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Dean NL, Gras J, Lantz EE, Patterson JP, Inglese G, Goldstine JV, Medina-Rivera M, Bionda N, Strickland AD, Sileika TS. Microbial Transfer by Intermittent Catheters: An In Vitro Evaluation of Microbial Transfer in Catheter With Variable Protective Features. J Wound Ostomy Continence Nurs 2024; 51:66-73. [PMID: 38215300 DOI: 10.1097/won.0000000000001042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
PURPOSE The purpose of this study was to evaluate the effects of various protective features (eg, catheter cap, introducer tip, and catheter sleeve) of hydrophilic intermittent catheters against contamination with urinary tract infection-associated microorganisms using an in vitro model. DESIGN An in vitro study of microbial transfer. MATERIALS AND METHODS Gloves were contaminated with uropathogenic microorganisms and used to simulate intermittent catheterization of male anatomical models with and without the protective features present in 5 commercially available hydrophilic catheters. Using this contaminated touch transfer method, both the meatus of the sterile male anatomical models and sterile surgical gloves of an operator were inoculated with a high level of microorganisms (107 and 109 colony-forming units [CFU], respectively). The operator then performed catheterization of the anatomical model. The most relevant segments of the catheter were sampled, and the level of microbial transfer and catheter contamination was quantified. Results from experimental and sample replicates from the 3 microbial species and 5 catheters (sleeved and unsleeved) were analyzed by pair-wise t tests and analysis of variance. RESULTS Of the 5 commercially available sleeved intermittent catheters evaluated in this study, use of catheters with multiple protective components (ring cap, introducer tip, and catheter sleeve) resulted in significant improvement in protection against contamination with a 25- to 2500-fold lower level of microbial contamination (C1 segment) across all species as compared to catheters protected with only sleeves or un-sleeved catheters. CONCLUSIONS The combination of a ring cap, protective introducer tip, and protective sleeve provides additional protection when compared to sleeve alone from transferring microbial contamination from the meatus to the advancing catheter. Additional research is needed to determine whether these design features result in fewer urinary tract infections among intermittent catheter users.
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Affiliation(s)
- Nicole L Dean
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
| | - James Gras
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
| | - Ellen E Lantz
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
| | - Jillian P Patterson
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
| | - Gary Inglese
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
| | - Jimena V Goldstine
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
| | - Mariely Medina-Rivera
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
| | - Nina Bionda
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
| | - Aaron D Strickland
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
| | - Tadas S Sileika
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
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Neumeier V, Stangl FP, Borer J, Anderson CE, Birkhäuser V, Chemych O, Gross O, Koschorke M, Marschall J, McCallin S, Mehnert U, Sadri H, Stächele L, Kessler TM, Leitner L. Indwelling catheter vs intermittent catheterization: is there a difference in UTI susceptibility? BMC Infect Dis 2023; 23:507. [PMID: 37533010 PMCID: PMC10398982 DOI: 10.1186/s12879-023-08475-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/20/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Patients with neurogenic lower urinary tract dysfunction (NLUTD) often rely on some type of catheterization for bladder emptying. Intermittent catheterization (IC) is considered the gold standard and is preferred over continuous catheterization, since it is considered to cause fewer urinary tract infections (UTIs) than indwelling catheterization. The main objective of our study was to describe UTI prevalence (at visit) and incidence (within the last 12 months) and urine culture characteristics between patients using an indwelling catheter versus (vs) those performing IC. METHODS In this cross-sectional study, we prospectively evaluated from 02/2020 to 01/2021 patients with NLUTD undergoing urine cultures for prophylactic reasons or due to UTI symptoms. At visit, all patients underwent a standardized interview on current UTI symptoms as well as UTI history and antibiotic consumption within the past year. Patients using an indwelling catheter (n = 206) or IC (n = 299) were included in the analysis. The main outcome was between-group differences regarding UTI characteristics. RESULTS Patients using an indwelling catheter were older (indwelling catheter vs IC: median 66 (Q1-Q3: 55-77) vs 55 (42-67) years of age) and showed a higher Charlson comorbidity index (indwelling catheter vs IC: median 4 (Q1-Q3: 2-6) vs 2 (1-4) (both p < 0·001). A total of 40 patients from both groups were diagnosed with a UTI at visit (indwelling catheters vs IC: 8% (16/206) vs 8% (24/299); p = 0·782), and the number of UTIs within the past 12 months was not significantly different between groups. Overall, Escherichia coli (21%), Enterococcus faecalis (17%), and Klebsiella spp. (12%) were the most frequently detected bacteria. CONCLUSIONS In this cohort of patients with NLUTD, we did not find relevant differences in UTI frequency between groups. These results suggest that UTI-related concerns should not be given undue emphasis when counseling patients for catheter-related bladder emptying methods.
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Affiliation(s)
- Vera Neumeier
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Fabian P Stangl
- Department of Urology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Joëlle Borer
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zürich, Switzerland
- Department of Urology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Collene E Anderson
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zürich, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Veronika Birkhäuser
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Oksana Chemych
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Oliver Gross
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Miriam Koschorke
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Jonas Marschall
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis Missouri, USA
| | - Shawna McCallin
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Ulrich Mehnert
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Helen Sadri
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Lara Stächele
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Lorenz Leitner
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zürich, Switzerland.
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