Catheter-associated urinary tract infections in the intensive care unit during and after the COVID- 19 pandemic

Background: Urinary tract infections (UTIs) acquired in hospitals, particularly among patients in intensive care units (ICUs), are prevalent and represent a significant clinical issue as they are associated with increased patient morbidity, prolonged hospital stays, elevated healthcare costs, and antimicrobial resistance development. Methods: This study was conducted in the ICU of the University Hospital in Wrocław, Poland, from January 1, 2020, to June 30, 2024, and included 2,751 patients. The aim was to evaluate the incidence, epidemiological, and microbiological characteristics, mortality rates, and prevention strategies of UTIs during and after COVID-19 pandemic. Results: Catheter-Associated Urinary Tract Infection (CAUTI) (48 hours after admission) was recorded in 243/2751 (8.83%) patients, whereas UTI at admission was found in 63/2751 (2.3%). The mean CAUTI incidence rate (per 1,000 patient-days) was 6.99, 95% CI (6.13-7.85), whereas the mean CAUTI incidence density (per 1,000 urinary catheter days) was 7.04, 95% CI (6.18-7.91). CAUTI was significantly more frequent in females (12.32%) than in males (6.85%), p = 0.0000008, and in internal-medical patients (14.07%) compared to surgical patients (6.45%), p < 0.000001. The mean CAUTI density during the pandemic equaled 8.03, 95% CI (6.46-9.60) and was greater than in the post-pandemic period 6.25, 95% CI (5.34-7.17), p = 0.051. No statistically significant difference was observed in CAUTI incidence between COVID-positive 27/264 (10.23%) and COVID-negative 83/904 (9.18%) patients, p = 0.942. The most frequently identified pathogen in CAUTI was Klebsiella pneumoniae ESBL/MBL, whereas in UTI at admission, it was Escherichia coli. The percentage of alert pathogens among CAUTI etiological factors was significantly higher during the pandemic 72/116 (62.07%), compared to the post-pandemic period 62/143 (43.36%), p = 0.002. There was no statistically significant difference in mortality between CAUTI patients 56/207 (27.05%) and patients without CAUTI 810/2,544 (31.84%), p = 0.119. Conclusion: Although there were no statistically significant differences observed in CAUTI incidence between COVID-positive and COVID-negative patients, CAUTI remains a significant challenge in the ICU setting, with particularly elevated risks among female and internal-medical patients. Consistent monitoring of CAUTI, implementation, evaluation of preventive measures, and ongoing assessment are essential for improving clinical outcomes. © The Author(s) 2025.