Jin Zhilin, Yin Ruijie, Brown Eric Christopher, Shukla Bhavarth, Lee Brandon Hochahn, Abdulaziz-Alkhawaja Safaa, Magray Tahera Anwar, Agha Hala Mounir, El-Sisi Amal, Ali El-Kholy Amani, Bayani Victor, Daboor Mohammad Abdellatif, Ruzzieh Majeda Afeef Al, Guclu Ertugrul, Olmez-Gazioglu Esra, Dursun Oguz, Kara Tuğçe Tural, Koksal Iftihar, Eroglu Ahmet, Havan Merve, Kendirli Tanıl, Ozturk Deniz Suna Secil, Aktas Gizem, Yildizdas Dincer, Horoz Ozden Ozgur, Okulu Emel, Kostekci Yasemin Ezgi, Omar Abeer Aly, Memish Ziad A, Rosenthal Victor Daniel
Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA.
Department of Medicine, University of Miami Miller School of Medicine, Miami, USA.
Oman Med J. 2023 Nov 30;38(6):e571. doi: 10.5001/omj.2023.121. eCollection 2023 Nov.
To identify urinary catheter (UC)-associated urinary tract infections (CAUTI) incidence and risk factors (RF) in nine Middle Eastern countries.
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.
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; < 0.0001); female sex (aOR = 1.31, 95% CI: 1.09-1.56; < 0.0001); LOS before CAUTI acquisition, rising risk 6.0% daily (aOR = 1.06, 95% CI: 1.05-1.06; < 0.0001); and UC/DU ratio (aOR = 1.11, 95% CI: 1.06-1.14; < 0.0001). Patients from lower-middle-income countries (aOR = 4.11, 95% CI: 2.49-6.76; < 0.0001) had a similar CAUTI risk to the upper-middle countries (aOR = 3.75, 95% CI: 1.83-7.68; < 0.0001). The type of ICU with the highest risk for CAUTI was neurologic ICU (aOR = 27.35, 95% CI: 23.03-33.12; < 0.0001), followed by medical ICU (aOR = 6.18, 95% CI: 2.07-18.53; < 0.0001) when compared to cardiothoracic ICU. The periods 2014-2016 (aOR = 7.36, 95% CI: 5.48-23.96; < 0.001) and 2017-2019 (aOR = 1.15, 95% CI: 3.46-15.61; < 0.001) had a similar risk to each other, but a higher risk compared to 2020-2022.
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.
确定中东九个国家中导尿管（UC）相关尿路感染（CAUTI）的发病率及危险因素（RF）。
2014年1月1日至2022年12月2日，我们在中东九个国家（巴林、埃及、约旦、科威特、黎巴嫩、摩洛哥、沙特阿拉伯、土耳其和阿联酋）38个城市的67家医院的212个重症监护病房（ICU）开展了一项前瞻性队列研究。为估算CAUTI发病率，我们以导尿管使用天数为分母，以CAUTI病例数为分子。为估算CAUTI的危险因素，我们使用多因素逻辑回归分析了以下10个变量：患者性别、年龄、发生CAUTI前的住院时间（LOS）、发生CAUTI前的导尿管使用天数、导尿管设备使用率（DU）、住院类型、ICU类型、机构所有权、世界银行分类的国家收入水平以及时间段。
在住院434523个患者日的50637例患者中，有580例发生了CAUTI。每1000个导尿管使用日的合并CAUTI发生率为1.84。以下变量与CAUTI独立相关：年龄，每年风险上升1.0%（调整优势比[aOR]=1.01，95%置信区间[CI]：1.01 - 1.02；P<0.0001）；女性（aOR = 1.31，95%CI：1.09 - 1.56；P<0.0001）；发生CAUTI前的LOS，每日风险上升6.0%（aOR = 1.06，95%CI：1.05 - 1.06；P<0.0001）；以及导尿管/设备使用率（aOR = 1.11，95%CI：1.06 - 1.14；P<0.0001）。中低收入国家的患者（aOR = 4.11，95%CI：2.49 - 6.76；P<0.0001）与中高收入国家的患者（aOR = 3.75，95%CI：1.83 - 7.68；P<0.0001）发生CAUTI的风险相似。CAUTI风险最高的ICU类型是神经科ICU（aOR = 27.35，95%CI：23.03 - 33.12；P<0.0001），与心胸外科ICU相比，其次是内科ICU（aOR = 6.18，95%CI：2.07 - 18.53；P<0.0001）。2014 - 2016年期间（aOR = 7.36，95%CI：5.48 - 23.96；P<0.001）和2017 - 2019年期间（aOR = 1.15，95%CI：3.46 - 15.61；P<0.001）相互之间风险相似，但与2020 - 2022年相比风险更高。
以下CAUTI危险因素不太可能改变：年龄、性别、ICU类型和国家收入水平。基于这些发现，建议着重于缩短住院时间、降低导尿管/设备使用率，并实施基于证据的CAUTI预防建议。
