Antimicrobial Resistance and Infection Control | |
High proportion of healthcare-associated urinary tract infection in the absence of prior exposure to urinary catheter: a cross-sectional study | |
Ilker Uçkay9  Hugo Sax2  Angèle Gayet-Ageron4  Christian Ruef3  Kathrin Mühlemann1  Nicolas Troillet6  Christiane Petignat10  Enos Bernasconi8  Carlo Balmelli10  Andreas Widmer5  Karim Boubaker7  Didier Pittet9  | |
[1] Department of Infectious Diseases, University Hospital Bern, Bern, Switzerland | |
[2] Current addresses: Department of Infectious Diseases and Hospital Hygiene, University of Zurich, Zurich, Switzerland | |
[3] Division of Infectious Diseases, University Hospital of Zurich, Zurich, Switzerland | |
[4] Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland | |
[5] Division of Infectious Diseases, University of Basel Hospitals, Basel, Switzerland | |
[6] Department of Infectious Diseases, Central Institute of the Valais Hospitals, Sion, Switzerland | |
[7] Current addresses: Public Health Service for the Canton of Vaud, Lausanne, Switzerland | |
[8] Department of Infectious Diseases, Ospedale Civico, Lugano, Switzerland | |
[9] Department of Infectious Diseases, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland | |
[10] Department of Hospital Preventive Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland | |
关键词: Risk factors; Nosocomial; Urinary tract infection; Acute care; Urinary catheter; Prevalence; | |
Others : 790955 DOI : 10.1186/2047-2994-2-5 |
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received in 2012-10-09, accepted in 2013-01-14, 发布年份 2013 | |
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【 摘 要 】
Background
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. In this study, we assessed the impact of urinary catheterisation (UC) on symptomatic healthcare-associated UTI among hospitalized patients.
Methods
A nationwide period prevalence survey of healthcare-associated infections was conducted during 1 May to 30 June 2004 in 49 Swiss hospitals and included 8169 adult patients (4313 female; 52.8%) hospitalised in medical, surgical, intermediate, and intensive care wards. Additional data were collected on exposure to UC to investigate factors associated with UTI among hospitalised adult patients exposed and non-exposed to UC.
Results
1917 (23.5%) patients were exposed to UC within the week prior to survey day; 126 (126/8169; 1.5%) developed UTI. Exposure to UC preceded UTI only in 73 cases (58%). 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]).
Conclusions
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.
【 授权许可】
2013 Uçkay et al; licensee BioMed Central Ltd.
【 预 览 】
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【 参考文献 】
- [1]Nicolle LE: Urinary tract infection in long-term-care facility residents. Clin Infect Dis 2000, 31:757-761.
- [2]Eriksen HM, Iversen BG, Aavitsland P: Prevalence of nosocomial infections in hospitals in Norway, 2002 and 2003. J Hosp Infect 2005, 60:40-45.
- [3]Maki DG, Tambyah PA: Engineering out the risk for infection with urinary catheters. Emerg Infect Dis 2001, 7:342-347.
- [4]Bouza E, San Juan R, Muñoz P, Voss A, Kluytmans J: Co-operative Group of the European Study Group on Nosocomial Infections II: A European perspective on nosocomial urinary tract infections I. Clin Microbiol Infect 2001, 7:532-542.
- [5]Wald H, Epstein A, Kramer A: Extended use of indwelling urinary catheters in postoperative hip fracture patients. Med Care 2005, 43:1009-1017.
- [6]Foxman B: Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Dis Mon 2003, 49:53-70.
- [7]Tambyah PA, Knasinski V, Maki DG: The direct costs of nosocomial catheter-associated urinary tract infection in the era of managed care. Infect Control Hosp Epidemiol 2002, 23:27-31.
- [8]Gardam MA, Amihod B, Orenstein P, Consolacion N, Miller MA: Overutilization of indwelling urinary catheters and the development of nosocomial urinary tract infections. Clin Perform Qual Health Care 1998, 6:99-102.
- [9]Pittet D, Harbarth S, Ruef C, Francioli P, Sudre P, Pétignat C, Trampuz A, Widmer A: Prevalence and risk factors for nosocomial infections in four university hospitals in Switzerland. Infect Control Hosp Epidemiol 1999, 20:37-42.
- [10]Sax H, Hugonnet S, Harbarth S, Herrault P, Pittet D: Variation in nosocomial infection prevalence according to patient care setting: a hospital-wide survey. J Hosp Infect 2001, 48:27-32.
