Pediatric ambulatory catheter-associated urinary tract infections (CAUTIs): Incidence, risk factors, and patient outcomes
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Published on: June 24, 2025
Michael L Rinke1,2, Suzette O Oyeku1,2, Moonseong Heo3
1Children's Hospital at Montefiore, Bronx, New York.
Insights
Pediatric ambulatory CAUTIs affect 18% of children with catheters, leading to significant morbidity and healthcare use. Further research is needed to reduce these infections.
Area of Science:
- Pediatric healthcare
- Infectious disease epidemiology
- Medical device-related infections
Background:
- Catheter-associated urinary tract infections (CAUTIs) are common in hospitalized children.
- Few studies have examined CAUTIs in children using urinary catheters outside the hospital (ambulatory setting).
- Understanding ambulatory CAUTI is crucial for at-risk pediatric populations using home urinary catheterization.
Purpose of the Study:
- To determine the incidence, risk factors, and outcomes of pediatric patients experiencing ambulatory CAUTI.
- To investigate the occurrence of CAUTI in children with both indwelling and clean intermittent catheterization (CIC) in an ambulatory setting.
Main Methods:
- Retrospective cohort and case-control study design.
- Inclusion of pediatric patients (<22 years) from five urban academic medical centers (October 2010–September 2015).
- Identification of ambulatory CAUTI through electronic queries and chart review, including CIC.
Main Results:
- Out of 3,598 eligible patients, 359 used ambulatory catheters (186,616 catheter days).
- 63 patients (18%) experienced 95 ambulatory CAUTIs, with an overall incidence of 0.51 per 1,000 catheter days.
- Ambulatory indwelling catheter CAUTI incidence (1.35/1000 days) exceeded national inpatient rates; 45% of CAUTIs led to hospitalization.
Conclusions:
- Pediatric ambulatory CAUTIs affect 18% of catheterized patients, causing significant morbidity and healthcare utilization.
- The incidence of CAUTI with ambulatory indwelling catheters is higher than national inpatient CAUTI rates.
- Quality improvement initiatives are necessary to reduce the burden of pediatric ambulatory CAUTIs.
Objective:
Catheter-associated urinary tract infections (CAUTIs) occur frequently in pediatric inpatients, and they are associated with increased morbidity and cost. Few studies have investigated ambulatory CAUTIs, despite at-risk children utilizing home urinary catheterization. This retrospective cohort and case-control study determined incidence, risk factors, and outcomes of pediatric patients with ambulatory CAUTI.
Design:
Broad electronic queries identified potential patients with ambulatory urinary catheters, and direct chart review confirmed catheters and adjudicated whether ambulatory CAUTI occurred. CAUTI definitions included clean intermittent catheterization (CIC). Our matched case-control analysis assessed risk factors.
Setting:
Five urban, academic medical centers, part of the New York City Clinical Data Research Network.
Patients:
Potential patients were age <22 years who were seen between October 2010 and September 2015.
Results:
In total, 3,598 eligible patients were identified; 359 of these used ambulatory catheterization (representing186,616 ambulatory catheter days). Of these, 63 patients (18%) experienced 95 ambulatory CAUTIs. The overall ambulatory CAUTI incidence was 0.51 infections per 1,000 catheter days (1.35 for indwelling catheters and 0.47 for CIC; incidence rate ratio, 2.88). Patients with nonprivate medical insurance (odds ratio, 2.5; 95% confidence interval, 1.1-6.3) were significantly more likely to have ambulatory CAUTIs in bivariate models but not multivariable models. Also, 45% of ambulatory CAUTI resulted in hospitalization (median duration, 3 days); 5% resulted in intensive care admission; 47% underwent imaging; and 88% were treated with antibiotics.
Conclusions:
Pediatric ambulatory CAUTIs occur in 18% of patients with catheters; they are associated with morbidity and healthcare utilization. Ambulatory indwelling catheter CAUTI incidence exceeded national inpatient incidence. Future quality improvement research to reduce these harmful infections is warranted.
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