A prospective analysis of urinary tract infections among elderly trauma patients

Martin D. Zielinski, Melissa M. Kuntz, Stephanie F. Polites, Andy Boggust, Heidi Nelson, Mohammad A. Khasawneh, Donald H. Jenkins, Scott Harmsen, Karla V. Ballman, Rembert Pieper

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

BACKGROUND: Catheter-associated urinary tract infections (CAUTIs) have been deemed "reasonably preventable" by the Centers for Medicare and Medicaid, thereby eliminating reimbursement. Elderly trauma patients, however, are at high risk for developing urinary tract infections (UTIs) given their extensive comorbidities, immobilization, and environmental changes in the urine, which provide the ideal environment for bacterial overgrowth. Whether these patients develop CAUTI as a complication of their hospitalization or have asymptomatic bacteriuria (ASB) or UTI at admission must be determined to justify the "reasonably preventable" classification. We hypothesize that a significant proportion of elderly patients will present with ASB or UTI at admission. METHODS: Institutional review board permission was obtained to perform a prospective, observational clinical trial of all elderly (≥65 years) patients admitted to our Level I trauma center as a result of injury. Urinalysis (UA) and culture (UCx) were obtained at admission, 72 hours, and, if diagnosed with UTI, at 2 weeks after injury. Mean cost of UTI was calculated based on Centers for Disease Control and Prevention estimates of $862 to $1,007 per UTI. RESULTS: Of 201 eligible patients, 129 agreed to participate (64%). Mean (SD) age was 81 (8.6) years. All patients had a blunt mechanism of injury (76% falls), with a mean Injury Severity Score (ISS) of 13.8 (7.6). Of the 18 patients (14%) diagnosed with CAUTI, 14 (78%) were present at admission. In addition, there were 18 patients (14%) with ASB at admission. The most common bacterial species present at admission urine culture were Escherichia coli (24%) and Enterococcus (16%). Clinical features associated with bacteriuria at admission included a history of UTI, positive Gram stain result, abnormal microscopy, and pyuria. The estimated loss of reimbursement for 18 UTIs at admission was $15,516 to $18,126; however, given an estimated cost of $1,981 to screen all patients with UA and UCx at admission, up to $16,144 savings was realized. CONCLUSION: Many elderly trauma patients present with UTI. Screening UA and UCx at admission for elderly trauma patients identifies these UTIs and is cost-effective.

Original languageEnglish (US)
Pages (from-to)638-642
Number of pages5
JournalJournal of Trauma and Acute Care Surgery
Volume79
Issue number4
DOIs
StatePublished - 2015

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Urinary Tract Infections
Wounds and Injuries
Bacteriuria
Catheter-Related Infections
Urinalysis
Costs and Cost Analysis
Urine
Pyuria
Nonpenetrating Wounds
Injury Severity Score
Trauma Centers
Research Ethics Committees
Enterococcus
Medicaid
Centers for Disease Control and Prevention (U.S.)
Medicare
Immobilization
Comorbidity
Microscopy
Hospitalization

Keywords

  • Elderly
  • Medicare
  • Microbiome
  • Trauma
  • Urinary tract infection

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Zielinski, M. D., Kuntz, M. M., Polites, S. F., Boggust, A., Nelson, H., Khasawneh, M. A., ... Pieper, R. (2015). A prospective analysis of urinary tract infections among elderly trauma patients. Journal of Trauma and Acute Care Surgery, 79(4), 638-642. https://doi.org/10.1097/TA.0000000000000796

A prospective analysis of urinary tract infections among elderly trauma patients. / Zielinski, Martin D.; Kuntz, Melissa M.; Polites, Stephanie F.; Boggust, Andy; Nelson, Heidi; Khasawneh, Mohammad A.; Jenkins, Donald H.; Harmsen, Scott; Ballman, Karla V.; Pieper, Rembert.

In: Journal of Trauma and Acute Care Surgery, Vol. 79, No. 4, 2015, p. 638-642.

Research output: Contribution to journalArticle

Zielinski, MD, Kuntz, MM, Polites, SF, Boggust, A, Nelson, H, Khasawneh, MA, Jenkins, DH, Harmsen, S, Ballman, KV & Pieper, R 2015, 'A prospective analysis of urinary tract infections among elderly trauma patients', Journal of Trauma and Acute Care Surgery, vol. 79, no. 4, pp. 638-642. https://doi.org/10.1097/TA.0000000000000796
Zielinski, Martin D. ; Kuntz, Melissa M. ; Polites, Stephanie F. ; Boggust, Andy ; Nelson, Heidi ; Khasawneh, Mohammad A. ; Jenkins, Donald H. ; Harmsen, Scott ; Ballman, Karla V. ; Pieper, Rembert. / A prospective analysis of urinary tract infections among elderly trauma patients. In: Journal of Trauma and Acute Care Surgery. 2015 ; Vol. 79, No. 4. pp. 638-642.
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AU - Kuntz, Melissa M.

