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Rosenthal VD, Yin R, Abbo LM, Lee BH, Rodrigues C, Myatra SN, Divatia JV, Kharbanda M, Nag B, Rajhans P, Shingte V, Mehta Y, Sarma S, Todi SK, Bhattacharyya M, Basu S, Sahu S, Mishra SB, Samal S, Chawla R, Jain AC, Nair PK, Kalapala D, Arjun R, Singla D, Sandhu K, Badyal B, Palaniswamy V, Bhakta A, Gan CS, Mohd-Basri MN, Lai YH, Tai CW, Lee PC, Bat-Erdene I, Begzjav T, Acharya SP, Dongol R, Ikram A, Tumu N, Tao L, Jin Z. An international prospective study of INICC analyzing the incidence and risk factors for catheter-associated urinary tract infections in 235 ICUs across 8 Asian Countries. Am J Infect Control 2024; 52:54-60. [PMID: 37499758 DOI: 10.1016/j.ajic.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Identify urinary catheter (UC)-associated urinary tract infections (CAUTI) incidence and risk factors (RF) in 235 ICUs in 8 Asian countries: India, Malaysia, Mongolia, Nepal, Pakistan, the Philippines, Thailand, and Vietnam. METHODS From January 1, 2014, to February 12, 2022, we conducted a prospective cohort study. To estimate CAUTI incidence, the number of UC days was the denominator, and CAUTI was the numerator. To estimate CAUTI RFs, we analyzed 11 variables using multiple logistic regression. RESULTS 84,920 patients hospitalized for 499,272 patient days acquired 869 CAUTIs. The pooled CAUTI rate per 1,000 UC-days was 3.08; for those using suprapubic-catheters (4.11); indwelling-catheters (2.65); trauma-ICU (10.55), neurologic-ICU (7.17), neurosurgical-ICU (5.28); in lower-middle-income countries (3.05); in upper-middle-income countries (1.71); at public-hospitals (5.98), at private-hospitals (3.09), at teaching-hospitals (2.04). The following variables were identified as CAUTI RFs: Age (adjusted odds ratio [aOR] = 1.01; 95% CI = 1.01-1.02; P < .0001); female sex (aOR = 1.39; 95% CI = 1.21-1.59; P < .0001); using suprapubic-catheter (aOR = 4.72; 95% CI = 1.69-13.21; P < .0001); length of stay before CAUTI acquisition (aOR = 1.04; 95% CI = 1.04-1.05; P < .0001); UC and device utilization-ratio (aOR = 1.07; 95% CI = 1.01-1.13; P = .02); hospitalized at trauma-ICU (aOR = 14.12; 95% CI = 4.68-42.67; P < .0001), neurologic-ICU (aOR = 14.13; 95% CI = 6.63-30.11; P < .0001), neurosurgical-ICU (aOR = 13.79; 95% CI = 6.88-27.64; P < .0001); public-facilities (aOR = 3.23; 95% CI = 2.34-4.46; P < .0001). DISCUSSION CAUTI rate and risk are higher for older patients, women, hospitalized at trauma-ICU, neurologic-ICU, neurosurgical-ICU, and public facilities. All of them are unlikely to change. CONCLUSIONS It is suggested to focus on reducing the length of stay and the Urinary catheter device utilization ratio, avoiding suprapubic catheters, and implementing evidence-based CAUTI prevention recommendations.
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Affiliation(s)
- Victor D Rosenthal
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, USA; Infeciton Control Department, International Nosocomial Infection Control Consortium, INICC Foundation, Miami, USA.
