289. Evaluation of the Etiology and Management of Catheter-associated Urinary Tract infections (CAUTI) in Hospitalized Patients at the University of Colorado Hospital (UCH)
Session: Poster Abstract Session: HAI: Device Associated Infections
Thursday, October 8, 2015
Room: Poster Hall
Background: Catheter-associated UTI’s (CAUTIs) are the second most common healthcare-associated infections. No formal recommendations exist regarding treatment of CAUTI and clinical practices related to managing these infections are not well understood. The purpose of this study was to evaluate the management, microbial etiologies, and patient response to therapy among hospitalized patients with CAUTI at UCH. 

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.

Michael Casias, PharmD and Douglas N. Fish, PharmD, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO

Disclosures:

M. Casias, None

D. N. Fish, None

Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.