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Prospective cohort study of incidence and risk factors for catheter-associated urinary tract infections in 145 intensive care units of 9 Latin American countries: INICC findings

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Abstract

Purpose

Identify urinary catheter (UC)-associated urinary tract infections (CAUTI) incidence and risk factors (RF) in Latin American Countries.

Methods

From 01/01/2014 to 02/10/2022, we conducted a prospective cohort study in 145 ICUs of 67 hospitals in 35 cities in nine Latin American countries: Argentina, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Panama, and Peru. To estimate CAUTI incidence, we used the number of UC-days as the denominator, and the number of CAUTIs as numerator. To estimate CAUTI RFs, we analyzed the following 10 variables using multiple logistic regression: gender, age, length of stay (LOS) before CAUTI acquisition, UC-days before CAUTI acquisition, UC-device utilization (DU) ratio, UC-type, hospitalizationtype, ICU type, facility ownership, and time period.

Results

31,631 patients, hospitalized for 214,669 patient-days, acquired 305 CAUTIs. The pooled CAUTI rate per 1000 UC-days was 2.58, for those using suprapubic catheters, it was 2.99, and for those with indwelling catheters, it was 2.21. The following variables were independently associated with CAUTI: age, rising risk 1% yearly (aOR = 1.01; 95% CI 1.01–1.02; p < 0.0001 female gender (aOR = 1.28; 95% CI 1.01–1.61; p = 0.04), LOS before CAUTI acquisition, rising risk 7% daily (aOR = 1.07; 95% CI 1.06–1.08; p < 0.0001, UC/DU ratio (aOR = 1.14; 95% CI 1.08–1.21; p < 0.0001, public facilities (aOR = 2.89; 95% CI 1.75–4.49; p < 0.0001. The periods 2014–2016 and 2017–2019 had significantly higher risks than the period 2020–2022. Suprapubic catheters showed similar risks as indwelling catheters.

Conclusion

The following CAUTI RFs are unlikely to change: age, gender, hospitalization type, and facility ownership. Based on these findings, it is suggested to focus on reducing LOS, UC/DU ratio, and implementing evidence-based CAUTI prevention recommendations.

