Early urinary tract infection after spinal cord injury: a retrospective inpatient cohort study

Louise M. Goodes, Gabrielle K. King, Alethea Rea, Kevin Murray, Peter Boan, Anne Watts, Jen Bardsley, Carly Hartshorn, Jeffrey Thavaseelan, Matthew Rawlins, James A. Brock, Sarah A. Dunlop

Research output: Contribution to journalArticle

Abstract

Study design: Retrospective audit. Objectives: Examine factors associated with urinary tract infection (UTI), UTI incidence and impact on hospital length of stay (LOS) in new, inpatient adult traumatic spinal cord injury (SCI). Setting: Western Australian Hospitals managing SCI patients. Methods: Data on UTIs, bladder management and LOS were obtained from hospital databases and medical records over 26 months. Adherence to staff-administered intermittent catheterisation (staff-IC) was determined from fluid balance charts. Results: Across the cohort (n = 70) UTI rate was 1.1 starts/100 days; UTI by multi-resistant organisms 0.1/100 days. Having ≥1 UTIs compared with none and longer duration of initial urethral indwelling catheterisation (IDC) were associated with longer LOS (p-values < 0.001). For patients with ≥1 UTIs (n = 43/70), longer duration of initial IDC was associated with shorter time to first UTI (1 standard deviation longer [SD, 45.0 days], hazard ratio (HR): 0.7, 95% confidence interval [CI] 0.5–1.0, p-value 0.044). In turn, shorter time to first UTI was associated with higher UTI rate (1 SD shorter [30.7 days], rate ratio (RR): 1.32, 95%CI 1.0–1.7, p-value 0.039). During staff-IC periods (n = 38/70), protocols were followed (85.7% ≤ 6 h apart, 96.1% < 8 h), but 26% of IC volumes exceeded 500 mL; occasional volumes > 800 mL and interruptions requiring temporary IDC were associated with higher UTI rates the following week (odds ratios (ORs): 1.6, 95%CI 1.1–2.3, p-value 0.009; and 3.9, 95%CI 2.6–5.9, p-value < 0.001 respectively). Conclusions: Reducing initial IDC duration and limiting staff-IC volumes could be investigated to possibly reduce inpatient UTIs and LOS. Sponsorship: None.

Original languageEnglish
JournalSpinal Cord
DOIs
Publication statusE-pub ahead of print - 6 Aug 2019

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Spinal Cord Injuries
Urinary Tract Infections
Inpatients
Length of Stay
Cohort Studies
Catheterization
Urinary Catheterization
Water-Electrolyte Balance
Hospital Records
Medical Records
Urinary Bladder
Retrospective Studies
Odds Ratio
Databases
Incidence

Cite this

Goodes, Louise M. ; King, Gabrielle K. ; Rea, Alethea ; Murray, Kevin ; Boan, Peter ; Watts, Anne ; Bardsley, Jen ; Hartshorn, Carly ; Thavaseelan, Jeffrey ; Rawlins, Matthew ; Brock, James A. ; Dunlop, Sarah A. / Early urinary tract infection after spinal cord injury : a retrospective inpatient cohort study. In: Spinal Cord. 2019.
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abstract = "Study design: Retrospective audit. Objectives: Examine factors associated with urinary tract infection (UTI), UTI incidence and impact on hospital length of stay (LOS) in new, inpatient adult traumatic spinal cord injury (SCI). Setting: Western Australian Hospitals managing SCI patients. Methods: Data on UTIs, bladder management and LOS were obtained from hospital databases and medical records over 26 months. Adherence to staff-administered intermittent catheterisation (staff-IC) was determined from fluid balance charts. Results: Across the cohort (n = 70) UTI rate was 1.1 starts/100 days; UTI by multi-resistant organisms 0.1/100 days. Having ≥1 UTIs compared with none and longer duration of initial urethral indwelling catheterisation (IDC) were associated with longer LOS (p-values < 0.001). For patients with ≥1 UTIs (n = 43/70), longer duration of initial IDC was associated with shorter time to first UTI (1 standard deviation longer [SD, 45.0 days], hazard ratio (HR): 0.7, 95{\%} confidence interval [CI] 0.5–1.0, p-value 0.044). In turn, shorter time to first UTI was associated with higher UTI rate (1 SD shorter [30.7 days], rate ratio (RR): 1.32, 95{\%}CI 1.0–1.7, p-value 0.039). During staff-IC periods (n = 38/70), protocols were followed (85.7{\%} ≤ 6 h apart, 96.1{\%} < 8 h), but 26{\%} of IC volumes exceeded 500 mL; occasional volumes > 800 mL and interruptions requiring temporary IDC were associated with higher UTI rates the following week (odds ratios (ORs): 1.6, 95{\%}CI 1.1–2.3, p-value 0.009; and 3.9, 95{\%}CI 2.6–5.9, p-value < 0.001 respectively). Conclusions: Reducing initial IDC duration and limiting staff-IC volumes could be investigated to possibly reduce inpatient UTIs and LOS. Sponsorship: None.",
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Early urinary tract infection after spinal cord injury : a retrospective inpatient cohort study. / Goodes, Louise M.; King, Gabrielle K.; Rea, Alethea; Murray, Kevin; Boan, Peter; Watts, Anne; Bardsley, Jen; Hartshorn, Carly; Thavaseelan, Jeffrey; Rawlins, Matthew; Brock, James A.; Dunlop, Sarah A.

