An 86-year-old man is hospitalized for a complicated hip fracture requiring surgical repair following a fall. His medical problems include prostate cancer, gout, and osteoarthritis. An indwelling urinary catheter is placed due to initial urinary retention and immobilization following the surgery. On the eighth day of hospitalization, the patient develops fever and altered mental status. After evaluation and laboratory testing, a urinary tract infection is diagnosed. Which of the following is the most effective strategy for preventing this complication?

Question

An 86-year-old man is hospitalized for a complicated hip fracture requiring surgical repair following a fall.  His medical problems include prostate cancer, gout, and osteoarthritis.  An indwelling urinary catheter is placed due to initial urinary retention and immobilization following the surgery.  On the eighth day of hospitalization, the patient develops fever and altered mental status.  After evaluation and laboratory testing, a urinary tract infection is diagnosed.  Which of the following is the most effective strategy for preventing this complication?

Quizplus · Accepted Answer

Catheter-associated urinary tract infection (UTI) is a frequent complication in hospitalized patients. Common symptoms are fever and pyuria. Suprapubic, flank, and costovertebral tenderness and new-onset altered mental status (delirium) can also occur. The diagnosis is based on a positive urine culture and ruling out other systemic infections (eg, pneumonia). Duration of catheterization is the most significant risk factor for UTI. Preventive measures include avoiding unnecessary catheterization, using sterile technique when inserting the catheter, and removing the catheter promptly when no longer needed. (Choice A) Antibiotic-coated urinary catheters are costly and have not shown consistent benefit in reducing the risk for UTI. (Choice B) Bladder irrigation is reserved for patients with hematuria and blood clots and does not prevent UTI. (Choice D) Prophylactic antibiotics have not been shown to reduce risk of catheter-associated UTI and are associated with development of antibiotic-resistant strains. (Choice E) Although replacing an indwelling catheter can cause a short-lived reduction in urine bacterial load, it does not confer any clear benefit. Routine replacement of indwelling catheters to prevent infection is not helpful, and catheters should be changed only for specific indications (eg, active infection, obstruction). Educational objective: Urinary tract infections (UTIs) are common in hospitalized patients with indwelling urinary catheters. The risk for UTI can be reduced by avoiding unnecessary catheterization, using sterile technique when inserting the catheter, and removing the catheter as soon as possible. __________ References: Role of duration of catheterization and length of hospital stay on the rate of catheter-related hospital-acquired urinary tract infections. (http://www.ncbi.nlm.nih.gov/pubmed/25848551) Nosocomial urinary tract infections: A review. (http://www.ncbi.nlm.nih.gov/pubmed/25451882)

An 86-Year-Old Man Is Hospitalized for a Complicated Hip Fracture