Exposure to urinary catheters is considered the most important risk factor for healthcare-associated urinary tract infection (UTI) and is associated with significant morbidity and substantial extra-costs. Uçkay, et al. (2013) assessed the impact of urinary catheterization (UC) on symptomatic healthcare-associated UTI among hospitalized patients.
A nationwide period prevalence survey of healthcare-associated infections was conducted during May 1 to June 30, 2004 in 49 Swiss hospitals and included 8,169 adult patients (4313 female; 52.8 percent) hospitalized in medical, surgical, intermediate and intensive care wards. Additional data were collected on exposure to UC to investigate factors associated with UTI among hospitalized adult patients exposed and non-exposed to UC.
Results show that 1,917 (23.5 percent) patients were exposed to UC within the week prior to survey day; 126 (126/8169; 1.5 percent) developed UTI. Exposure to UC preceded UTI only in 73 cases (58 percent). By multivariate logistic regression analysis, UTI was independently associated with exposure to UC (odds ratio [OR], 3.9 [95% CI, 2.6-5.9]), female gender (OR, 2.1 [95% CI, 1.4-3.1]), an American Society of Anesthesiologists' score > 2 points (OR, 3.2 [95% CI, 1.1-9.4], and prolonged hospital stay >20 days (OR, 1.9 [95% CI, 1.4-3.2]. Further analysis showed that the only significant factor for UTI with exposure to UC use was prolonged hospital stay >40 days (OR, 2.9 [95% CI, 1.3-6.1], while female gender only showed a tendency (OR, 1.6 [95% CI, 1.0-2.7]. In the absence of exposure to UC, the only significant risk factor for UTI was female gender (OR, 3.3 [95% CI, 1.7-6.5]).
The researchers conclude that exposure to UC was the most important risk factor for symptomatic healthcare-associated UTI, but only concerned about half of all patients with UTI. Further investigation is warranted to improve overall infection control strategies for UTI. Their research was published in Antimicrobial Resistance and Infection Control.
Reference: Uçkay I, Sax H, et al. High proportion of healthcare-associated urinary tract infection in the absence of prior exposure to urinary catheter: a cross-sectional study. Antimicrobial Resistance and Infection Control 2013, 2:5 doi:10.1186/2047-2994-2-5