Relationship of catheter-associated urinary tract infection to mortality and length of stay in critically ill patients: A systematic review and meta-analysis of observational studies
Why this work is in the frame
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Bibliographic record
Abstract
OBJECTIVE: To determine whether catheter-associated urinary tract infections are associated with increased morbidity and mortality in critically ill patients. DATA SOURCES: MEDLINE, HealthStar, EMBASE, and CINAHL databases from inception to June 2010 and bibliographies of included studies without language restriction. STUDY SELECTION: Studies reporting mortality or morbidity in adult intensive care unit patients with and without catheter-associated urinary tract infections. DATA EXTRACTION: Two authors independently selected studies and extracted data on study methodology, quality, and patient outcomes using a standardized form. Meta-analyses were performed using random-effects models. DATA SYNTHESIS: Of 720 citations, 11 studies enrolling 2,745 patients with and 60,719 patients without catheter-associated urinary tract infections met inclusion criteria. Catheter-associated urinary tract infection was associated with a significant increase in mortality (odds ratio [OR], 1.99; 95% confidence interval [CI], 1.72-2.31; p < .00001; I2 = 54%; eight studies; 62,063 patients) and length of stay in the intensive care unit (weighted mean difference of + 12 days; 95% CI, 9-15; p < .00001; I2 = 96%; seven studies; 13,011 patients) and hospital (mean difference + 21 days; 95% CI, 11-32; p < .0001; I2 = 98%; five studies; 10,183 patients). Restricting the analysis only to the two studies that adjusted for other outcome predictors, catheter-associated urinary tract infections were not associated with an increase in mortality (OR, 0.97; 95% CI, 0.82-1.16; p = .77; I2 = 0%; two studies; 5,626 patients). Although both studies individually demonstrated significantly increased intensive care unit length of stay after adjustment, pooled data showed that catheter-associated urinary tract infections were associated with a significant increase in intensive care unit length of stay using only a fixed effects model (mean difference + 2.6 days; 95% CI, 2.3-3.0; p < .00001) and not a random effects model (mean difference + 8 days; 95% CI, -13 to +28 days; p = .46) due to the high degree of heterogeneity for this outcome between the two studies (I2 = 99.6%) which results in a larger CI. CONCLUSIONS: Catheter-associated urinary tract infection is associated with significantly increased mortality and length of stay in unmatched studies. Increased mortality and possibly increased length of stay appear to be consequences of confounding by unmeasured variables. These findings highlight the importance of evaluating risks and benefits of commonly used treatments such as antibiotics to manage catheter-associated urinary tract infection.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.046 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.008 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it