Antibiofilm activity of promethazine against ESBL-producing strains of Escherichia coli in urinary catheters.

The bacterium Escherichia coli is one of the main causes of urinary tract infections. The formation of bacterial biofilms, especially associated with the use of urinary catheters, contributes to the establishment of recurrent infections and the development of resistance to treatment. Strains of E. coli that produce extended-spectrum beta-lactamases (ESBL) have a greater ability to form biofilms. In addition, there is a lack of drugs available in the market with antibiofilm activity. Promethazine (PMZ) is an antihistamine known to have antimicrobial activity against different pathogens, including in the form of biofilms, but there are still few studies of its activity against ESBL E. coli biofilms. The aim of this study was to evaluate the antimicrobial activity of PMZ against ESBL E. coli biofilms, as well as to assess the application of this drug as a biofilm prevention agent in urinary catheters. To this end, the minimum inhibitory concentration and minimum bactericidal concentration of PMZ in ESBL E. coli strains were determined using the broth microdilution assay and tolerance level measurement. The activity of PMZ against the cell viability of the in vitro biofilm formation of ESBL E. coli was analyzed by the MTT colorimetric assay and its ability to prevent biofilm formation when impregnated in a urinary catheter was investigated by counting colony-forming units (CFU) and confirmed by scanning electron microscopy (SEM). PMZ showed bactericidal activity and significantly reduced (p < 0.05) the viability of the biofilm being formed by ESBL E. coli at concentrations of 256 and 512 µg/ml, as well as preventing the formation of biofilm on urinary catheters at concentrations starting at 512 µg/ml by reducing the number of CFUs, as also observed by SEM. Thus, PMZ is a promising candidate to prevent the formation of ESBL E. coli biofilms on abiotic surfaces.

Materials-based incidence of urinary catheter associated urinary tract infections and the causative micro-organisms: systematic review and meta-analysis.

BACKGROUND: Both long (> 30 days) and short-term (≤ 30 days) catheterisation has been associated with urinary tract infections (UTIs) due to the invasive nature of device insertion through the urethra. Catheter associated Urinary Tract Infections (CAUTIs) are common (prevalence of ~ 8.5%) infections which can be treated with antibiotics; however, CAUTIs are both expensive to treat and contributes to the antibiotic usage crisis. As catheters are unlikely be replaced for the management of patients' urination, ways of reducing CAUTIs are sought out, using the catheter device itself. The aim of this review is to assess the incidence of CAUTI and the causative micro-organisms when different urinary catheter devices have been used by humans, as reported in published research articles. METHODS: A Systematic Literature Review was conducted in Ovid Medline, Web of Science and PubMed, to identify studies which investigated the incidence of UTI and the causative micro-organisms, in patients with different urinary catheter devices. The articles were selected based on a strict set of inclusion and exclusion criteria. The data regarding UTI incidence was extracted and calculated odds ratio were compared across studies and pooled when types of catheters were compared. CAUTI causative micro-organisms, if stated within the research pieces, were also gathered. RESULTS: A total of 890 articles were identified, but only 26 unique articles met the inclusion/exclusion criteria for this review. Amongst the large cohort there were catheters of materials silicone, latex and PVC and catheter modifications of silver nanoparticles and nitrofurantoin antibiotics. The meta-analysis did not provide a clear choice towards a single catheter against another although silver-based catheters, and silver alloy, appeared to statistically reduce the OR of developing CAUTIs. At genus level the three commonest bacteria identified across the cohort were E. coli, Enterococcus spp. and Pseudomonas spp. whilst considering only at the genus level, with E. coli, Klebsiella pneumonia and Enterococcus faecalis most common at the species-specific level. CONCLUSIONS: There does not appear to be a catheter type, which can significantly reduce the incidence of CAUTI's in patients requiring catheterisation. Ultimately, this warrants further research to identify and develop a catheter device material that will reduce the incidence for CAUTIs.

Use of indwelling urinary catheters in nursing home residents: results from a cross-sectional study in 21 German nursing homes.

