Global burden, trends, and cross-country inequalities of urinary tract infections in adolescents and young adults, 1990 to 2019.

BACKGROUND: Limited studies have evaluated the global burden, trends, and cross-country inequalities for urinary tract infections (UTIs) in adolescents and young adults (AYAs). METHODS: Age-standardized incidence rate, age-standardized mortality rate, and age-standardized Disability-Adjusted Life Years (DALYs) rate were used to describe the UTI burden. The estimated annual percentage changes were calculated to evaluate the temporal trends from 1990 to 2019. The slope index of inequality and concentration index were utilized to quantify the distributive inequalities. RESULTS: From 1990 to 2019, a significant increase in age-standardized incidence rate (estimated annual percentage change =0.22%, 95% confidence interval 0.19%-0.26%) was found for UTIs in AYAs, and the increasing trend was more pronounced in males than females. Significant decreases in age-standardized mortality rate and age-standardized DALY rate were found in females but not in males. The slope index of inequality changed from 21.80 DALYs per 100,000 in 1990 to 20.91 DALYs per 100,000 in 2019 for UTIs in AYAs. Moreover, the concentration index showed -0.23 in 1990 and -0.14 in 2019. DISCUSSION: Countries with lower sociodemographic development levels shouldered a disproportionately higher UTI burden. CONCLUSIONS: UTIs remain an ongoing health burden for AYAs globally, with substantial heterogeneities found across countries, sex, and age groups.

PATHWAYS ASSOCIATED WITH POSITIVE SEPSIS SURVIVAL OUTCOMES IN AFRICAN AMERICAN/BLACK AND NON-HISPANIC WHITE PATIENTS WITH URINARY TRACT INFECTION.

ABSTRACT: Urinary tract infections (UTIs) are a common cause of sepsis worldwide. Annually, more than 60,000 US deaths can be attributed to sepsis secondary to UTIs, and African American/Black adults have higher incidence and case-fatality rates than non-Hispanic White adults. Molecular-level factors that may help partially explain differences in sepsis survival outcomes between African American/Black and Non-Hispanic White adults are not clear. In this study, patient samples (N = 166) from the Protocolized Care for Early Septic Shock cohort were analyzed using discovery-based plasma proteomics. Patients had sepsis secondary to UTIs and were stratified according to self-identified racial background and sepsis survival outcomes. Proteomics results suggest patient heterogeneity across mechanisms driving survival from sepsis secondary to UTIs. Differentially expressed proteins (n = 122, false discovery rate-adjusted P < 0.05) in Non-Hispanic White sepsis survivors were primarily in immune system pathways, while differentially expressed proteins (n = 47, false discovery rate-adjusted P < 0.05) in African American/Black patients were mostly in metabolic pathways. However, in all patients, regardless of racial background, there were 16 differentially expressed proteins in sepsis survivors involved in translation initiation and shutdown pathways. These pathways are potential targets for prognostic intervention. Overall, this study provides information about molecular factors that may help explain disparities in sepsis survival outcomes among African American/Black and Non-Hispanic White patients with primary UTIs.

Hospitalized Infections in Lupus: A Nationwide Study of Types of Infections, Time Trends, Health Care Utilization, and In-Hospital Mortality.

OBJECTIVE: To examine the time trends in hospitalized infections in patients with systemic lupus erythematosus (SLE), and the factors associated with health care utilization and in-hospital mortality. METHODS: US National Inpatient Sample data from 1998-2016 were used to examine the epidemiology, time trends, and outcomes of 5 common hospitalized infections in patients with SLE, namely, pneumonia, sepsis/bacteremia, urinary tract infection (UTI), skin and soft tissue infections (SSTIs), and opportunistic infections (OIs). Time trends were compared using the Cochran-Armitage test. Multivariable-adjusted logistic regression models were used to examine the factors associated with health care utilization (hospital stay >3 days, hospital charges above the median, or discharge to a nonhome setting) and in-hospital mortality. RESULTS: Hospitalization rates per 100,000 claims among SLE patients in 1998-2000 versus in 2015-2016 were as follows: for OIs, 1.13 versus 1.61 (1.2-fold increase); for SSTIs, 4.78 versus 12.2 (2.5-fold increase); for UTI, 1.94 versus 6.12 (3.2-fold increase); for pneumonia, 15.09 versus 17.05 (1.1-fold increase); and for sepsis, 6.31 versus 39.64 (6.3-fold increase). In 2011-2012, sepsis surpassed pneumonia as the most common hospitalized infection in patients with SLE. In multivariable-adjusted models, a diagnosis of sepsis, older age, a Deyo-Charlson common comorbidities score of ≥2, having Medicare or Medicaid insurance, and urban hospital location were significantly associated with increased odds of in-hospital mortality and with all health care utilization outcomes. African American race was significantly associated with increased odds of health care utilization. CONCLUSION: The results of this study indicate that the rates of hospitalized infections increased over time in patients with SLE, and that pneumonia was surpassed by sepsis as the most common hospitalized infection. In addition, associations of risk factors with poorer outcomes were identified. These findings may help inform patients, providers, and policy makers with regard to the burden of infection in SLE, and could lead to interventions/pathways to improve outcomes.

