Physical predictors of infection in patients treated with clean intermittent catheterization: A prospective 7-year study

Objective To study urinary tract complications in patients treated using long-term clean intermittent catheterization (CIC), and to evaluate the physical factors which might be implicated in these complications, Patients and methods During 1995, 170 patients (84 men and 86 women, mean age 56.9 years) with a mean duration of use of CIC for 8.8 years were assessed for complications related to CIC, The same patients had participated in a thorough follow-up study during 1988-9 and were examined again using questionnaires and the analysis of urine samples. CIC was practised by two-thirds of the patients because they had neurogenic bladder dysfunction and for nonneurogenic dysfunction in the remainder, Results In this prevalence study, 111 patients (65%) had no signs of clinical urinary tract infection (UTI), while 10 patients (6%) had pronounced symptoms, The remaining 29% had only minor signs of UTI, There were three predictive factors of clinical UTI; women reported more infections than men, the patients most affected by UTI in the present study were those suffering UTI during the 1988-9 study and patients with UTI had the highest mean catheterization volume now, and the highest increase in mean catheterization volume from 1989 to 1995. Bacteriuria was found in 61% of the urine samples, with Escherichia coli the dominant species among women and Gram-positive cocci among men. Patients who did not use anti-infective agents had a 31% rate of sterile urine while the corresponding value among those using antibiotics was 54%. The frequency of catheterization was the only variable predictive of bacteriuria apart from the use of antibiotics. Conclusion This study confirms previous reports showing CIC to be an excellent procedure for minimizing urinary tract complications and supports the current recommendations, e.g. restricting the use of antibiotics in patients using CIC and ensuring that they catheterize sufficiently often to ensure that the mean volume of each catheterization is kept to <400 mL in adults.