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Pediatric ambulatory catheter-associated urinary tract infections (CAUTIs): Incidence, risk factors, and patient outcomes

Published online by Cambridge University Press:  05 June 2020

Michael L. Rinke Open the ORCID record for Michael L. Rinke [Opens in a new window] ,
Suzette O. Oyeku ,
Moonseong Heo ,
Lisa Saiman ,
Philip Zachariah ,
Rebecca E. Rosenberg ,
Patricia DeLaMora ,
Barbara Rabin ,
Parsa Mirhaji  and
Elizabeth Klein
...Show all authors
Michael L. Rinke*
Affiliation:
Children’s Hospital at Montefiore, Bronx, New York Albert Einstein College of Medicine, Bronx, New York
Suzette O. Oyeku
Affiliation:
Children’s Hospital at Montefiore, Bronx, New York Albert Einstein College of Medicine, Bronx, New York
Moonseong Heo
Affiliation:
Clemson University, Clemson, South Carolina
Lisa Saiman
Affiliation:
Columbia University Irving Medical Center, and New York-Presbyterian Hospital, New York, New York
Philip Zachariah
Affiliation:
Columbia University Irving Medical Center, and New York-Presbyterian Hospital, New York, New York
Rebecca E. Rosenberg
Affiliation:
New York University School of Medicine, New York, New York
Patricia DeLaMora
Affiliation:
Weill Cornell Medical College, New York, New York
Barbara Rabin
Affiliation:
Icahn School of Medicine at Mount Sinai, New York, New York
Parsa Mirhaji
Affiliation:
Albert Einstein College of Medicine, Bronx, New York
Elizabeth Klein
Affiliation:
Albert Einstein College of Medicine, Bronx, New York
William J. H. Ford
Affiliation:
Weill Cornell Medical College, New York, New York
Oghale Obaro-Best
Affiliation:
State University of New York Upstate Medical University, Syracuse, New York
Michael Drasher
Affiliation:
Wayne State University School of Medicine, Detroit, Michigan
Alexandre Peshansky
Affiliation:
Albert Einstein College of Medicine, Bronx, New York
Kelly Ann Balem
Affiliation:
Children’s Hospital at Montefiore, Bronx, New York Albert Einstein College of Medicine, Bronx, New York
David G. Bundy
Affiliation:
Medical University of South Carolina, Charleston, South Carolina
*
Author for correspondence: Michael L. Rinke, E-mail: mrinke@montefiore.org
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Abstract

Objective:

Catheter-associated urinary tract infections (CAUTIs) occur frequently in pediatric inpatients, and they are associated with increased morbidity and cost. Few studies have investigated ambulatory CAUTIs, despite at-risk children utilizing home urinary catheterization. This retrospective cohort and case-control study determined incidence, risk factors, and outcomes of pediatric patients with ambulatory CAUTI.

Design:

Broad electronic queries identified potential patients with ambulatory urinary catheters, and direct chart review confirmed catheters and adjudicated whether ambulatory CAUTI occurred. CAUTI definitions included clean intermittent catheterization (CIC). Our matched case-control analysis assessed risk factors.

Setting:

Five urban, academic medical centers, part of the New York City Clinical Data Research Network.

Patients:

Potential patients were age <22 years who were seen between October 2010 and September 2015.

Results:

In total, 3,598 eligible patients were identified; 359 of these used ambulatory catheterization (representing186,616 ambulatory catheter days). Of these, 63 patients (18%) experienced 95 ambulatory CAUTIs. The overall ambulatory CAUTI incidence was 0.51 infections per 1,000 catheter days (1.35 for indwelling catheters and 0.47 for CIC; incidence rate ratio, 2.88). Patients with nonprivate medical insurance (odds ratio, 2.5; 95% confidence interval, 1.1–6.3) were significantly more likely to have ambulatory CAUTIs in bivariate models but not multivariable models. Also, 45% of ambulatory CAUTI resulted in hospitalization (median duration, 3 days); 5% resulted in intensive care admission; 47% underwent imaging; and 88% were treated with antibiotics.

Conclusions:

Pediatric ambulatory CAUTIs occur in 18% of patients with catheters; they are associated with morbidity and healthcare utilization. Ambulatory indwelling catheter CAUTI incidence exceeded national inpatient incidence. Future quality improvement research to reduce these harmful infections is warranted.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 8 , August 2020 , pp. 891 - 899
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Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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Footnotes

PREVIOUS PRESENTATION: These data were presented as a platform presentation at the Pediatric Academic Societies meeting on April 27, 2019, in Baltimore, Maryland.

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