Impact of antibiotic treatment duration on outcomes in older men with suspected urinary tract infection: Retrospective cohort study.

PURPOSE: Clinical guidelines recommend at least 7 days of antibiotic treatment for older men with urinary tract infection (UTI). There may be potential benefits for patients, health services, and antimicrobial stewardship if shorter antibiotic treatment resulted in similar outcomes. We aimed to determine if treatment duration could be reduced by estimating risk of adverse outcomes according to different prescription durations. METHODS: This retrospective cohort study included men aged greater than or equal to 65 years old with a suspected UTI. We compared outcomes in men prescribed 3, 5, 7, and 8 to 14 days of antibiotic treatment in a multivariable logistic regression analysis and 3 versus 7 days in a propensity-score matched analysis. Our outcomes were reconsultation and represcription (proxy for treatment failure), hospitalisation for UTI, sepsis, or acute kidney injury (AKI), and death. RESULTS: Of 360 640 men aged greater than or equal to 65 years, 33 745 (9.4%) had a UTI. Compared with 7 days, men prescribed 3-day treatment had greater odds of reconsultation and represcription (adjusted OR 1.48; 95% CI, 1.25-1.74) but lower odds of AKI hospitalisation (adjusted OR 0.66; 95% CI, 0.45-0.97). We estimated that treating 150 older men with 3 days instead of 7 days of antibiotics could result in four extra reconsultation and represcriptions and one less AKI hospitalisation. We estimated annual prescription cost savings at around £2.2 million. CONCLUSIONS: Antibiotic treatment for older men with suspected UTI could be reduced to 3 days, albeit with a small increase in risk of treatment failure. A definitive randomised trial is urgently needed.

Risk factors for hospital-acquired non-catheter-associated urinary tract infection.

BACKGROUND AND PURPOSE: Nosocomial urinary tract infection in patients with no Foley catheter [non-catheter-associated urinary tract infection (non-CAUTI)] has been a serious health issue that is associated with an increase in the cost of care, morbidity, and mortality. Identifying the risk factors of non-CAUTI would help determine patients at high risk and prevent complications. This study aims to identify the risk factors of non-CAUTI. METHOD: This study was conducted in four hospitals in three Middle Eastern countries: Jordan, Qatar, and Saudi Arabia. A convenience sample of 189 participants was recruited, of which 83 had non-CAUTI. Case-control design was used. Patients who had non-CAUTI while hospitalized were compared with others who did not. A questionnaire was developed based on the non-CAUTI diagnostic criteria from the Centers for Disease Control and Prevention. The questionnaire contained two parts: part one included participants' characteristics and part two assessed the symptoms of non-CAUTI. CONCLUSION: Comorbidity is associated with a higher risk of having nosocomial non-CAUTI among hospitalized patients. This study showed that the diagnosis and management of comorbidity is important in lowering the risk of non-CAUTI in hospitalized patients. Age and antibiotic administration were statistically significant; however, their effects were small and were unlikely to have any clinical significance. IMPLICATION FOR PRACTICE: Identifying patients at high risk is imperative to prevent the development of non-CAUTI. Nurse practitioners may implement an early intervention for patients with comorbidity to counteract its effect on patients' health.

Urinary tract infection-related hospitalization among older adults receiving home health care.

