Advertisement
No AccessJournal of UrologyAdult Urology1 May 2012

Complications of Foley Catheters—Is Infection the Greatest Risk?

    View All Author Information

    Purpose:

    Foley catheters cause a variety of harms, including infection, pain and trauma. Although symptomatic urinary tract infection and asymptomatic bacteriuria are frequently discussed, genitourinary trauma receives comparatively little attention.

    Materials and Methods:

    A dedicated Foley catheter nurse prospectively reviewed the medical records of inpatients with a Foley catheter at the Minneapolis Veterans Affairs Medical Center from August 21, 2008 to December 31, 2009. Daily surveillance included Foley catheter related bacteriuria and trauma. Data were analyzed as the number of event days per 100 Foley catheter days.

    Results:

    During 6,513 surveyed Foley catheter days, urinalysis/urine culture was done on 407 (6.3%) days. This testing identified 116 possible urinary tract infection episodes (1.8% of Foley catheter days), of which only 21 (18%) involved clinical manifestations. However, the remaining 95 asymptomatic bacteriuria episodes accounted for 39 (70%) of 56 antimicrobial treated possible urinary tract infection episodes (for proportion of treated episodes with vs without symptomatic urinary tract infection manifestations, p = 0.005). Concurrently 100 instances of catheter associated genitourinary trauma (1.5% of Foley catheter days) were recorded, of which 32 (32%) led to interventions such as prolonged catheterization or cystoscopy. Trauma prompting an intervention accounted for as great a proportion of Foley catheter days (0.5%) as did symptomatic urinary tract infection (0.3%) (p = 0.17).

    Conclusions:

    In this prospective surveillance project, intervention triggering Foley catheter related genitourinary trauma was as common as symptomatic urinary tract infection. Moreover, despite recent increased attention to the distinction between asymptomatic bacteriuria and symptomatic urinary tract infection in catheterized patients, asymptomatic bacteriuria accounted for significantly more antimicrobial treatment than did symptomatic urinary tract infection. Elimination of unnecessary Foley catheter use could prevent symptomatic urinary tract infection, unnecessary antimicrobial therapy for asymptomatic bacteriuria and Foley catheter related trauma.

    References

    • 1 : Are physicians aware of which of their patients have indwelling urinary catheters?. Am J Med2000; 109: 476. Google Scholar
    • 2 : A decade of prevalence surveys in a tertiary-care center: trends in nosocomial infection rates, device utilization, and patient acuity. Infect Control Hosp Epidemiol1999; 20: 543. Google Scholar
    • 3 : Urinary tract etiology of bloodstream infections in hospitalized patients. J Infect Dis1983; 148: 57. Google Scholar
    • 4 : Catheter-associated urinary tract infection is rarely symptomatic: a prospective study of 1,497 catheterized patients. Arch Intern Med2000; 160: 678. Google Scholar
    • 5 : Clinical and economic consequences of nosocomial catheter-related bacteriuria. Am J Infect Control2000; 28: 68. Google Scholar
    • 6 : CMS proposes additions to list of hospital-acquired conditions for fiscal year 2009: Document CMS-1533-FC. Fact sheet. In: . Baltimore: Centers for Medicare & Medicaid ServicesApril 2008: 304. Google Scholar
    • 7 : Inappropriate treatment of catheter-associated asymptomatic bacteriuria in a tertiary care hospital. Clin Infect Dis2009; 48: 1182. Google Scholar
    • 8 : Management of catheter-associated urinary tract infection. Curr Opin Infect Dis2010; 23: 76. Google Scholar
    • 9 : Catheter-associated urinary tract infection and the Medicare rule changes. Ann Intern Med2009; 150: 877. Google Scholar
    • 10 : Strategies to prevent catheter-associated urinary tract infections in acute care hospitals. Infect Control Hosp Epidemiol2008; 29: S41. Google Scholar
    • 11 : Indwelling urinary catheters: a one-point restraint?. Ann Intern Med2002; 137: 125. Google Scholar
    • 12 : Vena cava air embolism after traumatic Foley catheter placement. Urology2009; 73: 748. Google Scholar
    • 13 : Incidence and prevention of iatrogenic urethral injuries. J Urol2008; 179: 2254. LinkGoogle Scholar
    • 14 : Treatment of posterior and anterior urethral trauma. BJU Int2002; 89: 752. Google Scholar
    • 15 : Urinary tract infections. Infect Dis Clin North Am2011; 25: 103. Google Scholar
    • 16 : Reduction of inappropriate urinary catheter use at a Veterans Affairs hospital through a multifaceted quality improvement project. Clin Infect Dis2011; 52: 1283. Google Scholar
    • 17 : Systematic review and meta-analysis: reminder systems to reduce catheter-associated urinary tract infections and urinary catheter use in hospitalized patients. Clin Infect Dis2010; 51: 550. Google Scholar
    • 18 : Catheter-associated urinary tract infections in intensive care units can be reduced by prompting physicians to remove unnecessary catheters. Infect Control Hosp Epidemiol2004; 25: 974. Google Scholar
    • 19 : Decreasing nosocomial urinary tract infection in a large academic community hospital. Lippincotts Case Manag2001; 6: 127. Google Scholar
    • 20 : A multicenter qualitative study on preventing hospital-acquired urinary tract infection in US hospitals. Infect Control Hosp Epidemiol2008; 29: 333. Google Scholar
    • 21 : CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control2008; 36: 309. Google Scholar
    • 22 : Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis2010; 50: 625. Google Scholar
    • 23 : Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis2005; 40: 643. Google Scholar
    • 24 : Potentially inappropriate treatment of urinary tract infections in two Rhode Island nursing homes. Arch Intern Med2011; 171: 438. Google Scholar
    • 25 : Antimicrobial urinary catheters: a systematic review. Expert Rev Med Devices2008; 5: 495. Google Scholar
    • 26 : Patient Safety Component Manual: Catheter-Associated Urinary Tract Infection (CAUTI) Event. March, 2009. http://www.cdc.gov/nhsn/TOC_PSCManual.html. Accessed May 8, 2011. Google Scholar
    Advertisement