Catheter replacement in catheter-associated urinary tract infection: current state of evidence

• Published in: European journal of clinical microbiology & infectious diseases Vol. 43; no. 8; pp. 1631 - 1637
• Main Authors: Westgeest, Annette C., van Uhm, Janneke I.M., Pattacini, Laura, Rozemeijer, Wouter, Schout, Barbara M.A., Groenwold, Rolf H.H., Geerlings, Suzanne E., Lambregts, Merel M.C.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.08.2024; Springer Nature B.V
• Subjects: Biomedical and Life Sciences; Biomedicine; Catheter-Related Infections - prevention & control; Catheters; Clinical outcomes; Clinical trials; Device Removal; Guidelines; Health services; Humans; Internal Medicine; Medical instruments; Medical Microbiology; Observational studies; Observational Studies as Topic; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Recovery; Recurrence; Urinary Catheterization - adverse effects; Urinary Catheters - adverse effects; Urinary tract; Urinary tract diseases; Urinary tract infections; Urinary Tract Infections - therapy; Urogenital system; Urinary tract infection; Catheter related infection
• ISSN: 0934-9723; 1435-4373; 1435-4373
• DOI: 10.1007/s10096-024-04878-9

Purpose Catheter associated urinary tract infection (CAUTI) is the most common healthcare associated infection. A significant knowledge gap exists regarding the necessity of catheter replacement as part of CAUTI treatment. Current guidelines recommend replacement for faster recovery and to prevent recurrences, but adherence is low. In this systematic review, we aimed to assess the available evidence regarding catheter replacement for CAUTI. Materials and methods Eligible studies investigated the effect of catheter replacement in CAUTI on clinical outcomes and/or recurrence rates, irrespective of catheter type or setting. We searched electronic literature databases from inception to October 15th, 2023. Information was extracted regarding setting, eligibility criteria, definition of CAUTI, timing of replacement, and outcomes. Results Of the 257 identified studies, four were considered relevant and included. Two were randomized controlled trials (RCT) and two were observational studies. One RCT showed higher rates of clinical recovery and lower recurrence rates in the replacement group, while results of the other RCT favoured retainment, with a lower recurrence rate in the retainment group, although longer antimicrobial treatment in this group. Two observational studies were inconclusive. Conclusions Current guidelines rely heavily on recommendations from a single study, emphasizing the need for further research. The burden of catheter replacement, including patient discomfort and resource impact, warrants careful consideration. A randomized trial is essential to provide more evidence on the effect of catheter replacement on clinical outcomes including CAUTI recurrence.