Factitious Catheter-Associated Urinary Tract Infections (CAUTI) in a Neuroscience ICU

Background: Catheter-associated urinary tract infections (CAUTI) is a common complication experienced by critically ill patients. Unfortunately, the surveillance definition for CAUTI is imprecise and institutions may be financially penalized or suffer degradation of reputation as a result of inaccurate CAUTI diagnosis.

Methods:  Retrospective review of cases meeting CDC-NHSN CAUTI definition in a neuroscience ICU from January 2013-February 2015. Data collected included: body temperature; duration of urinary catheterization; white blood cell count (WBC); results of urinalysis, urine cultures, and blood cultures; neurologic diagnosis; response to antibiotics; and presence of other potential causes for fever.

Results: 41 patients met the CDC-NHSN definition for CAUTI. Mean age of the patients was 55.4 +/- 13 years and 76% were women. CAUTI was diagnosed at hospital day 9.6 +/- 5.5 days after a mean of 7.2 +/- 5.2 days of urinary catheterization. Only 35 patients had a urinalysis performed and 16 (46%) did not exhibit pyuria (<10 WBC/HPF). 20 patients (48.8%) remained febrile for at least 72 hours after administration of antibiotics with activity against the microbe recovered from the urine. 3 patients (7.3%) had resolution of fever without administration of antibiotics. 13 patients (31.7%) had another possible site of infection (pneumonia (8), Clostridium difficile (1), skin (1), ventriculitis (1), influenza (1)) and 33 patients (80.5%) had a possible noninfectious cause for fever (subarachnoid or other intracerebral hemorrhage (31), cerebral vascular accident (2)). 38 patients (93%) had blood cultures, of which 5 (13%) revealed bacteremia. The bloodstream isolate was the same species as the urine isolate in 3 patients.

Conclusion:  Despite meeting the CDC-NHSN surveillance definition for CAUTI, in this neuroscience ICU population, 63.4% of the patients most likely did not have a UTI (39% lack of pyuria, 19.5% of patients with pyuria did not resolve fever with antibiotics, 4.9% of patients with pyuria resolved fever without antibiotics).In addition, most patients (80.5%) had a well-defined noninfectious potential etiology for fever. There is great opportunity to improve the surveillance definition for CAUTI in this patient population as well as better utilize institutional laboratory and clinical resources.