Etiology and risk factors of catheter associated urinary tract infections in ICU patients

Background: Catheter associated urinary tract infections (CAUTI) are common infections in ICUs patients. Unnecessary treatment of CAUTI causes economic burden on healthcare and contributes to antibiotic resistance. Objectives: This study was planned to determine the incidence of CAUTI in ICU patients, to find the risk factors and to identify the causative agents and their antimicrobial susceptibility. Materials and Method: This prospective study was performed over a period of one year, enrolling patients admitted and catheterised with indwelling urinary catheter for ≥48 hours in ICU of our hospital. Urine samples were collected from patients suspected of developing signs and symptoms suggestive of CAUTI after more than 48 hours of catheterisation and processed by semi-quantitative method. CAUTI was diagnosed using CDC definition. Results: Out of 163, 26 patients (15.95%) were diagnosed with CAUTI. Risk factors identified for development of CAUTI were analyzed. Female gender, mechanical ventilation, duration of catheterization ≥ 5 days, Diabetes were independent risk factors while increasing age (≥ 65 years) was not found to be associated with CAUTI. 69.2% of CAUTIs were due to bacteria and 30.8% were due to yeast. The single most common organism isolated was Candida species (30.8%) followed by Escherichia coli and Enterococcus faecalis (19.2%) each. Incidence of drug resistance was high in CAUTI isolates. Conclusion: CAUTI is common in ICU patients. Females, diabetics, patients on mechanical ventilation and with prolonged catheterization are independent risk factors for CAUTI. Majority pathogens were bacterial in origin and were resistant to multiple drugs.