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between hospital D and F, and hospital E and F, (P= 0.036 and 0.006, respectively). Only theP-value for hospitals E and F was significantly different after the Bonferroni correction. Stom-ach operations were performed in 26 patients and the median IUC-days was 3 (1Q 2.8, 3Q 6)with significant inter-hospital differences (P= 0.027). There were significant differences incatheter days between hospital B and D, and hospital D and E, (P= 0.006 and 0.029). Only theP-value for hospitals B and D was significantly different after the Bonferroni correction.CA-UTI.A total of 285 urine cultures were set up, and the median number of urine cul-tures per 1,000 catheter days was 32.3 (1Q 17.0, 3Q 38.5). A total of 25 pathogens were identi-fied by urine culture from 23 patients with CA-UTI.Enterococcusspp. was the leadingcausative organism (8/25, 32%), followed byEscherichia coli(7/25, 28%) (Table 4). The medianprevalence of CA-UTI per 1,000 catheter days was 1.6 (1Q 0.7, 3Q 3.8).The clinical characteristics of patients with CA-UTI are compared with those of patientswithout CA-UTI inTable 5. The median age of the CA-UTI group was 69 (1Q 56, 3Q 74), andthat of the non-CA-UTI group was 64 (1Q 50, 3Q 74.8) (P= 0.194). Male gender was morecommon in the CA-UTI group (62.5% vs. 42.4%,P= 0.049). Among underlying diseases,hypertension was more frequent in the CA-UTI group (65.2% vs. 42.8%,P= 0.037), but therewere no significant differences for other parameters. As for the use of additional equipment, theCA-UTI group used ventilators more frequently than the non-CA-UTI group (21.7% vs. 6.5%,P= 0.008). There were no significant differences in the use of central venous catheters, nasogas-tric tubes and endotracheal tubes. The non-CA-UTI group underwent more operations withina month before enrollment than the CA-UTI group (52.3% vs. 30.4%,P= 0.044). Median IUC-days was significantly longer in the CA-UTI group than the non-CA-UTI group [18 days (1Q 1,3Q 28) vs. 5 days (1Q 3, 3Q 9),P<0.001]. Inappropriate use of IUCs on days 7, 14, 21, and 28was not correlated with the development of CA-UTI (P= 0.709,>0.99, 0.163, and>0.99,respectively). In multivariate logistic regression analysis, only IUC-days was significantly associ-ated with CA-UTI (Odd ratio 1.127, 95% confidence interval 1.077–1.180,P<0.001).DiscussionThe purpose of this multicenter study was to examine the frequency and adequacy of IUC use,to identify reasons for catheter maintenance, and to assess the extent and risk of hospital-acquired CA-UTI associated with IUCs in hospital wards as a whole.Table 4. Causative organisms of catheter-associated urinary tract infection.PathogensNumber (%)Acinetobacter spp.2 (8)Candida spp.4 (16)Enterococcus spp.8 (32)Escherichia coli7 (28)Proteus mirabilis1 (4)Pseudomonas spp.2 (8)Staphylococcus spp.1 (4)Total25a(100)aTotal number of identified organisms from 23 patientsIndwelling urinary catheter use and CA-UTIPLOS ONE |October 9, 20177 / 11
In a previous study by Lewis et al., the IUC utilization ratio was 0.83 in ICUs, 0.21 in non-ICUs, and 0.24 overall . The incidence rate of CA-UTI per 1,000 catheter days was 1.21throughout hospitals. Even though the IUC utilization ratio was lower in non-ICUs thanICUs, the incidence rates of CA-UTI were similar (1.31 and 1.33 per 1,000 catheter days innon-ICUs and ICUs, respectively). In this study, the IUC utilization ratio in all hospital wards