Department of Neurology, New York University School of Medicine, New York, New York, USA.
Department of Medicine, New York University School of Medicine, New York, New York, USA.
Clin Infect Dis. 2021 Nov 2;73(9):e2690-e2696. doi: 10.1093/cid/ciaa1152.
Standard urine sampling and testing techniques do not mitigate against detection of colonization, resulting in false positive catheter-associated urinary tract infections (CAUTI). We aimed to evaluate whether a novel protocol for urine sampling and testing reduces rates of CAUTI.
A preintervention and postintervention study with a contemporaneous control group was conducted at 2 campuses (test and control) of the same academic medical center. The test campus implemented a protocol requiring urinary catheter removal prior to urine sampling from a new catheter or sterile straight catheterization, along with urine bacteria and pyuria screening prior to culture. Primary outcomes were test campus CAUTI rates, compared between each 9-month pre- and postintervention epoch. Secondary outcomes included the percent reductions in CAUTI rates, compared between the test campus and a propensity score-matched cohort at the control campus.
A total of 7991 patients from the test campus were included in the primary analysis, and 4264 were included in the propensity score-matched secondary analysis. In the primary analysis, the number of CAUTI cases per 1000 patients was reduced by 77% (6.6 to 1.5), the number of CAUTI cases per 1000 catheter days was reduced by 63% (5.9 to 2.2), and the number of urinary catheter days per patient was reduced by 37% (1.1 to 0.69; all P values ≤ .001). In the propensity score-matched analysis, the number of CAUTI cases per 1000 patients was reduced by 82% at the test campus, versus 57% at the control campus; the number of CAUTI cases per 1000 catheter days declined by 68% versus 57%, respectively; and the number of urinary catheter days per patient decreased by 44% versus 1%, respectively (all P values < .001).
Protocolized urine sampling and testing aimed at minimizing contamination by colonization was associated with significantly reduced CAUTI infection rates and urinary catheter days.
标准的尿液采样和检测技术不能减轻定植的检测，导致假阳性的导管相关性尿路感染（CAUTI）。我们旨在评估一种新的尿液采样和检测方案是否能降低 CAUTI 的发生率。
在同一学术医疗中心的两个校区（试验和对照）进行了一项干预前和干预后研究，并设有同期对照组。试验校区实施了一项方案，要求在从新的导管或无菌直线导管进行尿液采样之前，先拔出导尿管，并且在培养之前进行尿液细菌和脓尿筛查。主要结局是比较每个 9 个月的干预前和干预后时期试验校区的 CAUTI 发生率。次要结局包括与对照校区的倾向评分匹配队列相比，CAUTI 发生率的降低百分比。
试验校区共有 7991 名患者纳入主要分析，4264 名患者纳入倾向评分匹配的次要分析。在主要分析中，每 1000 名患者的 CAUTI 病例数减少了 77%（从 6.6 例降至 1.5 例），每 1000 个导管日的 CAUTI 病例数减少了 63%（从 5.9 例降至 2.2 例），每位患者的导尿管天数减少了 37%（从 1.1 天降至 0.69 天；所有 P 值均≤.001）。在倾向评分匹配的分析中，与对照校区的 57%相比，试验校区每 1000 名患者的 CAUTI 病例数减少了 82%，每 1000 个导管日的 CAUTI 病例数减少了 68%，而每 1000 个导管日的 CAUTI 病例数减少了 57%，每位患者的导尿管天数减少了 44%，而对照校区的导尿管天数减少了 1%（所有 P 值均<.001）。
旨在最大限度减少定植污染的方案化尿液采样和检测与 CAUTI 感染率和导尿管天数的显著降低相关。
