The battle against urinary tract infections (UTIs) is on. UTIs are a heavy burden for many: the healthcare system, society and, not least, the individual.
Recurrent problems are common among people with spinal cord injury and patients suffering from incomplete bladder emptying. The link between catheter use and UTI is also sufficiently strong to be defined by its own term, catheter-associated urinary tract infection (CAUTI).
So how do we overcome the problem? New research highlights several solutions. It is well known that indwelling catheters are both the reason for and the solution to the problem. Studies continuously show successful results from prevention programs restricting their use but one new study in elderly patients suggests that we need to widen the scope beyond indwelling catheter use.
Restricting their use is one part of the solution but how can we address the other risk factors for UTI? Can we do something about the fact that women are at higher risk? Maybe not, but we might be able to address the higher risk for UTI in rehabilitation units, among patients who are immunosuppressed, have acute urinary retention, post-void residuals, a history of UTI, or who are dependent on assistance.
A recent review investigates different options and concludes that the evidence for both prophylactic antibiotic use and bladder installations are scarce. It furthermore states that the only certain recommendation to prevent recurrent UTIs in patients with incomplete bladder emptying is to perform frequent intermittent catheterization with a proper technique.
Finally, there seems to be a general consensus in the scientific literature that antibiotic prophylactic treatment is a poor strategy for overcoming UTIs. Not only due to the limited efficacy but also for the high risk of development of antibiotic resistant bacteria. In a way antibiotics may be a dead-end that has the potential to actually worsen the problem with UTIs in the long run.
Recurrent urinary tract infections in patients with incomplete bladder emptying: is there a role for intravesical therapy?
http://tau.amegroups.com/article/view/14759
Author and Origin
Dray EV, Clemens JQ. US
Summary
Review summarizing strategies in preventing urinary tract infection (UTI) in patients with incomplete bladder emptying.
Conclusions
Frequent and properly performed intermittent catheterization is the most important part of preventing recurrent UTI in patients with incomplete bladder emptying. Evidence for prophylactic antibiotics and bladder installations therapies is scarce.
Comments
Review highlighting the importance of intermittent catheterization in the battle against recurrent UTI in patients with incomplete bladder emptying.
Open access.
Risk factors for urinary tract infections in geriatric hospitals.
https://www.ncbi.nlm.nih.gov/pubmed/28526270
Author and Origin
Girard R, Gaujard S, Pergay V, Pornon P, Gaujard GM, Bourguignon L; UTIC Group. France
Summary
Observational retrospective study of urinary tract infection (UTI) risk factors in 4669 elderly patients, hospitalized at a geriatric unit.
Conclusions
UTI was seen in 4.0% of the patients. UTI was significantly more frequent among:
- Women
- Patients in rehabilitation units
- Patients who were immunosuppressed
- Patients with acute retention
- Patients with post-void residuals
- Patients with previous UTI
- Patients dependent on carers
- Patients who used a catheter
Comments
Study identifying risk factors for hospital-acquired UTI in the elderly. The results suggest a widened scope of UTI prevention target areas in addition to catheter use.
A National Implementation Project to Prevent Catheter-Associated Urinary Tract Infection in Nursing Home Residents.
https://www.ncbi.nlm.nih.gov/pubmed/28525923
Author and Origin
Mody L, Greene MT, Meddings J, Krein SL, McNamara SE, Trautner BW, Ratz D, Stone ND, Min L, Schweon SJ, Rolle AJ, Olmsted RN, Burwen DR, Battles J, Edson B, Saint S. US
Summary
Observational study of the implementation of a prevention program for catheter-associated urinary tract infection (CAUTI) at 404 community-based nursing homes in the US.
Conclusions
The program included catheter removal, aseptic insertion, regular assessments, training for catheter care, and incontinence care planning. CAUTI rates decreased from 6.78 to 2.63 infections per 1000 catheter-days.
Comments
Large scale study showing successful implementation of CAUTI prevention programs in community-based nursing homes in the US.
