The association between indwelling urinary catheter use in the elderly and urinary tract infection in acute care

Retrospective chart review. Chi square used to test significance of differences in proportions.Seventy three percent of patients who received an IUC in the ED were elderly (≥65 years old). During the study period, 277 elderly patients received an IUC prior to admission. Of these, 77 (28%) were diagnosed with UTI during their hospitalization. Fifty three (69%) of those diagnosed with a UTI by discharge either had the UTI diagnosed in the ED or had bacteriuria ≥105 organisms/ml prior to IUC placement. Of the 24 elderly patients who developed a catheter-associated UTI (i.e., 9% of the elderly population who received an IUC), 11 of the IUCs were placed inappropriately. Thus, 4% of elderly patients with no indication of UTI on admission who received an inappropriate IUC in the ED had a primary or secondary diagnosis of UTI by discharge. The overall rate of nosocomial UTI due to an inappropriately placed IUC was the same in males and females.This study indicates that the strong association between IUC use and UTI may be partly explained by the high prevalence of preexisting UTI prior to IUC placement. Further prospective studies are needed to clarify the true risk vs benefit ratio for IUC use in acutely ill elderly patients.Approximately 4 million people each year receive an indwelling urinary catheter (IUC) [1] and 5–20% of hospitalized patients who receive an IUC will be diagnosed with a urinary tract infection (UTI) [1,2]. IUC use is thought to be the most significant risk factor for developing nosocomial UTIs, especially in acutely ill elderly patients [3-6]. Indeed, the leading category of nosocomial infections are UTIs [7], and 80% of these are associated with IUCs [1]. UTIs are associated with increased morbidity, mortality, length of stay, and costs [4,8-11]. Even with improvements in nursing care of the catherized patient and experimental redesign of catheters themselves, UTI remains a problem in the catherized patient [1,10,12-15]. It is important, therefore, to