- [11]Sax H, Swiss-NOSO: Nationwide surveillance of nosocomial infections in Switzerland–methods and results of the Swiss Nosocomial Infection Prevalence Studies (SNIP) in 1999 and 2002. Ther Umsch 2004, 61:197-203.
- [12]Sax H, Pittet D, Swiss-NOSO Network: Interhospital differences in nosocomial infection rates: importance of case-mix adjustment. Arch Intern Med 2002, 162:2437-2442.
- [13]Owens WD, Felts JA, Spitznagel EL Jr: ASA physical status classifications: a study of consistency of ratings. Anesthesiology 1978, 49:239-243.
- [14]McCabe WR, Jackson GG: Gram negative bacteremia I: etiology and ecology. Arch Intern Med 1962, 110:847-855.
- [15]Charlson ME, Pompei P, Ales KL, MacKenzie CR: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987, 40:373-383.
- [16]Lambert P, Major L, Saint-Onge E, Saulnier D, Tilquin C, Vanderstraeten G: L'intégration de la planification des soins et de la mesure de la charge de travail au service des démarches scientifiques du soignant et du gestionnaire: la méthode PRN. In Les systèmes de mesure de la charge de travail en soins infirmiers. Edited by Thibault C. Montréal, Canada: Association des Hôpitaux du Québec; 1990:189-194.
- [17]Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM: CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988, 16:128-140.
- [18]Warren JW: Catheter-associated urinary tract infections. Int J Antimicrob Agents 2001, 17:299-303.
- [19]Jepsen OB, Larsen SO, Dankert J, Daschner F, Grönroos P, Meers PD, Nyström B, Sander J: Urinary-tract infection and bacteraemia in hospitalized medical patients - a European multicentre prevalence survey on nosocomial infection. J Hosp Infect 1982, 3:241-252.
- [20]Moro ML, Stazi MA, Marasca G, Greco D, Zampieri A: National prevalence survey of hospital-acquired infections in Italy, 1983. J Hosp Infect 1986, 8:72-85.
- [21]Mertens R, Kegels G, Stroobant A, Reybrouck G, Lamotte JM, Potvliege C, Van Casteren V, Lauwers S, Verschraegen S, Wauters G: The national prevalence survey of nosocomial infections in Belgium, 1984. J Hosp Infect 1987, 9:219-229.
- [22]Srámova H, Bartonova A, Bolek S, Krecmerova M, Subertova V: National prevalence survey of hospital-acquired infections in Czechoslovakia. J Hosp Infect 1988, 11:328-334.
- [23]Emmerson AM, Enstone JE, Griffin M, Kelsey MC, Smyth ET: The Second National Prevalence Survey of infection in hospitals-overview of the results. J Hosp Infect 1996, 32:175-190.
- [24]Gastmeier P, Kampf G, Wischnewski N, Schumacher M, Daschner F, Rüden H: Importance of the surveillance method: national prevalence studies on nosocomial infections and the limits of comparison. Infect Control Hosp Epidemiol 1999, 20:124-127.
- [25]Scheel O, Stormark M: National prevalence survey on hospital infections in Norway. J Hosp Infect 1999, 41:331-335.
- [26]Vaqué J, Rossello J, Arribas JL: Prevalence of nosocomial infections in Spain: EPINE study 1990–1997. J Hosp Infect 1999, 43:105-111.
- [27]The French Prevalence Group: Prevalence of nosocomial infections in France: results of the nationwide survey in 1996. J Hosp Infect 2000, 46:186-193.
- [28]Gikas A, Pediaditis J, Papadakis JA, Starakis J, Levidiotou S, Nikolaides P, Kioumis G, Maltezos E, Lazanas M, Anevlavis E, Roubelaki M, Tselentis Y, Greek Infection Control Network: Prevalence study of hospital-acquired infections in 14 Greek hospitals: planning from the local to the national surveillance level. J Hosp Infect 2002, 50:269-275.
- [29]Lizioli A, Privitera G, Alliata E, Antonietta Banfi EM, Boselli L, Panceri ML, Perna MC, Porretta AD, Santini MG, Carreri V: Prevalence of nosocomial infections in Italy: result from the Lombardy survey in 2000. J Hosp Infect 2003, 54:141-148.
- [30]Klavs I, Bufon Luznik T, Skerl M, Grgic-Vitek M, Lejko Zupanc T, Dolinsek M, Prodan V, Vegnuti M, Kraigher A, Arnez Z: Slovenian Hospital-Acquired Infections Survey Group: Prevalence of and risk factors for hospital-acquired infections in Slovenia - results of the first national survey, 2001. J Hosp Infect 2003, 54:149-157.
