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Catheter Related Urinary Tract Sepsis Is Associated With Longer ICU Length of Stay, Hospital Length of Stay, and Higher Mortality in Trauma Patients FREE TO VIEW

Akella Chendrasekhar, MD; Ryan Ismail, BS
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Richmond University Medical Center, Staten Island, NY

Chest. 2013;144(4_MeetingAbstracts):383A. doi:10.1378/chest.1702808
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SESSION TITLE: ICU Infections Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Catheter Associated Urinary Tract Infection [CAUTI] are thought to be detrimental to trauma patients, there is little data to support this association. Infection is associated with mortality through induction of systemic inflammatory response syndrome [SIRS]. Sepsis is defined as SIRS with a plausible infection.

METHODS: We retrospectively evaluated 2252 trauma patients admitted to our level 1 trauma center from July 2010 to January 2013 and found 53 CAUTIs [2.35%]. We collected demographic and clinical data on these patients to assess impact on mortality, ICU length of stay [ICU-LOS] and hospital length of stay [H-LOS]. The data were analyzed by one-way analysis of variance[ANOVA].

RESULTS: 30 patients grew gram-negative pathogens, 19 patients had gram-positive pathogens and 4 had both gram-positive and gram-negative pathogens. The patients with SIRS were younger than the patients without SIRS [61.8 ± 3.7 versus 82.1 ± 5.0, p=0.002]. The presence of SIRS was associated with a higher Injury Severity Score [ISS, 19.5 ± 1.6 versus 12.1 ± 2.0,p=0.013]. The absence of SIRS in this population had zero mortality and the presence of SIRS was associated with 25 % mortality [p=0.03]. Multi-drug resistance organisms [MDROs] were seen more often in patients with SIRS as compared to patients without SIRS [65.6 ± 8.4 % versus 27.8 ± 11.2 %, p=0.009]. ICU-LOS was longer for patients with SIRS as compared to those without SIRS [10.9 ± 1.4 days versus 1.5 ±1.8 days, p=0.0002] as was H-LOS [22.4 ± 4.4 days versus 8.4 ± 5.4 days, p=0.05]. Finally the presence of MDROs was independently associated with a higher mortality [26.1 ± 7.4% versus 4.8 ± 7.8%, p=0.05]

CONCLUSIONS: CAUTI in trauma patients is rare, but does contribute significantly to mortality if accompanied by SIRS or MDROs.

CLINICAL IMPLICATIONS: Patients with CAUTI and either SIRS or MDROs have a significantly high mortality and longer length of stay and should be managed more aggressively

DISCLOSURE: The following authors have nothing to disclose: Akella Chendrasekhar, Ryan Ismail

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