Beyond catheter-associated urinary tract infection: A prospective study of infectious, noninfectious, and psychosocial risks of indwelling catheters.

Abstract

Background: Indwelling urethral catheters (IUCs) are indispensable in modern urology; however, prolonged dwell times increase the risk of infection and patient-reported morbidity. Evidence-based stewardship, therefore, requires risk estimates by catheter material and dwell duration.

Methods: We conducted a prospective, single-center cohort study from July to December 2023. Consecutive adults who received an IUC were followed until its removal. Dwell was stratified as ≤5, 6-14, 15-30, and >30 days. A baseline urine culture was collected within 24 h of insertion. Follow-up cultures were planned for day 7 or at removal, and symptom-triggered thereafter, with additional sampling for catheters kept for more than 14 days. Culture-confirmed catheter-associated urinary tract infection (CAUTI) and noninfectious events were prospectively recorded.

Results: Among 670 eligible participants, 20 refused; 592 were analyzed (median age 51.7 years, 41% of women). Latex, silicone, and Bactiguard Infection Protection (BIP)-coated silicone catheters were used in 451, 120, and 21 insertions, respectively. Culture-confirmed CAUTI occurred in 50% of Latex, 22% of silicone, and 5% of BIP-coated silicone catheterizations (P < 0.0001). The overall incidence of the Centers for Disease Control and Prevention-defined symptomatic CAUTI in the study cohort was 16.7%. Versus ≤5 days, dwell >30 days markedly raised pain/discomfort (RR: 7.1, 95% confidence interval, 2.1-24), hematuria (RR: 10.6, 2.2-51) and sexual issues (RR: 21.2, 2.0-228). Regression identified dwell length (OR: 1.07 per day) and latex material (OR: 3.8) as independent CAUTI drivers. Prolonged catheterization was also associated with marked psychosocial morbidity, including social restriction and sexual dysfunction, which increased exponentially beyond 14 days.

Conclusion: Complications escalate sharply after day 5 and are amplified by Latex. Replacing Latex with silicone and limiting dwell time could potentially halve the incidence of culture-confirmed CAUTI. BIP catheters appear highly protective, but demand confirmation in future, robust, multicenter trials.