Araştırma Makalesi
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Evaluating the Fungal and Bacterial Colonization on Hospitalized Patients with Transient Urinary Catheterization

Yıl 2021, Cilt: 43 Sayı: 4, 364 - 373, 18.05.2021
https://doi.org/10.20515/otd.872372

Öz

In this cross-sectional study, it’s aimed to evaluate fungal and bacterial colonization and related risk factors in patients with transient urinary catheterization. Microorganisms yielded in the catheter lumen and urine those sampled from intra-catheter and simultaneous urine samples and related risk factors were evaluated. Study was conducted in General Surgery, Urology, Orthopedics and Traumatology, Gynecology and Obstetrics wards of Eskişehir Osmangazi University Faculty of Medicine Training, Research and Practice Hospital, in patients who underwent temporary urinary catheterization during the 3-month study period. Patients with clinical signs and symptoms of urinary tract infection during hospitalization were excluded from the study. Demographic data of the patients were recorded. The microorganisms were identified with mini API device. The data were evaluated by SPSS 15.0 statistical program, p <0.05 values were considered significant. One hundred and twenty-nine patients underwent transient urinary catheterization were enrolled in this study. Urine culture and/or intraluminary swab cultures were positive in 56 (%43.4) patients whom enrolled the study. Seventy three (56.6%) of patients were culture negative. Bivariate analysis showed statistically significant relation between female gender, prolonged duration of catheterization, urgent-elective catheterization, person performing catheterization, previously urinary procedures, and presence of diabetes and microorganism isolation in urine and/or intraluminary swab cultures (p < 0.05). Therefore in logistic regression model, female gender (OR=2.730) and duration of catheterization longer than 7 days (OR= 3.232) were found as important risk factors for microorganism isolation in urine and/or intraluminary swab cultures (p< 0.05). Though the relation between intraluminary microorganism colonization and NUTIs is not clearly established, it may lead bacteriuria. Identifying risk factors can be useful in preventing colonization and other complications. In patients with catheter associated urinary tract infection and not responding adequate antimicrobial therapy, it may be considered to discontinue urinary catheterization or change urinary catheter.

