Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-28T04:42:22.322Z Has data issue: false hasContentIssue false
  • English
  • Français

Bacteremia and Mortality with Urinary Catheter–Associated Bacteriuria

Part of: BARRY FARR AWARD RECIPIENTS

Published online by Cambridge University Press:  02 January 2015

Quratulain F. Kizilbash ,
Nancy J. Petersen ,
Guoqing J. Chen ,
Aanand D. Naik  and
Barbara W. Trautner
Quratulain F. Kizilbash
Affiliation:
Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
Nancy J. Petersen
Affiliation:
Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas Houston Veterans Affairs Health Services Research and Development Center of Excellence, Houston, Texas Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
Guoqing J. Chen
Affiliation:
Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas Houston Veterans Affairs Health Services Research and Development Center of Excellence, Houston, Texas Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
Aanand D. Naik
Affiliation:
Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas Houston Veterans Affairs Health Services Research and Development Center of Excellence, Houston, Texas Section of Geriatrics, Department of Medicine, Baylor College of Medicine, Houston, Texas
Barbara W. Trautner*
Affiliation:
Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas Houston Veterans Affairs Health Services Research and Development Center of Excellence, Houston, Texas
*
2002 Holcombe Boulevard, Houston, TX 77030 (trautner@bcm.edu) or Aanand Naik, MD, MEDVAMC (152), 2002 Holcombe Boulevard, Houston, TX 77030 (anaik@bcm.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

Although catheter-associated urinary tract infection (CAUTI) and catheter-associated asymptomatic bacteriuria (CAABU) are clinically distinct conditions, most literature describing the risks of bacteriuria does not distinguish between them. We studied the relationship between catheter-associated bacteriuria and bacteremia from a urinary source in CAUTI relative to that in CAABU. Second, we investigated whether the presence or absence of urinary symptoms in catheterized patients with bacteriuria was associated with bacteremia from any source or mortality. Finally, we explored the effect of antimicrobial treatment of bacteriuria on subsequent bacteremia from any source and mortality.

Design.

We performed a retrospective cohort study with 30 days of follow-up after an initial positive urine culture. CAUTI and CAABU were defined by Infectious Diseases Society of America guidelines.

Setting.

A large tertiary care facility.

Patients.

All inpatients with a urinary catheter (external or indwelling) and a positive urine culture between October 2010 and June 2011.

Results.

We captured 444 episodes of catheter-associated bacteriuria in 308 patients; 128 (41.6%) patients had CAUTI, and 180 (58.4%) had CAABU. Three episodes of bacteriuria were followed by bacteremia from a urinary source (0.7%). CAUTI, rather than CAABU, was associated with bacteremia from any source, but neither CAUTI nor CAABU predicted subsequent mortality. Use of antimicrobial agents to treat bacteriuria was not associated with either bacteremia from any source or mortality.

Conclusions.

