catheter-associated UTIs. Thus, development of specific approaches for the prevention of Candida urinary infections is needed. Cranberry juice-derived proanthocyanidins (PACs) have efficacy in the prevention of bacterial UTIs, partially due to anti-adherence properties, but there are limited data on their use for the prevention and/or treatment of Candida UTIs. Therefore, we sought to systematically assess the in vitro effect of cranberry-derived PACs on C. albicans biofilm formation in artificial urine. C. albicans biofilms in artificial urine were coincubated with cranberry PACs at serially increasing concentrations and biofilm metabolic activity was assessed using the XTT assay in static microplate and silicone disc models. Cranberry PAC concentrations of ≥16 mg/L significantly reduced biofilm formation in all C. albicans strains tested, with a paradoxical effect observed at high concentrations in two clinical isolates. Further, cranberry PACs were additive in combination with traditional antifungals. Cranberry PACs reduced C. albicans adherence to both polystyrene and silicone. Supplementation of the medium with iron reduced the efficacy of cranberry PACs against biofilms. These findings indicate that cranberry PACs have excellent in vitro activity against C. albicans biofilm formation in artificial urine. We present preliminary evidence that cranberry PAC activity against C. albicans biofilm formation is due to anti-adherence properties and/or iron chelation.

S70 Antimicrobial susceptibility pattern of nosocomial urinary tract infections in patients with spinal cord injury in a rehabilitation setting

S70 Antimicrobial susceptibility pattern of nosocomial urinary tract infections in patients with spinal cord injury in a rehabilitation setting

Resistance patterns of nosocomial urinary tract infections in urology departments: 8-year results of the global prevalence of infections in urology study

To present the worldwide antibiotic resistance rates of uropathogens reported in nosocomial urinary tract infections (NAUTI) during the period of 2003-2010. Data from the Global Prevalence Study of Infections in Urology from the period of 2003-2010 were analyzed to evaluate the resistance rates of pathogens causing NAUTI. The web-based application was used to record data of investigators from urology departments participating in the study every year during the days allocated in November. Each center was allowed to enter data on a single day of the study. The point prevalence data was used to find differences among geographic regions and years by utilizing multiple logistic regression analysis. A total of 19,756 patients were hospitalized during the study period, and in 1,866 of them, NAUTI was reported. Proof of infection was reported in 1,395 patients. Resistance rates of all antibiotics tested other than imipenem against the total bacterial spectrum were higher than 10 % in all regions. Resistance to almost all pathogens was lowest in North Europe, and there is no single year where an outbreak of resistance has been detected. The resistance rates of most of the uropathogens against the antibiotics tested did not show significant trends of increase or decrease with Asia exhibiting the highest rates in general. The only antibiotic tested with an overall resistance rate below 10 % was imipenem. Knowledge of regional and local resistance data and prudent use of antibiotics are necessary to optimize antibiotic therapy in urological patients with NAUTI.

Intermittent versus indwelling urinary catheterisation in hip surgery patients: A randomised controlled trial with cost-effectiveness analysis

BackgroundHip surgery is associated with the risk of postoperative urinary retention. To avoid urinary retention hip surgery patients undergo urinary catheterisation. Urinary catheterisation, however, is associated with increased risk for urinary tract infection (UTI). At present, there is limited evidence for whether intermittent or indwelling urinary catheterisation is the preferred choice for short-term bladder drainage in patients undergoing hip surgery. ObjectivesThe aim of the study was to investigate differences between intermittent and indwelling urinary catheterisation in hip surgery patients in relation to nosocomial UTI and cost-effectiveness. DesignRandomised controlled trial with cost-effectiveness analysis. SettingThe study was carried out at an orthopaedic department at a Swedish University Hospital. MethodsOne hundred and seventy hip surgery patients (patients with fractures or with osteoarthritis) were randomly allocated to either intermittent or indwelling urinary catheterisation. Data collection took place at four time points: during stay in hospital, at discharge and at 4 weeks and 4 months after discharge. ResultsEighteen patients contracted nosocomial UTIs, 8 in the intermittent catheterisation group and 10 in the indwelling catheterisation group (absolute difference 2.4%, 95% CI −6.9–11.6%) The patients in the intermittent catheterisation group were more often catheterised (p<0.001) and required more bladder scans (p<0.001) but regained normal bladder function sooner than the patients in the indwelling catheterisation group (p<0.001). Fourteen percent of the patients in the intermittent group did not need any catheterisation. Cost-effectiveness was similar between the indwelling and intermittent urinary catheterisation methods. ConclusionsBoth indwelling and intermittent methods could be appropriate in clinical practice. Both methods have advantages and disadvantages but by not using routine indwelling catheterisation, unnecessary catheterisations might be avoided in this patient group.

