American Journal of Infection Control 42 (2014) 17-22
Contents lists available at ScienceDirect
American Journal of Infection Control
American Journal of Infection Control
journal homepage: www.ajicjournal.org
Major article
Trends in catheter-associated urinary tract infections among a national cohort of hospitalized adults, 2001-2010 Kelly R. Daniels PharmD a, b, Grace C. Lee PharmD a, b, Christopher R. Frei PharmD, MSc a, b, * a b
College of Pharmacy, University of Texas at Austin, Austin, TX Pharmacotherapy Education and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, TX
Key Words: Health care-associated infections Medical device infections Health care epidemiology Population health
Background: Catheter-associated urinary tract infections (CAUTIs) have become a major public health concern in the United States. This study provides national estimates of CAUTI incidence, mortality, and associated hospital length of stay (LOS) over a 10-year period. Methods: This was a retrospective analysis of the National Hospital Discharge Surveys from 2001 to 2010. Adults age 18 years with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure code for urinary catheter placement or other major procedure were included. Urinary tract infections were identified by ICD-9-CM code. Data weights were applied to derive national estimates. Predictors of CAUTI were identified using a logistic regression model. Results: These data represent 70.4 million catheterized patients, 3.8 million of whom developed a CAUTI. The incidence of CAUTIs decreased from 9.4 cases/100 catheterizations in 2001 to 5.3 cases/100 catheterizations in 2010. Mortality in patients with a CAUTI declined from 5.4% in 2001 to 3.7% in 2010. Median (interquartile range [IQR]) hospital LOS also declined, from 9 days (IQR, 5-16 days) in 2001 to 7 days (IQR, 4-12 days) in 2010. Independent predictors of CAUTI included female sex, emergency hospital admission, transfer from another facility, and Medicaid payment (P < .0001 for all variables). Conclusions: The incidence of CAUTIs in US hospitals declined over the study period. Furthermore, patients with these infections experienced lower hospital mortality and shorter hospital LOS. Copyright Ó 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
Catheter-associated urinary tract infections (CAUTIs) are the most common health careeassociated infections in the United States (US), accounting for approximately one-third of all nosocomial infections.1 An estimated 15%-25% of hospitalized patients will have a urinary catheter inserted at some time during hospitalization, suggesting the presence of a large population at risk for
* Address correspondence to Christopher R. Frei, PharmD, MSc, BCPS, University of Texas Health Science Center at San Antonio, Pharmacotherapy Education and Research Center, 7703 Floyd Curl Dr, MSC-6220, San Antonio, TX 78229-3900. E-mail address: [email protected] (C.R. Frei). No funding was obtained for the conduct of this study. K.R.D. is supported by the National Institutes of Health/National Center for Advancing Translational Sciences Loan Repayment Program (1 L30 TR000604-01), an American Foundation for Pharmaceutical Education Fellowship in Clinical Pharmaceutical Sciences, and a University of Texas Continuing Graduate Fellowship. Conflict of interest: C.R.F. has received research grants and/or served as a scientific consultant/advisor for the National Institutes of Health, AstraZeneca, BristolMyers Squibb, Elan, Forest, Ortho McNeil Janssen Pharmaceuticals, and Pfizer. K.R.D. and G.C.L. have no conflicts of interest to disclose.
developing these infections.2,3 CAUTIs are associated with significant morbidity. Approximately 15% of nosocomial bacteremias can be attributed to the urinary tract.4 Other sequelae include prolonged hospital length of stay (LOS) and additional health care costs.5 Furthermore, previous studies have reported an estimated mortality as high as 10% in patients with a CAUTI and concurrent bacteremia.6 The emergence of CAUTIs has prompted clinical and political prevention initiatives in the US. Clinical interventions include implementing infection control programs, limiting catheter use and duration, promoting proper catheter insertion technique, and implementing catheter maintenance bundles.6 Recent political interventions have included public reporting of infection rates and nonreimbursement for health careeassociated infections (HAIs).7 Few studies have described longitudinal and national trends in CAUTIs in the US in recent years, however. The primary objective of this study was to estimate the national incidence of CAUTIs over a 10-year period. Secondary objectives included identifying trends in mortality and hospital LOS in patients with a CAUTI and
0196-6553/$36.00 - Copyright Ó 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajic.2013.06.026
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K.R. Daniels et al. / American Journal of Infection Control 42 (2014) 17-22
identifying risk factors for the development of CAUTIs in catheterized adults. METHODS Data source This study used data from the Centers for Disease Control and Prevention’s (CDC) National Hospital Discharge Survey (NHDS). These annual surveys, conducted by the CDC’s National Center for Health Statistics (NCHS), provide a national probability sample of inpatients discharged from nonfederal short-stay hospitals (average LOS
