Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-23T13:41:44.940Z Has data issue: false hasContentIssue false
  • English
  • Français

Does Catheter-Associated Urinary Tract Infection Increase Mortality in Critically Ill Patients?

Published online by Cambridge University Press:  02 January 2015

Christophe Clec'h ,
Carole Schwebel ,
Adrien Français ,
Dany Toledano ,
Jean-Philippe Fosse ,
Maïté Garrouste-Orgeas ,
Elie Azoulay ,
Christophe Adrie ,
Samir Jamali  and
Adrien Descorps-Declere
...Show all authors
Christophe Clec'h
Affiliation:
Medical-Surgical Intensive Care Unit (ICU), Avicenne Teaching Hospital, Bobigny, Grenoble Department of Epidemiology, INSERM/UJF U 823, Grenoble
Carole Schwebel
Affiliation:
Medical ICU, Albert Michallon Teaching Hospital, Grenoble
Adrien Français
Affiliation:
Department of Epidemiology, INSERM/UJF U 823, Grenoble
Dany Toledano
Affiliation:
Medical ICU, Hospital of Gonesse, Gonesse
Jean-Philippe Fosse
Affiliation:
Medical-Surgical Intensive Care Unit (ICU), Avicenne Teaching Hospital, Bobigny, Grenoble
Maïté Garrouste-Orgeas
Affiliation:
Medical ICU, Saint-Joseph Hospital, Paris
Elie Azoulay
Affiliation:
Medical ICU, Saint-Louis Teaching Hospital, Paris
Christophe Adrie
Affiliation:
Medical ICU, Delafontaine Hospital, Saint-Denis
Samir Jamali
Affiliation:
Medical-Surgical ICU, Hospital of Dourdan, Dourdan
Adrien Descorps-Declere
Affiliation:
Surgical ICU, Antoine Beclere Teaching Hospital, Clamart, France
Didier Nakache
Affiliation:
Conservatoire National des Arts et Métiers, Paris
Jean-François Timsit
Affiliation:
Medical ICU, Albert Michallon Teaching Hospital, Grenoble Department of Epidemiology, INSERM/UJF U 823, Grenoble
Yves Cohen*
Affiliation:
Medical-Surgical Intensive Care Unit (ICU), Avicenne Teaching Hospital, Bobigny, Grenoble
*
Service de Réanimation, Hôpital Avicenne, 125, route de Stalingrad 93009 Bobigny Cedex, France ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To produce an accurate estimate of the association between catheter-associated urinary tract infection (UTI) and intensive care unit (ICU) and hospital mortality, controlling for major confounding factors.

Design.

Nested case-control study in a multicenter cohort (the OutcomeRea database).

Setting.

Twelve French medical or surgical ICUs.

Methods.

All patients admitted between January 1997 and August 2005 who required the insertion of an indwelling urinary catheter. Patients who developed catheter-associated UTI (ie, case patients) were matched to control patients on the basis of the following criteria: sex, age ( ± 10 years), SAPS (Simplified Acute Physiology Score) II score ( ± 10 points), duration of urinary tract catheterization, and presence or absence of diabetes mellitus. The association of catheter-associated UTI with ICU and hospital mortality was assessed by use of conditional logistic regression.

Results.

Of the 3,281 patients who had an indwelling urinary catheter, 298 (9%) developed at least 1 episode of catheter-associated UTI. The incidence density of catheter-associated UTI was 12.9 infections per 1,000 catheterization-days. Crude ICU mortality rates were higher among patients with catheter-associated UTI, compared with those without catheter-associated UTI (32% vs 25%, P = .02); the same was true for crude hospital mortality rates (43% vs 30%, P>.01). After matching and adjustment, catheter-associated UTI was no longer associated with increased mortality (ICU mortality: odds ratio [OR], 0.846 [95% confidence interval {CI}, 0.659-1.086]; P = .19 and hospital mortality: OR, 0.949 [95% CI, 0.763-1.181]; P = .64).

Conclusion.

