Bacterial etiology and prevalence of catheter-associated urinary tract infections in hospitalized patients: A five-year study in Rasht, Iran

Erfan  Ghanbarzadeh; Fatemeh  Abbasi Mozhdehi; Maedeh  Ghahremanzadeh Jeid; Sara  Pourmirza Langroudi; Tofigh  Yaghoubi; Mojtaba  Hedayati Ch; Hadi Sedigh Ebrahim-Saraie

doi:10.61882/jcbior.6.1.293

Authors

Erfan Ghanbarzadeh Student Research Committee, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
Fatemeh Abbasi Mozhdehi Student Research Committee, School of Dentistry, Guilan University of Medical Sciences, Rasht, Iran
Maedeh Ghahremanzadeh Jeid Student Research Committee, School of Dentistry, Guilan University of Medical Sciences, Rasht, Iran
Sara Pourmirza Langroudi Student Research Committee, School of Dentistry, Guilan University of Medical Sciences, Rasht, Iran
Tofigh Yaghoubi Razi Clinical Research Development Unit, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
Mojtaba Hedayati Ch Department of Microbiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
Hadi Sedigh Ebrahim-Saraie Department of Microbiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran https://orcid.org/0000-0001-8339-5199

DOI:

https://doi.org/10.61882/jcbior.6.1.293

Keywords:

Catheter-associated urinary tract infection, Antimicrobial resistance, Uropathogens, Nosocomial infections

Abstract

Catheter-associated urinary tract infections (CAUTIs) are among the most prevalent healthcare-associated infections, posing substantial clinical and economic burdens. The increasing incidence of antimicrobial resistance among uropathogens further complicates their management, necessitating region-specific surveillance to inform therapeutic strategies. This study aimed to assess the bacterial etiology and antibiotic resistance patterns of CAUTIs over a five-year period in a tertiary referral hospital in northern Iran. A retrospective cross-sectional analysis was conducted on 158 hospitalized patients diagnosed with CAUTIs from 2018 to 2024 at Razi Educational and Medical Center. Urine samples were processed using standard microbiological techniques, and antimicrobial susceptibility testing was performed via the Clinical and Laboratory Standards Institute (CLSI) recommended disk diffusion method. Demographic, clinical, and microbiological data were analyzed using descriptive statistics. The majority of cases were male (53.3%), with a mean age of 63 ± 14.95 years. Escherichia coli was the most frequently isolated pathogen (55.7%), followed by Klebsiella spp. (17.7%) and Citrobacter spp. (12%). High resistance rates were observed among Enterobacteriaceae, particularly against cefixime (80.5%), trimethoprim-sulfamethoxazole (79.5%), and ciprofloxacin (73.9%) for E. coli. Nitrofurantoin (18.2%) and amikacin (30.2%) with lowest resistance remained the most effective agents. E. coli remains the dominant CAUTI pathogen and exhibits high resistance to commonly prescribed antibiotics, underscoring the urgency of local resistance surveillance. Nitrofurantoin and amikacin shows promise as an effective treatment option. These findings highlight the need for targeted antimicrobial stewardship, infection control practices, and continuous regional monitoring to control resistance trends and optimize patient outcomes.

References

1. Jha T, Khaparde M, Parkhe TS, Purandare B, Lavate R. Incidence Risk Factors and Drug Resistance Patterns of Bacterial Isolates in Patients with Catheter-associated Urinary Tract Infections. Indian J Crit Care Med. 2025;29(4):338-344. DOI: 10.5005/jp-journals-10071-24932 PMID: 40322239

2. Mancuso G, Midiri A, Gerace E, Marra M, Zummo S, Biondo C. Urinary Tract Infections: The Current Scenario and Future Prospects. Pathogens. 2023;12(4):623. DOI: 10.3390/pathogens12040623 PMID: 37111509

3. Yang X, Chen H, Zheng Y, Qu S, Wang H, Yi F. Disease burden and long-term trends of urinary tract infections: A worldwide report. Front Public Health. 2022;10:888205. DOI: 10.3389/fpubh.2022.888205 PMID: 35968451

4. Venkataraman R, Yadav U. Catheter-associated urinary tract infection: an overview. J Basic Clin Physiol Pharmacol. 2022;34(1):5-10. DOI: 10.1515/jbcpp-2022-0152 PMID: 36036578

5. Rubi H, Mudey G, Kunjalwar R. Catheter-Associated Urinary Tract Infection (CAUTI). Cureus. 2022;14(10):e30385. DOI: 10.7759/cureus.30385 PMID: 36407206

6. Sabir N, Ikram A, Zaman G, Satti L, Gardezi A, Ahmed A, et al. Bacterial biofilm-based catheter-associated urinary tract infections: Causative pathogens and antibiotic resistance. Am J Infect Control. 2017;45(10):1101-1105. DOI: 10.1016/j.ajic.2017.05.009 PMID: 28629757

7. El Husseini N, Carter JA, Lee VT. Urinary tract infections and catheter-associated urinary tract infections caused by Pseudomonas aeruginosa. Microbiol Mol Biol Rev. 2024;88(4):e0006622. DOI: 10.1128/mmbr.00066-22 PMID: 39431861

