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Indwelling Urethral versus Suprapubic Catheters in Nursing Home Residents: Determining the Safest Option for Long-Term Use.
J Hosp Infect. 2018 Jul 26;:
Authors: Gibson KE, Neill S, Tuma E, Meddings J, Mody L
Abstract
BACKGROUND: Long-term infectious complications associated with type of indwelling urinary catheter are unknown.
AIM: To compare catheter-associated urinary tract infection (CAUTI) rates and multidrug resistant organism (MDRO) colonization between nursing home (NH) residents with indwelling urethral and suprapubic catheters.
METHODS: Participants included 418 NH residents with an indwelling device enrolled in a prospective Targeted Infection Prevention (TIP) study between 2010-2013. Resident age, gender, function, comorbidities, and information on infections, antibiotic use, & recent hospitalizations were obtained at study enrollment, day 14, & every 30 days thereafter for up to 1 year. Microbiological samples were obtained from several anatomic sites at each visit. Cox proportional hazard models were adjusted for facility-level clustering and other covariates.
FINDINGS: Two-hundred and eight study participants had an indwelling urinary catheter, contributing 21,700 device-days; 173 (83%) with a urethral catheter, 35 (17%) with a suprapubic catheter. After covariate-adjustment, the suprapubic group had a lower incidence of CAUTI (6.6/1000 device-days vs. 8.8/1000 device-days; p = 0.05), were half as likely to be hospitalized (hazard ratio (HR) = 0.46; p < 0.01) and 23% less likely to have antibiotics in the past 30 days (HR = 0.77; p = 0.02). Among residents catheterized ≥90 days, the mean number of MDROs isolated in the suprapubic group was significantly higher than the urethral group (0.57 vs. 0.44; p = 0.01). Ciprofloxacin-resistant Gram-negative bacilli were common in both groups.
CONCLUSION: Residents with a suprapubic catheter may have fewer CAUTIs, hospitalization and antibiotic use, but are more likely colonized with MDROs.
PMID: 30056015 [PubMed - as supplied by publisher]