The evolution of catheter-associated urinary tract infection (CAUTI): Is it time for more inclusive metrics?

AbstractCatheter-associated urinary tract infection (CAUTI) has long been considered a preventable healthcare-associated infection. Many federal agencies, the Centers for Medicare and Medicaid Services (CMS), and public and private healthcare organizations have implemented strategies aimed at preventing CAUTIs. To monitor progress in CAUTI prevention, the National Healthcare Safety Network (NHSN) CAUTI metric has been adopted nationally as the primary outcome measure and has been refined over the past decades. However, this surveillance metric may underestimate infectious and noninfectious catheter harm. We suggest evolving to more inclusive performance metrics to better reflect quality improvement efforts underway in hospitals. The standardized device utilization ratio (SUR) provides a good surrogate for preventable catheter harm. On the other hand, a population-based metric that combines both standardized infection ratio (SIR) and SUR would address both infectious and noninfectious harm, while adjusting for population risk. Finally, electronically captured catheter-associated bacteriuria may contribute essential information on local testing stewardship.

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Risk of Cancer after Lower Urinary Tract Infection: A Population-Based Cohort Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16030390 ◽

2019 ◽

Vol 16 (3) ◽

pp. 390 ◽

Cited By ~ 2

Author(s):

Chia-Hung Huang ◽

Ying-Hsiang Chou ◽

Han-Wei Yeh ◽

Jing-Yang Huang ◽

Shun-Fa Yang ◽

...

Keyword(s):

Urinary Tract Infection ◽

Cohort Study ◽

Urinary Tract ◽

Urinary Bladder ◽

Tract Infection ◽

Lower Urinary Tract ◽

Population Based ◽

Control Group ◽

Lower Urinary Tract Infection ◽

Lower Urinary

To investigate the association among lower urinary tract infection (UTI), the type and timing of antibiotic usage, and the subsequent risk of developing cancers, especially genitourinary cancers (GUC), in Taiwan. This retrospective population-based cohort study was conducted using 2009–2013 data from the Longitudinal Health Insurance Database. This study enrolled patients who were diagnosed with a UTI between 2010 and 2012. A 1:2 propensity score-matched control population without UTI served as the control group. Multivariate analysis with a multiple Cox regression model was applied to analyze the data. A total of 38,084 patients with UTI were included in the study group, and 76,168 participants without UTI were included in the control group. The result showed a higher hazard ratio of any cancer in both sexes with UTI (for males, adjusted hazard ratio (aHR) = 1.32; 95% confidence interval (CI) = 1.12–1.54; for females, aHR = 1.21; 95% CI = 1.08–1.35). Patients with UTI had a higher probability of developing new GUC than those without UTI. Moreover, the genital organs, kidney, and urinary bladder of men were significantly more affected than those of women with prior UTI. Furthermore, antibiotic treatment for more than 7 days associated the incidence of bladder cancer in men (7–13 days, aHR = 1.23, 95% CI = 0.50–3.02; >14 days, aHR = 2.73, CI = 1.32–5.64). In conclusion, UTI is significantly related to GUC and may serve as an early sign of GUC, especially in the male genital organs, prostate, kidney, and urinary bladder. During UTI treatment, physicians should cautiously prescribe antibiotics to patients.

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Antepartum urinary tract infection and postpartum depression in Taiwan: A nationwide population-based study

Urological Science ◽

10.1016/j.urols.2016.05.288 ◽

2016 ◽

Vol 27 (2) ◽

pp. S77

Author(s):

Jui-Ming Liu ◽

Hsun-Hao Chan ◽

Ren-Jun Hsu

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Postpartum Depression ◽

Population Based ◽

Population Based Study

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Impact of early-life weight status on urinary tract infection in children: a nationwide population-based study in South Korea

Epidemiology and Health ◽

10.4178/epih.e2021005 ◽

2020 ◽

pp. e2021005

Author(s):

Hyung Eun Yim ◽

Kyung Do Han ◽

Bongseong Kim ◽

Kee Hwan Yoo

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

South Korea ◽

Early Life ◽

Weight Status ◽

Population Based ◽

Population Based Study

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Outcome of community-onset ESBL-producing Escherichia coli and Klebsiella pneumoniae bacteraemia and urinary tract infection: a population-based cohort study in Denmark

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkaa361 ◽

2020 ◽

Vol 75 (12) ◽

pp. 3656-3664

Author(s):

Rasmus Richelsen ◽

Jesper Smit ◽

Henrik Carl Schønheyder ◽

Pavithra Laxsen Anru ◽

Belen Gutiérrez-Gutiérrez ◽

...

