Catheter-Associated Urinary Tract Infections among Trauma Patients: Poor Quality of Care or Marker of Effective Rescue?

Abstract

Background: Catheter-associated urinary tract infection (CAUTI) is associated generally with worse outcomes among hospitalized patients, but the impact of CAUTI on clinical outcomes is poorly described in trauma patients. We hypothesized that trauma patients with CAUTI would have worse outcomes such as longer length of stay (LOS), fewer discharges to home, and higher outcome of death. Methods: Patients with LOS >2 d in the 2016 Trauma Quality Improvement Program (TQIP) database were included. Patients with and without CAUTI were matched 1:1 via a propensity score using patient, injury, and hospital factors as covariates. Matched pair analysis was performed to compare difference in clinical outcomes between patients with and without CAUTI. Results: There were 238,274 patients identified, of whom 0.7% had a diagnosis of CAUTI. Prior to matching, CAUTI patients had a higher mortality rate (6.6% vs. 3.4%, p < 0.01), but groups differed significantly. There were 1,492 matched pairs created, with effective reduction in bias; post-match propensity score covariates all had absolute standardized differences <0.1. In matched pair analysis, CAUTI patients had lower outcome of death compared with patients without CAUTI (6.7% vs. 10.1%, p < 0.01). The CAUTI was associated with longer length of stay, more intensive care unit and ventilator days, more unplanned events, and fewer discharges to home (all p < 0.01). Conclusions: Trauma patients with CAUTI had lower outcome of death compared with patients without CAUTI, despite worse clinical outcomes in all other aspects. This difference may be associated with ''rescue'' care in the form of unplanned events, and CAUTI may be an unintended consequence of this ''rescue'' care, rather than a marker of poor quality of care.

Hospital-Acquired Condition Rate of Admitting Facility Does Not Predict Mortality in Traumatically Injured Patients

“…As such, the placement of a urinary catheter represented more effective care, but at the cost of an increased likelihood of CAUTI. Ladhani et al hypothesized that due to urinary catheterization being a necessary component of rescue care, CAUTIs may represent a “necessary evil” [ 25 ].…”