A Multicenter Study of Patient-Reported Infectious and Noninfectious Complications Associated With Indwelling Urethral Catheters

Sanjay Saint, Barbara W Trautner, Karen E Fowler, John Colozzi, David Ratz, Erica Lescinskas, John M Hollingsworth, Sarah L Krein, Sanjay Saint, Barbara W Trautner, Karen E Fowler, John Colozzi, David Ratz, Erica Lescinskas, John M Hollingsworth, Sarah L Krein

Abstract

Importance: Indwelling urethral catheters (ie, Foley catheters) are important in caring for certain hospitalized patients but can also cause complications in patients.

Objective: To determine the incidence of infectious and noninfectious patient-reported complications associated with the indwelling urethral catheter.

Design, setting, and participants: A prospective cohort study of consecutive patients with placement of a new indwelling urethral catheter while hospitalized at 1 of 4 US hospitals in 2 states. The study was conducted from August 26, 2015, to August 18, 2017. Participants were evaluated at baseline and contacted at 14 days and 30 days after insertion of the catheter about complications associated with the indwelling urethral catheter and how catheterization affected their social activities or activities of daily living.

Exposures: Indwelling urethral catheter placement during hospitalization. Patients were enrolled within 3 days of catheter insertion and followed up for 30 days after catheter placement, whether the catheter remained in or was removed from the patient.

Main outcomes and measures: Infectious and noninfectious complications associated with an indwelling urethral catheter as well as how the catheter affected patient social activities or activities of daily living.

Results: Of 2967 eligible patients, 2227 (75.1%) agreed to participate at 1 of 4 study sites; 2076 total patients were evaluated. Of these, 71.4% were male; mean (SD) age was 60.8 (13.4) years. Most patients (1653 of 2076 [79.6%]) had short-term catheters placed for surgical procedures. During the 30 days after urethral catheter insertion, 1184 of 2076 patients (57.0%; 95% CI, 54.9%-59.2%) reported at least 1 complication due to the indwelling urethral catheter. Infectious complications were reported by 219 of 2076 patients (10.5%; 95% CI, 9.3%-12.0%), whereas noninfectious complications (eg, pain or discomfort, blood in the urine, or sense of urinary urgency) occurred in 1150 patients (55.4%; 95% CI, 53.2%-57.6%) (P < .001). Women were more likely to report an infectious complication (92 of 594 [15.5%] women vs 127 of 1482 [8.6%] men; P < .001), while men were more likely to report a noninfectious complication (869 of 1482 [58.6%] men vs 281 of 594 [47.3%] women; P < .001). Restrictions in activities of daily living (49 of 124 patients [39.5%]) or social activity (54 of 124 [43.9%]) were commonly reported by the patients who had catheters still in place; sexual problems were reported by 99 of 2034 patients (4.9%) after their catheter was removed.

Conclusions and relevance: Noninfectious complications of urethral catheters affect a substantial number of patients, underscoring the importance of avoiding urethral catheterization whenever possible. Given the high incidence of these patient-reported complications, urethral catheter-associated noninfectious complications should be a focus of surveillance and prevention efforts.

Conflict of interest statement

Conflict of Interest Disclosures: Dr Saint reported serving on the medical advisory board for Doximity (a social networking site for physicians), and on the scientific advisory board of Jvion, a health care technology company. No other disclosures were reported.

Figures

Figure 1.. Patient Flowchart of Study Enrollment…
Figure 1.. Patient Flowchart of Study Enrollment and Follow-up
Of the 2967 patients who met eligibility criteria, 2227 (75.1%) agreed to participate. The 4 participating study sites were the University of Michigan Medical Center and Veterans Affairs Ann Arbor Healthcare System, both in Ann Arbor, Michigan, and Ben Taub Hospital and the Michael E. DeBakey Veterans Affairs Medical Center, both in Houston, Texas.
Figure 2.. Percentage of 2076 Patients Reporting…
Figure 2.. Percentage of 2076 Patients Reporting Infectious or Noninfectious Complications During the Month After Urethral Catheter Insertion
Statistically significant differences by sex were found in both infectious and noninfectious patient-reported complications (P < .001).

