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Infect Control Hosp Epidemiol. 2019 Sep 2:1-6. doi: 10.1017/ice.2019.241. [Epub ahead of print]

Incidence and risk factors of non-device-associated urinary tract infections in an acute-care hospital.

Author information

1
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
2
Department of Hospital Epidemiology, University of North Carolina Medical Center, Chapel Hill, North Carolina.
3
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
4
Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
5
Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
6
Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, North Carolina.

Abstract

OBJECTIVE:

To update current estimates of non-device-associated urinary tract infection (ND-UTI) rates and their frequency relative to catheter-associated UTIs (CA-UTIs) and to identify risk factors for ND-UTIs.

DESIGN:

Cohort study.

SETTING:

Academic teaching hospital.

PATIENTS:

All adult hospitalizations between 2013 and 2017 were included. UTIs (device and non-device associated) were captured through comprehensive, hospital-wide active surveillance using Centers for Disease Control and Prevention case definitions and methodology.

RESULTS:

From 2013 to 2017 there were 163,386 hospitalizations (97,485 unique patients) and 1,273 UTIs (715 ND-UTIs and 558 CA-UTIs). The rate of ND-UTIs remained stable, decreasing slightly from 6.14 to 5.57 ND-UTIs per 10,000 hospitalization days during the study period (P = .15). However, the proportion of UTIs that were non-device related increased from 52% to 72% (P < .0001). Female sex (hazard ratio [HR], 1.94; 95% confidence interval [CI], 1.50-2.50) and increasing age were associated with increased ND-UTI risk. Additionally, the following conditions were associated with increased risk: peptic ulcer disease (HR, 2.25; 95% CI, 1.04-4.86), immunosuppression (HR, 1.48; 95% CI, 1.15-1.91), trauma admissions (HR, 1.36; 95% CI, 1.02-1.81), total parenteral nutrition (HR, 1.99; 95% CI, 1.35-2.94) and opioid use (HR, 1.62; 95% CI, 1.10-2.32). Urinary retention (HR, 1.41; 95% CI, 0.96-2.07), suprapubic catheterization (HR, 2.28; 95% CI, 0.88-5.91), and nephrostomy tubes (HR, 2.02; 95% CI, 0.83-4.93) may also increase risk, but estimates were imprecise.

CONCLUSION:

Greater than 70% of UTIs are now non-device associated. Current targeted surveillance practices should be reconsidered in light of this changing landscape. We identified several modifiable risk factors for ND-UTIs, and future research should explore the impact of prevention strategies that target these factors.

PMID:
31475662
DOI:
10.1017/ice.2019.241

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