Program Schedule

869
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)

Session: Poster Abstract Session: Device-Associated HAIs
Friday, October 10, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • cauti 9-22-14 FINALsd.pdf (1.2 MB)
  • Background:

    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. 

    Methods:

    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.   

    Results:

    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).

    Conclusion:

    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.

    Anupama Neelakanta, MD1, Sarit Sharma, MD2, Vishnu Priya Kesani, MBBS3, Madiha Salim, MD1, Amina Pervaiz, MD1, Nida Aftab, MD4, Tal Mann, MD3, Nader Tashtoush, MD3, Shigehiko Karino, MD3, Sorabh Dhar, MD3 and Keith Kaye, MD, MPH1, (1)Infectious Diseases, Detroit Medical Center/ Wayne State University, Detroit, MI, (2)Detroit Medical Center and Wayne State University, Detroit, MI, (3)Detroit Medical Center / Wayne State University, Detroit, MI, (4)Detroit medical center/Wayne state university, Detroit, MI

    Disclosures:

    A. Neelakanta, None

    S. Sharma, None

    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

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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