Grzegorz Ziółkowski1, Iwona Pawłowska2, Michał Stasiowski3,4, Estera Jachowicz5, Jadwiga Wójkowska-Mach5, Tomasz Bielecki6. 1. Sosnowiec Medical College, Wojska Polskiego 6 Str, 41-200 Sosnowiec, Poland. 2. St. Barbara Specialised Regional Hospital No 5, Division of Microbiology and Epidemiology, Medyków 1 Square, 41-200 Sosnowiec, Poland. 3. Clinical Department of Anaesthesiology and Intensive Therapy, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland. 4. Department of Anaesthesiology and Intensive Therapy, St. Barbara's Memorial Regional Hospital in Sosnowiec, Plac Medyków 1, 41-200 Sosnowiec, Poland. 5. Department of Microbiology, Faculty of Medicine Jagiellonian University Medical College, 31-121 Kraków (Cracow), Poland. 6. Department of Orthopedics of the Faculty of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland.
Abstract
BACKGROUND: The risk of healthcare-associated infections (HAIs) in surgical wards remains closely related to the type of surgery and procedures performed on patients. Those factors also condition the risk of various forms of clinical infections, especially urinary tract infections (UTIs). UTIs are most frequently (70-80% of cases) caused by the use of bladder catheter in the perioperative period. The aim of this study was to perform an epidemiological and microbiological analysis of UTIs in orthopedic patients, with an emphasis on multidrug-resistant (MDR) micro-organisms. Methods: The study was conducted in a 38-bed Department of Orthopedic-Traumatic Surgery in Sosnowiec, Poland. 5239 patients, operated on in 2013-2015, were included in the study. The urinary catheter use rate was 30.7%. Laboratory-based study used the UTI definition of the HAI-Net program. A micro-organism was declared MDR if it was resistant to at least one antibiotic from three or more groups of antibacterial drugs, and extensively drug-resistant (XDR) if it was sensitive to antibiotics from no more than two groups of drugs. Results: The UTI incidence was 3.2% (168 cases), the CA-UTI incidence density was 9.6/1000 catheter days. The highest risk of UTI was found in patients aged 75 or older. Monomicrobial cultures were detected in 163 specimens (78% of all microbiologically confirmed UTIs). Gram-negative flora prevailed among the micro-organisms, the predominantly isolated Enterobacteriaceae being Escherichia coli and Klebsiella pneumoniae. In 16 patients (7.7% of microbiologically confirmed UTIs), yeast infection was confirmed. Isolated micro-organisms were fully sensitive to carbapenems. Gram-negative bacilli showed the lowest sensitivity to extended substrate spectrum penicillins and fluoroquinolones (37-64%), as well as to trimethoprim-sulfamethoxazole (50%). The MDR prevalence was 24.4%. Conclusions The presented data indicates that UTIs are a significant problem in the studied population, so is antimicrobial resistance, especially to quinolones, and extended-spectrum cephalosporins, which are often used as first-line therapy. To tackle the problem of high UTI incidence and MDR prevalence, reducing the UTI risk factors should be prioritized.
BACKGROUND: The risk of healthcare-associated infections (HAIs) in surgical wards remains closely related to the type of surgery and procedures performed on patients. Those factors also condition the risk of various forms of clinical infections, especially urinary tract infections (UTIs). UTIs are most frequently (70-80% of cases) caused by the use of bladder catheter in the perioperative period. The aim of this study was to perform an epidemiological and microbiological analysis of UTIs in orthopedic patients, with an emphasis on multidrug-resistant (MDR) micro-organisms. Methods: The study was conducted in a 38-bed Department of Orthopedic-Traumatic Surgery in Sosnowiec, Poland. 5239 patients, operated on in 2013-2015, were included in the study. The urinary catheter use rate was 30.7%. Laboratory-based study used the UTI definition of the HAI-Net program. A micro-organism was declared MDR if it was resistant to at least one antibiotic from three or more groups of antibacterial drugs, and extensively drug-resistant (XDR) if it was sensitive to antibiotics from no more than two groups of drugs. Results: The UTI incidence was 3.2% (168 cases), the CA-UTI incidence density was 9.6/1000 catheter days. The highest risk of UTI was found in patients aged 75 or older. Monomicrobial cultures were detected in 163 specimens (78% of all microbiologically confirmed UTIs). Gram-negative flora prevailed among the micro-organisms, the predominantly isolated Enterobacteriaceae being Escherichia coli and Klebsiella pneumoniae. In 16 patients (7.7% of microbiologically confirmed UTIs), yeastinfection was confirmed. Isolated micro-organisms were fully sensitive to carbapenems. Gram-negative bacilli showed the lowest sensitivity to extended substrate spectrum penicillins and fluoroquinolones (37-64%), as well as to trimethoprim-sulfamethoxazole (50%). The MDR prevalence was 24.4%. Conclusions The presented data indicates that UTIs are a significant problem in the studied population, so is antimicrobial resistance, especially to quinolones, and extended-spectrum cephalosporins, which are often used as first-line therapy. To tackle the problem of high UTI incidence and MDR prevalence, reducing the UTI risk factors should be prioritized.
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