Methods: The study was a prospective analysis of 292 nursing home (NH) residents with indwelling urinary catheters enrolled in a larger intervention trial, the Targeted Infection Prevention (TIP) study. Clinical and demographic data including age, Charlson’s comorbidity score, functional status, infections, and clinical symptoms were used to identify clinically-defined CAUTIs that met standardized definitions. Clinical symptoms as a function of infection by specific uropathogens were analyzed using logistic regression methods adjusted for clustering by facility.
Results: There were 292 catheterized participants from 12 NHs enrolled in the parent TIP study. The study participants were predominantly elderly (age 74 ± 12.2) and dependent for care (mean functional score 21.6 ± 4.0). The majority of the catheterized participants had indwelling Foley catheters (85%); 15% had suprapubic catheters. 65% had been hospitalized within 30 days of enrollment in the study and 35% had wounds. The participants were approximately half male (52%), and had diabetes (42%), dementia (34%), a history of CVA (23%), and COPD (20%). 183 clinically-defined CAUTIs occurred in 175 residents. CAUTIs occurring <30 days after enrollment were predominantly monomicrobial and involved Escherichia coli; CAUTIs that occurred ≥30 days after enrollment were more likely to be polymicrobial. CAUTIs involving Klebsiella pneumoniae were the most likely to meet standardized definitions of symptomatic CAUTI (OR 7.78; P<0.007) and were associated with an acute change in mental status (OR 6.76; P<0.003).
Conclusion: K. pneumoniae CAUTIs are more likely to be symptomatic and meet standardized criteria for CAUTI in NHs. Further examination of CAUTI symptoms associated with specific uropathogens could yield critical information for defining and treating infections in NH settings.
H. Mobley, None
L. Mody, VA Healthcare System Geriatric Research Education and Clinical Care Center, NIA-Pepper Center, NIA R01AG032298, and R01AG041780: Grant Investigator , Grant recipient and Research grant