Catheter-associated urinary tract infection is rarely symptomatic - A prospective study of 1497 catheterized patients

Background: Catheter-associated urinary tract infection (CAUTI) is the most common nosocomial infection, accounting for more than 1 million cases each year in US hospitals and nursing homes. Objective: To define the clinical features of CAUTI. Setting and Patients: A university hospital; 1497 newly catheterized patien ts. Design: Every day that the catheter was in place, a quantitative urine cult ure and urine leukocyte count were obtained, and the patient was queried by a research worker regarding symptoms. To more precisely define the role of CAUTI in patients' symptoms, a subset of 1034 patients, 89 of whom develop ed CAUTI with more than 10(3) colony-forming units per milliliter, who did not have another potentially confounding site of infection besides the urin ary tract, was analyzed. Outcome Measures: Presence of fever, symptoms commonly associated with comm unity-acquired urinary tract infection, and peripheral leukocytosis. Results: There were 235 new cases of nosocomial CAUTI during the study peri od. More than 90% of the infected patients were asymptomatic; only 123 infe ctions (52%) were detected by patients' physicians using the hospital labor atory. In the subset analysis, there were no significant differences betwee n patients with and without CAUTI in signs or symptoms commonly associated with urinary tract infection-fever, dysuria, urgency, or flank pain-or in l eukocytosis. Only 1 of the 235 episodes of CAUTI that were prospectively st udied was unequivocally associated with secondary bloodstream infection. Conclusions: Whereas CAUTIs are a major reservoir of antibiotic-resistant o rganisms in the hospital, they are rarely symptomatic and infrequently caus e bloodstream infection. Symptoms referable to the urinary tract, fever, or peripheral leukocytosis have little predictive value for the diagnosis of CAUTI.