Nosocomial Catheter-associated Urinary Tract Infection Research Articles

Prevention of Nosocomial Catheter-Associated Urinary Tract Infections Through Computerized Feedback to Physicians and a Nurse-Directed Protocol.

Catheter-associated urinary tract infections (CAUTIs) represent the most common nosocomial infection. The authors' baseline rate of CAUTI for general medical service was elevated at 36 per 1000 catheter-days. The medical literature has consistently linked inappropriate catheter use with the development of CAUTI. The baseline data also revealed a high rate of inappropriate use of indwelling urinary catheters. Using the dual modalities of technology through prompts in the computerized order/entry system and handheld bladder scanners, as well as in combination with staff education and nurse empowerment, the authors were successful in reducing the use and duration of urinary catheters as well as the incidence of CAUTI. In subsequent data collection cycles over the following 2 years, 81% reduction in device use and a 73% reduction in the clinical end point of nosocomial CAUTI (36/1000 catheter-days to 11/1000 catheter-days; P < .001) was demonstrated.

CAUTIon With Our Patients: The Development and Implementation of a CAUTI Tracer Program

BACKGROUND The most common hospital acquired infection is catheter associated urinary tract infection (CAUTI). Approximately 75% of urinary tract infections acquired in the hospital are associated with urinary catheters. CAUTI increases the length of stay by two days and incurs unnecessary costs to the patient. Our nosocomial CAUTI SIR (Standardized infection ratio) in 2017 was 1.161 which is above the Center for Medicare and Medicaid services Hospital Value- Based Purchasing (CMS VBP) benchmark of 0.822. The purpose of this project is to reduce nosocomial CAUTI SIR and to increase catheter bundle compliance. METHODS We utilized a multidisciplinary approach partnering with our corporate Infection Preventionist. We performed a gap analysis using the Targeted Assessment for Prevention (TAP) report to identify our units with opportunities for improvement. We built a CAUTI tracer tool that can be utilized to measure compliance of catheter care and a report can be generated for analysis. A tip sheet was developed and education was provided on all of the bundle components including alternatives for external urinary devices. For sustainment we engaged senior leadership and the units identified with opportunities were required to perform daily catheter care audits until CAUTI free for four months. RESULTS After the process changes were initiated in quarter 1 2018, the hospital acquired CAUTI SIR started to show a steady decline. The 2018 quality year January through September CAUTI SIR is at 0.883 which is a 28% reduction from 2017. With the implementation of the tracer tool, bundle compliance was observed to increase from 80% to 95%. CONCLUSIONS Initiation of the education tip sheet and the CAUTI tracer tool were successful interventions in reducing hospital acquired CAUTI's. Support from both corporate and entity leadership has proven to be effective towards deployment, reduction and sustainment.

MP23-09 COMPARISON OF POSTOPERATIVE CATHETER-ASSOCIATED URINARY TRACT INFECTION (CAUTI) RATES IN THE UROLOGIC PATIENT WITH A SUPRAPUBIC CATHETER VERSUS TRANSURETHRAL CATHETER

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder II1 Apr 2018MP23-09 COMPARISON OF POSTOPERATIVE CATHETER-ASSOCIATED URINARY TRACT INFECTION (CAUTI) RATES IN THE UROLOGIC PATIENT WITH A SUPRAPUBIC CATHETER VERSUS TRANSURETHRAL CATHETER Jason Warncke, Brittan Sutphin, John Hohenmeyer, E. David Crawford, and Brian Flynn Jason WarnckeJason Warncke More articles by this author , Brittan SutphinBrittan Sutphin More articles by this author , John HohenmeyerJohn Hohenmeyer More articles by this author , E. David CrawfordE. David Crawford More articles by this author , and Brian FlynnBrian Flynn More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.741AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urinary tract infections (UTIs) are the most common type of healthcare-associated infection. Among UTIs acquired in the hospital, 75% are catheter-associated urinary tract infections (CAUTI). CAUTI has gained much attention, as in 2008 Medicare regulations ceased reimbursement for costs related to nosocomial CAUTIs. Traditional teaching has been that suprapubic catheters (SPC) are associated with less risk of CAUTI than transurethral catheters (TUC). However, studies directly comparing the CAUTI rate in patients with SPC versus TUC are lacking, particularly in the postoperative Urologic patient. Thus, in this study we aim to compare the CAUTI rate with SPC versus TUC in the postoperative Urologic patient. METHODS We retrospectively reviewed and compared the medical records of 354 patients over a 5-yr period that underwent Urologic surgery. The SPC group consisted of patients that underwent SPC placement at the time of concomitant autologous rectus fascia pubovaginal sling (PVS) by a single surgeon (BJF). SPC placement was accomplished using the T-Spec device from Swan Valley Medical. The TUC group consisted of patients that underwent TUC placement using an 18 Fr Foley at the time of open radical prostatectomy (RP) by a single surgeon (EDC). Patients without a SPC or TUC and patients with both were excluded from the study. The primary outcome of comparison was the CAUTI rate (defined by the 2017 CDC guidelines) between the SPC and TUC cohorts. A Fisher’s exact test was performed to determine if the difference in CAUTI rate between the two cohorts was statistically significant (p<0.05). RESULTS 252 patients were included, including 145 (57.6%) in the SPC group and 107 (42.5%) in the TUC group, mean age 54.5 and 61.5 yrs, respectively. The mean catheter duration at the time of CAUTI for the SPC and TUC groups were 21.3 and 16.0 days, respectively (p=0.79). The mean catheter duration for the TUC group with and without CAUTI was 25.4 and 14.7 days, respectively (p=0.14). The overall CAUTI rate when catheter duration was less than 15 days compared to greater than 15 days was 3.3% and 5.0%, respectively (p=0.39). The CAUTI rate for the SPC group was 2.1% versus the TUC group 7.5% (p=0.039; OR 3.82). CONCLUSIONS In this study of postoperative Urologic patients, SPC was found to have a statistically significant lower rate of CAUTI when compared to TUC. This information may help guide providers when choosing the appropriate bladder drainage modality for their patients, particularly in the postoperative Urologic setting. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e284 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Jason Warncke More articles by this author Brittan Sutphin More articles by this author John Hohenmeyer More articles by this author E. David Crawford More articles by this author Brian Flynn More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

S-Nitroso-N-acetylpenicillamine (SNAP) Impregnated Silicone Foley Catheters: A Potential Biomaterial/Device To Prevent Catheter-Associated Urinary Tract Infections.

Urinary Foley catheters are utilized for management of hospitalized patients and are associated with high rates of urinary tract infections (UTIs). Nitric oxide (NO) potently inhibits microbial biofilm formation, which is the primary cause of catheter associated UTIs (CAUTIs). Herein, commercial silicone Foley catheters are impregnated via a solvent swelling method with S-nitroso-N-acetyl-D-penicillamine (SNAP), a synthetic NO donor that exhibits long-term NO release and stability when incorporated into low water-uptake polymers. The proposed catheters generate NO surface-fluxes >0.7 × 10–10 mol min–1 cm–2 for over one month under physiological conditions, with minimal SNAP leaching. These biomedical devices are demonstrated to significantly decrease formation of biofilm on the surface of the catheter tubings over 3, 7, and 14 day periods by microbial species (Staphylococcus epidermidis and Proteus mirabilis) commonly causing CAUTIs. Toxicity assessment demonstrates that the SNAP-impregnated catheters are fully biocompatible, as extracts of the catheter tubings score 0 on a 3-point grading scale using an accepted mouse fibroblast cell-line toxicity model. Consequently, SNAP-impregnated silicone Foley catheters can likely provide an efficient strategy to greatly reduce the occurrence of nosocomial CAUTIs.

Lock-Out Valve to Decrease Catheter-Associated Urinary Tract Infections

Patients with long-term indwelling urinary catheters are at an increased risk for urinary tract infection due to bacteriuria. Catheter-associated urinary tract infections (CAUTIs) are a significant source of morbidity and mortality in long-term care facilities as well as in ambulatory patients requiring long-term catheterization. There is increased interest in the financial impact of CAUTI as Medicare no longer provides reimbursement for nosocomial CAUTIs. Ascending bacteria may in part enter the closed drainage system when the patient switches between leg and night collection bags. In an attempt to reduce this ascent, a double valve lock-out system was devised that maintains a closed system during bag exchange. The concept is introduced and CAUTIs are reviewed.

Factors That Affect Nosocomial Catheter-Associated Urinary Tract Infection in Intensive Care Units: 2-Year Experience at a Single Center

PurposeThis study took a retrospective approach to investigate patients with catheter-associated urinary tract infection (CAUTI) over 2 years at a single hospital's intensive care unit (ICU) to identify meaningful risk factors and causative organisms.Materials and MethodsA retrograde analysis was performed on patients with indwelling catheters between January 2009 and December 2010 in Yeouido St. Mary Hospital medical and surgical ICU. CAUTI was defined as isolated bacterial growth of 100,000 colony-forming units or more either 48 hours after transfer to the ICU if a urinary catheter was placed before the transfer or 48 hours after insertion if the catheter was inserted in the ICU. Only the patients whose culture results were negative before ICU admission were included.ResultsThere were a total of 1,315 patients with indwelling urinary catheters in our hospital's medical and surgical ICU between January 2009 and December 2010. Of these patients, 241 had positive urine culture results, and 61 had CAUTI. Using multivariate logistic regression analysis, those with diabetes were 4.55 (p<0.001) times as likely to have occurrences of CAUTI than were those without and also had a 1.10-fold (p<0.01) longer duration of an indwelling catheter. Upon urine culture, among the 61 patients with CAUTI, Escherichia coli was the most common bacterium grown; it was identified in 24 patients (38.7%).ConclusionsThe factors and causative organisms contributing to the development of CAUTI in the management of ICU patients must be considered to prevent the occurrence of UTIs in this setting.

Garlic blocks quorum sensing and attenuates the virulence ofPseudomonas aeruginosa

Pseudomonas aeruginosa is an opportunistic pathogen that colonizes urinary catheters, forms biofilms, and is responsible for causing persistent and recurrent nosocomial catheter-associated urinary tract infections (UTIs). These infections show increased morbidity and mortality in immunocompromised patients. Quorum sensing in P. aeruginosa plays a key role in biofilm formation, virulence factor production and antimicrobial resistance. Because of emerging antimicrobial resistance in P. aeruginosa, there is a need to find an alternate nonantibiotic agent for the control of infections caused by this organism. In the present study, garlic was evaluated as a prophylactic agent in vivo in a mouse UTI model. Oral treatment with garlic significantly lowered renal bacterial counts and protected mouse kidney from tissue destruction. In vitro data showed decreased elaboration of virulence factors and reduced production of quorum-sensing signals by P. aeruginosa in the presence of fresh garlic extract. The results suggest that decreased virulence of P. aeruginosa in garlic-fed mice can be attributed to the quorum-sensing inhibitory property of garlic. This might have contributed towards reduced production of virulence factors, as seen in vitro.

Nosocomial Infection, the Deficit Reduction Act, and Incentives for Hospitals

For every 100 patients admitted to US hospitals in 2002, 4.5 patients developed a nosocomial infection On October 1, 2008, the Centers for Medicare & Medicaid Services (CMS) will stop reimbursement to hospitals for the cost of treating nosocomial catheter-associated urinary tract infections, vascular catheter-associated bloodstream infections, and surgical site infections following certain elective procedures, including mediastinitis, certain orthopedic surgeries, and bariatric surgery. This regulation arises from the Deficit Reduction Act, signed by the president on February 8, 2006. The goal is to reduce the increases in Medicare and Medicaid spending by stopping payments for conditions that result in the assignment of a higher-cost diagnosis related group and, in the opinion of the regulators, are reasonably preventable by the application of evidence-based guidelines. The standard for reasonably preventable was intentionally not defined.

Reduction in catheter-associated urinary tract infection (CAUTI) using a silver-coated all-silicone Foley catheter versus a silver-impregnated latex Foley catheter in a Southeastern U.S. long-term acute care facility

BACKGROUND: Infection control surveillance for nosocomial catheter-associated urinary tract infection (CAUTI) is often performed in intensive care units (ICUs) where comparison to NNIS data is possible. There is much information regarding CAUTI incidence in large teaching facilities. However, there are few benchmarks for use in small specialty facilities. This facility is a 49 bed long-term acute care (LTAC) hospital located in the Southeastern United States. Average LOS (length of stay) is >25 days. The LTAC serves a geographic radius of approximately 100 miles. OBJECTIVES: Compare the facility's existing CAUTI rate using a silver-impregnated latex Foley catheter to the CAUTI rate using a silver-coated all-silicone catheter. Quantify the economic and patient safety impact on this hospital. METHODS: Total facility surveillance of nosocomial CAUTIs was completed using Centers for Disease Control and Prevention (CDC) definitions. A comprehensive concurrent chart review was conducted for all patients with Foley catheters who presented with positive urine cultures >48 hours after admission. The baseline period utilizing the silver latex catheter was March–December 2003. These months were then compared to the same months utilizing the all-silicone silver-coated Foley in the subsequent year. RESULTS: The novel silver-coated all-silicone Foley catheter had 17% fewer CAUTIs in the time period studied. Compliance with hand hygiene and Foley catheter care was similar during the two timeframes. The calculated cost savings in the trial period was $49,439. CONCLUSIONS: Use of a novel silver-coated all-silicone Foley catheter resulted in major reductions in the incidence of CAUTI and cost. Switching to all-silicone silver-coated urinary catheters in the LTAC setting could substantially decrease nosocomial CAUTI, thereby improving patient safety. Further investigation is recommended. BACKGROUND: Infection control surveillance for nosocomial catheter-associated urinary tract infection (CAUTI) is often performed in intensive care units (ICUs) where comparison to NNIS data is possible. There is much information regarding CAUTI incidence in large teaching facilities. However, there are few benchmarks for use in small specialty facilities. This facility is a 49 bed long-term acute care (LTAC) hospital located in the Southeastern United States. Average LOS (length of stay) is >25 days. The LTAC serves a geographic radius of approximately 100 miles. OBJECTIVES: Compare the facility's existing CAUTI rate using a silver-impregnated latex Foley catheter to the CAUTI rate using a silver-coated all-silicone catheter. Quantify the economic and patient safety impact on this hospital. METHODS: Total facility surveillance of nosocomial CAUTIs was completed using Centers for Disease Control and Prevention (CDC) definitions. A comprehensive concurrent chart review was conducted for all patients with Foley catheters who presented with positive urine cultures >48 hours after admission. The baseline period utilizing the silver latex catheter was March–December 2003. These months were then compared to the same months utilizing the all-silicone silver-coated Foley in the subsequent year. RESULTS: The novel silver-coated all-silicone Foley catheter had 17% fewer CAUTIs in the time period studied. Compliance with hand hygiene and Foley catheter care was similar during the two timeframes. The calculated cost savings in the trial period was $49,439. CONCLUSIONS: Use of a novel silver-coated all-silicone Foley catheter resulted in major reductions in the incidence of CAUTI and cost. Switching to all-silicone silver-coated urinary catheters in the LTAC setting could substantially decrease nosocomial CAUTI, thereby improving patient safety. Further investigation is recommended.

Reduction of nosocomial catheter-associated urinary tract infection (CAUTI) in a U.S. Southeastern teaching facility with an all-silicone silver Foley catheter

BACKGROUND: In this 600-plus-bed teaching hospital with multiple services, catheter-associated urinary tract infections (CAUTIs) was measured in the ICU only. A hospital-wide algorithm has been in place to assist healthcare workers in discontinuing Foley catheters. The rate of CAUTI infection in other units was unknown at the time the study was initiated. The catheter in use was an uncoated latex Foley. The epidemiology department sought to determine the rate of CAUTI hospital-wide and to make interventions to lower the hospital-wide CAUTI rate by introducing an all-silicone silver Foley catheter. The economic impact was also measured. METHODS: A retrospective review was done of all adult inpatients with an indwelling Foley catheter and a positive urine culture >105 cfus collected at least 72 hours post catheterization. The Centers for Disease Control and Prevention (CDC) definitions for nosocomial UTI were used to determine infection. Data were collected during a baseline period of May–July 2003, and a trial period of June–October 2004. The average cost to treat CAUTI at the hospital was determined through a review of patient charges and estimated at $2200. The additional cost of the all-silicone silver Foley catheter was considered. RESULTS: During the baseline period, there were 39 CAUTIs in 23,738 risk-adjusted patient days (1.6 CAUTIs/1000 risk-adjusted patient days). During the trial period, the incidence of CAUTI was reduced to 13 CAUTIs in 37,933 risk-adjusted patient days (0.39 CAUTI/1000 risk-adjusted patient days). A 73.8% reduction in CAUTI incidence was evident. CONCLUSIONS: A 73.8% reduction in nosocomial CAUTI represents a significant improvement in patient safety. In addition, the economic savings of $229,000 in direct patient care costs is significant to the organization. Another added benefit is the replacement of a latex Foley catheter with the all-silicone Foley catheter, thereby reducing the potential of latex sensitivity in both patients and staff. Further study and evaluation of the Foley catheter at the hospital is warranted. BACKGROUND: In this 600-plus-bed teaching hospital with multiple services, catheter-associated urinary tract infections (CAUTIs) was measured in the ICU only. A hospital-wide algorithm has been in place to assist healthcare workers in discontinuing Foley catheters. The rate of CAUTI infection in other units was unknown at the time the study was initiated. The catheter in use was an uncoated latex Foley. The epidemiology department sought to determine the rate of CAUTI hospital-wide and to make interventions to lower the hospital-wide CAUTI rate by introducing an all-silicone silver Foley catheter. The economic impact was also measured. METHODS: A retrospective review was done of all adult inpatients with an indwelling Foley catheter and a positive urine culture >105 cfus collected at least 72 hours post catheterization. The Centers for Disease Control and Prevention (CDC) definitions for nosocomial UTI were used to determine infection. Data were collected during a baseline period of May–July 2003, and a trial period of June–October 2004. The average cost to treat CAUTI at the hospital was determined through a review of patient charges and estimated at $2200. The additional cost of the all-silicone silver Foley catheter was considered. RESULTS: During the baseline period, there were 39 CAUTIs in 23,738 risk-adjusted patient days (1.6 CAUTIs/1000 risk-adjusted patient days). During the trial period, the incidence of CAUTI was reduced to 13 CAUTIs in 37,933 risk-adjusted patient days (0.39 CAUTI/1000 risk-adjusted patient days). A 73.8% reduction in CAUTI incidence was evident. CONCLUSIONS: A 73.8% reduction in nosocomial CAUTI represents a significant improvement in patient safety. In addition, the economic savings of $229,000 in direct patient care costs is significant to the organization. Another added benefit is the replacement of a latex Foley catheter with the all-silicone Foley catheter, thereby reducing the potential of latex sensitivity in both patients and staff. Further study and evaluation of the Foley catheter at the hospital is warranted.

Prevention of Nosocomial Catheter-Associated Urinary Tract Infections Through Computerized Feedback to Physicians and a Nurse-Directed Protocol

Catheter-associated urinary tract infections (CAUTIs) represent the most common nosocomial infection. The authors' baseline rate of CAUTI for general medical service was elevated at 36 per 1000 catheter-days. The medical literature has consistently linked inappropriate catheter use with the development of CAUTI. The baseline data also revealed a high rate of inappropriate use of indwelling urinary catheters. Using the dual modalities of technology through prompts in the computerized order/entry system and handheld bladder scanners, as well as in combination with staff education and nurse empowerment, the authors were successful in reducing the use and duration of urinary catheters as well as the incidence of CAUTI. In subsequent data collection cycles over the following 2 years, 81% reduction in device use and a 73% reduction in the clinical end point of nosocomial CAUTI (36/1000 catheter-days to 11/1000 catheter-days; P < .001) was demonstrated.

Reduction of ICU Nosocomial Catheter-Associated Urinary Tract Infections

Reduction of ICU Nosocomial Catheter-Associated Urinary Tract Infections

Reduction of ICU Nosocomial Catheter-Associated Urinary Tract Infections

ISSUE: The Infection Control Department is responsible for an annual review and update of the surveillance plan. Surveillance is extremely important in the context of continuous quality improvement because it makes use of objective data to improve organizational performance. Catheter-associated urinary tract infection (CA-UTI) rates were compared to data from the National Nosocomial Infection Surveillance System (NNIS). It was noted that infection rates in the intensive care unit (ICU) from October 2001 to September 2002 were consistently greater than the 90th percentile when compared to NNIS. PROJECT: An action plan was devised through a root-cause analysis identifying issues in practice, patient demographics, and human characteristics. The action plan included lecture and demonstration in handwashing techniques with a program that included the use of fluorescent lotion to help the staff with visualization of residue left on the hands after hand hygiene, encouraging the use of a waterless hand sanitizer (already available in all the ICU rooms), anonymous culturing of the hands of the ICU staff (for educational purposes), environmental culturing, trialing a new catheter securement device, and reviewing the CDC recommendations for prevention and/or reduction of CA-UTIs. RESULTS: The action plan was implemented from July through September 2002. The data collected from September 2002 to the present shows a consistent decline in the incidence of CA-UTIs in the ICU, with a rate of 2.8 infections per 1000 urinary catheter days, which falls between the 25th and 50th percentile when compared to NNIS. Annual statistics show a total of 13 infections per 1000 urinary catheter days from October 2001 to August 2002, and a total of 4 infections per 1000 urinary catheter days from September 2002 to September 2003, a decrease of 70%. LESSONS LEARNED: It is extremely important to continue to monitor and give feedback to the staff on all of the actions taken. Several monitoring systems were also put into place, one for the usage of the alcohol hand sanitizer and one for the use of the new catheter securement device.

Evaluation of the Impact on Patient Safety Resulting from Use of Silver-Coated Foley Catheters in a Community Hospital

BACKGROUND: Research into prevention of catheter-associated urinary tract infections (CA-UTIs) with the use of silver-coated Foley catheters (SCFCs) has been documented in several large university medical centers. Little is known about the impact of SCFCs in smaller community hospitals. Olean General Hospital (OGH) is a 103-year-old, 186-bed community medical center located in Olean, New York. The Hospital has a primary service area of 60,000 people. OBJECTIVES: Determine the impact on patient safety resulting from use of SCFCs to reduce the incidence of CA-UTI in a community medical center. Quantify the economic impact of this intervention for the hospital. METHODS: House-wide surveillance of nosocomial CA-UTIs was completed using CDC definitions. A comprehensive chart review was conducted for all patients with Foley catheters who presented with positive urine cultures at >48 hours after admission. The baseline period employing regular Foley catheters (RFCs) was February, March, and April 2001. These results were then compared to the same months using SCFCs in 2002. RESULTS: The following incidence of CA-UTI was observed in the baseline period: February, 6 per 2402 patient days; March, 9 per 2853 patient days; April, 13 per 2607 patient days. This represents an average rate of CA-UTI of 3.6 infections per 1000 patient days. The following incidence of CA-UTI was observed in the evaluation period: February, 2 per 2852 patient days, March, 3 per 2485 patient days, April, 5 per 2828 patient days. This represents an average rate of CA-UTI of 1.2 infections per 1000 patient days. The relative risk of CA-UTI per 1000 patient days with the SCFC compared to the RFC was 0.35 (95% confidence interval, 0.17–0.71; p=0.003). Using an average cost for CA-UTI of $3803, a net annual cost avoidance of $221,359 was computed. CONCLUSION: SCFCs can reduce the incidence of CA-UTI in a community medical center by 65%. These catheters also offer a significant cost savings to the facility. Based on these patient safety and economic benefits, SCFCs are the standard of care at OGH.

Risk factors of nosocomial catheter-associated urinary tract infection in a polyvalent intensive care unit.

Due to a regrettable technical error, the article was published twice. The editorial office and the publisher present their apologies to the authors and the readers for this mistake.

Risk factors of nosocomial catheter-associated urinary tract infection in a polyvalent intensive care unit.

To determine the risk factors for catheter-associated urinary tract infection in a polyvalent intensive care unit (ICU). Prospective cohort study. Sixteen-bed polyvalent ICU in a French university hospital. Prospective patient surveillance of patients included in two successive studies of two urine drainage systems. Bacteriuria occurrence in 553 ICU patients requiring a bladder catheter for longer than 48 h. The following variables were analyzed as possible risk factors: age, sex, severity score at admission, diagnosis on admission, duration of bladder catheterization, length of ICU stay, prior exposure to antibiotics, and system of urine drainage. The frequency of catheter-associated bacteriuria was 9.6%. From the multivariate analysis, five independent risk factors were determined: female sex, length of ICU stay, use of an antimicrobial therapy, severity score at admission, and duration of catheterization. In our study, the drainage system did not influence the occurrence of bacteriuria. To decrease the rate of catheter-associated bacteriuria in polyvalent ICU patients, removal of the bladder catheter must be performed as soon as possible.

Risk factors of nosocomial catheter-associated urinary tract infection in a polyvalent intensive care unit.

To determine the risk factors for catheter-associated urinary tract infection in a polyvalent intensive care unit (ICU). Prospective cohort study in a 16-bed polyvalent ICU in a French university hospital. Prospective patient surveillance of patients included in two successive studies of two urine drainage systems. Bacteriuria occurrence in 553 ICU patients requiring a bladder catheter for longer than 48 h. The following variables were analyzed as possible risk factors: age, sex, severity score at admission, diagnosis on admission, duration of bladder catheterization, length of ICU stay, prior exposure to antibiotics, and system of urine drainage. The frequency of catheter-associated bacteriuria was 9.6%. From the multivariate analysis, five independent risk factors were determined: sex female, length of ICU stay, use of an antimicrobial therapy, severity score at admission, and duration of catheterization. In our study the drainage system did not influence the occurrence of bacteriuria. To decrease the rate of catheter-associated bacteriuria in polyvalent ICU patients removal of the bladder catheter must be performed as soon as possible.

The direct costs of nosocomial catheter-associated urinary tract infection in the era of managed care.

To determine the additional direct costs of hospitalization attributable to catheter-associated urinary tract infection (CAUTI) in 1,497 newly catheterized patients. Prospective observational and laboratory study. University hospital. Data were collected on risk factors for CAUTI (defined as > 10(3) colony-forming units [CFU]/mL), severity of illness, and diagnostic and therapeutic interventions in consenting newly catheterized patients. Daily urine cultures were obtained from each newly catheterized patient, but the results of these cultures were not revealed to his or her physician. During the study, one of the investigators (DGM) reviewed each patient's record and made a judgment as to which of the diagnostic tests and treatments ordered and what incremental length of stay could reasonably be ascribed to his or her CAUTI. The total hospital costs for each patient were also obtained. Overall, 235 patients acquired CAUTIs during the study; most of the CAUTIs were completely asymptomatic, and only 52% were diagnosed by the patients' physicians using the hospital laboratory. Only 1 patient with a CAUTI had a secondary bloodstream infection. Thirty-three (13%) of the CAUTIs were caused by Escherichia coli; 63 (25%) by Klebsiella, Enterobacter, Citrobacter, Pseudomonas aeruginosa, or other antibiotic-resistant, gram-negative bacilli; 87 (35%) by enterococci or staphylococci; and 67 (27%) by Candida species. The 123 CAUTIs diagnosed by the hospital laboratory were judged to have been responsible for an additional $20,662 in extra costs of diagnostic tests and $35,872 in extra medication costs, a mean of $589 (median, $356) per CAUTI. CAUTIs caused by E. coli cost considerably less than infections caused by other gram-negative bacilli ($363.3 +/- $228.2 vs $690.4 +/- $783.7; P = .02) or yeasts ($821.2 +/- $2,169.9). There were less striking differences in the costs per CAUTI caused by staphylococci or enterococci ($387.1 +/- $434.8). The extra direct costs associated with nosocomial CAUTI found in this prospective study, which was done in the era of managed care during the late 1990s, are substantially lower than those reported in the largest comparable studies done more than 15 years ago, most of which were retrospective, reflecting the powerful impact of cost-containment measures that are now implemented in managed care.

The relationship between pyuria and infection in patients with indwelling urinary catheters: a prospective study of 761 patients.

Pyuria is universally considered as essential for identifying urinary tract infections in noncatheterized patients. The utility of pyuria in the catheterized patient, to identify catheter-associated urinary tract infection (CAUTI), has not been adequately defined. We prospectively studied 761 newly catheterized patients in a university hospital; 82 (10.8%) developed nosocomial CAUTI (> 10(3) colony-forming units per milliliter). While catheterized, each patient was seen daily, a quantitative urine culture was obtained, and the urine white blood cell concentration was measured quantitatively using a hemocytometer. The mean urine leukocyte count in patients with CAUTI was significantly higher than in patients without infections (71 vs 4 per microliter; P= .006). Pyuria was most strongly associated with CAUTI caused by gram-negative bacilli (white blood cell count, 121 vs 4 per microliter; P = .03); infection with coagulase-negative staphylococci and enterococci (white blood cell count, 39 vs 4 per microliter; P = .25) or yeasts (white blood cell count, 25 vs 4 per microliter; P = .15) produced much less pyuria. Pyuria with a white blood cell count greater than 10 per microliter (>5 per high-power field in a conventional urinalysis) had a specificity of 90% for predicting CAUTI with greater than 10(5) colony-forming units per milliliter but a sensitivity of only 37%. In patients with short-term indwelling urinary catheters, pyuria is less strongly correlated with CAUTI than in noncatheterized patients with urinary tract infection. The strongest association is with CAUTI caused by gram-negative bacilli; the association is far weaker for infections caused by gram-positive cocci or yeasts. Most patients with CAUTI are asymptomatic and do not have associated fever. Pyuria should not be used as the sole criterion to obtain a urine culture in a patient with a catheter.

Catheter-associated urinary tract infection is rarely symptomatic: a prospective study of 1,497 catheterized patients.

Catheter-associated urinary tract infection (CAUTI) is the most common nosocomial infection, accounting for more than 1 million cases each year in US hospitals and nursing homes. To define the clinical features of CAUTI. A university hospital; 1,497 newly catheterized patients. Every day that the catheter was in place, a quantitative urine culture and urine leukocyte count were obtained, and the patient was queried by a research worker regarding symptoms. To more precisely define the role of CAUTI in patients' symptoms, a subset of 1,034 patients, 89 of whom developed CAUTI with more than 10(3) colony-forming units per milliliter, who did not have another potentially confounding site of infection besides the urinary tract, was analyzed. Presence of fever, symptoms commonly associated with community-acquired urinary tract infection, and peripheral leukocytosis. There were 235 new cases of nosocomial CAUTI during the study period. More than 90% of the infected patients were asymptomatic; only 123 infections (52%) were detected by patients' physicians using the hospital laboratory. In the subset analysis, there were no significant differences between patients with and without CAUTI in signs or symptoms commonly associated with urinary tract infection-fever, dysuria, urgency, or flank pain-or in leukocytosis. Only 1 of the 235 episodes of CAUTI that were prospectively studied was unequivocally associated with secondary bloodstream infection. Whereas CAUTIs are a major reservoir of antibiotic-resistant organisms in the hospital, they are rarely symptomatic and infrequently cause bloodstream infection. Symptoms referable to the urinary tract, fever, or peripheral leukocytosis have little predictive value for the diagnosis of CAUTI.