Trauma as common as infection in hospitalized patients with Foley catheters
MedWire News: Results from a prospective surveillance project published in the Journal of Urology indicate that hospitalized patients who have Foley catheters have rates of genitourinary trauma similar to those of urinary tract infection (UTI).
Up to 25% of hospitalized patients will have an indwelling Foley catheter at some point during their stay. However, Foley catheters are often prone to microorganism build-up, causing a wide range of infections. Other side effects of Foley catheter use are pain, movement restriction, and genitourinary trauma (including hematuria).
Limited data are available on Foley catheter-related trauma, and no studies had reviewed the frequency or significance of trauma compared with Foley catheter-related infection. To determine the frequency of genitourinary trauma and any subsequent clinical outcomes, Anne-Marie Leuck, James R Johnson, and colleagues (University of Minnesota, Minneapolis, USA) conducted a prospective surveillance of their medical center's records for Foley catheter-related complications over a 16-month period.
The study team reviewed results of urinalyses or urine cultures in patients who had Foley catheters and recorded any instances of UTI symptoms and/or formal diagnoses and traumatic complications associated with the Foley catheters. These complications included pain, gross hematuria, overt mechanical trauma, and incidentally noted catheter migration. Frequency was documented as the number of event days (days on which an infection-related or traumatic event was recorded) per 100 Foley catheter days.
During the study period, 116 possible UTIs were identified in 82 patients. Of these UTIs, 21 were symptomatic and 95 were asymptomatic although symptomatic episodes were significantly more likely to receive antimicrobial therapy than were asymptomatic episodes (17 of 21, 81% vs 39 of 95, 41%), 70% of the 56 possible UTI episodes treated with antimicrobial therapy lacked clinical manifestations.
There were 100 instances of genitourinary trauma in 89 patients. Sixty-eight of the episodes were resolved with manipulation or replacement of the Foley catheter; the other 32 required additional interventions, including prolonged catheterization, cystoscopy, and suprapubic catheter placement. Trauma was as common as symptomatic UTI (0.5% of Foley catheter days vs 0.3%). Trauma with pain occurred on 0.9% of Foley catheter days.
The investigators conclude that trauma related to Foley catheter use is more common than catheter-related infections, and that asymptomatic infections may be overtreated with antimicrobials. In the investigators' assessment, "the current focus on infection as the main
Foley catheter-associated harm may be counterproductive by causing providers to overlook other important risks, especially trauma, and motivating them to prescribe unnecessary antimicrobial therapy. Therefore, the most effective way to avoid all harms associated with Foley catheters may be to focus on the total avoidance of unnecessary Foley catheter use."
By Stephanie Leveene