BACKGROUND: Indwelling urinary catheters often lead to complications such as symptomatic urinary tract infections. In nursing home residents, catheter prevalence is high, but prevalence differences by sociodemographic characteristics, comorbidities, and health services use have rarely been investigated. The purpose of this work was to describe the use of indwelling urinary catheters in nursing home residents and to examine whether catheter use is associated with individual characteristics. METHODS: Cross-sectional data of the "Inappropriate Medication in patients with REnal insufficiency in Nursing homes" (IMREN) study conducted in 21 German nursing homes between October 2014 and April 2015 were analyzed. For all residents of the involved care units, nurses of the participating institutions completed an anonymous questionnaire including the Modified Rankin Scale to assess physical impairments. The proportion of nursing home residents with indwelling urinary catheter was determined. Associations between catheter use and individual characteristics were investigated via cluster-adjusted multivariable logistic regression. RESULTS: Of 852 residents (76.5% female; mean age 83.5 years), 13.4% had an indwelling urinary catheter. The adjusted odds ratios for catheter use for men vs. women was 2.86 (95% confidence interval 1.82-4.50). For residents with "moderate" disability vs. those with "no to slight" disability it was 3.27 (1.36-7.85), for individuals with "moderately severe" disability vs. the reference group it was 9.03 (3.40-23.97), and for those with "severe" disability vs. the reference group it was 26.73 (8.60-83.14). For residents who had been hospitalized within the last 12 months vs. those without a hospitalization it was 1.97 (1.01-3.87). For age, dementia, overweight/obesity, other indwelling devices, and long-term medications no significant associations were found. CONCLUSIONS: Male nursing home residents, residents with a higher degree of physical impairment, and those who had been hospitalized within the last 12 months were more likely to use an indwelling urinary catheter than their counterparts. Data on circumstances of and indications for catheters, catheter types, and duration of catheterization are needed to evaluate the appropriateness of catheter use in nursing home residents and the need for interventions.

Development and psychometric evaluation of an expanded urinary catheter self-management scale: A cross-sectional study.

AIM: To develop and test the psychometric properties of an expanded catheter self-management scale for patients with in-dwelling urinary catheters. DESIGN: A cross-sectional validation study. Despite the utility of the original 13-item catheter self-management scale, this instrument did not include bowel management, general hygiene and drainage bag care, which are fundamental skills in urinary catheter self-management to prevent common problems resulting in unnecessary hospital presentations. The expanded catheter self-management scale was developed with 10 additional items to comprehensively assess all five essential aspects of urinary catheter self-management. METHODS: A total of 101 adult community-dwelling patients living with indwelling urinary catheters were recruited from Western Sydney, Australia. Using exploratory factor analysis with Varimax rotation, the number of factors to be extracted from the expanded 23-item expanded catheter self-management scale was determined using a scree plot. The reliability of the overall scale and subscales was measured using Cronbach's alpha. Convergent validity was assessed using Spearman's correlations between clinical characteristics, overall scale and subscales. RESULTS: The 23-item expanded catheter self-management scale yielded a 5-factor solution, labelled as: (i) self-monitoring of catheter function, (ii) proactive, help-seeking behaviour function, (iii) bowel self-care function, (iv) hygiene-related catheter site function and (v) drainage bag care function. Cronbach's alpha of the expanded catheter self-management scale indicating all 23 items contributed to the overall alpha value. Convergent validity results showed a negative correlation between the overall expanded catheter self-management scale and catheter-related problems. CONCLUSION: The 5-factor structure provided a comprehensive assessment of key aspects of urinary catheter self-management essential to reduce the likelihood of catheter-related hospital presentations. IMPLICATIONS: The expanded catheter self-management scale can be used to assess and monitor effective patient-centred interventions for optimal self-management to prevent catheter-related problems and improve the quality of life of patients. IMPACT: Many patients start their journey of living with a urinary catheter unexpectedly and are not supported with quality information to care for their catheter. The findings of this study show the correlation between catheter self-management skills and catheter-related problems. The expanded catheter self-management scale (E-CSM) assists with analysing the self-management skills of patients living with a catheter and developing tailored interventions to prevent problems and improve their quality of life. In addition, this screening tool can be included in policies, guidelines, and care plans as a standard for improving catheter management and developing educational resources for patients. REPORTING METHOD: STROBE checklist was used to report all aspects of this study comprehensively and accurately. PATIENT OR PUBLIC CONTRIBUTION: Patients living with indwelling urinary catheter and their carers have participated in surveys, interviews and co-designing interventions. This paper reports the psychometric analysis of the expanded catheter self-management scale (E-CSM) used in the patient survey as part of the main study 'Improving Quality of Life of Patients Living with Indwelling Urinary Catheters: IQ-IDC Study' (Alex et al. in Collegian, 29:405-413, 2021). We greatly value our consumers' contributions and continue to communicate the progress of the study to them. Their contributions will be acknowledged in all publications and presentations. In addition, all participants will be provided the option of receiving the interventions and publications generated from this study.

Effectiveness and safety of a simple catheter securement device aimed at preventing catheter-associated urinary tract infection in intensive care unit patients: A randomized controlled trial.

