Background: Catheter-associated urinary tract infections (CA-UTIs) account for 40 percent of nosocomial infections worldwide. Their elimination is at the forefront of quality improvement in one South Texas acute care hospital.
Methods: Over a period of 6 months, five CA-UTIs occurred in one South Texas acute care hospital. These cases were identified via regular surveillance by Infection Prevention staff and the Laboratory Department of the hospital. This research reviews patient age, sex, length of stay, bacteria contracted, appropriate antibiotic use, patient characteristics, and overall outcomes.
Results: Between the months of July and December 2021, 5 CAUTIs were contracted. Patients ranged in age from 44 to 71 years old with a mean age of 68.8 years old; 2 were male and 3 were female; the average length of stay ranged from 19 to 59 days with an average stay of 32.2 days. All patients had severe illness on presentation and multiple comorbidities. Organisms isolated included klebsiella oxytoca, carbapenem-resistant Enterobacteriaceae, extended-spectrum beta-lactamase E. coli and klebsiella pneumoniae. Susceptibility studies were conducted on all 5 patients. Antibiotics used include piperacillin-tazobactam, ceftriaxone, levofloxacin, and meropenem. CAUTIs resolved in 4 patients; two of them were discharged to skilled nursing facilities, one was discharged home, and one died due to complications from COVID-19.
Conclusions: Among these cases, factors such as local rates of COVID-19 cases (the cases happened when hospital census was unusually high), extended length of stay, use of mechanical ventilation, Foley catheter placement in the Emergency Department, severe illness, and comorbid health conditions should be considered when assessing risk of CA-UTI and treatment outcome. While antibiotics that were prescribed appropriately corresponded with sensitivity studies, sustainability of infection prevention processes for the prevention of CA-UTIs is difficult to sustain during periods of crisis as exemplified in this project
