Catheter-Associated Urinary Tract Infection (CAUTI) in the NeuroICU: Identification of Risk Factors and Time-to-CAUTI Using a Case-Control Design

Incidence Risk Factors and Drug Resistance Patterns of Bacterial Isolates in Patients with Catheter-associated Urinary Tract Infections

Introduction

Catheter-associated urinary tract infections (CAUTIs) account for 80% of nosocomial UTIs and 40% of hospital-acquired infections, making them the most common healthcare-associated infections globally. Despite the rise of quinolone-resistant Escherichia coli and extended-spectrum β-lactamase-producing gram-negative bacteria, fluoroquinolones remain a common empirical treatment. Understanding antimicrobial resistance (AMR) associated with CAUTIs is critical.

Methods

A prospective observational study was conducted from November 2023 to July 2024 at Deenanath Mangeshkar Hospital, Maharashtra, India. The study included catheterized patients in the intensive care unit (ICU) with a duration of over 48 hours showing UTI symptoms, including fever, suprapubic discomfort, urgency, or dysuria. Among 80 patients (mean age 56.75 ± 23.65 years; 53% male), bacterial isolates, resistance patterns, and risk factors were analyzed.

Results

Catheter-associated UTIs developed in 59 patients (73.75% prevalence; 83.1 per 1,000 catheter days). Patients aged over 60, hospitalized for more than 10 days, or with comorbidities like diabetes (51.3%), hypertension (HTN) (37.5%), or chronic kidney disease (10%) were at higher risk. Escherichia coli and Klebsiella pneumoniae were the most common pathogens (34.14%), with gram-negative bacilli constituting 84.74% of isolates. Candida species, particularly C. tropicalis (34.78%) and C. auris (26%), were also significant.

Conclusion

This study identifies E. coli, K. pneumoniae, and Candida species as major CAUTI pathogens, with substantial multidrug resistance among gram-negative bacteria. Regular AMR surveillance and targeted infection control strategies are essential to combat CAUTI-related challenges and improve clinical outcomes.

How to cite this article

Jha T, Khaparde M, Parkhe TS, Purandare B, Lavate R. Incidence Risk Factors and Drug Resistance Patterns of Bacterial Isolates in Patients with Catheter-associated Urinary Tract Infections. Indian J Crit Care Med 2025;29(4):338-344.

1,4-Bis(2-hydroxyethyl)piperazine-derived water-dispersible and antibacterial polyurethane coatings for medical catheters

To prolong usage and mitigate infections associated with bacterial colonization on medical catheters, the development of water-dispersible polyurethane (PU) coatings with bactericidal properties is desirable. With this objective, we have formulated polyurethane coatings that exhibit both antibacterial activity and water dispersibility. A piperazine-based diol, 1,4-bis(2-hydroxyethyl)piperazine (HEPZ), was synthesized and used as a chain extender in PU synthesis. The PUs were prepared using hexamethylene diisocyanate (HDI), 4,4'-methylene diphenyl diisocyanate (MDI), polyethylene glycol (PEG600), and polypropylene glycol (PPG400), resulting in a series of polyurethanes (PU1-PU4). MDI-containing PUs showed superior tensile strength (3.2-3.6 MPa) and elongation (67-70%) attributable to their higher aromatic content. The PEG600-containing PUs (PU1 and PU3) were alkylated using methyl iodide (MeI) to varying degrees whereby a significant reduction in contact angle from ∼82° to ∼62° was observed, indicating enhanced hydrophilicity. MPU3-D with 72.5% methylation demonstrated the most stable water dispersion with a particle size of ∼190.8 nm and a zeta potential of +49.0 mV. In vitro cytocompatibility studies further revealed that methylated PU3 exhibited higher compatibility (80-90%) compared to methylated PU1 (30-40%). The hemolysis test showed the non-hemolytic behavior of MPU3-D films with a % hemolysis of 0.4 ± (0.2)% making it suitable for coating on medical devices. Additionally, MPU3-D films also demonstrated antibacterial activity against Gram-negative (E. coli) and Gram-positive (S. aureus) bacteria, with zones of inhibition measuring 7 mm and 8 mm, respectively. Also, water-dispersible MPU3-D-based coatings with a hardness of ∼75 A and a thickness of ∼17 μm (as observed through FESEM) showed strong adhesion to PVC catheters, exhibiting an adhesion strength of 4B rating. Our results suggest that water-dispersible polyurethane coatings with antibacterial properties are promising materials to reduce catheter-associated infections and enhance patient care.

