724 Po1485 Pseudomonas Aeruginosa Urinary Tract Infection In Outpatients With Permanent Urinary Catheter

Conference: 
Author(s): 
Evangelia Ikonomopoulou1, Irini Katsarou2, Ilias Kapros3 e Vasiliki Diamanti1
1Biopathology Department of Patras General Hospital “Agios Andreas”; 2Gen Hospital Zakynthos; 3Radiology Department of Zakynthos General Hospital “Agios Dionysios”
Text: 
Urinary catheterisation consists the major causative factor in the development of Gram-negative infections and bacteraemia. The presence of catheter in the urinary permits bacteria to by-pass normal defence mechanism of the body and to acquire direct access to the urinary system.
Objective: To determine the incidence of urinary tract infection (UTI) from Pseudomonas aeruginosa in outpatients with permanent urinary catheter and also to determine the resistance of the isolated bacteria in routine antimicrobial therapy.
Material: We studied 2210 positive urine cultures of outpatients in our department during a period of two years. The identification of the strains was done by conventional methods and resistance testing was done either by the mini API system or the VITEK (Biomerieux) system.
Results: P. aeruginosa isolated in 163 out 2210 positive urine cultures of outpatients (7.38%). Resistance of the isolated bacteria in routine antibiotics was found as follows: ticarcilin 32.5%, ticarcilin/clavulanic Acid 25.2%, piperacillin 15.3%, piperacillin/tazobactam 12.9%, amikacin 12.3%, gentamicin 17.2%, netilmicin 13,5%, tobramycin 20,2%, colistin 18%, imipenem 14.1%, meropenem 14.1%, Ciprofloxacin 27.0%, aztreonam 14.1%, trimethoprim/sulfamethoxazole 55.2%, ceftazidime 9.8% and cefepim 10.4%. The 163 patients with P. aeruginosa infection showed the following characteristics: 157 (96.3%) of them had permanent urinary catheter. Man to woman ratio was 93/70. 98 (60.12%) patients had Diabetes. 62 (38.04%) patients were older than 75 years. 10 patients (6.13%) had cancer. 49 (30.06%) patients had severe renal insufficiency (clearance of creatinine 40ml/min).
Conclusions: P. aeruginosa is found as the cause of urinary tract infection in a small but not insignificant proportion among non-hospitalized patients. It consists a significant virulence factor in patients with permanent urinary catheter (96.3%). Immunodeficiency (diabetes, renal insufficiency, advanced age, neoplastic disease) is the main aggravating factor. The isolated Pseudomonas aeruginosa strains showed increased resistance to various antibiotics, a fact that necessitates treatment of these patients according to the antibiogram. Urinary catheter should be placed in carefully selected patients. The reduction in the duration of catheterisation of the urinary bladder is the key to prevention of UTI. The incidence of UTI as a result of urinary catheterisation may be reduced more than 80% if the catheter is removed 4 days after placement.
Literature: 
724 PO1485 PSEUDOMONAS AERUGINOSA URINARY TRACT INFECTION IN OUTPATIENTS WITH PERMANENT URINARY CATHETER
Keywords: 
PSEUDOMONAS AERUGINOSA; URINARY CATHETER; antibiogram; immunodeficiency