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Czwikla J, Wandscher K, Helbach J, Fassmer AM, Schmiemann G, Hoffmann F. Prevalence of indwelling urinary catheters in nursing home residents: Systematic review. Int J Nurs Stud 2023; 145:104555. [PMID: 37421830 DOI: 10.1016/j.ijnurstu.2023.104555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/10/2023] [Accepted: 06/09/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND This systematic review examines the prevalence of indwelling urinary catheters in nursing home residents. METHODS MEDLINE via PubMed, CINAHL, and EMBASE were searched from inception to 9 August 2022. Cross-sectional studies and longitudinal studies with cross-sectional analyses reporting catheter prevalence in nursing home residents were identified and summarized descriptively. Study quality was assessed using the Joanna Briggs Institute's tool. RESULTS Sixty-seven studies (92.5 % cross-sectional) were included. The reported number of included residents ranged from 73 to 110,656. The median catheter prevalence was 7.3 % (interquartile range 4.3-10.1 %; n = 65 studies). It was higher in Germany (10.2 % [9.7-12.8 %]; n = 15) than in the United States of America (9.3 % [6.3-11.9 %]; n = 9), United Kingdom (6.9 % [4.8-8.5 %]; n = 7), and Sweden (7.3 % [6.4-7.9 %]; n = 6). Furthermore, it was higher among men (17.0 % [16.0-26.0 %]) than among women (5.3 % [4.0-9.5 %]) (n = 9). Only one study investigated differences by age. The prevalence was higher for transurethral (5.7 % [5.6-7.2 %]; n = 12) than for suprapubic (1.2 % [0.6-2.5 %]; n = 13) catheters. Most catheterized residents were long-term catheterized (n = 6) and had their catheter changed within 3 months (n = 2). Symptomatic urinary tract infections were more common among catheterized than among non-catheterized residents (n = 4). DISCUSSION Catheter prevalence in nursing home residents varies between studies and countries. Prevalence differences by sex, age, and catheter type as well as duration of catheterization, catheter change intervals, and catheter-associated urinary tract infections are rarely reported because most studies do not primarily focus on catheters. Future studies should focus on the circumstances of urinary catheter use and care in nursing home residents. REGISTRATION AND FUNDING PROSPERO (29 August 2022; CRD42022354358); no funding.
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Affiliation(s)
- Jonas Czwikla
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraße 114-118, 26129 Oldenburg, Germany; Department of Health, Long-term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359 Bremen, Germany; High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359 Bremen, Germany.
| | - Kathrin Wandscher
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraße 114-118, 26129 Oldenburg, Germany
| | - Jasmin Helbach
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraße 114-118, 26129 Oldenburg, Germany
| | - Alexander M Fassmer
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraße 114-118, 26129 Oldenburg, Germany
| | - Guido Schmiemann
- High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359 Bremen, Germany; Department for Health Services Research, Institute of Public Health and Nursing Research (IPP), University of Bremen, Grazer Straße 4, 28359 Bremen, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraße 114-118, 26129 Oldenburg, Germany
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Lodeta B, Lovrinic D, Lodeta M, Zavidic T, Baric H. Use of Urinary Collection Devices in Community and Nursing Homes in Istria County. Urol Int 2018; 100:333-338. [PMID: 29502119 DOI: 10.1159/000486900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 01/17/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study is aimed at assessing the use of various types of urinary catheters, appropriateness of catheter placement and factors associated with antibiotic use in a population of chronically catheterized patients in Istria County. MATERIALS AND METHODS This cross-sectional study, conducted between March and June 2017 in Istria County, Croatia, was initiated through a network of general family medicine offices. Data were collected from general practitioners (GPs) and from medical managers in nursing homes. Participants were asked to review medical records of their patients and to complete a 10-item questionnaire designed to retrieve information on patients with urinary catheter. RESULTS All GPs in the county were surveyed. We identified 309 patients with urinary catheter: 216 men (70%) and 93 women (30%). The overall prevalence of individuals with urinary catheters was 0.18%: 4.7% in nursing home population and 0.1% among non-institutionalized adult population. Most common indication for catheterization was chronic urinary retention (52%). One hundred eighty-six patients (60.4%) reported antibiotic usage in the previous 3 months for treating urinary infection. CONCLUSIONS In Istria County, the prevalence of indwelling urinary catheters is highest in males, especially among patients in nursing homes. There is a need for focused education among GPs regarding urinary catheter maintenance and antibiotic prescription for suspected urinary tract infections.
