Exploring relationships of catheter‐associated urinary tract infection and blockage in people with long‐term indwelling urinary catheters

Abstract

Aims The aims were to describe and explore relationships among catheter problems in long-term indwelling urinary catheter users, including excess health care utilization for treating catheter problems. Background Long-term urinary catheter users experience repeated problems with catheter-related urinary tract infection (CAUTI) and blockage of the device, yet little has been reported of the patterns and relationships among relevant catheter variables. Design Secondary data analysis was conducted from a sample in a randomized clinical trial, using data from the entire sample of 202 persons over 12 months’ participation. Methods Descriptive statistics were used to characterize the sample over time. Zero-inflated negative binomial models were employed for logistic regressions to evaluate predictor variables of the presence/absence and frequencies of CAUTI and blockage. Results CAUTI was marginally associated with catheter blockage. Problems reported at least once per person in the 12 months were: CAUTI 57%, blockage 34%, accidental dislodgment 28%, sediment 87%, leakage (bypassing) 67%, bladder spasms 59%, kinks/twists 42%, and catheter pain 49%. Regression analysis demonstrated that bladder spasms were significantly related to CAUTI and sediment amount, and catheter leakages were marginally significantly and positively related to CAUTI. Frequencies of higher levels of sediment and catheter leakage were significantly associated with higher levels of blockage, and being female was associated with fewer blockages. Persons who need help with eating (more disabled) were also more likely to have blockages. Conclusions CAUTI and blockage appear to be related and both are associated with additional health care expenditures. More research is needed to better understand how to prevent adverse catheter outcomes and patterns of problems in sub-groups. Relevance to clinical practice Nurses can develop care management strategies to identify catheter blockage prior to its occurrence by tracking the amount of sediment and frequency of leakage. Bladder spasms could be an early warning of CAUTI.

Factors associated with long-term urinary catheterisation and its impact on urinary tract infection among older people in the community: a population-based observational study in a city in Japan

“…Regarding the incidence of UTI, a US study described the incidence rate of UTI as 164 per 100 person-years among people with LTUC 11. The incidence rate was higher than our result of 33.8 per 100 person-years, and the difference can be explained by the different methods used to identify UTI; a questionnaire was used by interviewers in the US study, and the incidence of UTI was counted multiple times for each individual.…”

“…Potential harms associated with urinary catheterisation include urinary tract infection (UTI) 9 10. A US study reported that UTI occurred in 50% of people with LTUC in the community 11. However, this study did not include a comparison group of people without LTUC, and the relative risk of UTI in people with LTUC was not reported.…”

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“…Early ureter extraction caused a reduction in the risk of urinary tract infection42; however, this study found that there was no significant difference between ERAS and the control group. Sensitivity analysis showed that by excluding Kim’s study,33 the ERAS group had a lower risk of urinary tract infection than the control group.…”

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“…CAUTI have also been associated with bladder spasms ( 25 ). Treating the CAUTI with antibiotics may reduce the spasms, however in some patients the spasms will persist.…”