Bacteriology and Antibiotic Sensitivity Patterns of Urine in Urology Patients with Indwelling Urinary Catheters at the University Teaching Hospital in Lusaka, Zambia

  • Misinzo Moono University Teaching Hospital, Department of Surgery, Urology P/B RW1X, Lusaka, Zambia
  • Spasojevic Nenad University Teaching Hospital, Department of Surgery, Urology P/B RW1X, Lusaka, Zambia
  • Victor Mapulanga University Teaching Hospital, Department of Surgery, Urology P/B RW1X, Lusaka, Zambia
Keywords: Catheter-Associated Urinary Tract Infection, Urinary Tract Infection, University Teaching Hospital

Abstract

Introduction: Catheter-associated urinary tract infection (CAUTI) is the most common nosocomial infection in hospitals worldwide, and the incidence has been reported to be up to 35%. The growing antibiotic resistance amongst the uropathogens isolated from CAUTI makes it challenging to manage. In Zambia, prolonged catheter use is a burden, particularly in patients awaiting definitive surgery, the elderly and socioeconomically challenged. Bacterial colonisation following catheterisation 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 the duration of catheterisation the most important factor. Methodology: The study was a descriptive cross-sectional study conducted at UTH over a period of 10 months from July 2015 to May 2016. 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 who 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 was analysed by the microbiologist based at the UTH microbiology laboratory. The patients were recruited at one point, and the data collection exercise employed a questionnaire to collect socioeconomic demography and clinical information. The variables were collected using the data collection sheet for each participant. The data was then entered into SPSS software to clean and analyse data. The categorical variables were presented as proportions. The main concerns arising during specimen collection were the duration between the 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 the collection were accepted. Results: 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 the highest resistance of the above isolates to ampicillin, nalidixic acid, norfloxacin, ciprofloxacin, levofloxacin, and borderline with cotrimoxazole. The organisms were least resistant to amikacin, imipenem, nitrofurantoin, and gentamycin. Acetinobacter and Citrobacter species were also highly resistant to the above drugs with nitrofurantoin in addition but least resistant to ampicillin. Conclusion: The study revealed a high prevalence of CAUTI 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 the size of the catheters used and patients level of education. High resistance to antibiotics to many organisms of concern was noted.

