Piplani Charoo, Geller Jennifer E, Nithikasem Sorasicha, Hung George A, Teichman Amanda L, Barie Philip S, Narayan Mayur, Choron Rachel L
Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
Rutgers Acute Care Surgery Research Laboratory (RASR), New Brunswick, New Jersey, USA.
Surg Infect (Larchmt). 2025 May;26(4):249-254. doi: 10.1089/sur.2024.196. Epub 2024 Dec 23.
Catheter-associated urinary tract infections (CAUTIs) account for 1 million nosocomial infections annually and 75% of all hospital-acquired UTIs. A risk factor for CAUTI is prolonged urinary catheterization (UC); therefore, transitory UC during laparoscopic appendectomy (LA), a common practice justified to avoid iatrogenic bladder injury, is believed to be safe. However, data on the incidence of post-operative UC-related complications, including CAUTI, following LA or their avoidance are limited. Patients who underwent UC for LA developed more post-operative UTIs than patients without UC (noUC), without effect on the incidence of bladder injury. Retrospective analysis of patients ≥21 years who underwent LA (2016-2023) at an academic hospital. The primary outcome was post-operative UTI in UC versus noUC patients, defined as symptoms or urinalysis findings compatible with UTI within 21 days from LA. Secondary outcomes included bladder injury, catheter-related complications, time until UTI diagnosis, and antibiotic exposure. Statistics: Mann-Whitney U and Fisher exact tests; p < 0.05. Among 981 LA, there were 678 UC and 303 noUC. A majority was male (56%) and young [38 years, inter-quartile range (IQR) 28-50]. Duration of catheterization was 102 min (IQR 85-123), whereas duration of the procedure was 58 min (IQR 44-80). There were more catheter-related complications in the UC versus noUC group (10 [1.5%] vs. 0; p = 0.04). The incidence of UTI was 0.5%, with five cases (0.7%) after UC and zero for noUC (p = 0.34). UTIs were detected at 11 post-operative days (IQR 6-17) and treated with antibiotic agents for 5 days (IQR 5-13). Four UC patients had urinary retention (two required re-catheterization and discharge with an indwelling catheter). One UC urinary "retainer" developed a post-operative UTI and required hospital re-admission. There was no urinary retention in the noUC group. There were no bladder injuries. The incidence of UTI was low following LA; bladder injuries were non-existent. UC-related complications were greater among UC patients, but there was neither urinary retention and post-operative catheterization nor bladder injury in the noUC group; we suggest the omission of UC for LA.
导尿管相关尿路感染（CAUTIs）每年导致100万例医院感染，占所有医院获得性尿路感染的75%。CAUTI的一个危险因素是长期留置导尿管（UC）；因此，腹腔镜阑尾切除术（LA）期间的临时UC被认为是安全的，这一常见做法是为了避免医源性膀胱损伤。然而，关于LA后与UC相关的术后并发症（包括CAUTI）发生率或避免这些并发症的数据有限。接受LA并进行UC的患者比未进行UC（noUC）的患者术后发生尿路感染的情况更多，但对膀胱损伤的发生率没有影响。对一家学术医院2016 - 2023年接受LA的≥21岁患者进行回顾性分析。主要结局是UC组与noUC组患者的术后尿路感染，定义为LA后21天内出现与尿路感染相符的症状或尿液分析结果。次要结局包括膀胱损伤、与导尿管相关的并发症、尿路感染诊断时间以及抗生素暴露情况。统计学方法：曼 - 惠特尼U检验和费舍尔精确检验；p < 0.05。在981例LA手术中，有678例进行了UC，303例未进行UC。大多数患者为男性（56%）且较为年轻[38岁，四分位间距（IQR）28 - 50]。导尿管留置时间为102分钟（IQR 85 - 123），而手术时间为58分钟（IQR 44 - 80）。与noUC组相比，UC组有更多与导尿管相关的并发症（10例[1.5%] vs. 0例；p = 0.04）。尿路感染的发生率为0.5%，其中UC组有5例（0.7%），noUC组为零例（p = 0.34）。尿路感染在术后11天被检测到（IQR 6 - 仃），并使用抗生素治疗5天（IQR 5 - 13）。4例UC患者出现尿潴留（2例需要重新留置导尿管并带留置导尿管出院）。1例UC尿潴留患者发生了术后尿路感染并需要再次住院。noUC组未出现尿潴留。未发生膀胱损伤。LA后尿路感染的发生率较低；未出现膀胱损伤。UC组中与UC相关的并发症更多，但noUC组既没有尿潴留和术后导尿管留置情况，也没有膀胱损伤；我们建议LA手术省略UC操作。