Compliance with Urinary Catheter Removal Guidelines Leads to Improved Outcome in Enhanced Recovery After Surgery Patients.
https://www.ncbi.nlm.nih.gov/pubmed/28547632
Author and Origin
Okrainec A, Aarts MA, Conn LG, McCluskey S, McKenzie M, Pearsall EA, Rotstein O, Victor JC, McLeod RS; members of the iERAS Group. Canada
Summary
Observational prospective study of urinary tract infection (UTI) rates from restricted catheter use in 2927 patients undergoing colorectal surgery at 15 academic hospitals.
Conclusions
Following colonic operations, 0.8% of patients who practiced restricted catheter use had a UTI, compared to 4.1% in non-compliant patients. Length of hospital stay was also different in favor of guideline-compliant patients (4 vs 5 days).
Comments
Study reinforcing the link between indwelling catheter use and UTI. It shows that restricted indwelling catheter use can shorten hospital stay after surgery.
Systematic Review of Interventions to Reduce Urinary Tract Infection in Nursing Home Residents.
https://www.ncbi.nlm.nih.gov/pubmed/28459908
Author and Origin
Meddings J, Saint S, Krein SL, Gaies E, Reichert H, Hickner A, McNamara S, Mann JD, Mody L. US
Summary
Review of studies evaluating prevention programs for urinary tract infection (UTI) in nursing homes.
Conclusions
A total of 20 studies were included and the majority showed a reduction in UTI. It seems likely that prevention strategies such as improving hand hygiene and reducing indwelling catheter use can reduce UTI in nursing home residents.
Comments
Review summarizing prevention programs for catheter-associated UTI in nursing homes.
Prevalence and Appropriateness of Urinary Catheters in Japanese Intensive Care Units: Results From a Multicenter Point Prevalence Study.
https://www.ncbi.nlm.nih.gov/pubmed/28475778
Author and Origin
Kuriyama A, Takada T, Irie H, Sakuraya M, Katayama K, Kawakami D, Iwasaki H, Fowler KE, Tokuda Y, Saint S. Japan
Summary
Observational study of indwelling catheter use in 7 intensive care units in Japan.
Conclusions
Indwelling catheters were used in 76% but appropriate in only 54%. The study concluded with a call for action to limit inappropriate use of urinary indwelling catheters in intensive care units in order to restrict infections.
Comments
Study showing significant prevalence of inappropriate indwelling catheter use as a cause of catheter-associated UTI.
A 5-day antibiotic course for treatment of intermittent catheter-associated urinary tract infection in patients with spinal cord injury.
https://www.ncbi.nlm.nih.gov/pubmed/28503324
Author and Origin
Previnaire JG, Le Berre M, Hode E, Dacquet V, Bordji H, Denys P, Soler JM. France
Summary
Observational retrospective study evaluating a 5-day antibiotic course for treatment of mild urinary tract infection (UTI) in 57 patients with spinal cord injury (SCI), practicing intermittent catheterization.
Conclusions
All patients were free from UTI after the 5-day course but recurrence was common and seen in half of the patients (16% at 3 weeks, 38% at 6 weeks, and 50% at 9 weeks).
Comments
Case study suggesting benefits with a short antibiotic course for treatment of mild UTI among people with SCI who practice intermittent catheterization. Antibiotic treatment of asymptomatic bacteriuria is discarded.
Validity of urine dipstick test to assess eradication of urinary tract infection in persons with spinal cord injury.
https://www.ncbi.nlm.nih.gov/pubmed/28479108
Author and Origin
Previnaire JG, Soler JM, Chouaki L, Pawlicki L, Le Berre M, Hode E, Denys P. France
Summary
Observational prospective study of the predictive value of dipstick testing in 61 inpatients with spinal cord injury (SCI), using either an intermittent or indwelling catheter.
Conclusions
The results suggest that dipstick testing was useful for showing eradication of bacteria during antibiotic treatment. Dipstick testing during UTI diagnosis showed limited benefit.
Comments
Study suggesting that dipstick testing is of limited benefit when assessing UTI in people with SCI.
This blog post is an extract of the Science Alert from June 2017 (76040-USX-1706)
