Bacteremia and Mortality with Urinary Catheter–Associated Bacteriuria

2013 ◽  
Vol 34 (11) ◽  
pp. 1153-1159 ◽  
Author(s):  
Quratulain F. Kizilbash ◽  
Nancy J. Petersen ◽  
Guoqing J. Chen ◽  
Aanand D. Naik ◽  
Barbara W. Trautner
Keyword(s):  
Antimicrobial Agents ◽  
Urine Culture ◽  
Urinary Catheter ◽  
Tertiary Care ◽  
Asymptomatic Bacteriuria ◽  
Care Facility ◽  
Antimicrobial Treatment ◽  
Positive Urine Culture ◽  
Tertiary Care Facility ◽  
Positive Urine

Objective.Although catheter-associated urinary tract infection (CAUTI) and catheter-associated asymptomatic bacteriuria (CAABU) are clinically distinct conditions, most literature describing the risks of bacteriuria does not distinguish between them. We studied the relationship between catheter-associated bacteriuria and bacteremia from a urinary source in CAUTI relative to that in CAABU. Second, we investigated whether the presence or absence of urinary symptoms in catheterized patients with bacteriuria was associated with bacteremia from any source or mortality. Finally, we explored the effect of antimicrobial treatment of bacteriuria on subsequent bacteremia from any source and mortality.Design.We performed a retrospective cohort study with 30 days of follow-up after an initial positive urine culture. CAUTI and CAABU were defined by Infectious Diseases Society of America guidelines.Setting. A large tertiary care facility.Patients.All inpatients with a urinary catheter (external or indwelling) and a positive urine culture between October 2010 and June 2011.Results.We captured 444 episodes of catheter-associated bacteriuria in 308 patients; 128 (41.6%) patients had CAUTI, and 180 (58.4%) had CAABU. Three episodes of bacteriuria were followed by bacteremia from a urinary source (0.7%). CAUTI, rather than CAABU, was associated with bacteremia from any source, but neither CAUTI nor CAABU predicted subsequent mortality. Use of antimicrobial agents to treat bacteriuria was not associated with either bacteremia from any source or mortality.Conclusions.Bacteremia from a urinary source was infrequent, and there was no evidence of an association of mortality with symptomatic versus asymptomatic bacteriuria in this population. Antibiotic treatment of bacteriuria did not affect outcomes.

scholarly journals 1371. Trends in Antibiotic Resistance Among Uropathogens in the Pediatric Population: A Single Center Experience in the US

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S695-S695
Author(s):  
Leena B Mithal ◽  
Sebastian Otero ◽  
Shan Sun ◽  
Mehreen Arshad
Keyword(s):  
Antibiotic Resistance ◽  
Urine Culture ◽  
Pediatric Population ◽  
Tertiary Care ◽  
Fourth Generation ◽  
Care Hospital ◽  
Beta Lactams ◽  
Positive Urine Culture ◽  
Positive Urine ◽  
Tract Infections

Abstract Background Urinary tract infections (UTIs) are common infections in children. Overuse of antibiotics has led to an increasing prevalence of antibiotic resistance among uropathogens in adults; however, data on pediatric trends have not been previously reported. Our objective was to characterize antibiotic resistance trends in uropathogens among children at a tertiary care hospital in a diverse urban US city. Methods Positive urine culture data (>20,000 CFU/ml) from January 1st, 2010 through December 31st, 2019 were obtained from the electronic medical records (inpatient and outpatient). Yearly antibiotic agent-specific resistance rates were calculated based on culture, patient, and organism level data. Results A total of 7,512 patients had ≥1 positive urine culture, with 13,327 positive individual cultures. The average age at sample collection was 6 yrs (IQR 2-11). Overall, 66% of cultures showed resistance to at least 1 antibiotic. Ampicillin resistance (50.1% IQR: 48.2%-52.4%) was the most common and remained stable over the study period. However, resistance against amoxicillin-sulbactam, third and fourth generation cephalosporins, and fluoroquinolones has increased significantly over this period (Figure 1). There was also a corresponding increase in the prevalence of extended spectrum beta-lactamase (ESBL) Enterobacteriaceae (Figure 2). Among infants < 1 year, a similar trend in increasing resistance against beta-lactams was noted (ampicillin-sulbactam 0% to 38%, ceftriaxone 0% to 9% and cefepime 0% to 4%, Figure 3). Figure 1 Figure 2 Figure 3 Conclusion There are rising rates of antibiotic resistance to broad spectrum antibiotics, including beta-lactams and quinolones, in a pediatric population over the last 10 years, with a notable increase in resistance starting in 2015-2016. While we were not able to distinguish patients with community acquired UTI, the increase in resistance among infants < 1 year suggests a community reservoir of multi-drug resistant gram-negative bacteria. Colonization by resistant uropathogens has implications for empiric antibiotic choice, limited oral therapy options, and clinical outcomes which necessitate further study. Disclosures All Authors: No reported disclosures