| | - Ruijie Yin
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, USA
| | - Lilian M Abbo
- Division of Infectious Disease, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Camilla Rodrigues
- Pd Hinduja National Hospital and Medical Research Centre, Department of Microbiology, Mumbai, India
| | - Sheila N Myatra
- Tata Memorial Hospital, Homi Bhabha National Institute, Department of Anesthesiology, Critical Care and Pain, Mumbai, India
| | | | - Mohit Kharbanda
- Deenanath Mangeshkar Hospital And Research Center Erandwane Pune, Pune, India
| | - Bikas Nag
- Deenanath Mangeshkar Hospital And Research Center Erandwane Pune, Pune, India
| | - Prasad Rajhans
- Deenanath Mangeshkar Hospital And Research Center Erandwane Pune, Pune, India
| | - Vasudha Shingte
- Deenanath Mangeshkar Hospital And Research Center Erandwane Pune, Pune, India
| | - Yatin Mehta
- Medanta The Medicity, Department of Critical Care and Anesthesiology, Haryana, India
| | - Smita Sarma
- Medanta The Medicity, Department of Critical Care and Anesthesiology, Haryana, India
| | - Subhash K Todi
- Advanced Medicare Research Institute AMRI Hospitals, Department of Critical Care, Kolkata, India
| | - Mahuya Bhattacharyya
- Advanced Medicare Research Institute AMRI Hospitals, Department of Critical Care, Kolkata, India
| | - Sushmita Basu
- Advanced Medicare Research Institute Mukundapur Unit, Kolkata, India
| | | | - Shakti B Mishra
- Critical Care Department, IMS and SUM Hospital, Bhubaneswar, India
| | - Samir Samal
- Critical Care Department, IMS and SUM Hospital, Bhubaneswar, India
| | - Rajesh Chawla
- Indraprastha Apollo Hospitals, Department of Critical Care, New Delhi, India
| | - Aakanksha C Jain
- Indraprastha Apollo Hospitals, Department of Critical Care, New Delhi, India
| | - Pravin K Nair
- Critical Care Department, Holy Spirit Hospital, Mumbai, India
| | - Durga Kalapala
- Critical Care Department, Holy Spirit Hospital, Mumbai, India
| | - Rajalakshmi Arjun
- Kerala Institute Of Med Sciences Health, Department of Critical Care, Trivandrum, India
| | - Deepak Singla
- Critical Care Department, Maharaja Agrasen Hospital, New Delhi, India
| | - Kavita Sandhu
- Max Super Speciality Hospital Saket Delhi, Department of Critical Care, New Delhi, India
| | - Binesh Badyal
- Max Super Speciality Hospital Saket Delhi, Department of Critical Care, New Delhi, India
| | | | - Arpita Bhakta
- University Malaya Medical Centre, Department of Pediatric Intensive Care, Kuala Lumpur, Malaysia
| | - Chin S Gan
- University Malaya Medical Centre, Department of Pediatric Intensive Care, Kuala Lumpur, Malaysia
| | - Mat N Mohd-Basri
- International Islamic University Malaysia, Department of Anesthesia and Critical Care, Kuantan, Pahang, Malaysia
| | - Yin H Lai
- International Islamic University Malaysia, Department of Anesthesia and Critical Care, Kuantan, Pahang, Malaysia
| | - Chian-Wern Tai
- Universiti Kebangsaan Malaysia Specialist Children's Hospital, Department of Critical Care, Kuala Lumpur, Malaysia
| | - Pei-Chuen Lee
- Universiti Kebangsaan Malaysia Specialist Children's Hospital, Department of Critical Care, Kuala Lumpur, Malaysia
| | - Ider Bat-Erdene
- Critical Care Department, Intermed Hospital, Ulaanbaatar, Mongolia
| | - Tsolmon Begzjav
- Critical Care Department, Intermed Hospital, Ulaanbaatar, Mongolia
| | - Subhash P Acharya
- Critical Care Department, Grande International Hospital, Kathmandu, Nepal
| | - Reshma Dongol
- Critical Care Department, Grande International Hospital, Kathmandu, Nepal
| | - Aamer Ikram
- Critical Care Department, Armed Forces Institute of Urology, Rawalpindi, Pakistan
| | - Nellie Tumu
- Department of Public Health Sciences, Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | - Lili Tao
- Zhongshan Hospital, Fudan University, Department of Pneumonology, Shanghai, China
| | - Zhilin Jin
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, USA
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