Urinary Tract Infections in Pennsylvania Long-Term Care Facilities: An Epidemiological Study From 2016 Through 2020


  • Amy Harper, PhD, RN Patient Safety Authority
  • Shawn Kepner, MS Patient Safety Authority




healthcare-associated infection, HAI, long-term care, urinary tract infection, SUTI, CAUTI, Proteus, fluoroquinolone, antibiotic stewardship


Urinary tract infections (UTIs) are common healthcare-associated infections (HAIs) in older adults that live in long-term care (LTC) facilities. A query of the Pennsylvania Patient Safety Reporting System (PA-PSRS) found that symptomatic UTI (SUTI) and catheter-associated UTI (CAUTI) rates increased from 2016 and peaked in the second quarter of 2020. Although the number of urinary catheter days reported by LTC facilities has trended downward from 2016 to the beginning of 2020, the urinary catheter utilization rate increased slightly in the second quarter of 2020. We also examined various epidemiological factors. An average of 47.6% of SUTIs and 32.3% of CAUTIs were associated with E. coli from 2016 through 2020. However, the percentage of CAUTIs associated with E. coli decreased while the percentage of CAUTIs associated with organisms of the tribe Proteeae (Proteus, Providencia, and Morganella genera) increased from 2016 through 2020. Furthermore, the percentage of CAUTIs associated with carbapenem-resistant Enterobacterales (CRE) and organisms producing extended-spectrum beta-lactamases (ESBL) also increased, while the percentage of CAUTIs associated with vancomycin-resistant Enterococci (VRE) decreased from 2016 through 2020. An average of 38.5% of SUTIs and 41.5% of CAUTIs were reported to be treated with fluoroquinolones from 2016 through 2020. However, the percentage of both SUTIs and CAUTIs treated with fluoroquinolones decreased from 2016 through 2020, while an increasing percentage of both SUTIs and CAUTIs was reported to have been treated with cephalosporins and carbapenems from 2016 through 2020. Thus, to promote resident safety, we use these epidemiological trends to better understand current risks for residents and to further guide development of best practices for prevention, identification, and treatment of UTIs as well as to advance antibiotic stewardship practices.

Author Biographies

Amy Harper, PhD, RN, Patient Safety Authority

Amy Harper (amharper@pa.gov) is an infection prevention analyst for the Patient Safety Authority. She is board certified in medical-surgical nursing (CMSRN) and in infection control and epidemiology (CIC), and is a member of the Association for Professionals in Infection Control and Epidemiology (APIC) and the Society for Healthcare Epidemiology of America (SHEA).

Shawn Kepner, MS, Patient Safety Authority

Shawn Kepner is a statistician at the Patient Safety Authority.


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How to Cite

Harper, A., & Kepner, S. (2021). Urinary Tract Infections in Pennsylvania Long-Term Care Facilities: An Epidemiological Study From 2016 Through 2020. Patient Safety, 3(4), 57–73. https://doi.org/10.33940/data/2021.12.7



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