Urinary tract infection is characterized as an intrusive bacterial illness which triggers an inflammatory response and creates fever, emergency, recurrence and painful urination. (1)

More than 40 % of all nosocomial infections in medical centre and facilitated living facilities is CAUTI. (2)

According to the CDC, individuals who are catheterized and remains there for two days or longer having CAUTI. One of leading causes of illness and death among hospitalized patients has been CAUTI infections. (3)

Gram-positive and gram-negative microorganisms, such as Enterococcus species, Staphylococcus species, Klebsiella species, Escherichia coli, and others, are the cause of CAUTI. (4)

Identifying risk indicators and microbial agents, proportion and the profile of AST for UTIs linked to catheter use is the aim of the study. This will enhance the institutions antibiotic policy and reduce the frequency of illness received in hospitals. (5)

UTIs fall into one of two categories: upper (kidney/pyelonephritis) or lower (bladder/cystitis, urethra/urethritis). They can also be separated into two groups: uncomplicated (healthy non-pregnant individuals) and challenging (presence of factors that increase the chance of treatment failure). (6)

The gastrointestinal system contains E. coli, which is the main reason of UTI. Pseudomonas, Klebsiella, Enterococcus, and Proteus are also causing UTIs. (7)

Due to the frequent and extended use of urinary catheters, patients in ICUs are particularly vulnerable to CAUTIs.

The key factor of having a CAUTI was found to be prolonged indwelling catheter use. Only approved catheters should be placed, and they should be taken out shortly thereafter. (8)

This study is conducted in TMU hospital, Moradabad. Isolated pathogenic microbes in urine samples obtained in the bacteriology section of Microbiology Department.

The study was approved by IEC - Ref no. TMU/IEC/2024-25/PG/138.

After the patient agree for our study then we fill the informed consent form Patient.

Statistical analysis

Tables and figures were created using Microsoft Word and Excel

Procedure

Sample collection:

The entire urine specimen was given to the Microbiology department bacteriology section after being collected in a universal container.

In Catheterised patients

Always use a versatile container with a sterilized syringe and needle to collect it from the distal edge of the catheter tube, and then take it right away to lab. Collect from the urine bag must be ignored at all costs. (9)

SAMPLE PROCESSING

Urine specimen was obtained in a multipurpose container, inoculated on CLED agar, and then incubated overnight. After one day gram stain was done and growth was noted.

• Both gram positive and negative bacteria reported to biochemical analysis based on culture parameters.

AST was performed to check the drug sensitivity.

• Biochemical test was used to identify the species. (10)

This study is conducted in TMU hospital, Moradabad. Isolated pathogenic microbes in urine samples obtained in the bacteriology section of Microbiology Department.

The study was approved by IEC - Ref no. TMU/IEC/2024-25/PG/138.

After the patient agree for our study then we fill the informed consent form Patient.

Statistical analysis

Tables and figures were created using Microsoft Word and Excel

Procedure

Sample collection:

The entire urine specimen was given to the Microbiology department bacteriology section after being collected in a universal container.

In Catheterised patients

Always use a versatile container with a sterilized syringe and needle to collect it from the distal edge of the catheter tube, and then take it right away to lab. Collect from the urine bag must be ignored at all costs. (9)

SAMPLE PROCESSING

Urine specimen was obtained in a multipurpose container, inoculated on CLED agar, and then incubated overnight. After one day gram stain was done and growth was noted.

• Both gram positive and negative bacteria reported to biochemical analysis based on culture parameters.

AST was performed to check the drug sensitivity.

• Biochemical test was used to identify the species. (10)

Antibiotics sensitivity pattern against gram positive isolates

Antibiotic resisted to NX (100%), Co-trimoxazole (80.6%), and CIP (78.2%) was strongest in gram-positive pathogens. Nitrofurantoin (90.32%), Vancomycin (100%), and Fosfomycin (100%), were the no.

