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Suprapubic catheter placement improves antimicrobial stewardship among Veterans Affairs nursing care facility residents
ARTICLE IN PRESS American Journal of Infection Control 000 (2020) 1−3
Contents lists available at ScienceDirect
American Journal of Infection Control journal homepage: www.ajicjournal.org
Brief Report
Suprapubic catheter placement improves antimicrobial stewardship among Veterans Affairs nursing care facility residents Deanna J. Buehrle PharmD a,*, Cornelius J. Clancy MD a,b, Brooke K. Decker MD, CIC a a b
Division of Infectious Diseases, Department of Medicine, VA Pittsburgh Healthcare System, Pittsburgh, PA Department of Medicine, University of Pittsburgh, Pittsburgh, PA
Key Words: Urinary catheters Nursing facility Antibiotics
In a Veterans Affairs nursing facility, suprapubic catheters were associated with significantly fewer urinary tract infections (catheter-associated urinary tract infection) than were indwelling urinary catheters (mean: 0.95 vs 4.5/1,000 device-days, P = .05) among 18 patients with a history of both catheter types. Suprapubic catheters were associated with significantly shorter antibiotic treatment courses for catheter-associated urinary tract infection or asymptomatic bacteriuria (mean: 28.3 vs 88.8 days, P = .02). Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc.
Urinary tract infections (UTIs) are a leading reason for antibiotic use in skilled nursing facilities (SNFs).1 Urinary catheters are a major risk factor for the development of UTI in SNF residents.2 However, definitions of catheter-associated urinary tract infection (CAUTI) lack specificity, and CAUTIs often are difficult to distinguish from asymptomatic bacteriuria that does not require antibiotic treatment. These factors contribute to antibiotic over-prescribing in catheterized patients. Annual antibiotic prescription rates in SNF residents in the United Kingdom with and without urinary catheters were 440 and 188/100 persons, respectively.3 Suprapubic and indwelling urethral catheters (SCs, IUCs) commonly are used for long-term catheterization. Since SCs require surgical placement, they often are a last-line option. Some, but not all, studies in acute care settings have shown that SCs decrease CAUTIs compared to IUCs.4-7 The impact of catheter type on CAUTI frequency is not extensively investigated in long-term care settings. A recent study demonstrated, for the first time, that SCs were associated with fewer CAUTIs in SNF residents than IUCs.8 The Centers for Disease Control and Prevention have endorsed research on risks and benefits of SCs as an alternative to IUCs.9 In this study, we determined if incidence of CAUTIs and asymptomatic bacteriuria associated with SCs or IUC differed in SNF residents who had each type of catheter at various times. We also compared antibiotic usage between SC and IUC periods. We hypothesized that SCs were associated with
lower rates of CAUTI and asymptomatic bacteriuria, and less antimicrobial use. METHODS We conducted a retrospective cohort study of unique VA Pittsburgh Healthcare System SNF residents with SCs placed from February 2015 to March 2018. We included patients with an SC for ≥30 days who had a prior IUC for ≥30 days. Patients were excluded if they had a urologic malignancy or urologic care outside the VA system. Each patient served as their own control, and demographic, laboratory, microbiologic, and antibiotic data were compared for each patient over the same number of days for IUC and SC periods (eg, if an SC was in place for 3 months, we assessed the first 3 months of IUC use). CAUTI was defined by presence of UTI symptoms with no other identified source and 103 colony-forming units per milliliter (CFU/mL) of ≥1 bacterial species in a single catheter urine specimen or midstream voided urine specimen from a patient whose catheter had been removed within the previous 48 hours.10 Asymptomatic bacteriuria was defined by ≥105 CFU/mL of bacteria in a urine specimen from a patient with an IUC or SC who lacked UTI symptoms. Dichotomous and continuous variables were compared using Fisher exact and Mann-Whitney tests, respectively. P values ≤.05 (2-tailed) were considered significant. RESULTS
* Address correspondence to Deanna Buehrle, PharmD, Division of Infectious Diseases, Department of Medicine, VA Pittsburgh Healthcare System, 4100 Allequippa Street, Pittsburgh, PA 15213 E-mail address: [email protected] (D.J. Buehrle). Conflicts of interest: All authors report no conflicts of interest relevant to this article.
Eighteen patients with SC and a prior IUC were included. Median age at time of SC placement was 74.5 years (range: 57-91 years); all patients were men. IUCs and SCs were in place for a median of 213 days (range: 49-1,085; 4,881 device-days in total for each
https://doi.org/10.1016/j.ajic.2020.01.005 0196-6553/Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc.
