# Assessment of a Protocol for Reducing Indwelling Urinary Catheter Usage: Reduced Infection Without Increased Acute Kidney Injury

## TL;DR

A hospital campaign to reduce urinary catheter use successfully lowered infections without harming kidney health.

## Contribution

Demonstrates that reducing catheter use in trauma patients can decrease infections without increasing kidney injury.

## Key findings

- CAUTI cases dropped from 0.4% pre-campaign to 0 post-campaign.
- Pyuria decreased significantly after the campaign, remaining significant in multivariate analysis.
- No significant increase in acute kidney injury was observed post-campaign.

## Abstract

Introduction

In 2019, a level one trauma center in St. Louis, Missouri launched a campaign to reduce the use of indwelling urinary catheters (IUC) in the trauma population. Our study assesses whether the campaign achieved the intended effect of reducing catheter-associated urinary tract infection (CAUTI) and whether this came at the cost of increased acute kidney injury (AKI).

Methods

We examined a cohort of patients from before and after the IUC reduction campaign. We compared days with IUC, UTI, CAUTI, and AKI, both recorded in the registry and based on a direct review of laboratory results. Significance testing is performed with the Student’s t-test for continuous variables and Fisher’s exact test for categorical variables. For multivariate analysis, multivariate linear regression is used for continuous outcomes, and multivariate logistic regression is used for binary categorical outcomes.

Results

On average, the post-campaign cohort was older and more severely injured. There was a modest decrease in IUC usage following the campaign, which was significant when adjusted for common trauma covariates, B=-0.93; p=0.04. There were 10 (0.4%) cases of CAUTI in the pre-intervention group versus 0 post-intervention (p=0.002). Pyuria was significantly lower post-intervention: 118 (40.3%) versus 84 (29.3%), p=0.007. This remained significant on multivariate analysis: odds ratio (OR): 0.52, p=0.008. There were no significant differences in creatinine (Cr) absolute values or temporal trends over the course of admission between the cohorts. There was no increased AKI measured by kidney disease improving global outcomes (KDIGO) criteria.

Conclusion

The IUC reduction protocol was associated with a significant decrease in CAUTI without a significant increase in AKI.