Is a project needed to prevent urinary tract infection in patients admitted to spanish ICUs?

Abstract

Objective: To analyze epidemiological data of catheter-associated urinary tract infection (CAUTI) in critically ill patients admitted to Spanish ICUs in order to assess the need of implementing a nationwide intervention program to reduce these infections.

Design: Non-intervention retrospective annual period prevalence analysis.

Setting: Participating ICUs in the ENVIN-UCI multicenter registry between the years 2007-2016.

Patients: Critically ill patients admitted to the ICU with catheter-associated urinary tract infection (CAUTI).

Main variables: Incidence rates per 1,000 catheter-days; urinary catheter utilization ratio; proportion of CAUTIs in relation to total health care-associated infections (HAIs).

Results: A total of 187,100 patients, 137,654 (73.6%) of whom had a urinary catheter in place during 1,215,673 days (84% of days of ICU stay) were included. In 4,539 (3.3%) patients with urinary catheter, 4,977 CAUTIs were diagnosed (3.6 episodes per 100 patients with urinary catheter). The CAUTI incidence rate showed a 19% decrease between 2007 and 2016 (4.69 to 3.8 episodes per 1,000 catheter-days), although a sustained urinary catheter utilization ratio was observed (0.84 [0.82-0.86]). The proportion of CAUTI increased from 23.3% to 31.9% of all HAIs controlled in the ICU.

Conclusions: Although CAUTI rates have declined in recent years, these infections have become proportionally the first HAIs in the ICU. The urinary catheter utilization ratio remains high in Spanish ICUs. There is room for improvement, so that a CAUTI-ZERO project in our country could be useful.

Keywords: CAUTI Zero project; Catheter-associated urinary tract infection; Infección tracto urinario relacionada con sonda uretral; Intensive Care Unit; Proyecto ITU-Zero; Proyectos Zero; Unidad de Cuidados Intensivos; Zero projects.