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Catheter-Associated Urinary Tract Infections in Intensive Care Unit Patients

Published online by Cambridge University Press:  20 July 2015

Rudy Tedja ,
Jean Wentink ,
John C O’Horo ,
Rodney Thompson  and
Priya Sampathkumar
Rudy Tedja*
Affiliation:
Division of Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
Jean Wentink
Affiliation:
Infection Prevention and Control, Mayo Clinic, Rochester, Minnesota
John C O’Horo
Affiliation:
Division of Infectious Disease, Mayo Clinic, Rochester, Minnesota
Rodney Thompson
Affiliation:
Division of Infectious Disease, Mayo Clinic, Rochester, Minnesota Infection Prevention and Control, Mayo Clinic, Rochester, Minnesota
Priya Sampathkumar
Affiliation:
Division of Infectious Disease, Mayo Clinic, Rochester, Minnesota Infection Prevention and Control, Mayo Clinic, Rochester, Minnesota
*
Address correspondence to Rudy Tedja, 200 First Street SW, Marian Hall 2-115, Rochester, MN 55905 (tedja.rudy@mayo.edu).
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Abstract

OBJECTIVE

To delineate the epidemiology of catheter-associated urinary tract infections (CAUTIs) and to better understand the value of urine cultures for evaluation of fever in the intensive care unit (ICU) setting

DESIGN

Two-year retrospective review (2012–2013)

SETTING

A single tertiary center with 1,200 hospital beds and 158 adult ICU beds

PATIENTS

ICU patients with a CAUTI event

METHODS

The cohort was identified from a prospective infection prevention database. Charts were reviewed to characterize the patients. CAUTI rates and device utilization ratio (DUR) were calculated. Clinical outcomes were recorded.

RESULTS

A total of 105 CAUTIs were identified using the National Health and Safety Network (NHSN) definition. Fever was the primary indication for obtaining urine culture in 102 patients (97%). Of these 105 patients, 51 (51%) had an alternative infection to explain the fever, with pneumonia (55%) being the most common followed by bloodstream infection (22%). A total of 18 patients (18%) had fever due to noninfectious cause, and 32 patients (32%) had no alternative explanation. Of these, 66% received appropriate empiric antimicrobial therapy, but no targeted therapy changes were made based on urine culture results. The other 34% did not receive antimicrobial therapy at all. Only 6% of all CAUTIs resulted in blood cultures positive for the same organism within 2 days. The urinary tract was not definitely established as the source of bloodstream infection.

CONCLUSIONS

Urine cultures obtained for evaluation of fever form the basis for identification of CAUTIs in the ICU. However, most patients with CAUTIs are eventually found to have alternative explanations for fever. CAUTI is associated with a low complication rate.

Infect. Control Hosp. Epidemiol. 2015;36(11):1330–1334

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 11 , November 2015 , pp. 1330 - 1334
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

REFERENCES

1. Dudeck, MA, Horan, TC, Peterson, KD, et al. National Healthcare Safety Network report, data summary for 2011, device-associated module. Am J Infect Control 2013;41:286–300.Google Scholar
2. Laupland, KB, Shahpori, R, Kirkpatrick, AW, Ross, T, Gregson, DB, Stelfox, HT. Occurrence and outcome of fever in critically ill adults. Crit Care Med 2008;36:1531–1535.Google Scholar
3. Al-Qas Hanna, F, Sambirska, O, Iyer, S, Szpunar, S, Fakih, MG. Clinician practice and the National Healthcare Safety Network definition for the diagnosis of catheter-associated urinary tract infection. Am J Infect Control 2013;41:1173–1177.Google Scholar
4. Catheter-associated urinary tract infection (CAUTI) event. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/PDFs/pscManual/validation/pscManual_july2013.pdf. Published 2013. Accessed May 16, 2015.Google Scholar
5. Catheter-Associated Urinary Tract Infection (CAUTI) event. Centers for Disease Control and Prevention website. http://onthecuspstophai.org/wp-content/uploads/2012/04/CDC-CAUTI-Event-Definition-Criterion-Form.pdf. Published 2012. Accessed March 24, 2015.Google Scholar
6. Hartley, S, Valley, S, Kuhn, L, et al. Inappropriate testing for urinary tract infection in hospitalized patients: an opportunity for improvement. Infect Control Hosp Epidemiol 2013;34:1204–1207.Google Scholar
7. Neelakanta, A, Sharma, S, Kesani, VP, et al. Impact of changes in the NHSN Catheter-Associated Urinary Tract Infection (CAUTI) surveillance criteria on the frequency and epidemiology of CAUTI in Intensive Care Units (ICUs). Infect Control Hosp Epidemiol 2015;36:346–349.Google Scholar
8. Meddings, J, Reichert, H, McMahon, LF Jr. Challenges and proposed improvements for reviewing symptoms and catheter use to identify National Healthcare Safety Network catheter-associated urinary tract infections. Am J Infect Control 2014;42:S236–S241.Google Scholar
9. Hooton, TM, Bradley, SF, Cardenas, DD, et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 international clinical practice guidelines from the Infectious Diseases Society of America. Clin Infect Dis 2010;50:625–663.Google Scholar
10. O’Grady, NP, Barie, PS, Bartlett, JG, et al. Guidelines for evaluation of new fever in critically ill adult patients: 2008 update from the American College of Critical Care Medicine and the Infectious Diseases Society of America. Crit Care Med 2008;36:1330–1349.Google Scholar
11. Circiumaru, B, Baldock, G, Cohen, J. A prospective study of fever in the intensive care unit. Intensive Care Med 1999;25:668–673.Google Scholar
12. Rehman, T, Deboisblanc, BP. Persistent fever in the ICU. Chest 2014;145:158–165.CrossRefGoogle ScholarPubMed
13. Tambyah, PA, Maki, DG. Catheter-associated urinary tract infection is rarely symptomatic: a prospective study of 1,497 catheterized patients. Arch Intern Med 2000;160:678–682.Google Scholar
14. Press, MJ, Metlay, JP. Catheter-associated urinary tract infection: does changing the definition change quality? Infect Control Hosp Epidemiol 2013;34:313–315.Google Scholar
15. Urinary tract infection (catheter-associated urinary tract infection [CAUTI] and non-catheter-associated urinary tract infection [UTI] and other urinary system infection [USI]) events. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/pdfs/pscManual/7pscCAUTIcurrent.pdf. Published 2015. Accessed February 15, 2015.Google Scholar
16. Kizilbash, QF, Petersen, NJ, Chen, GJ, Naik, AD, Trautner, BW. Bacteremia and mortality with urinary catheter–associated bacteriuria. Infect Control Hosp Epidemiol 2013;34:1153–1159.Google Scholar