Catheter-Related UTIs Not More Frequent in the ICU

SAN DIEGO—Catheter-associated urinary tract infections (CAUTIs) occur at similar rates in the intensive care unit (ICU) and in non-ICU settings, according to a new study.

Researchers at Duke University Medical Center in Durham, N.C., analyzed CAUTI surveillance data from 15 community hospitals in the Duke Infection Control Outreach Network over a two-year period (January 1, 2010 to December 31, 2011).

During the study period, 506 CAUTIs occurred over 312,946 catheter-days and 1,331,280 patient-days during the 24-month study period. Only 143 of the CAUTIs (28%) occurred in ICU patients. The overall CAUTI rate was 1.6 per 1,000 catheter days, according to the investigators. The rates of CAUTI in the ICU and non-ICU patients were 1.83 and 1.55 cases per 1,000 catheter days, respectively, a non-significant different between the groups.

“Overall, we found that three quarters the catheter-associated urinary tract infections occurred outside the intensive care unit,” said lead investigator Sarah Lewis, MD, an infectious diseases fellow at Duke. “It was a little bit of a surprise because we traditionally think of the ICU as being the most high-risk hospital location for these infections. We often think that ICU patients are sicker and have more medical comorbidities, which make them more susceptible to hospital-acquired infections.”

CAUTIs are the leading cause of hospital-acquired infections in the United States, Dr. Lewis said. Surveillance and prevention initiatives, however, mainly have focused on patients in the ICU. The epidemiology of CAUTIs in non-ICU settings and in community hospitals has not been well documented, she noted.

“We may need to reframe our prevention efforts and initiatives,” Dr. Lewis told Renal & Urology News. “We may need to look more specifically what is different between ICU and non-ICU patients and target things differently outside the ICU than we do in the ICU to prevent catheter-associated urinary tract infections.” She presented study findings at IDWeek, a joint meeting of the Infectious Diseases Society of America and three other medical societies.

The most common pathogens were Escherichia coli (24%), Enterococcus species (20%), Candida species (20%), and Klebsiella species (7%). In addition, 8% of the pathogens exhibited multiple drug resistance. The researchers observed no major differences in causative organisms when comparing ICU and non-ICU patients, except for Candida species, which were observed more often in ICU patients.

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