Burden and Antimicrobial Resistance Trends of Catheter-Associated and Non-Catheter UTIs in Trauma Care: A Retrospective Analysis (2017–2024)

Abstract Background:Catheter-associated urinary tract infections (CAUTIs) are a major healthcare-associated infection (HAI) in trauma care settings, contributing to morbidity, mortality and antimicrobial resistance. In this study we characterize the epidemiology, microbiological profile, antimicrobial resistance patterns, and clinical outcomes of CAUTIs and non-CAUTI urinary tract infections (UTIs) at a Level 1 Trauma Centre in India from 2017 to 2024, using a modified CDC-NHSN definition and digital surveillance. Methods: A retrospective analysis of 723 UTI events was conducted using Centers for Disease Control and Prevention’s National Healthcare Safety Network (CDC-NHSN) definitions, modified to include Candida spp. at ≥10⁵CFU/mL. Surveillance was performed by dedicated Hospital Infection Control Nurses (HICNs) using a digital system. Microbiological identification and antimicrobial susceptibility testing (AST) were conducted via the conventional manual methods and automated systems. Results: of 723 UTI events, 608 (84.0%) were CAUTIs. The cohort had a median age of 34 years (IQR:22-45) and was 76% male. Pseudomonas aeruginosa (18%), Klebsiella pneumoniae (17.9%), and Escherichia coli (15%) were predominant pathogens. Antimicrobial resistance was high, with 100% resistance to ceftazidime in Acinetobacter baumannii and 93.6-94.1% resistance to ciprofloxacin in Klebsiella spp. and Enterococcus spp. Mortality was 25.5% (28.2% in CAUTI, 12.9% in non-CAUTI). Conclusion: This large-scale, trauma specific study with modified fungal criteria and digital surveillance highlights the importance of CAUTI burden and the high resistance in pathogens causing this infection.