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Restriction of long-term indwelling urethral catheterisation in the elderly
Insights
Indwelling urethral catheters in chronic care patients are often unnecessary and contribute to high rates of multiresistant bacteriuria. Restricting catheter use in hospitals could improve patient outcomes and reduce antimicrobial resistance.
Area of Science:
- Gerontology
- Infectious Diseases
- Urology
Background:
- Indwelling urethral catheters are frequently used in healthcare settings.
- Catheter use is associated with significant risks, including infection and antimicrobial resistance.
Purpose of the Study:
- To evaluate the incidence and impact of indwelling urethral catheter use in a chronic care center.
- To assess the prevalence of bacteriuria and antimicrobial resistance in catheterized patients.
Main Methods:
- Retrospective analysis of 543 patients admitted to a chronic care center.
- Data collection on catheterization status, insertion location, duration, and reasons for change.
- Microbiological analysis of urine samples to determine bacteriuria and antimicrobial resistance patterns.
Main Results:
- 16% of patients had an indwelling catheter, with over half inserted in general hospitals.
- 90% of catheterized patients developed bacteriuria, with 37% involving multiresistant bacteria.
- Catheterized patients received a disproportionate share of antimicrobial drugs, though 65% did not require treatment.
Conclusions:
- A more restricted use of indwelling catheters in hospitals is feasible.
- Catheter use significantly increases the risk of bacteriuria and multiresistant infections.
- Judicious catheter management is crucial to combat antimicrobial resistance in chronic care settings.
Abstract:
Eighty-nine (16%) of 543 patients admitted to a chronic care centre in 1983 had an indwelling urethral catheter. Of the 89, 51 patients (57%) received the catheter in a general hospital, 4 (5%) at home and 34 (38%) in the centre. More than half of the catheters that were inserted in the hospital could be removed within 4 weeks of admission to the centre, implying that a more restricted use of indwelling catheters in hospitals is possible. Only 18% of the indwelling catheters remained in situ for the designated period of 1 month. The other catheters were changed before that time, mainly because of obstructed drainage or leakage of urine around the catheter. The incidence of bacteriuria among catheterised patients was 90%. The bacteria were multiresistant in 37% of these cases, compared with 25% of non-catheterised patients. Multiresistant microflora were present significantly more often in the urine of patients admitted from hospitals (irrespective of whether they had a catheter) and the catheterised residents of the centre than in that of the other patients (P less than 0.001). When all patients of the centre were considered, it was found that 30.6% were treated with antimicrobial agents in the course of the year; 10.9% were treated more than once a year. This latter group of patients received 58% of all prescribed antimicrobial drugs; 37% of them had an indwelling catheter. The majority of catheterised patients (65%) did not need antimicrobial treatment. No significant influence of catheterisation on mortality could be demonstrated.