ARTICLE IN PRESS D.J. Buehrle et al. / American Journal of Infection Control 00 (2020) 1−3
2
Table 1 Outcomes in nursing facility residents with indwelling urethral catheters and suprapubic catheters
Mean number of urine cultures collected per 1,000 device-days Mean rate of CAUTI per 1,000 device-days* Mean antimicrobial days of therapy for CAUTI per 1,000 device-days Mean rate of asymptomatic bacteriuria per 1,000 device-days Mean antimicrobial days of therapy for asymptomatic bacteriuria per 1,000 device-days Mean antimicrobial days of therapy for CAUTI or asymptomatic bacteriuria per 1,000 device-days
Indwelling urinary catheter period (N = 4,881 device-days)
Suprapubic catheter period (N = 4,881 device-days)
P Value
20.2 (SD 13.3) 4.5 (SD 7.3) 53.6 (SD 83.9) 9.4 (SD 10.7) 35.2 (SD 48.4)
8.5 (SD 14.9) 0.95 (SD 1.9) 8.4 (SD 16.6) 7.6 (SD 14.3) 20.4 (SD 33.7)
.02 .05 .03 .66 .30
88.8 (SD 87.5)
28.3 (SD 43.3)
.02
CAUTI, catheter-associated urinary tract infection; SD, standard deviation. *The most common CAUTI-causing organisms were Pseudomonas aeruginosa in (n = 5), Klebsiella pneumoniae (n = 3), Candida albicans (n = 2), Enterococcus faecalis (n = 2), Staphylococcus aureus (n = 2); >100,000 CFU of mixed flora were reported for 4 CAUTIs.
catheter type). Indications for catheterization were urinary retention in 67% (12/18) of patients, neurogenic bladder in 28% (5/18), and decubitus ulcer healing in 5% (1/18). Underlying diseases included benign prostatic hyperplasia in 56% (10/18) of patients, multiple sclerosis in 11% (2/18), Parkinson’s disease in 11% (2/18), and other conditions (cerebrovascular accident, traumatic brain injury, and detrusor areflexia) in 17% (3/18). Thirty-nine percent (7/18) and 22% (4/18) of patients received at least 1 antibiotic course for treatment of CAUTI during IUC and SC periods, respectively (P = .47). Forty-four percent (8/18) and 39% (7/18) of patients received at least 1 antibiotic course for asymptomatic bacteriuria during the respective periods. Compared to IUCs, SCs were associated with significantly fewer urine cultures being performed, lower CAUTI rates, and fewer days of antibiotic therapy (Table 1). There were no significant differences between IUCs and SCs in rates or days of antibiotic treatment of asymptomatic bacteriuria. Overall, mean days of antibiotic therapy for CAUTI or asymptomatic bacteriuria were significantly lower in the SC period. DISCUSSION We demonstrated that SCs were associated with significantly lower rates of CAUTI and fewer days of antibiotic therapy for CAUTI or for CAUTI plus asymptomatic bacteriuria than IUCs among VA SNF residents. These results are in keeping with those of a recent study of community-based SNF residents with urinary catheters, in which SCs were associated with significantly lower rates of CAUTI (6.6 vs 8.8/ 1,000 device-days) and less use of antibiotics within the preceding 30 days than IUCs.8 Our study design differed from that of the earlier report by comparing CAUTI rates and other endpoints in individual patients during periods of catheterization with SCs or IUCs, rather than making comparisons across groups of patients. Since patients had SCs after IUCs, the cumulative duration of catheterization was greater during the SC period, as were the risks of exposure to health care-associated pathogens and antimicrobials. Nevertheless, SCs were associated with significant infection prevention and antimicrobial stewardship benefits. Our design acknowledges that many patients with an SC have had an IUC previously. The fact that 2 studies employing different methods found that CAUTI rates and antibiotic consumption were lower with SCs than IUCs supports the validity of the data. A plausible explanation for lower CAUTI rates with SCs is that they lessen the risk of infection by avoiding urogenital and enteric flora found in the perineal region. There are limited other data comparing SC- and IUC-associated infections in long-term care settings. In a study of spinal cord injury patients, SCs and IUCs did not differ in rates of CAUTIs, calculi, or cancer.11 A review of literature on long-term bladder drainage found that SCs were associated with higher patient satisfaction and lower rates of urethral injury and other mechanical complications, but no
