Characteristics and outcomes of ICU patients with bacterial catheter-associated urinary tract infection

Background Catheter-associated urinary tract infection (CAUTI) is a common device-associated complication in intensive care units (ICUs). Objective To characterize bacterial CAUTI in an ICU cohort and identify independent associations with demographic and clinical characteristics available at or before ICU admission. Methods This single-center retrospective cohort included 3326 index ICU admissions from January 2017 through June 2023. After exclusion of 95 fungal-only clinically classified cases, 3231 records remained. Bacterial CAUTI required compatible clinical findings, at least 48 hours of catheter exposure, and ≥10³ CFU/mL of one or two bacterial species. All patients were catheterized throughout the observed ICU stay. The primary logistic model included only admission characteristics; ICU stay/catheter duration was descriptive because exact CAUTI onset dates were unavailable. Skewed biomarkers were summarized with medians, interquartile ranges, and Mann-Whitney tests. Results Bacterial CAUTI occurred in 301 patients (9.3%; 95% CI 8.4%−10.4%). Mean ICU stay/catheter duration was 28.3 versus 13.6 days (difference 14.8 days; 95% CI 11.7–17.8), but duration was not interpreted as an independent risk estimate. Mortality was 49.2% versus 45.9% (risk difference 3.2 percentage points; 95% CI −2.7 to 9.1), and bacterial CAUTI was not associated with death after adjustment for admission characteristics (OR 0.95; 95% CI 0.75–1.22). Female sex (OR 1.48; 95% CI 1.15–1.90), obesity (OR 1.62; 95% CI 1.20–2.19), and COVID-19 (OR 2.16; 95% CI 1.55–3.00) were independently associated. At least one resistance phenotype was recorded in 200 patients (66.4%). Conclusions Bacterial CAUTI was associated with a distinct admission profile and longer observed ICU stay/catheter exposure, although causal direction could not be determined. It was not associated with adjusted in-hospital mortality.