Epidemiology of hospital acquired urinary tract infections in a medical college hospital in Goa

BACKGROUND: Hospital Acquired Urinary Tract Infection (HAUTI) is the commonest among the nosocomial infections, and hospital specific data concerning its magnitude and attributes is essential to its effective control. MATERIALS AND METHODS: Prospective study was undertaken among 498 in-patients at the medical college hospital in Goa, employing the clinico-bacteriologic criteria of CDC, Atlanta, in the representative medicine and surgery wards. Antimicrobial sensitivity was tested using the Kirby-Bauer disc diffusion method. STATISTICAL ANALYSIS: Statistical significance of association was tested using the chi-square test and the unpaired t-test at 5% level of significance, while the strength of association was expressed as the Odd's ratio with 95% confidence interval calculated by Wolff's method. RESULTS: While the overall infection rate was 8.03/100 admissions, 33.6% of the catheterized patients developed HAUTI. Effect of gender was found to remain restricted to the development of HAUTI among females at an earlier age and earlier in time series compared to males, but no overall difference in incidence in the two sexes. The factors significantly associated with HAUTI included: duration of hospitalization, per urethral catheterization and the duration of catheterization. E. coli, Pseudomonas, Kebsiella, and Candida accounted for over 90% of the isolates, and 73.5% of these were resistant to all the antibiotics for which sensitivity was tested. The remaining isolates demonstrated sensitivity to amikacin and/or cefoperazone-sulbactam. CONCLUSION: High infection rate coupled with widespread isolation polyantimicrobial resistant nosocomial pathogens emphasizes the importance of meticulous surveillance of nosocomial infections in the hospital, with due attention to antibiotic prescription practices.