Long-term Indwelling Urethral Catheter Research Articles

LBA01-07 MULTI-DISCIPLINARY DEVELOPMENT AND IMPLEMENTATION OF A TRIAL OF VOID ALGORITHM TO REDUCE INDWELLING URETHRAL CATHETER USE

You have accessJournal of UrologyCME1 Apr 2023LBA01-07 MULTI-DISCIPLINARY DEVELOPMENT AND IMPLEMENTATION OF A TRIAL OF VOID ALGORITHM TO REDUCE INDWELLING URETHRAL CATHETER USE David Han, Lovie Amolo, Hersy Contreras, Maureen Lowers Roach, Bridgette Bennett, Maria Sofia Luga, Shelly-Anne Layne, Coraima Rihan Veliz, Subhash Krishnamoorthy, David Weiner, Christopher Anderson, and Gina Badalato David HanDavid Han More articles by this author , Lovie AmoloLovie Amolo More articles by this author , Hersy ContrerasHersy Contreras More articles by this author , Maureen Lowers RoachMaureen Lowers Roach More articles by this author , Bridgette BennettBridgette Bennett More articles by this author , Maria Sofia LugaMaria Sofia Luga More articles by this author , Shelly-Anne LayneShelly-Anne Layne More articles by this author , Coraima Rihan VelizCoraima Rihan Veliz More articles by this author , Subhash KrishnamoorthySubhash Krishnamoorthy More articles by this author , David WeinerDavid Weiner More articles by this author , Christopher AndersonChristopher Anderson More articles by this author , and Gina BadalatoGina Badalato More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003360.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prolonged indwelling catheter use is a risk factor for catheter-associated urinary tract infections (CAUTIs). To reduce catheter use among post-operative patients, we sought to create and implement a novel algorithm to standardize the removal of indwelling Foley catheters. METHODS: We partnered with nursing leadership and the General Surgery Department to develop an evidence-based trial of void algorithm for a surgical Step-Down Unit at an urban teaching hospital [Figure 1A]. Our cohort included post-operative patients treated with intraabdominal, thoracic, vascular, and gynecologic surgeries; patients having urologic surgeries with an imperative indication for a long-term indwelling urethral catheter were excluded from the algorithm but included in analysis. The primary outcome was mean cumulative indwelling urethral catheter days (ex. if 2 patients had catheters for 3 and 7 days, then cumulative catheter days would be 10). We also measured mean total patient days (as a surrogate for patient volume), mean daily number of patients with catheters, and the number of CAUTIs, which are all nationally reported outcomes from the Centers for Disease Control and Prevention. Another surgical unit where the algorithm was not implemented was used as a natural control. We analyzed changes in relevant outcomes 90 days before and after algorithm implementation. RESULTS: The mean number of hospitalized patient days before and after algorithm introduction did not differ on the Step-Down Unit (32.2 vs. 32.0, p=0.60). After implementation, mean cumulative catheter days decreased (14.8 vs. 9.9, p<0.01), as did mean daily number of patients with catheters (3.7 vs. 3.1, p=0.02). Measures of catheter use variation also decreased [Figure 1B]. There was one CAUTI before and after algorithm implementation, the latter deemed potentially associated with algorithm non-adherence on root cause analysis. Measures of catheter use in the surgical floor control group did not differ for any outcome (p>0.05) over the same time-period. CONCLUSIONS: A multi-disciplinary approach to standardize catheter care with an evidence-based trial of void algorithm is feasible and effective in reducing catheter use. Further expansion of this pilot is needed to establish an impact on the associated rate of CAUTI. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1178 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Han More articles by this author Lovie Amolo More articles by this author Hersy Contreras More articles by this author Maureen Lowers Roach More articles by this author Bridgette Bennett More articles by this author Maria Sofia Luga More articles by this author Shelly-Anne Layne More articles by this author Coraima Rihan Veliz More articles by this author Subhash Krishnamoorthy More articles by this author David Weiner More articles by this author Christopher Anderson More articles by this author Gina Badalato More articles by this author Expand All Advertisement PDF downloadLoading ...

Long-term outcomes of urethral catheterisation injuries: a prospective multi-institutional study.

