Incidence of CAUTI in a new integrated ICU/HD in Singapore over 1 year
Hospital-acquired infection worldwide has been associated with significant mortality and morbidity and unfortunately catheter-associated urinary tract infection (CAUTI) is known to be one of the commonest hospital-acquired infections.
A retrospective study was done to determine the incidence of CAUTI in the Intensive Care Unit/High Dependency (ICU/HD) in Ng Teng Fong General Hospital (NTFGH) since it was opened from 1 July 2015 to 31 July 2016. NTFGH Intensive Care Unit is an integrated ICU/HD unit that manages a combination of surgical, medical, trauma and cardiac patients. The inclusion criteria were patients catheterized and with urinary tract infections diagnosed in ICU/HD and also diagnosed with UTI within 48 hours of discharge from ICU/HD. The data was retrieved from hospital electronic database. The types of organisms and their resistant pattern to antibiotics were analysed.
A total of 3159 patients were admitted to the ICU/HD during this period. One hundred eighteen patients were diagnosed with urinary tract infections in general and out of this group 69 patients were noted to have CAUTI based on CDC criteria. The commonest organisms related to CAUTI were Escherichia coli and Klebsiella pneumoniae. These two organisms showed a similar pattern of establishing resistance to all the first line antibiotics used and they were ampicillin, amoxicillin-clavulanic acid and cephalosporins. Though the usage of quinolones, sulfamethoxazole-trimethoprim and gentamicin were low, these organisms have also established resistance to these 3 antibiotics. Enterococcus fecalis was the next commonest organism and was often associated with the presentation of diarrhea. Other organisms including Pseudomonas, Proteus, Enterobacter, Morganella, Citrobacter, Burkholderia and Staphylococcus were sporadically reported.
The common risk factors for developing CAUTI noted were surgical elderly male patients with diabetes and a history of obstructive UTI.
A committee involving a team from ICU has been set to review the current indwelling urinary catheter bundle and rectify the problems and implement new measures to reduce the incidence of CAUTI.