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Characteristics and outcomes of hospitalised inpatients with indwelling urinary catheter-a retrospective study from a large regional hospital in Queensland

      Highlights

      • Catheter associated urinary tract infection (CAUTI) is a common iatrogenic infection.
      • Likelihood of CAUTI development increases 9% each additional day of catheterisation.
      • We found no difference in medical and surgical patients for developing CAUTI.
      • Interventions reducing catheter days could be used to improve CAUTI rates.

      Abstract

      Background

      Indwelling urinary catheters (IDCs) are a common invasive device in hospitalised patients. Their use is associated with increased risks of developing catheter associated urinary tract infections (CAUTI), and blood stream infections (BSI).

      Aims

      To examine the characteristics and outcomes of adult inpatients with an IDC inserted in hospital and identify risk factors for developing CAUTI and BSI.

      Methods

      We performed a retrospective observational study of 430 patients with IDC admitted to medical and surgical units of a leading (tertiary) hospital between Nov 2019 till April 2020. Multiple logistic regression analysis was performed to determine independent risk factors for developing urinary tract infection and blood stream infection.

      Results

      The prevalence of CAUTI in our study was 7.4%. Results of multiple logistic regression indicated that with each day of IDC in situ, the likelihood of UTI development increased by 9% (OR 1.09; 95% CI 1.00 to 1.18; p = 0.03). Age, gender, and catheter reinsertion were not associated with UTI development.

      Conclusions

      Longer duration of IDC was associated with elevated risk of developing CAUTI. CAUTI rates were higher than some of those previously published. There was no statistical significance in frequency of CAUTI between medical and surgical patients. No statistically significant variables that contributed to the development of BSI were found. Interventions targeted at reducing catheter days should be used to improve CAUTI rates.

      Keywords

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      References

        • Flores-Mireles A.
        • Hreha T.N.
        • Hunstad D.A.
        Pathophysiology, treatment, and prevention of catheter-associated urinary tract infection.
        Top Spinal Cord Inj Rehabil. 2019; 25: 228-240
        • Hooton T.M.
        • Bradley S.F.
        • Cardenas D.D.
        • Colgan R.
        • Geerlings S.E.
        • Rice J.C.
        • et al.
        Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 international clinical practice guidelines from the infectious diseases society of America.
        Clin Infect Dis. 2010; 50: 625-663
        • Authority T.I.H.P.
        Pricing and funding for safety and quality: risk adjustment model for hospital acquired complications.
        2018
        • Gomila A.
        • Carratala J.
        • Eliakim-Raz N.
        • Shaw E.
        • Tebe C.
        • Wolkewitz M.
        • et al.
        Clinical outcomes of hospitalised patients with catheter-associated urinary tract infection in countries with a high rate of multidrug-resistance: the COMBACTE-MAGNET RESCUING study.
        Antimicrob Resist Infect Control. 2019; 8: 198
        • Lillie P.J.
        • Johnson G.
        • Ivan M.
        • Barlow G.D.
        • Moss P.J.
        Escherichia coli bloodstream infection outcomes and preventability: a six-month prospective observational study.
        J Hosp Infect. 2019; 103: 128-133
        • Otter J.A.
        • Galletly T.J.
        • Davies F.
        • Hitchcock J.
        • Gilchrist M.J.
        • Dyakova E.
        • et al.
        Planning to halve Gram-negative bloodstream infection: getting to grips with healthcare-associated Escherichia coli bloodstream infection sources.
        J Hosp Infect. 2019; 101 ([Electronic)]): 1532-2939
        • Care ACoSaQiH
        Hospital-acquired complication. vol. 3. Healthcare-Associated Infections, 2018
        • Werneburg G.T.
        Catheter-associated urinary tract infections: current challenges and future prospects.
        Res Rep Urol. 2022; 14: 109-133
        • Apisarnthanarak A.
        • Thongphubeth K.
        • Fau—Sirinvaravong S.
        • Sirinvaravong S Fau—Kitkangvan D.
        • Kitkangvan D Fau—Yuekyen C.
        • Yuekyen C Fau—Warachan B.
        • Warachan B.
        • Fau—Warren D.K.
        • et al.
        Effectiveness of multifaceted hospital wide quality improvement programs featuring an intervention to remove unnecessary urinary catheters at a tertiary care center in Thailand.
        Infect Control Hosp Epidemiol. 2007; 28 (823X) ([Print))]): 899
        • Trickey A.W.
        • Crosby M.E.
        • Vasaly F.
        • Donovan J.
        • Moynihan J.
        • Reines H.D.
        Using NSQIP to investigate SCIP deficiencies in surgical patients with a high risk of developing hospital-associated urinary tract infections.
        Am J Med Qual. 2014; 29: 381-387
        • Barbadoro P.
        • Labricciosa F.M.
        • Recanatini C.
        • Gori G.
        • Tirabassi F.
        • Martini E.
        • et al.
        Catheter-associated urinary tract infection: role of the setting of catheter insertion.
        Am J Infect Control. 2015; 43: 707-710
        • Letica-Kriegel A.S.
        • Salmasian H.
        • Vawdrey D.K.
        • Youngerman B.E.
        • Green R.A.
        • Furuya E.Y.
        • et al.
        Identifying the risk factors for catheter-associated urinary tract infections: a large cross-sectional study of six hospitals.
        BMJ Open. 2019; 9e022137
        • Mitchell B.G.
        • Anderson M.
        • Ferguson J.K.
        A predictive model of days from infection to discharge in patients with healthcare-associated urinary tract infections: a structural equation modelling approach.
        J Hosp Infect. 2017; 97: 282-287
        • Chan J.K.
        • Gardner A.B.
        • Mann A.K.
        • Kapp D.S.
        Hospital-acquired conditions after surgery for gynecologic cancer—an analysis of 82,304 patients.
        Gynecol Oncol. 2018; 150: 515-520
        • Laan B.J.
        • Vos M.C.
        • Maaskant J.M.
        • van Berge Henegouwen M.I.
        • Geerlings S.E.
        Prevalence and risk factors of inappropriate use of intravenous and urinary catheters in surgical and medical patients.
        J Hosp Infect. 2020; 105: 698-704
        • CfDCa Prevention
        Catheter-associated urinary tract infection [CAUTI] and non-catheter-associated urinary tract infection [UTI]) and other urinary system infection [USI]) events.
        2019
        • Secondary Bsi Attribution R.P.L.
        A tale of two scenarios.
        National Center for Emerging and Zoonotic Infectious Diseases: Center for Disease Control, 2019
      1. Project R. 4.04 ed. 2017.

        • Nicolle L.E.
        Catheter associated urinary tract infections.
        Antimicrob Resist Infect Control. 2014; 3: 23
        • Basbug A.
        • Yuksel A.
        • Ellibes Kaya A.
        Early versus delayed removal of indwelling catheters in patients after elective cesarean section: a prospective randomized trial.
        J Matern Fetal Neonatal Med. 2020; 33: 68-72
        • Cortese Y.J.
        • Wagner V.E.
        • Tierney M.
        • Devine D.
        • Fogarty A.
        Review of catheter-associated urinary tract infections and in vitro urinary tract models.
        J Healthc Eng. 2018; 20182986742
        • Okrainec A.
        • Aarts M.A.
        • Conn L.G.
        • McCluskey S.
        • McKenzie M.
        • Pearsall E.A.
        • et al.
        Compliance with urinary catheter removal guidelines leads to improved outcome in enhanced recovery after surgery patients.
        J Gastrointest Surg. 2017; 21: 1309-1317
        • Pickard R.L.T.
        • Lam T.
        • MacLennan G.
        • Starr K.
        • Kilonzo M.
        • McPherson G.
        • et al.
        Types of urethral catheter for reducing symptomatic urinary tract infections in hospitalised adults requiring short-term catheterisation: multicentre randomised controlled trial and economic evaluation of antimicrobial- and antisepticim pregnated urethral catheters (the CATHETER trial).
        2012 (Report No.: 1366-5278 Contract No.: 47)
        • Chan J.Y.
        • Semenov Y.R.
        • Gourin C.G.
        Postoperative urinary tract infection and short-term outcomes and costs in head and neck cancer surgery.
        Otolaryngol Head Neck Surg. 2013; 148: 602-610