Department of Physical Medicine and Rehabilitation, McGovern Medical School, Houston, Texas.
Top Spinal Cord Inj Rehabil. 2023 Winter;29(1):94-107. doi: 10.46292/sci22-00009. Epub 2023 Feb 15.
The belief that intermittent catheterization results in fewer infections than indwelling catheters is commonly expressed in the spinal cord injury literature. Some practice guidelines strongly recommend intermittent over indwelling catheterization due to concerns about infections and other complications. However, studies on this topic are of low quality. Guidelines from the Consortium for Spinal Cord Medicine suggest the data regarding infection risk are mixed, and they do not recommend one bladder management method over the other.
To compare risk of bias in studies reporting higher rates of urinary tract infection (UTI) with indwelling catheters to studies that found equal rates of UTI between indwelling and intermittent catheterization, and to describe implications in clinical decision-making.
A systematic search of PubMed, CINAHL, Embase, and SCOPUS databases from January 1, 1980, to September 15, 2020, was conducted. Eligible studies compared symptomatic UTI rates between indwelling and intermittent catheterization. We used a risk of bias assessment tool to evaluate each study.
Twenty-four studies were identified. Only three of these reported significantly higher UTI risk with indwelling catheters, and all three demonstrated a critical risk of bias. More than half of the studies reported differences in UTI risk of less than 20% between the two methods. Studies with larger (nonsignificant) differences favoring intermittent catheterization were more susceptible to bias from confounding.
The hypothesis that indwelling catheters cause more UTIs than intermittent catheterization is not supported by the scientific literature. Most studies failed to demonstrate a significant difference in UTI risk, and studies with nonsignificant trends favoring intermittent catheterization were more susceptible to bias from confounding. Perceived risk of infection should not influence a patient's choice of catheter type.
在脊髓损伤文献中，间歇性导尿比留置导尿管导致的感染更少，这一观点被普遍认可。一些实践指南强烈推荐间歇性导尿而非留置导尿，原因是担心感染和其他并发症。然而，关于这个主题的研究质量较低。脊髓医学联合会的指南表明，关于感染风险的数据存在差异，他们不建议将一种膀胱管理方法优于另一种。
比较报告留置导尿管尿路感染（UTI）发生率较高的研究与发现留置导尿和间歇性导尿之间 UTI 发生率相等的研究之间的偏倚风险，并描述其对临床决策的影响。
系统检索了 1980 年 1 月 1 日至 2020 年 9 月 15 日PubMed、CINAHL、Embase 和 SCOPUS 数据库，纳入比较留置导尿和间歇性导尿的症状性 UTI 发生率的研究。我们使用偏倚风险评估工具对每项研究进行评估。
共确定了 24 项研究。仅有 3 项报告了留置导尿管的 UTI 风险显著增加，且这 3 项研究均存在严重的偏倚风险。超过一半的研究报告了两种方法之间 UTI 风险差异小于 20%。支持间歇性导尿的研究差异较大（无统计学意义），更容易受到混杂因素的偏倚影响。
留置导尿管比间歇性导尿导致更多 UTI 的假设在科学文献中没有得到支持。大多数研究未能证明 UTI 风险存在显著差异，且倾向于间歇性导尿的无统计学意义的趋势研究更容易受到混杂因素的偏倚影响。感染风险的感知不应影响患者对导管类型的选择。
