Catheter-Associated Urinary Tract Infections, Bacteremia, and Infection Control Interventions in a Hospital: A Six-Year Time-Series Study

Abstract

Catheter-associated urinary tract infections (CAUTIs) are among the most common healthcare-associated infections. Urine catheters are often reservoirs of multidrug-resistant (MDR) bacteria and sources of pathogens transmission to other patients. The current study was conducted to investigate the correlation between CAUTIs, MDR bacteremia, and infection control interventions, in a tertiary-care hospital in Athens, from 2013 to 2018. The following data were analyzed per month: 1. CAUTI incidence; 2. consumption of hand hygiene disinfectants; 3. incidence of isolation of MDR carrier patients, and 4.incidence of bacteremia/1000 patient-days [total resistant a.Gram-negative: carbapenem-resistant Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae; b.Gram-positive: vancomycin-resistant Enterococci and methicillin-resistant Staphylococcus aureus]. The use of scrub disinfectant solutions was associated with decreased CAUTI rate in Total Hospital Clinics (OR: 0.97, 95% CI: 0.96−0.98, p-value: <0.001) and in Adults ICU (OR: 0.79, 95% CI: 0.65−0.96, p-value:0.018) while no correlation was found with isolation rate of MDR-carrier pathogens. Interestingly, an increase in total bacteremia (OR: 0.81, 95% CI: 0.75−0.87, p-value:<0.001) or carbapenem-resistant bacteremia correlated with decreased incidence of CAUTIs (OR: 0.96, 95% CI: 0.94−0.99, p-value: 0.008). Hand hygiene measures had a robust and constant effect on infection control, reducing the incidence of CAUTIs.

Keywords: catheter-associated urinary tract infection; healthcare-associated infections; infection control measures; multi-drug resistant bacteria; time series data.

Figure 1

Observed values and estimated time trends for CAUTI rate in (a) total Hospital Clinics, (b) Adults Intensive Care Unit from January 2013 to December 2018.CAUTI: catheter-associated urinary tract infection; trends shown with dashed lines derived from Poisson regression models with robust standard errors, seasonality terms and linear or piecewise linear long term trend: log(N) = β₀ +β₁t₋ +β₂t ₊ +β₃ × sin(2πt/12) + β₄ × cos(2πt/12) + β₅ × sin(4πt/12) + β₆ × cos(4πt/12) + log(ventilator-days) with N being the number of cases and t being time since study start in months (t₋ and t₊ piecewise linear time terms). Trends shown with grey area derived similarly but spline terms of time were used for long term trend instead of piecewise linear terms.