Bacterial colonization, species diversity and antimicrobial susceptibility patterns of indwelling urinary catheters from postpartum mothers attending a Tertiary Hospital in Eastern Uganda
Loading...
Date
2022
Journal Title
Journal ISSN
Volume Title
Publisher
PLoS ONE
Abstract
Postpartum urinary Catheter-Related Infections (CRIs) are a significant cause of maternal
sepsis. Several studies done have reported the presence of mixed populations of bacteria
with a significant increase in Extended-Spectrum Beta-Lactamase (ESBL) Enterobacteriaceae
spps, Methicillin-Resistant Staphylococcus aureus (MRSA), Multi-Drug Resistant
(MDR) bacteria in urine and blood cultures of catheterized patients despite the use of prophylactic
antibiotics. This study aimed at determining the bacterial species diversity and susceptibility
patterns of indwelling urinary catheters from postpartum mothers attending Mbale
Regional Referral Hospital (MRRH).
Methods
A cross-sectional study employing quantitative and qualitative was carried out in MRRH
among postpartum mothers with urinary catheters and their care-takers. The purposive
non-random sampling strategy was used to collect data using an interviewer-administered
questionnaire for the quantitative data collection and in-depth interviews for qualitative data
collection. All the data collection tools used were developed, pretested and validated. At the
point of de-catheterization, Catheter tips from enrolled participants were cut about 2-3cm
below the balloon aseptically into test-tube containing peptone water, sonication technique
employed, and incubation done 24hours then cultured to ensure phenotypic identification.
An antibiotic sensitivity test was performed using the disc diffusion method following Clinical
and Laboratory Standards Institute (CLSI) guidelines. Quantitative data collected was entered in Microsoft Excel and then exported to STATA14 for statistical analysis. Thematic
analysis was used to analyse and organise qualitative data by an inductive coding method
using Nvivo 12 software.
Results
In this study, 208 postpartum mothers participated, the majority of whom were caesarean
section mothers of age range 20–24 years and 17 care-takers with a median age of 32
years. The prevalence of catheter tips bacterial colonisation was 98% despite 88.5% of the
participants being on broad-spectrum antibiotics. The average duration of catheterisation
was 2 days. All bacteria isolates were potential uro-pathogens with a mean occurrence of 2
bacteria species in each urinary catheter tip. The rates of MDR to commonly used antibiotics
were high. The urinary catheter size of greater than F14 and duration of catheterization
greater than 2 days were significantly associated with the number of bacterial species isolated
from each sample. The maintenance care and knowledge of care-urinary catheter
care among the care-takers was found sub-optimal.
Conclusion
There was a high prevalence of catheter colonisation with bacterial spps diversity averaging
2 spps per sample despite use of broad spectrum antibiotics. The MDR rates were high,
which calls for routine culture and sensitivity. Health workers practicing obstetric medicine
need to pay attention to catheter sizes during catheterisation and its duration. Health education
should be part of antenatal and postnatal care education.
Description
Keywords
Bacterial colonization, Species diversity, Antimicrobial susceptibility, Urinary catheters
Citation
Nakawuki AW, Nekaka R, Ssenyonga LVN, Masifa G, Nuwasiima D, Nteziyaremye J, et al. (2022) Bacterial colonization, species diversity and antimicrobial susceptibility patterns of indwelling urinary catheters from postpartum mothers attending a Tertiary Hospital in Eastern Uganda. PLoS ONE 17(1): e0262414. https://doi.org/ 10.1371/journal.pone.0262414