Abstract
The outbreak of urinary tract infection by multi-drug-resistant Pseudornonas aeruginosa (MDRP) has occurred in our hospital between May 2001 and July 2002. In 28 hospitalized patients (ward A(urology, surgery, medicine, pediatrics) : 21, ward B (medicine) : 5, ward C (sanatorium) : 1, ward. D (orthopedics, ophthalmology, medicine) : 1) and 4 outpatients of urology, 33 strains of Pseudornonas aeruginosa that was tolerant to all examined antibiotics including Carbapenems were detected. 24 hospitalized patients except for 4 patients of surgery had all continuous urinary catheterization and 25 strains of MDRP were gained in their urines. The patients in whose urines MDRP was detected first at ward A, B, D have had urological treatments including urethral catheterization at dispensary before admission to each ward. DNA analysis of these MDRP strains with pulsed-field gel electrophoresis revealed an almost similar pattern of phoresis in 26 of 28 strains tested. However, only the patient of the ward C had no epidemiological relationship not only with urology but also with MDRP-detected patients of other wards. Furthermore, the pattern of DNA electrophoresis of this patient's strain was quite different from the others. Thus, these epidemiological findings including DNA analysis suggested that the majority of the MDRP that was detected during the outbreak had been brought in wards with outpatients who were hospitalized after being cross-contaminated with MDRP through urological treatment of urinary tract and had spread in each ward through handling of urinary catheters. On the other hands, inspection of management of urinary catheters at the wards showed that handlings of outlet tube of drainage bag and urinal using for dumping urine out of drainage bag were not adequate. So, infection control team carried out some interventions for control of catheter-associated urinary tract infection of MDRP. As a result, sterile handling of outlet tube of drainage bag was effective for subsiding of the outbreak and the infection rate of catheterassociated urinary tract infection surveillance was reduced along with diminution of MDRP detection. Therefore, it is thought that the outlet tube of drainage bag may be one of the most important sites for bacterial immigration and careful maintenance of this site is necessary for control of catheter-associated urinary tract infection.
