Hospital-Acquired Urinary Tract Infections: Results of a Cohort Study Performed in an Internal Medicine Department
Autor(a) principal: | |
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Data de Publicação: | 2017 |
Outros Autores: | |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/8606 |
Resumo: | Introduction: Urinary tract infections are the most frequent healthcare associated infections, being related to both high costs and morbidity. Our intention was to carry out an epidemiological characterization of hospital acquired urinary tract infections that occurred in an internal medicine department of a Portuguese hospital.Material and Methods: Retrospective cohort study (historic cohort). Data were analysed from a systematic random sample of 388 patients, representative of the 3492 admissions occurred in 2014 in that department.Results: One in four patients underwent the placement of a bladder catheter [24.7% (n = 96); 95% CI: 20% - 29%], 36.5% (95% CI: 33% - 48%) of which in the absence of clinical criteria for that procedure. The global cumulative incidence rate for nosocomial urinary tract infections was 4.6% (95% CI: 2.5% - 6.7%). Most hospital acquired urinary tract infections (61.1%) were related to bladder catheter use. We quantified 3.06 infections / 1000 patient-days and 14.5 infections / 1000 catheter-days. Catheter associated urinary tract infection occurred at an early stage of hospitalization. The vast majority of patients (66.7%) that developed a catheter associated urinary tract infection were subjected to bladder catheter placement at emergency department. Seventy one per cent of catheter associated urinary tract infection occurred in patients that were subjected to bladder catheter placement without criteria.Discussion: These results point to an excessive and inadequate use of urinary catheters, highlighting the need for judicious use taking into account the formal clinical indications. The incidence of catheter associated urinary tract infection is similar to what we found in other studies. Nevertheless we found a very high incidence density per catheter-days that may foresee a problem probably related to the absence of early withdrawal of the device, and to both bladder catheter placement and maintenance practices. A significant part of catheter associated urinary tract infection occurred in patients that had the bladder catheter placed in the emergency department, before the admission to the internal medicine ward, which highlights the need to assess the urinary catheterization practices in those departments.Conclusion: The high rate of catheter associated urinary tract infection that occurred in the absence of bladder placement indication reinforces the need to implement prevention strategies that contemplate the reduction of its use. Emergency departments should be part of quality improvement projects in this area. Causes for the early onset of catheter associated urinary tract infection in this cohort should be investigated. |
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Hospital-Acquired Urinary Tract Infections: Results of a Cohort Study Performed in an Internal Medicine DepartmentInfecção do Tracto Urinário Adquirida no Hospital: Resultados de um Estudo de Coorte Realizado num Departamento de Medicina InternaCommunity-Acquired InfectionsCross InfectionHospital DepartmentsInternal MedicineUrinary Tract InfectionsInfecção HospitalarInfecções Comunitárias AdquiridasInfecções UrináriasMedicina InternaIntroduction: Urinary tract infections are the most frequent healthcare associated infections, being related to both high costs and morbidity. Our intention was to carry out an epidemiological characterization of hospital acquired urinary tract infections that occurred in an internal medicine department of a Portuguese hospital.Material and Methods: Retrospective cohort study (historic cohort). Data were analysed from a systematic random sample of 388 patients, representative of the 3492 admissions occurred in 2014 in that department.Results: One in four patients underwent the placement of a bladder catheter [24.7% (n = 96); 95% CI: 20% - 29%], 36.5% (95% CI: 33% - 48%) of which in the absence of clinical criteria for that procedure. The global cumulative incidence rate for nosocomial urinary tract infections was 4.6% (95% CI: 2.5% - 6.7%). Most hospital acquired urinary tract infections (61.1%) were related to bladder catheter use. We quantified 3.06 infections / 1000 patient-days and 14.5 infections / 1000 catheter-days. Catheter associated urinary tract infection occurred at an early stage of hospitalization. The vast majority of patients (66.7%) that developed a catheter associated urinary tract infection were subjected to bladder catheter placement at emergency department. Seventy one per cent of catheter associated urinary tract infection occurred in patients that were subjected to bladder catheter placement without criteria.Discussion: These results point to an excessive and inadequate use of urinary catheters, highlighting the need for judicious use taking into account the formal clinical indications. The incidence of catheter associated urinary tract infection is similar to what we found in other studies. Nevertheless we found a very high incidence density per catheter-days that may foresee a problem probably related to the absence of early withdrawal of the device, and to both bladder catheter placement and maintenance practices. A significant part of catheter associated urinary tract infection occurred in patients that had the bladder catheter placed in the emergency department, before the admission to the internal medicine ward, which highlights the need to assess the urinary catheterization