Retrospective analysis of catheter-acquired urinary tract infection (CAUTI): Relationship to stroke diagnosis

Abstract

Background: Eighty percent of hospital-acquired urinary tract infections are associated with urinary catheters (Joint Commission Resources, 2011). Catheter-acquired urinary tract infections (CAUTI) continues to be at the forefront of the fight against hospital-acquired infections (HAI). Despite ongoing efforts to decrease the incidence of catheter-acquired urinary tract infections (CAUTI) in the acute care setting, overall standardized infection rates (SIR) for CAUTI have decreased only 7% since 2009 (Centers for Disease Control and Prevention (CDC), 2013). Purpose: The purpose of this study was to compare patients with a diagnosis of stroke to patients without a primary diagnosis of stroke to determine if patients diagnosed with stroke had a higher incidence of CAUTI infection. A secondary aim was to examine use of antibiotics, steroids, length of hospital stay, catheter days, and ICU length of stay in both stroke and non-stroke patients.
Methods: The study method is a retrospective chart review analysis uses data from an 874-bed large teaching hospital located in the Southeastern United States from 2011 and 2012. After approval from both the Nursing Scientific Advisory Committee and the Institutional Review Board of the institution, analysis of data began.
Results: 600 patients were potential candidates for analysis. Of the 600 patients, 23 developed a CAUTI in the two-year period. After matching patients on age, race, and gender, stroke patients, these 23 patients underwent in-depth analysis. In comparison with non-stroke patients, use of antibiotics was less in stroke patients, while length of hospital days, catheter days, and days in the intensive care unit were longer in stroke patients. There was no statistical significant difference between the two groups for steroid use. When these variables were accounted for using generalized estimating estimates (GEE), diagnosis of CAUTI was 3.1% more likely in stroke patients.
Conclusion: Patients with a primary diagnosis of stroke are more likely to develop a CAUTI and have longer hospital length of stay, intensive care unit length of stay, and more catheter days than non-stroke patients. These conclusions substantiate earlier research and add to the growing body of knowledge relating to patient risk factors and complications for the development of CAUTI in the hospitalized patient. Further definitions relating to this baseline affords healthcare professionals the opportunity to design interventions to prevent CAUTI in at-risk populations.
Introduction: With the highest rates of CAUTI in areas that care for stroke patients, the need to quantify catheter-acquired urinary tract infection (CAUTI) in the stroke population is essential for evidence-based care. Retrospective analysis of 23/600 patients with a indwelling urinary catheter (IUC) who developed CAUTI infections from 2010-2012 at an 800+ bed urban level-one trauma center in the Southeastern United States reveals that patients with a primary stroke diagnosis are 3.1 times more likely to be diagnosed with a CAUTI than patients with a non-stroke diagnosis. Stroke patients are also more likely to have indwelling urinary IUCs longer, a longer ICU length of stay (LOS), and a longer hospital LOS. Due to neurogenic bladder complications, patients with a diagnosis of stroke often suffer from acute urinary retention. The goal of this research study is to examine known catheter acquired urinary tract infections (CAUTI) among patients who had an indwelling urinary catheter in an 874-bed urban acute care hospital in the Southeastern United States. Among the patients diagnosed with CAUTI, statistical analysis occurred to determine the correlation between primary admitting diagnosis of any type of stroke specific and the development of CAUTI infections. For health care professionals, admitting diagnosis patterns could determine evidence-based structures to allow additional intervention designs around the most vulnerable populations to prevent the development of CAUTI infections.
Background: Healthcare-associated infections have potential to affect institutions in the areas of morbidity, cost, length of stay and hospital cost (Givens & Wenzel, 1980; Gould et al., 2010; Platt, Polk, Murdock, & Rosner, 1982; Saint, 2000; Schaeffer, 2003; Tambyah, Knasinski, & Maki, 2002). Urinary tract infections account for In the United States, stroke affecting approximately 795,000 people a year (Mozaffarian et al., 2015). Internationally, stroke is remains the second leading cause of death, with 71.7% of lost daily-adjusted life years occurring in people younger than 75 years old (Feigin et al., 2014). Worldwide, stroke affects 6.8 million adults greater over 20 years old. In 2005, the estimate of cost of ischemic stroke in the United States was $140,000. As of 2011, the total cost estimate for stroke in the United States is 34.3 to 65.5 billion (Lloyd-Jones et al., 2009; Taylor et al., 1996; Heidenreich et al., 2011; Mozaffarian et al., 2015; Taylor et al., 1996). Changes in payment structures by the Centers for Medicare and Medicaid Services mean hospitals receive decreased to no reimbursement for expenses associated with the treatment of CAUTIs (Centers for Medicare and Medicaid Services (CMS), 2014; Centers for Medicare and Medicaid Services (CMS), 2014; Hagerty et al., 2015a)
Based on national estimate of healthcare-associated infections, urinary catheter tract infections (UTIs) comprised 36%-40% of the total HAI estimate (APIC 2008). The most common cause of gram negative bloodstream infections is bacteriuria with 17% of gram negative bloodstream infections (BSI) attributed to the urinary tract (Weinstein et al., 1997). Studies estimate that at 48 hours 30-56% of IUCs do not meet criteria for continuance (Bursle et al., 2015; Loeb et al., 2008) Rates of infection range between a low of 3.1infections per 1,000 catheter-days in surgical and medical intensive care units (ICUs) to 7.7 in neurology and burn critical care units (Hagerty et al., 2015a). In 2010, the international range of CAUTI rates varies from 0.4 per 1,000 catheter-days for surgical-cardiothoracic ICUs to a high of 13.9 in neurosurgical ICUs (Rosenthal, 2010). Outcomes for stroke who develop UTIs can be more serious than for general medical patients (Langhorne et al., 2000; Poisson, Johnston, & Josephson, 2010). CAUTI incidence is higher for stroke patients due to common variables and contributing factors related to stroke such as stroke-induced immunosuppression, bladder dysfunction, and up to a 24% increased likelihood of IUC catheter placement (Poisson et al., 2010).

Reference List

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