Antibiogram Audit of Catheter-associated Uropathogenic Isolates in University of Calabar Teaching Hospital, Calabar, Nigeria: Advocating Laboratory-based Prescription Practices

Main Article Content

G. I. Ogban
A. A. Iwuafor
U. E. Emanghe
S. N. Ushie
E. M. Bisong
S. N. Okonkwo


Background: The most important risk factor to developing UTI is the presence of an indwelling urethral catheter. Eighty percent of nosocomial UTI was reported to be caused by urethral catheterization. UTIs in health care institutions and in those with frequent antibiotic exposures were frequently caused by multi- drug resistant pathogens. This study sought to determined the antibiogram of isolates from catheterized patients with UTIs with a view to establishing if there were justifications for empiric treatment of this condition in the study area in the absence of quality antibiotic formulary.

Materials and Methods: Interviewer administered questionnaires were used to collect socio-demographic data. Specimens were cultured on 5% sheep blood agar (SBA), MacConkey and sabouraud dextrose agar plates and incubated at 37°c for 24 hours in ambient air. Significant bacteriuria was determined on growths from SBA. Growths were identified using standard biochemical techniques.

Results: The study established 74.3% (52) prevalence of CAUTIs amongst catheterized patients in the study area with 29 (41.4%) female dominance. Imipenem (93.9%) recorded the highest percentage susceptibility, followed by Amikacin (91.8%) and Piperacillin/ tazobactam (88.8%). E. coli 17(32.7%) was the dominant isolate. Extended spectrum β-lctamase prevalence was 23(44.2%) and MRSA 2(3.8%). There was significant statistical relation between ESBL production and resistance to other classes of antibiotics.

Conclusion: There is high percentage prevalence of multidrug resistance (MDR) among isolates of CAUTIs in the study area. We therefore advocate laboratory based prescription practice and de-emphasized empiric treatment pending when there would be in a quality drug formulary founded on regular resistance surveillance.

Antimicrobial audit, catheter-associated, prescription practice, empiric treatment.

Article Details

How to Cite
Ogban, G. I., Iwuafor, A. A., Emanghe, U. E., Ushie, S. N., Bisong, E. M., & Okonkwo, S. N. (2020). Antibiogram Audit of Catheter-associated Uropathogenic Isolates in University of Calabar Teaching Hospital, Calabar, Nigeria: Advocating Laboratory-based Prescription Practices. Asian Journal of Medicine and Health, 18(10), 18-27.
Original Research Article


Chinoweth CE, Saint S. Urinary tract infections. Infect Dis Clin North Am. 2011;25:1-15.

Hooton TM, Bradley SF, Cardenas DD, et al. Diagnosis, prevention and treatment of catheter associated urinary tract infection in adults. 2009 international clinical guideline from the infectious diseases society of America. Clin. Infect. Dis. 2010; 50(5):625 -63.

Weinstein JW, Mazon D, Pantelick E, Reagan-Ciricione P, Dembry LM, Hierholzer WJ. A decade of prevalence surveys in a tertiary care centre: Trends in nosocomial infection rates, device utilization and patience acuity. Infect. Control Hosp. Epidemiology. 1999;20:543-548.

Evelyn LO, Lindsay Nicolle, David Classen, Kathleen M, et al. Strategies to prevent catheter – associated urinary tract infections in acute care hospitals. Infect Contr and Epid. 2008;9(1).

Umesh S. Kamat, Agnelo Ferreira, Dilip Amonkar, Dilip D. Motghare, Manof S. Kulkarni. Epidemiology of hospital acquired urinary tract infections in a medical college hospital in Goa. Indian J. Urol. 2009;25(1): 76-80.

Banadio M, Meini M, Spitaleri P, Gigli C. Current microbiological and clinical aspects of urinary tract infections. Eur. Urol. 2001;40:439-445.

Ashkenazi S, Even TS, Samra Z, Dinari G. Uropathogens of various populations and their antibiotic susceptibility. Paediatr. Infect. Dis. 1991;10:742-46.

Gruneberg RN. Changes in urinary pathogens and their antibiotic sensitivities. 1971-9192. J. Atimcrob. Chemother. 1994; (suppl A ):1-8.

Ademoye AA, Gbadagesin RA, Onyemenem TN, Ekweozor CC. Urinary tract pathogens and antimicrobial sensitivity pattern in children in Ibadan, Nigeria. Ann. Trop. Paediatr. 1994;14(4): 271-274.

Kanj SS, Kanafani SA. Current concept in antimicrobial therapy against resistant gram negative organisms, extended beta-lactamase producing Enterobacteriaceae and multi- drug resistant Pseudomonas aeruginosa. Mayor Clin. Proc. 2011;86(3): 250-9.

