Claire Aumeran1,2,3, Benoit Mottet-Auselo4, Christiane Forestier5, Paul-Alain Nana5, Claire Hennequin5,6, Frédéric Robin6,7,8, Bertrand Souweine5,9, Ousmane Traoré4,5, Alexandre Lautrette5,9. 1. Infection Control Department, 3IHP, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France. caumeran@chu-clermontferrand.fr. 2. Université Clermont Auvergne, UMR CNRS 6023 'Laboratoire Microorganismes: Génome Environnement (LMGE)', F-63000, Clermont-Ferrand, France. caumeran@chu-clermontferrand.fr. 3. Service d'Hygiène Hospitalière, Hôpital Gabriel Montpied, 58 Rue Montalembert, 63003, Clermont-Ferrand Cedex 1, France. caumeran@chu-clermontferrand.fr. 4. Infection Control Department, 3IHP, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France. 5. Université Clermont Auvergne, UMR CNRS 6023 'Laboratoire Microorganismes: Génome Environnement (LMGE)', F-63000, Clermont-Ferrand, France. 6. Bacteriology Department, 3IHP, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France. 7. Université Clermont Auvergne, UMR INSERM 1071 'Laboratoire Microbe intestin inflammation et Susceptibilité de l'Hôte (M2ISH)', USC INRA2018, F-63000, Clermont-Ferrand, France. 8. Laboratoire associé Résistance des Entérobactéries BLSE/Céphalosporinases, Centre National de Référence Résistance aux Antibiotiques, Clermont-Ferrand, France. 9. Intensive Care Medicine, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France.
Abstract
BACKGROUND: Updating the pathogenesis of catheter-associated bacteriuria (CA-bacteriuria) in the intensive care unit (ICU) is needed to adapt prevention strategies. Our aim was to determine whether the main pathway of CA-bacteriuria in ICU patients was endoluminal or exoluminal. In a prospective study, quantitative urine cultures were sampled from catheter sampling sites, collector bags and the catheter outer surface near the meatus from days 1 to 15 after catheterization. The endoluminal pathway was CA-bacteriuria (defined as 102 CFU/mL) first in collector bags and then in catheters. The exoluminal pathway was CA-bacteriuria first in catheters, on day 1 in early cases and after day 1 in late cases. RESULTS: Of 64 included patients, 20 had CA-bacteriuria. Means of catheterization days and incidence density were 6.81 days and 55.2/1000 catheter-days. Of 26 microorganisms identified, 12 (46.2%) were Gram positive cocci, 8 (30.8%) Gram negative bacilli and 6 yeasts. Three (11.5%) CA-bacteriuria were endoluminal and 23 (88.5%) exoluminal, of which 10 (38.5%) were early and 13 (50%) late. Molecular comparison confirmed culture findings. A quality audit showed good compliance with guidelines. CONCLUSION: The exoluminal pathway of CA-bacteriuria in ICU patients predominated and surprisingly occurred early despite good implementation of guidelines. This finding should be considered in guidelines for prevention of CA-bacteriuria.
BACKGROUND: Updating the pathogenesis of catheter-associated bacteriuria (CA-bacteriuria) in the intensive care unit (ICU) is needed to adapt prevention strategies. Our aim was to determine whether the main pathway of CA-bacteriuria in ICU patients was endoluminal or exoluminal. In a prospective study, quantitative urine cultures were sampled from catheter sampling sites, collector bags and the catheter outer surface near the meatus from days 1 to 15 after catheterization. The endoluminal pathway was CA-bacteriuria (defined as 102 CFU/mL) first in collector bags and then in catheters. The exoluminal pathway was CA-bacteriuria first in catheters, on day 1 in early cases and after day 1 in late cases. RESULTS: Of 64 included patients, 20 had CA-bacteriuria. Means of catheterization days and incidence density were 6.81 days and 55.2/1000 catheter-days. Of 26 microorganisms identified, 12 (46.2%) were Gram positive cocci, 8 (30.8%) Gram negative bacilli and 6 yeasts. Three (11.5%) CA-bacteriuria were endoluminal and 23 (88.5%) exoluminal, of which 10 (38.5%) were early and 13 (50%) late. Molecular comparison confirmed culture findings. A quality audit showed good compliance with guidelines. CONCLUSION: The exoluminal pathway of CA-bacteriuria in ICU patients predominated and surprisingly occurred early despite good implementation of guidelines. This finding should be considered in guidelines for prevention of CA-bacteriuria.
Authors: Thomas M Hooton; Suzanne F Bradley; Diana D Cardenas; Richard Colgan; Suzanne E Geerlings; James C Rice; Sanjay Saint; Anthony J Schaeffer; Paul A Tambayh; Peter Tenke; Lindsay E Nicolle Journal: Clin Infect Dis Date: 2010-03-01 Impact factor: 9.079
Authors: Wolfgang Kram; Henrike Rebl; Julia E de la Cruz; Antonia Haag; Jürgen Renner; Thomas Epting; Armin Springer; Federico Soria; Marion Wienecke; Oliver W Hakenberg Journal: Polymers (Basel) Date: 2022-08-16 Impact factor: 4.967