| 摘要(英) | Prevalence of indwelling urinary catheter among hospitalized patients
and analysis of uropathogens and pattern of antimicrobial resistance associated with the use of urinary catheter
Purpose:
Indwelling urinary catheter has been frequently used to manage urinary retention or incontinence despite it might cause certain complications. In this study, we evaluated the prevalence of indwelling urine catheter among hospitalized patients in Taiwan. We also analyzed uropathogens and pattern of antimicrobial resistance associated with urinary catheter utilization. Information from this analysis can be used as reference in future care and treatment of patients.
Materials and Methods:
Using the files of inpatient expenditures by admissions, details of inpatient orders and registry for contracted medical facilities from the National Health Insurance Research Database, we estimated the overall and stratum specific prevalence of indwelling urinary catheter among hospitalized patients according to admitted department, geographic area and accreditation level of hospitals, age and gender of patients in 2003. The distribution of uropathogens and pattern of antimicrobial resistance were analyzed with the reports of all urine cultures from the laboratory of a regional hospital in 2004. Comparison was made to examine whether the use of urinary catheter may be associated with different uropathogens and pattern of antimicrobial resistance.
Results:
The overall prevalence of indwelling urinary catheter among all hospitalized patients was 14.1% in 2003. The prevalence among patients admitted to the department of internal medicine, surgery, orthopedic and gynecology and obstetric was estimated at 11.1%, 13.4%, 18.2% and 35.5% respectively. The prevalence among patients admitted to the department of internal medicine was 11.2% in medical centers, 10.4% in regional hospitals, and 11.9% in local hospitals. Geographic variation showed that the prevalence in northern, middle, southern and eastern part of Taiwan was 10.3%, 11.2%, 12.2% and 8.5% respectively. According to age and gender, the prevalence for male patients aged 50-59, 60-69, 70-79 and 80-89 years was estimated at 7.5%、11.6%、15.8% and 21.1%, respectively. The corresponding figures for female were 7.0%, 10.4%, 18.2% and 24.0%.
Analysis of uropathogens showed that Escherichia coli (36.8%) was the most common pathogen causing urinary tract infections of patients without indwelling urinary catheter, followed by non-E. coli Enterobacteriaceae (19.2%), Pseudomonas spp. (8.6%), and Enterococcus spp. (7.3%). Of the patients with indwelling urinary catheter, Escherichia coli (23.4%) was still the most common uropathogen, followed by non-E. coli Enterobacteriaceae (20.5%), Pseudomonas spp. (16.4%), and rare Gram negative bacilli (5.8%).
The resistance rates of Escherichia coli against sulfamethoxazole + trimethoprim (SXT) were high, ranging from 32.3% to 73.5%. Indwelling urinary catheter further increased the risk of resistance. With regarding to the resistance of Escherichia coli to other commonly prescribed antimicrobials, the resistance rates were higher against cefazoline(CZ), amoxicillin+clavulanic acid (AMC), ciprofloxacin (CIP) and gentamicin (GM); but relatively low against amikacin (AN), ceftazidime (CAZ) and imipenem (IPM). Indwelling urinary catheter may also increase the risk of resistance against nearly all antibiotics except IPM.
The resistance rate for non-E.coli Enterobacteriaceae against SXT was also high, especially among the patients with indwelling urinary catheter. Additionally, the resistance rates were also high against CZ and AMC, but low against IMP. Again, indwelling urinary catheter was also observed to increase risk of resistance. Pseudomonas spp. was observed to be highly resistant against AMC and was less likely to be resistant against AN, CAZ and IPM. However, indwelling urinary catheter did not seem to be able to increase the risk of resistance of Pseudomonas spp. The resistance rates were generally high for rare Gram negative bacilli against all tested antimicrobials except IPM. Moreover, indwelling urinary catheter did not increase much of the risk of resistance of Pseudomonas spp. and rare Gram negative bacilli.
With regard to concurrent resistance, it showed that concurrent resistance of SXT with CZ, AMC, CIP and GM, respectively was all significant for the Enterobacteriaceae including Escherichia coli. Concurrent resistance was particularly evident among patients with indwelling urinary catheter.
Conclusions:
In 2003, the prevalence of indwelling urinary catheter among all hospitalized patients and patients admitted to the department of internal medicine in Taiwan was 14.1% and 11.1% respectively. Indwelling urinary catheter not only increased the urinary tract infections caused by intrinsically more resistant pathogens such as Pseudomonas spp. and rare Gram negative bacilli, but also increased the risk of antimicrobial resistance of Enterobacteriaceae. This may lead to difficulty in treating patients. We recommended caution be exercised before using indwelling urinary catheter.
