Hostname: page-component-8448b6f56d-qsmjn Total loading time: 0 Render date: 2024-04-19T10:31:57.678Z Has data issue: false hasContentIssue false
  • English
  • Français

Incidence and risk factors of non–device-associated urinary tract infections in an acute-care hospital

Published online by Cambridge University Press:  02 September 2019

Paula D. Strassle Open the ORCID record for Paula D. Strassle [Opens in a new window] ,
Emily E. Sickbert-Bennett ,
Michael Klompas ,
Jennifer L. Lund ,
Paul W. Stewart ,
Ashley H. Marx ,
Lauren M. DiBiase  and
David J. Weber
Paula D. Strassle*
Affiliation:
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Emily E. Sickbert-Bennett
Affiliation:
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Hospital Epidemiology, University of North Carolina Medical Center, Chapel Hill, North Carolina
Michael Klompas
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
Jennifer L. Lund
Affiliation:
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Paul W. Stewart
Affiliation:
Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Ashley H. Marx
Affiliation:
Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, North Carolina
Lauren M. DiBiase
Affiliation:
Department of Hospital Epidemiology, University of North Carolina Medical Center, Chapel Hill, North Carolina
David J. Weber
Affiliation:
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Hospital Epidemiology, University of North Carolina Medical Center, Chapel Hill, North Carolina
*
Author for correspondence: Paula D. Strassle, PhD, MSPH, E-mail: paula_strassle@med.unc.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To update current estimates of non–device-associated urinary tract infection (ND-UTI) rates and their frequency relative to catheter-associated UTIs (CA-UTIs) and to identify risk factors for ND-UTIs.

Design:

Cohort study.

Setting:

Academic teaching hospital.

Patients:

All adult hospitalizations between 2013 and 2017 were included. UTIs (device and non-device associated) were captured through comprehensive, hospital-wide active surveillance using Centers for Disease Control and Prevention case definitions and methodology.

Results:

From 2013 to 2017 there were 163,386 hospitalizations (97,485 unique patients) and 1,273 UTIs (715 ND-UTIs and 558 CA-UTIs). The rate of ND-UTIs remained stable, decreasing slightly from 6.14 to 5.57 ND-UTIs per 10,000 hospitalization days during the study period (P = .15). However, the proportion of UTIs that were non–device related increased from 52% to 72% (P < .0001). Female sex (hazard ratio [HR], 1.94; 95% confidence interval [CI], 1.50–2.50) and increasing age were associated with increased ND-UTI risk. Additionally, the following conditions were associated with increased risk: peptic ulcer disease (HR, 2.25; 95% CI, 1.04–4.86), immunosuppression (HR, 1.48; 95% CI, 1.15–1.91), trauma admissions (HR, 1.36; 95% CI, 1.02–1.81), total parenteral nutrition (HR, 1.99; 95% CI, 1.35–2.94) and opioid use (HR, 1.62; 95% CI, 1.10–2.32). Urinary retention (HR, 1.41; 95% CI, 0.96–2.07), suprapubic catheterization (HR, 2.28; 95% CI, 0.88–5.91), and nephrostomy tubes (HR, 2.02; 95% CI, 0.83–4.93) may also increase risk, but estimates were imprecise.

Conclusion:

Greater than 70% of UTIs are now non–device associated. Current targeted surveillance practices should be reconsidered in light of this changing landscape. We identified several modifiable risk factors for ND-UTIs, and future research should explore the impact of prevention strategies that target these factors.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 11 , November 2019 , pp. 1242 - 1247
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

PREVIOUS PRESENTATION. Portions of this manuscript were presented at SHEA Spring Conferencs on April 24, 2019, and at the 35th International Conference on Pharmacoepidemiology and Therapeutic Risk Management (ICPE) on August 28, 2019, in Philadelphia, Pennsylvania.

