Dr Dorothy Ling1, Ms. Elizabeth Kindred1, Ms. Melissa Sajeva1, Dr Victoria Madigan1
1Northern Health, Epping, Australia
Biography:
Dorothy Ling is an Infectious Diseases physician with a special interest in antimicrobial stewardship and infection prevention and control.
Introduction: Hospital-acquired urinary tract infections (HAUTI) constitute a significant proportion of hospital-acquired infections in Australia and misdiagnosis is common.
Abstract:
Methods
This retrospective study analysed inpatients discharged from Northern Health during two three-month periods (June to September 2023 and January to March 2024) with a HAUTI diagnosis. Data on clinical symptoms, microbiological results, and antibiotic administration were extracted from medical records. The primary outcome was the inappropriate diagnosis of HAUTI, defined by published diagnostic criteria (National Healthcare Safety Network (NHSN), Infectious Diseases Society of America (IDSA), and revised McGeer criteria) and expert review.
Results
A total of 97 HAUTI episodes were identified in 84 patients, comprising 69 non-catheter-associated urinary tract infection (NC-UTI) and 28 catheter-associated urinary tract infection (CAUTI) episodes. Inappropriate diagnoses occurred in a median 39 (57%) NC-UTI and 19 (68%) CAUTI episodes. Among NC-UTI episodes, 39 (57%), 45 (65%), and 28 (41%) did not meet NHSN, McGeer, and expert review criteria respectively. Among CAUTI episodes, 21 (75%), 18 (64%), 19 (68%), and 19 (68%) did not meet NHSN, IDSA, McGeer, and expert review criteria respectively. NHSN and McGeer criteria had highest diagnostic accuracy for NC-UTI and CAUTI respectively. Expert review considered additional factors including pyuria and preceding antibiotic exposure. Absence of appropriate clinical findings accounted for most HAUTI misdiagnoses. Antibiotics were administered in 95 (97%) HAUTI episodes.
Conclusion
This study demonstrated a high prevalence of inappropriate HAUTI diagnoses and antibiotic exposure. Discordance between diagnostic criteria and expert review was documented. Utilisation of accurate diagnostic criteria may reduce HAUTI misdiagnosis.