BACKGROUND: Clinical practice guidelines for the prevention of catheter associated urinary tract infection (CAUTI) recommend urinary catheter securement in critical patients although there is scant research on its effectiveness. AIM: To analyse whether securement of an indwelling urinary catheter (IUC) reduces the risk of CAUTI and meatal pressure injury among intensive care unit (ICU) patients and assess medical adhesive-related skin injury (MARSI) associated with the securement device. STUDY DESIGN: Open randomized controlled trial involving patients admitted to two ICUs in Spain. In the intervention group (n = 169 patients), the IUC was secured to the thigh using an in-house device piloted as part of this trial. Controls (n = 181) received standard care, including non-securement of the IUC. Barrier film spray was applied to the securement site with the aim of preventing MARSI. The definitions of the main outcomes were: CAUTI was diagnosed according to the criteria of the European Centre for Disease Prevention and Control, meatal pressure injury was categorized into four grades and MARSI was classified as either erythema or skin tears. Bivariate analysis and multivariate logistic regression were performed. Log-rank and Cox regressions were used to compare risk over time to CAUTI and meatal pressure injury in the two groups. RESULTS: Data from 350 patients were analysed, 169 (48.29%) from IG and 181 (51.71%) from CG. In the multiple logistic regression analysis, IUC securement was an independent protective factor against both CAUTI (RR = 0.2, 95% CI [0.05, 0.67]) and meatal pressure injury (RR = 0.31, 95% CI [0.15, 0.58]). The incidence of MARSI was 7.1%. CONCLUSION: Effective IUC securement significantly reduces the risk of CAUTI and meatal pressure injury among ICU patients. The in-house device piloted in the present trial is simple for nurses to use, and the incidence of MARSI was low. These results underline the benefits of IUC securement. RELEVANCE TO CLINICAL PRACTICE: Indwelling urinary catheter (IUC) securement reduces the risk of urinary tract infection. IUC securement helps prevent meatal pressure injury. IUC securement with in-house devices is safe and effective.

Determining the Spiritual Care Needs of Patients with Indwelling Urinary Catheterization: A Cross-Sectional Descriptive Study in Turkey.

This study was undertaken to ascertain the spiritual care requirements of patients undergoing indwelling urinary catheterization. Identifying the spiritual care needs of patients with indwelling urinary catheterization is crucial for fortifying their resilience and fostering positive health behaviors. Furthermore, it proves pivotal in devising customized nursing interventions. A descriptive cross-sectional study involving 122 participants (50 female, 72 male) undergoing indwelling urinary catheterization within the inpatient clinics of a state hospital in Turkey was conducted. Data were meticulously gathered through a participant information form and the Spiritual Care Needs Scale. The subsequent analysis employed the Kruskal-Wallis and Mann-Whitney U tests, facilitated by the SPSS 22.0 program. This study adhered to the STROBE recommendations in reporting. The findings indicated that individuals with indwelling urinary catheters exhibit spiritual care needs exceeding the norm, with heightened scores in subdimensions such as meaning and hope, caring, and respect. A statistically significant positive association was identified, revealing a difference in spiritual care needs between women and men. Similarly, a positive association, statistically significant, was observed in the spiritual care needs of patients aged 72-98 compared to those aged 41-71. Furthermore, a positive and statistically significant difference surfaced in the spiritual care needs of patients with long-term indwelling urinary catheters as opposed to those with medium and short-term urinary catheters. Therefore, it is imperative to consider the spiritual care needs of patients undergoing indwelling urinary catheterization.

The first evidence of antibiofilm action of Proteus mirabilis with tetra-cationic porphyrins containing cisplatin by antimicrobial photodynamic therapy.

Biofilms are responsible for up to 80% of antimicrobial-resistant nosocomial infections. Most of these infections are associated with medical devices such as urinary catheters, and in this context, it is estimated that 90-100% of patients who undergo long-term catheterization develop infections. Proteus mirabilis, the most prevalent microorganism, is responsible for 20-45% of these infections. Thus, this study aimed to evaluate, for the first time, the antimicrobial and antibiofilm effects of cationic porphyrins on P. mirabilis. Neutral porphyrins 3-H2TPyP and 4-H2TpyP and tetra-cationic derivatives 3-cis-PtTPyP and 4-cis-PtTPyP were evaluated in broth microdilution tests to determine the minimum inhibitory and bactericidal concentrations. Time-kill curves, checkerboard test, reactive oxygen species (ROS) scavenger assays, conventional biofilm formation, and biofilm assay with catheters were also performed. The microdilution tests showed greater efficacy against P. mirabilis when 3-cis-PtTPyP was exposed to white-light conditions; this also occurred when the microbial time-kill curve was performed at 0, 2, 6, and 12 h. The radical superoxide species was possibly responsible for photoinactivation in the ROS scavenger assays. In biofilm assays (conventional and catheter), 3-cis-PtTPyP obtained better results when irradiated with a white-light source. In the checkerboard assay, the same compound showed no differences when tested in association with ciprofloxacin hydrochloride. Our findings lead us to conclude that antimicrobial photodynamic therapy and cationic porphyrins obtained positive results and are promising alternatives to treat P. mirabilis biofilms.

A stable cyclized antimicrobial peptide derived from LL-37 with host immunomodulatory effects and activity against uropathogens.

The increasing antibiotic resistance among uropathogenic bacteria warrants alternative therapeutic strategies. We demonstrate the potential of the synthetic peptide CD4-PP, designed by dimerization and backbone cyclization of the shortest antimicrobial region of human cathelicidin, LL-37. CD4-PP is active against clinical and type strains of common uropathogens Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa at concentrations substantially below cellular cytotoxic levels and induced membrane deformation and leakage in E. coli and P. aeruginosa. Furthermore, CD4-PP treatment prevented the formation of new biofilm and dissolved mature biofilm created by E. coli and P. aeruginosa and targeted curli amyloid in E. coli biofilms. In addition, CD4-PP also induced production of LL-37 by uroepithelial cells and increased the expression of tight junction proteins claudin-14 and occludin. During uroepithelial cell infection, CD4-PP significantly reduced uropathogen survival when treatment was given at the start of infection. Low micromolar of CD4-PP treatment initiated after 2 h was successful with all tested species, except P. aeruginosa where CD4-PP was unable to reduce survival, which could be attributed by early biofilm formation. Finally, we demonstrated that urinary catheter pieces coated with saline fluid supplemented with CD4-PP reduced the attachment of E. coli, giving it a potential clinical application.

Medical clowns versus sedation for paediatric urinary catheter insertion-A randomised pilot study.

AIM: To investigate the potential benefits of medical clowns (MCs) in reducing anxiety and pain during paediatric urinary catheter insertion. METHODS: In this prospective pilot study, 51 children who required urinary catheter insertion were randomised into two groups; the first group (n = 29) underwent the procedure in the presence of a MCs, and the second control group (n = 22) underwent the procedure using sedation. Pain and anxiety levels as well as procedural duration were recorded. All procedures were filmed and evaluated for anxiety level by a paediatric psychiatrist. General satisfaction questionnaires were filled by the medical team and parents in the clown group. RESULTS: There were no differences in pain scores or anxiety levels between the two groups. Procedure duration and total hospital stay were significantly shorter in the MC group (p < 0.001). One hundred percent of the parents and the medical team were in favour of incorporating MCs during urinary catheter insertion. CONCLUSION: MCs are as good as sedation in lowering anxiety and pain levels in children undergoing urinary catheter insertion. In addition, MCs reduce the duration of the procedure and elicit a high degree of overall satisfaction from the parents and medical team.

Impact of early postoperative indwelling urinary catheter removal: A systematic review.

BACKGROUND: Indwelling urinary catheters (IDUCs) are associated with complications and early removal is therefore essential. Currently, it is unknown what the effect of a specific removal time is and what the consequences of this removal time are. RESEARCH QUESTION: To present an overview of the available evidence to determine the effects of three postoperative IDUC removal times (after a certain number of hours, at a specific time of day and flexible removal time) on the development of complications in hospital. METHODS: PubMed, Medline, Embase, Emcare and Cochrane Central Register of Controlled Trials were searched till 6 June, 2021. Studies were included that described the effect of the removal time in relation to re-catheterisation, urinary tract infections (UTIs), ambulation time, time of first voiding and hospital stay. The quality of the studies was assessed with the Newcastle-Ottawa Scale and the Cochrane Effective Practice and Organisation of Care. A narrative descriptive analysis was performed. PRISMA guidelines were followed in reporting this review. RESULTS: Twenty studies were included from which 18 compared removal after a number of hours, 1 reported on a specific removal time and 1 reported on both topics. The results were contradicting regarding the hypothesis that later removal increases the incidence of UTIs. Earlier removal does not lead to a higher re-catheterisation rate while immediate removal is beneficial for reducing the time to first ambulation and shortening the hospital stay. Studies reporting on specific removal times did not find differences in outcomes. No study addressed flexible removal time. CONCLUSIONS: There is inconclusive evidence that earlier removal results in less UTIs, despite the incidence of UTIs increasing if the IDUC is removed ≥24 h. Immediate or after 1-2 day(s) removal does not lead to higher re-catheterisation rates while immediate removal results in earlier ambulation and shorter length of hospital stay. IMPLICATIONS OF KEY FINDINGS: Nurses should focus on early IDUC removal while being aware of urinary retention.

