Length of stay and mortality associated with healthcare-associated urinary tract infections: A multi-state model

Journal article


Mitchell, Brett G., Ferguson, J. K., Anderson, Malcolm, Sear, J. and Barnett, A.. (2016) Length of stay and mortality associated with healthcare-associated urinary tract infections: A multi-state model. Journal of Hospital Infection. https://doi.org/10.1016/j.jhin.2016.01.012
AuthorsMitchell, Brett G., Ferguson, J. K., Anderson, Malcolm, Sear, J. and Barnett, A.
Abstract

Background: The emergence of antimicrobial resistance is of particular concern with respect to urinary tract infections, since the majority of causative agents are Gram-negative bacteria. Healthcare-associated urinary tract infections (HAUTIs) are frequently associated with instrumentation of the urinary tract, specifically with indwelling catheters. Aim: To evaluate the current incidence, mortality, and length of hospital stay associated with HAUTIs. Methods: A non-concurrent cohort study design was used, conducted between January 1st, 2010 and June 30th, 2014. All patients admitted to one of the eight participating Australian hospitals and who were hospitalized for more than two days were included. The primary outcome measures were the incidence, mortality, and excess length of stay associated with HAUTIs. Findings: From 162,503 patient admissions, 1.73% [95% confidence interval (CI): 1.67–1.80] of admitted patients acquired a HAUTI. Using a multi-state model, the expected extra length of stay due to HAUTI was four days (95% CI: 3.1–5.0 days). Using a Cox regression model, infection significantly reduced the rate of discharge (hazard ratio: 0.78; 95% CI: 0.73–0.83). Women were less likely to die (0.71; 0.66–0.75), whereas older patients were more likely to die (1.40; 1.38–1.43). Death was rarer in a tertiary referral hospital compared to other hospitals, after adjusting for age and sex (0.74; 0.69–0.78). Conclusion: This study is the first to explore the burden of HAUTIs in hospitals using appropriate statistical methods in a developed country. Our study indicates that the incidence of HAUTI, in addition to its associated extra length of stay in hospital, presents a burden to the hospital system. With increasing incidence of UTI due to antimicrobial-resistant organisms, surveillance and interventions to reduce the incidence of HAUTI are required.

Keywordseconomic; length of stay; mortality; urinary tract infection
Year2016
JournalJournal of Hospital Infection
PublisherW.B. Saunders Ltd
Digital Object Identifier (DOI)https://doi.org/10.1016/j.jhin.2016.01.012
Research GroupSchool of Nursing, Midwifery and Paramedicine
Place of publicationUnited Kingdom
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Cerin, Ester, Sit, Cindy, Barnett, Anthony, Cheung, Man-chin and Chan, Wai-man. (2013) Walking for recreation and perceptions of the neighborhood environment in older Chinese urban dwellers. Journal of Urban Health. 90(1), pp. 56 - 66. https://doi.org/10.1007/s11524-012-9704-8
Socioeconomic status, neighborhood characteristics, and walking within the neighborhood among older Hong Kong Chinese
Cerin, Ester, Mellecker, Robin, Macfarlane, Duncan J., Barnett, Anthony, Cheung, Man-chin, Sit, Cindy H.P. and Chan, Wai-man. (2013) Socioeconomic status, neighborhood characteristics, and walking within the neighborhood among older Hong Kong Chinese. Journal of Aging and Health. 25(8), pp. 1425 - 1444. https://doi.org/10.1177/0898264313510034
Socio-economic status, neighbourhood characteristics, and walking within the neighbourhood among older Hong Kong Chinese
Cerin, Ester, Mellecker, Robin, Macfarlane, Duncan, Barnett, Anthony, Cheung, Man-chin, Sit, Cindy and Chan, Wai-man. (2013) Socio-economic status, neighbourhood characteristics, and walking within the neighbourhood among older Hong Kong Chinese. Journal of Aging and Health. 25(8), pp. 1425 - 1444. https://doi.org/10.1177/0898264313510034
Identifying mediators of training effects on performance-related psychobiosocial states: A single-case observational study in an elite female triathlete
Barnett, Anthony, Cerin, Ester, Reaburn, Peter and Hooper, Sue. (2012) Identifying mediators of training effects on performance-related psychobiosocial states: A single-case observational study in an elite female triathlete. Psychology of Sport and Exercise. 13(5), pp. 541 - 549. https://doi.org/10.1016/j.psychsport.2012.02.010
Healthcare associated infection surveillance: Examining influences on reliable and valid data collection and analysis
Mitchell, Brett. (2012) Healthcare associated infection surveillance: Examining influences on reliable and valid data collection and analysis [Thesis]. https://doi.org/10.4226/66/5a962ea8c689a
Mortality and Clostridium difficile infection: a review
Mitchell, Brett G. and Gardner, Anne. (2012) Mortality and Clostridium difficile infection: a review. Antimicrobial Resistance and Infection Control. 1(1). https://doi.org/10.1186/2047-2994-1-20
Reliability and validity of the IPAQ-L in a sample of Hong Kong Urban older adults: Does neighborhood of residence matter?
