Impact of Changes in the NHSN Catheter-Associated Urinary Tract Infection (CAUTI) Definition on the Frequency and Epidemiology of CAUTIs in Intensive Care Units (ICUs)
In January, 2013, the wording of the NHSN definition for CAUTI was changed to include fever as a diagnostic criteria regardless of the presence of an alternative fever source. The objective of this study was to determine the impact of changes in the CAUTI definition on the frequency and clinical relevance of CAUTI cases meeting NHSN criteria.
We conducted a retrospective cohort analysis at the Detroit Medical Center (DMC). We included 4 DMC sites and 15 adult ICUs from July 1, 2012 to June 30, 2013. Patients were identified who met CAUTI criteria, based in part, on the presence of fever. Detailed data collection was conducted to identify other potential fever sources.
A total of 107 patients who met current NHSN criteria for CAUTI were studied, with a mean age of 57.1 ± 17.3 and 60.8% were female. Prior to urine culture, the median ICU length of stay was 20 days (IQR 7,33) and median foley days was 6 days (IQR 3,12). The most common pathogens responsible for CAUTI was Candida glabrata (23.1%) and enterococcus species (14.1%). 48 (44.8%) patients had another NHSN-defined infection other than CAUTI, including pneumonia (27.1%) and bloodstream infection (21.5%). Twelve patients (11.2%) had a non-infectious etiology of fever. Patients with alternative fever sources (n=60) were categorized as having CAUTI according to NHSN 2013 definitions only and would not have been diagnosed with CAUTI according to previous NHSN definitions. These patients were compared to those patients for whom CAUTI was the only source of fever (and thus would have been diagnosed with CAUTI by both older and new NHSN definitions) (n=47). There were no significant differences between the two groups although there were trends for a higher frequency of physician-diagnosed "other infections" (OR 5.8, p<0.001) among patients in the "new CAUTI only" group. Presence of Candida spp. was also more frequent among patients this group (OR 1.8, p=0.17).
The change in NHSN CAUTI definition led to a more than 2-fold increase in CAUTIs. Using current, 2013 definitions, CAUTIs are frequently diagnosed in the presence of other infections. Positive urine cultures, (e.g. Candida spp.) often represent colonization rather than clinically meaningful urinary tract infection.
V. P. Kesani, None
M. Salim, None
A. Pervaiz, None
N. Aftab, None
T. Mann, None
N. Tashtoush, None
S. Karino, None
S. Dhar, None
K. Kaye, None