Temporary Central Venous Catheter Utilization Patterns in a Large Tertiary Care Center Tracking the “Idle Central Venous Catheter”

2012 ◽  
Vol 33 (1) ◽  
pp. 50-57 ◽  
Author(s):  
Sheri Chernetsky Tejedor ◽  
David Tong ◽  
Jason Stein ◽  
Christina Payne ◽  
Daniel Dressler ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Observational Study ◽  
Dwell Time ◽  
Antimicrobial Agents ◽  
Tertiary Care ◽  
Care Facility ◽  
Venous Catheter ◽  
Retrospective Observational Study ◽  
Central Venous ◽  
Tertiary Care Facility

Objectives.Although central venous catheter (CVC) dwell time is a major risk factor for catheter-related bloodstream infections (CR-BSIs), few studies reveal how often CVCs are retained when not needed (“idle”). We describe use patterns for temporary CVCs, including peripherally inserted central catheters (PICCs), on non-ICU wards.Design.A retrospective observational study.Setting.A 579-bed acute care, academic tertiary care facility.Methods.A retrospective observational study of a random sample of patients on hospital wards who have a temporary, nonimplanted CVC, with a focus on on daily ward CVC justification. A uniform definition of idle CVC-days was used.Results.We analyzed 89 patients with 146 CVCs (56% of which were PICCs); of 1,433 ward CVC-days, 361 (25.2%) were idle. At least 1 idle day was observed for 63% of patients. Patients had a mean of 4.1 idle days and a mean of 3.4 days with both a CVC and a peripheral intravenous catheter (PIV). After adjusting for ward length of stay, mean CVC dwell time was 14.4 days for patients with PICCs versus 9.0 days for patients with non-PICC temporary CVCs (other CVCs; P< .001). Patients with a PICC had 5.4 days in which they also had a PIV, compared with 10 days in other CVC patients (P< .001). Patients with PICCs had more days in which the only justification for the CVC was intravenous administration of antimicrobial agents (8.5 vs 1.6 days; P = .0013).Conclusions.Significant proportions of ward CVC-days were unjustified. Reducing “idle CVC-days” and facilitating the appropriate use of PIVs may reduce CVC-days and CR-BSI risk.Infect Control Hosp Epidemiol 2012;33(1):50-57

scholarly journals Evaluation of Asymptomatic Bacteruria Management Before and After Antimicrobial Stewardship Program Implementation: Retrospective Study

2021 ◽  
Author(s):  
Ahlam Alghamdi ◽  
Majed Almajed ◽  
Raneem Alalawi ◽  
Amjad Alganame ◽  
Shorooq Alanazi ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Program Implementation ◽  
Urine Culture ◽  
Asymptomatic Bacteriuria ◽  
Antimicrobial Stewardship Program ◽  
Positive Urine Culture ◽  
Inappropriate Use ◽  
Stewardship Program ◽  
Positive Urine ◽  
Before And After

Abstract BackgroundThe Infectious Diseases Society of America (IDSA) recommends against screening for and/or treating asymptomatic bacteriuria (ASB). This study aims to evaluate the inappropriate use of antibiotics in ASB before and after Antimicrobial Stewardship Program implementation and advance towards its appropriate use. MethodWe performed a retrospective study of patients diagnosed with ASB from 2016 to 2019 at a tertiary hospital in Saudi Arabia. This study included hospitalized patients ≥18 years old who had a positive urine culture with no signs or symptoms of urinary tract infection and were on antibiotics for asymptomatic bacteriuria. We excluded pregnant women, solid organ transplant patients, patient on active chemotherapy, and patients about to undergo urological surgery.ResultsA total of 716 patients with a positive urine culture were screened . Among these, we identified 109 patients with ASB who were enrolled in our study. The rate of inappropriate antibiotic use was 95% during the study period. The implementation of the Antimicrobial Stewardship Program was associated with a significant reduction in the use of carbapenems (P = 0.04) and an increase in the use of cephalosporins (P = .099687). However, overprescribing antimicrobial agents was a concern in both eras. Approximately 90% of the microorganisms identified were gram-negative bacteria. Of those, 38.7% were multidrug-resistant strains. ConclusionThe urine culture order in ASB is considered relatively small number; however, it showed a high rate of the inappropriate use of antibiotics when there is an order of urine culture in both era. ASP ought to focus on targeting the ordering physician, promoting awareness and/or organizational interventions that appear to reduce the incidence of overtreatment.

