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KMID : 1011820170580010061
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Investigative and Clinical Urology
2017 Volume.58 No. 1 p.61 ~ p.69
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Prospective study analyzing risk factors and characteristics of healthcare-associated infections in a Urology ward
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Jose Medina Polo
Raquel Sopena Sutil
Raul Benitez Sala
Alba Lara Isla
Manuel Alonso Isa
Javier Gil Moradillo
Juan Justo Quintas
Esther Garcia Rojo
Daniel Antonio Gonzalez Padilla
Juan Bautista Passas Martinez
Angel Tejido Sanchez
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Abstract
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Purpose: Healthcare-associated infections (HAIs) in urological patients have special features due to specific risk factors. Our objective was to evaluate the characteristics and risk factors for HAIs in patients hospitalized in a Urology ward.
Materials and Methods: We evaluated prospectively, from 2012 to 2015, the incidence, types and risk factor for HAIs, microbiological and resistance patterns.
Results: The incidence of HAIs was 6.3%. The most common types were urinary infections (70.5%) and surgical site infections (22.1%). Univariate analysis showed an increased risk of HAIs among patients with American Society of Anesthesiologists physical status classification system III?IV (odds ratio [OR], 1.39; p<0.001), immunosuppression (OR, 1.80; p=0.013), previous urinary infection (OR, 4.46; p<0,001), and urinary catheter before admission (OR, 1.74; p<0.001). The surgical procedures with the highest incidence of HAIs were radical cystectomy (54.2%) and renal surgery (8.7%). The most frequently isolated microorganisms were Escherichia coli (25.1%), Enterococcus spp. (17.5%), Klebsiella spp. (13.5%) and Pseudomonas aeruginosa (12.3%). Enterococcus sp was the most common microorganism after radical cystectomy and in surgical site infections, E. coli showed resistance rates of 53.5% for fluoroquinolones, 9.3% for amikacin. The percentage of extended-spectrum betalactamase producing E. coli was 24.7%. Klebsiella spp. showed resistance rates of 47.8% for fluoroquinolones, 7.1% for amikacin and 4.3% for carbapenems. Enterococcus spp showed resistance rates of 1.7% for vancomycin and; P. aeruginosa of 33.3% for carbapenems and 26.2% for amikacin.
Conclusions: Comorbidities, previous urinary infections, and urinary catheter are risk factors for HAIs. The microorganisms most commonly isolated were E. coli, Enterococcus and P. aeruginosa. Prospective monitoring may decrease the incidence of infections.
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KEYWORD
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Hospital Urology Department, Infection control, Multiple drug resistance, Surgical wound infections, Urinary tract infections
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