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Longer Duration of Urinary Catheterization Increases Catheter-Associated Urinary Tract Infection in PICU
Kahoru Fukuoka1,2, Mihoko Furuichi1,3, Kenta Ito1,4
1Division of Infectious Diseases, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
Insights
Catheter-associated urinary tract infections (CAUTIs) are a significant concern in pediatric intensive care units (PICUs). Longer urinary catheterization duration directly increases the risk of developing CAUTIs in children.
Area of Science:
- Pediatric critical care medicine
- Infectious disease epidemiology
- Healthcare-associated infections
Background:
- Catheter-associated urinary tract infections (CAUTIs) represent a substantial proportion of hospital-acquired infections.
- Pediatric intensive care units (PICUs) have a notable incidence of CAUTIs, yet research on pediatric CAUTI risk factors remains limited.
- Understanding the relationship between catheterization duration and CAUTI risk is crucial for infection prevention strategies in PICUs.
Purpose of the Study:
- To investigate the association between the duration of urinary catheterization and the incidence of catheter-associated urinary tract infections (CAUTIs) in a pediatric intensive care unit (PICU).
- To quantify the increased risk of CAUTI per day of catheterization in pediatric patients.
Main Methods:
- A retrospective cohort study was conducted involving children with urethral catheters in a PICU.
- Catheter-associated urinary tract infection (CAUTI) cases were identified using National Healthcare Safety Network (NHSN) criteria.
- Statistical analysis assessed the relationship between catheterization duration and CAUTI occurrence, calculating odds ratios.
Main Results:
- A total of 1,890 catheterizations yielded 23 CAUTI cases, with an overall incidence rate of 2.35 per 1,000 catheter-days.
- The median duration of catheterization for patients with CAUTI was 7 days.
- Each additional day of urinary catheterization was associated with a 5% increased risk of developing a CAUTI (adjusted OR, 1.05; 95% CI, 1.01-1.09).
Conclusions:
- Prolonged urinary catheterization in the PICU significantly elevates the risk of catheter-associated urinary tract infections (CAUTIs) in pediatric patients.
- The findings underscore the importance of timely urinary catheter removal to mitigate CAUTI risk.
- Implementing strategies for prompt catheter discontinuation is recommended to improve patient safety in PICUs.
Objectives:
Catheter-associated urinary tract infections account for 30% of healthcare-associated infections. To date, few studies have addressed pediatric catheter-associated urinary tract infection in PICUs. The aim of our study was to assess the risk of catheter-associated urinary tract infection in relation to the duration of catheterization in the PICU.
Design:
Retrospective cohort study.
Setting:
PICU at a tertiary children's hospital.
Patients:
Our study was conducted between April 2012 and June 2015 at Tokyo Metropolitan Children's Medical Center in Japan. Children in the PICU with an urethral catheter were included. Catheter-associated urinary tract infection cases were defined according to the National Healthcare Safety Network criteria. The patients' demographic data and isolated organisms were reviewed. Duration of catheterization and the catheter-associated urinary tract infection occurrence rate were analyzed.
Interventions:
None.
Measurements And Main Results:
Among 1,890 catheterizations, 23 catheter-associated urinary tract infection cases were identified. The overall occurrence rate was 2.35/1,000 catheter-days. Among the patients with catheter-associated urinary tract infection, 13 were boys. The median age was 11 months (interquartile range, 7-35 mo), and the median duration of catheterization was 7 days (interquartile range, 5-12 d). The isolated bacteria were Escherichia coli (26.5%), Enterococcus faecalis (17.6%), and Klebsiella pneumoniae (11.8%). Two species were isolated in each of 11 cases (47.8%). Each additional day of catheterization increased the risk of catheter-associated urinary tract infection (odds ratio, 1.06; 95% CI, 1.02-1.10, and odds ratio adjusted for contact precaution status and surgical procedures was 1.05; 95% CI, 1.01-1.09).
Conclusions:
Longer duration of catheterization increased the risk of catheter-associated urinary tract infection by 5% each day at the PICU. Prompt removal of the urethral catheter is strongly recommended whenever feasible.
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