Min Zhou,1,2,* Hui Li,3,* Xiuxia Geng,2 Huihua Dai,1 Zhanjie Li4 

1Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, People’s Republic of China; 2Department of Infection Management, Taizhou Fourth People’s Hospital, Taizhou, Jiangsu, 225300, People’s Republic of China; 3Department of Medicine, Taixing People’s Hospital, Taizhou, Jiangsu, 225400, People’s Republic of China; 4Department of Infection Control, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Huihua Dai, Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, People’s Republic of China, Tel +86-13851848886, Email Daihuihua65@163.com Zhanjie Li, Department of Infection Control, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, People’s Republic of China, Tel +86-18052106999, Email lzj070591@163.com

Purpose: This study aims to examine the risk factors for catheter-associated urinary tract infection (CAUTI) following radical hysterectomy for cervical cancer (CC). Furthermore, the study seeks to develop a visual model that can effectively assist physicians in improving their proficiency in diagnosing, treating, and preventing CAUTIs.
Patients and Methods: 48 subjects who developed CAUTI postoperatively were assigned to the infection group. There were 443 cases who did not develop CAUTI, and a 1:1 propensity score matching (PSM) method was employed to match 48 cases for the non-infection group. Univariate logistic and multivariate stepwise regression analyses were used to analyze the risk factors for CAUTI following radical hysterectomy for CC. Subsequently, a nomogram-based model was developed, and its effectiveness was comprehensively assessed.
Results: The incidence rate of CAUTI in 491 patients who underwent radical hysterectomy for CC was 9.76% (48/491). Multivariate stepwise regression analysis revealed that the duration of urinary catheterization, urinary leukocyte esterase, and positive urine culture were the independent risk factors for CAUTI after radical hysterectomy for CC (all β > 0, P < 0.05). A nomogram model incorporating these independent risk factors was constructed, and receiver operating characteristic (ROC) and decision curve analysis (DCA) curves were generated. The ROC curve exhibited an area under the curve value of 0.9035, 95% CI of 0.8352– 0.9718, specificity of 0.8214, sensitivity of 0.8571, accuracy of 0.8429, positive predictive value of 0.8780, and negative predictive value of 0.7931.
Conclusion: The duration of urinary catheterization, urinary leukocyte esterase, and positive urine culture are independent risk factors for CAUTI after radical hysterectomy for CC. This nomogram-based model exhibits numerous advantages, including simplicity, user-friendliness, high diagnostic accuracy, and significant clinical value, which can provide assistance in early clinical diagnosis decision-making.

Keywords: risk factors, hysterectomy, uterine cervical neoplasms, urinary tract infections, propensity score