Urinary tract infection after catheter ablation of atrial fibrillation.
BACKGROUND
Urinary tract infection (UTI) is common after surgical procedures and a quality improvement target. For non-surgical procedures such as catheter ablation of atrial fibrillation (AF), UTI risk has not been characterized. We sought to determine incidence and risk factors of UTI after AF ablation and risk variation across sites.


METHODS
Using Marketscan commercial claims databases, we performed a retrospective cohort study of patients who underwent AF ablation from 2007 to 2011. The primary outcome was UTI diagnosis within 30 days after ablation. We performed multivariate analyses to determine risk factors for UTI and risk of sepsis within 30 days after ablation with UTI as the predictor variable. Median odds ratio was used to quantify UTI site variation.


RESULTS
Among 21 091 patients (age 59.2 ± 10.9; 29.1% female; CHA2 DS2 -VASc 2.0 ± 1.6), 622 (2.9%) were diagnosed with UTI within 30 days. In multivariate analyses, UTI was independently associated with age, female sex, prior UTI, and general anesthesia (all P < .01). UTI diagnosis was associated with a substantial increased risk of sepsis within 30 days (5.0% vs. 0.3%; odds ratio 17.5; 95% confidence interval [CI] 10.8-28.2; P < .0001). Among 416 sites, 211 had at least one UTI. Among these 211 sites, the incidence of postablation UTI ranged from 0.7 to 26.7% (median: 5.4%; Interquartile Range (IQR): 3.0-7.1%; 95th percentile: 14.3%; median odds ratio: 1.45; 95% CI 1.41-1.50).


CONCLUSIONS
UTI after AF ablation is not uncommon and varies substantially across sites. Consideration of UTI as a quality measure and interventions targeted at high-risk patients or sites warrant consideration.
['Cluckey|Andrew|A|', 'Perino|Alexander C|AC|', 'Fan|Jun|J|', 'Askari|Mariam|M|', 'Nasir|Javed|J|', 'Marcus|Gregory M|GM|', 'Baykaner|Tina|T|0000-0002-0476-2972', 'Narayan|Sanjiv M|SM|0000-0001-7552-5053', 'Wang|Paul J|PJ|', 'Turakhia|Mintu P|MP|0000-0001-8025-0904']
D001281:Atrial Fibrillation D017115:Catheter Ablation D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D012189:Retrospective Studies D012307:Risk Factors D014481:United States D014552:Urinary Tract Infections
urinary tract infection catheter ablation atrial fibrillation quality assessment