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High proportion of healthcare-associated urinary tract infection in the absence of prior exposure to urinary catheter: a cross-sectional study

Ilker Uçkay123, Hugo Sax111, Angèle Gayet-Ageron1, Christian Ruef124, Kathrin Mühlemann5, Nicolas Troillet6, Christiane Petignat7, Enos Bernasconi8, Carlo Balmelli7, Andreas Widmer9, Karim Boubaker1013, Didier Pittet13* and for the Swiss-NOSO network

Author Affiliations

1 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

2 Orthopaedic Surgery Department, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland

3 Department of Infectious Diseases, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland

4 Division of Infectious Diseases, University Hospital of Zurich, Zurich, Switzerland

5 Department of Infectious Diseases, University Hospital Bern, Bern, Switzerland

6 Department of Infectious Diseases, Central Institute of the Valais Hospitals, Sion, Switzerland

7 Department of Hospital Preventive Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland

8 Department of Infectious Diseases, Ospedale Civico, Lugano, Switzerland

9 Division of Infectious Diseases, University of Basel Hospitals, Basel, Switzerland

10 Swiss Federal Office of Public Health, Bern, Switzerland

11 Current addresses: Department of Infectious Diseases and Hospital Hygiene, University of Zurich, Zurich, Switzerland

12 Current addresses: Hirslanden Clinics, Zurich, Switzerland

13 Current addresses: Public Health Service for the Canton of Vaud, Lausanne, Switzerland

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Antimicrobial Resistance and Infection Control 2013, 2:5  doi:10.1186/2047-2994-2-5

Published: 7 February 2013

Abstract

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.

Keywords:
Prevalence; Urinary catheter; Acute care; Urinary tract infection; Nosocomial; Risk factors