References

1. Labib MA, Spasojevic N, Problem of Catheter-Associated Urinary Tract Infections in Sub-Saharan Africa, Recent Advances in the Field of Urinary Tract Infections 2012.
2. Tambyah PA, Maki DG, Catheter-associated urinary tract infection is rarely symptomatic: A Prospective Study of 1497 Catheterized patients,2000.
3. Keith FP et al., EAU Guidelines,2015 Ed.Arnhem, Netherlands: Drukerij; Catheter-associated urinary tract infections, 31-39;2015.
4. Geng V, Emblem E L, EUAN Good Practices in Health Care, Urethral Catheterization.2006 Ed.Arnhem, Netherlands; 2006.
5. Geng V, Cobussen-Boekhorst V.EAUN Evidence-based Guidelines for Best Practice in Urological Health care, Catheterization, Indwelling catheters in adults. 2012 ed.Anaheim, Netherlands;2012.
6. Mbata T. Prevalence and Antibiogram of Urinary Tract Infections among Prison Inmates in Nigeria. Int. J Microbiol. 2007; 3:12-23.
7. Arslan H, Azap OK, Ergonul O, Timurkaynak F. Risk factors for ciprofloxacin resistance among Escherichia coli strains isolated from community-acquired urinary tract infections in Turkey. J. Antimicrob. Chemother. 2005; 56:914 918.
8. Wright SW, Wrenn KD, Haynes MLR. Trimethoprim-Sulfamethoxazole Resistance Among Urinary Coliform Isolates. J. Gen. Intern. Med.1999; 14:606 609.
9. Pondei K, Orutugu L, Pondei J. Current Microbial And Culture Sensitivity Pattern Of Urinary Tract Infection In A Private Hospital Setting In Bayelsa State, Nigeria. Int. Research J. Microbiol. 2012; 3:393-398
10. Nwankwo I. U., Godwin C. T. and Nwankwo E. O., Bacterial profile in patients with indwelling urinary catheters in Federal Medical Center, Umuahia, Abia State, Nigeria,2014
11. Kazi M, Harshe A, Sale H, Mane D, Yande M, et al. (2015) Catheter-Associated Urinary Tract Infections (CAUTI) and Antibiotic Sensitivity Pattern from Confirmed Cases of CAUTI in a Tertiary Care Hospital: A Prospective Study. Clin. Microbiol. 4:193. Doi: 10.4172/2327-5073.1000193.
12. Nzalie RN, Gonsu HK, Koulla-Shiro S. Bacterial Etiology and Antibiotic Resistance Profile of Community-Acquired Urinary Tract Infections in a Cameroonian City. Int J. Microbiol. 2016;2016:3240268. doi:10.1155/2016/3240268
13. Ovarian O, Osevwe Josephine Ayodeji et al. The Prevalence of Urinary Catheter-Related Infections in Federal Medical Centre Abeokuta Nigeria. 2016
14. Alison B. Intermittent self-catheterisation in women: reducing the risk of UTIs. British J. Nursing. DOI: https://doi.org/10.12968/bjon.2014.23.Sup18.S20
15. Kırmusaoğlu S. The Correlation of The Biofilm Production with Methicillin Resistance in Staphylococcus aureus and Staphylococcus epidermidis. Ponte. 2017;73(4):191-205.
16. Susan H et al. The association between indwelling urinary catheters and use in the elderly, 2006.
17. Warren JW. Catheter-Associated Urinary Tract Infections. Infect Dis Clin North Am 1997; 11:609-22.
18. Onipede A, Oyekale O, Olopade Bet al. Urinary Pathogens and Their Antimicrobial Susceptibility in Patients with Indwelling Urinary Catheter.2010.
19. Dougnon T V, Bankole H S, Johnson R C, Hounmanou G, Moussa Toure I, et al. Catheter-Associated Urinary Tract Infections at a Hospital in Zinvie, Benin (West Africa). Int J Infect. 2016;3(2):e34141. doi: 10.17795/iji-34141.
20. Maha T, Soad H, Tamer S, Reham E, Surveillance of catheter-associated urinary tract infection in 4 intensive care units at Alexander university hospitals in Egypt;2009.
21. Mbanga J, Dube J, Munyanduki H, Prevalence and drug resistance in bacteria of the urinary tract infections in Bulawayo province, Zimbabwe.2000.
22. Wazait D, Patel H, Veer V, Kelsey, et al.: Catheter-associated urinary tract infections: Prevalence of Uropathogens and microbial resistance patterns in a UK hospital .1996–2001.
23. Sedor J, Mulholland G, Hospital-acquired urinary tract infections associated with the indwelling catheter. Urol. Clin. North. Am. 1999; 26:821-828.
24. Haili W, Wenliang L, Lixiao G, Xiaofang G, Bin N, Haiteng D, Ruifu Y, Yanping H. Emergence of two distinct subpopulations from Klebsiella pneumonia grown in the stimulated microgravity environment: Future Microb. 2017; 12: 11:939-951. https://doi.org/10.2217/fmb-2017-0032
25. Adegun PT, Michael SO, Julius GO, Eyitayo EE. Comparison of uropathogens and antibiotic susceptibility patterns in catheterized ambulant middle-aged and elderly Nigerian patients with bladder outlet obstruction. Turkish J. UroL. 2018; 45 1: 48-55.
26. Leelakrishna P, Karthik RB. A study of risk factors for catheter associated urinary tract infection. Int. J Adv. Med. 2018; 5:334-9.
Published
2022-01-06
How to Cite
1.
Moono M, Nenad S, Mapulanga V. Bacteriology and Antibiotic Sensitivity Patterns of Urine in Urology Patients with Indwelling Urinary Catheters at the University Teaching Hospital in Lusaka, Zambia. University of Zambia Journal of Agricultural and Biomedical Sciences [Internet]. 6Jan.2022 [cited 4Jul.2022];5(3):13-4. Available from: https://journals.unza.zm/index.php/JABS/article/view/692
Section
Biomedical Sciences