Characteristics and outcomes of ICU patients with bacterial catheter-associated urinary tract infection.

BACKGROUND: Catheter-associated urinary tract infection (CAUTI) is a common device-associated complication in intensive care units (ICUs). OBJECTIVE: To characterize bacterial CAUTI in an ICU cohort and identify independent associations with demographic and clinical characteristics available at or before ICU admission. METHODS: This single-center retrospective cohort included 3326 index ICU admissions from January 2017 through June 2023. After exclusion of 95 fungal-only clinically classified cases, 3231 records remained. Bacterial CAUTI required compatible clinical findings, at least 48 hours of catheter exposure, and ≥10³ CFU/mL of one or two bacterial species. All patients were catheterized throughout the observed ICU stay. The primary logistic model included only admission characteristics; ICU stay/catheter duration was descriptive because exact CAUTI onset dates were unavailable. Skewed biomarkers were summarized with medians, interquartile ranges, and Mann-Whitney tests. RESULTS: Bacterial CAUTI occurred in 301 patients (9.3%; 95% CI 8.4%-10.4%). Mean ICU stay/catheter duration was 28.3 versus 13.6 days (difference 14.8 days; 95% CI 11.7-17.8), but duration was not interpreted as an independent risk estimate. Mortality was 49.2% versus 45.9% (risk difference 3.2 percentage points; 95% CI -2.7 to 9.1), and bacterial CAUTI was not associated with death after adjustment for admission characteristics (OR 0.95; 95% CI 0.75-1.22). Female sex (OR 1.48; 95% CI 1.15-1.90), obesity (OR 1.62; 95% CI 1.20-2.19), and COVID-19 (OR 2.16; 95% CI 1.55-3.00) were independently associated. At least one resistance phenotype was recorded in 200 patients (66.4%). CONCLUSIONS: Bacterial CAUTI was associated with a distinct admission profile and longer observed ICU stay/catheter exposure, although causal direction could not be determined. It was not associated with adjusted in-hospital mortality.