Insertion of a urinary catheter on admission lowers acute kidney injury incidence in patients with hip fractures.

PURPOSE: Acute kidney injury (AKI) is a common adverse event in patients undergoing hip fracture repair surgery, increasing morbidity and mortality. Our study hypothesis was that routine insertion of a urinary catheter, on admission to the hospital or immediately before surgery, will reduce AKI incidence in hip fracture patients. METHODS: Determined by alternating days of admission, a urinary catheter was inserted routinely on admission (catheter group) or as needed (non-catheter group) in 250 consecutive patients who presented with a hip fracture to our emergency department. The incidence of AKI according to the KDIGO criteria and morbidity and mortality were compared between the study groups. RESULTS: The overall incidence of AKI was 11.6% (29/250). The catheter group (N = 122) had a significantly lower rate of AKI (6.6% vs. 16% p = 0.018). At 12-month follow-up, the overall mortality was 10.8% (27/250), in-hospital 7.4% (2/27), short-term (within 30 days) 7.4% (2/27), and long-term (30 days to 1 year) 85.8% (23/27). All in-hospital mortality occurred in the AKI group. Patients with no AKI had a better survival rate; however, the difference was not significant (p-value = 0.21). Mortality rate was lower in the catheter group but not significant (8.2% compared with 13.8% in the non-catheter group, p = 0.225). Post-operative respiratory and cardiac complications were more frequent in the AKI group (p = 0.02 and 0.043 accordingly). CONCLUSIONS: Insertion of a urinary catheter upon admission or before surgery lowered AKI incidence significantly. Peri-operative AKI was associated with higher rates of post-operative complications and worse survival.

[Prevention of the development of catheter-associated urinary system infections in the early postoperative period].

BACKGROUND: Bladder catheterization is a common medical manipulation that is associated with the risk of complications, including catheter-associated urinary tract infection (CAUTI), which accounts for 80% of all nosocomial infections of the urological profile. AIM: To evaluate the combined use of the biologically active additive Uronext and ceftriaxone in the prevention of the development of CAUTI in the early postoperative period in 120 patients aged 20-80 years with a Foley indwelling catheter. MATERIALS AND METHODS: The patients were divided into 2 groups: in group I (n=60), D-mannose with cranberry extract and vitamin D3 as part of Uronext dietary supplement was administered orally in the form of sachets 48 hours before surgery and after surgery until urethral catheter was placed, as well as intravenous ceftriaxone 1000 mg 2 hours before surgery and in the postoperative period within 7 days. In group II (n=60), ceftriaxone monotherapy was prescribed in a similar way. RESULTS: According to the results of bacteriological examination of the removed urinary catheter on 3-7 days in Uronext group, bacterial growth was absent in 40 patients (66.67%, p<0.05), versus 23 cases (38.33%) in the control group. CONCLUSIONS: The data obtained confirm the efficiency of the use of the biologically active additive Uronext in combination with an antibacterial drug, which allows to recommend this scheme in patients with an indwelling urinary catheter for the prevention of the development of CAUTI.

Probiotic lactic acid bacteria as a means of preventing in vitro urinary catheter colonization and biofilm formation.

BACKGROUND: Catheter-associated urinary tract infections (CAUTIs) are the most common infections found in healthcare facilities. Urinary catheters predispose the development of CAUTIs by destroying natural barriers and providing a source for infection and biofilm formation (BF). This study aimed to evaluate probiotic lactic acid bacteria (LAB) as a means of preventing in vitro urinary catheter colonization and BF. METHODS: Cross-sectional screening, followed by an experimental study, was conducted on 120 catheterized patients admitted to the urology department in a tertiary care hospital for 7 months. The isolated and identified uropathogens were tested for their antimicrobial susceptibility patterns by the disk diffusion method according to Clinical and Laboratory Standards Institute recommendations and examined for their ability to produce biofilms using a microtiter plate (MtP) assay. Five LAB (Lactobacillus acidophilus (L. acidophilus), Bifidobacterium bifidum (B. bifidum), L. paracasei, L. pentosus, and L. plantarum) were identified and examined for preventing in vitro colonization and BF of some isolated uropathogens on Foley urinary catheter surfaces. RESULTS: Of the 120 samples collected, 32.5% were found to be associated with CAUTIs. Of isolated organisms, 74.4% were gram-negative bacilli, while gram-positive cocci represented 14%, and only 11.6% were of the Candida species. About two-thirds of isolated uropathogens were biofilm formers. All five probiotic strains had inhibitory effects on the growth of all the uropathogens tested but with varying intensities according to the duration of application after 2, 4, and 6 days. CONCLUSIONS: The prevalence of CAUTIs was high, and the predominant bacterial isolates were gram-negative bacilli. Many of the studied uropathogens were biofilm formers. The bacterial isolates had a higher prevalence of resistance to commonly prescribed antimicrobial agents. Probiotics have the potential to prevent in vitro urinary catheter colonization and inhibit BF. Pre-coating urinary catheters with probiotics is recommended after ensuring the safety of probiotics' use in vivo by carrying out further large-scale studies.

Catheter-associated urinary tract infection and urinary catheter utilization ratio over 9 years, and the impact of the COVID-19 pandemic on the incidence of infection in medical and surgical wards in a single facility in Western Qatar.

INTRODUCTION: Catheter-associated urinary tract infection (CAUTI) is a frequently reported healthcare-associated infection in critical and non-critical patients. Limited data are available about CAUTI incidence in non-critical patients. We aim to describe the incidence of CAUTI over 9 years and evaluate the impact of the pandemic on the incidence in non-critical acute care patients. METHODS: A retrospective observational study of CAUTI in medical-surgical and maternity wards was carried out at a public hospital in the west of the State of Qatar. Data collected included the annual CAUTI incidence (per 1,000 device days), urinary catheter utilization ratio (UC-UR), etiology, and antimicrobial resistance. RESULTS: 115,238 patient days and 6,681 urinary catheters (UC) days were recorded over the study period, and 9 and 4 CAUTI were confirmed in medical-surgical and maternity wards, respectively. The infection rate was 1.9 per 1,000 UC days, and the UC-UR was 0.06. The CAUTI rate was higher in medical-surgical wards over the COVID-19 period (2.4 × 1,000 UC days) in comparison with the non-COVID-19 period (1.7 × 1,000 UC days) (RR 1.46; 1.12-1.80). However, in the maternity ward, the result was 0 and 2.5 × 1,000 UC days during these periods, respectively. No differences were observed in the infection rate among periods for all patients (RR 1.06; 0.81-1.31). Multidrug-resistant organisms were identified in 7 patients, and non-multidrug-resistant in 6 cases. CONCLUSION: The study findings describe a lower CAUTI risk over 9 years in non-critical acute care patients. The impact of COVID-19 on the CAUTI risk is mainly related to medical patients who had previously been admitted to critical care. The infection control program should consider these data as a benchmark for quality improvement.

Short-term catheter management options for urinary retention following pelvic surgery: a cost analysis.

BACKGROUND: Several studies have compared short-term catheterization approaches and have demonstrated no difference in patient satisfaction, but no study has evaluated their costs. OBJECTIVE: To evaluate the costs of 3 pathways for short-term catheter management in patients diagnosed with urinary retention following pelvic surgery. STUDY DESIGN: We utilized a Markov decision tree to model costs from the society's perspective. In pathway 1, patients have an indwelling catheter and return to the office for a voiding trial. In pathway 2, patients have an indwelling catheter and discontinue the catheters at home. In pathway 3, patients are taught clean intermittent catheterization postoperatively. We accounted for office visits, emergency department visits, urinary tract infection testing and treatment, transportation, caregiver time, teaching time, and supplies. RESULTS: Clean intermittent catheterization is the least costly catheterization method at $79 per patient, followed by self-removal of the catheter ($128) and office voiding trial ($185). One-way sensitivity analyses showed that the distance between the patient and office and the rates of spontaneous voiding following catheterization had the greatest impact. When patients need to travel >5 miles to the office for catheter removal, self-removal of a catheter is less costly than an office voiding trial. Once it has been determined that patients have urinary retention and require catheterization, clean intermittent catheterization is the most cost-saving option only if the patients are taught clean intermittent catheterization postoperatively. If all patients were to be taught clean intermittent catheterization routinely before surgery, it becomes the most costly option. Based on annual surgical volume, if even $30 were saved per patient with postoperative urinary retention, the estimated total societal savings would be $420,000 to $7.2 million. CONCLUSION: Clean intermittent catheterization as initial management of urinary retention following pelvic surgery is the most cost-saving option when it is only taught postoperatively to patients after determining the need for catheterization. When this is not possible, self-removal of an indwelling catheter is the most cost-saving option, especially as the distance between the patient and provider increases. Choosing the optimal management guided by patient and provider factors can lead to substantial cost savings annually in the United States.

