Skip to main content

Trends in Catheter-Associated Urinary Tract Infections in Adult Intensive Care Units—United States, 1990–2007

  • Deron C. Burton (a1), Jonathan R. Edwards (a1), Arjun Srinivasan (a1), Scott K. Fridkin (a1) and Carolyn V. Gould (a1)...

Over the past 2 decades, multiple interventions have been developed to prevent catheter-associated urinary tract infections (CAUTIs). The CAUTI prevention guidelines of the Healthcare Infection Control Practices Advisory Committee were recently revised.


To examine changes in rates of CAUTI events in adult intensive care units (ICUs) in the United States from 1990 through 2007.


Data were reported to the Centers for Disease Control and Prevention (CDC) through the National Nosocomial Infections Surveillance System from 1990 through 2004 and the National Healthcare Safety Network from 2006 through 2007. Infection preventionists in participating hospitals used standard methods to identify all CAUTI events (categorized as symptomatic urinary tract infection [SUTI] or asymptomatic bacteriuria [ASB]) and urinary catheter–days (UC-days) in months selected for surveillance. Data from all facilities were aggregated to calculate pooled mean annual SUTI and ASB rates (in events per 1,000 UC-days) by ICU type. Poisson regression was used to estimate percent changes in rates over time.


Overall, 36,282 SUTIs and 22,973 ASB episodes were reported from 367 facilities representing 1,223 adult ICUs, including combined medical/surgical (505), medical (212), surgical (224), coronary (173), and cardiothoracic (109) ICUs. All ICU types experienced significant declines of 19%–67% in SUTI rates and 29%–72% in ASB rates from 1990 through 2007. Between 2000 and 2007, significant reductions in SUTI rates occurred in all ICU types except cardiothoracic ICUs.


Since 1990, CAUTI rates have declined significantly in all major adult ICU types in facilities reporting to the CDC. Further efforts are needed to assess prevention strategies that might have led to these decreases and to implement new CAUTI prevention guidelines.

