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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

Published online by Cambridge University Press:  04 January 2024

Victor Daniel Rosenthal*
Affiliation:
Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States International Nosocomial Infection Control Consortium, INICC Foundation, Miami, Florida, United States
Ruijie Yin
Affiliation:
Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
Eric Christopher Brown
Affiliation:
Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
Brandon Hochahn Lee
Affiliation:
University of Miami, Miami, Florida, United States
Camilla Rodrigues
Affiliation:
Department of Microbiology, Pd Hinduja National Hospital and Medical Research Centre, Mumbai, India
Sheila Nainan Myatra
Affiliation:
Department of Anesthesiology, Critical Care and Pain, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, India
Mohit Kharbanda
Affiliation:
Department of Critical Care, Desun Hospital, Kolkata, India
Prasad Rajhans
Affiliation:
Deenanath Mangeshkar Hospital and Research Center Erandwane Pune, Pune, India
Yatin Mehta
Affiliation:
Department of Critical Care and Anesthesiology, Medanta the Medicity, Haryana, India
Subhash Kumar Todi
Affiliation:
Department of Critical Care, Advanced Medicare Research Institute Hospitals, Kolkata, India
Sushmita Basu
Affiliation:
Advanced Medicare Research Institute Mukundapur Unit, Kolkata, India
Suneeta Sahu
Affiliation:
Apollo Hospital Bhubaneswar, Bhubaneswar, India
Shakti Bedanta Mishra
Affiliation:
IMS and SUM Hospital, Bhubaneswar, India
Rajesh Chawla
Affiliation:
Department of Critical Care, Indraprastha Apollo Hospitals, New Delhi, India
Pravin K. Nair
Affiliation:
Holy Spirit Hospital, Mumbai, India
Rajalakshmi Arjun
Affiliation:
Department of Critical Care, Kerala Institute of Medical Sciences Health, Trivandrum, India
Deepak Singla
Affiliation:
Maharaja Agrasen Hospital, New Delhi, India
Kavita Sandhu
Affiliation:
Department of Critical Care, Max Super Speciality Hospital Saket Delhi, New Delhi, India
Vijayanand Palaniswamy
Affiliation:
Mahatma Gandhi Hospital, Jaipur, India
Arpita Bhakta
Affiliation:
Department of Pediatric Intensive Care, University Malaya Medical Centre, Kuala Lumpur, Malaysia
Mohd-Basri Mat Nor
Affiliation:
Department of Anesthesia and Critical Care, International Islamic University Malaysia, Kuantan Pahang, Malaysia
Tai Chian-Wern
Affiliation:
Department of Critical Care, Universiti Kebangsaan Malaysia Specialist Children’s Hospital, Kuala Lumpur, Malaysia
Ider Bat-Erdene
Affiliation:
Intermed Hospital, Ulaanbaatar, Mongolia
Subhash P. Acharya
Affiliation:
Grande International Hospital, Kathmandu, Nepal
Aamer Ikram
Affiliation:
Armed Forces Institute of Urology, Rawalpindi, Pakistan
Nellie Tumu
Affiliation:
Port Moresby General Hospital, Port Moresby, Papua New Guinea
Lili Tao
Affiliation:
Department of Pneumonology, Zhongshan Hospital, Fudan University, Shanghai, China
Gustavo Andres Alvarez
Affiliation:
Instituto Central De Medicina, Provincia de Buenos Aires, La Plata, Argentina
Sandra Liliana Valderrama-Beltran
Affiliation:
Pontificia Universidad Javeriana Hospital Universitario San Ignacio, Bogota, Colombia
Luisa Fernanda Jiménez-Alvarez
Affiliation:
Clinica Universitaria Colombia, Bogota, Colombia
Claudia Milena Henao-Rodas
Affiliation:
Fundacion Hospital San Jose De Buga, Guadalajara De Buga, Colombia
Katherine Gomez
Affiliation:
Clinica Sebastian de Belalcazar, Cali, Colombia
Lina Alejandra Aguilar-Moreno
Affiliation:
Clinica Infantil Santa María del Lago, Bogota, Colombia
