학술논문
Prospective Cohort Study of Incidence and Risk Factors for Catheter-associated Urinary Tract Infections in 212 Intensive Care Units of Nine Middle Eastern Countries.
Document Type
Academic Journal
Author
Jin Z; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA.; Yin R; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA.; Brown EC; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA.; Shukla B; Department of Medicine, University of Miami Miller School of Medicine, Miami, USA.; Lee BH; University of Miami, Miller School of Medicine. Miami, USA.; Abdulaziz-Alkhawaja S; Department of Critical Care, Salmaniya Medical Center, Manama, Bahrain.; Magray TA; Department of Critical Care, Salmaniya Medical Center, Manama, Bahrain.; Agha HM; Department of Critical Care, Cairo University Specialized Pediatric Hospital, Cairo, Egypt.; El-Sisi A; Department of Critical Care, Cairo University Specialized Pediatric Hospital, Cairo, Egypt.; Ali El-Kholy A; Department of Critical Care, Dar Alfouad Hospital, 6th of October City, Egypt.; Bayani V; Department of Critical Care, Dar Alfouad Hospital, 6th of October City, Egypt.; Daboor MA; Department of Critical Care, King Hussein Cancer Center, Amman, Jordan.; Ruzzieh MAA; Department of Critical Care, King Hussein Cancer Center, Amman, Jordan.; Guclu E; Department of Critical Care, Sakarya University Training and Research Hospital, Sakarya, Turkey.; Olmez-Gazioglu E; Department of Critical Care, Sakarya University Training and Research Hospital, Sakarya, Turkey.; Dursun O; Department of Critical Care, Akdeniz University Medical School, Antalya, Turkey.; Kara TT; Department of Critical Care, Akdeniz University Medical School, Antalya, Turkey.; Koksal I; Department of Critical Care, Karadeniz Technical University School of Medicine, Trabzon, Turkey.; Eroglu A; Department of Critical Care, Karadeniz Technical University School of Medicine, Trabzon, Turkey.; Havan M; Department of Critical Care, Ankara University Faculty of Medicine, Ankara, Turkey.; Kendirli T; Department of Critical Care, Ankara University Faculty of Medicine, Ankara, Turkey.; Ozturk Deniz SS; Department of Critical Care, Pamukkale University Hospital, Denizli, Turkey.; Aktas G; Department of Critical Care, Pamukkale University Hospital, Denizli, Turkey.; Yildizdas D; Department of Critical Care, Balcali Hospital Pediatric Intensive Care Unit, Adana, Turkey.; Horoz OO; Department of Critical Care, Balcali Hospital Pediatric Intensive Care Unit, Adana, Turkey.; Okulu E; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA.; Department of Critical Care, Salmaniya Medical Center, Manama, Bahrain.; Kostekci YE; Neonatal Intensive Care Unit, Children's Hospital, Ankara University Faculty of Medicine, Ankara, Turkey.; Omar AA; Infection Control Directorate, Ministry of Health, Kuwait City, Kuwait.; Memish ZA; Department of Infection Control, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia.; Rosenthal VD; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA.; International Nosocomial Infection Control Consortium Foundation, Miami, USA.
Source
Publisher: Oman Medical Specialty Board Country of Publication: Oman NLM ID: 101526350 Publication Model: eCollection Cited Medium: Print ISSN: 1999-768X (Print) Linking ISSN: 1999768X NLM ISO Abbreviation: Oman Med J Subsets: PubMed not MEDLINE
Subject
Language
English
ISSN
1999-768X
Abstract
Objectives: To identify urinary catheter (UC)-associated urinary tract infections (CAUTI) incidence and risk factors (RF) in nine Middle Eastern countries.
Methods: We conducted a prospective cohort study between 1 January 2014 and 2 December 2022 in 212 intensive care units (ICUs) of 67 hospitals in 38 cities in nine Middle Eastern countries (Bahrain, Egypt, Jordan, Kuwait, Lebanon, Morocco, Saudi Arabia, Turkey, and the UAE). To estimate CAUTI incidence, we used the number of UC days as denominator and the number of CAUTIs as numerator. To estimate CAUTI RFs, we analyzed the following 10 variables using multiple logistic regression: patient sex, age, length of stay (LOS) before CAUTI acquisition, UC-days before CAUTI acquisition, UC-device utilization (DU) ratio, hospitalization type, ICU type, facility-ownership, country income level classified by World Bank, and time period.
