A new paper in Infection Control and Hospital Epidemiology takes us another step closer to reclassifying CAUTI from a healthcare associated infection to a healthcare associated myth. Tom Fraser and colleagues at the Cleveland Clinic worked with their ICUs to reach consensus to limit urine cultures in patients with fever to kidney transplant recipients, neutropenic patients, patients with recent GU surgery, and patients with evidence of urinary tract obstruction. One year later, here’s what they found:
  • There was no significant change in urinary catheter utilization (approximately 70% of patient days were associated with catheter use 1 year before and after implementation of changes in ordering urine cultures).
  • The number of urine cultures ordered fell by ~50%.
  • The CAUTI rate fell from 3.0 to 1.9/1,000 catheter days, a significant reduction of 33%.
  • There was no change in the rate of healthcare associated bloodstream infections, and no change in the subset due to Enterobacteriacae, which implies that there was no increase in bacteremic urinary tract infections. The potential for bacteremia is a major reason for treating CAUTI.
A similar study from Mayo Clinic showed similar findings (50% reduction in urine cultures ordered and a 30% reduction in CAUTI).

It would be interesting to know how many cases of C. difficile have been caused by treating this noninfection, or as the Cleveland authors call it, “an artificial construct designed to reflect clinical events for surveillance purposes.” And as we become more serious about antibiotic stewardship, “CAUTI” should be viewed as low hanging fruit.

In previous posts on this blog (here and here) there have been discussions questioning the existence of CAUTI. We now seem to be reaching a tipping point where it’s becoming increasingly clear that the opportunity cost of this medicalized artificial construct outweighs the benefit of continued focus.


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