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Abstract

Introduction: Urinary catheters are an essential device for some critically ill patients in the ICU. National Nosocomial Infections Surveillance (NNIS) found ~20% of healthcare-acquired infections in the pediatric population are related to an indwelling urinary catheter. This retrospective case-controlled study aims to determine the risk factors associated with the development of catheter-associated urinary tract infection (CA-UTI). Hypothesis: We hypothesized that the duration of catheter utilization and illness severity would be associated with CA-UTI. Methods: UTI data for PICU patients from 6/1/2009 to 5/30/2012 were reviewed. CA-UTI was defined as a urine culture having > 105 CFU/ml,?2 organisms, and indwelling urinary catheter?48 hours. Exclusion criteria: >18 yr of age, an admission diagnosis of urosepsis, history of recurrent UTIs, chronic routine bladder catheterization program, or the current admission included urological surgery. A randomly selected sample (N=60) from the same time period was chosen utilizing our Daily PICU QI Checklist. Demographic information, ICU LOS, catheter days, severity of illness using PRISM, PELOD, and PIM 2, mechanical ventilation, use of antimicrobials, presence of other devices, and planned admission data were collected. Categorical data was evaluated using Fisher’s Exact test. Numeric data was evaluated using 2-tail T test. Results: There were 5090 catheter-days during this period. Thirty PICU patients were found to have a CA-UTI, and 60 randomly selected controls were compared. Severity of illness (PRISM (P<0.002) and PIM 2 (p<0.0075), catheter-days?7.0 (RR 5.23, 95% CI: 2.37-11.54, p<0.0001) were highly associated with increased risk of CA-UTI. Mean catheter-days were increased in patient who developed CA-UTI (12.8 ± 8.8, range 2-34, median 10) compared to controls (7.0 ± 8.8 (range 1-55, median 3.5), p <0.005, as was ICU LOS (32.7+16.5, range 11-78, median 29.5) vs. (15.6+19.9, range 1-128, median 9) p<0.0001 respectively. Patients were more likely to have mechanical ventilation (p<0.047), and other medical devices (p<0.0047). There was no difference in age, gender, survival, use of sedation, paralytics or steroids. Conclusions: Increased risk of CA-UTI is associated with severity of illness, ICU LOS, catheter-days, mechanical ventilation and presence of other medical devices. Further research is needed to determine methods to reduce the risk of infection when catheter utilization is necessary and of long duration.