Investigative and Clinical Urology (Jan 2017)

Prospective study analyzing risk factors and characteristics of healthcare-associated infections in a Urology ward

  • José Medina-Polo,
  • Raquel Sopeña-Sutil,
  • Raúl Benítez-Sala,
  • Alba Lara-Isla,
  • Manuel Alonso-Isa,
  • Javier Gil-Moradillo,
  • Juan Justo-Quintas,
  • Esther García-Rojo,
  • Daniel Antonio González-Padilla,
  • Juan Bautista Passas-Martínez,
  • Ángel Tejido-Sánchez

DOI
https://doi.org/10.4111/icu.2017.58.1.61
Journal volume & issue
Vol. 58, no. 1
pp. 61 – 69

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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