Stephen I. Feller , 2025-05-05 21:05:00
Key takeaways:
- An expert at SHEA suggested using catheter-associated bacteria as a metric for measuring hospital safety instead of CAUTI.
- Bacteria detected in urine often is not the cause of symptoms in a patient, she said.
ORLANDO — Using catheter-associated urinary tract infections as a metric for care quality misidentifies some infections, according to an expert who argued that using catheter-associated bacteria instead is more accurate.
Catheter-associated urinary tract infections (CAUTIs) have been used by the CDC and others to measure the quality of care and infection prevention at hospitals for nearly 2 decades, according to officials.
Priya Sampathkumar, MD, professor of medicine and infectious diseases consultant at the Mayo Clinic, said during a presentation at SHEA Spring that although a patient has an infection discovered during CAUTI screening, that does not necessarily mean they have a UTI.
“The CAUTI metric should be retired,” Sampathkumar told Healio. “The main problem I have is really with the use of the term urinary tract infection. What we’re really measuring is catheter-associated bacteria, and reducing that is a laudable goal, but we’re working at cross purposes when we’re calling it bacteriuria.”
CAUTI is the most common type of health care-associated infection (HAI), representing nearly one-third of HAIs reported to the National Healthcare Safety Network (NHSN), Sampathkumar said during the presentation.
The NHSN in 2009 changed the definition of CAUTI to no longer include asymptomatic bacteriuria, requiring the reporting of only symptomatic and bacteremic cases.
The change led to concerns that the new definition would complicate oversight of hospital-associated infections and the overall quality of care at facilities, although experts also noted that treating fewer patients with antibiotics who have asymptomatic bacteriuria is a key part of antimicrobial stewardship efforts.
Other experts have suggested using metrics such as the NHSN Standardized Infection Ratio or the Standardized Device Utilization Ratio to better measure the quality of care and differentiate between a UTI and other catheter-related health events.
According to the Agency for Healthcare Research and Quality guidelines, which are similar to those from the Infectious Diseases Society of America and the U.S. Protective Services Task Force, asymptomatic bacteriuria — a positive urine culture from a person with zero symptoms of a UTI — should, in nearly all cases, not be treated with antibiotics.
According to Sampathkumar, estimates have shown that more than 13,000 deaths per year are associated with UTIs. Although CAUTI has been associated with a significant increase in mortality risk, she said during the presentation that analyses that have been adjusted for other outcome predictors suggest CAUTI is not associated with an increase in mortality.
UTIs overall can lead to poor outcomes if they are not treated, but Sampathkumar noted that a culture of testing stewardship — such as not testing for asymptomatic infections that clinicians will not be treating — offers an opportunity to game the system: Just skip the culture.
According to one study she noted, out of 105 CAUTIs reported in a hospital ICU in the previous 2 years, just over half had an alternative infection to explain fever, one of the most common CAUTI symptoms. Additionally, 18% had a fever due to a noninfectious cause, 32% had no alternative explanation and 6% were associated with positive blood cultures for the same pathogen but the urinary tract was not definitively linked to the bloodstream infection.
Sampathkumar argued that because it is unclear how strongly associated CAUTI is with patient harm and the current definition of CAUTI also appears to negate efforts to reduce catheter use, it should not be used as a metric.
“One of the best ways to reduce [CAUTIs] is by not doing cultures,” Sampathkumar said. “So we’re really working at cross purposes telling some people that this is something that’s really bad and harms our patients and simultaneously telling people not to look for it by not doing cultures.”
References:
Sources/Disclosures
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Sampathkumar P. It’s time to retire CAUTI as a metric. Presented at: SHEA Spring; April 27-30, 2025; Orlando.
Disclosures:
Sampathkumar reports no relevant financial disclosures.
