Letter to the editor: Inappropriate use of urinary catheter and its common complications in different hospital wards

• Main Author: Kamarulzaman, Mohd Nazli
• Format: Article
• Language: English
• Published: Saudi Center for Organ Transplantation 2013
• Subjects: R Medicine (General)
• Online Access: http://irep.iium.edu.my/29304/1/Inappropriate_Use_of_Urinary_Catheter.pdf; http://irep.iium.edu.my/29304/; http://www.sjkdt.org/article.asp?issn=1319-2442;year=2013;volume=24;issue=2;spage=382;epage=383;aulast=Kamarulzaman

I read with great interest the article entitled "Inappropriate use of urinary catheter and its common complication in different hospital wards" by Davoodian et al. Their report is very informative, with some insight into the current trend of usage of indwelling urinary catheters (IUCs). However, their classification of urinary tract infection (UTI) is not precise. [1] The authors did not elaborate which classification of UTI they have used. Moreover, they also did not identify whether the patient had symptomatic UTI or asymptomatic UTI. In other studies, this definition of UTI was clearly stated in the methodology, and thus the end result of the study was able to determine whether the patients had symptomatic UTI or only bacteriuria. In an earlier study, Leone et al found that majority of the patients were asymptomatic and only 7.7% (15/194) of the patients developed symptomatic UTI. [2] Besides that, this study has not specified the gender of the patients included in the analysis. As documented in the literature, the risk of UTI in males and females was different due to anatomical variety, which was similar in patients with IUCs. This finding was noted by Leone et al and Tambyah et al in their previous studies. [2],[3] They found that the male to female ratio of UTI was 11% vs. 22% (P <0.01) and 8.9% vs. 23.2% (P <0.01), respectively. [2],[3] Not considering the gender of the patients might have led to a high rate of UTI in this study (44.2%) in comparison with the previous two studies by Tambyah et al and Leone et al, which were 14.9% and 12.0%, respectively. I do agree that the rate of inappropriate use of IUCs is high in most health-centers around the world. The use of local intervention strategies including education and information to the health-care personnel has been shown to reduce this rate significantly. This has been shown by van den Broek et al in their study involving 10 medical centers in the Netherlands, which revealed that the rate of inappropriate usage of IUCs reduced from 36 to 24%.