Catheter Associated Urinary Tract Infection in Patients Admitted to Katihar Medical College Hospital, Katihar, Bihar

Abstract

Catheter associated urinary tract infection (CAUTI) is the commonest device associated infection acquired from hospital settings. CAUTI accounts for 80% of all nosocomial urinary tract infection and 40% of all hospital acquired infection. Approximately 15% to 25% of patients in hospitals have to undergo catheterization at some time during their stay. CAUTI according to the Centre of Disease Control and Prevention (CDC) is defined as urinary tract infection where an indwelling urinary catheter was in place for more than two calendar days on the day of event (day one being the day of device placement).
Materials and Methods: This prospective observational study was carried out from April 2024 to September 2025 over a period of 18 months in the department of Microbiology, Katihar Medical College, Katihar, Bihar. Determination of the risk factors and etiological agents associated with CAUTI, antimicrobial and antifungal susceptibility pattern of isolates was done using standard microbiological procedures. CAUTI rate was calculated per 1000 catheter days.
Results: A total of 3826 urine samples were received in the laboratory during the study period, out of which 3453 were voided urine samples and 373 were catheterized urine samples. 621 of the voided urine samples and 57 of the catheterized urine samples showed growth. CAUTI rate was found to be 8.8 per 1000 urinary catheter days. Maximum CAUTI patients were seen in 51-60 years age group 20/57(35.1%) followed by 41-50 years age group 12/57 (21.1%). Female to male ratio was found to be 3:1. The highest number of CAUTI cases were seen from the Obstetrics and Gynaecology department comprising 20/57 (35.1%), followed by General Medicine 17/57 (29.8%) whereas the least number of CAUTI cases were seen from the Orthopaedics department accounting for 2/57 (3.5%). Predominant isolates were Escherichia coli 22/57 (38.6%), followed by Klebsiella pneumoniae and Pseudomonas aeruginosa 7/57 (12.3%) each. Less common ones were Candida albicans 5/57 (8.8%), Enterococcus faecalis 4/57 (7.0%), Acinetobacter baumannii and Enterobacter spp. 3/57 (5.3%) each, Candida tropicalis and Candida guilliermondii 2/57 (3.5%) each, Enterococcus faecium and Serratia spp. 1/57 (1.7%) each. The association of gender, age group, duration of catheterization with CAUTI was found to be statistically significant (p value<0.05) whereas diabetes and hypertension were independent risk factors of CAUTI. Gram-positive cocci showed 100% resistance to gentamicin high level, ciprofloxacin, levofloxacin and erythromycin. Gram- negative bacilli (fermenters) showed 100% resistance to cefalotin and ampicillin followed by cefixime (94.0%), ceftriaxone (93.9%). Gram- negative bacilli (non-fermenters) showed 100% resistance to cotrimoxazole, levofloxacin, cephalosporins, carbapenems and aztreonam. Antifungal susceptibility pattern of Candida species showed 100% sensitivity to amphotericin B, voriconazole, micafungin, flucytosine and fluconazole.
Conclusion: CAUTI rate was found to be 8.8 per 1000 urinary catheter days which is similar to the CAUTI rates reported in several other studies done across India. The duration of urinary catheterization was found to be a predominant risk factor for CAUTI. Maximum CAUTI patients were seen in 51-60 years age group. Female to male ratio was found to be 3:1. There was a predominance of Gram-negative pathogens, majority of which were multidrug resistant.