Clinical Relevance of the 2014 and 2015 National Healthcare Safety Network’s Catheter-Associated Urinary Tract Infection Definitions

Abstract

BackgroundThe National Healthcare Safety Network’s (NHSN) catheter-associated urinary tract infection (CAUTI) definition has changed multiple times in the previous decade with substantial changes occurring in 2009, 2013, and 2015. Efforts to improve the clinical relevance of this definition have been made, notably the exclusion of Candida species. This study quantifies the magnitude of discrepancy in CAUTI between the 2014 and 2015 definitions and determines which of these definitions has more clinical relevance.MethodsThis is a retrospective study at a 500 bed academic hospital. Eligible cases were identified by a query of our facility’s 2014 NHSN CAUTI cases. We reviewed cases to determine whether they met criteria for CAUTI using the 2014 and 2015 NHSN definitions and also to determine the clinical relevance of the CAUTI. Clinical CAUTI was defined as a provider documenting CAUTI in the progress notes or discharge summary. Subcategories of Clinical CAUTI included “Definite CAUTI”, the presence of UTI in clinical documentation without another documented etiology of fever, and “Possible CAUTI”, documentation of both UTI and another cause of fever. A positive urinalysis was defined as The presence of ≥10 WBC, moderate/large leukocyte esterase, or nitrites.ResultsThere were 65 eligible CAUTI in 61 patients reported to NHSN in 2014. All met the 2014 definition, but only 38 (58%) met the 2015 definition. The median age was 57 years (IQR 51–67), and 54% (n = 33) were male. Clinical CAUTI was diagnosed in 44 patients (68%) meeting the 2014 definition and 33 patients (87%) meeting the 2015 definition (P < 0.001). Half of Clinical CAUTI identified by the 2014 definition were considered to be Definite CAUTI; similar results were found using the 2015 definition. Independent predictors of Clinical CAUTI included urine cultures positive for Gram-negative bacilli (OR 5.2, 95% CI 0.9 to 29.2), positive urinalysis (OR 7.1, 1.4 to 36.1), and use of the 2015 definition (OR 4.7, 0.9 to 23.4).ConclusionThis data suggests that introduction of the 2015 definition may result in a 42% reduction in CAUTI. The 2015 definition was associated with more Clinical CAUTI. Further refinement of the 2015 CAUTI definition could be attained by excluding those cases attributed to other causes of fever.Disclosures All authors: No reported disclosures.