Paterson DL,Bonomo RA. Extended spectrum β-lactamases: A clinical udate. Clin Microbiol.Rev. 2005;18:657-86.

Abdul H. Siddiqui Janak Koirala. Methicillin resistant Stsphylococus aureus (MRSA). 2020. Acessed Sept. 17, 2020.

Paul A. Tambyah, Denis G. Maki. Catheter associated urinary tract infection is rarely symptomatic. Arch. Intern. Med. 2000;160: 678-682.

Stamm WE, Urinary infections. In: Benett JV, Brachman PS, editors. Hospital infections 4th ed. Philadelphia Lipincott-Raven Publishers. 1998;447-85.

Stamm WE. Catheter associated urinary tract infections: Epidemiology, pathogenesis and prevention. Am J. med. 1991;91:65-71.

Turck M, Stamm WE. Nosocomial infections of urinary tract. Am. J. Med. 1981;70:651-4.

Platt R, Polk F, Murdock B, Rosner B. Mortality associated with urinary tract infections. N. Engl J. Med. 1982;307:637-41.

Manual of clinical microbiology, 5th ed. Washington DC: American society for clinical microbiology; 1991.

Gaynes RP, Horan TC. Surveillance of nosocomial infections. In: Marhall GC, editor. Hospital epidemiology and infection control. 2nd ed. Philadelphia: Linpincott Williams and Wilkins. 2005.199:1285-319.

Clincal laboratory standard institute: Performing standard for antimicrobial disc susceptibility test. Approved standard- 10th ed. CLSI Document. 2009;29(3):M100-S19.

Kalsi J, Arya M, Wilson P, Mundy A. Hospital-acquired urinary tract infection. Int J Clin Pract. 2003;57(5):388–391.

Maharjan G, Khadka P, Shilpakar GS, Chapagain G, Dhungana GR. Catheter –associated urinary tract infection and obstinate biofilm producers. Canadian Journal of Infectious Diseases and Medical Microbiology; 2018. Available:https//

Nicolle LE. Catheter associated urinary tract infections. Antimicrobial resistance and Infection Control. 2014;3(1):1-8.

Hooton TM, Bradley SF, Cardenas DD, Colgan R, Geerlings SE, Rice JC, Saint S, Schaeffer AJ, Tambayh PA, Tenke P, Nicolle LE. Infectious diseases society of America. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 international clinical practice guidelines from the infectious diseases society of America. Clin Infect Dis. 2010;50(5):625–663.

Tenke P, Kovacs B, Bjerklund Johansen TE, Matsumoto T, Tambyah PA, Naber KG. European and Asian guidelines on management and prevention of catheter-associated urinary tract infections. Int J Antimicrob Agents. 2008; 31(1):68–78.

Mossain MD, Kabir Md, S. Antibiotic resistance pattern of uropathogens isolated from catheterized and non-catheterized patients in Dhaka, Bangladesh. Tzu Hhi Medical Journal. 2014;127-131.

Ushie SN, Oyedeji KS, Ogban GI, Ushie DE, Nwaokorie FO, Odeniyi OM, Ola-Bello OI, Okorafor KS, Ezeador CO. Molecular epidemiology of extended spectrum β-lactamases producing Escherichia coli and Klebsiella species in catheterized patients. European journal of Medical and Health Sciences. 2020;2(4). Available:https// 2020.2.4.326

Spellberg B, Blaser M, et al. Combating antimicrobial resistance: Policy recommen-dations to save lives. Clin Infect Dis. 2011; 52(5):397–428.

Arnoldo L, Migliavacca R, Regattin L, Annibale R , Laura Pagani, Nucleo E, et al. Prevalence of urinary colonization be extended spectrum β –lactamases Enterobacteriaceae among catheterized in-patients in Italian long term care facilities. BMC Infect. Dis. 2013;13:124. Available:https//

Ogban GI, Oduyebo OO, Fajolu IB, Oshun PO, Emanghe UE, Iwuafor AA, Simon N. Ushie SN, Agan TU. Maternal vagina colonization with extended spectrum Β-lactamase producing Enterobacteriaceae in pregnancy: Any correlation with ESBL-positive early onset neonatal sepsis? IOSR Journal of Dental and Medical Sciences. 2020; 19(2):13-22.

Viswanathan R, Sigh K, Basu S, Chatterjee S, Sardar S, Isaacs D. Multi-drug resistant Gram negative Bacilli causing early neonatal sepsis in India. Arch Dis Child Fetal Neonatal Ed. 2012; 97:182–7.

Morosini M, García-Castillo M, Coque T, Valverde A, Novais A, Loza E, et al. Antibiotic co-resistance in extended-spectrum- β- lactamase- producing Enterobacteriaceae and In vitro activity of tigecycline. Antimicrob Agents Chemother. 2006;50(8):2695–9.