In the JournalsPerspective

More than 70% of UTIs are non-device associated

Paula D. Strassle, PhD, MSPH
Paula D. Strassle

Researchers found that more than 70% of UTIs at University of North Carolina hospitals were non-device associated, according to recently published study findings.

“Over the past few decades substantial efforts have been made to reduce the incidence of catheter-associated urinary tract infections (CAUTIs) in the United States, with great success. However, these interventions mainly focus on the placement, maintenance, removal and properties of indwelling urinary catheters,” Paula D. Strassle, PhD, MSPH, assistant professor in the department of epidemiology at the University of North Carolina at Chapel Hill, told Infectious Disease News. “Unsurprisingly, these interventions have had no impact on the rates of non-device associated UTIs (ND-UTIs), and there is a paucity of research on these infections. So, as part of my dissertation work, I sought to update the data on the trends of ND-UTIs and identify potential risk factors for these infections.”

Strassle and colleagues obtained electronic medical records of adults aged 18 years or older admitted to the University of North Carolina Hospitals between Jan. 1, 2013 and Dec. 31, 2017 from the Carolina Data Warehouse for Health.

According to the data, between 2013 and 2017, the rate of ND-UTIs remained stable at roughly six infections per 10,000 hospitalization days, but the proportion of UTIs that were non-device associated increased from 52% to 72%. The researchers found that female sex, older age, paralysis, immunosuppression, opioid use, total parenteral nutrition, and trauma admission were markers for increased risk for infection.

According to the study, urinary retention (HR, 1.41; 95% CI, 0.96-2.07), suprapubic catheters (HR 2.28; 95% CI, 0.88-5.91) and nephrostomy tubes (HR, 2.02; 95% CI, 0.83-4.93) also appeared to be markers of increased risk, but estimates were imprecise. Strassle said several of these are also risk factors for CAUTI (eg, female sex, paralysis, immunosuppression), suggesting that some patients may be at higher risk for UTI, irrespective of whether they require an indwelling urinary catheter during their hospitalization.

“The majority of health care-associated UTIs now appear to be non-device associated, and they largely occur outside of the of ICU. This suggests that targeted surveillance may need to be reconsidered in light of this changing landscape, as we would miss most UTIs using currently recommended strategies,” Strassle concluded. “Additionally, further research is needed to identify risk factors and prevention strategies for non-device associated UTIs, and opioid use, suprapubic catheterization, and nephrostomy tubes may be potential targets.” – by Caitlyn Stulpin

Disclosures: Strassle reports no relevant financial disclosures.

Paula D. Strassle, PhD, MSPH
Paula D. Strassle

Researchers found that more than 70% of UTIs at University of North Carolina hospitals were non-device associated, according to recently published study findings.

“Over the past few decades substantial efforts have been made to reduce the incidence of catheter-associated urinary tract infections (CAUTIs) in the United States, with great success. However, these interventions mainly focus on the placement, maintenance, removal and properties of indwelling urinary catheters,” Paula D. Strassle, PhD, MSPH, assistant professor in the department of epidemiology at the University of North Carolina at Chapel Hill, told Infectious Disease News. “Unsurprisingly, these interventions have had no impact on the rates of non-device associated UTIs (ND-UTIs), and there is a paucity of research on these infections. So, as part of my dissertation work, I sought to update the data on the trends of ND-UTIs and identify potential risk factors for these infections.”

Strassle and colleagues obtained electronic medical records of adults aged 18 years or older admitted to the University of North Carolina Hospitals between Jan. 1, 2013 and Dec. 31, 2017 from the Carolina Data Warehouse for Health.

According to the data, between 2013 and 2017, the rate of ND-UTIs remained stable at roughly six infections per 10,000 hospitalization days, but the proportion of UTIs that were non-device associated increased from 52% to 72%. The researchers found that female sex, older age, paralysis, immunosuppression, opioid use, total parenteral nutrition, and trauma admission were markers for increased risk for infection.

According to the study, urinary retention (HR, 1.41; 95% CI, 0.96-2.07), suprapubic catheters (HR 2.28; 95% CI, 0.88-5.91) and nephrostomy tubes (HR, 2.02; 95% CI, 0.83-4.93) also appeared to be markers of increased risk, but estimates were imprecise. Strassle said several of these are also risk factors for CAUTI (eg, female sex, paralysis, immunosuppression), suggesting that some patients may be at higher risk for UTI, irrespective of whether they require an indwelling urinary catheter during their hospitalization.

“The majority of health care-associated UTIs now appear to be non-device associated, and they largely occur outside of the of ICU. This suggests that targeted surveillance may need to be reconsidered in light of this changing landscape, as we would miss most UTIs using currently recommended strategies,” Strassle concluded. “Additionally, further research is needed to identify risk factors and prevention strategies for non-device associated UTIs, and opioid use, suprapubic catheterization, and nephrostomy tubes may be potential targets.” – by Caitlyn Stulpin

Disclosures: Strassle reports no relevant financial disclosures.

    Perspective
    Sonali Advani

    Sonali Advani

    Historically, the majority of health care-associated UTIs are considered to be CAUTIs. In a recent article published in Infection Control & Hospital Epidemiology, the authors highlight the trends and risk factors for ND-UTIs within the University of North Carolina Health Care System. The authors reviewed 1,273 UTIs (715 ND-UTIs and 558 CAUTIs) from all adult hospitalizations between 2013 and 2017. During the 5-year study period, the incidence of CAUTIs decreased, but rates of ND-UTIs remained consistent. Interestingly, the proportion of ND-UTIs increased from 52% to 72% (P < .0001). Risk factors for ND-UTIs in adjusted analysis included female sex, older age, peptic ulcer disease, paralysis, immunosuppression, opioid use, parenteral nutrition and trauma. Some of the limitations of the study include the use of surveillance definitions for UTIs, which may not correlate well with clinical definitions. Additionally, specific medications like opiates may also correlate with immobility or retention leading to a higher risk of UTIs. Despite these limitations, this study highlights the need to expand surveillance efforts to include ND-UTIs in light of the changing landscape.

    • Sonali Advani, MBBS, MPH
    • Associate medical director for infection prevention
      Yale New Haven Hospital
      Assistant professor of infectious Diseases
      Yale School of Medicine

    Disclosures: Advani reports no relevant financial disclosures.