Impact of urinary catheter on resistance patterns and clinical outcomes on complicated urinary tract infection.

Introduction and hypothesis Complicated urinary tract infection (cUTI) is highly prevalent and costly for health systems. The impact of the indwelling urinary catheter on etiologic agents and clinical outcomes has been poorly studied
in Latin America.
Methods Cross-sectional study including patients with cUTI, with positive urine culture, treated at Hospital Universitario San Ignacio, Bogotá (Colombia) between 2017 and 2020. Clinical and microbiologic characteristics, treatments
and outcomes are explored, comparing those with and without indwelling urinary catheter.
Results Seven hundred thirty-five patients with non-catheter-associated cUTI (NC-cUTI) and 165 with catheterassociated cUTI (CAUTI) were included. CAUTI group had a higher proportion of recurrent UTI (18% vs 33.3%, p
< 0.001), ICU requirement (2.7% vs 8.5%, p < 0.001), longer hospital stay (6 vs 10 days, p < 0.001) and > 30 days
unplanned readmission rate (5.8% vs 10.3%, p < 0.001). In the same group, we found a higher frequency of Pseudomonas spp (2.6% vs 9.4%, p < 0.001), Enterococcus spp. (2.4% vs 3.3%, p = 0.016), Serratia marcescens (0.6% vs
3.3%, p < 0.001) and Citrobacter freundii (0.5% vs 5.7%, p < 0.001). It implied a higher number of patients treated
with fourth-generation cephalosporins (1.4% vs 4.8%, p = 0.004), ertapenem (32.9% vs 41.8%, p = 0.027) and carbapenems associated with a second antibiotic (1.9% vs 8.5%, p < 0.001).
Conclusions Patients with CAUTI have a higher frequency of resistant germs, require greater use of resources and
have worse clinical outcomes than patients who do not require such devices. Measures should be strengthened to
minimize its use, in both the hospital and outpatient setting.