Exploring relationships of catheter-associated urinary tract infection and blockage in people with long-term indwelling urinary catheters.
Mary H Wilde, James M McMahon, Hugh F Crean and 1 others
PMID 27805758WHAT IT FOUND
Long-term catheter users reported blockage and urinary infection often, and the two were only modestly related.
Sediment, leakage and bladder spasms were linked to them, so nurses should record each problem separately.
Key findings
01CAUTI occurred at least once in 57% of participants (n=110), with 268 events, and blockage occurred at least once in 34% (n=66), with 507 events over 12 months.
02Blockage and CAUTI counts were modestly correlated (.35, p<.001), and blockage was only marginally associated with CAUTI in the main association analysis (odds ratio 1.52; CI 0.99 to 2.33; P=.057).
03In the repeated-measures models, more bladder spasms were associated with more CAUTI events (B=.003, p=.044), while larger sediment amount (B=1.019, p<.001) and more leakage (B=.016, p=.002) were associated with more blockage events.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
All outcomes were self-reported. CAUTI was based on the participant reporting that a physician had diagnosed it and that it was treated with an antibiotic, and urine cultures or provider diagnostic criteria were not available. Blockage reporting was incomplete for very frequent events: only the first 12 blockage events per interview were asked about for treatment, and extreme blockage values were set to 9, so true blockage frequency and related healthcare use are uncertain. The analysis pooled the randomised self-management and usual-care groups because both improved in CAUTI and blockage, so it cannot tell whether the intervention changed the relationships being studied. Follow-up was not complete: 75% completed the full 12 months, and the analysed samples after baseline were 193 for CAUTI and 192 for blockage, with missing data handled by averaging and imputation. The study did not collect billing or diagnostic codes, so it could not fully quantify the cost or healthcare utilization associated with catheter problems.
Declared interests
Professor Wilde has been a consultant with NovaBay Pharmaceutics Inc. since June 2013. The remaining authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that irrigating prevents blockage or that blockage causes urinary infection. Irrigation was associated with blockage, but the study only observed self-reported practices, and blockage was only marginally associated with infection.