Dalia Adukauskienė, Tadas Kaučikas, Agnė Adukauskaitė, Romualdas Mačiulaitis, Inga Skarupskienė, Daiva Pentiokinienė, Giedrė Stanaitienė
Aim of study. Estimation of urinary tract infection (UTI) risk factors, antimicrobial treatment, length of UTI-treatment and stay in Cardiac intensive care unit (CICU), mortality and its risk factors in CICU patients. Methods. Retrospective analysis of data of 57 patients with bacteriuria, who were treated in Kaunas Clinics CICU. Results. Bacteriuria rate between males and females was found to be equal (47,4 % and 52,5 %). Mean age 73,01 ± 12,3 y/o; bacteriuria was more often present among patients over 65 y/o compared to younger ones, p<0,05. 52 out of 57 had UTI. UTI has evolved in all 11 patients with diabetes mellitus (DM). Urinary catheterization was performed in 49 patients, of whom 45 had UTI. Mean urinary catheterization duration was found to be 10±2 days. Most often UTI was caused by Gram-negative rods – 44 cases out of 64, among which by E. coli – 43,2 % (p<0,05); fungi were found in critical and longer treated patients. The most often used antibiotic (AB) – cefuroxime (77 %). Duration of UTI in patients with adequate empirical antibacterial treatment (n= 24, 46 %) was 9,9±4,7 days, in patients with inadequate AB-treatment (usually because of antibacterial resistance) 15,7±3,3 days, p<0,05. Mean length of stay in CICU in case of colonization was 3,6±1,8 days, in case of UTI – 10,67±3,9 days and generally mean length of stay in CICU was found to be 1,08±0,4 days, p<0,05. When UTI was caused by fungi, length of stay in CICU was 27,75±12,3 days, when caused by bacteria – 10,68±5,3 days, p<0,05. When empirical antibacterial treatment was adequate, duration of treatment in CICU was 3,3±2,1 days, when inadequate – 14,7±5,3 days, p<0,05. Mortality was related to age over 50 y/o, DM (95%, OR 1,3, CI 0,33 – 4,99), urinary tract catheterization and its duration (all patients were catheterized; among those with long term catheterization 76 % died), p<0,05. Conclusions. Bacteriuria is prevalent among patients over 65 y/o and is almost always related to UTI, which has relevant risk factors, such as DM and urinary catheterization. Two thirds of UTI causal agents are Gram-negative rods, in half of cases – E. coli. Most often empirical antibiotic was intravenous cefuroxime. Empirical antibiotic treatment was adequate in half of the cases; the most often cause of inadequacy was antimicrobial resistance. Length of stay in CICU was longer not only in case of UTI, but in case of urinary colonization as well. Length of stay in CICU was shortest when UTI was caused by E. coli and longest when caused by fungi. In case of adequate antibacterial treatment, the length of UTI-treatment as well as stay in CICU is significantly shorter. Mortality of CICU patients with UTI is 40 %. The mortality rate was related to age over 50 y/o, DM and urinary catheterization, especially, long term.
Keyword(s): urinary tract infection; risk factors; antimicrobial treatment; mortality.
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