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Nosocomially Acquired Urinary Tract Infections in Urology Departements

Nosocomially Acquired Urinary Tract Infections in Urology Departements. Truls E. Bjerklund Johansen Århus University Hospital, Århus, DK (ESIU). Characteristics. University hospital (N=67). Teaching hospital (N=46). District hospital (N=33). Other types of hospital (N=5).

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Nosocomially Acquired Urinary Tract Infections in Urology Departements

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  1. Nosocomially Acquired Urinary Tract Infections in Urology Departements Truls E. Bjerklund Johansen Århus University Hospital, Århus, DK (ESIU)

  2. Characteristics University hospital (N=67) Teaching hospital (N=46) District hospital (N=33) Other types of hospital (N=5) Median (Range) Median (Range) Median (Range) Median (Range) Number of beds in the hospital 856 (40-2206) 600 (31-1800) 418 (20-1100) 320 (120-1600) Number of beds in the urology department 38 (8-200) 30,5 (10-96) 21 (3-60) 25 (7-130) Number of admissions per year 1481 (330-8700) 1600 (70-8960) 993 (0-2896) 1255 (98-2509) Average period of hospitalisation 6,0 (2-19) 5,4 (3,8-38)** 4,7 (1-11)* 15 (5-21,7) Number of urine cultures per year 621 (0-9763) 700 (0-6000) 370 (0-2145) 347 (65-2210) N of urine cult./n of admissions per year 0,44 (0-5,9) 0,59 (0-2,9) 0,46 (0,01-3,4) 0,82 (0,07-1,2) Characteristics for each type of hospital taking part in the PEP and PEAP-studies * excluded one outlier (7286) ** excluded one outlier (611)

  3. University hospital (n=67) Teaching hospital (n=46) District hospital (n=33) Other type of hospital (n=5) The urology department has approved protocol for: Perioperative prophylaxis 70 76 67 60 Urinary catheter insertion and catheter care 73 67 88 60 The urology department prepares annual reports on: Number of NAUTI 43 46 36 40 Pathogens causing NAUTI 46 41 36 40 Resistance patterns for the above 45 41 36 40 Infection control program in different types of hospitals (n=151) given as percent

  4. Germany (n=29) Hungary (n=23) Russia (n=8) Turkey (n=21) Europe (n=55) Asia (n=15) p-value The urology department has approved protocol for: Perioperati-ve antibiotic prophylaxis 76 65 75 76 66 80 Ns Catheter insertion and care 79 83 75 62 73 73 Ns The urology department prepare annual reports on: Number of NAUTI 55 52 75 43 31 27 P=0,05 Pathogens causing NAUTI 62 35 88 43 33 27 P<0,01 Resistance patterns for the above 59 35 88 38 33 33 P=0,02 Infection control program in different regions (151 hospitals) given as percent. P-value given for frequencies in one or more regions/countries that differ from the others (Chi-square test)

  5. No of patients screened in the ESIU-prevalence studies (cumulative numbers)

  6. No of patients with NAUTI in the ESIU-prevalence studies database (cumulative numbers)

  7. Characteristics of patients with NAUTI • Urinary catheter 74% • Average catheter duration 6-11 days • Urinary tract obstruction 49% • Previous UTI 44% • Hospitalisation in prev. 6 months 45% • Urinary stones 20%

  8. Catheters on study day (n=2849) 51 10 2 11 12 14 % of total

  9. Number (% of patients) Median (days) Range (days) 1st quartile 3rd quartile Urethral 371 (69) 6 0-223 2 14 Suprapubic 76 (14) 9,5 0-2000 3,25 60 Ureteral 73 (14) 11 0-137 5 25,5 Nephrostomy 87 (16) 13 0-425 5 30 Other 12 (2) 4,5 0-180 0 50,5 Type and duration of 619 catheters in 537 patients with nosocomially acquired urinary tract infections

  10. Endo-scopic (n=276) Per-cutaneous (n=107) Laparo-scopic (n=11) Open (n=220) Total (n=614) Clean 126 (46) 29 (27) 5 (46) 71 (32) 231 (38) Clean-contami-nated 88 (32) 40 (37) 3 (27) 84 (38) 215 (35) Contami-nated 3 (1) 9 (9) 3 (27) 31 (14) 46 (7) Infected 59 (21) 29 (27) 0 (0) 34 (16) 122 (20) Contamination status of 614 surgical procedures in 588 patients with nosocomially acquired urinary tract infections

  11. Pathogens causing NAUTI % of total

  12. AETIOLOGYof uncomplicated UTI ARESC N° (%) E. coli 76.7% 3018 uropathogens

  13. Relative distribution of pathogens within regions and countries (n=727)

  14. Proteus Sensitive Escherichia coli Intermediate Resistant Enterococcus Pseudomonas Klebsiella Susceptibility of the most common pathogens to the most commonly used antibiotics. Columns from left to right represents: Ampicilln/amoxicillin+betalactamase inhibitor; cefuroxime; cefotaxime/ceftriaxone; ciprofloxacin; co-trimoxazol

  15. Susceptibility of total bacterial spectrum (%)10 COUNTRIES (N=1562) ARESC 08-03-24

  16. E coli Regional susceptibility to the most commonly used antibiotics

  17. ARESC Susceptibility of E.coli (%)SUSCEPTIBILITY PATTERNS IN 10 COUNTRIES (1562) 08-03-24

  18. Clinical presentation of NAUTI 29 26 21 12 12 % of total

  19. Clinical presentation of NAUTI in countries and regions

  20. Clinical presentation of NAUTI in countries and regions

  21. ESIU-prevalence studies on NAUTI

  22. The overall prevalence of NAUTI is 11% (10 and 14%) • ABU accounts for 29%, urosepsis 12% • There are significant differences between regions and types of hospitals in • prevalence of NAUTI (7-21%) and • microbiological evidence for diagnosing urosepsis (9-50%)

  23. Lessons learned

  24. 70% of urology departments have protocols for catheter insertion and care, 43% prepare annual reports about NAUTI • The number of culture tests and the infection control systems vary significantly (0-5,9 per patient) • Urinary catheters are the most common risk factors

  25. The distribution of pathogens and the susceptibility of pathogens is a cause of concern in many regions • International recommendations on prophylaxis may have a limited value

  26. Annual costs of NAUTI • Incremental cost of hospital stay: 500 Euro/day • Extra period of hospitalisation per NAUTI: 3 days • Extra costs for one urology dept. with 1931 admissions (mean) and prevalence of 21% : 608 265 Euro • Total costs of NAUTI in Europe (800 mill. people): 1.216.530.000 Euro

  27. Prevalence of NAUTI will be reduced by: • 0.12 if the department has protocol for catheter insertion and care (ie. from 20 to 8%) • 0.08 if the dept. is in ”other European countries” (ie. from 20 to 12%) • 0.002 per patient receiving antimicrobial prophylaxis (ie. with 4 percent-points for 20 patients) • 0.002 per extra patient hospitalised

  28. Resistance rates of uropathogens, 1994 – 2004, Straubing; n (313 - 535); % resistant

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