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Incidence and risk factors of non–device-associated urinary tract infections in an acute-care hospital

Published online by Cambridge University Press:  02 September 2019

Paula D. Strassle Open the ORCID record for Paula D. Strassle [Opens in a new window] ,
Emily E. Sickbert-Bennett ,
Michael Klompas ,
Jennifer L. Lund ,
Paul W. Stewart ,
Ashley H. Marx ,
Lauren M. DiBiase  and
David J. Weber
Paula D. Strassle*
Affiliation:
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Emily E. Sickbert-Bennett
Affiliation:
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Hospital Epidemiology, University of North Carolina Medical Center, Chapel Hill, North Carolina
Michael Klompas
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
Jennifer L. Lund
Affiliation:
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Paul W. Stewart
Affiliation:
Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Ashley H. Marx
Affiliation:
Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, North Carolina
Lauren M. DiBiase
Affiliation:
Department of Hospital Epidemiology, University of North Carolina Medical Center, Chapel Hill, North Carolina
David J. Weber
Affiliation:
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Hospital Epidemiology, University of North Carolina Medical Center, Chapel Hill, North Carolina
*
Author for correspondence: Paula D. Strassle, PhD, MSPH, E-mail: [email protected]
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Abstract

Objective:

To update current estimates of non–device-associated urinary tract infection (ND-UTI) rates and their frequency relative to catheter-associated UTIs (CA-UTIs) and to identify risk factors for ND-UTIs.

Design:

Cohort study.

Setting:

Academic teaching hospital.

Patients:

All adult hospitalizations between 2013 and 2017 were included. UTIs (device and non-device associated) were captured through comprehensive, hospital-wide active surveillance using Centers for Disease Control and Prevention case definitions and methodology.

Results:

From 2013 to 2017 there were 163,386 hospitalizations (97,485 unique patients) and 1,273 UTIs (715 ND-UTIs and 558 CA-UTIs). The rate of ND-UTIs remained stable, decreasing slightly from 6.14 to 5.57 ND-UTIs per 10,000 hospitalization days during the study period (P = .15). However, the proportion of UTIs that were non–device related increased from 52% to 72% (P < .0001). Female sex (hazard ratio [HR], 1.94; 95% confidence interval [CI], 1.50–2.50) and increasing age were associated with increased ND-UTI risk. Additionally, the following conditions were associated with increased risk: peptic ulcer disease (HR, 2.25; 95% CI, 1.04–4.86), immunosuppression (HR, 1.48; 95% CI, 1.15–1.91), trauma admissions (HR, 1.36; 95% CI, 1.02–1.81), total parenteral nutrition (HR, 1.99; 95% CI, 1.35–2.94) and opioid use (HR, 1.62; 95% CI, 1.10–2.32). Urinary retention (HR, 1.41; 95% CI, 0.96–2.07), suprapubic catheterization (HR, 2.28; 95% CI, 0.88–5.91), and nephrostomy tubes (HR, 2.02; 95% CI, 0.83–4.93) may also increase risk, but estimates were imprecise.

Conclusion:

Greater than 70% of UTIs are now non–device associated. Current targeted surveillance practices should be reconsidered in light of this changing landscape. We identified several modifiable risk factors for ND-UTIs, and future research should explore the impact of prevention strategies that target these factors.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 11 , November 2019 , pp. 1242 - 1247
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

PREVIOUS PRESENTATION. Portions of this manuscript were presented at SHEA Spring Conferencs on April 24, 2019, and at the 35th International Conference on Pharmacoepidemiology and Therapeutic Risk Management (ICPE) on August 28, 2019, in Philadelphia, Pennsylvania.

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