between hospital D and F, and hospital E and F, (
P
= 0.036 and 0.006, respectively). Only the
P
-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 in
catheter days between hospital B and D, and hospital D and E, (
P
= 0.006 and 0.029). Only the
P
-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.
Enterococcus
spp. was the leading
causative organism (8/25, 32%), followed by
Escherichia coli
(7/25, 28%) (
Table 4
). The median
prevalence 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 patients
without CA-UTI in
Table 5
. The median age of the CA-UTI group was 69 (1Q 56, 3Q 74), and
that of the non-CA-UTI group was 64 (1Q 50, 3Q 74.8) (
P
= 0.194). Male gender was more
common 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 there
were no significant differences for other parameters. As for the use of additional equipment, the
CA-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 within
a 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 28
was 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).
Discussion
The 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.
Pathogens
Number (%)
Acinetobacter spp
.
2 (8)
Candida spp
.
4 (16)
Enterococcus spp
.
8 (32)
Escherichia coli
7 (28)
Proteus mirabilis
1 (4)
Pseudomonas spp
.
2 (8)
Staphylococcus spp
.
1 (4)
Total
25
a
(100)
a
Total number of identified organisms from 23 patients
Indwelling urinary catheter use and CA-UTI
PLOS ONE |
October 9, 2017
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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 [
12
]. The incidence rate of CA-UTI per 1,000 catheter days was 1.21
throughout hospitals. Even though the IUC utilization ratio was lower in non-ICUs than
ICUs, the incidence rates of CA-UTI were similar (1.31 and 1.33 per 1,000 catheter days in
non-ICUs and ICUs, respectively). In this study, the IUC utilization ratio in all hospital wards
