Journal of Clinical Microbiology and Biochemical Technology

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Clinical Group

Journal of Clinical Microbiology and


Biochemical Technology
DOI CC By

Sachin C Deorukhkar1*, Santosh


Saini1, Namita A Raytekar1 and M Research Article
Dawna Sebastian2
Catheter Associated Urinary Tract
1
Department of Microbiology, Rural Medical College
and Hospital, Pravara Institute of Medical Sciences
(Deemed University), Loni, Maharshtra India.
Candida Infections in Intensive Care
Infection Control Nurse, Pravara Rural Hospital,
Unit Patients
2

Pravara Institute of Medical Sciences (Deemed


University), Loni, Maharshtra India

Dates: Received: 01 November, 2016; Accepted: 09


December, 2016; Published: 10 December, 2016
Abstract
*Corresponding author: Sachin C Deorukhkar,
Assistant Professor, Department of Microbiol- Introduction: Health care associated infections (HCAIs) or nosocomial infections have a propensity
ogy, Rural Medical College and Hospital, Pravara to strike in the critical care areas. Surveillance of HCAIs, so as to define the magnitude and nature of the
Institute of Medical Sciences (Deemed Univer- problem, is the primary step towards reducing the risk for infection in vulnerable hospitalized patients.
sity), Maharshtra, India, Tel: +91-9545181908; The present study was conducted in a rural tertiary care teaching hospital with an aim to determine the
+91-9850775564; Fax: +91-2422-273442; E-mail: rate of catheter associated urinary tract Candida infections in medical intensive care unit patients.

Methods: A prospective study was done on catheter associated urinary tract infection (CAUTI). The
Keywords: Catheter associated urinary tract infec-
urine samples were collected and processed following standard microbiological protocols.
tion; Candida albicans; Candiduria; Non albicans Can-
dida spp; Health care associated infections Results: The overall rate of CAUTI was found to be 1.6 per 1000 catheter days. The rates of catheter
associated bacteriuria and candiduria in our health care setup were noted as 1.2 and 0.4 respectively.
https://www.peertechz.com

Conclusion: The present surveillance study helped us to generate institutional data regarding CAUTI
in ICU patients with a special reference to candiduria. In our institute, the incidence of candiduria was low.

Introduction rate of catheter associated urinary tract Candida infections in


medical ICU patients.
Health care associated infections (HCAIs) are cross
infections arising in hospitals. These infections are neither Materials and Methods
present nor incubating upon hospital admission. The incidence
of HCAIs is usually high in intensive care unit (ICU) and The present study was conducted in the department of

seems to be related to an extent to management decisions and Microbiology, Rural Medical College and Hospital of Pravara

practices. Institute of Medical Sciences (Deemed University), Loni,


Maharashtra, India for a period of 5 years (January 2011 to
HCAIs infections can lead to complications in 25-50% of December 2015). The protocol of the study was approved by
those admitted to ICUs [1]. Approximately half of all cases Institutional Ethics Committee.
of HCAIs are associated with indwelling medical devices [2].
Therefore the greatest threat against safety in ICUs is from Urine sample was aseptically collected from sampling port
device associated infections (DAIs), particularly ventilator- of indwelling urinary catheter with sterile syringe and needle
associated pneumonia (VAP), central venous catheter (CVC)- from suspected cases of CAUTI. The patient was labelled as a
related blood stream infection and catheter-associated urinary case of CAUTI, when a catheterized patient developed one or
tract infection (CAUTI). more of the following conditions after 48 hours admission to
ICU: fever, urgency, suprapubic tenderness, dysuria, turbid
Over the past few decades the isolation of Candida spp. urine and burning micturition.
has been increasingly reported from DAIs especially those
involving the blood stream and urinary tract [2]. Nearly about The urine samples were inoculated by calibrated loop
10-15% of health care associated UTIs are caused by Candida (0.01mL) onto blood agar, MacConkey’s agar and Sabouraud
spp [3]. As number of literature on CAUTI are focused on dextrose agar (SDA) supplemented with 100 μg/ml of
bacterial isolates, the present study was conducted in a rural chloramphenicol. The culture plates were incubated at 370C for
tertiary care teaching hospital with an aim to determine the 24-48 h.

