The Development of a Urinary Tract Infection Is Associated With Increased Mortality in Trauma Patients

• DOI: 10.1097/ta.0b013e31821e2b8f
• Publication Date: 2011-07-16T14:04:19Z
• Authors: Sean F. Monaghan; Daithi S. Heffernan; Rajan K. Thakkar; Steven E. Reinert; Jason T. Machan; Michael D. Connolly; Shea C. Gregg; Matthew S. Kozloff; Charles A. Adams; William G. Cioffi
• Keywords: Adult; Male; Multiple Trauma; Incidence; Comorbidity; Middle Aged; Risk Assessment; Survival Analysis; 3. Good health; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Trauma Centers; Catheter-Related Infections; Cause of Death; Urinary Tract Infections; Humans; Female; Hospital Mortality; Registries; Urinary Catheterization; Follow-Up Studies; Retrospective Studies

In October 2008, Medicare and Medicaid stopped paying for care associated with catheter-related urinary tract infections (UTIs). Although most clinicians agree UTIs are detrimental, there are little data to support this belief.This is a retrospective review of trauma registry data from a Level I trauma center between 2003 and 2008. Two proportional hazards regressions were used for analyses. The first predicted acquisition of UTI as a function of indwelling urinary catheter use, adjusting for age, diabetes, gender, and injury severity. The second predicted hospital mortality as a function of UTI, covarying for age, gender, chronic obstructive pulmonary disease, congestive heart failure, hypertension, diabetes, pneumonia, and injury severity.After excluding patients who stayed in the hospital <3 days and those with a UTI on arrival, 5,736 patients were included in the study. Of these patients, 680 (11.9%) met criteria for a UTI, with 487 (71.6%) indwelling urinary catheter-related infections. Predictors of UTI included the interaction between age and gender (p = 0.0018), Injury Severity Score (p = 0.0021), and indwelling urinary catheter use (p < 0.001). The development of a UTI predicted the risk of in-hospital death as a patient's age increased (p = 0.002). Similar results were seen when only catheter-associated UTIs are included in the analysis.Indwelling urinary catheter use is connected to the development of UTIs, and these infections are associated with a greater mortality as the age of a trauma patients increases.