An Observational Study from Northern India to Evaluate Catheter-associated Urinary Tract Infection in Medical Intensive Care Unit at a Tertiary Care Centre
Smriti Parihar, Rajni Sharma, Sulika V Kinimi, Sidhya Choudhary
Catheter-associated urinary tract infection, Healthcare-associated infection, Medical intensive care unit, Urinary tract infection
Citation Information :
Parihar S, Sharma R, Kinimi SV, Choudhary S. An Observational Study from Northern India to Evaluate Catheter-associated Urinary Tract Infection in Medical Intensive Care Unit at a Tertiary Care Centre. Indian J Crit Care Med 2023; 27 (9):642-646.
Background: Healthcare-associated infections are the leading cause of morbidity and mortality in hospitalized patients. Catheter-associated urinary tract infection (CAUTI) is a leading infection in ICU settings. This study aims to evaluate the patient and catheter-related factors contributing to the urinary tract infection as well as implementing the preventive measures ultimately curbing down the burden of healthcare-associated infections.
Material and methods: This is a hospital-based observational study conducted in Department of Microbiology, from October 2020 to September 2021. A total of 150 patients admitted to Medical Intensive Care Unit (MICU) with the indwelling urinary catheter were included. Urine samples were collected with proper aseptic precautions and processed within 2 hours of collection. Identification and antimicrobial susceptibility testing of the isolated pathogens was done as per CLSI guidelines 2019.
Results: In this study, the CAUTI rate was 9.4 per 1000 urinary catheter days, while the overall magnitude was 14.67%. It was predominantly reported in 51–70-years age group (34%), and females (63.63%) outnumbered males (36.36%), with Escherichia coli being the commonest pathogen. The highest incidence was reported in the 3rd week of catheterization with diabetes being a predominant risk factor (17.24%).
Conclusion: This study provides baseline data on CAUTI rate, pathogens isolated, and risk factors at our institute. The overall goal is to identify, educate, and implement best-practice measures for prevention and curbing down the incidence rates of catheter-associated urinary tract infections.
Saint S, Lipsky BA. Preventing catheter-related bacteriuria: Should we? Can we? How? Arch Intern Med 1999;159(8):800–808. DOI: 10.1001/archinte.159.8.800.
Foxman B. Epidemiology of urinary tract infections: Incidence, morbidity, and economic costs. Am J Med 2002;113(Suppl 1A):5S–13S. DOI: 10.1016/s0002-9343(02)01054-9.
Lee JH, Kim SW, Yoon BI, Ha US, Sohn DW, Cho YH. Factors that affect nosocomial catheter-associated urinary tract infection in intensive care units: 2-Year experience at a single centre. Korean J Urol 2013;54(1):59–65. DOI: 10.4111/kju.2013.54.1.59.
Nicolle LE. Catheter associated urinary tract infections. Antimicrob Resist Infect Control 2014;3:23. DOI: 10.1186/2047-2994-3-23.
Parida S, Mishra SK. Urinary tract infections in the critical care unit: A brief review. Indian J Crit Care Med 2013;17(6):370–374. DOI: 10.4103/0972-5229.123451.
Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36(5):309–332. DOI: 10.1016/j.ajic.2008.03.002.
Stamm WE. Catheter-associated urinary tract infections: Epidemiology, pathogenesis, and prevention. Am J Med 1991;91(3B):65S–71S. DOI: 10.1016/0002-9343(91)90345-x.
Warren JW. Catheter-associated urinary tract infections. Infect Dis Clin North Am 1997;11(3):609–622. DOI: 10.1016/s0891-5520(05)70376-7.
Jain M, Kaushal R, Bharadwaj M. Infection surveillance analysis of catheter associated urinary tract infections in obstetrics and gynecology department of a tertiary care hospital of North India. Int J Reprod Contracept Obstet Gynecol 2018;7(1):215–219. DOI: 10.18203/2320-1770.ijrcog20175848.
Chenoweth CE, Gould CV, Saint S. Diagnosis, management, and prevention of catheter-associated urinary tract infections. Infect Dis Clin 2014;28(1):105–119. DOI: 10.1016/j.idc.2013.09.002.
Bereket W, Hemalatha K, Getenet B, Wondwossen T, Solomon A, Zeynudin A, et al. Update on bacterial nosocomial infections. Eur Rev Med Pharmacol Sci 2012;16(8):1039–1044. PMID: 22913154.
Rosenthal VD, Todi SK, Alvarez-Moreno C, Pawar M, Karlekar A, Zeggwagh AA, et al. Impact of a multidimensional infection control strategy on catheter-associated urinary tract infection rates in the adult intensive care units of 15 developing countries: Findings of the International Nosocomial Infection Control Consortium (INICC). Infection 2012;40(5):517–526. DOI: 10.1007/s15010-012-0278.
