Restriction of long-term indwelling urethral catheterisation in the elderly.

Eighty-nine (16%) of 543 patients admitted to a chronic care centre in 1983 had an indwelling urethral catheter. Of the 89, 51 patients (57%) received the catheter in a general hospital, 4 (5%) at home and 34 (38%) in the centre. More than half of the catheters that were inserted in the hospital could be removed within 4 weeks of admission to the centre, implying that a more restricted use of indwelling catheters in hospitals is possible. Only 18% of the indwelling catheters remained in situ for the designated period of 1 month. The other catheters were changed before that time, mainly because of obstructed drainage or leakage of urine around the catheter. The incidence of bacteriuria among catheterised patients was 90%. The bacteria were multiresistant in 37% of these cases, compared with 25% of non-catheterised patients. Multiresistant microflora were present significantly more often in the urine of patients admitted from hospitals (irrespective of whether they had a catheter) and the catheterised residents of the centre than in that of the other patients (P less than 0.001). When all patients of the centre were considered, it was found that 30.6% were treated with antimicrobial agents in the course of the year; 10.9% were treated more than once a year. This latter group of patients received 58% of all prescribed antimicrobial drugs; 37% of them had an indwelling catheter. The majority of catheterised patients (65%) did not need antimicrobial treatment. No significant influence of catheterisation on mortality could be demonstrated.