Intensive care unit-acquired urinary tract infections in a regional critical care system

Abstract

Introduction Few studies have evaluated urinary tract infections (UTIs) specifically acquired within intensive care units (ICUs), and the effect of such infections on patient outcome is unclear. The objectives of this study were to describe the occurrence, microbiology, and risk factors for acquiring UTIs in the ICU and to determine whether these infections independently increase mortality. Methods A surveillance cohort study was conducted among all adults admitted to multi-system and cardiovascular surgery ICUs in the Calgary Health Region (CHR, population about 1 million) between 1 January 2000 and 31 December 2002. Results During the 3 years, 4465 patients were admitted 4915 times to a CHR ICU for 48 hours or more. A total of 356 ICU-acquired UTIs (defined as at least 10 5 colony-forming units/ml of one or two organisms 48 hours or more after ICU admission) occurred among 290 (6.5%) patients, yielding an overall incidence density of ICU-acquired UTIs of 9.6 per 1000 ICU days. Four bacteremic/fungemic ICU-acquired UTIs occurred (0.1 per 1000 ICU days). Development of an ICU-acquired UTI was more common in women (relative risk [RR] 1.58; 95% confidence interval [CI] 1.43-1.75; P < 0.0001) and in medical (9%) compared with non-cardiac surgical (6%), and cardiac surgical patients (2%). The most common organisms isolated were Escherichia coli (23%), Candida albicans (20%), and Enterococcus species (15%). Antibiotic-resistant organisms were identified among 14% isolates. Although development of an ICU-acquired UTI was associated with significantly higher crude inhospital mortality (86/290 [30%] vs. 862/4167 [21%]; RR = 1.43; 95% CI 1.19-1.73; P < 0.001); an ICU-acquired UTI was not an independent predictor for death. Conclusions Development of an ICU-acquired UTI is common in critically ill patients. Although a marker of increased morbidity associated with critical illness, it is not a significant attributable cause of mortality.

A comparison of monomicrobial versus polymicrobial Enterococcus faecalis bacteriuria in a French University Hospital

“…Bacteriuria was considered to be colonization if no clinical signs suggestive of UTI were noted (no fever and no urine symptoms). In women, cystitis and pyelonephritis were graded according to the clinical criteria of the European Urology Association [2,3,15]. In men, the clinical signs of UTI are heterogeneous, and little consensus has been reached regarding their classification into cystitis, pyelonephritis or prostatitis [4,16].…”

“…We therefore decided to group these together into a single category of male UTI. A patient was considered to be suffering from a nosocomial UTI if this met the French clinical definition of care-related infections: occurrence of a UTI 48 h after hospital admission [3,17].…”

“…The most frequent site of enterococcal infection is the urinary tract (65 %), with enterococci accounting for less than 5 % of community-acquired urinary tract infections (UTI) [4] and 15 % of hospital-acquired UTI [3]. These infections, however, are considered to be less severe than those involving other uropathogens [5].…”

“…In addition, urinary tract colonizations by enterococci, devoid of urinary tract symptoms or signs, are even more common. It would appear that an underlying pathological condition of the urinary tract, kidney transplant [6,7], urinary catheter [2,3] or recent use of antibiotics [8] increases the risk of enterococcal UTI or colonization. However, few studies have been published on this subject and no consensus has been reached, particularly regarding a definition of a threshold in terms of colony count [9].…”

Prevalence of erythromycin and clindamycin resistance among clinical isolates of the Streptococcus anginosus group in Germany

“…However, the organisms can also cause serious invasive infections, including infections of the liver and lung, brain abscesses, bacteraemia, endocarditis and intra-abdominal infections Rashid et al, 2007). In a recent study, members of the SAG were identified as the most frequent cause of invasive pyogenic streptococcal infections in Canada (Laupland et al, 2006). SAG are generally considered to be susceptible to penicillin, other b-lactam antibiotics and macrolides, but resistant strains have been reported (Aracil et al, 1999;Limia et al, 1999;Tracy et al, 2001).…”