Short-term urinary catheter usage in endoscopic skull base surgery and impact on urinary tract infection and reconstructive outcomes

Objectives

Hospital-acquired catheter-associated urinary tract infections (UTIs) have been regarded as preventable adverse events, yet their risk in endoscopic skull base surgery (ESBS) has not been well described despite common use. We determine the incidence of UTI following ESBS and identify contributing clinical factors.

Methods

Retrospective review was conducted for a cohort of 229 consecutive adult patients who underwent endoscopic endonasal surgery for treatment of any skull base pathology between July 2018 and June 2022 at a tertiary academic skull base surgery program. Postoperative UTI comprised the primary outcome. Independent variables included patient demographics, use and length of urinary catheterization, and pre-existing genitourinary conditions.

Results

Nosocomial UTIs were identified in 1.3% (3/229) of patients, occurring on postoperative days 2, 9, and 14, respectively; all were catheter-associated. Overall, 86.0% (197/229) of patients received urinary catheters (mean duration 2.2 ± 1.8 days). Compared to those without, patients with UTI were older (70.0 ± 15.4 vs. 52.2 ± 16.8 years, p = 0.034), had lengthier stays (94.7 ± 126.8 vs. 5.9 ± 8.4 days, p < 0.001), and had prolonged catheterizations (9.3 ± 5.5 vs. 2.1 ± 1.5 days, p < 0.001). Preoperative genitourinary conditions were also associated with UTI development, namely, chronic urinary retention/obstruction (66.7% vs. 4.0%, p = 0.006), urinary incontinence (66.7% vs. 6.2%, p = 0.013), prostate disease (100.0% vs. 17.8%, p = 0.035), and renal dysfunction (100.0% vs. 9.7%, p = 0.001). Among intraoperative cerebrospinal fluid leak patients, postoperative CSF leak incidence was not associated with catheter use versus nonuse (3.3% vs. 12.5%, p = 0.276).

Conclusion

Although UTIs are uncommon in ESBS patients, advanced age, length of stay, duration of indwelling urinary catheterization, and comorbid genitourinary conditions may elevate risk.

Preparation and properties of silver-carrying nano-titanium dioxide antimicrobial agents and silicone composite

The characteristics of dopamine self-polymerization were used to cover the nano-titanium dioxide (TiO2) surface and produce nano-titanium dioxide-polydopamine (TiO2-PDA). The reducing nature of dopamine was then used to reduce silver nitrate to silver elemental particles on the modified nano-titanium dioxide: The resulting TiO2-PDA-Ag nanoparticles were used as antimicrobial agents. Finally, the antibacterial agent was mixed with silicone to obtain an antibacterial silicone composite material. The composition and structure of antibacterial agents were analyzed by scanning electron microscopy, transmission electron microscopy, X-ray photoelectron energy spectroscopy, and X-ray diffraction. Microscopy and the antibacterial properties of the silicone antibacterial composites were studied as well. The TiO2-PDA-Ag antimicrobial agent had good dispersion versus nano-TiO2. The three were strongly combined with obvious characteristic peaks. The antibacterial agents were evenly dispersed in silicone, and the silicone composite has excellent antibacterial properties. Bacillus subtilis (B. subtilis) adhesion was reduced from 246 × 104 cfu/cm2 to 2 × 104 cfu/cm2, and colibacillus (E. coli) reduced from 228 × 104 cfu/cm2 leading to bacteria-free adhesion.

