الفهرس | Only 14 pages are availabe for public view |
Abstract The frequency of UTI generates a significant workload for the laboratory. Most specimens sent to a laboratory will show no evidence of infection when tested, and consequently, there has been considerable interest in ways to screen out specimens before processing them for culture by a rule-out test strategy as microscopic examination of urine and dipstick urinalysis testes. This work aimed at evaluating the performance of simple screening methods as microscopic urine analysis and dipstick tests for urine leukocyte esterase and nitrite in order to use the negative results of these methods as rule out tests to exclude catheter associated urinary tract infections in hospitalized patients in Kobry El-kobah Military Hospital. Moreover, the antimicrobial profile of the isolated pathogens was determined to help guiding empirical antimicrobial therapy. The present study was conducted on 60 hospitalized patients. All patients were hospitalized in different ICUs of Kobry Elkobah Military Hospital. All patients were catheterized by indwelling urinary catheters ≥48 hours. Catheterized urine samples were collected from all patients and subjected to culture on suitable media, microscopic examination of Gram stained films for bacteriuria, microscopic examination of wet preparations from uncentrifuged urine and from the urine deposit for pus cells and dipstick testing for leukocyte esterase and nitrite. All isolated organisms were identified and tested for antibiotic susceptibility by disc diffusion method. Isolated Summary and Conclusion 103 Gram negative bacilli were tested for ESβLs production by combined disc method. E-coli was the most prevalent isolate responsible for CAUTIs among the studied cases, followed by Candida spp., and klebsiella pneumonia. Dipstick testing for leukocyte esterase had a higher performance quality than microscopic examination of urine samples for detection of pus cells. Microscopic examination of Gram stained films of uncentrifuged urine had the highest performance in relation to microscopic examination of wet preparations made from centrifuged or uncentrifuged urine for diagnosis of CAUTI. Considering the negative results of two screening tests increased the performance quality to rule out UTI in catheterized patients. The negative results of dipstick testing and microscopic examination of Gram stained films are the best among other test combinations to rule out CAUTI in our study. Although a high pattern of antimicrobial resistance was encountered among different isolates, susceptibility was high to Imipenem in most isolates, followed by Nitrofurantoin for E-coli and klebsiella pneumoniae, and Amikacin for Pseudomonas aeruginosa. Enterococci were highly sensitive to Vancomycin, Rifampicin and Chloramphenicol although they were resistant to other tested antibiotics. ESBLs producing species were 65.62% of all isolated Gram negative bacilli. |