Role of duration of catheterization and length of hospital stay on the rate of catheter-related hospital-acquired urinary tract infections

Abstract Background The “SPICE organisms” intrinsically produce low levels of a chromosomally encoded β-lactamase enzyme, AmpC. When SPICE organisms are exposed to certain antimicrobial agents, they can select for de-repressed mutants and induce the AmpC gene. No study to date has determined the optimal treatment of lower inoculum infections such as urinary tract infections (UTIs) caused by SPICE organisms. Methods This study is a single-center, retrospective observational review of adult hospitalized patients with a UTI caused by a SPICE organism from November 2012 to November 2015. The objective of this study was to compare outcomes amongst patients with UTIs caused by select SPICE organisms treated with drugs susceptible to AmpC hydrolysis (penicillins, cephalosporins except cefepime, and monobactams) vs. drugs stable against AmpC (carbapenems, cefepime, and non-β-lactam agents). The primary outcome was clinical response, defined as resolution of signs and symptoms of UTI without requiring escalation of antimicrobial therapy after 48 hours of therapy initiation. Secondary outcomes include 30-day infection-related readmission, 30-day infection recurrence rate, 30-day all-cause mortality, and length of hospital stay. Patients with resistance to ceftriaxone were reviewed for β-lactam exposure (≥7 days) within the last month. Results One-hundred 56 patients were identified. Clinical response, 30-day infection-related readmission, 30-day infection recurrence, 30-day mortality rates, and median length of hospital stay were similar between the AmpC stable and AmpC susceptible groups (Table 1). Notably, 39.1% of patients with ceftriaxone resistance reported had recent β-lactam exposure vs. only 11.6% of patients without ceftriaxone resistance (P = 0.0028). Conclusion Based our data, there does not appear to be a difference in clinical response, 30-day-related readmission, 30-day infection recurrence, 30-day all-cause mortality rates, or length of stay in patients with UTIs treated with AmpC stable and AmpC susceptible agents. AmpC induction can be seen with at least 7 days of β-lactam use in the past 30 days as demonstrated by more frequent use of recent β-lactam agents in those with ceftriaxone resistance detected. Disclosures All authors: No reported disclosures.

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Frequency of Healthcare-Associated Infections in the Elderly Patient Hospitalized

Elderly Health Journal ◽

10.18502/ehj.v7i1.6548 ◽

2021 ◽

Author(s):

Aria Rahmani ◽

Alireza Namazi Shabestari ◽

Maryam Sadeh ◽

Reza Bidaki ◽

Saeidreza Jamalimoghadamsiahkli ◽

...

Keyword(s):

Urinary Tract ◽

Hospital Stay ◽

Urinary Tract Infections ◽

Length Of Hospital Stay ◽

The Elderly ◽

Central Line ◽

Ventilator Associated Pneumonia ◽

Healthcare Associated Infections ◽

Tract Infections ◽

Healthcare Associated

Introduction: Healthcare- Associated Infections (HAI) are known to be one of the most important health issues in developed and developing countries. The most common infections include central line-associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated pneumonia and surgical site infection. The aim of this study was to investigate the incidence of nosocomial infections in the elderly patients. Methods: In this cross-sectional study, 1279 patients were 60 years of age or older. Patients who had been admitted for more than 48 hours in the hospital and had no signs of infection at the time of admission, were entered into the study. It was evaluated four most common HAI, according to CDC include bacteremia, central line-associated blood stream infections, urinary tract infections, and ventilator-associated pneumonia. Infections may also occur at surgery sites, known as surgical site infections. The Chi-square and T- test or analysis of variance was used for data analysis. Results: Of the total patients, 93 (7.3%) developed HAI at duration admission. The highest rate of infection was bacteremia, which was 48.4 % and then urinary tract infection 21.5%. The prevalence of HAI among patients with cardiovascular diseases was relatively higher than underlying diseases. The frequency of length of hospital stay was significant in patients > 7 days with 68.8% in the HAI group. Conclusion: Our findings showed that patients with cardiovascular, renal and pulmonary disease are more susceptible to HAIs. Due to the increased length of hospital stay increases the risk of infection, it is recommended to discharge patients as soon as possible.

