Catheter-Associated Urinary Tract Infection and the Medicare Rule Changes

Abstract

Catheter-associated urinary tract infection, a common and potentially preventable complication of hospitalization, is one of the hospital-acquired complications chosen by the Centers for Medicare and Medicaid Services (CMS) for which hospitals no longer receive additional payment. To help understand the potential consequences of the recent CMS rule changes we examine the preventability of catheter-associated infection, review the CMS rules changes regarding catheter-associated urinary tract infection, offer our assessment of the possible consequences of these changes, and provide guidance for hospital-based administrators and clinicians. Though controversial, we conclude that the CMS rule changes related to catheter-associated urinary tract infection may do more good than harm since hospitals are likely to re-double their efforts in preventing catheter-associated urinary tract infection, which may minimize unnecessary placement and facilitate prompt removal of indwelling catheters. While we applaud CMS for forcing hospitals to increase efforts to prevent complications stemming from hospital-acquired infection, the opportunity costs and potential for unintended consequences cannot be overlooked. Consequently, how hospitals and physicians respond to the CMS rule changes must be monitored closely.

Alterations in antibiotic susceptibility of urinary tract infection pathogens

“…Women (especially in pregnancy period), renal transplant recipients, patients with a chronic indwelling bladder catheter, stone formers and patients with anatomical or functional abnormalities of genitourinary tracts, are more prone (1)(2)(3)(4)(5)(6). Although a broad range of pathogens can cause UTI, gram-negative bacteria, particularly Escherichia coli is remained the most common (7)(8)(9).…”

Similar Neutrophil-Driven Inflammatory and Antibacterial Responses in Elderly Patients with Symptomatic and Asymptomatic Bacteriuria

“…The symptoms include fever (Ն38.5°C), rigors, altered mental status, malaise, lethargy, flank pain, costovertebral angle tenderness, hematuria, suprapubic discomfort, dysuria, and urgent/frequent urination. In patients with spinal cord injuries, increased spasticity and autonomic dysreflexia are also considered (3,8). Most laboratories define UTI and CAUTI as the presence of 10 5 CFU/ml urine with UTI symptoms, but a threshold of 10 3 CFU/ml is also applied (3, 4).…”

“…To define ASB in women, Ն10 5 CFU/ml urine in two consecutive clean-catch specimens and identification (ID) of at least one microbial species not considered to be a commensal organism of the vagina and perineum, such as Gardnerella, Lactobacillus, and Corynebacterium species, were previously suggested (11). Lowering the count to 10 4 CFU/ml urine for species considered less pathogenic, e.g., S. agalactiae and Candida species (11), and to 10 2 CFU/ml for catheterized urine specimens (8) is accepted practice in some clinical laboratories. A recent CDC report recommended defining CAUTI and CAASB as conditions requiring insertion and maintenance of a catheter for more than 2 calendar days prior to diagnosis (12).…”

Assessment of Urinary Cultures and Catheter-Associated Urinary Tract Infection (CAUTI) Rates at a Free-Standing Rehabilitation Hospital

“…Nationally, CAUTIs cause an estimated $131 million in annual excess medical costs [4]. This is critical because Centers for Medicare and Medicaid Services (CMS) no longer include CAUTIs among conditions that are reimbursed for the extra cost of care [5]. Among all hospitals with inpatient beds, rehabilitation facilities had the highest rates of CAUTIs [3].…”