Catheter-Associated Urinary Tract Infection Following Caesarean Section in Nnewi, Nigeria: A Prospective Comparative Study

Abstract

Background: Urinary tract catheterization is a major risk factor for urinary tract infections (UTIs). Catheter associated urinary tract infections (CAUTIs) still remain a major reservoir of antibiotic resistant pathogens with attendant increase in morbidity and mortality. Objective: To determine and compare the incidence of catheter associated urinary tract infections following immediate and 24-hour postoperative removal of urethral catheters for caesarean section. Design:  The study was a prospective, comparative study. Place and Duration of Study:  Labour ward, Theatre and Postnatal wards of Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi between August 2012 to April 2013. Methodology: The study involved 156 women admitted for caesarean section where the urethral catheters were removed 24-hour post operatively (group A) or immediately after caesarean section (group B). Urine samples were collected. Outcome measures included pre-operative and 72 hour postoperative urine microscopy, culture and sensitivity, urinary frequency, dysuria, urgency, fever and duration of hospital stay. The patients’ data were coded, computed and analyzed using SPSS version 16. A P-value of <0.05 was considered significant. Results: Of the 79 patients in group A, 9 (11.4%) had significant bacteriuria in the 72 hour post operative urine culture while 5 (6.5%) had significant bacteriuria in group B, (OR=1.85: 95% CI 0.59-5.80, P=0.28). The overall incidence of catheter associated urinary tract infection in NAUTH was 14(9.0%).  Escherichia coli were mostly isolated 4 (44.4%). The lowest level of resistance was seen with Amoxycillin- clavulanic acid (Augmentin). Conclusion: The present study showed that significant bacteriuria in Group A almost double the incidence in Group B, however, the difference was not statistically significant. Further studies should be carried out to compare catheterization with non- catheterization for caesarean section.