I thought I would take a break from the ECRI top 10 lists of bad things causing safety related concerns and return to an issue that remains problematic within hospitals. It is now a bit over a year since my father suffered a broken knee cap, underwent surgery to repair the fracture and was then admitted to acute rehab. While he was in rehab he developed a urinary track infection from a urinary catheter he had during his surgery. He did not respond to antibiotics. He got sicker and sicker while his physicians failed to recognize that he was declining. This is called failure to rescue. He ultimately suffered a cardiac arrest and somewhat miraculously survived, though his rehabilitation is slow. He will never fully recover from this event.
So let’s look at the status of CAUTI’s.
Catheter-related urinary tract infections (CAUTIs) continue to be a significant concern in hospitals. The incidence of CAUTIs varies widely across different settings and patient populations. For instance, a study conducted in Korea found a median CAUTI prevalence of 1.9 per 1,000 catheter days. This means that the problem is not specific to the U.S, it is an international concern. In ICUs, the incidence can be higher, with a systematic review reporting a weighted CAUTI incidence of 7.78 per 1,000 catheter days.[1-2]
The risk factors for CAUTIs include prolonged catheterization, female sex, advanced age, and specific ICU types such as trauma and neurologic ICUs.[3-4] The duration of catheter use is one of the most critical modifiable risk factors.[1]
Pathogen profiles in CAUTIs are dominated by gram-negative bacteria, fungi, and gram-positive bacteria, with high rates of antimicrobial resistance observed, particularly in ICU settings.[2] Common pathogens include Escherichia coli, Enterococcus spp. (this is what my Dad had), and Candida spp., with notable resistance to antibiotics like ampicillin and ciprofloxacin.[2]
Opportunities for improvement will come next time.
References:
Current Status of Indwelling Urinary Catheter Utilization and Catheter-Associated Urinary Tract Infection Throughout Hospital Wards in Korea: A Multicenter Prospective Observational Study. Kim B, Pai H, Choi WS, et al. PloS One. 2017;12(10):e0185369. doi:10.1371/journal.pone.0185369.
Epidemiology of Pathogens and Antimicrobial Resistanceof Catheter-Associated Urinary Tract Infections in Intensivecare Units: A Systematic Review and Meta-Analysis. Peng D, Li X, Liu P, et al. American Journal of Infection Control. 2018;46(12):e81-e90. doi:10.1016/j.ajic.2018.07.012.
An International Prospective Study of INICC Analyzing the Incidence and Risk Factors for Catheter-Associated Urinary Tract Infections in 235 ICUs Across 8 Asian Countries. Rosenthal VD, Yin R, Abbo LM, et al. American Journal of Infection Control. 2024;52(1):54-60. doi:10.1016/j.ajic.2023.07.007.
Incidence and Risk Factors for Catheter-Associated Urinary Tract Infection in 623 Intensive Care Units Throughout 37 Asian, African, Eastern European, Latin American, and Middle Eastern Nations: A Multinational Prospective Research of INICC. Rosenthal VD, Yin R, Brown EC, et al. Infection Control and Hospital Epidemiology. 2024;45(5):567-575. doi:10.1017/ice.2023.215.