Should Catheters Be Replaced in Patients with UTI?

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Routine catheter replacement does not improve outcomes for hospitalized patients with catheter-associated urinary tract infection (UTI), according to a report in Journal of the American Geriatric Society.

The prospective, observational cohort study included 315 patients who developed a symptomatic UTI after having an indwelling urinary catheter in place for longer than 1 week. The patients, mean age 79.2 years, were being treated in six internal medicine departments and the geriatric department of an Israeli university hospital. Most were residents of a nursing home or other long-term care facility; they had high comorbidity, with a median Charlson score of 3.

Routine catheter replacement does not improve outcomes for hospitalized patients with catheter-associated urinary tract infection (UTI), according to a report in Journal of the American Geriatric Society.

The prospective, observational cohort study included 315 patients who developed a symptomatic UTI after having an indwelling urinary catheter in place for longer than 1 week. The patients, mean age 79.2 years, were being treated in six internal medicine departments and the geriatric department of an Israeli university hospital. Most were residents of a nursing home or other long-term care facility; they had high comorbidity, with a median Charlson score of 3.

In 98 patients, the catheter was removed and replaced within 6 hours, based on department practice. In the remaining 217 patients, the catheter was left in place. The main outcome of interest was clinical failure, defined as death or clinical signs or symptoms of sepsis within 7 days. The two groups were matched using a propensity-score model for catheter replacement.

The 7-day clinical failure rate was 35.2% and 30-day mortality 30.8%. Neither outcome was significantly different for patients who did and did not undergo catheter replacement. The results were similar on subgroup analyses of patients with more than 30 days of catheterization and those with definite catheter-associated UTI. There were no adverse outcomes associated with catheter replacement. Patients with catheter replacement spent a median of 2 more days in the hospital.

There are no universally accepted guidelines for managing symptomatic UTI in patients with long-term urinary catheters. While catheter removal and replacement may be a reasonable strategy, there are potential harms of routine catheter removal.

This study questions the benefit of replacing long-term catheters in hospitalized patients at the onset of catheter-associated UTI. The researchers conclude, “Until a randomized controlled trial in the relevant population shows otherwise, we see no reason to support routine replacement of a long-term urinary tract catheter in individuals with a symptomatic UTI” [Babich T, et al. Replacement of urinary catheter for urinary tract infections: a prospective observational study. J Am Geriatric Soc 2018; 66:1779–1784].

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