Urinary Tract Infections in a Paediatric Intensive Care Unit: A Three-Year Retrospective Study

Abstract

Urinary tract infections (UTIs) are one of the most common nosocomial bacterial infections in children. This study aimed to investigate the prevalence of UTIs and determine the factors associated with UTI onset in children hospitalised in the PICU. A retrospective study was conducted on data collected from 2015 to 2017 and analysed medical records of 308 patients (aged from 23 days to 17 years old) who were admitted to the PICU. The analysis focused more on 144 patients with urine cultures (positive/sterile) and catheterization, analysing commonalities in the variables such as individual characteristics, days of catheterization and length of PICU stay, urine culture result test, bacteria species, etc. The mean age of the 308 hospitalised children was 6.6 ± 5.5 years old, and 174 out of 308 (56.5%) underwent urinary catheterization; however, 144 out of 174 had a urine culture available. Also, 11 out of 144 (7.6%) were diagnosed with UTIs (positive urine culture) with a mean age of 2.3 ± 2.6 years old. Children with UTIs were hospitalised the longest (22.9 vs. 8.6 days, p = 0.001). The hierarchical models of the logistic regression analysis revealed that participants with increment days of catheter placement (> 5 days, > 10) were more likely to present UTI (OR = 2.30; 1.39–3.81, p = 0.001) compared to participants with no catheter, suggesting that longer duration of catheterization was strongly and independently associated with a higher probability of UTI and thus with catheter-associated urinary tract infections (CUTIs) development. Furthermore, higher age was related to lower odds of having UTI (OR = 0.75; 0.59–0.96, p = 0.023), even after adjusting for days of catheterization (OR = 0.76; 0.57–0.99, p = 0.047) and although females were twice more likely to present UTIs (OR = 1.72; 0.42–6.97, p = 0.451) compared to males, this association was not significant. UTIs are linked to prolonged urinary catheter use, especially in younger females. This suggests UTIs may cause CAUTIs. Interventions to reduce UTIs are crucial in the paediatric intensive care unit (PICU).