Appraising epidemiology data and antimicrobial resistance of urinary tract infections in critically ill adult patients

a 7-year retrospective study in a referral Brazilian hospital

Authors

Keywords:

Chain of infection, Bacterial zoonoses, Urinary tract infections, Epidemiology

Abstract

BACKGROUND: Urinary tract infections (UTI) are highly preventable and have significant clinical and financial impact on the patient and the health care system. OBJECTIVE: To investigate UTIs in critically ill adult patients and the relationship of antimicrobial consumption and multidrug-resistant isolate. DESIGN AND SETTING: A cohort study performed in a Brazilian tertiary-care university hospital in the city of Uberlandia (MG), located at the Federal University of Uberlandia, southeast region of the country. METHODS: We analyzed a cohort of 363 patients with first episode of UTIs from the adult intensive care unit (ICU), from January 2012 to December 2018. The daily doses of antimicrobial administered were calculated. RESULTS: The incidence rate of UTI was 7.2/1000 patient days, with 3.5/1000 patient-days of bacteriuria, and 2.1/1000 patient-days of candiduria. Of 373 microorganisms identified, 69 (18.4%) were Gram-positive cocci, 190 (50.9%) Gram-negative bacilli, and 114 yeasts (30.7%). Escherichia coli and Candida spp. were the most common. Patients with candiduria had higher comorbidity score (Charlson Comorbidity Index ≥ 3), longer length of stay (P = 0.0066), higher mortality (P = < 0.0001) severe sepsis, septic shock, and were immunocompromised when compared with patients with bacteriuria. We observed correlation between antibiotics consumption and multidrug-resistant (MDR) microorganisms. CONCLUSION: The UTIs incidence was high and was mainly caused by Gram-negative bacteria that were resistant to common antibiotics. We observed increase in the consumption of broad-spectrum antibiotics in ICU correlating with MDR microorganisms. In general, ICU-acquired candiduria may be associated with critical illness and poor prognosis.

Downloads

Download data is not yet available.

Author Biographies

Vitelhe Ferreira de Almeida, Universidade Federal de Uberlândia

MSc. Biologist and Doctoral Student, Institute of Biomedical Sciences, Laboratory of Molecular Microbiology, Universidade Federal de Uberlândia (UFU), Uberlândia (MG), Brazil.

Maria Clara Bisaio Quiliici, Universidade Federal de Uberlândia

MSc. Nurse, Institute of Biomedical Sciences, Laboratory of Molecular Microbiology, Universidade Federal de Uberlândia (UFU), Uberlândia (MG), Brazil.

Sebastiana Silva Sabino, Universidade Federal de Uberlândia

MSc. Nurse and Doctoral Student Institute of Biomedical Sciences, Laboratory of Molecular Microbiology, Universidade Federal de Uberlândia (UFU), Uberlândia (MG), Brazil.

Daiane Silva Resende, Universidade Federal de Uberlândia

PhD. Biologist, Institute of Biomedical Sciences, Laboratory of Molecular Microbiology, Universidade Federal de Uberlândia (UFU), Uberlândia (MG), Brazil.

Iara Rossi, Universidade Federal de Uberlândia

PhD. Biologist, Institute of Biomedical Sciences, Laboratory of Molecular Microbiology, Universidade Federal de Uberlândia (UFU), Uberlândia (MG), Brazil.

Paola Amaral de Campos, Universidade Federal de Uberlândia

PhD. Biologist, Institute of Biomedical Sciences, Laboratory of Molecular Microbiology, Universidade Federal de Uberlândia (UFU), Uberlândia (MG), Brazil.

Rosineide Marques Ribas, Universidade Federal de Uberlândia

PhD. Biologist and Full Professor, Department of Microbiology, Universidade Federal de Uberlândia (UFU), Uberlândia (MG), Brazil.

Paulo Pinto Gontijo Filho, Universidade Federal de Uberlândia

PhD. Retired Professor, Department of Microbiology, Universidade Federal de Uberlândia (UFU), Uberlândia (MG), Brazil.

References

Ding R, Li X, Zhang X, Zhang Z, Ma X. The epidemiology of symptomatic catheter-associated urinary tract infections in the intensive care unit: a year single center retrospective study. Urol J. 2019;16(3):312-7. PMID: 30178453; https://doi.org/10.22037/uj.v0i0.4256.