UTIs were one of the most prevalent bacterial illnesses in people. CAUTIs were identified when a person had a high temperature more than 38°C except any obvious reason, urgency or irritation in the suprapubic area. Majority of CAUTI diagnostic, treatment, and prevention aspects are impacted by the persistence of uropathogens linked to biofilms. ⁽¹¹⁾

Typically, catheterization is used to treat urinary tract blockage. It also helps individuals with ischuria and uninhibited bladder abnormality and gives clinical illness patients accurate assessments of their urine production. ⁽¹²⁾

126 catheterized CAUTI patients admitted to the TMMC and RC in ICU participated in a cross-sectional observational study over the course of one year. The causative uropathogens were identified by collecting and cultivating urine samples.

In are an investigation, there were 83 (65.87%) more CAUTI cases in female patients than in male patients (43, 34.13%). According to comparable studies by Almalki and Varghese and Jayasukhbhai et al., 56.46% of patients were male and 75% were female with CAUTI. ⁽¹³⁾

Following to this study, females had a higher rate of UTIs, which could be because females have a higher burden of periurethral flora introduced during catheterization. We discovered that the prevalence of UTIs was higher in people aged 21-30, 40-50, and 61-70. A related study by Sangamithra V et al. found that UTIs had high prevalence in 18-40 and 41-60 age groups. We discover ⁽¹⁴⁾

The majority of uro pathogens in our investigation were isolated from CAUTI Gram-Negative Bacteria. 30(23.80%) Klebsiella sp. were less isolated than E. coli (37, 29.36%). Same research was done by Bhatia N. et al. ⁽¹⁵⁾

Gram positive bacteria accounted for 42 (33.34%) of the infections in our study, while gram negative bacteria accounted for 84 (66.7%). According to related research by Thattil S. J. et al., GPC accounted for 14.8% of the total, while gram-negative bacteria represented for 85%. ⁽¹⁶⁾

According to our research, the two most effective medications against gram-negative pathogens are Fosfomycin (94.36%) and Colistin (95.77%). The most efficient antibiotics for gram-negative pathogens were determined to be Colistin (99.7%) and Fosfomycin (100%) by Shrief R, Mahmoud R, et al. ⁽¹⁷⁾

The resistant pattern of Ampicillin (91.55%) and Norfloxacin (95.78%) against gram-negative organisms in our study were same to those Breijyeh Z. et al. reported. The study concluded that the two drugs that were most effective against gram-negative bacteria were Ampicillin (99.12%) and Norfloxacin (96.35%). ⁽¹⁸⁾

The high prevalence of E. coli Extended-spectrum beta-lactamase-producing organisms 13 (54.16%) in our research was same to that of Quan J, Zhao D, et al. (2024), where the highest number of E. coli Extended-spectrum beta-lactamase strains was 55.5%. ⁽¹⁹⁾

Gram-positive pathogens from the current investigation exhibited resistant to P 36 (85.7%), comparable to Teferi S et al. 37 (91.6%). However, every gram-positive bacterium exhibited 100% sensitive to VA 42, which was exact to findings of the Teferi S et al. investigation. ⁽²⁰⁾

A significant risk to health, CAUTIs accounted for at least 40% of Inpatient infections. A key component of the pathogenesis of CAUTIs is the biofilm that uropathogens build on indwelling urinary catheters. Motive of Research is antibiogram of Catheterized people using uropathogens isolated from CAUTI patients and identified the incidence of CAUTI with suspected UTI cases in the intensive care unit. Although particularly sensitive to FOS, PB, and CL, the majority of bacteria that were found exhibited considerable resistance to common antibiotics such as AMP, NX, COT and CIP.