- [31]Nicastri E, Petrosillo N, Martini L, Larosa M, Gesu GP, Ippolito G: Prevalence of nosocomial infections in 15 Italian hospitals: first point prevalence study for the INF-NOS project. Infection 2003, 31:10-15.
- [32]Tammelin A: Urinary catheters and antibiotic treatment, Guidelines adherence could be better. Lakartidningen 2005, 102:378-381.
- [33]Gravel D, Taylor G, Ofner M, Johnston L, Loeb M, Roth VR, Stegenga J, Bryce E: Canadian Nosocomial Infection Surveillance Program, Matlow A: Point prevalence survey for healthcare-associated infections within Canadian adult acute-care hospitals. J Hosp Infect 2007, 66:243-248.
- [34]Hopmans TE, Blok HE, Troelstra A, Bonten MJ: Prevalence of hospital-acquired infections during successive surveillance surveys conducted at a university hospital in the Netherlands. Infect Control Hosp Epidemiol 2007, 28:459-465.
- [35]Klevens RM, Edwards JR, Richards CL Jr, Horan TC, Gaynes RP, Pollock DA, Cardo DM: Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep 2007, 122:160-166.
- [36]Pellizzer G, Mantoan P, Timillero L, Allegranzi B, Fedeli U, Schievano E, Benedetti P, Saia M, Sax H, Spolaore P: Prevalence and risk factors for nosocomial infections in hospitals of the Veneto region, north-eastern Italy. Infection 2008, 36:112-119.
- [37]van den Broek PJ, Wille JC, van Benthem BH, Perenboom RJ, van den Akker-van Marle ME, Niël-Weise BS: Urethral catheters: can we reduce use? BMC Urol 2011, 11:10. BioMed Central Full Text
- [38]Cairns S, Reilly J, Stewart S, Tolson D, Godwin J, Knight P: The prevalence of health care-associated infection in older people in acute care hospitals. Infect Control Hosp Epidemiol 2011, 32:763-767.
- [39]Cotter M, Donlon S, Roche F, Byrne H, Fitzpatrick F: Healthcare-associated infection in Irish long-term care facilities: results from the First National Prevalence Study. J Hosp Infect 2012, 80:212-216.
- [40]Askarian M, Yadollahi M, Assadian O: Point prevalence and risk factors of hospital acquired infections in a cluster of university-affiliated hospitals in Shiraz Iran. J Infect Public Health 2012, 5:169-176.
- [41]Hopkins S, Shaw K, Simpson L: English national point prevalence survey on healthcare-associated infections and antimicrobial use. London, UK: Health ProtectionAgency; 2011. http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317134304594 webcite
- [42]Kyrklund K, Taskinen S, Rintala RJ, Pakarinen MP: Lower urinary tract symptoms from childhood to adulthood: A population bases study of 594 Finnish individuals 4 to 26 years old. J Urol 2012, 188:588-593.
- [43]Malmsten UGH, Milsom I, Molander U, Norlen LJ: Urinary incontinence and lower urinary tract symptoms: an epidemiological study of men aged 45 to 99 years. J Urol 1997, 158:1733-1737.
- [44]Al-Rubeaan KA, Moharrem O, Al-Naqeb D, Hassan A, Rafiullah MRM: Prevalence of urinary tract infection and risk factors among Saudi patients with diabetes. World J Urol 2012.
- [45]Garibaldi RA, Mooney BR, Epstein BJ, Britt MR: An evaluation of daily bacteriologic monitoring to identify preventable episodes of catheter-associated urinary tract infection. Infect Control 1982, 3:466-70.
- [46]Vieira FA: Nursing actions to prevent urinary tract infection associated with long-standing bladder catheter. Einstein 2009, 7:372-375.
- [47]Stéphan F, Sax H, Wachsmuth M, Hoffmeyer P, Clergue F, Pittet D: Reduction of urinary tract infection and antibiotic use after surgery: a controlled, prospective, before-after intervention study. Clin Infect Dis 2006, 42:1544-1551.
- [48]Slade N: Postoperative urinary tract infections in urology and gynaecology: a review. J R Soc Med 1980, 3:739-743.
- [49]Newman DK, Willson MM: Review of intermittent catheterization and current best practices. Urologic Nurs 2011, 31:12-28.
- [50]Wyndaele JJ: Complications of intermittent catheterization: their prevention and treatment. Spinal Cord 2002, 40:536-541.