8. Sweileh WM, Al-Jabi SW, Zyoud SH, Sawalha AF, Abu-Taha AS. Global research output in antimicrobial resistance among uropathogens: A bibliometric analysis (2002-2016). J Glob Antimicrob Resist. 2018;13:104-114. DOI: 10.1016/j.jgar.2017.11.017 PMID: 29224787

9. Von Vietinghoff S, Shevchuk O, Dobrindt U, Engel DR, Jorch SK, Kurts C, et al. The global burden of antimicrobial resistance - urinary tract infections. Nephrol Dial Transplant. 2024;39(4):581-588. DOI: 10.1093/ndt/gfad233 PMID: 37891013

10. Plando R, Obaid L, Al Baker AS, Khan O, Solatorio M, De Leon BJ, et al. Prevention and Control of Catheter-Associated Urinary Tract Infection (CAUTI): A Patient Safety and Quality Improvement Project. Cureus. 2024;16(10):e72105. DOI: 10.7759/cureus.72105 PMID: 39575052

11. CLSI. Performance Standards for Antimicrobial Susceptibility Testing; 35th Informational Supplement. CLSI document M100. Wayne, PA: Clinical and Laboratory Standards Institute; 2025. URL: https://clsi.org/shop/education/courses/m100-course/

12. Werneburg GT. Catheter-Associated Urinary Tract Infections: Current Challenges and Future Prospects. Res Rep Urol. 2022;14:109-133. DOI: 10.2147/RRU.S273663 PMID: 35402319

13. Vakilzadeh MM, Heidari A, Mehri A, Shirazinia M, Sheybani F, Aryan E, et al. Antimicrobial Resistance among Community-Acquired Uropathogens in Mashhad, Iran. J Environ Public Health. 2020;2020:3439497. DOI: 10.1155/2020/3439497 PMID: 33082791

14. Khosravi AD, Abasi Montazeri E, Ghorbani A, Parhizgari N. Bacterial urinary tract infection in renal transplant recipients and their antibiotic resistance pattern: A four-year study. Iran J Microbiol. 2014;6(2):74-8. PMID: 25705355

15. Hashemi SH, Esna-Ashari F, Tavakoli S, Mamani M. The prevalence of antibiotic resistance of Enterobacteriaceae strains isolated in community- and hospital-acquired infections in teaching hospitals of Hamadan, west of Iran. J Res Health Sci. 2013;13(1):75-80. PMID: 23772019

16. Bien J, Sokolova O, Bozko P. Role of Uropathogenic Escherichia coli Virulence Factors in Development of Urinary Tract Infection and Kidney Damage. Int J Nephrol. 2012;2012:681473. DOI: 10.1155/2012/681473 PMID: 22506110

17. Lupo A, Haenni M, Madec JY. Antimicrobial Resistance in Acinetobacter spp. and Pseudomonas spp. Microbiol Spectr. 2018;6(3):10.1128/microbiolspec.arba-0007-2017. DOI: 10.1128/microbiolspec.ARBA-0007-2017 PMID: 30101740

18. Chang CY, Huang PH, Lu PL. The Resistance Mechanisms and Clinical Impact of Resistance to the Third Generation Cephalosporins in Species of Enterobacter cloacae Complex in Taiwan. Antibiotics (Basel). 2022;11(9):1153. DOI: 10.3390/antibiotics11091153 PMID: 36139933

19. Dehbanipour R, Rastaghi S, Sedighi M, Maleki N, Faghri J. High prevalence of multidrug-resistance uropathogenic Escherichia coli strains, Isfahan, Iran. J Nat Sci Biol Med. 2016;7(1):22-6. DOI: 10.4103/0976-9668.175020 PMID: 27003964

20. Afsharikhah S, Ghanbarpour R, Mohseni P, Adib N, Bagheri M, Jajarmi M. High prevalence of β-lactam and fluoroquinolone resistance in various phylotypes of Escherichia coli isolates from urinary tract infections in Jiroft city, Iran. BMC Microbiol. 2023;23(1):114. DOI: 10.1186/s12866-023-02860-7 PMID: 37087426

21. Sorlozano A, Jimenez-Pacheco A, de Dios Luna Del Castillo J, Sampedro A, Martinez-Brocal A, Miranda-Casas C, et al. Evolution of the resistance to antibiotics of bacteria involved in urinary tract infections: a 7-year surveillance study. Am J Infect Control. 2014;42(10):1033-8. DOI: 10.1016/j.ajic.2014.06.013 PMID: 25278389

22. Haindongo EH, Funtua B, Singu B, Hedimbi M, Kalemeera F, Hamman J, et al. Antimicrobial resistance among bacteria isolated from urinary tract infections in females in Namibia, 2016-2017. Antimicrob Resist Infect Control. 2022;11(1):33. DOI: 10.1186/s13756-022-01066-2 PMID: 35151360

23. Sanchez GV, Baird AM, Karlowsky JA, Master RN, Bordon JM. Nitrofurantoin retains antimicrobial activity against multidrug-resistant urinary Escherichia coli from US outpatients. J Antimicrob Chemother. 2014;69(12):3259-62. DOI: 10.1093/jac/dku282 PMID: 25063776