Keywords: urinary catheter, uropathogen, antimicrobial, resistance
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| 參考文獻 | 六、參考文獻
Barnett BJ, Stephens DS. Urinary tract infection: an overview. Am J Med Soc 1997;314:245-249.
Bauer AW, Kirby WM, Sherris JC, Turck M. Antibiotics susceptibility testing by a standardized single disc method. Am J Clin Pathol 1966;45:493-496.
Beunders AJ. Development of antibacterial resistance: the Dutch experience. J Antimicrob Chemother 1994;33(Suppl.A):17-22.
Bonadio M, Meini M, Spitaleri P, Gigli C. Current microbiological and clinical aspects of urinary tract infections. Eur Urol 2001;40:439–444.
Bryan CS, Reynolds KL. Hospital-acquired bacteremic urinary tract infection: epidemiology and outcome. J Urol 1984;132:494-498.
Chiang TL. Taiwan’s1995 health care reform. 1997;39:225-239.
Coates KW, Harris RL, Cundiff GW, Bump RC. Uroflowmetry in women with urinary incontinence and pelvic organ prolapse. Br J Urol 1997;80:217-221.
Cox AJ, Hukins DW, Sutton TM. Infection of catheterised patients: bacterial colonisation of encrusted Foley catheters shown by scanning electron microscopy. Urol Res 1989;17:349-350.
Dyer IE, Sankary TM, Dawson JA. Antibiotic resistance in bacterial urinary tract infections, 1991 to 1997. West J Med 1998;169:265-268.
Ena J, Amador C, Martinez C, Ortiz de la Tabla V. Risk factors for aquisition of urinary tract infections caused by ciprofloxacin resistant Escherichia coli. J Urol 1995;153:117-120.
Ena J, Lopez-Perezagua MM, Martinez-Peinado C, Cia-Barrio MA, Ruiz-Lopez I. Emergence of ciprofloxacin resistance in Escherichia coli isolates after widespread use of fluoroquinolones. Diagn Microbiol Infect Dis 1998;30:103-107.
Finkelstein R, Rabino G, Kassis I, Mahamid E. Device-associated, device day infection rates in an Israeli adult general intensive care unit. J Hosp Infect 2000;44:200-205.
Fitzgerald MP, Kulkarni N, Fenner D. Postoperative resolution of urinary retention in patients with advanced pelvic organ prolapse. Am J Obstet Gynecol 2000;183:1361-1363.
Gales AC, Jones RN, Gordon KA , Sader HS, Wilke WW, Beach ML, Pfaller MA, Doern GV. Activity and spectrum of 22 antimicrobial agents tested against urinary tract infection pathogens in hospitalized patients in Latin America: report from the second year of the SENTRY Antimicrobial Surveillance Program (1998). J Antimicrob Chemother 2000;45:295-303.
Gammack JK. Use and management of chronic urinary catheters in long term care: much controversy, little consensus. J Am Med Dir Assoc 2002;3:162-168.
Garau M, Xercavins M, Rodriguez-Carballeira M, Gomez-Vera JR, Coll I, Vidal D, Llovet T, Ruiz-Bremon A. Emergence and dissemination of quinolone-resistant Escherichia coli in the community. Antimicrob Agents Chemother 1999;43:2736-2741.
Garibaldi RA, Burke JP, Dickman ML, Smith CB. Factors predisposing to bacteriuria during indwelling urethral catheterization. N Engl J Med. 1974;291:215-219.
Givens CD, Wenzel RP. Catheter-associated urinary tract infections in surgical patients: a controlled study on the excess morbidity and costs. J Urol 1980;124:646-648.
Godfrey H, Evens A. Catheterization and urinary tract infections: microbiology. Br J Nursing 2000;9:682-690.
Goetz AM, Kedzuf S, Wagener M, Muder RR. Feedback to nursing staff as an intervention to reducecatheter-associated urinary tract infections. Am J Infect Control 1999;27:402-404.
Green MS, Rubinstein E, Amit P. Estimating the effects of nosocomial infections on the length of hospitalization. J Infect Dis 1982;145:667-672.
Gupta K, Sahm DF, Mayfield D, Stamm WE. Antimicrobial resistance among uropathogens that cause community-acquired urinary tract infections in women: a nationwide analysis. Clin Infect Dis 2001;33:89-94.
Gupta K, Scholes D, Stamm W. Increasing prevalence of antimicrobial resistance among uropathogens causing acute uncomplicated cystitis in women. JAMA 1999;281:736-738.