practices in those departments.Conclusion: The high rate of catheter associated urinary tract infection that occurred in the absence of bladder placement indication reinforces the need to implement prevention strategies that contemplate the reduction of its use. Emergency departments should be part of quality improvement projects in this area. Causes for the early onset of catheter associated urinary tract infection in this cohort should be investigated.Introdução: As infecções urinárias são as infecções associadas aos cuidados de saúde mais frequentes, estando associadas a elevados custos e morbilidade. Pretendeu-se efectuar uma caracterização epidemiológica das infecções urinárias adquiridas no Hospital ocorridas num serviço de Medicina Interna de um hospital português.Material e Métodos: Estudo de coorte retrospectivo (coorte histórica). Analisaram-se os dados correspondentes a uma amostra aleatória sistemática de 388 doentes, representativa das 3492 admissões ocorridas, em 2014, nesse Serviço.Resultados: Um em cada quatro doentes foi sujeito à colocação de uma sonda vesical [24,7% (n = 96); IC 95%: 20% - 29%], em 36,5% (IC 95%: 33% - 48%) dos casos na ausência de critérios clínicos. A taxa de incidência cumulativa global de infecções urinárias nosocomiais foi de 4,6% (IC 95%: 2,5% - 6,7%). A maior parte das infecções (61,1%) associou-se à utilização de um cateter vesical. Ocorreram 3,06 infecções por mil dias de internamento e 14,5 infecções por mil dias de algaliação. As Infecções urinárias associadas a cateter vesical ocorreram numa fase precoce do internamento. A grande maioria dos doentes que desenvolveram infecções urinárias associadas a cateter vesical (66,7%) foram algaliados no serviço de urgência. Setenta e um por cento das infecções urinárias associadas a cateter vesical ocorreram em doentes algaliados na ausência de critérios para o procedimento.Discussão: Estes resultados apontam para um uso excessivo e inadequado de cateteres urinários, destacando-se a necessidade do uso criterioso tendo em conta as indicações clínicas formais. A incidência de infecção do tracto urinário associada ao cateter vesical foi semelhante à encontrada noutros estudos. No entanto, encontrámos uma densidade de incidência por dia de cateter muito elevada, o que permite antever um problema relacionado com ausência de retirada precoce do dispositivo ou com as práticas de colocação e manutenção da algália. Uma parte significativa das infecções associadas a cateter vesical ocorreu em doentes cuja colocação de cateter vesical ocorreu no serviço de urgência, antes da admissão na enfermaria de medicina interna, o que enfatiza a necessidade de avaliar as práticas de algaliação nesses serviços.Conclusão: A elevada taxa de Infecções urinárias associadas a cateter vesical ocorrida na ausência de indicação para algaliação, reforça a necessidade de implementação de estratégias de prevenção que contemplem a redução do número de algaliações. Os serviços de urgência devem ser integrados nos projectos de melhoria nesta área. As causas para a ocorrência precoce de infecções urinárias associadas a cateter vesical nesta coorte devem ser investigadas.Ordem dos Médicos2017-09-29info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfimage/tiffimage/tiffapplication/pdfapplication/vnd.openxmlformats-officedocument.wordprocessingml.documentapplication/pdfhttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/8606oai:ojs.www.actamedicaportuguesa.com:article/8606Acta Médica Portuguesa; Vol. 30 No. 9 (2017): September; 608-614Acta Médica Portuguesa; Vol. 30 N.º 9 (2017): Setembro; 608-6141646-07580870-399Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/8606https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/8606/5148https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/8606/8999https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/8606/9000https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/8606/9031https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/8606/9159https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/8606/9291Direitos de Autor (c) 2017 Acta Médica Portuguesainfo:eu-repo/semantics/openAccessLobão, Maria JoãoSousa, Paulo2022-12-20T11:05:34Zoai:ojs.www.actamedicaportuguesa.com:article/8606Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T16:19:37.360687Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Hospital-Acquired Urinary Tract Infections: Results of a Cohort Study Performed in an Internal Medicine Department Infecção do Tracto Urinário Adquirida no Hospital: Resultados de um Estudo de Coorte Realizado num Departamento de Medicina Interna |
title |
Hospital-Acquired Urinary Tract Infections: Results of a Cohort Study Performed in an Internal Medicine Department |
spellingShingle |
Hospital-Acquired Urinary Tract Infections: Results of a Cohort Study Performed in an Internal Medicine Department Lobão, Maria João Community-Acquired Infections Cross Infection Hospital Departments Internal Medicine Urinary Tract Infections Infecção Hospitalar Infecções Comunitárias Adquiridas Infecções Urinárias Medicina Interna |
title_short |
Hospital-Acquired Urinary Tract Infections: Results of a Cohort Study Performed in an Internal Medicine Department |
title_full |
Hospital-Acquired Urinary Tract Infections: Results of a Cohort Study Performed in an Internal Medicine Department |
title_fullStr |
Hospital-Acquired Urinary Tract Infections: Results of a Cohort Study Performed in an Internal Medicine Department |
title_full_unstemmed |
Hospital-Acquired Urinary Tract Infections: Results of a Cohort Study Performed in an Internal Medicine Department |
title_sort |
Hospital-Acquired Urinary Tract Infections: Results of a Cohort Study Performed in an Internal Medicine Department |