reduction in symptomatic CAUTIs.12 Data from more extensive literature in acute care settings likewise are mixed. In a meta-analysis of studies of gynecologic surgery patients, CAUTI rates were significantly lower with SCs than IUCs but the risk of mechanical complications was increased.4 SCs were associated with less bacteriuria and recatheterization than IUCs in a meta-analysis of studies of patients who underwent abdominal surgery.6 A Cochrane meta-analysis looking at short-term catheterization in hospitalized patients found that SCs were associated with less asymptomatic bacteriuria, recatheterization, and pain, but data were insufficient for a conclusion about symptomatic CAUTIs.7 We did not find significantly less asymptomatic bacteriuria with SCs, despite the reduction in CAUTIs. Reduced antibiotic utilization with SCs in our patients was driven by decreased treatment of CAUTIs. CONCLUSIONS Multifaceted interventions that include technical (aseptic techniques, regular catheter assessment, and routine hygiene) and socioadaptive strategies (team building and engagement) have been shown to reduce CAUTI rates in SNFs.13 Our data suggest that use of SCs over IUCs may be helpful as part of such infection prevention interventions, if a choice between options is available for a patient. To date, we have not observed the emergence of multidrug-resistant bacteria in our patients with SCs, as was reported in a previous study.8 We recognize that our conclusions are limited by the small sample size, and that our experience at a single VA SNF may not be applicable to other settings. Since data on the benefits of SCs versus IUCs are conflicting, facilities should make decisions on long-term catheterization based on local experience and circumstances in individual patients. Multicenter, prospective studies are needed to establish definitively if the type of long-term catheter impacts CAUTI, asymptomatic bacteriuria and inappropriate antibiotic usage rates in SNFs and other long-term care facilities. References 1. Benoit SR, Nsa W, Richards CL, et al. Factors associated with antimicrobial use in nursing homes: a multilevel model. J Am Geriatr Soc. 2008;56:2039–2044. 2. Strausbaugh LJ, Joseph CL. The burden of infection in long-term care. Infect Control Hosp Epidemiol. 2000;21:674–679. 3. Sundvall PD, Stuart B, Davis M, Roderick P, Moore M. Antibiotic use in the care home setting: a retrospective cohort study analysing routine data. BMC Geriatr. 2015;15:71. 4. Healy EF, Walsh CA, Cotter AM, Walsh SR. Suprapubic compared with transurethral bladder catheterization for gynecologic surgery: a systematic review and meta-analysis. Obstet Gynecol. 2012;120:678–687. 5. Orikasa S, Kanbe K, Shirai S, Shintaku I, Kurosu S. Suprapubic versus transurethral bladder drainage after radical prostatectomy: impact on patient discomfort. Int J Urol. 2012;19:587–590. 6. McPhail MJ, Abu-Hilal M, Johnson CD. A meta-analysis comparing suprapubic and transurethral catheterization for bladder drainage after abdominal surgery. Br J Surg. 2006;93:1038–1044.
ARTICLE IN PRESS D.J. Buehrle et al. / American Journal of Infection Control 00 (2020) 1−3 7. Kidd EA, Stewart F, Kassis NC, Hom E, Omar MI. Urethral (indwelling or intermittent) or suprapubic routes for short-term catheterisation in hospitalised adults. Cochrane Database Syst Rev. 2015;12:CD004203. 8. Gibson KE, Neill S, Tuma E, Meddings J, Mody L. Indwelling urethral versus suprapubic catheters in nursing home residents: determining the safest option for longterm use. J Hosp Infect. 2019;102:219–225. 9. Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA, Healthcare Infection Control Practices Advisory Committee. Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol. 2010;31:319–326. 10. Hooton TM, Bradley SF, Cardenas DD, et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 international clinical
3
practice guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010;50:625–663. 11. Katsumi HK, Kalisvaart JF, Ronningen LD, Hovey RM. Urethral versus suprapubic catheter: choosing the best bladder management for male spinal cord injury patients with indwelling catheters. Spinal Cord. 2010;48:325–329. 12. Hunter KF, Bharmal A, Moore KN. Long-term bladder drainage: suprapubic catheter versus other methods: a scoping review. Neurourol Urodyn. 2013;32: 944–951. 13. Mody L, Greene MT, Meddings J, et al. A national implementation project to prevent catheter-associated urinary tract infection in nursing home residents. JAMA Intern Med. 2017;177:1154–1162.
