Comparison Of Povodine-Iodine Versus Savlon For Pre-Catheterization Cleansing And The Association Of Bacteriuria With Its Antibiotic Susceptibility In Catheterised Patients Of The Surgical Ward 991-996
Dr Shobha K.L Professor Department of Microbiology
Melaka Manipal Medical College
Manipal 576104 E.Mail: email@example.com
Background:Urinary tract infection is one of the most common nosocomial infections, and urinary catheterization is the most frequent predisposing factor. Nosocomial infections associated with urinary catheters may increase the mortality rate upto three times. These infections also pose a considerable financial burden. Different methods for urinary tract infection prophylaxis have been proposed for patients who undergo continuous catheterization. This study compared the disinfection of the genital area with Povodine â€“Iodine or Savlon (Chlorhexidine and Cetrimide) before inserting the Foleyâ€™s catheter with respect to the quantitative results of the urine culture and sensitivity to commonly used antibiotics.
Methods:Hundred inpatients who underwent clean continuous catheterization with the Foleyâ€™s catheter post operatively in the surgical ward, were divided into groups â€˜Aâ€™ and â€˜Bâ€™.Group â€˜Aâ€™ and group â€˜Bâ€™ consisted of 50 patients each. Group â€˜Aâ€™ patients were directed to use povodine â€“iodine as a disinfectant for pre-catheterization cleansing, and group â€˜Bâ€™ was directed to use savlon. The control group included 50 post operative patients, those who were not on urinary catheters. The urine sample was collected shortly after the catheter was inserted, and the samples with no growth on the culture plate were only included in the study. Patients with a previous history of urinary tract infection or with growth on the culture plates collected from urine immediately after catheterization, and patients with congenital urinary tract anomaly, were excluded from the study. Catheter samples were collected using a sterile needle and syringe. Urine samples collected on the third and fifth day of catheterization were processed and considered to be culture positives if the count was >10(4) organisms per milliliter of urine. Midstream urine samples were collected from the postoperative patients without urinary catheters. Organisms were identified by conventional biochemical methods, and susceptibility to antimicrobial agents was tested by the Kirby-Bauer standardized disc-diffusion technique.
Results: 14% patients in group A and 16% in group B developed bacteriuria and candiduria by the end of the 5th day of catheterization. Females had higher rate of bacteriuria than males, following three days and five days of catheterization in both the groups (Group A female: male bacteriuria ratio on third day was 2(8%):1(4%) and on fifth day 4(16%): 3(12%).Group B female:male bacteriuria ratio on third day and fifth day were 2(7.62%):1(4.16%) and 5(19.23%:3(6.25%). None from group A and one from group B presented with symptoms. .Klebsiella species was the commonest organism isolated, followed by candida species and E.coli. Our study showed no significant difference between disinfecting with Povodine â€“Iodine or Savlon in the pre-catheterization cleansing procedure and the occurrence of bacteriuria..Microorganisms were sensitive to cephalosporins and amikacin, and were resistant to commonly used antibiotics like Trimethoprim-sulfamethoxazole, ampicillin and gentamicin. None of the controls had any bacteriuria.
Interpretation: Performing catheterization by a proper aseptic procedure using available disinfectants should be thought as a preventive measure, and use of appropriate antimicrobial drug therapy with developing drug resistance should also be considered during treatment.