Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, USA.
University of Miami, Coral Gables, USA.
World J Urol. 2023 Dec;41(12):3599-3609. doi: 10.1007/s00345-023-04645-z. Epub 2023 Oct 12.
Identify urinary catheter (UC)-associated urinary tract infections (CAUTI) incidence and risk factors (RF) in Latin American Countries.
From 01/01/2014 to 02/10/2022, we conducted a prospective cohort study in 145 ICUs of 67 hospitals in 35 cities in nine Latin American countries: Argentina, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Panama, and Peru. To estimate CAUTI incidence, we used the number of UC-days as the denominator, and the number of CAUTIs as numerator. To estimate CAUTI RFs, we analyzed the following 10 variables using multiple logistic regression: gender, age, length of stay (LOS) before CAUTI acquisition, UC-days before CAUTI acquisition, UC-device utilization (DU) ratio, UC-type, hospitalizationtype, ICU type, facility ownership, and time period.
31,631 patients, hospitalized for 214,669 patient-days, acquired 305 CAUTIs. The pooled CAUTI rate per 1000 UC-days was 2.58, for those using suprapubic catheters, it was 2.99, and for those with indwelling catheters, it was 2.21. The following variables were independently associated with CAUTI: age, rising risk 1% yearly (aOR = 1.01; 95% CI 1.01-1.02; p < 0.0001 female gender (aOR = 1.28; 95% CI 1.01-1.61; p = 0.04), LOS before CAUTI acquisition, rising risk 7% daily (aOR = 1.07; 95% CI 1.06-1.08; p < 0.0001, UC/DU ratio (aOR = 1.14; 95% CI 1.08-1.21; p < 0.0001, public facilities (aOR = 2.89; 95% CI 1.75-4.49; p < 0.0001. The periods 2014-2016 and 2017-2019 had significantly higher risks than the period 2020-2022. Suprapubic catheters showed similar risks as indwelling catheters.
The following CAUTI RFs are unlikely to change: age, gender, hospitalization type, and facility ownership. Based on these findings, it is suggested to focus on reducing LOS, UC/DU ratio, and implementing evidence-based CAUTI prevention recommendations.
确定拉丁美洲国家导尿管相关性尿路感染（CAUTI）的发生率和危险因素（RF）。
我们于 2014 年 1 月 1 日至 2022 年 2 月 10 日在拉丁美洲 9 个国家的 35 个城市的 67 家医院的 145 个 ICU 进行了一项前瞻性队列研究：阿根廷、巴西、哥伦比亚、哥斯达黎加、多米尼加共和国、厄瓜多尔、墨西哥、巴拿马和秘鲁。为了估计 CAUTI 的发生率，我们使用导尿管留置天数作为分母，CAUTI 的数量作为分子。为了估计 CAUTI 的 RF，我们使用多变量逻辑回归分析了以下 10 个变量：性别、年龄、CAUTI 获得前的住院时间（LOS）、CAUTI 获得前的导尿管留置天数、导尿管使用比例（DU）、导尿管类型、住院类型、ICU 类型、机构所有权和时间段。
31631 名患者，住院 214669 患者日，发生 305 例 CAUTI。每 1000 个导尿管日的 CAUTI 发生率为 2.58，使用耻骨上导尿管的 CAUTI 发生率为 2.99，使用留置导尿管的 CAUTI 发生率为 2.21。以下变量与 CAUTI 独立相关：年龄，每年风险增加 1%（aOR=1.01；95%CI 1.01-1.02；p<0.0001）；女性（aOR=1.28；95%CI 1.01-1.61；p=0.04）；CAUTI 获得前的 LOS，每日风险增加 7%（aOR=1.07；95%CI 1.06-1.08；p<0.0001）；导尿管/ DU 比例（aOR=1.14；95%CI 1.08-1.21；p<0.0001）；公共设施（aOR=2.89；95%CI 1.75-4.49；p<0.0001）。2014-2016 年和 2017-2019 年的风险明显高于 2020-2022 年。耻骨上导尿管和留置导尿管的风险相似。
以下 CAUTI 的 RF 不太可能改变：年龄、性别、住院类型和机构所有权。基于这些发现，建议重点减少 LOS、导尿管/ DU 比例，并实施基于证据的 CAUTI 预防建议。
