2171. Comparing Surveillance Definitions for Non-Catheter Associated Urinary Tract Infections
Session: Poster Abstract Session: Healthcare Epidemiology: HAI Surveillance
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • IDWeek UTI Poster 9.25.2018 FINAL.pdf (314.2 kB)
  • Background: Patient sharing between hospitals and long-term care facilities (LTCF) is widespread.  However, surveillance criteria for non-catheter associated urinary tract infection (UTI) vary by healthcare setting.  Consequently, patients with identical features of UTI may meet criteria in LTCF but not in hospitals.  A common definition that spans hospitals and LTCF may inform UTI surveillance efforts across healthcare facilities.

    Methods: We performed a cohort analysis of all suspected UTI cases in women ≥ 65 years from 21 LTCF enrolled in a clinical trial evaluating cranberry capsules to reduce bacteriuria plus pyuria from 8/2012 to 10/2015.  We applied 2017 hospital National Healthcare Safety Network (NSHN), 2012 LTCF NSHN, and proposed criteria (Figure 1) to all suspected UTI cases.  Proposed criteria were derived a priori.  Differences in the correlated proportions of UTI detected per criteria were assessed using McNemar’s test. 

    Results: Of 350 suspected UTI cases, LTCF NSHN criteria detected more UTI (22/350, 6.3%) compared to hospital NHSN (15/350, 4.3%; p=0.04) and proposed (15/350, 4.3%; p=0.02) criteria (Table 1).  Half (11/22) of LTCF NHSN UTI included ≥102 CFU/ml of organisms from a catheterized urine as the microbiological criterion. Four UTI meeting LTCF NHSN or proposed criteria did not meet the hospital NHSN criteria because fever is only a listed clinical feature for patients ≤ 65 years.

    Conclusion: Current hospital and LTCF NHSN criteria both have limitations.  The hospital NHSN criteria exclude fever in older adults as a clinical feature. The LTCF NHSN criteria include insensitive microbiological criteria.  Our proposed surveillance criteria address these limitations and may be generalizable to both hospitals and LTCF.

    Table 1. UTI detection by surveillance criteria.

    Criteria

    P value

     

    LTCF NHSN

    Hospital NHSN

    Present

    Absent

    Present

    13

    2

    Absent

    9

    326

    0.04

     

    LTCF NHSN

    Proposed

    Present

    Absent

    Present

    15

    0

    Absent

    7

    328

    0.02

     

     

     

    Rupak Datta, MD PhD1, Sonali Advani, MBBS, MPH;1, Andrea Rink, RN2, Luann Bianco, BA2, Peter Van Ness, PhD, MPH2, Vincent Quagliarello, MD, FIDSA1 and Manisha Juthani-Mehta, MD, FIDSA, FSHEA1, (1)Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, (2)Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT

    Disclosures:

    R. Datta, None

    S. Advani, None

    A. Rink, None

    L. Bianco, None

    P. Van Ness, None

    V. Quagliarello, None

    M. Juthani-Mehta, Iterum Therapeutics: Scientific Advisor , Consulting fee .

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.