Corresponding author
Prevention and Response Branch, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Mailstop A-35, 1600 Clifton Road NE, Atlanta, GA 30333 (
Hide All
1.Klevens, RM, Edwards, JR, Richards, CL Jr, et al.Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep 2007;122(2):160166.
2.Wise, M, Scott, R, Ellingson, K, et al.Burden of major hospital-onset device-associated infection types among adults and children in the United States, 2007. Paper presented at: 21st Annual Scientific Meeting of the Society for Healthcare Epidemiology of America; April 2, 2011; Dallas, Texas. Abstract 3703.
3.Scott, R, Wise, M, Ellingson, K, Baggs, J, Jernigan, J. Economic burden of major device-associated, acute-care hospital-onset infections among adults and children in the United States, 2007. Paper presented at: 21st Annual Scientific Meeting of the Society for Healthcare Epidemiology of America; April 3, 2011; Dallas, Texas. Abstract 4552.
4.Pennsylvania Patient Safety Authority 2009 Annual Report. Harrisburg, PA: Pennsylvania Patient Safety Authority, 2010. Accessed November 24, 2010.
5.Weinstein, J, Mazon, D, Pantelick, E, Reagan-Cirincione, P, Dembry, L, Hierholzer, W Jr, A decade of prevalence surveys in a tertiary-care center: trends in nosocomial infection rates, device utilization, and patient acuity. Infect Control Hosp Epidemiol 1999;20:543548.
6.Saint, S, Wiese, J, Amory, J, et al.Are physicians aware of which of their patients have indwelling urinary cathters? Am J Med 2000;109:476480.
7.Richards, M, Edwards, J, Culver, D, Gaynes, R. Nosocomial infections in medical intensive care units in the United States: National Nosocomial Infections Surveillance System. Crit Care Med 1999;27:887892.
8.Cornia, P, Lipsky, B. Indwelling urinary catheters in hospitalized patients: when in doubt, pull it out. Infect Control Hosp Epidemiol 2008;29:820822.
9.Meddings, J, Rogers, MA, Macy, M, Saint, S. Systematic review and meta-analysis: reminder systems to reduce catheter-associated urinary tract infections and urinary catheter use in hospitalized patients. Clin Infect Dis 2010;51:550560.
10.Saint, S, Kowalski, C, Forman, J, et al.A multicenter qualitative study on preventing hospital-acquired urinary tract infection in US hospitals. Infect Control Hosp Epidemiol 2008;29:333341.
11.Gould, C, Umscheid, C, Agarwal, R, Kuntz, G, Pegues, D; Healthcare Infection Control Practices Advisory Committee. Guideline for prevention of catheter-associated urinary tract infection. Infect Control Hosp Epidemiol 2010;31:319326.
12.Saint, S, Meddings, JA, Calfee, D, Kowalski, CP, Krein, SL. Catheter-associated urinary tract infection and the Medicare rule changes. Ann Intern Med 2009;150(12):877884.
13.Umscheid, C, Mitchell, M, Doshi, J, Agarwal, R, Williams, K, Brennan, P. Estimating the proportion of reasonably preventable hospital-acquired infections and associated mortality and costs. Oral presentation at: 19th Annual Scientific Meeting of the Society for Healthcare Epidemiology of America; March 19–22, 2009;San Diego.
14.Reilly, L, Sullivan, P, Ninni, S, Fochesto, D, Williams, K, Fetherman, B. Reducing foley catheter device days in an intensive care unit. AACN Adv Crit Care 2006;17:272283.
15.Topal, J, Conklin, S, Camp, K, Morris, V, Balcezak, T, Herbert, P. Prevention of nosocomial catheter-associated urinary tract infections through computerized feedback to physicians and a nurse-directed protocol. Am J Med Qual 2005;20:121126.
16.Jain, M, Miller, L, Belt, D, King, D, Berwick, D. Decline in ICU adverse events, nosocomial infections and cost through a quality improvement initiative focusing on teamwork and culture change. Qual Saf Health Care 2006;15:235239.
17.Burton, DC, Edwards, JR, Horan, TC, Jernigan, JA, Fridkin, SK. Methicillin-resistant Staphylococcus aureus central line–associated bloodstream infections in US intensive care units, 1997–2007. JAMA 2009;301:727736.
18.The National Healthcare Safety Network (NHSN) Manual: Patient Safety Component Protocol. Atlanta: Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, 2008. Accessed December 11, 2009.
19.Horan, TC, Gaynes, R. Surveillance of nosocomial infections. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2004:16591702.
20.Horan, T, Andrus, M, Dudeck, M. CDC/NHSN surveillance definition of health care–associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309332.
21.Apisarnthanarak, A, Thongphubeth, K, Sirinvaravong, S, et al.Effectiveness of multifaceted hospitalwide quality improvement programs featuring an intervention to remove unnecessary urinary catheters at a tertiary care center in Thailand. Infect Control Hosp Epidemiol 2007;28:791798.
22.Misset, B, Timsit, J, Dumay, M, et al.A continuous quality-improvement program reduces nosocomial infection rates in the ICU. Intensive Care Med 2004;30:395400.
23.Rosenthal, V, Guzman, S, Safdar, N. Effect of education and performance feedback on rates of catheter-associated urinary tract infection in intensive care units in Argentina. Infect Control Hosp Epidemiol 2004;25:4750.
24.Huang, W-C, Wann, S-R, Lin, S-L, et al.Catheter-associated urinary tract infections in intensive care units can be reduced by prompting physicians to remove unnecessary catheters. Infect Control Hosp Epidemiol 2004;25:974978.
25.Stéphan, FF, Sax, HH, Wachsmuth, MM, Hoffmeyer, PP, Clergue, FF, Pittet, DD. Reduction of urinary tract infection and antibiotic use after surgery: a controlled, prospective, before-after intervention study. Clin Infect Dis 2006;42:15441551.
26.Tambyah, P, Maki, D. Catheter-associated urinary tract infection is rarely symptomatic: a prospective study of 1497 catheterized patients. Arch Intern Med 2000;160:678682.
27.Hooton, T, Bradley, S, Cardenas, D, 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;50:625663.
28.Gastmeier, P, Geffers, C, Brandt, C, et al.Effectiveness of a nationwide nosocomial infection surveillance system for reducing nosocomial infections. J Hosp Infect 2006;64(1):1622.
29.Centers for Disease Control and Prevention. Reduction in central line-associated bloodstream infections among patients in intensive care units—Pennsylvania, April 2001–March 2005. MMWR Morb Mortal Wkly Rep 2005;54:10131016.
30.Pronovost, P, Needham, D, Berenholtz, S, et al.An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355:27252732.
31.Richards, C, Emori, TG, Edwards, J, Fridkin, S, Tolson, J, Gaynes, R. Characteristics of hospitals and infection control professionals participating in the National Nosocomial Infections Surveillance System 1999. Am J Infect Control 2001;29(6):400403.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed