Abbreviated Surveillance of Nosocomial Urinary Tract Infections: A New Approach

Costel, Esther E.; Mitchell, Sue; Kaiser, Allen B.

doi:10.1017/s0195941700062433

Cited by 23 publications

(9 citation statements)

References 6 publications

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“…An ICU-acquired UTI was defined using a modification of the criteria of Costel and colleagues as those patients with a positive urine culture (at least 100,000 colony-forming units/ml of one or two organisms) first identified on ICU day 3 (48 hours) or later [2,13]. Patients with positive urine cultures within 48 hours of ICU discharge were also considered to have ICU-acquired UTIs.…”

Section: Methodsmentioning

confidence: 99%

Intensive care unit-acquired urinary tract infections in a regional critical care system

et al. 2005

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Introduction Few studies have evaluated urinary tract infections (UTIs) specifically acquired within intensive care units (ICUs), and the effect of such infections on patient outcome is unclear. The objectives of this study were to describe the occurrence, microbiology, and risk factors for acquiring UTIs in the ICU and to determine whether these infections independently increase mortality. Methods A surveillance cohort study was conducted among all adults admitted to multi-system and cardiovascular surgery ICUs in the Calgary Health Region (CHR, population about 1 million) between 1 January 2000 and 31 December 2002. Results During the 3 years, 4465 patients were admitted 4915 times to a CHR ICU for 48 hours or more. A total of 356 ICU-acquired UTIs (defined as at least 10 5 colony-forming units/ml of one or two organisms 48 hours or more after ICU admission) occurred among 290 (6.5%) patients, yielding an overall incidence density of ICU-acquired UTIs of 9.6 per 1000 ICU days. Four bacteremic/fungemic ICU-acquired UTIs occurred (0.1 per 1000 ICU days). Development of an ICU-acquired UTI was more common in women (relative risk [RR] 1.58; 95% confidence interval [CI] 1.43-1.75; P < 0.0001) and in medical (9%) compared with non-cardiac surgical (6%), and cardiac surgical patients (2%). The most common organisms isolated were Escherichia coli (23%), Candida albicans (20%), and Enterococcus species (15%). Antibiotic-resistant organisms were identified among 14% isolates. Although development of an ICU-acquired UTI was associated with significantly higher crude inhospital mortality (86/290 [30%] vs. 862/4167 [21%]; RR = 1.43; 95% CI 1.19-1.73; P < 0.001); an ICU-acquired UTI was not an independent predictor for death. Conclusions Development of an ICU-acquired UTI is common in critically ill patients. Although a marker of increased morbidity associated with critical illness, it is not a significant attributable cause of mortality.

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Section: Methodsmentioning

confidence: 99%

Intensive care unit-acquired urinary tract infections in a regional critical care system

et al. 2005

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“…An ICU-acquired UTI refers to those patients who develop a positive urine culture first identified on ICU Day 3 (48 h) or later. [915] Patients developing positive urine cultures within 48 h of being discharged from an ICU, could also be defined as having ICU-acquired UTI. The Centers for Disease Control and Prevention (CDC) defines CAUTI for those patients who have an indwelling catheter in place for 48 h or more.…”

Section: Definition Of Cautimentioning

confidence: 99%

Urinary tract infections in the critical care unit: A brief review

Parida¹,

Mishra²

2013

Indian Journal of Critical Care Medicine

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The use of indwelling catheters in the Critical Care Units (CCUs) has a major role in determining the incidence and the morbidity as well as mortality from hospital-acquired urinary tract infections (UTIs). Instituting evidence-based protocols can significantly reduce both the prevalence of indwelling catheterization as well as the incidence of hospital-acquired UTIs. The prevalence of catheter-associated urinary tract infections (CAUTIs) in the CCUs is directly linked to the widespread use of indwelling catheters in these settings. CAUTIs result in significant cost escalation for individual hospitals as well as the healthcare system as a whole. A UTI is an inflammatory response to colonization of the urinary tract, most commonly by bacteria or fungi. A UTI should be differentiated from the mere detection of bacteria in the urinary tract. This condition, referred to as asymptomatic bacteriuria, is common and does not require treatment, especially in the patient with an indwelling urinary catheter. A CAUTI occurs when a patient with an indwelling urinary catheter develops 2 or more signs or symptoms of a UTI such as hematuria, fever, suprapubic or flank pain, change in urine character, and altered mental status. CAUTI is classified as a complicated UTI. The current review highlights the important management issues in critical care patients having CAUTI. We performed a MEDLINE search using combinations of keywords such as urinary tract infection, critical care unit and indwelling urinary catheter. We reviewed the relevant publications with regard to CAUTI in patients in CCU.

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“…12 Pneumonia was defined by a positive culture from sputum or bronchoalveolar lavage. A urinary tract focus required concomitantly positive urine culture at greater than or equal to 10 8 cfu/L as per Costel et al 17 Bone or joint, central nervous system, skin or soft tissue, pleural space and intra-abdominal foci were diagnosed if cultures were obtained from the respective sites in association with BSI.…”

Section: Definitionsmentioning

confidence: 99%