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[Etiology, risk factors, and outcome of urinary tract infection]
Dalia Adukauskiene1, Aida Kinderyte, Rimantas Tarasevicius
1Clinic of Intensive Therapy, Kaunas University of Medicine, A. Mickeviciaus 9, 44307 Kaunas, Lithuania.
Objectives:
To determine the incidence and variety of microorganisms of positive urine culture in patients of intensive care units of Kaunas University of Medicine Hospital and to estimate the risk factors for colonization, development of urinary tract infection, and outcome during the period of 2003-2004.
Material And Methods:
We retrospectively reviewed patients with a positive urine culture with or without clinical symptoms of urinary tract infection admitted to an intensive care unit.
Results:
The growth of microorganisms was determined in urine of 82 (3.9%) patients: urinary tract infection in 64 (78%) and colonization in 18 (22%) patients. Among pathogens of urinary tract infection rods predominated significantly (p<0.05). No significant difference was found among colonizing microorganisms (p>0.05). E. coli in urine culture was obtained exclusively in cases of urinary tract infection. All patients with a positive urine culture had catheterized urinary bladder (p<0.05). No influence of age, sex, or duration of catheterization alone on the occurrence of urinary tract infection, colonization, or outcome was found (p>0.05). In cases of the same sex, age, and underlying disease of the patients, the risk of urinary tract infection with every day of catheterization significantly increased by 21.7% (p<0.05). Among patients with lethal outcome there was a significant prevalence of rods in urine culture (p<0.05). In survivors, no significant pathogen was detected in urine culture (p>0.05). In cases of the same sex, age, underlying disease, and duration of catheterization, the development of urinary tract infection significantly increased the risk of lethal outcome by 5.5 times (p<0.05).
Conclusions:
Positive urine culture was found in 3.9% of patients, three-quarters of them were due to urinary tract infection. Rods were the predominant pathogens in urinary tract infection. E. coli in urinary tract always resulted in urinary tract infection. Catheterization of urinary bladder resulted in urinary tract infection or colonization. Each day of urinary bladder catheterization increased the risk of development of urinary tract infection by 21.7%. Rods in urine culture were associated with lethal outcome. Development of urinary tract infection increased the risk of lethal outcome 5.5 times.
Insights
Urinary tract infections (UTIs) affect 3.9% of ICU patients, with rods being the main cause. Catheterization significantly increases UTI risk and lethal outcomes.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Urinary tract infections (UTIs) are a common complication in intensive care units (ICUs).
- Identifying causative microorganisms and risk factors is crucial for patient outcomes.
Purpose of the Study:
- To determine the incidence and types of microorganisms in positive urine cultures from ICU patients.
- To identify risk factors for colonization, UTI development, and patient outcomes.
- To analyze the impact of urinary bladder catheterization on UTI incidence and severity.
Main Methods:
- Retrospective review of ICU patients with positive urine cultures (2003-2004).
- Analysis of microorganism types, clinical symptoms, and patient demographics.
- Statistical evaluation of risk factors including catheterization duration and pathogen prevalence.
Main Results:
- 82 patients (3.9%) had positive urine cultures; 78% developed UTIs, 22% had colonization.
- Rods were the predominant UTI pathogens (p<0.05); E. coli exclusively caused UTIs.
- All positive cultures were associated with urinary bladder catheterization (p<0.05).
- Each day of catheterization increased UTI risk by 21.7% (p<0.05).
- Rods in urine cultures correlated with lethal outcomes (p<0.05).
- UTIs increased lethal outcome risk 5.5 times (p<0.05).
Conclusions:
- Positive urine cultures are significant in ICUs, often leading to UTIs, predominantly caused by rods.
- Urinary bladder catheterization is a primary risk factor for UTIs in this population.
- Catheter duration significantly elevates UTI risk, and UTIs substantially increase mortality risk.
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