nhsn-defined cauti and alternate sources of fever 1237 table 1. Summary of NHSN 2009 Surveillance Criteria for Symptomatic CAUTI
CAUTI category Laboratory criteria
Ia IIa
Positive urine culture ≥105 CFU/mL, no more than 2 species
Positive urine culture ≥103 and <105 CFU/mL, no more than 2 species, and one of the following: positive dipstick for leukocyte esterase or nitrite, pyuria (≥10 WBC/mm3 of unspun urine or ≥3 WBC/HPF of spun urine)
Ib
Positive urine culture ≥105 CFU/mL, no more than 2 species
IIb
Positive urine culture ≥103 and <105 CFU/mL, no more than 2 species, and one of the following: positive dipstick for leukocyte esterase or nitrite, pyuria (≥10 WBC/mm3 of unspun urine or ≥3 WBC/HPF of spun urine)
NOTE. Adapted from Centers for Disease Control and Prevention/ National Healthcare Safety Network (NHSN) Surveillance Definition of Healthcare-Associated Infection and Criteria for Specific Types of Infections in the Acute Care Setting, March 1, 20101; table does not include criteria for patients <1 year of age or asymptomatic bacteremic urinary tract infection. CAUTI, catheter-associated urinary tract infection;
CFU, colony-forming units; HPF, high-power field; WBC, white blood cells. aSymptom not attributed to another source except fever, which cannot be attributed to another source.
table 2. Agreement of NHSN-Defined CAUTI With Clinically Diagnosed CAUTI and Alternate Sources of Fever Among Patients With Catheter-Associated Bacteriuria
NHSN CAUTI Variable Clinical CAUTIa Alternate source of feverb
Yes No
Yes No
Yes, N=85 n (%) 42 (49%)
43 (51%) 46 (54%)
38 (45%)
No, N=45 n (%) 27 (60%)
18 (40%) 13 (29%)
32 (71%)
NOTE. CAUTI, catheter-associated urinary tract infection; NHSN, National Healthcare Safety Network. aAgreement between NHSN-defined CAUTI and clinical CAUTI: (42+18)/130=46%. bAgreement between NHSN-CAUTI and alternate sources of fever: (46+32)/129=61%. Information on alternate source of fever could not be obtained for one patient.
agreement between NHSN-definedCAUTI andalternate sources of feverwas higher (61%) (κ,0.23[95%CI,0.08–0.38]) (Table 2). In multivariable analysis, after controlling for pyuria and
0.10 [95% CI, 0.26 to
colony count, presence of an alternate source of fever (odds ratio [OR], 3.8 [95% CI, 1.5–9.2]) and organism other than yeast (2.8 [1.1–7.1]) were independently associated with NHSN-defined CAUTI. Factors associated with clinical CAUTI
musculoskeletal infection (3), deep venous thrombosis (3), intra-abdominal infection (2), endocarditis (2), central nervous system infection (2), ischemic bowel (2), abdominal hematoma (1), and acute necrotizing pancreatitis (1). There was 46% agreement between NHSN-defined CAUTI and clinical CAUTI (κ,
− − − 0.07]). The
were absence of an alternate source of fever (OR, 3.1 [95% CI, 1.1–8.6]), organism other than yeast (9.3 [3.1–28.5]), pyuria (>25 vs <10 white blood cells per high-power field) (4.0 [1.3–11.8]), and colony count (≥100,000 colony-forming units per mL vs <100,000 colony-forming units per mL) (3.1 [1.1–9.3]).
discussion
In the absence of a gold standard for CAUTI, we used a novel method to demonstrate the poor specificity of the NHSN CAUTI surveillance definition: finding a strong association of NHSN-CAUTI with the presence of alternate sources of fever.
Indwelling urinary catheter removed within 48 hours prior to specimen collection
Fever (temperature >38°C) in patient ≤65 years, urgency, frequency, dysuria, suprapubic tenderness, or costovertebral angle pain or tenderness
Indwelling catheter criteria
Indwelling urinary catheter at time of specimen collection
Symptom criteriaa
Fever (temperature >38°C), suprapubic tenderness, or costovertebral angle pain or tenderness
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