Hospital-onset bacteremia, fungemia common among patients with UTI
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Key takeaways:
- The overall rate of hospital-onset bacteremia and fungemia that was likely secondary to HOUTI was 3.7%.
- Secondary HOB were more common among patients with non-CAUTI HOUTIs compared CAUTI.
Non-catheter-associated hospital-onset were a common source for hospital-onset bacteremia and fungemia and associated with longer hospital stays and higher hospital costs, researchers found.
“The CDC has made public plans to enable volunteer reporting of hospital-onset bacteremia and fungemia (HOB) events to the National Healthcare Safety Network [NHSN] this calendar year on the heels of last year’s independent review and endorsement by Battelle of HOB as a potential CMS quality metric,” Kalvin Yu, MD, vice president of U.S. medical affairs at Becton, Dickinson and Company, told Healio.
“However, the attributable major sources of HOB events are less well studied," Yu said.
To assess the rate of HOB secondary to catheter-associated urinary tract infection (CAUTI) and non-CAUTI hospital-onset (HOUTI), Yu and colleagues conducted a retrospective observational study of patients from 43 acute-care hospitals.
According to the study, CAUTI cases were defined as those reported to the NHSN, whereas non-CAUTI HOUTI was defined as a positive, noncontaminated, noncommensal culture collected on day 3 or later with a new antibiotic prescribed. Study outcomes assessed by the researchers included secondary HOB, total hospital costs, length of stay (LOS), readmission risk and mortality.
Among 549,433 admissions, 434 CAUTIs and 3,177 non-CAUTI HOUTIs were recorded. The researchers determined that secondary HOB were more common in non-CAUTI HOUTIs compared with CAUTI (101 vs. 34) and that the overall rate of HOB that was likely secondary to HOUTI was 3.7%.
The study also demonstrated that CAUTI was associated with adjusted incremental total hospital cost and an LOS of $9,807 (< .0001) and 3.01 days (P < .0001), whereas non-CAUTI HOUTIs were associated with adjusted incremental total hospital cost and LOS of $6,874 (P < .0001) and 2.97 days (P < .0001).
“As a former hospital administrator, I know infection prevention and antimicrobial stewardship programs tend to not be well-funded; if they are funded, articulating targeted metrics of success using real-world evidence tends to be a challenge,” Yu said.
“In this paper, we quantify the added LOS and cost of care for both CAUTI and, uniquely, non-CAUTI hospital-onset UTIs. We clarify to what degree both contribute to HOB bloodstream events which carry with it higher mortality and readmission rates compared to just urine infections," he said.
Yu said that by clarifying urine as a large source of HOB, he hopes they provide the evidence and outcomes data needed for infection prevention and antimicrobial stewardship programs to form more targeted patient safety programs addressing not only CAUTI/non-catheter UTIs but also to get a head start on tackling HOB in the process.
“If you talk to any infectious disease clinician, a bloodstream infection is at the top of the list of things to avoid so moving further upstream in that disease state process could be interesting in a up study,” he concluded.
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