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Incidence and risk factors of non–device-associated urinary tract infections in an acute-care hospital

  • Paula D. Strassle (a1), Emily E. Sickbert-Bennett (a1) (a2), Michael Klompas (a3) (a4), Jennifer L. Lund (a1), Paul W. Stewart (a5), Ashley H. Marx (a6), Lauren M. DiBiase (a2) and David J. Weber (a1) (a2)...

Abstract

Objective:

To update current estimates of non–device-associated urinary tract infection (ND-UTI) rates and their frequency relative to catheter-associated UTIs (CA-UTIs) and to identify risk factors for ND-UTIs.

Design:

Cohort study.

Setting:

Academic teaching hospital.

Patients:

All adult hospitalizations between 2013 and 2017 were included. UTIs (device and non-device associated) were captured through comprehensive, hospital-wide active surveillance using Centers for Disease Control and Prevention case definitions and methodology.

Results:

From 2013 to 2017 there were 163,386 hospitalizations (97,485 unique patients) and 1,273 UTIs (715 ND-UTIs and 558 CA-UTIs). The rate of ND-UTIs remained stable, decreasing slightly from 6.14 to 5.57 ND-UTIs per 10,000 hospitalization days during the study period (P = .15). However, the proportion of UTIs that were non–device related increased from 52% to 72% (P < .0001). Female sex (hazard ratio [HR], 1.94; 95% confidence interval [CI], 1.50–2.50) and increasing age were associated with increased ND-UTI risk. Additionally, the following conditions were associated with increased risk: peptic ulcer disease (HR, 2.25; 95% CI, 1.04–4.86), immunosuppression (HR, 1.48; 95% CI, 1.15–1.91), trauma admissions (HR, 1.36; 95% CI, 1.02–1.81), total parenteral nutrition (HR, 1.99; 95% CI, 1.35–2.94) and opioid use (HR, 1.62; 95% CI, 1.10–2.32). Urinary retention (HR, 1.41; 95% CI, 0.96–2.07), suprapubic catheterization (HR, 2.28; 95% CI, 0.88–5.91), and nephrostomy tubes (HR, 2.02; 95% CI, 0.83–4.93) may also increase risk, but estimates were imprecise.

Conclusion:

Greater than 70% of UTIs are now non–device associated. Current targeted surveillance practices should be reconsidered in light of this changing landscape. We identified several modifiable risk factors for ND-UTIs, and future research should explore the impact of prevention strategies that target these factors.

Copyright

Corresponding author

Author for correspondence: Paula D. Strassle, PhD, MSPH, E-mail: paula_strassle@med.unc.edu

Footnotes

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PREVIOUS PRESENTATION. Portions of this manuscript were presented at SHEA Spring Conferencs on April 24, 2019, and at the 35th International Conference on Pharmacoepidemiology and Therapeutic Risk Management (ICPE) on August 28, 2019, in Philadelphia, Pennsylvania.

Footnotes

References

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Incidence and risk factors of non–device-associated urinary tract infections in an acute-care hospital

  • Paula D. Strassle (a1), Emily E. Sickbert-Bennett (a1) (a2), Michael Klompas (a3) (a4), Jennifer L. Lund (a1), Paul W. Stewart (a5), Ashley H. Marx (a6), Lauren M. DiBiase (a2) and David J. Weber (a1) (a2)...

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