THE EVOLVING LANDSCAPE OF CATHETER-ASSOCIATED URINARY TRACT INFECTION: A SYSTEMATIC REVIEW OF MECHANISMS, RISK, DIAGNOSIS, AND PREVENTION ACROSS GENERAL AND NEUROGENIC BLADDER POPULATIONS

Background: Catheter-associated urinary tract infection (CAUTI) is the most common healthcare-associated infection worldwide and remains a major contributor to patient morbidity, prolonged hospitalization, antimicrobial resistance, and increased healthcare costs. Despite advances in infection prevention and catheter management, CAUTI continues to be a significant challenge in tertiary care hospitals. Retrospective and observational studies provide valuable real-world evidence regarding epidemiology, risk factors, microbiological profiles, clinical outcomes, and prevention strategies. This systematic review was conducted to synthesize current evidence on the evolving landscape of CAUTI in tertiary care settings. Objectives: The objectives of this systematic review were to evaluate the incidence and epidemiology of CAUTI in tertiary care hospitals, identify major risk factors and causative microorganisms, assess diagnostic and preventive practices, and summarize clinical outcomes reported in retrospective and observational studies. Methods: A PRISMA 2020-compliant systematic review was conducted. Electronic databases including PubMed, Scopus, Google Scholar, Web of Science, and DOAJ were searched for eligible studies published between January 2000 and June 2026. Retrospective and observational studies conducted in tertiary care hospitals that reported CAUTI incidence, risk factors, microbiological characteristics, prevention strategies, or patient outcomes were included. Data extraction and quality assessment were performed using standardized forms and the Joanna Briggs Institute (JBI) critical appraisal tools for observational studies. Results: A total of 50 studies met the inclusion criteria. Reported CAUTI rates ranged from 3.5 to 15.0 per 1,000 catheter-days, with intensive care units showing the highest incidence. Prolonged catheterization, female sex, advanced age, diabetes mellitus, critical illness, and inadequate catheter care practices were consistently identified as significant risk factors. Escherichia coli, Klebsiella pneumoniae, Enterococcus spp., Pseudomonas aeruginosa, and Candida spp. were the predominant pathogens. Several studies reported increasing antimicrobial resistance, particularly among Gram-negative organisms. Implementation of catheter care bundles, staff education, reminder systems, and early catheter removal protocols significantly reduced CAUTI rates, with reported reductions ranging from 25% to 75%. Diagnostic challenges related to asymptomatic bacteriuria and overuse of antibiotics were frequently highlighted. Conclusions: CAUTI remains a substantial healthcare burden in tertiary care hospitals despite ongoing preventive efforts. Prolonged catheter use continues to be the strongest modifiable risk factor. Evidence supports the effectiveness of multifaceted prevention strategies, including catheter stewardship programs, adherence to aseptic techniques, continuous staff education, and prompt catheter removal. Future research should focus on innovative non-antibiotic preventive approaches, antimicrobial resistance surveillance, and standardized diagnostic criteria to further reduce the incidence and impact of CAUTI.