Antimicrobial-resistant pathogens related to catheter-associated urinary tract infections in intensive care units: A multi-center retrospective study in the Western region of Saudi Arabia

Abstract

BackgroundCatheter-associated urinary tract infections (CAUTIs) are among the most common types of healthcare-associated infections. In Saudi Arabian hospitals, there is a scarcity of data on the pathogens and factors that cause CAUTIs. Therefore, data on the specific regional patterns of pathogens and their resistance are needed to update clinical practices to treat infectious diseases. This multicenter study explored antimicrobial-resistant pathogens causing CAUTIs in the intensive care unit (ICU). MethodsA retrospective cohort study was conducted on patients in ICUs in three centers between January 2017 and December 2020. The list of pathogens that caused CAUTIs, resistant pathogens, and medications used for treating CAUTI were identified from patient records (n = 393). ResultsA total of 162 of 393 (41.2%) patients from three hospitals were diagnosed with CAUTIs, of whom 55.5% were females and 67.7% were from Saudi Arabia. The patients had ages ranging from 47 to 73 years, with a median weight of 75.0 kg. Around 91.1% of them had a 2-way latex catheter, whereas only 8.9% had a silicone catheter. Twenty different pathogenic microorganisms have been found to cause CAUTI, including Candida albicans (18.4%), Escherichia coli (13.5%), yeast other than Candida (10.4%), and Klebsiella pneumonia (8.5%). Among the causative pathogens recorded by CAUTI, 19.67% were antibiotic-resistant pathogens. The most resistant isolates recorded from CAUTI in the ICUs were carbapenem-resistant Enterobacteriaceae K. pneumonia (n = 17), and extended-spectrum β-lactamase K. pneumonia and E. coli (n = 11 and 19, respectively). The incidence rate of antimicrobial resistance among the study participants was 62.0%. Three cases of untreated pan-drug-resistant pathogens were recorded. Resistance to ciprofloxacin (16.5%) and trimethoprim or sulfamethoxazole (16.1%) was the most frequently observed pathogen. Importantly, antimicrobial resistance was significantly different between males and females (χ2 = 4.65, P < 0.031). ConclusionAntimicrobial-resistant pathogens pose a real challenge in ICU clinical practice. Our study provides information about patterns of antibiotic resistance and risk factors for CAUTI-related infections in ICUs in Saudi Arabian hospitals.