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. 2018 Oct;19(10):e547-e550.
doi: 10.1097/PCC.0000000000001628.

Longer Duration of Urinary Catheterization Increases Catheter-Associated Urinary Tract Infection in PICU

Kahoru Fukuoka  1   2 , Mihoko Furuichi  1   3 , Kenta Ito  1   4 , Yoshihiko Morikawa  2 , Ichiro Watanabe  5 , Naoki Shimizu  5 , Yuho Horikoshi  1
Affiliations

Longer Duration of Urinary Catheterization Increases Catheter-Associated Urinary Tract Infection in PICU

Kahoru Fukuoka et al. Pediatr Crit Care Med. 2018 Oct.

Abstract

Objectives: Catheter-associated urinary tract infections account for 30% of healthcare-associated infections. To date, few studies have addressed pediatric catheter-associated urinary tract infection in PICUs. The aim of our study was to assess the risk of catheter-associated urinary tract infection in relation to the duration of catheterization in the PICU.

Design: Retrospective cohort study.

Setting: PICU at a tertiary children's hospital.

Patients: Our study was conducted between April 2012 and June 2015 at Tokyo Metropolitan Children's Medical Center in Japan. Children in the PICU with an urethral catheter were included. Catheter-associated urinary tract infection cases were defined according to the National Healthcare Safety Network criteria. The patients' demographic data and isolated organisms were reviewed. Duration of catheterization and the catheter-associated urinary tract infection occurrence rate were analyzed.

Interventions: None.

Measurements and main results: Among 1,890 catheterizations, 23 catheter-associated urinary tract infection cases were identified. The overall occurrence rate was 2.35/1,000 catheter-days. Among the patients with catheter-associated urinary tract infection, 13 were boys. The median age was 11 months (interquartile range, 7-35 mo), and the median duration of catheterization was 7 days (interquartile range, 5-12 d). The isolated bacteria were Escherichia coli (26.5%), Enterococcus faecalis (17.6%), and Klebsiella pneumoniae (11.8%). Two species were isolated in each of 11 cases (47.8%). Each additional day of catheterization increased the risk of catheter-associated urinary tract infection (odds ratio, 1.06; 95% CI, 1.02-1.10, and odds ratio adjusted for contact precaution status and surgical procedures was 1.05; 95% CI, 1.01-1.09).

Conclusions: Longer duration of catheterization increased the risk of catheter-associated urinary tract infection by 5% each day at the PICU. Prompt removal of the urethral catheter is strongly recommended whenever feasible.

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