199. Epidemiology and prevention of catheter-associated urinary tract infections in hospitalized children
Session: Poster Abstract Session: Catheter-associated UTIs
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • IDSA_CAUTI_abstract.pdf (100.1 kB)
  • Background:

    Catheter-associated urinary tract infections (CAUTI) are among the most common healthcare-associated infections in the U.S., yet little is known about the epidemiology of pediatric CAUTI.

    Methods:

    We reviewed medical records of inpatients with CAUTI at The Children's Hospital of Philadelphia between July 2009 and June 2012 to: (1) describe patient and infection characteristics; and, (2) determine the impact associated with implementation of a CAUTI prevention bundle derived from existing adult prevention strategies.

    Results:

    Forty-five patients with CAUTI were identified. Median age in years was 9.5 (IQR: 0.4 to 17.5).. Most were female (n = 34, 76%), received care in the pediatric or cardiac intensive care units (n=20, 44% and n=11, 24%, respectively), and had at least one complex chronic condition, most commonly respiratory (n = 30, 67%), cardiovascular (n=20, 44%) and neuromuscular (n=16, 36%).  Seventeen patients had known risk factor(s) for CAUTI, including genitourinary condition (n=12, 27%), history of intermittent catheterization at home (n=6, 13%) and immunocompromising condition (n=6, 13%). Median length of stay until CAUTI was 15 days (IQR: 9 to 37). Median dwell time was 4 days (IQR: 2 to 11).  Over 90% (n=41) of patients had a recognized indication for initial catheter placement, but only 76% (n=34) had an indication at CAUTI onset (p = 0.040). Organisms isolated included Enterobacteriaceae (n=25, 56%), Pseudomonas aeruginosa (n=11, 24%), yeast (n=5, 11%), Enterococcus spp. (n=3, 7%) and Lactobacillus spp. (n=1, 2%).

    Implementation of the CAUTI prevention bundle was associated with a 64% reduction in the median monthly CAUTI rate (pre 5.79/1000 catheter days vs. post 2.26/1000 catheter days; p<0.001) (FIGURE).

    More pre-bundle patients had history of intermittent catheterization at home (p = 0.007). No other pre- vs. post-bundle differences were observed.

    Conclusion:

    CAUTI is a relatively common healthcare-associated infection in hospitalized children.  Many pediatric CAUTI can be prevented through implementation of a prevention bundle.  Future research is needed to define the relative contribution of individual bundle elements on CAUTI prevention and to evaluate the bundle's impact in other pediatric health care settings.

     

    Sarah B. Klieger, MPH1, Julia Shaklee Sammons, MD, MSCE2, Katherine Finn Davis, PhD, RN, CPNP3, Ann Colebaugh, MSN, CNS, RN, CPI4, Ben Eithun, RN, MSN, CRNP, CCRN5, Dennis Meredith, DVM, CIC6, Natalie Plachter, CRNP7, Allison Thompson, MSN, RD, RN, CCRN, CRNP5, Susan E. Coffin, MD, MPH8 and for the CDC Prevention Epicenter Program, (1)Division of Infectious Diseases, Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, (2)Perelman School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Department of Infection Prevention and Control, The Children's Hospital of Philadelphia, Philadelphia, PA, (3)The Center for Pediatric Nursing Research and Evidence Based Practice, The Children's Hospital of Philadelphia, Philadelphia, PA, (4)Nursing - Medical and Rehab, The Children's Hospital of Philadelphia, Philadelphia, PA, (5)Critical Care Department, The Children's Hospital of Philadelphia, Philadelphia, PA, (6)Department of Infection Control, Office of Patient Safety, The Children's Hospital of Philadelphia, Philadelphia, PA, (7)Department of Surgery, Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA, (8)Department of Pediatrics, Division of Infectious Diseases, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA

    Disclosures:

    S. B. Klieger, None

    J. S. Sammons, None

    K. Finn Davis, None

    A. Colebaugh, None

    B. Eithun, None

    D. Meredith, None

    N. Plachter, None

    A. Thompson, None

    S. E. Coffin, None

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