708. The Role of Red Blood Cell Transfusion in the Development of Urinary Tract-related Bloodstream Infection
Session: Poster Abstract Session: UTIs - Epidemiology and Prevention
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • 708_MaryRogers.pdf (2.6 MB)
  • Background: Healthcare-associated bacteriuria can spread to the bloodstream, but factors contributing to dissemination are not fully known.  There is a growing body of evidence indicating that transfusion alters host defenses against infection, with several trials showing that restrictive use of red blood cell (RBC) transfusion may decrease the risk of infection.  Therefore, we evaluated the association between transfusion and developing urinary tract-related bloodstream infection. 

    Methods: An individually matched case-control design was used.  Subjects were 969 patients hospitalized within the University of Michigan Health System between 2000 and 2008. Administrative and clinical records were used, including individual medical record review by an infectious diseases physician. Cases had positive urine and blood cultures that grew the same microorganism. Controls were an incidence-density sample of patients with positive urine cultures, but without positive blood cultures, matched by calendar time to the cases.

    Results:  The odds of developing a urinary tract-related bloodstream infection increased 4.7-fold with RBC transfusion (95% CI: 2.8-7.9) after adjusting for age, gender, race, medications (including antibiotics and immunosuppressants), urgency of admission, diabetes mellitus, surgery, and reason for hospitalization. Significant dose-response was observed; for each liter of RBC given, the odds of developing a bloodstream infection increased by 42% (95% CI: 21%-68%).  Patients who received RBC units stored for a longer amount of time were more likely to develop a bloodstream infection.  Each week of RBC storage increased the odds of infection by 60% (OR=1.60; 95% CI: 1.10, 2.34) after adjusting for covariates and the total volume of RBC transfusion.  There was a significant correlation between hospital length of stay and the age of RBCs received in both cases (r=0.23; p<0.001) and controls (r=0.17; p=0.010). 

    Conclusion: Bacteriuria is more likely to become a bloodstream infection when a RBC transfusion is given, particularly when the RBC units are stored for a longer period of time.  The decision to order a RBC transfusion in a hospitalized patient should involve careful deliberation, keeping in mind updated evidence-based guidelines.    


    Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

    Mary Rogers, Ph.D.1, Neil Blumberg, M.D.2, Latoya Kuhn, MPH3, Todd Greene, PhD, MPH4, Carol Chenoweth, MD5, Emily Shuman, MD3, Robert Chang, MD6 and Sanjay Saint, MD, MPH7, (1)Internal Medicine, University of Michigan, Ann Arbor, MI, (2)Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, (3)University of Michigan, Ann Arbor, MI, (4)The University of Michigan Health System, Ann Arbor, MI, (5)Internal Medicine-Infectious Diseases, University of Michigan Health System, Ann Arbor, MI, (6)1500 East Medical Center Drive, University of Michigan Medical Center, Ann Arbor, MI, (7)VA Medical Center, Ann Arbor, MI

    Disclosures:

    M. Rogers, None

    N. Blumberg, None

    L. Kuhn, None

    T. Greene, None

    C. Chenoweth, None

    E. Shuman, None

    R. Chang, None

    S. Saint, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.