Intermittent Catheterization and Urinary Tract Infection

Abstract

PURPOSE: The purpose of this study was to describe and compare factors that affect urinary tract infection (UTI) rates in people with spina bifida (SB) and neurogenic bladder dysfunction before and following initiation of intermittent catheterization (IC). DESIGN: A quantitative, descriptive, correlational study. SUBJECTS AND SETTING: The study included people who were from Germany, a high-income nation, and Brazil, a middle-income nation. Brazilian participants were recruited from a public rehabilitation hospital in the state of Minas Gerais. German participants were drawn from different regions of the country. The study sample included 200 participants; participants were either individuals diagnosed with SB and neurogenic bladder dysfunction and using IC, or caregivers of persons using IC for bladder management. METHODS: Data were collected through a survey questionnaire developed for urological follow-up of SB patients. A translated and validated version of the form was used to collect data in Germany. To evaluate annual episodes of UTI, we considered the number of symptomatic UTI before and after IC. RESULTS: Participants from Brazil were significantly younger than German patients (median age 9 vs 20 years, P < .001). Brazilians predominately used assisted catheterization (63.0%), whereas most Germans performed self-catheterization (61.0%). Use of IC greatly reduced the incidence of UTI in both groups (mean 2.8 episodes per year before IC vs mean 1.1 episodes after starting IC, P < .001). Women had a higher number of UTI, both before and after IC, but enjoyed greater reduction in UTI after initiating IC than men. Self-catheterization also promoted a greater reduction of UTI than assisted IC (P = .022). CONCLUSIONS: Intermittent catheterization reduced annual episodes of UTI in both samples despite differences in catheterization technique. Patients practicing and performing self-catheterization achieved a greater reduction than those who relied on assisted IC. Comparative studies among additional countries with varying median income levels are needed to better understand the needs of individuals with SB and their families, and to plan and implement safe nursing interventions.

The burden of illness in initiating intermittent catheterization: an analysis of German health care claims data

“…The highest prevalence of comorbidities, complications, and critical events, including UTI, was recorded before initial IC use, which may suggest that patients are experiencing inadequate bladder management prior to initiating IC. UTI rates decreased when comparing pre- and post-index, which is in line with previously published hypotheses that IC does not necessarily lead to UTI and may have a positive impact on UTIs overtime [ 2 , 6 , 14 ]. This positive impact is further emphasized by the decrease of complications during FP1 and FP2.…”

Quality of Life and Autonomy in Patients with Intermittent Bladder Catheterization Trained by Specialized Nurses

“…Among the most relevant results of this study were that the profile of people requiring IBC varied greatly in sociodemographic and clinical characteristics, with neurological damage as the reason for prescription in one in three patients. This variability in the prescriptions and characteristics of patients requiring IBC can also be seen in other works [20,21].…”

Adult Neurogenic Lower Urinary Tract Dysfunction and Intermittent Catheterisation in a Community Setting: Risk Factors Model for Urinary Tract Infections

“…Self-catheterisation versus catheterisation by others was associated with a significantly reduced UTI rate in a Canadian national survey of intermittent catheterisation practices following SCI [25]. Similar, after commencement of IC in a SB population, it appeared that IC self-catheterisation prompted a greater reduction of UTI than assisted IC [96].…”