Healthcare-associated urinary tract infection (HA UTI)

Risk of symptomatic infection and duration of disease

Healthcare-associated urinary tract infection (HA UTI) is defined in accordance with the ECDC case definition (ECDC, 2012). A systematic review of the literature was performed to estimate the sequelae and the probability of developing these sequelae following a UTI. This review took into consideration the role of co-morbidities by estimating the attributable impact of a UTI: attributable mortality, attributable risk of developing sequelae and duration (effect on length of hospital stay).

The extracted literature was limited to catheter-associated UTIs because no specific literature was found for more general search terms.

Attributable ICU and hospital mortality due to UTIs was not statistically significant and we therefore did not attribute a case-fatality rate to UTIs directly. The attributable length of stay for patients with urinary tract infections was 2.6 days (Chant, 2011).

According to the ECDC surveillance definition for UTI used in the point prevalence study, which was the source of the incidence data, both the presence of bacteruria and symptoms are required for the diagnosis of HA UTI. From the systematic literature review, we could not find evidence of the risk of secondary bacteraemia or urosepsis among patients with symptomatic HA UTI, in order to calculate the transitional probability related to complications and death. Therefore we indirectly estimated this risk by combining the risk of developing secondary bacteraemia/urosepsis in critically-ill patients with catheter-associated bacteruria, 1.3–4.8% (Laupland, 2002; Laupland, 2005; Clec‘h, 2007), and the risk of developing a urinary tract infection in patients with bacteruria, 24% (Saint, 2000). The resulting transitional probability was set to 5.42–20%.

We assumed that all patients developing bacteraemia/urosepsis will have the same outcomes and relative risks as those developing sepsis. For details, please refer to the bloodstream infection outcome tree.

Model input summary

Table 1. Transition probabilities used in the outcome tree

 Health outcome
 (Health state)

Distribution of health states in health outcome

Transition probability

Source/assumption

Secondary bacteraemia/urosepsis

 

5.42-20%

Laupland, 2002; Laupland, 2005; Clec‘h , 2007; Saint, 2000

Post-traumatic stress disorder (PTSD) following severe sepsis or septic shock

 

13-21%

Kessler, 1995; Deja, 2006; Schelling, 1998; Stoll, 1999; Kapfhammer, 2004; Hopkins, 2005

Cognitive impairment following severe sepsis or septic shock

 

11-47%

Hopkins, 2005; Iwashyna, 2010

Physical impairment following severe sepsis or septic shock

 

100%

Hopkins, 2005; Herridge, 2003; Hofhuis, 2008

Renal failure and renal replacement therapy following severe sepsis or septic shock

 

0.9-1.3%

Gallagher, 2014; Wisplinghoff, 2004

Deaths following secondary bacteraemia/urosepsis

 

9-20%

Renaud, 2001; Olaechea, 2013

Table 2. Disability weights and duration

Health outcome
(Health state)

Disability Weight (DW) (Haagsma, 2015)

Duration

DW

Label

In years

Source/assumption

Symptomatic disease

0.051 (0.039-0.06)

Infectious disease, acute episode, moderate

0.007

Chant, 2011

Secondary bacteraemia/urosepsis

0.655 (0.579-0.727)

Intensive care unit admission

0.027-0.036

Olaechea, 2013; Renaud, 2001

Post-traumatic stress disorder (PTSD) following severe sepsis or septic shock

0.088 (0.07-0.108)

Subacute sclerosing panencephalitis – phase 1

(chosen according to best fitting description)

Remaining life expectancy

 

Cognitive impairment following severe sepsis or septic shock

0.043 (0.026-0.064)

Intellectual disability, mild

Remaining life expectancy

 

Physical impairment following severe sepsis or septic shock

0.011-0.053

Range between Motor impairment, mild and Motor impairment, moderate

Remaining life expectancy

 

Renal failure and renal replacement therapy following severe sepsis or septic shock

0.487-0.030

Range between End-stage renal disease, on dialysis and End-stage renal disease, with kidney transplant

Remaining life expectancy

 

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