Kaynakça

  • Barford JM, Anson K, Hu Y et al. A model of catheter-associated urinary tract infection initiated by bacterial contamination of the catheter tip. BJU Int. 2008; 102: 67-74.
  • Matsukawa M, Kunishima Y, Takahashi S et al. Bacterial colonization on intraluminal surface of urethral catheter. Urology. 2005;65: 440-4.
  • Saint S, Chenoweth CE. Biofilms and catheter-associated urinary tract infections. Infect DisClin North Am. 2003;17:411-32
  • Johnson JR, Kuskowski MA, Wilt TJ. Systematic review: antimicrobial urinary catheter s to prevent catheter-associated urinary tract infection in hospitalized patients. Ann Intern Med. 2006. 144:116-26.
  • Warren JW. Nosocomial urinary tract infections. Mandell GL, Bennett JE, Dolin R (eds). Principles and practice of infectious diseases, 6th ed. Philadelphia: Elsevier Churchill Livingstone; 2005. pp. 3370-80
  • Özinel MA, Bakır M, Çek M et al. Üriner Kateter İnfeksiyonlarının Önlenmesi Kılavuzu. Hastane Enfeksiyonları Dergisi. 2008; 8: 3-9.
  • Henderson HK, Fischman N. Preventionand Control of Hospital-Acquired Infections. Goldman L, Ausiello D (eds). Cecil Medicine, 23rd ed. Philadelphia: Saunders Elsevier; 2008. pp. 2124-32.
  • Esen S, Leblebicioglu H. Prevalence of nosocomial infections at intensive care units in Turkey: a multicentre 1-day point prevalence study. Scand J Infect Dis. 2004; 36:144-8.
  • Bouza E, San Juan R, Munoz P et al. European perspective on nosocomial urinary tract infections II. Report on incidence, clinical characteristics and outcome (ESGNI-004 study). European Study Group on Nosocomial Infection. Clin Microbiol Infect. 2001; 7:532-42.
  • Ferrieres L, Hancock V, KlemmP. Specific selection for virulent urinary tract infectious Escherichia coli strains during catheter-associated biofilm formation. FEMS ImmunolMed Microbiol.2007;51:212-9.
  • Apisarnthanarak A, Rutjanawech S, Wichansawakun S et al. Initial inappropriate urinary catheters use in a tertiary-care center: incidence, risk factors, and outcomes. Am J Infect Control.2007;35:594-9.
  • Tambyah PA, Maki DG. Catheter-associated urinary tract infection is rarely symptomatic: a prospective study of 1,497 catheterized patients. ArchIntern Med.2000;160:678–82.
  • Maki DG, TambyahPA. Engineering out the risk of infection with urinary catheters. Emerg InfectDis. 2001; 7:342-7.
  • Raffaele G, Bianco A, Aiello M et al. Appropriateness of use of indwelling urinary tract catheters in hospitalized patients in Italy. Infect Control Hosp Epidemiol. 2008; 29:279-81.
  • Munasinghe RL, Yazdani H, Siddique M, et al. Appropriateness of use of indwelling urinary catheters in patients admitted to the medical service. Infect Control Hosp Epidemiol. 2001; 22:647-9.
  • Gokula RR, Hickner JA, Smith MA.Inappropriate use of urinary catheters in elderly patients at a midwestern community teaching hospital. Am J Infect Control. 2004; 32:196-9.
  • Hazelett SE, Tsai M, Gareri M et al. The association between indwelling urinary catheter use in the elderly and urinary tract infection in acute care. BMC Geriatr.2006;6:15.
  • Tissot E, Limat S, Cornette C et al. Risk factors for catheter-associated bacteriuria in a medical intensive care unit. Eur J Clin Microbiol Infect Dis.2001; 20:260-2.
  • Wald HL, Ma A, Bratzler DW et al. Indwelling urinary catheter use in the postoperative period: analysis of the national surgical infection prevention project data. ArchSurg. 2008;143:551-7.
  • Colau A, Lucet JC, Rufat P et al. Incidence and risk factors of bacteriuria after transurethral resection of the prostate. EurUrol. 2001; 39:272-6.
  • Leone M, Albanese J, Garnier F et al. Risk factors of nosocomial catheter-associated urinary tract infection in a polyvalent intensive care unit. Intensive Care Med.2003;29:1077-80.
  • Puri J, Mishra B, Mal A, et al. Catheter associated urinary tract infections in neurology and neuro surgical units. J Infect. 2002;44:171-5.
  • Laupland KB, Zygun DA, Davies HD et al. Incidence and risk factors for acquiring nosocomial urinary tract infection in the critically ill. J CritCare. 2002;17:50-7.
  • Johnson EN, Marconi VC, MurrayCK.Hospital-acquired device-associated infections at a deployed military hospital in Iraq. J Trauma.2009;66:157-63.

Hastanede Yatan ve Geçici Üriner Kateterizasyon Uygulanan Hastalarda Kateterde Bakteriyel ve Fungal Kolonizasyonun Araştırılması

Yıl 2021, Cilt: 43 Sayı: 4, 364 - 373, 18.05.2021
https://doi.org/10.20515/otd.872372

