Exec Director, ACT Pathology. Infectious Diseases Physician and Microbiologist, Canberra Hospital. Professor, Medical School. Australian National University.
Urinary tract infections are very common in the community. They are also frequent Healthcare Associated Infections (HAIs) – both in acute and aged care facilities. Most of these healthcare associated infections are the result of instrumentation of the urinary tract, especially with catheter associated urinary tract infections (CAUTIs). These cause not only discomfort for patients but many are also associated with increased length of hospital stays. A subset of people with these infections develops Blood Stream Infections (BSIs) as a more severe complication, which causes both increased morbidity and mortality.
Since 1998 at the Canberra Hospital, all BSI episodes have been followed by Infection Prevention and Control nursing staff. Seven-day mortality is assessed, the anatomical site from where their infection originated and whether infections are community or healthcare associated. BSI’s related to the urinary tract are now the most common types of BSIs seen with now over 120 episodes per year and over 1,300 episodes from 1998 to 2015. The proportion with community onset is falling and is now only 50% of episodes. The rise in healthcare associated infections has been predominately community onset healthcare associated infections, rising from about 15% of total urinary tract BSI’s infection to 25%. Most infections occur in those aged between 55 to 90 years of age, with peak numbers in those 80 to 84 years of age. Males account for 50% of infections. E.coli is the most common associated pathogen and is more common as a proportion of community onset infections compared to healthcare associated infections. E.coli now accounts for 60% of all BSI episodes. Ureteral catheters are responsible for about 25 episodes per year. Prostate biopsies also contributed to over 60 BSI episodes over the 18-year study period. Overall 3% of patients with urinary tract associated BSI’s died within 7 days of onset of their episode.
BSI’s associated with healthcare associated UTI’s are increasing. Medical procedures such as catheterisation, prostate biopsies and nephrostomy tubes/stents are factors associated with these increasing numbers of infections. Interventions can and should be put into place to decrease the number of these life-threatening infections that are occurring.