The development of a urinary tract infection is associated with increased mortality in trauma patients

J Trauma. 2011 Dec;71(6):1569-74. doi: 10.1097/TA.0b013e31821e2b8f.


Background: In October 2008, Medicare and Medicaid stopped paying for care associated with catheter-related urinary tract infections (UTIs). Although most clinicians agree UTIs are detrimental, there are little data to support this belief.

Methods: This is a retrospective review of trauma registry data from a Level I trauma center between 2003 and 2008. Two proportional hazards regressions were used for analyses. The first predicted acquisition of UTI as a function of indwelling urinary catheter use, adjusting for age, diabetes, gender, and injury severity. The second predicted hospital mortality as a function of UTI, covarying for age, gender, chronic obstructive pulmonary disease, congestive heart failure, hypertension, diabetes, pneumonia, and injury severity.

Results: After excluding patients who stayed in the hospital <3 days and those with a UTI on arrival, 5,736 patients were included in the study. Of these patients, 680 (11.9%) met criteria for a UTI, with 487 (71.6%) indwelling urinary catheter-related infections. Predictors of UTI included the interaction between age and gender (p = 0.0018), Injury Severity Score (p = 0.0021), and indwelling urinary catheter use (p < 0.001). The development of a UTI predicted the risk of in-hospital death as a patient's age increased (p = 0.002). Similar results were seen when only catheter-associated UTIs are included in the analysis.

Conclusions: Indwelling urinary catheter use is connected to the development of UTIs, and these infections are associated with a greater mortality as the age of a trauma patients increases.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Catheter-Related Infections / diagnosis
  • Catheter-Related Infections / epidemiology*
  • Catheter-Related Infections / therapy
  • Cause of Death
  • Comorbidity
  • Female
  • Follow-Up Studies
  • Hospital Mortality / trends*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Multiple Trauma / diagnosis
  • Multiple Trauma / epidemiology
  • Multiple Trauma / therapy
  • Registries
  • Retrospective Studies
  • Risk Assessment
  • Survival Analysis
  • Trauma Centers
  • Treatment Outcome
  • Urinary Catheterization / adverse effects*
  • Urinary Tract Infections / diagnosis
  • Urinary Tract Infections / epidemiology*
  • Urinary Tract Infections / therapy
  • Wounds and Injuries / diagnosis
  • Wounds and Injuries / epidemiology*
  • Wounds and Injuries / therapy