Risk Factors and Burden of Hospital Acquired Urinary Tract Infections among Catheterized Patients at Kenyatta National Hospital’s Critical Care Unit

Abstract

Intensive Care Unit Acquired Urinary tract infection is a complication which is common in critical illness and has been associated with increased patient morbidity. Urinary tract infections are the most common type of nosocomial infections in the world. Indwelling catheter device contribute 80% of the UTIs. Urinary tract infections are said to complicate the critically ill patients’ clinical course and at the same time create substantial economic and human cost. There is relatively few researches on nosocomial urinary tract infection specifically acquired in the intensive care unit and more studies need to be done to explain more on the epidemiology and management of the said infections. The study was aimed at establishing the Risk factors and burden of hospital acquired urinary tract infections among catheterized patients at Kenyatta National Hospital’s Critical Care Unit. The study was done at the Kenyatta National Hospital Critical Care Unit. A prospective cohort study design was used in this study. The study population was all patients admitted in the unit and were put on urinary catheter. The duration of the study was one year. The patients were recruited consecutively for the period of the study. The patients were followed up until they were out of the unit. The unit admits approximately 50 patients per month (approximately 600 per year). The researcher used census to recruit the study participants. 238 participants were recruited.1st, 2nd, 3rd and 4th Urine specimens were collected within the first 12 hours, then second sample at 72 hours, third sample at the 7th day and the fourth sample at the 14th day of patient’s admission. The analysis of the urine samples were done in the microbiology laboratory for the growth of microorganism to determine the incidence rate of nosocomial urinary tract infections and causative organisms. The temporal treads were determined by assessing the sequence on the micro-organisms grown. The time taken to acquire the infection was analyzed using survival analysis. The relationship between causative organisms, patients’ comorbidities and characteristics were established by calculating the relative ratios. Cox-regression model was used to test association between the factors and the time to infection. Data was analyzed using SPSS version 23.0. The incidence density of hospital acquired catheter associated urinary tract infection was 32 per 1000 Catheter-days in the critical care unit. The cumulative incidence was 28.7%. Patients with comorbidities had a higher risk to acquire catheter associated urinary tract infection; risk ratio of 1.669 (95% CI: 1.01 to 2.75). Failure to observe aseptic techniques during emptying of the urine bag had a higher risk to acquire catheter associated urinary tract infection; risk ratio of 3.4 (95% CI:2.0 to 5.9). Failure to secure the urinary catheter on the patient’s thigh had a higher risk to acquire catheter associated urinary tract infection; risk ratio of 1.84 (95% CI: 1.1 to 3.0). The most common micro-organisms cultured were; Enterococcus faecalis (25%) and Escherichia coli (20%).The gram-negative micro-organisms were more common during the warmest month of the year. Time to CAUTI increased non-linearly for each additional day of catheterization. The factors that increased the risk of UTI also reduced the time to CAUTI. The incidence of infection was high as compared to other studies. There is need to emphasize strict adherence to infection prevention and control measures in caring for the patients admitted in the CCU set-up.