Urinary tract infections in hospital patients with urinary catheters are especially costly and harmful if complicated by bacteremia. The mortality rate from bacteremia secondary to catheter-associated urinary tract infection (CAUTI) is 12.7%. Studies of independent risk factors for bacteremia secondary to CAUTI conducted to date are severely limited by potential confounding and small sample sizes. These studies have not adjusted for patients' severity of illness and have not examined duration of catheterization. Reports of the incidence of bacteremia secondary to CAUTI are inconsistent; estimates vary by a factor of 10. In short, there is a tremendous knowledge gap regarding the incidence and risk factors for secondary bacteremia among patients with CAUTI.
The specific aim of this proposed research is to describe the incidence and risk factors for secondary bacteremia among adult patients with nosocomial CAUTI. The study uses a unique comprehensive and validated dataset that merges clinical and administrative data for a large, heterogenous sample of patients from 3 hospitals over 3 years (>250,000 discharges). The sample will include all patients who developed CAUTI. The design will be matched case-control; cases will be patients with CAUTI who developed secondary bacteremia, and controls will be patients with CAUTI who did not develop secondary bacteremia. Cases and controls will be matched on severity of illness and age within 10 years. Multivariate regression analysis will be employed to examine the independent effects of multiple concurrent risk factors (i.e., gender, medications, comorbidities, duration of catheterization). Results will enable clinicians to direct interventions such as early catheter removal, in and out catheterization, and use of condom catheters instead of indwelling urethral catheters, to patients at highest risk for bacteremia secondary to CAUTI. Results will expand and refine current evidence and serve as a basis for interventional studies to reduce these infections.
The aim of the study is closely aligned with the mission of the National Institut of Nursing Research to prevent disease and build the scientific basis for clinical practice. CAUTI are nursing-sensitive outcomes - measures of the quality of care that will be publicly reported beginning in 2014. The planned study is a logical progression in the principal investigator's (PI) emerging program of research in healthcare-associated infections. It is central to the PI's goals for this National Research Service Award fellowship, which are to conduct strong, ethical research that contributes generalizable knowledge to nursing science; to use research results to positively influence the quality of healthcare delivery; and to prepare for an academic career to support the growth of the nursing workforce.
This research will describe the risk factors for developing a bloodstream infection among hospitalized patients with a urinary tract infection associated with bladder catheterization. Knowing which patients are at risk will provide evidence-based guidance to clinicians for removal indwelling catheters as early as possible, or using an alternative like a condom catheter. These actions have the potential to reduce rates of morbidity and mortality in hospitalized patients with urinary catheters.
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