1204. Catheter-Associated Urinary Tract Infections (CAUTIs) and Secondary Hospital-Onset Bloodstream Infections (HO-BSIs)… Only the Tip of the Iceberg?
Authors: Ai ChinEn , Jung Molly , Kelly Timothy , Yu Kalvin 
Published: December 2022

Abstract

Background
HO-BSIs – secondary to urinary tract infections (UTIs) – can result in substantial morbidity and mortality. The Centers for Disease Control and Prevention report that CAUTIs are the leading cause of secondary BSIs. However, more than 70% of hospital-onset UTIs (HO-UTIs) may be non-device associated. If that is the case, are a substantial number of HO-BSIs caused by non-CAUTI HO-UTIs?

Methods
A retrospective cohort analysis of nosocomial infections from 37 US hospitals was conducted using de-identified, real-world data from an electronic infection surveillance system. The analytic cohort included adults ≥ 18 years, without an infection diagnosis, and hospital length of stay ≥ 2 days, between October 2015 and June 2019. HO-UTI subjects presented with a non-contaminated positive urine culture on day 3 or later. Clinically meaningful HO-UTIs, were those with antimicrobials ordered ±2 days of the positive urine culture. CAUTI was defined per the National Healthcare Safety Network definition. Non-CAUTI HO-UTI were HO-UTIs not meeting the CAUTI definition. Secondary HO-BSIs were defined as non-contaminated, positive blood cultures occurring 2 days before or 4 days after the positive urine specimen, requiring an antimicrobial susceptibility test, and presenting with the same pathogen.

Results
Of the 568,293 inpatient admissions, 465,246 met the inclusion criteria. The vast majority of CAUTIs (401 of 436; 92%) and 75% of non-CAUTI HO-UTIs (3,256 of 4,374) were clinically meaningful. The relative burden of secondary HO-BSI was greater in patients with CAUTI (8%) compared to non-CAUTI HO-UTI (3%). However, the absolute risk of secondary HO-BSI was 3-times greater in non-CAUTI HO-UTI compared to CAUTI (96 cases vs 32 cases, respectively). 56% of secondary HO-BSI in CAUTI, and only 31% of secondary HO-BSI in non-CAUTI HO-UTI, likely originated in the intensive care unit (ICU).
Case Tree
Frequency of CAUTI and non-CAUTI HO-UTI. Frequency of secondary HO-BSI. Location of HO-UTI.

Conclusion
This retrospective, observational study found clinically meaningful non-CAUTI HO-UTIs to be 10-fold higher than the number of CAUTIs. In addition, the absolute burden of secondary HO-BSI is substantially higher in these non-CAUTI HO-UTIs and more likely to be associated with the non-ICU setting. The data suggests that evaluating CAUTI alone may underestimate the true burden of clinically meaningful HO-UTI.

Disclosures
ChinEn Ai, MPH, BD - Becton, Dickinson and Company: Employee|BD - Becton, Dickinson and Company: Stocks/Bonds Molly Jung, MPH, BD - Becton, Dickinson and Company: Employee|BD - Becton, Dickinson and Company: Stocks/Bonds Timothy Kelly, MS, MBA, BD - Becton, Dickinson and Company: Employee|BD - Becton, Dickinson and Company: Stocks/Bonds Kalvin Yu, MD, FIDSA, Becton, Dickinson and Company: Employee of, and shareholder in, Becton, Dickinson and Company, and the company received funding from GlaxoSmithKline plc. to conduct this study|GlaxoSmithKline plc.: GlaxoSmithKline plc.-sponsored study 212502.