DETERMINATION AND EVALUATION OF FACTORS ASSOCIATED WITH CATHETER-ASSOCIATED URINARY TRACT INFECTIONS AMONG ELDERLY NEUROSURGICAL PATIENTS

Abstract

Catheter-associated urinary tract infections (CAUTI) are a cause of complications among neurosurgical patients, leading to greater morbidity and mortality.  In this study, we aimed to determine and evaluate the factors significantly associated with CAUTI among elderly neurosurgical patients at the study institution in order to inform preventive measures and optimize patient care by identifying modifiable and non-modifiable factors associated with CAUTI.  Inclusion criteria for study subjects were being a neurosurgical patient aged ≥60 years with an indwelling urinary catheter for ≥48 hours, having a negative urine culture on admission and in whom the complete medical records were available to review.  Exclusion criteria were having abnormal coagulation testing, severe autoimmune disease or an endocrine disease.  Subjects were divided into those with and without a CAUTI, and the final outcome, including death, was recorded.  The criteria for a CAUTI were having a symptomatic urinary tract infection in a patient with an indwelling urinary catheter or developing an infection within 48 hours of catheter removal.  This study was a retrospective review of patient charts.  Multivariate logistic regression analysis was used to determine independent and dependent factors significantly associated with a CAUTI among study subjects.  The following factors were significantly associated with a CAUTI on multivariate logistic regression analysis: a Glasgow Coma Scale (GCS) score <8 (adjusted odds ratio (aOR): 4.079, 95% confidence interval (CI): 1.156-14.393, p = 0.029), having diabetes mellitus (aOR: 2.822, 95% CI: 1.200-6.632, p = 0.017), having a urinary catheter for ≥7 days (aOR: 2.952, 95% CI: 1.115-7.810, p = 0.029), having a D-dimer level >0.5 mg/ml (aOR: 2.704, 95% CI: 1.146-6.381, p = 0.023), having undergone bladder irrigation (aOR: 3.179, 95%CI: 1.396-7.235, p = 0.006) and receiving ≥2 types of antibiotics during hospitalization (aOR: 2.873, 95% CI: 1.247-6.620, p = 0.013).  In summary, a number of factors were significantly associated with a CAUTI, some of which are modifiable.  We conclude urinary catheters should be removed prior to 7 days where possible and bladder irritation should be avoided.  Those with non-modifiable risk factors should be monitored regularly for a urinary tract infection.  Further studies are needed to determine if making these modifications in this study population can reduce the incidence of CAUTI.