Contents lists available at ScienceDirect
American Journal of Infection Control journal homepage: www.ajicjournal.org
Brief Report
Suprapubic catheter placement improves antimicrobial stewardship among Veterans Affairs nursing care facility residents Deanna J. Buehrle PharmD a,*, Cornelius J. Clancy MD a,b, Brooke K. Decker MD, CIC a a b
Division of Infectious Diseases, Department of Medicine, VA Pittsburgh Healthcare System, Pittsburgh, PA Department of Medicine, University of Pittsburgh, Pittsburgh, PA
Key Words: Urinary catheters Nursing facility Antibiotics
In a Veterans Affairs nursing facility, suprapubic catheters were associated with significantly fewer urinary tract infections (catheter-associated urinary tract infection) than were indwelling urinary catheters (mean: 0.95 vs 4.5/1,000 device-days, P = .05) among 18 patients with a history of both catheter types. Suprapubic catheters were associated with significantly shorter antibiotic treatment courses for catheter-associated urinary tract infection or asymptomatic bacteriuria (mean: 28.3 vs 88.8 days, P = .02). Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc.
Urinary tract infections (UTIs) are a leading reason for antibiotic use in skilled nursing facilities (SNFs).1 Urinary catheters are a major risk factor for the development of UTI in SNF residents.2 However, definitions of catheter-associated urinary tract infection (CAUTI) lack specificity, and CAUTIs often are difficult to distinguish from asymptomatic bacteriuria that does not require antibiotic treatment. These factors contribute to antibiotic over-prescribing in catheterized patients. Annual antibiotic prescription rates in SNF residents in the United Kingdom with and without urinary catheters were 440 and 188/100 persons, respectively.3 Suprapubic and indwelling urethral catheters (SCs, IUCs) commonly are used for long-term catheterization. Since SCs require surgical placement, they often are a last-line option. Some, but not all, studies in acute care settings have shown that SCs decrease CAUTIs compared to IUCs.4-7 The impact of catheter type on CAUTI frequency is not extensively investigated in long-term care settings. A recent study demonstrated, for the first time, that SCs were associated with fewer CAUTIs in SNF residents than IUCs.8 The Centers for Disease Control and Prevention have endorsed research on risks and benefits of SCs as an alternative to IUCs.9 In this study, we determined if incidence of CAUTIs and asymptomatic bacteriuria associated with SCs or IUC differed in SNF residents who had each type of catheter at various times. We also compared antibiotic usage between SC and IUC periods. We hypothesized that SCs were associated with
lower rates of CAUTI and asymptomatic bacteriuria, and less antimicrobial use. METHODS We conducted a retrospective cohort study of unique VA Pittsburgh Healthcare System SNF residents with SCs placed from February 2015 to March 2018. We included patients with an SC for ≥30 days who had a prior IUC for ≥30 days. Patients were excluded if they had a urologic malignancy or urologic care outside the VA system. Each patient served as their own control, and demographic, laboratory, microbiologic, and antibiotic data were compared for each patient over the same number of days for IUC and SC periods (eg, if an SC was in place for 3 months, we assessed the first 3 months of IUC use). CAUTI was defined by presence of UTI symptoms with no other identified source and 103 colony-forming units per milliliter (CFU/mL) of ≥1 bacterial species in a single catheter urine specimen or midstream voided urine specimen from a patient whose catheter had been removed within the previous 48 hours.10 Asymptomatic bacteriuria was defined by ≥105 CFU/mL of bacteria in a urine specimen from a patient with an IUC or SC who lacked UTI symptoms. Dichotomous and continuous variables were compared using Fisher exact and Mann-Whitney tests, respectively. P values ≤.05 (2-tailed) were considered significant. RESULTS
* Address correspondence to Deanna Buehrle, PharmD, Division of Infectious Diseases, Department of Medicine, VA Pittsburgh Healthcare System, 4100 Allequippa Street, Pittsburgh, PA 15213 E-mail address: [email protected] (D.J. Buehrle). Conflicts of interest: All authors report no conflicts of interest relevant to this article.
Eighteen patients with SC and a prior IUC were included. Median age at time of SC placement was 74.5 years (range: 57-91 years); all patients were men. IUCs and SCs were in place for a median of 213 days (range: 49-1,085; 4,881 device-days in total for each
https://doi.org/10.1016/j.ajic.2020.01.005 0196-6553/Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc.
