Objective: To study the clinical outcomes, economic burden, and associated factors in patients with long-term urinary catheterization who develop extended-spectrum beta-lactamase producing (ESBL) Enterobacteriaceae catheter associated urinary tract infection (CAUTI).

Materials and Methods: The retrospective cohort study was conducted in the long-term urinary catheterization in Songklanagarind Hospital between January 2010 and December 2014 to compare clinical outcomes of patients with longterm urinary catheterization as those without CAUTI, those with non-ESBL Enterobacteriaceae CAUTI, and those with ESBL Enterobacteriaceae CAUTI.

Results: There were 9,726 patients with urinary catheterization and 4,176 of those were categorized as patients with long-term urinary catheterization. Among the patients with long-term urinary catheterization, 207 patients developed CAUTI (4.96%). The causatives were Enterobacteriaceae (179; 86%), Staphylococcus aureus (10; 5%), non-fernetator gram negative Bacilli (10; 5%), and Candida spp. (8; 4%). Of those with Enterobacteriaceae CAUTI, there were 101 patients (56%) infected with ESBL strains. The patients with ESBL CAUTI had higher mortality, hospital cost, and longer hospital stay than those infected with non-ESBL. Retention of other medical devices, immunocompromised status, emergent indication for admission, and initial admission to an intensive care unit were associated with non-ESBL and ESBL Enterobacteriaceae CAUTI. Previous antibiotic use was associated with the emergence of ESBL Enterobacteriaceae CAUTI. Only invasive procedures/operations, previous use of fluoroquinolones, broad spectrum cephal sporins, and beta-lactamase inhibitor antibiotics were associated with the ESBL Enterobacteriaceae CAUTI.

Conclusion: The patients with ESBL CAUTI had worst outcomes including mortality, hospital costs, and length of stay than those with non ESBL CAUTI. Invasive procedures/operations, previous use of fluoroquinolones, broad spectrum cephalosporins, and beta-lactamase inhibitor antibiotics were associated with the ESBL Enterobacteriaceae CAUTI in long-term catheterization.

Keywords: Long-term urinary catheterization, Catheter associated urinary tract infection, Extended spectrum beta-lactamase producing