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An In Vitro Bladder Model of Catheter-Associated Urinary Tract Infection
Published on: June 24, 2025
The effect of urinary bladder catheterization on patient care in an internal medicine department
Zvi Shimoni1, Michael Mullerad, Mark Niven
1Internal Medicine B, Laniado Hospital, Netanya, Israel.
Insights
Urinary catheterization in hospitalized patients is often inappropriate or lacks clear benefit. Over half of procedures had uncertain clinical advantages, highlighting risks versus benefits.
Area of Science:
- Internal Medicine
- Urology
- Patient Safety
Background:
- Inconsistent recommendations exist for urinary catheterization in new hospital admissions.
- The necessity and benefit of urinary catheterization require further clarification.
Purpose of the Study:
- To evaluate the appropriateness and clinical benefit of urinary catheterization in newly hospitalized patients.
- To identify instances of inappropriate catheterization and assess associated patient outcomes.
Main Methods:
- Prospective study of consecutive patients undergoing urinary catheterization in an internal medicine department.
- Chart review to assess catheterization indication against accepted criteria and demonstrable patient care effect.
- Follow-up for 6 months or until catheter removal.
Main Results:
- 17.7% of patients were catheterized; 14.7% of these had definite inappropriate catheterization.
- 56.6% had unclear clinical benefits, including those with fever, heart failure, stroke, or respiratory insufficiency.
- Catheter removal failed in 13 patients, with 4 experiencing permanent catheterization and 1 developing urosepsis.
Conclusions:
- Over 50% of catheterized patients had acceptable indications but no demonstrable benefit.
- Potential complications of urinary catheterization must be weighed against uncertain benefits.
- Further research is needed to determine the impact of acute urinary catheterization on patient care.
Introduction:
Recommendations for urinary catheterization in newly hospitalized patients are inconsistent and unclear.
Methods:
The authors studied prospectively consecutive patients who were catheterized in an internal medicine department over a 3-month period, with follow-up for 6 months or until the catheter was removed. Patient records were reviewed to determine if catheterization was definitely not indicated by commonly accepted criteria. After chart review, a category of possibly not indicated was defined as having no demonstrable effect on patient care.
Results:
There were 17.7% patients (122/691) catheterized during their admission. According to accepted criteria, definite inappropriate catheterization occurred in 18 patients (14.7%). There were an additional 69 patients (56.6%) with unclear clinical benefits, hospitalized because of fever, acute congestive heart failure, a cerebral vascular accident or respiratory insufficiency due to exacerbation of chronic obstructive lung disease. During hospitalization, attempts to remove the catheter failed in 13 patients, 4 of who remained with the catheter permanently, complicated by urosepsis in 1 patient.
Conclusion:
Over 50% of the patients had acceptable indications for catheterization but no demonstrable benefit from the procedure. In such patients, the uncertain benefits of catheterization should be balanced by potential complications. Additional studies are warranted to determine the effect of acute urinary catheterization on patient care.
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