CAUTI ‘ought to be retired’ as hospital metric, knowledgeable says
Key takeaways:
- An knowledgeable at SHEA instructed utilizing catheter-associated micro organism as a metric for measuring hospital security as a substitute of CAUTI.
- Micro organism detected in urine typically is just not the reason for signs in a affected person, she stated.
ORLANDO — Utilizing catheter-associated urinary tract infections as a metric for care high quality misidentifies some infections, in response to an knowledgeable who argued that utilizing catheter-associated micro organism as a substitute is extra correct.
Catheter-associated urinary tract infections (CAUTIs) have been utilized by the CDC and others to measure the standard of care and an infection prevention at hospitals for almost 2 many years, in response to officers.
Though diagnostic stewardship targets encourage clinicians to keep away from cultures for asymptomatic infections, CAUTI monitoring efforts problem whether or not these checks ought to be executed. Picture: Adobe Inventory
Priya Sampathkumar, MD, professor of medication and infectious ailments advisor on the Mayo Clinic, stated throughout a presentation at SHEA Spring that though a affected person has an an infection found throughout CAUTI screening, that doesn’t essentially imply they’ve a UTI.
“The CAUTI metric ought to be retired,” Sampathkumar advised Healio. “The principle drawback I’ve is actually with using the time period urinary tract an infection. What we’re actually measuring is catheter-associated micro organism, and lowering that may be a laudable objective, however we’re working at cross functions once we’re calling it bacteriuria.”
CAUTI is the commonest kind of well being care-associated an infection (HAI), representing almost one-third of HAIs reported to the Nationwide Healthcare Security Community (NHSN), Sampathkumar stated throughout the presentation.
The NHSN in 2009 modified the definition of CAUTI to now not embody asymptomatic bacteriuria, requiring the reporting of solely symptomatic and bacteremic instances.
The change led to considerations that the brand new definition would complicate oversight of hospital-associated infections and the general high quality of care at amenities, though consultants additionally famous that treating fewer sufferers with antibiotics who’ve asymptomatic bacteriuria is a key a part of antimicrobial stewardship efforts.
Different consultants have instructed utilizing metrics such because the NHSN Standardized An infection Ratio or the Standardized Machine Utilization Ratio to higher measure the standard of care and differentiate between a UTI and different catheter-related well being occasions.
In keeping with the Company for Healthcare Analysis and High quality tips, that are much like these from the Infectious Ailments Society of America and the U.S. Protecting Companies Job Pressure, asymptomatic bacteriuria — a optimistic urine tradition from an individual with zero signs of a UTI — ought to, in almost all instances, not be handled with antibiotics.
In keeping with Sampathkumar, estimates have proven that greater than 13,000 deaths per 12 months are related to UTIs. Though CAUTI has been related to a big improve in mortality threat, she stated throughout the presentation that analyses which were adjusted for different consequence predictors counsel CAUTI is just not related to a rise in mortality.
UTIs general can result in poor outcomes if they aren’t handled, however Sampathkumar famous {that a} tradition of testing stewardship — resembling not testing for asymptomatic infections that clinicians is not going to be treating — gives a possibility to recreation the system: Simply skip the tradition.
In keeping with one research she famous, out of 105 CAUTIs reported in a hospital ICU within the earlier 2 years, simply over half had another an infection to elucidate fever, one of the vital widespread CAUTI signs. Moreover, 18% had a fever resulting from a noninfectious trigger, 32% had no various clarification and 6% have been related to optimistic blood cultures for a similar pathogen however the urinary tract was not definitively linked to the bloodstream an infection.
Sampathkumar argued that as a result of it’s unclear how strongly related CAUTI is with affected person hurt and the present definition of CAUTI additionally seems to negate efforts to cut back catheter use, it shouldn’t be used as a metric.
“The most effective methods to cut back [CAUTIs] is by not doing cultures,” Sampathkumar stated. “So we’re actually working at cross functions telling some people who that is one thing that’s actually dangerous and harms our sufferers and concurrently telling folks to not search for it by not doing cultures.”
References:
Sources/Disclosures
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Sampathkumar P. It’s time to retire CAUTI as a metric. Offered at: SHEA Spring; April 27-30, 2025; Orlando.
Disclosures:
Sampathkumar reviews no related monetary disclosures.
