Preliminary study of intrahospital urinary tract infections in Internal Medicine rooms from a public Hospital in San Lorenzo
DOI:
https://doi.org/10.18004/anales/2018.051(02)17-026Keywords:
intra-hospital urinary tract infection, Extended-Spectrum β-lactamase (ESBL), Carbapenemase, nosocomial urinary tract infections, risk factors, ParaguayAbstract
Ground and objective: On this preliminary study we aim to determine the demographic features and the relation between certain risk factors and the presence of Gram negative betalactamase producing bacteria (ESBL) in urinary tract infections (UTI) on hospitalized patients.
Materials and Methods: An observational, retrospective, cross sectional, case control type study was performed; on adult patients of both genders that were hospitalized in the Internal Medicine wards from Hospital de Clínicas, in the city of San Lorenzo, from January 2015 to August 2017, that had positive urine culture for Gram negative bacteria, and its relationship with diverse factors. Results: Escherichia Coli was isolated on 43% of nosocomial UTI, followed by Klebsiella pneumoniae (32%), Pseudomona aeruginosa (9%), Enterobacter cloacae (4%), Proteus mirabilis (4%), Morganella morganii (2%). As for the risk factors associated to nosocomial UTI produced by Gram negative ESBL-producing bacteria, the prior use of antibiotics was the greatest associated factor with an OR 2,5 (CI 95% 2,5-21,8) p 0,001. Conclusion: The most implicated Gram negative bacteria on nosocomial UTI was Escherichia Coli. The greatest percentage of patients that presented nosocomial UTI during their admission belonged to female sex, presented comorbidities and was hospitalized for a period longer than 10 days. As to the associated risk factors for nosocomial UTI produced by Gram negative ESBL-producing bacteria, the prior use of antibiotics was the greatest associated factor.
References
1. Flores K, Pérez LM, Trelles Guzmán M, Malaga Rodríguez G, Loza Munariz C, Tapia Egoavil E. Infección urinaria intrahospitalaria en los servicios de hospitalización de Medicina de un hospital general. Rev. Med Hered. 2008;19:46-52
2. Katsumi S, Kazushi T, Hiroshi O, Yuzo N, Shohiro K, Akinobu G, Soichi A, Masato F. Pathogen occurence and antimicrobial susceptibility of urinary tract infection case during a 20 year period (1983-2002) at a single institution in Japan. Jpn. J. Infect. Dis., 2005, 58: 303-308
3. García - Mostajo JA, Alva – Díaz C, Rivera – Morón P. Frecuencia de infección del tracto urinario intrahospitalaria por enterobacterias productoras de betalactamasas de espectro extendido y factores asociados en un Hospital nacional. Rev Soc Perú Med Interna, 2015, vol. 28: 113-120
4. García-Tello A, Gimbernat H, Redondo C., Arana D.M., Cacho J., Angulo J.C. Betalactamasas de espectro extendido en las infecciones del tracto urinario causadas por enterobacterias: aproximación a su conocimiento y pautas de actuación. Actas urológicas españolas. 2014; 38 (10): 678-684
5. Bush K, Jacoby A, Medeiros AA. A functional classification scheme for beta-lactamases and its correlation with molecular structure. Antimicrob Agents Chemother. 1995;39:1211-1233
6. Paterson DL, Bonomo RA. Extended-spectrum β-lactamases: A clinical update. Clin Microbiol Rev. 2005;18:657-686
7. Canton R, Coque TM. The CTX-M βlactamase pandemic. Curr Opin Microbiol. 2006;9:466-475.
8. Etienne M, Lefebvre E, Frebourg N, Hamel H, Pestel-Caron M, and Caron F. Antibiotic treatment of acute uncomplicated cystitis based on rapid urine test and local epidemiology: lessons from a primary care series. BMC Infect Dis. 2014; 14: 137-144
9. Fagan M, Lindbæk M, Reiso H, Berild D. A simple intervention to reduce inappropriate ciprofloxacin prescribing in the emergency department. Scand J Infect Dis. 2014;46(7):481-5.
10. Bartoloni A, Sennati S, Di Maggio T, Mantella A , Riccobono E, Strohmeyer M et al. Antimicrobial susceptibility and emerging resistance determinants (blaCTX-M, rmtB, fosA3) in clinical isolates from urinary tract infections in the Bolivian Chaco. Int J Infect Dis. 2016;43:1-6
11. Pereira A, Fariñ a N, de Vega M, González P, Rodríguez F, de Figueredo L. Enterobacterias productoras de Betalactamasas de espectro extendido aisladas de pacientes ambulatorios y hospitalizados en un laboratorio privado de Asunción, Paraguay. Mem. Inst. Investig. Cienc. Salud. 2016;14(1):17-24
12. Guillén R, Velázquez G, Lird G, Espínola C, Laconich M, Carpinelli L et al. Detección molecular de belactamasas de espectro (BLEE) en enterobacterias aisladas en Asunción. Mem. Inst. Investig. Cienc. Salud. 2015;13(2):8-16.