There are no prospective data describing the incidence and spectrum of long-term complications associated with traumatic urethral catheterisation (UC). We prospectively monitored the long-term clinical outcomes and complications of patients with traumatic UC injuries. A prospective study at two tertiary university hospitals was performed to record all referrals for iatrogenic urethral injuries caused by UC. Long-term follow-up was prospectively maintained by regular outpatient department visits and by monitoring all urological interventions and their outcomes from urinary catheter-related injuries. The incidence of traumatic UC was 13.4 per 1000 catheters inserted in male patients and 37 iatrogenic urethral injuries were recorded. The mean age was 74 ± 12years and the mean length of follow-up was 37 ± 3.7months. Urethral injuries were caused by inflating the catheter anchoring balloon in the urethra (n = 26) or by creating a false passage with the catheter tip (n = 11). In total, 29 patients (78%) developed urethral stricture disease during their follow-up; of which 11 have required at least one urethral dilation and two have required one urethrotomy. Three patients required long-term indwelling suprapubic catheter placement and seven patients opted for a long-term indwelling urethral catheter. There were eight patient mortalities; one of which was due to severe urosepsis resulting from catheter balloon inflation in the urethra. Catheter-related injuries are associated with significant long-term complications in this vulnerable patient cohort. In future, such injuries may be preventable if the safety profile of the urinary catheter is modified.

Candida albicans Fungaemia following Traumatic Urethral Catheterisation in a Paraplegic Patient with Diabetes Mellitus and Candiduria Treated by Caspofungin.

A 58-year-old paraplegic male, with long-term indwelling urethral catheter, developed catheter block. The catheter was changed, but blood-stained urine was drained intermittently. A long segment of the catheter was seen lying outside his penis, which indicated that the balloon of Foley catheter had been inflated in urethra. The misplaced catheter was removed and a new catheter was inserted correctly. Gentamicin 160 mg was given intravenously; meropenem 1 gram every eight hours was prescribed; antifungals were not given. Twenty hours later, this patient developed distension of abdomen, tachycardia, and hypotension; he was not arousable. Computed tomography of abdomen revealed inflamed uroepithelium of right renal pelvis and ureter, 4 mm lower ureteric calculus with gas in right ureter proximally, and vesical calculus containing gas in its matrix. Urine and blood culture yielded Candida albicans. Identical sensitivity pattern of both isolates suggested that the source of the bloodstream infection was most likely urine. Both isolates formed consistently high levels of biofilm formation in vitro as assessed using a biofilm biomass stain, and high levels of resistance to voriconazole were observed. Both amphotericin B and caspofungin showed good activity against the biofilms. HbA1c was 111 mmol/mol. This patient was prescribed human soluble insulin and caspofungin 70 mg followed by 50 mg daily intravenously. He recovered fully from candidemia.

Transvaginal Bladder Neck Closure With Posterior Urethral Flap for Devastated Urethra

To present a modified transvaginal bladder neck closure (TV BNC) technique using a posterior urethral flap to minimize the potential risk of ureteral injury and fistula formation. Urethral and bladder neck destruction owing to chronic indwelling urethral catheters in female neurogenic patients is a devastating complication. A retrospective review was performed of all patients undergoing TV BNC at a single institution during a 3-year period. All patients had had a nonfunctional or destroyed urethra because of a long-term indwelling urethral catheter. In brief, the devastated outlet was closed using the dorsally bivalved urethra as a flap that was rotated cephalad onto the incised anterior bladder wall for closure, thereby rotating the suture line high into the retropubic space. A postoperative cystogram was obtained at 2-3 weeks. A total of 11 consecutive female patients with a devastated outlet underwent TV BNC, as described, with placement of a suprapubic tube. One patient experienced failure at 6 weeks postoperatively. The mean follow-up for the entire cohort was 9.6 months (range 1-36). Serial upper tract imaging at the last follow-up visit revealed no new hydroureteronephrosis. The results of our study have shown that TV BNC with a posterior urethral flap provides satisfactory early results. This technique creates a suture line far removed from the ureteral orifices, minimizing the risk of upper tract injury during closure. Also, the rotation of the posterior urethra onto the anterior bladder wall secures the suture line high into the retropubic space, minimizing the risk of failure and postoperative fistula formation.