Yuliana Andrea Cano-Medina
Affiliation:
Instituto Del Corazon De Bucaramanga Sede Bogota, Bogota, Colombia
Maria Adelia Zuniga-Chavarria
Affiliation:
Hospital Clinica Biblica, San Jose de Costa Rica, Costa Rica
Guadalupe Aguirre-Avalos
Affiliation:
Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
Alejandro Sassoe-Gonzalez
Affiliation:
Hospital Regional de Alta Especialidad Ixtapaluca, Ixtapaluca, Mexico
Mary Cruz Aleman-Bocanegra
Affiliation:
Hospital San Jose TecSalud, Monterrey, Nuevo Leon, Mexico
Blanca Estela Hernandez-Chena
Affiliation:
Hospital General Regional 6 de Ciudad Madero, Madero, Mexico
Maria Isabel Villegas-Mota
Affiliation:
Instituto Nacional de Perinatología, Mexico DF, Mexico
Daisy Aguilar-de-Moros
Affiliation:
Hospital del Niño Dr José Renán Esquivel, Panama, Panama
Alex Castañeda-Sabogal
Affiliation:
Hospital Victor Lazarte Echegaray, Trujillo, Peru
Eduardo Alexandrino Medeiros
Affiliation:
Hospital Sao Paulo, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
Lourdes Dueñas
Affiliation:
Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
Nilton Yhuri Carreazo
Affiliation:
Universidad Peruana de Ciencias Aplicadas, Hospital de Emergencias Pediatricas, Lima, Peru
Estuardo Salgado
Affiliation:
Hospital Marie Curie, Quito, Ecuador
Safaa Abdulaziz-Alkhawaja
Affiliation:
Salmaniya Medical Center, Manama, Bahrain
Hala Mounir Agha
Affiliation:
Cairo University Specialized Pediatric Hospital, Cairo, Egypt
Amani Ali El-Kholy
Affiliation:
Cairo University, Dar Alfouad Hospital, 6th of October City, Egypt
Mohammad Abdellatif Daboor
Affiliation:
King Hussein Cancer Center, Amman, Jordan
Ertugrul Guclu
Affiliation:
Sakarya University Training and Research Hospital, Sakarya, Turkey
Oguz Dursun
Affiliation:
Akdeniz University Medical School, Antalya, Turkey
Iftihar Koksal
Affiliation:
Karadeniz Technical University School of Medicine, Trabzon, Turkey
Merve Havan
Affiliation:
Ankara University Faculty of Medicine, Ankara, Turkey
Suna Secil Ozturk-Deniz
Affiliation:
Pamukkale University Hospital, Denizli, Turkey
Dincer Yildizdas
Affiliation:
Balcali Hospital Pediatric Intensive Care Unit, Adana, Turkey
Emel Okulu
Affiliation:
Ankara University Faculty of Medicine Childrens Hospital NICU, Ankara, Turkey
Abeer Aly Omar
Affiliation:
Infection Control Directorate. Ministry of Health, Kuwait City, Kuwait
Ziad A. Memish
Affiliation:
King Saud Medical City, Ministry of Health, Riyadh, the Kingdom of Saudi Arabia
Jarosław Janc
Affiliation:
4th Clinical Military Hospital, Wroclaw, Poland, Europe
Sona Hlinkova
Affiliation:
Faculty of Health, Catholic University in Ruzomberok, Central Military Hospital Ruzomberok, Ruzomberok, Slovakia
Wieslawa Duszynska
Affiliation:
Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland
George Horhat-Florin
Affiliation:
University of Medicine and Pharmacy Victor Babes Timisoara Emergency Clinical County Hospital Romania, Timisoara, Romania
Lul Raka
Affiliation:
National Institute For Public Health, Prishtina, Kosovo
Michael M. Petrov
Affiliation:
Department of Microbiology, Faculty of Pharmacy, Medical University of Plovdiv, Bulgaria
Zhilin Jin
Affiliation:
Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
*
Author for correspondence: Victor D. Rosenthal, MD, PhD, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Floor 9, Office 912, Miami, FL 33136, Emails: vdr21@miami.edu or vic@inicc.org

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.

Type
Original Article
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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