Bacteremia and mortality with urinary catheter-associated bacteriuria

Area of Science:

• Infectious Diseases
• Urology
• Hospital Epidemiology

Background:

• Catheter-associated urinary tract infections (CAUTI) and asymptomatic bacteriuria (CAABU) are common in hospitalized patients.
• Distinguishing between CAUTI and CAABU is crucial for understanding associated risks.
• Existing literature often fails to differentiate the clinical implications of CAUTI versus CAABU.

Purpose of the Study:

• To investigate the relationship between catheter-associated bacteriuria (CAB) and subsequent bacteremia from a urinary source, comparing CAUTI and CAABU.
• To determine if urinary symptoms in patients with CAB correlate with bacteremia from any source or mortality.
• To evaluate the impact of antimicrobial treatment for CAB on subsequent bacteremia and mortality.

Main Methods:

• Retrospective cohort study design with 30-day follow-up post-positive urine culture.
• Inclusion of all inpatients with indwelling or external urinary catheters and a positive urine culture.
• Definitions of CAUTI and CAABU based on Infectious Diseases Society of America guidelines.

Main Results:

• 444 episodes of CAB were identified in 308 patients; 41.6% were CAUTI and 58.4% were CAABU.
• Bacteremia from a urinary source occurred infrequently (0.7% of episodes).
• CAUTI was associated with bacteremia from any source, but neither CAUTI nor CAABU predicted mortality. Antimicrobial treatment did not impact outcomes.

Conclusions:

• Bacteremia originating from the urinary tract is rare in catheterized patients.
• Symptomatic bacteriuria (CAUTI) versus asymptomatic bacteriuria (CAABU) did not show a differential association with mortality.
• Antimicrobial therapy for catheter-associated bacteriuria did not influence the risk of subsequent bacteremia or mortality.