Bacterial colonization, species diversity and antimicrobial susceptibility patterns of indwelling urinary catheters from postpartum mothers attending a Tertiary Hospital in Eastern Uganda

Background Postpartum urinary Catheter-Related Infections (CRIs) are a significant cause of maternal sepsis. Several studies done have reported the presence of mixed populations of bacteria with a significant increase in Extended-Spectrum Beta-Lactamase (ESBL) Enterobacteriaceae spps, Methicillin-Resistant Staphylococcus aureus (MRSA), Multi-Drug Resistant (MDR) bacteria in urine and blood cultures of catheterized patients despite the use of prophylactic antibiotics. This study aimed at determining the bacterial species diversity and susceptibility patterns of indwelling urinary catheters from postpartum mothers attending Mbale Regional Referral Hospital (MRRH). Methods A cross-sectional study employing quantitative and qualitative was carried out in MRRH among postpartum mothers with urinary catheters and their care-takers. The purposive non-random sampling strategy was used to collect data using an interviewer-administered questionnaire for the quantitative data collection and in-depth interviews for qualitative data collection. All the data collection tools used were developed, pretested and validated. At the point of de-catheterization, Catheter tips from enrolled participants were cut about 2-3cm below the balloon aseptically into test-tube containing peptone water, sonication technique employed, and incubation done 24hours then cultured to ensure phenotypic identification. An antibiotic sensitivity test was performed using the disc diffusion method following Clinical and Laboratory Standards Institute (CLSI) guidelines. Quantitative data collected was entered in Microsoft Excel and then exported to STATA14 for statistical analysis. Thematic analysis was used to analyse and organise qualitative data by an inductive coding method using Nvivo 12 software. Results In this study, 208 postpartum mothers participated, the majority of whom were caesarean section mothers of age range 20–24 years and 17 care-takers with a median age of 32 years. The prevalence of catheter tips bacterial colonisation was 98% despite 88.5% of the participants being on broad-spectrum antibiotics. The average duration of catheterisation was 2 days. All bacteria isolates were potential uro-pathogens with a mean occurrence of 2 bacteria species in each urinary catheter tip. The rates of MDR to commonly used antibiotics were high. The urinary catheter size of greater than F14 and duration of catheterization greater than 2 days were significantly associated with the number of bacterial species isolated from each sample. The maintenance care and knowledge of care-urinary catheter care among the care-takers was found sub-optimal. Conclusion There was a high prevalence of catheter colonisation with bacterial spps diversity averaging 2 spps per sample despite use of broad spectrum antibiotics. The MDR rates were high, which calls for routine culture and sensitivity. Health workers practicing obstetric medicine need to pay attention to catheter sizes during catheterisation and its duration. Health education should be part of antenatal and postnatal care education.

Bio-Inspired Antibacterial Coating on Urinary Catheter for Encrustation Prevention

Urinary tract infection (UTI) represents one of the most common nosocomial infections, which is mainly related to indwelling catheters or stents. In addition to the formation of biofilms to resistant...

Urinary Tract Infections in Pennsylvania Long-Term Care Facilities

Urinary tract infections (UTIs) are common healthcare-associated infections (HAIs) in older adults that live in long-term care (LTC) facilities. A query of the Pennsylvania Patient Safety Reporting System (PA-PSRS) found that symptomatic UTI (SUTI) and catheter-associated UTI (CAUTI) rates increased from 2016 and peaked in the second quarter of 2020. Although the number of urinary catheter days reported by LTC facilities has trended downward from 2016 to the beginning of 2020, the urinary catheter utilization rate increased slightly in the second quarter of 2020. We also examined various epidemiological factors. An average of 47.6% of SUTIs and 32.3% of CAUTIs were associated with E. coli from 2016 through 2020. However, the percentage of CAUTIs associated with E. coli decreased while the percentage of CAUTIs associated with organisms of the tribe Proteeae (Proteus, Providencia, and Morganella genera) increased from 2016 through 2020. Furthermore, the percentage of CAUTIs associated with carbapenem-resistant Enterobacterales (CRE) and organisms producing extended-spectrum beta-lactamases (ESBL) also increased, while the percentage of CAUTIs associated with vancomycin-resistant Enterococci (VRE) decreased from 2016 through 2020. An average of 38.5% of SUTIs and 41.5% of CAUTIs were reported to be treated with fluoroquinolones from 2016 through 2020. However, the percentage of both SUTIs and CAUTIs treated with fluoroquinolones decreased from 2016 through 2020, while an increasing percentage of both SUTIs and CAUTIs was reported to have been treated with cephalosporins and carbapenems from 2016 through 2020. Thus, to further promote resident safety, we use these epidemiological trends to better understand current risks for residents and to further guide development of best practices for prevention, identification, and treatment of UTIs as well as to further advance antibiotic stewardship practices.

Quality Improvement Initiative: Foley Catheters in Patients Undergoing Pectus Deformity Repair

Background and Hypothesis: Pectus excavatum and carinatum are sternal deformities that often require surgeries with significant postoperative pain that can limit a patient’s ability to void. An indwelling urinary catheter is placed for the operation, but is often removed on the first postoperative day due to concerns of infection, which begs the necessity of these catheters in the first place. In this study, we hypothesized that there would be no increased risk of urinary retention or urinary tract infection irrespective of whether urinary catheters were utilized. Experimental Design: A pre/post quality improvement study was undertaken of patients undergoing pectus excavatum/carinatum repair between June 1, 2015 and May 31, 2022. The pre intervention group spanned from June 1, 2015 to May 31, 2021, where Foley catheters were placed intraoperatively and removed the first postoperative day. Pediatric surgery and anesthesia groups changed practice effective June 1, 2021 and decided to no longer utilize urinary catheters in pectus repairs. Pre-intervention patients were acquired through the surgery billing database. Post-intervention patients were acquired prospectively. Rates of urinary retention (any event requiring mechanical intervention for voiding) and urinary tract infections (UTI, >100,000 CFU bacteria/mL urine) were compiled into REDCap. Data are expressed as percent of the total cohort. Results: Of 179 patients undergoing pectus repair (162 Excavatum, 17 Carinatum), 12 patients (6.7%) in the pre-intervention group experienced urinary retention. Of these, 9 received in/out catheterization, 1 had a Foley catheter replaced, and 2 underwent in/out catheterization and had a Foley replaced. There were no urinary tract infections recorded among the pre-intervention group. Conclusion and Potential Impacts: Urinary retention and UTI are rare in patients who have an indwelling urinary catheter. Data acquired over the next year from the post-intervention group will help determine the true necessity for these catheters in the perioperative pectus population.