Burton DC, Edwards JR, Srinivasan A, Fridkin SK, Gould CV. Trends in catheter-associated urinary tract infections in adult intensive care units-United States, 1990-2007. Infect Control Hosp Epidemiol. 2011;32(8):748-56. PMID: 21768757; https://doi.org/10.1086/660872.

de Oliveira AC, Kovner CT, da Silva RS. Nosocomial infection in an intensive care unit in a Brazilian university hospital. Rev Lat Am Enfermagem. 2010;18(2):233-9. PMID: 20549123; https://doi.org/10.1590/s0104-11692010000200014.

Salomao R, Rosenthal VD, Grimberg G, et al. Device-associated infection rates in intensive care units of Brazilian hospitals: findings of the International Nosocomial Infection Control Consortium. Rev Panam Salud Publica. 2008;24(3):195-202. PMID: 19115547; https://doi.org/10.1590/S1020-49892008000900006.5.

Tandogdu Z, Wagenlehner FM. Global epidemiology of urinary tract infections. Curr Opin Infect Dis. 2016;29(1):73-9. PMID: 26694621; https://doi.org/10.1097/QCO.0000000000000228.

Centers for Disease Control and Prevention (CDC). Healthcare-associated infections (HAIs). Catheter-associated urinary tract infection. Available from: https://www.cdc.gov/hai/ca_uti/uti.html. Accessed in 2021 (Nov 22).

Saharman YR, Karuniawati A, Severin JA, Verbrugh HA. Infections and antimicrobial resistance in intensive care units in lower-middle income countries: a scoping review. Antimicrob Resist Infect Control. 2021;10(1):22. PMID: 33514432; https://doi.org/10.1186/s13756-020-00871-x.8.

Silva MCM, Sousa RMC. A versão simplificada do therapeutic intervention scoring system e seu valor prognóstico [Simplified version of the therapeutic intervention scoring system and its prognostic value]. Rev Esc Enferm USP. 2001;13(1):6-14. PMID: 15973981; https://doi.org/10.1590/s0080-62342004000200013.

Chaves TA, Carneiro CBR, Peters M et al. Microorganisms causing urinary tract infections in a teaching hospital in northeastern Brazil. J Health NPEPS. 2018;3(1):51-66. https://doi.org/10.30681/252610102834.

Foxman B. Urinary tract infection syndromes: occurrence, Recurrence, Bacteriology, risk factors, and disease burden. Infect Dis Clin North Am. 2014;28(1):1-13. PMID: 24484571; https://doi.org/10.1016/j.idc.2013.09.003.

Tedja R, Wentink J, O’Horo JC, Thompson R, Sampath KP. Catheter-associated urinary tract infections in intensive care unit patients. Infect Control Hosp Epidemiol. 2015;36(11):1330-4. PMID: 26190686; https://doi.org/10.1017/ice.2015.172.

McCusker ME, Périssé ARS, Roghmann MC. Severity-of-illness markers as predictors of nosocomial infection in adult intensive care unit patients. Am J Infect Control. 2002;30(3):139-44. PMID: 11988707; https://doi.org/10.1067/MIC.2002.121662.

Charlson ME, Pompei P, Ales kl, Mackenzie CR. A new method of classifying prognostic comorbity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83. PMID: 3558716; https://doi.org/10.1016/0021-9681(87)90171-8.

Gül F, Arslantas MK, Cinel İ, Kumar A. Changing definitions of sepsis. Turk J Anaesthesiol Reanim. 2017;45(3):129-38. PMID: 28752002; https://doi.org/10.5152/TJAR.2017.93753.

Instituto Latino Americano de Sespe (ILAS). 2018. Implementação de protocolo gerenciado de sepse – Protocolo clínico – Atendimento ao paciente adulto com sepse/choque séptico. São Paulo. Available from: https://www.ilas.org.br/assets/arquivos/ferramentas/protocolo-de-tratamento.pdf. Accessed in 2019 (Nov 22).

Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309-32. Erratum in: Am J Infect Control. 2008;36(9):655. PMID: 18538699. https://doi.org/10.1016/j.ajic.2008.03.002.

Aubron C, Suzuki S, Glassford NJ, et al. The epidemiology of bacteriuria and candiduria in critically ill patients. Epidemiol Infect. 2015;143(3):653-62. PMID: 24762978; https://doi.org/10.1017/S0950268814000934.

Agência Nacional de Vigilância Sanitária (ANVISA). Infecções do Trato Urinário e Outras Infecções do Sistema Urinário. Gerência de Vigilância e Monitoramento em Serviços de Saúde - GVIMS Gerência Geral de Tecnologia em Serviços de Saúde GGTES. 2016. Available from: http://www.riocomsaude.rj.gov.br/Publico/MostrarArquivo.aspx?C=pCiWUy84%2BR0%3D. Accessed in 2019 (Nov 22).

