Catheter-Associated Urinary Tract Infections in a Burn Unit: Epidemiological Study

  • Luis Sepúlveda Serviço de Urologia – Centro Hospitalar De Trás-os-Montes e Alto Douro
  • Miguel Vaz Serviço de Cirurgia Plástica e Queimados - Centro Hospitalar e Universitário de Coimbra
  • Íris Brito Serviço de Cirurgia Plástica e Queimados - Centro Hospitalar e Universitário de Coimbra
  • Catarina Chaves Serviço de Patologia Clínica - Centro Hospitalar e Universitário de Coimbra
  • Luís Cabral Serviço de Cirurgia Plástica e Queimados - Centro Hospitalar e Universitário de Coimbra
  • Jorge Lima Serviço de Cirurgia Plástica e Queimados - Centro Hospitalar e Universitário de Coimbra
  • Filipe Rodrigues Serviço de Urologia – Centro Hospitalar De Trás-os-Montes e Alto Douro

Abstract

Introduction: Besides burn wound infections, burned patients are also more susceptible to other types of nosocomial infections. Catheter-associated urinary tract infections (CA-UTI) are one of the most common infections in this context, responsible for high morbidity, increased hospital stay and associated costs. The aim of this study was to characterize catheter-associated urinary tract infections in hospitalized burn patients and evaluate the frequency of microbiologic agents responsible for these infections.


Material and Methods: Retrospective study, performed in a Burn Center (Coimbra Burns Unit) of a University Hospital (Centro Hospitalar e Universitário de Coimbra, Portugal – CHUC), based in the clinical data and urine cultures of burned patients who have performed at least once this exam between 1 January 2010 and 31 December 2014. Different variables such as date of infection, general characteristics of the population and the responsible pathogen were analyzed. Infections were further categorized taking into account the existence of previous episodes of CA-UTI, thereby defining primary infection, re- infection, relapse and over-infection.


Results: Between January 2010 and December 2014, 213 CA-UTI were diagnosed in 143 patients. The most common uropathogens were E. coli (27.2%), Enterococcus faecalis (20.2%), Pseudomonas spp. (13.1%), Candida spp. (12.1%), Klebsiella spp. (10.8%) and Acinetobacter baumannii (9.9%). The most common microorganisms varied significantly depending on the gender of the patient. The CA-UTI analyzed corresponded to 143 primary infections, 44 reinfections, 17 relapses and nine over-infections. Relapse corresponded to 11% of infections in males and 5.7% in females and was significantly more frequent in infections due to Acinetobacter baumannii.


Discussion/Conclusion: Catheter-associated urinary infections are common in intensive care units, particularly at Burn Units. The most common pathogens identified were similar to those reported in the literature. Pathogens responsible for polymicrobial infections were similar to those in monomicrobial infections, probably due to the short-term nature of urinary catheterization. Infections by Acinetobacter baumannii showed high susceptibility to relapse, which is probably related to its multi-drug resistance, common in this pathogen. The high relapse rate detected in males is probably related to the greater frequency of Acinetobacter baumannii infections in this gender. Candiduria was more frequent in the context of reinfection and over-infection, probably due to disruption of bacterial flora secondary to previous systemic antibiotics.

References

1. HLari AR, Alaghehbandan R, Nikui R. Epidemiological study of 3341 burns
patients during three years in Tehran, Iran. Burns. 2000;26:49-53.

2. M Revathi G, Puri J, Jain BK. Bacteriology of burns. Burns. 1998;24:347–9.

3. Lari AR, Alaghehbandan R. Nosocomial infections in an Iranian burn care center.
Burns. 2000;26:737–40.

4. Pruitt BA, McManus AT. The changing epidemiology of infection in burn patients.
World J Surg. 1992;16:57-67.

5. Lesseva MI, Hadjiski OG. Analysis of bacteruiria in patients with burns. Burns.
1995;21:3–6.

6. Arantes A, Carvalho ES, Medeiros ES, Farhat CK, Mantese OC. Uso de diagramas
de controle na vigilância epidemiológica das infecções hospitalares. Rev
Saúde Pública. 2003;37:768-74

7. Gragnani A, Gonçalves ML, Feriani G, Ferreira ML. Análise microbiológica em
queimaduras. Rev Soc Bras Cir Plást. 2005;20:237-40.

