Kumar Anuj, Singh Riddhi, Gupta Ravindra, Raj Nikhil, Kalyan RajKumar
Microbiology, King George's Medical University, Lucknow, IND.
Microbiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND.
Cureus. 2025 Apr 28;17(4):e83134. doi: 10.7759/cureus.83134. eCollection 2025 Apr.
Background Catheter-associated urinary tract infections (CAUTIs) are a significant concern in ICU patients, often leading to complications such as bloodstream infections, urosepsis, prolonged hospitalization, and increased mortality, particularly due to delayed diagnosis and rising antibiotic resistance. For therapy to be effective, the causing pathogens must be identified quickly and accurately. This study compares conventional microbiological methods with Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS) for identifying urinary isolates in CAUTI cases and examines their antibiotic susceptibility patterns. Methods Over one year, we analyzed 780 catheterized urine samples from ICU patients at a tertiary care hospital. All samples were processed using standard culture techniques and MALDI-TOF MS for pathogen identification. Antibiotic susceptibility testing was performed according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Descriptive statistics were used for data summarization, and Chi-square test assessed associations between risk factors and CAUTI occurrence, with agreement between MALDI-TOF MS and conventional identification methods evaluated by Cohen's Kappa analysis. The Chi-square test's statistical significance was set at < 0.05. Results Out of 780 samples, 156 (20%) showed significant bacterial or fungal growth. The most common pathogens were species (56.4%), (17.9%), and (12.2%). MALDI-TOF MS demonstrated good accuracy, with misclassifications in 12 isolates (7.7%) mainly involving misidentification in and Despite these discrepancies, a strong agreement was observed between the two methods, with a Cohen's Kappa value of 0.787. High resistance was observed against fluoroquinolones and cephalosporins, while fosfomycin and linezolid remained effective against spp. Conclusion MALDI-TOF MS enhances the speed and accuracy of pathogen identification, making it a valuable tool for managing CAUTI cases. The increasing antibiotic resistance observed in this study highlights the urgent need for targeted treatment strategies and stricter infection control measures in ICU settings.
背景 导尿管相关尿路感染（CAUTIs）是重症监护病房（ICU）患者的一个重大问题，常常导致诸如血流感染、泌尿道感染、住院时间延长和死亡率增加等并发症，尤其是由于诊断延迟和抗生素耐药性上升。为使治疗有效，必须快速准确地识别致病病原体。本研究比较了传统微生物学方法与基质辅助激光解吸/电离飞行时间质谱（MALDI-TOF MS）在识别CAUTI病例中尿液分离株方面的效果，并检查它们的抗生素敏感性模式。方法 在一年多的时间里，我们分析了一家三级护理医院ICU患者的780份导尿管尿液样本。所有样本均采用标准培养技术和MALDI-TOF MS进行病原体鉴定。根据临床和实验室标准协会（CLSI）指南进行抗生素敏感性测试。描述性统计用于数据汇总，卡方检验评估风险因素与CAUTI发生之间的关联，通过科恩kappa分析评估MALDI-TOF MS与传统鉴定方法之间的一致性。卡方检验的统计学显著性设定为P < 0.05。结果 在780份样本中，156份（20%）显示有显著的细菌或真菌生长。最常见的病原体是大肠埃希菌属（56.4%）、肺炎克雷伯菌（17.9%）和粪肠球菌（12.2%）。MALDI-TOF MS显示出良好的准确性，12份分离株（7.7%）存在错误分类，主要涉及肠杆菌科和葡萄球菌属的错误鉴定。尽管存在这些差异，但两种方法之间观察到高度一致性，科恩kappa值为0.787。观察到对氟喹诺酮类和头孢菌素类药物的高耐药性，而磷霉素和利奈唑胺对肠球菌属仍然有效。结论 MALDI-TOF MS提高了病原体鉴定的速度和准确性，使其成为管理CAUTI病例的有价值工具。本研究中观察到的抗生素耐药性增加凸显了在ICU环境中采取针对性治疗策略和更严格感染控制措施的迫切需求。
