Iatrogenic bladder injury and prevention of catheter-related bacteriuria

Literature review conducted and presented by Dr. Clara Farley

EUA guidelines on iatrogenic bladder trauma:

  • Repair in two layers with absorbable sutures
  • Postop bladder drainage is required for 7-14 days
  • Cystoscopy is advised

Bacteriuria in patients with indwelling catheters occurs at a rate of approx. 3-10% per day of catheterization:

  • Of those with bacteriuria, approx. 10-25% develop UTI (GU or systemic symptoms)
  • 4% of less develop catheter related bacteremia

Association between the rate of UTI and duration of catheterization:

  • 15% at 3 days
  • 68% at 8 days

Prevention:

  • Proper aseptic technique, gloves when emptying/manipulating
  • No evidence to support irrigation, antimicrobial drugs in drainage bag, rigorous meatal cleansing
  • Silver coated catheters *might* prevent though mixed results – silver alloy catheters more promising than silver oxide catheters
  • Prophylactic antibiotic therapy tends to be most useful in patients requiring urinary catheterization for 3-14 days – those with shorter duration are not high enough risk to warrant ABX.

References:

Al-Hazmi H. Role of duration of catheterization and length of hospital stay on the rate of catheter-related hospital-acquired urinary tract infections. Res Rep Urol. 2015 Mar 25;7:41-7.

Cohen AJ, Packiam VT, Nottingham CU, et al. Iatrogenic Bladder Injury: National Analysis of 30-Day Outcomes. Urology. 2016 Nov;97:250-256.

de Moya MA, Zacharias N, Osbourne A, et al. Colovesical fistula repair: is early Foley catheter removal safe? J Surg Res. 2009 Oct;156(2):274-7.

Esparaz AM, Pearl JA, Herts BR, et al. Iatrogenic urinary tract injuries: etiology, diagnosis, and management. Semin Intervent Radiol. 2015 Jun;32(2): 195-208.

Saint S, Lipsky BA. Preventing catheter-related bacteriuria: should we? Can we? How? Arch Intern Med. 1999 Apr 26;159(8):800-8.

Siskind E, Sameyah E, Goncharuk E, et al. Removal of foley catheters in live donor kidney transplant recipients on postoperative day 1 does not increase the incidence of urine leaks. Int J Angiol. 2013 Mar;22(1):45-8.

Summerton DJ, Kitrey ND, Lumen N, Serafetinidis E, Djakovic N; European Association of Urology. EAU guidelines on iatrogenic trauma. Eur Urol. 2012 Oct;62(4):628-39.

Fekete T. Catheter-associated urinary tract infection in adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. https://www.uptodate.com (Accessed on November 6, 2021.)

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