scholarly journals A study on the bacteriological profile of urinary tract infection in adults and their antibiotic sensitivity pattern in a tertiary care hospital in central Kerala, India

2017 ◽  
Vol 5 (2) ◽  
pp. 666 ◽  
Author(s):  
Jubina Bency A. T. ◽  
Priyanka R. ◽  
Ponnu Jose
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Antimicrobial Agents ◽  
Urine Culture ◽  
Antibiotic Sensitivity ◽  
Positive Urine Culture ◽  
E Coli ◽  
Sensitivity Pattern ◽  
Positive Urine ◽  
Culture And Sensitivity

Background: Urinary tract infection is one of the most common bacterial infections in humans and a major cause of morbidity. The etiology of UTI and the antibiotic sensitivity pattern varies with the widespread availability of antimicrobial agents; UTI has become difficult to treat because of appearance of pathogens with increasing resistance to antimicrobial agents.Methods: A descriptive study done during January-June 2013. All positive urine culture and sensitivity reports of males and females aged 20-70years were included. A total of 373 positive urine culture cases were taken from the culture and sensitivity register from Microbiology department and details were entered using a questionnaire.Results: Out of 373 adults, males were 137 (36.7%) and females were 236 (63.3%). E. coli (74.3 %) was the most common organism, followed by Klebsiella (15.8%), Enterococcus, Pseudomonas and Staphylococcus. The incidence of UTI was more in patients in the age group of 60-70years. E. coli and Klebsiella were sensitive to Amikacin (97.1%), Nitrofurantoin (90.7%), Gentamycin and Imipenem. Both organisms were resistant to Ampicillin (>90%).Conclusions: In this study, females were mostly affected and the most common organisms were E.Coli and Klebsiella. These organisms were most sensitive to Amikacin, Nitrofurantoin and resistant predominantly to Ampicillin. The sensitivity and resistance pattern of uropathogens to common antimicrobial agents must be taken into account when selecting treatment plans for UTI.

scholarly journals An Evaluation of the Management of Asymptomatic Catheter-Associated Bacteriuria and Candiduria at The Ottawa Hospital

2005 ◽  
Vol 16 (3) ◽  
pp. 166-170 ◽  
Author(s):  
Dawn M Dalen ◽  
Rosemary K Zvonar ◽  
Peter G Jessamine
Keyword(s):  
Antimicrobial Agents ◽  
Urine Culture ◽  
Positive Urine Culture ◽  
Indwelling Catheter ◽  
Heart Institute ◽  
Ottawa Hospital ◽  
Positive Urine ◽  
Low Incidence ◽  
Tract Infections ◽  
The University

BACKGROUND: Asymptomatic catheter-associated urinary tract infections (CAUTIs) are common in hospitalized patients. They are associated with a low incidence of sequelae and morbidity, and in most patients resolve spontaneously on removal of the catheter. As a result, it is not recommended that asymptomatic catheter-associated bacteriuria or candiduria be treated with antimicrobial agents while the catheter remains in place because it may lead to the evolution of resistant flora.OBJECTIVE: To assess the current management of patients with CAUTIs with respect to antimicrobial therapy at The Ottawa Hospital and the University of Ottawa Heart Institute, Ottawa, Ontario.METHODS: A prospective observational study over a period of 26 consecutive days was conducted at The Ottawa Hospital (General and Civic campuses) and the University of Ottawa Heart Institute. Inpatients with an indwelling catheter, a positive urine culture and the absence of UTI signs or symptoms were assessed. Patients were followed for five days to determine whether antimicrobials were prescribed.RESULTS: From March 3 to March 28, 2003, 29 of 119 patients screened met inclusion criteria. Of these 29 patients, 15 (52%) were prescribed antimicrobials and were therefore considered to be inappropriately managed. Differences were observed between the appropriate and inappropriate management groups in terms of duration of stay to positive urine culture and whether yeast or bacteria were isolated from the culture.CONCLUSION: Antimicrobial agents were prescribed in over one-half of CAUTI cases, contrary to recommendations from the literature. Education is required to bring this strongly supported recommendation into clinical practice.

scholarly journals Predictors of Hospital-Acquired Urinary Tract–Related Bloodstream Infection