13. Melgarejo N, Martinez M, Franco R, Falcón M. Enterobacterias resistentes a Carbapenemes por producción de KPC, aisladas en hospitales de Asunción y Departamento Central. Rev. Salud Pública Parag. 2013(3);1:30-35.
14. Marston H, Dixon D, Knisely J, Palmore T, Fauci A. Antimicrobial Resistance. JAMA. 2016;316(11):1193-1204.
15. García-Hernández AM, García-Vázquez E, Hernández-Torres A, Ruiz J, Yagüe G, Herrero JA, Gómez J. Bacteraemia due to Escherichia coli producing extended-spectrum beta-lactamases (ESBL): clinical relevance and today’s insights. Rev Esp Quimioter. 2011;24(2):57-66.
16. Kass EH. Bacteriuria and the diagnosis of infections of the urinary tract; with observations on the use of methionine as a urinary antiseptic. AMA Arch Intern Med. 1957;100:709-14.
17. Velázquez G, Lird G, Melgarejo L, Walder A, Chírico C, Santa Cruz F. Resultados de urocultivos en adultos realizados por el laboratorio de microbiologia del Hospital de Clinicas - San Lorenzo de enero 2015 a agosto de 2016 y métodos de estudio de las infecciones urinarias disponibles en la institución. An Fac Cien Méd 2017;50(2):51-65
18. Melgarejo L, Walder A, Ovando F, Velázquez G, Chirico C, Santa Cruz F. Susceptibilidad in vitro a los antibióticos de bacterias productoras de infecciones urinarias en la mujer: evaluación retrospectiva de 5 años. Rev Nefrol Dial Traspl. 2017; 37 (2): 96-103.
19. Wilson ML, Gaido L. Laboratory diagnosis of urinary tract infections in adult patients. Medical Microbiology. Clin Infect Dis. 2004;38:1150–8
20. Avilés C, Betancour P, Velasco CL, Godoy R, Barthel E, Martínez F. Factores asociados a infecciones urinarias producidas por enterobacterias productoras de β-lactamasas de espectro extendido: una cohorte prospectiva. Rev Chilena Infecto 2016;33(6):628-634
21. Rodríguez-Baño J, Navarro MD, Romero L, Martínez-Martínez L, Muniain MA, Perea EJ, Pérez-Cano R, Pascual A. Epidemiology and clinical features of infections caused by extended-spectrum beta-lactamase-producing Escherichia coli in nonhospitalized patients. J Clin Microbiol. 2004;42(3):1089-0
22. Ocampos Ugarte JG, Vivian Estela Takahasi Alvarez VE. Enterobacterias productoras de carbapenemasas en pacientes del Servicio de Clínica Médica del Hospital Nacional de Itauguá. Rev. Virtual Soc. Parag. Med. Int. 2015;2(02):33-42
23. Bouassida K, Jaidane M, Bouallegue O, Tlili G, Naija H, Mosbah AT. Nosocomial urinary tract infections caused by extended-spectrum beta-lactamase uropathogens: Prevalence, pathogens, risk factors, and strategies for infection control. Can Urol Assoc J. 2016;10(3-4):E87-E93. doi:10.5489/cuaj.3223.
24. Pigrau C. Infecciones del tracto urinario nosocomiales. Enferm Infecc Microbiol Clin. 2013;31(9):614-24.
25. Ho PL, Chan WM, Tsang KW, Wong SS, Young K. Bacteremia caused by Escherichia coli producing Extended-spectrum ß-lactamases: a case control study of risk factors and outcomes. Scand J Infect Dis 2002;34:567-73.
26. Khawaja T, Kirveskari J, Johansson S, Väisänen J, Djupsjöbacka A, Nevalainen A, Kantele A. Patients hospitalized abroad as importers of multiresistant bacteria-a cross-sectional study. Clin Microbiol Infect. 2017 Sep;23(9):673.e1-673.e8. doi: 10.1016/j.cmi.2017.02.003.
27. Johansen TE. Nosocomially acquired urinary tract infections in urology departments. Why an international prevalence study is needed in urology. Int J Antimicrob Agents. 2004;23(Suppl1):304. http://dx.doi.org/10.1016/j.ijantimicag.2003.09.003.