Results: Among 50 637 patients hospitalized for 434 523 patient days, there were 580 cases of acquired CAUTIs. The pooled CAUTI rate per 1000 UC days was 1.84. The following variables were independently associated with CAUTI: age, rising risk 1.0% yearly (adjusted odds ratio [aOR] = 1.01, 95% CI: 1.01-1.02; p < 0.0001); female sex (aOR = 1.31, 95% CI: 1.09-1.56; p < 0.0001); LOS before CAUTI acquisition, rising risk 6.0% daily (aOR = 1.06, 95% CI: 1.05-1.06; p < 0.0001); and UC/DU ratio (aOR = 1.11, 95% CI: 1.06-1.14; p < 0.0001). Patients from lower-middle-income countries (aOR = 4.11, 95% CI: 2.49-6.76; p < 0.0001) had a similar CAUTI risk to the upper-middle countries (aOR = 3.75, 95% CI: 1.83-7.68; p < 0.0001). The type of ICU with the highest risk for CAUTI was neurologic ICU (aOR = 27.35, 95% CI: 23.03-33.12; p < 0.0001), followed by medical ICU (aOR = 6.18, 95% CI: 2.07-18.53; p < 0.0001) when compared to cardiothoracic ICU. The periods 2014-2016 (aOR = 7.36, 95% CI: 5.48-23.96; p < 0.001) and 2017-2019 (aOR = 1.15, 95% CI: 3.46-15.61; p < 0.001) had a similar risk to each other, but a higher risk compared to 2020-2022.
Conclusions: The following CAUTI RFs are unlikely to change: age, sex, ICU type, and country income level. Based on these findings, it is suggested to focus on reducing LOS, UC/DU ratio, and implementing evidence-based CAUTI prevention recommendations.
(Copyright © 2023, Oman Medical Journal.)
Methods: We conducted a prospective cohort study between 1 January 2014 and 2 December 2022 in 212 intensive care units (ICUs) of 67 hospitals in 38 cities in nine Middle Eastern countries (Bahrain, Egypt, Jordan, Kuwait, Lebanon, Morocco, Saudi Arabia, Turkey, and the UAE). To estimate CAUTI incidence, we used the number of UC days as denominator and the number of CAUTIs as numerator. To estimate CAUTI RFs, we analyzed the following 10 variables using multiple logistic regression: patient sex, age, length of stay (LOS) before CAUTI acquisition, UC-days before CAUTI acquisition, UC-device utilization (DU) ratio, hospitalization type, ICU type, facility-ownership, country income level classified by World Bank, and time period.
Results: Among 50 637 patients hospitalized for 434 523 patient days, there were 580 cases of acquired CAUTIs. The pooled CAUTI rate per 1000 UC days was 1.84. The following variables were independently associated with CAUTI: age, rising risk 1.0% yearly (adjusted odds ratio [aOR] = 1.01, 95% CI: 1.01-1.02; p < 0.0001); female sex (aOR = 1.31, 95% CI: 1.09-1.56; p < 0.0001); LOS before CAUTI acquisition, rising risk 6.0% daily (aOR = 1.06, 95% CI: 1.05-1.06; p < 0.0001); and UC/DU ratio (aOR = 1.11, 95% CI: 1.06-1.14; p < 0.0001). Patients from lower-middle-income countries (aOR = 4.11, 95% CI: 2.49-6.76; p < 0.0001) had a similar CAUTI risk to the upper-middle countries (aOR = 3.75, 95% CI: 1.83-7.68; p < 0.0001). The type of ICU with the highest risk for CAUTI was neurologic ICU (aOR = 27.35, 95% CI: 23.03-33.12; p < 0.0001), followed by medical ICU (aOR = 6.18, 95% CI: 2.07-18.53; p < 0.0001) when compared to cardiothoracic ICU. The periods 2014-2016 (aOR = 7.36, 95% CI: 5.48-23.96; p < 0.001) and 2017-2019 (aOR = 1.15, 95% CI: 3.46-15.61; p < 0.001) had a similar risk to each other, but a higher risk compared to 2020-2022.
Conclusions: The following CAUTI RFs are unlikely to change: age, sex, ICU type, and country income level. Based on these findings, it is suggested to focus on reducing LOS, UC/DU ratio, and implementing evidence-based CAUTI prevention recommendations.
(Copyright © 2023, Oman Medical Journal.)