UTI's in Spinal-Cord-Injury Patients with Indwelling Catheters
UTI's in Spinal-Cord-Injury Patients with Indwelling Catheters
Purpose: The effect of replacing the indwelling catheter of patients suspected of having a urinary tract infection (UTI) before collecting a urine sample on the number of organisms isolated in cultures and on drug and microbiology laboratory costs was studied.
Methods: Data were collected for all patients hospitalized in two spinal cord injury (SCI) units between October 2001 and March 2002 who had an indwelling catheter or suprapubic catheter and were suspected of having a UTI. Urine samples were obtained through a port of the indwelling catheter in one SCI unit, while the indwelling catheter was replaced immediately before each urine sample was obtained in the second SCI unit. Patient demographics, history of antimicrobial use, bacterial isolate sensitivity data, and current antimicrobial treatment were recorded.
Results: A total of 85 patients, 41 in the control group and 44 in the intervention group, were enrolled during the six-month study period. In the control and intervention groups, 93 and 79 organisms were isolated, respectively, with an average of 2 isolates per patient in the control group and 1 per patient in the intervention group. Patients in the control group had significantly more multidrug-resistant organisms in their urine, with 34 isolated from 26 patients (63%) ( p < 0.001). Changing the indwelling catheter decreased antimicrobial and microbiology laboratory costs, resulting in a cost saving of $15.64 per patient.
Conclusion: Replacement of the indwelling catheter before collecting a urine sample for culture and conducting susceptibility testing reduced the pathogens identified, the number of toxic antimicrobials prescribed to treat the infection, and the costs of antimicrobials and microbiology laboratory technician time.
Patients with spinal cord injury (SCI) and a neurogenic bladder who use a chronic indwelling urinary catheter are at risk for developing urinary tract infections (UTIs), which may involve multiple organisms. Of patients with long-term indwelling catheters, approximately 85% will have significant bacteriuria at any given time. Bacteria can enter the bladder either through the lumen of the catheter or by migration along the external surface of the catheter. The inner surface of chronic indwelling catheters becomes coated with bacteria, commonly referred to as a biofilm. When a culture is taken directly from the urinary catheter, the microorganisms colonizing the biofilm are found, but the pathogens causing the infection are difficult to identify. One method of preventing the formation of a biofilm is catheter replacement. Clinical trials have shown that replacing the catheter in patients living in nursing homes eliminates the biofilm, increases the diffusion of antimicrobial therapy to the pathogenic site, and yields a more valid urine culture.
At our institution, urine samples from SCI patients suspected of having a UTI are routinely obtained through the port of the indwelling catheter. Microbiology laboratory technicians isolate and identify multiple significant organisms (≥10 colony-forming units [CFUs]) from these specimens, which has increased the workload of the microbiology laboratory. As all of the isolates are thought to be the etiologic organisms of the infection, multiple antimicrobials are prescribed.
The purpose of this study was to assess the effect of a new procedure for collecting urine samples. The effect of indwelling catheter replacement before obtaining a urine specimen for bacterial culture, as recommended by the Society for Healthcare Epidemiology of America (SHEA), was compared with the previous practice of obtaining a urine culture through the catheter port. We expected the change in the collection method to decrease the number of organisms identified and allow more precise prescribing of antimicrobial therapy, as well as savings from decreased drug costs and time required of microbiology laboratory technicians.
Purpose: The effect of replacing the indwelling catheter of patients suspected of having a urinary tract infection (UTI) before collecting a urine sample on the number of organisms isolated in cultures and on drug and microbiology laboratory costs was studied.
Methods: Data were collected for all patients hospitalized in two spinal cord injury (SCI) units between October 2001 and March 2002 who had an indwelling catheter or suprapubic catheter and were suspected of having a UTI. Urine samples were obtained through a port of the indwelling catheter in one SCI unit, while the indwelling catheter was replaced immediately before each urine sample was obtained in the second SCI unit. Patient demographics, history of antimicrobial use, bacterial isolate sensitivity data, and current antimicrobial treatment were recorded.
Results: A total of 85 patients, 41 in the control group and 44 in the intervention group, were enrolled during the six-month study period. In the control and intervention groups, 93 and 79 organisms were isolated, respectively, with an average of 2 isolates per patient in the control group and 1 per patient in the intervention group. Patients in the control group had significantly more multidrug-resistant organisms in their urine, with 34 isolated from 26 patients (63%) ( p < 0.001). Changing the indwelling catheter decreased antimicrobial and microbiology laboratory costs, resulting in a cost saving of $15.64 per patient.
Conclusion: Replacement of the indwelling catheter before collecting a urine sample for culture and conducting susceptibility testing reduced the pathogens identified, the number of toxic antimicrobials prescribed to treat the infection, and the costs of antimicrobials and microbiology laboratory technician time.
Patients with spinal cord injury (SCI) and a neurogenic bladder who use a chronic indwelling urinary catheter are at risk for developing urinary tract infections (UTIs), which may involve multiple organisms. Of patients with long-term indwelling catheters, approximately 85% will have significant bacteriuria at any given time. Bacteria can enter the bladder either through the lumen of the catheter or by migration along the external surface of the catheter. The inner surface of chronic indwelling catheters becomes coated with bacteria, commonly referred to as a biofilm. When a culture is taken directly from the urinary catheter, the microorganisms colonizing the biofilm are found, but the pathogens causing the infection are difficult to identify. One method of preventing the formation of a biofilm is catheter replacement. Clinical trials have shown that replacing the catheter in patients living in nursing homes eliminates the biofilm, increases the diffusion of antimicrobial therapy to the pathogenic site, and yields a more valid urine culture.
At our institution, urine samples from SCI patients suspected of having a UTI are routinely obtained through the port of the indwelling catheter. Microbiology laboratory technicians isolate and identify multiple significant organisms (≥10 colony-forming units [CFUs]) from these specimens, which has increased the workload of the microbiology laboratory. As all of the isolates are thought to be the etiologic organisms of the infection, multiple antimicrobials are prescribed.
The purpose of this study was to assess the effect of a new procedure for collecting urine samples. The effect of indwelling catheter replacement before obtaining a urine specimen for bacterial culture, as recommended by the Society for Healthcare Epidemiology of America (SHEA), was compared with the previous practice of obtaining a urine culture through the catheter port. We expected the change in the collection method to decrease the number of organisms identified and allow more precise prescribing of antimicrobial therapy, as well as savings from decreased drug costs and time required of microbiology laboratory technicians.