Presentation is loading. Please wait.

Presentation is loading. Please wait.

Healthcare Associated Urinary Tract Infection Epidemiology And Pathogenesis CHENG-HUA HUANG, M.D. VICE-SUPERINTENDENT CATHAY GENERAL HOSPITAL.

Similar presentations


Presentation on theme: "Healthcare Associated Urinary Tract Infection Epidemiology And Pathogenesis CHENG-HUA HUANG, M.D. VICE-SUPERINTENDENT CATHAY GENERAL HOSPITAL."— Presentation transcript:

1 Healthcare Associated Urinary Tract Infection Epidemiology And Pathogenesis CHENG-HUA HUANG, M.D. VICE-SUPERINTENDENT CATHAY GENERAL HOSPITAL

2 Definition of HAI-UTI Asymptomatic UTI: bacteriuria/funguria + no constitutional symptoms The presence of bacteria/fungi in the urine does not always imply infection or a clinically significant condition HAI-UTI: indicating clinical, histologic or immunologic evidence of infection

3 Pyuria vs Bacteriuria Musher:100% of u/c > CFU/ml with presence of pyuria Musher: presence of pyuria in catheterized p’t, 30% U/C (-) Intermittent cathetherized p’t (ICP) pyuria with 100% U/C >100000/ml Tambyah: short-term catheterized p’t :37% each pyuria vs Bacteriuria

4 Infection vs Colonization Bacteriuria is present in almost all p’t with prolonged catheterization The usual symptoms of dysuria, hesitancy, urgency are not seen in catheterized p’t Fever, leukocytosis may also be caused by non- infectious conditions Only 30% (2-4 days short-term catheterized) with presence of constitutional S/S

5 HAI-UTI HAI-UTI: 30-45% of total nosocomial infections 80-85% HAI-UTI related to the use of urethral catheter 5-10% caused by other genito-urethral procedures

6 Important Events on HAI-UTI 1927: Frederick E. Foley: invested a retention balloon on indwelling catheter (control bleeding after prostate surgery) 1950: Cuthbert Dukes: closed drainage system for better infection control (70-85% of UTI are preventable) 1960s: Calvin Kunin stated the important issue of infection control

7 HAI-UTI In US, 600,000 p’ts annually and occupy 15% of total hospital infection cost Bacteriuria occur in 1-5% after single brief catheterization Bacteriuria: 100% in indwelling catheter, no closed drainage< 4 days 3-10%/ day of catheterized indwelling with closed drainage system(U/C +)

8 Inappropriated Bladder Catheterization 28% of physicians were not aware of bladder indwelling catheter 41% of bladder catheter judged inappropriately 69% of bladder catheter only for incontinence p’ts (31.7% by Dr and 37.3% by RN)

9 Pathogenesis of HAI-UTI Role of the catheter Bacterial factors Pathways of infection Host factor

10 Pathogenesis Normal non-catheterized urethra and bladder with good defense function (epithelial cell) Each urinations clears 99.9% of existed bladder organisms Tamm-Horsfall protein and oligoSaccharide will bind the organism and suspended in urine Bladder mucosa with bactericidal effect Glycocalix/ Biofilm helps the bacteria survive

11 Routes of Infection in Catheter Associated UTI: 1 Through Insertion 2 Intraluminal 3 Extraluminal

12 Route of Entry Tambyah: intra-luminal entry(23%) Tambyah: extra-luminal route (34%) Garibaldi et al : peri-urethral colonization (GNB/ Enterococci) → UTI (18%);non-colonized(5%) Removal of catheter with remain risk for 24 hours

13 Indications of Indwelling Catheter Acute urine retention/ outlet obstruction For accurate measurement of urine output in critically ill p’t Peri-operative use for selected surgery(uro, prolonged surgical time, or large amount of blood or fluid replacement) To assist in healing of open wound at perineal region in incontinent p’t P’t requires for prolonged immobilization Others

14 Inappropriate Uses of Indwelling Catheter As a substitute for nursing care for incontinent elderly As a means of obtaining urine for culture or diagnosis need on p’t can voluntarily void. For prolonged post-operation duration to recovery

15 Alternatives for Indwelling Catheter External catheter on non-retention or bladder outlet no obstruction Intermittent catheterization (clean) in spinal cord injury Frequent change of absorbed diaper and perineal hygiene care plan

16 Risk Factors for HAI-UTI ↑ duration of use (catheter days) Female gender Delay recognized of systemic infection DM/ Renal insufficiency Advanced age Severity of underlying disease Meatal colonization(peri-urethral) (72% in female; 30% in male)

17 CGH 醫療照護相關感染微生物排名 -UTI 排名排名 98 年度 99 年度 100 年度 1E. coli 2FungiP. aeruginosaFungi 3P. aeruginosaFungiP. aeruginosa 4K. pneumoniae 5E. faecalis

18 CGH 加護單位醫療照護相關感染微生物排名 -UTI 排名排名 98 年度 99 年度 100 年度 1FungiE. coli 2 Fungi 3K. pneumoniaeS. marcescensP. aeruginosa 4 K. pneumoniaeE. faecalis 5 K. pneumoniae

19 TNIS( 醫中 ) 加護單位醫療照護相關感染微生物排名 -UTI 排名排名 98 年度 99 年度 100 年度 1Fungi 2E. coli 3P. aeruginosa 4K. pneumoniae 5A. baumannii

20 TNIS( 區域)加護單位醫療照護相關感染微生物排名 -UTI 排名排名 98 年度 99 年度 100 年度 1Fungi 2E. coli 3K. pneumoniae 4P. aeruginosa 5A. baumannii

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38 ESBL 菌株 E.coliKlebsiella pneumoniaeKlebsiella oxytoca 平均 年度數量 ESBL 百分比數量 ESBL 百分比數量 ESBL 百分比 % % %6.47% % % %6.47% % % %5.45% % % %7.50% 平均 % % %6.47%

39 Therapeutic Plans Host risk-factor consideration Microbiologic factors Clinical essential data Recognizing situation where the usual treatment may be inappropriate Trend of antimicrobial resistance and D.Dx colonization or infection

40 Treatment Goals Draumatic reduce or eradicate pathogenic strains Limit the extent and severity of HAI-UTI Minimize alterations in normal flora( ↓ superinfection of candida and MDROs ↑ hour urine amount ml/hr for washing out the organism and non-obstructionly

41 Antimicrobial Therapy in HAI-UTI Most authorities believe that antibiotics to postpone bacteriuria are not indicated, but exception on specific p’ts (renal transplant and febrile neutropenia) Indication for HAI-UTI with antibiotics is a subject of debate and controversy but also is virtually universal Routine therapy for culture is not only cost-waste but also increasing adverse reaction and selective of MDROs

42 Mortality Related to HAI-UTI Uncertain, but <10% Bacteremia from pre-existence of HAI-UTI % total HAI-UTI may progress into sepsis and /or mortality Transient Bacteremia (6.5%) may occur after bladder catheterization, or removal of catheter (within 24 hours)


Download ppt "Healthcare Associated Urinary Tract Infection Epidemiology And Pathogenesis CHENG-HUA HUANG, M.D. VICE-SUPERINTENDENT CATHAY GENERAL HOSPITAL."

Similar presentations


Ads by Google