Background: In October 2008, the Centers for Medicare and Medicaid Services stopped paying for care associated with catheter-related urinary tract infections. Since that time, there has been a huge push for decreased use of Foley catheters in order to decrease hospital acquired urinary tract infections (UTI). No direct evidence exists correlating a negative impact from the presence of a UTI. This study describes the impact of a hospital acquired urinary tract infection on a trauma patient.

Methods: All trauma patients from 2003 to 2008 were included in this IRB-approved study if they survived past a three-day hospital stay. All available urinalysis and urine cultures were reviewed for these patients. A positive urinary tract infection was defined as either the presence of >5 WBCs, or leukocyte esterase on urinalysis or a positive urine culture. The medical chart was reviewed for injury severity score, specific body site injury scores, mechanism of injury, age, and gender. Primary outcome measure was hospital length of stay but it also included ICU stay, ventilator days, and mortality. Kaplan-Meier curves, Chi square and Student’s t-test were applied to the data.

Results: Over this period, 8841 patients were admitted to the trauma service, with 6145 patients accounting for 17,924 urinalyses sent and 2494 patients accounted for the 6756 urine cultures. 5751 patients stayed longer than three days, of which 683 patients had a UTI. The length of stay in a patients with a UTI was 26.7 days compared to 9.5 days (p=<0.001). Patients who had a UTI have a significantly higher ISS (17.7 vs 12.2, p=<0.001). When patients were divided into groups based upon ISS (<15, 15-25, and >25) and censored for death, all groups had significantly longer length of stay if the patient developed a UTI. For those with mild injury (ISS<15), the median length of stay was 5 days (95% CI=4.9-5.2) which increased to 12 days (95% CI=10.6-13.4) if the patient had a UTI. In moderately injured patients (ISS15-25), the median stay was 7 days (95% CI=6.6-7.4), which increased to 21 days (95% CI=17.7-24.3) in the presence of a UTI. In severely injured patients (ISS>25) the median stay was 14 days (95% CI=12.5-15.5), but a UTI increased median length of stay to 35 days (95% CI=29.4-40.6) Within mild and moderate ISS groups, mortality was also significantly increased in the presence of a UTI. (mild 6.8 versus 1.1, p=<0.001; moderate 11.7 versus 5.2, p=0.003).

Conclusion: This is the first description of the impact of a UTI on hospitalized trauma patients. When accounting for death and across all ISS, trauma patients who acquire a UTI while in the hospital extend their hospital length of stay. Furthermore the presence of a UTI independently negatively impacts the mortality of trauma patients, however the degree of cause and effect versus an association needs further delineation. In light of these findings, it is apparent that all available means to prevent UTI in trauma patients should be employed.