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Pediatric ambulatory catheter-associated urinary tract infections (CAUTIs): Incidence, risk factors, and patient outcomes

Published online by Cambridge University Press:  05 June 2020

Michael L. Rinke Open the ORCID record for Michael L. Rinke [Opens in a new window] ,
Suzette O. Oyeku ,
Moonseong Heo ,
Lisa Saiman ,
Philip Zachariah ,
Rebecca E. Rosenberg ,
Patricia DeLaMora ,
Barbara Rabin ,
Parsa Mirhaji  and
Elizabeth Klein
...Show all authors
Michael L. Rinke*
Affiliation:
Children’s Hospital at Montefiore, Bronx, New York Albert Einstein College of Medicine, Bronx, New York
Suzette O. Oyeku
Affiliation:
Children’s Hospital at Montefiore, Bronx, New York Albert Einstein College of Medicine, Bronx, New York
Moonseong Heo
Affiliation:
Clemson University, Clemson, South Carolina
Lisa Saiman
Affiliation:
Columbia University Irving Medical Center, and New York-Presbyterian Hospital, New York, New York
Philip Zachariah
Affiliation:
Columbia University Irving Medical Center, and New York-Presbyterian Hospital, New York, New York
Rebecca E. Rosenberg
Affiliation:
New York University School of Medicine, New York, New York
Patricia DeLaMora
Affiliation:
Weill Cornell Medical College, New York, New York
Barbara Rabin
Affiliation:
Icahn School of Medicine at Mount Sinai, New York, New York
Parsa Mirhaji
Affiliation:
Albert Einstein College of Medicine, Bronx, New York
Elizabeth Klein
Affiliation:
Albert Einstein College of Medicine, Bronx, New York
William J. H. Ford
Affiliation:
Weill Cornell Medical College, New York, New York
Oghale Obaro-Best
Affiliation:
State University of New York Upstate Medical University, Syracuse, New York
Michael Drasher
Affiliation:
Wayne State University School of Medicine, Detroit, Michigan
Alexandre Peshansky
Affiliation:
Albert Einstein College of Medicine, Bronx, New York
Kelly Ann Balem
Affiliation:
Children’s Hospital at Montefiore, Bronx, New York Albert Einstein College of Medicine, Bronx, New York
David G. Bundy
Affiliation:
Medical University of South Carolina, Charleston, South Carolina
*
Author for correspondence: Michael L. Rinke, E-mail: mrinke@montefiore.org
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Abstract

Objective:

Catheter-associated urinary tract infections (CAUTIs) occur frequently in pediatric inpatients, and they are associated with increased morbidity and cost. Few studies have investigated ambulatory CAUTIs, despite at-risk children utilizing home urinary catheterization. This retrospective cohort and case-control study determined incidence, risk factors, and outcomes of pediatric patients with ambulatory CAUTI.

Design:

Broad electronic queries identified potential patients with ambulatory urinary catheters, and direct chart review confirmed catheters and adjudicated whether ambulatory CAUTI occurred. CAUTI definitions included clean intermittent catheterization (CIC). Our matched case-control analysis assessed risk factors.

Setting:

Five urban, academic medical centers, part of the New York City Clinical Data Research Network.

Patients:

Potential patients were age <22 years who were seen between October 2010 and September 2015.

Results:

In total, 3,598 eligible patients were identified; 359 of these used ambulatory catheterization (representing186,616 ambulatory catheter days). Of these, 63 patients (18%) experienced 95 ambulatory CAUTIs. The overall ambulatory CAUTI incidence was 0.51 infections per 1,000 catheter days (1.35 for indwelling catheters and 0.47 for CIC; incidence rate ratio, 2.88). Patients with nonprivate medical insurance (odds ratio, 2.5; 95% confidence interval, 1.1–6.3) were significantly more likely to have ambulatory CAUTIs in bivariate models but not multivariable models. Also, 45% of ambulatory CAUTI resulted in hospitalization (median duration, 3 days); 5% resulted in intensive care admission; 47% underwent imaging; and 88% were treated with antibiotics.

Conclusions:

Pediatric ambulatory CAUTIs occur in 18% of patients with catheters; they are associated with morbidity and healthcare utilization. Ambulatory indwelling catheter CAUTI incidence exceeded national inpatient incidence. Future quality improvement research to reduce these harmful infections is warranted.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 8 , August 2020 , pp. 891 - 899
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Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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Footnotes

PREVIOUS PRESENTATION: These data were presented as a platform presentation at the Pediatric Academic Societies meeting on April 27, 2019, in Baltimore, Maryland.

