Vaginal Lactobacilli and Catheter Associated Urinary Tract Infections among inpatients admitted in medical wards and Medical ICU in a Tertiary Hospital in South India

BACKGROUND AND OBJECTIVES: Catheter associated urinary infections are among the most common nosocomial infections. While CAUTI is a well-studied entity, other incidence of symptomatic urinary infections in the weeks following urinary catherization is unknown; we attempted to study the same. The pro-biotic role of vaginal lactobacilli in urinary tract infections has been consistently shown. In this study we attempted to extend the co-relation with catheter associated urinary infections. DESIGN AND METHODS: A prospective observational conducted between January 2015 to July 2015 in a tertiary health care centre in south India among catheterized women in medical wards and ICUs we attempted to study the incidence of a clinically diagnosed associated symptomatic urinary infection within 30 days of urethral cathterization and also to co-relate its incidence to baseline vaginal lactobacilli concentration on gram stain and quantification by Nugent scoring technique. RESULTS: During the study period 6 (11.32%) of the 53 developed a symptomatic urinary tract infection (SUTI) within 30 days of catheter removal of whom 2 (3.77%) fulfilled CDC definition for catheter associated urinary tract infection (CAUTI). It was also noted that low lactovaginal indices on the Nugent scoring system was associated with a higher incidence (RR=5.92, P=0.094) of symptomatic urinary tract infections. CONCLUSIONS: The incidence of SUTI when compared to well-studied CAUTI rates in our study illustrates the true community burden of catheter related urinary infections. Larger prospective cohorts are needed to determine the true incidence. In our study we have noted a trend of increasing incidence of catheter related symptomatic urinary tract infections with depletion of vaginal lactobacilli. Larger studies are needed to validate the association and interventional trial to study its pro-biotic role as a prophylactic in catheter related urinary infections are warranted