Characteristics of the Pathogens Causing Catheter-associated Urinary Tract Infection in Critically Ill Patients_Chinese Journal of Evidence-Based Medicine

Authors：

 HEChao ¹ , LIUYu-qi ² , LIJi-wen ² , DAIZhong-Qiu ¹ , ZHUli-Na ¹ , XIEYi ¹ , CHENZhi-Xing ¹ ,  KANGMei ¹

1. Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, China;
2. West China School of Medicine, Sichuan University, Chengdu 610041, China;

Corresponding author：

KANGMei, Email: kangmei@sina.com

Keywords：

Catheter-associated urinary tract infection; Critically ill patients; Pathogen; Resistance; Cross-sectional study

DOI：

10.7507/1672-2531.20150103

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Objective To investigate the species and resistance phenotypes of the pathogens causing catheter-associated urinary tract infection (CAUTI) in critically ill patients in West China Hospital of Sichuan University, and to provide the basis for the prevention and treatment of this kind of infection. Methods The clinical data and findings of the laboratory examination of the patients, who were admitted to intensive care units and suffered from CAUTI in our hospital during January 2012 to December 2014, were retrospectively analyzed. The pathogens isolates from the urine specimens of the patients with CAUTI and their resistance phenotypes were analyzed. Results Three hundred and seventy patients suffering from CAUTI were included in this study. Five hundred and seventeen strains of pathogens were isolated from the urine specimens of these patients, including 222 isolates (42.9%) of fungus, 181 isolates (35.0%) of gram negative bacteria, and 114 isolates (22.0%) of gram positive bacteria. In terms of species distribution, Candida albicans (105 isolates, 20.3%), C.glabrata (78 isolates, 15.1%) and C.glabrata (30 isolates, 5.8%) were the predominant fungus. Among the gram negative bacteria, Escherichia coli (81 isolates, 15.7%), Klebsiella pneumoniae (37 isolates, 7.2%), and Acinetobacter calcoaceticus-baumannii complex (23 isolates, 4.4%) were the main species. Enterococcus faecium (79 isolates, 15.3%) and E.faecalis (13 isolates, 2.5%) were the frequently isolated gram positive bacteria. Analysis of the resistance phenotype showed that the resistance rates to itraconazole, voriconazole and fluconazole of Candida spp. were above 10%. Thirty percent of the isolates of E.coli and K.pneumoniae, and 60% of the isolates of A.calcoaceticus-Baumannii complex were resistant to many of the regular antibiotics. Imipenem resistance rate of A.calcoaceticus-Baumannii complex was 60.8%. Sixty percent of the isolates of E.faecium and E.faecalis were resistant to many of the regular antibiotics. The vancomycin-resistant isolates accounted for 16.5% of E.faecium and 31.0% of E.faecalis. Conclusion Candida species are the major pathogens for CAUTI in critically ill patients in our hospital and show the resistance to azoles. We should focus on the drug resistance of gram negative bacteria and gram positive bacteria. The rational use of antibiotics and application of effective infection control measures are important to decrease the CAUTI.

Citation： HEChao, LIUYu-qi, LIJi-wen, DAIZhong-Qiu, ZHUli-Na, XIEYi, CHENZhi-Xing, KANGMei. Characteristics of the Pathogens Causing Catheter-associated Urinary Tract Infection in Critically Ill Patients. Chinese Journal of Evidence-Based Medicine, 2015, 15(6): 621-624. doi: 10.7507/1672-2531.20150103 Copy

