Is There a Difference in the Incidence of UTI and Outcome Between Emergency General Surgery and Trauma Patients?

Author(s):
Jose Aldana; Ricardo Fonseca; Rohit Rasane; Christina X Zhang; Adrian Coleoglou Centeno; Christopher Horn; Javier Rincon; Qiao Zhang; Kelly Marie Bochicchio; Obeid Ilahi; Grant Bochicchio

Background:

Urinary tract infection (UTI) is associated with significant morbidity and mortality in hospitalized patients.  To our knowledge, there is an absence of data evaluating whether there is a difference in both incidence of UTIs and the virulence of the causative pathogens and outcome between emergency general surgery (EGS) and trauma patients.

Hypothesis:

We hypothesize that UTIs are more common and are associated with more virulent pathogens in trauma patients due to the emergent nature of Foley catheter insertions as well as multisystem injury.

Methods:

EGS and trauma registries spanning years 2008 to 2018 were retrospectively queried for patients with diagnosis of UTI and catheter-associated UTI (CAUTI) using ICD 9 and 10 codes. Patients were divided into 2 cohorts (EGS and trauma patients). Demographics, culture data, and outcomes were abstracted. Student’s T-test was used for continuous variables and Chi-square test was used for categorical variables.

Results:

Out of 15475 EGS and 37293 Trauma patients, 1175 and 2683 patients were diagnosed with UTI respectively. There was no significant difference in the incidence of UTI between EGS and trauma patients (7.59% vs 7.19% respectively p=0.2488).  EGS females had a significantly higher UTI rate (13.66% vs 9.84% p=<.0001). Trauma patients were older (70.00±20.16 vs 57.83±18.57 p=<.0001) and had a higher Charlson comorbidity index (4.76±2.95 vs 4.39±3.16 p=0.0004).  EGS patients had more Foley catheter days (4.86±9.13 vs 3.43±8.15 p= <0.0001), longer hospital length of stay (LOS) (12.11±13.45 vs 9.81±12.59 p= <0.0001) and mortality (6.30 % vs 4.36% p=0.0107). On logistic regression with mortality as outcome, UTI was significantly associated with a greater mortality in EGS but not Trauma (OR 1.72, 1.30 to 2.26 p=0.0001).  Candida and Acinetobacter UTIs were significantly higher in EGS patients (10.90% vs 4.77% and 1.33% vs 0.38% p= <.0001).

Conclusions:

Despite similar incidence of UTI in EGS and Trauma patients, there were significantly greater hospital and ICU days and mortality in EGS patients.  This may be the result of greater Foley catheter days and associated virulent pathogens. Further prospective research is required to validate these findings.