Drainage Method and UTI 

UTI and Urinary Catheter

  • SCI is a long-term disease. Voiding dysfunction almost universally accompanies SCI/D, and thus at sometime catheter drainage is required.
  • Artificial drainage including catheter usage is associated with bacteriuria [National Institute on Disability and Rehabilitation Research Consensus Statement. 1992] are:
    • Indwelling catheterization, including suprapubic, condom catheters and intermittent catheterization, is associated with bacterial colonization of the urinary tract.
    • Urinary diversion is as well.
  • There are more than 1 million urinary catheter-associated UTIs a year in the United States [Stamm 1991]
    • Catheter-associated bacteriuria remains the most common source of gram-negative bacteremia in hospitalized patients [Kreger 1980].
    • Method of bladder management remains the most influential factor in reducing the risk of UTI in persons with SCI. [Trautner 2002]
    • There is no doubt that the greatest risk for complicated UTI in these individuals is the use of an indwelling catheter. Intermittent catheterization during the rehabilitation phase has been shown to lower the rate of UTI [Biering-Sorensen 2001]

    Pathophysiologic Mechanism of Catheter-related UTI

    • Catheter serves a conduit or pathway for introducing bacteria.
    • Outer or luminal surfaces of the catheter serve a niche for the bacteria (biofilm).
    • Catheter causes foreign body reaction and resultant leukocyte inflammatory reaction.
    • Urea splitting organism form stones and the bacteria form part of the matrix.
    • For more information, please refer to this

    Catheter indwelling and UTI

    • 900,000 episodes catheter related bacteriuria in the US, making this the most common of all hospital acquired infections [Haley 1985]
    • Three fold increase in mortality in catheterized patients with bacteriuria and nearly 50% of those who died had features of serious infections [Platt 1982]
    • Chronic indwelling bladder catheters usage is highly prevalent in patients with serious urinary infections
    • Urea-splitting organisms form stones associated with bacteremic episodes. [Wall 2003]
    • Bacteriuria is unavoidable regardless of the bladder drainage methods as long as the catheter is introduced (intermittent catheterization or chronic indwelling) [Warren 1997].
    • Most urethral complications are the result of pressure necrosis and chronic infection.
    • For more information, please refer to this

    CIC and UTI

    [National Institute on Disability and Rehabilitation Research Consensus Statement, 1992]

    • Infection risk is reduced with intermittent catheterization, but more severely disabled people who require catheterization by others are at greater risk for UTIs.
    • If CIC is used to empty the neurogenic bladder, better pregnancy rates have been found than with indwelling catheterization [Ohl 1992; Rutkowski 1995].
    • Self CIC does not pose a greater risk of infection than sterile self-intermittent catheterization and is much more economic.
    • However, care must be given to proper cleansing of reusable catheters
    • Most of the urethral complication is the results caused by bacteriuria
    • Also refer to the other chapters
    Key Points of This Section
    • Catheter use, diversion urinary diversion and condom catheter methods are all associated with bacterial colonization. Frank urosepsis is common in hospitalized patients treated with catheters, but less common in patients with spinal cord injury. Still the mortality from urosepsis in SCI patients is 50X the expected rate in aged matched normal persons.
    • The risk of urosepsis is higher with indwelling catheters and lowest in patients treated by CIC and bladder pressure control.

    References

    • Biering-Sorensen F, Bagi P, Hoiby N. Urinary tract infections in patients with spinal cord lesions: treatment and prevention. Drugs. 2001;61(9):1275-87.
    • Haley RW, Culver DH, White JW, Morgan WM, Emori TG. The nationwide nosocomial infection rate. A new need for vital statistics. Am J Epidemiol. 1985 Feb;121(2):159-67.
    • Kreger BE, Craven DE, Carling PC, McCabe WR. Gram-negative bacteremia. III. Reassessment of etiology, epidemiology and ecology in 612 patients. Am J Med. 1980 Mar;68(3):332-43.
    • Ohl DA, Denil J, Fitzgerald-Shelton K, McCabe M, McGuire EJ, Menge AC, Randolph JF. Fertility of spinal cord injured males: effect of genitourinary infection and bladder management on results of electroejaculation. J Am Paraplegia Soc. 1992 Apr;15(2):53-9.
    • Platt R, Polk BF, Murdock B, Rosner B. Mortality associated with nosocomial urinary-tract infection. N Engl J Med. 1982 Sep 9;307(11):637-42.
    • Rutkowski SB, Middleton JW, Truman G, Hagen DL, Ryan JP. The influence of bladder management on fertility in spinal cord injured males. Paraplegia. 1995 May;33(5):263-6.
    • Stamm WE. Catheter-associated urinary tract infections: epidemiology, pathogenesis, and prevention. Am J Med. 1991 Sep 16;91(3B):65S-71S.
    • The prevention and management of urinary tract infections among people with spinal cord injuries. National Institute on Disability and Rehabilitation Research Consensus Statement. January 27-29, 1992, J Am Paraplegia Soc. 1992 Jul;15(3):194-204.
    • Trautner BW, Darouiche RO. Prevention of urinary tract infection in patients with spinal cord injury. J Spinal Cord Med. 2002 Winter;25(4):277-83.
    • Wall BM, Mangold T, Huch KM, Corbett C, Cooke CR. Bacteremia in the chronic spinal cord injury population: risk factors for mortality. J Spinal Cord Med. 2003 Fall;26(3):248-53.
    • Warren JW. Catheter-associated urinary tract infections. Infect Dis Clin North Am. 1997 Sep;11(3):609-22.
    • Trautner BW, Darouiche RO. Prevention of urinary tract infection in patients with spinal cord injury. J Spinal Cord Med. 2002 Winter;25(4):277-83.
    • Wall BM, Mangold T, Huch KM, Corbett C, Cooke CR. Bacteremia in the chronic spinal cord injury population: risk factors for mortality. J Spinal Cord Med. 2003 Fall;26(3):248-53.
    • Warren JW. Catheter-associated urinary tract infections. Infect Dis Clin North Am. 1997 Sep;11(3):609-22.

    ©2007 University of Michigan - UTI

    Home Link to UMHS