title: Clean intermittent catheterization and urinary tract infection: review and guide for future research.
abstract: What's known on the subject? and What does the study add? Clean intermittent catheterization (CIC) is considered the method of choice for bladder emptying when neurological or non-neurological causes make normal voiding impossible or incomplete. The outcome is overall good, also in the long-term. There is neither one best technique nor one best material, as both depend greatly on patients' individual anatomic, social and economic possibilities. The most frequent complication is urinary tract infection (UTI). Studies differ in the definition criteria for UTI, methods for evaluation, CIC techniques, frequency of urine analysis, prophylaxis and patients studied. The study provides a literature review and shows that most studies do not have a high level of evidence. There are various risk factors for UTI and phenotyping them helps to assess prognosis by considering what can happen if treatment is not initiated. The study concludes, that the role of biofilms in CIC deserves more attention and that diagnosis should be made on urine sample obtained with catheterization, because symptoms are often less reliable. It also concludes that treatment in those who catheterize for a long time is only necessary for symptomatic infections. The study identifies the following areas for further research: prevention of UTI in patients performing CIC; the use of special catheter types; and the role of frequency of catheterization, prophylactic antibiotics and preservation of natural defence mechanisms in the lower urinary tract.
  
  
  OBJECTIVE
  • To review the factors related to urinary tract infection (UTI), the most prevalent complication in patients who perform clean intermittent catheterization (CIC).
  
  
  METHODS
  • We conducted a literature search then a group discussion to gather relevant information on aspects of UTI to guide future research and to help provide clearer recommendations for the prevention of UTI in patients performing CIC.
  
  
  RESULTS
  • UTI is a major complication of CIC, the incidence of which varies widely in the literature owing to differences in methodology and definitions. • Phenotyping the risk factors for UTI helps to assess prognosis by considering what can happen if treatment is not initiated. The role of biofilms in CIC deserves more attention. • Diagnosis is made using the urine sample obtained by catheterization. Because of neurological or other deficiencies in patients performing CIC, symptoms are less reliable. Thorough evaluation for the source of signs and symptoms should be made before attributing them to UTI. • There have been many different proposals for the prevention of UTI in patients performing CIC, but most need more research. The role of the type of catheter is unclear but further exploration of special catheter types might be worthwhile. • Treatment in those who perform CIC for a long time is best reserved for symptomatic infections.
  
  
  CONCLUSIONS
  • Several mechanisms are relevant in UTI related to CIC. • As UTI is prevalent, more research into its prevention is needed.
authors.affiliation: University Antwerp and Antwerp University Hospital, Antwerp, Belgium. jean-jacques.wyndaele@ua.ac.be
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Wyndaele
authors.forename: Annelie
authors.initials: A
authors.lastname: Brauner
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Geerlings
authors.forename: Koves
authors.initials: K
authors.lastname: Bela
authors.forename: Tenke
authors.initials: T
authors.lastname: Peter
authors.forename: Truls E
authors.initials: TE
authors.lastname: Bjerklund-Johanson
mesh_terms: D035843:Biomedical Research; D014943:Global Health; D017408:Guidelines as Topic; D006801:Humans; D015994:Incidence; D057928:Intermittent Urethral Catheterization / Q000009:adverse effects*; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000209:etiology*