Bacteremia from a urinary source was infrequent, and there was no evidence of an association of mortality with symptomatic versus asymptomatic bacteriuria in this population. Antibiotic treatment of bacteriuria did not affect outcomes.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 11 , November 2013 , pp. 1153 - 1159
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Kleyens, RM, Edwards, JR, Richards, CL Jr, et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep 2007;122:160–166.Google Scholar
2.Siddiq, DM, Darouiche, RO. New strategies to prevent catheter-associated urinary tract infections. Nat Rev Urol 2012;9:305–314.Google Scholar
3.Tambyah, PA, Maki, DG. Catheter-associated urinary tract infection is rarely symptomatic: a prospective study of 1497 cath-eterized patients. Arch Intern Med 2000;160:678–682.Google Scholar
4.Platt, R, Polk, BF, Murdock, B, Rosner, B. Mortality associated with nosocomial urinary-tract infection. N Engl J Med 1982;307: 637–642.Google Scholar
5.Clec'h, C, Schwebel, C, Français, A, et al. Does catheter-associated urinary tract infection increase mortality in critically ill patients? Infect Control Hosp Epidemiol 2007;28:1367–1373.Google Scholar
6.Laupland, KB, Bagshaw, SM, Gregson, DB, Kirkpatrick, AW, Ross, T, Church, DL. Intensive care unit-acquired urinary tract infections in a regional critical care system. Crit Care 2005;9:R60–R65.CrossRefGoogle Scholar
7.Hooton, TM, Bradley, SF, Cardenas, DD, et al. 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.Google Scholar
8.Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309–332.Google Scholar
9.Nicolle, LE, Bradley, S, Colgan, R, Rice, JC, Schaeffer, A, Hooton, TM. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis 2005;40:643–654.Google Scholar
10.Warren, JW, Anthony, WC, Hoopes, JM, Muncie, HL Jr.Cephalexin for susceptible bacteriuria in afebrile, long-term catheter-ized patients. JAMA 1982;248:454–458.Google Scholar
11.Tenke, P, Kovacs, B, Bjerklund Johansen, TE, Matsumoto, T, Tambyah, PA, Naber, KG. European and Asian guidelines on management and prevention of catheter-associated urinary tract infections. Int J Antimicrob Agents 2008;31(suppl 1):S68–S78.Google Scholar
12.Leone, M, Perrin, AS, Granier, I, et al. A randomized trial of catheter change and short course of antibiotics for asymptomatic bacteriuria in cafheterized ICU patients. Intensive Care Med 2007;33:726–729.Google Scholar
13.Bahagon, Y, Raveh, D, Schlesinger, Y, Rudensky, B, Yinnon, AM. Prevalence and predictive features of bacteremic urinary tract infection in emergency department patients. Eur J Clin Microbiol Infect Dis 2007;26:349–352.Google Scholar
14.Saint, S, Kaufman, SR, Rogers, MA, Baker, PD, Boyko, EJ, Lipsky, BA. Risk factors for nosocomial urinary tract-related bacteremia: a case-control study. Am J Infect Control 2006;34:401–407.CrossRefGoogle ScholarPubMed
15.Greene, MT, Chang, R, Kuhn, L, et al. Predictors of hospital-acquired urinary tract-related bloodstream infection. Infect Control Hosp Epidemiol 2012;33:1001–1007.Google Scholar
16.Burns, AC, Petersen, NJ, Garza, A, et al. Accuracy of a urinary catheter surveillance protocol. Am J Infect Control 2012;40:55–58.Google Scholar
17.Trautner, BW, Kelly, PA, Petersen, N, et al. A hospital-site controlled intervention using audit and feedback to implement guidelines concerning inappropriate treatment of catheter-associated asymptomatic bacteriuria. Implement Sci 2011;6:41.Google Scholar
18.Trautner, BW, Bhimani, RD, Bush, AL, et al. Development and validation of an algorithm to recalibrate mental models and reduce diagnostic errors associated with catheter-associated bacteriuria. BMC Med Inform Decis Making 2013;13:48.Google Scholar
19.Viera, AJ, Garrett, JM. Understanding interobserver agreement: the kappa statistic. Earn Med 2005;37:360–363.Google Scholar
20.Landis, JR, Koch, GG. The measurement of observer agreement for categorical data. Biometrics 1977;33:159–174.Google Scholar
21.Smith, MW, Joseph, GJ. Pharmacy data in the VA health care system. Med Care Res Rev 2003;60(3 suppl):92S–123S.Google Scholar
22.Sedor, J, Mulholland, SG. Hospital-acquired urinary tract infections associated with the indwelling catheter. Urol Clin North Am 1999;26:821–828.CrossRefGoogle ScholarPubMed
23.Kauffman, CA, Vazquez, JA, Sobel, JD, et al. Prospective multicenter surveillance study of funguria in hospitalized patients. Clin Infect Dis 2000;30:14–18.Google Scholar
24.Paul, N, Mathai, E, Abraham, OC, Michael, JS, Mathai, D. Factors associated with candiduria and related mortality. J Infect 2007; 55:450–455.Google Scholar
25.Âlvarez-Lerma, F, Nolla-Salas, J, Leon, C, et al. Candiduria in critically ill patients admitted to intensive care medical units. Intensive Care Med 2003;29:1069–1076.CrossRefGoogle ScholarPubMed
26.Magill, SS, Swoboda, SM, Johnson, EA, et al. The association between anatomic site of Candida colonization, invasive candidiasis, and mortality in critically ill surgical patients. Diagn Microbiol Infect Dis 2006;55:293–301.Google Scholar
27.Toya, SP, Schraufnagel, DE, Tzelepis, GE. Candiduria in intensive care units: association with heavy colonization and candidaemia. J Hosp Infect 2007;66:201–206.Google Scholar