P021: Effect of urinary tract infections at multiresistant bacteria (MRB) in hospital of Dakar

Results During the study period, 123 patients were followed up and 79 urine samples were made corresponding to 56.4% of all diagnostic samples. The average age of patients was 55 ± 21.22 and sex ratio of 0.97. Thirty-nine percent of patients were admitted with a neurological disorder. These patients were referred by another health facility (56.3%) came from home (34.4%) or had undergone internal transfer (9.4%). The attack rate of urinary tract infections was 3.96. These urinary tract infections were of nosocomial acquisition in 56 cases (78.9%) with an average delay of 12.75 days. The bacteria isolated were Enterobacteriaceae 61 (77.2%), non-fermenting Gram-negative bacilli 14 (17.7%) and staphylococci 4 (5.1%). In order of frequency, these were Escherichia coli 25 (31.6%), Klebsiella pneumoniae 21 (26.6%), Pseudomonas 8 (10.2%) and Enterobacter 5 (6.3%). We found 32 strains (40.5%) producing extended-spectrum beta-lactamase (ESBL) and 2 strains (2.5%) of Staphylococcus aureus resistant to methicillin (MRSA). From urinary tract infections associated with ESBL Enterobacteriaceae urinary catheter was potentially the source of infection in 18 cases. BMR attack rate was 1.80 per 100 admissions and the incidence rate of 1.99 BMR for 1000 days patients. To wane, 18 patients or 30% died. Conclusion The decrease in the incidence of nosocomial urinary tract infections must be accompanied by antibiotic stewardship and a strict hygiene policy. Disclosure of interest None declared.

Nosocomial urinary tract infections caused by Pseudomonas aeruginosa and Acinetobacter species: Sensitivity to antibiotics and risk factors

Pseudomonas aeruginosa and Acinetobacter species frequently cause intrahospital urinary tract infections (IUTI), contributing to increased hospital morbidity and mortality. Our objective was further exploration of possible risk factors for development of IUTI caused by P aeruginosa and Acinetobacter spp, including their resistance to various antibiotics. The prospective case control study was conducted in Clinical Center Kragujevac, Serbia, during the period January 2009 to December 2011 and covered all patients with IUTI according to the Centers for Disease Control and Prevention criteria. The patients classified as "cases" had an IUTI caused by P aeruginosa or Acinetobacter spp. The control patients were matched to the cases and selected randomly from the remaining patients. There were 79 cases (11.9%) and 586 (88.1%) controls in the study. According to the multivariate binary logistic regression, there were 3 significant predictors of P aeruginosa and Acinetobacter spp IUTI: male sex (odds ratio [OR], 0.423; 95% confidence interval [CI]: 0.251-0.711; P = .001), stay in another hospital ward before emergence of IUTI (OR, 1.704; 95% CI: 1.013-2.864; P = .044), and previous use of penicillins and their combinations with inhibitors of β-lactamases (OR, 2.643; 95% CI: 1.044-6.692; P = .040). Knowing that IUTI caused by above-mentioned bacteria are especially frequent among male patients, after previous use of penicillins, and in patients who spent some time previously at other wards, sound strategies for prevention of such infections in clinical practice should be developed.

Evaluation of the bacterial distribution within the biofilm by denaturing gradient gel electrophoresis in the rat model of urinary catheters

Most nosocomial urinary tract infections are related to urinary catheters and their biofilm. For the research in this province, animal models are needed to explain the host-pathogen interactions and have an advantage in controlling external interference. This study investigated the validity of the denaturing gradient gel electrophoresis (DGGE) technique for identification of bacteria in a rat model of urinary catheter biofilm. After cutting with aseptic technique, the 24-gauge polyurethane IV catheter was placed in the female rat bladder through the urethra. The catheters were kept in the bladder for 2, 4, or 6 weeks for each group. The genomic DNA was isolated from harvested biofilm of the extracted catheter, and DGGE was performed. The band patterns of DGGE results were analysed, and the sequences were compared using the BLAST from the NCBI. The results show that Pseudomonas aerusinosa, Escherichia coli, Enterococcus spp., and Corynebacterium sp. were the dominant bacterial species, regardless of the indwelling periods, and other species of bacteria, including Burkholderia and Achromobacter, were identified. The changes in bacterial distribution for the different indwelling periods were non-specific. This study using rat model of urinary catheter suggests that DGGE is a useful method in the analysis of the bacterial community in biofilms. Molecular techniques, including DGGE, are valuable to identify fastidious bacteria in the urinary catheter biofilm. This study may be used as fundamental data for studies involving human materials hereafter.

