CAUTI: A diagnosis in search of a disease

Last month, we had a series of posts on CAUTI that generated a great deal of interest. Yesterday, a reader of the blog alerted me to a recently published paper that I hadn't seen on the implementation of a CAUTI prevention bundle at the Mayo Clinic. Like the recent NEJM paper led by U. of Michigan investigators on CAUTI reduction, this was a quasi-experimental before and after study; however, it was performed in a single center. The reduction in CAUTI was substantial at 30%. Importantly, the Mayo bundle was implemented after successfully reducing urinary catheter utilization, and it contained a critical component not found in the Michigan bundle: culturing urine only when the indication was clear. In addition to education, the EMR interface forced providers ordering a urine culture on a patient with a urinary catheter to specify the indication for the culture. The pick list options were: fever in a kidney tranplant recipient; fever in a pregnant patient; neutropenic fever; fever after urologic procedure/surgery; fever and known urinary tract obstruction; unexplained suprapubic or flank pain; spinal cord injury patient with new or worsening spasticity, autonomic hyperreflexia, maliase, lethargy, or sense of unease; at admission of chronically catheterized patient with new fever or unexplained mental status changes; septic shock; or other (free text). The impact of this change in the EMR resulted in a 50% reduction in urine cultures obtained, and suggests that we significantly overdiagnose CAUTI.

CAUTI increasingly appears to be a diagnosis in search of a disease. Will our delusional obscession with it ever end?