ARTICLE IN PRESS D.J. Buehrle et al. / American Journal of Infection Control 00 (2020) 1−3
2
Table 1 Outcomes in nursing facility residents with indwelling urethral catheters and suprapubic catheters
Mean number of urine cultures collected per 1,000 device-days Mean rate of CAUTI per 1,000 device-days* Mean antimicrobial days of therapy for CAUTI per 1,000 device-days Mean rate of asymptomatic bacteriuria per 1,000 device-days Mean antimicrobial days of therapy for asymptomatic bacteriuria per 1,000 device-days Mean antimicrobial days of therapy for CAUTI or asymptomatic bacteriuria per 1,000 device-days
Indwelling urinary catheter period (N = 4,881 device-days)
Suprapubic catheter period (N = 4,881 device-days)
P Value
20.2 (SD 13.3) 4.5 (SD 7.3) 53.6 (SD 83.9) 9.4 (SD 10.7) 35.2 (SD 48.4)
8.5 (SD 14.9) 0.95 (SD 1.9) 8.4 (SD 16.6) 7.6 (SD 14.3) 20.4 (SD 33.7)
.02 .05 .03 .66 .30
88.8 (SD 87.5)
28.3 (SD 43.3)
.02
CAUTI, catheter-associated urinary tract infection; SD, standard deviation. *The most common CAUTI-causing organisms were Pseudomonas aeruginosa in (n = 5), Klebsiella pneumoniae (n = 3), Candida albicans (n = 2), Enterococcus faecalis (n = 2), Staphylococcus aureus (n = 2); >100,000 CFU of mixed flora were reported for 4 CAUTIs.
catheter type). Indications for catheterization were urinary retention in 67% (12/18) of patients, neurogenic bladder in 28% (5/18), and decubitus ulcer healing in 5% (1/18). Underlying diseases included benign prostatic hyperplasia in 56% (10/18) of patients, multiple sclerosis in 11% (2/18), Parkinson’s disease in 11% (2/18), and other conditions (cerebrovascular accident, traumatic brain injury, and detrusor areflexia) in 17% (3/18). Thirty-nine percent (7/18) and 22% (4/18) of patients received at least 1 antibiotic course for treatment of CAUTI during IUC and SC periods, respectively (P = .47). Forty-four percent (8/18) and 39% (7/18) of patients received at least 1 antibiotic course for asymptomatic bacteriuria during the respective periods. Compared to IUCs, SCs were associated with significantly fewer urine cultures being performed, lower CAUTI rates, and fewer days of antibiotic therapy (Table 1). There were no significant differences between IUCs and SCs in rates or days of antibiotic treatment of asymptomatic bacteriuria. Overall, mean days of antibiotic therapy for CAUTI or asymptomatic bacteriuria were significantly lower in the SC period. DISCUSSION We demonstrated that SCs were associated with significantly lower rates of CAUTI and fewer days of antibiotic therapy for CAUTI or for CAUTI plus asymptomatic bacteriuria than IUCs among VA SNF residents. These results are in keeping with those of a recent study of community-based SNF residents with urinary catheters, in which SCs were associated with significantly lower rates of CAUTI (6.6 vs 8.8/ 1,000 device-days) and less use of antibiotics within the preceding 30 days than IUCs.8 Our study design differed from that of the earlier report by comparing CAUTI rates and other endpoints in individual patients during periods of catheterization with SCs or IUCs, rather than making comparisons across groups of patients. Since patients had SCs after IUCs, the cumulative duration of catheterization was greater during the SC period, as were the risks of exposure to health care-associated pathogens and antimicrobials. Nevertheless, SCs were associated with significant infection prevention and antimicrobial stewardship benefits. Our design acknowledges that many patients with an SC have had an IUC previously. The fact that 2 studies employing different methods found that CAUTI rates and antibiotic consumption were lower with SCs than IUCs supports the validity of the data. A plausible explanation for lower CAUTI rates with SCs is that they lessen the risk of infection by avoiding urogenital and enteric flora found in the perineal region. There are limited other data comparing SC- and IUC-associated infections in long-term care settings. In a study of spinal cord injury patients, SCs and IUCs did not differ in rates of CAUTIs, calculi, or cancer.11 A review of literature on long-term bladder drainage found that SCs were associated with higher patient satisfaction and lower rates of urethral injury and other mechanical complications, but no
