Urinary catheter-related infection in critically ill patients

Objective

To determine the incidence and microorganisms responsible for urinary catheter-related infection (UCRI) in critically ill patients.

Methods

It is a prospective study performed during 30 months of the patients admitted to a 24-bed medical–surgical ICU of a 650-bed university hospital. Urinary cultures were taken on admission and twice weekly. UCRI were diagnosed according to CDC criteria. UCRI were classified based on the onset moment as early onset and late onset: early onset were those developed during the first 4 days of the ICU stay; and late onset were those developed 5 days after ICU admission. The statistical analysis was performed using the SPSS 11.0 program. Continuous variables are reported as means and standard deviation, and categoric variables as percentages.

Results

A total of 1582 patients were admitted, 953 males (60.24%). The mean age was 57.91 ± 18.83 years (median 63 years, interquartile range 44–73 years). The mean APACHE II score was 13.95 ± 8.93 (median 14, interquartile range 10–19). Admission diagnoses were: 737 (46.59%) heart surgery, 189 cardiological (11.95%), 196 neurologic (12.29%), 185 trauma (11.69%), 120 respiratory (7.59%), 104 digestive (6.57%) and 51 intoxication (3.22%). Mortality rate was 14.79% (234 patients). A total of 1392 patients (87.99%) needed a urinary catheter, during 12,556 days. Of the 1392 patients, 72 (5.17%) developed 75 UCRI (late onset in 54 cases and early onset in 21 cases). All UCRI were caused by only a microorganism. The incidence density was 5.97 UCRI/1000 urinary catheter-days. The microorganisms responsible for UCRI were the following: Escherichia coli (16), Pseudomonas aeruginosa (seven), Morganella morganii (four), Klebsiella (four), Citrobacter (five), Proteus mirabilis (three), Enterococcus faecalis (eight), coagulase-negative staphylococci (seven), MSSA (two), Candida albicans (12) and other fungi (seven).

Conclusions

In our series, most UCRI had a late onset, were caused by only a microorganism and were mainly due to E. coli and C. albicans.