BACKGROUND: Urinary tract infection (UTI)- related hospitalizations are a poor patient outcome in the rapidly growing home health care (HHC) arena that serves a predominantly elderly population. We examined the association between activities of daily living (ADL) and risk of UTI-related hospitalization among this population. METHODS: Using a retrospective cohort design, we conducted a secondary data analysis of a 5% random sample of a national HHC dataset, the Outcome and Assessment Information Set for the year 2013. Andersen's Behavioral Model of Health Service Utilization was used as a guiding framework for statistical modeling. We used logistic regression to examine the association between UTI-related hospitalization and predisposing, enabling, or need factors. RESULTS: Among beneficiaries (n = 24,887) hospitalized in 2013, 1,133 had UTI-related hospitalizations. HHC patients with a UTI-related hospitalization were more likely to have severe ADL dependency, impaired decision making, and lower Charlson Comorbidity Index, than those with a non UTI-related hospitalization (P < .001). Risk factors for UTI-related hospitalization included female sex, (adjusted odds ratio [AOR], 1.44; 95% confidence interval [CI], 1.25-1.66), Medicaid recipient (AOR, 1.99; 95% CI, 1.09-3.64), severe ADL dependency (AOR, 1.50; 95% CI, 1.16-1.94), the presence of a caregiver to assist with supervision and safety (AOR, 1.26; 95% CI, 1.06-1.49), treatment for UTI in the previous 14 days (AOR, 2.85; 95% CI, 2.46-3.29), presence of a urinary catheter (AOR, 3.77; 95% CI, 2.98-4.77), and prior history of indwelling or suprapubic catheter (AOR, 1.44; 95% CI, 1.06-1.94). CONCLUSIONS: ADL dependency levels are a potentially modifiable risk factor for UTI-related hospitalization on admission to HHC. ADL dependency levels can inform clinical interventions to ameliorate ADL dependency in HHC settings and identify groups of patients at high risk for UTI-related hospitalization.

A Prospective Comparison of Quick Sequential Organ Failure Assessment, Systemic Inflammatory Response Syndrome Criteria, Universal Vital Assessment, and Modified Early Warning Score to Predict Mortality in Patients with Suspected Infection in Gabon.

The quick sequential organ failure assessment (qSOFA) score has been proposed for risk stratification of emergency room patients with suspected infection. Its use of simple bedside observations makes qSOFA an attractive option for resource-limited regions. We prospectively assessed the predictive ability of qSOFA compared with systemic inflammatory response syndrome (SIRS), universal vital assessment (UVA), and modified early warning score (MEWS) in a resource-limited setting in Lambaréné, Gabon. In addition, we evaluated different adaptations of qSOFA and UVA in this cohort and an external validation cohort from Malawi. We included 279 cases, including 183 with an ad hoc (suspected) infectious disease diagnosis. Overall mortality was 5%. In patients with an infection, oxygen saturation, mental status, human immunodeficiency virus (HIV) status, and all four risk stratification score results differed significantly between survivors and non-survivors. The UVA score performed best in predicting mortality in patients with suspected infection, with an area under the receiving operator curve (AUROC) of 0.90 (95% confidence interval [CI]: 0.78-1.0, P < 0.0001), outperforming qSOFA (AUROC 0.77; 95% CI: 0.63-0.91, P = 0.0003), MEWS (AUROC 0.72; 95% CI: 0.58-0.87, P = 0.01), and SIRS (AUROC 0.70; 95% CI: 0.52-0.88, P = 0.03). An amalgamated qSOFA score applying the UVA thresholds for blood pressure and respiratory rate improved predictive ability in Gabon (AUROC 0.82; 95% CI: 0.68-0.96) but performed poorly in a different cohort from Malawi (AUROC 0.58; 95% CI: 0.51-0.64). In conclusion, UVA had the best predictive ability, but multicenter studies are needed to validate the qSOFA and UVA scores in various settings and assess their impact on patient outcome.

Attributable clinical and economic burden of carbapenem-non-susceptible Gram-negative infections in patients hospitalized with complicated urinary tract infections.

BACKGROUND: Gram-negative complicated urinary tract infections (cUTIs) can have serious consequences for patients and hospitals. AIM: To examine the clinical and economic burden attributable to Gram-negative carbapenem-non-susceptible (C-NS; resistant/intermediate) infections compared with carbapenem-susceptible (C-S) infections in 78 US hospitals. METHODS: All non-duplicate C-NS and C-S urine source isolates were analysed. A subset had principal diagnosis ICD-9-CM codes denoting cUTI. Collection time (<3 vs ≥3 days after admission) determined isolate classification as community or hospital onset. Mortality, 30-day re-admissions, length of stay (LOS), hospital cost and net gain/loss in US dollars were determined for C-NS and C-S cases, with the C-NS-attributable burden estimated through propensity score matching. Three subgroups with adequate patient numbers were analysed: cUTI principal diagnosis, community onset; other principal diagnosis, community onset; and other principal diagnosis, hospital onset. FINDINGS: The C-NS-attributable mortality risk was significantly higher (58%) for the other principal diagnosis, hospital-onset subgroup alone (odds ratio 1.58, 95% confidence interval 1.14-2.20; P < 0.01). The C-NS-attributable risk for 30-day re-admission ranged from 29% to 55% (all P < 0.05). The average attributable economic impact of C-NS was 1.1-3.9 additional days LOS (all P < 0.05), US$1512-10,403 additional total cost (all P < 0.001) and US$1582-11,848 net loss (all P < 0.01); overall burden and C-NS-attributable burden were greatest in the other principal diagnosis, hospital-onset subgroup. CONCLUSION: Greater clinical and economic burden was observed in propensity-score-matched patients with C-NS infections compared with C-S infections, regardless of whether cUTI was the principal diagnosis, and this burden was most severe in hospital-onset infections.

