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Does Catheter-Associated Urinary Tract Infection Increase Mortality in Critically Ill Patients?

Published online by Cambridge University Press:  02 January 2015

Christophe Clec'h ,
Carole Schwebel ,
Adrien Français ,
Dany Toledano ,
Jean-Philippe Fosse ,
Maïté Garrouste-Orgeas ,
Elie Azoulay ,
Christophe Adrie ,
Samir Jamali  and
Adrien Descorps-Declere
...Show all authors
Christophe Clec'h
Affiliation:
Medical-Surgical Intensive Care Unit (ICU), Avicenne Teaching Hospital, Bobigny, Grenoble Department of Epidemiology, INSERM/UJF U 823, Grenoble
Carole Schwebel
Affiliation:
Medical ICU, Albert Michallon Teaching Hospital, Grenoble
Adrien Français
Affiliation:
Department of Epidemiology, INSERM/UJF U 823, Grenoble
Dany Toledano
Affiliation:
Medical ICU, Hospital of Gonesse, Gonesse
Jean-Philippe Fosse
Affiliation:
Medical-Surgical Intensive Care Unit (ICU), Avicenne Teaching Hospital, Bobigny, Grenoble
Maïté Garrouste-Orgeas
Affiliation:
Medical ICU, Saint-Joseph Hospital, Paris
Elie Azoulay
Affiliation:
Medical ICU, Saint-Louis Teaching Hospital, Paris
Christophe Adrie
Affiliation:
Medical ICU, Delafontaine Hospital, Saint-Denis
Samir Jamali
Affiliation:
Medical-Surgical ICU, Hospital of Dourdan, Dourdan
Adrien Descorps-Declere
Affiliation:
Surgical ICU, Antoine Beclere Teaching Hospital, Clamart, France
Didier Nakache
Affiliation:
Conservatoire National des Arts et Métiers, Paris
Jean-François Timsit
Affiliation:
Medical ICU, Albert Michallon Teaching Hospital, Grenoble Department of Epidemiology, INSERM/UJF U 823, Grenoble
Yves Cohen*
Affiliation:
Medical-Surgical Intensive Care Unit (ICU), Avicenne Teaching Hospital, Bobigny, Grenoble
*
Service de Réanimation, Hôpital Avicenne, 125, route de Stalingrad 93009 Bobigny Cedex, France (yves.cohen@avc.aphp.fr)
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Abstract

Objective.

To produce an accurate estimate of the association between catheter-associated urinary tract infection (UTI) and intensive care unit (ICU) and hospital mortality, controlling for major confounding factors.

Design.

Nested case-control study in a multicenter cohort (the OutcomeRea database).

Setting.

Twelve French medical or surgical ICUs.

Methods.

All patients admitted between January 1997 and August 2005 who required the insertion of an indwelling urinary catheter. Patients who developed catheter-associated UTI (ie, case patients) were matched to control patients on the basis of the following criteria: sex, age ( ± 10 years), SAPS (Simplified Acute Physiology Score) II score ( ± 10 points), duration of urinary tract catheterization, and presence or absence of diabetes mellitus. The association of catheter-associated UTI with ICU and hospital mortality was assessed by use of conditional logistic regression.

Results.

Of the 3,281 patients who had an indwelling urinary catheter, 298 (9%) developed at least 1 episode of catheter-associated UTI. The incidence density of catheter-associated UTI was 12.9 infections per 1,000 catheterization-days. Crude ICU mortality rates were higher among patients with catheter-associated UTI, compared with those without catheter-associated UTI (32% vs 25%, P = .02); the same was true for crude hospital mortality rates (43% vs 30%, P>.01). After matching and adjustment, catheter-associated UTI was no longer associated with increased mortality (ICU mortality: odds ratio [OR], 0.846 [95% confidence interval {CI}, 0.659-1.086]; P = .19 and hospital mortality: OR, 0.949 [95% CI, 0.763-1.181]; P = .64).

Conclusion.

After carefully controlling for confounding factors, catheter-associated UTI was not found to be associated with excess mortality among our population of critically ill patients in either the ICU or the hospital.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 12 , December 2007 , pp. 1367 - 1373
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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