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

Rosenthal VD 1 , Yin R 1 , Brown EC 1 , Lee BH 2 , Rodrigues C 3 , Myatra SN 4 Show all authors , Kharbanda M 5 , Rajhans P 6 , Mehta Y 7 , Todi SK 8 , Basu S 9 , Sahu S 10 , Mishra SB 11 , Chawla R 12 , Nair PK 13 , Arjun R 14 , Singla D 15 , Sandhu K 16 , Palaniswamy V 17 , Bhakta A 18 , Nor MM 19 , Chian-Wern T 20 , Bat-Erdene I 21 , Acharya SP 22 , Ikram A 23 , Tumu N 24 , Tao L 25 , Alvarez GA 26 , Valderrama-Beltran SL 27 , Jiménez-Alvarez LF 28 , Henao-Rodas CM 29 , Gomez K 30 , Aguilar-Moreno LA 31 , Cano-Medina YA 32 , Zuniga-Chavarria MA 33 , Aguirre-Avalos G 34 , Sassoe-Gonzalez A 35 , Aleman-Bocanegra MC 36 , Hernandez-Chena BE 37 , Villegas-Mota MI 38 , Aguilar-de-Moros D 39 , Castañeda-Sabogal A 40 , Medeiros EA 41 , Dueñas L 42 , Carreazo NY 43 , Salgado E 44 , Abdulaziz-Alkhawaja S 45 , Agha HM 46 , El-Kholy AA 47 , Daboor MA 48 , Guclu E 49 , Dursun O 50 , Koksal I 51 , Havan M 52 , Ozturk-Deniz SS 53 , Yildizdas D 54 , Okulu E 55 , Omar AA 56 , Memish ZA 57 , Janc J 58 , Hlinkova S 59 , Duszynska W 60 , Horhat-Florin G 61 , Raka L 62 , Petrov MM 63 , Jin Z 1

Affiliations 

  • 1 Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
  • 2 University of Miami, Miami, Florida, United States
  • 3 Department of Microbiology, Pd Hinduja National Hospital and Medical Research Centre, Mumbai, India
  • 4 Department of Anesthesiology, Critical Care and Pain, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, India
  • 5 Department of Critical Care, Desun Hospital, Kolkata, India
  • 6 Deenanath Mangeshkar Hospital and Research Center Erandwane Pune, Pune, India
  • 7 Department of Critical Care and Anesthesiology, Medanta the Medicity, Haryana, India
  • 8 Department of Critical Care, Advanced Medicare Research Institute Hospitals, Kolkata, India
  • 9 Advanced Medicare Research Institute Mukundapur Unit, Kolkata, India
  • 10 Apollo Hospital Bhubaneswar, Bhubaneswar, India
  • 11 IMS and SUM Hospital, Bhubaneswar, India
  • 12 Department of Critical Care, Indraprastha Apollo Hospitals, New Delhi, India
  • 13 Holy Spirit Hospital, Mumbai, India
  • 14 Department of Critical Care, Kerala Institute of Medical Sciences Health, Trivandrum, India
  • 15 Maharaja Agrasen Hospital, New Delhi, India
  • 16 Department of Critical Care, Max Super Speciality Hospital Saket Delhi, New Delhi, India
  • 17 Mahatma Gandhi Hospital, Jaipur, India
  • 18 Department of Pediatric Intensive Care, University Malaya Medical Centre, Kuala Lumpur, Malaysia
  • 19 Department of Anesthesia and Critical Care, International Islamic University Malaysia, Kuantan Pahang, Malaysia
  • 20 Department of Critical Care, Universiti Kebangsaan Malaysia Specialist Children's Hospital, Kuala Lumpur, Malaysia
  • 21 Intermed Hospital, Ulaanbaatar, Mongolia
  • 22 Grande International Hospital, Kathmandu, Nepal
  • 23 Armed Forces Institute of Urology, Rawalpindi, Pakistan
  • 24 Port Moresby General Hospital, Port Moresby, Papua New Guinea
  • 25 Department of Pneumonology, Zhongshan Hospital, Fudan University, Shanghai, China
  • 26 Instituto Central De Medicina, Provincia de Buenos Aires, La Plata, Argentina
  • 27 Pontificia Universidad Javeriana Hospital Universitario San Ignacio, Bogota, Colombia
  • 28 Clinica Universitaria Colombia, Bogota, Colombia
  • 29 Fundacion Hospital San Jose De Buga, Guadalajara De Buga, Colombia
  • 30 Clinica Sebastian de Belalcazar, Cali, Colombia
  • 31 Clinica Infantil Santa María del Lago, Bogota, Colombia
  • 32 Instituto Del Corazon De Bucaramanga Sede Bogota, Bogota, Colombia
  • 33 Hospital Clinica Biblica, San Jose de Costa Rica, Costa Rica
  • 34 Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
  • 35 Hospital Regional de Alta Especialidad Ixtapaluca, Ixtapaluca, Mexico
  • 36 Hospital San Jose TecSalud, Monterrey, Nuevo Leon, Mexico
  • 37 Hospital General Regional 6 de Ciudad Madero, Madero, Mexico
  • 38 Instituto Nacional de Perinatología, Mexico DF, Mexico
  • 39 Hospital del Niño Dr José Renán Esquivel, Panama, Panama
  • 40 Hospital Victor Lazarte Echegaray, Trujillo, Peru
  • 41 Hospital Sao Paulo, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
  • 42 Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
  • 43 Universidad Peruana de Ciencias Aplicadas, Hospital de Emergencias Pediatricas, Lima, Peru
  • 44 Hospital Marie Curie, Quito, Ecuador
  • 45 Salmaniya Medical Center, Manama, Bahrain
  • 46 Cairo University Specialized Pediatric Hospital, Cairo, Egypt
  • 47 Cairo University, Dar Alfouad Hospital, 6th of October City, Egypt
  • 48 King Hussein Cancer Center, Amman, Jordan
  • 49 Sakarya University Training and Research Hospital, Sakarya, Turkey
  • 50 Akdeniz University Medical School, Antalya, Turkey
  • 51 Karadeniz Technical University School of Medicine, Trabzon, Turkey
  • 52 Ankara University Faculty of Medicine, Ankara, Turkey
  • 53 Pamukkale University Hospital, Denizli, Turkey
  • 54 Balcali Hospital Pediatric Intensive Care Unit, Adana, Turkey
  • 55 Ankara University Faculty of Medicine Childrens Hospital NICU, Ankara, Turkey
  • 56 Infection Control Directorate. Ministry of Health, Kuwait City, Kuwait
  • 57 King Saud Medical City, Ministry of Health, Riyadh, the Kingdom of Saudi Arabia
  • 58 4th Clinical Military Hospital, Wroclaw, Poland, Europe
  • 59 Faculty of Health, Catholic University in Ruzomberok, Central Military Hospital Ruzomberok, Ruzomberok, Slovakia
  • 60 Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland
  • 61 University of Medicine and Pharmacy Victor Babes Timisoara Emergency Clinical County Hospital Romania, Timisoara, Romania
  • 62 National Institute For Public Health, Prishtina, Kosovo
  • 63 Department of Microbiology, Faculty of Pharmacy, Medical University of Plovdiv, Bulgaria
Infect Control Hosp Epidemiol, 2024 May;45(5):567-575.
PMID: 38173347 DOI: 10.1017/ice.2023.215

Abstract

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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