2012 ◽  
Vol 33 (10) ◽  
pp. 1001-1007 ◽  
Author(s):  
M. Todd Greene ◽  
Robert Chang ◽  
Latoya Kuhn ◽  
Mary A. M. Rogers ◽  
Carol E. Chenoweth ◽  
...  
Keyword(s):  
Risk Factors ◽  
Urinary Tract ◽  
Bloodstream Infection ◽  
Urine Culture ◽  
Conditional Logistic Regression ◽  
Tertiary Care ◽  
Incidence Density ◽  
Care Hospital ◽  
Positive Urine Culture ◽  
Positive Urine

Objective.Bloodstream infection (BSI) secondary to nosocomial urinary tract infection is associated with substantial morbidity, mortality, and additional financial costs. Our objective was to identify predictors of nosocomial urinary tract-related BSI.Design.Matched case-control study.Setting.Midwestern tertiary care hospital.Patients.Casesn= 298) were patients with a positive urine culture obtained more than 48 hours after admission and a blood culture obtained within 14 days of the urine culture that grew the same organism. Controls (n= 667), selected by incidence density sampling, included patients with a positive urine culture who were at risk for BSI but did not develop one.Methods.Conditional logistic regression and classification and regression tree analyses.Results.The most frequently isolated microorganisms that spread from the urinary tract to the bloodstream wereEnterococcusspecies. Independent risk factors included neutropenia (odds ratio [OR], 10.99; 95% confidence interval [CI], 5.78-20.88), renal disease (OR, 2.96; 95% CI, 1.98-4.41), and male sex (OR, 2.18; 95% CI, 1.52-3.12). The probability of developing a urinary tract-related BSI among neutropenic patients was 70%. Receipt of immunosuppressants (OR, 1.53; 95% CI, 1.04-2.25), insulin (OR, 4.82; 95% CI, 2.52-9.21), and antibacterials (OR, 0.66; 95% CI, 0.44-0.97) also significantly altered risk.Conclusions.The heightened risk of urinary tract-related BSI associated with several comorbid conditions suggests that the management of nosocomial bacteriuria may benefit from tailoring to certain patient subgroups. Consideration of time-dependent risk factors, such as medications, may also help guide clinical decisions in reducing BSI.Infect Control Hosp Epidemiol2012;33(10):1001-1007

scholarly journals Asymptomatic bacteriuria: Impact of an antimicrobial stewardship bundle to reduce unnecessary antibiotics in patients without urinary catheters

2021 ◽  
Author(s):  
Matthew Rico ◽  
Rand Sulaiman ◽  
Rachel MacLeod
Keyword(s):  
Antimicrobial Stewardship ◽  
Primary Outcome ◽  
Antimicrobial Agents ◽  
Urine Culture ◽  
Asymptomatic Bacteriuria ◽  
Urinary Catheters ◽  
Positive Urine Culture ◽  
Significant Difference ◽  
Quasi Experimental ◽  
The Difference

Abstract Purpose The purpose of this study was to evaluate the effect of an antimicrobial stewardship bundle on the management of asymptomatic bacteriuria (ASB). Methods In this quasi-experimental study, patients were selected by retrospective, consecutive sampling of patients with a positive urine culture report in 3 separate groups: preintervention, postdiagnostic intervention, and posteducation. Patients met the prespecified criteria for non–catheter-associated ASB. The diagnostic intervention involved a new urinalysis/urine culture ordering process in place of urinalysis with reflex to urine culture. Additionally, an educational intervention involved pharmacist-led sessions to educate providers with patient cases and guideline-based recommendations. The primary outcome of this study was the difference in the rate of inappropriate management of ASB, defined as the use of antimicrobial agents intended to treat ASB. Secondary outcomes included length of antimicrobial therapy, length of stay, and change in urine culture orders per 1,000 patient-days. Results A total of 120 patients were included. There was a significant reduction in the inappropriate management of ASB between the preintervention and postdiagnostic intervention groups (P = 0.0349). This was not seen when comparing the postdiagnostic intervention and posteducation groups (P = 0.93). Additionally, there was a significant difference in urinalysis/urine culture ordering between the preintervention and postdiagnostic intervention groups (370 vs 224 urinalysis orders per 1,000 days present, P &lt; 0.0001; 131 vs 54 urine culture orders per 1,000 days present, P &lt; 0.0001). Conclusion An antimicrobial stewardship bundle involving a diagnostic stewardship intervention and pharmacist-led education reduced treatment of ASB in patients without urinary catheters.

scholarly journals 1470. Linezolid for Treatment of Urinary Tract Infections Caused by Vancomycin-resistant Enterococci

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S537-S537
Author(s):  
Benjamin Pontefract ◽  
Karl Madaras-Kelly
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Urine Culture ◽  
Oral Treatment ◽  
Asymptomatic Bacteriuria ◽  
Negative Outcomes ◽  
Positive Urine Culture ◽  
Positive Urine ◽  
Vancomycin Resistant ◽  
Tract Infections