Acute urinary retention rates following early removal or no placement in colon and rectal surgery: a single-center analysis.

BACKGROUND: The adequate duration of urinary drainage following colorectal surgery remains debated. The purpose of this study was to compare acute urinary retention (AUR) rates among various durations of urinary catheterization following colon and rectal surgery. METHODS: We conducted a retrospective analysis of patients undergoing elective colorectal resection enrolled in the Enhanced Recovery After Surgery (ERAS) protocol from 2018 to 2019. Patients were placed into four groups: no catheter placement (NC), catheter removed immediately after surgery (CRAS), removal less than 24 h (CR < 24), and removal greater than 24 h (CR > 24). Our primary endpoint was the rate of AUR in each group. Secondary endpoints included hospital length of stay and urinary tract infections (UTI). A multivariate logistic regression analysis was done to predict AUR. RESULTS: A total 641 patients were included in this study. 27 patients (4.2%) had NC with an AUR rate of 3.7%. 249 patients (38.8%) had CRAS with an AUR rate of 6.8%. 214 patients (33.4%) had CR < 24 with an AUR rate of 4.2%. 151 patients (23.6%) had CR > 24 with an AUR rate of 2.6%. There was no significant difference in AUR among the groups (p = 0.264). In our multivariant logistic regression, pelvic surgery was an independent risk factor for AUR (p = 0.008). There was a statistically significant higher hospital length of stay (p = 0.001) and rate of UTIs (p = 0.017) in patients with prolonged catheterization. CONCLUSION: Deferral or early removal of urinary catheters is safe and feasible following colorectal surgery without a significant increase in AUR. Avoiding prolonged indwelling urinary catheterization may decrease associated complications such as UTI and hospital length of stay.

Systematic review and meta-analysis of early removal of urinary catheter after colorectal surgery with infraperitoneal anastomosis.

AIM OF THE STUDY: To review and to analyse the feasibility of using no urinary catheter or a catheter for less than 24 h compared with longer post-operative catheter after colorectal surgery with infraperitoneal dissection. METHODS: We performed a systematic review and meta-analysis of studies comparing no urinary catheter or a catheter for less than 24 h (early removal, ER) and urinary catheter drainage for 2 days or longer (late removal, LR) after colorectal surgery with infraperitoneal dissection. Primary endpoint was acute urinary retention (AUR) requiring a re-catheterization. Secondary endpoints were urinary tract infection (UTI), overall morbidity and hospital length of stay. Meta-analysis met the PRISMA criteria, with a random model. RESULTS: Out of 3659 articles found, 82 comparative studies on catheter duration were selected, of which five were in colorectal surgery: three randomized trials, one retrospective and one prospective series. There were 396 ER and 410 LR patients. All had undergone surgery with infraperitoneal dissection. There was no significant difference regarding AUR (OR = 2.09 [95%CI 0.97-4.52]) but significantly less UTI (OR = 0.39 [95%CI 0.22-0.67]) for early urinary catheter removal. The number needed to harm was much higher for AUR than for UTI (23.3 vs. 8). CONCLUSION: This meta-analysis suggests that, in terms of benefit/risk ratio, in colorectal surgery with infraperitoneal anastomosis, early removal (< 24 h) of the urinary catheter would be beneficial (because of a more frequent UTI after LR than AUR after ER) and would reduce the occurrence of UTI if no AUR risk factors are present. However, these findings should be interpreted with caution because of the low quality of evidence.

Active versus Passive Voiding Protocols after Same-day Minimally Invasive Hysterectomy.

