Catheter-associated Urinary Tract Infection Prevention Research Articles

Psychological safety and infection prevention practices: Results from a national survey

Psychological safety is a critical factor in team learning that positively impacts patient safety. We sought to examine the influence of psychological safety on using recommended health care-associated infection (HAI) prevention practices within US hospitals. We mailed surveys to infection preventionists in a random sample of nearly 900 US acute care hospitals in 2017. Our survey asked about hospital and infection control program characteristics, organizational factors, and the use of practices to prevent common HAIs. Hospitals that scored 4 or 5 (5-point Likert scale) on 7 psychological safety questions were classified as high psychological safety. Using sample weights, we conducted multivariable regression to determine associations between psychological safety and the use of select HAI prevention practices. Survey response rate was 59%. High psychological safety was reported in approximately 38% of responding hospitals, and was associated with increased odds of regularly using urinary catheter reminders or stop-orders and/or nurse-initiated urinary catheter discontinuation (odds ratio, 2.37; P = .002) for catheter-associated urinary tract infection prevention, and regularly using sedation vacation (odds ratio, 1.93; P = .04) for ventilator-associated pneumonia prevention. We provide a snapshot of psychological safety in US hospitals and how this characteristic influences the use of select HAI prevention practices. A culture of psychological safety should be considered an integral part of HAI prevention efforts.

Proper indwelling catheter use to prevent CAUTIs

Proper indwelling catheter use to prevent CAUTIs

1162. An Evaluation of Metrics for Catheter-Associated Urinary Tract Infections (CAUTIs): A Statewide Comparison

BackgroundThe Standardized Infection Ratio (SIR) is a metric used to gauge catheter-associated urinary tract infection (CAUTI) prevention, both locally and nationally. The device utilization ratio (DUR) is a process metric that captures catheter harm. More recently, the cumulative attributable difference (CAD) was introduced, which identifies the number of excess infections that need to be prevented to reach the desired goal. Our objective was to evaluate these metrics across all acute care hospitals in Connecticut (CT) by facility size.MethodsA CAUTI Targeted Assessment for Prevention (TAP) Report for acute care hospitals across CT was generated from 1/1/2018 to December 31/2018, using the National Healthcare Safety Network (NHSN) database. CAUTI events, SIR, DUR, and CAD were compared across all hospitals. The SIR goal of 0.75 was used to calculate the CAD. Hospitals were stratified into large ( >425 beds), medium (250 to 424 beds), and small ( <249 beds) based on the Healthcare Cost and Utilization Project NIS Description of Data Elements, Agency for Healthcare Research and Quality for urban hospitals in the northeast region.ResultsA comparison of CAUTI metrics for 29 acute care hospitals across CT is shown in Table 1. Median SIR and DUR were 0.97, 1.02, 0.77, and 22%, 14%, 14.5% for large, medium and small hospitals, respectively. Of the 20 small hospitals, SIR could not be calculated for 5 hospitals, while 2 hospitals had an SIR = 0, as they had no reported infections. Median CAD for large, medium and small hospitals was 6.17, 1.3 and 0.25, respectively. Of note, 40% of small hospitals (J – CC, as in Table 1) had a negative CAD. Interestingly, 5 of these 8 hospitals with a negative CAD had a DUR higher than 16%.ConclusionBased on CT hospital data, metrics like CAD and SIR may be more suitable for larger hospitals or hospitals with higher CAUTI events, whereas DUR may be a more useful metric for smaller hospitals or hospitals with rare events. Hospitals with high SIR and low DUR may represent a population with high-risk catheter use, poor catheter care or higher rates of urine culturing. On the other hand, hospitals with high DUR and low SIR may represent low-risk populations, better catheter care practices or lower rates of urine culturing. Ultimately, we need a combination of metrics to measure preventable catheter harm. DisclosuresLouise Dembry, MD, MS, MBA, ReadyDock: Consultant, Stock options.

