Department of Internal Medicine, An-Najah National University Hospital, Nablus, Palestinian Territory.
Palestinian Ministry of Health, Jericho, Palestinian Territory.
PLoS One. 2024 Aug 30;19(8):e0309755. doi: 10.1371/journal.pone.0309755. eCollection 2024.
Catheter-associated urinary tract infections (CAUTI) are the most common secondary cause of bloodstream infection. CAUTI is particularly prevalent in critical care departments and developing countries, where the duration of catheterization remains the most significant risk factor. This study focused on the characteristics, risk factors, and outcomes of CAUTI patients in a tertiary care hospital setting. It also provides the incidence rate of CAUTI in an ICU setting in Palestine. The study adopted a retrospective observational design at a tertiary care hospital in Palestine. The data were collected from patient records as well as from nursing flow charts. Variables are reported as frequencies, percentages and means + standard deviations. Independent t-tests was used for numerical variables, while Pearson's chi-square or Fisher's exact test were used for categorical variables. Multivariate analysis was performed to adjust for confounders using binary logistic regression. Mortality risk factors were assessed using the proportional Cox regression model. Of the 377 patients included in the study, 33 (9%) developed CAUTI. Among CAUTI patients, 75% had Candida species isolated, with non-albicans Candida predominating (72%) fungal isolates. On the other hand, 25% of the patients had bacterial isolates in their urine, with a predominance of Escherichia coli growing in 36% of bacterial cultures. Multivariate regression analysis revealed that female gender, longer catheterization days, and corticosteroid use were associated with an increased risk of CAUTI. On the other hand, developing CAUTI, having a malignant disease, developing kidney injury, and developing shock were associated with increased mortality. This study highlighted the emerging presence of fungal and resistant bacterial CAUTI. It also emphasized that the risk of CAUTI was associated with a longer duration of urinary catheterization. The findings of this study may help formulate antimicrobial management and stewardship plans as well as emphasize the risk of urinary catheterizations.
导管相关性尿路感染（CAUTI）是血流感染最常见的继发性病因。CAUTI 在重症监护病房和发展中国家尤为普遍，其中导尿管留置时间仍然是最重要的危险因素。本研究聚焦于三级保健医院环境中 CAUTI 患者的特征、风险因素和结局，并提供了巴勒斯坦重症监护病房（ICU）中 CAUTI 的发生率。本研究采用巴勒斯坦一家三级保健医院的回顾性观察设计。数据来自患者病历和护理流程图。变量以频率、百分比和平均值+标准差报告。对于数值变量，使用独立 t 检验，对于分类变量，使用 Pearson 卡方或 Fisher 确切检验。使用二元逻辑回归进行多变量分析，以调整混杂因素。使用比例 Cox 回归模型评估死亡率的危险因素。在纳入的 377 例患者中，有 33 例（9%）发生 CAUTI。在 CAUTI 患者中，75%分离出念珠菌属物种，其中非白念珠菌念珠菌占优势（72%）；真菌分离株。另一方面，25%的患者尿液中有细菌分离株，其中大肠埃希菌在 36%的细菌培养物中占优势。多变量回归分析显示，女性、留置导尿管时间延长和使用皮质类固醇与 CAUTI 风险增加相关。另一方面，发生 CAUTI、患有恶性疾病、发生肾损伤和发生休克与死亡率增加相关。本研究强调了真菌和耐药细菌 CAUTI 的出现，并强调了 CAUTI 的风险与导尿管留置时间延长有关。本研究的结果可能有助于制定抗菌药物管理和管理计划，并强调导尿的风险。
