Cluster analysis identifies patients at risk of catheter-associated urinary tract infections in intensive care units: findings from the SPIN-UTI Network. (January 2021)

• Record Type: Journal Article
• Authors: Barchitta, M.; Maugeri, A.; Favara, G.; Riela, P.M.; La Mastra, C.; La Rosa, M.C.; San Lio, R. Magnano; Gallo, G.; Mura, I.; Agodi, A.; Brusaferro, Marco; Fenaroli, Salesia; Sicoli, Ennio; Montagna, Maria Teresa; Squeri, Raffaele; Di Bartolo, Rosario Massimo; Tribastoni, Salvatore; Mattaliano, Anna Rita; Bellocchi, Patrizia; Castiglione, Giacomo; Astuto, Marinella; Longhitano, Anna Maria; Monea, Maria Concetta; Scrofani, Giorgio; Di Benedetto, Antonino; Riggio, Maria Carmela; Manta, Giuseppe; Tetamo, Romano; Dei, Ignazio; Pandiani, Irene; Cannistrà, Antonino; Piotti, Paola; Girardis, Massimo; Righi, Elena; Sarchi, Pierangelo; Arnoldo, Luca; Brusaferro, Silvio; Coniglio, Salvatore; Borracino, Albino; Pintaudi, Sergio; Minerva, Massimo; Milazzo, Marina; Bissolo, Emanuela; Rigo, Alberto; Fabiani, Leila; Marinangeli, Franco; Stefanini, Paolo; D'Errico, Marcello Mario; Donati, Abele; Tardivo, Stefano; Moretti, Francesca; Carli, Alberto; Pagliarulo, Riccardo; Bianco, Aida; Pavia, Maria; Pasculli, Marcello; Vittori, Cesare; Orsi, Giovanni Battista; Arrigoni, Cristina; Laurenti, Patrizia; Ingala, Franco; Farruggia, Patrizia;
• Is Part Of: Journal of hospital infection. Volume 107(2021)
• Page Start: 57
• Page End: 63
• Publication Date: 2021-01
• Subjects: Catheter-associated urinary tract infection -- Cluster analysis -- Intensive care unit -- Risk factor -- Sepsis; Cross infection -- Periodicals; Cross infection -- Prevention -- Periodicals; Nosocomial infections -- Periodicals; Nosocomial infections -- Prevention -- Periodicals; Cross Infection -- Periodicals; Cross Infection -- prevention & control -- Periodicals; Infection Control -- Periodicals; Electronic journals; 614.44
• DOI: 10.1016/j.jhin.2020.09.030
• Languages: English
• ISSNs: 0195-6701

Abstract

Summary: Background: Although preventive strategies have been proposed against catheter-associated urinary tract infections (CAUTIs) in intensive care units (ICUs), more efforts are needed to control the incidence rate. Aim: To distinguish patients according to their characteristics at ICU admission, and to identify clusters of patients at higher risk for CAUTIs. Methods: A two-step cluster analysis was conducted on 9656 patients from the Italian Nosocomial Infections Surveillance in Intensive Care Units project. Findings: Three clusters of patients were identified. Type of admission, patient origin and administration of antibiotics had the greatest weight on the clustering model. Cluster 1 comprised more patients with a medical type of ICU admission who came from the community. Cluster 2 comprised patients who were more likely to come from other wards/hospitals, and to report administration of antibiotics 48 h before or after ICU admission. Cluster 3 was similar to Cluster 2 but was characterized by a lower percentage of patients with administration of antibiotics 48 h before or after ICU admission. Patients in Clusters 1 and 2 had a longer duration of urinary catheterization [median 7 days, interquartile range (IQR) 12 days for Cluster 1; median 7 days, IQR 11 days for Cluster 2] than patients in Cluster 3 (median 6 days, IQR 8 days; P <0.001). Interestingly, patients in Cluster 1 had a higher incidence of CAUTIs (3.5 per 100 patients) compared with patients in the other two clusters (2.5 per 100 patients in both clusters; P =0.033). Conclusion: To the authors' knowledge, this is the first study to use cluster analysis to identify patients at higher risk of CAUTIs who could gain greater benefit from preventive strategies.