PREVALENCE AND PATTERN OF CATHETER ASSOCIATED URINARY TRACT INFECTION AT LAGOS UNIVERSITY TEACHING HOSPITAL, IDI ARABA
Background to Study
Almost all healthcare-associated urinary tract infections (UTI) are caused by instrumentation of
the urinary tract with about 80% of these being associated with the presence of an indwelling
urinary catheter (IUC). This study aimed to determine the prevalence and pattern of catheter
associated urinary tract infection at the Lagos University Teaching Hospital.
Study Design and Methods
The study was a prospective observational study of 200 participants aged 18 and 65 years who had
an IUC inserted as part of their care at the hospital between July 2015 and May 2016. 5ml samples
of urine were obtained for culture at the time of urethral catheterization and on days 3, 7, 10, 14
and 28 post catheterization. The primary endpoint of the study was the development of CA-UTI.
Data was analysed using SPSS version 22. Continuous data are presented as means and standard
deviation while categorical data are presented as percentages. Comparison between means was
done using the Student’s t-test, while comparison between percentages was done using chi-square
test. . Logistic regression analysis was subsequently used to determine the factors that were
independently associated with the development of bacteriuria. The level of statistical significance
was set at a p-value ≤0.05.
The overall frequency of CA-UTI was 43%. The most common microbial isolate was E. coli which
accounted for 29(33.7%) of all isolates cases. The other isolates in decreasing order of frequency
were; C. albicans 25(29.1%), P. aeroginosa 14(16.3%), K. pneumonia 10(11.6%), enterococcus
2(2.3%) and A. iwoffi 2(2.3%). In 4(4.7%) of the participants, more than one organism was isolated
(E.coli and C. albicans).
Bacteriuria was associated with duration of catheterization (p-value = 0.001); age (p-value <
0.0001); presence of diabetes (p-value < 0.001); presence of hypertension (p-value = 0.005);
presence of renal insufficiency (p-value = 0.001) and presence of urinary tract obstruction (p-value
= 0.003) on univariate analysis. However, logistic regression analysis identified duration of
catheterization (odds ratio (OR) = 12.0; 95% confidence interval (CI) = 5.6 - 25.5; p-value <0.001),
presence of diabetes (OR = 5.6; 95% CI = 1.5 - 20.9; p-value = 0.01), presence of urinary tract
obstruction (OR = 3.9; 95% CI = 1.3 - 11.3; p-value = 0.013) and age (OR = 1.1; 95% CI = 1.0 -
1.1; p-value = 0.001) as the factors independently associated with bacteriuria.
Bacteriuria was a frequent complication among patients with IUC in this study. The predominant
causative organism was E. coli. Duration of catheterization, presence of diabetes, presence of
urinary tract obstruction and older age were the factors associated with development of bacteriuria.