Replacement of Urinary Catheter for Urinary Tract Infections: A Prospective Observational Study

Abstract

Objectives: To assess whether catheter replacement is associated with better clinical outcomes in individuals with long-term urinary catheters.

Design: Prospective, noninterventional study.

Participants: Individuals (mean age 79.2±11.5) who had had an indwelling urinary catheter for longer than 7 days and a symptomatic urinary tract infection (UTI) (N=315).

Measurements: The exposure assessed was replacement of the indwelling urinary catheter within 6 hours. The primary outcome was clinical failure at day 7. We developed a propensity score model for catheter replacement to match participants. Multivariate analysis was conducted to adjust for other risk factors.

Results: The catheter was replaced in 98 participants and not in 217. More than half of the participants resided in long-term care facilities and had high Charlson comorbidity scores. The rate of clinical failure on day 7 was 35.2% (108/306). The 30-day fatality rate was 30.8% (96/315). We found no statistically significant association between catheter replacement and clinical failure (propensity-adjusted odds ratio (OR)=0.90, 95% CI=0.50-1.63) or 30-day fatality (OR=0.76, 95% CI=0.40-1.44).

Conclusion: We found no clinical benefit of replacing a long-term catheter at the onset of the catheter-associated UTI. Further research is needed through randomized controlled trials.

Keywords: antimicrobial therapy; catheter replacement; indwelling catheter; mortality; urinary tract infection.