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

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.