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

L. Sepúlveda, M. Vaz, Í. Brito, C. Chaves, L. Cabral, J. Lima, Filipe Rodrigues
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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 Universitario 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.
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烧伤病房导尿管相关尿路感染:流行病学研究
导读:除了烧伤创面感染外,烧伤患者也更容易发生其他类型的医院感染。导尿管相关性尿路感染(CA-UTI)是这种情况下最常见的感染之一,导致高发病率、住院时间和相关费用增加。本研究的目的是描述住院烧伤患者导尿管相关尿路感染的特征,并评估导致这些感染的微生物因子的频率。材料和方法:回顾性研究,在大学医院(Centro Hospitalar e Universitario de Coimbra, Portugal - CHUC)的烧伤中心(科英布拉烧伤科)进行,基于2010年1月1日至2014年12月31日期间至少进行过一次该检查的烧伤患者的临床数据和尿液培养。分析了感染日期、人群总体特征和病原等不同变量。考虑到既往CA-UTI发作的存在,进一步对感染进行分类,从而定义原发性感染、再感染、复发和过度感染。结果:2010年1月至2014年12月,143例患者中213例被诊断为CA-UTI。泌尿系致病菌以大肠杆菌(27.2%)、粪肠球菌(20.2%)、假单胞菌(13.1%)、念珠菌(12.1%)、克雷伯氏菌(10.8%)和鲍曼不动杆菌(9.9%)最为常见。最常见的微生物因患者的性别而有显著差异。CA-UTI分析对应143例原发感染,44例再感染,17例复发和9例过度感染。男性感染的复发率为11%,女性感染的复发率为5.7%,鲍曼不动杆菌感染的复发率明显更高。讨论/结论:导尿管相关性尿路感染常见于重症监护病房,尤其是烧伤科。鉴定出的最常见病原体与文献中报道的相似。导致多微生物感染的病原体与单微生物感染的病原体相似,可能是由于导尿的短期性质。鲍曼不动杆菌感染表现出较高的复发易感性,这可能与该病原体常见的多重耐药有关。在男性中检测到的高复发率可能与该性别中鲍曼不动杆菌感染的频率较高有关。念珠菌在再感染和过度感染的情况下更为常见,可能是由于以前全身性抗生素继发的细菌菌群破坏。
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