8. Robins EV. Immunosuppression of the burned patient. Crit Care Nurs Clin North
Am. 1989;1:767–74.

9. Tambyah PA, Maki DG. Catheter-associated urinary tract infection is rarely
symptomatic: a prospective study of 1,497 catheterized patients. Arch Intern
Med. 2000;160:678-82.

10. Christ-Libertin C, Black S, Latacki T, Bair T. Evidence-based prevent catheter-
-associated urinary tract infections guidelines and burn-injured patients: a pilot
study. J Burn Care Res. 2015;36:e1-6.

11. Hooton TM, Bradley SF, Cardenas DD, Colgan R, Geerlings SE, Rice JC, 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;50:625-63.

12. Kizilbash QF, Petersen NJ, Chen GJ, Naik AD, Trautner BW. Bacteremia and
mortality with urinary catheter-associated bacteriuria. Infect Control Hosp Epidemiol.
2013;34:1153-9.

13. Gould CV, Umscheid CA, Agarrwal RK, Kuntz G, Pegues DA. Healthcare
Infection Control Practices Advisory Committee. Guideline for Prevention of
catheter-associated tract infection 2009. Infect Control Hosp Epidemiol. 2010;
31:319-26

14. Umscheid CA, Agarwal RK, Brennan PJ, et al. Updating the guideline development
methodology of the Healthcare Infection Control Practices Advisory
Committee (HICPAC). Am J Infect Control. 2010;38:264-73.

15. Gleckman RA, Crowley MM, Natsios GA, Madoff S. Recurrent urinary
tract infections in men: a role for aberrant bacterial forms? J Clin Microbiol.
1980;11:650-3.

16. Daifuku R, Stamm WE. Bacterial adherence to bladder uroepithelial cells in
catheter-associated urinary tract infection. N Engl J Med. 1986; 314:1208–13.
17. Nicolle LE. Catheter-related urinary tract infection. Drugs Aging. 2005; 22:627–
39.

18. Laupland KB, Zygun DA, Davies HD, Church DL, Louie TJ, Doig CJ. Incidence
and risk factors for acquiring nosocomial urinary tract infection in the critically
ill. J Crit Care. 2002;17:50-7.

19. Talaat M, Hafez S, Saied T, Elfeky R, El-Shoubary W, Pimentel G. Surveillance
of catheter-associated urinary tract infection in 4 intensive care units at Alexandria
university hospitals in Egypt. Am J Infect Control. 2010;38:222-8.

20. Tenney JH, Warren JW. Bacteriuria in women with long-term cath- eters:
paired comparison of indwelling and replacement catheters. J Infect Dis.
1988;157:199–202.

21. Rosenthal VD, Bijie H, Maki DG, Mehta Y, Apisarnthanarak A, Medeiros EA, et
al. International Nosocomial Infection Control Consortium (INICC) report, data
summary of 36 countries, for 2004-2009. Am J Infect Control. 2012;40:396–407.

22. Weinberger M, Sweet S, Leibovici L, Pitlik SD, Samra Z. Correlation between
candiduria and departmental antibiotic use. J Hosp Infect. 2003;53:183–186.

23. Paul N, Mathai E, Abraham OC, Michael JS, Mathai D. Factors associated with
candiduria and related mortality. J Infect. 2007;5:450–455.

24. Wazait HD, Patel HR, Veer V, Kelsey M, Van Der Meulen JH, Miller RA, Emberton
M. Catheter-associated urinary tract infections: prevalence of uropathogens
and pattern of antimicrobial resistance in a UK hospital (1996-2001). BJU
Int. 2003;91:806-9.

25. Tambyah PA, Halvorson KT, Maki DG. A prospective study of path- ogenesis of
catheter-associated urinary tract infections. Mayo Clin Proc. 1999;74:131–136.

26. Piljic D, Porobic-Jahic H, Piljic D, Ahmetagic S, Jahic R. Chateter-associated
Urinary Tract Infections in Adults. Mater Sociomed. 2013;25:182-6.
Published
2017-07-20
How to Cite
SEPÚLVEDA, Luis et al. Catheter-Associated Urinary Tract Infections in a Burn Unit: Epidemiological Study. Acta Urológica Portuguesa, [S.l.], v. 34, n. 1-2, p. 33-39, july 2017. ISSN 2387-0419. Available at: <http://www.actaurologicaportuguesa.com/index.php/aup/article/view/4>. Date accessed: 18 oct. 2017.