MAKI DG, KNASINSKI V, TAMBYAH PA; Interscience Conference on Antimicrobial Agents and Chemotherapy.
Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 1999 Sep 26-29; 39: 612 (abstract no. 770).
Univ. of Wisconsin, Madison, WI.
CAUTI is the most frequent nosocomial infection and comprises the largest reservoir of antibiotic-resistant pathogens in healthcare institutions. The impact of compliance with catheter care on the risk of CAUTI has not been adequately examined. We prospectively studied risk factors for CAUTI in 850 newly-catheterized patients in a university hospital; each patient was seen daily by research nurses, a urine culture was obtained and catheter care was scored quantitatively: integrity of closed drainage, position of the catheter, collection tubing and bag, and protection of the drainage port. Data bearing on the risk of CAUTI, including age, gender, urologic disease, implanted stents, co-morbidities, APACHE II score, immunosuppressant therapy, ambulatory status, ICU care, surgery, antimicrobial therapy, uses of the catheter and catheter-care scores, were recorded. CAUTI was defined as new bacteriuria or candiduria > 10[3] CFU/mL. Risk factors for CAUTI were identified by stepwise logistic regression and Cox proportional hazard modeling. Overall, 158 (18.6 percent) of the patients developed CAUTI during the study. Only seven factors were independently predictive of increased risk: extended catheterization (OR 5.2, P<0.001), female gender (OR 3.7, P<0.001), a urologic stent (OR 2.5, P<0.008), other active infections (OR 2.4, P<0.001), malnutrition (OR 2.4, P<0.001), insulin-requiring diabetes (OR 2.2, P<0.002), and drainage tube position (OR 2.1, P<0.03); antimicrobial therapy (OR 0.1, P<0.001) conferred protection against CAUTI. The only catheter-care violation predictive of an increased risk of CAUTI was a drainage tube sagging below the level of the collection bag. These data indicate that we are at the point of diminishing returns with regard to what further can be achieved with compliance in catheter care and point up the importance of novel technology designed for prevention of CAUTI, vis-a-vis infection-resistant catheters, a goal coming to fruition with catheters manufactured with antinfective surfaces.
Publication Types:
Keywords:
- Anti-Bacterial Agents
- Bacteriuria
- Catheterization
- Cross Infection
- Drainage
- Female
- Hospitals, University
- Humans
- Intensive Care Units
- Prospective Studies
- Risk Factors
- Urinary Tract Infections
- surgery
Other ID:
UI: 102246233
From Meeting Abstracts