Intermittierender Einmal-Katheterismus und Prävention von Harnwegsinfekten bei Patienten mit neurogener Harnblasenfunktionsstörung – „Best practice“. Eine Übersicht

Background: Intermittent catheterization (IC) is the method of choice for draining the bladder of patients with neurogenic lower urinary tract dysfunction (NLUTD). Despite the substantial reduction in urinary tract infections (UTI) achieved by low-pressure bladder emptying of patients with NLUTD, they represent common complications in patients with NLUTD and IC. Furthermore, diagnosis of UTI in patients with NLUTD is challenging. Method: A systematic selective literature search was carried out, using electronic databases as also existing national and international guidelines on preventing UTI in patients with NLUTD and IC. Existing recommendations of best practices for IC were researched and assessed. In addition, the recommendations of a new S2kguideline on IC are presented. Results: The issue of diagnosing an UTI and differentiating it from asymptomatic bacteriuria in patients with NLUTD is discussed. The symptoms of an UTI among this patient population differ significantly from those in non-neurogenic patients, and a universally accepted urine analysis threshold does not exist. A new guideline for IC, based upon the current state of knowledge and best practices, is to align the procedures, in order to minimize uncertainty for physicians and patients and to avoid long-term complications. It provides specific information on available IC equipment (catheter systems, sizes and tops), instructions for hand disinfection procedure and of the meatus urethrae as well as recommendations on how to perform catheterization. The method of the recommended aseptic catheterization is described in detail. Despite partially positive and empirically promising results, there is no adequate statistical evidence in support of any drug-based UTI prophylaxis methods. Conclusion: In the absence of adequate evidence for specific UTI prophylaxis methods, a low long-term UTI rate among patients can only be achieved by implementing the recommended best practices for IC.