Epidemiology and risk factors of healthcare-associated urinary tract infections: a prospective study in a Tunisian tertiary hospital

Healthcare-associated urinary tract infections (HAUTIs) represent a significant challenge to healthcare systems worldwide, contributing to patient morbidity, mortality, and increased healthcare costs. Understanding the epidemiology and risk factors associated with HAUTIs is crucial for implementing targeted prevention strategies and optimizing patient care. This study aimed to assess the incidence and characteristics of HAUTIs, as well as their associated factors, at the University Hospital Center Sahloul in Sousse, Tunisia. We conducted a longitudinal study over a three-month period at the University Hospital Center Sahloul in Sousse, Tunisia, over a 3-month period (September-November 2022). Patient data were collected daily, and HAUTIs were defined according to standardized criteria. Statistical analysis was performed to identify risk factors associated with HAUTIs. A total of 1947 patients were included, with an age median of 55 years and a male predominance. Patients were mainly hospitalized in medical and surgical departments with a median length of stay of seven days. Among our patients, 23.1% had been hospitalized in the past 6 months and 33% had a urinary catheter at the time of HAUTI diagnosis. The incidence of HAUTIs was 2.8% and 3.75% among catheterized patients, with an incidence density of 3.08 cases per 1000 hospitalization days. HAUTIs were more frequent in medical (3.9%) and surgical (1.9%) departments. The majority of HAUTIs were symptomatic, with fever being the most common sign. Urinary cultures were positive in all cases with the majority of pathogens isolated being Gram-negative bacteria (56.6%). Pathogens were resistant to antibiotics in 37.5% of the cases. Univariate analysis showed several risk factors associated with HAUTIs, while multivariate analysis showed independent risk factors including increased length of stay (p < 0.001), advanced age (p = 0.012), hospitalization method (p = 0.005), and history of neurogenic bladder (p = 0.019). Clinical improvement was observed in 72.2% of cases, and mortality was low (1.7%). HAUTIs remain a big concern, particularly in medical and surgical departments. Our study shows that prolonged hospitalization, advanced age, hospitalization method and history of neurogenic bladder are significant risk factors for HAUTIs. The high prevalence of antibiotic resistance highlights the need for antimicrobial stewardship programs in local hospitals. In order to reduce HAUTI incidence and improve quality of care, strict infection control measures must implemented, patients at risk must be detected early and catheter management must be optimized.