872The Yield of Urine Cultures in Intensive Care Unit Patients with Indwelling Urinary Catheters

Background. Catheter associated urinary tract infections (CAUTIs) are the most frequent healthcare-associated infection (HAI). Intensive care unit (ICU) CAUTIs identified using the National Healthcare Safety Network (NHSN) definition are publicly reported and are considered as a quality measure. However, clinicians are often challenged with differentiating CAUTI from asymptomatic bacteriuria. We sought to delineate the epidemiology of ICU CAUTIs in order to identify the role of urine cultures in the ICU setting. Methods. All ICU CAUTIs identified in 2012 and 2013 by Infection Control using the NHSN definition were reviewed. Patient demographics, urinary catheter data, and culture results were obtained from the Infection Control database. Additional chart review was done to abstract information on indications for urine culture, symptoms, antimicrobial therapy, adverse drug reactions and patient outcome. Results. A total of 105 ICU CAUTIs were identified for a CAUTI rate of 2.5 per 1,000 catheter days. 3,767 ICU catheter urine cultures were submitted during this time period, for a CAUTI rate of 2.8%. The most common organisms were yeast (53%), E. coli (18%), Enterococcus spp (12%), and Pseudomonasspp (7%). The primary indication of urine culture for patients who had CAUTIs was fever (97%). In the majority of patients an alternative explanation of fever was found: fever due to infection other than CAUTI (51%), and non-infectious cause of fever (17%). Pneumonia (53%) was the most common infection identified. Of the 34 (32%) patients with positive urine cultures and no other identifiable cause of fever, only 17/34 (50%) received antimicrobials directed at the urinary pathogen. Conclusion. Urine cultures are frequently obtained in ICUs for an evaluation of fever, but they have a low yield. Fever was attributed to an alternative cause in most patients. When an alternative cause was not found, urine culture results were not used to guide antimicrobial therapy in the majority of patients. Urine cultures in all catheterized ICU patients with fever is likely not a cost-effective strategy. There are no clinical findings that distinguish bacteriuria from CAUTI in the febrile ICU patient in most cases. Disclosures. All authors: No reported disclosures.