EAU 2009: Risk Factors for Nosocomial Urinary Tract Infection Identified

Fran Lowry

March 20, 2009

March 20, 2009 (Stockholm, Sweden) — In patients who undergo transurethral resection of the prostate (TURP), the presence of urinary catheters on admission to hospital, treatment with antibiotics immediately before TURP, and recent replacement of the urinary catheter were found to be significantly linked to the development of nosocomial urinary tract infections (NAUTIs), according to a study presented here at the European Association of Urology 24th Annual Congress.

The results are from the Global Prevalence Study on Nosocomial UTI in Urology (GPIU), which began in 2003 in Europe and has since expanded, said lead author Mete Çek, MD, associate professor and chief of the urology clinic at Taksim Teaching Hospital, in Istanbul, Turkey. "We started as the European prevalence study in 2003, and then added Asia in 2006. As a result, we found that certain practices encouraged the development of infection after TURP. Now this has turned into a truly global study," Dr. Çek told Medscape Urology.

The goal of the current study was to determine the importance of an indwelling urinary catheter and preoperative administration of antibiotics in the development of NAUTIs.

Investigators who were members of the GPUI in 2006 and 2007 were invited to complete a questionnaire about their patients who underwent TURP.

The questionnaire posed the following questions:

  • Did patients receive catheters upon admission to hospital?

  • If so, was the catheter replaced within the last week?

  • Did patients receive antibiotics in the days preceding TURP?

  • What was the duration of catheterization?

  • Did the patient develop a NAUTI after TURP?

 

These factors were then analyzed for correlation with the development of NAUTI after TURP.

In all, 129 investigators responded, and a total of 599 patients who underwent TURP were included for analysis. Of these patients, 403 (67.3%) were 65 years or older. Their rate of UTI after TURP was 9.7%. The remaining 196 patients (32.7%) were 65 years or younger. Their rate of UTI after TURP was slightly higher, at 11.2%.

Among patients who had urinary catheters on admission, 17.3% developed UTI post-TURP, compared with 6.7% among patients without a catheter (P = .001). Of 318 patients who were receiving antibiotics in the period leading up to TURP, 42 (13.2%) developed a UTI, compared with 22 of 281 patients (7.8%) who were not receiving antibiotics (P = .001).

Of patients who did not have catheters on admission to hospital or who had a catheter for 1 week or less, 7.9% developed NAUTI, compared with 19.1% of patients who had catheters for more than 1 week (P = .001). Among the patients who had a catheter replaced in the week immediately preceding TURP, 17 of 91 patients (18.7%) developed a UTI, compared with 36 of 364 patients (9.9%) with no catheter replacement (P = .001).

The fact that the patients had a high rate of infection if they had recently been on antibiotics "is a bit difficult to comment on, I think, because we don't have enough data to check the test. Probably the development of resistance is the cause, so that people who are receiving antibiotics for the operation develop postoperative infection," Dr. Çek noted.

"From these data, we know that many people are put on catheters for long periods of time before the operation," Dr.Çek said. "This is not a good thing, because when people are on catheters, they develop new infections that are resistant to all sorts of antibiotics."

This study shows that the duration on a catheter should be as short as possible and, if feasible, patients should not be catheterized at all before admission for TURP. "They should also not be given long-term antibiotic treatment, because this causes the growth of resistant organisms," Dr. Çek said.

Florian Wagenlehner, MD, consultant in urology at the University of Geissen, in Germany, pointed out that the trial is a very large multicenter study and remains one of the first studies in urology to collect data on these "very important infections."

Dr. Wagenlehner added that the study is ongoing. Now in its fifth year, it is extending around the world.

"This is a really good study for urologists," Dr. Wagenlehner told Medscape Urology. "It is giving us the statistical data that we can use later to work on and solve this serious event. TURP is one of the most frequently performed operations in the field of urology and, if we can find out the risk factors for NAUTIs, we will be able to improve the health of our patients and, at the same time, reduce costs associated with their healthcare."

European Association of Urology (EAU) 24th Annual Congress: Abstract 431. Presented March 19, 2009.

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