Page 2 - CUAJ February 2019: Clean intermittent catheterization: Single use vs. reuse

CIC: Single use vs. reuse

catheterization*”) AND (coated OR uncoated)] or [(“inter- of the articles on the risk of UTI associated with different
mittent catheterization*”) AND (coated OR uncoated)] or methods of catheterization.
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[(“intermittent catheter*”) AND (coated OR uncoated)]. The Kanaheswari et al conducted a prospective crossover
date of publication was limited to 2014 to present/current. study among children with neurogenic bladder (n=40) and
The results were reviewed to select the publications that concluded that a longer duration of catheter reuse resulted in
addressed the relation between IC and clinical UTI or cost/ an increased prevalence of ABU, without changing the inci-
cost-effectiveness/QoL. After removing the duplicates, the dence of UTI. In this study, a comparison was made between
non-English articles, the non-systematic reviews/commen- weekly and triweekly catheter replacement over nine-week
taries, and congress presentation abstracts were excluded. intervals. The 65% ABU noted at baseline increased to 74.2%
during the triweekly CIC. This percentage plummeted to
Results 34.2% when the catheter was changed on a weekly basis.
There were no symptomatic UTIs over the 18 weeks of study
in either group. However, the authors suggested that adher-
Risk of UTI ence to the cleaning technique might have been unusually
high among the participants, impacting their findings. No
Before discussing the risk of UTI, it is important to empha- comparison to single-use of catheters was made. 17
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size the difference between asymptomatic bacteriuria (ABU) A retrospective study by Krassioukov et al surveyed
and UTI. The former is defined as the presence of bacteria athletes with spinal cord injuries (n=61); they found that
in the urine culture without any urinary tract symptoms, those who reused catheters experienced 4±3 UTIs per year,
while the latter is a positive bacterial culture accompanied while the figures for single-users stood at only 1±1 UTI(s)
by urinary tract symptoms. Table 1 provides a breakdown per year. This association between catheter reuse and UTI
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Table 1. Different methods of intermittent catheterization and associated UTI risk
Method of catheterization Author, date Age (years) Outcome Type/ duration of Duration of use Frequency
(comparator) study before disposal of CIC
Duration of use Kanaheswari 1–18 Lower risk of ABU with Prospective 1 week (9 At least 3
(with multiple use of et al, 2014 shorter duration of use 18 weeks cycles) vs. 3 times per
catheters) (Z-score 6.218; p<0.001) weeks (3 cycles) day
Single use vs. multiple Krassioukov et Paralympic Lower risk of UTI with Retrospective (1year 2–200 times per 6±2 times
use of catheters al, 2015 athletes: single use of catheter data) catheter per day
16–60 (p<0.001)
Single use vs. multiple Christison et Not No significant difference Appraisal of a Variable Variable
use of catheters al, 2017* specified Cochrane review
HC catheters vs. other Christison et Not Lower risk of UTI with Appraisal of a Variable Variable
catheters al, 2017* specified HC catheters** (p=0.043) Cochrane review
Single use of HC vs. Håkansson, Not Lower risk of UTI with Systematic review Variable Variable
multiple use of other 2014 specified single use HC catheter
catheters (20–30%)
Single use of HC Kiddoo et al, 6–18 Lower risk of UTI with Prospective cross-over 1 day–1 week 3 or more
(SpeediCath) vs. multiple 2015 multiple use of PVC 24-week: HC catheter times per
use of PVC catheters catheters (p<0.001) 24-week: standard PVC day
Single use of HC vs. Rognoni and Adult/ Lower risk of UTI Systematic review Variable 4–5 times
multiple use of PVC Tarricone, adolescent with single use of HC per day
catheters 2017* catheters (p=0.003)
Single use of HC (Lofric) DeFoor et al, Children Lower risk of UTI with Prospective RCT Advised to use 3 or more
vs. single use of UC 2017 with HC catheters (p=0.003) (1year) only once times per
dexterity day
Single use HC vs. single Rognoni and Adult/ Lower risk of UTI Systematic review Single 4–5 times
use non-HC Tarricone, adolescent with single use of HC per day
2017* catheters (p=0.003)
Prelubricated catheters Shamout et al, Adult Lower incidence Systematic review: 1 Variable Variable
(Instantcath) or those 2017 compared to standard study on each topic
with AMC or those with catheters was found
introducer
*This study provided two subanalyses and, therefore, has been repeated twice. **After UTI definition was adjusted, the difference between HC catheters and other catheters was no longer
significant. ABU: asymptomatic bacteriuria; AMC: anti-microbial coating; CIC: clean intermittent catheterization; HC: hydrophilic-coated; PVC: polyvinyl chloride; RCT: randomized controlled trial;
UTI: urinary tract infection.

CUAJ • February 2019 • Volume 13, Issue 2 65