References

Magill, SS, Edwards, JR, Bamberg, W, et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med 2014;370:1198–1208.CrossRefGoogle ScholarPubMed
Magill, SS, O’Leary, E, Janelle, SJ, et al. Changes in prevalence of health care-associated infections in US Hospitals. N Engl J Med 2018;379:1732–1744.CrossRefGoogle Scholar
Klevens, RM, Edwards, JR, Richards, CL , Jr, et al. Estimating health care-associated infections and deaths in US hospitals, 2002. Public Health Rep 2007;122:160–166.CrossRefGoogle Scholar
Landrigan, CP, Parry, GJ, Bones, CB, Hackbarth, AD, Goldmann, DA, Sharek, PJ. Temporal trends in rates of patient harm resulting from medical care. N Engl J Med 2010;363:2124–2134.CrossRefGoogle ScholarPubMed
Umscheid, CA, Mitchell, MD, Doshi, JA, Agarwal, R, Williams, K, Brennan, PJ. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol 2011;32:101–114.CrossRefGoogle ScholarPubMed
Zimlichman, E, Henderson, D, Tamir, O, et al. Health care-associated infections: a meta-analysis of costs and financial impact on the US healthcare system. JAMA Intern Med 2013;173:2039–2046.CrossRefGoogle Scholar
Tambyah, PA, Knasinski, V, Maki, DG. The direct costs of nosocomial catheter-associated urinary tract infection in the era of managed care. Infect Control Hosp Epidemiol 2002; 23:27–31.CrossRefGoogle ScholarPubMed
Richards, MJ, Edwards, JR, Culver, DH, Gaynes, RP. Nosocomial infections in combined medical-surgical intensive care units in the United States. Infect Control Hosp Epidemiol 2000;21:510–515.CrossRefGoogle ScholarPubMed
Calfee, DP, Farr, BM. Infection control and cost control in the era of managed care. Infect Control Hosp Epidemiol 2002;23:407–410.CrossRefGoogle ScholarPubMed
Weber, DJ, Sickbert-Bennett, EE, Gould, CV, Brown, VM, Huslage, K, Rutala, WA. Incidence of catheter-associated and non–catheter-associated urinary tract infections in a healthcare system. Infect Control Hosp Epidemiol 2011;32:822–823.CrossRefGoogle Scholar
Weber, DJ, Sickbert-Bennett, EE, Brown, V, Rutala, WA. Completeness of surveillance data reported by the national healthcare safety network: an analysis of healthcare-associated infections ascertained in a tertiary care hospital, 2010. Infect Control Hosp Epidemiol 2012;33:94–96.CrossRefGoogle Scholar
DiBiase, LM, Weber, DJ, Sickbert-Bennett, EE, Anderson, DJ, Rutala, WA. The growing importance of non–device-associated healthcare-associated infections: a relative proportion and incidence study at an academic medical center, 2008–2012. Infect Control Hosp Epidemiol 2014;35:200–202.CrossRefGoogle ScholarPubMed
Kanamori, H, Weber, DJ, DiBiase, LM, et al. Longitudinal trends in all healthcare-associated infections through comprehensive hospital-wide surveillance and infection control measures over the past 12 years: substantial burden of healthcare-associated infections outside of intensive care units and “other” types of infection. Infect Control Hosp Epidemiol 2015;36:1139–1147.CrossRefGoogle Scholar
Lee, EW, Wei, LJ, Amato, DA, Leurgans, S. Cox-type regression analysis for large numbers of small groups of correlated failure time observations. In: Klein, JP, Goel, PK, eds. Survival Analysis: State of the Art. Dordrecht: Springer Netherlands; 1992:237–247.CrossRefGoogle Scholar
Fine, JP, Gray, RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc 1999;94:496–509.CrossRefGoogle Scholar
Seaman, SR, White, IR. Review of inverse probability weighting for dealing with missing data. Stat Methods Med Res 2013;22:278–295.CrossRefGoogle ScholarPubMed
Wasserstein, RL, Lazar, NA. The ASA’s statement on P-values: context, process, and purpose. Am Stat 2016;70:129–133.CrossRefGoogle Scholar
Wasserstein, RL, Schirm, AL, Lazar, NA. Moving to a world beyond “P < 0.05”. Am Stat 2019;73:1–19.CrossRefGoogle Scholar
Gould, CV, Umscheid, CA, Agarwal, RK, Kuntz, G, Pegues, DA. Guideline for prevention of catheter-associated urinary tract infections, 2009. Infect Control Hosp Epidemiol 2010;31:319–326.CrossRefGoogle Scholar
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.CrossRefGoogle ScholarPubMed
Foxman, B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Am J Med 2002;113:5–13.CrossRefGoogle ScholarPubMed
Letica-Kriegel, AS, Salmasian, H, Vawdrey, DK, et al. Identifying the risk factors for catheter-associated urinary tract infections: a large cross-sectional study of six hospitals. BMJ Open 2019;9:e022137.CrossRefGoogle ScholarPubMed
Garibaldi, RA, Burke, JP, Dickman, ML, Smith, CB. Factors predisposing to bacteriuria during indwelling urethral catheterization. N Engl J Med 1974;291:215–219.CrossRefGoogle ScholarPubMed
Verhamme, KM, Sturkenboom, MC, Stricker, BH, Bosch, R. Drug-induced urinary retention: incidence, management and prevention. Drug Saf 2008;31:373–388.CrossRefGoogle Scholar
Will you have urinary retention with ranitidine—from FDA reports. eHealthMe website. https://www.ehealthme.com/ds/ranitidine. Published 2019. Accessed March 23, 2019.Google Scholar
Rogers, MA, Fries, BE, Kaufman, SR, Mody, L, McMahon, LF , Jr, Saint, S. Mobility and other predictors of hospitalization for urinary tract infection: a retrospective cohort study. BMC Geriatr 2008;8:31.CrossRefGoogle ScholarPubMed
Muskett, H, Shahin, J, Eyres, G, Harvey, S, Rowan, K, Harrison, D. Risk factors for invasive fungal disease in critically ill adult patients: a systematic review. Crit Care 2011;15:R287.CrossRefGoogle ScholarPubMed
Yang, SP, Chen, YY, Hsu, HS, Wang, FD, Chen, LY, Fung, CP. A risk factor analysis of healthcare-associated fungal infections in an intensive care unit: a retrospective cohort study. BMC Infect Dis 2013;13:10.CrossRefGoogle Scholar
Kidd, EA, Stewart, F, Kassis, NC, Hom, E, Omar, MI. Urethral (indwelling or intermittent) or suprapubic routes for short-term catheterisation in hospitalised adults. Cochrane Database Syst Rev 2015;10:CD004203.Google Scholar
Supplementary material: File

Strassle et al. supplementary material

Supplemental Appendix

Download Strassle et al. supplementary material(File)
File 25.8 KB