Keyword(s):

Escherichia Coli ◽

Urinary Tract Infection ◽

Cohort Study ◽

Urinary Tract ◽

Tract Infection ◽

Klebsiella Pneumoniae ◽

Population Based ◽

Esbl Production ◽

E Coli ◽

Community Onset

Abstract Objectives To assess the impact of ESBL production on mortality and length of hospital stay (LOS) of community-onset infections due to Escherichia coli or Klebsiella pneumoniae. Methods A population-based cohort study including all adult patients hospitalized with a first-time community-onset E. coli or K. pneumoniae bacteraemia or urinary tract infection in the North Denmark Region between 2007 and 2017. For each bacterial agent, we computed 1 year Kaplan–Meier survival curves and cumulative incidence functions of LOS, and by use of Cox proportional hazard regression we computed HRs as estimates of 30 day and 1 year mortality rate ratios (MRRs) and LOS among patients with and without ESBL-producing infections. Results We included 24 518 cases (among 22350 unique patients), of whom 1018 (4.2%) were infected by an ESBL-producing bacterium. The 30 day cumulative mortality and adjusted MRR (aMRR) in patients with and without ESBL-producing isolates was as follows: E. coli bacteraemia (n = 3831), 15.8% versus 14.0%, aMRR = 1.01 (95% CI = 0.70–1.45); E. coli urinary tract infection (n = 17151), 9.5% versus 8.7%, aMRR = 0.97 (95% CI = 0.75–1.26); K. pneumoniae bacteraemia (n = 734), 0% versus 17.2%, aMRR = not applicable; and K. pneumoniae urinary tract infection (n = 2802), 13.8% versus 10.7%, aMRR = 1.13 (95% CI = 0.73–1.75). The 1 year aMRR remained roughly unchanged. ESBL-producing E. coli bacteraemia was associated with an increased LOS compared with non-ESBL production. Conclusions ESBL production was not associated with an increased short- or long-term mortality in community-onset infections due to E. coli or K. pneumoniae, yet ESBL-producing E. coli bacteraemia was associated with an increased LOS.

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Sodium glucose cotransporter 2 inhibitors and risk of genital mycotic and urinary tract infection: A population‐based study of older women and men with diabetes

Diabetes Obesity and Metabolism ◽

10.1111/dom.13820 ◽

2019 ◽

Vol 21 (11) ◽

pp. 2394-2404 ◽

Cited By ~ 25

Author(s):

Iliana C. Lega ◽

Susan E. Bronskill ◽

Michael A. Campitelli ◽

Jun Guan ◽

Nathan M. Stall ◽

...

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Older Women ◽

Population Based ◽

Population Based Study ◽

Sodium Glucose Cotransporter

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Regional Variation in Urinary Catheter Use and Catheter-Associated Urinary Tract Infection: Results from a National Collaborative

Infection Control and Hospital Epidemiology ◽

10.1086/677825 ◽

2014 ◽

Vol 35 (S3) ◽

pp. S99-S106 ◽

Cited By ~ 25

Author(s):

M. Todd Greene ◽

Mohamad G. Fakih ◽

Karen E. Fowler ◽

Jennifer Meddings ◽

David Ratz ◽

...

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Regional Variation ◽

Regional Differences ◽

Urinary Catheter ◽

Population Based ◽

Census Bureau ◽

The West ◽

Cross Sectional

Objective.To examine regional variation in the use and appropriateness of indwelling urinary catheters and catheter-associated urinary tract infection (CAUTI).Design and Setting.Cross-sectional study.Participants.US acute care hospitals.Methods.Hospitals were divided into 4 regions according to the US Census Bureau. Baseline data on urinary catheter use, catheter appropriateness, and CAUTI were collected from participating units. The catheter utilization ratio was calculated by dividing the number of catheter-days by the number of patient-days. We used the National Healthcare Safety Network (NHSN) definition (number of CAUTIs per 1,000 catheter-days) and a population-based definition (number of CAUTIs per 10,000 patient-days) to calculate CAUTI rates. Logistic and Poisson regression models were used to assess regional differences.Results.Data on 434,207 catheter-days over 1,400,770 patient-days were collected from 1,101 units within 726 hospitals across 34 states. Overall catheter utilization was 31%. Catheter utilization was significantly higher in non-intensive care units (ICUs) in the West compared with non-ICUs in all other regions. Approximately 30%–40% of catheters in non-ICUs were placed without an appropriate indication. Catheter appropriateness was the lowest in the West. A total of 1,099 CAUTIs were observed (NHSN rate of 2.5 per 1,000 catheter-days and a population-based rate of 7.8 per 10,000 patient-days). The population-based CAUTI rate was highest in the West (8.9 CAUTIs per 10,000 patient-days) and was significantly higher compared with the Midwest, even after adjusting for hospital characteristics (P = .02).Conclusions.Regional differences in catheter use, appropriateness, and CAUTI rates were detected across US hospitals.

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