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Catheter-associated urinary tract infection: Role of the setting of catheter insertion

  • Pamela Barbadoro
    Affiliations
    Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy

    Services Department, Hospital Hygiene Unit, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
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  • Francesco M. Labricciosa
    Affiliations
    Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy
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  • Claudia Recanatini
    Affiliations
    Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy
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  • Giada Gori
    Affiliations
    Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy
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  • Federico Tirabassi
    Affiliations
    Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy
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  • Enrica Martini
    Affiliations
    Services Department, Hospital Hygiene Unit, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
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  • Maria Grazia Gioia
    Affiliations
    Services Department, Hospital Hygiene Unit, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
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  • Marcello M. D'Errico
    Correspondence
    Address correspondence to Marcello M. D'Errico, MD, Sezione di Igiene, Medicina Preventiva e Sanità Pubblica, Facoltà di Medicina e Chirurgia - Università Politecnica delle Marche, Via Tronto 10/a, Torrette, 60020 Ancona, Italy.
    Affiliations
    Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy

    Services Department, Hospital Hygiene Unit, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
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  • Emilia Prospero
    Affiliations
    Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy

    Services Department, Hospital Hygiene Unit, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
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Published:March 31, 2015DOI:https://doi.org/10.1016/j.ajic.2015.02.011

      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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