Highlights
- •Catheter insertion in the ward was a risk factor for catheter-associated urinary tract infection.
- •Prolonged catheterization (>4 days) was an independent risk factor for catheter-associated urinary tract infection.
- •Of the isolated bacteria, 82.5% were resistant to various classes of antibiotics.
- •Catheter-associated urinary tract infections should not be empirically treated unless in the context of emergency care.
Background
This study aimed to describe the epidemiology of catheter-associated urinary tract
infections (CAUTIs) in patients admitted to a surgical ward in Central Italy and to
analyze the associated risk factors.
Methods
An active surveillance program for CAUTI was carried out in patients catheterized
for at least 48 hours. Place of catheter insertion (operating room, hospital ward,
cystoscopy room, emergency care unit), indication for catheterization and its duration,
among other risk factors were monitored until discharge. Antibiotic resistance profiles
of isolates were analyzed.
Results
There were 641 catheterized patients monitored for CAUTI onset. Of these, 40 (6.2%)
developed a CAUTI (rates were 15.1/1,000 catheter days, 95% confidence interval [CI],
11.9-22.6; 8.7/1,000 patient days, 95% CI, 6.9-13.1). Patients with CAUTI were older
(P < .05) and their durations of hospitalization and catheterization were both longer
compared with those who were not affected (P < .05). Catheterization >4 days (odds ratio [OR] = 8.21; 95% CI, 3.79-17.73; P < .05) and place of catheter insertion different from the operating room (OR = 7.9;
95% CI, 2.83-22.08; P < .05, for catheters placed in the ward) were associated with CAUTI. Among the micro-organisms
isolated in CAUTIs, the most common were Pseudomonas aeruginosa (41.5%), Klebsiella pneumoniae (19.5%), and Escherichia coli (12.2%); 82.5% of them were resistant to different classes of antibiotics.
Conclusion
These results highlight the role played by the setting of catheter insertion in CAUTIs
onset, therefore reflecting the importance of hand hygiene and proper aseptic insertion
techniques as crucial determinants in CAUTIs prevention.
Key Words
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References
- Catheter-associated urinary tract infection.Curr Opin Infect Dis. 2012; 25: 365-370
- The European Centre for Disease Prevention and Control (ECDC) pilot point prevalence survey of healthcare-associated infections and antimicrobial use.Euro Surveill. 2012; 17 (pii: 20316)
- Biofilms and catheter-associated urinary tract infections.Infect Dis Clin North Am. 2003; 17: 411-432
- Incidence of catheter-associated and non-catheter-associated urinary tract infections in a healthcare system.Infect Control Hosp Epidemiol. 2011; 32: 822-823
- Inappropriate use of urinary catheters in elderly patients at a midwestern community teaching hospital.Am J Infect Control. 2004; 32: 196-199
- Are physicians aware of which of their patients have indwelling urinary catheters?.Am J Med. 2000; 109: 476-480
- Overuse of the indwelling urinary tract catheter in hospitalized medical patients.Arch Intern Med. 1995; 155: 1425-1429
- Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: 2014 update.Infect Control Hosp Epidemiol. 2014; 35: 464-479
- Guideline for prevention of catheter-associated urinary tract infections, 2009.Infect Control Hosp Epidemiol. 2010; 31: 319-326
- epic2: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England.J Hosp Infect. 2007; 65: S1-S64
- A large, randomized clinical trial of a silver-impregnated urinary catheter: lack of efficacy and staphylococcal superinfection.Am J Med. 1995; 98: 349-356
- Diagnosis, prevention and treatment of catheter-associated urinary tract infection in adults: 2009 international clinical practice guidelines from the Infectious Diseases Society of America.Clin Infect Dis. 2010; 50: 625-663
- Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009-2010.Infect Control Hosp Epidemiol. 2013; 34: 1-14
- Catheter-associated urinary tract infection is rarely symptomatic: a prospective study of 1497 catheterized patients.Arch Intern Med. 2000; 160: 678-682
- Impact control of the duration of urinary catheterization: impact on catheter-associated urinary tract infection.J Hosp Infect. 2007; 67: 253-257
- Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance.Clin Microbiol Infect. 2012; 18: 268-281
- Healthcare-associated infections in a department of urology: incidence and patterns of antibiotic resistance.Scand J Urol. 2014; 48: 203-209
- Prospective assessment of the efficacy of the EAU guidelines for the prevention of nosocomial acquired infections after genitourinary surgery in a district hospital.Arch Ital Urol Androl. 2009; 81: 46-50
- Nosocomial urinary tract infections in urologic patients: assessment of a prospective surveillance program including 10,000 patients.Eur Urol. 2002; 41: 483-489
- Active training and surveillance: 2 good friends to reduce urinary catheterization rate.Am J Infect Control. 2012; 40: 692-695
- Perioperative antibiotic prophylaxis: improved compliance and impact on infection rates.Epidemiol Infect. 2011; 139: 1326-1331
- Antimicrobial resistance surveillance in Europe 2013. Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net).European Centre for Disease Prevention and Control, Stockholm, Sweden2014
- Hospital acquired urinary tract infections in urology departments: pathogens, susceptibility and use of antibiotics. Data from the PEP and PEAP-studies.Int J Antimicrob Agents. 2006; 28: S91-S107
- Attributable hospital cost and length of stay associated with health care-associated infections caused by antibiotic-resistant gram-negative bacteria.Antimicrob Agents Chemother. 2010; 54: 109-115
- Catheter-associated and nosocomial urinary tract infections: antibiotic resistance and influence on commonly used antimicrobial therapy.Int Urol Nephrol. 2009; 41: 461-464
- Emergence of extended-spectrum β-lactamase-producing Escherichia coli in catheter-associated urinary tract infection in neurogenic bladder patients.Am J Infect Control. 2014; 42: 29-31
- Outbreak of cystoscopy related infections with Pseudomonas aeruginosa: New Mexico, 2007.J Urol. 2008; 180: 588-592
- An outbreak of carbapenem-resistant Pseudomonas aeruginosa in a urology ward.Clin Microbiol Infect. 2003; 9: 938-943
- Risk factors for catheter-associated urinary tract infection in Italian elderly.Am J Infect Control. 2014; 42: 898-901
Article Info
Publication History
Published online: March 31, 2015
Footnotes
Conflicts of interest: None to report.
Identification
Copyright
© 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
