title: Bladder pressure measurements and urinary tract infection in trauma patients.
abstract: BACKGROUND
  The purpose of this trial was to determine if using a closed technique for bladder pressure measurements (BPMs) would eliminate them as a risk factor for urinary tract infection (UTI) in trauma patients, as was shown previously using an open technique.
  
  
  METHODS
  Data were collected prospectively from January 2006 until December 2009 by a dedicated epidemiology nurse and combined with trauma registry data at our Level 1 trauma center. All trauma patients admitted to the surgical trauma intensive care unit (STICU) with and without UTIs were compared for demographic and epidemiologic data. A closed system was used in which the urinary drainage catheter (UDC) remained connected to the bag and 45 mL of saline was injected through a two-way valved sideport, with subsequent measurements through the sideport.
  
  
  RESULTS
  There were 1,641 patients in the trial. The UTI group was sicker (Injury Severity Score [ISS] 18.7±11.9 no UTI vs. 28±10.7 UTI; p<0.0001), with longer stays (11.4±12.4 days no UTI vs. 37.9±20.3 days UTI; p<0.0001) and more UDC days (4.3±6.6 no UTI vs. 23.9±16.6 UTI; p<0.0001). The BPM group had more UDC days (15.6 days±16.0 BPM vs. 5.4 days±7.3 no BPM; p<0.0001), yet no difference in UTI rate/1,000 UDC days (5.7 no BPM vs. 8.0 BPM; p=0.5291). Logistic regression demonstrated only UDC days to be a predictor of UTI (1.125; 95% confidence interval [CI] 1.097-1.154; p<0.0001), whereas ISS (1.083, 95% CI 1.063-1.104; p<0.0001) and age (1.051, 95% CI 1.037-1.065; p<0.0001) were the only predictors of death.
  
  
  CONCLUSIONS
  Although patients undergoing BPM have more UTIs than patients without BPM, the measurements are not an independent predictor of UTI when done by the closed technique. These findings emphasize the judicious use of BPM with a closed system and, more importantly, the need for early removal of catheters.
authors.affiliation: Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA. tmduane@vcu.edu
authors.forename: Therèse M
authors.initials: TM
authors.lastname: Duane
authors.forename: Andrew
authors.initials: A
authors.lastname: Young
authors.forename: William
authors.initials: W
authors.lastname: Weber
authors.forename: Luke G
authors.initials: LG
authors.lastname: Wolfe
authors.forename: Ajai K
authors.initials: AK
authors.lastname: Malhotra
authors.forename: Michel B
authors.initials: MB
authors.lastname: Aboutanos
authors.forename: James F
authors.initials: JF
authors.lastname: Whelan
authors.forename: Julie
authors.initials: J
authors.lastname: Mayglothling
authors.forename: Rao R
authors.initials: RR
authors.lastname: Ivatury
mesh_terms: D004322:Drainage; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D011312:Pressure; D011446:Prospective Studies; D012307:Risk Factors; D001743:Urinary Bladder / Q000502:physiology*; D014546:Urinary Catheterization / Q000379:methods; D014552:Urinary Tract Infections / Q000503:physiopathology / Q000517:prevention & control*; D014947:Wounds and Injuries / Q000150:complications*