The Bacteriology of Urine in Urologic Patients with Prolonged Indwelling Urinary Catheters in the Philippine General Hospital

The Bacteriology of Urine in Urologic Patients with Prolonged Indwelling Urinary Catheters in the Philippine General Hospital
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Title:The Bacteriology of Urine in Urologic Patients with Prolonged Indwelling Urinary Catheters in the Philippine General Hospital
Author/Abstract:

Patrick Joseph M. Matias, MD1 and Marie Carmela M. Lapitan, MD, FPUA1,2,3

1Division of Urology, Department of Surgery, Philippine General Hospital, University of the Philippines Manila
2Department of Surgery, College of Medicine, University of the Philippines Manila
3 National Institutes of Health, University of the Philippines Manila

Objective: The objective of this study was to determine the bacteriologic pattern (strain and sensitivity) of the urine of urologic patients with prolonged indwelling urinary catheters. The study also aimed to determine the presence and nature of any relationship between age, presence of significant pyuria/hematuria, catheter type, elevated creatinine level, duration of catheterization and a positive urine culture.

Materials and Methods: This is a prospective surveillance study of urine cultures of urologic patients with prolonged indwelling urinary catheters. A urine specimen was aseptically collected for urinalysis and urine culture. Blood was also extracted for serum creatinine determination. The susceptibility and resistance pattern of isolated bacteria against the most commonly used antibiotics in the Philippine General Hospital were evaluated. Various patient factors were statistically analyzed using Fisher's exact test and unpaired T-test to determine their association with a positive urine culture.

Results: A total of 116 patients were included in this study. The most commonly isolated
microorganism was Escherichia coli. Of the 44 samples with E. coli, 97.73% showed sensitivity
against meropenem. This was followed by nitrofurantoin (75.00%) and ceftazidime (59%). Other
gram-negative organisms isolated were Enterobacter aerogenes (12.41%), Pseudomonas aeruginosa (9.66%), Enterobacter agglomerans (9.66%) and Proteus mirabilis (6.21%). Most of the bacteriaisolated were resistant to ampicillin, with a resistance rate of 92.14%., ciprofloxacin (80.71%), and cotrimoxazole (80.0%). Not enough evidence was found to associate any clinical factor with a positive urine culture.

Conclusion: Escherichia coli was found to be the most common bacteria in the urine of urologic
patients with long-term indwelling catheters. Meropenem, nitrofurantoin and ceftazidime were found
to be the most effective antibiotics against E. coli. High resistance rates were demonstrated with
ampicillin, ciprofloxacin and cotrimoxazole. A larger study is recommended to establish the association of patient factors to the occurrence of bacteriuria in catheterized patients.

Key words: indwelling urinary catheters

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