Background

The incidence of infectious complications has not been previously compared for two types of common urinary catheters used in the long-term care setting: indwelling urethral catheters and suprapubic catheters.

Aim

To compare catheter-associated urinary tract infection (CAUTI) rates and multidrug-resistant organism (MDRO) colonization between nursing home residents with indwelling urethral and suprapubic catheters.

Methods

Participants included 418 nursing home residents with an indwelling device enrolled in a previously published prospective targeted infection prevention study conducted between 2010 and 2013. Resident age, gender, function, comorbidities, and information on infections, antibiotic use, and recent hospitalizations were obtained at study enrolment, day 14, and every 30 days thereafter for up to one 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

In all, 208 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 vs 8.8 per 1000 device-days; P = 0.05), were half as likely to be hospitalized (hazard ratio (HR) = 0.46; P < 0.01) and were 23% less likely to have had 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 in the urethral group (0.57 vs 0.44; P = 0.01). Ciprofloxacin-resistant Gram-negative bacilli were frequent in both groups.

Conclusion

Residents with a suprapubic catheter may have fewer CAUTIs, less hospitalization and less antibiotic use, but are more likely colonized with MDROs.

中文翻译：

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疗养院居民留置尿道导管与耻骨上导管：确定长期使用的最安全选择。

背景

此前尚未对长期护理环境中使用的两种常见导尿管（留置导尿管和耻骨上导尿管）的感染并发症发生率进行比较。

目的

比较留置导尿管和耻骨上导尿管的疗养院居民之间的导尿管相关尿路感染 (CAUTI) 发生率和多重耐药菌 (MDRO) 定植情况。

方法

参与者包括 418 名拥有留置装置的疗养院居民，他们参加了之前发表的一项 2010 年至 2013 年间进行的前瞻性针对性感染预防研究。研究中获得了居民年龄、性别、功能、合并症以及感染、抗生素使用和近期住院情况的信息注册，第 14 天，此后每 30 天一次，最多一年。每次访问时从几个解剖部位获取微生物样本。Cox 比例风险模型针对设施级聚类和其他协变量进行了调整。

发现

总共有 208 名研究参与者留置了导尿管，贡献了 21,700 个装置日；173 例 (83%) 使用导尿管，35 例 (17%) 使用耻骨上导尿管。协变量调整后，耻骨上组的 CAUTI 发生率较低（每 1000 个设备日分别为 6.6 例 vs 8.8 例；P = 0.05），住院可能性降低一半（风险比 (HR) = 0.46；P < 0.01），并且过去 30 天内使用过抗生素的可能性降低了 23%（HR = 0.77；P = 0.02）。在留置导尿管≥90天的居民中，耻骨上组分离出的MDRO平均数量显着高于尿道组（0.57 vs 0.44；P = 0.01）。两组中均常见耐环丙沙星革兰氏阴性杆菌。

结论

使用耻骨上导管的居民可能会减少 CAUTI、住院次数和抗生素使用量，但更有可能感染多重耐药菌。