015

Citation: Deorukhkar SC, Saini S, Raytekar NA, Sebastian MD (2016) Catheter Associated Urinary Tract Candida Infections in Intensive Care Unit Patients. J Clin
Microbiol Biochem Technol 2(1): 015-017.
Deorukhkar, et al. (2016)

Colony count of > 104colony form units (CFUs)/mL was Discussion


considered as significant for candiduria whereas, in case of
bacteriuria, colony count of 105 CFU/mL was considered as Surveillance of HCAIs is one of the important functions of
significant. Additionally, a Gram stained smear was prepared Hospital Acquired Infection Control Committee. The purpose of
from a centrifuged urine sample [3]. surveillance of HCAIs is to reduce the incidence of nosocomial
infections, which in turn will reduce the associated morbidity,
Candida isolates were identified upto species level by mortality and costs. The primary aim of surveillance of
combination of germ tube test, sugar assimilation and nosocomial infections is to establish its baseline rates in a
chromogenic assay on HiChrome Candida agar (Himedia particular health care setup. Once these rates are known, the
Laboratories Pvt. Ltd. Mumbai). HiCandida identification kit surveillance can continue and further trends can be effectively
(Himedia Laboratories Pvt. Ltd. Mumbai) supplemented the monitored.
species identification. Bacterial isolates were identified as per
standard microbiological protocol. In the present study, the overall rate of CAUTI was 2.2% or
1.6 per 1000 device days. This rate was low than those reported
The rate of CAUTI was expressed as the number of CAUTI by Prasanna et al. [4] and Datta et al. [5]. However, the rate of
per 1000 device days and was calculated using the following CAUTI at our setup was high compared to that reported by Singh
formula. et al. [6]. The CAUTI rates reported in various studies are highly
variable and range from 4.4 to 56.5% or 1.7 to 30 infections
Number of patients developing CAUTI X 1000
_____________________ per 1000 device days [6]. Several possible explanations can be
given to a lower rate of CAUTI in ICU patients at our health
Total number of catheter days
care setup. The first possibility can be attributed to the intense
Results efforts of Hospital Infection Prevention and Control Committee
of our institute which unceasingly monitor every aspect of
In these five years period, a total of 108 (2.2%) out of 4889 Infection Prevention and Control. The other possibilities include
patients admitted to ICU for more than 48 h developed CAUTI. maintenance of meticulous hygiene of hospital, conduction
The total device days were 63784. The overall rate of CAUTI of regular sensitization programmes and strict adherence to
was found to be 1.6. Out of these 108 CAUTI cases, bacteria were universal standard precautions.
isolated from a total of 77 (1.5%) cases. Catheter associated
candiduria was noted in 31 (0.7%) cases. In this study, the incidence of catheter associated bacteriuria
was high compared to candiduria. The rate of catheter associated
The rates of catheter associated bacteriuria and candiduria bacteriuria was 1.5% or 1.2 per 1000 device days. E. coli (33.7%)
in our health care setup were noted as 1.2 and 0.4 respectively. was the predominant isolate. This member of Enterobacteriaceae
The spectrum of microorganism isolated from CAUTI is shown family is the most commonly isolated bacterial pathogen from
in Table 1. hospital acquired UTI [7]. E. coli is the commonest facultative
anaerobic commensal of gastrointestinal tract. Although both
E. coli (33.7%) followed by Klebsiella pneumoniae (22.2%)
commensal and uropathogenic E. coli (UPEC) strains colonize
and Enterococcus spp. were predominant bacterial isolate in the
human gastrointestinal tract only UPEC can selectively
present study. Predominance of Non albicans Candida (NAC)
proliferate in the urinary system [7]. The pathogenicity of UPEC
spp. over C. albicans was noted. C. tropicalis followed by C.
can be attributed to various virulence factors like haemolysin,
glabrata were the major NAC spp.
P fimbriae, S fimbriae and cytotoxic necrotizing factor 1. In
addition, few strains UPEC bear surface pili particularly type
I fimbriae, which bind to latex catheters and human kidney
Table 1: Spectrum of microorganisms isolated from catheter associated
urinary tract infections. epithelial cells [8].

I. Bacterial isolates In the present surveillance, the rate of catheter associated


E. coli 26 (33.8) candiduria was 0.7% or 0.4 per 1000 device days. The incidence
Klebsiella pneumoniae 17 (22.1) of catheter associated candiduria was low. Candiduria is a
Enterococcus spp. 11 (14.3) relatively rare finding in a structurally normal urinary tract
[9,10]. It is strongly associated with presence of indwelling
Pseudomonas aeruginosa 09 (11.7)
urinary catheters and other risk factors like diabetes mellitus,
Staphylococcus aureus 09 (11.7)
extremes of age, female sex, use of immunosuppressive agents
Coagulase negative Staphylococci 05 (6.5) and broad spectrum antibiotic therapy [11,12].
Total 77
In our study, C. albicans was isolated from only 07 CAUTI
II. Candida isolates
patients whereas, NAC spp were isolated from 24 cases. In
C. albicans 07 (22.6)
recent years, incidence of Candida infections due to NAC spp.
C. tropicalis 15 (48.4) is increasing compared with that of C. albicans. NAC spp.
C. glabrata 06 (19.3) are not only better adapted to the urinary tract but also are
C. krusei 03 (9.7) difficult eradicate compared to C. albicans [13]. C. tropicalis was
the predominant NAC spp. in the present study. In recent
Total 31
016