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Author information

Authors and Affiliations

  1. Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, USA

    Ruijie Yin, Zhilin Jin & Victor Daniel Rosenthal

  2. University of Miami, Coral Gables, USA

    Brandon Hochahn Lee

  3. Instituto Central De Medicina, La Plata, Provincia de Buenos Aires, Argentina

    Gustavo Andres Alvarez & Juan Pablo Stagnaro

  4. Pontificia Universidad Javeriana Hospital Universitario San Ignacio, Bogotá, Colombia

    Sandra Liliana Valderrama-Beltran & Sandra Milena Gualtero

  5. Clinica Universitaria Colombia, Bogotá, Colombia

    Lidia Patricia Reyes

  6. Fundacion Hospital San Jose De Buga, Guadalajara De Buga, Colombia

    Claudia Milena Henao Rodas

  7. Clinica Sebastian de Belalcazar, Cali, Colombia

    Katherine Gomez & Johana Alarcon

  8. Clinica Infantil Santa María del Lago, Bogotá, Colombia

    Lina Alejandra Aguilar Moreno & Juan Sebastian Bravo Ojeda

  9. Instituto Del Corazon De Bucaramanga Sede Bogota, Bogotá, Colombia

    Yuliana Andrea Cano Medina & Edwin Giovannny Chapeta Parada

  10. Hospital Clinica Biblica, San Jose de Costa Rica, Costa Rica

    Maria Adelia Zuniga Chavarria & Ana Marcela Quesada Mora

  11. Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico

    Guadalupe Aguirre-Avalos & Julio Cesar Mijangos-Méndez

  12. Hospital Regional de Alta Especialidad Ixtapaluca, Ixtapaluca, Mexico

    Alejandro Sassoe-Gonzalez & Claudia Marisol Millán-Castillo

  13. Hospital San Jose TecSalud, Monterrey, Nuevo Leon, Mexico

    Mary Cruz Aleman-Bocanegra & Clara Veronica Echazarreta-Martínez

  14. Hospital General Regional 6 de Ciudad Madero, Madero, Mexico

    Blanca Estela Hernandez-Chena & Rajab Mohamed Abu Jarad

  15. Instituto Nacional de Perinatología, Mexico DF, Mexico

    Maria Isabel Villegas-Mota & Mildred Montoya-Malváez

  16. Hospital del Niño Dr José Renán Esquivel, Panama, Panama

    Daisy Aguilar-de-Moros, Elizabeth Castaño-Guerra & Judith Córdoba

  17. Hospital Victor Lazarte Echegaray, Trujillo, Peru

    Alex Castañeda-Sabogal

  18. Hospital Sao Paulo, Universidade Federal de Sao Paulo, Sao Paulo, Brazil

    Eduardo Alexandrino Medeiros & Dayana Fram

  19. Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador

    Lourdes Dueñas

  20. Hospital de Emergencias Pediatricas, Universidad Peruana de Ciencias Aplicadas, Lima, Peru

    Nilton Yhuri Carreazo

  21. Department of Infection Control, Hospital Marie Curie, Quito, Ecuador

    Estuardo Salgado

  22. International Nosocomial Infection Control Consortium, INICC Foundation, Miami, USA

    Victor Daniel Rosenthal

Authors
  1. Ruijie Yin
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  2. Zhilin Jin
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  3. Brandon Hochahn Lee
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  4. Gustavo Andres Alvarez
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  6. Sandra Liliana Valderrama-Beltran
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  7. Sandra Milena Gualtero
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  8. Luisa Fernanda Jiménez-Alvarez
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  9. Lidia Patricia Reyes
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  10. Claudia Milena Henao Rodas
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  11. Katherine Gomez
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  12. Johana Alarcon
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  13. Lina Alejandra Aguilar Moreno
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  14. Juan Sebastian Bravo Ojeda
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  15. Yuliana Andrea Cano Medina
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  16. Edwin Giovannny Chapeta Parada
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  17. Maria Adelia Zuniga Chavarria
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  18. Ana Marcela Quesada Mora
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  19. Guadalupe Aguirre-Avalos
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  20. Julio Cesar Mijangos-Méndez
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  21. Alejandro Sassoe-Gonzalez
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  22. Claudia Marisol Millán-Castillo
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  23. Mary Cruz Aleman-Bocanegra
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  24. Clara Veronica Echazarreta-Martínez
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  26. Rajab Mohamed Abu Jarad
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  27. Maria Isabel Villegas-Mota
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  28. Mildred Montoya-Malváez
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  29. Daisy Aguilar-de-Moros
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  30. Elizabeth Castaño-Guerra
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  31. Judith Córdoba
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  32. Alex Castañeda-Sabogal
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  33. Eduardo Alexandrino Medeiros
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  34. Dayana Fram
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  35. Lourdes Dueñas
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  36. Nilton Yhuri Carreazo
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  37. Estuardo Salgado
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  38. Victor Daniel Rosenthal
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Contributions

RY data management, data analysis, manuscript writing, manuscript editing. ZJ data management, data analysis, manuscript writing, manuscript editing. BHL manuscript writing, manuscript editing. GAA data collection, manuscript editing. JPS data collection, manuscript editing. SLV-B data collection, manuscript editing. SMG data collection, manuscript editing. LFJ-A data collection, manuscript editing. LPR data collection, manuscript editing. CMH-R data collection, manuscript editing. KG data collection, manuscript editing. JA data collection, manuscript editing. LAA-M data collection, manuscript editing. JSB-O data collection, manuscript editing. YAC-M data collection, manuscript editing. EGC-P data collection, manuscript editing. MAZ-C data collection, manuscript editing. AMQ-M data collection, manuscript editing. GA-A data collection, manuscript editing. JCM-M data collection, manuscript editing. AS-G data collection, manuscript editing. CMM-C data collection, manuscript editing. MCA-B data collection, manuscript editing. CVE-M data collection, manuscript editing. BEH-C data collection, manuscript editing. RMAJ data collection, manuscript editing. MIV-M data collection, manuscript editing. MM-M data collection, manuscript editing. DAM data collection, manuscript editing. EC-G data collection, manuscript editing. JC data collection, manuscript editing. AC-S data collection, manuscript editing. EAM data collection, manuscript editing. DF data collection, manuscript editing. LD data collection, manuscript editing. NYC data collection, manuscript editing. ES data collection, manuscript editing. VDR protocol development, project development, data collection, data management, data analysis, manuscript writing, manuscript editing.

Corresponding author

Correspondence to Victor Daniel Rosenthal.

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Conflict of interest

All authors declare that they do not have any financial or personal relationships with other people or organizations that could inappropriately influence (bias) their work. All authors declare that they have no potential competing interests, such as employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications or registrations, and grants or other funding. Submission of this article implies that the work described has not been published previously, that it is not under consideration for publication elsewhere, that its publication is approved by all authors and tacitly or explicitly by the responsible authorities where the work was carried out, and that, if accepted, it will not be published elsewhere in the same form, in English or in any other language, including electronically, without the written consent of the copyright holder.

Research involving human participants and/or animals

This project involved the analysis of big data collected prospectively using standardized forms. There was not any recruitment involved. The study sample reflects the demographics of the hospitalized patients in intensive care units (ICUs) in Latin America, which are 50/50 male and female. The hospital team's ICU surveillance of catheter-related urinary tract infections (CAUTI) rates was based on U.S. CDC/NHSN methodology, without patient identifiers or any patient detail, and collected only "urinary catheter” and "acquisition of a CAUTI." Our IPPs obtained CAUTI surveillance data from ICU records of surveillance without being in contact with patients. To determine the rates of CAUTI, IPPs visited all ICUs and checked ICU records from Monday to Friday for 60 min each time. On Mondays, weekend data were collected. This gold standard approach to CR-BSI and MDRO surveillance is a well-documented method that adheres to the legal and ethical framework of the US CDC NHSN.

Informed consent

This is a surveillance study without any intervention, and for that reason, informed consent was not required. The research team maintained the highest level of confidentiality with the data of hospitalized patients. Individually identifiable information was not collected or shared with anyone. Any potential data and identifiers were removed at data entry. These data were kept in separate, locked file drawers and on a password-protected computer. The computerized data were kept on a non-networked computer. Only de-identified datasets were kept on a computer that resides inside the university network and is protected by multiple firewalls. VD Rosenthal, Z Jin, and R Yin had access to the collected data. This research did not collect any information on the participants, thus no personal identifier information.

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Yin, R., Jin, Z., Lee, B.H. et al. Prospective cohort study of incidence and risk factors for catheter-associated urinary tract infections in 145 intensive care units of 9 Latin American countries: INICC findings. World J Urol 41, 3599–3609 (2023). https://doi.org/10.1007/s00345-023-04645-z

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