Cerin, Ester, Barnett, Anthony, Cheung, Man-chin, Sit, Cindy, Macfarlane, Duncan J. and Chan, Wai-man. (2012) Reliability and validity of the IPAQ-L in a sample of Hong Kong Urban older adults: Does neighborhood of residence matter? Journal of Aging and Physical Activity. https://doi.org/10.1123/japa.20.4.402
Healthcare-associated infections: Getting the balance right in safety and quality v. public reporting (Review)
Mitchell, Brett, Gardner, Anne and McGregor, Alistair. (2012) Healthcare-associated infections: Getting the balance right in safety and quality v. public reporting (Review). Australian Health Review. 36(4), pp. 365 - 366. https://doi.org/10.1071/AH11200
Can homemade fit testing solutions be as effective as commercial products?
Mitchell, Brett, Wells, Anne, McGregor, Alistair and McKenzie, Duncan. (2012) Can homemade fit testing solutions be as effective as commercial products? Healthcare Infection. 17(4), pp. 111 - 114. https://doi.org/10.1071/HI12019
The epidemiology of Staphylococcus aureus bacteraemia in Tasmania
Mitchell, Brett, Gardner, Anne and Stewart, Lee. (2012) The epidemiology of Staphylococcus aureus bacteraemia in Tasmania. Healthcare Infection. 17(3), pp. 98 - 103. https://doi.org/10.1071/HI12020
Prolongation of length of stay and Clostridium difficile infection : A review of the methods used to examine length of stay due to healthcare associated infections
Mitchell, Brett and Gardner, Anne. (2012) Prolongation of length of stay and Clostridium difficile infection : A review of the methods used to examine length of stay due to healthcare associated infections. Antimicrobial Resistance and Infection Control. 1(14), pp. 1 - 6. https://doi.org/10.1186/2047-2994-1-14
An increase in community onset Clostridium difficile infection : A population-based study, Tasmania, Australia
Mitchell, Brett, Wilson, Fiona and McGregor, Alistair. (2012) An increase in community onset Clostridium difficile infection : A population-based study, Tasmania, Australia. Healthcare Infection. 17(4), pp. 127 - 132. https://doi.org/10.1071/HI12029
Impact of an active video game on healthy children's physical activity
Baranowski, Tom, Abdelsamad, Dina, Baranowski, Janice, O'Connor, Teresia, Thompson, Debbe, Barnett, Anthony, Cerin, Ester and Chen, Tzu-An. (2012) Impact of an active video game on healthy children's physical activity. Pediatrics. 129(3), pp. 636 - 642. https://doi.org/10.1542/peds.2011-2050
Predictors of pre- and post-competition affective states in male martial artists: A multilevel interactional approach
Cerin, Ester and Barnett, Anthony. (2011) Predictors of pre- and post-competition affective states in male martial artists: A multilevel interactional approach. Scandinavian Journal of Medicine & Science in Sports. 21(1), pp. 137 - 150. https://doi.org/10.1111/j.1600-0838.2009.01006.x
Clostridium difficile infection in Tasmanian public hospitals 2006-2010
Mitchell, Brett G., Ware, C., McGregor, A., Brown, S. and Wells, A.. (2011) Clostridium difficile infection in Tasmanian public hospitals 2006-2010. Healthcare Infection (print version). 16(3), pp. 101 - 106. https://doi.org/10.1071/HI11009
Active video games for youth: A systematic review
Barnett, Anthony, Cerin, Ester and Baranowski, Tom. (2011) Active video games for youth: A systematic review. Journal of Physical Activity and Health. 8(5), pp. 724 - 737. https://doi.org/10.1123/jpah.8.5.724
Measuring walking within and outside the neighborhood in Chinese elders: Reliability and validity
Cerin, Ester, Barnett, Anthony, Sit, Cindy, Cheung, Man-chin, Lee, Lok-chun, Ho, Sai-yin and Chan, Wai-man. (2011) Measuring walking within and outside the neighborhood in Chinese elders: Reliability and validity. BMC Public Health. 11(851), pp. 3 - 10. https://doi.org/10.1186/1471-2458-11-851
