Healthcare-associated urinary tract infections with onset post hospital discharge

Miriam R. Elman, Craig D. Williams, David T. Bearden, John Townes, John Heintzman, Jodi Lapidus, Ravina Kullar, Sheila Markwardt, Amanda T. Trieu, Arrash A. Vahidi, Jessina C. Mcgregor

Research output: Contribution to journalArticle

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Abstract

Objective: Current surveillance for healthcare-associated (HA) urinary tract infection (UTI) is focused on catheter-associated infection with hospital onset (HO-CAUTI), yet this surveillance does not represent the full burden of HA-UTI to patients. Our objective was to measure the incidence of potentially HA, community-onset (CO) UTI in a retrospective cohort of hospitalized patients.Design: Retrospective cohort study.Setting: Academic, quaternary care, referral center.Patients: Hospitalized adults at risk for HA-UTI from May 2009 to December 2011 were included.Methods: Patients who did not experience a UTI during the index hospitalization were followed for 30 days post discharge to identify cases of potentially HA-CO UTI.Results: We identified 3,273 patients at risk for potentially HA-CO UTI. The incidence of HA-CO UTI in the 30 days post discharge was 29.8 per 1,000 patients. Independent risk factors of HA-CO UTI included paraplegia or quadriplegia (adjusted odds ratio [aOR], 4.6; 95% confidence interval [CI], 1.2-18.0), indwelling catheter during index hospitalization (aOR, 1.5; 95% CI, 1.0-2.3), prior piperacillin-tazobactam prescription (aOR, 2.3; 95% CI, 1.1-4.5), prior penicillin class prescription (aOR, 1.7; 95% CI, 1.0-2.8), and private insurance (aOR, 0.6; 95% CI, 0.4-0.9).Conclusions: HA-CO UTI may be common within 30 days following hospital discharge. These data suggest that surveillance efforts may need to be expanded to capture the full burden to patients and better inform antibiotic prescribing decisions for patients with a history of hospitalization.

Original languageEnglish (US)
Pages (from-to)863-871
Number of pages9
JournalInfection control and hospital epidemiology
Volume40
Issue number8
DOIs
StatePublished - Aug 1 2019

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Cross Infection
Urinary Tract Infections
Delivery of Health Care
Odds Ratio
Confidence Intervals
Hospitalization
Prescriptions
Catheter-Related Infections
Quadriplegia
Indwelling Catheters
Paraplegia
Incidence
Insurance
Penicillins
Cohort Studies
Referral and Consultation
Retrospective Studies
Anti-Bacterial Agents

ASJC Scopus subject areas

  • Epidemiology
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Healthcare-associated urinary tract infections with onset post hospital discharge. / Elman, Miriam R.; Williams, Craig D.; Bearden, David T.; Townes, John; Heintzman, John; Lapidus, Jodi; Kullar, Ravina; Markwardt, Sheila; Trieu, Amanda T.; Vahidi, Arrash A.; Mcgregor, Jessina C.

In: Infection control and hospital epidemiology, Vol. 40, No. 8, 01.08.2019, p. 863-871.

Research output: Contribution to journalArticle

Elman, MR, Williams, CD, Bearden, DT, Townes, J, Heintzman, J, Lapidus, J, Kullar, R, Markwardt, S, Trieu, AT, Vahidi, AA & Mcgregor, JC 2019, 'Healthcare-associated urinary tract infections with onset post hospital discharge', Infection control and hospital epidemiology, vol. 40, no. 8, pp. 863-871. https://doi.org/10.1017/ice.2019.148
Elman, Miriam R. ; Williams, Craig D. ; Bearden, David T. ; Townes, John ; Heintzman, John ; Lapidus, Jodi ; Kullar, Ravina ; Markwardt, Sheila ; Trieu, Amanda T. ; Vahidi, Arrash A. ; Mcgregor, Jessina C. / Healthcare-associated urinary tract infections with onset post hospital discharge. In: Infection control and hospital epidemiology. 2019 ; Vol. 40, No. 8. pp. 863-871.
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abstract = "Objective: Current surveillance for healthcare-associated (HA) urinary tract infection (UTI) is focused on catheter-associated infection with hospital onset (HO-CAUTI), yet this surveillance does not represent the full burden of HA-UTI to patients. Our objective was to measure the incidence of potentially HA, community-onset (CO) UTI in a retrospective cohort of hospitalized patients.Design: Retrospective cohort study.Setting: Academic, quaternary care, referral center.Patients: Hospitalized adults at risk for HA-UTI from May 2009 to December 2011 were included.Methods: Patients who did not experience a UTI during the index hospitalization were followed for 30 days post discharge to identify cases of potentially HA-CO UTI.Results: We identified 3,273 patients at risk for potentially HA-CO UTI. The incidence of HA-CO UTI in the 30 days post discharge was 29.8 per 1,000 patients. Independent risk factors of HA-CO UTI included paraplegia or quadriplegia (adjusted odds ratio [aOR], 4.6; 95{\%} confidence interval [CI], 1.2-18.0), indwelling catheter during index hospitalization (aOR, 1.5; 95{\%} CI, 1.0-2.3), prior piperacillin-tazobactam prescription (aOR, 2.3; 95{\%} CI, 1.1-4.5), prior penicillin class prescription (aOR, 1.7; 95{\%} CI, 1.0-2.8), and private insurance (aOR, 0.6; 95{\%} CI, 0.4-0.9).Conclusions: HA-CO UTI may be common within 30 days following hospital discharge. These data suggest that surveillance efforts may need to be expanded to capture the full burden to patients and better inform antibiotic prescribing decisions for patients with a history of hospitalization.",
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AU - Elman, Miriam R.

AU - Williams, Craig D.

AU - Bearden, David T.

AU - Townes, John

AU - Heintzman, John

AU - Lapidus, Jodi

AU - Kullar, Ravina

AU - Markwardt, Sheila

AU - Trieu, Amanda T.

AU - Vahidi, Arrash A.

AU - Mcgregor, Jessina C.

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N2 - Objective: Current surveillance for healthcare-associated (HA) urinary tract infection (UTI) is focused on catheter-associated infection with hospital onset (HO-CAUTI), yet this surveillance does not represent the full burden of HA-UTI to patients. Our objective was to measure the incidence of potentially HA, community-onset (CO) UTI in a retrospective cohort of hospitalized patients.Design: Retrospective cohort study.Setting: Academic, quaternary care, referral center.Patients: Hospitalized adults at risk for HA-UTI from May 2009 to December 2011 were included.Methods: Patients who did not experience a UTI during the index hospitalization were followed for 30 days post discharge to identify cases of potentially HA-CO UTI.Results: We identified 3,273 patients at risk for potentially HA-CO UTI. The incidence of HA-CO UTI in the 30 days post discharge was 29.8 per 1,000 patients. Independent risk factors of HA-CO UTI included paraplegia or quadriplegia (adjusted odds ratio [aOR], 4.6; 95% confidence interval [CI], 1.2-18.0), indwelling catheter during index hospitalization (aOR, 1.5; 95% CI, 1.0-2.3), prior piperacillin-tazobactam prescription (aOR, 2.3; 95% CI, 1.1-4.5), prior penicillin class prescription (aOR, 1.7; 95% CI, 1.0-2.8), and private insurance (aOR, 0.6; 95% CI, 0.4-0.9).Conclusions: HA-CO UTI may be common within 30 days following hospital discharge. These data suggest that surveillance efforts may need to be expanded to capture the full burden to patients and better inform antibiotic prescribing decisions for patients with a history of hospitalization.

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