Current guidelines recommend catheter replacement for CAUTI, however, these are based on sparse and conflicting evidence, resulting in significant variation in clinical practice. This lack of definitive evidence underlines the urgency to find answers about the necessity of catheter replacement, as it could have profound implications for patient care and healthcare costs.
Our recent systematic review highlights the paucity of robust evidence on this topic. Only four studies met the inclusion criteria, two being randomized controlled trials (RCTs) and two observational studies. The findings were conflicting. Despite these limited and mixed results, current guidelines recommend catheter replacement if the catheter has been in place for more than two weeks. This recommendation primarily relies on a single small RCT, demonstrating a significant knowledge gap that fuels practice variability.
In response to this evidence gap, the REPLACE study - The Impact of Catheter Replacement in Patients with Catheter-Associated Urinary Tract Infection - is set to begin in 2025. This multicenter randomized controlled trial aims to determine whether retaining the catheter during antibiotic therapy for CAUTI affects the 90-day risk of recurrence of infection. The study's design involves a 1:1 allocation between patients whose catheters are not replaced during treatment and those who undergo catheter replacement within three days of starting antibiotic therapy. Secondary outcomes will assess not just recurrence-rate, but 30-day mortality, quality of life, time to resolution of symptoms, and healthcare costs.
Addressing the current evidence gap is essential to guide future clinical practice, reduce variability, and optimize patient care. Given the burden associated with catheter replacement -patient discomfort, risk of complications, and resource utilization - the outcomes of the REPLACE study will be instrumental in informing clinicians and standardizing care.
In summary, while catheter replacement has long been a recommended practice in CAUTI management, the lack of high-quality evidence has led to considerable practice variation. The upcoming REPLACE study aims to clarify whether catheter replacement impacts clinical outcomes.
Written by:
- Merel Wilmsen, Research Assistant, Leiden University Medical Center, Leiden, Netherlands.
- Janneke van Uhm, Department of Urology, Leiden University Medical Center, Leiden, Netherlands.
- Merel Lambregts, Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands