European Journal of Cardiovascular Medicine

Catheter associated Urinary tract infection (CAUTI) is the most common among the device associated infections acquired from the hospital settings. Among hospital acquired UTIs, approximately 75% are associated with a urinary catheters. Between 15-25% of hospitalized patients receive urinary catheters during their hospital stay leading to Catheter Associated Urinary Tract Infections (CAUTI) where care bundles are not practiced.[1] Catheter-associated urinary tract infections (CAUTI) according to the centers of disease control and prevention(CDC) is defined as UTI where an indwelling urinary catheter was in place for more than two calendar days on the date of event (day 1 being the day of device placement). [2] Multiple risk factors can affect the occurrence of CAUTI. These include quality of aseptic technique, duration of catheterization, appropriate hand hygiene and care of catheter. [3].The urethral catheter is the most prevalent cause of nosocomial infections and gram-negative bacteremia. The duration of catheterization is directly related to the development of infection. Bacteria can easily invade the lower urinary tract along the external surface of the catheter or by ascending route through the lumen of the catheter. [4] CAUTI can lead to complications such as prostatitis, epididymitis, and orchitis in males, and cystitis, pyelonephritis, gram-negative bacteremia, endocarditis, vertebral osteomyelitis, septic arthritis, endophthalmitis, and meningitis. Complications associated with CAUTI cause discomfort to the patient, prolonged hospital stay, and increased cost and mortality. In addition, hospital acquired CAUTIs are often due to multidrug resistant strains which require higher antibiotics. [5] The present study was done to assess the incidence of CAUTI in a tertiary care hospital, to identify the uropathogens associated with it and to detect the antibiotic sensitivity pattern in the isolated organisms. This plays a significant role in initiating appropriate antibiotics which decreases complications and hospital stay and also helps the infection control team to implement proper care bundles which reduces the hospital stay of patients there by reducing the morbidity and mortality. 

Study design: Prospective Study

Place of study: Apollo Multispeciality Hospitals, Kolkata

Period of Study: 1 year

Sample size: 400

Inclusion criteria: Patients of all ages and genders diagnosed with Catheter-Associated Urinary Tract Infections (CAUTI) as per CDC guidelines.

·         Patients with urinary catheters in place for more than 48 hours.

·         Positive urine culture with significant growth of uropathogens.

·         Patients receiving treatment in inpatient hospital wards, ICUs, or long-term care facilities.

·         Willingness to provide informed consent (or consent from a guardian if required).

Exclusion criteria:

·         Patients with urinary tract infections prior to catheterization.

·         Patients with intermittent catheterization or suprapubic catheter use.

·         Those on antibiotics for any other infections at the time of admission.

·         Patients with incomplete medical records or insufficient urine culture data.

·         Individuals who declined consent for participation in the study.

Statistical Analysis:

Data were entered into Excel and analyzed using SPSS and GraphPad Prism. Numerical variables were summarized using means and standard deviations, while categorical variables were described with counts and percentages. Two-sample t-tests were used to compare independent groups, while paired t-tests accounted for correlations in paired data. Chi-square tests (including Fisher’s exact test for small sample sizes) were used for categorical data comparisons. P-values ≤ 0.05 were considered statistically significant.

Table: 1. Antibiotic Susceptibility Profile of Uropathogens

Antimicrobial resistance (AMR) is a significant global health challenge, especially among uropathogens responsible for urinary tract infections (UTIs). This study assessed the susceptibility patterns of key uropathogens—Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter species—to commonly used antibiotics. The results revealed substantial variability in resistance profiles across the pathogens. E. coli, the most common uropathogen, showed moderate susceptibility to ampicillin (AMP, 82.33%) and piperacillin-tazobactam (PIT, 82.33%), with complete resistance to amoxicillin-clavulanate (AM, 100%). Resistance to ceftriaxone (CXM, 82.33%) and ceftazidime (CAZ, 65.67%) was also noted. Aminoglycosides such as gentamicin (GEN) and tobramycin (TOB) exhibited low efficacy (15.67%), while cefazolin (CZ, 32.33%) demonstrated limited activity. K. pneumoniae presented a concerning resistance profile, with 100% resistance to several antibiotics, including AMP, AM, PIT, and CXM. Although partial susceptibility was observed with cefazolin (CZ, 50%) and ceftazidime (CAZ, 82.33%), aminoglycosides such as gentamicin (65.67%) and netilmicin (NET, 32.33%) showed limited effectiveness. Ciprofloxacin (CIP, 32.33%) and tobramycin (50%) were similarly less effective. P. aeruginosa exhibited extreme multidrug resistance, with complete resistance to AMP, AM, and PIT. Notably, it showed high susceptibility to imipenem (IC, 82.33%) and meropenem (MRP, 65.67%), which are considered last-resort antibiotics. Resistance to cefazolin (CZ, 100%) and ceftazidime (CAZ, 100%) underscores its ability to evade β-lactam antibiotics. Aminoglycosides demonstrated mixed efficacy, with tobramycin (65.67%) outperforming gentamicin (50%).