reduction in symptomatic CAUTIs.12 Data from more extensive literature in acute care settings likewise are mixed. In a meta-analysis of studies of gynecologic surgery patients, CAUTI rates were significantly lower with SCs than IUCs but the risk of mechanical complications was increased.4 SCs were associated with less bacteriuria and recatheterization than IUCs in a meta-analysis of studies of patients who underwent abdominal surgery.6 A Cochrane meta-analysis looking at short-term catheterization in hospitalized patients found that SCs were associated with less asymptomatic bacteriuria, recatheterization, and pain, but data were insufficient for a conclusion about symptomatic CAUTIs.7 We did not find significantly less asymptomatic bacteriuria with SCs, despite the reduction in CAUTIs. Reduced antibiotic utilization with SCs in our patients was driven by decreased treatment of CAUTIs. CONCLUSIONS Multifaceted interventions that include technical (aseptic techniques, regular catheter assessment, and routine hygiene) and socioadaptive strategies (team building and engagement) have been shown to reduce CAUTI rates in SNFs.13 Our data suggest that use of SCs over IUCs may be helpful as part of such infection prevention interventions, if a choice between options is available for a patient. To date, we have not observed the emergence of multidrug-resistant bacteria in our patients with SCs, as was reported in a previous study.8 We recognize that our conclusions are limited by the small sample size, and that our experience at a single VA SNF may not be applicable to other settings. Since data on the benefits of SCs versus IUCs are conflicting, facilities should make decisions on long-term catheterization based on local experience and circumstances in individual patients. Multicenter, prospective studies are needed to establish definitively if the type of long-term catheter impacts CAUTI, asymptomatic bacteriuria and inappropriate antibiotic usage rates in SNFs and other long-term care facilities. References 1. Benoit SR, Nsa W, Richards CL, et al. Factors associated with antimicrobial use in nursing homes: a multilevel model. J Am Geriatr Soc. 2008;56:2039–2044. 2. Strausbaugh LJ, Joseph CL. The burden of infection in long-term care. Infect Control Hosp Epidemiol. 2000;21:674–679. 3. Sundvall PD, Stuart B, Davis M, Roderick P, Moore M. Antibiotic use in the care home setting: a retrospective cohort study analysing routine data. BMC Geriatr. 2015;15:71. 4. Healy EF, Walsh CA, Cotter AM, Walsh SR. Suprapubic compared with transurethral bladder catheterization for gynecologic surgery: a systematic review and meta-analysis. Obstet Gynecol. 2012;120:678–687. 5. Orikasa S, Kanbe K, Shirai S, Shintaku I, Kurosu S. Suprapubic versus transurethral bladder drainage after radical prostatectomy: impact on patient discomfort. Int J Urol. 2012;19:587–590. 6. McPhail MJ, Abu-Hilal M, Johnson CD. A meta-analysis comparing suprapubic and transurethral catheterization for bladder drainage after abdominal surgery. Br J Surg. 2006;93:1038–1044.
ARTICLE IN PRESS D.J. Buehrle et al. / American Journal of Infection Control 00 (2020) 1−3 7. Kidd EA, Stewart F, Kassis NC, Hom E, Omar MI. Urethral (indwelling or intermittent) or suprapubic routes for short-term catheterisation in hospitalised adults. Cochrane Database Syst Rev. 2015;12:CD004203. 8. Gibson KE, Neill S, Tuma E, Meddings J, Mody L. Indwelling urethral versus suprapubic catheters in nursing home residents: determining the safest option for longterm use. J Hosp Infect. 2019;102:219–225. 9. Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA, Healthcare Infection Control Practices Advisory Committee. Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol. 2010;31:319–326. 10. Hooton TM, Bradley SF, Cardenas DD, et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 international clinical
3
practice guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010;50:625–663. 11. Katsumi HK, Kalisvaart JF, Ronningen LD, Hovey RM. Urethral versus suprapubic catheter: choosing the best bladder management for male spinal cord injury patients with indwelling catheters. Spinal Cord. 2010;48:325–329. 12. Hunter KF, Bharmal A, Moore KN. Long-term bladder drainage: suprapubic catheter versus other methods: a scoping review. Neurourol Urodyn. 2013;32: 944–951. 13. Mody L, Greene MT, Meddings J, et al. A national implementation project to prevent catheter-associated urinary tract infection in nursing home residents. JAMA Intern Med. 2017;177:1154–1162.