Cost-effectiveness of hydrophilic-coated intermittent catheters compared with uncoated catheters in Canada: a public payer perspective.

STUDY DESIGN: A Markov model was used to analyze cost-effectiveness over a lifetime horizon. OBJECTIVE: To investigate the cost-effectiveness of hydrophilic-coated intermittent catheters (HCICs) compared with uncoated catheters (UCs) among individuals with neurogenic bladder dysfunction (NB) due to spinal cord injury (SCI). SETTING: A Canadian public payer perspective based on data from Ontario; including a scenario analysis from the societal perspective. METHODS: A previously published Markov decision model was modified to compare the lifetime costs and quality-adjusted life years (QALYs) for the two interventions. Three renal function and three urinary tract infection (UTI) health states as well as other catheter-related events were included. Scenario analyses, including utility gain from compact catheter and phthalate free catheter use, were performed. Deterministic and probabilistic sensitivity analyses were conducted to evaluate the robustness of the model. RESULTS: The model predicted that a 50-year-old patient with SCI would gain an additional 0.72 QALYs if HCICs were used instead of UCs at an incremental cost of $48,016, leading to an incremental cost-effectiveness ratio (ICER) of $66,634/QALY. Moreover, using HCICs could reduce the lifetime number of UTI events by 11%. From the societal perspective, HCICs cost less than UCs, while providing superior outcomes in terms of QALYs, life years gained (LYG), and UTIs. The cost per QALY further decreased when health-related quality-of-life (HRQoL) gains associated with compact HCICs or catheters not containing phthalates were included. CONCLUSION: In general, ICERs in the range of CAD$50-100,000 could be considered cost-effective. The ICERs for the base case and sensitivity analyses suggest that HCICs could be cost-effective. From the societal perspective, HCICs were associated with potential cost savings in our model. The results suggest that reimbursement of HCICs should be considered in these settings.

Hospitalization for community-acquired febrile urinary tract infection: validation and impact assessment of a clinical prediction rule.

BACKGROUND: There is a lack of severity assessment tools to identify adults presenting with febrile urinary tract infection (FUTI) at risk for complicated outcome and guide admission policy. We aimed to validate the Prediction Rule for Admission policy in Complicated urinary Tract InfeCtion LEiden (PRACTICE), a modified form of the pneumonia severity index, and to subsequentially assess its use in clinical practice. METHODS: A prospective observational multicenter study for model validation (2004-2009), followed by a multicenter controlled clinical trial with stepped wedge cluster-randomization for impact assessment (2010-2014), with a follow up of 3 months. Paricipants were 1157 consecutive patients with a presumptive diagnosis of acute febrile UTI (787 in validation cohort and 370 in the randomized trial), enrolled at emergency departments of 7 hospitals and 35 primary care centers in the Netherlands. The clinical prediction rule contained 12 predictors of complicated course. In the randomized trial the PRACTICE included guidance on hospitalization for high risk (>100 points) and home discharge for low risk patients (<75 points), in the control period the standard policy regarding hospital admission was applied. Main outcomes were effectiveness of the clinical prediction rule, as measured by primary hospital admission rate, and its safety, as measured by the rate of low-risk patients who needed to be hospitalized for FUTI after initial home-based treatment, and 30-day mortality. RESULTS: A total of 370 patients were included in the randomized trial, 237 in the control period and 133 in the intervention period. Use of PRACTICE significantly reduced the primary hospitalization rate (from 219/237, 92%, in the control group to 96/133, 72%, in the intervention group, p < 0.01). The secondary hospital admission rate after initial outpatient treatment was 6% in control patients and 27% in intervention patients (1/17 and 10/37; p < 0.001). CONCLUSIONS: Although the proposed PRACTICE prediction rule is associated with a lower number of hospital admissions of patients presenting to the ED with presumptive febrile urinary tract infection, futher improvement is necessary to reduce the occurrence of secondary hospital admissions. TRIAL REGISTRATION: NTR4480 http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4480 , registered retrospectively 25 mrt 2014 (during enrollment of subjects).

