To evaluate whether reinstrumentation after failed TOV further elevates catheter-associated urinary tract infection (CAUTI) risk beyond that associated with prolonged catheterization alone in patients with pelvic fractures.
A retrospective review was conducted of patients with pelvic fractures and no urethral injury treated at a Level 1 trauma center (University Hospital, Newark, NJ) between 2017 and 2024. Variables included demographics, catheter duration, number of replacements, and urine culture results. CAUTI incidence was compared across catheter duration groups (1-4, 5-7, >7 days) and stratified by number of replacements. Patients who were female, did not undergo a voiding trial, or had bladder or urethral injuries were excluded.
Of 380 identified patients, 223 met inclusion criteria. Among patients without catheter replacement, UTI incidence did not differ by duration (p = 0.282). With one replacement, risk increased significantly with duration (p = 0.048), driven by a 15.4% incidence in the >7-day group. With two replacements, duration strongly correlated with infection (p = 0.0009), with CAUTI reaching 77.8% in the >7-day group. Overall, UTI risk rose with the number of replacements (p < 0.0001).
CAUTI risk in pelvic fracture patients is primarily driven by repeat catheterization rather than duration alone, with a synergistic increase once indwelling time exceeds seven days. Optimizing TOV timing and minimizing re-instrumentation may reduce infection rates.
Urology. 2026 Apr 04 [Epub ahead of print]
Kunj Jain, Mahima Gurushankar, Matthew Dumbroff, Ian Briggs, Aleksander Popovic, Meher Pandher, Nina Glass, Ziad Sifri, Evan Kovac, Robert E Weiss, Amjad Alwaal
Department of Surgery, Division of Urology, Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark NJ. Electronic address: ., Department of Surgery, Division of Urology, Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark NJ., Department of Surgery, Division of Trauma and Critical Care Surgery, Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark NJ.