Urinary tract infections in the critically ill patient with a urinary catheter

BACKGROUND: The diagnosis of urosepsis should be entertained each time a pa tient has a febrile episode. Urosepsis carries with it a mortality rate of 25% to 60%. We determined the incidence and risk factors of urosepsis in th e catheterized critically in patient. MATERIALS AND METHODS: The charts of 142 subjects admitted from November 19 94 to November 1995 to the trauma intensive care units at our institution w ith a urinary catheter weve reviewed. Urosepsis was defined as (1) positive blood and urine cultures that correlated; (2) positive urine cultures with radiologic evidence of obstructive uropathy or infection; or (3) positive urine cultures and all other cultures negative to be eligible for the urose psis group. RESULTS: Of the 126 patients evaluated for sepsis, 20 (15.8%) were diagnose d with urosepsis. Multivariant analysis demonstrated that the incidence of urosepsis was correlated with the following: age >60 years, extended length of stay in the intensive care unit and/or hospital, and duration of urinar y catheterization. All 20 patients who developed urosepsis had a positive u rinalysis and a positive urine culture (sensitivity 100%). However, urinaly ses were positive in another 63 patients who did not have urosepsis (specif icity 24.1%), and urine cultures were positive in 31 patients who did not h ave urosepsis (specificity 70.8%). CONCLUSION: We found a 15.8% incidence of urosepsis in our patient populati on. Urosepsis was more likely to occur in patients over 60 years of age, pa tients with extended length of stay in the intensive cave unit or in the ho spital in general, and patients with an extended duration of urinary cathet erization. Am J Surg. 1999; 177:287-290. (C) 1999 by Excerpta Medica, Inc.