Analysis of "never events" following adult cardiac surgical procedures in the United States.

BACKGROUND: This study was conducted to determine the risk factors, nature, and outcomes of "never events" following open adult cardiac surgical procedures. Understanding of these events can reduce their occurrence, and thereby improve patient care, quality metrics, and cost reduction. METHODS: "Never events" for patients included in the Nationwide Inpatient Sample who underwent coronary artery bypass graft, heart valve repair/replacement, or thoracic aneurysm repair between 2003-2011 were documented. These events included air embolism, catheter-based urinary tract infection (UTI), pressure ulcer, falls/trauma, blood incompatibility, vascular catheter infection, poor glucose control, foreign object retention, wrong site surgery and mediastinitis. Analysis included characterization of preoperative demographics, comorbidities and outcomes for patients sustaining never events, and multivariate analysis of predictive risk factors and outcomes. RESULTS: A total of 588,417 patients meeting inclusion criteria were identified. Of these, never events occurred in 4377 cases. The majority of events were in-hospital falls, vascular catheter infections, and complications of poor glucose control. Rates of falls, catheter based UTIs, and glucose control complications increased between 2009-2011 as compared to 2003-2008. Analysis revealed increased hospital length of stay, hospital charges, and mortality in patients who suffered a never event as compared to those that did not. CONCLUSIONS: This study establishes a baseline never event rate after cardiac surgery. Adverse patient outcomes and increased resource utilization resulting from never events emphasizes the need for quality improvement surrounding them. A better understanding of individual patient characteristics for those at risk can help in developing protocols to decrease occurrence rates.

A national point prevalence study on healthcare-associated infections and antimicrobial use in Austria.

BACKGROUND: The first point prevalence survey performed in Austria had the aim to assess the magnitude of healthcare-associated infections and antimicrobials use in the country. METHODS: A multicentre study was carried out from May until June 2012 in nine acute care hospitals with a mean bed number of 620. Data from 4321 patients' clinical charts were reviewed. RESULTS: The overall healthcare-associated infections prevalence was 6.2% (268/4321) with the highest rate in intensive care departments (20.9%; 49/234). In medical and surgical departments the healthcare-associated infections prevalence was 5.4% (95/1745) and 6.6% (105/1586), respectively. The most frequent healthcare-associated infections were: urinary tract infections (21.3%; 61/287), pneumonia (20.6%; 59/287) and surgical site infections (17.4%; 50/287). The most common isolated microorganisms were: Escherichia coli (14.8%; 26/176), Enterococcus species (13.1%; 23/176) and Pseudomonas aeruginosa (11.4%; 20/176). Thirty-three per cent (1425/4321) of the patients received antimicrobials because of community-acquired infections treatment (14.2%; 615/4321), healthcare-associated infections treatment (6.4%; 278/4321), and surgical (8.2%; 354/4321) and medical prophylaxis (3.2%; 138/4321). Surgical prophylaxis was the indication for 22.0% (394/1792) of the overall prescriptions and was prolonged for more than 1 day in 77.2% (304/394) of the cases. CONCLUSION: The national Austrian survey proved the feasibility of a nation-wide network of surveillance of both healthcare-associated infections and antimicrobial use that will be repeated in the future. Healthcare-associated infections and antimicrobial use have been confirmed to be a grave health problem. The excessive prolongation of perioperative prophylaxis in Austria needs to be limited.

Empirical therapies among adults hospitalized for community-acquired upper urinary tract infections: A decision-tree analysis of mortality, costs, and resistance.

