To define nosocomial urinary tract infection (NUTI) rates in a pediatric intensive care unit, and determine whether practice recommendations have been sustained after 10 yrs.Design
Retrospective, descriptive observational study followed by point prevalence audits of duration of urinary tract catheterization.Setting
A 32-bed pediatric intensive care unit in a multidisciplinary, 300-bed, university-affiliated tertiary care hospital.Subjects
The retrospective review included patients admitted to the pediatric intensive care unit between December 1997 and July 1999 who developed a NUTI. The audits of duration of urinary tract catheterization were performed in December 2001.Interventions
None.Measurements and Main Results
The primary outcome measure was the development of NUTI. Out of 2,832 consecutive admissions, 25 patients developed 27 episodes of NUTI (rate, 0.95/100 admissions). Previous surgery for congenital heart disease was the primary risk factor for NUTI. All 18 patients for whom the duration of catheterization was available had been catheterized for at least 3 days. Gram-negative bacilli and yeast accounted for 82% of NUTI pathogens. Twenty percent of bacterial pathogens were antibiotic resistant. Audits of the duration of urinary tract catheterization done on five separate occasions revealed that the mean duration of catheterization ranged from 3.5 to 4.7 days, with a peak absolute value of 16 days.Conclusions
NUTIs in children in our pediatric intensive care unit were associated with previous cardiovascular surgery and with urinary tract catheterization of at least 3 days. The need for careful fluid monitoring by catheterization must be balanced against the increased risk of catheter-related urinary tract infection. Removal of urinary catheters at the earliest opportunity will prevent many infections. Ongoing education or innovative strategies will be required to sustain optimal practice.