Prevalence of Catheter-Associated Urinary Tract Infections in Neurosurgical Intensive Care Patients – The Overdiagnosis of Urinary Tract Infections

Abstract

Background: Hospital-acquired infections (HAIs) are profound causes of prolonged hospital stay and worse patient outcomes. HAIs pose serious risks, particularly in neurosurgical patients in the intensive care unit, as these patients are seldom able to express symptoms of infection, with only elevated temperatures as the initial symptom. Data from Center for Disease Control (CDC) and the Infectious Disease Society of America (IDSA) have shown that of all HAIs, urinary tract infections (UTIs) have been grossly over-reported, resulting in excessive and unnecessary antibiotic usage.Methods: We conducted a retrospective analysis of 686 adult patients that were evaluated by the neurosurgery service at Arrowhead Regional Medical Center between July 2018 and March 2019. Inclusion criteria were adults greater than 18 years of age with neurosurgical pathology requiring a minimum of one full day admission to the intensive care unit (ICU), and an indwelling urinary catheter. Exclusion criteria were patients under the age of 18, those who did not spend any time in the ICU, or with renal pathologies such as renal failure.Results: We reviewed 686 patients from the neurosurgical census. In total, 146 adult patients with indwelling urinary catheters were selected into the statistical analysis. Most individuals spent an average of 8.91 ± 9.70 days in the ICU and had an indwelling catheter for approximately 8.14 ± 7.95 days. Forty-two out of the 146 individuals were found to have a temperature of 100.4°F or higher. Majority of the patients with an elevated temperature had an infectious source other than urine, such as sputum (22 out of 42, 52.38%), blood (three out of 42, 7.14%) or CSF (one out of 42, 2.38%). We were able to find only two individuals (4.76%) with a positive urine culture and no evidence of other positive cultures or deep vein thrombosis.Conclusions: Our analysis shows evidence to support the newest IDSA guidelines that patients with elevated temperatures should have a clinical workup of all alternative etiologies prior to testing for a urinary source unless the clinical suspicion is high. This will help reduce the rate of unnecessary urine cultures, the over-diagnosis of asymptomatic bacteriuria, and the overuse of antibiotics. Based on our current findings, all potential sources of fever should be ruled out prior to obtaining urinalysis, and catheters should be removed as soon as they are not needed. Urinalysis with reflex to urine culture should be reserved for those cases where there remains a high index of clinical suspicion for a urinary source.

Urinary Tract Infections and Associated Factors among Patients with Indwelling Urinary Catheters Attending Bugando Medical Centre a Tertiary Hospital in Northwestern Tanzania

“…As explained above, the longer the urinary catheter remains in situ, the higher the risk of CA-UTI from bacteria colonizing the urinary catheter bag. The prevalence of confirmed CA-UTI was significantly high compared to the prevalence in higher-income countries (HICs), the U.K. (4.76%) [46], Columbia (1.41%) [29], Australia (0.9%) [27], and England (8.5%) [47]. This could be attributed to the out-patients who had IUCs for a long-term period (≥6 weeks) outside healthcare facilities with no instructions on the proper handling of catheters at home, and infrequently changing the catheters.…”

Use of Antimicrobial-Coated Catheters in Preventing Catheter-Associated Urinary Tract Infections and Bacteriuria: A Meta-Analysis for Clinicians

“…CAUTIs, while considered preventable, are estimated to contribute to more than 13,000 deaths each year and are of major concern to physicians and hospitals. 23 To qualify for the diagnosis of CAUTI, a patient must have UTI-associated symptoms and at least ≥10 3 colony-forming units/ml and no other infection source besides the catheter. 24 It is also well documented in the literature that presence of an indwelling catheter can lead to bacteriuria within 24–48 hours, and it is not recommended to screen or treat asymptomatic bacteriuria.…”

Catheter-Associated Urinary Tract Infection in Neurological Intensive Care Units: A Narrative Review

“…Altogether, it is important to keep in mind that diagnosis with the help of lab tests is accurate, but the essential basic component is to avoid overdiagnosis and the following overtreatment in the path of saving patients against inpatient complications. 17 Additional data of literature on the diagnosis of CAUTI in neuro ICU is available in Table 2.…”