Components of the diet associated with child adiposity: A cross-sectional study
Ledoux, Tracey A., Watson, Kathy, Barnett, Anthony, Nguyen, Nga T., Baranowski, Janice C. and Baranowski, Tom. (2011) Components of the diet associated with child adiposity: A cross-sectional study. Journal of the American College of Nutrition. 30(6), pp. 536 - 546. https://doi.org/10.1080/07315724.2011.10720000
Mechanisms linking affective reactions to competition-related and competition-extraneous concerns in male martial artists
Cerin, Ester and Barnett, Anthony. (2011) Mechanisms linking affective reactions to competition-related and competition-extraneous concerns in male martial artists. Scandinavian Journal of Medicine & Science in Sports. 21(5), pp. 700 - 712. https://doi.org/10.1111/j.1600-0838.2009.01072.x
The effects of training on performance and performance-related states in individual elite athletes: A dynamic approach
Barnett, Anthony, Cerin, Ester, Reaburn, Peter and Hooper, Sue. (2010) The effects of training on performance and performance-related states in individual elite athletes: A dynamic approach. Journal of Sports Sciences. 28(10), pp. 1117 - 1126. https://doi.org/10.1080/02640414.2010.497817
A literature review supporting the proposed national Australian definition for Staphylococcus aureus bacteraemia
Mitchell, Brett, Gardner, Anne, Collignon, Peter, Stewart, Lee and Cruickshank, Marilyn. (2010) A literature review supporting the proposed national Australian definition for Staphylococcus aureus bacteraemia. Healthcare Infection. 15(4), pp. 105 - 113. https://doi.org/10.1071/HI10030
Testing theories of dietary behavior change in youth using the Mediating Variable Model with intervention programs
Cerin, Ester, Barnett, Anthony and Baranowski, Tom. (2009) Testing theories of dietary behavior change in youth using the Mediating Variable Model with intervention programs. Journal of Nutrition Education and Behavior. 41(5), pp. 309 - 318. https://doi.org/10.1016/j.jneb.2009.03.129
Using recovery modalities between training sessions in elite athletes: Does it help?
Barnett, Anthony. (2006) Using recovery modalities between training sessions in elite athletes: Does it help? Sports Medicine. 36(9), pp. 781 - 796. https://doi.org/10.2165/00007256-200636090-00005
A processual analysis of basic emotions and sources of concerns as they are lived before and after a competition
Cerin, Ester and Barnett, Anthony. (2006) A processual analysis of basic emotions and sources of concerns as they are lived before and after a competition. Psychology of Sport and Exercise. 7(3), pp. 287 - 307. https://doi.org/10.1016/j.psychsport.2005.07.002
Individual calibration for estimating free-living walking speed using the MTI monitor
Barnett, Anthony and Cerin, Ester. (2006) Individual calibration for estimating free-living walking speed using the MTI monitor. Medicine and Science in Sports and Exercise. 38(4), pp. 761 - 767. https://doi.org/10.1249/01.mss.0000210206.55941.b2
Peak oxygen uptake of 12 to 18-year-old boys living in a densely populated urban environment
Barnett, Anthony, Bacon-Shone, John, Tam, K. H., Leung, Mauriceping and Armstrong, Neil. (1995) Peak oxygen uptake of 12 to 18-year-old boys living in a densely populated urban environment. Annals of Human Biology. 22(6), pp. 525 - 532. https://doi.org/10.1080/03014469500004182
Response of unacclimatized males to repeated weekly bouts of exercise in the heat
Barnett, Anthony. (1993) Response of unacclimatized males to repeated weekly bouts of exercise in the heat. British Journal of Sports Medicine.
Leg muscle pH following sprint running
Costill, Davlid L., Barnett, Anthony, Sharp, Rick, Fink, William J. and Katz, Abram. (1983) Leg muscle pH following sprint running. Medicine and Science in Sports and Exercise. 15(4), pp. 325 - 329. https://doi.org/10.1249/00005768-198315040-00013