title: Intra-abdominal pressure measurement using the FoleyManometer does not increase the risk for urinary tract infection in critically ill patients.
abstract: OBJECTIVE
  The aim of this study was to determine whether intra-abdominal pressure (IAP) monitoring using the FoleyManometer (Holtech Medical, Charlottenlund, Denmark) increases the risk of urinary tract infection (UTI).
  
  
  METHODS
  A retrospective database review was conducted.
  
  
  METHODS
  The study was conducted in the 12-bed medical intensive care unit of ZNA Stuivenberg Hospital (Antwerp, Belgium), a tertiary hospital.
  
  
  METHODS
  There were 5,890 patients admitted to the medical intensive care unit of which 1,097 patients underwent intrabladder pressure (IBP) monitoring as estimate for IAP.
  
  
  METHODS
  Crude and adjusted UTI rates were compared among patients undergoing IAP measurements with three different intrabladder methods: a modified homemade technique, a FoleyManometer with 35 ml reservoir, and a FoleyManometer low volume (FoleyManometerLV) with less than 10 ml priming volume.
  
  
  RESULTS
  Four consecutive time periods of 24 months were defined and compared with regard to IAP measurement: period 1 (2000-2001), during which IAP monitoring was not used routinely (which serves as a control group), was compared with period 2 (2002-2003), using a modified homemade technique; period 3 (2004-2005), introducing the FoleyManometer; and finally period 4 (2006-2007), in which the FoleyManometerLV was introduced. The incidence of IBP measurements increased from 1.4% in period 1 to 45.4% in period 4 (p < 0.001). At the same time, the Simplified Acute Physiology Score (version 2) (SAPS-II) increased significantly from 24.4 ± 21.5 to 34.9 ± 18.7 (p < 0.001) together with the percentage of ventilated patients from 18.6% to 40.7% (p < 0.001). In total, 1,097 patients had IAP measurements via the bladder. The UTI rates were adjusted for disease severity by multiplying each crude rate with the ratio of control versus study patient SAPS-II probability of mortality. Crude and adjusted UTI rates per 1,000 catheter days (CD) were on average 16.1 and 12.8/1,000 CD, respectively, and were not significantly different between the four time periods.
  
  
  CONCLUSIONS
  Intrabladder pressure monitoring as estimate for IAP either via a closed transducer technique or the closed FoleyManometer technique seems safe and does not alter the risk of UTI in critically ill patients.
authors.affiliation: Department of Intensive Care, Ziekenhuis Netwerk Antwerpen (ZNA) Stuivenberg, Lange Beeldekensstraat 267, B-2060 Antwerpen, Belgium. manu.malbrain@skynet.be.
authors.forename: Nele
authors.initials: N
authors.lastname: Desie
authors.forename: Alexandra
authors.initials: A
authors.lastname: Willems
authors.forename: Inneke
authors.initials: I
authors.lastname: De Laet
authors.forename: Hilde
authors.initials: H
authors.lastname: Dits
authors.forename: Niels
authors.initials: N
authors.lastname: Van Regenmortel
authors.forename: Karen
authors.initials: K
authors.lastname: Schoonheydt
authors.forename: Martine
authors.initials: M
authors.lastname: Van De Vyvere
authors.forename: Manu Lng
authors.initials: ML
authors.lastname: Malbrain