Does intra-abdominal pressure measurement increase the risk of urinary tract infection in critically ill patients?

Abstract

Introduction. Intra-abdominal hypertension and abdominal compartment syndrome have been shown to contribute to organ dysfunction and mortality in critically ill patients. The diagnosis relies on intra-abdominal pressure measurement. Aim. To determine whether intra-abdominal pressure monitoring using the Foley catheters and bladder pressure measurements increases the risk of urinary tract infection. Material and methods. Retrospective chart and database review of 130 critically ill patients who underwent intravesical pressure monitoring was done in the Intensive Care Unit at the University Clinic for Anesthesia, Reanimation and Intensive Care, Skopje-Macedonia. For the measurements of intra-abdominal pressure a standard sterile procedure was used. A system was used in which a three-way stopcock was inserted for measuring the intra-abdominal pressure after instillation of 25 mL of saline into the bladder. Analysis and urine cultures of patients that developed fever of > 38.5°C were obtained. Urinary tract infection was defined by microbiological culture documentation of more than 100,000 colony-forming units per high power field of either a specific bacterium or fungus together with significant pyuria. Results. In a total of 130 patients intra-abdominal pressure measurements were made via the bladder. Patients had 520 intravesical pressure measurements performed. In total 4.6% of the patients who required intravesical pressure monitoring developed a urinary tract infection. Conclusion. Intravesical pressure monitoring does not have an influence on the risk of urinary tract infection in critically ill patients.