Uropathogens in Catheterized ICU Patients: Frequency, Pattern and Antimicrobial Susceptibility

Abstract

Background: Catheter-associated urinary tract infections (CAUTIs) are among the leading healthcare-associated infections in intensive care units (ICUs), contributing to prolonged hospitalization, antimicrobial resistance, and increased mortality. Locally relevant data from Pakistani ICUs on uropathogen profiles and resistance patterns are limited.

Objective: To determine the frequency, microbiological profile, and antimicrobial susceptibility of uropathogens causing CAUTI in catheterized ICU patients at a tertiary care hospital in Lahore, Pakistan.

Methods: A cross-sectional study was conducted from December 2024 to April 2025 in the Medical ICU of Mayo Hospital, Lahore. Urine samples from 70 eligible patients were cultured on CLED, Blood, and MacConkey agars, followed by Gram staining and biochemical identification. Antimicrobial susceptibility testing was performed using the Kirby–Bauer disk diffusion method according to CLSI 2024 guidelines. Phenotypic extended-spectrum beta-lactamase (ESBL) and carbapenemase detection were performed. Data were analysed using SPSS version 26.0.

Results: Eighteen of 70 patients (25.7%) had culture-confirmed CAUTI. Predominant isolates were Candida albicans (33.3%), Klebsiella pneumoniae (27.8%), Escherichia coli (16.7%), Acinetobacter spp. (16.7%), and Staphylococcus aureus (5.5%). ESBL was confirmed in 60% K. pneumoniae and 66.7% E. coli isolates. All three Acinetobacter isolates were carbapenem-resistant. Prolonged catheterization was significantly associated with CAUTI (p =0.003), while female sex and diabetes mellitus also showed notable associations.

Conclusion: The CAUTI affected approximately one in four catheterized ICU patients and was predominantly caused by multidrug-resistant organisms, including ESBL-producing Klebsiella pneumoniae and Escherichia coli and carbapenem-resistant Acinetobacter species, together with a notable proportion of Candida albicans.