Haley RW, Culver DH, White JW, Morgan WM, Emori TG. The nationwide nosocomial infection rate: a new need for vital statistics. Am J Epidemiol 1985;121:159-167.
Haley RW, Hooton TM, Culver DH, Stanley RC, Emori TG, Hardison CD, Quade D, Shachtman RH, Schaberg DR, Shah BV, Schatz GD. Nosocomial infections in U.S. hospitals, 1975-1976: estimated frequency by selected characteristics of patients. Am J Med 1981;70:947-959.
Harding GK, Nicolle LE, Ronald AR, Preiksaitis JK, Foward KR, Low DE, Cheang M. How long should catheter –acquired urinary tract infection in women be treated? A randomised controlled study. Ann Intern Med 1991;114:713–719.
Hastie KJ, Dickinson AJ, Ahmad R, Moisey CU. Acute retention of urine: Is trial without catheter justified? J R Coll Surg Edinb 1990;35:225-227.
Jacoby GA, Archer GL. New mechanisms of bacterial resistance to antimicrobial agents. New Eng J Med 1991; 324:601-612.
Infectious Diseases society of the Republic of China. Guidelines for antimicrobial therapy of urinary tract infections in Taiwan. J Microbial Immunol Infect 2000;33:271-272.
Jacoby GA, Archer GL. New mechanisms of bacterial resistance to antimicrobial agents. New Eng J Med 1991;324:601-612.
Jain P, Parada JP, David A, Smith LG. Overuse of the indwelling urinary tract catheter in hospitalized medical patients. Arch Intern Med 1995;155:1425-1429.
Kaufman JM, Fam B, Jacobs SC, Gabilondo F, Yalla S, Kane JP, Rossier AB. Bladder cancer and squamous metaplasia in spinal cord injury patients. J Urol 1977;118:967-971.
Krieger JN, Kaiser DL, Wenzel RP. Urinary tract etiology of blood stream infections in hospitalized patients. J Infect Dis 1983;148:57-62.
Kunin CM, Douthitt S, Dancing J, Anderson J, Moeschberger M. The association between the use of urinary catheters and morbidity and mortality among elderly patients in nursing homes. Am J Epidemiol 1992;135:291-295.
Kunin CM, Steele C. Culture of the surfaces of urinary catheters to sample urethral flora and study the effect of antimicrobial therapy. J Clin Microbiol 21:902,1985.
Kunin CM. Can we build a better urinary catheter? N Engl J Med 1988;319:365-366.
Lauderdale TL, McDonald LC, Shiau YR, Chen PC, Wang HY, Lai JF, Ho M. The status of antimicrobial resistance among gram-negative pathogens: the Taiwan surveillance of antimicrobial resistance (TSAR) program, 2000. Diagn Microbiol Infect Dis 2004;48:211-219.
Liedl B. Catheter-associated urinary tract infections. Curr Opin Urol 2001;11:75-79.
Lu JF, Hsiao WC. Dose universal health insurance make health care unaffordable? Lessons from Taiwan. Health aff(Millwood) 2003;22:77-88.
Maki DG, Tambyah PA. Engineering out the risk of infection with urinary catheters. Emerg Infect Dis 2001;7:1–13.
Mazzulli T. Antimicrobial resistance trends in common urinary pathogens. Can J Urol 2001;8 suppl 1:2-5.
National Committee for Clinical Laboratory Standards. 2003. Approved standard M2-A8. Performance standards for antimicrobial disk susceptibility tests, 8th ed. NCCLS, Wayne, Pa.
Nickel JC, Gristina AG, Costerton JW. Electron microscopic study of an infected Foley catheter. Can J Surg 1985;28:50-53.
Nickel JC, Ruseska I, Wright JB, Costerton JW. Tobramycin resistance of Pseudomonas aeruginosa cells growing as a biofilm on urinary catheter material. Antimicrob Agents Chemother 1985;27:619-623.
Nicolle LE, Strausbaugh LJ, Garibaldi RA. Infections and antibiotic resistance in nursing homes. Clin Microbiol Rev 1996;9:1-17.
Nicolle LE. Resistant pathogens in urinary tract infections. J Am Geriatr Soc 2002;50:230-235.
Nicolle LE. The chronic indwelling catheter and urinary infection in long-term care facility residents. Infect Control Hosp Epidemiol 2001;22:316-321.
Ouslander JG, Greengold B, Chen S. Complications of chronic indwelling catheters among male nursing home patients: A prospective study. J Urol 1987;138:1191-1195.
Patel HR, Arya M. The urinary catheter: 'a-voiding catastrophe'. Hosp Med 2000;62:148–149.
