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Expanded UTI surveillance needed in discharged patients
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Study findings showed that health care-associated, community-onset UTIs — or HA-CO UTIs — may be common within 30 days of hospital discharge, suggesting a need for expanded surveillance, researchers wrote in Infection Control & Hospital Epidemiology.
Health care-associated UTI surveillance currently targets hospital-onset catheter-associated UTIs, according to Jessina C. McGregor, PhD, FSHEA, associate professor at Oregon State University College of Pharmacy, and colleagues. But McGregor and colleagues said the full burden of health care-associated UTIs is not represented through this surveillance.
“Every health care-associated infection represents an undesirable patient outcome. If people are still at risk for those types of infections after they leave the hospital, then health care-associated infection research should focus more broadly than the current definitions of surveillance definitions,” McGregor said in a news release. “We need more data to stimulate innovation for better informing patient care and preventing these types of infections."
The researchers conducted a retrospective cohort study to measure the incidence of community-onset UTIs that may have potentially been acquired in the health care setting. The study included 3,273 hospitalized adult patients aged 18 years or older at risk for HA-CO UTIs who were admitted to the Department of Family Medicine at Oregon Health and Science University between May 2009 and December 2011.
McGregor and colleagues reported an incidence of 29.8 HA-CO UTIs per 1,000 patients in the 30 days after discharge — 72.2% of all hospital-associated UTIs. The incidence of health care-associated, hospital-onset UTIs was 10.6 per 1,000 patients.
According to the study, independent risk factors for HA-CO UTIs included paraplegia or quadriplegia (adjusted OR = 4.6; 95% CI, 1.2-18), indwelling catheter during index hospitalization (aOR = 1.5; 95% CI, 1-2.3), prior piperacillin-tazobactam prescription (aOR = 2.3; 95% CI, 1.1-4.5), prior penicillin class prescription (aOR, 1.7; 95% CI, 1-2.8) and private insurance (aOR = 0.6; 95% CI, 0.4-0.9).
McGregor and colleagues also suggested that improved surveillance may better inform antibiotic prescribing practices, specifically for patients with a history of hospitalization.
“Patients who got sick after discharge had similar pathogens and antibiotic sensitivities to those who got sick while still in the hospital, which suggests that patients developing a UTI following discharge may need different treatment strategies than patients who develop UTIs that aren't associated with hospital stays,” McGregor said. – by Marley Ghizzone
Disclosures: McGregor reports receiving research funding from Merck. All other authors’ report no relevant financial disclosures.
Perspective
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Raghavendra Tirupathi, MD, FACP
Current National Healthcare Safety Network health care-associated UTI criteria specifically state that surveillance for health care-associated UTI after the patient is discharged from the facility is not required. Hence, current surveillance efforts by infection prevention teams are inadequate in capturing infections with onset after discharge, as reflected by this retrospective single-center study by Elman and colleagues. This is also partly true for other health care-associated infections (HAIs), such as Clostridioides difficile infection. The article showed that the problem is underestimated, which could potentially lead to poorly targeted infection prevention measures both locally and nationally. In the era of shorter hospital stays, patients with HAIs could become symptomatic after discharge. In this study, most patients with HA-CO UTIs were symptomatic in the first 2 weeks after discharge.
The study also points out another interesting fact — that the uropathogens and their microbial susceptibilities in HA-CO UTI cases were similar to those of health care-onset UTI cases, indicating that the treatment options for these patients could be very different from those of patients with typical community-onset UTIs. This is especially relevant to hospitals with a high incidence of multidrug-resistant organisms.
Health care-associated UTIs constitute a significant proportion of HAIs. A robust and comprehensive surveillance and quantification system that factors in the post-discharge-onset infections is the cornerstone on which to build further research and innovation in the prevention of health care-associated UTIs.
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