In: Spinal Cord, 06.08.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Early urinary tract infection after spinal cord injury

T2 - a retrospective inpatient cohort study

AU - Goodes, Louise M.

AU - King, Gabrielle K.

AU - Rea, Alethea

AU - Murray, Kevin

AU - Boan, Peter

AU - Watts, Anne

AU - Bardsley, Jen

AU - Hartshorn, Carly

AU - Thavaseelan, Jeffrey

AU - Rawlins, Matthew

AU - Brock, James A.

AU - Dunlop, Sarah A.

PY - 2019/8/6

Y1 - 2019/8/6

N2 - Study design: Retrospective audit. Objectives: Examine factors associated with urinary tract infection (UTI), UTI incidence and impact on hospital length of stay (LOS) in new, inpatient adult traumatic spinal cord injury (SCI). Setting: Western Australian Hospitals managing SCI patients. Methods: Data on UTIs, bladder management and LOS were obtained from hospital databases and medical records over 26 months. Adherence to staff-administered intermittent catheterisation (staff-IC) was determined from fluid balance charts. Results: Across the cohort (n = 70) UTI rate was 1.1 starts/100 days; UTI by multi-resistant organisms 0.1/100 days. Having ≥1 UTIs compared with none and longer duration of initial urethral indwelling catheterisation (IDC) were associated with longer LOS (p-values < 0.001). For patients with ≥1 UTIs (n = 43/70), longer duration of initial IDC was associated with shorter time to first UTI (1 standard deviation longer [SD, 45.0 days], hazard ratio (HR): 0.7, 95% confidence interval [CI] 0.5–1.0, p-value 0.044). In turn, shorter time to first UTI was associated with higher UTI rate (1 SD shorter [30.7 days], rate ratio (RR): 1.32, 95%CI 1.0–1.7, p-value 0.039). During staff-IC periods (n = 38/70), protocols were followed (85.7% ≤ 6 h apart, 96.1% < 8 h), but 26% of IC volumes exceeded 500 mL; occasional volumes > 800 mL and interruptions requiring temporary IDC were associated with higher UTI rates the following week (odds ratios (ORs): 1.6, 95%CI 1.1–2.3, p-value 0.009; and 3.9, 95%CI 2.6–5.9, p-value < 0.001 respectively). Conclusions: Reducing initial IDC duration and limiting staff-IC volumes could be investigated to possibly reduce inpatient UTIs and LOS. Sponsorship: None.

AB - Study design: Retrospective audit. Objectives: Examine factors associated with urinary tract infection (UTI), UTI incidence and impact on hospital length of stay (LOS) in new, inpatient adult traumatic spinal cord injury (SCI). Setting: Western Australian Hospitals managing SCI patients. Methods: Data on UTIs, bladder management and LOS were obtained from hospital databases and medical records over 26 months. Adherence to staff-administered intermittent catheterisation (staff-IC) was determined from fluid balance charts. Results: Across the cohort (n = 70) UTI rate was 1.1 starts/100 days; UTI by multi-resistant organisms 0.1/100 days. Having ≥1 UTIs compared with none and longer duration of initial urethral indwelling catheterisation (IDC) were associated with longer LOS (p-values < 0.001). For patients with ≥1 UTIs (n = 43/70), longer duration of initial IDC was associated with shorter time to first UTI (1 standard deviation longer [SD, 45.0 days], hazard ratio (HR): 0.7, 95% confidence interval [CI] 0.5–1.0, p-value 0.044). In turn, shorter time to first UTI was associated with higher UTI rate (1 SD shorter [30.7 days], rate ratio (RR): 1.32, 95%CI 1.0–1.7, p-value 0.039). During staff-IC periods (n = 38/70), protocols were followed (85.7% ≤ 6 h apart, 96.1% < 8 h), but 26% of IC volumes exceeded 500 mL; occasional volumes > 800 mL and interruptions requiring temporary IDC were associated with higher UTI rates the following week (odds ratios (ORs): 1.6, 95%CI 1.1–2.3, p-value 0.009; and 3.9, 95%CI 2.6–5.9, p-value < 0.001 respectively). Conclusions: Reducing initial IDC duration and limiting staff-IC volumes could be investigated to possibly reduce inpatient UTIs and LOS. Sponsorship: None.

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