TY - JOUR
T1 - Incidence and risk factors for acquiring nosocomial urinary tract infection in the critically ill
AU - Laupland, Kevin B.
AU - Zygun, David A.
AU - Davies, H. Dele
AU - Church, Deirdre L.
AU - Louie, Thomas J.
AU - Doig, Christopher J.
N1 - Funding Information:
Supported by the 2000 Bayer Healthcare/Canadian Institutes of Health Research/Canadian Infectious Diseases Society Research Fellowship and a Clinical Fellowship award from the Alberta Heritage Foundation for Medical Research (AHFMR) (K.B.L.); by the Meredith Graduate Master's Scholarship, University of Calgary (D.A.Z.); and by a grant from the Department of Critical Care, Calgary Health Region (C.J.D.). H.D.D. is a Medical Scholar of the AHFMR.
PY - 2002
Y1 - 2002
N2 - Purpose: A urinary tract infection (UTI) is the most common hospital-acquired infection. However, the epidemiology of intensive care unit (ICU)-acquired UTIs is not well defined. The objective of this study was to describe the incidence, risk factors, and clinical outcomes of ICU-acquired UTIs. Materials and Methods: All patients admitted to adult multidisciplinary ICUs in the Calgary Health Region (CHR, population ∼ 1 million) during May 1, 1999 to April 30, 2000 were studied using a cohort design. Results: A total of 1,158 admissions to a CHR ICU were 48 hours in duration or more. A total of 111 episodes of ICU-acquired UTI (defined as > 105 CFU/mL of 1 or 2 organisms >48 hours after ICU admission) occurred in 105 (9%) patients and 5 (0.4%) had ICU-acquired bacteremic/fungemic UTIs for incidences of 11.3 and 0.5 UTIs per 1,000 ICU days, respectively. Significant independent risk factors for developing an ICU-acquired UTI as determined by a logistic regression model were female gender (adjusted odds ratio [ORadj], 2.31; 95% confidence interval [CI], 1.48-3.59) and natural logarithmic transformation of ICU length of stay (ORadj, 3.96; 95% CI, 3.02-5.17). No differences in admitting vital signs, routine blood tests, APACHE II and TISS scores, or overall hospital mortality rate were observed among patients who developed an ICU-acquired UTI as compared with those who did not. The most common UTI etiologies were Enterococcus spp. (24%), Candida albicans (21%), and Escherichia coli(15%). Only 4 (3%) of the organisms were highly antibiotic resistant. Conclusions: Nosocomial UTIs develop commonly in the critically ill and women and those with an extended ICU stay are at increased risk. Although ICU-acquired UTIs are markers of morbidity, they do not significantly increase mortality.
AB - Purpose: A urinary tract infection (UTI) is the most common hospital-acquired infection. However, the epidemiology of intensive care unit (ICU)-acquired UTIs is not well defined. The objective of this study was to describe the incidence, risk factors, and clinical outcomes of ICU-acquired UTIs. Materials and Methods: All patients admitted to adult multidisciplinary ICUs in the Calgary Health Region (CHR, population ∼ 1 million) during May 1, 1999 to April 30, 2000 were studied using a cohort design. Results: A total of 1,158 admissions to a CHR ICU were 48 hours in duration or more. A total of 111 episodes of ICU-acquired UTI (defined as > 105 CFU/mL of 1 or 2 organisms >48 hours after ICU admission) occurred in 105 (9%) patients and 5 (0.4%) had ICU-acquired bacteremic/fungemic UTIs for incidences of 11.3 and 0.5 UTIs per 1,000 ICU days, respectively. Significant independent risk factors for developing an ICU-acquired UTI as determined by a logistic regression model were female gender (adjusted odds ratio [ORadj], 2.31; 95% confidence interval [CI], 1.48-3.59) and natural logarithmic transformation of ICU length of stay (ORadj, 3.96; 95% CI, 3.02-5.17). No differences in admitting vital signs, routine blood tests, APACHE II and TISS scores, or overall hospital mortality rate were observed among patients who developed an ICU-acquired UTI as compared with those who did not. The most common UTI etiologies were Enterococcus spp. (24%), Candida albicans (21%), and Escherichia coli(15%). Only 4 (3%) of the organisms were highly antibiotic resistant. Conclusions: Nosocomial UTIs develop commonly in the critically ill and women and those with an extended ICU stay are at increased risk. Although ICU-acquired UTIs are markers of morbidity, they do not significantly increase mortality.
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U2 - 10.1053/jcrc.2002.33029
DO - 10.1053/jcrc.2002.33029
M3 - Article
C2 - 12040549
AN - SCOPUS:0036106102
SN - 0883-9441
VL - 17
SP - 50
EP - 57
JO - Journal of Critical Care
JF - Journal of Critical Care
IS - 1
ER -