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Published on: June 24, 2025
Risk Factors for Urinary Tract Infections in Cardiac Surgical Patients
Jacob R Gillen1, James M Isbell1, Alex D Michaels1
1Department of Surgery, University of Virginia Health System , Charlottesville, Virginia.
Insights
Catheter-associated urinary tract infections (CAUTIs) in cardiac surgery patients are linked to older age, female gender, diabetes, and longer ICU stays. CAUTIs indicate higher patient risk but are not an independent cause of mortality.
Area of Science:
- Infection Control
- Cardiac Surgery
- Healthcare Epidemiology
Background:
- Catheter-associated urinary tract infections (CAUTIs) are common hospital-acquired infections.
- Risk factors for CAUTIs are established in non-cardiac surgery but less defined in cardiac procedures.
- Identifying specific risk factors in cardiac surgery is crucial for targeted prevention strategies.
Purpose of the Study:
- To investigate and define the perioperative risk factors associated with CAUTIs in patients undergoing cardiac surgery.
- To analyze the correlation between patient characteristics and CAUTI development in this specific population.
Main Methods:
- Retrospective review of 4,883 cardiac surgery patients from 2006-2012.
- Identification of CAUTI cases based on CDC criteria using hospital quality data.
- Statistical analysis including univariate and multivariable logistic regression to identify significant risk factors.
Main Results:
- A total of 55 (1.1%) CAUTIs were identified.
- Univariate analysis showed older age, female gender, diabetes, cardiogenic shock, urgent surgery, PRBC transfusion, and ICU length of stay (LOS) were associated with CAUTI.
- Multivariable analysis confirmed older age, female gender, diabetes, and ICU LOS as independent risk factors for CAUTI.
Conclusions:
- Identifiable risk factors for CAUTI exist in cardiac surgery patients.
- CAUTI is not an independent predictor of mortality but serves as a marker for sicker patients.
- Increased vigilance for high-risk patients may improve perioperative outcomes and reduce CAUTI rates.
Background:
Risk factors for catheter-associated urinary tract infections (CAUTIs) in patients undergoing non-cardiac surgical procedures have been well documented. However, the variables associated with CAUTIs in the cardiac surgical population have not been clearly defined. Therefore, the purpose of this study was to investigate risk factors associated with CAUTIs in patients undergoing cardiac procedures.
Methods:
All patients undergoing cardiac surgery at a single institution from 2006 through 2012 (4,883 patients) were reviewed. Patients with U.S. Centers for Disease Control (CDC) criteria for CAUTI were identified from the hospital's Quality Assessment database. Pre-operative, operative, and post-operative patient factors were evaluated. Univariate and multivariable analyses were used to identify significant correlations between perioperative characteristics and CAUTIs.
Results:
There were 55 (1.1%) documented CAUTIs in the study population. On univariate analysis, older age, female gender, diabetes mellitus, cardiogenic shock, urgent or emergent operation, packed red blood cell (PRBC) units transfused, and intensive care unit length of stay (ICU LOS) were all significantly associated with CAUTI [p<0.05]. On multivariable logistic regression, older age, female gender, diabetes mellitus, and ICU LOS remained significantly associated with CAUTI. Additionally, there was a significant association between CAUTI and 30-d mortality on univariate analysis. However, when controlling for common predictors of operative mortality on multivariable analysis, CAUTI was no longer associated with mortality.
Conclusions:
There are several identifiable risk factors for CAUTI in patients undergoing cardiac procedures. CAUTI is not independently associated with increased mortality, but it does serve as a marker of sicker patients more likely to die from other comorbidities or complications. Therefore, awareness of the high-risk nature of these patients should lead to increased diligence and may help to improve peri-operative outcomes. Recognizing patients at high risk for CAUTI may lead to improved measures to decrease CAUTI rates within this population.
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