Epidemiology, Microbiology and Outcomes of Catheter-Associated Urinary Tract Infection and Complicated Urinary Tract Infection in the USA

Abstract

BackgroundAn estimated 93,300 cases of healthcare-associated urinary tract infection (UTI) were recorded in US acute care hospitals in 2011. Many are classified as catheter-associated UTI (CAUTI) or complicated UTI (cUTI). Although CAUTI and cUTI share some commonalities, strategies differ for their prevention and treatment. We examined the epidemiology, microbiology and outcome of patients with CAUTI and cUTI in a large multicenter US database.MethodsThis was a retrospective cohort study using the 2013–2015 Premier Healthcare Database. ICD-9-CM codes were used to identify hospitalized adults (≥18 years) with CAUTI or cUTI. The demographics, clinical characteristics, microbiology, and hospital outcomes of all identified patients were compared. Differences between groups were examined using χ2 test for categorical variables and Student’s t-test for continuous variables. Statistical significance was set at P ≤ 0.05.ResultsOf 120,332 identified patients, 50,034 (41.6%) had CAUTI (87.0% present on admission [POA]) and the remainder had cUTI [95.3% POA]. Patients with CAUTI were older (71.3 ± 16.1 vs. 56.3 ± 19.5 years) and more likely to be male (62.5% vs. 30.6%) and white (71.6% vs. 66.7%) (all P < 0.001). They also had greater comorbidity burden (Charlson Comorbidity Index of 2.8 ± 2.4 vs. 1.7 ± 2.2) and a higher ICU care rate (23.2% vs. 17.8%) than cUTI patients (all P < 0.001). Although Escherichia coli was the most common pathogen in both (69.8% cUTI vs. 39.5% CAUTI), Pseudomonas aeruginosa accounted for one quarter of all CAUTIs and only 5.0% of cUTIs. Compared with cUTI, CAUTI carried a >2-fold increase in unadjusted mortality (3.6% vs. 1.6%) and a higher rate of 30-day readmission (3.9% vs. 2.5%) (all P < 0.001). Additionally, CAUTI was associated with a greater unadjusted ICU length of stay (LOS, 6.0 ± 8.8 vs. 5.5 ± 5.5 days), hospital LOS (8.4 ± 12.9 vs. 5.5 ± 6.4 days) and cost ($16,871+$29,513 vs. $11,915 ± $19,657) (all P < 0.001).ConclusionThe volume of CAUTI and cUTI hospitalizations in the US is high, and a majority of infections were present on admission. CAUTI is associated with greater mortality and resource use than cUTI. The high rate of P aeruginosa portends a greater potential for antimicrobial resistance in CAUTI, which may require different prevention and treatment approaches from cUTI.Disclosures S. Merchant, 1Merck & Co., Inc.: Employee and Shareholder, Salary E. M. Sarpong, Merck & Co., Inc.: Employee and Shareholder, Salary M. Zilberberg, EviMed Research Group, LLC,; Universtiy of Massachusetts: Shareholder, Research grant