Abstract Background Urinary tract infections (UTI) caused by vancomycin-resistant enterococcus (VRE) are difficult to manage due to lack of effective oral treatment options. Linezolid is an antibiotic with activity against VRE that is available orally, but only 30% of each dose is excreted in the urine. Data on the efficacy of linezolid in the treatment of UTI is limited. The purpose of this analysis was to assess the comparative efficacy of linezolid to other VRE-active antibiotics in the treatment of UTI. Methods A national retrospective cohort of inpatient veterans with a positive urine culture for VRE during years 2013 through 2018 was developed. Patient demographics, vital signs, urinary symptoms, antibiotics prescribed, and 14-day post-treatment outcomes were collected. Patients without UTI symptoms, urine cultures with < 105 CFU/mL (<103 CFU/mL for catheterized patients), or patients not treated with VRE-active antibiotics were excluded. Odds ratios were used to compare linezolid and non-linezolid antibiotics for 14-day VRE bacteriuria, UTI retreatment, and death endpoints. Results Of 3,846 urine cultures identified with VRE, 624 (16%) patients were eligible for evaluation of UTI symptoms. Of these, 92/624 (15%) met study criteria. The primary reason for exclusion was asymptomatic bacteriuria [339/532 (64%)]. Linezolid was prescribed in 54/92 (59%) of cases. Comparators included penicillin’s [12/92 (13%)], nitrofurantoin [11/92 (12%)], daptomycin [7/92 (8%)], tetracycline’s [6/92 (7%)], and others [2/92 (2%)]. Between linezolid and comparator groups, mean (+S.D.) patient age [70 (12) vs. 68 (13) years, P = 0.45] and Charlson Comorbidity Index [8.9 (3.1) vs. 8.3 (3.5), P = 0.39] were similar. Negative outcomes were uncommon: 7% VRE bacteriuria, 8% UTI re-treatment, 4% death. No difference in [(OR) +95% CI] between linezolid and comparators was observed: positive VRE bacteriuria [0.3 (0.1, 1.9), P = 0.20], UTI retreatment [1.8 (0.3, 10.0), P = 0.49], death [1.4 (0.1, 16.1), P = 0.79]. Conclusion Most patients with a VRE positive urine culture who received antibiotics did not meet diagnostic criteria for UTI, and negative outcomes were uncommon. Linezolid and comparator regimens with VRE activity were effective for treating mild VRE UTI. Disclosures All authors: No reported disclosures.

scholarly journals A STUDY ON THE BACTERIOLOGICAL PROFILE OF URINARY TRACT INFECTION INADULTS AND THEIR ANTIMICROBIAL SENSITIVITY PATTERN IN DMCH, LAHERIASARAI, BIHAR

2020 ◽  
pp. 31-32
Author(s):  
Neha Jha ◽  
R. S. Prasad ◽  
P. N. Jha ◽  
Debarshi Jana
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Antimicrobial Agents ◽  
Urine Culture ◽  
Positive Urine Culture ◽  
E Coli ◽  
Antimicrobial Sensitivity ◽  
Sensitivity Pattern ◽  
Positive Urine ◽  
Culture And Sensitivity

Background: Urinary tract infection is one of the most common bacterial infections in humans and a major cause of morbidity. The etiology of UTI and the antimicrobial sensitivity pattern varies with the widespread availability of antimicrobial agents; UTI has become difficult to treat because of appearance of pathogens with increasing resistance to antimicrobial agents. Methods: A descriptive study done during January 2020 to June 2020. All positive urine culture and sensitivity reports of males and females aged 20-70years were included. A total of 373 positive urine culture cases were taken from the culture and sensitivity register from Microbiology department and details were entered using a questionnaire. Results: Out of 373 adults, males were 137 (36.7%) and females were 236 (63.3%). E. coli (74.3 %) was the most common organism, followed by Klebsiella (15.8%), Enterococcus, Pseudomonas and Staphylococcus. The incidence of UTI was more in patients in the age group of 60-70years. E. coli and Klebsiella were sensitive to Amikacin (97.1%), Nitrofurantoin (90.7%), Gentamycin and Imipenem. Both organisms were resistant to Ampicillin (>90%). Conclusions: In this study, females were mostly affected and the most common organisms were E.Coli and Klebsiella. These organisms were most sensitive to Amikacin, Nitrofurantoin and resistant predominantly to Ampicillin. The sensitivity and resistance pattern of uropathogens to common antimicrobial agents must be taken into account when selecting treatment plans for UTI.

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