Effect of spinal cord injury upon prostate: adenocarcinoma of prostate in a spinal cord injury patient - a case report

IntroductionFollowing spinal cord injury, prostate undergoes atrophy probably due to interruption of neuro-hormonal pathways. The incidence of carcinoma of prostate is lower in patients with spinal cord injury above T-10 than in those with lesion below T-10.Case presentationA Caucasian male sustained T-4 paraplegia in 1991 at the age of 59-years. He had long-term indwelling urethral catheter. In May 1995, routine blood test showed prostate-specific antigen to be 17.7 mg/ml. Prostate biopsy revealed moderately differentiated primary adenocarcinoma of prostate; Gleason score was 3+3. Bone scans showed no evidence of metastatic bone disease. Bilateral orchidectomy was performed in September 1995. MRI of pelvis revealed no evidence of spread beyond prostatic capsule. There was no pelvic lymphadenopathy. In October 1996, this patient got chest infection and recovered fully after taking amoxicillin. In February 2001, he developed pneumonia and was prescribed cefuroxime intravenously. In March 2001, cystoscopy and electrohydraulic lithotripsy of vesical calculi were carried out. In August 2001, this patient was admitted to spinal unit for management of pressure sores. He expired on 28 June 2002 in local hospital. Cause of death was recorded as acute ventricular failure, congestive heart failure, chronic respiratory failure and spinal cord injury.ConclusionAlthough prostate gland undergoes atrophy in men who sustained spinal cord injury in early age, physicians should be vigilant and look for prostatic diseases particularly in men, who have sustained spinal cord injury during later period of life. Patients with cervical and upper dorsal lesions are at risk of developing potentially life-threatening chest complications after major surgical procedures including radical prostatectomy. Therefore, it may be advisable to consider chemoprevention of prostate cancer with Finasteride, especially in men, who sustained cervical and upper dorsal spinal cord injury during later part of their life.

Post-traumatic female urethral reconstruction

Post-traumatic urethral damage resulting in urethrovaginal fistulas or strictures, though rare, should be suspected in patients who have unexpected urinary incontinence or lower urinary tract symptoms after pelvic surgery, pelvic fracture, a long-term indwelling urethral catheter, or pelvic radiation. Careful physical examination and cystourethroscopy are critical to diagnose and assess the extent of the fistula. A concomitant vesicovaginal or ureterovaginal fistula should also be ruled out. The two main indications for reconstruction are sphincteric incontinence and urethral obstruction. Surgical correction intends to create a continent urethra that permits volitional, painless, and unobstructed passage of urine. An autologous pubovaginal sling, with or without a Martius flap at time of reconstruction, should be considered. The three approaches to urethral reconstruction are anterior bladder flaps, posterior bladder flaps, and vaginal wall flaps. We believe vaginal flaps are usually the best option. Options for vaginal repair of fistula include primary closure, peninsula flaps, bilateral labial pedicle flaps, and labial island flaps. Outcomes are optimized by using exacting surgical principles during repair and careful postoperative management by an experienced reconstructive surgeon.

Long catheter sign: a reliable bedside sign of incorrect positioning of foley catheter in male spinal cord injury patients

IntroductionIndwelling urethral catheter is often used in male spinal cord injury patients to provide drainage to neuropathic bladder. If the balloon of a Foley catheter is inflated in urethra or, when a properly inserted Foley catheter is later pulled and thereby, the Foley balloon comes to lie in urethra, an excessive length of catheter will remain outside the penis. This sign is termed "long catheter sign". Long catheter sign will also be positive when Foley catheter slips out of urinary bladder in situations where Foley balloon is ruptured by a spiky vesical calculus or deflated due to a defective valve.Case PresentationA fifty-year-old Caucasian male with paraplegia at T-5 level had been managing neuropathic bladder by long-term indwelling urethral catheter. During his stay in spinal unit, the patient felt that there had been a tug on the drainage tube when he was being turned during night as part of the routine care for relief of pressure. Next morning, a health professional noticed that a long segment of catheter was lying outside penis. There was no bleeding from urethral meatus. Catheter continued to drain urine, which was yellowish in colour. Urine output was satisfactory. This patient did not develop any clinical feature of autonomic dysreflexia nor was he feeling unwell. In view of positive long catheter sign, radiological studies were performed to check the position of Foley catheter, which confirmed the clinical impression of incorrectly positioned Foley catheter. The catheter was removed; flexible cystoscopy was performed. A 16 Fr, 20 ml balloon Foley catheter was inserted over a 0.032" guide wire. Following this procedure, a considerably shorter length of Foley catheter remained outside the penis.ConclusionPositive long catheter sign indicates that the Foley catheter is placed incorrectly and needs repositioning urgently. Prompt recognition of long catheter sign and immediate repositioning of Foley catheter will help to prevent complications such as chronic distension of urinary bladder, urine infection, and pressure necrosis of urethra especially if Foley balloon remains inflated within urethra for a long period. In this patient, use of a Foley catheter with 20 ml balloon, and securing the drainage tube to thigh with two straps, helped to prevent inadvertent pull of Foley balloon into the urethra.

Fatality due to septicemia and hemorrhage in a patient with spinal cord injury and ischemic heart disease with the need for long-term catheter drainage

Percutaneous suprapubic cystostomy is generally considered to be a safe procedure provided the bladder is distended adequately, as palpable bladder is the landmark for insertion of a trocar. This report describes fatality due to septicemia and hemorrhage following suprapubic catheter insertion in a tetraplegic male patient with long-term indwelling urethral catheter drainage and urine infection with Escherichia coli, Pseudomonas species, and Enterococcus faecalis. Before the surgical procedure was begun, the urinary bladder was distended by repeated injection of 50 mL of sterile, 0.9% sodium chloride through the urethral catheter with a catheter-tip syringe until the bladder became palpable in the suprapubic region; by this time, the bladder had been filled forcibly with 500 mL of saline. Percutaneous cystostomy was performed with the use of an Add-a-Cath trocar and cannula (Femcare Limited, Nottingham, Nottinghamshire, UK). Immediately after a 16 French Foley catheter had been inserted, the drainage fluid appeared heavily stained with blood. The patient developed septicemia, and a blood culture report, received posthumously, showed growth of E. coli. Despite resuscitative measures, the patient expired 13 hours after suprapubic catheter insertion. Postmortem examination revealed bilateral hydronephrosis with fluid and clotted blood in the renal pelves and ureters; the urinary bladder showed a thick wall and hemorrhagic mucosa. This fatal incident raises the question of whether forcible distention of the urinary bladder for percutaneous cystostomy is safe in patients with spinal cord injury who have a small-capacity bladder, infected urine, and ischemic heart disease. In such patients, it may be prudent to avoid forcible distention of the urinary bladder and instead perform ultrasound-guided or fluoroscopically guided suprapubic cystostomy.

Meanings and practical knowledge of people with long-term urinary catheters

The lived experience of people with long-term indwelling urethral catheters is described and interpreted. This hermeneutic (interpretive) phenomenologic study used Merleau-Ponty's philosophy and van Manen's methodology. Fourteen adults aged 35 to 95 years who had worn a catheter more than 4 months (range = 6 months to 18 years) comprised the purposive sample. Data were obtained through audiotaped and transcribed interviews conducted in the homes of participants. The study provided both meanings and practical knowledge related to the experience of catheter use. Despite its drawbacks, participants recognized the device's value in their daily lives and weighed its positive features against concerns associated with long-term use. Individual meanings included making aesthetic harmony with a new catheter, the convenience of the catheter compared with the inconvenience of incontinence, and the catheter as a symbol and reminder of one's mortality. Practical knowledge related to participants' awareness of their catheter needs and practices, such as features of supplies, intervals for changes, catheter insertions, emptying the urine bag, and changes associated with sex. Knowledge of the lived experience with a urinary catheter can assist nurses in sensitive decision making about care and help them become better patient advocates. (J WOCN 2003;30:33-43.)

Meanings and Practical Knowledge of People With Long-term Urinary Catheters

In Brief The lived experience of people with long-term indwelling urethral catheters is described and interpreted. This hermeneutic (interpretive) phenomenologic study used Merleau-Ponty's philosophy and van Manen's methodology. Fourteen adults aged 35 to 95 years who had worn a catheter more than 4 months (range 6 months to 18 years) comprised the purposive sample. Data were obtained through audiotaped and transcribed interviews conducted in the homes of participants. The study provided both meanings and practical knowledge related to the experience of catheter use. Despite its drawbacks, participants recognized the device's value in their daily lives and weighed its positive features against concerns associated with long-term use. Individual meanings included making aesthetic harmony with a new catheter, the convenience of the catheter compared with the inconvenience of incontinence, and the catheter as a symbol and reminder of one's mortality. Practical knowledge related to participants' awareness of their catheter needs and practices, such as features of supplies, intervals for changes, catheter insertions, emptying the urine bag, and changes associated with sex. Knowledge of the lived experience with a urinary catheter can assist nurses in sensitive decision making about care and help them become better patient advocates. A hermeneutic phenomenological study of the lived experience of fourteen adults with long-term, indwelling urethral catheters.

