title: Catheter-associated urinary tract infection: Role of the setting of catheter insertion.
abstract: BACKGROUND
  This study aimed to describe the epidemiology of catheter-associated urinary tract infections (CAUTIs) in patients admitted to a surgical ward in Central Italy and to analyze the associated risk factors.
  
  
  METHODS
  An active surveillance program for CAUTI was carried out in patients catheterized for at least 48 hours. Place of catheter insertion (operating room, hospital ward, cystoscopy room, emergency care unit), indication for catheterization and its duration, among other risk factors were monitored until discharge. Antibiotic resistance profiles of isolates were analyzed.
  
  
  RESULTS
  There were 641 catheterized patients monitored for CAUTI onset. Of these, 40 (6.2%) developed a CAUTI (rates were 15.1/1,000 catheter days, 95% confidence interval [CI], 11.9-22.6; 8.7/1,000 patient days, 95% CI, 6.9-13.1). Patients with CAUTI were older (P < .05) and their durations of hospitalization and catheterization were both longer compared with those who were not affected (P < .05). Catheterization >4 days (odds ratio [OR] = 8.21; 95% CI, 3.79-17.73; P < .05) and place of catheter insertion different from the operating room (OR = 7.9; 95% CI, 2.83-22.08; P < .05, for catheters placed in the ward) were associated with CAUTI. Among the micro-organisms isolated in CAUTIs, the most common were Pseudomonas aeruginosa (41.5%), Klebsiella pneumoniae (19.5%), and Escherichia coli (12.2%); 82.5% of them were resistant to different classes of antibiotics.
  
  
  CONCLUSIONS
  These results highlight the role played by the setting of catheter insertion in CAUTIs onset, therefore reflecting the importance of hand hygiene and proper aseptic insertion techniques as crucial determinants in CAUTIs prevention.
authors.affiliation: Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy; Services Department, Hospital Hygiene Unit, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy.
authors.forename: Pamela
authors.initials: P
authors.lastname: Barbadoro
authors.affiliation: Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Francesco M
authors.initials: FM
authors.lastname: Labricciosa
authors.affiliation: Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Recanatini
authors.affiliation: Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Giada
authors.initials: G
authors.lastname: Gori
authors.affiliation: Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Tirabassi
authors.affiliation: Services Department, Hospital Hygiene Unit, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy.
authors.forename: Enrica
authors.initials: E
authors.lastname: Martini
authors.affiliation: Services Department, Hospital Hygiene Unit, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Gioia
authors.affiliation: Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy; Services Department, Hospital Hygiene Unit, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy. Electronic address: igiene.ricerca@gmail.com.
authors.forename: Marcello M
authors.initials: MM
authors.lastname: D'Errico
authors.affiliation: Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy; Services Department, Hospital Hygiene Unit, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy.
authors.forename: Emilia
authors.initials: E
authors.lastname: Prospero
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification; D016022:Case-Control Studies; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000382:microbiology; D002404:Catheterization / Q000379:methods*; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012307:Risk Factors; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000382:microbiology
keywords: Catheter-associated urinary tract infection; Health care–associated infection; Risk factor; Surveillance