Epidemiology and risk factors of healthcare-associated urinary tract infections: a prospective study in a Tunisian tertiary hospital
Abstract Healthcare-associated urinary tract infections (HAUTIs) represent a significant challenge to healthcare systems worldwide, contributing to patient morbidity, mortality, and increased healthcare costs. Understanding the epidemiology and risk factors associated with HAUTIs is crucial for impl...
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2025-08-01
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| author | Hela Ghali Omar Khalil Ben Saad Sana Bhiri Salma Balhi Farah Azouzi Amani Maatouk Sameh Boughattas Saoussen Layouni Jihed Anoun Sofien Benzarti Emna Trabelsi Zeineb Mrizak Maha Brahim Arwa Nafetti Aroua Kamel Fatima E. Khouya Sofien Aidani Yosr Boussoukaya Mohamed Ben Rejeb AbdelHalim Trabelsi Houyem S. Latiri Asma Ben Cheikh |
| author_facet | Hela Ghali Omar Khalil Ben Saad Sana Bhiri Salma Balhi Farah Azouzi Amani Maatouk Sameh Boughattas Saoussen Layouni Jihed Anoun Sofien Benzarti Emna Trabelsi Zeineb Mrizak Maha Brahim Arwa Nafetti Aroua Kamel Fatima E. Khouya Sofien Aidani Yosr Boussoukaya Mohamed Ben Rejeb AbdelHalim Trabelsi Houyem S. Latiri Asma Ben Cheikh |
| author_sort | Hela Ghali |
| collection | DOAJ |
| description | Abstract Healthcare-associated urinary tract infections (HAUTIs) represent a significant challenge to healthcare systems worldwide, contributing to patient morbidity, mortality, and increased healthcare costs. Understanding the epidemiology and risk factors associated with HAUTIs is crucial for implementing targeted prevention strategies and optimizing patient care. This study aimed to assess the incidence and characteristics of HAUTIs, as well as their associated factors, at the University Hospital Center Sahloul in Sousse, Tunisia. We conducted a longitudinal study over a three-month period at the University Hospital Center Sahloul in Sousse, Tunisia, over a 3-month period (September-November 2022). Patient data were collected daily, and HAUTIs were defined according to standardized criteria. Statistical analysis was performed to identify risk factors associated with HAUTIs. A total of 1947 patients were included, with an age median of 55 years and a male predominance. Patients were mainly hospitalized in medical and surgical departments with a median length of stay of seven days. Among our patients, 23.1% had been hospitalized in the past 6 months and 33% had a urinary catheter at the time of HAUTI diagnosis. The incidence of HAUTIs was 2.8% and 3.75% among catheterized patients, with an incidence density of 3.08 cases per 1000 hospitalization days. HAUTIs were more frequent in medical (3.9%) and surgical (1.9%) departments. The majority of HAUTIs were symptomatic, with fever being the most common sign. Urinary cultures were positive in all cases with the majority of pathogens isolated being Gram-negative bacteria (56.6%). Pathogens were resistant to antibiotics in 37.5% of the cases. Univariate analysis showed several risk factors associated with HAUTIs, while multivariate analysis showed independent risk factors including increased length of stay (p < 0.001), advanced age (p = 0.012), hospitalization method (p = 0.005), and history of neurogenic bladder (p = 0.019). Clinical improvement was observed in 72.2% of cases, and mortality was low (1.7%). HAUTIs remain a big concern, particularly in medical and surgical departments. Our study shows that prolonged hospitalization, advanced age, hospitalization method and history of neurogenic bladder are significant risk factors for HAUTIs. The high prevalence of antibiotic resistance highlights the need for antimicrobial stewardship programs in local hospitals. In order to reduce HAUTI incidence and improve quality of care, strict infection control measures must implemented, patients at risk must be detected early and catheter management must be optimized. |
| format | Article |
| id | doaj-art-a04ee0d3e4ed4bb294631410571dab55 |
| institution | Kabale University |
| issn | 2045-2322 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Nature Portfolio |
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| series | Scientific Reports |
| spelling | doaj-art-a04ee0d3e4ed4bb294631410571dab552025-08-20T03:42:48ZengNature PortfolioScientific Reports2045-23222025-08-0115111110.1038/s41598-025-03971-zEpidemiology and risk factors of healthcare-associated urinary tract infections: a prospective study in a Tunisian tertiary hospitalHela Ghali0Omar Khalil Ben Saad1Sana Bhiri2Salma Balhi3Farah Azouzi4Amani Maatouk5Sameh Boughattas6Saoussen Layouni7Jihed Anoun8Sofien Benzarti9Emna Trabelsi10Zeineb Mrizak11Maha Brahim12Arwa Nafetti13Aroua Kamel14Fatima E. Khouya15Sofien Aidani16Yosr Boussoukaya17Mohamed Ben Rejeb18AbdelHalim Trabelsi19Houyem S. Latiri20Asma Ben Cheikh21Department of Prevention and Security of Care, Sahloul University Hospital, University of Sousse, Faculty of Medicine of SousseUniversity of Sousse, Faculty of Medicine of SousseDepartment of Prevention and Security of Care, Sahloul University Hospital, University of Sousse, Faculty of Medicine of SousseDepartment of Prevention and Security of Care, Sahloul University Hospital, University of Sousse, Faculty of Medicine of SousseUniversity of Sousse, Faculty of Medicine of SousseDepartment of Epidemiology and Preventive Medicine, University of Monastir, Faculty of Medicine of Monastir, University Hospital Fattouma Bourguiba of MonastirLaboratory of Microbiology, Sahloul University HospitalResearch Laboratory, Exercise Physiology and Physiopathology: From Integrated to Molecular “Biology, Medicine and Health”, LR19ES09, University of Sousse, Faculty of Medicine of SousseUniversity of Sousse, Faculty of Medicine of SousseUniversity of Sousse, Faculty of Medicine of SoussePhysical Medicine and Rehabilitation Department, Sahloul HospitalOrthopedic Surgery and Trauma Department, Sahloul University HospitalFamily Medicine, Faculty of Medicine of SousseDepartment of Prevention and Security of Care, Sahloul University Hospital, University of Sousse, Faculty of Medicine of SousseFamily Medicine, Faculty of Medicine of SousseFamily Medicine, Faculty of Medicine of SousseFamily Medicine, Faculty of Medicine of SousseDepartment of Internal Medicine, Sahloul University HospitalDepartment of Prevention and Security of Care, Sahloul University Hospital, University of Sousse, Faculty of Medicine of SousseLaboratory of Microbiology, Sahloul University HospitalDepartment of Prevention and Security of Care, Sahloul University Hospital, University of Sousse, Faculty of Medicine of SousseDepartment of Prevention and Security of Care, Sahloul University Hospital, University of Sousse, Faculty of Medicine of SousseAbstract Healthcare-associated urinary tract infections (HAUTIs) represent a significant challenge to healthcare systems worldwide, contributing to patient morbidity, mortality, and increased healthcare costs. Understanding the epidemiology and risk factors associated with HAUTIs is crucial for implementing targeted prevention strategies and optimizing patient care. This study aimed to assess the incidence and characteristics of HAUTIs, as well as their associated factors, at the University Hospital Center Sahloul in Sousse, Tunisia. We conducted a longitudinal study over a three-month period at the University Hospital Center Sahloul in Sousse, Tunisia, over a 3-month period (September-November 2022). Patient data were collected daily, and HAUTIs were defined according to standardized criteria. Statistical analysis was performed to identify risk factors associated with HAUTIs. A total of 1947 patients were included, with an age median of 55 years and a male predominance. Patients were mainly hospitalized in medical and surgical departments with a median length of stay of seven days. Among our patients, 23.1% had been hospitalized in the past 6 months and 33% had a urinary catheter at the time of HAUTI diagnosis. The incidence of HAUTIs was 2.8% and 3.75% among catheterized patients, with an incidence density of 3.08 cases per 1000 hospitalization days. HAUTIs were more frequent in medical (3.9%) and surgical (1.9%) departments. The majority of HAUTIs were symptomatic, with fever being the most common sign. Urinary cultures were positive in all cases with the majority of pathogens isolated being Gram-negative bacteria (56.6%). Pathogens were resistant to antibiotics in 37.5% of the cases. Univariate analysis showed several risk factors associated with HAUTIs, while multivariate analysis showed independent risk factors including increased length of stay (p < 0.001), advanced age (p = 0.012), hospitalization method (p = 0.005), and history of neurogenic bladder (p = 0.019). Clinical improvement was observed in 72.2% of cases, and mortality was low (1.7%). HAUTIs remain a big concern, particularly in medical and surgical departments. Our study shows that prolonged hospitalization, advanced age, hospitalization method and history of neurogenic bladder are significant risk factors for HAUTIs. The high prevalence of antibiotic resistance highlights the need for antimicrobial stewardship programs in local hospitals. In order to reduce HAUTI incidence and improve quality of care, strict infection control measures must implemented, patients at risk must be detected early and catheter management must be optimized.https://doi.org/10.1038/s41598-025-03971-zEpidemiologyCross infectionRisk factorsCatheterRelated infections |
| spellingShingle | Hela Ghali Omar Khalil Ben Saad Sana Bhiri Salma Balhi Farah Azouzi Amani Maatouk Sameh Boughattas Saoussen Layouni Jihed Anoun Sofien Benzarti Emna Trabelsi Zeineb Mrizak Maha Brahim Arwa Nafetti Aroua Kamel Fatima E. Khouya Sofien Aidani Yosr Boussoukaya Mohamed Ben Rejeb AbdelHalim Trabelsi Houyem S. Latiri Asma Ben Cheikh Epidemiology and risk factors of healthcare-associated urinary tract infections: a prospective study in a Tunisian tertiary hospital Scientific Reports Epidemiology Cross infection Risk factors Catheter Related infections |
| title | Epidemiology and risk factors of healthcare-associated urinary tract infections: a prospective study in a Tunisian tertiary hospital |
| title_full | Epidemiology and risk factors of healthcare-associated urinary tract infections: a prospective study in a Tunisian tertiary hospital |
| title_fullStr | Epidemiology and risk factors of healthcare-associated urinary tract infections: a prospective study in a Tunisian tertiary hospital |
| title_full_unstemmed | Epidemiology and risk factors of healthcare-associated urinary tract infections: a prospective study in a Tunisian tertiary hospital |
| title_short | Epidemiology and risk factors of healthcare-associated urinary tract infections: a prospective study in a Tunisian tertiary hospital |
| title_sort | epidemiology and risk factors of healthcare associated urinary tract infections a prospective study in a tunisian tertiary hospital |
| topic | Epidemiology Cross infection Risk factors Catheter Related infections |
| url | https://doi.org/10.1038/s41598-025-03971-z |
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