Identifying the risk factors for catheter-associated urinary tract infections: a large cross-sectional study of six hospitals

Abstract

MotivationCatheter-associated urinary tract infections (CAUTI) are a common and serious healthcare-associated infection. Despite many efforts to reduce the occurrence of CAUTI, there remains a gap in the literature about CAUTI risk factors, especially pertaining to the effect of catheter dwell-time on CAUTI development and patient comorbidities.ObjectiveTo examine how the risk for CAUTI changes over time. Additionally, to assess whether time from catheter insertion to CAUTI event varied according to risk factors such as age, sex, patient type (surgical vs medical) and comorbidities.DesignRetrospective cohort study of all patients who were catheterised from 2012 to 2016, including those who did and did not develop CAUTIs. Both paediatric and adult patients were included. Indwelling urinary catheterisation is the exposure variable. The variable is interval, as all participants were exposed but for different lengths of time.SettingUrban academic health system of over 2500 beds. The system encompasses two large academic medical centres, two community hospitals and a paediatric hospital.ResultsThe study population was 47 926 patients who had 61 047 catheterisations, of which 861 (1.41%) resulted in a CAUTI. CAUTI rates were found to increase non-linearly for each additional day of catheterisation; CAUTI-free survival was 97.3% (CI: 97.1 to 97.6) at 10 days, 88.2% (CI: 86.9 to 89.5) at 30 days and 71.8% (CI: 66.3 to 77.8) at 60 days. This translated to an instantaneous HR of. 49%–1.65% in the 10–60 day time range. Paraplegia, cerebrovascular disease and female sex were found to statistically increase the chances of a CAUTI.ConclusionsUsing a very large data set, we demonstrated the incremental risk of CAUTI associated with each additional day of catheterisation, as well as the risk factors that increase the hazard for CAUTI. Special attention should be given to patients carrying these risk factors, for example, females or those with mobility issues.

Chronic indwelling foley catheter, a risk factor for catheter associated urinary tract infection.

“…Whereas, Letica-Kriegel AS et al found that duration of indwelling urethral catheter is a risk factor for 16.5% episodes of CAUTI. Out of these 12% of patients develop CAUTI 11. These findings are in agreement with our study.…”

“…4 3-10% of residents in United States are being managed using long term Foley catheters. 14 11 Incidence of febrile illness from a likely urinary device is 7-11/1000 catheter days, which is approximately three times more than the incidence in patients without a Foley catheter. 20 Tambyah PA et al studied that 3% of patients having catheter associated asymptomatic bacteriuria progress to bacteremia with the urinary pathogen.…”

A Clinical Control Study on the Retroperitoneal Laparoscopy for Unilateral Simple Renal Cyst Decortication in the Day Ward

“…There have been many kinds of urological surgery performed in the day ward mode, including lithotripsy (soft) mirror ureter, bladder calculi lithotripsy, urethra stone lithotripsy, urethra meat with resection, occult penis orthopedics, cryptorchidism by xation, stress urinary incontinence, etc. An analysis of risk factors for catheter-related urinary tract infections found that each additional day of catheter retention increased the risk of urinary tract infections [15].Since the hospital stay in the day ward mode does not exceed 24 hours, reducing the indwelling time of urinary catheters can further increase the turnover rate of patients when they are admitted to the hospital, and also greatly reduce the incidence of nosocomial infections. If postoperative infection occurs, in order to better select the appropriate antibiotic application, it is recommended that clinicians collect secretions and send them to bacterial culture as much as possible.…”

Comparison of the Effect of Perineal Care with Normal Saline and 2% Chlorhexidine Solution on the Rate of Catheter-Associated Urinary Tract Infection in Women Hospitalized in Intensive Care Units: A Quasi-Experimental Study

“…Colonized microorganisms in the perineal skin and around the urethra can move into the urinary system through the outer surface of the urinary catheter and cause infection (14). Therefore, interventions designed to prevent the colonization of pathogens around the urinary tract can be very important in controlling CAUTIs (15). One of these interventions is the proper care of the perineal area.…”