BACKGROUND: Poor outcomes occur when patients with serious infections receive antibiotics to which the organisms are resistant. METHODS: Decision trees simulated in-hospital mortality, costs, incremental cost-effectiveness ratio per life year saved, and carbapenem resistance according to 3 empirical antibiotic strategies among adults hospitalized for community-acquired (CA) upper urinary tract infections (UTIs): ceftriaxone (CRO) plus gentamicin (GM) in the intensive care unit (ICU), imipenem (IMP), and individualized choice (IMP or CRO) based on clinical risk factors for CA- extended-spectrum ß-lactamase (ESBL). RESULTS: The estimated prevalence of CA-ESBL on admission was 5% (range, 1.3%-17.6%); 3% and 97% were admitted to the ICU and medical ward (MW), respectively. In the ICU, CRO plus GM was dominated; IMP was cost-effective (incremental cost-effectiveness ratio: €4,400 per life year saved compared with individualized choice). In the MW, IMP had no impact on mortality and was less costly (-€142 per patient vs CRO, -€38 vs individualized choice). The dominance of IMP was consistent in sensitivity analyses. Compared with CRO, colonization by carbapenem-resistant pathogens increased by an odds ratio of 4.5 in the IMP strategy. CONCLUSION: Among the ICU patients, empirical IMP therapy reduces mortality at an acceptable cost. Among MW patients, individualized choice or CRO is preferred to limit carbapenem resistance at a reasonable cost.

Impact of urinary tract infection definitions on colorectal outcomes.

BACKGROUND: Hospital-acquired urinary tract infections (UTIs) significantly impact hospital outcomes. Colorectal surgery is inherently high risk for postoperative infections including UTI, and these patients may have unique outcomes as compared to other medical and surgical hospitalizations. We aim to assess the impact of the differing definitions of UTI captured by our hospital quality measures on hospital charges, length of stay (LOS), and mortality after colorectal resections at our institution. MATERIALS AND METHODS: Existing hospital quality surveillance was used to retrospectively identify postcolorectal resection UTI, as defined by the National Surgical Quality Improvement Program (NSQIP), and the Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN)-defined catheter-associated UTIs (CAUTI), from 2006-2012. Both groups were compared to colorectal resections performed during the same period that did not develop a UTI. Groups were compared for differences in 30-d surgical outcomes with multivariate analysis of total hospital charges and LOS. RESULTS: During our study period, we identified 18 CAUTIs and 42 NSQIP-UTI, and 1064 other colorectal resections (UTI rate, 5.3%). Our overall mortality rate was 4.4% and was not associated with CAUTI or NSQIP-UTI on univariate analysis. CAUTI, but not NSQIP-UTI, was associated with a 73% increase in LOS and 70% increase in total hospital charges on multivariate analysis. CONCLUSIONS: By reviewing quality outcomes surveillance modalities at our hospital, we identified postcolorectal resection CAUTI, but not NSQIP-UTI, to be associated with increased total hospital charges and LOS. Neither was associated with mortality.

[Impact of copper in the reduction of hospital-acquired infections, mortality and antimicrobial costs in the Adult Intensive Care Unit]. / Impacto del cobre en la reducción de infecciones intrahospitalarias, mortalidad y gasto en antimicrobianos en una Unidad de Cuidados Intensivo de adultos.

UNLABELLED: We conducted a clinical trial to determine the impact of coating surfaces with copper in reducing hospital-acquired infections, mortality associated with nosocomial infections and antimicrobial costs in the UCI. The study took place at Carlos Van Buren Hospital, Valparaíso, Chile. No differences in the frequency of nosocomial infections were found. Not in rates of ventilator-associated pneumonia (p = 0.9), nor in catheter- associated urinary tract infection (p = 0.9) or in central venous catheter associated bacteremia (p = 0.3). There were no differences in infection-free survival (p = 0.9). There were less costs of antimicrobials in patients in which copper was used. The fact that the sample size was not completed could explain that no significant differences in infections were found. CONCLUSION: The use of copper as a surface in the ICU showed no statistically significant differences in rates of nosocomial infections during the study period, however, these results could be related to the sample size.

Impacto del cobre en la reducción de infecciones intrahospitalarias, mortalidad y gasto en antimicrobianos en una Unidad de Cuidados Intensivo de adultos / Impact of copper in the reduction of hospital-acquired infections, mortality and antimicrobial costs in the Adult Intensive Care Unit

We conducted a clinical trial to determine the impact of coating surfaces with copper in reducing hospital-acquired infections, mortality associated with nosocomial infections and antimicrobial costs in the UCI. The study took place at Carlos Van Buren Hospital, Valparaíso, Chile. No differences in the frequency of nosocomial infections were found. Not in rates of ventilator-associated pneumonia (p = 0.9), nor in catheter- associated urinary tract infection (p = 0.9) or in central venous catheter associated bacteremia (p = 0.3). There were no differences in infection-free survival (p = 0.9). There were less costs of antimicrobials in patients in which copper was used. The fact that the sample size was not completed could explain that no significant differences in infections were found. Conclusion: The use of copper as a surface in the ICU showed no statistically significant differences in rates of nosocomial infections during the study period, however, these results could be related to the sample size.

