Infect Control Hosp Epidemiol. 2007 Dec;28(12):1367-1373. Epub 2007 Nov 1.

Does Catheter-Associated Urinary Tract Infection Increase Mortality in Critically Ill Patients?

Clec'h C, Schwebel C, Francais A, Toledano D, Fosse JP, Garrouste-Orgeas M, Azoulay E, Adrie C, Jamali S, Descorps-Declere A, Nakache D, Timsit JF, Cohen Y; OutcomeRea Study Group.
Medical-Surgical Intensive Care Unit (ICU), Avicenne Teaching Hospital, Bobigny, France.

OBJECTIVE : To produce an accurate estimate of the association between catheter-associated urinary tract infection (UTI) and intensive care unit (ICU) and hospital mortality, controlling for major confounding factors.Design. Nested case-control study in a multicenter cohort (the OutcomeRea database).

SETTING : Twelve French medical or surgical ICUs.

METHODS : All patients admitted between January 1997 and August 2005 who required the insertion of an indwelling urinary catheter. Patients who developed catheter-associated UTI (ie, case patients) were matched to control patients on the basis of the following criteria: sex, age (+/- 10 years), SAPS (Simplified Acute Physiology Score) II score (+/- 10 points), duration of urinary tract catheterization, and presence or absence of diabetes mellitus. The association of catheter-associated UTI with ICU and hospital mortality was assessed by use of conditional logistic regression.

RESULTS : Of the 3,281 patients who had an indwelling urinary catheter, 298 (9%) developed at least 1 episode of catheter-associated UTI. The incidence density of catheter-associated UTI was 12.9 infections per 1,000 catheterization-days. Crude ICU mortality rates were higher among patients with catheter-associated UTI, compared with those without catheter-associated UTI (32% vs 25%, P=.02); the same was true for crude hospital mortality rates (43% vs 30%, P<.01). After matching and adjustment, catheter-associated UTI was no longer associated with increased mortality (ICU mortality: odds ratio [OR], 0.846 [95% confidence interval {CI}, 0.659-1.086]; P=.19 and hospital mortality: OR, 0.949 [95% CI, 0.763-1.181]; P=.64).

CONCLUSION : After carefully controlling for confounding factors, catheter-associated UTI was not found to be associated with excess mortality among our population of critically ill patients in either the ICU or the hospital.