964. Journey to Zero Harm: Eliminating Catheter-Associated Urinary Tract Infections (CAUTIs) for 12 Consecutive Months at Two Community Hospitals

BackgroundMany US hospitals have implemented CAUTI prevention bundles (CPB) but few have achieved the goal of zero CAUTIs for 12 consecutive months. We report our journey to zero harm at two community hospitals that have each successfully eliminated CAUTIs from all their units, including the intensive care unit (ICU), for over 12 consecutive months.MethodsFrom April 2015 to March 17 (Period A), CPB was implemented at University of Maryland-Upper Chesapeake Medical Center (UM-UCMC) and University of Maryland-Harford Memorial Hospital (UM-HMH), each with 195 and 128 beds, respectively. UM-UCMC has a 15-bed ICU while UM-HMH has a 5-bed ICU. The CPB included placement of urinary catheters only for approved indications, use of two persons (buddy system) for catheter insertion, Nurse Driven Protocol for catheter removal, and silver-impregnated cloths for perineal care. A massive frontline engagement campaign “You can’t have a CAUTI if you don’t have a foley” was launched from April 2017 to March 2019 (Period B). The focus was intensified on reducing catheter utilization rates. Real-time feedback on new CAUTIs cases was provided to leadership at the daily safety briefs and to nurses and physicians at the unit-based huddles. The number of CAUTIs and “days without a CAUTI” was shared with team members via small posters and whiteboards.ResultsA statistically significant decrease in utilization of urinary catheters was observed (Table 1). Both hospitals and their respective ICUs remained CAUTI free for >12-consecutive months (Figure 1).ConclusionEliminating CAUTIs for 12 consecutive months in acute care community hospitals is possible and serves as a step toward the journey to zero harm. Reducing catheter utilization is a key strategy. Humanizing each infection and providing real-time feedback to the frontline staff and leadership in whole numbers (instead of the old paradigm of reporting CAUTI rates) may have resulted in greater engagement. Disclosures All Authors: No reported Disclosures.

Catheter-Associated Urinary Tract Infections in Adults: Diagnosis, Treatment, and Prevention.

Urinary tract infections (UTIs) are among the most common healthcare-associated infections, and 70%-80% are catheter-associated urinary tract infections (CAUTIs). About 25% of hospitalized patients have an indwelling urinary catheter placed during their hospital stay, and therefore, are at risk for CAUTIs, which have been associated with worse patient outcomes. Additionally, hospitals face a significant financial impact since the Centers for Medicare & Medicaid Services incentive program penalizes hospitals with higher than expected CAUTIs. Hospitalists care for many patients with indwelling urinary catheters and should be aware of and engage in processes that reduce the rate of CAUTIs. This article will discuss the diagnosis, treatment, and prevention of CAUTIs in adults.

Spinal Cord Injury Creates Unique Challenges in Diagnosis and Management of Catheter-Associated Urinary Tract Infection.

Background: Catheter-associated urinary tract infection (CAUTI) is associated with increased morbidity and mortality and influences the quality of life of patients with spinal cord injury (SCI). Objectives: This clinical review aims to highlight the unique surveillance, prevention, diagnosis, and management challenges of CAUTI in the SCI population. Methods: Narrative review of the current literature on catheter use in persons with SCI was conducted to determine gaps in knowledge and opportunities for improvement. Results: Surveillance of CAUTI is challenging in the SCI population as the ability to detect symptoms used to diagnose CAUTI (ie, suprapubic pain, dysuria) is impaired. In terms of prevention of CAUTI, current strategies refocus on appropriate catheter insertion and care and early removal of catheters, which is not always feasible for persons with SCI. Prophylactic antibiotics, nutraceuticals, and coated catheters show limited efficacy in infection prevention. Diagnosing CAUTI after SCI is challenging, often resulting in an overdiagnosis of CAUTI when truly asymptomatic bacteriuria exists. In the management of CAUTI in patients with SCI, the use of multiple antibiotics over time in an individual increases the rate of multidrug-resistant organisms; therefore, the exploration of novel non-antibiotic treatments is of importance. The patient experience should be at the center of all these efforts. Conclusion: Better diagnostic tools or biomarkers are needed to define true CAUTI in people with SCI. SCI-specific evidence to inform catheter management and CAUTI treatment guidelines is needed, with the goal to minimize catheter-related harm, reduce antibiotic resistance, and improve satisfaction and overall quality of life for SCI patients.

