Tanya Babich1,2, Oren Zusman1,2, Michal Elbaz1,2, Haim Ben-Zvi3, Mical Paul4, Leonard Leibovici1,2, Tomer Avni1,5. 1. Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. 2. Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel. 3. Microbiology Laboratories, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel. 4. Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel. 5. Department of Infectious Disease, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel.
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.
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.
Authors: Kristian Stærk; Rasmus Birkholm Grønnemose; Yaseelan Palarasah; Hans Jørn Kolmos; Lars Lund; Martin Alm; Peter Thomsen; Thomas Emil Andersen Journal: Front Microbiol Date: 2021-06-25 Impact factor: 5.640