Author contribution: author 1^st writes the manuscript, author 2^nd & 3^rd supervise the manuscript

1. An observational study from northern India to evaluate catheter-associated urinary tract infection in medical intensive care unit at a tertiary care center. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine. 2023 Sep;27(9):642.
2. Poddar KN, Pathi B, Pattnaik D, Praharaj A, Jena J. Microbiological profile of catheter associated urinary tract infection in ICUs of a tertiary care hospital Bhubaneswar, Odisha, India. IP Int J Med Microbiol Trop Dis. 2020;6(2):107-12.
3. Stamm WE. Catheter-associated urinary tract infections: epidemiology, pathogenesis, and prevention. The American journal of medicine. 1991 Sep 16;91(3):S65-71.
4. R. Thombare, Neelam K. Jaitly IB. Microbiological evaluation of catheter associated urinary tract infection in a tertiary care hospital. Int J Biol Health Sci. 2013;1(2):01–10.
5. Parihar S, Sharma R, Kinimi SV, Choudhary S. An observational study from northern India to evaluate catheter-associated urinary tract infection in medical intensive care unit at a tertiary care center. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine. 2023 Sep;27(9):642.
6. Urinary Tract Infection (Catheter-Associated Urinary Tract infection) and (NON-Catheter-Associated Urinary Tract infection).2024.
7. Urinary tract infections: causes, signs, symptoms and prevention created. 2017;16:27 IST.
8. Das R, Perrelli E, Mehta J M, Towle V, Ness P. Antimicrobial susceptibility of bacteria isolated from urine samples obtained from nursing home residents. Infect Control Hosp Epidemiol. 2009;30(11):1116–19.
9. Sangamithra, V., Sneka, Praveen S. Manonmoney. Incidence of Catheter Associated Urinary Tract Infection in Medical ICU in a Tertiary Care Hospital. Int J Curr Microbiol App Sci. 2017;6(4): 662-9.
10. Jenkins RD, Fenn JP, Matsen JM. Review of urine microscopy for bacteriuria. Jama. 1986 Jun 27;255(24):3397-403.
11. Noskin GA, Stosor V, Cooper I, Peterson LR. Recovery of vancomycin-resistant enterococci on fingertips and environmental surfaces. Infection Control & Hospital Epidemiology. 1995 Oct;16(10):577-81.
12. Tomar R., Paviaya R., Ghosh S., Murthy R., Pradhan S., Agrawal E. Biofilm production by uropathogens causing catheter associated urinary tract infection. IIJMRR.
13. Jayasukhbhai M, Komal P, Vegad M. Study of incidence and risk factors of urinary tract infection in catheterised patients admitted at tertiary care hospital. International Journal of Research in Medical Sciences. 2015:3808-811.
14. Christy VR, Athinarayanan G, Mariselvam R, Dhasarathan P, Singh R. Epidemiology of urinary tract infection in South India. Biomed Res Clin Prac. 2019;4:1-5
15. Bhatia N, Daga MK, Garg S, Prakash SK. Urinary catheterization in medical wards. J Glob Infect Dis. 2010:2(2):83-90
16. Thatti SJ, Santosh S. Prevalence of UTI in different Age Groups in a Tertiary Care Hospital and their Antibiogram. IJCMR. 2018;5(1):3-6.
17. Shrief R, El-Ashry AH, Mahmoud R, El-Mahdy R. Effect of colistin, fosfomycin and meropenem/vaborbactam on carbapenem-resistant Enterobacterales in Egypt: a cross-sectional study. Infection and Drug Resistance. 2022 Jan 1:6203-14.
18. Breijyeh Z, Jubeh B, Karaman R. Resistance of Gram-Negative Bacteria to Current Antibacterial Agents and Approaches to Resolve It. Molecules. 2020;25(6):1340. PMID: 32187986
19. Quan J, Zhao D, Liu L, Chen Y, Zhou J, Jiang Y, et.al. High prevalence of ESBL-producing Escherichia coli and Klebsiella pneumoniae in community-onset bloodstream infections in China. J Antimicrob Chemother. 2017;72(1):273-80. PMID: 27624571

Karaman R, Jubeh B, Breijyeh Z. Resistance of Gram-Positive Bacteria to Current Antibacterial Agents and Overcoming Approaches. Molecules. 2020;25(12):2888. PMID: 3258604