Öz

Çalışmamızda geçici üriner kateterizasyon uygulanan hastalarda kateter içi ve eş zamanlı idrar örneği alınarak kateter lümeninde ve idrarda mikroorganizma kolonizasyonunun araştırılması ve olası risk faktörlerinin değerlendirilmesi amaçlandı. Eskişehir Osmangazi Üniversitesi Tıp Fakültesi Eğitim, Araştırma ve Uygulama Hastanesi Genel Cerrahi, Üroloji, Ortopedi ve Travmatoloji, Kadın Hastalıkları ve Doğum kliniklerinde 3 aylık çalışma periyodu boyunca geçici üriner kateterizasyon uygulanan hastalarda kateter içi ve eş zamanlı idrar örneği alınarak kateter lümeninde ve idrarda üreyen mikroorganizmalar ve risk faktörleri değerlendirmeye alındı. Yatış esnasında üriner sistem enfeksiyonu (ÜSE) klinik ve bulguları olan hastalar çalışma kapsamı dışında bırakıldı. Hastaların demografik bilgileri kaydedildi. Kateter lümeni veya idrar kültürlerinde üreyen mikroorganizmalar mini API cihazı yardımıyla tanımlandı. Veriler SPSS 15.0 istatistik programı ile değerlendirildi, p<0.05 değerleri anlamlı olarak kabul edildi. Geçici üriner kateterizasyon uygulanan 129 hasta çalışmaya alındı. Çalışma grubunu oluşturan hastaların 56’sında (%43.4) idrar ve/veya kateterinde mikroorganizma üremiş olup, 73’ünde (%56.6) herhangi bir üreme saptanmadı. Yapılan bivaryet analizlerde kadın cinsiyet, kateterizasyon süresinin uzaması, acil-elektif kateterizasyon uygulanması, üriner kateterizasyonu uygulayan kişi, yakın dönemde üriner girişim öyküsü, diyabet öyküsü gibi bağımsız değişkenlerle idrar ve/veya kateter lümeninden mikroorganizma izolasyonu arasında anlamlı ilişki saptandı (her biri için p< 0.05). Oluşturulan lojistik model sonuçlarına göre de kadın olmak (OR=2.730) ve kateterizasyon süresinin >7 gün olması (OR= 3.232) geçici üriner kateterizasyon uygulanan hastalarda kateter içi ve idrarda mikroorganizmaların kolonizasyonu açısından önemli risk faktörleri olarak saptandı (her biri için p<0.05). Kateter lümeni içinde mikroorganizmaların kolonizasyonu ile nozokomiyal üriner sistem enfeksiyonları (NÜSE) arasındaki ilişki henüz tam olarak aydınlatılamamış olmakla beraber bakteriüri gelişimine öncülük edebilir. Risk faktörlerinin tanımlanması, kolonizasyonun ve diğer komplikasyonların önlenmesinde faydalı olabilir. Kateter ilişkili üriner sistem enfeksiyonu (KİÜSE) tanısı alan ve uygun antimikrobiyal tedaviye rağmen yeterli klinik yanıt alınamayan hastalarda üriner kateter içinde biyofilm gelişmiş olabileceği de göz önüne alınarak üriner kateterizasyonun sonlandırılması veya üriner kateterin değişimi tartışılması gereken konulardır.

