Bacteriology and antibiotic sensitivity patterns of urine in urology patients with indwelling urinary catheters at the University Teaching Hospital in Lusaka, Zambia.

Abstract

Catheter associated urinary tract infection (C.A.U.T.I.) is the most common nosocomial infection in hospitals worldwide and the incidence has been reported to be upto 35%. The growing antibiotic resistance amongst the uropathogens isolated from CAUTI makes it difficult for its management.In Zambia,prolonged catheter use is a burden particularly in patients awaiting definitive surgery,the elderly and socioeconomically challenged.Bacterial colonisation following catheterization is inevitable with reports estimating the risk to be around 5-10% per day.By day 10,virtually all patients with urinary tract instrumentation have healthcare associated UTI with he duration of catheterization the most important factor. The study was carried out because it offers an opportunity to show the pattern of microorganisms present in urine of patients with indwelling catheters at UTH and the aim is be to bring down the prevalence of CAUTI at the institution with the knowledge of the antibiotic sensitivity of pathogens isolated. The study was a descriptive cross-sectional which was conducted at UTH over a period of 10 months. The cases were inpatients and outpatients with indwelling catheters in situ for not less than three calendar days. Simple random sampling was used to select candidates, which were inpatients awaiting definitive surgery and outpatients in the same category as they attended clinics. Data collection and collection of specimens were done by the principal investigator which were analyzed by the microbiologist based at the UTH microbiology laboratory. The patients were recruited at one point time and the data collection exercise employed with use of a questionnaire to collect socioeconomic demography and clinical information. The above variables were collected using the data collection sheet for each participant. The above data was entered into SPSS software, used to clean and analyze data. The categorical variables were presented as proportions. The main concerns arising during the collection of specimens was the duration between time of specimen collection and transfer to and processing at the main laboratory which was kept within one hour. Specimens received within two hours of collection were accepted A total of 228 patients were enrolled from both outpatient and inpatient departments. Approximately 75% yielded growth of bacteria and 25.0% were negative. The pure growth yielded Klebsiella Pneumoniae 28.0% and E. coli 25.2%, as the most isolated pathogens .The antibiotic susceptibility testing revealed highest resistance of e.coli and klebsiella pneumonia to ampicillin, nalidixic acid, norfloxacin, ciprofloxacin and levofloxacin and borderline with cotrimoxazole. The organisms were least resistant to amikacin, imepenem, nitrofurantoin, and gentamycin. Acetinobacter and Citrobacter species were also highly resistant to the above drugs with nitrofurantoin in addition but least resistance to Ampicillin. The study revealed that there is a high prevalence of catheter associated UTI in the urology section of the UTH and practices such as poor hand hygiene, open catheter drainage, non-aseptic methods of catheter insertion and poor catheter care are possible contributing factors. There is an association between insertion of indwelling catheters and subsequent development of CAUTI and the strongest factors noted are size of the catheters used and patients level of education .High resistance to antibiotics to many organisms of concern was noted. Keywords: Catheter associated urinary tract infections, Uropathogens, Catheterization, Colonization, Prevalence, Antibiotic sensitivity, Resistance and Catheter size