Prospective Cohort Study of Incidence and Risk Factors for Catheter-associated Urinary Tract Infections in 212 Intensive Care Units of Nine Middle Eastern Countries

Zhilin Jin; Ruijie Yin; Eric Christopher Brown; Bhavarth Shukla; Brandon Hochahn Lee; Safaa Abdulaziz-Alkhawaja; Tahera Anwar Magray; Hala Mounir Agha; Amal El-Sisi; Amani Ali El-Kholy; Victor Bayani; Mohammad Abdellatif Daboor; Majeda Afeef Al Ruzzieh; Ertugrul Guclu; Esra Olmez-Gazioglu; Oguz Dursun; Tuğçe Tural Kara; Iftihar Koksal; Ahmet Eroglu; Merve Havan; Tanıl Kendirli; Suna Secil Ozturk Deniz; Gizem Aktas; Dincer Yildizdas; Ozden Ozgur Horoz; Emel Okulu; Yasemin Ezgi Kostekci; Abeer Aly Omar; Ziad A Memish; Victor Daniel Rosenthal

doi:10.5001/omj.2023.121

Prospective Cohort Study of Incidence and Risk Factors for Catheter-associated Urinary Tract Infections in 212 Intensive Care Units of Nine Middle Eastern Countries

Oman Med J. 2023 Nov 30;38(6):e571. doi: 10.5001/omj.2023.121. eCollection 2023 Nov.

Authors

Zhilin Jin¹, Ruijie Yin¹, Eric Christopher Brown¹, Bhavarth Shukla², Brandon Hochahn Lee³, Safaa Abdulaziz-Alkhawaja⁴, Tahera Anwar Magray⁴, Hala Mounir Agha⁵, Amal El-Sisi⁵, Amani Ali El-Kholy⁶, Victor Bayani⁶, Mohammad Abdellatif Daboor⁷, Majeda Afeef Al Ruzzieh⁷, Ertugrul Guclu⁸, Esra Olmez-Gazioglu⁸, Oguz Dursun⁹, Tuğçe Tural Kara⁹, Iftihar Koksal¹⁰, Ahmet Eroglu¹⁰, Merve Havan¹¹, Tanıl Kendirli¹¹, Suna Secil Ozturk Deniz¹², Gizem Aktas¹², Dincer Yildizdas¹³, Ozden Ozgur Horoz¹³, Emel Okulu^{1

4}, Yasemin Ezgi Kostekci¹⁴, Abeer Aly Omar¹⁵, Ziad A Memish¹⁶, Victor Daniel Rosenthal^{1

17}

Affiliations

¹ Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA.
² Department of Medicine, University of Miami Miller School of Medicine, Miami, USA.
³ University of Miami, Miller School of Medicine. Miami, USA.
⁴ Department of Critical Care, Salmaniya Medical Center, Manama, Bahrain.
⁵ Department of Critical Care, Cairo University Specialized Pediatric Hospital, Cairo, Egypt.
⁶ Department of Critical Care, Dar Alfouad Hospital, 6th of October City, Egypt.
⁷ Department of Critical Care, King Hussein Cancer Center, Amman, Jordan.
⁸ Department of Critical Care, Sakarya University Training and Research Hospital, Sakarya, Turkey.
⁹ Department of Critical Care, Akdeniz University Medical School, Antalya, Turkey.
¹⁰ Department of Critical Care, Karadeniz Technical University School of Medicine, Trabzon, Turkey.
¹¹ Department of Critical Care, Ankara University Faculty of Medicine, Ankara, Turkey.
¹² Department of Critical Care, Pamukkale University Hospital, Denizli, Turkey.
¹³ Department of Critical Care, Balcali Hospital Pediatric Intensive Care Unit, Adana, Turkey.
¹⁴ Neonatal Intensive Care Unit, Children's Hospital, Ankara University Faculty of Medicine, Ankara, Turkey.
¹⁵ Infection Control Directorate, Ministry of Health, Kuwait City, Kuwait.
¹⁶ Department of Infection Control, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia.
¹⁷ International Nosocomial Infection Control Consortium Foundation, Miami, USA.

Abstract

Objectives: To identify urinary catheter (UC)-associated urinary tract infections (CAUTI) incidence and risk factors (RF) in nine Middle Eastern countries.

Methods: We conducted a prospective cohort study between 1 January 2014 and 2 December 2022 in 212 intensive care units (ICUs) of 67 hospitals in 38 cities in nine Middle Eastern countries (Bahrain, Egypt, Jordan, Kuwait, Lebanon, Morocco, Saudi Arabia, Turkey, and the UAE). To estimate CAUTI incidence, we used the number of UC days as denominator and the number of CAUTIs as numerator. To estimate CAUTI RFs, we analyzed the following 10 variables using multiple logistic regression: patient sex, age, length of stay (LOS) before CAUTI acquisition, UC-days before CAUTI acquisition, UC-device utilization (DU) ratio, hospitalization type, ICU type, facility-ownership, country income level classified by World Bank, and time period.

Results: Among 50 637 patients hospitalized for 434 523 patient days, there were 580 cases of acquired CAUTIs. The pooled CAUTI rate per 1000 UC days was 1.84. The following variables were independently associated with CAUTI: age, rising risk 1.0% yearly (adjusted odds ratio [aOR] = 1.01, 95% CI: 1.01-1.02; p < 0.0001); female sex (aOR = 1.31, 95% CI: 1.09-1.56; p < 0.0001); LOS before CAUTI acquisition, rising risk 6.0% daily (aOR = 1.06, 95% CI: 1.05-1.06; p < 0.0001); and UC/DU ratio (aOR = 1.11, 95% CI: 1.06-1.14; p < 0.0001). Patients from lower-middle-income countries (aOR = 4.11, 95% CI: 2.49-6.76; p < 0.0001) had a similar CAUTI risk to the upper-middle countries (aOR = 3.75, 95% CI: 1.83-7.68; p < 0.0001). The type of ICU with the highest risk for CAUTI was neurologic ICU (aOR = 27.35, 95% CI: 23.03-33.12; p < 0.0001), followed by medical ICU (aOR = 6.18, 95% CI: 2.07-18.53; p < 0.0001) when compared to cardiothoracic ICU. The periods 2014-2016 (aOR = 7.36, 95% CI: 5.48-23.96; p < 0.001) and 2017-2019 (aOR = 1.15, 95% CI: 3.46-15.61; p < 0.001) had a similar risk to each other, but a higher risk compared to 2020-2022.

Conclusions: The following CAUTI RFs are unlikely to change: age, sex, ICU type, and country income level. Based on these findings, it is suggested to focus on reducing LOS, UC/DU ratio, and implementing evidence-based CAUTI prevention recommendations.

Keywords: Incidence; Intensive Care; Middle East; Risk Factors; Urinary Tract Infections.