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To delineate the epidemiology of catheter-associated urinary tract infections (CAUTIs) and to better understand the value of urine cultures for evaluation of fever in the intensive care unit (ICU) setting
Two-year retrospective review (2012–2013)
A single tertiary center with 1,200 hospital beds and 158 adult ICU beds
ICU patients with a CAUTI event
The cohort was identified from a prospective infection prevention database. Charts were reviewed to characterize the patients. CAUTI rates and device utilization ratio (DUR) were calculated. Clinical outcomes were recorded.
A total of 105 CAUTIs were identified using the National Health and Safety Network (NHSN) definition. Fever was the primary indication for obtaining urine culture in 102 patients (97%). Of these 105 patients, 51 (51%) had an alternative infection to explain the fever, with pneumonia (55%) being the most common followed by bloodstream infection (22%). A total of 18 patients (18%) had fever due to noninfectious cause, and 32 patients (32%) had no alternative explanation. Of these, 66% received appropriate empiric antimicrobial therapy, but no targeted therapy changes were made based on urine culture results. The other 34% did not receive antimicrobial therapy at all. Only 6% of all CAUTIs resulted in blood cultures positive for the same organism within 2 days. The urinary tract was not definitely established as the source of bloodstream infection.
Urine cultures obtained for evaluation of fever form the basis for identification of CAUTIs in the ICU. However, most patients with CAUTIs are eventually found to have alternative explanations for fever. CAUTI is associated with a low complication rate.
Infect. Control Hosp. Epidemiol. 2015;36(11):1330–1334
To study a cluster of Mycobacterium wolinskyi surgical site infections (SSIs).
Observational and case-control study.
Subjects who developed SSIs with M. wolinskyi following cardiothoracic surgery.
Electronic surveillance was performed for case finding as well as electronic medical record review of infected cases. Surgical procedures were observed. Medical chart review was conducted to identify risk factors. A case-control study was performed to identify risk factors for infection; Fisher exact or Kruskal-Wallis tests were used for comparisons of proportions and medians, respectively. Patient isolates were studied using pulsed-field gel electrophoresis (PFGE). Environmental microbiologic sampling was performed in operating rooms, including high-volume water sampling.
Six definite cases of M. wolinskyi SSI following cardiothoracic surgery were identified during the outbreak period (October 1, 2008–September 30, 2011). Having cardiac surgery in operating room A was significantly associated with infection (odds ratio, 40; P = .0027). Observational investigation revealed a cold-air blaster exclusive to operating room A as well a microbially contaminated, self-contained water source used in heart-lung machines. The isolates were indistinguishable or closely related by PFGE. No environmental samples were positive for M. wolinskyi.
No single point source was established, but 2 potential sources, including a cold-air blaster and a microbially contaminated, self-contained water system used in heart-lung machines for cardiothoracic operations, were identified. Both of these potential sources were removed, and subsequent active surveillance did not reveal any further cases of M. wolinskyi SSI.
Infect Control Hosp Epidemiol 2014;35(9):1169-1175
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