Kaynakça

  • Barford JM, Anson K, Hu Y et al. A model of catheter-associated urinary tract infection initiated by bacterial contamination of the catheter tip. BJU Int. 2008; 102: 67-74.
  • Matsukawa M, Kunishima Y, Takahashi S et al. Bacterial colonization on intraluminal surface of urethral catheter. Urology. 2005;65: 440-4.
  • Saint S, Chenoweth CE. Biofilms and catheter-associated urinary tract infections. Infect DisClin North Am. 2003;17:411-32
  • Johnson JR, Kuskowski MA, Wilt TJ. Systematic review: antimicrobial urinary catheter s to prevent catheter-associated urinary tract infection in hospitalized patients. Ann Intern Med. 2006. 144:116-26.
  • Warren JW. Nosocomial urinary tract infections. Mandell GL, Bennett JE, Dolin R (eds). Principles and practice of infectious diseases, 6th ed. Philadelphia: Elsevier Churchill Livingstone; 2005. pp. 3370-80
  • Özinel MA, Bakır M, Çek M et al. Üriner Kateter İnfeksiyonlarının Önlenmesi Kılavuzu. Hastane Enfeksiyonları Dergisi. 2008; 8: 3-9.
  • Henderson HK, Fischman N. Preventionand Control of Hospital-Acquired Infections. Goldman L, Ausiello D (eds). Cecil Medicine, 23rd ed. Philadelphia: Saunders Elsevier; 2008. pp. 2124-32.
  • Esen S, Leblebicioglu H. Prevalence of nosocomial infections at intensive care units in Turkey: a multicentre 1-day point prevalence study. Scand J Infect Dis. 2004; 36:144-8.
  • Bouza E, San Juan R, Munoz P et al. European perspective on nosocomial urinary tract infections II. Report on incidence, clinical characteristics and outcome (ESGNI-004 study). European Study Group on Nosocomial Infection. Clin Microbiol Infect. 2001; 7:532-42.
  • Ferrieres L, Hancock V, KlemmP. Specific selection for virulent urinary tract infectious Escherichia coli strains during catheter-associated biofilm formation. FEMS ImmunolMed Microbiol.2007;51:212-9.
  • Apisarnthanarak A, Rutjanawech S, Wichansawakun S et al. Initial inappropriate urinary catheters use in a tertiary-care center: incidence, risk factors, and outcomes. Am J Infect Control.2007;35:594-9.
  • Tambyah PA, Maki DG. Catheter-associated urinary tract infection is rarely symptomatic: a prospective study of 1,497 catheterized patients. ArchIntern Med.2000;160:678–82.
  • Maki DG, TambyahPA. Engineering out the risk of infection with urinary catheters. Emerg InfectDis. 2001; 7:342-7.
  • Raffaele G, Bianco A, Aiello M et al. Appropriateness of use of indwelling urinary tract catheters in hospitalized patients in Italy. Infect Control Hosp Epidemiol. 2008; 29:279-81.
  • Munasinghe RL, Yazdani H, Siddique M, et al. Appropriateness of use of indwelling urinary catheters in patients admitted to the medical service. Infect Control Hosp Epidemiol. 2001; 22:647-9.
  • Gokula RR, Hickner JA, Smith MA.Inappropriate use of urinary catheters in elderly patients at a midwestern community teaching hospital. Am J Infect Control. 2004; 32:196-9.
  • Hazelett SE, Tsai M, Gareri M et al. The association between indwelling urinary catheter use in the elderly and urinary tract infection in acute care. BMC Geriatr.2006;6:15.
  • Tissot E, Limat S, Cornette C et al. Risk factors for catheter-associated bacteriuria in a medical intensive care unit. Eur J Clin Microbiol Infect Dis.2001; 20:260-2.
  • Wald HL, Ma A, Bratzler DW et al. Indwelling urinary catheter use in the postoperative period: analysis of the national surgical infection prevention project data. ArchSurg. 2008;143:551-7.
  • Colau A, Lucet JC, Rufat P et al. Incidence and risk factors of bacteriuria after transurethral resection of the prostate. EurUrol. 2001; 39:272-6.
  • Leone M, Albanese J, Garnier F et al. Risk factors of nosocomial catheter-associated urinary tract infection in a polyvalent intensive care unit. Intensive Care Med.2003;29:1077-80.
  • Puri J, Mishra B, Mal A, et al. Catheter associated urinary tract infections in neurology and neuro surgical units. J Infect. 2002;44:171-5.
  • Laupland KB, Zygun DA, Davies HD et al. Incidence and risk factors for acquiring nosocomial urinary tract infection in the critically ill. J CritCare. 2002;17:50-7.
  • Johnson EN, Marconi VC, MurrayCK.Hospital-acquired device-associated infections at a deployed military hospital in Iraq. J Trauma.2009;66:157-63.
Toplam 24 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm ORİJİNAL MAKALELER / ORIGINAL ARTICLES
Yazarlar

Salih Atakan Nemli 0000-0002-2720-9870

Elif Doyuk Kartal 0000-0002-6984-3351

Yayımlanma Tarihi 18 Mayıs 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 43 Sayı: 4

Kaynak Göster

Vancouver Nemli SA, Doyuk Kartal E. Hastanede Yatan ve Geçici Üriner Kateterizasyon Uygulanan Hastalarda Kateterde Bakteriyel ve Fungal Kolonizasyonun Araştırılması. Osmangazi Tıp Dergisi. 2021;43(4):364-73.


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