Comparison Between Non-Catheterized And Catheter Associated Urinary Tract Infections Caused By Extended Spectrum ��-Lactamase Producing Escherichia Coli And Klebsiella Pneumoniae

Abstract

Abstract: Catheter associated urinary tract infection's (CAUTI) account for more than 80% of all healthcare associated infections (HAIs) as compared to non-catheterized urinary tract infections. Catheter associated urinary tract infections occur on the third day after insertion of catheter in patients having urinary tract infection (UTI). In long term catheter use, bio-film form along the catheter which increases the risk of antibiotic resistant pathogens. Most common pathogens involved were Escherichia coli and Klebsiella pneumoniae which produce the enzymes Extended Spectrum ��-Lactamases (ESBLs). Objective: To compare the frequency of ESBLs in catheterized and non-catheterized UTI infections. Materials and Methods: This comparative study was conducted at the Microbiology Department, Allama Iqbal Medical College, Lahore, from June 2014 to January 2015. Urine samples were cultured according to WHO protocol and antimicrobial Susceptibility testing was performed by Modified Kirby-Bauer disc diffusion Method. Escherichia coli and Klebsiella pneumoniae were tested for ESBL production by phenotypic confirmatory method of disk diffusion synergy using a disc of amoxicillin-clavulonate (30��g) and ceftrixone (30��g), cefotaxime (30��g) and aztreonam (30��g) discs. Results: Out of 300 positive urinary isolates of Escherichia coli and Klebsiella pneumoniae from CAUTI, 65.33% were ESBL producing isolates whereas out of 300 positive urinary isolates of Escherichia coli and Klebsiella pneumoniae from non-catheterized UTI, 47.66% were ESBL producing isolates. The results were highly significant (p < 0.001). Conclusion: Results showed that frequency of ESBLs were higher in catheterized patients as compared to non-catheterized patients. This is suggestive of a need for regular screening and surveillance for ESBL producing organisms. Patients infected with these organisms should be nursed with contact precautions to avoid the spread of nosocomial infection.