Pediatric ambulatory catheter-associated urinary tract infections (CAUTIs): Incidence, risk factors, and patient outcomes

Abstract

Objective: Catheter-associated urinary tract infections (CAUTIs) occur frequently in pediatric inpatients, and they are associated with increased morbidity and cost. Few studies have investigated ambulatory CAUTIs, despite at-risk children utilizing home urinary catheterization. This retrospective cohort and case-control study determined incidence, risk factors, and outcomes of pediatric patients with ambulatory CAUTI. Design: Broad electronic queries identified potential patients with ambulatory urinary catheters, and direct chart review confirmed catheters and adjudicated whether ambulatory CAUTI occurred. CAUTI definitions included clean intermittent catheterization (CIC). Our matched case-control analysis assessed risk factors. Setting: Five urban, academic medical centers, part of the New York City Clinical Data Research Network. Patients: Potential patients were age <22 years who were seen between October 2010 and September 2015. Results: In total, 3,598 eligible patients were identified; 359 of these used ambulatory catheterization (representing186,616 ambulatory catheter days). Of these, 63 patients (18%) experienced 95 ambulatory CAUTIs. The overall ambulatory CAUTI incidence was 0.51 infections per 1,000 catheter days (1.35 for indwelling catheters and 0.47 for CIC; incidence rate ratio, 2.88). Patients with nonprivate medical insurance (odds ratio, 2.5; 95% confidence interval, 1.1–6.3) were significantly more likely to have ambulatory CAUTIs in bivariate models but not multivariable models. Also, 45% of ambulatory CAUTI resulted in hospitalization (median duration, 3 days); 5% resulted in intensive care admission; 47% underwent imaging; and 88% were treated with antibiotics. Conclusions: Pediatric ambulatory CAUTIs occur in 18% of patients with catheters; they are associated with morbidity and healthcare utilization. Ambulatory indwelling catheter CAUTI incidence exceeded national inpatient incidence. Future quality improvement research to reduce these harmful infections is warranted.

Costs of ambulatory pediatric healthcare-associated infections: Central-line–associated bloodstream infection (CLABSIs), catheter-associated urinary tract infection (CAUTIs), and surgical site infections (SSIs)

“…Data from another study on this cohort suggest that fewer than half of patients with ambulatory CAUTI were hospitalized, whereas 85% of patients with ambulatory CLABSI were hospitalized. 39,40 Finally, cost-to-charge ratios, while commonly used in HAI research, 8,9,35 may misestimate costs for a given institution, and the group all-payer inpatient cost-to-charge ratio for urban, nonprofit hospitals with >300 beds may not apply to all pediatric charges found in our patients, especially ambulatory visits.…”

Strategies to prevent catheter-associated urinary tract infections in acute-care hospitals: 2022 Update

“…Available data are insufficient to determine whether specific patients would benefit more from an open drainage system despite an increased risk of CAUTI. 36,37 Risk factors for developing healthcare-associated urinary-tract–related bloodstream infection include neutropenia, renal disease, and male sex. 38–40 …”

“…Available data are insufficient to determine whether specific patients would benefit more from an open drainage system despite an increased risk of CAUTI. 36 , 37…”

Health Care Associated Infections (HCAIs) a New Threat for World; U-Turn from Recovery to Death

“…The most effective way to prevent the CAUTIs, give proper guidance to medical staff and insist the nurse to do more practice [56]. In United Kingdom [57] developed the set rules in the name of "epic3 Guidelines "which based one scientific literature and expertise of medical staff.…”