Removing Yeast from the Catheter-Associated Urinary Tract Infection Definition: The Impact on Rates for a Large Healthcare System

Abstract

significant, reduction in MRSA incidence, as compared to bathing with non-antiseptic washcloths. Practice of CHG bathing may offer an additional infection control solution in reducing MRSA incidence, even in endemic settings.

Impact of modified CDC/NHSN surveillance definition on the incidence of CAUTI: a study from an Indian tertiary care hospital

“…Bardossy et al (2016), in a single-centre study, reported a reduction of approximately 50% in the rates of CAUTI, primarily due to the exclusion of candiduria (Bardossy et al, 2016). As per CDC-NHSN guidelines, a secondary bloodstream infection (BSI) may be erroneously classified as CLABSI if the fungal aetiology is excluded from CAUTI (Kieffer et al, 2015). There are few studies that evaluate the impact of change of the definitions of funguria and low levels of bacteriuria on the incidence of CAUTI rates (e.g.…”

“…There are few studies that evaluate the impact of change of the definitions of funguria and low levels of bacteriuria on the incidence of CAUTI rates (e.g. Fakih et al, 2017;Kieffer et al, 2015). In those studies, CLABSI rates increased by 27.1% and 15%, respectively.…”

“…In the analysis by Fakih et al (2017), Candida-associated CLABSI increased by 91.1%, from 0.104 to 0.198 per 1000 device days. In the analysis by Kieffer et al (2015), 7.6% of fungal CAUTI were reclassified as primary CLABSI resulting in a non-significant 15% increase in the overall ICU CLABSI rate. In our analysis of BSI data (central line-associated as well as secondary BSI), there was no BSI event attributed to Candida during the two-year period.…”

“…from the CAUTI surveillance definition (Allen-Bridson et al, 2015). Moreover, 15% of secondary bloodstream infections (BSI) may be erroneously classified as central line-associated bloodstream infections (CLABSI) if funguria is not classified as a CAUTI (Kieffer et al, 2015), thus leading to falsely inflated rates of CLABSIs. Even if Candida funguria is excluded from the CDC-NHSN surveillance definition of CAUTI, laboratories should still continue with speciation of non-albicans Candida spp., with particular attention to Candida auris, for purposes of infection control.…”

A Letter in Response to “Diagnosing Catheter-Associated Urinary Tract Infection in Critically ill Patients: Do the Guidelines Help?”

“…[ 1 ] where the authors have suggested an approach to catheter-associated urinary tract infection (CAUTI) in catheterized patients with fever in Intensive Care Units (ICUs). The Centers for Disease Control and Prevention-National Health Safety Network (CDC-NHSN) CAUTI definition excluded Candida as a valid causative organism based on several factors: “ Candida is a rare cause of UTI but urinary catheter colonization is common in some patient populations; treatment of candiduria is not associated with clinical benefit; and the inclusion of Candida in the definition may encourage inappropriate antifungal prescribing.”[ 2 ] It is also to be emphasized that the CDC-NHSN CAUTI definitions are primarily for surveillance purposes only, whereas the definitions of Infectious Diseases Society of America (IDSA) are largely concerned with diagnosis as well as patient management. In this context, I would like to make the following modifications to the suggested managerial approach for CAUTI in ICU settings.…”