Urinary tract infections in the critically ill patient with a urinary catheter

The diagnosis of urosepsis should be entertained each time a patient has a febrile episode. Urosepsis carries with it a mortality rate of 25% to 60%. We determined the incidence and risk factors of urosepsis in the catheterized critically ill patient.

The charts of 142 subjects admitted from November 1994 to November 1995 to the trauma intensive care units at our institution with a urinary catheter were reviewed. Urosepsis was defined as (1) positive blood and urine cultures that correlated; (2) positive urine cultures with radiologic evidence of obstructive uropathy or infection; or (3) positive urine cultures and all other cultures negative to be eligible for the urosepsis group.

Of the 126 patients evaluated for sepsis, 20 (15.8%) were diagnosed with urosepsis. Multivariant analysis demonstrated that the incidence of urosepsis was correlated with the following: age >60 years, extended length of stay in the intensive care unit and/or hospital, and duration of urinary catheterization. All 20 patients who developed urosepsis had a positive urinalysis and a positive urine culture (sensitivity 100%). However, urinalyses were positive in another 63 patients who did not have urosepsis (specificity 24.1%), and urine cultures were positive in 31 patients who did not have urosepsis (specificity 70.8%).

We found a 15.8% incidence of urosepsis in our patient population. Urosepsis was more likely to occur in patients over 60 years of age, patients with extended length of stay in the intensive care unit or in the hospital in general, and patients with an extended duration of urinary catheterization.