References

Mak, RH, Kuo, HJ. Pathogenesis of urinary tract infection: an update. Curr Opin Pediatr 2006;18:148–152.CrossRefGoogle ScholarPubMed
Weber, DJ, Sickbert-Bennett, EE, Gould, CV, Brown, VM, Huslage, K, Rutala, WA. Incidence of catheter-associated and non-catheter-associated urinary tract infections in a healthcare system. Infect Control Hosp Epidemiol 2011;32:822–823.CrossRefGoogle Scholar
Chant, C, Smith, OM, Marshall, JC, Friedrich, JO. Relationship of catheter-associated urinary tract infection to mortality and length of stay in critically ill patients: a systematic review and meta-analysis of observational studies. Crit Care Med 2011;39:1167–1173.CrossRefGoogle ScholarPubMed
Dudeck, MA, Weiner, LM, Allen-Bridson, K, et al.National Healthcare Safety Network (NHSN) report, data summary for 2012, device-associated module. Am J Infect Control 2013;41:1148–1166.CrossRefGoogle ScholarPubMed
Davis, KF, Colebaugh, AM, Eithun, BL, et al.Reducing catheter-associated urinary tract infections: a quality-improvement initiative. Pediatrics 2014;134:e857–e864.CrossRefGoogle ScholarPubMed
Kaplan, JA, Carter, JT. Near-perfect compliance with SCIP Inf-9 had no effect on catheter utilization or urinary tract infections at an academic medical center. Am J Surg 2018;215:23–27.CrossRefGoogle ScholarPubMed
Scott, RD. The direct medical costs of healthcare-associated infections in US hospitals and the benefits of prevention. Centers for Disease Control and Prevention website. https://www.cdc.gov/HAI/pdfs/hai/Scott_CostPaper.pdf. Published 2009. Accessed June 17, 2019.Google Scholar
Zingg, W, Fu, Q, Neves, D. Review on the burden and prevention of healthcare-associated infections in outpatient care. Strategie NOSO Ambulant Systematic website. https://www.bag.admin.ch/dam/bag/de/dokumente/mt/i-und-i/noso/nosoambulant/schlussbericht-systematic-review-noso-ambulant.pdf.download.pdf/171212_Schlussbericht%20Systematic%20Review_NOSOambulant-en.pdf. Published 2017. Accessed June 17, 2019.Google Scholar
Umscheid, CA, Mitchell, MD, Doshi, JA, Agarwal, R, Williams, K, Brennan, PJ. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol 2011;32:101–114.CrossRefGoogle ScholarPubMed
Klevens, RM, Edwards, JR, Richards, CL Jr, et al. Estimating health care-associated infections and deaths in US hospitals, 2002. Public Health Rep 2007;122:160–166.CrossRefGoogle Scholar
Foxman, B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Am J Med 2002;113 suppl 1A:5S–13S.CrossRefGoogle ScholarPubMed
Saint, S. Clinical and economic consequences of nosocomial catheter-related bacteriuria. Am J Infect Control 2000;28:68–75.CrossRefGoogle ScholarPubMed
Alten, JA, Rahman, A, Zaccagni, HJ, et al.The epidemiology of healthcare-associated infections in pediatric cardiac intensive care units. Pediatr Infect Dis J 2018;37:768–772.CrossRefGoogle ScholarPubMed
Brilli, RJ, McClead, RE Jr, Crandall, WV, et al.A comprehensive patient safety program can significantly reduce preventable harm, associated costs, and hospital mortality. J Pediatr 2013;163:1638–1645.CrossRefGoogle ScholarPubMed
Catheter-associated urinary tract infection rate. 2018. Solutions for Patient Safety website. https://www.solutionsforpatientsafety.org/our-results/. Published 2018. Accessed June 17, 2019.Google Scholar
Larijani, FJ, Moghtaderi, M, Hajizadeh, N, Assadi, F. Preventing kidney injury in children with neurogenic bladder dysfunction. Int J Prevent Med 2013;4:1359–1364.Google ScholarPubMed
Kasabian, NG, Bauer, SB, Dyro, FM, Colodny, AH, Mandell, J, Retik, AB. The prophylactic value of clean intermittent catheterization and anticholinergic medication in newborns and infants with myelodysplasia at risk of developing urinary tract deterioration. Am J Dis Child 1992;146:840–843.Google ScholarPubMed
Madigan, E, Neff, DF. Care of patients with long-term indwelling urinary catheters. Online J Issues Nurs 2003;8:7.Google ScholarPubMed
Jewes, LA, Gillespie, WA, Leadbetter, A, et al.Bacteriuria and bacteraemia in patients with long-term indwelling catheters—a domiciliary study. J Med Microbiol 1988;26:61–65.CrossRefGoogle ScholarPubMed