Introducción: Las infecciones nosocomiales incrementan la mortalidad y costos en las instituciones de salud. El revestimiento con cobre, de superficies de alto contacto en la unidad clínica en torno a los pacientes, reduce la colonización bacteriana de las mismas. Objetivo: Determinar el impacto del revestimiento de las superficies con cobre en la disminución de las infecciones intrahospitalarias, la mortalidad asociada a las infecciones intrahospitalarias y los costos en antimicrobianos en pacientes hospitalizados en UCI adultos en el Hospital Carlos Van Buren. Pacientes y Métodos: Estudio prospectivo, comparativo, mayo de 2011-mayo de 2012. Asignación aleatoria de pacientes adultos ingresados en UCI, que permanecieran al menos por 24 h en dicha unidad, a unidades de aislamiento recubiertas (n: 7) o no recubiertas con cobre (n: 7). Resultados: Ingresaron al estudio 440 pacientes, 217 pacientes (49,3%) en el grupo sin cobre y 223 en el grupo con cobre (50,7%). No se encontraron diferencias en la frecuencia de infecciones intrahospitalarias en ambos grupos. Tampoco se encontraron diferencias significativas en las tasas de neumonía asociada a ventilación mecánica (p = 0,9), infección urinaria asociada a catéter urinario (p = 0,9) y bacteremias asociada a catéter venoso central (p = 0,3). Tampoco se encontraron diferencias en la sobrevida libre de infección (p = 0,9). Se encontró un gasto menor de antimicrobianos en pacientes atendidos en unidades revestidas con cobre. Durante el período del estudio no se completó el tamaño de muestra y las diferencias no significativas podrían deberse a este hecho. Conclusión: El uso del cobre como revestimiento de las superficies hospitalarias en UCI, mostró diferencia en la tasa de bacteriemia asociada a dispositivos venosos, aunque no significativa, y no mostró diferencia en neumonías e infecciones urinarias. Las diferencias no significativas pueden deberse a que no se completó el tamaño de la muestra. Se observó un mayor gasto de antimicrobianos en pacientes de unidades no cobrizadas, lo que plantea una nueva área de investigación.

Healthcare associated infections (HAI) perspectives.

Healthcare associated infections (HAI) are among the major complications of modern medical therapy. The most important HAIs are those related to invasive devices: central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), ventilator-associated pneumonia (VAP) as well as surgical site infections (SSI). HAIs are associated with significant mortality, morbidities and increasing healthcare cost. The cited case-fatality rate ranges from 2.3% to 14.4% depending on the type of infection. In this mini-review, we shed light on these aspects as well as drivers to decrease HAIs.

Medicare reimbursement attributable to catheter-associated urinary tract infection in the inpatient setting: a retrospective cohort analysis.

BACKGROUND: Most catheter-associated urinary tract infections (CAUTIs) are considered preventable and thus a potential target for health care quality improvement and cost savings. OBJECTIVES: We sought to estimate excess Medicare reimbursement, length of stay, and inpatient death associated with CAUTI among hospitalized beneficiaries. RESEARCH DESIGN: Using a retrospective cohort design with linked Medicare inpatient claims and National Healthcare Safety Network data from 2009, we compared Medicare reimbursement between Medicare beneficiaries with and without CAUTIs. SUBJECTS: Fee-for-service Medicare beneficiaries aged 65 years or older with continuous coverage of parts A (hospital insurance) and B (supplementary medical insurance). RESULTS: We found that beneficiaries with CAUTI had higher median Medicare reimbursement [intensive care unit (ICU): $8548, non-ICU: $1479) and length of stay (ICU: 8.1 d, non-ICU: 3.6 d) compared with those without CAUTI controlling for potential confounding factors. Odds of inpatient death were higher among beneficiaries with versus without CAUTI only among those with an ICU stay (ICU: odds ratio 1.37). CONCLUSIONS: Beneficiaries with CAUTI had increased Medicare reimbursement and length of stay compared with those without CAUTI after adjusting for potential confounders.

Impact of hospital-acquired infection on long-term outcomes after endovascular and open abdominal aortic aneurysm repair.