Nerve fibres in urothelium and submucosa of neuropathic urinary bladder: an immunohistochemical study with S-100 and neurofilament.

Intravesical administration of drugs has been used commonly in spinal cord injury patients to suppress detrusor hyperreflexia (eg oxybutynin, verapamil, terodiline) or, to initiate a micturition reflex (eg 15S 15-methyl prostaglandin F2 alpha, protaglandin E2); however, the response has been variable and sometimes, unpredictable. This prompted us to study the presence of nerve fibres in the vesical urothelium and submucosa in mucosal biopsies taken from the dome and trigone (obtained prior to performing a therapeutic procedure eg, vesical lithotripsy, or a diagnostic cystoscopy) in 47 consecutive, unselected paraplegic/tetraplegic patients with a neuropathic urinary bladder. Nerve fibres were demonstrated by routine immunohistochemical technique using commercially available monoclonal and polyvalent antibodies against S-100 (DAKO A/S, Glostrup, Denmark) and Neurofilament (MILAB, Malmo, Sweden). Biopsy specimens were graded for the presence of nerve fibres on a 0-3 scale for urothelium, and superficial/deep submucosa separately in a blind and randomised manner. Virtually no fibre presence was found in one paraplegic patient and no superficial or single fibres were noted in a tetraplegic patient. Absence of C-fibre hyperplasia (Grade 0) was found in nine cases (paraplegic: 4; tetraplegic: 5); Grade 1 hyperplasia was observed in 17 cases (paraplegic: 4; tetraplegic: 13); Grade 2 hyperplasia was seen in 11 cases (paraplegic: 7; tetraplegic 4); and Grade 3 hyperplasia was noticed in eight cases (paraplegic 3: tetraplegic: 5). The magnitude of C-fibre hyperplasia was not significantly different between paraplegic and tetraplegic patients (chi(2) = 4.64; P = 0.3262). The relationship, if any, between the degree of C-fibre hyperplasia and duration of paralysis was studied by categorising patients as < 5 years, and > 5 years of paralysis. No evidence of single fibre or fibre bundle hyperplasia (Grade 0) was seen in five and six cases, grade 1 hyperplasia in six and 11 cases, grade 2 hyperplasia in two and nine cases, and grade 3 hyperplasia in three and five cases respectively in these two categories of patients. (chi(2) = 1.92; P = 0.58). The possible relationship between C-fibre hyperplasia in the vesical mucosa/submucosa and (i) the vesical response to intravesical drug administration; (ii) the vesical urothelial proliferation arrest; (iii) the electrical stimulation of urinary bladder by implanted electrodes (sacral anterior root stimulator); and (iv) long-term indwelling urethral Foley catheter drainage, are discussed with illustrative case reports. In conclusion, mucosal biopsy and study of nerve fibres in urothelium and submucosa of neuropathic bladder has helped to generate hypotheses on the association between C-fibre hyperplasia and response to intravesical pharmacotherapy and the predictive value of such a study in identifying those patients who are likely to respond to intravesical pharmacotherapy.

The use of intraurethral prostatic spiral in high risk patients for surgery with benign prostatic hyperplasia.

Under local anaesthesia, 31 patients underwent insertion of an expandable stainless steel tubular spiral into the prostatic urethra under fluoroscopic control. All were considered to be at major risk from prostatic surgery. Most of them had long-term indwelling urethral catheters (14 patients). The spiral allowed unobstructed voiding and is a good alternative to an indwelling urethral catheter. We recommend insertion of a spiral in patients with urinary obstruction if they are unfit for surgery.

Urological outcome in female patients with spinal cord injury: the effectiveness of intermittent catheterisation

