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Catheter-associated urinary tract infection is rarely symptomatic: a prospective study of 1,497 catheterized patients
1Department of Medicine, University of Wisconsin Medical School, Madison, USA.
Insights
Catheter-associated urinary tract infections (CAUTI) are often asymptomatic, with common symptoms like fever or leukocytosis having little predictive value for diagnosis. Most CAUTIs do not lead to bloodstream infections.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Clinical Microbiology
Background:
- Catheter-associated urinary tract infection (CAUTI) is a prevalent nosocomial infection in US hospitals and nursing homes, affecting over a million individuals annually.
- Understanding the clinical presentation of CAUTI is crucial for effective diagnosis and management.
Purpose of the Study:
- To elucidate the clinical features and diagnostic indicators of catheter-associated urinary tract infections.
- To assess the symptomatic presentation of CAUTI in hospitalized patients.
Main Methods:
- A prospective study involving 1,497 newly catheterized patients at a university hospital.
- Daily quantitative urine cultures, leukocyte counts, and symptom assessments were performed.
- A subset of 1,034 patients was analyzed to correlate CAUTI with specific clinical signs and symptoms.
Main Results:
- Over 90% of the 235 identified CAUTI cases were asymptomatic.
- Physicians detected only 52% of CAUTI cases using hospital laboratory data.
- No significant differences in fever, urinary symptoms, or leukocytosis were observed between patients with and without CAUTI.
Conclusions:
- Catheter-associated urinary tract infections are frequently asymptomatic and rarely lead to secondary bloodstream infections.
- Clinical signs such as fever, urinary symptoms, or leukocytosis have low predictive value for diagnosing CAUTI.
- CAUTIs represent a significant reservoir for antibiotic-resistant organisms within healthcare settings.
Background:
Catheter-associated urinary tract infection (CAUTI) is the most common nosocomial infection, accounting for more than 1 million cases each year in US hospitals and nursing homes.
Objective:
To define the clinical features of CAUTI.
Setting And Patients:
A university hospital; 1,497 newly catheterized patients.
Design:
Every day that the catheter was in place, a quantitative urine culture and urine leukocyte count were obtained, and the patient was queried by a research worker regarding symptoms. To more precisely define the role of CAUTI in patients' symptoms, a subset of 1,034 patients, 89 of whom developed CAUTI with more than 10(3) colony-forming units per milliliter, who did not have another potentially confounding site of infection besides the urinary tract, was analyzed.
Outcome Measures:
Presence of fever, symptoms commonly associated with community-acquired urinary tract infection, and peripheral leukocytosis.
Results:
There were 235 new cases of nosocomial CAUTI during the study period. More than 90% of the infected patients were asymptomatic; only 123 infections (52%) were detected by patients' physicians using the hospital laboratory. In the subset analysis, there were no significant differences between patients with and without CAUTI in signs or symptoms commonly associated with urinary tract infection-fever, dysuria, urgency, or flank pain-or in leukocytosis. Only 1 of the 235 episodes of CAUTI that were prospectively studied was unequivocally associated with secondary bloodstream infection.
Conclusions:
Whereas CAUTIs are a major reservoir of antibiotic-resistant organisms in the hospital, they are rarely symptomatic and infrequently cause bloodstream infection. Symptoms referable to the urinary tract, fever, or peripheral leukocytosis have little predictive value for the diagnosis of CAUTI.
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