Association between indwelling urinary catheters and the poor prognosis among elderly patients with pulmonary...

With the rapid aging of society, the number of elderly patients with pulmonary infection (PI) is increasing significantly. Indwelling urinary catheters (IUC) are commonly used in elderly patients and appear to be associated with poor prognosis in this population; however, supporting evidence remains insufficient. Therefore, this study aimed to clarify the association between IUC and 30-day mortality in elderly patients with PI.

This retrospective study was conducted at one of the largest tertiary general hospitals in China. We enrolled all elderly patients with PI who did or did not undergo IUC, and statistically analyzed the association mentioned above.

By retrospectively searching the hospital's patient medical database, a total of 700 patients (aged ≥65 years) with PI were screened from January 1, 2018, to December 31, 2023, with an overall 30-day mortality of 17.3% (121/700). Among these patients, 295 (42.1%, 295/700) had an IUC within 72 hours of admission. Compared with patients without IUC, patients with IUC had a higher proportion of urinary tract infection (18.9% vs. 9.7%), female gender (35.3% vs. 25.2%), CURB-65 score ≥2 (73.7% vs. 37.2%), residence in the respiratory intensive care unit (RICU admission) (49.2% vs. 21.7%), and 30-day mortality (28.1% vs. 9.4%). Kaplan-Meier (KM) survival curves demonstrated that IUC, rather than urinary tract infection, was significantly associated with 30-day mortality (P<0.001). Cox multivariate regression analysis revealed that IUC was an independent risk factor for 30-day mortality compared with urinary tract infection (hazard ratio [HR]=2.8, 95% confidence interval [CI] 1.9-4.2, P<0.001)). However, after adjusting for four confounding factors (urinary tract infection, CURB-65 score ≥2, RICU admission, female gender and mechanical ventilation), IUC was no longer an independent risk factor, though it still increased the 30-day mortality by 30% (HR = 1.3, 95% CI: 0.8-2.0, P = 0.246).

Indwelling urinary catheterization, rather than urinary tract infection, was associated with 30-day mortality in elderly patients with pulmonary infection. Indwelling urinary catheter is a double-edged sword: while it is an important medical tool, it is by no means harmless. The principle of "an unnecessary urinary catheter is also harmful" should be strictly incorporated into clinical guidelines for indwelling urinary catheters.