Risk factors for healthcare-associated urinary tract infection and their applications in surveillance using hospital administrative data: a systematic review

King, Carlene; Álvarez, Leticia García; Holmes, Alison; Moore, Luke; Galletly, Tracey; Aylin, Paul

doi:10.1016/j.jhin.2012.05.004

Cited by 34 publications

(25 citation statements)

References 38 publications

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“…Any potential issue of underestimating the incidence of HAUTI using the HPA surveillance definition is less important where data are used in a quality improvement framework, as these data can be used to inform and evaluate interventions38 rather than for diagnostic purposes or for performance management (ie, trends overtime being most important). Other authors have commented that prospective UTI surveillance is costly and time consuming to conduct39 40; therefore, we explored alternatives to prospective UTI surveillance by comparing our prevalence data with postdischarge coding data. Australian coding data do not distinguish between HAI cases and non-HAI cases.…”

Section: Discussionmentioning

confidence: 99%

A point prevalence cross-sectional study of healthcare-associated urinary tract infections in six Australian hospitals

et al. 2014

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ObjectivesUrinary tract infections (UTIs) account for over 30% of healthcare-associated infections. The aim of this study was to determine healthcare-associated UTI (HAUTI) and catheter-associated UTI (CAUTI) point prevalence in six Australian hospitals to inform a national point prevalence process and compare two internationally accepted HAUTI definitions. We also described the level and comprehensiveness of clinical record documentation, microbiology laboratory and coding data at identifying HAUTIs and CAUTIs.SettingData were collected from three public and three private Australian hospitals over the first 6 months of 2013.ParticipantsA total of 1109 patients were surveyed. Records of patients of all ages, hospitalised on the day of the point prevalence at the study sites, were eligible for inclusion. Outpatients, patients in adult mental health units, patients categorised as maintenance care type (ie, patients waiting to be transferred to a long-term care facility) and those in the emergency department during the duration of the survey were excluded.Outcome measuresThe primary outcome measures were the HAUTI and CAUTI point prevalence.ResultsOverall HAUTI and CAUTI prevalence was 1.4% (15/1109) and 0.9% (10/1109), respectively. Staphylococcus aureus and Candida species were the most common pathogens. One-quarter (26.3%) of patients had a urinary catheter and fewer than half had appropriate documentation. Eight of the 15 patients ascertained to have a HAUTI based on clinical records (6 being CAUTI) were coded by the medical records department with an International Classification of Diseases (ICD)-10 code for UTI diagnosis. The Health Protection Agency Surveillance definition had a positive predictive value of 91.67% (CI 64.61 to 98.51) compared against the Centers for Disease Control and Prevention definition.ConclusionsThese study results provide a foundation for a national Australian point prevalence study and inform the development and implementation of targeted healthcare-associated infection surveillance more broadly.

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Section: Discussionmentioning

confidence: 99%

A point prevalence cross-sectional study of healthcare-associated urinary tract infections in six Australian hospitals

et al. 2014

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“…Factors that increase the risk of hospitalacquired infections, in particular catheter-associated urinary tract infections (CAUTIs), have been well documented in medical patients and in many types of surgical patients. These risk factors include older age, female gender, diabetes mellitus, and greater length of time with urinary catheter in place [4][5][6]. Other associations, such as peri-operative blood transfusions and peak urine flow rates, have also been reported [7,8].…”

