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A Prospective Study of 1497 Catheterized Patients

Paul A. Tambyah, MBBS; Dennis G. Maki, MD

Arch Intern Med. 2000;160:678-682.

Background  Catheter-associated urinary tract infection (CAUTI) is the most common nosocomial infection, accounting for more than 1 million cases each year in US hospitals and nursing homes.

Objective  To define the clinical features of CAUTI.

Setting and Patients  A university hospital; 1497 newly catheterized patients.

Design  Every day that the catheter was in place, a quantitative urine culture and urine leukocyte count were obtained, and the patient was queried by a research worker regarding symptoms. To more precisely define the role of CAUTI in patients' symptoms, a subset of 1034 patients, 89 of whom developed CAUTI with more than 10³ colony-forming units per milliliter, who did not have another potentially confounding site of infection besides the urinary tract, was analyzed.

Outcome Measures  Presence of fever, symptoms commonly associated with community-acquired urinary tract infection, and peripheral leukocytosis.

Results  There were 235 new cases of nosocomial CAUTI during the study period. More than 90% of the infected patients were asymptomatic; only 123 infections (52%) were detected by patients' physicians using the hospital laboratory. In the subset analysis, there were no significant differences between patients with and without CAUTI in signs or symptoms commonly associated with urinary tract infection—fever, dysuria, urgency, or flank pain—or in leukocytosis. Only 1 of the 235 episodes of CAUTI that were prospectively studied was unequivocally associated with secondary bloodstream infection.

Conclusions  Whereas CAUTls are a major reservoir of antibiotic-resistant organisms in the hospital, they are rarely symptomatic and infrequently cause bloodstream infection. Symptoms referable to the urinary tract, fever, or peripheral leukocytosis have little predictive value for the diagnosis of CAUTI.

From the Section of Infectious Diseases, Department of Medicine, University of Wisconsin Medical School, Madison.

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