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(Chest. 2001;120:220-224.)
© 2001 American College of Chest Physicians

Prevention of Nosocomial Urinary Tract Infection in ICU Patients*

Comparison of Effectiveness of Two Urinary Drainage Systems

Marc Leone, MD; Franck Garnier, MD; Myriam Dubuc, MD; Marie Christine Bimar, MD and Claude Martin, MD, FCCP

* From the Intensive Care Unit and Trauma Center (Drs. Leone, Garnier, Bimar, and Martin), and Department of Biostatistics (Dr. Dubuc), Nord Hospital, Marseilles University Hospital System, Marseilles School of Medicine, Marseilles, France.

Correspondence to: Marc Leone, MD, Service de Réanimation Polyvalente, Hôpital Nord, 13915 Marseille Cédex 1, France; e-mail: mleone{at}mail.ap-hm.fr

Study objectives: To determine whether the rate of acquisition of bacteriuria differs between the use of a complex closed drainage system (CCDS) with a preattached catheter, antireflux valve, drip chamber, and povidone-iodine releasing cartridge, and a two-chamber open drainage system (TCOS) in ICU patients.

Design: Prospective, nonrandomized, controlled trial.

Setting: Medical/surgical/trauma ICU in a university hospital.

Patients: Two hundred twenty-four ICU patients requiring an indwelling urinary catheter.

Intervention: We compared the rate of acquisition of bacteriuria in two groups of consecutive patients (n = 113 and n = 111, respectively) who underwent bladder catheterization with a TCOS during the first 6 months and with a CCDS during the next 6 months. Urinary catheters were managed by a team of trained nurses following the same written protocol. No prophylactic antibiotics were administered, either during management of catheter placements or catheter withdrawal, but 75% of patients received one or more antimicrobial medications for treatment of infected sites other than the urinary tract. Urine samples were obtained weekly for the duration of catheterization and within 24 h after catheter removal, and each time symptoms of urinary infection were suspected. Only patients who required an indwelling catheter for > 48 h were evaluated.

Measurements and results: There was no statistical difference in the rate of bacteriuria between the two groups. Bacteriuria occurred in 11.5% and 13.5% of patients, and was diagnosed on day 14 ± 8 and 13 ± 9 of catheterization (mean ± SD) for the TCOS and the CCDS, respectively. A CCDS cost $3 (US dollars) more than the TCOS.

Conclusions: To our knowledge, this is the first study to compare the effectiveness of a TCOS and a CCDS in ICU patients. No differences were noted between the two systems ({alpha} = 0.05). The higher cost of a CCDS is not justified for ICU patients.

Key Words: bacteriuria • closed drainage system • ICU • urinary tract infection






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