805

Abstract

Introduction: The optimal duration for treating catheter-associated urinary tract infection (CA-UTI) in critically ill patients is unclear. Current guidelines recommend up to 14 days of therapy; however, short duration therapy for 3-5 days (SDT) is often used in trauma ICU patients at our center. The efficacy of SDT for CA-UTI has not been studied in this population. The purpose of this study was to evaluate the efficacy of SDT for CA-UTI compared to longer duration therapy (>5 days (LDT)) in trauma patients. Methods: This was a retrospective study of patients with CA-UTI in the trauma ICU at the Regional Medical Center at Memphis. Patients with suspected sepsis had urine cultures collected as part of standard work-ups. Patients were included if they had a urine culture growing bacteria ≥ 100,000 cfu/mL and were treated with definitive antibiotics. Duration of therapy was at the discretion of the trauma team. Exclusion criteria included concomitant infection, renal replacement therapy, or pregnancy. Clinical and microbiological success were evaluated using standard definitions. Results: A total of 104 patients were included (SDT=77, LDT=27); with all comparisons listed as SDT vs. LDT. The mean duration of therapy was 4 vs. 7 days. There were no significant differences in age, sex, race, type of injury, or ICU LOS. The incidence of polymicrobial infection (4% vs. 15%), multidrug resistant organisms (34% vs. 44%), and inappropriate empiric antibiotic therapy (8% vs. 7%) were also similar between groups. The SDT group had lower BMI (26 vs. 31, p=0.002), injury severity score (27 vs. 34, p=0.014), and hospital LOS (29 days vs. 37 days, p=0.014). The most common organisms in each group were E. coli, Enterococcus sp., and Pseudomonas sp. There were no significant differences between groups for any of the following parameters: clinical success (82% vs. 85%), microbiological success (75% vs. 79%), relapse rate (8% vs. 5%), overall mortality (4% vs. 11%), and UTI-related mortality (0% vs. 0%). Conclusions: SDT can be considered an alternative to LDT for treating CA-UTI trauma ICU patients.