Incidence and risk factors for acquiring nosocomial urinary tract infection in the critically ill

Kevin B. Laupland, David A. Zygun, H. Dele Davies, Deirdre L. Church, Thomas J. Louie, Christopher J. Doig

Research output: Contribution to journalArticle

102 Citations (Scopus)

Abstract

Purpose: A urinary tract infection (UTI) is the most common hospital-acquired infection. However, the epidemiology of intensive care unit (ICU)-acquired UTIs is not well defined. The objective of this study was to describe the incidence, risk factors, and clinical outcomes of ICU-acquired UTIs. Materials and Methods: All patients admitted to adult multidisciplinary ICUs in the Calgary Health Region (CHR, population ∼ 1 million) during May 1, 1999 to April 30, 2000 were studied using a cohort design. Results: A total of 1,158 admissions to a CHR ICU were 48 hours in duration or more. A total of 111 episodes of ICU-acquired UTI (defined as > 105 CFU/mL of 1 or 2 organisms >48 hours after ICU admission) occurred in 105 (9%) patients and 5 (0.4%) had ICU-acquired bacteremic/fungemic UTIs for incidences of 11.3 and 0.5 UTIs per 1,000 ICU days, respectively. Significant independent risk factors for developing an ICU-acquired UTI as determined by a logistic regression model were female gender (adjusted odds ratio [ORadj], 2.31; 95% confidence interval [CI], 1.48-3.59) and natural logarithmic transformation of ICU length of stay (ORadj, 3.96; 95% CI, 3.02-5.17). No differences in admitting vital signs, routine blood tests, APACHE II and TISS scores, or overall hospital mortality rate were observed among patients who developed an ICU-acquired UTI as compared with those who did not. The most common UTI etiologies were Enterococcus spp. (24%), Candida albicans (21%), and Escherichia coli(15%). Only 4 (3%) of the organisms were highly antibiotic resistant. Conclusions: Nosocomial UTIs develop commonly in the critically ill and women and those with an extended ICU stay are at increased risk. Although ICU-acquired UTIs are markers of morbidity, they do not significantly increase mortality.

Original languageEnglish (US)
Pages (from-to)50-57
Number of pages8
JournalJournal of Critical Care
Volume17
Issue number1
DOIs
StatePublished - Jan 1 2002

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Cross Infection
Critical Illness
Urinary Tract Infections
Intensive Care Units
Incidence
Logistic Models
Episode of Care
Confidence Intervals
APACHE
Mortality
Vital Signs
Enterococcus
Hematologic Tests
Hospital Mortality
Candida albicans
Length of Stay
Epidemiology
Odds Ratio
Escherichia coli
Anti-Bacterial Agents

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Incidence and risk factors for acquiring nosocomial urinary tract infection in the critically ill. / Laupland, Kevin B.; Zygun, David A.; Davies, H. Dele; Church, Deirdre L.; Louie, Thomas J.; Doig, Christopher J.

In: Journal of Critical Care, Vol. 17, No. 1, 01.01.2002, p. 50-57.

Research output: Contribution to journalArticle

Laupland, Kevin B. ; Zygun, David A. ; Davies, H. Dele ; Church, Deirdre L. ; Louie, Thomas J. ; Doig, Christopher J. / Incidence and risk factors for acquiring nosocomial urinary tract infection in the critically ill. In: Journal of Critical Care. 2002 ; Vol. 17, No. 1. pp. 50-57.
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abstract = "Purpose: A urinary tract infection (UTI) is the most common hospital-acquired infection. However, the epidemiology of intensive care unit (ICU)-acquired UTIs is not well defined. The objective of this study was to describe the incidence, risk factors, and clinical outcomes of ICU-acquired UTIs. Materials and Methods: All patients admitted to adult multidisciplinary ICUs in the Calgary Health Region (CHR, population ∼ 1 million) during May 1, 1999 to April 30, 2000 were studied using a cohort design. Results: A total of 1,158 admissions to a CHR ICU were 48 hours in duration or more. A total of 111 episodes of ICU-acquired UTI (defined as > 105 CFU/mL of 1 or 2 organisms >48 hours after ICU admission) occurred in 105 (9{\%}) patients and 5 (0.4{\%}) had ICU-acquired bacteremic/fungemic UTIs for incidences of 11.3 and 0.5 UTIs per 1,000 ICU days, respectively. Significant independent risk factors for developing an ICU-acquired UTI as determined by a logistic regression model were female gender (adjusted odds ratio [ORadj], 2.31; 95{\%} confidence interval [CI], 1.48-3.59) and natural logarithmic transformation of ICU length of stay (ORadj, 3.96; 95{\%} CI, 3.02-5.17). No differences in admitting vital signs, routine blood tests, APACHE II and TISS scores, or overall hospital mortality rate were observed among patients who developed an ICU-acquired UTI as compared with those who did not. The most common UTI etiologies were Enterococcus spp. (24{\%}), Candida albicans (21{\%}), and Escherichia coli(15{\%}). Only 4 (3{\%}) of the organisms were highly antibiotic resistant. Conclusions: Nosocomial UTIs develop commonly in the critically ill and women and those with an extended ICU stay are at increased risk. Although ICU-acquired UTIs are markers of morbidity, they do not significantly increase mortality.",
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