Current status of indwelling urinary catheter utilization and catheter-associated urinary tract infection throughout hospital wards in Korea: A multicenter prospective observational study.

To evaluate the frequency and appropriateness of indwelling urinary catheters (IUC) use and the incidence of catheter-associated urinary tract infections (CA-UTI), and explore the risk factors for CA-UTI in hospitals as a whole, we conducted a study. This study was divided into two parts; a point-prevalence study on Dec 12th 2012 and a prospective cohort study from Dec 13th 2012 to Jan 9th 2013 were performed in six hospitals in Korea. All hospitalized patients with newly-placed IUCs were enrolled and monitored weekly for 28 days after IUC placement. In the point-prevalence study, the IUCs were present in median 14.9/100 hospitalized patients (1Q 14, 3Q 16) across the six hospitals. In the prospective cohort study, the median IUC-days per patient was 5 (1Q 3, 3Q 10) and the median CA-UTI prevalence per 1,000 catheter days was 1.9 (1Q 0.7, 3Q 3.8) with significant inter-hospital variation. The proportion of patients with inappropriate IUC maintenance increased with number of IUC-days (8.5% on day 7, 9.4% on day 14, 16.3% on day 21, and 23.1% on day 28). Urinary output monitoring (23/36, 63.9%) was the most common indication for inappropriate use after 1 week of ICU placement. In multivariate analysis, IUC-days was significantly associated with the development of CA-UTI (odds ratio 1.122, 95% confidence interval 1.074-1.173, P< 0.001). IUC-days and CA-UTI rates vary between hospitals. IUC-days is a risk factor for CA-UTI, and is correlated with inappropriate use.

Fluoroquinolone resistance in uncomplicated acute pyelonephritis: epidemiology and clinical impact.

The objectives of this study were to investigate antibiotic resistance in urinary pathogens from Korean patients with uncomplicated acute pyelonephritis (UAPN), and to determine the effect of fluoroquinolone (FQ) resistance on clinical outcome in those patients with UAPN initially treated with FQ. Clinical and microbiologic data for all the APN patients attending 14 hospitals in South Korea in 2008 were collected retrospectively. Urinary pathogens were identified in 719 cases, and Escherichia coli was the most common pathogen (661/719, 91.9%). Antibiotic susceptibilities to several E. coli antibiotics were as follows: ciprofloxacin, 84.1%; trimethoprim-sulfamethoxazola (TMP-SMX), 67.2%; and extended-spectrum beta-lactamase-negative, 92.4%. FQ was the most frequent antibiotic prescribed for UAPN (45.3% intravenously and 53.9% by mouth). We compared clinical outcomes and hospital days in patients with FQ-resistant (32) and FQ-sensitive E. coli (173) who received FQ as initial empirical therapy. Clinical cure was higher in the FQ-sensitive group (78% vs. 91%, p=0.027), and hospital days were longer in the FQ-resistant group (9.6±5.5 days vs. 7±3.5 days, p=0.001). In conclusion, FQ-sensitivity of E. coli from UAPN was 84.1%. FQ treatment of UAPN caused by FQ-resistant E. coli has a lower cure rate and involves longer hospital stay than FQ treatment of cases caused by FQ-sensitive E. coli.