Journals / Türk Üroloji Dergisi/Turkish Journal of Urology / 2003 / Cilt: 29 - Sayı: 2
Nosocomial urinary tract infections related with urinary catheter in patients from intensive care units
- Pages
- 209–214
- DOI
- —
Abstract
Introduction: Nosocomial infections are one of the most seen complications in intensive care units (ICU) and 25% of nosocomial infections observed in whole the hospital develop in ICUs. Nosocomial urinary system infection (MUSI) is the most frequently diagnosed one that is recognized in 2 or 3 of 100 patients, which includes 30-40% of hospital infections. Thus, NUSI is a very important subject that should be investigated with its etiology, clinics and prevention. Nearly 80% of NUSI develop due to urinary catheters; systoscopy and other urological processes are responsible for the remain infections. There are some factors increasing bacteriuria due to urinary catheters. This are; catheterization duration, microbial colonization of drainage bag, diabetes mellitus (DM), prophylactic antibiotic usage, female patient, surgical process or using urinary catheters for some reasons except urine measurement, abnormal serum creatinine and malpractice on catheter control. Urinary catheterization duration is the most important risk factor for development of bacteriuria due to catheters. In this study we aimed, to detect, the frequency of urinary system infection related with urinary catheter, the relation between the urinary system infection and the period of urinary catheterization, risk factors, effective microorganisms and antibiotic resistance patterns. Materials and Methods: One hundred adult ICU patients home taken part in the study and all the patients assessed until discharge or transfer to another clinic. Firstly, agen sex, admission, admission diagnoses, underlying disease if available was recorded. Prophylactic antibiotic usage and duration, the day of urinary catheterization, the reason of using urinary catheter, urine culture results were noted on follow-up forms. Urine culture were taken on the first 24th hour, 4l1 day and lO'1 day following urinary catheter administration to ICU patients. More than 10s CFU/mL productions were taken for evaluation. Conventional techniques were used for isolated microorganism diagnosis. Antibiotic sensation tests were apph'ed with Kirby- Bouver disc diffusion method according to National Clinical Committee Laboratory Standards criteria. Clinical infections were diagnosed by Center for Disease Control standard criteria. ' Student's and chi-square tests were used for comparing two group continuous variants. p<0.05 results were accepted statistically significant. Results: Catheter related NUSI ratio was found as 30.5/1000 urinary catheter day. Risk factors for urinary catheter related NUSI acquired from intensive care units were age higher or equal to 60, underlying disease, serum creatinine level of 2 tng/dl or higher. And also urinary catheterization time was of risk too. Gender was of no risk. When factors which cause NUSI were documented it has been found that while Esherichia coli (11%), Klebsiella pneumoniae (7%), Candida spp. (5%) were in first three, on the 4th day of catheterization ; on the 10th day that were Candida spp. (21%), Klebsiella pneumoniae (10%) and Esherichia coli (8%). When antibiotic resistance patterns responsible for NUSI has been examinated the most sensitive antibiotics were determined as Amicasin, Cefepime, Imipenem in order and the most resistant antibiotics were Ampicillin, Cefazolin and Chloramphenicol hi order.
Özet
Çalışmamızda yoğun bakım ünitelerinde (YBÜ) yatan hastalarda; üriner kateterle ilişkili üriner sistem enfeksiyon sıklığı, üriner kateterizasyon süresi ile ilişkisi, risk faktörleri, etken mikroorganizmalar, antibiyotik direnç paternleri, tespit edilmesi amaçlandı. Hastanemiz YBÜ'lerinde Mayıs 2001- Temmuz 2001 tarihleri arasında yatan 100 üriner kateterli hasta takip edildi ve üriner kalelerin 4. gününde %32, 10. gününde ise %52 oranında nozokomiyal üriner sistem enfeksiyonu (NÜSÎ) saptandı. Kateterle ilişkili nozokomiyal üriner sistem enfeksiyonu (NÜSİ) oranı 30.5/1000 üriner kateter günü olarak bulundu. Yoğun bakım ünitelerinde (YBÜ) edinilmiş üriner kateterle ilişkili NÜSl için risk faktörleri incelendiğinde hastayla ilgili parametrelerden ; yaşın 60 veya üzerinde olması, altta yatan hastalığın olması, serum kreatinin düzeyinin 2mg/dL ve üzerinde olmasının risk oluşturduğu, cinsiyetin ise risk oluşturmadığı belirlendi. Ayrıca üriner kateterizasyon süresi de NÜSÎ için risk faktörü olarak tespit edildi. NÜSİ'ye yol açan etkenler dökümente edildiğinde üriner kateterin 4. gününde izole edilen etkenler arasında ilk üç sırayı Escheria coli %11, Klepslella pneumoniae %7, Candida spp. %5 oranıyla alırken, üriner kateterizasyonun 10. gününde ilk üç sırada Candida spp. %21, K.pneumoniae %10, E.coli %8, Enterekok spp. %8 oranlanyla yer aldığı belirlendi. NÜSİ'den sorumlu etken patojenlerin antibiyotik direnç patentleri incelendiğinde en duyarlı antibiyotikler arasında ilk üç sırayı Amikasin, Sefepim, imipenem almakla birlikte, en dirençli antibiyotiklerin ise sırasıyla Ampisilin, Sefozolin ve Kloromfenikol olduğu saptandı.