Efficacy of expanded periurethral cleansing in reducing catheter-associated urinary tract infection in comatose patients: a randomized controlled clinical trial

BACKGROUND

The effect of the periurethral cleansing range on catheter-associated urinary tract infection (CAUTI) occurrence remains unknown. The purpose of this study was to evaluate the efficacy of expanded periurethral cleansing for reducing CAUTI in comatose patients.

METHODS

In this randomized controlled trial, eligible patients in our hospital were enrolled and allocated randomly to the experimental group (expanded periurethral cleansing protocol; n = 225) or the control group (usual periurethral cleansing protocol; n = 221). The incidence of CAUTI on days 3, 7, and 10 after catheter insertion were compared, and the pathogen results and influencing factors were analyzed.

RESULTS

The incidences of CAUTI in the experimental and control groups on days 3, 7, and 10 were (5/225, 2.22% vs. 7/221, 3.17%, P = 0.54), (12/225, 5.33% vs. 18/221, 8.14%, P = 0.24), and (23/225, 10.22% vs. 47/221, 21.27%, P = 0.001), respectively; Escherichia coli and Candida albicans were the most common species in the two groups. The incidences of bacterial CAUTI and fungal CAUTI in the two groups were 11/225, 4.89% vs. 24/221, 10.86%, P = 0.02) and (10/225, 4.44% vs. 14/221, 6.33%, P = 0.38), respectively. The incidences of polymicrobial CAUTI in the two groups were 2/225 (0.89%) and 9/221 (4.07%), respectively (P = 0.03). The percentages of CAUTI-positive females in the two groups were 9.85% (13/132) and 29.52% (31/105), respectively (P < 0.05). The proportion of CAUTI-positive patients with diabetes in the experimental and control groups was 17.72% (14/79), which was lower than the 40.85% (29/71) in the control group (P < 0.05).

CONCLUSION

Expanded periurethral cleansing could reduce the incidence of CAUTI, especially those caused by bacteria and multiple pathogens, in comatose patients with short-term catheterization (≤ 10 days). Female patients and patients with diabetes benefit more from the expanded periurethral cleansing protocol for reducing CAUTI.

Incidence and risk factors for catheter-associated urinary tract infection in 623 intensive care units throughout 37 Asian, African, Eastern European, Latin American, and Middle Eastern nations: A multinational prospective research of INICC

OBJECTIVE

To identify urinary catheter (UC)-associated urinary tract infection (CAUTI) incidence and risk factors.

DESIGN

A prospective cohort study.

SETTING

The study was conducted across 623 ICUs of 224 hospitals in 114 cities in 37 African, Asian, Eastern European, Latin American, and Middle Eastern countries.

PARTICIPANTS

The study included 169,036 patients, hospitalized for 1,166,593 patient days.

METHODS

Data collection took place from January 1, 2014, to February 12, 2022. We identified CAUTI rates per 1,000 UC days and UC device utilization (DU) ratios stratified by country, by ICU type, by facility ownership type, by World Bank country classification by income level, and by UC type. To estimate CAUTI risk factors, we analyzed 11 variables using multiple logistic regression.

RESULTS

Participant patients acquired 2,010 CAUTIs. The pooled CAUTI rate was 2.83 per 1,000 UC days. The highest CAUTI rate was associated with the use of suprapubic catheters (3.93 CAUTIs per 1,000 UC days); with patients hospitalized in Eastern Europe (14.03) and in Asia (6.28); with patients hospitalized in trauma (7.97), neurologic (6.28), and neurosurgical ICUs (4.95); with patients hospitalized in lower-middle-income countries (3.05); and with patients in public hospitals (5.89).The following variables were independently associated with CAUTI: Age (adjusted odds ratio [aOR], 1.01; P < .0001), female sex (aOR, 1.39; P < .0001), length of stay (LOS) before CAUTI-acquisition (aOR, 1.05; P < .0001), UC DU ratio (aOR, 1.09; P < .0001), public facilities (aOR, 2.24; P < .0001), and neurologic ICUs (aOR, 11.49; P < .0001).

