Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon.
J Infect Public Health. 2024 May;17(5):825-832. doi: 10.1016/j.jiph.2024.03.022. Epub 2024 Mar 22.
Catheter-associated urinary tract infections (CAUTIs) are the most common device-associated healthcare-acquired infections and pose a significant burden on patients and healthcare systems worldwide. However, there is a paucity of data on CAUTI epidemiology and microbiology in the Middle East and North Africa (MENA) region, including Lebanon.
This 14-year retrospective cohort study was conducted at a tertiary care center in Lebanon. It analyzed data on all adult patients diagnosed with CAUTI between January 2009 and December 2022 in intensive care units (ICUs) and between June 2011 and December 2022 in regular units. Incidence rates, urinary catheter utilization ratios, and microbiological profiles were collected and analyzed.
A total of 620 CAUTI cases were identified during the study period. The overall CAUTI rate was 2.4 per 1000 catheter-days, with higher rates in ICUs (3.2 per 1000 catheter-days) compared to regular units (1.4 per 1000 catheter-days). No significant changes in the rates were noted despite implementing many interventions. The most common pathogens were Gram-negative bacteria, with Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae being predominant. Multidrug-resistant organisms represented 48% of all isolates. Enterobacterales were largely extended-spectrum β-lactamase (ESBL) producing, and most Acinetobacter baumannii isolates showed multidrug resistance.
This study provides important insights into CAUTI epidemiology and microbiology in a tertiary care center in Lebanon, addressing the knowledge gap in this area in the MENA region. Despite implementing prevention measures, CAUTI rates remained stable over the 14-year period. The findings highlight the need for continuous improvement in infection prevention practices, diagnostic stewardship, and antimicrobial stewardship, especially given the rising threat of antimicrobial resistance. These results can serve as a guide for the development of targeted preventive strategies to reduce the burden of CAUTIs, particularly in low- and middle-income countries where antimicrobial resistance is a major issue.
导管相关尿路感染（CAUTI）是最常见的与器械相关的医院获得性感染，给全球的患者和医疗系统带来了重大负担。然而，中东和北非（MENA）地区，包括黎巴嫩，关于 CAUTI 流行病学和微生物学的数据却很少。
这是一项在黎巴嫩一家三级保健中心进行的为期 14 年的回顾性队列研究。它分析了 2009 年 1 月至 2022 年 12 月重症监护病房（ICU）和 2011 年 6 月至 2022 年 12 月普通病房中所有诊断为 CAUTI 的成年患者的数据。收集并分析了发病率、导尿管使用率和微生物学特征。
在研究期间共发现 620 例 CAUTI 病例。总的 CAUTI 发生率为每 1000 个导尿管日 2.4 例，ICU 中的发生率（每 1000 个导尿管日 3.2 例）高于普通病房（每 1000 个导尿管日 1.4 例）。尽管实施了许多干预措施，但发病率并没有显著变化。最常见的病原体是革兰氏阴性菌，其中大肠埃希菌、铜绿假单胞菌和肺炎克雷伯菌最为常见。多药耐药菌占所有分离株的 48%。肠杆菌科主要产生超广谱β-内酰胺酶（ESBL），大多数鲍曼不动杆菌分离株表现出多药耐药性。
本研究提供了黎巴嫩一家三级保健中心 CAUTI 流行病学和微生物学的重要见解，填补了 MENA 地区这方面的知识空白。尽管实施了预防措施，但在 14 年期间 CAUTI 发病率保持稳定。这些发现强调了需要持续改进感染预防措施、诊断管理和抗菌药物管理，特别是考虑到抗菌药物耐药性的威胁日益增加。这些结果可以作为制定有针对性的预防策略的指南，以减少 CAUTI 的负担，特别是在中低收入国家，那里的抗菌药物耐药性是一个主要问题。