Differences in the antibiotic susceptibility of human Escherichia coli with poultry-associated and non-poultry-associated extended-spectrum beta-lactamases

The concurrent presence of bla CTX-M-1 and bla TEM-52 genes on similar plasmids of Escherichia coli isolated from poultry, chicken meat and humans supports the occurrence of food-borne transmission of extended-spectrum beta-lactamase (ESBL) genes. ESBL-producing E. coli (ESBL-E. coli) are most frequently detected in hospitalised patients and are known to spread in healthcare settings. We hypothesised that poultry-associated (PA) ESBL genes are predominant in the community, where acquisition is fuelled by food contamination, whereas non-PA ESBL genes are predominant in hospitals, with acquisition fuelled by cross-transmission. Then, differences in antimicrobial selective pressure in hospitals and poultry would create differences in co-resistance between PA and non-PA ESBL-E. coli. We, therefore, determined the prevalence and co-resistance of PA and non-PA ESBL-E. coli in community-acquired and nosocomial urinary tract infections in humans and bla CTX-M-1 and bla TEM-52 isolates from poultry. A total of 134 human ESBL-E. coli urine isolates were included in this study. Isolates containing bla CTX-M-1 or bla TEM-52 were considered to be PA, with the remainder being non-PA. Also, 72 poultry ESBL-E. coli were included. Minimum inhibitory concentration (MIC) values were determined by broth microdilution. The prevalence of PA ESBL genes in isolates obtained in general practice and hospitals was 28% versus 30% (n.s.). Human PA ESBL-E. coli were more frequently susceptible to ciprofloxacin (51% vs. 25%; p = 0.0056), gentamicin (86% vs. 63%; p = .0.0082), tobramycin (91% vs. 34%; p = 0.0001) and amikacin (98% vs. 67%; p = 0.0001) compared to human non-PA ESBL-E. coli. PA ESBL-E. coli are not more prevalent in community acquired than nosocomial urine samples, but are more often susceptible to ciprofloxacin and aminoglycosides than non-PA ESBL-E. coli. This does not support the existence of different reservoirs of ESBL genes.

A case-control study of risk factors of nosocomial urinary tract infection due to ESBLs-producing Escherichia coli and the measures for intervention

Objective To explore the risk factors and control effects of nosocomial urinary tract infection due to ESBLs-producing Escherichia coli.Methods 46 patients with nosocomial urinary tract infection due to ESBLs-producing Escherichia coli were assigned to the study group,and another 46 patients with the same urinary tract infection not due to ESBLs-producing Escherichia coli were assigned to the control group.A case-control study was conducted.Conditional logistic regression was used to screen the risk factors of nosocomial urinary tract infection due to ESBLs-producing Escherichia coli; and the corresponding control techniques were applied to assess the results of infection control prospectively.Results Longer length of hospital stay,uses of indwelling urinary tube,early use of the third generation cephalosporin,and use of multiple antibacterials (≥ 3 types) had a statistical significance by univariate and multi-univariate analysis.After the corresponding control measures were taken,the detection rate of ESBLs-producing strains of Escherichia coli declined from 57％ in 2011 to 31％ in 2012.Conclusions Longer length of hospital stays,use of indwelling urinary tube,early use of the third generation cephalosporin,and use of multiple antibacterials (≥ 3 types) are the independent risk factors for nosocomial urinary tract infection due to ESBLs-producing Escherichia coli.Strengthened awareness of ESBLs-producing strains,termination of transmission route,strict control of broad-spectrum antibiotic uses,correct placement of urinary tube,and shorter length of hospital stay are effective measures for controlling nosocomial urinary tract infection due to ESBLs-producing Escherichia coli. Key words: Urinary tract; ESBLs-producing Escherichia coli; Nosocomial infection; Risk factors; Case-control; Intervenion measures