Maximizing the Benefit of Quality Improvement Activities: A Spread of Innovations Model.

Many organizations struggle to efficiently and effectively spread improvement activities. This article presents findings from a model developed to standardize the sharing of innovative ideas within nursing at an academic medical center. Quality improvement activities were occurring in many nursing units but often did not spread beyond the originating unit. Challenges included variability in operationalizing initiatives, inconsistent understanding of project goals, and the lack of a dissemination process. The Spread of Innovations Model was developed to ensure structure and resources are in place to spread successful initiatives. The model uses Lean problem-solving and engages frontline nurses with senior leadership when spreading internally developed best practices. The model was piloted by spreading a catheter-associated urinary tract infection (CAUTI) prevention project throughout nursing. Using the model led to significantly decreased CAUTIs. Improvement efforts without a process for spreading can lead to inefficiencies and variable outcomes.

Prevention of catheter-associated urinary tract infection in neurological post-operation patients: a best practice implementation project

The objective of this evidence based implementation project was to promote evidence based practice in the prevention of catheter-associated urinary tract infection (CAUTI) in the neurology and neurosurgery units of a Taipei hospital. Catheter-associated urinary tract infection has been associated with increased morbidity, mortality, hospital costs and length of stay. Urinary drainage systems are often reservoirs of infection in patients, thus effective prevention of CAUTI requires an evidence-based approach. The CAUTI incidence in the neurosurgery units of the hospital was 1.86-2.69% urinary catheter days, which ranked as medium when compared to the entire hospital. A clinical audit was undertaken using the Joanna Briggs Institute Practical Application of Clinical Evidence System tool, based on eight audit criteria that represented best practice recommendations for CAUTI. A baseline audit of the neurology and neurosurgery units was performed, followed by the implementation of multiple strategies throughout a 20-week period. A follow-up audit was undertaken after this to assess changes in practice. The post strategy implementation audit results indicated that compliance with clinical guideline recommendations improved considerably. Proper utilization of an appropriate closed drainage system and training of persons maintaining catheters achieved 100% compliance. The guideline recommendation that catheter and drainage bags be changed only when clinically indicated reached 94% compliance. Catheters removed within 24 hours postoperatively improved by more than 50% compliance. Compliance with systemic antimicrobials being clinically indicated and their use justified improved by 25% and documentation on a clinically appropriate indication for ongoing urinary catheterization improved by almost 33.3%. The implementation project was successful in improving nurses' knowledge and skills related to the prevention of CAUTI. A variety of strategies, such as an education program, simple and clear instruments, collaboration with physicians in caring for patients with a high risk of CAUTI, and multiple educational materials can facilitate implementation of evidence based procedures in clinical practice.

Pathophysiology, Treatment, and Prevention of Catheter-Associated Urinary Tract Infection.

Urinary tract infections (UTIs) are among the most common microbial infections in humans and represent a substantial burden on the health care system. UTIs can be uncomplicated, as when affecting healthy individuals, or complicated, when affecting individuals with compromised urodynamics and/or host defenses, such as those with a urinary catheter. There are clear differences between uncomplicated UTI and catheter-associated UTI (CAUTI) in clinical manifestations, causative organisms, and pathophysiology. Therefore, uncomplicated UTI and CAUTI cannot be approached similarly, or the risk of complications and treatment failure may increase. It is imperative to understand the key aspects of each condition to develop successful treatment options and improve patient outcomes. Here, we will review the epidemiology, pathogen prevalence, differential mechanisms used by uropathogens, and treatment and prevention of uncomplicated UTI and CAUTI.

Effect of Non-Infection Prevention Champions on Catheter-Associated Urinary Tract Infection Rates

BACKGROUND The Healthcare-Associated Infections and Antibiotic Resistance Program of the Louisiana Department of Health (LDH) conducted 25 infection control assessment and response (ICAR) surveys in acute care hospitals between 2015 and 2018. Survey domains include questions on physician and/or nurse champions for prevention activities. LDH HAI/AR Program aimed to determine if facilities that have non-IP champions for catheter-associated urinary tract infection (CAUTI) prevention experience fewer infections than facilities that either have IP champions or no champions at all. METHODS The CAUTI domain of ICAR surveys were reviewed. Responses were categorized into five groups: 1) no champion, 2) IP champion, 3) non-unit-based multidisciplinary champion teams, 4) unit-based non-IP champions, and 5) champions who had unspecified designations. Infection and device-day denominator data from 2015 to 2017 for each facility were extracted from the LDH National Healthcare Safety Network (NHSN) group. Incidence density rates were compared by year and between each category. Similar, by-year comparisons were conducted using IP champions as the reference group and collapsing categories 3, 4, and 5. P-values were assessed for statistical significance at the 95% confidence level using NHSN's Statistics Calculator. RESULTS There were four facilities with no champion, six with an IP champion, seven with multidisciplinary teams, seven with unit-based champions, and one with a champion with unspecified designation. Non-IP champion facilities (categories 3-5) experienced fewer infections per 1,000 device days (p=0.0223) in 2015. Subsequent years showed non-significant comparisons between these groups. Facilities with non-IP champions had significantly lower rates than hospitals with IP champions only in 2015 (p=0.0018). Comparisons for 2016-2017 between these groups were non-significant. CONCLUSIONS Although results were mixed, marginal data showed non-IP champions experienced fewer infections. Gold standard IP programs include unit-based champions who promote infection prevention among bedside clinicians. Results will be shared to encourage a shared culture of patient safety.

Taking Every Precaution – an Inter-professional Approach to Reducing Catheter Associated Urinary Tract Infections in an Acute Care Medical Center

According to the Centers for Disease Control and Prevention (CDC), Catheter Associated Urinary Tract Infections (CAUTIs) are associated with increased morbidity, mortality, healthcare costs, and length of stay. The purpose of this performance improvement (PI) initiative is to decrease CAUTIs for inpatients for 2018. An inter-professional CAUTI workgroup addressed this by implementing evidence based practices (EBPs) and interventions focused on processes. The setting was a 397 bed, urban, acute-care, teaching hospital. The sample included inpatients with indwelling urinary catheters. In 2017, the CAUTI rate was above the benchmark established by the National Healthcare Safety Network. The goal was to decrease CAUTIs in 2018, as reflected by the Standardized Infection Ratio (SIR) - a statistical summary measure that tracks Hospital Acquired Infections over time. An inter-professional workgroup was developed to review the data, perform a gap analysis and implement a corrective action, preventative action plan. The CDC guidelines for prevention of CAUTI (2009) was used as the source for EBP and PI. Interventions focused on processes included: a two-person urinary catheter insertion checklist (wingman), non-invasive alternatives to urinary catheters, daily audits of bundle compliance and device removal (nurse driven protocol), urinary retention protocol, and guidelines for indications for urine culturing. After implementing these interventions, the number of CAUTIs was measured. Interventions (wingman, audits, guidelines, and protocols) decreased CAUTIs from 15 to 2. The overall, 12 month, rolling rates for SIR improved for Intensive Care Units (ICU) from 0.94 to 0.45, and for Non-ICU from 1.51 to 0.24. Non-invasive alternatives and the nurse driven device removal protocol improved catheter utilization rates for ICU from 0.55 to 0.43. There was no statistical change for non-ICU device utilization rates. This PI initiative found that an inter-professional workgroup focused on process interventions can reduce CAUTI in both ICU and non-ICU inpatient settings.

Epidemiology and health-economic burden of urinary-catheter-associated infection in English NHS hospitals: a probabilistic modelling study

Catheter-associated urinary tract infection (CAUTI) and bloodstream infection (CABSI) are leading causes of healthcare-associated infection in England's National Health Service (NHS), but health-economic evidence to inform investment in prevention is lacking. To quantify the health-economic burden and value of prevention of urinary-catheter-associated infection among adult inpatients admitted to NHS trusts in 2016/17. A decision-analytic model was developed to estimate the annual prevalence of CAUTI and CABSI, and their associated excess health burdens [quality-adjusted life-years (QALYs)] and economic costs (£ 2017). Patient-level datasets and literature were synthesized to estimate population structure, model parameters and associated uncertainty. Health and economic benefits of catheter prevention were estimated. Scenario and probabilistic sensitivity analyses were conducted. The model estimated 52,085 [95% uncertainty interval (UI) 42,967-61,360] CAUTIs and 7529 (UI 6857-8622) CABSIs, of which 38,084 (UI 30,236-46,541) and 2524 (UI 2319-2956) were hospital-onset infections, respectively. Catheter-associated infections incurred 45,717 (UI 18,115-74,662) excess bed-days, 1467 (UI 1337-1707) deaths and 10,471 (UI 4783-13,499) lost QALYs. Total direct hospital costs were estimated at £54.4M (UI £37.3-77.8M), with an additional £209.4M (UI £95.7-270.0M) in economic value of QALYs lost assuming a willingness-to-pay threshold of £20,000/QALY. Respectively, CABSI accounted for 47% (UI 32-67%) and 97% (UI 93-98%) of direct costs and QALYs lost. Every catheter prevented could save £30 (UI £20-44) in direct hospital costs and £112 (UI £52-146) in QALY value. Hospital catheter prevention is poised to reap substantial health-economic gains, but community-oriented interventions are needed to target the large burden imposed by community-onset infection.

What US hospitals are currently doing to prevent common device-associated infections: results from a national survey

BackgroundDespite focused initiatives to reduce device-associated infection among hospitalised patients, the practices US hospitals are currently using are unknown. We thus used a national survey to ascertain the use of...

The evolution of catheter-associated urinary tract infection (CAUTI): Is it time for more inclusive metrics?

Catheter-associated urinary tract infection (CAUTI) has long been considered a preventable healthcare-associated infection. Many federal agencies, the Centers for Medicare and Medicaid Services (CMS), and public and private healthcare organizations have implemented strategies aimed at preventing CAUTIs. To monitor progress in CAUTI prevention, the National Healthcare Safety Network (NHSN) CAUTI metric has been adopted nationally as the primary outcome measure and has been refined over the past decades. However, this surveillance metric may underestimate infectious and noninfectious catheter harm. We suggest evolving to more inclusive performance metrics to better reflect quality improvement efforts underway in hospitals. The standardized device utilization ratio (SUR) provides a good surrogate for preventable catheter harm. On the other hand, a population-based metric that combines both standardized infection ratio (SIR) and SUR would address both infectious and noninfectious harm, while adjusting for population risk. Finally, electronically captured catheter-associated bacteriuria may contribute essential information on local testing stewardship.

Catheter-Associated Urinary Tract Infections: Diagnosis, Treatment, and Prevention

The most common type of healthcare-associated infection (HAI) is a urinary tract infection (UTI), and 80 percent of these are associated with the use of indwelling urinary catheters (IUCs). These are termed catheter-associated urinary tract infections (CAUTIs). It has been estimated that about 25 percent of all hospitalized patients have an IUC placed during their hospital stay. In addition to the morbidity and mortality that may be associated with a CAUTI, there are also financial consequences. This is particularly true since as of October 1, 2008, the Centers for Medicare and Medicaid Services stopped reimbursing hospitals for several types of infections acquired during a hospital stay, including CAUTIs. In United States (U.S.) the estimated annual cost of treating these CAUTIs is $350 million. It has been proposed that a large percentage of CAUTIs should be preventable. This article will discuss the diagnosis, treatment, and prevention of CAUTIs

The CAUTI Prevention Tool Kit: A Professional Practice and Collaborative Project of the Wound, Ostomy and Continence Nurses Society.

In order to address the need for a tool to support hospital-based nurses in catheter-associated urinary tract infection (CAUTI) prevention, the American Nurses Association (ANA) was asked to convene a Technical Expert Panel of stakeholders in CAUTI prevention. The Technical Expert Panel was chaired by the ANA's Senior Policy Fellow, a certified wound, ostomy and continence (WOC) nurse. The panel comprised 23 representatives, including nurses from specialty practice organizations, nursing affiliated with the ANA, infection control specialists, patient safety authorities, award-winning hospitals using the National Database of Nursing Quality Indicators, and content experts. The Wound, Ostomy and Continence Society appointed 2 representatives to this panel, a key nurse researcher with expertise in this area of care and a former Society President. The CAUTI Prevention Tool Kit, combined with supplemental guidance documents developed, supports WOC nurses and Society members in achieving quality clinical outcomes for their patients.

Teaming up to Reduce Catheter-Associated Urinary Tract Infections

Indwelling urinary catheters are a frequent cause of infection, which may result in hospitalization and increased morbidity and mortality. Catheter-associated urinary tract infection (CAUTI) and its complications are linked to increased health care costs. Adherence to proper indications and techniques for insertion and maintenance can prevent infection. The Centers for Disease Control and Prevention has published guidelines and recommendations on CAUTI prevention, quality programs and strategies to reduce CAUTI rates.

Comparison of uropathogens and antibiotic susceptibility patterns in catheterized ambulant middle-aged and elderly Nigerian patients with bladder outlet obstruction.

Advanced age is one of the notable risk factors for catheter-associated urinary tract infections (CAUTIs), and differences between middle aged and elderly men with CAUTIs is poorly understood. This study aimed at comparing the pattern of urinary pathogens and antibiotic susceptibility in ambulant catheterized middle-aged and elderly Nigerian men. One hundred and fifty-four patients catheterized for >48 hours had provided clean catch mid-stream urine samples for microscopic analysis, culture and sensitivity tests. Eighty-two men aged <65, and 72 men aged ≥65 years matched for age, level of education, occupation and marital status were compared. Prevalence of CAUTIs among middle-aged men was middle-aged men was higher than the elderly (90.2% and 80.6% respectively) but this was not statistically significant (p=0.086). CAUTIs in middle-aged men with suprapubic catheters were significantly more frequent than those with urethral catheters (p=0.000). The prevalence of CAUTIs in middle-aged men with urethral stricture was different from other causes of bladder outlet obstruction (p=0.004). Men with indwelling catheters longer than 2 weeks had higher CAUTIs (p=0.000). Escherichia coli was the commonest pathogen in both groups while nitrofurantoin was the most sensitive drug. There are differential rates of CAUTIs in both the middle-aged men and the elderly with bladder outlet obstruction in our environment. The knowledge of the common pathogens and the antibiotic susceptibility will prevent irrational antibiotic use. Middle-aged men had higher prevalence of CAUTIs when Proteus spp. was the infectious agent. However, E. coli was the commonest pathogen of CAUTIs in all men. Also, middle- aged men with suprapubic catheters had higher rates of CAUTIs. Nitrofurantoin was the best drug in all men with CAUTIs but elderly men had higher rates of multi-resistance.

Incidence and Etiology of Catheter Associated Urinary Tract Infection among Admitted Patients at Kabale Regional Referral Hospital, South Western Uganda

Introduction: Catheter Associated Urinary Tract Infection is the most common hospital acquired infection worldwide. Urinary Tract Infections among catheterised patients are on rise regardless of antibiotic use and this is due to erratic use of antibiotics, treatment failure, antimicrobial resistance and emergency of Extended Spectrum Beta Lactamase producing bacteria leading to patient distress, increased healthcare costs, long hospital stay and poor patient response to antibiotics. In Uganda, no previous studies have sought to study the burden of CAUTI among catheterized patients, the bacterial pathogens involved and their antimicrobial susceptibility patterns yet there is upsurge in antimicrobial resistance of uropathogens. The effective management of patients suffering from Catheter Associated Urinary Tract infection (CAUTI) relays on the identification of uropathogens that cause CAUTI and the selection of an effective antibiotic agent to the uropathen in question. Objectives: The objectives of this study were to determine incidence, etiology and antibiotic susceptibility pattern among the uropathogens causing Catheter Associated Urinary Tract Infections among patients with indwelling catheters at Kabale Regional Referral Hospital. Methods: Using a descriptive prospective observational hospital-based study, the study was conducted on 150 catheterized patients recruited from Emergency, Obstetrics and gynecology, Medical, Maternity and Surgical wards at Kabale Regional Referral Hospital between April and May 2019. The urine samples from study participants were processed in Kabale RRH microbiology laboratory as per standard operating procedures. After isolation and identification, all the isolates were subjected to antibiotic susceptibility testing for commonly used antibiotics. Results: Following the urine culture from 150 catheterized patients, urine from 23 (15.3%) patients showed significant growth. The common bacterial isolates were Escherichia coli 12 (52%), followed by the Klebsiella pneumoniae 6 (26%), Staphylococcus aureus 3 (13%) and Pseudomonas spp. 2 (8.7%). All Gram-negative isolates were sensitive to Imipenem 20 (100%) while all S. aureus isolates (3) were 100% sensitive to Vancomycin and Cefoxitin. Isolates were sensitive to Gentamicin 20 (82.6), Ceftriaxone 16 (69.6), Ciprofloxacin 10 (43.5) and Nitrofurantoin 9 (39.1). All isolates were 100% resistant to Cotrimoxazole. 6 gram negative isolates were resistant to ceftazidime and were tested for Extended Spectrum Beta (s) Lactamase (ESBL), 5 (83.3%) were identified as ESBL-producing bacteria. K. pneumonia 3 (60%) presented the highest percentage of ESBLs as compared to E. coli 2 (40%). Conclusions: The Incidence of CAUTI among patients with indwelling urinary catheters at Kabale Regional Referral Hospital is high (15.3%) and is mostly caused by E. coli and K. pneumoniae. These bacteria are resistant to most commonly used antibiotics and thus there is a need to put more emphasis on CAUTI prevention strategies and use culture and sensitivity tests before prescription of antibiotics.

1362. A Novel Intravesical Antimicrobial for CAUTIs

BackgroundAs many as 1.5 million people reside in long-term care facilities in the United States. Nearly all of these patients will develop catheter-associated urinary tract infections (CAUTIs) within a month of catheterization. These infections collectively cost the healthcare system billions of dollars each year. In addition, the emergence of multi-drug-resistant ESKAPE (Enterobacter species, Staphylococcus aureus, Klebsiella species, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterococcus species) pathogens affects the severity of infections, increasing both morbidity and mortality. Our research group is exploring a novel, dual-acting, antimicrobial, glycerol monolaurate (GML)-containing gel to prevent and treat CAUTIs.MethodsPieces (7 mm in length) of RenaSil Silicone Tubing were placed in the bladders of BALB/c female mice (n = 5/group). Approximately 1 × 108 colony-forming units/mL ESKAPE pathogens (50 µL) were inoculated into the bladder, and animals were returned to cages for 18 hours. One hundred microliters of 2.5% GML Gel (50:50 mix of saline and human-approved glycols) or phosphate-buffered saline (placebo) was administered into the bladders. After 2 hours, animals were euthanized and colony-forming units in bladders and on catheters were determined, and histological analysis of bladders was performed.ResultsGML Gel was bactericidal against ESKAPE pathogens at 2 hours post-treatment. Subsequent histological analysis of bladders from infected and noninfected mice showed that GML Gel was not toxic to bladder tissue.ConclusionOur results in this murine catheter infection model indicate that the newly formulated GML Gel may be useful in prevention and treatment of CAUTIs.Disclosures M. Peterson, Hennepin Life Sciences: Board Member, Consulting fee. S. Kilgore, Hennepin Life Sciences: Employee, Salary. P. Schlievert, Hennepin Life Sciences: Board Member, Consulting fee.