AU - Polites, Stephanie F.

AU - Boggust, Andy

AU - Nelson, Heidi

AU - Khasawneh, Mohammad A.

AU - Jenkins, Donald H.

AU - Harmsen, Scott

AU - Ballman, Karla V.

AU - Pieper, Rembert

PY - 2015

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N2 - BACKGROUND: Catheter-associated urinary tract infections (CAUTIs) have been deemed "reasonably preventable" by the Centers for Medicare and Medicaid, thereby eliminating reimbursement. Elderly trauma patients, however, are at high risk for developing urinary tract infections (UTIs) given their extensive comorbidities, immobilization, and environmental changes in the urine, which provide the ideal environment for bacterial overgrowth. Whether these patients develop CAUTI as a complication of their hospitalization or have asymptomatic bacteriuria (ASB) or UTI at admission must be determined to justify the "reasonably preventable" classification. We hypothesize that a significant proportion of elderly patients will present with ASB or UTI at admission. METHODS: Institutional review board permission was obtained to perform a prospective, observational clinical trial of all elderly (≥65 years) patients admitted to our Level I trauma center as a result of injury. Urinalysis (UA) and culture (UCx) were obtained at admission, 72 hours, and, if diagnosed with UTI, at 2 weeks after injury. Mean cost of UTI was calculated based on Centers for Disease Control and Prevention estimates of $862 to $1,007 per UTI. RESULTS: Of 201 eligible patients, 129 agreed to participate (64%). Mean (SD) age was 81 (8.6) years. All patients had a blunt mechanism of injury (76% falls), with a mean Injury Severity Score (ISS) of 13.8 (7.6). Of the 18 patients (14%) diagnosed with CAUTI, 14 (78%) were present at admission. In addition, there were 18 patients (14%) with ASB at admission. The most common bacterial species present at admission urine culture were Escherichia coli (24%) and Enterococcus (16%). Clinical features associated with bacteriuria at admission included a history of UTI, positive Gram stain result, abnormal microscopy, and pyuria. The estimated loss of reimbursement for 18 UTIs at admission was $15,516 to $18,126; however, given an estimated cost of $1,981 to screen all patients with UA and UCx at admission, up to $16,144 savings was realized. CONCLUSION: Many elderly trauma patients present with UTI. Screening UA and UCx at admission for elderly trauma patients identifies these UTIs and is cost-effective.

AB - BACKGROUND: Catheter-associated urinary tract infections (CAUTIs) have been deemed "reasonably preventable" by the Centers for Medicare and Medicaid, thereby eliminating reimbursement. Elderly trauma patients, however, are at high risk for developing urinary tract infections (UTIs) given their extensive comorbidities, immobilization, and environmental changes in the urine, which provide the ideal environment for bacterial overgrowth. Whether these patients develop CAUTI as a complication of their hospitalization or have asymptomatic bacteriuria (ASB) or UTI at admission must be determined to justify the "reasonably preventable" classification. We hypothesize that a significant proportion of elderly patients will present with ASB or UTI at admission. METHODS: Institutional review board permission was obtained to perform a prospective, observational clinical trial of all elderly (≥65 years) patients admitted to our Level I trauma center as a result of injury. Urinalysis (UA) and culture (UCx) were obtained at admission, 72 hours, and, if diagnosed with UTI, at 2 weeks after injury. Mean cost of UTI was calculated based on Centers for Disease Control and Prevention estimates of $862 to $1,007 per UTI. RESULTS: Of 201 eligible patients, 129 agreed to participate (64%). Mean (SD) age was 81 (8.6) years. All patients had a blunt mechanism of injury (76% falls), with a mean Injury Severity Score (ISS) of 13.8 (7.6). Of the 18 patients (14%) diagnosed with CAUTI, 14 (78%) were present at admission. In addition, there were 18 patients (14%) with ASB at admission. The most common bacterial species present at admission urine culture were Escherichia coli (24%) and Enterococcus (16%). Clinical features associated with bacteriuria at admission included a history of UTI, positive Gram stain result, abnormal microscopy, and pyuria. The estimated loss of reimbursement for 18 UTIs at admission was $15,516 to $18,126; however, given an estimated cost of $1,981 to screen all patients with UA and UCx at admission, up to $16,144 savings was realized. CONCLUSION: Many elderly trauma patients present with UTI. Screening UA and UCx at admission for elderly trauma patients identifies these UTIs and is cost-effective.

KW - Elderly

KW - Medicare

KW - Microbiome

KW - Trauma

KW - Urinary tract infection

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