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Healthcare-Associated Bloodstream Infections Secondary to a Urinary Focus The Québec Provincial Surveillance Results

Published online by Cambridge University Press:  02 January 2015

Elise Fortin ,
Isabelle Rocher ,
Charles Frenette ,
Claude Tremblay  and
Caroline Quach
Elise Fortin*
Affiliation:
Institut National de Santé Publique du Québec, Québec and Montréal, Québec, Canada Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec, Canada
Isabelle Rocher
Affiliation:
Institut National de Santé Publique du Québec, Québec and Montréal, Québec, Canada
Charles Frenette
Affiliation:
Infectious Diseases Division and Department of Medical Microbiology, McGill University Health Centre, Montréal, Québec, Canada
Claude Tremblay
Affiliation:
Centre Hospitalier Universitaire de Québec–Pavillon Hôtel-Dieu de Québec, Québec, Canada
Caroline Quach
Affiliation:
Institut National de Santé Publique du Québec, Québec and Montréal, Québec, Canada Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec, Canada Infectious Diseases Division and Department of Medical Microbiology, McGill University Health Centre, Montréal, Québec, Canada
*
Montreal Children's Hospital of the McGill University Health Centre, C1242-2300 Tupper Street, Montreal, Québec H3H 1P3, Canada ([email protected])
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Abstract

Objective.

Urinary tract infections (UTIs) are an important source of secondary healthcare-associated bloodstream infections (BSIs), where a potential for prevention exists. This study describes the epidemiology of BSIs secondary to a urinary source (U-BSIs) in the province of Québec and predictors of mortality.

Design.

Dynamic cohort of 9,377,830 patient-days followed through a provincial voluntary surveillance program targeting all episodes of healthcare-associated BSIs occurring in acute care hospitals.

Setting.

Sixty-one hospitals in Québec, followed between April 1, 2007, and March 31, 2010.

Participants.

Patients admitted to participating hospitals for 48 hours or longer.

Methods.

Descriptive statistics were used to summarize characteristics of U-BSIs and microorganisms involved. Wilcoxon and X2 tests were used to compare U-BSI episodes with other BSIs. Negative binomial regression was used to identify hospital characteristics associated with higher rates. We explored determinants of mortality using logistic regression.

Results.

Of the 7,217 reported BSIs, 1,510 were U-BSIs (21%), with an annual rate of 1.4 U-BSIs per 10,000 patient-days. A urinary device was used in 71% of U-BSI episodes. Identified institutional risk factors were average length of stay, teaching status, and hospital size. Increasing hospital size was influential only in nonteaching hospitals. Age, nonhematogenous neoplasia, Staphylococcus aureus, and Foley catheters were associated with mortality at 30 days.

Conclusion.

U-BSI characteristics suggest that urinary catheters may remain in patients for ease of care or because practitioners forget to remove them. Ongoing surveillance will enable hospitals to monitor trends in U-BSIs and impacts of process surveillance that will be implemented shortly.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 5 , May 2012 , pp. 456 - 462
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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References

