Symptomatic nosocomial urinary tract infection in ICU patients: identification of antimicrobial resistance pattern

Background: Nosocomial infections are generally occurring 72 hours after admittance and are not present or incubating prior to admittance. The most common nosocomial infection is urinary tract infection (UTI). Scanty data are available regarding the nosocomial infections in Iranian teaching hospitals. The aim of the present study was to determine the frequency of symptomatic nosocomial UTI, identify the etiologic organisms, and determine their antimicrobial susceptibility pattern. Patients and methods: This cross sectional study was conducted on ICU patients of Firoozgar hospital affiliated to Iran University of Medical Sciences from September 2003 to September 2005. Antimicrobial susceptibility pattern was achieved by disk-agar diffusion and E. test methods. Results: Totally, 306 patients were admitted to ICU, of whom 28 (9.2%) suffered from symptomatic UTI. The most common isolated organism was Klebsiella (13 cases, 46%) followed by E.coli, Pseudomonas and Enterobacter spp. A high level of resistance was observed for third generation cephalosporins (Pseudomonas 100%, Klebsiella 92%, E.coli 71% and Enterobacter 25%), however, microorganisms were less resistant to imipenem and cefepime. Conclusion: Based on observed results, carbapenems and cefepime are the drugs of choice for empiric antibiotic therapy of nosocomial UTIs in Firoozgar hospital.