Urinary tract nosocomial infections at the Clinical centre in Kragujevac

Abstract

Introduction. Urinary tract infections are the most frequent hospital infections and account for about 40% of total hospital infections. The main risk factor for their development is the use of catheters. Objective. Assessment of basic epidemiological and etiological characteristics of nosocomial urinary tract infections (NUTIs) and investigation of differences in risk factors among the patients with NUTIs with and without the urinary catheter. Methods. The study comprised patients treated in chosen units/ of the Clinical Center in Kragujevac, in whom NUTI was registered during 2009. Differences in risk factors for NUTIs between the catheterized and uncatheterized patients were tested by the logistic regression analysis. Results. NUTIs was registered in 162 patients whose average age was 66.2?13.5 years with approximately equal gender participation (51.2% men and 48.8% women). Almost three quarters of the patients with NUITs had indwelling urinary catheter, 12.0?7.7 days on average (from 1 to 39 days). In the patients with urinary catheter, the risk for NUITs was significantly positively associated with emergency admission to hospital treatment (p=0.0185). The uncatheterized patients had a significant frequency of malignant tumours comparing to the patients with a urinary catheter (p=0.039). The compared groups did not differ in other risk factors. The most frequently isolated microbial agents was Klebsiella spp (37.3%), then Pseudomonas aeruginosa (14.1%) and Proteus mirabilis (11.9%). Most of the bacteria showed a great level of resistance to frequently used antibacterial drugs, even up to 100%. Conclusion. It is necessary to define national recommendations for the prevention and control of NUTIs in the future.Uvod. Infekcije urinarnog trakta su najcesce bolnicke infekcije, a cine oko 40% svih infekcija dobijenih tokom bolnickog lecenja. Glavni faktor rizika za nastanak ovih infekcija je nosenje katetera. Cilj rada. Cilj istrazivanja bio je da se sagledaju osnovna epidemioloska i etioloska obelezja bolnickih infekcija urinarnog trakta (BIUT) i ispitaju razlike u faktorima rizika izmedju obolelih od BIUT koji su nosili mokracni kateter i onih kojima on nije postavljen. Metode rada. Istrazivanjem su obuhvaceni bolesnici leceni u Klinickom centru u Kragujevcu kod kojih je tokom 2009. godine dijagnostikovana BIUT. Razlike u faktorima rizika za BIUT izmedju bolesnika kojima je postavljen kateter i onima kojima nije ispitane su logistickom regresionom analizom. Rezultati. Prosecna starost 162 bolesnika sa BIUT bila je 66,2?13,5 godina, a broj ispitanika oba pola bio je priblizno isti (51,2% muskaraca i 48,8% zena). Skoro tri cetvrtine bolesnika sa BIUT nosilo je mokracni kateter, u proseku 12,0?7,7 dana (od jednog do 39 dana). Kod bolesnika s kateterom rizik za nastanak BIUT bio je znacajno pozitivno povezan s hitnim prijemom na bolnicko lecenje (p=0,0185). Bolesnici bez mokracnog katetera znacajno su cesce bolovali od malignih tumora u poredjenju sa bolesnicima koji su nosili kateter (p=0,039). Dve posmatrane grupe ispitanika nisu se razlikovale u pogledu drugih faktora rizika. Uzrocnici BIUT bili su: Klebsiella spp (37,3%), Pseudomonas aeruginosa (14,1%) i Proteus mirabilis (11,9%). Vecina bakterija ispoljila je visok stepen rezistencije na najcesce koriscene antibakterijske preparate (cak i do 100%). Zakljucak. U narednom periodu neophodno je definisati nacionalne preporuke za prevenciju i kontrolu BIUT.