Page 3 - Flipbook

BPR: Catheter use

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>10 cfu/mL). In cases of short-term catheterization, it is con- Antimicrobial-coated catheter vs. non-antimicrobial-coated catheters
sidered acceptable to obtain a specimen aseptically through
the catheter port. Specimens should never be collected from Antibiotic and silver-coated catheters appear to only be
a catheter drainage bag. effective in reducing bacteriuria and UTIs in the short-
Method of bladder management remains of paramount term. Long-term use of antibiotic and silver-coated catheters
importance for reduction of CA-ASB and CA-UTI. IC is increases the risk for antimicrobial resistance and silver tox-
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associated with fewer CA-UTI when compared to other icity; therefore, these are not recommended for routine use.
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modalities and should, therefore, be used whenever pos-
sible. When IC is not possible, a closed catheter drainage Impact of IC catheterization technique on UTIs
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system should be used to reduce CA-ASB and CA-UTI in
those with short- or long-term indwelling catheters. Data are Clean vs. aseptic
insufficient to recommend SPC over urethral catheterization
for long-term prevention of CA-ASB and CA-UTI. 10 When analyzing IC techniques, there was a significant
reduction in the incidence of UTIs with aseptic vs. clean
Impact of IC catheter type and material on UTIs techniques. However, there was no difference in bacteriuria
between these techniques. 17,24
Hydrophilic vs. uncoated catheters
Single-use vs. multiple-use
Two recent systematic reviews and meta-analyses explored the
risk of UTI associated with hydrophilic catheters (HC) in com- Studies have estimated that risk of UTI associated with
parison to polyvinyl chloride catheters (PVC) in adult patients multiple-use catheters is about 70–80%, whereas the risk
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with NLUTD. Shamout et al reported less frequent UTIs with with single-use catheters is about 40–60%. A recent RCT
HC, but this was not statistically significant and there was no evaluated the risk of UTI and bacteriuria among spina bifida
significant difference in terms of bacteriuria. Rognoni et al patients who used either single-use PVC catheters or reused
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reported significantly less UTIs with single-use HC compared PVC catheters. There was no significant difference in terms
to multiple-use PVC catheter (risk ratio [RR] 0.84; 95% confi- of bacteriuria (32.4% vs 23.7%; p=0.398) or UTIs (35.2%
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dence interval [CI] 0.75–0.94), with the estimated risk reduc- vs. 36.8%; p=0.877) between these two methods of IC.
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tion to be 16%. This confirmed the meta-analysis results of
Li et al (five studies, 462 subjects), which demonstrated a Summary
significantly lower UTI incidence in the hydrophilic group
(odds ratio [OR] 0.36; 95% CI 24–54%; p<0.0001). In the era of rapidly advancing medical technology, the con-
Two prospective randomized controlled trials (RCTs) temporary urinary catheter has changed very little since its
evaluated UTI risk in children with neurogenic bladder. 19,20 introduction in the 1930s. A number of catheter coatings
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While Defoor et al reported a significant lower risk of UTI in and physical alterations have been developed in an attempt
the HC group even with single-use PVC catheter (9.1% vs. to prevent biofilm production, CA-bacteriuria and CA-UTI.
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51.5% UTIs per person-year; p=0.003), Kiddoo et al found Unfortunately, no effort has been proven unequivocally suc-
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no difference in incidence of symptomatic UTI between HC cessful in clinical studies. The IDSA does not recommend
and multiple-use PVC catheters. 4 antimicrobial (silver or antibiotic)-coated or hydrophilic
urinary catheters for the reduction of CA-ASB or CA-UTI.
Hydrophilic vs hydrophilic catheters
2.2 Urethral complications
Only one study (27 patients) compared three different types
of HC catheters (Lofric, EasiCat, and Flocath). No signifi- 2.2.1 Urethral trauma
cant difference in bacteriuria incidence between these three
catheters. 21 Microscopic hematuria, gross hematuria, and quantity of
epithelial cells left on a catheter after removal have all been
Prelubricated vs. non-pre-lubricated catheters used as markers of urethral trauma in the literature. However,
definitions of microscopic hematuria have included 1–5
Ginnantoni et al found that prelubricated catheters red blood cells (RBCs) per high-powered field, >10 RBCs
(Instantcath) significantly reduce the incidence of UTI (7.4% per high-powered field, and a simple positive dipstick for
vs. 22.2%) and bacteriuria (14.8% vs. 33.3%) when com- blood. 29-31 Other studies have used only macroscopic bleed-
pared to standard PVC catheters. 22 ing episodes as an indication of urethral trauma. 29,32

CUAJ • July 2020 • Volume 14, Issue 7 E283