Flächendesinfektion im Kontext von Infektionsprävention auf Intensivstationen

The highest proportion of nosocomial infections occurs on intensive care units (ICU) and infections with multiresistant pathogens are an ever increasing problem. Preventative measures should consist of a bundle of different measures including measures that address a specific problem and standard hygiene measures that are relevant in all areas. Specific measures in ICUs primarily aim at the prevention of ventilator associated pneumonia, blood vessel catheter associated infections and nosocomial urinary tract infections. Surface disinfection belongs to the standard hygiene measures and plays an inferior role compared to hand hygiene; however, surfaces come into focus in outbreak situations. The Commission on Hospital Hygiene (KRINKO) at the Robert Koch Institute (the German health protection agency) published recommendations regarding the cleaning and disinfection of surfaces. The frequency with which cleaning and/or disinfection is required varies according to defined areas of risk. The frequency and the disinfection agents used are documented in the disinfection plan.

Infecciones del tracto urinario nosocomiales

Nosocomial urinary tract infections (UTI) are mainly related to urinary catheterisation. In this paper we review the pathogenic mechanisms, particularly the route by which the microorganisms colonise the urinary tract, their adhesion ability, and their capacity to form biofilms, and are related not only to the microorganism but also to the type of urinary catheter. The aetiology of catheter related UTI is variable, and multiresistant microorganisms are often isolated, making empirical antibiotic therapy complex. Clinical findings are frequently atypical, and its diagnosis is difficult. The therapeutic management of catheter-related UTI should be stratified according to the type of UTI: asymptomatic bacteriuria should not be habitually treated, but patients with septic shock should receive a broad spectrum antibiotic. In this review, the value of the different preventive measures are discussed.

Evaluation of the Treatment of Vancomycin-Resistant Enterococcal Urinary Tract Infections in a Large Academic Medical Center

Vancomycin-resistant enterococci (VRE) are a common cause of nosocomial urinary tract infections (UTIs) among hospitalized patients. Clinicians need to differentiate between VRE-associated urinary colonization, asymptomatic bacteriuria, and UTIs to determine the need for treatment and length of therapy. To characterize the diagnosis and management of VRE from urinary sources, including compliance with institutional treatment guidelines, and identify risk factors associated with clinical failure. We performed a retrospective, single-center, cohort study among patients with VRE-positive cultures from urinary sources over a 3-year study period (July 2008-September 2011). Descriptive statistics were used to evaluate demographics, diagnostics, guideline compliance, pharmacotherapy, and outcomes. Risk factors associated with clinical failure were identified by multivariate logistic regression analysis. Two hundred sixty-nine distinct episodes of VRE met inclusion criteria among 252 patients. Forty-seven percent and 77% of episodes occurred in patients admitted to an intensive care unit and hospitalized for 7 or more days, respectively. Fifty-eight percent of the episodes were classified as asymptomatic bacteriuria or colonization. Compliance with institutional treatment guidelines for the appropriate drug, dose, and duration occurred in approximately 70% of the cases. Among noncompliant cases (n = 83), 48 (58%) were overtreated, and 35 (42%) were undertreated. Clinical failure among all cases was common, including mortality (17.1%). Factors independently associated with clinical failure determined on multivariate analysis included weight 100 kg or more (OR 5.30; 95% CI 1.42-12.21; p = 0.014), renal disease (OR 2.57; 95% CI 1.02-6.47; p = 0.048), indwelling catheter (OR 4.62; 95% CI 1.05-18.24; p = 0.046), and VRE bloodstream infection (OR 15.71; 95% CI 2.9-128.7; p < 0 .001). Improved education is needed to minimize cases of overtreatment and undertreatment of VRE-associated UTIs and decrease inappropriate drug-related costs and clinical failure rates. Risk factors for clinical failure can be used to risk stratify VRE-associated UTIs and further guide treatment decisions.