Platt R, Polk BF, Murdock B, Rosner B. Mortality associated with nosocomial urinary-tract infection. N Engl J Med 1982;307:637-642.
Ribeiro BJ, Smith SR. Evaluation of urinary catheterization and urinary incontinence in a general nursing home population. J Am Geriatr Soc 1985;33:479-482.
National Committee for Clinical Laboratory Standards. 2003. Approved standard M2-A8. Performance standards for antimicrobial disk susceptibility tests, 8th ed. NCCLS, Wayne, Pa.
Sahm D. Surveillance of antimicrobial resistance patterns and data for urinary tract pathogens in the USA. Clin Drug Invest 2001;21 suppl 1:1-5.
Sahm DF, Thornsberry C, Maryfield DC, Jones ME, Karlowsky JA. Multidrug-resistant urinary tract isolates of Escherichia coli: prevalence and patient demographics in the United States in 2000. Antimicrob Agents Chemother 2001;45:1402-1406.
Saint S, Lipsky BA, Goold SD. Indwelling urinary catheters: a one-point restraint? Ann Intern Med 2002;137(2):125–127.
Saint S, Lipsky BA. Preventing catheter related bacteriuria. Should we? Can we? How? Arch Intern Med 1999;159:800-808.
Schaeffer AJ. Urinary tract infections: antimicrobial resistance. Curr opin Urol 2000;10:23-24.
Sobel JD, Kaye D. Urinary tract infections. In: Mandell GL, Bennett JE, Dolin R; eds. Mandell, Douglas and Bennett's principles and practice of infectious diseases. 4th ed. New York: Churchill Livingstone;1995:662-690.
Sotto A, De Boever CM, Fabbro-Peray P, Gouby A, Sirot D, Jourdan J. Risk factors for antibiotic-resistant Escherichia coli isolated from hospitalized patients with urinary tract infections: a prospective study. J Clin Microbiol 2001;39:438-444.
Spicer WJ. Enterobacteriaceae. In: Clinical bacteriology, Mycology and parasitology: an illustrated color text. 1st ed. Spicer WJ. London: Churchill Livingstone;2000. pp40-43.
Spicer WJ. Pseudomonas and rare gram-negative rods. In: Clinical bacteriology, Mycology and parasitology: an illustrated color text. 1st ed. Spicer WJ. London: Churchill Livingstone;2000. pp46-47.
Tambyah PA, Halvorson KT, Maki DG. A prospective study of pathogenesis of catheter associated urinary tract infections. Mayo Clin Proc 1999;74:131-136.
Vromen M, van der Ven AJ, Knols A, Stobberingh EE. Antimicrobial resistance patterns in urinary isolates from nursing home residents. Fifteen years of data reviewed. J Antimicrob Chemother 1999;44:113-116.
Warren JW, Damron D, Tenney JH, Hoopes JM, Deforge B, Muncie HL Jr. Fever, bacteremia and death as complications of bacteriuria in women with long term urethral catheters. J Infect Dis 1987;155:1151-1158.
Warren JW, Steinberg L, Hebel JR, Tenney JH. The prevalence of urethral catheterization in Maryland nursing homes. Arch Intern Med 1989;149:1535-1540.
Warren JW. Catheter-associated urinary tract infections. Infect Dis Clin North Am 1997;11:609–622.
Wazait HD, Patel HR, Veer V, Kelsey M, Van Der Muelen JH, Miller RA, Emberton M. Catheter-associated urinary tract infections: prevalence of uropathogens and pattern of antimicrobial resistance in a UK hospital. BJU Int 2003;91:806-809.
Weinstein MP, Towns ML, Quartey SM, Mirrett S, Reimer LG, Parmigian G, Reller LB. The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect Dis 1997;24:584-602.
Wingard E, Shlaes JH, Mortimer EA, Shlaes DM. Colonization and cross-colonization of nursing home patients with trimethoprim-resistant gram-negative bacilli. Clin Infect Dis 1993;16:75-81.
Winstanley TG, Limb DI, Eggington R, Hancock F. A 10 year survey of antimicrobial susceptibility of urinary tract isolates in the UK: the Microbe Base project. J Antimicrob Chemother 1997;40:591-594.
Wong ES. Guideline for prevention of catheter-associated urinary tract infections. Am J Infect Control 1983;11:28-36.
Woolf B. On estimating the relation between blood group and disease. Ann Hum Genet 1955;19:251-523.
Zimakoff JD, Pondoppidan B, Larsen SO, Poulsen KB, Stickler DJ. The management of urinary catheters: compliance of practice in Danish hospitals, nursing homes and home care to national guidelines. Scand J Urol Nephrol 1995;29:299-309.
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