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Healthcare-associated urinary tract infections with onset post hospital discharge

Published online by Cambridge University Press:  20 June 2019

Miriam R. Elman
Affiliation:
School of Public Health, Oregon Health and Science University–Portland State University, Portland, Oregon
Craig D. Williams
Affiliation:
Department of Pharmacy Practice, College of Pharmacy, Oregon State University/Oregon Health and Science University, Portland, Oregon
David T. Bearden
Affiliation:
Department of Pharmacy Practice, College of Pharmacy, Oregon State University/Oregon Health and Science University, Portland, Oregon
John M. Townes
Affiliation:
Division of Infectious Diseases, Department of Medicine, School of Medicine, Oregon Health and Science University, Portland, Oregon
John D. Heintzman
Affiliation:
Department of Family Medicine, School of Medicine, Oregon Health and Science University, Portland, Oregon
Jodi A. Lapidus
Affiliation:
School of Public Health, Oregon Health and Science University–Portland State University, Portland, Oregon
Ravina Kullar
Affiliation:
Doctor Evidence, Santa Monica, California
Sheila Markwardt
Affiliation:
School of Public Health, Oregon Health and Science University–Portland State University, Portland, Oregon
Amanda T. Trieu
Affiliation:
Kaiser Permanente, Portland, Oregon
Arrash A. Vahidi
Affiliation:
Department of Pharmacy Services, Veterans’ Affairs Portland Health Care System, Portland, Oregon
Jessina C. McGregor
Affiliation:
School of Public Health, Oregon Health and Science University–Portland State University, Portland, Oregon Department of Pharmacy Practice, College of Pharmacy, Oregon State University/Oregon Health and Science University, Portland, Oregon
Corresponding

Abstract

Objective:

Current surveillance for healthcare-associated (HA) urinary tract infection (UTI) is focused on catheter-associated infection with hospital onset (HO-CAUTI), yet this surveillance does not represent the full burden of HA-UTI to patients. Our objective was to measure the incidence of potentially HA, community-onset (CO) UTI in a retrospective cohort of hospitalized patients.

Design:

Retrospective cohort study.

Setting:

Academic, quaternary care, referral center.

Patients:

Hospitalized adults at risk for HA-UTI from May 2009 to December 2011 were included.

Methods:

Patients who did not experience a UTI during the index hospitalization were followed for 30 days post discharge to identify cases of potentially HA-CO UTI.

Results:

We identified 3,273 patients at risk for potentially HA-CO UTI. The incidence of HA-CO UTI in the 30 days post discharge was 29.8 per 1,000 patients. Independent risk factors of HA-CO UTI included paraplegia or quadriplegia (adjusted odds ratio [aOR], 4.6; 95% confidence interval [CI], 1.2–18.0), indwelling catheter during index hospitalization (aOR, 1.5; 95% CI, 1.0–2.3), prior piperacillin-tazobactam prescription (aOR, 2.3; 95% CI, 1.1–4.5), prior penicillin class prescription (aOR, 1.7; 95% CI, 1.0–2.8), and private insurance (aOR, 0.6; 95% CI, 0.4–0.9).

Conclusions:

HA-CO UTI may be common within 30 days following hospital discharge. These data suggest that surveillance efforts may need to be expanded to capture the full burden to patients and better inform antibiotic prescribing decisions for patients with a history of hospitalization.

Type
Original Article
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

PREVIOUS PRESENTATION: Portions of this work were previously presented at IDWeek 2013 on October 4, 2013, in San Francisco, California.

References

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