Hospital-acquired urinary tract infection point prevalence in Turkey: Differences in risk factors among patient groups

BackgroundThe aim of this study was to determine the point prevalence of nosocomial urinary tract infections (UTIs) and to investigate risk factors for pathogen type (E. coli vs. others) and extended-spectrum beta-lactamase (ESBL) positivity among nosocomial UTI patients.MethodsA questionnaire consisting of 44 questions on demographic data and risk factors of UTI cases was sent to 51 tertiary care hospitals. Univariate and multivariate analyses were conducted.ResultsThe overall prevalence of UTI was 1.82% (483/26534). The prevalence of UTI was higher in intensive care units (ICUs) with 6.77% versus 1.45% outside ICUs. Hospitals of the Ministry of Health (compared to university hospitals), hospitals in less developed provinces and hospitals with bed capacity < 500 had higher UTI prevalence. Patients without a urinary catheter were more likely to have received immunosuppressive therapy, current corticosteroid use, renal transplantation and uterine prolapsus and less likely to have another infection outside the urinary tract, as compared to catheterized patients. Among the 422 culture-positive patients, the most common pathogen was E. coli (45.5%). The risk factors increasing the likelihood of E. coli in urine culture were being female, history of urinary tract operation, no use of antibiotics in the preceding three months and infection outside the urinary tract. There were 247 patients with E. coli or Klebsiella spp. positive in culture. Among these, 61% (n=151) were ESBL- positive. Among patients having E. coli/Klebsiella positive in culture, antibiotic use in the preceding three months and history of urinary tract operation were the independent risk factors significantly increasing the risk of ESBL.ConclusionsThe reasons underlying the high prevalence of nosocomial UTIs, and a better understanding of the risk factors might lead to improved control of these infections.

Factors That Affect Nosocomial Catheter-Associated Urinary Tract Infection in Intensive Care Units: 2-Year Experience at a Single Center

PurposeThis study took a retrospective approach to investigate patients with catheter-associated urinary tract infection (CAUTI) over 2 years at a single hospital's intensive care unit (ICU) to identify meaningful risk factors and causative organisms.Materials and MethodsA retrograde analysis was performed on patients with indwelling catheters between January 2009 and December 2010 in Yeouido St. Mary Hospital medical and surgical ICU. CAUTI was defined as isolated bacterial growth of 100,000 colony-forming units or more either 48 hours after transfer to the ICU if a urinary catheter was placed before the transfer or 48 hours after insertion if the catheter was inserted in the ICU. Only the patients whose culture results were negative before ICU admission were included.ResultsThere were a total of 1,315 patients with indwelling urinary catheters in our hospital's medical and surgical ICU between January 2009 and December 2010. Of these patients, 241 had positive urine culture results, and 61 had CAUTI. Using multivariate logistic regression analysis, those with diabetes were 4.55 (p<0.001) times as likely to have occurrences of CAUTI than were those without and also had a 1.10-fold (p<0.01) longer duration of an indwelling catheter. Upon urine culture, among the 61 patients with CAUTI, Escherichia coli was the most common bacterium grown; it was identified in 24 patients (38.7%).ConclusionsThe factors and causative organisms contributing to the development of CAUTI in the management of ICU patients must be considered to prevent the occurrence of UTIs in this setting.

Evaluation of Bactereuria and Antimicrobial Susceptibility among Hospitalized Patients With and Without Catheter in Kerman Province- Iran in 2011.

Nearly 15% to 25% of patients in general hospitals have a catheter at some time during their stay. Up to 97% of nosocomial urinary tract infections (UTIs) are related to catheter. The type of bacteremia is usually polymicrobial which makes the treatment more difficult. Previous studies showed an increase in mortality from bacteremia in these patients. The aim of the present study was to compare the prevalence of UTIs among patients with and without catheter, and to detect the type of bacteriuria and antibacterial resistance pattern. In this cross sectional study, samples were taken between Jan 2011 and July 2011. 678 hospitalized patients in different wards of Afzalipour hospital, Kerman- Iran, were enrolled in the study. E-test was applied to detect the pattern of resistance to gentamicin, nitrofurantoin, ciprofloxacin, ceftriaxon and co-trimoxazole. Results showed positive culture samples in 86% of female patients. Escherichia coli, Candida and Staphylococcus aureus were detected in 72, 20 and 7 percent of the positive cultures, respectively. 52.3% of detected E.coli was sensitive to gentamicin , 62% to ceftriaxone, 71.4% to ciprofloxacin, and 91.9% were sensitive to nitrofurantoin. Therefore, the most sensitive antibiotics in UTIs were ciprofloxacin and ceftriaxone. Unfortunately, the rate of antibacterial drug resistance was high in comparison with developed countries. Wise selection of antibiotics at hospitals and increasing the knowledge of patients to prevent self use of antibiotics can reduce antimicrobial resistance.