• Daithi S Heffernan, William G Cioffi, Sean F Monaghan, Rajan K Thakkar, Jason T Machan, Steven E Reinert, Michael D Connolly, Shea C Gregg, Matthew S Kozloff, and Charles A Adams.
• Division of Trauma and Surgical Critical Care, Department of Surgery, Warren Alpert School of Medicine, Rhode Island Hospital, Providence, Rhode Island 02903, USA.
• J Trauma. 2011 Dec 1;71(6):1569-74.

BackgroundIn October 2008, Medicare and Medicaid stopped paying for care associated with catheter-related urinary tract infections (UTIs). Although most clinicians agree UTIs are detrimental, there are little data to support this belief.MethodsThis is a retrospective review of trauma registry data from a Level I trauma center between 2003 and 2008. Two proportional hazards regressions were used for analyses. The first predicted acquisition of UTI as a function of indwelling urinary catheter use, adjusting for age, diabetes, gender, and injury severity. The second predicted hospital mortality as a function of UTI, covarying for age, gender, chronic obstructive pulmonary disease, congestive heart failure, hypertension, diabetes, pneumonia, and injury severity.ResultsAfter excluding patients who stayed in the hospital <3 days and those with a UTI on arrival, 5,736 patients were included in the study. Of these patients, 680 (11.9%) met criteria for a UTI, with 487 (71.6%) indwelling urinary catheter-related infections. Predictors of UTI included the interaction between age and gender (p = 0.0018), Injury Severity Score (p = 0.0021), and indwelling urinary catheter use (p < 0.001). The development of a UTI predicted the risk of in-hospital death as a patient's age increased (p = 0.002). Similar results were seen when only catheter-associated UTIs are included in the analysis.ConclusionsIndwelling urinary catheter use is connected to the development of UTIs, and these infections are associated with a greater mortality as the age of a trauma patients increases.

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