Predictors of Nosocomial Urinary Tractrelated Bloodstream Infection

1University of Michigan Health System, Ann Arbor, MI
2Department of Veterans Affairs Hospital, Ann Arbor, MI

Meeting: Hospital Medicine 2012, April 1-4, San Diego, Calif.

Abstract number: 97596

Background:

Urinary tract infection (UTI) is the most frequent healthcare–associated infection in the US. Although bloodstream infection (BSI) secondary to nosocomial UTI occurs less often, it is associated with substantial morbidity, mortality, and additional costs. Despite renewed interest in nosocomial UTI, surprisingly little is known about the epidemiology of nosocomial urinary tract–related BSI. Given the importance of preventing nosocomial infections, elucidating potential predictors of nosocomial urinary tract–related BSI could help define proper infection control practices and enhance the safety of hospitalized patients.

Methods:

Using data from patients at a tertiary care hospital from January 2000 to December 2008, we conducted a case–control study to investigate potential risk factors for nosocomial urinary tract–related BSI. Cases were defined as hospitalized adult patients with a positive urine culture obtained > 48 h after admission and a blood culture obtained within 14 days of the urine culture which grew the same organism. Controls were selected by incidence density sampling and included adults with a positive urine culture who were at risk for but did not develop BSI. Controls were matched to each case by calendar time when the BSI occurred in that case. Conditional logistic regression was used to account for matching.

Results:

We identified 298 cases and 667 controls. The odds of developing urinary tract–related BSI were twice as high in males (Table). Neutropenia and renal disease were among the strongest comorbid predictors, increasing the risk 11–fold and 3–fold, respectively. We also detected a number of time–dependent factors that may alter BSI risk. For example, patients given insulin and immunosuppresants were more likely to develop BSI, while patients given antibacterials were less likely to develop BSI. Statins also demonstrated a protective, albeit non–significant, effect (OR = 0.85, CI: 0.51–1.41).

Conclusions:

The likelihood of BSI after nosocomial UTI among hospitalized patients can be predicted by several host–specific factors. Although females are at higher risk of UTI, males are more likely to develop BSI secondary to nosocomial UTI. The heightened risk of urinary tract–related BSI associated with several comorbid conditions suggests that the management of nosocomial UTI should perhaps be tailored to certain patient sub–groups (e.g., neutropenia patients susceptible to bacterial infections). Considering time–dependent risk factors, including medications administered during the hospital stay, may also help guide clinical decisions in reducing this common and costly patient safety problem.

Table 1Significant Predictors of Nosocomial Urinary Tract–Related Bloodstream Infection

To cite this abstract:

Chenoweth C, Shuman E, Kuhn L, Greene M, Rogers M, Chang R, Saint S. Predictors of Nosocomial Urinary Tractrelated Bloodstream Infection. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97596. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/predictors-of-nosocomial-urinary-tractrelated-bloodstream-infection/. Accessed October 20, 2019.

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