EC Microbiology

Background: The incidence of catheter-associated urinary tract infections (CAUTIs), and etiologic agents and antibiotic resistant patterns associated with CAUTIs in the intensive care unit at Salmaniya medical complex were recorded to identify risk factors as- sociated with acquiring these infections and recommended treatment.

Methods: Prospective surveillance of CAUTIs was conducted from January 1, 2014 till December 31, 2015 using the standard Centers for Disease Control National Nosocomial Infection Surveillance (NNIS) case definitions. Rates were expressed as the number of infec- tions per 1000 catheter days.

Results: During the study period, 1490 patients were monitored for a total of 11,602 patient days and 9,630 patient urinary catheter days. Fifty-one episodes of CAUTI were diagnosed, for an overall rate of 5.3/1000 catheter days. Compliance to the UTI prevention bundle was more than 90%. Male gender, older age, prolonged ICU stay, and medical rather than surgical admission were important risk factors associated with acquiring CAUTI. The most frequently isolated organisms were E. coli (28.8%), Klebsiella spp. (26.9%), and Candida (25%,), followed by Pseudomonas spp. (11.6%) and Proteus mirabilis (ESBL) spp. (7.7%).

Conclusion: Our incidence of ICU acquired CAUTIs was lower than previously reported in our center, which could be attributed to a significant increase in adherence to infection control policies and procedures. Significant risk factors for developing an ICU-acquired UTI were male gender, old age, prolonged ICU stay, and medical admission. Meropenem as monotherapy or in combination with aminoglycoside seems to be the most appropriate empiric choice for the treatment of CAUTI among critically ill ICU patients; subsequent de-escalation after sensitivity testing of the causative organism is essential.

keywords: Catheter-Associated Urinary Tract Infection; Critical Care Unit; Urinary Tract Infection; Bahrain; Surveillance; Infection Control

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