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Abstract

Introduction: Catheter associated urinary tract infections (CA-UTIs) are among the leading hospital-acquired infections (HAIs), accounting for more than 30% of all HAIs reported by acute care hospitals. While central line infections and ventilator-associated pneumonia increase morbidity, mortality, and costs, the impact of CA-UTI is less clear. We therefore conducted a retrospective case control study to assess the impact of CA-UTI in children admitted to the PICU. Hypothesis: Critically ill children with CA-UTI have a longer PICU LOS compared to matched controls without CA-UTI. Methods: We conducted a retrospective case control study of patients with CA-UTI admitted to our tertiary PICU over a period of 5 years (2006-2010). CA-UTI was diagnosed according to standard CDC/NHSN criteria. Index cases of CA-UTI were identified from the hospital infection control database and were matched with control patients by age, gender, Foley days, PRISM-III scores, and primary diagnostic category. A p-value < 0.05 was considered significant. Results: We identified 51 index cases and 85 controls during the period of study. There were no differences between groups in age, gender, PRISM-III score, or primary diagnostic category. The Foley catheter days before infection were similar to the total number of Foley catheter days in the control group. However, the total number of Foley catheter days was significantly longer in the CA-UTI group (CA-UTI: median, 14 days, IQR 6, 23 vs. Control: median, 8 days, IQR 4, 15; p=0.0006). Similarly, PICU LOS was significantly longer in the CA-UTI group (median, 28 days, IQR 16, 62) versus the Control group (median, 14 days, IQR 5, 24) (p<0.0001). Conclusions: Urinary catheterization significantly increases the risk of CA-UTI in critically ill children admitted to the PICU. Moreover, the consequence of CA-UTI is not trivial, as patients with CA-UTI have a significantly longer LOS. This study highlights the importance of implementing measures aimed at CA-UTI prevention to decrease the associated morbidity and related financial costs on the healthcare system.