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Healthcare-associated urinary tract infections with onset post hospital discharge

  • Miriam R. Elman (a1), Craig D. Williams (a2), David T. Bearden (a2), John M. Townes (a3), John D. Heintzman (a4), Jodi A. Lapidus (a1), Ravina Kullar (a5), Sheila Markwardt (a1), Amanda T. Trieu (a6), Arrash A. Vahidi (a7) and Jessina C. McGregor (a1) (a2)...

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.

Copyright

Corresponding author

Author for correspondence: Jessina C. McGregor, PhD, OSU/OHSU College of Pharmacy, 2730 SW Moody Ave, CL5CP, Portland, OR 97201. Email: mcgregoj@ohsu.edu Or Miriam R. Elman, MS, MPH, OHSU-PSU School of Public Health, 3181 SW Sam Jackson Park Rd, CB669, Portland, OR 97239. Email: elmanm@ohsu.edu

Footnotes

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

Footnotes

References

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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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