Risk Factors for Multiresistant Catheter-Associated Urinary Tract Infection in the Paediatric Critical Patient.

Aim: Catheter-associated urinary tract infections (CAUTIs) are common hospital-acquired infections in the paediatric intensive care unit (PICU), with high rates of multidrug resistance (MDR), conditioning worse outcomes. The aim of the study was to identify specific MDR-CAUTI risk factors and to compare outcomes between MDR and non-MDR infections.

Methods: Single centre, prospective, observational study, conducted between 2015 and 2022, including PICU patients with a microbiologically confirmed CAUTI. Demographical, clinical, and microbiological data and outcomes were compared among patients with and without MDR-CAUTI.

Results: Ninety-one CAUTI episodes were included, 32 (35.2%) caused by MDR microorganisms. In the univariate analysis, comorbidity (p = 0.010), previous antibiotic therapy (p = 0.003), first 48 h antibiotic exposure (p = 0.005), PICU stay before CAUTI (p = 0.017), previous MDR colonisation (p < 0.001), and previous MDR infection (p = 0.002) were associated with MDR-CAUTI. In the multivariate analysis, previous colonisation (OR 6.056), previous MDR infection (OR 9.153), and first 48 h antibiotic exposure (OR 3.029) were independently associated with MDR-CAUTI. Higher empirical treatment inappropriateness (39.3% vs. 7.1%, p < 0.001) and longer stays were observed for MDR-CAUTI, without differences in mortality.

Conclusions: MDR rates among CAUTI in PICU are concerning and can jeopardise empirical treatment success. Acknowledging risk factors for MDR-CAUTI is crucial to guide empirical antibiotic therapy.