Meddings, J, Saint, S, McMahon, LF Jr. Hospital-acquired catheter-associated urinary tract infection: documentation and coding issues may reduce financial impact of Medicare’s new payment policy. Infect Control Hosp Epidemiol 2010;31:627–633.CrossRefGoogle ScholarPubMed
Duane, TM, Ramanathan, R, Leavell, P, Mays, C, Ober, J. CAUTIs and CLABSIs: do physicians REALLY know what they are? Surg Infect (Larchmt) 2016;17:13–16.CrossRefGoogle ScholarPubMed
Tieder, JS, Hall, M, Auger, KA, et al.Accuracy of administrative billing codes to detect urinary tract infection hospitalizations. Pediatrics 2011;128:323–330.CrossRefGoogle ScholarPubMed
Bardsley, A. Safe and effective catheterisation for patients in the community. Br J Community Nurs 2015;20:166–172.CrossRefGoogle Scholar
Tsan, L, Davis, C, Langberg, R, et al.Prevalence of nursing home-associated infections in the Department of Veterans’ Affairs nursing home care units. Am J Infect Control 2008;36:173–179.CrossRefGoogle Scholar
Mody, L, Krein, SL, Saint, SK, et al.A targeted infection prevention intervention in nursing home residents with indwelling devices: a randomized clinical trial. JAMA Intern Med 2015;175:714–723.CrossRefGoogle ScholarPubMed
Tsan, L, Langberg, R, Davis, C, et al.Nursing home-associated infections in Department of Veterans’ Affairs community living centers. Am J Infect Control 2010;38:461–466.CrossRefGoogle Scholar
Weber, DJ, Brown, V, Huslage, K, Sickbert-Bennett, E, Rutala, WA. Device-related infections in home health care and hospice: infection rates, 1998–2008. Infect Control Hosp Epidemiol 2009;30:1022–1024.CrossRefGoogle ScholarPubMed
Rosenheimer, L, Embry, FC, Sanford, J, Silver, SR. Infection surveillance in home care: device-related incidence rates. Am J Infect Control 1998;26:359–363.CrossRefGoogle ScholarPubMed
Prasad, A, Cevallos, ME, Riosa, S, Darouiche, RO, Trautner, BW. A bacterial interference strategy for prevention of UTI in persons practicing intermittent catheterization. Spinal Cord 2009;47:565–569.CrossRefGoogle ScholarPubMed
Kaushal, R, Hripcsak, G, Ascheim, DD, et al.Changing the research landscape: the New York City Clinical Data Research Network. J Am Med Informat Assoc 2014;21:587–590.CrossRefGoogle ScholarPubMed
Hardin, AP, Hackell, JM, Committee On, P, Ambulatory, M. Age limit of pediatrics. Pediatrics 2017;140.Google ScholarPubMed
Harris, PA, Taylor, R, Thielke, R, Payne, J, Gonzalez, N, Conde, JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42:377–381.CrossRefGoogle ScholarPubMed
International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Centers for Disease Control and Prevention website. https://www.cdc.gov/nchs/icd/icd9cm.htm. Published 2015. Accessed March 12, 2020.Google Scholar
National Healthcare Safety Network. Urinary tract infection (catheter-associated urinary tract infection [CAUTI]). Centers for Disease Control and Prevention website. https://www.cdc.gov/hai/ca_uti/uti.html. Published October 16, 2015. Accessed May 13, 2020.Google Scholar
Feudtner, C, Christakis, DA, Connell, FA. Pediatric deaths attributable to complex chronic conditions: a population-based study of Washington State, 1980–1997. Pediatrics 2000;106:205–209.Google ScholarPubMed
Kleinbaum, DG, Klein, M. Logistic Regression: Self-Learning Text, third edition. New York: Springer; 2010.CrossRefGoogle Scholar
Bellomo, R, Ronco, C, Kellum, JA, et al.Acute renal failure—definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004;8:R204–R212.CrossRefGoogle ScholarPubMed
Lo, E, Nicolle, LE, Coffin, SE, et al.Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35 Suppl 2:S32–S47.CrossRefGoogle ScholarPubMed
Letica-Kriegel, AS, Salmasian, H, Vawdrey, DK, et al.Identifying the risk factors for catheter-associated urinary tract infections: a large cross-sectional study of six hospitals. BMJ Open 2019;9:e022137.CrossRefGoogle ScholarPubMed
Kabbani, MS, Ismail, SR, Fatima, A, et al.Urinary tract infection in children after cardiac surgery: incidence, causes, risk factors and outcomes in a single-center study. J Infect Public Health 2016;9:600–610.CrossRefGoogle Scholar
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