Detection and management of catheter-associated urinary tract infections: an audit of clinical practice in a district general hospital

Abstract number: P682

Pollara G., Sivananthan A., Schwenk A., Adhami Z.

Objectives: Urinary catheters introduce a portal for invasion by infectious organisms, resulting in catheter associated urinary tract infections (CAUTI), the source of 8% of hospital acquired bacteraemia. North Middlesex University Hospital, London, UK guidelines on managing CAUTI indicated the need for catheter change and sensitivity-guided antibiotic usage, but did not focus on distinguishing between asymptomatic bacteriuria and septic patients. Thus, a clinical audit was carried out to identify clinical parameters involved in the detection and management of microbiologically confirmed catheter associated bacteriuria.

Methods: Patients were identified from catheter specimen urine (CSU) that had grown a single organism >10⁵ cfu/ml. Their medical records were then analysed to assess the parameters being audited: the indication for CSU collection (clinical suspicion, costovertebral tenderness or fever), change of catheter (+/- antibiotic prophylaxis) and antibiotic usage. Overall 41 patient records were collected over a 2 month period. 30/41 patients were female and the median age was 75 (range 38–98).

Results: Only 13/41 (32%) of samples originated from patients with possible symptomatic UTI. While 21/41 (52%) of catheters were removed, this occurred only in 6/13 (46%) of patients where symptomatic infection was suspected. Furthermore, 15 catheters were removed when not clinically indicated, and 6 of these were replaced, potentially introducing a second bacteraemic event. Of the 21 removed catheters, only 9 patients (43%) received gentamicin prophylaxis. With regards to treatment of suspected CAUTI, of the 20 patients that received antibiotics, only 8 (40%) had a clinical indication for doing so at the time of sample collection. Furthermore, there was no association between catheter removals and administration of antibiotics to treat a suspected UTI.

Conclusion: The variability in clinical practice identified by this audit have resulted in new hospital guidelines, specifying clear indications for CSU collection (fevers, localising tenderness, rigors) and gentamicin prophylaxis (history of CAUTI following catheter manipulation, recent catheterisation following urinary tract instrumentation, neutropaenia). An education programme has been rolled out to reinforce these new guidelines, prior to a comprehensive re-audit. This audit may serve as a template for other hospitals to compare local practice in the management of CAUTI to evidence based standards.