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

• Published in: BMJ open Vol. 9; no. 2; p. e022137
• Main Authors: Letica-Kriegel, Allison S, Salmasian, Hojjat, Vawdrey, David K, Youngerman, Brett E, Green, Robert A, Furuya, E Yoko, Calfee, David P, Perotte, Rimma
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 21.02.2019; BMJ Publishing Group
• Subjects: Adolescent; Adult; Age Factors; Aged; Catheter-Related Infections - etiology; Catheters; Cerebrovascular Disorders - complications; Child; Child, Preschool; Cross-Sectional Studies; Disease control; Female; Humans; Infant; Infant, Newborn; Infectious Diseases; Male; Medical records; Middle Aged; Paraplegia - complications; Patient safety; Pediatrics; Retrospective Studies; Risk Factors; Sex Factors; Time Factors; Urinary Catheterization - adverse effects; Urinary tract infections; Urinary Tract Infections - etiology; Young Adult; United States > US; patient safety; infection control; catheter-related infections; quality in health care
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2018-022137

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.