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Affiliation(s)
- Branimir Lodeta
- Department of Urology, Klinikum Klagenfurt, Klagenfurt am Wörthersee, Austria
| | | | - Maja Lodeta
- Special Hospital for Medical Rehabilitation, Varazdinske Toplice, Croatia
| | | | - Hrvoje Baric
- Department of Neurosurgery, University Hospital Centre Zagreb, Zagreb, Croatia
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Fagan M, Lindbæk M, Grude N, Reiso H, Romøren M, Skaare D, Berild D. Antibiotic resistance patterns of bacteria causing urinary tract infections in the elderly living in nursing homes versus the elderly living at home: an observational study. BMC Geriatr 2015; 15:98. [PMID: 26238248 PMCID: PMC4523906 DOI: 10.1186/s12877-015-0097-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 07/23/2015] [Indexed: 01/02/2023] Open
Abstract
Background Antibiotic resistance is a problem in nursing homes. Presumed urinary tract infections (UTI) are the most common infection. This study examines urine culture results from elderly patients to see if specific guidelines based on gender or whether the patient resides in a nursing home (NH) are warranted. Methods This is a cross sectional observation study comparing urine cultures from NH patients with urine cultures from patients in the same age group living in the community. Results There were 232 positive urine cultures in the NH group and 3554 in the community group. Escherichia coli was isolated in 145 urines in the NH group (64 %) and 2275 (64 %) in the community group. There were no clinically significant differences in resistance. Combined, there were 3016 positive urine cultures from females and 770 from males. Escherichia coli was significantly more common in females 2120 (70 %) than in males 303 (39 %)(p < 0.05). Enterococcus faecalis was significantly less common in females 223(7 %) than males 137 (18 %) (p < 0.05). For females, there were lower resistance rates to ciprofloxacin among Escherichia coli (7 % vs 12 %; p < 0.05) and to mecillinam among Proteus mirabilis (3 % vs 12 %; p < 0.05). Conclusions Differences in resistance rates for patients in the nursing home do not warrant separate recommendations for empiric antibiotic therapy, but recommendations based on gender seem warranted.
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Affiliation(s)
- Mark Fagan
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Postboks 1130, Blindern, 0318, , Oslo, Norway.
| | - Morten Lindbæk
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Postboks 1130, Blindern, 0318, , Oslo, Norway. .,Antibiotic Centre for Primary Care, University of Oslo, Postboks 1130, Blindern, 0318, , Oslo, Norway.
| | - Nils Grude
- Department of Microbiology, Vestfold Hospital Trust, Tønsberg, Postboks 2168, 3103, Tønsberg, Norway.
| | - Harald Reiso
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Postboks 1130, Blindern, 0318, , Oslo, Norway.
| | - Maria Romøren
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Postboks 1130, Blindern, 0318, , Oslo, Norway.
| | - Dagfinn Skaare
- Department of Microbiology, Vestfold Hospital Trust, Tønsberg, Postboks 2168, 3103, Tønsberg, Norway.
| | - Dag Berild
- Department of Infectious Disease, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, PO Box 4950, Nydalen, 0424, , Oslo, Norway.
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Abstract
From 5-10% of elderly residents of long-term care facilities require chronic indwelling catheters for management of urine voiding. These residents are always bacteriuric, because of biofilm formation along the catheter, and experience increased morbidity associated with urinary tract infection. A wide variety of bacteria or yeast species are isolated. Occasional episodes of symptomatic infection may be accompanied by localizing genitourinary findings. However, when fever is present and there are no localizing findings, symptomatic infection is a diagnosis of exclusion. Many of these episodes are not from a urinary source, so critical clinical evaluation is always necessary. A urine specimen for culture should be obtained from patients with symptomatic infection prior to institution of antimicrobial therapy. When the catheter has been present for 2 weeks or longer, it should be replaced and the urine specimen collected through the new catheter. This provides a specimen of bladder urine without biofilm contamination, and catheter replacement also improves clinical outcomes. Treatment algorithms with a goal of limiting inappropriate treatment of asymptomatic bacteriuria have been developed. Empiric antimicrobial therapy should be avoided when possible. Guidelines for prevention of catheter-acquired urinary infection should be followed. The most important of these is to avoid use of a urinary catheter whenever possible and, when there is no longer an indication for the catheter, to remove it promptly.
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Nicolle LE. Catheter associated urinary tract infections. Antimicrob Resist Infect Control 2014; 3:23. [PMID: 25075308 PMCID: PMC4114799 DOI: 10.1186/2047-2994-3-23] [Citation(s) in RCA: 280] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 07/07/2014] [Indexed: 12/12/2022] Open
Abstract
Urinary tract infection attributed to the use of an indwelling urinary catheter is one of the most common infections acquired by patients in health care facilities. As biofilm ultimately develops on all of these devices, the major determinant for development of bacteriuria is duration of catheterization. While the proportion of bacteriuric subjects who develop symptomatic infection is low, the high frequency of use of indwelling urinary catheters means there is a substantial burden attributable to these infections. Catheter-acquired urinary infection is the source for about 20% of episodes of health-care acquired bacteremia in acute care facilities, and over 50% in long term care facilities. The most important interventions to prevent bacteriuria and infection are to limit indwelling catheter use and, when catheter use is necessary, to discontinue the catheter as soon as clinically feasible. Infection control programs in health care facilities must implement and monitor strategies to limit catheter-acquired urinary infection, including surveillance of catheter use, appropriateness of catheter indications, and complications. Ultimately, prevention of these infections will require technical advances in catheter materials which prevent biofilm formation.
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Affiliation(s)
- Lindsay E Nicolle
- Departments of Internal Medicine and Medical Microbiology, University of Manitoba, Health Sciences Centre, Room GG443 – 820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada
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Manage catheter-related urinary tract infection in the elderly in long-term care by limiting catheter use and avoiding the inappropriate use of antimicrobials. DRUGS & THERAPY PERSPECTIVES 2014. [DOI: 10.1007/s40267-014-0130-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Griebling TL. Detrusor Underactivity and Urinary Retention in Geriatric Patients: Evaluation, Management and Recent Research. CURRENT BLADDER DYSFUNCTION REPORTS 2013. [DOI: 10.1007/s11884-013-0183-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jonsson KARIN, Hedelin HANS. Costs associated with long-term catheter care in nursing home patients. Scand J Urol 2012; 47:113-7. [DOI: 10.3109/00365599.2012.704941] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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