Risk factors and dose-response relationship of catheter-associated urinary tract infection in neurosurgical patients

Background: Catheter-associated urinary tract infection (CAUTI) is a common and preventable healthcare-associated infection, particularly in neurosurgical populations where prolonged catheter use is often unavoidable. Although the duration of catheterization is a recognized risk factor, its dose–response relationship with CAUTI risk remains underexplored. The present study aimed to identify risk factors associated with CAUTI and explore a dose–response relationship between urinary catheter days and CAUTI occurrence. Methods: A retrospective cohort study was conducted in 1975 on neurosurgical patients. A multivariable logistic regression model was used to estimate adjusted odds ratios for CAUTI. Multivariate logistic regression identified independent risk factors. Restricted cubic spline analysis was used to assess the dose-response relationship. Moreover, a nomogram was developed and internally validated. The concordance index (C-index) with 95% CI was calculated using bootstrap resampling. Results: CAUTI occurred in 10.2% of patients. Independent risk factors included age >60 years, low Karnofsky performance status (<80), diagnosis, treatment type, indication of indwelling urinary catheter, and catheter duration significantly increased CAUTI risk. The dose–response analysis showed a sharp increase in predicted CAUTI probability up to day 91, after which the slope plateaued. The nomogram demonstrated good discrimination (C-index: 0.81; 95% CI: 0.76–0.86). Conclusion: Prolonged catheterization is the strongest modifiable risk factor for CAUTI in neurosurgical patients. The developed nomogram allows individualized risk prediction and may inform catheter management protocols. Early catheter removal and stratified care should be emphasized to reduce CAUTI incidence.