I've blogged before about the waste of time, effort and resources being utilized to prevent catheter-associated urinary tract infections (CAUTI) (see here and here), and a new paper in Infection Control and Hospital Epidemiology adds fuel to my fire. This 2-year study was performed in the adult ICUs at the Mayo Clinic and analyzed 105 CAUTI episodes. In 97% of cases fever was the primary indication for obtaining the urine culture, but on analysis two-thirds of the patients with CAUTI had alternative diagnoses to explain the fever. Thus it appears that CAUTI is highly over diagnosed. Moreover, preventability is relatively low and secondary bacteremias are uncommon.
The authors “question the utility of surveillance for this low-frequency, low-morbidity HAI, which does not serve as a valuable patient-centered outcome.” And they conclude: “CAUTIs, as currently defined by NHSN (even with the 2015 definition changes), are not clinically relevant, and efforts to reduce CAUTI may be better directed at other more serious health care infections.”
The paper is accompanied by an excellent editorial by Dan Livorsi and Eli Perencevich. They thoughtfully dissect all the problems with the CAUTI metric and offer some alternatives. They note that it is debatable whether a NHSN-defined CAUTI represents an episode of preventable harm. And they remind us that the opportunity cost is significant.
Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on improving the quality and safety of health care, and sees patients in the inpatient and outpatient settings. This post originally appeared at the blog Controversies in Hospital Infection Prevention.