CONCLUSIONS

CAUTI rates are higher in patients with suprapubic catheters, in middle-income countries, in public hospitals, in trauma and neurologic ICUs, and in Eastern European and Asian facilities.Based on findings regarding risk factors for CAUTI, focus on reducing LOS and UC utilization is warranted, as well as implementing evidence-based CAUTI-prevention recommendations.

An international prospective study of INICC analyzing the incidence and risk factors for catheter-associated urinary tract infections in 235 ICUs across 8 Asian Countries

BACKGROUND

Identify urinary catheter (UC)-associated urinary tract infections (CAUTI) incidence and risk factors (RF) in 235 ICUs in 8 Asian countries: India, Malaysia, Mongolia, Nepal, Pakistan, the Philippines, Thailand, and Vietnam.

METHODS

From January 1, 2014, to February 12, 2022, we conducted a prospective cohort study. To estimate CAUTI incidence, the number of UC days was the denominator, and CAUTI was the numerator. To estimate CAUTI RFs, we analyzed 11 variables using multiple logistic regression.

RESULTS

84,920 patients hospitalized for 499,272 patient days acquired 869 CAUTIs. The pooled CAUTI rate per 1,000 UC-days was 3.08; for those using suprapubic-catheters (4.11); indwelling-catheters (2.65); trauma-ICU (10.55), neurologic-ICU (7.17), neurosurgical-ICU (5.28); in lower-middle-income countries (3.05); in upper-middle-income countries (1.71); at public-hospitals (5.98), at private-hospitals (3.09), at teaching-hospitals (2.04). The following variables were identified as CAUTI RFs: Age (adjusted odds ratio [aOR] = 1.01; 95% CI = 1.01-1.02; P < .0001); female sex (aOR = 1.39; 95% CI = 1.21-1.59; P < .0001); using suprapubic-catheter (aOR = 4.72; 95% CI = 1.69-13.21; P < .0001); length of stay before CAUTI acquisition (aOR = 1.04; 95% CI = 1.04-1.05; P < .0001); UC and device utilization-ratio (aOR = 1.07; 95% CI = 1.01-1.13; P = .02); hospitalized at trauma-ICU (aOR = 14.12; 95% CI = 4.68-42.67; P < .0001), neurologic-ICU (aOR = 14.13; 95% CI = 6.63-30.11; P < .0001), neurosurgical-ICU (aOR = 13.79; 95% CI = 6.88-27.64; P < .0001); public-facilities (aOR = 3.23; 95% CI = 2.34-4.46; P < .0001).

DISCUSSION

CAUTI rate and risk are higher for older patients, women, hospitalized at trauma-ICU, neurologic-ICU, neurosurgical-ICU, and public facilities. All of them are unlikely to change.

CONCLUSIONS

It is suggested to focus on reducing the length of stay and the Urinary catheter device utilization ratio, avoiding suprapubic catheters, and implementing evidence-based CAUTI prevention recommendations.

7295 elderly hospitalized patients with catheter-associated urinary tract infection: a case-control study

BACKGROUND

Catheter-associated urinary tract infection (CAUTI) ranks second among nosocomial infections in elderly patients after lung infections. Improper treatment can lead to death. This study analysed the risk factors, pathogen distribution, clinical characteristics and outcomes of CAUTI in elderly inpatients with a large sample size to provide evidence for clinical prevention and control.

METHODS

Based on the HIS and LIS, a case‒control study was conducted on all hospitalized patients with indwelling urinary catheters ≥ 60 years old from January 1, 2019, to December 31, 2022, and the patients were divided into the CAUTI group and the non-CAUTI group.

