Catheter-associated urinary tract infections rates, causative pathogens and their antimicrobial susceptibilities in Intensive Care Units of Gazi University Faculty of Medicine Hospital

In this study; urinary catheter utilization rates, catheter-associated urinary tract infections (CAUTI) rates, and causative agents and their antimicrobial susceptibilities were investigated in the intensive care units (ICU) of Gazi University Faculty of Medicine, in 2009. Overall, urinary catheter utilization rate and CAUTI incidence per 1000 urinary catheter days were found as 0.91 and 10.87. Urinary catheter utilization rate and CAUTI incidence per 1000 urinary catheter days were found as 0.94 and 10.04 in the Anesthesiology and Reanimation ICU, 0.88 and 16.38 in the Neurosurgery ICU, 0.90 and 11.02 in Internal Medicine ICU, 0.85 and 4.32 in General Surgery ICU, 0.99 and 13.26 in Neurology ICU, respectively. In order to reduce the CAUTI rate, which is found to be high in our intensive care units, targeted surveillance should be continued, unnecessary catheter use should be reduced, closed drainage system should be provided during catheterization and the strict compliance with the infections control measures should be forced.The most common etiological agents of CAUTI were Candida species (34.7%) in our study. The most frequent isolated pathogen was C.albicans among Candida species (52.4%). All of C. albicans were susceptible to fluconazole.Microdilution method, used as a reference method to determine the antifungal susceptibility, was compared with E test. E test method was found to be sufficient to analyze the susceptibility for amphotericin B, caspofungin, fluconazole and voriconazol, but inappropriate for itraconazole.When survival and mortality rates were compared, mortality rates were found higher in the patients with Candida. This result may be associated with Candida infections are seen more frequently in severe patients.E.coli and Klebsiella spp. were found 20.6% and 9.9% as causative agents of CAUTI. Pseudomonas spp. and Acinetobacter spp. were isolated 14% and 8.2%, respectively. All E.coli and Klebsiella strains were found susceptible to carbapenems. Carbapenem susceptibility was found as 47.1% and 30% among Pseudomonas and Acinetobacter strains, respectively. Resistance to colistin was not detected among Pseudomonas and Acinetobacter strains in our study.According to our results, fluconazole therapy seems an appropriate choice for the treatment of CAUTI due to C.albicans. 3. and 4. generation cephalosporins should not be used for empirical treatment because of high prevalence of extended spectrum beta-lactamase production among E.coli and Klebsiella isolates. Colistin is the most appropriate choise for the treatment of CAUTI due to Pseudomonas and Acinetobacter.