A 46-year-old woman is admitted for elective hysterectomy due to abnormal uterine bleeding. The patient has a history of diabetes mellitus and urinary incontinence, and she smoked cigarettes occasionally for years before quitting 5 years ago. She is prepared for surgery, and an indwelling urinary catheter is placed. The surgery is completed without complications and the patient is transferred to the hospital ward for recovery. The indwelling catheter is kept in place for the next 72 hours. The patient subsequently develops a fever of 39 C (102.2 F), along with suprapubic and costovertebral angle tenderness. Urine culture shows 10⁵ colony-forming units/mL of extended-spectrum, beta-lactamase-producing Escherichia coli. Which of the following is the most important risk factor for this patient's infection?

Question

A 46-year-old woman is admitted for elective hysterectomy due to abnormal uterine bleeding. The patient has a history of diabetes mellitus and urinary incontinence, and she smoked cigarettes occasionally for years before quitting 5 years ago. She is prepared for surgery, and an indwelling urinary catheter is placed. The surgery is completed without complications and the patient is transferred to the hospital ward for recovery. The indwelling catheter is kept in place for the next 72 hours. The patient subsequently develops a fever of 39 C (102.2 F), along with suprapubic and costovertebral angle tenderness. Urine culture shows >10⁵ colony-forming units/mL of extended-spectrum, beta-lactamase-producing Escherichia coli. Which of the following is the most important risk factor for this patient's infection?

Quizplus · Accepted Answer

11ec160b_3867_ca2b_9249_23ab0427b421_MD0001_00 This patient has a catheter-associated urinary tract infection (CAUTI), and the antibiotic resistance pattern (ie, extended-spectrum, beta-lactamase-producing Escherichia coli) suggests a nosocomial source. CAUTI is most commonly due to the formation of a bacterial biofilm on the catheter surface or retrograde passage of bacteria via the catheter lumen. The duration of catheterization is the single most important risk factor for CAUTI. Placement of a catheter for >48 hours (when biofilm formation is most likely to occur) significantly increases CAUTI risk. Prevention includes avoiding inappropriate catheterization (eg, incontinence alone is an inappropriate indication for indwelling catheter placement) and promptly removing the catheter when it is no longer needed (eg, immediately following surgery). (Choices A and C) Patients with diabetes mellitus are at increased risk for infections, including CAUTI; glucosuria (spontaneous or due to glucosuric medications [eg, sodium-glucose cotransporter 2 inhibitors]) further increases the risk. Female patients are also at increased risk, likely due to a shorter transit distance to the bladder. However, the duration of catheterization has a higher attributable risk for CAUTI compared to these factors. (Choice D) Smoking may increase susceptibility to bladder infection but only minimally increases CAUTI risk; moreover, this patient's light and remote smoking history represents a less significant risk factor than her extended duration of catheterization. (Choice E) Urinary incontinence is the most common inappropriate indication for placement of an indwelling catheter. However, incontinence itself is not associated with a significant increase in the risk for CAUTI. Educational objective: The duration of catheterization (especially >48 hr) is the most important risk factor for catheter-associated urinary tract infection. Prevention strategies include avoiding inappropriate catheterization (eg, placing catheter solely due to incontinence) and promptly removing the catheter when it is no longer needed.

A 46-Year-Old Woman Is Admitted for Elective Hysterectomy Due to Abnormal