Viscoli C. Bloodstream infections: the peak of the iceberg. Virulence. 2016;7(3):248-51. PMID: 26890622; https://doi.org/10.1080/21505594.2016.1152440.

Magiorakos AP, Srinivasan A, Carey RB et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria an international expert proposal for interim standard definitions. Clin Microbiol Infect. 2012;18(3):268-81. PMID: 21793988; https://doi.org/10.1111/j.1469-0691.2011.03570.x.

Akova M, Akan H, Korten V, et al. Comparison of meropenem with amikacin plus ceftazidime in the empirical treatment of febrile neutropenia: a prospective randomised multicentre trial in patients without previous prophylactic antibiotics. Meropen Study Group of Turkey. Int J Antimicrob Agents. 1999;13(1):15-19. PMID: 10563400; https://doi.org/10.1016/S0924-8579(99)00096-5.

Clinical and Laboratory Standards Institute. QMS05-A2 Quality management system: qualifying, selecting, and evaluating a referral laboratory; approved guideline-Second edition. 2012. Available from: https://clsi.org/media/1519/qms05a2_sample.pdf. Accessed in 2021 (Nov 22).

National Nosocomial Infections Surveillance System. National nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004 issued October 2004. Am. J Infect Control. 2004;32(8):470-85. PMID: 15573054; https://doi.org/10.1016/S0196655304005425.

Braga IA, Campos PA, Batistão DWDF, Gontijo Filho PP, Ribas RM. Using point prevalence survey to define burden of antimicrobial use among 35 adult intensive care units in Brazil. Infect Dis (Lond). 2019;51(6):459-62. PMID: 30821555; https://doi.org/10.1080/23744235.2019.1581371.

Tambyah PA, Maki DG. Catheter-associated urinary tract infection is rarely symptomatic: a prospective study of 1,497 catheterized patients. Arch Intern Med. 2000;160(5):678-82. PMID: 10724054; https://doi.org/10.1001/archinte.160.5.678.

Warren JW. The catheter and urinary tract infection. Med Clin North Am. 1991;75(2):481-93. PMID: 1996045; https://doi.org/10.1016/S0025-7125(16)30465-5.

Joseph NM, Bhanupriya B, Shewade DG, Harish BN. Relationship between antimicrobial consumption and the incidence of antimicrobial resistance in Escherichia coli and Klebsiella pneumoniae isolates. J Clin Diagn Res. 2015;9(2): DC08-12. PMID:25859453; https://doi.org/10.7860/JCDR/2015/11029.5537.

Yang P, Chen Y, Jiang S, et al. Association between antibiotic consumption and the rate of carbapenem-resistant Gram-negative bacteria from China based on 153 tertiary hospitals data in 2014. Antimicrob Resist Infect Control. 2018;7:137. PMID: 30479750; https://doi.org/10.1186/s13756-018-0430-1.

Gianino MM, Lenzi J, Bonaudo M, et al. Predictors and trajectories of antibiotic consumption in 22 EU countries: findings from a time series analysis (2000-2014). PLoS One. 2018;13(6):e0199436. PMID: 29933377; https://doi.org/10.1371/journal.pone.0199436.30.

Filippini M, Masiero G, Moschetti K. Socioeconomic determinants of regional differences in outpatient antibiotic consumption: evidence from Switzerland. Health Policy. 2006;22;78(1):77-92. PMID: 16290129; https://doi.org/10.1016/J.HEALTHPOL.2005.09.009.

Matuz M, Benko R, Doro P, et al. Regional variations in community consumption of antibiotics in Hungary. 1996-2003. Br J Clin Pharmacol. 2006;61(1):96-100. PMID: 16390356; https://doi.org/10.1111/J.1365-2125.2005.02525.X.

Downloads

Published

2023-10-05

How to Cite

1.
Almeida VF de, Quiliici MCB, Sabino SS, Resende DS, Rossi I, Campos PA de, Ribas RM, Gontijo Filho PP. Appraising epidemiology data and antimicrobial resistance of urinary tract infections in critically ill adult patients: a 7-year retrospective study in a referral Brazilian hospital. Sao Paulo Med J [Internet]. 2023 Oct. 5 [cited 2025 Feb. 7];141(6):1-8. Available from: https://periodicosapm.emnuvens.com.br/spmj/article/view/356

Issue

Section

Original Article