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Faculty Opinions recommendation of Appropriate antibiotic use for patients with urinary tract infections reduces length of hospital stay.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718154767.793491158 ◽

2014 ◽

Author(s):

George Sakoulas

Keyword(s):

Urinary Tract ◽

Hospital Stay ◽

Urinary Tract Infections ◽

Length Of Hospital Stay ◽

Antibiotic Use ◽

Tract Infections

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Hospital-Acquired Catheter-Associated Urinary Tract Infection: Documentation and Coding Issues May Reduce Financial Impact of Medicare's New Payment Policy

Infection Control and Hospital Epidemiology ◽

10.1086/652523 ◽

2010 ◽

Vol 31 (6) ◽

pp. 627-633 ◽

Cited By ~ 59

Author(s):

Jennifer Meddings ◽

Sanjay Saint ◽

Laurence F. McMahon

Keyword(s):

Urinary Tract ◽

Medical Record ◽

Urinary Tract Infections ◽

Length Of Hospital Stay ◽

International Classification Of Diseases ◽

Secondary Diagnosis ◽

Diagnosis Codes ◽

Tract Infections ◽

Hospital Acquired ◽

Present On Admission

Objective.To evaluate whether hospital-acquired catheter-associated urinary tract infections (CA-UTIs) are accurately documented in discharge records with the use of International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes so that nonpayment is triggered, as mandated by the Centers for Medicare and Medicaid Services (CMS) Hospital-Acquired Conditions Initiative.Methods.We conducted a retrospective medical record review of 80 randomly selected adult discharges from May 2006 through September 2007 from the University of Michigan Health System (UMHS) with secondary-diagnosis urinary tract infections (UTIs). One physician-abstractor reviewed each record to categorize UTIs as catheter associated and/or hospital acquired; these results (considered “gold standard”) were compared with diagnosis codes assigned by hospital coders. Annual use of the catheter association code (996.64) by UMHS coders was compared with state and US rates by using Healthcare Cost and Utilization Project data.Results.Patient mean age was 58 years; 56 (70%) were women; median length of hospital stay was 6 days; 50 patients (62%) used urinary catheters during hospitalization. Hospital coders had listed 20 secondary-diagnosis UTIs (25%) as hospital acquired, whereas physician-abstractors indicated that 37 (46%) were hospital acquired. Hospital coders had identified no CA-UTIs (code 996.64 was never used), whereas physician-abstractors identified 36 CA-UTIs (45%; 28 hospital acquired and 8 present on admission). Catheter use often was evident only from nursing notes, which, unlike physician notes, cannot be used by coders to assign discharge codes. State and US annual rates of 996.64 coding (~1% of secondary-diagnosis UTIs) were similar to those at UMHS.Conclusions.Hospital coders rarely use the catheter association code needed to identify CA-UTI among secondary-diagnosis UTIs. Coders often listed a UTI as present on admission, although the medical record indicated that it was hospital acquired. Because coding of hospital-acquired CA-UTI seems to be fraught with error, nonpayment according to CMS policy may not reliably occur.

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Medicare claims data identify hospital-acquired catheter-associated urinary tract infections with limited accuracy

PsycEXTRA Dataset ◽

10.1037/e504412010-006 ◽

2009 ◽

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Claims Data ◽

Medicare Claims ◽

Tract Infections ◽

Hospital Acquired ◽

Medicare Claims Data ◽

Limited Accuracy

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The role of nurse (practitioner) to improve the diagnosis of urinary tract infections in nursing home residents

Journal of Nursing and Health Studies ◽

10.21767/2574-2825-c3-008 ◽

2018 ◽

Vol 03 ◽

Author(s):

J Haaijman ◽

E Stobberingh

Keyword(s):

Nursing Home ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Nurse Practitioner ◽

Nursing Home Residents ◽

Tract Infections

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The Role of Gut, Vaginal, and Urinary Microbiome in Urinary Tract Infections: From Bench to Bedside

Diagnostics ◽

10.3390/diagnostics11010007 ◽

2020 ◽

Vol 11 (1) ◽

pp. 7

Author(s):

Tomislav Meštrović ◽

Mario Matijašić ◽

Mihaela Perić ◽

Hana Čipčić Paljetak ◽

Anja Barešić ◽

...

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Subsequent Development ◽

Potential Influence ◽

Urinary Microbiome ◽

Important Field ◽

Tract Infections ◽

The Relationship ◽

Current Paradigm

The current paradigm of urinary tract infection (UTI) pathogenesis takes into account the contamination of the periurethral space by specific uropathogens residing in the gut, which is followed by urethral colonization and pathogen ascension to the urinary bladder. Consequently, studying the relationship between gut microbiota and the subsequent development of bacteriuria and UTI represents an important field of research. However, the well-established diagnostic and therapeutic paradigm for urinary tract infections (UTIs) has come into question with the discovery of a multifaceted, symbiotic microbiome in the healthy urogenital tract. More specifically, emerging data suggest that vaginal dysbiosis may result in Escherichia coli colonization and prompt recurrent UTIs, while urinary microbiome perturbations may precede the development of UTIs and other pathologic conditions of the urinary system. The question is whether these findings can be exploited for risk reduction and treatment purposes. This review aimed to appraise the three aforementioned specific microbiomes regarding their potential influence on UTI development by focusing on the recent studies in the field and assessing the potential linkages between these different niches, as well as evaluating the state of translational research for novel therapeutic and preventative approaches.

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