Nosocomially Acquired Urinary Tract Infections in Urology Departements

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Nosocomially Acquired Urinary Tract Infections
in Urology Departements

• Truls E. Bjerklund Johansen
• Århus University Hospital, Århus, DK
• (ESIU)

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Characteristics for each type of hospital taking
part in the PEP and PEAP-studies
excluded one outlier (7286) excluded one
outlier (611)
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Infection control program in different types of
hospitals (n151) given as percent
 
 
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Infection control program in different regions
(151 hospitals) given as percent. P-value given
for frequencies in one or more regions/countries
that differ from the others (Chi-square test)
 
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No of patients screened in the ESIU-prevalence
studies (cumulative numbers)
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No of patients with NAUTI in the ESIU-prevalence
studies database (cumulative numbers)
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Characteristics of patients with NAUTI

• Urinary catheter 74
• Average catheter duration 6-11 days
• Urinary tract obstruction 49
• Previous UTI 44
• Hospitalisation in prev. 6 months 45
• Urinary stones 20

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Catheters on study day (n2849)
51
10
2
11
12
14
of total
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Type and duration of 619 catheters in 537
patients with nosocomially acquired urinary tract
infections
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Contamination status of 614 surgical procedures
in 588 patients with nosocomially acquired
urinary tract infections
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Pathogens causing NAUTI
of total
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AETIOLOGYof uncomplicated UTI
ARESC
N ()
E. coli 76.7
3018 uropathogens
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Relative distribution of pathogens within
regions and countries (n727)
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Escherichia coli
Proteus
Sensitive
Intermediate
Resistant
Enterococcus
Pseudomonas
Klebsiella
Susceptibility of the most common pathogens to
the most commonly used antibiotics. Columns from
left to right represents Ampicilln/amoxicillinbe
talactamase inhibitor cefuroxime
cefotaxime/ceftriaxone ciprofloxacin
co-trimoxazol
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Susceptibility of total bacterial spectrum ()
10 COUNTRIES (N1562)
ARESC
08-03-24
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E coli Regional susceptibility to the most
commonly used antibiotics
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Susceptibility of E.coli ()SUSCEPTIBILITY
PATTERNS IN 10 COUNTRIES (1562)
ARESC
08-03-24
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Clinical presentation of NAUTI
29
26
21
12
12
of total
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Clinical presentation of NAUTI in countries
and regions
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Clinical presentation of NAUTI in countries
and regions
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ESIU-prevalence studies on NAUTI
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• The overall prevalence of NAUTI is 11 (10 and
  14)
• ABU accounts for 29, urosepsis 12
• There are significant differences between regions
  and types of hospitals in
• prevalence of NAUTI (7-21) and
• microbiological evidence for diagnosing urosepsis
  (9-50)

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Lessons learned
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• 70 of urology departments have protocols for
  catheter insertion and care, 43 prepare annual
  reports about NAUTI
• The number of culture tests and the infection
  control systems vary significantly (0-5,9 per
  patient)
• Urinary catheters are the most common risk
  factors

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• The distribution of pathogens and the
  susceptibility of pathogens is a cause of concern
  in many regions
• International recommendations on prophylaxis may
  have a limited value

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Annual costs of NAUTI

• Incremental cost of hospital stay
• 500 Euro/day
• Extra period of hospitalisation per NAUTI 3 days
• Extra costs for one urology dept. with 1931
  admissions (mean) and prevalence of 21
• 608 265 Euro
• Total costs of NAUTI in Europe (800 mill.
  people) 1.216.530.000 Euro

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Prevalence of NAUTI will be reduced by

• 0.12 if the department has protocol for catheter
  insertion and care (ie. from 20 to 8)
• 0.08 if the dept. is in other European
  countries (ie. from 20 to 12)
• 0.002 per patient receiving antimicrobial
  prophylaxis (ie. with 4 percent-points for 20
  patients)
• 0.002 per extra patient hospitalised

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Resistance rates of uropathogens, 1994 2004,
Straubing n (313 - 535) resistant