infection control and hospital epidemiology december 2007, vol. 28, no. 12
Does Catheter-Associated Urinary Tract Infection Increase Mortality in Critically Ill Patients?
Christophe Clec’h, MD; Carole Schwebel, MD; Adrien Franc¸ais, MSc; Dany Toledano, MD; Jean-Philippe Fosse, MD;
Maı¨te´ Garrouste-Orgeas, MD; Elie Azoulay, MD, PhD; Christophe Adrie, MD, PhD; Samir Jamali, MD;
Adrien Descorps-Declere, MD; Didier Nakache, PhD; Jean-Franc¸ois Timsit, MD, PhD;
Yves Cohen, MD; on behalf of the OutcomeRea Study Group
objective. To produce an accurate estimate of the association between catheter-associated urinary tract infection (UTI) and intensive
care unit (ICU) and hospital mortality, controlling for major confounding factors.
design. Nested case-control study in a multicenter cohort (the OutcomeRea database).
setting. Twelve French medical or surgical ICUs.
methods. All patients admitted between January 1997 and August 2005 who required the insertion of an indwelling urinary catheter.
Patients who developed catheter-associated UTI (ie, case patients) were matched to control patients on the basis of the following criteria:
sex, age (_ 10 years), SAPS (Simplified Acute Physiology Score) II score (_ 10 points), duration of urinary tract catheterization, and
presence or absence of diabetes mellitus. The association of catheter-associated UTI with ICU and hospital mortality was assessed by use
of conditional logistic regression.
results. Of the 3,281 patients who had an indwelling urinary catheter, 298 (9%) developed at least 1 episode of catheter-associated
UTI. The incidence density of catheter-associated UTI was 12.9 infections per 1,000 catheterization-days. Crude ICU mortality rates were
higher among patients with catheter-associated UTI, compared with those without catheter-associated UTI (32% vs 25%, Pp.02); the
same was true for crude hospital mortality rates (43% vs 30%, P ! .01). After matching and adjustment, catheter-associated UTI was no
longer associated with increased mortality (ICU mortality: odds ratio [OR], 0.846 [95% confidence interval {CI}, 0.659-1.086]; Pp.19
and hospital mortality: OR, 0.949 [95% CI, 0.763-1.181]; Pp.64).
conclusion. After carefully controlling for confounding factors, catheter-associated UTI was not found to be associated with excess
mortality among our population of critically ill patients in either the ICU or the hospital.
references
1. Eriksen HM, Iversen BG, Aavitsland P. Prevalence of nosocomial infections in hospitals in Norway, 2002 and 2003. J Hosp Infect 2005; 60:40-45.
2. Lizioli A, Privitera G, Alliata E, et al. Prevalence of nosocomial infections in Italy: result from the Lombardy survey in 2000. J Hosp Infect 2003;54:141-148.
3. Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infectionsin combined medical-surgical intensive care units in the United States.Infect Control Hosp Epidemiol 2000; 21:510-515.
4. Vincent JL, Bihari DJ, Suter PM, et al. The prevalence of nosocomial infection in intensive care units in Europe: results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International
Advisory Committee. JAMA 1995; 274:639-644.
5. Platt R, Polk BF, Murdock B, Rosner B. Mortality associated with nosocomial urinary-tract infection. N Engl J Med 1982; 307:637-642.
6. Rosenthal VD, Guzman S, Orellano PW. Nosocomial infections in medical- surgical intensive care units in Argentina: attributable mortality and length of stay. Am J Infect Control 2003; 31:291-295.
Does Catheter-Associated Urinary Tract Infection Increase Mortality in Critically Ill Patients?
Christophe Clec’h, MD; Carole Schwebel, MD; Adrien Franc¸ais, MSc; Dany Toledano, MD; Jean-Philippe Fosse, MD;
Maı¨te´ Garrouste-Orgeas, MD; Elie Azoulay, MD, PhD; Christophe Adrie, MD, PhD; Samir Jamali, MD;
Adrien Descorps-Declere, MD; Didier Nakache, PhD; Jean-Franc¸ois Timsit, MD, PhD;
Yves Cohen, MD; on behalf of the OutcomeRea Study Group
objective. To produce an accurate estimate of the association between catheter-associated urinary tract infection (UTI) and intensive
care unit (ICU) and hospital mortality, controlling for major confounding factors.
design. Nested case-control study in a multicenter cohort (the OutcomeRea database).
setting. Twelve French medical or surgical ICUs.
methods. All patients admitted between January 1997 and August 2005 who required the insertion of an indwelling urinary catheter.
Patients who developed catheter-associated UTI (ie, case patients) were matched to control patients on the basis of the following criteria:
sex, age (_ 10 years), SAPS (Simplified Acute Physiology Score) II score (_ 10 points), duration of urinary tract catheterization, and
presence or absence of diabetes mellitus. The association of catheter-associated UTI with ICU and hospital mortality was assessed by use
of conditional logistic regression.
results. Of the 3,281 patients who had an indwelling urinary catheter, 298 (9%) developed at least 1 episode of catheter-associated
UTI. The incidence density of catheter-associated UTI was 12.9 infections per 1,000 catheterization-days. Crude ICU mortality rates were
higher among patients with catheter-associated UTI, compared with those without catheter-associated UTI (32% vs 25%, Pp.02); the
same was true for crude hospital mortality rates (43% vs 30%, P ! .01). After matching and adjustment, catheter-associated UTI was no
longer associated with increased mortality (ICU mortality: odds ratio [OR], 0.846 [95% confidence interval {CI}, 0.659-1.086]; Pp.19
and hospital mortality: OR, 0.949 [95% CI, 0.763-1.181]; Pp.64).
conclusion. After carefully controlling for confounding factors, catheter-associated UTI was not found to be associated with excess
mortality among our population of critically ill patients in either the ICU or the hospital.
references
1. Eriksen HM, Iversen BG, Aavitsland P. Prevalence of nosocomial infections in hospitals in Norway, 2002 and 2003. J Hosp Infect 2005; 60:40-45.
2. Lizioli A, Privitera G, Alliata E, et al. Prevalence of nosocomial infections in Italy: result from the Lombardy survey in 2000. J Hosp Infect 2003;54:141-148.
3. Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infectionsin combined medical-surgical intensive care units in the United States.Infect Control Hosp Epidemiol 2000; 21:510-515.
4. Vincent JL, Bihari DJ, Suter PM, et al. The prevalence of nosocomial infection in intensive care units in Europe: results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International
Advisory Committee. JAMA 1995; 274:639-644.
5. Platt R, Polk BF, Murdock B, Rosner B. Mortality associated with nosocomial urinary-tract infection. N Engl J Med 1982; 307:637-642.
6. Rosenthal VD, Guzman S, Orellano PW. Nosocomial infections in medical- surgical intensive care units in Argentina: attributable mortality and length of stay. Am J Infect Control 2003; 31:291-295.