Uro-pathogenic Profile and Risk Factors for Catheter-associated Urinary Tract Infection (CAUTI) in the Medical Intensive Care Unit of a Tertiary Care Hospital

BACKGROUND: Catheter-associated urinary tract infections (CAUTIs) are among the most common nosocomial infections, and implies increased morbidity and higher treatment costs. This study aims to assess risk factors, causative agents and anti-microbial susceptibilities of CAUTI in MICU patients which can help in formulating appropriate preventative strategies and optimization of empirical antibiotic guidelines. METHODS: After approval from the Institutional Ethics Committee, this prospective cohort study was carried out at the Medical Intensive Unit of a tertiary care teaching medical institute from October 2022 to April 2023. Participants (n = 148) were aged ≥ 18 years old having indwelling urinary catheters minimal for the recent 48 hours. Patients who developed UTI within 48 hours of hospitalization to MICU or had cystitis were excluded. CAUTI was diagnosed as per CDC criteria. Univariate and multiple logistic regression analysis was performed to determine the association between the risk factors and the prevalence of CAUTI. The odds ratio and 95% confidence interval (CI) were calculated to estimate the strength of the association. A p-value of < 0.05 was considered statistically significant. RESULTS: Total catheterizations done in the study period were 1304, out of which 148 developed CAUTI. The incidence of CAUTI was 11.35%. The CAUTI rate was 91.72 CAUTI cases per 1000 catheter days. The study found that Diabetes mellitus (OR = 2.69 95% CI=1.87 to 3.87; p < 0.0001) and duration of catheterization (OR = 8.92 95% CI = 1.02–11.83; p = 0.002) were significant factors related to CAUTI. Female gender (p = 0.078) and hypertension (p = 0.054) were found to have a trend towards being risk factors but did not reach statistical significance. The most common uro-pathogens identified in CAUTI patients were Escherichia coli (46%), Klebsiella pneumoniae (18%), and Enterococcus faecalis (14%). CONCLUSION: Gram-negative bacilli Escherichia coli was the most common etiological agent in CAUTI. Diabetes mellitus and longer duration of the catheter in situ were risk factors for CAUTI.