Do not go with the flow, remember indwelling catheters.

PURPOSE: To determine the precise clinical and economic effect of catheter- related bladder infection. To enhance understanding of the importance of preventing catheter-related infection. BACKGROUND: Indwelling bladder catheters are frequently used in patients admitted to acute care hospitals. Approximately 15% to 25% of hospitalized patients have an indwelling catheter placed at some point during their stay. 1 The risk of developing bacteruria, urinary tract infection (UTI), and bacteremia is directly related to the duration of catheterization. 2 Approximately 40% of nosocomial infections are due to UTI, and 80% of these are secondary to an indwelling catheter. 1,3 Continuation of catheter use is frequently not reviewed, and indwelling catheters may be left in place inappropriately, leading to development of complications. These include fever, symptomatic UTI, acute pyelonephritis, bacteremia, sepsis, and death. The incidence of developing catheter-related bacteruria has been estimated to be between 3% and 10% per day. 1,2,4 The growing emphasis on improving hospital care and decreasing hospital errors supports revisiting the morbidity, mortality, and economic effect of indwelling bladder catheters in hospitalized patients. DATA SOURCES: The studies in this quantitative review were identified through a Medline search of English language articles published between 1966 and 1998 using specific Medical Subject Headings (MeSH) and selected authorities in catheter-related infection. The term nosocomial infection was not used in the MeSH heading search but could be an appropriate inclusion. Additional studies were obtained through review of cited references. Peer-reviewed publications, published theses, and abstracts were considered, but not every possible report was located and reviewed. STUDY SELECTION CRITERIA: No specific selection criteria are documented. Ten prospective studies, natural history evaluations or randomized trials that compared various ways of preventing bacteruria, were used to estimate cumulative incidence of bacteruria. The patients assessed were those with standard, noncoated indwelling bladder catheters with closed drainage systems in place for 2 to 10 days who were not receiving systemic antimicrobials or other interventions to prevent bacteruria. Only the consequences of short-term catheterization (<30 days) were examined. DATA EXTRACTION: In determining the incidence of bacteruria, data were extracted from 10 studies that included participants from urology, surgery, and medicine services. The definition of bacteruria in these studies was not consistent. The proportion of patients with bacteruria who develop symptomatic UTI was determined by pooling data from two prospective studies. The definition of UTI in both studies was similar: temperature greater than 100.0°F for more than 12 hours in the absence of other sites of infection or presence of symptoms referable to the urinary system (bladder discomfort, dysuria). Bacteremia was defined as isolating the same organism from both the urine and the blood. The incidence of catheter-related bacteremia was determined from five studies, two of which were large-scale studies participating in the National Nosocomial Infections Survey System.