Armed Forces Institute of Pathology, National University of Medical Sciences, Islamabad, Pakistan.
Armed Forces Institute of Pathology, National University of Medical Sciences, Islamabad, Pakistan.
Am J Infect Control. 2017 Oct 1;45(10):1101-1105. doi: 10.1016/j.ajic.2017.05.009. Epub 2017 Jun 16.
We sought to determine the incidence of bacterial biofilm-based catheter-associated urinary tract infections, identify variables affecting biofilm formation, and identify etiologic bacterial pathogens and antibiotic-resistance patterns associated with biofilm-based catheter-associated urinary tract infections (CAUTIs) in our setup.
Patients who developed at least 2 symptoms of urinary tract infection after at least 2 days of indwelling urinary catheters were included. Urine was collected aseptically from catheter tubing and processed per standard microbiologic practices. Bacterial pathogens were identified on the basis of gram staining, colony morphology, and biochemical reactions. The detection of the biofilm was done using the tube adherence method. Drug susceptibility testing was done using the Kirby-Bauer disc diffusion method.
Biofilm was detected in 73.4% isolates, whereas 26.6% of isolates were nonbiofilm producers. Mean duration of catheterization after which biofilm was detected was 5.01 ± 1.31 days. A latex catheter was used in 69.5% of patients, whereas a silicone catheter was used in 30.4% of patients. Escherichia coli was found to be the most common pathogen isolated (52.3%), whereas Enterobacter cloacae exhibited the highest biofilm production (87.5%) among isolated pathogens. Among biofilm producers, the highest resistance was observed with ampicillin (100%). Fosfomycin exhibited the lowest resistance (17.2%). Significant association with biofilm was detected for gender, duration of catheterization, and type of catheter.
Biofilm-based CAUTI is an emerging problem. E coli was the most frequent isolate. High antibiotic resistance was observed in biofilm-producing strains. Using the variables affecting biofilm formation, tailored intervention strategies can be implemented to reduce biofilm-based CAUTIs.
我们旨在确定以细菌生物膜为基础的与导尿管相关的尿路感染的发生率，确定影响生物膜形成的变量，并确定与我们设定中的以生物膜为基础的与导尿管相关的尿路感染（CAUTI）相关的病原菌和抗生素耐药模式。
将至少留置导尿管 2 天后出现至少 2 种尿路感染症状的患者纳入研究。无菌采集导尿管管腔尿液并按标准微生物学操作进行处理。根据革兰氏染色、菌落形态和生化反应确定病原菌。采用管附着法检测生物膜。采用 Kirby-Bauer 纸片扩散法进行药敏试验。
在 73.4%的分离物中检测到生物膜，而 26.6%的分离物是非生物膜生产者。在检测到生物膜的情况下，导尿管留置的平均时间为 5.01±1.31天。在 69.5%的患者中使用乳胶导管，而在 30.4%的患者中使用硅胶导管。在分离出的病原菌中，最常见的病原体是大肠埃希菌（52.3%），而阴沟肠杆菌的生物膜生成率最高（87.5%）。在生物膜生产者中，氨苄西林的耐药率最高（100%）。磷霉素的耐药率最低（17.2%）。性别、导尿管留置时间和导管类型与生物膜显著相关。
以生物膜为基础的 CAUTI 是一个新出现的问题。大肠埃希菌是最常见的分离株。生物膜产生菌表现出较高的抗生素耐药性。利用影响生物膜形成的变量，可以实施有针对性的干预策略，以减少以生物膜为基础的 CAUTI。