RESULTS

CAUTI occurred in 182 of 7295 patients, and the infection rate was 3.4/per 1000 catheter days. Urine pH ≥ 6.5, moderate dependence or severe dependence in the classification of self-care ability, age ≥ 74 years, male sex, hospitalization ≥ 14 days, indwelling urinary catheter ≥ 10 days, diabetes and malnutrition were independent risk factors for CAUTI (P < 0.05). A total of 276 strains of pathogenic bacteria were detected in urine samples of 182 CAUTI patients at different times during hospitalization. The main pathogens were gram-negative bacteria (n = 132, 47.83%), followed by gram-positive bacteria (n = 91, 32.97%) and fungi (n = 53, 19.20%). Fever, abnormal procalcitonin, positive urinary nitrite and abnormal urination function were the clinical characteristics of elderly CAUTI patients (P < 0.001). Once CAUTI occurred in elderly patients, the hospitalization days were increased by 18 days, the total hospitalization cost increased by ¥18,000, and discharge all-cause mortality increased by 2.314 times (P<0.001).

CONCLUSION

The situation of CAUTI in the elderly is not optimistic, it is easy to have a one-person multi-pathogen infection, and the proportion of fungi infection is not low. Urine pH ≥ 6.5, moderate or severe dependence on others and malnutrition were rare risk factors for elderly CAUTI in previous studies. Our study analysed the clinical characteristics of CAUTI in the elderly through a large sample size, which provided a reliable basis for its diagnosis and identified the adverse outcome of CAUTI.

Catheter-Associated Urinary Tract Infection in Neurological Intensive Care Units: A Narrative Review

Catheter-associated urinary tract infection (CAUTI) is among the most common types of healthcare-associated infection (HAI), which is associated with poor outcomes and prolonged hospitalization in critically ill patients. Previous studies have mentioned that patients admitted to neurological ICUs are at higher risk of CAUTI compared to patients in other ICU settings. This review paper aims to review studies published during the last decade that evaluated the incidence, risk factors, causative pathogens, and preventive strategies and treatment in neuro-critically ill patients.

Frailty and Neutrophil Lymphocyte Ratio as Predictors of Mortality in Patients with Catheter-Associated Urinary Tract Infections or Central Line-Associated Bloodstream Infections in the Neurosurgical Intensive Care Unit: Insights from a Retrospective Study in a Developing Country

OBJECTIVE

We aim to evaluate the role of frailty and inflammatory markers in predicting the short-term outcomes after catheter-associated urinary tract infections (CAUTI) and central line-associated bloodstream infections (CLABSI).

METHODS

Data regarding the patients' characteristics, isolates on CAUTI and CLABSI, antibiotic susceptibility, frailty (11-point Modified Frailty Index), and inflammatory markers were retrospectively collected. Their impact on the short-term outcomes was assessed using regression modeling response.

RESULTS

One hundred and one patients with CAUTI (n = 71) and CLABSI (n = 30) between January 2018 and December 2019 were included in this study. The pooled incidence rates for CAUTI were 5.50 and for CLABSI 3.58 episodes/1000 catheter-days. We observed 74.7% drug resistance in our CAUTI isolates and 93.3% in CLABSI. In the multivariate analysis, frailty (P = 0.006), neutrophil/lymphocyte ratio (NLR) (P = 0.007) and the presence of sepsis (P = 0.029) were found to be significant predictors of in-hospital mortality in CAUTI. In patients with CLABSI, frailty (P = 0.029) and NLR (P = 0.029) were found significant and along with sepsis (P = 0.069) resulted in a regression model with good accuracy in predicting mortality. The receiver operating characteristic curve showed that 11-point Modified Frailty Index and NLR as well as the regression model significantly predicted mortality with an area under the curve of 86.1%, 81.4%, and 95.4%, respectively, in CAUTI, and 70.9%, 77.8%, and 95.2%, respectively, in CLABSI.