Incidence and risk factors for acquiring nosocomial urinary tract infection in the critically ill.
OBJECTIVE
A urinary tract infection (UTI) is the most common hospital-acquired infection. However, the epidemiology of intensive care unit (ICU)-acquired UTIs is not well defined. The objective of this study was to describe the incidence, risk factors, and clinical outcomes of ICU-acquired UTIs.


METHODS
All patients admitted to adult multidisciplinary ICUs in the Calgary Health Region (CHR, population approximately 1 million) during May 1, 1999 to April 30, 2000 were studied using a cohort design.


RESULTS
A total of 1,158 admissions to a CHR ICU were 48 hours in duration or more. A total of 111 episodes of ICU-acquired UTI (defined as >10(5) CFU/mL of 1 or 2 organisms >48 hours after ICU admission) occurred in 105 (9%) patients and 5 (0.4%) had ICU-acquired bacteremic/fungemic UTIs for incidences of 11.3 and 0.5 UTIs per 1,000 ICU days, respectively. Significant independent risk factors for developing an ICU-acquired UTI as determined by a logistic regression model were female gender (adjusted odds ratio [OR(adj)], 2.31; 95% confidence interval [CI], 1.48-3.59) and natural logarithmic transformation of ICU length of stay (OR(adj), 3.96; 95% CI, 3.02-5.17). No differences in admitting vital signs, routine blood tests, APACHE II and TISS scores, or overall hospital mortality rate were observed among patients who developed an ICU-acquired UTI as compared with those who did not. The most common UTI etiologies were Enterococcus spp. (24%), Candida albicans (21%), and Escherichia coli (15%). Only 4 (3%) of the organisms were highly antibiotic resistant.


CONCLUSIONS
Nosocomial UTIs develop commonly in the critically ill and women and those with an extended ICU stay are at increased risk. Although ICU-acquired UTIs are markers of morbidity, they do not significantly increase mortality.
Laupland
Kevin B
KB
Division of Critical Care Medicine, University of Calgary, Calgary Health Region, Canada.
Zygun
David A
DA
Davies
H Dele
HD
Church
Deirdre L
DL
Louie
Thomas J
TJ
Doig
Christopher J
CJ
D018806:APACHE; D000328:Adult; D000368:Aged; D000416:Alberta / Q000453:epidemiology; D016638:Critical Illness; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000592:standards / Q000706:statistics & numerical data*; D008875:Middle Aged; D012307:Risk Factors; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000382:microbiology