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Healthcare-Associated Bloodstream Infections Secondary to a Urinary Focus The Québec Provincial Surveillance Results

Published online by Cambridge University Press:  02 January 2015

Elise Fortin ,
Isabelle Rocher ,
Charles Frenette ,
Claude Tremblay  and
Caroline Quach
Elise Fortin*
Affiliation:
Institut National de Santé Publique du Québec, Québec and Montréal, Québec, Canada Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec, Canada
Isabelle Rocher
Affiliation:
Institut National de Santé Publique du Québec, Québec and Montréal, Québec, Canada
Charles Frenette
Affiliation:
Infectious Diseases Division and Department of Medical Microbiology, McGill University Health Centre, Montréal, Québec, Canada
Claude Tremblay
Affiliation:
Centre Hospitalier Universitaire de Québec–Pavillon Hôtel-Dieu de Québec, Québec, Canada
Caroline Quach
Affiliation:
Institut National de Santé Publique du Québec, Québec and Montréal, Québec, Canada Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec, Canada Infectious Diseases Division and Department of Medical Microbiology, McGill University Health Centre, Montréal, Québec, Canada
*
Montreal Children's Hospital of the McGill University Health Centre, C1242-2300 Tupper Street, Montreal, Québec H3H 1P3, Canada (caroline.quach@mcgill.ca)
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Abstract

Objective.

Urinary tract infections (UTIs) are an important source of secondary healthcare-associated bloodstream infections (BSIs), where a potential for prevention exists. This study describes the epidemiology of BSIs secondary to a urinary source (U-BSIs) in the province of Québec and predictors of mortality.

Design.

Dynamic cohort of 9,377,830 patient-days followed through a provincial voluntary surveillance program targeting all episodes of healthcare-associated BSIs occurring in acute care hospitals.

Setting.

Sixty-one hospitals in Québec, followed between April 1, 2007, and March 31, 2010.

Participants.

Patients admitted to participating hospitals for 48 hours or longer.

Methods.

Descriptive statistics were used to summarize characteristics of U-BSIs and microorganisms involved. Wilcoxon and X2 tests were used to compare U-BSI episodes with other BSIs. Negative binomial regression was used to identify hospital characteristics associated with higher rates. We explored determinants of mortality using logistic regression.

Results.

Of the 7,217 reported BSIs, 1,510 were U-BSIs (21%), with an annual rate of 1.4 U-BSIs per 10,000 patient-days. A urinary device was used in 71% of U-BSI episodes. Identified institutional risk factors were average length of stay, teaching status, and hospital size. Increasing hospital size was influential only in nonteaching hospitals. Age, nonhematogenous neoplasia, Staphylococcus aureus, and Foley catheters were associated with mortality at 30 days.

Conclusion.

U-BSI characteristics suggest that urinary catheters may remain in patients for ease of care or because practitioners forget to remove them. Ongoing surveillance will enable hospitals to monitor trends in U-BSIs and impacts of process surveillance that will be implemented shortly.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 5 , May 2012 , pp. 456 - 462
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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