BACKGROUND: We hypothesized that infectious complications after open surgery (OPEN) and endovascular repair (EVAR) of nonruptured abdominal aortic aneurysms (AAAs) negatively affected long-term outcomes. METHODS: Elective OPEN and EVAR cases were selected from 2005-2007 Medicare databases, and rates of postoperative infection, readmission, and longitudinal mortality were compared. RESULTS: Forty thousand eight hundred ninety-two EVARs and 16,669 OPEN AAA repairs were evaluated. Patients with OPEN developed infection during and after the index hospitalization (12.8% and 4.9%, respectively) more often than those who had undergone EVAR (3.2% and 3.9%, respectively; P < 0.0001 for both). Patients with hospital-acquired infection compared to noninfectious ones were more likely to die during the index hospitalization (odds ratio [OR]: 3.7 [95% confidence interval {CI}: 3.22-4.30]) and within 30 days after discharge (OR: 3.6 [95% CI: 2.83-4.45]). They also were more likely to be readmitted to the hospital during 30 days after index discharge (OR: 1.8 [95% CI: 1.63-1.94]). Index infections associated with the greatest readmission were urinary tract infection after OPEN and sepsis after EVAR. Hospital-acquired infection significantly increased the duration of hospital stay (14.2 ± 13.2 vs 4.0 ± 4.4 days; P < 0.0001) and total hospital charges ($133,070 ± $136,100 vs $66,359 ± $45,186; P < 0.0001). The most common infections to develop 30 days after initial discharge were surgical site infection after EVAR (1.27%) and urinary tract infection after OPEN (1.38%). CONCLUSION: Hospital-acquired infections had a dramatic effect by increasing hospital and 30-day mortality, readmission rates, and hospital resource use after AAA repair. Programs minimizing infectious complications may decrease future readmissions and mortality after AAA repair.

Impact of infectious complications after elective surgery on hospital readmission and late deaths in the U.S. Medicare population.

BACKGROUND AND PURPOSE: Whereas the negative impact of infectious complications (IC) during the index hospitalization after elective surgery is well established, the long-term ramifications of hospital-acquired post-operative infections are not well studied. This analysis evaluated the impact of a hospital-acquired IC after open abdominal vascular surgery on the readmission rate and the mortality rates 30 and 90 days after initial discharge. METHODS: Data from all hospitals in the United States that performed elective open abdominal vascular operations in the Medicare population from 2005 to 2007 were extracted from the national Medicare Provider Analysis and Review database. The cohort consisted of all patients undergoing open abdominal vascular operations, including aortic, iliac, and visceral procedures. The ICs evaluated were pneumonia, urinary tract infection (UTI), postoperative sepsis (sepsis), surgical site infection (SSI), and Clostridium difficile infection (CDI). Patients were categorized as either developing an IC during their initial hospitalization (Index+INF) or not developing an IC (No INF). The rates of 30-day readmission, 30-day IC, and 30- and 90-day mortality after the initial discharge were evaluated longitudinally and compared in patients with and without an IC. RESULTS: A total of 29,549 open abdominal vascular procedures were identified, and 4,016 patients (13.6%) developed an IC during their index hospitalization: Pneumonia (5.1% of the total), UTI (2.7%), sepsis (1.6%), SSI (1.4%), and CDI (0.6%). Additionally, 1.13% of patients developed pneumonia, UTI, SSI, or CDI complicated by sepsis. The hospital mortality rate during the initial hospitalization was 13.7% (Index+INF) versus 4.0% (No INF) (p<0.0002). Infectious processes (pneumonia, UTI, SSI, and CDI) complicated by sepsis had an in-hospital mortality rate significantly higher than patients having an IC alone (50.9% vs. 13.7%; p<0.002). The mortality rate 30 and 90 days after the initial discharge was significantly higher for Index+INF than for No INF (4.4% vs. 1.2% and 8.6% vs. 2.6%, respectively; p<0.0002). The highest 30-day mortality rates after discharge were found after CDI+sepsis (30%), pneumonia+sepsis (12.6%), and postoperative sepsis alone (8.6%). The same rank was found for the 90-day mortality rate: 30%, 22.5%, and 13.8%. Overall, readmission was more likely for Index+INF than for No INF (33.7% vs. 21.5%; p<0.0002). Rates of 30-day readmission after an index IC ranged from 32% to 50%. CONCLUSION: For Medicare beneficiaries undergoing elective open abdominal vascular procedures, the development of any IC significantly increased not only the in-hospital mortality rate but also the mortality rates 30 and 90 days after discharge from the hospital. Index ICs also were associated with a higher 30-day readmission rate. Hospital-acquired infections have a profound late effect on outcomes after discharge. Future programs targeting high-risk patients may improve long-term survival and minimize readmissions.