Bacterial pathogens and their antibiotic susceptibility pattern in patients with catheter associated urinary tract infections in Mulago Hospital
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Catheter associated urinary tract infection (CA-UTI) still remains the most common infections encountered by clinicians in health settings. Understanding the type of pathogens responsible for CA-UTI, susceptibility and resistance pattern of the causative agents at a specific area will help the clinicians in choosing correct treatment regimen. This study was aimed to investigate the burden of CA-UTI among catheterized patients in Mulago National Referral Hospital, the bacterial pathogens involved and their antimicrobial susceptibility patterns. A descriptive prospective study was conducted between 1st February and 11th April 2014. Participants enrolled from the Medical, urology, spinal, obstetric and the surgical wards, Catheter urine samples were collected from 131patients aged 18 years and above, with no UTI or history of passed catherization on admission. Urine samples were studied by quantitative culture method. Anti-microbial sensitivity test was done by disc diffusion technique according to Clinical and Laboratory Standards Institute guidelines. Of the 131study patients, 42 (32.1%) had CA-UTI (as defined by bacteriuria or funguria of ≥103 colony forming units per ml) at 72 hours of follow up, giving a 3 day incidence of 32.1%. Catheter associated bacteriuria was found in 34 (26%) of the 131 participants, giving a 3 day incidence of catheter associated bacterial urinary tract infection of 26%. Staphylococcus Spp were the commonest bacterial pathogens among gram positives (12 of the 17 isolates (35.3%)), seven of the eight staphylococcus aureus (87.5%) were resistant to methicillin. while for gram negative rods, Klebsiella spp were the predominant isolate (7 of the 17 isolate (23.5%) The isolates demonstrated high rates of resistance to tested relevant antibiotics including gentamicin (100%),ampicillin (94.1%), cotrimoxazole (94.1%), and Amoxicillin-clavulanic acid (94.1%). 60% of the enterobacteriaceae isolate were extended β-lactamase producing strains. No resistance was observed to imipenem and amikacin while rifampicin, clindamycin, vancomycin and nitrofurantoin resistance were at 11.8%, 11.8% 47.1% and 23.5% respectively. This study has revealed that catheter associated urinary tract infections are a problem among catheterized patients in Mulago Hospital and forms a reservoir of multiply resistant bacterial strains within the hospital. Rifampicin, clindamycin and nitrofurantoin are relatively effective against gram positive cocci, while amikacin and imipenem are effective against the Gram-negative rods.