Urinary tract infection in patients with hip fracture

Abstract

Introduction: Urinary tract infection (UTI) is a frequent complication of hip fractures. The Danish national clinical guideline for hip fracture recommends early and systematic mobilisation after surgery and that indwelling catheters are not used perioperatively.

Aims: The aim of this study was to describe the number of patients who received nursing care to prevent UTIs in accordance with the recommendations from the national Danish clinical guidelines. Specifically, the aim was to report the number of patients developing UTIs during admission, have indwelling catheters removed and being mobilised with 24 hours after surgery.

Methods: This prospective study included 65 patients. Data were collected on mobilisation and catheter use with a chart designed for this study. Sterile intermittent catheterisation was used to collect urine samples on admission and at discharge. Urine samples were sent for analysis at the microbiology laboratory. The urine sample was positive for UTI if the test showed 10⁴ CFU/ml bacteria.

Results: A total of five patients contracted nosocomial UTI during their hospital stay (7.7%), while 29.2% of patients had a positive urine culture on admission and were treated for UTI. At discharge, 20% of the patients had a positive urine sample but no symptoms. Postoperatively, 52.3% of the patients were mobilised within 24 hours.

Conclusion: The incidence of nosocomial UTI was similar to what has been found in other studies (95% [CI], 0.03-0.17]). The percentage of patients with nosocomial UTI was 7.7%. Nursing care related to hygienic performance of catheterisation or intermittent catheterisation adhered to the Danish national clinical guidelines, and 52.3% of the patients were mobilised within 24 h after surgery, which showed low adherence to the guidelines.

Keywords: Hip fractures; Intermittent catheterisation; Mobilisation; Urinary tract infections.