Urinary Tract Infection Associated with Multidrug-Resistant Bacteria in a Second level Hospital During a Two Year Period

Abstract

Objective: determine the frequency of urinary tract infections associated with MDR bacteria, characteristics patients with such infections and the mortality rate associated in Hospital ISSSTECALI during 2015-2016. Design: Descriptive, observational, analytic, transversal Methods: We collected data from clinical files of each patient that had been diagnosed with a urinary tract infection and had an uroculture of 10x105 CFU of bacteria with a multidrug-resistant profile. It included, gender, age, comorbidities, predisposing risk factors, obtained isolation, sensibility pattern, days of stay and proper technique of culture. We calculated frequencies and rates. Results: During January 2015- November 2016 a total of 2401 urocultures were solicited, we isolated bacteria in 123 of them (5.12%). 94 urocultures were included, 71% of the cultures were from women with a median age of 68.14 years; comorbidities: Hypertension (50%), diabetes (41.5%), chronic renal disease (14.9%), history of stroke and bed-rest. An average of 14.15 days of stay was calculated. They all had a urinary catheter. Of the total of urocultures obtained, 54 urocultures demonstrated bacteria growth with a MDR phenotype (attack rate: 0.43 cases/1000 discharges) Escherichia coli was isolated in 26 (48.14%) cultures; Pseudomona aeruginosa 7.4%; and Klebsiella pneumonia 5.5%; its mechanism of resistance was calculated according to the reported phenotype on the antimicrobiogram, demonstrating resistance to more than two family of antibiotics. A mortality rate of 21.3% was calculated of which the direct cause was related to the infective process (rate: 0.23 deaths/1000 discharges). Conclusion: the isolation of bacteria with a multidrug-resistant profile is not very common; however, they generate a high morbimortality index and a great weight in resources to our unit. Recommendations: reinforcement of programs that encourage rational use of antibiotics as well as the control of nosocomial infections should be employed in the hospital.