Evaluation of intensive care unit-acquired urinary tract infections in Singapore.

ABSTRACT

INTRODUCTION: Urinary tract infections remain one of the most frequently encountered acquired complications in an intensive care unit (ICU). The objective of this study was to determine the incidence, risk factors, microbial sensitivity patterns, and clinical outcomes of patients with UTIs acquired during their admission to an ICU in an acute care hospital in Singapore. MATERIALS AND METHODS: This was a 14-week prospective study. All ICU patients > or =18 years who remained in the ICU for > or =48 hours were eligible for this study. Patients were reviewed daily and the presence of an ICU-acquired UTI was identified via urinary microscopic examination or culture results. Other data collected included patient demographics, ICU admission criteria, concomitant illnesses, presence of invasive lines, microbial sensitivity and treatment outcomes. RESULTS: Thirty-fi ve (13.7%) cases of ICU-acquired UTI occurred in 256 separate ICU admissions. The most common micro-organisms isolated were Candida spp. (34%). Female gender and prior exposure to antibiotics were independent risk factors for developing an ICU-acquired UTI (P <0.01). Both mean length of ICU stay and duration of catheterisation were significantly longer for patients with ICU-acquired UTI (P <0.001). The mortality rate of patients with ICU-acquired UTIs (12.1%) was slightly higher than those without (9.9%). CONCLUSIONS: The incidence of ICU-acquired UTIs was similar to figures reported for nosocomial UTIs from the previous studies. Significant risk factors for developing an ICU-acquired UTI were female gender and history of antibiotic exposure prior to ICU admission. The insignificant link between ICU-acquired UTI and mortality requires further investigation in larger cohorts.