Methods: This was a retrospective observational study of patients diagnosed with CAUTI from July 2012 through June 2014. Data collected included presence of concurrent infections, physical and laboratory findings, antibiotic regimens, urine culture and sensitivities, removal of urinary catheter if performed, and patient response based on physical and laboratory evidence.
Results: A total of 99 patients were evaluated. All patients had positive urine cultures with 108 organisms identified; 90% of infections were monomicrobial. The most common pathogens were E. coli (28% of patients, including one ESBL-producer), Enterococcus (23%, including 7% VRE), K. pneumonia (13%), P. aeruginosa (11%), and Candida spp. (8%). Patients with concurrent infection were most often initially treated with piperacillin/tazobactam (26% of patients); those without concurrent infection most often initially begun on ceftriaxone (38% of patients). Urinary isolates were sensitive to initial antibiotics in 89% of patients overall; VRE occurred in nearly half of cases (4/9) of inappropriate initial therapy and was more common among patients with concurrent infection. The median duration of therapy was 5 days and favorable response occurred in 78% of patients overall. Urinary catheters were changed or removed in 73% of patients; clinical response occurred in 88% of these patients versus 56% of patients when catheters were not removed [P=0.002, Odds Ratio 1.58 (95% CI, 1.11-2.23)].
Conclusion: In hospitalized patients with CAUTI, most infections were monomicrobial and highly resistant pathogens accounted for only a small number of cases. Initial broad-spectrum antibiotic therapy was appropriate in nearly 90% of cases. Clinical responses were significantly improved with change or removal of the urinary catheter but this occurred in only 72% of patients.