CAUTI and readmission penalties: urologists beware.

摘要

An infected urinary sphincter prosthesis implanted 4 years ago is removed after it eroded into the urethra of a spinal cord injured patient. Cultures of the time of the explant are positive. Per institutional protocol, the Centers for Disease Control and the State Health Department are immediately notified by the hospital infection control officers about a "surgical site infection". A patient treated elsewhere with an indwelling ureteral stent is taken to the operating room to complete the needed transurethral resection of a large bladder tumor. Pre op cultures are negative but 36 hours after admission a fever work up reveals a Candida urinary tract infection. This is reported as a "catheter associated UTI" (CAUTI) since the continuous bladder irrigation catheter was still in after the resection. A 52-year-old male is admitted with urosepsis and an obstructing mid ureteral calculus. The patient is treated with antibiotics and taken to the operating room for stent placement. The management plan is for readmission for ureteroscopic stone extraction 2 weeks later. Shortly after the readmission for the definitive stone extraction, the hospital system red flags this appropriate follow up and pre-planned surgery as a reportable "unnecessary readmission". Several of these occurrences also generated an automated "apology" letter from our hospital sent directly to the patient for these events.