1.	Hooton TM,Bradley SF,Cardenas DD,et al.Diagnosis,prevention,and treatment of catheter-associated urinary tract infection in adults:2009 international clinical practice guidelines from the Infectious Diseases Society of America.Clin Infect Dis,2010,50(5):625-663.
2.	Magill SS,Edwards JR,Bamberg W,et al.Multistate point-prevalence survey of health care-associated infections.N Engl J Med,2014,370(13):1198-1208.
3.	Leblebicioglu H,Erben N,Rosenthal VD,et al.International nosocomial infection control consortium (inicc) national report on device-associated infection rates in 19 cities of turkey,data summary for 2003-2012.Ann Clin Microbiol Antimicrob,2014,13(1):51.
4.	Greene MT,Fakih MG,Fowler KE,et al.Regional variation in urinary catheter use and catheter-associated urinary tract infection:Results from a national collaborative.Infect Control Hosp Epidemiol,2014,35(Suppl 3):S99-S106.
5.	Chenoweth C,Saint S.Preventing catheter-associated urinary tract infections in the intensive care unit.Crit Care Clin,2013,29(1):19-32.
6.	Apostolopoulou E,Raftopoulos V,Filntisis G,et al.Surveillance of device-associated infection rates and mortality in 3 greek intensive care units.Am J Crit Care,2013,22(3):e12-20.
7.	Keten D,Aktas F,Guzel TO,et al.Catheter-associated urinary tract infections in intensive care units at a university hospital in turkey.Bosn J Basic Med Sci,2014,14(4):227-233.
8.	殷翠香,李泽文,史瑀,等.ICU导尿管相关性泌尿道感染病原体分布及耐药性.中国感染控制杂志,2014,13(4):252-253.
9.	邵俊,郑瑞强,林华,等.ICU导管相关性尿路感染的病原菌分布及耐药性分析.医学实践与理论,2013,26(22):2941-2947.
10.	张昭勇,张吉才,陈永梅.ICU导管相关性尿路感染病原分布及危险因素分析.现代中西医结合杂志,2014,23(15):1635-1636.
11.	Nerurkar A,Solanky P,Chavda A,et al.Isolation of Candida species in clinical specimens and its virulence factors:The biofilm.Nt J Med Sci Public Health,2012,1(2):97-100.
12.	杨爱祥,杨静,郑贞苍,等.ICU院内尿路真菌感染临床分析.中华医院感染学杂志,2012,22(23):5416-5418.
13.	李晓哲,董海新,高岩,等.尿路念珠菌感染的菌种构成及其体外对抗真菌药物耐药性的变迁分析.国际检验医学杂志,2010,31(9):939-940.
14.	Eckenrode S,Bakullari A,Metersky ML,et al.The association between age,sex,and hospital-acquired infection rates:results from the 2009-2011 National Medicare Patient Safety Monitoring System.Infect Control Hosp Epidemiol,2014,35 Suppl 3:S3-9.
15.	杨爱平,郭远愉,汪敏,等.ICU内侵袭性真菌感染临床分析及药敏情况.中国微生态学杂志,2013,25(1):77-81.
16.	姚燕,胡昌弟,李小青,等.ICU留置导尿患者尿培养病原菌分布与耐药性.中华医院感染学杂志,2015,25(1):64-66.
17.	Hsu HE,Shenoy ES,Kelbaugh D,et al.An electronic surveillance tool for catheter-associated urinary tract infection in intensive care units.Am J Infect Control,2015,43(6):592-599.

1. Hooton TM,Bradley SF,Cardenas DD,et al.Diagnosis,prevention,and treatment of catheter-associated urinary tract infection in adults:2009 international clinical practice guidelines from the Infectious Diseases Society of America.Clin Infect Dis,2010,50(5):625-663.
2. Magill SS,Edwards JR,Bamberg W,et al.Multistate point-prevalence survey of health care-associated infections.N Engl J Med,2014,370(13):1198-1208.
3. Leblebicioglu H,Erben N,Rosenthal VD,et al.International nosocomial infection control consortium (inicc) national report on device-associated infection rates in 19 cities of turkey,data summary for 2003-2012.Ann Clin Microbiol Antimicrob,2014,13(1):51.
4. Greene MT,Fakih MG,Fowler KE,et al.Regional variation in urinary catheter use and catheter-associated urinary tract infection:Results from a national collaborative.Infect Control Hosp Epidemiol,2014,35(Suppl 3):S99-S106.
5. Chenoweth C,Saint S.Preventing catheter-associated urinary tract infections in the intensive care unit.Crit Care Clin,2013,29(1):19-32.
6. Apostolopoulou E,Raftopoulos V,Filntisis G,et al.Surveillance of device-associated infection rates and mortality in 3 greek intensive care units.Am J Crit Care,2013,22(3):e12-20.
7. Keten D,Aktas F,Guzel TO,et al.Catheter-associated urinary tract infections in intensive care units at a university hospital in turkey.Bosn J Basic Med Sci,2014,14(4):227-233.
8. 殷翠香,李泽文,史瑀,等.ICU导尿管相关性泌尿道感染病原体分布及耐药性.中国感染控制杂志,2014,13(4):252-253.
9. 邵俊,郑瑞强,林华,等.ICU导管相关性尿路感染的病原菌分布及耐药性分析.医学实践与理论,2013,26(22):2941-2947.
10. 张昭勇,张吉才,陈永梅.ICU导管相关性尿路感染病原分布及危险因素分析.现代中西医结合杂志,2014,23(15):1635-1636.
11. Nerurkar A,Solanky P,Chavda A,et al.Isolation of Candida species in clinical specimens and its virulence factors:The biofilm.Nt J Med Sci Public Health,2012,1(2):97-100.
12. 杨爱祥,杨静,郑贞苍,等.ICU院内尿路真菌感染临床分析.中华医院感染学杂志,2012,22(23):5416-5418.
13. 李晓哲,董海新,高岩,等.尿路念珠菌感染的菌种构成及其体外对抗真菌药物耐药性的变迁分析.国际检验医学杂志,2010,31(9):939-940.
14. Eckenrode S,Bakullari A,Metersky ML,et al.The association between age,sex,and hospital-acquired infection rates:results from the 2009-2011 National Medicare Patient Safety Monitoring System.Infect Control Hosp Epidemiol,2014,35 Suppl 3:S3-9.
15. 杨爱平,郭远愉,汪敏,等.ICU内侵袭性真菌感染临床分析及药敏情况.中国微生态学杂志,2013,25(1):77-81.
16. 姚燕,胡昌弟,李小青,等.ICU留置导尿患者尿培养病原菌分布与耐药性.中华医院感染学杂志,2015,25(1):64-66.
17. Hsu HE,Shenoy ES,Kelbaugh D,et al.An electronic surveillance tool for catheter-associated urinary tract infection in intensive care units.Am J Infect Control,2015,43(6):592-599.

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