Bacteriological Profile of Urine of postoperative Patients Undergone Open Heart Surgery at Shahid Gangalal National Heart Centre, Nepal

Abstract

Cardiac surgery is associated with high rate of postoperative complications in cludingrenal dysfunction. Persons with asymptomatic bacteriuria are at increased risk of developing symptomatic urinary tract infection and other complications.This study was performed in the laboratory of Shahid Gangalal National Heart Centre (SGNHC),Bansbari, from March to September, 2008 that included 151 midstream urine samples from postoperative patients who had undergone open heart surgery. The samples were processed for culture by semi quantitative standard loop method. Identification of thes ignificant isolates was done by standard microbiological techniques and antibiotic susceptibility testing was done by Kirby Bauer disc diffusion method.The prevalence of significant bacteriuria was 11.92%among postoperative patients who had under goneopen heart surgery.Out of 18 significant bacteriuric cases, 17 were asymptomatic.Females had higher percentage of significant bacteriuria than males, however, was statistically insignificant (p=0.22). Significant bacteriuria was higher among valve surgery cases 15.91% (14/88) followed by vascular surgery 10.52 % (2/19) and congenital 5.40% (2/37). The six different bacterial species isolated wereEscherichiacoli (44.44%), Klebsiella pneumoniae (16.67%), Acinetobacter spp. (11.11%),Staphylococcus aureus(11.11%), Enterococcus spp. (11.11%) and Pseudomonasaeruginosa(5.56%). All the gram negative isolates were sensitive to amikacin and most(92.31%) were resistant to ampicillin. All the gram positive isolates were sensitive tovancomycin and resistant to ampicillin, ciprofloxacin, cotrimoxazole, cloxacillin,cephalexin and erythromycin. Multidrug resistance (MDR) was 87.50 %( 7/8) inEscherichia coli and 100% inKlebsiella pneumoniae(3/3),Acinetobacter spp. (2/2),Pseudomonas aeruginosa(1/1), Staphylococcus aureus(2/2) andEnterococcus spp.(2/2).A significant number of urinary isolates from postoperative cardiac patients wereMDR which can result in unavoidable treatment failure. Therefore, the rationale use ofantibiotics is suggested. Keywords: Asymptomatic bacteriuria, Midstream urine, MDR strains, Postoperativepatients