After carefully controlling for confounding factors, catheter-associated UTI was not found to be associated with excess mortality among our population of critically ill patients in either the ICU or the hospital.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 12 , December 2007 , pp. 1367 - 1373
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Eriksen, HM, Iversen, BG, Aavitsland, P. Prevalence of nosocomial infections in hospitals in Norway, 2002 and 2003. J Hosp Infect 2005;60 40–45CrossRefGoogle ScholarPubMed
2.Lizioli, A, Privitera, G, Alliata, E, et al. Prevalence of nosocomial infections in Italy: result from the Lombardy survey in 2000. J Hosp Infect 2003;54:141–148.CrossRefGoogle ScholarPubMed
3.Richards, MJ, Edwards, JR, Culver, DH, Gaynes, RP. Nosocomial infections in combined medical-surgical intensive care units in the United States. Infect Control Hosp Epidemiol 2000;21:510–515.CrossRefGoogle ScholarPubMed
4.Vincent, JL, Bihari, DJ, Suter, PM, et al. The prevalence of nosocomial infection in intensive care units in Europe: results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA 1995;274:639–644.Google Scholar
5.Piatt, R, Polk, BF, Murdock, B, Rosner, B. Mortality associated with nosocomial urinary-tract infection. N Engl J Med 1982;307:637–642.Google Scholar
6.Rosenthal, VD, Guzman, S, Orellano, PW. Nosocomial infections in medical-surgical intensive care units in Argentina: attributable mortality and length of stay. Am J Infect Control 2003;31:291–295.CrossRefGoogle ScholarPubMed
7.Vosylius, S, Sipylaite, J, Ivaskevicius, J. Intensive care unit-acquired infection: a prevalence and impact on morbidity and mortality. Acta Anaesthesiol Scand 2003;47:1132–1137.Google Scholar
8.Garcia-Martin, M, Lardelli-Claret, P, Jimenez-Moleon, JJ, Bueno-Cavanillas, A, Luna-del-Castillo, JD, Galvez-Vargas, R. Proportion of hospital deaths potentially attributable to nosocomial infection. Infect Control Hosp Epidemiol 2001;22:708–714.Google Scholar
9.Laupland, KB, Bagshaw, SM, Gregson, DB, Kirkpatrick, AW, Ross, T, Church, DL. Intensive care unit-acquired urinary tract infections in a regional critical care system. Crit Care 2005;9:R60–R65.Google Scholar
10.Tambyah, PA, Maki, DG. Catheter-associated urinary tract infection is rarely symptomatic: a prospective study of 1,497 catheterized patients. Arch Intern Med 2000;160:678–682.Google Scholar
11.Maki, DG, Tambyah, PA. Engineering out the risk for infection with urinary catheters. Emerg Infect Dis 2001;7:342–347.Google Scholar
12.Mnatzaganian, G, Galai, N, Sprung, CL, et al. Increased risk of bloodstream and urinary infections in intensive care unit (ICU) patients compared with patients fitting ICU admission criteria treated in regular wards. J Hosp Infect 2005;59:331–342.CrossRefGoogle ScholarPubMed
13.Garibaldi, RA, Mooney, BR, Epstein, BJ, Britt, MR. An evaluation of daily bacteriologie monitoring to identify preventable episodes of catheter-associated urinary tract infection. Infect Control 1982;3:466–470.Google Scholar
14.Laupland, KB, Zygun, DA, Davies, HD, Church, DL, Louie, TJ, Doig, CJ. Incidence and risk factors for acquiring nosocomial urinary tract infection in the critically ill. J Crit Care 2002;17:50–57.CrossRefGoogle ScholarPubMed
15.Leone, M, Albanese, J, Gamier, F, et al. Risk factors of nosocomial catheter-associated urinary tract infection in a polyvalent intensive care unit. Intensive Care Med 2003;29:1077–1080.Google Scholar
16.Shapiro, M, Simchen, E, Izraeli, S, Sacks, TG. A multivariate analysis of risk factors for acquiring bacteriuria in patients with indwelling urinary catheters for longer than 24 hours. Infect Control 1984;5:525–532.Google Scholar
17.Tissot, E, Limat, S, Cornette, C, Capellier, G. Risk factors for catheter-associated bacteriuria in a medical intensive care unit. Eur J Clin Microbiol Infect Dis 2001;20:260–262.Google Scholar
18. OutcomeRea. Available at: http://www.outcomerea.org/index.php/documents/56-epidemiologie-biostatistiques/75-datamining-et-bases-de -donnees/voir-categorie.html. Accessed October 22, 2007.Google Scholar
19.McCabe, WJ, GG, . Gram-negative bacteremia. I. Etiology and ecology. Arch Intern Med 1962;110:847–855.CrossRefGoogle Scholar
20.Knaus, WA, Draper, EA, Wagner, DP, Zimmerman, JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818–829.CrossRefGoogle ScholarPubMed
21.Le Gall, JR, Lemeshow, S, Saulnier, F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 1993;270:2957–2963.Google Scholar
22.Vincent, JL, Moreno, R, Takala, J, et al. The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996;22:707–710.Google Scholar
23.Le Gall, JR, Klar, J, Lemeshow, S, et al. The logistic organ dysfunction system: a new way to assess organ dysfunction in the intensive care unit. ICU Scoring Group. JAMA 1996;276:802–810.CrossRefGoogle ScholarPubMed
24.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.Google Scholar
25.Dettenkofer, M, Ebner, W, Els, T, et al. Surveillance of nosocomial infections in a neurology intensive care unit. J Neurol 2001;248:959–964.Google Scholar
26.Rosenthal, VD, Guzman, S, Crnich, C. Device-associated nosocomial infection rates in intensive care units of Argentina. Infect Control Hosp Epidemiol 2004;25:251–255.Google Scholar
27.Rosser, CJ, Bare, RL, Meredith, JW. Urinary tract infections in the critically ill patient with a urinary catheter. Am J Surg 1999;177:287–290.CrossRefGoogle ScholarPubMed
28.Alvarez-Lerma, F, Nolla-Salas, J, Leon, C, et al. Candiduria in critically ill patients admitted to intensive care medical units. Intensive Care Med 2003;29:1069–1076.Google Scholar