Lobão, MJ

Sousa, P

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Identifying risk factors for bladder catheterization in Internal Medicine patients: can it be helpful for clinical practice?Maria João Lobão1,2, Paulo Sousa 21 Internal Medicine Department, Hospital de Cascais, 2 National School of Public Health, NOVA University of LisbonBackgroundUrinary tract infections are one of the most common nosocomial infections worldwide and the vast majority of it is indwelling catheter related.1 Bladder catheterization is a veryfrequent procedure and it should be done strictly accomplishing the indications for it.1 In many cases, catheters are placed inappropriately leading to unnecessary and prolonged usewhich can result in avoidable infections.1-3 The morbidity, mortality and costs associated to catheter-associated urinary tract infections (CAUTI) are not negligeble.4,5With this study, we aim to identify risk factors for bladder catheterization in patients admitted to an internal medicine ward that could help clinical reasoning and decision aboutcatheter placement in addition to formal recommended indications.Discussion and ConclusionsReferencesIn this study we found a high percentage of inappropriate bladder catheterization (36,5%).1,11,12 This finding, that deserves further study and improve quality initiatives, underscoresthe need of judicious clinical reasoning about indications and benefits of this procedure for each patient individually. The independent risks factors for bladder catheterization foundwere total dependency and very high dependency for activities of daily life on Barthel Index on admission, Age adjusted Charlson Comorbidity Index and length of stay. The riskmodel can be used as a complement tool for clinical decision. Given their characteristics (high specificity and low sensibility) it only can be used to identify patients at risk for whom itmust be important to establish a closer surveillance and individual decision strategy, avoiding the procedure unless it is really necessary. As we know from the literature the best wayto avoid CAUTI is to restrict the use of catheters and guarantee the implementation and accomplishment of prevention bundles.1,3,12MethodsWe performed a historical cohort study that included a systematic random sample of 388 patients, representative of the 3492 admissions occurred in a Portuguese internal medicineward (93-beds) in 2014. Patients transferred from or to another hospital, as well as patients with admission diagnosis of urinary tract infection were excluded. Variables related topatient (age, sex, age adjusted Charlson comorbidity index6,7, place of residency, functional8 and nutritional status9, sphincter incontinence, pressure ulcers), and to admissionepisode (department from admission, principal diagnosis and length of stay) were analyzed.Univariate analysis was done to characterize the cohort. We performed a bivariate analysis to identify statistically significant variables that were associated to bladder catheterization.Binary Logistic Regression (enter method) was used to identify independent risk factors for catheter use and to develop the predictive risk model. Odds Ratio and 95% confidenceintervals were calculated. We tested several consecutive models until the final one that only considered variables with p-value < 0.05 (value considered to be statistically significant inthis study). We performed Hosmer and Lemeshow to test the goodness of fit of the model. The Receiver Operating Characteristic (ROC) curve was used as a measure of the model’spredictive discrimination.10 Statistical analysis was performed with SPSS IBM® Statistics Software (24th version).ResultsBivariate analysisFigure 1 Cohort patients inclusion diagram Figure 2 Cohort characterization and  main results Mul$variate analysis and predic$ve risk modelLegend: n.a – not applicable; SD – Standard deviation; IQR – Interquartile range; § - Qui-Square test; §§ -Mann-Witney U TestLegend: n.a – not applicable; SD – Standard deviation; IQR – Interquartile range; § - Qui-Square test; §§ - Mann-Witney U Test;§§§ - Exact Fisher Test3412Legend: n.a – not applicable; OR – Odds ra4o; OR IC95% - Confidence Interval for Odds ra4o; § - p-value, Wald TestThe variables with significant p-value (n=9) on the bivariate analysis were all ini4ally introduced in the mode. The variables in the final model are the ones that figures in the upper table.AUROC82,5%1.Gould C V, Umscheid CA, Rajender,Agarwal K, Kuntz G, Pegues DA. Guideline for PrevenEon of Catheter-Associated Urinary Tract InfecEons (2009) GUIDELINE FOR PREVENTION OF CATHETER-ASSOCIATED URINARY TRACT INFECTIONS 2009 [Internet]. [cited 2019 Feb 15]. Available from: hZps://www.cdc.gov/infecEoncontrol/pdf/guidelines/cauE-guidelines.pdf. 2. Chenoweth CE, Gould C V., Saint S. Diagnosis, management, and prevenEon of catheter-associated urinary tract infecEons [Internet]. Vol. 28,InfecEous Disease Clinics of North America. 2014 [cited 2019 Feb 22]. p. 105–19. Available from: hZps://linkinghub.elsevier.com/retrieve/pii/S0891552013000731 3.Nicolle LE. Catheter-related urinary tract infecEon: PracEcal management in the elderly. Drugs and Aging. 2014 J;31(1):1–10. 4. Umscheid CA, Mitchell MD, Doshi JA, Agarwal R, Williams K, Brennan PJ. EsEmaEng the ProporEon of Healthcare-Associated InfecEons That Are Reasonably Preventable and the Related Mortality and Costs. Infect ControlHosp Epidemiol. 2011;32(02):101–14. 5. Klevens RM, Edwards JR, Richards CL, Horan TC, Gaynes RP, Pollock DA, et al. EsEmaEng Health Care-Associated InfecEons and Deaths in U.S. Hospitals, 2002. Public Health Rep. 2007;122(2):160–6. 6. Sundararajan V, Henderson T, Perry C, Muggivan A, Quan H, Ghali WA. New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality. J Clin Epidemiol. 2004 ;57(12):1288–94. 7. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method ofclassifying prognosEc comorbidity in longitudinal studies: Development and validaEon. J Chronic Dis. 1987;40(5):373–83. A8. Cid-Ruzafa J, Damn-Moreno J.]. Rev Esp Salud Publica. 2009;71(2):127–37. 9. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M, EducaEonal and Clinical PracEce CommiZee ES of P and EN (ESPEN). ESPEN guidelines for nutriEon screening 2002. Clin Nutr. 2003;22(4):415–21.10. Aguiar P. EstajsEca em InvesEgação Epidemiológica: SPSS.Guia práEco de Medicina. First. Climepsi, editor. Lisboa;2007. 237 p.11. Munasinghe RL, Yazdani H, Siddique M, Hafeez W. Appropriateness of Use of Indwelling Urinary Catheters in PaEents AdmiZed to the Medical Service. Infect Control Hosp Epidemiol. 2001;22(10):64 12. Vincitorio D, Barbadoro P, Pennacchiep L, Pellegrini I, David S, Ponzio E, et al. Risk factors for catheter-associated urinary tract infecEon in Italian elderly. Am J Infect Control. 2014;42(8):898–901.

Identifying risk factors for bladder catheterization in Internal Medicine patients: can it be helpful for clinical practice?

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Identifying risk factors for bladder catheterization in Internal Medicine patients: can it be helpful for clinical practice?

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