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Randomized Controlled Trial
. 2024 May 13;28(1):162.
doi: 10.1186/s13054-024-04947-7.

Efficacy of expanded periurethral cleansing in reducing catheter-associated urinary tract infection in comatose patients: a randomized controlled clinical trial

Xingsong Qin  1 , He Zhao  1 , Wei Qin  1 , Xinglei Qin  2 , Songying Shen  1 , Hongyu Wang  3   4
Affiliations
Randomized Controlled Trial

Efficacy of expanded periurethral cleansing in reducing catheter-associated urinary tract infection in comatose patients: a randomized controlled clinical trial

Xingsong Qin et al. Crit Care. .

Abstract

Background: The effect of the periurethral cleansing range on catheter-associated urinary tract infection (CAUTI) occurrence remains unknown. The purpose of this study was to evaluate the efficacy of expanded periurethral cleansing for reducing CAUTI in comatose patients.

Methods: In this randomized controlled trial, eligible patients in our hospital were enrolled and allocated randomly to the experimental group (expanded periurethral cleansing protocol; n = 225) or the control group (usual periurethral cleansing protocol; n = 221). The incidence of CAUTI on days 3, 7, and 10 after catheter insertion were compared, and the pathogen results and influencing factors were analyzed.

Results: The incidences of CAUTI in the experimental and control groups on days 3, 7, and 10 were (5/225, 2.22% vs. 7/221, 3.17%, P = 0.54), (12/225, 5.33% vs. 18/221, 8.14%, P = 0.24), and (23/225, 10.22% vs. 47/221, 21.27%, P = 0.001), respectively; Escherichia coli and Candida albicans were the most common species in the two groups. The incidences of bacterial CAUTI and fungal CAUTI in the two groups were 11/225, 4.89% vs. 24/221, 10.86%, P = 0.02) and (10/225, 4.44% vs. 14/221, 6.33%, P = 0.38), respectively. The incidences of polymicrobial CAUTI in the two groups were 2/225 (0.89%) and 9/221 (4.07%), respectively (P = 0.03). The percentages of CAUTI-positive females in the two groups were 9.85% (13/132) and 29.52% (31/105), respectively (P < 0.05). The proportion of CAUTI-positive patients with diabetes in the experimental and control groups was 17.72% (14/79), which was lower than the 40.85% (29/71) in the control group (P < 0.05).

Conclusion: Expanded periurethral cleansing could reduce the incidence of CAUTI, especially those caused by bacteria and multiple pathogens, in comatose patients with short-term catheterization (≤ 10 days). Female patients and patients with diabetes benefit more from the expanded periurethral cleansing protocol for reducing CAUTI.

Keywords: Catheter-associated urinary tract infection; Disinfection technology; Intensive care unit; Periurethral cleansing; Povidone-iodine.

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Conflict of interest statement

The authors have no conflicts of interest to declare for the present study.

Figures

Fig. 1
Fig. 1
The periurethral cleansing area in usual periurethral cleansing protocol (in red circles)
Fig. 2
Fig. 2
The periurethral cleansing area in expanded periurethral cleansing protocol (in blue circles)
Fig. 3
Fig. 3
Study design and enrolment
Fig. 4
Fig. 4
Occurrences of Catheter-Associated Urinary Tract Infection in the two groups
See this image and copyright information in PMC

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