The Acinetobacter species exhibited pan-resistance to all tested antibiotics, including AMP, AM, carbapenems (IC, MRP), PIT, and aminoglycosides (GEN, AK, TOB). The universal resistance pattern highlights the critical threat posed by Acinetobacter in clinical settings and emphasizes the need for novel therapeutic strategies.

These findings illustrate the alarming extent of AMR among common uropathogens, necessitating stringent antimicrobial stewardship and targeted therapy based on local resistance patterns. The high resistance to first-line antibiotics and the limited efficacy of last-resort agents, particularly in P. aeruginosa and Acinetobacter species, underscore the urgency for new antimicrobials and alternative treatment approaches. Future research should focus on understanding the genetic mechanisms underlying resistance and implementing robust surveillance systems to mitigate the spread of AMR.

In terms of morbidity and mortality, CAUTIs place a heavy cost on patients. One of the most frequent illnesses acquired in hospitals is catheter-associated urinary tract infections (CAUTI). In addition to greater rates of morbidity and mortality, hospital stays have significantly increased, and both patients and health systems are paying more for hospital care. Serious health issues that plague hospitalized patients are catheter-associated urinary tract infections (CAUTIs) [6]. E. coli, K. pneumoniae, P. aeruginosa, E. faecalis, and Candida species are the most frequent bacteria that cause CAUTIs in hospitalized patients [7]. In the current study, the total incidence of CAUTI was 5 per 1000 catheter days, which was less than the standard established by the hospital infection control committee (HICC). Compared to previous research, the incidence is quite low [8]. Untrained employees who lack the necessary training and experience in infection prevention techniques may be the cause of the variation in the incidence rate during the past few months. Prolonged catheterization is a significant risk factor for the development of CAUTI, which is the other main explanation. Regular training has been provided at the current institute to practice preventive measures to lower the incidence of CAUTI and to continuously assess hand hygiene compliance. During the monthly meetings, the staff was shown and informed of the attack rates. Other investigations, however, have revealed a very high incidence of CAUTI in patients who have had catheterization [9]. The patient's gender, infection prevention measures such aseptic procedures, catheter care, length of catheterization, close drainage system, etc., could all contribute to the high occurrence. The infection control staff was able to maintain a low incidence of CAUTI in catheterized patients because to the hospital's strict infection prevention procedures. This was accomplished by having members of the infection control team visit catheterized patients on a daily basis at various times to closely check the preventative bundles. Hand hygiene compliance, aseptic technique, a closed drainage system, putting a urobag below the waist, and catheter care are some of the preventive bundles that were seen during the round. It was discovered that the uropathogens isolated from CAUTI cases were resistant to many drugs. These results are consistent with a number of prior investigations [10] that isolated multidrug-resistant uropathogens. Pseudomonas aeruginosa and Acinetobacter species were the most resistant uropathogens in the current investigation. It demonstrated a high level of resistance to imipenem and Meropenem, among other antibiotics. The uropathogens' increased antibiotic resistance suggests that they were acquired in hospitals and are therefore challenging to cure. If infection control procedures are not followed when caring for patients who are catheterized, this will become much more deadly. If healthcare professionals do not strictly adhere to preventive measures, there is a significant risk of these multidrug-resistant diseases spreading. Because of ongoing staff training and monitoring, the incidence is significantly reduced in the current study.

CAUTI continued to pose a serious threat to patient safety and to the infection control team. A major factor in lowering CAUTI rates, which in turn lowers patient morbidity and hospital stays, is the implementation of appropriate care bundles and ongoing training for healthcare professionals. Multidrug-resistant uropathogens such as E. coli and Klebsiella spp. present therapeutic challenges for catheter-associated urinary tract infections (CAUTI), which continue to be a major healthcare concern. In clinical settings, lowering CAUTI incidence, maximizing therapy, and enhancing patient outcomes depend heavily on routine monitoring of antibiotic sensitivity patterns, aseptic protocol observance, and antimicrobial stewardship.

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