The Impact of Catheter-Associated Urinary Tract Infection (CA-UTI) in Critically Ill Children in the Pediatric Intensive Care Unit

Abstract

Objective Catheter-associated urinary tract infections (CA-UTIs) comprise a significant proportion of hospital-acquired infections. However, the impact of CA-UTIs on important outcome measures, such as length of stay (LOS) and hospital charges, has not been examined in the pediatric intensive care unit (PICU) setting.

Design Single-center, retrospective, case-matched, cohort study and financial analysis.

Setting PICU in a tertiary-care children's medical center.

Patients A total of 41 critically ill children with CA-UTIs and 73 critically ill children without CA-UTI, matched for age, gender, severity of illness, and primary admission diagnosis.

Interventions None.

Measurements and Main Results We compared the length of hospital stay (LOS in PICU and in hospital), mortality, and hospital costs in critically ill children with CA-UTIs and their matched controls. Critically ill children experiencing CA-UTI had significantly longer PICU LOS, hospital LOS, duration of mechanical ventilation, and mortality compared with matched controls without CA-UTI. The longer LOS resulted in higher PICU and hospital charges in this group.

Conclusion Critically ill children with CA-UTI experience worse outcomes in the PICU compared with those without CA-UTI. Further studies on the impact of CA-UTI in the PICU are warranted.

Keywords

catheter-associated urinary tract infections - hospital-acquired infection - increased health care costs - patient safety - quality improvement

• References

• 1 Klevens RM, Edwards JR, Richards Jr CLJ , et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep 2007; 122 (2) 160-166
• 2 Kung HC, Hoyert DL, Xu J, Murphy SL. Deaths: final data for 2005. Natl Vital Stat Rep 2008; 56 (10) 1-120
• 3 Peleg AY, Hooper DC. Hospital-acquired infections due to gram-negative bacteria. N Engl J Med 2010; 362 (19) 1804-1813
• 4 Stone PW, Hedblom EC, Murphy DM, Miller SB. The economic impact of infection control: making the business case for increased infection control resources. Am J Infect Control 2005; 33 (9) 542-547
• 5 Yokoe DS, Mermel LA, Anderson DJ , et al. A compendium of strategies to prevent healthcare-associated infections in acute care hospitals. Infect Control Hosp Epidemiol 2008; 29 (Suppl. 01) S12-S21
• 6 Chenoweth CE, Saint S. Urinary tract infections. Infect Dis Clin North Am 2011; 25 (1) 103-115
• 7 Patrick SW, Kawai AT, Kleinman K , et al. Health care-associated infections among critically ill children in the US, 2007-2012. Pediatrics 2014; 134 (4) 705-712
• 8 Platt R, Polk BF, Murdock B, Rosner B. Mortality associated with nosocomial urinary-tract infection. N Engl J Med 1982; 307 (11) 637-642
• 9 Givens CD, Wenzel RP. Catheter-associated urinary tract infections in surgical patients: a controlled study on the excess morbidity and costs. J Urol 1980; 124 (5) 646-648
• 10 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 (2) R60-R65
• 11 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 (1) 50-57
• 12 King C, Garcia Alvarez L, Holmes A, Moore L, Galletly T, Aylin P. Risk factors for healthcare-associated urinary tract infection and their applications in surveillance using hospital administrative data: a systematic review. J Hosp Infect 2012; 82 (4) 219-226
• 13 Plowman R, Graves N, Esquivel J, Roberts JA. An economic model to assess the cost and benefits of the routine use of silver alloy coated urinary catheters to reduce the risk of urinary tract infections in catheterized patients. J Hosp Infect 2001; 48 (1) 33-42
• 14 National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004; 32 (8) 470-485
• 15 Saint S, Meddings JA, Calfee D, Kowalski CP, Krein SL. Catheter-associated urinary tract infection and the Medicare rule changes. Ann Intern Med 2009; 150 (12) 877-884
• 16 Brilli RJ, McClead Jr REJ, Davis T, Stoverock L, Rayburn A, Berry JC. The Preventable Harm Index: an effective motivator to facilitate the drive to zero. J Pediatr 2010; 157 (4) 681-683
• 17 Crandall WV, Davis JT, McClead R, Brilli RJ. Is preventable harm the right patient safety metric?. Pediatr Clin North Am 2012; 59 (6) 1279-1292
• 18 Centers for Disease Control and Prevention. Catheter-Associated Urinary Tract Infection (CAUTI) Event. Atlanta, GA: Centers for Disease Control and Prevention; 2013 [cited June 1, 2012]. Available at: http://www.cdc.gov/nhsn/PDFs/pscManual/7pscCAUTIcurrent.pdf
• 19 Sparling KW, Ryckman FC, Schoettker PJ , et al. Financial impact of failing to prevent surgical site infections. Qual Manag Health Care 2007; 16 (3) 219-225
• 20 Brilli RJ, Sparling KW, Lake MR , et al. The business case for preventing ventilator-associated pneumonia in pediatric intensive care unit patients. Jt Comm J Qual Patient Saf 2008; 34 (11) 629-638
• 21 Nowak JE, Brilli RJ, Lake MR , et al. Reducing catheter-associated bloodstream infections in the pediatric intensive care unit: business case for quality improvement. Pediatr Crit Care Med 2010; 11 (5) 579-587
• 22 Pollack MM, Patel KM, Ruttimann UE. PRISM III: an updated Pediatric Risk of Mortality score. Crit Care Med 1996; 24 (5) 743-752
• 23 Langley JM, Hanakowski M, Leblanc JC. Unique epidemiology of nosocomial urinary tract infection in children. Am J Infect Control 2001; 29 (2) 94-98
• 24 Lo E, Nicolle L, Classen D , et al. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals. Infect Control Hosp Epidemiol 2008; 29 (Suppl. 01) S41-S50
• 25 Brindha SM, Jayashree M, Singhi S, Taneja N. Study of nosocomial urinary tract infections in a pediatric intensive care unit. J Trop Pediatr 2011; 57 (5) 357-362
• 26 Saint S, Kowalski CP, Kaufman SR , et al. Preventing hospital-acquired urinary tract infection in the United States: a national study. Clin Infect Dis 2008; 46 (2) 243-250
• 27 Institute for Improvement. Reducing Catheter-Associated Urinary Tract Infections. Boston, MA: Institute for Healthcare Improvement; 2009 [cited January 1, 2010]. Available at: http://www.ihi.org/IHI/Programs/ImprovementMap/PreventCatheterAssociatedUrinaryTractInfections.html
• 28 Centers for Disease Control and Prevention. The Direct Medical Costs of Healthcare-Associated Infections in US Hospitals and the Benefits of Prevention. Atlanta, GA: Centers for Disease Control and Prevention; 2009 [cited May 1, 2013]. Available at: http://www.cdc.gov/ncidod/dhqp/pdf/Scott_Cost.Published . March 2009
• 29 Goudie A, Dynan L, Brady PW, Rettiganti M. Attributable cost and length of stay for central line-associated bloodstream infections. Pediatrics 2014; 133 (6) e1525-e1532
• 30 Harrod M, Kowalski CP, Saint S, Forman J, Krein SL. Variations in risk perceptions: a qualitative study of why unnecessary urinary catheter use continues to be problematic. BMC Health Serv Res 2013; 13: 151
• 31 Krein SL, Kowalski CP, Harrod M, Forman J, Saint S. Barriers to reducing urinary catheter use: a qualitative assessment of a statewide initiative. JAMA Intern Med 2013; 173 (10) 881-886