Contents lists available at ScienceDirect
American Journal of Infection Control
American Journal of Infection Control
journal homepage: www.ajicjournal.org
Major article
Trends in catheter-associated urinary tract infections among a national cohort of hospitalized adults, 2001-2010 Kelly R. Daniels PharmD a, b, Grace C. Lee PharmD a, b, Christopher R. Frei PharmD, MSc a, b, * a b
College of Pharmacy, University of Texas at Austin, Austin, TX Pharmacotherapy Education and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, TX
Key Words: Health care-associated infections Medical device infections Health care epidemiology Population health
Background: Catheter-associated urinary tract infections (CAUTIs) have become a major public health concern in the United States. This study provides national estimates of CAUTI incidence, mortality, and associated hospital length of stay (LOS) over a 10-year period. Methods: This was a retrospective analysis of the National Hospital Discharge Surveys from 2001 to 2010. Adults age 18 years with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure code for urinary catheter placement or other major procedure were included. Urinary tract infections were identified by ICD-9-CM code. Data weights were applied to derive national estimates. Predictors of CAUTI were identified using a logistic regression model. Results: These data represent 70.4 million catheterized patients, 3.8 million of whom developed a CAUTI. The incidence of CAUTIs decreased from 9.4 cases/100 catheterizations in 2001 to 5.3 cases/100 catheterizations in 2010. Mortality in patients with a CAUTI declined from 5.4% in 2001 to 3.7% in 2010. Median (interquartile range [IQR]) hospital LOS also declined, from 9 days (IQR, 5-16 days) in 2001 to 7 days (IQR, 4-12 days) in 2010. Independent predictors of CAUTI included female sex, emergency hospital admission, transfer from another facility, and Medicaid payment (P < .0001 for all variables). Conclusions: The incidence of CAUTIs in US hospitals declined over the study period. Furthermore, patients with these infections experienced lower hospital mortality and shorter hospital LOS. Copyright Ó 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
Catheter-associated urinary tract infections (CAUTIs) are the most common health careeassociated infections in the United States (US), accounting for approximately one-third of all nosocomial infections.1 An estimated 15%-25% of hospitalized patients will have a urinary catheter inserted at some time during hospitalization, suggesting the presence of a large population at risk for
* Address correspondence to Christopher R. Frei, PharmD, MSc, BCPS, University of Texas Health Science Center at San Antonio, Pharmacotherapy Education and Research Center, 7703 Floyd Curl Dr, MSC-6220, San Antonio, TX 78229-3900. E-mail address: [email protected] (C.R. Frei). No funding was obtained for the conduct of this study. K.R.D. is supported by the National Institutes of Health/National Center for Advancing Translational Sciences Loan Repayment Program (1 L30 TR000604-01), an American Foundation for Pharmaceutical Education Fellowship in Clinical Pharmaceutical Sciences, and a University of Texas Continuing Graduate Fellowship. Conflict of interest: C.R.F. has received research grants and/or served as a scientific consultant/advisor for the National Institutes of Health, AstraZeneca, BristolMyers Squibb, Elan, Forest, Ortho McNeil Janssen Pharmaceuticals, and Pfizer. K.R.D. and G.C.L. have no conflicts of interest to disclose.
developing these infections.2,3 CAUTIs are associated with significant morbidity. Approximately 15% of nosocomial bacteremias can be attributed to the urinary tract.4 Other sequelae include prolonged hospital length of stay (LOS) and additional health care costs.5 Furthermore, previous studies have reported an estimated mortality as high as 10% in patients with a CAUTI and concurrent bacteremia.6 The emergence of CAUTIs has prompted clinical and political prevention initiatives in the US. Clinical interventions include implementing infection control programs, limiting catheter use and duration, promoting proper catheter insertion technique, and implementing catheter maintenance bundles.6 Recent political interventions have included public reporting of infection rates and nonreimbursement for health careeassociated infections (HAIs).7 Few studies have described longitudinal and national trends in CAUTIs in the US in recent years, however. The primary objective of this study was to estimate the national incidence of CAUTIs over a 10-year period. Secondary objectives included identifying trends in mortality and hospital LOS in patients with a CAUTI and
0196-6553/$36.00 - Copyright Ó 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajic.2013.06.026
18
K.R. Daniels et al. / American Journal of Infection Control 42 (2014) 17-22
identifying risk factors for the development of CAUTIs in catheterized adults. METHODS Data source This study used data from the Centers for Disease Control and Prevention’s (CDC) National Hospital Discharge Survey (NHDS). These annual surveys, conducted by the CDC’s National Center for Health Statistics (NCHS), provide a national probability sample of inpatients discharged from nonfederal short-stay hospitals (average LOS
