Clean intermittent catheterization and urinary tract infection: review and guide for future research

Abstract

What ' s known on the subject? and What does the study add? Clean intermittent catheterization (CIC) is considered the method of choice for bladder emptying when neurological or non-neurological causes make normal voiding impossible or incomplete. The outcome is overall good, also in the long-term. There is neither one best technique nor one best material, as both depend greatly on patients ' individual anatomic, social and economic possibilities. The most frequent complication is urinary tract infection (UTI). Studies differ in the defi nition criteria for UTI, methods for evaluation, CIC techniques, frequency of urine analysis, prophylaxis and patients studied.The study provides a literature review and shows that most studies do not have a high level of evidence. There are various risk factors for UTI and phenotyping them helps to assess prognosis by considering what can happen if treatment is not initiated. The study concludes, that the role of biofi lms in CIC deserves more attention and that diagnosis should be made on urine sample obtained with catheterization, because symptoms are often less reliable. It also concludes that treatment in those who catheterize for a long time is only necessary for symptomatic infections. The study identifi es the following areas for further research: prevention of UTI in patients performing CIC; the use of special catheter types; and the role of frequency of catheterization, prophylactic antibiotics and preservation of natural defence mechanisms in the lower urinary tract. OBJECTIVE• To review the factors related to urinary tract infection (UTI), the most prevalent complication in patients who perform clean intermittent catheterization (CIC). METHODS• We conducted a literature search then a group discussion to gather relevant information on aspects of UTI to guide future research and to help provide clearer recommendations for the prevention of UTI in patients performing CIC. RESULTS• UTI is a major complication of CIC, the incidence of which varies widely in the literature owing to differences in methodology and defi nitions.• Phenotyping the risk factors for UTI helps to assess prognosis by considering what can happen if treatment is not initiated. The role of biofi lms in CIC deserves more attention.• Diagnosis is made using the urine sample obtained by catheterization. Because of neurological or other defi ciencies in patients performing CIC, symptoms are less reliable. Thorough evaluation for the source of signs and symptoms should be made before attributing them to UTI.• There have been many different proposals for the prevention of UTI in patients performing CIC, but most need more research. The role of the type of catheter is unclear but further exploration of special catheter types might be worthwhile.• Treatment in those who perform CIC for a long time is best reserved for symptomatic infections. CONCLUSIONS• Several mechanisms are relevant in UTI related to CIC.• As UTI is prevalent, more research into its prevention is needed.

Urologic self-management through intermittent self-catheterization among individuals with spina bifida: A journey to self-efficacy and autonomy

“…Clean intermittent catheterization (CIC) has been shown to be of great benefit in the care of SB-related neurogenic bladder and leads to improved long-term outcomes [4,5]. Along with improving health-related quality of life, it reduces the frequency of urinary tract infections and preserves renal function [6,7].…”

Infectious Diseases, Immunizations and Universal Precautions

“…UTI is the most common complication of this process and patients may have subtle or no symptoms [ 42 ]. Detailed discussion of the mechanisms and other factors contributing to the risk associated with these conditions are beyond the scope of this chapter.…”

Intermittent catheterisation: an option for managing bladder dysfunction

“…The use of antibacterial and silver -coated alloy indwelling catheters have been demonstrated to reduce UTI rates in short term indwelling catheterisation for inpatients, however the effect in catheters used for IC is as yet unproven (Wyndeale et al, 2012) From an individuals point of view the most important aspects when choosing a catheter are comfort, discretion, ease of use and maintainance of independence where possible. Individuals should always be offered the product most suitable for their needs.…”