Longer Duration of Urinary Catheterization Increases Catheter-Associated Urinary Tract Infection in PICU

Objectives: Catheter-associated urinary tract infections account for 30% of healthcare-associated infections. To date, few studies have addressed pediatric catheter-associated urinary tract infection in PICUs. The aim of our study was to assess the risk of catheter-associated urinary tract infection in relation to the duration of catheterization in the PICU. Design: Retrospective cohort study. Setting: PICU at a tertiary children’s hospital. Patients: Our study was conducted between April 2012 and June 2015 at Tokyo Metropolitan Children’s Medical Center in Japan. Children in the PICU with an urethral catheter were included. Catheter-associated urinary tract infection cases were defined according to the National Healthcare Safety Network criteria. The patients’ demographic data and isolated organisms were reviewed. Duration of catheterization and the catheter-associated urinary tract infection occurrence rate were analyzed. Interventions: None. Measurements and Main Results: Among 1,890 catheterizations, 23 catheter-associated urinary tract infection cases were identified. The overall occurrence rate was 2.35/1,000 catheter-days. Among the patients with catheter-associated urinary tract infection, 13 were boys. The median age was 11 months (interquartile range, 7–35 mo), and the median duration of catheterization was 7 days (interquartile range, 5–12 d). The isolated bacteria were Escherichia coli (26.5%), Enterococcus faecalis (17.6%), and Klebsiella pneumoniae (11.8%). Two species were isolated in each of 11 cases (47.8%). Each additional day of catheterization increased the risk of catheter-associated urinary tract infection (odds ratio, 1.06; 95% CI, 1.02–1.10, and odds ratio adjusted for contact precaution status and surgical procedures was 1.05; 95% CI, 1.01–1.09). Conclusions: Longer duration of catheterization increased the risk of catheter-associated urinary tract infection by 5% each day at the PICU. Prompt removal of the urethral catheter is strongly recommended whenever feasible. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (https://ift.tt/2gIrZ5Y). Dr. Horikoshi’s institution received funding from a MOH&LW science grant, a Tokyo project grant, and a Ministry of Health, Labour and Welfare National Center for Child Health and Development grant, and he received funding from Pfizer for lecture honorarium, Japan vaccine for lecture honorarium, Sumitomo Dainippon Pharm for lecture honorarium, Abbvie GK for lecture honorarium, Astellas Pharm for article writing fee, Maruho Co for lecture honorarium, JCR Pharm for lecture honorarium, and Taisho Toyama Pharm for lecture honorarium. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: kahoru_fukuoka@tmhp.jp ©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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