A review of 52 female patients with spinal cord injury is presented. Twenty five of 38 patients seen within 3 months of their injury were discharged on a clean intermittent catheterisation regime. Of the 14 patients seen at an interval of 3 months or greater after the injury, only 3 practised clean intermittent catheterisation but 8 had a long-term indwelling urethral catheter as the method of management. At 49 months median follow-up, only 14 (50%) continue on the programme of intermittent catheterisation and 9 (32%) are dry. This lack of success was due to incontinence, despite drug therapy in 17 patients. Recurrent symptomatic urinary tract infection occurred in 10 (36%). Thirteen of the 14 patients (92%) on long-term indwelling urethral catheter developed complications. Five patients voided normally. Automatic bladder emptying was employed in only 2 patients but was associated with the development of a non-functioning kidney in 1 and severe incontinence in another. Upper tract changes occurred in 7 patients (13%) including 3 on indwelling catheter drainage and 2 on intermittent catheterisation. Four patients have had implantation of the Brindley intradural sacral anterior root stimulator because of recurrent symptomatic urinary tract infections and incontinence in all 4. Post-operatively the incidence of infection has been reduced. Improvement in the degree of incontinence is related to the completion of posterior root section. Those patients who have no alternative to long-term catheter drainage are managed by the suprapubic route to avoid urethral incompetence. This is combined with catheter clamping for 2 hours daily to maintain bladder capacity and anti-cholinergic therapy to reduce detrusor contractility.(ABSTRACT TRUNCATED AT 250 WORDS)

Use of bladder washouts: a study of nurses' recommendations.

The performance of intermittent bladder washouts by nurses for patients with long-term indwelling urethral catheters forms a frequent aspect of nursing practice. This study has interviewed 106 hospital and district nurses to establish their recommendations concerning the use of intermittent bladder washouts. Information collected comprised: when a bladder washout should be performed, its frequency, the solutions to be used and the rationale for its prescription. It was concluded that nurses' recommendations were not always correct or consistent, and that there is a need for further education regarding the use of bladder washouts so that recommendations are based upon scientific evidence. The implications of the findings for nursing practice and the need for fundamental research are discussed.

Study of Information Given by Nurses for Catheter Care to Patients

Patients who are to use a long-term undwelling urethral catheter, and their informal carers, require knowledge and information for its successful management. Education of both patients and carers regarding catheter care has been recommended but not always came out in practice. This study has investigated the information given by 106 hospital and district nurses to patients who are to use an indwelling urethral catheter in the community, and their carers. It was concluded that the information given for catheter care was not comprehensive nor consistent and differed according to the nurse's location of work. The implications this has for nursing practice are a need for further education of nurses regarding catheter care and improved teaching of patients who are to use a long-term indwelling urethral catheter, and their carers.

Long-term catheter-associated bacteriuria: species at low concentration

Polymicrobial bacteriuria in patients with long-term (≥ 30 days) indwelling urethral catheters is common and is associated with potentially serious acute and long-term complications. The dynamics of organisms at low concentration (< 10 5 cfu/mL) in this setting has not been well-characterized; however, in patients with short-term catheters organisms initially present at low concentration (<10 5 cfu/mL) usually grow to high concentration (≥10 5 cfu/mL). At the time of catheter replacement for 7 long-term catheterized patients who were not receiving antibiotics, we identified all species at ≥10 2 cfu/mL in fresh urine aspirated from the old indwelling catheter and the new sterile replacement catheter and then determined which of these species were present at high concentration two weeks later. A total of thirty-seven species, nineteen at high and eighteen at low concentration were detected in either the old or the new catheters. Eighteen of the nineteen initially detected at high concentration but only one of the eighteen initially detected at low concentration (p < 0.001) were present at high concentration two weeks later. In patients with long-term indwelling urethral catheters, the number and multiplicity of species causing bacteriuria at low concentration rival that of species at high concentration; however, species at low concentration usually do not grow to high concentration in the presence of other species at high concentration.

Cephalexin for Susceptible Bacteriuria in Afebrile, Long-term Catheterized Patients

Patients with long-term indwelling urethral catheters are subject to acute and long-term complications of bacteriuria. To evaluate the common practice of short-course antibiotic therapy in such patients, we performed a randomized controlled trial of ten-day courses of cephalexin monohydrate repeated whenever a susceptible bacteriuria was present. We observed 17 cephalexin group patients for 545 patient-weeks (160 cephalexin courses) and 18 control group patients for 477 patient-weeks. Throughout the study, the groups were comparable in regard to incidence and prevalence of bacteriuria, number of bacterial strains per weekly urine specimen, incidence of febrile days, and incidence of obstructed catheters. In the cephalexin group, the frequency of fever during periods when antibiotics were being used was similar to that during periods when antibiotics were not being used. More cephalexin-resistant bacteria were isolated from cephalexin group patients. Routine treatment with cephalexin of asymptomatic long-term catheterized patients, even for susceptible organisms, does not seem to be warranted.