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808. Evaluating the Incidence of Bacteriuria in Female Patients Before and After Implementation of External Catheter Devices

BACKGROUND: Bacteriuria associated with indwelling urinary catheters is commonly linked to inappropriate antibiotic use in hospitals. The use of external catheter devices (ECD) has increased in recent years to reduce bacteriuria risk in women, based on data in male patients. Currently no studies hav...

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Autores principales: Noval, Mandee, Leekha, Surbhi, Bhatt, Meghna, Armhazizer, Michael, Celotto, Abigale, Claeys, Kimberly C
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7776950/
http://dx.doi.org/10.1093/ofid/ofaa439.998
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author Noval, Mandee
Leekha, Surbhi
Bhatt, Meghna
Armhazizer, Michael
Celotto, Abigale
Claeys, Kimberly C
author_facet Noval, Mandee
Leekha, Surbhi
Bhatt, Meghna
Armhazizer, Michael
Celotto, Abigale
Claeys, Kimberly C
author_sort Noval, Mandee
collection PubMed
description BACKGROUND: Bacteriuria associated with indwelling urinary catheters is commonly linked to inappropriate antibiotic use in hospitals. The use of external catheter devices (ECD) has increased in recent years to reduce bacteriuria risk in women, based on data in male patients. Currently no studies have shown a similar benefit in the female population. METHODS: This was a quasi-experimental study among adult female ICU patients with urinary catheters (indwelling or external) between 12/2015 – 5/2017 (pre-ECD) and 12/2017 – 6/2019 (post-ECD). The primary outcome was the incidence of positive urine cultures pre- vs post-intervention. An a priori subgroup patient-level analysis evaluated positive urine cultures and antibiotic use pre- vs post-intervention in medical and surgical ICU patients who had a urinalysis ordered in the presence of an indwelling or external urinary catheter. Antibiotic use was considered appropriate when prescribed in the presence of a positive urine culture, clinical signs and symptoms of UTI, and a UTI order indication. RESULTS: There were 4,640 patient ICU encounters during the study period; 2,201 pre- vs 2,439 post-intervention. Mean age was 59.2 (SD 15.4) years, median Elixhauser Score was 6 (IQR 4, 7), and there were no significant differences between groups. In the overall cohort, there was a decrease in the monthly rate of indwelling urinary catheter use pre- versus post- intervention (Figure 1) of 182/1,000 vs 166/1,000 patient days, P = 0.03. There was also a decrease in rate of positive urine cultures from pre- to post- intervention (38/1,000 vs 28/1,000 patient days, P = 0.004). Antibiotic days of therapy (DOTs) for UTI indication was similar in the pre- versus post-intervention groups with 1.9/1000 vs. 1.8 DOT/1,000 patient days (P = 0.7). In the subgroup of 210 patients (73 pre- vs 137 post-intervention) who underwent urinalysis, there was also a decrease in the proportion of positive urine cultures from pre- to post-intervention (42.5% vs. 24.3%; P = 0.007). Of patient receiving antibiotics for UTI indication, appropriateness was numerically higher post-intervention (9.1% vs. 31.6%; P = 0.21). [Image: see text] CONCLUSION: The use of external urinary catheters may be beneficial in reducing bacteriuria and related antibiotic use among female ICU patients. DISCLOSURES: All Authors: No reported disclosures
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spelling pubmed-77769502021-01-07 808. Evaluating the Incidence of Bacteriuria in Female Patients Before and After Implementation of External Catheter Devices Noval, Mandee Leekha, Surbhi Bhatt, Meghna Armhazizer, Michael Celotto, Abigale Claeys, Kimberly C Open Forum Infect Dis Poster Abstracts BACKGROUND: Bacteriuria associated with indwelling urinary catheters is commonly linked to inappropriate antibiotic use in hospitals. The use of external catheter devices (ECD) has increased in recent years to reduce bacteriuria risk in women, based on data in male patients. Currently no studies have shown a similar benefit in the female population. METHODS: This was a quasi-experimental study among adult female ICU patients with urinary catheters (indwelling or external) between 12/2015 – 5/2017 (pre-ECD) and 12/2017 – 6/2019 (post-ECD). The primary outcome was the incidence of positive urine cultures pre- vs post-intervention. An a priori subgroup patient-level analysis evaluated positive urine cultures and antibiotic use pre- vs post-intervention in medical and surgical ICU patients who had a urinalysis ordered in the presence of an indwelling or external urinary catheter. Antibiotic use was considered appropriate when prescribed in the presence of a positive urine culture, clinical signs and symptoms of UTI, and a UTI order indication. RESULTS: There were 4,640 patient ICU encounters during the study period; 2,201 pre- vs 2,439 post-intervention. Mean age was 59.2 (SD 15.4) years, median Elixhauser Score was 6 (IQR 4, 7), and there were no significant differences between groups. In the overall cohort, there was a decrease in the monthly rate of indwelling urinary catheter use pre- versus post- intervention (Figure 1) of 182/1,000 vs 166/1,000 patient days, P = 0.03. There was also a decrease in rate of positive urine cultures from pre- to post- intervention (38/1,000 vs 28/1,000 patient days, P = 0.004). Antibiotic days of therapy (DOTs) for UTI indication was similar in the pre- versus post-intervention groups with 1.9/1000 vs. 1.8 DOT/1,000 patient days (P = 0.7). In the subgroup of 210 patients (73 pre- vs 137 post-intervention) who underwent urinalysis, there was also a decrease in the proportion of positive urine cultures from pre- to post-intervention (42.5% vs. 24.3%; P = 0.007). Of patient receiving antibiotics for UTI indication, appropriateness was numerically higher post-intervention (9.1% vs. 31.6%; P = 0.21). [Image: see text] CONCLUSION: The use of external urinary catheters may be beneficial in reducing bacteriuria and related antibiotic use among female ICU patients. DISCLOSURES: All Authors: No reported disclosures Oxford University Press 2020-12-31 /pmc/articles/PMC7776950/ http://dx.doi.org/10.1093/ofid/ofaa439.998 Text en © The Author 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Poster Abstracts
Noval, Mandee
Leekha, Surbhi
Bhatt, Meghna
Armhazizer, Michael
Celotto, Abigale
Claeys, Kimberly C
808. Evaluating the Incidence of Bacteriuria in Female Patients Before and After Implementation of External Catheter Devices
title 808. Evaluating the Incidence of Bacteriuria in Female Patients Before and After Implementation of External Catheter Devices
title_full 808. Evaluating the Incidence of Bacteriuria in Female Patients Before and After Implementation of External Catheter Devices
title_fullStr 808. Evaluating the Incidence of Bacteriuria in Female Patients Before and After Implementation of External Catheter Devices
title_full_unstemmed 808. Evaluating the Incidence of Bacteriuria in Female Patients Before and After Implementation of External Catheter Devices
title_short 808. Evaluating the Incidence of Bacteriuria in Female Patients Before and After Implementation of External Catheter Devices
title_sort 808. evaluating the incidence of bacteriuria in female patients before and after implementation of external catheter devices
topic Poster Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7776950/
http://dx.doi.org/10.1093/ofid/ofaa439.998
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