STUDY OBJECTIVE: To determine the proportion of patients discharged with a urinary catheter after a same-day benign gynecologic minimally invasive hysterectomy (MIH) according to active vs passive voiding protocols. The secondary objectives included assessing postanesthesia care unit (PACU) duration and postoperative urinary retention (POUR) rate ≤2 weeks of discharge. DESIGN: Retrospective, observational cohort study. SETTING: Large integrated healthcare system serving approximately 40% of the Northern California population. PATIENTS: Patients aged 18 years or older undergoing same-day MIH without urogynecology procedures from 2015 to 2018 were categorized into active or passive voiding trial groups. Active voiding trials were defined as patients arriving in the PACU with a catheter, retrograde filling of the bladder with 300 mL saline then allowing for voiding ≥50% within 30 minutes. If the patients were unable to void this volume, they were discharged with a catheter to be removed within 24 hours. A passive voiding trial involved filling or not filling the bladder before PACU arrival without a catheter, then allowing for voiding or performing a straight catheterization if the patients were unable to void. INTERVENTIONS: Retrospective cohort study. MEASUREMENTS AND MAIN RESULTS: A total of 1644 (83.2%) patients underwent passive voiding trials, and 333 (16.8%) underwent active voiding trials. The proportion of patients discharged with a catheter was lower in the passive voiding group than in the active voiding group (5.4% vs 10.5%; p = .001). The passive group had a shorter mean PACU time than the active group (218 ± 86 vs 240 ± 93 minutes; p <.001). The crude POUR rates for the passive and active voiding groups were 1.8% and 3.0%, respectively (p = .16). CONCLUSION: Within an integrated healthcare system, patients who underwent passive voiding trials compared with those who underwent active voiding trials were discharged home from the PACU after a shorter duration. In addition, a larger proportion of the patients who underwent passive voiding trials were discharged home without a urinary catheter. There were no differences in the POUR rates. Our findings suggest that passive voiding trials can be safely used after a benign MIH to reduce hospital duration, optimize healthcare resources, and improve patient experience.

A Novel Balloon Catheter-based Dilation Intervention for Patients with Cricopharyngeus Achalasia After Stroke: A Randomized Study.

This study aimed to investigate the efficacy and safety of a novel balloon catheter in dilation intervention for patients with cricopharyngeus achalasia after stroke. Thirty-four patients with cricopharyngeus achalasia after stroke received routine swallowing rehabilitation training and were randomly assigned to an experimental group (Exp, n = 17) that received dilation therapy using the novel balloon catheter once daily for 5 days per week or a control group (Con, n = 17) that received dilation therapy with a 14-Fr ordinary urinary catheter once daily for 5 days per week. The intervention duration, Eating Assessment Tool (EAT)-10 scores, and Functional Oral Intake Scale (FOIS) scores were recorded at baseline and each day during intervention. The time for a patient's FOIS score to be ≥ 3 as well as the recovery time for oral intake of water, liquid food, mushy food, and solid food were recorded or estimated. Complications were also recorded during intervention. The intervention duration was shorter in the Exp group than in the Con group (p = 0.005). The Exp group patients improved faster than the Con group patients, with a shorter recovery time for oral intake of liquid food (p = 0.002), mushy food (p = 0.001), and solid food (p = 0.001). At the time of intervention termination, EAT-10 scores were lower in the Exp group than in the Con group (p = 0.005). The Exp group had a similar incidence of complications as the Con group but with better tolerability (p = 0.028). Compared with the urinary catheter, the novel balloon catheter for dilation in patients with cricopharyngeus achalasia after stroke may lead to a better and more rapid recovery.

[Factors Associated With Catheter-Associated Urinary Tract Infection in Patients in the Intensive Care Unit].

BACKGROUND: Catheter-associated urinary tract infection (CAUTI) commonly occurs in intensive care units (ICU) and is associated with longer hospital stays and higher healthcare costs, morbidity, and mortality. PURPOSE: The purpose of this study was to examine the factors associated with CAUTI in ICU patients. METHODS: This study was a secondary analysis of data from a study on the usage of indwelling catheters in adult internal and surgical ICU patients at a teaching hospital in southern Taiwan conducted between January 1 and December 31, 2017. Descriptive analysis, the independent t test, chi-square test, and logistic regression were used to examine the factors associated with CAUTI. RESULTS: Of the 1,120 patients with an indwelling urinary catheter in the ICU, 330 revealed a positive urine culture result, indicating a 29.5% prevalence of CAUTI. The average duration of indwelling urinary catheter usage was 6.55 (SD = 4.89) days. The participants averaged 69.93 years old (SD = 15.19 years), and 627 (56.0%) were men and 493 (44.0%) were women. Being female, having diabetes, having a large indwelling urinary catheter, having a longer duration of indwelling urinary catheter usage, and being unable to remove the indwelling urinary catheter during the ICU stay were found to be associated with a significantly higher risk of CAUTI. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Women and patients with diabetes are particularly vulnerable to CAUTI. Thus, urinary catheters should be used with caution. Using smaller-sized urinary catheters and reducing the duration of urinary catheter use are suggested. The results of this study may be used to guide clinical practice to help reduce the incidence of CAUTI and enhance overall healthcare service quality.