title: The development of a urinary tract infection is associated with increased mortality in trauma patients.
abstract: BACKGROUND
  In October 2008, Medicare and Medicaid stopped paying for care associated with catheter-related urinary tract infections (UTIs). Although most clinicians agree UTIs are detrimental, there are little data to support this belief.
  
  
  METHODS
  This is a retrospective review of trauma registry data from a Level I trauma center between 2003 and 2008. Two proportional hazards regressions were used for analyses. The first predicted acquisition of UTI as a function of indwelling urinary catheter use, adjusting for age, diabetes, gender, and injury severity. The second predicted hospital mortality as a function of UTI, covarying for age, gender, chronic obstructive pulmonary disease, congestive heart failure, hypertension, diabetes, pneumonia, and injury severity.
  
  
  RESULTS
  After excluding patients who stayed in the hospital <3 days and those with a UTI on arrival, 5,736 patients were included in the study. Of these patients, 680 (11.9%) met criteria for a UTI, with 487 (71.6%) indwelling urinary catheter-related infections. Predictors of UTI included the interaction between age and gender (p = 0.0018), Injury Severity Score (p = 0.0021), and indwelling urinary catheter use (p < 0.001). The development of a UTI predicted the risk of in-hospital death as a patient's age increased (p = 0.002). Similar results were seen when only catheter-associated UTIs are included in the analysis.
  
  
  CONCLUSIONS
  Indwelling urinary catheter use is connected to the development of UTIs, and these infections are associated with a greater mortality as the age of a trauma patients increases.
authors.affiliation: Division of Trauma and Surgical Critical Care, Department of Surgery, Warren Alpert School of Medicine, Rhode Island Hospital, Providence, Rhode Island 02903, USA.
authors.forename: Sean F
authors.initials: SF
authors.lastname: Monaghan
authors.forename: Daithi S
authors.initials: DS
authors.lastname: Heffernan
authors.forename: Rajan K
authors.initials: RK
authors.lastname: Thakkar
authors.forename: Steven E
authors.initials: SE
authors.lastname: Reinert
authors.forename: Jason T
authors.initials: JT
authors.lastname: Machan
authors.forename: Michael D
authors.initials: MD
authors.lastname: Connolly
authors.forename: Shea C
authors.initials: SC
authors.lastname: Gregg
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Kozloff
authors.forename: Charles A
authors.initials: CA
authors.lastname: Adams
authors.forename: William G
authors.initials: WG
authors.lastname: Cioffi
mesh_terms: D000328:Adult; D055499:Catheter-Related Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D002423:Cause of Death; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D014193:Trauma Centers; D016896:Treatment Outcome; D014546:Urinary Catheterization / Q000009:adverse effects*; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D014947:Wounds and Injuries / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy