Exploring the Bottom of the Iceberg - Analyzing Non-CAUTI Hospital-onset UTIs

Session Description: In 2002, Urinary tract infections (UTIs) were the most common healthcare-associated infection (HAI) accounting for 36 percent of all HAIs. Today, catheter-associated urinary tract infections (CAUTIs) are the fifth most common HAI after pneumonia, gastrointestinal infections, surgical site infections, and bloodstream infections. The relative decline in the contribution of UTIs, to the overall challenge of HAIs, is the result of intense focus on prevention strategies but also a result of two definitional changes in 2009 and 2015. Some researchers have observed that in spite of aggressive CAUTI prevention measures, the most recent definition change appears to bear primary responsibility for decreases in CAUTI rates.

With a relentless focus on CAUTI, but also a sense that some UTIs may escape classification, a question emerges: “Is there is a bottom to the ‘CAUTI iceberg?’” Can we characterize those hospital-onset UTIs that do not meet the CAUTI definition? This presentation will present the results of a 43-hospital retrospective observational analysis. A definition for non-CAUTI hospital-onset UTI was developed requiring both a positive urine culture and an order for an appropriate antimicrobial. The results of that analysis will be presented and will include the prevalence of the non-CAUTI hospital-onset UTIs, the attributable cost of those infections, and their contribution to secondary bloodstream infections.

This presentation will inform attendees of the presence of treated infections that may not be part of conventional reporting initiatives. In addition, infection preventionists who are likely to begin to enlarge their focus from central line-associated bloodstream infections (CLABSIs), to the broader category of hospital-onset bacteremia and fungemia (HOB), may be well-served by an understanding the potential contribution of non-CAUTI hospital-onset UTIs. The hospital locations where bloodstream infections, secondary to both CAUTI and non-CAUTI hospital-onset UTI, will be examined so as to advise mitigation efforts.