Antimicrobial Susceptibility Patterns of Isolates from Catheterized Patients at Kenyatta National Hospital Critical Care Unit

Abstract

Background: Intensive care unit acquired urinary tract infection is a complication which is common in critical illness and has been associated with increased patient morbidity and mortality. Urinary tract infections are said to complicate the critically ill patients’ clinical course and at the same time create substantial economic and human cost. Identification of the type of microorganisms causing the infections and their drug sensitivity profiles is essential in the management of these infections. The aim of this study was to identify microorganisms causing catheter associated urinary tract infection in the Kenyatta National Hospital critical care unit and their drug sensitivity.

Methodology: The study was conducted at Kenyatta National Hospital main critical care unit. The study population was two hundred and thirty eight patients admitted in the critical care unit between January 2019 and January 2020 and on urinary catheters. A prospective cohort design was adopted. Urine culture and sensitivity was done to identify infective microorganisms and their drug sensitivity profiles. Patients were recruited consecutively for the period of the study.

Results: The microorganisms identified were Enterococcus species (32%), Escherichia coli (20%), Klebsiella species (10.4%), Acinobacter baumaunnii (8%), Pseudomonas aeruginosa (6%), Candida albicans (6%), Serratia species (11.7%), Pantoea agglomerans (3.5%), and Raoultella planticola (2.4%). Enterococcus species were 100% sensitive to Vancomycin, Linezolid and Teicoplanin and 73% to Nitrofurantoin and Ampicillin. Staphylococcus haemolyticus was also 100% sensitive to Vancomycin, Linezolid and Teicoplanin. Serratia species was sensitive to Cefazolin, Nitrofurantoin, Amoxicillin/ Clavulanic Acid, Piperacillin/ Tazobactam, and Ampicillin/ Sulbactam. Pantoea agglomerans was 66.7% sensitive to Amikacin. Klebsiella species were sensitive to Amikacin and Meropenem. Escherichia coli was sensitive to Amikacin, Meropenem and Nitrofurantoin. Acinetobacter baumaunnii and Raoultella planticola were resistant. Candida albicans were highly sensitive to Fluconazole and Voriconazole.

Conclusion: The most common microorganisms (60.9%) causing catheter associated urinary tract infections in ICU are gram-negative: (Escherichia coli 20%, Klebsiella species 10.4%, Acinobacter baumaunnii 8%, Pseudomonas aeruginosa 6%, Serratia species 8% and others 6.5%). Gram positive organisms were isolated at a proportion of 33.2%: (Enterococcus species, 32% & Staphylococcus haemolyticus 1.2%). Candida albicans 6%. Majority of the gram-negative microorganisms were sensitive to Amikacin, and Meropenem. Gram positive micro-organisms were sensitive to Vancomycin, Linezolid, and Teicoplanin. Fluconazole and Voriconazole therapy were the most appropriate choice for the treatment of Catheter-Associated Urinary Tract Infections (CAUTIs) caused by C. albicans.