TEMPORAL TRENDS, PREDICTORS, AND OUTCOMES OF CATHETER-ASSOCIATED URINARY TRACT INFECTIONS: A RETROSPECTIVE ANALYSIS FROM THE NATIONAL INPATIENT SAMPLE DATABASE (2011-2018)

Background: Catheter associated urinary tract infection (CAUTI) is a leading cause of hospital acquired infections. In this analysis, we aim to examine the incidence of CAUTI over the last 8 years and potential social determinants of health that lend to increasing mortality and morbidity during inpatient hospitalizations.

Methods: Patient data was collected for years 2011-2018 from the National inpatient database (NIS) using International Classification of Disease-Revision Codes (ICD-9 and 10). We selected patients hospitalized with a diagnosis of CAUTI. Separately, Urinary Bladder and Bladder Neck Catheter procedure codes were tabulated among all hospitalized patients. Multivariate hierarchical logistic regression was used to determine predictors of mortality, length of stay (LOS), and hospital charges in CAUTI patients. We separately analyzed the patients for presence of comorbidities, acute kidney injury (AKI), and septic shock.

Results: The study included 137857 patients with a diagnosis of CAUTI. 43367 had underlying AKI while 11099 had Septic Shock. The mean age of patients with CAUTI was 70.38 while the mean age of those who died was 74.99, P < 0.001. There were 63.5% males vs 36.4% females. Caucasian was the predominant racial subgroup with 97114, (70.4%). The presence of AKI and septic shock in patients with CAUTI increased mortality risk by approximately by 213% and 596% respectively via adjusted odds ratio (CI 1.99-2.27 and 5.56-6.40 respectively, P< 0.001). Females had a 34% increased risk of mortality compared to men via adjusted odds ratios (1.257-1.43, P < 0.001). Increased mortality risk was additionally observed in patients with Medicaid and Private Insurance compared to Medicare patients with adjusted odds ratios of 15.3% and 29.1% respectively (CI 1.001-1.329 P = 0.048 and CI 1.41-1.45, P< 0.001 respectively). Mean LOS and hospital charges were significantly higher in deceased CAUTI patients (7.97 vs 12.4 days and 61397$ vs 136085$ respectively). No statistically significant difference in mortality was observed over time via one way ANOVA testing. There was a decreasing trend in urinary catheter placement denoted by separate procedure code abstraction, showing discordance with mildly elevated CAUTI incidence over 8 years.

Conclusions: We observed significantly higher hospital mortality in female patients diagnosed with CAUTI compared to males. Additionally, we observed an overall mild increase in CAUTI incidence, however there was no statistically significant change in mortality over time. There additionally was discordance in the amount of urinary catheters placed and the overall mildly increasing trend in CAUTI prevalence, possibly signifying improved indication utilization of urinary catheter placement over time.