Identifying the risk factors for catheter-associated urinary tract infections: a large cross-sectional study of six hospitals
Related Experiment Video
Updated: Jan 28, 2026
An In Vitro Bladder Model of Catheter-Associated Urinary Tract Infection
Published on: June 24, 2025
Allison S Letica-Kriegel1, Hojjat Salmasian2,3, David K Vawdrey4,5
1Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
Insights
Catheter-associated urinary tract infections (CAUTI) risk increases with each day of catheter use. Female sex, paraplegia, and cerebrovascular disease are significant risk factors for developing CAUTI.
Area of Science:
- Healthcare-associated infections
- Infectious disease epidemiology
- Patient safety research
Background:
- Catheter-associated urinary tract infections (CAUTI) are a significant healthcare burden.
- Existing research has gaps regarding CAUTI risk factors, particularly catheter dwell time and patient comorbidities.
Purpose of the Study:
- To analyze the relationship between urinary catheter dwell time and CAUTI risk.
- To identify patient-specific risk factors (age, sex, comorbidities) that modify CAUTI risk over time.
Main Methods:
- Retrospective cohort study of over 47,000 patients undergoing catheterization between 2012 and 2016.
- Analysis of indwelling urinary catheterization duration as the primary exposure variable.
- Inclusion of both pediatric and adult patients within a large urban academic health system.
Main Results:
- A total of 61,047 catheterizations were analyzed, with 1.41% resulting in CAUTI.
- CAUTI rates increased non-linearly with each additional day of catheterization.
- CAUTI-free survival decreased significantly over time (71.8% at 60 days).
- Paraplegia, cerebrovascular disease, and female sex were identified as significant risk factors for CAUTI.
Conclusions:
- The duration of urinary catheterization is a critical, incremental risk factor for CAUTI.
- Specific patient characteristics, including female sex and certain neurological/vascular conditions, elevate CAUTI hazard.
- Targeted interventions for high-risk patients are crucial for CAUTI prevention.
Motivation:
Catheter-associated urinary tract infections (CAUTI) are a common and serious healthcare-associated infection. Despite many efforts to reduce the occurrence of CAUTI, there remains a gap in the literature about CAUTI risk factors, especially pertaining to the effect of catheter dwell-time on CAUTI development and patient comorbidities.
Objective:
To examine how the risk for CAUTI changes over time. Additionally, to assess whether time from catheter insertion to CAUTI event varied according to risk factors such as age, sex, patient type (surgical vs medical) and comorbidities.
Design:
Retrospective cohort study of all patients who were catheterised from 2012 to 2016, including those who did and did not develop CAUTIs. Both paediatric and adult patients were included. Indwelling urinary catheterisation is the exposure variable. The variable is interval, as all participants were exposed but for different lengths of time.
Setting:
Urban academic health system of over 2500 beds. The system encompasses two large academic medical centres, two community hospitals and a paediatric hospital.
Results:
The study population was 47 926 patients who had 61 047 catheterisations, of which 861 (1.41%) resulted in a CAUTI. CAUTI rates were found to increase non-linearly for each additional day of catheterisation; CAUTI-free survival was 97.3% (CI: 97.1 to 97.6) at 10 days, 88.2% (CI: 86.9 to 89.5) at 30 days and 71.8% (CI: 66.3 to 77.8) at 60 days. This translated to an instantaneous HR of. 49%-1.65% in the 10-60 day time range. Paraplegia, cerebrovascular disease and female sex were found to statistically increase the chances of a CAUTI.
Conclusions:
Using a very large data set, we demonstrated the incremental risk of CAUTI associated with each additional day of catheterisation, as well as the risk factors that increase the hazard for CAUTI. Special attention should be given to patients carrying these risk factors, for example, females or those with mobility issues.
Related Concept Videos
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...
01:26Urinary Tract Infection I: Introduction
01:25Urinary Tract Infection II: Pathophysiology
01:50Cross-Sectional Research
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care
01:17Urinary Tract Infection IV: Nursing Management