Urinary tract infection in elderly trauma patients: Review of the Trauma Quality Improvement Program identifies the population at risk

Background: Elderly trauma patients are at high risk for urinary tract infection (UTI). Despite this, UTI has been deemed a potentially preventable problem and therefore not reimbursable by the Centers for Medicare and Medicaid Services. Early identification of UTI in these patients should lead to prompt treatment, improved outcomes, and cost savings. Risk factors for UTI development in this population must be elucidated to realize these goals.

Methods: The Trauma Quality Improvement Program (TQIP) database was used to analyze elderly patients (Q65 years) admitted as a result of injury during 2011. Patients with genitourinary injuries or undergoing dialysis before admission were excluded. Multivariable logistic regression analysiswas conducted to identify UTI risk factors. Mean cost of UTI was calculated based on the assumption of $862 to $1,007 per UTI.

Results: In total, 33,257 patients were identified; 1,492 developed UTI (4.5%). Multiple significant risk factors were identified, including age greater than 75 years, female sex, ascites, moderate head injury, impaired sensorium, congestive heart failure, and duration of hospital stay (all p<G 0.05). Assuming that UTIs diagnosed on hospital Day 1 were preexisting, the cost of UTI to TQIP hospitals ranged from $1,280,959 to $1,496,434 per year.

Conclusion: Duration of stay has a profound impact on the development of UTIs in elderly trauma patients, but overall severity of injury does not. In addition, multiple nonmodifiable risk factors were identified, prompting the possibility for increased screening of occult UTIs. Reimbursement for care ofUTI in this complicated patient population should be revisited. The TQIP databasemust improve urinary catheter data.