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confidence: 99%

Risk Factors for Urinary Tract Infections in Cardiac Surgical Patients

Gillen

Isbell

Michaels

et al. 2015

Surgical Infections

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Background: Risk factors for catheter-associated urinary tract infections (CAUTIs) in patients undergoing noncardiac surgical procedures have been well documented. However, the variables associated with CAUTIs in the cardiac surgical population have not been clearly defined. Therefore, the purpose of this study was to investigate risk factors associated with CAUTIs in patients undergoing cardiac procedures. Methods: All patients undergoing cardiac surgery at a single institution from 2006 through 2012 (4,883 patients) were reviewed. Patients with U.S. Centers for Disease Control (CDC) criteria for CAUTI were identified from the hospital's Quality Assessment database. Pre-operative, operative, and post-operative patient factors were evaluated. Univariate and multivariable analyses were used to identify significant correlations between perioperative characteristics and CAUTIs. Results: There were 55 (1.1%) documented CAUTIs in the study population. On univariate analysis, older age, female gender, diabetes mellitus, cardiogenic shock, urgent or emergent operation, packed red blood cell (PRBC) units transfused, and intensive care unit length of stay (ICU LOS) were all significantly associated with CAUTI [p < 0.05]. On multivariable logistic regression, older age, female gender, diabetes mellitus, and ICU LOS remained significantly associated with CAUTI. Additionally, there was a significant association between CAUTI and 30-d mortality on univariate analysis. However, when controlling for common predictors of operative mortality on multivariable analysis, CAUTI was no longer associated with mortality. Conclusions: There are several identifiable risk factors for CAUTI in patients undergoing cardiac procedures. CAUTI is not independently associated with increased mortality, but it does serve as a marker of sicker patients more likely to die from other comorbidities or complications. Therefore, awareness of the high-risk nature of these patients should lead to increased diligence and may help to improve peri-operative outcomes. Recognizing patients at high risk for CAUTI may lead to improved measures to decrease CAUTI rates within this population.

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“…Seasonal viral infections can also be considered as putative risk factors in pediatric nosocomial infections (Mühlemann et al, 2004). It has been demonstrated that the highest risk is due to the pre-formation of urinary catheterization (King et al, 2012). Hence, unnecessary urethral catheterization should be avoided to prevent nosocomial UTIs (Savas et al, 2006).…”

Section: Risk Factors For Nosocomial Infectionsmentioning

confidence: 99%

Nosocomial infections in intensive care and medical rehabilitation units, and evaluation of antibiotics prescription

Al-Shenqiti¹,

Bahashwan²,

Ghanem³

et al. 2017

Afr. J. Microbiol. Res.

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Although, nosocomial infections (NIs) are considered to be an important cause of mortality and prolonged stay in hospitals, there are only a few studies that are concerned with their prevention and reduction in rehabilitation units. This could be because most NI surveys have been carried out mainly in acute and long-stay in hospitals. As a result, limited information is available on prevention and reduction of NIs in rehabilitation units. The present study is a systematic review that draws attention to the significance of setting up specific means for infection control in hospital units concerned with critical cases, and stresses on the need to adapt to new infection control policies, training of healthcare professionals, educating patients regarding safety measures and fighting nosocomial infections. Furthermore, this study aims to show the obligations of following certain considerations while prescribing antimicrobial therapy so as to maximize the efficacy and reduce the adverse effects of conventional antibiotics. Systematic review survey methods were adopted throughout the study. Results of the study were debatable concerning the question of predominance of Gram positive or negative microorganisms as nosocomial etiological agents. Infection control measures such as continuous surveillance protocols, suitable prevention methods and appropriate therapeutic treatment strategies such as de-escalation and rotational antibiotic therapies might help reduce nosocomial infections. Much attention should be given in hospitals to the environmental conditions including quality of water and air. Patients with a suppressed immune system during their stay in hospitals are susceptible to levels of microorganisms that are considered safe for a healthy community. Hence, this study suggests that special safety levels should be set up regarding the levels of microorganisms in hospitals and these should be much lower than those used for a healthy community.

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Risk factors for healthcare-associated urinary tract infection and their applications in surveillance using hospital administrative data: a systematic review

Cited by 34 publications

References 38 publications

A point prevalence cross-sectional study of healthcare-associated urinary tract infections in six Australian hospitals

A point prevalence cross-sectional study of healthcare-associated urinary tract infections in six Australian hospitals

Risk Factors for Urinary Tract Infections in Cardiac Surgical Patients

Nosocomial infections in intensive care and medical rehabilitation units, and evaluation of antibiotics prescription

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