Best Practices & Benign Disease
Introduction & Objective : Rates of positive urine cultures (PUC) in patients undergoing bedside urologic procedures (BUP) compared to foley catheter placement (FCP) are poorly represented in available literature. We report our experience with PUC in patients undergoing FCP versus BUP, as well as risk factors for development of PUC and antibiotic-resistant bacteria.
A retrospective analysis was performed of a prospectively maintained database of patients between 1/2015 and 12/2017. Type of procedure was indexed (catheter alone, cystoscopy, urethral dilation, suprapubic catheter), as well as pre- and post-procedural novel PUC (NPUC), defined as no prior culture present, a prior negative culture, or a culture with a newly represented organism obtained within 30 days of the procedure. Fisher’s exact test and multivariable logistic regression were performed to assess the comparative risk of NPUC associated with each procedure.
141 patients met criteria for analysis. 73.0% of patients had successful FCP alone (n=103), while 27% required BUP (n=38). BUP included cystoscopy (n=14), cystoscopy with dilation (n=18) and suprapubic tube placement (n=6). 11.3% of patients also underwent recurrent FCP during the study period (n=16).
The total incidence of NPUC was 9.9% (n=14) and the median time to NPUC was 19.0 days. 57.1% of NPUC had growth of an antibiotic resistant organism (n=8). NPUC occurred in 13.5% of patients undergoing BUP (n=5) and 6.4% of patients with FCP (n=9). There was no significant difference in NPUC between patients undergoing BUP versus FCP (RR 1.42, CI CI 0.66-3.04; p=0.522) or patients undergoing recurrent FCP (RR 2.27, CI 0.73-7.08; p=0.172). Previous PUC was associated with an increased risk of development of NPUC (RR 9.07, CI 3.38-24.36; p<0.001) as well as a subsequent antibiotic-resistant PUC (RR 8.31, CI 3.17-21.82; p=0.002). Logistic regression revealed that previous PUC was the only significant predictor of NPUC (OR 16.39, CI 3.48-32.26; p<0.001) and antibiotic resistant PUC (OR 71.43, CI 5.49-1000.00; p=0.001), when taking into account type of procedure, repeat difficult catheter placement, and medical comorbidities.
There is no difference in NPUC or the development of antibiotic resistance between bedside urologic procedures and foley catheter placement. Recurrent difficult foley catheter placement also does not increase this risk. Previous PUC significantly increases the risk of NPUC and the development of antibiotic resistant bacteria, likely secondary to previous antibiotic therapy and patient-specific factors. Future research should examine antibiotic usage in these patients.