References

    1. Elder M. US catheter market In: Global Markets for Catheters. Wellesley, MA: BCC Research; 2016:91-96.
    1. Saint S. Clinical and economic consequences of nosocomial catheter-related bacteriuria. Am J Infect Control. 2000;28(1):68-75. doi:10.1016/S0196-6553(00)90015-4
    1. Magill SS, Edwards JR, Bamberg W, et al. ; Emerging Infections Program Healthcare-Associated Infections and Antimicrobial Use Prevalence Survey Team . Multistate point-prevalence survey of health care–associated infections. N Engl J Med. 2014;370(13):1198-1208. doi:10.1056/NEJMoa1306801
    1. Meddings J, Saint S, Fowler KE, et al. . The Ann Arbor Criteria for appropriate urinary catheter use in hospitalized medical patients: results obtained by using the RAND/UCLA appropriateness method. Ann Intern Med. 2015;162(9)(suppl):S1-S34. doi:10.7326/M14-1304
    1. World Health Organization Report on the Burden of Endemic Health Care–Associated Infection Worldwide: A Systematic Review of the Literature. Geneva, Switzerland: World Health Organization; 2011.
    1. Fakih MG, Gould CV, Trautner BW, et al. . Beyond infection: device utilization ratio as a performance measure for urinary catheter harm. Infect Control Hosp Epidemiol. 2016;37(3):327-333. doi:10.1017/ice.2015.287
    1. Leuck AM, Wright D, Ellingson L, Kraemer L, Kuskowski MA, Johnson JR. Complications of Foley catheters—is infection the greatest risk? J Urol. 2012;187(5):1662-1666. doi:10.1016/j.juro.2011.12.113
    1. Aaronson DS, Wu AK, Blaschko SD, McAninch JW, Garcia M. National incidence and impact of noninfectious urethral catheter related complications on the Surgical Care Improvement Project. J Urol. 2011;185(5):1756-1760. doi:10.1016/j.juro.2010.12.041
    1. Hollingsworth JM, Rogers MA, Krein SL, et al. . Determining the noninfectious complications of indwelling urethral catheters: a systematic review and meta-analysis. Ann Intern Med. 2013;159(6):401-410. doi:10.7326/0003-4819-159-6-201309170-00006
    1. Kashefi C, Messer K, Barden R, Sexton C, Parsons JK. Incidence and prevention of iatrogenic urethral injuries. J Urol. 2008;179(6):2254-2257. doi:10.1016/j.juro.2008.01.108
    1. Thomas AZ, Giri SK, Meagher D, Creagh T. Avoidable iatrogenic complications of urethral catheterization and inadequate intern training in a tertiary-care teaching hospital. BJU Int. 2009;104(8):1109-1112. doi:10.1111/j.1464-410X.2009.08494.x
    1. Zhu J, Stuver SO, Epstein AM, Schneider EC, Weissman JS, Weingart SN. Can we rely on patients’ reports of adverse events? Med Care. 2011;49(10):948-955. doi:10.1097/MLR.0b013e31822047a8
    1. Barry MJ, Fowler FJ Jr, O’Leary MP, et al. ; Measurement Committee of the American Urological Association . The American Urological Association symptom index for benign prostatic hyperplasia. J Urol. 1992;148(5):1549-1557. doi:10.1016/S0022-5347(17)36966-5
    1. Zou G. A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159(7):702-706. doi:10.1093/aje/kwh090
    1. Awad MA, Osterberg EC, Chang H, et al. . Urethral catheters and medical malpractice: a legal database review from 1965 to 2015. Transl Androl Urol. 2016;5(5):762-773. doi:10.21037/tau.2016.08.02
    1. Davis NF, Quinlan MR, Bhatt NR, et al. . Incidence, cost, complications and clinical outcomes of iatrogenic urethral catheterization injuries: a prospective multi-institutional study. J Urol. 2016;196(5):1473-1477. doi:10.1016/j.juro.2016.05.114
    1. Maki DG, Tambyah PA. Engineering out the risk for infection with urinary catheters. Emerg Infect Dis. 2001;7(2):342-347. doi:10.3201/eid0702.010240
    1. Saint S, Greene MT, Krein SL, et al. . A program to prevent catheter-associated urinary tract infection in acute care. N Engl J Med. 2016;374(22):2111-2119. doi:10.1056/NEJMoa1504906
    1. Saint S, Fowler KE, Sermak K, et al. . Introducing the No Preventable Harms Campaign: creating the safest health care system in the world, starting with catheter-associated urinary tract infection prevention. Am J Infect Control. 2015;43(3):254-259. doi:10.1016/j.ajic.2014.11.016
    1. Meddings J, Rogers MA, Krein SL, Fakih MG, Olmsted RN, Saint S. Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review. BMJ Qual Saf. 2014;23(4):277-289. doi:10.1136/bmjqs-2012-001774
    1. Saint S, Lipsky BA, Goold SD. Indwelling urinary catheters: a one-point restraint? Ann Intern Med. 2002;137(2):125-127. doi:10.7326/0003-4819-137-2-200207160-00012
    1. Meddings JA, Reichert H, Rogers MA, Saint S, Stephansky J, McMahon LF. Effect of nonpayment for hospital-acquired, catheter-associated urinary tract infection: a statewide analysis. Ann Intern Med. 2012;157(5):305-312. doi:10.7326/0003-4819-157-5-201209040-00003

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