Quality Gaps in Documenting Urinary Catheter Use and Infectious Outcomes

Trautner, Barbara W.; Patterson, Jan E.; Petersen, Nancy J.; Hysong, Sylvia J; Horwitz, Deborah; Chen, G. John; Grota, Patti G.; Naik, Aanand D.

doi:10.1086/671267

Cited by 10 publications

(7 citation statements)

References 23 publications

(21 reference statements)

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“…Of these, 376 (37.3%) were from external (condom) catheters, and more of the urine cultures collected from condom catheters were positive than those collected from indwelling catheters (77.1% versus 55%, respectively, P<0.001). 28 Strategies to reduce CAUTI by substituting external catheters for indwelling catheters could inadvertently lead to increased antimicrobial overuse for ASB if the risk of bacteriuria with condom catheters proves to be a general phenomenon.…”

Section: Epidemiology and Significance Of Asbmentioning

confidence: 99%

Approach to a Positive Urine Culture in a Patient Without Urinary Symptoms

Trautner

Grigoryan

2014

Infectious Disease Clinics of North America

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Asymptomatic bacteriuria (ASB) is a condition in which bacteria are present in a noncontaminated urine sample collected from a patient without signs or symptoms related to the urinary tract. ASB must be distinguished from symptomatic UTI by the absence of signs and symptoms compatible with UTI or by clinical determination that a nonurinary etiology accounts for the patient's symptoms. ABU is a very common condition that is often treated unnecessarily with antibiotics. Pregnant women and persons undergoing urologic procedures expected to cause mucosal bleeding are the only two groups with convincing evidence that screening for and treating ASB is beneficial. Randomized, controlled trials of ASB screening and/or treatment have established the lack of efficacy in premenopausal adult women, diabetic women, patients with spinal cord injury, catheterized patients, older adults living in the community, and elderly institutionalized adults. The overall purpose of this review is to promote an awareness of ASB as a distinct condition from UTI and to empower clinicians to withhold antibiotics in situations in which antimicrobial treatment of bacteriuria is not indicated.

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Section: Epidemiology and Significance Of Asbmentioning

confidence: 99%

Approach to a Positive Urine Culture in a Patient Without Urinary Symptoms

Trautner

Grigoryan

2014

Infectious Disease Clinics of North America

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“…, 11 , 21 Our findings demonstrate that device days and bed days were equally effective adjustment metrics for comparing HAI rates between VHA hospitals from 2011 to 2013. Collection of device-day and bed-day data is a manual, labor-intensive practice with frequent inaccuracies 4 22 – 24 Although NHSN allows reporting from electronic surveillance, this requires an integrated electronic medical record system that captures device use, which is not available in many facilities 7…”

Section: Discussionmentioning

confidence: 99%

“…1 As public reporting of HAI continues to expand, the accurate measurement of HAIs is essential for the evaluation of quality improvement projects within individual facilities and across different institutions. [2][3][4][5][6] The convention in HAI reporting is to report infection rates standardized by 1,000 device days. [7][8][9] One strategy for HAI prevention is to reduce the number of device days by discontinuing devices that are no longer required.…”

mentioning

confidence: 99%

Denominator Doesn’t Matter: Standardizing Healthcare-Associated Infection Rates by Bed Days or Device Days

Horstman

Almenoff

et al. 2015

Infect. Control Hosp. Epidemiol.

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“…Most studies have been performed either among outpatients or catheterized inpatients, populations that differ significantly from the general inpatient population. 8–14 Our objective in this study is to describe the frequency of urine cultures performed in inpatients without additional testing for pyuria by urinalysis or urine microscopy.…”

Section: Introductionmentioning

confidence: 99%

Inpatient Urine Cultures Are Frequently Performed Without Urinalysis or Microscopy: Findings From a Large Academic Medical Center

Carlson

Munigala

Russo

et al. 2017

Infect. Control Hosp. Epidemiol.

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OBJECTIVE To describe the frequency of urine cultures performed in inpatients without additional testing for pyuria DESIGN Retrospective cohort study SETTING A 1,250-bed academic tertiary referral center PATIENTS Hospitalized adults METHODS This study included urine cultures drawn on 4 medical and 2 surgical wards from 2009 to 2013 and in the medical and surgical intensive care units (ICUs) from 2012 to 2013. Patient and laboratory data were abstracted from the hospital's medical informatics database. We identified catheter-associated urinary tract infections (CAUTIs) in the ICUs by routine infection prevention surveillance. Cultures without urinalysis or urine microscopy were defined as "isolated." The primary outcome was the proportion of isolated urine cultures obtained. We used multivariable logistic regression to assess predictors of isolated cultures. RESULTS During the study period, 14,743 urine cultures were obtained (63.5 cultures per 1,000 patient days) during 11,820 patient admissions. Of these, 2,973 cultures (20.2%) were isolated cultures. Of the 61 CAUTIs identified, 31 (50.8%) were identified by an isolated culture. Predictors for having an isolated culture included male gender (adjusted odds ratio [aOR], 1.22; 95%; confidence interval [CI], 1.11-1.35], urinary catheterization (aOR, 2.15; 95% CI, 1.89-2.46), ICU admission (medical ICU aOR, 1.72; 95% CI, 1.47-2.00; surgical ICU aOR, 1.82; 95% CI, 1.51-2.19), and obtaining the urine culture ≥1 calendar day after admission (1-7 days aOR, 1.91; 95% CI. 1.71-2.12; >7 days after admission aOR, 2.81; 95% CI, 2.37-3.34). CONCLUSIONS Isolated urine cultures are common in hospitalized patients, particularly in patients with urinary catheters and those in ICUs. Interventions targeting inpatient culturing practices may improve the diagnosis of urinary tract infections. Infect Control Hosp Epidemiol 2017;38:455-460.

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Quality Gaps in Documenting Urinary Catheter Use and Infectious Outcomes

Abstract: ClinicalTrials.gov identifier: NCT01052545.

Cited by 10 publications

References 23 publications

Approach to a Positive Urine Culture in a Patient Without Urinary Symptoms

Approach to a Positive Urine Culture in a Patient Without Urinary Symptoms

Denominator Doesn’t Matter: Standardizing Healthcare-Associated Infection Rates by Bed Days or Device Days

Inpatient Urine Cultures Are Frequently Performed Without Urinalysis or Microscopy: Findings From a Large Academic Medical Center

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