1.Foritela, PS, Platt, RW, Rocher, I, et al. Surveillance Provinciale des Infections Nosocomiales (SPIN) program: implementation of a mandatory surveillance program for central line-associated bloodstream infections. Am J Infect Control 2011;39:329–335.Google Scholar
2.Frenette, C. Surveillance des Bactériémies Nosocomiales Associées aux Accès Veineux en Hémodialyse: Avril 2007-Mars 2008. Québec: Institut National de Santé Publique du Québec, 2010.Google Scholar
3.Galarneau, LA, Rocher, I, Frenette, C, Gilca, R, Gourdeau, M. Surveillance Provinciale des Bactériémies Nosocomiales à Staphylococcus aureus: Rapport 2008. Québec: Institut National de Santé Publique du Québec, 2009.Google Scholar
4.Rocher, I, Quach, C, Frenette, C, Gilca, R. Surveillance des Bactériémies Nosocomiales Panhospitalières: Avril 2007-Mars 2008. Québec: Institut National de Santé Publique du Québec, 2009.Google Scholar
5.Fortin, E, Quach, C, Rocher, I, Trudeau, M, Frenette, C. Surveillance des Bactériémies Nosocomiales Panhospitalières: Avril 2009-Mars 2010. Québec: Institut National de Santé Publique du Québec, 2010.Google Scholar
6.Edwards, JR, Peterson, KD, Mu, Y, et al. National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009. Am J Infect Control 2009;37: 783–805.CrossRefGoogle ScholarPubMed
7.Bussy-Malgrange, V, Jebabli, M, Thiolet, J-M.Surveillance des Bactériémies Nosocomiales en France-Réseau BN-Raisin: Résultats 2004. Saint-Maurice: Institut National de la Veille Sanitaire, 2008.Google Scholar
8.Rosenthal, VD, Maki, DG, Jamulitrat, S, et al. International Nosocomial Infection Control Consortium (INICC) report, data summary for 2003-2008, issued June 2009. Am J Infect Control 2010;38:95–104.Google Scholar
9.Saint, S, Kaufman, SR, Rogers, MAM, Baker, PD, Boyko, EJ, Lipsky, B. Risk factors for nosocomial urinary tract related bacteremia: a case-control study. Am J Infect Control 2006;34:401–407.CrossRefGoogle ScholarPubMed
10.Cober, E, Shuman, EK, Chenoweth, CE. Urinary tract infection. In: Lautenbach, E, Woeltje, KF, Malani, PN, eds. Practical Healthcare Epidemiology. 3rd ed. Chicago: University of Chicago Press, 2010:156–163.Google Scholar
11.Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309–332.CrossRefGoogle ScholarPubMed
12.Frenette, C, Quach, C, Gourdeau, M, et al. Surveillance des Bactériémies Nosocomiales dans les Centres Hospitaliers de Soins Aigus du Québec: Protocole. Québec: Institut National de Santé Publique du Québec, 2007.Google Scholar
13.Greenland, S. Introduction to regression modeling. In: Rothman, KJ, Greenland, S, Lash, TL. Modern Epidemiology. 3rd ed. Philadelphia: Lippincott, Williams & Wilkins, 2008:418–458.Google Scholar
14.European Antimicrobial Resistance Surveillance System (EARSS). EARSS Annual Report 2008: Ongoing Surveillance of S. Pneumoniae, S. aureus, E. coli, E. faecium, E. faecalis, K. pneumoniae, P. aeruginosa. Bilthoven, Netherlands: EARSS, 2009.Google Scholar
15.Krieger, JN, Kaiser, DL, Wenzel, RP. Urinary tract etiology of bloodstream infections in hospitalized patients. J Infect Dis 1983; 148:57–62.CrossRefGoogle ScholarPubMed
16.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 1):S41–S50.Google Scholar
17.Maki, DG, Tambyah, PA. Engineering out the risk of infection with urinary catheters. Emerg Infect Dis 2001;7:342–347.Google Scholar
18.Tenke, P, Kovacs, B, Bjerklund Johansen, TE, Matsumoto, T, Tambyah, PA, Naber, KG. European and Asian guidelines on management and prevention of catheter-associated urinary tract infections. Int J Antimicrob Agents 2008;31(Suppl 1):S68–S78.CrossRefGoogle ScholarPubMed
19.Graves, N, Tong, E, Morton, AP, et al. Factors associated with health care-acquired urinary tract infection. Am J Infect Control 2007;35:387–392.CrossRefGoogle ScholarPubMed
20.Nguyen-Van-Tam, SE, Nguyen-Van-Tam, JS, Myint, S, Pearson, JC. Risk factors for hospital-acquired urinary tract infection in a large English teaching hospital: a case-control study. Infection 1999; 27:192–197.CrossRefGoogle Scholar
21.Institut National de Santé Publique du Québec. Prévalence des Principaux Problèmes de Santé Chroniques, Population de 12 ans et plus, Québec, 2007-2008. Québec: Institut National de Santé Publique du Québec, 2010. http://www.inspq.qc.ca/Santescope/element.asp?NoEle=101. Accessed September 28, 2011.Google Scholar
22.Louchini, R, Beaupré, M, Bouchard, C, Goggin, P. La Prévalence du Cancer au Québec en 1999. Québec: Institut National de Santé Publique du Québec, 2005.Google Scholar
23.Fontela, PS, Platt, RW, Rocher, I, et al. Epidemiology of central line-associated bloodstream infections in Québec intensive care units: a 6-year review. Am J Infect Control 2011, doi:10.1016/j.ajic.2011.04.008.Google Scholar