author |
Lobão, Maria João |
author_facet |
Lobão, Maria João Sousa, Paulo |
author_role |
author |
author2 |
Sousa, Paulo |
author2_role |
author |
dc.contributor.author.fl_str_mv |
Lobão, Maria João Sousa, Paulo |
dc.subject.por.fl_str_mv |
Community-Acquired Infections Cross Infection Hospital Departments Internal Medicine Urinary Tract Infections Infecção Hospitalar Infecções Comunitárias Adquiridas Infecções Urinárias Medicina Interna |
topic |
Community-Acquired Infections Cross Infection Hospital Departments Internal Medicine Urinary Tract Infections Infecção Hospitalar Infecções Comunitárias Adquiridas Infecções Urinárias Medicina Interna |
description |
Introduction: Urinary tract infections are the most frequent healthcare associated infections, being related to both high costs and morbidity. Our intention was to carry out an epidemiological characterization of hospital acquired urinary tract infections that occurred in an internal medicine department of a Portuguese hospital.Material and Methods: Retrospective cohort study (historic cohort). Data were analysed from a systematic random sample of 388 patients, representative of the 3492 admissions occurred in 2014 in that department.Results: One in four patients underwent the placement of a bladder catheter [24.7% (n = 96); 95% CI: 20% - 29%], 36.5% (95% CI: 33% - 48%) of which in the absence of clinical criteria for that procedure. The global cumulative incidence rate for nosocomial urinary tract infections was 4.6% (95% CI: 2.5% - 6.7%). Most hospital acquired urinary tract infections (61.1%) were related to bladder catheter use. We quantified 3.06 infections / 1000 patient-days and 14.5 infections / 1000 catheter-days. Catheter associated urinary tract infection occurred at an early stage of hospitalization. The vast majority of patients (66.7%) that developed a catheter associated urinary tract infection were subjected to bladder catheter placement at emergency department. Seventy one per cent of catheter associated urinary tract infection occurred in patients that were subjected to bladder catheter placement without criteria.Discussion: These results point to an excessive and inadequate use of urinary catheters, highlighting the need for judicious use taking into account the formal clinical indications. The incidence of catheter associated urinary tract infection is similar to what we found in other studies. Nevertheless we found a very high incidence density per catheter-days that may foresee a problem probably related to the absence of early withdrawal of the device, and to both bladder catheter placement and maintenance practices. A significant part of catheter associated urinary tract infection occurred in patients that had the bladder catheter placed in the emergency department, before the admission to the internal medicine ward, which highlights the need to assess the urinary catheterization practices in those departments.Conclusion: The high rate of catheter associated urinary tract infection that occurred in the absence of bladder placement indication reinforces the need to implement prevention strategies that contemplate the reduction of its use. Emergency departments should be part of quality improvement projects in this area. Causes for the early onset of catheter associated urinary tract infection in this cohort should be investigated. |
publishDate |
2017 |
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2017-09-29 |
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info:eu-repo/semantics/publishedVersion |
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info:eu-repo/semantics/article |
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article |
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publishedVersion |
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https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/8606 oai:ojs.www.actamedicaportuguesa.com:article/8606 |
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https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/8606 |
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oai:ojs.www.actamedicaportuguesa.com:article/8606 |
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eng |
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eng |
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https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/8606 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/8606/5148 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/8606/8999 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/8606/9000 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/8606/9031 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/8606/9159 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/8606/9291 |
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Direitos de Autor (c) 2017 Acta Médica Portuguesa info:eu-repo/semantics/openAccess |
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Direitos de Autor (c) 2017 Acta Médica Portuguesa |
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application/pdf image/tiff image/tiff application/pdf application/vnd.openxmlformats-officedocument.wordprocessingml.document application/pdf |
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Ordem dos Médicos |
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Ordem dos Médicos |
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Acta Médica Portuguesa; Vol. 30 No. 9 (2017): September; 608-614 Acta Médica Portuguesa; Vol. 30 N.º 9 (2017): Setembro; 608-614 1646-0758 0870-399X reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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