Verma S, Naik SA, Deepak TS. Etiology and risk factors of catheter associated urinary tract infections in ICU patients. IP Int J Med Microbiol Trop Dis 2017;3(2):65–70. DOI: 10.18231/2455-6807.2017.0015.
Hooton TM, Bradley SF, Cardenas DD, Colgan R, Geerlings SE, Rice JC, et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis 2010;50(5):625–663. DOI: 10.1086/650482.
Vyawahare CR, Gandham NR, MisraRN, Jadhav SV, Gupta NS, Angadi KM. Occurrence of catheter-associated urinary tract infection in critical care units. Med J Dr DY Patil University 2015;8(5):585–589. DOI: 10.4103/0975-2870.164974.
Doddaiah V, Harikumar S, Krishna K, Swathi J, Thygaraja R. Catheter associated urinary tract infection at Vasavi Hospital, Bangalore, India. Int J Curr Res 2020;12(02):10380–10383. DOI: 10.24941/ijcr.38062.02.2020.
Lundstrom T, Sobel J. Nosocomial candiduria: A review. Clin Infect Dis 2001;32(11):1602–1607. DOI: 10.1086/320531.
Masih SM, Goel S, Singh A, Khichi SK, Vasundhara, Tank R. Epidemiology and risk factors of healthcare associated infections from intensive care unit of a tertiary care hospital. Int J Res Med Sci 2016;4(5):1706–1710. DOI: 10.18203/2320-6012.ijrms20161254.
Tomar A P, Kushwah A, Shah H, identification and susceptibility pattern of gram-negative bacterial isolates of Catheter Associated urinary Tract Infections (CAUTI) in a tertiary care institute. Indian J Microbiol Res 2017;4(4):373–376. DOI: 10.18231/2394-5478.2017.0082.
Alam J, Verma PK, Kala S et.al. Incidence and microbiology of catheter associated urinary tract infection in hospitalized patients in a tertiary care hospital in Kumaon region. International Journal of Research and Review 2020;7(5):114–117. DOI: 10.5281/zenodo.3938495.
Patil HV, Patil VC. Clinical, bacteriology profile, and antibiotic sensitivity pattern of Catheter associated Urinary tract infection at tertiary care hospital. Int J Health Sci Res 2018;8(1):25–35. Available from: https://www.ijhsr.org/IJHSR_Vol.8_Issue.1_Jan2018/5.pdf.
Ruqaiyah Nadeem, Furquan Alam, Dimple Raina, Gaurav Saxena. Bacteriological Profile in the Catheter Associated Urinary Tract Infection (CAUTI) Patients in a Tertiary Care Hospital of Uttarakhand, India. International Journal of Health and Clinical Research 2021;4(18):77–80. Available from: https://ijhcr.com/index.php/ijhcr/article/view/2905.
Mohammadzadeh M, Behnaz F. Incidence and risk factors of catheter-associated urinary tract infection in Yazd – Iran. Int J Urol Nurs 2012;6(2): 60–65. DOI: 10.1111/j.1749-771X.2011.01133.x.
Lee NG, Marchalik D, Lipsky A, Rushton HG, Pohl HG, Song X. Risk factors for catheter associated urinary tract infections in a Pediatric Institution. J Urol 2016;195(4 Pt 2):1306–1311. DOI: 10.1016/j.juro.2015.03.121.
Md. Yousuf Khan, Venkateshwarlu C, Sreenivas G, Rahul P. Study of incidence and risk factors of urinary tract infection in catheterized patients admitted at tertiary care hospital, Nizamabad, Telangana State, India. IAIM 2016;3(8):83–92.
Podkovik S, Toor H, Gattupalli M, Kashyap S, Brazdzionis J, Patchana T, et al. Prevalence of catheter-associated urinary tract infections in neurosurgical intensive care patients – The overdiagnosis of urinary tract infections. Cureus 2019;11(8):e5494. DOI: 10.7759/cureus.5494.
Vikram B. Gohil, Adhish V. Vyas, Milan S. Vaghasia. The prospective study of urinary tract infection among indoor patients who underwent catheterization. International Journal of Contemporary Medical Research 2020;7(5):E5–E8. DOI: 10.21276/ijcmr.2020.7.5.2.
Chatterjee N, Chatterjee C, Ghosh S, Mukhopadhyay M, Brahmachari R, Patar K. Pattern of urinary antibiograms in a tertiary care hospital of Eastern India. J Assoc Physicians India 2016;64(4):26–30. PMID: 27734638.
Allegranzi B, Bagheri Nejad S, Combescure C, Graafmans W, Attar H, Donaldson L, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet 2011;377(9761):228–241. DOI: 10.1016/S0140-6736(10)61458-4.
Lakhani JD, Lakhani SJ, Meera S, Sanket P, Sandeep J. Appropriate use of antimicrobial agents in urinary tract infections: Perception of physicians and resident doctors. J Integr Health Sci 2019;7(1):19–24. DOI: 10.4103/JIHS.JIHS_18_19.