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March 10, 1997

Low Risk of Bacteremia During Catheter Replacement in Patients With Long-term Urinary Catheters

Author Affiliations

From the Division of Infectious Diseases (Drs Bregenzer and Zimmerli), Bacteriology Laboratory (Dr Frei), Division of Clinical Epidemiology (Dr Widmer), Geriatric Clinics (Drs Seiler and Probst), and Clinic of Urology (Dr Mattarelli), University Hospitals Basel, Basel, Switzerland.

Arch Intern Med. 1997;157(5):521-525. doi:10.1001/archinte.1997.00440260067010

Background:  Geriatric patients with long-term urinary catheters have an increased morbidity and mortality. It is conceivable that catheter replacement causes bacteremia and contributes to this morbidity and mortality. The purpose of our study was to determine the incidence and clinical relevance of bacteremia induced by urinary catheter replacements.

Methods:  We analyzed clinical signs and symptoms and laboratory measures (leukocyte count, C-reactive protein, urine sediment, urine culture) during 120 routine catheter replacements in geriatric patients. In addition, blood cultures were drawn before and at 5, 15, and 30 minutes after catheter replacement.

Results:  The urine cultures showed growth of 1 to 5 different microorganisms before replacement. Of 480 blood cultures, 27 (5.6%) were positive. However, the same species grew from blood and urine in only 5 catheter replacements. None of the patients met criteria for systemic inflammatory response syndrome. There were no significant differences in clinical and laboratory findings between patients with and without bacteremia. Coagulase-negative staphylococci grew in 12 blood cultures. Their distribution over time suggested that they mainly represented catheter replacement—related bacteremia rather than contaminants. Consequently, 64 intraurethral catheter segments were additionally cultured. Coagulase-negative staphylococci grew in 10 catheter cultures, but in only 2 simultaneously cultured urine samples.

Conclusion:  Bacteremia induced by routine replacement of long-term urinary catheters occurred in 4.2% (5/ 120) of replacements in geriatric patients. Such bacteremia did not have a detectable clinical relevance in our study.Arch Intern Med. 1997;157:521-525