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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 review and describe device utilization and central line-associated bloodstream (CLABSI) events among patients in a non-intensive care unit (ICU) setting and to examine the morbidity and mortality associated with these events.
One-year descriptive review.
A single tertiary center with a 1,200-bed hospital and 209 adult ICU beds.
Hospitalized patients identified as having a CLABSI event attributed to a non-ICU setting.
The cohort was identified from a prospective infection prevention database. Charts and administrative data sets were reviewed to further characterize the patients. Device utilization ratios (DURs) and CLABSI rates were calculated using National Health and Safety Network (NHSN) CLABSI definitions. Need for ICU stay and crude mortality rates were recorded.
A total of 136 patients with 156 CLABSIs were identified, of whom 78 (57%) were being treated for a hematological malignancy (HM). The overall DUR was 0.27. A tunneled line was in place for 118 (76%) of the CLABSI events, and a peripherally inserted central catheter was in place for 32 (21%) of the CLABSI events. The non-ICU CLABSI rate was significantly higher than the concurrent ICU rate (2.1 CLABSIs per 1,000 catheter-days vs 1.5 CLABSIs per 1,000 catheter-days; P = .02). Hospital mortality was 23% in the affected group and was significantly higher in patients with HM.
CLABSI rates over a 1-year period were higher in patients outside the ICU at our hospital and were associated with significant mortality.
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