ISR 87 - Timing of Catheter-associated Urinary Tract Infections (CAUTIs) and Non-cauti Hospital-onset Urinary Tract Infections – Implications for Mitigating Infection Risk

Background: Catheter-associated urinary tract infections (CAUTIs) are one of the most common hospital-acquired infections (HAIs). Sometimes overlooked when focusing on quality reporting programs are those hospital-onset urinary tract infections (HOUTIs) not meeting the CAUTI definition. The frequency of CAUTI is well-understood from point prevalence analyses, however, the prevalence of non-CAUTI HOUTIs is not, neither is the timing of the presentation of these infections.

Methods: A retrospective real-world analysis was conducted using de-identified data from adult inpatients admitted to 41 hospitals between October 2015 and June 2019. Patients < 18 years, admitted for an infection, presenting with another HAI, and/or having a stay of < 2 days were excluded. HOUTIs were algorithmically identified from positive, non-contaminated urine cultures. CAUTIs were confirmed by hospital infection preventionists. For this analysis, all CAUTIs and non-CAUTI HOUTIs also had an antimicrobial, consistent with the urinary pathogen, ordered ±2 days of the positive urine culture. The times from admission to collection of the specimen yielding the positive culture were analyzed based on type of infection, sex, and patient location.

Results: 205 CAUTIs and 1,056 non-CAUTI HOUTIs were observed in male patients in the analysis sample. For females, the values were 229 and 2,121, respectively. By hospital day 5, 55(27%) CAUTIs and 407(39%) non-CAUTI HOUTIs had presented in males, similarly, 83(36%) CAUTIs and 989(47%) non-CAUTI HOUTIs had presented in females. 203(47%) of the CAUTI specimens, and 2,487(78%) of the non-CAUTI HOUTI specimens, were collected outside the intensive care unit (ICU).

Conclusions: Non-CAUTI HOUTIs are more prevalent than are CAUTIs. Non-CAUTI HOUTIs present earlier during a patient's course of care. Both CAUTIs and non-CAUTI HOUTIs present sooner in females. Almost half of CAUTIs and three-quarters of non-CAUTI HOUTIs present outside the ICU. Infection prevention efforts – particularly those aimed at mitigating non-CAUTI HOUTIs – should begin early and focus beyond the ICU.