Castro, J

Gorgulho, A

Grilo, A

Lobão, MJ

Sepúlveda, C

Sousa, P

Taborda, AL

Taborda, F

English

Repositório Comum

Catheter-associated urinary tract infec2on in medical pa2ents of a Portuguese hospital: incidence and risk factors1 Internal Medicine Department, Hospital de Cascais, 2 National School of Public Health, NOVA University of LisbonReferencesMaria João Lobão1,2, Ana Lúcia Taborda1, Ana Grilo1, Carolina Sepúlveda1, Filipa Taborda1, Jorge Castro1, Ana Gorgulho1, Paulo Sousa2BackgroundDiscussion and ConclusionsMethodsResultsCatheter-associated urinary tract infections (CAUTI) are frequent and preventable hospital-acquired infections, which often result in patient morbidity and mortality as well as high costsfor healthcare systems.1-4Portugal is one of the EU countries with higher prevalence of Hospital-Acquired infections (HAI).5-6Although CAUTI represents one of the most frequent HAIin general wards, the epidemiological data available in our country about it is scarce which turns difficult to better understand and characterize these infectious events and developtargeted measures to prevent it.With this study we aimed to estimate incidence, to identify risk factors and to evaluate the impact of CAUTI in intra-hospital mortality and length of stay of medical patients admitted toan internal medicine department of a Portuguese hospital.A prospective cohort study was conducted in an Internal medicine department of a Portuguese Hospital (93-beds) from October 2017 to June 2018. This hospital has an accreditationin Quality and Patient Safety since 2012. All patients with chronic bladder catheters or submitted to the procedure during the admission episode were considered eligible. We excludedall patients with UTI at admission.We analysed variables related to the patient (age, sex, age adjusted Charlson comorbidity Index7), admission episode (type, local, principal diagnosis according to ICD-10), bladdercatheter (type, local where the procedure was done, indications, catheters-days) and outcome (CAUTI, in-hospital mortality and length of stay). For infection definition we used CAUTICDC definitions and metrics.8,9 Risk factors identification was performed using Binary Logistic Regression. To analyse CAUTI association with Length of Stay (LOS) and mortality, weused Mann-Whitney U and Qui-Square test, respectively.10 A p-value < 0.05 was considered statistically significant. Statistical analysis was performed with SPSS IBM® StatisticsSoftware (24th version). The study was approved by the Institutional Review Board.Figure 2 Diagram of CAUTI, LOS and in-hospital death distribution Urinary catheter utilization ratio: 13,9%(2997 catheter-days/21553 hospital-days) Incidence density rate: 5,7/1000 catheter-days ((17 CAUTI/2997 catheter-days)*1000))Figure 1 Diagram of inclusion of patients in the study Bivariate Analysis12Multivariate Analysis4Cumulative incidence rate: 6,4%3Legend: OR: Odds ra-o; CI:  Confidence interval; a) adjustment for age only; b) adjustment for sex onlyLegend: OR – Odds Ra-o; 95% IC OR - Confidence Interval for Odds Ra-o; p - value, Wald TestThe variables with significant p-value on the bivariate analysis were all ini-ally introduced in the model (admission type, LOS, Type of bladder catheter, bladder catheteriza-on days). In this cohort the only independent risk factor for CAUTI is the number of catheter-days. The risk to develop a CAUTI is 6% for each day of bladder catheteriza=on. In this study we have found a high11,12 CAUTI rate per 1000 catheters-day which undersores the importance of directed mulAdisciplinary programs to improve compliance to good pracAces in orderto reduce this avoidable nosocomial infecAon. Taking into account the urinary catheter uAlizaAon rate we found it seems clear that there is a need to improve bladder catheterizaAon bundles in thisdepartment.. As the only independent risk factor idenAfied in this cohort was the number of catheter-days, it is very important to consider the early remove of the device as fundamental part ofCAUTI prevenAon strategy in this case. We didn´t found any associaAon between CAUTI end LOS and in-hospital death, but further studies are needed to beIer address this issue.1. Al-Tawfiq JA, Tambyah PA. Healthcare associated infecLons (HAI) perspecLves. J Infect Public Health. 2014; 7(4):339–44. 2.Magill SS, Edwards JR, Bamberg W, Beldavs ZG, DumyaL G, Kainer MA, et al. MulLstate Point-Prevalence Survey of Health Care–Associated InfecLons. N Engl J Med. 2014;370(13):1198–208. 3. Zimlichman E, Henderson D, Tamir O, Franz C, Song P, Yamin CK, et al. Health Care–Associated InfecLons. JAMA Intern Med. 2013;173(22):2039. 4. Rahmqvist M, Samuelsson A, Bastami S, Rutberg H. Direct health care costs and length of hospital stay related to health care-acquired infecLons in adult paLents based on point prevalence measurements. Am J Infect Control. 2016;44(5):500–6. 5. Suetens C. Point prevalence survey of healthcare-associated infecLons and anLmicrobial use in European acute care hospitals [Internet]. ECDC Eurosurveillance report. 2013 [cited 2019 Feb 22]. 1-109 p. Available from: www.ecdc.europa.eu. 6. Ana Isabel Lebre, Adelaide Alves, Ana Maria Félix, Duarte Tavares, Elena Noriega, Isabel Neves, Margarida Valente, Maria GoreL Silva, Maria João Faria NP e PP. Infeções e aos AnLmicrobianos.[internet] PPCIRA 2018 [cited 2019 Feb 22] Available from: hnps://webcache.googleusercontent.com/search?q=cache:Z6qfN-_UMzkJ:hnps://www.dgs.pt/portal-da-estaLsLca-da-saude/diretorio-de-informacao/diretorio-de-informacao/por-serie-1003038-pdf.aspx%3Fv%3D11736b14-73e6-4b34-a8e8-d22502108547+&cd=1&hl=en&ct=clnk& 7.Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognosLc comorbidity in longitudinal studies: development and validaLon. J Chronic Dis. 1987;40(5):373–83. 8. Gould C V, Umscheid CA, Rajender, Agarwal K, Kuntz G, Pegues DA. Guideline for PrevenLon of Catheter-Associated Urinary Tract InfecLons (2009). Infect Control Hosp Epidemiol 2010; 31: 319-26.9. CDC. NaLonal Healthcare Safety Network (NHSN) PaLent Safety Component Manual [Internet]. 2017 [cited 2019 Feb 15]. Available from: www.cdc.gov/nhsn/PDFs/HPS-manual/HPS_Manual-exp-plus-flu-porxolio.pdf. 10 Aguiar P. EstaysLca em InvesLgação Epidemiológica: SPSS. Guia práLco de Medicina. First. Climepsi, editor. Lisboa; 2007. 237 p. 11. Saint S, Greene MT, Krein SL, Rogers MAM, Ratz D, Fowler KE, et al. A Program to Prevent Catheter-Associated Urinary Tract InfecLon in Acute Care. N Engl J Med. 2016; 374(22):2111–9.  12. Davies PE, Daley MJ, Hecht J, Hobbs A, Burger C, Watkins L, et al. EffecLveness of a bundled approach to reduce urinary catheters and infecLon rates in trauma paLents. Am J Infect Control. 2018;46(7):758–63. 

Catheter-associated urinary tract infection in medical patients of a Portuguese hospital: incidence and risk factors

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Catheter-associated urinary tract infection in medical patients of a Portuguese hospital: incidence and risk factors

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