Citation: Deorukhkar SC, Saini S, Raytekar NA, Sebastian MD (2016) Catheter Associated Urinary Tract Candida Infections in Intensive Care Unit Patients. J Clin
Microbiol Biochem Technol 2(1): 015-017.
Deorukhkar, et al. (2016)

years, C. tropicalis is increasingly reported from various types 3. Jain M, Dogra V, Mishra B, Thakur A, Loomba PS, et al. (2011) Candiduria in
of candidiasis [14,15]. This NAC spp. often demonstrates catheterized intensive care unit patients: Emerging microbiological trends.
Indian J Pathol Microbiol 54: 552-555. Link: https://goo.gl/RV0rgH
reduced susceptibility to fluconazole [15]. Jain et al. [3], also
reported this NAC spp. as the frequent cause of candiduria in 4. Prasanna SS, Doble M (2008) Medical biofilm-its formation and prevention
catheterized ICU patients. using organic molecules. J Ind Inst Sci 88: 27-36. Link: https://goo.gl/DftmBE

Conclusion 5. Datta P, Rani H, Chauhan R, Gomber S, Chander J (2014) Health-care-


associated infections: Risk factors and epidemiology from an intensive care
Surveillance of health care associated infections, so as to unit in Northern India. Indian J Anaesth 58: 30-35. Link: https://goo.gl/okqCly

define the magnitude and nature of the problem, is the major 6. Singh S, Pandya Y, Patel R, Paliwal M, Wilson A, et al. (2010) Surveillance
step towards reducing the risk for infection in vulnerable of device-associated infections at a teaching hospital in rural Gujarat-India.
hospitalized patients. The present surveillance study helped us Indian J Med Microbiol 28: 342-347. Link: https://goo.gl/QPnj1L
to generate institutional data regarding CAUTI in ICU patients
7. Jacobsen SM, Stickler DJ, Mobley HLT, Shirtliff ME (2008) Complicated
with a special reference to candiduria. In our institute, the
catheter-associated urinary tract infections due to Escherichia coli and
incidence of candiduria was low. The predominance of NAC Proteus mirabilis. Clin Microbiol Rev 21: 26-59. Link: https://goo.gl/saFzjS
spp. over C. albicans was noted. Surveillance of health care
associated infections though a very tedious process has many 8. Dowling KJ, Roberts JA, Kaack MB (1987) P-fimbriated Escherchia coli urinary
tract infection: a clinical correlation. Southern Med J 12: 1533-1536. Link:
beneficial outcomes. The data obtained from surveillance can
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convince clinicians and hospital administrators of the need for
improvements in infection prevention and control practices. 9. Lundstrom T, Sobel J (2001) Nosocomial candiduria: A review. Clin Infect Dis
32: 1602-1607. Link: https://goo.gl/GsG3Uo
Acknowledgement
10. Bukhary ZA (2008) Candiduria: a review of clinical significance and
This study was conducted under the aegis of Laboratory, management. Saudi J Kidney DisTranspl 19: 350-360. Link:

Department of Microbiology, Rural Medical College. We are 11. Kauffman CA (2005) Candiduria. Clin Infect Dis 41: S371-S376. Link: https://
grateful to the management of Rural Medical College and Rural goo.gl/pjD4NL
Hospital of Pravara Institute of Medical Sciences, Deemed
12. Achkar JM, Fries BC (2010) Candida infections of the genitourinary tract. Clin
University, Loni, Maharashtra, India for their encouragement
Microbiol Rev 23: 253-273. Link: https://goo.gl/b8sRWz
and support throughout the study. We also thank the technical
staff of Department of Microbiology for their assistance in the 13. Deorukhkar SC, Saini S, Mathew S (2014) Non-albicans Candida infection:
study. an emerging threat. Interdiscip Perspect Infect Dis 2014: 615958: 7. Link:
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2. Deorukhkar SC, Saini S (2016) Medical device-associated Candida infections 15. Deorukhkar SC, Saini S, Mathew S (2014) Virulence factors contributing to
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Copyright: © 2016 Deorukhkar SC, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and r eproduction in any medium, provided the original author and source are credited.

017

Citation: Deorukhkar SC, Saini S, Raytekar NA, Sebastian MD (2016) Catheter Associated Urinary Tract Candida Infections in Intensive Care Unit Patients. J Clin
Microbiol Biochem Technol 2(1): 015-017.

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