Catheter associated urinary tract infection: role of the setting of catheter insertion

BACKGROUND This study aimed to describe Catheter-associated urinary tract infections (CAUTIs) epidemiology in patients admitted to a surgical ward in Central Italy, and to analyze the associated risk factors. METHODS: An active surveillance program for CAUTI was carried out in patients catheterized for at least 48 hours. Place of catheter insertion (operating room, hospital ward, cystoscopy room, emergency care unit), indication for catheterization , and its duration, amongst other risk factors were monitored until discharge. Antibiotic resistance profiles of isolates were analysed. RESULTS: 641 catheterized patients, were monitored for CAUTI onset. 40 of them (6.2%) developed a CAUTI (rates were 15.1/1000 catheter-days, 95%CI:11.9–22.6 and 8.7/1000 patient-days,95%CI:6.9–13.1. Patients with CAUTI were older (p<0.05), and their durations of hospitalization and catheterization were both longer compared to not-affected (p<0.05). Catheterization exceeding four days (OR8.21,95%CI:3.79-17.73,p<0.05) and place of catheter insertion different from the Operating Room (OR7.9,95%CI:2.83-22.08,p<0.05 for catheters placed in the ward) were associated to CAUTI. Among the microorganisms isolated in CAUTIs, the most common were Pseudomonas aeruginosa (41.5%), Klebsiella pneumoniae (19.5%) and Escherichia coli (12.2%); 82.5% of them was resistant to different classes of antibiotics. CONCLUSION: These results highlight the role played by the setting of catheter insertion in CAUTIs onset, thus reflecting the importance of hand hygiene and proper aseptic insertion techniques as crucial determinants in CAUTIs prevention.